Social issues seems to come in and out of fashion in our culture like a new style of dress.Two topics that are somewhat in vogue these days are women’s issues and mental health, specifically depression. It is no surprise that these two are coming up together.
Since ancient times, physicians have believed that women are especially vulnerable to certain mental illness. (Wenegrat, p1) Much of women’s behavior has been perceived as outside the norm for thousands of years. These differences were believed early on to be corrupt and were deemed unacceptable. One of the most extreme examples of this was the persecution of women as witches in Massachusetts during the 1600’s. Over time, this persecution ideology metamorphosed into the more current mental health explanation. By the mid-19th century in England, there was a predominance of women in public mental hospitals and by the end of the century there were more women than men in private hospitals also. ( Russell , p10) Even mental hospitals were set up, they were not clearly separated from alms houses or prisons ( Russell, p17), thereby continuing to associate a stigma with this already confusing phenomena. While the understanding of mental disorders has increased somewhat in the past, the stigma is still strongly associated and an additional issue for women.
Even in a population where mental health is not only expected, it is the reason for the community, (such as professional mental health workers), there is still misunderstanding and confusion around women. The Diagnostic Statistical Manual is the bible of sorts for diagnosing mental health issues. Even in the most up-to-date version, the DSM-IV, there have been accusations of gender bias in psychiatric diagnosis. (Brannon, p411) Russell quotes a study by M. Zimmerman wherein “idiosyncrasies of interpreting data” (Russell, pg53) are attributed with having negative repercussions for women. On pages 32 and 33 of her book, Russell cites Maria Kaplan’s comparison of the DSM-IIIR description of histrionic personality disorder with the Broverman description of women’s behavior; they are virtually identical (see appendix B). Broverman was a 1970 study done on 79 clinicians: psychologists, psychiatrists and social workers. They were asked to evaluate and compare healthy behaviors of men, women and a person of indeterminate sex. When a woman’s “normal” behavior so closely matches a professionally accepted description of a mental problem, it becomes clear that issues go above and beyond those of an strictly nature. The focus of DSM-IIIR is on problems within a particular individuals behavior rather than problematic features of a particular social context. (Russell, p40) The influence on society on a woman and as the framework for evaluating her behavior is disregarded.
Adolescence and puberty are important times of development in all aspects , for all people. There are physical , social, emotional, and psychological changes. This is the time that is hypothesized that women’s predisposition for depression first comes to light. Adolescence brings with it a sense of the limitations young girls face as they begin to view themselves and be treated by others as women. (Silverstein & Perlick, p52) This is a frustrating change for girls, and this powerless feeling is often internalized against herself because it seems so societally acceptable. Depressive symptoms experienced by female adolescents often do not develop into full-blown cases if clinical depression until later in life. (Silverstein & Perlick, p45)
One of the biggest limiting factors that develops for girls at this stage is the application of gender roles on to their behaviors. Women’s restricted social roles in this society may be responsible for the high levels of mental health problems in all women. “(Hammen, p145) Sex role stereotypes conceal women’s oppression and legitimate male dominance ( Penfold & Walker, p112) There is a documented connection between competence and curvaceousness that leads those women particularly concerned with intellectual and professional achievements to eschew curvaceous bodies ( Silverstein, p23) Therefore, many of young girls’ are persuaded by society to essentially dispose of her dreams at the time that her breasts develop and her hips widen. Not the most logical of courses of action but it is what happens in our culture. These traditionalist gender “roles” pose a risk to all women. (Wenegrat, p16) Nontraditional women have often been placed in the position of feeling spilt between their femininity and aspects of themselves defined by academic, professional or political achievement. (Silverstein & Perlick, p7) This forces women into an impossible situation ( Russell, p30) of having goals that it is antithetical for them to want, if they are true women.
This is featured in the Silverstein & Perlick examination the lives of many prominent women from history in regard to their own psychological functioning. (see appendix A) They determined an association between women with great achievements correlated with depression, eating disorders, and physical symptomolgy such as headaches. They quote a letter written by Harriet Beecher Stowe, author of Uncle Tom’s Cabin, where she describes her own struggles. She referred to her emotional state as one of “great depression”, she felt “scarcely alive”, ” a slave to morbid feeling”, and she had a “wish to die young”. (Silverstein & Perlick, p46) Hannah Arent, apolitical philosopher also wrote about her mental state; “madness, joylessness, disaster, annihilation”Ã¢Â?Â¦”the end, long and fervently hoped for…puts an end to this needless and futile life.” (Silverstein & Perlick, p46)
Different studies over time have attributed these problems to different causes. Hammen explains on page 145 of her essay the there are two kinds of contributors that are believed to influences female depression. They are susceptibility factors (biological and learned psychological mechanism) and precipitating factors (such as life stress events and episodic or enduing conditions)
Under the classification of susceptibility, hormonal and biological factors are suspected culprits. Pre-menstrual syndrome is the “world’s commonest disease, is experienced by 80-100% of women” (Russell, p51) and only recently has been examined in relations to the differences in women’s behaviors. However, these is a danger that real causes of women’s depression will be ignored by attributing symptoms to hormones and also increases the risk of overlooking serious medical problems. (Brannon, p380) If the body, without accounting for a syndrome such as PMS or other hormonal influences, is determined to be a cause under the assumption of a biological basis of depression, also comes the assumption that women are weaker. ( Russell, p53) Research to date has not established a biological (re: physiological) base for depression. (Russell, p58) Research has indicated that biases relating to class, skin color, or sexuality may interact with a sex role bias. (Russell, p31) Socio-economic status is inversely related to rates of depressive illness. (Wenegrat, p16)Women as the most frequent victims of violence also predispose them to depression, as does lack of a communicative partner, children under the age of 14 in the house, lack of a job or lack of social support. (Brannon, p389)
The success of sociological studies and lack of success of the biological research might lead easily into the view that depression in women can be understood asÃ¢Â?Â¦an expression of frustration with the woman role, especially the restriction of that role. (Russell, p61) This can be connected to precipitating factors that were previously mentioned. Women undergo different events than men through out their lives and also react to similar events in different ways. Patterns of gender differences in mental disorders may relate to differences in stress and coping strategies. (Brannon, p411) Among other things, Brant Wenegrat states on page 3 that women have a “psychology of a subordinate class.” This forces a woman to meet expectations of the “oppressors” and compromise her own standards. A prime example of that is the “Barbie” ideal of womanhood. This doll is held up to be the gold standard of femininity for women and therefore women to aspire to that. However, the majority of the female population looks nothing like a Barbie doll, as even those that do are not up to par. If Barbie’s measurements were imposed of a real woman, she would have measurements of 42-22-39, about 6 1/2 feet tall and her legs would be about 40 inches long!* This leads back again to the sense of frustration that is pervasive to women and the complications that come with it.
There are other sources of frustration that are more difficulty to grasp than impossibility of being Barbie. The subordinate psychology is translated directly into the lack of power for women. Women’s higher risk of mental disorders results from their relative powerlessness in many societies. (Wenegrat, p1) When one has little or no say in her day to day life, let alone the larger issues of politics, health care, living standards and the like, it is very disconcerting. If lack of social power contributes to women’s disorders, then women’s relative power should be a matter of greater concern and interest on the part of mental health professionals ( Wenegrat, pg1) While validation and empowerment are part of many therapies, it should be considered as of particular importance to women. Unfortunately, many clinicians do not currently view this as so.
There is a theme of commonality that runs through out all of the factors and the theories presented thus far. That is the essential view of women and men as different. This is deeper than just the physiological disparity. There are different perceptions about and within each gender, different experiences, events, and talents. On page 30 of her book, Denise Russell refers to a 1972 study on perceptions of women in comparison to men. Her commentary on the findings are as follows:
Healthy women differ from healthy men by being more submissive, less independent, less adventurous, more easily influenced, less aggressive, less competitive, more excitable in minor crises, having feelings more easily hurt, being more emotional, more conceited about their appearance and less objective, and disliking maths and science. These are traits that are devalued and hence, these judgments involve a powerful negative assessment of women.
The most ironic of the point about this observation is that this is the definition of healthy! As was earlier mentioned, healthy for a female is disordered by male parameters. An interesting idea is the fact the depression might actually manifest itself differently in men and women, taking on a more disguised course in men. (Wenegrat, p17) According to Linda Brannon, women are more likely to seek health care than men (p399) which might contribute to mental health professionals being more familiar with female-type depression. Also, while Russell states that women outnumber men in to a significant extent in the diagnosis of multiple personality disorder, borderline personality disorder, self -defeating-personality disorder, dependent personality disorder and histrionic personality disorder, Wenegrat points out at that men are in the same time more prone than women to violent behavior or drug abuse. (p 17) Women attempt suicide more often than men but, with the exception of professional women, men are more successful than females at taking their own lives. (Silverstein, p46) Perhaps these are examples of the “disguised courses” of depressive behavior in men?
Even women themselves do not see the differences in behavior manifestations. In 1972, three-fourths of people of each sex agreed that when compared to men, women are more illogical, have more difficulty making decisions, are less ambitious and less skilled in business. (Silverstein & Perlick, p21) Self evaluation is the same. Women attribute failure more to internal cause that did males and success to external causes. (Hammen, p148) All of this creates the scenario where women are more likely to be persuaded, cajoled or forced to submit themselves for assessment by a psychiatrist or psychologist. (Russell, p35) Then this entire cycle of misinterpretation continues.
So, now that the sociological (and some other) influences on depression have been examined, how is it possible to address these issues? Will direct address of women’s mental health increase the stigma for women’s differing psyche? It may at first, but the only ways to truly address this issue is through direct intervention. One of the first solutions would also decrease the stigma. That is to increase education and awareness about the psychological needs of girls and women. With greater understanding of both differences and similarities, many of the social influences can be made less powerful.
However, a comprehensive and effective education program for all of western culture does not seem to be on the political agenda any time in the near future. The most technically optimistic and politically feasible solution is to address services directly to the needs of women. On page 247, Elaine Gadd goes through what women say they want and need in a counselor or a therapist:
~want to be listened to
~concerns and experiences need to be taken seriously
~professionals to understand their culture
~participate in care choices
~feel safe and comfortable
~address diverse issues
With these qualities in place, it is likely that women might be able to address their issues. However, there are also practical issues for women that are more prominent that they are for men. Women need primary care doctors and specialist, treatments accommodations and occupational training. ( Gadd, p248) Due to women’s devaluation by society and lower wages, many of these basic requirements are inaccessible. If a woman can’t get to the services, their quality or appropriateness is a moot point. This brings around the final point and that is there must be assessment of service quality. Factors to look for include equity, appropriateness, accessibility, acceptability, effectiveness, and efficiency. (Gadd, p252) With proper address of a woman’s practical and emotional needs, as well as fair and consistent monitoring of services, there is a chance to bring the number of women suffering from depression closer to the male percentages.
It is impossible to get a full understand of all of the cultural contributors to women’s propensity for depression. Without direct address of the current societal mores and norms, it is impractical to even consider curing this social issue. With education and acceptance of differences, there may be a possibility. However, the best that can be done currently is to provide the services that are needed and ensure all women the chance to use them.
Appendix A: Silverstein & Perlick The Cost of Competence (pages 163-166)
Mental Disorders in Eminent Women Throughout History
Name/Field Depression Disordered Eating
Louisa May Alcott 8 4
Jane Austen 8 8
Emily Bronte 4 8
Charlotte Bronte 8 4
Elizabeth Barrett Browning 8
Emily Dickinson 8 8
Virginia Woolf 8 8
Georgia O’Keefe 8
Marie Curie 8 8
Anna Freud 8 8
Karen Horney 8 8
Catherine the Great 8
Queen Elizabeth I 8 8
Indira Gandhi 8
Joan of Arc 8
Eleanor Roosevelt 8 8
Susan B. Anthony 8
Simone de Beauvoir 8 4
Elizabeth Cady Stanton8
Appendix B: Denise Russell Women, Madness and Medicine (pages 32-33)
DSM III Description of Histrionic Personality Disorder vs. Broverman Definition of a Mentally Healthy Woman
DSM III Broverman
Self-dramatization, e.g., Being more emotional
exaggerated expression of emotions
Overreaction to minor events More excitable in minor crisises
Irrational, angry outbursts or tantrums More excitable, more emotional, less objective
Vain and demanding More conceited about appearance
Dependent, helpless. More submissive, less independent,
Constantly seeking reassurance less adventurous, more easily influenced
Brannon, Linda. Gender: Psychological Perspectives. Allyn & Bacon Publishing, Needham Heights, MA. 1996.
Gadd, Elaine M. “Developing psychiatric services for women.” Planning Community Mental Health Services for Women: A multiprofessional handbook. Edited by Karyn Abel, Marta Buszewicz, Sophie Davison, Sonia Johnson and Emma Staples. Routledge, NY. 1996
Hammen, Constance L. “Gender and Depression.” Gender and Psychopathology. Edited by Ihsan Al-Issa. Academic Press, NY. 1982.
Penfold, P. Susan, & Gillian A. Walker. Women and the Psychiatric Paradox. Eden Press, MontrÃ?Â©al, Canada. 1983.
Russell, Denise. Women, Madness and Medicine. Polity Press, Cambridge, England. 1995.
Silverstein, Brett, Ph. D. & Deborah Perlick, Ph.D. The Cost of Competence: Why Inequality Causes Depression, Eating Disorders and Illness in Women. Oxford university Press, NY. 1995.
Wenegrat, Brant. Illness & Power: Women’s Mental Disorders and the Battle between the Sexes. New York University Press, NY. 1995