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The book explores the theme that womens subordinate position in society and (in part consequently) their gendered life experiences lead to womens being at greater risk for developing mental illness.
It is a fact that a variety of mental disorders (including depression, obsessive compulsive disorders, somatization disorder [formerly classified as hysteria], panic disorder, some phobias, etc.) are more frequently exhibited by women. It may appear natural (in particular in the growing atmosphere of return to the biological roots) to interpret that fact by appeal to basic biological differences between men and women. Astbury challenges the naturalization of this fact at a variety of levels (see points 1-3 below). She gives ample evidence for the plausibility of investigating a socially based approach to understanding womens mental illness. In particular, she argues that the recognition of the reality of childhood sexual abuse as well as its enormous importance in the genesis of mental disorders (Chapter 8) can already explain womens greater risk (girls fall victim to childhood sexual abuse with greater frequency than do boys) as can other aspects of womens social reality.
1. Crazy for you - because you set the standard of what normal is
In Chapter 1, Astbury argues that the very raising of the question why women are particularly prone to develop certain disorders reveals the assumption that the womens rates are pathological, that the norm are the males rates. She proceeds to explore the various ways in which viewing the male as the normal and the female as abnormal has for the research and the therapy. Chapter 4 explores the derivative status of women in the psychoanalytic theory emphasizing the fact that the woman is primarily understood negatively in terms of not being a man, most importantly as lacking a penis (i.e. in terms of a folk-biological difference). Even motherhood is understood not as a genuine form of being but is explained negatively by the penis envy.
Given the kinds of stereotyped expectations that people (men and women) have of women, the very idea of womens voice can be challenged (Chapter 2). One of the startling examples of this phenomenon is the fact that even psychotherapists (the very people to whom troubled women will turn for help) reproduce such stereotypes. (One study conducted by Fabrikant in 1974 showed that male therapists rated 70% of "female" words as negative, while 71% of "male" words as positive. The corresponding percentages for female therapists were 68 and 67.)
2. Crazy for you - because you want to see us as crazy
Astbury investigates the prejudices that constituted the background to and shaped the scientific discoveries relating to womens madness in the 19th century (Chapter 3). Far from discovering womans nature based on the bedrock of biological facts, the science of the day in fact "discovers" its own "malignant fantasies of the woman as the other" (12). She discusses a medley of examples of the sort of preconceptions that shaped and perpetuated the image of women as different and inferior, ranging from social interpretations of the evolution theory through "evidence" that higher education has deleterious effects on womens health to the view that women do not advance to the higher levels of development but remain "childlike, never growing to the same height as men or developing other traits, like beards, which indicate[s] true biological maturing in human beings." (48)
3. Crazy for you - crazy because of you, because the kinds of situations you put us into cause us to be beside ourselves
Chapter 5 investigates Freuds infamous change of heart with regard to the pathogenesis of hysteria. Freud rejected his early theory (that childhood sexual abuse causes the disorder) and adopted the view that hysteria is caused by sexual fantasies of childhood. The shift of attention from the world to the world of fantasy had three major consequences.
First, attention was turned away from the phenomenon of childhood sexual abuse. Second, the patients were effectively denied a voice they suffered being heard by the ears that do not listen. The patient entering a psychoanalytic session is expected to have had sexual fantasies involving a parent (the most frequent perpetrators of sexual abuse). The addition of "Really!", however deafening, is not going to cross the mind-reality abyss. Someone faced with a systematic attempt to fantasize away the most painful experience of her life is going to be more than "almost beside herself" (Freuds description of Dora at the revelation that she is fantasizing). Astbury makes a good case of arguing (Chapter 6) that Freuds theoretical expectations did cause him to miss out on a number of important aspects of the case (among them possible childhood sexual abuse, homosexual feelings).
Third, to the extent that abuse is conceptualized it looks like a realization of the childs fantasy (Chapter 7). As a result the child is perceived as "promiscuous", "seductive," "incestuous." The child is perceived to be the active party in the relationship shifting the part of the perpetrator into the background. The abuse is perceived by the eyes that do not see.
The book (as indicated by the subtitle) is concerned with "womens madness" so it might appear that the omission of talk about mens madness is warranted by a delimitation of the subject. One cannot but feel when reading in particular the critique of Freud that one exclusion has replaced another. Astbury does note that most of Freuds patients were women (so there is some reference to men as the remainder of "most"). But the phrasing of most of her conclusions about the silencing effect of Freuds "talking cure" with respect to childhood sexual abuse is limited to women. (Making quite a general point: "the female [sic] patient and her analyst are in a remarkable relationship to one another," 136) This is morally jarring. Surely one does not want to silence the other one third of the victims. (Interestingly when Astbury talks about children she does not refer to them as girls or daughters, not exclusively. She simply talks about "children". They only grow up to be women.)
This brings to light a more important omission. It would have been good methodologically (if only for the purposes of contrast, but the purpose of freeing oneself from the swaying current of ones narrative is also worthy) to include some more substantive discussion of the kind of story of mental illness for the other gender. Given the central importance of childhood sexual abuse, a lot of questions can be asked: What (if any) differences are there in the way that girls and boys cope with the trauma. How does the mens experience of coming to power in their later lives affect the way that they handle their lives. (In view of the statistic Astbury does cite that many more abused boys (than girls) become abusers themselves, this question is most pressing not only for theoretical but for practical reasons. [*])
The consequences of Freuds change of heart are astounding. If Masson is right, all the suffering that followed is due to Freuds moral weakness, to his desire for fame and recognition by colleagues (Astbury adds to this the possibility of viewing the change as response to anti-Semitic attitudes, Chapter 5). One cannot but feel that the kind of reversal of vision she notes in the case of childhood sexual abuse (which brings to the agentive fore the victim while hiding the perpetrator in the background) is partially present in our eagerness to throw all the blame at Freud.
No blame should be denied Freud. But what is abominable is that only he gets blamed. Even if one accepts that his change of mind was an icing of heart, one ought not to lose sight of what or rather who was an integral part of that change. That he is blamed is due him. But that in the same breath the featureless face of the scientific community before whom he retreats is not blamed is abominable. And yet it is clear that it is the cause. Freud did after all listen to his patients. He not only had the moral courage to think but to publish his thoughts. And then something inexplicable in its persuasive and motivating force to rethink happened. Nothing. The silence of others is probably the most powerful social force in academia. Only a few can cope with it. Freud could not. Unlike the abused child, he deserves the blame. But we should not turn our eyes away from the perpetrator.
The book is based on a course the author teaches. This partly explains its uneven jotty structure. It is filled with experimental results from a variety of disciplines, with case studies some historical, some literary, with too extensive a discussion of Freud (more than half of the book) all conspiring to conjure up an image of womens madness. The assembly is impressive. But the vice of such an approach is that what the author does not include may be even more important than what she does include.
Footnote (*): I am gesturing at a hypothesis here that would explain (in a gesturing way) the limited data brought out. The conjecture is that both abused women and men have a propensity to reproduce abuse. But whereas men reproduce it by directing it toward others, women tend to direct it inwardly at themselves thus generating a variety of mental disorders. One line of investigation might pursue the consideration of a variety of factors having to do with the privileged/subordinate position in the society that women/men are divided by. I do not know whether there is any research done to support the conjecture in this form. My point here is limited to the illustration of the suggestion that one could gain in understanding women even if one does not narrow ones vision to an attempt to understand women alone. [Back to main text]
Katarzyna Paprzycka is a full-time mother, teaching part-time at the University of Southern Mississippi.
Jill Astbury, Ph.D., MAPS sent the following response to this review on April 18, 2000
As an author, it is a real, if not frequent pleasure to read a genuinely thoughtful response to one's work. So thanks, Katarzyna! Writing is such a solitary pursuit and even after you finish writing and the book is published and sales figure tell you people are actually reading it, a sense of unreality remains. What do readers think? Have you managed to transmit what is of burning importance to you in a way that others can identify with? Will anything change as a result? Jill Astbury directs the postgraduate teaching program of the Key Centre for Women's Health in Society at the University of Melbourne and chairs the Policy Sub Committee of the Ministerial Advisory Committee on Women's Health in Victoria, Australia.
Regarding the last of these questions, what most needs to change are the dominant models employed to explain mental illness in women. To my mind it is essential to go beyond biological individualism and the idea that psychological disorder is primarily an expression of organic pathology in an affected individual's brain, necessitating pharmacological correction or the manifestation of women's faulty reproductive functioning. If hormones are the answer, obviously the wrong questions are being asked.
Huge changes are needed in the teaching of psychology, psychiatry and social work and a gendered, social health determinants approach must be incorporated into research on women's mental health. Conceptual remapping is required of all the explanatory models of emotional distress and disorder where large gender differences obtain but where understanding has been obstructed by an excessive focus on biological mechanisms alone.
I have used a gendered, social health determinants approach to examine recent research evidence on 'Gender and Mental Health' (1999). This working paper was prepared under the Global Health Equity Initiative project on 'Gender and Health Equity' based at the Harvard Center for Population and Development Studies.