Abstract
It was rather odd, as a man, reviewing this book. I found myself questioning again and again why men were given such short shrift! The aim of this volume, as stated by the editors, is to ‘draw the attention of as many healthcare professionals as possible to the present state of knowledge of mood disorders in women’, and in many ways it succeeds. Yet I believe that most of the areas covered (apart from those relating to female hormones, I suppose) in the 31 chapters are pertinent to men as well. Even the excellent chapter on grief at the loss of a pregnancy, could have been enhanced by more specific mention of the impact of the loss on the father, and the cumulative impact that that has on the already grieving mother.
But perhaps I am overstating the point. I asked a female colleague to look at this book for me, and she liked it a lot, believing the messages to be important, relevant and well articulated. The editors have elicited contributions from a number of different professionals, both male and female, from a number of different countries, though North America-based medical women predominate. The juxtaposition and ordering of chapters works well, though tighter editing could have resulted in less overlap and redundancy between chapters.
The spread of topics is broad, encompassing biological/hormonal, neuroanatomical, behavioural and psychosocial domains. The different stages of a woman's life are all covered (menarche, adolescence, premenstrual disorders and the perimenopause); childhood disorders are not explicitly dealt with. A number of chapters address issues relating to fertility, most obviously mood during pregnancy and postpartum disorders, but also psychiatric aspects of pregnancy loss, and the emotional consequences of subfertility. There are refreshing chapters on evolutionary aspects of gender differences in depressive disorders, and ‘sociogeopolitical’ issues relating to the mental health of women. Treatment issues are mentioned by a number of contributors, and the main treatment themes brought together in two discrete chapters, one on psychopharmacological and the other on psychosocial therapies.
In some ways I was disappointed that more attention was not given in individual chapters to the question of why men and women differ in their expression of psychiatric morbidity. For example, in the personality disorder chapter it is concluded that women outnumber men among those diagnosed with borderline personality disorder. The issue is taken further, in an exposition of gender differences in the expression of certain symptoms relevant to that diagnosis; yet I would have been interested in exploration, for example, why women with cluster B traits tend to be intro-punitive, and males extro-punitive.
Who should have this book? I'm not sure yet how much I will use it, though certainly the neuroendocrine and other ‘basic science’ chapters are comprehensive and well written, and useful to be able to reach for readily. Some of the other contributions are excellent examples of how to evaluate critically a body of information, and are well worth reading and referring to; Kessler's epidemiology chapter is a case in point. For most of the rest, they are at the very least a bringing together of a wide literature, and mostly a condensation into an informed exposition.
So, this volume represents a good selection of chapters on mood and related disorders in women. Yet an opportunity lost, in some ways, to bring overarching themes and messages to the reader's attention; I sense it will be read mostly by women, and thus fail in promoting awareness of women's mental health issues among the less fair sex!