Expanding our understanding of women’s mental health

Oct 20, 2017

By Robyn D. Walser, PhD

I was recently at a conference on the science of psychology and mental health treatment. I was struck by the number of women in attendance compared to the number of men. Women outnumbered the men three to one. But the women were largely sitting in the audience—while the men were standing at the podium, lecturing.

This experience led me to, once again, ponder questions about gender and equality in mental health and psychology. It also led me to question how we define mental health given the lower level of participation by women than men in creating that definition.

Hippocrates, hysteria, and the wandering uterus

I decided to take a closer look at the some of the first accounts of mental health, and discovered that Greek history played a significant role. In ancient narratives, Hippocrates was one of the first to depict women’s mental health. Indeed, his portrayals of hysteria (viewed as a female ailment) were foundational in the birth of psychiatry.

Hysteria was believed to be due to abnormal movements of the uterus in the body. It could be “cured” by drawing the uterus back into place using sex and aroma therapy (i.e., placing bad smells near the mouth and nose and good smells near the vagina). It was also believed that the wandering uterus was the cause of many a malady, including anxiety, tremors, convulsions, and paralysis.

Thank goodness that we no longer think that psychological difficulties in women are the fault of a nomadic uterus. But, it is still interesting to note how the focus of psychological ailments was placed on something internal, something going wrong inside the skin.

If we fast-forward, much of what is considered mentally healthy is still defined largely by men. For instance, the first iteration, in the 1950s, of the Diagnostic and Statistical Manual, a book defining psychological disorders, was written entirely by men. In recent editions, women have been more involved, but the path of what it means to have a mental disorder was already paved.

This knowledge, as well as seeing the discrepancy in numbers between men and women at the conference I recently attended, has given me pause. Research demonstrates that women are diagnosed with mental disorders far more often than men, and women are more frequently given psychotropic medications to treat these problems.

Has this historical notion of what creates mental disorders, in combination with today’s social pressure to be happy and succeed in one’s life, set women up to reflect on their own mental health struggles as something that is caused, almost entirely, by internal experiences such as feelings of low worth and self-esteem?

When it comes to mental health, don’t rule out more complex causes

Wombs don’t wander, but the blaming of internal experience remains. We haven’t yet abandoned the assumption that psychological struggle is the “fault” of the emotions and thoughts we experience inside our body.

So, what else is possible? What are the other factors that a woman might consider when it comes to her mental health?

“Perhaps continuing to limit our thinking about mental health problems (from stress to depression) as a set of symptoms existing inside the person is too narrow.”

Perhaps continuing to limit our thinking about mental health problems (from stress to depression) as a set of symptoms existing inside the person is too narrow. A more useful understanding might be that problems arise in the dynamic interaction of people and their environments.

Assessing the circumstances of one’s life and the context of current experience is an important factor in determining personal mental health. Depression, anxiety, and bodily symptoms are significantly related to gender-based roles, stressors, and other negative life experiences. Risk factors for mental health problems in women include a wide range of external events such as violence, socioeconomic disadvantage, income inequality, subordinate social status, and unremitting responsibility for the care of others.

If you are feeling depressed, stressed, or anxious, rather than leap to the conclusion that a contemporary version of an “unruly uterus” is wandering around inside of you, (i.e. that there is some internal experience that makes you broken or disordered), you might also find it helpful to reflect on your environmental stress and other life circumstances. It is worth better understanding what is affecting your mental health in your outer environment rather than simply assuming that something is wrong or disordered on the inside.

Of course, get help and support. Managing stress in your life will make a big difference. But remember that good mental health isn’t just about being free of internal symptoms, it is also about the ability to feel fulfilled, the ability to love and play, to learn and grow, and to be free and exercise choice in your life.


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DISCLAIMER: The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Robyn D. Walser, Ph.D. is co-author of Learning ACT: An Acceptance and Commitment Therapy Skills Training Manual for Therapists and The Mindful Couple: How Acceptance and Mindfulness Can Lead You to the Love You Want. She has also co-authored two additional books on ACT focused on trauma and spirituality. She currently serves as Co-Director of the Bay Area Trauma Recovery Center and Director of TL Consultation Services. She maintains an international training, consulting, and therapy practice.