Women on the Couch

In the eyes of ardent feminists, psychiatrists and psychologists rank high--if not highest--on the list of males who oppress women. The most recent and radical statement of this view is a book called Women and Madness (Doubleday; $8.95) by Phyllis Chesler, a self-styled anarchist who teaches psychology at the City University of New York. The militant wing of Women's Lib enthusiastically approves Author Chesler's attack, and some psychotherapists admit that there is a measure of truth in what she says. The consensus, however, seems to be that her charges are both overstated and underdocumented.

Chesler uses statistics to launch her assault. About 90% of U.S. psychiatrists and psychologists are male, but their patients in hospitals, clinics and private therapy are predominantly female, she says. She claims, for instance, that women make up two-thirds of the patients in private treatment--even though only 51% of the population is female. In fact, reliable statistics on private patients are impossible to come by. But assuming that Chesler is essentially correct, why is the proportion of women so high? The answer, she maintains, is that psychiatrists subscribe to a double standard of mental health: independent, assertive men are healthy but women with similar personalities are emotionally ill.

Chesler also charges that therapists consider women to be inferior beings. In treatment, she insists, women are encouraged to talk instead of to act, to live passively instead of being active and to conform to a "feminine" role. They are forced to re-enact with their patriarchal therapists the role that initially made them sick: little girls in thrall to their fathers. Worst of all, women patients are often sexually exploited by male therapists, Chesler alleges.

One professional who agrees in part with Chesler is Manhattan Psychoanalyst Natalie Shainess: "Many psychiatrists are unconsciously contemptuous of women," she says. Isaiah Zimmerman, a psychologist in Washington, D.C., doubts that therapists of his age (44) can entirely overcome the effects of their rearing in a male-oriented society. "My generation won't make it," he admits. All the same, alerted by his wife, daughters and patients to minor signs of his own bias (habitual use of the pronoun he instead of she, for instance), Zimmerman reports that he has brought about some "moderately profound changes" in himself.

Acknowledging that "some psychiatrists may be male chauvinist pigs," Burness Moore of Manhattan, president-elect of the American Psychoanalytic Association, emphasizes that such chauvinism "isn't implicit in the theory of analysis." Psychiatric theories of personality, he observes, do not hold women inferior to men. True, many psychiatrists accept Freud's famous "anatomy is destiny" dictum, which is anathema to feminists. To professionals, though, the doctrine does not condemn women to second-class citizenship; it means only that, as Hartford Psychoanalyst Rebecca Solomon puts it, "Women have to cope psychologically with the facts of their biology. They are human beings who have the capacity to procreate whether they choose to do so or not."

Bias. In fact, says Boston Psychoanalyst Helen Tartakoff, most reputable psychiatrists measure the emotional strength of men and women by a single standard. She adds: "I have never been therapeutically successful with a woman patient unless she became capable of developing her talents and interests outside her marriage and family. I don't think she is a really mature person until she can do this." Jane Thayer, a Washington, D.C., clinical psychologist, believes that male therapists promote the maturing process by actively encouraging "a get up and stand on your own two feet" attitude in female patients and refusing "to let women play a sweet, submissive role." Generally, most professionals agree, the better the psychiatrist, the fewer his prejudices--including bias against women. Asserts Washington Psychiatrist Dorothy Starr: "Male chauvinism does not affect therapy at the highest level."

The most serious indictment of Chester's book is that she displays little familiarity either with that kind of high-level therapy or even with typical psychiatric patients. The evidence for her conclusions comes largely from interviews with only 60 women patients, among whom were nine lesbians, nine blacks and Puerto Ricans, 14 feminists, eleven women who had been hospitalized in mental asylums and eleven who had had sexual relations with their therapists. Yet lesbians, blacks and feminists make up only a small proportion of all psychiatric patients. Therapists who have intercourse with their patients are not typical either; those who are not outright charlatans tend to be both emotionally disturbed and the most poorly qualified members of their profession.

With no pretense of objectivity, Chesler includes herself among her 60 subjects (in the feminist category). Moreover, as she interviewed the others, she often argued to bring them around to her way of thinking. When she is unable to provide documentation, she simply prefaces generalizations with "probably" or "I suspect that . . ." Furthermore, she does her cause a disservice by her advocacy of a society in which women are not equal but dominant and her suggestion that "science must be used to release women from biological reproduction--or to allow men to experience the process." Such eccentricities obscure both the legitimate abuses that Chesler would like to eliminate and the need for research to find out what really happens when male therapists treat typical female patients in a culture that favors men.

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