Women
and Madness is the reissued,
revised edition of a book first published at the height of second wave feminism
in 1972. The Female Eunuch (Germaine Greer), and Sexual Politics (Kate Millet)
were published in 1970. Chesler’s book has a more specific focus than the other
two; it is concerned with ‘madness’, or perhaps more correctly the social
construction of madness in western patriarchal societies. This revised edition
retains much of the original text, with an extended new introduction. The
substantial content of the original book remains, with occasional comments on
what has or hasn’t changed of the intervening three decades. The result is
rather unsatisfactory if you are looking for a comprehensive review of the
original issues, or a discussion of new issues that have emerged since 1972.
The later comments appear shoehorned into the text in many cases, and much of
the original material is showing its age. But the book is still a timely
reminder that much of what is taken for granted in terms of gender analysis
these days had, and not too long ago, to be argued. The argument is still in
progress. Second wave feminism achieved some major gains for women, but not
their liberation. And even the gains that were subject of so much struggle are
taken for granted by younger men and women today, who have little time for
organized political campaigns on issues such as continuing economic disparities,
and disproportionate levels of male partner violence towards women.

The first
six chapters of the book cover different aspects of women and madness, and
focuses mainly on institutional psychiatry and the psychiatric professions. The
next three chapters present results of Chesler’s interviews with lesbians,
third world women and feminists, and there is a concluding chapter that takes
Amazon societies as a basis for examining female psychology. In considering the
current place of Women and Madness, the significance of the book is its articulation of a
new, political perspective on womens’ mental health, one that was radical for
the time and which resonates still. It may be misleading to describe Chesler’s
perspective as ‘new’: the idea that in patriarchal societies health is
politically defined and that ‘illness’ is a form of resistance was already
established in 1972. Chesler’s contribution was to apply that perspective to
institutional psychiatry and psychology, to argue that feminism, not treatment,
was what mentally distressed women need, and to link that argument to the
broader issue of womens’ rights. For Chesler, gender is one’s fundamental
social identity, taking precedence over ethnicity, class or any other category.
That makes feminism the necessary political response to oppression, not
generally improved social conditions or improvements in race relations.
Oppression of women will survive these reforms, as both men of color and male
political activists are invested in the oppression of women.

Women and Madness is more of
a polemic than an academic critique. Facts and statistics are linked to
ideological claims as if the solidity of one automatically underpins the logic
of the other. Chesler might have been working within the theories of one of the
psychiatric revisionists she cites: what is important is not the facts, but how
they are employed to create a perspective. Foucault had no difficulty with such
a view, and it did Madness and Civilization no harm as a counter to the
standard history of psychiatry to arrange that history in a way that suited his
purposes. Indeed, Women and Madness
has something of a similar effect to Madness and Civilization: you can
disagree with aspects of it, even find it overly didactic, but the basic thesis
is compelling. For example, after acknowledging ‘bio-anatomical differences’
between men and women, Chesler questions whether such differences are
‘necessary or desirable.’ ‘Anatomy,’ Chesler argues, ‘is history, not destiny.’
While many would agree with the latter part of that argument, not everyone
would agree with the former, but the argument is a powerful rhetorical device.

Despite
the gender fundamentalist nature of Chesler’s arguments she does not align
herself philosophically with Szasz, Laing, or others who deny that ‘mental
illness’ has any objective reality. She argues that the enslavement of women is
prior to the enslavement of psychiatric patients as argued by Szasz. She sees
little difference between Szasz and Laing on the one hand, and mainstream psychiatrists
on the other, in terms of their positions as patriarchal figures. Chesler’s
acceptance that there is some reality to ‘mental illness’ (on page 18 she
states that depression has a neurochemical basis) sharpens her critique of
asylum practices. If asylum inmates, however unjustifiably incarcerated, really
are mentally distressed they need more than liberation from the asylum; they
need the help that the asylum promises but doesn’t deliver.

Women and Madness was
written at the time of the DSM II, a diagnostic system that was used to support
the sorts of subjective value judgments Chesler rightly complains of. How
ironic then, that the use of the more objective criteria of the DSM IV makes
little difference to the gendered distribution of mental illness. It will come
as no surprise to Chesler to see that despite the influence of political
arguments such as those of Women and Madness, change has been limited.
Public health literature is depressingly consistent in showing that despite
increased knowledge of risk factors, it is still the poor and the oppressed who
experience the worst health outcomes. Chesler is under no illusions that the
struggle she articulated three decades ago continues.

Women and Madness is a revolutionary book. Many women (but no men that I am
aware of) have identified it as ‘life-changing’. It is the sort of book that
carries the reader by the sheer force of its arguments, and by creating a
paradigm that changes the way readers think about mental health. It is not
without its limitations. In the chapter on clinicians, the most numerous female
workforce in psychiatry, nursing, is ignored in favour of the psychiatric
elites: psychiatrists, psychologists and social workers. The 2005 ‘revision and
updating’ of the book suggests that it has the sort of relevance to
contemporary times that it did to 1972. While the book definitely has
relevance, it contains no analysis of issues that have emerged since its first
publication. There is a body of theory and research that extend the arguments articulated
by Chesler in 1972. But this revised and updated edition contains no
discussion of how the psychology of witch persecution has been employed in
allegations of satanic ritual abuse, or of the growing body of work that takes
seriously womens’ reports of physical and sexual trauma. Much of the more
recent scholarship on mental health issues is indebted to the critique provided
by writers such as Chesler, and it would have been interesting to see Chesler’s
response to that work.

Overall, Women and Madness
deserves to be regarded as a classic in the critical literature on mental
health. It offers one of the strongest expressions of feminist critique of
psychiatry and psychology, and it brings together diverse strands of historical
and theoretical analysis. I am not sure that the revisions add to what was
already a powerful text, but Women and Madness should be on the reading
list of every mental health clinician.

© 2006 Tony O’Brien

Tony O’Brien, M Phil, is a lecturer
in mental health nursing and PhD student at the University of Auckland, New
Zealand: a.obrien@auckland.ac.nz

Categories: Sexuality, Ethics