Chapter 13 Womens Mental Health

1
Chapter 13Womens Mental Health

• Sexism, Gender Roles, Negative Life Events

2
Womens Experiences and Mental Health

• What are the threats to womens mental health?
• Are they biological? Based in gendered
  experiences?
• How do women express emotional distress? Do they
  seek help more often than men do?
• What happens when women seek help from
  professionals?
• How are women with psychiatric diagnoses viewed
  by society?

3
Biases in the DSM-IV

• Absence of a diagnostic category for male
  violence.
• PMDD?
• Is it helpful to have this category?
• Legal implications for women?

4
Disorders Affecting Women and Men Equally

• Schizophrenia
• Bipolar disorder
• Depression with psychotic features
• OCD

5
Gender Patterns in Psychiatric Diagnoses

• Females have more
• Depression
• Eating Disorders Anxiety Disorders (some)
• Dissociative Disorders
• Borderline Personality Disorder

• Males have more
• Substance Abuse Addiction
• Antisocial Personality
• Aggressive Behavior (not a DSM-IV category)

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GENDER-LINKED PSYCHOLOGICAL DISORDERS

• internalizing disordersnegative affect turned
  inward
• externalizing disordersnegative affect expressed
  outwardly
• Some researchers believe womens higher rates of
  internalizing disorders are due to gender
  socialization (e.g., Rosenfield, 2000).
• These gender differences are evident in children

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Understanding Gender Differences in Disorders

• Due to differences in biology?
• Due to differences in help-seeking ?
• Due to sex bias in psychiatry/attitudes towards
  women?
• Are there real differences in psychopathology due
  to life circumstances and gender roles?
• Life experiences that may be more common among
  women
• Ways women experience and express unhappiness
• CONSEQUENCES of these disorders can differ for
  women.
• Stereotypes
• Unrealistic expectations
• Violation of scripts

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The Womans Experience of Psychiatric Disorder

• The reaction of families and society to a woman
  with a disorder shape her experience.
• E.g. Women with addictive disorders
• Women with dual disorders
• The reaction of mental health professionals shape
  her recovery.

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The Case of Depression

• Depression varies in severity and has a range of
  symptoms
• Affects mood, thinking, behavior, physiology
• Women are 2-3x more likely to develop depression
  than men.
• This is found across cultures.
• What factors may account for this pronounced
  gender difference?

10
Factors No Longer Considered Relevant

• Biochemical factors such as hormonal
  fluctuations.
• Careful reviews of the literature suggest that
  biological factors do not convincingly explain
  the greater prevalence of depression in women.
  (Nolen-Hoeksema, 2002).

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Help Seeking Presentation

• Women are somewhat more likely than men to seek
  help.
• Yet studies of the incidence in the general
  population (epidemiological surveys) still show
  greater frequency of depression among women.
• Differences in presentation, or symptoms may
  influence underdiagnosis of depression in men.
• men may drink to mask feelings of depression
• Women more clearly express their feelings

12
Stressful Life Events

• Subtle and overt discrimination
• Interpersonal violence and abuse
• Poverty
• Role stress

13
Gender Scripts Roles

• Gender role expectations in relationships
• Double binds
• Gendered expectations around beauty, caregiving,
  selflessness, etc.

14
Sexism and Subtle Discrimination

• Several forms of discrimination seem to increase
  the incidence of depression in women
• Devalued achievements, value, careers being
  limited
• Everyday discrimination and sexism makes women
  feel lack of control in their lives, this
  contributes to depression

15
Violence

• Many females are targets of interpersonal
  violence. Victimization is a risk factor for
  depression for many reasons.
• Women tend to assume the blame and are blamed by
  society.
• Depression in response to interpersonal violence
  and abuse also develops as a secondary problem
  from PTSD. PTSD makes you feel helpless and
  out-of-control and crazy. Women blame themselves
  for this too.

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Poverty

• Low-income women raising children have limited
  options, and are especially vulnerable to
  depression. When you consider the feminization
  of poverty, the link becomes especially clear.
• It is surprising that more low-income women do
  not experience depression. What protects them?

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Womens Roles in Family Relationships

• The caregiving role can lead to taking on too
  much of others problems and needs while
  neglecting ones own.
• Housework experienced as undervalued and under
  stimulating
• Multiple role stress arises along with caregiving
  responsibilities
• Scripts discourage women from focusing on and
  communicating their own needs.

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Beauty Stereotypes Beauty Culture

• Constant pressure to look a certain way is
  experienced as a stress.
• Threats to stereotyped beauty ideals (overweight,
  body type, aging) can lead to depression for some
  women.
• Feelings of helplessness in response to the
  stereotypes.

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How Women Cope with Depressed Mood

• Women often respond differently from men when
  they are experiencing a depressed mood.
• A ruminative style has been identified (Susan
  Nolen-Hoeksema, 2002) as typical of how women
  respond. They worry about how tired they are and
  keep thinking about all the things that are wrong
  in their life.

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SEXIST BIAS IN THE MEDICATION OF PSYCHOLOGICAL
DISORDERS

• Historically, women have been disproportionately
  targeted as candidates for psychotropic
  medications, especially when they experienced
  distress related to their traditional feminine
  roles as mothers and homemakers.
• Women are more likely to be portrayed as
  consumers of prescriptive drugs than men.
• In a recent content analysis of 10 leading U.S.
  magazines, researchers found that prescription
  drug advertisements appeared more often in the
  publications aimed at women than in those geared
  toward men or general readership (Woloshin,
  Schwartz, Tremmel, Welch, 2001).
• Prescribing tranquilizers (Xanax, Valium) to
  women creates a risk for abuse and dependence on
  these medications

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Traditional Psychotherapy

• The primary criticisms that have been leveled at
  traditional psychotherapy include
• Theoretical orientation and/or personal
  perspective may be based on gender stereotypes
  and sexist attitudes.
• A focus on the individual as the source of the
  psychological distress with little or no
  consideration of social contextual factors that
  may contribute to the clients problems, such as
  sexism and racism.
• The relationship between the therapist and client
  is an unequal one in which the therapist is the
  more powerful expert and the client is in a
  subordinate and vulnerable position.

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FEMINIST THERAPY

• womens subjective experiences are valid and
  important to attend to given the androcentrism
  that has pervaded psychological theory
• not all problems originate in the individual, and
  personal problems are not merely personal but
  are sometimes social and political
• therapy should be a collaboration between
  therapist and client rather than a hierarchical
  relationship
• the goals of therapy are to help women feel
  positive about themselves and empowered to make
  social change, not to educate them about what is
  wrong with them
• it is imperative for the therapist to be
  cognizant of the fact that women are diverse and
  their experiences are affected by social factors
  (age, race, ethnicity, sexual orientation, class,
  disability, etc.).