Take Two Sexist, Demeaning Remarks and Call Me in the Morning

Today I read an opinion piece from this week's New York Times which reminded me that objectifying women is still alive, well, and sometimes even spun as "therapy". The piece: a blog post by psychiatrist and Columbia University professor David J. Hellerstein, published June 12, 2015, titled The Dowdy Patient. (Yep, the title serves as the Coming Attractions.) What unfolds is a cautionary tale about what can happen when a helping professional objectifies, demeans, and trivializes, through the treatment of one person, an entire group; in this case, women. The sad part is the degree to which Hellerstein is oblivious that this is the story he's actually telling.

The post begins with Hellerstein fielding a question from a colleague about "that dowdy person who comes in at lunchtime". Hellerstein knows immediately to whom the colleague is referring, since the patient in question, he writes, is notable for her "homely dresses and unstylish hairdo". (Nice to know, if you're a female patient or prospective patient, that if you go to Hellerstein's practice, your appearance will not only be critically appraised, but might be the subject of light-hearted, patient-insulting banter among colleagues).

It gets worse. Hellerstein goes on to present the case, with details reportedly disguised to protect confidentiality, of his ten-year treatment of the "dowdy patient", who came seeking help for panic attacks. She apparently has many strengths, as Hellerstein mentions the patient having "Ivy league degrees" and "a Wall Street career", as well as having worked through a childhood reportedly marked by loss and family stress. To Hellerstein, however, these strengths and accomplishments were mere backdrop to a serious problem: despite her deep longing for a husband and family, the patient, year after year, remained single. The reason, in Hellerstein's professional assessment? His patient "refused to be attractive".

He went on to describe his various efforts to "help" her with the problem, including two fairly direct verbal interventions, one in which he raises the possibility of a "makeover", the other in which, after he directly raised the issue of her appearance a second time, she reportedly "began to find him creepy" (Go figure.)

In reflecting on their decade of sessions, Hellerstein framed their work together as a treatment failure, since he never found the right words to convince her of the therapeutic value she might find in giving up her  "Good Housekeeping hair", "frumpy skirt", and "too-sensible shoes". His post, which tries to make sense of the treatment failure, suggests various factors might have been to blame, including a medical training which, while preparing psychiatrists to deal with "seductive patients" (whose attire, rather than being "frumpy", was geared toward "luring you away from therapeutic neutrality"), did little to prepare him for the challenges of working with the chronically "dowdy".

I was offended by the post as both a therapist and a woman. As a therapist, I wonder how many current and prospective therapy clients, upon reading the article, were was alarmed as I was by the idea that a psychiatrist was not only judging a patient so cruelly and superficially, but was sharing judgments of this nature with the readership of the New York Times. It seemed like a piece that could certainly deter someone from seeking needed treatment, and that by itself is harmful and sad.

I was also dismayed by Hellerstein's lack of understanding of sexism as a social problem, its obvious presence in the therapeutic interactions he described, and the harmful impact his words almost certainly had on his client as well as any number of female readers. That he could not see in his own writing the depiction of women in the two most common and trivializing stereotypes: the seductress and the insufficiently appealing woman, both of whom are defined by only their appearance and their interactions and relationships with men.

To me, it simply read like another chapter in a long, sad story of a patriarchal, misogynistic society: A woman seeks helps from a professional who happens to be a man, and the focus immediately becomes what he thinks of her appearance; then, later, her failure to conform to his ideas of how she could make herself more appealing to prospective partners. It is her fault for being single, he's sure, and what is a well-meaning doctor to do when a patient simply will not change her hair or clothes when a male in authority suggests that she should?

I do wonder if, despite her identifying information being "disguised", the patient might have recognized herself in his published account of their discussions about appearance. Certainly it seems to me that she could, and that, for that matter, so could a number of other female patients of his. (We can only guess at how common Hellerstein's appearance-focused interventions might be!)  And in this case, looking at the decision to write and publish this piece, what about the long-standing doctor mandate about "doing no harm"?

Having read Hellerstein's post, I feel the strange wish to connect with this former patient of Hellerstein's, if only to say something to her about her obvious strengths (as if that could possibly undo the cumulative effect of ten years of treatment with someone whose opinions and interventions must have deflated and demoralized her, if those he described in writing are any indication of the therapy norm). I'd love to know if she's happy, and would want her to know that she should really take Hellerstein's offensive comments with a grain of salt.

It isn't as if, in ten years of being her doctor, he ever truly saw her in the first place.