“Crazy” Women and the History of Women’s Psychiatric Care

When Charlotte Perkins Gilman published “The Yellow Wallpaper,” a short story based on her own experience with postpartum and psychiatric care, in 1892, I doubt that she expected her experience would remain relevant over a century later. The story is an infuriating chronicle of the physician-supervised mental decline of a woman who any trained 21st century health care professional would identify as suffering from postpartum psychosis, a disorder characterized by hallucinations and paranoia common to psychosis, and depression and anxiety associated with postpartum depression. Gilman’s work not only vividly captures the state of psychiatric care for women in the 19th century but also captures the process by which women have historically succumbed to medical gaslighting by their providers, slowly forfeiting their ability to self-advocate.

The story’s unnamed narrator, who has recently given birth, is locked away in a bedroom at her holiday mansion. Her husband, who is also her physician, has prescribed the rest cure, for what the narrator reports he calls a “temporary nervous depression — a slight hysterical tendency.” Historically, the rest cure — which, as its name suggests, was a regime of bed rest, isolation, and lack of stimulation — was almost exclusively prescribed to women for “hysteria,” which was once the most common mental disorder used to classify women suffering from an array of neurotic symptoms, most of which arose from physiological and hormonal changes throughout their lifetime. This diagnosis, which was standard practice at the time, relied on stereotypes of women’s irritable, reactive, and emotional tendencies that distanced them from being sensible and trustworthy patients.

In reality, physicians were simply uninterested in investigating a diagnosis that actually explained women’s symptoms, perhaps because dismissing women as “crazy” enabled them to maintain patriarchal control. In fact, the 1800s was a time of rampant hysterical diagnoses for women exhibiting any signs of mental disorder, or none at all. Women suffering from various psychiatric conditions were readily labeled as insane, unstable, or attention seeking. Interestingly, the neurologist who developed the treatment, Silas Weir Mitchell, encouraged male patients exhibiting similar symptoms to engage in the exact opposite course of treatment, and referred to it as the “West Cure.” You can take a guess as to which group of patients demonstrated improved mental status.

Prohibited from writing, reading, socializing, or doing anything at all, the story’s narrator is a prisoner with nothing but the intricacies of the room’s yellow wallpaper to keep her mind occupied (that the room is hideous is perhaps the most offensive thing of all). She identifies her husband’s medical training as an obstacle to her recovery, noting that he “is a physician, and perhaps — perhaps that is one reason I do not get well faster.”

Though the narrator recognizes her husband’s power as a barrier to her getting better, she is unable to do anything about it. The narrator’s husband reinforces his authoritative evaluations of her health, and her loss of control makes it increasingly difficult for the narrator to defend her perspective. Although her husband has not properly diagnosed or treated his wife, he is able to convince her that his treatment is correct, until she is driven to the point of a nervous breakdown.

Having been a patient of Dr. Silas Weir Mitchell herself, Gilman’s story is a clear critique of the rest cure approach, which she has said “nearly [drove her] mad.” The story was meant to serve as a warning to others of the dangers of this treatment, and yet the current state of women’s psychiatric care still carries the legacy of female hysteria. Take physician and researcher Bernadine Healy’s coining of a concept known as “Yentl syndrome,” which helps explain the disparity in diagnoses between men and women. This phenomenon states that unless the symptoms and illnesses experienced by a woman conform to those of men, they are likely to be misdiagnosed and mistreated. And this is certainly the case — currently women experiencing symptoms of a heart attack are more likely to receive a psychiatric referral rather than attention from a cardiologist. Additionally, studies show that women with endometriosis can see upwards of five different providers before being diagnosed, and half the time, the condition is first misdiagnosed as a mental health issue.

The paradigm for women’s health and psychiatry is certainly shifting, but centuries of medical misogyny will require years of thoughtful effort to undo. Historically, conditions and treatments that disproportionately impact women have been shamefully under-researched and -funded. As a result, women can experience diagnostic delays that reduce years from their life, or greatly diminish its quality. There are far too many changes in the reproductive life cycle capable of causing debilitating symptoms for these gaps in research to continue. Understanding these complexities, in addition to sex-oriented societal factors impacting health, is a necessity to improving the overall status of women’s health.