Women and Madness: Exposing Patriarchy in the Consulting Room

Trained as a research psychologist in the mid-1960s, Chesler authored Women and Madness (1972) as a protest against what she saw as unjust and sometimes inhumane conditions for women in psychotherapy. In a personal memoir (Chesler, 1995), she describes returning home from the 1969 convention of the American Psychological Association, at which a feminist protest had occurred, feeling compelled to use her skills as a researcher to document empirically how psychotherapy oppressed women. She used early tools of feminist analysis, focusing attention on how problematic societal gender relations were replicated in the psychotherapy relationship. She argued persuasively that in psychotherapy, the conditions of a sexist and oppressive society were reproduced, with the ultimate outcome of harm done to women in a place where they had gone to seek healing.

Chesler’s observations occurred within a particular professional and historical context. At the time of her writing most doctoral psychotherapists were male and, as noted by Guthrie (1976), predominantly Euro American. The majority of practicing psychotherapists through the middle of the decade of the 1960s either were trained in the U.S. psychoanalytic orthodoxy of the day, which implicitly denigrated women in its particular interpretations of psychoanalytic theory (Bernardez, 1995; Luepnitz, 1988), or were proponents of some variety of humanistic psychotherapies. While the humanistic therapies were more apparently open and accepting of women’s experiences, they also often lacked boundaries to sexual contact between therapist and client and continued to reinforce social norms about gender for women even while preaching self-actualization. The nascent family therapies of that era were also deeply sexist, blaming women, particularly mothers, for many of the ills of families (Hare-Mustin, 1978) without questioning how motherhood was socially constructed.

Then, as today, a majority of people seeking private psychotherapy were women, frequently women struggling to make sense of conflicts between pursuing their goals, desires, and interests and societal demands that Euro American, middle-class, educated women work as unpaid homemakers and full-time parents. When women of color sought psychotherapy—then as now an infrequent occurrence—they were often greeted with numbing medications and conceptualizations of their distress that were both racist and sexist (Bernardez, 1995; Greene, 1986; Morris & Espin, 1995). Chesler noted that in this configuration of male authority and female distress, women were defined as dangerously disturbed simply because of desires to work in professions, not to parent full-time, or in some other manner to violate gender norms for their time. She suggested that in therapy as in life outside the consulting room, a woman was defined as a wife or daughter to the male psychotherapist who assumed the complementary role of husband or father.

Chesler was the first author to document the existence of hitherto denied or minimized sexual boundary violations in therapy and to compare such violations and their effects to other forms of sexual assault. While in the 21st century therapists take for granted a prohibition on sexual contact with clients, Chesler’s work occurred in an era when some well-known psychotherapists, among them some of the founding fathers of certain humanistic approaches, were publicly flaunting sexual relationships with their clients. At that time women’s reports of any form of sexual violation, in or outside of therapy, were routinely dismissed as fantasy productions arising from a woman’s own repressed sexual needs or attributed to the woman’s own so-called seductiveness. One of the founders of Gestalt therapy detailed such activities in an autobiography (Perls, 1969).

Chesler’s work was both revolutionary and controversial when it was published. Her willingness to state that psychotherapy as usual could be harmful to women because of its replication of oppression was itself consciousness-raising to many of her readers, allowing them to experience validation of what they had personally encountered in psychotherapy and helping them to develop the feminist consciousness that they were neither alone in their suffering nor the source of the problem. Her insights into what needed to happen in psychotherapy to render it both nonharmful to women and potentially contributory to feminist social change laid the groundwork for what was to follow. Women and Madness remains relevant 4 decades later.