Lisa Appignanesi has a good track record writing about women and psychiatry (Freud's Women: Orion, 2005). Her current historical approach to women's predicament and their relationship with mental illness is reminiscent of, but less proselytising than, the magnificent book by feminist author Elaine Showalter The Female Malady: Women, Madness, and English Culture, 1830–1980 (Pantheon, 1985). I would recommend Appignanesi's book to anyone gladly. Comments such as ‘I have long been aware of the shallowness of sanity’, suggest a writer at ease with her thinking, her emotions and their expression. An ideal state for the task she sets out: ‘to tell the story of madness, badness and sadness’ and the ways in which women have fared among our understandings of them over the past 200 years. Appignanesi relies heavily on famous ‘mad’ women such as Mary Lamb, Zelda Fitzgerald and Virginia Woolf (as if starstruck at times) to exemplify how we take flight in era-bound exigencies, becoming what we need to become for the society in which we live. She implies that women (as reflectors of male-dominated society) are duped by mind doctors into beliefs about the consequences of their rotten lives, framing them as diagnoses in need of an ever-expanding lexicon of treatments. The idea that us ‘alienists’ medicalise, into illness/madness, appropriate responses to life's harsh landscape is far from original. But the spectre of a pharmaceutical industry, hot-on-the-heels of DSM–V, waving new multi-purpose compounds at us means the accusation remains pertinent; today's gender-sensitive clinical practice, acknowledging abuse and resilience in women's lives, and women's role in their own treatment, continues to struggle with a culture of drugs for disorders.
Appignanesi's long and detailed book fails to recognise recent change in clinical approach but presents a captivatingly informed and thoughtful history of psychological medicine with particular reference to women. What's not to like about that? She touches tantalisingly on reasons behind gender differences in psychological vulnerability and comes to sensitive and intelligent conclusions about the future of help for the distressed, reminding us that everybody needs help sometimes and that this should be seen as a common human requirement. She acknowledges the role of the sufferer in the treatment dialogue also, requiring a broad perspective from those who offer care with greater emphasis on the individual rather than the diagnosis, sentiments recently articulated in Women's Mental Health: Into the Mainstream (UK Department of Health, 2002).