Mad, Bad and Sad

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Lisa Appignanesi, Virago, £20

In Mad, Bad and Sad Lisa Appignanesi sets out to describe the relationship between psychiatry and women over the last 200 years. This is no small ambition but the resulting book is serious, well researched, fascinating and above all humane.

Appignanesi uses the biographies of well known women, including writer Mary Lamb, French revolutionary Theroigne de Mericourt, Alice James (sister of Henry and William), Virginia Woolf, Sabina Spielrein (Jung's patient, lover and early analyst), Sylvia Plath and Marilyn Monroe.

Too often in discussions about mental illness people become a list of symptoms. By using the biographies of well known women Appignanesi is able to show that women suffering from mental illness are more than their diagnosis. They are not just mad; they are also creative, kind, funny and human in the full sense of the world.

It wouldn't have been possible for Appignanesi to use the stories of ordinary working class women suffering mental illness as these stories simply don't exist, these women being unable to write their own stories through lack of education, while historians didn't record these stories through lack of interest.

However, these women were often able to buy the best treatment, so the description of Zelda Fitzgerald's hospital set on 350 acres of land with its tennis courts, golf courses and swimming pools stands in stark contrast to the treatment that most women would have been subjected to. Appignanesi describes the treatment women in large institutions suffered. This included tonsillectomy, removal of teeth and forced feeding. However, without the life stories of the women involved the tales of these barbaric treatments lose some of their impact.

Many books about women and mental health denounce "mind doctors" as patriarchal and contributing to the oppression of women. Appignanesi recognises that care, medication and therapeutic talk do help people in distress. However, she places the development of mental illness and its diagnosis within the context of women's oppression. The label that women with mental illness will be given has changed from hysteric in the 1880s, to schizophrenic in the 1960s, and at the moment Borderline Personality Disorder. But there is a consistent theme through the ages that mad women are women who won't or can't conform to society's ideals of femininity.

Appignanesi shows how political changes affect women's mental health. In the 1960s the radical psychiatrist RD Laing declared that madness was a sane response to an insane world. Women were challenging their roles and campaigning not just for equality but for liberation. Through campaigning and fighting women had more control over their own lives. Rape and sexual violence were no longer things women had to put up with but were political issues that could be campaigned against. An increasing number of women became psychiatrists and analysts.

As the feminist project declined into identity politics, all men became potential rapists and all women became potential victims. In the 1980s the identity politics of the feminist movement, along with the increasingly influential ideas of neoliberalism, led to individual solutions being sought. The issues of rape, feeling worthless and frustration moved from the streets to the analyst's room. Later in the book, Appignanesi looks at the illnesses that women suffer from today, such as anorexia and depression. She illustrates that poverty often leads to mental illness.

This book is a serious and sober account of a very important issue and is needed now more than ever. A teenage girl is nine times more likely to attempt suicide, and several hundred more times more likely to suffer from an eating disorder, than her brother. As Appignanesi argues, women's oppression and poverty can lead to mental illness, both of them creations of the mad system we live in.