Anne Gulland: Mental health problems—a gender divide

Anne_GullandFeckless, hysterical, neurotic, sluttish: these are just some of the adjectives used to describe female patients suffering from psychological illness in the book Good General Practice, an investigation into general practice published in the mid 1950s. [1] The author was Stephen Taylor, an eminent GP and civil servant whose views were typical of an age when it was still thought that women were biologically more prone to mental ill health than men.

However, at a seminar at the Institute of Historical Research in London recently, Alison Haggett, a historian at the University of Exeter, outlined her research, which showed that men were just as likely to suffer mental ill health as women. However, GPs either misdiagnosed them with some kind of physical condition or simply overlooked their mental health problems.

Haggett’s research was based on archival sources as well as oral history interviews with 15 GPs working between the 1950s and the 1980s. And it is the oral histories that reveal attitudes towards male mental illness that statistics cannot show. The GPs agreed that historically men with mental health problems presented—and have been diagnosed and treated—differently to women.

“Statistically, psycho-neurotic illness has always been more common in women than in men but when we look more closely we see that men cite ill-defined disorders such as backache or stomach problems or problems often defined as an illness with no organic cause,” said Haggett.

A female GP who had worked in the East End of London told Haggett: “Almost uniformly the first presentation and the first multiple presentations were usually physical symptoms… You got the feeling that some of this back pain was a metaphor for having a heavy load somewhere in their lives.”

Men presenting with stress-related symptoms were often treated for stomach problems as stress, prior to the discovery of the bacteria H. pylori, was seen as a major factor in the development of ulcers, Haggett told the seminar. In the 1960s new drugs were introduced which were known as “combi-drugs,” combining a gastric compound with a tranquiliser such as benzodiazepine. These were often prescribed to men where “anxiety” played a part in gastric disorders, but not included in recorded data for the prescribing of psychotropic drugs.

Men were also unwilling to have psychological problems recorded on a sick note, said Haggett. Numerous GPs told her that they would record mental illness as a physical illness “because that was more acceptable to their friends, their boss and everyone else.”

One GP said: “There was a double collusion. [Sickness] certificates were not representative of what was happening because the men didn’t want this labelled as psychological and the doctor would go along with it.”

A culture of masculinity meant that men with mental health problems were not always treated sympathetically by their doctors, their employers or their family and friends. One doctor, who diagnosed psychological illness within the framework of Second World War ideas, recalled: “I used to write on patients’ notes: LMF, which stood for lack of moral fibre. I realised how wrong I was—it’s not a decent diagnosis.”

Alcoholism, which was much more common in men, also tended to be treated as a physical problem, whereas among women it was treated as a psychological problem, said Haggett.

Haggett concluded the seminar by looking at the mental health of men in contemporary Britain. According to the latest data from the Office for National Statistics 78% of suicides in 2013 were among males and 22% were among females. [2]

“Today, men are much more likely to commit suicide and they are three times more likely to be come alcohol dependent. I wonder how far we have come?” she asked.

• This year’s Oral History Society conference focuses on the oral histories of medicine, science and technology and takes place on 10 July to 11 July at Royal Holloway, University of London. For more information go here.


1. Taylor, SJL Good General Practice: A report of a survey. 1954. Oxford University Press
2. Office for National Statistics. Statistical update on suicide. February 2015.
3. Wilkins D, Untold Problems: A Review of the Essential Issues of the Mental Health of Men and Boys. Men’s Health Forum. 2011.

Anne Gulland is a freelance journalist. 

Competing interests: Anne Gulland is a freelance journalist and the publicity officer (voluntary role) for the Oral History Society