The Washington Post Book World

August 20, 2006

A Brain of One's Own;
Deborah Tannen on Louann Brizendine's Provocative Theories About the Way Women Think

Reviewed by Deborah Tannen

THE FEMALE BRAIN

By Louann Brizendine

Morgan Road. 279 pp. $24.95

In the past, "nature" was used to maintain the status quo. A physician at Harvard University once cited biology as a reason to bar women from higher education: All that blood rushing to their brains would be drained from their wombs, he claimed, impairing their ability to bear children. Then the pendulum swung the other way. In the 1960s and '70s, nearly every aspect of human behavior was attributed to "nurture," including sex differences. If parents raised children the same way, giving dolls to boys and trucks to girls, they'd grow up acting the same.

In the 1990s, the pendulum swung again: A steady flow of books about evolutionary biology explained nearly every aspect of human behavior as a result of the organism's urge to get its genes into the next generation -- the female by ensuring her offspring's survival, the male by spreading his sperm far and wide. And books such as Ann Moir and David Jessel's Brain Sex, Deborah Blum's Sex on the Brain and Melissa Hines's Brain Gender provided accounts of gender differences based on brain structure and hormonal chemistry.

Now Louann Brizendine joins this trend. Her book The Female Brain is distinguished by her direct experience as a neuropsychiatrist and the founder of the Women's and Teen Girls' Mood and Hormone Clinic in San Francisco. Brizendine does not deny the influence of culture; she writes, "Gender education and biology collaborate to make us who we are." But her goal is to lay out the evidence for the role played by biology and its effects on women's lives. With 80 pages of notes and references supporting 190 pages of text, she seamlessly weaves together the findings of innumerable articles and books, both technical and popular, along with accounts of patients she treated at her clinic, to support her claim that "the female brain is so deeply affected by hormones that their influence can be said to create a woman's reality."

In a breezy, playful style (the calming hormone oxytocin is a "fluffy, purring kitty," while testosterone "has no time for cuddling"), Brizendine follows the development of women's brains from birth through the teen years, to courting, pregnancy, childbirth and child-rearing, and on to menopause and beyond. Throughout the book, I recognized biological accounts for social behaviors I had observed and written about. For example, the major role played by talk in women's and girls' close relationships is explained by differences in the brain. For one thing, "some verbal areas of the brain are larger in women than in men." How did they get that way? "The testosterone surge" that male fetuses experience in utero "shrinks the centers for communication." In addition, "It is during the teen years that the flood of estrogen in girls' brains will activate oxytocin and sex-specific female brain circuits, especially those for talking, flirting, and socializing."

Anthropologists and linguists who have studied children at play have noted that girls form bonds by telling secrets. Here, too, Brizendine finds "a biological reason": "Connecting through talking activates the pleasure centers in a girl's brain. Sharing secrets that have romantic and sexual implications activates those centers even more. ... It's a major dopamine and oxytocin rush." Many readers will find it intriguing or reassuring that their own experiences are supported by brain studies, though such studies may raise the question of what's cause and what's effect. Do girls and women enjoy talking because it creates this hormonal rush, or do they get the hormonal rush because they enjoy talking about personal matters? Either way, brain studies dovetail with anthropological observations.

In the sections addressing menopause, Brizendine advises that each post-menopausal woman must decide for herself whether to take the hormones estrogen, progesterone or testosterone, but an implicit advocacy emerges. We read, for example, that "hormones in the brain are part of what makes us women" and that "when we lose this hormonal fuel," our brain cells "shrivel," and also that, "in women who took estrogen, there was less shrinkage in the brain areas for decision making, judgment, concentration, verbal processing, listening skills, and emotional processing." This statement doesn't directly claim that if you don't take hormones, your abilities to make decisions, use good judgment, concentrate, process language, listen and process emotions will deteriorate, but many will read it that way. Furthermore, the connection between brain size and brain function is an obvious assumption but not a scientifically based one. You might be able to do just as good a job with a smaller brain; after all, Brizendine tells us on the first page that although men's brains are larger, women's brains have essentially as many cells -- they're just "packed more densely."

Many of the book's case histories illustrate that hormonal changes cause problems that are solved, in part at least, by taking hormones, often along with an anti-depressant. For example, Brizendine reports that one 47-year-old patient found she was "fine one minute, but just the wrong comment from [her husband] could send her slamming doors throughout the house and taking refuge in the garage for an hour-long sob fest. She couldn't take it anymore and wanted me to prescribe something to treat her symptoms. ... So I gave her estrogen and Zoloft. In two weeks she was amazed at how much better she felt. Her brain needed the neurochemical support."

Here's another case and another hormone: A woman, Marilyn, came to Brizendine with her husband, Steve, who "was at his wit's end from being rejected sexually" by his wife. After tests showed that Marilyn's testosterone level was "barely present," Brizendine "prescribed the patch, and she slapped it on that very day." Two weeks later, when the couple returned, "Steve gave me two thumbs up. ... Her brain circuits for sexual desire had been reignited by a little hormonal rocket fuel. Use it or lose it goes for everything, memory and sex included. The brain below the waist will shrivel up if it isn't used." Though she cautions that testosterone "can contribute to thinning hair, acne, body odor, facial hair growth, and a lower voice," Brizendine nonetheless suggests that "women who complain of a lack of sexual interest -- whether they are premenopausal or postmenopausal -- deserve a trial of testosterone just as most doctors would prescribe for a man."

The descriptions of how hormonal surges and plunges might result in women's erratic behavior and emotional unpredictability can seem like a dangerous reinforcement of stereotypes. But Brizendine argues that not understanding the effects of hormonal cycles is itself dangerous because women end up blaming themselves. She notes, crucially, that 80 percent of women are only mildly affected by hormone fluctuations, and that "a hormone alone does not cause a behavior. Hormones merely raise the likelihood that under certain circumstances a behavior will occur." Perhaps these caveats should be repeated as running heads on every page.

Paleontologist Stephen Jay Gould once said he despaired of the constant question "Is it nature or nurture?" because "biology and environment are inextricably linked." Ideally, readers will sift through the case studies, research findings and scientific conjectures gathered in this non-technical book and be intrigued by some while questioning others, bearing in mind the caution that hormones and brain structure play a role in gender differences but are not the whole story. And if this book joins a "nature" chorus that has swelled as a corrective to the previous pendulum swing toward "nurture," we can assume that another corrective will follow. But given the character -- and rancor -- of our dichotomous approach to the influences of biology and culture, readers likely will be fascinated or angered, convinced or skeptical, according to the positions they have staked out already. That would be a pity.

Deborah Tannen, a professor of linguistics at Georgetown University, is the author of "You Just Don't Understand: Women and Men in Conversation" and, most recently, of "You're Wearing That? Understanding Mothers and Daughters in Conversation."