How to beat the biases harming women’s mental health

A commanding examination of the factors that play into women’s mental ill health should prompt soul searching by readers of all stripes

Out of Her Mind: How We Are Failing Women’s Mental Health and What Must Change Linda Gask Cambridge Univ. Press (2024)

Psychoanalyst Sigmund Freud argued in the 1890s that women’s symptoms of ‘neurosis’ and ‘hysteria’ stemmed not from trauma — from being victims of sexual abuse or physical violence, for instance — but from their own “desire to be seduced”. This perception led physicians and psychologists to routinely dismiss legitimate symptoms of post-traumatic stress disorder (PTSD) in women. Nearly 130 years on, the same presumption is still often evident.

This is one example of the many deep-seated biases in the field of mental and brain health that psychiatrist Linda Gask meticulously exposes and dismantles in Out of Her Mind. From eating disorders and maternal mental illnesses to menopause and age-related dementia, the misconception that women frequently fabricate or exaggerate their symptoms has persisted for centuries. Doctors and nurses, Gask asserts, “hope women will just shut up and go away, but it isn’t clear how women have to behave to be taken more seriously”. The result is poor health — and even loss of life — for women, and huge costs for society and health-care systems.

Gask provides a powerful wake-up call, as she advocates for a future in which women’s mental health — including the health of transgender women and other LGBT+ people — is addressed with the nuance and care it deserves. The voices of women who have experienced discrimination are a key element of her work, allowing readers to empathize with those who have faced violence and abuse, been disbelieved when describing their pain, fears and sorrows, and even been ridiculed or marginalized when accessing care.

Unfair expectations

Gask begins by examining societal expectations about how “young women should behave”, and how these shape girls’ mental health from an early age. Conventional family roles often place caring responsibilities on women, which can affect their psychological well-being, emotional health and professional development as they neglect themselves to please or care for others.

One young woman Gask speaks to says that when her brother was diagnosed with a mental illness, she was expected to be the family’s “emotional switchboard”. That meant helping family members to cope with their feelings while also managing the cooking and cleaning. She feels that these expectations would never have been placed on her brother, and that they are part of the reason she developed anxiety.

Social media can harm young women’s self esteem, especially through societal pressure.Credit: Aleksander Kalka/NurPhoto via Getty

One direct consequence of societal pressures — in particular the pressure to strive for a ‘perfect’ body shape and weight — can be a change in young women’s self-images. This might in part be attributable to the beauty norms perpetuated on social media. One study, for instance, has found that looking at images of the results of facial cosmetic surgery makes young women more likely to want cosmetic surgery themselves (C. E. Walker et al. Curr. Psychol. 40, 3355–3364; 2021).

Gask also addresses mental-health challenges related to pregnancy, fertility issues and motherhood. This is a vital discussion. In my work, I’ve seen how the commercial business approach of reproductive health — from in vitro fertilization to egg freezing, sold as panaceas to infertility — can put a psychological and physical burden on those who hope to be mothers.

And post-partum depression remains heavily stigmatized, often overshadowed by societal expectations of what motherhood should be like. Suicide remains the leading cause of death among women during the perinatal period, which encompasses pregnancy and the year after childbirth.

Post-partum mental illness can come in many guises, from suicidal thoughts to bipolar disorder or psychosis. Gask treated one woman who refused to believe she had a child, and was “screaming, singing hymns at the top of her voice, and trying to pull a sink from the wall with her bare hands”. Yet this illness is under-researched and under-treated.