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Women outnumber men, two to one, in the prevalence of depressive illness. Discuss the reasons for this.

 

 

 

DSM IV classification of Depressive illness;

 

Overview:

Depressed Mood

Somatic or Sexual Dysfunction

Guilt or Obsession

Anxious or Fearful Dependent Personality

Dramatic or Erratic or Antisocial Personality

 

Diagnostic Criteria;

 

A, Depressed mood for most of the day, for more days than not, as indicated by subjective account or observation by others, for at least two years. Note in children and adolescents, mood can be irritable and duration must be at least 1 year.

 

B Presence, whilst depressed, of two (or more) of the following;

 

1 poor appetite or overeating

 

2 insomnia or hypersomnia

 

3 low energy or fatigue

 

4 low self-esteem

 

5 poor concentration or difficulty making decisions

 

6 feelings of hopelessness.

 

 

 

It is the author’s intention to discuss the above question by bringing into discussion a number of relevant factors that contribute towards females suffering depression more than males. These factors will include;

biological, lifestyle which will look at stress, demands, and self-esteem, relationships, societal expectations, and interweaving the thought processes that create and maintain a depressed state with a Cognitive Behaviour/Rational Emotive Behaviour perspective.

 

 

Biological

 

According to an article “More women suffer depression. Until puberty, males and females develop depression with about the same frequency, if anything, boys are a bit more likely to be depressed. Once puberty hits, everyone becomes more susceptible to depression, but females are twice as susceptible as males…what is interesting is that the gender difference in rates of depression begins to wind down among those in their 50s”. Another way of looking at it is that depression seems to be especially, but by no means exclusively, a disorder of women in their child bearing years”. http//health.yahoo.com/topic/depression/overview/article/pt/psychology_Today_artic…

 

Women with premenstrual syndrome (PMS) are more likely to become depressed. Depression is more common a week before a woman’s period and in the weeks after a woman gives birth (this is called post partum depression). However some studies have shown that a woman with a major depressive illness after childbirth very often had undiagnosed episodes before it.

In some woman, taking birth control pills may cause symptoms of depression. Researchers have confirmed that hormones have an effect on the brain chemistry that controls emotions and mood, however specific biological mechanisms are not yet known. Planned pregnancies have not been shown to contribute towards depression, and that depression at the menopause is no different than at other ages. However woman most commonly experience depression during their primary reproductive years (25-45) and so are especially vulnerable to experiencing depression during the childbirth years.

“Depressive symptoms and syndromes are associated with periods when gonadal hormones are undergoing considerable change, mainly during the premenstrual period, the postpartum period, and at the initiation of the menopause” p1.www.mcmanweb.com/article-31.htm

 

“Approximately 6 million girls and woman abuse and are addicted to alcohol in the US-15 million use illicit drugs and misuse prescription drugs…one-third of all girls had their first alcoholic drink before entering high school- and 25 per cent they began to drink before the age of 13…studies have shown that teenage girls are almost six times more likely to attempt suicide than girls who don’t drink..Women metabolize alcohol and drugs differently than men. Women’s bodies contain less water and more fatty tissue compared with men of similar sizes. Because alcohol and drugs dissolve more in water than in fat, woman maintain higher concentrations of alcohol in their blood…In addition hormones-especially estrogen-play a significant role in the effects of alcohol on woman.” p1 www.orchidrecoveryforwoman.com Of course, alcohol is also a depressant.

 

 

Occupation

 

What has been more prevalent over the last 30 years or so is the numbers of woman working in full time employment whilst juggling the responsibilities of rearing a family and running a home, in effect; three jobs! This added pressure will no doubt create excessive stress and in turn affect the serotonin levels in the brain.

 

Stress, being insidious can gradually wear a person’s immune system down and sensitize the nervous system; electrical impulses in the nervous systems circuitry can be felt too acutely thus, the sufferer can experience fear, seemingly unbidden, that is frightening and therefore bewildering if the person does not know what it is. One such “sudden” experience of this or a series of them can make a person fearful of the state that she is in, with continued fear-bewilderment-fear the person will then anxiously introspect and inadvertently add even more fear. Over time, mental, emotional and physical fatigue may be felt, in the case of mental fatigue, the mind has become very tired and susceptible to a scary thought that ordinarily may be dismissed at will. The frightening intractability of these frightening thoughts (obsession) will lead to even more stress and possible emotional fatigue; a sad sight being felt tragically, a joyful sight hysterically, therefore scaring the sufferer into even more bewilderment and leading to a state of depletion which can be the forerunner of depression. “Depression in the nervously ill woman (or man) is more complicated, because it is often based on the physical depletion that may follow continuous anxiety”. Dr Claire Weekes Simple, Effective Treatment of Agoraphobia. It is therefore easy to see how for many sufferers, depression and anxiety feel interlinked

 

If we reverse the cycle it will take us back to the expectations and demands that society has by now come to expect and accept of modern living i.e. having three jobs. Men do seem to be taking a more hands on approach in helping the running of the house but this would still not explain why a woman is more susceptible to depression than a man.

 

Society

 

If we were to focus on society’s “acceptance of stress as modern day living”, we may find another answer to the question.

If it has become part and parcel of daily living to put oneself under inordinate pressure, have we not fallen into the trap of trying to “keep up with the Jones’” or to put it in a more modern term, “maintain our lifestyle”, if this is striving for material possessions and sending the children to a private school, thus, creating undue pressure onto the traditional role of a woman being the mother and breadwinner combined.

Dr Albert Ellis (originator of CBT/REBT) states that “most forms of human psychological problems are a form of demandingness and that depression is no more than demanding we get what we want then get depressed when we get something else back in return”. The author is therefore of the opinion that self-esteem is contaminating self-worth, i.e. if I have a big house this makes me a big person; it would therefore follow with this conditional thinking that if I have a small house this makes me a small person. A woman’s mothering instincts and wanting the best for her children, may in some instances be superseding the almost mundane by comparison, but longed for normality of a loving caring family life for the child. In short, if it be under the guise of social expectations or whatever, the expectations now has been transformed into a stress ridden depression inducing, ineffective demand. This needs to be addressed with more realistic, health inducing ways of thinking. “Depression is a highly treatable illness” p5 www.nimh.nih.gov/publicat/depwomanknows.cfm

 

A more effective way of thinking may also reduce separation or divorce between couples, as rates of major depression is highest here and lowest amongst the married. “The quality of the marriage, however may contribute significantly to depression. Lack of an intimate, confiding relationship, as well as overt marital disputes, have been shown to be related to depression in woman. In fact, rates of depression were shown to be highest among unhappily married woman”. P.3 NIMH National Institute of Mental Health

 

Lack of intimacy, mental and sexual abuse by a man towards a woman has to be taken into account when depression is being discussed, “Childhood sexual abuse, adult sexual assault and male partner violence have been “consistently linked” to higher rates of depression in woman”, p1 www.mcmanweb.com/article-31.htm.  It is also relevant in as much that it is well known that men are far less likely to discuss his emotional feelings with their General Practitioner than a woman. This may also account as to why the statistics of women being more depressed than men are higher. The male macho image of being able to cope and not to show emotion may contribute towards a lack of intimate communication between heterosexual couples and therefore create a divide, and need for a dependence on materialistic possessions. Mirowsky and Ross found that women did indeed express their emotions more than men. About 68 per cent of males in the study agreed that they kept their emotions to themselves. http://findfarticles.com.

It is certainly not uncommon in my experience in clinical practice of hearing a woman telling me that she has everything she could possibly wish for by way of house, car, and children so is therefore all the more confused why she feels depressed. Intimacy and love have been replaced with a striving for possessions as an easy replacement.  Intercommunication between people may be the real issue.

 

In a letter to the Times Newspaper, 15 senior obstetricians and psychiatrists say that new evidence has uncovered a clear link with abortion and mental illness in woman with no previous history of psychological problems. “Women who have had abortions have twice the level of psychological problems and three times the level of depression as woman who have never been pregnant.” P1 www.timesonline

 

“Almost half of all women with early breast cancer experience depression in their first year after diagnosis…younger woman, those with previous psychological problems, those experiencing difficulties unrelated to cancer (such as relationship problems) and those with no one to confide in  were more likely to develop depression and anxiety”. P1 http://info.cancerresearchuk.org/news/ressreleases/2005/march/70536.

 

The above article prompts the author again to consider how unrealistic some people’s expectations of good health are.  If we take the Rational Emotive Behaviour philosophy that the world is an inherently bad place, so that therefore nothing is awful, it becomes silly and grandiose to then say that bad things should not happen.

 

If a person is experiencing sadness, annoyance or concern, they will at worst be preferring to, hoping to, and wishing to not be unwell and if they are it is a damn nuisance, but if depression, anxiety and anger is accessed they will be demanding that the illness or bad things should not, ought not, must not happen-when it is happening. Unrealistic expectations of self and interaction within the world are then brought into question and this then raises a further question; that due to this Pollyannaish thinking, is depression bound to happen?

 

Allied to this is the belief that from an REBT perspective, perfectionism is at the root of most psychological difficulties, with this in mind, the excessive demands of maintaining the ideal lifestyle that I mentioned before becomes even more relevant. It is well and good discussing the fact that more woman than men suffer depression, but what we are going to do about it?

 

 

As has been discussed, there are a wide variety of contributing factors in relation to depression and it would be preferable to treat it. It is essential that education is then offered as soon as possible namely in the schooling system.

 

Financially, it would save a lot of money in the health service if people were taught the basic principles of what creates and maintains psychological misery and ways to avoid falling into the demandinness trap. This money could be used for other areas. Since a great deal of the clients self-talk will be of the conditional type, teaching Unconditional Self Acceptance would be a great starting point with further disputing tactics to challenge life’s unfairness. This approach would be levelled at both sexes, as we all are responsible for dis-ease. This I do not think is a utopian dream, after all if the TV chef Jamie Oliver can begin to re-educate school children on their eating habits and receive backing from Downing Street, it would be nice to think that helping the nation’s mental health may too receive backing.

 

Taking action further, if there are health warnings on food and what it contains, given the trash that is written in newspapers and magazines and bearing in mind how many women will be aspiring towards conditional fashion acceptance. “Since the number of consistently well-behaving individuals in this world appears to be exceptionally small and the number of highly fallible and ill-behaving persons appear to be legion, the consistent achievement of self-esteem by most of us would seem to be remote. On the other hand, the steady feeling of self-acceptance would seem to be quite attainable.” Dr Albert Ellis

 

 

The prevalence of depression has increased dramatically since the turn of the century, in America depression is the number 1 disability for woman alone. By 2020, it is expected to follow coronary heart disease as the second most common form of disability for both sexes.

The rate of depression for adolescents has increased about one-thousand fold since 1950 which is partly due to earlier pubescence, less exercise, and social changes.

 

A US department report offers encouragement to those experiencing depression with a projected forecast of 80 percent recovering and the remaining making lesser but significant changes. As stated earlier, depression is rarely an illness on its own. The Biological, Psychological and Societal aspects can then be complicated with anxiety, perfectionism and substance abuse.

 

A way forward;

 

Anti-depressants represent a major treatment against depression, but even they have their limitations, “If people quit taking Paxil (Paroxitene) after four months, their relapse rate was twice that of therapy patients…it establishes I think once and for all that Cognitive Therapy does as well as pharmacotherapy, and what’s even more important is that it has a much lower relapse rate.”  Professor Aaron Beck, University of Pennsylvania, added to that it does not have the chemical side-effects of antidepressant drugs, nor does it have the psychological dependency upon then either. “It’s a fact that pharmaceutical companies have held back negative results from their own anti-depressant studies. This very serious emission cannot be ethically justified… Cognitive methods used to help eliminate distorted depressive thinking are significantly more effective than antidepressants in preventing depression from coming back” P3. Dr Bill Knaus, Depression can be defeated.www.rebtnetwork.org/essays/depression2.html . Since CBT aims to teach the client a set of skills to keep with her for life, if anything it enhances confidence, self-worth, and self-dependence

 

We can be affected by external events but we always have a choice as to how we react to them. The psychiatrist Victor Frankl who was interned in a concentration camp during the war, tells the story of the Commandant walking through the camp with his entourage one day, with the backdrop of hunger, death, suffering, starvation and cruelty, he approached the commandant and started singing ‘Zip-ad-dee-doo-dah’. The man looked with astonishment and asked Frankl “how he could be happy in a place like this”? Frankl replied “You can do anything you wish to me, but there is one thing you cannot do and that is change the way that I think”. We always have the choice as to how we react to an event, we can easily upset ourselves, with demands that the activating event should not, ought not, must not happen or we can accept the fact that it is happening then work to change it. We always have the choice.

Since woman during the Second World War were required to work around the clock in ammunitions factories, drive three ton trucks in the Blackout, and look after families when husbands were at war fighting for their lives, what choices have people then taken today to make themselves feel depressed?

 

Two of the best antidepressants there are is exercise and occupation, maybe then woman are not doing enough to exercise their rational muscle and occupy themselves with meaningful, educational pursuits. Since people with emotional problems will think crookedly, dogmatically and magically according to Dr Ellis, it would follow that challenging and changing this thinking will bring less emotional disturbance.

 

As previously mentioned rates of depression are highest amongst men and woman who are separated or divorced, how then does the thinking change?  Does it cause separation and divorce in the first place with a belief that I must be loved at all costs and if not I am not getting what I want, so that depression is now accessed? Is it the demand to be loved at all costs that is the real problem? Does this emanate from the fact that the male is usually regarded as the important member amongst siblings, so that the girl is always playing catch up?  It would certainly  be the case amongst woman who have moved into predominantly male employment fields and complain of having an up hill struggle to be recognised, but there again it did not seem to stop Margaret Thatcher from being Prime Minister for a number of successive terms.

I think what is relevant is that woman in general may be more sensitive to stress. This is probably the difference between the sexes and in the authors opinion should be celebrated as this is fundamental.

 

Maybe this is not politically correct, but a return to more traditional roles and better verbal expression between people may significantly reduce depression. Society and self-expectations have become too high by trying to always to be seen to do the right thing.

 

Conclusion;

 

There are no definitive reasons as to why women suffer depression more than men, and as ever is probably a combination of a variety of factors ranging from biological, societal, psychological. As highlighted earlier from Dr Albert Ellis that most forms of human psychological disturbance is a form of demandingness, given the fact he was voted the second most influential psychologist in the last 100 years by the American Psychological Association’s members, it may be prudent to use this as our answer. Whether these demands come from males, females, governments, churches, society or collectively all of us, it would be therefore less psychologically disturbing to educate and re-educate the male, the female, the young, middle aged or more senior amongst us to think more rationally during life.

This, in the authors opinion, can only be achieved through education and a definite wish by the government and a pulling together of agreement and determination by all therapists to work in the right direction of better mental health for all people. It would be great to see therapists in schools teaching simple, common sense ways of thinking so that everyone could live more effectively together in greater harmony.

 

“If children were not brought up with the philosophy of blaming themselves and others for possible or actual mistakes and wrongdoings, they would have great difficulty becoming anxious, guilty  or depressed ( which result from self-blame) or hostile bigoted, or grandiose (which result from blaming others)”.Dr Albert Ellis

 

 

“An astounding 92 percent do not receive it (treatment for alcohol and drugs problems) because often stigma, shame and ignorance hide the problem”.

P1 www.orchidrecoveryforwoman.com.

 

Robin Thorburn

 

 

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