Picture credit: DeAgostini via Getty Images

Just a pill?

How psychiatry pathologises female experience

Artillery Row Books

Photos of ghost children decorated the walls of the adolescent psychiatric unit. “Patients from the olden days,” staff would tell us. “They could have been locked up for life.” Unlike you lot, was the implication. The year was 1987 and I was twelve years old. I’d stare at the blank-eyed, monochrome children and count my unlobotomised blessings.

It seems no one is ever in any doubt about psychiatry’s shameful past: fathers institutionalising wayward daughters, husbands locking up inconvenient wives, brains destroyed for being too female, too black, too gay.

It’s not as though the discipline itself shies away from these truths. They are in plain sight, pictures put in the service of promoting a more enlightened present. Why not, I guess. When you’ve got the clitoridectomies, chemical castration and the pathologisation of runaway slaves in your back catalogue, anything you do henceforth will look enlightened by contrast.

Reading Jessica Taylor’s Sexy but Psycho, a feminist challenge to the psychiatric labelling of women and girls, I find myself thinking of contemporary psychiatry as the abusive partner who tries to control you by telling you how shit all the other men are.

“C’mon,” he wheedles. “It’s not as though I’m administering electric shocks until you start to have seizures. Or sticking an ice pick through your eye socket and wiggling it around in your brain matter. It’s just, like, a pill or two. What’s the big deal?”

Of course, contemporary psychiatry doesn’t see itself that way. It sees itself as a force for good and anyone who disagrees is, at best, anti-scientific and stuck in the past, at worst, a conspiracy theorist, a promoter of stigma, a pill-shamer, and maybe, just maybe, a little bit mad.

Like communism, like “sex positive” feminism, it just hasn’t been done properly yet

I don’t think Taylor is mad. I don’t think I’m mad, either, but then I would say that. The problem with women who say they’re not mad is that people who disagree and have qualifications in such matters — who are experts in reality, so to speak — might simply read this as a further failure on the part of such women to perceive the world as it truly is.

Having learned at an early age that the best way to please psychiatrists — and men — is to reflect their worldview back at them, I’m distinctly uncomfortable with the thought of situating myself on the Wrong Side of Sanity. I want to be thought of as clever, rational, science-y. I don’t want to be considered anti-psychiatry, not least with its current overtones of anti-vaxxer. Alas, I think anti-psychiatry may be what I am.

Taylor is uncompromising, stating that psychiatry is wholly incompatible with women’s liberation. The present-day examples she offers are numerous and shocking: women and girls harmed by sexual violence being told their signs of trauma reveal them to have personality disorders; abused women being encouraged to get diagnostic labels in order to access support, then having their diagnoses used to discredit their testimonies; women’s reports of violence and abuse being treated as evidence that they are fantasists, particularly if they already have histories of being labelled mentally ill; women’s physical ailments being treated as emotional, while their emotional distress is treated as physical in origin.

A label becomes a kind of criminal record one must carry for life

The current vogue for “de-stigmatising” mental illness, suggests Taylor, is actually a way of de-stigmatising the act of stigmatising women and girls rather than offering them the trauma-informed support they require. I’m sure there are many who will claim that the misogyny she identifies is a bug, not a feature of psychiatry, and that a prejudice-free, politically neutral psychiatric praxis is just around the corner. Like communism, like “sex positive” feminism, it just hasn’t been done properly yet.

Still, I am wondering just how much more time it needs. While we’re waiting for some God-like genius to properly divine the difference between abused woman and crazy bitch, the trauma of those subjected to physical, emotional and sexual violence becomes a narrative repeatedly used against them.

Others might claim that having a psychiatric label has helped them, even if it fails to capture the roots of their suffering. I understand this. It is a shorthand, and often the only means one might have of accessing financial and community support. There is a point, however, at which a label becomes a kind of criminal record one must carry for life. Applying for life insurance in my late forties, I am forced to reveal that I have spent time “inside”. This instantly knocks me out of the same category as my partner, who might drink while I do not, who might not exercise like me, but isn’t, you know, one of them. We are both aware that if our relationship were to falter, he would have courtroom advantages I lack. Neither of us expects this to ever happen, but still. Whether he wants it or not, he has the hand grenade in his back pocket. I don’t worry about this or get cross (not openly, that is. Crossness or worry, for those with a record, might smack of a personality disorder. Then again, the absence of either might indicate “flat affect”. Once you are labelled, performing sanity becomes an etiquette nightmare).

The thing that convinces me most that Taylor is right about the incompatibility of feminism and psychiatry is the repetition of one scenario affecting all women, from the unnamed abuse victim to Britney Spears. A psychiatric diagnosis robs women and girls of two of the things for which feminists have fought longest and hardest: our credibility and our right to consent to what is done to our own bodies. It tells us we are not reliable witnesses to our own lives and hence must defer to others to tell us what is real. It does not recognise that this is what men have always done to women, let alone acknowledge that this dynamic, as it operates in the wider world, is what has traumatised many of us in the first place.

This is not to say that women cannot be deluded or wrong or self-harming, but it makes of it a principle, a way of reading every act and perception, extending indefinitely into the future. Henceforth, if you say what people want you to say you are manipulative, and if you refuse, you are non-compliant.

Sexy but Psycho, Dr Jessica Taylor (Constable, £16.99)

As a traumatised adolescent slapped with a label, I recall endless “handover” meetings in which I struggled to work out the best way to respond to the latest incident of “normal behaviour being re-interpreted as weird”. Should I agree that yes, maybe I do seem a bit obsessed with Madge in Neighbours, even though I think I’m not? Or do I deny it, in which case I become someone who is not only obsessed with Madge but, when challenged, refuses to defer to authority? As Taylor’s book makes clear, women and girls are still being placed in this double bind (and Madge died in 2001. Although she did visit Harold as a ghost in 2015. Not that I’m obsessed or anything).

I know not all feminists will agree with me or Taylor. Many find it easier to take issue with the prescribing of puberty blockers to young children than the prescribing of psychiatric medication to traumatised girls, with one comment I often hear being that the former will soon be “a scandal akin to lobotomies”. This relies on the assumption that the fall of the lobotomy constituted some great act of atonement, as opposed to their being replaced by high-strength medications (one drug I was forced to take, aged twelve, was originally marketed as “the chemical lobotomy”).

What the relatively untouchable status of psychiatry should teach us is that once something becomes an established norm it can become intractable, no matter how murky its past or how visible the present-day harms. And when the promotion of harmful practices can be cloaked in the language of social justice — fighting stigma, ending pill-shaming, promoting wellness — we cannot wait for such practices to run their course.

In 1990’s The Beauty Myth, Naomi Wolf argued that “new possibilities for women quickly become new obligations. It is a short step from ‘anything can be done for beauty’ to ‘anything must be done’”. She was right. In 1990 it was not normal for wealthy women to have their faces injected with poison during their lunch hours; now it is. I think the same principle operates in terms of psychiatric labelling and treatments. If it can be done, it will, and once it is being done, it is seen as justified.

When I arrived at the unit with the photos on the walls, I wasn’t allowed books, letters or magazines. I had to stare at the walls, so I used to time myself staring at one wall for an hour or so, then another. Very Charlotte Perkins Gilman, I like to think now. Turns out 1987 wasn’t as enlightened as 1987 thought it was at the time. The thing is: I don’t think now is, either.

I would say that, though, wouldn’t I?

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