This Friday on October 10 is Hat Day where Australian Rotary
Health—the largest non-government funder of mental health research in
Australia—has asked people throughout Australia to wear a hat and donate to
mental health research. I personally am very grateful for the hard work of
Rotarians to raise such funds; I have been awarded an Ian Scott scholarship. My
own research would not be possible without it.
The aim of my PhD project is to understand women’s
experiences of endometriosis, particularly the effect that living with this
condition has on their mental health. Throughout my research I have seen
evidence of the need to approach all aspects of health, particularly mental
health, in a comprehensive manner. I use ‘comprehensive’ to mean an approach
that takes into account the person in their social context, not just the
biological aspects of their illness. In this blog post I explain why such an
approach is important in mental health research and practice, and why it is an essential
topic for the next generation of doctors in Australia to understand and
consider.
People do not experience illness in a vacuum, void of
social, cultural and political influences, nor is medical practice immune to such
influences. A well-known example is the
entry of homosexuality as a disorder in the Diagnostic and Statistical Manual
of Mental Disorders (DSM; version: DSM-I)—the US diagnostic reference for
mental health—despite the lack of empirical data. It was removed in 1986 because
of changing social norms and the emergence of a politically active lesbian,
gay, bisexual, and transsexual (LGBT) community.
The impact of sociocultural influences on people’s
experience of illness is most evident when we consider women and their mental
health. While both women and men experience mental illness, women in general are
more often diagnosed and each is more prone to certain diagnoses. For example,
mood disorders (such as depression) and anxiety disorders (such as generalised
anxiety, post-traumatic stress) are more likely to be experienced by women than
by men (mood: 18% vs 12%; anxiety: 32% vs 20%).
There are many factors that contribute to such gendered differences,
one of which is women’s social context. The 1997 United Nations Human
Development Report concluded that “no society treats its women as well as its
men.” Although this report was published over 10 years ago little has changed. Gendered
inequalities within society have been reported to be a significant factor in
increased rates of mental illness among women.
Ignoring social factors has led many to attribute poor
mental health among women to personal deficits rather than identifying it as an
understandable reaction to adverse social circumstances. (It is ironic that
this oppression—which is enacted by men who predominantly benefit from it—also adversely
affects the ability of men and boys to seek care for mental health problems
because of fear that it is not masculine to do so.) By not acknowledging social
circumstances and their relationship to mental illness within health research
and practice, we not only overlook significant determinants of women’s health
but also perpetuate inequality.
Failure to consider all aspects of mental health also contributes
to the unnecessary pathologisation of people’s distress, much of which is
understandable given their circumstances. This pathologisation can result in
the misallocation of resources, for example, funding pharmaceutical
interventions rather than psychosocial interventions such as domestic violence
campaigns and improved social support for women experiencing endometriosis. It
can also lead to increased pressure on medical professionals, including general
practitioners (GPs), to ‘treat’ problems for which they have received little or
no training, when this burden could be distributed across the community.
It can be difficult to incorporate these concepts of a comprehensive
approach into medical practice, given the restraints inherent in the modern
medical environment, such as short consultation times and minimal training for
non-specialist mental health professionals. As the future of Australian
medicine, you are well placed to revolutionise the system to ensure that all
women receive the best possible care. You may choose to take time now to become
informed about how your service will contribute to people’s experience of
illness. I hope this blog post contributes at least in a small way to your conversation
with your peers.
For more information on the topics mentioned in this post
I recommend the following:
o
Gender and sex, and its relevance to medical
practice: http://www.med.monash.edu.au/gendermed/sexandgender.html
o
A review of the evidence of the psychosocial
effects of living with endometriosis: Young K, Fisher J, Kirkman M. (2014).
Women’s experiences of endometriosis: A systematic review and synthesis of
qualitative research. Journal of Family Planning and Reproductive Health Care.
http://www.ncbi.nlm.nih.gov/pubmed/25183531;
doi: 10.1136/jfprhc-2013-100853.
o
The risks of ‘too much medicine’: http://www.bmj.com/too-much-medicine
Kate Young
PhD Candidate
Jean Hailes Research
Unit, School of Public Health and Preventive Medicine, Monash University