‘Into the sunlight’: gender, narrative, (mental) health. Resources for a missing conversation.

This paper was originally written during 2004 and 2005. A shorter version was presented at the BSA (British Sociological Association) Auto/Biography Study Group Conference (2005), Lives and Times and Auto/Biography. London: Institute of Education. A lot has happened in the intervening years (now September 2009): some would point to progress; others to delay and resistance to change; or worse. There are still horror stories a plenty. However, the paper has not been updated, except for the addition of three references: Keane, 2006; Walsh, 2007; Johnson, 2008.

  • Gender, health and the status quo
  • Some structural features.
  • The dilemma of the professional therapist.
  • Anger and its uses. Aggression and its violations.
  • Life history process: memory, narrative, agency.
  • Women’s peer group process.
  • In conclusion.
  • References.
  • Footnotes
    The paper is hybrid in its materials, which include personal testimony, experiential evidence, journalism, feminist analysis, and   ‘fictional’narrative.  These are not seen as discrete categories: not labels, but narrative resources.  Similarly, academics, policy-makers, serviceproviders, service users and carers in the broad remedial and therapeutic field are not discrete and ‘pure’ identities, and this also counters stereotypes of the ‘mad / bad / evil’ Other, i.e.‘not me’.1  Trauma and recovery narratives make important contributions to a politics of health perspective which bears witness to and illuminates the role of gender and gender differentials in lives, and in the field of remedial and therapeutic practice. A politics of health perspective identifies gendered stereotypes of trauma, damage and the therapeutic in academic and media practices, as both evidence (hitherto ignored), and obstacle to health and well being.

Gender, health and the status quo.
The complex of equality and social justice issues combine to shape professional practice, service delivery, social experience, and experience as service users.2  This recognition sets the scene for recording the complexity and importance of experiential evidence; the transformational function of life narratives, peer group process,3 and alliance.  After over thirty years of various equality initiatives (activist, political and policy-driven), we can see how people’s experiential and organisational strategies in combination, ‘not all these little legislative steps that hardly add up’ (Shields, 2003: 251), contribute to optimal (i.e. effective and ethical) functioning, on the part of practitioners / service users, in our joint efforts towards health and well-being; dignity and social efficacy.4  These are profound journeys towards meaning; as well as efforts to change society and (find / make) our place within it.  As Professor John Ashton declared:  ‘I regard all public health as about mental health’.5   Good mental health may by extension be seen as a mark of a decent (just?) and sustainable society, rather than an individual accomplishment, personal virtue, or commodity.

Since the 1970s, the politics of health, and the politics of self, community and society, have been understood sociologically and by equality activists (including academics), such as anti-racists / feminists / disability rights campaigners and Age Concern, as about power differentials, disadvantage, stigma and abuse, for example.  Stereotypes prepare the ground for stigma, which functions as a powerful tool for hierarchical, social organisation, and the engineering of conformity and compliance.  For example, the stigma of social class, disability, old age, ‘ugliness’, mental illness, learning problems, ‘unmanliness’, impairment generally, requires and produces simplicity: instant recognition / fear / repulsion.  By attaching to the body, of victim and offender alike, stigma organises a hierarchy of rejection and acceptance, shame and virtue, (and in UK New Labour terminology: exclusion and inclusion).  In a society dominated by images of the élite, designer body, (affluent, fast, successful, workaholic, ‘perfected’, ‘beautiful’), the powerlessness which attaches to marginality, poverty and damage, is itself a social stigma, and produces shame, which further reinforces disadvantage and vulnerability.

In a society and economy which steer us relentlessly towards ‘rugged individualism’ and ‘pathological narcissism’ (hooks, 2000: 81), western media imagery and reporting play an overly influential part in the construction of an aesthetic which serves economic, social and political ends.  The now pre-eminent western binary of beautiful (sexy) / ‘ugly’ (unsexy) seeps into everything as part of the process / price of commodification and marketing, be it of food, furniture, technology, bodies, identities, exercise.  In this scenario, there appears to be no honourable escape, for not to be visibly participating in the process of self-marketisation is to risk social contempt, as at the very least ‘old-fashioned’ (perhaps the most serious modern cultural ‘failure’, as it implies an element of ‘faulty choice’ / bad taste); or ineligibility (no choice here, simply the stigma of not being suitably equipped, e.g. wrong body, insufficient financial resources).  To be identified as without social or market value / status is to be deemed unsexy.

There are evident costs as well as consequences which flow from the unremitting (hetero)sexualization of society and culture, which penetrates and works to manage both individual self-esteem, and our relations with each other.6  While society and its institutions are now variously prepared to admit and tackle prejudice, stereotypes and disadvantage rooted in ageism, homophobia, racism and fear of disability, gender as a system of disadvantage and damage has never fully been accorded social and political acknowledgement as the problem, affecting everyone, beyond the liberal idea of ‘equality’: whether of women being seen as  ‘different but equal’ (the Equal Opportunities Commission slogan), or about women wanting to be like men, to do things the way men do things, and therefore no longer be regarded as second-class or subordinate.  Many women and men now see women as in no further need of ‘equality’: we have it all.7

“But we’ve come so far; that’s the thinking.  So far compared with fifty or a hundred  years ago.  Well, no, we’ve arrived at the new millennium and we haven’t ‘arrived’ at all.  We’ve been sent over to the side pocket of the snooker table and made to disappear” (Shields, 2003: 99).

Like any poison, the gender system is all the more serious when glossed over or denied.  Toxic levels build up to unmanageable proportions; any solution seems over-ambitious; the will to change, improve, recover (designated ‘unsexy’ and old-hat), ebbs away.  The galloping demand for therapeutic services and medication signal crisis (see Meikle, 2004).  Evidence of gender (heterosexism, homophobia, misogyny) as a powerful, distorting agency within the therapeutic field itself is therefore a matter for critical scrutiny.

Some structural features.
Therapy and the therapeutic are established ‘outsiders’ and ‘other’ to the academic community: on the inside mainly as subject-matter for scrutiny, research, judgement.  It is an established power relation into which sections of the modern media machine in the west have entered, lending their propensity for sensationalism, exploitation and the inculcation of fear and loathing, in the search for a ‘good story’.8   Despite this, the field of therapeutic practices has expanded exponentially since the 1960s, and the boundary between ‘mainstream’ and ‘alternative’ is now blurred by increasingly hybrid practices.9  This could be described as a ‘supermarket’ approach to self-maintenance and recovery: individuals pick and choose their preferred ‘product’ / service.  It could also be taken as evidence of a deepening recognition of   health and well-being as holistic projects of self and society, which reconceive and join education, therapy and politics, with personal and social creativity.  Women appear to be at the centre of this expansion and hybridisation, both as practitioners and as service users.  Latterly, celebrity men have come out openly as service users.10

The first key difference is between women.  Women-only self-help groups and networks have been important features of women’s consciousness-raising, self-organization and feminist politics since the 1970s.  Lived, but previously privatised (and ‘shameful’), experience is ignited by peer group process, for example on a domestic violence and abuse programme, a local self esteem or assertiveness course.  These groups are informal, experiential, and therefore risk being seen as ‘amateur’ (and these attributes render them clearly feminised zones), even when offered as part of a college curriculum in the community (such as PACE – Personal and Community Effectiveness – which brings together home-based parents and carers, and both the unemployed and employed).

Many women in the UK find themselves positioned outside formal educational and political practices, but in at the deep end in situations and relationships damaging to health and self-esteem, whether on the domestic front or in paid employment.11  These women can lay the basis for an understanding of the politics of health and the politics of identity, via the experiential, self-help, peer group route.  Nonetheless, they may remain encumbered by dependents, such as children and/or domestic partners, who exert control and power over the trajectory of their lives, time and concentration.12  Although women of different classes avail themselves of these community-based opportunities, the class and gender connotations of this split in access to ‘knowledge which saves lives’13 are resonant, perhaps reinforced by the fact that trauma, damage and the therapeutic signify inferiority, irrationality, lack of control (the feminine), to an academy which historically enshrines Reason, rationality, control (élite masculinity).

The ‘touchy-feely’ identity of the self-help group stands in sharp contrast to the ‘rigour’ associated with conventional academic and political peer groups (seen as zones of professionalism / élite masculinity).  Being onsite (university campus) or offsite (community centre) is more than a geographical designation, with lingering class and gender connotations.  Middle class women may feel they are entering a working-class space, and are in a minority.  Some will leave, unable to cope with associating with women disadvantaged by social class, lack of education and poverty.  Others will stay, learn and be changed by the experience.

Black women may also stay away, not only from what are perceived as white / white-dominated social spaces, but if they still ‘reject the idea that any “therapy” – be it self-help program or a professional therapeutic setting – could be the location for political praxis’ (hooks, 1993: 15).  As much as anything, this is about distrust of ‘mainstream psychoanalytical practices (which) do not consider “race” an important issue’ (ibid).  As hooks points out, it has been the celebrated fiction of black women writers which has identified the issues for black women, and provided not just black women with ‘imaginatively constructed maps for healing’ (ibid: 11).

Academic disdain and media contempt damn the self-help and therapy route as evidence of ‘failed subjectivity’, as proof of deficit as a person, and as a mark of hysteria and personal desperation.  This writes off the women as ‘ignorant’, and as gullible suckers, rather than knowledgeable, determined and courageous Subjects, in search of ways of learning from, dealing with, and moving on from loss, abuse, oppression, damage.  Identifying as victim has been an historically important first step towards political strategy and organization (e.g. trade unions, the labour movement, black American civil rights, women’s movements, environmental groups).  Labelling women’s personal initiatives for survival and recovery as ‘therapeutic’ / ‘crackpot’, turning us all into ‘patients’ needing treatment, deliberately denies (while perhaps being nervous about) the political import of these journeys, both for women themselves and for society.  It’s meant to put us off our stride.

Most of these groups are open to men as well as women, and become women-only environments because men stay away.  Men of any class may want to avoid the stigma and embarrassment of being the only man in a mixed self-help group on, for example, self-esteem or anger management.   So while gay men have demonstrated their networking, friendship, and self-help skills in maintaining mental health and keeping each other alive (notably since the advent of AIDS),14 heterosexual men too often appear to prefer public bonding around stereotypically masculine pursuits (sport, drinking, cars, women’s bodies, computer games, workplace agendas), rather than peer groups which take as their starting-point the critical challenges of modern masculinities.

Another feature of the differential position of women and men within these discourses is that women are more readily identified as ‘victims’ (done to), men as ‘offenders’ (acting on).  Peer group process across this binary divide is therefore unlikely: victims and offenders mix with difficulty, even danger.  And for a male offender, a self-help group may not only signal admission of offending behaviour, but a loss of power by association with that feminised space.  To be a victim is worse than being an offender: it is bottom of the pile.  The offender, after all, is seen as having power to exercise.15 And male offenders are glamourised.  They are the stuff of novels, soaps and films; and high-profile court cases.  They become film stars and national leaders.

This ‘segregation’ signals another gender difference.  Whereas women’s experience as victims drives many to seek out self-help groups, men’s involvement in therapeutic groups is more likely to be as a result of being referred, whether inside prison or within the community.  The offending behaviour (whether domestic violence or criminal activity) makes them a target for remedial treatment imposed by social services or prison authorities.16  Generally, therefore, these offenders are not early, willing or conscious volunteers in their own rehabilitation and development.  This may be a significant difference, in terms of what can be achieved.

On the other hand, women in self-help groups are looking deep into selves, lives, and at society.  Such women have decided, in the face of intense, even brutal opposition, hostility and abuse, not to give up on themselves.  In her book on black women and self-recovery, bell hooks speaks to all women; and all the injured, insecure, and ill-at-ease in society:

‘Living as we do in a white-supremacist capitalist patriarchal context that can best exploit us when we lack a firm grounding in self and identity (knowledge of who we are and where we have come from), choosing ‘wellness’ is an act of political resistance” (hooks, 1993: 14).  Emphasis added.

Yet another gender difference is how women’s and men’s trauma and recovery is identified  academically, in the media, and institutionally.  Women’s journeys are more likely to be viewed as proof of instability, inferiority, an inability to cope with life’s complexities.  A woman’s recovery narrative may actually serve to confirm the idea of inadequacy, and undermine power, influence and opportunities in the public domain (with a little help from the media if she is in the public eye).  By contrast, while the pressure on men to perform in a manly fashion makes it more difficult for them to admit to vulnerability, dis-ease, any sense of failing in their masculinity, when élite or celebrity men (usually white) tell their recovery stories, this can now produce a ‘revised (new) manliness’, a new ‘heroism’.  Their accounts and their lives circulate within the existing gendered political economy as both exceptional and virtuous (even if baffling).  These men may even be, consciously or not, ‘hetero-patriarchal whistleblowers’: men ‘recovering from’, in remission from, and even angry about, normative heterosexual masculinity and its injuries.17

The conjunction of class, race and gender is then, an influential and instrumental factor for service-users in a number of ways: in terms of access, and point of contact (early / delayed / late / avoided / as a voluntary commitment or as referral); how involvement is publicly interpreted; how women and men feel about their involvement and experience, in view of these demarcations and stereotypes; why they embark on therapeutic journeys, and the desired outcomes.  We know, for example, that many male offenders look to this work as a way of ‘improving’ and returning to a former heterosexual relationship, in order to ‘do it better’.  For women, on the other hand, therapeutic and other self-development work (including, of course, higher education) is more usually about getting or staying out of an abusive relationship, not going back for more.  These moves into self-protection, therapeutics and self-development may also be seen as the ‘personal’ initiatives of women failed by society’s institutions: for example, left unprotected and exposed to heterosexual male violence (whether in the home, on the street, or in the war zone).  The consequences of not managing to take these steps into the public domain, into the self-help peer group, can be catastrophic, even terminal.

Teresa was not just a victim of violence at the hands of her husband: she was also a victim of the state’s failure to prevent and punish that violence.  She was denied her constitutional right to equal protection under the law because she was a woman, a victim of family violence, and a member of an ethnic minority (Campbell, 2004a: 18).

The dilemma of the professional therapist.
“No-one has a clue what prevention is or might be” (Ashton, 10.02.04).

This is not a judgemental statement nor shameful admission: rather an honest recognition of the complexity of mental health and its disorders.   Clues and ideas abound, but to register and understand them, professionals and politicians must listen attentively to the experiential evidence of people’s lives, rather than determinedly continuing down the twin routes of medicalisation and criminalisation.   This is an issue of authority, power and hierarchy, for example in the therapeutic encounter.   Hanging on to traditional notions of ‘expert’ v. ‘patient’, ‘professional’ v. ‘deviant’, ‘well’ v.‘ill’, may be seen as territorial and defensive behaviour on the part of those in authority, faced with pressure from service users to be better represented within mental health structures and processes: i.e. at least to be seen and heard.  In his response to Frank Furedi’s book, Therapy Culture: Cultivating Vulnerability in an Uncertain Age, Harry Ferguson challenges Ferudi’s argument that:

“All social practices that exist to help people are actually doing the opposite.  They make people dependent and diminish their expectations by making them define themselves as unable to cope.”

There are undoubtedly practitioners who work in this way: intrusively manipulating vulnerability; perpetuating their client group; and protecting their own professional identity and authority.  But within the broad and diverse field of therapeutic practice, there are practitioners working in partnership with clients and/or group members.   Crucial to the difference between these two kinds of practitioners, will be whether they demonstrate equality awareness and commitment to social justice in these areas, in both their personal lives, and in their professional practice.

It is pre-eminently women’s autobiographical testimony, feminist activism, research and theory since the 1970s, which have articulated the core significance of sexual politics and gender power relations for professional practice as well as individual lives.  Issues of authority, dominance, control and abuse have been further illuminated by anti-racist activists and post-colonial theorists, as well as therapists such as Dorothy Rowe.18  It is clear that a person’s own biography and identity inform professional performance and role in ways which can be significant for outcomes: and no more so than in face-to-face work with (vulnerable) people, such as education, social work, healthcare, therapeutic practices.  Given the levels of prejudice and abuse becoming visible in our institutions (residential homes, the Catholic Church, psychiatric wards, prisons, for example), as a society we have clearly not yet achieved a sufficient level of social and self-awareness, care and protection for when we are most vulnerable (and lack authority), and when we are most powerful (and exert authority).

The liminality now inherent in such personal / professional encounters puts pressure on professional conduct, rooting and redefining it in terms of ethics and politics, rather than ‘neutral’ notions of authority, expertise and respect.   This invites (requires?) professional practitioners to ask themselves to what extent they have listened to and been changed by the lives, voices and narratives of the previously silent majority of non-élites and ‘marginals’, including of course, service users.   To what extent are service providers part of these social changes, or standing back, defending territory?   Have they undertaken a critical, self-reflexive journey into their own biography and identity (including fears, prejudices, hurt, social positioning), in order to understand how these might equip or dis-enable them in relation to their professional role?   I will illustrate the relevance of these issues with three examples.

A psychiatrist speaking at a mental health conference with a mixed audience of carers, service users, services providers and others,19 described a case-study involving one of his female patients.   When asked how old she was, he replied, ‘Twenty-four’.   ‘A woman then’, I said.  It was unclear whether he had heard me properly, as he continued by telling us that she had been self-harming since she was fourteen.  I said that at twenty-four, she was now a woman.  ‘Oh, did I say “girl”?’ he asked quickly, smiling.  I explained to him later, that I thought it impossible for anyone to accompany a young woman on a therapeutic journey, if that person, the figure of authority (and in this case, an older man, a ‘father figure’) thought of the young woman as ‘girl’.  This would be a parent / child scenario and distinctly unhelpful.  This was unfamiliar territory for him.

A consultant psychotherapist, responsible for setting up an innovative, mixed residential treatment centre, ‘run on democratic lines’, was asked to say something about how this community worked, given that familial and heterosexual power relations are key factors in abuse and damage.  How could a mixed therapeutic environment work, for the women in particular?   While he said it was a very good question, he was not willing to address it himself, and asked the two residents who accompanied him for this occasion to speak of their own experience.  When pressed, he made ‘excuses’ (smiling all the time) about the fact that he predated ‘political correctness’. . . . at which my internal alarm bells went off.   His use of the term ‘political correctness’ identified his resistance to taking gender issues seriously, either as a man or as a psychotherapist.  Audience members who came up to speak to me later, understood my question and were equally dissatisfied with his reaction.  They were all women.

For (male) journalists too, the idea can simply not occur, that gender is a significant factor when discussing mental health issues.  In an otherwise sensitive article about sportsmen and mental health, immediately following the suicide of cyclist Marco Pantani, journalist Paul Weaver consults an ‘expert’, an academic, Dr. John Kremer from the School of Psychology at the Queens University of Belfast, who ‘attempted to shed light on the subject’ (Weaver, 2004).  Kremer mentions three factors: the link between physical fitness and psychological well-being, and therefore the problem of consequent unfitness in retirement; the problem of coming off steroids; and the lack of forward planning by sportsmen before retirement.  Such a ‘rational’, tick-box list, which identifies each casualty as an individual (and there are many), who just slipped up in the management of his life.  No mention of (élite) masculinity as a factor in the onset of depression, after a career as a high-performing, élite male body (see Sparkes, 1996;1997), where ‘real life is put on hold’ (Weaver, ibid.).   We also get no sense that these men (the male suicides of sport and the academic ‘expert’) have anything in common.

This academic distancing is shocking, not least from someone working in a city which has provided gruelling evidence of normative masculinity as punishing, as a war footing: entrenched masculinities pursued relentlessly via disciplinary control and violence (mainly men on men).  The Ardoyne in Northern Ireland suffered thirteen suicides of young men in the two month period after Christmas 2003.  Some of these young men had been the subject of paramilitary persecution and terrorizing, with subsequent consequences for mental health, prior to suicide (C4 News, 24.02.04).

Anger and its uses.  Aggression and its violations.
“The last thing I want is to be possessed by a sense of injury so exquisitely refined that I register outrage on a daily basis.  Anger is not humanizing.  . . . Probably you will dismiss this as a crank letter from one of those women who go around begging to be offended, but you must understand that I am trying to protect Norah, and her two younger sisters, Christine and Natalie, who want only to be allowed to be fully human.  And you should know, as I set down these words, that I am shaking like a tree of nerves” (Shields, 2003: 221).20

‘If I die, I want you to tell the world what happened to me.  I don’t want other women to suffer as I have suffered.  I want them to be listened to.’  The police in Sonoma County, California did not listen to Maria Teresa Macias.  Her husband killed her on 15 April 1996 (Campbell, 2004: 4).21

Gender attaches to anger in this society.  Girls used to be brought up with an understanding that anger made them ‘ugly’, i.e. unfeminine, unladylike.  (Or was that just white, middle class girls?)  Girls were not expected to express dissatisfaction with their lot.  Boys’ anger was taken-for-granted as boys just being boys, preparing for some kind of dominance or leadership.  Recently, some girls and women have adopted aggressive behaviours, perhaps to demonstrate ‘independence’, to copy or compete with men.  And faced with rapid social change in heterosexual relations, some men are silently bottling up anger.  Anger which remains inchoate and unexamined, produces erratic, dominant and controlling behaviour: the aggression which turns men into abusers / offenders / prisoners.  Whereas angry women are more likely to see themselves as in disarray and despair: as victims.  This is not a fixed scenario:  Fathers4Justice in the UK present themselves as both victims and as lawless aggressors in pursuit of their cause.  Bob Geldorf is a good example of this emotive combination: (celebrity) victim identity fuelled by aggressive, misogynist rhetoric and anti-feminist demands and tactics.  Anger management programmes, using Cognitive Behaviour Therapy, propose ways out of all this dysfunction and destructive behaviour.22  But there are different versions to be had.

In the prison Zoe Williams visited, for her article on the use of anger management work with male prisoners, she found an emphasis on ‘distorted thoughts’ (ibid: 32), which needed ‘rationalising’ (ibid: 36).  This model of self-control almost implies that male prisoners should be discouraged from feeling at all: any feeling could get them into trouble.  There is no mention of key factors in men’s violence:  the burden of normative heterosexual masculinity, the injuries of social class and racism; and that men’s heterosexual masculinity may be rooted in fear of failure to perform appropriately.  There seems little awareness that under pressure to be ‘successfully masculine’, heterosexual men frequently find it difficult to cope with, talk about, and express feelings without being controlling.  Communication skills are limited.   Intimacy is threatening.  Yet these prisoners were being encouraged to give up their usual means of control: ‘You can’t control someone with assertiveness’ (Williams, ibid: 38).

Williams describes the methodology and theory behind CBT as ‘essentially practical- . . . not about delving into anyone’s childhood, . . . or anything else typically associated with talking cures’ (2003: 32).   She refers to Noam Chomsky’s reservations in 1977, about behaviourist therapy providing ‘a palatable ideology for the application of techniques of coercion’.  This implies that CBT ‘teaches people to operate in society without causing trouble and, . . . . teaches them not to strive for fairness, or justice. . . .’ (ibid).  These were serious accusations, but more recent evidence has shown that the CBT cycle of change is not in itself mechanistic  or depoliticizing.

One of the key components of the CBT cycle of change is the importance of thought as a means of identifying experiences, as, for example: hostile or friendly, abusive or supportive, risky or safe, predatory or loving, controlling or nurturing, personal or general.  Within the CBT cycle, thought is seen as having consequences: feelings about what we have identified, how we have understood a situation or action.  This in turn generates behaviour.  So the CBT cycle can be understood as about thought as central to feeling, and not in binary opposition to it.  Thought as part of a creative cycle of awareness and behaviour.   And working-class men who grow up seeing thought and language as the prerogative of élite white men, or (now) educated women, are painfully disadvantaged within this problematic.  Language and speech are not the province of those young men heading into the underclass of the uneducated, untrained, unqualified, unemployed, unemployable, undesirable, whose numbers are increasing, and who fill our prisons.  And men schooled in rationality as masculinity, as emotional control, are likely to view feelings as ‘feminine’, disruptive, and as obstacles to be ‘tamed’.

More than thirty years after Chomsky’s comments, CBT has entered ‘alternative’ therapies and a range of self-help programmes, which are about activation not passification; agency and empowerment not conformity.  The best of these programmes count as equality work, which draws attention to coercion and conformity as undermining, even damaging.  I suggest there are three key factors which have brought about this change since the 1970s.

The first is feminist activism, research and theory / gender awareness / equality discourse and practice.  Women working with women (and men) have seen the potential of gender-aware CBT for domestic violence and abuse programmes, courses in self-esteem, assertiveness, and anger management, for example.  Because of its emphasis on critical self-reflexivity and peer process, with the right facilitator this work enables group members to take risks and develop their own tools for change. It places learning, responsibility and innovation in the hands of individuals within a supportive peer group context.

The rise to prominence of peer group process is the second key factor.  Peer groups displace the conventional leader and led formation, whatever the context: social, business, educational, therapeutic, campaigning.  The structure of authority in the group is dispersed and shared (see footnote 3).

The third key factor is the increasing understanding of and importance attached to ‘Energy’ (Ki / Qi) and spirituality in the west (the mind / body / spirit connection), drawing on holistic Eastern traditions, such as TCM (Traditional Chinese Medicine).  The programmes mentioned above may be offered in the context of other work, such as meditation and bodywork, as well as the possibility of one-to-one counselling.  Practioners working in these local contexts, for example a community centre or a healthy living centre, include those employed directly by formal educational institutions.  But they are likely to have more varied life experience and very different personal and professional profiles from those responsible for inhouse assertiveness training or anger management provided as part of a business environment (aimed at career salvage or advancement); or within a prison regime (working with ‘offenders’ in a bid to keep them out of prison).  This difference may be even more marked if staff are ex-army (as many prison officers are).   By contrast, increasing numbers of self-help programme facilitators / service providers / therapists, are now women who have themselves ‘graduated’ from victim to survivor to professional practitioner.23

As more heterosexual men find themselves living lives which resemble women’s (multi-tasking across the public / private divide, putting in longer hours, responding to contingency, living with less clearly defined boundaries, being required to cope routinely with ambiguity, uncertainty and complexity), many are running for cover: abandoning partners and families, for the apparent simplicity of life as an unattached male (with discretionary access to younger women).24  Many (older?) heterosexual men are angry at their (new) lot as men.  Upbringing and education have not prepared them for this hard work, now that ‘wife’ no longer means full-time, home-based ‘carer’ and all-purpose back-up.  Faced with unanticipated personal and social complexity, many lack courage and motivation.  And in these circumstances, perhaps heterosexual men fear the exposure of sharing and learning in peer groups.

The ‘certainties’ of manhood, such as they were, have gone (see Beynon, 2002).  Emotional literacy and communication skills are underdeveloped and under strain, yet more in demand by both women and organisations.  Unsupported and bewildered, feeling abandoned and angry, men may turn to recreational sex, drugs, alcohol, rock ’n’ roll. . . . and too often, violence and murder.  The testimony of one celebrity perpetrator whose behaviour landed him in prison on more than one occasion, captures the sense of out-of-control desperation:

“I had to tell myself that I didn’t have to enrol in the same programme for the next forty years, with the same things dragging me down – the resentments, the unadulterated anger, the mother-fucking rage.  I allowed myself to let go of that shit and it means that I’m no longer a miserable prick” (Downey, cited in Wilde, ibid: 6)

Far from being something incidental:  ‘Anger is a defining interest – your future is defined by revenge strategies . . . . ‘ (Williams, ibid: 39).  Williams conflates anger and aggression, perhaps because her subject here is male prisoners.  (See footnote 22.)  And victims of revenge are mainly women: for example, women whose autonomous actions (whether in choosing a disallowed sexual partner, or in attempting to escape domestic violence and abuse) are seen as a threat to heterosexual male power (see Addley, 2003; Butalia, 2003; Campbell, 2004), and are killed in the name of ‘honour’ or possession; or women in heterosexual relationships who decide that silent servicing is not a life as such, more a sentence, and that education, paid employment, their own income, and time for themselves, are not beyond the bounds of possibility or desire. They may even be prerequisites for mental health and well-being. . .

Working with male prisoners on anger management in a way which does not address issues of heterosexual masculinity, misogyny, racism and homophobia, would seem to be working at a dangerously superficial level, which will not in the long run produce greater safety or satisfaction for the men themselves, their partners and families, or society at large.  The problem of men’s violence towards other men, towards women and children, and towards society, cannot be covered by a set of institutional tick-boxes / government targets.  What counts is the context in which you explore your cycle of change, and why, and here again we see sharp gender differences.  At the moment, CBT for men / male offenders constitutes an intervention.  For (mainly) women in self-help groups, it is an initiative, even an ambitious adventure.

Does it have to be polarised in this way?  Suddenly faced with the trauma of degenerative disease while still a young man, Michael J. Fox eventually took the initiative, and found himself also having to face up to his identity as a man, and his lifestyle as a male celebrity.  He entitled his compelling memoir of this gruelling and continuing journey, Lucky Man.

“I didn’t suddenly burst out of a cocoon of fear. Neither was it a linear progression, an easily followed map of self-discovery. As Joyce [his counsellor] might say, it all came down to showing up for my life – and doing the work” (Fox, 2002: 218).

We should not underestimate how much courage it takes to develop reflexive critical auto/biographical consciousness and responsibility as a man in this society (see Fox, 2002; Jackson, 1990; 2004; Parsons, 1999; 2003).  It may even be more difficult (to get started) if you are not a known abuser, but just a guy overwhelmed by the challenges presented by un/employment and relationships, and struggling (consciously or otherwise) with contemporary, gendered realities in relative social isolation.  Recently, young men (in prison and at home) have been turning on themselves, giving up before they have hardly started, living is so difficult.  To avoid such casualties, as well as the toll on women’s and children’s lives, the supportive care and educational work on contemporary masculinities needs to start with boys as early as possible (see Doyal 2001).

Helping men move away from dependence on controlling behaviour and violence, and/or from falling into self-pity and depression, is a complex, long-term project, probably as complex and long-term as women’s feminist journeys away from deference, self-hatred, fear, internalised shame.  Within the constraints of a prison environment, a start may be made, but follow-up, transitional spaces and opportunities are essential if men are to properly support each other in their transformations and healing.

Life history process: memory, narrative, agency.
“But there is something more, a story from long ago that I will tell you face to face, father to son, when you are older.  It’s a very personal story but it’s part of the picture.  It has to do with the long lines of blood and family, about our lives and how we can get lost in them and, if we’re lucky, find our way out again into the sunlight” (Keane, (1996: 37).  Emphasis added.

We now know, because journalist Fergal Keene has since shared his recovery narrative, that he was alluding here to his own struggles with alcoholism, in the aftermath of his disrupted relationship with his alcoholic father, the actor Éamonn Keane (see Keane, 2006). The evidence of those who have made journeys from abuse and shame, addiction and despair, or lived in their shadow, suggests that we do have to go back as far as is necessary, and that the process cannot be undertaken only ‘in the present’ (a quick massage, the ‘right’ medication).

White American actor Robert Downey Jr. provides an example of one man’s journey from ‘pharmaceutically-fuelled, headline-grabbing mayhem’ (Wilde, 14.11.03), from addictive self-harm and aggression, to healing process and recovery mode – a return to both domestic commitment and creative / professional responsibility.  His testimony points to the deep roots of addictive and self-destructive behaviour.  He grew up in apparent privilege, but asked when his problems started, he says: ‘You’d have to go way, way back’ (ibid).   His pharmaceutical experimentation started before his teens, with ‘the active encouragement of his film producer father, Robert Downey Sr.’. And he is, after all, Robert Downey Jr..  To be  Jr. to a Sr. for most of your adult life must carry intrinsic disadvantages: always in the shadow of the father.  Downey’s recovery exemplifies a whole person process over time, carried out in the supportive company of others, be they specialists (therapists), peers or intimates.

‘That’s not to say that I’m in the clear yet. I might be shifting out of it, but I’m still the same guy that did all that crap’ (cited Wilde, 2003: 6).

The American novelist, James Baldwin, being poor, black, gay in 1950s America, and unhappily adopted, did not grow up in privilege. He also felt this shadow effect, and his first novel ‘was moulded by the painful relationship with his disciplinarian step-father . . . . who repeatedly told his stepson that he was ugly, marked by the devil’ (Field, 2003: 36).  [Emphasis added.]  Like all oppressors / abusers, his father made sure Baldwin experienced his stigma as written on the body.

Similarly, students on the MOWL project (Moving On With Learning) at the University of Liverpool, testify to the destructive impact of labelling on lives.  In their case, the ‘special needs’ label acted as a ‘ball and chain around my neck’, and with it came a whole vocabulary / stream of abuse:  stupid, backward, spazzy, slow, mental, retard.25  Stigma sticks: ‘I feel that pain deep down’ said Terry in his presentation to the Duncan Society in Liverpool.   And when black British footballer, Stan Collymore, spoke about his problems with depression, he too was mocked (Weaver, 2004).  Celebrity afforded exposure, not protection.

For people with learning difficulties, like Bill and Terry, who started off designated as ‘sub-human’, the struggle is not to recover from a downfall, but, now in their forties, ‘simply’ to achieve ‘human’ status and dignity.  Life history process helps in this, and the narrative power of their witness and public telling helps to educate and change those who work alongside them, and those (be they ministers or the general public) who come to listen and learn from them in their public presentations.  These men aspire to humanity before masculinity, and even in that, teach the rest of us something important.

“I used to be afraid to tell this story because it brought memories back . . . . Before I was nervous, I was shy.  Nobody would believe that now” (Terry, MOWL student: 10.12.03).

Black American writer, Toni Morrison, is in no doubt about the importance of our relationship with our past:

“Until one comes to terms with it, the past will be a haunting – something you can’t shake” (cited Jaggi, 2003).

Academic and social worker, Harry Ferguson, cites Judith Herman’s manual, Trauma and Recovery, and suggests her three-stage conceptualization of healing for abuse victims  provides a valuable insight and guide to working with trauma survivors:

“First, victims need safety. Then, once the violence has been stopped and they feel more secure, the task is to help them to remember the full extent of the violation, to mourn for the lost self. The final stage involves integration of a new self and reconnection with wider society” (Ferguson, 2003).26

Confession and intimacy are normally kept beyond the gates of academia, being seen as contaminants of academic rigour, but Ferguson argues that ‘confessional intimacy goes somewhere really important’, and is part of a process of ‘finding a voice and taking back [their] power’.  The process he describes is not something merely ‘technical’, nor some kind of quick fix, but attends to issues of power and powerlessness, including questions of poverty, resources and life-planning.  It is understood that clients are very often dealing with the aftermath of trauma (loss, abuse, violation), and this makes them vulnerable (and open to [further] abuse) but not necessarily helpless.  Bill and Terry (10.12.03) described how the labels made them public property, and legitimated a range of behaviours used against them, such as:  being shouted at, patronised, bullied, ignored, degraded, abused, disrespected, humiliated and dismissed.27

Abuse and violation are instant, whether as an isolated instance, or repeated over time.  Fear, self-loathing, anger, despair, a lack of self-worth, build up over time: hence the importance of looking back from a position of relative safety.28 Mental health activist, Judith Mawer,

describes ‘talking therapy as the only way to lasting recovery’ (10.02.04), and instead of getting herself married with children, as her doctor suggested, she took herself off to do a scriptwriting course as part of her recovery process.  As Morrison said in her Nobel lecture: ‘Narrative is radical, creating us at the very moment it is being created’ (cited Jaggi, 2003).

As a writer, Baldwin also recognized the importance of one’s roots and early beginnings, as both problem and ‘solution’: resources for self-understanding and change; for psychic recovery and creative purpose; for a kind of functionality (not ‘cure’ or problem-free existence), which wards off self-harm and addictive behaviour.  He too cites the significance of narrative and life history process:

Go back to where you started, or as far as you can, examine all of it, travel your road again and tell the truth about it.  Sing or shout or testify or keep it to yourself: but know whence you came  (Go Tell it on the Mountain, 1953, cited Douglas Field, 2003).  Emphasis added.

As all narratives of healing and self-recovery demonstrate, you need a team.  ‘The students made me feel wanted’, said MOWL student Terry about the university students who worked alongside him.  ‘I am a human being’, he said, claiming and celebrating his new identity.

Women’s peer group process.
As the example of Maria Teresa Macias shows, listening and being listened to are vital to survival.  Active listening is at the heart of human relationship, including intimacy: essential to proper conversation and dialogue.  Speaking plays its part in communication and relationship, but speaking not rooted in a listening habit too easily turns to dominance and control; display and arrogance.   Within the current arrangements, many (older?) heterosexual men seem to think listening is a sign of passivity, femininity, inferiority, lack of power.

“Inclusion isn’t enough.  Women have to be listened to and understood.”
“I’ve only had a handful of conversations with men, “ I said.  “Other than Tom.”
“I’ve had about two.  Two conversations with men who weren’t dying to ‘win’ the conversation.”
“I’ve never had one,” said Sally.  “It’s as though I lack the moral authority to enter the conversation.
I’m outside the circle of good and evil”  (Shields, 2003: 116).

As this excerpt from a conversation in Carol Shields’ final novel demonstrates, women’s peer process facilitates the joining in understanding of private experience, social arrangements and structures, and public pressures.  These are intellectual as well as emotional journeys; peer group process is the vehicle; self and society the targets.   Women’s peer process goes on every day, everywhere: face-to-face, by email, on the phone, in the car, on the sidewalk, up a hill, over a meal, in a group, at a conference (but generally, not in the gym).  It nourishes our lives and creativity.  It is therapeutic.  The best group-work resembles this mutual stimulation and nourishment.

Many women write as ‘self-protection’ during times of greatest turmoil and risk; as part of their recovery process; and as self-maintenance: whether as ‘secret’ scribblers, as members of writing groups, and/or on creative writing or scriptwriting courses; and of course, for publication (see Henke 2000; Butler 2000).  When individual women allude to this, they invariably say: ‘It kept / keeps me sane’.  Others use the visual arts and crafts in the same way.  We know in our bones the link between creativity and mental health and well-being: the importance of creative routine, repair and renewal.  In this process, ‘art’ and ‘therapy’ are not separate or opposed, but fused.29  Baldwin too made love and creativity his ‘redemption’ and healing, in his search for the means to function as a human being not damaged beyond repair.  This is everyone’s odyssey.  He understood: it is the artist in each of us that knows about reparation, regeneration and healing; how to move from damage to creativity / love. 

Working alongside women in five different self-help groups / courses which drew on CBT, I witnessed women growing in self-understanding, social awareness and courage, just as I had previously witnessed women in higher education, on communication studies and women’s studies degree programmes, achieving personal / intellectual change.  These ‘training programmes’ are able to take women’s experience openly as the core of the therapeutic, consciousness-raising, educational, peer process.  By contrast, inside academia the taboo on experiential learning is still very much in place, and women’s studies students and tutors, for example, have to work within its constraints on a daily basis.  Feminist academics are aware of the stigma attached to such work (see Caplan, 1994; Morley & Walsh, 1995); and the danger (see Lee, 2002).

Damage, abuse, loss, a sense of powerlessness, can lead any of us to ask: Tell me what to do, tell me what to think, to take away the pain and danger.  Give me the recipe.  Like going to the doctor to be cured, this invites the professional / therapist, alternative or otherwise, to be the authority figure, to direct and control.  But that is not my understanding of therapeutic process, educational process or creative process, and women’s self-care and healing is all these, as well as being a highly political process, with considerable social and political consequences, not just personal, psychological outcomes (see Butler, 2000; Cardinal, 1991; 1993; 1996; hooks, 1993; Walsh, 1997; 2007).

In conclusion
The historian, CLR James, who championed [Toni] Morrison in Britain, found Sula (her 1974 novel) astonishing and revealing in its implication that the “real, fundamental human difference is not between black and white but between men and women” (Jaggi, 2004).

The increasingly sexualized context of the stereotypes of trauma, damage and the therapeutic in society produce damaging and differential consequences for women and men.  Within a politics of health perspective, gender can be seen as the most denied and the most pertinent factor in the alleviation of suffering, and the development of good mental health as a social as well as personal asset.  A more co-ordinated and diverse approach, rooted in the experiential evidence of lives and testimony, has consequences for professional identity, practice and training.  Narrative is a key evidential and healing strategy in the field, as opposed to ‘rational’ tick-boxes and instrumentalism.  And there is now evidence that gender-aware CBT can be part of a healing, creative process, as seen in women’s self-help peer groups.  Women’s experience and initiatives, as service users and providers, are mapping ways forward, and these creative initiatives offer heterosexual men a potential template for their own development and healing strategies.

The therapeutic / communication skills field is a modern hybrid, which brings together the technical, performative and cultural focus of language and communication work, with the emotional and intellectual self-reflexivity and creativity of therapeutic approaches to identity, trauma and social effectiveness.  Whether this is informed by a conscious, responsible politics of education / health / well-being, will depend on the professional facilitator’s own sense of identity, her/his sexual politics, as well as personal / professional skills and commitment.   This is because first, we are all implicated in the crisis.   Second, the problem of gender is not just a matter of gender difference or differentials (access, provision, respect, and opportunity).  Heterosexual men’s fear of femininity / women / mothers persists in some quarters; the cultural linking of sex, violence and male heterosexual desire has surged; the urge to dominate in the face of overwhelming desire / lack remains damaging; the slag / bitch / cunt mindset, which (young) women are now being encouraged to adopt in the name of ‘equality’, and in turn recommending to other / older women, as a mark of ‘progress’ and ‘power’30 is surely no answer.  All these factors make for a complex and volatile ‘crime scene’.

In addition (and like most young men), most young women are still denied an upbringing and education which provide them with an understanding of how they arrived at where they are now (individually and collectively as women), and the economic, social and cultural factors which continue to shape girls’ and women’s lives and prospects.  This unavoidably produces ignorance and social vulnerability.  Or is it possible that ignorance affords protection, enabling women to be and do in new and liberated ways, not determined by the exigencies of male heterosexuality; by still male-dominated, masculinist, domestic, social and working environments; by the unrelenting onslaught of advertising, fashion and popular culture; and by the escalating and widespread routine violence against all kinds of women?   Can ignorance be armour?  Maybe, short-term.

Narrative resources to support change are never written on a clean slate.   Commenting on the dilemma of journalists when China started to open up, ‘like a starving child devouring everything within reach indiscriminately’ (Xinran, 2003: 216), after years as a closed and authoritarian society, Xinran saw ‘a body racked by the pain of indigestion’ (ibid.).

“But it was a body whose brain they could not use, for China’s brain had not yet grown the cells to absorb truth and freedom.  The conflict between what they knew and what they were permitted to say created an environment in which their mental and physical health suffered ” (ibid.).  Emphasis added.

‘The words to say it’ (Cardinal, 1993) are rooted in our bodies, our lives, our relations, our imaginations.  We work together with the materials at our disposal, to create the (narrative) resources we need to go on: this is our co/creativity.  Life process itself.  To forge alliances, to build dialogue and good practice across demarcations, ‘restoring intimacy across social chasms’ (Morrison, cited Jaggi, 2004) is a tall order.  It means challenging academic disdain, media contempt and institutional instrumentalism where we find it.  Owning and flexing our hybridity is part of this process.  For once you acquire a label, you acquire a fixed and singular identity, as Judith Mawer found out.  When it came to returning to her job, she was told ‘either you’re sick or you’re well’ (Mawer, ibid).  Tough if that does not describe your reality, and you want a phased re-entry to paid employment.  While the professional or service provider must allow themselves to say, ‘Sometimes I’m effective, sometimes I’m not’; we all have to be able to say, ‘Sometimes I’m well, sometimes I’m not’.  That’s the reality we share.

References.
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Footnotes
1 Myths of Madness, a film made by Headlines: Mental Health Media, was shown as part of a Duncan Society meeting at FACT, Liverpool (10.02.04), focussing on mental health issues.  Contributors on camera are presented first in their professional, work-related roles / identities, for example as academic, service provider or researcher.  Later, the same people identify themselves in terms of their experience of mental health problems and as service users.  In terms of the demarcation ‘them and us’, three themes from the film are particularly relevant at the outset: ‘1 in 4 people will experience severe mental distress at some time in their lives’ (cited Mental Illness: The Fundamental Facts, 1993), produced by the Mental Health Foundation; ‘Life experiences and mental distress – discrimination is bad for your mental health’; (Headlines notes on the film); and ‘In the last two decades of the community care policy the number of homicides committed by mentally ill people has not increased while the number committed by others has more than doubled’ (Finding a Place: A Review of the Mental Health Services, Audit commission, HMSO).

The Duncan Society in Liverpool is a public health debating society, which brings together professionals, service providers, service users and other members of the general public in monthly meetings.  Speakers include international and national experts and activists, as well as local and community experts and activists.  Emphasis is placed on full and open dialogue and debate.

2 While this paper focuses on gender as its primary theoretical and political construct, this is not meant to suggest that, for example, social class and racism are seen as separate or excluded categories of difference and disadvantage.  Rather that they intersect and are never ‘isolated’ from one another.  See, for example, the working-class community reported by journalist Matthew Parris on his return to the North East, in which the men had disappeared to leave the women to bring up the children in an environment shaped by extremes of poverty, unemployment and environmental decline.  The sense of abandonment was palpable. Parris noted that, twenty years after his last visit as a new, young MP, all the adults and children he interviewed were on serious levels of medication (tranquillisers, anti-depressants), without which they felt they could not cope with daily life.  See also ‘No holding back’ in which past and present service users and practitioners share their experiences of institutional racism in NHS mental health services. (Gould et al, 11.02.04).  Also Francis (11.02.04).  The problem of long term tranquilliser ab/use is highlighted in Meikle (11.02.04)

3 Peer group process does not refer to the composition of a group (i.e. same age or occupation), but to the relational dynamic of the group, which is based on everyone entering the group process as equal in terms of mutual respect and dignity, and what they might contribute.  It seeks to leave aside the parent / child structure of authority, and assumptions of dominance and submission, of hierarchy, as ‘natural’, inevitable or desirable in group process.  Peer process thus invites and facilitates a conscious, intuitive and responsible working with and through differences of identity and circumstance (such as age, affluence, experience, ethnicity, gender, sexual preference, social class), and differences of values (such as religion and politics), usually in pursuit of some ‘third thing’, such as skills acquisition; social and personal understanding; campaigning goals and strategies.

4 Particularly since the late 1960s, experiential and organisational initiatives within individual lives have also led to what have become enduring projects and organisations, which, in terms of their impact on lives, must be counted within both the therapeutic and political fields.  The London Lesbian and Gay Switchboard, which celebrates 30 years of action and care in 2004, is one such.  See Shifron, 2004.

5 Professor Ashton is Director of the North West Regional Health Authority, and was chairing the Duncan Society event at FACT, Liverpool (see footnote 1 above).

6 See Walsh (2003a; 2003b). Also Doyal (3.11.01) for a summary which provides some general ‘sex, gender, health’ background to the specific themes of this paper.

7 See Equal Opportunities Commission (July 2003), ‘”75 Years On”: Equality for women and men today?’

8 ‘Good stories’ are sensational, ‘shocking’, as the initial coverage by the UK tabloid press, of black boxer, Frank Bruno’s sudden removal to a psychiatric hospital demonstrated.  Such ‘good stories’ are above all about selling papers, not covering issues.  ‘On the news media – bulletins on BBC1 and ITV – of all the people with mental health problems that are presented, 70% of them are associated with violence’ (Adlam, 17.02.90).

9 These include talking therapies (psychiatric and/or therapeutic counselling; life history process; health narratives; trauma narratives); bodywork (massage, reiki, pilates, shiatsu, Qi Gong, yoga, as well as dancing, running, swimming, gym workouts); spiritual practices (meditation, chanting); other endorphin-inducing methods, including art and craftwork, film-going, theatre, performance, etc.; nutritional approaches; and finally, but not least, self-help groups, peer groups, networking groups.  This range of therapeutic practices / services demonstrates differences in what would previously have been referred to as diagnosis and treatment.  Avoiding this terminology, I suggest four approaches to life crisis / mental health problems, which in turn shape our therapeutic journeys / decisions:  numb the pain, make me forget; help me remember, understand and mourn; repair the damage, renew my strength; feed my fire, ignite my spirit / ambition, activate my connection to the wider world.

10 Robert Downey Jr, interview, Wilde (2003); and Michael J. Fox’s memoir (2002).  See also the recent interview with Peter Beresford, ‘the first “out” mental health service user to become a professor’ (Benjamin: 2005), as professor of social policy and a director of the Centre for Citizen Participation at Brunel University: ‘Historically, social policy has been about those who solve problems and those who have problems, and never the twain shall meet’.

11 See Walsh (2003b).

12 It is also possible to graduate with few or no tools of consciousness regarding the workings of society.  Since the early 1990s, new managerialism and its business ethos have shifted universities and many degree courses towards the confines of the narrowly technical and ‘specialist’, without contextualisation or the development of critical dialogue.  See Crace (2004); Walsh (2002); Howie & Tauchert (2002).

13 Alice Walker’s famous womanist claim / exhortation (1984); ‘Womanist is to feminist as purple is to lavender’, see p xi/xii.

14 See for example, Mike Nichols’ TV adaptation of Tony Kushner’s Angels in America, shown in the UK on C4, in two parts, at 9 00 pm –12 30 am, 7 & 8.02.04. See Fanshawe (05.02.04).

15 Does self-harming further exhibit the impact of gender differences and distortion?   Are women self-harmers, by ‘taking control’ of their bodies, by taking action against their ‘femininity’, ‘offenders’ in society’s eyes and masculinised in the process?   And are men self-harmers perceived as ‘feminised’ by making themselves visibly ‘victims’ and done to, rather than instrumental ‘action man’?  Both appear to muddy the neat gender binary, masculine / feminine, and in doing so, illuminate both ‘sides’ and their binary relation.

16 The fact that the majority of male prisoners are now black, illustrates how gender, race and mental health issues are imbricated.

17 See for example, Jackson (1998); (1990); (2004); Rutherford (2000); Stoltenberg (1990).  Male journalists and novelists have also started to explore this terrain, e.g. Parsons (2002; 2003).  See also Shields’ novel (1998).  And The Guardian has introduced several columns written as experiential, as well as analytical pieces by men, on disability, prison, alcoholism and depression, and other health issues.

18 See for example, Rowe, Dorothy (1987) Beyond Fear.  London: Fontana/Collins.

19 The occasion was a day conference on World Mental Health Day (10.10.03): New Approaches to People with a Diagnosis of  “Personality Disorder”.  The Wirral Mind Fountain Project, Birkenhead.

20This is excerpted from a letter written by the narrator (mother / wife / writer) to Dennis Ford-Helpern, in Carol shields’ complex and life-affirming novel, Unless.  Ford-Helpern has written a book about moral problems, in which ‘All the problem-solvers in your examples are men, all fourteen’ (ibid: 219).  The narrator writes to protest, in the nicest way possible:  ‘I don’t think you intend to be discouraging in your book.  I think you have merely overlooked those who are routinely overlooked, that is to say half the world’s population’ (ibid: 220).  This is a book of multiple strands and meanings, one of which is what it means to be ‘real, ‘good’, ‘moral’, ‘sane’; and the conditions for and obstacles against these states of consciousness and being.  Shields offers us the means to explore ourselves, our world, in all our vulnerability, frailty, and strength.  We accompany her characters to the edge and beyond.  See also the work of Algerian-born, French writer, Cardinal (1991; 1993; 1996).  The Words to Say It (1993) has been described as ‘world-renowned as the most important book ever written on the personal experience of psychoanalysis and the journey through therapy to recovery’ (The Women’s Press, 1996).

22 Anger is an important message from the self to the self, identifying a (potential) problem: whether about public, social justice issues, or personal affront or abuse.  It is an act of identification and self-protection: a warning.  Left unexpressed, unchannelled in appropriate and creative ways (for example, through language and/or public activism), it festers, and corrodes self-esteem and relationships.  This inhibition is a mark of a sense of powerlessness and fear (the unavailability of language, perhaps; and/or the fear of speaking, of making one’s needs known).  When people (including journalists) talk about anger, most of the time they mean aggression, which is different.  Aggression is a form of attack / dominance; it is violent and destructive (whether physical or verbal); it produces fear and intimidation in others; and is therefore also a violation of others.  Anger in itself is none of these.  So ‘anger management’ may be both a misnomer and misleading.  But bottled-up anger can lead to aggression.

23 The Rotunda Community College was a feminist-inspired, political initiative, set up in Liverpool in the 1980s, to provide a safe and stimulating place for local women to explore health issues together, and take up educational opportunities and skills training.  Today, its emphasis has shifted towards alternative / complementary therapies, and it has recently set up Rotunda Angels, a business run by fully trained, former College students, offering ‘treatments aimed at improving well-being and lessening tension’ (Rotunda Angels information leaflet).   Such ‘upward mobility’ can be seen as a feminist trajectory: moving from isolation, poverty and low self-esteem towards self-determination and greater financial independence.  It can also be seen as a retreat from political activism into the ‘pamper’ industry; an industry based on a recognition that many women are still having a very bad time living their lives; that more women have greater spending power today; that we will be allowed to address each other as service providers and service users, without opposition, because we thereby establish a new, expanding and profitable market segment; that the pamper end of the therapeutic field, can be conducted without politics (as a turning-away from the sources of pain and damage), as opposed to the education / healing / recovery end, which is more designed to help develop a politics of health and well-being perspective, enabling women to make life changes which support survival and well-being.  Another important difference, is that massage, for example, is individual and private; the self-help group is semi-public and collective.  These observations should not be taken to deny the value of bodywork (I trained as a shiatsu practitioner in the 1990s); but like the remedial and therapeutic field itself, we are variously positioned as active and passive within therapies, as ‘patients’ or partners, and that remains an important distinction.   I am aware that yet another industry is being built both on the back of women’s exhaustion, pain and desperation, and some women’s increasing affluence.  This is a political issue, not a medical matter: alternative therapies can act to disperse us as ‘consumers’ and clients, as opposed to facilitating collective awareness and action ‘as women’.  Any chance of a feminist constituency could be ‘pampered to death’ in the confines of the steam room and sauna, or on the massage bench.  While we may come away feeling more relaxed and invigorated, some alternative therapies serve to perpetuate denial, which as we know, is a short-term strategy while we gather our strength to do what has to be done.  A similar move appears to have taken place at The Health Place, Blackburne House, Liverpool, which offers ‘Holistic Health and Fitness for Women of all Ages’ (information leaflet).  Another feminist-inspired initiative, even down to its two women architects, when it opened about twenty years ago, Blackburne House was seen by many women in the city as the long-hoped-for hub for women’s networking and feminist-inspired education and training.  We were not thinking ‘creative nails’ (a recent event), more creative minds.  Has the politics bled out of these two inspired feminist projects from the 1980s?   In 2005 neither the Rotunda nor Blackburne House printed its information on recycled paper, so I assume they have no ethical / environmental policy.  Indications of a broader, environmental, internationalist perspective, such as has grown up in the UK since the 1980s, for example in relation to using local, organic and/or Fair Trade products, are not evident.  Any women’s business must beware commodifying women for its own purposes.

24 See Parsons (1991):  ‘But now I got it. Now I could understand the attraction.  Men of my age like younger women because the younger woman has fewer reasons to be bitter. . . .  It was cruel but true. The younger woman is far less likely to have had her life fucked up by some man. . . . ‘ , p 211.  See also Beynon, ‘Masculinities and the notion of crisis’ and ‘Millenium masculinity’ in Beynon (2002):  75-97 & 122-143.

25 The MOWL project at the University of Liverpool brings undergraduates together with students previously designated with learning difficulties, and left to languish in day-care centres.   MOWL is committed to their students rights to: choices, community participation, relationships, respect, rights as adults; and to this end provides support and opportunities for learning and achievement.  E-mail mowl@liv.ac.uk

26 And aggressors (like Robert Downey Jnr.) are first victims. See Mark Johnson’s (2008) account of his desolate childhood; his drug-fuelled youthful criminality and general love-lack; the trail of human casualties; and his path, from the age of thirty, out of chaotic behaviour and self-loathing, towards connection with others and wider society.

27 The new Mental Health Act introduces new labels, such as Anti-Social Personality Disorder, to identify those who are dangerous.  See Personality Disorder:  No longer a diagnosis of exclusion (23.01.03)

28 We have seen, in the recent surge of testimony from abuse victims, from residential homes in the UK, and the Catholic Church in the USA and Ireland, for example, that it can take many years, almost a lifetime in some cases, before survivors feel able to bear witness to their own and others’ systematic and often prolonged abuse by those in authority over them.  This measure of sufficient safety is not achieved individually, but collectively.

29 Speaking at a meeting of the University of Liverpool Creative Writing Society for Lifelong Learning, Tim Diggles of the Federation of Worker Writers noted a shift amongst its writers since the Federation was set up in 1976, from ‘anger to creativity’ (2.03.04).  The Federation had been male-dominated in its early days, and it is therefore possible to link this shift to the greater participation of women, as well as the passing of time and changes in the social and political climate in this period, which of course encompasses the Thatcher Years (1979-198 ).  This shift in emphasis and purpose would seem to echo the trajectory of the Rotunda Community College and Blackburne House, discussed in

footnote 23 above.  Anger has been historically important for working-class men’s politics.  Does the power and pleasure of ‘creativity’ enable people to throw off victimhood and/or channel anger differently?  Is this a turning away from the traditional politics of the left, and/or a redefining of politics and purpose?  Is this ‘feminization’ retreat or advance?  Certainly, moving away from anger as a motivational drive is significant, and I got the impression that in the Federation of Worker Writers, this shift did not just apply to the women.

30 This recent conversation with a young Norwegian woman highlighted what are probably both generational and cultural issues: we disagreed that this was misogynist language and therefore off-limits to women.  It is also a question of experience and education: by this I mean that, if you do not know any women’s / feminist history, feminist sociology and anthropology (cross-cultural knowledge), for example, it is all too easy to deny their importance for women today, and to believe that as young women you can create a ‘clean slate’.  (But saying it does not make it so.)

val walsh.  2004 / 2005

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