This
is an excellent book. It is a
collection of essays written by a variety of authors. Their perspectives on the kinds of human suffering that are, in
North America, often called mental illnesses raise a number of fundamental
questions about the medical model promoted by mainstream clinical psychologists
and psychotherapists. The key to
appreciating this book is to first of all be comfortable with feminism. Once the reader understands that two of the
primary feminist arguments are that you can’t generalize from one to many (and
vice versa) and that you can’t generalize from men to women (and vice versa),
you have the necessary basics to understand the so-called feminist perspective
on mental illness.

This
book makes visible how feminists have raised the awareness of mental healthcare
providers and consumers in a number of significant ways. For example feminists have pointed out that
psychological research data is often generalized from study samples that are
too small to be statistically significant, that conclusions based on research
conducted on males (such as in the area of personality or moral development)
often aren’t true of women, that the observed phenomenology of so-called mental
illnesses in men have been used to develop diagnostic criteria that are biased
against women, and that some treatment methods—such as a male therapist’s
masculine dialogical style—may be counter-productive to women in therapy. In other words, feminism has brought to
light the fact that gender differences produce a greater complexity in the
human condition than male mental healthcare professionals have been willing to
acknowledge.

One
other important point made by feminism that is especially relevant to mental
healthcare is that the medical model of a mental illnesses may be unjustified
in the majority of cases because it is unscientific. In the Preface the editors write,

“Human
behavior is increasingly being forced into the box of biology. Hormonal, evolutionary, and genetic models
of behavior are more frequently being proposed as explanations for all human
behaviors, even in the absence of strong empirical science to support such
models….” (xi)

The
reason this point is so important is because if a person’s behavior or thinking
is attributed to biology it effectively eliminates the autonomy or free will of
that person. It diminishes a
description of their actions from the language of intentions to that of
biological determinism. A number of
writers in this book point out that women have historically been described as
primarily determined by their biology, thereby having their rationality
summarily dismissed. One author goes so far as to argue that the recent
diagnosis of “Pre-Menstrual Syndrome (PMS)” and “Post-Partum Depression (PPD)”
are the most recent examples of the anti-rational medicalization of the normal
emotional rhythms of a woman’s life experiences because they are different from
the “male-as-normal” experiences.

This
book contains eleven essays written by a variety of authors in the field of
psychology, and is divided into two parts. 
The first part is titled “Developing Feminist Theories” and deals with
feminist perspectives on issues such as personality development, attachment
theory, personal identity, and human nature. 
The conception of the autonomous person is a central theme throughout
this part of the book. For example, in
chapter 3, titled “New Developments in
Relational-Cultural Theory,” authors Judith Jordan and Linda Hartling agree
that it is important to help individuals diagnosed with a mental illness
develop what has been called an internal locus of control (ILOC). 
The realities of sexism, racism, heterosexism, and other forms of
discrimination can severely limit a person’s ability to feel such an internal
locus of control. But they caution that
this ILOC can also be used by the dominant group in society to distract from
the social realities of oppression by convincing the oppressed that they should
in fact feel that they are in control and therefor responsible for their
oppression.

These
same authors also give some very good advice to therapists for the treatment of
Post Traumatic Stress Disorder (PTSD)
that may not be found in mainstream psychotherapy texts. One of the aftereffects of the sever trauma
that brings on the symptoms of PTSD is a mistrust of other individuals and an
avoidance of connections through relationships. The authors suggest that the therapists ought to show her
humanity and truthfulness by acknowledging her own relational imperfections and
limits to her client, that the therapist recognize her client’s strategy of
disconnecting herself from others as necessary for survival, that the therapist
admit to her own mistakes and apologize 
(thereby lessening the power differential between therapist and client,
as well as heightening the humanity within the relationship), that the
therapist encourage her client to develop new relationships, and that the
therapist encourage the client to voice her dissatisfaction and discomfort with
any aspect of the therapy. This is the
sort of cooperative, inter-dependent, and non-paternalistic approach to therapy
not readily found in traditional psychotherapy texts.

The
second part of the book is titled “Psychopathology” and offers the feminist
point of view on things like premenstrual syndrome, postpartum depression,
alcohol and drug addiction in women, depression and schizophrenia in women, and
treatment approaches and recovery for women. 
In Chapter 9, titled “The Chrysalis Program: Feminist Treatment Community for Individuals Diagnosed as
Personality Disordered” author Margo Rivera argues that the North American
approach—which fragments the stress of trauma and victimization into
comorbidity or a multiplicity of individual disorders, and then treats these as
medical illnesses—is not as therapeutically effective as the approach used in
the Chrysalis Program which treats the sufferer, usually a female victim, in a
more holistic manner. She also
reiterates what feminist-informed practitioners have often said: when distress is labeled as a pathology or
disorder it locates the source of the problem in the distressed individual
rather than in its cause. It thereby
reduces any normative expression of gender, race, or class that contradicts the
status quo to individual pathology. 
This is an appropriately political perspective on what psychotherapists
typically consider the very personal predicament of mental illness.

For
readers who have had no experience with feminist critique of clinical
psychology and psychotherapy this book will be an eye-opener that answers many
questions while raising many more. For
those who are familiar with the territory this book is a challenge to readers
to beware of complacency, and to not assume that the demands of feminism have
been satisfied because all wrongs have been righted. This is a powerfully thought-provoking book that will complement
any other text devoted to the discussion of mental health and disorder.

© 2002 Peter B. Raabe

Peter B. Raabe
teaches philosophy and has a private practice in philosophical counseling in
North Vancouver, Canada. He is the author of the books Philosophical
Counseling: Theory and Practice (Praeger, 2001) and Issues
in Philosophical Counseling (Praeger, 2002).

Categories: Ethics, Philosophical