INTERNATIONAL CONGRESS ON MENTAL HEALTH CARE FOR WOMEN
Amsterdam, 19-22 december 1988
TREATMENT OF MENTAL DISORDERS
FOR FEMALE PATIENTS
Elvira Reale and Vittoria Sardelli, Italy
I. A work of decoding and treatment of women mental disorders on 671 women in the period 1981-1985 and 442 women in the period 1986-1987 is in progress since 1981.(Link with data in power point)à
These, women presented different psychiatric diseases:
Psycho-organic Syndrome 3.13%
The work was organized by the National Health Service and addressed to each woman looking for a treatment at the Mental Health Service on the territory.
The territory in which the research was carried out corresponds, in the administrative subdivision of the Region, to the local Unit of the Social and Health Services no. 39. ]t includes two districts of Naples, Soccavo and Pianura. The population is about 150.000 inhabitants. Characteristics of our assisted are: Age range, compared to age range in the general population, cultural level, working activity and marital status.
These data show that:
a. Each age in the population (with the exclusion of '5-14) is represented enough among patients in the Mental Health service;
b. The most represented age is the 25-34.
The married women represent the biggest percentage of our patients.
Primary School 38.15%
Secondary School 28.91%
High School 23.25%
The biggest percentage of our patients is grouped together in the Secondary and High School with the 52.16%.
Unemployed women 2.38%
The biggest percentage is represented by housewives, but comparing to working women in the same district, working patients are a high percentage.
From a general analysis of data we can deduce that there is an almost perfect correspondence between our patients and the population; women's typical profile in the population corresponds to women's typical profile of our sample; the housewife at an intermediate educational level, married, with 2 or 3 children. This profile gives us neither socio- economical nor cultural data related to the illness.
On the contrary, the unitary reference of our patients, different for age, marital status, occupation, cultural and socio-economical level, is the "social role experience". This experience reaches its biggest intensity at the stage of marriage with little children, in fact the age between 25-34 is the most represented among our patients.
The biggest incidence of this age range shows a significant correlation between risk of illness and extension of social role related tasks.
These tasks, both for the housewife and for the emancipated woman, become too heavy during the marriage because of the totalizing maternal functions.
II. Given this correlation, the following task was to prepare instruments good at coping with the female diseases starting from the analysis of role, as the main condition of illness.
The research we carried on with C.N.R. (National Institute of Research) from 1982 up to now, had as main purpose:
a. to identify specific links between illness and the structure of role;
b. to create instruments for analysis, and to emphasize these links between illness and social role;
c. to prepare instruments qualified to the treatment.
These tasks and purposes are discussed in the presentation of the "Handbook for Treatment of Women Mental Disorder". The book includes the presentation and the methodological explanation of the instruments for clinical and research approach to the illness.
l. Medical report
2. Patient interview
3. Analysis of daily life and personal history data
4. Analysis of perception of illness.
Furthermore, it includes the description and representation of links between role tasks and the process of becoming ill.
The aim of the Research was to make the women aware of their disease as a consequence of the overload from the environment. These instruments represent a particular way of interpreting mental disease. These instruments cannot replace the therapeutic relation between assistant and assisted. They are used in order to specify the clients' style of life and the factors (significant people, events, places) in their daily life related to the origin of the mental disease. The instruments can be static or dynamic.
Static instruments are:
a. Medical Report
b. Interview about how and why the assisted got ili and how and why they got over the illness.
Dynamic instruments are:
a. Analysis of woman personal daily life
b. Analysis of the process of construction of the perception of illness.
By using these instruments the assistant and the assisted are able to analyse the different stages of the process of getting ill of each woman:
1. Overload from the social and family environment; excessive requirements 'in terms of work and responsibility.
2. Failure to cope with these requirements mentioned in 1.
3. Interruption of the quarrel with the environment, in terms of women incapacity to construct their own life.
4. Acceptance of the society's life expectations for women.
It is synthetical and true recording of different stages of the treatment. ]t is based on the analysis of the problem of help seeking women (to the Service).
There is no space in the Medical Report for personal opinions, narrations, points of view that are different from the assisted one's. Medical Report is aimed to register what the patient tells, recalls and perceives.
In the Medical Report there is no space for a diagnosis. In fact, it is not used in the process of identification of the patient's problems. In the daily interview we record the patient's words and the assistant's words (technicians', therapists') as accurately as possible, trying to avoid inductive interpretations.
Medical Report is not aimed to record context's and technicians' opinions but only what the assisted tells, works out, interprets, connects and so on.
Interview is an instrument of verification of the treatment in the Mental Women Service and, particularly of the methodology.
It has two main purposes:
a. To verify in the follow-up (6 months - 1 year after the conclusion of the treatment) the main results obtained by the relationship with the Psychiatric Service; especially the qualitative factors present when the patient comes over the perception of illness.
b. To verify if and how the description of the link: illness, induction of incapacity, pressure put by the social context on the conformity with the role models gives to the assisted sufficient cognitive and emotional instruments to overcome the perception of illness.
The Interview based on a precise mechanical recording of the client's point of view. It is aimed at the recording of important factors of the patient's personal history: before the illness up to the arrival to the Service, during the illness and during the relationship with the Service; after the illness and after the conclusion of the relationship with the Service.
The fundamental interest of the Interview is dual. From the assisted's point of view, it is a significant situation in order to synthesize the process of getting ill and the corresponding process of coming over the illness.
In the Interview the assisted gives a personal interpretation of the general process, reaching a specification and a codification of wellbeing conditions in contrast with a discomfort condition.
The assisted, having to explain ex novo the steps of the therapeutic process, considers them comprehensively, reaching many other factors of awareness.
From the Service's point of view, the Interview is used to define the most significant elements of the strategies used in order to cope with the mental disease. The Interview becomes so an important instrument to analyse the validity of the treatment.
Analysis of daily life
The analysis of dati life and personal history bases on the idea that mental illness is always related to a series of events important for the social role. Daily life is examined in six different areas:
1 . Family work
2. Extra-family work
3. Study or professional activity
4. Social relations
5. Sexual relations
6. Free time.
These six areas are analysed for each stage in the vital cycle:
These biological stages are the most important moments of training for the female role: social context presses the woman to conform to models, socially more convenient.
The fundamental mode] the woman is pressed to is maternity as a natural function.
Maternity and necessity of caring for offspring is usually extended to other significant people in her life: partners, parents, friends, colleagues and so on. The function of looking after somebody else always limits her own interests and personal space in life.
The detailed analysis of daily life is used to explain woman's real position in relation to her environmental context.
Herewith the define what society asks to women: overload of work and responsibility women would or wouldn't like to assume in relation to their social context and overload of work and responsibility that they actually assume.
From the general analysis of the requirements made to women and of those made to other significant people of their life, it derives the overload of work that women assume and the limitation of their personal space and their own interests towards others' advantage.
The disproportion of the overload that woman assumes, and that the context requests in relation to the fulfilment of a natural role, and the limitation of personal interests give rise to the stage in which woman perceives the heaviness and the unbearableness of her life conditions.
Perception of unbearableness precedes and prepares the condition of illness. When the woman's interests are limited; when by seeking help from the social context she is accused of incapacity to conform to a role that is "normal for each other woman"; when she fails her own life project (the only one able to show her capacity and her dreams) because of this overload; then she finds the only escape: to attribute her personal failure to some pathology.
The connecting factor between unbearableness and illness stage is related to the complete woman's sharing of context opinion about the total legitimacy of overload requested from the social context.
Under the condition of illness, because of this condivision of social context opinion and interests, there isn't any quarrel between woman and social family context. Signals of this different way to relate with the social context are persistent feeling of tiredness, a lack of interests and of enthusiasm, a fall in the general tone. At this stage we can concretize the hypothesis of the individual pathology as the only plausible incapacity of be as other women are, and to live without discomfort and strange sensations.
Analysis of perception of illness.
The process of construction of perception of illness is divided into four stages, that we analyse starting from the last one (which is the first from the point of view of the Service).
Stage n.4 (0) Chronicity:
it represents the specific women's route in the Medical-psychiatric institution, starting from the moment in which a personal experience of pathology and individual dysfunction begins.
Stage n.3 (0) Process of getting ill:
it individuates the women's route from the situation of unbearableness (0°°) to that of illness (0°). The process from a of situation to another is characterized by a change upsetting their own point of view on life situation in relation with the social context. Illness perception at this stage is still lacking of a technical codification (it becomes a confirmation of perception of the chronicity route).
Stage n.2 (ù) Perception of incapacity preceding the route of getting ill:
it characterizes the construction of perception of incapacity following the quarrel with the context, because of the assertion of personal of necessities in any stage of women's life, preceding the specific route of getting ill. At this stage we concretize the woman's sharing of negative judgements expressed by the social context without giving up her own opinions and without any attribution of pathology to this incapacity.
Stage N.1 Perception of incapacity in the stage of role training.
Construction of role project (A):
at this stage we identify the perception of incapacity a woman assumes related to the adolescence quarrel within the family context.
The importance of this stage is in the construction of the role project that the women show us as demonstration of their denied capacity. The quarrel with the context during adolescence is mainly about future projects: when a precise project satisfies the necessity to prove their own capacity ot succeed; it is loaded of specific expectations that make difficult the change and exchange in case of impracticability. The failure of the adolescence project, and the impossibility to change it, will be one of the factors opening to women the route of getting ill.