Understanding the Crazy Woman: Schizophrenia in Feminist Social Change Models

A SYTYCB entry

As a social worker and a queer, feminist woman, my passionate engagement with issues of mental illness has numerous roots. This post is most immediately a reaction to recent conversations with friends wherein these (otherwise very aware, inclusive, sometimes even social-worker) folks surprised me with oblivious use of the term “crazy.” I even recall a few referrals to medication someone probably wasn’t but should be taking. Cuz that, as we all know, solves the crazy. Recent discussions about last month’s Aurora shootings got me thinking about just how pervasive this misunderstanding of mental illness is, even (or especially) within feminist activism.

I work with women who are both homeless and mentally ill, and have been particularly challenged by those with schizophrenia, as they remind me that my work is not done when I succeed in sitting everyone around a table to discuss the realities of poverty, rape culture, or domestic violence. They remind me of the complexity of identity and perspective. This reminder has taken the following form, and is ever-transforming.

Feminist work within social service nonprofits and grassroots organizations historically grounds its goal of social change in a search and critique of the “societal causes of individual and interpersonal problems,”[1] while simultaneously rejecting a psychiatric paradigm. Such a rejection appears rooted, as argued by Bonnie Burstow,[2] in the reality that tools of the psychiatric profession have been and often are used abusively against women, creating mistrust.

Because of its utilization as a means of social control, because of its historical tendency to medicalize and pathologize women’s unhappiness, feminist theory has strictly departed from the theoretical and practical frameworks of psychiatry. However, a method dedicated solely to social change and the critique of social roots of women’s issues has often excluded women with schizophrenia by virtue of defining mental illness as exclusively the product of societal oppression without acknowledging the clinical needs of the severely mentally ill.

In an effort to explore how feminist formations of mental illness, therapy and community organizing can incorporate the views, voices, ideas and needs of women with schizophrenia without adhering to a medical model, I’ve laid out three strategies. They are more exploratory and open-ended than conclusive, and perhaps even tangential by intention, as I work to frame my daily struggles at work and in the city of Chicago. I firmly believe that without incorporation of  women who are severely mentally ill (I use people-first language intentionally throughout, however clunky), a feminist social work framework that emphasizes the importance of activism fails to accomplish its claimed goal of inclusivity and is denied vital insight. Schizophrenia, like other traits that are systemically stigmatized, must be granted validity in order for us to build a community and engage in activism that fully incorporates all perspectives.

How does the schizophrenic person fit into the oppression/oppressed paradigm, and how, if the ultimate goal is to build a world wherein everyone is granted validity and voice within the discourse, should schizophrenia be understood by the schizophrenic and by the outsider? How can women with schizophrenia be brought into the feminist/activist conversation?

First, schizophrenia can and should be understood as a marginalizing trait or condition, rather than just as a disease. Little is known about the causal factors or biological materialization of schizophrenia, though it seems apparently linked to both biological predisposition and traumatic experience. The average age of onset is between 18 and 25. Despite obvious differences between severe mental illness and other traits that deem one oppression-worthy such as non-whiteness, non-cis-maleness, or non-straightness, schizophrenia can be articulated as a sort of non-normalized way of thought—different in form but similar in its interpretation as “inadequacy.”[4] The point here is that schizophrenia, like other non-normative aspects of a person, is articulated within the daily discourse of the West through a lens of stigmatization and pathologization. The medicalization of schizophrenia should not eliminate the important step of linking it to other key struggles around voice and identity.

From there, certain clinical knowledge and the realization of schizophrenia as a condition that makes functional social living more difficult are important to one’s work with women with schizophrenia. While “viewing disability as a social construction has been the first theoretical step toward moving the discourse away from pathology and into politics,”[5] it is also important to leave room for the ways schizophrenia may differ from other forms of oppression.

The goal should be recognition of the severity of the disorder through a medical model alongside a process of theorizing ways of its incorporation into social justice goals. Without allowing for this recognition and subsequent clinical assessments, services, and accommodations, attempts at including schizophrenic voices are inadequate. Essentially, in an attempt to de-medicalize the disorder and pull away from psychiatric methods, we may instead disregard needs that must be met for the full participation of women with schizophrenia.

Like Elizabeth Donaldson in “The Corpus of the Madwoman: Toward a Feminist Disabilities Studies Theory of Embodiment and Mental Illness,” I urge that “theorizing about mental illness” requires “a difference focus on impairment” that includes “a shift toward medical models of illness” that can indeed be risky.[7] The historical medical model has in part allowed for the ‘treatment’ of the person and her condition rather than the ‘treatment’ of the “social processes and policies that construct disabled peoples lives.”[8] Further, it has allowed for the view that the minoritized mentally ill woman suffers a “private tragedy” rather than from universal problems.[9] Donaldson suggests a useful tool to counter this tendency of reversion to biological determinism and essentialism: a reconceptualization of embodiment. “It is useful,” she says, “to begin with the understanding that bodies are not simply born, but made.”[10] Donaldson is talking specifically about physical disabilities, though she mentions mental illness and developmental disabilities a few times and I think the point translates well. We need to envision embodiment not as a predetermined fact, but as developed in time and heavily influenced by society. A body exists only in that it carries meaning, and this meaning is produced by the discourse within which it functions.

It is vital, in other words, to define severe mental illness as both a “neurobiological disorder” and a socially constructed aspect of one’s identity. Once this dislodging of the perception of biology as objectively prior to meaning is achieved, it becomes easier to understand the process of incorporating perspectives otherwise linked to this biological fate of ‘othering.’ Below are three strategies for effectively incorporating the voices and experiences of women with schizophrenia into the discourse of social change.

The first strategy I propose is to challenge the stigmatic reaction to ‘crazy,’ and thus envision new possibilities for recovery. This requires that we de-center the centralized concept of ‘normalcy’ and consider the mentally ‘ill’ perspective as equally real and acceptable. To first dislodge and then to complicate and reform the categorizations themselves allows for the restoration of the agencies of women defined as schizophrenic.

After all, it remains true that mental illness itself “disrupts and unsettles.” We must thus begin by dismantling our everyday assumptions and embedded misperceptions about mental illness while simultaneously understanding that psychiatric diagnosis leaves much unsaid.[13] Further, as Bonnie Burstow put it, “There are serious problems with the unquestioned belief in normalcy and in the superior status accorded it.”[14]

Such leads directly to the second strategy I propose: an in depth reconsideration of the concept of progress. This includes a devaluation of the revered concept of linearity in favor of fluidity and multiplicity. This notion is deeply feminist. A “recovery model” is an example of how this might look, emphasizing meeting women where they are and working with them to articulate goals. These goals may look completely different from those an outsider may have set for her, because the purpose is to incorporate rather than homogenize, listen rather than enforce (again, feminist!). Further, any process of growth is inherently multifaceted and multi-directional.

Accordingly, the third proposed strategy is the practice of trauma-informed organizing. First of all, to state that traumatic events are those outside of usual human experience is a misstep. As Laura Brown puts it,[15] to effectively limit the range of human experience to “the range of what is normal and usual in the lives of men of the dominant class; White, young, able-bodied, educated, middle class,” is to completely disregard and pathologize the experiences of the majority of the population. “Trauma,” by the above definition, thus becomes “what disrupts the lives of these particular men but no other.”[16]

Instead trauma should be defined as the ways in which “people,” in most cases oppressed people, “are routinely worn down by the insidious trauma involved in living day after day in a sexist, racist, classist, homophobic, and ableist society:” enduring street harassment daily, working long hours for still less pay than the average man, “hearing racist innuendoes even from one’s White allies.”[17] When such experiences are recognized, the conversation is enriched by histories full of relevant and problematic social experiences. The issue of mental illness can thus be linked to social justice issues through the validation of women’s life experiences.

Again, a fundamental reversion to an unquestioned standard of normalcy can hinder trauma-based practice. “Two underlying assumptions that are equally problematic, are: 1. The world is essentially benign and safe, and so general trust is appropriate; and 2. people who have been traumatized have a less realistic picture of the world than others.”[18] The traumatized person is not blinded by their trauma–it is in fact the untraumatized person who can see things as they may not actually be (the woman who can walk the streets at night with little concern, though the streets pose a real threat). This shroud of safety is beneficial for daily functioning, and its removal makes otherwise simple tasks troublesome for the trauma survivor.

Like other manifestations of trauma, biological disposition, and societal oppressions, schizophrenic perspectives must be accepted as they are, without recourse to a ‘return’ to a ‘normal’ state of thought. While I am not urging against the notion that schizophrenia can be ‘recovered’ from, I am arguing that recovery cannot be a static, or even widely articulated concept, but that it does and must look different for everyone.

Through the strategies above and through many others, we can work toward the “construct[ion of] ways of belonging and reclaiming moral agency”[21] accomplished by and with women whose real life experiences and histories have lead to what is medically labeled a thought disorder but what can become a significant and transformational perspective in a feminist framework for social change.

Cited Works:

[1] Lisa Avery, “A Feminist Perspective on Group Work with Severely Mentally Ill Women.” Women & Therapy, 1998, Volume 21, Issue 4, pg 1.

[2] Marina Morrow, “Critiquing the ‘Psychiatric Paradigm’ Revisited: Reflections on Feminist Interventions in Mental Health,” Resources for Feminist Research, 2007, Volume 32, Issue ½, pg 69.

[3] Avery, 2.

[4] Rosemarie Garland Thomson, “Redrawing the Boundaries of Feminist Disability Studies,” Feminist Studies, 1994, Volume 20, Issue 3, pg 583.

[5] Ibid.

[6] Elizabeth J. Donaldson, “The corpus of the madwoman: Toward a feminist disability studies theory of embodiment and mental illness,” Feminist Formations, 2002, Volume 14, Issue 3, pg 101.

[7] Ibid., 112.

[8] Ibid.

[9] Ibid.

[10] Ibid.

[11] Ibid.

[12] Thomson.

[13] Kim Hopper, “Rethinking social recovery in schizophrenia: What a capabilities approach might offer,” Social Science & Medicine, 2007, Issue 65, pg 870.

[14] Bonnie Burstow, “Toward a Radical Understanding of Trauma and Trauma Work,” Violence Against Women, 2003, Volume 9, pg 1298.

[15] Brown, Laura. “Not outside the range,” Trauma: Explorations in memory, 1995, pg 100-112. Baltimore: Johns Hopkins University Press.

[16] Ibid.

[17] Ibid.

[18] Ibid.

[19] Donaldson, 102.

[20] Ibid., 101.

[21] Hopper, 871.