Episode 6 - Do Men or Women Face More Mental Health Stigma?

In this episode, Hayley and Kerri discuss how gender interacts with mental health stigma. Some of the factors they consider include toxic masculinity, female hysteria, and overdiagnosis in men and women. Some of the suggestions to combat stigma include accessible healthcare, education, and open communication.

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Transcript

Mental Health Stigma

What is stigma?

Mental health–related stigma is an umbrella term that includes social (public) stigma, self-stigma (perceived), professional stigma, and cultural stigma. Social stigma refers to the negative attitudes toward and disapproval of a person or group experiencing mental health illness rooted in misperception that symptoms of mental illness are based on a person having a weak character. These perceptions can lead to discrimination, avoidance, and rejection of persons experiencing mental illness. This is usually the type of stigma that is discussed most often. Self-stigma is the internalization of social stigma, in that the person with the mental illness feels shame about his or her symptoms. Professional stigma assumes that health professionals transfer and reinforce stigmatization of their clients, while cultural stigma comprises the various ways that individual cultures interpret mental illness (Cerully et al., 2018; Hack et al., 2020; Holder et al., 2019).

What are examples of mental illness stigma? 

When someone with a mental illness is called 'dangerous', 'crazy', or 'incompetent' rather than unwell, it is an example of a stigma. It's also stigma when a person with mental illness is mocked or called weak for seeking help. Stigma often involves inaccurate stereotypes.

Stigma leads to delayed treatment, increased morbidity, and diminished quality of life for those with poor mental health.

• ABS (2022) More than a third of women experience an anxiety condition in their lifetime. Men are less likely to seek help for mental health conditions than women (ABS, 2022)
• In Australia, men are three times more likely to die by suicide than women. ABS (2022 different )

ADHD overdiagnosis in boys

ADHD often goes undiagnosed in females because of the different ways it presents in females as opposed to males.

BPD overdiagnosis in girls

The use of the diagnosis of ‘personality disorder’ causes diagnostic overshadowing of developmental and complex trauma due to public services excluding those with a diagnosis of ‘personality disorder’. Also, the police will often accompany public services to 999 calls when they are flagged as coming from somebody with this diagnosis.

Female hysteria 

• Ancient Egypt to 500 BCO
• From the wondering of the female uterus, known as ‘uterine melancholy’
• Anything that couldn’t be figured out
• Up until the 20th century, doctors blamed the uterus
• It was categorized as a disease even though it was just normal womanly behaviors due to menstrual cycles and sexuality
• Independent and strong-willed were classified as witches. 
• In a Chinese region, people that do not conform to local norms were labeled as witches. Households tagged as “witches” were more likely to be headed by women and were actually slightly wealthier than average

Lobotomies and history of female mental health - TIMES (2021)

• A lobotomy was categorized as a medical procedure where an instrument that closely resembled an ice pick was carefully inserted into a person’s eye to sever the lower prefrontal lobe.
• Most (84% of 1,340 subjects from France, Switzerland, and Belgium from 1935–85) lobotomies were done on women
• according to 19th-century psychiatry, female independence was madness.
• Elizabeth Packard (1860) I”, though a woman, have just as good a right to my opinion as my husband has to his”—but assertive women in those days were swiftly dispatched to asylums, institutionalized for causing “the greatest annoyances to the family” and for defying “all domestic control. When Elizabeth’s husband looked into the matter, he found he could arrange his wife’s committal simply “by the request of the husband” and specifically “without the evidence of insanity required in other cases.”
• any woman who rejected her submissive, domestic role was medically impaired.
• Women who studied or read—or who simply had minds of their own and a determination to use them—were demonstrating “eccentricity of conduct,” which meant they were “morally insane,” a diagnosis invented by James Cowles Prichard in 1835.
• The theory ran that a woman’s sexual organs caused her madness, so cutting off her clitoris would calm her. Doctors claimed a 70% success rate. Other treatments of the era included the removal of the ovaries, the injection of ice water inside intimate orifices, and the application of leeches and caustics to the genitals.
• By 1968, the “minor” tranquilizer Valium (diazepam), marketed as an antidote for socially dysfunctional women — the excessively ambitious, the visually unkempt, the unmarried, and the menopausal misfits — was the best-selling drug in the world as well as one prescribed overwhelmingly to women.
• Today  symptoms are in womens’ head or are caused by hormones

Mizock and Brubaker 2021

Serious mental illness is more common among women than men — but women with serious conditions are often overlooked in psychiatric research, treated less effectively with psychiatric drugs, and face discrimination and stigma by medical professionals who diagnose them and oversee their care.

Pouba and Tianen (2006) - forced institutionalisation 

Such attitudes have had a range of practical consequences: From the mid-1800s through the early 20th century, for instance, societal norms, male expectations of how women should act, and limits on women’s rights led to forced institutionalization of women. For example, symptoms of epilepsy, depression or lacking a menstrual cycle might have instead been labeled as “insanity.”  Lobotomies and institutionalisations occured for simply having opinions.

Nickert (2023)

• More boys than girls are being referred to mental health clinicians due to the externalisation of symptoms that females tend to internalise

MEN:

Chatmon (2020)

• Although both men and women are affected by mental illness, it is oftentimes overlooked in males
• mental health among men often goes untreated because they are far less likely to seek mental health treatment than women
• Men seem to internalise feelings a lot more > Men (79% of 38,364) die by suicide at a rate four times higher than women (Mental Health America [MHA], 2020). They also die due to alcohol-related causes at 62,000 in comparison to women at 26,000. Men are also two to three times more likely to misuse drugs than women (Center for Behavioral Health Statistics and Quality, 2017). These statistics are troubling because they reinforce the notion that males are less likely to seek help and more likely than women to turn to dangerous, unhealthy behaviors.
• Toxic masculinity is the demonstration of masculinities that are enforced by restriction in behaviors (e.g, crying, fear) based on gender roles that amplify existing power structures that favor the dominance of men. Toxic masculinity may lead to difficulty in expressing emotions, which is seen often.
• The overall prevalence of mental illness in men is typically lower (Substance Abuse and Mental Health Services Administration ([SAMHSA], 2018 > under or over-diagnosis still?
• Does man vs. women stigma (i.e. who experiences stigma more) depend on the culture? > e.g. western, spanish (macho), eastern european, middle-eastern, asian.

James H. Wirth and Galen V. Bodenhausen (2009)

• Males are more likely than females to be stereotyped as violent, Females are more likely than males to be stereotyped as dependent. 
• Previous research suggests that women are generally subjected to less mental-illness stigma than men (e.g., Farina, 1981)
• behaving in a gender-atypical way may itself be a source of stigmatization, and the backlash may ensue (Rudman & Fairchild, 2004). If so, individuals who display gender-atypical mental illness symptoms may be stigmatized to a greater extent than persons who display gender-typical symptom
• N = 186 (54% female, 46% male; mean age = 47 years, skewness = 0.22, age range = 18-89 years) 
• gender- atypical disorders were more likely to be viewed as having a biological cause than were gender-typical ones > reduced stigma in gender-atypical cases
• gender-atypical mental illnesses elicit more favorable reactions than gender-typical ones. When people deviate from gender scripts in this context, it suggests the existence of a genuine mental disturbance, and one that may have a biological cause

Queer People and Mental Health

• LGBTQIA+ community are at higher mental health risk compared to others
• Negative attitudes towards queer people and/or mental illness may affect access to high quality (mental) health care
• LGB adults are more than twice as likely as heterosexual adults to experience a mental health condition. Transgender individuals are nearly four times as likely as cisgender individuals to experience a mental health condition". Many factors aside, this is because many people identifying as LGBTQIA+ face discrimination, family rejection, harassment, and fear of violence > stigma is compounding

What can we do about stigma?

1.  Medicare and proper health care
2. Education
3. Open conversations

Stuart 2016

For example, the average per capita spending on mental healthcare is less than 2 US$ and less than 25 cents in low-income countries. Almost half of the world's population lives in a country with less than one psychiatrist per 200 000 residents.