Thursday, March 08, 2007

Sexism Makes Me Sick: Gender and Mental Ill Health.

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.


Mary said...

The damage from assumed gender differences cuts both ways. Men become damaged because it is difficult for them to access support in the same way women might, and if they do access the support, the fact of them recieving that kind of help can cause its own problems. Women become damaged because they have "support" they may neither need nor want actively thrust upon them. There are few winners.

Example: X and Y have a child, Z. When the child is a toddler, X has an affair and suddenly leaves the family home. Y has to leave work, take care of Z alone 24/7, and pick up the pieces of a broken home, smashed finances, and not least a broken heart.

The way it goes and the support that is available for Y if Y is the woman is very, very different to the way it goes if Y is the man.

Anonymous said...

if you're interested in mental health, you might want to read these guys. Don't let the title put you off, they are dealing with their mental illness via their allotment, but there's a LOT there about the mental health system.

and yes. i'm still reading!


The Goldfish said...

Indeed Mary, although I feel the disadvantage to women remains the greater. In any case, it doesn't matter; gender messes us all up in this regard.

Hey Kethry - good to see you about, and like the look of your new blog (which I realise isn't that new, but I hadn't seen in before).

Smiffy said...

Despite the fact that more women than men tend to suffer from low thyroid (hypothyroid), this is so often mis-diagnosed as depression and antidepressants are handed out.

Then here's me, a bloke. I go to the doctor actually complaining of chronic depression (caused by hypothyroid, just like the girls) and this symptom is completely ignored.

Seems like there is trend in the medical profession to assume that all women are depressive, but not men. Whether the fact that the medical profession still seems to be under male domination may - or may not - be a contributing factor here remains to be seen.

It's enough to make one depressed.

(And sorry I never got around to my Blogging Against Sexism post. Blame the Chronic Fatigue.)

seahorse said...

There is still an old-guard patriarchy at the heart of psychiatry, and it's unfortunately exhibited by as many female psychiatrists as males in my experience. This provides a twist to your post (kind of reminiscent of the shoulderpad thrusting go-getters of the 80s). Women in many professions fight the perception of stereotypical 'behavioural inconveniences' attributed to their gender by male colleagues (emotional displays - generally put down to time of the month, so-called 'feminist' leanings such as whining on about equal pay, lack of career focus when motherhood beckons etc etc). Some women remain women, have children, achieve equal pay. Some are absorbed into the patriarchy and assimilate its doctrines in order to progress as far as they can. In the case of some female psychiatrists in my experience, they have been subjected to sexism themselves, and have had to sell out and perpetuate an evil (weakening other women with diagnoses based on the patriarchal model) to progress in their field. Convoluted point, but I hope there's some sense in it. Which is more than can be said for psychiatry, which in my opinion is just convoluted and senseless.

Stark1974 said...

Hey Goldfish,

I'd just like to say thanks for your interesting post. I have "mental health issues" myself and am a woman. You've fuelled my thinking on the issues by bring up the element of femininity as well.

This was something I had considered in the background as an additional factor that has an impact, but you've now brought it into the foreground for me.

Interestingly, once labelled as mentally ill, those who know are often on the lookout for symptoms in the individual that are indicative of an "ill" mind. Now also, I feel it is important to distinguish between that which can legitimately be deemed as stemming from illness, and that which may in fact simply be an individual difference based on personality and/or gender.

Hope this makes sense.

I just had a recent negative experience that brought into total clarity the whole stigma + mental illness, and discovered just how alive and well that stigmatisation is.

If you're interested, feel free to check out my blog (

Keep up the good work!

ben said...

yes, yes, yes.

spot on. there's obviously more to say, but this gets right to the point that the circumstances inscribed by society (and the response to those) quickly become the diagnostic criteria....

Anonymous said...

"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."

Cannot agree more, and you can largely blame romance writers and Hollywood for this. Many females today in school expect to meet rich men, fall in love and have it easy! This is so dangerous! It's scary actually.

Unknown said...

I'd just like to say thanks for your exciting publish. I have "mental wellness issues" myself and am a lady. You've driven my considering on the problems by carry up the aspect of womanliness as well.This was something I had regarded in the qualifications as an extra aspect that has an effect, but you've now introduced it into the forefront for me.