The Historical Context

Abstract

In this chapter I want to build on the analysis of gender and mental disorder I have developed so far, by setting it in a broader context of changes in mental health services. I have argued that theoretically mental disorder is best understood as a shifting, changing category which classifies certain social problems as problems of mind, a process that involves attributions of irrationality and unreason. I have also argued that, given the generally greater reluctance to attribute rationality and agency to women than men and particularly to see them as more ‘emotional’, women may be particularly prone to be categorised by clinicians as having certain mental disorders (both in terms of the development of general categories and of individual cases). It is necessary, however, to examine how these processes operate in socially and historically specific situations, and how the development of particular institutional arrangements, which are themselves shaped by a range of social forces, affect the processes of category construction and the gender balance of patient populations.

If doctors found themselves diagnosing nervous exhaustion more frequently at the end of the nineteenth century, they may have been prompted to do so by the ease with which they could flourish the new, all-inclusive designation for a very mixed bag of symptoms… On the other hand, they may well have been under strong pressure from patients to dispense the neurasthenic diagnosis. Once propagated, disease entities assume dimensions that the medical profession cannot always predict or control. Those that take root and thrive most luxuriantly are the ones that best further the confluence of patient’s and physician’s needs (Oppenheim 1991:99).