Book Cover
Freeman, D. and Freeman, J.

The Stressed Sex - Uncovering the Truth about Men, Women and Mental Health

Oxford University Press, Oxford, UK, 2013, Hardback
ISBN: 978-0-19-965135-1
267pp

Reviewer: Jacqueline H Watts
The Open University, UK
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I first came across this book when listening to an edition of the BBC's long-running Radio 4 programme Woman's Hour in which one of the book's authors, Daniel Freeman, set out his conceptual and empirical 'stall' on the matter of whether rates of psychological disorder are different for men and women. Highlighting some contentious issues such as changing disease classifications and contradictory 'expert opinion', his clear exposition of both the book's key findings and limitations was very engaging and I ordered the book immediately. On reading it, I have not been disappointed. The accessible writing style that includes explanation of scientific and technical terms sets out with great clarity what is currently 'known' about gender and mental distress and also what, through rigorous analysis, we might reasonably 'claim' or understand as causality in terms of women's and men's risk of suffering mental health problems.

Mental health issues that most commonly centre on psychological and emotional problems are a global concern and, according to the World Health Organisation, constitute the number one cause of disability in the world. 10-20 per cent of people will experience depression at some point in their lives and women are more likely than men to develop the condition. Data from a broad range of epidemiological surveys consistently attest to psychological differences between the sexes. However, the extent to which these differences are the result of biological factors or the product of social and cultural factors points to the pivotal issue of gender and mental health that the book's authors describe as a battleground with sociologists and epidemiologists as the chief protagonists. The feminist lobby has made a significant contribution to the debate about gender and mental health arguing that psychological disorder is essentially a gender issue with high numbers of women traditionally treated for mental illness by the overwhelmingly male-dominated profession of psychiatry. It is this cultural construction of mental health and specifically the question of whether madness is a female malady that is at the core of the book's polemic.

The book is usefully organised into two distinct parts essentially characterised by the 'what' and the 'why'. The first part presents data from 12 national surveys on the patterns and prevalence of psychiatric problems and the second part discusses how differences between men and women in terms of their experiences of mental health might be explained.

For the first part the authors, having applied a set of strict criteria, present data drawn from 12 selected national large-scale surveys that offer an international 'flavour' of mental health prevalence in the population - 3 UK studies, one each from Germany and the Netherlands, two from the US, two from Australia and one each from New Zealand, Chile and South Africa. All twelve surveys focused on 'recent' problems identified according to disorder classifications as set out in the two principal reference books in the world of mental health - the International Classification of Diseases and Health Related Problems (ICD), published by the World Health Organisation and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, commonly known as the DSM. Problems identified in the surveys were wide ranging including eating and sleep disorders, dissociative disorders, substance-related disorders and mood and anxiety disorders such as depression and phobias. Analysis of the survey data by the authors highlights that certain problems such as depression are more prevalent in women and others such as alcohol and substance misuse are more common in men. The old hypothesis that women worry and men drink, though simplistic, appears to hold a kernel of truth. Overall, however, the 12 national surveys discussed by Freeman and Freeman point towards the conclusion that women are more likely than men to experience a mental health disorder.

The second part of the book that for me was the most enjoyable and arresting, sets out to explore the possible reasons for this conclusion and for many readers, these explanations though complex and multi-dimensional, will come as no surprise. In general, women appear to experience higher levels of mental distress because of the demands of their social role as homemaker, carer and breadwinner. These competing roles can give rise to women feeling that they have 'failed' or not 'matched up' in one or more of these aspects with this experienced as negative self concept or low self esteem making women particularly vulnerable to psychological disorders. Mental health problems are usually neither innate nor inevitable and many difficulties would not occur if it were not for the contribution of social pressures connected to gendered expectations and assumptions. The authors thus argue that gender can no longer be assumed to be a marginal issue in considering the causes and treatment of mental illness.

Because of the broadly 'western' context of the survey data on which the authors draw, it is not possible to get a sense of the wider global picture of gender and mental health from this text and that is one of its limitations. However, the authors are transparent about the book's parameters and their intention to interrogate only data from nationally representative samples of adult populations. Despite its narrow focus, I thoroughly recommend this book, not just as an evidence-based academic text for health and social care practitioners and policy-makers, but more widely, not least because it is a 'good read' as well as certainly extending thinking on this important and controversial topic.

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