Women and Disability: Mental Health and Mental Illness

This section reviews topics concerning women and mental health and/or mental illness. Included are sources on the perspectives of women on “madness” and serious mental illness, depression, self-esteem, psychological adjustment to disabilities and impairments, the affects of postpartum depression on mothers, the unique needs of women’s mental health as well as the needs of women with severe mental illness.


Ali, A., & Toner, B. B. (2001, September). Symptoms of depression among Caribbean women and Caribbean-Canadian women. Psychology of Women Quarterly, 25(3), 175-180.

This study compared an immigrant sample of Caribbean-Canadian women (n =: 20) and a sample of women living in the Caribbean (n = 20) on the following variables: dominant domain of meaning (defined as that aspect of the participant’s life from which she derives primary meaning for her sense of self); self-silencing (defined as the tendency to silence one’s thoughts and feelings; Jack, 1991); and symptoms of depression. Results revealed that the Caribbean women were more likely to report relational domains of meaning as primary (e.g., family, friendships, intimate relationships), while the Caribbean-Canadian women were more likely to report domain of self-nurturance as primary (e.g., career goals, spirituality). Furthermore, univariate analysis revealed that the Caribbean-Canadian women reported higher levels of self-silencing and depressive symptoms, and derived less meaningfulness from their primary domains of meaning compared to the Caribbean women. These findings suggest that the immigrant experience may be a factor in women’s emotional well-being.


Altman, B. M., & Smith, R. T. (1992). Impact of rehabilitation on psychological distress: Gender differences. International Journal of Rehabilitation Research, 15(1), 75-81.

Analysis of data (n=11,739) from a Social Security Survey (1978) examined rehabilitation and mental health characteristics of people with various disabilities or health problems. Correlates of psychological distress included nature of the disability, race, education, gender. Men and women also responded differently to rehabilitation with men experiencing increased stress in medical rehabilitation models.


Amirault, C. (1994). Teaching the culture of mental illness. Journal of Criminal Justice and Popular Culture, 2(3), 32-55. Retrieved March 12, 2005 from http://www.albany.edu/scj/jcjpc/vol2is3/mental.html

The author writes about how in the fall of 1993 he designed and taught a course entitled “American Psychos and the Culture of Mental Illness.” The author emphasizes his grounding in cultural studies for the course, then analyzes his experience with the course, especially the history and culture of mental illness with many examples throughout on gender and feminist theory. He also discusses the discourse with his students and how he learned from them.


Andrews, A. (2001, Summer/Fall). Missing links: women, mental illness and the need for a new model of HIV prevention and sexual health promotion. In A. Andrews, J. Larkin, C. Mitchell, R. Moletsane, & E. Tharao (Eds.), Women and HIV/AIDS [Feature Issue]. Canadian Woman Studies, 21(2), 82-89.

“Although women constitute over half the general population and almost two-thirds of the psychiatric patient population, many studies of mental illness do not report women’s data separately and many do not include women (Penfold and Walker; Brunette and Drake). Similarly, information about or pertinent to women at risk of HIV infection has been concealed within study data or neglected all together. Although the lack of information about the sexual and drug-using behaviours of people with serious mental illness at first impeded the development of appropriate AIDS prevention efforts, it is now widely assumed that people living with mental illness may engage in “sexual risk behaviour” because of “their inability to evaluate appropriately their HIV risk” (McKinnon 25). In spite of this knowledge, and the knowledge that women are more biologically at risk for HIV infection than men, the HIV prevention needs of women have gone largely unconsidered. There is a great need to develop comprehensive and appropriate HIV prevention and sexual health promotion strategies and programs with and for women living with mental illness” (p. 82).


Association of State and Territorial Health Officials. (2005). Maternal and child health fact sheet: The role of state public health in perinatal depression. Washington, DC: Author. Retrieved March 12, 2005 from http://www.astho.org/pubs/PerinatalDepressionFS.pdf.

The Role of State Public Health in Perinatal Depression discusses the role of state public health agencies in partnering with national and statewide programs to ensure access to mental health information and services for pregnant women and new mothers. The fact sheet, produced by the Association of State and Territorial Health Officials, begins with an overview containing a definition of perinatal depression and information on its prevalence and its impact on women and their families. Other topics include the role of state public health agencies in partnering with federal and state agencies to increase awareness and support, and specific state initiatives (Virginia, Texas, and Pennsylvania) to address issues related to perinatal depression. A conclusion, quick facts about perinatal depression, and a list of references are also included. The fact sheet is intended for use by state public health agencies and their national and state partners in efforts to expand depression screening and referral to improve the overall health of women, children, and families.


Astbury, J. (1999, December). Gender and mental health. Carlton, Australia: Gender and Health Equity Project, Global Health Equity Initiative (GHEI). Retrieved January 11, 2005 from http://www.hsph.harvard.edu/Organizations/healthnet/HUpapers/gender/
astbury.pdf

This paper addresses the relationship between gender and mental health. First, the field of mental health and the concept of gender is introduced. This is followed by a discussion of the forms of gender bias implicated in mental health research. Next, gender differences in mental health outcomes are described, including differences in the prevalence and course of conditions. Evidence related to a gendered, social determinants model of mental health is examined. Depression is used as an illustrative example of a mental health condition characterized by a very large gender difference in rates and one to which certain gender differences in life events and social position, such as socioeconomic disadvantage and gender based violence make a significant contribution. Policy recommendations from the evidence based review of gender and mental health conclude the paper.


Backhouse, C. (2005). “Pleasing appearance…only adds to the danger”: The 1930 insanity hearing of Violet Hypatia Bowyer. Canadian Journal of Women and the Law, 17(1), 1-13.

The state’s legal authority to detain individuals within insane asylums in early twentieth-century Canada was deeply influenced by factors of gender, class, and race. Violet Hypatia Bowyer, a working-class, white woman who was just twenty-two years old in 1928, was initially incarcerated in Ontario for leading a “dissolute” life. Wrongly diagnosed as “insane” by prison officials, she tried valiantly, but failed, to secure her release through legal challenge. The expert testimony of the prison officials, the psychiatric “experts,” and the decision of the court all testify to the terrifying coerciveness of law in Canadian history.


Banks, M. E. (2008). Women with disabilities: Cultural competence in rehabilitation psychology. In M. J. Scherer & M. A. Dicowden (Eds.), Feature issue: Issues Regarding Women with Disabilities. Disability & Rehabilitation, 30(3), 184-190.

Women with disabilities represent a cultural group with specific issues. Rehabilitation psychologists are encouraged to familiarize themselves with some of those issues in order to deliver culturally relevant treatment. An overview is provided of psychological guidelines for attending to cultural issues in assessment, treatment, and research. Broad issues faced by Women with Disabilities are described. Disability-specific safety concerns are discussed with attention to ways in which they might be addressed by rehabilitation psychologists.


Bartlett, A., & Hassell, Y. (2001). Do women need special secure services? Advances in Psychiatric Treatment, 7, 302-309.

Clinicians working with women patients in secure units will already know that they are the centre of a debate not of their own making, which is about the appropriate specification of services for women patients with security needs. This paper attempts to outline the relevant issues and proposed solutions.


Barson R. (2006). Considering interventions for depression in reproductive age women in family planning programs. Baltimore, MD: Women’s and Children’s Health Policy Center, Johns Hopkins Bloomberg School of Public Health. Retrieved August 14, 2006 from http://www.jhsph.edu/wchpc/publications/ConsiderInterven
DepressionWomenFPP.pdf
.

Considering Interventions for Depression in Reproductive Age Women in Family Planning Programs explores family planning programs as possible sites for incorporating interventions related to depression, including screening and treatment, in women of reproductive age. The policy brief, produced by the Women’s and Children’s Health Policy Center at the Johns Hopkins Bloomberg School of Public Health, reviews the literature and presents ideas from the author’s direct experience in the family planning field and from key informant interviews on interventions for depression within family planning settings. Topics include an overview of different types of depression, the prevalence of depression among women in the United States, selected consequences of depression at different points in the lifecourse, commonly used depression-screening tools, and the potential for integrating primary care services into family planning programs. Issues to consider, potential interventions, recommendations for future action, and a conclusion are also presented.


Beauboeuf-Lafontant, T. (2007). You have to show strength: An exploration of gender, race, and depression. Gender & Society, 21(1), 28-51.

Investigating the possible overlap between depressed and presumably strong Black women, this article maintains that women’s experiences of depression are both gendered and raced. A review of clinical and popular literatures examining Black women’s experiences of depression as well as findings from an interview study with a nonclinical sample of 44 Black women suggest that the discourse of being strong may normalize a distress inducing level of selflessness and powerlessness among such women. Implications of this study include the need to consider the racially specific ways in which women are placed at risk for and experience depression.


Beeber, L. S. (1999, March). Testing an explanatory model of the development of depressive symptoms in young women during a life transition. Journal of American College Health, 47(5), 227-234.

Factors to explain the rising incidence of depressive symptoms among young women making the transition from home to university life were investigated. A path analysis of data from 213 18- and 19-year-old women entering a large university indicated that negative life events, interpersonally derived social support, self-esteem, and depressive symptoms were significantly related. Negative life events that affected the women’s self-esteem (drawn from the women’s performance in interpersonal relationships) were most strongly associated with depressive symptoms, and self-esteem derived through efficacy (ie, taking control and acting assertively) was not associated with negative events. The women in the sample appeared to derive efficacy self-esteem from relationships. An analysis of the data supported developing interventions to improve interpersonal relationships rather than focusing on competence in gaining access to resources.


Blehar, M. C., & Keita, G. P. (Eds.). (2003, March). Women and depression [Feature issue]. Journal of Affective Disorders, 74(1).

“For the second time in ten years, The Journal of Affective Disorders (JAD) devotes a special issue to the topic of women and depression. In 1993, the Journal published a special issue, titled Toward a New Psychobiology of Depression in Women, based on a National Institute of Mental Health (NIMH) workshop organized by Blehar. This special issue on women and depression builds on NIMH’s contribution and that of the American Psychological Association (APA). This publication comes ten years after the 1990 report by the APA Task Force on Women and Depression, titled Women and Depression: Risk Factors and Treatment Issues. That book, edited by McGrath, Keita, Strickland, and Russo was one of the first reports that focused on women’s depression.

This issue also stems from the APA’s sponsorship of an October 2000 Summit on Women and Depression. The meeting was initially conceived of by the APA as a way to update the 1990 report. But more importantly, it was brought about through a working partnership that APA forged with other sponsors – among them the Bureau of Primary Health Care/Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) Office on Women’s Health, and NIMH. Other federal and private organizations collaborated in this undertaking in addition to some of our nation’s foremost experts across disciplines. An executive summary of the Summit is posted on the APA web site www.apa.org/pi/wpo/women&depression.pdf and the NIMH web site at www.nimh.nih.gov.” (p. 1).


Blum, L. M. (2004). Gender in the Prozac nation: Popular discourse and productive femininity. Gender & Society, 18(3), 269-286.

Since Prozac emerged on the market at the end of 1987, there has been a dramatic increase in antidepressant use and in its discussion by popular media. Yet there has been little analysis of the gendered character of this phenomenon despite feminist traditions scrutinizing the medical control of women’s bodies. The authors begin to fill this gap through a detailed content analysis of the 83 major articles on Prozac and its “chemical cousins” appearing in large-circulation periodicals in Prozac’s first 12 years. They find that popular talk about Prozac and its competing brands is largely degendered, presented as manifestly gender neutral, yet replete with latent gendered messages. These are about women with neurochemical imbalances but also about the need to discipline elite female bodies, to enhance their productivity and flexibility. This new form of female “fitness” mirrors demands of the New Economy and indicates how psychiatric discourse contributes to the historically specific shaping of gendered bodies.


Bodenhausen, G. V., & Wirth, J. (2004, April). The role of gender stereotypes in mental illness stigma. Time-sharing Experiments for the Social Sciences (TESS). Philadelphia, PA: National Science Foundation. Retrieved March 12, 2005 from http://www.experimentcentral.org/data/data.php?pid=174

Provides information concerning a brief project where respondents read a vignette describing a target displaying psychiatric symptoms that varied in whether they were stereotypically associated with men or with women. Also included is information on hypotheses, experimental manipulations, key variables, summary of findings and conclusion. It is also possible to download all material concerning the research.


Boyd, J. A. (1998). Can I get a witness? For sisters, when the blues is more than a song. New York: Dutton.

This book is a wake-up call to black women, their families, and the mental-health community on the subject of depression. Although it’s the leading cause of mental-health-related deaths, depression is still not an illness that many African American women have been willing to recognize and treat. The author explores the links between self-esteem, depression, and women’s health, and gives vivid testimony to black women’s battle with the beast.


Bradford, J., Emanuel, K., & Rogers, T. L. (2002). Sexual minorities seeking services: A retrospective study of the mental health concerns of lesbian and bisexual women. Journal of Lesbian Studies, 7(1), 127-146.

Understanding the mental health needs of lesbian and bisexual (sexual minority) women is an integral part of designing and providing appropriate mental health services and treatment for them. In an effort to understand the mental health needs of sexual minority women who seek community treatment, a chart review was conducted of the 223 lesbian and bisexual women who presented for services between July 1, 1997 and December 31, 2000 at Fenway Community Health in Boston, MA. Data are based on clients’ self-reports and clinician assessments of clients’ presenting problem, relevant developmental history, prior mental health and substance abuse treatment, current reports of emotional/ psychological symptoms, and areas of impaired functioning. Although substance abuse and suicidal ideation were commonly reported problems, other concerns were more frequently reported. High percentages of lesbians and bisexual women reported relationship concerns and lack of adequate social networks; rates of depression and anxiety based on clinicians’ assessments were also high. Overall, lesbians and bisexual women did not differ in the issues they brought to treatment or level or types of impairment. Compared with previous community survey samples, however, study participants appeared to be healthier than general, non-clinical samples of self-identified lesbians, possibly reflecting the special characteristics of sexual minority women who seek treatment in specialized community sites such as the Fenway. Although patients who come to these sites may not represent the more general population of sexual minority women, community health centers known to serve lesbian, gay, bisexual and transgender (LGBT) individuals may be fruitful access points for studying the mental health status and treatment needs of sexual minority women.


Braverman, L. (Ed.). (1988). A guide to feminist family therapy. New York: Harrington Park Press.

This collection includes chapters written by scholars from a variety of mental health disciplines. All the authors are practicing psychotherapists who have struggled with the problems of integrating a feminist perspective with the practice of family therapy. The book provides an overview of theoretical developments in feminist family therapy, describes how to apply a feminist-sensitive perspective in the treatment of women, and discusses the implications of a feminist-sensitive perspective to therapy training and supervision in family therapy.

The collection is divided into three sections dealing with theoretical issues, clinical applications, and supervision and training issues respectively. The collection starts out by providing a historical review of the literature which has attempted to integrate feminist issues and family therapy. The following chapters address diverse issues such as criticism of family systems theory as a model for treatment for women; abuse and violence against women; lesbian mothers and lesbian daughters; women in alcoholic families; and women and eating disorders. The collection concludes with an essay on teaching an integrated model of family therapy. Also included is an annotated bibliography which lists readings on feminist critique of family therapy, feminist theory and frameworks, feminist critique of the family, research on women and mental health, and contemporary theory and research on women’s development. In short, this book contains a wealth of information for those interested in a feminist approach to women’s mental health problems and family therapy.


Brickman, B. J. (2004). ‘Delicate’ cutters: Gendered self-mutilation and attractive flesh in medical discourse. Body & Society, 10(4), 87-111.

In 1960, a relatively new ‘syndrome’ began appearing with growing frequency in psychiatric hospitals and in doctors’ offices. Eventually termed ‘delicate self-cutting’, this new model for typical self-mutilative behavior was developed in conjunction with a description of the ‘typical’ self-mutilator: young (adolescent to just post-adolescent), female, and almost always attractive. This article contends that, despite recent efforts to change the nature of research on self-mutilation, the myth of a typical mutilator, developed from a particular historical bias, continues to work in popular and medical discourses on the subject. I will begin with a detailed discussion of the medical discourse in an effort to ask how the myth was made. Noting that the female body, here, is singled out as pathological at a time when, specifically in the USA, the emergent Women’s Movement was beginning to contest certain gender lines, I would like to examine how the medical discourse and material bodies interrelate and interact with each other and with the cultural narratives around them. Finally, I end with examples from the 1999 film Girl, Interrupted, as well as other recent popular and medical accounts, to illustrate not only the perpetuation of the myth of the ‘typical’ self-mutilator but also the inability or refusal to recognize the biased nature of the medical discourse in the instance on self-mutilation.


Brown, D., & Keith, V. (Eds.). (2003). In and out of our right minds: The mental health of African American women. New York: Columbia University Press.

African American women have commonly been portrayed as “pillars” of their communities–resilient mothers, sisters, wives, and grandmothers who remain steadfast in the face of all adversities. While these portrayals imply that African American women have few psychological problems, the scientific literature and demographic data present a different picture. They reveal that African American women are at increased risk for psychological distress because of factors that disproportionately affect them, including lower incomes, greater poverty and unemployment, unmarried motherhood, racism, and poor physical health. Yet at the same time, rates of mental illness are low. This invaluable book is the first comprehensive examination of the contradictions between the strengths and vulnerabilities of this population. Using the contexts of race, gender, and social class, In and Out of Our Right Minds challenges the traditional notions of mental health and mental illness as they apply to African American women.


Burr, J. (2002, April). Providing a contrasting view to evolutionary psychology’s hypotheses on depression: Using a ‘material-discursive’ approach to interpret the experiences of depression in women from South Asian communities. Psychology, Evolution & Gender, 4(1), 93-113.

This study reports findings from a qualitative study exploring women from South Asian communities resident in the UK and their ‘experiences of depression’. The paper aims to provide an apparently contrasting social context to the evolutionary perspective on women’s experiences of depression. The theoretical foundation for the analysis of these findings is a ‘material-discursive approach’. Depression is recognized as ’embodied’, that is as grounded in the materiality of the body which is immersed in subjective experiences and the social context of women’s lives.


Cahn, S. (2003, Spring). Come out, come out whatever you’ve got! Or, still crazy after all these years. Feminist Studies, 29(1), 7-18.

Cahn relates her experience in living as a lesbian and describes how she struggled to cope with her chronic fatigue syndrome. Many people see homosexuals as disgusting, sinful, tolerable, abominable, and crazy. Although their is no proof that homosexuality and mental disorder is correlated, many psychiatrists still believe that several mental diseases are caused by homosexuality, and are finding reparative therapies and reconversion programs to treat homosexuals.


Chaplin, T. M., Gillham, J. E., Reivich, K., Elkon, A. G. L., Samuels, B., Freres, D. R., Winder, B., & Seligman, M. E. P. (2006). Depression prevention for early adolescent girls: A pilot study of all girls versus co-ed groups. The Journal of Early Adolescence, 26(1), 110-126.

Given the dramatic increase in depression that occurs during early adolescence in girls, interventions must address the needs of girls. The authors examined whether a depression prevention program, the Penn Resiliency Program, was more effective for girls in all-girls groups than in co-ed groups. Within co-ed groups, the authors also tested whether there were greater effects for boys than for girls. Participants were 20811-to 14-year-olds. Girls were randomly assigned to all-girls groups, co-ed groups, or control. Boys were assigned to co-ed groups or control. Students completed questionnaires on depressive symptoms, hopelessness, and explanatory style before and after the intervention. Girls groups were better than co-ed groups in reducing girls’ hopelessness and for session attendance rates but were similar to co-ed groups in reducing depressive symptoms. Co-ed groups decreased depressive symptoms, but this did not differ by gender. Findings support prevention programs and suggest additional benefits of girls groups.


Chernomas, W., & Clarke, D. E. (n.d.). Social support and women living with serious mental illness. Winnipeg, MB: Prairie Women’s Health Centre of Excellence.

This project explored the social support in the lives of women living with schizophrenia. It was designed to build on an initial study, which examined the informational, and support needs as perceived by this population. In the initial study, women indicated there were a limited number of people in their lives. This present study focused on exploring with women their formal and informal sources of support, the kind of support people in their lives provided, and the kind of support women felt was lacking. Women were encouraged to talk about support in the context of their everyday lives, responsibilities, and sense of self, in light of having a serious mental illness. The Executive Summary and a link to the document in PDF is available at http://www.pwhce.ca/socialSupport.htm


Chernomas, W. M., Clarke, D. E., & Chisholm, F. A. (2000). Perspectives of women living with schizophrenia. Psychiatric Services, 51(12), 1517-1521.

Study examining how women with schizophrenia or schizoaffective disorder perceive their own daily lives and health needs. Narratives and direct quotations are provided based on five focus groups conducted with a total of 28 community-dwelling women. Topics include work, the experience of stigma and rejection, relationships and intimacy, pregnancy and motherhood, feelings of responsibility for their disability, physical health and interactions with physicians, and hope and spirituality.


Clift, E. (Ed.). Women’s encounters with the mental health establishment: Escaping the Yellow Wallpaper. Binghamton, NY: Haworth Press.

This unique contemporary anthology of women’s experiential writing shares women’s realities, perceptions, and experiences (positive and negative) within the therapeutic environment. These artistic expressions of personal experience will help women understand their own encounters in a new light. They are also instructive and enlightening for any practitioner working with women in a mental health setting.

Charlotte Perkins Gilman’s famous short story (included here), The Yellow Wallpaper, which inspired this title, has come to represent the struggle of contemporary women to be understood by the therapeutic milieu from whom they seek psychological support and psychiatric treatment. An icon of feminist writing, the 1892 story symbolizes affirmation and validation for the female experience regarding mental health and therapy. This anthology, in the spirit of Gilman’s work, gives voice to today’s women so that their own encounters with the mental health establishment can be validating and affirming to others. It will also enlighten those in the helping professions as they extend their services to women in a time of growing need and shrinking resources.

In addition to The Yellow Wallpaper and a foreword and afterword by noted psychiatric professionals, Women’s Encouters with the Mental Health Establishment: Escaping the Yellow Wallpaper also contains works by authors including Sylvia Plath, Kate Millett, Anne Sexton, Lauren Slater, Martha Manning, Elayne Clift, and many more.

Through prose and poetry, the contributors to this volume offer a creative, artistic, and highly readable contribution to the literatures of women’s studies and psychology. Visit the author’s website at http://www.sover.net/~eclift.


Constantinou, S. (1997). Between the lines [Film]. Boston: Fanlight Productions.

A visually lyrical, experimental documentary about women who cut themselves, this film explores the gray areas in women’s relationships to their bodies in the context of deliberately self-inflicted injury. The women in Between the Lines negotiate the fine line between self-destructive behavior and self-preserving coping mechanisms.


Cook, J. A. (2003, June). Depression, disability, and rehabilitation services for women. Psychology of Women Quarterly, 27(2), 121-129.

The purpose of this paper is to review scientific evidence for the co-occurrence of major depressive illness and disability, and to examine this phenomenon specifically for women in the United States today. Following a discussion of different ways of operationalizing the concept of disability, the analysis addresses gender biases in disability measurement as well as in recent research on depression and functional impairment. Next, the results of research regarding co-occurrence of disability and depression are reviewed, highlighting those studies focused specifically on women. Turning to research on rehabilitation services for those with psychiatric disabilities, studies suggest that service delivery models fail to address needs specific to women with mental illness in general, as well as those women experiencing severe depression. Thus, the analysis concludes with a series of suggestions and future directions for investigators seeking to better understand the linkages between depression, disability, and rehabilitation services for women.


Cook, J. A., Jonikas, J. A., & Bamberger, E. I. (2002).  Assessing the needs of women with psychiatric disabilities: Needs assessment protocol and documentation manual. Chicago: National Research and Training Center on Psychiatric Disability, University of Illinois at Chicago, Department of Psychiatry. Available: http://www.cmhsrp.uic.edu/download/WNA.manual-appendix.pdf.

“The purpose of this manual is to present the WNA [Women Consumers/Survivors Needs Assessment] Protocol, describe its history and development as part of the National Women Consumers/Survivors Needs Assessment Project, identify methods for administering the assessment, and encourage its use as a tool to identify the unique, gender-specific needs of women with psychiatric disabilities” (p. 3).


Corbett, C. A. (2003, June). Special issues in psychotherapy with minority Deaf women. In M. E. Banks, & E. Kaschak (Eds.), Women with visible and invisible disabilities: multiple intersections, multiple issues, multiple therapies, Part II [Special issue]. Women & Therapy, 26(3/4), 311-329.

Minority Deaf women have been traditionally underserved by mental health professionals, and specifically, therapists are unaware of issues unique to this population. It would be highly unlikely for a minority Deaf woman to have a therapist who matches her in racial background, hearing status, and communication mode. Therefore, the therapy process will be completely cross-cultural. Therapists who provide psychotherapy services to minority Deaf women need to be aware that their clients are members of a community where deafness is a culture and not a disability. Minority Deaf women are also likely to report feeling forced to choose between competing identities in order to get important needs met. In the following article, case examples are provided which illustrate some of the major issues that are likely to arise in therapy with minority Deaf women. These issues include: access to important information; communication, support and level of involvement with biological families; competing cultural demands; health concerns; and coping with chronic mental illness.


Dangoor, N., & Florian, V. (1994, June). Women with chronic physical disabilities: Correlates of their long-term psychosocial adaptation. International Journal of Rehabilitation Research, 17(2), 159-168.

This study examined the effects of demographic factors, disability status, and individual internal resources to the long-term psychosocial adjustment of 88 married women with orthopedic, neurological, and internal chronic diseases. Results suggest that sense of coherence and socioeconomic status, rather than disability status variables, accounted most for variance in adaptational outcome.


Danquah, M. A. (1999). Willow weep for me: A black woman’s journey through depression. New York: One World/Ballantine.

This moving memoir of an African-American woman’s lifelong fight to identify and overcome depression offers an inspirational story of healing and emergence. Wrapped within Danquah’s engaging account of this universal affliction is rare and insightful testimony about what it means to be black, female, and battling depression in a society that often idealizes black women as strong, nurturing caregivers. A startlingly honest, elegantly rendered depiction of depression, Willow Weep for Me calls out to all women who suffer in silence with a life-affirming message of recovery. Meri Danquah rises from the pages, a true survivor, departing a world of darkness and reclaiming her life.


Das, V., & Addalha, R. (2001, Fall). Disability and domestic citizenship: Voice, gender, and the making of the subject. Public Culture, 13(3), 511-531.

“In this essay, we propose to analyze notions of impairment and disability through a reconfiguration of the domestic sphere, offering ethnographic vignettes from the fieldwork we have conducted in different kinds of locations in Delhi. We hope to show that the domestic, once displaced from its conventionally assumed reference to the private, becomes a sphere in which a different kind of citizenship may be enacted—a citizenship based not on the formation of associational communities, but on notions of publics constituted through voice. The domestic sphere we present, then, is always on the verge of becoming the political. A focus on kinship not as the extension of familial relations into community, but as the sphere in which the family has to confront ways of disciplining and containing contagion and stigma yields startling revelations about disability and impairment as located not in (or only in) individual bodies, but rather as “off” the body of the individual and within a network of social and kin relationships.

Finally, by pairing the notion of the domestic with that of citizenship, we will also suggest that community as imagined by the modern liberal state in India makes state and citizenship complicated entities, and that claims to membership and belonging within the state may be enacted in everyday life in all kinds of dispersed sites. We identify the hospital as one such site, at which the domestic is instantiated performatively in relation to both state- and kinship-bounded figurations of community. Our ethnographic examples are drawn from a study of Punjabi kinship in which Veena Das was engaged in varying intensity from 1974 through 1994, and from a study of hospitalized female psychiatric patients in Delhi conducted by Renu Addlakha from 1990 to 1992” (pp. 511-512).


Davar, B. V. (2008). From mental illness to disability: Choices for women users/ survivors of psychiatry in self and identity constructions. Indian Journal of Gender Studies, 15(2), 261-290.

This article traces the critical engagement of the women’s movement with psychiatry, mental health and disability in India over the past two decades. Three phases can be discerned in this history. The first was a phase of radical intellectual disbelief about the very existence of mental illness as a valid knowledge category. In the second phase the experiential reality of women, who had to engage with their own emotional states, found expression in a variety of discourses about women and mental health. The marginalisation of women by the mainstream medical sciences was addressed, and the right to care was redefined as the creation of gender-sensitive sciences. In the third and present phase I interrogate the paths we have taken in the creation of such gender-sensitive mental health practices. A mental illness language has been exhausted of any positive content. The rights orientation to mental health can be developed from disability thinking, which is providing an alternative vision for the world, as well for persons labelled mentally ill.


DiClemente, R. J., Wingood, G. M., Lang, G. L., Crosby, R. A., Salazar, L. F., Harrington, K., & Hertzberg, V. S. (2005, July). Adverse health consequences that co-occur with depression: A longitudinal study of black adolescent females. Pediatrics, 116(1), 78-81.

Objective. The purpose of this study was to identify adverse health consequences that may co-occur with depression among black female adolescents.

Methods. Adolescents were recruited from high-risk neighborhoods in Birmingham, Alabama. The sample comprised 460 black female adolescents (aged 14–18 years) who completed assessments at baseline and at 6 and 12 months. Only adolescents who consistently scored above the threshold for depression at all 3 assessments (n = 76) or below the threshold at all 3 assessments (n = 174) were included (N = 250) in the data analysis. Within this sample, adolescents who were depressed were compared with those who were not depressed with respect to the following health consequences: low self-esteem, emotional abuse, physical abuse, verbal abuse, poor body image, and antisocial behavior.

Results. Using generalized estimating equations and controlling for covariates, depressed adolescents were 5.3 times more likely to report low self-esteem, 4.3 times more likely to report emotional abuse, 3.7 times more likely to report being physically abused, and almost 3 times as likely to report being verbally abused. Furthermore, depressed adolescents were more than twice as likely to report poor body image and nearly twice as likely to report engaging in antisocial behaviors.

Conclusions. The findings suggest that a broad range of adverse health consequences may accompany depression among black female adolescents. Physicians need to be alert to the co-occurrence of depression and low self-esteem; emotional, physical, and verbal abuse; poor body image; and antisocial behaviors among this population.


Durgin, P. F. (2008). Psychosocial disability and post-ableist poetics: The “case” of Hannah Weiner’s Clairvoyant Journals. Contemporary Women’s Writing, 2(2), 131-154.

“In an example of late-twentieth-century synchronicity, as Michel Foucault delivered a lecture which would be a crucial component of disability studies’ theoretical portmanteau, Hannah Weiner turned the monstrous elements of language and consciousness to the service of poetry, a poetry of the `everyday’ and the `miniscule.’ The manuscript page of that project, The Early and Clairvoyant Journals, dated `Feb 5′ reads, in part and eerily apropos, `TAUGHT OBEDIENCE as children, INDEPENDENCE/I was going to say I saw TAUGHT INDEPENDENCE… NOT THAT SIMPLE says my ms. our.` The words she `saw` started speaking back. A full decade before writing to Bernadette Mayer regarding the dialogic visions of language she associated with psychic powers and others with some form of psychopathology, Weiner wrote in her diaristic Hell Books project her own prognosis: “To be master of my mind, yes, that would be what the dialogues with my mind will I hope some day add up to` (“hell day 7”). It seems she taught herself a great deal in those 10 years. Foucault’s chronicle of the forced domestication of antisocial behaviors – those that disturb the self-preservation `instincts` of the body politic – rhymes well with Mayer’s characterization: that the hallucinatory sources of Weiner’s written work subvert medicalized and commercially viable figures of the proverbial mad genius of letters. This is a time when American poets found disobedience to be a critical value in their development of an avant-garde that could deploy experimental compositional forms and processes in the interest of a quickly maturing counterculture. What makes Weiner’s work of the period a vivid example is that where she subverts the blandly naturalized tradition of modern verse, against which Donald Allen and Jerome Rothenberg defined their signal assessments of the modernist legacy and the mid-century modernism of Black Mountain, Beat, and New York schools, she simultaneously complicates the very myth of the poet as seer that informs her claim to be a `clairvoyant,` to have special access to hallucinatory `pictures and early words,`even audible voices. Ever protesting the culture of obedience she found to be based on ideo-linguistic constructs of power, Weiner’s work chronicles the cultivation of her health, fitness, and power. For Weiner, writing becomes a way of exercising her survival instincts, rather than giving over to received ways of being. As a sort of avant-garde journalist, she finds independence in `silent teaching,` her figure for radical interdependence strictly at odds with the rampant essentialist recuperation that followed and fueled ongoing civil rights struggles. Her work provides a formal index of a variability of self, scrutinizing the social realm in which one becomes subject to the vicissitudes of power. The various `instincts`one is liable to associate with poetic expression are highly complicated when one takes seriously her claim to have done away with outmoded recourse to intentionality, beauty, and formal propriety. Working in diverse forms, which defy conventional grammar, syntax, rhetoric, and prosody, Weiner’s claims on poetic form are developed in direct proportion to the challenge she raised against conventional identity politics” (pp. 131-132).


Edhborg, M., Friberg, M., Lundh, W., & Widström, A. M. (2005, August). “Struggling with life”: Narratives from women with signs of postpartum depression. Scandinavian Journal of Public Health, 33(4), 261-267.

Aim: The aim of this study was to explore and describe how Swedish women with signs of postpartum depression two months postpartum experience the first months with their child.

Method: A grounded theory approach was chosen. Twenty-two women who showed signs of depression, i.e. scored 10 or more on the Edinburgh Postnatal Depression Scale (EPDS), were interviewed at an average of 80 days after the delivery.

Results: The new mothers were struggling with life related to the self, the child, and the partner. They expressed feelings of loss of who they are, felt overwhelmed by the responsibility for the child, and were struggling with feelings of abandonment, worries, and breastfeeding problems. They often felt like “bad mothers” but they never blamed the child. Most mothers were reluctant to speak about their feelings and they assigned their depressed mood to personal weakness rather than illness. In relationship to the partner the mothers were struggling to keep their equality in the new situation and to get him involved in childcare.

Conclusions: The findings suggest that depressed feelings postpartum may be explained in terms of losses and changes. However, postpartum depressive symptoms remain hidden and it is important to understand the complexity of postpartum depressive mood, described here as struggling with life related to three different dimensions: the self, the child, and the partner.


Edell, D. (2003, August 25). Depression and gender stereotypes [Online]. Retrieved March 12, 2005 from http://www.healthcentral.com/drdean/deanfulltexttopics.
cfm?ID=60603&storytype=DeanTopics

“The media’s coverage of depression has changed dramatically in the age of Prozac. Articles are now far more likely to depict women’s mental issues in relation to gender-stereotyped roles rather than in medical terms. But descriptions of depression in men have not shifted in the same way.”


Eleveld, K. L. (2003). Isn’t she lovely [Video]. Boston: Fanlight Productions.

When the filmmaker was twelve, her mother began showing signs of mental illness, but when she was a junior in high school the illness appeared to be stabilizing. Kerry remembers months of visits, to model new outfits and make dinners and cookies together. Then her mother stopped answering the teenager’s phone calls. When Kerry went to see her, and demanded that her mother open the door, the response was “I love you, but I can’t be with you right now.”

“I think I knew,” Kerry says fifteen years later, “that she was never coming back.” This moving personal documentary is a brave attempt to understand a childhood profoundly affected by a parent’s severe mental illness. Kerry’s mother, Lynn, was not only a loving mother but a respected social worker, at a time and in a community where women in the professions were not common. Suddenly—or so it seemed to Kerry and her brother Rob—she was behaving strangely and distancing herself from her family. Without warning, she disappeared on a cross-continental odyssey that ended with her first institutionalization. Refusing any kind of “talk therapy,” time after time Lynn was able to use her knowledge of the mental health system to avoid long-term institutional care, and she rarely stayed on medication for long.

“Schizoid personality, bipolar type?” “Bipolar disorder with psychotic features?” The filmmaker struggles to reach the person behind the shifting diagnoses, but ultimately has to accept that she “can’t fix it.” This is less a film about Lynn’s mental illness than it is about the courage and resilience that have enabled Kerry and Rob to create independent lives for themselves despite their feelings of loss and abandonment.


Faber, M. (1993). Delirium [Film]. New York: Women Make Movies.

Taking her mother’s mental illness as its point of departure, Mindy Faber’s Delirium exposes the historical relationship between women and madness with wit and sensitivity. Documentary footage of her mother is seamlessly interlaced with experimental, performance and archival images to shed light on the complexity of female hysteria. It shows that it is often women who do not conform to traditional social roles who are labeled “mad” and that women’s reactions of violence, anger and depression are frequently not expressions of madness but rather sane responses to abhorrent situations.


Feld, R., Colantonio, A., Yoshida, K., & Odette, F. (2003, August). Mental health and vitality among Canadian women with physical disabilities. Psychological Reports, 93(1), 75-83.

This study investigated scores for mental health and vitality in a large community-based sample of women with physical disabilities. The scores from two subscales of the SF-36 were collected from 1,096 women with physical disabilities through a mailed survey regarding health and well-being. These scores were compared to normative data using t tests. The mean scores of the vitality subscale were significantly lower than that of the normed sample when analyzed by age groups. The mental health scores were significantly lower as well, except for one age group (65-74 yr.). These results suggest that health care workers should address aspects of mental health and energy when caring for women with physical disabilities, as these areas are often overlooked in this population. Health promotion programs aimed at these topics should be designed specifically for this population as well.


Fernández, I. C. (2001). A journey to madness: Jane Bowles’s narrative and schizophrenia. Journal of Medical Humanities, 22(4), 265-283.

This work is a study of Jane Bowles’s madness as revealed through several of her literary works and her life story. On a parallel plane, it is an epistemological exploration of the points of intersection between humanistic psychoanalysis and deconstructive literary criticism. Here we consider the schizoid traits in Two Serious Ladies (1943) and in “Camp Cataract” (1949), using the theories developed in this area by the psychiatrist R. D. Laing (1927–1989).


Frick, K. (2002). Women’s mental illness: A response to oppression. Women’s Issues Then and Now: A Feminist Overview of the Last 2 Centuries [Online]. Retrieved March 12, 2005 from http://www.cwrl.utexas.edu/~ulrich/femhist/
madness.shtml
.

“Women throughout history have been considered the weaker sex. They are commonly believed to be more susceptible to emotional breakdowns and mental illness as they are deemed to be not as psychologically durable as men. Are women truly a weaker sex mentally, or do we perceive them this way because of patriarchal society and existing stereotypes? Are women fragile or are the breakdowns simply results of years of male domination? I intend to detail and describe women’s mental illness during the Victorian era and in today’s society in order to explore these questions as I believe women’s mental illness has, for the most part, been created by man.”

This web site gives a brief history of women and mental illness in the last two centuries. It is part of a site constructed by the Spring 2002 Rhetoric of Anglo-American Feminism class at the University of Texas. They have compiled information on some of the major issues facing women and feminism during the past 200 years, and discussed how the issues have changed over time, and also how they have stayed the same.


Gadalla, T. M. (2008, July). Disability associated with comorbid anxiety disorders in women with chronic physical illness in Ontario, Canada.  Women & Health, 48(1), 1-20.

Anxiety disorders are more prevalent in individuals with chronic physical illness compared to individuals with no such illness, and about twice as prevalent in women as in men. This study used data collected in the 2005 Canadian Community Health Survey (21,198 women and 20,478 men) to examine factors associated with comorbid anxiety disorders and to assess the relation of these disorders on short-term disability and suicidal ideation. Comorbid anxiety disorders were more prevalent among women who were young, single, poor, and Canadian-born, and among women with chronic fatigue syndrome; fibromyalgia, bowel disorder or stomach or intestinal ulcers, or bronchitis had the highest rates of anxiety disorders. The presence of comorbid anxiety disorders was significantly associated with short-term disability, requiring help with instrumental daily activities, and suicidal ideation. Our findings underscore the importance of early detection and treatment of anxiety disorders in the physically ill, especially those who also suffer from mood disorders.


Gearon, J. S., Kaltman, S. I., Brown, C., & Bellack, A. S. (2003). Traumatic life events and PTSD among women with substance use disorders and schizophrenia. Psychiatric Services, 54(4), 523-528.

Study examined the prevalence of traumatic life events and the association between traumatic life events and posttraumatic stress disorder (PTSD) among women schizophrenia or schizoaffective disorder and co-occurring substance abuse. Participants were 54 psychiatric outpatients who completed a battery of clinical assessments. Analysis of the data revealed that 96 percent of the sample reported experiencing at least one traumatic life event; the average number of traumatic life events reported was 8. High rates of trauma, particularly physical abuse, and of being abused both as a child and as an adult were reported. PTSD was significantly associated with childhood sexual abuse and revictimization.


Gender and women’s mental health. (n.d.). Geneva, Switzerland: World Health International. Retrieved March 12, 2005 from http://www.who.int/mental_health/prevention/genderwomen/en/

Fact sheet on gender and women’s mental health published by WHO. Reviews the facts concerning gender disparities and mental health, women’s mental health, gender specific risks, gender bias, and WHO’s focus on women’s mental health. Other resources concerning gender and mental health from WHO are available at http://www.who.int/mental_health/resources/gender/en/


Glidden, L. M., & Schoolcraft, S. A. (2003). Depression: It’s trajectory and correlates in mothers rearing children with intellectual disability. Journal of Intellectual Disability Research, 47(4/5), 250-263.

BACKGROUND: Rearing a child with an intellectual disability (ID) is a lifelong activity, and research needs to reflect the extended nature of the task as well as its complexity. The present longitudinal study reports on an 11-year follow-up of adoptive and birth families rearing children with ID. Its focus was on depressive symptoms and how these changed over time in a sample of 187 mothers. In particular, the authors were interested in whether initial differences in depression between adoptive mothers who knowingly and willingly decided to rear their children with disabilities, and birth mothers for whom the diagnosis of disability was unexpected and frequently crisis-inducing, would persist over time.

METHODS: A longitudinal method with three times of measurement provided data which were analysed with analysis of variance and regression techniques. Moreover, several other individual and family adjustment measures were examined with respect to their correlations with depression and an outcome variable that measured subjective well-being with regard to the child. Furthermore, mothers were classified as typical or atypical for their adoptive/birth group based on their depression scores at the first time of measurement. The authors predicted that later depression would be different based on the earlier scores.

RESULTS: Both adoptive and birth mothers reported low depression, not significantly different from each other, at the 11-year follow-up. The personality variable of neuroticism was the strongest predictor of depression for both adoptive and birth mothers, accounting for 24% and 23% of the variance, respectively, but it did not predict the mother’s subjective well-being with regard to the child. Mothers classified as typical or atypical for their groups at initial measurement continued to report significantly different depression scores 11 years later.

CONCLUSIONS: The low depression scores, not significantly different for birth and adoptive mothers, portray the long-term prognosis for adjustment to rearing children with disabilities as primarily positive. Moreover, the predictive value of neuroticism suggests that general mental health is an important component influencing this adjustment. Nevertheless, a different pattern for a different outcome variable suggests that multiple measures are necessary to portray accurately the complexity of reaction over time.


Goodman, L. A., Glenn, C., Bohlig, A., Banyard, V., & Borges, A. (2009). Feminist relational advocacy: Processes and outcomes from the perspective of low-income women with depression. The Counseling Psychologist, 37(6), 848-876.

This article describes a qualitative study of how low-income women who are struggling with symptoms of depression experience feminist relational advocacy, a new model that is informed by feminist, multicultural, and community psychology theories. Using qualitative content analysis of participant interviews, the authors describe the processes and outcomes of feminist relational advocacy from participants’ perspectives; they also consider how emergent themes fit with principles of the model, including the importance of women’s narratives, the inseparability of emotional and practical support, the centrality of the advocacy relationship, and oppression as a source of emotional distress. The article concludes with a discussion of the practice and research implications of the study, highlighting the possibilities of feminist relational advocacy as a new tool for counseling psychologists and the lessons for advocacy models in general.


Gray, D. E. (2003, February). Gender and coping: The parents of children with high functioning autism. Social Science & Medicine, 56(3), 631-642.

Gender is a concept that is frequently discussed in the literature on stress, coping and illness. Research has reported that women are more vulnerable than men are to stressful events and use different strategies to cope with them. Furthermore, it is often asserted that these gender-based differences in coping may partially explain the differential impact of stressful events on men and women. Unfortunately, much of this research has equated gender with sex and failed to contextualise the experience of illness and coping. This paper presents a qualitative analysis of the role of gender and coping among parents of children with high functioning autism or Asperger’s syndrome in an Australian sample. It attempts to analyse the different meanings of the disability for mothers and fathers and describes the various strategies that parents use to cope with their child’s disability.


Hamdan, A. (2009, July). Mental health needs of Arab women. Health Care for Women International, 30(7), 595-613.

Researchers indicate that the prevalence of psychiatric morbidity in the Arab region is similar to that found in other parts of the world. Women, in particular, are more likely to suffer various disorders including depression, anxiety disorders, somatization, and eating disorders. In this article, the author highlights some of the research on the mental health needs of Arab women. Consideration is given to important cultural and contextual factors related to mental illness as well as potential risk factors. Finally, suggestions for future directions are provided in order to attempt to close the gap between the needs and the services available.


Harris, J. (2000). Self-harm: Cutting the bad out of me. Qualitative Health Research, 10(2), 164-173.

The practice of self-harm is increasing in the United Kingdom, accounting for the highest number of acute medical admissions for women. The medical and nursing response to repeaters, set within a climate of dwindling emergency and accident resources, has been one of impatience, frustration, and hostile care. The author undertook a correspondence study with 6 women who regularly self-harmed. The women claimed that medical and nursing professionals viewed their self-harm as irrational and illogical. However, a qualitative examination of the motivations and interests of all parties reveals that self-harm acts possess situated internal logic, whereas professionals tend to use rational logic in attempting to understand them.


Harrison, T., & Stulfbergen, A. (2002, July). Disability, social support, and concern for children: Depression in mothers with multiple sclerosis. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 31(4), 444-453.

Objective: To investigate the relationship between disability, concern for children, social support, and depressive symptoms in a group of mothers with multiple sclerosis (MS).

Design: An exploratory secondary analysis using correlation and multiple regression techniques.

Setting and Participants: Two hundred one women with MS responded to a survey as part of a cohort participating in a longitudinal study of health promotion and quality of life.

Outcome Measures: Depressive symptoms were measured using the CESD-10.

Results: The results indicate that disability and concern for children are independent predictors of depressive symptoms, and social support can partially mediate the effect of concern for children on depressive symptoms.

Conclusion: Appropriate support should be identified and provided by nurses caring for mothers with disabilities such as MS to decrease the depressive symptoms related to the concern they have for their children.


Hassouneh, D. M., & Kulwicki, A. (2007, May). Mental health, discrimination, and trauma in Arab Muslim women living in the US: A pilot study. Mental Health, Religion & Culture, 10(3), 257-262.

In recognition of the need to identify groups of women who may be at high risk for mental disorders and contribute to the knowledge base about ethnic and cultural minority mental health, this paper provides an overview of findings obtained from a small pilot study of mental health in Muslim women living in the US. Findings indicate that Muslim women face numerous stressors that threaten their mental health including discrimination, acculturative stress, and trauma.


Hauenstein, E. J., Petterson, S., Merwin, E., Rovnyak, V., Heise, B., & Wagner, D. (2006, July/September). Rurality, gender, and mental health treatment. In A. Bushy & R. H. Steeves (Eds.), Rural Health [Feature issue]. Family & Community Health., 29(3), 169-185.

Mental health problems are common and costly, yet many individuals with these problems either do not receive care or receive care that is inadequate. Gender and place of residence contribute to disparities in the use of mental health services. The objective of this study was to identify the influence of gender and rurality on mental health services utilization by using more sensitive indices of rurality. Pooled data from 4 panels of the Medical Expenditure Panel Survey (1996-2000) yielded a sample of 32,219 respondents aged 18 through 64. Variables were stratified by residence using rural-urban continuum codes. We used logistic and linear regression to model effects of gender and rurality on treatment rates. We found that rural women are less likely to receive mental health treatment either through the general healthcare system or through specialty mental health systems when compared to women in metropolitan statistical areas (MSA) or urbanized non-MSA areas. Rural men receive less mental health treatment than do rural women and less specialty mental health treatment than do men in MSAs or least rural non-MSA areas. Reported mental health deteriorates as the level of rurality increases. There is a considerable unmet need for mental health services in most rural areas. The general health sector does not seem to contribute remarkably to mental health services for women in these areas.


Heath, C. D. (2006, April). A womanist approach to understanding and assessing the relationship between spirituality and mental health. Mental Health, Religion & Culture, 9(2), 155-170.

Mental health is a growing concern for Black women. Issues of gender, race, and class contribute to Black women’s mental health status. Over-burdened and over-extended, Black women are continuously plagued by stress. Thus, mental health for Black women is an art of self-healing, and spirituality plays a major role in the recovery of their mental health and well-being. The connection between spirituality and mental health enables Black women to remain on life’s course in spite of obstacles. However, sociopolitical assessments of how spirituality functions in culturally diverse populations are seldom present in mental health research and provide little if any value to mental health issues specific to Black women. In response, a womanist research agenda is proposed to address Black women’s mental health needs. A womanist research agenda is needed to contribute to the process of understanding the liberating function of spirituality in Black women’s lives.


Hebald, C. (2001). The heart too long suppressed: A chronicle of mental illness. Boston: Northeastern University Press.

The Heart Too Long Suppressed documents, from a personal viewpoint, schizophrenia as an unconscious choice. It is my aim that readers might recognize similar choices in themselves, or in loved ones, who have succumbed to the seeming certainty that there are none.

In tracking the development of my former illness from infancy through middle age, I place within a historical context my and my helpers’ errors in judgment. I pinpoint what went wrong. What is the meaning of schizophrenia? To answer I re-enter the experience and clarify in human terms those “dissociative states of being” and “splits between mind and feeling” by which we are clinically defined. Is there really a private world peculiar to schizophrenics? In taking the reader through mine, I show an inner world of dream and desire at odds with an outer world of fact and experience common to us all. For what did I earn my label? How and why did I inadvertently court it? By what means did I get well? Answers to these questions point to my contribution to the field.

I am not the first ex-patient to report that conditions in most psychiatric hospitals are breeding grounds for the eruption of psychotic behavior, but I hope to be among the last. To this end I address their ideal purpose as havens for the release of intolerable and so-called inappropriate feelings.

Finally, I question the widely-held belief that schizophrenia is a brain disease. Hospital records indicate no biomedical condition underlay mine. I am an exception, others exist. Why, despite us, is the international psychiatric community so eager to embrace this latest “definitive” theory? Is it because it lets them, patient families who foot their bills, and patients themselves, off the hook insofar as responsibility for the illness is concerned? This implicit, if not explicit, question lies at the heart of my book.


Hewitt, K. (2006, Winter). Women and madness: Teaching mental illness as a disability. In T. Meade & D. Serlin (Eds.), Disability and history [Special issue]. Radical History Review, 94, 155-169.

“When I first designed a class titled ‘Women and Madness,’ my primary goal was to synthesize my interests in the history of mental illness and gender issues and offer a course that would attract students to an important and controversial historical topic. I was aware that even though race, class, and gender had become important topics in history and cultural studies programs, few academic programs study people marginalized by disability. Even scholars in the field of disability studies seem reluctant to approach mental illness. The rare extant courses about cultural components of mental illness often reside in programs addressing the history of medicine, or in women’s studies programs. Gender easily functions as the inroad to discuss interactions between the body and culture and hegemonic definitions of normal, and as I designed the course, a rich history of women and psychiatry and a broad range of autobiographical texts allowed me to choose among myriad topics” (p. 156).


Hiersteiner, C. (1999). Viewing a mental health service maze from the inside out: Women clients share their stories. Women & Therapy, 22(4), 89-105.

The purpose of this qualitative inquiry is to describe the experiences of women who have been long-term consumers of mental health services and to understand the meaning and quality of care from their inside point of view. The American mental health service system might be better described as a maze or as a ‘‘non-system,’’ requiring important maneuvering skills on the part of clients. Women are the largest consumer group of mental health services and, due to their contextual, person-in-environment thinking, are expert observers of the people and processes in a network designed to help with psychological and emotional distress. Social justice ethics support the recording of their stories, historically suppressed and marginalized, and call for system-wide collaboration and cooperation on their behalf.


High, K. (1989). I need your full cooperation [Film]. New York: Women Make Movies.
This fascinating video chronicles the relationship between women and the medical institution using experimental techniques. Critical commentary is provided by feminist scholars Barbara Ehrenreich and Carroll Smith-Rosenberg. Archival footage from educational and Hollywood films reveals the persistent image of male doctors’ control of female patients. Finally, a dramatization of Charlotte Perkins Gilman’s classic story, “The Yellow Wallpaper,” illustrates the use of the “rest cure” to quell the emancipatory urges of upper class white women in the 1890s, an era in which female sexuality and reproductive capacity were identified with illness.


Holm, A. L., Berg, A., & Severinsson, E. (2009). Longing for reconciliation: A challenge for women with borderline personality disorder. Issues in Mental Health Nursing, 30(9), 560-568.

The aim of this study was to explore the way in which traumatic childhood experiences influenced the daily life of women with Borderline Personality Disorder (BPD). An explorative design comprising in-depth interviews and a qualitative content analysis was used. The findings revealed one main theme—Longing for Reconciliation—comprising two themes: (1) Living with a sense of shame and guilt and (2) Struggling to be released from a sense of being trapped. Longing for reconciliation influenced the women’s daily life as well as their search for the meaning of traumatic childhood experiences. New meaning can emerge through change, forgiveness, and reconciliation, thus helping women with BPD overcome their struggle and gain the insight and strength to look into their secret knowledge. Meaning can emerge and help them to develop an empathic understanding of themselves in the context of past and present relationships.


Holt, G. (Ed.). (2004, October). Women with learning disabilities and mental health [Feature issue]. Tizard Learning Disability Review, 9(4).

In May 2002 a conference, Meeting the Mental Health Needs of Women with Learning Disability, was held at Guy’s Hospital [UK], a joint venture between the Judith Trust and the Estia Centre, Guy’s. The aim was to enable discussion of the importance of good mental health for everyone, for good services for those who become mentally ill and for these services to be sensitive to the particular needs of women with learning disabilities.


Holte, M. C., & Dinis, M. C. (2001). Self-esteem enhancement in deaf and hearing women: Success stories. American Annals of the Deaf, 146(4), 348-354.

Report examines factors affecting self-esteem in women who are deaf or hard of hearing. Nine deaf and 14 hearing women participated in in-depth interviews to generate themes to describe their self-esteem and how they have enhance their own self-esteem. Eight themes emerged from the data, 5 of which are common to both groups of women. Deaf women were more likely to report education as a factor in enhancing self-esteem. Deaf women also cited language and communication as critical to self-esteem enhancement; this was not mentioned by the hearing women.


Hommel, K. A., Wagner, J. L., Chaney J. M., & Mullins L. L. (1998, July). Gender-specific effects of depression on functional disability in rheumatoid arthritis: A prospective study. International Journal of Rehabilitation and Health, 4(3), 183-191.

We examined the prospective impact of depression on objective ratings of disability as a function of gender in a sample of persons with rheumatoid arthritis. Forty-two individuals from an outpatient rheumatology clinic completed measures of depression, disability, and pain over the course of 1 year. A physician’s assistant completed objective measures of functional disability following a routine physical examination. Results demonstrated a significant main effect for gender on Time 2 objective ratings of disability (after controlling for disease variables and self-report indices of pain and disability), indicating that physician assistants rated female participants as more disabled than male participants. Importantly, the interaction of gender and Time 1 depression contributed significant variance to Time 2 disability. Findings suggest that women, relative to men, may experience greater declines in functional capacity over time, independent of self-perceptions of pain and disability, and that depression plays a significant role in this process. Discussion focuses on treatment considerations for health care teams, with particular focus on women’s adjustment of to RA.


Horwitz, S. M., Kelleher, K. J., Stein, R. E. K., Storfer-Isser, A., Youngstrom, E. A., Park, E. R., Heneghan, A. M., Jensen, P. S., O’Connor, K. G., & Hoagwood, K. E. (2007, January). Barriers to the identification and management of psychosocial issues in children and maternal depression. Pediatrics, 119(1), e208-e218.

Context. Child psychosocial issues and maternal depression are underidentified and undertreated, but we know surprisingly little about the barriers to identification and treatment of these problems by primary care pediatricians.

Objectives. The purpose of this work was to determine whether (1) perceived barriers to care for children’s psychosocial issues and maternal depression aggregate into patient, physician, and organizational domains, (2) barrier domains are distinct for mothers and children, and (3) physician, patient, and practice/organizational characteristics are associated with different barrier domains for children and mothers.

Methods. We conducted a cross-sectional survey of the 50818 US nonretired members of the American Academy of Pediatrics. Of a random sample of 1600 members, 832 (745 nontrainee members) responded. This was a mailed 8-page survey with no patients and no intervention. We measured physician assessment of barriers to providing psychosocial care for children’s psychosocial problems and maternal depression.

Results. Pediatricians frequently endorse the lack of time to treat mental health problems (77.0%) and long waiting periods to see mental health providers (74.0%) as the most important barriers to the identification and treatment of children’s psychosocial problems. For maternal depression, pediatricians most often endorsed lack of training in treatment (74.5%) and lack of time to treat (64.3%) as important barriers. Pediatricians’ reports of barriers clustered into physician and organizational domains. Physician domains were distinct for children and mothers, but organizational domains were not. Several physician and practice characteristics are significantly associated with the 4 barrier scales, and different characteristics (eg, sociodemographic, attitudinal, and practice features) were related to each barrier area.

Conclusions. Pediatricians endorse a wide range of barriers with respect to the diagnosis and treatment of children’s mental health problems and maternal depression. The specificity of factors relating to various barrier areas suggests that overcoming barriers to the identification and treatment of child mental health problems and maternal depression in primary care pediatrics is likely to require a multifaceted approach that spans organizational, physician, and patient issues. In addition, comprehensive interventions will likely require social marketing approaches designed to engage diverse audiences of clinicians and their patients to participate.


Houston, R. A. (2002, September). Madness and gender in the long eighteenth century. Social History, 27(3), 309-326.

The article uses a wide range of archival and literary sources to examine perceptions of mental incapacity. It looks first at what quantifiable measures may and may not tell us about the nature of madness in eighteenth-century Scotland and about the relationship between pathologies and the ‘normal’ structures of society. It seeks to test a common assumption or assertion that ‘madness is a female malady because it is experienced by more women than men’ (Showalter). It further questions whether those with mental problems were really just the victims of an oppressive (professional and male) form of discourse by offering a nuanced analysis of the social context in which mental disability was identified. The second half of the article explores certain qualitative aspects of how insanity was construed by the sane, in order to assess the extent of gendering in the day-to-day understanding of mental problems. These aspects include the connections between madness and issues such as emotion, language, class, suicide, alcohol and ‘work’.


Houston, R. A. (2004, January). Class, gender and madness in eighteenth century Scotland. Clio Medica/The Wellcome Series in the History of Medicine, 73(1), 45-68.

This chapter uses a wide range of qualitative and quantitative sources from eighteenth-century Scotland to ask whether identifying someone as mad was an arbitrary means of exerting power over them. Separate sections analyse the effect of gender and class on the constructions of mental disability. The conclusion is that rather than providing evidence of a crude bourgeois and/or male conspiracy, understandings of mental incapacity reveal in a subtle and nuanced way the nature and extent of distinctions between people based on their social status, age, occupation and sex.


Huang, Z. J., Wong, F. Y., Ronzio, C. R, & Yu, S. M. (2007, May). Depressive symptomatology and mental health help-seeking patterns of U.S.- and foreign-born mothers. Maternal and Child Health Journal, 11(3), 257-267.

Objectives: This report presents the national estimates of maternal depressive symptomatology prevalence and its socio-demographic correlates among major racial/ethnic-nativity groups in the United States. We also examined the relationship of mental health-seeking patterns by race/ethnicity and nativity.

Methods: Using the Early Childhood Longitudinal Survey-Birth Cohort Nine-month data, we present the distribution of Center for Epidemiological Study-Depression (CES-D) score by new mothers’ nativity and race/ethnicity. The mental health-seeking pattern study was limited to mothers with moderate to severe symptoms. Weighted prevalence and 95% confidence intervals for depression score categories were presented by race/ethnic groups and nativity. Multi-variable logistic regression was used to obtain the adjusted odds ratios of help-seeking patterns by race/ethnicity and nativity in mothers with moderate to severe symptoms.

Results: Compared to foreign-born mothers, mothers born in the U.S. were more likely to have moderate to severe depressive symptoms in every racial/ethnic group except for Asian/Pacific Islanders. These US-born mothers were also more likely to be teenagers, lack a partner at home, and live in rural areas. Among Asians, Filipina mothers had the highest rate of severe depressive symptoms (9.6%), similar to those of US-born black mothers (10.2%). Racial/ethnic minorities and foreign-born mothers were less likely to consult doctors (OR: 2.2 to 2.5) or think they needed consultation (OR: 1.9 to 2.2) for their emotional problems compare to non-Hispanic White mothers.

Conclusion: Our research suggests that previous “global estimates” on Asian American mental health underestimated sub-ethnic group differences. More efforts are needed to overcome the barriers in mental health services access and utilizations, especially in minority and foreign-born populations.


Hubert, S. J. (2002). Questions of power: The politics of women’s madness narratives. Newark: University of Delaware Press.

Questions of Power: The Politics of Women’s Madness Narratives explores the ways in which women have used autobiographical writing in response to psychiatric symptoms and treatment. By addressing health and healing from the patient’s perspective, the study raises questions about psychiatric practice and mental health policy. The ultimate thesis is that autobiographies by women psychiatric patients can expose many of the problems in psychiatric treatment and indicate directions for change.


Husaini, B. A., Sherkat, D. E., Levine, R., Bragg, R., Holzer, C., Anderson, K., Cain, V., & Moten, C. (2002). Race, gender, and health care service utilization and costs among Medicare elderly with psychiatric diagnoses. Journal of Aging and Health, 14(1), 79-95.

Objective: To investigate race and gender differences in health care service utilization and costs among the Medicare elderly with psychiatric diagnoses.

Methods: The authors employ a 5% sample of Medicare beneficiaries from Tennessee (N =33, 680), and among those with a psychiatric diagnosis (n =5, 339), they examine health care service utilization and costs by race and gender.

Results: African Americans had significantly higher rates of diagnosis for dementia, organic psychosis, and schizophrenia, whereas Whites had significantly higher rates for mood and anxiety disorders. White and African American men have higher rates of utilization of emergency and inpatient services and lower rates of outpatient utilization compared to White women and African American women. African American men have significantly higher health care costs.

Discussion: The findings suggest that race and gender interact to influence service utilization and preventive care, thereby driving up costs of care, for elderly persons with psychiatric diagnoses.


James, M., & Warner, S. (2005). Coping with their lives – Women, learning disabilities, self-harm and the secure unit: a Q-methodological study. British Journal of Learning Disabilities, 33(3), 120–127.

Deliberate self-harm represents a significant, yet it can be argued, a poorly theorized area of concern with respect to women who have learning disabilities – particularly in the context of secure service provision. Utilizing ideas from social constructionism we explore how some ways of understanding dominate the professional literature and, thereby, restrict how such women can be understood. We recognize that despite this, multiple understandings about why women with learning disabilities self-harm do exist and are drawn upon by practitioners and the women themselves. In order to identify how women with learning disabilities who self-harm are understood a Q-methodological study was conducted with patients and professionals in a medium secure unit. Six distinct accounts of why women self-harm emerged. These accounts emphasized that self-harming behaviour is meaningful and that women with learning disabilities are understood to have complex needs and a range of strategies for coping with these. The study, therefore, suggests that when working with such women consideration should be given to how they understand and manage their experiences, cognitions and emotions.


Jesse, D. E., Dolbier, C. L., & Blanchard, A. (2008, January). Barriers to seeking help and treatment suggestions for prenatal depressive symptoms: focus groups with rural low-income women. Issues in Mental Health Nursing, 29(1), 3-19.

Interviews were conducted with 21 pregnant or recently pregnant African American and Caucasian low-income women living in a rural southeastern community to elicit perceived barriers to seeking help for depressive symptoms in pregnancy and ways to overcome these barriers, as well as intervention suggestions. Participants identified themes regarding barriers to seeking help. These were: (1) lack of trust, (2) judgment/stigma, (3) dissatisfaction with the health care system, and (4) not wanting help. Themes identified regarding overcoming barriers were: (1) facilitating trust and (2) offering support and help. These and other findings point to the importance of integrating women’s ideas into culturally sensitive interventions for women with depressive symptoms or depression in pregnancy that can be provided by a psychiatric nurse-practitioner or other mental health provider.


Jimenez, A. L., Alegria, M., Pena, M., & Vera, M. (1997). Mental health utilization in women with symptoms of depression. Women & Health, 25(2), 1-21.

This paper examines the help-seeking process of mental health services in women with high depressive symptoms. The data are based on an island wide probabilistic sample (n = 1,062) of 18- to 64-year-old women living in low socioeconomic areas in Puerto Rico. Symptoms of depression were measured by the Center for Epidemiological Studies Depression Scale (CES-D). Results show that one out of three women living in poor residential areas report high depressive symptoms. Of these women with high depressive symptoms, only 12% seek help from a mental health specialist and 14.5% from a general health care provider to deal with their emotional problems. Some factors related to the use of mental health services are: presence of an occupational disability, head of household status, having private insurance, and having a regular source of care. These data suggest that women underutilize mental health services and overutilize physical health services to deal with their emotional problems. The lack of recognition of emotional problems by these women may explain the low utilization of mental health services.


Johansson, A., Brunnberg, E., & Eriksson, C. (2007, May). Adolescent girls’ and boys’ perceptions of mental health. Journal of Youth Studies, 10(2), 183-202.

The aims of this study are to analyse the concept of mental health from the perspective of adolescent girls and boys and to describe what adolescent girls and boys regard as important determinants of mental health. Interviews with 48 children, 13 and 16 years old, in Sweden were held individually or in focus groups. The adolescents perceived mental health as an emotional experience, where positive as well as negative health is part of the concept. Family is the most important determinant for young people’s mental health, closely followed by friends. Neither girls nor boys believed that there were any large differences in mental health between girls and boys. Age differences seemed to be more important than gender in the perception of mental health by children.


Jonikas, J. A., Laris, A., & Cook, J. A. (2003, Fall). The passage to adulthood: Psychiatric rehabilitation service and transition-related needs of young adult women with emotional and psychiatric disorders. In C. T. Mowbray (Ed.), Women and Psychiatric Rehabilitation Practice [Special section]. Psychiatric Rehabilitation Journal, 27(2), 114-121.

Literature review examines the needs and experiences of young adult women, aged 16 to 21, who have a diagnosis of serious emotional disturbance or mental illness, as they transition into adulthood. Review includes research on mental health needs of young adults with depressive disorder, bipolar disorders, adolescent schizophrenia and other psychotic disorder, and substance abuse disorders. Authors also examined research on transition-related needs and outcomes of female youth, including relationships with family and peers, abuse and trauma, academic performance, independent living, and employment.


Joseph, D. (1993). Deaf female clients give voice: A feminist perspective and counseling implications. Unpublished doctoral dissertation, Union Institute, Chicago, IL.

A dearth of research exists in the field of counseling related to deafness. Especially scant are studies from the perspective of the deaf clients, particularly women. This research used Patton’s (1986) Utilization-focused Evaluation to collect qualitative data from prospective deaf female clients and to assess current and future services provided at a Deaf Service Center in Pinellas County, Florida. Invested stakeholders were identified and joined as cc-evaluators from the onset of planning this study through the analysis of its data. Their issues and concerns were assimilated into a questioning route and presented to two separate focus groups for discussion. The attempt was not to prove hypotheses but to gather as much data as possible from a variety of women participants as the results could provide for a multileveled analysis and serve as a springboard to further discussions. The focus groups consisted of prospective deaf female clients, one group targeted women younger than the age of 50, another targeted women older than the age of 50. For each group there was a total of three focused group interviews of one to one and a half hours each. The participants were asked to share opinions on a variety of issues related to mental health services. A richness of information was discussed through the natural setting and social interaction present in these groups. The women participants found current services favorable, prefer specific characteristics in their counselors, and desire future services to emphasize quality and privacy. Recommendations urge educational counseling to occur in many areas. Service providers are reminded to combine the cultural and linguistic context of deaf women with their oppressive history when working toward empowerment. The women of this study expressed internal experiences, shared their previously unseen worlds, and hoped to contribute more data to this growing field of research.


Kamm-Steigelman, L., Kimble, L. P., Dunbar, S., Sowell, R. L., & Bairan, A. (2006, February/March). Religion, relationships and mental health in midlife women following acute myocardial infarction. In C. L. Coleman (Ed.), Spiritual and religious activities: Implications for improving mental health [Special issue]. Issues in Mental Health Nursing, 27(2), 141-159.

Little is known about coping in women following an acute myocardial infarction (AMI). In midlife, women have worse outcomes than men following AMI. Innovative interventions need to be developed that respond to these women’s unique recovery needs. In this correlational, descriptive study, 59 women aged 35–64 who had experienced AMI reported low satisfaction with life and decreased mental health; 49% were experiencing depression. However, they also reported that religion, family, and friends provided strength and comfort at the time of their AMI. Greater activation of simple, family-oriented, coping resources during recovery may be key. It is recommended that mental health nurses be essential members of the recovery planning team.


Kennedy, C. (1997). Mental health, disabilities, and women: A policy-oriented data review. In K. F. Schriner, S. N. Barnartt, & B. M. Altman, (Eds.), Disabled women and public policy: Where we’ve been, where we’re going [Special issue]. Journal of Disability Policy Studies, 8(1&2), 129-156.

Discusses policy considerations related to the special needs of women who are disabled by mental illness; describes the four data sets on which the article is based; US. 1994 Disability Survey conducted by the National Center for Health Statistics (NCHS); 1992 National Health Interview Survey (NHIS); Social Security Disability Insurance and Supplemental Security Income programs of the US Social Security Administration; Disability-Adjusted Life Years, (DALYs), an international measure developed for a study sponsored by Harvard University, the World Bank, and the World Health Organization (WHO).


Killen, A. (2003). From shock to Schreck: Psychiatrists, telephone operators and traumatic neurosis in Germany, 1900-26. Journal of Contemporary History, 38(2), 201-220.

This article examines the debates surrounding the clinical diagnosis ‘traumatic neurosis’ in the context of interactions between psychiatrists and female switchboard operators. It traces these debates from the turn of the century, when these women first began receiving extensive medical attention for their nervous and hysterical disorders, up until 1926, when the nation’s accident insurance laws were revised to disqualify traumatic neurosis as a compensatable condition. Along with war neurotics, operators played a central role in the medical recasting of traumatic neurosis from legitimate illness into pseudo-illness.


Kolotylo, C. J., & Broome, M. E. (2000). Exploration of migraine pain, disability, depressive symptomatology, and coping: A pilot study. Health Care for Women International, 21(3), 203-218.

As many as 29% of women suffer from migraine headache, yet it remains a poorly understood phenomenon. Our purpose in conducting this pilot study was to determine the relationships among migraine pain, disability, depressive symptomatology, and coping in women. A convenience sample of 34 women was recruited from university and workplace populations. Nineteen women met the International Headache Society criteria for migraine, while 15 women served as a nonmigraine comparison group. Participants completed eight instruments measuring migraine pain, disability, depressive symptomatology, and coping. The two groups of women were not significantly different on demographic variables. Migraineurs scored significantly higher for pain characteristics, disability, depressive symptomatology, and total coping scores.


Koss-Chioino, J. D. (1999). Depression among Puerto Rican women: Culture, etiology, and diagnosis. Hispanic Journal of Behavioral Sciences, 21(3), 330-350.

As in most of the societies that have been studied, more than twice the number of Puerto Rican women compared to men suffer from diagnosed depression. The aim of this article is to examine depression in women in Puerto Rico from epidemiological, etiological, and especially, experiential perspectives. This study includes a comparison of women’s complaints around negative mood states in cases within the public mental health system and equivalent cases encountered within a traditional healing system, espiritismo. Several general questions are raised concerning the effect on the etiology of depression of cultural constructions regarding female roles and statuses, reproductive events, and negative life events in general, as well as the value of closely examining the experience of depressed women relative to standard diagnostic assessments in mental health care.


Leatham, V. (2006). Bloodletting: A memoir of secrets, self-harm, and survival. Oakland: New Harbinger Publications.

On the outside, she appears to have it all. She is creative, beautiful, confident. But inside Victoria Leatham struggles with silent, secret, and unbearable pain. In her late teens, Leatham is struck with an undeniable urge to cut herself. Oddly, the wounds she inflicts on herself mute the pain she feels inside.

This memoir, a compelling and often chilling account, vividly details Leatham’s ordeal and reveals her most intimate thoughts as she struggles with cutting and a range of other psychological problems including eating disorders, sexual promiscuity, substance abuse, and bipolar disorder. And finally, it describes her discovery of the psychological secret that helps her escape from this spiral of self-destruction. Breathless readers won’t be able to put down this odyssey through one of the darkest realms of human experience.


Light, A. (1993). Dialogues with madwomen [Film]. New York: Women Make Movies.
“I was always so afraid that someone would ask me (where I was when JFK was shot), and I would have to say I was in a mental institution”, says director Allie Light. This moving and informative film features seven women–including the filmmaker–describing their experiences with manic depression, multiple personalities, schizophrenia, euphoria and recovery. Candid interviews are enriched with dramatic reenactments and visualizations of each woman’s history, emotions, and dreams–the private symbols of madness and sanity. The social dimensions of women and mental illness are revealed in testimony about sexual assault, incest, racism and homophobia, the abuses of the medical establishment, family, and church. Acknowledging that “madness” is often a way of explaining women’s self-expression, this film charges us to listen to the creativity and courage of survivors.


Little, L. (Ed.). (1999). Spotlight 16: Depressed moms & child development. Chapel Hill, NC: University of North Carolina at Chapel Hill, National Center for Early Development & Learning (NCEDL). Retrieved March 18, 2005 from http://www.fpg.unc.edu/~ncedl/PDFs/spot16.pdf

This short document contains excerpts from a study reported in the September, 1999 issue of Developmental Psychology on the effects of mothers’ depression on children. The study, carried out by the National Institute of Child Health & Human Development, is a longitudinal study following more than 1,200 children and families from 10 locations around the US. Begun in 1991, it is one of the most comprehensive on-going child care studies in the nation.


Long, K., Wood, H., & Holmes, N. (2000). Presentation, assessment and treatment of depression in a young woman with learning disability and autism. British Journal of Learning Disabilities, 28(3), 102–108.

The association between autism and affective disorders in adults with learning disability (LD) is reviewed, alongside a discussion of some of the problems identified with the accurate differential diagnosis of depression in individuals with more severe impairment. This case study describes the presentation, differential diagnosis and treatment of a young woman with a severe LD, autism and depression. Behavioural factors which were felt to reflect this individual’s depressive disorder, but which are not usually associated with the diagnosis of depression, are highlighted. Further work on the development and refinement of a reliable method of assessing depression in individuals with LD and autism is discussed.


Lunsky, Y. (2003, September). Depressive symptoms in intellectual disability: Does gender play a role? Journal of Intellectual Disability Research, 47(6), 417-427.

Background: Gender issues remain largely unaddressed in the dual diagnosis arena, even in the area of depression where there is a 2 : 1 female to male ratio in the general population. This paper argues that women with intellectual disability (ID) report higher levels of depressive symptoms than men with ID and that risk factors for depression identified for women in the general population are relevant to this group.

Method: Findings are based on structured interviews with 99 men and women with ID, with corroborative information provided from caregivers and casebook reviews.

Results: Overall, women reported higher levels of depression than men. Individuals with higher depression scores were more lonely and had higher stress levels than individuals with lower scores. Women with higher depression scores were more likely to report coming from abusive situations, to have poor social support from family and to be unemployed when compared to women with lower scores, but similar differences were not found when comparing men with higher and lower depression scores.

Conclusion: Men and women who report experiencing these psychosocial correlates of depression should be a target group for future prevention efforts, taking gender specific concerns into consideration.


Magaña., S., Seltzer, M. M., & Krauss, M. W. (2004, February). Cultural context of caregiving: Differences in depression between Puerto Rican and non-Latina white mothers of adults with mental retardation. Mental Retardation, 42(1), 1–11.

Differences in depression between Puerto Rican and non-Latina White mothers providing care to their adult child with mental retardation were examined. The focus of this study is on how family problems may mediate the effect of the adult’s behavior problems on the mother’s level of depressive symptoms and how this process differs across the two groups of mothers. As hypothesized, family problems was a stronger predictor of depressive symptoms for Puerto Rican mothers than for non-Latina White mothers. In addition, Puerto Rican mothers were in poorer physical health, which further accounted for differences in depression between the two groups.


McConnell, D., Mayes, R., & Llewellyn, G. (2008, June). Pre-partum distress in women with intellectual disabilities. Journal of Intellectual & Developmental Disability, 33(2), 177-183.

Background: This study investigates depression, anxiety and stress in pregnant women with intellectual disabilities and/or self-reported learning difficulties, and examines the association between these negative emotional states and perceived support and conflict in the women’s interpersonal relationships.

Method: Eight-hundred-and-seventy-eight women attending their first antenatal visit in a socioeconomically disadvantaged area of Sydney, Australia during a 5-month period in 2002 completed a brief questionnaire to identify those with intellectual disabilities (ID) and/or self-reported learning difficulties. These 57 women were then invited to participate in a series of three interviews (two pre- and one post-partum). The second interview, which was conducted with 31 women in their third trimester, incorporated standard measures of depression, anxiety and stress, and support and conflict in interpersonal relationships, and is the subject of the research reported here.

Results: More than one-third of the women interviewed reported moderate to severe depression, anxiety and stress. A significant association was found between depression and both perceived support and conflict in interpersonal relationships. Stress was associated with conflict but not with either perceived support. Anxiety was not significantly associated with either perceived support or conflict.

Conclusions: Negative emotional states in this population of women may be confounded with their cognitive deficits. Routine antenatal screening for negative emotional states is therefore recommended to ensure that the mental health care needs of women with ID and/or self-reported learning difficulties are not overlooked.


McLearn, K. T., Minkovitz, C. S., Strobino, D. M., Marks, E., & Hou, W. (2006, July). The timing of maternal depressive symptoms and mothers’ parenting practices with young children: Implications for pediatric practice. Pediatrics, 118(1), 174-182.

Background. The prevalence of maternal depressive symptoms and its associated consequences on parental behaviors, child health, and development are well documented. Researchers have called for additional work to investigate the effects of the timing of maternal depressive symptoms at various stages in the development of the young child on the emergence of developmentally appropriate parenting practices. For clinicians, data are limited about when or how often to screen for maternal depressive symptoms or how to target anticipatory guidance to address parental needs.

Purpose. We sought to determine whether concurrent maternal depressive symptoms have a greater effect than earlier depressive symptoms on the emergence of maternal parenting practices at 30 to 33 months in 3 important domains of child safety, development, and discipline.

Methodology. Secondary analyses from the Healthy Steps National Evaluation were conducted for this study. Data sources included a self-administered enrollment questionnaire and computer-assisted telephone interviews with the mother when the Healthy Steps children were 2 to 4 and 30 to 33 months of age. The 30- to 33-month interview provided information about 4 safety practices (ie, always uses car seat, has electric outlet covers, has safety latches on cabinets, and lowered temperature on the water heater), 6 child development practices (ie, talks daily to child while working, plays daily with child, reads daily to child, limits child television and video watching to <2 hours a day, follows 3 daily routines, and being more nurturing), and 3 discipline practices (ie, uses more reasoning, uses more harsh punishment, and ever slapped child on the face or spanked the child with an object). The parenting practices were selected based on evidence of their importance for child health and development, near complete data, and sample variability. The discipline practices were constructed from the Parental Response to Misbehavior Scale. Maternal depressive symptoms were assessed using a 14-item modified version of the Center for Epidemiologic Studies-Depression Scale. Multiple logistic regression models estimated the effect of depressive symptoms on parenting practices, adjusted for baseline demographic characteristics, Healthy Steps participation, and site. No significant interactions were found when testing analytic models with dummy variables for depressive symptoms at 2 to 4 months only, 30 to 33 months only, and at both times; reported models do not include interaction terms. We report main effects of depressive symptoms at 2 to 4 and 30 to 33 months when both are included in the model.

Results. Of 5565 families, 3412 mothers (61%) completed 2- to 4- and 30- to 33-month interviews and provided Center for Epidemiologic Studies-Depression Scale data at both times. Mothers with depressive symptoms at 2 to 4 months had reduced odds of using car seats, lowering the water heater temperature, and playing with the child at 30 to 33 months. Mothers with concurrent depressive symptoms had reduced odds of using electric outlet covers, using safety latches, talking with the child, limiting television or video watching, following daily routines, and being more nurturing. Mothers with concurrent depressive symptoms had increased odds of using harsh punishment and of slapping the child on the face or spanking with an object.

Conclusions. The study findings suggest that concurrent maternal depressive symptoms have stronger relations than earlier depressive symptoms, with mothers not initiating recommended age-appropriate safety and child development practices and also using harsh discipline practices for toddlers. Our findings, however, also suggest that for parenting practices that are likely to be established early in the life of the child, it may be reasonable that mothers with early depressive symptoms may continue to affect use of those practices by mothers. The results of our study underscore the importance of clinicians screening for maternal depressive symptoms during the toddler period, as well as the early postpartum period, because these symptoms can appear later independent of earlier screening results. Providing periodic depressive symptom screening of the mothers of young patients has the potential to improve clinician capacity to provide timely and tailored anticipatory guidance about important parenting practices, as well as to make appropriate referrals.


Metzl, J. M. (2003). Prozac on the couch: Prescribing gender in the era of wonder drugs. Durham, NC: Duke University Press.

Pills replaced the couch; neuroscience took the place of talk therapy; and as psychoanalysis faded from the scene, so did the castrating mothers and hysteric spinsters of Freudian theory. Or so the story goes. In Prozac on the Couch, psychiatrist Jonathan Michel Metzl boldly challenges recent psychiatric history, showing that there’s a lot of Dr. Freud encapsulated in late-twentieth-century psychotropic medications. Providing a cultural history of treatments for depression, anxiety, and other mental illnesses through a look at the professional and popular reception of three “wonder drugs”—Miltown, Valium, and Prozac—Metzl explains the surprising ways Freudian gender categories and popular gender roles have shaped understandings of these drugs.

Prozac on the Couch traces the notion of “pills for everyday worries” from the 1950s to the early twenty-first century, through psychiatric and medical journals, popular magazine articles, pharmaceutical advertisements, and the popular autobiographical “Prozac narratives.” Metzl shows how clinical and popular talk about these medications often reproduces all the cultural and social baggage associated with psychoanalytic paradigms—whether in a 1956 Cosmopolitan article about research into tranquilizers to “cure” frigid women; a 1970s American Journal of Psychiatry and introducing Jan, a lesbian who “needs” Valium to find a man; or Peter Kramer’s description of how his patient “Mrs. Prozac” meets her husband after beginning treatment.

Prozac on the Couch locates the origins of psychiatry’s “biological revolution” not in the Valiumania of the 1970s but in American popular culture of the 1950s. It was in the 1950s, Metzl points out, that traditional psychoanalysis had the most sway over the American imagination. As the number of Miltown prescriptions soared (reaching 35 million, or nearly one per second, in 1957) advertisements featuring uncertain brides and unfaithful wives miraculously cured by the “new” psychiatric medicines filled popular magazines. Metzl writes without nostalgia for the bygone days of Freudian psychoanalysis and without contempt for psychotropic drugs, which he himself regularly prescribes to his patients. What he urges is an increased self-awareness within the psychiatric community of the ways that Freudian ideas about gender are entangled in Prozac and each new generation of wonder drugs. He encourages, too, an understanding of how ideas about psychotropic medications have suffused popular culture and profoundly altered the relationship between doctors and patients.


Metzl, J. M. (2003). Selling sanity through gender: The psychodynamics of psychotropic advertising. In P. Gardner, J. M. Metzl, & B. E. Lewis (Eds.), Cultural Studies of Psychiatry [Feature issue]. Journal of Medical Humanities, 24(1-2), 79-103.

This paper provides a brief visual history of the ways women patients, and specifically women patients whose marital status is identified in conjunction with their “illness,” have been constructed as abnormal in the images of advertisements designed to promote psychotropic medications to an audience of psychiatrists. The advertisements I discuss come from the two largest circulation American psychiatric journals, The American Journal of Psychiatry and Archives of General Psychiatry, between the years 1964 and 2001. I use the ads to focus on two concomitant narratives. On one hand, I show how the advertisements situate the rise of “wonder drugs” in the context of an era described as the “golden age of psychopharmacology,” during which time drug treatments helped revolutionize the diagnosis and treatment of anxiety, depression, and other outpatient mental illnesses in the United States. On the other hand, the advertisements also illustrate the ways in which these new scientific treatments could not function free of the culture in which they were given meaning. In the space between drug and wonder drug, or between medication and metaphor, the images thus hint at the ways psychotropic treatments became imbricated with the same gendered assumptions at play in an American popular culture intimately concerned with connecting “normal” and “heteronormal” when it came to defining the role of women in “civilization.”


Milan, S., Ickovics, J., Vlahov, D., Boland, R., Schoenbaum, E., Schuman, P., & Moore, J. (2005, August). Interpersonal predictors of depression trajectories in women with HIV. Journal of Consulting and Clinical Psychology, 73(4), 678-688.

This article tests an interpersonal model of depression symptom trajectories tailored to the experiences of women with HIV. Specifically, the authors examined how bereavement, maternal role difficulty, HIV-related social isolation, and partner conflict predicted change in depressive symptoms over 5 years in 761 women with HIV, controlling for sociodemographic and clinical health factors. Of these interpersonal characteristics, partner conflict emerged as a robust predictor of change in depressive symptoms in growth curve and cross-lag models. Results highlight the need for interventions focusing on interpersonal issues, particularly intimate relationships, in women with HIV.


Milliken, P. J. (2001, January-February). Disenfranchised mothers: Caring for an adult child with schizophrenia. Health Care for Women International, 22(1-2), 149-166.

Interviews with 29 parent caregivers of adult children with schizophrenia discovered that they periodically redefine their parental role over the course of the family member’s illness. A grounded theory of “redefining parental identity” is briefly reviewed. As the child’s schizophrenia develops, parents come to regard themselves as disenfranchised. That is, although parents assume the right to take on responsibility for their family member, neither the legal system, mental health practitioners, nor often the ill persons themselves recognize that right. Particularly for the 16 mothers who tend to be the primary family caregivers, this lack of parental rights negatively affects their caregiving experience, especially as regards their caregiver stress, their experience of guilt and grief, and ultimately their own health.


Miles, A. (1991). The neurotic woman: The role of gender in psychiatric illness. New York: New York University Press.

This is a British study on the influence of gender on mental illness. It is based on interviews with 65 women and 20 men who were referred to outpatient psychiatric treatment for a variety of neurotic-level disorders. The book provides an overview of the major theoretical approaches to mental illness and feminist application of these approaches. The author uses these theoretical approaches to interpret the interview material and focuses on issues such as social support, stigma, work within the home and outside the home, and how people responded to the treatment they are given. The study focuses on how these people experience and interpret their lives, their mental problems, and the treatment. Many of the chapters explore the differences or similarities between the experiences of men and women. The author describes many of the women as distressed and overburdened caretakers of family members who are ill or have disabilities, and sometimes links improvement in their psychological status to changes in their caretaking role.


Mollow, A. (2006, Fall). “When Black women start going on Prozac”: Race, gender, and mental illness in Meri Nana-Ama Danquah’s Willow Weep for Me. In J. C. James & C. Wu (Eds.), Special Issue: Race, Ethnicity, Disability, and Literature. MELUS, 31(3), 67-99.

“Meri Nana-Ama Danquah’s Willow Weep for Me: A Black Woman’s Journey Through Depression (1998) is a first-person narrative by an author who, without identifying as `disabled’ or signaling any alliance with the disability rights movement, describes the ‘suffering’ her ‘illness’ caused and recounts her ‘triumph’ over it, an overcoming achieved through a combination of ‘courage,’ ‘resilience,’ prescription drugs, and other medical interventions… Examining such intersectionality in Danquah’s memoir complicates aspects of some disabled people’s critiques of the medical or psychiatric model of mental illness; for many African American women with depression, lack of access to health care, rather than involuntary administration of it, is the most oppressive aspect of the contemporary polities of mental illness” (p. 67).


Morris, C. (1997). Mental health matters: Toward a non-medicalized approach to psychotherapy with women. Women & Therapy, 20(3), 63-77.

This article discusses the epistemological biases and therapeutic risks of overly-medicalized and deterministic approaches to women’s psychological problems. Constructivist and feminist perspectives are used to illuminate the essentially political enterprise of naming psychological distress, and to argue the necessity of feminist theories of psychotherapy. These too, however, must be critically examined for deterministic assumptions which emphasize pathology or victimization, thereby limiting recognition of women’s agency, and capacity for resistance and change. One alternative model is Adler’s Individual Psychology. This humanistic approach is neither medicalized nor deterministic, assumes human freedom and purposefulness, emphasizes the dialectic interaction of the individual and society, and is philosophically committed to gender equality.


Most, D. E., Fidler, D. J., Laforce-Booth, C., & Kelly, J. (2006). Stress trajectories in mothers of young children with Down syndrome. Journal of Intellectual Disability Research, 50(7), 501-514.

Background: In this study, we investigated the early development of stress in mothers of children with Down syndrome, compared with mothers of children with developmental disabilities of mixed aetiologies. Growth modelling analyses were used to explore: (1) whether mothers of children with Down syndrome demonstrated distinct patterns of stress during their children’s early development, compared with mothers of children with other developmental disabilities; and (2) whether there was a relation between child behavioural characteristics and the level and rate of change in stress observed in each population.

Method: The stress trajectories of mothers of young children with Down syndrome (n = 25) and a mixed-aetiology comparison group (n = 49) were estimated, using growth modelling on data collected at ages of 15, 30 and 45 months.

Results: On average, stress in the mixed comparison group was higher at Time 1 and remained unchanged over time, while stress in the Down syndrome group was lower at Time 1 but increased steadily. After taking diagnostic group membership into account, more advanced cognitive-linguistic functioning and lower levels of maladaptive behaviours at all time points were associated with lower levels of maternal stress.

Conclusions: These findings suggest that the cognitive-linguistic and behavioural trajectory observed in early development in Down syndrome may contribute to the changes in maternal stress levels observed throughout these early years. Implications for developing targeted and time- sensitive family interventions for families of children with Down syndrome are discussed.


Mowbray, C. T., Lanir, S., & Hulce, M. (Eds.). (1985). Women and mental health: New directions for change. New York: Harrington Park Press.

This book is written by the Women’s Task Force of the Department of Mental Health in the State of Michigan. The book examines sex differences in mental health problems and sexist treatment by mental health agencies. The focus of the book is twofold. First, “To present the most relevant, up-to-date data and factual evidence on women’s mental health problems, causes, and treatment” (p. 2). Second, “To present recommended changes and alternatives for improving prevention and treatment of women’s mental health problems” (p. 3).

The book outlines a feminist perspective which takes into account the specific and different needs of women and men and challenges the traditional view that typically defines the woman as “the patient” and “the problem.” Instead, it is argued that what is commonly labelled “pathology” in women patients by state agencies is often women’s desperate response to highly stressful situations like loss of financial support, physical abuse, and martial problems.

The materials in this book were originally published as a special double issue of the feminist quarterly, Women & Therapy (Volume 3, Numbers 3/4, Fall/Winter 1984). The book contains a wealth of information about women and mental health and should be of interest to anyone looking for materials about sexism in mental health practices.


Mowbray, C. T., Bybee D., Hollingsworth L., Goodkind, S., & Oyserman, D. (2005, March). Living arrangements and social support: Effects on the well-being of mothers with mental illness. Social Work Research, 29(1), 41-55.

This article examines the effects of living arrangements on the well-being of mothers with a serious mental illness. Analyses of data from a National Institute of Mental Health-funded study of an urban, primarily African American sample of 379 mothers with mental illness revealed few differences in parenting or social functioning between mothers living with their children and a spouse or partner and those living with their children only. However, mothers living with their children and extended family had significantly better outcomes than women in the other two living arrangements. Structural equation modeling analyses indicated that living with relatives significantly related to mothers’ well-being (social functioning and parenting) above and beyond relatives’ provision of social support. Multilevel modeling revealed racial differences in the effects of living with relatives on functioning and parenting stress: Effects were positive for African American mothers but mixed for white American mothers.


Mowbray, C. T., Nicholson, J., & Bellamy, C. D. (2003). Psychosocial rehabilitation services needs of women. Psychiatric Rehabilitation Journal, 27(2), 104-113.

Article discusses ways to identify and respond to the needs of women receiving psychosocial rehabilitation services. The differences between men and women with psychiatric illness are described regarding diagnosis, substance abuse, victimization, physical health problems, and receipt of service. The special service needs of women may include additional areas of training in substance-use, relationship, basic survival, communication, stress management, self-help group, vocational/educational, and peer support/counseling skills. Methods to address the rehabilitation needs of women with psychiatric disabilities are presented.


Muñoz, J. E. (2006). Feeling brown, feeling down: Latina affect, the performativity of race, and the depressive position. Signs: Journal of Women in Culture and Society, 31(3), 675-688.

“Depression has become one of the dominant affective positions addressed within the cultural field of contemporary global capitalism. However, such a blanket statement requires fine-tuning. While art and media that depict the affective contours of depression have certainly become more prevalent, it is nonetheless important to be attentive to the ways in which the current historical moment is able to mimetically render various depictions of the problem of depression that plagues the contemporary citizen subject with a crypto-universalist script. Certainly depression is gendered. Female depression and male depression resonate quite differently. While female depression is more squarely framed as a problem, the depression that plagues men is often described as a full-on condition, registering beyond the sphere of the individual, linked to a sort of angst and longing that are often described as endemic to postmodernism. However, that statement also requires some amending insofar as such a distinction reproduces a default white subject. The topic of depression has not often been discussed in relation to the question of racial formations in critical theory. This essay dwells on a particular depiction of depression that most certainly speaks to the general moment but resists the pull of crypto-universalism. The art project at the center of this essay considers how depression itself is formed and organized around various historical and material contingencies that include race, gender, and sex” (p. 675).


Nicholson, J., & Henry, A. D. (2003). Achieving the goal of evidence-based psychiatric practices for mothers with mental illnesses. Psychiatric Rehabilitation Journal, 27(2), 122-130.

Article presents the rationale for standardized interventions that have been shown to improve outcomes for mothers with psychiatric disorders, as measured objectively in research conducted by independent investigators. Suggestions for relevant interventions are derived from the recommendations of mothers with a mental illness, generic parent intervention models, interventions specifically developed for mothers with a mental illness, and evidence-based practices proven effective with adults with mental illness. The value of a psychiatric rehabilitation approach and the challenges inherent in documenting and testing interventions are discussed.


Nicki, A. (2001, Fall). The abused mind: Feminist theory, psychiatric disability, and trauma. In E. Kittay, S. Silvers, & S. Wendell (Eds.), (2001, Fall). Special issue: Feminism and disability. Hypatia, 16(4), 80-104.

“I show how much psychiatric disability is informed by trauma, marginalization, sexist norms, social inequalities, concepts of irrationality and normalcy, oppositional mind-body dualism, and mainstream moral values. Drawing on feminist discussion of physical disability, I present a feminist theory of psychiatric disability that serves to liberate not only those who are psychiatrically disabled but also the mind and moral consciousness restricted in their ranges of rational possibilities.”


Nicki, A. (2002, October). Feminist philosophy of disability, care ethics and mental illness. Nursing Philosophy, 3(3), 270-273.

Thought-provoking critique of feminist philosophy of disability, especially how it focuses more on physical disabilities rather than mental disabilities.


Nolen-Hoeksema, S., & Keita, G. P. (Eds.). (2003, June). Women and depression [Special section]. Psychology of Women Quarterly, 27(2).

Although women’s 2 to 1 likelihood of developing a depressive disorder is a well-established fact, research over the last decade has expanded our knowledge of risk factors and issues of treatment and service delivery. The American Psychological Association convened an interdisciplinary Summit in 2000 on Women and Depression to examine these findings and to make recommendations on future research and policy needs, and to highlight treatment implications. This special section contains five articles from the Summit addressing a range of issues, including the relationship between women’s depression and their lesser power and status in society (resulting in physical and sexual abuse and poverty), and the menstrual cycle and depression. Additionally, the special section includes articles on the rehabilitation of women with depression and treatment of depressed women in primary care settings.

For more information, the document, Summit on Women and Depression: Proceedings and Recommendations, can be accessed online at www.apa.org/pi/wpo/womendepression.pdf.


Niemeier, J. P. (2008). Unique aspects of women’s emotional responses to disability. In M. J. Scherer & M. A. Dicowden (Eds.), Feature issue: Issues Regarding Women with Disabilities. Disability & Rehabilitation, 30(3), 166-173.

Purpose. To improve rehabilitation clinicians’ awareness of gender differences in emotional responses to disability as a means of enhancing accuracy and sensitivity in diagnosis and treatment of persons in their care.

Method. A prospective survey study using a new grief measure, the Loss Inventory (LI), with a diverse convenience sample of persons undergoing inpatient rehabilitation in the USA. Focused review of the bereavement, depression, and disability literatures related to observed gender differences.

Results. Study participants reported grief symptoms in varying intensities. Consistent with all literature reviewed, significant gender differences were found in kind and intensity of grief and depression symptoms reported. Ethnicity also significantly affected responses to disability by LI study participant responses.

Conclusions. While persons with disabilities as a whole may not necessarily develop depression, gender is a risk factor for onset of mood problems after illness or injury-related losses. As compared with study sample disabled men, disabled women reported more intense and different symptoms of grief and depression. Women with disabilities in the LI sample were twice as likely as disabled men to be depressed. Rehabilitation clinicians may wish to incorporate consideration of these differences in their mental health assessments, diagnoses, and treatment plans.


Nosek, M. A., & Hughes, R. B. (2001, January/February/March). Psychospiritual aspects of sense of self in women with physical disabilities. Journal of Rehabilitation, 67(1), 20-25.

This paper reviews findings on sense of self and spirituality that have emerged in several of the studies conducted by the Center for Research on Women with Disabilities. It presents a review of literature on self-esteem, self in connection to others, and self-efficacy, and describes findings from two qualitative and one quantitative study of these constructs in women with disabilities. Discussion leads to the hypothesis that the sense of self in connection to others is a fundamental determinant of self-esteem, and that self-efficacy, when perceived as a power drawn from a divine source, is an important mechanism used to transcend the challenges to both that often accompany disability.


Nosek, M. A., & Hughes, R. B. (2003, June 1). Psychosocial issues of women with physical disabilities: The continuing gender debate. Rehabilitation Counseling Bulleting, 46(1), 224-233.

Rehabilitation and disability-related research has only recently begun to examine the complex interaction of gender and disability. Women with disabilities experience the double impact of being female and disabled. As women, they have greater risks of psychosocial health problems than do men. As persons with disabilities, they may be even more vulnerable to these gender disparities; for example, compared to women in general, women with disabilities report higher rates of depression and stress. This article describes a new and promising body of research. We offer evidence that corrects any misunderstandings held by rehabilitation specialists that the psychosocial experiences of women with disabilities can be explained by research conducted on men with disabilities or women in general. Clinically and empirically based gender-driven recommendations are offered for research and practice.


Nosek, M. A., Hughes, R. A., & Robinson-Whelen, S. (2008). The complex array of antecedents of depression in women with physical disabilities: Implications for clinicians. In M. J. Scherer & M. A. Dicowden (Eds.), Feature issue: Issues Regarding Women with Disabilities. Disability & Rehabilitation, 30(3),174-183.

Purpose. This article discusses the complex interrelation of elements of the physical, psychological, social, and environmental life context of women with physical disabilities and the association of these elements with significant disparities in rates of depression and access to mental health care for this population.

Method. Literature and concept review.

Results. High rates of depression in women with physical disabilities are well documented in the literature. Many elements that are disproportionately common in the lives of women with physical disabilities, including socio-economic disadvantage, functional limitations, pain and other chronic health conditions, poor diet, physical inactivity, smoking, violence, low self-esteem, sexuality problems, chronic stress, environmental barriers, and barriers to health care, have also been linked with higher rates of depression and depressive symptomatology. Depression self-management interventions tailored for women with disabilities have been developed and proven effective.

Conclusions. Many women who must deal with the stresses surrounding an array of health problems may experience symptoms of depression without necessarily meeting the criteria for clinical depression. Psychologists, counselors, primary care physicians, specialists, and other medical and rehabilitation professionals are challenged to recognize the symptoms of depression in women with physical disabilities and assist them in obtaining appropriate psychological and pharmacological interventions.


Nosek, M. A., Hughes, R. B., Swedlund, N., Taylor, H. B., & Swank P. (2003, April). Self-esteem and women with disabilities. Social Science & Medicine, 56(8), 1737-1747.

This study examines the sense of self of women with physical disabilities in terms of self-esteem, self-cognition (perceptions of how others see them), and social isolation. It was hypothesized that these variables mediate the relation of precursor variables (age, education, severity of disability, and childhood experiences, including overprotection, familial affection, and school environment) and outcomes (intimacy, employment, and health promoting behaviors). Data were gathered from a sample of 881 community-dwelling women in the USA, 475 with a variety of mild to severe physical disabilities, and 406 without disabilities. Correlation analyses indicated that the women with disabilities had significantly lower self-cognition and self-esteem, and greater social isolation than the women without disabilities, as well as significantly less education, more overprotection during childhood, poorer quality of intimate relationships, and lower rates of salaried employment. Path analysis indicated that each of the sense of self mediators was significantly related to the outcome of intimacy, that both social isolation and self-esteem were significantly related to health promoting behaviors, and that only self-esteem was significantly related to employment. Respondents who were older, less disabled, less educated, less over-protected, and had more affection shown in the home tended to feel that others saw them more positively. Women with positive school environments, less over-protection, and more affection in the home experienced less social isolation; age, education, and disability severity were not significantly related to social isolation. Older respondents with less disability, a more positive school environment, less over-protection, and more affection in the home tended to have greater self-esteem; education was not significantly related to self-esteem. Older respondents tended to report less intimacy. Younger, more educated, and less disabled respondents were significantly more likely to be employed. More highly educated respondents reported engaging in more health promoting behaviors.


Nosek, M. A., Hughes, R. B., & Robinson-Whelen, S. (2008). The complex array of antecedents of depression in women with physical disabilities: Implications for clinicians. Disability & Rehabilitation, 30(3), 174-183.

Purpose. This article discusses the complex interrelation of elements of the physical, psychological, social, and environmental life context of women with physical disabilities and the association of these elements with significant disparities in rates of depression and access to mental health care for this population.

Method. Literature and concept review.

Results. High rates of depression in women with physical disabilities are well documented in the literature. Many elements that are disproportionately common in the lives of women with physical disabilities, including socio-economic disadvantage, functional limitations, pain and other chronic health conditions, poor diet, physical inactivity, smoking, violence, low self-esteem, sexuality problems, chronic stress, environmental barriers, and barriers to health care, have also been linked with higher rates of depression and depressive symptomatology. Depression self-management interventions tailored for women with disabilities have been developed and proven effective.

Conclusions. Many women who must deal with the stresses surrounding an array of health problems may experience symptoms of depression without necessarily meeting the criteria for clinical depression. Psychologists, counselors, primary care physicians, specialists, and other medical and rehabilitation professionals are challenged to recognize the symptoms of depression in women with physical disabilities and assist them in obtaining appropriate psychological and pharmacological interventions.


O’Toole, C. J., & Brown, A. A. (2002, December). No reflection in the mirror: Challenges for disabled lesbians accessing mental health services. Journal of Lesbian Studies, 7(1), 35-49.

Lesbians with disabilities have atypical life experiences–they are virtually invisible within the mainstream culture. Both women with disabilities and lesbians experience societal, familial and economic pressures that directly impact their lives and the range of options available to them. When a lesbian is also a woman with a disability, the combination of these pressures has important mental health implications. This article explores the issues and barriers related to disabled lesbians accessing mental health services. Because no systematic research on the mental health needs and experiences of lesbians with disabilities exists, it is unknown how many of them are in need of, access, or are denied appropriate mental health services. The little research that exists on the mental health needs of women with disabilities has either excluded or ignored the particular experiences associated with lesbian identity. Likewise, lesbian mental health research has historically overlooked disabled women’s identity and experiences. Shared experiences and other similarities, such as discriminatory attitudes in the health service system, social stigma, and self-devaluation, are discussed within the context of disabled lesbians’ compounded risk for mental health problems. Service access and barriers, key therapeutic issues, and cultural competency are discussed as additional issues that emerge when addressing mental health services. We also examine how lesbians with disabilities have proactively networked, caring for each other through informal supports within their communities, and have creatively developed their own strategies and resources. The paper concludes with a discussion of new efforts toward gaining visibility, successful strategies for mental health practitioners in addressing issues and challenges associated with providing care to lesbians with disabilities, and recommendations for further research.


Palmer, C. J. (2003). Body mass index, self-esteem, and suicide risk in clinically depressed African American and white American females. Journal of Black Psychology, 29(4), 408-428.

Self-esteem and depression, as well as depression and body mass index (BMI), have consistently been found to be significantly associated for African American and White American females. The results are dissimilar when BMI and self-esteem are studied. Historically, the relationship between BMI and self-esteem is weak or nonexistent for African American females; however, for White American females, the relationship is usually significant. The goal of this study was to determine whether clinically depressed, healthy-weight, overweight, and obese females would differ significantly on self-esteem and suicide risk measures. In a voluntary hospital-based inpatient psychiatric unit, 165 clinically depressed females completed the self-esteem rating scale and the suicide risk scale. Healthy-weight, overweight, and obese African American females did not differ significantly on measures of self-esteem and suicide risk. However, depressed, obese White American females had significantly lower self-esteem and increased suicide risk than depressed healthy-weight and overweight White American females. Implications of the current results are discussed.


Pentland, W., Miscio, G., Eastabrook, S., & Krupia, T. (2003). Aging women with schizophrenia. Psychiatric Rehabilitation Journal, 26(3), 290-302.

Article presents findings of a study that examined the experiences of aging women with schizophrenia, their perceived concerns and issues, and how they cope with aging. All of the participants reported feeling that their lives have improved with age, despite traumatic losses and suffering in the past and physical declines that currently make doing things harder. The women expressed that life is better because they have fewer responsibilities, their schizophrenia is improving, and they understand themselves better. Major concerns expressed were their future mental and physical health, and who will care for them if they get sick. The women developed numerous coping strategies that help them deal with their symptoms as well as support from family and friends, health care professionals and medication, their lodging home and its staff, and community health services.


Pickens, J. M. (2003, March). Formal and informal social networks of women with serious mental illness. Issues in Mental Health Nursing, 24(2), 109-127.

The case study method was used to describe formal and informal social networks of four women with serious mental illness and to capture what happens in network interactions. Supportive roles were identified, with significant overlap between roles performed by formal and informal network members. In contrast to many studies, this study’s participants all showed reciprocity in relationships. Network relationships, while supportive, often were conflicted. Themes related to stability of relationships were identified. Practice recommendations include recognition of each person’s “context” apart from his or her illness and the importance of capitalizing on positive factors within the person’s life context. Further research is needed to identify confirming and contradictory findings.


Pinto-Foltz, M. D., & Logsdon, M. C. (2008, January). Stigma towards mental illness: A concept analysis using postpartum depression as an exemplar. Issues in Mental Health Nursing, 29(1), 21-36.

Stigma towards mental illness is poorly understood, often unrecognized by nurses, and impacts both treatment seeking behavior and treatment adherence. Stigma towards mental illness is a serious issue in all cultures and ethnicities, and has a detrimental impact on an individual’s functioning in all life domains. The aim of this analysis is to clarify the modern use of the concept of stigma towards mental illness, using the Walker and Avant concept analysis method, with postpartum depression as the exemplar. The second aim is to promote further dialogue about stigma in nursing. This analysis provides a foundation for further concept exploration in nursing, and generates hypotheses to be tested in various populations and circumstances. Nursing interventions, implications for research, and further concept development are discussed.


Porter, R. (1987). Mad women. In R. Porter (Ed.), A social history of madness: The world through the eyes of the insane (pp. 103 124). New York: Weidenfeld & Nicolson.

This chapter on “mad women” is in a book that explores the lives of “mad people” as they themselves recorded them. Much of the history of madness has focused on medicine or psychiatry. This book is different in that it attempts to explore the thoughts and feelings of mad people from earlier centuries and is based on their autobiographical writings. In the chapter on mad women the author reflects upon autobiographical writings by women and much of the chapter centers around madness and women’s gender roles. The author is critical of traditional psychiatry and points out, among other things, that liberationalist psychiatry does not seem to have had a desire to free women from traditional gender roles.


Posen, J., Moore, O., Tassa, D. S., Ginzburg, K., Drory, M., & Giladi, N. (2000). Young women with PD: A group work experience. Social Work in Health Care, 32(1), 77-91.

Parkinson’s Disease (PD) affects between 5-10% of the PD population prior to the age of 40. The psychosocial changes that patients with early PD encounter may be more devastating and disabling than the actual motor disability. The paper describes a unique experience in group work with young female PD patients treated in the Movement Disorders Unit of the Tel Aviv Sourasky Medical Center. The paper focuses on the special issues which characterized this group’s experience: stigma, body and sexual image, and personality traits.


Poulin, C., & Gouliquer, L. (2003). Part-Time Disabled Lesbian Passing on Roller Blades, or PMS, Prozac, and Essentializing Women’s Ailments. In M. E. Banks & E. Kaschak (Eds.), Women with visible and invisible disabilities: Multiple intersections, multiple issues, multiple therapies, Part I [Special issue]. Women & Therapy, 26(1/2), 95-108.

This paper discusses the role of the medical and psychiatric systems, as well as the pharmaceutical industry, in the social construction of women’s hormonally-related ailments and their treatments. For some marginalised groups, passing as normal is a protection strategy against discrimination and maltreatment. Lesbians and invisibly disabled persons are examples of such groups. Given that the reproductive cycle and madness have been linked historically, women suffering from disabling cyclical conditions might also be stigmatised. In this context, the dilemma between seeking treatment versus being labelled psychologically ill is expounded.


Proctor, G. (2001, May). Listening to older women with dementia: Relationships, voices and power. Disability & Society, 16(3), 361-376.

Four older women with dementia were interviewed about their experiences of their services. People with dementia are rarely asked for their opinions or judged to be fully legitimate persons. Gaps in previous research concerning people with dementia is presented, with respect to listening to people with dementia themselves and with respect to gender issues. The present study is described and the methodology for analysis, Brown and Gilligan’s Voice Relational Method, is presented. This method was developed to listen to adolescent girls and has been used to listen to the voices of others who are disempowered in society. Its focus on relationships and issues of power was useful in this study. The methodology is presented in the context of debates within feminist and disability research. The results of the interviews are discussed, particularly with respect to power in the women’s relationships, and particularly the relationships between the women with dementia and medical staff. Some implications of these power issues are presented and recommendations are made.


Ramsay, R., Welch, S., & Youard, E. (2001, March). Needs of women patients with mental illness. Advances in Psychiatric Treatment, 7(2), 85-92.

“Women patients suffer from a range of mental disorders similar to those that men may experience. However, there are some striking differences in the prevalence of specific disorders, and in their presentation and management. Some mental illnesses only occur in women. It seems that women patients may have a different experience of treatment, a consequence of differences in their needs and also of the way that health professionals perceive those needs. These differences are embedded in the wider cultural milieu in which we live. There are particular issues for women patients in relation to, for example, childhood sexual abuse, rape and domestic violence. At present, tools to measure needs of individual patients are generally not gender specific.”


Rayburn, N. R., Wenzel, S. L., Elliott, M. N., Hambarsoomians, K., Marshall, G. N., & Tucker, J. S. (2005, August). Trauma, depression, coping, and mental health service seeking among impoverished women. Journal of Consulting and Clinical Psychology, 73(4), 667-677

The authors examined the relationship among trauma, coping, depression, and mental health service seeking in a probability sample of sheltered homeless and low-income housed women. Results highlight the diversity of trauma. In a longitudinal analysis, women who lived in shelters or experienced major violence had a twofold increase in their risk of depression over the 6-month follow-up. In a cross-sectional analysis, childhood sexual abuse, living in a shelter, physical violence, childhood physical abuse, and death or injury of a friend or relative predicted avoidant coping and symptoms of depression. Active coping and depression predicted mental health service seeking among traumatized women. Modifying coping strategies may ameliorate some of the negative impact of trauma and potentially enhance mental health service use among at-risk women.


Reeves, J. (1993). Chronic and other films [Video]. New York: Women Make Movies.
This collection of films from emerging filmmaker Jennifer Reeves includes The Girl’s Nervy, Monsters in the Closet, and Chronic. Innovative, perceptive, and powerful, each challenges filmic conventions. The Girl’s Nervy is a cut and paste study of the single frame and the eye’s rhythms. Monsters in the Closet links stories of little girls and girl gangs with tales from the closet of adolescence. Chronic is an experimental narrative of one young woman living with “so-called” mental illness. Beautiful and skillful, it probes her misogynistic and violent surroundings for the motives behind her compulsive self-mutilation.


Reece, J. (2005, July). The language of cutting: Initial reflections on a study of the experiences of self-injury in a group of women and nurses. Issues in Mental Health Nursing, 26(6), 561-574.

Non-suicidal self-injury is a distressing act, which can arouse dissent and negative comment in service users and providers. The purpose of the study was to describe how women who self-injure and nurses assign meaning to shared discourses about self-injury. The wider study is framed in a grounded theory methodology. Fourteen qualified nurses and 11 women who have self-injured were interviewed using unstructured and initially open-ended interviews, lasting 45–90 minutes. Initially a thematic analysis was used to code data. In this report, three of the early themes are reported with some comparative interpretations. Nurses lack understanding of the meanings of cutting behaviour. A common language is needed if nurses are to be effective in helping women who have self-injured to express distress in less damaging ways.


Research and Training Center on Disability in Rural Communities. (2007, July). Rural women with disabilities and depression, part one: Characteristics and treatment patterns [Rural Disability and Rehabilitation Research Progress Report #36]. Missoula, MT: The University of Montana Rural Institute. Available: http://rtc.ruralinstitute.umt.edu/health/Depression.htm.

“Th(is) study tested the effectiveness of a peer-led depression self-management intervention for rural women with physical disabilities.”


Rice, D. (1999). Daughter of suicide [film]. New York: Women Make Movies.

Daughter of Suicide is the story of my journey, but it reflects the journey of many other survivors of suicide in the United States. I provide pieces to one woman’s complex puzzle of memories, ideas, emotions and facts and in doing so explore issues that are repeated time and time again in the lives of people who take their own lives. I, like many survivors of suicide, have realized that my connection to my mother is through friends and family and through my memories of my young childhood before my mother became ill. In getting to know her through the making of the film, I have also realized just how great the loss of life to suicide is. I will never know the woman I discovered making this film, but I hope that her story will help others to recognize the dangers of depression in themselves and in the people they love.”

A detailed synopsis and study guide is available at http://www.daughterone.net/dosTheFilm.html


Rich-Edwards, J. W., Kleinman, K., Abrams, A., Harlow, B. L., McLaughlin, T. J., Joffe, H., & Gillman, M. W. (2006). Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. Journal of Epidemiology and Community Health, 60(3), 221-227.

Objective: Data are scarce regarding the sociodemographic predictors of antenatal and postpartum depression. This study investigated whether race/ethnicity, age, finances, and partnership status were associated with antenatal and postpartum depressive symptoms.

Setting: 1662 participants in Project Viva, a US cohort study.

Design: Mothers indicated mid-pregnancy and six month postpartum depressive symptoms on the Edinburgh postpartum depression scale (EPDS). Associations of sociodemographic factors with odds of scoring >12 on the EPDS were estimated.

Main results: The prevalence of depressive symptoms was 9% at mid-pregnancy and 8% postpartum. Black and Hispanic mothers had a higher prevalence of depressive symptoms compared with non-Hispanic white mothers. These associations were explained by lower income, financial hardship, and higher incidence of poor pregnancy outcome among minority women. Young maternal age was associated with greater risk of antenatal and postpartum depressive symptoms, largely attributable to the prevalence of financial hardship, unwanted pregnancy, and lack of a partner. The strongest risk factor for antenatal depressive symptoms was a history of depression (OR = 4.07; 95% CI 3.76, 4.40), and the strongest risk for postpartum depressive symptoms was depressive symptoms during pregnancy (6.78; 4.07, 11.31) or a history of depression before pregnancy (3.82; 2.31, 6.31).

Conclusions: Financial hardship and unwanted pregnancy are associated with antenatal and postpartum depressive symptoms. Women with a history of depression and those with poor pregnancy outcomes are especially vulnerable to depressive symptoms during the childbearing year. Once these factors are taken in account, minority mothers have the same risk of antenatal and postpartum depressive symptoms as white mothers.


Robinson-Whelen, S., Hughes, R. B., Taylor, H. B., Hall, J. W., & Rehm, L. P. (2007, August). Depression self-management program for rural women with physical disabilities. Rehabilitation Psychology, 52(3), 254-262.

Objective: To examine the efficacy of a depression self- management intervention for rural women with physical disabilities.

Participants and Design: A sample of 96 rural women with disabilities experiencing depression, who were recruited through centers for independent living (CILs), were randomly assigned to either a depression self-management intervention or a control group, and completed pre-, post-, and 3-month follow-up questionnaires.

Intervention: An 8-week depression self-management program led by CIL staff members who received preintervention training and ongoing clinical supervision.
Measures: Primary outcomes were the Beck Depression Inventory II (BDI–II) and the 10-item Center for Epidemiologic Studies–Depression scale (CESD-10).

Results: Relative to the control group, women in the intervention group demonstrated a greater reduction in BDI–II scores at posttest and follow-up. Significant differential improvement was not observed on the CESD-10 or on the following hypothesized mediators: self-efficacy, depression self-management skills, social support, and connectedness.

Conclusion: A brief, peer-led, depression self-management program resulted in a reduction of depressive symptomatology on 1 of the 2 measures of depression. This study serves as 1 model for delivering depression treatment to a rural population with significant needs yet extremely limited access to mental health services.


Rosefield, S. (2003, June). Gender stratification, stress, and mental illness. In A. Maney & J. Ramos (Eds.), Socioeconomic conditions, stress and mental disorders:
Toward a new synthesis of research and public policy.
Bethesda, MD: National Institute of Mental Health (NIMH). Retrieved March 13, 2005 from http://www.mhsip.org/pdfs/rosenfield.pdf

“The search for… social positions and experiences [of women vs. men] is the subject of this analysis. Major institutions, such as the workplace and the family, shape social roles and experiences. Stratified by gender, these institutions produce different stresses for males and females and differential access to social and personal resources. Furthermore, such gender inequalities are reproduced through differential socialization of males and females. Childhood socialization shapes core dimensions of the self that are consistent with adult social roles and positions. These socialization processes combine with adult experiences to produce different types of mental disorders in males and females throughout the life course.”


Sachs, G., Amering, M., Berger, P., & Katschnig, H. (2002, May). Gender related disabilities in panic disorder. Archives of Women’s Mental Health, 4(4), 121-127.

Gender differences with regard to specific psychosocial factors were investigated in 100 outpatients with the diagnosis of panic disorder (DSM-IV) with and without agoraphobia (78% with agoraphobia). Patients were recruited for a randomized clinical trial of paroxetine alone versus paroxetine plus a specific form of group psychotherapy. Similar to previous results, no significant differences were found on measures of demographic data, symptomatology and comorbidity. However, psychosocial disabilities and interpersonal problems were associated with being female. Family function was more highly impaired in women than in men, and women had a higher rate of catastrophic thinking. Women differed from men in one interpersonal factor, namely being overly expressive.


Sales, E., & Frieze, I. H. (1984). Women and work: Implications for mental health. In L. E. Walker (Ed.), Women and mental health policy [Sage Yearbooks in Women’s Policy Studies] (pp. 229 246). Newbury Park, CA: Sage Publications.

One of the most noted social trends in recent decades is the dramatic increase in women’s labor force participation. This chapter examines what implications this may have for women’s mental health. Because women have been heavy users of mental health services some authors have suggested that women’s increased labor force participation, especially mothers with young children, might increase stress and result in more mental health problems. Others have suggested that because work is central to adult adjustment and a major source of satisfaction, women’s increased labor force participation should have the opposite effect; it should improve their mental health. After a thorough review of the literature on the topic the authors conclude that the evidence regarding the mental health consequences of work for women shows many positive relationships while few negative effects have been found. They state that work is clearly a source of self-esteem and satisfaction for most women. They also point out that the group of women who are most at risk of having mental health problems are non-white, nonmarried, nonemployed women, and women who lived in social isolation with limited roles. This suggests that the women who may most need mental health services may be those not in the work arena, especially women who are isolated or homebound because of young children or limited social roles.


Sartori, G. (1995). Toward empathy: Access to transition houses for psychiatrized women. Whitehorse, YT: Second Opinion Society of Whitehorse.

In 1990, the disAbled Women’s Network (DAWN Canada) published a report called Meeting Our Needs: An Access Manual for Transition Houses. The authors had looked extensively at the situation of disabled women in accessing transition house services in an abuse crisis. Of the various categories of disability that they examined, “psychiatrically disabled” women were the most likely to seek such services–and the most likely to be turned away on the basis of their disability. This manual is designed to promote the equal access to transition houses that DAWN Canada found lacking. It is written by and from the point of view of women who have experienced psychiatric treatment.


Schreiber, R. (2001, January-February). Wandering in the dark: Women’s experiences with depression. Health Care for Women International, 22(1-2), 85-98.

In North America, rates of depression for women are consistently higher than for men. This phenomenon is poorly understood; nonetheless, the use of grounded theory to investigate women’s experiences with depression, treatment, and recovery revealed some unexpected findings. In this article I discuss findings resulting from examination of data from three grounded theory studies of women and depression. In all, data were collected through participant observation and more than 70 interviews and the study sample included participants varying in race, marital status, cultural background, and sexual orientation between 18 to 69 years of age, and included both mothers and nonmothers. Findings included the presence in women of an internal dialogue, reinforcing the philosophical origins of the method in symbolic interactionism; oppression and marginalization of women’s experiences; the impact of violence in women’s lives; the roles of treatment and learning; and the hope of recovery. I will finish by identifying some questions arising from the findings.


Shannonhouse, R. (Ed.). (2003). Out of her mind: Women writing on madness. New York: The Modern Library.

Out of Her Mind, edited by Rebecca Shannonhouse, captures the best literature by and about women struggling with madness. A remarkable chronicle of gifted and unconventional women who have spun their inner turmoil into literary gold, the collection features classic short stories, breathtaking literary excerpts, key historical writings, and previously unpublished letters by Zelda Fitzgerald.


Shaw, C., & Proctor, G. (2005, November). Women at the margins: A critique of the diagnosis of Borderline Personality Disorder. Feminism & Psychology, 15(4): 483–490.

“The diagnosis of borderline personality disorder (BPD) is applied predominantly to women and, in particular, to survivors of childhood sexual abuse. In this article, we argue that this diagnosis distracts from the aetiological importance for psychological distress of the experience of childhood sexual abuse, and that it pathologizes survivors. We have developed our understandings of the psychiatric response to women’s distress within very different locations in the psychiatric power structure–one as service survivor with a diagnosis of BPD, one as a clinical psychologist. Yet, differently located as we are, we both believe that the diagnosis of BPD individualizes and pathologizes women for their responses to oppression, because of its fundamental failure to locate and understand distress within its social context. We draw on feminist, postmodern and anti-psychiatric critiques in order to present and develop our shared perspective on the diagnosis of BPD, and challenge health professionals and wider society to locate survivors’ distress within the context of sexual violence and gender power relations in society.”


Simsek, Z., Ak, D., Altindag, A., & Günes. M. (2008). Prevalence and predictors of mental disorders among women in Sanliurfa, Southeastern Turkey.
Journal of Public Health, 30(4), 487-493.

Background: Mental health is one of the most important public health issues because of major contributor to the global burden of disease. In this study, we examined the prevalence and predictors of mental disorders among married women from 15 to 49 years of age and the need for mental health services in the primary health care settings.

Methods: In this cross-sectional study, 270 women were selected using probability cluster sampling method at 95% confidence interval (91.5% response rate). The Structured Clinical Interview for DSM-IV (SCID-I) and women socio-demographic information form were used to collect data.

Results: Although the prevalence of mental disorder was 25.9% (8.5% with one diagnosis; 17.4% were two or more diagnoses), 4.7% of these women had contacted a carer in the last year for psychological reasons. According to the SCID-I assessment, the most prevalent diagnoses were major depressive disorder (7.3%), phobic disorder (4.8%) and posttraumatic stress disorder (3.6%). In this study, comorbid diagnoses were present in 67.2% of patients. Logistic regression analyses revealed that domestic violence, history of previous trauma, anemia and cutaneous leishmaniasis were significant predictors of any mental disorders (P < 0.05).

Conclusions: These findings highlight the need for systematic development of community-based mental health services in conjunction with primary health care services for the screening, early identification and treatment of women suffering from mental disorders, and the improvement of anemia and cutaneous leishmaniasis control programme.


Singer, G. H. S. (2006). Meta-analysis of comparative studies of depression in mothers of children with and without developmental disabilities. American Journal on Mental Retardation, 111(3), 155-169.

Meta-analysis was used to synthesize findings from comparative studies of depression in mothers of children with and without developmental disabilities. Effect sizes were determined for 18 studies conducted between 1984 and 2003. A weighted effect size of .39 indicated an elevated level of depression in mothers of children with developmental disabilities. Planned comparisons found that age of child and disability category moderated effect sizes. Results show that mothers of children with developmental disabilities are at elevated risk of depression compared to mothers of typically developing children. Depression in mothers of children with developmental disabilities is a condition that is presently not being addressed on a wide scale, although promising interventions are available.


Smith, D. E. (1990). The conceptual practices of power: A feminist sociology of knowledge [The Northeastern Series of Feminist Theory]. Boston: Northeastern University Press.

In this book Dorothy Smith, one of the leading feminist theorists today, argues that conventional sociology perpetuates traditional patriarchal relations of power through ideological practices. She is especially concerned with the application of sociological ideology to the human service bureaucracy and the way institutions of mental health reconstruct women’s lives.


Stacciarini, J. R. (2008, July). Focus groups: Examining a community-based group intervention for depressed Puerto Rican women. Issues in Mental Health Nursing, 29(7), 679-700.

Puerto Ricans manifest high rates of depression but avoid seeking treatment. The purpose of this pilot was to learn directly from Puerto Rican women how culturally appropriate they would consider a proposed community-based intervention for treating depression. Interactive activities were reviewed by two focus groups of women (N = 16), all working in community-based health programs. All activities (e.g., writing, role playing, and music) except individual drawing were deemed appropriate. Categories that emerged were family/community values, mainland/non-mainland cultural variances, communication style, religion, education/occupational variances, health beliefs, Puerto Rican traditions/customs, emotions, and coping skills. Categories provided guidance for refining a community-based intervention for treating depression in Puerto Rican women.


Stoppard, J. M., & McMullen, L. M. (Eds.). (2003). Situating sadness: Women and depression in social context [Qualitative Studies in Psychology Series]. New York: NYU Press.

It is well known that depression occurs more often in women than in men. It is the most commonly encountered mental health problem among women and ranks overall as one of the most important women’s health problems.

Researchers have studied depression a great deal, yet women’s depression has rarely been the primary focus. The contexts of women’s lives which might contribute to their depression are not often addressed by the mental health establishment, which tends to focus on biological factors. Situating Sadness sheds light on the influence of sociocultural factors, such as economic distress, child-bearing or child-care difficulties, or feelings of powerlessness which may play a significant role, and points to the importance of context for understanding women’s depression.

Situating Sadness draws on research in the United States and other parts of the world to look at depression through the eyes of women, exploring what being depressed is like in diverse social and cultural circumstances. It demonstrates that understanding depression requires close attention to the social context in which women become depressed.


Swartz, S. (2006, November). The third voice: Writing case-notes. Feminism & Psychology, 16(4), 427-444.

The article examines the activity of writing case-notes. For this purpose, case-notes are broadly defined as textual records of encounters between mental health practitioners and their clients. The primary focus is on psychotherapy notes, written for private use. It suggests that note writing is potentially a lively addition to the dialogue within the therapy room, an essential part of the unique relationship that grows between practitioner and client. In particular, it looks at the possibilities of representing intersubjectivity, the third voice, emerging from the dialogue between two subjectivities, in ways that forward both theoretical understanding and the therapeutic endeavour. It will argue that serious engagement with case-notes must of necessity tackle questions of voice, speaking rights, a variety of deafnesses, power, the inscription or oblation of race and gender in professional discourses, and reclamation of knowledge colonized by patriarchal and colonial structures of authority. It is feminist in its orientation. It speaks from a postcolonial African context, and a psychoanalytic approach, and draws on psychotherapy experience saturated with those foundational identities.

Included in this issue of Feminism & Psychology are a series of responses and rejoinders to Swartz, including:
I. Analytic Third or Law? Reflection vs. Regulation in Psychotherapy Case Notes
II. Response to Sally Swartz’s Article on Writing Case-notes
III. Creating the Text of Therapy: A Fourth Voice
IV. Commentary on ‘The Third Voice: Writing Case-notes’
V. Never Mind the Qualitative, Feel the Documentation
VI. Reflecting on the Third Voice from a Narrative Perspective
VII. Two Voices Are Just Fine By Me
VIII. Story, Voice, Text


Taggart, L., McMillan, R., & Lawson, A. (2008). Women with and without intellectual disability and psychiatric disorders: An examination of the literature. Journal of Intellectual Disabilities, 12(3), 191-211.

This article examines the literature on women with and without intellectual disability and psychiatric disorders, using a gender social model of health. Relevant empirical studies, international literature reviews and policies between 1980 and 2007 were identified from electronic databases, journals and secondary sources. Three areas were examined: psychiatric disorders, their contextual background, and their clinical presentation. There are minimal levels of research into women with intellectual disability and psychiatric disorders. However, this article hypothesizes that women with intellectual disability have higher rates of psychiatric disorders than women without. This may result from greater vulnerability related both to internal factors (`intra’: cognitive deficits, poorer communication skills, limited social skills) and to the external world (`inter’: lack of opportunities, stigma, poor social support networks). The article argues that such women require gender-sensitive mental health services. However, more empirical evidence is required to support this claim and to inform development and delivery of services.


Taggart, L., McMillan, R., & Lawson, A. (2009). Staffs’ knowledge and perceptions of working with women with intellectual disabilities and mental health problems.
Journal of Intellectual Disability Research, 54(1), 90-100.

Aim: There is a growing evidence of the physical and mental health inequalities in people with intellectual disability (ID) although less has been written concerning the mental health of women with ID (International Association for the Scientific Study of Intellectual Disabilities). This is compared with the substantive literature published within mainstream psychiatry on gender. The aim of this study was to explore a range of health and social care staffs’ knowledge and perceptions of caring for women with ID who have mental health problems focusing upon risk and resilient/protective factors.

Method: A qualitative methodology was used. Eight focus groups were conducted with hospital, community and residential staff across one region of the UK. The focus groups were audiotaped and the transcriptions were subjected to a thematic content analysis using Newell & Burnard’s framework.

Findings: Six inter-related risk factors were identified by the participants as potential causes for the women with ID to develop a mental illness and these were: having an ID and being female, unmet expectations, dysfunctional family upbringing, unstable relationships/loss of children, domestic violence and negative life experiences. Few of the participants acknowledged hormonal issues as a risk factor. Resilient/protective factors included being proactive, greater community participation, early recognition and mental health maintenance.

Conclusion: These results are discussed in light of current developments and policy within mainstream psychiatric gender approaches. Greater recognition of a proactive health approach for both staff and women with an ID is recommended.


Tang, T. N., & Tang, C. S. (2001, September). Gender role internalization, multiple roles, and Chinese women’s mental health. Psychology of Women Quarterly, 25(3), 181-196.

The influence of gender role internalization as a moderator in the relationship between women’s multiple roles and psychological distress was investigated. Study 1 identified three components of gender role internalization, which were labeled “Traditional Ideal Person,” “Self-sacrifice,” and “Competence without Complaint,” and found that it did not overlap with existing gender-typed measures among 128 female Chinese university students. The multidimensionality of gender role internalization was confirmed in Study 2 among a sample of 225 women in the paid Hong Kong workforce. As expected, role quality was a better predictor of psychological distress than role quantity. Gender role internalization accounted for significant portions of explained variance even after taking role quality into account. Internalization of Traditional Ideal Person and Competence without Complaint messages exacerbated distress in certain areas when role quality was low. However, internalization of Self-Sacrifice messages mitigated distress for Chinese women with low work quality.


Tenzer, S. A., Murray, D. W., Vaughan, C. A. & Sacco, W. P. (2006). Maternal depressive symptoms, relationship satisfaction, and verbal behavior: A social-cognitive analysis. Journal of Social and Personal Relationships, 23(1), 131–149.

Two studies applied a social-cognitive interpersonal process model to investigate mechanisms underlying the association of maternal depressive symptoms with maternal relationship satisfaction and maternal verbal behavior. Study 1 participants were 86 mothers of 6–12-year-old children with a history of ADHD. Study 2 participants were 81 mother–child dyads recruited from a children’s inpatient unit and the surrounding community. Negative trait perceptions and negative affective reactions mediated the effect of maternal depressive symptoms on both maternal relationship satisfaction and maternal verbal behavior. The link between maternal depression level and negative maternal reactions remained after controlling for the child’s psychological problems. Results support the value of applying social-cognitive constructs to clinical problems that are embedded in distressed interpersonal relationships.


Tonmyr, L., Jamieson, E., Mery, L. S., MacMillan, H. L. (2005, October). The relation between childhood adverse experiences and disability due to mental health problems in a community sample of women. Canadian Journal of Psychiatry, 50(12), 778-783.

Objective: The objective of this study was to examine the association between selected childhood adverse experiences and disability due to mental health problems in a community sample of women. Variables of interest included childhood physical and sexual abuse, parental psychiatric and substance abuse history, and sociodemographic factors.

Method: Girls and women (aged 15 to 64 years) from a province-wide community sample (n = 4239) were asked about disability and most childhood adverse experiences through interview; a self-administered questionnaire inquired about child abuse. Logistic regression (crude and adjusted odds ratios) was used to test the associations between childhood adversity and disability due to mental health problems.

Results: Approximately 3% of the women had a disability due to mental health problems. Among women with a disability, about 50% had been abused while growing up. After controlling for income and age, we found that disability showed the strongest association with childhood sexual abuse, physical abuse, and parental psychiatric disorder.

Conclusion: Disability due to mental health problems was experienced by women with and without exposure to abuse in childhood. However, childhood sexual abuse and physical abuse were important correlates of disability. Disability creates suffering and loss for the individual and society; this issue merits more research in relation to child abuse.


Tsakanikos, E., Bouras, N., Sturmey, P. & Holt, G. (2006). Psychiatric co-morbidity and gender differences in intellectual disability. Journal of Intellectual Disability Research, 50(8), 582-587.

Although gender differences in psycho-pathology among the general psychiatric population appear to be well documented, such differences have been either ignored or inconsistently investigated among people with intellectual disability (ID). The study examined psychiatric co-morbidity in 295 men and 295 women with ID and significant social impairments living in community settings. The sample was drawn from consecutive clinical referrals to a specialist mental heath service of South-East London. Psychiatric diagnoses were based on ICD-10 criteria. Personality disorder was more common among men, although dementia and adjustment reaction were more common among women. There were also gender differences in marital status, with a larger percentage of women being either married or in a stable relationship. Gender differences in the source of referral were also observed, with more women being referred through primary care and more men being referred through generic mental health services. Female patients seem to have at some extent different mental health needs from male patients. Such differences should be taken into account in the design and delivery of clinical service for people with ID.


Twohey, D. (2001). Feminist psychotherapy in cases of life-threatening illness. In E. Kaschack (Ed.), Minding the Body: Psychotherapy in Cases of Chronic and Life-Threatening Illness [Feature issue]. Women & Therapy, 23(1), 111-120.

In this article the author discusses therapeutic issues facing clients and psychotherapists who deal with life-threatening illnesses. She writes from the dual perspective of feminist client and psychotherapist, having recently undergone surgery for the removal of a malignant brain tumor. Numerous feminist therapeutic issues have emerged post-surgically including changed relationships, new boundaries, individual denial, altered sexuality and existential issues. Personal vignettes introduce each subsection, culminating in considerations for psychotherapists. Conclusions are then drawn.


Ussher, J. M. (2003). The role of premenstrual dysphoric disorder in the subjectification of women. In P. Gardner, J. M. Metzl, & B. E. Lewis (Eds.), Cultural Studies of Psychiatry [Feature issue]. Journal of Medical Humanities, 24(1-2), 131-146.

This paper will examine the way in which premenstrual symptomatology has been represented and regulated by psychology and psychiatry. It questions the “truths” about women’s premenstrual experiences that circulate in scientific discourse, namely the fictions framed as facts that serve to regulate femininity, reproduction, and what it is to be “woman.” Hegemonic truths that define Premenstrual Dysphoric Disorder (PMDD) and its nosological predecessor Premenstrual Syndrome (PMS) are examined to illustrate how regimes of objectified knowledge and practices of “assemblage” come to regulate individual women through a process of subjectification. Five interconnected “truths” are presented as objects of scrutiny: PMDD is a thing that can be objectively defined and measured; PMDD is a pathology to be eradicated; PMDD is caused and can be treated by one factor; PMDD is a bodily phenomenon; PMDD causes women’s problems or symptoms. I examine the way in which these hegemonic truths function in framing the reproductive body as a cause of disorder or distress that leads women to interpret premenstrual experiences within a pathological framework deserving medical or psychological treatment. Finally, I offer an alternative framework drawing on Eastern models of selfhood that provides a more empowering model of women’s premenstrual experiences.


Waite, R., & Ivey, N. (2009). Unveiling the mystery about adult ADHD: One woman’s journey. Issues in Mental Health Nursing, 30(9), 547-553.

Attention deficit hyperactivity disorder (ADHD), a neurobiological disorder, affects millions of individuals and can significantly impact an individual’s life course. Research guidelines used in assessment, diagnosis, and treatment have focused primarily on Caucasian males generating, in part, the need to redress how gender and other contextual factors are considered. Consequently many women and persons from diverse cultural groups can be ignored or misdiagnosed. Undiagnosed and untreated women with ADHD are therefore limited in their potential to flourish socially, academically, interpersonally, and in their family roles. This case example of a 38-year-old African American woman illustrates how her life journey was affected by undiagnosed ADHD.


Walker, K. (Ed.). (2007). Women’s Mental Health [Feature Issue]. Issues in Mental Health Nursing, 28(5).

“As poignantly discussed throughout several articles in this special issue on women’s mental health, women continue to suffer disproportionately as a result of a multitude of barriers (socioeconomic, educational, gender inequality and discrimination, and domestic and intimate partner violence), which increase a woman’s risk to develop mental illness and impede her ability to achieve optional mental health” (Walker, p. 443).

Articles in this feature issue include:

  • EVIDENCE ON POSTPARTUM DEPRESSION: 10 PUBLICATIONS TO GUIDE NURSING PRACTICE
  • THE INFLUENCE OF CULTURE ON IMMIGRANT WOMEN’S MENTAL HEALTH CARE EXPERIENCES FROM THE PERSPECTIVES OF HEALTH CARE PROVIDERS
  • GROUP THERAPY AS TREATMENT FOR DEPRESSED LATINO WOMEN: A REVIEW OF THE LITERATURE
  • COPING WITH BREAST CANCER: A QUALITATIVE ANALYSIS OF REFLECTIVE JOURNALS
  • REVIEW OF INTERVENTION STUDIES ON DEPRESSION IN PERSONS WITH MULTIPLE SCLEROSIS
  • A CLOSER LOOK: THE BENEFITS AND EFFECTIVENESS OF COGNITIVE BEHAVIORAL THERAPY ON A FEMALE-SPECIFIC UNIT FOR TREATMENT OF BIPOLAR DISORDER

 


 

Walker, L. E., (Ed.). (1984). Women and mental health policy [Sage Yearbooks in Women’s Policy Studies]. Newbury Park, CA: Sage Publications.

This volume reviews the major issues for women in mental health and links them to policy decisions and directions. The editor points out that although women use mental health services disproportionately, mental health research focusing on issues related to women is often hard to get funded and disseminated. The reason for this lack of support for women’s studies within mental health is, according to the editor, that this research often challenges current male-dominated practices. This volume is no exception and many of the chapters deal with topics which are not popular with the larger male-dominated culture nor the mental health subculture.

The first chapter describes the emergence of a feminist perspective in mental health research and public policy. The following chapters cover a wide variety of topics such as the influence of female psychologists on policy making; women and psychotherapy research; the inaccessibility of the mental health system for low-income minority women; lesbian women and mental health policy; violence against women; the problem of sexual intimacy between female-clients and male-therapists; feminist therapy; and many more. This volume contains a wealth of information about women and mental health and is a good starting point for anyone interested in this topic.


Warren, C. A. B. (1991). Madwives: Schizophrenic women in the 1950s. New Brunswick, NJ: Rutgers University Press.

This is a study of the relationship between mental illness and the gender roles of married women in the fifties, and how gender roles influenced the responses to, and experience of mental illness. The data Carol Warren uses was collected in the 1950s in a study of married women who were admitted to a mental hospital. The focus of the original study was on how women’s crises were modified during hospitalization, but Warren uses the same data to examine how the gender roles of the fifties shaped the experiences of these same women. Warren’s analysis shows how the problems these women experienced were shaped by their gender roles and that gender roles were an important factor in the hospitalization of these housewives. A very interesting study.


Webb, M. S., & Gonzalez, L. O. (2006, April). The burden of hypertension: Mental representations of African American women. Issues in Mental Health Nursing, 27(3), 249-271.

A qualitative study using focus groups to explore African American women’s mental representations of hypertension was conducted with 47 participants. The ability of participants to select and perform rational procedures for threat management also was explored. Leventhal’s Self-Regulation Process Model was used to guide the development of the study. African American women (mean age 50.11 years) were recruited from community settings to participate in focus groups. Transcripts from the focus groups were coded and analyzed using comparative analysis. Four themes were generated from the women’s mental representations: (1) Vulnerability and Inevitability, (2) Biobehavioral Assaults, (3) Barriers to Effective Management, and (4) Culturally Relevant Remedies. Hypertension was perceived as a significant disease threat; causality was associated with risk factors interacting within the context of psychological stress. Acquiring a clear perspective of how African American women perceive hypertension and their ability to reduce risk factors can assist in developing a model for stimulating the use of health promotive behavior.


Wenegrat, B. (1996). Illness and power: Women’s mental disorders and the battle between the sexes. New York: NYU Press.

Since ancient times, physicians have believed that women are especially vulnerable to certain mental illnesses. Contemporary research confirms that women are indeed more susceptible than men to anxiety, depression, multiple personality, and eating disorders, and several forms of what used to be called hysteria.

Why are these disorders more prevalent in women? Brant Wenegrat convincingly asserts that women’s excess risk stems from a lack of social power. He reviews women’s social power from an evolutionary and cross-cultural perspective and places mental disorders in the context of evolution and societal organization. In this comprehensive look at mental disorders commonly associated with women, Brant Wenegrat convincingly asserts that women’s excess risk stems from a lack of social power.


Weissman, M. M., Pilowsky, D. J., Wickramaratne, P. J., Talati, A., Wisniewski, S. R., Fava, M., Hughes, C. W., Garber, J., Malloy, E., King, C. A., Cerda, G., Sood, A. B., Alpert, J. E., Trivedi, M. H., & Rush, A. J. (2006, March 22/29). Remissions in maternal depression and child psychopathology: A STAR*D-Child Report. JAMA, the Journal of the American Medical Association, 295(12). 1389-1398.

Context: Children of depressed parents have high rates of anxiety, disruptive, and depressive disorders that begin early, often continue into adulthood, and are impairing.

Objective: To determine whether effective treatment with medication of women with major depression is associated with reduction of symptoms and diagnoses in their children.

Design: Assessments of children whose depressed mothers were being treated with medication as part of the multicenter Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial conducted (between December 16, 2001 and April 24, 2004) in broadly representative primary and psychiatric outpatient practices. Children were assessed by a team of evaluators not involved in maternal treatment and unaware of maternal outcomes. Study is ongoing with cases followed at 3-month intervals.

Setting and Patients: One hundred fifty-one mother-child pairs in 8 primary care and 11 psychiatric outpatient clinics across 7 regional centers in the United States. Children were aged 7 to 17 years.

Main Outcome Measures: Child diagnoses based on the Kiddie Schedule for Affective Disorders and Schizophrenia; child symptoms based on the Child Behavior Checklist; child functioning based on the Child Global Assessment Scale in mothers whose depression with treatment remitted with a score of 7 or lower or whose depression did not remit with a score higher than 7 on the Hamilton Rating Scale for Depression.

Results: Remission of maternal depression after 3 months of medication treatment was significantly associated with reductions in the children’s diagnoses and symptoms. There was an overall 11% decrease in rates of diagnoses in children of mothers whose depression remitted compared with an approximate 8% increase in rates of diagnoses in children of mothers whose depression did not. This rate difference remained statistically significant after controlling for the child’s age and sex, and possible confounding factors (P = .01). Of the children with a diagnosis at baseline, remission was reported in 33% of those whose mothers’ depression remitted compared with only a 12% remission rate among children of mothers whose depression did not remit. All children of mothers whose depression remitted after treatment and who themselves had no baseline diagnosis for depression remained free of psychiatric diagnoses at 3 months, whereas 17% of the children whose mothers remained depressed acquired a diagnosis. Findings were similar using child symptoms as an outcome. Greater level of maternal response was associated with fewer current diagnoses and symptoms in the children, and a maternal response of at least 50% was required to detect an improvement in the child.

Conclusions: Remission of maternal depression has a positive effect on both mothers and their children, whereas mothers who remain depressed may increase the rates of their children’s disorders. These findings support the importance of vigorous treatment for depressed mothers in primary care or psychiatric clinics and suggest the utility of evaluating the children, especially children whose mothers continue to be depressed.


Wetzel, J. W. (2000, April). Women and mental health: A global perspective. International Social Work, 43(2), 205-215.

“For the first time in history, on 10 October 1996, the UN focused on the global conditions of women and their high vulnerability to mental illness and emotional trauma. The information presented in this article, a culmination of years of study, is as relevant today as it was when it was presented at the UN. Women’s at-risk status remains constant.” (p. 205)


Wiener, D. R. (2005, September). Antipsychiatric activism and feminism: The use of film and text to question biomedicine. Journal of Public Mental Health, 4(3).

This article examines the relationships between antipsychiatric activism and feminism, paying particular attention to the civil liberties of mental health consumer/survivor/expatient (c/s/x) individuals in relation to mental health practices. It argues that a continually rigorous exploration of the complex (and at times uneasy) relationships between antipsychiatric activism, feminism and mental health practice is necessary and useful for pursuing social justice by working toward the diminishment of mental health inequalities. The article includes an overview of the ‘spectrum’ of antipsychiatric stances and a review of some of the literature covering the relationship between antipsychiatry and feminism, and uses cinematic and literary examples to highlight the complexity of addressing issues like medication ‘compliance’ and ‘non-compliance’ among mental health users and consumers in biomedical contexts.


Wiener, D. R. (2005). Narrativity, emplotment, and voice in autobiographical and cinematic representations of ‘mentally ill’ women, 1942-2003. Unpublished doctoral dissertation, University of Arizona.

This dissertation presents an historical overview of the interdependent representations of gender, class, ethnicity, race, nationality, sexuality, and (dis)ability in a selection of films and first-person written autobiographical texts from the 1940s to the early twenty-first century. Cinematic and written autobiographical representations of “mental illness” reflect and shape various models of psychological trauma and wellness. I explore the ways that these two genres of representation underscore, exert influence upon, and interrogate socio-cultural understandings and interpretations of deviance and normalcy, madness and sanity, and pathology and health. Some models of health and illness carry more ideological weight than others, and thus differentially contour public policy formation and the materiality of people’s daily lives. My project is distinct from other kinds of scholarship on the subject of women’s “madness.” Whereas scholarship has been written on “madness” and cinema, and on “madness” and autobiography, this related academic work has not consistently drawn linkages between multiple genres or utilized interdisciplinary methodologies to critically explore texts. Feminist scholars who address the interconnections between autobiographies and cinematic representations often pay only limited attention to psychiatric survivors. I draw parallels and distinctions between these genres, based upon my training in social work, cultural studies, film and autobiography theory, medical and linguistic anthropology, and disability studies. My perspective hinges upon my longstanding involvement with and commitment to the subject of women’s “madness” in both personal and professional arenas.


Wiener, D. (2005). “Normals, crazies, insiders, and outsiders”: The relevance of Sue Estroff’s Medical Anthropology to Disability Studies. Review of Disability Studies, 1(3), 76-82.

This essay explores the promising interdisciplinary connections between Disability Studies and Medical Anthropology by examining the work of long-time ethnographer and activist Sue Estroff in the context of a Disability Studies perspective and philosophy. The author provides an array of examples of how Estroff ’s historical, and more recent scholarship, is relevant to Disability Studies praxis today, and suggests that Medical Anthropology as a field would benefit from utilizing a Disability Studies orientation in its own scholarship and practices.


Williams, S. (2003). Women’s psychology: Mental illness as a social disease. Seattle: Radical Women Publications.

A critique of the modern Western mental health system which encourages women to adapt to oppression rather than rebel.


Wilson, M. (2001, Summer). Black women and mental health: Working towards inclusive mental health services. Feminist Review, 68(1), 34-51.

The position concerning the mental health of black and minority ethnic women in Britain is closely linked to that of their respective communities in general. Issues concerning inappropriate care and treatment; lack of access to services; and service delivery based on assumptions and stereotypes govern the way in which black women and men experience mental health care and treatment. This article discusses the specific nature of black women’s position, within the wider context of black communities’ experience as a whole. While the term ‘black and minority ethnic communities’ covers a range of differing communities, the focus here is on the experiences of women from African, African-Caribbean and Asian communities. In relation to women in these communities, reference is made to issues concerning: (1) older women; (2) women of mixed heritage; (3) women’s roles as care-givers; and (4) the position of refugees and asylum seekers. The article also explores and outlines the importance of self-help strategies including, e.g. befriending and counseling and the role of religion and spirituality in enabling many black people to manage their mental distress.


Women & Mental Health. (1998, Summer). Consumer Affairs Bulletin, 3(2). Washington, DC: Substance Abuse and Mental Health Services Administration (SAMHSA). Retrieved January 2, 2005 from http://www.mentalhealth.samhsa.gov/
publications/allpubs/cmh98-5021/cabvo398-02.asp

This portion of SAMHSA’s Consumer Affairs Bulletin concern’s women’s mental health. They share findings on where women can find information on mental health issues, how women’s mental health needs are different than men’s, and what is being done to address women’s mental health.


Worell, J. (2000). Feminism in psychology: Revolution or evolution? The ANNALS of the American Academy of Political and Social Science, 571(1), 183-196.

This article discusses the major contributions of feminism to the discipline of psychology in the areas of theory, research, and practice. Among the most important of these innovations are the introduction of the psychology of girls and women as legitimate topics of study; naming and exploring important issues in the lives of women; reconstructing research methods and priorities to study women in the context of their lived experiences; integrating multiple diversities into all areas of the discipline; developing innovative approaches to therapeutic practice; transforming institutions toward being more inclusive and collaborative; and advocating for social action and public policies that benefit the health and well-being of both women and men. Although feminist scholarship and practice have permeated substantive areas of the discipline in both subtle and visible ways, many sectors of psychology remain wary of perspectives that are openly feminist. Feminist psychology remains active, however, and will continue to insist on the visibility of women in all its sectors and practices and on a discipline that values and promotes equality and social justice for all.


Zautra, A. J., & Smith, B. W. (2001). Depression and reactivity to stress in older women with rheumatoid arthritis and osteoarthritis. Psychosomatic Medicine, 63(4), 687-696.

Objective: The purpose of this study was to examine the role of depressive symptoms in reactivity to stress and pain in older women with rheumatoid arthritis (RA) and osteoarthritis (OA).

Methods: Participants were 188 older women with RA (N = 87) and OA (N = 101). They were initially assessed for depressive symptoms and interviewed weekly for 12 to 20 weeks regarding interpersonal stress, arthritis pain, and negative affect.
Results: Hierarchical linear modeling (HLM) revealed that depressive symptoms were related to weekly elevations in arthritis pain, negative events, perceived stress, and negative affect for RA respondents and elevations in arthritis pain and negative affect for OA respondents. HLM analyses also indicated that depressive symptoms were related to increased reactivity to perceived stress and arthritis pain in people with RA, but not those with OA.

Conclusions: Depression may be related to elevations in pain for people with RA and OA and to elevations in stress and increased reactivity to stress and pain for those with RA.