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Women and Psychiatry
by Eva Gede, M.D.
ABSTRACT/RESUME
La psychiatrie est trSs redevable au
mouvement des femmes du fait que cette
derniere a appeli l'attention sur les
ripercussions du conditionnement social
des enfonts du sexe fiminin, lequel
tend d faire accepter la soumission, le
manque d'autoriti, le manque d'indipendance emotive ou financi§re, le manque
de latitude pour I'originaliti,
la
criativiti,
les rialisations
et le
success,
ouvrant ainsi la voie d
I'angoisse et d la maladie.
faut trouver un nouveau type d'hygiene
mentale & partir d'une intigration des
qualitis humaines.
On a procidi & un premier travail de
recherche de la ville de Hamilton, en
vue d'obtenir des donnies au sujet de
la tendance de la pratique privie en
psychiatrie.
Les malades du sexe
fiminin I'emportaient en nombre sur
ceux de I'autre sexe, dans une proportion de 3d 2. Dans le cas de
quarante-cinq pour cent des femmes on
a diagnostiqui la dipression. On a
constats une corrilation entre la dipression et le mariage; venait ensuite
Une itude scientifique objective menie
une corrilation entre la dipression et
par Broverman chez les travailleurs du
le mariage; venait ensuite une corridomaine de I 'hygiine mentale fait Stat
lation entre la digression et le veud'une double norme de I'hygiene mentale. vage ou le divorce. Les femmes
On pergoit les hommes comme itant
cilibataires
semblaient moins exposies
normaux et adultes et les femmes comme d la depression que les femmes mariies.
n 'itant ni normales ni adultes si
Toutefois, les femmes cilibataires
elles poss§dent les qualitis qu'on est itaient plus sugettes d un diagnostic
censi trouver chez les femmes sirieuses
de troubles de personnaliti que ne
bien adapties aux exigences due la
l'itaient les hommes cilibataires. Il
80ciiti.
y avait en outre une corrilation entre
la depression et la situation en
matiSre
d'emploi, alors que la plupart
Dans une analyse psychosociologique,
des
femmes
dSprimies itaient soit des
Dorothy Dinnerstein a prouvi que la
menagSres,
des assistees sociales ou
division artificielle
des qualitis
des
personnes
travaillant d plein
humaines en deux groupes, tel que le
temps dans des emplois de bas niveau.
veut le portage traditionnel des
fonctions entre le secteur masculin et
le secteur fiminin, est malsaine. Il
Les ordonnances de midicaments pour le
traitement des principaux
troubles
mentaux ont StS auelque peu exagSrSes
dans le cas des femmes. Toutefois,
oontre toute attente, on n'a pas constats qu'il y avait abus de tranquillisants et d'antidSpresseurs
de la
part des psyohiatres
soit <$ I 'endroit
des hommes, soit & I 'endroit des
femmes.
On a constats une diffSrence
importante
dans la durSe de la psychothSrapie. Les
hommes I'emportaient en nombre sur les
femmes dans le cas de thSrapie <5 court
terme alors que les femmes Staient
plus nombreuses que les hommes d suivre
des traitements de thSrapie d'une
durSe de plus de six mois.
To say that women are treated d i f ferently from men by p s y c h i a t r i s t s
generally would be true, just as i t
i s true that a l l of society treats
women d i f f e r e n t l y . P s y c h i a t r i s t s
tend to r e f l e c t society's values.
Psychiatrists are not i n the vanguard
of s o c i a l change; they respond to
s o c i e t a l changes but probably faster
than the other medical s p e c i a l t i e s .
The Canadian P s y c h i a t r i c Association
has had a Task Force on Women's I s sues f o r four years. The American
Psychiatric Association has had i t s
counterpart for over s i x years. Attendance at these conferences are
suddenly including very pregnant
mental health workers and babies i n
Snugglies; events previously unheard
of at a professional conference. Discussion on t o p i c a l issues of rape,
wife-battering, c h i l d abuse, alternate
l i f e s t y l e s and s o c i o p o l i t i c a l issues
as they a f f e c t the practice of psychiatry, have become a regular feature
at such national meetings of psychiat r i s t s . I have not found to date any
comparable demonstration of s o c i a l and
p o l i t i c a l awareness at conferences of
other medical s p e c i a l t i e s . I have
shown one of the p s y c h i a t r i c convention's programs recently to a feminist
obstetrician friend of mine who
gasped at seeing some of the items and
said: " i t would be unheard of at an
OBGYN conference," and promptly attended a p o l i t i c a l analysis of wifebattering i n Toronto.
Of course, the psychiatric profession
i s not free from sexism but i t can be
said that p s y c h i a t r i s t s are t r y i n g
to become aware of i t . A considerable amount o f change has taken place
already, and i t continues to happen.
The attitudes and awareness of
younger p s y c h i a t r i s t s change quicker
than those of the older ones, but I
doubt there are many p s y c h i a t r i s t s
today who have been l e f t untouched
by the influence of the Women's
Movement.
Psychiatry owes much to the Women's
Movement. I t has drawn attention to
the poverty of knowledge about female
psychology, female psychosexual
development, sex role stereotypes and
t h e i r contribution to p s y c h i a t r i c mor-
b i d i t y , by which I mean emotional d i s tress and i l l n e s s . I t has also emphasized the role of s o c i a l i z a t i o n of
female children that tends to lead to
the acceptance of submission, lack of
power, lack of emotional or f i n a n c i a l
independence, lack of power, lack of
emotional or f i n a n c i a l independence,
lack of scope for o r i g i n a l i t y , creat i v i t y , achievement and success.
This
i s the "slave mentality," as some might
c a l l i t , with the devastating price i t
costs i n terms of i d e n t i t y and selfhood,
self-esteem and the respect of others.
I would l i k e to emphasize some of the
work done both by p s y c h i a t r i s t s and
non-psychiatrists that has had a major
impact on the p r i n c i p l e s and practices
of psychiatry and which has led to
further research and findings. The
book that has changed the course of my
career as a p s y c h i a t r i s t was P h y l l i s
Chesler's Women and Madness. (1) I
have never seen mental i l l n e s s i n the
same way since I read Chesler. The
Broverman study,(2)now a c l a s s i c , also
had an impact with i t s objective scient i f i c survey that pointed out the
double standard of mental health. Ment a l health workers o f various d i s c i p l i n e s , ages and both sexes were
asked to score q u a l i t i e s and characteri s t i c s provided i n a l i s t that would
be appropriate for a normal adult male,
a normal adult female and a normal
adult sex unspecified. Scores of normal adults were p r a c t i c a l l y the same as
those of normal adult males—while
quite d i f f e r e n t from the scores of
normal adult females. The inconsistency
has brought to public attention the
fact that only males are seen as undisputedly normal and adult. Females
are seen as not normal, nor adult i f
they have the q u a l i t i e s expected of
mature, well-adjusted females i n the
society. This i s a clear case of a
double bind. I f a woman i s w e l l adjusted to her s o c i a l r o l e , as i s
expected of her, she cannot be r e garded as a normal adult person; i f
her q u a l i t i e s , however, approximate
the normal a d u l t s , she cannot not
be regarded as well-adjusted or
feminine, and so w i l l m i s f i t her
expected s o c i a l r o l e . She cannot
be r i g h t or well however hard she
t r i e s to be.
1
As a r e s u l t of the Broverman study
much attention has been paid to sex
r o l e s e s p e c i a l l y of women's sex
r o l e s . There followed an increased
acceptance o f a much broader range of
"normal" or acceptable behaviours i n
women. Perhaps p s y c h i a t r i s t s have
been more cautious i n declaring
"abnormal" the housewife-mother i f
she happens to be happy i n her r o l e .
This i s I think a welcome correction
for the swing of the pendulum, which
i s a r e s u l t of the momentum of soc i a l change i n women's r o l e s , but
which put the occasional happy
housewife i n s t i l l another double
bind, making a l o t of women f e e l
that unless they went out i n
search of a career they were abnormal.
\
Dorothy D i n n e r s t e i n , a New York anal y s t , p u b l i s h e d a book i n 1977 c a l l e d
The Mermaid and t h e Minotaur - s e x u a l
arrangements and human m a l a i s e . ( 3 )
In an e x c e l l e n t s o c i o l o g i c a l - p s y c h o l o g i c a l a n a l y s i s , she demonstrates
the i n h e r e n t u n h e a l t h i n e s s o f b o t h
the t r a d i t i o n a l male and female
roles.
The s i c k n e s s i s n o t i n t h e
p a r t i c u l a r q u a l i t i e s o f e i t h e r male
or female, b u t r a t h e r i n t h e a r t i f i c i a l d i v i s i o n o f human q u a l i t i e s
i n t o two h i g h l y p o l a r i s e d , v e r y
different sets.
Such s p l i t t i n g and
polarisation i s b a s i c a l l y neurotic
and adherence t o e i t h e r r o l e demands s u p p r e s s i o n o f some q u a l i t i e s
and e x a g g e r a t i o n o f o t h e r s — b o t h
resulting i n neurotic characters.
Male and female have t o be m u t u a l l y
dependent on each o t h e r i n such a
system, f o r s t e r i n g a b a s i c a l l y i n f a n t i l e a t t i t u d e i n b o t h . Hence
men do n o t take women s e r i o u s l y —
"women a r e s i l l y , - " and women do n o t
take men s e r i o u s l y — " m e n a r e such
children."
D i n n e r s t e i n ' s major cont r i b u t i o n i s t h e statement t h a t t h e
" h e a l t h y a d u l t " model we have thought
h e a l t h y and a d u l t i s , i n f a c t , n e i t h e r
healthy nor a d u l t .
A new model o f mental h e a l t h has t o be
found and t h e b a s i s o f i t i s an i n t e g r a t i o n o f human q u a l i t i e s , t o undo
the p r e v i o u s p o l a r i s a t i o n .
Human b e ings possess the p o t e n t i a l f o r a l l
human q u a l i t i e s and t h e development
of human p o t e n t i a l i s what i s h e a l t h y .
A f t e r b e i n g human, people a r e male
and female, because they a r e b o r n
t h a t way, n o t because they c u l t i v a t e
s t e r e o t y p e d , o f t e n s t i l t e d , beh a v i o u r s . People s h o u l d be r e c o g n i z e d
as i n d i v i d u a l s w i t h t h e i r unique
b l e n d o f p o t e n t i a l s , r a t h e r than as
masculine o r f e m i n i n e , because they
r o l e - p l a y what s o c i e t y expects o f
them and hence what they expect o f
themselves.
These s t u d i e s have had an impact on
my own r e s e a r c h conducted l a s t y e a r
i n t h e c i t y o f Hamilton.(4)
My aim
was t o o b t a i n d a t a about t h e p a t t e r n s
of p s y c h i a t r i c p r i v a t e p r a c t i c e .
Thirteen o f the nineteen p s y c h i a t r i s t s
i n p r i v a t e p r a c t i c e have co-operated
i n t h e study, two female and e l e v e n
male p s y c h i a t r i s t s .
A l l were r e q u e s t e d t o f i l l o u t one
b r i e f q u e s t i o n n a i r e about each and
every p a t i e n t seen o v e r a f o u r month
p e r i o d . The q u e s t i o n s i n c l u d e d t h e
age, sex, m a r i t a l and o c c u p a t i o n a l
status o f the p a t i e n t ; also the
d i a g n o s i s , t h e form o f treatment, and
the date o f f i r s t c o n t a c t and t h e
date o f d i s c h a r g e i n o r d e r t o o b t a i n
some i d e a about t h e l e n g t h o f t r e a t ment. The t o t a l number o f p a t i e n t s
o v e r e i g h t e e n was 1448; o f those 880
were women and 567 were men.
The most important f i n d i n g s have been
t h a t women p a t i e n t s outnumbered the
men p a t i e n t s by a r a t i o o f 3 : 2.
F o r t y - f i v e p e r c e n t o f women were
diagnosed as depressed, making depres-
sion the single most frequent diagnosis. A correlation was found between depression and marriage, the
next highest correlation between
depression and widowhood and
divorce. Single women were less
often depressed than those marr i e d . Another interesting correl a t i o n was found between depression
and job status. Most of the depressed women were either housewives on welfare or employed f u l l time i n a low-paying low status
job. Although there were depressed women i n high status jobs as
w e l l , the proportion of the depressed was much lower i n t h i s
group than the proportion i n the
housewife, low status job o r welfare group.
Another interesting finding was that
the diagnosis o f personality d i s order was found with roughly simil a r frequencies i n single o r marr i e d men. But single women, i n cluding the divorced and the never
married, were diagnosed as having
personality disorder about 30% more
often as single men were. This
finding provokes the question as to ,
whether non-marriage i n women may be
seen by p s y c h i a t r i s t s as a sign of
deviance and so receive the diagnosis
of personality disorder.
Some differences i n the treatment
of men and women patients were also
found. Although more men than women
were diagnosed schizophrenic (8% :
7.5%), about 9% of women received
antipsychotic drugs as opposed to
only 5.5% of the men. Also, psychotic
depressive i l l n e s s including manicdepressive i l l n e s s was diagnosed i n
3% of both men and women, yet about
4% of women patients were prescribed
Lithium to about 2% o f the men. Thus,
the drugs f o r the treatment of major
mental disorders were s l i g h t l y overprescribed f o r women.
Contrary to expectations, t r a n q u i l l i z e r s and anti-depressants were not
found to be overprescribed by psyc h i a t r i s t s f o r either men or women.
Other studies such as that of Ruth
Cooperstock from Toronto Drug Research
Foundation,(5)show a d e f i n i t e overp r e s c r i p t i o n o f t r a n q u i l l i z e r s and
anti-depressants to women, and the
prescribers are shown to be family
doctors. Electroshock treatment, a l though seldom used by private psyc h i a t r i s t s , was given t o about 3% of
women as opposed to 1% o f men i n the
sample.
Other important differences i n t r e a t ment were found i n the length of
psychotherapy. Men outnumbered women
for consultations by 16% to 12%.
There were s l i g h t l y more men seen i n
short term therapy of less than s i x
months' duration, and more women than
men i n the s i x to twenty-four months
length of treatment. There were
twice as many women as men i n the
small group who were i n treatment f o r
more than two years.
physicians; less than 7% of the
patients are treated by p s y c h i a t r i s t s
and the rest receive treatment by
hospitals and other agencies.
C a r l D'Arcy's group from Saskatchewan,
studying the patterns of p s y c h i a t r i c
i l l n e s s and p s y c h i a t r i c care i n that
province, have confirmed most of my
findings.(6) He has an additional
i n t e r e s t i n g finding that would be
worth looking into i n Ontario as w e l l .
He found that 80% of p s y c h i a t r i c
treatment i s rendered by family
There i s c l e a r l y a necessity for more
research i n a l l these areas.
NOTES
1.
Chesler, P h y l l i s , Women and Madness, (New York: Doubleday, 1970).
2.
Broverman, Inge K. e t _ a l , "Sex role stereotypes and c l i n i c a l Judgements of
mental health," Journal of consulting and C l i n i c a l Psychology (1970), Vol.
34, pp. 1-7.
3.
Dinnarstein, Dorothy, The Mermaid and the Minjtaur (Hew York: Harper 6 Row,
1976).
4.
Cooperstock, Ruth, "A review of women's psychotropic drug use," Canadian Journal of Psychiatry, V o l . 24 (February, 1979), pp. 29-34.
5.
D'Arcy, C a r l , Schmitz, J.A., "Sax differences i n the u t i l i z a t i o n of health
services for p s y c h i a t r i c problems i n Saskatchewan, Canadian Journal of Psychiatry, V o l . 24 (February, 1979), pp. 19-27.