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by Mary B. Ballou and Laura S. Brown (editors)
Guilford Press, 2002
Review by Peter B. Raabe Ph.D. on Dec 5th 2002

Rethinking Mental Health and Disorder

This is an excellent book.  It is a collection of essays written by a variety of authors.  Their perspectives on the kinds of human suffering that are, in North America, often called mental illnesses raise a number of fundamental questions about the medical model promoted by mainstream clinical psychologists and psychotherapists.  The key to appreciating this book is to first of all be comfortable with feminism.  Once the reader understands that two of the primary feminist arguments are that you can’t generalize from one to many (and vice versa) and that you can’t generalize from men to women (and vice versa), you have the necessary basics to understand the so-called feminist perspective on mental illness. 

This book makes visible how feminists have raised the awareness of mental healthcare providers and consumers in a number of significant ways.  For example feminists have pointed out that psychological research data is often generalized from study samples that are too small to be statistically significant, that conclusions based on research conducted on males (such as in the area of personality or moral development) often aren’t true of women, that the observed phenomenology of so-called mental illnesses in men have been used to develop diagnostic criteria that are biased against women, and that some treatment methods—such as a male therapist’s masculine dialogical style—may be counter-productive to women in therapy.  In other words, feminism has brought to light the fact that gender differences produce a greater complexity in the human condition than male mental healthcare professionals have been willing to acknowledge. 

One other important point made by feminism that is especially relevant to mental healthcare is that the medical model of a mental illnesses may be unjustified in the majority of cases because it is unscientific.  In the Preface the editors write,

“Human behavior is increasingly being forced into the box of biology.  Hormonal, evolutionary, and genetic models of behavior are more frequently being proposed as explanations for all human behaviors, even in the absence of strong empirical science to support such models....”  (xi)

The reason this point is so important is because if a person’s behavior or thinking is attributed to biology it effectively eliminates the autonomy or free will of that person.  It diminishes a description of their actions from the language of intentions to that of biological determinism.  A number of writers in this book point out that women have historically been described as primarily determined by their biology, thereby having their rationality summarily dismissed. One author goes so far as to argue that the recent diagnosis of “Pre-Menstrual Syndrome (PMS)” and “Post-Partum Depression (PPD)” are the most recent examples of the anti-rational medicalization of the normal emotional rhythms of a woman’s life experiences because they are different from the  “male-as-normal” experiences. 

This book contains eleven essays written by a variety of authors in the field of psychology, and is divided into two parts.  The first part is titled “Developing Feminist Theories” and deals with feminist perspectives on issues such as personality development, attachment theory, personal identity, and human nature.  The conception of the autonomous person is a central theme throughout this part of the book.  For example, in chapter 3, titled  “New Developments in Relational-Cultural Theory,” authors Judith Jordan and Linda Hartling agree that it is important to help individuals diagnosed with a mental illness develop what has been called an internal locus of control  (ILOC).  The realities of sexism, racism, heterosexism, and other forms of discrimination can severely limit a person’s ability to feel such an internal locus of control.  But they caution that this ILOC can also be used by the dominant group in society to distract from the social realities of oppression by convincing the oppressed that they should in fact feel that they are in control and therefor responsible for their oppression. 

These same authors also give some very good advice to therapists for the treatment of Post Traumatic Stress Disorder  (PTSD) that may not be found in mainstream psychotherapy texts.  One of the aftereffects of the sever trauma that brings on the symptoms of PTSD is a mistrust of other individuals and an avoidance of connections through relationships.  The authors suggest that the therapists ought to show her humanity and truthfulness by acknowledging her own relational imperfections and limits to her client, that the therapist recognize her client’s strategy of disconnecting herself from others as necessary for survival, that the therapist admit to her own mistakes and apologize  (thereby lessening the power differential between therapist and client, as well as heightening the humanity within the relationship), that the therapist encourage her client to develop new relationships, and that the therapist encourage the client to voice her dissatisfaction and discomfort with any aspect of the therapy.  This is the sort of cooperative, inter-dependent, and non-paternalistic approach to therapy not readily found in traditional psychotherapy texts. 

The second part of the book is titled “Psychopathology” and offers the feminist point of view on things like premenstrual syndrome, postpartum depression, alcohol and drug addiction in women, depression and schizophrenia in women, and treatment approaches and recovery for women.  In Chapter 9, titled “The Chrysalis Program:  Feminist Treatment Community for Individuals Diagnosed as Personality Disordered” author Margo Rivera argues that the North American approach—which fragments the stress of trauma and victimization into comorbidity or a multiplicity of individual disorders, and then treats these as medical illnesses—is not as therapeutically effective as the approach used in the Chrysalis Program which treats the sufferer, usually a female victim, in a more holistic manner.  She also reiterates what feminist-informed practitioners have often said:  when distress is labeled as a pathology or disorder it locates the source of the problem in the distressed individual rather than in its cause.  It thereby reduces any normative expression of gender, race, or class that contradicts the status quo to individual pathology.  This is an appropriately political perspective on what psychotherapists typically consider the very personal predicament of mental illness.   

For readers who have had no experience with feminist critique of clinical psychology and psychotherapy this book will be an eye-opener that answers many questions while raising many more.  For those who are familiar with the territory this book is a challenge to readers to beware of complacency, and to not assume that the demands of feminism have been satisfied because all wrongs have been righted.  This is a powerfully thought-provoking book that will complement any other text devoted to the discussion of mental health and disorder.  

 

© 2002 Peter B. Raabe

Peter B. Raabe teaches philosophy and has a private practice in philosophical counseling in North Vancouver, Canada. He is the author of the books Philosophical Counseling: Theory and Practice (Praeger, 2001) and Issues in Philosophical Counseling (Praeger, 2002).