Men who act out the female role and who, for example, are “dependent,” “passive,” sexually and physically “fearful,” or “inactive,” or who, like women, choose men as sexual partners, are seen as “neurotic” or “psychotic.” If they are hospitalized they are usually labeled as “schizophrenic” or homosexual. It is important to note, however, that men in general are still able to reject more of their sex-role stereotype without viewing themselves as “sick,” and without being psychiatrically diagnosed or hospitalized, than are women. Women are so conditioned to need and/or to service a man that they are more willing to take care of a man who is “passive,” “dependent,” or “unemployed”—than men are willing to relate to, no less take care of, a “dominant,” “independent,” or “employed” woman. What this means is that clinically “depressed” or “suicidal” females who do not serve men (or husbands) are as often rejected by them, and thereby subjected to relative poverty, or illegal and life-threatening prostitution, as are clinically “schizophrenic” or “hostile” females. Married men seek psychiatric help less frequently and remain in asylums for shorter time periods than do married women or single men.35 Homosexuals, although psychiatrically “labeled” and legally persecuted, seek help less frequently than lesbians do and, like male schizophrenics, still exhibit fewer (devalued) female traits than do lesbians or female schizophrenics.36
Men who act out the male role—but who are too young, too poor, or non-white—are usually incarcerated as “criminals” or as “sociopaths,” rather than as “schizophrenics” or “neurotics.” In order to be “men,” less powerful men in our society have to “steal” what more powerful men can “buy.” (And they are punished for doing so.) The kinds of behaviors that are considered “criminal” and “mentally ill” are sex-typed. They are also typed by race and class, and each sex is conditioned accordingly. Psychiatric categories themselves are sex-typed. Many more women than men manifest, seek help, and are hospitalized for what we categorize as a “psychiatric disease.” It is important to know what type of clinical treatment these psychiatric patients receive; how many clinicians there are, the theories on which the clinicians draw, and how these psychiatrists and psychologists view their patients.
CHAPTER THREE
THE CLINICIANS
I met Wilhelm Reich in October 1939 shortly after his arrival in the States. I became his wife, secretary, laboratory assistant, bookkeeper, housekeeper, and general factotum, soon thereafter, the mother of his son in 1944…. I had to continue my work, which at that time and place consisted mainly of typing Reich’s manuscripts. I also had to take care of the baby. I remember well typing away at a manuscript while pushing the carriage back and forth with one foot to keep the baby quiet because Daddy could not bear to hear him cry. Or Reich, very graciously telling me in the late afternoon to take off for a while and go fishing out on the lake while he would look after the baby, then after half an hour, his waving to me frantically because the baby needed to be changed, an ordeal which he could not face.
Ilse Ollendorf Reich1
At home [Freud’s] family revolved around him and his work…. “I am afraid I do have a tendency toward tyranny” he admitted more than once…. Unlike his success with adopted [intellectual] daughters, Freud had trouble with all his “sons” in psychoanalysis. Especially for men, working for such a genius could be very frustrating: it was bound to offend a man’s sense of autonomy…. [Helene Deutsch’s] career seems to contradict the Freudian theories of femininity which she expounds in her book. Far from being clinging and dependent, as a psychiatrist she was both active and independent, yet toward Freud and his concepts, which she did so much to make popular, Helene remained passive and receptive…. [Freud psychoanalyzed Deutsch’s] “Oedipal situation” [and told her to continue her “identification” with her father—and with himself].
Paul Roazan2
Freud was merely a diagnostician for what feminism purports to cure … a thorough restatement of Freud in feminist terms would make a valuable book.
Shulamith Firestone3
The Women’s Liberation Movement cannot afford to indulge the bad poetry about women, when we have a science we can use, explore, criticize, amend. For psychoanalysis, like all sciences, is open, not closed.
Juliet Mitchell4
By an irony nearly tragic, the discoveries of a great pioneer [Freud], whose theories of the unconscious and of infant sexuality were major contributions to human understanding, were in time invoked to sponsor a point of view essentially conservative … the effect of Freud’s work, that of his followers, and still more that of his popularizers was to rationalize the invidious relationship between the sexes, to ratify traditional roles, and to validate temperamental differences…. Although the most unfortunate effects of vulgar Freudianism far exceeded the intentions of Freud himself, its anti-feminism was not without foundation in Freud’s own work.
Kate Millett5
PSYCHIATRISTS AND PSYCHOLOGISTS are no more misogynist than politicians, soldiers, poets, physicists, or bartenders are. However, they are no less so—despite their rather special concern with and power over individual women. We owe our familiarity with feminine “hysteria,” as well as our ambivalence about whether such behavior is universal and “normal,” or universal and “abnormal,” to such scientific fathers and mothers. I do not think that any one social or professional group is “responsible” for or can change the entire fabric of social reality, although at a given moment, each group or individual threads its way rather unalterably through it. I do believe that individual exceptions exist, and are valuable, as well as limited to those individuals involved. Individual exceptions are also irrelevant to any understanding of the rules or forces to which they take exception.
In this chapter, I would like to present some general facts about clinicians:
(1)The extent to which the professions of psychiatry and psychology in America are numerically dominated by men.
(2)The extent to which most contemporary female and male clinicians, whether they are disciples of a particular psychoanalytic or psychological theory or not, currently share and act upon traditional myths about “abnormality,” sex-role stereotypes, and female inferiority.
(3)The extent to which most traditional psychoanalytic and therapeutic theories and practices perpetrate certain misogynistic views of women and of sex-role stereotypes as “scientific” or “curative.”
(4)The extent to which both modern and traditional ideologies are played out within the institution of private therapy, which is, like that of the mental asylum, a mirror of the female experience in patriarchal culture.
HOW MANY CLINICIANS ARE THERE IN AMERICA?
Clinicians, like ghetto schoolteachers, do not study themselves or publicize their own motives, personalities, and values as easily or frequently as they do those of their neurotic patients or “culturally deprived” pupils. Most clinicians are too busy, too unwilling, or too “important” to fill out questionnaires or be experimental subjects. The response of psychiatrists and psychologists to questionnaire inquiries is generally rather low; they are not willing subjects and they are often too busy to do so.6 Nevertheless, the major professional organizations do publish membership lists; government research bureaus do publish estimates of psychiatric hospital staffing patterns; psychologists and psychiatrists have published studies about their profession’s attitudes, behaviors, and “personal” lifestyles; psychoanalytic theorists and clinicians have published their case histories and theories; their disciples have often published their biographies.
In the past, the membership of the American Psychiatric Association totaled 11,083, of whom 10,100 were men and 983 were women. Over time, their membership increased to 17,298, of whom 14,267 were men and 1,691 were women. (The sex of 1,340 names on the membership list is unclear.) Thus, ninety percent of all psychiatrists during the 1960s and 1970s were men. It is important to remember that psychiatry is the most powerful of the mental illness professions,
in terms of prestige, money, and ultimate control over psychiatric policies, both in private practice and in mental hospitals. Psychiatrists, both medically and legally, decide who is insane and why; what should be done to or for such people; and when and if they should be released from treatment. (As we shall see, both their medical training and their legal responsibility predispose most psychiatrists to diagnose ‘“pathology” everywhere—even, or especially, where non-experts are blind to it.)
I italicized the word “ultimate” above because, powerful as psychiatrists are, there are far too few of them to carry out their opinions in all psychiatric wards at every moment. For example, years ago, the National Institute of Mental Health conducted a survey of staffing patterns in transitional mental health facilities.7 Based on a sample, they documented that psychiatrists comprise no more than five percent of the staff—and that the majority of them are employed on a part-time basis. Sixty-eight percent of the full-time and thirty-seven percent of the part-time staff in these facilities are “non-professionals.” Social workers constitute ten percent of the full- and part-time staff; psychologists comprise about two percent of the staff. In community mental health facilities, psychiatrists were seen as constituting fourteen percent of the staff involved in consultation and education.8
Within mental asylums, most psychiatrists function as well-paid administrators whose minimal and prima donna presence lends a paternal air of scientific and legal efficiency. Their will will be done—even in their absence. The non-professional staff is influenced by their “expert” views which, after all, are not very different from the supposedly less enlightened views and practices of social workers, nurses, dieticians, and orderlies. (Also, since the less prestigious hospital professionals are mainly women, there is a conditioned and much reinforced tendency to serve, please, and second-guess the male psychiatrist before he even makes his judgment known.)
In the past, the American Psychological Association totaled 18,215 members. This increased to 30,839 members. This Association does not publish an accurate sex-ratio count of their members but, in a personal communication, estimated that twenty-five percent are women. (Personal communication from Ms. Jane Hildreth, American Psychological Association Membership Office.) This would mean that approximately 4,580 women in the 1960s and 7,500 women in the 1970s were psychologist-members at all levels of “expertise.” We must remember that not all psychologists are clinicians. Many teach and/or do research—exclusively. (Most psychiatrists combine their research or teaching with clinical responsibilities in both hospital and private settings.) In any event, however many clinical psychologists there are, they occupy positions subordinate to psychiatrists, especially within the hospital hierarchy. I would estimate that women have comprised fifteen percent of all clinical psychologists and that they, together with female psychiatrists, comprise no more than twelve percent of America’s two most powerful clinical professions.
Today, as I’ve noted in the 2005 introduction, more women have joined the ranks of psychiatry and psychology; many are feminists, many are not. As I’ve also noted in the new introduction, like male mental health professionals, women have also internalized sexist views and are not always mindful about it.
Feminist thought has influenced many clinicians but an even greater number have remained immune to it or are phobic about feminism.
Of course, there are more clinicians in America, both male and female, than are listed as members of the American Psychiatric and Psychological Associations. The number of lower-“ranking” clinicians has increased tremendously during the last decades, and include degreed and non-degreed social workers, lay analysts, behavior therapists, traditional and anti-traditional and/or encounter group specialists, marriage and family counselors, school and vocational counselors, and “trained” and “untrained” paraprofessionals involved in community mental health and drug addiction projects. All such clinicians are subordinate to and take their cues from psychiatrists and psychologists. The male-female ratio is probably more equal in some of these professions—and to less avail. Predictably enough, these women are disproportionately involved in “women’s work” within the profession: they see préadolescent children and women. “Troubled” male adolescents are usually referred to male therapists for fatherly role-modeling; and adult males—as well as females—prefer male therapists.9
Today, whether there are more female or feminist-oriented clinicians is not as important as whether insurance will or will not cover treatment, including psychotherapy, medication, and hospitalization for indigent or working poor patients. Hospital wards are overcrowded, there are never enough beds, people in need are either not admitted or are quickly discharged. While on the ward, few patients get high quality or any expert attention.
Some time ago, Dr. William Schofield sent basic information questionnaires to randomly selected practitioner members of the American Psychiatric and Psychological Associations, and to the National Association of Social Workers.10 Complete returns were obtained from 140 psychiatrists, 149 psychiatric social workers, and 88 clinical psychologists. He found that clinical psychologists were predominantly male, in a ratio of two to one; that ninety percent of the psychiatrists were male; and that social workers (the least prestigious and well-paying of the three professional groups) were predominantly female, in a ratio of two to one. He also found that the psychiatrists and psychologists were about the same age (an average of forty-four), and were married. (Two percent of the psychiatrists and ten percent of the psychologists were divorced.) Both the psychiatrists and psychologists had backgrounds that Schofield characterized as containing “pressure toward upward social mobility.” Also, of those psychiatrists and psychologists who expressed a preferred sex in their “ideal” patient, the majority “preferred” a young, attractive female patient—with no more than a B. A. degree. Perhaps this preference makes good sense. A male therapist (whose “masculinity” is already somewhat compromised by his involvement in a “soft” and “helping” profession) may receive a real psychological “service” from his female patient: namely, the experience of controlling and feeling superior to a female being upon whom he has projected many of his own forbidden longings for dependency, emotionality, and subjectivity, and from whom, as a superior expert, as a doctor, he is protected as he cannot be from his mother, wife, or girl friend. There are other reasons for this preference which I will discuss later.
It is obvious that a predominantly female psychiatric population in America (see Chapters Two and Four) has been diagnosed, psychoanalyzed, researched, and hospitalized by a predominantly male professional population. Despite individual differences among clinicians, most have been steeped, professionally and culturally, in both contemporary and traditional patriarchal ideologies—ideologies which they put into some sort of practice within a patriarchal institution, such as private therapy or the mental asylum.
Before reviewing some traditional psychological and psychoanalytic theories and practices regarding sex roles and women, I’d like to review some studies about what clinicians classically believed and practiced—regardless of what kind of traditional ideologies they may have been taught.
CONTEMPORARY CLINICAL IDEOLOGY
Most contemporary professionals (like most non-professionals) unthinkingly consider what happens to men as somehow more important than what happens to women. Although men are less diagnosed than women are, male psychiatric illness or “impairment” is viewed as more “disabling” than female illness. The ghost of female expendability and “outsiderness” haunts almost every page of psychiatric and psychological journals—even when the subject of the article is female illness. Fewer (male) “virtues” are expected of women: it is not catastrophic or even surprising when they don’t manifest any—even though their absence is both socially devalued and psychiatrically diagnosed as neurosis or psychosis.
In the 1960s and 1970s, women as subjects remained quite literally “outside” of many psychological experiments, particularly in learni
ng or achievement-motivation: female performance proved too variable or too “minimal” to yield up the manly and publishable phenomena being sought.11 Women—even the college sophomore subject—constituted a troublesome “error” or “noise” factor which must be excluded. Unfortunately, the results of just such experiments were accepted as the standards for normal learning or “performance,” standards which, by definition, women could not achieve.
Let me remind us that some of this has changed. (See the new 2005 introduction.) As I said, more studies about female psychology have been done in the last thirty to thirty-five years. And, as we have seen, such studies have not always made it into the undergraduate, graduate, medical, law, and divinity school curricula. An academic and cultural phobia about feminist approaches to mental health have prevailed—especially at the most elite universities.
Thus, the struggle to disseminate sophisticated, relevant, and often life-saving or life-enhancing feminist research and clinical practices still continues.
The classical clinical research literature documents, challenges, and is guilty of certain biases shared by most practicing clinicians. I would like to discuss five major biases—all of which I have been “taught” either directly or indirectly, in my training as a psychologist.
Women and Madness Page 14