Jane Ussher has written a highly complex and academic book about real experiences of women and the social and psychological labels that have been applied to their distress. She begins her book with a very real issue—how we understand the historical and current labeling of women as mad. Medical practitioners tell us that women suffer from very real “brain diseases.” Some feminists argue that such labels are purely a social construction and that women are labeled as mad when their behavior is outside societal norms or expectations.

Ussher begins with a discussion of how the term “mad” came to be applied disproportionately to women. She eschews explanations that point to women's biological or hormonal frailty, instead focusing on the social and cultural stresses that women face. She maintains that behaviors that come to be labeled as symptoms and that lead to a psychiatric diagnosis are constructed by the culture and the times in which a woman lives. With a special focus on depression, Ussher puts forward the premise that many behaviors labeled as symptoms may in fact be responses or adaptations to stressful life events, a position that, although compelling, is not new to the field. For example, a woman struggling with the need to be a “super mom” may feel overwhelmed and defeated when she fails to live up to those unrealistic and socially imposed expectations.

Ussher applies this same basic formulation to our understanding of posttraumatic stress disorder, borderline personality disorder, and premenstrual dysphoric disorder. Using DSM-IV criteria for these disorders, Ussher illustrates with case examples that a response is to be expected given the abuse or neglect that the woman had encountered. For example, she sees the intense, inappropriate anger for borderline personality disorder as a very reasonable response to years of abuse and betrayal. Ussher's writing is most engaging when she uses the words of actual women, as she does here.

In her final chapter on resistance and survival, Ussher offers actions that women can take to combat the construct of madness as a women's problem. In contrast to the complexity of her theoretical formulations, her solutions seem rather limited. She advocates “saying no” to ideal images and expectations of how a woman should behave and employing more self-care strategies, such as resting, taking a bath, or finding time to read a book. Such a lapse may be understandable because Ussher is not a clinician but a researcher and sociocultural thinker.

Ussher has written a complex and intriguing book. Her philosophical constructions, however, are extremely complex and perhaps not well suited to the practicing clinician. Anyone interested in a feminist and cultural perspective on how women come to be labeled as mad will find this book an interesting but valuable challenge.