Psychol Psychother. 2021 Sep;94(3):704-720. doi: 10.1111/papt.12317. Epub 2020 Nov 20.
How psychosis interrupts the lives of women and men differently: a qualitative comparison.
Psychology and psychotherapy
Ruth L Firmin, Aieyat B Zalzala, Jay A Hamm, Lauren Luther, Paul H Lysaker
Affiliations
Affiliations
- Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, Rhode Island, USA.
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA.
- Department of Psychiatry, The Institute of the Living at Hartford Hospital, Hartford, Connecticut, USA.
- Midtown Community Mental Health Center, Eskenazi Hospital, Indianapolis, Indiana, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA.
- Roudebush VA Medical Center, Indianapolis, Indiana, USA.
PMID: 33215851
DOI: 10.1111/papt.12317
Abstract
PURPOSE: Psychosis disrupts how persons experience themselves and their lives. Despite knowledge that gender differences have been noted in presentation and course of psychosis symptoms, little is known about differences in how men and women experience these disruptions.
METHOD: The narratives of 26 men and 27 women diagnosed with psychosis, matched on age, education, and race, of the impact of psychosis on one's life, were compared. Using secondary data from semi-structured interviews, themes were identified using inductive, phenomenological qualitative analyses.
RESULTS: Women and men discussed psychosis-related interruptions to the roles and relationships that shape their identity. Both genders discussed the impact of psychosis on their sense of self, work, and relationships. Nuanced gender differences emerged, informing unique areas of challenge related to (1) parenting and loss of parenting roles, (2) work and loss or changes in work trajectories, (3) isolation and strain on interpersonal relationships, and (4) manifestations of stigma.
CONCLUSIONS: Psychosis may disrupt distinct aspects of life for men and women. Each gender faces the intersection of socially informed expectations that impact one's experiences of stigma, expectations of others, and manifestations of losses felt in one's role and sense of identity. Findings inform important considerations for therapy and other services.
PRACTITIONER POINTS: Gender-based socialized expectations, losses, and challenges that accompany psychosis are important areas for therapeutic consideration. Current treatments may neglect challenges that are more commonly experienced by women with psychosis.
© 2020 British Psychological Society.
Keywords: gender; identity; parenting; psychosis; schizophrenia; sense of self; stigma; work
References
- Abu-Akel, A., & Bo, S. (2013). Superior mentalizing abilities of female patients with schizophrenia. Psychiatry Research, 210, 794-799. https://doi.org/10.1016/j.psychres.2013.09.013 - PubMed
- Aleman, A., Kahn, R.S., & Selten, J.P. (2003). Sex differences in the risk of schizophrenia: Evidence from meta-analysis. Archives of General Psychiatry, 60, 565-571. https://doi.org/10.1001/archpsyc.60.6.565 - PubMed
- Andresen, R., Oades, L., & Caputi, P. (2003). The experience of recovery from schizophrenia: Towards an empirically validated state model. Australian and New Zealand Journal of Psychiatry, 37, 586-594. https://doi.org/10.1046/j.1440-1614.2003.01234.x - PubMed
- Angermeyer, M.C., & Kühnz, L. (1988). Gender differences in age at onset of schizophrenia. European Archives of Psychiatry and Neurological Sciences, 237, 351-364. https://doi.org/10.1007/bf00380979 - PubMed
- Bargenquast, R., & Schweitzer, R.D. (2014). Enhancing sense of recovery and self-reflectivity in people with schizophrenia: a pilot study of metacognitive narrative psychotherapy. Psychology and Psychotherapy: Theory, Research and Practice, 87, 338-356. https://doi.org/10.1111/papt.12019 - PubMed
- Barker-Collo, S., & Read, J. (2011). The roles of gender and coping styles in the relationship between child abuse and the SCL-90-R subscales' psychoticism' and 'paranoid ideation'. New Zealand Journal of Psychology (Online), 40, 30-40. https://psycnet.apa.org/record/2012-16687-003 - PubMed
- Berg, B.L. (2001). Qualitative research methods for the social sciences, 8th ed. Boston: Allyn & Bacon. - PubMed
- Bleuler, E. (1911/1950). Dementia praecox or the group of schizophrenias. New York, NY: International Universities Press. - PubMed
- Bonfils, K.A., Adams, E.L., Firmin, R.L., White, L.M., & Salyers, M.P. (2014). Parenthood and severe mental illness: Relationships with recovery. Psychiatric Rehabilitation Journal, 37, 186-193. https://doi.org/10.1037/prj0000072 - PubMed
- Boyle, M. (1997). Making gender visible in clinical psychology. Feminism & Psychology, 7, 231-238. - PubMed
- Canuso, C., & Pandina, G. (2007). Gender and schizophrenia. Psychopharmacology Bulletin, 40, 178-190. - PubMed
- Carr, E.R., Green, B., & Ponce, A.N. (2015). Women and the experience of serious mental illness and sexual objectification: Multicultural feminist theoretical frameworks and therapy recommendations. Women & Therapy, 38(1-2), 53-76. https://doi.org/10.1080/02703149.2014.978216 - PubMed
- Chaplin, T.M., Cole, P.M., & Zahn-Waxler, C. (2005). Parental socialization of emotion expression: gender differences and relations to child adjustment. Emotion, 5(1), 80-88. https://doi.org/10.1037/1528-3542.5.1.80 - PubMed
- Denham, S.A., Zoller, D., & Couchoud, E.A. (1994). Socialization of preschoolers' emotion understanding. Developmental Psychology, 30, 928-936. https://doi.org/10.1037/0012-1649.30.6.928 - PubMed
- Diaz-Caneja, A., & Johnson, S. (2004). The views and experiences of severely mentally ill mothers: A qualitative analysis. Social Psychiatry and Psychiatric Epidemiology, 39, 472-482. https://doi.org/10.1007/s00127-004-0772-2 - PubMed
- Firmin, R.L., Luther, L., Lysaker, P.H., Minor, K.S., McGrew, J.H., Cornwell, M.N. & Salyers, M.P.(2017). Stigma resistance at the personal, peer, and public levels: A new conceptual model. Stigma and Health, 2, 182-194. https://doi.org/10.1037/sah0000054 - PubMed
- Garrett, N.R. (2004). Treatment of a transgender client with schizophrenia in a public psychiatric milieu: A case study by a student therapist. Journal of Gay & Lesbian Psychotherapy, 8(3-4), 127-141. https://doi.org/10.1300/j236v11n01_06 - PubMed
- Gilligan, C. (1982). In a different voice. Cambridge, MA: Harvard University Press. - PubMed
- Goldstein, J.M., & Tsuang, M.T. (1990). Gender and schizophrenia: An introduction and synthesis of findings. Schizophrenia Bulletin, 16, 263-275. https://doi.org/10.1093/schbul/16.2.179 - PubMed
- Haarmans, M. (2019a). Everything you always wanted to know about sex [and gender] in psychosis but were afraid to ask: A review. In M. Sáenz-Herrero (Ed.), Psychopathology in women - incorporating gender perspectives into descriptive psychopathology (pp. 361-387). Cham: Springer. https://doi.org/10.1007/978-3-030-15179-9_18 - PubMed
- Haarmans, M. (2019b). Improving our science with a sex- and gender-based analysis in psychosis research. In M. Sáenz-Herrero (Ed.), Psychopathology in women - incorporating gender perspectives into descriptive psychopathology, 2nd ed. (pp. 83-110). Cham: Springer. https://doi.org/10.1007/978-3-030-15179-9_6 - PubMed
- Haarmans, M., McKenzie, K., Kidd, S.A., & Bentall, R.P. (2018). Gender role strain, core schemas, and psychotic experiences in ethnically diverse women: A role for sex-and gender-based analysis in psychosis research? Clinical Psychology & Psychotherapy, 25, 774-784. https://doi.org/10.1002/cpp.2307 - PubMed
- Haarmans, M., Vass, V., & Bentall, R.P. (2016). Voices’ use of gender, race and other social categories to undermine female voice-hearers: Implications for incorporating intersectionality within CBT for psychosis. Psychosis, 8, 203-213. https://doi.org/10.1080/17522439.2015.1131323 - PubMed
- Häfner, H., Behrens, S., De Vry, J., & Gattaz, W.F. (1991). An animal model for the effects of estradiol on dopamine-mediated behavior: Implications for sex differences in schizophrenia. Psychiatry Research, 38, 125-134. https://doi.org/10.1016/0165-1781(91)90038-q - PubMed
- Hewitt-Taylor, J. (2001). Use of constant comparative analysis in qualitative research. Nursing Standard, 15, 39-42. https://doi.org/10.7748/ns2001.07.15.42.39.c3052 - PubMed
- Hill, C.E. (2012). Consensual qualitative research: A practical resource for investigating social science phenomena. Washington, DC: American Psychological Association. - PubMed
- Hill, C.E., Knox, S., Thompson, B.J., Williams, E.N., Hess, S.A., & Ladany, N. (2005). Consensual qualitative research: An update. Journal of Counseling Psychology, 52, 196. https://doi.org/10.1037/0022-0167.52.2.196 - PubMed
- Johnson, J.L., & Repta, R. (2012). Sex and gender: beyond the binaries. In J.L. Oliffe & L. Greaves (Eds.), Designing and conducting gender, sex, & health research (pp. 39-64). Los Angeles: Sage Publications Inc. https://doi.org/10.4135/9781452230610.n2 - PubMed
- Jones, D., Marcias, R., Gold, P.B., Barreira, P. & Fisher, W.(2008). When parents with severe mental illness lose contact with their children: Are psychiatric symptoms or substance use to blame? Journal of Loss and Trauma, 13, 261-287. https://doi.org/10.1080/15325020701741849 - PubMed
- Jones, N., Rosen, C., Kamens, S., & Shattell, M. (2018). “It was definitely a sexual kind of sensation”: Sex, sexual identity, and gender in the phenomenology of psychosis. Psychosis, 10, 122-131. https://doi.org/10.1080/17522439.2018.1469036 - PubMed
- Kean, C.S. (2009). Silencing the self: Schizophrenia as a self-disturbance. Schizophrenia Bulletin, 35, 1034-1036. https://doi.org/10.1093/schbul/sbp043 - PubMed
- Koestner, R., & Aube, J. (1995). A multifactorial approach to the study of gender characteristics. Journal of Personality, 63, 681-710. - PubMed
- Laing, R.D. (1988/1959). The divided self: An existential study in sanity and madness. London, UK: Penguin Books. - PubMed
- Lampshire, D. (2012). The sounds of a wounded world. In J. Geekie, P. Randal, D. Lampshire & J. Read (Eds.), Experiencing psychosis: Personal and professional perspectives (pp. 139-145). New York, NY: Routledge. https://doi.org/10.1002/j.2167-4086.2013.00045.x - PubMed
- Lauveng, A. (2012). When you have lost yourself, there's really not very much left. In J. Geekie, P. Randal, D. Lampshire & J. Read (Eds.), Experiencing psychosis: Personal and professional perspectives (pp. 79-86). New York, NY: Routledge. - PubMed
- Levant, R.F. (2011). Research in the psychology of men using the gender role strain paradigm as a framework. American Psychologist, 66, 765-776. https://doi.org/10.1037/a0025034 - PubMed
- Lewine, R.R. (1981). Sex differences in schizophrenia: timing or subtypes? Psychological Bulletin, 90, 432-444. https://doi.org/10.1037/0033-2909.90.3.432 - PubMed
- Lysaker, P.H., Buck, K.D., Taylor, A.C., & Roe, D. (2008). Associations of metacognition and internalized stigma with quantitative assessments of self-experience in narratives of schizophrenia. Psychiatry Research, 157(1), 31-38. https://doi.org/10.1016/j.psychres.2007.04.023 - PubMed
- Lysaker, P.H., Clements, C.A., Plascak-Hallberg, C.D., Knipscheer, S.J., & Wright, D.E. (2002). Insight and personal narratives of illness in schizophrenia. Psychiatry, 65, 197-206. https://doi.org/10.1521/psyc.65.3.197.20174 - PubMed
- Lysaker, P.H., Dimaggio, G., Daroyanni, P., Buck, K.D., LaRocco, V.A., Carcione, A., & Nicolo, G. (2010). Assessing metacognition in schizophrenia with the Metacognition Assessment Scale: Associations with the Social Cognition and Object Relations Scale. Psychology and Psychotherapy: Theory, Research and Practice, 83, 303-315. https://doi.org/10.1348/147608309x481117 - PubMed
- Lysaker, P.H., Hamm, J.A., Vohs, J., Kukla, M., Pattison, M., Leonhardt, B., & Lysaker, J.T. (2018). Understanding the course of self-disorders and alterations in self-experience in schizophrenia: Implications from research on metacognition. Current Psychiatry Reviews, 14, 160-170. https://doi.org/10.2174/1573400514666180816113159 - PubMed
- Lysaker, P.H., & Klion, R. (2017). Recovery, meaning-making, and severe mental illness: A comprehensive guide to metacognitive reflection and insight therapy. New York: Routledge. - PubMed
- Lysaker, P.H., & Lysaker, J.T. (2010). Schizophrenia and alterations in self-experience: A comparison of 6 perspectives. Schizophrenia Bulletin, 36, 331-340. https://doi.org/10.1093/schbul/sbn077 - PubMed
- Lysaker, P.H., Roe, D., & Buck, K.D. (2009). Recovery and wellness amidst schizophrenia: Definitions, evidence and the implications for clinical practice. Journal of the American Psychiatric Nurses Association, 16(1), 36-43. https://doi.org/10.1177/1078390309353943 - PubMed
- Lysaker, P.H., Roe, D., & Kukla, M. (2012). Psychotherapy and rehabilitation for schizophrenia: Thoughts about their parallel development and potential integration. Journal of Psychotherapy Integration, 22, 344. https://doi.org/10.1037/a0029580 - PubMed
- Mendrek, A., & Mancini-Marïe, A. (2015). Sex/gender differences in the brain and cognition in schizophrenia. Neuroscience & Biobehavioral Reviews, 67, 57-78. https://doi.org/10.1016/j.neubiorev.2015.10.013 - PubMed
- Moernaut, N., Vanheule, S., & Feyaerts, J. (2018). Content matters: A qualitative analysis of verbal hallucinations. Frontiers in Psychology, 9, 1958. https://doi.org/10.3389/fpsyg.2018.01958 - PubMed
- Mowbray, C.T., Oyserman, D., Bybee, D., MacFarlane, P., & Rueda-Riedel, A. (2001). Life circumstances of mothers with serious mental illnesses. Psychiatric Rehabilitation Journal, 25, 114-123. https://doi.org/10.1037/h0095034 - PubMed
- Nassar, E.H., Walders, N., & Jankins, J.H. (2002). The experience of schizophrenia: What's gender got to do with it? A critical review of the current status of research on schizophrenia. Schizophrenia Bulletin, 28, 351-362. https://doi.org/10.1093/oxfordjournals.schbul.a006944 - PubMed
- Nicholson, J., Biebel, K., Hinden, B.R., Henry, A.D., & Stier, L. (2001). Critical issues for parents with mental illness and their families. Rockville, MD: Center for Mental Health Services/Substance Abuse and Mental Health Services Administration. - PubMed
- Nicholson, J., Biebel, K., Katz-Leavy, J., & Williams, V. (2002). The prevalence of parenthood in adults with mental illness: Implications for state and federal policymakers, programs, and providers. In R.W. Manderscheid & M.J. Henderson (Eds.), Mental health, United States, 2002 (pp. 120-137). Rockville, MD: Substance Abuse and Mental Health Services Administration. - PubMed
- Nicholson, J., Nason, M.W., Calabresi, A.O., & Yando, R. (1999). Fathers with severe mental illness: Characteristics and comparisons. American Journal of Orthopsychiatry, 69, 134-141. https://doi.org/10.1037/h0080390 - PubMed
- Ochoa, S., Usall, J., Cobo, J., Labad, X., & Kulkarni, J. (2012). Gender differences in schizophrenia and first-episode psychosis: A comprehensive literature review. Schizophrenia Research and Treatment, 4, 1-12. https://doi.org/10.1155/2012/916198 - PubMed
- Riecher-Rössler, A., Butler, S., & Kulkarni, J. (2018). Sex and gender differences in schizophrenic psychoses-a critical review. Archives of Women's Mental Health, 21, 627-648. https://doi.org/10.1007/s00737-018-0847-9 - PubMed
- Rodgers, B. (2008). Audit trail. In L. Given (Ed.), The Sage encyclopedia of qualitative research methods, Vol. 1 (pp. 43-44). Thousand Oaks, CA: Sage. - PubMed
- Sajatovic, M., Jenkins, J.H., Strauss, M.E., Butt, Z.A., & Carpenter, E. (2005). Gender identity and implications for recovery among men and women with schizophrenia. Psychiatric Services, 56(1), 96-98. https://doi.org/10.1176/appi.ps.56.1.96 - PubMed
- Seeman, M.V. (1983). Schizophrenic men and women require different treatment programs. Journal of Psychiatric Treatment Evaluation, 5, 143-148. - PubMed
- Seeman, M.V. (1997). Psychopathology in women and men: Focus on female hormones. American Journal of Psychiatry, 12, 1641-1647. - PubMed
- Seeman, M.V., & Lang, M. (1990). The role of estrogens in schizophrenia gender differences. Schizophrenia Bulletin, 16, 185-194. - PubMed
- Shtasel, D.L., Gur, R.E., Gallacher, F., Heimberg, C., & Gur, R.C. (1997). Gender differences in the clinical expression of schizophrenia. Schizophrenia Research, 7, 225-231. - PubMed
- Smith, J.A., & Shinebourne, P. (2012). Interpretative phenomenological analysis. In H. Cooper, P.M. Camic, D.L. Long, A.T. Panter, D. Rindskopf & K.J. Sher (Eds.), APA handbook of research methods in psychology, Vol. 2. Research designs: Quantitative, qualitative, neuropsychological, and biological (pp. 73-82). Washington, DC: American Psychological Association. - PubMed
- Spitzer, R.L., Williams, J.B., Gibbon, M., & First, M. (1994). Structured clinical interview for DSM-IV. New York, NY: Biometrics Research Department. - PubMed
- Szymanski, S., Lieberman, J.A., Alvir, J.M., Mayerhoff, D., Loebel, A., Geisler, S., … Woerner, M. (1995). Gender differences in onset of illness, treatment response, course, and biologic indexes in first-episode schizophrenic patients. American Journal of Psychiatry, 152, 698-703. https://doi.org/10.1176/ajp.152.5.698 - PubMed
- Thorup, A., Petersen, L., Jeppesen, P., Ohlenschlaeger, J., Christensen, T., Krarup, G., … Nordentoft, M. (2007). Gender differences in young adults with first-episode schizophrenia spectrum disorders at baseline in the Danish OPUS study. Journal of Nervous and Mental Disease, 195, 396-405. https://doi.org/10.1097/01.nmd.0000253784.59708.dd - PubMed
- Wertz, F.J. (2008). A Comparison of Analytic Methods in Phenomenology, Grounded Theory, Discourse Analysis, Narrative Psychology and Intuitive Inquiry. In Proceedings from 115th Annual APA Convention, Boston - PubMed
- White, L.M., McGrew, J.H., & Salyers, M.P. (2013). Parents served by assertive community treatment: parenting needs, services, and attitudes. Psychiatric Rehabilitation, 36, 22-27. https://doi.org/10.1037/h0094743 - PubMed
- Wirth, J.H., & Bodenhausen, G.V. (2009). The role of gender in mental-illness stigma: A National Experiment. Psychological Science, 20, 169-173. https://doi.org/10.1111/j.1467-9280.2009.02282.x - PubMed
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