THE WOMAN PATIENT Volume 3 Aggression, Adaptations, and Psychotherapy WOMEN IN CONTEXT: Development and Stresses Editorial Matina Homer, Radcliffe College Board: Martha Kirkpatrick, University of California at Los Angeles Claire B. Kopp, University of California at Los Angeles Carol C. Nadelson, Tufts University School of Medicine Malkah T. Notman, Tufts University School of Medicine Carolyn B. Robinowitz, American Psychiatric Association Jeanne Spurlock, American Psychiatric Association THE WOMAN PATIENT Volume 1: Sexual and Reproductive Aspects of Women's Health Care Edited by Malkah T. Notman and Carol C. Nadelson Volume 2: Concepts of Femininity and the Life Cycle Edited by Carol C. Nadelson and Malkah T. Notman Volume 3: Aggression, Adaptations, and Psychotherapy Edited by Malkah T. Notman and Carol C. Nadelson BECOMING FEMALE: PERSPECTIVES ON DEVELOPMENT Edited by Claire B. Kopp WOMEN'S SEXUAL DEVELOPMENT: EXPLORA TIONS OF INNER SPACE Edited by Martha Kirkpatrick WOMEN'S SEXUAL EXPERIENCE: EXPLORA TIONS OF THE DARK CONTINENT Edited by Martha Kirkpatrick THE WOMAN PATIENT Volume 3 Aggression, Adaptations, and Psychotherapy EDITED BY MALKAH T. NOT MAN, M. D. AND CAROL C. NADELSON, M. D. Tufts University School of Medicine Boston, Massachusel/s PLENUM PRESS· NEW YORK AND LONDON Library of Congress Cataloging in Publication Data Main entry under title: Aggression, adaptations, and psychotherapy. (The woman patient; v. 3) (Women in context) Bibliography: p. Includes index. 1. Aggressiveness (Psychology). 2. Women-Mental health. 3. Women-Crimes against. 4. Psychotherapist and patient. I. Notman, Malkah T. II. Nadelson, Carol C. III. Series. IV. Series: Women in context. [DNLM: 1. Delivery of health care. 2. Genital diseases, Female. 3. Women. WP 100.3 W872 1978J RC451.4.W6A37 616.89'0088042 82-5325 AACR2 ISBN 978-1-4684-4096-6 ISBN 978-1-4684-4094-2 (eBook) DOI 10.1007/978-1-4684-4094-2 ©1982 Plenum Press, New York Softcover reprint of the hardcover 1st edition 1982 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means. electronic, mechanical, photocopying, microfilming, recording. or otherwise, without written permission from the Publisher Contributors E. P. Benedek, M.D . • Clinical Professor of Psychiatry, University of Michigan Medical Center; Director of Research and Training, Center for Forensic Psychiatry, Ann Arbor, Michigan Karen A. Cohen • Program Coordinator for Health Education, Capital Area Community Health Plan, Albany, New York G. A. Farley • Private practice, Ann Arbor, Michigan Susan M. Fisher, M.D . • Lecturer, Department of Psychiatry, Univer sity of Chicago School of Medicine, Chicago, Illinois Rochelle Friedman, M.D . • Psychiatrist, Massachusetts Institute of Technology, Cambridge, Massachusetts; Clinical Associate in Psy chiatry, Massachusetts General Hospital, and Clinical Instructor in Psychiatry, Harvard University School of Medicine, Boston, Mas sachusetts. Abraham Genack, M.D., Ph.D . • Department of Psychiatry, Harvard Medical School and Mount Auburn Hospital, Boston; Medical Di rector, Metropolitan Beaverbrook Mental Health and Retardation Center, Watertown, Massachusetts Stuart T. Hauser, M.D., Ph.D . • Associate Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts Astrid N¢klebye Heiberg, M.D . • Associate Professor, Psychiatric Insti tute, University of Oslo, and Deputy Minister of Health, Norway Berit He[(je, D.D.S . • Department of Oral Surgery and Oral Medicine, University of Oslo, Norway Elaine (Hilberman) Carmen, M.D . • Associate Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina Irving Hurwitz, Ph.D . • Associate Professor, School of Education, Bos ton College, Chestnut Hill; Consultant Division of Child Psychia try, New England Medical Center, Boston, Massachusetts v vi CONTRIBUTORS Lewis A. Kirshner, M.D . • Assistant Professor of Psychiatry, Harvard Medical School, Boston; Harvard Community Health Plan, Welles ley, Massachusetts Gerald L. Klerman, M.D . • Professor of Psychiatry, Harvard Medical School and Director, Stanley Cobb Psychiatric Research Laborato ries, Massachusetts General Hospital, Boston, Massachusetts Harriet E. Lerner, Ph.D . • Staff Psychologist, The Menninger Founda tion, Topeka, Kansas Don R. Lipsitt • Associate Professor of Psychiatry, Harvard Medical School and Mount Auburn Hospital, Cambridge, Massachusetts Mirjam Mathe, M.D . • Assistant Clinical Professor of Psychiatry, Al bert Einstein College of Medicine; Clinical Director, Outpatient Child Psychiatry, Soundview Throgs Neck Mental Health Center, New York Barbara S. McCrady, Ph.D . • Butler Hospital, Brown University, Prov idence, Rhode Island Jean Baker Miller, M.D . • Clinical Professor of Psychiatry, Boston University Medical School, Boston; Director, Stone Center for De velopmental Studies and Services, Wellesley, Massachusetts Carol C. Nadelson, M.D . • Professor and Vice-chairman, Director of Training and Education, Department of Psychiatry, Tufts Univer sity School of Medicine-New England Medical Center Hospital, Boston, Massachusetts Theodore Nadelson, M.D . • Clinical Professor of Psychiatry, Tufts Uni versity School of Medicine; Chief of Psychiatry, Boston Veterans Administration Medical Center, Boston, Massachusetts Malkah T. Notman, M.D . • Clinical Professor, Department of Psychia try, Tufts University School of Medicine-New England Medical Center Hospital, Director, Women's Resource Center, and Direc tor of Psychotherapy, Boston, Massachusetts Cynthia R. Pfeffer, M.D . • Assistant Professor of Psychiatry, Cornell University Medical College; Chief, Child Inpatient Unit, The New York Hospital-Cornell Medical Center, Westchester Division, White Plains, New York Nancy Rudes, M.S.W . • Private practice, New York Earle Silber, M.D . • Supervising and Training analyst, Washington Psychoanalytic Institute, Washington, D.C. CONTRffiUTORS vii Veronica Tisza • Lecturer, Department of Psychiatry, Harvard Medical School; Consultant, Department of Child Psychiatry, Massachu setts General Hospital, Boston, Massachusetts Myrna M. Weissman, Ph.D . • Professor of Psychiatry and Epidemiol ogy; Director, Depression Research Unit, Yale University School of Medicine, Department of Psychiatry; Connecticut Mental Health Center, New Haven, Connecticut Joan J. Zilbach, M.D . • Associate Clinical Professor of Psychiatry, Tufts University School of Medicine; Lecturer, Harvard Medical School; Senior Psychiatrist and Co-director, Family Therapy and Research Program, Judge Baker Guidance Center, Boston, Massachusetts Preface This volume continues some of the issues raised in Volume 2 and fo cuses more closely on therapeutic intervention. The theoretical discus sion of aggression provides a background for the presentation of pat terns of aggression and violence affecting women, as well as possible connections between physical and emotional symptoms and indirect expressions of aggression. The section on aggression against and by women is an extension of some of the content of The Woman Patient, Volume 1 (e.g., the chapter on rape). Theoretical and clinical views that are not often linked in this fashion are included here because we are interested in understanding the development of a self-concept that incorporates the constructive aspects of "aggression" as well as an un derstanding of violence. In this context, loss, abandonment, delin quency, and child and adolescent suicide are also extensions of these issues. The chapters that follow address aspects of symptom formation and concepts of illness. There is, as yet, no definitive explanation for why women experience certain illness patterns more or less than men. Current considerations have been reviewed, but these do not answer. They are a beginning on which we must build. It is apparent that any discussion of these subjects better elucidates the complexity if it in cludes an intermingling of general problems with concrete symptoms. Those specific problems that are usually thought of as psychological such as depression, and behaviors (such as substance abuse) provide a focus for understanding wider issues. In the section on psychotherapy, the relationship between the woman patient and her therapist in analytic therapy is discussed gen erally as well as specifically with regard to women's relationships to their families. As in the previous volumes in this series, we hope to raise ques tions and stimulate thought rather than to provide any kind of jefin itive answers to many of the questions raised. We would like to thank all of the contributing authors for their ix x PREFACE hard work, patience, and tolerance during the process of writing and rewriting; our families for their support; and our editor, Hilary Evans, for her continual enthusiasm and help. CAROL C. NADELSON MALKAH T. N OTMAN Boston, Massachusetts Contents Aspects of Aggression and Violence Chapter 1 • Social Change and Psychotherapeutic Implications 3 CAROL C. NADELSON and MALKAH T. NOTMAN Chapter 2 • Aggression in Women: Conceptual Issues and 17 Clinical Implications CAROL C. NADELSON, MALKAH T. NOTMAN, JEAN BAKER MILLER, and JOAN ZILBACH Chapter 3 • Women and Violence 29 E. P. BENEDEK and G. A. FARLEY Chapter 4 • Wife Abuse: Culture as Destiny 47 ELAINE (HILBERMAN) CARMEN Chapter 5 • Incest 65 VERONICA TISZA Chapter 6 • The Adolescent Girl in a Group Home 83 MIRJAM MATHE and NANCY RUDES Chapter 7 • Juvenile Delinquency in Girls 95 SUSAN M. FISHER and IRVING HURWITZ Chapter 8 • Childhood and Adolescent Suicidal Behavior, with 115 an Emphasis on Girls CYNTHIA R. PFEFFER Symptom Formation and Illustrative Symptoms Chapter 9 • The Organic-Functional Controversy 133 THEODORE NADELSON Chapter 10 • The Painful Woman: Complaints, Symptoms, and 147 Illness DON R. LIPS ITT xi