Textbook of Men's Mental Health. Edited By Jon E. Grant & Marc N. Potenza. American Psychiatric Publishing. 2007. 468pp. US $75.00 (hb). ISBN 158562215X

Q. Why does it take 45 million sperm to fertilise one egg?

A. Because none of them will ask the way.

Males have a problem in asking for help. This is a serious disadvantage given that, on almost all measures, we are more vulnerable than females to biological or psychological challenges. Men tend to rely on women to get them to doctors, and indeed to keep them socialised and in contact with their own children, even if they are not fully aware of this.

This is a psychiatric and psychological textbook, not a medical one, though pharmacological and neurodevelopmental issues are well covered. The missing link is the evolutionary theme, which is not explored at all. Men die before women (Barford et al, 2006), boys more than girls, and male before female foetuses. A more cohesive society reduces some of these differences (Westerling, 2003). Apart from neural tube defects and chromosomal abnormalities, everything that can go wrong from conception to delivery is more likely to affect the male. While many more males than females are conceived, the gap has diminished by the time of birth. Under severe stress (such as war or natural disaster) the male:female ratio at birth falls further (Catalano et al, 2006). Death, damage and disease are more common (or more severe) in males throughout their life-span (Kraemer, 2000; Rutter et al, 2003).

The Y chromosome is a poor thing but with two Xs, females are endowed with what is in effect a spare battery (Christensen et al, 2001). In nature, the majority of males are redundant. Successful mating in most mammalian species is the preserve of only the most successful high-ranking individuals. In contrast, there are far more opportunities for human males to procreate but being a man is more complicated. In modern societies masculinity is fragile, when for so many men, except in sport and furniture removal, non-violent, physical superiority is of little value (Kraemer, 1995).

None of these evolutionary data are acknowledged in the text, a significant omission. Apart from that, the scientific and psychological material is up to date and thorough though the clinical advice is rather pedestrian. The suggestion (p. 57) that older men would be more likely to accept psychiatric care if it were integrated with medical services makes good sense, however. There are lively case vignettes in each chapter but, oddly, these are not taken up in the subsequent text. They are worth reading on their own.

A thicker corpus callosum in women (p. 285) may aid richer left-right communication in their brains. Whatever the reason, women tend to make more social connections too:

‘…in response to a depressed mood, men would be more likely to avoid thinking about why they were depressed, to take drugs, or to do something physical, whereas women would try to determine why they were depressed, talk to others about how they were feeling, or cry’ (p. 99).

Throughout life stressed males tend to be irritable and restless. The reason why more men than women kill themselves is not simply owing to greater impulsivity (p. 26) or the more violent and efficient methods chosen (p. 99), but also to a prevailing belief that no one will be there to help.