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I recently taught a section of this book in an undergraduate course on Philosophy and Mental Illness, and I can say that it was influential with my students, who returned to its arguments again and again throughout the course. Without question, this book makes an important contribution to the relatively scanty analytical literature on the subject of women and mental illness. The author, Jane Ussher, provides a skeptical view of current empirical evidence that women are more likely to be mentally ill than men and offers alternative accounts of how to understand women’s relationship to psychiatry and psychology. She doesn’t deny that women’s lived experiences can give rise to distress. What she does do, however, is argue against the medicalizing and pathologizing of such distress, especially as it has occurred in both nosology and practice. She does much more than this, though.
The primary strengths of this book are that it is historically situated, it defines various models and scientific movements that the author discusses (such as ‘positivism’ and ‘categorization’), and that it develops a sustained argument for a particular model that Ussher advances that she calls a ‘materialist-discursive-intrapsychic analysis’ of women’s madness. By this she means that a meta-analysis of women’s relationship to psychiatry and psychiatric illness requires a contextualized understanding not only of sources of women’s distress but also ways that epistemic bodies (such as medicine and, in particular, psychiatry and psychology) push women to be taken up as--and to take themselves up as--ill.
For example, in a chapter focusing on the diagnosis of depression in women, Ussher shows that a history of constructing women as hysterical, the ‘emotional’ gender, premenstrual, and otherwise genetically predisposed to being depressed is a way to enforce what is called hetero-patriarchal gender roles--a way of categorizing people into two and only two ways of expressing their identity, bodily ways of being, desires, thinking and relating: masculine and feminine. Norms of femininity police women, Ussher argues, to such a degree that, when they deviate from those norms, they develop ‘symptoms’ and fall ‘ill’ (terms she puts in quotation marks herself.) Ussher follows up this subject in later chapters when she discusses topics like borderline personality disorder and premenstrual changes in later chapters.
The theory behind Ussher’s approach is feminist and decontructionist in that it examines ways that subject positions are constructed through political discourses and systems of oppression. She relates the long-standing legacy of perceiving women as mad to the material, psychological, legal, and political oppression of women. She doesn’t give a formal definition of oppression (which would have been useful) but makes clear through analysis and the use of women’s own voices throughout history what such oppression might look like. Her use of women’s voices is especially powerful and effective in a chapter on sexual violence and how various girls’ and women’s lives have been affected by it.
Ussher also makes use of women’s voices in the last chapter when she takes up the theme of resistance. This theme is crucial to her theory and argument in that a feminist discursive analysis does not take oppression to be totalizing but, instead, as leaving space for pockets of resistance to the power of authoritative institutions and regimes. Readers might wish she had developed this leg of the argument, though; her previous chapters hit hard at the effects of oppression such that more examples needs to be given of ways women have always resisted--and sometimes successfully navigated away from--dichotomies of sane/insane, normal/ill.
It is good that she includes women’s voices of experience, for the book can be quite heady. Because it is grounded in a particular, quite abstract theory that has its own language and set of assumptions, it could be dense and difficult for readers at times. And some readers may wish she had included a discussion of schizophrenia and other major mental disorders in order to speak more to the skeptical. It is worth the commitment, though, for anyone who wishes to gain a more sophisticated and complex understanding of arguments against psychiatry’s instantiation of gendered norms and assumptions. It would make an excellent text for graduate school courses not only in psychiatry and psychology, but in social work, nursing, and philosophy. It would also make a great book for a reading group to discuss.
© 2012 Nancy Nyquist Potter
Professor Potter’s last book, Mapping the Edges and the In-between (Oxford 2009) was on Borderline Personality Disorder. She is now working on compliance, noncompliance, and defiance as they intersect with psychiatric norms.