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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? –… –… –… – 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? – – – – – … … … … … – What are some specific health concerns and illnesses? • • • • … … … ... 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 – – – – 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 • • • • • • • • Stereotypes … … … Eating Disorders … … … 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 –… –… – ... Eating Disorders cont’d • Anorexia Nervosa (Crawford & Unger, 2000, p.540) – – – – • 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 • 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? –… –… –… Stress • Sources of stress –… –… –… • 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