.

13/G·ender-Related Psychology

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Nada L. Stotland, M.D.
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GENERAL OBJECTfYE:' Civen ~~ :¿~arillri'~ti~O of ~

patíent, díscuss the influence of the pa-
t

tíent's sex on the person's, behavior and OE the doctor-patíent relationship. '
SPECIFIC OBJECTIYES:
1. Discuss the impact of a person's sex 00 medical careo
2. Discuss the impact of recent social changes in sexual roles on stress and health care nal
needs. m.
3. Summaríze the ernbryology of sex, ha'
4. Explaín tbe socialízatíon of boys and girls into theír sexual roles. ". , me
5. State the irnpact of a person's sex on the tcndency to seek rnedícal careo th,
6. Discuss the effects of sexual expectatíons 00 the rnedícal care provided to rnen and de
, womeo. (1:
-7 ~~ c:!gO!!:g !.."'...sb..'1~Scl sexual díscrimínatíon in. western society.
8. Discuss psychologic consideratíons related to menstruatíon, meno pause, the postpartum eh
period, and induced ahortion. , , .th
9. :List the m~-dical consideratíons fo~owjng rape or spouse abuse. wc
in
tic
;a ,(1
Ccnder-relatcd Jactors TlUIy affect your provider? How does' thc illness aflect the per- la
c}¡~ice uJ spccialty (1J at;d tlie l{tlality and S(.'l1- son's ernployment and relations with othcrs?
sitivity oJ yOllr pracucc oJ that specialt-q (2). How wíll gender-related fcdings and behav- a
T"e1j 11UJyaJfect IU'al'" .protnotion praciiccs, iors aflect compliance with trcatrnent? 1t is a n
(¡!lali/y and st qlc aJ lije (1, 3, 4J, illucss prcoa- mistake to assurne that a paticnt cngagcs in F
lcncc (5. 6), sicl: n/Ir behaoior: uJ patients (7, spccific gcndá-related bchaviors. .L~in this v
8), response to and sidc cffccts oJ treatmcnts vignette: T
(9), and suroical itsclj (5, 10). Every doctor
and patíent brings to their relatíonship a f./Is. G. was the 36-~r-old .executiVe director
unique cornbination of inherited and lcamed 01 a professionel ors9nization. She had never
sex role attitudes and other behaviors that in- rrerried. At the office, sbe set et her desk for long
fluence the rclationship. bours, building the orgenizetion while the rnern-
To effectivcly treat patients. )'ou nced to bers, trustees, and steff mede conflicting de-
understand the patients gendcr-rdatcd rules, menos. Aft~ _wOO:,',she relexed by playing
attitudes, and expericnccs, How does the pcr- bridge etl evening' with friends. Then $he
•. son feel about depcncli'ng on a health care oevelped severe lo-ver back pain.
",
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13/Gcnder-Related PsycholOS)' 155

She consulted en orthoceecic sUf3eon in her
suburb. He exernined her and diagnosed muscle
strein. Never csking ebout the reelities of her lite,
he. exborted, her to "stop driving ell those Cub
Scouts eround in the stetion wagon end carrying
in ell tbose heavy bags of srcceríes." He never
de1ermired that sbe spent many hOUT5sitting,
\.".;¡ich asgravated the strein on her beck He tooc
no opportunirv to edvise ber to correct her sit-
ting posture, or to determine wnether her joo
stress wes increosing her musclt:-¡~nsion,
Her woi: performance eno her recreetico
....-.-ere
bo¡h bernpered. Her condition worsencd
daity, ano sbe WcS cencerree about the multiple
rnuscle relexems and anelgesics sbe icok. Ar.e;r
me orrbcpeedist reoeetec his uninformed se-
vice a secooo time, sbe cencelled her next ep-
pointrnent and sew enorher ooctor.
Unfcrtunatelv, rnedical tr..úlling: and jour- . sexual di fTc re necs. For examplc. pan..'llt:.ll atri-
nals rnav T"f·ill(nrcT t radition«] ill)arC'.c; and
rnvths al~)ut the' sexes \2. 11, 12;. Ht.:~~:arch('n
have srudied how a perscn's se); is depicted in
medica} tcxtbooks a:nd journal ads and found
dlat womcn are portrayed as scx objects, in
demeaning ways, and in stereetyped roles
(13). ,
Phvsícíans are ruso affected bv recent
botb men and wornen in socicrv () fi). NeglcC't
of thcse qncstions could he cvcn more damag-
infT, howcver. An example is initial testinc t- of
t- .
medications only on rnen. and thcn generali~-
ing the findings to wornen without eX1'loring
pcsxible diflcrcnccs in cffccts (17), Aspirín for
thc prevention of coronar)' artcrv disenso (a
major cause of dt.:ath in wornc-n ) \\':1$ tvstcd
onlv on rnen. Another cxarnple gaining \\iJe-
sprcad attention ís lack of SCriO\lS rcscarch
conducted on hcalth issucs spccific to WOlTIt:n,
notably rescarch on brcast can ce r.
SOClocurrURAL INFLUENCES
\\-'t: hegin \\ith, and return as él central
thernc to, sociocultural illfrul'lIl'l.:S nn obscrvc-d
tlln('s towards c-hildren arr- ~(·no('f-rl'}:¡I¿·d
even before birth (lo). Childn.:anng pra~til't:s
are gender-dependent; we not onl." name and
dress children aecordíng to scx, but we also
talk to and touch thern diílcrentlv (l9). Boys
and girls tend to be assigned diflerent tasks
. ~. . -
(p',r1., bovs rnow the lawn: ~r}s babvsit).
,
Men ./

and women still do not cnjov thc sarne oppor- .

changes in sexual roles and expectations. AJ-
tunities (3)., Men scldorn havc thc chancc to
though thc nurnber of worncn in thc paíd
take pri~a~ rcsponsibilíty for thc- hands-on
work force. inclurung mcdícal practice, have
care of home and childrcn, whcreas worncn
increased dramaticallv, changes in the domes-
have not advanced in signiflc:ml nurnbcrs into
tic sp 1iere h ave not e 1langcd proportionatelv
r 1 1
( 14 ): ior examp e, lomcmaking
upN'r c:orpor ..ríe and man::i!!.ement ranks (1).
ancl parenting r- ".
larcelv
~.... . rernain wornc ' t ks (-)
ns. a<; :). b Wcrncn .' care for dependent rclalivcs
. at borne:
- --- .:_-----~n··
_, '=-. .' ~----mefl-een-t-rol-wef'-hj')1-fK'e-h'¡rii'lg-afl(~-'prem0titHl
....•.pcr.;on s sex 1Il ucnees. pnrn:!ry, sceono- . .'
.
ary, and tertiary prevention. \Vomen :h;¡\:e a \\ 'hen ~lcs ,change, .our adaptution :0 new op-
rnajor inOUClll'" nn famil." dict and other ~_ r:'rtumtics IS complicatcd by the Iaílurc of so-
pects of lifc that aflcct hcalth. For cxample, cial supports and c~p~t'tatl()ns to k:'ej) pace.
wornen visit dOC!OTSmore oftcn (han men and Fcw doctors and clinics han: l'\'l'lllllg hOIlTS
mak~ decisíons about the mecÚcal care of reJa~ for ernploycd patients: [ew workplaces pro-
, tives in many familics .. Rccentlv, health pro- vide da)' care for childrcn: homcmukcrs are
víders have bcgun to re(.'ognizt: thcse Iarnilv expected to behave like traditional women,
responsibilities and now rnarkct .scrviecs spc- - ernployed persons likc traditional rncn. M uch
cificaJly to worncn (15). ' - oí the litcraturc labcllcd g{'ncln p~."('holo,l;\·
Too little scicutific attcntion h:l.~bccn paíd Iocuscs on the psychology of women because
~o él person's xcx ;L~ it affl"et.s ph~'i;¡1l hehav- m:J.: :qc:\:clopmcllt and he)¡avior was por-
10r and patient hcalth. Sorne profi-ssionals Icar tO;'ed_ 'as the nornl for hllm;¡w..-;.' lIntil re-
this :ltlenlioll W¿lllld \'aliclate pn~i\llpl'(!S ¡¡houl ¿·~nt~\'. \_ye wUlIld hcnefit fmlll moa: stlldies
sexi.,;u diÍlerenc:es tha! I¡mi! partici~pation of focu.sc,d on malcs a.~ males.
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,156 SECTION 11. DEYElOPMENT
,/ "

Ilistoric:al ancl anthropological studics en- Ior wornen. But sorne people are nostalgic for T
lighten tlie atternpt to determine what bchav- . thc "good old days" whcn rnen valed. finan- tl
iors are inhcrently rnasculine or Iernininc. Ir ciall)' supportedwomen ano chíldrcn, and Iim- s:
similar bchaviors are assocíated with each scx ítcd domestic duties to stuble, g~lT"ge. und .g
in m;\IIV societies separated by time and dis- grollnd~. wlule worncn cured fOI" chíldrcn, n
lance,. we could reasonahly define thern as cookcd, handkd clothing, and clcuned horncs. p
masculine or ft:mininc. . .. But the good old days do not have a long s:
Historicallv, most human socíetíes have de- history. The wornan who spcnt - all her time a
Iincd c:ompl~menlary but clifferent gcndcr preparing rncals and enriching chíldrcns lives n
roles Ior rnen and women. For example, is more a creature of the 1950s than of the a
worncn cooked anímals for which rnen 1íOOs or 1800s. AmI. altlrougl: men have long d
hunted, Wornen kept small chíldren safe at been viewed as stronger and more competen! p
home. whíle rnen defended thc group from than women, sexual roles varicd greatly as cir-
cnemics. Differcnces in behaviors of Iernales curnstances changed. Poor women, mothcrs d
and males are also Iound in other species. or not. had to earn mone)' or help with the a
\\:e .írcqucntlv use other species for exarn- [arnilv Iarrn or business. whilc privilcged [ami- rr
plcs vof normal sexual lx-haviors. hut sclcc- líes hired servants. Nevcrthcless. the fant;L\:' a,
tivc-lv, to Sllpport our biase-s. \Vt", note th{' de- tluit the normal woman is cutircÍv occupied e-
votion of the rnother snakc or bird lo her eK_gs with childrearillg pervades our socictv, con- f(
and yOllng. und ('\'('11 the fierceness of many trihutinr: to the laC'k of social and cl()nl('~ti{' a:
m.nnrnalian moriu-rs in dt'klls(' of thcir ;'OUI1!! supports for women ;L~they take more respoll- h
off.spring. However, among. nonhuman pri- síbilirv outside the home.' Thcse dutics are tl
mates, males ma:-' also be very attached to in- typically added to .the responsibilities for rr
fants. and in sorne other spccies, males care horne and Iarníly, whercas the male parrner. if n
[or the ver)' )'oung. Malc bircls bcar brilliant thcre is one at home, is sccn as an assistant, le
plllmagc to attract Iernalcs, in contrast to the not equally rcsponsíble. . l' v,
scrnber i7i<J¿ and colorful Iernule garb iti lltlist Sorne studíes suggest that mothcrhood and d
human socictícs (20), cmploymcnt combine to: add stress and 'rr
Women care for thcir chíldren in alrnost all worsen health; other studics dcrnonstratc no v
. human civilizations, although. in many ~e re- \\'orscning. or posítíve efTc~ts 1(21). For cach
sponsibílitv Ior cure is divided among many Ic- person, personality traits. qunlity of the mar- ti
male group membcTS.· American socicty dif- riage. jobo and the degrcc of financial dísad- g
Ierentíates names, nurserv decor; tO\'5. and \':mtagc contribute to outcome. y.
dress for maje and femall' infa.nts. and encour- b
ages gellder-rcbted behaviors for young chil- d
drcn, At or bcforc puberty in most socictics, EMBRYOLOGY ANO PHYSIOLOGY e
bovs spcnd almost all thcir time witl; men and g
Th(.; sex uf nn cmbryo ís dctcrmiuc-d ai con-
~irls witl: womcn. Socialízation and education
tlu-n Iocus on m;l~tl'rin~ \!ender-re1ated be- ception, Either the fertilized c·R~eontains two -lie:
-, haviors. Often. a ccrcrnony marks the adoles- X chromosornes, and bccornes. Icmale, or an X· tf
ccnt's cntrv into adult socictv as a rnan or and a Y. and becorncs male. A single gene on ~. 1
wornan. i'lan\' societies b;l\'e menstrual thc Y chromosomc (tcstís-dctermining factor e
taboos, which' Iurther segregate men Irorn gene [TDF]. probably tlie SRY gene) (2+. 2.:3) d
worncn for ccrtaín da\'s 'in thc menstrual cvcle . . is responsible for scx diffcrentiution. Withollt ¿
Many of us \.;~\\' ~ progress the recent cul- a y chrornosome. or whcn a genetic nberratíon ', r.
tural trend toward overlap in sexual roles (e.g .. blocks its effcct the ernbrvo bccornes [ernnle. v
more men in\'uh-ed in child care. more The Y chrom;some call~es the cmbryonic
womcn holdillg ad\'anccd dcgrecs). alld the gonad to difTercntiate from an O\'UT)' to a testis ._ r
during lhe sc\'enlh \Veek of embryonic: life. e
~ gradual evoluti~n t()\\'arel illcrc~(;d legal righlS
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 B/Gender·Rdoted Psychology 157-,

·IJg;ic:Ior Then, testes secrete .nndrogcns which direct rnale and Icrnale childrcn: before they are
L finan- \
the devcloprncnt of the primitivo urogenita1 born, they are Iutúrc hc;wty c¡il'c<:ns 01' nurses
'md lim- structurcs into thc rnale internal and external and Iootball stars or doctors lo tlieir parcnts.
:!_e, and genitaJia and inhihit the developmcnt of Ie- Adults who do not knowa newborn's sex will
luldren, male genitaJia. Thís differentiation is bound to vary thcir behavior towards it depending on
homes. precise st'ages of ernbryonic developrnent. Thc whethcr they are told it is a hoy or a girl (35).
I a Jon¡?; sarne hormones do not have the sume effccts They wíl] handlc gen tI)' a hah~' the;, are told is
,'1' time at other stages. In rhe absence of male hor- a ~rl, and cornmcnt on her good looks. They
;1'5 lives mones. or when a tissue dc:feet blocks their '\,\'i11 bounce what thev think is a baliv bov
, of tlie action (androgcn inscnsitivitv), the ernbrvo more \~goroüsly and ~'(>mrncnt on his viF:0'r
.vc long ,develops into ;1 fetus and newhorn that ap' and strength. Ncwly delivercd rnothcrs talk
:Ipetent pears Iernale (24, 25). more to theír daughters than to their sons
,'as cir- What are the causal Iinks bctween sexual (36).
.iothers differcntiation and outeornes and behaviors Especially in the U.S .. as rnentioncd ear-
ilh the after birth? Both bcforc and after birth, more licr, names. nursel)' dccor, clothing, and to;,s
ti Iarni- male infants dic. At al! ages in childhood and for the newborn are dcsip1atcd by scx: the lit-
- rantas)' adulthood. the life expectancy fo; Iernales ex- tle girl in her pink rufflcs shakes a Ilower-
eupied ceeds that [or males (5), M en afie! wornen dir· ~h;¡p<:d rattle: tlle litt le bo:' in bis bluc jn<;(·ball
.'. con- fer in their susccptibilitv to various conditions, uniforrn sucks on toy boxin¡! glo\'es, Sex is a
mcstic and sorne of thc difTcrenees are linked to sex core eomponcnt of ide-ntirv. \\'}¡CTl childre»
'Sj)\lll- hormones ;5, 2.~, For exarnple- ..••.-omr-n In 1>ct.'OTlH'toddlers, the:' kno .••..w!sat St~X t]'l'Y arv,
,'S are their {orbes have fewer hcart attacks than which parcnt is the sarne 5CX, and how pt:r.;ons
es Ior meno The administration of estrogens after the of each sex are expected to look and behave
+ner. ir menopause, whcn they naturally Iall, ma)' pro- (3i). Sexual idcntíty arises prirnarily from thc
-istant, long ""'om en 's resístanee to heart attacks. The sex of re.aring (which is ~rtually alwavs based
vast majoríty of chíldhood psychíatric disor- _ on biologíc sex) (38). lt also develops from be-
~ and " ders ::lrf", m0~ comrnon b ~)':; {.::!5}. Y.:;:,¡¡;g haviors ~1It.'OtJrJged bv adulrs and peers, and
.; and / men have a higher incidcnce of sports injuries., from adrniration and .identificarion with the
.ite no Women are more vulnerable to breast cancer, parent of thc sarne scx, Childrcns Iathers
r each Males are heavier and longer at birth and ,pla)íul1y taunt and punch thcir -sons and flirt
. mar- throughout life except at agcs 11 arid 12, when with their daughtcr.; (39). With' infa.n~ SOIlS
disad- ' girls expcrience a pubertal growth spurt 2 (compared with chughters).,Jathers -are more, .,
years. on 3\'erage. before boys (27). Infant ph)'SicaJly rough, use to/s less. and play more
boys are sornewhat more active (28) and more gross motor games (29. 34, 39. 40). Boys'
difficult to soothe than girls (2S), (E ven srnall clothes are designed for active play. ¡;irIs' [or
;y
effects such as these could be important for a sedentary decoratíon. The depiction of girls
given pcrson.) Ncvcrtheless, ohscrvers can re- and boys in advcrtisernents and toy p:ll'b!!es
con-
:1
, líably id('nti~\' th~ scx o[newhon1s onl:-' if ~~y~ _!<it!_l1!I~~sh:p-')rtr:;l.!,i; s-invelved "ilb. '
JjJ.l: .male-a ..
.s,t\\'o --- .can- sec--theiT-genit!lh;::It¡rougliolitlifl~ ñlales h.lilding. action, and agg;rl'ssion, and the fe·
'_ ':, an-X -
, tend to he more aggressÍ\'e than [emules (29). rnale involved wíth appearancc, dornestic du-
'JlC on This has medícal implications. Male ndoles- tieso and c'hildrcaring.
Iactor cents are injured in f1ghL<;and are more apt to Cirls have been cxpectcd to be dernure and
_~, 2.3)
die in aecidents. Women are injured by male passive, suhordinating 'their opinions :lOd pref-
Ilhollt
domestie p:lrtnl'TS. Doctor.; treat thesc inju· eren("(!s to those of othcrs. ",hile bo:'s are rc-
:~Ition
ries, and should attcnd to detec:tion and pre- warded for being acti\'e, asserti\'e, competi-
male, vention. ti\'c. and dominant. In acC'ordance \\;th the
"\'(mie
)Us \\'elll'stahlisll{'d that hoys and prh are preferencc for males and maJe bchm;or, girls
\('5ti5 regarded :md treated difTcrently (29-34), Par· who displa~' tomho)ish g\lalities arC' better ac-
Jif•..
·. •. ents ha\'e d¡fTerc:nt pbns and l:xpec:tations for Ct'ptcd than hoyoS who are sissies (41, 42).

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I
 158 SECTION!I, DEYELOPMENT

ftl1 adult \VOl11en repor1 heing

Many SI IL·<.:eSS ration is markcd by scconclarv sexual chamc.
tomboys in childliood (42), tcristics: hrcasts und a [c-malc hudy shupe fur
What is thc scientifie e\'idcnce for thc orí- girls. larger genilals. lowcr voice, und hody
gins of thcse diflcrcnccs? I\ese:lrchers havc and facial haír [or IH>)'s. Cirls hegin lo mcn- lis}
observed c.:hilclrcn born wit]: ahnorrnalíties struatc: boys have nocturnal crnissions (wet les:
which cause their genctic and go~adal scx to drcams). Cirls rcach pubcrty and bccome in- sio
he at variancc with the appearancc of thcir ex- tercstcd in heterosexual rclations sooncr than aJl~
terna] genitals, and thus, with the sex assigned 00)'5. contrihuting to the cmbarrassnu-nt and COI
thcm at birth. Thc inlluence of sexual ;Lc¡sign- uwkwardness hetwccn ~hc scxcs during junior ser
ment ancl expectation predominares. Chíldren high school yc.:ars. in
reared as fe males idcntifv thernsclves as fe- Bchavioral differentiatioll accompaníes 010
rnale and are satisfied ma'st or all of the til~C phyxical difTerentiation. Cirls tend to dissoci- en'
to he female (38. 43). This is truc even in fe- ate thernselvcs Irom roughhollsing: Thev the
rnale children who have bcen exposed to a]» swoor» over movie stars, gossip about boys, stir
normally Iarge arnounts of maje hormones (as and drearn of romanee and Iamilv. Bovs, too; wil
in congenitaJ adrenal hypcrplasiu) ami, are are preoccupícd ...víth the opposítc ~ex. el- me
more physicallv active. more intcrestcd in though. (espccially dl!Dng midadolcscence) ent
bovs' acti ...-ities. and lt'ss intvrcstcd in [rillv their falltasi('s tellel to Iocus on couqucst hOI
cl~thing and mothcrhoocl. than nthcr ~fis ruther lhall doinesticitv. Both bovs ancl girls ver
their agl' (3oS. 4+-;(;), lx-come attcntivc to ¡.:woming ami dress (49), tra
TI 1('fe are- dett'cl:lh!c difrl'rl'lIl'('~ 1l{'!\\'('('11 l lumosvxual adolcsccuts l'(JllfroJlt p:..Li 11Iul
males ami fehdes talso on a\'er..lge). with c-onflicts. Thcy shun- other tcenagcn' in tense the
males excclling in mathematicál. spatial, and dcsire to be part of the pOllp and to drcss and inf
gross motor skills (c,g" those involved in bicv- lx-have like tlieir pecrs. Bu! thcir sexual object sta
ele riding). and fCI~alcs' excelling in certain choice varíes Irom social norms. Although ter
language skills (29. 47), Jt is difficult to sepa- many boys (inc!uding many with a primaríly to
rate naturc fmm nurture. rrive.n th(~ di!T"r"'l- heterosexual orientation) have hacl hornosex- t~!.
lI;J Iantasícs sincc carlier in childhood, heter-
tial encouragement adult~ ~vc hoy~ :md- ~;Is
in dcvcloping these skills (48). Thc ovcrlap is osexual bchavior is expcctcd to bcgin at ado- prc
so grcal that thcre is no justificatíon for ex- lcscencc, Thev 111\1st[ind a \\-..1\' to deal with : ·an(
pecting or acl\isi;;g certain bchaviors and Jife dating ~Ild rit~ds such as high 'school proms.: . tio
choices bascd 'on a person's scx alonc. The A ga;- ofganization in Chit.·:.tgo arr.lJIges a city- int
presencc of wornen role rnodcls ...and dctcr- wide prom. . .. .. . ano
rents to worncn's advancemcnt ¡n~l(litiOldh· Tr.Ic!ition;l1 and ch:ln~rjllg sexual roles and of
maje endeavors, are more influential on mores complicare the de velopment of n:spon-
worncn's Cllt'T\' into those activitics than anv siblc scxual lx-havior in adolcsccnts. Sexual in-
tercoursc is toleratcd bv socictv at cvcr carlier erro
sexual difTerc'nccs in abilitv. Tbe increa,c;in;'
agl·s. alle! thcr~. is nut ('II()lIg¡'l prcvcntion of abl
p(.·rtTnta~es of \\'OIIl('n Sllt~"t'ssflllk l'nll'rin~
sexual acti\ityby cha¡wTOning or otlu-r slI¡>l'r-
tlw pro~'SSiOllS l~>lifim~5 thís. SiJl~'t' \\'Olll("~
:....: .. _- visión. 130ys are expectud to be sexually ag-
havc bcen equitably encou raged and acccpted
gressi vc ami to pro ve virility by ha ...;n~ ínter- aTt
into medical school. the proportion of Icmalc
coursc, Círls are cxpected to he the limiting on
studcnts has risca- to ncarly 50%. .
force. but thcír nhílitv to do so is constrained ph
lx-cause thcy ;irc:' so~:ializccl to acquicsce to .th;
. SEXUAL DEVELOPMENT DURING otlicrs wishes. School scx cducation is límíted. be
ADOLESCENCE These factors contrihute to a socíallv disas- re)
trous incidcnce of. aclolesccnt . pr;gnan(.::" an
Puberty is a crucial stcp in thc dcvclop- parcnthood. abortion, and scxuallv tr..IIlSJ1lit~-
ment of1x>th WOTllcnamI Jllt'JI. I'h\'sÍt'al matll- tt·d disc;l~es incllldillg A10S. ' he

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.. .,_
 \ .
\
. .

',,\
13/Gender-Related PsycholoSY. ,,159

ADurr SEXUAL DIFFERENCEs Wornen established wornen's hcalth ecnters

that excluded physicíans or subordinatecl their
J'crsonality traits and 'sexual roles estab- authority tu nonphysicían m;l1lagers" Pu hlica-
líshcd in chíldhood and reinfon:t:d during ado- tions (44, 54) criticized medicine and edu-
-lescenct: mt:rgc ioto the truits and role divi- cated consumers about thcir hcalth. 1\-1:1n)'
sions of adult life. As for e}¡ilclhoocl, it is .•. -irtu- doetors, especiallv mcn, f~lt llnjtl~t1y accused
. all), irnpossible tu sort out the respective nnd ignorcd alter devoting: 50 much to mcdical
contributións uf nature ano nurture to ob- tr.:úning to ofTer expcrt care. Situatious sut-h <1$
served diflercnces. For cxumple, dlffcrenecs tlicsc sornctimes make .both mcn ami wouu-n,
in central ncrvous systcm anatorny and physí- doctors and paticnts, f(·¡_:) thc othcr is incorn-
ology (50-.52) may rcsult from difTen:llces in prehcnsible. .
en\~ronmt:ntar stimuli, jus: as devclopment of Diflercnces between men and womcn in
the brain's visual cortcx depcnds upon retinal cxprcssed cmotion are ",dI esrahlislu-d in
stimulation. An infant horn with lens opacitics early childhood and pcrsist IhTClll!!]¡OIlI adult-
'I'~11ncvcr see norrnally unlcss treated within 6 hood. As people move Irom middlc to 010 agt:,
months. So. too, the brain ma)' dcvelop dífler- the contrast between the sexes becorncs less
ently depending on whethcr the child spcnds marked. Older udults tend lo f<:el more ('0)))-
hours mnnin!! ruthcr than cuddling. Con- fllrtable Iwha\;ng as tl)(,;' pll';l~l'. alld k·ss apl
verselv, biolopc difTerc::m'cs could undcrlie tn lx-havo as otlu-rs expc-ct. !lkn (and roall;'
traditional sexual roles, women) have malle t},l'ir carecrs and ma;'
\ \ 1Iat("'er t he ¡:('lH'sis of sexual JifTerl·llt't',~,
sinh thcir arte-ntion f«¡lll t'(lmpctitioTl to mure-
'they can be observed and mcasured. But this conternplative ~T hurnanistic cndcavors. Hav-
information can be rnísuscd. The Iollowing are ing reared their childrcií. worncn who dcvoted
statístical (not absoluto) difTcrem:es of inde- thcir lives to home and family oftcn dcvelop
termínate (probably multidimensional) cause, other skílls and interests. less concerned about '
to be viewed as data. (not judgmcnts); men appea.ting passive and Ierníníne.
tend.to be more skílled at roatial and m:ühp.-
matícal thinldng (25); they more often couch
problems in terrns of abstraer right and \\"r~mg,_ , OTHER SOCIAL AND ENYIRONMENTAL
ancl Iecl mC?re irnpelled to íntcrvene wíth a¿tJ, FACTORS
~n (53); wornen tend to think in terms of the
interconnecting wcbs of human relationships As st.ned carlier, difTer~~llt·t:s in parental al-
and feelinp: .,rnost worncn 's scnse of sclf and titudes toward a child dt:pt:nd on its scx from
of self-worth ís groundl!d in their abilirv to bcfore it is born (55, 56). Boys are vulucd
rnake and maintain r~Lationshp-,(_J2S_)_:_,Ücn_: _p.r:der-cntially---wH,.,khr'Íde-;-!n-e-hitr:r.·\\1fl¡--it5,
~cleiiv~m(l~ satisfaction [rom achicvcment in hillion people, sons ano their [amilics earv for
ernplovrnent.: and tend to he more comfort- p;lrents dutinl(sieknc~s or old :lge, The prcf-
able with compctñion than 'V.:omen, e re nce Ior boys is so t'(lll)!wllillg: t)¡a! íhc- gm'-
Sexual díffercnces in stvle can complícate crnmcnt ealllpaigllt'd agai,lISl lb:\l preferellt:·
diagnosis and treatrncnt. For example, women in attempting to con t rol thc ,risc in Ihe Chi-
are ernotional: that is, they, display and dwcll nese population. Poslers cxlolling the virtucs
on feelings more. Doctors sometimes down- of Iimiling cacl: married couple to one chíld
, play wome n's medid complaínts, assuming picture a daughter.
that wornen cxa~t!cr.lte discomfórt. This can In wcstcrn culture, hoys are socialized into
be disastrous for th~ Otltc:ome of an illness. the tcam sports, playing by strict rules and hiding
reJation -net\\'cen a wornan and hcr doctor, feelings of weakness (57). Sports rnetuphors
and worncn and llon_..- mcdical profcssíon.. -Ó, _ pcrvadc ndult entcrpriscs: "the ball is in )'our

L.h
a Reeentl~.. the eonsurner
.:eaJthca,e has qu.'tiQucd such
rnovemcnt in
",;~mt;.""'· Mueh;,
court." "he madc an t'lId .run." and so forth.
writtcn about the "old boys' nctwork"

-
 1bO SECTIOH 11. DEYELOPMEHT
.
,
.

/.
,
.F.•

/
. and its exclusión of wornen from rnajor deci- hood their central activitv, or cO!lsiclered dcvi- rent se:
sion-making in medicine and society (1, 58). ant if they do not. Feelj¡;gs about oncs scx in- ongoín,
Onlv rccently have sizeable nurnbers of ¡;irIs fluence the use of contrnccption and the tirn- . bi.lities
been encouraged to develop educational and ing of childbearing: For' cxample, in sorne and the
carcer aspirations like those of boys. Women nonwestcrn societies and Ior sorne Arnericans, rnotion
have been deflned by their Iathers' or hus- ¡;iris and boys are riot considered full mcrn- (cornp«
bands' carccrs, Married women took theír bers of the adult sexual group until thcy have (14). c.
husbands' last narnes and first names (e.g. sired or borne chíldren. . they m'
Mrs. ]ohn Smith, meaning wífe of John menstr.
Smith). When a familv ...••-as described in the avoíd ti
SEX AND ILLNESS
media, the sons tended to be defincd by their tural cv
employment and the daughters by their mar- Certain conditions and illnesses (e.g., preg- ing Ji".
riages and children. Motherhood ...••
~.lS consid- 1 d f 1 symptu
nancy, erectí e ys unction, prostatíc en argc-
ered a full-time occupation, fatherhood an af- mento ovarían cancer) occur in one scx. Thís Stud
ter-hours activitv, Men wcre expectcd to sup- ineludes psychiatríc syndrornes assocíated 63) anc
port their [amilies financially, women to be _y.;th reproductive functions (e.g .. postpartum conditi:
supported. These mores were Iargely limited 'psvchosis [p. 126)). Líttlc attention has been creascd
to the white rníddle class, but this d;L<¡S set the been h,
g:i\'cn tu this associ.uion in 1I\(:n. 111 women,
cultural tone [or North Arncrica. pressioi
mcnstruation, abortion, childbirth. und meno-
Bovs, who are slowe r to dcvelop fine motor h L. t 1.. 1 (·1::.1) 61) does in,
pause ave oeen s 11( I(OU 11\. • .
skills and a 1(·n.¡;_1h!'n~d attr-ntinn span .. do not .1 1. el I 1 . Psvc.
lt is ceuate W Il'l icr ~()IlI(: \\"011llOII lrave

perform as well in the earlv school vears. s:mploms in thc da~ prcceding menstruation has also
Good little oirls sit still and produce ncat h h an indo
o: severe enoug to constitute a psye iatric syn-
work. But by junior high, teachers begin to drome (60). This question is cornplicated be- has e.~(
encourage boys prefercntially and expcct girls ° . 1 ble in
cause many wornen are taug 1t to expcct s)mp-
to have less interest or aptitud e, especially for toms, which: may reflcct negative feclings stances.
math ·and science. Soon vrls fall behind in: . . d ' hood d b p~y(:}¡ia¡
aoout rnenstruatíon an woman 1 • an c-
these áreas. .tha~ fol
. cause people typically \;ew irritabilitv and ag-
!....
fan.y cultures throllghout hís ton,' have irn-. wornan
gression as character traíts in men (e.g., a
posed strict taboos .on menstruating women "typical aggressive. ~urgeon") and as illness in that he!
and on others contact with thern (59), ·:\1- . curnstar
wornen,
though these eonspicuous forms of avóidance . Besearch on mcnstrually related symptorns minirníz
are no longer part of our culture, people still underseores another dilermna. Ovcrlooking outcorn-
have strong. often unacknowledged, feelings. 'gcnder-re)::¡ted conditíons deprives us uf the !ogicall)
about rncnstruation and menopause. Cultural chance to understand thcrn ano relieve suífer- tion tha
belíefs about worncn's moodiness focus on the
ing. But focusing on them can reinforce unjus-
menstrual cycle: comparable variability and tified stereotypes. Cousiderntion of women (
intensitv in mcn's mood states are ignorcd or candidates Ior positions of hi¡::h rcspousilnlitv ./
scen as charactcr traits and eccentricities. .
oftcn ¡;i\"es rise to -COI1l:Cnl about o. r.lhring hor- Med:
mones:' And althoug:h thcre llave bcen huge . the can:
SEX AND REPRODUCTION increases in the nurnbcrs of wornen in the Rape vi
professions and managen1(.!nt, tl'¡ere are still to hospi
Reproduction is crucial for sexual roles. Iew at the highest levcls. inc:llloing tenured ríes, anr
Difficulties with reproductive capacity are professorships, chuirs. and deanships (whích vestigat:
deeply upsetting to a couplc, making thcrn would providc role modcls for women stu- this vul:
guestion theír adcquacy. Women are more dents) (l). The rea ..'iOI1S Ior this relative pall- fered ar
psychosocíallv defined by thcir reproductivo citv, bevond the [act that far Icwcr wornen safe an:
roles,' howevcr, expccting to rnake rnothcr- wcre admítted to thcse Iiclds whcn the curo most of
~

·~i.
 . -,;~\
. --
.. ~

13/Gcnd~r-Related !>syc::hology 161

ren! senior cohort W:L~ in training, include thc thc clinic or emcrgene)' room. Thcy m:Jy need
ongoing disproportiouate dorncstic rcsponsi- care Ior acute injuries, or complaín o[ pain,
bilitics (notably the care of childrcn, the ¡B, but rarely report the abuse itsclf. If lile abu-
and the ddcrly) assumed by wornen, and pro- sive situarion ís not rccognízed and hclp not
motion policícs that rcward chnractcristics o fTcred , cven i[ the patient rcfuses it al Iirst,
(competition. asscrtivencss ) nurtured in me-n the abuse will alrnost alwa\'s continue. and
(14). Conscqucntly, ~omc worncn mav feel sorne parients will be murdered. Evcn whcn
ihey musí supprcss symptorns eonnected with the outcome is not so drarnatic. thc situation .
mcnstmatiun, pregnallcy, and mcnopause to traurnatizes the victim ;LC; wcll as children in
. avoid discrimination. Therc is sorne cross-cul- the home and tends be rcpeatcd in the next
rural cvidcnce that worncn who havc reward- gcner..ltion whcn th« childrcn have chíldrcn of
infT thcir own (42, 60, 61, 6-4. 65).
o lives tcnd not to exneriencc ~'. cllsauJinfT e
symptoms. • Rape is a comrnon. underrcportcd crirne
Studies of worncn dllring menop:wse (62. (66. 6,). Thcre are popular misconccptions
63) and aítcr hystcrectorny for nonrnaligna»; that most rape victims sornchow tcrnptcd their
conditions reveal that thcv do not have an in- attackers, that rape is perpctrated only on at-
cre2.Sed rate of clinical "·dcpression. as had tractíve youllg womcn, ::md that no woman can
been belicvcd previouslv. But the •.uc uf de- he Ioreed "lo llave intcrcoursc ¡¡gainst hcr will.
pression and other serious psychiatrie illness But victirns rJ.ngc in ag<' [rorn toddlers to Üw
does incn-ase postpartulll (p. J 26). elderlv, and looks and provocation have little
Ps\'Chl;11 ru outeomc alter im3ucec:1 abortion to do with r.ljX'. a crinu- oí" \101l'nt"t' and hu-
has also lx-en srudíed. The wornan undergoing miliation (66). Sexualitv is rnerelv the "chicle
211 induced abortíon is doing so because' she by which the rapíst expresses his ragc. Rape
bis experieneed a pregnanc)' she finds untena- victírns fe el sullíed, worthless. and gui)ty. re-
ble in her ' current highly stressful circurn- . gardless of whether thcir own behavior was a
stanees. The incidence .. however, of rnajor .' factor in the circurnstanecs of the attack. Mo~t
. .... ." r.,._., .. ,....,~c P\"''' _,..¡ ~ ..••. _-
,...,.... : •.••. ••......-_ 1·:.__ ...._ ~-
y5yC:l hlalnc tuUe.:)!"!"alter urXJmon 15 IO\"'·cr trian --r-'" -- _ _- u.:r ,""",If''-V'''- I'\.UV"'·.l·' lU
that foBo\~;ng chi)dbirth (61), the prc~ant the victirn, and many take place in the victim's
wornan's only other .al te m ative ... Counseling home (62). In date rape, aman fecls cnritled
that helps thc woman identify her valucs, cir- to ha ve intereourse with a date, forcing ii on
cumstances, preferences, and supports, and her if she does not agrce.
rninimizes thc pressun: from others, improves The ph:~ica.l and psycbologícal ab.us~ of
outcomc so that she rnav fed better psycho- spo~sc~, chíldren, and the :)derly \\,~hm a
logícally and eontracept bettcr :ifter an abor-
._ --~ti-onl:}13.rn>cTorc (6T}.·
f:lnu)y 15 also _:ommon, crosslllg. all SOCl{)(·(.'(l::_ _ _:.
'-.-. ·-nomlc bound:trics. Spoust's are abused in ap- ..
. .
-- _.----- ---_.-
..-

proximatcly 3-6 milJion Iamílícs in thr- U.s..

. GENDER-RELATED YIOLENCE
Medícal proícssionals playa majar role in
the cm of victirns of gender-rcJatcd violcnce.
. Rape victirns, most oftcn womcn, are hrought
t~ hospítals for cxarnination, trcatrncnt of inju-
nes, and gathcring of cvidcnce for criminal in-
ve~tigati~n. Inscn.siti\'Íl)' of profcssionals
tbs vulnerable time incrcases the.: trauma suf-
fered and dccrcases thc victirns ahilitv lo f(.'el sault. To countcr our tcndcncv . lo eh!n\'. thesc
safe and tnlsting. \'ictims of d()J1l{'Sli~ all\l~c,
mos! often children, womcll, :llld c.:Jders, ';sil
(68). Victirns of dorncstíc violcnce al so f~el
hclpless. gllilty, and worthlc-ss. eonlrihlllill!! to
a tcndcncy amon!! health providers to fed tliat
thc victirns wilIingly submit .to. thcir plight.
Rape and domcstic violcnce (whicl; rnav in-
elude rape) are 1'0 upsetting lo us that wetend
to dcny they exist, evcn whcn cvidencc is
clear. This oftcn lcads to hlaming lhe victim
al (66, 6í). An cxarnination inscnsiti\'e to these
rnatt crs fcel; to the patient like another as-
--
tr:\¡:;ic situations, b\\'s no\\' mandate the rc-
porting of child and elder abuse.

..•
 162 SECTION 11. DEYELOPMENT

Many eommunities ano medica] cenlcrs dorncstie violencc are S<:riOIlS amI long-hq.
have programs for tlie victims of violen! . sex- illgo Victirns are ofll:n ps)'dlOlügi<:ally dis-
related crírnes. Thcy includc tho lIS(.! of fe- ablcd. their lowcrcd sclf-cstccm del:n::l.ses
male staff; having a supportive ndvocate ac- their chances [or succcxs, ano thcir persisten¡
compan)' thc paticnt througbout the examina- anxiety intcrfcrcs with tlicir cnjoyrncnt uf
tion. treatment. and CJllcstionin); hy polícc: heterosexual rclationx. Bcc.mse putienis US11·
ernergency housin~ if the victirn is uneorn- allv 00 not volunteer Ibis iníormntion. the
fortable going heme •.done; ano Iollow-up phvsician ShOllld includc iuquirics uhont -
-
counseling. Thc t'unscC]ucncl:$ uf rape ano abuse whcncvcr I:lkin" a [iixturv.
,... o

GE
of
SP
1.
20
3.
40
50
50
70
80

,A.

fom
deci
mus
lifet
2)0
:E
for
:.: " spai
de\'
one
- exp
fae(
is a
atir
des
ter!
sur
mi:
'. o

.. "-
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r- ~ o'.

._--