July 5 juillet 10:15 – 12:15
Room NCDH–200
Chair:
Hélène Tessier
, Commission
des droits de la personne et de la jeunesse du Québec
Depression is a serious health problem in women, with prevalence rates twice that of men. A significant number of women who seek treatment for depression will not demonstrate a positive treatment response to antidepressant drug therapies. Predicators of response to specific types of antidepressants remain elusive. Research in the treatment of depression is hampered by the recognition that depression represents a heterogeneous spectrum of disorders. Previous attempts to subtype depression have been based on symptom clustering or in relation to a specific event, as in the case of postpartum depression. These attempts fail to adequately acknowledge the role of traumatic life events, either in the vulnerability towards developing depression or their impact on treatment response. This is the case despite strong evidence of the close relationship between serious stressors and depression in women. Indeed, the most common response to a serious stressor in women is depression. Combined psychological and neuroendocrine data will be presented to illustrate the need for mental health professionals to include historical questions related to traumatic life events and an assessment of whether those events have impacted on a woman’s health. In the face of new drug development based on neuroendocrine abnormalities associated with depression, it becomes even more important for clinicians to understand the impact of life events on a woman’s health. Evidence is accumulating that if the depression is part of a larger health issue related to posttraumatic syndromes, there is an increase in the complexity of symptoms beyond classical depressive symptoms and higher risk of antidepressant drug treatment failure in women. Being able to identify this subgroup of depressed women would improve our ability to combine highly targeted psychotherapies with drug therapies, thus avoiding adding to their often-overwhelming feelings of despair.
Severe anorexia nervosa is life threatening, raising various
dilemmas about the place of coercion in therapy. Treatment regimes adopt
different stances
about its place with a program. Australia’s federal system of
government offers a matching variety of regulatory agencies from which authority for involuntary treatment may be
obtained, including from family and ordinary courts, mental health tribunals,
and adult guardianship boards.
This paper explores differences in the policy and reasoning
adopted by these bodies (such as the weight given to the patient’s
choice, best-interest
protection from self-harm and principles of habilitation) and in their ‘style’ of discourse
(including deference to clinicians and parents). It will explore possible paradigms for establishing an optimal
approach to the resolution
of these difficult dilemmas.
‘No matter how deep the craving’, the law expects and implies certain standards for defendants. How does the law read disabled women’s bodies? What does this mean for women ‘diagnosed’ with Munchausen’s Syndrome By Proxy and charged with child abuse? What does this suggest about the legal concept of the Self, created in and through legal discourses? This paper explores the interface between medical and legal discourses about Munchausen’s Syndrome By Proxy. Through an examination of recent case law, both criminal and civil, I consider the ways in which judicial treatment of the syndrome ‘fits’ into dominant legal paradigms of voluntariness and contrition. I will consider the gendered assumptions and implications of the legal discourse on Munchausen’s. Drawing on recent feminist commentary on this subject, this paper critically examines the concept of the legal Self through a problematisation of the categorisation and legal treatment of Munchausen’s ‘syndrome’.
Pharmaceutical manufacturers owe a duty of care to patients to warn of product risks as well as benefits. For prescription drugs, the company discharges this duty by warning the physician, who is the “learned intermediary” between the drug company and the patient/consumer. Uncertainty in the science underlying innovative drug therapies creates difficult legal problems and these have a differential impact on women, certain racial groups and elderly persons. For example, lack of information about the long-term effects of a product undermines the duty to disclose risks by pharmaceutical manufacturers and health professionals. Where clinical trials have been conducted on samples unrepresentative of the population for whom the drug will be prescribed or where small sample sizes have precluded sub-sample analysis, data on differential adverse effects and efficacy will be lacking. Causation is difficult to prove in these cases. Particular drugs prescribed for psychiatric conditions are subject to these problems. The silicone gel breast implant litigation illustrates the difficulties of proof for plaintiffs who are unable, because of scientific uncertainty, to prove a causal link between their health problems and the medical device.
In many institutional health settings, patients, staff, and
administrators grapple with the question of patient sexuality. Health facilities
must create and maintain safe environments that meet the requisite standard of
care. They must also acknowledge that in many settings (particularly where
individuals experience extended stays of months or years), sexual expression may
be inevitable, and must be addressed in a respectful and dignified manner. This
paper will look at the historical regulation of women’s sexuality in mental
health and related settings, from a Canadian perspective. It will explore the
notion of a ‘right’ to sexual expression, and will also examine the capacity
of certain categories of disabled persons (e.g. those suffering from acute
mental disorder, the developmentally disabled, and the dually diagnosed) to
consent to sexual activity. Finally, it will evaluate the development of
comprehensive sexuality policies as an institutional response to the regulation
of women’s sexuality.
Health promotion seems to be the buzz word of today, but
what does it mean in the context of women’s lives? Working in health promotion
with women means understanding the complexity of women’s lives. Issues such as
violence, poverty, mental health and multiple roles are all experiences that
place women at high risk for using substances as a way of coping. The Ottawa
Charter for Health Promotion (World Health Organization 1986) defines health
promotion as “the process of enabling people to
increase control over, and improve their health.” The criterions to health are
no longer only disease prevention, but also must reflect the standard of living
or lifestyle of the individual. Many women are living in socioenvironmental risk
conditions such as poverty, low-paying jobs or unemployment and lack of
education or the inability to obtain one. A commitment to providing health
promotion/prevention services in the community stems from the resolve to help
women take control of the factors affecting their health and well-being,
preferably before substance misuse/abuse occurs. It also reflects the belief
that social change is necessary too, if women are to be able, well and whole.
The Health Promotion program at Amethyst Womens Addiction Centre has been
developed for a woman’s individual healing, addressing such areas as
self-esteem, anger, assertiveness, stress and wellness. The work being done by
the women in their communities is change-oriented. Change means opportunity, the
opportunity to have a healthier lifestyle.
The paper will address the programs currently provided by the Health Promotion program that mitigate against those conditions in women’s lives that put them at risk. Participants feedback provides further insight into the need and effectiveness of health promotion programming.
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