I congratulated my patient Diane on being selected for a very prestigious Woman of Achievement award. Imagine my surprise when this very powerful, self-possessed executive dissolved into tears in my consulting room!
Her accomplishments had come at some personal cost. The constant stress and competition had taken its toll on her sleeping habits and relationships. I wanted to talk about those issues, but instead, she seemed fixated on a colleague of hers, a man who occupied a very similar position to her own in a different division of the company, and whose reaction to the pressure was diametrically opposed to her own.
“The tighter the deadline, the bigger the risk, and the greater the consequences if we fail, the happier he seems to be. The stress is like food for him. He thrives on it, while I feel utterly depleted by it”, she wept. “He makes me feel like I’m going crazy.” I was pleased to report to Diane that she wasn’t crazy. Her impressions were correct:
Men and women experience and react differently to stress.
Of course, our different experiences and reactions matter tremendously. We’ve all known or been in relationships that seemed as solid as bedrock until a variety of stressors closed in, squeezing us until we could barely breathe. Life, after all Is stressful – and now more than ever. Most American families struggle under tremendous pressure. We’re worried about our personal health, about terrorism at home, about how will take care of our aging parents, about our children and what their futures hold. We work long hours and take very little vacation time, but it seems that no matter what we do, the wolf is never far from the door. We don’t sleep enough or get enough exercise, leaving our bodies without the resources they need.
There are couples who can ride outside stormy weather – and, indeed, have a loving and supportive partner can be a true life raft in times of extreme strain. Why then does it seem that for the majority of people, stress is a profoundly alienating influence in our relationships, one that drives a wedge between us? When work is stressful, why do we find ourselves squabbling over who left the cap off the toothpaste? How does the same relationship that seems like such a respite when we were lying on that tropical beach became a become a drain on our resources? Why does our partner so often seem like an additional burden instead of a sanctuary where we can gratefully find refuge from the storm? And why are our relationships so taxed by the major events we go through together, instead of fuel for further intimacy?
Here again, I believe that the explanation lies in the differences between us. Stress, and all its manifestations, is different for men and women. The majority of the time, men and women are stressed out about different things, and the concerns of the other person in the relationship can seem baffling and low-priority compared to our own. The way we experience stress is different, and the effect that stressful conditions have upon us, both physically and mentally, is gender-specific. Not surprisingly, the tactics we use to manage or deflect it are also different, and it is quite often the disparity between the strategies that gives rise to many of the conflicts that take place between us.
So again, given the differences between us, it’s not a surprise to find ourselves on opposite sides of the fence when the going gets tough. It doesn’t have to be this way. We can and should be one another’s greatest allies and resources, especially when we’re under pressure. It is my hope that a better understanding of what our partners think, feel, and experience when tensions rise can help us use one another as bulwarks against inevitable outside pressures, as opposed to being the straw that breaks the proverbial camel’s back
Marianne J. Legato, MD, Ph. D. (hon. c.), FACP is an internationally renowned academic, physician, author, lecturer, and pioneer in the field of gender-specific medicine. She is a Professor Emerita of Clinical Medicine at Columbia University College of Physicians & Surgeons and an Adjunct Professor of Medicine at Johns Hopkins Medical School. Dr. Legato is also the Director of the Foundation for Gender-Specific Medicine, which she founded in 2006 as a continuation of her work with The Partnership for Gender-Specific Medicine at Columbia University. She received an honorary PhD from the University of Panama in 2015 for her work on the differences between men and women.
At its core, gender-specific medicine is the science of how normal human biology differs between men and women and how the diagnosis and treatment of disease differs as a function of gender. Dr. Legato’s discoveries and those of her colleagues have led to a personalization of medicine that assists doctors worldwide in understanding the difference in normal function of men and women and in their sex-specific experiences of the same diseases.
She began her work in gender-specific medicine by authoring the first book on women and heart disease, The Female Heart: The Truth About Women and Coronary Artery Disease, which won the Blakeslee Award of the American Heart Association in 1992. Because of this research, the cardiovascular community began to include women in clinical trials affirming the fact that the risk factors, symptoms, and treatment of the same disease can be significantly different between the sexes. Convinced that the sex-specific differences in coronary artery disease were not unique, Dr. Legato began a wide-ranging survey of all medical specialties and in 2004, published the first textbook on gender-specific medicine, The Principles of Gender-Specific Medicine. The second edition appeared in 2010 and the third edition, dedicated to explaining how gender impacts biomedical investigation in the genomic era, won the PROSE Award in Clinical Medicine from the Association of American Publishers in 2018. A fourth edition is forthcoming.
She also founded the first scientific journals publishing new studies in the field, The Journal of Gender-Specific Medicine, and a newer version, Gender Medicine, both listed in the Index Medicus of the National Library of Medicine. She has founded a third peer-reviewed, open access journal, Gender and the Genome, which focuses on the impact of biological sex on technology and its effects on human life.
Dr. Legato is the author of multiple works, including: What Women Need to Know (Simon & Schuster, 1997), Eve’s Rib (Harmony Books, 2002), Why Men Never Remember and Women Never Forget (Rodale, 2005), Why Men Die First (Palgrave, 2008), The International Society for Gender Medicine: History and Highlights (Academic Press, 2017), and most recently, The Plasticity of Sex (Academic Press, 2020). Her books have been translated into 28 languages to date.
As an internationally respected authority on gender medicine, Dr. Legato has chaired symposia and made keynote addresses to world congresses in gender-specific medicine in Berlin, Israel, Italy, Japan, Panama, South Korea, Stockholm, and Vienna. In collaboration with the Menarini Foundation, she is co-chairing a symposium on epigenetics, Sex, Gender and Epigenetics: From Molecule to Bedside, to be held in Spring 2021 in Italy. She maintains one of the only gender-specific private practice in New York City, and she has earned recognition as one of the “Top Doctors in New York.”
