Subtitled A History of Women and the Mind Doctors, Appignanesi's book aims to trace the relationship between women's "madness, badness, and sadness" and their treatment by (usually male) professionals from the late 18th century to the present day. The book does a good job of describing the connection early physicians saw between physical and mental ailments — the "moving womb" theory of hysteria, the fits of numbness and paralysis supposedly brought on by a frightening sight or memory. The "mind doctors" of the 18th and 19th centuries were of course wrong about the specifics of these connections (breast milk, for instance, does not travel into the brain and cause insanity), but it's interesting to note that they understood what we sometimes forget — that the mind and body can influence each other, for good and ill.

Unfortunately, this awareness often led to sexism. Appignanesi notes that doctors in the second half of the 19th century believed that problems with the female reproductive system caused "nervous afflictions," and that,

Throughout this period, doctors and scientists seemed determined to raise the existing division of labor in the middle class to a universal given, and to transform women's place in the domestic sphere into a biological inevitability from which deviation of any kind would bring breakdown, not only of the mind but of the species. Women were understood as being fashioned by evolution for the home and maternity, nervously fragile, intellectually inferior. Moving away from that lesser birthright, allowing energies to be drained by intellectual or imaginative exertion would lead to nervous collapse or to that capacious list of symptoms which most often went under the catch-all diagnosis of neurasthenia or its near-neighbour hysteria.

Prejudicial theory was often matched by brutal practice. Pelvic surgery and force-feeding were common treatments, and Appignanesi tells the story of one woman fed so violently in an asylum that all her teeth were broken. Especially gruesome was early 20th-century hospital superintendent Henry Cotton, who believed psychosis was caused by "chronic pus infections" and who "treated" sufferers not only with tooth removal but with surgery on the stomach, tonsils, uterus, and colon.

There's an interesting book to be written about how fads in mental treatment have harmed and helped women's bodies and minds over the past two centuries. Mad, Bad & Sad is not that book. Appignanesi offers overlong and sometimes jumbled case histories in lieu of any real tracking of trends. Instead of a full picture of how culture has shaped women's diagnosis and treatment, we get scattershot portraits of such ailments as hysteria, neurasthenia, eating disorders, and borderline personality disorder without a coherent explanation of what brought each of these conditions to the fore. It's clear that aspects of mental illness are culturally determined — there's a reason why the diagnosis and even the symptoms of hysteria were prevalent in one century, BPD in another, but Appignanesi doesn't really examine what that reason is.

She does say that "therapies [...] can create their own best patients," and she seemed nearly as skeptical of modern SSRIs and cognitive-behavioral therapy as she does of tooth removal and pelvic surgery. Despite her graphic descriptions of blood-vomiting hysterics, she sometimes seems to think that mental illness is largely illusory, something imposed by doctors on women going through normal life phases like adolescence and childbirth. The only therapies she seems to support are journaling, psychoanalysis (with some reservations), and just growing out of your problems.

Appignanesi makes good points at the beginning of her book about the inherent sexism of early psychiatric theories. She might have used these insights to examine how modern-day therapists might transcend gender stereotypes and treatment fads to give their patients the best possible care. Instead, she seems to consider almost all mental health treatments to be forms of insidious social programming. Of course, psychotherapy does tend to reinforce social norms even as it helps patients deal with their very real pain. Whether the two necessarily go hand in hand is an interesting question. It's too bad Appignanesi doesn't make a serious effort to answer it.

Mad, Bad, And Sad: A History Of Women And The Mind Doctors [Amazon]

Called "prolonged exposure" therapy, it requires patients to imagine reliving their most terrifying moments — the rapes, muggings, combat scenarios, or accidents that sent them to therapy in the first place. Long used for OCD, phobias, and anxiety, exposure therapy hasn't been popular for post-traumatic stress disorder because, according to Kamps, "PTSD sufferers may be in extremis, crippled by their fear and sometimes violent." But therapist and anxiety expert Edna Foa says "that people need to viscerally learn that they can withstand what they think they can't." When they repeat their traumatic memories over and over, they can "become, if not bored by them, then at least less distressed."

Kamps quotes Kim McGillivray, who received the therapy to help her deal with dramatic memories of her abusive ex-husband. She tells the story of seeing her ex-husband after a breakthrough in therapy. He was "wearing tiny jogging shorts and tube socks pulled up snug to his knees." McGillivray says,

I had that instant flash of recognition, but in the second flash, I just thought, Dork! I was sitting there in the car, laughing, going, ‘Oh my God. Whatever is happening is working, it's taking root.' I could finally see him as other people did-as just this nerd who didn't have the right athletic equipment-instead of as the monster he was to me. After years of being told I was utterly useless, it's like I've been given another shot. And that I'm able to say all this without weeping-to view things in my past without having to be totally rolled-is testament to the process. I'm back in the human race.

The science seems to back up her experience. A small survey of 127 women who underwent prolonged exposure therapy showed that, at an average of six years post-treatment, 80% had none of the symptoms of PTSD. Other studies have found that the therapy reduces PTSD symptoms by 70%. These findings are particularly encouraging in a field where confirmation of a technique's effectiveness is uncommon — Kamps reports that there is no hard data on how well traditional psychodynamic therapy works.

These concepts — "evidence," the very idea of something "working" — are fraught in the field of psychotherapy. I've had a therapist tell me my goal shouldn't be getting rid of my anxiety, but rather gaining better insight into myself, and I'm sure I'm not alone. And while insight is indeed valuable, patients do have the right to therapy that improve their ability to live their lives. And insofar as this improvement can be measured — obviously, it's not as simple as curing strep throat — it should be.

Kamps talks to psychologist Patricia Resick, who suggests that our relatively safe modern-day lives have given us an "illusion of control" that contributes to PTSD and other mental illnesses. "When something bad happens," Resick says, "people think they must have done something wrong to deserve it." But in reality, there are plenty of things in modern life that we don't control — from our own health to, say, healthcare reform — and people are smart enough to know that. By giving them an evidence-based tool they can use, exposure therapy may give PTSD sufferers a way to control, if not their lives, at least their thoughts. Being able to do this is a big step along the way to being mentally well — and to feeling empowered again after something or someone has taken that power away.

Prolonged Exposure Therapy [Elle]

The study, published in the CSIRO journal Sexual Health examined the reports of sexual satisfaction from 36 couples who had undergone counseling sessions and 35 who had not. They found that premarital counseling raises the number of women who report having a "problem-free" sex life, but lowers the number of men.

Of the women, 81% who attended the sessions said they had a "problem-free sex life" while only 77% of the non-counseled ladies said the same. The disparity is greater for the men: 71% of the men who went with counseling said they had perfect, but 64% who had counseling made that claim. While the study does not offer any possible explanations why men reported better sex without counseling, we have one idea: Maybe they just didn't know. It seems possible that, prior to counseling, some of the men could have been unaware of their partner's dissatisfaction, thus leading them to assume they were problem-free.

Whatever the cause of this disparity, researchers still advise couples to undergo premarital counseling:

"A recommendation to encourage engaged couples to attend premarital sexual counselling is made based on the findings," the research found.

"It is thought that an intervention plan ... will help nurses guide recently-married couples to greater sexual satisfaction."

Men More Likely To Have 'Problem-Free Sex Without Premarital Counseling [News.com.au]

According to Maia Szalavitz, writing for Time:

But according to 10 students, two separate parents, and a current part-time employee interviewed by TIME - some of whom are involved in the state inquiry - Mount Bachelor Academy regularly uses intensely humiliating tactics as treatment. For instance, in required seminars that the school calls Lifesteps, students say staff members of the residential program have instructed girls, some of whom say they have been victims of rape or sexual abuse in the past, to dress in provocative clothing - fishnet stockings, high heels and miniskirts - and perform lap dances for male students, as therapy.

The school, naturally, denies the charges.

Mount Bachelor's executive director, Bitz, says her school uses widely accepted psychological treatments to help children overcome their problems. "We also use a psychodrama treatment approach designed to do one or both of two things," said Bitz in her statement, "get a student to embrace qualities of their character (such as beauty or courage) about which they have doubt, or assist them in recognizing qualities that are unproductive (such as selfishness or conceit) about which they have little insight."

One student described the "psychodrama" treatment.

One 18-year-old former student and victim of rape wept while recounting what happened to her during a Lifestep seminar. Jane, who asked not to be identified with her real name, left the school in March. "They had me dress up as a French maid," she said, describing an outfit that included fishnet stockings and a short skirt. "I had to sit on guys' laps and give them lap dances," while sexually suggestive songs, such as "Milkshake" by Kelis, played at high volume.

"They told me I was dirty and I had to put mud on myself for being raped," she said, in reference to a separate Lifestep session. "They basically blamed me for getting raped."

Unfortunately, slut-shaming for the enjoyment of the male students is hardly a new therapeutic technique at Mount Bachelor.

[Melissa] Maisa attended Mount Bachelor between 1992 and 1994 under largely the same management that runs the school today, and graduated the school with honors. She was sent there in part because of promiscuous behavior as a teen, which Maisa associates with being a victim of child sexual abuse and date rape. "Mount Bachelor made me feel even more dirty and more shameful than either one of those experiences ever did. I just want to make sure the things I suffered through there never happen again," Maisa says.

She describes a Lifestep in which she says she was required to perform an exercise called "the holidays." "I had to stand up in the sluttiest way possible and strut over to every male in the room," including the counselors, Maisa says. She was instructed to sit on the floor before each man, place her left foot on his right knee and say, "This foot is Christmas." She then placed her right foot on his left knee and said, "This foot is New Year's. Do you want to meet me between the holidays?"

Maisa says she performed the holidays more than 250 times. When she failed to show sufficient enthusiasm, Maisa says she and her peers were punished, each having to repeat their own humiliating skit.

The bad treatment plans aren't limited to rape and abuse survivors either. One girl, who turned to drugs and alcohol after the death of her sister, describes what counselors put her through.

According to Ozier and others, in a Lifestep called "Forever Young," students were placed on a mattress and taunted with painful information about their childhood that they had previously revealed, an apparent attempt to trigger regression to infancy. Once more, Ozier was instructed to recall her sister's death against her will. "That was probably the thing that traumatized me the most," she says, describing how she thrashed on the mattress until she vomited. "They prey on people who have already been hurt."

Sounds more like aversion therapy than regression — and certainly it's probably made her rather averse to therapy.

So where the fuck does this kind of "therapy" come from?

Synanon began as a drug rehabilitation program before morphing into a controversial cult and is credited with putting forth the idea that confrontation and boot-camp-style breakdown tactics could cure teen misbehavior and addiction. Synanon's confrontational techniques influenced est and LifeSpring, which began selling weekend seminars designed to prompt emotional breakthroughs in participants.

Food, sleep and access to the outside world - sometimes even to the bathroom - were strictly controlled. Using intense role-playing, humiliation and physical experience, the seminars attempted to liberate people from victimhood by teaching them that they are ultimately responsible for everything that happens to them, including being a victim of child abuse or rape.

Mount Bachelor's Lifesteps appear to share these tactics and philosophy. Several of its top employees formerly worked at a now defunct chain of troubled-teen programs known as CEDU, which was founded by former Synanon members.

I think that's known as "a cult."

As an aside, Szalavitz posts in a related piece on the Huffington Post that Mount Bachelor's parent company — through Aspen Education, owned by U.S. Aspen, owned by CRC Health — is actually Bain Capital. Does that name sound familiar to you? It might, since it's the company founded by former (and possibly future) Presidential candidate Mitt Romney. And while he's been retired from the company since 1998 (before it took over CRC Health), he still receives income from Bain, which it is getting by charging parents to dress their daughters up in slutty costumes to make them accept responsibility for their rapes.

The state of Oregon is reportedly investigating the abuses — but this isn't even the first time they've done so.

In 1998, Mount Bachelor was investigated by the Oregon DHS based on claims by several former employees that students were "subjected to frequent obscenity-laced screaming sessions by staff members; students were deprived of sleep; a group of girls emerged from one group therapy session with bruising on their arms after they were ordered to clasp their hands in front of them and pound a mattress for an extended period," according to the Bend Bulletin. The Oregon DHS cleared the program following the investigation.

Of course they did. Because, after all, it's a bunch of fucked up kids — and mostly girls — making the allegations.

An Oregon School For Troubled Teens Is Under Scrutiny [Time]

Related: Do Lap Dances and Humiliation Treat ADHD— and Should Public Schools Pay? [Huffington Post]
Millionaires-in-Chief [CNN]

[Picture via Buy Costumes]

Yes, "therapy" is something certain ladies do when their sisters have more babies than they do. After getting over her skepticism and seeing a shrink, author Lorna Martin writes, "when my sister reveals another miracle baby is coming, I don't have to feel bad about feeling a little bad." But you don't have to take Martin's word for it — celebs like Halle Berry and Jennifer Aniston are into this therapy thing too! How do you get on the bandwagon? Just ask your friend's therapist for a referral.

Of course, if some of your stress is related to, say, money troubles, and you don't have insurance or can't afford the co-pays, you are SOL — Marie Claire has no advice for you (but Wise Bread has some ideas). Although maybe you could "move to a friend's farm for a year," like Marie Claire writer Justine van der Leun did. Just don't try taking Marie Claire's quiz to see if therapy is right for you — unless one of your big problems is that you "see a pair of Marc Jacobs heels for 75 percent off and keep walking." If that's the case, you should probably ask your friend Jennifer for her shrink's number, you loon.

Seriously, not everyone's problems are cute, and not everyone has the resources of a celebrity at her disposal. For the cash-strapped and struggling, sidebars like "Running into my shrink at the mall" aren't very funny. And a women's magazine running articles on dealing with anxiety is a little bit like when cigarette companies started paying for antismoking ads. Marie Claire isn't nearly as bad as Cosmo (Is your man cheating? Are you infertile? Is your orgasm face ugly?). But it's still chock-full of scary beauty treatments (instead of getting implants, inject goo into your boobs), expensive shit, and ads that say things like "I want a man to get lost in my eyes. NOT in my pores." If you need to relax, start by putting down Marie Claire and picking up something that doesn't make its money convincing you you're not hot enough.

Marie Claire [Official Site]

The class was based on cognitive behavioral principles, and Maran and the other "stressed-out survivors plugged away, and after two months I was stunned to discover that I had less anxiety, and more tools in my psychological repertoire, than talk therapy had yielded in 20 years." She continues to use her "little yellow pills" to help her manage her anxiety in the rough spots, but Maran still can't shake the theory "that the popularity of the behavioral/pharmaceutical cocktail is driven more by what's good for Big Pharma than by what's good for semi-psychos like me."

Anxiety expert Jerilyn Ross listens to Maran's concerns and then tells her:"So what if it's a conspiracy? It works…The psychoanalysts say we're putting Band-Aids on our patient's problems. I say if it stops the bleeding, who cares?" Yeah, I know it's sort of Orwellian with all the mind control but I completely agree. Now where are my pills?

When Panic Attacks! [Salon]
Girl Dies After Cancun Senior Class Trip [CBS News]

Grossman notes:

Writing long has been considered a therapeutic outlet for people facing problems. A 2003 British Psychological Society study of 36 people suggested that writing about emotions could even speed the healing of physical wounds: Researchers found that small wounds healed more quickly in those who wrote about traumatic personal events than in those who wrote about mundane activities. But it's the public nature of blogs that creates the sense of support.

We got an email from a reader yesterday. She claims that Jezebel has been her therapy. "This is what I dreamed of in high school and after, a space of kindred spirits and friends," she wrote. She continued:

My husband cheated, with my best friend, thank you very much. The Jezebel editors AND especially the commenters were there. Giving out advice, support, and snark. In real life, where people where choosing sides and making bland, passive aggressive statements to my plight, the sheer volume of outpouring and sincerity of I got was both heart-warming and bolstering. EVERY SINGLE DAY, there were words of support, so many of the commenters, there are waaaay too many to name. And it helped, more than I can articulate in words. On Monday, I received a hand-written note from my landlord telling me my children and I have to be out by Monday the 12 (end of lease). There's a whole story behind that, but its still the same story. The Jezebelles mobilized into action! People looking up links, offering advice...

Your Blog Can Be Group Therapy [CNN]

[Image by wjmckelvey via Flickr.]

New York Times

Some things sound simply awful: a family reunion holiday cruise, an all-you-can-eat haggis buffet, a television series set entirely in a psychotherapist's office. In Treatment, however, is hypnotic, mostly because it withholds information as intelligently as it reveals it. Each night a new half-hour episode follows a different patient's session. In every session the patients' words are veined with allusions and elusions, clues to problems or patterns that are invisible to them but absorbing for the viewer.

The series aims for a rawness that depicts the troubled aspects of people in crisis written with intelligence and deft emotional shading. Where In Treatment actually ends up, however, is quite different. The writing is forced and thin, some of the acting stagey, most of the characters unlikable and - the show-killer quality that HBO execs apparently failed to see - profoundly boring... At its worst, In Treatment feels like an Oprah show without the commercials.

It all makes for lots of great soapy intrigue, and Byrne makes you believe he can solve everyone's problems. Except his own.

In Treatment's intensity does build as the weeks progress, but it's never completely absorbing, and you wonder how many viewers will commit to such a demanding regimen even with multiple plays to catch up on missed half-hours..."Don't assume that everybody who comes to see me is miserable," Paul protests at one point. But they are, as well as a bit too nutty to make HBO's latest merit a regular appointment.

At times the construct of two or three people sitting in a room talking for half an hour becomes stagey, and the level of antagonism each patient aims at Paul in almost every episode strains not only believability (surely grown-ups would not waste their money talking about their therapist's failings when they could be talking about themselves) but also the dramatic pitch.

It's hard to imagine anyone sitting through this show in anything close to its entirety outside of Byrne's immediate family, and even some of them would lie about it...Unfortunately, even at its sporadic best, In Treatment comes across as no more than an actor's exercise, one likely to be best remembered for providing future acting students with a large supply of two-character scenes for class projects.

Truth be told, it's a little addictive to hear these deeply intimate secrets revealed. And as the patients tell their stories - or edit their emotional lives to make them appear a certain way - Byrne is asked to do a lot of reacting, which he makes endlessly interesting. He does an impressive job of appearing to be the impassive therapist while indicating Paul's complicated inner life. It's worth seeing the program just for his nuanced, truthful performance, but the other actors are generally quite strong. Wasikowska, in particular, is quite a find.

The series may prove irresistible to a viewer in its fullness. In Treatment has the allure of smart drama spiked with juicy eavesdropping. And as further reward for the devoted viewer, the seemingly distinct daily narratives begin to seep from one to another — collecting in Weston's agitated psyche, where the real story resides.

Four Days, A Therapist; Fifth Day, A Patient [New York Times]
HBO's 'In Treatment' Painfully Boring [San Francisco Chronicle]
In Treatment [Entertainment Weekly]
In Treatment [Variety]
In Treatment [Los Angeles Times]
'In Treatment' Has Some Issues [USA Today]
'In Treatment' 5 Nights A Week? Here's Why That May Not Be A Bad Idea [Chicago Tribune]
HBO Drama Has Interesting Format [Houston Chronicle]

Do women's body-image issues tend to rub off on their daughters? We hope not, because Victoria and David Beckham — parents to three boys — are reportedly on special diets to help them conceive a baby girl. [Babble]

Something to send onto Mom and Grandma: Aspirin in small amounts may provide a lowering the risk of death among older women. [CNN]

More and more female athletes are suffering torn ACLs and no one really knows why. [CNN]

More proof we may have wasted thousands of dollars on therapy. Sigh. [WSJ]