Posted in Advocacy, autism, Mental Health, neurodiversity

Misogyny and The Psychiatric Complex

I think nowadays more and more people are aware that sexism connects with and is compounded by other factors such as racism, economic insecurity, homophobia etc. However few people are aware of the links between misogyny and the psychiatric complex. I’d go a step further and say a majority of people are reluctant to examine or criticise the psychiatric complex at all. However this ignorance is harming the most vulnerable among us at their lowest points, and threatens to affect all of us should we experience a mental health issue (as an estimated 1 in 4 people will every year). So let’s have a brief look at the relationship between misogyny and the psychiatric complex:

Throughout history psychiatry has been used majorly to uphold societal values. As such the history of psychiatry is entrenched with sexism. The most obvious example of this was the epidemic treatment of ‘hysteria’ in women. Hysteria has been described from the second millennium BC, but it was not until Freud – a man – that it was officially considered an exclusively female disease, though it’s important to note women were disproportionately institutionalised for hysteria for hundreds of years before this. It may surprise you to know that it was not until the DSM-3 (the DSM is the leading book used for the classification and diagnosis of mental disorders) that ‘hysterical neurosis’ was deleted. 

The treatment of hysteria can be very generally described as using natural remedies to calm the nervous system until the renaissance period, notably the end of the 16th century. This is also notably where it became considered much more of a ‘female’ disease’. Around this time hysterical women would be treated by a physician interesting their fingers into genital organs to try and produce an orgasm and semen production (which raises serious questions about consent and abuse in the history of psychiatry which still pervade to this day. Some people considered suffering women to be witches or possessed with demons around this time also. For doctors at the time the uterus was their explanation for hysteria in women – claiming it caused them to be psychologically and physiologically inferior.

During the 16th century physicians and philosophers such as Thomas Sydenham, Rene Decartes, and Ambroise Pare started to recognise that hysteria was connected to the brain and other organs also, not just the uterus, but the idea of a uterine, female disease continued. For example, Joseph Raulin in the 1700s suggested hysteria was due to the fumes of big cities, so in theory it could affect both sexes but women were just weaker. 

Perhaps the most famous outbreak of hysteria is the Salem witch trials in 1692. Marion Starkey related it to more contemporary events after WW2 with the theory that classic hysteria was actually a reaction to social conflict and restriction, such as the puritanism in Salem. Note she’s the first woman mentioned. Much evidence would support that mental illness and the classification of it is intrinsically tied to the pressures of the world we live in, notably under hyper capitalist values nowadays, so I would not think it too much of a stretch to think that women during these times under such enormous pressure to conform would present symptoms of hysteria. But they were labelled as mad – their individual character was named as the problem, not as a symptom of a societal issue. And they were labelled mad by men. 

This general hypothesis of hysteria, especially during this period, seems to make sense in the majority of cases when you consider that women could be committed to mental institutions – which were comparable to jails at the time and arguably still are – by their male relatives simply for not conforming to the standards expected of them. The inhumane conditions in many of these asylums are well documented, and I personally think some treatments could be considered comparable to torture. As Angela Davis so eloquently put it: ‘Studies indicating that women have been even more likely to end up in mental facilities than men suggest that while jails and prisons have been dominant institutions for the control of men, mental institutions have served a similar purpose for women. That is, deviant men have been constructed as criminal, while deviant women have been constructed as insane.’

While psychiatry may have changed – yes, in some ways for the better and in some ways just more palatable to a modern society – its roots cannot be ignored as they are the foundation upon which modern psychiatry is directly built and this harm still exists. Let’s have a look at the current day now, through the lens of BPD diagnosis, aka Borderline Personality Disorder. 

Women are disproportionately diagnosed with BPD. There’s a 3:1 female to male ratio in the diagnosis of BPD which is quite pronounced for a mental disorder, and has led to speculation about its cause by professionals. However critics of the diagnosis have gone as far to say it is the modern day version of hysteria – a label extremely loaded with stigma that judges the emotional reactions of women. Think even of the title ‘personality disorder’ – the name itself suggests it is solely an individual issue, a defect of their character, not linked to anything in the outside world.

I write on mental health from a place of personal experience, and I will admit that because of this I am biased in how I view mental illness. There appears to be some research that genetics plays a factor in BPD for example, which would be an individual trait. However I believe it is essential that we also look at how the world as it is is unsuitable for people with that genetic component. Can we answer the question of whether that genetic and neurobiological component would present in the way it does if that individual was not subjected to trauma and systemic pressure? Perhaps not in full. But there is ample evidence that sociocultural factors affect mental illness, and that seems to be so often ignored. 

A sociocultural factor could explain why more women are diagnosed with BPD, as they often experience more pressures in the world to conform, and are more likely to be the victims of violence and assault that contributes to trauma in BPD. However the stigma surrounding BPD stemming from its symptoms may explain this too. Hypersexuality for example is a trait of BPD; being sexual as a woman is still less acceptable than being sexual as a man, so for example a woman’s behaviour may be labelled as hypersexual while for a man it’s just seen as a strong expression of his sexuality, or perhaps not even noticed at all. Likewise anger is also a symptom of BPD, and we are much faster to label women as problematic for expressing anger than we are men. So the social misogyny impacts when we start to consider a person’s behaviour as more than just odd, more than just problematic, but actually disordered. 

It would be unjust to write this article without drawing attention to the disparity in mental health care between races. Like aforementioned, psychiatry and misogyny are intrinsically linked with other social justice issues. If we ignore this intersectionality we are ignoring the full picture. For example, Black women are more likely to struggle with mental health issues, less likely to get treatment, more likely to be misdiagnosed, and more likely to be sectioned (an example of the criminalisation of mental illness, but that’s a story for another day). In fact detention rates under the Mental Health act during 2017/2018 were four times higher for people in the ‘Black’ or ‘Black British’ groups than those in the ‘White’ group, and 29% of Black/ Black British women experienced a common mental disorder in the past week, higher than for White British women or Other White women. Clearly we can see the link between the pressures and pain of racism to the experience of mental illness in Black women, and their subsequent further incarceration and abuse in the mental health industry. Likewise we can see a mirror image effect in the LGBTQ+ population – almost half of trans people (46 per cent) have thought about taking their own life in the last year, 31 per cent of LGB people who aren’t trans said the same. This is not a stand alone issue.

Another example of misogyny in the psychiatric complex is the recognition of neurodiversity in women and trans people. Early autism research was based on white boys from middle class backgrounds. Outdated tests, and a lack of understanding of how autism presents in other races and genders in the general population still result in late diagnosis or misdiagnosis of women and trans people everywhere. And here seems to be a good time to put all of this information into context – the misogyny in the psychiatric complex damages and ends lives. Whether from the trauma of institutionalisation from stigmatised diagnoses, or the pain of leading a life without understanding or accommodations, individuals and communities suffer every day. As a late diagnosed autistic myself I can attest to how painful it is to grow up being bullied, misunderstood, and confused without any path forward. I can’t imagine how different my life might have been if I had known I was autistic and had the resources to help me and my family as I navigated a world not built for me. And I had it easy! 

Yet if we take a look at neurodiversity through the lens of knowledge that gender is a construct, we can see clearly how much the pressures of the world to conform to gender norms affect people. I was taught to be a girl, while autistic. So the way my autistic brain processed that (for lack of a better phrase) was to make me mask so heavily I couldn’t see myself through it all. This is common in those who identify in genders other than male. The world taught me to be a woman and because I learnt to do it, in a system that ignores neurodiverse women, I had no idea how my brain worked. I had no idea who I was, and I was in pain. And to add a little history again, a major leader in the foundation of autism research was Hans Asperger – a man with well associated ties to the eugenics programme of the nazis. Asperger’s and autism aren’t different, but Asperger’s was used to basically say they were more intelligent, and therefore more worthy to society. These messed up roots run deep in all directions. 

However, diagnoses aren’t all great. In fact they can be downright damaging in themselves. As mentioned, a BPD diagnosis is highly stigmatised, and disproportionate in women. Having a diagnosis of any mental health issue or neurodiversity can lead to people’s experience being invalidated. If you’re labelled as mad, how can you ever convince someone you are sane? For one it can be very hard to get out of hospital and escape that system if you are committed, and extremely hard to report any abuses taking place there as they often do because concerns can simply be brushed aside as delusional, symptomatic. Any legitimate problems in interpersonal relationships can be labelled as a symptom. Any very real feeling is simply boiled down to a mental illness. Women – already more likely to experience violence – see their diagnosis weaponised against them when they try to report violence; and people with a mental illness are significantly more likely than the general population to experience violence!

The sexism in society and psychiatry doesn’t just adversely affect women and trans people though. It also affects men who are significantly less likely to come forward if experiencing a mental health issue. In 2021 men were three times more likely to commit suicide than women. And much of this can be traced to the stigma of men expressing emotions in fear of being seen as weak (translate: as fear of being seen as expressing a feminine trait). Everyone, including men, are being harmed by the systems men built. 

And yes, the modern psychiatric complex was built by men. Built on the foundations of male researchers at a time when women were denied an education, and continuing to be led by men. I’ll end on a story about how the DSM – that book used to diagnose mental illness – was created. The DSM-III was the version of the DSM that formulated how we see and diagnose disorders nowadays. It included innovations such as explicit diagnostic criteria and multidimensional diagnostic systems. But the formulation of it was hardly clear or scientific. Robert Spitzer was appointed editor of the DSM 3 and by his own admission the editorial meetings over six years between 1974-1980 were chaotic. New Yorker’s journalist Alex Spiegel reported that the psychiatrists invited would yell over each other, and the loudest voice tended to win out, while no one took minutes. People would yell out names of new diagnoses and possible checklists for symptoms, and if the cacophony in the room seemed to agree it would be typed out, set in stone. The diagnoses in that book still have very real implications for very real people nowadays, and diagnoses are removed and added in each edition following. It’s not an exact science; it doesn’t centre the lived experience of people.

If you take nothing else from reading this article I hope you remember this – sexism is systematic; it affects all of us in all aspects of our lives. But our distress, our joy, our love and our pain? That’s not just symptomatic of a system, that’s symptomatic of being human. 

Sources:

Posted in Advocacy, Mental Health

‘Bedlam’s’ True Horror History

Today’s post is the first that looks into the history of psychiatry and ‘treatments’ for the insane, mad, mentally ill and neurodivergent, through a brief overview of the history of Bethlem. I think it’s important to share and learn about this history because it helps us to better understand the foundations and influences on psychiatry nowadays, and therefore understand the problems and potential solutions within the mental health system, including abolitionist approaches. I hope you find this little guide to be informing, let me know if you have any questions in the comments! Just a quick trigger warning for psychiatric violence and restraints.

Bethlem Royal Hospital was one of the first lunatic asylums. It’s horrifying history has inspired lots of books, movies and TV shows, most notably Bedlam.

So the real life horror in its history should be evident, otherwise why would it inspire such horror stories? Yet often we don’t stop to wonder about such histories that informed modern day psychiatry. It’s important to learn about this stuff because the legacies can still be seen nowadays in abusive, neglectful, and ineffective systems.

Bethlem was originally founded in 1247, and was linked to the Church of Bethlehem. It’s foundations are muddied and muddled – it was first used to house alms and poor people with religious ties and with the aim to make money. This monetary trend is also something we still see nowadays in many areas of life, including in the mental health system and coupled pharmaceutical industry.

It’s not known exactly when Bethlem was first used for the insane but is frequently assumed that this was from 1377. Management was through ‘keeperships’, with essentially sole control. Jumping ahead a bit, during Sleford’s keepership at the hospital (1579-1598) the buildings fell into disrepair – ‘so loathsomly filthely kept not fit for any man to come into the house’

However, living conditions didn’t exactly improve. Into the 19th century many inmates were left to sleep on straw beds and only permitted to go the toilet in their cells. Simultaneously financial exploitation by head physicians was common from the 17th century onwards – they were getting rich while the people inside suffered. In fact, in the 17th century several patients were found to be suffering from starvation, and staff practices were found to be a significant contributing factor to this. Staff practices are often a main complaint by inpatients today as well – but they are far too frequently brushed aside; once you’ve been labelled as unstable it’s incredibly difficult to reclaim your power and have your concerns legitimised.

While it appears restraints and solitary confinement were used for the insane at Bethlem from the start (and still today!), not a lot is known about so-called ‘treatment’ in the medieval period. However from 1460 the transition to a specialist institution for the insane was mostly complete and more is known from then on. In the 1680s cold baths were introduced as a form of treatment, as were incredibly hot baths later. Patients were bled, blistered, then dosed with emetics (make you vomit) and laxatives indiscriminately during the 18th century.

Perhaps one of the most disturbing parts of Bethlem’s history is that from the 17th century onwards visitors could pay to come and gawk at patients like animals in a zoo. Can you imagine the shame and anxiety of having your distress put on show as amusement for others? How could anyone possibly heal in that environment? We can infer from this a part of the pattern of control and benefit from locking mad people away rather than a genuine care for them as individuals and a desire for them to heal.

There was even an ‘Incurables Division’ added 1725-1738; patients in here could never hope to leave. One approach was rotational therapy: a patient was put in a chair suspended from a ceiling and spun at sometimes more than 100 rotations a minute

Experimental (read: unsafe) treatments were also used on patients at Bethlem. Furthermore modern investigations have uncovered mass graves on the property, dug exclusively for those who died under care at Bethlem.

This barely scratches the surface of Bethlem’s horrifying history of abuse and exploitation. The hospital is still in use today and many patients are still voicing their pain and trauma from their time there – restraints are still used, as are forced medication, and mad voices are not respected. There’s even a museum of patient’s artwork there, and while some exalt this as them respecting the patient’s expression, I have to wonder to what degree is it a modern day version of gawking st misunderstood minds?

We may have come a long way, but there’s still a lot further needed to travel.

Sources:

https://www.huffpost.com/entry/bedlam-the-horrors-of-lon_b_9499118/amp

https://en.m.wikipedia.org/wiki/Bethlem_Royal_Hospital

Porter 2006, Whittaker 1947 

Porter 1997 

Andrews et al, 1997 

‘A view of Bethalem’ 4th December 1598, quoted in Allderidge 1979

Posted in Advocacy, Mental Health

Over Pathologisation of Mental Health

We hear a lot nowadays about removing the stigma from mental illness, and that is incredibly important. After all, we all have mental health. But I also I think it’s essential while advocating in mental health spaces that we not only call for destigmatisation, but we also question the systems; call out the injustices of the systems meant to care for us. We must question whether medicalisation of mental health really helps us. Would it be necessary if our society wasn’t structured the way it is in the west? Does it further the link between mental illness and criminalisation? Because destigmatising mental distress isn’t only recognising that it exists, it’s asking why it exists, is the language we use to describe mental illness helpful, what does healing really mean, and how are we failing to learn the lessons from our madness? So here are some of my musings on the over pathologisation of mental health:

It individualises our pain without individualising our care – that is to say it tells us we are broken, it is our individual chemistry that is flawed, and we are to blame, yet also not putting us at the forefront of understanding our pain and choosing how we heal. It tells us we are too sick to know what’s really good for us, or that we don’t know ourselves well enough. It doesn’t allow us to learn who we are and what’s really at the root of our pain; doesn’t encourage us to put it into a sociopolitical context, and the context of what has informed our life. Doesn’t allow us to heal with others.

There is no community. No value given to peer support, to healing with others who are experiencing the same things or similar things or completely different things, but feel safe to heal with. Doesn’t encourage the connections that are vital to long term healing and alternative methods of care. If you want proof that peer support methods of healing work, look at AA – it revolutionised care for alcoholics. What was a death sentence became an opportunity for hope and healing.

Our pain is shunned and labelled, pathologised. Instead of learning to embrace the madness as part of who we are, we learn shame which in turn births more pain. Instead of learning to see mental distress as a natural human reaction, however difficult, we learn to be afraid of it. Language that could be used to free us is instead weaponised against us to strip us of our wholeness and our identity through clinical rotes.

But it doesn’t have to be that way. I don’t have all the answers. I listen to psychiatric abolitionists and I think, yeah, they have the answer. I listen to amazing healers in other cultures outside of the west and am filled with inspiration and hope. Then I look back at the world as it is and wonder if we don’t need to adapt our goals to be a little more realistic within the current frame of society here in the UK. I don’t have the answer nor a clear label for my ideology surrounding this all. But I do have hope. And I do know things are already changing. 

We don’t have to wait to build communities. We don’t have to wait to create new ways of healing. We don’t have to wait to find hope. 

You can also find a version of this post on my Instagram @our.happy.notes

Posted in Advocacy, autism, Mental Health

Diagnosis – Good, Bad, or Dependant on the System?

Validation:

It can be very hard to access treatments and be validated by ‘professionals‘ within this system without a diagnosis. Budget issues and a mental health system based in oppression that seeks to produce productivity rather than healing and often doesn’t recognise its intrinsic links to all other aspects of capitalist society doesn’t help this. However, more importantly, without a diagnosis it can be hard to validate ourselves – to give ourselves permission to display certain symptoms, feel what we feel, and believe that it’s real.

Getting a diagnosis can be a validating and liberating experience for many people – my autism diagnosis certainly was for me. It helped me understand myself, put my entire life into context, and connect with other people going through similar experiences. That was incredibly useful with all my diagnoses – finding people going through the same thing and learning how they were managing in a world often not built for us which helped me find ways to define and facilitate my own healing. Community truly is a powerful force. It teaches us that we are not alone, and is one of the most invigorating tools in supporting mental health; my diagnoses are helping me find mine.

But we must ask the question – why do we lack validation without a diagnosis? Why have we not been taught validation and community by the systems surrounding us? If human experience was universally understood as fluid and acceptable, would we need diagnoses at all?

Stigma and Stereotyping:

However, diagnoses have also been used as oppressive tools throughout history, and being given a diagnosis can be a terrifying experience. For example women could be put into mental institutions if their husbands thought they weren’t living up to their duties and this was justified under the label of hysteria. Nowadays Black women are significantly more likely to be diagnosed with BPD – this may be a misdiagnosis of a neurodivergency (chronically under recognised in Black people) or due to how their traits and emotions are perceived so different within the system. Black people are also four times more likely to be detained under the Mental Health Act in the Uk – a hugely oppressive tool that twins criminal incarceration.

It may feel like a condemnation to receive a diagnosis due to preconceived notions of stigmatised mental illnesses, and lack of care options. Sometimes it can seem like a lifetime of suffering and inevitable failures lie ahead. It may even be harder to be taken seriously within the system – especially in psychiatry wards where any legitimate complaints can be brushed off as ‘symptoms’. Telling family and friends may elicit negative reactions due to their preconceived ideas, regardless of how positive the experience was for the individual

Stuck in a Box:

Although it can be liberating to understand your behaviour through the lens of a diagnoses, it can also be challenging when dealing with others and interpreting your own experience. It can be difficult to know where you start and where the illness ends, or to what extent you should view yourself as your illness. It can be difficult to know whether an emotional reaction is ‘natural’ or a symptom or a potential warning for future issues. It can be difficult to be heard and seen as anything but your diagnosis and your experiences as anything separate or unrelated to it by others.

Diagnosing a mental illness is not straight forward. No one person presents the same, and often two psychiatrists will have completely different opinions leading to misdiagnosis/ confusion for the individual trying to grapple with many opinions and find understanding.

And yet once given a diagnosis we are often stuck in a box or a more rigid understanding of who we are and how me must think and will behave. Does that seem logical? It doesn’t to me. But it’s understandable within a system that looks for easy processing, and profit – both achieved through the over medicalisation of human distress. 

When the DSM was first released in 1952 there were 102 diagnoses in it. By 2000 there were 365. This has since reduced again – but you can see how inexact and dramatic the medicalisation has been.

Nonetheless, getting a diagnosis, finding community and comfort it in, can be a very positive experience. My autism diagnosis certainly was for me, and being able to say I’m bipolar helps me feel whole and proud of everything I’ve been through. But getting those diagnoses, navigating conversations, therapy, and life with them has been challenging and complicated. And I am privileged in many ways. Bottom line – receiving a diagnosis is not something to be afraid of, and if your experience was good then that is amazing, and valid! But negative experiences are just as valid too. Perhaps even more so because they often fall on the more marginalised. And everyone’s emotions, pain, and trauma are valid with or without a label. We deserve a society that teaches us that.

Sources

  • Sedated: How modern capitalism created our mental health crisis by James Davies
  • verywellmind.com 
  • mind.org.uk
  • Phenomenology of Borderline Personality Disorder, The Role of Race and Socioeconomic Status, Natacha M. De Genna, PhD and Ulrike Feske, PhD
  • My brain