It is unethical to engage in sex with one’s patients. Prevailing wisdom suggests that once a patient—always a patient; once a therapist—always a therapist. Nevertheless, in the 1950s and 1960s, a number of leading psychoanalysts married their most beautiful, troubled, brilliant, and adoring patients. Some marriages worked out; others didn’t. At the time, no one thought there was anything wrong with this. Today, a feminist analysis of sex and power suggests that such a boundary violation is analogous to psychological incest.
A minority of therapists, both male and female, gay and straight, are psychopaths. They form cults around themselves, isolate cult members from their friends and family, teach that “sexual encounters” with the leader are both an honor and an occasion for spiritual enlightenment. These are criminal and psychotic enterprises that good therapists often whisper about but, for many reasons, are unable to expose or abolish. Often, such psychopathic therapists have no advanced degrees and/or do not belong to any professional associations; even when they do, our ability to stop them is limited.
I am not saying that a therapist is forbidden from falling in love with a patient, or even from acting on it. There are once-in-a-lifetime exceptions to this rule and ethical ways of handling such a situation should it arise. This includes referring one’s patient elsewhere, entering therapy oneself, ending all contact with one’s patient for at least a year, and then—once a suitable separation has been established—proceeding very slowly, and with extreme caution.
Freud and Company had, of course, insisted that both “transference” (what a patient may project onto her therapist) and “countertransference” (what the analyst may project onto a patient) be carefully analyzed. Freud was very clear: “kisses” were to be avoided at all costs. But back in Vienna, analyses were sometimes concluded in months and/or within a year, analysands socialized and worked with their analysts, and boundaries blurred. Freud himself analyzed his own daughter, Anna, and, not surprisingly, denied that incestuous dynamics existed in the family: in his, or in anyone else’s.
In my view, Freud was a genius. He was right about many important things: Unconscious motivation does exist, both symptoms and dreams can be interpreted, the “talking cure” can work. (The talking and listening cure was really suggested by one of Freud’s patients, Anna O., aka Bertha Pappenheim, a wealthy Orthodox Jewish girl who went on to become a feminist and anti-Nazi crusader).
Freud was wrong about women’s masochism and penis envy. He was also wrong about fathers and sons: it was fathers, in Judaeo-Christian and Muslim cultures, who physically and psychologically “kill” their sons, not sons who wish for their fathers’ deaths. Freud did not understand the mother-daughter relationship as well as he did that between mother and son. We now understand that Freud-as-genius did not transcend the patriarchy of his time. Did anyone?
I do not want to underestimate the importance of Freud’s discoveries or his popularization of concepts such as the unconscious, denial, repression, projection, dream analysis, etc. However, Freud’s theories may, in fact, have become as popular as they did—and when they did—for a wide variety of reasons. What was done in Freud’s name—whether Freud intended it this way or not—sometimes supported the most backward of institutional psychiatrists. While some analytic patients, both male and female, learned treasured things about themselves, more often Freudian-inspired psychoanalytic therapy in America was used to reinforce church teachings and to curtail potential feminist political fervor in each woman, one by one. As social worker and scholar Dr. Nzinga Shaka Zula writes, “Therapists are often the soft police of the dominant culture.”
Even if a psychoanalytic understanding of one’s life is potentially liberating—and I think it may be—psychoanalytic therapy, by itself, cannot overcome trauma, or human nature. Nor can psychological healing take place in isolation.
While society has changed—it also remains the same. For some, family life has changed radically in the last thirty-five years; more than half of all marriages end in divorce; many mothers (and some fathers) are raising children alone, both with and without extended family support; many mothers are daring to leave men who abuse them and their children; lesbians and homosexuals are creating alternative families and raising children.
Nevertheless, most girls and boys continue to experience childhood in father-dominated, father-absent, and/or mother-blaming families. Sex-role stereotyping still exists in most homes, as does maternal and paternal child abuse. Incest and family violence remain epidemic but have, increasingly, been de-politicized: first, by women who believe that appearing on television is a form of “treatment”; second, by the media, which happily capitalizes on the entertainment value of such public accusations and confessions; third, by the understandable but misguided belief in the power of individual therapeutic solutions as opposed to collective legal or social justice solutions.
I am not opposed to television confessions or discussions of trauma. On the contrary. Such programs often educate women who are otherwise totally misinformed and isolated. In a sense, daytime TV programs are the heirs of early feminist consciousness-raising groups—but without a political perspective. This missing dimension should not be underestimated.
The cumulative effect of being forced to lead circumscribed lives is toxic. The psychic toll is measured in anxiety, depression, phobias, suicide attempts, eating disorders, and such stress-related illnesses as addictions, alcoholism, high blood pressure, and heart disease. Understanding and overcoming all this is a process; no instant “exorcism” is equal to the task.
It is not surprising that many women—whether they are educated and have careers or not—still behave as if they’ve been “colonized.” Let’s not forget that in many countries the colonization is physical as well as psychological.
The image of women as colonized is a useful one. It explains why some women cling to their colonizers the way a child or a hostage clings to an abusive parent or captor; why many women blame themselves (or other women) when they are brutalized (she really wanted it, she freely chose it); and why most women defend their colonizers’ right to possess them (God or loyalty to one’s family demands it).
“Colonization” exists when the colonized has valuable natural resources that are used to enrich the colonizer, but not the colonized: when the colonized does the colonizer’s work, but earns little of the colonizer’s money; when the colonized try to imitate or please the colonizer, and truly believe that the colonizer is, by nature, superior/inferior, and that the colonized cannot exist without her colonizer.
Many women still believe that men are superior to women and that a woman is worthless without a man.
Like others who are colonized, women are often harder on themselves. Women expect a lot from each other—but rarely forgive another woman when she fails, even slightly. Women are emotionally intimate with each other but often tend to take that intimacy for granted.
Psychologically, seemingly contradictory things can be true. (Thank you Herr Doktor Freud). Women mainly compete against other women and women mainly rely upon other women; women envy and sabotage each other through slander, gossip, and shunning and women also want other women’s respect and support.
In Women and Madness, I described asylums as dangerous patriarchal institutions. This means that both male and female staff tormented female inmates. Tragically, such snakepits still exist in America today, in which patients are wrongfully medicated, utterly neglected, and psychologically and sexually abused.
On June 23, 1997, in Kansas v. Hendricks, the Supreme Court upheld the 1994 Kansas Sexually Violent Predator Act that allows the state to commit a sex offender to a mental asylum—perhaps indefinitely—until he can show “that he is no longer dangerous” nor subject to “irresistible impulses.” The decision stresses that such civil commitment is meant to provide “treatment, not punishment” and that “the conditions surrounding confinement do not suggest a punitive purpose … such restraint of the dangerously mentally ill has been h
istorically regarded as a legitimate non-punitive objective.”
If pedophiles and rapists are judicially deemed too dangerous to roam society’s streets, what does the Court believe such men might do to other inmates in state custody? Especially to male or female inmates who are child-like in size or mental abilities, and may in addition be sedated, strait-jacketed, physically disabled, deaf, blind, wheelchair-bound, or lobotomized?
Patients raped in psychiatric institutions have civilly sued for damages in many states, including California, Louisiana, Michigan, New York, Ohio, and Oregon.
In 1997, a case was certified as a class-action suit in the Nebraska Federal District Court. There were four named plaintiffs, ranging in age from nineteen to sixty-two, who had been variously diagnosed as mentally ill and/or developmentally disabled. They sued the highest-ranking officials of the state’s Department of Public Institutions. From July 1991 through July 1994, each of the four plaintiffs was raped, repeatedly, by the same three male patients at the Hastings Regional Center (HRC) in Nebraska. They each reported the rapes and beatings. The women asked for monetary damages and demanded structural changes in the way HRC operates.
Women who have been repeatedly raped in childhood—often by authority figures in their own families—are traumatized human beings; as such, they are often diagnosed as borderline personalities. If they are institutionalized, they are rarely treated as the torture victims they really are. On the contrary. In state custody, women are more, not less, likely to be raped again (and each time it is more, not less, traumatic). Instead of being trained to understand this, most institutional staff—psychiatrists, psychologists, nurses, and attendants alike—do not believe the rape victims, nor do they think of rape as a life-long trauma.
There is no excuse for subjecting twenty-first-century institutional inmates to the same awful conditions that existed in the nineteenth century. By this, I am referring to solitary confinement, restraints, unending physical and psychological cruelty, criminality unrestrained among the inmates by overworked or punitive staff.
Institutional psychiatry may fail us but madness still exists. I said so in 1972—but I also said that most women were not mad, merely seen as such. My own and other historical accounts of asylums strongly suggest that most women in asylums were not insane; that help was not to be found in doctor-headed, attendant-staffed and state-run institutions; that what we call madness can also be caused or exacerbated by injustice and cruelty within the family and society; and that freedom, radical legal reform, political struggle, and kindness are crucial to psychological and moral mental health.
Certain groups—who often disagree with each other—agree that institutional abuse does exist. Some antipsychiatry groups maintain that mental illness either does not exist or is not a medical illness; psychiatrists are not physicians in the same way that neurologists or cardiologists are; psychiatric medication is usually harmful, not helpful; psychiatrists continue to administer shock therapy and perform psychosurgery—even when it is harmful or ineffective; people are still institutionalized against their will or without informed consent.
Dr. David Cohen, associate professor and editor of Mind and Behavior, cites studies that suggest that despite de-institutionalization, involuntary commitments are as high now as they once were. He says, “Many persons are informally but effectively coerced, coerced by threats, are not aware of their legal status.” In Cohen’s view, the attempt to re-institutionalize the homeless as mentally ill “is similar to calls of a century ago by prominent figures to segregate America’s growing dangerous classes, or of twenty-five years ago to incarcerate heroin addicts in work camps and force methadone on them. Such reforms made things worse for the least powerful actors in the system.”
According to a survivor of institutional abuse, “I survived not only childhood abuse that initiated my involvement in the mental health system, but also the re-traumatization that occurred as a patient in five hospitals. I survived solitary confinement for two weeks, without clothing, and with only a rubber mattress and blanket. I survived four-point restraints, again without clothing, and the forced administration of devastating drugs.”
Similarly, another survivor says, “I survived forced electroshock, along with weeks of solitary confinement and restraint. High dosages of forced neuroleptic drugs gave me seizures. I was locked up for many months.”
According to Dr. Keith Hoeller, editor of the Review of Existential Psychology and Psychiatry, “The most dangerous political movement in America is the mental health movement. Family members pose as advocates for the so-called mentally ill, and are funded in part by the drug companies [one million dollars in 1995 alone]. The National Alliance for the Mentally Ill has succeeded in [their] desire to expand several state laws so that innocent American citizens can be incarcerated for reasons other than dangerousness to self and others.”
On the other hand, the family members and friends of people who suffer from schizophrenia or depression know that something is seriously “wrong” with a relative who can no longer eat or sleep, hears voices, can’t work, is afraid to leave the house, has become suicidal, verbally and physically aggressive, or homicidal. They see their family member suffer, and learn that they cannot help or even continue to live with them. Families of the mentally ill often see major improvements with psychiatric medication and psychotherapy and are, in fact, concerned about the right to treatment.
All these groups are important. Consumer education and legal action remain crucial in the struggle to humanize both institutional and noninstitutional life.
Often those who condemn institutional psychiatry, psychiatric medication, shock therapy—any kind of therapy-for-hire—do not feel responsible for the female casualties of patriarchy. Such critics, even if well intentioned, may 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.
So what did I mean when I said that quite a lot has changed in the last twenty-five years? For one thing, we’ve learned more about the genetic and chemical bases of mental illness. We’ve learned that those suffering from manic depression, panic and bipolar disorders, or schizophrenia often respond to the right drug at the right dosage level; that all drugs have negative side effects; that we shouldn’t prescribe the same drug for everyone especially without continually monitoring the side effects; and that verbal or other supportive therapies are often impossible without such medication.
Despite the progress in biological psychiatry, both women and men are still wrongfully or overly medicated—or denied proper medication—by harried low-fee/high-fee psychiatrists and psychopharmacologists. Psychiatric inpatients are often overly medicated for the convenience of staff, who do not always treat the to-be-expected side effects with compassion or expertise.
As bad as many institutions are, turning the mentally ill loose, into the streets, is not the solution; it is merely another unacceptable alternative. People do have a right to treatment, if that treatment exists. I realize this statement is almost laughable today, given how insurance and drug companies, managed care and government spending cuts have made quality psychotherapy totally out of reach for most people. This means that just when we know what to do for the victims of trauma, there are very few teaching hospitals and clinics that treat poor women in feminist ways.
Medication by itself is never enough. Women who are clinically depressed or anxious also need access to feminist information and support.
What does a feminist therapist do that’s different? A feminist therapist tries to believe what women say. Given the history of psychiatry and psychoanalysis, this alone is a radical act. When a woman begins to remember being sexually molested as a child, a feminist does not conclude that the woman’s flashbacks or hysteria prove that she’s lying or crazy.
A feminist therapist believes that a woman needs to be told that she’s not crazy; that it’s normal to feel sad or angry about being overworked, u
nderpaid, underloved; that it’s healthy to harbor fantasies of running away when the needs of others (aging parents, needy husbands, demanding children) threaten to overwhelm her.
A feminist therapist believes that women need to hear that men “don’t love enough” before they’re told that women “love too much”; that fathers are equally responsible for their children’s problems; that no one—not even self-appointed feminist saviors—can rescue a woman but herself; that self-love is the basis for love of others; that it’s hard to break free of patriarchy; that the struggle to do so is both miraculous and life-long; that very few of us know how to support women in flight from—or at war with—internalized self-hatred.
A feminist therapist tries to listen to women respectfully, rather than in a superior or contemptuous way. A feminist therapist does not minimize the extent to which a woman has been wounded. Nevertheless, a feminist therapist remains resolutely optimistic. No woman, no matter how wounded she may be, is beyond the reach of human community and compassion.
A feminist therapist does not label a woman as mentally ill because she expresses strong emotions or is at odds with her feminine role. Feminists do not view women as mentally ill when they engage in sexual, reproductive, economic, or intellectual activities outside of marriage. They do not pathologize women who have full-time careers, are lesbians, refuse to marry, commit adultery, want divorces, choose to be celibate, have abortions, use birth control, choose to have a child out of wedlock, choose to breast-feed against expert advice, or expect men to be responsible for 50 percent of the child care and housework. Women have lost custody of their children for these very reasons—pronounced unfit by courtroom psychiatrists, psychologists, or social workers.
Some feminist theorists and therapists have been moved by the radical liberation psychology in Women and Madness. They agree that women’s control of our bodies is as important as sexual pleasure, and that we must be able to defend “our bodies, ourselves” against violent or unwanted invasions—like rape, battery, unwanted pregnancy, or unwanted sterilization.
Women and Madness Page 4