Women's Health: Hormones, Emotions, and Behavior
This book's title, which is provocative, over-inclusive, and awkward, is a good indicator of both the strengths and the weaknesses of its essays. With its everything-but-the-kitchen-sink approach, it manages to address many important clinical and research issues but gives short shrift to some.
As a member of an increasingly small cohort of generalists in psychiatry, I welcome a volume that does much of the leg work of seeking out and synthesizing large amounts of primary research on questions that come up regularly in general practice. These questions include such perennial issues as the role of female hormones and reproductive cycles in mood and mood disorders, gender differences in pharmacodynamics and pharmacokinetics, the use of psychotropic agents in pregnancy and lactation, and current thinking on hormone replacement therapy for postmenopausal women. Each of these subjects is treated seriously in the book, with a clear and crisp synthesis of the relevant recent research literature. This approach makes the book an invaluable resource for clinicians who wish their practice to be informed by knowledge of the research findings that lead to usual and customary practice.
The weakness of the volume is its attempt, more prominent in some articles than others, to be so inclusive that psychosocial and developmental formulations are summarized in a paragraph or two. These factors are not given the depth of analysis or the elucidation from contemporary research that they, like the biological and endocrinological factors, deserve. For instance, in the chapter on "Growing Up Female," the section on self-concept and self-esteem has the usual, by now all-too-familiar references to Freud, Erikson, and Mahler, but it does not cite at all the extensive recent research literature on female adolescence and the development of the self.
Several of the chapters are exemplary in their clear exegesis of massive amounts of statistical and epidemiological material. The last essay, for instance, "Intervention Trials Concerned With Disease Prevention in Women," fulfills a difficult dual purpose in clarifying and critiquing the methodology of large-scale trials while underlining what results can be known with relative certainty. The careful reader will come away from this paper with an improved ability to make sense of the kinds of study designs and methodologies behind these trials and better equipped to evaluate the results.
Overall, Women's Health: Hormones, Emotions, and Behavior presents useful data in a well-organized and readable format. Most important, it addresses the complex issues that many alert and thoughtful clinicians who treat women across the life cycle must puzzle over daily. If all the questions are not definitively answered, it is still very helpful to have a sense that work focused on these questions is being done and that a community of researchers will continue to refine that knowledge and communicate their findings. That is, after all, what clinicians need to remain honest and forward looking.
Dr. Engel is in the private practice of psychiatry in Cambridge, Massachusetts, and is on the staff of the Harvard University Health Service.
