Women and Mental Health

DSM- IV Diagnostics and statistics manual of mental

disorders. The definition of normality changes

depending on the social context. Based on the medical model. The distinction between what is deemed

‘normal’ and ‘abnormal’ has profound implications for cultural understanding of what is acceptable behaviour (Kingwell,1998).

How is the DSM Constructed? With minimal agreement among raters

and extreme methodological weaknesses (ie.small samples, self-selection).

Made by consensus votes and committees. DSM is based on sexist, narrowly defined

definitions of mental illnesses which are tied up to political agendas and power issues (Caplan, 1995).

Mark Kingwell (1998), “ Fewer than two hundred people are involved in

the process, culled from a membership that is disproportionably male. In general, these professionals are resistant to change and jealous of their reputations… They insist, as always that aberrant behavior is susceptible to treatment with medication, the patients considered in isolation from social and cultural forces. The standards of scientific proof acceptable for the identification of mental illnesses also seem to vary according to the desires of the small, inordinately powerful group of authors (Kingwell, 1988, p.132).

Depression Formal Diagnostic Criteria

Sad, depressed mood most of the day nearly every day. Loss of interest and pleasure in usual activities. Difficulties in sleeping such as not falling asleep, sleeping to

much, waking to early or frequently. Either feeling restless, agitated or ‘figidity’ or the opposite,

lethargic and slow. Poor appetite and weight loss, or the opposite increased appetite

and weight gain. Loss of energy and feeling very tired. Negative self concepts such as feelings of guilt or worthlessness. Inability to make every day decisions or an inability to focus and

concentrate. Recurrent thoughts of death and suicide. *** Five out of these nine symptoms must be met in order to meet

criteria for clinical depression.

Prevalence Rates

Two to three times as common in women as in men.

General North American prevalence rate is said to be close to 5 percent.

Tends to reoccur so that 80 percent of people who experience depression once will experience another episode at some time in their lives.

Why Women? 1- Diagnostic Bias

Therapists tend to over diagnose depression in women and under diagnose depression in men. Why do you think this is ?

2- Gender Discrimination Against Women.

3- Poverty

4- Housework

5- Physical Appearance

6- Violence

7- Women’s Relationships

8- Pharmaceutical Influence

Anorexia Nervosa

“ I always lie about my weight. I don’t want anyone to know how much I weigh. That’s because I’m ashamed of it. I hate my fat

hips and thighs. They are grotesque. I feel like everyone’s thinner than I am. They

always look good, and I’m a fat disgusting thing” (Meadow and Weiss, 1992, p. 8).

90% of people with anorexia are females.

onset is between age 14-18 Highest mortality rate - 10

percent of women with anorexia die from it.

Also associated with a host of physical problems including organ failure, osteoporosis and deathly nutritional deficiencies.

Anorexia NervosaFormal Diagnostic Criteria DSM-IVA. Refusal to maintain body weight at or above a

minimally normal weight for age and height. B. Intense fear of gaining weight or becoming

fat, even though underweight. C. Disturbance in the way in which one's body

weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles.

Bulimia Nervosa Binge eating means consuming huge amounts of

food – 2000- 3000 calories at one sitting and then trying to get rid of it through vomiting or laxatives.

Obsessed with food, eating and physical appearance.

90 % of people with bulimia are women.

1- 5 % of these women are adolescents.

Medical consequences of bulimia include gastrointestinal, heart, liver and metabolism

problems.

Formal Diagnostic Criteria DSM-IV

A. Recurrent episodes of binge eating characterized by both of the following:

eating, in a discrete period of time (as within any 2 hours), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances

a sense of lack of control over eating during the episode (a feeling that one cannot stop eating or control what or how much one is eating) 

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise 

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months

D. Self-evaluation is unduly influenced by body shape and weight

Why Women?

Culture of Slimness:

1- Media

2- Discrimination Against Overweight Women

3- Female Dissatisfaction with Bodies

Psychoanalytic

Affective disorders a result of incomplete satisfaction at a particular stage in childhood, setting up a vulnerability in adulthood for affective instability.

A fixation, particularly at the oral stage creates an environment ripe for the development of depression at a later stage in response to loss of a loved one.

The major theoretical underpinning of the

psychodynamic view is that depression is anger turned towards oneself.

Cognitive- Behavioural

Depressed people feel as they do because their thinking is biased towards negative interpretations (Beck, 1967).

Creation of negative schemata ( a tendency to see the world negatively) is at the root of false or irrational beliefs about the self which lead to depression or dejection about the self.

Negative view of the self, world and future Negative schemata or beliefs triggered by negative life events Cognitive Biases Depression.

What are some problems with the Cognitive Approach to treating disorders in women?

Biological The biological explanation assumes that

there is a bio-chemical imbalance that causes affective disorders.

Focus on genetics and neurochemistry.

Research has consistently shown that chemical changes can cause changes in behavior. However, it has also shown

that behavior and emotion can changechemical make – up in the body

“Consciousness creates the body. Our bodies are made up of dynamic energy systems that are affected by our diets, relationships, heredity, and culture and the interplay of all these factors and activities.” (Northrup, p. 3)

Our emotions and thoughts have such profound effects on us on us because they are physically linked to our bodies via the immune, endocrine, and central nervous systems. All emotions, even those that are suppressed and unexpressed, have physical effects. Unexpressed emotions tend to ‘stay’ in the body like small ticking time bombs they are illnesses in incubation.” (Northrup, p. 19)

“The mind is located throughout the body. (Pert,1997). “The mind can no longer be thought of as being confined to the brain or the intellect; it exists in every cell of our bodies. Every thought we think has a biochemical equivalent. Every emotion we feel has a biochemical equivalent.” ( Northrup, pg. 30)

What came first, the depression or the chemical change? And what does this mean in our treatment of women with depression?

Principles of Feminist Therapy

( Matlin, p.411). 1- Women’s major problems are not internal, personal deficiencies instead, the problems are primarily societal ones, such as sexism and racism.

2- Women and men should have equal power in their social relationships.

3- Society should be changed to be less sexist; women should not be encouraged to adjust to a sexist society by being quieter and more obedient.

4- We must focus on women’s strengths, not on characteristics that are presumed as deficiencies. Women can use these strengths to help define and solve problems.

5 - We must work to change those institutions that devalue women, including governmental organizations, the justice system, educational systems and the structure of the family.

6- Inequalities with respect to ethnicity, age, sexual orientation, social class, and disabilities should also be addressed; gender is not the only inequality.

Eating Disorders and Feminist Therapy

Occurs 90 percent in females

Possible Causes:- Genetic - Faulty family relationships- Child abuse- Personality factors such as perfectionism

and/or need for high control- Low self esteem

Principles of Feminist Therapy

( Matlin, p.411).

1- Women’s major problems are not internal, personal deficiencies instead, the problems are primarily societal ones, such as sexism and racism.

2- Women and men should have equal power in their social relationships.

3- Society should be changed to be less sexist; women should not be encouraged to adjust to a sexist society by being quieter and more obedient.

4- We must focus on women’s strengths, not on characteristics that are presumed as deficiencies. Women can use these strength to help define and solve problems.

5 - We must work to change those institutions that devalue women, including governmental organizations, the justice system, educational systems and the structure of the family.

6- Inequalities with respect to ethnicity, age, sexual orientation, social class, and disabilities should also be addressed; gender is not the only inequality.

What Would Feminist

Mental Health Look Like to

You?