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Psychological perspectives on women's health
206
Book reviews
Psychological Pempectlves on Women’s Health Vincent J. Adesso, Diane M. Reddy and Raymond Fleming, Taylor & Francis, London, 1994; 360 pp.; g14.95 What makes this book interesting is not so much its content. It is the struggle in order to achieve a multidimensional psychological view on gender and health. The editors had two goals: to create a thorough book on the important topics in women’s health, and to provide a resource for current and future research in this field. They therefore collected 12 chapters of material that would illustrate ‘the multifaceted nature of gender, illuminating the role of psychological factors, broadly construed as encompassing behavioral and socio-cultural factors, and demonstrating the ways in which psychological and biological factors interact to influence women’s health’ (p. 5). The result is a broad scope of areas analyzed from very different perspectives. The books’ range of perspectives - on gender and on psychology - undoubtedly reflects the state of the art. It is also the main cause of its weakness. Gender is treated alternately as an independent variable, a multidimensional variable, and a dependent variable or rather a ‘window’. Although the editors notify these differences and seem to rank them as progressive steps, they have overlooked the possibility to utilize them for the organization of the chapters. As each contributor also presents their own psychological model (tacitly or explicitly), and makes bis or her own weighing of genetic, hormonal, physiological, behavioral, social and sometimes cultural factors, the book lacks consistency. Presumably, it is too early for a compilation of women’s health studies from a coherent gender perspective. My dissatisfaction with the book as a whole is not equally distributed over the separate chapters. Gender and Aging, Women and Their Aging by Leventhal fully meets the promises of the editors. Psychology and Women’s Health: Some Reflections and Future Directions by Gallant, Coons and Morokoff offers an interesting example of the theoretical and methodological problems connected with research on gender differences in coping and social support. Toward an Understan-
ding of Women’s Experience of Menstrual Cycle Symptoms by Kato, Klebanov and Ruble is also stimulating on account of the attention paid to methodological and interpretation problems, the suggestions for future research and its ‘ear’ for women’s voices. A biopsychological approach to stress in women and men by Frankenhaeuser gives an excellent example of the theoretical work that must be done before a multidimensional gender approach can be realized. The outcome of the other chapters is informative but barely innovative in its gender approach. In Pain, Reading presents Loesers multifaceted hierarchical model that provides a valuable map for understanding pain develop ment, management and treatment. However, in this case I missed the ensuing application and regretted the reduction to female reproductive organs. Similar biological reductions of women are applied in Cancer in Women by Ott and Levy, and Sexuality and Infertility by Morokoff and Calderone. This last chapter even almost neglects the psychological components of the problems. Another questionable reduction appears in Women’s Health: The Impact of the Expanding AIDS Epidemic by Murphy and Kelly, when they depict women as mothers in the first place. The chapter on coronary risks is very traditional in its psychological approach whereas the contributions on women and drugs, and on body image and the regulation of weight highlight the physical aspects at the cost of the psychological ones. From a psychological point of view, I was amazed that only three chapters (on body image and weight, menstruation, and pain) paid attention to processes of meaning attribution. From a methodological point of view, I was embarrassed by the fact that some chapters are built on findings obtained by instruments (DSM, GHQ, MMDS, MMPI) that are genderbiased according to other chapters. From a practical point of view, I sometimes even forgot that I was supposed to learn about women’s health, because authors persisted in a bizarre sex neutral approach and language. What will this book contribute to patient education and counseling? Do caring professionals want to know that many women managers have a
Book reviews
high physiology arousal level in the evening; that the popular interpretation of behavioral medicine research findings on oncology may induce stress and guilt in patients with cancer; that the beliefs about menst~tion and pain may be strategically used by women as an excuse, and also to maintain their self-esteem? Do they like to be informed about women-specific prevention and treatment programs on cancer, pain, AIDS, and female infertility? In that case, the book could be useful, though it does not offer an adequate index for them. Researchers may use the book in order to look for white spots, and for disti~ing new topics for investigation, and they will absolutely learn about the pitfalls they should avoid.
Assistant Professor at the Department of Clinical and Health Psychology of Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Ne~erl~ds (Visiting Professor ‘Women’s Mental Health Care’ at the University for Humanistic Studies). SSDZ 0738-3991{95)~83~0
QuaIity and ExceIlenee in Human Services (A volume in the Wiley series on clinical psychology) Paul Dickens, John Wiley &c Sons Ltd., Chichester, 205 pp.; f 14.95 A number of intluences have brought about an increased concern for quality in human services. Firstly, most public services in the Western world have come under increased financial constraint and, at the same time, increased public scrutiny. Secondly, ahnost all areas of human services have witnessed major changes in values, organizational structure and operational methods, which provide an excellent op~~u~ty for both service purchasers and service providers to evaluate the effectiveness and quality of services provided. In addition to this, there has been a rise of consumer infhtence on service provision, paired with a greater emphasis on customer satisfaction. This partly reflects the general pre-eminence of quality as the topic for management and industry in the 1990s.
207
Lastly, the concern for quality in the human services has been intluenced by the desire for professional identity, which brings with it increased emphasis on training, pre- and post-qua&I&ion, and professional competence and legitimacy. The aim of Dickens’ book is to draw together work from a variety of sources to enable human services professionals to examine the quality of their service, and to improve it in case this should be necessary. In the second chapter, the issue of quality is considered by examining work done in industry in general, and finally in service industries. The third chapter starts with a definition of human services as ‘those service industries that are mainly concerned with supplying services for people in the areas of social, health and educational care’. Next, several problems with respect to defining quality within human services are discussed, including their heterogeneous, multiprofessional ‘input’ and the in~~bili~ of their ‘product’, and it is described how the value system of a service organization influences its quality. The chapter concludes with a discussion of components of quality healthcare services, and the i&nti~~tion of three of them - structure, process and outcome - as essential to any description or assessment of the quality of a healthcare system. The fourth chapter deals with quality assurance, which refers to the framework within which a number of methods for the development, evaluation, monitoring and maintenance of quality and excellence are carried out. By considering the main features of quality assurance in industry, the basic elements that such an approach requires are examined. Next, total quality management (TQM) is presented as a way to integrate the disparate parts of an overall approach to quality. TQM can be seen as the last stage in the evolution of quality management procedures, focusing on both ‘hard’ (tools and techniques, frameworks) and ‘soft’ (attitudes, values and interpersonal behavior) aspects of quality. At the end of this chapter, two models of TQM are discussed. In the next three chapters, several tools and techniques of human service quality are examined and ,practical illustrations of their application are given. In Chapter 8, practical examples of the development of a systematic approach to quality
Book reviews
Psychological Pempectlves on Women’s Health Vincent J. Adesso, Diane M. Reddy and Raymond Fleming, Taylor & Francis, London, 1994; 360 pp.; g14.95 What makes this book interesting is not so much its content. It is the struggle in order to achieve a multidimensional psychological view on gender and health. The editors had two goals: to create a thorough book on the important topics in women’s health, and to provide a resource for current and future research in this field. They therefore collected 12 chapters of material that would illustrate ‘the multifaceted nature of gender, illuminating the role of psychological factors, broadly construed as encompassing behavioral and socio-cultural factors, and demonstrating the ways in which psychological and biological factors interact to influence women’s health’ (p. 5). The result is a broad scope of areas analyzed from very different perspectives. The books’ range of perspectives - on gender and on psychology - undoubtedly reflects the state of the art. It is also the main cause of its weakness. Gender is treated alternately as an independent variable, a multidimensional variable, and a dependent variable or rather a ‘window’. Although the editors notify these differences and seem to rank them as progressive steps, they have overlooked the possibility to utilize them for the organization of the chapters. As each contributor also presents their own psychological model (tacitly or explicitly), and makes bis or her own weighing of genetic, hormonal, physiological, behavioral, social and sometimes cultural factors, the book lacks consistency. Presumably, it is too early for a compilation of women’s health studies from a coherent gender perspective. My dissatisfaction with the book as a whole is not equally distributed over the separate chapters. Gender and Aging, Women and Their Aging by Leventhal fully meets the promises of the editors. Psychology and Women’s Health: Some Reflections and Future Directions by Gallant, Coons and Morokoff offers an interesting example of the theoretical and methodological problems connected with research on gender differences in coping and social support. Toward an Understan-
ding of Women’s Experience of Menstrual Cycle Symptoms by Kato, Klebanov and Ruble is also stimulating on account of the attention paid to methodological and interpretation problems, the suggestions for future research and its ‘ear’ for women’s voices. A biopsychological approach to stress in women and men by Frankenhaeuser gives an excellent example of the theoretical work that must be done before a multidimensional gender approach can be realized. The outcome of the other chapters is informative but barely innovative in its gender approach. In Pain, Reading presents Loesers multifaceted hierarchical model that provides a valuable map for understanding pain develop ment, management and treatment. However, in this case I missed the ensuing application and regretted the reduction to female reproductive organs. Similar biological reductions of women are applied in Cancer in Women by Ott and Levy, and Sexuality and Infertility by Morokoff and Calderone. This last chapter even almost neglects the psychological components of the problems. Another questionable reduction appears in Women’s Health: The Impact of the Expanding AIDS Epidemic by Murphy and Kelly, when they depict women as mothers in the first place. The chapter on coronary risks is very traditional in its psychological approach whereas the contributions on women and drugs, and on body image and the regulation of weight highlight the physical aspects at the cost of the psychological ones. From a psychological point of view, I was amazed that only three chapters (on body image and weight, menstruation, and pain) paid attention to processes of meaning attribution. From a methodological point of view, I was embarrassed by the fact that some chapters are built on findings obtained by instruments (DSM, GHQ, MMDS, MMPI) that are genderbiased according to other chapters. From a practical point of view, I sometimes even forgot that I was supposed to learn about women’s health, because authors persisted in a bizarre sex neutral approach and language. What will this book contribute to patient education and counseling? Do caring professionals want to know that many women managers have a
Book reviews
high physiology arousal level in the evening; that the popular interpretation of behavioral medicine research findings on oncology may induce stress and guilt in patients with cancer; that the beliefs about menst~tion and pain may be strategically used by women as an excuse, and also to maintain their self-esteem? Do they like to be informed about women-specific prevention and treatment programs on cancer, pain, AIDS, and female infertility? In that case, the book could be useful, though it does not offer an adequate index for them. Researchers may use the book in order to look for white spots, and for disti~ing new topics for investigation, and they will absolutely learn about the pitfalls they should avoid.
Assistant Professor at the Department of Clinical and Health Psychology of Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Ne~erl~ds (Visiting Professor ‘Women’s Mental Health Care’ at the University for Humanistic Studies). SSDZ 0738-3991{95)~83~0
QuaIity and ExceIlenee in Human Services (A volume in the Wiley series on clinical psychology) Paul Dickens, John Wiley &c Sons Ltd., Chichester, 205 pp.; f 14.95 A number of intluences have brought about an increased concern for quality in human services. Firstly, most public services in the Western world have come under increased financial constraint and, at the same time, increased public scrutiny. Secondly, ahnost all areas of human services have witnessed major changes in values, organizational structure and operational methods, which provide an excellent op~~u~ty for both service purchasers and service providers to evaluate the effectiveness and quality of services provided. In addition to this, there has been a rise of consumer infhtence on service provision, paired with a greater emphasis on customer satisfaction. This partly reflects the general pre-eminence of quality as the topic for management and industry in the 1990s.
207
Lastly, the concern for quality in the human services has been intluenced by the desire for professional identity, which brings with it increased emphasis on training, pre- and post-qua&I&ion, and professional competence and legitimacy. The aim of Dickens’ book is to draw together work from a variety of sources to enable human services professionals to examine the quality of their service, and to improve it in case this should be necessary. In the second chapter, the issue of quality is considered by examining work done in industry in general, and finally in service industries. The third chapter starts with a definition of human services as ‘those service industries that are mainly concerned with supplying services for people in the areas of social, health and educational care’. Next, several problems with respect to defining quality within human services are discussed, including their heterogeneous, multiprofessional ‘input’ and the in~~bili~ of their ‘product’, and it is described how the value system of a service organization influences its quality. The chapter concludes with a discussion of components of quality healthcare services, and the i&nti~~tion of three of them - structure, process and outcome - as essential to any description or assessment of the quality of a healthcare system. The fourth chapter deals with quality assurance, which refers to the framework within which a number of methods for the development, evaluation, monitoring and maintenance of quality and excellence are carried out. By considering the main features of quality assurance in industry, the basic elements that such an approach requires are examined. Next, total quality management (TQM) is presented as a way to integrate the disparate parts of an overall approach to quality. TQM can be seen as the last stage in the evolution of quality management procedures, focusing on both ‘hard’ (tools and techniques, frameworks) and ‘soft’ (attitudes, values and interpersonal behavior) aspects of quality. At the end of this chapter, two models of TQM are discussed. In the next three chapters, several tools and techniques of human service quality are examined and ,practical illustrations of their application are given. In Chapter 8, practical examples of the development of a systematic approach to quality