Book Review

Gender and Psychopathology

N Engl J Med 1996; 334:870March 28, 1996

Article

Gender and Psychopathology
Edited by Mary V. Seeman. 402 pp. Washington, D.C., American Psychiatric Press, 1995. $52. ISBN: 0-88048-564-7

Sigmund Freud reminded us that nursemaids had always known about the sexuality of children. Similarly, all of us have always known that the differences between the sexes go far beyond the fascinating yet superficial difference in the appearance of the external genitalia. Every mother or father who watches children on a playground (at least in our culture) will notice that the young girls are more likely to stand together talking or negotiating; the young boys are more likely to be running around, pushing each other. There are easily observable early differences in behavior, activity, style of interactions, patterns of play, and patterns of illness. Doctors have always known that there is a difference in the diseases of men and women: lung cancer was, until recently, more common in men, and childbirth fever unique to women; alcoholism and substance abuse were primarily a problem for men, and borderline personality disorder was more likely to be diagnosed in women. Nonetheless, these differences have generally been ignored, in our studies, in our textbooks, and in our practice. Perhaps the Jeffersonian injunction that “all men are created equal,” which has helped us move toward ignoring the unimportant differences between people, reinforced our inattention to many important issues in the diagnosis and care of our patients. It may also be that the recent “remedicalization” of psychiatry has permitted us to pay more attention to biologic differences.

Gender and Psychopathology is an attempted early correction of our neglect, a move to provide us with a developmental comparative anatomy of the impact of sex on psychopathology, and a discussion of the complex interaction between them. The chapters include a presentation of non-mendelian inheritance, a brief review of the psychodynamics of development, a sequence of chapters presenting the findings in specific diagnoses (e.g., depression, schizophrenia, and sleep disorders), and one on the issue of the differential provision of health care. More space is provided for areas in which there are more data.

Inevitably, at this stage of our knowledge, the material available is primarily descriptive and epidemiologic; information about mechanisms (social, psychological and psychodynamic, genetic and biologic) is mostly speculative. There is discussion of the possibility, however, supported by what data are available, that the reported differences are due to multiple causes: styles of reporting and complaint; genetics; biologic, family, social, or individual psychodynamic developmental differences; and the attitudes of caretakers. In some sense this is a book “untimely ripped”; it suffers and benefits from its early appearance. While we wish to know more, it tells us what we do know, gives us the references, and points us in the right direction. For those who are capable of learning, it will serve as an important corrective to our blindnesses and lead us to the light.

William A. Frosch, M.D.
Cornell University Medical College, New York, NY 10021