Ethical principles are influenced by personal values and beliefs, and by societal context. They are not immutable. In medicine, as new technologies have developed and changes in health-care delivery have resulted, historically held views about the responsibilities, obligations and relationships between health-care providers and patients have been challenged.

“Except as occasional consultants, the less men doctors have to do with female lunatics the better”. (Lowe, 1883)

“As long as women are over-represented among mental patients and family caretakers and under-represented among psychiatrists, administrators and politicians, their lives will continue to be unhappily affected by decisions in which they take no part”. (Showalter, 1987)

Depression in treated samples shows an approximately 2:1 female predominance. The sex ratio is not due simply to more help-seeking behaviour in women, for it applies equally in studies of community prevalence. Differential acknowledgement and direction of distress may be a partial explanation, supported by male predominance of alcoholism and completed suicide, and by a possible recent increase in depression in young men. Biological mechanisms acting through hormonal effects on the brain are plausible, but hard to test. Epidemiological studies indicate that much of the excess occurs in married women aged 25–45 years with children. This strongly suggests social causation and highlights the vulnerable situation of young mothers. The full explanations for the sex difference are not yet clear, but are likely to combine factors related to expression of distress, biology and social situation.

The reasons for women in Europe and North America being prescribed over twice as many psychotropic drugs as men are complex. Psychiatric disorders such as depression and anxiety appear to be more common in women than in men, and women more commonly complain of psychological symptoms. There may be a gender bias in medical diagnosis and choice of medication. Sociological factors may also be involved, including the likelihood that women have fewer outlets than men for symptom control by activities outside the home (e.g. the social use of alcohol). Women also have special problems including pregnancy, lactation, child rearing and pre-menstrual tension. Probably, much use of psychotropic-drug use for women (and men) is inappropriate and not closely related to the symptoms or conditions for which they are prescribed. Furthermore, the chronic use of some psychotropic drugs, especially benzodiazepines, may compound the problem by inducing dependence and withdrawal symptoms.

Most research into substance misuse has focused on men but the problem among women is considerable and the social consequences and causation differ between the sexes. In the US, one-third of alcohol abusers are women and in the UK 1% of women are estimated to be drinking at a dangerous level. Drug and alcohol misuse holds additional problems for women since abusers tend to be of childbearing age. Rehabilitation units and prevention strategies would benefit more women substance abusers if they were tailored to suit their specific needs.

This is a preliminary report from a prospective study of the influence of psychosocial stressors on post-natal relapse in women at high risk of psychiatric disorder after childbirth. Forty-three index subjects with a previous history of psychosis or severe depression were compared with 45 pregnant control subjects without any previous psychiatric disorder. After delivery 51% of index subjects relapsed (RDC diagnoses): 28% were categorised as psychotic and 23% non-psychotic. All psychotic relapses were in women with a previous history of bipolar or schizoaffective disorder (46% of this subgroup). Only the non-psychotic post-partum relapses (mostly depressions) were associated with an increased likelihood of a severe life event in the 12 months preceding illness onset.

A strong emphasis on individual psychopathology has informed much discussion on female crime, although more recent research has stressed its social setting and influences. Women commit all types of crime, although to a much lesser extent than men, particularly with regard to violent crime. Social and economic marginalisation is a significant factor in female crime. Criminal convictions seem to be more stigmatising for women. In court, women are treated as doubly deviant and their actions are explained in psychopathological terms. Because of the small numbers of women offenders, non-custodial and custodial provisions for them are inadequate. Although men are more likely to be victims of, for example, street crime, women express more fear of crime. One reason for this may be the prevalence of domestic crime committed by men against women (and children) that is underestimated in some surveys.

At present there is no consensus of opinion about the short-term or long-term effects of child sexual abuse, although there is a growing body of literature on the subject. Definitions of what constitutes child sexual abuse vary enormously and, even where agreed, include a wide range of behaviours. Most clinical reports are retrospective in nature and based on self-report. Many authors agree that effects can be classified into four general areas, however, emotional/psychological; sexual adjustment; interpersonal relationships; and social functioning. There are considerable implications for treatment of those who have been abused and for the protection of their children.

Standardised personality assessments were administered to 50 consecutive referrals to an Eating Disorders Clinic. A history of childhood sexual abuse was identified in 30% of patients using a modified version of the SLEI. This rate is comparable with those from other studies. Overall, 52% of the patients were rated as having a personality disorder but a significantly higher proportion of women with a personality disorder had a history of childhood sexual abuse compared with those without a personality disorder (13/26 v. 2/24, Fisher P < 0.001). Although in patients with eating disorders no clear causal link between CSA and personality disorder was demonstrated, our findings emphasise the need to inquire sensitively into the sexual history of such patients.

Recent research shows that the demands of the caregiving role are experienced differently by men and women. Both the subjective and the objective strain and burden appear to be greater in female carers of dementia sufferers, and factors that influence this include differences in role expectations and coping strategies. These findings have implications for the provision of services for dementia sufferers and their carers.

There is a paucity of research concerning service usage and needs of female long-term psychiatric patients. A series of studies comparing the provisions for chronically mentally ill men and women in a south London community-focused rehabilitation and continuing care service indicate marked differences in the services received by men and women, and raise questions concerning whether the needs of female patients are adequately served. As a group the women had been in contact with services for longer, had received less intensive input from services, and it appeared that the services had been less responsive to their changing needs. Among those in high contact with the services, the functioning of men and women did not differ, yet women were over-represented in workshops designed for those functioning at a lower level. Women over 45 years of age seemed to be particularly badly served by the organised activities offered.

The closure of large psychiatric institutions has led to alternative accommodation being developed for people with long-term psychiatric disabilities, with an emphasis on group living. Despite this, very little is known about where these people live, about the accommodation needs of this group, or whether men and women have differing needs. This paper examines the accommodation of all people with long-term and severe psychiatric disabilities in one South London borough who were in contact with a specialist service. It was found that the majority of people either live with their families – although the family member differed for men and women – or live alone. Men were more likely than women to live in hostels or alone, while women were more likely than men to live with their families.

Aspects of the normal psychology and psychopathology of women are discussed in relation to adolescence, young womanhood and motherhood. Perversions of motherhood exist, although they are largely denied by a society which idealises being a mother. This denial may be caused by society's inability to see a woman as a complete human being. The aetiology of perversions in women is both psychobiological and social and it is bound up with the politics of power. Perverse motherhood can be seen as the product of the emotional instability and inadequate individuation brought about by a process involving at least three generations.