Cultural Factors Among Women with Serious Mental Illness

This chapter covers intersectional stigma, the overlapping, multiple levels of stigma and discrimination faced by women of color with serious mental illness, particularly with regard to racism, mental illness stigma, and misogyny. This chapter contains several case narratives of women of color with serious mental illness in order to demonstrate the impact of compounded levels of discrimination on their lives. The strengths, resilience, spirituality, and empowerment manifested by women with serious mental illness in overcoming the challenges of mental illness, racism, sexism, and daily life are discussed. Clinical recommendations are provided to facilitate culturally competent care with this group. The chapter includes a clinical strategies list, discussion questions, activities, and a clinical worksheet (“Cultural Strengths and Stigma Worksheet”).

Work and Class Among Women with Serious Mental Illness

This chapter presents the literature on women with serious mental illness and the intersecting experiences of work, class, poverty, and homelessness. This chapter includes literature that sheds light on challenges related to work, class, and poverty among this unique population, including a review of data that will explore these intersecting experiences. Research is presented on the mental health challenges for women in work. The effects of a serious mental illness for these women are explored in terms of how they can interfere with pursuit of work and financial wellness. The resilience of this group is discussed with regard to carving out meaningful work. This chapter includes several case narratives, a clinical strategies list, discussion questions, activities, and a clinical worksheet (“Work and Class Worksheet”).

Women’s Empowerment and Recovery-Oriented Care

This chapter introduces the Women’s Empowerment and Recovery-Oriented Care (WE-ROC) intervention, a model that integrates gender-sensitive and recovery-oriented approaches to clinical care for women with serious mental illness. The model focuses on the unique experiences that women with serious mental illness may encounter as a result of gender oppression and intersectional stigma. The origin of the model, the findings of a pilot study, and applications to clinical work with men with serious mental illness are presented. This chapter also includes a clinical strategies list, discussion questions, activities, and an evaluation worksheet that was used to elicit feedback from participants in the intervention.

Women with Serious Mental Illness, Resilience, and the Recovery Movement

This chapter reviews the recovery movement and the importance of its role in the mental health care of women who experience serious mental illness. This chapter explores the foundations of recovery and how this perspective seeks to decrease the impact of stigma and increase self-determination, while still recognizing the role that stigma and marginalization have played in women’s experience of serious mental illness. Literature is presented regarding the basic components of recovery in serious mental illness. Ways that recovery programs for people with serious mental illness can become more sensitive to woman’s issues are discussed. The biological and developmental concerns uniquely faced by women with serious mental health issues are addressed, as well as the value of a multidisciplinary, recovery-oriented treatment team. Case narratives, a clinical strategies list, discussion questions, activities, and a clinical worksheet (“My Recovery Journey”) are included.

History of the Mistreatment of Women with Serious Mental Illness

Chapter 2 reviews the history of psychiatric treatment of women with mental illness in the United States and Western Europe. The chapter covers ways in which labeling women as “mad’ has marginalized women, while those with actual psychiatric symptoms were mistreated or overlooked in mental health care. This chapter reviews relevant mental health trends in the treatment of women in the Western world for the past several centuries, from the mass hysteria of witch hunts, to gynecological surgeries believed to cure insanity. Critics of misogynistic treatments and their struggles for justice are highlighted. Themes in the mistreatment of women’s mental health that continue in the present day are also explored. Discussion questions and activities are included.

Introduction

This introductory chapter offers an overview of the book. It describes the need for this book given the lack of focus on women with serious mental illness as a whole in research and clinical training. The authors discuss the inspiration for developing this book as part of an initiative developed at the American Psychological Association. Issues of terminology and challenges with medical model language are addressed. The introduction also highlights the problems faced by women with serious mental illness during treatment. This chapter offers summaries for each chapter. The framework of the book from a gender-sensitive and recovery-oriented perspective is proposed.

Preventing Retraumatization of Women with Serious Mental Illness

This chapter discusses the increased rates of victimization among women with serious mental illness. The concept of retraumatization in mental health services is explained and an overview of the literature in this area is provided. Factors that contribute to retraumatization of women with serious mental illness in psychotherapy are discussed. Feminist frameworks and evidence-based treatments for trauma that are consistent with feminist therapy are explored. Clinical strategies for promoting an atmosphere of trust and safety for trauma survivors are provided. This chapter also includes case narratives, a clinical strategies list, discussion questions, activities, and a clinical worksheet (“Preventing Retraumatization Worksheet”).

Trauma and Sexual Objectification of Women with Serious Mental Illness

This chapter reviews the feminist framework of objectification theory to help providers understand the unique experiences of women who live in a culture that views and values their bodies as sexual objects. The literature related to sexual objectification is explored, as well as the empirical links to mental health problems. The literature on sexual exploitation of women who experience serious mental illness is also examined. The implications of these unique intersecting experiences of women with serious mental illness are discussed. This chapter includes two case narratives, a clinical strategies list, discussion questions, activities, and a clinical worksheet (“Gender Role Analysis Worksheet”).

Motherhood, Family, and Relationships for Women with Serious Mental Illness

This chapter discusses the impact of a serious mental illness on relationships for women, including motherhood, friendship, family, and dating. The chapter will explore the ways in which a serious mental illness can interfere with pursuit of these roles, impacting the woman’s sense of womanhood and personhood. Risk factors like intimate partner violence and custody loss will be examined. The chapter will discuss how motherhood and other relationships can serve as a context for recovery. The way in which women with serious mental illness navigate stigma and isolation to seek meaning in peer advocacy and other social roles will be presented. Case narratives, a clinical strategies list, discussion questions, activities, and a clinical worksheet (“Relationship Structuring Worksheet”) are included.