Laura Miller

Bipolar Disorder in Women

This article summarizes research pertinent to the clinical care of women with bipolar disorder. With bipolar disorder, female gender correlates with more depressive symptoms and different comorbidities. There is a high risk of symptom recurrence postpartum and possibly during perimenopause. Women with bipolar disorder have increased risk of sexually transmitted diseases, unplanned pregnancies, excessive weight gain, metabolic syndrome, and cardiovascular disease. Mood stabilizing medications, specific psychotherapies, and lifestyle changes can stabilize mood and improve functioning. Pharmacologic considerations include understanding interactions between mood stabilizing medications and contraceptive agents and risks and benefits of mood stabilizing medication during pregnancy and lactation.

Japan's Cinderella Motif: Beauty Industry and Mass Culture Interpretations of a Popular Icon

The tale of Cinderella is firmly entrenched in the global imagination as that of a pitiable girl who transforms into a stunning example of Euroamerican beauty in which her magnificent gown and sparkling accoutrements enable her to capture the heart of a handsome prince. Cinderella proved to be immensely popular in Japan. Her name appears in countless manga, films, books and other forms of popular culture. She has been especially prevalent in imagery found in the beauty industry. Because Japan has its own rich storehouse of pretty heroines and exemplary women, one wonders why Cinderella proved to be so appealing to a Japanese consumer. Why do girls, and in some cases boys, want to present themselves as modern-day versions of the European cinder maid? The answer can partly be found in how the meaning of Cinderella has morphed into a strong message of self-transformation and individual achievement in the Japanese setting. Cinderella is especially attractive to young women, gay men and the working class. For everyone, both inside and outside mainstream folk models of success, Cinderella offers a powerful allure in that she represents the possibility of triumph over adversity. This potential for victory is egalitarian, available to anyone willing to believe in their dreams. There is a long history of feminist critique of fairytales such as Cinderella. Karen Rowe (1979) notes how the story has a negative impact on female socialisation and acculturation by promoting the belief that it is only passivity and beauty that are rewarded. Cinderella buttresses patriarchal social models of women as dependent on male objectification, approval and rescue (see, for example, Simone de Beauvoir,

Reproductive Psychiatry: The Gap Between Clinical Need and Education

Over the past three decades, there have been substantial advances in our understanding of the strong influence of sex hormones on women’s mental and physical health. In particular, the literature clearly documents that fluctuating levels of reproductive hormones can manifest as premenstrual, perinatal, andperimenopausalpsychiatricdisorders inwomenwho arevulnerable to thesefluctuations (1–3).Theresearchover the past three decades came in response to a 1985 Public Health Service task force report onwomen’s health that noted deficits in our knowledge regarding key women’s health problems and that called for an expansion of biomedical and behavioral research to emphasize conditions unique to, or more prevalent in, women (4). In response, the National Institutes of Health (NIH) created a policy encouraging inclusion of women in clinical research. Because implementation of this policy was inconsistent and unmonitored, Congress passed legislation in 1993 mandating fair inclusion of women and minorities in clinical research.As a result, in 1994NIHbeganmandating that all grant applications either include women or justify the exclusion.This policywasupdated in 2001,with furtherguidance on reporting data by sex. Research resulting from these changes has dramatically expanded knowledge of the psychiatric sequelae of reproductive cycle transitions. Due to the accumulation of ample evidence, premenstrual dysphoric disorder, described in the medical literature since the time of Hippocrates, was finally included in DSM-5 (5). Perimenopause has also been recognized as a time of heightened risk for depressive and anxiety symptoms (6–10), and the role of hormonal and other novel interventions is being investigated(11). Importantly, depression has been found to be among the most prevalent perinatal illnesses, affecting up to 15% of women in the perinatal period (12–14). As of 2003, antidepressants were being used in approximately 13% of pregnancies—a rate that had climbed dramatically in the previous 10 years (15, 16); with the current U.S.birthrate, thatmeans thatmore than600,000fetusesevery year are exposed to depression and/or its treatments. The risks of untreated antenatal depression have been identified and include a lower likelihood of engaging in prenatal care; increased rates of smoking and alcohol use; poorer physical health; and higher rates of preeclampsia, gestational diabetes, preterm birth, and low birth weight (17, 18). Epigenetic effects of antenatal stress and depression on fetal development (“fetal programming”) are increasingly understood (19–21), as are the adverse long-term effects of postpartum depression on children (22–25). In addition to these risks, there is also considerable literature on the potential risks of treatments to both mother and fetus (26–28), as well as a body of literature concerning drug disposition and pharmacokinetic changes in pregnancy and postpartum that may require dosage adjustments (29–32). Clinicians who specialize in the field routinely use this new scientific information to craft individualized risk analyses for pregnant women who require treatment. This increased body of knowledge has led to the growth of international professional societies such as the Marcé International Society for Perinatal Mental Health and the International Society of Psychosomatic Obstetrics andGynecology. It has influenced public policy initiatives, including, for example, a number of statewide perinatal depression projects (33) and mandatory screenings (34). It has also begun to be disseminated into clinical practice via the emergence and growth of specialized clinical programs, which include outpatient and inpatient programs that offer perinatal consultations and ongoing treatment (35); perinatal care settings that integratemental health care (36); a peripartumday hospital (37); and, most recently, the first mother-baby inpatient unit in the United States (38). Such programs have been created by specialists out of necessity becausemany general psychiatrists havenot sufficientlymastered thisnewbodyofknowledgeand are unwilling or unable to treat pregnant and postpartum patients. While there is no doubt that such programs provide outstanding care (39, 40), they can neither begin to keep up with theclinical demandthat leads towaiting listsmonths long

Gender-specific mental health care needs of women veterans treated for psychiatric disorders in a Veterans Administration Women's Health Clinic

Objective:This pilot study aims to ascertain the prevalence of self-reported premenstrual, perinatal, and perimenopausal influences on mental health, and of gynecologic conditions that could interact with psychiatric conditions, among women veterans receiving psychiatric care within a Veterans Administration (VA) Women’s Health Clinic (WHC). Methods:Participants included all women veterans (N=68) who received psychiatric evaluations within a VA WHC over a 5-month period. This setting encompasses colocated and coordinated primary care, gynecologic and mental health services. Evaluations included a Women’s Mental Health Questionnaire, a psychiatric interview, and medical record review. Deidentified data were extracted from a clinical data repository for this descriptive study. Results:High proportions of study participants reported that their emotional problems intensified premenstrually (42.6%), during pregnancy (33.3%), in the postpartum period (33.3%), or during perimenopause (18.2%). Unintended pregnancy (70.0% of pregnancies) and pregnancy loss (63.5% of women who had been pregnant) were prominent sex-linked stressors. Dyspareunia (22.1% of participants) and pelvic pain (17.6% of participants) were frequent comorbidities. Conclusions:Among women veterans receiving psychiatric care within a VA WHC, there are high rates of self-reported premenstrual, perinatal, and perimenopausal influences on mental health. This population also has substantial comorbidity of psychiatric disorders with dyspareunia and pelvic pain. This underscores the importance of recognizing and addressing women veterans’ sex-specific care needs, including interactions among reproductive cycle phases, gynecologic pain, and psychiatric symptoms. The findings support the need for greater awareness of the sex-specific mental health needs of women veterans, and for more definitive studies to further characterize these needs.

Reproductive Psychiatry Residency Training: A Survey of Psychiatric Residency Program Directors

ObjectiveThe reproductive life cycle has unique influences on the phenotypic expression of mental illness in women. Didactic and clinical training focused on these sex-specific influences should be a vital component of the education of future psychiatrists. The authors sought to determine the current state of and attitudes toward reproductive psychiatry in resident education.MethodsThe authors administered a web-based survey to psychiatry residency training directors. They assessed the availability of both mandated and optional didactic and clinical training experiences in reproductive psychiatry.ResultsFifty residency program directors answered the survey, for a response rate of 28%. More than half of residency program directors (59%) reported requiring some training in reproductive psychiatry. Both the breadth and depth of topics covered varied greatly among programs. Lack of time (48%) and lack of qualified faculty (26%) were the most frequently cited barriers to more training. Only 40% of residency directors surveyed agreed that all residents should be competent in reproductive psychiatry.ConclusionsThese findings suggest that specific training in reproductive psychiatry is inconsistent in US residency programs, and that training that does exist varies considerably in clinical time and content. Given that women comprise more than 50% of all psychiatric patients and most women will menstruate, give birth, and undergo menopause, future psychiatrists would benefit from more systematic instruction in this area. The authors propose the development of a national, standardized reproductive psychiatry curriculum to address this gap and aid in producing psychiatrists competent to treat women at all stages of life.

Mental health across the reproductive cycle in women veterans

IntroductionnPremenstrual, perinatal, and/or perimenopausal psychiatric problems require specific screening, assessment, and treatment strategies. The scope of these reproductive-linked psychiatric symptoms among women veterans is unknown. Due to high rates of sexual trauma among women veterans, it is also important to ascertain relationships between sexual trauma experiences and reproductive cycle mood problems. This pilot study investigates the prevalence of self-reported premenstrual, perinatal, and perimenopausal emotional problems and whether these correlate with pre-military sexual abuse, military sexual harassment, and/or military sexual assault, among veterans receiving psychiatric evaluations within a Veterans Administration Womens Health Clinic.nnnMaterials and MethodsnParticipants included all women veterans (N = 186) who received psychiatric evaluations within a Veterans Administration Womens Health Clinic over a 13-mo period. Evaluations included a clinical questionnaire, a psychiatric interview, and medical record review. De-identified data were extracted from a clinical data repository for this descriptive study.nnnResultsnHigh proportions of study participants reported emotional problems premenstrually (43.3%), during pregnancy (35.1%), postpartum (30.4%), or during perimenopause (31.2%). Unintended pregnancy (73.3% of pregnancies) and pregnancy loss (56.6% of women who had been pregnant) were prominent perinatal stressors. Military sexual harassment was significantly associated with emotional problems during pregnancy and postpartum.nnnConclusionnThese pilot data suggest the need for further study of the reproductive mental health needs of women veterans and their relationship with sexual trauma. The findings underscore the need for Veterans Administration facilities and other providers of veterans health care to be prepared to detect, diagnose, and treat premenstrual, perinatal, and perimenopausal mental health problems.

Book Review: Le Blanc, Robin M. The Art of the Gut: Manhood, Power, and Ethics in Japanese Politics Berkeley: University of California Press, 2009. 229 pp.

Robin LeBlanc’s study of contemporary local politics in Japan centers on the trajectories of two rather different men. The politicos are almost stereotypically identifiable masculine types: one is a middle-aged liquor merchant in the fictively named rural town of Takeno and the other is a younger, slick mama’s boy in a Tokyo ward, who is the product of privilege and the heir of a political family. It is not hard to figure out right away that Baba-san, the family sake merchant in Takeno, is the core story in the book, and we come to respect him as much as LeBlanc does. The cynical and well-to-do Tokyo urbanite Takada-san, however, is much less interesting or likable. LeBlanc takes the reader along with her as she hangs out with the two men as they campaign, meet in smoke-filled homes with supporters, attend budget planning meetings, and give both rousing and uninspiring speeches. The two case studies demonstrate the manner in which male desire to adhere to gender ideology about what constitutes being a ‘‘good man’’ constrains and molds their uses of power as well as their options for ethical conduct. As LeBlanc tracks how an ideology of male gender is put to play in the enactment of honorable behavior, she also reveals the degree to which political competence is inescapably associated with ideals of masculinity. Because of LeBlanc’s engaging prose style and gorgeous writing, we are happy to make this journey with her. In addition to other aspects of gender and culture that enable men in politics to succeed, LeBlanc analyzes one particularly interesting form of male prerogative in Japan: stomach-to-stomach communication. This is an art of the gut thought to be a special skill cultivated by powerful men. Women, especially those in politics, are said to lack the ability to read other’s intentions and attitudes through the belly. Haragei, literally ‘‘belly art,’’ is the antique term used to describe the maneuvering skills considered necessary for success in leadership roles. The concept has often been part of the bread and butter of business and cross-cultural communication lore and is frequently essentialized as a type of mysterious Japanese nonverbal 386 Men and Masculinities 14(3)

24.95 (paper),

A prevailing fear of ambiguity, coupled with a global business imperative, has given birth to a new readership for the Japan-book trade. This new market, a large and lucrative one, is for general-interest books targeted at those who read about Japan not because they want to, but because they think they must in order to “succeed.” However, another book focused on Japanese and American communication may still hold the potential to teach us something new and valuable. A recent addition to this burgeoning literature is the book under review. Yamada has a lively writing style, a graceful use of metaphor and stories, and a Tannenesque “linguistics for the masses” formula to lead the reader through a few areas of probable communicative misunderstanding. On the basis of anecdotes, fables, TV dramas, samurai movies, proverbs, and some of her own previously published findings on bank contract meetings, Yamada sets out what she sees as the crucial discrepancies between American and Japanese conversational styles. These are easily summarized with her repeated characterizations of each group: Americans are independent and individualistic, and use explicit language, while Japanese are interdependent and group-oriented, and use implicit language.