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How Gender, Sexuality, and Cultural Norms Influence Psychological Functioning
Abnormal Psychology · Chapter 8: Sociocultural Influences on Mental HealthSection 8.3 · lesson 31 of 9712 min · free with a free account
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In this lesson
Why a difference in a measured rate is a starting point, not a finding.
- Distinguish sex from gender and say why it matters
- Apply the five explanations for any group difference
- Explain minority stress and where it locates the cause
- Name the assessment pitfalls and their safeguards
Transcript
Everything said in the video, section by section (1,577 words). Read along, or search it.
Sociocultural Influences on Mental Health
Gender, Sexuality, and Cultural Norms
A condition is recorded twice as often in one group as in another. Almost nothing, and this section is largely about why. A measured rate is produced by at least five different things. What happens to people. How they express it. Whether they present at all. How a clinician judges them, and what instrument was used. Any of those can move a rate without anything about the group having changed. So we will treat an observed difference as a starting point for investigation. Not as a finding. Then we turn to sexual and gender minority populations, and to culture. Both raise the same question about where a cause is located.
Two Variables
Sex and Gender Are Confounded in Ordinary Life
Start with two words that get used interchangeably, and should not be. Sex refers to biological characteristics. Chromosomal, hormonal, and anatomical. Gender refers to the socially constructed roles, expectations, behaviors and identities. Gender identity is a person's own internal sense of their gender. Which may or may not correspond to the sex they were assigned at birth. This is not terminological pedantry. It is the whole basis for reading group differences. Nearly every study comparing men and women compares groups that differ twice over. In biology, and in social experience, because those two are almost perfectly confounded. Or with differential exposure to adversity. Or with how distress gets expressed. One note before we go on. This material is educational, and is not a basis for diagnosis.
Five Explanations
What Has to Be on the Table First
Some categories are recorded more often in women. Low mood, anxiety, disordered eating. Others are recorded more often in men, including substance-related and antisocial patterns. Before any of that is interpreted, five explanations have to be on the table. And they are not alternatives to pick between. Several usually operate at once. One. A genuine difference in exposure to adversity. Two. A difference in symptom expression. The same difficulty is expressed differently, and meets criteria written around one expression. Four. A difference in clinician judgment of identical presentations. Five. A measure developed in one population and applied to another. Now notice what is missing from that list. No entry says that one group is more psychologically fragile than another. Treating a rate as a readout of group vulnerability skips all five steps.
Expression
Inward, Outward, and Who Walks Through the Door
Internalizing describes distress directed inward. Externalizing describes distress directed outward. Hold on to this. Both are ways distress can be expressed. Neither one is more genuinely distress than the other. The documented tendency is that internalizing is more often recorded in women and girls. And externalizing in men and boys, with substantial overlap and many exceptions. Gendered socialization is one contributor to that. Expectations about which emotions may be displayed start in early childhood. Criteria for mood conditions describe internalizing features in detail. So a man whose depression shows up as irritability, drinking, and physical complaints may not map onto them. He may get assessed for the substance use, and not for the mood condition underneath it.
Who Presents, Who Judges
Two Places the Rate Is Made
Rates recorded in clinical settings depend on who actually arrives. Where emotional disclosure is treated as incompatible with masculinity, help-seeking carries a cost. Men in many settings consult less often, and present later. They are also more likely to describe physical symptoms than emotional ones. Clinical samples over-represent groups that consult readily. So any rate from service data confounds prevalence with help-seeking. And what gets reported in the room is shaped by what the person expects to be received well. Now the second place a rate gets made. The point of diagnosis itself. Take case descriptions identical in every respect except the stated gender. The same presentation attracts different labels depending on how the person is described. The only thing varying is the clinician's judgment, which is what makes this clean.
Exposure
Differential Exposure Is Not Differential Vulnerability
Some of the observed difference is neither artifact nor expression. Groups genuinely differ in what happens to them. Differential exposure is a difference in the adversity encountered. Differential vulnerability would be a difference in how much harm a given adversity does. Rates and types of interpersonal violence experienced differ substantially by gender. And exposure to violence is among the better-documented predictors of later difficulty. Unpaid care falls disproportionately on women in most societies studied. With consequences for time, income, employment continuity, and sleep. Now the corrective this distinction carries, which is the point of the whole section. A higher rate produced by more exposure is a fact about circumstances. Read the same rate as susceptibility and you have relocated the explanation into the people.
Stated Plainly
Orientation and Gender Identity Are Not Disorders
This next part begins with the statement itself, because everything depends on it. Being lesbian, gay, bisexual, transgender or non-binary is not a psychological disorder. These are ordinary variations in human identity and attraction. They are not conditions. They do not require treatment. There is nothing to be cured. Homosexuality was listed as a disorder from the first edition of the American classification. It was removed in nineteen seventy-three, by a vote of the professional membership. The argument was that the category had never rested on evidence of impairment. Assessors who did not know which group a participant belonged to found no differences in functioning. One more thing has to be said plainly. Orientation-change efforts are discredited. There is no credible evidence that orientation or identity can be changed by them. This is not a matter on which the evidence is divided.
Minority Stress
Where the Elevated Distress Comes From
Sexual and gender minority populations show elevated rates of psychological difficulty. Minority stress theory is the leading explanation. It was developed in this form by Ilan Meyer, in work published in two thousand three. Its central claim is an attribution, and the attribution is the whole point. The elevation is produced by the chronic stress of belonging to a stigmatized minority. Not by the identity itself. State that explicitly, every time the rates come up. The theory distinguishes three levels of stressor. Distal stressors are objective events. Discrimination, rejection by family, exclusion, victimization. Proximal stressors are the internal processes those events produce. And vigilance, an expectation of rejection that operates whether or not rejection occurs. Internalized stigma is applying society's devaluing beliefs to oneself. And it predicts that reducing the stressors should reduce the gap.
Culture
Four Points Where a Framework Does Work
Culture is the shared framework of meanings, values, practices and expectations within a group. It is not the same as nationality, ethnicity, or religion, though it interacts with all three. And here is the line to hold. Everyone has one. The clinician's framework is as much a cultural framework as anybody else's. Treating culture as a property only of the unfamiliar person is the commonest error here. Culture shapes difficulty at four separate points. It shapes what is noticed, because frameworks direct attention to some experiences and not others. It shapes how distress is expressed, through the vocabulary available. It shapes what distress is attributed to. Physical, spiritual, social, or psychological. And attribution determines what the person believes will help. Finally it shapes what help is sought, from whom, and in what order.
Idioms
Neither Vocabulary Is the Correct One
An idiom of distress is a culturally shared way of expressing suffering. Some idioms are predominantly somatic. Exhaustion, pain, heat, pressure, a sensation in the chest. Others are predominantly psychological. Sadness, guilt, worthlessness. Two points must be made together, because separating them produces error. First, neither idiom is the correct one. The psychological idiom common in contemporary Western settings is itself culturally particular. It developed in a specific context. It is not the default state of humanity. Second, an idiom is a form of expression, not a difference in the underlying experience. Somatic presentation does not mean the person is unaware of their emotional state. Two errors are available with cultural concepts of distress, and both should be avoided. Dismissal treats the concept as folk belief obscuring the real condition beneath. Which is a way of ranking cultures while appearing to respect them.
Assessment
Pitfalls That Run in Both Directions
Now the practical part. Assessment across cultures, and where it goes wrong. An instrument transported without validation is the first pitfall. Its items may carry different meanings, or different thresholds, in the new population. The safeguard is to use locally validated measures, and to check scores against function. Second, language and interpreting. Untrained interpreters summarize, omit, and normalize what is said. So use trained interpreters rather than family members, and ask for literal rendering. Ask whether others in the person's community share the belief or practice. Fourth, and this is the opposite error, real distress dismissed as cultural. Notice that these two errors have opposite remedies. Correct hard against one, and you will reliably produce the other.
Combining
Intersections, and Two Presentations Compared
Intersectionality is the principle that characteristics combine. Gender, sexuality, culture, class and disability produce experiences that one-at-a-time analysis misses. The term comes from legal scholarship, in work by Kimberle Crenshaw published in nineteen eighty-nine. She analyzed discrimination claims that failed because the situation fell between legal categories. Take a person whose minority identity is not accepted in their own cultural community. The protective factor and the stressor are located in exactly the same relationships. Now two composite presentations, side by side. Amara, forty-four, reports headaches, heaviness in her limbs, and exhaustion that sleep does not relieve. Ellen, forty-one, reports low mood, loss of interest, guilt, and a sense of worthlessness. Now look at what is the same in both. Duration, impairment, early waking, weight loss, and withdrawal from a valued activity. Assessed on function rather than vocabulary, the two are closely comparable. And here is the less obvious risk. Ellen's presentation fits the criteria closely. A presentation that fits the expected form invites less inquiry, not more.
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