The Female Body in Mind

The Interface between the Female Body and Mental Health

Mervat Nasser, Karen Baistow, Janet Treasure, Mervat Nasser, Karen Baistow, Janet Treasure

• Publisher: Routledge
• Year: 2007
• Print ISBN: 9780415385145
• eBook ISBN: 9781134173075
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

The Female Body in Mind introduces new ways of thinking about issues of women's mental health assessment and treatment. Its multidisciplinary approach incorporates social, psychological, biological and philosophical perspectives on the female body.

The contributions, from notable academics in the field of women's mental health, examine the relationship between women's bodies, society and culture, demonstrating how the body has become a platform for women's expression of their distress and anguish. The book is divided into six sections, all centred on the theme of the body, covering:

• The body at risk.
• The hurting body.
• The reproductive body.
• The interactive body.
• Body-sensitive therapies.
• The body on my mind.

All professionals involved in women's mental health will welcome this exploration of the complexities involved in the relationship between women bodies and their mental health.

Part I
The body at risk

The question of why women in particular—that is, gender risk factors—is discussed in the first chapter of this volume. It begins with an evolutionary history of the female body from the religious to the medical to the social, touching on definitions of femininity within the social/feminist discourse. It moves on to discuss the assertion that women’s bodies make them susceptible to mental health problems, outlining gender differences in the epidemiology of mental health problems and basic principles of research methodology.

The second chapter’s authors discuss through the notion of the open body the constant dialogue between the body and its environment, through figurative re-construction. The newly-constructed form represents a more grounded self/identity, perhaps more able to negotiate the demands of transition and the forces of socio-cultural instability. It also touches on the struggle between the female body and the aging process, and how to reconcile perceptual frailty and infirmity with identity.

Chapter 1
At risk by reason of gender

Helen Malson and Mervat Nasser

INTRODUCTION

While the name of the symbolic female disorder may change from one historical period to the next, the gender asymmetry of the representational tradition remains constant.

(Showalter, 1985:4)

Being a woman is, it could be argued, a risky business. Women in both Western and non-Western societies appear historically and often currently to have been systematically disadvantaged across almost every aspect of public and private life: in terms of, for example, economics (Olsen and Walby, 2004), education, political representation (Sayers, 1982), career prospects (Wager, 1998), unequal divisions of labour both inside (Dryden, 1999) and outside (Ussher, 1991) the home, subjection to domestic violence (Garimella et al., 2000) and some forms of violence outside of the home (Liebling, 2004) and, perhaps not surprisingly therefore, also in terms of health and mental health status (e.g. Stoppard, 2000; Ussher, 2000). Women, it seems, have been and still are more likely than men to experience mental health problems.

The aim of this chapter is to consider the assertion that women are more susceptible than men to mental health problems, and to consider explanations of women’s seeming greater susceptibility. An examination of the facts about gender differences which emerge in the epidemiology of mental health is clearly crucial to an understanding of this issue, but it is by no means the only task entailed. In addition to examining the merits of the explanations of these statistics, it is also important that we trouble the key terms themselves—“women”, “gender”, “reality”, “risk” and “mental health”. How, for example, might contemporary cultural concerns about risk management in relation to an increasingly individualised responsibility for health (see e.g. Department of Health, 2004) shape our assumptions about the nature of “risk”? Do modern Western conceptualisations of “mental health problems” or “mental illness” refer simply to naturally existing psychopathologies which might occur in any culture, or are they part of a culturally and historically contingent modern Western perspective which perhaps should not be privileged above the perspectives of other cultures and which cannot therefore be applied unproblematically outside of modern Western and Westernised cultural contexts (Littlewood and Lipsedge, 1987; see also Nasser, 1997, 2000)?

Further, might our conceptualisations of mental health and illness be not only historically contingent and Eurocentric but also gendered? That is, what relationships pertain between culturally dominant ideas about “women” and about “mental health”, and how might such relationships inform our understanding of women’s seemingly increased susceptibility to mental health problems? And what, for example, do we mean by “women” (see Butler, 1993; Weedon, 1987)? The term’s meaning may seem so blindingly obvious as to require no further consideration but, in fact, it has been subject to considerable debate and controversy within the social sciences; its apparent naturalness often masks a plethora of issues crucial to a thorough understanding of gender and mental health or indeed gender and any issue. How, for example, should we best understand the relationship(s) between sexed bodies and gender? Are women’s identities, experiences and behaviours a natural consequence of having a female body? Is it a matter of biology or a culturally and historically variable interpretation of having a female body? Indeed, are sexed bodies themselves culturally constituted (Butler, 1993)? Does it make sense to talk of women as a universal, ahistorical category (Riley, 1988)? What assumptions are made and what differences and inequalities within the category of woman are occluded when women of different ages, sexualities, ethnicities and social classes, women living in different historical periods and in different societies, are considered as a single, monolithic homogeneity? How might we consider issues of gender in ways which are cognisant of these differences and inequalities which exist within that category of persons (e.g. Bordo, 1993; Wilkinson, 2002)?

Clearly we have raised more questions here than we could possibly answer within the space of a single chapter but they are, nevertheless, important as they illustrate some of the complexities entailed in questions about gendered differences in mental health problems and the implications of women’s gendered embodiment. With all this in mind, however, a consideration of the statistics about women’s mental health problems clearly represents a logical starting point in considering the nature of the relationship(s) between women and mental health problems.

MENTAL HEALTH AND GENDER DIFFERENCES: FACT, ARTEFACT, INTERPRETATION AND EXPERIENCE

Gender differences have long been apparent in the statistics on mental health and illness. While there is some controversy over the historical data (see Busfield, 1994), it is generally accepted that in Europe throughout the eighteenth and nineteenth centuries more women than men were diagnosed with and treated for “mental illness” (Ehrenreich and English, 1974; Showalter, 1985). And for some diagnoses this gender difference constituted a near-total monopoly: hysteria, neurasthenia and chlorosis, for example, were very rarely diagnosed in men (Brumberg, 1982; Showalter, 1985). Current epidemiological statistics demonstrate a continuation of this preponderance of women in overall diagnoses of mental health problems (Ussher, 1991, 2000) and in particular diagnostic categories. Depression, for instance, appears to be twice as common in women as men (Culbertson, 1997), while girls and women represent 95% of those diagnosed with eating disorders (the magnitude of such problems is discussed in detail within this volume).

These epidemiological data are obtained through quantitative research methodologies, depending on quantified variables to assess incidence and prevalence rates. The incidence of any particular disorder is taken as the number of episodes of such disorder within a specified period of time, usually of one year, while prevalence rate refers to the number of existing episodes of that disorder at any one time. However, while these data are produced within an empiricist framework of quantitative research, issues of cultural interpretation are nevertheless present. The reliability and validity of the instruments used, as well as the nature of the diagnostic manuals (ICD10 and DSMIV) with which caseness decisions are reached, introduce sources of error, misrepresentation and cultural bias. Further, incidence and prevalence data, being derived either from community data or hospital rates of admissions and referrals, are inevitably influenced by the ways in which both users and providers of mental health care services interpret service users’ experiences. For example, women have been found to seek help from primary care services more often than men when experiencing distress, a gender difference which may be due to differences in help-seeking and expressing emotional dis/content as much as to gender differences in levels of distress.

This in turn often leads to women’s subsequent referral to specialist psychiatric services, particularly when general practitioners’ interpretation of the nature of their distress is medicalised (Johnson and Buszewicz, 1996). And, where “women” are interpreted as a homogeneous category, overall gender differences in referral rates obscure other issues: the tendency towards presentation to medical services by women is not uniform, as women from some minority racial/cultural groups were found to have little faith in conventional medical services and therefore tended to be under-represented in statistical data (Nasser, 1997).

Statistical data regarding gender differences in mental health problems cannot then be viewed as unproblematically reflecting the “reality” of women’s mental health problems but, rather, are subject to the multiple and diverse influences of interpretation. And further controversy emerges when inferring causality from such data. Are women diagnosed with mental health problems in greater numbers than men because women’s bodies render them/us “naturally” more susceptible to such problems, or is it because of gender differences in, for example, pay, career paths, family commitments or political and personal power? Is it a question of biology or of the consequences of systematic gender differences in lived experience, of society’s gender ideologies and politics (Choi and Nicolson, 1994)?

Attributing causality either to “women’s bodies” or “women’s lives” or some combination of both (Stoppard, 2000:406) results in very different kinds of research questions for which very different research methodologies are appropriate. Whilst epidemiological research and research investigating possible biological causes of gender differences in mental health deploy empiricist quantitative methods, studies investigating socially contextualised explanations and women’s experiences of distress require a variety of quantitative and qualitative methods.

There is, therefore, a ...

Table of contents

• Contents
• Contributors
• Preface
• Acknowledgment
• The body in question
• Part I The body at risk
• Part II The hurting body
• Part III The reproductive body
• Part IV The interactive body
• Part V Body-sensitive therapies
• Part VI The body on my mind
• Index