What Is the Truth About Men, Women and Mental Health?
Dr. Freeman, with his journalist brother, Jason Freeman, wrote a book on these gender-based differences in mental health diagnoses called The Stressed Sex: Uncovering the Truth About Men, Women, and Mental Health. In researching the book, generalizations that in the past might have led to accusations of sexism are put to the test and the results are indisputable. Some of the statistics are hard to swallow: according to a large scale study, women are diagnosed with depression almost twice as often as men, and anxiety disorders at a rate of almost 25 percent for women compared to 14 percent for men. Despite men being diagnosed more frequently with addictions and antisocial behaviors, the statistics still favored women as being more frequently diagnosed with any mental illness overall: depression, anxiety disorders, sleep disorders, sexual disorders and eating disorders - all more frequently diagnosed in women than men. In fact, in any given year, according to the study cited, women are diagnosed with mental illnesses at a rate of 20 percent to 40 percent greater than men.
This information raises important questions about women, men and mental illness in our society. But first, before accepting the results at face value, some challenges or questions about the studies themselves should be addressed.
The first question the authors tackle is that of over-reporting versus under-reporting. Is it possible, naysayers argue, that women are not experiencing mental illness in greater numbers than men, but simply more willing to talk about it with their doctors. Depression or anxiety might be easier for a woman to fess up to than for a guy, right? Many men might not want to talk about irrational fears or a vague sense of dread, persistent sadness or frequent tearfulness - all classic symptoms of depression or anxiety. According to the research, however, this is not the case. The authors state that the data are corrected for male-female differences in reporting and willingness to admit to symptoms of mental illness, and that women still take the lead in diagnoses.
Further, the authors state that women “suffer from” mental illnesses at a greater frequency than men, but the data being collected is on diagnosis. As any consumer of mental health service knows, you can easily wind up with a diagnosis that you yourself feel is inaccurate or don’t agree with. However, the data on diagnosis is what’s being considered as evidence that women are indeed more frequently experiencing mental illness. Yes, they are being diagnosed more often but does this really mean they are sicker? A more detailed analysis of the data might be necessary to determine this.
The researchers do not address other possible sources of “chatter” in the data: one being bias on the part of professionals making the diagnosis. If a man and a woman both see the same clinician and report the same set of symptoms, you would expect that each would receive the same diagnosis. But clinicians can have gender-based biases, and depending upon their own cultural backgrounds, may hold strong beliefs about the male versus female psyche. These biases could easily impact the final diagnosis: it may be that women are being diagnosed with depression or anxiety more frequently than men reporting the same symptoms due to a societal expectation that women are more likely to experience these disorders - a self-fulfilling prophesy of sorts.
If we take the result as reported, that women do indeed have a greater prevalence of mental illnesses of all different types, the next questions to ask are why? And what can we do about this?
The authors speculate about causes of this trend. They mention important sociological and economic issues that could impact women’s mental health: namely wage-earning inequality in the workforce, and the lion’s share of child care responsibilities falling upon women. Childhood sexual abuse is more common among women, and thus the role of trauma should be more thoroughly explored in future research. It may be that trauma - be it sexual abuse, physical abuse, neglect, exposure to domestic violence or substance abuse, etc. - is the critical mechanism by which the risk of mental illness is increased, for men and women.