Women, Mental Health, and the Psychiatric Enterprise: A Review

Women's issues create intriguing connections with clinical practice because they touch on many fundamental philosophical questions of deep concern to social workers. They brush up against the nature-nurture debate, the centuries-old history of oppression, the ability of the powerful to create language and define reality, the blatant and recalcitrant inequity in the distribution of resources, the unmistakable reality of resulting despair and loss, and the human search for meaning. The hope here is to inform, challenge, and inspire further reflection, further research, and more important, further action toward realizing a truly responsive service system and cadre of learned and compassionate social workers and other providers. It is unlikely that this work will "unravel the contradictions in the conundrum" (Ussher, 1992, p. 8) between the radical critics of psychiatry on one hand, and those who want to respond to the real-life needs of individual women within the system. This article examines the history and theoretical context of mental health services for women, reviews lessons learned from women's own descriptions of their lived experiences with mental illness, and summarizes needed responses to the treatment needs of women. HISTORICAL PERSPECTIVES ON GENDER BIAS IN PSYCHIATRY In the past 25 years, almost every manuscript focusing on women and mental health starts with a reference to the Broverman study in the 1970s (Broverman, Broverman, Clarkson, Rosenkrantz, & Vogel, 1970) and perhaps rightfully so. In this study, participants chose specific adjectives to describe a "mentally healthy adult," versus a "mentally healthy man" and a "mentally healthy woman." Findings showed that participants selected the same descriptors for "healthy adult" (for example, independent, objective, self-confident, and ambitious) as they did for "healthy man," and very different, less socially desirable adjectives for women (for example, dependent, subjective, passive, and gentle). To many, this was a declaration that an emotionally stable adult was necessarily a man. Women were something altogether different, "other" or "less than." Around the same time, Chesler's (1972) classic work Women and Madness passionately exposed our culture's practice of defining women's experience as pathological and its use of psychiatrists to diminish and control women. It demonstrated how these and other factors in the mental health system operated to ensure maintenance of the status quo in terms of gender roles and in the allocation of power and status. It was said that mental health clinicians--both women and men--were guilty of perpetuating an ideology that reinforced a view that women's mental health problems were related to the individual, or more important, were not related to the oppressive forces in society (Smith, 1975). In addition, a number of feminist scholars of the time, including Carmen, Russo, and Miller (1981), pointed out that the old traditional model of helping--an expert male authority and a subordinated female patient--"replicates and reinforces the inequitable power distribution" that exists in families and at work (p. 1325). These arguments, promulgated in the 1970s and 1980s, helped spur on a new era of theorizing among feminists regarding women's experience with respect to mental health. Today, for example, students learn a new psychology of women, energized by Gilligan (1982) and others, who argue that women make decisions--and thus structure their lives--in ways that are very different from men but are equally valid and legitimate. Miller and Stiver (1997), for example, contended that women's connectedness (as opposed to the male value of independence) and "moments of shared 'mutual empathy'" lead to strength and health. Disconnectedness and the experiences of rupture lead women to anxiety and depression (Miller & Stiver). In addition to these new ideas, feminist critiques of the older male-privileged theories of Freud, Erikson, Bertelheim, and Kohlberg (to name a few) have stemmed their blind acceptance. …