Woman; Mental Health Care for Women. Part 2

Oh. Good evening and welcome to our doctor and a practicing doctor Professor of Psychology at the State University of New York at Buffalo.

Why do I think women go. They're unhappy and I think that if you ask an individual woman patient are you going to the therapist. She'd say well I have these problems and I can't solve them. And nothing seems to get better on my own. And I'm going to somebody to help me solve them. So I think that at one level the answer is simple. Women and people in general go to therapists because they perceive that they have certain kinds of problems that they can't solve themselves. I think there's another level in which you can ask that question. You can say why is it that more mental patients are women than men. Why is it that mental patients generally tend to be women. And there you get into a whole question of what the society is organized like such that women

decide that they're sick or are diagnosed as sick or have to seek help. And in that sense I think that you can talk about women living in a society which does not like them which thinks they're in fear of you which treats them with contempt. And there are two responses that a person can have to a society which does not like that person. By virtue of something a person can do nothing about. One of the responses is to internalize what society thinks that that person and the other response is to get very very angry at certain agents in the society. I think that in other words women can either hate themselves or they can hate other people. Now neither response is going to make for good mental health. Women are taught to love people to care for them to nurture them. It's very difficult for women to express rage there.

That's taught out of them a very early age so that either way if they've got a rage towards themselves or if they've got feelings or rage towards people who for some reason they feel are treating them right. They have no way of effectively expressing that way. And one of the institutions which is set up to help them express that rage or do something with it is the institution of therapy. And if you want to comment on that. Well. I think. There's a great deal to all of it. I also think it's important to realize that. The therapy as well as women. And I wouldn't want someone to fall to miss the point of what you're saying by virtue of the fact that they know some men who are in treatment also. It seems to me that women seek therapy. By and large for the same reasons that men do at least those men who do seek therapy. They are. Miserable. They want help. Or.

They're behaving in ways that lead someone else to decide. That they need help. That happens to women as well as men. And not in terms of all of outpatient treatment settings where the treatment is most likely to be pure psychotherapy. Women more often than not than men will will come in. But I think there is some there's another all. Aspect of this which reminds me a little bit of what. You were saying. Earlier in the discussion that. It was presented last week. That. One part of therapy. And we may disagree because I don't think it's the only part but one important part of psychotherapy is the young the kind of. Sympathetic. Listening. That a good friend can provide. That makes a person feel less alone with their problems. Creates an atmosphere within which the person can think more constructively about their problems and maybe think of something that they can actually do about the problem to actually change it. All it takes.

All. Good listener. Someone who while. All he has. An ability to to be empathic and someone who has self has listening skills. And. I think one of the reasons that. Women. May seek this out somewhat more than. Men do. Is that. Women have been trained in just those skills. And many men get a kind of informal psychotherapy from women. Which women. Can't. As securely getting from men. Although. Many women. Don't get it for many men and that's the basis of of some mob of some very valued relationships. Some of the kinds of. Data that. Bear on it are. What happens to widows and widowers and. It's really. Really interesting it. Is. Men in general seem to be able to handle being widowed less well than women do. And not. The.

Sociologists who have studied this. In. Part it's because women are more likely to have. A woman friend was a confidant even though they are married. And perhaps have several people that they can talk with. There are. Large numbers of men who have. No confidant. Other than their wife and if they're not married perhaps no confident at all. And it's interesting that statistics on. Seeking or needing therapy for men. Are different depending on whether they're single or married. The difference with women is much less than the difference with men goes in the opposite direction for men not being married is a mental health risk. For women. Being married may be a mental health risk depending on many things about the quality of the marriage. There are people who say that women are isolated from each other and that could also I suppose think some women are very isolated from each other.

But many women are. Isolated from each other one of the interesting things in our society is that large numbers of women have very cherished friendships with other women which were enormously valuable in making life more worthwhile and stabilizing their mental health. And in all kinds of ways is one of the good things in life. It's it's interesting that this has continued. To be so. More I think than. People realize. It's perhaps less true for women who move around a lot. Because they're likely to break up those friendships when those friendships are strongest. They often hear phone started in girlhood. And continue throughout life. They may be with close old friends. They may be with relatives. And for some women who reach the public eye because they've done things that have been moving around leaving the place where they. Don't have. The same kind of long lasting friendships that. In many many women including I'm sure. Many. Of your viewers have.

One of the real tragedies is that some women are taught. To. Not value their friendships with women. As much as they otherwise might. You know. High school. There are. Girls who are encouraged to. Fall. Break plans to do something for an evening with their girlfriends if they should get a date. There's a tendency to fall. In a sense. Three female friendships as a sort of. Farm team where you practice until you get to the big wigs where the real action happens which is viewed as being relationships between men and women. But. Relationships with men are only part of life for women. It's that part that has been more. Celebrated. You know. Our movies television shows. Our. Short stories and mill and novels in the very real and. Honest and valuable words of relationships with other women. Although it has continued hasn't.

Had the attention and I think I'm interested in discussing some specific complaints. And I'm very interested in depression. And would like you to talk about that a little bit. Depression is considered a. Prototypical woman's illness in a sense most of the studies of the incidence of depression show really clear cut difference somewhere around three times as many women. As men. Are likely to be treated for depression. It's a little bit hard to interpret it because again. More men. Are likely to have alcoholism still in some people would view that as another form of expressing depression and say that perhaps. The incidence isn't as different it's just in how it sucks how it shone. But certainly among patients who come to treatment for depression. Many more. Women. Than Men will be found to want to comment on that. Yeah I think it's a very interesting kind of symptom. One of the things that happens. When we talk about mental health is

I think that the discussion necessarily wavers back and forth. Between talking about. People who are quote normal. And are unhappy and people who for some reason think that they're kind of crazy. And I think there really. Are. Both in the public and also in the eyes of therapists. Well we know that distinctions are blurred in the eyes of therapists because there are a lot of studies. Which show that there is really can't tell the difference. Well let me say it a different way. There are a lot of studies which show that a therapist diagnoses a given patient on a given day as being let's say schizo phrenic or depressed or hysterical or whatever the category is. Three months later saying the same intake interview in the same bunch of tests and the same thing from that same patient. Chances are it will give a different diagnosis to that saying hey I know

I have to make some comment on that because of been a number of studies. Some go the way you say others call the other one. OK it's not OK established that it's a random OK. Although there are there are a number of studies which seem to say this particular sample it's fairly random. Let me just get back to the question that because I think that in that in that case. It's really difficult to distinguish. Depression. What happiness. I mean a lot of people ask how do you know you're depressed. Well you know you're depressed what's clinical depression clinical depression is maybe you can't get up. You sleep all day. You know you're too depressed even to commit suicide something like that. On the other hand. Nobody would make the cut off there. I mean nobody would say if you're not clinically depressed if you're not that depressed and we don't want to see you

you're just unhappy. And so it's got these gradations of not wanting to thinking that there's nothing out there that's going to be satisfied of saying why should I get up this morning and say you know what is it. What kind of not being able to work with kinds of things that go into the common complaints which make up depression. So when you know when you when the statistics are quoted OK three times as many women as men come in with this complaint of depression. Again it says what. I hope this isn't a mental health problem. This is a society problem this is a problem that has to do with a society which treats women so badly that they're prized. Well. We might have an argument about whether we were willing to consider that there is an illness depression. I think there is I think it's a little bit like in the old days or used to be an illness called fever. Remember there's a song she

died of a fever and no one could save her. Fever was the name of the illness. Now we know more. We know that there are a number of different causes of fever and the appropriate treatment for one may be beside the point for another. But at one point people in group the illnesses could see that all these people had this kind of thing in common. No cold fever I think among the people who feel depressed. There can be a variety of different causes. And the. Tell. All. I think that. Clinicians ought to be able to do the best that's possible at any given time to work with the patient to figure out what are the causes for her feeling this one. And among those causes I don't think. There are some people who have an illness which responds. Very dramatically in some cases to medication as well as to therapy. And I think it's terribly hard for the individual to know. There are people of course who know when it will pass out without listening to the patient. I'm not defending it either. But I think that

it's. Terribly important for people to know. The tone if they're. Feeling persistently on hampering. That it could be an illness which could be treatable and that a good clinician ought to be able to work with them to figure out what the causes are. Rather than. Go on thinking that. That has to be their. Lot in. Life forever. Talk to someone you maybe want to talk to several. Maybe they don't want. Several opinions about it. I really agree with you and I think again it's really interesting that. The area of agreement is where you say well there's pills for this. Because I think that in certain cases and we don't know very much about these cases when we isolate problems medical problems for things like depression or hallucinations things like that in there and we talk about drug therapies all of a sudden light breaks at

the end of the tunnel you say well maybe there is some way out. When we get back to insight therapy when we get back to let's look at depression and let's find out the causes in your head and so forth and so on. Back say I think that maybe. Well I agree with you that a friend can help and a therapist can be a friend. I think we're back to social causes. And let me just. I keep saying social causes social conditions can change behavior. Let me just give a couple of examples. There was a very interesting article in New York Times where they took convicts. And again they had a control group a group that they do nothing on and they had an experimental group in the experiment the group got plastic surgery. And their faces were made over the scars were removed they were made to look like nice guys. And the rate of. Going back. Into incarceration the recidivism rate for the experimental group for the

convicts whose faces had become very pleasant to look at. Dropped dramatically. I don't know but I think I think you know a good therapist ought to be a good diagnostician and. Might. Well consider. That form of treatment. Sure sure. But then what we're saying is when you talk about therapy you're talking about somebody who says who would be able to say look this is a social problem. Your problem is that you're a woman. And this society does not like women. Your problem may be biochemical and let's try you on this drug. And see if that works. I think there are very few therapists around who will say your problem is that you're a woman. I may be out of business. You know me let me ask you this do you think it would be helpful to examine some of the evidence. That's used to construct theories about women.

Well sure are. There's I think that for instance in again classical therapy by which I don't mean just broad but the inside therapy in the whole clinical tradition the theories about women have come from quote years of intensive clinical experience years of dealing with women. And there's no better way to confirm your biases than to have you be talking to a patient who is in a relatively helpless position. You mean the authority figure the power figure and having no external test except what you think is happening to that person. And some of the theories that have come out about women from very eminent people in the field are again the same kinds of stereotypes that we talked about last week for instance Erick Erickson who's done all this on identity when he wrote in 1964 young women often ask me what kind of identity can I have. Before I know who I will marry. And for whom I will make a home. I mean he's coming right out and

saying women do not have. Oh I understand he's apologized for that statement now which is perhaps a response to the fact that people like you have called attention to the implications of what he said. Well in spite of his apology how does this male bias damages and how do you assess that damage. Well I think that what you would have to say is what are the expectations for women. What do what do therapists expect us to be. Again there's a whole literature which says that people are going to act in ways. Which are expected of them and they're going to feel like the people they're supposed to be. So if you expect. That somebody is going to be stupid and incompetent chances are that person will behave in a stupid and incompetent way. Now the question is. Can male therapist or therapist or any of us change that fast so that overnight I suddenly apologies I'm sorry I said that and that women in 64 I don't think that anymore they have an independent identity. That. People

really. Have expectations for women. Which allow them their full humanity creativity courage dignity honor joy to. Better. Or just in a nutshell which anticipate that a woman would not have health and goals in life defined in terms of subordinating Her Needs to someone else's needs. Because I think that's that's really the crux of the matter. That. Didn't. Very often not we have had the expectation that tell that a woman should subordinate her needs to others and that if she has trouble doing it. Then. That is a problem. But she needs to be helped to do rather than to be help to find some ways in which those others that she's trying to be helpful too. Can strike a fair bargain with her. Let me ask you a question about that because I think that's a really interesting thing and I want to know we're there because I left clinical psychology I want to know whether anything has changed since I've been in clinical psychology about that particular thing. When women have needs that they refuse to

subordinate to the needs of men. Whether it be Nan who asked them to please type this something for them or make them coffee or their husbands or their lovers or whatever they were called castrating women. Which is a term which has a long and tragic history from Freud and so forth and so on. I want to know whether the therapeutic community still uses the term castrated woman. I haven't heard it since I was a resident but I'm sure that there are. Places where one still can hear that term. Because I think that that term. Summarizes. The nacelle in another nutshell. Because it says. If you really don't subordinate you it's if you're assertive. If you say I have an independent identity then you are doing. The worst kind of violence.

To a man. All right let me ask you both this what needs to happen to make it better for women. I think the continuing strength of the woman's health. Is too bored in this regard. The. Informed responsible women are doing considerable research. Into while. Both saw Syrian practice in psychiatric and medical care in many places in this country. They're asking a lot of hard tough questions. And No. Questions that they are asking. Our story you know considerable thought. I think there is that in itself is having a large impact. You know medical services in general psychotherapeutic services. Are run are provided. I think another thing that's tremendously important is that till. They. All proportion of women among psychotherapists and among physicians is increasing. And not I think fit. One of the outcomes of it is set.

Of course will have far. Far better therapists and better physicians because. What. Discrimination means. Is that you take a less qualified person. From the. Not discriminated group instead of a more qualified person from the discriminated against group. So I see a lot of a lot of room for growth for optimism. People are raising a lot of questions. I don't. Think. They yeah. They kind of theory that was widely thought that was criticized by your paper which was one of the really important ones so criticized and it. Is now in. Many places. Presented in a more. Tentative. With room for discussion. And No. Room for for people to walk. Raise their. Their doubts. I think I think that all that is good. And to compare it to your analogy was really a beautiful one. If the water

supply is. Poisoned. And there's an outbreak of typhoid. You've got to treat. The victims the patients and you've also got to find. That water you've got to find what's wrong with that water. I think it would be nice. To have. Competent. People treating the victims. I think that one of the things we've been discussing is or we've been hinting at is that there's a whole lot of incompetence. In treatment of the victims. But I think that just using that analogy that's a holding action. You're training victims for typhoid because you haven't found. What's polluting the water supply. And I think therapy at its best. Will always be a holding action. And what we have to do is we have to find that water supply and we have to change it. Which means for women we've got to. Change the society. Which calls us. Inferior. Which despises us which

treats us with such contempt. And when we do that. I think the need for therapy. Will really decreased. Dramatically. I think it's important not to set up these two things in opposition to each other. Because it seems to me that many of the women who are working for change. Are feeling all the stresses that are involved in change and all the stresses that may be involved in leadership. And I've seen many women who feel the film. Because of their commitment to changing the water supply and they're feeling that that's a place that they should be directing their efforts. To feel. Hesitant. To get help. For their personal problems which they really might be very badly in in some cases if you do battle you're more subject to combat fatigue. No. I think fit it what it would be a. Terrible shame. You know. Those of us

who have concentrated on. Work. At. Tel either end of this problem have to feel that we were in opposition to those who were working at the other end. If you were looking for a therapist and we had just a couple of minutes. And how would you be able to tell if his or her sexism was interfering with your therapy. I think the qualities that. You want to look for are. An ability to. Listen. And give you a feeling that you are understood. I think fit. If there's any. Question about what's. What's going on and whether there might not be some. Other perhaps medical kind of of your problems you want to know that the therapist is able to. Consider. Those causes by virtue of. Her or his own training or having a consultant. Does have it. Trying to. Think you want to. Have a therapist was able to view things from several

points of view. Again. Tolerate. Questions and disagreement. Or you could have a. Mutual feeling of hashing things out. When you started out with with different viewpoints about some of us I'm going to have interrupted. We're out of time again. Thank you both for coming. I've been talking to Naomi Watts and siding on mental health care for women. See you next week. Before the boy a public television station and public broadcasting.