Book Review
Gender Issues
Women’s Mental Health: A Comprehensive Textbook. Susan G Kornstein, Anita H Clayton, editors. New York: The Guilford Press; 2002. 638 p. US$65.00.
Reviewer
rating*: Very Good
Review by: Gail Erlick Robinson, MD, DPsych, FRCPC
Toronto, Ontario
This comprehensive overview of women’s mental health was designed to offer a combined psychobiological, psychosocial, and policy perspective to guide clinical practice and research. It is aimed at all levels, from beginners to those with a experience in this field. Dr Kornstein and Dr Clayton are known experts in this area, and the authors they have assembled range from locally prominent to internationally known experts.
The book has 5 major sections covering women’s psychobiology and reproductive life cycle, assessment and treatment of psychiatric disorders in women, psychiatric consultation in women, sociocultural issues, and research and health policy. All 37 chapters end with conclusions that vary from detailed and useful summary to brief and vague paragraphs. Despite having 37 chapters authored by different groups, the work is uniformly well written and readable.
The first 2 chapters focus on basic science, discussing the sex differences in neuroendocrine and neurotransmitter systems and psychopharmacology in women. The concise summaries of the effects of sex hormones and reproductive cycles on stress and anxiety are detailed enough to be interesting and useful without overwhelming nonspecialists in this area. It is important for health care professional to learn more about the differences in absorption, metabolism, and distribution of psychotropic drugs—not just between men and women but across the menstrual cycle. As well as presenting information on CYP450 isoenzymes, the authors present practical information about the use of antipsychotics, benzodiazepines, and antidepressants.
The remaining chapters of Part 1 deal with the psychiatric aspects of the menstrual cycle, including the premenstrual period, pregnancy, postpartum, and menopause. The chapter on premenstrual syndrome (PMS) has a useful decision tree for premenstrual complaints. This, as well as the postpartum chapter, includes excellent tables summarizing the research on treatment and prevention. However, the pregnancy chapter focuses almost exclusively on psychopharmacology, with little attention paid to psychological issues, and is disappointing. The chapter on psychiatric aspects of hormonal contraception reviews in detail the efficacy and side effects of various types of contraceptives. It also discusses the noncontraceptive benefits of these medications, such as the decreased risk of ovarian and endometrial cancer. The authors discuss the medications’ effects on mood, anxiety, and sexual functioning and include practical information on drug interactions.
Part 2 covers the assessment and treatment of psychiatric disorders such as depression, schizophrenia, and anxiety. Again, the approach varies, with a detailed review of all the etiological theories of anxiety but no attention to causation of schizophrenia. However, the chapter on schizophrenia does include important and seldom-addressed topics, such as the vulnerability of women with schizophrenia to abuse and the need to consider sexuality and fertility issues in these women. The chapter on sexual dysfunction takes a very biological stance, only briefly mentioning psychological factors. The editors have also included chapters on such less commonly covered topics as sleep disorders. The information on complementary and alternative medicine is important: many women are seeking out these treatments. Again, however, I wish that more detail had been provided.
The section on Psychiatric Consultation reviews the psychological aspects of various other medical specialties, such as cardiology, gastroenterology, and rheumatology. These chapters remind us that women’s health includes more than gynecology. Women may present with different symptoms that are too frequently ignored or treated less than adequately. Ironically, the chapter on gynecology seemed less comprehensive, with only minimal information about important issues such as infertility. Once again, the editors have included information on less commonly described issues—cosmetic surgery, migraine, and multiple sclerosis.
Part 4, Sociocultural Issues, includes chapters on developmental perspectives, marriage, careers, and special groups (for example, women of colour, elderly women, and lesbian women). The chapter on trauma and violence was disappointing: it discusses posttraumatic stress disorder (PTSD) but contains little information on specific problems such as sexual assault or domestic violence. As well, probably because it was written by a psychologist, it extensively covers the psychotherapy of PTSD and only a casually mentions the use of selective serotonin reuptake inhibitors (SSRIs), which have been found to effectively treat this disorder.
Part 5 discusses the problems related to the lack of research in women’s mental health. The authors look at the methodological issues in clinical trials that are related to sex and gender and suggest several psychopharmacology topics requiring special evaluation in women. Unfortunately, I found the last chapter, on health policy, to be repetitious and covered better in earlier sections.
This book’s comprehensive approach is both a strength and a problem. It gives a broad overview of the field of women’s mental health, covering many areas that other texts often overlook. Conversely, this format requires that the information be presented in a very compact form, which can lead to significant sections being left out. I wish the editors had ensured that all chapters on disorders included information on the biological, psychological, and sociocultural aspects of etiology and treatment. I was also somewhat concerned about the references in many chapters. I was often surprised to see no references to authors considered to be world authorities in particular areas. It was also annoying to find that, several times, references in the text were not cited in detail.
Despite these concerns, I found this overall to be a good book that contains a great deal of information. It was clear, readable, and remarkably free of production errors. I see it as a suitable general introduction to this field and an excellent reference book for all therapists who, even though they may not specialize in women’s mental health, will encounter these issues in their female patients.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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