Women and the Psychosocial Construction of Madness

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 Psychoanalytic Studies:
Clinical, Social, and Cultural Contexts
Series Editor:
Michael O’Loughlin, Adelphi University

Mission Statement
Psychoanalytic Studies seeks psychoanalytically informed works addressing the implica-
tions of the location of the individual in clinical, social, cultural, historical, and ideologi-
cal contexts. Innovative theoretical and clinical works within psychoanalytic theory and in
fields such as anthropology, education, and history are welcome. Projects addressing
conflict, migrations, difference, ideology, subjectivity, memory, psychiatric suffering,
physical and symbolic violence, power, and the future of psychoanalysis itself are wel-
come, as are works illustrating critical and activist applications of clinical work.

See https://rowman.com/Action/SERIES/LEX/LEXPS for a list of advisory board

members.

Titles in the Series

Lives Interrupted: Psychiatric Narratives of Struggle and Resilience, edited by Michael

O’Loughlin, Secil Arac-Orhun, and Montana Queler
Women and the Psychosocial Construction of Madness, edited by Marie Brown and
Marilyn Charles
Revisioning War Trauma in Cinema: Uncoming Communities, by Jessica Datema and
Manya Steinkoler
Women and Psychosis: Multidisciplinary Perspectives, edited by Marie Brown and Mari-
lyn Charles
Psychoanalysis from the Indian Terroir: Emerging Themes in Culture, Family, and Child-
hood in India, edited by Manasi Kumar, Anup Dhar, and Anurag Mishra
A Three-Factor Model of Couples Psychotherapy: Projective Identification, Level of
Couple Object Relations, And Omnipotent Control, by Robert Mendelsohn
Women and the Psychosocial
Construction of Madness
Edited by Marie Brown and
Marilyn Charles

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ISBN: 978-1-4985-9194-2 (cloth : alk. paper)

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 Contents

Acknowledgments vii
Introduction 1
Marie Brown & Marilyn Charles

Part I: INTERSECTIONALITY: WOMEN, PSYCHOSIS, AND

MARGINALIZED IDENTITIES
1 Race, Gender, and Psychosis 9
Harshad Keval
2 Mourning and Melancholia in Transwomen: Inscription and the
Risk for Melancholic Psychosis 31
Álvaro D. Moreira
3 My Monster, My Self 55
Casadi “Khaki” Marino

Part II: WOMEN, PSYCHOSIS, AND THE DOCTOR-

PATIENT RELATIONSHIP
4 Sabina Spielrein and Frau M: Two Historical Cases of Female
Psychoses 67
Ilona Melker
5 Lucia 93
Steven Poser
6 I Call This Institutionalized Rape 117
Erin Soros

v
vi Contents

7 The Locust of Words and the Locus of Saying: Femininity and

Psychosis 125
Manya Steinkoler

Part III: WOMEN, PSYCHOSIS, AND PATRIARCHAL

OPPRESSION
8 The Scarlet Diagnosis: Trauma, Psychosis, and Pathologizing
the Feminine 145
Noël Hunter
9 Being of Sound Mind 169
Debra Lampshire
10 Faith: A Woman Interrupted 189
Michael O’Loughlin & Montana Queler

Conclusion 211
Marilyn Charles
Index 217
About the Contributors 225
 Acknowledgments

An earlier version of Chapter Seven was published under the same title in
The Fiddlehead, Autumn 2019, No. 277.

vii
 Introduction
Marie Brown & Marilyn Charles

This companion volume to Women and Psychosis: Multidisciplinary Per-

spectives focuses on the question of women and psychosis from a critical,
psychoanalytic, sociopolitical, and deconstructionist lens. Picking up on the
themes of the first volume, this second book is divided into three sections:
Intersectionality: Women, Psychosis, and Marginalized Identities; Women,
Psychosis, and the Doctor-Patient Relationship; and Women, Psychosis, and
Patriarchal Oppression. In keeping with our preference for being multidisci-
plinary, the chapters in this book span the disciplines of psychoanalysis,
critical theory, women’s/feminist studies, and first-person accounts of mad-
ness. This introduction provides an overview of each chapter as it fits within
the theme of the general text.

PART I: INTERSECTIONALITY: WOMEN AND PSYCHOSIS AND

MARGINALIZED IDENTITIES

Granted, there is something wholly artificial on having a separate section

dedicated to intersectionality, a gesture which seems to assume that multiple
overlapping identities can somehow be separated from the larger topic of
women and psychosis (and from the other chapters in this text as well as the
preceding volume, Women and Psychosis: Multidisciplinary Perspectives).
However, in putting these three chapters together we attempted to highlight
issues specific to marginalized identities and mental health, including race/
ethnicity, sexuality, and socioeconomic status. Therefore, our goal in creat-
ing a separate section on intersectionality is to emphasize the importance of
this perspective when discussing the question of women and psychosis.

1
2 Introduction

Harshad Keval’s chapter, “Race, Gender, and Psychosis,” focuses on

black and minority ethnic (BME) groups and what he views as the erasure of
racialized women from psychosis discourse. Keval uses postcolonial feminist
thought to bring a critical lens to the epidemiological data on higher rates of
psychosis in BME populations. For Keval, biomedical discourse’s privileg-
ing of the body both conceals the role of structural inequalities in the creation
of mental ill-health and propagates othering. In particular, Keval focuses on
the ways in which the othering of psychiatric discourse is racialized, contrib-
uting to notions of “risk” dominated by a white hegemony. He looks first at
the sociopolitical construction of the “angry, dangerous, psychotic black
man” before shifting to an acknowledgment of the lack of discourse sur-
rounding black women and psychosis. Importantly, Keval brings to light
limits of white, liberal, feminist discourse with regards to racialized women’s
experiences of madness.
The following chapter, “Mourning and Melancholia in Transwomen: In-
scription and the Risk for Melancholic Psychosis,” by Álvaro D. Moreira
looks at so-called “psychotic” process in transwomen. He begins with a
critique of the scientific discourse on the co-morbidity of schizophrenia and
gender dysmorphic disorder, situating the assumptions of this literature as
reductionist and neglectful of trauma. Using psychoanalytic theory, he then
explores the ways in which rigid sociocultural understandings of gender
leave transwomen at risk for psychosis as they take on the experience of
gender reassignment. He evokes Lacan’s understanding of psychosis as a
foreclosure from the social world in order to describe how trans identity can
leave these women disconnected from the gendered world—and full of unre-
solved mourning.
Lastly, Casadi “Khaki” Marino’s chapter, “My Monster, My Self,” is a
theoretical and personal narrative of the experience of voices and visions.
Beginning with a comprehensive literature review on the relationship be-
tween childhood trauma, psychosis, and women, Marino goes on to discuss
the ways in which recovery is often contingent on a “re-writing” of one’s old
identity for a new one. This re-writing is situated as an attempt to subvert the
dominant paradigm; a way to create an identity unpolluted by prevailing and
hegemonic social discourse. Using her own story, Marino speaks about the
ways in which multiple politics of her identity contributed to her experience
of madness and recovery. In particular, she speaks the historical and inter-
generational trauma of racism her family was subjected to as Native
Americans; the trauma of poverty; the gendered trauma of sex work (when in
desperation); as well as domestic violence.
 Introduction 3

PART II: WOMEN, PSYCHOSIS, AND

THE DOCTOR-PATIENT RELATIONSHIP

In Part II, “Women, Psychosis, and the Doctor-Patient Relationship,” we

offer four vantage points through which to consider ways in which meanings
can evolve or be occluded depending on the strength, reciprocity, and respect
inherent in the relationship. In “Sabina Spielrein and Frau M: Two Cases of
Women’s Psychosis and Treatment,” Ilona Melker uses two cases that view
psychosis through a Jungian lens. The first is a case treated by Jung himself.
Then the patient from the first case, Sabina Spielrein, becomes the doctor in
the second, presenting us with the first recorded case of a woman treating a
woman with psychosis. The author presents these two cases together, in part,
because they affirm the value of psychoanalysis in the treatment of psychosis
and also because they highlight the psychosocial factors—paternal abuse and
problematic maternal relationships in both cases—often found in histories of
those struggling with psychosis.
Melker suggests that Jung’s theory of complexes provides one way of
understanding trauma-based disorders, as situations in which the ego is over-
whelmed by the onslaught of archetypal energies. Although Spielrein bene-
fited from her work with Jung, the powerful erotic feelings that developed
between them were not sufficiently analyzed. Jung’s failure to acknowledge
his own part left him in the position of the father-as-betrayer. Spielrein was
left to work through her own ideas regarding the transference and counter-
transference, particularly in relation to the power dynamics in a therapeutic
relationship with a vulnerable and passionate young woman. Passion being
highly problematized for women at that time, the combination of intense
feelings and a power imbalance often resulted in guilt and the potential for
psychosis, which marked the problem in coded form. As a female therapist
who had struggled with her own psychosis, passion, and power, Spielrein
was able to value the material that emerged in the dreams, free associations,
and symptoms of her patient. Through these two stories, we can see ways in
which unrecognized trauma, along with the woman’s limited choices regard-
ing marriage, childbearing, and sexuality, at times can undermine develop-
ment, thwarting desire in ways that can move towards psychosis.
In “Lucia,” Steven Poser offers us his reflections on the case of a woman
who had been hospitalized for psychosis for over two decades, since the age
of nineteen. This case reminds us of the many women (and men) whose lives
were foreclosed in an era in which a diagnosis of psychosis could be literally
a life sentence. When Poser encountered Lucia, she was unintegrated, in
pieces, cohesive neither in gender, age, or even continuity of being. She was
facing a lifetime of imprisonment in the asylum. Through their interchanges,
Poser was able to recognize Lucia’s capacity to grow and to change but also
recognized how much time and engagement would be needed in order that
4 Introduction

Lucia might reach a point where she would be able to take on the challenges
of daily life on her own.
In these two chapters, we can see ways in which meaning can be made
through respectful, ongoing engagement with one who is suffering from
psychosis. We also see how much time and attention would have to be
devoted in order to provide the crucial relational function of making meaning
together, through which the bits and pieces might be put together sufficiently
that an autonomous life might be built.
In “The Locust of Words and the Locus of Saying: Femininity and
Psychosis,” Manya Steinkoler uses Lacanian theory to point to ways in
which women and psychosis have been used to mark both a limit and an
excess or transgression of that limit. Using the case of Schreber, she notes
how Schreber positions himself not as a woman but as the Woman, thereby
avoiding the problems of lack and limit, and also pointing to the trauma-
driven failures that have left him in that dilemma. When women are theor-
ized as either a problem or a solution, then we must look at the function of
our language and what we are doing or undoing; saying or unsaying. In this
sense, Steinkoler uses the term psychotic, not to refer to an individual, but
rather as a problematic position in relation to possibilities of meaning.
Steinkoler situates our dilemma precisely at the point of trying to under-
stand psychosis from an external perspective that theorizes about the person
and her experience in ways that both illuminate something about the dilem-
ma and also, in some sense, do violence to the person being theorized about.
In this way, Steinkoler brings us to an essential question being asked in
this volume: how do we find common threads in our various language struc-
tures: the person with lived experience of psychosis from the inside, and the
person with lived experience of psychosis from the outside? How do our
attempts to describe our experience enrich one another rather than doing
violence to one another? How can we tolerate hearing the discourse of the
other and trying to make sense of it in ways that enlarge and enrich our
understanding rather than merely refusing what seems disrespectful and off-
putting?
In this volume, we are asking practitioners to stand back sufficiently to
see ways in which they stand accused by the experience of the other. In
Steinkoler's piece, there is the potential for an enriched understanding if one
can push past some of the difficulties of the language structure and enter into
her poetry, which in some ways meets the uniquely, metaphorically concrete
language of psychosis. Psychosis attempts to speak the unspeakable. We are
invited to a realm beyond words, and our words are feeble but essential entry
points into the possibility of dialogues with one another.
Lastly, Erin Soros’ chapter, “I Call This Institutionalized Rape,” interro-
gates the relationship between gender, forced psychiatric drugging, rape, and
human rights. Soros counters her own experience of forced psychiatric drug-
 Introduction 5

ging with that of Elyn Saks, another woman who has also experienced invol-
untary commitment. Unlike Saks, Soros questions how individuals can be
viewed as “competent” whilst in a state of madness. Her chapter questions
the State’s right in protecting individuals, particularly women, from them-
selves, as well as the general interpretation of madness as a state to be
suppressed and avoided, rather than seen as important in its own right.

PART III: WOMEN, PSYCHOSIS,

AND PATRIARCHAL OPPRESSION

This final section of Women and the Psychosocial Construction of Madness

places a specific emphasis on how psychosis is experienced under patriarchal
oppression. Again, although this entire volume is inherently about how
psychosis in women operates within a context of gendered oppression, we
created this section in order to emphasize this intersection. The first chapter,
“The Scarlet Diagnosis: Trauma, Psychosis, and Pathologizing the Femi-
nine,” by Noël Hunter, is a spirited look at diagnosis as it relates to the
upholding of social norms, specifically, gender norms. Her chapter explores
the formation of diagnostic categories across the spectrum of psychosis/
dissociation (e.g., borderline, dissociative identity disorder, schizophrenia) to
discuss the ways in which diagnosis has created artificial divides within
people’s experiences. In addition, Hunter argues that diagnosis has worked as
a means of maintaining social order, labeling those who do not conform,
often resulting in re-traumatization. Hunter not only uses the theoretical and
research literature to make her claims, she also grounds her work within her
own lived experience. She states, “As a woman who wanted help with heal-
ing from a lifetime of trauma, I found the authority of mental health profes-
sionals as only seeking to confirm the belief that I was the defective, worth-
less and hopeless person my family always told me I was.” She then goes on
to detail the history of women as “pathological” in distinction from men. She
challenges the Diagnostic and Statistical Manual of Mental Disorders (DSM-
5) as particularly discriminatory towards women through the text’s use of
feminine traits as markers of pathology. Hunter is also particularly concerned
with the way in which psychotic spectrum diagnoses, such as schizophrenia
and schizoaffective disorder, obfuscate the reality of trauma, leading people
to focus more on the materiality of the body/brain rather than an individual’s
life history and social context.
The second chapter within the section, “Being of Sound Mind,” by Debra
Lampshire, presents a lived-perspective of madness under patriarchal power
structures. Lampshire’s chapter has strong resonance with that of Hunter’s,
as she states,
6 Introduction

And I have pondered about how society sees fit to label people in such ways as
to stigmatize and discriminate against them. I have in my musing also become
acutely aware of the role my gender played in the marque I came to bear—It
was easy for females to be branded as “crazy” as we were regarded as more
genetically inclined to “hysteria” and emotional instability, raised as we were
in a patriarchal society.

Lampshire herself sees much of her madness as derived from growing up

female in a male-dominated and oppressive world. Beginning with her own
birth—a product of her mother’s “forbidden love”—to foster homes and
schooling, Lampshire continually reflects upon how being female shaped her
life experiences. She movingly speaks of hearing a “maternal” voice, and the
way in which this experience brought about (a uniquely feminine) power:

I am forever grateful to my maternal voice who steered me to where I am

today. Her wisdom, guidance, bravery and love encapsulated all that I required
to take command of my own life and offered me the most valuable insights
into my own recovery. She has been the only constant in my life with her
unassailable devotion to me and my cause. She remains the very embodiment
of all the finest virtues of what it means to me to be a woman. She is, and
remains, my second soul.

Lastly, Michael O’Loughlin and Montana Queler present the story of

“Faith: A Women Interrupted,” a participant from their ethnographic field-
work at a psychosocial clubhouse. O’Loughlin and Queler contextualize
Faith’s story from within the broader context of a male-dominated psychiat-
ric field. The intent of their research is to illustrated the “gendered, cultural,
and psychosocial origins of human suffering” and promote the use of more
human-centered and narrative approaches to treatment. They state, “[Faith’s]
story raises troubling questions not only about the harshness and vacuousness
of contemporary institutional psychiatry, but also about the straitjacket that
norms of ‘femininity’ impose on all girls.” One can argue that their work
advocates for a more “feminine” approach to understanding human suffering,
one that does not rely on “masculine” notions of biological “truth” but rather
harnesses the multidimensional perspective(s) of personal narrative.
Taken together, we hope this book provides a challenging and enlighten-
ing perspective on the question of women and madness.
 Part I

INTERSECTIONALITY:
WOMEN, PSYCHOSIS,
AND MARGINALIZED IDENTITIES