Chapter 11: Psychology and Women’s Health Issues
Gender and Health
Worldwide, being born female is dangerous to your health
In the US, males have a higher death rate than females
Average life expectancy in US:
Females: 80 years
Males: 75 years
Leading causes of death
Gender differences and similarities
Heart Disease
Effects of estrogen on cholesterol
Silent disease
Women manifest heart disease 10 yrs later
Heart attacks are more often fatal for women
Different symptoms and signs
Women misdiagnosed as having an anxiety attack
Interventions
Women are less likely to receive
Gender bias in medical research
Discrimination and Health
High blood pleasure
Discrimination, stereotype threat may be chronic, repeated stressors for women
Women and the Health Care System
Feminists have been critical of the treatment of women in the health care system
The physician-patient relationship reflects the subordinate status of women in society
The medical profession has actively discriminated against women as practitioners
Medical care offered to women is often inadequate, irresponsible, or uncaring
E.g., 70% of hysterectomies are unnecessary
Medical research conducted on women is often irresponsible or simply missing
Health Needs of Poor and Minority Women
Poor and ethnic minority women have higher rates of infant mortality than White women
Chronic diseases are more prevalent among ethnic minority women than among White women
Life expectancy of ethnic minority women is 5-7 years less than that of White women
Ethnic minority women are overrepresented among the poor
Menstruation
Menstrual Problems: Cramps
Dysmenorrhea: painful menstruation, cramps
Women vary in the experience of cramps
Cramps are caused by Prostaglandins: hormone-like biochemicals that stimulate the muscles of the uterus to contract
Treatment: antiprostaglandin drugs
Psychological Aspects of the Menstrual Cycle
Do girls and women experience changes in personality or mood depending on the phase of the menstrual cycle?
Retrospective reports of symptoms and moods
Unreliable
Prospective self-reports
Small fluctuations in mood and symptoms
Correlational studies cannot prove that hormone levels influence mood
Psychological Aspects of the Menstrual Cycle
Paige’s (1971) study with oral contraceptives
High levels of estrogen and progestin lead to steady mood
Premenstrual syndrome (PMS): a combination of severe physical and psychological symptoms (such as depression) occurring in some women for a few days before menstruation
Vaguely defined
PMS is far from universal among women
Ruble (1977): women report more problems when they think they are in the premenstrual phase
Cultural influences on menstrual-cycle mood shifts
Perspectives of different ethnic groups suggest new interpretations
Practical Implications
Magnitude of mood shift depend on individual woman
Regarding hiring decisions, performance is more important that mood
Generally no fluctuations in performance across cycle
3-D spatial ability negatively correlated with estradiol
Likely that monthly hormonal cycles exist in men
Other Menstrual-Cycle Fluctuations
Sensitivity of the senses
Pain sensitivity
Substantial variability in menstrual cycle mood fluctuations
Contraception
1 out of 14 women between the ages of 15 and 19 become pregnant every year
59% of these pregnancies result in live births
27% of these pregnancies are terminated by abortion
the remainder end in miscarriage
Worldwide, family planning is an important issue for women’s physical and mental health
When women are able to practice contraception and space pregnancies farther apart, infant mortality declines and women’s physical health and mental health benefit
Abortion
1.2 million abortions are performed in U.S. each year
1 in 3 women have an abortion by age 45
Medical abortion
16% of abortions in US
Take a medication (e.g., mifepristone) in a pill, which causes the lining of the uterus to be sloughed off
Can be done up to 9 weeks
Surgical abortion
Most commonly, vacuum aspiration
Done in 1st trimester
Done on outpatient basis with local anesthetic
Very safe
Severe problems following abortion are rare
Worst stress occurs before abortion
Risk for psychiatric disorder increases in year following childbirth, but not in year following abortion
Adolescents who choose abortion are more likely to graduate from high school than those who carry pregnancy to term
Political bias a problem in research
Poor quality studies report poorer long-term mental health outcomes of abortion
But high quality students report better outcomes
Long-term consequences of restricting abortion
220 children born to women denied abortion in Czechoslovakia
Do poorly in school, more likely to drop out
Poorer relationships with mothers
Poorer adjustment in adulthood
Women and HIV
AIDS: acquired immunodeficiency syndrome
HIV: human immunodeficiency virus
Spread through:
Sexual intercourse
Contaminated blood
Contaminated hypodermic needles
Passage from an infected pregnant woman to her baby during pregnancy or childbirth
Ingestion of breastmilk from infected mother
Number of infected women in the US is rising
25% of new AIDS cases are women
80% of those women were infected through heterosexual intercourse
HIV/AIDS are important issues for women
Because women are disproportionately in caregiving roles such as nursing, they bear a huge burden in the care of HIV-infected patients
HIV-infected women are more likely than infected men to be unemployed or to be employed in situations in which they feel vulnerable to being fired if status is known
HIV-infected women are more likely than infected men to have sole responsibility for their children
Race and ethnicity are also important
African Americans make up 65% of AIDS cases among women
The pattern of transmission of HIV tends to be different in minority populations from its pattern among Whites
Inequalities in power between women and men are at the heart of women’s heterosexual infection with HIV
Implications of social dominance theory
In Conclusion
Key issues discussed:
Do women experience menstrual cycle fluctuations in mood and are these shifts caused by fluctuating hormone levels?
At menopause, psychological symptoms such as depression and irritability show no increases compared with other life stages
Contraception is a major issue for women
Ability to space pregnancies is crucial
Abortion is generally not a traumatic experience
AIDS affects women in growing numbers, either because they are infected or because they are the wives, mothers, sisters, or caretakers of infected men
Emotions, Stress and Health
Emotion
Emotion
a response of the whole organism
physiological arousal
expressive behaviors
conscious experience
Theories of Emotion
Does your heart pound because you are afraid... or are you afraid because you feel your heart pounding?
James-Lange Theory of Emotion
Cannon-Bard Theory of Emotion
.
Schachter’s Two-Factor Theory of Emotion
Cognition and Emotion
While some emotional responses—especially simple likes, dislikes, and fears—involve no conscious thinking, complex emotions—including moods such as depression—are greatly affected by our interpretations, memories, and expectations.
Arousal and Performance
Performance peaks at lower levels of arousal for difficult tasks, and at higher levels for easy or well-learned tasks
In day-to-day life, performance on a task is usually best when arousal is moderate--varies with the difficulty of the task. With easy tasks, peak performance comes with relatively high arousal, which enhances the dominant, usually correct, response. With more difficult tasks, the optimal arousal is somewhat less.
Emotion - Lie Detectors
Polygraph
machine commonly used in attempts to detect lies
measures several of the physiological responses accompanying emotion
perspiration
cardiovascular
breathing changes
Expressed Emotion
Communicate nonverbally as well as verbally. Example: firm handshake=an outgoing, expressive personality. With a gaze, an averted glance, or a stare intimacy, submission, or dominance is communicated. Fear and anger read mostly from the eyes: happiness from the mouth.
Introverts are better emotion-detectors than extraverts; extraverts are easier to read.
People more speedily detect an angry face than a happy one
Women are better than men at reading emotions.
Effects of facial expressions on emotional experience
Facial feedback hypothesis: expressions communicate emotion, amplify the felt emotion and signal the body to respond accordingly.
Example: students made to make a frowning expression reported feeling a little angry. People instructed to express other basic emotions react similarly---just activating one of the smiling muscles by holding a pen in the teeth is enough to make cartoons seem more amusing.
Culturally universal expressions
some gestures culturally determined, facial expressions, such as those of happiness and fear, are common the world over. The physiological symptoms of emotion also cross cultures.
Cultures differ in how, and how much, they express emotions. Example: in communal cultures that value interdependence, intense displays of potentially disruptive emotions are infrequent.
Experienced Emotion
Anger: most often aroused by frustrating or insulting acts that seem willful and unjustified. Expressing anger may be temporarily calming, but in the long run it can actually arouse more anger.
Catharsis: emotional release The catharsis hypothesis maintains that “releasing” aggressive energy through action or fantasy reduces anger.
Although “blowing off steam” may temporarily calm an angry person, it may also amplify underlying hostility, and it may provoke retaliation. Angry outbursts may be reinforcing and therefore habit forming. In contrast, anger expressed without accusing someone can benefit relationships by leading to reconciliation rather than retaliation
Happiness boosts people’s perceptions of the world and their willingness to help others.
Feel-good, do-good phenomenon
people’s tendency to be helpful when already in a good mood
Subjective Well-Being
How happy are you? One way to measure happiness:
Subjective well-being:An approach by which people evaluate their lives in terms of both their thoughts and emotions
Characteristic of happy people:
High self esteem: more intelligent and better interpersonal skills than average person
Firm sense of control: feel in control of their lives
Optimistic: glass is ½ full
Like to be around other people: tend toward extraversion and to have supportive others
Significant good events seldom increase happiness for long, a fact explained by the adaptation-level and relative deprivation principles.
Adaptation-Level Phenomenon
tendency to form judgments relative to a “neutral” level, defined by our prior experience. describes tendency to judge various stimuli relative to what we have previously experienced. If income or social prestige increases, feel initial pleasure. We then adapt to this new level of achievement, come to see it as normal, and require something better to give us another surge of happiness. Even really good, such as winning a state lottery, seem not to increase happiness for long. We overestimate the duration of our emotions and underestimate our capacity to adapt
Relative Deprivation
perception that one is worse off relative to those with whom one compares oneself
In summary----
Happiness is...
High self-esteem, close friendships or a satisfying marriage, and meaningful religious faith are among the predictors of happiness. Age, gender, educational level, and parenthood are among the factors unrelated to happiness.
Stress and Health
Health Psychology: subfield of psychology that provides psychology’s contribution to behavioral medicine
Health psychologists and physicians---interdisciplinary field of behavioral medicine. Health psychologists study the causes and effects of stress as well as effective strategies for alleviating it.
Stress and Illness
Stress and Stressors:
the process by which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging
Stress is the physiological response of the body to physical and psychological demands. The response to events that threaten or challenge an individual.
Stress comes from how we interpret or appraise events; not so much coming from the event itself. To study stress and stressors: interested in how we appraise and cope with environmental threats and challenges
Stressors can be both pleasant events and unpleasant events (feel stress from things that threaten or challenge us)
Both positive and negative effects from stress: positive effects: motivation to conquer problems. Negative effects: threaten resources
Effects of Stress:
Walter Cannon: in response to stress, the sympathetic nervous system activates the secretion of stress hormones, triggers increased heart rate and respiration, diverts blood to skeletal muscles, and releases sugar and fat from the body’s stores, all to prepare the body for either “fight or flight.
Sources of Stress
Stressful Life Events
Catastrophes: unpredictable, large-scale events e.g., war, earthquake. Can have significant health consequences. Catastrophic floods, hurricanes, and fires are followed by increased rates of psychological disorders such as depression and anxiety.
Life Changes e.g., death, marriage, divorce, loss of job
Major life events, or significant life changes--- such as the death of a family member, that have immediate negative consequences—but with time, stress levels generally fade. Those who experience significant life changes, such as the death of a spouse, divorce, or loss of a job, are vulnerable to disease. Experiencing a cluster of such crises puts one even more at risk
Daily Hassles(or background stressors): annoying events in everyday life, such as being stuck in traffic, long lines at the bank or store, and aggravating housemates--cause minor irritations that may have long-term ill effects if they continue or are compounded by other stressful events.
Daily hassles may be the most significant source of stress, because over time these little stressors take a toll on our health and well-being. cumulative effect on health
Another area to consider with daily hassles, is the impact of: DailyUplifts-----Minor positive events that make one feel good
What is stress?
Most organisms reacting to stressors go through three stages, called the General Adaptation Syndrome.
Hans Selye, Canadian scientist, pioneered research into stress. He discovered that the body has an adaptive response to stress that is very general; stress may feel and look the same, regardless of type of stressor.
The body’s adaptive response to stress is composed of three stages
Stages of General Adaptation Syndrome:
Alarm Reaction----aware of presence of stressor. sympathetic nervous system is activated
Resistance---try to cope with stressor. With resources mobilized, we then fight the challenge during resistance.
Exhaustion----Persistent stress may eventually deplete body's resources. Ability to adapt to stressor declines to point where negative consequences of stress appear.
If resist or cope with a stressor in the second stage, physical resources will not be drained.
Long-term, continuous exposure to stressors may result in a reduction of the body's ability to deal with stress.
Perceived Control
Catastrophes, important life changes, and daily hassles are especially stressful when appraised as negative and uncontrollable.
Rats that experience uncontrollable shock are more susceptible to ulcers and experience a lowered immunity to disease--- animal and human studies show that loss of control provokes an outpouring of stress hormones that can contribute to health problems.
Explanatory style
Optimism
use external, unstable, & specific explanations for negative events
predicts better health outcomes
Pessimism
use internal, stable, & global explanations for negative events
predicts worse health outcomes
Pessimism also influences stress vulnerability. Optimists report less fatigue, have fewer aches and pains, and respond to stress with smaller increases in blood pressure. Optimists outlive pessimists.
Habitually grouchy people tend to have poorer health outcomes
Stress and the Heart--- Coronary heart disease is the leading cause of death.clogging of the vessels that nourish the heart muscle
Risk factors in heart disease include smoking, stress, Type A personality traits, obesity, a high-fat diet, and lack of exercise.
Type A—characteristics are time urgency; general hostility;
& intense ambition and competitiveness
associated with heart disease
Friedman and Rosenman’sbegan using this term for competitive, hard-driving, impatient, verbally aggressive, and anger-prone people.
Found there to be an increased risk of heart disease linked with the competitive, hard-driving, and impatient Type A personality.
Type B
Friedman and Rosenman’s term for easygoing, relaxed people. . The noncompetitive, relaxed, easy-going Type B personality is less physiologically reactive when harassed or given a difficult challenge. Less susceptible to coronary heart disease.
Research on type A personality
Time urgency & competitiveness not associated with poor health outcomes.
The toxic core of Type A is negative emotions, especially the anger associated with an aggressively reactive temperament. Under stress, the body of the Type A person secretes more of the hormones that accelerate the buildup of placques on the heart’s artery walls.
High levels of hostility increase chance of all disease (e.g., cancer)
Reducing stress, increasing exercise, and maintaining a low-fat diet can help minimize the build-up of fatty deposits in the arteries and the risk for cardiovascular disease.
Research indicates that depressed people are also at risk for heart disease
Stress and Disease
Psychophysiological Illness
“mind-body” illness
any stress-related physical illness---some forms of hypertension; some headaches
distinct from hypochondria— misinterpreting normal physical sensations as symptoms of a disease
Immune system function--stress leads to suppressed immune function
Diverts energy to muscles & brain
Even brief exposure alters immune function
Stress-weakened immune system increases risk of cancer
depression
bereavement
bottled-up negative emotions
Negative emotions and health-related consequences
Modifying Type A life-style can reduce recurrence of heart attacks
Strategies for coping with stress:
Studies suggest that aerobic exercise can reduce stress, depression, and anxiety.