Introduction to Gender Matters.
This article samples your interest in brief clinical observations.
Gardner and Jackson are both analysts trained at Columbia and both practicing in Greenwich Ct. for some decades. They note here that at their community general medical hospital and some outpatients, the staff and psychiatric patient responses (even demands) of the psychiatrist/psychoanalyst varies depending on the gender of the physician. But, Jackson and Gardner go beyond looking only at the overt gender of the physician: they reflect on how their upbringing and how they comport themselves also may contribute to the differential expectations of both staff and patients. This, in our view, is both thoughtful and courageous.
We hope that Dr Gardner’s and Jackson’s brief vignettes will elicit your comments.
N. Szajnberg, MD, Managing Editor
Gender Matters
Wynn K. Jackson, MD and Charles G. Gardner, MD[1]
Groups produce intense and primitive psychological phenomena studied by LeBon (The Crowd: A Study of the Popular Mind, 1896) in the nineteenth century, continuing with Bion in the twentieth, through Kernberg, who noted the responses to early, intense, and primitive transferences of psychiatrically sicker patients. While there once was a more robust literature on group and institutional phenomena in mental hospitals (Goffman, Maxwell Jones, Stanton and Schwartz, Bettelheim, Foucault), little is written today as psychiatric stays have become vestigial. We present our experiences over the past few decades as senior psychiatrists working in a small, prestigious general (medical) hospital to note gender differences in three areas: staff and patients’ responses to us and our counter-responses. We hope to elicit observations from colleagues.
First, nursing staffs in the general hospital seem to fear psychiatric patients and want the psychiatrist to get rid of or control these patients. Winnicott’s “Hate in the Countertransference” also describes how psychotic patients elicit fear (and hate) in staff. (Thomas Main’s 1956, “The Ailment,” describes a more complex reaction within staff to “special patients.”) While staff reactions have been studied in psychiatric hospitals when those had longer stays, we report on staff in a small community’s general hospital. Staff often demand that the psychiatrist come “right now” and “every day” or “transfer the patient right away.” This may escalate to angry complaints that the psychiatrist is not doing enough. But, we found that such demands seem to be more intense with the female than male psychiatrist.
Second, intriguingly, some patients develop intense complaints soon after starting an evaluation. Often the quality of these complaints is the same as the nursing staff’s: they demand that their symptoms be alleviated “right now” and
complain that the psychiatrist is not doing enough. Again, we found that such patients often are more strident with the female than male psychiatrist.
We hypothesize that the stronger reaction to female psychiatrists is a
function of the stronger tendency to activate a negative maternal transference,
particularly with hostile “paranoid-schizoid” elements. Such negative transferences are challenging to resolve, even in the more circumscribed consulting room.
Third, we have collaborated as colleagues for several decades and recognize that we tend to present as stereotypically male and female. We suggest here that both the staff and more character-disordered patients make differential demands upon us, possibly because we are differentially activating more classically paternal or maternal transferences. We do not believe that this has been studied in these kinds of settings.
We also have discussed our differential reactions to such demands by staff and patients. That is, we thought about how each of us might be contributing to the gender-differentiated demands by the staff (and patients).We both come from traditionally organized families and tend to respond in stereotypically male and female ways. Thus WKJ’s countertransference response to demands is to feel she should gratify them and sometimes to do so too much; CSG’s response is not to feel he should gratify the demands, but to feel that the staff or patients have gotten out of hand. As we discussed this over the years, we note that CSG’s “paternal” response presents with more equanimity; the staff and patients, in turn, seem to view him as a wise father rather than a depriving mother. WKJ finds that even when she is accommodating with both staff and these patients, they experience her as depriving, paradoxically; we wonder whether these patients are in the throes of a maternal negative transference, so their demands may always feel insatiable.
We wonder whether other psychiatrists/psychoanalysts have noticed these
differences. We speculate that these differences may contribute to partially explain why males tend to assume leadership roles in organizations and to see
sicker patients. In addition, these patterns may be explained by gender roles:
women tend to assume more responsibility for child care, therefore limiting their practices and administrative responsibilities.
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[1] Drs. Gardner and Jackson are graduates of the Columbia Psychoanalytic Center and in private practice in Greenwich, Ct.