Women's Mental Health

by Susan G. Kornstein and Anita H. Clayton (editors)
Guilford Press, 2002
Review by Peter B. Raabe Ph.D. on Aug 20th 2003

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.

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).

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