Women and Madness

by Phyllis Chesler

  Female patients, like female children, are closely supervised by other women (nurses, attendants) who, like mothers, are relatively powerless in terms of the hospital hierarchy and who, like mothers, don’t really like their (wayward) daughters. Such supervision, however, doesn’t protect the female as patient-child from rape, prostitution, pregnancy, and the blame for all three—any more than similar motherly supervision protects the female as female child in the “real” world, either within or outside the family. Over the years, there have been numerous newspaper accounts of the prostitution, rape, and impregnation of female mental patients by the professional and non-professional staff, and by male inmates. Over the years, I have testified for a number of such women.

  THE FEMALE SOCIAL ROLE AND PSYCHIATRIC SYMPTOMS: DEPRESSION, FRIGIDITY, AND SUICIDE ATTEMPTS

  Why are women psychiatrically “disturbed” and hospitalized? Why do they seek private therapy? What is schizophrenia or mental illness like, or about, in contemporary women?

  Two researchers stated that men are really as “psychologically disturbed” as women are:

  There is no greater magnitude of social stress impinging on one or the other sex. Rather [each sex] tends to learn a different style with which it reacts to whatever fact has produced the psychological disorder.8

  I would not so much disagree with this statement as qualify it in several important ways. Many men are severely disturbed—but the form their disturbance takes is either not seen as neurotic or is not treated by psychiatric incarceration. Theoretically, all men, but especially white, wealthy, and older men, can act out many disturbed (and non-disturbed) drives more easily than women can. Men are generally allowed a greater range of acceptable behaviors than are women. It can be argued that psychiatric hospitalization or labeling relates to what society considers unacceptable behavior. Thus, since women are allowed fewer total behaviors and are more strictly confined to their role-sphere than men are, women, more than men, will commit more behaviors that are seen as ill or unacceptable.

  The greater social tolerance for female help-seeking behavior, or displays of emotional distress, does not mean that such conditioned behavior is either valued or treated with kindness. On the contrary. Both husbands and clinicians experience and judge such female behavior as annoying, inconvenient, stubborn, childish, and tyrannical. Beyond a certain point, such behavior is “managed,” rather than rewarded: it is treated with disbelief and pity, emotional distance, physical brutality, economic and sexual deprivation, drugs, shock therapy, and psychiatric diagnoses.

  Given the custodial nature of asylums and the anti-female biases of most clinicians, women who seek help or women who have symptoms are actually being punished for their conditioned and socially approved self-destructive behavior. Typically female and male symptomatology appear early in life. Studies of childhood behavior problems have indicated that boys are most often referred to child guidance clinics for aggressive, destructive (anti-social), and competitive behavior; girls are referred (if they are referred at all) for personality problems, such as excessive fears and worries, shyness, timidity, lack of self-confidence, and feelings of inferiority. Self-destructive or “loser” behavior, from suicide attempts to a fearful narrowing of life experience, is only fully punished as the female grows older. The female child is usually praised for the maturity of her submissiveness, obedience, and unadventurousness.9 Similar, sex-typed symptoms exist in adults also:

  … the symptoms of men are also much more likely to reflect a destructive hostility toward others, as well as a pathological self-indulgence…. Women’s symptoms, on the other hand, express a harsh, self-critical, self-depriving, and often self-destructive set of attitudes.10

  A study by E. Zigler and L. Phillips, comparing the symptoms of male and female mental hospital patients, found male patients significantly more assaultive than females and more prone to indulge their impulses in socially deviant ways like “robbery, rape, drinking, and homosexuality.”11 Female patients were often found to be “self-deprecatory, depressed, perplexed, suffering from suicidal thoughts, or making actual suicidal attempts.”

  This may still be true. However, an increasing number of female adolescents and adults have increasingly engaged in drinking, drug-taking, and in physically aggressive behavior toward others. But in general, most women display “female” psychiatric symptoms such as depression, frigidity, paranoia, suicide attempts, panic, anxiety, and eating disorders. Men display “male” diseases such as sex addiction, alcoholism, drug addiction, personality disorders, sociopathic personalities, and brain diseases (see Table 1). There are still fewer men hospitalized for “male” diseases than women hospitalized for “female” diseases. Typically female symptoms all share a “dread of happiness”—a phrase coined by Thomas Szasz to describe the “indirect forms of communication” that characterize “slave psychology.” He writes:

  In general, the open acknowledgement of satisfaction is feared only in situations of relative oppression (e.g. all-suffering wife vis-á-vis domineering husband). The experiences of satisfaction (joy, contentment) are inhibited lest they lead to an augmentation of one’s burden … the fear of acknowledging satisfaction is a characteristic feature of slave psychology. The “properly exploited” slave is forced to labor until he shows signs of fatigue or exhaustion. Completion of his task does not signify that his work is finished and that he may rest. At the same time, even though his task is unfinished, he may be able to influence his master to stop driving him—and to let him rest—if he exhibits signs of imminent collapse. Such signs may be genuine or contrived. Exhibiting signs of fatigue or exhaustion—irrespective of whether they are genuine or contrived (e.g. “being on strike” against one’s boss)—is likely to induce a feeling of fatigue or exhaustion in the actor. I believe that this is the mechanism responsible for the great majority of so-called chronic fatigue states. Most of these were formerly called “neurasthenia,” a term rarely used nowadays. Chronic fatigue or a feeling of lifelessness and exhaustion are still frequently encountered in clinical practice.

  Psychoanalytically, they are considered “character symptoms.” Many of these patients are unconsciously “on strike” against persons (actual or internal) to whom they relate with subservience and against whom they wage an unending and unsuccessful covert rebellion.12

  The analogy between “slave” and “woman” is by no means a perfect one. However, there is some theoretical justification for viewing women, or the sex-caste system, as the prototype for all subsequent class and race slavery.13 Women were probably the first group of human beings to be enslaved by another group. In a sense, “woman’s work,” or woman’s psychological identity, consists in exhibiting the signs and “symptoms” of slavery—as well as, or instead of, working around the clock in the kitchen, the nursery, the bedroom, and the factory.14

  Depression

  Women become “depressed” long before menopausal chemistry becomes the standard explanation for the disease. National statistics and research studies all document a much higher female to male ratio of depression or manic-depression at all ages.15 Perhaps more women do get “depressed” as they grow older—when their already limited opportunities for sexual, emotional, and intellectual growth decrease even further. Dr. Pauline Bart studied depression in middle-aged women and found that such women had completely accepted their “feminine” role—and were “depressed” because that role was no longer possible or needed.16

  Traditionally, depression has been conceived of as the response to—or expression of—loss, either of an ambivalently loved other, of the “ideal” self, or of “meaning” in one’s life. The hostility that should or could be directed outward in response to loss is turned inwards toward the self. “Depression” rather than “aggression” is the female response to disappointment or loss. The research and clinical evidence for any or all of these views is controversial. We may note that most women have “lost”—or have never really “had”—their mothers; nor is the mat
ernal object replaced for them by husbands or lovers. Few women ever develop strong socially approved “ideal” selves. Few women are allowed, no less encouraged, to concern themselves with life’s “meaning.” (While this may also be true for many men, it is certainly not untrue for most women.) Women lose their jobs as “women,” rather than any existential hold on life’s meaning. In a sense, women can’t “lose” what they’ve never had. Also, as I’ll discuss in Chapter Ten, women are conditioned to “lose” in order to “win.”

  Women are in a continual state of mourning—for what they never had—or had too briefly, and for what they can’t have in the present, be it Prince Charming or direct worldly power. It is not very easy for most women to temper, idle, or philosophize away their mourning with sexual, physical, or intellectual exercises. When female depression swells to clinical proportions, it unfortunately doesn’t function as a role-release or respite. Sometimes “depressed” women are even less verbally “hostile” and “aggressive” than nondepressed women; their “depression” may serve as a way of keeping a deadly faith with their “feminine” role.18 “Depressed” patients were actually less verbally hostile than “normal” control patients—and their verbal hostility and “resentment” decreased even further as they “improved”—i.e., became less “depressed” according to clinical and self-rating. One classic study done by Dr. Alfred Friedman consisted of 534 white patients, hospitalized in Philadelphia. Seventy-one percent were women, with a median age of forty-two, who attended but did not complete high school; eighty-nine percent of the female patients were or had been married. (Depressed male patients were more verbally hostile than their female counterparts.) Dr. Friedman’s interpretation of this finding is as follows: he hypothesizes that the “depressive” usually expresses very little verbal hostility (or other forms of) hostility, and become “depressed” only when the “usual defenses break down”:

  It may be that it is their [the depressives’] inability to verbalize the hostility spontaneously to the person for whom they feel it at the time when it is appropriate [that] is part of their predisposition to become depressed. The tendency to deny the “bad” in significant others and to perceive them selectively so they do not consciously become angry or depressed may be one of the ways to ward off a disturbed or depressive reaction.

  It is important to note that “depressed” women are (like women in general) only verbally hostile; unlike most men, they do not express their hostility physically—either directly, to the “significant others” in their lives, or indirectly, through physical and athletic prowess. It is safer for women to become “depressed” than physically violent. Physically violent women usually lose physical battles with male intimates; are abandoned by them as “crazy” as well as “unfeminine”; are frequently psychiatrically or (less frequently) criminally incarcerated. Further, physically strong and/or potentially assaultive women would gain fewer secondary rewards than “depressed” women; their families would fear, hate, and abandon them, rather than pity, sympathize, or “protect” them. Psychiatrists and asylums would behave similarly: hostile or potentially violent women (and men) who are oppressed and powerless are, understandably, hardly ever treated ethically or legally—or kindly—by others.

  As I’ve noted previously, many new diagnostic categories (and treatments) exist today. For example, Rape Trauma Syndrome, Battered Woman’s Syndrome, Post Traumatic Stress Disorder, and so on. The violence and hatred of women involved in rape, incest, or battery often lead to situational or even life-long depressions.

  In 1974, I cofounded the National Women’s Health Network, which remains in existence today. Our initial focus was on the dangers of medication for women, especially the birth control pill. Over time, other issues emerged, such as the medicalization of menstruation, pregnancy, and menopause. Initially, feminists did not want women’s bodies or normal life-cycle realities to be further pathologized or psychiatrically diagnosed.

  However, it became increasingly clear to me that “mood swings,” rage, and depression did often correlate with some women’s menstrual and menopausal cycles and could be alleviated with a variety of either herbal or pharmaceutical medication. In addition, postpregnancy depression was real, not imagined and could have potentially dangerous consequences, if not acknowledged and treated.

  In 2003, a University of Michigan researcher, Dr. Sheila Marcus, found that 1 out of 5 expectant mothers suffer from depression that mainly goes untreated, even by psychotherapy. Many factors may be involved, including hormonal changes, economic and relationship stress, previous traumas, and a genetic pre-disposition toward depression. Some physicians are reluctant to medicate pregnant women; others have found that anti-depressants do not have a negative effect on the developing foetus.

  According to the Massachusetts General Hospital’s Center on Women’s Mental Health, during the postpartum period, about 85 percent of women experience some type of “mood disturbance” or Postpartum Depression (PPD). Symptoms may appear within 48 to 72 hours of childbirth. This form of the “blues” is mainly short-lived and quite normal. New mothers may feel sad, guilty, exhausted, and unable to concentrate; they may experience mood swings, an eating disorder, anxiety, tearfulness, and irritability; they may also suffer from a sleep disturbance and have suicidal thoughts. This usually passes within a few weeks. Interestingly, many women who exhibit these symptoms also suffer from certain risk factors. For example, they experienced depression in the past, either during a previous pregnancy or in general; they recently were very stressed; or they are suffering from marital discord and an absence of social support.

  Ten to 15 percent of women develop more “significant symptoms of depression or anxiety,” which last longer. About 1 to 2 per 1,000 women suffer from postpartum psychosis in which they suffer from delusions such as hearing voices that tell them to kill themselves or their infants. Short-term therapy may help with postpartum depression but not with postpartum psychosis. The right medication may be needed in both instances.

  Frigidity

  A hoarder of secret sexual grievances, a wife.

  Joan Didion19

  A great deal of information has now been circulated regarding the political basis of female frigidity; women are sexually repressed by patriarchal institutions which enforce fear, dislike, and confusion about female sexual and reproductive anatomy in both men and women. Phallus-worship is well represented in myth, painting, sculpture, and modern bedroom practices: clitoris-worship and/or non-reproductive vagina-worship is not. I do not wish to repeat or even review this information here, except as briefly as possible.

  Clinical case histories, psychological and sociological surveys and studies—and our own lives—have documented the extent to which most pre-feminist twentieth-century women were not having orgasms; or not having the “right” kind of orgasms; or not having any kind of orgasms very frequently or very easily; or having orgasms only under conditions of romantic monogamy, legal prostitution, or self-degradation; or only after much purposeful “learning.”20 One psychoanalyst, Marie Robinson, has characterized the proper female orgasm as one in which the woman may be rendered unconscious for up to three minutes. Women have been seen as sexually “insatiable” by witch-hunters and modern scientists; they have also been seen as not really “needing” orgasms as much as they need love, maternity, and fine silverware.21 Nevertheless, the psychoanalytic tradition (combined with a growing addiction to instant pleasure) has viewed “neurosis” and even “psychosis” as stemming from sexual repression. Consequently, most clinicians have tried hard to help their female patients “achieve” heterosexual orgasms—usually by counseling a joyous and/or philosophical acceptance of the female role as envisioned and enforced by men: as Madonna-housewife and mother, or as Magdalene Earth Goddess. Even sexual liberationist pioneers, such as Wilhelm Reich, have posited the primacy of vaginal eroticism, and viewed bisexuality and lesbianism as “regressive” or “infantile.”

  Most clinicians have not thought d
eeply about the sociopolitical—or the psychological—conditions that are necessary for female sexual self-definition or agency. Women can never be sexually actualized as long as men control the means of production and reproduction. Women have had to barter their sexuality (or their capacity for sexual pleasure) for economic survival and maternity. Female frigidity as we know it will cease only when such bartering ceases. Most women cannot be “sexual” as long as prostitution, rape, and patriarchal marriage exist, with such attendant concepts and practices as “illegitimate” pregnancies, enforced maternity, “non-maternal” paternity, and the sexual deprivation of “aging” women. From a psychological point of view, female frigidity will cease when female children are surrounded by and can observe non-frigid female adults.

  In the years since I first wrote this, some things have changed. Many more divorces are initiated by women who want freedom from violence for themselves and their children, and companionate intimacy, including sexual intimacy for themselves.

  Historically, both royal and ruling-class women—and impoverished women—have engaged in extramarital or recreational sex. Today, more middle-class women do so, as well. And they better understand the importance of foreplay and the role of the clitoris in achieving orgasm. In addition, feminist- and post-feminist-era girls and women have experimented with lesbianism, bisexuality, multiple heterosexual partners, and sex with younger men or women.

  At the same time, many men, including HIV positive men, have insisted on unprotected sex with ever-younger women and with children in both America and in Third World countries and have infected their female partners with the deadly AIDS virus.

  Male lust and greed continue to drive an unholy worldwide trafficking in girls and women. Rape, including public and videotaped gang rape became weapons of war in the early 1970s in Bangladesh; in the 1990s in Bosnia and Algeria; and most recently in Rwanda and Sudan, where the women have previously been genitally mutilated and vaginally sewn up. This means that gang rape amounts to serious physical torture, which may also have grave medical consequences.