Mad, Bad, and Sad: A History of Women and the Mind Doctors

by Lisa Appignanesi

  An experimenter on various fronts, Delay in the fifties also gave Jacques Lacan space at the Sainte-Anne to hold his increasingly influential and popular seminars. Here, until 1963 when Lacan moved to the Collège de France, the ‘return to Freud’ was teased out. But by 1968 things had changed, and Delay was seen as a reactionary. It was his office at the University of Paris that the May 1968 students attacked, seeing in his brand of newly successful psychiatry a bastion of the imprisoning social order that demanded toppling. Psychiatry, for them, was the sadistic twin of CIA mind-control and brainwashing experiments, the kind Ewan Cameron had notoriously carried out in Montreal, and which they understood as synonymous with Delay’s culture of psychopharmacology.

  In Germany the greatly respected psychoanalyst Alexander Mitscherlich’s books, The Inability to Mourn and The Fatherless Society, became key in the nation’s attempts to deal with its unpalatable Nazi past. These functioned during the sixties as ‘banners and slogans for a newly coalesced psychoanalytically informed social vision’ which affected mass society and the whole West German educational system.

  In Italy, Franco Battaglia, who had been director of vast asylums in Gorizia and Trieste, led a distinctly political ‘Democratic Psychiatry Movement’. This resulted in the passing of the famous Law 180 in 1978, which saw the closing of the large asylums. The United States under its seemingly progressive Community Mental Health Center Act of 1963 had opened some 640 local centres in which de-institutionalized patients could be treated and low-cost outpatient care made readily available. Sadly, there were insufficient funds and insufficient centres to meet demand. Poor, lonely, disoriented people with few social or work skills were left to roam the streets, often a danger to themselves and sometimes to others. Similarly in Britain, the movement to provide ‘care in the community’, from the 1970s on and under various governments, all too often led to the discharging of patients into no care anywhere.

  For all the interest of its writings and its cultural status, the new anti-psychiatry could promise no more stability for its treatments and cures than the less humane physical/chemical therapies or more traditional talking therapies had done. Mary Barnes herself, when in 1977 she came to the opening of David Edgar’s stage adaptation of her and Joseph Berke’s book about her ‘case’, admitted to recurring acute attacks of depression and withdrawal.

  After the sixties peak of the Dialectics of Liberation conference which brought together black leaders, psychiatrists and political thinkers, Laing left Britain and–like his contemporary cultural heroes, the Beatles–the blighted materialism of the West to travel East in search of spiritual enlightenment. As it did for so many of the period’s celebrities, the tripping, drugs and alcohol took their toll. In the seventies Laing produced little that had the audacious mark of his earlier work. He became a casualty of the very culture he had helped to create. When he returned to the ICA at my invitation in the eighties, it was to talk to the American poet Allen Ginsberg and meditate with him to the beat of an Indian drum: the event was a pastiche of a ritual which no longer carried its radical origins. On another occasion, in 1985, when he discussed his memoir, it was clear that he had more or less returned to the initial moment of his anti-psychiatric project, leaving behind the romantic terms of the spiritual journey of the schizophrenic and the political impetus to cull universal insights from the schizophrenic mind. In his last books, Laing once more emphasized his attempt to make the speech of the schizophrenic intelligible and to provide compassionate treatment for the disturbed. No longer the guru, he became once more the reforming doctor–one who couldn’t quite heal himself.

  In conversations recorded before his death at the age of sixty-one on a Saint-Tropez tennis court in August 1989, Laing described his own therapy thus: ‘You could call some of it psychoanalytic, some of it existential, some of it gestalt, some of it psychosynthesis, some of it primal–all these little bits and pieces were all fragments of an integrated whole array of possibilities.’ At the end Laing had returned to the starting point of his critique of psychiatry–the talking therapies rather than the physical ones were the most humane of possible treatments.

  If the spiritual adventure of Laing’s latter-day schizophrenic trips lost its glow in the sobering light of the later seventies, this didn’t diminish his and the anti-psychiatrists’ impact. Whatever their therapeutic successes or failures, their influence is still there to be read. Setting out to make schizophrenia intelligible, Laing ended up not only destigmatizing madness, but making its ‘language’ available and in some measure glorifying it. Paradoxically this not only helped to make the mad feel more kin and made crises or breakdowns more acceptable, but fed into the ageing century’s increased willingness to read unhappiness and malaise in terms of symptoms. Never mind Freud’s neuroses–psychotic symptoms, too, were now to become part of the growing democratic repertoire of illness. Schizophrenia, anorexia, PTSD, manic depression, multiple personality disorder, obsessive-compulsive disorder–even these terrible diagnoses, by making the unbearable seem intelligible in a name and an ordered set of symptoms, gradually took on the glow of fashion.

  The scorpion’s sting in the tale of anti-psychiatry was that paradoxically, it helped turn everyone into a patient. This was not the cowed patient of old but a patient who could be on increasingly equal terms with a doctor, even if both were women.

  WOMEN REBEL

  Laing and his colleagues had paid little attention to the gender-specificity of their patients’ problems. But their descriptions of the lives of women unwittingly brought women’s very specific plight into dramatic view. Through the eyes of hindsight, their patients, from the hospitalized schizophrenics to Mary Barnes, seemed to cry out both for explicitly gendered consideration and for liberation. Nor were the sexual politics of the doctors themselves any more enlightened than those of the sixties radicals in general. The sexual revolution, for all its emphasis on freeing desire, more often than not meant freeing male desire. Women paid for this in many indeterminate ways, some large, some small, whether they were patients or not. The anti-psychiatrists’ radical attack on social control and the structures of power both in and out of the asylum hardly extended to their unexamined control over women. Laing himself had ten children and three wives, and along with David Cooper, who advocated ‘bed therapy’, exemplifies what Elaine Showalter described as the fundamental anti-psychiatric constellation: a ‘combination of charisma in the male therapist and infantilism in the female patient’.

  For the women’s movement, which championed before all else taking control of one’s own life, including its sexuality, it now grew evident that what men, doctors and the world they had created had always done was to drive women mad by limiting their possibilities–by insisting on their sexual identity and their secondary status, by turning them into the ‘seen’ of the clinical, voyeuristic gaze, which was inevitably interiorized, so that a persecutor inhabited every woman.

  The feminists of the late sixties and seventies set out to wake women from the long sleep during which they had acquiesced to their secondary status. They did so not only in terms of economic and social power, though these were primary. Psychological characteristics, attributed to them by the patriarchy, had been naturalized and internalized as truth. Where men were active producers, women were passive reproducers and care-givers. Where they utilized rational intelligence, women’s lot was the emotions. The only dream permissible in this long night of inferior status was the enslaving fantasy of romance, which would bring woman to her acquiescent knees before the godlike glory that was phallic maleness.

  Simone de Beauvoir had set down her encyclopaedic tablets in 1948–9: translation into English came in 1953. The Second Sex punctured the myths of femininity and deftly showed how woman had always been defined in relation to man–a secondary term, the other to his absolute, the object to his subject. Her agenda for women underscored independence and freedom, that ultimate existentialist goal. Happiness, an American pursuit, was not a stat
ed part of the picture. De Beauvoir attacked, if not psychiatry, then the one related form of it which had philosophical status: psychoanalysis and its inventor Sigmund Freud, who stands in for a way of seeing, despite an elusive fluidity which irritates the rigorous French philosopher she is. She begins, however, by applauding Freud’s exemplary recognition that the body does not exist simply as the biologist’s object. It is the body as lived in and experienced by the human subject that is significant, the cultural body. It follows that a woman is female only to the extent that she feels herself such. Change that experience, and woman could be free, her destiny unshackled from biology and anatomy.

  But having understood this, de Beauvoir argues, Freud then falls into the patriarchal trap and makes the phallus both signifier and actual subject of power. He bases his world on a masculine model which inevitably results in woman emerging as castrated, a mutilated man, envious of the penis and of an authority she doesn’t possess. Elevating his views to the position of a universal truth, Freud gives them the legitimacy and inevitability of fact, thus positing a determining force which removes choice from the world. He fails to see that the primacy attributed to the phallus is a historical construct: ‘if woman should succeed in establishing herself as subject, she would invent equivalents of the phallus’.

  Betty Friedan and Kate Millett in America, Germaine Greer and Juliet Mitchell in Britain, amongst many others, took up the feminist baton. The first pointed out the part Freud’s psychoanalysis, in particular, had played in women’s oppression in America.

  Freud was accepted so quickly and completely at the end of the forties that for over a decade no one even questioned the race of the educated American woman back to the home…After the depression, after the war, Freudian psychology became much more than a science of human behavior, a therapy for the suffering. It became an all-embracing American ideology, a new religion…Freudian and pseudo-Freudian theories settled everywhere, like fine volcanic ash.

  Relegated to depression-inducing routines of housewifery, to the masochism and passivity which the influential psychoanalyst Helene Deutsch had laid down as basic to female sexual make-up, women developed the ‘problem with no name’ which was variously treated by drugs, alcohol, ECT and psychotherapy. Now women needed to expose the forces that had created their condition. Principal amongst these, Kate Millett noted, even before the publication of her important Sexual Politics (1970), was the category ploy of the ‘individual case’ begat by Freud and his ‘very private science’. This undercut an engagement in sexual politics, the very possibility of women acting as the collectivity they in fact were. It condemned sexual relations to an endless series of unique instances and converted resistance to sterile stereotypes of motherhood and wifeliness into neurosis. Any woman who dared not to conform was ‘clearly off her nut’.

  For Millett, Freud was the ‘strongest individual counter-revolutionary force in the ideology of sexual politics’, the man who ‘clothed the old doctrine of separate spheres in the fashionable language of science’. Betraying his initial radical insights into sexuality and the need for liberation, he had effectively been responsible for the demise of the first wave of feminism by turning protest into illness.

  Feminism, particularly in America, which valued empirical research, could also draw fuel from Masters and Johnson’s physiological proof that Freud and the psychoanalysts had been altogether mistaken in their views on what constituted mature female sexuality. The developmental model which stated that clitoral satisfaction was replaced in the well adjusted adult woman by vaginal orgasm was hokum. Feminists officially declared the vaginal orgasm a myth and with it that psychoanalytic diagnosis of ‘frigidity’. The contraceptive pill was the technology of liberation. It freed women’s sexuality from the age-old hold of reproduction. Women were now free to listen to their own bodies, and freed to a measure of control over childbirth. They no longer had to strive for what the shrinks laid down in terms either of sexual pleasure or of female roles.

  Phyllis Chesler, a psychologist, brought the feminist critique more closely into line with the anti-psychiatry project. In Women and Madness (1972) she questioned the very construct that was mental illness and argued, using historical examples, that it was an expression both of female powerlessness and of the attempt to overcome it. Symptoms of mental illness, Chesler argued, were directly linked to conventional understandings of masculinity and femininity. They were ‘norm violations’. Any transgression of the core attributes of male and female identity were understood as madness. But women were more likely than men to be categorized as insane or ill for the simple reason that the standards of health–independence, autonomy, objectivity, self-sufficiency–ran counter to any description of a well adjusted woman, who was meant to be submissive, emotional, dependent.

  In a double bind of health and femininity, women could be labelled crazy whether they rebelled against, or accepted, the feminine role. Men, on the other hand, exceeding the demands of masculinity and deviating from the norm, were more likely to be branded ‘sociopathic’ or criminal. Stereotypical assumptions about the sexes therefore made it inevitable that women would exhibit more symptoms of mental illness and be more often hospitalized. Institutions exacerbated women’s plight by subjecting them to the same degradation and disempowerment they suffered within the family. Chesler’s interviews with institutionalized women of all ages gave graphic examples of the ways in which ‘unfeminine’ behaviour–‘troublesome, needy’–or indications of a ‘fighting spirit’ could land women in hospitals when families couldn’t or wouldn’t keep them. Her interviews were backed up with graphs of hospital and private clinic admissions, which clearly indicated that even with corrections for population size and age, the number of institutionalized women of all races exceeded that of men, often by as much as 10 per cent or more; only in outpatient services for the under-eighteens did men exceed women.

  The first wave of feminism had been closely entangled with Freud’s invention of psychoanalysis. The founding study in hysteria, Anna O, the woman who had given the talking cure its name, had metamorphosed into Bertha Pappenheim, the altruistic women’s leader who had campaigned against the sexual exploitation of women and children throughout Europe and the Middle East. The philosopher Martin Buber had lauded her as that rarest being of all, a passionate spirit. Hysteria, rebellion and feminism, as women’s liberation was quick to underline, were intricately linked: their sources lay in the same discontent. To express their anger at the circumscription of their lives, women got ill or got organized. Sometimes they did both in turn.

  If the marriage of psychoanalysis and feminism sometimes looked like a Strindbergian dance of death, it was also often fruitful. Rethinking sexuality and gender in both personal and political terms, women from a variety of intellectual formations found themselves coming back to the crucible of psychoanalytic ideas.

  Freud, in any number of manifestations, together with Lacan but also and increasingly Klein, Winnicott and the object-relations school, shadowed and informed the entire feminist project. In examining the construction of femininity, sometimes phallus and its reinterpretations were prioritized, sometimes breast. A startling number of key feminist thinkers–from France’s Julia Kristeva to Juliet Mitchell in Britain–also became practitioners. Meanwhile, Freud’s Dora and later Ludwig Binswanger’s Ellen West, a troubled woman who died while refusing food, took on the aura of patron saints: women who through body and psyche had rebelled against the patriarchal doctors. As women’s studies began to take shape, feminists recovered a history which needed to be voiced or reinterpreted. Virginia Woolf provided an early lead. In Three Guineas she had written, ‘the public and private worlds are inseparably connected…the tyrannies and servilities of one are the tyrannies and servilities of the other’. ‘The personal is political’, as one of the key slogans of the early seventies had it, was already enmeshed in her work, as it was in women’s experience.

  In her early book, Women’s Estate (1971), Juliet Mitc
hell noted that the first step on the path from an individual complaining woman towards the creation of a women’s political movement was the consciousness-raising group. It was through women meeting together to share the ‘unspecified frustration of their own private lives’ that the personal problem–abortion, a miserable sex life, the look of a body–became political. ‘The process of transforming the hidden, individual fears of women into a shared awareness of the meaning of them as social problems, the release of anger, anxiety, the struggle of proclaiming the painful and transforming it into the political–this process is consciousness-raising.’

  Mitchell likens the process of consciousness-raising both to group therapy, a tag its critics needlessly deride it with, and to the Chinese practice of self-criticism, speaking ‘bitter thoughts’ in a group. ‘Speaking the unspoken,’ she notes, is, of course, also the ‘purpose of serious psychoanalytic work.’ Given that their condition has been made to seem ‘natural’, women’s oppression is hidden from them, unconscious. Thus this task of consciousness-raising, which bears a distinct relationship to psychoanalytic practice, is both necessary and a political step.

  Three years later Juliet Mitchell’s influential Psychoanalysis and Feminism (1974) appeared and began the task of salvaging psychoanalysis and marking out Freud’s crucial importance for the feminist project. Mitchell underlined the feminist fallacy of assuming a direct translation between the social order and the individual subject. There was no mirror that reflected one in the other. Women were not simple victims on which the social order inscribed itself: if that were the case there could be no escape from the patriarchal condition, no breaking of the mould of oppression. To give way to an essentialism, a fixed entity that was woman, forced woman into the position of being ‘nature’ to man’s ‘culture’. But both sexes, Mitchell argued, functioned in the cultural sphere. Freud had offered a theory of what it means to become woman. He had not trapped her in fixed, unchanging characteristics. Reinterpreted by Lacan, whom Mitchell followed in this respect, the ‘penis’ which Freud had understood women as ‘envying’ was the phallus of symbolic function, the signifier of sexual difference. Both sexes are marked out by their desire for its power. Both suffer from its lack. Lack (not unlike Freud’s discontent) underpins both sexes’ relation to ‘civilization’. Psychoanalytic thinking, which posited a dynamic psychic reality and no gendered essentials, was women’s best hope of escaping a reduction to essentialist terms.