New work from social work professor Merrick Pilling investigates clinical practices inside a psychiatric hospital, revealing the complicity of mental health professionals with rape culture. His work finds that the notes of mental health workers often minimize and normalize sexual violence against women and trans people, cast doubt on women’s accounts of victimization, and construe symptoms of sexual assault as pathological and/or medical. This work also documents the specific ways that the experiences and behavior of Black and trans women and men are singled out as particularly untrustworthy, inappropriate, and pathological.
Rape culture refers to the normalization of violence against women and trans people and has been shown to impact the mental health of sexual assault and abuse survivors. Several scholars have insisted that apparent psychosis or voice-hearing in women is not a symptom of madness or disease but instead an inevitable outcome of rape culture.
Further, a culture of anti-Blackness has been shown to contribute to the emergence of psychosis for persons discriminated against based on minority status. In general, people from ethnic minority backgrounds typically experience greater psychological distress, which is linked to poor mental health outcomes.
Pilling, a professor of Women’s and Gender Studies in the School of Social Work at the University of Windsor in Canada, writes:
“The confluence of anti-Black racism and misogyny, also known as misogynoir, means that Black women are even less likely to be believed and more likely to be blamed for the violence they experience.”
The combined impacts of rape culture and anti-Blackness in psychiatric practice emerge clearly in Pilling’s work. Here, Pilling’s research team examined 161 charts written by mental health professionals working with patients diagnosed with a “psychotic illness.”
Analysis of these charts revealed five emergent themes: the normalization of sexual violence; sexual violence reconfigured as delusion; pathologizing the impact of sexual violence; invisibilizing perpetrators’ acts of sexual violence; and the interpretation of sexual violence as a symptom of psychosis.
In each case, the mental health professionals’ “sanism compounds rape culture in that sexual violence is perhaps even less likely to be recognized as such when experienced by those whose realities are already constructed as questionable.”
Through detailed analysis of specific case studies, Pilling documents how Black, female survivors’ claims of sexual assault are minimized and pathologized within clinical interpretations; how the complaints of white, cis women are taken more seriously; and how the abuses of white male perpetrators are viewed as psychiatric symptoms as opposed to social or criminal matters.
Both Black and white women’s “experiences of sexual harassment and violence are reconfigured as delusional thinking.” For example, when confronted with one woman’s assertion that males on the ward were harassing her, “the psychiatrist’s solution was to offer medication, a biomedical solution to a social problem.”
Thus, when confronted with symptoms of abuse, psychiatrists often assign diagnoses instead of contextualizing “symptoms” as a response to abuse.
In this way, “rape culture, Pilling writes, “shapes practitioners’ documentation about patient histories of sexual violence by failing to meaningfully connect past experiences of abuse to current distress and by pathologizing the impact of abuse as indicative of psychotic illness.”
In contrast, male perpetrators’ acts of sexual violence were often interpreted as directly linked to madness and seen as being caused by it, particularly in cases of psychotic illness. Aside from its gendered nature, this phenomenon also conflated violence with madness.
“Men’s abusive behavior is never identified as an issue that is separate from mental distress, even in cases where it seems clear from reading the chart that the perpetrator has a long history of abusive behavior. This indicates the presence of rape culture and sanism as governing logics in the charts of perpetrators.”
Pilling’s contribution to the study of sexual violence and rape culture within psychiatric wards suggests the necessity of recognizing how responses to sexual violence are imbricated with racism, anti-Blackness, and sanism, and how clinical practices do not exist outside of, but rather perpetuate, rape culture and other forms of oppression.
Pilling, M.D. (2021). Sexual Violence and Psychosis: Intersections of Rape Culture, Sanism, and Anti-Black Sanism in Psychiatric Inpatient Chart Documentation. In: Daley A., Pilling M.D. (eds) Interrogating Psychiatric Narratives of Madness. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-83692-4_6 (Link)
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Psychiatry retraumatizes, or traumatizes people. Period.
Often that trauma is not recognized until decades later, sometimes not at all,
which of course serves psychiatry well.
As a white cis woman who had life destroying experiences with the mental health system over a period of 4 decades, I guess it could have been even worse if I wasn’t white,… I’ve certainly gotten that message from several people including one person who told me that if I were a person of color I would be dead or in jail instead of someone who had gotten so many second chances from the helping system, but it’s hard for me to imagine that. It was pretty awful as it was. I was never believed by any treatment provider even the ones who put on a facade of acceptance and non-judgmental stance (the DBT ones). They never believe me about anything either.
The mental health system is definitely permeated with rape culture. Just the fact of being told you have to swallow something that you know yourself is poison and toxic and bad for you but they tell you is good for you and if you don’t swallow it we won’t ever release you from lock up and/or we will write more terrible things about you in your chart is a form of rape in my opinion. I was once not that long ago made to lie on my stomach so they could give me a shot in the butt of something that easily could have been injected into my arm but they had to humiliate me more and have four male security guards stand over me and watch.
Great article. This topic needs writ large. I endorse its campaign to bring any travesty of justice to light. Jenny Logan I like to arm wrestle with your brightspark articles. Done in the spirit of witty affection. I have no pretentions that anything I say can ever influence any atom of the world. The world is as it is. But let me have a sisterly squabble.
So, regards this article my only quibble is this…
As someone with real psychosis from real schizophrenia which is to me a real illness that really does disable me profoundly every single day, I am vulnerable to being molested in any setting, whether psychiatric or not. I am so ill most days that I cannot look after myself to the extent I would wish to. For instance, my schizophrenia has in the past insisted that I dress provocatively. This area of concern would come under the auspices of patient care.
If this article is trying to suggest that I am not ill with real psychosis from real schizophrenia, as is my own experience, then it is perhaps attempting to put me in a different “expert” box that tells me what I experience. My illness does not come from rape or abuse. I am in no way saying that “other people” are “the same” as “me”. Other people may have a history of rape and abuse preceeding their illness. Is their “psychosis” genuine psychosis then? Or is it, as the article seems to suggest, a breakdown caused by distress and trauma? Maybe in other people their symptoms are only due to appalling distress. Does that population of “the distressed” prove that psychosis and schizophrenia is not a real illness in “some” uniquely “different” people?
A misdiagnosis, even a mass gaslighting misdiagnosis, such as occurred in the Victorian era over diagnosing of hysteria in articulate women, does not prove that the illness that is diagnosable is an “impossibility”.
Both wholesale mass over diagnosing AND complete dismissive cease of diagnosing are to me both odious blanket applications of “assumption”. They “both” attempt to use shallow arguments to prove or disprove someones real experience. They “both” come the “expert” with all the latest research brain imaging gnossis or psychobabble gnossis.
Diagnosing should be “patient led”. The patient should be the new “expert”. And this patient, myself, says her psychosis is real and so is her schizophrenia illness real, and none of it comes from trauma.
That is not to say that the huge move to asign a designation of trauma to many things us not useful and important and necessary and good. The more civilization acquaints itself with the real reality of a brewing storm of mass rape and mass abuse trauma the better.
I am only saying that “my illness” is “not” caused by politics.
I am saying that for a therapist to be the new “expert” to treat my psychosis as if it is assumed to come from an event in my past is patronizing.
In recent history it was as patronizing to send someone with multiple sclerosis to a counsellor for “stress” or “anxiety” as it was to bore into their brains to rummage for plaques or molecules. Both the “brain is diseased” sort of “experts” and the “psycho social model” sort of “experts” are but flip sides of the same “non-listening” clanging tinkling betting gold bullion bullying coin, that is polished to gamble with someone elses “own” real experience.
One cannot thwart an institution that has been infiltrated by bullying henchmen, ones who pontificate that they know all about what makes you tick, by setting up a counter institution that delivers a riposte that “no no” there are new findings that know all about what makes you tick.
So, yes, people of the world I say you can flag up the massive scale of trauma. The sooner the better.
But I also say no, people, you cannot swap what you think makes me tick for my real experience of my real schizophrenia.
I say, yes, people, please do roll out some appropriate lessons in trauma informed care and have these tour every college and school.
But I say, no, people, you cannot daub my real psychosis, which is my actual illness, on your scandal highlighting political banner.
Schizophrenia has always been used as a political prop and a bandwagon. It is as if people cannot just mend it.
People have historically reviled the person with that illness.
People have used that ill person as an example and metaphor and lesson of what happens if you dont attend church.
Or conversely new people have used the person with that illness to humiliate those churches and governments.
In either way, whether historically using the psychotic as threat of what hell you will end up in if you do not toe the line, or using the psychotic as indicator of what will happen to you if you dont join everyone in an effort to bring down the walls of Jerico, it is often done under the auspices of “support and care”. But it seems to me in either case it merely props up another reason to stop actually “listening” to the ill person concerned, as if they are a puppet who cannot make choices for themselves, and cannot state how ill they really feel and state their own choice of gnossis of why they are ill and state their choice of care they want. This quasi supportive puppeteering is also a form of “abusing”.
Grooming is like gaslighting. It is where an “expert” in “your inner self” tells you what is really happening to you, or has happened to you. It is done to you “for your own good” because you are supposed to entertain the idea that you need schooled up in “you”.
Debunking is a blessing and a curse. It can be good to debunk the propaganda that streamed into you from previous groomers. It becomes an important and healing and rescuing form of de-culting. However, debunking can itself be a new form of grooming.
I am suspicious of any “lets all know we are the same and have the same needs and the have had the same experiences and have the same malaise and agree about the same religion or agree about the same politics and have the same utopian vision for the world.
It is a debunking of assumed ideology since it is an attempt at yet another form of “consensus” opinion.
A consensus that all are encouraged to sign up to in order to put paid to and rubble the disgraceful former era’s “consensus” seekers, for instance the tambourine men in the religion of psychiatry.
Consensus is alluring because it promises a sense of powerful and comforting samey belonging, but sometimes, as in the worst aspects of psychiatry, consensus is a togetherness only offered to you provided you give up your own freedom and ability to be different.
In branding everyone with schizophrenia, consensus opinion in the last century attempted, through “expertize” to debunk the reality of “difference”. It became a sport at “grouping” and “categorizing” via consensus opinion that all samey people were suffering from the samey condition.
In the branding of everyone as traumatized, consensus seems to be attempting, through new “expertize” to also debunk the reality of “difference”.
If I cannot come here and “be” my “own difference” without meeting wallpapers of articles that say I am “”the same” as everyone else then I am being measured for yet another straight jacket.
An illness is NOT the same thing as the BAD TREATMENT it has been given. The real tragic illness of leprosy is not the same thing as the BAD TREATMENT of a nightmare rat infested quaratine island.
When new “experts” attempt to marshal consensus opinion that purports to say that BAD TREATMENT of an illness should cease, then it is a commendable campaign full of the highest integrity.
New “experts” attempt to imply that the illness does not exist since it is “only” caused by BAD TREATMENT. In order to get rid of BAD TREATMENT, and therefore the illness it apparently caused, we all have to sort of debunk or get rid of the illness. We all have to bin experiences of illnesses of ourselves and even of strangers, people we have never met or spoken to, people who as unique individials with unique chemistry or biology may well actually have an illness that cannot be proved is real or disproved, since absence of proof is not proof of anything. Confidence in absence of proof as signalling what we all “have to” learn is reality is what spit roasted Gallileo. Just because science does not have a clue what consciousness is does not mean it does not exist as a personal experience.
We are not “all the same”, and researchers who think they know the exact cause of someone else’s illness, an illness maybe nobody else has, should be researchers who do not imagine their “expert” gnossis is enough to judge absolutely everyone….I say yet again this truth…
“The ill have a right to be ill”.
It comes from this…
“The different have a right to be different”.
If the vision of a new world is one where the ill and the different do not have that right then it may turn into an equally traumatizing world and so it can keep its belonging through consensus.
If I am forced to think I am schizophrenic when I am only traumatized, then that impostion of “expertize” by someone else can be experienced as a form of propaganda and rape of my freedom.
But equally if I am forced by someone else to think I am not schizophrenic but only suffering from trauma, then that also is an imposition of “expertize” by someone who is not me and that can be experienced as a form of propaganda and rape of my freedom.
Add to all of this the way, as your article rightly reveals, in which rape is not taken seriously in any campaign or institution, and what we could see is the actually ill, with say a very severe psychosis that has not been caused by trauma get inappropriate coercive therapy to “talk about” their trauma, in an effort to speed up their supposed halleluja eureka moment of magical acceptance. I can see a large population of severely ill schizophrenic people being regarded as “rebellious” for not taking the therapeutic consecrated wafer of the latest consensus opinion. I can see that if those genuinely psychotic people do not effusively transform themselves out of psychosis and schizophrenia and become “healed” or corrected by treatment then they may be concluded “treatment resistant”.
I do not doubt that many who read my efforts think that I am “treatment resistant” in this new consensus opinion about trauma.
Like I say, I am all for seeing trauma as a big factor in illness. I am not for thinking it is the cause of my illness. I suspect I am not alone. But I do not want to throw a dampner on the missionary zeal needed to mount a herculean task to get trauma taken a lot more seriously globally.
I recently had a covid vaccine and a flu vaccine. Covid is real. It causes real illness. Flu is real. It causes real illness. Trauma is real. It causes real illness. Schizophrenia is real. It causes real illness.
All people with all sorts of illnesses have a right to appropriate proper support and care. BAD TREATMENT, such as forced hospitalizing, forced treatment, forced diagnosis, forced medicating, without recourse to natural, holistic forms of care and healing must stop. FORCING is not LISTENING. Consensus opinion can start out enshrining the virtue of listening but in order to protect the reality of the growing power structure found in consensus belonging, there can arise a FORCING of everyone to be “the same”, and this goes against really listening.
Listening is not hard. It is only hard if the listener thinks they have to “do” something to “fix” the need of listening. Whereas in actuality the listening itself is the only medicine needed.
People think that both “doing” and “fixing” are exhausting obligations that require lots of consensus effort.
Doing and fixing are often the worst thing you can do to an individual.
Leave the individuals alone to be individuals and build a community of the uniquely dramatically different where there is no consensus but the consensus agreement not to be abusive, cruel or bullying.
But these are just my own views. I am not an “expert” on anything. No even on me.
I, honestly, don’t know about an anti-woman or a racist culture in psychiatry and by psychiatrists and related “health providers.” In my experience and opinion, they treat all their “patients” the same—like little “lab rats” to be experimented on with “drugs,” “therapies” and other alleged “treatments.” I have since I left the “psych world” considered how the word, “therapist” is actually “the-rapist.” “Psych World” does not discriminate. It rapes the minds and the bodies of all their “patients” although it may not be considered as rape in legal terms. But, it doesn’t matter. Taking the psych drugs makes your whole body insides feel dirty. Having someone interrogate your brain constantly as if you were an enemy combatant makes you feel dirty. You get involved in “psych world” to straighten yourself out, or be healed. But then it is after “psych world” you really need healing. But, then you come to the conclusion that like Dorothy in “The Wizard of Oz” the answer lies within you and you must find ir yourself, not rely on the illegitimate, sick people we call “psychiatrists, etc.” “There really is no place like Home.” Thank you.
Just to add…
Another reason why some people want to form consensus opinion is also because it is refreshingly unambiguous. That which is unambiguous to the human is soothing. It is burdensome to keep a tally of everyone’s meal preferences in a big family. Fussy little demands to be regarded as “exceptions” can be contageous and spread. There comes a clamp down on exceptions since variability and complexity weaken the unified smoothe coherence of consensus opinion. So there is a tendency in consensus to make a glib division between “us” and “them”, since consensus is a “group” mindset that needs to bind as a force made up of samey people. A lump or conglomeration of same cogs in the machine. Unification is by nature not endeared to the exception, therefore it is not welcoming of freedom of choice, even as it hoists a loudspeaker asking for increased freedom of choice for everyone.
It becomes irritating to dance with the exception when holding lots of exceptions becomes complicated and burdensome. That is when those burdened can begin to tell the exception that they are not the exception. They are not unique. They are “not” ill. They are “not” different.
It is also, when in particular a unifying consensus is about making everyone think they ought to like the same meals and be normal and sane, the leaders of that consensus can tell the exception that they “are” ill. They “are” different. They “are” strange.
Consensus is a remarkable phenomenon.
I have known mad people who want to belong to the consensus group.
I have known mad people who eschew such belonging if it feels like giving up being rare.
Finding a way to welcome both is honourable.
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The primary actual societal function of the “mental health professions” is covering up child abuse and rape.
And it’s all by DSM design – none of them can bill for helping child abuse survivors.
So, absolutely, the “mental health professions” actually make “rape culture” possible. They are the aiders, abetters, and empowerers of the pedophiles and human traffickers – that control, and are destroying – America from within.
What could be more discriminatory or discrediting than the Diagnosis of “Borderline Personality Didorder”.
thanks for the article and the explanations! This is exactly what had happened to me in therapy and this is the first time I ever read about it, can give a name to it and feel less alone with it.
Only, that I am a white cis woman – I would not exclude them from suffering from rape culture, this can happen to anyone.
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