Women's Health

 

Learning Outcome 3

 

Women and Mental Health - historical overview

 

 

What is mental health?

 

Mental health - and mental illness - covers a wide range of illnesses and disorders, which can vary greatly in severity and can last anything from a few months to a lifetime. While conditions such as schizophrenia have a relatively long history, our awareness of others, such as postnatal depression and Alzheimer's, has increased greatly in recent years.

 

The debate over what constitutes 'madness' and mental health is far from clear cut, and feminist critiques to the medical model of health, covered in LO1, are particularly relevant to this Outcome.

 

Atypical psychology is the area of psychology concerned with mental health issues, and as with other areas of psychology, different psychological approaches have different explanations of the causes of mental ill-health.

 

 

Revision exercise: psychological approaches

 

Consider the following three approaches from Psychology. How might these approaches attempt to explain the causes of a condition such as depression? Discuss in small groups and make notes below:

 

 

Biological approach

 

Psychoanalytical approach (Freud)

 

Social Constructionist approach

 

 

'Madness' and being a woman

 

Feminist writers such as Ussher argue that:

 

" 'Madness' acts as a signifier which positions women as ill, as outside, as pathological, as somehow second rate - the second sex."

 

                                                                        (Ussher, Women's Madness, 1991)

 

Ussher argues that 'madness' has been used throughout different periods of time as a label against women, to describe women who are seen to be stepping out of line with the expectations of their culture and society. For Ussher, such labels reflect not a diagnosis but a tool of social control, devaluing the opinions of women and silencing them on the basis that they are irrational. She argues that while men also experience 'madness', they experience it differently, and treated differently - while women are traditionally more likely to be medicated or admitted to psychiatric hospitals, men are more likely to go to commit suicide or go to prison.

 

Consider this argument in the context of Scotland in the 21st century. Is this still the case? Can you think of examples where you have experienced women being labelled in such a way, either in the media (in relation to celebrities or public figures), in the workplace or in wider society?

 

 

A brief overview of women and mental health

 

One of the most prominent associations of women and 'madness' is that of the witch-hunts between the 14th and 17th centuries. The hunts spread across Europe and North America and were particularly prevalent in Scotland, where thousands of women and men were put to their deaths. Although precise figures are disputed, there is little doubt that women were identified as 'witches' far more often than men, with estimates of ratios ranging from 6:1 to 20:1.

 

The debate continues among modern historians as to the real reason why so many unfortunate individuals were identified and brutally punished during this time - were they eccentric, mentally ill, or just in the wrong place at the wrong time? The Malleus maleficarum (Witches' hammer) was published in 1487, describing in detail the alleged crimes of 'witches', and several hundred thousand copies were distributed at a time when few accessed any books other than the bible.

 

From historical documents such as the Witches' hammer, Ussher identifies several factors contributing to the witch hunts:

 

·         Religious beliefs depicting the biblical 'Eve' as a bad influence corrupting weak men; and fear of possession by 'evil spirits'.

·         Communities seeking a scapegoat at a time when illness and disease was rife, with little scientific explanation available.

·         Those targeted were often vulnerable, older, unmarried or widowed women, who might have kept pets for company.

·         A fear of women's sexuality and menstruation - of women as 'Other'

 

Sick or strong?

 

While two physicians, Weyer and Scot, questioned in 1563 whether the 'witches' being burned for their crimes were in fact 'deluded individuals' who needed care rather than punishment, the assumption that witches were mentally ill has been challenged latterly by some feminist writers.

 

Instead, writers such as Gage (1972) have suggested that witches may well have been women healers, arguing that at the time, such women would have been the 'most developed scientists'. Others have suggested that such 'healers' would also have acted as midwives, and provided basic abortion services.

 

The advance of science and the Victorian 'female malady'

The Enlightenment and the advance of science into the field of mental health saw at least some improvement in the lot of the severely mental ill. Prior to 1828 asylums had no legal requirement for medical supervision, and there are accounts of patients being treated as animals and subjected to public voyeurism. The advance of scientific medicine led to a shift away from notions of 'possession' by evil spirits or witchcraft, and a recognition of mental disorders as 'illness', with the 1845 Lunatics Act establishing the care of the mentally ill as the responsibility of the medical profession. The period following this Act saw an expansion of provision through large-scale mental health institutions, with increasing numbers of women admitted - many of whom would previously have been confined at home.

 

Women's sexuality forms a common theme throughout Victorian attitudes towards women's mental health; disorders such as 'nymphomania', masturbation and homosexuality were investigated, and lesbians were among many labelled as 'mentally ill' for their sexual deviance. While asylums were used as forms of social control for those deemed to have taken too much interest in sex - those with unwanted pregnancies, or thought to be 'pursuing' male attention - sex and pregnancy were also seen as 'cures' for the abnormalities of the celibate, spinsters and lesbians.

 

Victorian attitudes towards women's mental health also varied according to a woman's social class and status; while working class women's mental health was largely ignored amidst a massive burden of labour, pregnancy and childbirth, middle class women - particularly young women - found themselves placed in a 'gilded cage' where a delicate state was seen as feminine and a variety of treatments were prescribed for 'hysterias'.

 

Twentieth Century

 

The twentieth century saw further medical scientific developments alongside the development of psychology as a separate discipline, from Freud's early theories on the mind, through the rise of Behaviourism to the Humanistic and Cognitive schools in the 1950s - 70s. Drug treatments and medical interventions evolved during this time, with the development and refinement of sedatives, and (at times quite brutal) experiments using surgical intervention and electric shock treatment.

 

The 1960s saw major challenges to orthodox concepts of mental health, both in terms of the nature of mental health and mental illness, and also in the treatment of patients. Enoch Powell was among those to call for 'care in the community' in the early 1960s, although the idea was not fully implemented until thirty years later, while R D Laing led the 'anti psychiatry movement', connecting mental illness - and in particular schizophrenia - to social and environmental factors, and especially the role of the family. Laing attributed women's 'madness' to a type of survival strategy in the face of competing and contradictory demands made on women in a patriarchal society, later describing schizophrenia as a 'journey' in which the therapist should act as guide rather than medical expert.

 

Laing was heavily criticised at the time, however, his ideas have influenced many modern psychologists and psychiatrists, and the anti-psychiatry movement has contributed to an increased awareness of patient rights and of alternatives to drug-based treatments in some cases.

 

Mental health care today continues to evolve, most notably with the 1990 NHS and Community Care Act. While the Act saw the closure of the large Victorian institutions that had dominated mental health care for over 100 years, the policy has been heavily criticised for 'dumping' vulnerable people into inadequately resourced communities, at a time when demand is greater than ever.

 

Questions and discussion points

 

·         How have knowledge and attitudes towards mental health changed in the last 500, 150 and 50 years? In what ways have they improved? Has scientific understanding always improved standards of care and treatment?

 

·         What common threads can be identified in attitudes towards women and mental health in different historical periods and the present day?

 

·         To what extent do you think the contradictions of Victorian times - 'damned if you do, damned if you don't' attitudes towards sexuality - still exist today?

 

·         What do you think Ussher means by women as 'Other'? Is this relevant to modern understandings of mental health?