Living with a Label an Action Oriented Feminist Inquiry Into Women's Mental Health

Department of Social Work and Social Policy Living with a label An action oriented feminist inquiry into women’s mental health Jennie Gray This thesis is presented for the degree of Doctor of Philosophy Of Curtin University of Technology October 2006 declaration This thesis contains no material which has been accepted for the award of any other degree or diploma in any university. To the best of my knowledge and belief this thesis contains no material previously published by any other person except where due acknowledgement has been made. Jennie Gray October 22, 2006 2 abstract Dorothy Smith (1987) says investigations often begin with ‘a feeling of uneasiness’. Smith’s insistence of the importance of starting with women’s standpoint, to redress the way in which women’s lives have been negated or neglected in research, informs the methodological premise of this inquiry. The unease that prompted this project emerged in conversations I had with women diagnosed with a psychiatric disorder whilst working as a practitioner at a women’s health centre. The frequency with which the discourses of biomedicine figured in these women’s narrated experiences engendered a collective commitment to make problematic ‘living with a label’. Loosely connected as mental health service recipients, the women I researched with are often positioned as ‘subject’ to an objective medical gaze. Disrupting dichotomies that these women are accustomed to in clinical settings, and destabilising notions of neutral and detached research, our investigations were contingent, reflexive and relational. Recognising that all were intrinsic to the knowledge production processes, this project was cast in the feminist ‘with’, rather than the ‘on’. Together we explored how women read and respond to a psychiatric diagnosis in their daily lives, to generate understandings that can be used by the women who joined this project. This included close consideration of social relations shaping the lived actualities these women described, and their agency in sustaining and unsettling these. Acknowledging these women’s capacity to have expertise not only as reporters, but as theorists too, experience and analysis were conflated in our explorations of ‘living with a label’. Congruent with feminist philosophy, our methodology had a praxis orientation as well, ‘to produce different knowledge and to produce knowledge differently’ as Patti Lather (2001) suggests. The attendant opportunities to research the process of researching and contemplate how we might participate in change-oriented activities were thus integral to this project. Our experience of researching together, and allowing the ‘researched’ room to know and act, produced possibilities, and also created conundrums, perhaps less frequently encountered in more conventional research – all of which gave rise to celebration! 3 acknowledgements First and foremost I would like to extend a big applause to the women I researched with. This project would not, of course, have been possible without their involvement. And it was their generosity, enthusiasm, courage, laughter and tears that made our research happen the way that it did. I am very appreciative of the counsel my supervisor, Associate Professor Fran Crawford, provided me during the course of this project. She was, to quote another one of her student’s descriptions (whose words capture my experience also), ‘my greatest critic and most unwavering supporter.’ Working alongside and with Fran was thought provoking, productive and motivating. I would like to thank her also for her care and concern. I owe debts of gratitude to other Department of Social Work & Social Policy staff as well, for their ongoing offers of review and advice, specifically Julie Dickinson whose attention to detail and thoughtful comments were invaluable in draft chapters. The encouragement, corroboration and debate liberally given by my peers was also very important. Of my fellow postgraduate students I would like to mention Tina Fernandes and Angela Barns in particular, who were always available. I am grateful to my friends who have similarly cheered my progress and sustained me during less easy times, especially Toni Wilkinson and Krysti Guest. As this thesis shows, there are many feminist commentators whose work I have followed. I would like to explicitly pay tribute to Dorothy Smith and Patti Lather – their respective theorising has influenced and inspired my own thinking and writing in this project and beyond. I would like to acknowledge that this research was made viable through an Australian Postgraduate Award. I am also grateful for the financial support of Curtin University. Reimbursement of research-related expenses allowed me to travel, purchase texts and so forth, during my candidature. This project was an ambitious undertaking with a young family. Perhaps unbeknown to them, they have been my most intimate companions on this journey. Thanks heaps and heaps Dave, for being so supportive. And also to my kids who, despite their reference here have nevertheless remained largely indifferent to my work, and lastly to Margaret and Stella Magini (my mother and grandmother), whose steadfast conviction in my abilities underlies most of what I do. I thank them all. 4 contents Declaration 1 Abstract 3 Acknowledgements 4 Contents 5 Prelude herstoricising women’s ‘madness’ 8 an institutionalised association 10 similar themes in subsequent times 15 gender blind practices 20 dissident and disruptive voices 23 prefacing our inquiry 27 Chapter 1 beginnings… 27 locating the ‘problematic’ 30 intentions of this inquiry 31 confluent/fluid and change oriented researching 31 a feminist framing, necessarily 33 ‘taking sides’ 36 working the thesis and thesis workings 38 Chapter 2 psychiatric discourse, and a problematic telling of self 42 ‘people without knowledge’ 43 constraint and incongruence within ‘proven’ categorical classifications 45 shifting and deferred diagnoses 52 pharmaceuticalisation of women’s lives 58 being inscribed 62 surveying and surveyed 68 to tell or pass? 74 the consequences of confessing 78 acquiescing to a depressing diagnosis 82 living out the operations of labelling 87 5 Chapter 3 thinking about theory 92 unsettling the traditional theoretical terrain 93 diverse and particular social agents 96 …together with some feminist critiques and cautions 97 feminist replies accounting for the particular and the general 107 turning to the narrative and storied positionality 112 situated and subjugated knowledges, and theory with a small ‘t’ 117 a feminist ‘method of inquiry’ 122 Chapter 4 negotiating movements within and beyond psychiatric categories 129 inside and beside: women with knowledge 131 resistant responses 135 embellishing stories of self with ‘other’ cultural accounts 149 building storylines with and/both 155 Chapter 5 doing theory 162 the ethics of (our) researching relationships 164 ‘give and take’ 171 exploring women's everyday everynight experiences 174 explicating extralocal influences 185 from talk to re presentations-in-text 192 staying responsive and responsible 200 Chapter 6 (re)considering voice 210 audibility, as an antecedent and adjunct to change? 212 ‘voice lessons’ 216 locating places and spaces to speak from 220 re visiting narratives of resilience and resistance 224 collaborative voices: re presenting researching experiences 228 presenting stories of self in public: reflections on our workshop 230 advocating for better re presentations and representations 239 success in failure? 244 6 Chapter 7 reflections on researching together 251 envoi 261 Appendix 1 an invitation to participate 263 Appendix 2 participant information form 264 Appendix 3 personal consent to participate in research 266 Appendix 4 talent release 267 Appendix 5 presenting stories of self in public: a workshop for women 268 Appendix 6 public speaking: the passion and the possibilities 269 Appendix 7 consent to participate in video production 270 Appendix 8 in our own words: connecting private stories and public speaking 271 Bibliography 272 7 PRELUDE herstoricising women’s ‘madness’ The newly born woman must transcend the heresies of history and the history of hysteria (Clément, in Davies 1990, p. 501). More than thirty years ago, amidst controversy and debate, Phyllis Chesler (1972) asserted that the overrepresentation of women in psychiatric systems was due to sex role stereotyping and could not be attributed to ‘nature’. In her now famous text, Women and Madness, Chelser interweaves theoretical perspectives, clinical notes, mythological stories, autobiographical accounts/personal testimonies, and photographic images to remind us that the construal of madness in women has an extensive history. She revisits the legend of Joan of Arc to personify the costs for women whose performances are not consistent with stereotypical feminine behaviour. In spite of being initially applauded for her military victories, Joan of Arc was ultimately persecuted for heresy and sorcery. Chesler maintains that the ‘virgin warrior’s’ childlessness, and spiritual and physical strength, represented a refusal of culturally condoned expectations of women that led to her execution at the age of nineteen. Chesler concludes that a double standard of mental health exists which leads, ‘to perceiving the distressed (or any) female as “sick” whether she accepts or rejects crucial aspects of the female role’ (p. 118). Chesler’s thesis, like other feminist interrogations, has troubled some traditional thinking about the occurrence of mental

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