Abstract
21 staff members from an inpatient psychiatric hospital were interviewed about their perceptions of symptomatological differences between male and female inpatients. Analysis of the interview data indicated significant staff agreement on 4 of 9 rated contrast categories and trends toward significance in two others. Staff described females as greater management problems, showing more emotion, being more troublesome and uncooperative, having poorer contact with reality, and being less willing to participate in social interactions than their male counterparts. These consistently perceived differences, it is suggested, likely lead to different ward atmospheres and different staff expectations for male and female inpatients.
Observations made by visitors to psychiatric hospitals about the greater chaos of female wards, the under-representation of females among studies of schizophrenia (4), and previous research on differing symptom patterns of male and female psychotics (1, 2, 3, 5) suggest that female psychiatric inpatients may be more active and unmanageable than their male counterparts. As a first step toward examining this interesting possibility, we sought to discover if such differences were, in fact, perceived by those who have the greatest contact with psychiatric inpatients, namely, hospital staff.
Twenty-one staff members, representing a variety of hospital roles (nurses, physicians, psychologists, social workers, recreational therapists, stenographers), were queried about their perceptions via a minimally structured interview conducted by the second author. Subjects were asked simply if they felt there was any difference between male and female inpatients and, if so, what those differences were. Responses were recorded verbatim and later scored blindly by two undergraduate raters (one male and one female). Scoring required judging whether each contrast noted between men and women patients involved Affect (how much emotion was typically shown), Aggression (how actively patients moved against others), Cleanliness (how tidy or untidy with respect to personal appearance), Contact With Reality (how aware of what was going on), Insistence (how demanding with complaints and requests), Manageability (how cooperative and non-troublesome), Reactivity (how easy to arouse or provoke), Sexuality (how sexually provocative or suggestive), and Social Responsiveness (how willing to engage in social interaction). Agreement between raters ranged from a low of 50% (Reactivity) to a high of 100% (Affect), with over-all agreement being 80.2%. Only contrast statements for which both raters agreed on the scoring were included in the final data.
The attribute most often used to contrast male and female patients was Affect. Of our 21 interviewees 16 used this distinction, and all 16 agreed that females tended to be more exaggerated in their affect (binomial p < .001). Manageability was the second most used contrast category (13 interviewees), and again all were in agreement, reporting that females were more unmanageable and uncooperative (p < .001). There was also significant, although non-unanimous, agreement that females were in poorer contact with reality (8 of 10 interviewees using this contrast category, p < .05), less socially responsive (8 of 10, p < .05), and less careful with personal appearance and hygiene (6 of 7, p < .06). There was also a tendency to perceive females as more pushy and demanding (7 of 9, p < .10).
Consistent with previous findings, staff perceived female inpatients as more troublesome, unattractive, and hard to manage than their male counterparts. Whether these perceived differences are “real,” natural ones, the consequences of social stereotyping, or merely biases in the eyes of the beholders we cannot say from these results. What is clear, however, is that hospital staff, from stenographer to psychiatrist, were relatively consistent in the sex differences they reported and that their perceptions, accurate or inaccurate, are likely to have important practical consequences. For example, it is likely that a female patient may receive a somewhat different welcome than a male patient upon entering the hospital. Likewise, she may be exposed to a very different ward atmosphere. Finally, it is not hard to imagine a self-fulfilling prophecy situation, where staff expectations, communicated through ward policies and staff reactions, could help create or perpetuate different male and female behavior patterns.
These findings are, at present, limited to a small staff sample from a single inpatient unit. It will be the task of future research, already in progress, to test the generalizability of the current findings and to determine the full implications of the perceived differences between male and female inpatients, as well as to discover the cause or causes for such perceived differences.