Women and Madness

by Phyllis Chesler

  As feminist clinician Janet Surrey says, “The work of feminist healers is to integrate our minds and our bodies, ourselves and others, human community and the life of the planet. I question our profession’s fear of feminism. I refuse to do psychology without a feminist liberation theology.”

  In Trauma and Recovery, psychiatrist Judith Lewis Herman models a new vision of therapy and of human relationships, one in which we are called upon to “bear witness to a crime” and to “affirm a position of solidarity with the victim.” Herman’s ideal therapist cannot be morally neutral but must make a collaborative commitment, and enter into an “existential engagement” with the traumatized. Such a therapist must listen, really listen, solemnly and without haste, to the factual and emotional details of atrocities, without flight or denial, without blaming the victim, identifying with the aggressor, or becoming a detective who “diagnoses” ritual or Satanic abuse after a single session, and without “using her power over the patient to gratify her personal needs.”

  While the love and understanding of relatives, friends, and political movements are necessary, they are not substitutes for the hard psychological work that victims must also undertake with the assistance of trained professionals; in fact, even enlightened professionals like Herman cannot themselves undertake this work without a strong support system of their own.

  The work of psychotherapist Miriam Greenspan is another good example of a feminist spiritual-political approach to human suffering. Greenspan’s book Healing Through the Dark Emotions: The Wisdom of Grief, Fear, and Despair (2003) models a healer’s shamanic journey. Greenspan describes enormous grief and terror—her own, that of the world’s—and explains what it means to surrender to fear, to face straight into it, to “let it be” as the royal road to sanity, rightful action and rightful nonaction, and to exuberance and freedom.

  Greenspan beholds that which is tragic about the human condition but embraces it in a daringly therapeutic and consoling way. Her values are Jewish, Buddhist, feminist, and humanist. She employs humor as well. Greenspan provides an excellent discussion of the “alchemy of fear,” and of the Buddhist concept of “toglen”: nonaction, action, surrender.

  Now, imagine both Judith Lewis Herman and Miriam Greenspan at work in Israel, among both Arabs and Jews who have emigrated there from every continent on earth; imagine them both at work in Australia, Ireland, Italy, Japan, Mexico, the United States, and the former Yugoslavia—and you have an idea of the ground covered by Claire Low Rabin in her 2005 anthology Understanding Gender and Culture in the Helping Process: Practitioners’ Narratives From Global Perspectives.

  While Herman and Greenspan may not be thinking about how their ideas and techniques may “translate” into different cultures—Rabin, et al. are. Thus, in addition to gender violence per se, Rabin and her contributors also look at how women of different cultures respond to such violence.

  Rabin suggests that culture is as important as gender and that mental health professionals must factor it in if they wish to help anyone, certainly anyone who has grown up in a nonwestern or rural culture. She and her associates are absolutely right. In their view, gender, class, race, birthplace, one’s generation, clan, tribe, religion, status as an immigrant, must all be factored into understanding any living being, especially one in trouble and in pain.

  Western psychoanalysis/psychotherapy tends to view the individual as the source of her own problems; in my view, this is not entirely wrong. Rabin et al. reject a medical model that focuses primarily on pathology, not on strengths, and that does not necessarily focus on the powers of elders or of the community to help one of their own. This volume proposes a different understanding of “boundaries” and of “active involvements.”

  The suggestions to rely upon nonwestern traditional elders as mediators and conflict-resolvers, and on holistic and indigenous healing methods are both exciting and practical. However, I doubt whether misogynist elders in Third World countries or among religious fundamentalists on every continent will uphold a woman’s right to individual freedom.

  Working with traditional, nonwestern peoples may require nontraditional (and old-fashioned social work) approaches. For example, helpers may need to meet in their clients’ homes, not in offices, wake clients up for job interviews and accompany them too. Helpers may need to talk to women at home, while the women are cooking or caring for children.

  The contributors to the Rabin volume understand that by the very act of helping, the helper can also engage in “social protest.” Allowing a survivor of violence to testify—creating the “listening” conditions that makes testimony possible—is also a way of taking a moral stand against human rights atrocities. “Social injustice” may also be confronted through “understanding.” Listening carefully allows the “silenced” a voice.

  Make no mistake: Feminists have learned what works, what must be done. We have made extraordinary discoveries. Nevertheless, the most important feminist work has been “disappeared” (or never made its way) into the graduate and medical school canon. This is truly astounding—given that contemporary mental health professionals did not learn about incest, rape, sexual harassment, wife-beating, or child abuse from graduate or medical school textbooks but from feminist consciousness-raising and research—and from grassroots activism. We all learned from the victims themselves, who had been empowered to speak not by psychoanalysis but by feminist liberation.

  As psychotherapist Sandra Butler, the author of Conspiracy of Silence: The Trauma of Incest, writes, “Nothing that sexually victimized women needed existed, so we had to create it. And we did.”

  In 1970, when I first began writing Women and Madness, there were few feminist theories of psychology and virtually no feminist therapists. Now we are everywhere. Feminists have established journals, referral networks, conferences, and workshops—programs that are both psychoanalytic and antipsychoanalytic in orientation. We have served incest and rape survivors, battered women, batterers, mentally ill and homeless women, refugees, alcoholics, drug addicts, the disabled, the elderly—and each other. Feminists have also published many extraordinary books and articles.

  They constitute, in psychotherapist Rachel Josefowitz Siegel’s words, “bibliotherapy.”

  Today, there are feminist psychopharmacologists, forensic experts, lesbian therapists, sex therapists, family therapists, experts on recovered memories, race, ethnicities—and, perhaps the truest sign of having arrived: feminist critics of feminist therapy!

  Our influence is international. There are feminist therapy and crisis counseling centers in South America, Europe, the Middle East, Africa, and Asia. Most recently, North American and European feminist therapists and lawyers worked with their counterparts in Bosnia on behalf of the raped women and other victims of torture and genocide. Had the United Nations Tribunal in the matter of Bosnia proceeded, I (and other North American and European feminists) might have been privileged to testify about Rape Trauma Syndrome.

  Over the years, I have lectured and worked with my colleagues in Canada, Europe, the Middle East—especially Israel—Australia, and Asia. In 1990, I was invited to lecture in Tokyo in celebration of the tenth anniversary of the first feminist therapy clinic, founded by my colleague, Kiyomi Kawano. There was no language barrier, we all spoke “feminist.” The visit was an exhilarating one.

  Despite such progress, most feminists in mental health remain frustrated. It is a sign of our ambitiousness: we understand how much remains to be done. But we have come a long way.

  We now understand that women and men are not “crazy” or “defective” when, in response to trauma, they develop post-traumatic symptoms, including insomnia, flashbacks, phobias, panic attacks, anxiety, depression, dissociation, a numbed toughness, amnesia, shame, guilt, self-loathing, self-mutilation, and social withdrawal. Trauma victims may attempt to mask these symptoms with alcohol, drugs, overeating, or extreme forms of dieting.

  We now understand more about what trauma is, and what it does.
We understand that chronic, hidden family/domestic violence is actually more, not less, traumatic than sudden violence at the hands of a stranger, or of an enemy during war. We understand that after even a single act of abuse, physical violence is only infrequently needed to keep one’s victim in a constant state of terror, dependent on her captor and tormentor.

  We understand that rape is not about love or even lust, but about humiliating another human being through forced or coerced sex and sexual shame. The intended effect of rape is always the same: to break the spirit of the rape victim, to drive her (or him) out of her body and quite often out of her mind, to render her incapable of resistance. The effects of terror on men at war and in enemy captivity are similar to the trauma suffered by women at home in violent “domestic captivity.”

  Rape has been systematically used by men of every class and race to destroy both their own women and the women of enemy men. This terrorist tactic, coupled with childhood sexual abuse and shaming, works. Most women do not resist, escape, or kill their rapists in self-defense. When women do try to resist, or simply report the rape, they are often killed by their rapists, jailed for long periods of time, or executed—especially in the Islamic world—either by the state or by the family in what is known as an “honor killing.”

  Those who have interviewed and tried to help the raped women of Bosnia have found the women distraught, intimidated, withdrawn, emotional, afflicted with nightmares, insomnia, depression, panic disorders, and/or suicidal. According to Alexandra Stiglymayer, “The rape victims are broken, not thinking about revenge, for the horror of their rape and expulsion has also taken away whatever power of resistance they might have had.” In addition to these typical peacetime Rape Trauma Syndrome symptoms, Zagreb psychiatrist Vera Folnegovic-Smalc also noted “anxiety, inner agitation, apathy, loss of self-confidence, an aversion to sexuality. Rape is one of the gravest abuses, with consequences that can last a lifetime.”

  Some feminists say that women have so little power that, even if they do hold sexist views, such views are not as consequential as male sexist views. I disagree. For example, consider how important it is for a female rape victim to have access to a sympathetic—or at least objective—woman police officer, mental health professional, physician, and emergency room nurse. (I do not mean to minimize the importance of sympathetic or objective men, but a minority of good or nonsexist men cannot hold up the sky alone.)

  As feminists, we have also learned that women and men can survive many things—if they are believed, if others are outraged on their behalf, if others denounce and attempt to stop the abuse. Thus, the victims of rape and other forms of torture are more upset by what good people fail to do than by the crimes actually committed. As eloquently articulated by Jacobo Timerman, the Argentinian political “prisoner without a name” and torture victim, “The Holocaust will be understood not so much for the number of victims as for the magnitude of the silence. And what obsesses me most is the repetition of silence.”

  Sins of omission are usually psychologically experienced as greater than sins of commission. The mother who stood by and did nothing as her daughter or son was being incestuously abused is hated even more than the abuser himself.

  What do the victims of violence need to ensure their survival and to maintain their dignity?

  Bearing witness is important; being supported instead of punished for doing so, especially by other women, is also important. Putting one’s suffering to use, through educating and supporting other victims is important; drafting, passing, and enforcing laws is important. However, as Judith Herman has written, “The systematic study of psychological trauma depends on the support of a political movement. In the absence of strong political movements for human rights, the active process of bearing witness inevitably gives way to the active process of forgetting.”

  In my view, in addition to therapy and political movement, we also need self-esteem, anti-pornography, anti-bullying, and rape prevention education for young girls. This might include self-defense and/or military training. We also need swift, effective prosecution of rapists; and successful civil suits for monetary remuneration in addition to criminal prosecution. Perhaps most important, we need to support women who have fought back against their batterers and rapists and are wasting away in jail for daring to save their own lives. They are political prisoners and should be honored as such—not seen as pathological masochists who “chose” to stay until they “chose” to kill.

  Unlike many Mental Patient Liberation Project members, who have their own worthy agenda, I also believe that what we call “madness” does exist; that it may sometimes be caused or exacerbated by violence and by certain social and environmental conditions; that people in its grip suffer terribly; that it doesn’t always last forever—although the culturally imposed stigma and shame seem to; and that the “helping” professions have been both helpful—and far from helpful.

  I cannot agree with blanket political opposition to psychiatric medication and hospitalization. Sometimes, psychiatric medication helps, sometimes it harms, sometimes it makes no difference. Sometimes, the talking cure, including “feminist” therapy, helps, harms, or has no effect whatsoever. Sometimes, political and legal struggle (and whole revolutions) help, harm, or make no difference.

  However, despite my own early critique of private patriarchal therapy geared primarily to high-income clients, I have come to believe that women can and do benefit from good therapy. Some feminists (anti-feminists too) have questioned whether any therapy, including feminist therapy, is desirable. They have noted, correctly, that “therapism” may indeed siphon off activist energies. They are right—but severely traumatized women cannot always rise to the occasion of political action.

  For example, an incest survivor with insomnia or panic attacks often cannot sit in a room long enough to have her consciousness raised; an anorexic or obese woman who is obsessed with losing weight may not be able to notice others long enough to engage in fundraising; a woman on a window ledge or in an alcoholic daze may not have the peace of mind to analyze her fate in feminist terms.

  Being traumatized does not necessarily make one a noble or productive person. Some women rise above it; others don’t. Some victims of patriarchal violence want feminist support and advice; others don’t. Some women want to be saved; others are too damaged to participate in their own redemption.

  As feminist author bell hooks wrote, “It had become more than evident that individual black females suffering psychologically were not prepared to go out and lead the feminist revolution. Working with women, especially black women, I have found that many of us are willing to acknowledge the evils of sexism, the way it wounds and hurts everyone, but are reluctant to make that conversion to feminist thinking that would require substantive changes in habits of being.” This applies to women of all colors.

  As feminist clinician E. Kitch Childs said, “We have a moral responsibility to take care of ourselves. Women of color are not ‘minorities.’ We are, world-wide, in the majority. Black women in America are not taking care of ourselves. We need a whole new level of consciousness-raising groups and networks. We must learn to speak our bitterness about each other to each other. It will liberate our energies to keep on working together.”

  Often, those who condemn institutional psychiatry, Freudian psychoanalysis, grassroots feminist shelters and feminist therapies—all in the same breath—do not feel personally, professionally, or politically responsible for the female casualties of patriarchy and do not know how to listen to others—especially to women. Such critics, even if well intentioned, do not comprehend how healing it is to be listened to in a loving and skillful “holding” environment; or how psychologically wounded women, men, or politically active people also are.

  Such critics may also be confusing the fact that quality mental health care is not available to all who want it with the question of whether or not quality mental health care exists at all.

  We need Feminist Institutes of Ment
al Health that are both local and global; learning communities that last beyond our lifetimes; clinical training programs that are not patriarchal; health and spiritual retreats with intellectual, political, and legal agendas; places where feminists can come together to learn and teach in ways that are inspired, rigorous, humane, and healing.

  I wanted to create such an Institute from the moment Women and Madness was on the way. In the early 1970s, Jeanette Rankin herself (!) actually offered me a physical structure in Athens, Georgia, to begin this work. Sadly, I did not accept her generous offer. I had too many other books to write and campaigns to organize. But others began to do this work.

  For example, the Cambridge Hospital Victims of Violence (VOV) Program was cofounded in Massachusetts in 1984 by Drs. Mary Harvey and Judith Herman. It offers crisis intervention, supportive therapy, and group support to “survivors of rape, incest and childhood sexual abuse, domestic violence, and physical abuse/assault.” A multidisciplinary staff develops programs, presents workshops, and conducts in-service trainings. VOV offers groups in Trauma Information, Parenting for Mothers with Trauma Histories, Time-Limited Rape Survivors Groups, Male Survivors of Childhood Trauma, etc.

  We need such programs in every city, every community, worldwide.

  The ideas in Women and Madness announced and anticipated many of the next steps in feminist theory and practice, including many of the themes I myself would subsequently explore.

  For example, Women and Madness may have been the first Second Wave feminist work to discuss the mother-daughter relationship; the psychology of both incest and rape; the importance of female role models; the nature of female heroism; and the enduring role that mother and warrior goddesses play in the collective female unconscious. (They’re role models—which was precisely the subject of my Ph.D. dissertation, “The Maternal Influence in Learning by Observation in Cats and Kittens,” which I published in Science magazine, in 1969. The unconscious always moves in rather obvious ways.)