Thread:
Depression and anxiety disorders occur more frequently in women & girls compared to boys & men, with estimates as high as 2:1. I have been wondering how much of this difference is attributable to misogyny and sexism (working with @kate_manne's definitions here)
(1/n)

A few points up front. (1) I do not have any answers to offer, this is essentially me wondering out loud. (2) This is from a psychiatrist’s perspective. (3) I am not going to get into ascertainment issues i.e. are women more likely to be diagnosed with depression & anxiety
(2/n)

(4) Such differences in prevalence are nearly always multifactorial (biology & environment). I am wondering how much misogyny and sexism contribute to this multifactorial causation. Given this particular focus, hopefully we can avoid whataboutery
(3/n)

Finally,(5)Needless to say, this is not a novel consideration in any way (see article by @JessicaValenti below), I am just going to try and specify some aspects of it in more detail.
(4/n) https://www.theguardian.com/commentisfree/2015/jan/26/sexism-is-making-women-sick

I am going to use @kate_manne’s definitions: sexism justifies and supports patriarchy and its structures, misogyny enforces them. So in patriarchal societies women are subject to structural inequalities and discrimination on the basis that they are women (sexism).
(5/n)

They are subject to various norms & expectations and penalised for ‘violating’ these. They experience hostility and often hatred for being/existing in a man’s world i.e. you shouldn’t be here (e.g. in the boardroom) or you should only be here in particular roles (misogyny)
(6/n)

Both sexism and misogyny are involved when one considers the abuse of and violence towards women. Experiences of adversity and trauma are major risk factors for depression, anxiety and other mental illnesses. However I am not going to examine these here.
(7/n)

This is not because they are not important but because their importance is already clear.
At this point in the thread it occurs to me that I cannot think of a suitable abbreviation for sexism & misogyny or misogyny & sexism*.

*M&S is problematic, the reverse more so.
(8/n)

What I want to think about is not:
Sexism & misogyny -> (recognised*) trauma -> depression & anxiety

But instead:
Sexism & misogyny -> depression & anxiety

*forms of trauma that are recognised risk factors for mental illness
(9/n)

Of course this would actually be:

Sexism & misogyny -> (consequences) -> depression & anxiety

Let’s examine what the possible consequences or intermediate factors might be.
(10/n)

One important & relevant point is that the gender differences in depression & anxiety emerge in adolescence. This certainly points to an important contribution of biology (puberty, sex hormones) but also environment (e.g. social and emotional impact of early puberty).
(11/n)

The above are known. But coincidentally, the impact of patriarchal structures, norms and expectations which affect children’s lives from very early on, also become more marked with puberty & adolescence and this is a major step change.
(12/n)

What are the possible ways in which sexism and misogyny might contribute to depression?
I am considering here a situation in which there are no massive structural inequalities such as lack of access to education/healthcare/work.
(13/n)

1.Increased risk of abuse/violence/exploitation i.e. living with the near constant threat of real danger (see @jessicavalenti article above)
(14/n)

2.Forms of trauma from forms of behaviour that have been wholly or partly normalised (‘It’s just boys being boys’).
(15/n)

Partly because of this these forms of trauma are likely to occur repeatedly, are difficult to call out and will be repeatedly dismissed/minimised.
(16/n)

Examples include: verbal hostility, sexist and sexual remarks/jokes, dismissive and patronising treatment, violations of personal space, violations of bodily privacy (e.g. physical contact without consent).
(17/n)

3. Under-recognition and denigration of one’s value, skills, expertise, knowledge
4. Under-recognition and denigration of one’s aspirations: ‘how you should be’ (misogyny) and ‘what you can be’ (misogyny & sexism).
(18/n)

5. Having to meet higher standards/expectations and knowing that this is solely because of one’s gender.
6. Having little room for and receiving unduly severe punishment for mistakes and failures.
7. Self-doubt and impacts on self-esteem consequent to 4-6.

(19/n)

8. Suffering the continual indignity of being treated less well than a boy/man, of having to work hard for what others get for free.
9. The constant fight to be present in a man’s world and the flexing and accommodating required to prevent misogynistic wrath.
(20/n)

10. The expectation (and often the inevitability) that one will provide emotional and physical labour.
11. The expectation and inevitability of transactional exchanges: needing to provide feminine coded goods to get access to commodities that men receive for free.
(21/n)

12. Having to put in greater effort for, and the lower likelihood of, success/achievement.
13. Living in a world that does not recognise even your physical needs, let alone the indignities and disadvantages it subjects you to.
(22/n)

14. The impact of failures that are related to systemic factors but are experienced as individual failures.
15. The loss of/exclusion from opportunities.
16. The reduced chance of being able to fulfill one’s potential/aspirations.
(23/n)

17.The significant additional cost incurred in managing all the above.
https://twitter.com/HZiauddeen/status/1303836408289861633
(24/n)

I am sure there is a lot that I have not thought of so please add stuff on. But even just with this, it is easy to see how considerable the mental impact of living with sexism and misogyny can be.
(25/n)

What would one need to study these factors?
1. Measurement: we’ll need tools that can capture the required level of detail.
2. Longitudinal examination: many of these factors enter the lives of girls very early and persist to varying degrees across their lives.
(26/n)

3. Control groups: where does one find a non-patriarchal society that would be reasonable comparator? One option would be to stratify by exposure and look for a dose response effect.
(27/n)

Please do comment/correct/make suggestions, they will be much appreciated.

Finally, how can we intervene? Simple:
1. Dismantle the patriarchy.
2. Repair the damage done.
(n/n)

END

PS: Most of those 17 possible factors are not unique to sexism & misogyny and could apply to other forms of discrimination such as racism.

Thanks @matthewrbroome! Replying to your tweet here to keep continuity with the original thread @kate_manne @lfoulkesy
https://twitter.com/matthewrbroome/status/1362674215900618757?s=20
(1/n')

In terms of empirical testing, I have given this some thought. My own view is that we should address misogyny and sexism (and other forms of discrimination) as public health and societal issues and there are plenty of reasons to do so for a better world @IanDunt
(2/n')

This is the overarching position from which I consider what the purpose(s) of empirical research into this issue would be and therefore what kind of empirical research would be useful to. To my mind the purposes are:
(3/n')

1. Is there an association and what is the magnitude? (I don't there is any way there could be no association but that is not a scientific approach). This would be important for ascertaining the environmental contribution (incl interactions with biology) to illness.
(4/n')

This would be about knowledge (he says confidently to a philosopher), not knowledge necessary for change but may help the fight for change.

2. Does it give us evidence and models for intervention?
(5/n')

As above, I think the interventions would be more at a societal level but the prevalence of depression and anxiety may be a useful outcome variable that we could look at in our field.
(6/n')

Some thoughts on purpose one and using observational data for this. So what we're looking to see is if some of the variance accounted by the gender variable is actually better explained by the latent variable of sexism and misogyny.
(7/n')

However we may not have many measured variables at the individual level that will allow us to capture this latent variable in extant data. Perhaps one way might be to look at indicators of gender inequality at regional/national level but this would be at group level.
(8/n')

Some possible indicators:
1. Gender pay gap
2. Levels of female educational attainment & employment attainment.
3. Maternity leave & shared parental leave provisions.
4. Distribution of women in the workforce.
5. Level of child and elderly care provision
(9/n')

6. Maternal mortality
7. Ease of access to contraception and abortion
8. Levels of abuse and violence against women
9. Legal frameworks for protection of women and criminal penalties for crimes against women.
10. Ease of access to support for victims of violence/abuse.
(10/n')

This isn't exhaustive but these are examples of regional/national level indicators of sexism and misogyny that I think could be examined across different regions and countries to see how much of the variance apportioned to female gender could be explained. More later.
(n'/n')

Some additional factors to add in to the original 17:
18. Being judged by your attractiveness no matter what you achieve, and losing that small amount of status once your appearance fails to conform to what is considered sexually attractive (from @lollyfoot)

19. Limitations on one's agency in one's own life: what you can wear, where you can go, etch (from @JoshuaFraser9)
20. Objectification: disregarding one's thoughts and feelings (from @chocogirlcat)

Btw, if anyone is interested in studying this, please feel free to get in touch or just take it and run with it (if you could include an acknowledgement then I could add it with the other scraps I have to present at the REF)