For Blog Against Sexism Day.
Since the birth of psychiatric medicine, gender has played a vital role in how we get sick, who is determined to be sick and how sickness is treated. The presence of any mental illness is, after all, determined by experiences and behaviours that are markedly different from what is considered normal or healthy. Perceptions of mental ill health are therefore far more prone to cultural influence than perceptions of physical ill health, because normal varies between cultures and those experiences and behaviours that are considered normal or healthy for a man differ from those experiences and behaviours considered normal or healthy for a woman.
As psychiatry has matured, there is a growing recognition that individual differences only need labelling and dealing with where someone’s experiences or behaviour are effecting or endangering their own wellbeing. You don’t need to have surgery on an extra large left ear lobe unless it causes you significant distress and you don’t need to take drugs to suppress the desire to wear a top hat in the bath. You can be different without being unwell. And I like my top hat; it keeps the soap fairies out of my hair.
However, our culture and the medicine it influences still maintains biased ideas about normality and gender. Earlier on, the situation was disastrous for women. Following the agricultural revolution, it became viable and therefore fashionable for an entire class of British women to be more idle than they had ever been before. At the same time, you have the beginnings of the boarding school system, which took boys out of the family home, and meant that girls and boys were brought up and educated seperately and in an entirely different manner. Upper-class men and women became more different than they had been in recent centuries and as often happens with gender, these culturally-constructed differences were very quickly seen as innate.
In many ways, femininity itself was (and still is) considered to be a state of illness; the much-envied life-giving womb being condemned as a very dangerous organ indeed. Women in the late eighteenth and nineteenth centuries were not felt to be mentally competent, they were considered physically and mentally fragile and as such, those who could afford to lived in conditions which positively promoted physical and mental fragility; physical exercise was discouraged, education and even reading was considered potentially dangerous to their tiny minds and there was very little to do. The first sign of deviation from this very passive gender role could be assumed to be hysteria or even nymphomania and responded to with medical intervention
However, women are still seen as innately emotionally fragile and our behaviours are still pathologised. We are brought up to pathologise our own behaviour; to question the reasonableness of our own reactions and to anticipate mental ill health. Not the more complex conditions like Bipolar Disorder or Schizophrenia, but Depression, Stress and Anxiety.
Fed up with your job? Unhappy in your relationship? Feel like you’re going mad? You probably are. Go to the doctor. Get some pills. The problem is you, not the life you happen to live.
Women remain in a position where we are more vulnerable to the triggers of mental ill health than men. Women are far more likely to live in poverty, to have to work two jobs or have unstable incomes. Women are far more likely to be bringing up children on our own. Women are more likely to experience sexual assault or systematic violence at the hands of a loved-one. Many of those women who do get an excellent education and enter good careers continue to come up against limited opportunities.
Idealistic presentation of love, marriage and/ or motherhood as providing total uncomplicated fulfilment for women sets us up for a fall. Men have long been taught – and have had far more power - to make their own happiness. Women are still taught to expect to have happiness arrive on their doorstep. When it doesn’t, instead of being encouraged to go looking for it, out in the world or within ourselves, we assume ourselves to be unwell and we are treated accordingly.
Just recently I was talking to a friend about a couple we both know whose marriage is on the rocks. The husband has a mental illness. This label followed a lengthy diagnostic process to eliminate every possible physical cause for his largely non-physical symptoms. I have never heard of a woman who needed more than present with insomnia, fatigue and low spirits before being told she was depressed, and almost every woman I know with a chronic physical illness of any kind has had it suggested that her physical symptoms are psychological in origin at some point.
The husband’s condition doesn’t look easy to live with. He can be extraordinarily absent-minded, bad-tempered and is often rather disconnected from events going on around him. The wife finds this all extremely frustrating and is not behaving with sympathy.
My friend suggested that she is most of the problem and should herself go on anti-depressants to help her cope and behave in a more reasonable manner.
“I don’t think she’s depressed,” I said. “I don’t see anything which suggests she is depressed.”
“She keeps snapping at him. She keeps having a go.”
I shrugged. “So she’s angry. She’s not ill.”
“But he is under a lot of stress. It isn’t fair.”
“She might be behaving unreasonably, but that doesn’t mean she has an illness.”
Certainly, there are unreasonable behaviours which are sanctioned and condemned for either gender. There are certain behavioural reactions which remain unacceptible in men, such as crying in public or spending a lot of money on high-heeled shoes. In all seriousness, gender does make men ill too; it exerts very particular and unreasonable pressures on them, attaches far greater stigma to certain experiences (like being the victim of sexual or domestic violence) and makes it far more difficult for them to seek help and to get help when it is sought. Mental ill health is probably underdiagnosed in men, and it carries a much greater stigma where it is recognised.
Conversely, women need to do far less to have their mental health speculated upon. A wife infuriated with her infuriating husband, for example. Women are not allowed to be angry, really angry. It’s unseemly. Women are supposed to look after themselves for the sake of other people; to look nice for the sake of lovers, to keep healthy for the sake of family and so on. Women therefore meet far more disapproval when we drink in excess, take recreational drugs, drive fast or vent our frustrations through casual sex or aggressive behaviour. This is why we are far more likely to stop eating, self-harm or attempt suicide (in italics because there are varying levels of earnest); we are more likely to turn our violent frustrations on ourselves. And self-harm with blades, burns and bruises is considered very much more serious than the more commonly masculine self-harm through large quantities of drink and drugs or general self-neglect.
Once again, I have got a long way down a rambling post before completely losing my bearings and struggling to wind up in a succinct manner. I didn't even get as far as saying anything about women within the psychiatric system. Suffice to say that sexism stinks. So there.