andrea nicki, "the abused mind"

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Page 1: Andrea Nicki, "The Abused Mind"

Hypatia, Inc.

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Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at .http://www.jstor.org/page/info/about/policies/terms.jsp

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of

content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms

of scholarship. For more information about JSTOR, please contact [email protected].

Hypatia, Inc. and Blackwell Publishing are collaborating with JSTOR to digitize, preserve and extend access toHypatia.

http://www.jstor.org

Page 2: Andrea Nicki, "The Abused Mind"

The Abused Mind: Feminist Theory, Psychiatric Disability, and Trauma

ANDREA NICKI

I show how much psychiatric disability is informed by trauma, marginalization, sexist norms, social inequalities, concepts of irrationality and normalcy, oppositional

mind-body dualism, and mainstream moral values. Drawing on feminist discussion

of physical disability, I present a feminist theory of psychiatric disability that serves to

liberate not only those who are psychiatrically disabled but also the mind and moral

consciousness restricted in their ranges of rational possibilities.

Much psychiatric disability is closely linked to trauma. Many people who

suffer from mental illnesses that force them to seek help are survivors of child-

hood abuse. "50-60 percent of psychiatric inpatients and 40-60 percent of

outpatients report childhood histories of physical or sexual abuse or both"

(Herman 1992, 122). Freud in 1896 publicly affirmed his discovery that hysteria in women was caused by childhood sexual trauma (Herman 1992, 122). In a

report entitled The Aetiology of Hysteria, Freud states, "I therefore put forward

the thesis that at the bottom of every case of hysteria there are one or more

occurrences of premature sexual experience" (1962, 13). Freud, infamously, later repudiated the hypothesis of trauma as the origin of hysteria, because

of its unseemly social implications which attacked proletariat and respectable

bourgeois families alike, claiming that his patients' accounts of childhood

sexual abuse were pure fabrications. For feminists this subsequent betrayal of women may be seen as engulfing the whole enterprise of diagnosis and

treatment of mental illness in smog (the smoke contributed by Freud's cigar),

casting it as suspect and confused in thought. In this paper I am concerned with mental illnesses related not only to

trauma and abuse but also, more generally, to prejudice, discrimination, sexist

Hypatia vol. 16, no. 4 (Fall 2001) © by Andrea Nicki

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socialization, social inequalities, marginalization, or poverty. The latter promote toxic social environments in which mental illness thrives. I hold to Thomas

Szasz's view of mental illness as involving "difficulties in social adaption" (1975,

54), but not in opposition to the common view of mental illness as biochemi-

cal disorder, analogous to physical illness. Mental illnesses have biochemical

and biophysical aspects that may be improved or worsened by pharmaceutical interventions. For instance, symptoms of clinical depression can include slow

thought-processes, negative affect, lack of appetite, or fatigue. These symptoms can be reduced or overcome by psychiatric medications, but this accomplish- ment by pharmaceutics alone does not establish an underlying biological cause

of the illness. Similarly, certain treatments may improve or worsen a physical illness like cancer, but this does not mean the underlying cause of cancer is

biological. For people who live next to toxic waste dumping sites and develop cancer, the primary cause of their disease is certainly not in their genes or

biological makeup. That many instances of mental illness are not best understood as having

primarily genetic or biological causes in no way means that these illnesses are

not real or genuine. Mental illnesses, like physical illnesses, involve difficulties

in social adaption that, without proper accommodation, sources of support, and

aid, can be seriously disabling. Just as anyone can become severely physically ill and disabled, so also can anyone fall severely mentally ill and disabled, with illness of both types exacerbated in those with unequal access to health care, social resources, and support. Susan Wendell argues that social structures based on able-bodiness, which do not integrate people with physical illnesses, serve to disable them (1992, 69). Similarly, social structures based on able-mindedness, which marginalize people with mental illnesses, and assume that they can

simply "snap out" of their conditions, are also disabling. The case of psychiatric disability is complex because a variety of beliefs

inform a social understanding of mental illness and thus attitudes toward those who are mentally ill: that mentally ill people are irrational and dominated

by emotion; that emotion lacks directive, cognitive content and is inferior to calm reason; and that negative behavioral or ideational components of mental illness can be easily suppressed or overcome. Also, norms of mental health are different for men and women. For instance, a woman who displays aggression and ambition, and is not feminine, risks being labelled "mentally ill" or, if

genuinely mentally ill, having her illness seen purely in terms of her transgres- sion against her gender. Cultural concepts of irrationality and sexist norms of mental health marginalize people with mental illnesses in attacking their

personhood. In attacking the personhood of those who are simply nonconform- ist they contribute to the development of mental health problems in such

people. Further, in attacking the personhood of those with mental illnesses to which low self-esteem is central, they promote their mental illnesses.

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I argue that cultural and social analysis of mental illness is important since cultural and social factors contribute to the development and prevalence of much mental illness in members of disadvantaged groups. However, in

considering how such factors inform many instances of mental illness, I stress

that it is important not to reduce these instances to their cultural and social

components. This reduction feeds into a mentality that blames mentally ill

people for their illnesses.

A mentality that blames sufferers for their health problems has been well

documented in the case of physical illness (Overall 1998; Wendell 1996). I

discuss how feminist theories of physical disability are illuminating for the case

of psychiatric disability, which has received much less attention in feminist

work on disability. Wendell writes, "We need a theory of disability for the

liberation of both disabled and able-bodied people since the theory of disability is also the theory of the oppression of the body by a society and its culture"

(1996, 78). Similarly, I argue that we need a theory of disability for the liberation

of both psychiatrically disabled and able-minded people. Whereas society's

rejection of physically disabled people is based on cultural insistence on the

control of the body, society's rejection of psychiatrically disabled people stems

from cultural insistence on the control of the mind.

Society devalues and despises extreme mental states that are beaten down,

fettered by this rejection: intense dissatisfaction or frustration becomes clinical

depression; mania or profound enthusiasm becomes manic-depressive illness.

I present a liberatory theory of psychiatric disability that validates diverse

mental states. It acknowledges the thought and behavior of people broken

by personal and social harms as rational responses to various facets of oppres- sion. For instance, trauma-related disorder is a rational response of a mind

subjected to intense psychological stress in the same way that cancer is a body's

meaningful and intelligible response to a toxic physical environment, to severe

physical stress. Just as we need to discard a paradigm of humanity as young

and healthy against which physically disabled people will be seen as lacking

(Wendell 1992, 66), we need to overcome a paradigm of humanity as mentally

healthy so that those with mental illnesses will not be judged deficient. Further,

since a lack of social acceptance or self-acceptance directly promotes mental

illness related to low self-esteem, we need to reject a paradigm of humanity as

rigidly self-controlled, moderate, dispassionate, pleasant, and conformist, with

strict adherence to norms of one's gender. In effect, we need to challenge the

values inherent in this paradigm, the belief that only certain human traits and

dispositions are praiseworthy. Wendell argues that people with physical disabilities desire some transcend-

ence of the body, of negative bodily states and limitations (1996, 166). People

with psychiatric disabilities also seek some transcendence of the mind, of nega-

tive mental states and limitations. In cases of trauma-related mental illnesses in

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which depression is common, I argue that symptom-management and recovery

may require the realization of values outside mainstream morality. In order to

overcome depression and attain more pleasant states of mind, survivors may need to experience and transcend other unpleasant states, such as anger or

cold indifference. Feminist theory of disability is inclusive toward those with

traumatic disorders by recognizing the moral merit of some alternate values. I

present a feminist theory of psychiatric disability that serves to liberate not only those who are psychiatrically disabled but also the mind and moral conscious-

ness restricted in their ranges of rational possibilities. I explore several topics: feminist theory and the social construction of mental illness; mental illness and

"craziness"; biopsychiatry, and marginalized people and mental states; feminist

theory, mind-body dualism, and coping with disability; and traumatic disorders

and feminist ethics.

FEMINIST THEORY AND THE

SOCIAL CONSTRUCTION OF MENTAL ILLNESS

Feminists (Chesler 1972; Millet 1990) and others (Szasz 1975) have extensively discussed the use of the construct of mental illness as a means of social control.

Certainly, many specific constructions or "discoveries" of mental illness have

served to support the status quo and to enforce the oppression of various social

groups based on gender, class, race, sexual orientation, or ability.' Only recently, in 1973, did homosexuality get removed from the Diagnostic and Statistical

Manual of Mental Disorders (the official register of psychopathologies) as a

real mental illness (Horrocks 1998, 15). The use of the term "mental illness" to

denounce deviant behavior and to problematize women and other oppressed

groups is at odds with the term's use to validate medically certain instances of

difficulties in social adaption as aspects of legitimate illnesses. While criticizing the former use is very important, such an endeavour, by partially invalidating the concept itself, throws into question the legitimacy of the latter use. In order

for mental illnesses to be conceived as real illnesses and those afflicted to be

treated appropriately, mental illnesses must not be seen purely in terms of their

cultural and social components. Phillis Chesler, in her classic book Women and Madness (1972), maintains

that mental illness in women is essentially and literally "an expression of female

powerlessness and an unsuccessful attempt to overcome this state" (1972, 16). Confinement in a mental institution is a penalty for "being female, as well as for

daring or desiring not to be" (Chesler 1972, 16). Women become mentally ill

as they realize to an extreme degree feminine norms of dependency, vulner-

ability, and helplessness in order to escape constraining traditional female

roles. For instance, in the mental illness of depression, women become ultra-

feminine-childlike, dependent, and helpless-seeking the help of an authori-

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tative, knowledgeable expert to guide and watch over them (Chesler 1972,

50). Discussing the cases of the female artists Ellen West, Zelda Fitzgerald, and

Sylvia Plath, whose intellectual creativity made them feel intensely alienated

in traditional female roles, she maintains that they became depressed in order

to be released from maternal and domestic duties (1972, 15). Their mental

illnesses were both protests against barriers confronting them and willful self-

entrapments within these barriers.

Similarly, Susan Bordo in her discussion of anorexia nervosa emphasizes the role of cultural norms, values, and ideals in accounting for the upsurgence and increasing incidence of the disorder, and for its predominance in women.2

While Bordo maintains that anorexia nervosa is a real illness, "a debilitating affliction" (1993, 147), she argues that it constitutes a protest against the confin-

ing traditional female roles of self-abnegating mother and wife (1993, 156). Women who suffer from anorexia nervosa become ultra-female by pursuing the

feminine ideal of excessive thinness, but in carrying this pursuit to an extreme,

they reject their female bodies, refashioning them into young boyish ones, not capable of menstruation or motherhood (Bordo 1993, 160). In obsessively and rigidly monitoring their food intake and dominating their bodies, they realize masculine ideals of aggressiveness, self-control, strength, and conquest.

However, in their physical and emotional exhaustion they are reduced to

feminine infantilism and dependency (Bordo 1993, 160). By directing all their

energies into the ideal of extreme thinness-obsessively exercising and count-

ing calories-anorexic women have nothing left for intellectual, moral, or

social development and achievement (Bordo 1993, 160). Bordo's work was a response to a relative absence of cultural or social analysis

in research on anorexia nervosa (Bordo 1993, 140), and contributed, alongside work by such authors as Hilde Bruch (1981) and Kim Chernin (1981), to a

better appreciation of the role of cultural and social factors in the disorder. But

while a social constructionist approach to mental illness is illuminating, the

view that mental illness in women is a self-contradictory protest against and

conformity to "the devalued female role" (Chesler 1972, 56) may be used to

undermine mental illness as a legitimate illness and disability. Those educated

in the role of social and cultural factors in the disorder may, when faced with

a woman suffering from anorexia, not view her condition as a debilitating

illness, perhaps unsympathetically attributing to her an extremely conformist

mentality or an irrational rebelliousness.

Similarly, if depression is understood in women as the enactment of a "female

role ritual" (Chesler 1972, 50), clinically depressed women might receive the

same kind of critical gaze as might be given to anorexic women. Chesler writes:

"Conditioned female behavior is more comfortable with, is defined by, psychic and emotional self-destruction .... Female suicide attempts are not so much

realistic 'calls for help' or hostile inconveniencing of others as they are the

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assigned baring of the powerless throat, signals of ritual readiness for self-

sacrifice" (1972, 49). These ideas are interesting and insightful regarding the

implication of feminine norms of self-destruction in promoting and sustaining mental illness in women. However, they may be used to express "ritual readi-

ness" to blame the suffering victim of illness. Such readiness has been well-

documented in cases of physical illness, with sufferers receiving unwelcome,

reductionist explanations about the psychological or behavioral causes of their

conditions (Overall 1998, 157; Wendell 1996, 97, 106). For instance, people with physical illness may be told that an unhealthy lifestyle or unresolved

psychological issues caused their illness (Wendell 1996, 97). The potential for victim-blaming in the case of mental illness can be seen

more clearly in the employment of metaphors of travel and place to illuminate

the phenomenology of mental illness, as when Chesler claims that women

attempt to escape confining female roles by "going crazy" (1972, 14). This

expression carries the implication that their conditions are actively and will-

fully self-imposed. On this view, women escape from one female domestic role

only to enter into another, more lethal female role of self-sacrifice. Women take

a journey into a nightmare state that often includes institutionalization in a

mental hospital, referred to by Kate Millett as a "loony-bin trip" (in the title of

her 1990 book by that name). The conception of mental illness as involving a "trip" informs and reinforces the practice of institutionalizing those with

mental illness: mental illness is a place where one goes. One goes down into

its hell, brought there by one's own feminine inferiority, resignation, and

helplessness-punished for femaleness-just as in Judeo-Christian religions one is condemned to hell for evilness: "Contemporary women carry themselves

headlong down . . . to the underworld" (Chesler 1972, 22). Similarly, John

Bentley Mays, who suffered from clinical depression, refers in a metaphoric vein

to depression's "black dogs" (1995). Also, Julia Kristeva emphasizes depression's "black sun" (in the title of her 1992 book by that name).

While all these authors are emphatically opposed to romanticizing mad-

ness, such metaphorical ways of describing mental illness preserve its morbidly romantic mystique. One would not say that someone who has acquired a

physical or cognitive disability has "gone ill," as if her illness were a place to

which she has journeyed. A hard existentialist would insist that a condition

of mental illness is much more voluntarily maintained than one of physical illness, pointing to negative factors or events in one's life that one could have

responded to more cheerfully or stoically (Sartre 1947). But at issue here is

the extent to which mental attitudes and emotional responses and the life

experiences related to them are in one's control and can be freely chosen.

Notably, while Chesler maintains that mental illness in women is an expres- sion of self-destructive female behavior, she also claims that this behavior is

conditioned, or determined by social norms (1972, 49). On her view, women

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are conditioned to be depressed, full of self-doubt and guilt, in the same way that they are conditioned to diet, attract male attention, or find husbands.

However, although feminine norms of self-destruction contribute to mental

illness in women, their mental illnesses are not merely realizations of these

norms-women being "simply unhappy and self-destructive in typically (and

approved) female ways" (Chesler 1972, xxii). Chesler does concede that a minority of women who have psychiatric

"careers," or who undergo continual psychiatric treatment, experience "genuine states of madness" (1972, xxii). However, it is not clear, in Chesler's account, what a woman must suffer or suffer from in order to be considered genuinely

mentally ill. Given that self-destructive behavior is debilitating, the woman

who engages in it is obviously disabled by it. Whether one argues that she is

willfully mentally ill as a result of female conditioning that she does not resist

or is mentally ill because of factors somehow more beyond her control, mental

illness is not something she desires or finds desirable. Women who commit

suicide are not simply "tragically ... outwitting or rejecting their 'feminine'

role" (Chesler 1972, 49). Rather, they are judging that their lives with mental

illnesses and the social sources of these illnesses are not worth living. None-

theless, the misuse of the term "mental illness" applied to those who are

mentally healthy deserves further exploration so that this misuse can be clearly

distinguished from the term's proper use. In the next section I will investigate the relation between the two uses and whether the term's misuse has any

bearing or impact on those who are genuinely mentally ill.

MENTAL ILLNESS AND "CRAZINESS"

Notably, social revolutionaries throughout the world have often been the first

to be labelled "mentally ill" and forcibly locked up in asylums or, as in Stalinist

Russia, in state mental hospital prisons. Perhaps because of the association of

mental illness with political fanaticism, the term has come to denote extremity, intense passion, or a lack of accessible meaning. This seems especially true

when seen as synonymous with the term "craziness." Like the label "mentally

ill," the label "crazy" is also used as a tool to control people who are simply nonconformist and not genuinely mentally ill.

A person called "crazy" is judged to be irrational, off the chariot of reason,

her speech and behavior thought offensively aimless or stupid: thus the phrase

"crazy as a loon" applied to wandering vagrants talking to themselves. A person

may also be termed "crazy" when believed to be dominated by wild feeling, caused by emotion taking the reins, as in the case of those called "crazy radicals."

The insult of "craziness" feeds on and expresses various beliefs: that strong or intense emotion is devoid of meaningful, directive cognitive content; that

people with mental illness are irrational; that they are cognitively impaired;

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and that they are frightening. The label of"craziness" directed at people who are

simply nonconformist or who challenge the status quo, without serious inquiry into their mental health, derives its power from prejudiced views of those

genuinely suffering from mental illness as irrational, disordered, cognitively

impaired, and frightening. For instance, Marilyn Frye describes an exchange she had with an angered

black woman in a discussion on white privilege: "One Black woman criticized

us very angrily for ever thinking we could achieve our goals by working only with white women.... She seemed to be enraged by our making decisions,

by our acting, by our doing anything....What she was saying didn't seem to

make any sense. She seemed crazy to me.... I backed off. To get my balance, I

reached for what I knew when I was not frightened" (1983, 111-12). The black

woman's anger and unfamiliar assertions frighten Frye and lead her to initially

judge her "crazy": because the other is dominated by emotion, her speech seems

to lack sense, and she provokes fear; Frye concludes she is "crazy." People suf-

fering from mental illness may be irrational, disordered, cognitively impaired, or frightening, but no more so than those not suffering from mental illness. In

the case of irrationality, it depends on how irrationality is being defined and

what frames of reference or value systems are being invoked; as Frye writes, after she reconsiders her initial response, "I have been thought crazy by others

too righteous, too timid and too defended to grasp the enormity of our differ-

ence and the significance of their offenses" (1983, 112). Further, while mental

illnesses in which depression is present involve a diminished capacity to think

or concentrate, many persisting factors in mentally healthy people's lives can

cause cognitive impairment, such as self-centeredness or arrogance, where one

has difficulty distinguishing between where one's self ends and another person

begins, between one's own interests and those of others.3 Finally, in the case of

women who are mentally ill, given that, as Chesler argues, the feminine norm

of self-destructiveness informs women's mental illnesses, they most often only

pose a threat to themselves (Herman 1992, 109). Many women with trauma-

related disorders frequently injure themselves (Herman 1992, 109). Such self-

inflicted injury might be thought of as irrational, or senseless. However, from

the perspective of those engaging in it, it is a method of self-preservation that

substitutes physical pain for unbearable emotional pain and produces a sense

of calm (Herman 1992, 109). The derogatory label of "craziness" serves to silence communication of dif-

ferences in ideas or intensity of emotion. Calling someone "crazy" keeps that

person and her differences away, but it also reinforces the belief that "crazy" or

mentally ill people are less than fully human and not deserving of respect. It

was because her initial view of the black woman as crazy expressed a lack of

respect for her opinion that Frye reconsidered it.

Calling someone "crazy" throws at her the same kind of verbal abuse as

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calling her a "mental retard" or "stupid cow."4 The latter terminology draws on

and serves to reinforce the oppression of cognitively challenged persons, who

are thought to be less than fully human, and of animals, who are thought to be

subhuman. One might argue that while some uses of these terms are explicitly meant to reduce or criticize another, other uses are more "fun-loving," as when

one calls another "crazy" jokingly for having done something silly or foolish or

"piggish" for sexual promiscuity or abundant food consumption. But even these

"fun-loving" uses are problematic, like the term "bitch" used in a light-hearted

way between friends.

Here I am not advocating a total policing of all language, putting the tongue in chains, but rather simply pointing out that uses of language that derive their

meanings from systems of oppression cannot be divided into good and bad

uses, as if a bucket lowered into the same polluted well could obtain clean

water. Perhaps a term like "bitch" used between women to secure bonds of

female friendship could serve as an antidote to help destroy a patriarchal well

of significance. The same may be said for the term "crazy" between mentally ill women. But that would only be to claim that uses of language that express and reinforce oppression can be used for other, good or bad ends-to enliven

or diminish. While a woman is laughingly calling her friend a "bitch" she is

also telling her she is more animal than human, only that she could use and

is using her animal nature to her admirable advantage. Similarly, in the case

of the use of the term "crazy" by a woman suffering from a mental illness to

refer good-heartedly to a kindred sufferer, the woman is saying that she finds

the other's "otherness" delightful, where others typically find it offensive (as

in: "Those people in the state mental hospital are really sick," a woman says, her voice dripping in disgust). She is affirming that her friend is other, only that this is acceptable, even praiseworthy in her eyes.5

The use of the term "crazy," whether intended good-humoredly or not, with

its various pejorative connotations, serves to sustain mental illness in sufferers

by enforcing their marginalization. Further, the application of the term to, on the one hand, people who are mentally ill and, on the other, people who

are simply nonconformist or who challenge the status quo, and who are not

actually mentally ill, also serves to promote mental illness in those afflicted by

reinforcing their "otherness" through association.

BIOPSYCHIATRY, MARGINALIZED PEOPLE, AND MENTAL STATES

The marginalization of mentally ill people and nonconformist people occurs

alongside the marginalization of another group, that of "mad, starving artists."

This group has been subject to much biopsychiatric mystification which has

served to obscure the connection between marginalization and much mental

illness.

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Biopsychiatrist Kay Redfield Jamison argues, referring to numerous studies, that there is a strong correlation between mental illness and artistic tempera- ment. She focuses particularly on manic-depressive illness. Presenting charts

of family histories characterized by generations of members with the illness or

significant aspects of it, she argues that manic-depressive illness is "indisputably

genetic" (1993, 16). Those committed to biopsychiatry, such as Jamison, insist

on a genetic and biophysical determinacy of mental illness perhaps as a way to

gain acceptance for it as a legitimate illness no less serious than cancer, with a

potentially fatal outcome.6 Without drug therapy, Jamison claims, a condition

of manic-depressive illness will inevitably worsen, with an increased risk of

suicide (1993, 16). One can sympathize with a sense of frustration behind Jamison's insistence

on a pure, unalloyed genetic and biophysical basis of mental illness in general in a culture where mental illness has become a flippantly used catchphrase: "I'm mentally ill. You're mentally ill. We're all mentally ill. People aren't sick;

society is." However, notably, after listing many prominent writers, artists, and

composers with probable, undiagnosed major depression, manic-depression, or

cyclothymia (mild manic-depression), Jamison admits in a footnote, "Many of [these] had other major problems as well, such as medical illnesses. .

alcoholism or drug addiction ... or exceptionally difficult life circumstances"

(1993, 268).7 Their mental illnesses were surrounded by other problems in social

living. These problems, one could argue, unavoidably influenced their illnesses.

Thus Jamison's reduction of their illnesses to their genetic, biochemical, and

biophysical components is not convincing. The manic-depressive illness of poets is related not only to their social

marginalization but also to the marginalization of mental states associated with

mania. One problem with arguing for the recognition of an illness like manic-

depression as a genuine illness and disability is that mental states central to

the condition can be socially advantageous. But their very extraordinariness

makes these also social liabilities. For instance, in the manic phase of manic-

depressive illness, there is a rapid increase in goal-directed activity (socially, at

work, or at school) and an increase in the production of ideas, with high self- esteem and enthusiasm (Jamison 1993, 262). However, all planes must land, and because a person experiencing mania does not want to come down she

will experience landing as crashing. She crashes down into a world that has

outlawed natural states of intense exhilaration and exaltation, preferring that these states be induced and controlled through artificially engineered products that are dangerous and illegal. It is a world that has outlawed manic thinking, or "divergent thinking" (Jamison 1993, 106), which often precedes or informs such pleasure-thinking which spins off into a variety of different directions and is not content with a box at the end of a question, as if there is only one conclusion or answer. It is a world that does not recognize the beauty of colors,

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often keenly appreciated in mania, where those fashioning beautiful tableaux

of color cannot earn a living doing so and have to pay to rent places where

others can come to enjoy them. It is a world where abilities heightened in

mania-fluency of thought, verbal fluency, and ideational fluency, or the abil-

ity to rapidly produce relevant, original, or innovative ideas-do not cause

appreciation or admiration in others but, rather, distress, fear, or anger. Running a mile a minute is seen as commendable; talking a mile a minute is not.

Kate Millett, who was diagnosed with manic-depression, refers to the social

rejection of mania: "Depression-that is what we all hate. We the afflicted.

Whereas the relatives and shrinks, . . . they rather welcome it: you are quiet and you suffer ... For we could enjoy mania if we were permitted to by others

around us so distressed by it, if the thing were so arranged that manics were

safe to be manic awhile without reproach or contradiction, the thwarting and

harassment on every side that finally exasperates them so that they lose their

tempers and are cross, offensive, defensive, antagonistic-all they are accused

of being" (1990, 72). Wendell argues that fear of "the other" is at bottom a

fear of oneself, of one's own vulnerability or susceptibility to the object of one's

response (1992, 73). As Millet exclaims: "How crazy craziness makes everyone, how irrationally afraid. The madness hidden in each of us... The more I fear

my own insanity the more I must punish yours" (1990, 68).

People who exhibit the extraordinary traits found in mania are berated

for them, treated as children and punished, force-fed medicine "for their own

good": "Accusing me of mania, my elder sister's voice has an odd manic quality. 'Are you taking your medicine?' A low controlled mania, the kind of control

in furious questions addressed to children, such as 'Will you get down from

there?'... [A friend's] hand approaches my mouth so fast I hardly see it; she is

forcing the pill between my lips, her other hand reaching to hold my chin, as

one forces a child to take pills, even a dog" (Millett 1990, 32-58). Women who

are manic are particularly vulnerable to others' abuse since, as Chesler claims,

women are conditioned to be filled with self-doubt and insecurity rather than to

have the opposite, inflated self-esteem or grandiose enthusiasm-traits that are

seen as normal and encouraged in men. Women who are denounced for their

mania are rejected for their "unwomanly" abilities or behavior, a denunciation

that they may internalize: "You should shut up because you talked too much

before, you should close down all your capacities because you were boastful

and extravagant about them before" (Millett 1990, 72). Conventional feminine

behavior involves quietness, self-effacement, and cautiousness that does not

give rise to manic, risky involvement in pleasurable activities like sexual affairs

or financial investments, activities that are condoned, even applauded, in men.

Women who display mania are doubly deviant, defying norms of femininity and challenging an Aristotelian paradigm of humanity as self-controlled and

moderate, occupying a mean between extremes. Women who exhibit levels

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of self-confidence and initiation that would be seen as normal or average in

men risk being labelled "mentally ill." Further, they might apply this label to

themselves, judging themselves mentally ill for self-praises or brilliant ideas,

especially insights into women's oppression (as in: A woman talks passionately and tirelessly about radically feminist critiques of culture and wonders if she is

"crazy."). As a result of this denigration, imposed by others or self, women might become mentally ill. Persistent insecurity and self-doubt develops into clinical

depression, just as genuine mania, through others' incessant beratement, turns

into manic-depressive illness.

In the absence of any cultural or social analysis, we risk applying the category of "mental illness" to people who are simply nonconformist, thereby promoting more mental illness. Unless attention is given to the cultural or social aspects of genuine mental illnesses, we risk giving these illnesses overly personalized

explanations-"bad genes," faulty biochemistry, and so on-and viewing them

as purely personal problems, in no way social. This is not to deny that there are

cases of mental illness that have primarily a biochemical or physical cause. For

instance, Wendell sometimes suffers from severe depression caused by chronic

fatigue immune dysfunction syndrome (1996, 174), and people may be afflicted

with mental illness as a result of brain injury or damage. But the reason that

members of oppressed groups form a high percentage of mentally ill people is no

mystery. Mental illness is found predominately among such groups as women,

homosexuals, the poor, unemployed, or homeless, the physically disabled, the

racially marginalized, or the elderly.8 In societies with rampant prejudice and dis-

crimination, social inequalities, violence against women and children, unequal access to health care, low-paying jobs, unsafe working conditions, technologi- cal domination, chemically compromised natural environments, waste, greed,

egoism, and so on, members of oppressed groups will be more likely to become

chronically or perpetually physically and/or psychiatrically disabled, with their

minds overwhelmed with the negative realities in their lives.

FEMINIST THEORY, MIND-BODY DUALISM,

AND COPING WITH DISABILITY

Understanding the role of social and cultural factors in physical and psychiatric

disability includes understanding the contribution of mind-body hierarchical

dualism to social and environmental problems. According to this dualism, mind and body are seen as oppositional and the mind is valued over and against the devalued body (Warren 1998). The devaluation of the body includes the

devaluation of entities associated with it, such as emotion, women, nature

(Warren 1998). However, in a society based on mind-body dualism and other

hierarchical dualistic conceptions, such as able-bodied/disabled and able-

minded/disabled, people with physical and mental disabilities are forced to

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conceive of their struggles to some extent according to a norm of value-

hierarchical thinking. Coping with disability requires learning to work with

rather than against a negative body or mind. In this section and the next

one, I show that because of various sources of oppression and social pressures, an oppositional relationship between self and body or self and mind can be

difficult to transcend.

Wendell discusses the feminist preoccupations with challenging mind-body dualism, which has fundamentally structured patriarchal theories throughout the ages, and with affirming the value of the body and bodily experience (1996,

165-69). She argues that feminist theorists need to take into account struggles that people who are physically disabled have with their bodies as sources of

pain and frustration. The body can be confused and confusing, providing information that is false and misleading, as in the case of chronic pain which

is meaningless and does not, as with acute pain, signify immediate danger (Wendell 1996, 173). For people who experience their bodies as intractably

negative, the ideal of bodily transcendence has appeal (Wendell 1996, 166). Feminists' celebration of the female body has been accompanied by celebra-

tion of the female mind which patriarchal theorists denigrated when they cast

women as other, body and mind, more body than mind. However, in the case of

people with psychiatric disabilities, some transcendence of the mind is desired.

Just as the body can be deceptive and misleading, so also can the mind. For

people with psychiatric illnesses the mind is sometimes experienced as other, as untrustworthy and disordered, and certain thoughts, ideas, and negative or

morbid beliefs need to be transcended.9 For instance, a person suffering from

clinical depression is plagued by negative judgements regarding her own worth

or abilities which are not accurate but which if not overcome may lead her to

abandon or sabotage important projects. Some women have ceased to trust

their minds because they have been subject to gender-based violence-because

they have been experienced as so infuriatingly "other"-just as a woman might become physically disabled after a male lover beats her. In this case they

might be tortured by ideas of self-blame that make them believe that they are

unworthy of respectful treatment or that resistance is futile. Negative thinking

might extend far and wide. Everything is caught up in it; there is no help,

comfort, or sanctuary perceived in anything or anyone; everywhere seems

horribly unsafe.

The kind of transcendence that Wendell favors toward the negative body involves a sensitive attunement to it, learning to adjust to its differences and

changes. Wendell gives an example of such attunement when she claims that

if her body tells her she must rest, she curtails her activities, explaining that

ignoring her body's need to rest could result in a worsening of her condition

(Wendell 1996, 173). Similarly, sensitive attunement to a disabled mind would

also mean working with its differences and changes. This could mean, in the

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case of those with traumatic memory syndrome, that they should not push for

the recollection of memories if recollecting is causing too much distress and

intensifying their symptoms, producing nightmares and intrusive flashbacks

throughout the day. Further, such sensitive attunement could also mean avoid-

ing situations or people that might trigger traumatic memories when survivors

are feeling emotionally drained from other sources of stress. Survivors could

monitor their responses and feelings toward others so that they do not become

entangled in relationships where they will be exploited and their recovery threatened.

But just as the state of one's body or one's mind is not under one's complete control, likewise sensitive attunement to a negative body or mind is not always

possible, nor can one always respond appropriately. Particularly overburdened

and overstressed people, such as women with multiple roles-self-abnegating mother and wife and full-time worker outside the home-may not have the

time or the necessary supports that would allow them to pay attention to their

bodily and psychological needs and respond accordingly. Notably, Christine

Overall relays how people regarded her illness of viral arthritis mistakenly as

the result of intense and constant exertion to hold her place in academia (1998,

157). However, she remarks significantly in a footnote that such great exertion

was necessary because of the prevalence of sexism in academia, specifically, the belief that women are less able to hold positions, and the higher standards

for women's performance (1998, 157). As Wendell states, people who look for

purely internal causes of someone's illness have a myopic view of the sufferer and her condition, wondering only what she must have done to get herself in that state (1992, 72). Heavy children on a mother's back could very well wear her down physically and/or psychologically. While, as Wendell claims, "health and vigour" are not "moral virtues" (1992, 72), these can be better obtained the more socially privileged one is (just as financial generosity and liberality are easier for the wealthy to achieve).

"NORMALCY," PSYCHIATRIC DISABILITY, AND THE WORKPLACE

Social arrangements which do not accommodate people with disabilities inten-

sify their disabilities. In this section I show that modifying the social environ- ment of the workplace, and the norms of behavior and personal interaction that structure it, can serve to liberate people with disabilities (Wendell 1992, 69). Toward this end of liberation, it is important to challenge a paradigm of

humanity as invulnerable, happy, and carefree. Cultural pressure on people with depression-centered mental illnesses to be cheerful and to completely deny their illnesses promotes in them an unhealthy oppositional relationship with their negative minds. In implying that people who suffer from clinical

depression really suffer from negative personality traits, such pressure also

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supports their low self-esteem. I stress that sound understanding of psychiatric disabilities is important in making changes in the workplace that support those

who are psychiatrically disabled.

Wendell discusses how Western society is structured on the assumption that

everyone is physically healthy and strong, that everyone can work smoothly and efficiently at the same rate, managing with the same number and length of breaks (1992, 69). Overall emphasizes specifically how the environment

of academia can be both physically and socially inhospitable to people with

physical disabilities (1998, 151-60). Overall talks about how she was, as a

temporarily physically disabled person, subject to "pressure to pass for normal"

(1998, 155). Some faculty and students continued to make demands on her

with full knowledge of her weakened condition as though she were not really or seriously impaired (1998, 156).10 In the case of people with psychiatric dis-

abilities, the obstacles in the social environment are in some ways similar but

in others different. Overall relays Lois Keith's (1996) point that the pressure to pass as normal brings with it a requirement that one appear cheerfully

pleasant at all times, and not at all affected by pain (Overall 1998, 166). This

is a requirement imposed on the abled and disabled alike. There is a cultural

insistence on cheerfulness; we are always supposed to appear as though life

were happy and carefree (Aries 1974). While, as Overall states, underlying the

insistence on cheerfulness in disabled people is the fear that they are needy and demanding (1998, 168), a cultural insistence on cheerfulness in everyone

expresses the fear that everyone is needy and demanding. This is the fear

of one's own vulnerability which the "othering" of disabled people expresses (Wendell 1992, 74). The cultural demand of cheerfulness is also supported by the requirement of social conformity and acceptance of the status quo.

Overall claims that the pressure to seem happy at all times affects the

psychological harmony of disabled people (1998, 167), forcing them to deny

feelings of discomfort and pain and so reject their disabilities as true parts of

themselves. The pressure on the disabled to be cheerful is particularly intense

for people afflicted with mental illnesses to which depression is central, since for

them the pressure to be cheerful requires a full-fledged denial of their disorders.

People suffering from a physical disability can explain their lack of cheerfulness

by reference to physical pain or weakness. They may encounter many people who find this explanation inadequate, who tell them that they simply do not

want to get better or that they have not tried all possible treatments, perhaps from a lack of effort (Overall 1998, 157; Wendell 1996, 97). People suffering from a psychiatric disorder, on the other hand, may receive no sympathy or

concern whatsoever, or only concern from those who have suffered from the

condition themselves, or who had a friend or relative so afflicted.1

Those who have no familiarity with the world of psychiatric disability may not only be dismissive of explanations of psychiatric illness, not seeing it as

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real illness, but outright hostile toward these explanations, seeing an afflicted

person as emotionally immature, self-centred and self-indulgent (focusing too

much on her own problems), attention-seeking, or morally or spiritually weak

(not able to cope with life). Of course a mentally ill person could be all these

things, but such traits do not in themselves inform or reveal mental illness.

There is no inherent correlation between these features and mental illness. A

person who tells others she is suffering from a mental illness such as depression

may be told, like a person suffering from a physical illness, that it is "all in her

mind." Her condition and symptoms are perceived as imaginary, as if she were

not really depressed but just thinks she is. Or her condition is thought to be

self-imposed, as though she were willfully depressed (perhaps with the view

that she is conforming too strongly to a female role of self-destruction and

helplessness). But in the case of a person suffering from a mental illness, the

claim that her illness is "all in her mind" would be in one sense correct. Her

condition is fundamentally constituted in her mind, in negative thoughts about

herself, about her worth and value, about her life and future, possibly about

others and their lives, or about the world in general as hopelessly evil. These

thoughts are like the eyes of storms of sad or angry emotion by which others

may feel resentfully engulfed. Insisting that a person suffering from clinical

depression be cheerful, they demand that she not only hide her illness-her

tearful or raging negativity-but that she immediately overcome it in order for

them to continue to respect her as a person. If a person cannot control her

mind-that which allegedly distinguishes persons from animals-the assump- tion is that she must be mentally defective and so not deserving of full human

respect.'2

People suffering from clinical depression risk becoming more depressed because of the hostile and confused attitudes of others regarding their illnesses.

Those who insist that people suffering from depression be cheerful ignore the

reality that depression, for those afflicted, is an undesirable state of unwelcome

thoughts and doubts that fill every corner of the mind-the thought of death

the worst intruder. If those afflicted could so easily overcome their conditions,

they would.

Notably, Millett concludes her book by displaying a speed of thought, a

wonderful flight of ideas-a denigrated state of manic consciousness which she

reclaims and champions: "We do not lose our minds, even 'mad' we are neither

insane nor sick. Reason gives way to fantasy-both are mental activities, both

productive. The mind goes on working, speaking a different language, making its own perceptions, designs, symmetrical or asymmetrical; it works. ... Why not hear voices? So what?" (1990, 315). In this passage Millet is directing her

arguments against, specifically, the cultural treatment of people diagnosed with

mental illnesses as criminals to be treated with forced hospitalization, drugging,

electroshock, or other "savage methods" (1990, 314). However, as Millet claims

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earlier in her text, whereas mania is desirable (except for mania in an irritable

form, which can be highly unpleasant), severe depression is not. Further, the

poet Anne Sexton (a survivor of childhood sexual abuse), who heard voices

telling her to kill herself, experienced these hallucinations as invasive and

coercive, as her mind working against her, speaking a language that was hostile

to her and that she could not silence (Middlebrook 1991, 16). There is a certain

fantastical soar to Millett's claims that forgets about mental illness as a response to oppressive life circumstances, about a mind fettered by trauma, cruelty,

neglect, prejudice, or discrimination. Millett writes, "If we go mad-so what?

We would come back again if not chased away, exiled, isolated, confined"

(1990, 314). Certainly, there is much that is wrong with aggressive approaches and medical treatments concerning mental illness.'3 But mentally ill people are disabled by their illnesses and have difficulty functioning from day to day, with adverse effects on various aspects of their lives.

Better understanding of psychiatric disability has great social and economic

importance. If others perceive a mental illness in a co-worker simply, and

unsympathetically, as a personality problem, the latter may be fired, not re-hired,

or not promoted. While understanding of psychiatric disability is important for

good communication in the workplace, and for the avoidance of misunderstand-

ings, a person suffering from a psychiatric disability might keep her condition a

secret for fear that others might be unsupportive about its background causes.

Some common psychiatric disorders such as "borderline personality disorder"

or "multiple personality disorder" are strongly linked to histories of childhood

sexual abuse (Herman 1992, 97). Because of the strength of this link, some

psychiatrists have proposed a new diagnosis for survivors of childhood abuse

called "complex post-traumatic stress disorder" (Herman 1992, 120). For the

psychiatrically educated, disclosures of these traumatic disorders can amount

to disclosures of abuse. Thus, in making their diagnoses public, the afflicted

risk putting themselves in the very vulnerable position of having possibly two

stigmatized identities, that of "disabled" and that of "abused child of 'bad

blood"' (shameful parents and "defective genes," as in, "Her own family abused

her").

Making the work/social environment more hospitable to people with psychi- atric disabilities would involve challenging a lot of prejudices and conventional

ways of thinking that blame victims and judge individuals in terms of family

backgrounds, including, of course, class and racial backgrounds (as in, "She

must be lying about the abuse; her parents are highly respected people"). It

would also require a greater place for the personal so that disabled people could

openly discuss and explain their conditions and limitations.

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TRAUMA-RELATED DISORDERS AND FEMINIST ETHICS

In the case of people with trauma-related disorders, discussing their conditions

could involve explaining behavior and decisions related to their recovery that

express values outside of mainstream moral thought. People with traumatic

disorders may need to realize alternate moral values for their recovery. In this

section I argue that feminist ethical theory can be inclusive toward people with

psychiatric disabilities linked to abuse by affirming a wide range of moral pos-

sibilities, and not simply ones that express love, compassion, and interdepen- dence.

Wendy Donner criticizes Karen Warren's ethic of care for, in cherishing an ideal of interdependence, essentially marginalizing people with difficulties

related to histories of abuse (Donner 1997, 385-88). She explores the case of

Elly Danica, a woman who wrote an autobiography (1988) about her experi- ences of incest and emotional abuse, her sense of entrapment in marriage and childcare, her subsequent departure from her husband and child, and her

solitary existence. As Donner argues, Danica achieves a better life only by

realizing selfishness as a moral value and severing all ties with others: "I have

no energy to bring anyone with me. No energy for relationships, not even with

a cat or a goldfish.... Soul dwelling: found. Self: found. Heart: found. Life:

found. Hope, once lost: found..... The mind, Free. Freedom. Bestowed from

within. Self... I am" (Danica 1988, 91-95). Only by caring for and loving herself in separation from others can Danica be able to properly love others

(Donner 1997, 338). According to Donner, Warren's account recognizes as

moral values only pleasant dispositions like compassion, kindness, empathy, and sensitivity. However, as other care ethicists argue, in a sexist culture where

women's self-sacrifice through caring is wrongly extolled as a moral virtue, women's selfishness through not caring can be morally good (Fisher and Tronto

1990, 35). Women should value their own well-being rather than abusive

relationships sustained by a love that excuses those who severely harm them

(Tronto 1987, 660). For survivors of violence, like Danica, realizing unpleasant

dispositions such as anger, callousness, insensitivity, and indifference as moral

values is necessary for their recovery and moral development-for them to be

capable of compassion and love. It is simply not realistic to maintain that one

can move from a very low level of self-devaluation, from feelings of worthless-

ness and self-hatred, to a level of free-flowing love and compassion for others, where one generously and warmly supports others' lives. Other, intermediate

steps, which are marked by unpleasant dispositions, are needed to get to a

higher moral level.

The outward expression of hostility is particularly important in people with clinical depression. As theorists, such as Freud, have traditionally argued, clinical depression is hostility turned inward. Hostility that could or should be

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directed outward in response to abuse and injustices is turned against the self.

Marilyn Frye claims that anger "implies a claim to domain," a claim that

one's projects, activities, and interests are worthy of respect (1983, 87). In the

case of women suffering from traumatic disorders as a result of chronic abuse

from battering partners, achieving unpleasant dispositions such as anger and

callousness toward their abusers may be necessary for their survival and moral

growth. As Claudia Card claims, a woman who ends an abusive relationship

"may be growing ethically in overcoming a sexist training to put others' needs

consistently ahead of her own" (1996, 88). To forcefully escape an abusive

relationship, a woman may need aggressive tools, which include the emotion

of anger. Several feminists (Card 1996, 88; Cuomo 1999, 272) have referred to

the inevitability of "dirty hands" in moral endeavour, where one is not purely an oppressed but also an oppressor. Sometimes the best one can do is to choose

the least harmful option and, after acting, to leave the situation with slimy

feelings of regret for having to cause harm at all (Card 1996, 88). However, sometimes one can only become "cleaner"-morally better-by dirtying one-

self, as when one rubs sticky hands through dirt to get them clean. Dirtying oneself may be seen as part of the project of "getting cleaner," more able to freely

express compassion and love. A feminist ethical account that does not mar-

ginalize people with certain psychiatric disabilities should not underestimate

or undervalue the ideals of autonomy and independence. Feminist ethicists

have been critical of traditional Kantian ideals of autonomy and independence,

arguing that these lie outside female identity, which is based on ideals of

connectedness and interdependence (Wendell 1996, 144). Wendell upholds these critiques as expressing sensitivity toward those who are unable to achieve

ideals of autonomy and independence because they need a great amount of

help from others (1996, 145). On her view, alternate ideals of connectedness

and interdependence value the lives of the disabled in valuing the relationships of dependency and interdependency so central to them (Wendell 1996, 145).

However, as Donner argues, accounts that emphasize connectedness must be

careful not to ignore the lives of severely abused women for whom a strong sense of disconnectedness, of being separate and apart, is necessary in their

struggles to manage, overcome, or survive their mental illnesses (1997, 385). For people like Danica, from severely abusive families, connectedness is a great source of despair and self-hatred (Donner 1997, 385).

Further, while the ideal of autonomy may present an unrealistic demand

for people with disabilities in general, who need a great amount of help from

others, this ideal may be acutely demanding for people with multiple personality disorder. Such people may not be able to achieve a unified personality and

continue to rely on different personality fragments or modalities to express different emotions and behavior. Moreover, in addition to undervaluing the

lives of people with multiple personality disorder, the ideal of autonomy could

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serve to undervalue the lives of people suffering from manic-depression who do

not have a tightly unified self which they can regulate and control. People with

widely varying moods, thoughts, ideas, or feelings, whose inner lives contract,

expand, or fly across personal boundaries, will have their lives devalued for

coursing and receding like waves.4 Thus, while feminist theory of psychiatric

disability should not neglect the moral value of selfishness expressed in the

ideals of autonomy and independence, it should be aware of the limitations of

these ideals to cast value on the lives of psychiatrically disabled people.

Finally, linked to the ideal of autonomy is the ideal of detached rational-

ity. Kantian philosophers maintain that moral agents have self-respect and

are reasonable, acting according to principles mutually agreed upon by other

reasonable agents. These claims marginalize people with trauma-related psy- chiatric disabilities who have fragile self-respect and who, because they have

mental illnesses, are necessarily cast as unreasonable, as explored earlier. In

her essay "Moral Failure," Cheshire Calhoun presents a Kantian conception of moral agency. She claims that there are four basic commitments, including the principle of character, involved in attempting to engage in moral action:

"a being with moral character ... will cultivate and express the virtues" (1999,

84). She argues that with "sufficient bad luck, our moral lives can fail because

they are characterized by abnormally frequent unintelligibility to others" (1999,

84). In stressing the predominant social and moral understandings, which

regard moral revolutionaries, those who challenge so-called just social systems, as perverse, Calhoun concludes that the lives of moral revolutionaries will be

partially "moral failures" (1999, 97). Wendell maintains that in societies that

regard certain human ideals as very important, those who cannot achieve these

ideals will feel inadequate (1996, 145). Calhoun's conclusion can only diminish

the self-esteem of moral revolutionaries, just as her belief that the cultivation

and expression of traditional virtues is necessary for moral character can only fail to cast value on the moral achievements of people, such as traumatized

women, who may need to realize alternate moral values for their survival.l5

No FINE MADNESS, ONLY MIND

In ethical discourse (and philosophical discourse in general) there needs to be

less talk of failures to realize ideals of rationality and autonomy and human

paradigms of normalcy and intelligibility. Rather, there should be more empha- sis on the achievements both of those challenging oppressive social systems who

are typically seen as "crazy radicals" and of those with abuse-related psychiatric disabilities who have been told far too many times through actions, words, or silence that they are worthless. Abuse-related disorders are complex, with

psychological and behavioral components that others find bizarre and incom-

prehensible. Survivors of childhood abuse are frequently misunderstood in the

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mental health system, accused of manipulation or malingering (Herman 1992,

123). Typically they receive many different diagnoses before being understood

as having a complex post-traumatic syndrome (Herman 1992, 123). The failures

that one should speak of are failures in others to open the windows of their

own closed worlds of intelligibility and dare to venture into other worlds of

meaning. Calhoun asks, "Would we think it tragic that a life devoted to

doing the right thing was incomprehensible to others or vilified as perverse,

irrational, or immoral?" (1999, 97). This question she answers affirmatively. I

prefer this question rephrased as, "Would we think it tragic that others could

not appreciate the moral excellence of a life and vilified it as perverse, irrational, or immoral?" To this question I respond affirmatively. Similarly, it is important that others try to appreciate the difficulties and struggles of those with abuse-

related disorders instead of seeing them as irrational and seeing necessary selfishness during their recovery as a sign of moral inferiority or moral damage16 rather than as a sign of blossoming self-respect. It is tragic that the predominant

meaningful worlds cannot appreciate the meaningful worlds of those with

psychiatric disabilities and accept them, thereby lessening their suffering. Feminist theory of physical disability focuses on society's oppression of the

body, of the alternate bodily states found in the physically disabled (Wendell

1992, 78). Similarly, feminist theory of psychiatric disability concerns the

oppression of the mind by a society that rejects and despises the alternate

mental states found in the psychiatrically disabled. The history of Western

thought has not truly been about the glorification of the mind. True apprecia- tion will come when there is no more oppressive talk of some mental island

called "madness" to which one in illness goes, no more morbid romanticization

of offshoots of oppression and abuse-of "mad starving artists"-or scientific

mystification of fettered minds. Let there be no more beliefs that partition the

complex wheel of the mind or that enforce the isolation of those suffering from

oppression and mental illness.

NOTES

I would like to thank Le Centre DArtisanal des Femmes, a non-profit women's arts

and crafts organization for underemployed and disabled women in Montreal, where

I worked as an instructor in the summer of 2000. The women I met shared with me

their experiences with abuse, mental illness, and psychiatric treatment. The central

arguments of this paper grew in conversation with artists Andree Blackburn and

Giovanna Parente. I would also like to thank the three anonymous reviewers of Hypatia who provided very constructive feedback on a much earlier version of this paper.

1. See Paula Caplan (1995) for a fascinating discussion on the formal processes used by the psychiatric establishment to determine legitimate categories of mental

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illness. She argues that judgments regarding proposals of categories of mental illness are

sometimes fraught with biases and assumptions that support the status quo. 2. Ninety percent of anorexics are women (Bordo 1993, 140). In 1973, when a

suicidal Ellen West stopped eating, anorexia nervosa was relatively rare (Bordo 1993,

140). In 1984, however, roughly "one in every 200-250 young women between thirteen

and twenty-two suffer[ed] from this disorder" (Bordo 1993, 140).

3. See Frye (1983) for a discussion of the cognitive impairment involved in an

arrogant perception of others.

4. See Joan Dunayer (1995) for a discussion on sexist, speciesist language. 5. Similarly, Claudia Card, in discussing the strongly negative meanings of "les-

bian" in heterosexist society, writes, "It is absurd to think that you can change the

meaning of something just by intending a different meaning when you use it yourself or with your friends" (1996, 150).

6. Notably, Wendell writes that people with unrecognized physical illness may be "socially isolated with it by being labeled mentally ill" (1992, 78). Psychological or

psychiatric explanations of serious physical illnesses serve to invalidate these illnesses

partially because mental illnesses are not seen as real illnesses.

7. It is not surprising that female poets, for instance, would be especially prone to mental illness or that their mental illness would be sustained through their work,

notwithstanding their social marginalization. As Germaine Greer (1995) argues, the

female norm of self-destructiveness is exemplified in criteria for "the great female

poet." On Greer's account, the most celebrated female poets of the twentieth century are women who killed themselves and who documented the course of their self-

destructiveness through their creations (Greer 1995, 390). Plath's blazing final poems about dying and self-contempt (for example, "Lady Lazurus," "Daddy") and her poem entitled "Edge" about self-completion, which records her final acts before her suicide

(for instance, of leaving her children with bottles of milk) are literally scripts for her

self-destruction.

8. For instance, 50 percent or more of the institutionalized (neglected or abused)

elderly suffer from a mental illness (Smyer 1995, 164). Regarding rates of mental illness

found in homosexuals, Joan Callahan relays that "roughly 30 percent of gay teenagers

report attempting suicide, and roughly 40 percent of all attempted teen suicides are

connected to real or perceived homosexual orientation" (1999, 263). 9. Inasmuch as perceptions, ideas, and evaluations are informed by and inform

emotional states like despair, rage, and hatred, which partially constitute some psychi- atric illnesses, people suffering from these will desire some transcendence of emotion, which patriarchal theorists have devalued with the body. This view does not affirm

a rigid mind-body dualism, as it recognizes the cognitive content of emotion and the

emotional affect of cognition. 10. I do think, however, that the pressure that non-disabled persons impose on

disabled persons to pass as normal does sometimes stem from a fully aware, shameful

sense of the true nature of their behavior; yet they believe that this behavior, though unfair and unreasonable, is unavoidable. For instance, a teaching assistant who is taking a prolonged length of time to mark essays, albeit for a good reason, might compromise the health of the course, because students need feedback on their work for upcoming

assignments and the professor needs an assessment of student comprehension before

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making any course adjustments. This case illustrates that a teaching assistant's difficulty in passing as normal may disturb an academic balance that is fragile because of a

strong general insistence that everyone be continually normal when this insistence is

unreasonable. By not taking into account the potential of a compromised capacity to

function, this insistence jeopardizes the health of the academic environment.

11. This, of course, is not an argument that those with psychiatric disabilities are

worse off than those with physical disabilities, or that the former deserve more concern

than the latter. Here I am simply exploring differences in social attitudes toward those

with psychiatric disabilities versus those with physical disabilities.

12. Notably, in the French language one might say of a mentally ill woman, "Elle a

l'air bete." While figuratively this expression means she seems "crazy," literally it means

that she seems like an animal, "bete" translating as "animal." Further, the expression

"crazy as a loon" also reinforces both the oppression of animals and that of people who

are mentally ill, in invoking a negative image of an animal to insult a person who is

(or judged to be) mentally ill.

13. For a critique of modern pharmaceutical interventions in mental illness, see

Breggin (1994).

14. A patchwork quilt is called a "crazy quilt" because of its multiple, disparate elements.

15. Calhoun's view of moral failure involves the notion that expressions of self-

respect in members of subordinate groups may be misunderstood by others as displays of arrogance, as when they condemn members of dominant groups or express moral

outrage concerning injustices (1999, 86). Her conception of a moral revolutionary does not include an individual who might in her struggle toward moral perfection realize as virtues what are usually considered vices. In my account, on the other hand,

interpretations of selfishness, and not appropriate pride, in members of subordinate

groups may in some cases be correct, and this selfishness may be morally good, because

it furthers moral growth. 16. In The Unnatural Lottery Claudia Card argues that oppression damages victims,

making certain virtues difficult for them to achieve (1996). On her view, traditional

vices are justifiable for self-defense, but this justification does not make them virtues

(1996, 53). She writes: "Those who tell just the right lies to the right people on the

right occasions may have a useful and needed skill. But it does not promote human

good, even if it is needed for survival under oppressive conditions" (1996, 53). However,

such behavior promotes the human good of the survivor.

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