Feminism, psychiatry and Mumsnet

[OnceThereWasThisGirlWho]

This started as a reply to a post on another thread (not a thread started by me). I don't want to upset anyone by theorising in a support forum so am posting my ponderings here.

My brain is not at optimal functioning to rephrase everything, so here is part of my reply:

"OP is understandably and justifiably frustrated and distressed and some posters are seeking to justify shoddy treatment and the smoke-and-mirrors operation of MH services. Which obviously makes the OP more frustrated and distressed.

It baffles me that an online community which appears to encompass thoughtful discussion, criticism of existing power structures/services/wider system, and has many strong feminist viewpoints/posters, should be so lacking in any kind of understanding support about how crappy the mental health system can be. Or, dare I say it, any kind of vaguely antipsychiatry/survivor movement type experiences/thinking/feeling."

At this point I realised this was a discussion to be had elsewhere. Personally, I have found it immensely helpful to look at alternative ways of viewing things to the narrow medical model of psychiatry. To realise that others have similar experiences of the system, similar criticisms or frustrations or alternative viewpoints encompassing the wider context. Even if I am very distressed, talking to someone who understands generally ends up in a lot of dark humour and discussion of the sociopolitical context. Especially helpful when things like gender role expectations, male on female violence and control, and issues around poverty and homelessness form part of the issues.

To be honest, if someone had started talking to me about the things I now agree with (including feminism!) in the past, I would have been polite but inwardly patting them on the head, trying not to dislodge their tinfoil hat. So I do understand others not understanding in general... but so surprised to see it on Mumsnet, where issues are normally pulled apart with alternative viewpoints argued.

I hope I'm making sense, and hope this is the right place to ask...

[OnceThereWasThisGirlWho]

Oops, brain not engaged... thread was in Mental Health. It is that forum in particular that I am talking about obviously, although to some extent the rest of MN. Although I'd expect it from boards that are not mental health specific.
Occasionally over the years I have dipped into forums where mental health is discussed and there are a variety of viewpoints. If I'd never seen the mental health board here I'd have predicted it to have a definite feminist flavour, with posters aware of gender related stuff around mental health, understanding of complex trauma especially women's trauma that is often overlooked, and how the current MH system doesn't really reconise or address it, bias in diagnosing and pathologising... etc etc. But there seems to be a ... compliance I find a bit unsettling and above all surprising.

So... why?

[MummySparkle]

I'm afraid you're not making much sense to me. Your posts seem a little hard to follow by that might be because I'm tired

So you agree that mental health services can be 'crappy' and don't always do the best for patients. And you are unsure why other people on mumsnet don't agree with you on this?

I'm not understanding the feminist aspect

[Xenophile]

Are you suggesting OP that you aren't getting what you want out of MH services because you're female? Because, in your case, I would have to say that that might be over egging the cake a bit given your history.

Or, are you trying to have a general discussion about feminism and MH services?

[CobbledTogether]

Why?

For the same reason that the general health board and the children's health board and the life limiting conditions board don't discuss things from a feminist perspective. It's because those areas are generally used by people in acute need or with acute illness, so they are looking for specific help with specific illness issues, rather than a discussion about philosophy of psychiatry.

If you want to discuss mental health from a feminist perspective, this would be the place.

[VestalVirgin]

It's because those areas are generally used by people in acute need or with acute illness, so they are looking for specific help with specific illness issues, rather than a discussion about philosophy of psychiatry.

I think that the question of whether you will be housed with males in a clinic is rather relevant for people who are seeking help with a specific acute illness.

The horror stories I have heard ...

A dear friend of mine (and brilliant fierce feminist) sometimes says that it's not terribly surprising that women struggle with mental health sometimes. It's not easy living in a world that oppresses you then gaslights you that it's not happening.

I also think that the goal of the system is not to heal you, but to turn you into the sort of Stockholm-Syndrome-sufferer that is happy in patriarchy.

There are, of course, psychotherapists who really want to help, and accept that what society considers normal is not really desirable - but if a woman's sanity is measured by whether she applies makeup to her face in the mornings, then clearly, the system that sets those standards is broken.

[Xenophile]

if a woman's sanity is measured by whether she applies makeup to her face in the mornings

Have never heard of any practitioner saying anything even remotely like this.

[OurLass]

I have actually had experience of a mental health practitioner saying I must be feeling a bit better because I'd started wearing my make up again and paying attention to my hair.

[CobbledTogether]

If someone was being house with males in a clinic then yes, I'd expect a discussion about whether it was appropriate, but I wasn't aware that was the discussion.

[Xenophile]

OurLass, that's not the same thing. If it's normal for you to wear make up and do your hair when well, then returning to your normal routine is an indicator of feeling better. If that isn't your normal 'well' behaviour, then I stand by my original point.

[Hrumphing]

I think lots of things aren't discussed from a feminist perspective on other forums in mumsnet. However, its interesting you talk about people being particularly compliant. I think if people are in a particularly vulnerable point then its harder to behave in a contrary way to engrained learnt patterns of behaviour. I think that sometimes makes it harder for women, esp women with a history of abuse to challenge the orthodoxy or those in positions of power. Im not sure if it would necessarily translate online though and i havent read the thread you are talking about. However couldthat be a factor?
Other than that - yes huge gendered issues in so many aspects of mental health and the way services are organised and function.

[Hrumphing]

As for the wearing makeup and doing your hair thing. I think both points of view expessed on this thread about that could be true at once. So it is valid in one sense to talk about returning to a normal level of self care and functioning (if that is normal for you). I work in mental health and we would think a fair amount about a man's self care too for instance.
At the same time it is also true that those kinds of judgement about make up and self care have an additional meaning for women so there should be some recognition of the added effect that kind of comment might have.

[Misnomer]

"if a woman's sanity is measured by whether she applies makeup to her face in the mornings"

"Have never heard of any practitioner saying anything even remotely like this."

I have. When I was triaged for postnatal depression the mental health nurse said I was ok because I was wearing make up. I tried to explain to her that it is no measure of my state of mind but she had a very fixed idea of what well and unwell looked like and didn't want to listen to me.

[Xenophile]

Fair enough, I must just have been very lucky with the professionals I've worked with over the last 20+ years, and those who cared for me when I was very unwell.

[Xenophile]

I'm quite shocked that the RMN didn't use one of the PND/depression scores though, and just wrote you off for wearing make up. That sounds like something you should definitely complain about.

[pennefortheguy]

When I was in hospital, the day I decided to put some lipstick on everyone commented on how much better I looked and how far I'd come along. I don't think it's about conforming to a feminine stereotype, it's because it indicates that you've taken an interest in how you look and made an effort. When you're deeply depressed, you're too caught up in misery to even think about lipstick or hair. It's actually not a shallow perspective at all, it's about what it represents.

[pennefortheguy]

As for the OP, I think calling MH services in general "smoke and mirrors" is to do them a massive disservice. I'd question the motive for this post as OP seems to have a personal axe to grind, and is trying to manipulate others into agreeing with her by making it into a feminist issue.

[Misnomer]

pennefortheguy - it's just not true for everyone. And you have to be very careful with some disorders (or individuals for that matter) whose illness doesn't run the usual course. For instance, with post partum psychosis individuals can go between being floridly psychotic to lucid very rapidly. Make up would be a fairly useless barometer of mental health there. It was the same for me with PND in that though I was in general low mood I also had periods of very rapid decline into extreme distress and suicidal thoughts.

And yep, I should have complained but I was not well enough at the time. I muddled through but the lack of treatment at that stage in all likelihood contributed to the very fast decline I went through after my next pregnancy. I very, very nearly didn't survive that one. Luckily, I had moved and the services in the area I moved to were much better. No one was fooled by the make up.

[pennefortheguy]

In that case, it's not a feminist issue around make-up being used as a sign, but a lack of training and knowledge about post-natal depression that led to issues with your care. It would have been a useful barometer for other MH conditions so I don't think it's something to be used in favour of antipsychiatry.

[Broken1Girl]

I have been told I must be ok because I was wearing earrings/ co-ordinated outfit.
It is definitely a feminist issue, surprised by posters saying judging by appearances is ok.

[Broken1Girl]

OP and others might like this:
recoveryinthebin.org/2016/04/11/you-look-fine-you-dont-need-help/

[MajesticWhine]

Appearance is something that psychiatrists are quite keen on reporting. I work in mental health and notes from a psychiatrist nearly always include comments like X was well kempt or X was casually dressed. I guess because poor hygiene or dirty clothes might be considered indicators of mental state. It's quite an old fashioned psychiatry approach IMO. I think most mental health workers are able to take a more nuanced approach and consider the individuals goals and values. Make up on one person might be a sign of improvement but on another person it might be the way they need to cope with poor body image. I would only comment on appearance if a person brought it up or if it was highly relevant to their personal goals. I have seen some very unwell people who are fully made up and look fabulous. It tells you something about them (possibly) but it doesn't tell you they are ok.

[OnceThereWasThisGirlWho]

Cobbled For the same reason that the general health board and the children's health board and the life limiting conditions board don't discuss things from a feminist perspective.

Ah, but it does sometimes creep in where relevant. For example conditions involving severe pain where women are fobbed off and told it's "normal" (I have endometriosis, I know this one!)
Or perhaps someone posts about something their male DP has done, with some posters suggesting that men are a bit daft whilst others will point out that sexist expectations are at play in the situation.

It's because those areas are generally used by people in acute need or with acute illness, so they are looking for specific help with specific illness issues, rather than a discussion about philosophy of psychiatry.

I do understand what you're saying. However, as above, with the "severe pain" example, there are times when you need support from people who understand, if the system is not geared up to do so.
There might be posters frustrated trying to navigate SEN provision, or struggling with disability benefit appeals... and criticism of the exisitng system or wider society sneaks in, perhaps suggestions for improvements, as well as advice on navigating the current system. And people will disagree, but there is that discussion going on.

Perhaps a better example is someone who's in an abusive relationship, and it has reached such a pitch that they have started to question things despite all the gaslighting. They are confused, and doubt themselves. Perhaps people irl all see their partner as a lovely chap, wouldn't hurt a fly. So they are surrounded by messages that reinforce the status quo - from their partner, from family or friends, and wider societal messages to do with women submitting to men. They post in Relationships, and are presented with a different viewpoint.
But the mental health system is in many ways a societally endorsed part of maintaining the status quo. It is part of society and thus reflects the prejudices and expectation of society. And yet there is a culture - irl, which I understand, and on MN, which surprises me - of going along with it without question, and um... tbh I think gaslighting .

I wonder if there is something specific about the demographic of MN that makes a difference in comparison to other forums. Perhaps those who are not well served by psychiatry are unlikely to be mothers, or unlikely to be mothers at a time when they are still unwell/posting for support. I don't know.

Hrumphing I think if people are in a particularly vulnerable point then its harder to behave in a contrary way to engrained learnt patterns of behaviour. I think that sometimes makes it harder for women, esp women with a history of abuse to challenge the orthodoxy or those in positions of power.

This is an interesting point I shall ponder further...


Penne Judging by appearances is not helpful in mental health. I get described as "well presented" when I have gone to appointments in my pj's, but with a lovely coat over the top (which is the nearest thing to hand). Plus if you're feeling vulnerable, the last thing you want is to draw attention to yourself by looking bedraggled. To actually get out and about to appointments one has to put on an act, try to look fine, cut yourself off from your emotions to some extent. It's really hard to convey this to MH professionals becaue of the value placed on appearances.

[Hrumphing]

Appearance is one of the items in a mental state examination so you would expect there to always be a comment on appearance in a psychiatrists letter as the mental state exam is the equivalent of a cardiologist doing a chest exam. The traditional mental state exam leans rather towards a focus on assessing psychotic illness and perhaps particular conditions like mania - where a comment about the patient wearing more flamboyant clothes than usual or dressed in a clown suit would be very relevant. It isnt so good for many other problems I agree.
'Casually dressed, well kempt' is usually shorthand for a 'nothing unusual/relevant/abnormal' in my experience. I agree that even that may have a different meaning for men and women and isnt necessarily unproblematic.
If a mental state exam is done well then contrasts such as the patient being very careful with their appearance despite other mental state abnormalities or incongruent aspects to the history are also seen as meaningful. Its useful to know if someone who is actually quite ill is able to still put on a front for instance. Practioners shouldnt take any element of a mental state exam or history in isolation and should consider all aspects though obviously that doesnt always happen.

[erinaceus]

A psychiatry vs anti-psychiatry debate is a straw man. "Like all dichotomies, this one is also false".

Psychiatry is a system embedded within a bigger system. Debating psychiatry-vs-anti-psychiatry is debating the system within the bigger system. One can discuss and debate any of psychiatry, anti-psychiatry, or the contexts in which these movements and more are embedded, and these debates should not be silenced. Nonetheless, debating these systems with posters who are so desperate as to turn to internet strangers for what they feel they need is not kind. MNers are kind people, IME.

The issues of physical presentation as an approximation of mental state, lack of validation of abused women, and so on, can be addressed of themselves. Mental state is difficult to define, let alone assess; the definition of what behaviour constitutes abuse and what does not is also a moving target. Both the definition of mental health or ill health and the behaviour that is defined in law as abusive or not, as well as the criteria to assess either of these, move over time as medicine and the law change.

The victim-vs-survivor dichotomy is not useful either. Why can it not be both? A survivor will not always be a victim, but they will always have been a victim.