An egregious example of this sort of thinking is the 1964 study of battered women entitled “The Wife-Beater’s Wife.” The researchers, who had originally sought to study batterers, found that the men would not talk to them. They thereupon redirected their attention to the more cooperative battered women, whom they found to be “castrating,” “frigid,” “aggressive,” “indecisive,” and “passive.” They concluded that marital violence fulfilled these women’s “masochistic needs.” Having identified the women’s personality disorders as the source of the problem, these clinicians set out to “treat” them. In one case they managed to persuade the wife that she was provoking the violence, and they showed her how to mend her ways. When she no longer sought help from her teenage son to protect herself from beatings and no longer refused to submit to sex on demand, even when her husband was drunk and aggressive, her treatment was judged a success.
While this unabashed, open sexism is rarely found in psychiatric literature today, the same conceptual errors, with their implicit bias and contempt, still predominate. The clinical picture of a person who has been reduced to elemental concerns of survival is still frequently mistaken for a portrait of the victim’s underlying character. Concepts of personality organization developed under ordinary circumstances are applied to victims, without any understanding of the corrosion of personality that occurs under conditions of prolonged terror. Thus, patients who suffer from the complex aftereffects of chronic trauma still commonly risk being misdiagnosed as having personality disorders. They may be described as inherently “dependent,” “masochistic,” or “self-defeating.” In a recent study of emergency room practice in a large urban hospital, clinicians routinely described battered women as “hysterics,” “masochistic females,” “hypochondriacs,” or, more simply, “crocks.”
This tendency to misdiagnose victims was at the heart of a controversy that arose in the mid-1980s when the diagnostic manual of the American Psychiatric Association came up for revision. A group of male psychoanalysts proposed that “masochistic personality disorder” be added to the canon. This hypothetical diagnosis applied to any person who “remains in relationships in which others exploit, abuse, or take advantage of him or her, despite opportunities to alter the situation.” A number of women’s groups were outraged, and a heated public debate ensued. Women insisted on opening up the process of writing the diagnostic canon, which had been the preserve of a small group of men, and for the first time, took part in the naming of psychological reality.
I was one of the participants in this process. What struck me most at the time was how little rational argument seemed to matter. The women’s representatives came to the discussion prepared with carefully reasoned, extensively documented position papers, which argued that the proposed diagnostic concept had little scientific foundation, ignored recent advances in understanding the psychology of victimization, and was socially regressive and discriminatory in impact, since it would be used to stigmatize disempowered people. The men of the psychiatric establishment persisted in their bland denial. They admitted freely that they were ignorant of the extensive literature of the past decade on psychological trauma, but they did not see why it should concern them. One member of the Board of Trustees of the American Psychiatric Association felt the discussion of battered women was “irrelevant.” Another stated simply, “I never see victims.”
In the end, because of the outcry from organized women’s groups and the widespread publicity engendered by the controversy, some sort of compromise became expedient. The name of the proposed entity was changed to “self-defeating personality disorder.” The criteria for diagnosis were changed, so that the label could not be applied to people who were known to be physically, sexually, or psychologically abused. Most important, the disorder was included not in the main body of the text but in an appendix. It was relegated to apocryphal status within the canon, where it languishes to this day.”
– Trauma and Recovery, Judith Herman (via annalevys)