Women and Mental Health
This small volume, edited by Dora Kohen, a consultation-liaison psychiatrist in London, aims to review the data and debates on women's mental health and on gender differences in mental health. In that endeavor it is partially successful.
The chapters on social role, psychology, and schizophrenia are outstanding and would be enlightening for any mental health professional. A chapter on the social role of women provides an excellent historical overview of the social construction of mental illness, covering, for example, mental illness as a social construct and the role of social factors in producing mental illness.
In a chapter on psychology, the author elaborates on various perspectives, their strengths and weaknesses, and their relationship with each other. Psychoanalytic theories are reviewed with specific consideration of Freud, Melanie Klein, and Lacan as well as the more modern theorists. The new psychology of women is mentioned but not discussed in the detail one might expect. Also included are feminist, vulnerability, attachment, and cognitive approaches. Whereas psychoanalytic theories do emphasize gender differences, attachment and cognitive theories do not address how gender influences psychological vulnerability and mental illness. All the theories are compared with the evidence, and "the lack of a theoretical framework within which to view gender" is noted.
A chapter on schizophrenia provides a comprehensive and well-integrated overview. Its author has an extensive grasp of the subject and is able to trace the origins of data supporting gender differences in schizophrenia and develop the "story" in an easy-to-read manner. Many studies are reviewed in enough detail to be meaningful but not so much as to render the chapter overly academic. The risk of pregnancy presented by women with schizophrenia is not addressed, however.
A physiological perspective is presented in an uneven chapter, with some parts written at a fairly elementary level and others assuming a fair amount of knowledge. A chapter on depression includes an extensive discussion of lack of diagnosis, psychopharmacology, and electroconvulsive therapy but relatively little consideration of gender issues. Eating disorders are covered in a chapter that contains useful tabular comparisons of DSM and ICD classifications. A chapter on alcohol and drug "misuse" concentrates on alcohol, includes three classic vignettes, and notes the debate about women-only drug treatment programs.
The three chapters written by the editor—the introduction, the conclusion, and a chapter on perinatal psychiatry—are among the book's weakest. Whereas the tone of the introduction is negative, focusing on women's disadvantages more than on gender differences, the conclusion optimistically states that "specific psychiatric services for women" are "being addressed quite successfully." The conclusion is tentative, making global statements about issues for which consensus is lacking and advocating broadly without giving any specifics. Cultural factors, which were not discussed in the body of the text, are raised for the first time on the last page of the book. The chapter on perinatal psychiatry is poorly referenced and lists findings of individual studies as facts. It is written more as a review of the literature than from clinical experience.
Although this book is uneven, it is worthwhile reading for the three enlightening chapters alone as well as the other chapters, many of which are competently done if not truly illuminating.
Dr. Gise is clinical professor in the department of psychiatry at the John A. Burns School of Medicine of the University of Hawaii in Honolulu and staff psychiatrist at the Maui Community Mental Health Center in Wailuku, Hawaii.
