This is a fascinating and
informative book built on the central premise that men and women ought to be
diagnosed and treated differently by mental healthcare professionals. It’s
important to note at the outset that this thick volume (628 pages) discusses
mental illness uncompromisingly according to the biological or medical model
using highly technical language.  In
other words, putting aside the extraordinary ambiguity of the term  "mental health," this book tries
to deal with those conditions within the human experience that psychological
testing can successfully diagnose as mental illnesses according to established
psychiatric criteria.  All but eight of
the seventy-two authors are medical doctors, the majority of whom are at work
in the field of psychiatry.  That having
been said as a cautionary remark, I must admit that the authors and editors do
an excellent job of what they set out to do. 

The book is divided into five main
parts containing a total of 37 chapters and a fairly good index.  The first part is titled  "Women’s Psychobiology and Reproductive
Life Cycle."  It deals with sex
differences in neurological systems, how certain medications affect women and
men quite differently, and what effects menstruation, pregnancy, birth,
contraception and menopause are believed to have on women’s mental health.  Part two is titled  "Assessment and Treatment of Psychiatric Disorders in
Women."  This part examines
specific conditions found in the Diagnostic and Statistical Manual of Mental
Disorders  (DSM), such as
depression, bipolar disorder, schizophrenia, anxiety, eating disorders, and
personality disorders, in relation to how they present in women, how they are
experienced differently in women than in men, and how they are best treated in
women.  For example, the chapter on
schizophrenia points out that while symptoms of schizophrenia tend to be
identical in women and men during acute psychotic episodes, several studies
have reported gender differences in symptoms outside of acute stages.  "Specific positive symptoms  (such as paranoia, persecutory delusions,
and auditory hallucinations), and some affective symptoms  (e.g., dysphoria), are more common in
women.  Negative symptoms, including
affective flattening and social withdrawal, tend to be more severe in men"
(184).  The authors caution practitioners
that these finding strongly suggest that women and men require different sorts
of treatment for what has been diagnosed as the same illness in both.

An interesting final chapter in
this second section discusses how alternative or non-conventional medicines
have been widely used by North American women but mostly overlooked by both
researchers and practitioners until very recently.  Recently treatments such as acupuncture, herbs, and yoga have
become more accepted by western health professionals, to the point that they
are now referred to as 
"complementary" or 
"integrative medicines."   

The third part, titled
"Psychiatric Consultation in Women," discusses the impact on women’s
mental health from disorders in a variety of medical areas such as gynecology,
cancer, rheumatological, cardiovascular, and gastrointestinal diseases,
endocrine disorders, HIV/AIDS, neurological disorders such as migraines,
multiple sclerosis, and Alzheimer’s disease, and cosmetic surgery.  Part four deals with a number of sociocultural
issues relevant to women’s mental health such as childhood development of
gender identity, marriage and family, career and workplace relationships,
trauma and violence in the onset of PTSD and other disorders, sexual
orientation, race, and aging.  The final
section, titled  "Research and
Health Policy Issues," offers recommendations on how mental health
research ought to be carried out and how mental health policy ought to be
formulated in such a way that it doesn’t perpetuate the male-as-norm bias that
has been so prevalent in the field since Freud’s day. 

The research in this volume is
extensive and the sources referred to are up to date and plentiful.  I was impressed by the high standard of
scholarship in this book compared to other clinical texts I’ve reviewed in
which information presented was trivial, arguments and conclusions were flawed,
and references were badly outdated. 
Many of the authors in this book are also following the recent trend in
psychiatry of abandoning the simplistic or reductionist approach to mental
illness–that of a single diagnosis per patient–and are instead advocating
what is termed "comorbidity" or the diagnosis of multiple disorders
in a single individual.  This approach
certainly has more explanatory utility within the paradigm of the medical
model.

But it’s instructive to note the
careful tone used by many of the authors writing sections and chapters
specifically highlighting biological or organic explanations.  For example, terms like  "may potentiate" or "may
enhance the potential" are used in the discussion of the relationship
between hormone-induced stress, natural cyclical hormonal fluctuations in
women, and mental disorders such as anxiety and depression.  These authors use what critical thinking
texts call  "weasel words" to
soften their claims in order to avoid being interpreted by their readers as
having stated categorically that overactive female hormones, or biochemically
induced stress, is indeed in a causal relationship with mental disorders in
women.  This may be because the research
into mental illness is still inconclusive, as many of the authors claim, or
because, as I believe, the research can’t be interpreted to support the medical
model to the extent that it is claimed to do so by many professionals in the
field.  Readers should keep in mind that
claims about women’s mental and organic functioning are predominantly
extrapolated from stress experiments carried out on female laboratory rats.  This has already proven to be an extremely
unreliable strategy at best when applied to men.  Passages that claim biological causality of mental illness in
women are understandably diluted with statements like "findings imply that
further research is needed…."

This is a book that requires time,
concentration, and a certain level of competence in comprehending medical and
psychiatric terminology.  On its cover
the book clearly announces that it is 
"a comprehensive textbook" and therefor not meant for a lay
readership.  But it does offer a very
informative read for non-professionals. 
It can be an excellent resource for anyone whose aim is to either
understand or treat, or both, the psychological and biological aspects of
women’s mental health problems. 

© 2003 Peter B. Raabe

Peter B. Raabe
teaches philosophy and has a private practice in philosophical counseling in
North Vancouver, Canada. He is the author of the books Philosophical
Counseling: Theory and Practice (Praeger, 2001) and Issues
in Philosophical Counseling (Praeger, 2002).

Categories: MentalHealth