'Rip That Book Up, I've Changed': Unveiling the Experiences of Women Living with and Surviving Enduring Mental Illness

By McKay, Elizabeth Anne | British Journal of Occupational Therapy, March 2010 | Go to article overview

'Rip That Book Up, I've Changed': Unveiling the Experiences of Women Living with and Surviving Enduring Mental Illness


McKay, Elizabeth Anne, British Journal of Occupational Therapy


Introduction

Women with enduring mental illness are poorly represented in the literature, particularly in occupational therapy writing. There appear to be few studies focused specifically on women, leaving a gap in knowledge (Wahl 1992). Payne (1995) discussed the difficulties of 'seeing' this particular population, suggesting that the specific needs of individuals and subgroups become organised around the most dominant group. In the case of people with enduring mental illness, the most dominant group is perceived to be men who suffer from schizophrenia, overshadowing women and increasing their invisibility. Harlene and Bernard (1994, p83) asserted that for these women 'invisibility enhances [their] vulnerability'.

Life history offers one way of seeing the whole person: presenting the woman's whole life experience, engaging with her life before, during and after the illness experience. Harlene and Bernard (1994, p85) advocated that 'women's lived experience should be the starting point for all health efforts'. This study examined the experiences of five women living with enduring mental illness in their communities. The study is purposely about women. This is not to say that men are treated differently or better; however, the focus here is on women.

Literature review

Women with enduring mental illness form a major part of the occupational therapist's work in the United Kingdom yet the literature gives little insight into their specific needs or concerns (Craik 1998).

A key body of literature, dating back to 1972, is associated with feminist thinking, research and policy, indicating that women have been discriminated against and oppressed within mental health services. Treatment has not met their needs, failing to reflect their changing roles within society. Gender stereotyping led to reduced opportunities: it is proposed that women's longevity might mean that their health and social care needs, over time, are disadvantaged and further neglected (Chesler 1972, Test and Berlin 1981, Showalter 1987, Bachrach and Nadelson 1988, MIND 1992, Doyal 1995, Russell 1995, Busfield 1996, Chesler 1996, Holmshaw and Hillier 2000, Kohen 2000).

Carmen et al (1981) presented the case that mental health workers needed to address issues that affected women with mental health problems. Bachrach (1985) suggested that women need special attention, as did Subotsky (1991) from a United Kingdom perspective. Faugier (1992) criticised psychiatry for tending to adhere to a gender-neutral view of mental illness, arguing for further research to analyse gender differences and identify practice implications. American occupational therapists Nahmias and Froelich (1993) purported that occupational therapy has been slow to respond to the changing socio-cultural climate. Therapists should explore their attitudes and beliefs in order to develop ways of knowing and working with women.

This literature raises awareness of the needs of women with mental illness: it promotes sensitivity to address women's needs and encourages feminist thinking to advance practice and the evidence base. In response, several studies have dealt specifically with women and enduring mental illness.

An American survey (Ritsher et al 1997) explored the issues related to living with enduring mental illness, identifying gender differences in a sample of 107 women and 59 men. More women were diagnosed as having affective disorders, whereas men were more likely to be diagnosed with schizophrenia. The women were slightly older and with a later age of onset than for men. They viewed their illness in several ways, with one-third believing that they did not have a mental illness. When asked about the causes of their problems, women tended to cite 'bad things in the past' or 'the result of the way I was raised'. Only one-third attributed their problems to a chemical imbalance in the brain.

The majority of the women reported a moderate effect of the illness on their lives, with 47% indicating that they had been forced to give up or to change their life goals, such as jobs, attending college or having children. …

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