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Women as the Scapegoats of Medicine: A Brief History of a Twisted Differential Diagnosis

Black hellebore, a flower of the deepest black and with petals the sinister shape of blunted arrowheads, grows wild in the cool, mountainous regions of the Balkans. Despite its unintimidating label as the “Christmas rose,” the hellebore has a much darker history, one bespoken more by the flower’s ebony hue than by its innocuous nickname. The flower is said to have healing benefits. According to Greek mythology, the healer Melampus developed a tonic made up of an infusion of hellebore to cure a group of virgins suffering from psychosis due to “uterine melancholy” and a lack of sexual stimulation. From the myth of Melampus was born the twisted concept of hysteria, and with it the inevitable fate of women to become the unjust scapegoats of mental health. History has shown that from hysteria to schizophrenia to drug addiction, psychological disorders of ambiguous etiology have initially been tossed aside as mere afflictions of the “weaker sex,” the unsurprising consequence of a feeble female constitution’s inability to handle the rigors of daily life. While this history may be unsurprising, considering medicine of the larger part of the past millennia was generally developed by male physicians, increasing gender equality within the health professions has allowed us to move away from such trends and spur a true shift in attitudes surrounding mental health.

Nonetheless, it is impossible to ignore a past in which beliefs in the frailty of women have had tragic societal and medicinal consequences. These traditional convictions contributed directly, for example, to an epidemic of opiate addiction among women, a testament to the fact that the belief in the mythologized susceptibility of women was not lost with time. French artists of the Victorian era were enraptured by the image of la morphinomane, the female morphine addict. She could be found in every corner of society, an aristocrat lounging leisurely in her home or a young woman working to support herself and her family.  Artists took inspiration from the universality of la morphinomane, with Paul Albert Bessnard’s etching of Victorian upper-class morphine addicts sitting in sharp contrast to Eugene Grasset’s iconic La Morphinomane, a jarring image of a young, working-class woman donning a nightgown and a grimace while injecting opium into her thigh.

One of the most commonly made diagnoses among women of this time was that of neurasthenia, a go-to female illness largely popularized by physician George Miller Beard, who described it as a disease of neuralgias and anxiety attributable to the uncomfortably rapid urbanization of society. Beard’s characterization of women as the “more nervous” sex contributed to women being disproportionately diagnosed with neurasthenia and subsequently prescribed opiates. Studies of the time showed that during the 19th century, between two-thirds and three-quarters of the chronic opium users in this country were women. While such disproportionality may seem shocking to us today, during the time the diagnosis of neurasthenia was in vogue, physicians were attributing such inequalities to the obviously higher “tendency to hysterical and chronic diseases” among women, a “hysteria and hypochondriasis” which opium could sufficiently pacify.

Interestingly, by the first half of the 20th century, characterizations of feminine docility and sensitivity provided convenient explanations for another mental illness: schizophrenia.  In his book, The Protest Psychosis: How Schizophrenia Became A Black Disease, psychiatrist Jonathon Metzl traces the history of mental illness, uniquely intertwining issues of race, class and gender into the story of the development of schizophrenia as a medical diagnosis. The majority of the work focuses on trends associating African-Americans with improper diagnoses of schizophrenia due to institutionalized racism, making the argument that the civil rights movement spurred diagnoses of schizophrenia due to perceived acts of disobedience and aggression. In tracing this history, however, Metzl acknowledges that prior to the civil rights movement, schizophrenia was believed to be a disease of the “sensitive” and “seclusive.” It was a disorder dismissively referred to as a disease of middle-class white women. As Metzl describes, certain sources even went as far as to claim that schizophrenia was nothing more than the outward manifestation of an unhappy marriage. This image of the “schizophrenic housewife” became a part of mainstream culture, even finding its way into Ladies Home Journal, which attributed schizophrenia and premenstrual symptoms to a “Dr. Jekyll and Mr. Hyde” syndrome in women. Like hysteria and neurasthenia before it, schizophrenia joined the list of diseases attributable to female debility, a frailty too often legitimized by the psychiatry of the times.

It is undeniable, however, that while women have been disadvantaged by stereotypes surrounding their perceived weakness, they have also been have been fundamental to challenging the status quo. Perhaps one of the most effective means by which women have challenged the popular “female frailty” conjecture has been through literature. For centuries, writers like Sylvia Plath and Charlotte Brönte have produced some of the most memorable female characters of literature. In looking closer at their works, it can be seen that several of these characters have served to shed light on the injustices facing women, especially those relating to stereotypes surrounding mental health.  Bertha’s infamous character in Brönte’s novel Jane Eyre provides a vivid example of the plight of female mental illness, graphically portraying a woman confined to an attic and condemned by her own husband to live alone for eternity. Believed to have descended into an incurable madness, Bertha was ignored, left for forgotten and in many ways vilified for her illness, a fact of moral ambiguity that Brönte was likely aware of. Similarly, in writing The Bell Jar, Sylvia Plath pours her personal experiences into the character of Esther Greenwood, a young woman who finds herself trapped by a profound depression. Her illness brings her in the path of a never-ending train of electroshock therapy and medications. The novel sheds light not only on mental health issues but also on the long list of other psychosocial factors keeping Esther from feeling the same freedom she believed men possessed. Plath herself committed suicide soon after the publication of her now-classic novel, perhaps for reasons mirroring the very oppressive forces supposedly keeping Esther down.

The century-old myth of Melampus paints black hellebore to be a symbol of female oppression, a kind of subservience in chemical form. Perhaps the flower can be better understood to represent female strength, an object of beauty and fragility but also an object with the power to crush oppressive forces that have served to keep women down for centuries. Characters like Esther and Bertha illustrate history’s tendency to label women who are “different” as women who are “insane.” Their experiences beg the question of whether this perceived insanity was yet another manifestation of stereotypes women have faced for most of history. Hysteria, addiction, neurasthenia and schizophrenia are only a few of many mental health issues that have historically been relegated to the world of women, a trend that perhaps reflects a path of least resistance and a path in which medicine has historically been able to over-simplify rather than truly understand. Women of the past, both real and fictional, have provided countless example of the dangers of gender inequality as it relates to the issue of mental health. However, with hope, their examples will serve as the impetus that medicine needs to continue to make progress, to continue to equalize the playing field, and to continue to ensure that the mistakes of the past are never repeated.

Photo credit: Photograph by jacki-dee.

Arya Shah Arya Shah (2 Posts)

Contributing Writer

Mayo Clinic School of Medicine

I'm currently in the Midwest at the Mayo Clinic School of Medicine and hoping to pursue a career in psychiatry, neurology or some combination of the two. What gets me through the cold, dark Minnesota winters is my writing, my hot yoga, and my perpetually growing to-do list of art projects. In continuing to pursue creative endeavors, and in working to engage my classmates in the arts, I hope to show people that creative expression can help to keep burnout at bay and help to keep humanism alive in medicine.