What
Women Don't Want: Psychiatric Abuse
Review
of Women, Madness and Medicine. By Denise Russell. Polity
Press in association with Blackwell Publishers,
Women,
Madness and Medicine begins with a brief but trenchant review of the history of approaches to
behavioral nonconformity. Identifying deviant behavior as bedevilment or, to
use author Denise Russell's preferred term, "madness," enables
society to banish or otherwise control troublemakers without benefit of the
formal proceedings afforded criminals. The process has been facilitated by the
use of medical terms to categorize emotional and behavioral aberrations thereby
bringing those who exhibit symptoms of "insanity" within the purview
of medicine.
In earlier times, the
behaviorally deviant were believed to be Satan-controlled, but the malevolent
witches of the 17th century became psychiatric patients in the 19th. No longer
in chains, the inmates of asylums were treated by physicians whose therapeutic
punishments included silent unresponsiveness and cold showers. Freud-based
talking cures were popular among the noninstitutionalized
but "worried" wealthy during most of the twentieth century, and the
influence of psychoanalytic theory is still with us, although medical
psychiatry has now substantially replaced psychodynamics as the accepted theory
and approach to misbehavior. Today's preferred treatment modalities stress
surgery and drugs over time-consuming and largely ineffective psychotherapies.
While not denying the existence of mental illness or forms of human distress
that cause people to seek relief from professional counselors, Russell rails
against the categorizations that regard inevitable turmoil due to external
forces as "illnesses" for which, perversely, victims are held
responsible.
In many societies,
males control the reproductive functions of females through subjugation. With purdah, chastity belts and infibulation
out of fashion, oppression via psychiatric diagnosis and treatment became the
method of choice in modern patriarchies. Russell declares boldly in her
introduction that for women psychiatry has "produced more harm than
good." Despite changes in accepted social and professional roles, women
who fail to meet cultural expectations of dependency, submission, and domestic
service still risk being characterized as "mentally disordered"
because sexism is inherent in many of the diagnostic categorizations
perpetuated through the widely used third revised edition of the Diagnostic and
Statistical Manual of Mental Disorders (1987, DSM-III-R). In a bow to
underlying confusion and public outcry, the term "disorder" largely
replaced "mental illness" in the revised edition but the vagueness of
many diagnostic categories still permits variable subjective and shifting
interpretations. The result is that virtually any action taken by a woman can
be considered pathological. In short, medical psychiatry is not neutral; it
"colludes in the maintenance of the subordination of women."
Regarding depression,
a condition more prevalent among women as compared with men, the Diagnostic
Manual attempts but does not fully succeed in clarifying a confusing tradition
extending at least as far back as Kraepelin that
depression may result either from a biological defect (endogenous) or a
stressful situation (reactive). The concept has incurred considerable recent
criticism as the result of studies that fail to find differences in stressful
conditions associated with the two. Some practitioners make a diagnosis only
after electric shock or drug treatments have been given. (Responding well to
ECT means the patient must have been suffering from endogenous depression,
etc.) It has been found that reserpine, which
depletes the neurotransmitter serotonin leads to depression in a fifth of the
patients studied but additional investigation brought inconclusive results.
Again, biomedical researchers also found some evidence that depression resulted
when dexamethasone, which depresses cortisol, seemed to produce symptoms in a substantial
proportion of subjects. But interpretation was clouded by confounding weight
losses. And the case for postpartum depression resulting from hormonal
secretions during childbirth foundered on inconsistency of results. Not all
women experience such depression and those who do may be reacting to
situational rather than biochemical conditions. Her review of the evidence
causes Russell to question whether depression is properly considered an
illness. This is particularly true of the milder forms ("dysthymia"). As Russell notes, Agnes Miles documents
in her book, Women and Mental Illness, that the long
working hours, monotony, absence of rules, isolation, confinement, and the
unending nature of the role of housewife might well produce a state diagnosable
as depression.
In later chapters,
Russell reviews the writings of women who have personally or professionally
encountered medical psychiatry. The experiences of the particular women
discussed differ in many ways, but all illustrate the theme of "medicalization" of the devalued female role. For
psychologist Phyllis Chesler, women are pigeonholed
as depressive, paranoid, suicidal, or frigid. The "idealistic"
Belgian feminist Luce Irigaray focuses on societal
repression of female sexuality and language. Fiction writers Charlotte Perkins
Gilman and Zelda Fitzgerald were ordered by psychiatrists to curb their
artistic impulses. Sylvia Plath's husband considered
her, not a literary genius, but an "excessively self-centered" woman.
Antonia White, whose books were inspired by a personal struggle against the
tribulations endured during a 10-month stay in a
It would be incorrect
to assume that therapy by talk alone is more benign than surgical and chemical
treatments. As the author of a critical analysis of psychotherapy (2), I
interviewed women who described therapy-induced damage of four types: sustained
and debilitating infatuation, dependency(3),
stigmatization, and inappropriate institutionalization(4).
In her conclusion,
Denise Russell also finds biological psychiatry sterile in the Popperian sense because the vagueness and subjectivity of
its conjectures and theories render them incapable of disproof. Furthermore,
although she is ready to admit the possible value of conceptions not fully
supported at the outset, in the case of medical psychiatry, not only does it
damage its victims, but its theories fail to meet scientific criteria of
ability to explain new facts. We've seen much of this before, but Russell's
book brings it all together concisely and effectively. Women,
Madness and Medicine belongs on every professional's book shelf as a
directory of the psychiatric abuse of women.
NOTES
(1) While there are
still those who insist that "therapy works," that effectiveness is
independent of therapist training is no longer in dispute.
(2) Psychotherapy, The Hazardous Cure, 1975, Abelard-Schuman.
After lengthy and detailed descriptions of the events of therapy, one woman
asked whether I agreed that the therapist returned her feelings. I said that I
saw no evidence of it from her descriptions of his actions. "But,"
she replied, unconvinced, because there is no convincing, "you haven't
seen his eyes." For twelve years, this woman's thoughts had daily focused,
not on children, husband, community or career, but on this man. With respect to
dependency strong enough to be called addiction, there was Evelyn, who began
psychotherapy as a teenager and had been "in" it ever since.
Remarkably, although she said she felt herself to have been duped, demeaned,
and violated by the various psychotherapists who had treated her over more than
35 years and despite a series of damaging therapy-induced incidents, her
long-standing dependency did not leave her and to the end of her life she
continued to allot substantial portions of her modest salary to professional
counselors.
(3) The term "limerence" refers to the overwhelming, involuntary
subcategory of the condition self-described as being in love. In psychoanalytic
parlance it was called "transference" when the psychotherapist is its
object.
(4) A woman induced by
her family to submit to voluntary institutionalization and electric shock
treatments was spared when a social worker at the hospital risked his career to
rescue her. She reported that "some things are even worse than in your
book."
(4) Melitta Schmideberg, a