labrys, études féministes/ estudos feministas
juillet /décembre / 2014  -julho/dezembro 2014

Gender, Feminisms and Mental Health: Implications For Research And Practice In Clinical Psychology

Gláucia Diniz

Cristina Vianna

Abstract

This article discusses the contributions to Clinical Psychology of adopting a gender and feminist perspective in research and clinical practice. We believe that it is essential to understanding the differences in how men and women experiences in relationships and in society affect their mental health. We discuss briefly the interaction between gender, mental health, culture and its impact on psychic suffering, keeping in mind that such interaction affects clinical practices and the way services are delivered. We comment on the importance of doing research on the topic of women´s mental health from a gender and feminist perspective. Our intention is to outline some of the complexities and the challenges that feminist therapists and researchers face in order to build gender and feminist research-intervention mental health projects.

Key Words: Gender; Feminisms; Mental Health; Clinical Psychology; Research-intervention.

Gender reflects the cultural attributions given throughout history to both sexes. It reveals the patterns, expectations and roles associated with being male or female in a given culture at a certain time in history. Seen as a category of historical analysis, it is the first field of knowledge in which power can be articulated. According to Scott (1995) it confers intelligibility to social identities. Gender analyses are a result/product of contemporary feminisms.

Feminism, on the other hand, constitutes an international, political, collective, heterogeneous and multifaceted social movement. It struggles to give recognition to the fact that women are the object and target of systematic oppression and that such oppression cannot be seen as “natural”.  A feminist critique offers us the lenses and the means to reveal the political nature of gender attributions and its impact on women´s mental health.  Its importance as both an analytical and political tool is to allow us to question the ways in which sexual characteristics were and still are valued and represented in order to produce and maintain hierarchies and  inequalities between the sexes.

The purpose of this article is to discuss the contributions of adopting a gender and feminist perspective in clinical practice.  We argue that the field of clinical psychology has undergone many changes since the late sixties and early seventies. The social movements that took place around this time reverberated in both academia and clinical practice. The field´s early focus on long term individual psychotherapy geared towards privileged groups was questioned.

 Such questioning led the area to recognize its ethical, social and political role and to broaden its insertion in mental health promotion and prevention. A similar change also occurred in the field of clinical research. It became a challenge to open space to research methodologies that can provide systematic and reliable information on women´s health conditions, confront the presence of sexism and other forms of prejudice in dealing with vulnerable groups, or to account for the complexities of group interventions (Reinharz, 1992).

The article is divided in three parts. In the first one we argue that adopting a gender and feminist perspective is essential to understanding the differences in how men and women experiences in relationships and in society are viewed and interpreted. Next, we discuss briefly the interaction between gender, mental health, culture and its impact on psychic suffering, keeping in mind that such interaction affects clinical practices, or in other words, the way services are delivered. Third, we comment on the importance of doing research on the topic of women’s mental health from a gender and feminist perspective. Our intention is to outline briefly some of the complexities and the challenges that feminist therapists and researchers face in order to build feminist research-intervention mental health projects.

Gender, science and clinical psychology - a feminist critique

The absence of women and/or the silence around their presence in the history and the making of all scientific areas, psychology being one of them, have reinforced the association between masculinity and scientific knowledge. Adopting a feminist critique implies questioning the ideas of neutrality, rationality and universality that mark the scientific field in general, and the clinical psychology area specifically. Brazilian sociologist Lourdes Bandeira (2008) gives us a definition of what a feminist critique is:

“To speak of a feminist critique, is to appeal to a block of heterogeneous perspectives that attempt to explain why women continue, to a great extent, to live for the most part in a subordinate condition, taking into account that in the base of any feminist approach lies the recognition that there is a social and cultural cause for such feminine condition of subordination. (…) It implies a struggle to change, to transform these relations, this situation/condition .”(Bandeira ,2008 :.220

The fact is that in order to promote changes in clinical practices and in service delivery, professionals in the mental health field need to gain familiarity with new paradigms. A gender and feminist approach can offer new perspectives on how the subjectivity of men and women as well as their experiences in the world are affected by cultural values and expectations. The same happens with theories and techniques used in the clinical area.

Feminist scholars were not the first, neither the only ones, to formulate a critique of modern science paradigms. Nonetheless, it is undeniable that feminist scholars have presented society with irrevocable arguments that have had a profound impact and have brought forth several changes in the ways the basic fundaments of science and the impact of culture’s values in the making of such science is understood (Bandeira, 2008).

The feminist perspective can be better understood through a division in three generations or “waves” often mentioned in feminist publications, although such division can be criticized for implying a linear historical chronology. According to Gonçalves and Pinto (2011), the first wave includes the last period of the nineteenth century until the end of the Second World War, when the movement experiences a set back after women conquer the right to vote in several countries. The second wave starts at the end of the 1960 as part of the counterculture movement, when feminism, besides immersing in social and political struggles, focused on building a theoretical corpus in the attempt to explain the oppression of women.

Around 1980 a critique of second wave feminist perspectives regarding the category “woman” emerged. Although women throughout the world may share common experiences, it became evident that culture, race, class, age, educational level, occupational roles combine to create many different experiences of womanhood (Oliveira, 2007; Praciano, 2011; Ramos, 2011).  “Gender” gained status as a category of analysis that better expressed the impact of cultural values, myths and stereotypes on both male and female biological bodies as well as in mental health (Louro, 1997).

According to Hall (2005) the difference expresses itself through these concrete social markers, which allow us to think about the social and political forces underneath power relations. Adopting a feminist critique nowadays implies the acknowledgment that women’s experiences are distinct and a product of multiple dimensions. Depending on how these dimensions combine they may result in many forms of vulnerability and social inequality.

Giffin (2006) provides us with a good example - the conflicts of interests between women of different social classes. The author calls attention to the fact that in Brazil middle and upper class women benefit from the low paid labor of lower class women who serve them as maids. Such arrangement allows upper and middle class women to work outside the home for professional benefits and success. In this way, they also maintain the advantages of their social class, since they can invest in cultural capital – they can provide their children with a high quality education that will ensure them the attainment of better jobs in the future. The impoverished women and their children, on the other hand, are the ones who end up paying the high price of the consequences of multiple journeys.  

The feminist project of social transformation must, therefore, take into consideration differences in the feminine condition.  It must strive for ethical, cultural and institutional changes by acknowledging the fact that efforts to build a more equal society do not take place at the structural level only. It must promote changes in the daily life of all those involved. Alvarez (2004) affirms that feminism contributes to the process of democratization through politics in the areas that demand social representation; it also contributes to changes in politics, by bringing to attention the processes of daily life in which power struggles and resistances circulate in an attempt to maintain differences.

Feminism gained space in Brazil and in Latin America in the decades of 1980 to 2000. A process characterized by plural and decentralized actions resulted in a multiplication of spaces of insertion of feminist ideas. Both women and men contributed to give visibility to feminist perspectives; to make known to both society and academia the feminist critique regarding gender inequalities and its understanding of gender relations. This process also resulted in the articulation of new practices in various fields of knowledge and social life. It led to significant growth in national and international collaborations with other feminist groups and organizations from around the world (Vianna, 2012).

Feminism must be seen as a plural movement/perspective. There are many feminisms, many theoretical and political ways to view, problematize and explain feminine oppression, thus affirming the multiplicity of contexts in which such oppression manifests itself. In the same way, there are multiple perspectives on how to transform it (Navarro-Swain, 2000). Although feminist perspectives vary among themselves, they have in common the political goal to attain equality for the sexes and the purpose to find ways to make it a lasting social achievement (Neves & Nogueira, 2005).   

Academic feminism also shares this objective. It participates in this struggle by bringing to attention the relationships between gender and science. Scientific epistemologies were and still are, for the most part, considered neutral. One of the purposes of academic feminism is to show that “appearances are deceiving” - behind their “neutral” façade these epistemologies sustain cultural and institutional beliefs as well as practices that legitimate “scientifically” sexist and androcentric points of view. By taking gender as a fundamental category of analysis to understand social inequalities, academic feminism points out this perverse stratagem, thus defending the construction of a new way to build scientific knowledge (Harding, 2003).

Feminist questioning turns itself to the ideological constructions over the biological bodies, in order to point out that dominant and naturalized discourses regarding being male/man and female/woman build how we are and how we function in society, not only as different, but also with unequal rights (Vianna, 2005). The field of feminist studies has made serious efforts to expose the mechanisms that produce gendered subjects, that is, built under a given truth regime. The gender/sex system (Rubin, 1989) articulated under a heterosexual matrix of identity, results in control over the bodies, specially the female body, and in the high valorization given to marriage and family life (Navarro-Swain, 2000: 2002).

Lauretis (1990) asserts that the paradox of being female consists in being treated as an object to be seen, but without voice, therefore invisible and alienated from discourse. The author proposes an eccentric position as a discursive position outside the heterosexual monopoly of masculine power and knowledge. Lauretis (1990) considers feminist women as eccentric subjects, since they live in a world of meanings, but they are able at the same time to situate themselves outside its contours, by assuming a critical and reflexive position. The eccentric position exists in feminist conscience and manifests itself as a subjective and political practice that allows feminists to manage two important tasks: first to describe the sex/gender system and its way of functioning, and second to expose its mechanisms of engendering bodies and lives, thus questioning its nature of truth (Lauretis, 1990; Navarro-Swain, 2002; Vianna, 2005).

By questioning and rejecting dominant theoretical models that reflect androcentric values and positions, and based on the principle that every discourse is historical feminists propose the construction of a situated knowledge. Haraway (1995/2007) defends an embodied and situated knowledge, constituted of critical, partial perspectives that can be situated. The author says:

 “The alternative to relativism is partial, locatable, critical knowledge sustaining the possibility of webs of connections called solidarity in politics and shared conversations in epistemology” .(Haraway, 1995/2007 :117)

Feminists believe that it is possible to articulate emancipatory values, in both theories and practices, to think women and men, in ways that transcend the coercive ideologies that are reproduced by gender stereotypes (Harding, 2003; Navarro-Swain, 2000).

Feminisms pose questions to the area of clinical psychology. The challenge is to deconstruct the idea of a neutral, impartial and apolitical body of psychological knowledge. The feminist critique informs us that to adopt a clinical theory, to plan an intervention or to do a research is not a neutral action. It is in fact a political and ethical action that demands social positioning and social compromise. Gender affects subjectivity, relationships and the construction of knowledge in psychology. We, therefore, argue that gender must be taken into consideration in projects geared towards the promotion of women’s mental health.

Gender and mental health: a challenge for Psychology

The intention behind promoting a gender debate is to deconstruct the binary dimension present in dominant systems of ideology and of knowledge. The sex/gender system, for instance, sustains the naturalization of masculine and feminine in the culture. Its naturalized evidence is maintained in all social dimensions, thus determining roles and actions that justify socially what is attributed to the biological sexes (Medrado & Lira, 2008; Navarro-Swain, 2000, 2002, 2003, 2005; Rubin, 1989).  Adopting a feminist perspective helps us to deconstruct what seems to be evidence (Borges & Spink, 2009).

The dichotomist and polarized way of thinking about sex/gender conceive men and women as opposites that maintain a relationship based on a dominance-submission logic. Scott (1995) argues that the justification for such polarity includes the belief that men and women are biologically distinct and therefore, the relationship between them derives and is marked by such distinction. This relational perspective presupposes a complementarity, in which men and women have a determined role.

Navarro-Swain (2003) affirms that according to social expectations for the sex/gender system, in order to be truly a woman, it is not enough to be young, beautiful and seductive - it is essential to be fertile, for in this resides the feminine essence. A feminist analysis makes clear that maternity has been institutionalized as the core of feminine subjectivity. Such perspective towards maternity is the result of heterosexual attributions of meanings to the female body. It imprisons women’s ways of being and limits their desires (Navarro-Swain, 2000. 2005; Pinto, 2004).   

Insofar as gender represents a cultural category assumed by the body, it is not possible to affirm that it derives naturally from the sex. On the contrary, such relationship implies a radical discontinuity between the biological bodies and the cultural attributions they receive (Butler, 2003). Pinto (2004) also questions the arbitrary definition of characteristics attributed to the bodies in society and its implication on male and female behavior.

According to the author several cultural behaviors of men and women do not fit the hegemonic description of masculine and feminine. Such incongruence becomes a serious political problem, especially if one asks about how to deal with issues of power, when it becomes evident that certain bodies, and we could add - certain behaviors, are excluded. Haraway (1995) points out that we need the power of critical theories to chad light on how the meanings of bodies are constructed, in order to not deny such meanings, so that we can live in bodies that can survive and have a future.

This critical understanding of the body articulated to the sex/gender system allows us to think that if gender is considered only as a tool to represent sexual binaries it loses its subversive power. Gender can only maintain its utility as a category of analysis if it incorporates questioning and the possibility of being subversively deconstructed in order to denaturalize its perverse binary correspondence, thus allowing us to understand how bodies are hierarchically classified in power relations. Rabinowitz and Martin point out:

“Critical frameworks are being erected throughout the social sciences to address the inadequacies of traditional research methods, particularly as they define and attempt to solve social problems. They reveal that the dilemmas faced by feminist psychologists and psychologists studying gender are not unique. The marginalization of critical approaches within the discipline of psychology has ensured that their common dilemmas and achievements remain obscure” (Rabinowitz and Martin, 2001: 29).

The fact is that gender is a category often ignored in theory, research and practice in psychology as a whole, but especially in clinical psychology (Diniz, 1999, 2003, 2004).  Gender is used inappropriately as a synonym of sex in research that deals with issues regarding women and men and the analysis and discussion of the data does not offer a gender analyses about the social construction of masculine and feminine identities. Rabinowitz and Martin (2001) argue that the study of gender is considered critical to understand and to improve the circumstances of life of all people, but especially of women and girls of all ages. By not given the necessary attention to gender questioning and reflection psychology runs the risk of reiterating gender stereotypes.

Medrado and Lira (2008) criticize the apolitical use of gender as a category of analyses. They remind scholars that the usage of the category is not restricted to issues regarding women, but it is also important when discussing men and masculinities. The authors understand that a common point in gender analysis is to encompass and give attention to a feminist critique and reflection. Scott (1995) also speaks of a lack of attention to gender analysis among authors that discuss social realities.  It is important to mention that a gender analysis includes a relational dimension, but not focused in the idea of complementarity - on the contrary, the intention is to show that the distribution of power between the sexes/genders is asymmetric. To the extent that a gender analysis emphasizes the differences, it reinforces and reinstates inequalities.

It is our contention that to ignore the contributions of a gender analysis creates biases in research, and therefore, in the knowledge that derives from such studies. The same applies for clinical practice and teaching. The psychological literature - at least in Brazil - tends to focus on general subjects - children/adolescents/women/men, showing a disregard for the fact that there are many childhoods, adolescences as well as male and female experiences. In previous papers (Diniz, 1999, 2003, 2004) I have made the point that researchers, clinicians, professors and so forth need to break away from the idea that there is a generic experience that encompasses all others.

To break away from the idea of generic subjects, generic experiences remain a challenge for Brazilian Psychology. The usage of a generic subject also poses a threat to the development of mental health research and interventions. The analysis of the feminine condition as a risk factor for mental health has been the focus of my attention in previous as well as more recent papers (Diniz, 1999, 2003, 2004, 2011, 2013).  The inclusion of a gender analysis in mental health allows us to reflect about many aspects of the feminine experience that are affected by social, economic, and relational factors along the life cycle. The differences in social conditions between men and women cannot be ignored, since they generate different risk factors for men and women´s mental health.

To understand the interactions between gender and women’s mental health has become a challenge and a choice for us. We realize that it is not the only starting point available, but we believe that a feminist critique and a gender analysis offers us important tools to problematize women’s realities and its impacts on their mental health. To put gender visibility at the center of our understanding of clinical psychology is to create ways to name all forms of inequalities between men and women and to understand its effects on mental health. It implies subversion in the usage of language to speak of the psychological difficulties of women by taking into consideration their distinct social realities. At the same time, it implies facing the challenge to avoid using diagnostic categories in an uncritical manner, since such usage could be to the disadvantage of women. 

It is our understanding that the usage of diagnostic categories needs to be accompanied of critical reflections that take into consideration discourses and practices regarding the ways men and women view and experience the world (Boyle, 1997). It is important to give especial attention to the ways in which social constructions mold identities, interpersonal relationships, marriage and family life imposing parameters, values, rules, roles that carry with them the potential and the power to imprison men and women to normative parameters that can generate physical and mental illnesses (Aguiar, 2009; Angelin, 2009, 2004; Alves, 2013; Medeiros, 2010; Miranda-Martins, 2006; Oliveira, 2007; Praciano, 2011; Ramos, 2011, Santos, 2008; Vianna, 2012).

  Nogueira (2001) points out that a Feminist Psychology, with its theories, methods and practices about and for women, is a survivor of the process of marginalization of gender in the area of Psychology. The marginalization of gender as a category of analysis manifests itself in many ways: it can be ignored, minimized, seen as absurd, or discounted as irrelevant, which results in an absence of gender analysis in productions of the area. Such disarticulation weakens the debate regarding gender issues in Psychology, since for the most part, gender is only accepted as an element to be accommodated to existing theoretical systems, in total disregard for its implications.  This posture neutralizes the more radical impact that a gender critique and analysis can bring to area of Psychology (Azeredo, 2010; Boyle, 1997). We share with the above mentioned authors the idea that the minimization or even the non-inclusion of gender as a category of analysis constitutes a fundamental obstacle to the development of feminist theories in Psychology.

Azeredo (2010) argues that to theorize about gender means to accept “encrenca” – a word in Portuguese that reflects the idea of gender trouble. It is seen by the author, a respected Brazilian feminist who works in the area of Social Psychology, as the word that best expresses what gender does to people, besides causing “trouble”. What is being emphasized is the fact that once a person understands the depth and the implications of adopting a gender and feminist perspective, a person/scholar cannot go on seeing psychological theories and processes in the same way.  The author acknowledges that given the complexity implied in adopting gender as a category of analysis, there is a general tendency to attempt to domesticate it, to limit its scope and bring it closer to what is familiar to us, to what is known.

There are many consequences in taking gender into consideration. In the area of Psychology one must review critically the processes involved in the constitution of subjectivity, taking into account social and political processes. Azeredo (2010) points out that this has been a blind spot in theorizations in the field. The prevalence of a Cartesian and positivist perspective in the discipline might be one of the factors that can justify the exclusion of gender from the scientific field of Psychology. The main argument used is that it is a political category, therefore considered as non-scientific.

The fact is that gender and social inequality are categories that have been kept at the periphery of the construction of theories and practices in clinical psychology in Brazil. The works in the area reveal their traditional background: for the most part they are based on androcentric, ethnocentric, heterosexual, classist and elitist elements. Theoretical constructions as well as practical interventions were and still are strongly seen as impartial. Their proposer’s argument is that they strive to be neutral in order to gain scientific credit (Boyle, 1997; Diniz, 1999, 2003, 2004, 2011, 2013; Vianna, 2005; Vianna & Diniz, 2006a, 2006b).

In an attempt to create resistance towards the invisibility of gender in psychology several Brazilian researchers and professors (Alves, 2013; Andrade, 2014; Azeredo, 2010; Diniz, 1999, 2003, 2004, 2011, 2013; Nascimento & Zanello, 2013; Narvaz & Koller, 2006; Vianna & Diniz, 2006a, 2006b, 2014; Zanello, 2014) have been trying to contribute to the field by including gender in their teaching, research, extension projects, clinical supervision. The idea is to raise the curiosity and interest of students towards the topic, by pointing out that to build a strong academic and professional background one must understand the gendered nature of subjectivity and social relations and the political dimensions of all the sciences, psychology included.

Diniz (1999, 2003, 2004, 2011, 2013) argues that the inclusion of gender as a category of analysis plays an important role in differentiating the factors that affect men and women’s mental health. The contention is that gender prescriptions and stereotypes have an impact on how each person experiences mental suffering (Borges, 2009; Porchat, 2010; Zanello, 2014). Several issues related to hegemonic ideas of masculinity - homophobia, aggressiveness, work dependency, relational difficulties with women and children, difficulties to acknowledge one’s own feelings and needs, appear in men’s descriptions of their sufferings (Aguiar, 2009). 

Women’s portrait of their suffering is marked by contradictions. Women’s social roles give them a heavy burden. On one hand they are seen as playing a fundamental role in society for giving birth and caring for the children, for providing emotional security, for caring for the elderly, in sum, for being responsible for the maintenance of families. On the other hand, they are treated as marginal beings by society: they are exploited in the labor market - they receive less pay then men for the same jobs; they are underrepresented in instances of power; and only recently they have become the targets of social developmental projects.

These contradictions affect women’s sense of identity. It is common to hear about feeling guilty if something goes wrong with the children, the marriage or the family; about feeling devalued if they do not live up to the standards/expectations of the husband, the families or the social group; or about feeling exhausted  for carrying a dual worker load. The combination of all these feelings put women in danger and obviously affects their mental health (Lima, 2009; Medeiros, 2010; Praciano, 2011; Ramos, 2011; Sommers-Flanagan & Sommers-Flanagan, 2006).

One must always remember that in the history madness, women’s relationships with their bodies and sexualities became the target of medical and psychiatric interventions. The common belief was that women’s physiology predisposed them to mental illnesses. Menstruation, pregnancy, giving birth, the exercise of maternity, and menopause were frequent targets – these phases of the life cycle were all used to diagnose women’s mental illness. Feminine madness is inscribed in their bodies. The feminine attributes that escaped sexuality and reproduction, were used to legitimate women’s submission to a rigid set of rules and values that were used to keep them domesticated and attached to their roles as wife and mothers (Engel, 1997; Foucault, 1999; Vianna, 2005).

Unfortunately, women’s reproductive functions continue to put them at risk. Girls of all ages are subject to pressures and discriminatory practices that aim to control their sexual behavior in the name of purity and the preservation of chastity (Diniz, 1999). Young women have their identities and lives regulated by social discourses around beauty, thinness, and keeping themselves desirable in order to catch men.  Older women are pressured to remain “young looking” at all costs. The fact is that maternity continues to be at the center stage as an organizing process of women’s identity. It is seen as an essential part of the feminine condition, and therefore it has been universalized. Although maternity has been questioned and problematized by feminism, the association between women, maternity and care is difficult to break.

Depression is another risk factor that affects women’s mental health. It ranks as one of the most frequent disorders present in women’s lives, together with affective disorders, eating disorders, agoraphobia, generalized anxiety and anguish. Women also appear as the social group that is more willing to seek professional help and to socially accept their diagnosis. They are the group that receives more prescriptions of tranquilizers and anti-anxiety medications (Carvalho & Dimenstein, 2004; Herranz, 2001; Paltiel, 1993; Zanello, 2014). It becomes evident that women pay a high price for conformity towards prescribed gender stereotypes and social expectations. Zanello (2014) in her research on women’s mental health points out that complaints around marriage and relationships are common. She calls attention to the fact that men’s silence around marriage and family life or even feeling depressed does not mean that they are not affected by these issues - they are not allowed to talk about it. Gender prescriptions have a role in this silence.

It is important to mention that social conditions such as marginalization, discrimination, poverty affect women’s mental health. Women are also exposed to several types of violence - marital, sexual, psychological that increase the risk for depression and isolation (Diniz, 2011, 2013). Characteristics of domestic labor, such as repetitive and excessive work load, isolation, loneliness, lack of free time, no remuneration and little or no recognition from family members are also risk factors that affect women’s physical and mental health (Diniz, 1999, 2011, 2013; Herranz, 2001; Santos, 2008; Santos & Diniz, 2011). 

After presenting this broad view of risk factors that can affect women’s mental health, it becomes clear that the roles of women in families and society constitute mental health risk factors. The psychosocial nature of their anxiety or depression is evident. We believe that the adoption of a gender and feminist perspective is fundamental to understand the complexity of women’s experiences. Based on this assumption, we discuss briefly the importance of gender in the process of designing research or planning interventions regarding women’s mental health.

A Gender and Feminist perspective on research and mental health practices

  Feminisms have highlighted the importance of giving voice to women. They have also called attention to fact that theoretical perspectives are not neutral. Researchers are not neutral as well - we carry to our projects our personal histories and our social and political positions. Wilkinson points out:

 “[…]particular theoretical perspectives underpin the kinds of questions feminists psychologists ask, the kind of methods we use to pursue these questions, the kinds of analyses we undertake, the kinds of answers we obtain”( Wilkinson, 2001 :17)

The personal, and we would add, the academic and the professional are political” remains a valid assertion to this day.

We believe that we have the responsibility “to discover ways to make women’s voices heard, without exploring or distorting these voices” (Olsen, 2008, p.235). Adopting a gender and feminist perspective on research includes assuming the responsibility for the analyses of the data, that cannot be distorted to fit previous assumptions or generalized ideas about “women” since they reflect the experiences of women at an specific historical time, living under specific social contingencies.

As Haraway  points out a feminist investigation must reflect a situated knowledges’ perspective:

“All western cultural narratives about objectivity are allegories of the ideologies governing the relations that we call mind and body, distance and responsibility. Feminist objectivity is about limited location and situated knowledge, not about transcendence and splitting of subject and object. It allows us to become answerable for what we learn how to see” (Haraway , 2007 :583).

Knowledge production from this perspective is a discursive process, in which the position of the researcher is clear – it is marked by reflexivity about his or her research or social intervention. Another important element is the analysis of power relations implied in dualities such as equality-inequality, male-female, and researcher-participant. It must also consider the social-historic period and its implications. Last, but not least, an important element is to promote a critical investigation of the research process (Olesen, 2008). Feminist researchers are invited to make use of their personal reflexivity, or in other words, to be conscious of their involvement with the investigation – the choice of the topic, methodology and the strategy used to analyze and reflect about the results and the products generated by the research (Neves & Nogueira, 2005; Vianna, 2005; Vianna & Diniz, 2006a, 2006b; Navarro-Swain, 2000, 2005).

In a feminist research the choice of method is fundamental. It is the procedure that the researcher will use to get to know the reality and the experience of the participants. The researcher is invited to reflect about who he or she is, what is his or hers involvement with the participants and the topic chosen, where lies the intersection between his or hers career and the objectives of the investigation, what are his values and beliefs regarding the theme and the research group (Neves & Nogueira, 2005; Nogueira, 2001).

Qualitative and quantitative approaches are equally valid in feminist studies, as long as the data analysis is donne in a non-sexist perspective (Bruschini, 1992; Narvaz & Koller, 2006). Feminist research is informed by politics understood not as a bias, but as an organizing element of subjectivity and all of all social relationships (Gonçalves & Pinto, 2011). It is also informed by examining gender at multiple levels of analysis. Rabinowitz and Martin  point out that

“[…]this perspective guides research by expanding the frame of analysis from individual difference to interpersonal, social, and cultural levels of explanation” (Rabinowitz and Martin , 2001: 31).

The researcher will get to know the experience of the participants and later will share his perspective on such experience with others. The fact that a research promotes exchanges with both lay and academic audiences, feminist research gives special attention to the location of the researcher in relation to the participants and the knowledge that he or she produced. He or she, must be aware of the consequences and implications of the research for the group investigated and for science in general (Narvaz & Koller, 2006; Neves & Nogueira, 2005).

Morrow and Hankivsky (2007) point out an important characteristic of feminist researches: they tend to privilege interactive practices and value diversity.  According to the authors this research perspective is also marked by an interest in calling attention to different experiences and realities with the intent to promote social change. Olesen (2008) presents another relevant point: feminist researchers should do research for women, not about women.

It is a challenge to ascertain that young researchers interested in mental health adopt explicitly a gender and feminist perspective regarding women’s health (Diniz,1999, 2003, 2004; Morrow & Hankivsky, 2007).  A feminist research involves a critical reflection about the participants’ reality and the knowledge produced about such reality. Those of us in academia face the challenge to show students, future researchers and professionals, the benefits of adopting gender and feminist perspective: it offers the tools that allows researchers to broaden the understanding of participants reality, by focusing on diversity, plurality and respect for differences. It also takes a firm stand against discrimination, such as looking at women’s needs, feelings and experiences as pathogenic. This broad vision of feminist research is made clear in Rabinowitz and Martin  affirmation:

“This approach recognizes that an individual´s gendered behaviors are part of interactions among men and women, structured by cultural norms and channeled and supported through organizational systems that reward individuals for engaging in behaviors deemed culturally appropriate” (Rabinowitz and Martin , 2001:.31).

One important dimension of doing research is the publication of the results. Articles play an important role in provoking thoughts and reflections that carry the potential of transforming ideas and ways of portraying realities. They contribute to social change. Diniz and Foltran (2004) did a research on a decade of publications of Revista Estudos Feministas - Journal of Feminist Studies, a Brazilian leading feminist periodic. They analysed articles from its first year – 1992 to its tenth year – 2002. Women had the majority of authorships (95%). Most of them came from the Social Sciences. The most frequently discussed topics were: sexual division of labor, reproduction, literary analysis and feminist theory.

The results also showed that Psychology contributed marginally in the publications – only 4%.  It became evident gender and feminism were not major subjects for scholars of the area during that decade. Another review of the national scientific literature regarding gender and health was done by Santos (2009). The results indicated a prevalence of themes in the areas of reproduction and contraception, followed by articles on gender violence - including domestic violence, marital and sexual violence, sexuality and health with a focus on STD/AIDS and work and health.

Both reviews show that the interactions between gender and mental health have remained practically ignored. Vianna (2005) points out that although research agendas and feminist publications in Brazil include the debate regarding health issues, the focus has been on sexual and reproductive health. Mental health remains a topic that has been hardly explored, especially if the criterion includes adopting a gender and feminist perspective. Looking at this scenario one could argue that the interaction between gender and mental health is yet to become a strong research topic.

Although the academic production is timid, publications that adopt a gender and feminist approach to look at mental health are growing in number. These publications play an important role in calling attention to the issue and in giving visibility to this area of gender studies. They provoke revisions of the theoretical and methodological approaches previously adopted and also call attention to the importance of articulating research and clinical intervention (Narvaz & Koller, 2006; Neves & Nogueira, 2005).

Gender and Feminist interventions in the area of Clinical Psychology have emphasized the usage of group interventions as an important tool in designing research-intervention projects geared towards women in different social and institutional contexts. The group promotes a collective exchange of experiences and becomes a protective factor for mental health (Coelho & Diniz, 2003; Diniz & Coelho, 2007, 2003; Vianna, 2005; Vianna & Diniz, 2006a, 2006b; Guimarães, 2009; Pondaag, 2009, 2003).

It is important to mention that group approaches have been and continue to be a strategy widely used by feminists.  The second wave of feminism had in the “conscience raising groups” an important asset to promote the exchange of experiences and ideas that could lead to collective action. The main characteristics of these groups were an equal distribution of power and the valorization of all forms of knowledge. Each and every woman’s voice and experience was valued and mattered. Latin American and Brazilian feminists were inspired by this experience of north-American feminists and adopted the methodology (Gonçalves & Pinto, 2011).

We have articulated research with group interventions in dealing with women’s mental health. We share the belief that this group approach besides being therapeutic carries the potential to promote personal growth and transformation as well as social change. We have been conducting groups in community settings such as health and mental health centers around the issues of gender violence - domestic violence physical, verbal, sexual, psychological and patrimonial violence, menopause, mental health, drug usage and alcoholism among women (Coelho & Diniz, 2003; Diniz & Coelho, 2007, 2003; Diniz & Pondaag, M. C. M., 2006; Guimarães, 2009; Pondaag, 2009, 2003; Vianna, 2012, 2005; Vianna & Diniz, 2006a, 2006b;).

Feminist therapy and intervention, as well as feminist research can encompass a wide variety of themes and strategies. They reflect the perspective of the clinician and/or researcher that builds the project. The aim is not necessarily to master one specific method or intervention technique but to be open to question and revise the ideals of objectivity and neutrality that have characterized knowledge construction. Feminist scholarship offers to those willing to become familiar with its perspectives a vast epistemological discussion and production. To become a gender and feminist clinician and/or researcher is the result of a process.  The person needs to be open to revising theories an practices regarding both research and intervention. Sommers-Flanagan and Sommers-Flanagan  point out:

“Feminist is simply someone who believes in the basic equality of women, and a feminist therapist is someone who believes and builds a practice according to feminist theories in psychotherapy. Feminist theories in general, and feminist theories in the area of mental health in particular have attempted to identify and to identify and to describe the forces and practices that are, in psychological terms, inherently prejudicial to women” (Sommers-Flanagan and Sommers-Flanagan, 2006: 212).

There are, however, some basic principles that the professional who wants to work with a feminist therapeutic perspective should consider. This therapist must understand the impact of gender roles and social expectations on both men and women. These aspects have to be taken into consideration when looking at clients “problems”. It is important to remember that those who venture to question dominant cultural values and models may be the object of discrimination and disregard. It is also important to recognize that changes result from reflection. Therapy, seen as a reflexive process, must help clients to gain awareness of the price they pay to ascribe to strict gender prescriptions, to understand how these prescriptions limits each sex, and to gain conscience about what needs to be changed for them to live a healthier and more fulfilling life (Sommers-Flanagan & Sommers-Flanagan, 2006; Alves, 2013; Zanello, 2014)

Psychologists who adopt traditional therapeutic models usually rely more on intrapsychic concepts. There is a tendency to focus on individual behavior in their practices and to try to help clients to conform to social prescriptions in order to keep marriage and family life stable. The therapeutic relationship is frequently based on differences of power and knowledge. Feminist therapists tend to focus on social processes such as gender prescriptions, power differentiations, inequality and oppression to understand behavior. They tend to value the voice, knowledge and the experiences of the clients. Therapists are facilitators of a dialogical exchange by asking reflexive questions (Narvaz & Koller, 2006; Neves & Nogueira, 2003).

We must confess that to identify oneself as a feminist scholar, researcher and/or practitioner is still viewed with prejudice in Brazil. However it is a promising and growing field of research and intervention in clinical psychology, more specifically in the area of mental health promotion and prevention. We understand that to assume a gender and feminist perspective/position is to face a lifelong project and challenge. We believe that adopting a gender critique and feminist approach helps create a therapeutic conversation that is based on dialogue, respect for the differences and on a political compromise to promote personal and social change.

Gender is a feminist concept that aggregates social and cultural meanings. It is an identity marker that reflects a binary understanding of the body and of subjectivity that are assumed to be in opposition. At the same time it carries an analytical power to question the roles and places ascribed to men and women in society. To adopt gender and a feminist critique as basic parameters that guide a researcher-practitioner’s work, is to be open to revisions of the premises that permeate psychological theories and practices. It indicates that such professional values the diversity and plurality of the experiences of the persons that come to him or her. 

To be a feminist and a clinical psychologist implies the adoption of a political view regarding all social relations, which translates itself in conducting research and developing intervention projects with a compromise to promote personal, relational and social change. The overall purpose of this paper was to broaden our understanding of   mental health and its impact on men and women’s lives.

Glaucia Ribeiro Starling Diniz
Graduação em Psicologia-Universidade Federal de Minas Gerais (1981); Especialização em Saúde Coletiva-Escola de Saúde de Minas Gerais/UFMG/FIOCRUZ (1983); Mestrado (1990) e Doutorado (1993) no Marriage And Family Therapy Program - United States International University, hoje Alliant International University, San Diego, California, EUA . Trabalha com Psicologia Clínica, Psicologia Conjugal e Familiar e Psicologia do Gênero. É Professora Adjunta da Universidade de Brasília, Departamento de Psicologia Clínica, Instituto de Psicologia. É docente permanente do Programa de Pós-Graduação em Psicologia Clínica e Cultura - PPG PsiCC/PCL/IP/UnB. Desenvolve pesquisas sobre a interação gênero, casamento e trabalho; gênero e violência; gênero e saúde mental. Coordenadora do NEGENPSIC e membro do NEPEM.

Cristina Vianna Moreira dos Santos
Doutora em Psicologia Clínica e Cultura (PPGPsiCC), UnB (2012). Mestrado em Psicologia, Área Clínica, UnB (2005). Graduação em Psicologia-PUC/Goiás (2001). Professora Titular do Curso de Psicologia e Supervisora do Centro de Psicologia Aplicada (CPA) da Universidade Paulista - UNIP/ Campus Goiânia. Foi Professora Convidada e Integrante do Programa de Direitos Humanos (PDH) da Pontifícia Universidade Católica de Goiás - PUC-GO (2012-2013). Possui experiência em atendimento, docência, supervisão e pesquisa em intervenção psicoterápica e Psicologia Clínica, e em intervenção psicossocial e Psicologia Social e Comunitária. Psicoterapeuta do Instituto de Desenvolvimento e Família - IDEF. Possui especial interesse em Processos Clínicos, Saúde Mental e Cultura, Intervenção em Crise, Sistemas Conjugal e Familiar, Processos Grupais, Direitos Humanos, Estudos Feministas e de Gênero.

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labrys, études féministes/ estudos feministas
juillet /décembre / 2014  -julho/dezembro 2014