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We live in a highly gendered society. Certain roles, behaviours, and experiences may be seen as typical of one gender but unacceptable in the other. Those who do not conform to gender norms and expectations, including those who identify as transgendered/queer/two-spirited, are met with fear and negative judgment. So what does this mean for mental health, both now and in the past?
Since the time of the ancient Greeks, the female uterus has been blamed for all sorts of problems, and sexual intercourse was often prescribed as a cure. The term hysteria comes from the Latin word for uterus (the same root as the word "hysterectomy"), and the condition was attributed to various factors include the retention of fluids in the uterus, sexual deprivation, and the tendency of the uterus to wander around the body of its own accord (an idea supported by such luminaries as Plato).
Hysteria was a common medical diagnosis in western Europe for many years. A wide variety of symptoms were attributed to it, including fainting, edema, nervousness, insomnia, insomnia, and decreased appetite for either food or sex.
Hysteria is commonly associated with Sigmund Freud. Freud proposed that lesions in consciousness as a child were responsible in hysteria in adult women. While he initially suggested that these lesions were due to childhood abuse, he later shifted his attention to childhood thoughts and fantasies about sexuality. These lesions prevented the woman from enjoying "normal" heterosexual intercourse. He used the term "conversion hysteria" to refer to physical symptoms that do not have a physical cause. The modern incarnation of this is known as conversion disorder in the DSM-5 (Diagnostic and Statistical Manual, 5th ed.). It is found in both sexes, but is more common in females.
Association of Gender with Certain Diagnoses
Conversion disorder is not the only disorder that has differences in rates between males and females, and sometimes these differences lead to certain diagnoses being generally thought of as male or female. Eating disorders occur in both genders, but males with eating disorders are often overlooked.
Several of the personality disorders are diagnosed more often in one gender than the other (antisocial personality disorder in males, borderline, histrionic, and dependent personality disorders in females), but the DSM-5 cautions: "Although these differences in prevalence probably reflect real gender differences in the presence of such patterns, clinicians must be cautious not to overdiagnose or underdiagnose certain personality disorders in females or in males because of social stereotypes about typical gender roles and behaviors." Yet stereotypes persist.
A meta-analysis by Wong and colleagues found that conformity to masculine social norms was associated with negative mental health outcomes and decreased help-seeking behaviour. There are various organizations, including Heads Up Guys, that are working specifically to address the lack of open dialogue about mental health issues in men.
However, a significant social problem that stands in the way of such efforts is toxic masculinity. This encompasses a range of socially destructive male traits that are directed toward domination and reinforcement of stereotypical gender roles, encompassing such elements as misogyny, homophobia and violence. Toxic masculinity amplifies common underlying social beliefs that displays of vulnerability by men represent weakness, which can make it more difficult to engage men in mental health treatment.
The DSM-IV diagnosis of gender identity disorder has changed to gender dysphoria in the DSM-5. It's a change that I see as moving away from pathologizing non-conforming gender identities and towards a recognition of the profound mental distress that these individuals may experience given the pressures of our current social climate. A study by the American Foundation for Suicide Prevention found that 46 percent of trans men and 42 percent of trans women had attempted suicide, and this is a high-risk group that needs greater support rather than judgment. It's interesting to note that in the Samoan culture, the gender non-binary fa'afafine are considered a valid third gender and do not generally appear to experience distress as a result of their gender identity.
Clearly gender can have an impact on how mental illness is viewed and treated. While gender norms and expectations aren't going to change overnight, it's important that we recognize the ways in which gender plays a role in the world around us, and the potential for this to disadvantage certain groups. Mental illness is an equal opportunity attacker. Despite any differences there may be in rates, the bottom line is that it can happen to anyone, and that means mental health promotion is important for everyone.
- DSM-5 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing.
- Kupers, T. A. (2005). Toxic masculinity as a barrier to mental health treatment in prison. Journal of Clinical Psychology, 61(6), 713-724.
- Maines, Rachel P. (1998). The Technology of Orgasm: "Hysteria", the Vibrator, and Women's Sexual Satisfaction. Baltimore: The Johns Hopkins University Press.
- Vasey, P. L., & Bartlett, N. H. (2007). What can the Samoan" fa'afafine" teach us about the Western concept of gender identity disorder in childhood? Perspectives in Biology and Medicine, 50(4), 481-490.
- Wong, Y. J., Ho, M. H. R., Wang, S. Y., & Miller, I. S. (2017). Meta-analyses of the relationship between conformity to masculine norms and mental health-related outcomes. Journal of Counseling Psychology, 64(1), 80.