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Mental Disorders

by Elaine Showalter
Columbia University Press, 1997
Review by Christian Perring, Ph.D. on Jun 30th 1997

Hystories

Elaine Showalter defines a "hystory" to be the explanation of a strange human condition or belief system as the product of neurotic unconscious mental processes. Her main claim in _Hystories_ is that it is a serious mistake to think that hysteria was restricted to affluent women in nineteenth century Vienna, because hysteria still exists and even flourishes today. The cover of her new book lists "alien abduction, chronic fatigue syndrome, satanic ritual abuse, recovered memory, Gulf War syndrome, and multiple personality syndrome." These are all supposed to be forms of modern hysteria.

 Showalter is a well known feminist theorist, who teaches in the English Department at Princeton University. Her book The Female Malady: Women, Madness, and English Culture, 1930-1980, (1985), was also on the topic of hysteria, but was more historical. In that book, Showalter tended to advocate a more standard feminist view that women were labeled as hysterical when they were troublesome to patriarchy, and women acted hysterically as a rational response when they couldn't express themselves in any other legitimate way. In _Hystories_, Showalter does not retract any of her previous views, but her emphasis changes. She is sharply critical of the recovered memory movement, the hype over multiple personality, and she is somewhat defensive of Freud's idea that unconscious sexual desires can have major psychological and even physiological effects. "Today's feminists need models rather than martyrs; we need the courage to think as well as the courage to heal," she writes (61). So she is placing herself in the growing group of thinkers who are against "victim feminism," as it has been called by its critics.

 Some feminists, including Phyllis Chessler in Women and Madness, (1972), have complained about male historians and psychologists because they did not believe women. Feminist methodology has often been supposed to require an acceptance of women's words. For instance, if women never reported two kinds of orgasm, "clitoral" and "vaginal," then who was Freud to insist that there were two kinds? When women reported memories of abuse from their childhoods, then who was Freud to dismiss those memories as illusions? Feminist methodology seemed to lead to a major change in our understanding of modern culture, since it enabled us to discover the terrible extent of the sexual assault of children and women. Showalter is placing herself in opposition to much of this thinking, which she think has led to worrying trends. She ends her book with the following dramatic warning, "If we can begin to understand, accept, pity, and forgive ourselves for the psychological dynamics of hysteria, perhaps we can begin to work together to break the crucible and avert the coming hysterical plague" (206).

 This last quote uses language that is unusually forthright. In much of the book, Showalter stands back and surveys recent history, quoting others' declarations but rarely explicitly setting out her own view of the topic in hand. Rather, she allows her views to come across more by implication of how she tells the story of the recent past, mainly through the voices of others. She tells the story well. Most of it is familiar, and she adds little in the way of her own research or theorizing. She introduces new characters with a phrase of personal description. Ian Hacking, author of the recent book Rewriting the Soul (1995) is "a rumpled professor of philosophy at the University of Toronto" (160). Dr. Judith Lewis Herman, author of Trauma and Recovery (1992) is "petite, dark haired" and " a compelling speaker to female audiences" (144). This adds to the rather journalistic style. Often general phenomena are illustrated with the details of individual cases and quotes from the persons involved. Almost every chapter reads like it could be a feature in the Sunday New York Times Magazine.

Overgeneralization

 The first half of the book gives the history of hysteria in the nineteenth and early twentieth century, and explains some of the recent developments in literary theory. It is only in the second half that Showalter gets to her really controversial claims, that Chronic Fatigue and Gulf War syndromes are forms of hysteria, and that many cases of remembered child abuse are false memories. Her argument is straightforward: these phenomena fit well into previous patterns of hysteria, and, despite a great deal of research, no substantial evidence has been found that proves these are really physiological disorders. Of course, neither has any substantial proof has been found that proves these are really psychosomatic, but Showalter is at least urging us to keep this possibility in mind, and seems to think that it is really the best explanation of the facts.

 An obvious weakness of the book is that it seems to put on a par people who have Chronic Fatigue, those who believe that they were abused as children, and those who believe they have been abducted by aliens. They are both symptoms of modern culture. Each group is equally sincere and each deserves sympathy, and will be best helped by understanding the psychological issues that cause their troubles. But the differences between the different groups seem more crucial than Showalter allows. People who believe that they have been abducted by aliens may have had some bizarre experiences, but it is highly unlikely that the correct explanation of them has anything to do with extraterrestrial life. In order to believe their views, they have to believe in cover-up conspiracies, which joins them with all those who believe in other conspiracies, including "people like Timothy McVeigh" (195). Of course Showalter is not saying that people with Chronic Fatigue are similar to mass murderers, but she does not do much to spell out where the difference lies. She leaves the impression that these are just different points on a spectrum.

 The readiness to overgeneralize is especially troubling in Showalter's discussion of recovered memory and multiple personality. She rightly points out that there has been sloppy thinking about these issues, and people have accepted the testimony with little testing or scrutiny, and this has led to alarming miscarriages of justice. Multiple personality, or dissociative identity disorder, the currently preferred name for the condition, has not been rigorously defined, and is easy to fake. The fact that there are far more diagnosed cases in the US than any other country is strange, and adds to the suspicion that therapists are misdiagnosing other conditions or are creating the condition through the treatment they give. The evidence is far from conclusive that the therapies offered are truly helpful. Showalter says the primary obligation of feminists "must always be to the truth" (158). She is surely right about this, but who would disagree? Those she criticizes also want to get to the truth. One of the facts that has emerged in the last decade or two is that sexual abuse and assault is rampant in the U.S. For Showalter to use the label of hysteria without giving clear criteria for when to determine when it actually exists seems just as irresponsible as her opponents throwing out accusations of child abuse. Indeed, what emerges from her discussion is just how difficult it is to establish the truth in many cases. The fundamental problem is how to proceed given the problems of finding any proof in these cases. The book gives little guidance in how to deal with that problem.

 Showalter's minimal point, that we should take seriously the possibility that some of the apparent memories are illusory, is correct. The mind has an ability to affect both itself and the body in unexpected and bizarre ways. But I am not satisfied that the label of 'hysteria' is at all clinically or socially useful. On the back of the book, Ian Hacking is quoted as saying, "Showalter brilliantly makes hysteria, which we had thought was dead, into a tool for understanding both images and epidemics." I don't think she has given us as much as Hacking supposes. The figure looming behind this book is that of Freud and his theory of psychoanalysis, because that is still the main theoretical framework associated with hysteria. Showalter discusses the theory only in connection with literary theory. Psychoanalytic therapy is in disrepute, and the so-called justifications of psychoanalysis by the old guard have been quite pitiful. When pressed, defenders of psychoanalysis will often try to get away from 'positivistic approaches' and point to the powerful uses of psychoanalysis as an 'interpretive approach,' giving us a way to see the world. That might be appropriate in finding new ways to discuss novels. It is a separate question whether bringing the ideology of hysteria and psychoanalysis to pressing social issues is productive. Given all the well-documented problems surrounding psychoanalysis and hysteria, it is up to Showalter to explain how her approach avoids those problems. But she leaves us in the dark about this.

Stirring Controversy

 What Showalter has done, and this may or may not have been a deliberate ploy, has been to attract a lot of media attention and controversy. She has enraged a good many people, and there are several groups with web sites devoted to contesting her views and organizing protests against her book marketing. In the same way that psychoanalysts take resistance to psychoanalytic interpretation be just further proof of the validity of their interpretation, so too can defenders of the hysterical view of Gulf War and Chronic Fatigue Syndrome. Showalter seems to have managed to particularly incense people, more than other defenders of the hysteria view. For instance, Edward Shorter has written two substantial books on the history of psychosomatic illness, From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era (1992), and From the Mind into the Body: The Cultural Origins of Psychosomatic Symptoms (1994). In both, he includes CFS as a case of psychosomatic illness. I don't recall any wave of protest against these books. The difference seems to be that Showalter has sought media attention. For instance, she gave an interview to the women's magazine Mirabella which devoted an article to her book earlier this year, and she has appeared on the cable TV new/interview show Crossfire this April. The cover of her book is not the typical academic style, and might even be thought sensationalistic, and while in the US it is published by a university press, in Britain it is published by the popular press Picador. Maybe also the fact that Showalter is a feminist and a professor of English, a university discipline considered disreputable with just about everyone these days, also contributes to people's readiness to pour scorn on her views.

 Those who disagree with psychoanalysis find it a cheap move to have their vehement disagreement turned into further evidence for the theory they take issue with, and rightly so. However, it does seem to me that the extreme hostility to hysteria theories such as Showalter's is a sign of the continuing stigma attached to mental illness. While physical illnesses are seen as external to the sufferers, mental illness is still seen as a reflection of a weak mental constitution, and psychosomatic illnesses are (wrongly) equated with malingering. Some cultural commentators emphasize how personal problems are increasingly medicalized and psychologized, and they certainly have identified an important trend. But it is important not to forget how much resistance there is the psychologization of problems, and how suspicious people can be of the mental health profession. The dispute over Showalter's book highlights this.

 The attention gained by Showalter probably helped her sales, and while some might write this off as a greedy ploy, I applaud those academics who are able to have some influence on public dialog. Too many people equate the term "academic" with "irrelevant." But the question here really is whether Showalter's contribution is useful. For a long time, hysteria was rejected by feminists because it aided the disbelieving and silencing of women. These days women have more abilities to speak out, although some still do not have as much expression as they want or need. Indeed, one of Showalter's claims is that the continued existence of hysteria is a result of women's continued frustration. In the last thirty years the cultural climate has changed a great deal, and talk of childhood abuse has become common. Yet, it is not clear that we are doing any better at reducing the amount of abuse that occurs, and it may even be on the increase. At this point, in the spirit of the new millennium which has encouraged so much apocalyptic talk, (including Showalter's), we could consider how to start afresh. Unfortunately what she gives us is not enough to constitute a new paradigm with which to sweep away the old.

 This leaves us, it seems to me, with the humdrum option of taking the middle way, going case by case, and being cautious. It is difficult for medical professionals to admit ignorance, but the fact is that in many instances we just don't know what the truth of the matter is, whether we are talking about CFS, Gulf War syndrome, or memories of child abuse. The central difficulty is formulating compassionate and sensible public policy in the face of this ignorance, since we can't just wait until we know for certain what the facts are. If I thought that public policy was formulated in rational ways, I'd complain that Showalter should have taken a more sober approach. However, I fear that using a little sensationalism is the only way to get attention from the mass media these days, so Showalter's tactics were probably the only way for her to get her viewpoint across to a wider audience.