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GENDER BIAS IN PSYCHIATRIC DIAGNOSES.

Analysis of the Diagnostic and Statistical Manual of Mental Disorders (DSM) as it relates to women. Contends that certain personality traits of women (dependent persoanlity, emotionalism) are labled as psychiatric disorders by the white male mental health community. Cites several articles discussing the issue. Historical bias against women. Suggestion for a better diagnostic system.

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Introduction
Perceptions of gender and gender roles have been constantly readjusting over the last few decades, resulting in a plethora of written material about the societal disadvantages experienced by women, as well as their emotional costs (Halgin, 2001, p. 14). Although researchers and clinicians have attempted to keep the Diagnostic and Statistical Manual of Mental Disorders (DSM) up to date, “psychiatric diagnosis and help-seeking behavior are multifaceted, and sometimes they involve subtle bias” (p. 14). Halgin presents Terry A. Kupers’ article, “The Politics of Psychiatry: Gender and Sexual Preference in DSM-IV” in contrast to “Gender Issues in DSM-IV” by Ruth Ross, Allen Frances, and Thomas A. Widiger, as examples of this ongoing discussion.
Summary of Articles

14). Kupers, T. P. R., ed., Women, Men, and Gender:Ongoing Debates. Instead of broaching the topic headon and meeting it point for point, the authors of "Gender Issues" chose togo through a list of questionable diagnoses and discuss the differentramifications for each. Guilford, CN: Dushkin/McGrawHill. (1997) "Gender Issues in DSM-IV," in Walsh, M. A. For instance,dependent personality disorder is frequently diagnosed to women, who havebeen raised in a culture which expects women, a subclass in the white maleculture, to be dependent and emotional. Despite the efforton the parts of the authors to yield to feminist psychiatrists andpsychologists in deleting such diagnoses as homosexuality and self-defeating personality disorder (p.2 ), there are still gender biases in thediagnosis of many conditions (p. 29). 126). 21). Even though homosexuality is no longer officiallypathologized in the DSM-IV, there is continued bias in the some parts ofthe mental health community to consider it as part of a continuum in apathology related internalized object relation (p. The strong point in Ross, et al's argument is this very fact thatthey put forth. 18). In this process there will be disagreementand "the opportunity for political, cultural, and ideological influences onthe establishment of the diagnostic criteria for disorders in such aprocess should be obvious" (Nolen-Hoeksema, 2 1, p. Then by extrapolating backward from that vision, we could pathologize the qualities that would make a person dysfunctional in that more equitable and just social order. In Halgin, R. Many of the diagnostic criteria for the disorders in questionhave specific cautions against making gender biased assumptions, however,the authors concede that in the future there may be separate criteriadeveloped for each gender (p. "Is There Gender Bias in the DSM-IV?" ClashingViews on Abnormal Psychology. A. Racism, misogyny, and homophobia would head the list of psychopathologies. Abnormal Psychology. 22). 4 5).Significance of Articles andValue to Society Gained from the Study The impact that further study of gender bias could have on society isstated succinctly by Kupers: Instead of a longer, more detailed list of mental disorders, we need a system of psychopathology that is informed by a vision of a better society. There are extremes in personalities that are unhealthy, and for thegood of those that need help with those extremes, they should be definedand pathologized, however greater care should be taken into consideringwhat is and is not unhealthy. In Halgin, R. Labeled "pathological arrhythmicity"by Kupers, this may indeed be considered unhealthy behavior considering howmuch has been written on the need to for humans to be able to "de-stress"and intimate contact with other human beings. 31).Finally, Ross, et al, believe that there is no reason to assume that theappearance of given disorders should be spread equally among genders (p.36).Strengths and Weaknesses of Articles The strength behind Kupers' argument is that historically there havesimply always been biases against women or minorities when coming intoconflict with the white male mental health community. While this is a thorough method, it is notstraightforward and seems to be avoiding the issue of gender bias.Ethical Considerations Society is very diverse and not only gender differences, but culturaldifferences, sexual preferences and lifestyle preferences are all creatinga world that is less cut and dried than can be assessed in the DSM-IV.Although allowances have been made by proposing, for example, that themasculine form of histrionic personality disorder will demonstrate itselfin an excessive show of machoism (Nolen-Hoeksema, 2 1, p. 18). Yale University Press. 35). Kupers' article, "The Politics of Psychiatry:Gender and Sexual Preference in DSM-IV" in contrast to "Gender Issues inDSM-IV" by Ruth Ross, Allen Frances, and Thomas A. The categories of mental disorders, statesKupers, have been constructed by those in power who determine whatconstitutes a mental disorder in those they hold power over. 18).Slaves who escaped from their owners' plantations were given the diagnosisof "drapetomania" or "flight-from-home-madness" (p. Guilford, CN: Dushkin/McGraw Hill. Boston: McGraw Hill. (2 1). (2 1). (1997) "The Politics of Psychiatry: Gender and SexualPreference in DSM-IV," in Walsh, M. The weak areaof their argument, however, is in their disallowance that biases do existand in the format of their argument. In other words,this same white male bias does not want those women to be too emotional anddependent and so pathologizes this behavior in women (Kupers, 1997).Conversely what about men being pathologized for their dread of dependency,or the "need to avoid all signs of emotion and dependency while maintainingan obsessively steady pace" (p. 27). "Is ThereGender Bias in the DSM-IV?" Clashing Views on Abnormal Psychology.Guilford, CN: Dushkin/McGraw Hill. R., ed., Women, Men, and Gender: Ongoing Debates. 21). 4 8), there isstill "substantial evidence that several of the disorders recognized by theDSM represent extreme versions of 'normal' personality traits" (p. Although researchers andclinicians have attempted to keep the Diagnostic and Statistical Manual ofMental Disorders (DSM) up to date, "psychiatric diagnosis and help-seekingbehavior are multifaceted, and sometimes they involve subtle bias" (p. Halgin presents Terry A. Kupers idea that the DSM be rebuilt from theground up, focusing on how society should be versus how it is would be ahuge step in the right direction. "A very male notion ofindependence and autonomy is at the core of traditional clinicaldescriptions of psychopathology" (Kupers, 1997, p. (2 1). 126). There is the exampleof Elizabeth Packard, whose husband declared that "her disagreement withhis religious views was evidence of insanity" (Kupers, 1997, p. We could begin by envisioning that society, one in which gender equality reigns and there is no homophobia or any other form of domination. However, they stillfeel that it is unclear as to whether these differences are "inherent toactual differences in psychopathology between women and men or are theartifactual result of biases in ascertainment, definition or assessment"(p. Introduction Perceptions of gender and gender roles have been constantlyreadjusting over the last few decades, resulting in a plethora of writtenmaterial about the societal disadvantages experienced by women, as well astheir emotional costs (Halgin, 2 1, p. Widiger, as examples ofthis ongoing discussion.Summary of Articles Kupers, in her article "The Politics of Psychiatry", asserts thatmany of the diagnoses contained in the DSM-IV pertaining to gender andsexuality are pathological. (2 1). The weak point in Kupers' argumentis that she does not allow for the progress that has been made in the lastfew decades and "these definitions represent a process of consensusbuilding and compromise among experts of different opinions" (Nolen-Hoeksema, 2 1, p. There is also the fact that theevery day life of the individual is being increasingly forced to fit into amore regimented role over the past century, "as a result the averagecitizen is permitted fewer eccentricities before deviance is declared (p.18). 2 ). References Halgin, R. In this casethose in power are straight, white males, and those they have power overare everyone else (Kupers, 1997, p. YaleUniversity Press. This kind of pathologizing might even serve to bring about the vision (1997, p. 14). Those diagnoses that were dropped fromthe DSM-IV, such as self-defeating personality disorder, underwent athorough examination before finally being deleted from the text (p. 25). Nolen-Hoeksema, S. Ross, et al, on the other hand, in their article "Gender Issues inDSM-IV" state that serious attempts have been made by the mental healthcommunity in regards to creating a fair and unbiased diagnostic manualbased on available data (Ross, et al, 1997, p. P. The DSM-IV is part of a continuum, a work in process, thatwill continue to evolve as the mental health community discovers more aboutmental health and how it works. Both of theseexamples may be over a hundred years old, but that doesn't negate the factthat those biases are still out there. "Is There Gender Bias in the DSM-IV?" Clashing Views on Abnormal Psychology. 25). P. Position Argument When individual "normal" personality traits are being pathologizedbecause they do not fit the dominant culture's assessment of how the worldworks, then, yes, there is a bias is the diagnosis. Although there has been an effort in the most recent edition of theDSM, the DSM-IV continues to pathologize normal phenomena found in women,such as menstrual cycles, while ignoring male characteristics, such asavoidance of emotional attachments, that could just as easily bepathologized (p. Ross, R., Frances, A., & Widiger, T.

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