Transcript Mental and Physical Health

Today’s Class
• Welcome
• Finish Sex & Gender & Childhood
– Video – Killing Us Softly III
• Physical and Mental Health
• Test two is March 14, 2008, in this room
– Chapers 6-10
• The final exam is April 28, 2008
Mental and Physical Health
• Some sex differences are evident
• FOR EXAMPLE
– Women are more likely than men to seek
psychotherapy
– Despite their longer life span, they are more
likely to seek medical help as well
• So, are women really sicker than men?
– If not, how can these gender differences be
explained?
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– Later on we will look at some specific theories
Physical and mental health are
not mutually exclusive
• Women and men are not all alike, both between
groups and within groups
• Each has a blend of strengths and weaknesses that
affect physical and psychological well-being
• It is difficult to look at psychological and physical
health completely separately
• E.g. stress can cause problems for both the mind
and the body.
– How one copes with stress influences health
Current Research
• Stress or bliss? Arteries respond (Star, March 8, 2005, A3)
• Research by U of T professor Robert Baker, 2005.
– “A stressful job coupled with an unhappy marriage may
be downright hazardous to your health”
• However, “the good news”
– “A happy marriage can be the balm for the day’s woes,
easing blood pressure back to healthy levels”
• “With job strain the blood pressure came up…If they came
home and the marriage was cohesive, it lowered the blood
pressure again”
– “ A cohesive marriage (is one with) those who did
things together, worked on common projects and did
not ‘scream and shout”
General Health
• General health
– Variables?
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– What are some specific health concerns and illnesses?
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Overview: Women’s and Men’s Physical
Vulnerability, Fitness and Strength
• Men have shorter life expectancies than women; this
difference is largest in developed countries
• Pregnancy and childbirth are significant causes of death
for women in developing countries, but not in
developed countries
• Men are more likely than women to die by suicide or
homicide
• Across all age groups, women report more physical illness
symptoms, take more medication, and visit the doctor
more than men do
Overview: Women’s and Men’s Physical
Vulnerability, Fitness and Strength
•On average, women are shorter, lighter, and less muscular
than men; however, women develop strength quite
rapidly under training conditions
• Women can outperform men on physical tasks that
demand endurance
Cardiac Health
• Affects both women and men
– Affected by diet, smoking etc. Women were “catching
up” a couple of years ago.
– What is the current comparison?
• But!!
– Research and clinical experience has shown that
women may have different symptoms
• nausea
• different pain
– These are often not recognized or diagnosed
– Treatment may not be sufficient
• Current Studies
• Mosca et al (2004)
– 500 doctors
– Evaluate men’s and women’s records for
recommendations
– The high risk for the women and men was the same
– Women were 40% LESS likely to be diagnosed as high
risk
– Women less likely to be recommended treatments “that
have been shown to significantly reduce the risk of
heart attacks and strokes.”
• Second study (Mosca et al., 2004)
– 1.1 million patient database
– Identified over 8000 women at high risk of a heart
attack
– Followed 3 years to see how their cholesterol was
managed
– Only 1/3 who should have been taking cholesterol
drugs were taking them
– At the beginning only 7% had desirable cholesterol
levels.
– Three years later, still only 12%.
• Other factors
– Environmental
– Today’s paper, The Toronto Star
• When you go into the hospital after a stroke can
affect your chances of survival
– Week-end admissions face a 15% greater chance of dying
Breast Cancer
• older women more likely - very few men
– 10% are men
• only 10% directly attributable to genes
– Research on BRCA1 and BRCA2 gene carriers
• Possible cause - HRT (Hormone replacement
Therapy)? “When good research goes bad”
• Other causes
– environmental factors - some control
• high-fat diets
• alcohol consumption
• smoking
• Detection
• cancer screening - breast exammammography
– Problems for men
• Treatment - lumpectomy, mastectomy
– chemotherapy - hormone therapy (tamoxifen) -
– psychosocial support and therapy
Other Cancers
• Lung cancer
– Still more prevalent in men
– However, increasing for women
– fewer cases than breast cancer-but more deaths
• Endometrial cancer
– cancer of the lining of the uterus
– pregnancies - progesterone - decreased risk
• Ovarian cancer
– early detection can result in 90% survival rate –
symptoms - no clear test
• Cervical cancer
– detected by Pap smear
– survival rate linked to screening
• Colon cancer
– Very high cure rate if detected early
OTHER HEALTH PROBLEMS FOR WOMEN
(Lips,2004)
• Anemia
– a deficiency of red blood cells or hemoglobin
– more common for women, especially pregnant
• Endometritis
– Symptoms
– treatment
• Autoimmune Diseases
– arthritis, lupus and multiple sclerosis
– more common in women: mainly ages 30-50
REPRODUCTIVE HEALTH PROBLEMS
• Worldwide more than 1/2 million women die each year due
to inadequate reproductive care (WHO)
• Risks vary according to region and economics
– African woman’s risk (all countries) 1/65 (PAI, 2001)
• Specific countries 1/10 (U.N. 2000)
– North American woman’s risk 1/4000 (U.N.2000)
• Some Causes?
– Inadequate care at all stages
– Hemorrhage, infection, unsafe abortions, obstructed
delivery (e.g., genital mutilation), hypertension
• Birth defects
– Women should take folic acid
• We all must be more proactive
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Diagnosis, treatment
Smoking and alcohol issues
Folic acid and other dietary
Women’s College Hospital - Cardiac
Rehabilitation Program
– Pushing doctors to perform tests for
• Prostrate problems
• Colon cancer screening
Gender and Mental Illness
• Patterns of diagnosis and treatment of mental
illness are very different for women and men
• Women: depression, eating disorders, phobias
and anxiety are more likely
• Men: personality, antisocial, and substance
abuse disorders more likely
Functional Disorders
• Severe pain and other symptoms
• Mostly women but some men
– Irritable Bowel Syndrome
– Fibromyalgia
– Chronic Fatigue Syndrome - Golden Girls
• Little if any physiological explanation
• Patients were told “It’s all in your head”
BUT real pain, real disability
Research and Therapy
• Clinical Research
– combination of medical and therapy
interventions
• Irritable Bowel Syndrome
– The Cognitive Scale for Patients with
Functional Bowel Disorders
• bowel problems and pain
• embarrassment
• affects whole life
– Cognitive Behavioural Therapy
Eating Disorders
• Video - Killing us softly III seen earlier
• The influence of the media on
– Stereotypes
– On prevalence of eating disorders
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Stereotypes
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Eating Disorders
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Eating Disorders
• What?
• Why?
– Desire for thinness
• Study (McCaulay et al, 1988) with 176 female and
male undergraduates
• 50% males and 40% females thought they were
normal weight
• The other 50% of males were equally divided feeling they were overweight or underweight
• majority of the remaining 60% of the women felt
they were overweight.
• Women wanted to lose 8.4 lb - men 2.9 lb.
• In the slightly overweight category, women wanted
to lose 24 lb. Men, 5.5 lb.
• Slightly underweight women - to lose 1.4 lb.
• Study with Finnish school children
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Eating Disorders cont’d
• Anorexia Nervosa (Crawford & Unger, 2000, p.540)
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• The refusal to maintain a weight that is minimally
normal for an individual of that age and height.
• Intense fears of gaining weight or becoming fat,
body image disturbance, and a denial of the
seriousness of the current low weight.
Usually between puberty and 17
90% are women
May use dieting, fasting, excessive exercise, may
induce vomiting and abuse laxatives
40% may recover, 30% improve, 20% become chronic
and 10% may die (Pike et al., 1997)
Bulimia Nervosa
• binging on food
• usually soft, sweet, highly caloric
• until the person feels uncomfortably full
• purging
• inducing vomiting
• misuse of laxatives
• reinforcing to the bulemic person because it relieves
the physical discomfort and mental distress
• in private -weight usually in normal range -harder to
detect than anorexia
• Prognosis - better than anorexia
• 50% recovery after 1 year of treatment compared to
10% with anorexia (Herzog et al, 1993)
• More recent cases have better recovery rates
Social and Media Expectations
• Culture of thinness
– As the ideal body image became thinner over the last
20-30 years, eating disorders increased (Myers et al,
1992)
– driven by culture and media
– Videos – Killing us softly III. Slim Hopes - in the
library here for those who wish to see it at some time.
– Dying to be Thin. Hopefully we can see portions of this
in class.
Body Image Problems for Men
• Anorexia and Bulimia
• G.I. Joe Syndrome
Depression
• Anyone can feel sad or depressed at times
• Clinical depression is far more severe
– sad facial expression, loss of appetite, fatigue,
insomnia, slow speech, indecisiveness
– feelings of hopelessness, inadequacy and guilt
• Gender roles and relational issues
– Self-silencing (Jack & Dill, 1992)
– silence authentic self and deny needs are not being met.
• Post-partum depression
– not ‘baby blues’
– serious condition - consequences
What reasons are there for the reported
gender differences in depression?
• The textbook discusses a summary of 5 theories accounting
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for gender differences in depression
• 1- The feminine role predisposes women to depression by
encouraging them to feel and act helpless
• 2- Women face more stress than men and so are more likely
really to be helpless or powerless
• 3- Women are particularly sensitive to stressors that are related
to the disruption of interpersonal relationships
• 4- The differences in depression are biologically based
• 5- A developmental model suggesting particular feminine
qualities that occur in adolescence to produce a greater
incidence of female depression
Could there be other reasons for gender
differences in depression?
• What do you think?
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Stress
• Sources of stress
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• Can be beneficial
– to a point
– Response is what counts
• Possible responses
• Adaptive – Pulling together
– Drawing on resources
• Maladaptive
– Heart problems
– Anger, depression, violence, physical problems,
psychological problems
– Excessive drinking
• Family stress increases chances of a heart attack (Elias,
Detroit News, Thursday, May 4, 2000, Feature Section)
• “Family stress increases a woman’s chance of a
heart attack much more than does stress on the job,
research shows”
• Working women make supportive friends on the job
– benefits them physically and mentally
• Five year study (Orth-Gomer, 2000)
• compared 292 women who had suffered heart attacks with 292
age-matched healthy women
• Findings
– Women with worse family stress were four times more
likely to suffer a first heart attack
– High work stress doubled the risk of a first heart attack
– Women ‘ coping poorly’ with conflicts at home were eight
times more likely to have recurrent heart problems
• But! Work stress spilling over into the home can increase
family stress (Gallinsky, 2000)
Overview: Gender and
Diagnoses of Mental illness
• Women are more likely than men to be diagnosed with
and treated for depression
• Men are more likely than women to abuse alcohol
• The eating disorders anorexia nervosa and bulimia nervosa
are much more common among women than men
• Agoraphobia, the most common of the specific phobias, is
much more likely to diagnosed in women than in men
• Antisocial personality disorder is more commonly
diagnosed among men than women
• Stereotypical gender roles are likely implicated both in the
ways women and men experience and express
emotional distress and in the ways their symptoms
are classified into particular diagnoses
Treatment
• Use of medication
– Gender related - women receive far more
prescriptions for psychotropic medications.
• Research - 8 women for every 6 men will receive
these drugs - and for a much longer period
• men given more pain killers after cardiac surgery
and women more sedatives
• Stereotypical beliefs - women more emotional exaggerated pain
• Prescriptions: Research suggests social issues
but body chemistry is more frequently considered
with resultant prescriptions
– For example, PMS - study showed that while
50% of the participants said they had PMS,
only 10% met criteria
• Therapy
– Individual and group; Traditional and feminist
– e.g., Cognitive Behavioural Therapy, CCRT
(Conflict Centred Relational Therapy)
– Should be suited to the patient, not the therapist