Women and Madness

by Phyllis Chesler

  Twentieth-century mental patients are not burned at the stake or subjected to the “water ordeal”—in which a witch’s “innocence” was established if she drowned. Many mental patients are sexually and physically assaulted; their earning capacity (as wives or in other capacities) is even more seriously damaged than a criminal inmate’s; their property and money are handed over to their husbands or children when they are declared “insane and incompetent”; like witches, they are publicly and constantly humiliated, and made to “confess” their sexual and other wrongdoings. While all of their body hair is not shaved off in a search for the “Devil’s mark,” many (male) mental patients are close-shaved and both male and female patients are kept short-haired and “anonymous”-looking, in regulation hospital-prison clothing.

  Szasz notes the similarity of zeal with which inquisitors and psychiatrists hunt and classify (or diagnose) witches and mental patients. (I have rarely heard of a psychologist diagnosing “normality” or “health” on the basis of projective test results; even more rarely have I heard of a psychiatrist presenting a “healthy” case history at a hospital staff meeting.) Armed with a fearful knowledge of illness and sinfulness, both the Holy Father (the Inquisitor) and the Scientific Father (the psychiatrist) are interested in saving female souls. Their methods: confession, recantation, and punishment. Of course, modern psychiatrists would not think that “helping” an “unhappy” woman accept her feminine role is at all similar to “helping” a witch return to Christ.

  Szasz is a provocative and political thinker, with a strong commitment to civil liberty, and a highly developed moral sensibility. I do not agree with him that private therapy is either very “private” or that it is necessarily freed from a variety of social abuses. Nor do I believe that madness does not exist. I agree that madness can be understood in terms of oppression and conditioning, but I am not sure our understanding alone will be enough to change what oppression has wrought—in our lifetime. Szasz is certainly right when he concludes that our treatment of “madness” is itself unethical and oppressive. However, I think he underestimates the deeply conditioned nature of woman’s compliance with her literal and psychological self-sacrifice. Many female mental patients view themselves as “sick” or “bad” and commit themselves, quite voluntarily, to asylums or to private psychiatrists. The fear of economic, physical, and sexual deprivation or punishment teaches women to value their own sacrifice so highly that they quite “naturally” perform it. And if their anger about this natural self-sacrifice drives them “mad,” asylum practices will exact their sacrifice anyway.

  The “revolutionary,” contemporary, and traditional ideologies and practices I’ve discussed thus far all subscribe to a double standard of mental health and/or to many patriarchal myths about “femininity.” As I’ve mentioned earlier, not every American clinician necessarily believes or acts upon all of these beliefs. However, he or she probably believes a good many. Further, all clinicians are involved in the institution of private practice—an institution which, like a mental asylum, is structurally modeled upon that of marriage and the patriarchal family.

  THE INSTITUTIONAL NATURE OF PRIVATE THERAPY

  A great deal has been written about the covertly or overtly patriarchal, autocratic, and coercive values and techniques of psychotherapy. Freud believed that the psychoanalyst-patient relationship must be that of “a superior and a subordinate.”45 The psychotherapist has been seen, by his critics as well as by his patients, as a surrogate parent (father or mother), savior, lover, expert, and teacher—all roles that foster “submission, dependency, and infantilism in the patient: roles that imply the therapist’s omniscient and benevolent superiority and the patient’s inferiority. Thomas Szasz has remarked on the dubious value of such a role for the patient and the “undeniable” value of such a role for the “helper.”46 Practicing psychotherapists have been criticized for treating unhappiness as a disease (whenever it is accompanied by an appropriately high verbal and financial output); for behaving as if the psychotherapeutic philosophy or method can cure ethical and political problems; for teaching people that their unhappiness (or neurosis) can be alleviated through individual rather than collective efforts (or can’t be alleviated since the human condition is “tragic”); for encouraging and legitimizing the tendency toward moral irresponsibility and passivity; and for discouraging emotionally deprived persons from seeking “acceptance, dependence, and security in the more normal and accessible channels of friendship.”47 The institution of psychotherapy can also be viewed as a form of social and political control that offers those who can pay for it temporary relief, the illusion of freedom, and a self-indulgent form of self-knowledge; and as an institution that punishes those who cannot pay for such illusions by being forced to label their unhappiness as psychotic or dangerous, thereby helping society consign them to asylums.

  The institution of private therapy is a patriarchal one—regardless of whether the individual clinician is female or male. As such, most clinicians are no more divinely inspired or in touch with their own emotions than anyone else is in our culture. Our culture’s criteria for an “expert” are the same for engineers and soul-healers: objectivity, rationality, impersonality. Clinicians, with rare and feared exceptions, are not oracles, priestesses, prophets, or tribal shamans. They do not make personal intercessions for their patients with the unknown or with the unconscious. As scientists, they probably do not believe in the “unknown,” or, if they do, wish to conquer it. Clinicians are more respected and trusted by their teachers, colleagues, and patients if they remain unavailable and impersonal. Unfortunately, some male clinicians who agree with such a critique have sometimes gotten involved in self-revelatory and “touching” or sexual behaviors with their patients. Given our culture, such behaviors are especially abusive to their female patients.

  Traditionally, any analysis or comparison of private therapy with mental asylums would be a class-based one. Poor people are hospitalized; middle- and upper-class people are not; or are hospitalized privately for a shorter time; or have access to private treatment. Nevertheless, with the increase in psychiatric outpatient clinics, community mental health centers, and “therapeutically” oriented case work in social agencies and schools, poor and people of color, especially women, are experiencing more contact with some of private therapy’s practices and ideas. Many more women than men are involved in private therapy, both as private and as clinic outpatients.

  For most women (the middle-class-oriented), psychotherapeutic encounter is just one more instance of an unequal relationship, just one more opportunity to be rewarded for expressing distress and to be “helped” by being (expertly) guided or dominated. Both psychotherapy and white or middle-class marriage isolate women from each other; both emphasize individual rather than collective solutions to women’s unhappiness; both are based on a woman’s helplessness and dependence on a stronger male authority figure; both may, in fact, be viewed as re-enactments of a little girl’s relation to her father in a patriarchal society; both control and oppress women similarly—yet, at the same time, are the two safest (most approved and familiar) havens for middle-class women in a society that offers them few—if any—alternatives.

  Both psychotherapy and marriage enable women to express and defuse their anger by experiencing it as a form of emotional illness, by translating it into hysterical symptoms: frigidity, chronic depression, phobias, anxiety and eating disorders, panic attacks, and the like. Each woman, as patient, thinks these symptoms are unique and are her own fault: she is “neurotic.” She wants from a psychotherapist what she wants—and often cannot get—from a husband: attention, understanding, merciful relief, a personal solution—in the arms of the right husband, on the couch of the right therapist. The institutions of therapy and marriage not only mirror each other, they support each other. This is probably not a coincidence but is rather an expression of the American economic system’s need for geographic and psychological mobility—i.e., for young, upwar
dly mobile “couples” to “survive” and to remain more or less intact in a succession of alien and anonymous urban locations, while they carry out the function of socializing children and making money. Most therapists have a vested interest, financially and psychologically, in the supremacy of the nuclear family. Most husbands want their wives to “shape up” or at least not to interfere with male burdens, male pleasures, or male conscience.

  The institution of psychotherapy may be used by many women as a way of keeping a bad marriage together or as a way of terminating it in order to form a good marriage. Some women, especially young and single women, may use psychotherapy as a way of learning how to catch a husband by practicing with a male therapist. Women probably spend more time during a therapy session talking about their husbands or boy friends—or lack of them—than they do talking about their lack of an independent identity or their relations to other women.

  However, like male therapy patients, women often talk about their mothers first and for a very long time before they talk about their fathers. And, as women have entered the work force at higher income levels, they have encountered women as employers, employees, physicians, judges, lawyers, spiritual counselors, and so on, and they do increasingly talk about them in therapy sessions.

  The institutions of middle-class psychotherapy and marriage both encourage women to talk—often endlessly—rather than to act (except in their socially prearranged roles as passive women or patients). In marriage, the talking is usually of an indirect and rather inarticulate nature. Open expressions of rage are too dangerous and too ineffective for the isolated and economically dependent women. Most often, such “kitchen” declarations end in tears, self-blame, and in the husband graciously agreeing with his wife that she was “not herself.” Even control of a simple—but serious—conversation is usually impossible for most wives when several men, including their husbands, are present. The wife-women talk to each other, or they listen silently, while the men talk. Very rarely, if ever, do men listen silently to a group of women talking; even if there are a number of women talking and only one man present, the man will question the women, perhaps patiently, perhaps not, but always in order to ultimately control the conversation from a superior position.

  In psychotherapy, the patient-woman is encouraged—in fact directed—to talk, by a therapist who is at least expected to be, or is perceived as, superior or objective. The traditional therapist may be viewed as ultimately controlling what the patient says through a subtle system of rewards (attention, interpretations, and so forth) or rewards withheld—but, ultimately, controlling, in the sense that he is attempting to bring his patient to terms with the female role, i.e., he wants her to admit, accept, and “solve” her need for love. However, such acceptance of the human need for other people, or for “love,” means something very different when women are already our culture’s “acceptors” and men our culture’s “rejectors.” Such acceptance is further confused by the economic nature of the female need for “love.”

  Traditionally, the psychotherapist has ignored the objective facts of female oppression. Thus, in every sense, the female patient is still not having a “real” conversation—either with her husband or with her therapist. But how is it possible to have a “real” conversation with those who directly profit from her oppression? She would be laughed at, viewed as silly or crazy and, if she persisted, removed from her job—as secretary or wife, perhaps even as private patient.

  Psychotherapeutic talking is indirect in the sense that it does not immediately or even ultimately involve the woman in any reality-based confrontations with the self. It is also indirect in that words—any words—are permitted, so long as certain actions of consequence are totally avoided—such as not paying one’s bills.

  Private psychoanalysis or psychotherapy is still a commodity available to those women who can buy it, that is, to women whose fathers, husbands, or boy friends can help them pay for it. Like the Calvinist elect, those women who can afford treatment are already “saved.” Even if they are never happy, never free, they will be slow to rebel against their psychological and economic dependence on men. One look at their less privileged (poor, black, older, and/or unmarried) sisters’ position is enough to keep them silent and more or less gratefully in line. The less privileged women have no real or psychological silks to smooth down over, to disguise their unhappiness; they have no class to be “better than.” As they sit facing the walls in factories, offices, whorehouses, ghetto apartments, and mental asylums, at least one thing they must conclude is that “happiness” is on sale in America—but not at a price they can afford. They are poor.

  Given the traditional and contemporary psychological ideologies about women and/or the patriarchal nature of the institution in which they are practiced, in what way should women relate to either the ideologies or the institutions? In what ways can therapy “help” women? Can female therapists “help” female patients differently than male therapists do? Can feminist or “radical” therapists “help” female patients in some special or rapid way? Can a technique based on transference, or on the resolution of an Oedipal conflict—i.e., on a romanticization of a rape-incest-procreative model of sexuality—wean women away from this very sexual model? What new “curative” techniques can emerge from a feminist analysis of human psychology?

  There are a number of contemporary clinicians who wish to “help” women. (Contemporary clinicians’ views regarding feminism are discussed in Chapter Nine.) Many still share the profession’s and our culture’s bias against or genuine ambivalence and confusion about feminism. Many such clinicians are trying to develop new views that will lead to new techniques. Many clinicians are trying to return to the originally revolutionary implications of Freudian psychoanalysis. And many women, dedicated feminists and anti-feminists alike, are still seeking “help” of some sort. I would like to share several thoughts with both the patients and the clinicians.

  First, contrary to what their hysterical detractors may think, these clinicians are not hot-headed nihilistic extremists. As a group, they are predominantly young, white, male, and middle-class. They have been steeped in “social reformism” and the importance of the individual. (None of which is bad.) As a group, they have little power and consequently, are often too unreflectively or impractically idealistic. They often tend to be as ideologically inflexible as establishment groups. Radical projects such as therapy communes and “freak-out” centers may be shortlived, and at best palliative, if larger social forces (over which clinicians have little control) don’t change. Another paradox or danger in radical as well as in any other mass psychiatric project involves viewing basic human needs for security and communication as “therapy,” rather than as normal human needs—and rights.

  The role that insight plays in effecting behavioral and emotional change is, like the effect of ideas on history, a matter resolved more by faith and experience than by scientific proof. To achieve political insight about one’s own oppression is no more a sure road to paradise on earth than is the achievement of personal insight a guarantor of individual happiness. Group defined and achieved insights or “alternative” working and living arrangements may not prove any more invulnerable to the pull of early conditioning or surrounding social forces than do individual solutions. Unfortunately, reality is not so easily captured, no less proclaimed away, by either tragic ideologies, for example by Freudian, Christian or liberal myths; or by optimistic ideologies, for example by Reichian or pagan myths. People and social structures change slowly if at all. More people inherit than experience revolutionary change. Very few people are transformed by myths before those myths have become the justificatory images of a new order. Most people simply obey new myths, as inevitably as they did old myths.

  The ideas and alternative structures of a radical or feminist psychotherapy both excite and disturb me. However, the difficulty of translating one’s ideology into therapeutic action remains a problem for clinicians and people, whether traditional o
r feminist. For example, what happens to us as children in families may be very difficult to “will” away psychologically, even in the best of peer-group structures, even by the most scrupulous “contracts” between a therapist and her patient, or between a group and an individual.

  * I wonder whether he would have treated white middle-class men this way. Certainly, many psychiatrists in city hospitals serving the poor treat drug addicts and blacks, Latinos, and/or female patients similarly: their professional competence or machismo is measured by their contempt for and distance from their “sneakily manipulative” patients.

  * Anatomy, like the bubonic plague, is history, not destiny. Of course, there are bio-anatomical differences between the sexes. The question now is whether these differences—or the cultural conclusions drawn from them—are either necessary or desirable.

  * I am now more familiar with their work. I admire Klein’s understanding of the early maternal-infant bond and its ramifications, especially for mother-daughter and female-female relationships.

  * I am suspicious of women romantically identifying with witches, who, after all, were tortured and martyred. Whoever they “really” were, witches were defeated; whatever their psychological and religious truths, they attained too little material power. Further, they (supposedly) still worshiped a male Devil and had ritual intercourse with phallus substitutes.

  * The Malleus, a kind of religious handbook of male superiority, claimed that “among women midwives (who often could perform abortions), surpass others in wickedness … all witchery comes from carnal lust [which in women] is insatiable.” On either count, they were dangerous to and therefore persecuted by the male Church.