Men, Women, and Madness: Understanding Gender and Mental Disorder (review)

Abstract

Reviewed by: Men, Women, and Madness: Understanding Gender and Mental Disorder Elizabeth Lunbeck Joan Busfield. Men, Women, and Madness: Understanding Gender and Mental Disorder. New York: New York University Press, 1996. xiv + 287 pp. Ill. $50.00 (cloth); $18.95 (paperbound). Compact, comprehensive, and judicious, Men, Women, and Madness surveys the immense professional and popular literature on gender and mental disorder [End Page 350] from a critical, feminist position. Joan Busfield subjects the controversial, widely held notion that mental disorder is a particularly female malady to careful scrutiny, yielding a more nuanced but still feminist rendering of the relationship between not only women but, more ambitiously, gender and mental illness. She evaluates a broad spectrum of explanatory paradigms—psychoanalytic, biological, feminist—that have been formulated to explain the origins of mental illness, finding strengths and weaknesses in each. And she examines a wide range of issues, from the history of psychiatric nosologies to the history of mental health service provision in twentieth-century Britain, that might at first seem a bit extraneous to the question at hand but that turn out to be absolutely central. For, as Busfield argues, it is not so much madness that is female, but the “broader territory of more ‘minor’ psychiatric conditions” (p. 19). Further, it is services for the latter that have recently increased, drawing more women—often voluntarily—into psychiatric treatment and resulting in their overrepresentation in the admissions data, an overrepresentation that in turn sustains the usual feminist critique. These are important claims, and Busfield supports them convincingly. With respect to the first, she argues that the term mental disorder, too often considered monolithically, should be seen as referring to a number of discrete conditions, some of which are linked to women (depression, anxiety, anorexia nervosa), some to men (alcohol-related disorders, antisocial personality), and some to neither (schizophrenia, mania). To be sure, gender is implicated in the construction of mental disorders, but the relationship is indirect, mediated through conceptions of properly male and female behavior. This process of embedding gender in diagnostic categories is most evident in the neuroses and behavior disorders, but the general principle that sees rationality and autonomy as male, and emotionality and passivity as female, holds across the diagnoses. Further, in a fascinating section on “normal cases” she argues that in making diagnostic judgments, psychiatrists necessarily privilege individuals’ particularities over the gender-neutral universalism of the official symptom descriptions. The case—so central to the psychiatric way of thinking—is always a gendered subject. With respect to her second claim, Busfield argues that the culturally female territory of emotional disorders “has seen the greatest expansion within the formal domain of psychiatry in the twentieth century” (p. 108). The overrepresentation of women in psychiatric populations, she contends, is a phenomenon not of the nineteenth century but of the second half of the twentieth, a period that coincides with this expansion. Epidemiologic data are of limited use in several ways: Patient statistics include only treated cases, and women are more likely than men to self-refer, as are those suffering from anxiety and depression (as opposed to the severe psychoses, as well as psychopathy, alcoholism, and drug abuse—the latter all “male” afflictions); “true” prevalence rates are impossible to establish. Such statistics are difficult to standardize across studies, making comparative claims problematic. And they cannot capture such critical distinctions as whether, for example, men’s alcoholism masks depression or actually treats it, or whether symptomatology differs by gender. In all, such data cannot sustain the [End Page 351] gendered critique of psychiatry—put baldly, that psychiatry is “primarily constituted through the male control of female patients” (p. 231). Psychiatry regulates men’s behavior as well; but it may do so through different institutions—prisons, for example—and different practices. Busfield’s stimulating book, with its many caveats, suggests that we have only begun to understand the relations between gender and mental disorder, and that what is needed are not programmatic statements but intensive studies of gender at work in particular contexts and in particular disorders. Elizabeth Lunbeck Princeton University Copyright © 1998 The Johns Hopkins University Press