Therapy assumes that someone is sick and that there is a cure, e.g., a personal solution. I am greatly offended that I or any other woman is thought to need therapy in the first place. Women are messed over, not messed up! We need to change the objective conditions, not adjust to them. Therapy is adjusting to your bad personal alternative.
— Carol Hanisch, “The Personal Is Political” (1969)
Introduction
In this paper we build on the work of previous feminist critics of psychotherapy’s treatment of women (including lesbians). We rely on personal accounts by lesbians, and we apply a radical feminist structural analysis to our collective, subjective observations, mirroring the radical feminist consciousness-raising process. Our conclusion is that the institution of psychotherapy is at its core patriarchal and not designed to serve the interests of women (especially lesbians); and that it needs to be abolished. We offer possible alternative structures consistent with radical feminist principles and processes.
Until the late 19th century, women were considered to have only one purpose, ordained by God and/or nature: to produce domestic comfort and male heirs for their husbands. It was argued that educating women would not only harm society, but would physically and emotionally harm women themselves.1 It followed that women were systematically excluded from higher education, from traveling alone, from earning money in exchange for labor, and even from choosing their own romantic partners. Virginity was required in brides. To be lesbian was largely unimaginable. This old model of ideal, “healthy” feminine functioning was built into the origins of psychotherapy and has never been completely expunged from psychotherapeutic ideology.
The diagnosis of “hysteria” (so named from the Greek word meaning uterus!) is ancient and was only removed from the Diagnostic and Statistical Manual of Mental Disorders (the DSM) in 1980. It was a diagnosis only applied to women and girls found to be “disagreeable,” as Dr. Judith Herman explained in her important criticism of psychotherapy.2 It was diagnosed randomly to explain “symptoms” that might include refusal of marital sex or behaving ‘dramatically’. Freud’s early ponderings about how the mind works were partly driven by his desire to understand hysteria.
Modern psychotherapists are required to provide a diagnostic label for insurance and data collection. A mental health diagnosis pathologizes a woman. It labels her with a disease to be cured, and then prescribes psychotropic drugs as treatment for the disease. Psychiatric diagnosis pins the problem squarely on the individual woman and intentionally ignores the systemic oppression of women, especially lesbians, as a sex class.
How do “feminist therapists” fit into this system? “Feminist therapists” represent a kind of tokenism, aimed at co-opting those feminists who can be controlled through credentialing and insurance regulations so that they can’t change the structure of the institution itself. But those tokens can be used to lure large numbers of angry lesbians into being diagnosed (and thereby dismissed), individually therapized, and drugged into submission. Revolutionary change is thereby averted.
Psychotherapeutic methodology leads us to conclude that its strategy for women and girls has consistently been, and continues to be, to cause women to feel less discomfort with the structural status quo (especially around sex roles/gender), and to increase compliance and decrease noncompliance with the requirements of femininity — i.e., to induce women’s acceptance of subordination to men, while appearing to be happy with it. These goals are inconsistent with the interests of women as a sex class.
We are grateful to the work of Phyllis Chesler in particular for her courageous, insightful, and damning critique of psychotherapy in Women and Madness,3 as well as its discussion on WDI’s Radical Feminist Perspectives webinar series. But unlike Chesler, we don’t think that psychotherapy can be reformed to be more likely to help women, including lesbians, than to harm them. We need a completely different way of addressing women’s (and lesbians’) relative lack of agency over their own lives.As part of our preparation for writing this article, we conducted a small, informal survey of lesbian signatories of the Declaration on Women’s Sex-Based Rights for the purpose of obtaining some personal accounts of psychotherapy. It asked the following questions:
- Are you a lesbian?
- What is your age?
- Have you ever sought psychotherapy? Why or why not?
- Has another person led you into psychotherapy? Family? Friend? Doctor? Was receiving psychotherapy ever made a condition of your receiving other medical care?
- If you have received psychotherapy: State any benefits and any harms.
- Have you ever had electroshock therapy? Describe the effects, both positive and negative.
- Have you ever taken prescription psych drugs? If so, describe the type of drugs and their effects, both good and bad; and the total length of time you have spent taking one or more psych drugs.
- Have you ever identified as “transgender?” Have you detransitioned? If so, describe any role either in your transition or detransition that psychotherapy played.
- On the whole, was psychotherapy worth it for you?
- Is there anything else you’d like to add on this topic?
The thirteen respondents to our survey reported very high rates of hospitalization, electroconvulsive therapy, and nearly universal administration of psychotropic drugs. In addition to these treatments, which we see as largely punitive and aimed at control, until recently lesbians were additionally punished by routinely losing custody of their children once they were known to be lesbians.
Side effects from psych meds that were mentioned by women responding to our survey included uncontrolled weight gain, decreased libido, numb face, and spontaneous lactation.
There are significant disparities in how, and how often, men are treated by psychotherapy compared with women. America’s Health Ratings report that as of 2024, “some 26.7 percent of females reported some type of mental illness in the past year, compared to 20 percent of males.” Specifically, “…depression was notably higher among women, with 26.4% of adult females diagnosed compared to 14.4% of adult males.” It seems reasonable to wonder whether living under patriarchy might itself cause women to experience depression at a higher rate than men, but pathologizing women removes from consideration any possible structural causes for their depression. In this way, psychotherapy functions as an institution of the unchallenged structural status quo to which women, and especially lesbians, must adapt.
Here’s how we see the pros and cons of the advice and support of friends, family, or village elders (i.e., non psychotherapeutic counseling resources), compared with psychotherapy:
- Pros: The sought-out advisor is not a stranger you know nothing about. The help is free of charge. You’re dealing with an individual who is more or less an equal and whose biases you can evaluate. There is no pathologizing diagnosis or medical treatment procedure; there is not even necessarily any stigma attached to the consultation.
- Cons: The advisor is not necessarily bound by confidentiality, although you might know enough about her in advance to be able to predict the likely degree of confidentiality. The advisor might change her opinion of your character. In a patriarchal community, you might be subjected to patriarchal punishments such as exorcism or other controls. But could it be that strong community bonds and radical feminist community ethics (including the welcoming of lesbians) could mitigate these dangers?
Has psychotherapy been effective and safe for lesbians?
In the 20th century, psychotherapy was largely ineffective in resolving lesbians’ practical problems and emotional pain. Some women, especially lesbians, were hospitalized, subjected to electroshock therapy, and/or drugged because they contradicted essential patriarchal narratives. Some women were even lobotomized, or involuntarily institutionalized by their fathers or husbands because they were embarrassing or inconvenient.4 Freud’s talk therapy uncovered, and subsequently suppressed, widespread reports of sexual abuse of daughters by fathers; the sexual abuse of little girls by men in their families was, and continues to be, a strong patriarchal taboo because it is so damaging to the patriarchal institutions of fatherhood, family, honor, and so forth. The cultural mythology that women and girls lie about rape is essential to discredit all such accusations. A corollary is that femaleness itself (and lesbianism especially) is framed as pathology.
Freud treated an 18-year-old patient named Dora who was being sexually abused by a friend of her father; instead of empathizing with his patient, Freud blamed her for her unhappiness and characterized the coercive arrangement as a consensual love affair (Chesler, 2018, pp. 137-138). Freud himself admitted that nearly all of his female patients reported memories of father-daughter incest (Freud, 1933, qtd. in Herman, 2000). We don’t mean to specifically demonize Freud himself for this; patriarchal society was, and largely remains, unwilling and unable to believe the high frequency of girls’ childhood sexual abuse by at least one male in her family. To do so undermines the patriarchal myth that fathers are the natural and benevolent heads of nuclear families. This disbelieving or reframing of accounts by women and girls of unwanted sexual experiences (rape) continued well into the 20th century and later. As Chesler recounts:
We were taught to view the normal female (and human) response to sexual violence, including incest, as a psychiatric illness. We were taught to blame the victim for what had happened to her. Relying on a superficial understanding of psychoanalytic theory, we blamed the woman as “seductive” or “sick.” We believed that women cried “incest” or “rape” in order to get sympathetic attention or revenge. (Chesler, 2018, p. 13)
Women still are not believed when we try to report men’s sexual assaults, and we are especially easy to discredit if we were very young when they happened. One of the lesbians we surveyed had a therapist who was sued by a patient’s family for allegedly implanting false memories of childhood sexual abuse in the patient; the pressure on psychotherapists to suppress, reframe, minimize, or simply not pursue accounts of sexual abuse did not end with Freud.
Yet it has become a cultural norm to consult therapists and take medications; fewer and fewer Americans attain adulthood without a psychiatric diagnosis and mood-altering prescriptions. Therapy is commonplace, but no one seems to be getting better. As radical feminists, we inquire into who benefits from therapy that keeps women (especially lesbians) sick and drugged. Clearly, the beneficiaries are not those women.
We also question whether therapy that prioritizes individual happiness, or the absence of emotional discomfort, is consistent with building a culture and community that centers the interests of all women as a class. Emotional discomfort is one product of radical feminist consciousness, and may act as an impetus for societal change.
Structural critique
There are several structural elements of the psychotherapeutic model that make it ineffectual and even counterproductive to women’s collective interests.
First, there is an intrinsic inequality of power between a client and her therapist; the therapist has the authority that comes from training, having the home turf, using technical jargon that the client may not be familiar with, and presumptively being the functional or mentally well person in the room.
A facet of the power inequality is the uni-directional flow of knowledge about each other. The therapist receives detailed information about the prospective client, usually starting at the very beginning of the matching process, with a detailed survey. The client, however, receives much more limited information about prospective therapists — usually a biography of a paragraph or two in length, perhaps a resume. You’re meant to choose another person to have a great deal of influence on you — and who will cost you a great deal of money — with very little ability to make an informed choice. This imbalance continues throughout the duration of the client-therapist relationship, as the therapist is privy to innumerable details about the client’s life, problems, worldview, priorities, values, and decision-making processes. By contrast, the client learns virtually nothing about the therapist’s own life, character, ethics, priorities, and so on. This knowledge void is deliberate, not accidental.
With more information, clients would not only have the power to make more informed decisions when choosing a therapist, but would also be better equipped to evaluate the perspectives they receive from their respective therapists. Knowledge is power, and the one-sided power dynamic together with the stringent emphasis on privacy lend themselves to enabling therapeutic abuse. In a world where women are already “crazy,” “hysterical,” “exaggerating,” “paranoid,” and so on, the discrepancy in social capital between therapist and therapized makes it even easier to dismiss and disbelieve a client-victim, particularly if she has a diagnosis dogging her footsteps.
Psychotherapy is inherently organized around individual solutions to problems that are predominantly collective in origin. It’s not only that individual solutions are valued more highly; it’s that they are promoted at the exclusion of class-level or collective change. An individual approach feeds into the narrative, already socialized into women, that we are the problem. Women already societally labeled as “deviants” in some way — lesbians, but also celibate women, childfree women, and others — are even more susceptible to this narrative than wife-mothers, who are merely framed as deviations from the norm of maleness.
Psychotherapy doesn’t only move the solution into the individual realm; it also moves the awareness of the collective problem out of public consciousness and into the private realm, preventing people, especially women, especially a lesbian, from being able to realize that at least some of her problems may not be unique to her; and may in fact be nearly universal. Even certain elements of therapeutic professional ethics, such as pretending not to recognize the client on the street outside the session, work to keep therapy conceptually separate from the real world.
This dynamic is an uncanny echo of the way the nuclear family has historically operated, atomizing women and causing each woman to think that she is the only one suffering from an abusive husband, domestic drudgery, postpartum depression, absence of orgasm, and so forth. Finding out that it’s not just you is a huge relief on an individual level, and opens the door to a structural answer to a structural problem. Perhaps it’s time to reiterate a foundational principle of feminism’s second wave: The personal is political. And that includes the private.
Funneling discussion of our problems into the therapist’s office keeps us from sharing them elsewhere, and keeps us in the dark about each other. Atomization — the breaking of bonds — is one of the most effective ways to prevent social change. This is the reason men don’t want women talking outside the supervision of men, and it’s the same reason your boss doesn’t want you and your coworkers to talk about your salaries. If you think everyone else is happy with the status quo, and you’re the only one struggling, then the natural conclusion is that you’re the problem; you sit down, shut up, expend your energy self-flagellating, and try to make it work. But if you find out that, actually, a lot of women are struggling, and that none of us is particularly happy with things as they stand, it suddenly becomes apparent that it is absurd to try to change yourself to fit an unwanted reality. Maybe instead, we could try together to change our collective realities.
Conclusions
This is a common pattern for lesbians: You feel angry, overwhelmed, isolated, sad, worried. You see a psychotherapist. You get an individualized diagnosis because without a diagnosis your therapy will not get insurance coverage. Once you have a diagnosis, the therapist is under pressure to see that you are treated for it with approved drugs. The interlocking patriarchal institutions of Big Psych, Big Pharma, and Big Insurance all profit from your being drugged long term. The drugs are routinely ineffective, frequently have serious adverse effects on your physical health, and often create dependency.
The institution of psychotherapy is unsalvageable. From its beginnings, it has focused on controlling women’s anger and preventing women from organizing in response to that anger. It would be in the interests of women, including lesbians, to stop engaging with psychotherapy altogether, and instead create a completely new system for understanding and addressing women’s (including lesbians’) emotional and related challenges, starting with a radical feminist structural analysis of the source of those challenges.
The institution of psychotherapy claims to aim for what it defines as individual health. But we have seen that what it actually accomplishes for women and especially lesbians is drug dependency, physical sickness, and diminished emotional range.
What might replacement systems look like? We might hold meetings that all community members would participate in, something like non-adversarial juries, except you’d know everyone at least to some degree. Women needing advice or emotional support could come to a meeting and describe the problem. The process might resemble radical feminist consciousness raising, or a different process devised collectively. The focus would be on the structural causes of the problem, and the solutions would prioritize what is best for the entire community. Prioritizing community interests over individual interests is ultimately in everyone’s interests, because a thriving lesbian (or women’s) community supports the well-being of all its members.
A community’s collective interests are better described and addressed within an ethics framework rather than a “health” framework linked to the ever-changing bible known as the DSM. That is, “dysfunction” in the new paradigm would mean something that’s bad for the community (e.g., of lesbians). Community would take priority over individual feel-good.
A radical feminist community would center ethics rather than “health” and everybody feeling okay. Where “health” and positive feelings are prioritized, women must aim never to offend anyone; meanwhile, criticism feels bad, like an attack, so it must be avoided. Lying is justified if it makes someone feel okay, including the liar. Prioritizing integrity, including truthfulness, along with the wellbeing of the community, seems likely to work better for promoting community cohesion as well as more authentic relationships within it. We think a coherent ethical system can best be developed collectively, as a new social contract by community members, in contrast to a superimposed ideology such as the Bible or the DSM.
The institution of psychotherapy is a significant contributor to the extreme individualism that characterizes contemporary American culture. In contrast, radical feminist consciousness raising requires participants to seek commonalities rather than individual uniqueness. To be clear, it doesn’t discourage individual uniqueness; the process encourages individual women to describe their apparently unique situations, and then encourages everyone to find similarities among those situations. So, in the interests of strong community bonds, we might want to encourage regular consciousness-raising sessions throughout the community.
We might also want to discuss what personal characteristics we want to strive for as individuals. Integrity? Truthfulness? Honest arguments only, that aim for mutual understanding of what’s true, rather than aiming to win the argument? Loyalty to the interests of all women and especially lesbians, coupled with the courage to act on that loyalty? The cultivation of courage may be especially subversive to patriarchy, considering how hard Big Insurance has worked at stamping it out. Courage leads to risk taking, and while risk taking is expensive to Big Insurance, in women it undermines gender, which props up all of patriarchy. Scripts such as “it’s hard” or “it’s uncomfortable” or “it doesn’t feel good” shouldn’t excuse failing to act in the interests of the community or otherwise ethically. Instead, we could cultivate radical feminist community ethics and individual strength of character.
But might some lesbians still need psych meds to function? How can we address those who are truly out of touch with reality? And what can we do about other lesbians who may not be helped by community counseling? We don’t know. On the other hand, are current methods, including drugs, actually effective in treating serious psychosis? Answering these questions is beyond our ability to evaluate. That said, it strikes us as legitimate to state that the institution of psychotherapy needs to be abolished without presenting a fully developed replacement structure. For that matter, psychotherapy doesn’t have a fully fleshed out structure even after 150 years; it just keeps recklessly experimenting.
In creating psychotherapy, Freud burdened women with a new and powerful patriarchal institution that has successfully shored up (and to some extent replaced) religion as an authority on correct thinking and behavior: Psychotherapy replaces obedience to God with what the ever-changing DSM deems to be emotionally healthy. As we have shown, women and especially lesbians are overdiagnosed with pathology and then overmedicated, compared to men. This occurs in part because dominance behaviors tolerated in men are generally not tolerated in women, who are more likely to be pathologized, drugged, and perhaps locked up for those same behaviors. Psychotherapy then isolates women in two ways: They can only work out their problems alone in a room with a therapist who is deliberately not in community with his or her clients; and each woman in therapy is given a unique set of diagnoses accompanied by a unique drug cocktail that underscores her difference, and not her structural similarities with other women or other lesbians.
To be fair and accurate, apart from the structure of the psychotherapy institution that aims to isolate and control, Freud especially has given us valuable descriptive and conceptual tools for understanding human behavior. Such concepts include the unconscious (accessible through dream interpretation, for instance), defenses such as repression and projection, and the value of reviving significant memories and understandings by talking. It may be useful to keep some of these descriptive tools as we create ways of dealing with seriously harmful behaviors, disconnection from material reality, and severe trauma outside the diagnostic and treatment protocols of the institution of psychotherapy.
Absent the institution of psychotherapy, we might try to sort out the roots of individual problems in the first instance by examining structural factors such as isolation, problems with institutional power/powerlessness, and/or failure of individuals to uphold community ethics. We predict that freeing women from psychotherapy and its associated drugging/numbing, and redirecting them into strong, supportive, ethical communities will greatly diminish the number of women who are actually a physical threat to themselves or others. Although we’re not suggesting that individual happiness should be prioritized, we speculate that women and lesbians will be overall happier when psychotherapy’s ideology, structural misogyny, stupefying drugs, and other painful or physically destructive interventions are replaced by social support within the kind of communities and community structures we’ve described.
The WDI USA Lesbian Caucus
Lauren Levey, coordinator
Arundel Castle
Mary Ellen Kelleher
Katherine Kinney
- Eisenmann, L. (2006). The Impact of Historical Expectations on Women’s Higher Education. Forum on Public Policy. JHU Press. ↩︎
- Herman, J.L. (1997). Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror. BasicBooks. ↩︎
- Chesler, P. (1972). Women and Madness: When Is a Woman Mad and Who Is It Who Decides?. Doubleday. ↩︎
- “I worked in emergency mental health for several years and had training in interviewing patients dx with mental illness, drug addiction, personality disorders, etc. and I believe many women are brought in by their partners as the ‘Sick’ person in the relationship, when of course, that’s not the case. (Once a man brought his wife in for committal because she was praying, fasting for a number of days and abstaining from sexual relations in accordance with her faith, can’t recall which now.) There was nothing wrong with her thinking at all.” (Mary Ellen Kelleher, personal communication, Dec. 16, 2025) ↩︎
