Language and cultural perceptions surrounding mental health can often be gendered, a result of a long history of mental health stigmas that persist today.
Dick’s House staff counselor Liz Stahler said her team considers gender identity in the context of a patient’s identity as a whole, though its immediate relevance varies case by case depending on the patient’s specific concerns.
“The whole gender spectrum may present with different concerns around gender based on masculinity or femininity or gender-role expectations or gender-nonconforming presentations and how the culture affects that,” she said. “So I think we’re all considering that, all the time.”
Stahler said that she and most of the other counselors at Dick’s House see about 25 patients each week, though she could not estimate the gender ratio of her patients. Katherine McAvoy ’17, vice chairman of the Student and Presidential Committee on Sexual Assault, noted that while Dick’s House is understaffed and underbudgeted, there are counselors with a range of identities that are available to students, a fact that may not be publicized or emphasized.
Geisel School of Medicine psychiatry professor Veronika Fuetchner said many mental disorders, including hysteria, anxiety and depression, have been associated with femininity since the mid-19th century when mental health research was first conducted.“From early on I think medical science was looking at this already through the lens of gender,” she said.
Disorders associated with excessive emotion were often labeled as feminine. The idea of male trauma or hysteria was nonexistent until World War I, when many soldiers arrived home traumatized by what they had seen. Even then, the way in which the medical profession began thinking about men and trauma was very different than the way in which they thought about women and trauma, Fuetchner said.
The diagnosis for depression has also changed drastically over the decades. She noted that in the 1950s, depression was associated with women, particularly those of privilege. The association arose from an image of housewives sitting at home taking care of children, isolated from both their work and social lives, she said. The case files of the 1950s were very judgmental of depression, insinuating it was a choice or could be easily addressed..
“Some of these stereotypes have ceased to exist but there are still references,” Fuetchner said, “Men and women are still treated differently around depression, and that comes from this history.”
McAvoy said the historical connection between gender and mental health still affects mental health treatment today, noting that some physicians have been known to take women’s pain less seriously.
“There’s a connection between mental health and marginalization and inherent power structures and society,” she said. “That is where women are more likely to experience sexism, which can have an impact on one’s mental health.”
Fuetchner added that women are often perceived as being more emotionally expressive, which can lead to slower mental health diagnoses of women as compared to men.
According to a 2015 American College Health Association report, 57.8 percent of undergraduate respondents said they had experienced “overwhelming anxiety” in the past 12 months. Of these, 74 percent were female and 25.1 percent were male. In addition, 15.8 percent of respondents said they had been diagnosed with anxiety in the past 12 months, of which 79.4 percent were female and 18.9 percent were male.
Stahler noted that the rates of eating disorders among women are significantly higher than among men, though there has been a stark increase in men diagnosed with eating disorders in the past 15 years.
In the ACHA survey, of the 1.4 percent of respondents who said they had been diagnosed with anorexia in the past 12 months, 81.7 percent were female and 15.1 percent were male. The statistics for bulimia were smiliar, with 1.2 percent of respondents said they had been diagnosed with bulimia in the past 12 months, of which 79.1 percent were female and 18.2 percent were male.
However, Stahler emphasized that mental health concerns can affect people of any gender.
“I can’t think of a single mental health concern that only women or only men or only transgender or only gender-nonconforming students are susceptible to,” she said. “No mental health concern that I’m aware of is impenetrable by a particular gender.”
At the College, aside from counseling services at Dick’s House, peer advising resources are also available to support students dealing with mental health issues, though these are often overlooked.
The Drug and Alcohol Peer Advisors and Eating Disorders Peer Advisors programs had low capacity as there were not enough students getting trained every year and not enough professional staff to continue those trainings, McAvoy said. The programs collapsed into the more holistic wellness peer position, and the students who were in those positions remained peer advisors but took on special concentrations. They were retrained to talk to students about ways that empower them to make their own changes, McAvoy said.
Amanda Geduld ‘15, an EDPA, said she was unable to estimate the gender ratio of her advisees because she has only been reached out to once during her four years as a EDPA.
“Students might not know what resources are available or wouldn’t seek out resources on their own,” she said. “If they see signs up around campus about this program specifically targeting this, they might be more likely to reach out to students as a mediator.”
Students are certified by a professional associated with Dick’s House, after which students are able to reach out to them if they or a friend they were concerned about had a problem, Geduld said.
“From what I saw, there weren’t a whole lot of resources,” she said. “We could send the students over to Dick’s House, but I don’t know if many people had good experiences with mental health help from Dick’s House.”
Dick’s House currently holds satisfaction surveys, but those are only filled out by students who seek counseling there, which creates a response bias because generally people who have had positive experiences are the ones to fill out the surveys, McAvoy said.
“Anecdotally, we hear a lot of negative things about counseling at Dick’s House compared to the qualitative data we have, which points out that students who go have overwhelmingly positive experience,” McAvoy said. “And we hopefully can come up with some ways of improving the Dick’s House experience if things come up showing that it needs to be improved or coming up with concrete ways to correct the misperceptions about the counseling experience.”
