Abstract
Jane Ussher’s new book on women and madness is her third, and every bit as good as her path-breaking, earlier discussions. It is a careful, r\eadable, and fair summation of much of the social science research and feminist theorizing about these matters, set within a sophisticated epistemology that recognizes and appreciates the force of social constructivist approaches while seeing their limitations for the feminist goal of doing something about women’s misery. The Madness of Women is also timely—it aims a frontal attack on Diagnostic and Statistical Manual of Mental Disorders (DSM)-type diagnostic thinking just as DSM-5 nears publication.
The book is focused around a series of issues, each with its own chapter. The first is the link between women and depression, and the range of conflicting explanations (biomedical, psychological, and sociocultural) offered for the undeniable fact that reported depression is gender-linked as a “women’s” disorder. The diagnostic labeling of women as mad is represented as an exercise of social control that serves to pathologize femininity. Here, however, Ussher stakes out her differences both with more exclusively constructivist theorizing about diagnosis and with the idiopathic assumption of diathesis-stress models of biological psychiatry, where a disorder resides—primarily, if not exclusively—inside the sufferer. (Disorder is both, and equally, inside and outside the person, according to Ussher’s view.) A “critical realist” framework also allows her to acknowledge each, without privileging any one of the trio of material conditions, meanings, and lived experience. About the known antecedents of women’s distress (being treated as an object and sexual violence), she emphasizes that depression and distress ought to be seen as appropriate responses to the kinds of oppressive social experience to which women are still commonly subject. The lived experience of women’s distress is illustrated using claims about premenstrual affective states to support her contention (grounded in her own empirical studies, one of which is included as an appendix) that such states are normal rather than aberrant.
Finally, there is discussion about what can be done, and how women can resist and fight back against the baleful societal forces making and labeling them as mad. Her suggestions include, and are not limited to social action to change the conditions that create women’s distress, empowering strategies, feminist therapy, self-help groups, and revising the ways girls and women are socialized. Her answers are not new—but the book primarily asks for acknowledgment of the problem, rather than offering new solutions. Specifically, Ussher asserts that, in order to establish that women’s misery and distress are not madness, we need to acknowledge the myths of women’s madness by exposing the fantasies, fears, and misogynistic attitudes that feed these misapprehensions. And yet at the same time, we must recognize and address the lived experience of misery that afflicts so many women.
This is a very tall order, as she well recognizes. Replacing the categories and presuppositions of medical psychiatry with the loose attribution of socially caused “misery,” “suffering,” or “distress,” as she proposes, risks weakening women’s claims to attention and care, for example. Moreover, the inappropriate medicalization of much normal and appropriate distress response is usually seen as compatible with the presence of more obdurate and debilitating suffering in some people—the problem, that is, one of overzealous diagnosis, not diagnosis itself. Ussher might perhaps have taken more pains to differentiate cases this way, or at least contend with the literature that does. Even if the “endogenously depressed” are few in number, their plight calls for separate acknowledgment and different responses.
I have one other quibble. Like many theorists, Ussher holds that the inchoate suffering resulting from oppressive social conditions finds expression according to the culturally determined “symptom pool” available at any given time and place. Many other conditions (eating disorders, most notably) are as gender linked as DSM-type depression; yet, they receive scant attention here, and for the most part the extension of “depression” remains as it is in the DSMs. Ussher notes at the outset that the disorders she chooses for attention are “ideal exemplars” of her thesis; nonetheless, there seems to remain a tension between the model of suffering adopted and the limited range of in-depth examples introduced. If “depression” is simply misery and suffering, the book is arguably incomplete—or at the least its choice of examples required a fuller justification.
Overall, however, this is a valuable and impressive book. It seems likely to attract a wide, general readership. It will be taken seriously by feminist theorists, as well as by those in the biomedical and social sciences, and it will prove a useful addition to curricula at graduate and undergraduate levels in the fields of psychology, feminist studies, and psychiatry.