Women and Madness

by Phyllis Chesler

  Christian religious communities continue to preach abstinence, celibacy, and sex within marriage only. Muslim religious communities continue to allow polygamy, concubinage, female genital mutilation, and slavery, including sexual slavery. Jewish religious communities outlawed polygamy nearly a thousand years ago, but do not punish men who routinely visit prostitutes or have girlfriends. Religious Jewish women can be divorced, lose custody of their children, and be ostracized by their communities for having an affair—or even for being accused of doing so.

  Although homophobic bias certainly still exists, in the three decades since I wrote Women and Madness, mental health professionals decided that homosexuality, bisexuality, and lesbianism are not psychiatric illnesses and that in some instances transsexual surgery might alleviate suffering. They have a better understanding of incest, rape, and pedophilia for which there is no known cure. They also understand that many male sexual predators have themselves been physically and sexually traumatized in childhood, mainly by their fathers.

  Teenage girls still have difficulties achieving orgasm, as do some women. Sexually traumatized women, especially in war zones, and horrifically persecuted women, especially in the Islamic world, routinely kill themselves.

  Suicide Attempts

  I have done it again.

  One year in every ten

  I manage it—

  ……………………..

  Dying

  Is an art, like everything else.

  I do it exceptionally well.

  I do it so it feels like hell.

  I do it so it feels real.

  I guess you could say I’ve a call.

  It’s easy enough to do it in a cell.

  It’s easy enough to do it and stay put

  It’s the theatrical

  Comeback in broad day

  Sylvia Plath22

  In the past, men commited actions; women commited gestures. Both sexes were imprisoned by separate vocabularies. “Manfully,” men kill themselves, or others—physically. Women attempt to kill themselves physically far more often than men do, and fail at it more often. Suicide is not an apolitical occurrence: the politics of caste (sex and race) shape American patterns of suicide. One study found that sixty-nine percent of attempted suicides in America are female and, conversely, that seventy percent of completed suicides are male.23 They also found that housewives comprised the largest single category of both “attempted and completed suicides” and, further, that about five times as many widows commit suicide as attempt suicide (twenty percent vs. four percent). Twice as many widowers commit suicide as attempt suicide (six percent vs. three percent). A government pamphlet entitled Suicide Among Youth documented that attempted suicide is far more frequent among student-age females than males but that student-age males complete more suicides.24 Nonwhite males between fifteen and twenty-five have the highest suicide commitment rate.

  Physical action—even the exquisitely private act of taking one’s own life—is very difficult for women. Conditioned female behavior is more comfortable with, and is defined by, psychic and emotional self-destruction. Women are conditioned to experience physicality—be it violent, destructive, or pleasurable—more in the presence of another, or at male hands, than alone or at (their own) female hands. Female suicide attempts are not so much realistic “calls for help” or hostile inconveniencing of others as they are the assigned baring of the powerless throat, signals of ritual readiness for self-sacrifice. Like female tears, female suicide attempts constitute an essential act of resignation and helplessness—which alone can command temporary relief or secondary rewards. As we have noted, however, women who try to kill themselves are not necessarily treated very kindly. Suicide attempts are the grand rites of “femininity”—i.e., ideally, women are supposed to “lose” in order to “win.” Women who succeed at suicide are, tragically, outwitting or rejecting their “feminine” role, and at the only price possible: their death.

  SCHIZOPHRENIA IN THREE STUDIES

  It is important to realize that schizophrenia, or madness, is crucially different from female symptoms such as depression or anxiety. Schizophrenia, in both women and men, always involves opposite as well as same-sex behavior. For instance, female schizophrenics are more openly hostile or violent, or more overtly concerned with sexual and bisexual pleasure, than are female “depressives.” Both groups of women still share many “feminine” traits such as mistrusting their own perceptions, feeling inferior, helpless, and dependent. Just as schizophrenia is no entree into power for women, neither are “female” diseases such as depression, promiscuity, paranoia, eating disorders, self-mutilation, panic attacks, and suicide attempts. Such “disorders,” whether hospitalized or not, constitute female role rituals, enacted by most women. As we shall see, whether and what kind of “treatment” is afforded these rituals is a function of age, class, and race.

  Thirty-forty years ago psychologists discussed “schizophrenia” in a very interesting way: in terms of sex-role alienation or sex-role rejection. Dr. Shirley Angrist compared female ex-mental patients who were returned to asylums with those who weren’t.25 She found that the rehospitalized women had refused to function “domestically” in terms of cleaning, cooking, child care, and shopping. The rehospitalized women were no different from the ex-mental patients in terms of their willingness to participate in “leisure” activities, such as traveling, socializing, or enjoying themselves. The rehospitalized women were, in Angrist’s terms, slightly more “middle class and more frequently married than their non-returned counterparts.” Further, the husbands who readmitted their wives expressed significantly lower expectations for their total human functioning. They seemed more willing to tolerate extremely childlike and dependent behavior in their wives—such as incessant complaining and incoherence—as long as the dishes were washed. These husbands also expressed great alarm and disapproval about their wives’ “swearing,” “cursing,” and potentially violent “temper tantrums.”

  Dr. Angrist published a book, entitled Women After Treatment, in which she compared both early and late “returnees” with “normal” or housewife female controls.26 A double standard of mental health accounts for such methodological and ideological practices as defining the “normal” woman as the “unemployed” housewife. Angrist found that the original differences between returned and non-returned women in the domestic performance area had completely disappeared. All “returned” women and all female ex-mental patients performed more poorly domestically than did “normal” housewives. In a further refinement of her data, in which she controlled for educational level, age, race, and social and marital status, these differences in domestic performance were eliminated. The differences between ex-mental patients and “normal” housewives were now in the “psychological” area—at least according to Angrist’s informant-observers. Ex-patients, whether they were rehospitalized or not, swore more often, attempted aggressive acts more frequently, got drunk, did not want to “see” people, and “misbehaved sexually”—behaviors considered more “masculine” than “feminine.” However, the ex-patients also exhibited many “feminine” behaviors, such as fatigue, insomnia, pill-taking, and general “inactivity.”

  It is interesting to note that both ex-patients and housewives equally displayed certain behaviors—behaviors which are negatively viewed. Angrist notes:

  [It was surprising] that so many of the controls [the normal housewives] were reported to have evidenced similar behavior as the ex-mental patients. Forty-six percent were described as restless; fifty-nine percent as worn out; sixty percent as tense and nervous; fifty-seven percent as “grouchy.”

  The husbands and mothers of both groups of women described them as

  making no sense when talking; walking, sitting, or standing awkwardly; moving around restlessly; saying she hears voices; trying to hurt or kill herself; needing help in dressing; being bad tempered; not knowing what is going on around her; saying she sees people who aren’t there.


  Dr. Frances Cheek published a compelling study entitled “A Serendipitous Finding: Sex Role and Schizophrenia.”27 She compared male and female “schizophrenics” between the ages of fifteen and twenty-six with their “normal” counterparts, expecting to find a classic profile of schizophrenic passivity, withdrawal, and emotionally constrained behavior. Dr. Cheek observed and rated a mainly verbal patient-parent interaction. The task behavior that Dr. Cheek rated as “dominant” or “aggressive” involved opinion-giving or clarification of the subject being discussed. She found that female schizophrenics were more dominant and aggressive with their parents than were female—or male—normals or male schizophrenics. (This information was obtained in a private communication.) The male schizophrenics presented a more “feminine” (or schizophrenic) pattern of passivity, more so than schizophrenic females and normal males.

  It is important to note that the male schizophrenics were still very similar to normal males in the expression of negative social-emotional behavior, such as expression of hostility and disagreement. For example, the male ex-mental patients involved in various Mental Patients Liberation Projects are aware—and troubled by their excessive hostility and/or indifference to women. The female schizophrenics were less “negative” emotionally than were female or male normals or male schizophrenics. Nevertheless, female schizophrenics were perceived by both their parents as the “least conforming” of all the groups. Their parents remembered them as unusually “active” (for girls?) during childhood. This reference to “activeness” may not refer as much to physical or aggressive behavior as to perceptual, intellectual, or verbal behavior. Perhaps it was this rather specific rejection of one aspect of the female role that caused family conflict, and ultimately led to psychiatric labeling and incarceration.

  Dr. Cheek refers to an earlier study done by Letailleur, in which he suggests that “the overactive dominating female and the underactive passive male are cultural anomalies and are therefore hospitalized.”28 The “passive” female schizophrenic is probably not hospitalized at so early an age, any more than is the “active” male schizophrenic. Letailleur thinks that the “role reversal” is a function of the disease process. I think that what Cheek calls the role “reversal” or “rejection” is what is labeled “crazy,” or is, partly, what the disease is about. However, I do not think “role rejection” is the appropriate term. The male schizophrenics were similar in many ways to normal males; the female schizophrenics were similar to—or even more “female” than—the “normal” females. Sex-role alienation is probably a better term—and is the exact phrase used by Drs. David McClelland and Norman Watt in their study.29

  McClelland and Watt compared twenty male and twenty female hospitalized schizophrenics between the ages of twenty and fifty with a number of “normal” control groups: “employed” males and females and “unemployed” housewives. The study measured conscious attitudes and preferences, attitudes to one’s own body, fantasy and storytelling patterns, and preferences for abstract geometric figures. (Most of these measures had previously been standardized among “normal” populations, and clear sex differences had emerged.) The researchers found a general pattern of more “masculine” test behavior among female schizophrenics and more “feminine” test behavior among male schizophrenics.

  There are many methodological criticisms to be made of this study; however, I think that the study’s findings are essentially correct. For example, female schizophrenics significantly favored the “intruding” and “penetrating” abstract geometric figures, usually preferred by normal males; female schizophrenics were significantly less “nurturant” and “affiliative” than normal female controls—but, in this regard, were no different from either normal or schizophrenic males; female schizophrenics chose “male” roles in imaginary plays: they preferred being “devils” to “witches,” “policemen” to “secretaries,” “bulls” to “cows.” Unfortunately, McClelland doesn’t make much of the fact that, to a great extent, the housewife control group preferred to play opposite-sex roles in this imaginary play. When shown a picture of a bull in a bullring, female schizophrenics evidenced “normal” male reaction—i.e., they said they would kill the bull. Male schizophrenics reacted as “normal” women and said they would flee the bullring.

  Perhaps this study’s most significant finding concerned satisfaction or dissatisfaction with various body parts, such as lips, face, elbows, body hair, hands, etc. Female schizophrenics were significantly less sensitive to their “feminine” appearance than were either normal female or male schizophrenics. (As we shall see in Chapter Three, this lack of concern has dire consequences for female mental patients in terms of releasing them from asylums.) In fact, sixty-nine percent of the female schizophrenics compared with fifty percent of the male normals were “satisfied” with their male or “strength” body parts. This should be compared with Cheek’s finding that female schizophrenics were more “dominant” (verbally) than male normals. McClelland and Watt do not always compare female schizophrenic performance to male normal performance. It is therefore difficult to evaluate how much female schizophrenics are “threatening” because they have not only deserted certain posts of the “feminine” role but have adopted certain “masculine” posts even more boldly than normal men. It is important to note that male schizophrenics were as “satisfied” with their male body parts as were male normals: they were simply more “satisfied” with their feminine or appearance body parts than normal males were. Female schizophrenics were relating to their bodies—at least verbally, in fantasy, or during a test—in a more recognizably “male” fashion. McClelland and Watt feel that concern with the body is a “primary and unconscious mode of expressing identity” and predates more secondary sex-role reversal behaviors, such as female wage-labor “employment” or “intellectual assertiveness.”

  The researchers are confused by the greater schizophrenic female than male “indifference” to all parts of their bodies.

  By itself such indifference might be attributable to long hospitalization but this explanation would not account for the differential results for the schizophrenic males. It seems plausible to conclude that some parts of the schizophrenic woman’s unconscious self-image is insensitive and more masculine, whereas some part of the schizophrenic man’s self-image is sensitive and more feminine. Whether this difference predates their entry to mental hospitals is a question for further research.

  Most women, while morbidly concerned with their “appearance,” are actually quite removed from their bodies in terms of either “satisfaction,” “confidence,” or “activity.” It is not surprising to find a continuation of this among female schizophrenics—who are, after all, “females.” More important, however, is the fact that the essentially female nature of psychiatric confinement is, in a certain sense, more enraging to women—who have already been through it and been driven “mad” by it—than to men. If asylums are where you go for being alienated from your sex role, then you might as well act out that alienation as much as possible; there is nowhere else to do so. It is not surprising, therefore, that female psychiatric wards have been characterized as generally “noisier” than male wards30; as more “excitable” than the “apathetic” male wards31; as dominated by more mood swings, more belligerent, bossy, and interpersonally disruptive behavior32; and as more potentially “violent” than male wards.33 What we must remember, however, is that such “masculine protests” are both ineffective and effectively punished, and are ultimately self-destructive. Patients on female wards have also been characterized as generally unable to make effective decisions, or to reason abstractly, and have been characterized by a marked lack of “ego strength.”34 Such traits often characterize long-term psychiatric patients and may, indeed, also be a function of hospitalization.

  Today, many schizophrenics are ambulatory, homeless, or living at home. Drugs (if taken) can often control the “voices,” nightmares, insomnia, super-aggressiveness, suicidal and homicidal ideation. Often, t
he drugs have extremely unpleasant and humiliating side-effects. Frequently, patients stop their medication—and the descent into schizophrenia or bi-polar disorders begins again.

  In my opinion, short-term hospitalizations, if they are not abusive, are often necessary to adjust or change medication, or for detoxification purposes.

  A THEORETICAL PROPOSAL

  Neither genuinely mad women, nor women who are hospitalized for conditioned female behavior, are powerful revolutionaries. Their insights and behavior are as debilitating (for social reasons) as they are profound. Such women act alone, according to rules that make no “sense” and are contrary to those of our culture. Their behavior is “mad” because it represents a socially powerless individual’s attempt to unite body and feeling. For example, Valerie Solanas, the author of The Scum Manifesto and the woman who shot Andy Warhol, the filmmaker, was considered both “crazy” and a “criminal” for acting on what many people are content simply to “name” and verbally criticize: the existence of misogyny in patriarchal culture and, in her case, the exploitation of female talent.

  Perhaps what we consider “madness,” whether it appears in women or in men, is either the acting out of the devalued female role or the total or partial rejection of one’s sex-role stereotype. Women who fully act out the conditioned female role are clinically viewed as “neurotic” or “psychotic.” When and if they are hospitalized, it is for predominantly female behaviors such as “depression,” “suicide attempts,” “anxiety neuroses,” “paranoia,” eating disorders, self mutilation, or “promiscuity.” Women who reject or are ambivalent about the female role frighten both themselves and society so much so that their ostracism and self-destructiveness probably begin very early. Such women are also assured of a psychiatric label and, if they are hospitalized, it is for less “female” behaviors, such as “schizophrenia,” “lesbianism,” or “promiscuity,” “Promiscuity,” like “frigidity,” is both a “female” and a “non-female” trait: either can mean a flight into or a flight from “femininity.”