On Experts in maternal and child health
Many throughout history have been considered “experts” in maternal and child health. Each of them have contributed to our understanding of how the human psyche, combined with culture, affect parenting. However, their often conflicting advice has caused some to question the value of adhering to cultural norms espoused by medical professionals when making parenting decisions. Author Lisa Appignanesi is of the opinion that
“Narrowing or medicalizing definitions too much limits the boundaries not only of so-called normality, but of human possibility.”
Her 2009 book, “Mad, Bad, and Sad: A History of Women and the Mind Doctors” provides an overview of the theories of maternal and child health care experts from 1800 to the present. The contents of the book were also transformed into an exhibition at the Freud Museum in London which ran from 10 October 2013 – 2 February 2014. The exhibition brought many of the fascinating case histories referred to in the book to life in the form of original documents, photographs, and paintings.
It is perhaps ironic that the book won a British Medical Association Award for contributing to the public’s understanding of science. According to a review of the book in the British Journal of Psychiatry,
“She implies that women (as reflectors of male-dominated society) are duped by mind doctors into beliefs about the consequences of their rotten lives, framing them as diagnoses in need of an ever-expanding lexicon of treatments.”
According to a review in The Independent, the author’s goal is
“to untwist the arguments about cures and causes for the madnesses that beset women (and men) today, from eating disorders to child abuse to depression in all its forms.”
Unlike many feminist writers, she does not base her arguments upon the premise of the existence of a conspiratorial patriarchy that subjugates women. She begins instead with the assumption that these influential professionals in the area of maternal and child health genuinely wanted to help the women they treated. She points to cases in which they succeeded in reducing their patients’ suffering, as well as to those in which they increased it.
This journey through the history of psychiatry takes readers from madhouses, where people were relegated for being problematic to society, to asylums, which focused more on the treatment of the individual. It also reveals the history of changing diagnoses, such as the diagnosis of “neurasthenia” to the modern-day diagnosis of “social anxiety”. Other diagnoses for which women are institutionalized and treated for in the book include
“frenzies, possessions, mania, melancholy, nerves, delusions, aberrant acts, dramatic tics, passionate loves and hates, sex, visual and auditory hallucinations, fears, phobias, fantasies, disturbances of sleep, dissociations, communion with spirits and imaginary friends, addictions, self-harm, self-starvation, depression”.
Insanity has historically been defined by comparing a subject’s behavior to what is considered “normal” within any social context. Rather than placing the blame for unjust institutionalization on an oppressive patriarchy, the author points out that women were, and are, often complicit in the creation and social enforcement of oppressive social norms. Girls throughout Western civilization are suffering from conditions like anorexia, PTSD, clinical depression and suicidal tendencies in greater numbers than ever before.
In a 2008 interview, Lisa partially attributed the rise in these disorders to the fact that in
“the West, the pursuit of happiness carries its own burden of guilt when you’re not happy, or experiencing dissatisfaction, because you haven’t attained the ideal of happiness. So it has played back on itself, and the pursuit of gladness drives people mad as well.”
Maternal and child health at top of the list
A high degree of maternal and child health is at the top of the list of criteria for achieving happiness. One of the concerns that prompted her to write the book was the fact that
“now we have over 950 pages of very specific diagnoses, which seem to handle every aspect of lived experience, and a lot of them seem to have pharmaceuticals attributed to their potential cure.”
Because of the rising incidences of these disorders, mothers are greatly in need of guidance and support. It may be, however, that they are more apt to find that guidance and support within their own ranks than within the psychiatric community. The book points out the extent to which, when it comes to overall maternal and child health, the psychiatric community has had a tendency to ignore social inequality and poverty as contributing factors to psychological disorders.
Increasingly, rather than the former social norm of competition, mothers are building their own cooperative support systems. Sometimes progress in raising the degree of maternal and child health means moving backwards, to the participation of a whole village in raising a child, rather than forward to the increasingly socially isolated nuclear family.