Mental Health Service and Female Psychiatric Disorders: the Experience of Women’s Mental Health Service in Naples, Italy:Journal of the Norwegian Psychological Association, vol. 24, n.9, 1987.

Our work for women friendly psychiatry and psychotherapy  began in 1977 in the Public Psychiatric Hospital "Frullone" in Naples. There we treated and rehabilitated Female inpatients who could not be discharged from Hospital above all for gender identity. Male psychiatrists feared pregnancy risks, once women got were freed. Female identity caused a sexual inequality in medical handling and other handicaps for women, besides their mental troubles.

              At that time as psychologists involved in the feminist movement we thought about limits, bias, and prejudices against women in Psychiatry and Psychology.

            Psychiatry underestimated women's mental problems, revolved around biological explanations of mental illness and treated women mostly with psycho-drugs.

            Psychology overcame the biological view of psychiatry regarding women, but underlined the importance of women's personality factors as "passivity, fragility, dependence" in the genesis of mental illness, in particular of depression.

            That is Psychology showed an axiomatic and nativistich view on women's mental disorders.

Research on etiological and risk factors was mainly orientated to evaluate, in an exclusively or principal way, the correlation between depressive pathology and hormonal cycle leaving out, prejudicially, different factors such as work and environment.

The under evaluation of the weight of environment and work (family and out side work) risk factors for women had clear consequences on the exclusion of women from important preventive prospects.

We thought it was necessary to modify criteria and standards in Psychiatry and Psychology regarding women and create new interpretative hypotheses and a new practice.

                This led to the organization of a mental health service only for women, and to the proposal of a methodology specifically created and applied to women's welfare. At the same time, in 1978 law n. 180 settling mental health care was applied in Italy. Thanks to this law many mental hospitals were closed and psychiatric care was organized in out-patients mental health centres.

Magnolia Centre

Our out-patients Centre is a public health care Centre specialized in women's mental health problems.

The equip is made up of: psychologists, a psychiatrist, a medical doctor specialized in homoeopathy, a sociologist, nurses. The Centre exemplifies the possibility of carrying on, within the Public Health System, activities of gender oriented Prevention, Treatment, Research and Training.

We have been working on women for more than twenty years and for many reasons. As women dealing with women’s disease we are interested in investigating certain features regarding women:

-         their  more frequent resort to psychiatric help  compared to men;

-         more elevated consumption of medicine;

-         high incidence of psychic disorders especially at the early in their married life when the  children are very young: on the one hand this is certainly the age of the greatest development of their female role but, on the other, it is also the one of greater responsibilities, environmental pressures and work.  Without doubt this is  the most difficult stage of life for housewives and outside workers as well;

-         the  poor quality of their life compared to men – as the annual report of the World Health Organization and many national and international epidemiological  studies have  indicated. 

Up to this time, about 6.000 women have been treated in our mental health service, and 1503 women have been treated in the last five years (1996-2000).  From an epidemiological point of view, this population corresponds to the general female population of Italy. It consists mainly of adult married women, with children.

Main symptoms are anxiety, depression, and/or psychosomatic troubles. In the recent years the demand for care has been growing, also from younger women, aged between 15 and 44.

       Our statistics have confirmed the international statistics. These show that psychic pathologies (major depression, anxiety, eating disorders) are prevalent and rising among women within the general population. Depression, specially, is the main cause of burden diseases among women between 15 and 44 years of age. The prevalence rates, in depression, are between 2 and 3 times higher among women than in men; in panic attacks they go up to three times more than in men.

              The prevalence rates in women, compared to men, are clearly rising starting from first adolescence time.  Female adolescents run a higher risk of disease and, in some cases like eating disorders, the rate for women goes up to 9:1 (90% of the total cases).

The range of activities is based on difference in age and status of female patients.

We set up three approaches: 1.  for married women, with children; 2. for adolescents and post-adolescents; 3. for women in menopause.

We offer: counselling, individual and group psychotherapy, self-help groups, expression and capability strengthening groups, homeopathic and allopathic treatment.

The Center develops research projects and training courses on the following topics:

-         psycho-social risk factors related to mental disorders in woman and in adolescents;

-         stress and women's daily life;

-         violence and pathology risks;

-         depression and risk of psychodrugs abuse.

Background

                             The background of our mental health work can be summed up in the following 4 points:

1.                Everyone is subjected to different kinds of pressures (economical, political, cultural, psychological, etc.) that can contribute to determine psychic troubles.

2.             Gender and sexual difference are additional causes of general pressure for women.

3.             The sociological notion of female role implies a number of rules of private and public behaviour aiming to create and increase a social and psychological subordination.

4.             The oppression of this  role can become unbearable for the woman. When this happens, then the psychic trouble may rise as the only possible expression of her suffering, of which she cannot recognize the source.

                 Daily life analysis is the field of our clinical and therapeutic treatment. It shows that two main factors contribute to the oppression linked to the female role:

- the burden and stress connected with  motherhood;

- the pressures exercised by the social and family environment, which lead the woman towards role behaviours, and induce her to accept global burden of motherhood.

                The analysis of being a mother and its characteristics (that is responsibility, expectations, models, tirelessness, her psychological dependence on the satisfaction of the needs of others, etc.). This analysis can form the central point of observation of the risk factors of mental illness for women.

                The characteristics of being "maternal" are part of gender identity and they do not apply only, nor specifically, to those women who have children.

                  Maternity is a social model which determines woman's behaviour and makes her neglect her personal needs  to the advantage  of others.

                Maternity is the prototype of a relationship of dependence, within which the person who is defined as socially in need of protection, is given a series of tasks to do, not considered as work but as services provided in the interests of personal realization.

Aims

             Increasing self-esteem among the women who ask for our help is our main objective, regardless of their age, education and intensity of disease.  This objective originates from the assumption – as many years of clinical experience have  already validated – that the disease comes from a wrong reading of the individual needs and as a consequence of  assent  to someone else’s point of view.

            The risk of confusing one’s own interests and points of view is higher among women  compared to men, since the spirit of self-sacrifice for someone else’s own good is  assumed  to be a natural connotation of female identity and it is  also required so as to conform   to socially accepted role models.  

            The general goals of this treatment are:

·                   - to modify women’s perception of themselves as being ill because of what is, in traditional psychiatry, a weakness

·                    - to modify their way of life and their dependence on those who are the cause of the symptoms and women’s perception of illness.

            The specific goals of psycho-clinical treatment are:

a)               -   to give women an opportunity to talk about their troubles and symptoms without thinking they are “ill”

b)                -  to make it possible for women to understand and recognise behind their symptoms the reasons for mental disorders linked to the events of everyday life (oppression, violence, work overload for the family, etc.)

       - to research and begin to test more suitable strategies for the expression/construction of personal needs and for overcoming pressures, violence and negative judgment expressed by the social context (often, specifically by the partner).