A SHORT HISTORY OF THE FUTURE - CiteSeerX

Psychology of Women Quarterly, 15 (1991), 521-536. Printed in the United States of America.

A SHORT HISTORY OF THE FUTURE

Feminism and Clinical Psychology

Jeanne Marecek Swarthmore Coflege

Rachel T. Hare-Mustin Villanova University

Since the 19th century, feminists have criticized the mental health establishment and its treatment of women. Issues include the sexist use of psychoanalytic concepts and psychiatric diagnoses, the misuse of medication, and sexual misconduct in therapy. Feminists have also called attention to psychological problems arising from gender inequality in everyday life. Physical and sexual abuse of women i s of special concern. Feminist innovations in therapy include consciousness-raising, sex-role resocialization, and new approaches to psychoanalysis and family therapy. We urge feminists to develop a fuller understanding of gender and power, and to use this knowledge to challenge the established theory and practice of clinical psychology.

Every history is a reconstruction of events, told from the vantage point of the teller. When psychology texts recount the history of clinical psychology, they often date the modern era from the time of the humanitarian reforms of Phillippe Pine1 and William Tuke at the close of the 18th century. In this account, what is emblematic about the modern era- “our” era- is its humane sensibility, its repudiation of physical coercion and restraint, and its regard for the rights of individuals in treatment. However, although the field may represent itself in this way, others have disputed this view (e.g., Edelman, 1974; Goffman, 1961; Showalter, 1985). Especially when viewed from the perspective of women and mem-

We would like to thank Sandy Graham-Bermann and three anonymous reviewers for their many suggestions and ideas.

Address correspondence to: Jeanne Marecek, Department of Psychology, Swarthmore Col- lege, 500 College Avenue, Swarthmore, PA 19081.

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522 MARECEK AND HARE-MUSTIN

bers of other marginalized groups, codified diagnoses and accepted treatments too often fall short of these emblematic ideals.

One such accepted treatment was Dr. Isaac Baker Brown’s use of clitori- dectomy as a cure for masturbation, which he regarded as a “disease” that, he claimed, would reduce women to “idiocy, mania, and death.” Brown, practicing in England in the latter part of the 19th century, oper- ated on women whose “symptom” was the wish for divorce, as well as on girls, some only 10 years old, who exhibited “restlessness” (Showalter, 1985). Even more widely acclaimed was Dr. S. Weir Mitchell’s so-called cure for female neurasthenia. Mitchell, an American psychiatrist, treated Charlotte Perkins Gilman, Edith Wharton, Jane Addams, and other prominent women of the late 19th century. As depicted in Gilman’s auto- biographical novella The Yellow Wallpaper (189211985) , Mitchell’s prescription involved forced bed rest, deprivation of mental stimulation, en- forced isolation from adult company, and constant heavy feeding, leading to weight gains of 50 pounds or more. Gilman’s heroine, rather then being restored, is made mad and driven to suicide. Gilman’s theme, that sexist treatments cause (or at least exacerbate) psychological difficulties, has been a recurring one in feminist protests against the mental health establishment (e.g., Cheder, 1972; Hare-Mustin, 1983). In this article, we sketch a brief history of feminism in clinical psychology.

PREFEMINIST CLINICAL PSYCHOLOGY

Clinical psychology in the United Stated has a short history. Although the field officially began in 1896 with the founding of Lightner Witmer’s Psychological Clinic (Watson, 1953), the tasks and roles of early applied psychologists bear little resemblance to those of present-day clinical psychologists. “Mental testing” was the primary focus in the early days. This included screening recruits for their suitability for military service and assessing the mental status of children (Korchin, 1983). A number of women psychologists made important, though not specifically feminist, contributions to testing. Among these women were Florence Goodenough (1926), Lauretta Bender (1938), Christiana Morgan (Morgan & Murray, 1935), and, in a later period, Karen Machover (1949). The number of women in applied psychology, although high relative to academic psychology, was small in absolute terms. Moreover, in keeping with gender norms of the day, women were underrepresented in military-related psychology and concentrated in settings, such as child guidance clinics, that focused on children and schools (Bohan, 1990; Furomoto, 1987).

In 1945, large-scale training programs were initiated by the Veterans Administration (VA) to meet heavy demands for mental health services occasioned by World War 11. This marked the start of a process by which clinical psychology evolved and expanded into its present form (Korchin, 1983). Despite the high demands, women were not welcomed into early

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Feminism and Clinical Psychology 523

VA clinical training programs. Furthermore, because U.S. military per- sonnel were mostly male, the VA setting offered little opportunity or in- centive for therapists to think about the needs of women in treatment.

Psychod y narn ic Influences

Postwar clinical psychology bears the indelible stamp of psychoanalysis. The history of psychoanalysis is replete with eminent women analysts; many of these women, including Helene Deutsch, Marie Bonaparte, Jeanne Lampl-de-Groot, Joan Riviere, and Frieda Fromm-Reichmann, took up issues of female sexuality and feminine psychology. Although these historical figures did not break with Freudian orthodoxy, a few others did, most notably Karen Horney and Clara Thompson. Horney took issue with the centrality of penis envy in psychoanalytic accounts of female development, pointing out how closely the ideas put forth by psychoanalysts resembled the “naive assumptions” of small boys (1926/1967). Dis- mayed by psychoanalysts’ lack of attention to motherhood, she asserted its importance for women’s psychic life; at the same time, she conjectured that women’s childbearing ability was at the root of male misogyny. Cul- tural devaluation of women concealed and served to counter men’s uncon- scious dread of women’s power to create new life (1932/1967). Horney also connected women’s “overvaluation of love” to their social and economic dependence on men and marriage (193411967). Thompson (1942, 1950), too, examined cultural pressures on women such as economic dependence, restricted opportunities, and the derogation of women’s sexuality and sexual organs. Although both Horney and Thompson suffered disdain and ostracism at the hands of many of their psychoanalytic colleagues, their thinking presaged the feminist critiques of psychoanalysis of the 1960s and 1970s (Garrison, 1981).

In the postwar years, psychoanalysis dominated the mental health professions. Psychoanalytic ideas about women were served up as scientific evidence for reinstating women in their “proper” domestic place. These ideas included interpreting women’s ambition as penis envy, blaming mothers for an extensive array of difficulties and disorders of childhood and adult life, and equating heterosexuality, marriage, and motherhood with psychological maturity (e.g., Lundberg & Farnham, 1947). Thus, it is not surprising that feminists of the late 1960s objected strongly to Freud- ian psychoanalysis. By devaluing, restricting, and pathologizing women, psychoanalysis helped to create the very unhappiness that it purported to cure (Hare-Mustin, 1983).

FEMINISM AND CLINICAL PSYCHOLOGY

In the past 25 years, feminists have made numerous and varied contributions to clinical psychology as activists, theorists, and practitioners (Brod-




sky, 1980). There are abundant interconnections among these areas, but we will examine them separately in order to highlight some of the major accomplishments. Developments have been uneven; nonetheless, feminist issues have been raised throughout this period with considerable moral and intellectual force.

Critique and Activism

Feminism is a form of oppositional knowledge, and its boldest efforts are its challenges to accepted dogma. The dominant discourses in clinical psychology have taken white males as the norm, and thus white women and people of color have been viewed as deviant and inferior. Early on, studies by Broverman and her colleagues (Broverman, Broverman, Clark- son, Rosenkrantz, & Vogel, 1970; Broverman, Vogel, Broverman, Clark- son, & Rosenkrantz, 1972) demonstrated that therapists, who were presumed authorities in human personality and behavior, did not draw their knowledge of women and men from scientific sources, but instead held biases and stereotypes similar to those of the public at large. The work of Broverman and her colleagues opened the way for a large number of subsequent studies (reviewed by Davidson & Abramowitz, 1980; Marecek &Johnson, 1980; Sherman, 1980) that investigated how these biases might influence clinical judgments, diagnoses, and interactions in therapy. In addition, feminist clinicians designed workshops and training exercises to help clinicians become aware of possible biases and modify their practices. Although research on therapy failed to reveal clear and consistent gender effects, it did show that gender enters into the clinical situation in any number of complicated, indirect, and mediated ways, often in interaction with other social categories such as race, age, social class, and sexual orientation (Brodsky & Hare-Mustin, 1980). Thus, this early work pointed the way toward the more complex and nuanced analyses of gender relations in clinical situations that are now being formulated (e.g., Goldner, Penn, Sheinberg, & Walker, 1990; Hare-Mustin, 1991; Holstein, 1987; Walters, Carter, Papp, & Silverstein, 1988).

Diagnosis and labeling: To what end? Since the beginning of the present feminist movement, feminists have insisted that diagnosis is not a neutral tool at the clinician’s disposal. Some have argued that diagnosis can be a means of discrediting and punishing women who do not conform to men’s interests (Cheder, 1972; Task Force on Sex Bias and Sex-Role Stereotyping in Psychotherapeutic Practice, 1975). Others have noted that gender stereotypes can lead therapists to overlook or minimize women’s complaints, to trivialize their distress, and thus to withhold needed treatment. Thus, both overdiagnosing and underdiagnosing can result from gender biases, and both can serve as mechanisms of social control over women.

In the early 1970s, feminists were among groups that mounted a protest




against the inclusion of homosexuality in the official Diagnostic and Statis- tical Manual (DSM), a protest that was ultimately successful.’ Later, ar- guing on grounds of both scientific adequacy and discriminatory impact on women, feminists challenged certain diagnoses proposed for the DSM- III-R (American Psychiatric Association, 1987), namely, paraphilic rapism, self-defeating personality disorder, and late luteal phase dysphoric disorder (the new psychiatric label for premenstrual syndrome [PMS]) (Sparks, 1985). Diagnoses of sexual dysfunction, which have proliferated in recent DSM revisions, have also come under attack. Critics have noted that definitions of normal sexual functioning are based on an implicit model of male sexual gratification (Tiefer, 1990).

Beyond the battles won and lost regarding specific diagnostic categories, the deeper issue is the political meaning of diagnosis. Far from resting solely on scientific evidence, decisions about what behaviors are accept- able or unacceptable and what behaviors demand intervention or restraint have moral and political dimensions. Diagnostic categories provide the language that therapists speak, and thus, the very framework for their judgments and actions. Moreover, the conventional diagnostic system identifies the individual as the locus of pathology. The influence of the social context - whether family, community, or the broader cultural system - is effectively removed from view. As constructivists, we ask not only what ends are served, but, more pointedly, whose ends are served. To what extent are diagnoses a means of social control, ensuring conformity to the interests of those in power, and denying the connection between social inequities and psychological distress (Foucault, 1980; Hare-Mustin & Marecek, 1980)T

Sexual abuse by therapists has been another prime target of feminist activism (e.g. , Bouhoutsos, Holroyd, Ler- man, Forer, & Greenberg, 1983; Hare-Mustin, 1974; Holroyd & Brodsky, 1977). In response to feminist activism, the American Psychological Asso- ciation (AF’A) incorporated a direct prohibition against sexual contact between therapist and client in the Ethical Standards of Psychologists in 1977. A subsequent revision of the Ethical Standards in 1981 added a prohibition against the sexual harassment of students and employees. In addition, feminist psychologists strove to raise the awareness of consumers’ rights in therapy more generally (Hare-Mustin, Marecek, Kaplan, & Liss- Levenson, 1979; Liss-Levenson, Hare-Mustin, Marecek, & Kaplan, 1980; National Coalition for Women’s Health, Task Force on Consumer Issues in Psychotherapy, 1985). Currently, about half the complaints to state licensing boards against psychologists concern sexual misconduct in therapy, and seven states have now criminalized such behavior (Youngstrom, 1990). Thus, public awareness of clients’ rights and of the seriousness of the problem has increased considerably.

Feminists have also voiced strong concerns about possible misprescribing and overprescribing of psychoactive drugs

Sexual misconduct in therapy.

Psychiatric medication.




for women (Cooperstock, 1980; Fidell, 1981; Travis, 1988). When used appropriately, psychoactive drugs have a legitimate and important role in the treatment of certain disorders. Feminist concerns has been aroused, however, by the evidence of bias in prescribing practices, by the lack of careful research on women’s response to medication, and by sexist depic- tions of women in pharmaceutical advertising. PMS, which was only re- cently declared a psychiatric disorder (rather than a disorder of the reproductive system), is a subject of renewed concern. In the eyes of a number of activists, the criteria for diagnosing PMS (or “late luteal phase dysphoric disorder”) are shaky at best. Moreover, as Parlee (1989) noted, the discov- ery/invention of PMS and the rush to establish it as a diagnostic entity were bankrolled by pharmaceutical firms that were eager to market new drugs to “cure” it.

Breaking the Silence/Reconstructing Knowledge

Voicing what has gone unsaid is the center of feminist scholarship. Echo- ing Charlotte Perkins Gilman and other early feminists, Betty Friedan (1963) named the “problem with no name,” the demoralizing effect that the housewife role had on middle-class women; this statement was a cou- rageous act in its time. This paved the way for psychological research linking disorders prevalent among women, such as depression, agorapho- bia, and problems with eating, to traditional femininity and stereotyped role behaviors (Franks & Burtle, 1974; Rawlings & Carter, 1977; Roth- blum & Franks, 1983; Widom, 1984).

There is a crucial distinction, however, between social role analyses like those of Friedan and the person-centered analyses that prevail in psychology. The former examines the social relations - especially the distribution of power and other resources - involved in roles such as housewife and mother; the latter has concerned itself with personal attributes thought to be dysfunctional. Thus, these psychological analyses often de- contextualize women’s experiences and fail to challenge the individualist bias of the discipline.

An important line of research for feminist clinical psychology has been to call attention to how the day-to-day life of women is shaped by gender inequality, and to how relations of inequality give rise to conflict, frustration, and demoralization. Examples include research on stresses in women’s family work (Baruch, Biener, & Barnett, 1987; Haavind & Andenaes, 1990; Hochschild, 1989) and in marriage (Hare-Mustin, 1991), the struggles of impoverished women (Belle, 1982), and the burdens that heterosexism and homophobia place on lesbian women (Brown, 1989; Golden, 1987; Krestan & Bepko, 1980; Kohr- baugh, 1990). Works such as these remind us all that clinical interventions must be accompanied by social and political change.

Everyday Zife as problematic.’



Feminism and Clinical Psychology 527 Prefeminist clinical psy-

chology was largely silent on the issues of intimate violence and the sexual abuse of women and girls. Feminists have called attention to the preva- lence of violence and abuse and to the devastating and protracted psychological consequences that they may have (Koss, 1985; Rush, 1984; Walker, 1979). A core tenet has been that intimate violence and abuse reflect basic themes of masculinity and dominance, and thus cannot be regarded as the aberrant behavior of a few disturbed individuals (Bograd, 1984). Connec- tions have been drawn between sexual abuse and accepted cultural views of male sexuality, male entitlement, and female subordination (Burt, 1980; Herman, 1981; Rush, 1984). Moreover, feminist scholars have shown how presumed experts, such as Freud and Kinsey, failed to recognize (or covered over) evidence of incest, made light of its consequences, and blamed the victims (and sometimes their mothers) rather than the male perpetrators (Lerman, 1986). A recent analysis of clinical literature on incest points out persistent tendencies to deny sexual abuse or minimize its effects, to excuse the perpetrator’s behavior, or to shift blame onto the mother (James 61 MacKinnon, 1990). Moreover, the recent efforts by the psychiatric establishment to introduce the diagnostic category of paraphilic rapism into the DSM demonstrate a continuing attempt to patholog- ize rape; that is, to label it as the aberrant act of an individual who is out of control. The invention of such a diagnostic category serves to deny that rape is instead an extreme instance of coercion aimed at maintaining male dominance and satisfying male sexual desire.

The abuse of women: Naming the problem.

Feminist Therapies

Of the many activities of feminist clinical psychologists, feminist therapy is the most difficult to characterize. Rather than present a false synthesis, we prefer to describe the heterogeneity of philosophies and approaches. Nearly all the major modes of therapy have generated feminist critiques and corresponding revisions. Moreover, feminist therapies draw on a wide range of feminist philosophies and political stances (Gilbert, 1980; Mare- cek & Kravetz, 1977; Sturdivant, 1980). Space is too limited to allow us to discuss this diversity in full; instead, we provide a sample of the ideas about feminist practice that have been put forth during the past 20 years.

The women’s liberation movement of the 1960s and 1970s gave rise to the practice of consciousness-raising, which involved thousands of American women (Kravetz, 1978). Consciousness- raising (CR) is akin to the practice of “speaking bitterness,” which was widely used in Chinese society during the Maoist revolution. In CR, groups of women met regularly for discussions that were focused on con- necting their private troubles to the conditions of society. Discovering that their dissatisfactions were rooted in social injustice in effect helped women

Consciousness-raising.



528 MARECEK A N D HARE-MUSTIN

see that “the personal is political.” Moreover, CR groups, which were leaderless in structure and egalitarian in process, fostered a sense of collective power and responsibility, political solidarity, and sisterhood among members (Kirsh, 1974; Kravetz, Marecek, & Finn, 1983). Some CR groups also engaged in collective political action or community projects.

The vitality of CR attracted many feminist therapists who incorporated CR into their work with clients (Brodsky, 1973; Lerman, 1974). Within therapy, however, the goals of CR shifted from political action to personal change (Kravetz, 1980). Moreover, it was no longer a means of gaining sisterhood and solidarity with a group of women. Nonetheless, as a way of helping individual women relate their difficulties to the social context, CR remains a valuable therapeutic technique.

Sex-role resocialization. Sandra Bem’s work on psychological androgyny had a strong influence on feminist clinicians’ thinking and practice for over a decade (Bem, 1974, 1976). Bem’s account focused on conventional prescriptions for masculinity and femininity, which she viewed as rigidly confining and ultimately dysfunctional. In their stead, she proposed psychological androgyny , which involved “liberation” from gender prescriptions; androgyny was expected to lead to greater flexibility, adaptability, and personal fulfillment. Bem’s choice of the term sex-role self-concepts to refer to masculinity, femininity, and androgyny was unfortunate, as little about so- cietal roles in any strict sense (as opposed to personality traits) was included in their definition. In any case, a number of feminist therapists adopted androgyny as a model of mental health and a goal of therapy. Sex-role resocialization then became a focus of therapy (Kaplan, 1976,1979).

Much has happened to dampen enthusiasm for androgyny theory and for resocialization as a metaphor for therapy. We refer the reader else- where for the trenchant philosophical and theoretical debates that Bem’s work inspired (cf. Morawski, 1990; Spence, 1985). We focus instead on the idea of therapy as sex-role resocialization. One example is assertiveness training (AT), a popular approach to personal change developed by be- haviorally oriented therapists. We do not doubt that AT can teach clients new and useful interpersonal skills, and that it can foster questioning of gender-role norms (e.g., “Why should women have to play dumb?”) as well. However, at the same time as we recognize the value of AT, we also see some problems. One such problem is that many popular publications on assertiveness have presented lack of assertiveness as a “woman’s problem.’’ As Gervasio and Crawford (1989) pointed out, the research does not give evidence of a pervasive gender difference in assertiveness. Thus, the popular literature, like much other popular psychology, exaggerates the difference between women and men (Hare-Mustin & Marecek, 1990). Moreover, by assuming that lack of assertiveness is a deficiency to be remedied, this view accepts the idea that it is women who are deficient (Crawford & Marecek, 1989). The question of whether assertiveness is



feminism and Clinical Psychology 529 always morally or ethically desirable is sidestepped, as is the issue of whether valuing assertiveness reflects an acceptance of male-centered norms. Moreover, by characterizing assertiveness as a set of individual skills, the AT literature deflects attention from contextual influences. The connection between the lack of domestic, economic, or political power and a lack of assertiveness is overlooked.

Feminist psychoanalysis. Orthodox psychoanalysis, with its obvious sex bias, was a ready target of the women’s liberation movement in the 1960s and early 1970s (e.g., Cheder, 1972). Thus, the development of feminist approaches to psychoanalysis within the past decade has taken many by surprise. In the United States, the impetus was the publication of Nancy Chodorow’s The Reproduction of Mothering (1978) .3 Chodorow, a sociologist by training, drew on object relations theory and Marxist social theory in an effort to place psychoanalytic ideas about early family life and feminine personality development in a sociocultural context. Many of the subtleties and intricacies of Chodorow’s thought have not survived translation into the writings of practitioners. Nonetheless, a recurring idea, which has been echoed by other strains of feminist psychoanalytic thought as well, -is that women, owing to experiences during in- fancy, have a richer emotional life, a deeper sense of connection to others, and an identity rooted in relationships. Readings of Chodorow in the clinical literature usually have focused on the positive aspects of women’s “connectedness” or relational self. However, Chodorow emphasized nega- tive aspects of this relationality, such as difficulties in developing a sepa- rate sense of identity.

Inaccurate readings or partial borrowings of Chodorow’s theory have also been used to bolster dubious claims about women and gender difference. These claims may be appealing because they include the ideas that women qua women are better therapists than men, and that all women are endowed with unique capacities for love, care, and empathy. Indeed, some individuals regard such ideas as the cutting edge of feminist therapy. In our view, however, these kinds of claims exaggerate male-female difference and often assume an essential female nature that is unmediated by culture or social circumstances. For us, they come perilously close to reaffirming the “true womanhood’ of the past, and in that way contribute to what Judith Stacey (1983) termed “the new conservative feminism.” Discussions of these issues have been ongoing among feminist scholars across a variety of disciplines (e.g., Alcoff, 1988; Chodorow, 1979; Scott, 1985).

Feminist psychoanalytic approaches have both virtues and dangers in our view. Most important, they represent efforts to disrupt the blatant sexism of orthodox psychoanalysis and to rewrite the account of women’s development in an affirmative, woman-centered way. Moreover, they offer rich possibilities for understanding how gender operates at symbolic levels. Fem- inist literary criticism, film studies, and cultural theory have used these pos-




sibilities to great advantage (e. g., Mulvey, 1975). However, troubling issues remain to be resolved. It seems difficult to avoid mother-blaming, which is so pervasive among orthodox analysts, in therapies that identify early in- fancy as the determinative period of life. In privileging the intrapsychic as the focus of therapy, therapists may fail to give due importance to the political, social, and interpersonal world. In exploring the dynamics and meaning that domestic violence or sexual abuse have for the victim, therapists may inadvertently convey the idea that the victim is to blame.

Feminists have criticized traditional family therapy for promoting a patriarchal family structure and traditional gender relations within the family (Hare-Mustin, 1987). Feminist critiques of family therapy have been put forth in increasingly trenchant ways in the 198Os, and they have gained considerable prominence (e.g., Goodrich, Rampage, Ellman, & Halstead, 1988; McGoldrick, Anderson, & Walsh, 1989; Walters, Carter, Papp, & Silverstein, 1988). Feminists’ insistence on the importance of context, though at odds with mainstream psychology’s focus on the individual, is compatible with the overarching framework of systems theory in family therapy. Indeed, viewing the family as an interrelated system has been the hallmark of family therapy since the 1950s. Moreover, feminists’ accounts of the social construction of gender fit with the constructivist stance that is prevalent within family therapy theory. Indeed, the writings of feminist family theorists offer some excel- lent examples of social constructivism in psychology (e.g., James & Mac- Kinnon, 1990; MacKinnon & Miller, 1987; Taggart, 1985).

Feminist family therapy.

FEMINISM AND THE FUTURE OF CLINICAL PSYCHOLOGY

As we read the record, feminist clinical psychology has been a nexus of tension between feminist insistence on social change and psychology’s focus on the individual. Indeed, the tension seemed so strong to one feminist psychologist that she flatly proclaimed the term feminist therapy an oxy- moron (Tennov, 1975).

Clinical psychology often has perpetuated a discourse of self-contained individualism. Like most other branches of psychology in the modern Western world, it is built on a mechanistic, rationalistic, biological model of humankind. Moreover, in recent decades, the mental health field has been undergoing a sweeping re-medicalization (Smith & Kraft, 1989), prompted by technological innovations (Andreasen, 1984), pressures to cut costs, and the resurgence of conservatism in national politics and public policy. Clinical psychology has not escaped these trends, as can be seen in the recent push for prescription privileges (“Psychology and the Pill,” 1991). All these developments call for renewed feminist activism against the medicalization of social problems and the possible overuse of medication for women.




The assumption that the reproductive dichotomy of women and men is the root cause of gender differences is so powerful that it has co-opted several intellectual currents that were initially unsympathetic to biolo- gism, such as role theory, psychoanalysis, and even some forms of feminism (Connell, 1987). The focus on male-female differences has pushed the question of male dominance and female subordination to the periph- ery. In feminist psychology there has been a renewed effort to place questions of gender and power at the center of inquiry (Goodrich, 1991; Haa- vind, 1984; Kitzinger, 1991). The focus on gender differences also tends to draw attention away from differences among women that arise from their social, cultural, and economic circumstances. The clinical literature has paid scant attention thus far to circumstances that place women at risk of demoralization and victimization - such as recent immigration, poverty, and chronic mental illness (Belle, 1982; Denny, 1986).

CONCLUSION

From the time of Charlotte Perkins Gilman, feminists have offered critiques of the mental health establishment and of treatment for women. Revisiting the history of efforts by feminist clinical psychologists should give us pride in what has been accomplished, but little reason to rest on our laurels. Feminists have produced powerful critiques, a substantial body of research, and a number of models of clinical intervention. None- theless, mainstream psychology has resisted feminist thought, as can be seen by the insufficient attention to gender issues in most textbooks in abnormal and clinical psychology, in standard treatment models, and in many training programs. Moreover, as the radicalism of the 1970s has faded, accounts of psychological problems that delineate the effects of the social and political context have been relegated once again to the periph- ery of the knowledge base and have become irrelevant to conventional individually focused treatment models.

As psychology enters its second century, our hope is that feminist thought can disrupt psychology’s gentle slide toward professional quiet- ism. The history of the future should not be like the past. We hope, too, that feminism retains and sharpens its disruptive edge- its courage to break the silence, its willingness to challenge established ways of doing things and accepted categories of meaning, and its determination to call into question the very questions themselves.

NOTES

1. The membership of the American Psychiatric Association voted to expunge homosexuality from the DSM in 1973. DSM-111, which incorporated this change, was published in 1980.

2. The title is taken from a work by Dorothy Smith (1987). 3 . There are other strains of feminist psychoanalytic theorizing as well. However, Chodor-



532 MARECEK AND HARE-MUSTIN ow’s work has had the strongest impact on psychoanalytically oriented feminist clinical psychology in the United States.

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