Women’s Mental Health

Adapted from my capstone.

Capstone Advisor: Dr. Darlene Cyrus-Blaize

Marshall, K., (2025). The Psychological Outcomes of Self-Silencing in Women as Compared to Men and Emotion-Focused Therapy.

(Except for where there are additional citations)

  • Women have historically had higher rates of mental illness compared to men (Maji & Dixit, 2019).

    The State of Mental Health in Canada 2024, a publication from the Canadian Mental Health Association (2024), has found that:

    • Women tend to have worse mental health and are more likely to have a mood or anxiety disorder than men.

    • Women from non-majority groups (e.g., LGBTQIA+, Indigenous women) and women in poverty (e.g., single mothers) are at higher risk of having worse mental health.

    • Women who sought help were less likely to have their needs met compared to men.

why does this matter?

  • Mental illness impacts a person’s vitality or how much they are able to enjoy their life and feel satisfied with their life experiences.

  • Mental illness has a big impact on money.

    The treatment and requirements for accommodations or flexible work schedules can impact a person’s earning potential and disposable income.

    For example:

    • If you struggle with mental illness, you might need a flexible work environment with benefits. This may limit your options, and you may require more unpaid time for sick days and appointments to maintain your mental health.

    • To get better, you may decide to undergo treatment, which is expensive and time-consuming.

  • Mental illness can increase dependence.

    The symptoms and treatment of mental illness can make you more dependent on support from your friends or family to get better, to navigate symptomatic days, and to attend appointments for treatment.

  • If women have higher rates of mental illness and this impacts their ability to work regular jobs and earn as much money as their healthier peers. They will have less money and their ability to earn as much money as their peers will be reduced.

    Why is this important?

    Money offers agency and decision-making authority.

    Money is important as it gives you opportunities for further education, occupational advancement, and greater treatment options.

    Money offers you with the agency you require to leave unhealthy situations and to create new opportunities that foster health and happiness.

    Money gives you a say in your relationships, and it allows you to take up space in the rooms that have traditionally valued women when they are compliant, submissive, uncertain, self-less, and small.

what are the impacts for women?

  • Gender norms are unwritten rules about how men and women should look, what they should value, and how they should behave in society. It is easy to assume that gender norms are natural and based on biological differences between women and men (Burns, 1996; Guy-Evans, 2023).

    There are some differences between men and women that exist because of these differences in their biology and physiology (e.g., hormones).

    That said, humans are a lot more alike than once thought, and a lot of differences between men and women come from how they are taught to behave in ways consistent with their gender.

    Before children are even born, society defines what is acceptable and desirable for the gender they are assigned at birth based on their biological sex (that is, male or female).

    For example, if your parents knew that you would be a boy before you were born, they may have described your behaviour in ways that aligned with your gender. In this case, they might have highlighted your ‘strength,’ ‘frustrations,’ or ‘rebellious or independent nature.’ If you were a baby girl, you may have been described as ‘sensitive,’ ‘emotional,’ ‘sad,’ or ‘sweet.’

    As a child grows, the people around the child will often highlight, encourage, and reinforce behaviours that align with the norms and standards of their assigned sex. That child may also be criticized, shamed, or punished when they act outside of the desirable gender norms.

  • Gender norms and rules about how to behave in relationships can simplify things for us humans. Gender can give us a sense of belonging.

    The problem is that gender norms maintain women’s powerless position in society and in their romantic relationships.

  • Money gives you agency, power, and decision-making authority. Money is important for creating meaningful change.

    The problem is that if more women than men are affected by mental illness, and they have less money because of their mental illness, then as a collective, women will have less money and decision-making authority to create opportunities, policies, and stories where women’s rights, women’s needs, and women’s voices matter.

    Women as a collective need more decision-making authority to be able to bring about change that would better support the mental and physical well-being of women.

  • Being logical, rational, or smart has often been viewed as better than being emotional.

    Women, because of their hormones, have been seen as more emotional than men. It is common for women to be described as ‘crazy,’ ‘hysterical,’ ‘irrational,’ or ‘PMS-ing’.

    While there may be some differences in how emotions are expressed, there are no differences in how women and men experience emotions.

    These views that women are overly emotional, irrational, or hysterical have been used to dismiss the concerns and complaints of women.

    The link between women and emotions and men and rationality is so strong that researchers, such as Pavco-Giaccia et al. (2019), have found people to link the words “men and reason” and “women and emotion” without even realizing. This is called ‘gendered rationality.’

    The problem is that if women have higher rates of mental illness than men, the symptoms of mental illness may be used to support gender stereotypes and bias that affect how much we believe and support the knowledge, lived experiences, and concerns of women.

how can this happen?

  • Self-silencing, or not speaking up, is a strategy women use to avoid conflict and maintain harmony in their relationships. Women also silence themselves so they can be seen as a “good woman” by others.

    Self-silencing is like an inner voice that criticizes and shames actions that don’t meet society’s expectations.

    There are four dimensions of self-silencing:

    1) Externalized self-perception is how much a person’s self-evaluation is based on external standards of female goodness.

    2) Care as self-sacrifice is how much a person prioritizes the needs and wants of people they are in relationships with to maintain relationship security. People who do ‘care as self-sacrifice’ believe that sacrificing what they need, want, or value is a way of showing love or care for another person.

    3) Silencing the self is how much a person pushes down their thoughts or feelings to maintain harmony and avoid conflict in a relationship.

    4) The divided self is how much of a mismatch is felt between a person’s true values, beliefs, and characteristics and a false version of themselves they present to others.

    Negative outcomes from self-silencing in women include:

    • depression

    • worse recovery from depression

    • disordered eating

    • rejection hostility

    • poor relationship quality (reduced commitment and satisfaction)

    This list is not exhaustive. Other outcomes have been identified like IBS, fibromyalgia, and worse cancer treatment outcomes. I have not included those because my focus has been on mental health outcomes.

    Some results, like those about cancer treatment outcomes, are weak because they have been based on ‘care as sacrifice,’ which is not very reliable. A better measure for ‘care as sacrifice’ is needed to validate these results, as it is thought that people high in ‘care as sacrifice’ may have worse treatment outcomes because they have difficulty prioritizing their own treatment and self-care as they manage a cancer diagnosis.

    Men are also affected negatively by self-silencing.

    Men often report higher levels of self-silencing than women, but the link between self-silencing and psychological outcomes are stronger for women than men.

    It’s not possible to know for sure, but this difference may be due to:

    • women’s powerlessness in society

    • the impacts of gender bias (e.g., men may be more likely to be believed because they are assumed to be more reasonable)

    • women being defined by their relationships

    • a different reason for self-silencing

    Page et al. (1996) suggested that men may unconsciously self-silence as a way of maintaining power or control in their relationships as power and control are important to a man’s manhood (e.g., masculinity).

    Masculinity is important to a man’s identity and rewards, such as money or status, that are available to him. To highlight the importance of being in control and dominant in their relationship, consider the weakness penalty.

    The weakness penalty:

    • When a man’s career has less status compared to his female partner, he is viewed as the weaker spouse and less respected as a result

    • It is assumed that men are also less satisfied in this kind of relationship.

    • In this same situation, women experience the dominance penalty and are liked less as a result.

  • In his book Shame and Anger in Psychotherapy, Greenberg (2024) claims anger that isn’t felt because it’s cut off, which he calls interrupted anger, is just as big of a problem for a client’s mental health and relationships as the excessive expression of anger. He says anger is a normal and adaptive feeling that occurs when a person feels like they have been taken advantage of, treated poorly, or violated. However, expressions of anger often provoke fear, shame, and other consequences. Therefore, many people learn to be afraid and ashamed of their anger and they try to control and suppress it, but this stops them from feeling anger that can be helpful (Marshall, 2025, p. 67).

    Interrupted anger can result in the following negative outcomes:

    • feelings of despair

    • depression

    • anxiety

    • disordered eating

    • headaches

    • an explosion of anger, aggression, and violence