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Mental Disorders

by Phyllis Chesler
Palgrave Macmillan, 2005
Review by Tony O'Brien, M Phil on May 30th 2006

Women and Madness

Women and Madness is the reissued, revised edition of a book first published at the height of second wave feminism in 1972. The Female Eunuch (Germaine Greer), and Sexual Politics (Kate Millet) were published in 1970. Chesler's book has a more specific focus than the other two; it is concerned with 'madness', or perhaps more correctly the social construction of madness in western patriarchal societies. This revised edition retains much of the original text, with an extended new introduction. The substantial content of the original book remains, with occasional comments on what has or hasn't changed of the intervening three decades. The result is rather unsatisfactory if you are looking for a comprehensive review of the original issues, or a discussion of new issues that have emerged since 1972. The later comments appear shoehorned into the text in many cases, and much of the original material is showing its age. But the book is still a timely reminder that much of what is taken for granted in terms of gender analysis these days had, and not too long ago, to be argued. The argument is still in progress. Second wave feminism achieved some major gains for women, but not their liberation. And even the gains that were subject of so much struggle are taken for granted by younger men and women today, who have little time for organized political campaigns on issues such as continuing economic disparities, and disproportionate levels of male partner violence towards women.

The first six chapters of the book cover different aspects of women and madness, and focuses mainly on institutional psychiatry and the psychiatric professions. The next three chapters present results of Chesler's interviews with lesbians, third world women and feminists, and there is a concluding chapter that takes Amazon societies as a basis for examining female psychology. In considering the current place of Women and Madness, the significance of the book is its articulation of a new, political perspective on womens' mental health, one that was radical for the time and which resonates still. It may be misleading to describe Chesler's perspective as 'new': the idea that in patriarchal societies health is politically defined and that 'illness' is a form of resistance was already established in 1972. Chesler's contribution was to apply that perspective to institutional psychiatry and psychology, to argue that feminism, not treatment, was what mentally distressed women need, and to link that argument to the broader issue of womens' rights. For Chesler, gender is one's fundamental social identity, taking precedence over ethnicity, class or any other category. That makes feminism the necessary political response to oppression, not generally improved social conditions or improvements in race relations. Oppression of women will survive these reforms, as both men of color and male political activists are invested in the oppression of women.

Women and Madness is more of a polemic than an academic critique. Facts and statistics are linked to ideological claims as if the solidity of one automatically underpins the logic of the other. Chesler might have been working within the theories of one of the psychiatric revisionists she cites: what is important is not the facts, but how they are employed to create a perspective. Foucault had no difficulty with such a view, and it did Madness and Civilization no harm as a counter to the standard history of psychiatry to arrange that history in a way that suited his purposes. Indeed, Women and Madness has something of a similar effect to Madness and Civilization: you can disagree with aspects of it, even find it overly didactic, but the basic thesis is compelling. For example, after acknowledging 'bio-anatomical differences' between men and women, Chesler questions whether such differences are 'necessary or desirable.' 'Anatomy,' Chesler argues, 'is history, not destiny.' While many would agree with the latter part of that argument, not everyone would agree with the former, but the argument is a powerful rhetorical device.

Despite the gender fundamentalist nature of Chesler's arguments she does not align herself philosophically with Szasz, Laing, or others who deny that 'mental illness' has any objective reality. She argues that the enslavement of women is prior to the enslavement of psychiatric patients as argued by Szasz. She sees little difference between Szasz and Laing on the one hand, and mainstream psychiatrists on the other, in terms of their positions as patriarchal figures. Chesler's acceptance that there is some reality to 'mental illness' (on page 18 she states that depression has a neurochemical basis) sharpens her critique of asylum practices. If asylum inmates, however unjustifiably incarcerated, really are mentally distressed they need more than liberation from the asylum; they need the help that the asylum promises but doesn't deliver.

Women and Madness was written at the time of the DSM II, a diagnostic system that was used to support the sorts of subjective value judgments Chesler rightly complains of. How ironic then, that the use of the more objective criteria of the DSM IV makes little difference to the gendered distribution of mental illness. It will come as no surprise to Chesler to see that despite the influence of political arguments such as those of Women and Madness, change has been limited. Public health literature is depressingly consistent in showing that despite increased knowledge of risk factors, it is still the poor and the oppressed who experience the worst health outcomes. Chesler is under no illusions that the struggle she articulated three decades ago continues.

Women and Madness is a revolutionary book. Many women (but no men that I am aware of) have identified it as 'life-changing'. It is the sort of book that carries the reader by the sheer force of its arguments, and by creating a paradigm that changes the way readers think about mental health. It is not without its limitations. In the chapter on clinicians, the most numerous female workforce in psychiatry, nursing, is ignored in favour of the psychiatric elites: psychiatrists, psychologists and social workers. The 2005 'revision and updating' of the book suggests that it has the sort of relevance to contemporary times that it did to 1972. While the book definitely has relevance, it contains no analysis of issues that have emerged since its first publication. There is a body of theory and research that extend the arguments articulated by Chesler in 1972. But this revised and updated edition contains no discussion of how the psychology of witch persecution has been employed in allegations of satanic ritual abuse, or of the growing body of work that takes seriously womens' reports of physical and sexual trauma. Much of the more recent scholarship on mental health issues is indebted to the critique provided by writers such as Chesler, and it would have been interesting to see Chesler's response to that work.

Overall, Women and Madness deserves to be regarded as a classic in the critical literature on mental health. It offers one of the strongest expressions of feminist critique of psychiatry and psychology, and it brings together diverse strands of historical and theoretical analysis. I am not sure that the revisions add to what was already a powerful text, but Women and Madness should be on the reading list of every mental health clinician.

 

© 2006 Tony O'Brien

 

Tony O'Brien, M Phil, is a lecturer in mental health nursing and PhD student at the University of Auckland, New Zealand: a.obrien@auckland.ac.nz