Women and Madness

by Phyllis Chesler

  Years after I had written Women and Madness, Drs. Jeffrey L. Geller and Maxine Harris asked me to introduce a very important volume titled Women of the Asylum: Voices From Behind the Walls, 1840–1945 (1994). I had read and written about some of these accounts—but even I had no idea that so many superb eyewitness accounts really existed.

  For example, Elizabeth T. Stone (1842), of Massachusetts, described the mental asylum as “a system that is worse than slavery”; Adriana Brinckle (1857), of Pennsylvania, described the asylum as a “living death,” filled with “shackles,” “darkness,” “handcuffs, straight-jackets, balls and chains, iron rings and … other such relics of barbarism”; Tirzah Shedd (1862), wrote: “This is a wholesale slaughter house … more a place of punishment than a place of cure”; Clarissa Caldwell Lathrop (1880), of New York, wrote: “We could not read the invisible inscription over the entrance, written in the heart’s blood of the unfortunate inmates, ‘Who enters here must leave all hope behind.’”

  According to these American autobiographical accounts, female patients were routinely beaten, deprived of sleep, food, exercise, sunlight, and all contact with the outside world, and were sometimes even murdered. Their resistance to physical (and mental) illness was often shattered. Sometimes, the women tried to kill themselves as a way of ending their torture.

  It is now clear that whether the nineteenth- or early-twentieth-century female patient was entirely sane, or whether she had experienced post-partum or other depression, heard voices, or was “hysterically” paralyzed; whether she was well-educated and well-to-do, or an illiterate member of the working poor; whether she had led a relatively privileged life or had been repeatedly beaten, raped, or abused in other ways; whether she accepted or could no longer cope with her narrow social role; whether she had been idle for too long or had worked too hard for too long and was fatigued beyond measure—she was rarely treated with kindness or medical expertise.

  I had also discovered that some rather accomplished women—the sculptor Camille Claudel, the writers Zelda Fitzgerald, Virginia Woolf, Lara Jefferson, and Sylvia Plath, the actress Frances Farmer, and the fictionally named Ellen West—had done “hard time,” psychiatrically speaking. Despite their beauty, genius, and class/skin privilege, none were helped, and all were deeply hurt by institutional psychiatry, patriarchal therapists, and by highly abusive families.

  In an allegedly post-feminist era, young women began writing accounts of their psychiatric hospitalizations and their descents into “madness.” The literature almost qualifies as a new genre.

  For example, the feminists Jill Johnston in Paper Daughter (1985), Kate Millett in The Loony Bin Trip (1990), and Shulie Firestone in Airless Spaces (1998), and the psychiatrist Kay Redfield Jamison in An Unquiet Mind: A Memoir of Moods and Madness (1995), all wrote about psychiatric symptoms, medication, and institutionalization. Some insisted that although they heard voices, wanted to die, tried to kill themselves, were highly anxious, and could not function, they were not and never had been “mentally ill.” Some were humbled by what had happened and acknowledged that something had gone terribly wrong. Some refused psychiatric medication. Others claimed that medication had saved their lives.

  Millett, Johnston, Firestone, and Jamison all grew up in a pre-feminist era. Interestingly, by the 1990s, and continuing on through the twenty-first century, a large number of younger women, who were mainly born after 1970, began publishing accounts of their experiences with “mental illness” such as schizophrenia, depression, anxiety, and a general malaise. Here, Mari Nana-Ama Danquah, in Willow Weep for Me: A Black Woman’s Journey Through Depression (1999); Carol Hebald’s The Heart Too Long Suppressed (2001); Ruth Kline’s It Coulda Been Worse: Surviving a Lifetime of Abuse and Mental Illness (2003); psychiatrist Carol North’s Welcome, Silence: My Triumph Over Schizophrenia (1987); Julie Gregory’s Sickened: The Memoir of a Munchausen by Proxy Childhood (2003); Rachel Reiland’s Get Me Out of Here: My Recovery from Borderline Personality Disorder (2004) all come to mind.

  But there are many more accounts by young women about suicide attempts, alcoholism, drug addiction, and self-mutilation. I am especially thinking of the following works: Susannah Kaysen’s Girl, Interrupted (1993); Marilee Strong’s A Bright Red Scream: Self-Mutilation and the Language of Pain (1998); Carolyn Kettlewell’s Skin Game. A Memoir (2000); and Elizabeth Wurtzel’s Prozac Nation (1994) and More, Now, Again: A Memoir of Addiction (2001).

  Accounts of postfeminist eating disorders may currently comprise a new literary genre as well. Of course, Suzy Orbach wrote Fat is a Feminist Issue (1978) in a feminist voice and in a feminist era, as did Kim Chernin in The Obsession: Reflections on the Tyranny of Slenderness (1982) and The Hungry Self: Women, Eating, and Identity (1986), which I reviewed for the New York Times Book Review. The Hungry Self is an inspired psychoanalytic meditation on eating disorders. Both Orbach and Chernin primarily described battles with anorexia. However, Orbach’s and Chernin’s voices were relatively isolated ones.

  The subject really gathered steam in the 1990s. For example, in 1991, Naomi Wolf published the bestselling The Beauty Myth: How Images of Female Beauty are Used against Women. She was also concerned with anorexia and the culturally induced need among girls and women to be too thin.

  In 1995, Dr. Mary Pipher published Reviving Ophelia: Saving the Selves of Adolescent Girls. Pipher’s work was about adolescent girls and their obsessive focus on weight gain and loss. Pipher views our culture as a “girl poisoning” culture that places impossible and contradictory demands on young women; they respond by becoming “female impersonators,” and by obsessing over their weight.

  As we entered the twenty-first century, college-aged Sara Shandler published Ophelia’s Daughters Speak, a collection of teenage responses to Pipher’s work. In addition, Marya Hornbacher published Wasted: A Memoir of Anorexia and Bulimia (1999); Carolyn Knapp published Appetites (2003); and Kathryn Harrison published The Mother Knot (2004).

  Caroline Knapp writes about her own experience of anorexia, but she broadens her discussion to include many other kinds of displaced hungers and compulsions to have sex, steal, and gamble. Knapp tries to explain why young women who have grown up in a postfeminist era might still be paralyzed. In reality, they also still live in a patriarchal era, and have not yet been carefully schooled to resist the self-demeaning and contradictory choices they face. Young women are also confounded by having too many choices. Knapp suggests that they acquaint themselves with their “hungers.” She writes:

  A woman’s relationship with hunger and satisfaction acts like a mirror, reflecting her sense of self and place in the wider world. How hungry, in all senses of the word, does a woman allow herself to be? How filled? How free does she really feel, or how held back? … It’s about the collision between self and culture, female desire unleashed in a world that’s still deeply ambivalent about female power and that manages to whet appetite and shame in equal measure…. Women get psychically larger and they are told to grow physically smaller.

  Some mental health experts believe that girls and women who refuse to eat (or who binge-eat and throw up) are engaging in a self-destructive protest against the contradictory cultural demands that they look boyishly thin, like high-fashion models—and, at the same time, look sexy and seductive. Some say that controlling one’s weight is an attempt to gain control when one’s life seems otherwise out of control.

  In 2004, in the second edition of Feminist Theories and Feminist Psychotherapies: Origins, Themes, and Diversity, Dr. Carolyn Zerbe Ennes reviews some of the literature that suggests that “eating disorders may be survival skills for dealing with anxieties about achievement. Achieving the perfect body may be a way to avoid negative stereotypes of high-achieving women as lonely, ruthless, unfeminine, or unattractive.” Some theorists also suggest that focusing on the “physical self” may be an attempt to “compensate for having an underdeveloped psychological self.”

  Mental health experts also believe that when
girls and women are more obsessed with losing a few inches from their bodies than with changing history by a few inches, that they are living in a nonpolitical (postfeminist) era, and that, as isolated individuals, they do not have the ego-strength to resist being culturally diminished and pornographically sexualized.

  I agree with all of these theoretical views. What may work, therapeutically, for a given individual, is an entirely separate matter.

  But, let’s return to what I did in order to create Women and Madness. First, I interviewed the real experts: women who had been psychiatric and psychotherapy patients. I interviewed white women and women of color, heterosexual women and lesbians, middle-class women and women on welfare, women who ranged in age from seventeen to seventy, women whose experiences in mental asylums and therapy spanned a quarter-century, coast to coast.

  And so I began to document how patriarchal culture and consciousness had shaped human psychology for thousands of years. I was charting the psychology of women who, as a caste, did not control the means of production or reproduction and who were, in addition, routinely shamed: sexually and in other ways. I was trying to understand what a struggle for freedom might entail, psychologically, when the colonized group was female.

  Women and Madness was first published in October of 1972. It was instantly embraced by other feminists and by women in general. It received hundreds of positive reviews, including one on the front page of the New York Times Book Review by Adrienne Rich. Over the years, it would sell almost three million copies and be translated into many languages including Japanese and Hebrew. I was interviewed everywhere, and deluged with letters and requests.

  While this book was embraced by other feminists and by many women in general, my analysis of how diagnostic labels were used to stigmatize women and of why more women than men were involved in “careers” as psychiatric patients, was either ignored, treated merely as a sensation, or sharply criticized, by those in positions of power within the professions.

  My statistics and theories were “wrong,” I had “overstated” my case regarding the institutions of marriage and psychiatry, I’d overly “romanticized” archetypes, especially of the Goddess and Amazon variety. Like so many feminists before me, I became a “dancing dog” on the “one night stand” feminist academic and professional circuit. Luckily, I was just about to gain tenure at a university; luckily, no father, brother, or husband wanted to psychiatrically imprison me because my ideas offended them.

  It is inconceivable, outrageous, but that is all Elizabeth T. Stone (1842), of Massachusetts, and Elizabeth Packard (1860), of Illinois did: express views that angered their brothers or husbands. Phebe B. Davis’ (1865) crime was daring to think for herself in the state of New York. Davis wrote: “It is now 21 years since people found out that I was crazy, and all because I could not fall in with every vulgar belief that was fashionable. I could never be led by everything and everybody.” Adeline T. P. Lunt, (1871), of Massachusetts, noted that within the asylum, “the female patient must cease thinking or uttering any ‘original expression’.” She must “study the art of doffing (her) true character … until you cut yourself to (institutional) pattern, abandon hope.” Spirited protest, or disobedience of any kind, would only result in more grievous punishment.

  In her work on behalf of both mental patients and married women, Elizabeth Packard proposed, as her first reform, that: “No person shall be regarded or treated as an Insane person, or a Monomaniac, simply for the expression of opinions, no matter how absurd these opinions may appear to others.” Packard was actually trying to enforce the First Amendment on behalf of women! Packard also noted that: “It is a crime against human progress to allow Reformers to be treated as Monomaniacs … if the Pioneers of truth are thus liable to lose their personal liberty … who will dare to be true to the inspirations of the divinity within them?” Phebe B. Davis (1865) was more realistic. She wrote that “real high souled people are but little appreciated in this world—they are never respected until they have been dead two or three hundred years.”

  Thus, more than a century after Packard lived, wrote, and crusaded, those in positions of institutional power either ignored the challenge my book posed or said that, by definition, any feminist work was biased, neurotic, and hysterical. (Yes, our critics psychiatrically pathologized an entire movement and the work it inspired—just as individual women were pathologized.) Some said my feminist views were “strident” (how they loved that word), “man-hating,” and too “angry”—a real no-no.

  Piffle.

  Over the years, I have received more than 10,000 letters about Women and Madness, mainly from women. I have them still. Most confirm what I’ve written. (My admiration to you, dear readers, for having survived your ordeals and my thanks for all your trust.)

  What has really changed since I wrote this book? The answer is too little—and quite a lot.

  Despite—or because—a visionary feminist movement was alive in the world, misogyny or misogyny-under-siege continued, unabated. The so-called backlash was upon us from the very moment we drew our first, Second Wave feminist breath. Yes, among mental health professionals too.

  THE MID-1970S

  Psychologist Paula Caplan, author of The Myth of Female Masochism, and a host of other wonderful books, including They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal and Bias in Psychiatric Diagnosis, was a graduate student at Duke University. She “mildly critiqued Freud” in one of her term papers. Caplan writes, “My professor returned the paper to me. He had scrawled on the front, ‘How many times in this century is Freud to be attacked for his views on women?’” Shortly thereafter, Caplan was “kicked out of the clinical doctoral program.”

  Psychotherapist Miriam Greenspan, author of A New Approach to Women and Therapy (1983) and the extraordinary Healing Through the Dark Emotions: The Wisdom of Grief, Fear, and Despair (2003), was told by her supervisors that “professionals (if they are female) must wear brassieres, that excessive anger in a woman was a sign of a character disorder, that an inordinate preoccupation with spiritual matters is a symptom of schizophrenia, that too much empathy is a serious lapse in professionalism, that too much compassion is an impediment to one’s expertise as a psychotherapist.”

  At Harvard, psychologist Carol Gilligan began to “connect her work and her life” in the research that would lead to In a Different Voice (1982). Gilligan writes that, “Initially, Lawrence Kohlberg was very dismissive of my research with women and basically ridiculed my abortion decision study, getting his class to vote that abortion was not a moral problem and telling my research seminar that I had confused gossip with research. I knew the research which Kohlberg was defending had included no women. [A]s long as they (Kohlberg and Erik Erickson) could incorporate my work into their theories or regard it, as Larry used to say, as a kind of interesting cross-cultural research—a study of this other culture, called women—then everything was fine. But when listening implied changing their theories, then there was a problem.”

  THE 1980S

  Psychiatrist Nanette Gartrell completed her three-year psychiatric residency at Harvard in 1979. She then served on the American Psychiatric Association task force to develop a curriculum on the psychology of women for psychiatric residency programs. Gartrell writes,

  When we submitted our detailed 200-page proposal two years later (1980–81), APA officials were incensed over a single sentence written by me: “Homosexuality is a normal variation in sexual expression.” The magnitude of the backlash surprised me. Never mind that homosexuality had been eliminated from the DSM [Diagnostic and Statistical Manual] six years previously. Prominent female psychiatrists pressured me to delete the sentence, warning that my professional career could be ruined if I did not comply. I was also subjected to a long-term smear campaign. Despite these tactics, I refused to capitulate. I resigned from the task force, withdrew my contributions to the curriculum, and removed my name from authorship. Many colleagues follow
ed suit. Sadly for women psychiatrists, the curriculum was never published. I became completely disillusioned about the possibility of making any changes within organized psychiatry without [encountering] major resistance.

  Psychiatrist Jean Shinoda Bolen, author of Goddesses in Everywoman: A New Psychology of Women (1984) and the founder of the Committee of Asian-American Psychiatrists, led the fight against the American Psychiatric Association’s decision to oppose the Equal Rights Amendment. She writes, “At the time, the APA was 89 percent male and two-thirds of our patients were female. Inequality, discrimination, and stereotyping affect self-esteem and limit opportunities for women; that psychiatrists who treat women did not support the ERA was appalling.”

  Psychiatrist Teresa Bernardez encountered trouble in her own medical school Department of Psychiatry at Michigan State University. A new chairman maintained she wasn’t a “mainstream psychiatrist” because, she writes, “I did not treat depressed women with drugs and because I was against involuntary hospitalization. I had to defend my position through a grievance, which I won. My position in protecting patients who had been victims of therapists’ abuse had already (resulted in) a series of disputes with a few faculty members.” Bernardez left the Department of Psychiatry “with their arcane views and biological reductionism,” which was “toxic to me.”

  Surprised? We were too.

  THE 1990S

  Clinical psychologist Helen Bolderston writes: “In two years of postgraduate study, I had been given just two hours of teaching on gender issues and there was no teaching on the effects on women of having been sexually abused as children. The clinical psychology training program had failed to prepare me for the nature of much of the clinical work I would be doing with women.”