From the Editors

The psychiatric patient is a rare figure among the case examples in any writing about biomedical ethics, feminist or not. Exciting and important advances made through an application of feminist approaches and theorizing to bioethics there have been aplenty, many of them in the pages of this journal. They have affected every aspect of how we construe ourselves, our health and ill health, our treatment, and our relationships with caregivers, as well as more fundamental conceptions, such as those of rights, fairness, self-identity, social power, and personal autonomy. Still, even though some early feminist work during the 1980s was about mental health, attempts to extend those advances to the mental patient, and to conceptions of mental disorder, have been scattered and incomplete, with three exceptions. Research has acknowledged the long Western history within which the feminine and female bodies have been associated with madness. Feminists have exposed and decried the gendering within psychiatric diagnostic categories, and have speculated as to why certain disorders are gender-linked. And the sexual exploitation of vulnerable female patients by male caregivers has been a source of outrage and concern. These explorations have provided essential groundwork for a feminist bioethics for psychiatry, undeniably. Yet—with some further, isolated exceptions—that has been about it.¹

Feminist approaches to bioethics are not alone, of course, in failing to acknowledge cases from psychiatry. Within contemporary biomedical disciplines, psychiatry is regularly depicted as differing from other subspecialties only in that it deals with the brain, and behavior, rather than other bodily systems. Isolated issues from the psychiatry setting, such as those about the validity of diagnostic categories, and about involuntary commitment and treatment, have been explored. But because of psychiatry's status as an undifferentiated subspecialty, it has often been presupposed that psychiatric ethics requires no particular attention. Even if defensible more generally, this is hardly a convincing justification for those bringing feminist theorizing to bear on biomedical ethics. A central focus of feminist bioethics has been health-care disparities affecting, and disadvantaging, vulnerable populations. And this is recognized to cut across all marginalized groups. Viewed from such a standpoint, psychiatry patients are in particular need of attention by feminists, for such patients represent one of the most marginalized groups in modern society. Their disorders often leave them with severe social dysfunction that limits them in a range of contexts and activities, added to which they remain subject to untold stigma and discrimination.

Beginning to make good this omission within feminist bioethics is the primary purpose of the present volume. The papers collected here cast a spotlight on the psychiatric patient, mental illness, and psychiatric care, distinguishing them from within the broader field of biomedicine. In so doing they also acknowledge some of the ethical issues that seem to be magnified when we turn to psychiatric practice. By more thoroughly extending feminist biomedical ethics to psychiatry and the category of mental illness, our hope is to stimulate greater recognition of a clinical setting in need of, and illuminated by, insights from feminist theory.

That theory is protean, granted, and not easily reduced to any particular ideas, approaches, or conceptions. (It is often said there are as many feminist theories as feminist theorists.) Nonetheless, feminist theory—or theories—contains some widely shared themes.

Themes

Consistent emphasis is placed on social power and power relationships, for instance, and the disparities in health care that result from imbalances among people and between groups. A focus on caring and care ethics is a recurrent theme, with its emphasis on the moral particularity that acknowledges contextual differences and is inimical to the principle-based approaches dominating much of traditional bioethics. Another theme is the gendered cultural norms that find their way into medical diagnosis, research, treatment, and lore. Much attention is also paid to self-identity—a self usually depicted as embodied, and socially embedded, or relational. Several of these themes intersect with the pervasive one of personal autonomy. Rather than individual and isolated, the autonomous individual in most feminist analyses is socially situated, and understood in relational terms.

Each of...