Mad, Bad, and Sad: A History of Women and the Mind Doctors

by Lisa Appignanesi

  From knowing that abuse is an intensely kept but widespread secret to conceiving of it as forgotten if one ‘experiences’ all the signs and symptoms the experts say it produces, is a mere slip of a step. Recovering memories of sexual abuse became a way of explaining the malaise of the present. Speaking the horror in front of sympathetic witnesses, perhaps in a women’s group or in therapy or most controversially in the courts, took on, particularly in the USA, the force of a moral injunction. From recovering memories to recovery itself–a usage familiar from Alcoholics Anonymous–was a mere matter of a few therapeutic steps away. Being part of a wide network of ‘incest survivors’ held out the promise of salvation.

  In 1988 the bible of what quickly became a recovered-memory movement appeared, laying out the steps by which the ills of the present could be found in past abuse. Written by Ellen Bass and her student Laura Davis, the emotive The Courage to Heal sold over eight hundred thousand copies. It was directly aimed at ‘you’–everywoman. And ‘you’ could tick a checklist of seventy-eight effects of incest, to see whether you qualified as a survivor. Given the questions, it wasn’t difficult to qualify. Here’s a random sample. ‘Do you have trouble feeling motivated? Do you feel alienated or lonely? Can you accomplish things you set out to do? Do you feel you have to be perfect? Do you feel yourself clinging to the people you care about? Are you satisfied with your family relationships? Do you have trouble expressing your feelings? Do you ever use alcohol, drugs, or food in a way that concerns you? Do you feel powerless, like a victim?’

  Bass and Davis also described ‘coping mechanisms’–eating disorders, super-achieving, denial, leaving the body and, of course, forgetting. Healing takes courage. It means recovering all of the painful past, stored in the fibres of the body, and letting it out. The pain of therapy, feeling the pain burn again, is part of the process. So too is confronting those responsible for the abuse. At the end of the process, every woman is welcomed into the sisterhood of incest survivors. The 1992 edition of The Courage to Heal contains a resource guide of not only some six hundred books, but support groups, organizations and newsletters, even a board game.

  Being alive as a woman at the end of the twentieth century meant to be an incest survivor. In 1991 Oprah Winfrey, as well as former Miss America Marilyn Van Derbur and the famous television comedienne Roseanne Barr Arnold, shared their abused pasts with the world. Time Magazine reported: ‘“It’s the secret that’s been killing me my whole life,” Arnold, 38, says. “I feel like screaming; I feel like running; I struggle hard not to forget again.”…And for every celebrity who has gone public, thousands of ordinary people have found the courage to confront their own pain, tell others about it and seek help.’

  Help, of course, means help from the therapeutic professions which had no little hand in constructing the illogicality of a killing secret so terrible one struggles not to forget it. Everywhere vulnerable people woke up to the possibility that their ailments, discomforts and failures, their sense that something was wrong, had a cause in a secret they had forgotten. A sizeable industry of therapists, psychologists, counsellors and social workers was at hand to diagnose, root out, suggest or simply cue repressed memories of abuse in their clients. They did so through any combination of hypnosis, journal-keeping, ‘guided imagery’ (a programme of ‘guided’ thoughts and suggestions), dreamwork and sodium amytal. The movement had its ambulance-chasing lawyers primed to sue accused parents at the first rush of memory. And as the abused took the accused family members to court for ‘reparations’, in high-profile cases which by 1994 had topped the three hundred mark and included murder and satanic abuse charges, a backlash set in.

  The turning point may have come around 1988 when in Olympia, Washington, Paul Ingram, a sheriff’s deputy who belonged to a religious group, the Church of the Living Water, which actively believed in Satan, confessed to child abuse and to murdering twenty-five children in satanic rituals. The case was brought by his daughters Erica and Julia, who recalled the abuse by their father and his poker friends, from when Erica was five until she left home. Ingram’s recollections of his wildly abusive past came during intensive interrogation. He was persuaded that he suffered from multiple personality disorder and so couldn’t at first remember the events. He confessed to a series of horrendous charges and was jailed, only later to withdraw his confession. This wasn’t accepted, despite the reports of memory experts such as Elizabeth Loftus, which showed that his original testimony had nothing to do with remembering. Ingram served fourteen years in prison. Investigated by Lawrence Wright, the Olympia story was published in the New Yorker in 1994 and fed the backlash, which by then included cases against therapists.

  Melody Gavigan, thirty-nine, a computer expert from California, checked into a local psychiatric hospital. She was severely depressed and needed help. During her five weeks of treatment, a family and marriage counsellor suggested that her depression stemmed from childhood incest. Desperate for any answers, Gavigan took the cue and started writing her journal of emerging memories. As Time Magazine reported on 29 November 1993: ‘She told about running into the yard after being raped in the bathroom. She incorporated into another lurid rape scene an actual girlhood incident, in which she had dislocated a shoulder. She went on to recall being molested by her father when she was only a year old–as her diapers were being changed–and sodomized by him at five.’ On her therapist’s advice, Gavigan confronted her father with her accusations. She broke off relations with her family, moved away and formed an incest survivors’ group. More memories came. Something in the college psychology course she had signed up for, however, made her sceptical of what she had ‘recovered’ and she concluded her memories were false. She filed a suit against the psychiatric hospital for the pain she and her family had suffered.

  The ‘memory wars’ were well under way. Where therapy was hailed as salvation, it was also now under attack, sometimes by patients, sometimes by theoreticians, sometimes by accused parents who banded together in America in the False Memory Syndrome Foundation early in 1992, and in the British False Memory Society. The new memory scientists–a grouping which included cognitive psychologists like Elizabeth Loftus, biochemists, neuroscientists and the new brain imagers–came together to dispute therapists’ recovered-memory findings. They argued that memories decayed, could easily be changed by suggestion or wish, and made to feel real by repetition. Freud’s name was bandied about by both sides: either he was responsible for having abandoned his original hypothesis that really occurring and later forgotten childhood seduction was a trigger to hysteria or, as the philosopher of repression and the unconscious, he was responsible for the entire package of recovered memory, with its real or therapy-induced rememberings.

  Memory had become the fin-de-siècle’s favourite conceptual cluster. It gathered under its aegis Holocaust museums, memorials and survivors’ reminiscences, which had never been forgotten but had rarely been spoken as fully. Alzheimer’s, the disease of forgetting, was the time’s shadow side, the great memory fear of the older generation. Abuse could be recovered or invented to create an identity. Sufferers from Alzheimer’s had nothing at all–no memory and no remembered subject to experience it. But as the most feared neurological condition of an ageing Western population at the end of a dying century and in the ‘decade of the brain’, it did have a great many investment dollars to nourish it.

  Phyllis Greenacre (1894–1989)

  In America, as elsewhere, it took traditional psychiatrists and psychoanalysts, even the women amongst them, a while to wake to the new, emphatically proclaimed evils contained in the package called sexual abuse and its prevalence as a central medical and morally defining category.

  The redoubtable Phyllis Greenacre, doyenne of American psychiatry, had experience of all sides of the profession. Beginning in 1916, she had served as an intern at Johns Hopkins and worked in the psychological laboratory of the Henry Phipps Clinic under the pioneering, if erratic, Adolf Meyer. One of the first women in
the profession, she was then engaged to assess the experimental research of the notorious and delusional Henry Cotton at Trenton State, with his theory of chronic infection causing madness. To her credit, she bravely damned his research. She became director of the outpatient unit at New York’s Payne-Whitney, and from 1932 began a psychoanalytic training, rising to become President of the American Psychoanalytic Association, as well as a professor of psychiatry at Cornell. She was also one of the founding editors, with Anna Freud, of the Psychoanalytic Study of the Child. Though Greenacre had written specifically on trauma and early childhood, the trauma here is not understood as necessarily sexual: it could be the effect on the child of an external act such as hospitalization or a mother’s depression.

  J. Laplanche and J.-B. Pontalis in their deservedly famous dictionary of psychoanalysis give a succinct, classic definition of trauma:

  An event in the subject’s life defined by its intensity, by the subject’s incapacity to respond adequately to it, and by the upheaval and long-lasting effects that it brings about in the psychical organisation.

  In economic terms, the trauma is characterised by an influx of excitations that is excessive by the standard of the subject’s tolerance and capacity to master such excitations and work them out psychically.

  In a 1950 paper on trauma in girls before puberty, Greenacre explores the case of Daphne, a thirty-year-old woman incapable of sustaining relationships with either men or women. Daphne is exceptionally tense, suffers from a fear of what she calls a ‘black presence’, as well as a dread of ‘growing up and wearing white stockings’. She goes to pieces whenever any public pressure is put on her: taking exams, speaking in front of people, or indeed watching sadomasochistic events such as fights. Such events cause her to ‘flood’–experience a spontaneous discharge (orgasm, blood, urine, excrement)–or faint. Like other patients in the more classical literature who have experienced a ‘trauma’ after the age of about four or five, Daphne has little trouble in remembering in analysis the event from which her troubles dated. The accuracy of the memory is not the question. She relates the episode, the details of which will be analysed, on her second visit. Greenacre recounts:

  At the age of about ten the girl was roller-skating in the cellar of her own home when a man entered to read the gas meter. She spoke to him and he offered to show her the meter, thereupon lifting her so that she could see the movement of the little hands upon the dials of the meter. In lifting her he put his hand under her dress and stimulated her genitals. She recalls having become extremely excited, ashamed and frightened; she squirmed free and the man quickly left. She could not recall exactly how the experience ended; she had the feeling that she lost consciousness or ‘went blank’.

  The ‘traumatic’ event happened during a period when Daphne and a girlfriend had been chatting excitedly and at length about matters sexual. Soon after this, thanks to her friend, she discovered a ‘peculiarly pleasant’ form of masturbation in the bathtub which continued up until the time of her analysis. After the event with the meter-reader, Daphne’s family moved, she suffered a humiliating rejection by her favourite male cousin; then they moved again, for no related reason. Daphne’s puberty coincided with the pregnancy of an aunt whose namesake she was and the birth of a boy whom Daphne thought of as her brother and who soon developed epilepsy, much to her fascinated distress.

  After a series of associations amplifying on the case, Greenacre draws what would, after feminism and the establishment of the classification of child abuse, be an almost impossible conclusion. She argues that in all of the patients she has seen of which Daphne is an exemplar, the ‘prepuberty trauma was induced by the child generally…under the stimulus of an adolescent or an older woman’. The traumatic situation was also ‘precipitated’ by the child, who was curious and preparing for puberty. It represented the condensation of pre-Oedipal, far earlier experiences which had disturbed the girl, and it was in that sense a repetition.

  In Daphne’s case, there were a number of earlier events which had stirred her pleasure and mixed it with fear–including the exhilaration of her father lifting her and hurling her around wildly, watching her mother perform what she interpreted as fellatio while her father was confined to bed and encased in a white cast (interpreted as the white stockings she fears as part of growing up). These earlier incidents, together with the event at the gas meter, were then mobilized by the patient as evidence of the (exciting) danger of sexuality and used as a defence against it. In Daphne’s case this also carried the masochistic gratification of ‘flooding’. When the traumatic event takes place with an adult, Greenacre also notes, ‘the guilt can be the more readily shifted’. The child’s own part in the trauma, together with the earlier events which have produced the pressure of provocation, can be more readily concealed.

  According to Greenacre’s paper, Daphne seems to have done well enough through her treatment, whether Greenacre was right or wrong in her interpretations and the points she draws. What is interesting from the vantage point of the present is the way in which she implicates the patient, ascribes an active part to her in her own life story. Daphne is not–though Greenacre herself followed Hélène Deutsch in understanding femininity as passive and charged with masochism–treated as a victim. A latter-day therapist might say that the analyst here is repeating the trauma which victimizes the patient by wrongly attributing a partly willed participation in a traumatic sexual act, by not taking Daphne’s story at face value; by enacting the patriarchal view of implicating the victim in the act of perpetration. All this may also be true. But what underlies Greenacre’s analysis is the understanding that children can and do experience sexual pleasure, that all sex is not an irreparable violation, a rape, an insurmountable evil. Daphne’s trauma is something that can be got over, and a life with sex (no matter what the orientation) lived. Our turn-of-the-century idea of ‘sexual abuse’ hardly permits this possibility through the door. To be molested by a stranger becomes an event as deeply shocking to the woman as an act of war: it indelibly colours life thereafter, marking all life as an afterlife, transforming it into a survivor’s tale.

  Greenacre’s cases in her 1950 paper are middle-class. Hospital and outpatient child psychiatrists and psychotherapists were, if anything, even more accustomed to seeing children who had been beaten, sexually violated by elders or siblings, or who had witnessed the kinds of scenes that Freud called ‘primal’. After all, separate bedrooms were relatively new in history and then only the property of the better off. The class aspect of the abuse and incest dilemma is now rarely noted.

  THE FRONT LINE

  In a talk at the December 1989 meeting of the American Academy of Psychoanalysis, Margaret Tsaltas, MD, looked back at her records over thirty-three years of psychiatric practice with ‘abused’ children to sift the changes that had taken place in theory and treatment. She noted that the children referred for outpatient treatment because of reaction to sexual abuse made up the smallest number in her case load: a total of forty-seven over a lifetime’s practice from 1953 on. But her account suggests that not only had numbers grown (which might have to do with the readiness of reporting), but so too had the brutality of the violence the children suffered.

  In the first five years of her practice in a teaching hospital she saw nine ‘sexually molested’ girls under twelve. The term in this context meant any kind of sexual behaviour other than penetration. All the abusers were fathers, who in this period were dealt with by being put on probation. This involved psychotherapy, though not being taken away from the family, which was understood as needing the father’s financial support. The child was placed in a foster home until such time as the acting social worker was confident the father would not repeat his acts. The treatment goal with the child was to relieve the conflict ‘between their guilt (over having to lose their family and their pleasure in what they regarded as their father’s special love for them) and their fear (of what their abuser might have done next and their fear of losing their
mother’s love)’.

  It is worth remarking that Tsaltas, who is of a pre-feminist generation, records and stresses the child’s pleasure in the sexual activity, the conflict between love and fear. This is something which disappears altogether in later understandings of abuse, where any sexual activity is equivalent to violence (which it may indeed by the turn of the century have become). Tsaltas notes that the girls saw their being taken away from the family as ‘punishment for the pleasure they had in their father’s manipulations of their bodies and they fantasised that their mothers would never forgive them for talking to outsiders about their guilt’. Invariably, the girls’ attempts to talk to their mother had met with the mother’s denial of their experience.

  Between 1958 and 1963, Tsaltas moved to another hospital outpatient department. Here, out of her case load, she saw twenty-three children who had been molested and six raped, four of whom were already teenagers. The state now prosecuted both molesters and rapists, and since the guilt of the latter was easier to establish, they were usually imprisoned for long terms. Mothers, left destitute with families, blamed daughters for ‘lying and fantasizing’ and bringing accusations against fathers, thereby precipitating poverty. All the girls needed to do to get the families off welfare was to retract what they had said. Tsaltas states as her primary treatment goals the resolution of conflicts ‘about personal integrity versus family interest as well as concerns about paternal betrayal and fear of bodily harm’. Rather than the usual play therapy, she feels she needs here to be both more intrusive and more educational in her approach.