How Does Rebecca Shanhouse Create An Ethic Of Care For Mental Illness

Ethic of Care for “Madness”

In order to construct an appropriate ethic of care for women deemed “mad” by mental practitioners and/or family members, special heed must be paid to culture, values, and the individuality of the patient. In Rebecca Shannonhouse’s anthology, Out of Her Mind: Women Writing on Madness, Shannonhouse includes brief excerpts of writings by women who have experienced this very situation: having expressed or been determined to have an unstable mental state. Excerpts from The Yellow Wallpaper by Charlotte Perkins Stetson Gilman, The Bell Jar by Sylvia Plath, and Girl, Interrupted by Susanna Kaysen will illustrate three necessary and intimately intertwined criteria for defining a common ethic of care. The first will confront

the idea that questioning a patient’s trustworthiness as it pertains to said patient’s confession of “mad” thoughts, feelings, or actions is necessary as an initial part of treatment.

Doubt in mental patients’ experiences due to the possible unfamiliarity of these experiences to the textbook situations with which mental practitioners are educated hinders the progression of treatment altogether. The second will address the importance of the patient before the education of the doctor. This is to say that the material or, again, textbook situations involved in the education of the mental health practitioner should be considered secondary to the specific patient’s individual experience. With the checklists that accompany the myriad of labeled mental illnesses it is easy to assign each patient with one of these illnesses and treat according to that illness rather than to the patient. The third criterion for an appropriate ethic of care is a continuation of the second: the patient’s lived experience should be as thoroughly understood as possible before an appropriate treatment can be crafted for the individual. This type of in-depth understanding before the use of symptom checklists to identify illnesses or speedy issuance of drugs can absolutely lower the risk of inappropriate diagnoses and

their accompanying treatments.

A patient or potential patient’s confession to irregular feelings or actions should never been taken lightly or brushed off as exaggerations.

Because of the complexity of the mind and its ailments, it has too often been assumed that certain abnormalities in behavior can be cured with rest and/or certain foods or drinks (or lack thereof). It would be clearly absurd, by modern medical standards, to treat a broken arm with rest and lots of water alone. However, a condition that is not as visible as a broken arm, such as cold, can in fact be aided with this exact treatment. Equating mental illness with that of a cold or other easily treated sickness is the real absurdity. As stated, neither a cold nor depression is visible beyond specific symptoms; however, a cold is fleeting in most instances while depression is ongoing and in many cases terminal. Doubt in the severity of a patient’s condition, as an immediate reaction, because it is invisible or unfamiliar to the cases studied by practitioner should be eliminated from the exercise of mental treatment completely. The discussion itself of this doubt obstructs and delays true treatment of individual patients. Gilman illustrates this very hindrance in her excerpt from The Yellow Wallpaper, a piece which reflects upon her experience being held in a room as a means of treatment by her husband, a doctor who did not believe his wife to be ill. Gilman recounts that this very disbelief by her husband is the “one reason [she does] not

get well faster” (33). Her husband was not the only doctor in her life who dismissed her illness. Gilman’s brother, “also of high standing…says the same thing” (33) about her behavior, and advocates a treatment of repetition, tonics, air, and absolutely no work: in other words, rest. Gilman believed that “society and stimulus…congenial work, with excitement and change, would do [her] good”, however that is not what she received (33). This point is not to say that the patient knows best when it comes to treatment, but the patient’s opinions are not irrelevant. Medical practitioners have a certain authority in the community; they are respected and trusted with lives. It is an abuse of this influence and power when a doctor considers her own medical opinion before her patient’s for the entire duration of the treatment. It is true that a doctor, an educated healer in a specific field, has educational knowledge and experience over her patient in most cases. However, the doctor is not the one living the experiences of the patient and, therefore, will not know the true nature of the case. Extensive research into the life and mind of her patient is absolutely necessary to reach as close an understanding as possible to that of the patient, the experiencer. Sufficient to say, the first criterion of an appropriate ethic of care involves full initial belief and reception of the patient’s experience or trauma without personal bias, including one’s medical education.

Continuing this further, the second criterion involves putting the experiences of the patient before the experiences studied by the doctor during her schooling. Though some cases can have similar elements to other cases making the treatment, diagnosis, or other progressions the same for both, this should not be assumed for every patient. Sylvia Plath demonstrates the failure of this scenario in an excerpt from her book The Bell Jar. The novel’s narrator, Esther Greenwood, meets her psychiatrist for the first time. She expects, or rather hopes, that her doctor will be more “kind, ugly, and intuitive”, more able to coax the words for her feelings out of hiding, and from there more able to clearly explain to her why she “couldn’t sleep and why [she] couldn’t read and why [she] couldn’t eat” (86). Esther is not hoping for a perfect mind doctor or a miracle, she is hoping that she falls into one of the categories she knows mind doctors work from. However, the doctor Esther ends up with seems to have predisposed ideas about her illness. This is proven when after a brief initial meeting between Doctor Gordon, Esther’s psychiatrist, and Esther he expects her to show up to their next meeting feeling somehow different. When Esther feels no change by their second meeting, Doctor Gordon decides she needs “shock treatments at his private hospital” (89). Though this may seem rash and unprofessional when put into plain words, this situation is common in the world of mind doctor and patient relationships. Many doctors handle numerous patients at a time and, hence the need to cycle through them as efficiently as possible (thus, the birth of checklist-made illnesses). It is in this cycle that patient-valuable time is cheated. More time per patient, and a fewer amount of patients overall, can make room for more research into the experience of the patient rather than the need to resort to immediate diagnosis and treatment.

In continuation, this lack of attempt to reach an intimate understanding of a patient’s experience is also a cause for inappropriate or rushed diagnoses. Just as Doctor Gordon rushed Esther’s treatment, many practitioners rush to conclusions to fuel his or her own agenda. This statement is not in ignorance to the difficulty involved in being a doctor, not to mention a mind doctor. It is more an acknowledgement of the wrong being done to “mad” patients on behalf of rushed or otherwise distracted and busy doctors. It is inarguably challenging to be a mind doctor, but it is also immeasurably grueling to be “mad”: living a life, with day-to-day trials, removed from or in depressing disbelief of reality. As an illustration of the distress involved in being “mad”, Shannonhouse’s anthology features a short excerpt from Susanna Kaysen’s memoir Girl, Interrupted. In this brief reflection, Kaysen explains the movement of an insane person’s thoughts, a movement sometimes so intense that it becomes an actual measure movement, of “velocity vs. viscosity” (117). One thought becomes an event: “I’m tired” becomes a harassment of every related notion to sleepiness from “pillows…[to] sea monsters” (117). A quick memory of illness as a child, of “swollen cheeks on pillows and pain on salivation” turns into an all-encompassing attention to the tongue’s placement and purpose in the mouth, evolving to one sitting there twirling her tongue around and staring at a wall. According to Kaysen, as a representative for many “mad” women, this is insanity. However, it is Kaysen’s written experience. It is hers and does not come from any other specific patient or the textbook of a medical student. These sorts of specific and colorful explanations of feelings or experiences are what need to be coaxed out by mind doctors. If it is impossible for the patient to explain in such detail, or at all, other means must be executed in order for the doctor to understand as best she can. This is up to the doctor. The point of this third criterion is simply to illustrate the importance of understanding before jumping to conclusions.

Before the conclusion of this article, it is important to acknowledge the differences in treatment regarding these criteria between male and female “madness”. This is mentioned lastly not due to the subject’s lack of importance but because an ethic of care should equally encompass all sex and gender identifications before the specifics of each are considered in individual diagnoses. Even so, these considerations should be the biological and physical differences between the sexes unless the patient’s voiced concern is of his or her sexual orientation, gender, or biological sex. All this aside, the intent of this last remark is to draw attention to the treatment of females determined “mad” by family members, friends, or mind doctors. Each of the formerly mentioned women who publically shared their experiences of mania have had to deal with more men in positions of authority than women in pertinence to their treatment, or lack thereof. Gilman, of The Yellow Wallpaper is placed in her confinement by her husband, the doctor, and held there by her brother, also a doctor, and husband’s advocacy for the idea. Esther of Plath’s The Bell Jar as well as Esther’s mother experience male authority in Esther’s doctor. Kaysen, of Girl, Interrupted, is shown in her full memoir to have been diagnosed by a male as well. Both Kaysen and Esther suffered quick diagnoses. The correlation between male doctors and quick diagnoses is irrelevant to this article, however the amount of male doctors to female patients in Shannonhouse’s collection of women writing on madness is absolutely relevant. The identified common ethic of care should encompass all genders, however knowledge of the historical treatment of “mad” women is necessary in the modern treatment of all patients to ensure such mistakes, such as ignorance of or expectation for a specific gender’s behavior, are seldom made again.

In summation, mental health practitioners should adhere to a common ethic of care including, but not limited to, three criteria: 1. Removing the question of belief in “mad” patients’ experiences from the doctor/patient relationship. This includes an attempt to investigate the “mad” individual more deeply before settling for the belittling and absurd treatment of rest alone. 2. Attention to the patients’ individual experiences before the situations studied in medical education. 3. Striving for as close to a full understanding as possible by the mind doctor of the patients’ individual experiences. By observing these criteria, the practitioners in the world of mental health can assist the progression toward a more perfect ethic of care for “mad” patients. Moreover, people outside the medical sphere can make more effective decisions in determining an ethic of care for their loved ones.