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Taking Issue   |    
Are Women's Health Needs Really "Special"?
Sally L. Satel, M.D.,
Psychiatric Services 1998; doi:
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Women's health is today's hot topic. Some practitioners have even sought to make it a medical specialty, like pediatrics or surgery. Psychiatric textbooks often put chapters on women in a section entitled "Special Populations." This month's Psychiatric Services is designated a special issue on women and chronic mental illness. It includes articles on female veterans with posttraumatic stress disorder, alcohol-dependent women, treatment programs for women with borderline personality disorder or schizophrenia, and mentally ill women as parents.

All important topics, certainly. But do we need a "special" issue to showcase them? After all, women's needs are not special; they are mainstream. Women represent 52 percent of the population. More women than men seek medical care in general, and psychiatric care in particular.

But wait, say proponents of women's issues: our gender has been underrepresented in medical research. In a handful of areas, yes. And that is all the more reason why quality studies of mental illness in women are likely to get published: they fill a void in the literature. But the widely touted claim that women have been systematically excluded as subjects of research is a myth. Within psychiatry, the study of borderline personality disorder and depression has focused predominantly on women—reasonably so, as larger numbers of women than men are afflicted. On the other hand, men alcoholics are better studied: they outnumber their female counterparts and more often enter court-ordered treatment programs, where they then become research subjects.

Nevertheless, the emphasis on women's mental health raises interesting research questions. Should we continue to rely on self-reports of childhood sexual trauma and combat-related stress given the distortions inherent in such reporting and the secondary gain sometimes involved? Shouldn't domestic violence studies routinely inquire about women's aggression toward their mates? What about the disadvantages of now-fashionable sexually segregated inpatient units? And what about the increasingly popular "feminist therapy," a victim-oriented form of psychotherapy that interprets women's distress as a product of patriarchy?

Both women and men deserve the best that psychiatry can offer. But designating "special" issues, treatment units, and populations gives credence to the notion that women's health problems are somehow so distinctive that they require specialty expertise beyond obstetrics and gynecology. By setting women's health apart from everyone else's—by marginalizing through specialization—we send a message that perhaps researchers and clinicians don't need to know a lot about psychiatric conditions in women. After all, that's a job for a specialist.




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