Sex Roles and Psychopathology Sex Roes and Psychopat ogy 0 Edited by Cathy Spatz Widom Indiana University Bloomington, Indiana Plenum Press • New York and London Library of Congress Cataloging in Publication Data Main entry under title: Sex roles and psychopathology. Includes bibliographical references and index. 1. Psychology, Pathological. 2. Sex role. I. Widom, Cathy Spatz, date- . [DNLM: 1. Identification (Psychology) 2. Psychopathology. WM 100 S518] RC455.4.S45S48 1984 616.89 83-24774 ISBN-13: 978-1-4684-4564-0 e-ISBN-13: 978-1-4684-4562-6 001: 10.1007/978-1-4684-4562-6 ©1984 Plenum Press, New York Softcover reprint of the hardcover 1s t edition 1984 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher To the memory of my father, Jack Spatz, to my mother, Paula, and to the future of my daughter, Rebecca Contributors Mary Ellen CoHen • Study Director, Center for Survey Research, 100 Arlington Street, Boston, Massachusetts 02116 Sue Cox • Research Associate, Langley-Porter Neuropsychiatric In stitute, University of California-San Francisco, 564 30th Street, San Francisco, California 94131 Nancy Datan • Professor of Psychology and Co-Director, West Virginia University Gerontology Center, Morgantown, West Vir ginia 26506 Ellen Dwyer • Assistant Professor of Forensic Studies, Indiana Univer sity, 302 Sycamore Hall, Bloomington, Indiana 47405 Robert F. Erne • Clinical Child Psychologist, Forest Hospital and Foun dation, Des Plaines, and private practice, 731 Grey Street, Evan ston, Illinois 60202 Linda Fidell • Professor of Psychology, California State University, Northridge, California 91330 Stephen Finn • Graduate Student in Clinical Psychology, University of Minnesota, N438, 75 East River Road, Minneapolis, Minne sota 55455 Linda Holt • Graduate School of Psychology, West Virginia University, Morgantown, West Virginia 26506 Ronald A. LaTorre • Research Associate, Program Resources, Van couver School Board, 1595 West 10th Avenue, Vancouver, British Columbia V6J 1Z8, Canada Gloria R. Leon • Associate Professor of Psychology and Psychiatry, and Associate Director, Clinical Psychology Training Program, Uni versity of Minnesota, 75 East River Road, Minneapolis, Minne sota 55455 David Lester· Professor of Psychology, Stockton State College, Pomona, New Jersey 08240 vii viii Contributors Jeanne C. Marsh • Assistant Professor, School of Social Service Admin istration, University of Chicago, 969 East 60th Street, Chicago, Illinois 60637 Jane E. Platt • Assistant Professor of Psychiatry, Millhauser Laborato ries HN 404, New York University Medical Center, 550 First Ave nue, New York, New York 10016 Lenore Sawyer Radloff • Research Psychologist, Statistician, and Psy chiatric Epidemiologist, National Institute of Mental Health, Center for Epidemiological Studies, Division of Biometry and Epidemiol ogy, Room lSC-05, 5600 Fishers Lane, Rockville, Maryland 20S57 Wendy E. Stock • Therapist and Research Assistant, Sex Therapy Cen ter, Department of Psychiatry and Behavioral Science, Health Sci ence Center-School of Medicine, State University of New York, Stony Brook, New York 11794 Cathy Spatz Widom • Chairperson and Associate Professor of Forensic Studies, and Associate Professor of Psychology, Indiana University, 302 Sycamore Hall, Bloomington, Indiana 47405 Barbara Ann Winstead • Assistant Professor of Psychology, Old Do minion University, 1410 West 4Sth Street, Norfolk, Virginia 2350S Barry E. Wolfe • Assistant Chief, Psychosocial Treatments Research Branch and Chief, Outcome Studies Section, Division of Extramural Research Programs, National Institute of Mental Health, Room 10C-1S, Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20S57 Peter B. Zeldow • Assistant Professor, Department of Psychology and Social Sciences, and Director of Education, Rush Presbyterian-St. Luke's Medical Center, 1753 West Congress Parkway, Chicago, Illinois 60612 Preface Psychopathology is the science of deviant behavior. However, as psy chopathologists, our explanations of deviant behavior are not developed in a sterile, laboratory environment. Abnormality is a relative concept, and the labeling of someone or some behavior as abnormal is inextrica bly linked to a particular social context. In the United States, for exam ple, a woman reporting vivid hallucinations is likely to be committed to a mental hospital and the behavior considered maladaptive. In other cultures, the same behavior may be interpreted as reflecting magical, healing powers, and the woman honored and revered. An explicit assumption underlying this book is that elements of social causality influence the development and maintenance of psycho pathology. While the chapters emphasize environmental influences, this is not intended to negate the importance of physiological, biological, genetic, or hormonal factors in relation to psychopathology. The purpose of this book is to examine the impact of sex role ster eotypes on the occurrence and distribution of specific forms of psycho pathology. In contrast to prior work, which emphasizes sex differences (e.g., Franks and Gomberg's Gender and Disordered Behavior) these are not the primary focus of this volume. Sex Roles and Psychopathology analyzes the extent to which cultural norms about the sexes, societal expectations and values about sex-typed behavior and sex differences, and profes sional biases influence the development, manifestation, and mainte nance of abnormal behavior among men and women. We hope to stimulate researchers to ask further questions about the relationship between sex roles and specific kinds of psychopathology. For example, to what extent are diagnostic criteria influenced by vari ables that may be theoretically irrelevant to a diagnosis? To what extent are similarities in the behavior of males and females interpreted differ ently in the context of psychiatric diagnoses? Sex Roles and Psychopathology should be of interest to a wide au- ix x Preface dience. Professionals and students alike in psychology, psychiatry, com munity psychology, evaluation research, epidemiology, mental-health service fields, social work, women's studies, and sociology should find these chapters informative and, in some cases, quite provocative. This book contains chapters that synthesize the results of empirical research, as well as chapters representing original theoretical analyses focusing on specific forms of psychopathology. Some chapters represent "state-of-the-art" reviews, particularly on topics where extensive re search has been done and conceptual models developed. Other chapters break new ground and encourage the emergence of new approaches to research. We begin with a historical review of psychiatric theory and practice in the 19th century and conclude with a discussion of contemporary medical practices. In between, chapters are organized into four major sections: Neurotic, Affective, and Schizophrenic Disorders; Social De viation and Sexual Dysfunction; Age-Related Disorders, and Societal Management and Control. As was evident in the 19th century, medical and psychiatric theory and practice were not sex blind. Some would argue that contemporary psychology and psychiatry cannot and should not be sex blind. Howev er, this book draws attention to the ways in which definitions, diagnos tic criteria, study designs, and conclusions are influenced by sex-role stereotypic assumptions. It is hoped that recognition of the biases inher ent in our theory and practice will lead to further research and under standing of the role of sociocultural factors in the etiology, diagnosis, and treatment of a variety of forms of psychopathology. Acknowledgments As editor, I want to express my appreciation to the authors of the chap ters. Their excitement and enthusiasm about the book and their interest and cooperation kept my spirits buoyed at difficult times. To Mary De Shong, my secretary in the Department of Forensic Studies, my sincere thanks for patience and good humor in typing and retyping chapter drafts. I am most appreciative of the advice and insightful, critical, and constructive comments of Michael G. Maxfield. Without his constant encouragement and emotional support, this book would never have been completed. Finally, to Rebecca, Michael, and Mary, I want to ex press my gratitude for tolerating my "craziness" during the final stages in the preparation of this volume. xi Contents PART I Introduction 1 Chapter 1 Sex Roles and Psychopathology 3 Cathy Spatz Widom Psychopathology in a Social Context 3 Sex, Roles, and Psychopathology 4 Overview of the Chapters 10 References 17 Chapter 2 A Historical Perspective 19 Ellen Dwyer Introduction 19 Nineteenth-Century Psychological Thought 20 Specific Syndromes 32 Nineteenth-Century Psychiatric Practice in Lunatic Asylums 38 Conclusion 42 References 43 PART II Neurotic, Affective, and Schizophrenic Disorders 49 Chapter 3 Gender Ideology and Phobias in Women 51 Barry E. Wolfe Introduction 51 Phobias 52 Sex Roles and the Ideology of Gender Differentiation 55 Gender Ideology and Phobias 56 Current Limitations of the Gender Ideology Model of Phobias 63 Summary and Conclusions 68 References 69 Chapter 4 Hysteria 73 Barbara Ann Winstead xiii