Firstly a bit of housekeeping. I’m referring to gender here, not sex; gender includes the societal influences and roles we play rather than just pure biology. i think this is vital in this discussion because whilst some mental illness is biological, down to genes etc, the environment around a person and their socialisation plays a huge part in causing mental ill health.
I’m focusing mostly on male and female here but am aware that not everyone fits into those gender boxes however, as these are what society predominately uses, it is a helpful way to think about it. Even if you are not male or female, the chances are you are perceived as one or the other which means you’re likely to be affected by the biases and stereotypes
related to that gender. I recognise that not fitting into the male/female boxes is likely to bring it’s own difficulties especially when it comes to engrained social biases and stereotypes. I think how gender affects mental health diagnoses when you’re not cisgendered (your gender matches the sex you were at birth) is probably a blog post on its own and is probably better written by someone with more experience. Similarly, your sexual orientation and how that plays with mental health diagnosis is also not something I’m going to cover right now but sounds interesting to look into (and I feel, as a bi woman, a bit more qualified to speak about that).
Within this discussion we need to remember the historical context in which gender and mental health sits. it would be a travesty to ignore or forget about the way women have been oppressed through the use of mental health diagnoses. a prominent example is the Victorian ‘mad woman in the attic’, a much critiqued view of mental illness. There are many writers who unpick the use of diagnoses to oppress women who weren’t submissive and obedient. Its an interesting area to read about and there’s lots of blog posts, articles, books etc about it. Here however, I’m looking more at the point of diagnosis in the contemporary world, mostly focussed on the developed world or the global north.
Er, get to the point…
So, men and women can experience a vast array of mental health issues for which they may receive a diagnosis and treatment related to that diagnosis. Having had the issue of equality and mental health diagnosis come up a couple of times in conversation with friends, I wanted to look into it a bit more.
Is there a difference?
Overall, the rates of diagnosed mental illness in men and women is much the same (and is under diagnosed across the board), but disparity does arise when it comes to the rates of diagnosis.
Diagnoses of common mental disorders including depression and anxiety are made up of mostly women eg depression is twice as likely to be diagnosed for a woman than a man. However when it comes to alcohol addiction in developed countries, 1 in 5 men and 1 in 12 women will receive this diagnosis at some point. Take another example; men are more than three times more likely to be diagnosed with antisocial personality disorder than women.
Interestingly, according to the WHO, there is little gender difference for diagnosis rates of severe and rarer mental disorders such as schizophrenia. I wonder if this is because they are rarer so have a less engrained stereotype?
So do men and women just have different mental health susceptibilities?
To answer this question, I think we need to start by mentioning that mental illness can be caused by a vast number of things including genetics, life experience, poverty etc.
The WHO states that gender specific risk factors include the nature of the stereotypical gender role, stressors and negative life events. We then have to consider that women are disproportionately affected by gender based violence, low status, economic disadvantage, responsibilities for the care of others etc.
Looking specifically at PTSD for example, because they are more likely to experience sexual violence, women are obviously more likely to have PTSD as a result of that violence. 1 in 3 women who have been raped develop PTSD instead of 1 in 20 when looking at non victims. And at least one in five women suffer rape or attempted rape in their lifetime.
When it comes to the impact of other types of abuse, we know that women who experienced childhood sexual abuse or partner violence as an adult, rates of depression are 3 to 4 times higher than the rest of the population. I’m obviously not saying that men do not suffer abuse, of course they do, but the figures are much higher for women. Lifetime prevalence rate of violence against women ranges from 16% to 50%.
In terms of life events impacting on women and their mental health, an estimated 80% of 50 million people affected by violent conflicts, civil wars, disasters, and displacement are women and children.
Similarly, low status, low income and the burden of taking care of others can place a lot of stress on a woman and in turn result in associated mental illness; women make up around 70% of the world’s poor and are paid significantly less than men. This lack of resources results in higher stress and being less able to seek help, or seek the same quality of help, as men who are earning more, which in turn makes things worse. People with higher income or good health insurance are more likely to seek support and therefore . This lack of resources means that women can get trapped in difficult situations such as domestic abuse as they have limited means to get out and this will obviously have some impact on mental health.
OK, so men and women have different types of mental illness, fine.
No. Sorry, it’s not that simple. Men and women may in general experience different types of mental illness. But we don’t know that. This is because of gender bias occurs in the treatment of mental illness. Even when presenting with the same score on a standardised test, women are more likely to be diagnosed with depression than men. Remember above, we noted that women are more likely to have this type of diagnosis than men…
There is also a difference in presenting for help. Women are more likely to approach their primary carer, such as a GP whereas men are more likely to turn to a specialist and are the main users of inpatient care, again, potentially affecting diagnosis. If you turn up to a substance misuse centre you’re likely to end to with a related diagnosis. Turn up to your gp who hasn’t got much experience about these things and doesn’t ask you the right question, maybe you’ll get a different diagnosis.
Returning to alcohol, men are more likely to admit to having a problem with it than women, again providing a possible reason for the large gap in diagnosis rates between genders. It could also be related to men feeling unable, because of gender stereotypes, to get help for depression, anxiety etc and are self medicating with alcohol which in turn gets picked up as a diagnosis of alcoholism.
Gender stereotypes themselves can get in the way of a diagnosis as they reinforce emotional problems in women and alcohol problems in men. This can be a barrier to a correct diagnosis.
So, why does it matter?
Well, cynically, i think that more money would go into treating, preventing and researching the more common mental illness if they were more commonly diagnosed in men. yes, i’m a feminist so i’m going to say that but look at the differing attitudes between erectile dysfunction and pain women experience during sex. one has lots of money thrown at it, the other is barely acceptable to say.
A second reason why it matters is that it could help understand what causes, triggers or perpetuates mental health issues. if particular conditions are more common in women, can we unpick it further, is it biological or societal? can we do anything to prevent this, such as ensuring women have the opportunity to be economical independent or free from abuse? As with most of these things, prevention is vastly superior to cure.
Thirdly, if diagnoses are bias based on gender than there could well be lots of unsupported men and women who are struggling with their mental health because their support and treatment is wrong due to an incorrect diagnosis. Access to services might be formally or informally restricted because of gender – if alcoholism is seen as male illness it could put a woman off seeking treatment and support. There are numerous accounts of men who’ve tried to seek support for eating disorders and the walls they’ve come across and the stigma they’ve faced. Again, correct diagnosis may mean more men are diagnosed with an eating disorder which in turn would hopefully mean that more men feel able to seek support for it and in doing so, perhaps health practitioners would no longer think about gender at the point of diagnosis.
One commonly quoted stat is that men are more likely to die by suicide than women. What it misses out is that women are more likely to attempt suicide than men. At the moment this means, in the UK, there is a lot of awareness raising going into supporting men who are suicidal. Which is great. However it seems to be at the expense of support for women. Perhaps diagnosis which wasn’t influenced by gender would help us to see the person in distress and help their actual needs rather than their perceived needs.
I’m fully aware I’ve not referenced things… However if you want to do some more reading and find out more for yourself, here’s a few links I found useful:
And for reading about whether men and women have different brains, check out Cordelia Fine’s Delusions of Gender. Well worth a read.