Psychology of Women Quarterly

The potential influence of sex-role stereotypes on women medical patients is examined in this paper. It is argued that medical practice is, in part, a social enterprise, influenced by sex-role stereotypic notions held by both patients and physicians, and particularly by the interaction of women patients' behavior with physicians' expectations. Indirect evidence suggests that physicians tend to attribute symptoms presented by women to psychogenic rather than organic causes, but that women nonetheless receive more medical treatment than men in the form of unnecessary surgery and psychotropic drugs. The latter is viewed as part of a historical trend that the feminist self-help movement is attempting to counteract.

The last decade has seen some major impacts of feminism on the institution of psychotherapy regarding theories, treatment techniques, and assessment instruments. The changes in attitudes toward women as therapists and as clients have reflected the general advances of the women's movement in that women clients are more likely to seek women therapists and to receive treatments specifically developed for crises affecting women such as rape, pregnancy and domestic violence. The difficulties in designing empirical studies to demonstrate bias in psychotherapy have resulted in a confusing state of the art because only the higher-order interactions have consistently been significant. Attempts of some women to resist changes brought about by the women's movement and the apathy and levity of others have also presented problems in the path of progress. However, movement toward the long-range goal is encouraging when one compares the writing on women and psychotherapy in recent professional journals with examples from the 1960s.

When mental illness is precisely defined as a functional disorder involving acute distress or disorganization (or both), women are consistently found to have higher rates of mental illness than men. This sex difference appears to be real and not an artifact of response bias, patient behavior, or clinician bias. The higher rates of mental illness among women can be linked to aspects of their societal role and particularly to aspects of the marital role. Therapists who treat women whose mental illness is in part a response to the characteristics of conventional sex roles have no treatment alternatives that are not in some way problematic. The treatment alternative chosen has, in the broadest sense, political implications for the society at large.

Two of Gove's points are given major consideration. First, his precise definition of mental illness is criticized because it excludes diagnostic groups comprised largely of males (personality disorders and substance abusers). Second, Gove's analysis of the value of traditional versus nontraditional therapy for women is challenged and support is offered for the role of feminist therapy. It is recommended that the relationship between sex roles and emotional problems be examined and that less emphasis be given to demonstrating that one sex has more problems than the other.

In this reply to Johnson, it is suggested that her response to my paper is largely on ideological grounds. Johnson totally ignores the theoretical and empirical basis for the definition of mental illness that is used. She appears not to have read my paper carefully, for all the issues she raises have been dealt with in the paper. She does not seem to comprehend the problematic aspects of both feminist and traditional theory. Johnson does not appear to understand that traditional therapists do not blame the victim and that they also see the therapeutic process as resulting in maturation and growth. Her ideology also apparently makes her unable to see that she and I are in substantial agreement on many issues regarding the role of women.

This paper updates an earlier review of research on sex bias in psychological evaluation and psychotherapy. The experimental analogue continues to dominate the literature and to return a resoundingly negative verdict. This evidence, however, is often discounted on the grounds of the analogue's transparency and clinical impoverishment. Naturalistic data have likewise failed to support claims of widespread sex bias, but have nonetheless whetted suspicions that gender and sex role attributes affect circumscribed clinical decisions. These correlational field studies are often dismissed, however, on the basis of their inadequate control for potential confounds. This empirical deadlock is discussed within the context of the sexual politics of research and of methodological preference in particular. The interpretive gerrymandering that has plagued this literature is linked to an unwillingness to be open about the sex role heritage of research strategies themselves and the deep personal and political investments at stake.

A survey of sex stereotyping in photographs was made for major current-edition textbooks of abnormal psychology published in the United States. In photographs of contributors to the field, women were significantly underrepresented, amounting to less than 5% of the contributors pictured. There was no overall difference in the frequency with which men and women were pictured as patients, although women were overrepresented in the field's largest selling textbook. Analysis of this text's editions since 1950 revealed this overrepresentation to be a recent reversal of a previous male stereotype of psychopathology. Possible causes of this reversal are (a) the changing nature of clinical practice and training; (b) changes in the process by which textbooks are produced and published; and (c) factors related to sex differences in the epidemiology of common psychopathologies.

Literature pertinent to sex discrimination in educational and vocational counseling is reviewed. Among the many factors that contribute to inequitable counseling are the sex role socialization that clients bring to the counseling interaction, the sex role attitudes and biases of counselors, deficiencies in counselor training, and shortcomings of tests and other source materials used in counseling practice. Recommendations are made toward more comprehensive counseling services for women and men.