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Multiple Truths and Contested Identities: Power, Gender, and Governance in First-Hand Accounts of Shock Therapy

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Multiple Truths and Contested Identities: Power, Gender, and Governance in First-Hand Accounts of Shock Therapy Multiple truths and contested identities: Power, gender, and governance in first-hand accounts of shock therapy By Jennie Donovan A Thesis Submitted to Saint Mary’s University, Halifax, Nova Scotia in Partial Fulfillment of the Requirements for the Degree of Master of Arts in Women & Gender Studies December, 2013, Halifax, Nova Scotia Copyright Jennie Donovan, 2013 Approved: Dr. Val Marie Johnson Supervisor Approved: Dr. Alexandra Dobrowolsky Secondary Reader Approved: Sheila Wildeman External Examiner Date: December 5, 2013 Abstract Multiple truths and contested identities: Power, gender, and governance in first-hand accounts of shock therapy By Jennie Donovan Abstract: This thesis explores relationships of power and resistance, and the production of truths and subjects in first-hand accounts of electroconvulsive therapy (ECT). Using a feminist poststructuralist approach and Foucauldian genealogical methods, I analyse texts from ECT professionals and former patients in order to destabilize dominant understandings of “mental illness” and ECT. I investigate patterns, contradictions and consistencies within and between dominant and obscured knowledges in these texts. Connections between electroconvulsive therapy, gender and class relations, and governmentality—including processes of reponsibilization and individualization—are highlighted. I discuss evidence of the production of particular subjects, specifically the “still mad” former patient, and active citizens. December 5, 2013. To Two Mum, John, and everyone with a story about psychiatry. Acknowledgments First of all, thank you to all my fellow former-patients-turned-critics of psychiatry. Your resistance inspires and comforts me. Thank you also to mental health service users who benefit from services. You remind me not to generalize my own experience. Thank you to critical mental health workers and educators for trying to understand different perspectives and bring compassion to the mental health system. Throughout my thesis process, I have been fortunate to have the most open, supportive, and encouraging thesis committee. My supervisor, Dr. Val Marie Johnson, has guided me through heavy theoretical work, offered her extensive knowledge and insight into my ideas, and constantly challenged me to think more deeply. Dr. Alexandra Dobrowolsky has introduced me to new ways of thinking and provided me with so many resources. You both have given me guidance, honesty and valuable feedback. You have my deepest gratitude and have contributed more than you know to my incredible graduate school experience. Thoughtful comments from my external examiner, Sheila Wildeman, have initiated further reflection upon my work, and possibilities for potential starting points for future research. Mom and Dad, thank you for always caring and helping me. Adam, you supported me through all the emotions that came out of this project; thank you. Scott, Lisa, and Erika: thanks for helping me take breaks and being generally great friends. I could not be happier that we’ve all ended up here together. And Annette, I can’t imagine meeting a better person to share the new ideas, frustrations, and successes of grad school with. I’m so pleased to take our friendship with me when I graduate. I could never have written this without all of you folks. Table of Contents Chapter 1: Introduction ................................................................................................................................... 1 ◦ Established narrative of electroconvulsive therapy (ECT) .......................................................... 6 ◦ Explanation of terms ................................................................................................................... 7 ◦ Research questions and why this is worthwhile ....................................................................... 10 Methodologies ............................................................................................................................ 12 ◦ Genealogy—A history of the present ECT ................................................................................ 12 ◦ Uncovering my primary sources ................................................................................................ 14 ◦ Genealogy, governance, and critiquing the mental health system ........................................... 23 Theoretical framework ................................................................................................................ 25 ◦ Foucault-inspired feminist poststructuralism – the (re) constitution of truths and subjects ... 26 ◦ Foucauldian toolkit .................................................................................................................... 32 Power .............................................................................................................................. 32 Subjugated knowledges .................................................................................................. 35 Governmentality ............................................................................................................. 36 Literature review .......................................................................................................................... 38 ◦ Critiques of psychiatry and mental illness ................................................................................. 38 ◦ Feminist critiques of psychiatry and the medical model of mental illness ............................... 39 ◦ Feminism and women’s diagnoses-depression and hysteria .................................................... 41 ◦ Histories of electroconvulsive therapy ...................................................................................... 43 ◦ Feminist work on ECT ................................................................................................................ 47 ◦ First-hand accounts: Patients’ perspectives .............................................................................. 49 A map of my research .................................................................................................................. 49 Limitations.................................................................................................................................... 50 Chapter 2: The simultaneous construction of truths and subjects ............................................ 52 A note on the texts....................................................................................................................... 52 Expert knowledges and truths ..................................................................................................... 53 Professionals’ version(s) of the truth ........................................................................................... 55 ◦ Gender neutrality ...................................................................................................................... 57 Changes and contradictions throughout the professional narrative ........................................... 60 ◦ Should ECT be replaced? ........................................................................................................... 60 ◦ Suicide ........................................................................................................................................ 60 ◦ The extent of “improvements” .................................................................................................. 61 ◦ “Last Resort” .............................................................................................................................. 62 ◦ Memory loss and brain damage ................................................................................................ 64 Accounts chosen by professionals to reinforce their version(s) of the truth .............................. 65 Alternative truths ......................................................................................................................... 66 ◦ More truths about memory loss and brain damage ................................................................. 70 Producing subjects ....................................................................................................................... 75 ◦ Hysteria and the construction of the “still mad” former patient .............................................. 77 ◦ Power of suggestion .................................................................................................................. 81 Chapter 3: Governing through mental health ............................................................................ 83 Active citizenship ......................................................................................................................... 86 ◦ Recognition of symptoms – acknowledgement of illness, getting help, and working towards wellness ........................................................................................................................................ 87 ◦ Building relationships with mental health professionals .......................................................... 96 ◦ Choice and informed consent .................................................................................................. 104 ◦ Managing the risks of treatment ............................................................................................. 109 ◦ How to criticize shock therapy ...............................................................................................
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