GNDR 24500 / HUDV 24200: Gender and Depression - Winter 2003

Instructor: Timothy McCajor Hall

Email: mccajor@post.harvard.edu

Course Description:

The experience, expression, and professional construction of mental illness are inextricably gendered (as well as shaped by social status and culture). This course introduces students to depression and some associated -- and highly gendered -- disorders (eating disorders, alcoholism, and Borderline Personality Disorder), from psychodynamic, cognitive-behavioral, psychobiological, anthropological, and feminist perspectives. Along the way, we will ask and attempt to answer the following questions:

• What is mental illness? To what extent is the label of mental illness something "real" in the world and to what extent does it represent social biases and punishment for nonconformity?
• How do women and men differently experience and cope with social, psychological, and physiological stresses, and how does similar behavior in men and women evoke different social responses?
• What evidence do we have for biological differences between women and men that might account for some of these differences? To what extent have such differences been overlooked, and to what extent have such differences been invoked to support existing social preconceptions?
• Why has there been an epidemic of eating disorders among women and girls in Western countries since at least the 1970s, why is it now spreading to non-Western countries, and why does it appear in the last decade to be affecting boys and men as well?

Course Requirements:

Grading is based on two take-home, essay exams, and a 12-15 page paper. Guidelines for the exams and the paper will be handed out later. The basic assignment for the paper will be to select a psychiatric condition with a strong link to gender or sexuality, and to review and evaluate theories and evidence for biological, psychological, and socio-cultural aspects. Proposals for other paper topics of similar scope will be considered.

Additional credit will be given for class participation.

Required Reading:

Most of the articles and excerpts listed in the syllabus will be available in two Course Readers.

Recommended Reading:

Some of the following books are excerpted in the Reader; others are recommended as starting points for students with interest in particular areas or for term paper ideas. All will be on reserve at Regenstein Library:

• BRUCH, Hilda. (1978) The Golden Cage: the enigma of anorexia nervosa. Cambridge, MA: Harvard University Press.

• BRUMBERG, Joan Jacobs. (1988 ) Fasting Girls: the emergence of anorexia nervosa as a modern disease. Cambridge, MA: Harvard University Press.

• CHERNIN, Kim. (1985) The Hungry Self: women, eating, and identity. New York: Harper & Row.

• KLEINMAN, Arthur; & GOOD, Byron. (eds.) (1985) Culture and Depression: studies in the anthropology and cross-cultural psychiatry of affect and disorder. Berkeley, CA: University of California Press.

• SIMONS, Ronald C.; and HUGHES, Charles C. (eds.). (1985) The Culture-Bound Syndromes: folk illnesses of psychiatric and anthropological interest. Dordrecht, The Netherlands: D. Reidel Publishing Company.

Outline of Topics and Readings:

Week 1: Meet the Mood Disorders

Questions: what are psychiatric definitions of mood disorders? What do they look like? What do we think causes them and how do we treat them?

• STYRON, William. (1990) Darkness Visible. New York: Random House.
• JAMISON, Kay Redfield. (1995) An Unquiet Mind. New York: Alfred A Knopf. (from each, a short selection for background illustration only)
• AKISKAL, Hagop. (1991) "Mood Disorders: Introduction and Overview." In Benjamin J. Sadock & Virginia Sadock (eds.) Kaplan & SadockÍs Comprehensive Textbook of Psychiatry (7th ed.). Philadelphia: Lippincott Williams & Wilkins. Pp. 1284-1298
• AMERICAN PSYCHIATRIC ASSOCIATION (2000) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: DSM-IV. Washington, DC: American Psychiatric Association.
  DSM criteria for major depressive disorder and bipolar disorder. Basics of psychiatric diagnosis.

Week 2: Basic approaches to the mood disorders: Psychodynamic, psychobiological & cognitive

• FREUD, Sigmund. (1917 [1956]) "Mourning and Melancholia." In J. Strachey, (ed.) Collected Works of Sigmund Freud, Vol. 4. London: Hogarth Press.
• AKISKAL, Hagop S. (1985) "Interaction of biologic and psychologic factors in the origin of depressive disorders." Acta Psychiatrica Scandinavica, Supplementum. 319:131-9, 1985.

  Recommended:

• AKISKAL, Hagop S.; and MCKINNEY, William T., Jr. (1975) "Overview of recent research in depression. Integration of ten conceptual models into a comprehensive clinical framework. Archives of General Psychiatry, 32: 285-305.

What is mental illness?
What evidence is there that mental illnesses are "real" illnesses, and what evidence that they are socially derived labels applied to nonconforming and inconvenient individuals?

• LUTZ, Catherine (1985b) "Ethnopsychology compared to what? Explaining consciousness and behavior among the Ifaluk." In G. White and J. Kirkpatrick (eds.) Person, Self, and Experience. Berkeley, CA: University of California Press.
• MURPHY, Jane. (1976) "Psychiatric Labeling in Cross-Cultural Perspective." Science, 191: 1019-1028.
• O'NELL, Theresa. (1996) Disciplined Hearts: History, Identity, and Depression in an American Indian Community. Berkeley/Los Angeles: University of California Press. Pp: 143-210
• WINOKUR, George. (1997) "All roads lead to depression: clinically homogenous, etiologically heterogenous." Journal of Affective Disorders, 45: 97-108.

  Recommended: (Not in course reader)

• ESTROFF, Sue E. (1981) Making It Crazy: an ethnography of psychiatric clients in an American community. Berkeley, CA: University of California Press.
• LUTZ, Catherine. (1985a) "Depression and the translation of emotional worlds." In KLEINMAN, Arthur; & GOOD, Byron. (eds.) Culture and Depression: studies in the anthropology and cross-cultural psychiatry of affect and disorder . Berkeley, CA: University of California Press. pp: 63-100.
• LUTZ, Catherine A. (1988) Unnatural Emotions: Everyday sentiments on a Micronesian atoll and their challenge to Western theory. Chicago: University of Chicago Press.

Week 3: Differences in Female and Male Depression?
Epidemiology of depression, different male and female responses to depression, suicidality, possibility that alcoholism is male manifestation of depression, reproductively linked depressions. What does it mean for men and women to have different kinds of depressions?

• PRIOR, Pauline M. (1999) Gender and Mental Health. New York: New York University Press. pp. 34-50, 77-95.
• BLAZER, Dan D. II ( ) "Mood Disorders: epidemiology," In Benjamin J. Sadock & Virginia Sadock (eds.) Kaplan & SadockÍs Comprehensive Textbook of Psychiatry (7th ed.). Philadelphia: Lippincott Williams & Wilkins. Pp: 1298-1308.

• NONACS, Ruta, & COHEN, Lee S. (200 ) "Postpartum psychiatric syndromes." In Benjamin J. Sadock & Virginia Sadock (eds.) Kaplan & SadockÍs Comprehensive Textbook of Psychiatry (7th ed.). Philadelphia: Lippincott Williams & Wilkins. Pp: 1276-1283.
• WISNER, Katherine L., & STOWE, Zachary N. (1997) "Psychobiology of postpartum mood disorders." Seminars in Reproductive Endocrinology, 15(1): 77-90.

Week 4: Reproductively linked Depressions: PMS and Menopause
Is recent attention (and controversy) around PMS, post-partum depression, and menopause due to greater attention being paid to the needs of women and to mental illness, or to perpetuation of sexual stereotypes? PMS: evidence for PMS in other primates, controvery over inclusion in DSM. Menopause: mental or physical illness, or product of social labeling? Menopause in cross-cultural perspective

• PARRY, Barbara L. (1997) "Psychobiology of Premenstrual Dysphoric Disorder." Seminars in Reproductive Endocrinology, 15(1): 55-68
• SCHMIDT, Peter J., ROCA, Catherine A., BLOCH, Miki, & RUBINOW, David R. (1997) "The perimenopause and affective disorders." Seminars in Reproductive Endocrinology, 15(1): 91-100.
• LOCK, Margaret. (1993) Encounters with Aging: mythologies of menopause in Japan and North America. Berkeley/Los Angeles: University of California Press. pp: xviii-xliv, 1-30, 303-329.

Week 5: Homosexuality, Stigma & Depression

• McNEAL, Keith E. (1999) "Behind the Make-Up: gender ambivalence and the double-bind of gay selfhood in drag performance." Ethos, 27(3): 344-378.
• SAVIN-WILLIAMS, R. C. (2001). "Suicide attempts among sexual-minority youth: Population and measurement issues." Journal of Consulting and Clinical Psychology, 69, 983-991.
• McNEAL, Keith E. (1999) "Behind the make-up: gender ambivalence and the double-bind of gay selfhood in drag performance," Ethos 27(3): 344-378.

FILM: Selections TBA

Mid-term Exam

Week 6: "Hysteria" and its successors
What was hysteria? Why is it no longer a DSM category? To what extent do its successors Ü personality disorders, conversion disorders, eating disorders Ü reflect similar social and moral judgements of nonconforming individuals, particularly women (and homosexuals)?

• SHOWALTER, Elaine. (1997) Hystories: hysterical epidemics and modern culture. New York: Columbia University Press. pp: 14-48.
• BREUER, Joseph and FREUD, Sigmund. (1961[1937]) Studies in Hysteria. Authorized translation with an intro by A. A. Brill. Boston, Beacon Press.
• PALMER, Ian P. (2001) "War-based hysteria -- the military perspective." In HALLIGAN, Peter W.; BASS, Christopher; and MARSHALL, John C. (2001) Contemporary approaches to the study of hysteria. New York: Oxford University Press. pp: 12-35.

FILM: "Girl, Interrupted"

Week 7: Characterological depression: Hysteria, Borderline PD, and Dysthymia
The concept of temperament and personality disorders. To what extent are these "disorders", and to what extent are these categories labels for socially disturbing individuals? How are these diagnoses actually used? What are the implications of exchanging a moral or social judgement for a medical diagnosis?

• ARONSON, Thomas A. (1985) "Historical perspectives on the Borderline Concept: a review and critique." Psychiatry, 48:209-222.
• MILLON, Theodore. (1993) "The Borderline Personality: a psychosocial epidemic." In PARIS, Joel (ed.) Borderline Personality: etiology and treatment. Washington, DC: American Psychiatric Press. pp: 197-224.
• AKISKAL, Hagop S. (1992) "Delineating irritable and hyperthymic variants of the cyclothymic temperament." Journal of Personality Disorders, 6(4): 326-342.

Recommended: (not in course reader)

• AKISKAL, Hagop S. (1994b) "The temperamental borders of affective disorders." Acta Psychiatrica Scandinavica, Supplementum. 379:32-7, 1994.
• (1996a) "Dysthymia as a temperamental variation of affective disorder." European Psychiatry, 11(Suppl 3): 117s-122s.
• AKISKAL, Hagop S.; CHEN, Shen E.; DAVIS, Glenn C.; PUZANTIAN, Vahe R.; KASHGARIAN, Mark; & BOLINGER John M. (1985) "Borderline: an adjective in search of a noun." Journal of Clinical Psychiatry. 46(2): 41-48.
• DAVIS GC.; & AKISKAL, HS. (1986) "Descriptive, biological, and theoretical aspects of borderline personality disorder." Hospital & Community Psychiatry. 37(7):685-92, 1986 Jul.

Week 8: Eating Disorders: Anorexia, Bulimia, Body Dysmorphism and Compulsive Exercise

• BRUMBERG, Joan Jacobs. (1988 ) Fasting Girls: the emergence of anorexia nervosa as a modern disease. Cambridge, MA: Harvard University Press. pp: 42-99.
• BRUCH, Hilda. (1978) The Golden Cage: the enigma of anorexia nervosa. Cambridge, MA: Harvard University Press.
• HALL, Timothy M. (1998) "Beyond the Rose-Colored Ribbon: towards a bio-psycho-social understanding of disordered eating." MA thesis, University of California - San Diego. Pp: 51-97.
• POPE, Harrison G., PHILLIPS, Katharine A., & OLIVARDIA, Roberto. (2000) The Adonis Complex: how to identify, treat, and prevent body obsession in men and boys. New York: Simon & Schuster. Pp: 1-61

Recommended:

• DRESSER, Rebecca. (1984) "Feeding the Hunger Artists: legal issues in treating anorexia nervosa." Wisconsin Law Review, 1984:297-374. (on e-reserve)
• CHERNIN, Kim. (1985) The Hungry Self: women, eating, and identity. New York: Harper & Row. (on reserve at Regenstein Library)
• ORBACH, Susie. (1978) Fat is a Feminist Issue. New York: Berkeley Books.

Weeks 9 & 10: Final Considerations on Gender, Depression & Culture: Male Violence

• MEAD, Margaret. (1935) Sex and Temperament in three primitive societies. New York: William Morrow & Company. Pp: 245-275, 290-309.
• ARBOLEDA-FLOREZ, J. (1985) "Amok," In SIMONS, Ronald C.; and HUGHES, Charles C. (eds.). The Culture-Bound Syndromes: folk illnesses of psychiatric and anthropological interest. Dordrecht, The Netherlands: D. Reidel Publishing Company. Pp: 251-262.
• WISE, Tim. (2001: March 22-29) "Whitewash" in The Portland Phoenix. Also at http://www.portlandphoenix.com/archive/features/01/03/23/feat_whitewash.html

Recommended:

• CARR, John E. (1985) "Ethno-behaviorism and the culture-bound syndromes: the case of amok.." In SIMONS, Ronald C.; and HUGHES, Charles C. (eds.). The Culture-Bound Syndromes: folk illnesses of psychiatric and anthropological interest. Dordrecht, The Netherlands: D. Reidel Publishing Company. Pp: 199-223.
• DEVEREUX, George. (1956) "Normal and Abnormal" In George Devereux. Basic Problems of Ethnopsychiatry. (1980: 3-71). Translated by Basia Miller Gulati and George Devereux. Chicago: University of Chicago Press.
• SPIRO, Melford E. (1965) "Religious Systems as Culturally Constituted Defense Mechanisms." In Benjamin Kilbourne & L. L. Langness (eds.) Culture and Human Nature: theoretical papers of Melford E. Spiro. Chicago: University of Chicago Press. Pp. 145-160

Recommended:

• WRANGHAM Richard & PETERSON, Dale. (1996) Demonic males: apes and the origins of human violence. Boston : Houghton Mifflin.

Final Paper Due & Final Exam Due