CHAPTER 14 (WOMEN & GENDER BY MARY CRAWFORD & RHODA
UNGER, 2004. BOSTON: MCGRAW HILL)
______________________________
Mental and Physical Health
CHAPTER OUTLINE (EXPANDED VERSION OF OUTLINE THAT APPEARS IN TEXTBOOK)
I.
Gender and psychological disorders
A. Is there a feminist view of psychological disorders?
1. Social norms defining what traits and behaviors are considered acceptable may change
over time, so what constitutes a healthy person changes, too
2. People who have little power are more likely to be punished for engaging in undesirable
behaviors
B. Gender and problems of psychological diagnosis
1. Sampling bias
a. Few objective standards can be applied
b. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)—differential
diagnosis rates
c. Women and men may differ in willingness to seek treatment, ability to acknowledge
that they have a disorder
d. An additional disorder may be present that affects likelihood of treatment
2. Gender bias and the DSM
a. Large majority of students agree that a person with a disorder is likely to be white,
middle-class, and female
b. Clinicians show strong connection between gender stereotypes and diagnostic labels
c. Individual, social, cultural factors all play a role in psychological symptoms
d. Identification, treatment of gender-characteristic disorders not value free
C. Gender differences in distress: A review of explanations
1. Medical model
a. Women are biologically more vulnerable to certain disorders
b. Women defined almost entirely in terms of their reproductive functions
c. Higher rate of mental illness in women—recent development in U.S.
d. In developing countries—more men diagnosed with depression
2. Stereotypes and gender identity
a. Traditional gender roles increase the risks for some disorders
b. Disorders prevalent in women are characterized by passivity, dependence, concern
for pleasing others
c. Women who have internalized characteristics that are traditionally considered
feminine seem to be most at risk
3. The impact of sexist events
a. Living in sexist society may contribute to women’s psychological distress
b. Score on “The Schedule of Sexist Events” related to level of psychological, physical
distress
c. Prototypic women who reported fewest incidents of sexist discrimination—32-yearold married white woman
D. The social construction of symptoms
1. Stereotypes function as prescriptions for women’s behavior
2. Social systems can create many behaviors considered maladaptive—the double bind
3. Social construction theories emphasize situational context of women’s lives
II.
Power issues
A. The case of Dora
1. Illustrates abuse of therapeutic power
2. She, rather than her family, was seen as source of her problems
3. Represents therapy in its most adversarial form
B. The social construction of female disorders: The view from history
1. An epidemic of nervous disorders
a. 1873—anorexia nervosa
b. Between 1870 and WWI—hysteria
i. At first—seizures, fits, choking
ii. Moved to traits, moods, personalities—almost interchangeable with “feminine”
c. Neurasthenia
i. Blushing, vertigo, headaches, insomnia, depression, uterine irritability
ii. Seen to be caused by increased mental activity in women
d. Treatment—Mitchell’s “rest cure”
2. Gender, class, and social control
a. Feminists attribute nervous diseases to limited roles during Victorian era
b. Nervous disorders provided escape from emotional and sexual demands
c. Men labeled “bad”; women labeled “mad”
d. Working-class women ignored
e. Twentieth-century female disorders may also function to deny responsibility for
actions, maintain self-definition of “good” woman
C. Social construction today
1. Some twentieth-century female disorders (e.g., PMS) may involve social construction
much as the nineteenth-century nervous disorders did
2. Differences in power because of ethnicity and class shape the social construction of
psychological disorders and how clinicians treat disorders
a. Altamese Thomas case
III.
Depression
A. The gender gap in depression
1. Gender gap begins around age 13 in Norway, according to study
2. Researcher attributed gender gap to gender intensification
3. Correlation between body dissatisfaction and low self-esteem
4. Married women—more depression than married men; single women—less depression
than single men
B. Blaming women: Reproductive function as a source of depression
1. Women regarded as being particularly vulnerable during critical points in reproductive
cycle
2. The example of PMS
a. No single symptom/pattern of signs necessary for diagnosis of PMS, no agreed-upon
standardized test to determine its existence or cure
b. Little evidence that most women have negative premenstrual phase
c. Social/diagnostic labels affect perception
d. As popularized in magazines—focuses on body, is class biased
3. Lack of agreement about what symptoms are required for diagnosis of postpartum
depression, menopausal depression as well
4. Deconstructing the reproductive syndromes
a. Existence of reproductive syndromes helps to justify beliefs in biological inferiority
of women
C. Personality characteristics and depressive symptoms
1. Self-esteem plays a role in the association between gender and depression.
2. Instability of self-esteem is a risk factor for depression
D. Gender roles and depression
1. Self in relation and self-silencing
a. Women’s need for relationship may be linked to higher risk of depression
b. Self-silencing (usually to maintain relationships with men) related to depression in
young white women
c. Depression in marginalized groups linked to economic and social disadvantage
E. Depression and cognitive styles of perceiving and coping with distress
1. Gender roles may be more important than biological sex in affecting behaviors associated
with depression
2. Degree of identification with traditional gender roles also influences the way depression
is expressed
3. Instrumental traits may protect men and women from depression
4. Emotionality may prolong, make depression more severe
F. Power and depression
1. Depression lower among women who: are employed full-time, have jobs that allow
autonomy, have little difficulty affording and arranging child care
2. Power is linked to psychological well-being
3. Task Force on Women and Depression
a. Women’s place in social structure depresses them
b. Sexual/physical abuse much greater than previously suspected, victims very
vulnerable to depression
IV. Eating disorders
A. The demographics of eating disorders
1. The “normal” desire for thinness
a. Depression associated with negative attitudes about weight, disordered eating
behavior
b. Body dissatisfaction increases as girls move into adolescence
B. Normal Strategies for Weight Control
a. “Fat talk” (e.g. “I’m so fat) repeated throughout the school day
b. Request for reassurance from peers that they aren’t fat
c. Confusion between thinness and a perfect life common among white adolescents
d. Perceptions of women, but no men, affected by size of meals they ate
C. Weight control and health
1. Smoking one of the most dangerous forms of weight control
D. Disordered eating as pathology
1. Anorexia
a. Refusal to maintain minimal normal weight, fears of gaining weight or becoming fat,
body image disturbance, denial of seriousness of low weight
b. Females account for more than 90% of reported cases of anorexia
2. Bulimia
a. Episodes of binge eating during which person feels loss of control
b. Weight regulated by excessive purging or use of laxatives, diuretics
3. Binge-eating disorder
a. Recurrent episodes of binge eating without regular attempts to control weight by
excessive use of laxatives and purging
b. Many women with eating disorders appear to be able to function well, may even be
rewarded for low weight
E. Ethnic differences in body concerns
a. Eating disorders increasing among women of color
b. Cultural context that equates beauty with whiteness does not “protect” ethnic
minority women from eating disorders
c. Stereotypes may have conspired against early recognition of eating disorders in
women of color
F. Feminist perspectives on eating disorders
1. Women who resist becoming obsessed with weight—less vulnerable to selfobjectification
2. Lesbians have less negative view of their bodies than heterosexual women
3. Person’s behavior cannot be changed without consideration of situation
V.
Issues in treatment—traditionally therapy used to reconcile powerless to their circumstances, not
assist them in creating social change
A. The double standard in diagnostic categories
1. The politics of labeling
a. DSM-IV perpetuates myths about women and femininity
b. Self-defeating personality disorder
i. Concept of masochism fails to consider sociocultural variables
ii. Ignoring history of abuse results in blaming victim
iii. Sexual and physical abuse contribute to serious mental illness in women
c. Posttraumatic stress disorder
i. Feminist therapists argue that it is applicable to battered women
ii. Recurrent, intrusive memories and dreams; distressful experiences when exposed
to events symbolizing the trauma; avoidance of thoughts, feelings associated with
the trauma; heightened arousal symptoms
iii. Ongoing, intimate nature of violence may lead to different set of reactions
d. Presumptions that autonomy and individualism are healthier than dependency and
concern with relationships
e. “Delusional dominating personality disorder”
B. Gender bias in practice
1. Biases increase likelihood that females will be treated for psychological disorders,
whereas physical disorders will be explored for males
2. Gender biases in treatment: The use of medication
a. Powerless individuals likely to be treated with drugs, electroshock, hospitalization
3. Double standard in way women and men are treated when violate normative standards of
acceptable behavior
4. Women more likely to be defined as ill, treated by clinical practitioners; men more likely
to be defined antisocial, dealt with by criminal justice system
C. The feminist critique of traditional treatment methods
1. Medical model—discourages women from finding social, collective avenues of self-help
2. Feminist therapists charge that traditional therapy leads to practitioners making the
fundamental attribution error
3. Traditional therapy—social control, focuses on personal not social change
D. Feminist therapy
1. Focuses on solutions to practical problems facing women
2. Gender as primary focus of oppression
3. Tries to avoid using diagnostic labels
4. Goal—personal empowerment
5. Egalitarian relationship between therapist and client
6. Feminist therapy incorporates political values and philosophy in therapeutic values and
strategies
E. Relational-cultural therapy
1. Focus on women’s inner lives as well as on their social situation
F. The impact of therapist characteristics
1. Does the gender or sexual orientation of the therapist matter?
a. Problem of sexual involvement between therapist and client
b. Heterosexual therapists may have prejudices about “homosexual lifestyle”, be
unaware of extent of violence lesbians experience, lack knowledge of lesbian
communities
c. Questions to stimulate therapists’ self-awareness
2. Does the race and ethnicity of the therapist matter?
a. Few, although growing number of, African-American therapists
b. Most therapists have little training in treatment of patients of color
G. Diversity and therapy
1. Therapy with marginalized women
a. Therapy is not equally available to all members of society
b. Therapists unable to “get inside the skin” of clients
2. African-American clients
a. Pervasive racism—live in a culture that frequently reminds them of their skin color
b. African-American women more vulnerable to unemployment, stress
c. Therapists’ lack of awareness of pervasive effects of racism (e.g., colorism)
3. Asian-American clients—may not seek therapy—silence supposed to convey pain and
suffering
4. Latina clients—major factor that contributes to differences between populations is how
they immigrated to U.S.
5. Immigrants
6. Poor Women—poor clients may have different set of priorities than middle-class
therapists
H. Invisible women—some groups of women ignored
1. Native American cultures, homeless women, lesbians
2. Disabled women
a. Denied traditional feminine nurturing role and role of independent worker
b. Minimizing client’s disability, overemphasizing impact on life—common
therapeutic pitfalls
I.
VI.
Invisible values
1. Psychologists more likely to focus on weaknesses rather than strengths
2. Value of women’s coping strategies may be ignored, difference from men’s strategies
seen as evidence of individual pathology
3. Differences from dominant culture unseen, misinterpreted
4. Women who deviate from cultural stereotypes about their weaknesses and needs may
also be ignored
5. Gender is not only way to organize social reality
The relationship between physical and mental health
A. Women of color—always worked outside home in greater numbers, overrepresented in jobs
with low wages, inadequate health insurance, high risks of occupational injuries
B. Survival has come at cost of adaptation to high levels of stress
1. Black, Latina women have higher mortality rate from coronary heart disease than do
white women
2. Excessive weight, poor diet, smoking are other cultural factors
C. Highest mortality rates—women with least education, exposed to more stress
D. Life expectancy for African-American women nearly six years shorter than for EuropeanAmerican women
E. Israeli women