When Women Rule Psychiatry

Article excerpt

Have you ever had a day when so many coincidences happened that they seemed like something more? I had a day like that recently.

On the way to work one morning, I heard a story on NPR about reality television shows. The point was that interest in such shows is waning, except for an upcoming one called "When Women Rule the World."

That thought made me wonder whether women currently "rule" psychiatry in the United States. All of our present American Psychiatric Association officers are women, including the president-elect. The chair of the task force charged with revising our ethical principles also is a woman.

Does--or will--the gender of our leaders make any difference in psychiatry or in psychiatric ethics?

A Question of Compassion

At lunch later that day, I attended a lecture by Joan Cassell, Ph.D., a medical anthropologist who wrote "The Woman in the Surgeon's Body" (Cambridge: Harvard University Press, 1998). The title of the lecture was, "Are Women More Compassionate?"

The talk was fascinating, as was the makeup of the audience. There were about 50 women there and only 4 men. One of the men had to be there, another was the tech help, a third was a psychologist friend of mine who worked in community medicine. I later learned that he attended because in recent years all of the residents he taught have been women. As a result, he thought that his lectures--such as those on eating disorders--needed to be better tailored to address women's issues.

Dr. Cassell started the lecture by discussing her research on female surgeons. Her initial question was whether they are as "arrogant, daring, and warlike" as male surgeons. Her findings showed that sometimes they are and sometimes they're not, largely depending on whether they're relating to nurses, patients, or peers.

She also discussed the extent to which many gender characteristics are influenced by social forces and history. In response to a question from me, Dr. Cassell expressed uncertainty about whether biologic differences are a major factor, because those differences are so difficult to study.

As to the original question of whether women are more compassionate, Dr. Cassell answered, "I wish." She found very little evidence of more compassion among female surgeons, or among other female physicians, for that matter.

She went on to wonder whether the social forces of male power, the rise of evidence-based medicine, and increasing time constraints make the expression of compassion more difficult for all physicians.

What Impact Do Hormones Have?

Before I went on to my next clinic, I checked my files on female psychiatrists. I quickly saw that the number of women in psychiatry in the last 30 years has increased dramatically. However, according to a review article I pulled out called "History of Women in Psychiatry," no clear effect of women on psychiatry could be determined (Academic Psy. 2004;28:337-43).

Female psychiatrists, however, did feel the need for a support group. The Association of Women Psychiatrists is now celebrating its 25th anniversary.

At this point, I was off to see some women of a different sort. I have been the medical director for about 15 years of a clinic that specializes in the treatment of gender disorders, especially transsexualism.

It had always been striking to me, to the staff, and to most of the patients, that after some patients are placed on hormones of the opposite gender, some of their personality characteristics seem to change. At the clinic, staff often comment that patients who are making the transition to become men tend to become more aggressive, and those making the transition to become women generally are more concerned with social relationships.

Back home again, I spoke briefly by telephone with my 2 1/2-year-old granddaughter. As a grandparent of three young children, I am beginning to notice some gender differences I hadn't paid as much attention to as a parent. …