Book Review

Women's Mental Health: A Life-Cycle Approach

N Engl J Med 2005; 353:1424-1425September 29, 2005

Article

Women's Mental Health: A Life-Cycle Approach
Edited by Sarah E. Romans and Mary V. Seeman. 414 pp. Philadelphia, Lippincott Williams & Wilkins, 2005. $59.95. ISBN: 0-7817-5129-2

“What do women want?” — Sigmund Freud's question, posed decades ago — implied that there is something unique about women and the factors that determine their mental health. But his question was essentially rhetorical and was never answered to his, or to women's, satisfaction. Now, 40 years after the initial stirrings of the 20th century's second wave of feminism, the issue of women's mental health has finally come center stage.

Women's Mental Health begins with great promise, because the editors have selected three highly relevant themes to structure the content: development, culture, and stress. Each of these topics has been examined individually to try to help the reader understand the unique challenges of the field. A small number of authors, myself included, have written about and studied the interaction of two of these variables — development and stress — as a way of understanding mental disorders to which women are especially vulnerable. Others have explored the interaction of cultural values and stress, but this book is the first to attempt to explore the intersection of all three domains.

The three introductory chapters, each of which is followed by an interesting commentary, introduce the themes of development, culture, and stress and describe their influence on women's mental health in very thoughtful ways. Unfortunately, the book's initial promise is only partially fulfilled. To better set the stage for the kinds of mental health problems that can occur when development goes awry, when culture conspires to burden women unduly, or when stress challenges the adaptive capacity of the organism, the book would have benefited from a chapter on normative development, both biologic and psychosocial.

The sections that come immediately after the introductory chapters follow the developmental theme, but other sections do not. In the three sections on childhood, adolescence, and adulthood, it is unclear why chapters on certain disorders are included and others are not. For example, the lack of a chapter on depression in the section on adolescence is striking, whereas the chapter on regulation of emotion is placed in the section on adolescence, implying that regulation of emotion is not a factor in childhood or at least not a factor relevant to psychopathology in preadolescent girls.

Some chapters, like the excellent one on conduct disorder in girls (a topic that is all too rarely discussed), provide accurate information on prevalence, course, risk, protective factors, and outcome. Other chapters in this section provide little of such epidemiologic information. In contrast, the final three sections on reproduction, aging, and health services for women are well integrated, giving the reader a sense of connectivity and relatedness among the chapters. Thus, there is unevenness both within and between the early sections of the book. A reader who leafs through the various sections in an effort to learn about a specific disorder would find very interesting but highly variable information.

The editors state that this book is intended for mental health professionals in practice and in training and for students of the many mental health disciplines. Clearly, its content will deepen and enrich the understanding of women's mental health on the part of experienced practitioners. In order to serve as a resource for trainees or those just entering practice, however, it will need to be used along with other materials.

Ellen Frank, Ph.D.
Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213

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