Gender issues in mental health

Defining gender

The term gender is often used to classify the anatomy of a person's reproductive system as either male or female. In the social sciences, however, the concept of gender means much more than biological sex. It refers to socially constructed expectations regarding the ways in which one should think and behave, depending on sexual classification. These stereotypical expectations are commonly referred to as gender roles. Attitudes toward gender roles are thought to result from complex interactions among societal, cultural, familial, religious, ethnic, and political influences.

Gender affects many aspects of life, including access to resources, methods of coping with stress , styles of interacting with others, self-evaluation, spirituality, and expectations of others. These are all factors that can influence mental health either positively or negatively. Psychological gender studies seek to better understand the relationship between gender and mental health in order to reduce risk factors and improve treatment methods.

Traditional gender roles define masculinity as having power and being in control in emotional situations, in the workplace, and in sexual relationships. Acceptable male behaviors include competitiveness, independence, assertiveness, ambition, confidence, toughness, anger, and even violence (to varying degrees). Males are expected to avoid such characteristics associated with femininity as emotional expressiveness, vulnerability (weakness, helplessness, insecurity, worry), and intimacy (especially showing affection to other males).

Traditional femininity is defined as being nurturing, supportive, and assigning high priority to one's relationships. Women are expected to be emotionally expressive, dependent, passive, cooperative, warm, and accepting of subordinate status in marriage and employment. Competitiveness, assertiveness, anger, and violence are viewed as unfeminine and are not generally tolerated as acceptable female behavior.

Gender theories

Differences in gender roles have existed throughout history. Evolutionary theorists attribute these differences to the physiological characteristics of men and women that prescribed their best function for survival of the species. In primitive societies, men adopted the roles of hunting and protecting their families because of their physical strength. Women's ability to bear and nurse children led them to adopt the roles of nurturing young, as well as the less physically dependent roles of gathering and preparing food. These gender-dependent labor roles continued into the period of written human history, when people began to live in cities and form the earliest civilized societies.

In the 1800s, the industrial movement marked a prominent division of labor into public and private domains. Men began leaving home to work, whereas women worked within the home. Previously, both men and women frequently engaged in comparably respected, productive activities on their homestead. When men began working in the public domain, they acquired money, which was transferable for goods or services. Women's work, on the other hand, was not transferable. Men's relative economic independence contributed to their power and influence, while women were reduced to an image of frailty and emotionality deemed appropriate only for domestic tasks and child-rearing.

Sigmund Freud's psychoanalytic theory of human development, which emerged from Freud's late-nineteenth-century European setting and medical training, reflected an attitude of male superiority. Freud asserted that as children, boys recognize they are superior to girls when they discover the difference in their genitals. Girls, on the other hand, equate their lack of a penis with inferiority. This feeling of inferiority causes girls to idolize and desire their fathers, resulting in passivity, masochistic tendencies, jealousy and vanity—all seen by Freud as feminine characteristics.

Other developmental theorists rejected Freud's notions. Eric Erikson (in 1950) and Lawrence Kohlberg (in 1969) theorized that all humans begin as dependent on caregivers and gradually mature into independent and autonomous beings. Such theories, however, still favored males because independence has historically been considered a masculine trait. By such a standard, males would consistently achieve greater levels of maturity than females.

Nancy Chodorow's object-relations theory (in 1978) favored neither sex. She proposed that children develop according to interactions with their primary caregivers, who tend to be mothers. Mothers identify with girls to a greater extent, fostering an ability to form rich interpersonal relationships, as well as dependency traits. Mothers push boys toward independence, helping them to adjust to the male-dominated work environment, but rendering them unaccustomed to emotional connection. Chodorow's theory suggests both strengths and weaknesses inherent in male and female development, with neither deemed superior. Around that same time (1974), Sandra Bem advocated for androgyny, or high levels of both masculinity and femininity, as the key to mental health.

In the 1980s, such psychologists as Carol Gilligan sought to build respect for stereotypically feminine traits. They introduced the notion that women function according to an ethic of care and relatedness that is not inferior to men—just different. In 1985, Daniel Stern's developmental theory favored traditional femininity, suggesting that humans start out as unconnected to others and gradually form more complex interpersonal connections as they mature.

Current gender studies appear less concerned with establishing male or female superiority. The general consensus seems to be that gender is socially constructed rather than biologically determined. The process of learning gender roles is known as socialization. Children learn which behaviors are acceptable or not acceptable for their sex by observing other people. They may also be shamed by caregivers or peers when they violate gender role expectations. As a result, gender roles usually become an internal guide for behavior early in childhood. Current studies focus on the ways in which extreme notions of masculinity or femininity affect mental health, and the social processes that shape one's concept of maleness or femaleness.

Gender role conflict

In current research, gender is viewed as an artificial (humanly constructed) concept that may not be related to biological sex at all. For example, masculinity and femininity may simply be sets of personality traits that can be exhibited by either sex. Individuals vary in degree of adherence to gender roles, resulting in large amounts of behavioral variation within the sexes.

Although attitudes toward gender roles are now much more flexible, different cultures retain varying degrees of expectations regarding male and female behavior. An individual may personally disregard gender expectations, but society may disapprove of his or her behavior and impose external social consequences. On the other hand, an individual may feel internal shame if he or she experiences emotions or desires characteristic of the opposite sex. Gender role conflict, or gender role stress, results when there is a discrepancy between how one believes he or she should act—based on gender role expectations learned in childhood—and how one actually thinks, feels, or behaves. If these discrepancies are unresolved, gender role conflict contributes to poor mental health.

Women's issues

Typical stressors

Women are often expected to occupy a number of roles at the same time: wife, mother, homemaker, employee, or caregiver to an elderly parent. Meeting the demands of so many roles simultaneously leads to stressful situations in which choices must be prioritized. Women are often forced to choose whether to pursue or further a career versus whether to devote more time to home and family.

Many women prefer to work outside the home because it gives them a greater sense of life satisfaction. For other women, such as those who run single-parent households, employment is not an option—it is a necessity. Compared with men, women are frequently given jobs with less autonomy or creativity, which decreases their level of job satisfaction. Women may also have more difficultly being accepted in the workplace because of hierarchical structures preferring men. Documentation repeatedly shows that women's salaries are lower than those of men in comparable positions; women tend to be paid less even when performing the same job as a man.

When women do choose or are required to work outside the home, they continue to perform the bulk of household duties as well. Sarah Rosenfield reported that compared to men, women perform 66% more of the domestic work, sleep one-half hour less per night, and perform an extra month of work each year. Needless to say, increased workloads and decreased attention to rest and relaxation are stressful and pose obstacles to women's mental health.

Divorce results in more severe consequences for women who choose or are able to stay home in deference to child-rearing. Such women depend on marriage for financial security. Such domestic skills as childcare and housecleaning are not highly valued by society, and thus are poorly compensated in terms of money. Women who have never been employed and then experience divorce often have few options for securing adequate income.

Although women's ability to form meaningful relationships is a buffer against stress, it can also be a source of stress. Caring about another person can be stressful when that person is not doing well physically or emotionally. Many families take for granted that the female members will care for elderly parents who are no longer self-sufficient. As a result, many women in their forties or fifties are caught between the needs of their college-age offspring and the needs of dependent parents or parents-in-law. Interpersonal conflicts resulting from these heavy burdens may cause stress or lower self-esteem. Women may also view unsuccessful relationships as representing failure on their part to fulfill traditional feminine qualities such as nurturance, warmth, and empathy.

Additional sources of stress common to women include victimization, assertiveness, and physical unattractiveness. Victimization is a constant concern due to the power differential between men and women. Assertiveness may be stressful for women who have had little experience in competitive situations. Physical unattractiveness may cause some women who adhere to unrealistic standards of feminine beauty to experience shame, or place them at risk for developing eating disorders. Women considered unattractive may also suffer discrimination in the workplace or in admission to higher education. In addition, the double standard of aging in contemporary society means that all women will eventually have to cope with the stigma of unattractiveness simply through growing older.

Typical coping strategies

Studies suggest that women typically react to stress by seeking social support, expressing feelings, or using distraction. These strategies might include praying, worrying, venting, getting advice, or engaging in behaviors that are not related to the problem at all (including such antisocial behaviors as drinking alcohol). Seeking social support and distraction are considered avoidant coping strategies because they do not focus on solving or overcoming a problem, only on alleviating the stress associated with the problem. Research is inconclusive regarding whether men or women are more likely to use problem-solving, which is considered an active coping strategy.

Typical patterns of psychopathology

Women are more likely than men to experience internalizing disorders. Primary symptoms of internalizing disorders involve negative inner emotions as opposed to outward negative behavior. Depression (both mild and severe) and anxiety (generalized or "free-floating" anxiety, phobias, and panic attacks) are internalizing disorders common to women. Symptoms include sadness; a sense of loss, helplessness, or hopelessness; doubt about one's ability to handle problems; high levels of worry or nervousness; poor self-esteem; guilt, self-reproach, and self-blame; decreased energy, motivation, interest in life, or concentration; and problems with sleep or appetite.

Men's issues

Typical stressors

Situations that typically produce stress for men are those which challenge their self-identity and cause them to feel inadequate. If their identity closely matches a traditional male role, they will experience stress in situations requiring subordination to women or emotional expressiveness. They will also experience stress if they feel they are not meeting expectations for superior physical strength, intellect, or sexual performance. Research indicates that men who strictly adhere to extreme gender roles are at higher risk for mental disorders.

Certain cultures are thought to adhere more strictly to traditional male gender roles. In a study by Jose Abreu and colleagues, Latino men were identified as adopting the most exaggerated form of masculinity, followed by European Americans, and then African Americans. The Latino image of masculinity is often referred to as machismo and includes such qualities as concern for personal honor, virility, physical strength, heavy drinking, toughness, aggression, risk-taking, authoritarianism, and self-centeredness. African American males are also thought to have a unique image of masculinity; however, Abreu's study showed that African Americans are more egalitarian in terms of gender roles than European Americans.

Typical coping strategies

Men typically respond to stress by putting on a tough image, keeping their feelings inside, releasing stress through such activities as sports, actively attempting to solve the problem, denying the problem, abusing drugs or alcohol, or otherwise attempting to control the problem. As stated previously, research is inconclusive regarding whether males or females use problem-solving strategies more often. This type of coping strategy, however, has more frequently been attributed to males. Problem-solving is seen as an active coping strategy, which is more effective than such avoidant strategies as denial , abuse of drugs or alcohol, or refusing to talk about problems.

Typical patterns of psychopathology

Men are more likely than women to experience externalizing disorders. Externalizing disorders are characterized by symptoms involving negative outward behavior as opposed to internal negative emotions. Such externalizing disorders as substance abuse (both drugs and alcohol) and antisocial behavior (such as anger, hostility, aggression, violence, stealing, etc.) are common to men. Substance abuse results in such negative physical and social consequences as hallucinations , blackouts, physical dependency, job loss, divorce, arrests, organ and brain damage, and financial debt. Antisocial behavior impairs interpersonal relationships and can also result in negative consequences in other areas of life, such as runins with the criminal justice system.

Men are not exempt from such internalizing disorders as anxiety and depression. In fact, one study found that high levels of masculinity appear to be related to depression in males. Some researchers feel that men's abuse of substances could be considered the male version of depression. Because male gender roles discourage admitting vulnerability, men may resort to substance abuse as a way of covering their feelings.

Men who adhere to rigid gender roles are also at a disadvantage in interpersonal relationships, especially intimate relationships. They may avoid emotional expressiveness, or may behave in domineering and hostile ways. These behaviors increase their risk of social isolation, disconnection from nurturance, and participation in unhealthy relationships.

Mental health

Research indicates that, overall, neither males nor females are at greater risk for developing mental disorders as such. Being male or female may indicate susceptibility to certain types of disorders, however. Neither masculinity nor femininity is uniformly positive; both gender identifications have strengths and weaknesses. For example, femininity appears to be protective against antisocial behaviors and substance abuse, but is associated with high levels of avoidant coping strategies and low levels of achievement. Masculinity appears to be protective against depression, but is high in antisocial behavior and substance abuse.

Information about gender roles has implications for treatment. Women may not seek treatment because of lack of such resources as money, transportation, or time away from childcare duties. A treatment center sensitive to women's issues should seek to provide these resources in order to facilitate access to treatment. Men, on the other hand, may not seek treatment because it is incongruent with their image of masculinity. Therapists may need to offer men less threatening forms of treatment, such as those that focus on cognitive problem-solving rather than on emotions.

The focus of therapy may differ according to one's gender issues. Therapists should recognize the potential for shame and defensiveness when exploring gender norms. Externalizing behaviors may point to underlying hidden shame. For women, the importance placed on various roles in their lives and how closely those roles are tied to their self-identity is relevant. Men may be encouraged to connect to the spiritual aspects of their being and to consider less stringent views of masculinity. Therapists should also consider the associated influences of generation, culture, class, occupation, and educational level when exploring gender role issues.

Mental health is best achieved by maintaining a balance between masculine and feminine qualities. Taking either set of qualities to an extreme and to the exclusion of the other is detrimental. A non-traditional gender role orientation would combine the best of both genders: a social focus (reciprocally supportive relationships and a balance between interests of self and others) and active coping strategies.

Flexibility in using coping strategies is also important. Active, problem-focused coping strategies help to change the situation that is causing the problem. Avoidant or emotion-focused coping strategies manage or reduce emotional distress. Avoidant and emotion-focused strategies may be helpful for the immediate crisis, but should be used in combination with more active strategies for complete problem resolution.

See also Stress

Resources

BOOKS

Gilligan, Carol. In a Different Voice: Psychological Theory and Women's Development. Cambridge, MA: Harvard University Press, 1982.

O'Neil, James M. "Assessing Men's Gender Role Conflict." In Problem Solving Strategies and Interventions for Men in Conflict, edited by Dwight Moore and Fred Leafgrean. Alexandria, VA: American Counseling Association, 1990.

Rosenfield, Sarah. "Gender and Mental Health: Do Women Have More Psychopathology, Men More, or Both the Same (and Why)?" In A Handbook for the Study of Mental Health, edited by Allan V. Horwitz and Teresa L. Scheid. New York: Cambridge University Press, 1999.

PERIODICALS

Abreu, Jose M., Rodney K. Goodyear, Alvaro Campos, and Michael D. Newcomb. "Ethnic Belonging and Traditional Masculinity Ideology Among African Americans, European Americans, and Latinos." Psychology of Men and Masculinity 1, no. 2 (2000): 75-86.

Barefoot, John C., Erik Lykke Mortensen, Michael J. Helms, Kirsten Avlund, and Marianne Schroll. "A Longitudinal Study of Gender Differences in Depressive Symptoms From Age 50 to 80." Psychology and Aging 16, no. 2 (2001): 342-345.

Bem, Sandra L. "The Measurement of Psychological Androgyny." Journal of Consulting and Clinical Psychology 42 (1974): 155-162.

Bruch, Monroe A. "Shyness and Toughness: Unique and Moderated Relations With Men's Emotional Inexpression." Journal of Counseling Psychology 49, no. 1 (2002): 28-34.

Efthim, Paul W., Maureen E. Kenny, and James R. Mahalik. "Gender Role Stress in relation to Shame, Guilt, and Externalization." Journal of Counseling and Development 79, no. 4 (2001): 430-438.

Lengua, Liliana J., and Elizabeth Stormshak. "Gender, Gender Roles, and Personality: Gender Differences in the Prediction of Coping and Psychological Symptoms." Sex Roles 43, no. 11/12 (2000): 787-820.

Mahalik, James R., and Robert J. Cournoyer. "Identifying Gender Role Conflict Messages That Distinguish Mildly Depressed From Nondepressed Men." Psychology of Men and Masculinity 1, no. 2 (2000): 109-115.

Mahalik, James R., and Hugh D. Lagan. "Examining Masculine Gender Role Conflict and Stress in relation to Religious Orientation and Spiritual Well-Being." Psychology of Men and Masculinity 2, no. 1 (2001): 24-33.

Marecek, Jeanne. "After the Facts: Psychology and the Study of Gender." Canadian Psychology 42, no. 4 (2001): 254-267.

Martire, Lynn M., Mary Ann Parris Stephens, and Aloen L. Townsend. "Centrality of Women's Multiple Roles: Beneficial and Detrimental Consequences for Psychological Well-Being." Psychology and Aging 15, no. 1 (2000): 148-156.

ORGANIZATIONS

Society for the Psychological Study of Men and Masculinity. Division 51 Administrative Office, American Psychological Association, 750 First Street, NE, Washington, DC 2002-4242. (202) 336-6013. <http://www.apa.org/about/division/div51.html> .

Society for the Psychology of Women. Division 35 Administrative Office. American Psychological Association, 750 First Street, NE, Washington, DC 2002-4242. (202) 336-6013. <http://www.apa.org/about/division/div35.html> .

Wellesley Centers for Women (Stone Center for Developmental Services and Studies; Center for Research on Women). Wellesley College, 106 Central Street, Wellesley, MA 02481. (781) 283-2500. <http://www.wcwonline.org> .

Sandra L. Friedrich, M.A.