4/ Editorial introductions

In this chapter Dawn Thibert looks at ethical dimensions of mental health ideology and care in relation to gender. She relates her discussion to clinical and personal experience. As with age, culture and race, from the previous two chapters, so with gender and sexuality. Our experience of personal reality is inextricably bound up with our experience as men, as women, as gay, as lesbian, as heterosexual and so on. Feminist critiques of psychiatry pay particular attention to such issues. They stress, for example, the effects of gender stereotyping in our reaction to bad experience: For example, men tending towards aggression and the penal system, women tending towards anxiety, depression and the psychiatric system. Having discussed these ideas, Dawn describes her experience of conducting a project to identify women's mental health needs in an inner city, community day-centre where she works. She looks at the impact of a women's project on the client group as a whole. Dawn conveys a sense of her own parallel struggle to find a space in the centre, both within the staff team and within the client group, as a lesbian woman. Dawn explores the difficulties in some aspects of this work, for example identifying needs, establishing realistic expectations and validating the right to be oneself. She then recounts the development of the project into an ongoing woman's group and concludes by discussing empowerment and the practical difficulties in encouraging women, herlself included, to assert their right to be themselves.

To give the chapter some historical context (an ommission from the text), BD tried to search out a passage which had struck him some years earlier in connection with psychiatry, gender and power. The reference was to the historical treatment of women in psychiatry. He asked the 250 members of an international psychiatric nursing list on the Internet for help. Did anyone "recall reading a passage which describes a form of treatment being researched at an asylum in Britain, possibly last century, in which varying amounts of water were poured from different heights (I think through grills on successively high floors in what may have been a tailor-made tower) to establish the therapeutic quantity of water to be used and correct force to be applied, as well as the optimum frequency of treatment. I think the case in question was one where the patient, a woman, was sexually unresponsive, or possibly had unacceptable ideas of developing interests other than her husband, and the success of the treatment, her return to sanity, was evaluated in relation to the woman's readiness to resume her marital role."

[Two references came back: Sklar, K (1984) "All hail to pure cold water!" In J Leavitt (ed) Women and Health in America. University of Wisconsin Press, pp. 246-254. (Thanks to Leana Uys, South Africa.); and Hunter, R. & MacAlpine, I. (1970) Three Hundred Years of Psychiatry Oxford University Press (Thanks to Joe Berke, London)]

A number of interesting comments also came back, three of which are reprinted below. Firstly, two from a contributor in the US:

"BEN.....While it can hardy be [disputed] that any system that has the power to define mental health can misused as a form of social control I HOPE you are not going to make the case that women are the gender most affected...

"...in response to your earlier post asking why I cared if you were making the case for women being the most oppressed by psychotherapy...I was reacting simply to the whole notion of women being oppressed period in the western world (probably the biggest myth EVER perpetrated in civilized society) Right now the whole psychotherapy field is rapidly becoming feminized ...either by women themselves..or the "sensitive" guys who raised in the 50's and 60's saw their fathers disrespect their mothers and thought this to be oppression. Hell I was one of them..I believed that since women defined their status as oppressed it must be so..HA!!! I'd give my eye teeth to have the range of choices western women have. IMO [in my opinion - ed] it is MEN who are oppressed but taught to suffer in silence the idiots don't have a clue. bchapel@eideti.com. Sometimes it is possible to be so open minded that your brains fall out"

"Ben, don't have a reference to help, just to say that even in todays world women still get cold water poured on their hopes and dreams. good luck, Brenda."