Women’s mental health: Integrating body and mind. A dialogue between psychiatry, obstetrics
and gynaecology.
The Royal Society of Medicine. 11th of March 2014.
Health professionals from the disciplines of psychiatry, obstetrics and gynaecology came together to
attend an interesting and stimulating conference entitled ‘Dialogue between Psychiatry and
Gynaecology’. It was attended by an impressive array of prominent and acclaimed clinicians from
across disciplines and professions generating much discussion and stimulating debate. Sessions
included both psychiatric and obstetric or gynaecology perspectives on topics such as domestic
violence, mental illness, and body dysmorphic disorder and the requests for genital cosmetic surgery
as well as recent relevant research in attachment and social behaviour.
Professor John Studd, Consultant Gynaecologist, opened the meeting with a discussion on ‘A
historical overview on how western society has viewed women’s health’. Professor Studd, has been
recognized as an authoritative and experienced gynaecologist, and has championed the use of
hormone implants for women with osteoporosis, severe depression or sexual problems after the
menopause and set up the first ever menopause clinic in the country. His presentation highlighted
the views held by people down the ages about the relationship of insanity with woman’s
reproductive health. He described how Charcot had described mental conditions in woman to be
related to female genitalia, how ‘menstrual madness ‘was treated by the removal of the clitoris and
ovaries. Interestingly Henry Maudsley had also made this association and there was reference to this
in books like ‘Sex in Mind and Education.’ He also talked about how ovaries were being surgically
removed as a way of treating insanity, the Battey’s operation. His talk confirmed what we are all
quite aware of and that is the inequalities in the position of woman in society in comparison to men
which is more prominent in the some countries and cultures but nonetheless also seen in the
western world.
The first session, on ‘Minds and Brains of the Future’ was delivered by two eminent and
internationally renowned figures. Professor Marinus IJzendoorn, Professor of Child and Family
Studies in the Netherlands presented on ‘The importance of early experiences on the
neurodevelopment of human babies’. He discussed his work on attachment behaviours, oxytocin
and infant crying and introduced the concept of oxytocin therapy as a way of sharpening emotional
recognition, lowering aversion, creating and maintaining relationships by lowering activity in
amygdala. Research on men demonstrated increased sensitivity to children’s play when given 24 IU
of oxytocin spray and stimulated food for thought about future treatments.
Professor Stephen Suomi, Chief, Laboratory of Comparative Ethology, USA gave a fascinating
presentation on ‘Leaning from research on non-human primates about the effects of mothering and
the environment and how genetics can affect behaviour’. He showed within his presentation short
videos of primates highlighting how social experiences early in life can have lasting effects on
primate behavioural development. Rhesus monkeys raised by their peers showed increased
aggression and fear when faced by stressors as compared to those who were raised by their
biological mothers. Differences were seen in their both their brain structure and function. His
research is looking at how this can translate to humans living in different cultures.
Professor Louise Howard, Professor and Head of Women’s Mental Health, Institute of Psychiatry,
needed no introduction. In her talk on ‘Mental health during pregnancy’ she highlighted recent
evidence relating to the prevalence, course of the illness and impact on the unborn child of
depression, anxiety disorders and eating disorders. She discussed the mechanisms leading to
adverse outcomes in this group of women which included smoking, obesity, domestic violence,
nutritional deficiencies, medication, impact of untreated illness on the newborn, and inadequate
antenatal care. She presented data on the short and long term impact of the use of antidepressants
on the new-born (including a number of papers which have presented controversial and conflicting
data on the use of antidepressant /SSRI’s during pregnancy) She referenced her current research in
which she will be looking at the outcomes in mothers managed on Specialist Mother and Baby Units
versus standard inpatient units or Crisis teams.
Professor Susan Brewley, Professor of Complex Obstetrics at Kings College, London, spoke on
‘Domestic violence during on-going pregnancy and associated with termination of pregnancy’ and
particularly the topic of intimate partner violence in pregnancy. We were informed about signs to
look out for during clinical contact (relationship difficulties, multiple admissions, non-attendance,
vague symptoms, abdominal pain, difficult patients, discharge against advice and substance and
alcohol misuse), things which on reflection, I must confess, I do sometimes overlook in reviews.
Accompanying her talk were some pictures of real situations which managed to reinforce her goal of
increasing awareness of domestic violence during pregnancy.
The session following lunch looked at ‘Reproductive depression: treatment from the psychiatrist’s
perspective’ by Dr Michael Craig, Senior Lecturer and Consultant Psychiatrist at the Maudsley,
Female Hormone Clinic, talked about the impact of prenatal stress on the unborn child, the
physiology behind this and the research around it’s management currently being undertaken in the
USA which includes RCT’s looking at SSRI’s versus oestrogens versus placebo.
This was followed by ‘Reproductive depression: treatment from a gynaecologist’s perspective’ by
Professor Studd whose offered his opinion that many woman are given a diagnosis of a severe
mental illness and are unnecessarily exposed to toxic medication (psychotropics),which otherwise
could be avoided just by asking a few relevant questions and treating them with hormones. His
examples included how patients with only pre-menstrual mood symptoms may respond to hormonal
therapy are instead treated for bipolar affective disorder or depressive disorder. He stated that by
asking only a few questions during assessments (like mood symptoms related to menstrual cycles,
symptoms better during pregnancy, but returning after delivery, worsening with age, associated
bloating and headaches )this could be prevented. Much debate followed!
Professor Linda Cardazo, OBE, Professor of Urogynaecology and Consultant Gynaecologist, held the
audience enthralled with her talk on ‘Female cosmetic genital surgery’ particularly labiaplasty
following on from a presentation by Dr David Veale on ‘Body dysmorphic disorder in a
gynaecological setting’ with focus on patients with a preoccupation with the shape and size of the
labia. Personally, though I was fascinated with both the absolutely brilliant presentation and its
content, whether labiaplasty should be offered under the umbrella of cosmetic surgery remains in
my opinion a very debatable subject.
The final session included presentations by Dr Jan Welch, Consultant in HIV Medicine and Sexual
Health, Kings College London, on ‘Rape and sexual assault’ and spoke of her clinical work in Sexual
Assault and Referral Centres in London. The day closed with a presentation by Dr Geoff Marston,
Consultant Psychiatrist, on ‘Forced marriage: the pressure to marry’ highlighting the need for
clinicians to be aware of the issue and vigilant to identify potential victims and the necessity to take
the opportunity to act.
We then came to the end of a very enlightening and satisfying day filled with lots of thoughts,
debates and information to reflect on and where relevant improve patient care in our clinical
practice.