gender bias article

gender bias article - behaviors and feelings of in have...

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Unformatted text preview: behaviors and feelings of in have been socialized to yiel dependency. At some other such behavior can be labeled is assigned the diagnosis of a , Terry A. Kupers argues ii zinatry has been influenced ganliticai causes have been at t‘iiilCGpt of mental health, as item socrally constructed. In 1 iii? case of psychiatry, mostly siftlt'r among those over when tint just when middle-class in numbers, increasing attention , .iaxi "premenstrual syndrome instill alogize just about any cha fifl‘s‘i'l‘. Thus, excessive emotii in: fogical, and so can excess . n the se ' ISSUE 8 RY n? i-i’iiiiger urging: C3211: {MIA titty different rates of occ filéllll about whether these éasses. They note that a dis< iii-cs stereotypical feminin: i‘; disorder in a biased sysi involves maladaptive vari and her colleagues argue i issriaed by serious attemp neat-ion of the available (it ISSUE 2 Is There Gender Bias in the DSM~I V? YES: Terry A. Ropers, from "The Politics of Psychiatry: Gender and Sexual Preference in DSM-lV,” in Mary Roth Walsh, ed, Women, Men, and Gender: Ongoing Debates (Yale University Press, 1997) N0: Ruth Ross, Allen Frances, and Thomas A. Widiger, from “Gender Issues in DSM—IV,” in Mary Roth Walsh, ed, Women, Men, and Gender: Ongoing Debates (Yale University Press, 1997) YES: Forensic psychiatric consultant Terry A. Kupers asserts that several phenomena pertaining to gender and sexuaiity are pathologized in the diagnostic system of the Diagnostic and Sta- tistical Manual of Mental Disorders, 4th ed. (DSM—l V). N0: Ruth Ross, Alien Frances, and Thomas A. Widiger, coeditors of the American Psychiatric Association’s DSM-IV Sourcebook, dis- agree with the notion of bias associated with gender and sexuality. - 3 During the last few decades of the twentieth century, Americans beca acutely aware of ways in which discrimination and bias pertaining to g der and sexuality have influenced culture. Much has been written about: ways in which societal disadvantages experienced by women have _; emotionally costly. Some contend that it should come as no surprise" women are more likely than men to be diagnosed with mental diso and are also more likely to seek professional help for their psycholo probiems. However, the issues of psychiatric diagnosis and help-5e behavior are multifaceted, and sometimes they involve subtle bias. Researchers and clinicians have been particularly interested in u standing the reasons why women are more likely than men to be assi particular diagnoses, such as mood and personality disorders. Some e have questioned whether or not there is a gender bias that results in nine personality characteristics being perceived as pathological. Tait case of dependent personality disorder, a diagnosis with characteristics in ing an excessive need to be taken care of, which leads to submissive, cl‘ 14 iiiaflv categories of mer fiesta-ire socially constructed «at in power who determ; iinstrtutes mental disorder a user whom they have pow i giathoiogizes normal pt Sound in women (e. at cycles) while ignorii erecteristics that could it be pathologized tors of DSM—IV yielded from feminist psychiatris isologists who argued th diagnoses stigmatized an sisters of domestic abuse. instances in the diagnos‘ -' snacfitions are well esiat fades-t diagnostic biases behaviors and feelings of insecurity. Some theorists contend that women have been socialized to yield control to men and to develop a style of dependency. At some other point along the continuum of dependency, such behavior can be labeled as pathological, and the dependent individual is assigned the diagnosis of a personality disorder. Terry A. Kupers argues in the following selection that the field of psy- ilaiatry has been influenced in overt and covert ways such that various political causes have been advanced, with the result being that society’s mncept of mental health, as well as categories of mental disorder, have later": socially constructed. In other Words, people in positions of power {in the case of psychiatry, mostly men) determine what constitutes mental dis- eri ler among those over whom they have power. For example, Kupers notes inst lost when middleclass women are entering the workplace in record eumhers, increasing attention is being given to the emotionally charged aria-l ”premenstrual syndrome.” According to Kupers, those in power can sail i mlogize just about any characteristic noted among those who are not in sewer. 'l‘hus, excessive emotionality in women can be characterized as “ in: :logical, and so can excessive assertiveness. In the second selection, Ruth Ross, Allen Frances, and Thomas d. Wuliger acknowledge that a number of psychiatric disorders have eternally different rates of occurrence in women and men, but they are a i‘t’lgllil about whether these differences are actual or attributable to var~ biases. They note that a disorder such as dependent personality disorder its stereotypical feminine traits, which could be mislabeled as per- l?" disorder in a biased system, but they assert that the diagnosis actu- ,' inrolves maladaptive variants of these stereotypic feminine traits. and her colleagues argue that the DSM-IV development process was " stored by serious attempts to base decisions on a fair and balanced giftiliillOl’] of the available data pertaining to gender issues in diagnosis. COUNTERPOINT riser—r V categories of mental ' The DSM—IV development process éri are socially constructed by involved serious attempts to base in power who determine decisions on fair and balanced in- teristitutes mental disorder in terpretatlons of available data on weer whom they have power. gender-related issues in diagnosis. E3 :ifithologizes normal phe- 0 DSMJV cautions against the impo» . found in women (e.g., sition of gender-biased assump— l cycles) while ignoring tions, especially when diagnosing aerat‘teristlcs that could just _ personality disorders. as? pathologized. ft of DSM—IV yielded to 0 The authors of DSMJV relied on a it's: r: feminist psychiatrists thorough empirical study of contro- ' g‘ists who argued that versial diagnoses {e.g., self-defeating _ .ses stigmatized and personality disorder) before making areas of domestic abuse. a determination to drop these labels. ences in the diagnosis 0 There is no reason to believe that the .. ’tions are well estab- appearance of given disorders should fittest diagnostic biases. be spread equally between genders. 15 iijsorder (DSM-ll) became B awe dropped, notably horn 77 Again, in DSM-IV, there launder, Sibling Relational ' there are name changes (Mt rim Identity Disorder)- ther tiers subsumes what used to a? i iiiildhood, of Adolescenc tiniest-aggressive Personaii are categories were added tr r the descriptions, presuma and: edition makes the dia an one does not need to be it down the diagnosis of e 3:} likgli); to be assigned a (CC I ‘ {aim-mncesesswe Compulsr Terry A. Ropers The Politics of Psychiatry: Gender- and Sexual Preference in DSM-IV ostic and Statistical Manual of Mental Disor— The fourth edition of the Diagn hiatric Association (APA) in ders (DSM-iV), published by the American Psyc 1994, contains the official list of diagnostic categories. It is touted as an _ improvement over previous editions, more precise in its descriptions of criteria for establishing diagnoses mental disorders, more rigorous in its There is some effort to (1 sexual orientation into consider claims of greater obiec ation, as well as race an tivity on account of the improvements, the detail, cultural contexts. But is the new edition really an improvement, or mere} a more rigorous rationalization for pathologizing nonmainstream behav tors and attitudes? And how suCCessful have the authors been in trait scending past gender ’ ful discussion of these questio requires reading between 1 as attending to the social a ' historical context. o Explanations re Detailed DSll _ has the DSM grown thi trans: explanations, one an, the other on the not i disorder are socially ar awarding to the positii . or psychiatry and rati. N’iSiiQUQ see Cohen, 1993‘ gairmit us to discover, anrlatected until now be innetioning was not as ; well: "Psychiatry’s self- . as a matter of increasin adorn is supposed to be tire controlling hand c er} reviews of clinical is with revised diagno: he see how much consists 4.: there is the rush to tegories. For instant V tor the Treatment - irate-irritant guidelines fig? rationale for allow V is truth is defined i air psychiatrists who ' treatment of each A Longer, More Detailed List of Diagnostic Categories The first thing to note about the DSM—IV is its size, 886 pages. DSM—l (A 1952) contained 130 pages; DSM-ll (APA, 1968) contained 134 pages; DSMr {A?A, 1980) contained 481 pages. (A revised DSM-lil, DSM-III~R, was lished in 1987, but i will leave it out of this summary for simplicity’s s In each edition there are new disorders, new groupings of disorders, 5 deletions, and various revisions in the way well—established disorders viewed. For instance, with the publication of the third edition in 1980, P Disorder, Social Phobia, and Agoraph Disorder, i’ostwtraurnatic Stress were added. The last two diagnoses had been lumped under the care Phobias in DSM~11; in DSM—lll they, along with Panic Disorder and " became subtypes of the group of Anxiety Disorders. And with the pub tion of DSMJII some names were changed, for instance Manic-Depre nder and Sexual Preference in D8 Ongoing Debates (Yale University vol. 3, no. 2 (i995). Cop “The Politics of Psychiatry: Ge in Mary Roth Walsh, ed., Women, Men, and Gender: _ _ . 1997), pp. 3404147. Originally published in masculmtnes, © 1995 by masculinides. Reorinted by permission. 16 From Terry A. Kupers, YES / Terry A. Kupers 17 Disorder (DSM-II) became Bipolar Disorder (DSM-Ill); and some categories were dropped, notably homosexuality. Again, in DSM-IV, there are new categories (Substancelnduced Anxiety Disorder, Sibling Relational Problem, Physical and Sexual Abuse of Adult); there are name changes (Multiple Personality Disorder becomes Dissocia~ live Identity Disorder); there are new groupings (Gender Identity Disor- ders subsumes what used to be three groupings: Gender identity Disorder of Childhood, of Adolescence, and of Adulthood); and there are deletions Il’assive—aggressive Personality Disorder, Transsexualism). Relatively few new categories were added to DSM—lV, the emphasis being on more detail in the descriptions, presumably to increase inter-rater reliability. And the imrrth edition makes the diagnostic categories relatively less exclusive so that one does not need to be as careful to rule out one category in order to pin down the diagnosis of another. Consequently a given individual is more likely to be assigned two or more “comorbid” diagnoses, for instance Obsessive Compulsive Disorder with Depression or with Alcohol iiependence. ‘li’f’svo Explanations for a Longer, hiore Detailed DSM @Wn’ has the DSM growu thicker, the list of disorders longer? There are ‘ 3: basic explanations, one built upon a positivist notion of scientific grass, the other on the notion that our concepts of mental health and ital disorder are socially and historically constructed. according to the positivist model, which underlies the stance of ' ridox psychiatry and rationalizes its current turn toward biologism a rritique see Cohen, 1993), advancing technology, and newer research ‘ rgs permit us to discover mental disorders which always existed, but i undetected until now because our understanding of the brain and l functioning was not as sophisticated as it is today. Joel Kovel (1980) it well: ”Psychiatry's self-image (is) of a medical profession whose h is a matter of increasing mastery over a phenomenon, mental ill— srhieh is supposed to be always present, a part of nature passively its; the controlling hand of science” (p. 72). The emphasis in DSM-IV r genitive reviews of clinical and research literatures and the conduct of ”ls with revised diagnostic categories reflect this assumption. The is. is: see how much consistency can be achieved among diagnosticians. teen there is the rush to develop “Treatment Guidelines,” keyed to retegories. For instance, the APA recently released its “Practice its for the Treatment of Patients with Bipolar Disorder" (APA, teatment guidelines provide medical centers and third-party .rii‘t a rationale for allowing some benefits and disallowing others. fir: truth is defined in terms of consensus among certain clini- t’iljfr psychiatrists who have clout in the APA, about the proper _ and treatment of each disorder. 18 ISSUE 2 I Is There Gender Bias in the DSM-IV? the existence of mental disorders idly and unfalteringly, psychia- Wusumerism in the 19205, nr ii iii]: taqure capable of working i , .. e purchase of I 5 one com :31 yet are unable to attain t; a tins and films. The successfut é, , . g: traps they need psychoa . antidepressant I13 ,g Wtlair/lime the positivist mode g, m more empirical data an ... (i; understand the way socia 5% i . mlogy as well as our views r Confident that their opinions about constitute a science that is advancing rap trists and their collaborators are not very likely to uncover the biases and social interests that determine the path of their scientific endeavors, for instance the fact that a significant part of their research is funded by phar— maceutical companies that would like very much to see them identify men« he treatment of choice is a pharmaceutical agent. tal disorders for which t The social/historical model holds that “the disorder and the remedy are both parts of the same social process, and that they form a unity sub- ty in which they take place” (Kovel, ject to the total history of the socie health as well as our categories of 1980, p. 72). Our concept of mental determine mental disorder are socially constructed, and people in power ong those they have power over what constitutes mental disorder am (Conrad, 1980; Foucault, 1965). jean Baker Miller (1976), building on satin)!“ H [(3. W. R} Hegel’s Master/Slave dialectic, points out that in the interest of 0111088161an 5 the model for ”normal continuing domination, the dominant group i human relationships" while the subordinate group is viewed as inferior in one way or another (Blacks are intellectually interior, women are “ruled by emotion”). Thomas and Sillen (1974) point out that slaves who ran away from their owriers’ plantations in the antebellum South received the diagnosis “drapetomania,” literally, "flight—frorn~home madness” (p. 2). - Elizabeth Packard’s husband declared in 1860 that her disagreement” with his religious views was evidence of insanity; and because the laws Illinois as well as the male asylum psychiatrist were on his side, he w able to have her locked in an asylum (Chesler, 1972). Hughes (199 uncovers some of the gender biases in the testimony of families who it a member admitted to an asylum in late nineteenth-century Alabama. skip to the present, is it merely coincidental that just when middle-c _ women are entering the workplace in record numbers, premenstrual s drome is declared a form of mental disorder? Social theory provides two related answers to the question of why DSM grows longer and more detailed in successive editions. First, growth of the mental health industry depends on the expansion of th ies. The number of psychiatrists, psychologists, avjti'bare about homosexuali ‘ . demonstrations at annug . imp was forced to back (I irrirasexualif}? from the Officf . 5: ii in the next edition, DSlt ii 22 the stigmatization did 11 s: merely the tip of the ice a: at: and psychotherapis in“: red to intervene in it ., in. is the decision to it 2g else, and the cliniciar W : her or his choices. In t is in women (for a sum] unit 1994). Why did th 3; in men’s defensive no it the 19605, analysts in align of psychopatholo tiers {including them g Wrath}? 561V nut believe there is anyth of diagnostic categor psychotherapists has grown considerably in recent years, as has the v of psychotropic medications. As clinicians examine and treat a larger ' .N » iii? Characteristics Sed portion of the citizenry, more diagnoses are needed to justify the - 7%” glitertarians and raldicaig endeavor. I will return to this point in the section on childhood disord . , n .33 ill mental illness w Wit than be Paths] | as Ogmed nd everyday lives have become in- irrns, why has homes Second, our consciousness a ingly regimented and administered over the past century, and as a the average citizen is permitted fewer eccentricities before devi : “ iihile homophobia h- d a disciplined workforce. w Eli? unstated biases re; g? ”@301? 01‘ mental declared. The industrial Revolution require ble of sufficient delayed gratification to endure long hours at hard for less than fair wages. Those who could not work had to be margi " as criminals, beggars, or lunatics. This was the period when gre of such psychotic conditions as d were made in the description praecox, later to be renamed schizophrenia. Since the explosive gr ti::truggle to transcer r osexuality is remot with} {1980), a new ca ted for gays and lesbi 3e converting their W YES / Terry A. Kupers 19 consumerism in the 19205, newer, milder diagnoses are needed for those who are capable of working, who buy into the promise of ad campaigns that the purchase of one commodity after another will lead to happiness, and yet are unable to attain the kind of happiness portrayed in advertise~ ments and films. T he successful but still unhappy people must be neurotic; perhaps they need psychoanalysis, psychotherapy, a tranquilizer, or an antidepressant. While the positivist model directs our attention toward the gathering o1 ever more empirical data analyses, the social/historical model permits us to understand the way social interests determine our views on psycho~ pathology as well as our views on What constitutes scientific progress. About Homosexuality tin: debate about homosexuality in the late 19605 and early 19703 included item demonstrations at annual meetings of the APA. The straight male idea'ship was forced to back dowri, voting in 1973 to delete the category homosexuality from the official list of mental disorders. The change was a tinted in the next edition, DSM—Ill, in 1980. ilut the stigrnatization did not end there. The official list of mental dis- ‘ so is merely the tip of the iceberg when it comes to pathologizing. Psy- snalysts and psychotherapists pathologize constantly, deciding, for i nice, when to intervene in the patient’s story and make an interpreta- ' There is the decision to interpret something and not to interpret rifting else, and the clinician’s vieWs about normalcy and pathology saline her or his choices. In the 19205, analysts repeatedly interpreted a envy in women (for a summary of psychoanalytic views on gender, mneii, 1994). Why did they not choose instead to interpret the are gy in men’s defensive need to exclude women from the halls of it in the 19605, analysts interpreted the radical activism of young as a sign of psychopathology. Why did they not interpret the inactin others (including themselves) in the face of great social upheavals @9313)? it 1:2 not believe there is anything inherently wrong with pathologizing hnnian characteristics. Sedgwick (1982) argues convincingly that the its libertarians and radical therapists in the sixties to get rid of the A step! of mental illness was misguided at best. The question is which salts shall be pathologized. Throughout the history of the mental Ions, why has homosexuality consistently been the target for ' ‘i‘he unstated biases reflected in these choices do not disappear - one category of mental disorder is deleted. at: the struggle to transcend homophobia, it is a positive develop- ”‘ homosexuality is removed from the list of mental disorders. In 20 ISSUE 2 / Is There Gender Bias in the DSM-IV? practice, a sub...
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