Gender and Psychiatry: Pathologized Emotions

Editor’s Note: This article first appeared on Mad in Mexico. It was written by Professor Sandra Caponi and expert by experience Virginia Carril.

As Phyllis Chesler warned us in 1974, gender bias has accompanied psychiatric power throughout its history. Years later, in 2005, in the last annotated edition of Women and Madness , the author insisted on the persistence of this bias, which even today, 50 years later, seems to remain unchanged. Authors such as Ussher, Caplan, Margot Pujal and many others were situated in that same space. With their differences and nuances, they all converge on the same point: gender problems and discomforts produce deep suffering. This suffering leaves marks on our bodies and our behavior.

Faced with a situation of violence, a lack of recognition, moral or sexual harassment, we will inevitably have some difficulty falling asleep or, on the contrary, we will sleep too much; we will feel guilty or insecure for not having been able to respond as we would have wished; we will have little desire to feed them or we will eat without stopping. The truth is that, in our “diagnostic culture,” all these behaviors and emotions will be translated as symptoms of some mental disorder classified in the DSM.

When it comes to understanding the conflicts and ailments that women and dissidents experience on a daily basis, it is surprising how quickly these sufferings are transformed into diagnoses and multiple diagnoses. Among women, mood and eating disorders are three times more common than those attributed to men. To understand the reasons for this gap, this gender bias, it is necessary to go beyond the framework defined by the disease-centered model and replace it with a model that is capable of integrating and understanding the conflicts, power networks, and specific situations that caused, in each case, this suffering.

The current culture of diagnosis has permeated our ways of being and of being in the world, often leading to an explanatory reductionism of our subjectivity, by which our self is defined in terms of neuron-narratives, crossed by psychiatric labels. Thus, we see, more and more frequently, women who define their identity, on social networks or in collective spaces, through the mediation of a diagnosis: I am depressed, I am bipolar, I am autistic. As if that label could sum up their entire existence and their entire history.

The lack of a gender perspective in the field of psychiatry is observed every time situations of psychological, physical or sexual violence are disregarded as causes of suffering and explanations based on neurochemical imbalances or genetic causes are used. But there are also other situations that cause deep suffering for women, such as breakups, emotional disagreements, surrender to the ideals of romantic love, which we have not yet been able to deconstruct.

Naif is an “expert by experience” and, contradicting this reductionist culture, she does not accept or wish to acknowledge or subsume her identity under a diagnosis. She does not care about the diagnostic label. After a long psychiatric career and with the help of her peers, she has been able to recognize her moments of sadness, feelings of anger that she cannot control, of anguish or extreme agitation. She knows when the time has come to seek therapeutic help, always trying to identify the factors that have caused these sufferings. She knows when it is necessary to resort to psychiatric medications and tries, little by little, and as far as possible, to reduce and withdraw those drugs that produce severe adverse effects on her body. Naif has learned to recognize these harmful effects, as well as to identify the withdrawal syndrome that produces the withdrawal of psychotropic drugs, assuming that this is a slow process, with conquests and setbacks.

This is not a story of overcoming, like those that multiply in newspapers and on social networks, it is a story of struggle and recognition, a story that highlights the need for the field of mental health to integrate that gender perspective that seems to be absent. Hers is a reflective and critical narrative about her first encounter with psychiatric power, an encounter that is part of a life story that resembles that of many other women, in which many will be able to recognize themselves. 

Naif’s story is crossed by the psychiatric institution. In his words: “Hospitals are part of life in this world. For me, the San Pablo hospital, now a tourist Modernist complex, was a place of play and distraction as a visitor to a sick father and a mother who worked in another hospital in Barcelona. Now they are places where I do not want to return because I have experienced operations there and then injections, screams and incomprehension. Friends of mine have also been admitted recently and having a diagnosis is something difficult to bear. Suffering to know how, day by day, some survive inner voices, perceptions of smells and colours, negative thoughts that they cannot bear, which some bear with resignation and others with more or less indignation, as is my case.”

This is the story of a woman who defines herself as “very much in love,” who has experienced love, heartbreak, loneliness, two abortions, and mourning for the premature loss of a father she adored. In Naif’s story we see the appearance of what Eva Illouz defines as the myth of romantic love.¹ A bond that appears represented with the force of an arrow, like an emotion that invades life, where the subject who loves identifies with the beloved in a way that can be total, although it is often detrimental to his own interests. Initially, Naif lives a passionate love with “a prince from a Nigerian village,” for whom she lied out of love, and with whom she was for a year, “the first abortion was with him and I paid for it,” because another love appeared and then a trip to Ireland that would radically change her life.

There in Ireland he meets the Irishman L. “I left Barcelona, ​​leaving behind a university degree and my family without thinking much. All for love. I had a job, in a wood factory, labelling slats.” There he participated in the first municipal elections for the political party Sinn Féin, from which he had to leave due to internal political conflicts.

One day she woke up, like so many other times, looking for L. who had left home without warning. She began a wandering aimlessly, unable to find him, she got lost, she was worried, she cried. She was in a faraway country, without the proximity of her family, distant from her mother, a respected and beloved reference, and from her friends, with a language that, although she mastered, was not her mother tongue. That anguished search ended, tragically, with her first psychiatric hospitalization. There are no memories of that moment, she says that a temporary gap with some isolated images still remains, nor is there any institutional record of that hospitalization. “To what extent was that moment madness or a moment of lucidity? I don’t feel like delving into something as painful as my first psychiatric hospitalization.” Days later her mother was able to travel to Ireland to look for her, managing to get her discharged from the asylum. Naif stresses that “people like me and many others are afraid, day after day, of reporting, of being reported, of accusing, of being accused. Fear of returning to a place where they give you medication and channel you back to mentally ill normality.”

Later, already in Barcelona, ​​Naif was able to save up money to pay for L.’s ticket so they could see each other again, and then another ticket to return to Ireland. It was difficult for him to adapt, he didn’t speak the language and he couldn’t adapt, “he couldn’t stand it, he was alone and the alcohol got the better of him,” the relationship became unsustainable.

Then came endless telephone conversations, letters sent to L. without receiving a reply, many Christmas cards to his mother, from whom he received a letter some time later. “L.’s mother sent me a very brief note, a letter written in her own handwriting in response to one of the many Christmas cards written by me. It is no more than fifteen lines long and is accompanied by a reminder of his death. When I received it I cried so much… I didn’t have his home phone number and I don’t know when I received it. He would call me many nights drunk, crying after chemotherapy. (…) He must have been so alone… He always was. He was my cowboy and I was his cowgirl. I still have a huge postcard and photos of our little house there on Convent Street where I am in his sweatshirt smilingly feeding the cats that came to the yard where we live.”

 A painful loss, a mourning that will be translated in our culture of diagnosis as another symptom of their mental illness. Then new diagnoses will appear, new hospitalizations, new prescriptions for psychotropic drugs that accumulate. New relationships and new loves will also emerge, with their joys and disappointments, but also new sufferings that will be read, from the medical model, as indicators of some mental disorder.

“I went to places I wish no one would go to: CPB (Barcelona Psychiatric Centre), CSMA’s (Mental Health Centre for Adults and Young People). I remember one year that a person who had also been to those places came to see me. I don’t wish anyone to live dependent on doctors who want us to take pills and who want us to fit into their DSM-5 and their ways of doing, living and feeling. We are not crazy and if we are, who isn’t a little bit crazy?” On the other hand, and faced with her desire to be a mother, she must have heard dissuasive phrases from psychiatrists, such as: “the child can come out with two heads” or that “there are women who have breastfed curtains.” 

As Eva Illouz states in “Love in Times of Capitalism,”² romantic love is crossed by the gender division, women give themselves over to an almost sacred experience of self-denial, which directly affects their emotions and their corporeality, because, since we were children, we were socialized in this framework of surrender to the other, of a love that can do everything, so that breaking with these ideals becomes a painful and complex task. Situations like this, in the same way as so many other gender sufferings and discomforts that go through our daily lives, are disregarded by the psychiatric power, generally masculine, with its imperative to record symptoms to identify a supposed diagnosis, which will be fixed in a clinical history. It is omitted that, as Chesler states, gender discomforts or sufferings, such as a disagreement or a love disappointment, often mark the moment of the absolutely avoidable beginning of true psychiatric careers. After the first hospitalization and the first diagnoses, new diagnoses will most likely follow, replacing or complementing the previous diagnoses, as well as new psychotropic drugs that will replace or complement the prescribed psychotropic drugs, which will inevitably prove ineffective or have severe adverse effects. Even today, Naif, due to his experiences and the diagnoses assigned to him, finds it difficult to speak freely about his history and his past.

Naif participated in spaces of encounter with experts through experience. She was an active and committed member of the Radio Nikosia and Activament groups. In these spaces she has found bonds of affection, trust and friendship and also a framework to think about her life, her history, her past, her present and her future. Today she participates in feminist groups, carrying out activities related to music, in addition to devoting time to the study of the classics of anti-psychiatry and the processes of demedicalization.

In her words: “Those ideas of terror are dispelled thanks to the listening and understanding of friends, like the air in the leaves of the trees in the green forests where I lived in Ireland when I was twenty years old and which I now remember with great nostalgia. On that island I lived, for a period of time, what many call a hallucination, others a delusion, but which for me was real.”

In the collectives of experts by experience, Naif has found a place to be able to express those questions that run through us all, and that, following Foucault, we can understand as constitutive of all technology of self-care.³ These questions are: “What am I missing out on because of fear? Am I doing what I should? For what or for whom am I doing this? Is this what I want to be? Who am I spending my time with?”

With many questions, but without renunciations or regrets, we find the traces of a love story, which remains in the memory associated with emotions and treasured memories, but which, unfortunately, is also crossed by a dramatic event such as the first psychiatric hospitalization. Naif concludes his story saying: “The land I walked on then was like now, but sometimes the stars and planets align so that people like L and I could see a whole rainbow. That encounter will not happen again. Only a few of us lived that moment. That couple and many others will always be a mystery.”

About the Authors

Sandra Caponi: Full Professor at the Department of Sociology at the Federal University of Santa Catarina, Brazil. Researcher at CNPq (Brazil) and MARC-URV (Spain).

Virginia Carril: Expert through experience. She participated in the groups Radio Nikosia Association and Activament (Barcelona-Spain).