Tag Archives: Gender

G – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health, letter G. This was a pretty hard letter for me, so most of the words I chose are not specifically related to mental health.

Gender

There is an increasing interest in gender-specific medicine, ie. medical research and practice that takes into account how medical (including psychiatric) conditions affect women differently from men. For example, autism spectrum disorders and ADHD used to be thought of as typically male conditions whereas borderline personalitty disorder was thought to affect females primarily. It now turns out that many women have been misdiagnosed with for instance BPD when they really have an ASD and/or ADHD. The reverse is also true: eating disorders are stereotypically thought of as female disorders, so men with eating disordes often remain undiagnosed.

Men and women also differ in their treatment-seeking patterns. Women seek counseling more often, whereas men are overrepresented in psychiatric hospitals and are sectioned or taken into forensic treatment more often.

Genetics

When DSM-5, the current edition of the psychiatrist’s manual, was being prepared, initially they wanted to use a dimensional diagnosis with genetics on one axis. However, they finally decided too little is known about the gentics of mental illness yet. Mental illness is not a purely genetic thing and it isn’t purely caused by life events. For example, when I studied psychology in 2007, there was some recent research into the interplay between a particular gene called the lazy MAO A gene and one’s upbringing in causing antisocial behavior. MAO A is an enzyme that breaks down certian neurotransmitters in the brain. When people have the lazy MAO A gene, they produce too little of this enzyme. This is linked to antisocial behavior. However, even if a person had this lazy gene, upbringing played a role in the risk for developing conduct disorder in childhood and antisocial personality disorder in adulthood. The two factors together cause people to become antisocial.

Geriatrics

Geriatrics is the branch of medicine specializing in older people and diseases of the elderly. Geriatrists may work in mental health care, but more often on units for people with neurocognitive disorders (dementia). The city institution I used to reside in had several units for older people, some of whch specialized in neurocognitive disorsers where behavior was particularly dysregulated. On these units, geriatrics and psychiatry are combined.

GP

Everyone in the Netherlands (and other countries with socialized healthcare) is entitled to the care of a general practitioner (G). Most peope in long-term inpatient mental health treatment don’t have a GP where they used to live. I for one have yet to find a GP near the tiny village. Therefore, the hospital employs GPs. GPs in mental hospitals do not generally involve themselves with the patients’ mental health and psychiatrists do not generally take care of the patients’ physical health. In this sense, a GP in a mental hospital has a different role than in the community. In the community, GPs are the gatekeeper to all care whether it’s mental or physical, after all.

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Career Aspirations

I have been feeling rather uninspired in the blogging department lately. It couldb e the lingerng effects of #Write31Days, the fact that my mind is too unquiet to write, or both. It could be something else entirely. I started to write a post earlier this evening, but deleted it after I went off on a tangent. The post was on my parents’ jobs and aspirations and how my aspirations growing up were different.

My mother worked in administration at a major science institute for 35 years. She started as a data entry assistant or something in 1977 and worked herself up to project management by the time she quit her job in 2011. When she started working for this institute, she had just earned a low-level high school diploma through adult education at the age of 22. She has regretted her entire life that she never got any more education. In spite of this, she worked herself up to a well-paying position where all of her colleagues had college degrees.

My father dropped out of college sometime in the 1970s. He was a physics major for years, but never got beyond the foundation (first-year) certificate, although he did work as a student assistant for a while. After leaving the university, my father worked various jobs and then was a homemaker for years, doing all sorts of community service while caring for my sister and me. It was through a volunteer job at my high school that he found employment in 2000: he was doing computer maintenance on a voluntary basis and got more and more tasks, until he eventually said he was willing to continue his job provided he got paid. He worked as a system administrator for ten years until he too quit his job.

My parents had gone on a very different path through education and employment. My mother was hard-working, always looking to make up for her lack of formal education. My father was more laid-back. Nonetheless, when I spoke to my parents about my own education and my parents’ decisions regarding it, they assured me they had always been on the same page, expecting me to reach my full academic potential.

I never had a good understanding of my mother’s job. In 2006, when I was myself in college, we had to interview someone about their job for communication skills. I assume I did a lousy job at the interview, because I still hardly have a clue what my mother’s project management duties entailed. With regard to my father’s job, I had a greater understanding, but still I find it hard to explain what he did except for fixing my computer when it was broken.

Consequently, I never aspired to become like my parents in terms of employment. I never understood why someone wanted to work in administration and, by the time my father got his job, I had already figured out I didn’t want to work in computers either. The reason I probably never aspired to get one of my parents’ jobs, however, is probably that neither did they. I don’t think that, growing up, my mother wanted to work in administration and computers didn’t exist when my father grew up. My parents are a great example of what my high school student counselor once said: hardly anyone ultimately gets the job they envisioned for themselves at the end of high school. A possible exception are those growing up among generations and generations of doctors or lawyers, and these are not a small group among the students of my high-level high school. However, in today’s era of flexibility in employment, very few people get to become exactly what they aspired to be thirty years on.

I probably already blogged about my childhood aspirations. Like many girls, I gravitated more towards working with people than objects. This turns out to be a common distinction between girls and boys on the autism spectrum, too. While autistic girls, being autistic, do not have good people skills, they do generally have more people-focused (special) interests than do boys.

I suppressed my interest in people-focused jobs for years. This had to do with my being aware of my lack of social skills, but also with the fact that both of my parents gravitate more towards objects than people. Both have a strong dislike for people in the “helping professions”. This could’ve been parlty learned, because the “helping professionas” weren’t all that helpful when I was growing up. However, I learned in school that children develop a preference for people vs. objects early on and this is a strong determiner of later career choices. Like I said, a common misconception about autism is that autistics naturally gravitate more towards objects than people. This is not necessarily true, particularly in autistic girls. Although my parents, both with some autistic traits, fit the stereotype, I do not.

Hurricane #WotW

Yesterday, I bought the book Women and Girls with Autism Spectrum Disorder by Sarah Hendrickx. I have been on the verge of crying as I read it. Hendrickx starts the book by recounting her meeting with her son’s autism diagnostician, whom she tells that she herself has autism too. The doctor doesn’t believe her, because she can hold down a two-way conversation. Wham! I heard that exact same stereotype countless times before. Hendrickx replied that maybe it’s because she’s an adult and a woman.

Last Wednesday, I was trying to communicate the mind-blowing chaos of thoughts and emotions and sensations in my head that is casuing me to have great difficulty functioning. I’ve tried to communicate this ever since I entered the mental health system in 2007, but it doesn’t seem like this is of any importance to my staff or treatment team. My psychologist put it down as rumination in an E-mail to the psychiatrist, because I asked for a med review. The “hurricane in my mind” led to a crisis yesterday. For whatever reason, a psychologist – one I hadn’t met before – was sent to talk to me today. Usually this means I’m in big trouble, but he didn’t threaten any consequences.

I’m not sure whether an unquiet mind is common with autism or whether it’s purely a borderline thing. I sense that it’s more to do with my autism, because it is not the content of my thoughts that is distressing, but the chaos the thoughts, emotions and sensations create. As such, it is particularly hard to communicate.

Unfortunately, my unit is not equipped to deal with autism and I appear to function too well to be getting autism-specialized support. The autism center’s entire recommendation was thrown into the bin by my psychologist and now I’m stuck being sent to a treatment team for personalty disorders. I won’t say I don’t have BPD too, but I also have autism and need support for this. Unfortunately, because I can hold down a two-way conversation, the team thinks I’m not all that autistic at all. Maybe that’s because I’m an adult and a woman.

After all, I was utterly incapable of holding down a two-way conversation even when in high school. As I’ve shared before, I am perhaps the opposite of the old DSM-IV autism criterion which says that autistics do not spontaneously share their feelings or interests. Hendrickx does point out that autistic girls may superficially appear quite sociable, but show self-centeredness on a deeper level. That’s exactly me.

But I don’t care about behavior, at least not anymore. Medication has sedated me enough that I don’t exhibit many troublesome behaviors anymore. Perhaps this means I can now come across relatively normal, but I don’t feel normal at all.

Another thing that’s annoying about this is people constantly attributing thought processes to me that aren’t there. For example, when I reacted with irritability at a psychotic man on my unit who constantly talks to his voices, I was told that I should try to imagine what it’d be like to hear voices all the time. I can’t imagine what that’s like, though I do understand it must be very distressing, but my irritability was not out of anger with this guy. It was just that I was utterly overwhelmed. And just so you know: thinking that the hurricane in my mind is just a breeze, doesn’t make it disappear.

Due to the stress of making arrangements for moving to the tiny village, the hurricane, the chaos in my mind, has been particularly strong this week. Therefore, I choose “hurricane” as my word of the week.

The Reading Residence

What Are Personality Disorders? #Write31Days

31 Days of Mental Health

Welcome to day 10 in the #Write31Days challenge on mental health. Today, I will discuss the broad category of disorders I’ve been diagnosed with: personality disorders. Though there is some debate as to whether borderline personality disorder should be conceptualized as a personality disorder, it currently is.

A personality disorder is a pervasive pattern of dysfunctional thought, behavior and emotion that is stable across time and across situations. It is out of line with cultural expectations and causes distress or impairment. It usually emerges in early adulthood, though adolescents may be diagnosed as being at risk for developing a personality disorder. In fact. when I attended a conference on BPD in 2013, a psychiatrist specializing in this said that BPD can be reliably diagnosed from age sixteen on. In other disorders, such as antisocial personality disorder, there is a specific age requirement of being over eighteen.

The Diagnostic and Statisticla Manual of Mental Disorders, both DSM-IV and DSM-5, divides specific personality disorders into three subcategories, called clusters. These are:


  • Cluster A includes paranoid, schizoid and schizotypal personality disorders. Individuals exhibiting these disorders often appear odd or eccentric. The disorders in this cluster can precede schizophrenia. I tend to think of cluster A personality disorders as “psychosis light”.

  • Cluster B includes antisocial, narcissistic, borderline and histrionic personality disorders. Individuals with disorders in this cluster are often seen as dramatic, emotional or erratic. People with cluster B personality disorders are often perceived as among the most difficult people to get along with. When peope think of personality disorders in general, they mostly mean cluster B disorders. The same goes for treatment programs focused on personality disorders.

  • Cluster C includes avoidant, dependent and obsessive-compulsive personality disorders. Individuals with cluster C personality disorders tend to be anxious or fearful.


In DSM-5, it is stated clearly that the clustering of personality disorders, while it has some merit, may not be very useful in clinical practice. After all, many people exhibit traits of personality disorders across clusters. When a person has features of more than one personality disorder but doesn’t teet the full criteria of any, they may be diagnosed with an unspecified personality disorder. People with other specified personality disorder display behavior that is seen as a personality disorder but isn’t listed specifically in DSM-5. Examples include passive-aggressive and self-defeating personality disorder.

There are some clear gender differences in how commonly personality disorders occur. Antisocial personality disorder occurs far more often in males than females. Borderline, histrionic and dependent personality disorder occur more in females. Though this may reflect real gender differences, it is also likely that stereotypical views shape clinicians’ diagnoses. For example, I once read that BPD is really about as common in males as in females but is overdiagnosed in women and underdiagnosed in men. Women misdiagnosed with BPD are often later found to have ADHD, which interestingly used to be seen as a typical male disorder.

diagnosticians always need to be aware of a patient’s cultural background and life history. After all, in some cultures, behavior that is seen as disordered in the western world may be normal. People who experienced extreme stress or trauma may also exhibit long-lasting dysfunctional behavior patterns and be misdiagnosed with personality disorders when they really have PTSD. Veterans are disproportionately often diagnosed with personality disorders, for example.

Extreme Male Theory of Autism #AtoZChallenge

Welcome to day 24 in the A to Z Challenge on autism. Today, I have cheated a little because my word for the X post doesn’t really start with an X. Then again, many bloggers participating in the challenge choose words for their X posts that start with “ex”. Today’s topic is the extreme male theory of autism. I might even try to find something on genetics so that the X and Y chromosomes, which determine a person’s sex, will be involved.

As I said yesterday, autism spectrum disorders are thought to be more common in boys and men than women and girls. Leo Kanner concluded this already in his initial study of autism in 1943, and Hans Asperger initially thought that the condition he described only affects males.

Not only is autism, and particularly Asperger’s Syndrome, still thought to occur more commonly in males than females, but researchers also believe that there is something “male ad then some” about autism. Asperger himself wrote that the boys he described might display something that is akin to a more extreme variant of male intelligence. Simon Baron-Cohen, an autism researcher in Cambridge, has therefore developed a theory by which autism is described as an “extreme male brain”.

Compared to females, even typically developing males have strengths in mathematical and spatial reasoning and weaknesses in social judgment, empaty and imaginiative play. They are also at a higher risk for delayed language development.

Baron-Cohen and his colleagues have developed a model to test their theory which divides the way the brain operates into two major areas: systemizing and empathizing. Systemizing refers to the drive to analyze or construct systems, whereas empathizing refers to the drive to understand other people’s emotions and thoughts.

The extreme male theory of autism views people with autism spectrum disorders ans hyper-systemizers. They are very much interested in non-human, rule-bound systems. This might seem like an idea that only applies to higher-functioning autistics, but it is thougth that in lower-functioning autisticcs, hypersystemizing might show itself in for example collecting and organizing buttons or suchlike.

On the other hand, autistic people would show weaknesses in social judgment, such as figuring out social cues, understanding what another person is feeling and grasping social hierarchies.

There is a theory that says that higher testosterone (male sex hormone) levels while in the womb lead to a more male-like profile on the systemizing-empathizing dichotomy, ie. higher systemizing scores and lower empathizing scores. Lower testosterone levels in the womb are thought to lead to a more empathizing-oriented brain style. This however has not been proven to explain autism. Further research in this area is needed.

Do you want to know whether you’re more of an empathizer or a systemizer? There is a test which gives you a score on both of these scales. My own empathizing score was 20 while my systemizing score was 30. Both are below-average.

Women and Girls with Autism #AtoZChallenge

Welcome to day 23 in the A to Z Challenge on autism. Today, I discuss autism as it maniffests itself differently depending on the autistic person’s gender. I particularly focus on women and girls with autism. IN tomorrow’s post, I will discuss autism as extreme male behavior.

It used to be thought that autism, and Asperger’s Syndrome in particular, is far more common in males than in females. Four to even eight times as many boys were thought to have Asperger’s than girls. In recent years however, there has been more attention paid to the ways in which autism spectrum disorders manifest themselves differently in girls and women.

There is little scientific research focused specificaly on females with autism. However, anecdotal evidence suggests that females with autism display the following characteristics, which differ from males with autism:


  • Better social imitation skills.

  • A desire to interact directly with people.

  • Shyness or passivity as opposed to being active but odd.

  • Better imagination.

  • Better language development.

  • (Special) interests focused on animals or people rather than objects.

Stereotypes about what is considered typical male or female behavior commonly hinder the diagnosis of females with autism. For example, characteristics such as shyness and oversensitivity are often seen as typical female characteristics rather than signs of an autism spectrum disorder. Another example is a girl who plays with dolls and is hence thought to display appropriate pretend play. On closer observation though, it is found that she plays with the dolls stereotypically.

Girls and women with autism usually also develop inventive strategies to hide their autistic tendencies. This often leads them to burn out or get depressed, which is then seen as the reason for their inability to cope rather than a consequence. There is finally also a bias towards diagnosing certain disorders in certain genders. As a result, many women with autism or ADHD end up with a diagnosis of for example borderline personality disorder because of their hypersensitivity.

Fortunately, authors like Rudy Simone (author of AsperGirls) internationally and Henny Struik in the Netherlands have raised increasing awareness of the fact that women too can be autistic and that their behavioral characteristics often differ from those in men with autism. I was honored to have been quoted (only a few lines) in Henny Struik’s book and I love AsperGirls. I hope that books like these will reach health professionals and researchers so that diagnostic tests for autism are adapted to meet the specific challenges of diagnosing females.

Breastfeeding in Public: It’s a Women’s Right

I follow a fair number of Mom bloggers, both through my feed reader and on Twitter. I also participate in a number of online blog and Twitter events. Through one, I got to know Jen from Liv, Laugh, Love. I found her through a Twitter follow thread on Facebook, and we were asked to engage with the particcipating tweeps. This could be as simple as retweeting some of their tweets, which I did with some, but it could also be starting real conversation. Jen’s first tweet I came across mentioned her blog post on public breastfeeding. Jen is a passionate breastfeeding advocate. I am not, and yet I wholeheartedly agree with her point in this post.

I don’t honestly think that “breast is best”. For some, it is, but other mothers cannot breastfeed due to taking certain medications, not being able to nurse a baby for whatever reason, etc. Still others choose not to breastfeed, and that’s fine with me too. There is probably research backing both sides of the breastfeeding/formula debate.

That being said, this post is about whether women are allowed to breastfeed in public, and my answer is a resounding “YES”. It’s not about whether breast milk is better than formula. It’s about whether women should be allowed to expose their boobs. And I would say as general rule they should.

I can see why exposure of some body parts would not be allowed. Genitalia, notably. Still, this is more to do with the nature of the exposure than the nature of the body part. If a person exposes their genitalia, it’s usually to shock other people. When a woman shoves her breasts in someone’s face so to speak, same. That is sexual harassment. However, breastfeeding in public isn’t intended to shock others. It merely serves the purpose of breastfeeding.

Also, of course, men expose their chests all the time, but that’s not a problem because they don’t have breasts, I suppose. This may sound logical, but in reality, women are just held to a higher standard of cover-up than men. A fomrer fellow patient was one day caught wearing only underwear and a T-shirt. The others commented that, had she been male, it would’ve been acceptable. Why? I believe male genitalia get more exposed when covered only by underwear than female genitalia. The only thing I can make of it is that women are not supposed to expose themselves, while men can go pretty far before their self-exposure is seen as indecent.

Pink Is a Color

There’s a lot of pooha against girls wearing pink lately. Apparently, dressing girls in pink is limiting their future success. Blimey. As the author of Parenting Highs and Lows says, pink is a color. No feminist in their right mind would say that having black skin limits people’s future success, even though in our still pretty racist society, it does. And I know you can change what clothes you wear and not what color your skin is, but so what?

In my opinion, firstly, this is holding girls and women accoutnable for the stereotypes created by society. When I was still active in feminist circles, I learned that making the minority feel responsible for defeating society’s steretotypes, is discrimination. Besides, if girls should not wear pink because it limits their future success, this is only perpetuating the idea that girls wearing pink should not be successful. This is ultimately counterproductive.

I haven’t even touched on what it is that girls are being unsuccessful in when they’ve been wearing pink. It is said to be limiting their careers. As if the only successful women are those who have a career outside the home. This is the mostly male, White, able-bodied society’s norm of success, and women’s rights include the right not to conform to this norm. The so-called feminists who are encouraging people to stop dressing girls in pink because it limits their ability to conform to the societal notion of success, are merely perpetuating the stereotypes they’re meaning to defeat.

Now I for one am not a big fan of pink. I never quite liked the color. I also do not agree with the idea that girls should wear pink, or that real girls or boys wear any color or even sort of clothes in particular. That’s stereotypical. People of any gender should be allowed to wear whatever they want, and if that is perceived to limit their ability to do whatever they want in life, that’s discrimination. Blaming the person being discriminated against, is allowing the discrimination to continue.

Gender and Autism Stereotypes: Problems for Autistic Girls

Yesterday, I bought Parenting Girls on the Autism Spectrum by Eileen Riley-Hall. I’ve only read bits and pieces of it yet, but what struck a chord with me are the problems faced by both passive and aggressive autistic girls due to gender stereotypes and stereotypes about what autism should be.

First, most girls on the autism spectrum are passive. This can easily lead to them being ignored in a classroom or even at home. I notice this on my ward, too, because I’m fairly withdrawn. Because of this, my needs are not always met, as there are many patients who act out to get what they need. In the book, Riley-Hall talks about a girl in her daughter’s nursery who was so shy that she could easily be isolated if not for her attentive teacher. Passive autistic girls, according to Riley-Hall, need as much one-on-one attention as possible. This seems coutnerintuitive, because they aren’t causing any trouble or being a danger to themselves or others. Then again, they too need to learn to relate to others. It is sad in this respect that isolation is no longer a ground for care in the Netherlands. Apparently, you need to be aggressive to be seen. Please note that, in DSM-IV, passive autism is seen as more severe than the active-but-odd type.

Yet aggressive autistic girls are also often mistreated. According to Riley-Hall, gender stereotypes dictate that less aggression should be expected and tolerated from girls than from boys. Consequently, if an autistic girl acts out, she’s punished more harshly than a boy. Riley-Hall does not say this, but it is my expereince that aggression in women and girls is also interpreted differently than in males. For example, many more women are diagnosed with borderline personality disorder rather than for example ADHD. Fortunately, researchers and clinicians are becoming more and more aware of gender differences in the symptoms of psychiatric and neurodevelopmental disorders.

Can Gender Identity and Sexuality Be Fluid?

Two weeks after I was hospitalized, my parents cameto the psychiatric hospital to speak to my doctor. They said that I wanted to be different in all sorts of ways, and one of hteir reasons of thinkign so wast hat I used to identify as lesbian. I wasn’t sure at the time whaht sexual orientation I identified with, and still am not, but it’s a fact that I’m now married in a heterosexual relationship.

Can sexual orientation and gender identity be fluid? I think so. That is not to say that it isn’t static for some, or that it can or should be changed from the outside, but like in my own case. I was in love – or what I thought of as being in love – with some girls first in the eighth or ninth grade, then in eleventh grade fell in love )or again, what I thought to be falling in love) with a boy, now am married to a man. Does this mean I was never a lesbian? Does it mean I am bisexual, bicurious, pansexual, or heterosexual posing as queer for the sake of beign different? Does it really mater? I’m happily married, so isn’t that the thing that counts?

In a society that fully accepts variations of gender identity and sexual orientation, we would be allowed to shift along the spectrum. We wouldn’t even need labels for our identities except in the sense that we needed to identify who we’re attracted to on dating sites. I guess we’ll not get to this point anytime soon, but I don’t think queer people are to blame for apparntly alienating themselves. HOneslty, I feel that if society isn’t fully accepting of the whole spectrum of experience, it’s not all that strange that queer people feel different, because, after all, they are.