It is the 1960s, and for the first time, the contraceptive pill has become widely available. While many women have welcomed it, some feminist groups have condemned it as a terrible form of exploitation: women being forced to stuff themselves with hormones that mess with their natural biological rhythms just to be able to pleasure men without inconveniencing them with a pregnancy and the consequent marital obligations.
A ludicrous-sounding alternative reality, right? Everyone knows that feminists heralded the pill as the dawn of female sexual liberation. But is there a strain of this extreme form of feminist argument, so concerned about the exploitation of gender that it rides roughshod over any notions of individual agency, in the debate now raging about flibanserin?
Flibanserin, approved by the US Food and Drug Administration (FDA) last week, is the first drug to be authorised for the treatment of female sexual dysfunction. Feminists who oppose it argue it is an example of the pharmaceutical industry doing what it does best: making money by inventing a new medical condition where one doesn’t exist, creating a perceived need for expensive drugs to manage it.
In doing so, they argue it has exploited a natural mismatch between female and male expectations of sex to develop a drug that messes with the female psyche and creates a creepy “on” switch for female lust. They point to the fundamental difference between flibanserin, which creates desire by boosting levels of brain chemicals linked to sexual excitement, and Viagra, which targets the physiological causes of male sexual dysfunction. (This hasn’t stopped the media dubbing flibanserin the “female Viagra”, perhaps because it has a terribly unsexy name).
Concerns about this drug aren’t unfounded: the pharma industry struck gold with Viagra and has been looking for a drug to cure female dysfunction since. But there is an active debate within the medical community as to whether female sexual dysfunction is actually a medical condition at all or whether it can simply be accounted for by psychological and social issues.
These concerns aren’t unique to this area, however. Pharmaceutical companies have long made big bucks by inappropriately marketing drugs in the context of the American for-profit healthcare system. Companies spend billions beaming aggressive advertising into people’s homes showing how wonder drug A is the solution to your life’s problems. Consumers push for it; doctors prescribe it; insurance premiums go up.
When it gets to what’s going on in our brains, things get even murkier. Take anti-depressants. In the US, they are almost certainly overprescribed by a healthcare profession that is not very good at understanding the psychosocial bases of many mental health conditions. But just as it would be ludicrous to argue all types of depression should be treated with drugs, isn’t it equally extreme to argue that they have no role to play in managing some forms of clinical depression that are caused by chemical imbalances in the brain?
Flibanserin sounds like a drug that will only be right for a small proportion of women for whom there is a biological, rather than purely psychological and social, cause of their sexual dysfunction. But shouldn’t these women have the right to make an informed choice? Rather than ban the drug altogether, isn’t the answer to address over-medicalisation in western healthcare by tackling attitudes in the pharma industry and teaching the medical profession to better distinguish between the biological and the psychosocial causes of conditions such as depression and sexual dysfunction?
But the anti-flibanserin feminist brigade has questioned whether there is such a thing as a meaningful choice. Forget the fact that some women with sexual dysfunction want this drug and say they believe it will make them feel human again. The essence of this feminist argument is that these women are slaves to social expectations about sex: they don’t ultimately want sex for themselves, but are fretting about not being able to satisfy their partners. No matter that women’s organisations have campaigned to get flibanserin on to the market: this is explained away by arguing they have been manipulated by the drugs companies.
In portraying women like this, the feminists sceptical of flibanserin rob women of their agency. They attribute to these women a sort of sexual false consciousness – you just think you want sex, you don’t know any better. And what women would want to risk feeling sick and dizzy for just the one extra sexual experience a month that flibanserin has been associated with?
But who are they to say? For some women, the difference between zero and one might be worth all the side effects in the world. The implication women can’t know what they really feel about sex is horribly patronising – isn’t desiring sex even while you don’t, or not wanting to eat the last doughnut in the box even as you’re reaching for it, what makes us wonderfully, but painfully, human? Whether it’s a drug to fix the chemical imbalances that are associated with low libido, companies paying for female employees to freeze their eggs or giving girls the right to wear the hijab to school, the truth is that what is liberating for one woman can be exploitative for another.
This is where the feminist movement – or movements – can run into trouble. In its fight for the sisterhood, feminism has tended to oversimplify what it is to be female. When all of our interests coincide, this has not only been unproblematic, but has helped feminism achieve some momentous wins, from female suffrage to the campaign for equal pay.
But a movement whose essence is to define women by their gender has not always been very good at coping with ethical complexity and moral nuance. At its worst, it can descend into a platform for women to air their own deeply personal views and experiences, while claiming the false legitimacy that comes from speaking on behalf of all women. Feminists need to remember when they speak for themselves and when they speak for half of the population. I, for one, will remain suspicious of any woman claiming to comment on ethically complex issues from a “feminist” standpoint on my behalf.