Women and Madness

by Phyllis Chesler

  (1)Everyone Is “Sick”

  In general, most clinician-theorists are trained to find “pathology” everywhere: in women, in children, in men, in nations, in entire historical epochs. This is dangerous because, in doing this, we banish the concepts of good and evil from the arena of human responsibility. This bias has been more easily attacked than avoided, and I will not dwell on it at length. Dr. Maurice K. Temerlin described an experiment that took place in Oklahoma, which demonstrated the extent to which psychiatrists and psychologists are predisposed to diagnose “pathology”—wherever they look—significantly more so than non-professionals; and the extent to which the prestige of authority accounts for the kind of diagnoses made in hospital settings.12 Temerlin asked a group of psychiatrists, clinical psychologists, and graduate students in clinical psychology to watch a taped, televised interview, on the basis of which they would make diagnoses of “psychotic,” “neurotic,” or “healthy.” (The interviewee was a male actor who had memorized a script that was prepared in accordance with consensus judgments of what is “normal” and “healthy.”) Before watching him each of the three professional groups were told by a “high-prestige” person within their own field that the man was “very interesting because he looked neurotic but actually was quite psychotic.” Sixty percent of the psychiatrists, twenty-eight percent of the clinical psychologists, and eleven percent of the graduate students diagnosed “psychosis.” Control (or comparison) groups, composed of professionals who did not hear any prestige suggestion, never diagnosed psychosis. Most important, perhaps, is the fact that a control group composed of non-professional people, who were randomly selected from a jury wheel and asked to watch the tape at a county courthouse, unanimously considered the man “sane.” (They were told that the court was experimenting with new sanity-hearing procedures.) Temerlin interprets these findings in terms of the medical training that predisposes judgments of “illness”—especially when in doubt—combined with the tendency toward diagnostic conformity which prestige figures enforce and reward. After one of the subject-psychiatrists was “debriefed,” he still defended his diagnosis as follows: “Of course he looked healthy, but hell, most people are a little neurotic, and who can accept appearances at face value anyway?”

  (2)Only Men Can Be Mentally Healthy

  Thus, many clinicians think their patients are “crazy” (dysfunctional, self-destructive, unstable) but they think their female patients are “crazier” yet. Many double standards of mental health and treatment exist: one for people of color, another for whites, one for the poor, another for the wealthy, one for natives, one for immigrants, and, of course, one for women and another for men. A study done by Dr. Inge K. Broverman et al. demonstrates the extent to which contemporary clinicians still view their female patients as Freud viewed his—and still hold to a double standard of mental health.13 (Although this study was done 35 years agto, the results, in my opinion, are still relevant.) Seventy-nine clinicians (forty-six male and thirty-three female psychiatrists, psychologists, and social workers) completed a sex-role stereotype questionnaire. The questionnaire consisted of 122 bipolar items, each of which described a particular behavior or trait. For example:

  very subjective very objective

  not at all aggressive very aggressive

  The clinicians were instructed to check off those traits that represent healthy male, healthy female, or healthy adult (sex unspecified) behavior. The results were as follows:

  (1)There was high agreement among clinicians as to the attributes characterizing healthy adult men, healthy adult women, and healthy adults, sex unspecified.

  (2)There were no differences among men and women clinicians.

  (3)Clinicians had different standards of health for men and women. Their concepts of healthy mature men did not differ significantly from their concepts of healthy mature adults, but their concepts of healthy mature women did differ significantly from those for men and for adults. Clinicians were likely to suggest that women differ from healthy men by being more submissive, less independent, less adventurous, more easily influenced, less aggressive, less competitive, more excitable in minor crises, more easily hurt, more emotional, more conceited about their appearances, less objective, and less interested in math and science.

  It is clear that for a woman to be healthy she must “adjust” to and accept the behavioral norms for her sex even though these kinds of behavior are generally regarded as less socially desirable. As the authors themselves remark, “This constellation seems a most unusual way of describing any mature, healthy individual.” The ethic of mental health is masculine in our culture. This double standard of sexual mental health, which exists side by side with a single and masculine standard of human mental health, is enforced by both society and clinicians. Although the limited “ego resources,” and unlimited “dependence,” and fearfulness of most women is pitied, disliked, and “diagnosed,” by society and its agent-clinicians, any other kind of behavior is unacceptable in women! The disquieting “submissiveness,” “shyness,” and “pettiness” of female children is never treated as a problem: it is viewed as evidence that girls “grow up” (into their eternal childhoods) more quickly than boys do. The only reason that the “aggressive” behaviors of male children are treated as a problem is because patriarchy wants male youth to wait until it grows older before being given its license to practice “masculinity.”

  It is important to note that gender stereotyping traditionally protected girls and women from being accurately observed. Thus, girl-on-girl cruelty (bullying, taunting, ostracizing, slandering) was rarely “seen” by school teachers, social workers, or psychologists.

  Similarly, female-on-female aggression and competition was rarely discussed—partly because female-on-female violence is far less dramatic and lethal than male violence and partly because no one much cared what women did to each other; people, including mental health professionals, cared about female aggression toward boys and men.

  Still, female adolescents and adults run serious risks when they persist in “male” activities. The reverse is often true too, of course. Their parents and husbands will ostracize and psychiatrically commit them for this—and the psychiatrists will keep them in hospitals until they assert their “femininity.”

  Less educated and more “attractive” women are probably released sooner and more easily from state hospitals and from private treatment; they are probably also sexually propositioned more often within the hospital (a blessing or a curse, depending on your viewpoint).14 Certainly, “feminine” domestic tasks—as opposed to “man’s work”—is the slave labor of choice for women in state asylums.

  In a study by Dr. Nathan Rickel, entitled “The Angry Woman Syndrome,” those husbands who “put up” with their middle-aged wives’ “angry” and male-like behavior are described as suffering from a “Job complex.”15 The author notes that while the reverse is often seen, namely, “where men are the angry protagonists and women the passive recipients … our society is so geared that it more readily accepts this as only an exaggeration of the expected masculine-feminine roles.” Rickel’s “angry” women are all highly successful professionally and are “neurotic” because they exhibit “male” behaviors such as

  an inability to brook criticism or competition; bursts of uncontrollable temper; the use of foul language; possessiveness or jealousy; the use of alcohol or drugs; and consorting with spouses who accept such behaviour.

  Like Angrist’s and McClelland’s female schizophrenics (Chapter Two), they also exhibit much female behavior such as suicide threats and attempts and a “very good memory for minor slights.” If such “male” behavior is “neurotic” or “self-destructive,” then it should be seen as such for both sexes. (Of course, when women do the very same things as men, it always has a completely different meaning and set of consequences: even here, it is the wives who are seeking treatment—the husbands, for all their “female”-like suffering, are not.)

  Looking back, I f
ind it amazing that Rickel and so many other researchers did not focus on male domestic violence at all. Obviously, both research, clinical practice, and laws and prosecution have changed in this area. True, there are still not enough beds in shelters for battered women, nor are there enough funded programs for battered women in terms of education, employment, housing, and health care, including mental health care, but it is still a different world.

  And in terms of mental health care, battered women are still often blamed for choosing their batterers—or for refusing to leave them; and for leaving them “knowing” that their batterers would become even more dangerous when abandoned. Being battered does not make a woman likeable. Think of her as a hyper-vigilant war veteran with insomnia, flashbacks, a drinking problem, panic attacks, and a bad temper.

  In the past, whenever sex-role stereotype lines are crossed, clinicians enforced the double standard of mental health. For example, a report tells how a male psychiatrist, Dr. Herbert Modlin, “managed” a group of “paranoid” women back to “feminine” health: he helped them re-establish their relationships with their husbands.16 The author’s therapeutic technique was as reprehensible as his goal. He decided that his “paranoid” patients needed “strong” male control, both within their marriages and within the hospital.* Modlin notes that many of these women’s husbands were too “passive and compliant.” He therefore “demonstrated to the man his wife’s need of him [and helped] him assume a stronger position for her sake.” Within the hospital, the psychiatrists were instructed to be firm and authoritarian, to disbelieve and be wary of the women’s “inclinations to interpret, react to, and manipulate [their] environment on the basis of their distorted perceptions.”

  In another study by Dr. Franklin Klaf, the majority of female paranoid patients reported that men were “persecuting” them. Of course, their perceptions may not be distorted at all: they may represent an appropriately panicked reaction to reality. For example, Modlin notes that the “precipitating factor” in all the “paranoid” cases was “an actual alteration in the husband-wife relationship” which often led to a decrease or cessation of sexual intercourse. Many of the husbands were involved in work that was more important to them than their marriages, and were not only happily absent from home for long periods but sexually ungiving when present. These women were not only sexually deprived—they were nearly out of jobs. Their “paranoia” was both a way of fulfilling and avoiding the consequences they feared and saw approaching: psychological and financial unemployment.

  Dr. Modlin may have listened to his patients but he did not hear what they were saying. He neatly glides over the meaning of such “delusions” as “conversations with the Devil,” reported by one of his “paranoid,” sexually deprived, and probably monogamous patients. The “Devil” is persuading her to become a “prostitute”—i.e., the only image of a sexually involved woman in our culture is that of a prostitute, and she (the patient) wished to be sexually involved. Accusations of “infidelity” are also considered as “delusionary” as is one of Dr. Modlin’s female patient’s complaints that twenty-one “previous shock treatments” had “ruined her brain.” (They might have done so.) Rickel also somewhat underestimates (but does not overlook) the fact that one of his patients, like Freud’s patient Dora, was in treatment as a “captive.” He says:

  … she constantly expressed the fear with some basis, that her mother and older brother would like to see her put away. In fact, the brother called me with that thought in mind.

  Another psychologist, in a study of female psychology, glosses over the perceptiveness of those female college students who explained their “frigidity” in terms of what the author calls “unconscious prostitution fears.”17 There is nothing very unconscious—or distorted—about such fears. For thousands of years, patriarchal society and, more recently, psychiatric and psychological journals have allowed men to separate love and sex and to condemn, prohibit, and punish female lust and agency.

  Traditional patriarchal themes, like bad dreams, have reappeared in a number of published accounts of female psychology and sexuality, like Mary Jane Sherfey’s conclusions at the end of her classic monograph on female sexuality, i.e., that “civilization” at its best would be undermined by female sexual liberation.18 Dr. Judith Bardwick wrote the first academic book about female psychology after the second feminist movement occurred in America.19 Bardwick presents a reasonable, thoughtful, and comprehensive review of various studies, accompanied by deceptive protestations of objectivity and political neutrality. Despite her clear understanding that American females never develop “selves” or “independence,” she is still a Dutiful patriarchal Daughter, in the best Helene Deutsch-Esther Harding tradition. She apparently accepts a double standard of mental health, lauding the “female virtues” for women but not for men. Although she criticizes Freud’s views of women, she joins him in the comfort of an “anatomy is destiny” bias. Like Horney, her version of it is “my vagina is bigger than your penis.” Many of her “professional” opinions sound remarkably similar to conventional opinions. She proclaims that female children develop sexuality later than male children; that, because the clitoris is so anatomically small, female children do not masturbate or “suffer” sexual frustration, nor do they experience prepubertal vaginal sensations; that male children suffer a harsher socialization than female children; that sex for women is much more tied up with love than it is for men; that the most basic pleasure for women is that of maternity; that the vaginal orgasm exists “psychologically” and “involves fusion with a loved man.”

  I do not question that women report and/or experience different intensities of orgasm. What I do question is whether this picture of female sexuality is indeed biologically predetermined or whether it is culturally and economically predetermined. However, she makes an interesting point: that women are more dependent on men than on other women because of the “indifferent (or hostile) relationships they’ve had with their mothers and girlfriends.” Horney does not interpret this in feminist terms at all. These are all familiar and “unprovable” views which, however, are more rewarded than an opposite and equally “unprovable” set of views would be.

  (3)“Real” Women All Are Mothers—but Once You’re A Mother, Anything That Goes Wrong Is Your Fault

  Clinician-theorists still share the belief that women need to be mothers and that children need intensive and exclusive female mothering in order for both to be mentally “healthy.” The absoluteness of this conviction is only equaled by the conviction that mothers are generally “unhappy” and inefficient, and are also the cause of neurosis, psychosis, and criminality in their children. Child-development textbooks are filled with these views, as is the research literature on the “schizophrenogenic” mother; the mother who produces “promiscuous” daughters, “homosexual” sons, and “criminal” or “neurotic” children.

  Joseph Rheingold, in his The Mother, Anxiety and Death, claims that he has “been struck by the number of women who almost indifferently admit the desire to abuse, rape, mutilate, or kill a child, any child.20 I have never known a man with this cold-blooded animosity for children.”

  While maternal abuse of children does exist and is exacerbated by poverty, drug addiction, unemployment, and overburdened single motherhood, most mothers do not sexually or physically abuse, neglect, abandon, or kill their children. Most women are “good enough” mothers. Some studies confirm that many fathers or live-in boyfriends have less patience with infants and children than women do and more routinely compete with, batter, abandon, or even kill children.

  On the other hand, in the last 30–35 years, more western men have gotten involved in joint and hands-on parenting both during marriage and after divorce or the death of a spouse. Homosexual couples and single men have also adopted children and have fought for the right to create intergenerational families. Nonviolent fathers have also battled for and won sole custody.

  Fathers do not often parent the same way mothers do—but
, for the most part, they do parent.

  (4)Lesbianism And Homosexuality Are Diseases

  Most clinicians once viewed lesbianism and homosexuality as “pathological” or, at best, as “second best.” Heterosexuality, rather than bisexuality, was the norm. Few clinicians differentiated between (male) homosexuals and (female) lesbians.

  As I’ve noted, homosexuality and lesbianism are no longer considered to be psychiatric illnesses. Some researchers suggest that sexual preference is genetically predetermined.

  However, homophobia still exists as a clinical and patriarchal cultural bias. Pre-adolescents and adolescents are taken to therapists by fundamentalist parents who view “feminine” boys and “masculine” girls as unnatural and unacceptable. Adolescents are sometimes sent to punitive military academies or to cult-like “reprogramming” centers to de-program their homosexual, bi-sexual, or lesbian inclinations.

  (5)Certain Pregnancies Are Illegitimate; Certain Women Are Promiscuous

  Clinician-theorists once accepted patriarchal notions of “illegitimate” pregnancies; female “promiscuity”; female “seductiveness”; and, paradoxically, female “sexlessness.”21 They acted on such views in rather powerful ways: by convincing women that they were true, or by psychiatrically incarcerating women, especially adolescents and wives, for “promiscuity.” In a personal communication, a practicing psychiatrist told me about a middle-aged American woman who was psychiatrically committed by her husband and psychiatrist in the 1950s for having taken a lover; she died ten years later in the asylum.

  A lawyer told me the following story: a woman in her thirties was privately hospitalized by her husband. In 1969, she began a sexual-emotional relationship in the asylum with a man younger than herself. Both seemed much happier. The asylum authorities forcibly separated them; both suffered “relapses” and, to her (the lawyer’s) knowledge, both remained hospitalized. Female children whose fathers raped them were seen as “seductive”—or the mothers were blamed for not preventing the rape-incest, or for secretly “wanting” it.22 In any event, the tone was one of “no great harm has been done anyway.” The few cases of maternal seduction and incest reported are all seen as the cause of the male child’s ultimate “schizophrenia.”23 Professional prostitution has been clinically viewed as female “revenge” and “aggression”—and not as female victimization.24