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Recent Titles in ­Women’s Psy­chol­ogy ­ omen and M W ­ ental Disorders, Four Volumes Paula K. Lundberg-­Love, Kevin L. Nadal, and Michele A. Paludi, Editors Reproductive Justice: A Global Concern Joan C. Chrisler, Editor The Psy­chol­ogy of Love, Four Volumes Michele A. Paludi, Editor An Essential Handbook of W ­ omen’s Sexuality, Two Volumes Donna Castañeda, Editor Psychological Health of W ­ omen of Color: Intersections, Challenges, and Opportunities Lillian Comas-­Díaz and Beverly Greene, Editors Vio­lence against Girls and W ­ omen: International Perspectives, Two Volumes Janet A. Sigal and Florence L. Denmark, Editors The Praeger Handbook on W ­ omen’s Cancers: Personal and Psychosocial Insights Michele A. Paludi, Editor The Wrong Prescription for ­Women: How Medicine and Media Create a “Need” for Treatments, Drugs, and Surgery Maureen C. McHugh and Joan C. Chrisler, Editors Bullies in the Workplace: Seeing and Stopping Adults Who Abuse Their Co-­Workers and Employees Michele A. Paludi, Editor Sexual Harassment in Education and Work Settings: Current Research and Best Practices for Prevention Michele A. Paludi, Jennifer L. Martin, James E. Gruber, and Susan Fineran, Editors Why Congress Needs ­Women: Bringing Sanity to the House and the Senate Michele A. Paludi, Editor Feminism and Religion: How Faiths View W ­ omen and Their Rights Michele A. Paludi and J. Harold Ellens, Editors Campus Action against Sexual Assault: Needs, Policies, Procedures, and Training Programs Michele A. Paludi, Editor


Psy­chol­ogy of ­Women: A Handbook of Issues and Theories Third Edition

Florence L. Denmark and Michele A. Paludi, Editors

­Women’s Psy­chol­ogy Michele A. Paludi, Series Editor


Copyright © 2017 by ABC-­CLIO, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or other­wise, except for the inclusion of brief quotations in a review, without prior permission in writing from the publisher. Library of Congress Cataloging-­in-­Publication Data Names: Denmark, Florence, editor. | Paludi, Michele Antoinette, editor. Title: Psychology of women : a handbook of issues and theories / Florence L. Denmark and Michele A. Paludi, editors. Description: Third edition. | Santa Barbara, Calif. : Praeger, [2017] | Includes index. Identifiers: LCCN 2017021351 (print) | LCCN 2017035146 (ebook) | ISBN 9781440842290 (ebook) | ISBN 9781440842283 (hard copy : alk. paper) Subjects: LCSH: Women—Psychology. | Feminist psychology. Classification: LCC HQ1206 (ebook) | LCC HQ1206 .P747 2017 (print) | DDC 155.3/33—dc23 LC record available at https://lccn.loc.gov/2017021351 ISBN: 978-1-4408-4228-3 EISBN: 978-1-4408-4229-0 21 20 19 18 17   1 2 3 4 5 This book is also available as an eBook. Praeger An Imprint of ABC-­CLIO, LLC ABC-­CLIO, LLC 130 Cremona Drive, P.O. Box 1911 Santa Barbara, California 93116​-­1911 www​.­abc​-­clio​.­com This book is printed on acid-­free paper  Manufactured in the United States of Amer­i­ca


We dedicate this handbook to girls across the globe.


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Contents

Series Foreword  Michele A. Paludi ix Acknowl­edgments

xi

Introduction  Florence L. Denmark and Michele A. Paludi xiii Part I: Foundations of the Psy­chol­ogy of W ­ omen and the ­Women of Psy­chol­ogy Chapter 1: ­Women in Psy­chol­ogy Florence L. Denmark, Maria D. Klara, Erika M. Baron, and Linda Cambareri-­Fernandez 3 Chapter 2: Teaching the Psy­chol­ogy of ­Women Course Michele A. Paludi, Elaine Bontempi, Tina Stern, Jennifer Martin, Darlene C. DeFour, and Andrew Hurd 31 Chapter 3: Women of Color: Perspectives on “Multiple Identities” in Psychological Theory, Research and Practice June Chisholm and Beverly Greene 67 Chapter 4: Meta-­Analysis in the Psy­chol­ogy of ­Women Jennifer L. Petersen 103 Part II: Selected Topics in ­Women’s Relationships, Development, and Health Chapter 5: Diverse W ­ omen’s Sexualities: A Con­temporary View Ruth E. Fassinger and Julie R. Arseneau 121 Chapter 6: Women’s Friendships and Romantic Relationships: Culture, Sexuality, and Lifespan Contexts Donna Castañeda and Alyson L. Burns-­Glover 151


viii Contents Chapter 7: The Menstrual Cycle Joan Chrisler 193 Chapter 8: Women in the ­Middle and L ­ ater Years Claire Etaugh 233 Chapter 9: Women and ­Mental Health: An Examination of F ­ actors Implicated in Gender Differences in Depression Josephine Tan 263 Chapter 10: Women’s C ­ areer Development Nancy E. Betz 281 Part III: Vio­lence Against W ­ omen Chapter 11: Complex Ramifications of Incestuous Abuse on Adult Survivors: A Discussion for Helping Professionals Felicia L. Mirghassemi, Paula K. Lundberg-­Love, Gavin D. Sanders, and John A. Gallien 317 Chapter 12: Vio­lence Against ­Women: Global Workplace Sexual Harassment and Domestic Vio­lence Janet A. Sigal, Charlene E. Chester, and Tracy R. M. Cudjoe 341 Chapter 13: Gender and Intimate Partner Vio­lence: Expanding Our Understanding Maureen C. McHugh, Cristina L. Reitz-­Krueger, and Sofia Alvarez 383 About the Editors and Contributors

423

Index 433


Series Foreword Michele A. Paludi ­ ecause ­women’s work is never done and is underpaid or unpaid or boring or B repetitious and w ­ e’re the first to get fired and what we look like is more impor­ tant than what we do and if we get raped it’s our fault and if we get beaten we must have provoked it and if we raise our voices ­we’re nagging bitches and if we enjoy sex ­we’re nymphos and if we ­don’t ­we’re frigid and if we love ­women it’s ­because we ­can’t get a “real” man and if we ask our doctor too many questions w ­ e’re neurotic and/or pushy and if we expect childcare ­we’re selfish and if we stand up for our rights w ­ e’re aggressive and “unfeminine” and if we d­ on’t ­we’re typical weak females and if we want to get married w ­ e’re out to trap a man and if we ­don’t ­we’re unnatural and b­ ecause we still c­ an’t get an adequate safe contraceptive but men can walk on the moon and if we ­can’t cope or ­don’t want a pregnancy ­we’re made to feel guilty about abortion and . . . ​for lots of other reasons we are part of the ­women’s liberation movement. —Author unknown, quoted in The Torch, September 14, 1987

This sentiment underlies the four major goals of Praeger’s book series, ­Women’s Psy­chol­ogy: 1. Valuing w ­ omen. The books in this series value w ­ omen by valuing ­children and working for affordable child care; valuing w ­ omen by respecting all physiques, not just placing value on slender ­women; valuing ­women by acknowledging older w ­ omen’s wisdom, beauty, aging; valuing w ­ omen who have been sexually victimized and viewing them as survivors; valuing ­women who work inside and outside of the home; and valuing ­women by respecting their choices of ­careers, of whom they mentor, of their reproductive rights, and of their spirituality and their sexuality. 2. Treating ­women as the norm. Thus, the books in this series make up for ­women’s issues typically being omitted, trivialized, or dismissed from other books on psy­chol­ogy.


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3. Taking a non-­Eurocentric view of w ­ omen’s experiences. The books in this series integrate the scholarship on race and ethnicity into ­women’s psy­chol­ogy, thus providing a psy­chol­ogy of all ­women. W ­ omen typically have been described collectively, but we are diverse. 4. Facilitating connections among readers’ experiences, psychological theories, and empirical research. The books in this series offer readers opportunities to challenge their views about ­women, feminism, sexual victimization, gender-role socialization, education, and equal rights. ­These texts, thus, encourage ­women readers to value themselves and ­others. The accounts of w ­ omen’s experiences as reflected through research and personal stories in the texts in this series have been included for readers to derive strength from the efforts of ­others who have worked for social change on the interpersonal, orga­nizational and societal levels. A student in one of my courses on the psy­chol­ogy of ­women once stated: I learned so much about w ­ omen. W ­ omen face many issues: discrimination, sexism, prejudices . . . ​by society. ­Women need to work together to change how society views us. I learned so much and talked about much of the issues brought up in class to my friends and ­family. My attitudes have changed t­ oward a lot of t­ hings. I got to look at myself, my life, and what I see for the f­ uture. (Paludi, 2002)

It is my hope that readers of the books in this series also reflect on the topics and look at themselves, their own lives, and what they see for the ­future. I am honored to have the third edition of Psy­chol­ogy of ­Women included in this series on ­Women’s Psy­chol­ogy. This volume offers suggestions for all of us who want to know more about ­women’s health and ­career development as well as prevention and responses to vio­lence against ­women. All of the contributors to this volume are deeply committed to ensuring educational and employment equity for ­women and men and the eradication of vio­lence against students and employees. I am honored to have had the opportunity to work with them on this volume. REFERENCE Paludi, M. (2002). The psy­chol­ogy of ­women. (2nd ed.). Upper ­Saddle River, NJ: Prentice Hall.


Acknowl­edgments

We extend our appreciation to Debbie Carvalko for her support and encouragement of us to edit a third edition of this handbook. We also thank the contributors to this volume for their collaboration, dedication to the field of the psy­chol­ogy of ­women, and patience with all stages of the production of this handbook. We thank our ­family, friends and colleagues for sharing their ideas with us and for supporting us throughout the pro­cess. We also acknowledge the researchers and instructors in the field of the psy­chol­ogy of ­women who have made this handbook become a real­ity.


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Introduction Florence L. Denmark and Michele A. Paludi The question has been asked, “What is a ­woman?” A w ­ oman is a person who makes choices. A ­woman is a dreamer. A ­woman is a planner. A ­woman is a maker, and a molder. A ­woman is a person who makes choices. A ­woman builds bridges. A ­woman makes ­children and makes cars. A ­woman writes poetry and songs. A w ­ oman is a person who makes choices. You cannot even simply become a ­mother anymore. You must choose motherhood. ­Will you choose change? Can you become its vanguard? —Eleanor Holmes Norton

Eleanor Holmes Norton’s sentiment is expressed throughout this third edition of Psy­chol­ogy of ­Women: A Handbook of Issues and Theories. ­Women are portrayed in terms of the choices we make in our c­ areers, achievement, leadership, friendships and romantic relationships. W ­ omen are portrayed as being multidimensional, for example, in the ways we integrate work and ­family ways. Furthermore, a non-­Eurocentric perspective on ­women is presented. The chapters are also balanced for sexual orientation, class, and national origin. Thus, w ­ omen are portrayed in terms of our culture. Albert (1988) described advantages in placing culture prominently in the psy­chol­ogy curriculum. We have found ­these advantages to be especially useful in the psy­chol­ogy of ­women: 1. We can obtain information that is not available in our own culture. 2. We can obtain information about the incidence of a psychological issue in a dif­fer­ent culture. 3. Values that are common to a certain cultural group can be discussed.

The generalizability of psychological research can be assessed by looking at research from several cultures.


xiv Introduction As in the second edition, the chapters in this handbook are guided by the following feminist frameworks: 1. Effective h ­ uman be­hav­ior in social interactions and within social systems is related to understanding the relationship between the personal and po­liti­cal. 2. The psy­chol­ogy of ­women should treat w ­ omen as the norm. 3. The subjective, personal experience of w ­ omen is valid and impor­tant. 4. The psy­chol­ogy of w ­ omen should identify the w ­ omen of psy­chol­ogy and contributions by historical and con­temporary ­women psychologists should be noted. 5. The information in the psy­chol­ogy of w ­ omen should encourage individuals to critically analyze all subareas in psy­chol­ogy for the portrayal of ­women (Adapted from Lord, 1982).

Mary Roth Walsh (1985) suggested that the psy­chol­ogy of ­women serves as a “catalyst of change” by revealing serious deficiencies in psychological research and theories relevant to ­women. Our goal for this edition is the same as we had for the previous editions: to have this handbook be a catalyst for change and a stimulant for further research and advocacy on the psy­chol­ogy of w ­ omen. Thus, our goal is to have readers do as Eleanor Holmes Norton asked: to choose change, to become its vanguard. REFERENCES Albert, R. (1988). The place of culture in modern psy­c hol­ogy. In P. Bronstein & K. Quina (Eds.), Teaching a psy­chol­ogy of ­people: Resources for gender and sociocultural awareness (pp. 12–18). Washington, DC: American Psychological Association. Lord, S. (1982). Research on teaching the psy­chol­ogy of w ­ omen. Psy­chol­ogy of ­Women Quarterly, 7(1), 96–104. Walsh, M. R. (1985). The psy­chol­ogy of w ­ omen course: A continuing catalyst for change. Teaching of Psy­chol­ogy, 12(4), 198–203.


PART I

Foundations of the Psy­chol­ogy of ­Women and the ­Women of Psy­chol­ogy


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Chapter 1

­Women in Psy­chol­ogy Florence L. Denmark, Maria D. Klara, Erika M. Baron, and Linda Cambareri-­Fernandez

Even when the path is nominally open–­when ­there is nothing to prevent a ­woman from being a doctor, a l­ awyer, a civil servant–­there are many phantoms and obstacles . . . ​looming in her way. ­—Virginia Woolf

The majority of the influential theories and research in psy­chol­ogy have been constructed by men and for men. As Gerda Lerner (1979) noted, Traditional history has been written and interpreted by men in an androcentric frame of reference; it might quite properly be described as the history of men. The very term “­Women’s History” calls attention to the fact that something is missing from historical Scholarship . . . . ​(p. xiv).

Due to the biased social structure and inherent sexism that was predominant from the time of the ancient Greeks, w ­ omen and psy­chol­ogy had been separated from one another, and psy­chol­ogy was not considered to be a field “appropriate” for ­women. As Agnes O’Connell and Nancy Russo (1991) noted, psy­chol­ogy’s history has been a social construction by and for male psychologists. Although ­women made significant contributions to psy­chol­ogy, they largely remained invisible; their contributions attributed to men (Russo & Denmark, 1987; O’Connell & Russo, 1991). However, with the advent of the ­ women’s movement, ­women fought and increasingly became a valuable part of the discipline. They not only took positions in research, as clinicians, and teachers, but also made significant contributions in each of ­these respective fields.


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HOW TO STUDY ­WOMEN IN HISTORY Before specifically discussing the history of ­women and psy­chol­ogy, it ­ ill be helpful to understand how ­women have been characterized in hisw tory in general and what methods have been used to study this subject. Gerda Lerner (1992) postulated that the traditional approach to w ­ omen’s history is that of “compensatory history,” where only w ­ omen who w ­ ere noteworthy or accomplished w ­ ere recognized. Using this framework to examine this history of the w ­ omen in psy­chol­ogy would entail studying such early female psychologists as Mary Calkins, Margaret Floy Washburn, and Christine Ladd-­Franklin. This approach is characterized by an examination of t­ hose who w ­ ere noteworthy or whose achievements distinguished them in a field primarily comprised of men. The next level of conceptualizing ­women’s history can be characterized as “contribution history.” H ­ ere, ­women are noted as impor­tant ­because of the contributions they made to certain fields, to reform movements, to po­liti­cal action, ­etc. This would support an examination of how ­women contributed to the ongoing development of psy­chol­ogy and would entail, for example, an analy­sis of the repercussions of the w ­ omen’s movement, the advent of feminist thought, e­ tc. Lerner (1992) also identified “transitional ­women’s history.” In this framework, ­women are not seen in one-­dimensional par­ameters where they are studied in specific time frames or within the bound­aries of definite contributions. Rather, it is a way of examining w ­ omen in relation to specific categories and how w ­ omen contribute, respond, develop, and react to them. Psychological issues such as sexuality, reproduction, the link between motherhood and raising c­ hildren, roles of w ­ omen, sexual values, sexual myths, ethnicity, race, class, and religion would all be taken into consideration as a multidirectional matrix when examining the history of ­women in psy­chol­ogy. Therefore, unilateral conclusions or examinations are not made, but rather an in-­depth analy­sis of the role of w ­ omen and the ­factors contributing to their lives would be sought. In 1974, Bern­stein and Russo published an article, “The History of Psy­ chol­ogy Revisited: Or, Up with Our Foremothers.” They provided the following quiz: 1. Who ­were the first persons to use the term “projective technique” in print? 2. Who was the first person to develop child analy­sis through play? 3. Who developed the Cattell Infant Intelligence Test Scale? 4. What do the following have in common? Bender Gestalt Test, Taylor Manifest Anxiety Scale, Kent-Rosanoff Word Association Test, Thematic Apperception Test, Sentence Completion Method 5. The following are the last names of individuals who have contributed to the scientific study of ­human be­hav­ior. What ­else do ­these names have in common? Ausubel, Bellak, Brunswick, Buhler, Dennis, Gardner, Gibson, Glueck,


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5

Harlow, Hartley, Hoffmen, Horo­witz, Jones, Kendler, Koch, Lacey, Luchins, Lynd, Murphy, Premack, Rossi, Sears, Sherif, Spence, Staats, Stendler, Whiting, Yarrow.

The answers to this quiz are the following: 1. Lois Murphy and Ruth Horo­witz 2. Hermine von Hug-­Hullmuth 3. Psyche Cattell 4. A ­woman is e­ ither the se­nior author or the sole author of each work 5. They are the surnames of female social scientists

Bernstein and Russo concluded that their colleagues were unable to correctly answer the questions. They concluded that women psychologists must be rediscovered.

In addition, Scarborough and Furumoto (1987) voiced their concern about the history of psy­chol­ogy being a history of male psy­chol­ogy: At the 1984 meeting of the American Psychological Association, we listened as a ­woman psychologist told an anecdote she offered as an example of the invisibility of the ­women in psy­chol­ogy’s past. The incident was drawn from her own experience and dated back to the days when she was a student in a psy­chol­ogy course that dealt with the topic of perception. She recalled that among the classical theories covered in the course was one labeled the Ladd-­Franklin theory of color vision, a theory that she assumed to be the work of Mr. Ladd and Mr. Franklin. Not ­until much ­later did she discover that the theory was, in fact, the contribution of a ­woman who ­after marriage used a hyphenated surname of Christine Ladd-­Franklin (p. 1).

The number of w ­ omen mentioned in history books in psy­chol­ogy is relatively small vis-­à-­vis men. The number of w ­ omen psy­chol­ogy majors, however, is large. If w ­ omen psychologists’ contributions to the discipline are not pres­ent in courses in the undergraduate and gradu­ate curricula, students may believe w ­ omen’s contributions are marginal, not central to the discipline (Paludi, 2002). As Paludi (2002) noted, exposure to ­women psychologists can contribute to w ­ omen’s self-­concept development, self-­ definition in terms of feminism, and pursuit of ­career options (p. 8). Paludi also noted that ­women psychologists (historical and con­temporary) are role models and mentors for ­women students. DEFINING THE PSY­CHOL­OGY OF WOMEN The psy­chol­ogy of ­women is an area of scientific investigation that can trace its roots back to early studies of so-­called sex differences; however, the field encompasses much more than this variation. Indeed, the emphasis


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on difference has an implicit assumption of a myriad of differences other than biological sex. While the psy­chol­ogy of gender comparisons is a more apt title, it still leaves out the many topics of investigation that encompass experiences unique to ­women, such as pregnancy, breast-­feeding, and menstruation. The term feminist psy­chol­ogy seems to invoke too many connotations and has a varied meaning among dif­fer­ent feminists. How, then, can we best define the psy­chol­ogy of ­women? Mednick (1976) defined the field as “the study of variations within a group and across time of the female experience.” Henley (1974) f­avors “psy­chol­ogy and ­women” as a descriptive term. However, Mednick believes this is too broad. We believe that Russo’s definition of the psy­chol­ogy of ­women, as the study of be­hav­ ior (not excluding male gender-­role be­hav­ior) mediated by the variable of female sex, is one of the most useful. In the past, psy­chol­ogy studied be­hav­ ior, but it was not mediated by the variable of female sex. Thus, the psy­ chol­ogy of w ­ omen is also defined as that which includes all psychological issues pertaining to w ­ omen and their experiences (Denmark, 1977). In defining the psy­chol­ogy of ­women in this manner, it is also productive to use Lerner’s (1992) “transitional history” lens, i.e., one where ­women’s experiences are examined through their multiple layers of understanding. ­WOMEN IN PSYCHOLOGICAL RESEARCH To understand the contributions that w ­ omen have made in the field of psy­chol­ogy, one must understand the status of ­women in psy­chol­ogy prior to this change. Feminists have long argued that the social sciences overlook and distort the study of ­women in a systematic manner which results favorably to men (Riger, 2002). The inclusion of the variables of sex and gender can be examined in three separate time frames and conceptualizations according to Marecek, et al. (2003): ­woman as prob­lem, female-­ male differences and similarities, and the feminist study of w ­ omen’s lives. When one examines the psychological research from Wundt’s 1874 establishment of the domain of psy­chol­ogy up to recent times, psy­chol­ ogy appeared to focus almost exclusively on the be­hav­ior of men or male animals. In other words, the first method of examining ­woman was to categorize them as lacking. Much early research which included female subjects came to the conclusion that w ­ omen ­were inferior in some way. Additionally, if females ­were included in the sample, neither sex nor gender differences ­were reported, which discounted the influence of ­these ­factors and, in essence, was an indication of the belief that men w ­ ere the norm when considering vari­ous psychological ­factors. And again, if ­women ­were included in the studies, biased results indicated that ­women ­were by nature inferior. For instance, Sir Francis Galton’s work in the 19th ­century focused on individual differences and concluded that “. . . ­women tend in all their capacities to be inferior to men” (cited in Lewin & Wild, 1991, p.  582). However, generally speaking, most early research never


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investigated comparisons between w ­ omen and men (Schwabacher, 1972). Wendy McKenna and Suzanne Kessler (1976) reported that over 95 ­percent of all early research did not examine female-­male comparisons, therefore ignoring any pos­si­ble differences due to sex and gender. Prior to the 1970s, almost all research on w ­ omen had been relegated to the periphery of psy­ chol­ogy rather than integrated into its main body. Although the definition of psy­chol­ogy has under­gone a metamorphosis over time, one fact remains increasingly clear: ­women and ­women’s issues have still not been adequately examined. Psychological research assumed profound differences between w ­ omen and men (Marecek, et al., 2003). This consensus supported male superiority and domination, a societal structure very much in place at the time. Some male researchers studied sex differences and largely interpreted them to demonstrate female inferiority (Shields, 1975). In contrast, Leta Hollingworth’s work in the early 1900s revealed no evidence of female-­ male differences in variability. In 1944, one of Sigmund Freud’s students, Helene Deutsch wrote the first book entitled The Psy­chol­ogy of ­Women (1944). Although agreeing with her mentor that w ­ omen had more delicate psychic structures than men, she did discuss the impor­tant role of motherhood and eroticism in her book (Unger, 2001). Psy­chol­ogy has often been defined as the science of be­hav­ior, both ­human and animal. Yet it was a common practice of researchers to include only white male h ­ umans or male animals in their research samples. It is especially ironic ­because even then ­every undergraduate statistics book stressed the basic premise that for any study to be generalizable, it had to have a representative, not a skewed, sample. Nevertheless, the idea of “male as representative of the norm” was so strong that even well-­trained psychologists did not realize that they w ­ ere excluding at least 50 ­percent of the population. What they fostered was not psy­chol­ogy, the science of be­hav­ior, but psy­chol­ogy, the science of white male be­hav­ior. The second method to approach gender research is currently more often being employed ­today, one that utilizes a feminist perspective (Marecek, et al., 2003). History is now viewed as contextual and is sensitive to gender as well as culture. When research is conducted vari­ous ­factors embedded in this contextual approach should be examined. Feminist researchers are concerned with the particulars of ­women’s experiences: how and why w ­ omen come to act, think and feel the way that they do. Although not an easy answer, it is giving credence to the perspective of w ­ oman as a multidimensional and complex being. TWO THREADS IN THE HISTORY OF THE PSY­CHOL­OGY OF ­WOMEN In the study of the history of the psy­chol­ogy of ­women, two main threads must be examined as they had profound consequences and


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promoted new directions in the field. The first of this was Charles Darwin’s 1859 publication, On the Origin of Species by Means of Natu­ral Se­lection, and the second was the work of Sigmund Freud. The common ele­ment between ­these two historical figures was the debased and the inferior perception of w ­ omen; ultimately, they constructed their theories to support this view. The response to t­ hese theories and the effort to discount them brought about a tremendous amount of reaction and research that helped to solidify and strengthen the fight of w ­ omen ­toward equality. Myths of Social Darwinism Social Darwinism was based on the social theories that arose as a result of the publication of Darwin’s On the Origin of the Species by Means of Natu­ ral Se­lection in 1859. In an attempt to explain individual variability and variability among dif­fer­ent species, Darwin posited theories of natu­ral and sexual se­lection. Darwin noted that while all members of a species had the possibility of producing many progeny, the population of any species remained fairly constant over time. Thus, he concluded that individuals within a species compete with each other in their “strug­gle for existence.” In addition, he also observed that all organisms vary. Combining t­ hese thoughts, he posited the theory of natu­ral se­lection, coined by Herbert Spencer as “the survival of the fittest.” Individuals who had favorable variations survived and reproduced, thus transmitting the favorable traits to their offspring. In this manner, “ge­ne­tic ­house­cleaning” was performed in that natu­ral se­lection eliminated unfavorable traits since t­ hose who had them did not survive long enough to reproduce and pass the unfavorable traits to their offspring. Darwin also observed that not all variability seemed essential to individual survival. He attempted to account for this nonessential individual variability with his theory of sexual se­lection. Briefly, sexual se­lection was similar to natu­ral se­lection in that it depended on a strug­gle, this one “not a strug­gle for existence but on a strug­gle between males for possession of the females” (Darwin, 1871, p. 575). Unsuccessful traits resulted not in “death to the unsuccessful competitor, but in few or no offspring” (Darwin, 1859, p. 100). Darwin also believed that most traits ­were inherited, but he did differentiate between “transmission of character” and the “development of character.” This differentiation was impor­tant in the development of sexual differences. Sexual se­lection theory encompassed an associated law of partial inheritance, which stated that the law of equal transmission (that is, the transmission of certain characteristics to both sexes) was not always equal; sometimes, transmission was only to the same-­sex offspring. Darwin stated that he was unsure as to why the inheritability of some traits seemed to be governed by the law of equal transmission, while other traits’ inheritability seemed to be governed by the law of partial


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inheritance. Darwin’s further observations led him to believe that physical traits such as size w ­ ere inherited via natu­ral se­lection and equally transmitted to both sexes but not always developed in both sexes. Other traits, such as intelligence and reason, he believed, w ­ ere acquired through sexual se­lection and seemed to be governed by the law of partial inheritance and same-­sex transmission. Now, ­here’s the rub. It appeared to Darwin that since females did not compete for males, they did not have the same evolutionary opportunity to develop the same intelligence, perseverance, and courage as males. Thus, for Darwin, the result of natu­ral and sexual se­lection was that men w ­ ere “superior” to ­women. This is the central myth of social Darwinism. Herbert Spencer based his theories on Darwin’s views and expanded them to include the interaction effects of function on biological modification. According to Spencer, b ­ ecause ­women ­were the primary childrearers in society, such traits as maternal instinct and nurturing ability would have been acquired as a result of their function, that is, daily care of ­children. Over time, according to Spencer, ­these traits became fixed in biological structures, that is, ­there would be a “constitutional modification produced by excess of function” (Spencer, 1864, p. 252). In addition, in his book, The Princi­ples of Biology, Spencer also applied Hermann Helmholtz’s conservation of energy theory to ­human growth. Spencer believed that ­human beings had a finite fund of energy (“vital force”) that could be applied to one’s individual growth or to reproduction. He also believed that the female reproductive system obviously required more “vital force” than the male’s reproductive system. So, simply put, ­women had less available “vital force” or energy for their individual m ­ ental and physical growth than men. Thus, ­women’s reproductive systems demanded a ­great supply of energy, and any requirement of energy demand for ­mental activity or “brain-­work,” particularly during adolescence, was thought by Spencer to lead to reproductive disorders, inability to breastfeed, or even infertility. Refutation of the Myth Given the ramifications of Darwin’s theory and the consequences that this theory had for ­women, many early w ­ omen in the field sought to prove Darwin wrong through systematic studies and alternative theories. Although no such separate field as the psy­chol­ogy of ­women existed prior to the 1970s, ­there ­were early scientists whose research impacted on the field. Leta Hollingworth was a leading harbinger of the psy­chol­ogy of ­women; she was adamant that psy­chol­ogy apply vigorous scientific stringency to research on w ­ omen. She was one of many early scholars, along with Helen Thompson, Mary Calkins, and Mary Putnam Jacobi, who responded to the trends of social Darwinism of her time with myth-­ refuting, solid empirical evidence.


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Psychology of Women

Leta Hollingworth Leta Stetter Hollingworth was one of the early researchers who concentrated on research issues that would l­ ater become relevant to the psy­ chol­ogy of ­women. She investigated areas of well-­established bias in psy­chol­ogy, such as ­women’s social role, the ­mental and physical per­for­ mance during the menstrual cycle, and the variability hypothesis. While a gradu­ate student at Columbia Teachers College, she was u ­ nder the tutelage of Edward Thorndike, who was himself a strong supporter of the variability hypothesis. One of Hollingworth’s contributions was her research on physical and ­mental per­for­mance during the menstrual cycle, research that demonstrated that changes in per­for­mance ­were unrelated to cyclical phases. Her doctoral dissertation was titled “Functional Periodicity: An Experimental Study of the M ­ ental and Motor Abilities of W ­ omen During Menstruation” (Hollingworth, 1914). Through her research she found no evidence to support the variability hypothesis, which mistakenly concluded that the higher status of males was based upon their greater variability. In 1914, with Helen Montague, Hollingworth examined the birth rec­ords of 1,000 male and 1,000 female neonates. When birth weight and length w ­ ere noted, the researchers found that if variability “favored” any sex, it was the female sex (Montague & Hollingworth, 1914). Also in 1914, Hollingworth responded to social Darwinist myths by critiquing the incorrect assumptions on which they ­ were based. For example, greater (male, of course) variability was considered to suggest greater range also. This inference is appropriate only if the distribution is Gaussian, which had not been proven. In short, Darwin may have had some romantic notion of greater male variability due to the “noble and intellectually enriching” male competition for females. However, in real­ ity, no greater male variability had been demonstrated. Further, even if ­there had been greater physical male variability, it would indicate nothing about greater male intellectual variability. Greater male intellectual variability had also not been proven, and even if it had been, it would not mean an innately greater intellectual variability among males. Rather, Hollingworth suggested that in order for the social sciences to examine adequately the cause of seemingly lesser female achievement, social scientists also needed to examine the interaction of social constraints and cultural barriers to female achievement. To Hollingworth and to many ­later feminists, the essence of the prob­ lem was that throughout history, ­women bore ­children and ­were their caretakers. She stated that she did not intend this issue to be interpreted as an attack on motherhood but rather a more plausible explanation than lack of “vital force” or “lack of variability.” Hollingworth fostered the examination of social and cultural ­factors that mediate female achievement. It is impor­tant to note that Hollingworth refuted myth with research. In 1916, she and an eminent anthropologist, Robert Lowie, reviewed the


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scientific lit­er­a­ture of their day. They found when cross-­cultural, biological, and psychological studies w ­ ere examined, the objective evidence did not support the notion of innate female inferiority (Lowie & Hollingworth, 1916). Lowie and Hollingworth ­were quick to note that “­every sex difference that has been discovered or alleged has been interpreted to show the superiority of males” (p. 284). For example, the higher number of males who w ­ ere institutionalized was often interpreted as proof of greater male variability. If t­ here had been a greater number of females in prisons and asylums, they wondered, would not that fact have been interpreted as evidence of general female inferiority? In summary, Hollingworth was one of the most prolific early feminist researchers whose myth-­refuting empirical evidence and logical mind did much to pave the way for what was ­later to become the psy­chol­ogy of ­women. Helen Thompson and Mary Calkins Other early researchers who responded to social Darwinism w ­ ere Helen Thompson and Mary Calkins. Helen Thompson’s psychological research challenged the social mores and cultural assumptions of her time. For her doctoral thesis, H. Thompson (1903) studied sex differences in m ­ ental ability. Often, she found similarities rather than differences between female and male research participants. When differences did occur, she also was able to show how experience and environment, rather than biology alone, would account for them. Like Hollingworth, Mary Whiton Calkins also disputed the popu­lar social Darwinist myth that w ­ omen’s m ­ ental capabilities w ­ ere less varied than men’s (1896). Mary Calkins was a forerunner in the psy­chol­ogy of ­women as she traversed through a field which did not readily recognize her many accomplishments. She is most known for becoming the first President of American Psychological Association (APA) in 1905, and her achievements during this year brought her many honors during that time. However, she is also known for being denied her doctorate from Harvard University even though she completed all of the degree requirements. The President and Fellows at Harvard in 1894, reviewed her request and refused on the basis that she was a ­woman and, therefore, officially unable to receive a degree from Harvard. To this day, Harvard has not issued any degree in honor of Mary Calkins. Calkins founded the psy­chol­ogy laboratory at Wellesley College in 1891, in­ven­ted the paired associate technique (attributed to another psychologist), and developed a theoretical perspective of self-­psychology. FREUD AND OTHER PSYCHOANALYTIC INFLUENCES ON THE PSY­CHOL­OGY OF ­WOMEN In addition to the reaction to social Darwinism, another thread in the development of the psy­chol­ogy of ­women was based on reaction to


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Psychology of Women

Sigmund Freud. Freud, a 19th-­century Viennese medical doctor who practiced neurology, founded the psychoanalytic school of psy­chol­ogy. Freud constructed his personality theory based on his own self-­analysis and his analy­sis of individual case studies. When evaluating the validity and generalizability of Freudian results, one must take into account the limitations of his methodology. Freud believed sexual drives ­were very impor­tant in the personality growth of both men and ­women. Successful satisfaction of sexual drives resulted in healthy development, whereas failure to obtain drive satisfaction would result in neurosis. Thus, a healthy individual is one who manages to obtain gratification of drives while remaining within societal norms and physiological capability. The disturbed individual would be someone who is unable to obtain gratification within the bounds of social and biological real­ity. According to Freud’s theory of psychosexual development, at birth, ­there is l­ ittle psychological difference between the male and female, with infants of both sexes viewing the ­mother as their primary love object. (In 19th-­century Vienna, the m ­ other was the expected caretaker. So, in fairness to Freud, we must take into account limitations of 19th-­century Viennese cultural norms.) Psychosexual development is similar for boys and girls in the “oral” and “anal” stages up u ­ ntil the “phallic” stage. At approximately three years of age, the boy’s sexual impulses are centered around the penis and the girl’s sexual impulses are centered around the clitoris. Both boys and girls are said to have “active” or “masculine” sexual aims. By labeling ­these sexual aims, which occur in both sexes, as “masculine” rather than bisexual, Freud implies such active sexual aims are somehow not appropriate for females and begins to focus on males. Just as early experimental psy­chol­ogy had used mostly male subjects and had focused on male be­hav­ior, the earliest psychoanalytic writings focused on male psychic development. Very briefly, one cornerstone of Freudian theory is that of the Oedipus complex, in which the boy feels rivalry and hostility ­toward the f­ ather and desires his m ­ other for himself. He fears his f­ ather’s retaliation and, thus, fears castration by the ­father. His fears of castration are made worse when, according to Freudian theory, he observes females and concludes that they have been castrated and the same ­thing could happen to him. This complex is resolved by identifying with the f­ather (identification with the aggressor). By identifying with the aggressor (the ­father), the boy gives up his ­mother as his love object with the expectation that he ­will ­later find a substitute who ­will not arouse the wrath of his ­father. At this time, the boy identifies with the ­father and incorporates his moral values and ­those of society for which the male moral value is seen as representative. This internalization of paternal/societal male moral standards results in the formation of a superego or what is often called the conscience. Male psychosexual development contains both conflict and compromise. However, in males, the conflict resolution manages to


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preserve the “active” sexual aims pres­ent during the phallic period, thus leaving the males active in attaining their satisfaction. Females, according to Freud, do not have the same constellation ­because, when they discover they do not have a penis, they envy l­ ittle boys and blame their m ­ others for what they are lacking (a penis). L ­ ittle girls switch their affectional cathexis from the m ­ other to the f­ ather, hoping to obtain a penis, but ­there is no identification with the aggressor and, thus, no internalization of that parent’s moral code. Thus, in females, according to Freud, superego development is stunted. The girl perceives her anatomical inferiority and blames her ­mother but does not identify with her “fellow castrati.” Curiously, she does not identify with her f­ ather e­ ither. According to Freudian theory, in time the “normal” female realizes that she cannot have a penis, so she wishes instead for a baby. Her sexual aims, which w ­ ere “active, masculine” aims during the phallic stage, are now transformed. Freudian theory posits that in “normal” development, the girl accepts the lack of a penis and also renounces the clitoris as the seat of sexual satisfaction. She transforms her active masculine sexuality into passive feminine receptivity. For Freud, a “masculine” w ­ oman has not adjusted to her anatomy. Then a tripartite bridge is formed in Freudian theory among anatomy, active versus passive sexuality, and feminine personality. The anatomical differences are perceived as causal ­factors in psychological and social differences. Thus, for Freud, the healthy ­woman renounces the active sexual satisfaction of the clitoris, has passive sexual aims, with her primary motivation being her wish for a baby, and does not socially engage in aggressive or achievement-­oriented be­hav­iors. Narcissism and vanity are essentially the “feminine” compensatory consequences of castration. In addition, jealousy, feelings of inferiority, and shame are more direct expressions of female genital dissatisfaction, ­because the female is less motivated to identify with the same-­sexed parent during the Oedipal conflict. The boy is motivated b ­ ecause he still has a penis and fears castration; the girl feels that she is already castrated and is not motivated. Therefore, ­women are less likely to internalize the moral codes and cultural ideals than men. The social and po­liti­cal implications of Freudian theory are vast. Quite simply, by virtue of their anatomy, w ­ omen are destined to be less morally mature and less acculturated than men. They are also destined to exhibit more unsatisfactory personality characteristics. According to Freudian theory, anatomical differences and the resulting differences in sexual functions are viewed as being the causal f­actors in the development of psychological differences. ­Here, body creates psyche, and the phrase “biology is destiny” is formed. The biologically “healthy” w ­ oman has passive sexual aims, is motivated by motherhood, and spurns achievement-­related be­hav­iors. Thus, biological differences are instrumental in the creation of psychological differences, which in turn, explain social be­hav­ior and serve to maintain the status quo.


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Psychology of Women

Helene Deutsch Helene Deutsch, a psychoanalyst who was trained by Freud, extended Freudian theory in her 1944 book, ironically titled The Psy­chol­ogy of ­Women. In her book, Deutsch posited that personality traits such as narcissism, passivity, and masochism are the result of “feminine” biology. In response to Freudian theory, Deutsch views ­women as being masochistic ­because they are biologically bound to childbirth and menstruation, which contain both plea­sure and pain. The fact that all living organisms (including men) experience both plea­sure and pain is overlooked by Deutsch, who goes on to posit that masochism is, therefore, an adaptive formation for females. The “healthy” female is not masochistic to the point of total self-­ annihilation, but she does renounce her “self” in that she denies her own needs in order to obtain “love,” that is, by becoming a wife and m ­ other. Both clitoral sexuality and active vaginal plea­sure are viewed by Deutsch as deviating from “normal” femininity. “Normal” female sexuality is operationally defined as female passivity, which Deutsch refers to as “receptive readiness.” In addition, she also posits the circular logic that w ­ omen possess a predisposition for compensatory narcissism that attempts to make up for their lack of a penis and to balance out their masochism, which is also the result of not having a penis. Plea­sure and pain, childbirth, and menstruation are facts of life. At the pres­ent time, a biological fact is that ­women have greater life expectancy than men, and behaviorally, men tend to exhibit greater alcohol and narcotic abuse than do ­women. However, present-­day Freudians would not conclude that man’s lack of a vagina leads to greater self-­destructive tendencies and earlier death. It is in­ter­est­ing to note that when this “biology is destiny” thinking is applied to men, the leaps in logic are glaring, yet the same leaps have long gone unnoticed as they apply to w ­ omen. Karen Horney Karen Horney (1926) in her book Flight from Womanhood was the first to question this bias in the psychoanalytic lit­er­a­ture, and almost all of t­ hose who have developed Freud’s ideas have been men. It is only right and reasonable that they should evolve more easily a masculine psy­chol­ogy and understand more of the development of men than of ­women (p. 59). ­After years of analyzing male and female patients, Horney was struck by strong male “envy of pregnancy, childbirth and motherhood, as well as breasts and the act of sucking” (p. 60). Horney believes that l­ ittle boys encounter “womb envy” and states that t­ here is an unconscious male desire to deprecate ­women and their ability to give birth. Penis envy is a way to shift the focus away from w ­ omen’s childbearing ability and focus instead on male anatomy. According to Horney, “this (male) depreciation would run as follows: In real­ity w ­ oman do simply desire the penis, when all is said


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and done motherhood is only a burden that makes the strug­gle for existence harder, and men may be glad that they have not to bear it” (p. 61). In a paper titled “Inhibited Femininity,” Horney (1926, 1967) regarded “ frigidity as an illness” and not “the normal sexual attitude of civilized ­woman.” She was also first to point out the social and cultural ­factors that impact on psychic development. Horney was the first of Freud’s students to break from him on the issue of preoedipal injury resulting in neurosis. Horney believed in the possibility of preoedipal injury and was also the first psychoanalyst to speak about the “real self.” Preoedipal injury, according to Horney, results when a child perceives herself or himself as helpless in a hostile environment: “instead of developing a basic confidence in self and ­others the child develops basic anxiety” (Horney, 1950, p. 366). The child puts a check on spontaneous feelings ­because of a need to relieve basic anxiety. Above all, ­there exists a need to feel safe. This is the beginning of what Horney calls the alienation from self. “Not only is his real self prevented from a straight growth, but in addition his need to evolve artificial strategic ways to cope with ­others has forced him to override his genuine feelings . . . ​It does not ­matter what he feels if only he feels safe” (Horney, 1950, p. 21). The child seeks to feel safe in a hostile environment. Solutions may be based on the appeal of love (moving ­toward), the appeal of mastery (moving against), or the appeal of freedom (moving away). In short, the child ­will attempt to change the environment by loving it, by fighting it, or by leaving it (Horney, 1950) Healthy ­people love, fight, and leave at appropriate times. Since the neurotic puts a check on spontaneous feelings, he or she does not know which solution is appropriate at dif­fer­ent times. “The three moves t­ oward, against, and away from o ­ thers therefore constitute a conflict, his basic conflict. In time, he tries to solve it by making one of ­these moves consistently predominant—(he) tries to make his prevailing attitude one of compliance, or aggressiveness, or aloofness” (Horney, 1950, p. 19). Horney’s reaction to Freud influenced o ­ thers and is part of one of the threads to what would l­ater become the psy­chol­ogy of w ­ omen. As Hollingworth and ­others ­were able to do in the area of experimental psy­ chol­ ogy, Horney was able to apply strict scrutiny to psychoanalytic theory and to refute androcentrism and sexist bias. By taking the focus of psychoanalysis away from the androcentric Oedipus complex, she was able to pave the way for the “psy­chol­ogy of the self,” so crucial to our pres­ent understanding of borderline and narcissistic personality disorders (Paludi, 2002). Horney suggests that Freud’s observation of the female’s wish for a penis may be no more impor­ tant than the young male’s frequently observed wish for breasts. Attributes with which Freud composed the constellation of the “masculinity complex,” that is, desire for power, envy, and egocentric ambition and which he ascribed to penis envy w ­ ere noted


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Psychology of Women

by Horney as characteristics exhibited by neurotic men as well as neurotic ­women. Horney posited that the characteristics of the “masculinity complex” are the result of feelings of inferiority that are pres­ent in both neurotic men and neurotic ­women and are multiply determined. She also looks at the social and cultural f­ actors involved in the development of feelings of inferiority, such as the cultural restrictions of ­women’s potential. Horney (1939) differs from Deutsch in her interpretation of masochism in that she views masochism as an empowering device used to promote well-­being in life through influencing o ­ thers by emphasizing one’s frailty and pain. Masochism is not viewed by Horney as a biologically based adaptive be­hav­ior incorporating plea­sure and pain as bound to feminine physiology but, rather, as a social, often eco­nom­ically based attitude. Our society tends to idealize the maternal w ­ oman who puts the needs of o ­ thers before her own, and it tends to pay ­women less than men. Horney posits that ­these ­factors better account for masochistic tendencies in w ­ omen than do physiological differences. Horney believes that rather than being fueled by a symbolic desire to possess a penis, both normal and neurotic w ­ omen tend to “overvalue love” as the result of their economic and social dependence on men due to cultural constraints on w ­ omen’s direct access to security, prestige, and power. By stressing the social and cultural ­factors as determinants of “feminine” psy­chol­ogy, Horney leaves room for the possibility of remediation of undesirable personality traits via the pro­cess of social change. Changes in economic opportunity as well as changes in socialization of w ­ omen are presumed to impact on the female personality constellation. Conversely, when “feminine” psy­chol­ogy is attributed to penis envy and pain inherent in childbirth, societal changes are presumed to be psychologically inconsequential, and psychological changes in personality are deemed to be impossible. Clara Thompson Another psychologist who responded to Freudian orthodoxy by walking out of the New York Psychoanalytic Institute with Horney was Clara Thompson. Both Horney and Thompson stressed the importance of experience, environment, and social influences that impact personality development. Like Horney, Thompson responded to androcentric Freudian psychosexual etiology of female personality development (1941, 1942, 1943, 1964a, 1964b). Her alternative theory also stressed the impact of social and cultural f­actors on personality development. Thompson posits that the discovery of the vagina, rather than the penis, in and of itself need not necessarily represent psychic trauma for a female. However, it can be traumatic if the presence of a vagina, rather than a penis, is associated with lower status (both social and economic) within the ­family constellation. Our historical obsession with primogenesis, a system that confers the highest status on the eldest male, serves to reinforce the association of “feminine” with lower status. As ­children reach the “phallic” stage of


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development (at approximately three to five years of age), both sexes strug­ gle for autonomy and seek in­de­pen­dence from their primary caretaker. If one assumes the primary caretaker is the m ­ other, Thompson posits that the ­mother often w ­ ill respond differently to her son’s and ­daughter’s attempts at autonomy, with female ­children being given less overt encouragement to express in­de­pen­dence and, instead, given more rewards for remaining within the confines of the home. Often with the onset of puberty, previously tolerated tomboyish activities are not accepted in the adolescent girl. She is pressured by society to become “attractive” and rewarded with marriage and motherhood. Rather than the renunciation of active aims for passivity, Thompson views behavioral changes in teenage girls and differences in sexual experimentation as the result of multiple societal pressures. Thompson views female psy­chol­ogy as an attempt to adjust to the existing social realities; she finds ­women who choose to find plea­sure in a life of self-­sacrifice not so much seeking pain (masochistic) but rather seeking a positive adaptation to a limiting status quo. Freudian theory also viewed ­women as morally inferior to men ­because they did not benefit from the internalization of a superego as a result of the resolution of the Oedipus complex via identification with the aggressor and ­because they did not have a penis and w ­ ere “already castrated.” Freud also observed that many ­women simply mimic the views of their male companions. Thompson posits that if this view is true, it is a function of females’ lower status rather than female failure to develop a conscience. P ­ eople who are in a lowered status situation, one in which they are dependent upon, and subject to, the moods and authority of a more power­ful other, do “try harder” to get along with the more power­ful other even to the extent of entertaining the same opinions. Social psychological research on the be­hav­ior of blacks and whites, that is, “integration” be­hav­ ior (Jones, 1964), provides empirical support for Thompson’s position in that the higher the status of an individual, the more successful such an individual would be in influencing o ­ thers and the less vulnerable to being influenced by a lower-­status individual. Social psychological data indicate that gender differences in interactional be­hav­ior follow status differences; males are more successful than females in their influence on ­others and less apt to change their positions than females. Within gender, status differences simply cannot be attributed to penis envy, castration anxiety, or the failure to identify with the aggressor and internalize a superego. The real differences between men’s and w ­ omen’s power and status appear to be a more parsimonious explanation of the behavioral differences that Freud observed. PSY­CHOL­OGY OF ­WOMEN: IN ­WOMEN’S VOICES In 1971, Naomi Weisstein concluded that much of psy­chol­ogy had been the “fantasy life of the male psychologist.” In the de­cade of the 1970s, much work was done to challenge that real­ity. As one of the authors of


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Psychology of Women

this paper noted (Denmark, 1977), during the 1970s, an increase in the research on ­women reflected a rapidly growing interest in them, their psy­ chol­ogy, and their issues. This occurred concurrently with the ­women’s liberation movement. The increasing interest in the psy­chol­ogy of ­women beginning during the late 1960s and continuing to the pres­ent time can be shown by many indicators of growth, such as papers presented at regional meetings, dissertation topics, journal articles, and books published. Papers The 1969 program of the American Psychological Association (APA) listed one symposium that specifically pertained to ­women. The total portion of the 1969 programs that dealt with ­women amounted to 7 papers, 4 participants, and 2 discussants. To mea­sure our growth, contrast this with the annual APA Convention in 2006, where ­there ­were 4 addresses, 12 symposia, 5 co-­sponsored symposia, 3 roundtable discussions, 2 poster sessions with numerous posters, 4 social events, and 3 business meetings sponsored by Division 35. Books By the 1970s, books fi­nally began to appear in the psy­chol­ogy of w ­ omen. Judith Bardwick (1970) published the first book titled The Psy­chol­ogy of ­Women: A Study of Bio-­cultural Conflicts, soon followed by Julia Sherman’s (1971) in-­depth analy­sis, On the Psy­chol­ogy of ­Women, and H. Baer and Carolyn Sherif’s (1974) A Topical Bibliography (Selectively Annotated) on the Psy­ chol­ogy of ­Women. In 1975, Rhoda Unger and Florence L. Denmark edited the first issue-­oriented reader in the field, containing original as well as reprinted articles. Also, in 1975, Martha Mednick and Hilda Weissman noted the growth of the psy­chol­ogy of ­women by reviewing pertinent topics in the Annual Review of Psy­chol­ogy. In 1976, a volume of reprinted articles that was totally focused on ­women appeared (Denmark). In 1978, Sherman and Denmark coedited a book based on a 1975 conference, “New Directions in Research,” the first research conference on the psy­chol­ogy of w ­ omen. Denmark and Paludi have co-­edited the third edition of the Psy­chol­ogy of ­Women: A Handbook of Issues and Theories. Textbooks for undergraduate and gradu­ate courses in the psy­chol­ogy of ­women introduce us to vari­ous stages of feminism and authors’ ideologies w ­ ere reviewed by Unger (2010). Journals The appearance of several new journals, such as Sex Roles and Signs in 1975 and The Psy­chol­ogy of ­Women Quarterly in 1976, indicated further growth of the field. ­T hese journals continue to flourish. Overall, the


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percentage of articles related to the psy­chol­ogy of ­women in APA journals has increased significantly and continues to grow. Division 35 Official indication of the ac­cep­tance of the psy­chol­ogy of ­women as a legitimate field of study within psy­chol­ogy came in 1973, when the Division of the Psy­chol­ogy of W ­ omen was established as Division 35 of the American Psychological Association. However, rather than simply a po­liti­ cal movement, the psy­chol­ogy of ­women represents a legitimate area of scientific investigation that can be traced back to the early 1900s. The origins of Division 35 can be traced back to the 1969 APA convention, at which members of the Association for ­Women in Psy­c hol­ogy (AWP) overtly attacked the discriminatory hiring practices of APA’s own employment center. At that time, w ­ omen, but not men, w ­ ere routinely asked their marital status, spousal employment status, and their intention to have c­ hildren. AWP members protested t­ hese unfair procedures, and the APA Council of Representatives responded in 1970 by creating an active Task Force to study the status of w ­ omen in psy­chol­ogy. The goal of the Task Force was “furthering the major purpose of APA, to advance psy­chol­ogy as a science and as a means of promoting ­human welfare—by making recommendations to insure that ­women be accepted as fully enfranchised members of the profession” (Task Force Report, 1973). The Task Force examined the status of female faculty and students in gradu­ ate psy­chol­ogy departments and gave recommendations to the APA. In par­tic­u­lar, the Task Force had concerns about gradu­ate curricula: “Colleges and universities should offer general education courses and programs that inquire into the psy­chol­ogy of ­women, and an opportunity for in-­depth study at both undergraduate and gradu­ate levels of the psy­chol­ ogy of ­women” (Task Force Report, 1973). The task force realized that knowledge of ­women needed to be expanded and that the generalizability of much research was questionable since ­women ­were not included in the sample. Many ­people believed that a new division within APA would better meet the needs of w ­ omen in psy­ chol­ogy. The APA Council of Representatives responded by approving the Division 35 petition, signed by 800 members who indicated interest in joining the new division in September 1973. The purpose of Division 35 was “to promote the research and study of w ­ omen . . . ​to encourage the integration of this information about ­women with the current psychological knowledge and beliefs in order to apply the gained knowledge to the society and its institutions” (Article 1.2, Division 35 Bylaws). Martha Mednick (1978) reports that in a 1973 APA Monitor article, she was quoted as saying, “The new division would not be a po­liti­cal organ­ization.” Rather than being a po­liti­cal organ­ization, Mednick stressed the division’s role of expanding knowledge about w ­ omen. One of the ways in which knowledge


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Psychology of Women

about ­women has been expanded is through Division 35’s journal, The Psy­chol­ogy of ­Women Quarterly. The psy­chol­ogy of ­women therefore had a recognized voice in the formal and informal decision making of APA. PSY­CHOL­OGY AND ­WOMEN ­TODAY We find it curious that thought is still heavi­ly influenced by such nineteenth c­ entury theorists as Darwin, Marx, and Freud. As products of their era, they w ­ ere primarily supportive of the status quo, of upper-­ class White male privilege with its limited knowledge of and marginal concern for w ­ omen. If they w ­ ere alive t­ oday, they would be astonished: What? You are still using t­ hose old books? Throw them away. —Rachel Hare-­Mustin and Jeanne Marecek, 1990

The psy­chol­ogy of w ­ omen which has been outlined continues to grow and develop. T ­ here have been major steps taken making the psy­chol­ogy of w ­ omen a legitimate field of study, but t­ here is still much to be done. The history of the psy­chol­ogy of ­women is not a finished tale. Numerous talented and insightful ­women are continuing to make strides in the field in research and gender equality. Feminist psy­chol­ogy has moved beyond finding fault in previous research to conducting sound research in its own right. ­Today, it is a multifaceted enterprise which has its place in virtually ­every specialization area as well as encompassing many research studies (Marecek, et al., 2003). It has produced a g ­ reat deal of valid and impor­tant research and continues to create such research as well. ­There needs to be a continuation of feminist research that builds upon existing theoretical conceptualizations that focus on critical issues in the field of the psy­chol­ogy of ­women. To do this, ­there are few methodological options which can be employed suggesting that the feminist positivist empirical and contextual approaches to understanding the needs of ­women require restructuring. A positivist empiricist approach utilizes conventional scientific methods to produce “factual” knowledge about a par­tic­u­lar question which is related to something observable and mea­sur­able in the external world (Wilkinson, 2001). Thus, feminist empiricists proposed that the prob­lem of gender bias in research can possibly be solved by advocating strict adherence to science (Riger, 2002). This is beneficial in that it provides concrete evidence that informs the influence that sex and gender have on research. However, one limitation is that it is only applicable to scientifically mea­sur­able concepts. Maureen McHugh, Randi Koeske, and Irene Frieze (1986) established a set of guidelines for eliminating bias in research. Among the many suggestions which are noted are: 1) delineating the circumstances in which gender differences are found; 2) assessing experimental tasks for their


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sex neutrality; and 3) examining the effect of a study’s female-­male composition as well as the sex similarities and differences that are pres­ent. If this framework is implemented, experiments w ­ ill neither make unfounded assumptions nor overlook impor­tant gender differences that exist. A contextual approach looks at the psy­chol­ogy of w ­ omen within a multi-­ dimensional framework that takes into account so­cio­log­i­cal and cultural ­factors when creating research questions (Wilkinson, 2001). Compared to the empiricist approach previously discussed, an epistemological (or contextual) approach focuses on the ­whole of ­women’s lives (Riger, 2002). Therefore, this method encourages feminist psychologists to view w ­ omen as w ­ hole beings or p ­ eople who exist in a bidirectional relationship with the environment in which they live. As Jeanne Maracek (1989) stated, “What we know and how we know depend on who we are, that is, on the knower’s historical locus and his or her position in the social hierarchy” (p. 372). Maracek, et  al. (2003) also called for methodological pluralism which promotes the use of new modes of inquiry such as case studies, focus groups, content analy­sis, observational techniques, participant-­ observation, and field research which allow for the study of phenomenon outside of the laboratory. APA’s Council of Representatives ­adopted a Resolution on Cultural and Gender Awareness in International Psy­chol­ogy on July 28, 2004, which emphasizes vari­ous aspects of the contextual approach. The following excerpt delineates the ten goals of the resolution:

1. advocate for more research on the role that cultural ideologies have in the experience of ­women and men across and within countries on the basis of sex, gender identity, gender expression, ethnicity, social class, age, disabilities, and religion.

2. advocate for more collaborative research partnerships with colleagues from diverse cultures and countries leading to mutually beneficial dialogues and learning opportunities.

3. advocate for critical research that analyzes how cultural, economic, and geopo­ liti­ cal perspectives may be embedded within US psychological research and practice.

4. encourage more attention to a critical examination of international cultural, gender, gender identity, age, and disability perspectives in psychological theory, practice, and research at all levels of psychological education and training curricula.

5. encourage psychologists to gain an understanding of the experiences of individuals in diverse cultures and their points of view and to value pluralistic world views, ways of knowing, organ­izing, functioning, and standpoints.

6. encourage psychologists to become aware of and understand how systems of power hierarchies may influence the privileges, advantages, and rewards that usually accrue by virtue of placement and power.


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Psychology of Women

7. encourage psychologists to understand how power hierarchies may influence the production and dissemination of knowledge in psy­chol­ogy internationally and to alter their practices according to the ethical insights that emerge from this understanding.

8. encourage psychologists to appreciate the multiple dilemmas and contradictions inherent in valuing culture and a­ ctual cultural practices when they are oppressive to ­women, but congruent with the practices of diverse ethnic groups.

9. advocate for cross national research that analyzes and supports the elimination of cultural, gender, gender identity, age, and disability discrimination in all arenas: economic, social, educational, and po­liti­cal.

10. support public policy that supports global change t­ oward egalitarian relationships and the elimination of practices and conditions oppressive to ­women (APA, 2004).

Regardless of the approach utilized, ­there is still much exploration required for the further development of theory and practice which ­will ultimately add to the contributions that ­women make to the field and to the history of the psy­chol­ogy of ­women. Although the large “gender gap” has slowly begun to close, upon closer inspection, ­there still exists a large divide. Critical issues to be explored in the ­future include changing negative, inaccurate and harmful images of ­women as well as removing occupational barriers for w ­ omen who are entering male-­dominated fields. The culture of masculinity and its negative impact on men as well as ­women ­people of both genders also needs to be redefined. In order to accomplish ­these goals, we should recognize the importance of qualitative as well as quantitative research methods. Furthermore, integrating both qualitative and quantitative perspectives might be the best approach to operationalizing theoretical concepts and accurately answering resulting research questions (Denmark, Rabinowitz, & Sechzer, 2005). It’s also impor­tant to reiterate that the psy­chol­ogy of ­women is not limited to the United States; we live in a multicultural world where inclusion of global perspectives and information is critical in conceptualizing ­women. For example, when we consider race as well as sex, we find ­women of color experience more discrimination as professors than do white ­women. Turner (2002) noted, Faculty ­women of color experience multiple marginality, characterized by lived contradiction and ambiguous empowerment. Their lives are often invisible, hidden within studies that ­either examine experiences of ­women faculty or faculty of color. (p. 74)

De la Luz Reyes and Halcon (1988) argued that ­women of color have been more disadvantaged in psy­chol­ogy than white w ­ omen as a consequence of their participation in a culture that has valued neither ­women


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nor nonwhite individuals. Beale (1970) referred to this as “double jeopardy.” De la Luz Reyes and Halcon (1988) noted that many gatekeepers operate u ­ nder the “one-­minority-­per-­pot” syndrome in academia: We believe that implicit in this practice is a deep-­seated belief that minorities are not as qualified as non-­minorities. This conviction stems from an unspoken fear that the presence of more than one minority . . . ​ in a mainstream, traditional department might reduce the department’s . . . ​ reputation . . . . ​(pp. 305–315)

Hune (2010) reported findings with Asian Pacific American (APA) ­ omen in academe “contest a popu­lar conception that Asian Pacific Amerw icans in higher education, especially ­women, are a “model minority” and a racial “success” story. Asian Pacific Americans have yet to achieve parity with whites in access and accommodation in the acad­emy” (p. 1). Hune noted how Asian Pacific American ­women faculty are ostracized in the acad­emy and treated as “strangers” and “outsiders.” According to Hune: Asian Pacific American female faculty often experience unwanted and unwarranted overattention as racial minority group representatives and may be treated as “tokens.” They find underattention as well in the devaluation of their research and teaching, and in the dismissal of issues they deem impor­tant. (p. 2)

Although many view history as occurring exclusively in the past, it is impor­tant to remember that history itself is an ongoing pro­cess. Therefore, we must rely on feminists to help shape the history of psy­chol­ogy, to draw attention to critical issues in the field of psy­chol­ogy of ­women, and to continue elucidating the impor­tant role that ­women play in vari­ous fields. ­Those who teach psy­chol­ogy courses should always include a discussion of the role that ­women have played in that par­tic­u­lar subfield and encourage students to point out the contributions of w ­ omen wherever appropriate in their courses. The early years of the 21st ­century represent a time of rapid social change, which has profound implications for modifying gender roles. The f­ uture is filled with novel challenges that w ­ omen ­will have to deal with as well as opportunities that they ­will be able to explore. It is ­t hese obstacles and prospects that ­w ill be reflected in the ongoing history of the psy­c hol­ogy of w ­ omen. Challenges include the following: a. Reducing ­ women’s isolation in male-­ dominated departments or institutions.

b. Addressing ­women’s experience as outsiders or being marginalized (Quinlan, 1999), and providing support for challenges par­tic­u­lar to w ­ omen’s ­career development and advancement (Quinlan, 1999).


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c. In addition, ­there must be a substantial number of ­women, especially minority ­women, among the faculty in departments. This has been achieved in certain disciplines however, not in ­others, including neuropsychology, management, engineering and other science, technology, engineering, and math (STEM) c­ areers (Storm & Gurevich, 2001).

d. The number of ­women in administrative positions in the acad­emy must be increased so as to make w ­ omen central, not marginal to academia.

e. Ensure minority faculty are pres­ ent to work with minority students. Research by DeFour (1991) provided compelling evidence of the importance of African American faculty in the retention of African American undergraduate and gradu­ate students. Contact with African American faculty was associated with better academic per­for­mance and psychological well-­being.

f. Offer family-­friendly policies, including ­career break policies for faculty who need to integrate work and life roles.

g. Train faculty and administrators about hidden biases, incivility, and microaggressions. The goal is to assist campuses in dealing with multiple forms of bias ­toward ­women si­mul­ta­neously rather than in­de­pen­dently.

h. Establish effective, objective criteria for evaluating applicants and faculty.

i. Develop, monitor, and evaluate tenure clock stop.

j. Offer paid leave and tenure clock stop for ­women faculty who adopt as well as who give birth to c­ hildren.

k. Provide child care for w ­ omen faculty.

l. Provide funds to help w ­ omen faculty defray child care and/or elder care during attendance at academic conferences.

The American Council on Education, Office of ­Women in Higher Education (2005) has provided several recommendations for campuses including,

a. Creating policies for faculty to take multiple-­year leaves for professional and/or personal reasons.

b. Providing tenure-­track or tenured faculty to opt to take part-­time positions to be used for a certain period of time as personal needs arise.

c. Providing flexible time frames for probationary periods.

d. Establishing tenure-­track reentry programs for PhDs who left academia full time to care for f­ amily members.

We concur with ­these culture climate changes in the university if ­ omen psychologists are ever to achieve parity with men in salary, menw toring and networking opportunities, unbiased evaluations, promotions and tenure awards, and work/life integration.


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REFERENCES American Council on Education, Office of ­Women in Higher Education. (2005). An agenda for excellence: Creating flexibility in tenure-­track faculty ­careers. Washington, DC: American Council on Education. American Psychological Association. (1983). Guidelines for nonsexist language in APA journals. In Publication Manual of the American Psychological Association (3rd ed.) (pp. 45–49). Washington, DC: American Psychological Association. American Psychological Association. (2004). Resolution on Culture and Gender Awareness in International Psy­chol­ogy. Retrieved on April  20, 2007 from http://­www​.­apa​.­org​/­international​/­resolutiongender​.­html. Baer, H., & Sherif, C. (1974). A topical bibliography (selectively annotated) on the psy­chol­ogy of ­women. Cata­logue of Selected Documents in Psy­chol­ogy, 4, 42. Bardwick, J. (1970). The psy­chol­ogy of w ­ omen: A study of bio-­cultural conflicts. New York: Harper & Row. Beale, F. (1970). Double jeopardy: To be black and female. Detroit, MI: Radical Education Proj­ect. Benjamin, L. T. (1974). Prominent psychologists: A selected bibliography of biographical sources. JSAS Cata­log Selected Documents in Psy­chol­ogy, 4, MS. 535. Benjamin, L. T., & Heider, K. L. (1976). The history of psy­chol­ogy in biography. JSAS Cata­log Selected Documents in Psy­chol­ogy, 6, MS. 1276. Bern­stein, M., & Russo, N. F. (1974). The history of psy­chol­ogy revisited: Or, up with our foremothers. American Psychologist, 29, 130–134. Bissell, M. T. (1985). Emotions versus health in ­women. In L. M. Newman (Ed.), Men’s ideas/women’s realities (pp.  48–53). Elmsford, NY: Pergamon Press. (Original work published in 1888.) Brehm, S. S., Kassin, S. M., & Fein, S. (2005). Social psy­chol­ogy (6th ed.). Boston, MA: Houghton Mifflin Com­pany. Calkins, M. W. (1896). Community of ideas of men and ­women. Psychological Review, 3, 426–430. Cantor, D. (2007). Dorothy Cantor. Retrieved on April 1, 2007 from http://­drdorothy​ cantor​.­com. Cattell, J. (1906). American men of science: A biographical directory. New York: Science Press. Chehrazi, S. (1987). Female psy­chol­ogy: A review. In M. R. Walsh (Ed.), The psy­ chol­ogy of ­women: Ongoing debates (pp. 22–38). New Haven, CT: Yale University Press. Darwin, C. (1859). On the origin of the species by means of natu­ral se­lection. London, UK: John Murray. Darwin, C. (1871). Descent of man. London, UK: John Murray. DeFour, D. C. (1991). Issues in mentoring ethnic minority students. Focus, 5, 1–2. De la Luz Reyes, M., & Halcon, J. (1988). Racism in academia: The old wolf revisited. Harvard Education Review, 58, 299–314. Denmark, F. L. (Ed.). (1976). ­Women: Volume  I. New York: Psychological Dimensions. Denmark, F. L. (1977). The psy­chol­ogy of w ­ omen: An overview of an emerging field. Personality and Social Psy­chol­ogy Bulletin, 3, 356–367. Denmark, F. L., & Diggory, J. (1966). Sex differences in attitudes t­oward leaders’ display of authoritarian be­hav­ior. Psychological Reports, 18, 863–872.


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Denmark, F. L., & Fernandez, L. (1984). Integrating information about the psy­chol­ ogy of ­women into social psy­chol­ogy. In F. L. Denmark (Ed.), Social/ecological psy­chol­ogy and the psy­chol­ogy of ­women (pp.  355–368). Proceedings of the 23rd International Congress of Psy­chol­ogy. North Holland: Elsevier Science. Denmark, F. L., & Guttentag, M. (1966). The effect of college attendance on mature ­women: Changes in self-­concept and evaluation of student role. Journal of Social Psy­chol­ogy, 69, 155–158. Denmark, F. L., & Guttentag, M. (1967). Dissonance in the self and educational concepts of college and non-­college oriented w ­ omen. Journal of Counseling Psy­chol­ogy, 14, 113–115. Denmark, F. L., Rabinowitz, J. C., & Sechzer, J. A. (2005). Engendering psy­chol­ogy: ­Women and gender revisited. New York: Pearson Education, Inc. Denmark, F. L., Russo, N., Frieze, I., & Sechzer, J. A. (1988). Guidelines for avoiding sexism in psychological research. American Psychologist, 43(7), 582–585. Deutsch, H. (1946). The psy­chol­ogy of ­women. New York: Grune & Stratton. Dimen, M. (1995). The third step: Freud, the feminists, and postmodernism. American Journal of Psychoanalysis, 55, 303–319.Furumoto, L. (1987). On the margins: ­Woman and the professionalization of psy­chol­ogy in the United States, 1890–1940. In  M. Ash & W. Woodward (Eds.), Psy­chol­ogy in the twentieth-­century thought and society (pp.  93–113). Cambridge, MA: Cambridge University Press. Furumoto, L., & Scarborough, E. (1986). Placing ­women in the history of psy­chol­ogy: The first American w ­ oman psychologists. American Psychologist, 41, 35–42. Hacker, H. M. (1951). ­Women as a minority group. Social Forces, 30, 60–69. Hare-­Mustin, R. T., & Marecek, J. (1990). Gender and the meaning of difference: Postmodernism and psy­chol­ogy. In R. T. Hare-­Mustin & J. Marecek (Eds.), Making a difference: Psy­chol­ogy and the construction of gender. New Haven, CT: Yale University Press. Hebb, D. O. (1953). Heredity and environment in mammalian be­hav­ior. British Journal of Animal Be­hav­ior, 1, 43–47. Henley, N. (1974). Resources for the study of psy­chol­ogy and ­women. Journal of Radical Therapy, 4, 20–21. Hollingworth, L. S. (1914). Functional periodicity: An experimental study of the ­mental and motor abilities of w ­ omen during menstruation. Teachers College Contributions to Education, 69. Horney, K. (1926). The flight from womanhood: The masculinity complex in ­women as viewed by men and by ­women. International Journal of Psychoanalysis, 7, 324–339. Horney, K. (1939). New ways in psychoanalysis. New York: W. W. Norton. Horney, K. (1950). Neurosis and ­human growth: The strug­gle ­toward self realization. New York: W. W. Norton. Horney, K. (1967). Inhibited femininity: Psychoanalytical contribution to the prob­ lem of frigidity. In  H. Kelman (Ed.), Feminine psy­chol­ogy (pp.  71–83). New York: W. W. Norton. (Original work published in 1926.) Hune, S. (2010). APA w ­ omen in higher ed: Claiming visibility and voice. IMDiversity​.­com. Retrieved on June  20, 2010 from www​.­imdiversity​.­com​/­villages​ /­asian​/­education​_­academia​_­study​/­archies​/­hune​_­asian. Jacobi, M. (1877). The question of rest for ­women during menstruation. New York: G. P. Putnam & Sons.


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Jones, E. (1964). Ingratiation: A social psychological analy­sis. New York: Appleton-­ Century-­Crofts. Klein, V. (1950). The ste­reo­t ype of femininity. Journal of Social Issues, 6, 3–12. Lerman, H. (1987). From Freud to feminist personality theory: Getting ­here from there. In M. R. Walsh (Ed.), The psy­ ­ chol­ ogy of ­ women: Ongoing debates (pp. 39–58). New Haven, CT: Yale University Press. Lerner, G. (1992). Placing w ­ omen in history: Definitions and challenges. In J. Bohan (Ed.), Re-­placing ­women in psy­chol­ogy: Readings ­toward a more inclusive history (pp. 31–43) Dubuque, IA: Kendall/Hunt. Lerner, G. (1979). The majority finds its past: Placing ­women in history. New York: Oxford University Press. Lewin, M., & Wild, C. L. (1991). The impact of the feminist critique on tests, assessment, and methodology. Psy­chol­ogy of ­Women Quarterly, 15, 581–596. Lowie, R., & Hollingworth, L. (1916). Science and feminism. Scientific Monthly, 3, 277–284. Maracek, J. (1989). Introduction: Theory and method in feminist psy­chol­ogy. [Special Issue]. Psy­chol­ogy of ­Women Quarterly, 13, 399–413. Marecek, J., Kimmel, E. B., Crawford, M., & Hare-­Mustin, R. (2003). Psy­chol­ogy of ­women and gender. In D. K. Freedheim & I. B. Weiner (Eds.), Handbook of psy­chol­ogy (Vol. 1), pp. 249–268). New York: John Wiley & Sons, Inc. McHugh, M., Koeske, R., & Frieze, I. (1986). Issues to consider in conducting nonsexist psychological research: A guide for researchers. American Psychologist, 41, 879–890. McKenna, W., & Kessler, S. (1976). Experimental design as a source of sex bias in social psy­chol­ogy. Sex Roles: A Journal of Research, 3(2), 117–128. Mednick, M. (1976). Some thoughts on the psy­chol­ogy of ­women. Signs, 1, 774. Mednick, M. (1978). Now we are four: What should we be when we grow up? Psy­ chol­ogy of ­Women Quarterly, 3, 123–138. Mednick, M., & Weissman, H. (1975). The psy­chol­ogy of ­women: Selected topics. Annual Review of Psy­chol­ogy, 26, 1–18. Montague, H., & Hollingworth, L. S. (1914). The comparative variability of the sexes at birth. American Journal of Sociology, 20, 335–370. O’Connell, A. (1988). Models of achievement: Reflections of eminent w ­ omen in psy­chol­ ogy. Mahwah, NJ: Lawrence Erlbaum Associates. O’Connell, A., & Russo, N. (1991). Overview: ­Women’s heritage in psy­chol­ogy: Origins, development, and ­future directions. Psy­chol­ogy of ­Women Quarterly, 15, 495–504. O’Connell, A., & Russo, N. (2001). Models of achievement: Reflections of eminent ­women in psy­chol­ogy. New York: Columbia University Press. Paludi, M. A. (1987). Teaching the psy­chol­ogy of ­women: Developmental considerations. Paper presented at the meeting of the Association for W ­ omen in Psy­chol­ ogy, Denver, CO. Paludi, M.A. (2002). The psy­chol­ogy of ­women. Upper ­Saddle River, NJ: Prentice Hall. Quinlan, K. M. (1999). Enhancing mentoring and networking of ju­nior academic ­women: What, why, and how? Journal of Higher Education Policy and Management, 21, 31–42. Riger, S. (2002). Epistemological debates, feminist voices: Science, social values, and the study of w ­ omen. In W. Pickren & D. Dewsbury (Eds.), Evolving


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perspectives on the history of psy­chol­ogy. Washington, DC: American Psychological Association. Rosen, H. (1996). Feminist psychoanalytic theory: American and French reactions to Freud. Journal of the American Psychoanalytic Association, 44, 71–92. Russo, N. F., & Denmark, F. L. (1987). Contributions of ­women in psy­chol­ogy. Annual Review of Psy­chol­ogy, 38, 279–298. Scarborough, E., & Furumoto, L. (1987). Untold lives: The first generation of American ­women psychologists. New York: Columbia University Press. Schwabacher, S. (1972). Male vs. female repre­sen­ta­tion in psychological research: An examination of the journal of personality and social psy­chol­ogy. JSAS Cata­logues of Selected Documents in Psy­chol­ogy, 2, 20. Sherman, J. (1971). On the psy­chol­ogy of w ­ omen. Springfield, IL: Charles C. Thomas. Sherman, J., & Denmark, F. L. (1978). The psy­chol­ogy of ­women: F ­ uture directions of research. New York: Psychological Dimensions. Shields, S. (1975). Functionalism, Darwinism and the psy­chol­ogy of ­women: A study in social myth. American Psychologist, 30, 739–754. Spence, J. (2007). Janet Taylor Spence. Retrieved on April 19 from http://­www​.­web​ ster​.­edu​/­∼woolflm​/­spence​.­html. Spencer, H. (1864). The princi­ples of biology. New York: Appleton. Storm, C., & Gurevich, M. (2001). Looking forward, looking back. W ­ omen in psy­ chol­ogy. Canadian Psy­chol­ogy, 42, 245–248. Strickland, B. (2007). Bonnie Ruth Strickland. Retrieved on April  19, 2007 from http:www​.­webster​.­edu​/­∼woolflm​/­Strickland​.­html. Task force report on the status of w ­ omen in psy­chol­ogy. (1973). American Psychologist, 28, 611–616. Thompson, C. (1941). The role of w ­ omen in this culture. Psychiatry, 4, 1–8. Thompson, C. (1942). Cultural pressures in the psy­chol­ogy of ­women. Psychiatry, 5, 331–339. Thompson, C. (1943). Penis envy in ­women. Psychiatry, 6, 123–125. Thompson, C. (1964a). Interpersonal psychoanalysis. In M. R. Green (Ed.). New York: Basic Books. Thompson, C. (1964b). On ­women. New York: New American Library. Thompson, H. (1903). The m ­ ental traits of sex. Chicago, IL: University of Chicago Press. Turner, C. (2002). ­Women of color in academe: Living with multiple marginality. JSTOR: The Journal of Higher Education, 73, 74–93. Unger, R. (2001). ­Women as subjects, actors, and agents in the history of psy­chol­ ogy. In  R. K. Unger (Ed.), Handbook of the psy­chol­ogy of ­women and gender (pp. 3–16). Hoboken, NJ: John Wiley & Sons, Inc. Unger, R. (2010). Leave no text ­behind: Teaching the psy­chol­ogy of ­women during the emergence of second wave feminism. Sex Roles, 62, 153–158. Unger, R. (Ed.) (2001), Handbook of the psy­chol­ogy of w ­ omen and gender (pp. 17–27). Hoboken, NJ: John Wiley & Sons, Inc. Unger, R., & Denmark, F. L. (1975). ­Woman: Dependent or in­de­pen­dent variable? New York, NY: Psychological Dimensions. Washburn, M. (1930). Margaret Flow Washburn. In C. Murchinson (Ed.), History of Psy­chol­ogy in Autobiography (pp. 333–358). Worcester, MA: Clark University Press.


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Weisstein, N. (1971). Psy­chol­ogy constructs the female. Journal of Social Education, 35, 362–373. Wilkinson, S. (2001). Theoretical perspectives on w ­ omen and gender. In R. K. (ed.).


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Chapter 2

Teaching the Psy­chol­ogy of ­Women Course Michele A. Paludi, Elaine Bontempi, Tina Stern, Jennifer Martin, Darlene C. DeFour, and Andrew Hurd

INTRODUCTION It seemed pure waste of time to consult all ­those gentlemen who specialize in ­woman and her effect on what­ever it may be-­politics, ­children, wages, morality-­ numerous and learned as they are. One might as well leave their books unopened. ­—Virginia Woolf

­ irginia Woolf’s sentiment about British universities in the 1930s can be V used to describe the need for courses in the psy­chol­ogy of ­women in the United States: the discipline of psy­chol­ogy, like the acad­emy itself, has been androcentric, focusing on men and coming from a male perspective. As Stimpson (1971) noted with regard to w ­ omen, ­there have been three kinds of prob­lems in the curriculum: omissions, distortions, and trivializations. For example, ­women’s contributions to psy­chol­ogy have been hidden from view and devalued (Furumoto & Scarborough, 1986; Scarborough & Furumoto, 1987). Mary Whiton Calkins, for example, founded the psychological laboratory at Wellesley College in 1891, in­ven­ted the paired associate technique, and created a theoretical perspective of self-­ psychology that brought her recognition in psy­chol­ogy and philosophy (Furumoto, 1980). Calkins was also the first ­woman president of the American Psychological Association in 1905. Her contributions have been


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essentially omitted (and trivialized) in the history of psy­chol­ogy. According to Stevens and Gardner (1982): Mary Whiton Calkins was a g ­ reat psychologist; one of the few ­women recognized as such, and one who has been poorly treated by history. . . . ​Her major contribution to her science . . . ​her invention of the experimental procedure she called the method of right associates, is now credited to someone e­ lse and even appears in textbooks ­under a dif­fer­ent name than the one she has bestowed upon it. Her general theory of psy­chol­ogy, which she developed over so many years and which was so controversial, is dismissed ­today as unscientific, inconsequential, or unoriginal (p. 88).

Denmark’s (1994) survey of psy­chol­ogy textbooks for their treatment of ­women and gender-­related issues (e.g., feminist therapy, ­women, and leadership) indicated the absence of citation of w ­ omen psychologists in 20 texts. The number of students who aspire to a c­ areer in psy­chol­ogy and, therefore, take introductory courses is quite large. Psy­chol­ogy is among the top ten most popu­lar majors (Prince­ton Review, 2000). ­These courses are the critical points at which students explore basic vocabulary and concepts in psy­chol­ogy. If w ­ omen psychologists’ contributions and gender-­ related topics are omitted from such entry-­level courses, ­women and gender-­related concerns may not be subsequently questioned. Therefore, they ­will remain marginal, not central, to the field of psy­chol­ogy. As Denmark (1994) noted, Much of the psy­chol­ogy curriculum being taught is without a gender-­ balanced perspective. . . . ​I believe it is impor­tant that we pres­ent our students with material that is not biased in order that they may obtain an accurate view the world and come to appreciate that society has been ­shaped by both ­women and men. . . . ​Part of our role as instructors is to make our students careful consumers of information, so that traditional female and male ste­reo­t ypes can be eliminated (p. 331).

In addition to gender biased curriculum, course material has also historically been very culturally biased (Bontempi, 2007). At its very basic foundation, feminism is a philosophy that attempts inclusion and equality not just for w ­ omen, but for other cultures and marginalized groups. Furthermore, multiculturalism, by definition, is not limited to the inclusion of vari­ous races but, rather, includes vari­ous dimensions including race, ethnicity, class, and gender. According to Worell and Remer (2003), the constructs of feminist theory include being gender-­fair, flexible-­multicultural, interactionist, and lifespan-­oriented. Therefore, any courses taught on the psy­chol­ogy of ­women, or any other topic, should incorporate instructional strategies that apply equally to p ­ eople across cultures, genders, age, and abilities (Corey, 2009). In t­ oday’s global economy and increasingly diverse workplace and educational setting, it is imperative that educational


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institutions and corporations understand the ways in which both gender and culture impact leadership, learning, communication, and motivation. Without this knowledge, ­future educators, leaders, politicians, and CEOs are destined to fail. Thus, it can be argued that ­these courses should be requirements in an educational or leadership program. Women’s contributions to psy­ ­ chol­ ogy have also been trivialized. ­Women psychologists have traditionally preferred person-­oriented and service-­oriented subfields of psy­chol­ogy rather than perception, learning, and motivation. T ­ hese latter subfields, however, have been traditionally viewed as more prestigious than applied psy­chol­ogy. The androcentric privileging of specialties that are seen to fall in the “hard” sciences stems from the belief that experimental psy­chol­ogy requires greater intelligence and competence than social, clinical, school, or developmental psy­ chol­ogy. This ste­reo­type exists to this day. Courses in social psy­chol­ogy, developmental psy­chol­ogy, educational psy­chol­ogy, and the psy­chol­ogy of w ­ omen are not typically viewed to be as rigorous as courses in learning, experimental psy­chol­ogy, and statistics. Feminist scholars have found dif­fer­ent topics worthy of study in psy­ chol­ogy, as well as studying the same topics differently. They have provided answers to a set of research prob­lems that did not come to light in traditional androcentric disciplines and could not be solved by the androcentric paradigm, e.g., rape, sexual harassment, battered w ­ omen, sexism in health research, and sexism in psychotherapy. Feminist scholarship is generated by examining the disparities between individual experiences and perceptions and existing theory. Feminist education is defined by the values reflected in the questions asked. Boneparth (1977) summarized the criteria used by the w ­ omen’s studies program at San Jose State University that we can use to relate to courses in the psy­chol­ogy of ­women: psy­chol­ogy courses need to look at new and old research about w ­ omen, raise new questions that are relevant to ­women, question the silence of traditional disciplines about ­women, question the androcentric bias of traditional fields, raise questions about gender-­role relationships, question basic assumptions about society, and encourage students and faculty to do research on ­women and to share it with ­others. Thus, a course in the psy­chol­ogy of ­women can help shift viewing the world from revolving around men to revolving around men and w ­ omen jointly. The psy­chol­ogy of ­women course proposes the rules of the discipline of psy­chol­ogy be changed in order to correct the omissions, distortions, and trivializations of ­women and w ­ omen’s lives. The psy­chol­ogy of ­women course, like the field of the psy­chol­ogy of ­women, does not merely consist of a set of po­liti­cal biases. Courses in the psy­chol­ogy of w ­ omen, like other ­women’s studies courses, have been the academic arm of the ­women’s liberation movement. As such, its goal has been both academic and po­liti­cal. We view the psy­chol­ogy of ­women course as a tool which


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seeks to inquire into the evaluation of concepts such as power, division of ­labor, and m ­ ental health which divide our world into two. In this chapter, we discuss t­hese goals of the psy­chol­ogy of ­women course, including incorporating emotional/personal learning, teaching traditional students, the inclusion of ­women of color, male students in the psy­chol­ogy of w ­ omen course, and stages of feminist identity development expressed in the psy­chol­ogy of w ­ omen course. We also discuss how the psy­chol­ogy of w ­ omen can be integrated into other courses in the psy­chol­ ogy curriculum. Our view compliments that offered by Walsh (1985), who asserted that the psy­chol­ogy of ­women course is a continuing catalyst for individual, orga­n izational, and societal change. We also share Lord’s (1982) teaching-­learning model that contains assumptions consistent with our learning objectives, our assumptions about how learning and motivation occurs, and our philosophy of ­ women’s optimal development. According to Lord (1982), The course should be a laboratory of feminist princi­ples.

• The traditional patriarchal teaching-­learning model is dysfunctional in the development of healthy w ­ omen and men.

• ­Every individual in the class is a potential teaching resource. ­ hole ­women and • Integration is imperative for the development of healthy, w men. Therefore, the course should foster mind/body integration as well as the integration of ideas and be­hav­ior, and of thoughts and feelings.

• Effective h­ uman be­hav­ior in social interactions and within social systems is related to understanding the relationship between the personal and po­liti­cal.

­ omen only and treat • A psy­chol­ogy of ­women course should deal with w ­women as the norm.

­ omen. • If at all pos­si­ble, the primary coordinators of the course should be w ­ omen and men is valid and • The subjective, personal experience of w impor­tant.

• The student should ultimately assume responsibility for her or his own learning and growth.

• Cooperation among students in pursuing learning objectives creates a more positive learning climate than does competition; cooperative learning is fostered through the use of criterion-­referenced rather than a norm-­references evaluation system.

• Providing vehicles outside the class through which students can deal with

personal feelings and frustrations such as journals, dyads, assertiveness training, and growth groups enhances the quality of class discussions.

­ oman, the female pronouns, refer to • The generic use of terms, such as w ­humans is an effective teaching-­learning tool.

• Both men and ­women should be exposed to and have an understanding of

the course material. However, a structure must be provided which allows ­women to meet with w ­ omen and men with men for a significant portion of the time.


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The traditional patriarchal teaching-­learning model is not only dysfunctional in the development of healthy ­women and men, but discriminates against vari­ous cultural groups as it promotes learning, cognitive pro­cessing, and motivational styles that differ than t­ hose preferred by the dominant group. Promoting culturally inclusive classrooms requires that teachers and instructional designers familiarize themselves with the ways in which culture and gender impact learning, cognitive pro­cessing, communication styles, and motivation. Developing culturally inclusive content, instructional strategies, and assessments is necessary for equality (Bontempi, 2007). CULTURE, GENDER, AND LEARNING When teaching the psy­chol­ogy of ­women, or any course, one frequently overlooked area involves examining the ways in which culture and gender can impact learning preferences, cognitive pro­cessing, and motivations. Gender differences are both similar to and dif­fer­ent from cultural differences. The impact of gender on learning is a direct result of culture. In Western culture, females are socialized to be more passive than males. Most h ­ uman growth and development models focus on a strug­gle ­towards in­de­pen­dence and autonomy, but feminist understand that w ­ omen are searching for connectedness rather than in­de­pen­dence (Corey, 2009). As a result of the socialization pro­cess, w ­ omen tend to internalize collectivist values, placing more emphasis on harmonious interdependence and relationships than individual competition or gain, nurturing ­others, and making sacrifices in order to strengthen the group (family/community) as opposed to the individual. As a result, w ­ omen have historically dominated ­careers in the “helping fields,” such as teaching, counseling, nursing, and other areas where they played more support roles. ­These differ considerably than t­ hose values endorsed and promoted in the individualistic cultures of the United States and western Eu­ro­pean cultures that include in­de­pen­dence, individual competition, recognition, and gain. Bontempi (2007) points out that the values internalized by men and ­women, as well as by vari­ous cultures, impact preferred learning styles, cognitive pro­cessing (global/haptic vs. analytical), communication styles (e.g., direct vs. indirect), and motivation (individual vs. group goals, and autonomy vs. relatedness). The historically patriarchal educational system promotes both gender and cultural bias in the manner in which content is created, distributed, promoted, and assessed. It has favored and promoted individual (as opposed to group) learning, goal setting, and competition, and analytical and linear learning (as opposed to global/haptic) styles that have all predominantly been associated with learning styles preferred by the dominant group and white ­middle class males. This pattern continues to prevail in the workplace where leadership, communication, and motivational styles, as well as goal orientations favored by white males still dominate. However, in ­ today’s increasingly culturally diverse


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workplace and educational setting, it is even more impor­tant to recognize how culture can shape cognition and learning, in order to design for a culturally diverse group and maximize their learning, while si­mul­ta­ neously improving learning, working, and training environments (McAnany, 2009). THE ACADEMIC CONTEXT: SUPPORTIVE FEATURES While some of the challenges involved in teaching psy­chol­ogy of ­ omen have been pres­ent since the course’s introduction on college camw puses in the 1970s, the context in which the course is taught has not remained static. Aydin (2014) asserts that it is being transformed ­because of globalization and growing demand, both of which are increasing diversity on campuses. Colleges and universities are revising their policies and curricula in an effort to address a variety of developments. T ­ hese and other changes in the academic environment in the 21st ­century have added new dimensions to existing issues and goals in psy­chol­ogy of ­women courses. As compared to earlier de­cades, some changes have resulted in an academic atmosphere that is friendlier to the goals of psy­chol­ogy of ­women, while o ­ thers have fostered a more hostile climate. Some current student-­ centered movements in higher education embrace and promote many of the goals that psy­chol­ogy of w ­ omen courses and feminist pedagogy have espoused for de­cades. Some of the overlapping goals include centralizing diversity, encouraging civic engagement and participatory learning, promoting intercultural knowledge and perspectives, advancing social change, developing personal and social responsibility, integrating affective with cognitive learning, and valuing students’ experiences (Association of American Colleges and Universities, 2002, 2008, 2011, 2015; McCormack & Gose, 2013; Milem, et al., 2005; Schneider, 2013; Wells & Grabert, 2004). It is significant that ­these movements differ from feminist pedagogy in their po­liti­cal and philosophical orientation, in that feminist pedagogy has as its primary focus issues of gender and power, and though some of ­these educational developments may address gender and power, t­hese topics are not their central organ­izing princi­ples. However, insofar as an institution endorses or participates in t­ hese educational trends, psy­chol­ ogy of w ­ omen courses can capitalize on t­ hese movements to gain institutional support for their curricular goals and pedagogical approaches, and, at the same time, they can help meet institutional goals. The Greater Expectations Report (Association of American Colleges and Universities, 2002) called for reshaping the acad­emy itself such that ­there is a change in emphasis t­oward being more student-­centered than teacher-­ centered, t­oward empowering students, promoting student involvement in social justice, valuing cooperative education, and emphasizing diversity. Another initiative of AAC&U, entitled Making Excellence


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Inclusive (Milem, et al., 2005), developed multiple reports that focus on making the integration of diversity on campuses a core goal of institutional functioning. The most recent initiative, Liberal Education and Amer­i­ca’s Promise (LEAP), has produced numerous documents to propose pathways, outcomes, and practices for promoting personal and social responsibility, encouraging local and global civic knowledge and engagement, and developing intercultural knowledge and competence (Association of American Colleges and Universities, 2008, 2011, 2015). All of t­hese objectives are consistent with ­those of feminist pedagogy and psy­chol­ogy of ­women courses. The ser­vice learning movement also shares some of the goals of the psy­chol­ogy of w ­ omen course. Ser­vice learning, which is now an option on most campuses, provides ser­vice opportunities for students. The ser­ vice learning movement, which distinguishes itself from volunteerism, recognizes that ser­vice and engagement is a valid source of learning, and faculty have the option of integrating a ser­vice learning component in their courses and awarding course credit for ­these experiences. The goal of engagement, participation, knowledge incorporation into students’ lives, cooperative learning, and social action can all be addressed by students’ participation in ser­vice learning (Wells & Grabert, 2004). Inclusion of a ser­vice learning component in the psy­chol­ogy of ­women course can help to meet the feminist goals of activism and student engagement. Scholarship on ser­vice learning distinguishes between a charity and change model, each of which have dif­fer­ent philosophies and objectives. The change model is compatible with feminist goals in that it requires students to examine ser­vice in relation to privilege and power and fosters a recognition of socially structured systemic in­equality and social justice issues. Among its goals are building collaborative and equitable relationships and exposure of assumptions. As Washington (2002) stated, While community-­based ser­vice learning is an effective tool for enhancing student learning in a setting, it is particularly useful for overcoming student re­sis­tance to feminism in general, and specifically to a feminism grounded in the theory of intersectionality. Well-­designed and structured service-­learning proj­ects with community organ­izations whose missions are aligned to course objectives allow students to integrate theory with application, often with the result that students unlearn ste­reo­types and misinformation, gain new levels of social consciousness, and even develop a burgeoning sense of civic responsibility (p. 181).

Over the past de­cades, student enrollment in U.S. colleges and universities has increased, and the student population has become more diverse racially, ethnically, and in terms of age, gender, disability and socioeconomic status (Chronicle of Higher Education, 2009; Snyder & Dillow, 2015). Correspondingly, colleges and universities have increasingly recognized


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the importance of addressing diversity (Goodman & Bowman, 2014; Humphreys, 2000; McCormack & Gose, 2013; Schneider, 2013; Spoor & Lehmiller, 2014). A majority of colleges and universities indicate that they e­ ither have or are planning to have a diversity requirement (Humphreys, 2000; Schneider, 2001; Spoor & Lehmiller, 2014). Colleges and universities are requiring courses on diversity and are attempting to integrate such material more broadly into the curriculum and to diversify their student bodies and faculty. Psy­chol­ogy of ­women courses have long recognized the importance of diversity, and they have also included the feminist perspective that acknowledges that “diversity confers advantages on some groups and disadvantages to ­others. . . .” (Adams, 2013, p. 1). Related to diversity, intercultural competence is now recognized as a value and a necessary skill set for students (Aydin, 2014; Schneider, 2013). ­These objectives in higher education are consistent with the goals of psy­chol­ogy of w ­ omen classes, and, as such, should lend institutional support for this course and the faculty who teach it. THE ACADEMIC CONTEXT: OBSTACLES While the movements described above support some of the goals of feminist pedagogy and the psy­chol­ogy of ­women course, other conditions in academia create challenges. Such challenges can be a result of student reactions, institutional obstacles, and/or a hostile po­liti­cal climate. Some student reactions that can create difficulties for ­those who teach psy­chol­ogy of ­women include students’ negative ste­reo­t ypes about feminism, re­sis­ tance to challenges to privilege, discomfort with feminist pedagogy, and reactions to difficult and new course content (Ergun, 2013; Pleasants, 2011; Spencer, 2015; Spoor & Lehmiller, 2014; Titus, 2000). Institutional challenges can include the academic devaluation of courses and research related to w ­ omen, which can result in risks to tenure and promotion for faculty engaged in ­these activities (Ergun, 2013). Challenges in the po­liti­ cal arena include conservative publications and legislative efforts that threaten academic freedom based on allegations of academic control by dangerous radical left-­wing faculty. Student challenges may include students’ failure to see the importance of their own gender and the relevance of feminism to themselves and their lives (Good & Moss-­Racusin, 2010). Gender issues and feminism may be seen as a “relic from past generations” (p. 418). They are individualistic and may fail to see the relevance of feminism to them and their lives. In addition, b ­ ecause of the assimilation of ­women’s and gender courses into the curriculum, many students take the course not out of a feminist sensibility, but to meet a requirement (Crawford & Suckle, 1999). The result is that many students who lack interest in or support for feminist classes’ values are pres­ent in courses like psy­chol­ogy of ­women. While this can have the benefit of exposing more students to feminist ideas, it can also


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create challenges. Having prior exposure to feminist perspectives in other courses can increase readiness among students for some of the concepts and feminist teaching style in psy­chol­ogy of w ­ omen classes (Ergun, 2013). The backlash against feminist and multicultural courses and ­those who teach them includes dismissive accusations of “po­liti­cal correctness” and worse, allegations of control of academia itself by “left-­wing professors.” A related development is the movement in several state legislatures to pass an “academic bills of rights.” ­These bills are based on the publicized allegation that progressive, liberal faculty members are requiring students to agree with their ideology and are punishing students who hold dif­fer­ ent opinions from themselves. Such bills are intended to have a chilling effect on courses taught from feminist and multicultural perspectives. Faculty members who teach such courses risk disapproval from students, colleagues, administrators, and now, state legislators. Though t­ hese proposals have declined significantly in recent years, and no bill has actually been passed, their advocates have not given up. As of 2007, such legislation was introduced in 28 states (American Association of University Professors, n.d.a; n.d.b.; Fenwick & Zipp, 2007), and in 2007 alone, ten such proposals w ­ ere introduced in state legislatures. Versions of t­hese bills began being introduced in 2007 with a new brand, called “intellectual diversity” legislation (American Association of University Professors, n.d.a; n.d.b). Mild consequences for t­hose teaching courses like psy­ chol­ ogy of ­women can include faculty isolation; extreme outcomes can include pay, rank, and tenure being jeopardized (Crabtree & Sapp, 2003). This may be of par­tic­u­lar concern for ­women of color faculty. Their dual status in two undervalued groups may make them particularly vulnerable to both the mild and extreme outcomes. For example, African American ­women faculty are tenured and promoted less rapidly than white w ­ omen and African American men. They are more concentrated in non-­tenure track jobs and lower ranks. Teaching “controversial” topics may put their c­ areers are risk. Fi­nally, the very hierarchical nature of academia itself can complicate the teaching of psy­chol­ogy of w ­ omen courses in a nonhierarchical fashion. Efforts to empower students and to reduce the power differences between students and teachers can be antithetical to the traditional classroom and the institution’s expectations of the role of the teacher. STAGES OF FEMINIST IDENTITY DEVELOPMENT IN THE PSY­CHOL­OGY OF ­WOMEN COURSE Downing and Rousch (1985) suggested that students typically proceed through five stages when confronted with feminist issues: passive ac­cep­ tance, revelation, embeddedness/emanation, synthesis, and active commitment. In the passive ac­cep­tance stage of development in the course, students may find themselves and o ­ thers saying that discrimination is no


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longer pres­ent in politics, economics, the ­family, or education. They may believe that traditional gender roles are advantageous. Student re­sis­tance has been widely discussed in the lit­er­a­ture from many standpoints. Some feminists reject the notion of re­sis­tance as simply a dif­fer­ent manifestation of teacher authority since it is generally applied only to students who do not agree with the teacher (Lindquist, 1994). O ­ thers have developed models of re­sis­tance, identified its components, and hypothesized about its c­auses (Rhoades, 1999; Markowitz, 2005). Many of the approaches that address student re­sis­tance also meet other goals of the feminist classroom. While preventing or reducing student re­sis­tance, t­ hese techniques can also help create a learning community, equalize power in the classroom, legitimatize individual’s experiences, and help students connect course content to their lives. Students have many ways of resisting information that challenges their preconceived ideas and their privileged status. Kimmel (1999) identified numerous types of re­sis­tance and faculty responses to it. Types of re­sis­ tance include silence, anger, denial, defensiveness, disagreement over teacher’s role, acting out, victim blaming, lack of empathy, embarrassment, feeling dismissed, avoiding complexity, confusion, giving low faculty evaluations. Some of the numerous faculty responses to it include focusing on classroom dynamics, turning challenges back on the questioner, setting ground rules for discussions, and encouraging students to tell their stories. Stake and Malkin’s research (2003) focuses on the role of alliances and cohesion in the classroom. Their research reaffirms that relationships ­matter, even in the classroom. They found that a strong alliance between the teacher and student, and high levels of class cohesion among students, ­were strong predictors of student satisfaction in w ­ omen and gender studies courses. The absence of perceived student alliance with teachers related to perceptions of teachers as intolerant and biased, one of the often cited criticisms of the feminist classroom and a source of re­sis­tance. Low levels of class cohesion ­were related to perceptions of other students as intolerant. The development of alliances with students and cohesion among them is a good preventative against re­sis­tance. One f­ actor that influences the student-­teacher relationship is identity differences between teacher and student (Ergun, 2013; Spencer, 2015). Some identities, including geo­ po­liti­cal origins, nationality, minority status, and gender, confer dif­fer­ent levels of power and privilege, and this can complicate the student-­teacher relationship. When teachers from a low-­power or privilege identity teach students who have identities of greater power or privilege, forming alliances can be complicated, especially when the course content is intended to make students aware of their privilege and to advocate for the sharing of power (Ergun, 2013; Spencer, 2015). Nonhierarchical teaching in this condition becomes more complicated and can confound forming a positive alliance.


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Crawford and Suckle (1999) asserted that re­sis­tance develops when students perceive that ideas are being imposed on them. Using collaborative teaching and learning pro­cesses allows students to become participants in the development of meaning and reduces re­sis­tance to the experience of imposed knowledge. Participatory learning is seen as a way to reduce re­sis­ tance. Enns and Forrest (2005) recommend the use of student-­generated discussion questions based on readings or experiences. Crawford and Suckle (1999) utilized a student check in system during the first quarter of the semester. They set aside time to discuss questions about pro­cess. Such question ask ­whether students feel heard, how they perceive interactions among students, and w ­ hether speaking time is shared or is dominated by a few students. They ask students to anonymously write one comment on a note card, they then shuffle the cards and redistribute them to be read by other students. They also suggest weekly check-­ins that ask students to respond to questions about topics students had trou­ble understanding, topics they agreed and disagreed with, and topics they would like to have discussed in class. Checking in with students builds rapport among students, empowers them and alerts the teacher to strong reactions to material (Crawford & Suckle, 1999). Pleasants (2011) suggests that students identify and reflect upon their reactions to the course content and the class itself. Interactions among students and any pro­cess analyses must recognize status and power differences among students (Ergun, 2013). Some authors suggested that addressing students’ expectations, preconceived ideas, and myths and ste­reo­types about feminism and psy­chol­ ogy of ­women reduces re­sis­tance. Rhoades (1999) suggests that re­sis­tance increases ­because students perceive feminism as anti-­feminine or unfeminine. Identifying the origins of such beliefs and their implications can help reduce re­sis­tance. In addition, making explicit the goals and expectations for the course, particularly the value of discussion, reflection, developing a community, including every­one, valuing student experiences, empowerment, valuing of feelings, and normalizing discomfort, can help reduce anxiety and re­sis­tance. Rhoades (1999) suggests that re­sis­tance is associated with negative or disturbing feelings, such as ­these. Dealing with emotions and affect through student-­generated discussions can help reduce re­sis­tance. Fisher (2001) defined feminist pedagogy as “teaching that engages students in po­liti­cal discussion of gender injustice . . . ​to understand and challenge oppressive power relations and question the meaning for differently situation w ­ omen of oppression and liberation” (p. 44). Good and Moss-­Racusin (2010) suggest an experiential exercise in which students interview individuals about feminism. As a result of this exercise, students reported an increased awareness of how feminism is misunderstood in society and how complex it is. In addition, students became more willing to examine their own misconceptions. Markowitz (2005) identified a relationship between simplistic, dichotomous thinking and student re­sis­tance. Emphasizing the constructed


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nature of knowledge, participatory learning, and the legitimization of personal experience can help to reduce students’ use of simplistic moral dichotomies by giving them more ways to understand complex phenomena. At the beginning of a psy­chol­ogy of ­women course, some of the traditionally taught topics start students questioning ­these assumptions, topics such as bias in research, first generation of American w ­ omen psychologists. They may never change their opinions about men and ­women but they may start to question why they have held on to certain ideas for a long time in the face of contrary evidence. Discussing issues related to w ­ omen’s lives commonly transitions students into the revelation stage. They begin to remember how they have been discriminated against b ­ ecause of their sex, race, age, and/or sexual orientation. Students also recall viewing magazine and tele­vi­sion advertisements that connote ­women as sex objects. During this revelation stage students may become angry with themselves ­because they ­hadn’t previously noticed the sexism and racism in advertisements u ­ ntil the class lecture/discussion. When students share their anger about ­these issues in class, they find themselves wanting to spend time with peers, sharing their experiences, asking how they have dealt with the sexism, and so on. This stage is referred to as the embeddedness/emanation stage. Students make comments in class that suggest they recognize the power imbalance between the sexes in the United States and other cultures. Consequently, students ­will notice themselves in the active commitment stage. They want to take more feminist courses, conduct research on w ­ omen’s issues, and volunteer at battered w ­ omen’s shelters and rape crisis centers. Thus, the course content of the psy­chol­ogy of ­women course pres­ents challenges to students. The course challenges students’ longstanding beliefs and perceptions (Burn, Aboud & Moyles, 2000). The psy­chol­ogy of ­women course asks that students question fundamental beliefs about science, truth, and value neutrality. Students are taught that knowledge is constructed and to question scientific methods, claims and received knowledge. That science and history, as well as sociology and psy­chol­ogy, have developed within a context that is not value neutral is a novel and disturbing idea for many students (Paludi, 1996). Learning information that is often missing from the media and their education, and questioning the “truth” of other long held beliefs can have many consequences for a student. Learning about some of the specific outcomes of sexism (e.g., the wage gap, economic discrepancies for educational achievements, gender discrepancies in ­house­work, and rates of and attitudes about sexual abuse) can be disheartening and discouraging; self-­ protective illusions may be shattered. The content of the psy­c hol­ogy of w ­ omen course challenges students’ beliefs that gender inequalities are a t­hing of the past, that received


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knowledge may not be as true or secure as they would like to believe, or that their realities may be a result of privilege rather than s­ imple merit. How are students to integrate such information into their existing cognitive schemas and lives? Such information may separate them from friends and/or ­family or may cause them to feel they must make changes in their lives that they feel unprepared to or do not want to make. They may not be prepared to relinquish the benefits of privileged status. They may become more cognizant of racism and sexism in their lives and in themselves. This knowledge can be profoundly disturbing. While many of t­ hese outcomes are desirable insofar as they increase critical thinking and analy­sis, they also complicate the lives of students. Often students report feeling angry, sad, or overwhelmed when they begin to see more clearly and in greater detail the inequities in society. When some long held beliefs or ideals are challenged, students can feel confused, betrayed, and overwhelmed. Dealing with ­these emotions and learning about empowerment can help address some of ­these reactions, however, first exposure to this material is often disturbing. In addition to raising internal conflicts or confusion, disturbing emotional reactions to the material can occur between students. Such encounters can be disturbing to both students and teachers. A faculty member’s preparation for and comfort level in h ­ andling such dialogues is crucial to the development of a positive class climate and to the pro­gress of the course (Goodman, 1995; Paludi, 1996). Teaching psy­chol­ogy of ­women pres­ents challenges that are numerous, complex, and difficult. While t­here are few certain answers and solutions, t­ here are many offerings of suggestions, possibilities, guides, and a growing body of empirical evidence for addressing the challenges. The resources now available are numerous and substantive. An especially impor­tant goal for the psy­chol­ogy of ­women course is to provide students with hope and empowerment. Classroom dynamics can be painful, the inequalities of real­ity disheartening, and the removal of self-­protective illusions frightening. Empowering, politicizing, and helping students to see themselves (versus the teacher) as potential problem-­solvers can provide an antidote to the demoralizing information they have learned (Titus, 2000). Some techniques to help students realize that change is pos­si­ble include providing descriptions of local, national, and global organ­izations and initiatives that are working, assigning readings and videos about effective innovative programs and reforms, offering collections of resource materials for achieving par­tic­u­lar goals, connecting students to organ­ izations and systems working against gender in­equality, and providing practical examples of be­hav­iors they can change as individuals, in their relationships, and in their communities (Ergun, 2013; Pleasants, 2011; Titus, 2000). As Crawford and Suckle (1999) state “Most simply, we can teach that change is pos­ si­ ble . . . . ​ We can offer a vision of collective change . . .” (p. 165).


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Psychology of Women

This certainly was illustrated by Martin (2005) who conducted an 1­ 8-­week intervention with high school girls that was planned around feminist pedagogy, including discussing sexist language and vio­lence against ­women. According to Martin, I observed at the start of the intervention that the young w ­ omen ­were inherently negative to w ­ omen. They embraced symbols that are degrading to ­women, such as the Playboy bunny symbol and used words such as “bitch” and “ho” to describe themselves and other w ­ omen . . . . ​Their relationships with males w ­ ere more impor­tant to them than w ­ ere their relationships with females and the perspectives they chose; or the eyes through which they saw the world justified ste­ reo­ t ypically male norms at the expense of female autonomy.

As some students noted, I think a lot of ­women ­can’t be friends ­because of men. For example, if I caught my boyfriend with another girl it w ­ ouldn’t be his fault, it would be her fault. ­Don’t ask me why, but that’s the way it is. We are all so used to degrading other ­women we never have time to stop and think about what we are saying. I think ­women should try to get along ­because if we do then maybe we can get more re­spect from every­body ­else. (Keisha) ­ omen could be friends if they ­weren’t as petty, judgmental, or comparaW tive. When girls see each other, they automatically look to see if the other girls are prettier than them. Nine out of ten times, they w ­ on’t want to be their friend. It’s all about image, body language, and self-­esteem. Truth is, girls check each other out more than guys, not in a sexual way, they basically inventory all other girls. (Cassie)

Martin (In press) also noted that as the w ­ omen began monitoring their language and using language affirmative to ­women, they started to view themselves more positively. As the ­women stated, I ­really like the class. I get along with all the girls a lot better than I ever did. It brought us all together and helped us understand each other in many ways, w ­ hether it be positive or negative. Somehow we found a way to make it through and I now understand females more than I ever did. It feels g ­ reat to know that we went from hating each other to becoming more understanding with friendship. (Veronica) I tried to use this class in my personal life. Like when my boyfriend would say something that was negative t­ oward me. If he called me the “B” word or something just joking around, when he does do that I stop him and say, “You ­don’t call me that ­because it bothers me.” And now he ­doesn’t do it no more. Even if he’s joking around, I told him that’s offensive to me and he just d ­ oesn’t do it no more. But I try to use it. If one of my friends is talking bad about somebody and t­hey’re like “Oh, she’s a slut or a ho,” I’m like


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“Well, you ­can’t just base that on how she’s dressed or how she’s acting. It ­doesn’t ­really ­matter who she’s been with or not or the way she’s dressing or her appearance.” I try to keep “ho” and “slut” out of my vocabulary even though it’s kind of hard but I try. (Sherri)

CRITICAL THINKING One goal that is considered a central tenet of liberal arts education is helping students to learn to think critically (Wheeler & Dember, 1979). Critical thinking involves several components: it requires empowerment, knowledge of tools of analy­sis and comprehended knowledge (Sinacore & Boatwright, 2005). Paludi and Steuernagel (1990) outlined several ways faculty can teach the introductory course in ­women’s studies as a way to facilitate students learning several foundations for a feminist restructuring of the academic disciplines. The goal of their approach is to have students critically question the treatment of ­women and gender (i.e., trivialization, omission, and distortion) in courses they subsequently take in their undergraduate curriculum. McTighe Musil (1992) also outlined several pedagogical techniques (e.g., discussion questions, and experiential exercises) and course requirements to meet this goal of critical thinking among students who major in w ­ omen’s studies. Paludi (1996) also noted that one goal of the psy­chol­ogy of ­women course is to help students to learn to think critically. Critical thinking skills permit w ­ omen students to see themselves as capable of critical analy­sis, to incorporate statistical methodologies in their analyses, and to possess sufficient knowledge and perspective to engage in substantive critical analyses. Critical thinking also encourages an opportunity for students to talk in the first person, and to value their opinions and analyses. Paludi offered several pedagogical techniques for faculty to use in guiding students’ critical thinking skills, including experiential exercises, popu­lar books, and essay/discussion questions. T ­ hese techniques provide students with an opportunity to reflect a broad range of knowledge and the need to define, to qualify, and to dispute commonly heard overgeneralizations about w ­ omen’s lives and be­hav­ior. An example of an experiential exercise suggested by Paludi to encourage critical thinking is the following: Select a journal article describing one or a series of empirical studies. Sample journals include the following: Developmental Psy­chol­ogy, Journal of Personality and Social Psy­chol­ogy, Psy­chol­ogy of ­Women Quarterly, Journal of Black Psy­chol­ogy, and Journal of Cross Cultural Psy­chol­ogy. Critically read the article, taking into account the issues of research design and research bias. Answer the following questions:

1. Is the purpose of the research clear? Explain.

2. Has the author been careful to cite prior reports contrary to the current hypothesis?


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Psychology of Women

3. Is the research hypothesis correctly derived from the lit­er­a­ture and theory that has been cited? Or, are ­there some impor­tant steps missing and left to the speculation of the reader?

4. Are ­there pos­si­ble biases in the sampling procedure used? For example, ­were volunteers used? Was ­there a differential attrition rate among potential participants?

5. Are ­there experimental biases?

6. Is information presented about the sex and race of the research participants?

7. ­Were the variables of sex and race used in the statistical analyses?

8. ­Were the conclusions drawn by the author consistent with the results obtained?

9. In what ways do you think the biases of the author distorted the methodology, results, and interpretation?

10. What follow up studies do you think are needed? Why?

11. ­Were tests of effect size performed?

Paludi finds this approach to critical thinking to be empowering for students, especially for re-­entry ­women students who may have been silenced in their life experiences as well as in other courses. Critical thinking, thus, instills in students the confidence and positive sense of self, two impor­tant outcomes that should be expected in the psy­chol­ogy of ­women course. Elliot (1993) reported using debates as a pedagogical technique to encourage critical thinking in the psy­chol­ogy of ­women course. Teaching Online With more courses on the psy­chol­ogy of w ­ omen being offered online, the opportunity for critical thinking among students is a major concern. Paludi (2017) recently recommended the following andragogical techniques that offer eight critical thinking opportunities: 1. Ask students to identify why w ­ omen scholars have typically been hidden from view in management textbooks. 2. Summarize the research on gender and nonverbal and verbal communication styles in the workplace. 3. Summarize the lit­er­a­ture on ­women’s and men’s use of occupational ste­reo­ types in their c­ areer choices. 4. Ask students to identify casual attribution patterns men and ­women use in explaining their successes and failures. 5. Ask students to develop a timeline of ­people of color in l­ abor history. 6. Ask students to develop a list of laws protecting ­women and ­people of color from employment discrimination.


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7. Invite students to share their experiences with certain topics during the month they are acknowledged/celebrated, as with the following examples: February: Black History Month March: W ­ omen’s History Month April: Sexual Assault Awareness Month May: Asian/Pacific American Heritage Month June: Gay and Lesbian Pride Month Ca­rib­bean American Heritage Month September: Hispanic Heritage Month October: National Disability Employment Awareness Month

National Domestic Vio­lence Awareness Month

November: National American Indian Heritage Month 8. Provide students with recommendations for reducing miscommunications when interacting with individuals of a variety of cultures.

Teaching a psy­chol­ogy of ­women course online brings with it several areas of concern, as it does with other courses. The difficulties of teaching online can be explained through a variety of issues. Two major issues are based on the instructor. How comfortable the instructors are with the material and how comfortable they are with dif­fer­ent pedagogical styles play a large role in their comfort of the course. Many instructors have a hard time transitioning between online pedagogy and face-­to-­face pedagogy. Instructors may not be comfortable with the technology and Firdyiwek (1999) believed that quality online instruction was based on effective use of a learning management system (LMS). Instructors try to transition their face-­to-­face course into an LMS and hope all learning objectives w ­ ill still be obtainable. This does not always work; many times, the learning objectives and materials are fine, but the course assessments need to transform into something dif­fer­ent. Instructors may not be ready for the transformation to teach online and may not understand what step might need to be taken to get their course material ready to be presented online. All the ­little steps and statements instructors say during a lecture need to now be in writing for the learner to follow. If the instructors are ­going to make videos to incorporate into their online classroom, then they should be scripted and practiced before the final recording is done. ­There are many dif­fer­ent steps online instructors must take when preparing their classroom, but they always need to think about their audience. Learners also play a large role in the difficulties faculty have in teaching online. ­There have been a few studies that determine the characteristics of successful online students. T ­ hese characteristics include being self-­motivated, striving for goals, willingness to attend class regularly, and the proper learning styles that help define achievement (Kerr, et al., 2006).


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Aragon, Johnson, and Shaik (2002) found that students with dif­fer­ent learning styles have dif­fer­ent preferences in their education, but this difference was not significant when dealing with the differences of online education and face-­ to-­ face instruction. Hurd (2014) gave the student choices in online learning and determined that the only characteristics that ­were statistically significant was prior online learning experience. Learners who have taken previous online courses w ­ ere better suited to teach themselves in an online class, and this in turn makes it easier for the instructor. Online learning models have focused on behavioral, cognitive, and social learning theories (Johnson and Aragon, 2003). T ­ hese studies have tried to address areas like avoiding information overloading, encouraging social interaction, and motivating students. In a face to face classroom the instructor has the power and control to manage ­those situations. In an online environment instructors, do not get to see the face of the learners when the learner is reading the course material. This is an essential aspect to lecturing to learners. In a face-­to-­face environment the instructor and the learner can have a personal experience as the instructor can observe how the learner reacts to what is said and how it is delivered. This is missing from an online environment and it is difficult to re­create in any way. Another challenge in teaching online is instructors feel that the outcomes for an online course need to differ from a face-­to-­face course. While the outcomes need not change, the pedagogical model does need to change for online instruction. This is not something all educators are comfortable with. Researchers asked questions like “What makes a learner successful in an online environment? What creates barriers or challenges?” (Song, et al., 2004). If we learn from the previous studies, then having motivated learners who have taken online classes before w ­ ill make is easier for the instructors. This sounds the like key to all successful teaching stories. Instructors who have ­these ideal students may still strug­gle to teach online b ­ ecause of their motivation to be in the online classroom. Most instructors who teach online enjoy the flexibility it offers in their schedule (Anderson, 2004). This is also a reason for students to take online courses (Ally, 2004). One of the largest indicators for student success in online courses is instructors staying active in their courses. Instructors have to stay motivated and must retain an active presence in their courses (Kanuka, Rourke & Laflamme, 2007). This is not always easy to maintain for instructors, and some can find it challenging to allocate the time. INTERSECTIONALITY AMONG RACE, CLASS, GENDER, AND SEXUAL ORIENTATION Boxer (1982) noted that the feminist goal for education is that it should be about and for all w ­ omen, not only ­free from sexism, but also from prejudice and discrimination based on race, class, age, sexual orientation, and


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other oppressive biases. Dissatisfaction with the treatment of ­women of color has been a source of conflict since the early 1970s and continues to plague w ­ omen’s studies programs and psy­chol­ogy of w ­ omen courses ­today. Brown, et al. (1985) reviewed 28 textbooks on the psy­chol­ogy of ­women and found that 18 offered ­either minor or no reference to African American ­women. Asian w ­ omen, Native American w ­ omen and Latinas received even less attention. Brown, et al. (1985) identified four definitive steps to be followed to rectify this prob­lem: 1. Psy­chol­ogy of ­women writers must confront the racism, ethnocentrism, and classism manifested in the exclusion and limited treatment throughout their works of Third World, non-­middle class w ­ omen. 2. In-­depth research and study must be undertaken, as well as research programs that specifically seek to reveal the impact of culture, race, and social class on the psychological development of Third World w ­ omen. 3. Course offerings on African American, Native American, Hispanic, Asian American, and other Third World w ­ omen must be added to the curriculum of W ­ omen’s Studies and given the same status as other required psy­chol­ ogy of ­women courses. 4. Efforts to develop a comprehensive and integrative study of the psy­chol­ ogy of ­women must be pursued. Model construction and theory development must reflect the importance of culture, racial, and social-­ class variables on female development. (p. 37).

de Barona and Reid (1992) also noted that ­women of color must be central to a psy­chol­ogy of w ­ omen course for two major reasons: 1) white ­women represent a small proportion of w ­ omen in the world, and 2) sex cannot be discussed in­de­pen­dently from class, race, and ethnicity. Santos de Barona and Reid recommended two topics to discuss in the psy­chol­ ogy of ­women course to make ­women of color central: f­amily relationships among ethnic groups and differential impact of employed m ­ others. According to Santos de Barona and Reid, Efforts to include ethnic issues in ongoing discussions of gender must continue. It is impor­tant to include topics for which ethnic data and theoretical perspectives are available. However, course content involving ethnic concerns should not be limited to ­t hese areas but should be expanded to promote discussion of the beliefs and ste­reo­t ypes about ­women of all classes and ethnicities (p. 49).

DeFour and Paludi (1991) described the necessity for instructors of courses in the psy­chol­ogy of ­women to integrate the scholarship on race, class and ethnicity into their curriculum. They offered examples of films, experiential exercises, popu­lar books, and course topics to assist instructors in providing more of an understanding of the psy­chol­ogy of all ­women. DeFour and Paludi made three recommendations for instructors.


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First, it is impor­tant to avoid the use of value-­laden references so as not to legitimize negative ste­reo­types of w ­ omen of color. Second, w ­ omen’s experiences are extremely diverse, yet most researchers describe w ­ omen of color collectively. This approach engenders the same error that occurs when one collectively describes any group: ­women of color are as varied and differ as much among themselves as do white w ­ omen. Third, the use of the term ­women of color should also address socioeconomic class stratification. Goodwin, McHugh, and Touster (2003) suggested several strategies for making diversity central including ­these four: 1. avoiding studying w ­ omen from marginalized groups only in comparison to ­women in the dominant group 2. incorporating into the course scholarship by w ­ omen from marginalized groups 3. integrating diversity throughout the course rather than the “mix and stir” approach of relegating it to a separate section of the course 4. addressing issues of privilege and oppression

When implementing t­hese strategies, Ergun (2013) cautions that much work on diversity, internationalization and globalization has been written by Western feminists, and therefore, it is essential to avoid a “feminist-­ as-­tourist or explorer model” (p. 89) and to dismantle the “rescue paradigm” (p. 93). Another impor­tant issue related to teaching diversity is the notion that students and teachers have multiple, intersecting social identities that have varying degrees of importance in dif­fer­ent contexts. Enns and Forrest (2005) indicate that “the goal, then, of a multicultural feminist pedagogy is to explore the intersections, borders, and bound­aries among identities.” (p. 20). This perspective recognizes that a person’s real­ity is complex, and is generally not defined by a single identity, but is ­shaped and influenced by many identities. Each of t­hese identities may be associated with dif­fer­ent degrees of privilege, power, and oppression that are dynamic depending on the context. To further complicate this issue, it is, of course, not only the student who has multiple social identities, but also the teacher. The multiple identities of the students and the teacher interact with one another, complicating efforts to equalize power in the classroom. Ways to address this include helping students become aware of their multiple social identities, their positionalities, and social locations inside and outside the classroom and how ­these affect experiences of power and oppression. Crawford and Suckle (1999) have proposed exercises that deconstruct ste­reo­t ypes and recognize the complexity of identities that include the rewriting of fairy tales and examining the roles and plots of romance novels. Having students describe their vari­ous identities, roles, and expectations or engaging in role plays from vari­ous positions and points of view can help students recognize the impact and intersection of multiple identities.


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A safe, supportive, and inclusive classroom environment is an impor­ tant condition for dealing with issues of diversity. Feminist pedagogy recognizes that some students, ­those from the dominant culture who bring their privilege into the classroom, ­will have an easier time feeling safe than ­those from marginalized positions. Students from marginalized groups need support from the teacher to take risks in what may have been an unsafe environment in other academic contexts (Sinacore & Enns, 2005a). Characteristics of the teacher also contribute to the perception of safety (Enns & Forrest, 2005; Sinacore & Enns, 2005b). Young (2005) suggests that when a course has a multicultural perspective, a diverse student population, and instructor-­student difference in race, ethnicity, gender, or sexual orientation the conditions increase for the likelihood of a difficult dialogue. Central to the creation of a safe environment is teachers’ comfort with, and preparation for, h ­ andling intense emotions and “difficult dialogues,” yet faculty report feeling ill-­equipped and unprepared to ­handle such dialogues, and so they attempt to avoid them (Byars-­Winston, et al., 2005; Goodman, 1995; Young, 2005). Goodman (1995) suggested that faculty can increase their comfort and preparation level by increasing their knowledge about vari­ous groups, developing awareness about themselves and their own prejudices and misinformation. The greater their knowledge, the more comfort they can have when addressing students’ ste­reo­types. Similarly, McAnany (2009) suggested that course developers and instructors ensure that the instruction does not offend ­people of vari­ous cultures, know who their learners are in order to create relevant and motivating instruction, and incorporate global concepts and images into instruction. Other methods for creating a favorable climate for difficult discussions include having and enforcing discussion guidelines, helping students understand that it is difficult to avoid learning ste­reo­types and prejudice when one is raised in a society with sexism and racism, using examples from the teacher’s life, and encouraging personal stories about experiences with discrimination. Young (2005) identified four conditions for dealing with difficult dialogues. ­These include creating a climate for inquiry, focusing on cognitive inquiry, focusing on emotional inquiry, and developing mindful listening. One of the goals of this model is to integrate the cognitive and affective responses. Using the pedagogical approaches of self-­study and collaboration can be helpful in promoting culturally responsive teaching (Gay & Kirkland, 2003). Culturally responsive teaching as defined by Gay and Kirkland (2003) involves the following three propositions: . . . ​multicultural education and educational equity and excellence are deeply interconnected . . . ​teacher accountability involves being more self-­conscious, critical, and analytical of one’s own teaching beliefs and be­h av­iors . . . ​ [and] teachers need to develop deeper knowledge and consciousness about what is to be taught, how, and to whom. (p. 181)


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Critical consciousness of racial and cultural issues should be examined in a self-­reflective manner (Gay & Kirkland, 2003). When training teachers and/or teacher leaders, it is not enough that students are asked to engage in conversations about social injustice; they need also to examine their own beliefs, biases, and the system of cultural hegemony that holds ­these ideas in place. T ­ hese conversations can be done as “participatory spaces” (hooks, 1994), where students take part in dialoguing with one another in a safe environment. Educators and instructional designers must not only become aware of their own cultural preferences for learning and not assume that theirs is the “right” or “best” way, but also familiarize themselves with the ways in which both gender and culture impact values, learning, cognitive pro­ cessing, goal setting, motivation, communication, and learning styles. Educators tend to often subconsciously assume that o ­ thers prefer to learn in the same manner in which they do, and, as a result, mistakenly create instruction and strategies consistent with their own personally preferred styles of learning. However, this is a dire m ­ istake and results in ethnocentric and gender-­centric learning. In ­today’s increasingly diverse educational and work environments, instructors and developers can no longer make overarching judgments about the demographics of their learners before having the opportunity to interact with them (Parrish & Linder-­ VanBerschot, 2010). DEVELOPMENTAL ISSUES Multigenerational inclusivity is a challenge in the psy­chol­ogy of ­ omen course. Young w w ­ omen often feel that ­t here is no longer a need for feminism since equality has been achieved (Crawford & Suckle, 1999). Two explanations have been offered for this conservatism and anti-­intellectualism: 1) It is part of the much larger wave of conservative politics and a retreat from liberalism in the United States (Crawford & Suckle, 1999), and 2) it signals the beginning of the next stage of feminism in which college w ­ omen may embrace feminist values but do not accept the collective efforts of the ­women’s movement as a means to achieve their individual goals (Komarovsky, 1985). The backlash against feminism and its intentional misrepre­sen­ta­tion has been an organ­izing princi­ple of the ultra-­conservative movement since the 1970s (Cobble, Gordon, & Henry, 2014). McRobbie (2011) suggests that antifeminist media and popu­lar culture remind young ­women of the gains of the ­women’s movement in order to signal that feminism is no longer relevant. They pres­ent “spurious and superficial” (p. 180) projections of equality, “faux feminist gestures” (p. 181), and focus on successes of individual ­women. The result is a new form of entrapment; a commercialization and marketization which entirely omits any messages about the role and importance of po­liti­cal participation, group action, and systemic


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change. “That w ­ omen can gain equality by taking individual control of their lives, becoming more ambitious, or setting better priorities” is a per­ sis­tent and perilous message that is reiterated not only in the media and popu­lar culture, but also in the po­liti­cal arena (Cobble, Gordon, & Henry, 2014, para 18). Young ­women have come to believe that structural inequalities can be addressed at the individual level (Scharff, 2012). Scharff (2012) argues, that feminism itself has been “generationalized;” it belongs to the past for both older and younger w ­ omen. Young w ­ omen may reject earlier visions of feminism and feminists while subscribing to many of its princi­ples (Zalk, described in Paludi, 1992). They may perceive an expectation that they conform to beliefs and be­hav­ior that are not part of their experience. Crucial to overcoming this belief is making the material relevant to the lives of young ­women. Using collaborative teaching approaches, having students identify discussion questions for class, relating course content to personal experiences, developing experiential activities, and including popu­ lar films, tele­ vi­ sion shows, and novels can help students find relevance in the course material. (Freedman, Golub, & Krauss, 1982; Paludi, 1991; Riger, 1979; Sholley, 1986). Young ­women who identify themselves as feminists, or third-­wave feminists, often identify themselves and their feminism in opposition to the previous generation of feminists (Sinacore & Enns, 2005a). Several recent studies on feminist identification suggest that w ­ omen are hesitant to self-­identify as feminists in large part b ­ ecause of the negative connotation associated with the term. Some researchers indicate that young w ­ omen tend to express feminist ideas without labeling themselves as feminists (Percy & Kremer, 1995; Renzetti, 1987). Burn, Aboud, and Moyles (2000) found that although both w ­ omen and men may agree with the goals of feminism, they may also avoid self-­identification with the term for fear of being associated with the stigmatized label. Martin (personal communication) stated that, In my own observation as a high school teacher, I have found that many young ­women ­today are quicker to accept negative reclamation, to self identify with traditionally negative terms used to refer to ­women such as “bitch,” than they are to embrace a term such as “feminist.” In my experience, most young high school aged w ­ omen express one of the following three sentiments: they have l­ittle understanding of feminism, they feel feminism is a negative term and disassociate with it, or they feel that feminism is no longer necessary.

Aronson (2003) found that feminist identification can be classified on a continuum. For example, “I’m a feminist,” “I’m a feminist, but,” “I’m not a feminist, but,” “I’m a fence sitter,” and “I’ve never thought about feminism.” This qualification often stems from this need to male identify, e.g., “I’m a feminist, but I ­don’t hate men,” “I agree with many feminist ­causes, but I’m not a prude,” “I would be a feminist, but I’m not that


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uptight,” ­etc. According to Aronson (2003), most ­women are fence sitters. Some researchers believe that this ambivalence t­oward feminism can be cultivated into active support for the feminist movement (Aronson, 2003; Martin, 2006). Some of the features that distinguish third-­ wave feminism from second-­wave feminism are a more flexible attitude about what it means to be feminist, a greater tolerance for ambiguities and contradictions, and being able to define for themselves the meaning they give to feminism (Sinacore & Enns, 2005a). As with cultural diversity, putting generational issues at the center of the discussion can illuminate the experiences, perceptions, concerns, needs, and prob­lems of young ­women, their multiple identities, and their positionality in the educational, social, occupational systems with which they interact. Paludi (1991) offered a life cycle developmental psy­chol­ogy perspective that emphasizes that the individual, cultural, and historical conditions affect each person’s development. She focused on the following life stages: infancy and childhood, adolescence and young adulthood, and m ­ iddle and l­ ater adulthood. She stresses the continuity in psychological pro­cesses during dif­fer­ent stages of development, e.g., separation. Dealing with separation is a developmental task for early childhood (e.g., separation from ­mothers who return to employment), during adolescence (when a young ­woman leaves home to attend college), and for adulthood (when a w ­ oman’s child leaves home to continue with her/his own adult life). The study of girls as a group is a relatively new phenomenon. Carol Gilligan began her research on the psy­chol­ogy of ­women as specifically dif­ fer­ent from that of the predominant “male universal” in the 1970s. Since then, a study of girls as a group slowly began to develop within psy­chol­ ogy and education with w ­ omen like Gilligan and organ­izations such as the American Association of University ­Women leading the way. In sum, the fields of psy­chol­ogy and education turned to an examination of girls as the next logical step. The history of girls’ studies is not very long or comprehensive. Beginning in the 1970s, scholars, such as Brown and Gilligan, sought to rectify the omission of girls from the discipline of psy­chol­ogy and from within feminism’s Second Wave by adding to the lit­er­a­ture of adolescence the voices of girls (Dohrn, 2004). Many of the first studies on girls focused on their victim status or on the prob­lems young females across racial and class lines faced living in a patriarchal society. T ­ here w ­ ere studies on sexual harassment, adolescent females’ loss of voice in a patriarchal society, and ultimately, on the socially constructed notion that girls lived experiences are just dif­fer­ent from that of boys. Such studies w ­ ere necessary in explaining the experiences of American girls in a variety of cultures, to indicate that girls had more to overcome when achieving success ­because of the obstacles they faced living in a sexist society (Gilligan, 1982; Peterson, 1988).


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This victim-­based “girl” lit­er­a­ture of the 1990s has sparked the creation of vari­ous school-­based and non-­profit organ­izations to tackle issues faced by girls (Sprague, 2003). Girls Inc. and Girls International Forum are just two examples of national organ­izations that strive for the health and educational well-­being of American girls t­ oday. MEN, ­WOMEN, SEX AND POWER . . . ​How l­ ittle can a man know even of [a w ­ oman’s life] when he observes it through the black or rosy spectacles which sex puts upon his nose. Hence, perhaps, the peculiar nature of ­woman in fiction; the astonishing extremes of her beauty and horror; her alternations between heavenly goodness and hellish depravity-­for so a lover would see her as his love r­ ose or sank, was prosperous or unhappy. ­—­­Virginia Woolf

Woolf’s statement suggests that ­women have been almost viewed in light of men and their needs (Langland, 1990). Worell (1990) also suggested that personality theories may be described as “traditional” when they reflect the following themes in their conception of h ­ uman be­hav­ ior: androcentrism, gendercentrism, ethnocentrism, and heterosexism. Worell noted that personality theories mostly use boys and men as the prototype of humankind and girls and ­women as variants on this dominant theme (androcentrism). Also, psychological theories often discuss separate paths of lifespan development for w ­ omen and men as a result of the biological differences between them (gendercentrism). Ethnocentrism refers to personality theories assuming that development is identical for all individuals across all racial, ethnic, and class groups. Fi­nally, Worell noted that personality theories assume that a heterosexual orientation is normative, while a lesbian, gay, bi, or transgendered orientation is deviant and changeworthy. The psy­chol­ogy of ­women course, as recommended by Lord (1982), needs to treat girls and ­women as the norm, recognize racial, class, and ethnic similarities and differences among ­women, and treat sexual orientation in a respectful manner, noting lesbian, bi, and transgendered orientations. Treating girls and ­women as the norm, however, may make men students interpret this as “man hating.” W ­ omen have this perception, too, and can resist this as well. It is impor­tant to discuss how thinking only in a dichotomous way is faulty. Valuing ­women does not mean devaluing men. This is but one of many challenges for the participation of men in psy­ chol­ogy of ­women courses. T ­ here are challenges for the man himself, for the faculty member, for ­women in the class and for the class dynamics. Men who enroll in the course do so for vari­ous reasons; increasingly, they may be fulfilling a course requirement (Orr, 1993), they may endorse the


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goals and values of feminist courses, they may come to the course as a provocateur with an opposing po­liti­cal agenda, or they may be naïve about the nature of the course content and, therefore, believe they w ­ ill learn about how/why their girlfriends behave. The psy­chol­ogy of ­women course may be the first encounter with feminist princi­ples. For faculty teaching the psy­chol­ogy of ­women course, the challenges and considerations related to teaching men are numerous and they include dealing with re­sis­tance, the perception that the course content (and perhaps the professor) is “man hating” or “male bashing,” provocative be­hav­ ior intended to ridicule or incite, guilt, and/or anger in response to discussions of privilege, power and dominance issues, being in a decentralized role in the class, and their reaction to feminist pedagogy (Crawford & Suckle, 1999; Orr, 1993). Orr (1993) concluded that “resistant students cannot learn effectively themselves and may seriously hamper the learning of their fellow students” (p. 240). She cited the failure of both feminist pedagogy and critical educational theory of dealing adequately with “male students as gendered subjects” (p. 252). In addition, Orr (1993) described the psychological benefits of using a specific critical theoretical framework to understand both masculinity and re­sis­tance of men. The framework she described allows the feminist teacher to address male re­sis­tance in three ways. First, it enables the teacher to respond to male re­sis­tance with a “more adequate and useful emotional relationship” (p. 246). Understanding re­sis­tance in terms of the critical framework allows the teacher to engage in a productive, instead of a reactive, response to some of the frustration and anger that resistant male students can generate. Second, in addition to assisting with her own reaction to student be­hav­ior, this framework helps the feminist teacher understand student be­hav­ior in a way that “can see in it the energy and desire for emancipation” (p. 257). Fi­nally, the framework can be used as a pedagogical strategy to help male students see themselves not only as the oppressor but also as the oppressed with re­spect to patriarchical social, po­liti­cal, and economic systems, and to help recognize their privilege at the same time understanding that masculinity is in opposition to their own real interests. According to Orr (1993), this approach can reduce the male experience of threat and guilt and help men related issues in the class to their own experiences. Pleasants (2011) describes another framework for understanding male re­sis­tance. Pleasants identifies multiple “discourses of re­sis­tance” (p. 230) that men in feminist classes assert, even men who are receptive to feminism. T ­ hese discourses function to protect male privilege, and recognizing and understanding t­ hese narratives can help reduce male re­sis­tance in feminist classrooms. Sinacore and Boatwright (2005) report that although female students respond more favorably to feminist pedagogical strategies than male students, some research (Ferguson, 1992) found that most men and ­women preferred strategies associated with feminist pedagogy. Several studies


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have found that male and female students have benefited similarly from feminist classes (Stake & Gerner, 1987; Stake & Malkin, 2003). Sinacore and Boatwright (2005) urged further research on which feminist strategies work best with which types of students in which types of settings. Both men and ­women stand to benefit from participation of men in psy­ chol­ogy of ­women courses. Since ­women are often in relationships with men, and since many of the issues affecting ­women involve men, it is crucial that ­women not be the only ones to understand the effects of privilege, power, androcentrism, and patriarchy. Finding an effective way to address the challenges and to teach male students this content is a worthwhile endeavor. Integration of the Psy­chol­ogy of ­Women into the Psy­chol­ogy Curriculum That it is impor­tant and necessary for psy­chol­ogy to move from its male Euro-­American origins and emphasis ­toward becoming a discipline that includes more of humanity is obvious. A discipline whose objective is to understand ­people should not have to defend their inclusion. Further, given the changing demographics of the United States, of students in higher education and in psy­chol­ogy courses, Hall’s (1997) warning that “American psy­chol­ogy may become ‘culturally obsolete’ u ­ nless revised to reflect a multicultural perspective” (p. 1063) was echoed by Sue, et al. (1999). Many changes are occurring as evidenced by a plethora of research, journals, and psychological organ­ izations dedicated to the study of ­women and other groups not previously represented in traditional psy­ chol­ogy. While many psychologists support the goal of becoming a more diverse discipline, integration of corresponding content has not necessarily found its way into standard psy­chol­ogy courses and text books (Madden & Hyde, 1998). Hence, many students who take a wide array of standard psy­chol­ogy courses continue to be taught primarily (or exclusively) theories and research based on a small segment of humanity. Madden and Hyde (1998) concluded that while psy­chol­ogy has become more inclusive, the psy­chol­ogy curriculum does not yet adequately include gender and ethnicity, text books do not portray w ­ omen well, and ­women of color are not represented in psy­chol­ogy text books at all. Copeland (1982) identified four approaches for integrating multicultural contents into courses which can be extrapolated to include content about ­women and gender. They are the separate course model, the area of concentration model, the interdisciplinary model, and the integration model. Psy­chol­ogy of W ­ omen courses are an example of the separate course model, and t­here are advantages and disadvantages to this approach. Quina and Bronstein (2003) suggest that the separate course model can “ghetto-­ize” and devalue scholarship in t­hese areas by suggesting that they are “special topics,” variations from the requisite course content, and


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­ ill not be covered in standard psy­chol­ogy classes (Denmark, 2003). w Another disadvantage is that the information is not widely disseminated; only the students who take ­these classes gain exposure to the material. The preferred model is the integration model which advocates the inclusion of content from multicultural and gender perspectives into all courses (Sue, et al., 1999). Integrating multicultural and gender perspectives into all courses has numerous advantages. The primary advantage is that courses become relevant to all students and a greater number of students have exposure to a more accurate reflection of ­human real­ity (Denmark, 2003; Madden & Hyde, 1998; Sue, 2003). The integration model advocated by most researchers in this area refers to curricular transformation rather than simply taking an existing course and adding facts or information about a par­tic­u­lar group, or the “mix and stir” approach (Madden & Hyde, 1999). Sue et al. (1999) go further and state that widespread systemic changes to the educational system are necessary to create a multicultural psy­chol­ogy. Alternatively, the separate course model need not be in opposition to the integration model. Rather, like many topics in psy­chol­ogy which are addressed and included in standard courses, they are then elaborated in a course that is more focused and specialized. Quina and Bronstein (2003) point out that while it is essential to integrate multiculturalism and gender perspectives into all psy­chol­ogy courses, “­there is a place in the curriculum for special foci” (p.  4). ­These courses are supported by the development of new course materials and new scholarship that focuses on individual groups, multicultural and cross-­cultural psy­chol­ogy, and the psy­chol­ogy of gender. Many obstacles have been identified to a full integration of gender and multiculturalism in psy­chol­ogy courses. Some of the obstacles recapitulate prob­lems identified in teaching the psy­chol­ogy of ­women course. Specifically, many faculty members feel uncomfortable, or embarrassed, have other negative emotions about addressing topics of race and gender in their classes (Sue, et al., 1999; Quina & Bronstein, 2003), feel unprepared for dealing with the difficult discussions that can result from addressing ­these topics (Sue, et al., 1999), may feel uncertain about their own expertise in ­these areas (Sue, et al., 1999; Quina and Bronstein, 2003), feel unprepared to challenge the existing Euro-­American assumptions by using new models (Sue, et al., 1999), may fear revealing their own biases or may feel they are exposing themselves to criticism (Quina & Bronstein, 2003), or may feel they do not have the time to add any additional content to their courses and they may not have a clear idea of how to determine which groups to cover and which groups to leave out (Madden & Hyde, 1999). As psy­chol­ogy recognizes the importance of integrating gender and multiculturalism in the curriculum, numerous books, articles, journals, associations, and guidelines have been developed to facilitate this goal. The importance of selecting textbooks that are inclusive is an agreed-­upon


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starting point (Hyde & Madden, 1999; Quina & Bronstein, 2003, Sue, 2003, Denmark, 2003). Textbooks are crucial as they often determine what ­will be taught in the course. In addition, t­here are numerous resources available for helping faculty to integrate gender and multiculturalism in courses (Bronstein & Quina, 2003). The American Psychological Association has published guidelines for teaching about gender and multiculturalism (APA, 2002). Integration of psy­chol­ogy of ­women into the broader psy­chol­ogy curriculum requires more than a series of techniques. Madden and Hyde (1999) and Quina and Bronstein (2003) emphasize the importance of developing a framework as well as strategies for integrating gender and multiculturalism into a broad range of classes. ­These frameworks must include ways to understand race, class, gender and sexuality and for dealing with difference in ways that are not simply comparative to the majority culture. As Makosky and Paludi (1990) summarized, with re­spect to ­women’s studies courses (of which the psy­chol­ogy of ­women course is one): Deciding ­whether ­women’s studies should be mainstreamed into the curriculum and/or maintained as a separate program in a w ­ omen’s studies department is a values decision made in the context of the history and mission of a par­tic­u­lar institution and of the faculty involved. T ­ here are dangers in establishing a single model for w ­ omen’s studies, similar to the danger in having a single strain of corn: with uniformity, you have uniform susceptibility and weakness. We have already seen that the strengths of mainstreaming are often what weaknesses of separationism, and vice versa. Stimpson (1971) discusses the diversity in education, social, and po­liti­cal circumstances that have given rise to the diversity of styles, methods, and goals in ­women’s studies and concludes that all programs must work out their own destiny, and that all ­women’s studies programs need to be seen as a multiplicity of intersection activities (p. 34).

As Giroux (2001/1983) stated, “Public schools d ­ on’t need standardized curriculum and testing. On the contrary, they need curricular justice—­ forms of teaching that are inclusive, caring, respectful, eco­ nom­ ically equitable, and whose aim, in part, is to undermine ­those repressive modes of education that produce social hierarchies and legitimate in equality while si­mul­ta­neously providing students with the knowledge and skills needed to become well-­rounded critical actors and social agents” (p. xxvi). Giroux (2001/1983) further stated, “At the very least, radical pedagogical work proposes that education is a form of po­liti­cal intervention in the world and is capable of creating the possibilities for social transformation. Rather than viewing teaching as technical practice, radical pedagogy in the broadest terms is a moral and po­liti­cal practice premised on the assumption that learning is not about pro­cessing received knowledge but actually transforming it as part of a more expansive strug­gle for individual rights and social justice” (p. xxvii).


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Chapter 3

­ omen of Color: Perspectives on W “Multiple Identities” in Psychological Theory, Research and Practice June Chisholm and Beverly Greene

“Some of us come from the poorest locales in the nation; some of us from very privileged backgrounds. Some of us are biracial or multiracial; some of us are disabled; some of us are lesbians or bisexuals. We come from all dif­fer­ent ethnic, cultural, and spiritual traditions. We are immigrants, some of us. We are ­mothers, some of us. We are beauties, inner and outer. We are heroines. We are winners, e­ very one of us. We are poets. We are the pres­ent. And, make no ­mistake, we are the f­ uture.” —Iris Jacob, age 18 Biracial

In the 21st ­century when one person of color asks another, “Where are you from?”, it no longer means, “From what southern state in the U.S.A. are your ­people from?” Black ­people can no longer assume that another black person is “African American” (black, Negro, or Colored depending upon one’s temporal/psychosociopo­liti­cal frame of reference). The question now acknowledges the potential for international origins of any person of color and leads to the question, “What country are you from?” The question reflects the changing demographics of immigrant groups in the United States of Amer­i­ca, especially in urban cities and is one effect of globalization on our society. Globalization leads us to question our assumptions about what are impor­tant issues for “­women” when we do not know where in the world the w ­ omen in question come from. Clearly, the meaning of gender is derived from a cultural context, and what is impor­tant to ­women in one cultural context may not be salient at all in another.


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American psy­chol­ogy as a cultural institution is also being influenced by globalization. The preparadigmatic “givens” of the major content areas within the field as well as the research methodology and scope of practice are being challenged to incorporate nonwestern and/or alternative views about the h ­ uman condition. The authors of this chapter contend that American psy­chol­ogy must out of necessity include in meaningful ways the ­human dimensions of race/ethnicity, gender, religion, age, sexual orientation, socioeconomic class, and disability in all psychological lit­er­a­ture on theories, research, and the practice of the profession. Comas-­Diaz (2001) speculates that this incorporation of nonwestern paradigms and imperatives ­will advance the field’s depth and breadth of knowledge about the complexities of the ­human condition. Developmental imperatives and cognitive patterns, such as in­de­pen­dence, separation, locus of control, and self-­efficacy ­will be re-­examined in the face of nonwestern cultural alternatives such as interdependence, amae (a Japa­nese concept of filial dependence and parental indulgence), the role of destiny, fate, karma, and the real­ity of external social systems. The shift within psy­chol­ogy to address the issues raised by the h ­ uman differences previously mentioned (ethnicity, gender, sexual orientation, age, disability, e­ tc.) as well as the way they are interrelated in the United States has begun, albeit slowly. For example, chapters focusing on t­hese issues are now seen in texts devoted to conventional content areas in psy­ chol­ogy. Also, we see a rise in the number of journals focused on dif­fer­ ent aspects of diversity and the use of supplemental texts to complement traditional texts in content areas listed in course syllabi to address the shortcomings of the latter, which continue to omit/exclude analy­sis of ­these facets of h ­ uman existence. While t­ hese efforts point out the limitations and misconceptions that persist within the traditional, mainstream approaches within psychological discourse, they do l­ittle to reform the enterprise that produces them. The multicultural perspective in psy­chol­ogy emerged as some tried to grapple with how group differences with re­spect to culture, ethnicity, and race should be addressed and included into theoretical discourse and research that recognizes the integrity of the group and views diversity as a resource rather than a social prob­lem. According to the American Psychological Association (2003), integrating ethnoracial/ethnocultural identity into the discipline is just beginning as psychologists pay greater attention to the differential effects of historical, economic, and sociopo­liti­ cal influences on individuals’ be­hav­ior and perceptions. In time, the discipline w ­ ill have a deeper awareness of ethnoracial/ethnocultural identity in psychological constructs and ­will more actively integrate this material into all applications of psy­chol­ogy. The goals of the multicultural perspective are persuasive; however, the discipline lacks a perspective that can account for other ways in which difference among ­people leads to categorizations that support the continued


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use of ste­reo­types. For example, in medicine some physicians fail to diagnose certain diseases in individuals ­because their information or misinformation about dif­fer­ent social groups leads them to consider only the possibilities that are consistent with their preconceived beliefs about that group’s members. The recent findings in the medical lit­er­a­ture which identify gender differences in the prodromal signs of an imminent heart attack suggest that many ­women with the condition have been and, for some time in the near f­uture, w ­ ill continue to be misdiagnosed and untreated b ­ ecause the standard symptom profile is based on the symptoms observed in men and taken as the norm. ­Here we see how a physicians’ stereotypic “understanding” of race/ethnicity, sexual orientation, social class, and gender prevents them from “seeing” the symptoms of a disease (Graves, 2001). Similarly, within the social sciences in general and American psy­chol­ ogy in par­tic­u­lar, the practitioner/researcher’s perspectives about dif­fer­ ent social groups reflect the broader societal biases and misconceptions stemming from a sociopo­liti­cal system structured to protect the domination and power of certain groups while ensuring the subordination and powerlessness of ­others, i.e., hegemony. Indeed, by using the U.S. Census Bureau categories for all nonwhite p ­ eople deemed “minority” and classifying individuals into the following groups (Hispanic or Latino, black or African American, Asian, Native Hawaiian and other Pacific Islanders, and American Indian and Alaska Natives), psychological research perpetuates and helps maintain the status quo. The assumption under­lying this classification scheme of “minorities” (within a minority group, one can expect homogeneity, and that between groups, one can expect heterogeneity), is flawed and inaccurate. The extensive body of findings based on flawed methodology lacks rigor, reflects the bias of the researcher, and supports the socially constructed “truths” about the “races/ethnicities” studied (Abreu, 2001; American Psychological Association, 2003; Betancourt & Opez, 1993; Graham, 1992; Helms & Talleyrand, 1997). Bond’s (1959) classic parody, “Talent—­and Toilets,” of psychologists’ historical preoccupation with race differences in intelligence (RDI) underscores how the “objective” methods of scientific inquiry serve the zeitgeist of the times. In a study he conducted, he found that National Merit Scholarship winners could more easily be identified by “more toilets, more talent; fewer toilets, less talent; lowest percentage of toilets, no talent at all” (p. 5). The premise is relevant ­today in that the number of toilets continues to symbolize the occupational stature and socioeconomic success of one’s ­family and one’s access to opportunities. Feminist perspectives pres­ent an alternative view to mainstream psychological thought but, u ­ ntil recently, have also been narrowly focused on the meaning of gender unwittingly excluding analyses of distinctions in class, racial/ethnic, and sexual orientation. Espin (1994) acknowledges the short-­sightedness of some feminists in psy­chol­ogy and agrees with


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several feminists of color (Anzaldua, 1990; Combahee River Collective, 1979; hooks, 1984; Lorde, 1984) who point out that the experiences of ­women of color are not only relevant but also necessary for understanding the commonalities as well as the differences among ­women, thus improving the scope and practice of the field. In Western culture, race, ethnicity, and gender are but three of several dimensions deemed impor­tant to account for the variability in psychological functioning in vari­ous domains (e.g., academic achievement, motivation) as well as discord between individuals and groups. Other dimensions include age, ableness, class, and sexual orientation. It is not the group difference that explains differences in be­hav­ior and per­for­mance alone; it is the meaning that t­hose differences are endowed with that creates variations in be­hav­ior and/or social tension. Race and ethnicity, gender, sexual orientation, disability, age, socioeconomic class, and religious/ spiritual orientations have ­little meaning in and of themselves. The social context in which ­these dimensions are perceived, experienced, understood, and defined is what makes them salient. Their salience is determined by how much of a difference ­these differences actually make in ­peoples’ lives at a given time and what they mean. It is the social context that helps to define social differences, thus giving them meaning. What does it mean to share group membership? What does it mean when individuals do not share that membership? What does it mean to share multiple memberships in some contexts and not in o ­ thers? Our challenge is to make sense of ­these questions as well as appreciating the complexity of ­these issues in the education of psychologists and training of h ­ uman ser­ vices professionals. Indeed, Espin (2003) admonishes that psy­chol­ogy must make substantive changes in its curriculum, training, research, and practice to keep abreast of the changing demographics occurring in the United States or risk professional, ethical, and economic prob­lems ­because the profession ­will no longer be a ­viable resource to the majority of the U.S. population. Diversity is a socially constructed concept indicating the mere presence of differences; however, we are challenged to understand the meaning of the difference, not simply to acknowledge its presence. ­Human beings differ from one another along a range of dimensions and in innumerable ways. The groups that the authors discuss are clearly dif­fer­ent from one another on many dimensions just as they are similar on other dimensions. When placed on a spectrum, some of ­those differences are highly vis­i­ble on one extreme while o ­ thers are completely invisible at the other extreme. However, aside from describing the groups, what makes ­these differences impor­tant? It is clear that some differences are deemed extremely salient while other kinds of differences, even though highly vis­i­ble, are deemed inconsequential The question we are left to interrogate if we are to understand the tension that often occurs when we directly experience or anticipate differences between ourselves and ­others is which differences make


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a difference and why some characteristics, beliefs, or be­hav­iors of p ­ eople are given g ­ reat importance while o ­ thers are not. In our attempts to understand the under­pinnings of social inequity in our clients’ lives, it is essential to gauge why differences ­matter, how do they make a difference in the clients’ lives, to whom do they ­matter most, who benefits from them and who decides which differences make a difference? Johnson (2001) points out that fear of the unknown is usually given as the reason that p ­ eople fear and distrust t­ hose who are not like them. It would seem logical that fear of difference would be normative. Johnson, however, argues that our fears are not based on what we do not know; they are based on what we think we do know. When we personally encounter someone for the first time from a dif­fer­ent ethnic group, someone who is lesbian, gay, or bisexual, someone from a dif­fer­ent religion, or a person with a disability, it is r­ eally not the first encounter. It represents the culmination of a series of previous symbolic encounters that takes place whenever a piece of information is formally or informally communicated about ­those group members or when they are conspicuously omitted as if they w ­ ere invisible. Symbolic encounters occur when we overhear conversations of adults as ­children or we watch movies or tele­vi­sion, and ­these encounters are perhaps most insidious when t­ here is no discussion about what has been said or about the feeling of tension that permeates the communication. The visceral negative reaction to the mention or presence of some group or its member among adults may leave a child in ­those encounters with a level of discomfort that comes to be associated with members of that group. T ­ hese negative associations may linger into adulthood when the presence of the dif­fer­ent group members elicits discomfort for reasons that you would be hard pressed to explain other than as a “feeling.” ­These symbolic encounters also occur when we read newspapers or watch or hear the news, and its contents reveal who and what is considered worthy and who is considered unworthy. Some of our information may come directly from peers as well as loved and trusted figures who tell us what they know about members of dif­fer­ent groups based on information that they may have garnered only second hand as well. Such encounters may be particularly problematic if we only encounter p ­ eople who belong to marginalized groups when they are in roles that are subservient to ours and when we are dominant and they are subordinate. What we think explains someone ­else’s position in the social hierarchy relative to our own in some ways explains what we think it tells us about ourselves. This collection of impressions serves as the body of what we think we know about p ­ eople who we do not r­ eally know at all. The information we have accumulated is s­ haped by many complex sociopo­liti­cal and economic variables that may have ­little to do with the real­ity of who “­those” p ­ eople ­really are. Descriptions of “them” that reflect ste­reo­types are not designed to accurately describe “them” and inform us; rather, they may be designed and used to serve other purposes in a larger system of


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hierarchical relationships. Distortions of groups often represent the way that it has become con­ve­nient or comfortable to see or perceive them. All constitute what we think we know about ­people who are dif­fer­ent long before we ever actually have direct relationships with them. AMERICAN CULTURE In the United States, the distinction among groups based on cultural heritage exists within a hierarchical stratification in which one group is a “dominant” culture, peopled with “a majority” and a variety of “sub-­ cultures” of “minority” groups that are subordinate. The dominant culture does the following: 1) it owns and controls the means of production and commerce; 2) has the power to grant and take away livelihoods; 3) owns and controls the channels of communication in the society; 4) decides what, how, and who gets addressed in the media; 5) promotes ­those aspects of culture in the media which are considered valuable; and 6) excludes, denigrates, or makes invisible ­those aspects of culture which it considers inferior or of less value. The ­people identified as being members of the dominant culture are afforded privileges denied ­those deemed nonmembers ­because of real or perceived differences that impact the quality of life for both the dominant and subordinate groups. Subordinates can and have coped with the power imbalance between them and the dominants through “horizontal hostility” (Pharr, 1988), i.e., members of a subordinate group expressing hostility in a horizontal direction ­toward one’s own kind. Consequently, ­there may be infighting among members of a subordinate group. According to Pharr (1988), “we may see ­people destroying their own neighborhoods, displaying vio­lence and crime t­oward their own kind, while respecting the power of ­those that make up the norm” (p. 61). Self-­hatred is often the result of the internalization of the dominant group’s beliefs that t­hose who are subordinates are substandard, defective, and inferior. The form self-­hatred takes varies from subordinate group to subordinate group based in part on that group’s experience of oppressive forces. For example, among African Americans, both men and w ­ omen, the preference for light skin and devaluation of dark skin indicates negative views about the self based on a history of ste­reo­types. One of our patients takes ­great pride in the fact that she comes from the town in a southern state known for its single, light-­skinned African American w ­ omen. ­T hese ­women are sought out by African American men who are interested in ­either maintaining or improving their social status, and seek to marry a light-­skinned African American w ­ oman. Another patient, who is Puerto Rican, recalled with g ­ reat sadness a conference on Latina w ­ omen she attended. According to her, the Latina w ­ omen pres­ent seemed to divide and splinter off into antagonistic groups in which inclusion/exclusion was


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seemingly determined by fluency in Spanish and degree of accentedness in En­glish. An impor­tant f­actor contributing to the assimilation/acculturation of the ethnic minority group is ­whether the group’ immigration was “voluntary” or “involuntary.” Ogbu (1994) states that voluntary or immigrant minorities are ­people (and their descendants) who have voluntarily come to the United States ­because they believe that the move ­will ultimately lead to more economic opportunities and greater po­liti­cal freedom. ­These expectations continue to influence the way the immigrants perceive and respond to obstacles confronting them in American society, e.g., discrimination. Voluntary minorities do relatively well in education and employment, especially a­ fter mastering the language. What is impor­tant is that they apparently do not interpret their presence and/or reception in the United States in terms of having been forced on them by Euro-­Americans. On the other hand, involuntary minorities are ­people and their descendants who ­were originally forced against their ­will by Euro-­Americans through slavery, conquest, and colonization to marginally participate in American society. They tend to define themselves and their cultures in opposition to cultural values of the majority. Examples of both types include ­people of color from the Ca­rib­bean (e.g., Jamaican Americans) and African Americans respectively. While both experience oppressive racism and sexism, West Indian Americans tend to be more successful than their African American counter­parts and are more optimistic about their success as well (Brice, 1982). Featherton (1994) makes the point that w ­ omen of color “live theater of the absurd” daily in their efforts to negate negative assumptions imposed from without and to create internal frames of reference that facilitate au­then­tic self-­awareness and expression. She quotes Toni Morrison (on a segment of Bill Moyer’s tele­vi­sion series World of Ideas), who observed that Eu­ro­pean immigrants from dif­fer­ent countries often had ­little connection to one another before leaving Eu­rope. Once in the United States, they could unite around their whiteness against blacks. According to Morrison, it was no coincidence that, “the second t­hing e­very immigrant learns when he gets off the boat is the word, ‘nigger’.” Morrison observes that in that way, immigrants establish oneness, solidarity, and ­union with the country. She argues that newcomers w ­ ere frightened coming to a strange country and in need of a job, friends and allies, having cut their bridges to their home country. Facing chaos in a new and strange place, it became impor­tant for immigrants to belong to something larger than themselves. T ­ here is a yearning to belong to what is deemed the “large idea” that is the United States. For t­ hose who are not p ­ eople of color, their whiteness is the pass key for membership in the larger and more power­ ful force (Featherton, 1994). Featherton’s (1994) review of race and ­labor in American history expands on the notion of immigrants becoming “white”


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in Amer­i­ca by distinguishing among t­ hose immigrants who are White on Arrival (WOA) and t­ hose who w ­ ere White Before Coming (WBC); the latter, Racial Thinkers Before Coming (RTBC) seemingly have a pattern of racial thinking prior to coming to Amer­i­ca which facilitates their rapidly learning the American racial system. Social Privilege Defined The Merriam-­Webster Dictionary defines privilege as a special advantage, immunity benefit granted to or enjoyed by an individual, and class or caste that ­people come to feel they have a right to hold. West (1994) refers to it as an “undeserved gift.” While privilege is often granted for capricious reasons, once p ­ eople have it, they become convinced they must deserve it, must have earned it, and have a preemptive right to continue to have it to the exclusion of o ­ thers who may want it. Social privilege facilitates the optimal development of an individual, increases access to societal opportunities, or simply makes life easier but is not acquired by virtue of merit or personal effort. It is gained simply by being a member of the group that is privileged. It is impor­tant to understand the nature of privilege as something that is not merit based to fully grasp the reluctance of many ­people to acknowledge that they may have it. Peggy McIntosh (1988) analyze white skin privilege as one form of social advantage and each discusses the ways that they and other white Americans benefit from having white skin in a racist society. In its essence, having white skin privilege makes life easier. In her examination of race privilege, Stephanie Wildman defines key ele­ments of privilege as the systemic conferral of benefit and advantage. She argues that the characteristics of p ­ eople who are members of privileged groups come to define societal norms and not surprisingly to the benefit of the p ­ eople who establish the norms. Members of other groups are mea­sured against the characteristics that are held by the privileged, usually most dominant members of a society, and are found to be wanting in some way. The privileged characteristic is legitimized as the norm and t­ hose who stand outside of it are considered deviant, deficient, or defective. ­These are impor­tant concepts in m ­ ental health. Overall, “they” are seen as deserving of their lot in life. Social disadvantage stands on the opposite end of the conceptual continuum of privilege. Marilyn Frye (2005) observes that it is impor­tant to make a distinction between social disadvantage and ­human misery. In her analy­sis of social oppression, she observes that ­people can suffer, experience pain, and be miserable without being socially disadvantaged and that privileged status does not always protect one from the experience of ­human suffering or failure. To be socially disadvantaged is to have your life confined and ­shaped by forces and barriers, which are not accidental or occasional and hence avoidable but are systematically related to each


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other in such a way as to catch one between and among them and restrict or penalize motion in any direction, and it is the systematic, unavoidable barriers restricting freedom of expression that can and cause suffering and pain. Achievements by members of privileged groups are usually attributed to individual efforts and rewards for ­those efforts are seen as having been earned and deserved. Greene (2003) observes that a myth of “earned power,” and “meritocracy” was developed by the members of the dominant culture to justify their right to discriminate against and limit social opportunities for ­people who w ­ ere dif­fer­ent. When t­hese myths are accepted, ­people are viewed as getting what­ever they deserve. ­People who are in positions of power are seen as deserving of privilege. ­People who are powerless, disadvantaged, or vulnerable and who are exploited are presumed to be getting what they deserve as well which includes blame, punishment, and contempt for their condition (Greene, 2003). Members of socially disadvantaged groups would not simply go along with this arrangement u ­ nless they w ­ ere convinced that the social system distributed opportunities fairly and that their subordinate place in the social hierarchy was a function of their own failings. When members of disenfranchised groups blame themselves, they do not look at the structural nature of privilege and disadvantage and protest their maltreatment. When they accept the myth of meritocracy, they may even blame themselves. This form of self-­blame is expressed in internalized racism, sexism, abilism, classism, heterosexism, ­etc. The person of color who believes that white ­people are superior and that they are inferior has internalized racism. Believing the negative ste­reo­types about some aspect of your identity is a form of internalized oppression. Hence, the systemic determinants of social privilege and disadvantage are usually invisible and if materialized are denied by ­those who are in power and who benefit from them. ­Needless to say, members of both socially privileged and socially disadvantaged groups w ­ ill have feelings about their social status relative to one another and ­those feelings that ­will affect the way they experience encounters with one another. Nancy Boyd-­Franklin writes that, in the course of her work training ­mental health professionals, it is usually acceptable and sometimes even welcome to discuss cultural differences between vari­ous societal groups. ­There is general agreement that many ­people ­will differ from the ­human ser­vices professional, and that it is incumbent on that professional to know something about the values, beliefs, and be­hav­iors that characterize ­people who are dif­fer­ent from us. ­These discussions about cultural specifics often evoke interest and most ­people agree that a working knowledge of ­these differences is crucial to ­doing culturally competent, sensitive work with clients from culturally diverse groups. However, when the discussion shifts to explore the systemic realities of belonging to certain groups, the mood changes, e.g., racism, as opposed to race; heterosexism,


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as opposed to lesbian or gay sexual orientation; classism as opposed to class status; abilism, ageism, e­ tc. Members of the audience, who had been previously receptive, polite, and accepting become defensive, angry, attacking, and sometimes absorbed in their own guilt. This response can serve as a meta­phor for what ­people who are members of socially disadvantaged groups report as a part of their experience when they attempt to talk about the ways they face societal discrimination or to express their anger and pain about it in the presence of members of dominant groups. Their comments evoke reactions that are often hostile. McLemore (1991) observes that color blindness, the belief that every­one has experienced some form of oppression making every­one the same and other forms of denial of differences, is designed to avoid confronting the real­ity of social injustice. McLemore (1991) argues that privilege is not just a prob­lem for ­those who do not have it but is for ­those who have it as well ­because of its relational nature. When ­people are unfairly disadvantaged by social systems and fail to get something they deserve, other ­people are unfairly privileged and gain something they do not deserve. The latter however is harder to acknowledge. Most p ­ eople do not want to be considered racist, heterosexist, classist, sexist, e­ tc., but they spend more of their time seeking to avoid t­ hose labels rather than exploring their be­hav­ior and the ways that they benefit from or have participated in systems of interrelated privilege and oppression, intended or not. It is unlikely that in a society that is racist, sexist, classist, and heterosexist and discriminates systemically on other levels that ­people can have privileged characteristics and not have benefited from them. But what does that mean? In a heterosexist society, heterosexual persons have the social rights that are accorded heterosexual persons and denied to LGB persons. In this example, they do not have to actively do anything to acquire the benefits of heterosexuality. Similarly, in a racist society, individuals who have white skin derive the benefits of white skin privileges simply b ­ ecause they possess that characteristic. What is derived is based on the presence of privileged characteristics, not effort, ability, or merit. The rationales for ­doing this are built into the rules and institutions of our society. The inability of ­people to point to, remember or name the specific events or times when they benefited from a privileged characteristic does not determine the degree to which they have benefited in some ways. Concept of “Multiple Identities” All ­people have more than one identity. Hierarchies of privilege and disadvantage exist within privileged and disadvantaged groups just as they exist between them. Some of their identities may be privileged while others may be disadvantaged. Most, however, are more comfortable ­


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expressing the ways they are disadvantaged than the ways they are privileged. We are all, however, responsible for acknowledging the presence of social privilege in our own lives and the ways we benefit from it. It is impossible to grapple with the complexity of difference if we do not acknowledge the social context of privilege and disadvantage within which salient h ­ uman differences are embedded. We are not personally responsible for the existence of t­ hese systems of privilege and disadvantage but we move within them all the time in some role or roles. Bullivant (1984) observed that the presence of a privilege does not eradicate the strug­gles an individual encounters when t­ hose strug­gles are defined outside the realm of their locus of privilege. When individuals have multiple identities, some of ­those identities or characteristics may place them in privileged groups while, si­mul­ta­neously, ­others ­will place them in disparaged groups. Some forms of privilege may mitigate or positively moderate some forms of disadvantage while other privileges may not mitigate them at all. Similarly, membership in some disadvantaged groups can compound the negative effects of simultaneous membership in another disadvantaged group or groups, e.g., a person of color with a disability, a poor ­woman with a disability, lesbians and gay men of color, and poor white or poor older men and w ­ omen. Institutional privilege is conferred by interlocking social systems as a reward for the possession of characteristics valued by ­those who are dominant. It is indeed a ­matter of luck but fortuitous to be born heterosexual in a heterosexist society; white in a racist society; financially well off in a classist society; male in a sexist and patriarchal society; young in an ageist society; and able bodied in an ableist society. Possession of t­hose desired characteristics does not make one a better person despite the fact that superior value is attributed to them as a rationale for the discrepancy in social power attendant to them; however, possessing ­those characteristics makes life easier. Membership in ­those categories is a function of the luck of the draw. P ­ eople do not control their ethnicity, the presence of a disability, their sex, sexual orientation, age, or the economic status of their parents; they are simply born into ­those statuses. For that reason, the benefits accrued as a function of t­ hese characteristics are privileges. Values associated with white male supremacy and white privilege predominate in American value systems, worldview, and social institutions (Bullivant, 1984; McIntosh, 1988; McLemore, 1991; Triandis, 1994). Wise (2002) states, “That which keeps p ­ eople of color off-­balance in a racist society is that which keeps whites in control: a truism that must be discussed if whites are to understand our responsibility to work for change. Each t­hing with which “they” have to contend as they navigate the ­waters of American life is one less t­hing whites have to sweat: and that makes every­thing easier, from finding jobs, to getting loans, to attending college.” (p. 107)


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GENDER One of the earliest and most pervasive tasks of childhood is learning to be a “psychological” male or female, a task which is generally accomplished by the age of three (Bussey & Bandura, 1984; Libby & Aries, 1989). According to Miller (1976), the dif­fer­ent status of men and ­women in which preferred roles in the culture are reserved for men, the dominants, who, having the power and social privilege, delegate to ­women, the subordinates, the roles and ser­vices the dominants do not want to perform. Boys are raised to be in­de­pen­dent, self-­reliant, aggressive, and achievement oriented to a greater extent than are girls. Low (1989) found that sexual restraint and industriousness w ­ ere instilled in girls in about 40 cultures while boys received such training in fewer than five cultures. Chodorow (1979) proposed that the female identity is based on attachment to the ­mother, whereas the male’s is based on detachment. The individual’s relationship to the ­mother in childhood is then posited to give rise to a specific style of thinking and be­hav­ior in adulthood. For the female, this style is person-­centered or relational and characteristic of subordinates, i.e., the social context influences thinking and prob­lem solving while, for the male, the cognitive style is object-­centered or non-­relational and characteristic of the dominants. Feminist theorists argue that the relational be­hav­ ior identified by many to be female, is more properly understood as a method of oppression designed by men, for ­women (Hogg & Frank, 1992). It is suggested to be a mechanism of social control for the purpose of excluding one gender from attaining equal access to the social power resources of the other (Hare-­Mustin, et al., 1988). The impact of the migration of ­women from the Third World to do “­women’s work” in the United States has not generated much psychological research (Hare-­Mustin & Maracek, 1988). Designing empirical studies to examine how the current migration patterns of many ­women who leave their c­ hildren ­behind to be cared for by relatives while they travel abroad to care for c­ hildren who are dif­fer­ent from them along a number of dimensions may shed new light on the developmental pro­cesses Chodorow (1979) describes. For example, knowing the ways in which the complex interactions of adult caregiver and child occur where differences in class, culture, native language, race/ethnicity influence the experiences of both and the meanings attached to ­these differences may contribute to our understanding of gender identity. GENDER-­ROLE IN­EQUALITY AND ABUSE The general pattern around the world is that men have more status and power than w ­ omen, but this difference is not the same across cultures (Rosaldo & Lamphere, 1974). Cultures differ in the degree of gender in­equality. In­equality in this context is meant to convey more than “unequal


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treatment.” It includes the heuristic view that the functions ascribed to ­women and, hence, ­women themselves, are subordinate in status to men. In some cultures, this subordinate status involves a pejorative devaluation of ­women and ­women’s work, which creates a diminished quality of life for them and can be a cause of m ­ ental health prob­lems or, in extreme cases, threatens their very lives. The under­lying ideology of this unequal treatment has been called hostile sexism in the psychological lit­er­a­ture (Glick & Fiske, 2001). Hostile sexism resembles other forms of prejudice typically directed ­toward groups who are seen as threats to the in-­group’s status and power. In contrast, benevolent sexism, despite its oxymoronic quality, is a subjectively favorable, chivalrous ideology that offers protection and affection to ­women who embrace conventional roles, roles, however, that perpetuate their in­equality in a patriarchal society. In some ways, its effects are more pernicious than hostile sexism ­because men and ­women, but especially ­women, embrace this ideology; thus, ­women tend to be more tolerant of sexist be­hav­ior and its consequences on their “inferior” status ­because they perceive the motivation for the be­hav­ior as being protective (Glick & Fiske, 2001). Even in cultures where an ideal of gender equality is stated explic­itly as in Mao’s China, the practice is inconsistent with the ideal. In band socie­ ties, t­here is often male-­female reciprocity and complementarity rather than hierarchy (Triandis, 1994). In stratified socie­ties, socioeconomic and gender inequalities are often correlated. In Africa, for example, in the non-­ Muslim areas, the status of w ­ omen was fairly equal to the status of men ­until the colonial powers took over (Etienne & Leacock, 1980). ­Under colonization economic exploitation occurred and gender in­equality increased. One index of gender in­equality is the percentage of illiterates who are ­women. In general, it is desirable to have an equal number of men and ­women who are literate as is the case in Scandinavia and Switzerland. In many of the developing countries, however, far more w ­ omen than men are illiterate. Even in the United States, ­women did not match the education levels of men u ­ ntil the late 1970s (Triandis, 1994). A second index of gender in­ equality is the gender-­ earnings ratio which indicates how much ­women earn as a percentage of what men earn. In general, w ­ omen continue to earn less than men. Indices of gender abuse include the prevalence of wife abuse, genital mutilation of girls and young ­women, acid-­ throwing, infanticide, and elder abuse (the majority of whom are ­women). Although husbands can no longer legally beat their wives in the United States and wives in the United States can legally sue their husbands for damages, domestic vio­lence remains a real­ity for far too many ­women and their families. In India, the phenomenon of bride burning has increased in the past 20 years. An Islamic court in Nigeria overturned an earlier decision that had condemned a divorced ­mother, Amina Lawal, who had given birth to a child conceived outside of marriage, to be stoned to death. Her case


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received worldwide attention, drawing sharp criticism from the Nigerian president, and the international community. Some hailed the court’s decision as a triumph for Islamic justice while ­others, who are seen as being conservative, adamantly denounced the ruling, claiming that ­there was no justice. What is impor­tant to note in this discussion about gender-­ role in­equality and abuse is that the man who was presumably sexually involved with Ms. Lawal and the f­ather of her child was not charged ­because he had three witnesses testify that he had not been involved with Ms. Lawal and that “evidence” was sufficient according to the law. Men in the United States, prior to the second wave of the feminist movement in the 1960s and developments in the field of DNA testing, used similar defenses when accused of sexual relations with a w ­ oman and subsequently impregnating her. “Clitordiction” and “infibulation” (technical terms for what is more commonly called female genital mutilation) of girls are practiced in many parts of Africa and the ­Middle East. According to the World Health Organ­ ization, more than 80 million females have been subjected to genital mutilation in Africa which range from the removal of the foreskin of the clitoris to removal of the clitoris and labia with unsterilized equipment and without anesthesia, and the two sides of the vulva sewn together. The practice reflects tribal customs and societal values and is considered a significant aspect of a w ­ oman’s identity. Some men, believing that w ­ omen’s sexual organs are unclean and that clitordiction/infibulation “purifies” ­women, ­will not marry ­women who have not under­gone the procedure (Heise, 1994). What is so inconceivable to t­ hose outside of the cultures in which t­ hese practices are condoned is that they are performed by ­women and are viewed as a rite of passage. The plight of 19-­year-­old Fauziya Kasinga, who sought asylum in the United States a­ fter fleeing Togo when she was 16, to escape having a tribal member “scrape my ­woman parts off,” drew international attention and condemnation of this type of gender abuse. The collective outcry from Westerners was garnered by focusing on the medical health hazards for ­these girls and young ­women rather than blatantly challenging the belief systems which condone the practice. Apropos of this, legislators, in several states including New York and responding to reports that the practice of genital mutilation is occurring in the United States by immigrants from ­those countries in which the practice is tradition, modeled bills based on a federal bill introduced by U.S. Rep. Pat Schroeder, which made genital mutilation illegal in the United States. Although one may fail to comprehend the actions of some w ­ omen from dif­fer­ent cultures, which not only adversely affect them but other ­women as well in their culture, it undoubtedly is much more difficult to examine the beliefs and practices in one’s own culture that, to ­others outside that culture, may be equally incomprehensible and perceived to be abusive to ­women. An example from American history is illustrative. It is noteworthy


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that in the 19th c­ entury, doctors in E ­ ngland and the United States performed clitoridectomies on ­women as a ­viable treatment for masturbation, nymphomania, and psychological prob­lems (Abusharaf, 1998). The recent medical practice in Amer­i­ca of discharging ­mother and her newborn child within 48 hours of delivery and, most recently, discharging within 48 hours of surgery ­women who have had mastectomies, prompted legislation to stop ­these practices that seem, at best, insensitive to the emotional/physical vulnerability of ­women at ­these times and at its worst, dangerous to their health and the health of the newborn. The policy for early discharge apparently stemmed from guidelines established by third-­party payers (insurance companies) based on greed, albeit, couched in terms of cost-­effective treatment. The meteoric rise in cosmetic procedures/surgeries (breast enlargement, liposuction, Botox injections, use of ste­roids, and growth hormones, e­ tc.) for ­women of all ages but most notably among adolescent females to improve their appearance and enhance their emotional sense of well-­being may well be another illustration of culturally sanctioned gendered based abuse in the 21st ­century in Amer­i­ca. In some parts of the world, most notably China, South K ­ orea, India, and Nepal, studies have shown that girls often receive inferior medical care and education and less food than their b ­ rothers (Landes et al., 1995). In India and China, many ­women use sonograms and amniocentesis to learn if they are carry­ing a girl; if they are, the fetus is frequently aborted (Heise, 1994). RACE IN AMER­I­CA Race m ­ atters in the United States. To the nonwhite person in the United States, race is the most impor­tant defining ­factor in all aspects of their life (West, 1994). It is one of the most “vis­i­ble” identity membership indicators based on visual cues enabling one to quickly categorize the “other” (e.g., black ­woman, Asian man). Historically, race was viewed as a biological category. Recent ge­ne­tic analy­sis of dif­fer­ent “racial groups” disputes this view and instead shows greater ge­ne­tic variation within a racial group than across racial groups (Pinderhughes, 1989). Race, now viewed as a social construction, takes on a cultural significance as a result of the social pro­cesses that sustain majority-­minority status (Pinderhughes, 1989). The subordinate status assigned to persons with given physical traits and the projections made upon them are used to justify exclusion or inclusion within the society. The responses of both ­those who are dominant and, therefore, exclude and the victims who are subordinate and, therefore, are excluded become part of their cultural adaptation. The meaning assigned to racial categorization is determined by the dynamics of stratification and stereotyping. Hopps (1982) suggests that true understanding of minority status requires understanding the vari­ous levels of oppression endured by the group. While discrimination and exclusion have existed in this


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country for a number of groups classified as “minorities,” oppression has been the most severe, deeply rooted, per­sis­tent and intractable for ­people of color (Hopps, 1982). Surveys on the attitudes of the majority (whites) concerning minorities show that attitudes do change often within one generation, especially during periods of social upheaval. Also, research suggests that more pro­gress t­ oward equality was made during the 1950s and 1960s than in the last 20 years of the 20th ­century; this trend is termed symbolic racism as it reflects subtler forms of prejudice in which race is not directly expressed but, nonetheless, is the subtext for opposition to policy changes/issues related to race relations (Bobo, 1998). Apropos of con­temporary forms of covert institutionalized and symbolic racism, Patricia Williams (1997), a law professor (and a w ­ oman of color), recounted her experience with the “new rhe­toric of racism” when she was in the market to buy a new, out-­of-­state home. The transaction with the bank (conducted by telephone) to obtain a mortgage had gone smoothly (e.g., she met all of the criteria) up u ­ ntil the bank received her “corrected” contract by mail (the loan officer at the bank had, in error, checked off “white” in the box on the fair housing form and Ms. Williams had crossed it out). The attitude of the bank changed dramatically (e.g., requests for more money, more points, a higher interest rate); “race” was never mentioned as a reason for the stalled pro­cess. The bank cited increased “economic risk;” translated, this means the bank personnel ­were concerned about “white flight” and decreased property values in the area which, heretofore, had been protected by redlining. She threatened to sue and was able to procure the loan based on the original terms (Williams, 1997). The labeling and grouping of p ­ eople into categories of “dominant” and “subordinate” racial/ethnic groups by governmental agencies, policy makers, and social scientists reflects the psychosociopo­liti­cal landscape of group relations in con­temporary American society, e.g., white (Euro-­ American), black/African American, American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, Asian, Some Other Race, tends to obscure rather than illuminate meaningful commonalities/differences among groups and serves to maintain the societal pro­cesses and structures of stratification of ­people. In con­temporary American society, the designation, “black,” for some, acknowledges the solidarity with p ­ eople of the black Diaspora, that is, ­people dispersed throughout the world whose ancestors are of African descent (Landrine, 1995). For o ­ thers, it is a racial designation in which race is ­either viewed as a biological, or ge­ne­tic fact, or a social construction with scientific, sociopo­liti­cal, moral, and economic ramifications. For example, a person of African descent, i.e., whose parents are African immigrants, who was born in the United States but whose ancestors w ­ ere not slaves in the United States would not readily identify with being called an African American, which is an ethnocultural group not a racial group b ­ ecause the term refers to African ancestors


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who ­were slaves during the slavery period in American history. However, they might be more inclined to identify with being “black” as does Barack Obama, one of the demo­cratic candidates who ran for President in 2008, whose ­father is African and m ­ other is “White” from Kansas, b ­ ecause his experience in the United States, i.e., the response of the dominant group ­towards him, a “minority,” despite his heritage, is that of being a black person. ETHNICITY In anthropological terms, an ethnic group is generally understood to designate a population that is largely self-­perpetuating, shares fundamental cultural values realized in overt unity in cultural forms, makes up a field of communication and interaction, has a membership which identifies itself, and is identified by ­others as constituting a category distinguishable from other categories of the same order (Narroll, 1964). Barth (1969) stresses that ethnic groups are categories of ascription and identification by the actors themselves and, thus, have the characteristic of organ­ izing interaction between ­people. When someone is identified as being a member of an ethnic group, that individual supposedly shares with that group many complex characteristics such as language, customs, traditions, physical characteristics, religion, and ancestral origin. Ethnicity is a key aspect of one’s identity. Erikson (1950) developed a framework for understanding how the individual is linked to the ethnic group and society. He viewed identity as a pro­cess located in the core of the individual yet also in the core of his or her communal culture. Ethnic identity may remain hidden and outside of awareness. Its effects on feelings, thoughts, perceptions, expectations, and actions of p ­ eople t­oward o ­ thers are not readily understood; nonetheless, it is maintained by a boundary (Barth, 1969). The following self-­descriptions offered by t­hese two individuals during a workshop on cultural sensitivity are illustrations: 1. “I’m Syrian and Italian—­pure on each side. To belong to both of ­these ethnic groups where I grew up meant being inferior. I have mixed feelings about my ethnic background ­because Italians are associated not only with food but with the underground and I have had to be connected with that emotionally. In the Syrian aspect of my life, they have not had a good historical reputation and are considered sort of sleazy—so you might say I come from a kind of underground sleaze.” (Pinderhughes, 1989, p. 41) 2. “I now realize my ­father taught us to hate being black. We ­couldn’t go out of the ­house u ­ ntil we straightened our hair—he was ashamed of being black, and I used to envy kids whose ­fathers taught them to feel proud. I have to work hard to overcome this—­even now” (Pinderhughes, 1989, p. 41)

For some individuals and groups (e.g., some En­glish speaking whites and some ethnic minorities), ethnicity as a defining characteristic of


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personality and group identity at the conscious and unconscious levels may no longer retain its salience. Symbolic ethnicity, involved with the more vis­i­ble aspects of ethnic heritage (e.g., acknowledging ceremonial holidays, eating ethnic food, wearing ethnic clothing on ceremonial occasions) does not bind the individual to adhere to the shared customs and traditions of the past. In other words, the term suggests that ethnicity has shifted from the center of identity to the peripheral, and that other identities may have more of an impact on what one does, how one thinks, and with whom one chooses to affiliate (Schaefer, 2001; Gans, 1979). African Americans and many individuals from the Asian and Hispanic populations are often reluctant to give up ethnic customs and traditions learned early in life in ­favor of Eurocentric middle-­class American values and lifestyles which may be contrary to their beliefs. African Americans have fought to overcome cultural dominance and discrimination and through efforts, such as the civil rights movement, have sought to understand and maintain our cultural heritage. In 1994, the U.S. Census Bureau began hearings to consider adding new categories to the pres­ent census choices. They found that Arab-­Americans, for example, are unhappy with their official designation of “White, non-­ European.” Many Native Hawaiians want to be redesignated as American Indians rather than Pacific Islander, reflecting historical accuracy. Some Hispanics want the U.S. Census Bureau to classify them in terms of race not ethnic origin and to replace the term “Hispanic” with “Latino.” For ­those with this view, the term Hispanic recalls the colonization of Latin Amer­i­ca by Spain and Portugal and has become as offensive as the term “Negro” became for African Americans. Survey results show that ­people would prefer to be identified as Puerto Rican, Colombian, Cuban, ­etc. About one in three black Americans would like the Census Bureau to adopt the term “African-­American.” P ­ eople from the Ca­rib­bean, however, tend to prefer being labeled by their country of origin such as Jamaican, or Haitian-­American. Africans who are not American also find the term inaccurate. It is imperative that the rich diversity in individual differences that exists within each of t­ hese groups not be overlooked. GENDER, RACE, AND ETHNIC IDENTITIES Gender ste­reo­t ypes affect how ­women and men think of themselves and how they evaluate their own be­hav­ior as well as the be­hav­ior of ­others; ­these ste­reo­types are learned early. The term, “prostitot,” refers to a ste­reo­type perpetrated on young girls and teen­agers who are brainwashed by the media, fashion, and toy industries to think of themselves as sex objects/toys and dress in scanty, provocative clothing like a prostitute. The Bratz Dolls® illustrate this ste­reo­type, which when internalized by youth, both males and females, contributes to a young girl/adolescent’s


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lower self-­esteem and the distorted, damaging image of what it means to be male vis-­à-­vis females. The girl Bratz Doll® uses lots of make-up (one’s natu­ral state is ugly), wears less clothing, and shows lots of skin. The style of dress is sexually provocative, like a prostitute, suggesting that a girl must see herself as a sex object/toy in order to be accepted and liked. In contrast, the boy Bratz Doll® is dressed well and often has books or a backpack, showing that he is smart and ambitious. The need to recognize the differences as well as the common experiences ­women share involving race and gender can be seen when one considers the dif­fer­ent ste­reo­types about ­women of color which are based not only on their gender but also on their ethnic/racial designation. For ­women of color, stress is often the result of significant role strain as we try to accommodate to dif­fer­ent cultural expectations and values and reject ste­reo­types about us based not only on our gender but also on our racial/ ethnic identity. Ste­reo­types about w ­ omen of color are more than racist and sexist; we propose the term rasexism to capture the complexity of the impact of t­ hese prejudices. African American w ­ omen have been ste­ reo­typed as “Aunt Jemima,” “Mammy,” “Sapphire,” “Whore,” and “Super ­Woman” (Young, 1989), as “matriarchies,” and as the prototypical “welfare recipient,” e.g., a lazy, morally loose, single w ­ oman who continues to have ­children out of wedlock for a larger welfare check. The Don Imus debacle in 2007 in which, on the airways, he called the predominately African American female basketball team from Rutgers University “nappy headed hos” thrust into the mainstream the pernicious denigration of ­women, especially African American w ­ omen prevalent in segments of the black community and ­music industry, e.g., gangsta rap. The Native American ­woman has been ste­reo­t yped as the “Squaw” a term which became synonymous with “Drudge” and/or “Prostitute” (Witt, 1976). The newer exotified image of the American Indian ­woman from Hollywood is an American Indian Princess, meaning Pocahontas. Hispanic American ­women have been variously ste­reo­typed as passive, submissive, male-­dominated, all suffering ­women or as loud, histrionic, hot-­tempered “Carmen Miranda” type (Rivers, 1995). The predominant stereotypic image for the Asian American ­woman is one of sexual/exotic attractiveness, reserve, passivity and paradoxically, martial arts warrior who defer to males, elders, and authority figures (Chan, 1987; Fujitomi and Wong, 1976). T ­ hese dif­fer­ent ste­reo­types of w ­ omen share a common theme but their differences reflect conscious and unconscious operations in the collective psyche of Americans about gender, race, and ethnicity. In some way, each set of ste­reo­types serves as a justification for the sexual exploitation of the ­women who belong to that group. For example, one of the authors met with a young Korean man for a psychological consultation. He had been in the United States for several years and was the f­ather of two young c­ hildren, a son and a d ­ aughter, who ­were born in the United States. He was experiencing emotional


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conflict about the best ways to raise his c­ hildren who had never been to ­Korea and ­were not acquainted with traditional Korean customs. He was raising his ­children the “American way” ­because they ­were “Americans” and he wanted them to be successful ­here. In contrast to traditional Korean childrearing practices, his child-­ rearing methods apparently involved much less discipline and less of an emphasis on honor, self-­ sacrifice, and re­spect for self and ­others. While expressing concern for both his ­children, he was more troubled by his fears for his d ­ aughter ­because he ­really ­didn’t like what he perceived to be the acceptable and desirable attitudes and be­hav­iors for w ­ omen in American society; he commented on media images of young girls which he found shameful ­because of their lack of self-­respect and modesty reflected in their style of dress and manner of speaking. In short, this man’s conflict reflected his ambivalence and uncertainty about how to raise his ­children to become “good” Koreans able to make it as Americans in this society. CLASS Classism or class oppression in Amer­i­ca is noteworthy to the degree to which its existence is denied. That denial is reflected in the meritocracy myth which suggests that every­one has equal opportunities for success. It is also reflected in Amer­i­ca’s dim view of poor p ­ eople. O’Hare (1992) write that Americans love to hate the poor and that to be labeled poor does not generally elicit sympathy. Instead, being poor may elicit hostility and disgust from ­others and trigger a sense of shame in one’s self. Economic impoverishment is often associated with negative character traits, such as having inadequate or the wrong values, ineptitude, laziness, or outright stupidity (O’Hare, 1992). Poor p ­ eople are also thought of as refusing to work, living in female-­headed h ­ ouse­holds, living in inner city ghettos, and living off of welfare (O’Hare, 1992). Even if it w ­ ere not for t­ hese direct negative characterizations, our feelings about the poor are reflected in our definitions of lower-­class and middle-­class values and be­hav­iors and of the word “class” itself. In psy­chol­ogy, class is discussed in terms of socioeconomic status of the individual/group, which signifies among other ­things, one’s degree of success in achieving a quality of life, standard of living, and lifestyle idealized in the “American Dream.” Presumably, the higher the socioeconomic level, the better the quality of life and the more successful are t­ hose who attain it. Conversely, the lower the socioeconomic status, the less successful the individual is in attaining a desirable standard of living, which according to demo­cratic ideals, is pos­si­ble for all. Class, defined by income, education, and power and analyzed solely in terms of its relationship with vari­ous psychological constructs, such as intelligence, locus of control, achievement motivation, ­mental health, ­etc., obscures the vulnerabilities of designated “minorities” who are “barred” from participating as equal players in the capitalistic marketplace of the United States. When gender,


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race, ethnicity, and, more recently, sexual orientation, age, and disability are included in discussions on class, the politics of deeply institutionalized policies and practices of discrimination become apparent. The Wyche and Crosby (1996) defines “class” as high social rank, elegance, high quality, a rating based on grade or quality. Wyche and Crosby (1996) tells us that when we say that p ­ eople have “no class,” we do not mean this literally. But what do we mean? We mean that they have lower or working-­class values and are behaving like poor or working-­class p ­ eople. The demeaning implication is that to have lower-­class values is the same as having no “class” at all. Consistent with Webster’s definition, being lower class is to lack elegance and to have no or low quality or low social rank. Middle-­class values are generally deemed to include the presence of upwardly mobile striving, valuing an education, possessing the ability to delay gratification, and showing a willingness to save and work hard. By defining middle-­class values in this manner, the implication is that ­people who are ­middle class acquired that status ­because they have the correct values and good moral character failing to include the role of social opportunity (jobs, education, ­etc.) as a pathway to solvency. This fails to address in any significant way, the critical role of class oppression reflected in differential access to opportunities, such as education, at one time, trade ­union membership as well as many jobs or ­careers that ­were closed to LGB ­people, physically challenged individuals, ethnic minority group members, ­women, et al. ­These forms of advancement serve as gateways to upward mobility and m ­ iddle class status. T ­ hese gateways are not equally distributed nor are they distributed on the basis of merit in this society. Poor ­people are blamed for their circumstances with the assumption that they did not work hard enough or take advantage of available opportunities, and are exhorted to feel ashamed of themselves and their circumstances. The pervasive and incorrect assumption is that sufficient opportunities are equally available to every­one. Blaming the poor for their plight serves to further obscure the real­ity of class oppression in this society. This is reflected poignantly in the lyr­ics of Billie Holiday’s jazz classic, “God Bless the Child,” “Them that’s got s­ hall have; them that’s not s­ hall lose . . . .” Sidel’s (1993) assessment of poverty in the United States highlights just how devastating the effects of poverty are on ­women and ethnic minority families. Single ­mothers are more likely to be poor than any other demographic group, affecting not only their psychological well-­being and physical health but also exposing their c­hildren to stress associated with poverty. The “feminization of poverty,” a phrase originally coined by sociologist Diana Pearce (Sidel, 1993), refers to social and economic ­factors resulting in the increased percentage of poor ­women and ­children. ­These include the rapid growth of female-­headed families, a ­labor market that continues to discriminate against female workers, and unpaid domestic responsibilities traditionally reserved for w ­ omen, e.g., child care. Rothenberg (1988) writes that she grew up with an obliviousness to her race but an acute awareness of her gender and her Jewish, upper


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middle-­class standing. She recalls being aware that her ­family was much better off than most ­people and that she felt sorry for ­those who ­were not as well off. Still, she acknowledges believing with absolute certainty that poor ­people must deserve to be (poor) b ­ ecause they ­either failed “to work hard enough, study hard enough, or save enough” (Rothenberg, 1988, p. 38). SEXUAL ORIENTATION In Engendered Lives, Ellyn Kaschak (1992) writes, The consensual real­ity of Western culture has held that gender is a given, contained in or identical with the sex of the newborn. Gender and gender linked attributes are viewed as natu­ral rather than as socially and psychologically constructed. Paradoxically, then, all ­ children must be taught what is natu­ral . . . ​and ­those who do not learn their lessons well are viewed as unnatural . . . ​(p. 39).

Kaschak’s incisive analy­sis draws our attention to an impor­tant but frequently overlooked subtlety in this design revealing its flaws. If specific gendered be­hav­iors are natu­ral outgrowths of biological sex and, if heterosexual sexual orientation is natu­ral for every­one, why would it be necessary to so assiduously teach that which is innate and natu­ral? Furthermore, why would that which is deemed unnatural require such strong prohibitions and stigmatizing to prevent its occurrence? It would seem that natu­ral be­hav­ior would just naturally evolve. It is precisely ­because traditional gender roles, which include heterosexual sexual orientation as the normative sexual orientation, are not ubiquitously natu­ral or normative, and that they do not naturally evolve in every­one. A natu­ ral evolution is not allowed to take place. A culture’s gender roles are socially constructed, assigned, agreed on and change over time. It is precisely b ­ ecause of ­these f­ actors that they require enforcing rather than simply allowing them to naturally evolve. In fact, lesbian and gay sexual orientations evolve in individuals in spite of explicit prohibitions, opposition and punitive responses to them. Kaschak (1992) observes that it is particularly shameful not to fit neatly into a gender category. This is reflected in the shame and embarrassment that p ­ eople feel when their gender is mistaken or cannot be quickly discerned. It is as if they have done something wrong, are “queer,” “peculiar,” or as if something is seriously wrong with them. She adds that when methods of enforcing traditional gender roles and categories fail, or as a result of the damage caused by them, the person in question may be deemed ill, and in need of psychotherapy. Despite many significant advances in LGB (lesbian, gay, and bisexual) psy­chol­ogy in the last several de­cades, the next c­ entury confronts us with many new challenges in the need to explore the more complex nuances


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and varied meanings of sexual orientation as well as the many ways it is interrelated to other aspects of ­human identity. It is also necessary to conduct similar explorations of heterosexism and its connection to other forms of social oppression. Heterosexism is not a singular or isolated experience or event. As such, heterosexism cannot be disconnected from the broader context of an individual’s development or existence any more than sexism, for example, can be understood apart from the context of a ­woman’s ethnicity, socioeconomic class, religion, or other significant aspects of her life. An exclusive focus on heterosexism as the primary locus of oppression for all lesbians and gay men presumes that it is experienced in the same way for all group members and that it has the same meaning and consequences for them. The core of this assumption is common in the psychological lit­er­a­ture as well as in practice. AGEISM Unlike ethnicity and other variables, the aged represent a group with permeable group bound­aries which, if we live long enough, ­will permit us entry. Unlike ­people with disabilities, a group which potentially any of us could belong to, or specific ethnic groups to whom we cannot belong ­unless we are born into them, all h ­ uman beings go from not belonging to this group to belonging to it. As the aged come from all social groups, the degree of their disadvantage due to ageism may vary across the group. Ageing has dif­fer­ent meanings across ethnic groups and dif­fer­ent implications for men versus ­women. Ehrenberg (1996) reports that older gay men may be more vulnerable to isolation than older lesbians. Owing to the longer lifespan of ­women, lesbians may be more likely to have surviving mates and peers, and are less biased (than gay men) against older partners. Older gay men ­were observed to be more concerned about physical appearance than older lesbians, perhaps owing to the preference for younger partners among older gay men (Ehrenberg, 1996). Within many subgroups of ­people of color, older ­family members are considered elders who are valued for their life’s accumulated wisdom and are accorded re­spect. In some Asian and East Indian cultural groups, adult ­children are expected to consult and, in some instances, conform to the wishes of their parents regarding c­ areer choices, when and whom to marry and in ways that Western cultures do not formally expect (although many Western ethnic groups do have this informal expectation). The status of elders in dif­fer­ent cultures differs depending on gender as well. In Western or mainstream American cultures, older p ­ eople are often viewed as if they are no longer as useful as younger persons. This perception of older persons is confounded if they are no longer producing capital. Older p ­ eople, like persons with disabilities, are frequently regarded as if they ­were asexual. T ­ here may be the assumption that older persons do


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not miss or desire the presence of a romantic partner or companion, are not interested in a date, or that they do not care about being sexually active. ABLENESS/DISABILITY Fine and Asch (1988) observe that in research on disability, sexual orientation, gender, race and class seem to be regarded as similarly irrelevant suggesting that having a disability overshadows all other dimensions of social experience. They suggest that disability (as opposed to the mere presence of physical challenges), like gender, sexual orientation, ethnicity, ­etc., is a social construct. Fine and Asch (1988) found, . . . ​no data on the numbers of lesbians with disabilities or on their ac­cep­ tance by non-­disabled lesbians as partners, but comments made by many disabled lesbians indicate that within the community of lesbians the disabled w ­ oman is still in search of love. (p. 3).

Despite reports from men and w ­ omen with disabilities that social f­actors influence their sexual experiences more profoundly than physiological ­factors, social ­factors are rarely discussed in the psychological lit­ er­a­ture (Linton, 1998). As in other forms of oppression, Linton (1998) observes that the prob­lem is not the person with disabilities; the prob­lem is the way that normalcy is socially constructed to create the prob­lem of the disabled. Most ­people have been acculturated to stigmatize ­those whose bodies or other aspects of their person are deemed aberrant. Scheer (1994) argues that p ­ eople with disabilities need to be contextualized in contexts of h ­ uman variation, as po­liti­cal category, as oppressed minority, and as cultural group. Linton (1998) observe that ­people with disabilities share an impor­tant commonality with lesbians and gay men. Both groups share the experience of growing up in families with other members who do not share their minority status. Members of both groups learn about what it means to be a member of their minority group outside of their families, rather than from their families. This sometimes occurs in the proximity of other peers and mentors, but sometimes not. Scheer (1994) suggests that the isolation that results has demonstrative social consequences and may provide an impor­tant driving force for a disability culture. Linton (1998) highlights difficulties in the development of group cohesion and culture and identity formation when t­ here is no consistent intergenerational transmission of culture as is true for lesbians, gay men, and ­people with physical challenges as well (p. 93). MARGINALIZATION AND MARGINALITY ­There is a connection between the need to establish clear bound­aries among groups differing in ethnicity, class, sexual orientation, ­etc., in our


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society and the existence of privilege and social disadvantage. The need for socially constructed bound­aries among heterosexuals and lesbians and gay men, men and ­women, lower and upper socioeconomic classes, ­people of color and white Americans and other groups is not to provide accurate descriptive information about them. T ­ hese bound­aries are in place to maintain and justify the system of social privilege and disadvantage associated with t­ hose characteristics. The ultimate goal is to make sure that the privileged maintain their privileged access while ­others do not have similar access; instead, they are marginalized. The ill effects of oppression and discrimination are evident among ­women and men who report experiencing a sense of marginality and/or invisibility as a function of one or more of their “minority identities” (Comas-­Diaz & Greene, 1994; Chisholm, 1996). By marginality, we mean to suggest that many individuals experience a profound schism between their public and private pre­sen­ta­tions of self, which reflects an awareness of how the dominant “other” perceives (misperceives by “not seeing” stereotyping, e­ tc.) them in ­those social contexts in which the minority identity/identities may be salient (e.g., f­ amily, school, work, relationships, ­etc.) in which ­there is a dynamic interplay between designated “majority” and “minority” status. The “not seeing” results in a sense of invisibility despite the fact that the individual may be highly “vis­i­ble,” i.e., invisible in terms of influence while being vis­i­ble in terms of tokenism. The individual experiencing marginality exists uncomfortably in both worlds of the dominant other and the minority group and is perceived and treated differently by both. In the world of work, for example, the person, marginalized ­because of their ethnicity/race is defined by their race and gender as well as their competence. In their personal life, he/she often feels set apart from ­family and friends who experience what­ever their “successes” may be, as determined by the dominant group, as a moving away from the minority group, sometimes literally as in leaving the old neighborhood, or emotionally. The psychological lit­er­a­ture has begun to explore what has been common knowledge among ­those identified as being “dif­fer­ent,” “ethnic” and/ or “a minority,” i.e., individuals have multiple identities, one or more of which may be “majority” or “minority;” the social context determines the salience of the one(s) that is/are operating at any given time (Sedikides and Brewer, 2001; Hornsey & Hogg, 2000). As identity represents an interaction between the social and internal world, some of our identities or differences in group membership are private, some are public, some are vis­i­ble, and some are invisible. When conducting psychological research, it is impor­tant to ascertain the salience of the identity in question to the individual when that characteristic of the individual is a variable in a study. Failure to do this may lead to a sampling error where homogeneity among the participants is assumed but in fact is non­ex­is­tent. Johnnetta Cole captures the dilemma facing scientist/practitioners who strive for


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competency with re­spect to race/ethnicity, gender, religion, age, sexual orientation, socioeconomic class, and disability: That which US w ­ omen have in common must always be viewed in relation to the particularities of a group, for even when we narrow our focus to one par­tic­u­lar group of ­women it is pos­si­ble for differences within that group to challenge the primacy of what is shared in common. For example, what have we said and what have we failed to say when we speak of “Asian American ­women”?

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Chapter 4

Meta-­Analysis in the Psy­chol­ogy of ­Women Jennifer L. Petersen

The study of gender differences in psy­chol­ogy has a long history with researchers debating ­whether men and ­women are more similar or more dif­fer­ent. Some researchers contend that gender differences are significant and meaningful (Benbow & Stanley, 1980; Ceci & Williams, 2011), whereas ­others contend that gender similarities prevail and small differences are insignificant (Hyde, 2005). Relying on opinions about the significance of gender differences is problematic for interpretation of empirical data and may lead to alpha or beta bias. Alpha bias refers to the exaggeration of gender differences, whereas beta bias refers to the minimization of gender differences (Hare-­Mustin & Marecek, 1988). Alpha bias can lead to sex discrimination if researchers or policy makers use it as justification for differential treatment for men and w ­ omen. Beta bias may be problematic ­because it can be dismissive of impor­tant gender differences that deserve attention, such as gender differences in employee payment. Empirical research can help to resolve differences in opinion and in alpha and beta biases by determining how large gender differences r­ eally are in any population. Meta-­analyses are particularly useful for describing the magnitude of gender differences in vari­ous areas of psy­chol­ogy ­because they combine empirical results from existing studies, creating a database of information from vari­ous populations and with a sample size exceedingly larger than any individual study. META-­ANALYSIS METHODOLOGY In contrast to traditional, narrative reviews, meta-­analyses use quantitative methods to combine data from multiple empirical studies to


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determine the size of an effect between two groups. Many meta-­analyses focus on gender b ­ ecause it is a category in which two groups are easily identified and empirical studies often report gender effects. Meta-­analyses typically proceed in several steps, beginning with a computerized search that locates empirical studies to be included in the study. Once researchers have established a representative sample of the studies on the topic of interest, studies are then coded for information that w ­ ill be included in statistical analyses. This information typically includes mean values for men and for w ­ omen, standard deviations for each gender, and any additional information to be included as moderators, such as race/ethnicity, quality of the study, study design characteristics, e­ tc. This information is used to compute standardized statistics for each study. Once researchers have computed the effect size for each study, they then determine w ­ hether ­there is heterogeneity among the studies and compute an overall effect sizes to summarize the size of the effect across all studies. Effect sizes can be calculated from a variety of dif­fer­ent information, such as means and standard deviations, correlations, and binary data (Borenstein, et al., 2009). Meta-­analyses on gender difference typically focus on effect sizes of mean differences. This effect size, d, is calculated by subtracting the mean of one group from the mean of another and dividing by the pooled within-­gender standard deviation. d=

X male − X female Sp

In the above equation, the mean value for females (Xfemale) is subtracted from the mean value for males (Xmale), but the order of groups is statistically irrelevant as long as the researcher is consistent across studies and he or she considers the order in interpretation. For example, if the mean value for females is subtracted from the mean value for males, then a negative effect size would indicate that females had higher means than males and vice versa. Note that the pooled within-­gender standard deviation (sp) in the denominator includes not only variability of each sample, but also includes sample size, thus standardizing the metric of d. This statistic also recognizes that men and ­women are not homogeneous by including a mea­sure of within-­gender variability. When means and standard deviations are not available, d may also be calculated with t-­values or F-­values. Once the effect size is calculated for all studies in the meta-­analysis, homogeneity analyses may be conducted to determine the variation among studies. If heterogeneity exists, then moderator analyses may be conducted to determine which ­factors predict variation in the effect sizes. Moderator analyses may be conducted with e­ ither categorical f­ actors, such as country of origin or ethnicity, or they may be conducted with continuous predictors, such as age of participants or the United Nations gender empowerment index for each nation (Petersen & Hyde, 2010).


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Advantages of Meta-­analysis Meta-­ analyses have many advantages over traditional, narrative reviews. Meta-­analyses are very useful for the study of gender differences ­because they can determine the exact size of a gender effect. Narrative reviews may fall short ­because they do not always take into account sample size, study characteristics, and variability. Narrative reviews may make conclusions about gender differences based on statistically significant results without taking into account the size of the effect. Both meta-­analyses and narrative studies may use large studies from diverse populations, but meta-­analyses also consider the sample size and power of each study. Meta-­analyses can also use population characteristics such as age, ethnicity, or country of origin to determine w ­ hether effect sizes differ across populations. In addition, the sample size of the overall effect size is essentially the combined sample size for all studies included in the model. Therefore, the meta-­analysis sample is exceedingly larger and more generalizable to diverse populations than any individual study, which results in increased external and construct validity. ­Because d is standardized, studies with dif­fer­ent designs and mea­sures may all be included in the same analy­sis. For example, ­there are many scales that mea­ sure depression, and dif­ fer­ ent scales might be used depending on the developmental level of the participants. Meta-­analyses standardize ­these scales so that the effect size for gender differences in depression can be evaluated regardless of the scales used. Researchers who are interested in determining w ­ hether the scales affect the effect size can code for the dif­fer­ent mea­sures or the quality of the study design and use moderator analyses to determine ­whether the scale or type of study affect d. Narrative reviews often focus on statistical significance of each study, sometimes even using a count of studies that indicated significant results in comparison to ­those studies without significant results. Meta-­analyses, in contrast, focus on the size of the effect and compute statistical significance for the overall summary effect. Statistical significance is largely affected by sample size such that studies with fewer participants are less likely to detect a significant difference even when a medium or large effect is pres­ent. Meta-­analyses significantly increase power to 99.9 ­percent (Borenstein, et al., 2009), thus providing a much more effective means for testing the null hypothesis. In addition, meta-­analyses move beyond the dichotomy of significant and non-­significant effects to provide a much more descriptive size of the effect. Methodological Concerns Despite the advantages of meta-­analyses, t­ here are several methodological concerns researchers must consider in their analyses. For example, in


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the case of both narrative reviews and meta-­analysis, the authors must choose a sample of studies to include in the analy­sis. Reviews are only as good as their sample of studies, and studies that are selectively included or excluded in the analyses may produce biased results. When conducting searches for relevant studies researchers must be careful to use terms that are broad enough to include all relevant results. For example, when conducting a meta-­analysis on gender differences in depression, researchers w ­ ill find more relevant results when conducting a search with the search term “depression” than with the terms “gender and depression.” The latter search ­will only result in studies that use the term “gender” in the title, keywords, or abstract. Many studies about depression ­will include separate averages for males and females even when the study is not focused on gender differences. Therefore, it is advisable to use search terms for the topic and not use terms such as “gender” or “sex.” Even when the sample of studies is chosen with care using broad search terms, publication bias raises concerns about the sample of studies. Published studies are more likely to pres­ent significant results than unpublished studies resulting in a bias t­oward gender differences over gender similarities, i.e., larger values of d. Researchers may combat this prob­lem by including unpublished dissertations and large national datasets in addition to published studies. In order to determine ­whether a meta-­analysis has publication bias, a funnel plot may be used. In a funnel plot, the effect size is plotted along the x-­axis of a graph and the sample size along the y-­axis. Smaller studies should spread out further along the bottom of the graph ­because of their increased sampling error, whereas larger studies tend to cluster around the mean effect size at the top, resulting in a plot that looks like a funnel. Publication bias is evident when the distribution of studies is symmetrical at the top, some studies are missing in the m ­ iddle, and more studies are missing at the bottom (Borenstein, et al., 2009). The effect size, d, is standardized. However, like a z-­score ­there is no upward or lower limit to d. Interpretation of an effect as large or small is a concern ­because it may be somewhat subjective. Cohen (1988) has established guidelines for interpreting d. According to ­these criteria, d = 0.80 indicates a large effect, d = 0.50 is a medium effect, and d = 0.20 is a small effect (Cohen, 1988). Effect sizes may also be interpreted in comparison to other effect sizes in a similar field. For example, researchers might compare the effect size for gender differences in math ability to the effect size for gender differences in verbal ability. Although the study design does not m ­ atter statistically b ­ ecause d is standardized, the theoretical meaning of dif­fer­ent study designs may be meaningful. For example, mea­sure­ment scales that are not generalizable or poorly designed studies ­will affect the quality of the overall meta-­ analysis. Moderator analyses may be used to code for the quality or type of study to determine w ­ hether study design affects the overall effect size.


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CURRENT META-­ANALYSES IN THE PSY­CHOL­OGY OF ­WOMEN Meta-­analyses play a prominent role in the study of the psy­chol­ogy of ­ omen by summarizing empirical results across existing data. The w remainder of this chapter reviews the results from some of the most well-­ known meta-­analyses that examine gender differences and similarities in psychological constructs. GENDER DIFFERENCES AND SIMILARITIES IN COGNITIVE PER­FOR­MANCE Ste­reo­types about gender differences in cognitive per­for­mance can lead to discrimination in the schools or workplace and affect individual’s confidence in their academic abilities. However, if gender differences do exist in cognitive per­for­mance, it is impor­tant to identify t­hese areas so that individuals may receive addition support or identify the context in which they can excel. Meta-­analysis is an excellent use of existing empirical data to determine w ­ hether the size and context of gender differences or similarities in cognitive per­for­mance. H ­ ere, we report the results of meta-­analyses that focus on gender differences in cognitive and academic per­for­mance. Verbal Abilities Traditional gender ste­reo­types would suggest that verbal ability is stronger in w ­ omen than in men. Hyde and Linn’s (1988) meta-­analysis of 120 individual studies indicated a small female advantage in overall verbal ability, d = −0.11. However, when the overall effect size is broken down into dif­fer­ent types of verbal ability, the results became more complex. Although girls performed better than boys at verbal fluency tasks, d = −0.33, ­there was no gender difference for vocabulary (d = −0.02), reading comprehension (d = −0.03), or essay writing (d = −0.09). To more fully understand the small effect sizes from the Hyde and Linn (1988) meta-­analysis, Hedges and Nowell (1995) conducted another meta-­ analysis on gender differences in vocabulary and reading comprehension. Similar to the previous meta-­analysis, results favored females, but ­were small. For reading comprehension, effect sizes ranged from −0.18 to +0.002. For vocabulary, effect sizes ranged from −0.06 to +0.25. Large, international datasets are also helpful for determining w ­ hether effect sizes change across nations or international context. In an analy­ sis of the Program for International Students Assessment (PISA) data, girls had higher reading achievement, d = −0.44, but variability in effect sizes was accounted for by the gender equality in participating nations (Reilly, 2012). Nations with greater gender equality had smaller effect sizes, indicating that social and cultural ­factors likely play a role in the magnitude of gender differences in verbal ability.


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Mathe­matics Per­for­mance Despite gender ste­reo­types about boys’ superior per­for­mance in math, meta-­analyses suggest that gender differences in math per­for­mance are trivial. In a recent assessment of state standardized math tests representing over 7 million students in the United States, effect sizes for math assessments was quite small ranging from −.02 in 7th grade to 0.06 in 11th grade (Hyde, et al., 2008). Gender differences in math per­for­mance ­were trivial at all grade levels. Although ­there was greater variability in boys’ math per­for­mance, the variability was small. Another meta-­analysis of 242 existing studies published between 1990 and 2007 found similar results indicating small gender differences in math per­for­mance (Lindberg, et al., 2010). The overall effect size for all studies was d = 0.05. Some researchers have claimed that boys might perform better than girls in complex mathematical prob­lem solving, which is not assessed on traditional computations math tests. However, this meta-­ analysis found an effect size of d = 0.16 for complex prob­lem solving, indicating that gender differences in math per­for­mance remain small even for complex prob­lems. Math Motivation and Attitudes Although gender differences in general math ability are trivial, gender differences continue to exist in math motivation. In par­tic­u­lar, motivation ­factors such as expectancy for success and interest in mathe­matics are impor­tant for students to pursue advanced coursework and ­careers in mathe­matics and science. A meta-­analysis indicated the boys had higher levels of math self-­confidence when compared with girls, d = 0.27, and girls had higher levels of math anxiety in comparison to boys, d = −0.23 (Else-­Quest, et al., 2006). Even when girls perform just as well as boys on mathe­matics assessments, girls w ­ ere more likely than boys to underestimate their math ability (Eccles, et al., 1998). Girls who had higher levels of self-­efficacy and self-­perceived math ability ­were more likely to pursue ­careers in math and science (Eccles, 1994). Spatial Per­for­mance One way to assess spatial per­for­mance is through 3D m ­ ental rotation tasks. In a 3D m ­ ental rotation task, individuals view a 3D object and then must visualize what it w ­ ill look like ­after it is rotated. An older meta-­ analysis on 3D ­mental rotation suggested that boys performed better on ­these tasks than girls did, d = 0.73 (Linn & Petersen, 1985). A more modern meta-­analysis indicated a smaller effect of 3D ­mental rotation, d = 0.56, but the effect was still significant and favored boys (Voyer, et al., 1995). However, the majority of 3D ­mental rotation tasks are timed and may be a


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function of strict time limits as much as the ­actual spatial per­for­mance required. In fact, the gender difference in 3D ­mental rotation was large when studies had strict time limits (d = 1.03), but the effect size was only moderate when no time limits w ­ ere used. (d = 0.51) (Voyer, 2011; Maeda & Yoon, 2013). In most schools, ­there is rarely any formal spatial training. Spatial training is more likely to occur in informal settings, such as in sports and video games. Boys are more likely than girls to engage in ­these forms of information spatial training (Rideout, Foeher & Roberts, 2010), which might give them an edge over girls in the 3D ­mental rotation tasks. For example, in one study, boys and girls ­were given 10 hours of training on a video game (Feng, 2007). ­After this training, gender differences in a 3D ­mental rotation task w ­ ere not significant. A meta-­analysis considering the effects of training on spatial ability indicated that spatial ability is quite malleable (Uttal, et al., 2013). This analy­sis indicated that both men and ­women benefitted from training, but most spatial training studies did not close the gender gap. GENDER DIFFERENCES AND SIMILARITIES IN OCCUPATIONS In the United States and many other countries, ­women earn less money on the job than men who hold the same occupations. Although small gender differences in c­ areer interests and preferences may exist, gender similarities largely prevail in leadership effectiveness; thus, gender disparities in salaries are unfounded. ­Career Interests Meta-­analytic results suggest that men and ­women may differ slightly in their c­ areer interests. Su et al. (2009) indicated that gender differences in c­ areer interests can be summarized as “Men and ­Things, ­Women and ­People.” That is, w ­ omen preferred jobs that required person-­to-­person interaction, whereas men preferred jobs that required working with physical objects, d = 0.93. In par­tic­u­lar, men preferred c­ areers in realistic (d = 0.84) and investigative fields (d = 0.26), whereas ­women ­were more interested in artistic (d = −0.35), social (d = −0.68), and conventional ­careers (d = −0.33). One of the largest gender differences in ­career interests was in engineering (d = 1.11), with men preferring engineering c­ areers more often than w ­ omen did. It is impor­tant to remember, however, that ­there are many counter-­ examples of the “Men and T ­ hings, ­Women and P ­ eople” dimension. For example, the world of business and politics, typically male-­dominated fields, require a ­great deal of person-­to-­person interaction, whereas dental hygienists and librarians are female-­dominated ­careers that require the employee to work with t­ hings. In addition, the gender differences in


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this meta-­analysis ­were generally small, indicating ­great overlap in the distributions of scores for males and females. By implication, ­there are many individuals who are interested in counter-­stereotypical ­careers. Assuming that girls are not interested in engineering, for example, or that boys are not interested in teaching may limit c­ areer aspirations and may lead to sex discrimination in the workplace. It is also impor­tant to recognize that t­hese gender differences in c­ areer interests are not innate or immutable. Gender differences in interest among high school students, for example, are likely largely influenced by years of gender socialization that shape girls t­oward nurturance and people-­oriented interests, and boys ­toward athletics and mechanical toys, such as trucks. Job Attribute Preferences A meta-­analysis examined gender differences in job attribute preferences such as the potential for high earnings, good work hours, challenges, and leadership opportunities (Konrad, et al., 2000). The authors suggested that, according to gender ste­reo­types, men would prefer financial incentives and leadership opportunities in their c­areers, whereas ­women would prefer jobs that allow for flexibility and nurturance. Of the 40 preferences, 33 exhibited significant effects of gender, but the majority of the effect sizes ­were small. For example, men ­were only slightly more likely than ­women to report that earnings (d = 0.12) and leadership opportunities (d = 0.14) ­were impor­tant, whereas w ­ omen w ­ ere more likely to prefer working with ­people (d = −0.35) and having opportunities to help ­others (d = −0.36). Some of the job preferences displayed results contrary to gender ste­reo­types. For example, ­women ­were slightly more likely than men to prefer some ste­reo­typically masculine roles, such as a feeling of accomplishment (d = −0.14) and good benefits (d = −0.09). In general, gender differences w ­ ere smaller for masculine job attributes, but w ­ ere larger for feminine job attributes. W ­ omen w ­ ere more likely to endorse both masculine and feminine job attributes, wanting both a high salary and ­family flexibility for example, whereas men endorse only masculine job attributes (Weisgram, et al., 2010). Although the majority of job attribute preferences showed significant differences, the differences ­were generally small (Konrad, et al., 2000). The authors noted that the small gender differences may be due to few studies including homemakers in their sample. Homemakers are likely to hold the most traditional gender-­role beliefs and traditional job attribute preferences, but they w ­ ere missing from many of the samples. Evidence suggests that, over time, ­women have become increasingly ­free to adopt masculine characteristics, but that men have not been e­ ager to adopt feminine characteristics (Twenge, 1997). Job attributes traditionally associated with masculine c­ areers became more impor­tant to w ­ omen between the 1970s and 1980s, but became less impor­tant from 1980 to 1990


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(Konrad, et al., 2000). Traditionally feminine job attributes followed a similar trend (Konrad, et al., 2000). Perhaps some changes from a feminist movement in the 1970s have leveled off. Leadership A meta-­analysis examined data on gender differences in leadership effectiveness (Eagly, et al., 1995; Paustian-­Underdahl, et al., 2014). Overall, ­there was no gender difference in leadership effectiveness, d = −0.05. Moderator analyses indicated that when self-­reports ­were used men reported themselves as more effective leaders than w ­ omen did, d = 0.21, but w ­ omen ­were reported as more effective leaders when o ­ thers’ ratings w ­ ere used, d = −0.12 (Paustian-­Underdahl, et al., 2014). Men and ­women may also differ in their leadership style. Eagly and colleagues identified three dif­fer­ent leadership styles: A transformational leader, a transactional leader, and a laissez-­faire leader (Eagly, et al., 2003). A transformational leader attempts to gain the trust of o ­ thers by serving as a role model. A transactional leader uses rewards and punishments to shape the be­hav­ior of her followers. A laissez-­faire leader is hands-­off and uninvolved with her followers. The meta-­analysis indicated a trivial gender difference favoring females in transformational leadership, d = −0.10 and transactional leadership, d = −0.13 (Eagly, et al., 2003). However, ­women ­were more likely to use reward-­based systems, whereas men ­were more likely to use punishments when prob­lems arose d = 0.27. Men ­were also somewhat more likely to engage in laissez-­faire leadership, d = 0.16. Overall, the gender differences for leadership effectiveness and style are small despite gender ste­reo­types to the contrary. GENDER DIFFERENCES AND SIMILARITIES IN SOCIAL BE­HAV­IOR Popu­lar opinion might suggest that men and ­women have very dif­fer­ ent social be­hav­iors in areas such as aggression and communication. Meta-­analyses suggest that gender differences in most social be­hav­iors are trivial, but that gender differences in sexual attitudes and be­hav­iors may be an exception to gender similarities. Aggression A meta-­analysis of gender-­differences in aggression indicated that, overall, males ­were more likely to be aggression than females, d = 0.48 (Hyde, 1984). Approximately 5 ­percent of the variation in aggression could be explained by gender. Gender differences in aggression w ­ ere larger in correlational studies than in experimental studies and observational data and peer reports produced larger gender differences favoring men than


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self-­reports. A subsequent meta-­analysis using more advanced moderator procedures determined that gender differences in physical aggression, d = 0.91, ­were larger than gender differences in verbal aggression, d = 0.46, (Knight, et al., 1996). Gender differences in impulsivity could help to understand the gender difference in aggression. A meta-­analysis of gender differences in impulsivity indicated no gender difference in general impulsivity, d = 0.08 (Cross, et al., 2011). One of the largest gender differences in specific types of impulsivity came from sensation seeking, d = 0.39, with men slightly more likely to report sensation seeking than ­women. Perhaps gender differences in aggression are explained more by sensation seeking than by general impulsivity. Consistent with this hypothesis, gender differences in aggression are larger and f­avor males more when the context elicits medium emotional arousal than when it elicits no emotional arousal (Knight, et al., 2002). Helping Eagly and Crowley (1986) conducted a meta-­analysis of research on gender differences in helping be­hav­ior. This meta-­analysis yielded overall d = 0.34, a small effect indicating that males help more. Moderator analyses indicated that some helping be­hav­iors ­were more common among men, such as stopping to help a motorist with a flat tire, but that other types of helping w ­ ere more common among w ­ omen, such as helping a distressed child. The authors argued that ­women are more likely to engage in relational helping be­hav­ior, and men are more likely to initiate agentic helping and prosocial be­hav­iors that require strength ­because they are consistent with social gender roles. Temperament A meta-­analysis examined gender differences in three broad dimensions of temperament including effortful control, negativity, and surgency (Else-­Quest, et al., 2006). Dimensions of effortful control included attention regulation, inhibitory control, and perceptual sensitivity. Girls scored higher on all mea­sures of effortful control than boys did (d range = −0.31 to 0.09). T ­ hese results are consistent with findings that boys are more likely to display externalizing be­ hav­ iors. Negativity included dimensions, such as anger, frustration, and emotional intensity. The majority of the dimensions in negativity showed no gender differences or small gender differences (d range = −0.12 to 0.10). Surgency was represented by f­actors including smiling and laughing, high-­intensity plea­sure, and was linked to extraversion. Boys scores 0.50 standard deviations higher than girls on the dimensions of surgency (d range = −0.11 to 0.30).


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Communication Ste­reo­types about enormous gender differences in communication, and the inability of ­women and men to communicate, abound (Tannen, 1991) In par­tic­u­lar, it has been said that w ­ omen use more tentative speech than men do, as indicated by greater use of tag questions (e.g., “He is correct, ­isn’t it?”) and hedge statements (e.g., “I’m not an expert, but I w ­ ill do my best”). T ­ hese communication patterns are impor­tant ­because the use of tag questions and hedge statements convey a lack of self-­confidence in one’s ability. According to a meta-­analysis of studies of tentative speech, however, the gender differences are small for tag questions, d = −0.23, and for hedges, d = −0.15 (Leaper & Robnett, 2011). ­Women used tag questions and hedges only slightly more often than men did. Importantly, the size of the effect depended on context, with larger gender differences in lab studies (d = −0.28) and smaller gender differences in naturalistic observation (d = −0.09). Sexual Attitudes and Be­hav­ior. Gender differences in sexual be­hav­iors are some of the larger gender differences in the psy­chol­ogy of ­women, but research suggests that they are becoming smaller over time. This line of research benefits from two meta-­analyses, which use the same procedures, but analyzed data from separate time periods. (Oliver & Hyde, 1993; Petersen & Hyde, 2010). Oliver and Hyde (1993) analyzed research between 1963 and 1990, and Petersen & Hyde (2010) included work from 1993 to 2007. The most commonly studied sexual be­hav­iors, with over 100 studies in each meta-­analysis, was incidence of heterosexual intercourse. In both meta-­analyses, males w ­ ere somewhat more likely to report intercourse than females ­were (d = 0.33 in Oliver & Hyde, 1993; d = 0.16 in Petersen & Hyde, 2010). Age of the sample moderated this relationship indicating a greater gender difference in incidence of intercourse for younger sample than for adults. This gender difference could be explained by ­either a younger age at first intercourse for young males or underreporting of intercourse among females. Males also reported somewhat more sexual partners than females did, though the difference was small in both meta-­a nalyses (d = 0.25 in Oliver & Hyde, 1993; d = 0.36 in Petersen & Hyde, 2010). The largest gender difference in sexual be­hav­ior was the incidence of pornography use, including the use of erotic materials such as videos, magazines, and the Internet, d = 0.63 (Petersen & Hyde, 2010). Both meta-­analyses also analyzed gender differences in sexual attitudes. Some published works include a mea­sure of general attitudes ­toward sexuality, such as Hendrick and Hendrick’s Sexual Attitudes Scale


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(Hendrick, et al., 2006). Meta-­analytic review of t­hese general attitudes scales indicated a small to medium gender difference in general attitudes ­toward sex, with males reporting more permissive attitudes than females did (d = 0.57 in Oliver & Hyde, 1993; d = 0.21 in Petersen & Hyde, 2010). Attitudes ­toward pre-­marital sex specifically ­were also more permissive among men, though the gender difference was small (d = 0.37 in Oliver & Hyde, 1993; d = 0.17 in Petersen & Hyde, 2010). ­Women ­were more likely than men to feel negative emotions in response to sexual be­hav­ior such as guilt or anxiety (d= −0.35 from Oliver and Hyde, 1993; d = −0.19 from Petersen and Hyde, 2010). Petersen and Hyde (2010) indicated that w ­ omen had slightly more accepting attitudes t­ oward gay men (d = −0.18), but that ­there was no gender difference in attitudes t­oward lesbian ­women (d = −0.02). Gender Differences and Similarities in Psychological Well-­Being Research on gender differences in psychological well-­being may be subject to alpha bias given assumptions about higher levels of depression and lower self-­esteem among w ­ omen in comparison to men. Meta-­ analyses are an excellent tool for synthesizing empirical results in order to obtain a more accurate repre­sen­ta­tion of gender and psychological well-­being. Self-­Esteem A meta-­analysis examining gender differences in self-­esteem found a small overall gender difference favoring boys and men, d = 0.21 (Kling, et al., 1999). The effect size increased from 0.16 in elementary school to 0.23 in ­middle school and 0.33 in high school, but then declined to 0.18 among college students and 0.10 among adults between the ages of 23 and 59. The effect size was not large in any age group, and it decreased among adults. An analy­sis by ethnicity for U.S. samples showed that the magnitude of the gender difference was larger for whites (d = 0.20) than it was for blacks (d = −0.04). Sociocultural explanations may help explain gender differences in self-­esteem in addition to explaining why gender differences vary across ethnic groups. Gender differences in self-­esteem may vary based on the context of self-­ esteem. A dif­fer­ent meta-­analysis examined studies that had mea­sured domain-­specific self-­esteem or self-­concept (Gentile, et al., 2009). Males scored higher than females on physical appearance (d = 0.35), athletics (0.41), and self-­satisfaction (0.33) self-­esteem, whereas females scored higher on behavioral conduct (d = −0.17) and moral-­ethical (−0.38) self-­ esteem. For all other domains, gender similarities w ­ ere found; effect sizes ­were close to zero for academic, social, and f­ amily self-­esteem.


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Depression The ­Children’s Depression Index is a commonly used scale to mea­sure depression among ­children between the ages of 8 and 16. A meta-­analysis of 310 samples of ­children who completed the depression scale revealed a very small gender difference favoring girls (d = 0.02, Twenge & Nolen-­ Hoeksema, 2002). Further analyses indicated that ­there w ­ ere no gender differences between ages 8 and 12, but between the ages of 13 and 16, the effect size grew and favored girls more d = 0.16. According to Response Style Theory, ­women are more likely to ruminate on negative events, which leads to higher rates of depression (Johnson & Whisman, 2013). A meta-­analysis including 59 studies on gender differences in rumination concluded that w ­ omen w ­ ere more likely to ruminate than men ­were (Johnson & Whisman, 2013; d = 0.24). In par­tic­u­ lar, ­women spent more time than men brooding (d = 0.19) and reflecting (d = 0.17). Although ­these effect sizes are significant, they are small and ­there are many other f­actors that might explain gender differences in depression. GENDER DIFFERENCES AND SIMILARITIES IN MOTOR PER­FOR­MANCE Gender differences in motor per­for­mance show some of the largest and most consistent gender differences. For example, a meta-­analysis of gender differences in motor per­for­mance showed a large gender difference favoring males for throwing velocity, d = 2.18, and throwing distance, d = 1.98 (Thomas & French, 1985). However, in some areas of motor per­ for­mance, such as balance, d = 0.09, and vertical jump, d = 0.18, gender differences ­were small. Developmental trends moderated gender differences in motor per­for­mance for many of the tasks. For example, gender differences for the majority of the motor tasks, including throwing velocity, balance, and grip strength, increased ­after puberty. The authors suggested that gender differences prior to puberty may be influenced more by environmental f­ actors, whereas gender differences ­after puberty ­were more likely to be due to ge­ne­tic differences. CONCLUSIONS Hyde reviewed 128 effect sizes among published meta-­analyses and found that 78 ­percent of the effect sizes w ­ ere small or close to zero (d [[ 0.36, Hyde, 2005). The few exceptions to gender similarities include motor per­ for­mance and some sexual be­hav­iors. ­These results led Hyde to propose a gender similarities hypothesis suggesting that the majority of gender differences in psychological variables are small. Inflated claims about gender differences when gender differences are actually small come at a cost


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to both men and w ­ omen. Ste­reo­t ypes about men and w ­ omen are often highlighted when researchers inflate small effect sizes. Emphasizing gender differences instead of similarities can create discrimination in the workplace, cause conflict in ­couple communication, and ignore the psychological and cognitive needs of boys and girls (Hyde, 2005). With a few exceptions, the majority of psychological gender differences are small and recognizing ­these gender similarities is impor­tant for equality among men and w ­ omen. Meta-­analyses serve as an informative tool for examining the empirical effects of gender differences in psy­chol­ogy and ignoring some of the bias and subjectivity characteristic of narrative reviews. However, researchers must be careful not to introduce alpha or beta bias into their analyses by following some of the best practices in meta-­analytic research, such as limiting publication bias, remaining inclusive in determining the study samples, and using moderators to examine the effects of study design (Borenstein, et al., 2009). REFERENCES Benbow, C., & Stanley, J. (1980). Sex differences in mathematical ability: Fact or artifact. Science, 210, 1262–1264. Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009). Introduction to meta-­analysis. West Sussex, UK: Wiley & Sons, Ltd. Ceci, S. J., & Williams  W. M. (2011). Understanding current ­causes of ­women’s underrepre­sen­ta­tion in science. PNAS, 108, 3157–3162. Cohen, J. (1988). Statistical power analy­sis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum. Cross, C. P., Copping, L. T., & Campbell, A. (2011). Sex differences in impulsivity: A meta-­analysis. Psychological Bulletin, 137, 97–130. Eagly, A. H., & Crowley, M. (1986). Gender and helping be­hav­ior: A meta-­analytic review of the social psychological lit­er­a­ture. Psychological Bulletin, 100, 283–308. Eagly, A. H., Johannesen-­Schmidt, M. C., & van Engen, M. L. (2003). Transformational, transactional, and laissez-­faire leadership styles: A meta-­a nalysis comparing ­women and men. Psychological Bulletin, 129, 569–591. Eagly, A. H., Karau, S., & Makhijani, M. (1995). Gender and the effectiveness of leaders: A meta-­analysis. Psychological Bulletin, 117, 125–145. Eccles, J. S. (1994). Understanding w ­ omen’s educational and occupational goals. Psy­chol­ogy of ­Women Quarterly, 18, 585–609. Eccles, J. S., Wigfield, A., & Schiefele, U. (1998). Motivation to succeed. In W. Damon and N. Eisenberg (Eds.), Handbook of Child Psy­chol­ogy (5th ed), pp. 1017–1095, New York: Wiley. Else-­Quest, N., Hyde, J. S., Goldsmith, H. H., Van Hulle, C. A. (2006). Gender differences in temperament: A meta-­analysis. Psychological Bulletin, 132, 33–72. Else-­Quest, N. M., Hyde, J. S., Linn, M. C. (2010). Cross-­national patterns of gender differences in mathe­matics: A meta-­analysis. Psychological Bulletin, 136, 103–127.


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Feng, J. (2007). Playing an action video game reduces gender differences in spatial cognition. Psychological Science, 18, 850–855. Gentile, B., Grabe, S., Dolan-­Pascoe, B., Twenge, J. M., Wells, B. E., & Maitino, A. (2009). Gender differences in domain-­specific self-­esteem: A meta-­analysis. Review of General Psy­chol­ogy, 13, 34–45. Hare-­Mustin, R. T., & Marecek, J. (1988). The meaning of difference: Gender, theory, postmodernism, and psy­chol­ogy. American Psychologist, 43, 455–464. Hedges, L. V., & Nowell, A. (1995). Sex differences in ­mental test scores, variability, and numbers of high-­scoring individuals. Science, 269, 41–45.
 Hendrick, C., Hendrick, S. S., & Reich, D. A. (2006). The brief sexual attitudes scale. Journal of Sex Research, 43, 76–86. Hyde, J. S. (1984). How large are gender differences in aggression: A developmental meta-­analysis. Developmental Psy­chol­ogy, 20, 722–736. Hyde, J. S. (2005). The gender similarities hypothesis. American Psychologist, 60, 581–592. Hyde, J. S., Lindberg, S. M., Linn, M. C., Ellis, A., & Williams, C. (2008). Gender similarities characterize math per­for­mance. Science, 321, 494–495. Hyde J. S., & Linn  M. C. (1988). Gender differences in verbal ability: A meta-­ analysis. Psychological Bulletin, 104, 53–69. Johnson, D. P., & Whisman, M. A. (2013). Gender differences in rumination: A meta-­analysis. Personality and individual differences, 55, 367–374. Kling, K. C., Hyde, J. S., Showers, C. J., & Buswell, B. N. (1999). Gender differences in self-­esteem: A meta-­analysis. Psychological Bulletin, 125, 470–500. Knight, G. P., Guthrie, I. K., Page, M. C., & Fabes, R. A. (2002). Emotional arousal and gender differences in aggression: A meta-­analysis. Aggressive Be­hav­ior, 28, 366–393. Knight, G. P., Fabes, R. A., Higgins, D. A. (1996). Concerns about drawing causal influences from meta-­analyses: An example in the study of gender differences in aggression. Psychological Bulletin, 119, 410–421. Konrad, A. M., Ritchie, E., Lieb, P., & Corrigall, E. (2000). Sex differences and similarities in job attribute preferences: A meta-­analysis. Psychological Bulletin, 126, 593–641. Lindberg, S. M., Hyde, J. S., Petersen, J., & Linn, M. C. (2010). New trends in gender and mathe­matics per­for­mance: A meta-­analysis. Psychological Bulletin, 136, 1123–1135. Linn M. C., & Petersen, A. C. (1985). Emergence and characterization of sex differences in spatial ability: A meta-­analysis. Child Development, 56, 1479–1498. Leaper, C., & Robnett, R. D. (2011). ­Women are more likely than men to use tentative language, ­aren’t they? A meta-­a nalysis testing for gender differences and moderators. Psy­chol­ogy of ­Women Quarterly, 35, 129–142. Maeda, Y., & Yoon, S. Y. (2013). A meta-­a nalysis on gender differences in m ­ ental rotation ability mea­ sured by the Purdue Spatial Visualization Tests: Visualization of rotations (PSVT:R). Educational Psy­chol­ogy Review, 25, 69–94. Meece, J. L., Eccles-­Parson, J., et al. (1982). Sex differences in math achievement: ­Toward a model of academic choice. Psychological Bulletin, 91, 324–348. Paustian-­Underdahl, S. C., Walker, L. S., & Woehr, D. (2014). Gender and perceptions of leadership effectiveness: A meta-­analysis of contextual moderator. Journal of Applied Psy­chol­ogy, 99, 1129–1145.


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Oliver, M. B., & Hyde, J. S. (1993). Gender differences in sexuality: A meta-­analysis. Psychological Bulletin, 114, 29–51. Petersen, J. L., & Hyde, J. S. (2010). A meta-­analytic review of research on gender differences in sexuality: 1993–2007. Psychological Bulletin, 136, 21–38. Reilly, D. (2012). Gender, culture, and sex-­t yped cognitive abilities. PLoS ONE, 7, e39904. doi:10.1371/journal.pone.0039904. Rideout, V. J., Foehr, U. G., & Roberts, D. F. (2010). Generation M2: Media in the lives of 8-­ to 18-­year-­olds. Menlo Park, CA: Kaiser F ­ amily Foundation. Su, R., Rounds, J., & Armstrong, P. (2009). Men and t­ hings, w ­ omen and p ­ eople: A meta-­a nalysis of sex differences in interests. Psychological Bulletin, 135, 859–884. Tannen, D. (1991). You just d­ on’t understand: ­Women and men in conversation. New York: Ballantine. Thomas, J. R., & French, K. (1985). Gender differences across age in motor per­for­ mance: A meta-­analysis. Psychological Bulletin, 98, 260–282. Twenge, J. M. (1997). Changes in masculine and feminine traits over time: A meta-­ analysis. Sex Roles, 36, 305–325. Twenge, J. M., & Nolen-­Hoeksema, S. (2002). Age, gender, race, socio-­economic status, and birth cohort differences on the C ­ hildren’s Depression Inventory: A meta-­analysis. Journal of Abnormal Be­hav­ior, 111, 578–588. Uttal, D. H., Meadow, N. G., Tipton, E., Hand, L. L., Alden, A. R., et al. (2013). The malleability of spatial skills: A meta-­analysis of training studies. Psychological Bulletin, 139, 352–402. Voyer, D. (2011). Time limits and gender differences on paper-­and-­pencil tests of ­mental rotation: A meta-­analysis. Psychological Bulletin Review, 18, 267–277. Voyer, D., Voyer, S., & Bryden, M. P. (1995). Magnitude of sex differences in spatial abilities: A meta-­analysis and consideration of critical variables. Psychological Bulletin, 117, 250–270. Weisgram, E., Bigler, R., & Liben, L. (2010). Gender, values, and occupational interests among c­ hildren, adolescents, and adults. Child Development, 81, 778–796.


PART II

Selected Topics in W ­ omen’s Relationships, Development, and Health


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Chapter 5

Diverse W ­ omen’s Sexualities: A Contemporary View* Ruth E. Fassinger and Julie R. Arseneau

A de­cade ago, when we wrote the original version of this chapter (Fassinger & Arseneau, 2008, on which the current discussion is based), articles in the popu­lar press w ­ ere reporting on the pharma-­scientific effort to create a female or “pink” Viagra®, a drug that would enhance ­women’s sexual functioning as Viagra® does for men. The accompanying illustration in one article (Gorney, 2002) highlighted the difficulty of the task by portraying gender differences in sexual response using light switches as an analogy: Men’s responses w ­ ere presented as a ­simple toggle switch with on and off positions, whereas ­women’s response was depicted as an entire light board with multiple switches and complicated circuitry. ­W hether or not this illustration accurately captures gendered sexual responses, we believe that it does reflect deeply entrenched assumptions about sexuality, that is, adherence to a bio-­physio-­medical model of sexual functioning in which predictable responses emanate from healthy or “normal” functioning of the wires, availability of professional interventions to re-­wire a malfunctioning system, bafflement about the per­sis­tent apparent breakdown of w ­ omen’s circuitry, and continued scientific and therapeutic tinkering to fix it. It is ­these assumptions about sexuality that we challenge in this chapter. Dramatic changes have occurred in the scientific study and popu­lar understanding of sexuality over the past several de­ cades, and still-­ emerging trends 10 years ago now are firmly entrenched in postmodern

*The contents of this article do not represent the views of the Department of Veterans Affairs or the United States government.


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U.S. society. Prominent, well-­respected business leaders, athletes, and entertainers have disclosed their sexual orientations and gender transitions publicly, challenging heterosexist, binary-­gender assumptions. The media explosion of sexual content and products has made sex ubiquitous and unavoidable, now including widespread attention—­and marketing—to sexual and gender minorities, e.g., lesbian, gay, bisexual, transgender, and gender-­nonconforming [TGNC], queer individuals. ­T here are medical and phar­ma­ceu­t i­cal treatments for a wide range of sexually related prob­lems, and they are advertised on prime time tele­vi­ sion. Same-­sex marriage is now ­legal, and ­there is ac­cep­tance of many kinds of blended and non-­traditional families. Advances in reproductive technologies (begun by the advent of the birth control pill) have cemented the separation of sexual be­hav­ior from reproduction, and have allowed situations unimaginable a de­cade ago, e.g., gender-­transitioning ­women freezing their eggs for post-­transition childbearing. The ascendancy of technology (website information and networking, online dating, cybersex, gaming) has made sexual material and activity anonymously accessible to vast numbers of ­people. Polyamory, friends with benefits (FWB), phone sex, sexual predators, binary gender labels, sex on the down-­low, gay pride, sexual misbehavior of the stars, and gender-­neutral bathrooms are in the popu­lar discourse, even among youth. And for psychologists and other health professionals, the recent two-­volume APA Handbook of Sexuality and Psy­chol­ogy (Tolman & Diamond, 2014) is a comprehensive and invaluable resource that summarizes vast lit­er­a­tures in the study of sexuality. However, t­ here is a backlash, exacerbated to crisis levels by the extreme conservatism of the current presidential administration, already making vigorous attempts to halt the march ­toward rights and protections for ­people who experience discrimination and marginalization, e.g., based on gender, sexual orientation, gender identity/expression, race/ethnicity, immigrations status, class, religious beliefs, and disability status. This social disruption inevitably filters down into individual lives and relationships, including sexual be­hav­ior, e.g., threats regarding reproductive choice, refusal to punish sexual vio­lence against w ­ omen and sexual minorities, and spousal deportation. ­There also are well-­documented disparities in the medical and m ­ ental health ser­vices available to and utilized by marginalized groups, which affect the capacity of individuals to address prob­ lems related to relationships and sexuality, e.g., lack of insurance coverage of gender reassignment surgeries for transgender p ­ eople, blockage of birth control or abortion access for ­women. Intransigent gendered wage gaps compound w ­ omen’s disadvantage, especially for w ­ omen in same-­sex relationships, who are doubly affected by depressed earnings. Moreover, the current wave of religious exemption legislation targeting sexual and gender minorities and ­women’s reproductive rights, as well as the threat to same-­sex marriage, demonstrate the fragility of l­egal protection at the


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federal level when so many rights are regulated primarily at state and local levels and in the private sector, resulting in vulnerability in the most intimate aspects of p ­ eople’s lives. The juxtaposition of unpre­ce­dented societal attention to sexuality and severe threats of repression create a critical moment in this period of herstory. Although a chapter devoted to deconstructing conceptions of female sexuality might appear to be a mere academic exercise in the face of impending social disaster (like the proverbial rearranging of the deck chairs on the Titanic), we contend that it is precisely at this juncture where clarity is most needed. As we argue in this chapter, it is implicit, unexamined assumptions undergirding conceptualizations of w ­ omen’s sexuality that permit a climate in which basic ­human rights—­such as control over one’s body, protection from exploitation and vio­lence, and freedom to love and create families—­are abridged for ­women. We challenge ­here the ways in which ­women’s sexual be­hav­ior and response have been situated in popu­lar and professional discourse, and we highlight the harm to ­women of a masculinist model emphasizing male-­oriented, cissexist, heterosexual sex in the ser­vice of men’s needs, with regulation and control of ­women’s sexuality. We include the experiences of sexual and gender minority w ­ omen throughout the chapter to demonstrate how observing their sexualities disrupts common assumptions about and enriches understanding of all ­women’s sexualities. Our discussion is conceptually driven, with specific research findings used for illustration, and it is necessarily embedded in gender-­binary language, as this is the very foundation of the work we critique. We conclude with implications of our observations for research, clinical practice, education/training, and policy/advocacy in advancing an accurate, con­temporary portrayal of ­women’s sexualities. INTERROGATING ­WOMEN’S SEXUALITY The historical context for the study of sexuality over the past c­ entury has been dominated by a bio-­physio-­medical model of sexuality (termed “sexological” by Tiefer, 2001 to denote its sociopo­liti­cal embeddedness, the label we use ­here), buttressed by evolutionary justifications and de-­ contextualized, technical definitions of body parts and functions. The model assumes the salience and universality of sexual experience as a crucial identity component for which fundamental physiological pro­cesses (stimulation, vasocongestion, orgasm) are experienced across time, place, and populations. It utilizes a health rhe­toric of sexuality, with the labeling of sexual thoughts (e.g., fantasies), feelings (e.g., desire), and be­hav­iors (e.g., response to genital stimulation) as “normal” or “abnormal,” thus constraining sexual expression to the dictates of society, i.e., private, heterosexual, cisgender, and, for w ­ omen, reproduction-­driven within a committed relationship.


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Historically, even as awareness of same-­sex be­hav­ior emerged in sexuality research, the sexological model held sway. The basic view of sexuality as dimorphic, heteronormative, physio-­erotic, essential, and immutable produced concepts of a dichotomous sexual “orientation” (­either homo or hetero) as a fundamental, inborn trait emerging early in life and remaining stable, focused primarily on erotic preferences based on partner gender as the defining manifestation, and exclusive homo­sexuality as the prototypic form, with sweeping, male-­defined characteristics of sexuality itself (fantasy, arousal, attraction, be­hav­ior, identification, and self-­labeling) (Diamond, 2014; Fassinger, 2017). Although early assumptions regarding the pathology of homosexual orientation mostly have dis­appeared, the dominant model, built on the experiences of men (Diamond, 2014), still defines “normal” be­hav­ior within heterosexist par­ameters, as the current societal rhe­toric around normalizing same-­sex be­hav­ior within the confines of marriage demonstrates (Fassinger, 2017). We assert that t­ hese assumptive under­pinnings in theorizing and studying sexuality have resulted in an erroneous view of ­women’s sexuality as homogenous and problematic (particularly as it compromises men’s access and enjoyment), with over-­attentive incomprehension of biological and physiological aspects of ­women’s sexual functioning, disregard of impor­ tant contextual f­actors and individual differences in w ­ omen’s sexual be­hav­ior, and the continued under-­investigation of experiences of sexual and gender minority ­women in research (Diamond, 2014; Fassinger & Arseneau, 2008). Social constructionists, who attend to the ways in which (sexual) experience is or­ga­nized and influenced by societal norms and expectations, point to temporal and historical contexts, cultural locations, and individual experiences that shape (i.e., construct) and perpetuate cultural norms, which are inculcated, in large part, through language (Fassinger, 2017). Thus, the discourse of “­women’s sexuality” is impor­tant to interrogate. ­Women do not constitute a monolithic group but rather reflect a rich diversity of experiences s­ haped by sociodemographic f­ actors (e.g., age, race/ethnicity, class, sexual orientation, gender identity/expression, disability), geographic locations, relationship statuses and configurations, and po­liti­cal commitments, intersecting in complex ways in each person. Moreover, the sexuality of diverse ­women is more accurately represented as myriad or multiple sexualities (encompassing attitudes, beliefs, be­hav­iors, motivations, preferences), which also are affected deeply by contextual realities. One classic example of contextual influences found college-­educated men to be twice as likely as other men to identify as gay or bisexual, while the odds for ­women increased 900 ­percent (Laumann, et al., 1994), suggesting a power­ful link between education and ­women’s sexualities. Given the sociocultural and po­liti­cal embeddedness of ­women’s sexualities (Brown, 2000; Diamond, 2014; Fassinger & Arseneau, 2007, 2008; Tiefer, 2001), a model that strips away context and presumes an essentialist frame cannot possibly represent such experiences accurately.


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Social constructionist perspectives on diverse ­women’s sexualities also highlight the ways in which be­hav­ior and identity become conflated in the attempt to or­ga­nize and categorize h ­ uman experience, imbue it with meaning, and assign labels to it. The societally determined terminology and discourse associated with same-­sex sexuality, for example, assume the manifestation of deep internal structures of the self, such that be­hav­ ior (i.e., same-­sex intimacy) comes to define what one is—­a “lesbian” or “bisexual”—­and the ac­cep­tance or rejection of ­those labels, in turn, is viewed as a reflection of impor­tant individual characteristics (e.g., maturity, m ­ ental health, identity integration) or sociopo­liti­cal realities (e.g., sexual prejudice) (Fassinger, 2017). The heteronormativity of such rhe­toric is captured by the fact that heterosexuals typically are not labeled as such, so it is the claiming of a dif­fer­ent identity that forces the distancing effect of sexual minority labels. Similarly, the cissexist rhe­toric of cultural debates about ­whether transwomen are “real” ­women or ­whether claims of being born into the “wrong” body are valid medical complaints obviates the victim-­blaming inherent in the ac­cep­tance of rigid, dichotomous gender categories that force all manner of gender transgression by sexual minority ­people (Fassinger & Arseneau, 2007). The rhe­toric of the sexological model denies ­women’s experiences by conflating many distinct aspects of sexuality—­sexual be­hav­ior, sexual identity, and sexual orientation—­into one overall undifferentiated response. However, disentangling t­ hese ideas is essential to understanding diverse ­women’s sexualities, ­because a substantial body of con­temporary research (Diamond, 2014 for a summary) demonstrates weak or inconsistent links between ­women’s sexual arousal, desires, be­hav­iors, preferences, identities, and self-­labeling. ­Women are more likely than men to experience sexual attraction and be­hav­ior that run c­ ounter to their overall orientation, and many ­women (especially sexual minority w ­ omen) experience their sexuality as fluid, dynamic, and gender-­inclusive. Compared to men, ­women are more likely to endorse multiple sexual orientations concurrently, their arousal is less gender-­specific, and their sexual expression is more sensitive to social and interpersonal influences, thus rendering their life course patterns less determined by under­lying predispositions. Many lesbian-­identified w ­ omen have been or continue to be intimately involved with men or acknowledge an ongoing possibility of heterosexual relationships, and more than twice as many heterosexual ­women as men reporting engaging in same-­sex be­hav­ior. W ­ omen are less likely than men to demonstrate a match between sexual be­hav­ior and self-­identification, instead utilizing self-­labels that encompass not only erotic feelings and be­hav­iors but also romantic, po­liti­cal, and social relationships with ­others, emphasizing the person, not the gender or sex. Relationships between ­women exhibit a wide range of be­hav­iors, including intense intimacy that may be romantic or passionate in nature, if not expressly erotic, e.g., Boston marriages, passionate friendships (Diamond, 2002, 2014; Rothblum &


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Brehony, 1993). Moreover, emotionally intense relationships appear to trigger fluidity in sexual attraction for w ­ omen (Diamond, 2014), making ­women’s reported attractions to other ­women difficult to interpret, a prob­ lem captured quite concisely in a quotation from an adolescent w ­ oman in one study (Diamond & Savin-­Williams, 2003, p. 140), who said, “I’m not sure if I want her or want to be her.” ­Women’s fluidity in desire and self-­labeling also is demonstrated in research on bisexual ­women, which suggests that only small percentages of w ­ omen who report attraction to ­women and men claim a bisexual identity, and most coupled bisexuals are in heterosexual relationships (Herek, et  al., 2010). Of course, homonegative prejudice and binegative stigma (Movement Advancement Proj­ect, 2016) prob­ably render bisexual identification a less ­viable choice for many ­women with other­wise bisexual attractions or be­hav­iors. Additionally, the stigma against bisexual ­people, which includes active hostility from both heterosexual and lesbian/gay ­people, denial of bisexual identity as real, confusion on the part of ­others, pressure to choose, exclusion from lesbian and gay communities, and ste­ reo­types of bisexuals as hypersexual and incapable of monogamous relationships (Bostwick & Hequembourg, 2014) may constrain w ­ omen in par­tic­u­lar, who have been socialized t­oward monogamy. However, contrary to ste­reo­types, a recent study of almost 300 bisexual p ­ eople (Mark, et al., 2014) found that most bi-­identified w ­ omen ­were seriously dating one person or ­were engaged or married, and more than half had been with their current partner for three or more years. Research also has found that sexual minority w ­ omen demonstrate a “core” sexual orientation (regardless of ­whether they identify as lesbian, bisexual or fluid), and that bisexual ­women’s patterns of same-­sex attraction appear to fit a “true” bisexual orientation in which attractions to members of the same and other sex are pos­si­ble, challenging the assumption that bisexuality is merely a phase or transition to becoming lesbian (Farr, et al., 2014). Emerging research on TGNC w ­ omen also appears to support the notion of sexual fluidity and flexible self-­labeling. Dargie, et al. (2014), for example, found that only a minority of their transgender sample reported exclusive heterosexual or LGB identification, with a wide range of attractions and sexual be­hav­iors described (including the rejection of gender and sexual orientation as meaningful organizers of experience). To date, most sexuality research with transwomen has focused primarily on sexual response and satisfaction post-­genital surgery or post-­hormone treatment, or on HIV risk in sex with cisgender men (Bauer & Hammond, 2015). This focus is unfortunate, as it does not represent the life course experiences of most transwomen, who voice sexual concerns common to many ­women, such as questions about who might desire them (in this case, ­whether they ­will not be desired or ­will only be desired ­because they are transgender, a manifestation of “flip sides of a cissexist coin”) (Bauer & Hammond, 2015, p. 7). The longstanding marginalization of TGNC ­people


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in public and professional discourse about sexuality has served to shore up the oversimplified, binary view of gender in the sexological model (Fassinger & Arseneau, 2007, 2008), another limitation of this model as applied to diverse ­women’s sexualities. The aspect of the sexological model that has been especially deleterious to ­women is the foregrounding of (heterosexual) men’s sexual experience. This masculinist conceptualization of sexuality privileges genital contact, penile penetration, male plea­sure, female passivity, and reproduction above all other considerations. ­T here are several clear prob­ lems for ­women—­and impediments to understanding diverse w ­ omen’s sexualities—­that emanate from this cissexist, heterosexist, and patriarchal view of sexuality, and they exert considerable harm on w ­ omen. PROB­LEMS FOR ­WOMEN OF CIS-­HETEROPATRIARCHAL CONSTRUCTIONS OF SEXUALITY The first prob­lem for w ­ omen of a cis-­heteropatriarchal view of sexuality is that it is phallocentric, in which frequency of sexual contact is prized over duration, and orgasm over intimacy. As traditionally defined and studied, “having sex” (or intercourse or coitus) is a heterosexual, relatively brief encounter (typically fewer than 15 minutes, with non-­genital, non-­ breast contact averaging less than one minute), in which the chief goal is the insertion of a penis into an orifice (preferably a vagina), ending with male ejaculation and subsequent penile flaccidity. A ­woman’s arousal (e.g., lubrication, climax) may be of interest in readying her body for penile penetration, but it is the penis that defines the start and end of a sexual event, and it is the frequency of ­these kinds of events that typically has been assessed in sexuality studies. The inappropriateness of mea­sur­ing this kind of sexual frequency for ­women is obviated by a substantial body of research suggesting that ­women tend to be more relational than men in their sexual activity, focusing more on intimacy and less on orgasm, with a broad and flexible notion of what constitutes intimate or erotic be­hav­ior (Diamond, 2014; Spurgas, 2013). Defining sex narrowly as penis-­vagina intercourse erases much of the sexual activity of ­women who may be engaging in oral-­genital activities that they do not view as “having sex.” This could be particularly true for young, unmarried heterosexual w ­ omen, who may deliberately choose oral-­genital be­hav­ior ­because they do not consider it sex, and therefore, it is not in violation of social scripts emphasizing chastity nor does it threaten pregnancy as a consequence of sexual be­hav­ior. What do researchers learn, for example, from asking girls about their “first” experiences of heterosexual sex or of intercourse? And how do girls who are sexually active with other girls answer such questions? For w ­ omen in same-­sex relationships, the absence of a live penis renders the phallocentric conception of “frequency” particularly absurd.


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Frye’s classic (1992, p. 110) critique of research reporting lower sexual frequency in lesbian than heterosexual ­couples captures this humorously: What we [lesbians] do . . . ​considerably less frequently, takes on the average, considerably more than 8 minutes to do. Maybe about 30 minutes at the least. Sometimes maybe about an hour. And it is not uncommon that among ­these relatively uncommon occurrences, an entire after­noon or eve­ning is given over to activities or­ga­nized around ­doing it. The suspicion arises that what . . . ​heterosexual married c­ ouples are d ­ oing more than once a month, and what . . . ​lesbian ­couples are ­doing less than once a month, are not the same ­thing.

Even 25 years ago, Frye was right. A recent study (Blair & Pukall, 2014) found that female same-­sex c­ ouples reported less frequency than male same-­sex and mixed-­sex c­ ouples, but significantly longer duration of sexual encounters. Moreover, sexual frequency does not necessarily lead to happiness. One report of more than 30,000 research participants found a curvilinear relationship between sexual frequency and well-­being, with sex and well-­being no longer associated at a frequency exceeding once a week (Muise, et al., 2015). Similarly, an experimental study of married, heterosexual ­couples found that doubling their sexual frequency led to declines in well-­being and the quality of sex, with both ­women and men reporting that increased sex was not very much fun (Loewenstein, et al., 2015). For w ­ omen, research has shown that social f­ actors such as intimacy, agency, emotional closeness, low stress, and greater sexual knowledge explain more variance in sexual satisfaction than does sexual (dys)function, with intimacy being the most impor­tant ­factor, and no background variables (e.g., age, education, race, parent status) implicated in ­women’s sexual satisfaction (Pronier & Monk-­Turner, 2014). The danger in defining sex by phallocentric frequency standards should not be dismissed as mere intellectual quibbling by feminists ­because such definitions exert harm on ­women, especially ­those in same-­ sex relationships. When two ­women—­who have been socialized to value intimacy and emotional connection—­devote hours or days to erotic activity that does not “count” as sex in the dominant social discourse, they may themselves come to dismiss that activity as sexual. The absence of a ­human penis, thus, renders sexual minority w ­ omen’s sexual activity invisible, erases the full range of same-­sex erotic be­hav­ior, and discounts the sexual aspects of their most intimate interactions. Moreover, defining relationships in overly sexual terms means that loss of an impor­tant same-­ sex relationship may raise doubts or confusion about sexual identity (Diamond, 2014; Fassinger, 2004), and decreased sexual activity may be viewed erroneously as loss of affection and relationship threat; the latter is exemplified by the myth of lesbian “bed death,” the presumed loss of sexual interest in long-­term lesbian relationships. However, lesbian c­ ouples report relationship satisfaction levels similar to or greater than same-­sex


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male or heterosexual ­couples (Kurdek, 2005; Peplau & Fingerhut, 2007), with higher relationship satisfaction linked to better sexual functioning (Cohen & Byers, 2014). W ­ omen in same-­sex relationships report the most frequent reasons for engaging in sex as physical desire/plea­sure and love/commitment (Wood, et al., 2014), and they experience their sexuality positively across cognitive-­affective, motivational, behavioral domains (e.g., frequency, genital/non-­genital activities, motivation/desire, satisfaction), reporting weekly genital and non-­genital sexual activity regardless of relationship duration (Cohen & Byers). That t­ hese patterns also defy age ste­reo­types is supported by research finding that w ­ omen at midlife and older are eight times more sexually active when in a relationship (Thomas, Hess, & Thurston, 2015), suggesting that it is partner availability, not age, that most affects sexual activity in ­later life (Etaugh, 2008; Schwartz, et al., 2014). A second prob­lem for ­women of the cis-­heteropatriarchal model of sexuality is the pervasive assumption that female sexuality exists only in reference to men and in the ser­vice of men’s needs. Gender-role socialization traditionally has reinforced w ­ omen’s sexual responsiveness to men and men only; indeed, the mere presence of a man is presumed to spark erotic energy in ­women (Brown, 2000), with dangerous or unavailable men often portrayed as especially desirable. ­Women’s erotic and romantic energies are to be funneled only into relationships with men (i.e., attracting and maintaining male interest), and erotic overtures t­oward other ­women are acceptable only as sexual “turn-­ons” for men. A ­woman’s sexual attractiveness is to be flaunted only enough to attract a male or shore up that male’s virile image to o ­ thers, lest she be viewed as sexually loose or overly available. Sexual plea­sure is largely the province of men, and ­women often have ­little awareness of their own erotic patterns and needs. ­Women are likely to experience guilt, fear, and ambivalence about sexual activity (including just talking about it; Montemurro, et  al., 2015), and young w ­ omen in par­tic­u­lar often manifest lack of agency in sexual be­hav­ ior (e.g., being pressured into sex or reporting that “it just happened”) (O’­Sullivan & Thompson, 2014). Self-­stimulation or masturbation is considered appropriate (even necessary) for men but not ­women, and boys and men engage in masturbation far earlier and more frequently than do girls and w ­ omen (O’­Sullivan & Thompson, 2014). Lesbian-­identified ­women report more frequent masturbation than heterosexual ­women (Matthews, et al., 2005), and sexual identity exploration appears to be good for all ­women in building sex positivity: In one study (Parent, et al., 2015), ­women who had ever claimed non-­heterosexual identities reported higher levels of sexual exploration, which w ­ ere related, in turn, to higher levels of sexual positivity, e.g., greater sexual self-­efficacy, sexual consciousness, sexual motivation, and sexual self-­schema organ­ization. Given that few ­women can climax through penile-­vaginal intercourse alone despite Hollywood images of 100 ­percent, exemplifying the profound dismissal of the


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clitoris in the cultural sexual script (Lloyd, 2005); that gender differences in orgasmic frequency differences are attenuated substantially in committed relationships where ­women experience greater attentiveness from male partners (Conley, et al., 2011); and that learning self-­pleasuring (including genital self-­stimulation) is a cornerstone of sex therapy with ­women, it seems imperative for w ­ omen to discover other pathways to plea­sure than relying on the male penis. However, this leads to the third prob­ lem for w ­ omen of the cis-­ heteropatriarchal model of sexuality, which is that female sexuality existing in the absence of a male is considered e­ ither invisible or dangerous. Thus, for sexual minority w ­ omen, most, if not all, of their sexual lives are cast as incomprehensible, unpleasant, immoral, and even criminal. Lesbians are threatening b ­ ecause their very existence debunks the myth that ­women are not sexual; the act of claiming a lesbian identity means declaring oneself as a person to whom a sexual life and erotic preferences ­matter (Brown, 2000; Fassinger, 2004). In addition to publicly claiming that they are sexual beings, lesbian and bisexual w ­ omen also expose the fallacy that men are the only ­viable path for meeting ­women’s sexual and relational needs. Of course, where strict heterosexuality is viewed as normative, deviations are rigidly categorized (with considerable social re­sis­tance to expanding or eliminating the categories), and congruence is demanded across all aspects of the erotic (e.g., desire, fantasy, be­hav­ior, attraction, self-­labeling) within each category. The act of claiming a socially transgressive sexuality in a dominant discourse of “compulsory heterosexuality” (Rich, 1994) compels p ­ eople to disclose their nonconformity, thereby making sexuality a public (vs. private) issue, prompting continual scrutiny by and defending against o ­ thers. This explains why “coming out” has been viewed as a critical developmental event for sexual minority individuals (Herek & Garnets, 2007) and why it has been privileged in gay-­affirmative discourse as the ultimate indicator of mature and comfortable ac­cep­tance of deviance (Fassinger, 2017, for critique and reformulation of affirmation). Transgression of heteronormativity also means that the biological sex of the (presumably cisgender) partner w ­ ill be the single dimension that defines sexual orientation, thereby conflating erotic, gender expression, and role preferences into one variable (van Anders, 2015, for re-­theorizing); this severely constrains w ­ omen’s openness and flexibility regarding erotic life. The need for public declaration of deviance from social norms can be particularly difficult for sexual and gender minority ­people who live in cultures or communities where open discussion of sexuality, considered highly private and personal, is taboo. In ­these communities, self-­disclosing any form of sexual be­hav­ior (deviant or not) means denying some of the most fundamental values of that culture (see Fassinger & Israel, 2010). Espin (1997), for example, noted that ­there may not be words to describe certain sexual experiences or the words may be too shameful in some


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languages; this is supported by her observation that many immigrant ­women discuss sexual ­matters in En­glish rather than their native languages. Greene (1997) contrasted “coming out” as an expression of identity to the “bringing in” of same-­sex partners in some African American families and communities, a practice that underscores the ac­cep­tance of a same-­sex relationship even in the absence of public claiming of a sexual minority identity label. Thus, while anti-­gay prejudice has been noted as a difficulty in some ethnic communities, it also is impor­tant not to interpret non-­disclosure as pathological, when it simply may be an identity management strategy aimed at retaining community identity and values (Fassinger & Israel, 2010). The fourth prob­lem for w ­ omen of the cis-­heteropatriarchal perspective on sexuality is that it compels sexual minorities to essentialize the very aspects of themselves that are dif­fer­ent or transgressive (Fassinger, 2017; Fassinger & Arseneau, 2007, 2008) in order to wage ­battles over po­liti­cal and social change. Most civil rights legislation relies on essentialist definitions (i.e., unchangeable aspects of the self that are beyond individual control) to invoke arguments for protected class status. Thus, sexual orientation must be represented as immutable, and the fluid, dynamic expressions that characterize diverse ­women’s sexualities ironically are erased in the ser­vice of social justice. However, despite increased public endorsement of biological explanations of sexual orientation, sexual minority ­women continue to report some degree of choice in sexual identity (Diamond, 2014); that they hold to a view that honors their lived experience despite the implied loss of ­legal protection suggests a fierce transgressive stance meriting attention. CONTROL AND REGULATION OF DIVERSE ­WOMEN’S SEXUALITIES A particularly pernicious outcome for w ­ omen of the cis-­heteropatriarchal perspective on sexuality is the pervasive, systematic control and regulation of w ­ omen’s sexual desire and be­hav­ior. The greater sexual freedom of men relative to ­women across most con­temporary socie­ties is so widely acknowledged as to be almost axiomatic. The regulation of ­women’s sexualities manifests in many forms and locations, from macro-­level, systemic control in the form of legislation, medicine, and ­mental health practices, to individual-­level enactments of social scripts. Thus, ­women’s day-­to-­day experiences of sexuality can be compromised not only by external actions and ste­reo­types of ­others but also by the internalization of social discourse and constraints, experienced as guilt, anxiety, and ambivalence regarding desire and erotic expression. Historically, cisgender heteropatriarchal definitions of sex have been transcribed into law, and only relatively recently has consensual sex between adults been decriminalized in the United States. The 2003


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Supreme Court decision in Lawrence v. Texas, which found the Texas law banning “homosexual conduct” unconstitutional, effectively repealed all state sodomy laws in effect at that time. Although ­these laws varied in their definitions of prohibited be­ hav­ ior, many criminalized all non-­ procreative sex acts (e.g., oral and anal sex, even certain uses of the hands) in any kind of coupling, a severe constriction of private life not widely recognized b ­ ecause the law was selectively enforced for same-­sex (especially male) ­couples only (American Civil Liberties Union, 2003). Despite the lifting of bans on some forms of sexual activity, however, ­women’s very bodies remain a constant battleground for po­liti­cal and legislative control as current strug­gles over abortion, birth control, prostitution and sex trafficking, and sexual vio­lence against w ­ omen clearly demonstrate. At the individual level, normative social scripts about sexuality are used to limit, direct, and control ­women’s sexual be­hav­iors. The Madonna/ whore bifurcation has given ­women two basic, contradictory (undersexualized or oversexualized) scripts around which to construct a sexual self, and they operate si­ mul­ ta­ neously and insidiously. The Madonna expectation focuses on ­women’s sexual be­hav­ior, emphasizing sexual purity and self-­control. Sexual activity apart from men and reproductive goals is viewed as suspect and problematic, and gendered double standards abound: young men are to gain sexual experience, girls are not; men are to be sexually aggressive, w ­ omen are not; men are to desire and enjoy sex, ­women are not, except (perhaps) in the confines of marriage or committed relationships (Conley, et al., 2011). W ­ omen are expected to demonstrate control over sexual activity (e.g., the messages about sex received by con­ temporary college ­women from male and female friends include sex-­ positive and sexual-­gatekeeping messages si­mul­ta­neously; Trinh, 2016) ­because it is they who carry the burden of preventing pregnancy due to men’s presumed uncontrollable urges that ­women must manage. Although double standards regarding sex before marriage and in committed relationships have loosened (Bordini & Sperb, 2013), the greater sexual permissiveness accorded men and restrictiveness of w ­ omen have remained intact over the past two de­cades of dramatic social change (Sprechter, et al., 2013). Both ­women and men, but men more strongly, endorse a double standard granting men greater allowance than w ­ omen for sex in casual relationships; the paradox of the sexual double standard is that males may push female partners into sex but then judge them harshly for their acquiescence whereas females may engage in token re­sis­tance to sex in an attempt to avoid negative judgment when they agree, a dangerous spiral of confusing or dishonest communication that leads to sexual coercion and vio­lence in casual relationship encounters (Sprechter, et al., 2013). In the current “hook-up” culture, a casual relationship form common among young ­people is “friends with benefits (FWB),” wherein certain friends are permitted the benefits of sexual access in a supposedly non-­romantic relationship. However, a double standard is apparent even in t­ hese seemingly


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neutral relationships: Williams and Jovanovic (2015) found dif­fer­ent motivations for entering FWB relationships in men (relationship simplicity) and ­women (hopes of a ­future committed relationship), with men reporting more overall relationship satisfaction than w ­ omen in FWB relationships. ­These findings support considerable research suggesting that casual hook-­ups tend to be disappointing and even humiliating for ­women as the double standard ensures “slut-­shaming” when they exercise casual sexual freedom (Gavey & Senn, 2014). The gendered double standard is vis­i­ble in same-­sex relationship patterns as well. Mark, Garcia, and Fisher’s (2015) examination of sex in casual vs. committed relationships across genders and sexualities revealed that men generally found both committed and casual sex more satisfying than did w ­ omen, but sexual satisfaction (which did not differ by gender or sexual orientation in committed relationships) showed differences in casual relationships, where gay men ­were most satisfied and lesbians least satisfied. Research on attitudes t­oward polyamorous/non-­monogamous relationships suggests that men view monogamy as more sacrificing than do ­women, but t­here are no gender differences in views of monogamy as enhancing to a relationship; heterosexuals are the most likely to see monogamy as enhancing, and bisexuals support polyamory more than other sexual orientation groups, viewing monogamy as less of enhancement and more of sacrifice in relationships (Manley, et al., 2015; Mark, et al., 2014). The irony of social prohibitions against ­women’s sexual be­hav­ior manifested in the Madonna aspect of the sexual double standard is that, despite being forbidden to behave sexually, ­women are supposed to look and act sexy (the oversexualized, whore side of the cultural sexual script). This ele­ment of the female sexual script is enacted primarily through media and other public messages and images regarding ­women, and research indicates that it is being ­adopted by girls of increasingly young ages (American Psychological Association, 2007). Not only does the sexualization of girls have negative effects on their ability to develop healthy sexual and body self-­images and self-­protective sexual be­hav­iors, it also has been linked to increased rates of eating disorders, depression, anxiety, poor body image, and low self-­esteem (APA, 2007), suggesting a wide range of negative consequences of sexual objectification, including sequelae that can be conceptualized as insidious trauma (Miles-­McLean, et  al., 2015) and self-­objectification (the internalization of objectifying messages) a particularly detrimental outcome. Research has found consistent links between exposure to sexualized images of ­women and self-­objectification and rape myth ac­cep­tance in w ­ omen (Fox, et al., 2015), greater tendency ­toward harassing be­hav­ior and sexual coercion in men (Galdi, et al., 2014), less sympathy for and negative judgment of sexualized victims, even when ­those victims are prepubescent girls (Holland & Haslam, 2016), and negative body-­image and sexual self-­esteem for ­women (APA, 2007);


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body image issues, in turn, are associated with compromised sexual functioning and sexual well-­being (Vencill, et al., 2015). Research suggests that sexual minority w ­ omen are less likely to internalize the heterosexist sociocultural standards of beauty and thinness that emanate from sexual objectification (Brown, et al., 2016; Huxley, et al., 2015), but when they do, they are just as likely as heterosexual w ­ omen to develop body image concerns (Watson, et al., 2015). The explosion of a sexualized culture that we noted in beginning this chapter ensures that girls and ­women ­will be bombarded by and repeatedly re-­exposed to societal messages about sexuality. Moreover, even as the ubiquity of sex seems to offer con­temporary w ­ omen more freedom regarding their sexualities, an examination of current sexual discourses reveals still-­dominant under­lying constraints. Atwood (2006) characterized recent cultural shifts as movement from a relational to recreational model of sexual be­hav­ior, in which the new relationship ideal is demo­ cratic mutual self-­interest. This leads to the commodification of sex, in which ­women’s sexual value is variable and fragile (like stocks), and eroticism becomes an end in itself. This, in turn, supports sexual consumerism for w ­ omen, in which sexual democ­ratization and female objectification intersect in new sexually liberated, classy, professional, female consumer (think Sex and the City) for whom sex is a ­matter of aesthetics, not ethics, meaning stylish, pleas­ur­able, healthy, athletic, self-­expressive, individually fulfilling, and expensive to maintain. Atwood (2006) noted that this sophisticated model of sexuality allows ­women (traditionally barred from access to sexually explicit material) a new sexual script for forging identity. However, even as t­hese new post-­feminist, postmodern discourses emerge, they are superimposed over traditional discourses, obscuring the regressive assumptions that undergird seemingly liberated sexual ideals and creating yet another form of control of w ­ omen’s sexuality: “An endless seduction by sex—­whatever that is—­and constant self-­scrutiny becomes the newest and most uncertain form of regulation . . . . ​We are left with the task of managing our sexuality, even as we are incited to abandon ourselves to it” (p. 89). Atwood’s observations (2006) are supported by recent empirical research (Brown-­Bowers, et al., 2015) finding young ­women’s sexual agency narratives built upon a model of sexuality as health, subjugating their desire to a rhe­toric of relationship hygiene, or an exercise-­esque part of a wellness regimen, or economy exchange (a commodity to barter in the heterosexual marketplace). ­These authors noted that young ­women ­were bound by “per­for­mance and competence imperatives” to be “permanently sexually prepared, proficient, and practicing,” trapped in a “neoliberal rhe­toric of self-­regulation,” where “sociopo­liti­cal analy­sis is silenced into a sanitized discourse of cheerful choices” obscuring w ­ omen’s limited possibilities and forcing them to “experience sexual plea­sure through their internal subjugation” (p.  331–332). Thus, a discourse that appears to reflect healthy sexual agency for ­women is grounded


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in the same repressive heteropatriarchal model that suppresses their desire and channels sexual be­hav­ior into pragmatic exchange with self-­ regulation now internalized (cheerfully) in a dogma of sexual health. The inescapable sexualization and objectification of ­women puts them at extraordinarily high risk for sexual exploitation, abuse, and vio­lence (American Psychological Association, 2007)—­and dismissal of ­these egregious events when they occur. The societal links between gender, power, and sexuality create a kind of “cultural scaffolding” (Gavey & Senn, 2014, p. 339) in which men’s sexual vio­lence against ­women is enabled yet obscured except in its most extreme forms (e.g., rape of c­ hildren). Research indicates that fully half or more of w ­ omen report experiencing sexual victimization (Gavey & Senn, 2014), much of it from partners, within families, or by other p ­ eople they know, making clear the pervasiveness of this form of control over ­women. Sexual victimization sends frightening and confusing messages about men, power, ­family, marriage, communities, and personal safety—­messages that prevent girls and w ­ omen from developing healthy, assertive ways of enacting sexual desires and needs—­ and the restrictions imposed on ­women’s lives by continual fear of sexual vio­lence ensure that all w ­ omen are adversely affected by living in a “rape culture,” even if not directly victimized (Gavey & Senn, 2014). Moreover, it does not appear that socioeconomic advantage necessarily offers protection for ­women and may even enable exploitation and promote self-­blame: Bay-­Cheng and Bruns (2016) found that affluent college w ­ omen made more normative rationalizations of unwanted sex experiences than did low-­income students/nonstudents, who more readily saw links between unwanted sex, vulnerability (e.g., past victimization), and social stigma. Sexual minority ­women occupy a particularly problematic place in this system of sexual regulation and subjugation as their public declaration of non-­male-­dependent sexuality (implicit in their identity disclosure) is threatening, and they are coerced into erasing the obviously erotic from their relationships so as not to oversexualize themselves or “flaunt” their sexuality within a heteronormative, oppressive social context, especially to men, who tend to exhibit the highest levels of sexual intolerance (Herek & Garnets, 2007). Moreover, as virtually all sexual, intimate, romantic, and affectional be­hav­ior may be viewed as flaunting in heterosexist culture, the other­wise vast erotic repertoire of sexual minority w ­ omen becomes severely constrained, and the internalization of societal homophobia creates difficulty in intimate relationships (Frost & Meyer, 2009). Continual denial of one’s partner—­what Fassinger (2004) termed “a thousand points of slight”—is a habitual pro­cess that does not simply dis­appear when the ­couple is safely home, the door locked, and the curtains drawn. When combined with barriers to coupling already pres­ent in the environment (e.g., uncertain legal/fiscal supports and protection of ­family structures), the similarity of female same-­sex ­couples to sanctioned (i.e., heterosexual married) relationships in longevity and relationship satisfaction (Kurdek,


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2005; Peplau & Fingerhut, 2007) is notable. The commitment of ­these ­couples offers impor­tant perspectives about relationship strength, sometimes denigrated in relational discourse as “fusion” or “merging” (overly close bonding between ­women); that ­there is no validity to this notion has been demonstrated empirically (e.g., Frost & Eliason, 2014), but the idea persists, an example of a male relational style (autonomy) applied to ­women’s relationships and finding their patterns to be pathological. Fortunately, one positive outcome of the growth in marketing to sexual and gender minorities is the creation of affirming media that offer more realistic depictions of their lives, including community diversity and realistic sexual situations (Bond, 2015), which validate their intimate relationships. Indeed, the importance of social support in buffering the impact of prejudice and heterosexism has been well-­documented for sexual minorities (Mason, et al., 2015) and gender (e.g., Barr, et al., 2016; Nuttbrock, et al., 2015). For w ­ omen and sexual or gender minorities who also are p ­ eople of color, the regulation and control of sexuality may be further exacerbated by culturally specific dictates about normative heterosexuality and the gendered roles and expectations for ­women and men, e.g., machismo and marianismo in Latino/a communities, the “Mammy” and “Jezebel” images of African American ­women, and the geisha ste­reo­types of Asian American ­women (Fassinger & Israel, 2010; Moradi & DeBlaere, 2010). Research has found, for example, that sexual minority p ­ eople of color experience compounded forms of oppression related to race/ethnicity, gender, and sexual orientation, with attendant risks of compromised m ­ ental health (Sung, et al., 2015; Sutter & Perrin, 2016; Velez, et al., 2015; Walch, et al., 2016). ­Women and sexual or gender minorities of color who are older or have disabilities are virtually invisible in discourse about sexuality (Miles-­Cohen & Signore, 2016; Schwartz, et al., 2014; Vacha-­Haase & Donaldson, 2017). Pathologizing and Medicalizing Diverse ­Women’s Sexualities One outcome of the regulation of w ­ omen’s sexuality and sexual be­hav­ ior is the problematizing of their sexual functioning, particularly through the medicalization of normative physiological pro­cesses. Examples of such bio-­political discourses are readily available, such as “raging hormones” associated with menstruation and menopause, feminine hygiene products that make bodily pro­cesses “sanitary” (i.e., invisible), and drugs that promote “freedom” by suppressing menstruation (an issue given recent impetus in debates about hormone suppression for gender-­variant adolescents). Moreover, the medicalization of ­women’s sexuality often is or­ga­nized around pleasing the (presumably) male partner. For example, “­laser vaginal rejuvenation” (a surgical procedure that reconstructs the hymen, tightens the vagina, and alters the appearance of the labia) is touted as a way of enhancing sex for ­women, but it is not connected to any known paths


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to ­women’s sexual arousal. As another example, the physical changes associated with menopause (e.g., vaginal dryness) are widely publicized and medically treated, but most w ­ omen report ­little or no change in subjective arousal (Etaugh, 2008; Schwartz, et al., 2014), suggesting that it is men’s needs being served by impediment-­free sexual access to ­women. Interestingly, lesbians report less concern about menopause than do heterosexual w ­ omen (Schwartz, et al., 2014), perhaps due, in part, to fewer prob­lems with body image and less self-­definition based on ­mother or spouse roles. Much of the regulation of ­women’s sexuality focuses on pregnancy and disease prevention, and t­ hese emphases in the dominant social discourse serve to maintain bifurcated views of ­women as reproductive vessels (Madonnas) or sexual miscreants (whores). The vaccine for ­human papillomavirus (HPV) is an example of the tendency to pathologize ­women’s (but not men’s sexuality) in that its initial rapid distribution was targeted at young girls in the name of disease prevention; indeed, one writer (Levine, 2007) asserted: “Never has compulsory use of a drug been pushed with such breakneck speed . . . ​advanced largely through po­liti­cal and legislative channels instead of medical authorities and public education campaigns.” The marketing of the drug focused the responsibility for preventing the spread of HPV solely on girls and ­women, and (although now marketed to boys and men as well) it illustrates the presumption of wanton female sexuality as a public health threat. The well-­documented reluctance of men to use condoms means that ­women bear the burden not only of preventing sexually transmitted infections (STIs) but pregnancy as well, and research shows w ­ omen reluctant or unable to interfere with male power and plea­sure even for reasons of self-­protection. One analy­sis (Bowleg, et al., 2004) of relationships and sexual scripts among African American w ­ omen, for example, illuminated the Catch-22 that ­these w ­ omen experience related to safer sex be­hav­iors. Researchers found two sexual scripts broadly endorsed by participants: men control sex, and w ­ omen want to use condoms but men control condom use; thus, ­women perceived no control over sexual activity and safer-­sex practices. Other research with African American ­women found paternalistic cultural practices to be negatively associated with their inquiring about male partners’ sexual histories whereas body esteem was positively associated with inquiry (Brown, et al., 2014). Of course, the dangers of illness and unwanted pregnancy for ­women are real, with ­women of color disproportionately affected (Simoni, et  al., 2010), and ensuring that ­women and girls protect themselves is necessary, but it is imperative that men be made responsible for sexual be­hav­ior. The social discourse around the medical regulation of ­women’s sexuality is codified in treatment of ­mental health concerns as well. The Diagnostic and Statistical Manual of ­Mental Disorders, e.g., DSM-5 (American Psychiatric Association, 2013) has been long-­criticized for its masculinist, ahistorical, and acultural bias, which ignores the impact of w ­ omen’s


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socialization and sexist environments (Basson, 2005; Caplan, 1995; Meston & Bradford, 2007; Spurgas, 2013). This decontextualized view of sexuality erases cultural impact on ­women and shores up the assumption that ­women’s ­mental health difficulties are linked to female anatomy and physiology (Spurgas, 2013). The view of ­women’s sexuality in the DSM-5 and the proposed revisions to the International Classification of Diseases (ICD-11) (Reed, et al., 2016), upon which the DSM is based, is revealing in this regard. In the DSM-5, Hypoactive Sexual Desire Disorder (HSDD), previously applied to both men and ­women (and still so in the ICD-11) is now applicable to men only; ­women are diagnosed using Sexual Interest/ Arousal Disorder (SI/AD) criteria in which desire has been eliminated and replaced with arousal and interest, the latter a cognitive, incentive-­based, reward-­seeking motivation (e.g., to enhance closeness, please one’s partner, avoid discord) for ­women’s engagement in sexual be­hav­ior. The ICD11 distinguishes Female Sexual Arousal Dysfunction from (male) Erectile Dysfunction (DSM-5’s Erectile Disorder), and it applies Orgasmic Dysfunction to both men and w ­ omen whereas the DSM-5’s Female Orgasmic Disorder applies only to w ­ omen. A reading of DSM-5 diagnostic changes, thus, suggests that men suffer difficulties in desire or erectile functioning whereas w ­ omen’s prob­lems are a complicated amalgam of cognitively-­ based motivations, compromised physiological arousal, and inability to climax through the penile-­vaginal intercourse that typifies heterosexual relationships (Spurgas, 2013). The DSM-5’s erasure of desire (and replacement with interest and arousal) in framing w ­ omen’s sexual prob­lems has been controversial (Reed, et al., 2016). According to Spurgas’ (2013) analy­sis of DSM-5 shifts, men’s desire is seen as constant, initiating, driven, and spontaneous, whereas w ­ omen’s desire is viewed as passive, receptive, responsive, flexible, and complex; w ­ omen are presumed to exist in a state of “sexual neutrality” (p. 188) in which they must be sexually triggered by a partner due to their natu­ral receptivity or responsiveness (vs. physical arousal, which is viewed as non­ex­is­tent, disconnected from emotional and m ­ ental arousal, or out of awareness in w ­ omen); ­women are thought to be motivated largely by non-­sexual incentives to sexual activity (e.g., enhancing the relationship). The new diagnostic criteria, thus, pres­ent receptivity, flexibility, and responsiveness as “essential features of female sexuality via [flawed] neuroscientific and photoplethysmographic research and as in need of training [via therapeutic intervention]. Lack of responsiveness to a partner’s advances is a criterion for diagnosis of sexual dysfunction” and desire is eradicated as a “constitutive component” of female sexuality (p. 187). Spurgas (2013) asserts that diagnostic schemas positing w ­ omen as “the receptive sex” reinforce a service-­oriented w ­ omen’s sexuality, support the primacy of male sexual demands, force w ­ omen into cost-­benefit analyses of sexual engagement, obfuscate the notion of consent, and promote coercive sex and trauma.


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Moreover, the framing of treatment in DSM-5 diagnostic discourse is especially damaging to w ­ omen (Spurgas, 2013). In men, sexual prob­lems are mechanical and hydraulic (physical ailments easily rectified through phar­ma­ceu­ti­cal interventions, e.g., Viagra®) whereas, in w ­ omen, prob­lems lie in fundamental errors in the mind-­body system itself (i.e., psychological blocks to physical plea­sure, requiring mind-­based interventions such as neurotransmitter drugs or psychotherapy). Hetero-­normative sexual proscriptions are encoded firmly in this discourse, with penile-­vaginal intercourse legitimized as the appropriate way to have sex and the presumption of a fundamental disconnect between ­women’s subjective and objective arousal invoked to “reaffirm narratives of sexual difference” (p. 195), thus reinforcing heteronormative assumptions of male-­female complementarity in sex. ­These assumptions, of course, ignore “questions regarding why ­women would need to find reasons to be interested in (heterosexual) sex or responsive to their (male) partners outside of their own desire . . . ​[or] questions concerning the inequities and systems of internalized domination that might produce this unequal sexual situation between men and ­women” (Spurgas, p. 201, 2013). The DSM-5 has received less criticism regarding sexual orientation and gender diversity ­after many years of determined attempts to eradicate heterosexism (and, more recently, cissexism) from diagnosis. The ICD-11 deletes all categories of disorders related to sexual orientation consistent with DSM-5. However, DSM-5 retains gender identity categories as m ­ ental disorders (labeled Gender Dysphoria, emphasizing distress/dysfunction although the challenge is distinguishing between distress related to social consequences of gender variance vs. transgender identity itself) whereas ICD-11 removed them as disorders (labeled Gender Incongruence) and permits diagnosis without distress/dysfunction, recognizing the stress of an oppressive environment. ICD-11 also is stricter than DSM-5 in the diagnostic criteria for Gender Dysphoria of Childhood to recognize gender-­ variant be­hav­ior as normal and typically not per­sis­tent into adulthood. Again, it may be tempting to dismiss seemingly minor details of diagnostic wording, but t­ hese systems proscribe the ways that sexual prob­ lems are judged and treated, and they lend medical and psychological credibility to demeaning messages about w ­ omen’s sexual functioning that are internalized by ­women to their own detriment. One study, for example, found that participants’ knowledge of Premenstrual Dysphoric Disorder diagnosis (now an official disorder in DSM-5) increased attributions of a hy­po­thet­i­cal ­woman’s premenstrual difficulties and likelihood that a psychiatric diagnosis would be applied (Nash & Chrisler, 1997). Spurgas (2013) summed up the danger: ­ omen who are produced as specific kinds of sexual beings live ­these W identities out with their partners (and their partners experience them as such). Labels and experiences interact, in a never-­ending feedback loop . . . ​


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It is about the living of embodied hierarchies, sexual categories, and ways of being in the world, which take shape within fields of power . . . ​Most ­women ­will never be diagnosed with SI/AD, and many w ­ ill never hear of the disorder . . . ​But we can be certain that the further medicalization and diagnosing of feminine receptivity w ­ ill continue to have intractable consequences for h ­ uman relationships—­sexual and other­wise. Husbandry is on the horizon (p. 202–203).

IMPLICATIONS AND APPLICATIONS The issues we raise in this chapter have impor­tant implications for psychological research, practice, education/training, and advocacy/policy regarding diverse w ­ omen’s sexualities. As our goal is to challenge deeply entrenched, nonconscious ideologies, we leave the reader with questions to ponder. In research, feminists have long pointed out that the dominant social discourse dictates the kinds of questions asked, topics studied, methods utilized, and inferences made from data obtained through scientific study. The cis-­heteropatriarchal social discourse of sexuality has left many impor­tant questions unasked (Brown, 1989). For example, what if the relational experiences of sexual minority w ­ omen (e.g., lesbians, bisexuals, transwomen) w ­ ere centralized rather than marginalized in professional discourse and research in psy­chol­ogy, and what could be learned about w ­ omen’s relational and erotic capacities when not constrained by men or by cis-­heteropatriarchal ideas? Would “relational orientation” instead of “sexual orientation” have become the basis for examining intimate partner choices? Instead of “fusion” or “merging” posited as a prob­ lem in ­women’s same-­sex relationships, would “deep intimacy” (rather than autonomy) be perceived as the standard for a successful intimate relationship? Would “economic heterosexuals” (­women who pair with male partners for financial security) garner as much suspicion as “po­liti­ cal lesbians” (­women who choose same-­sex partners based on feminist po­liti­cal ideologies)? Would “nonmonogamy,” defined by something it ­isn’t, become more acceptable as “polyamory,” something it is? Would attending to cultural realities prize “bringing in” intimate partners to families and communities instead of the individualistic “coming out” of a hy­po­thet­i­cal closet? What if ­women who broke through bound­aries of constrictive ideologies ­were viewed as admirable adventurers instead of dangerous deviants? ­These kinds of questions reveal the unexamined assumptions and beliefs that undergird con­temporary sexual discourse, beliefs that must be uncovered and interrogated. The implications of our discussion of diverse ­women’s sexualities for clinical practice can be condensed into one overarching question: How would counseling and psychotherapy effectiveness be enhanced by therapists learning how to talk about sex and gender in therapy (Pope, et al., 2006)? What could be gained—­individually and societally—by operating from a feminist multicultural standpoint of helping diverse ­women (and


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men, and t­ hose who eschew the gender binary) to understand and actively challenge the sociopo­liti­cal contexts of their sexual lives (Morrow & Hawxhurst, 2013)? What might change in intimate relationships if the full range of healthy (i.e., not harmful to oneself or ­others), egalitarian, pleas­ ur­able, playful, agentic sexual activities ­were celebrated rather than hidden and feared? Of course, prac­ti­tion­ers are unlikely to become facile in working with sexual content in therapy ­u nless they have been trained thoroughly and appropriately to work with such material; thus, sexually competent clinical practice is inextricably linked to issues of professional education and training. How can psychologists (who are not immune to internalization of societal messages about sexuality) be taught to avoid perpetuating the sexual status quo in their therapeutic interventions with clients? What kinds of experiences must be incorporated into doctoral training and continuing education to help prac­ti­tion­ers dispel myths and misinformation about sexuality in themselves and their clients? How can training programs minimize trainee refusal to work with clients based on religious beliefs (American Psychological Association, 2013 a, b)? In addition to inculcating accurate, appropriate knowledge and attitudes regarding diverse ­women’s sexualities, what can feminist multicultural models of therapy contribute to a liberatory practice in which m ­ ental health ser­vice delivery is radically transformed for accessibility and relevance to all p ­ eople? Unfortunately, professional psy­chol­ogy training programs appear to provide ­little or no consistent, coherent training in gender or sexual minority issues at pres­ent (Phillips & Fitts, 2017). Although most training directors of doctoral programs in counseling psy­chol­ogy (where diversity is considered a core value) have reported incorporating the APA’s multicultural (American Psychological Association, 2003) and LGB (American Psychological Association, 2012b) guidelines (93 ­percent and 88 ­percent respectively), very few (17  ­percent) included the APA guidelines for working with girls and ­women (American Psychological Association, 2007b). Use of the recent APA guidelines for TGNC p ­ eople (American Psychological Association, 2015) has not been studied, and issues of aging and disability w ­ ere absent (Miville, 2013), despite the existence of APA guidelines in both of ­those areas (American Psychological Association, 2012a; 2014). Moreover, reports from students regarding their training suggest “a troubling lack of complexity in training on sexual minority and TGNC issues in m ­ ental health programs” (Phillips & Fitts, 2017, p. 369), and it is prob­ ably safe to assume that, even when relevant coursework is offered, it very likely avoids explicit attention to sexual be­hav­ior and practices. ­There also is a disconnect between trainees’ (over)estimations of their competence to work with sexual minority clients vs. ­actual demonstration through formal assessment where they tend to use out-­dated, stereotypic language and conceptualizations in analogue studies of clients (Phillips & Fitts, 2017).


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Education in sexuality must not be limited to the training of professional psychologists; although this may produce clinicians better able to ameliorate suffering stemming from sexual difficulties, it does not prevent such difficulties from occurring in the first place. How can education about sexuality offer comprehensive and accurate information to girls and ­women (as well as boys and men and t­ hose who eschew the gender binary) in schools, religious institutions, communities, and families? How can school-­based sex education for adolescents (the predominant locus of public sex education) be protected in a context of increasingly expanding abstinence-­ only education programs funded by conservatives, especially in the south (Kendall, 2014)? How can comprehensive sex education programs become more effective in achieving desired sexual health and be­hav­ior outcomes (e.g., condom use) at the individual level? How can t­hese programs more successfully disrupt deeply entrenched systemic influences on adolescents, such as heterosexist/ homophobic school climates and gendered double standards in sexual scripts (Kendall, 2014)? In the advocacy/policy arena, the overarching question at pres­ent is: How can gains in basic rights for ­women and sexual/gender minorities be protected and advanced ­under the severe threat of conservative backlash? How can ­mental health consequences of hate-­motivated legislative efforts (Levitt, et al., 2009; Rostosky, et al., 2009) be addressed? How can psy­chol­ogy as a profession best fight the onslaught of healthcare refusal bills, blocked access to abortion and birth control, bathroom restriction bills, immigrant exclusion legislation, challenges to same-­sex marriage, and defense of male perpetrators of sexual vio­lence? Research indicates that collective action attenuates the stress of societal oppression for marginalized groups (Velez & Moradi, 2016), suggesting that advocacy is healthy. It is our hope that this chapter inspires collective efforts in schools, communities, workplaces, and ­legal institutions to advance accurate, inclusive, agentic, affirming, and empowering con­temporary portrayals of diverse w ­ omen’s sexualities. REFERENCES American Civil Liberties Union. (2003). Why sodomy laws m ­ atter. Retrieved on March 2, 2007 from http://­www​.­aclu​.­org​/­lgbt​/­crimjustice​/­11896res20030626​ .­html. American Psychiatric Association. (2013). Diagnostic and statistical manual of m ­ ental disorders (5th ed.). Arlington, VA: American Psychiatric Association. American Psychological Association. (2003). Guidelines on multicultural education, training research, practice, and orga­nizational change for psychologists. Retrieved from http://­www​.­apa​.­org​/­pi​/­oema​/­resources/policy/multicultural-­guide​ lines.aspx. American Psychological Association. (2007a). Report of the APA task force on the sexualization of girls. Washington, DC: American Psychological Association.


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Chapter 6

­Women’s Friendships and Romantic Relationships: Culture, Sexuality, and Lifespan Contexts Donna Castañeda and Alyson L. Burns-­Glover

The term “relationship” implies something more than a transitory interaction or superficial feeling for another, and it is in our relationships with friends and romantic partners that we often experience our deepest emotional connections. Although both w ­ omen and men need and seek out close relationships, several theories propose that relationships may be particularly impor­tant in ­women’s lives. For example, differential gender socialization may promote a greater interest in and concern for relationships among ­women than among men (Cancian, 1990; Maccoby, 1998). Object relations (Chodorow, 1978; Jordan & Surrey, 1986) and self-­in-­relation theory (Jordan & Surrey, 1986; Surrey, 1993) posit that relationships are more central to ­women’s sense of self than to men’s. According to the object relations approach, the centrality of relationships for w ­ omen is thought to stem from differing developmental experiences and pathways, i.e., the continuity of w ­ omen’s identification with m ­ others from early infancy, contrasted with men’s emotional and psychic separation from ­mothers in early infancy, thought to be necessary for men to establish a masculine identity. Our aim h ­ ere is not to debate the merits or limitations of t­ hese theories, but taken together, they point to the impor­tant role that relationships play in w ­ omen’s lives. In this chapter, we review research on w ­ omen’s friendships and romantic relationships. Regarding friendships, we discuss rules and expectations of ­women’s friendships with each other; the role of intimacy in ­women’s friendships; how they are related to ­mental health and


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well-­being; electronic media and ­women’s friendships; and how ­women’s friendships can serve as a form of re­sis­tance to oppression. We then turn to the topic of ­women’s romantic relationships, where we discuss dating, partner preferences, sexuality, sexual satisfaction, sexual prob­lems, and relationship satisfaction. ­WOMEN’S FRIENDSHIPS Although strong, affectionate, and enduring relationships between ­ omen have existed throughout history, w w ­ omen’s friendships with each other have historically been viewed as less impor­tant than men’s friendships with men, and this devaluation has been reflected, up ­until recently, in the invisibility of the study of ­women’s friendships in the research lit­ er­a­ture (O’Connor, 1992; Yalom & Brown, 2015). ­Today, ­women’s friendships with each other are increasingly understood to constitute some of the most impor­tant relationships established in their lifetime. In fact, modern social arrangements have redefined the importance of friendship and the functions its serves. While ­family and friends continue to be seen as distinct entities, non-­family members are now more likely to be seen as extensions of ­family and serve the functions of f­ amily members for many (Allan, 2008). The social capital afforded by friendships can serve as a bulwark against the fragility of f­ amily and partner ties. As Suanet, et al. (2013) noted, “kin and non-­kin have become more alike in terms of the degree of security, durability, and instrumental and emotional support provided within t­ hese relationships” (p. 641). Furthermore, in the U.S. context, demographic realities of ­women’s longer lifespan, and increasing numbers of never-­married or living-­alone ­women across all race/ethnic groups (Wang & Parker, 2014), have repositioned ­women’s reliance on non-­kin for support and well-­being. Implicitly, or sometimes explic­itly, definitions of friendship include the notion that they are entered into and maintained voluntarily, and that, unlike other significant relationships, friendships in Western cultures are not formalized through familial or societal structures or obligations (Fehr, 1996; Stein, 1993). In fact, the imposition of rigid role structures may be viewed as antithetical to formation of true friendship bonds (Bell & Coleman, 1999). On the other hand, research reminds us that friendships may not be completely voluntary. We are most likely to become friends with ­those who are of the same gender, similar in age, social class, sexual orientation, race/ethnicity, and who live in the same geographic area (O’Boyle & Thomas, 1996; Rose, 1995; Serafica, et al., 2000; Way & Chen, 2000). Immigrant w ­ omen may also be limited in their friendship choices by language, the ethnic/racial diversity of the communities they live in, and the degree of emphasis on ­family versus non-­family social network development (Serafica, et al., 2000). Lesbian ­women are more likely than heterosexual


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­ omen to develop friendships with other lesbian ­women through intenw tionally constructed situations, such as through mutual acquaintances, private parties, gay rights events, ­etc., than through chance encounters (O’Boyle & Thomas, 1996). In a large-­scale, comparative analy­sis of cross-­ category friendships Galupo (2009) found that sexual minority adults are significantly more likely to have cross-­orientation friendships than their heterosexual peers. Among Latinas, friendships with ­women ­family members are emphasized and may be especially close (Hurtado, 2003). Large-­scale studies of familial and friend relationships indicate that non-­Hispanic whites and African Americans differ in their preference for kin and non-­k in social support networks, in that African Americans have less frequent interactions with and give less support to non-­kin (Taylor, et al., 2013). However, qualitative researchers have found consistent evidence for the importance of same-­gender friendships (­sister friends) for African American w ­ omen and therapists note the importance of constructing and maintaining s­ ister friendships for healing and empowerment (Bryant-­Davis, 2013; Hughes & Heuman, 2006). Among working class w ­ omen, friendships with f­amily members are also more common than among middle-­class ­women, and working-­class ­women tend to interact more frequently with their friends than middle-­ class ­women (Walker, 1995). In addition, class differences are seen in the types of activities working-­class and middle-­class ­women engage in; for example, working-­class w ­ omen place more emphasis on same-­gender socializing and are more likely to engage in “girls’ night out” with their ­women friends, while middle-­class ­women are more likely engage in mixed-­gender socializing activities (Walker, 1995). Policy itself may contribute to or constrain w ­ omen’s friendships; for example, ­women of color who are poor may be especially subject to housing policies that ignore ­women’s social network and emotional needs (Cook, et al., 2000). ­Women’s Friendship Rules and Expectations While friendships may be entered into and ended more easily than other social relationships, be­hav­ior in friendships is guided by rules that, if broken, can lead to conflict and even the dissolution of a friendship. Friendship rules encompass a variety of be­hav­iors and values, such as being a friend in times of need, mutual self-­disclosure, respecting private information told in confidence, standing up for a friend in public, e­ tc., and ­women and men endorse t­ hese rules to the same extent (Argyle & Henderson, 1984; Argyle & Henderson, 1985; Felmlee, et  al., 2012). Among older adults, men and w ­ omen hold similar friendship norms for trust, re­spect, and commitment (Felmlee & Muraco, 2009). Nonetheless, ­women tend to hold their female friends to higher standards regarding t­ hese rules and to enforce and monitor adherence to them


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more compared to men (Felmlee, et al., 2012; Fuhrman, Flannagan, & Matamoros, 2009). W ­ omen are especially critical of female friends who break a confidence, t­ hose who cancel plans with them to be with someone e­ lse, or t­ hose who do not confide their feelings (Felmlee, et al., 2012). ­Women tend to value friendship be­hav­iors that contribute to emotional closeness, and, in fact, ­women who are less competent in providing emotional support in a friendship are judged by w ­ omen more negatively than men lacking such skills (Holmstrom, et al., 2005). Indeed, in a study investigating perceptions of high and low person-­centered online emotional support communications, w ­ omen preferred high person-­centered over low person-­ centered helpers, and all respondents w ­ ere more likely to attribute female gender to ­those who use high person-­centered communication when the gender was not specified (Spottswood, et al., 2013). A problematic aspect of friendship rules is that they are often assumed, rather than articulated. The supposed “naturalness” of friendship formation can inhibit ­women from explicit discussion of expectations from each other and the friendship. Without the formal societal mechanisms in place to support friendships as ­there are for other relationships (e.g., marital counseling, workplace mediation), friendships can easily disintegrate (Wiseman, 1986). In light of this, that w ­ omen’s friendships may entail contradictions and complexities is not surprising. The question then becomes not why ­women’s friendships may fail, but why they can be quite durable and strong (Finchum, 2005). Another unspoken rule that influences ­women’s friendships is that competitiveness should not be a part of t­hese relationships (Rind, 2002). For ­women, the presence of competition in a friendship can be lead to feelings of ambivalence and discomfort (Rind, 2002). In a series of interviews with ­women specifically about their best friends, Rind (2002) found that three major themes emerged: knowing and understanding, neediness and dependence, and competition among w ­ omen. In this case, competition among ­women friends took place over jobs, academic per­for­mance, social standing, among other arenas, but all the participants experienced competition negatively. Competition and rivalry between w ­ omen friends may also arise due to differing perceived levels of attractiveness. In a study of heterosexual white college ­women friendship pairs, researchers have found that, while ­women tended to be friends with ­others who ­were similar in attractiveness, they still perceived that one of the pair was more attractive. In this case, t­ hese w ­ omen agreed about which of the pair was the more attractive friend, and the less attractive friend reported a greater sense of competition in attracting male attention (Bleske-­Recheck & Lighthall, 2010). T ­ hese comparison effects ­were also seen in studies of body image. ­Women’s close friends’ body size, i.e., thin or heavy, affected their own feelings about their body, although this effect occurred only when w ­ omen w ­ ere less comfortable with intimacy in that par­tic­u­lar friendship. When ­women


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­ ere comfortable with intimacy in the friendship, this comparison effect w did not occur (Young, et al., 2014). Part of the difficulty with competition may stem from ­women’s socialization surrounding competition. ­Women are not necessarily socialized to deal forthrightly with competition; while girls’ play activities certainly include achievement, they are not necessarily at the expense of other girls, e.g., jump rope, hopscotch (Lever, 1976). Competition is more prevalent in boy’s play activities, than in t­hose of girls, and boys learn to negotiate competition in their play activities so the activities can continue (Maccoby, 1998). Boys’ activities are also more governed by rules than by relationships. Subsequently, when disputes develop among girls, they are more likely to dissolve their play activities than are boys (Maccoby, 1998). ­These interaction patterns may continue into adulthood and affect how ­women respond to competition in their friendships with w ­ omen. Evolutionary theory also contributes to understanding the role of competition in ­women’s friendships. In her review of female-­female competition, Benenson (2013) identified three consistent princi­ples: 1) females create alliances and co­ali­tions with other ­women to protect themselves from physical harm; 2) females promote and monitor equality in relationships to ensure reciprocal investment of resources; and 3) females’ friends are available to join in acts of social exclusion against a targeted other ­woman. According to Benenson (2013), ­women have developed elaborate strategies to avoid or disguise overt competition all in ser­vice to survival of themselves, their offspring, and kin. Likewise, another expectation of w ­ omen’s friendships is that they are, or should be, egalitarian. In a sample of young adults, Veniegas and Peplau (1997) found that 60 ­percent of their sample was involved in an unequal power friendship, thus countering the notion that friendships are always egalitarian. They found no differences in the proportion of w ­ omen and men who reported power inequalities in their friendships; they did find, however, that friendship quality was related to the distribution of power. Both ­women and men rated equal-­power friendships greater in relationship quality (e.g., emotionally close, satisfying, disclosing) than unequal-­power friendships. In this case, the effects of power on friendship quality ­were greater than the effects of gender. The assumption of equality in ­women’s friendships may also underplay needs w ­ omen have, and that friendships can fulfill, for power, status recognition, and ego support. In a study of ­women aged 14 through 80, for instance, three friendship functions that ­were impor­tant to ­women across age groups ­were identified (Candy, et al., 1981). Along with intimacy assistance, which includes the notion of intimacy and mutual assistance, this study also identified status, which implies that friends may provide recognition and self-­esteem, and fi­nally, power, which includes the notion of influence or control over o ­ thers. Similarly, one of the few gender differences in evaluation of the quality of same-­sex friendships found by


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Veniegas & Peplau (1997) was that ­women rated their friendships higher than men in ego support, meaning that their ­women friends more often noticed and appreciated their abilities and congratulated them on their good fortune. Bank and Hansford (2000) found that the concept of status orientation, the degree that a friendship provided re­spect, influence, and prestige for the other, contributed positively to intimate friendships. They also found that it was more impor­tant to ­women than to men that this ele­ ment be a component of their friendships. ­These studies highlight the expressive qualities that ­women’s friendships include, such as closeness and intimacy, but they also demonstrate the nonreciprocal qualities of friendship, such as power and recognition, that in a culture where gender in­equality is a per­sis­tent real­ity, may also be impor­tant aspects of ­women’s friendships. Research on lesbian friendships provides a picture of diverse and alternative forms that friendships between w ­ omen can take and may challenge narrower views of this relationship currently available in the research lit­er­a­ture. For example, sexuality is always thought to be potentially pres­ent in cross-­sex friendships (Bleske & Buss, 2000; Kaplan & Keys, 1997; Sapadin, 1988), but research on the role of sexuality in friendships between heterosexual ­women, or its developmental importance among heterosexual adolescent girls, is virtually unheard of (Diamond, 2000). On the other hand, research shows that, among lesbian w ­ omen, friendships may be less distinctly separated from romantic relationships and lesbian ­women appear to be more likely to remain close friends with their ex-­lovers than are heterosexual ­women (see Kitzinger, 1996; Kitzinger, & Perkins, 1993; Weinstock, 2004). Intimacy in ­Women’s Friendships As we have indicated previously, an over-­riding feature of ­women’s friendships is intimacy. Intimacy is often estimated from the extent of self-­ disclosure, or self-­revealing talk, that occurs between two persons and results in each feeling known and validated by the other (Altman & Taylor, 1973; Clark & Reis, 1988; Mark & Alper, 1985). Even though both ­women and men recognize the importance of talk for developing intimacy (Fehr, 2004; Radmacher & Azmitia, 2006), ­women engage in this talk more than men in their friendships (Adams, Blieszner, & De Vries, 2000; Hays, 1985), and this is true across age groups among w ­ omen (Goldman, et al., 1981). This may be a reason that, when friendship quality ratings are compared, men’s friendships with each other usually rank lowest in quality (Elkins & Peterson, 1993) or strength (Wright & Scanlon, 1991) compared to ­ women’s same-­ sex and cross-­ sex friendships. Even in friendships maintained exclusively online, t­ hose between w ­ omen, or between w ­ omen and men, show greater intimacy ­after two years than ­those between men (Cheng, et al., 2006).


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Other research contests this gender dichotomy in expressiveness and intimacy in friendships and suggests that the reported gender differences are e­ ither very small or non­ex­is­tent (Duck & Wright, 1993; Wright, 1982, 2006). What differences do exist are not necessarily due to w ­ omen and men defining intimacy differently, e.g., that men define intimacy as shared activities and w ­ omen as self-­disclosure. In fact, when women-­centered activities are the focus of investigation, ­women’s ability to create enduring and strong intimate bonds through shared activities is readily seen (Piercy & Cheek, 2004). ­These differences are also not due to ­women and men having dif­fer­ent developmental pathways to intimacy (Radmacher & Azmitia, 2006). Men may be just as able and even prefer greater intimacy in their friendships with men; they may also understand that openness and expressions of caring and support contribute to this. Recent research suggests that men choose to be less expressive primarily b ­ ecause they anticipate that their overtures would be negatively received by other men (Bank & Hansford, 2000; Fehr, 1996, 2004). In addition to gender differences in intimacy, variations to this pattern may also be seen when social class, ethnicity/race, and culture are considered. Professional middle-­class ­women may be less likely to self-­disclose to their ­women friends than working-­class ­women (Walker, 1994). This may be due to the greater geographic and occupational mobility middle-­ class professional ­women experience compared to working-­class ­women and to the workplace competition they perceive with ­women they work with. Walker’s research points to how conceptualization of gender as an ongoing social construction within specific contexts, rather than a result of socialization or psychoanalytic pro­cesses, may be more useful in understanding gender differences in expressiveness (Walker, 1994). In Western socie­ties, where an in­de­pen­dent construction of self exists, intimacy and self-­disclosure between friends are much more likely to occur, whereas in socie­ties where an interdependent construction of self predominates, ­these pro­cesses may be less pronounced, or may occur along with other culturally impor­tant pro­cesses. Native Hawaiian w ­ omen friends, for instance, stress the interpersonal pro­cess of aloha in their relations with each other. This concept refers to openness to o ­ thers, being generous both materially and emotionally, not being possessive, and willing to let other ­others touch one emotionally (Ito, 1999). In West African socie­ties, for instance, the notion of enemyship, that ­others may be a source of harm, is a more marked aspect of social real­ity; thus, cautious ambivalence surrounding closeness and intimacy in social relationships is more prevalent than in North American social relationships (Adams, et al., 2004). Due to the strength of ­family ties and cultural constraints on strong emotional expression, students in Asian countries may engage in less intimate sharing in their friendships. Compared to university students in the United States, Chinese university students self-­disclose less across vari­ous topics (work, opinions, personality, ­etc.,) and target persons (intimate


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friends, parents, acquaintances, ­etc.) (Chen, 1995). Among Korean and American university students, w ­ omen engage in intimate exchanges with their friends more than men in ­these two groups, but overall, Korean students do this less than American students (Yoo & Malley-­Morrison, 2000). In a study that compared students in Rus­sia and the United States, ­women university students in Rus­sia and the United States engaged in more intimate conversation in their friendships than did men in t­hese countries, but overall, Rus­sian ­women and men did this less than American ­women and men (Sheets & Lugar, 2005). Friendships among Rus­sian university students tended to be more focused on activity than on intimacy compared to t­hose in the United States. ­These differences can be interpreted as cultural differences, but they may also be related to the greater need for discretion that developed u ­ nder generations of Communist rule; greater communal and crowded living conditions that increase the need to control revelation of self-­relevant information; and the greater social and economic flux in Rus­sian society recently where d ­ oing t­ hings with and for each other emerges as a more impor­tant pro­cess in friendships than self-­disclosure. To date, a considerable amount of research has been done to explore and explain gender differences in friendship intimacy (Monsour, 2002), attesting to the cultural primacy given to ­women’s relationships with men that we mentioned earlier. But from a feminist perspective, a more impor­ tant question is how might the social construction of t­hese differences support and reinforce gender inequalities? ­Women’s friendships may be valorized for their greater intimacy than t­ hose of men, but w ­ omen still have less access to impor­tant resources and they continue to occupy a secondary status in relation to men in society. In the work world, access to power, influence, and upward mobility continue to be more available to men. Intimacy and expressiveness in relationships are resources that ­women may have to a greater extent than men, but t­ hese resources do not obtain for them greater mobility in the highest echelons of economic and po­liti­cal power. In fact, the qualities of caring, closeness, and intimacy that ­women may be more a­ dept at in their social relationships continue to be devalued in the larger culture (Taylor, 2002). Despite the emergence of a feminized version of friendship that is now considered the standard by which both ­women and men’s friendships are evaluated, and that men’s friendships might even be seen as deficient in comparison to ­women’s friendships (Cancian, 1990), this in no way alters patriarchal cultural, po­liti­cal, or institutional structures in society (O’Connor, 1998; Rose, 1995). ­Mental Health, Well-­Being, and ­Women’s Friendships Generally, having friends is related to positive ­mental health and well-­ being for ­women across age groups (Comas-­Diaz & Bakur Weiner, 2013) and a wealth of research attests to this. W ­ omen’s friendships with each


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other have been consistently demonstrated to lead to w ­ omen’s positive health outcomes (Griffiths, et al., 2009; Moremen, 2008), to lead to life satisfaction (Gillespie, et  al., 2014), and to modulate their stress responses (Howard & Hughes, 2012; Taylor, et  al., 2000). Furthermore, friendships provide w ­ omen with social support (Hall, 2011), opportunities for companionship and enjoyable social interaction (Fehr, 1996; Severance, 2005), intimacy (Fehr, 2004; Parks & Floyd, 1996; Sapadin, 1988), and instrumental assistance (Nyamathi, et al., 1995; Patterson & Bettini, 1993; Walker, 1995). Research also suggests that the quality of friendships is impor­tant to older ­women’s ratings of positive affect (Siu & Phillips, 2002); reduction of loneliness (Stevens & van Tilburg, 2000); and as a form of therapeutic intervention for el­derly ­women (Martina, Stevens, & Westerhof, 2012; Thanakwang, et al., 2012). Friendships also contribute to ­women’s social and personal identities, although this may vary across the lifecycle (Demir & Orthel, 2011; Felmlee & Murcao, 2009). For example, in her longitudinal study of college ­women’s female friendships, Martinez Alemán (2010) found that ­these relationships w ­ ere key ele­ments in young ­women’s cognitive development in the late adolescent/early adulthood life stage. Through dialogue, ­these relationships provided opportunities for increased learning, complex reasoning surrounding decision making, intellectual growth, and enhanced self-­development and self-­understanding. In her studies of how “nurturing and tending” are key features of ­women’s relationships Taylor (2002) provides a framework for understanding how such social ties affect health and well-­being. Taylor’s research focuses on the physiological expression of ­these social ties. She argues for the “complete necessity” of friendships (p. 89) and contends that the classic models of the ­human stress response and health do not capture the female experience. She asserts that ­under conditions of stress, ­women activate their social bonds, rather than avoiding social contacts. In addition, she found physiological distinctions based on gender. When ­under stress, ­women’s physiological systems ­were more negatively activated when in the presence of a supportive male companion than when in the presence of another ­woman. In addition, the research indicates that when ­women are ­u nder stress, they specifically seek out and choose to be with other ­women. The stress hormone system, according to Taylor (2002), differentiates between the gender of the social companion; men increase w ­ omen’s stress response, and other ­women activate a calming response. Taylor’s conclusion is that this model of seeking out support ­under conditions of stress is adaptive for ­women physiologically, socially, and materially. She also notes that this be­hav­ior is at odds with the individualistic values of the dominant culture. She argues for the need to re-­create our modern society into a “tending society” in which w ­ omen’s focus on social ties is valued instead of being viewed as antithetical to individual ambition or personal self-­realization.


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Electronic Media and ­Women’s Friendships Unlike in the past, where researchers relied on w ­ omen’s letters to each other or face-­to-­interactions to understand w ­ omen’s friendships with each other (Yalom & Brown, 2015), ­today, electronically mediated communication, such as social media sites, email, text­ing, chat rooms, news rooms, instant messaging, blogs, ­etc., afford a newer win­dow on ­women’s social relationships. At this point in time, use of electronic media has become an integral part of daily life for many. Cell phone use is virtually equal among ­women and men and text­ing to communicate with ­others is almost universal in the 18-­year-­old to 29-­year-­old age group (Duggan & Rainie, 2012). In fact, ­today’s Millennials, who as a generation are considered the first “digital natives,” are expected, as they age, to continue to use electronic media to share personal information, develop friendships, and take advantage of economic, po­liti­cal, and social opportunities that electronic connections provide (Smahel, et al., 2012). Furthermore, patterns of electronic media use, particularly social media, are remarkably similar in adolescents and emerging adults cross-­culturally (Smahel, et al., 2012). While the use of electronic media by w ­ omen and men has converged in terms of frequency, the types of platforms used, the purpose and goals of communication, and patterns of certain communication be­hav­iors, i.e., text­ing versus gaming, continue to differ by gender. For instance, with re­spect to social networking sites, where individuals interact directly with each and can build a personal network that connects them to ­others, ­until recently, w ­ omen ­were more likely to use such sites, but w ­ omen and men are now almost equally likely to participate in ­these platforms and previous racial/ethnic differences have largely dis­appeared (Perrin, 2015). On the other hand, gender differences are more pronounced in which platforms are used. For example, ­women are more likely to use Pinterest, Instagram, and Facebook, while men are more likely to participate in online discussion forums such as Reddit. Men and ­women do not significantly differ in use of Twitter or LinkedIn (Anderson, 2015). Among adolescents, despite similar and almost universal levels of social networking participation, some in­ter­est­ing gender differences can be found in their approach to online friendships (Lenhart, 2015). For example, 57 ­percent of adolescents between the ages of 13 to 17 have met a new friend online. However, girls are more likely to do this through the use of social media, while boys are more likely do so through online gaming activities. Similarly, while 55 ­percent of adolescents use cell phones to text their friends daily in order keep in touch with them, girls are more likely than boys to use text­i ng to converse with friends, while boys are more likely than girls to talk with friends through online gaming activity. Adolescents also use a variety of platforms to engage in cell phone communication, such as instant messaging, video chat, and messaging apps (e.g., Kik, WhatsApp). Fi­nally, social media connections can provide


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emotional support and a sense of social connection, but they can also be a source of interpersonal conflict and the ending of a friendship. When this occurs, adolescent girls are more likely than boys to unfriend, block, or untag photos of former friends in Facebook (Lenhart, 2015). Among emerging adults, social media use provides an impor­tant conduit for maintaining past friendships, such as with high school friends, as well as developing new ones (Manago, et al., 2012). In the transition from the late teens to early adulthood, social media use increasingly serves to support the social and psychological needs for personal connections, continuity in social lives, and relational intimacy in a geo­graph­i­cally mobile world, and this is true for both emerging adult ­women and men. Furthermore, as one study found, both ­women and men preferred to develop online relationships with friends, rather than ­family members or co-­ workers. In this case, the only significant predictor of preference for online communication and relationship building was extent of Internet use, in that t­hose who w ­ ere high users of the Internet had a greater preference for online communication and relationship building than t­hose who used the Internet less (Thayer & Ray, 2006). Contrary to what is generally believed, online relationships can be similar in strength, quality, and degree of self-­disclosure to offline relationships, although offline relationships may be of longer duration than ­those that are online (see McKenna & Bargh, 2000; Parks & Roberts, 1998). Furthermore, a significant proportion of online relationship partners go on to meet each other offline (McCown, et al., 2001; Parks & Roberts, 1998), suggesting that the bound­aries between online and offline relationships are not highly defined. While gendered patterns of self-­disclosure do migrate from face-­to-­face to Facebook interactions, ­there are still differences in be­hav­iors depending on the communication medium. In a recent study, Sheldon (2013) reported that college ­women discuss more topics with their exclusive Facebook and face-­to-­face friends than men, but men disclose more to strangers or new online friends. ­These findings support theories that ­women are more concerned with trusting the person to whom they disclose than are men. For both genders, the length of the relationship is the best determinant of levels of self-­disclosure. Similarly, ­women tend to use the instant messaging app Snapchat more often than men for bonding social capital goals, i.e., to support emotional closeness and strong social ties. Snapchat is an instant messaging app that is sent primarily to individuals or small groups of persons and ­these recipients are most often close friends, partners, or ­family members, rather than large social networks (Piwek & Joinson, 2016). Fi­nally, a recent study found that gender differences in the use of emotionally supportive language on Facebook had more to do with ­whether that communication was public or private. In response to a status update in Facebook, w ­ omen ­were more likely to post a public reply than men and their replies showed a higher level of


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emotional support, compared to ­those of men (Joiner et al., 2014). However, when private Facebook replies ­were examined, no difference in the level of emotional supportiveness between ­women and men was found. Results in this study point to the importance of social context, ­either public or private, in influencing supportive expressions online, rather than differential gender socialization (Joiner et al., 2014). To date, research specifically on w ­ omen’s online friendships is rare and the implications of technology for w ­ omen’s friendships are not yet fully understood. As ­women increase the amount and diversity of their online communication, we are likely to continue to see gender variation in friendship preferences, formation, and functions. An impor­tant understanding is that neither gender nor the Internet may be causally related to relationship formation and be­hav­ior, in as much as the motives, personalities, and identities of the persons involved also affect actors (McKenna & Bargh, 2000; Peter, et  al., 2005). Online interactions are dif­fer­ent from offline ones in that one can be anonymous, without the visual cues that influence interpersonal perceptual pro­cesses, and they offer the possibility of constructing multiple identities across social interactions (McKenna & Bargh, 2000). In fact, for ­those with identities that are marginalized in the larger society, such as t­ hose with stigmatized sexual identities, participation in online relationships can positively transform ­those identities and lead to the desire to more greatly express and incorporate them in real-­world relationships (McKenna & Bargh, 1998; McKenna, et al., 2001). Nonetheless, even with the demo­cratizing and transformative potential of the Internet, o ­ thers remind us that forces of traditional culture, ideology, politics, and economics do not dis­appear with technology use, and ­these forces can insert themselves in Internet relationships as in relationships in the real world (Beetham, 2006; Chiou & Wan, 2006). ­WOMEN’S FRIENDSHIPS AS A FORM OF RE­SIS­TANCE In psy­chol­ogy, w ­ omen’s friendships have been studied as relatively separate from the larger public world of work, politics, and social and cultural movements. Conversely, ­women’s solidarity and sisterhood in po­liti­ cal and social uplift work has been extensively studied (e.g., Giddings, 1985; Liss, et al., 2004; Morgan, 1970), but relatively ­little emphasis has been placed on the role of friendship in ­these efforts. Nevertheless, it would be a ­mistake to ignore how ­women’s friendships with each other can be connected to change at the larger social and cultural level, and that ­women’s friendships with each other can be viewed as “acts of re­sis­tance” (Andrew & Montague, 1998, p. 361). An especially significant historical ­factor related to ­women’s friendships was the rise of the Second Wave ­women’s movement in the 1960s and into the 1970s. In contrast to the up-­to-­then prevailing cultural images of ­women’s friendships with each other as superficial, fraught with envy


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and competition for male attention, and secondary to relationships with men, in the w ­ omen’s movement, friendships between w ­ omen w ­ ere considered primary. Its liberal ideology of sisterhood legitimated ­women’s relationships with each other and encouraged solidarity between ­women. In fact, uniting at both the personal and po­liti­cal levels was considered the ave­nue t­ oward overcoming oppression in a sexist society (Morgan, 1970). Subsequent interrogation of the ideology of sisterhood has exposed its shortcomings; for example, it ignored inequalities between w ­ omen based upon social class, ethnicity/race, and sexual orientation that continue to make friendships between ­women difficult and/or conflictual (Hurtado, 1996; Kilcooley, 1997; Simmonds, 1997). ­Women do not necessarily gravitate ­toward each other just ­because they are ­women, nor are friendships, even close and long-­lasting ones, safe harbors from larger social divisions. A legacy of the w ­ omen’s movement, however, is that it demonstrates how ­women’s relationships with each other are not only a source of individual affirmation and strength, but they also have the potential to initiate social change and challenge the status quo surrounding gender relations in the larger society (O’Connor, 1998; Rose & Roades, 1987). Even outside the context of the w ­ omen’s movement, w ­ omen’s friendships may provide ­women a location in which they can explore, redefine, and subvert their devaluation in the larger society, and friendships can form the basis for working for social change in the larger culture (Johnson & Aries, 1983). This is not a trivial consequence of friendship and can be a transformative experience for ­women. For example, social support, help in ­career advancement, and improvement in workplace atmosphere are all benefits derived from friendships at work (Berman, West, & Richter, 2002), but ­these benefits do not just accrue to individual ­women; they may also empower and help w ­ omen to resist male domination in a gendered workplace and beyond (Andrew & Montegue, 1998). Even among w ­ omen most at the margins of social power and prestige, such as working class, ethnic/racial minority w ­ omen, friendships can contribute to significant changes at the larger social and po­liti­cal level. Chicana cannery workers in California in the 1970s or­ga­nized for better pay, promotions, and equal treatment in the workplace, and this activity grew out of the friendship networks that ­were already in place on the job. Although ­these efforts ­were not explic­itly feminist in origin, they ­were inspired by the w ­ omen’s movement and feminist consciousness within ­these groups evolved over time (Zavella, 1993). Originally developed out of friendships with other ­women, Asian American w ­ omen created social networks that formed the basis of the Asian American ­women’s movement (Wei, 1993). ­Women’s friendships are so often the unexplored backdrop of what seems to be the more impor­ tant activity of po­ liti­ cal organ­izing and social change efforts, but shifting one’s focus brings to light the tremendously impor­tant role that friendships have played in ­these endeavors.


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With this shift in focus, we also begin to see the cumulative and influential effect of w ­ omen’s activities that are enacted outside the traditional oppositional politics and activism characteristic of social movements. ­Women’s re­sis­tance in oppressive marriages, caring and providing for ­children despite economic hardships, contending with racism, sexism, and sexual harassment in the workplace, interacting with hostile and unresponsive institutions—in other words, the daily lives of ­women—­can lead to social change and all t­ hese activities are so often made pos­si­ble with the help of supportive friends (Aptheker, 1989). For instance, using the concept of positive marginality, the idea that ­people at the margins of society do not “necessarily internalize their exclusion but instead embrace difference as a strength and sometimes as a source of critique and action,” Hall and Fine (2005, p 177) describe the friendship of two older black lesbian ­women. Throughout their lives, each could create support systems, spaces among peers ­free of prejudice and ste­reo­types, and possibilities for change despite lives marked by strug­gle and pain. Their friendship was a crucial ele­ment in their ability to derive strength from their experiences, rather than giving up. Louie (2000) describes the case of an immigrant Chinese w ­ oman who worked in the garment industry u ­ nder terrible conditions and with low pay. Over time, ­women in the factory developed nurturing and supportive relationships based upon mutual empathy, practical help, and camaraderie. ­ T hese relationships with other w ­ omen in the factory became the foundation for self-­esteem, personal strength, and validation that helped this ­woman surmount obstacles in her life outside the factory. Through support of her w ­ omen friends, she was ultimately able to break the cycle of oppression of ­women in her own ­family by financially and emotionally supporting her d ­ aughter, to fulfill her own educational and ­career plans. Emotional and personal connection in a friendship can be empowering and can sustain us in difficult times and provide the support to continue to strug­gle against oppression and in­equality, not just for w ­ omen, but for all marginalized and oppressed p ­ eople. Greater investigation of the connection between ­women’s friendships and social change can provide models of the power of ­women’s friendships and expand the definition and function of t­ hese relationships. ­WOMEN’S ROMANTIC RELATIONSHIPS Along with friendships with other w ­ omen, romantic relationships are also central in the lives of many ­women. By romantic relationships, we are referring to partnered relationships between adults that include sexuality, or at least the expectation of sexuality, and where the ongoing pro­cesses in the relationship, such as intimacy, communication, and conflict, are key (Duck, 1993; Scanzoni, et al., 1989).


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Before describing pertinent aspects of w ­ omen’s romantic relationships, we note the dramatic changes that have occurred in the last 40 years in the structure of relationships in the United States. T ­ hese changes include an almost 60 ­percent decline in marriage rates (from 77 marriages per 1000 ­women in 1970, to 32 marriages per 1000 w ­ omen in 2014) (Wu, 2015); the increase in age at first marriage from 21 and 23 years among ­women and men, respectively, in 1970 to 27 and 28  years among ­women and men, respectively, in 2009 (Elliott & Simmons, 2011); and a surprising decline in ­women’s divorce rates, from a high in 1979 of 23 divorces per 1000 ­women to 18 divorces per 1000 ­women in 2014. In fact, the divorce rate in the United States is now at its lowest level since 1970 (Eickmeyer, 2015). With ­these changes, it is not surprising that the rate of persons aged 25 and older who have not married is higher than ever before. In 2012, 1 in 5 persons aged 25 and over had never married, up from 1 in 9 persons aged 25 and older who never married in 1960 (Wang & Parker, 2014). Another change in the structure of relationships has been an increase in the number of c­ ouples who cohabitate, or live together as unmarried partners. Of w ­ omen interviewed between 2006 and 2010, 48 ­percent cohabitated with a male partner as their first u ­ nion, compared to 34 ­percent of ­women in 1995 (Copen, et al., 2013). Likewise, the proportion of same-­sex ­couples who live together has increased as well. Nationally, approximately 1 ­percent of all coupled ­house­holds are of same-­sex partners. The year 2010 was the first year that the U.S. Census Bureau began to count same-­ sex married c­ ouples, and, of the 605,472 same-­sex c­ ouples who reported living together in 2011, 28 ­percent reported they w ­ ere married (Kreider, 2013). With the Supreme Court ruling in 2015 that made same-­sex marriage ­legal across the United States, t­ hese same-­sex marriage numbers are expected to grow. In addition to changes in the structure of relationships in recent de­cades, the approach taken by both same-­sex and heterosexual w ­ omen to meet their romantic partners has changed. Starting in the 1940s, neighborhoods, churches, the workplace, school, and since 2000 even college, began to decline as the sites where heterosexual w ­ omen (and men) met their romantic partners. T ­ oday, the most frequent ways that heterosexual ­women meet romantic partners is through intermediation of friends; in bars, restaurants, and other public places; and through the Internet. For lesbian ­women (and gay men), the Internet has risen to the top of the list as the most frequent site where they meet romantic partners (Rosenfeld & Thomas, 2012). Dating Dating, or sometimes more formally referred to as courtship, is a significant relational activity for w ­ omen that may include sexual, emotional, and social components. Given the increased age at first marriage


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(Manning, et al., 2014), many young w ­ omen w ­ ill experience multiple dating relationships that vary in form, quality, and length u ­ ntil they ultimately ­settle into a committed relationship. Currently, however, a range of relationship options, styles, and forms exist that may fall outside the conventional notions of dating/courtship (­England, et al., 2008). This is particularly true for adolescent girls and young ­women who describe relationship forms that vary from casual, sex-­only relationships (hookups) to serious committed relationships (Banker, et al., 2010). Furthermore, lesbians report dating scripts that differ from t­ hose of heterosexual individuals. For lesbians, a friendship script for dating is the most common way to enter a romantic relationship, and they report being freer from gender roles in relationship development (Eaton & Rose, 2011; Rose & Zand, 2002). As part of the relationship-­building pro­cess, dating/courtship is generally the initial stage of a relationship. It is characterized by a set of be­hav­ iors that typically begin with mutual attraction, some degree of flirtation be­hav­ior, and may lead to sexual interaction, greater intimacy and commitment, and ultimately to some committed relationship status (Givens, 1978; Perper, 1989). The bound­aries of this stage in relationships t­ oday may appear to be vague, shifting, and variable, especially among adolescents (Furman & Hand, 2006), but certain commonalities exist in characteristics of the dating stage of a relationship (Allen, 2004; Giordano, Manning, & Longmore, 2006; Surra, et al., 2004). Among heterosexual partners, a dating/ courtship relationship is distinct from friendship in that ­these relationships tend to be more emotionally intense, greater role asymmetries are pres­ent, and exclusivity is a more predominant issue for dating/courtship partners than for friendship partners. Some c­ ouples move rapidly to high interdependence and, thus, relational commitment; ­others move to this stage of the relationship more slowly, and o ­ thers get to a certain point in a dating/courtship relationship and remain t­here for some time (Surra, 1985). Traditional heterosexual script theory portrays men as the initiators and w ­ omen as the boundary setters in dating/courtship (Byers, 1996; Peplau, Rubin, & Hill, 1977; Reiss, 1967), but variations to this behavioral script are common (Moore, 1995; Perper, 1989). In heterosexual situations, ­women, both adolescents and adults, just as often as men initiate flirtations through behavioral signals; men may also depend on w ­ omen’s behavioral signals to inform and moderate their own be­hav­ior in ­these initial interactions (Renninger, et al., 2004). This pattern is also seen in Internet dating situations where w ­ omen feel comfortable breaking from traditional dating/courtship scripts and gender norms. Although men visit online dating sites more frequently than ­women, both w ­ omen and men are equally likely to post profiles to online dating sites (Stampler, 2015; Valkenburg & Peter, 2007). In fact, online dating site use may be more related to dispositional f­ actors, such as low dating anxiety or high rejection sensitivity, rather than gender (Blackhart, et al.,


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2014; Valkenburg & Peter, 2007). Nonetheless, in online dating sites w ­ omen can be assertive, f­ ree from commitment and the need to pass through the vari­ous stages of the dating/courtship pro­cess, and can end or continue online relationships at w ­ ill (Lawson & Leck, 2006). On the other hand, when considering a face-­to-­face meeting with a potential dating partner met through online dating sites, men are more likely to not tell someone they are meeting this new person, compared to w ­ omen (Blackhart, et al., 2014). Similarly, in face-­to-­face situations, ­women continue to be less likely to agree to have sex with someone they have just met (Baranowski & Hecht, 2015). Thus, despite Internet dating’s expansive possibilities for ­women, their greater concern for safety and avoidance of risk, compared to men, likely continues to influence their be­hav­ior just as in face-­to-­face situations. Lesbian w ­ omen are just as likely as heterosexual ­women to depend on behavioral signals, such as smiling, eye contact, and touch to communicate sexual and romantic interest (Rose & Zand, 2002). Furthermore, regarding traditional dating/courtship be­hav­ior, such as asking someone out, picking up a date, paying for the date, ­etc., lesbian ­women tend to reject traditional gender roles and opt for mutual negotiation or turn-­ taking, depending on the situation (Eaton & Rose, 2011; Rose & Zand, 2002). Research also suggests that lesbian c­ ouples pro­gress from initial attraction to relational commitment more rapidly and show greater fluidity between friendships and dating relationships than heterosexual ­couples (Diamond, 2002; Rose & Zand, 2002). This may be positive in that lesbian ­women do not necessarily follow the scripted dating relationship pattern seen among heterosexual c­ ouples, but it may also lead to confusion about behavioral norms and expectations for some ­women (Gordon, 2006; Rose & Zand, 2002). In a study of the dating/courtship scripts used by lesbians, Rose and Zand (2002) found that the friendship script, where partners started out as friends and moved to a romantic, sexual relationship, was the most frequently used in their sample. Despite the ambiguity that it entailed for ­women, such as falling in love with a best friend, it was perceived to provide a more secure basis for a committed relationship. On the other hand, although it was used less than the friendship script, an equal number of w ­ omen stated a preference for the romance script, which included emotional intensity and overtly communicated sexual attraction. Despite greater freedom that w ­ omen have t­oday in their dating/ courtship options, activities, and definitions, traditional conceptions of femininity and its concomitant behavioral strictures may continue to influence ­women’s approach to this stage of relationships. In their review of dating practices among heterosexual adults over the last 35 years, Eaton and Rose (2011) found that gender-­t yped be­hav­ior continues to permeate the cultural and personal scripts used in dating activities. Although initiation of dates by w ­ omen has become more frequent, their review found that it was not sufficient to undo dominant heteronormative dating scripts.


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Other research confirms that, for w ­ omen, the heterosexual dating/courtship market is one where economic, cultural, and gendered power relations continue to hinder w ­ omen’s efforts at true self-­definition and pressure them to define themselves in ways that reflect conventional femininity (Chung, 2005; Jagger, 2001). To be successful in the dating/courtship pro­ cess, ­women must learn to navigate ­these conflicting and contradictory pressures. ­Women’ Partner Preferences ­Women’s partner preferences in dating/courtship, long-­term relationships, and marriage has been a topic of research interest, but the findings on what is considered a suitable partner vary depending on who is being asked. ­Because much of the research is based upon heterosexual college-­ aged ­women, results generally show that ­women prefer male partners who are a ­little older, with greater education, and the ability to provide financial stability (Knox, et al., 1997; Levesque & Caron, 2004). As w ­ omen age, the pool of suitable male partners is thought to shrink, as fewer men who are older and with greater education are available to w ­ omen, and ­those that are available may seek younger aged ­women (Levesque & Caron, 2004). More recent research adds qualifications to t­hese findings. In a study of relationship goals among participants aged 20 to 95 on a popu­ lar online dating site, interpersonal communication and individual companionate characteristics w ­ ere consistently rated more impor­tant than sexual attraction, although sexual attraction was rated higher by men compared to ­women across all age groups (Menkin, et al., 2015). Only ­women in the youn­gest age group valued communication more than their male counter­parts, whereas this gender difference dis­appeared by 39 years of age. African American ­women, in par­tic­u­lar, are thought to experience a shortage of suitable male partners, due to high incarceration and unemployment rates among African American men. However, this strictly demographic interpretation of suitable male partners has overlooked the possibility that the characteristics that w ­ omen prefer may change with age or that ­factors unrelated to male partners may play a role in ­women’s decisions to remain single. For instance, Hill (2006) contends that researchers have ignored African American ­women’s own agency and autonomy in their decision making about marriage or marriage partners. A strong tradition of female-­centered, eco­nom­ically self-­supporting families among African Americans is a legacy of slavery, and is possibly even rooted in West African cultures. This traditional ­family form contains benefits for African American ­women (i.e., in­de­pen­dence and economic safety), that ­women may prefer to maintain in the face of a patriarchal marriage ideal that has in the past, and even ­today, offered few economic or gender privilege benefits for them.


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Another study found that as ­women age, they show greater flexibility than younger ­women in their partner preferences; they are interested in younger men, less interested in a partner’s ability to provide financial stability, and do not require a partner that has never been married (Levesque & Caron, 2004). In the Levesque and Caron study, ­women did not perceive a shortage of suitable partners, rather, they remained single for a variety of reasons, such as not wanting to compromise their in­de­pen­dence or an unwillingness to put up with certain attributes in a partner, such as alcoholism. A study of widowed ­women ranging in age from 61 to 85 found that almost 80 ­percent ­were uninterested in remarrying (Talbott, 1998). The reasons for this had to do with length and quality of their previous marriage, number of previous marriages, existing grief over loss of a partner, ­whether they worked, drove a car, ­etc., but many ­women referred to the enjoyment of their newfound sense of in­de­pen­dence as a reason for remaining unmarried. Again, availability of men had l­ittle to do with ­women’s desires for remarriage. Fi­nally, a study of African American and white ­women who married ­after age 35 found that each group had adjusted their criteria for an acceptable partner, although in somewhat dif­fer­ent ways. White ­women tended to marry men who w ­ ere similar in age and education, but they w ­ ere accepting of other characteristics, such as less cultural sophistication in a partner, or they w ­ ere willing to move to a section of town that husbands preferred. African American w ­ omen w ­ ere more likely to marry men who ­were younger than they ­were, born outside the United States, and had less education. They w ­ ere also more willing to consider non-­African American men as partners (Emery & White, 2006). In the case of both groups of ­women, they expanded the traditional profile of what was considered a suitable partner. A recent study that incorporates the complexity of demographic characteristics and partner preferences shows that no one f­actor predicts ­women’s partner preferences (Morgan, Richards, & VanNess, 2010). First, this study examined both personal characteristics and partner preferences in an online dating advertisement site in adults aged 18 to 38 across gender and sexual orientation. It found that individuals seek persons with lifestyles and personality characteristics similar to their own, indicating support for the matching hypothesis. However, this study also found that the desired type of relationship, age, sexual orientation, and to a lesser extent, gender, influenced preferred characteristics, as well as ones that participants presented. For example, lesbian ­women (and gay men) ­were more likely to include physical characteristics and less likely to include lifestyle or personality characteristics in their profiles. They ­were also more likely to request casual or short-­term relationships than heterosexual participants. W ­ omen ­were more likely than men to include personality characteristics in their preferred partner narratives, but inclusion of


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physical characteristics did not differ by gender. Older participants ­were more likely than younger ones to list lifestyle characteristics in their personal narratives and personality characteristics in their preferred characteristics. Fi­nally, the type of relationship influenced personal and preferred characteristics that ­were mentioned. ­Those who sought short-­term relationships ­ were more likely to mention physical characteristics, while ­those who sought longer-­term relationships ­were more likely to mention personal competence, lifestyle, and their desire for honesty and niceness in a partner. Sexuality in Relationships For w ­ omen, sexuality can occur in casual or fleeting relationships; indeed, it can occur without the presence of a partner (Dodson, 2004; Manning, et al., 2006), but to a large extent, sexuality occurs within the context of an ongoing relationship. A consistent difference between w ­ omen and men in sexuality is that w ­ omen, more often than men, report a preference that sexuality occur within a relationship (Peplau, 2003). This difference is also found between lesbians and gay men, where lesbians have less permissive attitudes t­ oward casual sex and sex outside the relationship than gay men. Gay men in committed relationships are also more likely than lesbians or heterosexuals to have sex with persons outside their primary relationship (Peplau, et al., 2004). Despite t­ hese general findings, recent research has begun to add a more nuanced perspective to understandings of w ­ omen’s experience of sexuality and the relational context. For instance, Mark et al. (2015) found that, similar to expectations, both gay and heterosexual men report higher sexual and emotional satisfaction from casual sexual encounters (e.g., one night stands, sex on first date), compared to w ­ omen, with lesbian w ­ omen rating such relationships lowest in emotional and sexual satisfaction. With re­spect to committed relationship contexts (i.e., sex with a married partner, living together partner), however, no significant differences in emotional and sexual satisfaction ­ were found across gender and sexual orientation groups. In fact, compared to sex in casual relationships, sex in committed relationships was rated highest in emotional and sexual satisfaction by both w ­ omen and men, regardless of sexual orientation. Furthermore, the small amount of research that specifically focuses on lesbian, bisexual, and questioning ­women indicates that love/commitment and plea­sure are the most frequent motivations for engaging in sex and ­these motivations do not differ by length of the relationship (Wood, et al., 2014). Part of the explanation for the importance of plea­sure in both shorter and longer duration relationship in a lesbian, bisexual, and questioning ­women sample may be that w ­ omen in same-­sex relationships report a higher frequency of orgasms, longer duration of sexual encounters, and


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more varied sexual activities compared to heterosexual and male-­male sexual encounters (Blair, 2013). Likewise, while ­women’s motivations for engaging in sex can be complex and varied, they are often related to the type of relationship in which they are involved. In their study of ­women’s motivations for sex, Armstrong & Reissing (2015) found that physical motivations w ­ ere more often cited as reasons for casual sex, while emotional reasons ­ were more often cited for sex in committed relationships. However, they did not find that the gender of persons w ­ omen w ­ ere attracted to influenced motivations for sex, nor did w ­ omen who indicated they w ­ ere bisexual report dif­fer­ent motivations for sex with ­women or men. Nonetheless, while sexuality in committed relationships appears to be most positive for ­women and men, ­women and men differ in their sexual be­hav­ior in heterosexual relationships, in that w ­ omen are perceived more often to be the sexually compliant partner. Sexual compliance refers to consensual unwanted sex, where an individual who is less interested in sex agrees to engage in sex with the partner who is more interested in sex (Impett & Peplau, 2003). It does not refer to forced, coerced, or nonconsensual sex, although the line between what is consensual or nonconsensual sex may be questionable at times. In a review of explanations for why ­women in heterosexual relationships are more often the compliant sexual partner, three categories of explanations ­were emerged (Impett & Peplau, 2003). The first of t­hese categories was explanations due to gender. Adherence to traditional sexual scripts, where men are expected to always initiate sexual interactions and w ­ omen to wait u ­ ntil their male partner does so before engaging in sex, is an example of a gender-­related reason for greater sexual compliance among w ­ omen. The second category of explanations was relationship-­based reasons. For example, the degree of commitment to a relationship can increase the potential for engaging in compliant sex, especially on the part of the partner with higher commitment (Impett & Peplau, 2003). Why this should be the case is not clear, but may have to do with the belief that if one makes a sacrifice for a partner, and engaging in unwanted consensual sex can be thought of as a sacrifice, then the commitment level of the less committed partner, who understands a sacrifice has been made for her/him, may increase. Although commitment enhancement may be a reason ­behind some compliant sex situations, Impett & Peplau (2003) indicate that more research needs to be done to determine if this sexual sacrifice is successful in changing a partner’s level of commitment. A third category is motivationally based explanations for sexual compliance. ­These are based upon approach or avoidance strategies, meaning ­whether p ­ eople are motivated to pursue positive or pleas­ur­able experiences or to avoid negative or painful outcomes. For example, sexual compliance may occur to avoid rejection, separation, or angering a potentially


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violent partner; to re-­k indle passion in a relationship, or it may occur ­because a w ­ oman may be interested in becoming a parent, but the timing for conception may be on a day she has ­little desire for sexual intercourse. An impor­tant point to keep in mind about sexual compliance is that even though w ­ omen appear to engage in compliant sex to a greater degree than men, much overlap between w ­ omen and men exists in both rates of compliant sex and reasons each gender gives for this be­hav­ior. The concept of sexual compliance highlights the fact that both w ­ omen and men engage in sex for many reasons other than sexual plea­sure or desire and that sexual be­hav­ior, even in c­ ouples with seemingly established sexual routines and patterns, is a complex pro­cess. Sexual Satisfaction ­Women, compared to men, are often believed to be less interested in sexual satisfaction. Research demonstrates, however, that sexual satisfaction is as impor­tant to ­women as it is to men, and in heterosexual relationships Latina/o, African American, and white ­women report they are satisfied with sexuality (Castañeda, 2015; Henderson-­King & Veroff, 1994; Sprecher & Regan, 2000). Furthermore, no differences in level of sexual satisfaction have been found between ­those in lesbian, gay, and heterosexual relationships (Christopher & Sprecher, 2000). On the other hand, research points to the importance of understanding not just sexual satisfaction alone, but also emotional satisfaction with sexuality, and how ­these may vary across gender; relational contexts, e.g., one night stand, married, first date, living together; and sexual orientation. For instance, one study found that sexual satisfaction was stronger than emotional satisfaction in more casual relational contexts (one night stand, first date, sex with a friend, and hookups), compared to more committed contexts (married, living together, committed unmarried relationship); that men rated all relational contexts as more sexually and emotional satisfying than ­women, except for sex in committed unmarried relationship; and that lesbian ­women reported the least sexual and emotional satisfaction out of casual relational contexts, while gay men reported the highest satisfaction in ­these relational contexts (Mark, et al., 2015). Many w ­ omen realize that sexual satisfaction in relationships does not occur in a vacuum; it is related to satisfaction with the overall relationship. This is the case for heterosexuals, gay men, and lesbians, as well as married and dating c­ouples (Blumstein & Schwartz, 1983; Byers, et  al., 1998; Henderson-­King & Veroff, 1994; Oggins, et al., 1993; Peplau, et al., 1997; Sprecher, 2002; Sprecher & Regan, 2000). In fact, changes in the quality of a relationship are associated with changes in sexual satisfaction (Edwards & Booth, 1994). One study of unmarried heterosexual c­ ouples found that higher sexual satisfaction was also linked to greater relationship stability, i.e., less likelihood of breaking up (Sprecher, 2002). B ­ ecause specific aspects


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of relationships, such as commitment and love (Sprecher, 2002), intimacy (Sprecher & Regan, 2000), and quality of both general and sexual communication within the c­ ouple (Cupach & Comstock, 1990; Sprecher & Regan, 2000) are associated with sexual satisfaction as well as relationship satisfaction, the direction of causality is not clear, but undoubtedly, sexual and overall relationship satisfaction go hand in hand. When ethnic/cultural groups are considered, however, variations in the association between sexual and relationship satisfaction and gender are seen. For instance, African American married ­women are more likely to view positive sexual relations as impor­tant in and of themselves and less connected to the quality of the relationship (Oggins, et al., 1993). This is particularly true for low-­income African American wives compared to higher-­income African American wives. Low-­income African American ­women may be socialized to be less emotionally and financially dependent on male partners; therefore, they may idealize close relationships less than middle-­class African or Eu­ro­pean American ­women. The few studies of sexual satisfaction among Latinas/os have found that Latina ­women, compared to Latino men, express less satisfaction with sexuality (Amaro, 1988; Castañeda, 2015; Espin, 1997; Flaskerud, et  al., 1996). This may have to do with the general cultural silence surrounding ­women’s sexuality among Latinas/os (see Castillo, 1994; Marin, 2003); that Latinas have few models for positive, woman-­centered sexuality in the media and culture (see Castañeda, 2003); and that the sexual double standard, in which the rules and expectations surrounding sexuality more greatly constrain w ­ oman’s be­hav­ior than that of men, may be stronger among Latinas/os (see Castañeda & Collins, 1998; Castañeda & Burns-­ Glover, 2004; Faulkner, 2003). Sexual Prob­lems Just as satisfaction with sexuality is connected to the quality of the relationship, sexual prob­lems are also related to aspects of the relationship, particularly feelings about the partner (Bancroft, et al., 2003; Henderson-­ King & Veroff, 1994; Laumann, et al., 1999; Oggins, et al., 1993). This point tends to be neglected in the prevailing medical model approach to sexual prob­lems reported by w ­ omen and men (Tiefer, 1996, 2001). The medical model stresses correct genital per­for­mance, i.e., sexual desire, genital arousal, and orgasm, occurring in that sequence, and the ability to enjoy vaginal penetration (Tiefer, 2001). Therefore, the response by researchers to sexual prob­lems has been to expend g ­ reat efforts to produce pharmacological remedies that ­will improve sexual functioning in ­women with ­little attention “devoted to assessment or education about sexual motives, scripts, plea­ sure, power, emotionality, sensuality, communication, or connectedness” and the effect they may have on sexuality (Tiefer, 2001, p. 90). Particularly problematic for w ­ omen is that their sexual prob­lems


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have also tended to be approached from the perspective that ­women and men experience, both physically and emotionally, the sexual response cycle, and thus sexual prob­lems, in the same way. However, this approach may hinder understanding of w ­ omen’s sexual distress. For example, a representative national survey of African American and white ­women in heterosexual relationships found that negative emotional feelings during sexual interaction with the partner, as well as lack of emotional well-­being (i.e., depression, tiredness, general unhappiness) ­were stronger predictors of sexual distress than physiological aspects of female sexual response, such as pain or lubrication (Bancroft, et al., 2003). Despite such evidence, subjective emotional ele­ments like the ones uncovered in the Bancroft, et al., study (2003) are not included in the DSM-­IV categories of female sexual dysfunction (i.e., Hypoactive Sexual Desire Disorder (HSDD), female sexual arousal disorder, female orgasmic disorder, dyspareunia, and vaginismus), rather, the emphasis is on impaired physiological functioning. Reflective of this emphasis, and the assumption that ­women’s sexual prob­lems can be treated pharmacologically, just as are men’s, is the Federal Drug Administration (FDA) approval in 2015 of the first pharmacological treatment of hypoactive sexual disorder in premenopausal ­women. The drug flibanserin, or the “pink Viagra®,” works not on increasing blood circulation in the genital area as does Viagra® and similar drugs, but on neurotransmitters in the brain, particularly levels of dopamine, norepinephrine, and serotonin. Unlike Viagra® and similar drugs which are taken right before a sexual event is planned, flibanserin must be taken ­every day in order to be effective. It has serious and concerning side effects, such as low blood pressure and fainting if alcohol is consumed while taking the drug (Schulte & Dennis, 2015). The evidence for its effectiveness in treating hyposexual disorder among ­women is modest, at best, but more concerning is that its approval does not necessarily lead to greater understanding of the complexity of ­women’s sexual lives and prob­lems; rather, it continues to obscure them and promotes the increased medicalization of their sexuality. Relationship Satisfaction Given the primacy of relationships for ­women, and that early on researchers noted that the marriage experience of w ­ omen and men is qualitatively dif­fer­ent (Bernard, 1975), the role of gender in relationship satisfaction has been under-­studied (see Faulkner, et  al., 2005). When it has been explic­itly included as a variable in relationship satisfaction research, the results have been mixed, some showing large differences in marital satisfaction between ­women and men, and ­others showing non­ex­is­tent or small gender differences (Kiecolt-­Glaser & Newton, 2001; Kurdek, 2005). Investigation of gender differences in relational satisfaction, however, may


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be less impor­tant than understanding the specific f­ actors and conditions associated with w ­ omen’s assessment of satisfaction in their relationships. A variable that influences ­women’s perception of marital quality is gender-role attitudes, both their own and t­ hose of their male partner. For instance, one longitudinal study that investigated changes in gender-role attitudes found that as married ­women’s gender-role attitudes became less traditional, their marital quality declined. The reverse was true for married men; as their gender-role attitudes became more progressive, their marital quality increased (Amato & Booth, 1995). With fewer traditional attitudes about gender ­women may begin to see discrepancies between what they desire from their marriage and their partner and what they experience and, thus, become less satisfied with their relationship. In contrast, another study that examined the role of changes in gender-role attitudes on marital satisfaction found gender-role attitudes did not influence wives’ marital satisfaction (Faulkner, et al., 2005). However, while wives’ perception of in­equality in the relationship was not related to their own marital satisfaction, it was related to husbands’ report of more marital conflict. Possibly, ­women who perceived greater unfairness in their marital relationships initiated more conflict with husbands compared to ­those who did not perceive unfairness in their relationship. In this study, more immediate and concrete variables influenced wives’ marital satisfaction, such as wives’ own depression, physical health declines of the self and husband, having c­ hildren u ­ nder 18 living at home, having an adult child move back into the home, and greater number of hours a husband spent at work. ­Because w ­ omen are considered the “relationship experts” in society, believed to bring greater communal and interpersonal skills to relationships than men, researchers have investigated w ­ hether wives’ interpersonal and affective functioning is more predictive of marital quality outcomes for husbands than vice versa. In other words, does wives’ understanding of their husbands contribute to greater marital satisfaction than husbands’ understanding of their wives? This question is impor­tant, not just b ­ ecause it relates to marital satisfaction, but also b ­ ecause the need to have more knowledge about and insight into the partner indicates who must please the other more and, therefore, who has less power in the relationship. The answer also points to who may benefit more in relationships, ­women or men. Early research showed that ­women tended to have greater understanding of their male relationship partners than men had of their female partners, and that ­women’s understanding was linked to relationship satisfaction for both w ­ omen and men. Men’s understanding of their female partners was not linked to relationship satisfaction (Murstein, 1972, 1976). More recently, however, the answer to this question is mixed. In a longitudinal study using a primarily Eu­ro­pean American sample, Kurdek (2005) found that wives’ psychological distress and interpersonal variables, such


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as their marriage-­specific appraisals, spousal interactions, and social support, ­were predictive of husbands’ marital satisfaction, while husbands’ scores on ­these variables ­were not predictive of marital satisfaction in wives. However, Kurdek (2005) points out that the strength of cross-­spousal links on t­hese variables did not significantly differ between wives and husbands, and Kurdek asserts that marital satisfaction is not dependent upon the interpersonal skills of one partner or the other. In another longitudinal study of the predictors of change in marital satisfaction, Faulkner, et al. (2005) found that wives’ interpersonal functioning was more predictive of their husband’s marital satisfaction, but the reverse was not true. For example, wives’ depression influenced husbands’ marital satisfaction, but husbands’ depression did not predict the marital satisfaction of wives. The difference between effect sizes ­were not analyzed in this study, but Faulkner et al. (2005) contend that the pattern of results supports the notion that ­women’s interpersonal skills influence men’s satisfaction in marriages more than the reverse. ­Because of this, men benefit from marriage more than w ­ omen, and further, w ­ omen’s emotional needs in the relationship may remain unaddressed to a greater extent than t­ hose of men. Fairness, equity, and equality appear to be impor­tant issues for w ­ omen in their close relationships and they are highly linked to marital satisfaction (Amato, et al., 2003). Areas of conflict can vary within c­ ouples, but one study that included heterosexual, lesbian, and gay ­couples found, first, that areas of ­couple conflict ­were similar across all three types of relationships, and second, that conflicts over power, defined as influence over another, w ­ ere linked to decreased marital satisfaction both concurrently and one year ­later across all ­couple types (Kurdek, 1994). ­Women’s perception of the equitable division of ­house­hold l­abor is a key ele­ment in w ­ omen’s marital satisfaction (Lavee & Katz, 2002; Saginak & Saginak, 2005), although what is considered equitable or fair is itself influenced by gender (Coltrane, 2000). Men’s contribution to h ­ ouse­hold ­labor has increased, but ­women still perform the majority of ­house­hold ­labor, particularly tasks related to childcare. This, in turn, can influence ­women’s sense of unfairness and marital dissatisfaction (Coltrane, 2000). In a review of predictors of and changes in marital quality from 1980 to 2000, Amato, et al. (2003) found that only two gender differences in explanatory variables ­were found and ­these w ­ ere decision-­making equality and husband’s share of h ­ ouse­work. When decision-­making equality increased, the marital quality of both ­women and men improved. Furthermore, the average level of equality has increased for both ­women and men from 1980 to 2000. Husband’s average level of h ­ ouse­work increased from 1980 to 2000, and this increase was positively related to ­women’s marital quality, but it was negatively related to the marital quality of husbands. Furthermore, husbands’ increase in their share of ­house­work was positively related to their divorce proneness, although it was negatively related to


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divorce-­proneness for wives. This study not only affirms the critical role that equality plays in ­women’s perceptions of relationship satisfaction, but it demonstrates that the ordinary arena ­house­work (and the care of ­children around which so much h ­ ouse­work revolves) continues to be a source of contention for w ­ omen and men. Despite the vast amount of research on relationship and marital satisfaction in the United States, few studies of this issue that focus on diverse ethnic/cultural groups can be found. Most study samples are overwhelmingly Eu­ro­pean American, ­middle class, and often well-­educated. When African Americans are the focus of relationship research, dif­fer­ent patterns are found. For example, available research has found that African American marriages show high egalitarianism and greater involvement with extended f­amily members (Hunter & Sellars, 1998; Kane, 1992). In fact, one study points out that African American c­ ouples characterized by strong and positive marriages are often the first to receive knocks of need, where they are asked for financial, to care for ­children or other ­family members, sometimes for years at a time, or for other support from f­ amily and close friends (Marks, et al., 2008). Similar to studies with Eu­ro­pean American samples, gender is not always associated with relationship satisfaction among African Americans. Research on African American married c­ouples found that financial strain and neighborhood economic level, but not gender, w ­ ere the strongest predictors of marital quality (Bryant, et al., 2008; Cutrona, et al., 2003). Another study that included both Eu­ro­pean and African American ­couples found that African American wives and husbands reported less marital satisfaction than Eu­ro­pean American wives and husbands (Faulkner, et al., 2005). Due to the small number of African American c­ ouples in the overall sample, this study did not investigate the variables that w ­ ere associated with marital satisfaction within African Americans. Nevertheless, this result may have to do with the more negative environmental, contextual ele­ments African Americans experience relative to Eu­ro­pean Americans. Although many Eu­ro­pean American and African American ­couples include dual income earners, the proportion of ­women with ­children who work is greater among African Americans. African Americans also more often experience unfavorable and less family-­friendly work situations (i.e., longer and nonstandard work hours, low pay, less flexible work hours, fewer health benefits) (McLoyd & Enchautegui-­de-­Jesus, 2005). Some evidence also points to African American ­women’s greater ambivalence, compared to White ­women, about marriage. They may be more likely to view it as a loss of power or control (Emery & White, 2006; Hill, 2006). The few available studies on marital satisfaction among Latinas/os indicate that w ­ omen report less marital satisfaction than men, but level of acculturation, or some proxy for acculturation, such as immigration status, leads to qualifications regarding this relationship. Acculturation, the pro­cess that occurs when an individual from one culture contacts a new


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culture and must adjust to a new language, unfamiliar rules of interaction, new laws, values, attitudes, social customs, and sometimes lifestyle changes (see Chun, et al., 2003), has a significant impact on the be­hav­ior and psychological experience of Latinas/os (Balls Organista, et al., 2003). The pattern most often seen among Latinas/os is that higher acculturation among Latina ­women is related to marital distress (Parke et al., 2004; Vega, et al., 1988). Looking specifically at acculturation and marital satisfaction among Mexican American c­ ouples, Negy and Snyder (1997) found that t­hese c­ouples showed higher marital distress than non-­Mexican American ­couples, but this difference dis­appeared a­ fter controlling for sociodemographic variables. Acculturation was positively related to evaluation of companionship dissatisfaction and sexual dissatisfaction for Mexican American wives, but was unrelated to any dimension of relationship satisfaction for husbands. Among inter-­ethnic c­ ouples, i.e., one partner Mexican American and the other Eu­ro­pean American, when the wife was Mexican American, acculturation was related to her own non-­ traditional marital and gender-role orientation and dissatisfaction with ­children and to her husband’s dissatisfaction with ­children, conflict over child rearing, and disagreement about finances (Negy & Snyder, 2000). When the husband was Mexican American, his level of acculturation was unrelated to his or his wife’s marital satisfaction. Results from ­these studies suggest that Latina/o c­ ouples face many of the same issues faced by non-­Latina/o c­ ouples, but they must do so while navigating two sociocultural worlds. A consequence of this for Latina w ­ omen is that with greater acculturation renegotiation of gender roles and expectations may, to a greater extent, fall upon them. This may increase conflict within ­couples and lead to less marital satisfaction for them. In summary, our understanding of the close, romantic relationship experience of ­women from diverse ethnic/cultural backgrounds is limited. The available evidence hints at similarities across all w ­ omen, but it also points to the need to consider a wider array of f­ actors than has traditionally been included in close relationship research. By investigating the role of variables such as acculturation, discrimination, neighborhood quality, financial/economic ­factors, and gender-role expectations within and outside ­women’s par­tic­u­lar ethnic/cultural group, a more complex and insightful understanding of all w ­ omen’s relationship experience w ­ ill emerge. REFERENCES Adams, G., Anderson, S. L., & Adonu, J. K. (2004). The cultural grounding of closeness and intimacy. In  D. J. Mashek and A. Aron (Eds.), Handbook of closeness and intimacy (pp.  321–339). Mahwah, NJ: Lawrence Erlbaum Associates.


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Chapter 7

The Menstrual Cycle Joan Chrisler

The menstrual cycle is a perfect example of a biopsychosocial phenomenon. It is a normal physiological pro­cess that affects and is affected by ­women’s be­hav­ior. W ­ omen’s be­hav­ior is affected by beliefs and attitudes, which are in turn affected by physiological experiences. Furthermore, ­women’s experiences occur, our beliefs are learned, and our attitudes are formed within a cultural context. Therefore, although w ­ omen around the globe share the same physiology of the menstrual cycle, we experience it differently, and t­ hese differences are caused, for the most part, by sociocultural effects on our beliefs, attitudes, and be­hav­ior. ­Women who live in industrialized nations can expect to experience monthly menstrual cycles for three to four de­cades. The regular appearance of the menses is a sign of good health, is symbolic of our connection to other ­women, represents biological maturity, and signifies our ability to bear c­ hildren, but lets us know that we are not pregnant (Chrisler, 2004). Like other aspects of ­women’s bodies, the menstrual cycle has become po­liti­cal. It provides such a clear distinction between w ­ omen and men that “its correlates, concomitants, accompaniments, ramifications, and implications have become intrinsically bound up with issues of gender equality” (Sommer, 1983, p. 53). In this chapter, you w ­ ill learn about the physiological facts of the menstrual cycle and ways that t­hese facts have been interpreted in vari­ous cultures and time periods. You ­will read about menstrual cycle-­related changes in be­hav­ior, emotion, and cognition and why scientists have been so interested in documenting ­these changes. You ­will learn about attitudes ­toward menstruation and how they are influenced by, and, in turn, influence, popu­lar culture. You ­w ill read about menarche, the first


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menstruation, and menopause, the end of menstrual cycles. You ­will also learn about disorders that are related to the menstrual cycle. THE MENSTRUAL CYCLE The menstrual cycle only occurs in primates: h ­ umans, apes, and some species of monkeys (Golub, 1992). Other mammals experience estrus (also referred to as “heat”); around the time of ovulation, t­ hese females are sexually active and receptive. Estrus periods are generally the only time that females are interested in sexual be­hav­ior, and their interest is timed to coincide with fertility. The evolution from estrus cycles to menstrual cycles has allowed h ­ umans to separate ovulation from mating. Although the menstrual cycle has some effects on w ­ omen’s sexual desire, we are f­ ree to express our sexuality in a variety of ways at any time of the month. The menstrual cycle is regulated primarily by the actions of four hormones: follicle-­stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone. The first two (FSH and LH) are gonadotropic hormones that are produced by the anterior section of the pituitary gland to affect the ovaries. The ­others (estrogen and progesterone) are ovarian hormones produced by the ovaries to affect the uterus. The purposes of FSH are to stimulate the growth of follicles within the ovaries and to assist in the expulsion of a mature ovum. The purposes of LH are to stimulate ovulation and to promote the growth of the corpus luteum, i.e., the “yellow body” that forms within the follicle a­ fter the ovum has been released. Estrogen, which comes from the Greek words that mean “to produce mad desire” (Maddux, 1975, p. 51), stimulates the growth of the uterine lining prior to ovulation, so that it ­will be ready to receive the implantation of the ovum should fertilization occur. Progesterone, which comes from the Greek words for “in ­favor of birth” (Maddux, 1975, p. 51), is produced by the corpus luteum to prepare the uterine lining and, if a fertilized ovum is implanted in the lining, to maintain the endometrium during pregnancy. The average length of the menstrual cycle is 28 to 30 days, however, cycles that range in length from 21 to 40 days are still considered normal (Maddux, 1975). The typical 28-­day cycle w ­ ill be used to illustrate the physiological events that lead to menstruation. By convention, the first day of menstruation is considered Day 1 of the menstrual cycle. This may seem counterintuitive, but even as the uterine lining is being shed during menstruation, the bottom layer of the endometrium, which is never shed, is being prepared for the next opportunity to welcome an implanted ovum. Menstruation, also known as menses (from the Latin word for “month,” Maddux, 1975, p. 53), usually lasts 4 or 5 days; 3-­day to 7-­day menstrual periods are considered normal, although ­women who use oral contraceptives may have even shorter menses. In our “typical” cycle, menstruation ­will cease on Day 5.


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The first half of the menstrual cycle is called the follicular, preovulatory, or proliferative phase, and it culminates in ovulation at around Day 14. On Day 1, levels of both estrogen and progesterone are low, and the uterine lining begins to shed. Also on Day 1, an immature ovum in one of the two ovaries begins the pro­cess of maturation. During the weeks of the follicular phase a new uterine lining develops. About Day 14, levels of FSH, LH, and estrogen are at their highest levels, and the now mature ovum is released into the fallopian tube. Some ­women are aware of the exact moment of ovulation ­because they experience a quick, sharp pain known as mittleschmertz (from the German words for “pain in the ­middle” of the cycle). The second half of the menstrual cycle is called the luteal, postovulatory, or secretory phase. ­After ovulation estrogen levels fall somewhat, then rise again as progesterone levels rise. Progesterone reaches its highest level and estrogen is also high about Day 24. They quickly decline by Day 28 if fertilization and implantation have not occurred. Their decline signals the end of the menstrual cycle. Menstruation begins, and the body returns to Day 1 status. Although the menses is often called “bleeding,” blood makes up only 50–75 ­percent of the menstrual fluid (Maddux, 1975). Among the other ele­ ments in the fluid are endometrial tissue and cervical mucus. The amount of menstrual fluid discharged varies from w ­ oman to w ­ oman and usually from day to day in the same ­woman. The total amount of discharge averages 50 ml (about 3 tablespoons or less than a quarter of a cup); a range of 10 ml to 200 ml is considered normal (Gersh & Gersh, 1981). Some ­women discharge about the same amount of fluid daily from Day 1 to Day 5. ­Others experience a heavier flow during the first two days, which then tapers off. Still o ­ thers start off lightly, and then flow more heavi­ly. T ­ here is not one correct or healthy way to menstruate; what is impor­tant for each ­woman to know is what is normal for her. The menstrual cycle is a complicated series of events that is controlled by delicately balanced neuroendocrine mechanisms that involve the ce­re­ bral cortex, the hypothalamus, the pituitary gland, and the ovaries. The hormones regulate each other’s actions through a complex set of negative feedback loops. Contemplation of the system can leave one amazed at the beauty and intelligence of nature’s design of a physiological system that we take for granted w ­ ill be as regular as clockwork for de­cades of our lives. Still, not every­one sees it this way. The menstrual cycle, which was designed to produce life, is often described in destructive terms. The biologist Walter Heape (1913, as cited in Tavris, 1992, p. 159) considered menstruation to be a “severe, destructive” event that leaves in its wake “a ragged wreck of tissue, torn glands, ruptured vessels, jagged edges of stroma, and masses of blood corpuscles, which it would hardly seem pos­ si­ble to heal satisfactorily without the aid of surgical treatment.” Heape was an anti-­suffrage activist (Tavris, 1992), and his anger against the


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uppity ­women of his time is evident in the exaggerated and inflammatory language he chose to describe a benign pro­cess. Scientific objectivity is often found wanting where reproductive pro­ cesses are concerned. Emily Martin (1987) reviewed medical textbooks to see how the authors described the menstrual cycle. Menstruation is typically described as a negative event b ­ ecause it represents a “failure” to conceive. Cap­i­tal­ist, industrialized socie­ties are highly disapproving of systems that do not “produce,” and a menstrual cycle that is not interrupted by conception can be seen as even worse than unproductive: it is “production gone awry, making products of no use, not to specification, unsalable, waste, scrap” (p. 46). Martin (1987) suggested that ­women who menstruate are out of men’s control b ­ ecause they are not reproducing. Hence, male scientists’ description of the menses as a “hemorrhage . . . ​blood mixed with endometrial debris” (p.  45), the ovum as catastrophically disintegrating and “­dying” (p. 48), and the uterus as “degenerate,” “weakened,” and in need of “repair” (p. 47). The most positive language is reserved for the development of the ovum, which is typically described as “maturing” or “ripening” (p. 44) within the follicle. Martin (1987) contrasted the passive description of the development of the ova, all of which are already pres­ent in ­women’s bodies at birth, with the active description of the development of sperm, which are not pres­ent at birth and, thus, must be “manufactured.” One author she cited described that pro­cess as “remarkable” and noted that “perhaps the most amazing characteristic of spermatogenesis is its sheer magnitude: the normal ­ human male may manufacture several hundred million sperm per day” (p. 48). The man who wrote so much more enthusiastically about nature’s design of his own body than he did about w ­ omen’s bodies did so not only out of egocentrism or androcentrism, according to Martin (1987), but also b ­ ecause of his admiration for the fact that spermatogenesis does what menstruation does not do: produce “something deemed valuable” (p. 48). It is too bad that he did not consider that hundreds of millions of t­ hose sperm are wasted everyday; it only takes one to fertilize an ovum. Cultural and Historical Perspectives Across time and place menstrual blood has been considered both magical and poisonous (Golub, 1992). It is easy to understand how such ideas arose. Before the physiology of the menstrual cycle was understood, it must have seemed amazing that ­women who ­were not wounded could bleed and that five days of blood loss did not kill or even seriously weaken them. Therefore, menstruation seemed magical. B ­ ecause men did not have magical bleeding themselves, they must have been afraid of it, perhaps worried that close contact with it might do them some physical damage or pollute them by association with the female body. Thus, menstruation seemed poisonous. Do not dismiss t­hese ideas as naive and primitive;


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remnants of them are pres­ent ­today. As late as the 1920s and 1930s, scientists (Macht, 1924, and Schick, 1920; as cited in Delaney, et al., 1987) w ­ ere attempting to demonstrate that menstruating ­women exuded what w ­ ere called menotoxins (i.e., poisonous ele­ments) in menstrual fluid, perspiration, saliva, urine, and tears. Con­temporary feminists (Owen, 1993; Stepanich, 1992; Wind, 1995) who advocate the cele­bration of menstruation with praise to the Moon Goddess continue the idea that menses and magic are connected. Anthropologists have reported that most socie­ties have cultural prescriptions (i.e., rules of conduct) for menstruating ­women (Buckley & Gottlieb, 1988). In some socie­ties, menstruating ­women ­were considered taboo, that is, to be avoided while “unclean.” In ­others, menstruating ­women ­were required to refrain from some activities (e.g., cooking, cultivating crops) or required to engage in certain activities to mark the onset or the end of the menses (e.g., ritual bathing). Beliefs about menstruation have no doubt been used in the past as they are in the pres­ent to oppress ­women and limit our activities. However, it may be too ­simple to assume that all menstrual taboos are the result of misogyny and w ­ ere imposed on w ­ omen by men. Feminist anthropologists (e.g., Leacock, 1978; Martin, 1988) have suggested that ­women who ­were experiencing menstrual cramps or migraines might have been glad to have a break from cooking, weeding the crops, and walking long distances to collect w ­ ater, herbs, or other provisions. Similarly, the menstrual huts in which some cultures required w ­ omen to stay during their menses might have been less like a prison and more like “Mom’s Night Out.” In the huts or ritual bathing places ­women could relax together, talk and tell stories, and create a ­women’s culture they kept secret from men and ­children. For example, in his study of the Yurok ­people of the Pacific Northwest, Buckley (1982) learned that the Yurok believed that menstruating ­women should isolate themselves ­because they are at the height of their spiritual power and should not have to waste attention or energy on mundane tasks. Instead ­women should spend the time in meditation and other spiritual pursuits. The Yurok w ­ omen’s isolation sounds more like a religious retreat or a spa visit than a banishment. Nevertheless, superstitious beliefs about menstruation ­were (and are) common, and many have led to taboos that circumscribe menstruating ­women’s be­hav­ior. Among the taboos described by Frazer (1951) are that drops of menstrual blood upon the ground or in a river ­will kill plants and animals; wells w ­ ill run dry if a menstruating w ­ oman draws w ­ ater from them; men ­will sicken or die if they are touched by or use any objects that have been touched by menstruating w ­ omen; beer w ­ ill turn sour if a menstruating w ­ oman enters a brewery; and beer, wine, vinegar, milk, or jam ­will go bad if touched by a menstruating w ­ oman. T ­ hese beliefs have been reported in vari­ous places in Eu­rope, Asia, Africa, Australia, and the Amer­i­cas, and they are related to con­temporary beliefs that ­women should


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not bathe, swim, wash their hair, do heavy ­house­work, play sports, tend ­house­plants, carry heavy objects, drink or eat par­tic­u­lar foods, or engage in sexual intercourse during the menses (Fahs, 2011b; Marván, et al., 2006; Marván & Trujillo, 2010; Snow & Johnson, 1978; The Tampax Report, 1981; Williams, 1983). The rising influence of science and the development of biomedicine in the 19th and 20th centuries produced new myths about menstruating ­women. Physicians of the 19th c­ entury believed that w ­ omen w ­ ere ill, weak, and especially dependent during their menstrual periods (Golub, 1992), and they urged their patients to rest and conserve their strength during the menses. Only ­middle and upper-­class ­women could afford to seek a doctor’s advice and have h ­ ouse­hold help, whose efforts made pos­ si­ble their employers’ rest; poor and working-­class w ­ omen carried on their duties as usual during their menstrual periods, and no one seemed to think it odd that they ­were able to do so. The foremost proponent of menstrual disability was Edward H. Clarke, a professor at Harvard Medical School. He believed that education interferes with w ­ omen’s health. His thesis was that the menstrual cycle requires a considerable investment of energy; therefore, any energy directed at ­mental activity would necessarily reduce the amount left to produce ovulation and menstruation. Furthermore, the blood flow to the brain to support studying means, he thought, less blood available to supply the ovaries and uterus for their impor­tant activities. Clarke’s 1873 book Sex in Education went through 17 editions and was very influential with both professional and popu­lar audiences (Bullough & Voght, 1973). Clarke’s book was published at a time when ­there was a movement to promote educational opportunities for w ­ omen and girls. Some ­women’s colleges ­were established in the late 19th ­century, and it is sad to think that Clarke’s influence may have caused many parents to decide against allowing their d ­ aughters to attend. Despite several studies published around the turn of the 20th c­ entury that showed no difference in the health of ­women college students and w ­ omen who did not attend college, “experts” continued to warn parents not to allow their ­daughters to engage in intellectual activities (Bullough & Voght, 1973). John Harvey Kellogg, the diet and exercise guru, wrote that many young ­women had permanently damaged their health by studying too much while menstruating. He also warned of the danger to menstruating w ­ omen of exposure to cold, not getting enough rest, and not dressing or eating “properly.” G. Stanley Hall, a very influential psychologist of the early 1900s, was a fierce opponent of coeducation. He thought that ­women ­were too frail to stand up to the rigors that men students could ­handle, and he urged ­women’s colleges to provide at least four days of rest for students during their menstrual periods (Golub, 1992). As late as the 1930s, textbooks continued to state that most w ­ omen experienced at least some disability during menstruation and that ­women


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should limit their activities and get more rest during their periods. T ­ oday, few professionals would agree with “the debilitation hypothesis,” but many professionals and the general public alike are still certain that the menstrual cycle affects w ­ omen’s be­hav­ior, emotions, and intellectual abilities. In 1970, the physician Edgar Berman was widely quoted in the media for his comments about ­women politicians: “If you had an investment in a bank, you w ­ ouldn’t want the president of your bank making a loan u ­ nder t­hese raging hormonal influences at that par­tic­u­lar period. Suppose we had a president in the White House, a menopausal w ­ oman president, who had to make the decision of the Bay of Pigs, which was, of course, a bad one, or the Rus­sian contretemps with Cuba at that time?” In 1982, during a debate in the UN General Assembly about the war between ­Great Britain and Argentina over the Falkland Islands, a diplomat stated that Prime Minister Margaret Thatcher’s actions w ­ ere prob­ably influenced by “the glandular system of w ­ omen.” When men politicians declare war or make bad decisions, such as the Bay of Pigs incursion, no one ever seems to won­der what influence, if any, their physiology may have had on them. Menstrual Cycle Effects on Be­hav­ior Many hundreds of studies of the menstrual cycle’s effects on be­hav­ior have been conducted by biomedical and behavioral scientists, and feminist scientists have had to spend their time in critiquing and refuting the results of the few studies that have concluded that menstruation has debilitating effects on ­women’s abilities. Many of the studies on this topic are poorly designed, perhaps ­because they ­were conducted by ­people who had no expertise in cyclic biology, yet the researchers ­were able to publish their results in respectable journals, provided, of course, that their findings supported the debilitation hypothesis. It can be difficult to publish the results of studies that do not confirm expectations, a conundrum termed “the file drawer effect” (Sommer, 1987) in reference to the unpublished papers in feminist scholars’ files, many of which conclude that menstruation does not affect be­hav­ior or that w ­ omen and men do not differ in some ability. The file drawer effect contributes to the waste of feminists’ time as we conduct the same studies repeatedly ­because we do not have access to the unpublished data that show the research to be unnecessary. It is also true that the one study that demonstrates a menstrual cycle effect (or a sex difference) gets much more scientific and media attention than the six studies that refute it combined. Why are t­ here so few good studies of menstrual cycle effects? The menstrual cycle is complex; it represents a constantly changing biochemical pro­cess, and, b ­ ecause we cannot see the changes, it is not easy to know exactly what the state of the system is when mea­sure­ments are taken. The only way to tell what phase of the cycle a w ­ oman is in is to do hormone


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assays, that is, to take a blood or urine sample, and have it analyzed for hormone concentrations. If, for example, progesterone and estrogen are in high concentrations and FSH and LH are in low concentrations, then we can safely say that the ­woman is in the second half of the cycle or the luteal phase. Many researchers do not use the hormone assay method of participant assignment b ­ ecause they cannot afford to have the lab tests done and do not have the training to do the tests themselves or ­because they do not realize its importance. The next best method is the use of basal body temperature. Participants in the study are asked to take their temperature each morning when they awake and before they get out of bed. The temperatures are written in a notebook, and the researchers l­ater plot them on a graph. Basal body temperature is typically lower in the follicular phase than in the luteal phase; it drops just prior to ovulation, then spikes up 0.4 degrees or more ­after ovulation occurs and continues at a higher than earlier level during the rest of the cycle. Although hormone levels are not confirmed in this method, they can be inferred if ovulation occurred. ­Women do not necessarily ovulate during e­ very cycle, and it is impor­tant to confirm ovulation. If ovulation did not occur, the ­woman does not experience a “true” luteal phase (i.e., her hormone level is not typical). If ovulation cannot be confirmed, the participant’s data should not be included in the statistical analy­sis. The least reliable way to determine cycle phase is the calendar method. In this method, the researcher asks the participant for the date of the start of her most recent menstrual period. On the assumption that the ­woman’s cycle is 28 days long (an assumption that may well not be true), the researcher then uses a calendar to count the days since the reported date and estimates the participant’s cycle phase. This method relies on too many assumptions: that the ­woman’s recall of the date is accurate, that ovulation occurred, that her cycle is 28 days long. If w ­ omen are using oral contraceptives, the calendar method is even more unreliable b ­ ecause the pill alters hormone levels such that t­ here is no true menstrual cycle (e.g., no ovulation occurs). Although the calendar method is the least reliable, it is the most popu­lar b ­ ecause it is the easiest and least expensive and perhaps ­because the researchers who use it are ignorant about the method’s defects. Another methodological prob­lem that makes it difficult to compare the results of studies to each other is that researchers differ in the way they divide the menstrual cycle into phases. The s­ imple two-­phase division (follicular, luteal) described earlier is insufficient for ­those who wish to study ­whether menstruation affects be­hav­ior. Therefore, some researchers define a 5-­day or 7-­day phase termed “menstrual.” ­Others are interested in premenstrual effects on be­hav­ior, so they define a 5-­day or 7-­day phase termed “premenstrual” (occasionally the premenstrual phase is defined as 10 or even 14 days long). Sometimes, researchers want to know if w ­ omen’s be­hav­ior is dif­fer­ent around ovulation than at other times of the cycle, so they define a 3-­day or 4-­day phase termed “ovulatory.” So,


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we have studies that define 3, 4, or even 5 dif­fer­ent phases, the same phase definition is generally used for all participants in the study even though their menstrual cycles prob­ably differ in ­actual length, and, if the calendar method is used, we do not even know that the w ­ omen w ­ ere in the phases they w ­ ere assumed to be in anyway. You are prob­ably wondering why we should even discuss a body of lit­er­a­ture that is such a methodological mess, but we must ­because the results of ­these studies have been highly politicized. What scientists, journalists, and the general public alike know of the results of ­these studies influences ste­reo­types about w ­ omen, ­women’s beliefs and feelings about themselves and their bodies, and even classroom and ­labor force discrimination against ­women and girls. Following from the debilitation hypothesis, a number of researchers have looked for evidence that w ­ omen’s academic or work per­for­mance suffers when they are menstruating. The most frequently cited study of academic per­for­mance was done by Katharina Dalton (1960a). She looked at examination scores achieved by British schoolgirls ages 11–17. Using the calendar method to assign them to cycle phases, Dalton reported that 27 ­percent of the students’ scores w ­ ere lower when they w ­ ere premenstrual or menstrual than at other times in their cycles. However, she also found that 17 ­percent of the students’ scores improved when they ­were menstrual or premenstrual, and the other 56  ­percent scored about the same whenever they took their exams. Even though the majority of Dalton’s participants did not experience a decline in exam scores, the results of this study are frequently described in the media and even in college textbooks as evidence of a 27 ­percent drop in schoolgirls’ per­for­mance around the time of menstruation. Data from ­later studies (Bern­stein, 1977; Sommer, 1972; Walsh, et al., 1981), in which college or gradu­ate students ­were tested ­every other week for several months and their scores matched to cycle phases using the calendar method, showed no evidence of any menstrual cycle-­related per­for­mance decline. Nor have researchers found menstrual cycle-­related effects on tests of academic abilities, such as arithmetic (Lazarov, 1982; Wickham, 1958), spelling, vocabulary (Wickham, 1958), anagrams (Golub, 1976; Rodin, 1976), and puzzles (Rodin, 1976). Nor does ­women’s work per­for­mance seem to be negatively affected by the menstrual cycle. Harlow (1986) reviewed a series of studies from the 1920s to the 1980s that show no diminished efficiency in w ­ omen workers and no significant absenteeism due to menstrual pain. Seward’s (1944) review of studies of menstrual cycle effects on w ­ omen’s per­for­mance and productivity on a variety of work-­related tasks also concluded that t­ here was no evidence of significant decline during menstruation. For example, no differences ­were found in the work per­for­mance ratings of ­women factory workers (Smith, 1950) or the work output of w ­ omen laundry workers (Redgrove, 1971) across the menstrual cycle. Nor have researchers found menstrual cycle-­related differences in physical activities, such as arm movements (Stenn & Klinge, 1972), daily walking (Chrisler & McCool,


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1991; Morris & Urdry, 1970), or reaction time (Sommer, 1983), which may be related to work per­for­mance. One would think that so many studies over such a long period of time would put to rest the idea that menstrual cycle-­related changes make ­women less productive members of the work force. However, one can still find occasional news stories in which “authorities” speculate that menstrual cramps and premenstrual syndrome (PMS) cost industry billions of dollars due to employee absenteeism or underper­for­mance on the job (Tavris, 1992). Many scientists remain so convinced that w ­ omen’s hormones affect our be­hav­ior that even the weight of the evidence cannot dissuade them. Instead of concluding that menstrual cycle effects are minimal or absent, scientists argue that they must have taken the wrong mea­sure­ments, that their mea­sure­ments should be more specific than general, more molecular than molar. Thus, ­women have been tested across the menstrual cycle on standardized tests designed by psychologists to study cognitive and perceptual abilities and per­for­mance. No menstrual cycle effects have been found on tests of critical, creative, or abstract thinking (Chrisler, 1991; Golub, 1976; Sommer, 1972); spatial abilities (Golub, 1976; Lazarov, 1982; Wickham, 1958); speed and accuracy of cognitive per­for­mance (Rodin, 1976); speed and accuracy of visual perception (Chiarello, et al., 1989; Compton & Levine, 1997); learning and memory (Lough, 1937; Rodriguez, 1999; Sommer, 1992); or ability to recognize and label emotions accurately (Lazarov, 1982). W ­ omen have been found to be more sensitive to (i.e., better able to perceive) faint lights and odors around the time of ovulation (Parlee, 1983; Sommer, 1983), and at least one study (Parlee, 1983) has shown ­women’s hearing to be more acute at ovulation and at the start of the menses. Researchers (Hampson, 1990; Hampson & Kimura, 1988) have also reported that ­women perform better around ovulation on tests of verbal fluency, speech articulation, and manual dexterity. However, it is impor­tant to note that researchers have found evidence of sex differences that ­favor w ­ omen in sense of smell, verbal fluency, and fine motor abilities (e.g., manual dexterity). Thus, the way to interpret the above reported findings is that ­women’s abilities, which are always good, are even better at mid-­cycle. Behavioral scientists have also examined menstrual cycle effects on ­women’s sexual be­hav­ior. Evolutionary theory predicts that the species is most likely to survive if ­women are most sexually active around the time of ovulation, and a number of researchers (e.g., Adams, Gold, & Burt, 1978; Morris & Urdry, 1982; Williams & Williams, 1982) have found peak sexual interest and activity at mid-­cycle in ­women who ­were not using oral contraceptives. However, w ­ omen’s sexuality is complex, and researchers do not necessarily agree on what should be mea­sured (Golub, 1992, McHugh, 2007): desire, arousal, fantasies, “interest,” masturbation, orgasm, self-­ initiated sexual activity, partner-­initiated sexual activity? In one study (Golub, 1992) in which participants ­were unaware of the purpose of the


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research, ­women reported three peaks in sexual arousal: at mid-­cycle, during the premenstrual phase, and on Day 4. The mid-­cycle peak can be explained by evolutionary theory, but the o ­ thers cannot. However, they can be explained socioculturally. If w ­ omen live in a society that forbids or discourages sexual activity during the menses (for religious reasons—­ women are “unclean,” or for aesthetic reasons—it would be messy or “icky”), it makes sense to seek sexual activity just prior to the start of the menstrual taboo, and it is understandable that ­women would be sexually interested again as the taboo time draws to a close. Furthermore, if w ­ omen wish to avoid pregnancy, it makes sense to act on one’s sexual desire at times (i.e., immediately premenstrually and postmenstrually) when pregnancy is less likely to occur. Both questionnaire and daily diary studies show considerable variability in ­women’s sexual be­hav­ior across the menstrual cycle. Hormonal and social effects, including partner availability and even day of the week (Ripper, 1991), appear to play a role in w ­ omen’s sexual desires and expressions. One t­hing most Americans believe they know is that the menstrual cycle affects ­women’s moods. However, even in this case, the cycle’s effects are not reliably demonstrable, and, when they appear, they are less than expected. Golub (1976) found a significant increase in anxiety and depression scores during the premenstrual phase. However, when she compared her participants’ average scores to the scores of participants in other studies who took the same tests, she found that premenstrual anxiety scores ­were lower than anxiety scores reported during freshman orientation and during exam week; premenstrual depression scores ­were lower than ­those reported by psychiatric patients and about the same as t­ hose reported by pregnant w ­ omen in the first trimester. She concluded that, although the premenstrual rise in depression and anxiety was statistically significant, it was not clinically significant. In other words, ­women do not “go crazy” premenstrually; the changes are just part of the normal ups and downs of life. Other researchers, who took careful, daily mood mea­sure­ments from participants who w ­ ere unaware of the purpose of the studies, found that stress (Wilcoxon, Schrader, & Sherif, 1976) and day of the week (Englander-­ Golden, et al., 1986; Ripper, 1991; Rossi & Rossi, 1977) have a greater effect on w ­ omen’s mood than does the menstrual cycle and that mood fluctuates about as much in men as it does in ­women over the course of 28 days (Parlee, 1980; Rogers & Harding, 1981; Swandby, 1981). However, other researchers (Halbreich & Endicott, 1987; Mitchell, et al., 1994) have found that w ­ omen who experience depressive disorders often report that their depression is worse when they are premenstrual, a pattern that Nancy Fugate Woods and her colleagues termed “PMM”—­premenstrual magnification of existing symptoms. In this case, it would not be correct to say that the premenstrual phase is the cause of w ­ omen’s depression, which is already pres­ent, but it appears to be the case that cyclic biochemical changes enhance the mood that already exists.


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Even though daily reports do not show a pattern of menstrual cycle-­ related mood shifts, w ­ omen do tend to report increased negative emotions, especially depression and irritability, when they are questioned retrospectively (i.e., at the conclusion of the study as opposed to daily). It may be that premenstrual mood shifts are so subtle that most psychological tests are not sensitive enough to mea­sure them, or it may be that ­women have been so influenced by the ste­reo­type of premenstrual ­women that we incorrectly “remember” all our negative emotions as having occurred at that time rather than randomly throughout the month (Golub, 1992). Social psychologists refer to the latter as an illusory correlation. ­Because we expect certain events to be related to each other (e.g., premenstrual phase and bad mood, full moon and impulsive be­hav­ior), we remember instances that confirm our expectations and forget ­those that do not. Two groups of researchers (AuBouchon & Calhoun, 1985; Englander-­Golden, et al., 1986) designed studies to test two groups of ­women participants: one group was aware that the purpose of the study was to examine menstrual cycle effects on mood; the other group was unaware of the ­actual purpose. The “aware” groups reported a pattern of mood variability that was associated with the menstrual cycle; the “unaware” groups did not. T ­ hese studies illustrate both the importance of social expectancies (i.e., we notice symptoms and be­hav­iors that we expect ­will occur) and the role of experimental demand characteristics (i.e., participants who are “aware” assume that the researchers are looking for negative changes, and they try to be helpful by focusing their attention and reports on negative experiences). Attitudes ­toward Menstruation Perhaps the strongest taboo is communication about menstruation (Kissling, 1996). Most U.S. adults surveyed for The Tampax Report (1981) agreed that menstruation should not be discussed in “mixed com­pany,” and many thought it should not be discussed with the f­amily at home. Williams (1983) found that 33 ­percent of the adolescent girls she surveyed would not talk about menstruation with their f­athers, and nearly all her participants agreed that one should not discuss menstruation around boys. Even psychotherapists (especially men) have reported experiencing discomfort when their clients want to discuss some aspect of menstruation (Rhinehart, 1989). When teachers separate girls and boys to view films about puberty, when m ­ others arrange one-­on-­one “facts of life talks” with their ­daughters, they are conveying not only facts about menstruations but guidelines for how to talk about menstruation; they are marking menstruation “as a special topic, not one for ordinary conversation” (Kissling, 1996; p. 495). Exclusive talks held in privacy convey the notion that menstruation is an embarrassing event that must be concealed from o ­ thers and never discussed openly.


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The communication taboo is supported by the existence of dozens of euphemisms for menstruation (Ernster, 1975), and t­ hese euphemisms can be found in cultures around the world. Ernster (1976) examined a collection of American expressions in the Folklore Archives at the University of California at Berkeley, and she grouped the expressions into categories. For example, some refer to female visitors (e.g., “My friend is ­here,” “Aunt Flo/Susie/Sylvia/Tilly is visiting me”), o ­ thers to cyclicity (e.g., “It’s that time again,” “My time of the month/moon,” “my period”), illness or distress (e.g., “the curse,” “the misery,” “I’m u ­ nder the weather,” “Lady trou­ bles,” “weeping womb, ” “falling off the roof”), nature (e.g., “flowers,” “­Mother Nature’s gift”), redness or blood (e.g., “I’m wearing red shoes ­today,” “red plague,” “red moon,” “bloody scourge”), or menstrual products (e.g., “on the rag,” “riding the cotton pony,” “using mouse mattresses” or “­saddle blankets”). References to menstruation that w ­ omen find particularly offensive (e.g., “on the rag/OTR,” “her cherry’s in the sherry”) or that refer to the sexual taboo (e.g., “too wet to plow,” “the red flag is up”) are more commonly used by men and reflect especially negative attitudes ­toward ­women’s bodies. Advertisements for menstrual products are cultural artifacts that play an impor­tant role in the social construction of meaning (Merskin, 1999). Ads have contributed to the communication taboo by emphasizing secrecy, avoidance of embarrassment, freshness, and delicacy (Coutts & Berg, 1993; Delaney et al., 1998, Houppert, 1999; Merskin, 1999). Allegorical images, such as flowers and hearts, and blue liquid rather than reddish blood, have been used euphemistically to promote secrecy and delicacy (Merskin, 1999). Ads play on w ­ omen’s fear of being discovered as menstruating; discovery means stigma or being publicly tainted or “spoiled” (Coutts & Berg, 1993). With the invention of panty liners, advertisers began to tell us to use their products e­ very day so that we can feel “confident” that we can stay “fresh” and untainted (Berg & Coutts, 1994). When Oxley (1997) questioned 55 British w ­ omen about their experiences with menstruation, she found that they echoed many of the themes in the ads. They felt self-­conscious during their menses, preferred tampons b ­ ecause they are “less noticeable” than sanitary napkins, believed that menstrual blood is distasteful to self and o ­ thers, and supported the sex taboo. Advertisements are not the only form of public discourse about menstruation. Cultural attitudes are also conveyed through books, magazine and newspaper articles, jokes, and other cultural artifacts, such as “humorous” products like greeting cards and refrigerator magnets. Most of the attitudes t­ hese media convey are negative, and together, they have constructed a ste­reo­type of menstruating ­women, especially premenstrual ­women, as violent, irrational, emotionally labile, out-­of-­control, and physically or mentally ill. Over the past 20 years my students have brought me bumper stickers (e.g., “A ­woman with PMS and ESP is a bitch who knows every­thing”), buttons (e.g., “It’s not PMS, I’m always bitchy”), cartoons


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(e.g., In a cartoon titled “PMS Worst case Scenario” a w ­ oman sits alone on a small desert island while a man, in the ocean surrounded by sharks, says “Somehow it feels safer out h ­ ere”), greeting cards (e.g., a picture of a cake slashed to bits and the saying “Some special advice for the birthday girl—­ Never cut your cake during PMS”), a calendar of cartoons about a w ­ oman with a r­ eally bad case of PMS (e.g., “To take her mind off her premenstrual syndrome, Melinda decides to rearrange her furniture” by hacking it to pieces with an axe), and books (e.g., Raging Hormones: The Unofficial PMS Survival Guide, the cover of which pictures Joan Crawford as an axe murderer). When I share my extensive collection with my classes, students usually laugh at the first few instances, but by the time they have seen several dozen cartoons, buttons, ­etc., they are usually angry and disheartened. A content analy­sis (Chrisler & Levy, 1990) of 78 articles about premenstrual syndrome that ­were published in American magazines between 1980 and 1987 showed that writers have focused on negative ste­reo­types and sensational cases. The menstrual cycle was referred to as the “cycle of misery,” a “hormonal roller coaster,” “the inner beast,” and the “menstrual monster” (p. 98). The premenstrual and menstrual phases of the cycle ­were described as “weeks of hell” during which ­women are “hostages to their hormones,” and premenstrual ­women ­were described as “cripples” and “raging beasts” (p. 98). The titles of some of the articles in the analy­sis ­were “Premenstrual Frenzy,” “Dr. Jekyll and Ms. Hyde,” “Coping with Eve’s Curse,” “Once a Month I’m a ­Woman Possessed,” and “The Taming of the Shrew Inside of You” (p. 97). The articles suggest that most (or all) ­women experience PMS. Similar attitudes and ste­reo­types have been documented in films and tele­vi­sion (Rosewarne, 2011), online in chat rooms (King, et al., 2014), and in tweets (Thornton, 2013). The emphasis on violent, out-­of-­control w ­ omen in popu­lar culture could easily make us lose sight of the fact that only a small percentage of all violent crimes are committed by w ­ omen. The articles described above ­were influenced by the newspaper coverage of two criminal prosecutions in E ­ ngland of ­women who ­were accused of murder (Sandie Smith) and vehicular hom­i­cide (Christine En­glish). Dr. Katharina Dalton testified in their t­ rials about her belief that the ­women had premenstrual syndrome at the time of the crimes. Smith’s own l­awyer described her as a “Jekyll and Hyde” and stated that without medical treatment, the “hidden animal” in her would emerge (Chrisler, 2002). The t­ rials led to an explosion of media interest in PMS, which has contributed to ste­reo­types about ­women and influenced the way that ­women (and men) think about ­women’s bodies and their emotions (Chrisler, 2002). It is not surprising that ­people who are exposed to the cultural influences described above would have negative attitudes t­oward menstruation. ­These attitudes are formed early and are less influenced by personal experience than one might think. Clarke and Ruble (1978) asked boys and


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premenarcheal girls to rate the severity of the symptoms that they believed ­women experience during menstruation. Boys and premenarcheal girls had well-­defined beliefs and negative attitudes ­toward menstruation; they reported that it is accompanied by pain, emotionality, and a reduction in social and physical activities. The postmenarcheal girls did not let their own experiences guide their responses; they thought that most girls experienced more severe symptoms than they did. Similar results w ­ ere found in a more recent study (Chrisler, et al., 2006) of beliefs about and experience of premenstrual symptoms, in which ­women college students rated their own experience of premenstrual symptoms as mild to moderate, yet believed that severe PMS is widespread and that other ­women’s experience is significantly worse than their own. Researchers have found that men tend to view menstruation as more debilitating than w ­ omen do (, King et al., 2014); w ­ omen tend to rate menstruation as merely a “bothersome” event (Brooks-­Gunn & Ruble, 1980, 1986; Chrisler, 1988). Men are more likely than ­women to describe menstruation as embarrassing, to report that their sources of information about menstruation have been negative (Brooks-­Gunn & Ruble, 1986), and to associate menstruation with danger and stigma (Heard & Chrisler, 1999). ­People who score high on hostile sexism (Chrisler, et al., 2014; Forbes, et al., 2003; Marván, et al., 2014) and ­women who have internalized a more sexually objectified view of their own bodies (Johnston-­Robledo, et al., 2007; Roberts, 2004) have been found to report more negative attitudes toward menstruation and menstruating ­ ­ women. Older adults (who formed their attitudes before the PMS ste­reo­t ype appeared in the early 1980s) perceive menstruation as less debilitating and bothersome than do college students (Chrisler, 1988; Stubbs, 1989). Similar results have been found in Canada and Mexico (Lee, 2002; Marván, et al., 2006), but in other countries, e.g., India Hoerster, et al., 2003), attitudes ­toward menstruation are more positive than is the case in North Amer­i­ca. Attitudes ­toward menstruation are not just an esoteric topic for academic scholars; they have a real impact on ­women’s physical and m ­ ental health as well as our ability to attain success in our chosen pursuits. A number of studies (e.g., Levitt & Lubin, 1967; Paulson, 1961) have shown that negative attitudes ­toward menstruation are correlated with more painful menstrual cramps and greater incidence of other menstrual and premenstrual symptoms; however, the designs of ­those studies do not allow us to tell w ­ hether pain leads to negative attitudes or w ­ hether negative attitudes lead to more attention to, poorer ability to cope with, and a greater tendency to report pain. The answer prob­ably is that it works both ways; attitudes and experience influence each other. Negative attitudes ­toward menstruation and one’s body in general have been correlated with reluctance to try alternative hygiene methods (e.g., reusable cloths, menstrual cups), a desire to forgo menstruation, and an interest in trying birth control methods that suppress the menses (Grose & Grabe, 2014;


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Johnston-­Robledo, et al., 2003), even though t­ hese methods are relatively new and their safety over long-­term use is unknown. ­There is evidence (Roberts, 2004; Roberts & ­Waters, 2004) that negative attitudes ­toward menstruation are among the ­factors that that produce self-­objectification, the tendency to focus on external aspects of the self over internal aspects. It is easy to see how cultural messages (e.g., the text of advertisements for menstrual hygiene products) can lead ­women to be ashamed of their bodies and to engage in excessive bodily surveillance, two of the signs of self-­objectification. Researchers (Calogero, Davis, & Thompson, 2005; Szymanski & Henning, 2007 In a recent study (Marván, Islas, Vela, Chrisler, & Warren, 2008) where college students in the United States and Mexico ­were asked to write down several words that best describe a menstruating w ­ oman, the most common words w ­ ere irritable, moody, sensitive, depressed, and aching; 69  ­percent of the words contributed by Americans and 68 ­percent of t­ hose contributed by Mexicans w ­ ere negative.; Tylka & Hill, 2004) have shown that self-­objectification predicts eating disorders, depression, and sexual prob­lems in w ­ omen. Attitudes ­toward menstruation can divide ­women from each other by pitting ­those who experience severe symptoms against ­those who do not (Stubbs & Costos, 2004), and they affect what ­people think about menstruating ­women. For example, Forbes, et al. (2003) asked a group of college students to rate a set of adjectives in light of the following instruction: “compared with the average ­woman, the w ­ oman during her period is” (p. 59). Both ­women and men thought that a menstruating ­woman is more irritable, sad, and annoying, and less sexy and energized, than the average w ­ oman. In addition, men thought that a menstruating w ­ oman is more annoying and spacey, and less reasonable and nurturing, than average. Golub (1981) found that 75 ­percent of the male and 32 ­percent of the female college students surveyed believed that menstruation affects ­women’s thinking pro­cesses, and 59 ­percent of the men and 51 ­percent of the ­women believed that ­women are less able to function when they are menstruating. In an experiment (Roberts, et al., 2002), a researcher “accidentally” dropped ­either a tampon or a hair clip in front of the participants just before the study began. At the end of the study, the participants rated the researcher as less competent and less likable when she dropped the tampon than they did when she dropped the hair clip. They also exhibited a tendency to sit further away from her during the data collection ­after they had seen her tampon. If employers or coaches, for example, hold ­these negative attitudes and inaccurate beliefs about ­women, they w ­ ill be less likely to hire and promote ­women or to provide them with opportunities to excel on the playing field. Some w ­ omen have formed an online activist community to fight against negative cultural repre­sen­ta­tions of menstrual and premenstrual ­women; they encourage w ­ omen to celebrate menstruation, appreciate their bodies, and use alternative menstrual products that are better for the environment


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than tampons and pads (Bobel, 2006, 2010). Some public health professionals have begun a campaign to urge physicians and nurses to recognize menstruation as a vital sign and indicator of ­women’s health (www​ .­projectvitalsign​.­org). Perhaps t­hese efforts w ­ ill gather momentum and lead to more positive attitudes t­ oward menstruation. MENSTRUAL CYCLE-­RELATED TRANSITIONS AND DISORDERS Menarche Menarche, the first menstrual period, is a milestone in w ­ omen’s development and a psychologically significant event. Although it occurs relatively late in the pubertal pro­cess, as much as 2 years ­after breast buds develop (Tanner, 1978), it is menarche that provides the proof of puberty (Erchull, et al., 1999). Unlike the gradual changes that accompany puberty, menarche is sudden and con­spic­u­ous (Golub, 1992), and it, thus, provides a rather dramatic demarcation between girlhood and womanhood. The importance of menarche is illustrated by the fact that many ­women have vivid and detailed memories of it that are retained over time with surprising clarity. Given the cultural images discussed above, it is no surprise that most girls approach menarche with ambivalence. In studies of North American girls, participants typically report mixed feelings about menarche, such as proud and embarrassed or happy and frightened (Chrisler & Zittel, 1998; Koff, et al., 1981; Woods, et al., 1983; Zimmerman & Chrisler, 1996). African American and Latina girls have reported fewer positive reactions to menarche than Eu­ro­pean American girls, and Latinas also reported the most negative beliefs about menstruation (Zimmerman & Chrisler, 1996). Interviews with British early adolescents revealed that they thought of menstruation primarily as embarrassing, shameful, and something to be hidden; they also thought of their periods as a time of illness (Burrows & Johnson, 2005). Many girls are unprepared for menarche and do not understand what is happening to them when they experience it (Logan, 1980); this is especially likely to occur in early maturing girls for whom menarche appears to be more traumatic than for ­those who are “on time” or late (Petersen, 1983; Scott, et al., 1989). Many ­mothers find it difficult to talk to their ­daughters about menstruation and sexuality (Cooper & Koch, 2007; Gillooly, 1998), so they put off having the talk as long as pos­si­ble, sometimes ­until too late. When they do have “the talk” ­mothers often convey to their ­daughters the negative attitudes and inaccurate information that their own ­mothers told them (Britton, 1999; Costos, et al., 2002). In one study (Scott et al., 1989) of African American girls, 2 ­percent of the participants said that they felt totally unprepared for menarche; this can be compared to the 10–14  ­percent of Eu­ro­pean American girls


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found in other studies (Chrisler & Zittel, 1998; Koff, et al., 1981; Whisnant & Zegens, 1975). Preparation is not every­thing, however, as Koff, et al. (1982) found that even the 60 ­percent of their participants who rated themselves as prepared for menarche had negative feelings about the event when they experienced it. The films and pamphlets that girls are given to educate them about menstruation tend to use technical medical vocabularies to describe the physiological aspects of the menstrual cycle, but are other­wise vague and mysterious (Erchull, et al., 1999; Havens & Swenson, 1989; Whisnant, et al., 1975). Most of ­these educational materials are produced by the companies that manufacture menstrual products, and they tend to pres­ent menstruation as a hygiene crisis that should be hidden from the rest of the world by following rules of careful management and concealment. The emphasis on secrecy reinforces the idea that menstruation is a negative, stigmatizing, and embarrassing event. More positive messages can be found in the following books: Period: A Girl’s Guide to Menstruation (Loulan, et  al., 2001), Before She Gets Her Period: Talking to Your ­Daughter about Menstruation (Gillooly, 1998), and The Care and Feeding of You: The Body Book for Girls (Schaefer, 1998). Adjustment to one’s new menstrual status is entwined with adjustment to thinking of oneself as a young ­woman. Girls are taught that menarche signals the beginning of their adult lives (Koff et  al., 1982). When they experience their menstrual period for the first time, many girls are told that they are now ­women, and they are usually taught about the menstrual cycle in relation to reproduction (Erchull et al., 1999). Adolescents look forward to adulthood, but the average age of menarche in the United States is 12.3 years (Tanner, 1991), which is very young to be an adult. Body image concerns often arise around the time of menarche, as girls cope with menstruation and other pubertal changes, such as weight gain and changes in body shape (Roberts & ­Waters, 2004; Watzlawik, 2008). Koff, et al. (1978) asked adolescent girls to draw pictures of a same-­sex body on two occasions 6 months apart. The bodies drawn by postmenarcheal girls ­were significantly more sexually differentiated than t­ hose drawn by premenarcheal girls, and the contrast was particularly striking in the drawings of the girls whose menarcheal status changed during the study. ­These data show the importance of menarche to the way girls or­ga­nize their body image and sexual identity. Menarche can be seen as a rite of passage to adulthood. Cele­brations range from parties with the girls’ friends or with other w ­ omen in the ­family or village to rituals of cleansing or separation (Delaney et  al., 1987). Cele­brations of menarche are rare in Western countries (Chrisler & Zittel, 1998; Thuren, 1994), and most girls think of menstruation as too embarrassing to discuss with anyone but their ­mothers and close friends. Think about what a change it could make to adolescent girls’ self-­esteem and body image if the change in their menarcheal status was openly


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acknowledged with pride. (For suggestions of ways to celebrate menarche, visit the Red Web Foundation at www​.­redwebfoundation​.­org or First Moon at www​.­celebrategirls​.­org​.­) Dysmenorrhea Dysmenorrhea is the technical term used to describe the uterine cramps, headaches, backaches, and other unpleasant symptoms that may occur during menstruation. It typically starts 2–12 hours prior to the onset of the menstrual flow and lasts 24–36 hours (Golub, 1992). Dysmenorrhea occurs only during ovulatory cycles, and it is thought that the pro­cess of ovulation triggers the production of prostaglandins, that is, hormone-­ like substances that cause the uterine contractions that we call menstrual cramps (Dawood, 1981; Golub, 1992). The amount of prostaglandin produced differs from ­woman to ­woman and even from cycle to cycle in the same ­woman; therefore, w ­ omen may experience dysmenorrhea only during some cycles. Dysmenorrhea generally begins in the early teens and is most severe during the teens and early 20s; it, then, typically declines with age (Golub, 1992), although some ­women report its return prior to menopause. Almost ­every ­woman experiences menstrual cramps from time to time, and about 50 ­percent of ­women experience dysmenorrhea; about 5–10 ­percent of ­women experience symptoms severe enough to incapacitate them anywhere from 1 hour to 3 days (Golub, 1992). Although the connection between prostaglandins and menstrual cramps was known in the mid-1960s (Pickles, et al., 1965), prostaglandins ­were not generally accepted as the cause of cramps u ­ ntil around 1980. Prior to 1980, dysmenorrhea was commonly treated as a conversion disorder. ­Women who complained of severe symptoms ­were told that their prob­lems w ­ ere “all in their heads,” advised to have a baby, or referred to a psychiatrist. Many physicians believed that only ­women who reject the feminine gender role would experience pain during menstruation. ­There is a large lit­er­a­t ure that documents the attempt by physicians and psychologists to “prove” that neuroticism c­ auses dysmenorrhea. Many personality and attitude variables w ­ ere examined, with negative or obscure results. This research area quickly became inactive with the discovery that most w ­ omen w ­ ere helped by anti-­prostaglandin medi­cations, and physicians and psychologists turned their attention to premenstrual syndrome. ­Women themselves also seemed to turn their attention to PMS, as one rarely hears complaints ­these days about dysmenorrhea (Chrisler & Johnston-­Robledo, 2002), and self-­help books for PMS commonly list cramps and other symptoms of dysmenorrhea as symptoms of PMS (Chrisler, 2003). ­Today, w ­ omen with dysmenorrhea are advised to take an over-­the-­ counter anti-­prostaglandin medi­cation (e.g., ibuprofen). If that does not work, they should see a gynecologist who can prescribe a stronger


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medi­cation and conduct a physical examination to determine that the dysmenorrhea is indeed primary, as opposed to secondary, which could indicate a more serious condition, such as endometriosis or pelvic inflammatory disease (PID). Other strategies that w ­ omen find useful in coping with mild to moderate dysmenorrhea include muscle relaxation, pain control imagery, stretching exercises (e.g., yoga), warm baths, heating pads, rest, and orgasm. Systematic desensitization (Tasto & Chesney, 1974), autogenic training, and both temperature and electromyogramic biofeedback (Sedlacek & Heczey, 1977) have been used successfully in therapy to reduce menstrual pain. Premenstrual Syndrome Premenstrual syndrome (commonly known as PMS) refers to the experience of psychological and physiological changes in the 3–5 days prior to the onset of menstruation. The most frequently reported symptom of PMS is fluid retention, particularly in the breasts and abdomen. Other commonly reported symptoms include headaches, backaches, constipation, food cravings, acne, anxiety, tension, lethargy, sleep changes, irritability, and depression. Over 100 changes have been associated with PMS in the professional and popu­lar lit­er­a­ture (Chrisler, 2003; Chrisler & Levy, 1990; Figert, 1996; Laws, et al., 1985), including some so gendered that they would never be considered “symptoms” in men (e.g., craving for sweets, increased sexual desire). It has been suggested (Dalton, 1960a, 1960b, 1968), although ­there is ­little scientific evidence for this, that premenstrual ­women have difficulty concentrating, exhibit poor judgment, lack physical coordination, exhibit decreased efficiency, and perform less well at school or on the job. W ­ omen also report cognitive, behavioral, and psychological changes that they welcome and view as positive, such as bursts of energy and activity, increased creativity, increased sex drive, feelings of affection, increased personal strength or power, and feelings of connection to nature and other w ­ omen (Chrisler, et al., 1994; Lee, 2002; Nichols, 1995). ­These premenstrual experiences are rarely mentioned in the professional or popu­lar lit­er­a­ture ­because they do not fit the conceptualization of the premenstruum as a time of illness and dysphoria. Sometimes lists of the symptoms of PMS include some surprising items, such as seizures or convulsions, asthma attacks, and herpes. Obviously, normal luteal phase biochemistry does not cause w ­ omen to develop epilepsy, asthma, or sexually transmitted infections (STIs). However, Nancy Fugate Woods and her colleagues (Mitchell, et al., 1994; Woods, et al., 1999) have documented cases in which menstrual cycle fluctuations aggravate or magnify (premenstrual magnification or PMM) existing health conditions, and they suggested that menstrual cycle-­related changes are capable of triggering flare-­ups of chronic conditions. Among the conditions that can flare-up premenstrually are asthma, allergies, sinusitis, depression,


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anxiety disorders, herpes, irritable bowel syndrome, migraine headaches, and multiple sclerosis (Taylor & Colino, 2002). Symptoms of t­ hese conditions overlap with t­ hose listed above as commonly reported by w ­ omen as features of PMS (e.g., fatigue, tension, sadness, anxiety, irritability, insomnia, constipation, and diarrhea). Perhaps some ­women who think they have PMS have a relapsing-­remitting chronic illness that has not been diagnosed as such b ­ ecause some flare-­ups have coincided with the premenstrual phase and, thus, misled the w ­ oman to dismiss them as “just PMS.” Many of the commonly listed symptoms of PMS (e.g., headaches, backaches, irritability, tension, crying, fatigue) overlap with the physical sensations associated with stress (Chrisler, 2004). A number of researchers (Beck, et al., 1990; Coughlin, 1990; Gallant, et  al., 1992; Kuczmierczyk, Labrum, & Johnson, 1992; Maddocks, & Reid, 1992; Warner & Bancroft, 1990) have reported that w ­ omen who describe themselves as suffering from PMS also indicate that they experience high levels of stress from such sources as work load and work monotony, financial strain, marital dissatisfaction, hectic schedules, and ­family conflict. Some data indicate that w ­ omen who report severe symptoms of PMS do not cope as well with stress as do asymptomatic ­women (or ­those who report mild symptoms). ­Women who self-­report PMS have been found to be more likely than other ­women to use coping methods, such as avoidance, wishful thinking, appeasement, religion, withdrawal, and focusing on or venting emotions, and they are less likely than other ­women to use coping methods such as seeking social support, prob­lem solving, and direct action (Gallant, et al., 1994; Genther, et al., 1999; Ornitz & Brown, 1993). Researchers have also reported that ­women who seek treatment for premenstrual symptoms exhibit higher than average trait anxiety (Giannini, et al., 1985; Halbreich & Kas, 1977; Mira, et al., 1985; Picone & Kirby, 1990), adhere to the traditional feminine gender role (Freeman, Sondheimer, & Rickels, 1987; Stout & Steege, 1985), and have a higher than average lifetime incidence of sexual assault and abuse (Taylor, et al., 2001) and affective disorders, especially depression and anxiety (DeJong, et al., 1985; Dennerstein, et al., 1988; Endicott & Halbreich, 1988; Kraaimaat & Veeninga, 1995; Pearlstein et al., 1990; Warner, et al., 1991). It is also stressful to silence oneself when irritable or angry and to discipline oneself not to exhibit negative affect that might discomfit o ­ thers (Ussher, 2004), which many w ­ omen try hard to do. It is time to acknowledge the possibility that the stress of w ­ omen’s busy, over­ burdened lives and, in some cases, traumatic events contribute as much to the experience of PMS as does the menstrual cycle (Chrisler & Johnston-­ Robledo, 2002). If ­women’s coping abilities are being strained by a history of trauma and/or affective or anxiety disorders, it makes sense that changes associated with the menstrual cycle may be perceived as “the last straw” that strains them beyond control (Chrisler & Caplan, 2002). Nor is it surprising that ­women who endorse the traditional feminine gender role


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tend to choose indirect, passive, and self-­blaming (e.g., “It’s not your fault, it’s my PMS”) strategies for coping with stress (Chrisler & Johnston-­ Robledo, 2002). Although ­there is a large lit­er­a­ture about PMS in biomedical and psychosocial journals, ­there is no definitive cause of PMS (although speculations include gonadal or adrenal hormone levels, sleep disturbance, inadequate nutrition, stress, obesity, neuroticism, and self-­fulfilling prophecy); nor is t­here a cure. Although data do indicate that w ­ omen experience cyclic changes, it is difficult to know how common such changes are. Estimates of the number of w ­ omen who experience premenstrual “symptoms,” which depend on how the data ­were collected, vary from 2 ­percent (using the strictest criteria of a 30 ­percent increase in the intensity of selected emotional and physical experience charted daily over at least two menstrual cycles) to 100 ­percent (using the loosest criteria, e.g., “Have you ever experienced cyclic changes in your physical or emotional state?”) (Chrisler, 2004). Perhaps only 5  ­percent of ­women experience symptoms severe enough to require medical attention (Rose & Abplanalp, 1983). Despite efforts by the Society for Menstrual Cycle Research and the National Institute of ­Mental Health to produce a standard definition, ­there is ­little agreement on how many changes must be experienced or how severe the experience must be to be considered PMS. So many dif­fer­ent definitions exist in the lit­er­a­ture that the results of studies cannot easily be compared. Even the timing of the premenstrual phase is unclear. Some researchers define it as 3–5 days or 5–7 days prior to menstruation; ­others have defined it as the time between ovulation and menstruation (about 2 weeks). Some self-­help books suggest that the premenstrual phase can last almost 3 weeks (Chrisler, 2003). The prob­lem of prevalence estimates is made more difficult by the fact that premenstrual experience is highly variable and personal. All ­women do not experience the same changes; moreover, the experience of any given ­woman may vary from cycle to cycle. In addition, PMS has become such a part of popu­lar culture in the past 35 years that the results of surveys have undoubtedly been affected by a response bias in the direction of the ste­ reo­ type of the premenstrual w ­ oman (Chrisler, 2004). Thus, many ­women have diagnosed themselves with PMS. Feminist scholars (e.g., Chrisler & Caplan, 2002: Figert, 1996; Houppert, 1999; Martin, 1988; Ritten­house, 1991) have noted ways in which po­liti­cal expediency has influenced scientific and cultural interest in the premenstrual phase of the menstrual cycle. The social construction of PMS is generally agreed to have begun during the G ­ reat Depression with the publication of an article by Robert Frank (1931), an American gynecologist, who described a condition he called premenstrual tension. He wrote that ­women became tense and irritable just prior to menstruation, and he expressed concerns about their tendency to engage in “foolish and ill-­ considered actions” during that time (p. 1054). Frank’s discovery added a


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modern veneer to the cult of invalidism and Victorian-­era concerns about the ill effects that intellectual exertion might have on the menstrual cycle, and it provided a good reason why ­women should stay out of the workforce and leave the few jobs that w ­ ere available to men. Katharina Dalton, who coined the term premenstrual syndrome, published her first work on it during the 1950s, when middle-­class ­women w ­ ere being urged to become full-­time homemakers and leave their jobs to veterans of World War II. Biomedical and social scientists began to pay serious attention to PMS in the 1970s, ­after the widespread gains of the ­Women’s Liberation Movement. By the mid-1980s, during the conservative anti-­feminist backlash in the United States and the United Kingdom in which the British courts accepted PMS as a plea of diminished responsibility, PMS was firmly established as a cultural ste­reo­type of ­women (see Chrisler, 2002). At the same time, the American Psychiatric Association devised Premenstrual Dysphoric Disorder (PMDD; first termed “late luteal phase dysphoric disorder”) and inserted it into the Diagnostic and Statistical Manual of ­Mental Disorders (DSM-­III-­R). Thus, we can see a clear pattern of professionals stepping forward to remind ­women each time they make gains in the public sphere that they cannot go much further due to their delicate physical and emotional health. Premenstrual dysphoric disorder is defined in the DSM-5 (American Psychiatric Association, 2013) as requiring at least five of the following (at least one must be related to mood) symptoms pres­ent during most of the weeks that precede the menses: 1) marked affective lability (e.g., suddenly sad or tearful, mood swings, increased sensitivity to rejection); 2) marked irritability or anger or increased interpersonal conflicts; 3) marked depressed mood, feelings of hopelessness, or self-­deprecating thoughts; 4) marked anxiety, tension, or feeling “on edge;” 5) decreased interest in usual activities; 6) subjective difficulty concentrating; 7) lethargy, fatigue, or marked lack of energy; 8) marked change in appetite; 9) hypersomnia or insomnia; 10) sense of being overwhelmed or out of control; 11) physical symptoms (e.g., breast tenderness or swelling, “bloating,” weight gain, joint or muscle pain.

To distinguish PMDD from other forms of depression that might simply worsen at points during the menstrual cycle, the criteria state that all the symptoms must be absent during the week a­ fter the menses and that they must be severe enough to interfere with daily functioning or relationships. The American Congress of Obstetricians and Gynecologists (2011) has estimated that 85 ­percent of w ­ omen report minor or isolated premenstrual changes, but only 5–10 ­percent experience symptoms severe enough to interfere with daily functioning. Although it was the stated intent of the psychiatrists who developed PMDD to move away from the “kitchen sink” diagnostic criteria of PMS and define a subset of ­women who


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experienced a unique psychiatric disorder, the symptoms of PMDD overlap with ­those of PMS as defined by Debrovner (1982) and ­others, and advertisements for pharmacological treatments for PMDD have encouraged ­women to confuse PMS and PMDD (Chrisler & Caplan, 2002; Cosgrove & Riddle, 2003) to increase sales. Furthermore, no definitive evidence has ever been produced to show that PMDD is a separate entity from PMS or from other forms of depression (Chrisler & Caplan, 2002). Feminist scholars (Caplan, et al., 1992; Nash & Chrisler, 1997; Offman & Kleinplatz, 2004) have expressed concerns that the presence of PMDD in the DSM ­will result in more, not fewer, erroneous diagnoses of w ­ omen’s complaints and ­will lead to increased bias and discrimination against ­women. For a discussion of the politics of the development and implementation of the psychiatric diagnosis, see Caplan (1995) or Figert (1996). An in­ter­est­ing new line of research consists of qualitative studies (e.g., focus groups, interviews, discourse analy­sis) of ­women’s beliefs about, attitudes t­oward, and embrace of or re­sis­tance to the PMS label. Most of the participants in ­these studies have been white ­women, as have most of the ­women who have sought ser­vices at PMS clinics (Markens, 1996), and most of the ­women depicted in the cultural products mentioned earlier. Although African American and Eu­ ro­ pean American ­ women have reported similar levels of premenstrual symptoms in community studies (Stout et al., 1986), African American w ­ omen’s apparent reluctance to seek medical ser­vices, and the scarcity of articles about PMS in magazines that target black ­women (Markens, 1996), suggest that the re­sis­tance to the PMS label may be greater in some ethnic and socioeconomic groups than in ­others. Perhaps ­women who have experienced discrimination that is class-­, race-­, language-­, or sexual orientation-­based are less willing to call attention to their female state or less able to believe that they can expect sympathy for their condition than are ­women who have experienced less (or less overt) discrimination in their lives. In a series of interviews with w ­ omen patients recruited from a PMS clinic in ­England, Swann and Ussher (1995) found that their participants’ views of PMS ­were very similar to ­those presented in popu­lar culture. They firmly believed that PMS is biologically based, and they rejected situational attributions for their distress, which the authors described as “romantic discourse” (e.g., “every­thing ­else in my life is fine, it’s just my PMS”) (p. 365). Swann and Ussher’s participants ­adopted a “dualistic discourse” (p. 364) that parallels the Jekyll and Hyde or “me/not me” discourse in self-­help books for PMS (Chrisler, 2003). This discourse has also been found in more recent studies (Chrisler, et al., 2014; Cosgrove & Riddle, 2003). In framing their premenstrual experience this way, w ­ omen assert that Ms. Hyde “not me” is responsible for any interpersonal prob­ lems, impulsivity, or other negative outcomes that derive from actions taken during the premenstrual phase of the cycle. In studies (Cosgrove & Riddle, 2003; Lee, 2002) of community samples of w ­ omen with and without PMS, ­there is evidence of more ambivalence


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and some re­sis­tance, yet beliefs similar to t­ hose expressed by the En­glish PMS patients. Lee (2002) found that ­ women with negative attitudes ­toward menstruation ­were more likely to consider PMS to be an appropriate label for their personal experience and to believe that w ­ omen’s symptoms are not taken seriously without a medical explanation. ­Women with more positive attitudes ­toward menstruation ­were more critical of the label PMS, even though most of them said that they did experience it to some extent. Some commented that the term disempowers ­women by subsuming their experiences u ­ nder the umbrella of illness. A few spoke of “changes” rather than “symptoms,” as many feminist writers do, in order to “own” both the problematic and the positive fluctuations they experienced. Cosgrove and Riddle (2003) reported that the ­women in their study who resisted the PMS label used biological discourse (e.g., ge­ne­ tics) to explain why they did not suffer from PMS (e.g., “I’m just lucky that I have good genes”). This shows how firmly the biological basis of PMS is implanted in the culture, even though the scientific evidence to sustain it is lacking. Behavioral, nutritional, and pharmacological treatments that target individual symptoms can help w ­ omen to cope with premenstrual changes. Vitamin B, aspirin, diuretics, exercise, relaxation techniques, extra sleep, and reduction of salt intake may be particularly useful (Chrisler & Johnston-­Robledo, 2000). ­Women should also be encouraged to challenge their attributions about their premenstrual experiences. Instead of labeling their experiences as “symptoms,” they could call them “changes.” ­Women can be encouraged to think of themselves as “sensitive,” rather than as “ill” or as “overreacting” (Koeske, 1983). If we lived in a society in which ­women wore loose clothing such as robes or saris, would we even notice w ­ ater retention (Rome, 1986), much less consider it a symptom of a disorder? Why is an occasional urge to eat a candy bar or a salty snack seen as a sign of a medical condition (Chrisler, 2004)? Are ­there benefits to the experience of cyclic variations? Is change not preferable to stagnation (Chrisler & Johnston-­Robledo, 2000)? Furthermore, ­women should be educated about the fact that hormones do not make ­people angry or irritable, although they may intensify ­those reactions. ­There are always reasons for ­women’s anger, and it is t­ hose reasons, not hormonal levels, that should be addressed. Menopause Menopause refers to the cessation of reproductive capacity; it is defined as 12 months without a menstrual period. Menopause occurs as a result of age-­related changes that lead to the gradual diminishing of the production of ovarian hormones. The average age of North American w ­ omen at menopause is 51 years, but it can occur naturally at any age between 40 and 60 (Voda, 1997). The pro­cess that leads to menopause (known as perimenopause) takes about 7 years to complete. Therefore, a ­woman who w ­ ill


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reach menopause at age 50 might notice the first changes in her menstrual cycle at around 43 years of age. Early changes are likely to include menstrual cycle irregularity, including shorter or longer cycles and heavier or lighter menstrual flow. Menopause can also occur artificially, as a result of the surgical removal of the uterus and ovaries, and w ­ omen who reach menopause in this sudden way often report more severe symptoms and distress than t­ hose who approach it gradually (Dillaway, 2015; Voda, 1997). Perhaps b ­ ecause it is associated with aging, menopause is often viewed in Western socie­ties as a negative event. However, surveys (Huffman, et al., 2005; Maoz, et al., 1970; Neugarten, et al., 1968) of midlife w ­ omen have typically shown that w ­ omen have mixed feelings. The downside of menopause, w ­ omen say, is the loss of fertility, physiological changes that accompany it, feeling less feminine, having a clear sign of aging, and a belief that it has come too soon. The upside is the end of dealing with menstrual periods, the end of contraceptive concerns, and a general sense of liberation. Older ­women typically have more positive attitudes t­oward menopause than younger w ­ omen do, and they are more likely than younger w ­ omen to agree that postmenopausal ­women feel freer, calmer, and more confident than ever. Many w ­ omen find that the worst part of menopause is not knowing what to expect. One reason why ­women do not know what to expect is that ­u ntil recently menopause was not discussed very much; ­women tended to keep their experiences private. However, knowing about ­others’ experiences does not help much in predicting one’s own. Perimenopausal physiological changes and ­women’s emotional reactions to them are highly variable. The most common menopause-­related symptom is the hot flash (or flush), which, surveys show, is experienced by 43–93 ­percent of ­women (Woods, 1982). One reason why ­women complain about the experience of hot flashes is the concern that sweating or flushing red skin ­will alert other ­people to their perimenopausal status: the secret ­will be “out.” Other frequent perimenopausal complaints include sweating, vaginal dryness, headaches, vertigo, fatigue, weight gain, aches and pains, insomnia, irritability, tingling sensations, and anxiety. Some of t­hese symptoms are undoubtedly related to each other. For example, hot flashes that occur during sleep (also known as “night sweats”) can awaken ­women several times each night. Regular experience of sleep deprivation leaves ­women fatigued and irritable, and may increase their anxiety as bedtime draws near. Stress is known to trigger hot flashes, and so do caffeine, alcohol, hot weather, and spicy foods (Voda, 1982). The notion that depression is linked to menopause (once known as “involutional melancholia”) is not empirically supportable; data from large epidemiological surveys (e.g., McKinley, et  al., 1987) indicate that w ­ omen are no more likely to be depressed at midlife than they are at any other developmental stage. Images of older w ­ omen and information about menopause in the media tend to be negative (Chrisler, et  al., 1999; Gannon & Stevens, 1998;


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Mansfield & Voda, 1993; Rostosky & Travis, 2000). The first widespread public discussion of menopause was occasioned by the publication in 1966 of Robert Wilson’s book Feminine Forever, which championed estrogen replacement therapy. Wilson’s thesis was that menopause signals the end not only of w ­ omen’s reproductive capacity, but also of their attractiveness, femininity, sexuality, energy, and, ultimately, of their health. He defined menopause as a deficiency disease, and synthetic hormones as its cure. Articles in the popu­ lar press, inspired by Wilson’s book, described menopausal w ­ omen as “crippled castrates” and menopause as “a natu­ral plague,” “a horror of living decay,” “progressive defeminization,” “one of nature’s ­mistakes,” and a “serious physical and ­mental syndrome” that only medical treatment can “prevent” (Chrisler, et al., 1999; p. 30). It seems that Carol Tavris (1992, p. 133) was correct when she noted that “the only ­ thing worse for ­ women than menstruating is not menstruating.” Within 10 years of the publication of Wilson’s book (1966), the medical professionals’ and the public’s enthusiasm for unopposed estrogen treatment began to dim, as it became clear that it did not produce all the effects claimed for it. Estrogen did help to reduce hot flashes, but it did not retard aging, make older ­women supple and graceful, or improve psychological symptoms. Furthermore, it was shown to lead to uterine cancer. Feminist theorists (MacPherson, 1981; McCrea, 1983) and w ­ omen’s health organ­ izations (e.g., the Boston ­Women’s Health Book Collective, the National ­Women’s Health Network) urged w ­ omen to think of menopause not as an illness but as a normal developmental transition (like menarche) to which one must adjust. However, the potential to market hormone replacement therapy (HRT) to the approaching baby boomer generation may have been too much for phar­ma­ceu­ti­cal companies to resist. They began to produce combinations of synthetic estrogen and progesterone to avoid uterine cancer, and soon the media w ­ ere telling w ­ omen that HRT would not only reduce the troublesome symptoms of perimenopause, but would also prevent heart disease, osteoporosis, and cognitive decline. Experts urged all perimenopausal w ­ omen to begin HRT at the earliest signs of menstrual cycle-­related changes and to continue it for the rest of their lives, even though Medicaid, Medicare, and many private insurance plans did not reimburse w ­ omen for the cost. In 1991, the National Institutes of Health began the W ­ omen’s Health Initiative (WHI) HRT trial, which was designed to look at heart disease rates in a large scale, double-­blind, clinical trial, the type of research often referred to in medicine as the “gold standard.” The WHI was stopped in 2002, several years ahead of schedule, ­because the results showed that the number of blood clots in w ­ omen on HRT was three times higher than that in w ­ omen in the control group. The data also showed increased rates of stroke and breast cancer in w ­ omen on HRT. Thus, not only was HRT not the panacea its proponents had claimed, it could harm w ­ omen’s health.


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­ omen’s health activists, including members of the Society for Menstrual W Cycle Research, who had long expressed skepticism about the claims made for HRT and urged ­women not to use it over the long term in the absence of demonstrated need and safety, w ­ ere both vindicated and angered by the results of the WHI. Not only had millions of ­women put their health at risk by following medical advice, but proponents of HRT immediately began to criticize the carefully designed WHI and to seek ways to utilize HRT “safely.” Many w ­ omen who had been using HRT (or had been planning to use it) w ­ ere disappointed to learn that it was no longer an option for them, although physicians have begun again to prescribe it for severe symptoms (Derry, 2015). Coping with physical symptoms is an impor­tant task during the menopausal transition, and ­there are many safe ways to do it. Good health habits at midlife, such as exercise, proper diet, stress management, and reducing caffeine and alcohol intake and smoking, are often helpful. Vitamins E and C and herbal treatments (e.g., yams, motherwort, black cohosh) might help to control hot flashes, as would noting and then avoiding triggers of hot flashes. Cognitive-­behavioral techniques can also assist in coping. ­Women might try dressing in layers, carry­ing a fan, standing in front of an air conditioner or open refrigerator, sipping cool drinks, and using imagery, e.g., walking through a snowstorm, swimming in a mountain stream (Dillaway, 2015; Golub, 1992; Greenwood, 1996; Voda, 1997). Perimenopausal ­women should concentrate on the positive aspects of the achievement of menopause, and should remind themselves, that when a symptom occurs, this, too, s­ hall pass. Books such as Menopause: Me and You (Voda, 1997) and Mind Over Menopause: The complete mind/body approach to coping with menopause (Kagan, Kessel, & Benson, 2004) contain other good advice for midlife w ­ omen. CONCLUSION It is striking that a phenomenon as familiar as the menstrual cycle can be so misunderstood. College students in my Psy­chol­ogy of ­Women classes, who are other­wise well-­educated and sophisticated, tell me that they have never heard the word “menarche.” They do not understand the difference between dysmenorrhea and PMS, and they confuse “the menstrual cycle” with “the menses,” or menstrual phase of the cycle. How is it pos­si­ble that cultural images of ste­reo­t ypical premenstrual w ­ omen can be found everywhere, yet menstruation remains a taboo topic of conversation? The answer no doubt is po­liti­cal. As Sommer (1983) noted, the menstrual cycle is such a clear differentiation between ­women and men that its very existence has become politicized and used against ­women, i.e., to keep them out of higher education, good jobs, and power­ful roles; to keep them in their traditional places. In


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ancient times, men found menstruation frightening; it was mysterious ­because it could not be understood. ­Today, it is ­women who find menstruation (and menopause, and the premenstrual phase of the cycle) frightening b ­ ecause they have been convinced that anything to do with the menstrual cycle signals illness that requires medical treatment. ­Women fear that they w ­ ill lose control of their emotions and appetites when they are premenstrual; that they ­will be discovered, humiliated, and stigmatized when they are menstruating; that they w ­ ill not be able to cope with the symptoms of menopause and that the decline in gonadal hormone levels ­will leave them vulnerable to all manner of disease. ­Women have been taught to see their own bodies as the ­enemy, as shameful, disgraceful, and unmanageable, and to be preoccupied with their bodies’ deficits, real or ­imagined. If we accept this negative and medicalized cultural framing of a benign psychophysiological pro­cess once known to earlier generations of w ­ omen as “My Friend,” ­there w ­ ill be no need for the powers-­that-be to keep ­women in our “places,” we ­will do it ourselves. REFERENCES Adams, D. B., Gold, A. R., & Burt, A. D. (1978). Rise in female-­initiated sexual activity at ovulation and its suppression by oral contraceptives. New ­England Journal of Medicine, 229, 1145–1150. American Congress of Obstetricians and Gynecologists. (2011). ­Women’s health stats and facts. Retrieved from http://­w ww​.­acog​.­org​/­​-­​/­media​/­NewsRoom​ /­MediaKit​.­pdf. American Psychiatric Association. (2013). Diagnostic and statistical manual of m ­ ental disorders (5th ed.). Washington, DC: Author. AuBuchon, P. G., & Calhoun, K. S. (1985). Menstrual cycle Symptomatology: The role of social expectancy and experimental demand characteristics. Psychosomatic Medicine, 47, 35–45. Beck, L. E., Gevirtz, R., & Mortola, J. F. (1990). The predictive role of psychosocial stress on symptom severity in premenstrual syndrome. Psychosomatic Medicine, 52, 536–543. Berg, D. H., & Coutts, L. B. (1994). The extended curse: Being a ­woman ­every day. Health Care for ­Women International, 15, 11–22. Bern­stein, B. E. (1977). Effects of menstruation on academic per­for­mance among college ­women. Archives of Sexual Be­hav­ior, 6, 289–296. Bobel, C. (2006). “Our revolution has style”: Con­temporary menstrual product activists “­doing feminism” in the third wave. Sex Roles, 56, 331–345. Bobel, C. (2010). New blood: Third-­wave feminism and the politics of menstruation. New Brunswick, NJ: Rutgers University Press. Britton, C. J. (1999). Learning about “the curse”: An anthropological perspective on experiences of menstruation. ­Women’s Studies International Forum, 19, 645–653. Brooks-­Gunn, J., & Ruble, D. N. (1980). The menstrual attitude questionnaire. Psychosomatic Medicine, 42, 503–512.


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Martin, E. (1987). The w ­ oman in the body: A cultural analy­sis of reproduction. Boston, MA: Beacon Press. Martin, E. (1988). Premenstrual syndrome: Discipline, work, and anger in late industrial socie­t ies. In T. Buckley and A. Gottlieb (Eds.), Blood magic: The anthropology of menstruation (pp. 161–181). Berkeley, CA: University of California Press. Marván, M. L., Islas, M., Vela, L., Chrisler, J. C., & Warren, E. A. (2008). Ste­reo­t ypes of w ­ omen in dif­fer­ent stages of their reproductive lives: Data from Mexico and the United States. Health Care for ­Women International, 29, 673–687. Marván, M. L., Ramírez-­Esparza, D., Cortés-­Iniestra, S., & Chrisler, J. C. (2006). Development of a new scale to mea­sure Beliefs about and Attitudes ­toward Menstruation (BATM): Data from Mexico and the United States. Health Care for W ­ omen International, 27, 453–473. Marván M. L., & Trujillo, P. (2010). Menstrual socialization, beliefs, and attitudes concerning menstruation in rural and urban Mexican ­women. Health Care for W ­ omen International, 31, 53–67. Marván, M. L., Vázquez-­Toboada, R., & Chrisler, J. C. (2014). Ambivalent sexism, attitudes t­oward menstruation, and menstrual cycle-­related symptoms. International Journal of Psy­chol­ogy, 49, 280–287. McCrea, F. B. (1983). The politics of menopause: The “discovery” of a deficiency disease. Social Prob­lems, 31, 111–123. McHugh, M. (2007). ­Women and sex at midlife: Desire, dysfunction, and diversity. In V. Muhlbauer and J. C. Chrisler (Eds.), ­Women over 50: Psychological perspectives (pp. 26–52). New York: Springer. McKinley, J. B., McKinley, S. J., & Brambilla, D. (1987). The relative contribution of endocrine changes and social circumstances to depression in mid-­aged ­women. Journal of Health and Social Be­hav­ior, 28, 345–363. Merskin, D. (1999). Adolescence, advertising, and the idea of menstruation. Sex Roles, 40, 941–957. Mira, M., Vizzard, J., & Abraham, S. (1985). Personality characteristics in the menstrual cycle. Journal of Psychosomatic Obstetrics and Gynecol­ogy, 4, 329–334. Mitchell, E. S., Woods, N. F., & Lentz, M. J. (1994). Differentiation of ­women with three perimenstrual symptom patterns. Nursing Research, 43, 25–30. Morris, M. N., & Udry, J. R. (1970). Variations in pedometer activity during the menstrual cycle. Obstetrics and Gynecol­ogy, 35, 199–201. Morris, M. N., & Urdry, J. R. (1982). Epidemiological patterns of sexual be­hav­ior in the menstrual cycle. In R. C. Friedman (Ed.), Be­hav­ior and the menstrual cycle (pp. 129–154). New York: Marcel Dekker. Nash, H. C., & Chrisler, J. C. (1997). Is a ­little (psychiatric) knowledge a dangerous ­thing? The impact of premenstrual dysphoric disorder on perceptions of premenstrual ­women. Psy­chol­ogy of ­Women Quarterly, 21, 315–322. Neugarten, B. L., Wood, V., Kraines, R. J., & Loomis, B. (1968). W ­ omen’s attitudes ­toward menopause. In B. L. Neugarten (Ed.), ­Middle age and aging (pp. 195– 200). Chicago, IL: University of Chicago Press. Nichols, S. (1995). Positive premenstrual experiences: Do they exist? Feminism & Psy­chol­ogy, 5, 162–169. Offman, A., & Kleinplatz, P. J. (2004). Does PMDD belong in the DSM? Challenging the medicalization of w ­ omen’s bodies. Canadian Journal of H ­ uman Sexuality, 13, 17–27.


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Chapter 8

­Women in the M ­ iddle and ­Later Years Claire Etaugh

This chapter examines the major characteristics and experiences of middle-­aged and older w ­ omen. To do so, we should first define what is meant by “­middle age” and “old age.” In fact, t­ here is no firm consensus. Clearly, the bound­aries of the m ­ iddle and l­ ater years are quite flexible. No one biological or psychological event signals the beginning of ­m iddle or old age. Rather, individuals typically experience a number of life events and role transitions during ­ these years, including ­ those related to physical appearance and health, sexuality, marital status, parenting, grandparenting, caring for aging f­ amily members, employment, and retirement. T ­ hese events are not experienced by every­one, nor do they occur at the same age or in the same sequence. Fundamental changes in social attitudes regarding gender roles over the past several de­cades have begun to broaden the opportunities available to w ­ omen in midlife as well as in other life stages. Impor­tant to understanding the impact of role transitions in the m ­ iddle and ­later years is the timing or degree of predictability of ­these changes. For example, having the last child leave home and becoming a grandparent are frequently expected and welcome role transitions, whereas divorce, death of a spouse or partner, and providing care for ailing parents are often unplanned and stressful changes. PHYSICAL APPEARANCE Physical appearance begins to change in midlife (Etaugh & Bridges, 2013; Kilpela, et al. 2015). The hair becomes thinner and grayer. Weight increases u ­ ntil about age 50 and declines somewhat a­ fter that. Fat becomes


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redistributed, decreasing in the face, legs, and lower arms and increasing in the abdomen, buttocks, and upper arms. Starting at about age 40, the discs between the spinal vertebrae begin to compress, resulting in an eventual loss in height of one to two inches. Bones become thinner, brittle, and more porous, especially in ­women, sometimes resulting in painful and crippling fractures of the hip or vertebrae. The skin becomes drier and loses its elasticity, along with the muscles, blood vessels, and other tissues. Wrinkles appear, and age spots may develop. In our youth-­oriented society, the prospect of getting older generally is not relished by ­either sex. For ­women, however, the stigma of aging is greater that it is for men, a phenomenon labeled the “double standard of aging” (Sontag, 1979). A w ­ oman’s most socially valued qualities—­her ability to provide sex and attractive companionship and to have ­children—­are associated with the physical beauty and fertility of youth. As a ­woman ages, she is seen as less attractive b ­ ecause her years of social usefulness as child b ­ earer are ­behind her. Men, on the other hand, are seen as possessing qualities—­competence, autonomy, and self-­control—­that are not associated with youth but rather increase with age. Thus, the same wrinkles and gray hair that may enhance the perceived status and attractiveness of an older man may be seen as diminishing the attractiveness and desirability of an older ­woman. Given ­these societal views, it is not surprising that middle-­aged ­women are much more dissatisfied with their appearance than are midlife men (Slevin, 2010), and use more age-­concealment techniques (Chrisler, et al., 2014). The most distinct physiological change for most midlife ­women is menopause, the cessation of menses. In Western socie­ties, menopause is often viewed in terms of loss of reproductive capability and decline in sexual functioning. Menopause continues to be defined in medical and psychological lit­er­a­t ure by a long list of negative symptoms and terms, such as “hormonal deficiency” and “ovarian failure.” The popu­lar press reinforces the notion of menopause as a condition of disease and deterioration that requires treatment by drugs (van de Wiel, 2014). Most middle-­aged North American ­women minimize the significance of menopause, viewing it as only a temporary incon­ve­nience, and feeling relieved to be ­free from reproductive bodily functions (Chrisler & Versace, 2011; Pearce, et al., 2013). Postmenopausal w ­ omen have more positive attitudes ­toward menopause than premenopausal ­women (Morrison et al., 2014). ­Women in other cultures often have menopausal experiences and attitudes very dif­fer­ent from t­ hose reported by Western w ­ omen, indicating that menopausal symptoms are at least in part socially constructed Hoga, et al., 2014; Mackey, et al., 2014). For example, ­women of high social castes in India report very few negative symptoms, and hot flashes are virtually unknown among Mayan w ­ omen. Similarly, Asian w ­ omen are much less likely than U.S. and Canadian ­women to report hot flashes (Etaugh & Bridges, 2013).


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HEALTH The female-­male mortality gap begins before birth. While 115 males are conceived for ­every 100 females, the rate of miscarriage and stillbirth is higher for males. Although about 105 live males are born for e­ very 100 live females, more male babies die in infancy (Dyson, 2012) and, thereafter, throughout life. Starting at age 35, ­women in the United States outnumber men. Between ages 65 and 69, only 84 males survive for ­every 100 females. At age 85 and beyond, w ­ omen outnumber men by nearly two to one (U.S. Census Bureau, 2015b). At the turn of the 20th c­ entury, life expectancy in the United States was about 51 years for ­women and 48  years for men. Since then, the gender gap has widened. Life expectancy at birth now is about 81 for w ­ omen and 5 years fewer for men. The gender gap exists for all ethnicities. For example, white w ­ omen outlive white men by nearly 5 years (81.4 versus 76.7), black ­women outlive black men by 6 years (78.4 versus 72.3), and Hispanic ­women live almost 5 years longer than Hispanic men, 83.8 versus 79.1 (Centers for Disease Control and Prevention, 2014). Both biological and lifestyle explanations have been proposed to account for the sex difference in longevity. One biological explanation is that w ­ omen’s second X chromosome protects them against certain potentially lethal diseases such as hemophilia and some forms of muscular dystrophy that are more apt to occur in men, who have only one X chromosome (Maklakov & Lummaa, 2013). Another biological reason for ­women’s greater longevity is the impact of sex hormones. W ­ omen’s higher estrogen level has many protective effects, whereas testosterone appears to limit men’s life expectancy (Regan & Partridge, 2013). Differences in the lifestyles of w ­ omen and men also influence sex differences in longevity. Men are more likely to engage in risky be­hav­iors such as aggression, risk-­taking, smoking, and alcohol consumption, which contribute to their higher incidence of deaths from hom­i­cide, accidents, lung cancer, and cirrhosis of the liver. Men also are overrepresented in dangerous occupations. On the other hand, ­women are more likely than men to be overweight and physically inactive. ­These f­ actors contribute to a host of medical conditions including heart disease, many kinds of cancer, and stroke, the three leading ­causes of death for both w ­ omen and men (National Center for Health Statistics, 2014a). Also, while the frequency of men’s smoking has declined, that of ­women’s has increased. The result is that smoking-­related deaths from cancer, including lung cancer, have increased for w ­ omen but decreased for men (Thun, et al., 2013). ­Women, however, make greater use of preventive health ser­vices and are more likely to seek medical treatment when they are ill. This may help explain why w ­ omen live longer than men a­ fter the diagnosis of a potentially fatal disease. W ­ omen also are more likely than men to have extensive social support networks of f­ amily and friends, another f­ actor related to living longer (Etaugh & Bridges, 2013).


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Around the world, ­woman and men with higher incomes and more education have longer life expectancies and better health (Dorling, 2015; Underwood, 2014). Some of this difference can be accounted for by a higher incidence of risk ­factors, such as smoking, obesity, high blood pressure, and physical inactivity among the poor and working class. Additionally, ­people with lower incomes are less able to afford decent medical care or even adequate food, and they experience higher levels of chronic stress as a result of such experiences as financial difficulties and job loss. ­These ­factors combine to shorten life expectancy and increases rates of illness and disease (Zajacova, et al., 2014). Differences in mortality rates for ­women of dif­fer­ent ethnic groups are related to their economic status. Blacks and Native Americans, for example, have both higher mortality rates and lower lifetime f­ amily incomes than Asian Americans (Meyer & Herd, 2007). Sexual minority ­women may be at increased risk for certain health prob­lems b ­ ecause of vari­ous lifestyle ­factors. For example, lesbian, bisexual, and transgender w ­ omen face heightened risks of breast and ovarian cancer b ­ ecause they are less likely than heterosexual w ­ omen to experience the hormonal changes associated with pregnancy, and b ­ ecause they are more likely to smoke, consume alcohol, and be overweight (Boehmer & Elk, 2015). In addition, some LGBT individuals avoid seeking health care in order to avoid pos­si­ble discrimination based on their sexual orientation (Kamen, et al., 2015). Sexual minorities also face a number of challenges in accessing health ser­vices, especially if they are unmarried (Kates & Ranji, 2014). Although advances have taken place in recent years in understanding ­women’s health issues, inequalities still exist in the assessment, treatment, access to care, and research on health topics relevant to w ­ omen in general and to older ­women in par­tic­u­lar (Etaugh & Bridges, 2013). One example is that older ­women are less likely than younger ­women to receive Pap smears (Benard, et al., 2014) or mammograms (AARP, 2010). Another example is the diagnosis and treatment of older w ­ omen with HIV infection. Since older w ­ omen are generally viewed as sexually disinterested and inactive, they are less likely to be given information about safer sex practices (Agronin, 2014). ­Today, however, about 6 ­percent of new HIV/AIDS cases in U.S. ­women are diagnosed among ­women ages 55 and older, and the number of new cases per year is growing steadily (National Center for Health Statistics, 2014a). In the mid-1980s, most AIDS cases among ­women in that age group ­were caused by blood transfusions. Now, heterosexual contact is the leading cause. One f­ actor putting older w ­ omen at increased risk during heterosexual contact is the increased thinning of the vaginal tissues and the decrease in lubrication ­after menopause. ­These conditions can lead to small skin tears or abrasions during sexual activity that increase the chance of HIV entering the bloodstream (Centers for


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Disease Control and Prevention, 2015). Another ­factor in the rise of HIV in older ­women is the increase in sexual activity fueled by Viagra®, but without a corresponding increase in condom use (Centers for Disease Control and Prevention, 2015). Older ­women who have HIV infection may have a harder time than infected younger ­women in obtaining an early, correct diagnosis and treatment, since physicians do not expect to see AIDS in older w ­ omen. Older w ­ omen are also less likely to think of themselves as being at risk for AIDS, and so they may not think to ask for an HIV test (Durvasula, 2014; Pilowsky & Wu, 2015). Failure to diagnose HIV early has serious consequences at any age since it is harder to arrest the disease as it advances. But older adults with HIV are even more likely to deteriorate rapidly since their already weakened immune system does not respond as well to antiretroviral therapy (UNAIDS, 2014). ­Women spend 71 of their years in good health and ­free of disability, compared with only 67 years for men. But ­because they live longer than men, it is ­women who more often live many years with chronic, often disabling, illnesses (Short, et al., 2013). This phenomenon, known as the gender paradox, can be summed up in the saying: ­Women are sicker; men die quicker. The gender paradox is found in e­ very country studied (Alberts, et  al., 2014). ­Women have higher rates of chronic fatigue syndrome, fibromyalgia, thyroid conditions, migraine headaches, anemia, urinary incontinence, and more than 80 autoimmune disorders such as Crohn’s disease, rheumatoid arthritis, multiple sclerosis, and lupus (Mallampalli, et al., 2013) A person may have one or more chronic diseases without being disabled. The key issue is w ­ hether the chronic condition restricts daily life or reduces the ability to take care of oneself. As you might expect, the chance of developing a disability increases with age (Courtney-­Long, et al., 2015). The degree of disability resulting from chronic conditions is assessed by mea­sur­i ng how well individuals can carry out two group of activities: (1) activities of daily living (ADLs), which include basic self-­caring activities such as feeding, bathing, toileting, walking, and getting in and out of a bed or chair and (2) instrumental activities of daily living (IADLs), which go beyond personal care to include preparing meals, ­doing ­house­work, shopping, d ­ oing laundry, attending social activities, using the telephone, taking medi­cation, and managing money (Gu, et al., 2015). Older ­women are more likely than older men to have some difficulty with both ADLs and IADLs (Courtney-­Long, et  al., 2015). Native American w ­ omen are more likely than other ­women to report chronic and/or disabling conditions, followed by African American, white, and Latina w ­ omen. Asian American ­women are least likely to suffer from disabilities (National Center for Health Statistics, 2014a). Life satisfaction is often lower for ­women who have serious health prob­ lems. But chronic illness need not prevent a w ­ oman from enjoying her


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life. In the ­Women’s Health and Aging study, 35 ­percent of ­women with moderate to severe disabilities reported a high sense of happiness and personal mastery and low levels of anxiety and depression (Unger & Seeman, 2000). ­MENTAL HEALTH The psychological health of ­women tends to improve as they get older (Xu, et al., 2010). For example, older w ­ omen show fewer negative emotions, greater well-­being, and more emotional control than younger w ­ omen. Still, older w ­ omen, compared to older men, are more depressed (Nolen-­ Hoeksema, 2012), and report more stress, worry and sadness, more frequent negative emotions, and a lower sense of well-­being (George, 2010; Lawlor & Sterne, 2007). However, gender differences in depression decline or even dis­appear in l­ater life b ­ ecause men’s depression rates increase sharply ­after age 60, while t­ hose of w ­ omen remain the same or decrease (Federal Interagency Forum, 2012; Gilman, et al., 2013). Similarly, rates of frequent anxiety decline with age for w ­ omen but not for men (U.S. Department of Health and ­Human Ser­vices, 2009). SEXUALITY Menopausal changes in sexual physiology and hormone levels may affect sexual activity in the ­middle years (Buster, 2013; Newhart, 2013; Sommer, 2013). Decline in the production of estrogen is responsible for many of t­ hese changes. The vaginal walls become less elastic, thinner, and more easily irritated, causing pain and bleeding during intercourse. Decreases in vaginal lubrication can also lead to painful intercourse. Normal acidic vaginal secretions become less acidic, increasing the likelihood of yeast infections. Paradoxically, one of the best remedies is to have more sex. Sexual activity increases blood flow to the vagina, which makes the tissues fuller, and triggers lubrication (Brody, 2009). Signs of sexual arousal—­clitoral, labial, and breast engorgement and nipple erection—­become less intense in midlife, and sexual arousal is slower. Most menopausal w ­ omen, however, experience l­ ittle or no change in subjective arousal. Although the number and intensity of orgasmic contractions are reduced, few ­women ­either notice or complain about ­these changes. Furthermore, slower arousal time for both w ­ omen and men may lengthen the time of pleas­ur­able sexual activity (Etaugh, 2013b). While some midlife w ­ omen report a decline in sexual interest and the capacity for orgasm during t­ hese years, o ­ thers report the opposite pattern (Buster, 2013; Etaugh, 2013b). Many postmenopausal w ­ omen find that their sexual interest and plea­sure are heightened. Pos­si­ble reasons for this include freedom from worries about pregnancy, and the increase in marital satisfaction, which often develops during the postparental (“empty


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nest”) years (Etaugh, 2013b). The extent of sexual activity in middle-­aged ­women is strongly influenced by past sexual enjoyment and experience. Years of sexual experience can more than make up for any decrease in physical responsiveness. ­Women who have been sexually responsive during young adulthood are most likely to be sexually active as they get older (Etaugh, 2013b). In addition, both heterosexual and lesbian w ­ omen who communicate openly with their partners and make changes in their sexual activities to adapt to menopausal changes are more likely than other ­women to report active and satisfying sex lives (Winterich, 2003). Sexual activity and contentment during m ­ iddle and l­ ater life are more likely to diminish for individuals who have lost their partners (Thomas et al., 2015). For example, in one nationally representative study of sexuality in Americans age 45 and over, only 1 in 10 who had no partner, but over 6 in 10 of t­ hose with sexual partners, w ­ ere satisfied with their sex lives (Fisher, 2010). While w ­ omen in their forties and fifties are nearly as likely as men to have a sexual partner (78 ­percent compared to 84 ­percent), the “partner gap” between ­women and men grows in the ­later years. Among individuals age 75 and older, 58 ­percent of men but only 21 ­percent of w ­ omen have a partner (Lindau & Gavrilova, 2010). Unfortunately, t­ here are a number of myths and ste­reo­types about sexuality in ­later life. Most of ­today’s older Americans grew up at a time when attitudes t­oward sexuality w ­ ere more restrictive than they are t­oday, particularly for ­women (McHugh & Interligi, 2014). Unlike men, many ­women w ­ ere taught that they should not enjoy sex and should not initiate it. In addition to this “double standard” of sexuality for ­women, older ­women are subjected to the “double standard” of aging discussed earlier. That is, compared to older men, w ­ omen in their l­ater years are perceived as sexually inactive and sexually unattractive (McHugh & Interligi, 2014). Most postmenopausal w ­ omen in the United States are themselves dissatisfied with their bodies (Runfola, et al., 2013) and thus may avoid sexual activity with a partner or decide not to seek a new partner if they become widowed or divorced. Midlife w ­ omen with a positive body image, on the other hand, report greater sexual desire and satisfaction (Woertman & van den Brink, 2012). Interest in sexual activity remains fairly high throughout adult life, especially for men, declining only gradually in the ­later years (DeLamater & Koepsel, 2015). In one recent study, 40  ­percent of men but only 11  ­percent of ­women ages 75–85 reported still having sexual desires (Lindau & Gavrilova, 2010). Still, some ­women find sex more satisfying and their attitudes ­toward sex more positive and open in ­later life. In one nationwide survey of Americans over age 60, 70 ­percent of sexually active ­women said they ­were as satisfied, or even more satisfied, with their sex lives than they ­were in their forties (Etaugh, 2013b). A major reason for greater sexual inactivity in older ­women than older men is that they are more likely to lack a partner. In addition, good health is related to sexual


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interest and activity, and older ­women are less likely than older men to report being in good health (Lindau & Gavrilova, 2010). MIDLIFE: CRISIS OR PRIME OF LIFE? Contrary to popu­lar lit­er­a­t ure’s depiction of m ­ iddle age as a time of crisis, turmoil, and self-­doubt, empirical evidence shows that midlife ­women consider this period to be one of vibrancy and opportunity for growth. Mitchell and Helson (1990) characterize the early postparental period as w ­ omen’s prime of life. O ­ thers describe midlife as a period of “postmenopausal zest,” in which ­women have an increased determination, energy, and ability to fulfill their dreams and gain control over their lives. Freedom from reproductive concerns, a sense of accomplishment accompanying the successful launching of ­children, and an increase in available time enable w ­ omen to focus more on their self-­development and on their partner, job, and community (Etaugh & Bridges, 2013). One of the major midlife transitions for some sexual minority ­women is coming out as a lesbian, bisexual, or transgender w ­ oman. In some cases, ­these ­women have been married heterosexually and have ­children. Coming out in midlife is more likely to occur among older LBT ­women, who grew up during an era when cultural restraints prevented many from acknowledging their minority sexual orientation. Thus, when compared with heterosexual ­women, LBT ­women may experience midlife in a somewhat dif­fer­ent manner (Hostetler, 2013). MIDLIFE ROLE TRANSITIONS Although few w ­ omen experience a midlife crisis, many w ­ omen go through a pro­cess of life review, an intensive self-­evaluation of numerous aspects of their lives. One characteristic theme in the life reviews of current midlife w ­ omen is the search for an in­de­pen­dent identity. Helson (1992) notes that for many w ­ omen, the need to rewrite the life story in ­middle age is related to the lessening of the dependence and restriction associated with marriage and motherhood as c­ hildren grow up. Thus, many w ­ omen attempt to affirm their own being, in­de­pen­dent of their f­ amily, through gradu­ate education, beginning a c­ areer, or switching ­careers. For many midlife ­women, paid work is a significant predictor of psychological well-­being. Middle-­aged ­women who are involved in e­ ither beginning or building their ­career are both psychologically and physically healthier than w ­ omen who are maintaining or reducing their c­areer involvement (Etaugh & Bridges, 2013). Also, w ­ omen who have attained the occupational goals they set for themselves in young adulthood have a greater sense of life purpose and are less depressed in midlife than ­those who fall short of their expectations. Furthermore, satisfaction with work


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predicts a general sense of well-­being: the more satisfied ­women are with their jobs, the better they feel in general (Etaugh & Bridges, 2013). For other w ­ omen, being a full-­time homemaker can be as satisfying as combining a ­family and ­career, or having a ­career but no spouse or ­children (Bertrand, 2013). Midlife homemakers whose life goal was this domestic role have a comparable sense of purpose in life as ­women who aspired t­oward and achieved an occupational role. Not surprisingly, however, ­women who are involuntarily out of the workforce, owing to forced early retirement or layoff, are not as satisfied with midlife as w ­ omen with a chosen role (Etaugh & Bridges, 2013). Thus, ­there are multiple routes to well-­being in midlife, and it appears that a key ­factor influencing midlife role evaluation is not a w ­ oman’s role per se but fulfillment of her preferred role. Although some midlife ­women are satisfied with traditional roles, ­others are disturbed about missed educational or occupational opportunities (Torges, et al., 2005). Some middle-­class ­women who, as young adults, devoted themselves solely to marriage and motherhood, voice regrets in midlife about earlier traditional decisions. Stewart and Vandewater (1999) examined regrets experienced by w ­ omen who graduated from college in the mid-1960s. ­These ­women reported disappointments about not pursuing a more prestigious c­ areer, marrying before establishing a c­ areer, and not returning to work a­ fter having c­ hildren. The w ­ omen who made changes based on ­these regrets experienced greater psychological well-­being at midlife than did ­those who had regrets but did nothing to alter their life direction. SPOUSAL ROLE TRANSITIONS Experiences with marriage, divorce, widowhood, and remarriage during the m ­ iddle and l­ater years vary for w ­ omen and men. Men in the United States are more likely than w ­ omen to be married during the m ­ iddle and ­later years. Of ­those age 65 and over, 75  ­percent of men but only 45  ­percent of w ­ omen are married (U.S. Census Bureau, 2012). Among adults whose first marriage ended in divorce, men are much more likely than w ­ omen to remarry (Livingston, 2014). Divorce Approximately 40 ­percent of all American marriages end in divorce, although divorce rates have decreased somewhat in recent years. While divorce occurs throughout the population, divorce rates vary across ethnic groups and educational levels. Asian Americans have the lowest divorce rates in the United States, and black and Latina w ­ omen have the highest (Kreider & Ellis, 2011.) In addition, college-­educated individuals are less likely to divorce than ­those without college degrees.


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­Women with disabilities are more likely than able-­bodied w ­ omen or men with disabilities to be divorced (Olkin, 2008). Not surprisingly, both financial pressure and interpersonal prob­lems can be contributing ­factors. Consistent with the social construction of females as caregivers and the resultant socialization of girls to be responsive to the emotional needs within a relationship, wives are much less likely than husbands to leave a spouse who has a disability or serious medical condition (Etaugh & Bridges; Glantz, et al., 2009). Although divorced ­mothers view themselves as better parents than do ­mothers in high-­conflict marriages, single parenting a­ fter a divorce can be highly stressful (Hetherington & Kelly, 2002). The breakup of a marriage produces numerous stressors for custodial parents and their ­children. Not only must both deal with strong emotional reactions, such as grief, anger, and guilt, but their daily routines often involve major adjustment. Financial pressures can require the ­mother to begin or extend her employment, ­there can be major modifications in h ­ ouse­hold responsibilities, and the ­family may have to change residence. Given ­ these and other stressors associated with parental divorce, ­children tend to experience a variety of emotional and behavioral prob­ lems in the immediate aftermath (Amato, 2010; Gahler & Garriga, 2013; Potter, 2010), but most rebound within two years and are as psychologically healthy as ­children from two-­parent homes. Moreover, ­children in joint custody arrangements following divorce are as well-­adjusted as ­children in two-­parent families (Bauserman, 2002). Divorced ­women also experience initial prob­lems followed by satisfactory adjustment. Immediately following the breakup, it is common for divorced ­women to experience higher levels of depression and distress than married w ­ omen. ­These negative reactions are greatest in the first few years ­after the divorce and decline somewhat over time (Lasswell, 2002), with few long-­term effects on w ­ omen’s psychological adjustment. Ethnicity also can affect a w ­ oman’s adjustment to divorce. For example, black ­mothers show a greater sense of personal mastery following divorce than white ­mothers (McKelvey & McKenry, 2000), possibly ­because African American culture provides t­ hese w ­ omen with greater coping skills to deal with the adversities of divorce. Many w ­ omen experience a decline in f­amily income a­ fter divorce, which places them in a significantly worse financial situation than divorced men (Rhode, 2014). Custodial parent ­mothers are nearly twice as likely as custodial parent f­athers to live in poverty. Fewer than two-­ thirds of divorced m ­ others with ­children ­under 21 are awarded child support, and less than half of t­ hese receive full child support on a regular basis (Grall, 2011). Not surprisingly, divorced w ­ omen with low income and low occupational status are at risk for distress and depression (Etaugh & Bridges, 2013).


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Despite the prob­lems resulting from a breakup, divorce can represent a positive means of reacting to a neglectful, conflict-­ridden, or abusive relationship, and ­women do not feel more upset ­after a divorce than they did in their high-­conflict marriages. Although initially they experience depression and distress, w ­ omen tend to be happier two years post-­divorce than they w ­ ere during the last year of their marriage. Further, divorced ­women are likely to be less depressed than ­women in unhappy marriages (Hetherington & Kelly, 2002). In addition to relief from leaving a conflict-­laden marriage, many ­women report a variety of positive psychological outcomes, such as greater feelings of in­de­pen­dence and freedom, the ability to meet the challenges of living without a spouse and the ability to function as a single parent, which can produce a new sense of competence (Hetherington & Kelly, 2002). Employment can facilitate adjustment following divorce b ­ ecause it provides an identity outside of w ­ omen’s marital role. Social support from ­family and friends is also vitally impor­tant in helping divorced ­women cope (Jenkins, 2003; Krumrei, 2007). Having a stable, new partner is another source of support that can have beneficial effects in post-­divorce adjustment (Rice & Else-­Quest, 2006). Widowhood and Loss of a Partner Despite the increasing divorce rate, most marriages are terminated not by divorce, but by the death of a spouse. In most countries of the world, ­women are much more likely to become widowed than men, since w ­ omen not only have a longer life expectancy but also tend to marry men older than themselves (Kincel, 2014). In the United States, w ­ omen 65 and older are three times more likely than men of the same age to be widowed (Federal Interagency Forum, 2012). Remarriage rates are much higher for widowers than for ­widows in most nations (Dyson, 2012). One reason for the much lower remarriage rate of ­women is that unmarried older ­women greatly outnumber unmarried older men, as noted above. Furthermore, since men tend to marry ­women younger than themselves, the pool of potential mates expands for an older man but shrinks for an older w ­ oman. In addition, widowed ­women are much less likely than widowed men to be interested in forming a new relationship. Many w ­ idows value their in­de­pen­dence and are not e­ ager to resume the domestic responsibilities of a long-­term relationship. Some do not relish the idea of becoming a caregiver for an older man, having already experienced the stresses of caring for a terminally ill partner (Connidis, 2010; Sassler, 2010; Sweeney, 2010). Widowhood is one of the most stressful of all life events. During the first year a­ fter their husband’s death, w ­ idows show poorer m ­ ental and physical health than longer term w ­ idows (Holden, et al., 2010). Most el­derly


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widowed individuals adjust to their spouse’s death within two to four years, although feelings of loneliness, yearning, regret, missing their partner, and lowered life satisfaction remain for extended periods of time (Holland, et al., 2014; Naef, et al., 2013). As many as 10 to 20  ­percent of ­w idows, however, experience long-­term prob­lems, including clinical depression, abuse of alcohol and prescription drugs, and increased susceptibility to physical illness. Among ­these are ­women with a prior history of depression, t­hose with less satisfactory marriages, ­those whose husbands’ deaths followed the deaths of other close relatives and friends, and ­those who depended on their husbands for most social contact (Etaugh & Bridges, 2013). Other ­factors—­age, the degree of forewarning of the spouse’s death, and financial, social, and person resources—­also affect a w ­ oman’s reaction to widowhood (Holden et  al., 2010). Young w ­ idows initially experience greater difficulties in coping with their situation (Michael, et  al., 2003), perhaps b ­ ecause of the greater likelihood that the husband’s death was unexpected. Although younger individuals experience greater distress following their partner’s death, the length of recovery is greater for older ­people (Michael, et  al., 2003). Widowhood often results in a substantial reduction in financial resources for w ­ omen, not only b ­ ecause the husband’s income ceases, but also ­because considerable expenses may be incurred during the husband’s final illness (DiGiacomo et al., 2013). Loneliness is another prob­lem faced by ­widows. Having the social support of ­family, friends, and neighbors to stave off loneliness helps to alleviate the psychological and physical effects of loss-­related stress (Bookwala, et al., 2014; Powers, et al., 2014). The death of a spouse takes a heavier toll on men than on w ­ omen. Widowed men suffer more psychological depression, psychiatric disorders, physical illnesses, and have higher death rates and suicide rates than widowed ­women (Moon, et al., 2014; Shor, et al., 2012). This may be ­because ­women are more apt than men to admit a need for social support, to benefit from that support, and to have broad social networks with relatives and friends, including other ­widows (­Sullivan & Fenelon, 2013). Many ­widows learn to enjoy living alone and derive a sense of in­de­pen­dence, competence and resilience as they cope with the challenges of their new life (Moss & Moss, 2014). Keep in mind that our knowledge of ­widows has been obtained primarily from older ­women, most of whom had traditional marriages. When the young ­women of ­today become ­widows, they ­will be more likely to have had a dif­fer­ent set of life experiences, including a college education and a job or ­career that ­will better prepare them for a healthy adjustment to widowhood (Carr & Pudrovska, 2012). Sexual minority individuals may encounter unique prob­lems when their partner dies. They may not be eligible for survivor benefits and in the absence of a w ­ ill, they may have no claim to the partner’s estate that


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they have helped to build (OWL, 2010). Loss of a same-­sex partner is especially stressful if the relationship was not publicly acknowledged, or given legitimacy in broader society. Even when the relationship is open, friends, ­family, and work colleagues may not comprehend the severity and nature of the loss (Hughes et al., 2014; McNutt & Yakushko, 2013). Singlehood Approximately 4.5 ­percent of both ­women and men in the United States age 65 and over have never married (Kincel, 2014). ­Women with disabilities are more likely than able-­bodied w ­ omen or men with disabilities to remain single (Olkin, 2008). ­Today, t­ here is more ac­cep­tance of and support for single lifestyles than in the past (Wang & Parker, 2014). Still, single ­women continue to be portrayed negatively in the media and are widely perceived as odd, social outcasts who lead barren, disappointing lives (DePaulo, 2011; Simpson, 2011). Some never-­married heterosexual w ­ omen are ambivalent about their marital status. On the one hand, they miss the benefits of steady companionship and feel sad about growing old without a partner, but at the same time, they enjoy their freedom, in­de­pen­dence, and opportunities for self-­development (DePaulo, 2011; North, 2015; Sharp & Ganong, 2011). Increasing numbers of single ­women are signing up for ­house­warming and birthday registries, having deci­ded not to wait for marriage to request the china, crystal, and appliances they wish to own (Etaugh & Bridges, 2013). In addition, they are more likely than single men to purchase a home instead of renting (Prevost, 2013). The absence of a marital partner does not mean that single ­women are lacking social relationships. Some date or are in committed romantic relationships, and many spend considerable time with nonromantic significant o ­ thers, such as relatives, friends, and neighbors (DePaulo, 2011). Moreover, an increasing number of middle-­aged single w ­ omen are choosing to become m ­ others via sperm donors or adoption (Weisenberg & Landau, 2012). Never-­married ­women typically have developed skills in in­de­pen­dent living and in building support systems that stand them in good stead as they get older (Connidis, 2010). Compared with married w ­ omen, the never-­married older ­woman is better educated, in better health, places a ­great deal of importance on her job, is less likely to be depressed and commit suicide, values her freedom and autonomy, and has close connections with both siblings and other interpersonal supports (Dykstra & Hagestad, 2007; Wenger, et al., 2007). The workplace is as significant source of friends for single ­women, and in retirement, t­hese w ­ omen go on to form new friendships with neighbors or members of organ­izations to which they belong. Single older w ­ omen have also learned to cope in their earlier years with the “stigma” of not being married and so are better able to deal with


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the effects of ageism in their ­later years. Most older, single w ­ omen are satisfied with their lives and seem at least as happy as married w ­ omen (DePaulo, 2011; Newtson & Keith, 2001). PARENTAL ROLE TRANSITIONS The fertility rate (that is, the average number of births a ­woman ­will have in her lifetime) declined in the United States throughout the early 20th ­century, reaching a low point of 2.2 births during the depression years of the late 1930s. The “baby boom” following World War II peaked in the late 1950s, when the fertility rate reached 3.7. By the mid-1970s, the rate had dropped to 1.8, and by 2014, it was nearly 1.9. Hispanic w ­ omen have the highest fertility rate, followed in descending order by black, white, Asian, and Native American w ­ omen (Hamilton, et al., 2015). ­Women not only are having fewer c­ hildren, but also are having them ­later. Among 40-­to 44-­year-­olds, who are near the end of their childbearing years, 19 ­percent had no c­ hildren in 2014, compared with only 10 ­percent in 1976. However, a growing number of ­women are having c­ hildren ­after the age of 40. In 2014, over 117,000 U.S. ­women between 40 and 44, and more than 8400 w ­ omen between 45 and 49 gave birth, a rec­ord high (Hamilton, et  al., 2015). But b ­ ecause fertility begins to decline a­ fter age 32, older ­women have a harder time conceiving. Among w ­ omen over 40, half w ­ ill require medical assistance to conceive (American College of Obstetricians and Gynecologists, 2014a). By age 45, very few w ­ omen can conceive using their own eggs, as an increasing percentage of their eggs become abnormal. In addition, ­women over 35 have more miscarriages than younger ­women, more preterm, low-­birth-­weight and stillborn babies, higher levels of complications during pregnancy, more chromosomal abnormalities (such as Down syndrome), and are more likely to have cesarean sections (American College of Obstetricians and Gynecologists, 2014b). The good news is that almost all older m ­ others, like their younger counter­ parts, have healthy babies, and that infant mortality rates are comparable for the two groups (Lisonkova, et al., 2010). A lesser-­k nown fact about midlife pregnancy is that about half of the pregnancies of w ­ omen over 40 are unintended, a rate second only to teen­ agers. During perimenopause, the years prior to the end of menstruation, ­women may grow lax about birth control b ­ ecause they think t­ here is l­ ittle risk of pregnancy and may believe they have reached menopause. However, a ­woman’s menstrual cycle becomes less regular in perimenopause, and she may go several months without a period before having one (North American Menopause Society, 2012). More ­women in the developed world have deci­ded not only to postpone motherhood, but to remain childless (Miettinen, et  al., 2015). The decision to not have c­ hildren is facilitated by the availability and legality of effective forms of birth control, the ­women’s movement’s emphasis on


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­ omen’s right to make choices in their lives, and the wider participation w of w ­ omen in the ­labor force (Bianchi, 2014; Blackstone & Stewart, 2012). However, the decision not to have ­children—to be childless or “childfree”—­ goes against the traditional gender norms of almost all cultures. ­Women who make this choice are often criticized as shallow, selfish, deviant, and unfeminine. They may be marginalized, given unsolicited advice, and pressured by ­others to have ­children (Daum, 2015; Moore & Geist-­Martin, 2013). ­Women choose not to have ­children for a number of reasons. Some ­women want autonomy, self-­expression, education, economic in­de­pen­ dence, and opportunities for a better life. ­Others simply do not enjoy ­children, believe that they would not make good parents, or want a flexible lifestyle that would be hampered by ­children. Still ­others view motherhood to be a sacrifice and a burden, involving loss of time, energy, and ultimately, identity (Allen & Wiles, 2014; Morison et al., 2015; Shapiro, 2014; Walker, 2011). Even though more w ­ omen are deciding not to have ­children, the majority do become ­mothers. Motherhood still is considered to be a central component of a w ­ oman’s life, a concept that has been labeled the “motherhood mandate” (Ridgeway, 2011). In m ­ iddle age, some m ­ others are still chasing toddlers around the h ­ ouse, whereas ­others, who had c­ hildren in their teen years, have already launched their ­children into young adulthood. For most midlife ­mothers, however, a major event is the departure of their c­ hildren from the home. Similar to common folklore characterizing midlife as a time of crisis, this postparental period is popularly but inaccurately viewed as an unhappy “empty nest” stage of life for most ­women. ­Women generally describe the postparental years in positive rather than negative terms. ­Because c­ hildren can be a source of tension in any marriage, ­women report higher marital satisfaction once their c­ hildren have left home (Etaugh & Bridges, 2013). Furthermore, the departure of the last child from the home is an opportunity to begin or expand the development of a personal identity in­de­pen­dent of f­ amily roles. For many ­women, as we have seen, this event marks the beginning of a midlife review period when they evaluate their lives and consider other options such as pursuing new c­ areers, furthering their education, or providing ser­vice to their communities (Dare, 2010). However, the significant redefinition of their parenting responsibilities and the end to their identity as a child caregiver can be somewhat problematic for ­women whose primary identity has been that of ­mother. ­Mothers who are employed during the child-­rearing years and establish an identity additional to their ­mother role find it easier to relinquish their child-­care responsibilities when their ­children leave home than do ­women who have identified primarily with their role as ­mother (Better, 2014). Of course, m ­ others do not stop being parents when their c­ hildren move out, but rather remain involved in their c­ hildren’s lives in somewhat


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dif­fer­ent ways. While their contacts are generally less frequent, they continue to offer advice and encouragement and sometimes provide goal-­ directed help, such as financial assistance (Davidson, 2014; Seltzer & Bianchi, 2013). Closeness between m ­ others and ­daughters typically increases once the ­daughter leaves home to attend college (Smetana, et al., 2004), and mother-­daughter relationships often remain enormously satisfying throughout life (Lefkowitz & Fingerman, 2003; Sechrist et al., 2014). Although most ­mothers experience the departure of their ­children at some point during midlife, t­ here are variations in ­children’s age of departure, and a significant number return home for financial or personal reasons for some period ­after leaving. About one in three young adults between ages 18 and 34 currently live with their parents (Fry, 2015). Parents’ reaction to their ­children’s return is related to the degree to which the return is characterized by a continued dependence on the parents. Parents experience greater parent-­ child strain the greater the c­hildren’s financial de­pen­dency and the lower their educational attainment. Furthermore, parents’ satisfaction with the living arrangement is positively related to their child’s self-­esteem, possibly b ­ ecause low self-­esteem signals difficulty in assuming in­de­pen­dent adult roles. T ­ hese findings suggest that parents are most satisfied with the parent-­child relationship and experience the highest degree of well-­being when they perceive their ­children assuming the normative roles of adulthood (Etaugh & Bridges, 2013; Sechrist, et al., 2014). CAREGIVER ROLE TRANSITIONS Middle-­aged adults are often referred to as the “sandwich” generation ­ ecause of the responsibilities that they assume for their adolescent and b young adult c­ hildren on the one hand and for their aging parents on the other (Etaugh & Bridges, 2013). ­Women are described as the ­family “kinkeepers,” maintaining the bonds between and within generations. Typically, it is the midlife ­woman who carries out most of the caregiving and support functions for her el­derly parents and in-­laws (AARP & National Alliance for Caregiving, 2015; ­Family Caregiver Alliance, 2015). Demographic changes in recent years have increased the parent-­care responsibilities of middle-­aged ­women. More parents are living well into old age, and their caregiving ­children themselves are becoming old. Furthermore, as the birthrate declines, t­here are fewer siblings to share the burden of care. ­Because middle-­aged ­women are increasingly likely to be employed, caring for el­derly relatives adds to their list of competing roles and responsibilities (Etaugh & Bridges, 2013). In some cases, older persons who require care move in with f­amily members. Nearly 13 ­percent of el­derly ­women and 4 ­percent of el­derly men reside with their adult c­ hildren, siblings, or other relatives (U.S. Census Bureau, 2015a), usually b ­ ecause of increasing infirmity. Living in


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a multigenerational ­house­hold is more prevalent among ethnic minority el­ derly than among whites in the United States, and this living arrangement is also common in developing countries. In the United States, older Native Americans are most likely to live in multigenerational ­house­holds, followed by Hispanics, blacks, Asians, and whites (Lamanna & Reidmann, 2014). GRANDPARENTAL ROLE TRANSITIONS The ste­reo­typed portrayal of a grand­mother is often that of an el­derly, white-­haired w ­ oman providing treats for her young grandchildren. However, grand­mothers do not fit into any one pattern. While nearly 90 ­percent of Americans over age 65 are grandparents, some p ­ eople become grandparents as early as their late 40s. About half of ­women experience this event by age 50 and some spend half their lives as grand­mothers (Etaugh & Bridges, 2013). Many middle-­aged grand­mothers are in the ­labor force and, as we have seen, may also have responsibilities for caring for their el­derly parents (Holstein, 2015). Thus, they may have less time to devote to grandparenting activities. Reflecting the fact that ties between ­family generations are maintained largely by ­women, affectional ties across generations are much stronger for ­mothers than ­fathers. As one example, maternal compared to paternal grand­mothers are more involved with their grandchildren (Barnett, 2014). In some parts of the world, the presence of a maternal grand­mother literally spells the difference between life and death. Research in rural Gambia, for example, has found that the presence of a maternal grand­mother doubles the survival rate of her toddler grandchildren (Sear & Mace, 2008). During their grandchildren’s infancy and preschool years, nearly half of grand­mothers in the United States provide the c­ hildren’s parents with considerable emotional support, help with child care, h ­ ouse­hold chores, and economic support (Harrington Meyer, 2014). This supportive role tends to be more pervasive in ethnic minority groups than among whites. For example, black and Hispanic grandparents are more likely than other groups to care for their grandchildren whose m ­ others are employed (AARP, 2012). In one study of low-­income multiracial Hawaiian ­children who had an absent or incapacitated parent, the nurturance and guidance of grandparents was a key f­ actor in the c­ hildren’s well-­being as they grew to adulthood (Werner, 2013). For some ­children, grandparents are part of the ­family ­house­hold. The number of grandchildren living in homes with a grandparent in the United States has more than doubled since 1970 to 7.1 million in 2012, including 14 ­percent of black and Asian c­ hildren, 12 ­percent of Hispanic ­children, and 7 ­percent of white ­children (Ellis & Simmons, 2014). Some of the increase results from an uncertain economy and the growing number of single m ­ others, which has sent young adults and their ­children back to


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the parental nest. New immigrants with a tradition of multigenerational ­house­holds have also swelled the number of such living arrangements (Seltzer & Yahirun, 2013). Two in three h ­ ouse­holds with co-­resident grandparents are maintained by the grandparents. In nearly half of t­ hese grandparent-­headed h ­ ouse­holds, both grandparents are pres­ent, and in almost half, a grand­mother alone maintains the h ­ ouse­hold (Ellis & Simmons, 2014). Increasing numbers of grandparents now find themselves raising their grandchildren on their own. One -­third of the grandparents who live in a ­house­hold with grandchildren are raising t­ hese grandchildren without a parent pres­ent (Ellis & Simmons, 2014). Grandparents become full-­time caregivers for their grandchildren for a number of reasons: parental illness, child abuse, substance abuse, psychological or financial prob­lems, divorce, incarceration, or military deployment (Bailey et al., 2013; Hadfield, 2014). In some developing countries, parents migrate to urban areas to work, while grandparents remain b ­ ehind and raise the grandchildren (Gideon, 2015). The AIDS epidemic has also increased the number of grandparents who are raising their grandchildren in many nations, including the United States (Hadfield, 2014; Mhaka-­Mutepfa, et al., 2014). The belief that caregiving grand­mothers are primarily poor ethnic ­women of color is a myth. Parenting grand­mothers can be found across racial and socioeconomic lines (Dunifon, 2013). More than half (53 ­percent) of the grandparents raising grandchildren are white, 24  ­percent are black, 18 ­percent are Hispanic, and 3 ­percent are Asian (Livingston & Parker, 2011). Rearing a grand­child is full of both rewards and challenges (Dong, et al., 2013; Sampson & Hertlein, 2015). While parenting a grand­child is an emotionally fulfilling experience, t­ here are psychological, health, and economic costs. Grandparents primarily responsible for rearing grandchildren are more likely than other grandparents to suffer from a variety of health prob­lems including depression, diabetes, high blood pressure, heart disease, and a decline in self-­rated physical and emotional health. Furthermore, they tend to delay seeking help for their own medical prob­ lems (Chen, et al., 2014; Hadfield. 2014; Hayslip, et al., 2015). ­LABOR FORCE TRANSITIONS Labor force participation of middle-­ ­ aged and older ­ women has increased sharply over the past five de­cades (Kromer & Howard, 2013). Over two-­thirds of w ­ omen ages 55–61 and one-­fourth of ­those ages 65–69 are now are in the U.S. ­labor force. During the same 50-­year period, by contrast, men have been retiring earlier. By 2011, only 75 ­percent of men ages 55–61 ­were in the workforce, compared to 90 ­percent in 1963. Over the same time period, the participation rate of men ages 65–69 dropped from 43 to 37 ­percent. As a result of ­these changes, which hold across all


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ethnic groups, the proportion of paid workers 55 and over who are w ­ omen is higher than ever before (Federal Interagency Forum, 2012). Many midlife and older ­women have been employed throughout adulthood. For some working-­class ­women, w ­ omen of color, and single ­women, economic necessity has been the driving force. But for many ­women, a more typical pattern has been movement in and out of the ­labor force in response to changing ­family roles and responsibilities. Some ­women decide to reenter the ­labor force ­after their c­ hildren are grown or following divorce or the death of their spouse (Duberley, et al., 2014; Etaugh, 2013a). Older w ­ omen work for most of the same reasons as younger ­women. Economic necessity is a key ­factor at all ages. In addition, feeling challenged and productive, and meeting new coworkers and friends give ­women a sense of personal satisfaction and recognition outside the f­ amily (Etaugh, 2013a). Active involvement in work and outside interests in ­women’s m ­ iddle and l­ater years appear to promote physical and psychological well-­being. Work-­centered ­women broaden their interests as they grow older and become more satisfied with their lives. Employed older ­women have higher morale than ­women retirees, whereas ­women who have never been employed outside the home have the lowest (Etaugh, 2013a). As ­women get older, they also confront age discrimination in the workplace (Holstein, 2015; Olen, 2014). While ­women’s complaints filed with the Equal Employment Opportunity Commission primarily concern hiring, promotion, wages, and fringe benefits, men more often file based on job termination and involuntary retirement, ­Women also experience age discrimination at a younger age than men (Rife, 2001). This is another example of the double standard of aging, with w ­ omen seen as becoming older at an earlier age than men (Holstein, 2015). Retirement Much of what we know about the effects of retirement is based on studies of men, despite the steady increase in w ­ omen in the workplace over the past 70 years. This bias reflects the assumption that retirement is a less critical event for ­women than for men b ­ ecause of ­women’s lesser participation in the l­ abor force and their greater involvement in f­ amily roles. But almost half of workers now are ­women, and retirement has equally impor­ tant consequences for them (Price & Nesteruk, 2015; U.S. Bureau of ­Labor Statistics, 2014). The decision to retire depends upon many ­factors including health, income, occupational characteristics, and marital and ­family situations (Wang & Shi. 2014). When men retire, they are leaving a role that has typically dominated their adult years. They are more likely than w ­ omen to retire for involuntary reasons, such as mandatory retirement, poor


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health, or age. ­Women, on the other hand, are more apt to retire for voluntary, family-­related reasons, such as the retirement of one’s husband or the ill health of a relative (Griffin et al., 2012; Loretto & Vickerstaff, 2013; Szinovacz; 2013). Compared to men, w ­ omen arrive at the threshold of retirement with a dif­fer­ent work and f­ amily history, less planning for retirement, and fewer financial resources (Duberley, et  al., 2014; Griffin et  al., 2012). ­Because ­women typically experience greater job discontinuity, they may have had fewer opportunities to attain personal ­career goals and may, therefore, be more reluctant to retire. Given their more discontinuous employment history and their employment in lower-­paid jobs, w ­ omen are not as likely as men to be covered by pension plans, and their Social Security benefits are lower (Fischer & Hayes, 2013; U.S. Department of ­Labor, 2015). Many older ­women workers with low salaries may not be able to afford the luxury of retirement b ­ ecause of economic pressures, such as inadequate retirement income, spouse’s job loss, or sudden death of a spouse (Duberley, et al., 2014). Unmarried ­women are more apt than married ­women to postpone retirement or plan not to retire at all (Griffin, et al., 2013; Szinovacz, et al., 2012). A growing number of w ­ omen continue to work a­ fter their husbands retire (Bernard, 2014). In 2006, 18 ­percent of all ­couples involving a spouse age 65 or over consisted of a retired husband and an employed wife (Holder & Clark, 2008). In addition, ­women who have strong work identities have more negative attitudes ­toward retiring than ­those with weaker work identities. Professional ­women and ­those who are self-­employed, who presumably have strong work identities, are less likely than other ­women to retire early. Older professional ­women do not often make systematic plans for their retirement, nor do they wish to do so (Etaugh, 2013a; Heyl, 2004). Working-­ class ­women and men, on the other hand, are more likely to view retirement as a welcome relief from exhausting or boring l­ abor (Wang & Schultz, 2010). While some ­women delay their retirement, ­others retire early. Poor health is one of the major reasons p ­ eople retire (Wang & Shi, 2014). Health is a more impor­tant f­actor in the retirement decision for men, however, than for w ­ omen—­especially unmarried w ­ omen—­among both blacks and whites (Etaugh, 2013a). This gender difference may result from the fact that, unlike married men, married ­women in poor health may withdraw early from the l­abor force or do not enter it in the first place. Early withdrawal or nonparticipation in the workforce is enabled by having a provider husband and by societal expectations that employment is optional for ­women. ­Women’s role as primary caregiver is another f­actor contributing to their early retirement. ­Women provide most of the unpaid home care to frail el­derly ­family members (Duberley, et al., 2014). Elder care responsibilities often result in increased tardiness and absenteeism at work, as well


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as elevated levels of stress, anxiety, depression, and exhaustion for the caregiver (­Family Caregiver Alliance, 2015). ­Because most businesses do not offer work flexibility or support to workers who care for el­derly relatives, some ­women caregivers reduce their hours or take time off without pay. ­Others are forced to retire earlier than planned (Wang & Shi, 2014). Retirement has long been seen as an individual—­primary male—­ transition. But now, ­couples must increasingly deal with two retirements (Bernard, 2014). Phyllis Moen, et al. (2001) found that retirement was a happy time for retired c­ ouples. But the transition to retirement, defined as the first two years ­after leaving a job, often was a time of marital conflict. ­Couples who retired at the same time w ­ ere happier than t­ hose in which the spouses retired at dif­fer­ent times. Marital conflict was highest when husbands retired first, perhaps ­because of uneasiness with the role reversal of an employed wife and a stay-­at-­home husband. Not only does the situation pose a potential threat to the husband’s role as provider, but it can also lead to disagreements over the division of h ­ ouse­hold l­abor (Szinovacz, 2013). Although both ­women and men typically adjust well to retirement, ­women may take longer to get adjusted (Etaugh, 2013a). Newly retired ­women report lower morale and greater depression than newly retired men (Coursolle, et al., 2010). Men seem to enjoy the freedom from work pressure when they retire whereas w ­ omen appear to experience the retirement transition as a loss of roles. ­Because w ­ omen are not u ­ nder the same socially prescribed pressures to be employed as are men, t­hose who do work, ­whether out of financial need or commitment to their job, may find it more difficult to stop working (Etaugh, 2013a). For both men and w ­ omen, a high level of life satisfaction in retirement is associated with having good health, adequate income, and active participation in leisure pursuits (Heo, et al., 2014; Wang & Shi, 2014). Lower income and poorer health may account for the fact that black retirees have lower levels of life satisfaction than white retirees (Kim & Moen, 2001). Marital status also contributes to retirement satisfaction. Married ­people have more positive retirement attitudes and higher retirement satisfaction than unmarried retirees. Retired ­women, particularly unmarried ones, are more involved with friends, f­ amily, organ­izations, and volunteer work than are retired men or lifelong homemakers (Etaugh, 2013a; McDonald & Mair, 2010). ­FUTURE DIRECTIONS It is impor­tant to remember that as each generation of w ­ omen matures and grows older, it encounters a dif­fer­ent set of conditions and experiences. Our current information about ­women in the ­middle and ­later years is based on the lives of ­women who grew up in circumstances very dif­fer­ent from t­ hose of t­ oday’s young w ­ omen. If current trends involving


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f­ amily life, sexuality, reproductive freedom, and ­labor force participation continue, older ­women of the ­future are likely to increase their occupational prestige and economic in­de­pen­dence, as well as enhance their opportunities for a variety of rewarding interpersonal relationships. One cautionary note is that most of the research on w ­ omen’s m ­ iddle and ­later years has been done with white, highly educated, middle-­class Western w ­ omen. The midlife experiences of w ­ omen of color, less educated ­women, poor ­women, and ­those in non-­Western cultures have been almost completely unexplored.

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Chapter 9

­ omen and M W ­ ental Health: An Examination of F­ actors Implicated in Gender Differences in Depression Josephine Tan

Gender disparity in ­mental health prob­lems, especially depression, is a well-­documented finding. In 2010, the global prevalence rate for depression was 5.5 ­percent among w ­ omen and 2.9 ­percent among men (Baxter et al., 2014). Depression is also the leading cause of disease burden among ­women aged 15–44 living in high-­, middle-­, and low-­income countries, and is expected to be the leading cause of disease burden worldwide by 2030 (WHO, 2008). The gender disparity is pres­ent regardless w ­ hether depression is investigated as a clinical disorder (Abate, 2013) or as depression symptoms (Angst, et al., 2002). Additionally, not only is subjective well-­being lower among ­women than men, the gender gap has been increasing over the years since the 1970s (Stevenson & Wolfers, 2009). Research shows that the gender disparity in depression emerges during adolescence between the ages of 11–15 (Hankin, et al., 1998; Kessler, et  al., 1994). Evidence is mixed when it comes to the older population. Some works have found that the gender gap diminishes in late adulthood ­after the age of 50 (Bebbington, et al., 1998; Bland, et al., 1998; Jorm, 1987) while ­others have not (Beekman, et al., 1999; Cairney & Wade, 2002; Prince, et al., 1999; Sonnenberg et al., 2000). Investigations into the gender disparity across age groups are helpful to illuminate the f­ actors that contribute to the development and maintenance of depression in w ­ omen. T ­ hese ­factors can be categorized broadly into dif­fer­ent groups: artefactual, biological, psychological, and psychosocial. Earlier notable writings (Nolen-­ Hoeksema, 1990; Weissman & Klerman, 1977) have reviewed the dif­fer­ent


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groups of explanations in depth. More recently, advances have been directed ­toward the development of interactional models invoking t­ hese dif­fer­ent ­factors. This chapter w ­ ill discuss the dif­fer­ent explanations and models within the context of their research findings. ARTEFACTUAL ­FACTORS Some of the earliest explanations for the gender gap in depression invokes mea­sure­ment bias and other artefacts. For instance, it was proposed that w ­ omen are more likely than men to report mild forms of psychological distress (Maier, et al., 1999) and that ­these subclinical cases should not be included in the count ­toward the prevalence rates of major depression. However, research shows that the gender gap remains pres­ ent in patient populations (Maier, et al., 1999) indicating that the preponderance of ­women among depressed individuals remains regardless of how the depression is indexed. Another explanation which has received considerable support is that men are less likely to seek professional help (Addis & Mahalik, 2003). However, it is unlikely that gender difference in help-­seeking be­hav­ior is a sufficient explanation b ­ ecause the gender disparity has been reported in non-­health ser­vice contexts, such as research settings and epidemiological health surveys (Kessler, et  al., 1993). It was also speculated that recall bias might play a role, i.e., w ­ omen are better able to recall their depressive episodes (Wilhelm & Parker, 1994). However, ­there is evidence to also show no gender difference in recall (Kuehner, 1999). It has also been proposed that men “mask” their depression and express it through alcohol abuse and antisocial be­hav­ior. Addis (2008) undertook a critical examination of the relevant lit­er­a­ture and concluded that ­there is some indirect evidence for this view and that without more research, it is not pos­si­ble to arrive at a conclusion. O ­ thers have turned to the view that comorbid disorders such as anxiety disorders (Skodol, et al., 2002), eating disorders (Hudson, et al., 2007), and borderline personality disorder (Skodol, et al., 2002) which affect ­women more inflate the prevalence rate of depression in w ­ omen. One study found that the gender difference in depression was found primarily in individuals with comorbid anxiety and that having a prior history of anxiety disorder increased the risk of having depression (Breslau, et  al., 1995). However, more investigations need to be undertaken before the comorbid explanation can be evaluated. BIOLOGICAL ­FACTORS The presence of depression has been found to correspond with hormonal changes in w ­ omen that are linked to puberty (Angold, et al. (1999), premenstrual (Campagne & Campagne, 2007) and post-­partum periods (Hendrick, Altshuler, & Suri, 1998), and during perimenopause (Freeman


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et al., 2004). The biological explanations have been accorded greater interest in recent times given that studies tend to show that the gender disparity in depression appears during puberty (Hankin et  al., 1998; Kessler et al., 1994). Investigations have focused on changes in the balance of the sex ste­roids during the dif­fer­ent times in the w ­ oman’s reproductive cycle and throughout her reproductive years (Studd & Panay, 2004). A population-­based study showed that the risk of postpartum depression was 20 times higher among ­women with a history of depression than ­women without (Silverman, et  al., 2017). A meta-­analysis of studies on depression during perimenopause revealed that the risk of developing clinical depression during perimenopause was no greater than during premenopause (de Kruif, et  al., 2016). However, the odds of depressive symptoms during perimenopause doubled and the severity of the depression symptoms also increased. ­There was a positive association between the depressive symptoms and vasomotor complaints (e.g., hot flashes, night sweats). A review of prospective studies showed no clear association between mood and the premenstrual phase (Romans, et  al., 2012). Another prospective study tracked ­women over one and a half menstrual cycles to ascertain the relationship between their daily self-­rated positive and negative moods, perceived stress, physical health, and levels of estrone glucuronide and pregnanediol-3-­glucononide assessed from daily urinary samples (Schwartz, et al., 2012). The researchers found that perceived stress and physical health made a significant contribution to daily positive and negatives moods, whereas ovarian hormones did not. Overall, the evidence suggests that the risk of developing post-­partum depression is related to already having a prior history of depression, and that developing subclinical levels of depression symptoms is more likely among perimenopausal w ­ omen who experience vasomotor complaints. T ­ here was no evidence of depressed mood or major depression associated with the premenstrual phase. It needs to be noted that mood, behavioral, and somatic variations that correspond to hormonal fluctuations are normal ­because hormones regulate all aspects of ­human functioning. It is only when t­ hese variations result in functional impairment that they become a m ­ atter of clinical concern. Other biological ­factors that have been implicated include neurochemical f­actors, such as corticotropin-­releasing hormones (CRHs) that are associated with the activity of the hypothalamic-­pituitary-­adrenal (HPA) axis. The HPA axis, in turn, modulates the stress response (Claes, 2004) and is associated with the risk of depression (Varghese & Brown, 2001). It is proposed that changes in the development of the HPA axis can be brought about by early life stress and, thus, pres­ents as a biological vulnerability risk f­actor for depression (Claes, 2004; Weiss, et al., 1999). ­There is some evidence for this position. One early life adversity that is experienced more often by w ­ omen than men is child sexual abuse, also called CSA (Biere & Elliott, 2003). The incidence of CSA is higher among depressed


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­ omen than ­those who are not. Research comparing depressed patients w and healthy controls indicated that childhood trauma was associated with hyperactivity of the HPA axis and with depression in adulthood (Lu, et al. (2016). The researchers proposed the cautious conclusion that early childhood trauma could result in dysfunction within the HPA axis and eventually in the development of depression in adulthood. PSYCHOLOGICAL ­FACTORS Neuroticism Neuroticism, which is often conceptualized as a disposition to experiencing negative affect (Clark, et al., 1994), has been identified as a potential vulnerability ­factor in depression. Higher neuroticism scores have been found to be associated with a history of major depression and with current depressive symptoms (Duggan, et al., 1995). Neuroticism has also been found to moderate the link between the female gender and depression. However, even a­ fter the trait had been statistically adjusted, the female gender still held a significant association with depression (Goodwin & Gotlib, 2004) suggesting that t­here are other f­actors that might contribute to the female gender, e.g., the depression link. Hankin and Abramson (2001) suggested that neuroticism might pres­ent only a distal risk to depression, such as predisposing the individual to experiencing more stress, which is linked to depression. Evidence shows that individuals with high scores on neuroticism experience more adverse events (Van Os & Jones, 1999). A study with over 7,500 individual twins showed neuroticism to be linked to greater risk for major depression and to greater sensitivity to the depressogenic effects of stressful life events (Kendler, et al., 2004). An interaction effect was also reported, which showed that the link between neuroticism and depression was greater at higher levels of life stress than at lower levels. Additionally, a longitudinal study with outpatients experiencing mood and anxiety disorders showed that neuroticism did not have a direct impact on temporal course of the depression symptoms. Rather, it interacted with chronic stress, such as among individuals who experienced higher levels of chronic stress during followup examinations and t­ hose had the high neuroticism scores showed the least depression symptom improvement (Brown & Rosellini, 2011). It would appear that neuroticism contributes to depression and symptom improvement only u ­ nder certain conditions. Sociotropy Sociotropy is conceptualized as a cognitive personality style that sensitizes an individual to certain types of situational stress and increases the vulnerability to depression (Beck, Epstein, & Harrison, 1983). It is often equated with interpersonal de­pen­dency. A high sociotropic person is


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inclined to pleasing o ­ thers to win their approval and maintain close positive relationships, and ­will become depressed when relationships are disrupted. Research shows that w ­ omen place high value on relationships (Cross & Madson, 1997) and, thus, are thought to be more vulnerable to depression than men. Evidence for the sociotropy-­depression link has been mixed. Some studies report an association (Abela, et al., 2006) while ­others do not (Shahar, et al., 2004). Abela, et al. (2006), reported that the sociotropy-­depression link applied only to individuals with high self-­ esteem following experiences with life hassles, and to individuals with low self-­esteem. T ­ hese findings suggest that sociotropy might be associated with depression only in certain contexts. Rumination A substantial amount of research has shown rumination to be linked to the development and maintenance of depression (Butler & Nolen-­ Hoeksema, 1994; Nolen-­Hoeksema, et  al., 1993; Nolen-­Hoeksema, et  al., 2008). It is defined as repetitively thinking about personal prob­lems, and/ or the meanings, the c­ auses, and implications of depressed mood (Nolen-­ Hoeksema, et al., 2008). Although it can be considered as a maladaptive form of coping which interferes with problem-­solving, reduces motivation and is associated with a dependent interpersonal style (Lyubomirsky & Tkach, 2004; Nolen-­Hoeksema, et al., 2008), it can also be considered as a trait where the tendency to ruminate is stable despite varying levels of negative affect (Nolen-­Hoeksema, et al., 2008). ­Women tend to ruminate more than men (e.g., Butler & Nolen-­Hoeksema, 1994; Nolen-­Hoeksema, et al., 1994; Simonson, et al., 2011). However, the gender difference in rumination is mediated by beliefs that negative emotions are difficult to control, that one is responsible for the emotional tone of relationships, and that one does not have mastery over life events (Nolen-­Hoeksema & Jackson, 2001). Therefore, the reasons for rumination in w ­ omen might be related to their gender-role socialization that reinforces emotional expressivity, feeling responsible for maintaining a positive emotional climate in relationships, and believing that they do not have control over events in their lives. ­Women also experience more chronic strain and a greater sense of low mastery (Nolen-­Hoeksema, et al., 1999). Low mastery and chronic strain contributed to rumination over time, and rumination increased the effect of low mastery and chronic strain on depressive symptoms. The researchers proposed that ­women’s greater likelihood of experiencing uncontrollable stressors might lower their mastery expectations and increase their rumination, and that both low mastery and rumination might inhibit the ­women’s capacity to deal with the stressor. A study which investigated the onset of rumination and depression in adolescents ages 10–17  years showed that girls reported more stress,


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rumination, and depression than boys (Jose & Brown, 2008). The gender difference in rumination emerged at age 12 years, while the gender difference in stress and depression emerged at age 13 years. The temporal sequence suggests that having a ruminative style of coping with distress increases the risk of experiencing stress and depression. Together, the evidence suggests that rumination is linked to depression, ­women ruminate more than men, and the reasons for their greater rumination might be associated with their gender-role socialization. Rumination also serves as a vulnerability f­actor in that it increases the risk of stress and depression. PSYCHOSOCIAL ­FACTORS Stress and coping ­There is a g ­ reat abundance of research on stress and coping to explain why more ­women than men are depressed. Investigators have looked at the number and nature of stressors, stress appraisal, and coping strategies to determine w ­ hether they might explain the gender disparity. Evidence shows that w ­ omen experience more chronic stress and daily hassles than men (Almeida & Kessler, 1998; Matud, 2004; McDonough & Walters, 2001; Nolen-­Hoeksema, Larson, & Grayson, 1999). They also view their stressors as being more negative, threatening, and uncontrollable (Matud, 2004). In contrast, men tended to view their stressors as challenges. The stress that ­women experience appears to be tied to network events or life events that occur in the lives of ­others within their social network (Dalgard, et  al., 2006; Kendler, et  al., 2001; Kessler & McLeod, 1984). Given that w ­ omen tend to be more relational in nature (Cross & Madson, 1997), it is believed that interpersonal stresses would affect them to a greater degree than men. It is often thought and indeed ­there is research evidence to show that when faced with stress, ­women are more likely than men to use emotion-­ focused coping strategies and men are more likely than w ­ omen to use problem-­solving (Matud, 2004). Emotion-­focused coping tends to be less effective than prob­lem solving (Billings & Moos, 1984) in addressing stress. However, the picture might be a ­little more complex than it appears. A meta-­analysis of empirical studies with nonclinical populations showed that in general, w ­ omen are more likely than men to use a broader range of coping be­hav­iors that include problem-­focused, emotion-­focused, social support-­seeking, and w ­ omen more often turn to religion (Car­ter, 2007). The results also suggested that ­women might be predisposed to the use of emotional support, rumination, or positive self-­ talk b ­ ecause they engaged in ­these coping be­hav­iors to a greater degree than men regardless of the nature of the stressor. This predisposition might be linked to


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differential gender-role socialization where ­women are taught to be more relational and men to be more distant and less disclosing. It might also be explained by hormonal differences. ­Women tend to have higher levels of the affiliative hormone oxytocin (Car­ter, 2007) and, thus, might be more likely to turn to ­others for support in times of stress regardless of the nature of the stressor. The meta-­analysis also found that, in instances of health concerns (personal and o ­ thers), ­women engaged in a broader range of coping be­hav­iors. When it came to interpersonal stressors, men tended to use ventilation and avoidance while w ­ omen tended to engage in general prob­lem solving, active coping, support-­seeking, and rumination (Car­ter, 2007). In general, the meta-­analysis suggests that w ­ omen do take a more active role in addressing stress than previously thought. They also adopt a wider range of coping strategies including problem-­focused types in comparison to men, suggesting greater flexibility in their approaches to dealing with stress. However, t­ here remains a tendency among w ­ omen to use emotion-­focused coping strategies. It is unclear ­whether the use of emotion-­focused coping strategies can account for the gender disparity in depression. Several investigations have looked into gender differences in depression, stress and coping during adolescence when the gender divergence in rates of depression begin to appear. A 10-­year longitudinal study revealed that the depression symptoms for both girls and boys emerged around the ages 10–13, and the rates of depression for both genders continue to increase (Hankin, et al., 1998). However, the slope of increase was steeper for the girls such that by the time the adolescents w ­ ere between the ages 15–18 years, the rate for the girls had doubled that for the boys. The increase in new cases for both genders stopped between the ages 18–21 and declined a­ fter 21 years of age. The researchers identified the age period of 15–18 years as critical to investigate differential vulnerability to depression in men and ­women. So, what happens during adolescence to account for the gender divergence in rates of depression? Research indicates that prior to adolescence, girls are already at higher risk than boys for depression (Nolen-­Hoeksema & Girgus, 1994). Pre-­ adolescent girls tend to be lower on instrumentality, aggression, and dominance in social interactions, and to be higher on rumination, possibly due to their gender-role socialization. When ­these risk f­ actors interact with certain stressors in adolescence, the girls are more likely to experience depression. Research findings on stressors within the adolescent population generally parallel t­ hose found in research with adults. Compared to adolescent boys, adolescent girls are more likely to report greater amounts of episodic stress in general and to experience higher levels of interpersonal stress in general as well as interpersonal stress related to their own actions. In contrast, boys reported higher levels of chronic stress, particularly in relation to their academics and school be­hav­ior (Shih, et al., 2006). T ­ hese findings are in keeping with previous works which report


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that the association between stressful life events and depressed mood is stronger among girls than boys (Rudolph & Hammen, 1999) and that girls are also more reactive to interpersonal stress (Leadbeater, et al., 1995). In contrast, boys appear to be more reactive to non-­interpersonal stress such as school-­related difficulties (Sund, et al., 2003). Gender-­role socialization Nolen-­Hoeksema and Girgus (1994) proposed that gender-role intensification during adolescence pres­ents a depressogenic vulnerability ­factor for girls and ­women. This aligns with her research which shows girls to possess more of the traditional feminine qualities even during the pre-­ adolescent years (Nolen-­Hoeksema & Girgus, 1994). T ­ here is a societal pressure to conform to one’s gender role as the individual moves from childhood through puberty to adolescence and eventually to adulthood. Girls’ be­hav­iors are restricted and expectations placed on them to achieve and be competent are lower. Essentially, t­ here is no incentive to strive, accomplish, and gain a sense of mastery even while at the same time they are expected to be popu­lar and socially accepted based on their physical appearance. Thus, the sense of self-­worth for girls rests not on  achievement and competency but on social popularity and physical attractiveness. In the research with adult populations, gender-role expectations have also been cited as a contributing f­actor to the gender gap in depression. Notably, the main tenet in the self-­silencing model by Jack (1991) is that ­women are socialized to silence themselves in order to be loving and caring, and to keep harmony in their intimate relationships. The self-­silencing results in their putting ­others’ needs above their own, a loss of their au­then­tic self, a sense of a divided self (a division between their public persona and their private genuine self), and a reliance on ­others views to develop their perceptions of themselves. What­ever resentment and anger the ­women might feel are suppressed only to be expressed inappropriately when their negative feelings can no longer be kept inside. Their inappropriate anger expression results in their feeling remorseful for they have ­violated societal expectations of how they should behave as w ­ omen, and the self-­silencing returns. Over time, the self-­silencing leads to depression in the ­women. The link among self-­silencing, anger, and depression has been reported in several studies (Page, et al., 1996; Tan & Carfagnini, 2008; Thompson, 1995). Interestingly, men self-­silence to the same or greater degree as ­women (Duarte & Thompson, 1999; Page, et al., 1996; Remen, et al., 2002), but they do not become as depressed as w ­ omen. It is generally believed that the act of self-­silencing is dif­fer­ent for men and ­women. Where ­women self-­silence to avoid expressing their inner thoughts, men might self-­silence to avoid intimacy or avoid a situation where they see their autonomy as being compromised (Remen, et  al., 2002). Self-­ silencing has been examined in dif­fer­ent populations (e.g., among t­ hose


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who experienced intimate partner vio­lence), dif­fer­ent ethnic groups, and in dif­fer­ent countries (Jack & Ali, 2010). Stress generation model Hammen (1991) found that in comparison to w ­ omen with bipolar disorder, medical disorder, or no disorder, depressed w ­ omen not only reported experiencing more stress but also more interpersonal dependent events to which they had contributed. She proposed that a combination of context variables (e.g., unstable social circumstances, high-­risk situations) and personal characteristics contribute to the occurrence of the events. Thus, the stress generation model does not see depressed ­women as passive individuals but as active in the creation of interpersonal stress. The stress generation effect has been observed in many studies involving ­children and adolescents, college students, older adults, and ethnic minorities and seems to be more relevant to w ­ omen than men (Liu & Alloy, 2010). Many investigators have examined dif­fer­ent groups of predictors of stress generation: cognitive vulnerabilities (negative inferential style, dysfunctional attitudes, ruminative tendencies) and personality and interpersonal vulnerabilities (neuroticism, maladaptive coping strategy, sociotropy and autonomy, anxious attachment, avoidant attachment, excessive reassurance-­seeking, love de­pen­dency, maladaptive interpersonal be­hav­iors). While ­there is substantial support for the stress generation model, Liu and Alloy (2010) called for more investigations into the generation of chronic stress and the clarification of the role of the dif­fer­ ent predictors or vulnerability f­ actors while addressing methodological issues. Cognitive vulnerability-­transactional stress theory Hankin and Abramson (2001) proposed a cognitive vulnerability-­ transactional stress theory to explain the emergence of gender disparity in depression during adolescence. Specifically, adolescent girls tend to experience more negative life events which results in the initial negative affect. Due to the greater cognitive vulnerability (e.g., physical appearance, body image) in girls, the initial negative affect ­will pro­gress to depression, which leads to the self-­generation of dependent negative events which feeds back into the interpersonal pro­cess of depression. Hankin and Abramson (2001) also acknowledged the role of other vulnerability f­ actors such as ge­ne­tics, childhood trauma, and hormones, as contributing to the development of depression. DISCUSSION The question of why more w ­ omen than men are depressed has generated voluminous amount of information. Early works focused on artefacts,


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biological, psychological and psychosocial variables. ­Later works integrated dif­fer­ent explanations to produce frameworks to answer the question. Most of the investigations have used adult populations, and several have turned to adolescent and pre-­adolescent populations to understand the ­causes or f­ actors that can account for the emergence of the gender disparity during puberty. Some have also looked at older populations and found ambiguous findings. Of the dif­fer­ent explanations that have been proposed, the rumination and stress generation models have been most fruitful. They have been widely tested and received substantial empirical support. Both are currently conceptualized as transdiagnostic models as they have applications for other disorders (Conway, et al., 2012; McLaughlin & Nolen-­Hoeksema, 2011). The cognitive vulnerability-­transactional stress theory (Hankin & Abramson, 2001) is very elaborate and proposes to explain not only the emergence of depression during adolescence but also how it is maintained through a feedback system. It draws from dif­fer­ent areas of research, and its dif­fer­ent components and postulated pathways warrant further investigation. An examination of the dif­fer­ent explanations and models in this chapter suggests three common themes. First, it has been proposed that the psychological vulnerabilities (neuroticism, sociotropy, rumination), stress appraisal, stress reactivity, and coping strategies are associated with gender-­role socialization. ­Women are socialized to be relational and value interde­pen­dency, the psychological vulnerabilities that have been identified appear to be very similar to the gender-role characteristics that are prescribed for w ­ omen, and the types of stressors that seem to trigger negative affect in w ­ omen are more likely to be interpersonal in nature. Second, the vulnerability ­factors, w ­ hether psychological or biological, do not act in­de­pen­dently to generate depression but instead require specific environmental stressors to be pres­ent, such as early childhood adversity that affect the functioning of the HPA axis or network stressors that appear to have more relevance or importance to w ­ omen than to men. More research needs to be carried out to examine the relative contributions of the myriad of correlated variables that are associated with depression in w ­ omen. It is notable that the characteristics that are associated with the female gender role are considered as psychological vulnerability ­ factors in depression, but are not viewed as strengths. Perhaps extreme versions of ­these characteristics are problematic. It would be beneficial for f­uture works to pay some attention to the question as ­whether ­there are certain conditions or contexts where in which ­these features could prove to be advantageous or protective. To clarify the relative contributions of the vulnerability f­actors to explaining the gender disparity in depression, it is impor­tant that similar investigations be carried out with men. However, t­here is a paucity of research on depression in men. As noted by Addis (2008), “(w)hen gender


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is not used as a synonym for sex differences, it normally emerges as a conceptual framework for understanding social, historical, economic, and psychological pro­cesses that shape ­women’s experience of depression. The third conclusion that one therefore draws is that gender is much less frequently used as a framework for understanding depression in men. In fact, publications on men and depression are outnumbered by t­ hose focusing on ­women by a ratio of over three to one” (p. 153). Comparing findings from depression studies on both men and ­women can illuminate which ­ factors can explain the gender differential and the pathways whereby which they operate. Research also needs to be carried out with dif­fer­ent ethnic groups and in dif­fer­ent countries. T ­ here is a preponderance of w ­ omen among the depressed throughout the world, but the ­factors that contribute to the gender gap might be dif­fer­ent, depending on the context. For example, depression has been studied in 17 Islamic countries (Alansari, 2006). The gender gap was observed in nine countries, no gender differential was reported in seven countries, and in one country, the men ­were more depressed than the ­women. The results w ­ ere interpreted within the context of gender-­ role socialization. One last consideration is that of ­women who are not depressed despite facing adversity or possessing specific vulnerability traits. It would be informative to find out why they fare better than expected to obtain some understanding of f­actors that can decrease w ­ omen’s risk to the development of depression. CONCLUSION Current research on the gender disparity in depression involves consideration of multiple ­factors that are derived from biological, psychological, psychosocial, and context domains. Rumination and stress generation appear to be the dominant theories in the field. Investigations into depression in men are needed for comparison purposes to find out which f­ actors account for the gender disparity and how they explain the emergence of the gender disparity during the adolescent years. Cross-­cultural and international studies are also needed to provide a broader understanding of why more w ­ omen than men are depressed across the world. Fi­nally, the psychological vulnerability ­factors in ­women bear a ­great deal of similarity to gender-role characteristics. It is wondered ­whether they might serve as strengths and facilitative of ­mental health in other contexts. REFERENCES Abate, K. H. (2013). Gender disparity in prevalence of depression among patient population: A systematic review. Ethiopian Journal of Health Sciences, 23, 283–288.


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Remen, A. L., Chambless, D. L., & Rodebaugh, T. L. (2002). Gender differences in the construct validity of the silencing the self scale. Psy­chol­ogy of ­Women Quarterly, 26, 151–159. doi: 10.1111/1471-6402.00053. Romans, S., Clarkson, R., Einstein, G., Petrovic, M., & Stewart, D. (2012). Mood and the menstrual cycle: A review of prospective data studies. Gender Medicine, 9(5), 361–384. doi: 10.1016/j.genm.2012.07.003. Romans, S. E., Kreindler, D., Asllani, E., Einstein, G., Laredo, S., Levitt, A., Stewart, D. E. (2012). Mood and the menstrual cycle. Psychotherapy and Psychosomatics, 82, 53–60. doi: 10.1159/000339370. Rudolph, K. D., & Hammen, C. (1999). Age and gender as determinants of stress exposure, generation, and reactions in youngsters: A transactional perspective. Child Development, 70(3), 660–677. Russo, N. F., & Tartaro, J. (2008). ­Women and m ­ ental health. In F. L. Denmark and M. A. Paludi (Eds.), Psy­chol­ogy of w ­ omen: A handbook of issues and theories (2nd ed.), pp. 440–481. Westport, CT: Greenwood Press. Schwartz, D. H., Romans, S. E., Meiyappan, S., De Souza, M. J., & Einstein, G. (2012). The role of ovarian ste­roid hormones in mood. Hormones and Be­hav­ ior, 62(4), 448–454. doi: 10.1016/j.yhbeh.2012.08.001. Shahar, G., Blatt, S. J., Zuroff, D. C., Kuperminc, G. P., & Leadbeater, B. J. (2004). Reciprocal relations between depressive symptoms and self-­criticism (but not de­pen­dency) among early adolescent girls (but Not Boys). Cognitive Therapy and Research, 28(1), 85–103. Shih, J. H., Eberhart, N. K., Hammen, C. L., & Brennan, P. A. (2006). Differential exposure and reactivity to interpersonal stress predict sex differences in adolescent depression. Journal of Clinical Child and Adolescent Psy­chol­ogy, 35(1), 103–115. Silverman, M. E., Reichenberg, A., Savitz, D. A., Cnattinguis, S., Lichtenstein, P., Hultman, C. M., Sandin, S. (2017). The risk ­factors for postpartum depression: A population-­ based study. Depression and Anxiety, 34, 178–187. doi:10.1002/da.22597. [Epub ahead of print]. Retrieved from https://­www​ .­ncbi​.­nlm​.­nih​.­gov​/­pubmed​/­28098957. Simonson, J., Mezulis, A., & Davis, K. (2011). Socialized to ruminate? Gender role mediates the sex difference in rumination for interpersonal events. Journal of Social and Clinical Psy­chol­ogy, 30(9), 937–959. doi: 10.1521/jscp.2011.30.9.937. Skodol, A. E., Gunderson, J. G., Pfohl, B., Widiger, T. A., Livesley, W. J., & Siever, L. J. (2002). The borderline diagnosis I: Psychopathology, comorbidity, and personality structure. Biological Psychiatry, 51(12), 936–950. Sonnenberg, C. M., Beekman, A. T. F., Deeg, D. J. H., & Van Tilburg, W. (2000). Sex differences in late-­life depression. Acta Psychiatrica Scandinavica, 101(4), 286– 292. doi: 10.1034/j.1600-0447.2000.101004286.x. Stevenson, B., & Wolfers, J. (2009). The paradox of declining female happiness. American Economic Journal: Policy, 1(2), 190–225. doi: 10.3386/w14969. Studd, J., & Panay, N. (2004). Hormones and depression in ­women. Climacteric, 7, 338–346. Sund, A. M., Larsson, B., & Wichstrom, L. (2003). Psychosocial correlates of depressive symptoms among 12–14-­year-­old Norwegian adolescents. Journal of Child Psy­chol­ogy and Psychiatry, 44(4), 588–597. Tan, J., & Carfagnini, B. (2008). Self-­silencing, anger and depressive symptoms in ­women: Implications for prevention and intervention. Journal of Prevention and Intervention in the Community, 35(2), 5–18.


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Thompson, J. M. (1995). Silencing the self: Depressive symptomatology and close relationships. Psy­chol­ogy of ­Women Quarterly, 19(3), 337–353. Uebelacker, L. A., Courtnage, E. S., & Whisman, M. A. (2003). Correlates of depression and marital dissatisfaction: Perceptions of marital communication style. Journal of Social and Personal Relationships, 20, 757–769. doi: 10.1177/​02​ 65407503206003. Van Os, J., & Jones, P. B. (1999). Early risk ­factors and adult person-­environment relationships in affective disorder. Psychological Bulletin, 29(5), 1055–1067. Varghese, F., & Brown, E. S. (2001). The hypothalamic-­pituitary-­adrenal axis in major depressive disorder: A brief primer for primary care physicians. Primary Care Companion to the Journal of Clinical Psychiatry, 3(4), 151–155. Retrieved from https://­www​.­ncbi​.­nlm​.­nih​.­gov​/­pmc​/­articles​/­PMC181180​/.­ Weiss, E. L., Longhurst, J. G., & Mazure, C. M. (1999). Childhood sexual abuse as a risk ­factor for depression in ­women: Psychosocial and neurobiological correlates. American Journal of Psychiatry, 156(6), 816–828. Weissman, M. M., & Klerman, G. L. (1977). Sex differences and the epidemiology of depression. Archives of General Psychiatry, 34(1), 98–111. WHO (2008). The global burden of disease: 2004 update. Geneva, Switzerland: Author. Retrieved from http://­w ww​.­who​.­i nt​/­healthinfo​/­global​_­burden​ _­disease​/­GBD​_­report​_­2004update​_­full​.­pdf​?­ua​=­1. Wilhelm, K., & Parker, G. (1994). Sex differences in lifetime depression rates: Fact or artefact? Psychological Medicine, 24, 97–111. Zlotnick, C., Shea, M. T., Pilkonis, P. A., Elkin, I., & Ryan, C. (1996). Gender, type of treatment, dysfunctional attitudes, social support, life events, and depressive symptoms over naturalistic follow-up. American Journal of Psychiatry, 15, 1021–1027.


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Chapter 10

­Women’s ­Career Development Nancy E. Betz

Frank Parsons, in his (1909) classic volume “Choosing a vocation ” postulated that self-­k nowledge, knowledge of the world of work, and “true reasoning” to match the two, w ­ ere the sine qua non of satisfactory vocational choices. Although t­hese ideas made g ­ reat sense, it would be 55 years before they w ­ ere thought to have any relevance to the lives of w ­ omen. As recently as 1964, the preface to Borow’s volume “Man in a World at Work” stated the following: “Work is the social act around which each of us establishes a meaningful and rewarding life routine. One has but to witness the lives of men without work, or of men who lack edifying work alienated, thwarted and cutoff from the fulfillment of the most h ­ uman of sentiments, a sense of usefulness and purpose—to recognize the validity of the commonly voiced doctrine that work is, indeed, a way of life.” (p. xi). In this poignant statement, t­ here is no acknowl­edgment of nor concern expressed for ­women; it was assumed that when ­women “worked” (sic, as in outside the home), it was ­because their ­labor was needed by the economy, as was the case with the Rosie the Riveters of World War II (Colman, 1995), that they ­were working ­until they could “land” a husband, or that they w ­ ere that most pitiable of characters: the spinster (Toibin, 2004). It has only been since the 1960s that ­women’s work has been taken seriously by at least some segments within psy­chol­ogy and society, and the concept of w ­ omen having c­areers, vocations other than motherhood, received serious study. T ­ oday the study of w ­ omen’s c­ areer development is a vibrant and critically impor­tant field of psy­chol­ogy; we now take ­women’s ­careers seriously. ­Women now constitute a significant portion of the l­ abor force, and the majority of U.S. ­women work outside the home. In the year 2005, of ­women aged 25–44, 75 ­percent ­were employed (Bureau of ­Labor Statistics, 2005).


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Of w ­ omen with c­ hildren u ­ nder 18, 71 ­percent are employed, and 62 ­percent and 57 ­percent of t­ hose with c­ hildren u ­ nder age 6 and u ­ nder age 3, respectively, are employed (Bureau of ­Labor Statistics, 2005). The odds that a ­woman ­will work outside the home during her adult life are over 90 ­percent (U.S. Department of ­Labor, 2003). What this adds up to is that paid employment (versus work inside the home) is now the rule, not the exception. ­ There is no category of ­ women for whom the majority is not employed outside the home (Barnett & Hyde, 2001). Not surprisingly, the most common f­ amily life style t­ oday is the “dual-­ earner” ­family (Gilbert & Kearney, 2006). As described by Gilbert and Kearney (2006) and by Barnett and Hyde (2001), we now have “work-­ family convergence” (Gilbert & Kearney, 2006, p.  196) where both work and ­family are considered impor­tant in the lives of both w ­ omen and men, and where many if not most workers prefer the two roles equally. Thus, as psychologists, educators, and counselors, it is essential to understand the issues facing w ­ omen at work and the real­ity that both work and ­family roles are salient in the lives of con­temporary w ­ omen and men. WHY ­CAREERS ARE IMPOR­TANT TO A ­WOMAN’S QUALITY OF LIFE ­Women, like men, need a variety of major sources of satisfaction in their lives; as once stated by Freud (according to Erickson, 1950), the psychologically well-­adjusted ­human being is able “to love and to work” effectively. Both ­women and men need the satisfactions of interpersonal relationships, with ­family and/or friends, but also the satisfaction of achievement in the outside world. We now have research evidence that ­women, like men, need to utilize their talents and abilities and that multiple roles are impor­tant for ­people’s psychological well-­being. Utilization of Abilities Research has shown that the fulfillment of individual potential for achievement is vitally impor­tant. Although the roles of homemaker and ­mother are impor­tant and often very satisfying, they do not allow most ­women to fulfill their unique abilities and talents. ­These, rather, must be fulfilled through ­career pursuits or volunteer and avocational activities, just as they are in men. This is not to discount the importance of child-­ rearing but only its insufficiency as a lifelong answer to the issue of self-­ realization. Even if a ­woman spends a number of years creatively rearing ­children, ­these ­children inevitably grow up and begin their own lives, lives that must of necessity be increasingly in­de­pen­dent from the parental home. The evidence is strong that homemakers who do not have other outlets for achievement and productivity are highly susceptible to psychological


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distress, particularly as ­children grow and leave home. For example, of the ­women in the Terman studies of gifted c­ hildren (Terman & Oden, 1959), when followed up in their 60s (Sears & Barbie, 1977), the ­women who reported the highest levels of life satisfaction w ­ ere the employed w ­ omen. Least satisfied with their lives w ­ ere ­those who had been h ­ ouse­wives all their adult lives. The most psychologically distressed ­women ­were ­those with exceptionally high IQs (above 170) who had not worked outside the home. It seems clear in the Terman study that w ­ omen with genius-­level IQs who had not pursued meaningful ­careers outside the home have suffered psychological consequences. Kerr (1997; Kerr, et al., 2005), in an extensive program of research on gifted girls, notes that although the aspirations of girls are as high as are ­those of their gifted male counter­parts, that “the theme of their lives is one of declining achievement goals” (Kerr et al., 2005, p. 19). Gifted girls often experience pressure, subtle or not-so subtle, to do an “about face” (Kerr, 1997; Reis, et al., 1996) during adolescence—to shift their personal priorities and self-­evaluations from academic achievement to the achievement of romance. Gifted girls ­were also quite concerned about the effects of their giftedness on ­others’ attitudes t­ oward them, fearing that ­these attitudes would be negative (Kerr, et al., 1988). Not surprisingly, by the sophomore year of college gifted young w ­ omen have likely changed their majors to less challenging areas, by their se­nior year they have reduced the level of their ­career goals, and by college graduation they have given up their former ­career dreams altogether, all ­because of the pervasive “culture of romance” (Holland & Eisenhart, 1990; Kerr, et al., 198, 8 p. 16). It does seem reasonable to suggest that t­ hese young ­women of ­today ­will experience the same eventual loss of self and the psychological prob­lems experienced by the gifted ­women in the older Terman studies. Multiple Roles In a related vein, t­ here is strong evidence for the beneficial effects of working outside the home on a ­ woman’s psychological adjustment, regardless of her marital status. Early research on the relationship between marital status and psychological health concluded that the healthiest individuals ­were the married men and the single ­women, whereas married ­women w ­ ere at particularly high risk for psychological distress (Bernard, 1971). However, it does not seem to be marriage per se that is detrimental to ­women’s psychological adjustment, but rather the lack of meaningful paid employment. In ­these studies, the ­women who ­were not employed accounted for the more frequent occurrence of psychological distress among the married w ­ omen. In a related vein, t­ here is strong evidence that multiple roles, that is, ­those of both worker and ­family member, are impor­tant to ­women’s


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­ ental and physical health (Barnett & Hyde, 2001). Most research finds m that even though multiple roles are time consuming and can be stressful, they are protective against depression (Crosby, 1991) and are facilitative of positive m ­ ental health. T ­ here are several hypotheses concerning why multiple roles are beneficial for w ­ omen (Barnett & Hyde, 2001). First, when more than one role is impor­tant in one’s life, stress or disappointment in one domain can be “buffered” by success or satisfaction in another role. Second, the added income of a second job/career can reduce the stress of being the sole breadwinner and can, in fact, provide an economic “lifeline” when one spouse or partner becomes unemployed. In difficult economic times, characterized by high unemployment and corporate downsizing or collapse, two incomes can be virtually life-­saving. Third, jobs provide an additional source of social support, which increases well-­being (Barrett & Hyde, 2001). For example, Greenberger and O’Neil (1993) found that although men’s well-­being was related most significantly to social support from their wives, w ­ omen’s well being was related to support from neighbors, supervisors, and co-­workers, as well as from husbands. ­There is also evidence to contradict myths that ­women’s c­ areer commitment ­will have a negative effect on her marriage and ­family. It seems that more equitable sharing of breadwinning may benefit marital satisfaction in both spouses, but especially husbands (Wilke, et al., 1998). Also in­ter­ est­ing are data showing that the two roles are not contradictory but may, in fact, have a mutually catalytic effect; studies of the relationship between work commitment and f­amily commitment show a positive correlation between the two (Marks & MacDermid, 1996). In considering ­women’s c­areer development and multiple roles, it should also be noted that ­there are ­today many lifestyle alternatives. ­There are 12 million single parents in this country, most of them ­women (Gilbert, 2002). T ­ here is also an increasing number of p ­ eople who choose to remain single, as well as an increasing number of committed gay and lesbian c­ ouples, many of whom are now choosing to have or adopt c­ hildren. Thus, although the heterosexual dual ­career marriage ­will be the modal lifestyle, the options of remaining single or in a committed same-­sex or non-­marital partnership should also be considered ­viable in life planning (Farmer, 1997). It goes without saying that the issues of combining work and parenthood are dif­fer­ent for single p ­ eople who usually carry sole responsibility for home and parenting, and for ­those in same-­sex partnerships for whom t­ here is no obvious assignment of roles and responsibilities based on gender. But regardless of the precise nature of the ­family unit, helping p ­ eople to have and manage multiple roles ­will be beneficial. INEQUITIES IN ­WOMEN’S L ­ ABOR FORCE PARTICIPATION Although ­women now work in overwhelming numbers, their work continues to be focused in traditionally female occupations and to be less


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well paid than that of men (American Association of University ­Women, 2002). Even though w ­ omen have made much pro­gress in entering traditionally male-­dominated professions, such as medicine and law, where half the entering students are ­women, the occupational world still has many areas of extreme sex segregation. For example, over 90 ­percent of preschool, kindergarten, elementary, and special education teachers, along with dental hygienists, secretaries, child care workers, cleaners and servants, hairdressers, occupational and speech therapists, and teacher’s aides are ­women (U.S. Department of ­Labor, 2003). Men are still only 11 ­percent of nurses, although this percentage is up from 8 ­percent a few years ago. In contrast, ­women remain seriously underrepresented in scientific and technical c­ areers and in high-­level positions in business, government, education, and the military. For example, ­ women earn fewer than 20  ­percent of the Bachelor’s degrees in fields, such as engineering and physics (National Science Foundation) and fewer than 10 ­percent of the gradu­ate degrees in engineering (Kuh, 1998). High technology is among the fastest growing and well-­paid occupational fields, yet w ­ omen represent only about 14 ­percent of engineers, 30 ­percent of computer systems analysts, and 25 ­percent of computer programmers (U.S. Department of ­Labor, 2003; Bureau of L ­ abor Statistics, 2005). W ­ omen account for 8 ­percent of physicists and astronomers, 7 ­percent of air traffic controllers, 5 ­percent of truck ­drivers, 4 ­percent of pi­lots, and 5 ­percent of firefighters. ­Women remain only a small proportion of workers in the generally well-­paid skilled trades; for example, they are 2 ­percent of carpenters and electricians (Bureau of ­Labor Statistics, 2005). ­Career education programs continue to be seriously gender segregated, with 90  ­percent of ­women in training programs in traditionally female fields such as health care and office technology (American Association of University ­Women, 2002). ­Women also continue to be paid less for full-­time employment in this country. Overall, ­women make 77 ­percent as much as men when both are employed full time (Bureau of ­Labor Statistics, 2005) although this constitutes an improvement over the 73 ­percent reported in the 2003 data. The income gap is greater for middle-­aged and older workers than it is for young workers and is greater for white ­women compared to African American or Hispanic ­women, prob­ably ­because the incomes of African American and Hispanic males are also depressed relative to ­those of white men. However, ­women in non-­traditional ­careers earn 150 ­percent that of ­women in traditional ­careers (U.S. Department of ­Labor, 2003). In considering ­women’s lower income, it is essential to note that w ­ omen cannot assume they w ­ ill be taken care of by a husband. T ­ oday, the average marriage lasts seven years (Harvey & Pauwels, 1999), and 20 ­percent of ­children live in a single-­parent home. As mentioned, t­ here are 12 million single-­parent h ­ ouse­holds, most of them headed by w ­ omen (U.S. Department of ­Labor, 2003). ­Women are much more likely to be widowed than men, and ­women represent 75 ­percent of the el­derly poor, a percentage


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much greater than their repre­sen­ta­tion (59 ­percent) among the el­derly. The odds that a ­woman w ­ ill have to care for herself financially during adult life are high, and failure to prepare her for this likelihood with high-­ quality education and/or training can have tragic consequences. In summary, ­career pursuits ­will play a major role in most ­women’s lives, so it is imperative that we develop knowledge and interventions that ­will help ­women make ­career choices, which they find fulfilling, satisfying, and eco­nom­ically sustaining. Yet the data I have described suggest that a substantial number of w ­ omen are still selecting a smaller range of traditionally female, lower paid c­ areers and are making substantially less money than men, even when employed full-­time. In the next sections, I ­will discuss barriers to choice and barriers to equity, but following each discussion of barriers, I w ­ ill also discuss supportive ­factors. This organ­ ization follows the distinction of c­ areer barriers originated in the writings of Farmer (1976) and Harmon (1977) in their pioneering work on ­women’s ­career development (Farmer, 2006). We, as psychologists, can be better prepared to help girls and ­women make choices which can facilitate their quality of life if we understand both the barriers to and supports of ­women’s ­career development. BARRIERS TO ­WOMEN’S PERCEIVED C ­ AREER OPTIONS AND CHOICES Some barriers to c­ areer choices are socialized barriers, that is socialized belief systems or be­hav­ior patterns, which lead ­women themselves to avoid certain ­career fields. ­Factors that ­will be discussed herein are avoidance of mathe­matics coursework, low self-­efficacy and outcome expectations, gender and occupational ste­reo­types, and a restricted range of vocational interests. Prob­lems with our educational system, the concept of the null educational environment, and multiple role concerns are other barriers to w ­ omen’s c­ areer development. Math: The Critical Filter The critical importance of a sound mathe­ matics background for entrance to many of the best c­ areer opportunities in our society (e.g., engineering, scientific and medical ­careers, computer science, business, and the skilled trades) is now generally agreed upon (Chipman & Wilson, 1985), and a lack of math background constitutes one of the major barriers to ­women’s c­ areer development. The classic study of the importance of math to c­ areer options was that of Sells (1973). In a study of freshmen at the University of California at Berkeley, Sells (1973) found that only 8  ­percent of the ­women, versus 57 ­percent of the men, had taken four years of high school math. Four years of high school math was prerequisite to entering calculus or intermediate


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statistics courses required in three-­ fourths of the university’s major fields, and the university did not provide remedial courses to allow a student to complete the prerequisites post hoc. Thus, 92 ­percent of the freshmen ­women at Berkeley ­were prevented by lack of math background from even considering 15 of the 20 major fields. The five remaining “options” ­were predictable, such traditionally female major areas as education, the humanities, the social sciences, librarianship, and social welfare. Thus, decisions to “choose” ­these majors may have, in many cases, been by default, through failure to qualify for any major requiring considerable math background. Sells (1982) further elaborated the vital importance of math preparation for both ­career options and ­future earnings. Four full years of high school math are vital to surviving the standard freshman calculus course, now required for most undergraduate majors in business administration, economics, agriculture, engineering, forestry, health sciences, nutrition, food sciences, and natu­ral, physical and computer sciences. Only the arts and humanities do not now require a math background. Further, Sells (1982) showed a strong and direct relationship between college calculus background and both starting salaries and employers’ willingness to interview students for a given job. Mathe­matics and science are impor­tant even for non-­college-­degree technical occupations (U.S. Department of L ­ abor, 2000). As so well-­stated by Sells (1982), “Mastery of mathe­matics and science has become essential for full participation in the world of employment in an increasingly technological society” (Sells, 1982, p. 7). Given the importance of having an adequate math background to ­career options, females’ tendency to avoid math coursework has been one of the most serious barriers to their ­career development. Further, it is fairly clear now that it is lack of math background, rather than lack of innate ability, that is to blame for females’ poorer per­for­mance on quantitative aptitude and mathe­matics achievement tests (e.g., Chipman & Wilson, 1985; Eccles & Jacobs, 1986; Spelke, 2005.). Thus, a critical issue is females’ avoidance of math. Educational and counseling interventions capable of helping young w ­ omen to be full participants in an increasingly technological society may be among the most crucial strategies in attempts to broaden ­women’s ­career choices. ­These issues are dealt with more extensively in the discussion of counseling implications. Self-­efficacy Expectations The concept of self-­efficacy expectations has become one of the most impor­tant in helping to understand the c­ areer options that p ­ eople consider. Self-­efficacy expectations (Bandura, 1977, 1997) refer to ­people’s beliefs that they can successfully complete specific tasks or be­hav­iors to reach goals. For example, an individual may perceive herself as able (or unable) to solve algebraic equations, fix a flat tire, or care for an infant.


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Self-­efficacy expectations are postulated by Bandura (1977, 1997) to have at least three behavioral consequences: 1) approach versus avoidance be­hav­ior; 2) quality of per­for­mance of be­hav­iors in the target domain; and 3) per­sis­tence in the face of obstacles or disconfirming experiences. Thus, low self-­efficacy expectations regarding vari­ous behavioral domains are postulated to lead to avoidance of ­those domains, poorer per­for­mance in them, and an increased tendency to “give up” when faced with discouragement or failure. In the context of ­career development, self-­efficacy expectations can influence the types of courses, majors, and c­ areers individuals feel comfortable attempting. They can influence per­for­mance on the tests necessary to complete college coursework or the requirements of a job training program. Fi­nally, the postulated effects of self-­efficacy on per­sis­tence influence long-­term pursuit of one’s goals in the face of obstacles, occasional failures, and dissuading messages from the environment, such as gender or race-­based discrimination or harassment. Betz and Hackett (1981) postulated that the experiential antecedents leading to the development of strong self-­efficacy expectations w ­ ere much less available in the socialization experiences of young females than young males, at least in behavioral domains in the sciences, mathe­matics, technology, the out-­of-­doors, and mechanical areas, and that this experiential impoverishment could be a significant cause of w ­ omen’s continued underrepre­sen­ta­tion in c­ areers in science and technology and the skilled trades, among o ­ thers. Twenty-­five years of research has supported ­these postulates. As shown by Betz and Hackett (1981, 1997; Betz, et al., 2003; Borgen & Betz, 2007), in education or job content domains, college ­women tend to score lower than college men on self-­efficacy in domains having to do with math, science, computer science and technology, mechanical activities, and outdoor and physical activities. W ­ omen tend to score higher than men on self-­efficacy in social domains of activity, for example, teaching and counseling. For example, Betz and Hackett (1981) asked college w ­ omen and men to report w ­ hether they felt themselves capable of completing vari­ous educational majors. Even though the men and ­women as a group did not differ in their tested abilities, they differed significantly in their self-­efficacy beliefs. T ­ hese differences w ­ ere especially striking t­oward occupations involving mathe­matics: 59  ­percent of college men versus 41 ­percent of college w ­ omen believed themselves able to complete a degree in that field. Seventy-­four p ­ ercent of men, versus 59 ­percent of w ­ omen, believed they could be accountants. Most dramatically, 70 ­percent of college men but only 30 ­percent of comparably able ­women believed themselves able to complete a degree in engineering. Betz and Hackett (1981) also found that self-­efficacy was related to the range of ­career options considered, and that self-­efficacy for mathe­matics is linked to choice of a science c­ areer (Betz & Hackett, 1983). Other studies have shown that self-­ efficacy beliefs are related to per­ for­ mance and


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per­sis­tence. For example, Lent, Brown, and Larkin (1984, 1986) showed that efficacy beliefs regarding the educational requirements of scientific and technical occupations ­were related to both the per­for­mance and per­ sis­tence (continuing enrollment) of students enrolled in engineering programs. And studies (Pajares, 1996) have suggested that w ­ omen tend to more accurately estimate their mathematical abilities, while men often overestimate theirs. Overestimation is postulated to lead to “approach” be­hav­ior—­effort and persistence—­and so may lead to skill enhancement and expansion of options, more likely, therefore, to characterize the efforts of young males than females. Thus, low self-­efficacy, especially in relationship to male-­dominated ­careers and/or ­careers requiring mathematical or technical expertise, may reduce the self-­perceived c­ areer options of ­women. Another concept in Bandura’s (1997) social cognitive theory that is impor­tant for ­women is that of outcome expectations, the beliefs that desired outcomes w ­ ill follow from successful be­hav­iors. Given continuing discrimination in the work force, it would not be surprising if w ­ omen felt that competent work be­hav­ ior might not be rewarded or might even be disparaged in certain contexts. ­Women of color may have particularly low outcome, as well as self-­efficacy, expectations due to experiences with oppression and racial bias (Byars & Hackett, 1998). Occupational and Gender Stereotypes Gender-­related ste­reo­types detrimentally affect the development of girls and ­women in at least two ways. First, ste­reo­types regarding gender roles may lead girls to believe that they should prioritize homemaking and child-­rearing roles and de-­emphasize their own educational achievements. One manifestation of this stereotyping is a progressive decrease in the aspirations of girls. Numerous studies suggest that although boys and girls start out with equally high aspirations, girls reduce theirs over time (Farmer, 1997; Kerr, 1997). For example, in the high school valedictorian sample studied by Arnold and Denny (Arnold, 1995), the boys and girls initially aspired to relatively similar levels of c­ areer prestige, but as adults, the ­women selected less prestigious majors and ended up in lower-­level ­career fields. In Farmer’s (1997) longitudinal study of high school students, men’s per­sis­tence in science was related to high aspirations when young, while for ­women their youthful high aspirations often faded as they matured (Farmer, 1997). In Arnold and Denny’s (Arnold, 1995) sample of high school valedictorians, the girls but not the boys showed steady decrements in aspirations and in self-­esteem ­after college. The stronger the home/family priorities, the more precipitous w ­ ere the declines in both aspirations and self-­esteem. And as mentioned earlier, Kerr (Kerr, 1997; Kerr, et al., 2005), in their extensive program of research on gifted girls, noted the shift in


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adolescence in personal priorities and self-­evaluations from academic achievement to the achievement of romance and the increasing worry that high achievement would be negatively perceived by their male peers and potential romantic partners. This shift in priorities cannot help but be related to the progressive decline in aspirations once girls enter college (Kerr, et al., 2005). The second way that ste­reo­types affect ­women’s ­career choices is through ste­reo­types about occupations best suited for males and females. Although beliefs that some occupations are more appropriate for men versus ­women may have lessened, they still exist, as is shown by research. In an illuminating recent study, for example, Nelson, Acke, and Menis (1996) found that college students assumed that men w ­ ere majoring in engineering and w ­ omen in nursing even when contrary information was provided. For example, a 20-­year old male described as having worked in a day care center was assumed to be majoring in engineering, while a young ­woman who had had considerable outdoor and mechanical experience was assumed to be majoring in nursing. ­Children are susceptible to ­these ste­reo­types, and begin to use them to guide choice. Early studies (see Betz, 1994 for a review) showed that p ­ eople consistently rate many occupations as e­ ither masculine or feminine. For example, in the classic study of gender ste­reo­types in occupations, Shinar (1975) showed that miner, federal judge, engineer, physicist, and heavy equipment operator ­were judged to be highly masculine, while nurse, receptionist, elementary school teacher and dietician ­were judged to be highly feminine. ­Children learn ­these ste­reo­types at ages as young as 2 to 3 years old and begin to incorporate gender roles into their considerations of c­ areers at ages 6–8, grades 1 through 3 (Gottfredson, 1981). Restricted Vocational Interests Ability, aptitude, and vocational interest mea­sures are extensively used in c­ areer assessment and counseling with the idea of achieving a fit or match between the person and environment. This objective can be traced back to Frank Parsons’ (1909) “matching men and jobs” approach as discussed in the introduction to this chapter. Now referred to in more con­ temporary terms as “person environment fit” or “trait-­factor” models (Dawis, 1992; 2000), the basic assumptions of the model remain elegant in their simplicity while broad in their usefulness. Simply stated, the bases of this approach are that individuals differ in their job-­related abilities and interests, job/occupational environments differ in their requirements and in the kinds of interests to which they appeal, and congruence or “fit” between an individual’s characteristics and the characteristics of the job is an impor­tant consideration in making good ­career choices. Among the impor­tant variables to be taken into consideration in ­these models are abilities and aptitudes, such as ­those mea­sured by the Differential Aptitude Tests (DATs) and Armed Ser­vices Vocational Aptitude


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Battery (ASVAB), and vocational interests as included in Holland’s theory (1997) and as mea­sured by the Strong Interest Inventory (Donnay, et al., 2005; Walsh & Betz, 2001). From the matching perspective, the purpose of assessment is to assist a student or adult in generating educational or ­career options which represent a good person-­environment fit. While the “matching model” has been supported by much empirical research, we have also come to realize that this model oversimplifies the ­career choice pro­cess for some groups of p ­ eople. For example, research has indicated that ­women tend to underutilize their abilities in selecting ­careers (Betz & Fitzgerald, 1987). In addition, ­women’s overrepre­sen­ta­tion in traditionally female ­careers and underrepre­sen­ta­tion in many male-­ dominated c­ areers may be due partly to restrictions in how their vocational interests have developed and how they are mea­sured. Using Holland’s (1997) vocational theory as an example, ­women score lower on Realistic themes and higher on Social themes than men when raw scores (­simple number of items endorsed) are used to mea­sure the Holland types (Lunneborg, 1979). The Realistic theme includes technical, outdoor, and “hands-on” activities, the kinds of skills often taught in high school “shop,” electronics, and trades courses or u ­ nder the tutelage of a parent comfortable with home and automobile repair. Realistic interests are part of inventory suggestions for ­careers in engineering, and thus, lower scores on this theme constitute a significant barrier to the suggestion of this occupational field to young w ­ omen. The Social theme includes social, interpersonal skills often thought impor­tant to teach girls but neglected in the teaching of boys (Tipping, 1997; Yoder, 1999). When such mea­sures are used, gender ste­reo­types tend to be perpetuated by the test materials themselves. ­There is strong evidence that ­these interest differences are in part due to stereotypic gender socialization ­because boys are exposed to dif­fer­ent types of learning opportunities growing up than are girls. Educational and c­areer options are, thus, restricted b ­ ecause of restricted interest development. Although part of the answer to this prob­lem is to increase the breadth of socialization experiences afforded to both genders, at a practical level, we can also address ­these prob­lems by using interest inventories which are not gender restrictive, that is, that do not perpetuate gender ste­reo­types. This can be done using within-­gender normative scores (comparing raw scores to ­those of members of the same gender) and gender-­balanced interest inventories (where interest scales include items familiar to both genders rather than primarily to just one). ­These approaches ­will be discussed in the last section on implications for education and interventions. Multiple Role Concerns Fitzgerald, Fassinger, and Betz (1995) noted that “the history of ­women’s traditional roles as homemaker and m ­ other continue to influence e­ very aspect of their ­career choice and adjustment” (p.  72), typically in the


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direction of placing limits on what can be achieved. The research of Arnold and Denney (Arnold, 1995), following the lives of Illinois valedictorians, provided a particularly vivid illustration of how the aspirations of academically gifted ­women, but not ­those of similarly gifted men, steadily decreased as they completed college and entered ­career fields. In a longitudinal study of Midwestern high school students, Farmer (1997) noted that a large number of young ­women interested in science chose to pursue nursing b ­ ecause they thought it would fit well with having and rearing c­ hildren or with being a single or divorced head of ­house­hold. Men in the Farmer study made no such compromises. In Farmer’s sample of ­women (high school students in 1980), ­career motivation was inversely related to homemaking commitment. Kerr, et al. (2005), noted that “a culture of romance which is virulently inimical to female achievement still thrives in coeducational colleges and universities” (p. 30), and that it leads even gifted young w ­ omen to reduce their major and c­ areer aspirations, to be much more likely than their male counter­parts to follow their partner to his job location, to take responsibility for child care, to give up full-­time work for part-­time work, and to give up leadership positions as too demanding to combine with domestic responsibilities. In essence, she takes full executive responsibility at home (Bem & Bem, 1976), so it may be perceived as an undue burden (and prob­ably is!) to also take such responsibility at work. ­Women ­today may not be viewing home and c­ areer as an “either-or” choice, but many do plan ­careers mindful of how they ­will integrate t­ hese with home and ­family. In contrast, many men plan their ­careers without needing to sacrifice levels of achievement to accommodate home and families (Farmer, 1997). Spade and R ­ eese (1991) noted that men reconcile the demands of work and ­family by “reverting to the traditional definition of ­father as provider” (p. 319). As concluded by Gerson (1986) and discussed further by Eccles (1987), ­women’s choices about work continue to be inextricably linked with their decisions about f­ amily, and thus, f­ amily role considerations limit w ­ omen’s investment in the occupational world. Although we have witnessed tremendous increases in workforce participation among w ­ omen in all marital and parental categories, the relationship of marital/parental status to ­career attainment, commitment, and innovation is still very strong. Studies have shown inverse relationships between being married and having of c­ hildren and e­ very mea­sur­able criterion of c­ areer involvement and achievement (Betz & Fitzgerald, 1987). This inverse relationship is not true among men. Highly achieving men are at least as likely (if not more so) as their less highly achieving male counter­parts to be married and to have one or more ­children. In other words, men do not have to downscale their aspirations to have a home and ­family. W ­ omen, like men, deserve to “have it all.”


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Barriers in the Educational System It is prob­ably difficult to overestimate the importance of education to c­ areer development and achievement. The nature and level of obtained education are importantly related to subsequent ­career achievements and to adult socioeconomic status and lifestyle. An undergraduate degree is now a necessary minimum requirement for the pursuit of many occupations, and gradu­ate or professional education is the only route to ­careers in many professions. All workers, men and ­women, earn more with increasing levels of education. Education is crucial for economic power (Wycott, 1996) and in­de­pen­dence (Cardoza, 1991). In short, appropriate educational preparation is a major “gateway” to occupational entrance. Education creates options, while lack of education closes them; without options, the concept of “choice” itself has no real meaning. Thus, the decisions individuals make concerning their education, both in terms of level and major areas of study, w ­ ill be among the most impor­tant ­career decisions they ever make. Further, success and survival in the educational programs chosen w ­ ill be critical to the successful implementation of t­hese ­career decisions. Studies commissioned by the American Association of University ­Women (1992, 1999, 2002) and reviews done by Sadker and Sadker (1994) and Zittleman and Sadker (2003) document the continuing disadvantaged position of girls in our educational system. Researchers have concluded that girls receive less attention from teachers than do boys, that teachers have ste­reo­typed views of the sexes, and that teaching materials such as textbooks continue to have gender-­biased content or to marginalize or ignore w ­ omen. For example, Siegel and Reis (1998) found that although teachers perceived gifted girls as working harder and ­doing better work than gifted boys, they gave the boys higher grades. In another study (Fennema, et al., 1996), teachers continued to perceive that boys are better at math and like it better in comparison to gifted girls. Research by Brody (1997) and ­others has also convincingly documented a decline in self-­ esteem among girls, but not boys, from elementary to ­middle and high school. For example, 55 ­percent of elementary school girls agreed with the statement “I am good at a lot of ­things,” but this percentage declined to 29 ­percent in ­middle school and 23 ­percent in high school. Interestingly, girls who pursued math and science courses and who participated in sports maintained their self-­esteem over this period (American Association of University W ­ omen, 1992). B ­ ecause of the combination of lack of support with outright discouragement and harassment, Sandler and Hall (1996) described our schools as providing a “chilly educational climate” for girls and ­women. By the time girls enter college, they can expect to encounter an educational environment which may continue to be “chilly.” Sexual harassment,


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being discouraged from classroom participation, and lack of support and mentoring can affect w ­ omen in any major, but t­ hese and other subtle or direct messages that “she ­doesn’t belong” are particularly true in male-­ dominated fields, such as engineering and the physical sciences (see the discussion of the experiences of “token” w ­ omen in the section, called External Barriers to Equity). Ehrhart and Sandler (1987) documented other types of differential treatment of w ­ omen in higher education such as disparaging w ­ omen’s intellectual capabilities or professional potential, using sexist humor, advising w ­ omen to lower their academic and c­ areer goals, and focusing on marriage and ­children as a potential barrier to the ­career development of w ­ omen but as an advantage for men (Ehrhart & Sandler, 1987). As stated by Pearson, Shavlik, and Touchton (1988), “The pres­ent rec­ ord of higher education, in spite of some significant efforts, is not particularly good. Female students, on the w ­ hole, still experience a loss of personal and ­career confidence over the period they spend in higher education, even when they make very high grades. For men, the reverse is true.” The Null Educational Environment One of the most basic and impor­tant concepts summarizing the difficulties faced by w ­ omen in higher education is Freeman’s (1979) concept of the null educational environment. A null environment, as discussed by Betz (1989) and Freeman (1979), is an environment that neither encourages nor discourages individuals; it simply ignores them. Its effect is to leave the individual at the mercy of what­ever environmental or personal resources to which she or he has access. The effects of null environments on ­women ­were first postulated by Freeman (1979) following a study of students at the University of Chicago. Students w ­ ere asked to describe the sources and extent of environmental support they received for their educational and ­career goals. Although both male and female students reported being ignored by faculty (thus experiencing what Freeman called a null educational environment), male students reported more encouragement and support from o ­ thers in their environments, for example, parents, friends, relatives, and significant o ­ thers. When added to the greater occurrence of negative messages regarding ­women’s roles and, in par­t ic­u­lar, regarding w ­ omen’s pursuit of c­ areers in fields traditionally dominated by men, the effect of the faculty’s simply ignoring ­women students was a form of passive discrimination, i.e., discrimination through failure to act. As stated by Freeman (1979), “An academic situation that neither encourages nor discourages students of ­either sex is inherently discriminatory against ­women ­because it fails to take into account the differentiating external environments from which ­women and men students come,” where external environments refer to difference in familial, peer, and societal support for c­areer pursuits


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(Freeman, 1979, p. 221). In other words, professors do not have to overtly discourage or discriminate against female students. Society has already placed countless negative marks on the female student’s “ballot,” so a passive approach, a laissez-­faire attitude, may contribute to her failure. Career-­oriented female students, to survive, must do it without much support from their environments (Betz, 1989). Discrimination can, thus, result from errors of omission as well as commission, and both have negative effects on females’ pro­gress and success in higher education. Leppel (2001) illustrates a phenomenon akin to the null environment using w ­ omen in nontraditional majors as an example; they may feel both more negative pressure and less positive emotional support from friends and f­ amily than w ­ omen in more traditional majors. In many cases, ­these students then change to traditional majors. It is not enough to avoid discriminating; positive support must be provided to counteract other negative environmental influences. Thus, if we are not actively supporting and encouraging w ­ omen, we are, in effect, leaving them at the mercy of gender role and occupational ste­reo­types. Eccles (1987) stated it well: “Given the omnipresence of gender-­role prescriptions regarding appropriate female life choices, ­there is l­ittle basis for females to develop non-­traditional goals if their parents, peers, teachers, and counselors do not encourage them to consider t­hese options” (p. 164). Failure to support her may not be an error of commission, like overt discrimination or sexual harassment, but it is an error of omission ­because its ultimate effects are the same, which is limitations in a w ­ oman’s ability to fully develop and utilize her abilities and talents in educational and ­career pursuits. SUPPORTS TO ­WOMEN’S ­CAREER CHOICES Among the ­factors that have been found to facilitate ­women’s ­career achievements, including perceiving a broader array of c­ areer options, are a number of variables, which, by their absence, can serve as barriers. Just as unsupportive environments can serve as barriers, supportive environments can be very helpful. One of the most crucial areas of support is that from families, especially parents and older relatives, and this has been found true for w ­ omen of all racial/ethnic groups. Studies by Fisher and Padmawidjaja (1999), Pearson and Bieschke (2001), and Juntunen, et  al. (2001), among ­others, have found parental support and availability to be very impor­tant in the ­career aspirations and achievements of Mexican American, African American and Native American as well as white ­women. Kitano and Perkins (1996) noted that high achieving girls in Latino and Asian cultures are t­ hose with extra encouragement from their families. Other studies have found maternal employment, particularly in non-­ traditional c­ areer fields, is related to ­daughters’ higher c­ areer aspirations (e.g., Selkow, 1984). Gomez, et al. (2001) found that although Latina high achievers came from families where traditional gender roles ­were


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emphasized, most also had non-­traditional female role models; for example their m ­ others w ­ ere non-­traditionally employed or, if homemakers, held leadership roles in community organ­izations. On the other hand, Hackett, et al. (1989) and Weishaar, et al. (1981), among ­others, have reported that the presence of a supportive male f­amily member was impor­tant in girls’ pursuit of non-­traditional ­career fields. Many w ­ omen pursuing non-­ traditional ­career fields relied heavi­ly on male mentors (Betz, 2002) since no female mentors w ­ ere available in their environments. In addition to supportive f­ amily and mentors, much previous research has shown the importance of personality ­factors such as instrumentality, internal locus of control, high self-­esteem, and a feminist orientation in ­women’s ­career achievements (Betz & Fitzgerald, 1987; Fassinger, 1990). Instrumentality, one of the critical ­factors in Farmer’s (1997) study, refers to a constellation of traits which w ­ ere previously called “masculinity” but ­were seen eventually to reflect a collection of characteristics having to do with in­de­pen­dence, self-­sufficiency, and the feeling that one was in control of one’s life. It has also been described as “agency” and has much in common with self-­efficacy (Bandura, 1997). The possession of instrumental traits does not mean that one cannot also possess the most traditionally feminine traits of nurturance and sensitivity to o ­ thers. T ­ hese characteristics are now referred to as “expressiveness” or “communion.” Together, instrumentality and expressiveness form the “androgynous” personality style, which is thought to be desirable for both ­women and men. Thus, positive f­ actors related to support and mentoring from o ­ thers and a personality characterized by high self-­esteem and self-­efficacy and a sense of self-­sufficiency and instrumentality can help w ­ omen reach their c­ areer goals. ­WOMEN OF COLOR: CONTINUING DOUBLE JEOPARDY Before moving to a discussion of barriers to success in the workplace, explicit attention should be paid to the status and unique concerns of ­women of color. Although research on ­women of color is also mentioned where relevant throughout this chapter, a few more general f­ actors should be mentioned. (See the chapter called ­Women of Color, by Chisholm & Greene, in this volume.) The disadvantages facing ­women in the ­labor force are accentuated for ­women of color, who have often been described as facing the “double jeopardy” of both gender and race discrimination (Beale, 1970; Gomez et al., 2001). ­Women of color are employed at rates comparable to ­those of white ­women but earn less than do white ­women or minority men. Lesbians and physically disabled w ­ omen also earn less than heterosexual white w ­ omen (Yoder, 1999). With reference to specific groups, African American w ­ omen have achieved higher educational and occupational levels and have had more


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options than have African American men (DeVaney & Hughey, 2000), but African American w ­ omen have also often been found in menial jobs, such as maids and nannies at a rate exceeding that of white ­women and still make less money than do both white w ­ omen or African American men (DeVaney & Hughey, 2000). B ­ ecause they are the most likely group to be supporting a child or ­children alone, this can create special hardship (Bingham, Ward, and Butler, 2006). Latinos currently represent the largest minority group in the United States, with 32.8 million or 12.5 ­percent of the U.S. population in the 2000 census. The achievement of Latino men and w ­ omen both in terms of educational and occupational levels lags well b ­ ehind that of other U.S. minorities except for Native Americans (Arbona & Novy, 1991; Flores, et al., 2006). Mexican-­American ­women lag ­behind other ­women of Hispanic ethnicity in college completion rates (Flores, et al., 2006), and adult Latinas have higher unemployment rates and lower ­labor force participation rates in comparison to Latino males or white w ­ omen. They also lag ­behind Latino men who, on average, earned poorer grades in college. In understanding the c­ areer be­hav­ior of Latinas, Flores, et  al. (2006) urge the assessment of individual adherence to traditional Latino/a cultural values; although greater adherence may impair individual ­career development, counseling interventions must take an attitude of re­spect t­ oward the value systems of the culture if they are to be ultimately successful. Asian American ­women are somewhat more likely than other groups of ­women to be found in occupations emphasizing math or technology, but they are still predominately found in traditionally female fields and, like other groups of w ­ omen, earn less money than men (Ali, Lewis, & Sandil, 2006). Fi­nally, Native American w ­ omen, including Native Hawaiians, are almost absent from our lit­er­a­t ure (Bowman, 1998) and are the most occupationally disadvantaged and the most likely to be unemployed of any group of w ­ omen. McCloskey and Mintz (2006) have carefully reviewed issues which must be considered in aiding the c­ areer development of Native American ­women. Clearly, the ­career development needs of w ­ omen of color must receive more of our attention EXTERNAL BARRIERS TO EQUITY Discrimination The barrier of discrimination has long been discussed as crucial in ­ omen’s attempt to attain equity in the workplace (Fassinger, 2002a; Philw lips & Imhoff, 1997). Although outright gender discrimination is against the law, informal discrimination continues to exist (Fitzgerald & Harmon, 2001). For example, although ­women may be allowed to enter a male-­dominated workplace, it may be made clear to them, overtly or more subtly, that they are not welcome. Messages ranging from overt verbal harassment to simply being ignored and receiving no social support from


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colleagues can make a work environment very unpleasant, and less obvious forms of discrimination in pay, promotions, and perquisites of the job may exist as well (Fitzgerald & Harmon, 2001). The importance of promotions is related to the continuing existence of the “glass ceiling,” which refers to the very small number of ­women at top levels of management (Yoder, 1999). The glass ceiling refers to artificial barriers, based on attitudinal or orga­n izational bias, that prevent some groups of p ­ eople from advancing in an organ­ization. In 1995, the Department of ­Labor’s Federal Glass Ceiling Commission concluded that ­there still existed a corporate ceiling in that only 3–5 ­percent of se­n ior corporate leadership positions w ­ ere held by ­women, far fewer than their proportionate repre­sen­ta­t ion in the l­ abor force. The commission reported that, although the notion of a “glass ceiling” implies subtlety, the ceiling for ­women of color is by no means subtle and is better called a “concrete wall” (Federal Glass Ceiling Commission, 1995, pp. 68–69). Another barrier to ­women in non-­traditional ­careers is that of being a “token.” First described by Kanter (1977), tokens are ­people who in gender or race (or both) constitute less than 15 ­percent of their work group. Tokens experience stress, social isolation, heightened visibility, and accusations of role violations (“you d ­ on’t belong h ­ ere”). Research on w ­ omen of color who are double tokens, such as the African American w ­ omen fire fighters studied by Yoder and Aniakudo (1997) and the African American ­women police officers studied by Martin (1994), shows that ­these ­women faced insufficient instruction, co-­worker hostility, silence, overly close and punitive supervision, lack of support, and stereotyping, i.e., an unwavering message of exclusion and a hope that she would fail (Yoder & Aniakudo, 1997). ­These studies suggest that both race and gender are barriers to ­these w ­ omen’s satisfaction and success. As one African American firefighter put it “being a black female—it was like two t­ hings needed to be proven” (Yoder & Aniakudo, 1997, p. 336). Sexual Harassment Sexual harassment also continues to be a major prob­lem in the workplace, with serious consequences for both w ­ omen and organ­izations. Sexual harassment is described in detail by authors such as Fitzgerald (1993, 2003), Koss, et al. (1994), Mackinnon and Siegel (2003), and Norton (2002). Research now distinguishes two categories of sexual harassment: “quid pro quo” harassment and “hostile environment” harassment. Quid pro quo harassment refers to situations in which an employee is asked to give in to a supervisor’s sexual demands in exchange for pay, a promotion, or continued employment, with the implied threat of loss of raise or promotion, or loss of employment, if the employee refuses to comply. Hostile environment harassment refers to instances where the employee is subject to sexual innuendo, sexist or sexually oriented comments, physical


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touching, or sexually oriented posters or cartoons placed in the work area. The issue ­here is making ­women workers “sex objects” at work. ­Women are t­ here to make a living and advance their ­careers, and sexual harassment can seriously interfere with t­ hose aims. Although sexual harassment is not limited to men harassing ­women—​ ­can harass men, and same-­sex harassment can also occur—­the majority (90 ­percent) of complaints involve men harassing ­women. On the basis of large scale surveys of working w ­ omen, Fitzgerald (1993) estimated that one of e­ very two w ­ ill be harassed during their work lives. Gutek (1985) reported even greater likelihoods of harassment for Hispanic and African American w ­ omen. Although responses to sexual harassment are beyond the scope of this chapter, suffice it to say that this is a major barrier to ­women’s equity in the workplace. Research has shown decreases in job satisfaction and orga­nizational commitment, job withdrawal, increased symptoms of anxiety and depression, and higher levels of stress-­related illness as responses to sexual harassment (Norton, 2002). Clearly ­these are ­mental health as well as economic issues and can seriously compromise job per­for­mance and job satisfaction. Multiple Roles Another of the per­sis­tent conditions affecting ­women’s equity in the workplace, and their job satisfaction, is that although their work force participation has increased dramatically, their work at home has not decreased. Although multiple roles are in general positive for ­mental health, the picture becomes more complex when w ­ omen are expected to shoulder the major burden of homemaking and childcare. As stated by Barnett and Hyde (2001), “­there are upper limits to the benefits of multiple roles” (p. 789) when the number of roles becomes too ­great or the demands of one role become excessive; this would seem to apply to the case where the ­woman is now expected to cope with two full-­time jobs, one outside and the other inside the home. Instead of “having it all” ­women are “­doing it all” (Fitzgerald & Harmon, 2001, p. 215). Research suggests that few men view parenting and homemaking as their responsibility; they are primarily available to “help out” (Farmer, 1997). Yoder (1999) summarized data showing that on average w ­ omen in married c­ ouples do 33 hours of ­house­hold chores weekly, compared to 14 for their husbands. This constitutes 70 ­percent of the workload for w ­ omen and 30  ­percent for men, not including childcare. With childcare, t­hese ­women are working a full-­time job at home, in addition to what they are ­doing at work. T ­ hese figures describe African American and Latina/ Latino ­couples as well. Supreme Court Justice Ruth Bader Ginsburg noted that t­ here could be no equity in the workplace u ­ ntil men assume equal sharing of homemaking and parenting roles (Farmer, 1997). A related prob­lem is the lack of orga­nizational structures and support systems for employees with families. Subsidized child or elder care, paid


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f­amily leave, flextime, job sharing, and telecommuting can greatly ease the burdens of managing home, f­amily, and c­areers, burdens carried mostly by w ­ omen (Fitzgerald & Harmon, 2001). The United States is still the only developed country in the world without a national child care policy nor a systematic means of addressing the serious prob­lems of elder care (Fitzgerald & Harmon, 2001). SUPPORTS TO ­CAREER ACHIEVEMENT AND SATISFACTION A useful framework for considering supports to ­women’s c­ areer development has come from Fassinger’s (2002b) series of studies on diverse groups of eminent ­women. Using qualitative methodologies and modified grounded theory (Strauss & Corbin, 1998), they have studied eminent African American and Caucasian w ­ omen (Richie, et al., 1997), Asian American w ­ omen (Prosser, et  al., 1998), lesbians (Hollings­worth, et  al., 1997), Latinas (Gomez, Fassinger, et al., 2001), and w ­ omen with physical and sensory disabilities (Noonan, et al., 2004). They summarize findings of the supports that enabled ­these w ­ omen to persist and succeed in spite of extensive experience with oppression with the words “Per­sis­tence, Connection, and Passion” (1997, p. 133). T ­ hese might also be viewed as strengths of w ­ omen which carry them through or enable them to surmount the barriers they confront. “Per­sis­tence” is critical to succeeding in the face of obstacles, and strong self-­efficacy expectations for one’s ­career, self-­esteem, and a strong sense of purpose are essential to per­sis­tence. The characteristics of instrumentality discussed previously—­the sense of being in control of one’s own life and destiny, of being agentic, able to act on one’s own behalf—­are also impor­tant to per­sis­tence. Related to both self-­efficacy and instrumentality is “coping efficacy,” which plays an increasingly impor­tant role in the social cognitive ­career theory of Lent, et al. (1994; 2000). As stated “when confronted with adverse contextual conditions, persons with a strong sense of coping efficacy (beliefs regarding one’s capabilities to negotiate par­tic­u­lar environmental obstacles) may be more likely to persevere ­toward their goals . . . .” (Lent, et al., 2000, p. 76). Gomez, et al. (2001) found coping strategies especially impor­tant to their highly achieving Latinas, as did Richie, et  al. (1997) with highly achieving African Americans and white ­women. Gomez, et al. (2001) list “tenacity and per­sis­tence; flexibility; creativity; reframing and redefining challenges, barriers, or m ­ istakes; maintaining a balanced perspective in understanding how racism and sexism may affect career-­ related be­hav­iors; developing support networks congruent with personal style, values, and culture; and developing bicultural skills where applicable” (p. 298). “Connection” refers to the essential part played by familial and peer/ friend support in facilitating per­sis­tence in one’s goals. ­There is ample lit­ er­a­ture documenting the importance of ­family, including spouse and


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c­ hildren, friends both at work and outside of work, and mentors. This importance has been shown for ­women of color as well as for white ­women. As a few examples, Gilbert (1994) and Gomez, et al. (2001) discussed the crucial role of a supportive spouse in managing both ­career and home and ­family responsibilities. Gomez, et al. (2001) reported that supportive families ­were crucial in maintaining ­women’s c­ areer commitment ­after the birth of c­ hildren. Richie, et al. (1997) emphasized the importance of interconnectedness with ­others in the continuing high achievement of both African American and white w ­ omen. Connection may also be facilitated by a feminist orientation, which gives w ­ oman a sense of community beyond herself. Feminist orientation has consistently been shown to be a facilitative f­ actor in ­women’s c­ areer achievements (Fassinger, 1990). Fi­nally, “passion” is for some ­women loving what they do, and for ­others feeling that they had made a difference in the world (Gomez, et al., 2001). For some w ­ omen, this is the sense of a life’s “calling.” Although not all ­people, ­women or men, are lucky enough to have such a passion in their work, helping ­people find ­careers about which they can feel passionate should be one of the goals of the psychologist. IMPLICATIONS FOR INTERVENTIONS The preceding sections of this chapter have emphasized the importance to w ­ omen of successful c­ areer development as well as success in their personal relationships, yet have also outlined ways in which w ­ omen continue to lag b ­ ehind men in both the variety of c­ areer options they consider and the subsequent success in t­ hese pursuits. Psychologists and educators may be able to help w ­ omen to close ­these gaps. In general, suggestions for interventions can be divided into ­those facilitating the ­career choice pro­cess and t­ hose enabling the ­career adjustment pro­cess. Counseling for C ­ areer Choice ­Because a sexist society and stereotypic socialization have often “stood in the way” of ­women’s pursuit of a full range of ­career options, research supports overt attempts to restore options that society has taken away. In other words, psychologists need to remain aware of the pos­si­ble impact of sexism and stereotyping in concert with null environments and to accept the role of active options restorers. The following guidelines for assisting ­women in the pro­cess of making educational and c­ areer decisions are derived from the lit­er­a­ture reviewed in the first part of this chapter. They can be used by psychologists, counselors, educators, parents, and ­those in positions where they can influence public policy. 1. Encourage high quality and extensive education and training. Do not overlook the importance of technical schools, 2-­year and community colleges, and the military for excellent training and education.


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2. Adopt the rule that one cannot take too much math. Encourage young ­women to stay in math coursework as long as pos­si­ble. Math background opens options and prevents o ­ thers from being eliminated by default. 3. When in doubt, stress decisions which eliminate the fewest options, such as staying in school and continuing in math. 4. Serve as a catalyst for the creation of new learning experiences for ­women, so that she can fully develop all her capabilities, including ­those not reinforced by traditional gender stereotyping. 5. Explore a w ­ oman’s outcome expectations and barriers to her goal pursuits, with the idea of helping her to develop coping mechanisms, coping self-­ efficacy, and barrier-­surmounting sources of social support. 6. Remember that all it takes is one supportive psychologist, counselor, teacher, or parent to enrich the null environment. 7. Assess the role of culture and ethnicity in the client’s ­career planning. Help her to make decisions, which, as far as pos­si­ble, integrate her individual and cultural values. 8. Integrate facilitative psychological and ­career theories as appropriate in counseling and educational practice.

Using Theories to Guide Practice Several major theories of ­career development have relevance to the c­ areer choice pro­cess of ­women. The first of ­these is social cognitive theory, based originally on the theory of Albert Bandura (1997). This theory supports the idea of continuing growth through one’s lifetime as a result of new learning experiences and new ideas. Below are more detailed suggestions for the uses of social cognitive and trait-­factor theories in ­career choice counseling with ­women. Social Cognitive Theory It is impor­tant to informally or formally assess a ­woman’s self-­efficacy beliefs for c­ areer fields. Informal assessment may include general questions regarding her beliefs in her competence in domains relevant to her career decision making, per­ ­ for­ mance, or advancement. For a young ­woman, use questions like: “What would you ideally like to do for a ­career?” “What is holding you back from you ideal?” “What ­career fantasies have you had and what keeps you from pursuing them?” “What ­careers would you pursue if you thought you could do ANYTHING!” The purpose of t­hese questions is to identify self-­imposed limits on what she can do. It may be that ­these are realistic limits if the girl or ­woman does not have the aptitude for that area, but the real contribution of self-­efficacy is that it focuses our attention on p ­ eople who are unrealistically underestimating their capabilities. The evidence is clear that ­women are particularly prone to underestimate their capabilities and must


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accordingly have t­ hese beliefs challenged. Further probing when a young ­woman reports herself unable to master a specific domain of be­hav­ior should focus on the quality of her background experiences; if she dropped out of math in 10th grade ­because “math was for boys,” then it is no won­ der she lacks confidence and competence in math. Low self-­efficacy for ­career tasks and fields, ­because it leads to avoidance, can become a self-­fulfilling prophecy; we avoid what we fear so we ­don’t learn it and never become good at it, verifying our perceptions of ourselves as incompetent. Someone, perhaps a psychologist, needs to help her break this vicious circle. The psychologist should refuse to accept “I ­can’t” for an answer ­unless and ­until the client has made a serious attempt to learn it, to master it. In addition to the informal assessment of self-­efficacy, ­there is now many inventories assessing self-­efficacy with re­spect to ­career be­hav­iors. Mea­sures of ­career decision self-­efficacy, math self-­efficacy, ­career search self-­efficacy (Solberg et al. 1994), self-­efficacy for the Holland themes, and self-­efficacy with re­spect to the 28 basic domains of vocational activity, such as Leadership, Writing, Science, Public Speaking, and Using Technology (the ­Career Confidence Inventory; Borgen & Betz, 2007) are available. Self-­efficacy mea­sures may also be used jointly with parallel vocational interest mea­sures (Betz & Rottinghaus, 2006; Betz & Wolfe, 2005;). For example, the General Occupational Themes of the Strong Interest Inventory mea­sur­i ng the resemblance of the client to each of Holland’s six personality types now have parallel self-­efficacy mea­sures for the six types in the Skills Confidence Inventory (Betz & Rottinghaus, 2006). Using ­these two mea­sures jointly, we look for themes on which the client has both high interests and high self-­efficacy; ­these themes represent good possibilities for ­career exploration. However, areas of high interest but lower efficacy can be options if efficacy can be increased through interventions based on Bandura’s (1997) theory. Self-­efficacy interventions are based on Bandura’s four sources of efficacy information and should, therefore, ideally include per­for­mance accomplishments, vicarious learning or modeling, managing anxiety, and providing support and encouragement. In planning for successful per­for­mance accomplishments, opportunities should be sought where success is at first virtually ensured, and only ­after some success experiences (allowing a moderate degree of self-­ efficacy to be established) should more difficult challenges be faced. Community or technical colleges offering entry level or remedial courses, adult education programs, and programmed learning materials may be good sources for such learning. In using modeling, the counselor would need to locate p ­ eople who have succeeded in the area in which the client lacks self-­efficacy. It is helpful, though not essential, if ­these models are the same race and gender of the individual, and this may be especially true if the domain of be­hav­ior is


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non-­traditional for that person’s gender. For example, a w ­ oman teaching automobile maintenance and repair or carpentry to other w ­ omen ­will provide helpful modeling influences ­because ­these are traditionally male domains. Similarly, a man teaching parenting to young men would provide the additional benefit of modeling a nontraditional competency. Models can be in person, on film, tele­vi­sion, books, or via other media. For example, a book on the life of a female astronaut or scientist could provide useful modeling for a young girl considering ­these fields. Another component of an efficacy-­enhancing intervention is anxiety management. Learning new ­things may be associated with anxiety, par­ tic­u­lar if t­ hese are gender non-­traditional domains. If a domain like math has been associated with males, and if a w ­ oman has internalized a message of “girls ­can’t do math,” anxiety ­will likely accompany new learning efforts. Thus, teaching anxiety management techniques may also be appropriate. Relaxation training and learning to consciously focus self-­ talk on the task at hand rather than on the self can be helpful. Fi­nally, the psychologist or educator can serve as the w ­ oman’s “cheerleader” as she tries new ­things. This role includes generally encouraging her that she CAN do it, and, more specifically, reinforcing her efforts as she tries new t­hings. Helping her set goals, reinforcing her when she achieves them, and helping her to try again when she has temporarily faltered are impor­tant. Fi­nally, the psychologist can ­counter beliefs (such as “girls c­ an’t do math”) that are getting in her way. In addition to assessing self-­efficacy expectations, outcome expectations should also be assessed. This is especially true for w ­ omen of color, who may expect more barriers to their success than do white ­women. Similarly, ­women wishing to pursue traditionally male-­dominated occupations may have concerns about the extent to which their efforts ­will lead to desired rewards and outcomes. Although t­ hese concerns may be realistic, helping the ­woman to consider coping strategies and learn about typical or­gan­i­za­tion­al/institutional grievance procedures may be helpful. Assertiveness training, learning to seek social support, and externalizing rather than internalizing the c­ auses of discrimination and harassment may be useful. Using the Matching (Trait-Factor) Model Trait-­factor theories suggest that we should help young ­women to fully develop their abilities, talents, and interests. Structured methods of ability and interest assessment have always been a useful part of the assessment of ­these individuals, but ­there are a few additional considerations as well. First, where pos­si­ble, use within gender norms to highlight directions in which a female client has developed in spite of gender-role socialization.


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Many aptitude and interest mea­sures now provide same-­sex norms (usually within-­gender percentiles). For example, the Armed Ser­vices Vocational Aptitude Battery (ASVAB) and Differential Aptitude Test (DAT), two of the most widely used multiple aptitude batteries in ­career counseling with high school students, provide within-­gender percentiles as well as combined group standard scores (see Walsh & Betz, 2001) Most vocational interest inventories, for example, the Strong Interest Inventory, also now provide within-­gender norms. As with self-­efficacy expectations, we should see the w ­ oman as “a work in pro­gress,” not a finished product. New learning experiences and opportunities can “open the doors” in terms of capabilities and interests, and counselors should always ask questions enabling them to assess the relative richness versus poverty of a ­woman’s previous educational and experiential background. If she has not had a chance to learn it, then assume she can learn to do it, help her find new learning opportunities, and help convince her that she can do it. ­Career Education and Expanding Options Farmer (1997) noted the crucial importance of ­career education in the schools. Lack of guidance about how to prepare for higher education and occupations and how to choose a ­career in the first place characterize many of our schools. Farmer made suggestions for c­ areer education that can increase sex equity. For example, girls might be introduced to a wider range of ­careers and urged to gain information on ­those in science and engineering. The National Science Foundation funds Proj­ ect WISE (Brookhaven National Laboratory, Upton, New York), which supports programs that involve high school w ­ omen in science activities. The Proj­ect produces a booklet called The ­Future is Yours—­Get Ready that describes 250 dif­fer­ent occupations in the sciences and engineering (c.f., Farmer, 1997). The Girl Scouts of Amer­i­ca sponsors a program called Bridging the Gap, designed to help girls become involved in science and engineering (cf., Farmer, 1997). Many colleges and universities now have programs to assist ­women enrolled in colleges of engineering (Fassinger & Asay, 2006). Kerr (1997) developed programs to encourage and support mathematically and scientifically talented ­women at Arizona State University and have made extensive and widely applicable resources available. Psychologists should be aware of ­these resources and encourage talented girls and ­women to study them. Counseling for C ­ areer Achievement and Satisfaction For employed ­women, concerns usually fall in the areas of success/per­ for­mance and satisfaction. As was indicated previously, discrimination,


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sexual harassment, tokenism, and lack of support represent a few barriers to ­women’s ­career success and satisfaction. Additionally, the overload that may be experienced from two, rather than one, full-­time jobs for ­women taking full responsibility for ­family and ­house­work can be a major cause of decrements in both per­for­mance and satisfaction. A few general guidelines may be useful: 1. Help ­women at work develop support systems. 2. Help change the system, or help young ­women and men change the system, as it pertains to flexible work schedules and f­amily leave policies (ideally which allow leave for adoption as well as childbearing and for elder care, and which assume that men are as willing to be responsible for ­those they love as are ­women). 3. Help token w ­ omen (especially w ­ omen of color) find support, often by broadening the net which is cast to find support. For example, the lone w ­ oman faculty member in chemistry may find support in a group consisting of all the faculty ­women in the College of Sciences. 4. Teach w ­ omen to expect full participation in homemaking and child-­ rearing from their husbands or partners. Teach men that it is their responsibility, and to their benefit, to participate fully in home and f­ amily life and work. 5. Help ­women develop effective cognitive and behavioral coping strategies, as discussed earlier in the section on supports for ­career achievement and satisfaction.

For an adult ­woman considering c­ areer change or advancement, we should help her to explore areas of be­hav­ior where she feels her skills are holding her back or preventing her from pursuing desired options. In many fields, technical expertise is necessary but not sufficient to the pursuit of managerial or supervisory roles in t­hose areas—we know that ­women lack seriously in technical training and that that limits their advancement possibilities (American Association of University ­Women, 2002; U.S. Department of Education, 2000). If she wishes to make such a move, her self-­efficacy beliefs regarding her managerial/leadership skills may be highly relevant to her perceived options. Another assessment question might be “What new skills would increase your options or satisfaction and what is stopping you from developing t­hese new skills?” In many cases, the counselor w ­ ill hear perceived self-­efficacy—­self-­doubts about competence and ability to move in a new direction—­and should be prepared to help a w ­ oman with such self-­doubts to appraise accurately the competencies and abilities she feels she is lacking. ­There also may be cases where a w ­ oman is in an occupation with poor fit for her abilities or interests. In such cases, “­going back to the beginning,” i.e., ­doing a comprehensive assessment of her abilities, interests, values, and self-­perceptions may be the best place to start.


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Orga­nizational and Structural Change We, in psy­chol­ogy and counseling, also have a responsibility to work for orga­nizational, l­ egal, and societal changes that ­will reduce sexism, stereotyping, discrimination, and harassment and create more flexible and “family-­ friendly” workplaces (Meara, 1997). In focusing on w ­ omen’s ­career development and what is needed in order to facilitate it, Harmon (1997) also noted that we may have short-­changed the other side of the coin, that is, how to facilitate men’s development in homemaking and child-­rearing roles. For example, as we counselors provide support for ­women’s working and help them gain self-­efficacy for non-­traditional ­careers, we should also support men’s pursuits of nurturing roles and help them gain self-­efficacy with re­spect to nurturing and multiple role management. Gilbert (1994) and Harmon (1997) both suggest that it is time to develop theories that conceptualize c­areer development and ­family life in a more interactive way. Such theory development would hopefully increase the satisfaction and well-­being of both ­women and men in multiple life roles. SUMMARY In summary, although w ­ omen have made significant pro­gress in their attempts to fulfill their talents and interests and to achieve equity and satisfaction in their work, t­here remain many barriers and inequities that continue to demand our attention. T ­ hese barriers and inequities can be addressed at many levels: the individual, in institutions such as school and colleges, in business and military organ­izations, and through l­egal, po­liti­cal and societal change. As well, continuing research and study designed to examine the dynamics of choice, success and satisfaction and the mechanisms of positive change is needed. REFERENCES Ali, S. R., Lewis, S. Z., & Sandal, R. (2006). C ­ areer counseling for Asian w ­ omen. In W. B. Walsh and M. J. Heppner (Eds.), Handbook of c­ areer counseling with ­women (2nd ed., pp. 241–270). Mahwah, NJ: Lawrence Erlbaum. American Association of University W ­ omen. (1992). The AAUW Report: How schools shortchange girls. Washington, DC: Author. American Association of University ­Women. (1999). Gender gaps: Where schools still fail our c­ hildren. New York: Marlowe and Com­pany. American Association of University ­Women. (2002). Title IX at 30: Report card on gender equity. Washington, DC: Author. Arbona, C., & Novy, D. M. (1991). ­Career aspirations and the expectations of black, Mexican American, and White students. ­Career Development Quarterly, 39, 231–239. Arnold, K. D. (1995), Lives of promise: What becomes of high school valedictorians. San Francisco, CA: Jossey Bass.


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PART III

Vio­lence Against ­Women


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Chapter 11

Complex Ramifications of Incestuous Abuse on Adult Survivors: A Discussion for Helping Professionals Felicia L. Mirghassemi, Paula K. Lundberg-­Love, Gavin D. Sanders, and John A. Gallien

INTRODUCTION Throughout history evidence of incest has been recorded across cultures, religions, and class systems. However, this topic has been pushed into the shadows and labeled as taboo to preserve a false sense of stability within communities across the globe (Lieberman, et al., 2011; DeMause, 1991). Early research in the United States regarding incest began circa 1929 (Atwood, 2007). Unfortunately, ­little credibility was given to a child’s outcry of incest. Only recently have social scientists attempted to heighten awareness regarding the prevalence of incest in order to create effective treatment strategies and develop prevention programs for ­future generations (Myers, et al., 2008; Atwood, 2007). The purpose of this article is to increase awareness of incest by outlining the prevalence, risk ­factors, potential ­mental health consequences, effective treatment strategies, and prevention techniques to end the cycle of sexual abuse within families across the globe. Incest, defined by the Rape, Abuse, and Incest National Network (RAINN, 2009), refers to any form of sexual contact between ­family members. Unfortunately, specified ­legal definitions and repercussions for perpetrators vary by state. State-­to-­state differences in the ­legal definitions of incest create loopholes for perpetrators that often result in penalty reductions (Coleman, 1984). For example, all but five states in the United States


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limit the prosecution of criminal incest to sexual intercourse only. According to Coleman’s Law Review (Coleman, 1984), the variety of l­egal definitions often do not encompass the entirety of familial sexual abuse and its detrimental impact on the child. Furthermore, many incest laws do not apply to parent-­child sexual contact u ­ nless penetration occurs. Some states even specify that incest can occur only between biological relatives (Coleman, 1984). Since researchers have reported that the risk of stepfather incest may be 15 times higher than that of biological father incest (Sariola & Uutela, 1996), such laws can preclude l­ egal intervention. Treatment providers have written about specific psychological dynamics of incest that are critical to the definition in order to comprehend the entirety of the trauma. Vanderbilt (1992) suggests that the betrayal of trust is a necessary component to the overall definition of incest in order to comprehensively depict the vulnerability and hopelessness experienced by survivors of incest. Lindblom and Gray (2010) argue that specific trauma, such as incest, should be categorized through the act of trust betrayal that occurs between individuals in a close relationship, (i.e., child and caretaker. Controversy between the ­legal and psychological definitions of incest is apparent (O’Donoghue & Benuto, 2012). Further collaborative research between ­legal experts and treatment prac­ti­tion­ers is required to promote the effective prosecution of perpetrators and the protection of survivors of incest. For the purposes of this chapter, incest refers to coerced, non-­consenting sexual acts, which include penetration (e.g., oral, genital, and/or anal) and non-­penetration (e.g., sexualized kissing, hugging, disguised touching, verbal sexual invitations, pornographic viewing, and/or exposure to inappropriate sexual activity) initiated by anyone in a familial role (through blood or marriage) without the consent or the ability to consent (in the case of a child) of another (Atwood, 2007; Beard, et al., 2013; Finkelhor, 1979; Stroebel, et al., 2013). PREVALENCE In order to understand the complexity of the estimations of the prevalence of incest, we must understand the f­ actors that contribute to statistical underestimations. One of the greatest barriers to the determination of the accurate estimates of the prevalence of incest is the severity of backlash that occurs as a result of an outcry of abuse (Dawes, 2005; Paine & Hanson, 2002). Dawes (2005) discusses the damaging bias that heavi­ly weighs false accusations, rather than false denials, as an excuse to ignore the prevalence of child sexual abuse, including incest. Paine and Hanson (2002) further discuss the overall ­factors that influence self-­disclosure of child sexual abuse and briefly outline the unique aspect of incest self-­ disclosure. In addition to the diffusion of responsibility and shame placed on survivors of incest by their perpetrators, the proximity and power dynamic of the perpetrator’s presence in the child’s home can prevent any


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legitimate action from being taken to protect the child. In a questionnaire of adult incest survivors, researchers discovered that nearly 52 ­percent of survivors continued to face sexual abuse for at least a year despite disclosing incest to another parent (Roesler & Wind, 1994). The secret keeping of such abuse by another parent leads to learned helplessness and betrayal of trust, which destroys the child’s belief that reporting ­will lead to ­legal or therapeutic intervention (Paine & Hanson, 2002; Ballantine, 2012; Dawes, 2005). Fi­nally, traumatic amnesia has been a controversial topic of debate surrounding the accuracy of traumatic memories and the conviction of perpetrators (Dawes, 2005; Lindblom & Gray, 2010; Erdmann, et al., 2004). The difficulty of obtaining evidence of child sexual assault when the perpetrator is living with, and is the child’s caretaker, creates a burden of proof that limits court convictions. With the evidence surrounding underestimations of incest clearly detailed in the previous paragraph, current statistics from the 2012 National Incident-­Based Reporting System, released by the Federal Bureau of Investigation, indicated that of non-­forcible sex offenses, the prevalence rate of incest was 16.9 ­percent. It is impor­tant to note that incest is not, in fact, non-­forcible, as the FBI statistics categorize it. This incorrect categorization further underscores the disconnect between ­legal and psychological definitions surrounding incest. RAINN (2009) reported that 93 ­percent of juvenile sexual assault victims knew their attacker, and 34.2 ­percent of attackers ­were ­family members. The data indicated that 80 percent of perpetrators ­were parents (U.S. Department of Health and H ­ uman Ser­vices, 2012). Research surrounding transgenerational models of abuse revealed that female survivors of incest rarely become parental perpetrators; however, male survivors of incest had an increased likelihood of becoming perpetrators (Glasser, et  al., 2001). Researchers surveyed thousands of 9th-­grade females while they w ­ ere at their schools to determine the differences between the prevalence of incest perpetrated by biological ­fathers and stepfathers (Sariola & Uutela, 1996). Only 0.2  ­percent of females reported father-­daughter incest while a mere 0.3 ­percent of the participants indicated that they ­were victims of stepfather incest. The research population included adolescent females who w ­ ere asked ­whether incest was occurring presently in the home. Thus, t­ here w ­ ere potentially significant limitations to disclosing such abuse. Researchers suggested that false deniability was a real possibility given that the adolescent females surveyed would inevitably return home from school to the perpetrators. Stroebel, et al., have discussed the serious limitations surrounding pres­ ent prevalence research (Stroebel, et  al., 2013). Authors of the pres­ent chapter ­will discuss the ramifications and fears surrounding disclosure of incest in l­ater sections. Russell (1983) conducted the first ever randomized epidemiological study of 930 adult ­women in San Francisco to determine the prevalence of sexual abuse in w ­ omen. It was the first study of its kind. The prevalence of incest was found to be 19 ­percent. The data


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indicated that 40 ­percent of incest cases occurred within the nuclear ­family. Of the 74 cases of nuclear f­ amily incest, 42 w ­ omen reported incestuous relationships with their f­ather prior to 18 years of age. The epidemiological breakdown of fatherly relationships included biological ­fathers (27 reported cases), stepfathers (14 reported cases), foster f­ ather (1 reported case), and ­father by adoption (1 reported cases). ­These statistics revealed that 4.5 ­percent of the randomized sample reported sexual abuse by a ­father figure. It is impor­tant to note that researchers continue to disagree on ­whether biological ­fathers or stepfathers are more likely to be perpetrators (Russell, 1983; Sariola & Uutela, 1996). Other familial incest perpetrators include u ­ ncles. Russell (1983) found the prevalence rates of incest committed by ­u ncles (4.9  ­percent) w ­ ere slightly higher than ­those committed by ­fathers (4.5 ­percent). However, most researchers continue to report that father-­daughter incest is the most common form of incestuous relationship (Atwood, 2007; Finkelhor, 1984). Evidence regarding male survivors of incest suggests that its prevalence is less, but it is unclear ­whether this reflects a truly smaller prevalence rate of incest or ­whether ­these crimes are underreported to an even greater degree than ­those of female victims (Atwood, 2007). Research has, so far, indicated that approximately 90  ­percent of incest offenders are males assaulting females (Russell, 1986; Atwood, 2007). However, Vanderbilt (1992) brings up a valid possibility that social stigmatization surrounding male survivors of intrafamilial sexual abuse could be a significant ­factor in the underreporting of this crime. Indeed, to date, no epidemiological studies of the sexual abuse of males have been conducted. Previous research on the topic of sibling incest strongly downplayed its gravity. In fact, Russell (1983) found that only 2 ­percent of respondents reported ­brother incest and 3 ­percent of respondents reported male first cousins as perpetrators. Ballantine (2012) discusses the historical dismissal of child-­to-­child incest as developmental play. However, the psychological consequences of sibling incest that emerge during adulthood can be complicated such that they require special attention (Ballantine, 2012). It has been suggested that sibling incest is five times more common than parent-­child incest; however, it is the least likely form of incest to be reported or addressed (Ballantine, 2012). Moreover, it appears that extreme forms of ­family belief systems underlie such incidents. Large overly sexualized or overly puritanical f­ amily systems appear to develop unhealthy sibling relationships. Cases of sibling incest have often involved el­derly siblings forming deep attachments with younger siblings who yearn for the affection they do not receive from parental figures (Ballantine, 2012; Tidefors, et al., 2010). The demographic populations for families at greater risk of incest are difficult to discern due to the overall taboo nature of the topic (Lieberman, et al., 2011). However, Perry (2004) reported that, between the years of 1992 and 2001, Native Americans w ­ ere twice as likely to experience sexual


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assault when compared to other races. In fact, 25 ­percent of the reported cases involved ­family member offenders, which is 9 ­percent greater than the national average (U.S. Bureau of Justice Statistics, 2012). Furthermore, researchers Kenny and McEachern (2000) published an extensive review of the cultural differentiations of incestuous incidents among African American, Hispanic, Asian, and Asian American populations. The data suggested that Caucasian and African American females w ­ ere equally likely to be victims of incest (Wyatt, 1985). Interestingly, profiles of perpetrators differed significantly between the two racial groups. For Caucasian ­women, their biological ­fathers ­were more likely to be perpetrators while African American ­women ­were more likely to be incestuously abused by their ­u ncles or their m ­ other’s boyfriend (Pierce & Pierce, 1984; Kenny & McEachearn, 2000). Further analy­sis of data regarding the prevalence of incest in Hispanic ­women revealed discrepancies among perpetrator profiles. Huston, et al. (1995) reported that Mexican American ­daughters ­were more likely to be abused by an extended f­ amily member as opposed to a member of the nuclear ­family. Shaw, et al. (2001) reported data that differed from that of Huston (1995). They categorized their demographic as Hispanic without specifying the countries of origin of the participants. Their results indicated that, in a Hispanic f­amily, the perpetrator was more likely to be a ­father or stepfather. In Asian families, biological ­fathers ­were found to be the most likely perpetrators to incestuously abuse their ­daughters (Rao, et al., 1992; Kenny & McEachearn, 2000). Limited research exists regarding the prevalence of incest amongst families of ­Middle Eastern descent. Baker and Dwairy (2003) reported that approximately 40 ­percent of female c­ hildren and 20 ­percent of male c­ hildren are sexually abused by f­amily members or neighbors. However, the prevalence of incest among ­Middle Eastern families has not been reported, which may be due, in part, to the lack of disclosure and tendency for significant victim blaming that is used to protect the cultural traditions of honor and familial reputation (Baker & Dwairy, 2003). Overall, data regarding the prevalence of child sexual abuse are difficult to obtain. Hence, it is not surprising that information regarding the statistics for incestuous abuse is not necessarily accurate. Therefore, continued research to determine the prevalence of incest across vari­ous demographics is required to enhance advocacy, treatment, and prevention efforts for the protection of ­children. INTRAFAMILIAL PERPETRATOR PATTERNS AND GROOMING TECHNIQUES Typically, intimate relationships originate through a basic ­human need for affection and love. Incestuous relationships arise from a f­ amily member’s manipulation of ­these needs which results in an exploitive sexual relationship. Abusive incest occurs whenever a discrepancy in age, power, or experience exists regardless of arguments suggesting that desire or


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consent ­were acquired (Kluft, 2011). A study composed of 20 intensive interviews from incestuous f­athers found that an overly masculine gender identity, triggered by a sense of failure and loss of control, developed into a sense of entitlement and power dynamic directed ­toward the child (Wash & Knudson-­Martin, 1994). While each situation of intrafamilial incest is unique, patterns can be found in the perpetrator’s personality and the methods utilized to manipulate a child into silence. While some child sexual abusers have high levels of antisocial tendencies and/or unusual sexual interests (Seto, 2008), a meta-­analysis of vari­ ous studies revealed that perpetrators of intrafamilial child sexual abuse did not pres­ent with antisocial tendencies nor unusual sexual interests. Seto (2008) explains that, although offenders of intrafamilial child sexual abuse do not share trait f­actors with extrafamilial child sexual abuse offenders, they tend to victimize younger c­ hildren for longer periods of time. F ­ amily systems clinicians hypothesize that motivations under­lying offenses against c­ hildren by f­ athers or stepfathers stem from an authoritarian patriarchy in which the marital relationship has high levels of conflict and low levels of sexual intimacy. Seto (2008) discusses how the eldest ­daughter is often pushed into the surrogate role for the f­ amily unit. Eldest d ­ aughters often fill the marital surrogacy role through the development of an intimate and caregiver relationship. This hypothesis also postulates that ­mothers are often significantly dependent on the ­father and therefore, may not respond supportively to an outcry of abuse (Seto, 2008; Seto, et al., 2015). Researchers have only begun to unravel the grooming techniques of child sexual abuse perpetrators (National Center for Victims of Crime, 2012; Whittle, Hamilton-­Giachritsis, & Beech, 2015). Basic stages of grooming have been identified across child sexual abuse cases, including incest. In most cases of incest, offenders identify and target a victim based on familial vulnerability (The National Center for Victims of Crime, 2012). Furthermore, c­ hildren are engaged in the relationship by receiving special attention (“You are the only one that understands me”) or via significant violence/threats (Summit, 1983; The National Center for Victims of Crime, 2012). The attention (through coercion or vio­lence) escalates by telling ­children that they are playing “games” that need to be kept a secret. T ­ hese games often escalate from casual touching (e.g., holding hands, patting upper back) to inappropriate touching and eventually penetration. Following sexual contact, perpetrators often reinforce feelings of helplessness, powerlessness, and shame for the victim’s involvement in such activities (Summit, 1983; Whittle, et al., 2015). Perpetrators also echo the ­children’s fears that nobody w ­ ill believe them or that they w ­ ill be blamed if they attempt disclosure (Pettersen, 2013; Lundqvist, Hansson, & Svedin, 2004; The National Center for Victims of Crime, 2012). While limited research has specified the unique techniques utilized by intrafamilial sexual assault perpetrators, understanding the grooming techniques that a child


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might have encountered provides a greater scope of understanding for clinicians performing forensic interviews and therapeutic interventions. The psychological effects of grooming techniques on sexually victimized ­children have resulted in significant controversy in the area of criminal prosecution and testimony (Shiu, 2009). The increased detection of cases of child sexual assault and their prosecution has focused on the issue of false allegations. The Supreme Court case Pennsylvania v. Ritchie (1987)stated that, b ­ ecause the only witness of child sexual abuse is often the victim, it is one of the most difficult crimes to prosecute successfully ­because the child’s credible testimony in court is the most impor­tant piece of evidence for conviction (Shiu, 2009). However, the be­hav­ior of sexually traumatized ­children results in disagreement regarding how to assess their credibility, particularly when t­hese c­ hildren have recanted their statements 23.1 ­percent of the time during the forensic pro­cess (Malloy, Lyons, & Quas, 2007). In incest cases, ­factors such as parental involvement, perpetrator coercion, degree of familial support, and/or perceptions of blame can all be critical f­actors that influence a child’s willingness to uphold testimony in court. One of the first attempts to explain the dynamics under­lying the difficulty of ­children to testify in sexual abuse cases was described by Summit (1983). He called it the Child Sexual Abuse Accommodation Syndrome and suggested that the issues of secrecy, helplessness, accommodation, delayed disclosure, and retraction involved in cases of sexual abuse should be taken into account when assessing the credibility of testimony in ­children who have been sexually victimized (Shiu, 2009). O’Donoghue and Benuto (2012) lists 21 prob­lems that critics believe discredit this conceptualization including lack of operationalization of key dimensions, considerable overlap between the five stages, and lack of scientific evidence to name a few. Other researchers continue to support Summit’s explanation for a child’s retractions (Shiu, 2009). Further research is required to provide ­legal professionals and forensic interviewers with empirically supported tools and techniques to assess child testimony credibility when recantation of testimony has occurred. BEHAVIORAL EFFECTS OF REPORTING When sexual abuse is reported, all efforts should be made to cease contact between the suspected perpetrator and the child. Mandatory reporting laws of child abuse are in place for educators, nurses, doctors, counselors, and child care workers in all 50 states (Texas ­Family Code, Chapter 261). While efforts should be made to include the child in the decision to inform authorities, l­ egal and ethical boards dictate that suspected child abuse must be reported. Typically, child sexual abuse is reported to departments of Child Protective Ser­vices, and a detailed investigation surrounding the child’s safety ensues. As part of that investigation, a thorough forensic interview with the child is conducted.


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Forensic interviewers are trained in techniques regarding how to obtain information without tainting evidence. While jurors prefer detailed accounts of trauma to determine perpetrator guilt beyond a reasonable doubt, depth of detail does not equate to truthfulness (Zajac, et al., 2013). In fact, leading questions that attempt to extract detail by providing a variety of pos­si­ble scenarios have been found to taint the evidence (Erdmann, et al., 2004). Sixty-­seven 1st graders ­were interviewed suggestively four times regarding a true and false event. By the end of the pro­cess, only 19 ­percent of the ­children continued to believe the true event was, in fact, true by the end of the interviews. Interestingly, ­children added further specifying details to suggestive interviews to make sense of the story. It is impor­tant to consider the ramifications of suggestive interviewing for the sake of detailed accounts (Kluft, 2011). Child victims of incestuous abuse already face the difficulty of making sense of their traumatic event, so rather than expect detailed and vivid accounts of traumatic memories, interviewers and l­egal professionals should try to obtain witness testimony through f­ree recall to the greatest extent pos­si­ble for the most forensically defensible accounts of the crime (Zajac, et al., 2013). While the traumatic effects of sexual victimization within a ­family unit are detrimental to a child’s healthy development, Summit (1983) postulated that additional traumatic effects occur upon disclosure of incest to an authority figure. Since the grooming techniques used by perpetrators can instill deep feelings of shame, fear, and victim blaming, the responses of authority figures are critical in preventing continued traumatization of the child (O’Leary, Coohey, & Easton, 2010). Feiring, et al. (2002) examined the relationship between the childhood disclosure of severe sexual abuse and the m ­ ental health symptoms experienced during adulthood. Research revealed that, when disclosure was met with dismissive, disbelieving, non-­supportive, or hostile responses, the disclosure itself can result in the development of serious adult ­mental health symptoms (Feiring, et al., 2002). Thus, an adequate response of professionals to the disclosure of child sexual abuse is impor­tant for healthy adult functioning (Jonzon & Lindblad, 2005). While it has been found that a ­mother’s perceived support and engaged response to disclosure is a critical predictor for positive m ­ ental health outcomes (Luster & Small, 1997), p ­ eople should be careful not to blame m ­ others for their inability to detect signs of abuse in their c­ hildren (Jensen, 2005). Research regarding the coping strategies of ­children sexually abused by ­family members indicated that sexually abused c­ hildren displayed a greater fight or flight response than ­children who ­were physically abused (Katz & Barnetz, 2014). Although “fight” was the more dominant coping technique for sexually abused ­children, the severity of the abuse significantly altered behavioral responses such that ­children who experienced “under-­the-­clothes” touching or penetration by a f­ amily member displayed


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significantly greater self-­change be­hav­ior. Self-­change be­hav­iors are described as methods whereby c­hildren alter their typical behavioral responses to make sense of intrafamilial abuse to survive their given environment. Katz and Barnetz (2014) postulate that, when greater severity and force are used by a perpetrator living in the home, it becomes improbable for c­ hildren to utilize successfully fight or flight techniques to survive the abuse and, therefore, must alter their be­hav­ior in other ways. This research also provides some impor­tant insight regarding why c­ hildren may recant a truthful statement about incestuous abuse. Warning signs and behavioral changes observed in sexually abused ­children are critical components of prevention strategies of which non-­ offending f­amily members and p ­ eople in the community should be aware. Jensen (2005) has identified four major behavioral signs caretakers typically notice. 1. Bodily signs—­ enuresis, encopresis, stomach/headaches, and genital soreness 2. Affective signs—­fear, anxiety, sadness, acting out without immediate cause, bizarre be­hav­ior, refusal to visit alleged perpetrator and/or mood shifts, particularly in connection to being alone with suspected abuser 3. Sexual signs—­sexual experimentation with other c­ hildren, drawing sexual parts/acts, excessive masturbation, sexualized play with dolls 4. Verbal signs—­explicit self-­disclosure of abuse

While observation of one be­hav­ior listed is not evidence of child sexual assault, interpretations of be­hav­ior changes in conjunction with the above-­ mentioned signs should be investigated sensitively and thoroughly (Jensen, 2005; World Health Organ­ization, 2013). Regression in be­hav­ior, particularly when school per­for­mance and attainment of developmental milestones appear unusually slow, is one of the behavioral indicators identified by the World Health Organ­ization (2013). Other behavioral indicators include acute traumatic responses that could be described as clingy or irritable, sleep disturbances, eating disorders, school/social prob­lems, depression, poor self-­esteem, and/or inappropriate sexualized be­hav­ior (World Health Organ­ ization, 2013). Panic attacks ­ were reportedly 50 ­percent more likely amongst respondents of incestuous abuse as compared to respondents that had not reported such abuse (Renner, et  al., 2013). Hall and Hall (2011) reported that sexually abused girls are more likely to display symptoms of depression, anxiety, fear, and guilt. Furthermore, symptom development has been correlated with the duration and frequency of sexual abuse, the age of child at the time of abuse, and the severity of force (Trickett, et al., 2011). Incestuous traumatization also fosters the development of learned helplessness and as well as other psychological sequelae in adult survivors (Roth & Newman, 1992).


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THE LONG-­TERM CONSEQUENCES OF AND TREATMENT STRATEGIES FOR INCESTUOUS ABUSE Untreated childhood behavioral changes and symptoms can lead to significant m ­ ental health impairments for adult survivors of incestuous abuse. Individualized responses to such trauma contribute to significant psychological and emotional distress that can impair normal adult functioning. Certain aspects of incestuous trauma also have been found to increase the likelihood of the development of ­later psychiatric symptoms. Lundqvist, et al. (2004) reported a significant correlation between the age at which the trauma first occurred and the severity of psychiatric symptoms as mea­sured by the Symptom Checklist-90 (SCL-90). Substance Abuse A history of incestuous abuse has been found to double the risk of heavy substance abuse for female survivors (Snyder & Rubenstein, 2014). Furthermore, drug and alcohol abuse among adolescent victims of incest correlated with an increase in incest survivor self-­mutilation (Turell & Armsworth, 2000). Intervention strategies that seek to combat the influence of substance abuse as a means to escape the pain suffered from the effects of the abuse are necessary to prevent long-­term addictions. Rehabilitative treatment centers are available for adolescents that have developed a drug or alcohol abuse prob­lem. In fact, if treatment providers learn of incestuous abuse of minors, they are required to report such abuse to protect the minor. Adult survivors of incest that complete treatment in substance abuse rehabilitation programs should be further referred to more substantial trauma-­focused psychotherapy to ensure other psychological effects of trauma are assessed and treated. Anxiety and Depression Behavioral changes in ­children experiencing sexual abuse previously outlined (Jensen, 2005) can follow survivors into adulthood and become more complex if left untreated. In a comparative study of 35 female victims of incestuous abuse, the data suggested that anxiety was significantly higher and unique to this group of patients as compared to victims of other forms of child abuse (Carlson, 2011). In fact, the results of the study revealed that adult survivors of incest ­were more likely to believe that men cannot be trusted and that their lives would not ever be “normal”as a consequence of the trauma they experienced. Other reported symptoms included low self-­esteem, hostility, depression, and re-­victimization. Treatment strategies suggested for individuals faced with overwhelming anxiety, clinically significant depression and dysfunctional core beliefs due to childhood sexual abuse include Trauma-­ Focused Cognitive


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Behavioral Therapy (TF-­CBT) and group therapy (Morgan & Cummings, 1999). Cohen, et al. (2004) compiled evidence that supported TF-­CBT as a superior treatment for sexually abused ­children when compared to more nondirective techniques, such as play therapy. At a 6-­month follow-up, it was found that t­here w ­ ere significant reductions in anxiety, depression, sexual prob­lems, and dissociation. Twenty sessions of feminist-­based group therapy also ­were found to significantly improve symptoms of clinical depression with positive results of maintenance at follow-up (Morgan & Cummings, 1999). This type of group therapy utilized psychoeducational techniques to introduce common responses and symptoms of child sexual abuse. “Normalization” of responses to trauma was found to be beneficial for survivors of both intrafamilial and extrafamilial child sexual abuse. Depression, social maladjustment, self-­blame and post-­traumatic stress symptoms all ­were reduced significantly following completion of the 20-­session feminist-­based group therapy (Morgan & Cummings, 1999). Scant research exists that details the efficacy of Mindfulness Based CBT on anxiety in incest survivors. Prac­ti­tion­ers can speculate that mindfulness and stress reduction techniques can prove to be useful tools for providing healthy coping strategies for immediate symptom relief from anxiety and panic, but further research is needed to prove the efficacy of such treatment protocols for this population. Sexual Dysfunction in Adult Relationships Impaired psychosexual functioning is another predictable sequel to incestuous abuse (Easton, et al., 2011). Easton, et al., found that ­children who are sexually abused at an older age are more likely to feel fear and guilt during consensual sex during adulthood. Researcher’s postulate that older c­ hildren who experienced sexual abuse internalized feelings of shame and disgust associated with the sexual violations. Furthermore, negative responses to disclosure had a strong negative effect on psychosexual functioning. Researchers suggest that this occurs when the ­children’s outcry is met with minimization, shame, or disgust which further contributes to negative perceptions of their participation in sexual acts. One of the few studies in which ­women ­were randomly selected to participate revealed that adult ­women of child sexual abuse reported more prob­lems with sexual functioning than ­women who did not report child sexual abuse (Laumann, et al., 1994). While ­there is limited evidence specific to incest survivors, Easton, et  al. (2010) postulate that the psychological manipulation perpetrators use to enforce compliance and secrecy often work by shifting the blame and responsibility onto the child. The victim blaming that begins during childhood from the perpetrator is internalized by adult survivors and makes it difficult for intimate trust and sexual satisfaction to develop. When adult w ­ omen, who experienced child sexual abuse, are compared to ­women who did not, 59 ­percent reported


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sexual dysfunction due to emotional prob­lems (Laumann et al., 1994). Easton, et  al. (2010) defined emotional prob­lems related to sexual dysfunction as feelings of guilt or fear related to sex. Not surprisingly, adult survivors of child sexual abuse also report less relationship satisfaction (Davis, Petretic-­Jackson, & Ting, 2001). Vari­ous forms of psychotherapy can be used to treat and promote improved sexual functioning and healthy relationships. Individual psychotherapy that focuses on rebuilding safe support systems, developing feelings of trust, and reducing feelings of guilt and blame are impor­tant for the psychological well-­being of adult survivors. Efforts to assess and monitor clients’ relationship satisfaction and sexual functioning are impor­tant facets of psychological recovery that should not be overlooked in treatment. C ­ ouples counseling also can be utilized by adult survivors and their intimate partners to work together to identify the relationship prob­lems, create a resolution, change previously in­effec­t ive sexual intimacy patterns, and create positive sexual experiences (Maltz, 1988). M ­ ental health professionals have utilized incest resolution therapy, sex therapy, and ­couples therapy to promote healthy relationship satisfaction as a facet of psychological recovery for incest survivors. Post-­Traumatic Stress Disorder and Complex Trauma Post-­Traumatic Stress Disorder (PTSD) is diagnosed in individuals who have been exposed to a­ ctual or threatened death, serious injury, or sexual vio­lence if the traumatic event has occurred to the individuals directly and/or if individuals have witnessed the trauma, learned of the event occurring to a close ­family member/friend, or have experienced repeated exposure to aversive details of the trauma (American Psychiatric Association, 2013). The four symptom clusters as defined by the Diagnostic Statistical Manual of ­Mental Disorders, Fifth Edition, (DSM-5) include intrusions, avoidance, negative alterations in cognitions or mood, and/or changes in arousal and reactivity (American Psychiatric Association, 2013). In addition to a traumatic experience of sexual vio­lence, some of the most common symptoms that pres­ent in survivors of incest include per­ sis­tent re-­experiencing through triggers, increased anxiety, sleep disturbances, hypervigilance, exaggerated startle responses, and/or dissociation to name a few (Daniel, 1996). The most severe symptoms of PTSD presented in adult survivors of father-­daughter incest where sexual intercourse had occurred (Greenwald & Leitenberg, 1990). A ­ fter repeated exposure to horrific sexual trauma, c­ hildren may develop learned helplessness as a response to intense fear (Roth & Newman, 1992). Following repeated and failed attempts to escape the aversive abuse, the child may begin to accept feelings of helplessness and give up trying to escape or recover. The development of learned helplessness in childhood persists throughout adulthood when left untreated. When adults with learned


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helplessness begin to re-­experience their trauma during adulthood (e.g., nightmares, recurrent thoughts and images, flashbacks), it can feel as if they have become imprisoned by their own trauma histories. Unhealthy behavioral coping strategies begin to develop, which further isolate the survivor. Adult survivors of incest may begin to avoid potential triggers at all costs (e.g., restricted affect, diminished interest in activities, reluctance to leave their homes, non-­participation in social events), which can further hinder the survivors’ development of a strong support network (Daniel, 1996). Clinicians have attempted to specify the effects of repeated traumatic exposure on ­children and how that impacts them across their lifespans. This led to the use of the term “complex trauma” (Courtois, 2008). The complex trauma is predicated on the observation that the impact of repeated childhood sexual abuse may not pres­ent in the same manner as other cases of PTSD. Thus, it is impor­tant for ­mental health professionals to keep this in mind when they assess survivors of incest due to the likelihood that other psychological dysfunctions may be intertwined and co-­ occur (Courtois, 2008). Many adult disclosures of childhood incest come from multidisciplinary treatment facilities and the symptoms of PTSD may not pres­ent ­until the disclosure or traumatic memories have come to light (Graziano, 1992). Daniel (1996) discussed the necessity for clinicians not to overlook the potential for delayed-­onset PTSD in clients that disclose incest ­later in life. Recent changes to the DSM-5 incorporated delayed expression and dissociated subtypes that allow clinicians to properly diagnose individuals that do not pres­ent symptoms of PTSD ­until years following the traumatic event (American Psychiatric Association, 2013). In a unique review of the delayed onset of traumatic stress symptoms in geriatric incest survivor populations, it was found that they may be triggered by the loss of autonomy that occurs during that stage of life (Somer, 2000). Geriatric populations may begin counseling due to dissatisfaction with the end stage of their life only to, sometimes unknowingly, be triggered to recall the traumatic experiences from early childhood. Somer (2000) explains that older adult survivors of incest have often lived difficult adult lives and harbor a deep-­seated self-­blame for the trauma they have experienced. Group therapy could potentially help older survivors find a sense of belonging and pro­cess the real­ity that they are not to blame for their trauma. The emergence of delayed PTSD can be incredibly destabilizing for the client. In geriatric populations, clinicians should carefully evaluate their client’s physical tolerance for trauma pro­cessing including the presence of high blood pressure or other cardiovascular prob­lems, as ­these could be exacerbated during the development of the trauma narrative when conducting Trauma-­Focused Cognitive Behavioral Therapy (TF-­CBT). Therapeutic interventions utilized for adult incest survivors with PTSD and complex trauma symptoms include TF-­CBT and its variants. At the


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