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Heavy Mental
A Review by Andi Zeisler

"What has really changed since I wrote this book?" asks Phyllis Chesler in the introduction to the latest edition of her groundbreaking, controversial, and still-vital work on women and mental health. "The answer is too little -- and quite a lot."

The same can be said of how perceptions of feminism have changed over the years, and Women and Madness is nothing if not one of the second wave's definitive works. The book centers on the unavoidable truth that the sexism and disdain for women inherent in the medical profession has historically led them to be labeled "crazy," and that social discrimination too easily becomes the basis for mental pathologizing.

First published in 1972, Women and Madness brought to light the historical mistreatment of women in the service of "curing" them: Profiles of eminent 19th- and 20th-century clinicians, case histories of psychiatric patients (including writers Elizabeth Pack-ard and Charlotte Perkins Gilman), in-depth interviews, and analyses of treatment methods testify to systemic and often horrifying abuses of female patients by doctors and institutions. Women were delivered into treatment by their husbands and families not just because they were depressed, anxious, or schizophrenic, but also because they were frigid, "unfeminine," lesbians, unwilling to marry or leave home, victims of rape or molestation as children, or just plain nonconformist. As the patients of male psychiatrists, they were belittled, patronized, and often encouraged to engage in sex with their doctors as a "cure" for their frigidity or daddy issues. In institutions, they were regularly deprived and abused by both staff and fellow inmates.

The book was, for 1972, a revelation, and it electrified a burgeoning feminist consciousness among many of its readers. Women, Chesler argued, constitute a greater number of psychiatric patients than men not because they are appreciably more ill, but because women are socially marked as the "weaker" sex -- not just physically, but mentally. Their inferior social role has led to depression, and their lack of acceptable outlets has likewise led to long "careers" as psychiatric patients. That social limitations were inextricable from personal health was a crucial tenet of the feminist women's health movement. As the cofounder of the Association for Women in Psychology and the National Women's Health Network, Chesler has been a tireless advocate for the rights of women to voice their experiences from within an isolated realm. And though it's true that the subject of mental health can no longer be considered taboo, the stigma of mental illness -- particularly among women -- still exists. No one gets out their fainting couch when a lady comes calling, but the stereotype of women as the crazier sex still gets trotted out with alarming regularity.

Sadly, but perhaps not surprisingly, Women and Madness is still a revelation. The mainstream practice and teaching of psychiatry, Chesler notes in the new introduction, has certainly changed since she was a medical student, but clinical biases (sexism, racism, classism, homophobia, and more) are still threaded thickly through textbooks, medical journals, and published studies. She notes that, for female patients, often-debilitating medical conditions like lupus and chronic fatigue syndrome are regularly dismissed as "just" psychiatric illness; that psychiatric counseling for rape victims will invariably be used to further a "nuts and sluts" defense when the rape goes to trial; and that class and race stereotypes (wealthy white women are bored, not depressed; women of color are "stronger" than their less oppressed counterparts) run rampant in the white halls of psychiatric medicine.

It's a bracing read, and -- despite all the bad news -- an enjoyably varied one; the highly literary Chesler uses art and myth as analytical jumping-off points, incorporating the stories of Demeter and Persephone and Artemis and Athena into discussions of family pathology and drawing persuasive connections between witch hunts and 19th-century diagnoses of female patients. (She may lose you a little with some of the original poems that serve as chapter epigrams, but stick with it.) Although Chesler acknowledges that she has "moved on theoretically" since the book's publication, she also notes that it has informed all of her subsequent work. As an indictment of how the female perspective -- whether medical, legal, or political -- is unthinkingly, systematically marginalized, it can inform a lot more of us.

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