The Psychiatrist-Woman Patient Relationship

Abstract

This paper contends that the psychiatrist-woman patient relationship is affected by a number of powerful, yet often subtle, pressures. There are three major interacting sets of factors: the medical and mental health systems and the process of medicalization of life that has taken place over the last century; the psychiatrist, his or her training, attitude and theoretical background; and the woman patient, her socialization and view of the world which is based on perspectives formulated from a male viewpoint. As a result of these factors, any woman referred to a psychiatrist is likely to be given a psychiatric diagnosis, her problems viewed as individual and intrapsychic, the societal obstacles she faces ignored or minimized, and treatment probably geared to helping her adapt to traditional expectations. The implications for therapy are discussed, with emphasis on the need to appreciate how women have been forced into a second-hand understanding of the world. Alternatives to traditional psychotherapy are discussed briefly, stressing the need for recognition and use of these resources.

An appraisal of the relationship between women and psychotherapy: 80 years after the case of Dora.

“…Certain aspects of women's sex roles may influence the development of mental illness, such as holding in negative feelings, behaving to satisfy a male partner, passivity, learned helplessness, exaggerated femininity, and other-directedness. Furthermore, despite the idealization of women's mothering role, there is con-sistent evidence that children have a negative effect on the mental health of women (Kessler & McRae, 1981) and that mothers are widely scapegoated (Hare-Mustin & Broderick, 1979;Stephenson & Walker, 1979). I will briefly consider some disorders of high prevalence and special areas of concern for women.…”

“…For example, when male and female neurotic depressives who are equally distressed are compared with regard to treatment length and prescription of medications, females are seen for more ther-apy sessions and given more potent medications than males (Stein, Del Gaudio, & Ansley, 1976). Another well-documented difference is that women receive over 70% of prescribed psychotropic medications, including tranquilizers, sedatives, stimulants, and antidepressants (Fidell, 1980;Stephenson & Walker, 1979). Since such differential treatment is not related to outcome, one could argue that inherent biological differences in men and women necessitate such differential treatment, but data to support such an argument are lacking.…”

“…Perhaps in the 1980s it is time to reexamine not only what psychotherapy has done for women but also what it has not done for them. Some women's problems in living may actually be a result of social, economic, ethical, or legal conditions, but they have been misidentined or erroneously regarded as psychiatric disturbances subject to intervention by psychotherapy or clinical treatment (Stephenson & Walker, 1979). Paradoxically, other problems peculiar to women have not received appropriate attention.…”