Today, some 18.9% of all U.S. adults have a mental illness. That means 15.1% of all men and 22.3% of all women have a mental health disorder diagnosis. For those of us facing diagnosis and treatment, these numbers are important. Women have a large role in mental healthcare facilities in the United States and around the globe, yet much of treatment is not designed to be a safe space for them to learn and recover. Instead, women are more likely to be prescribed medication and left largely alone. As a result, more than 80% of all female suicides follow a period of mental healthcare, where women did not receive the treatment they needed.
Women face significant and often gender-specific vulnerabilities to trauma, depression, and anxiety. The female sex is also more prone to depression and anxiety through hormones and thyroid interaction, as well as to adverse life experiences. And, women are more likely to experience gendered violence resulting in trauma, anxiety, depression, and failure to build stable relationships. These and other issues can pose great obstacles in treating mental health for women.
Female-Specific Problems in Mental Health Treatment
Women face significantly different social norms, societal expectations, and hormones than men. Most Western cultures have slowly begun to relax traditional views of women, purity, the household, and care, but many do not. Today, women are raised with conflicting and difficult cultural and societal views around fulfilment, sexuality, purity, care for the self, and care for the home. Women therefore face complex, overlapping, and often contradictory pressures from society, family, and themselves alongside biological complications resulting from hormones (menstruation, hormonal birth control), and brain physiology. These can lead to significant challenges in traditional mental health treatment.
Biological roles are also important. For example, while men are more likely to be diagnosed with schizophrenia and autism, women are more likely to be diagnosed with anxiety and depression. 33% of women are eventually diagnosed with anxiety. This means that women are more genetically prone to certain disorders, which might mean they are more difficult to treat in those patients. But, with little clinical research into the topic, we do not have clear answers.
Hormones Influence Mental Health – Women and other people who menstruate experience significant fluctuations in hormones. Progesterone and estrogen levels change throughout the month, which significantly impact mood, coping, and emotional regulation. Hormonal birth control further impacts emotional regulation and mental health. Harvard Health suggests that hormonal birth control results in a .5% increase in the likelihood of depression. Similarly, pregnancy can result in wildly fluctuating hormones, with 29.2% of all pregnant persons experiencing natal or post-natal depression, and 16.5% experiencing post-partum depression. Hormonal problems can be difficult to treat, often because women are told they’re “just hormonal” and will go away. Yet, left untreated, hormone-related depression and anxiety can last for years or even decades.
Women Experience Different Symptoms – While men and women experience significant rates of the same illnesses, many have different symptoms. For example, women are more likely to attempt to hide mental illness with self-medication (alcohol, drugs, prescription medication, self-harm). This can result in women not seeking treatment until the disorder has significantly progressed. Women go into treatment having to unlearn harmful and dangerous coping mechanisms, necessitating behavioral therapy targeting how women cope and share about mental problems. This process can also lead to women receiving the wrong diagnoses.
Recurring Stress as a Contributor – Men and women both experience mental illness as a result of significant stress. But, women are more likely to have to return to that stress following treatment. Women take on significant expectations and workloads in the home, even when they work full time and have a partner. This means women are more likely to:
Take on heavy emotional burdens of talking to and supporting their partner
Facing stressful expectations to be or to look perfect/pure/etc.
To take on domestic tasks such as cleaning, laundry, and cooking
To take on domestic management such as organizing meals, trips, school, shopping, etc.
To solely manage or delegate childcare
To take on family support and emotional burdens for family members
Many of these cultural problems result in a condition in which women are constantly asked to perform. Women can seek out mental healthcare, but without learning how to shift some of the stress and burden of the home onto partners and family members, they return to the same stressful environment that caused the issues. The result is often a very fast relapse following treatment.
Lack of Follow-Up – Most studies show that women can very easily acquire medical prescriptions for antidepressants and antianxiety drugs. They have a much harder time getting into meaningful, long-term therapy designed to solve rather than cover up their problems. This means that many women seeking treatment receive a diagnosis and a prescription, but no behavioral therapy or counseling. This stems from historic ideas about hysteria, female purity, and weight causing problems, leading doctors to offer temporary solutions to what they see as temporary problems. This attitude is changing, but seeking out a third-party opinion or clinical treatment may be a good idea if you’ve been given a prescription and nothing else.
Most women are significantly vulnerable to gender-based trauma. For example, the United Nations shows that 70% of women experience violence from an intimate partner at some point during their lives. Women are also significantly more likely to be codependent in a relationship with an abuser or to be financially reliant on them because of childcare and poor job opportunities. Gender-based trauma has a significant impact on women’s health and treatment. For example, women who have experienced violence from an intimate partner are as much as 70% more likely to attempt suicide. Even gender-based street violence results in significant increases in depression, anxiety, and PTSD.
This also means that women might have difficulty in being treated alongside men. It’s difficult to concentrate, to learn coping mechanisms, or to deal with fear when a source of that fear is learning alongside you. This is especially true for women who have experienced significant harassment, attacks, or sexual violence at the hands of strangers.
Tailoring Women’s Mental Health Treatment
Good mental health treatment means creating a personal program designed around the needs and experiences of the person, demographic, and group. Women face vastly different social expectations, pressures in the home, and biological shifts than men do. Many women also face significant threats and violence from men, resulting in trauma.
At the Gooden Center, we believe that women must be given a safe space to recover. That means splitting men and women’s treatment, so that female-identifying people can seek treatment in spaces unaffected by male expectations, pressure, or the male gaze. This can be especially important for women facing pressure from their religion or family to remain pure, to present themselves in certain ways, or to be perfect.
Our approach includes a treatment program built around biology, social expectations, and the needs of women. Therapists must understand how menstruating patients are affected by hormone cycles, regulation, and hormonal birth control. Peers must be “safe” in that they do not cause or create trauma or generate unconscious needs to look or appear perfect or “feminine”.
In addition to cognitive behavioral therapy, many women need to learn life skills for stress management, for deferring responsibility, for saying no, and for reducing how much they attempt to take control of their lives. This is often directly opposite to what is needed by many men, making it important that women receive this in their own, space spaces.
Finally, women with mental illnesses are especially vulnerable to disruptive relationships. Female hormone production can temporarily reduce symptoms when the woman falls in love or forms an attachment, leading to reliance, codependency, and unhealthy relationships. Forming this sort of relationship with a male peer who is also struggling is especially difficult for both and may significantly impede recovery.
If you or a loved one is struggling with mental health, you’re not alone. One in five women will have a mental illness during their lifetime. There’s no shame in reaching out and getting help. When you do, it’s important that your treatment center be able to offer personal care, in-depth assessment of your problem, and real treatment for the problems underlying your mental illness.