16 November 2023

Catch Type 2: Analyzing Anti-Psychiatry Through Its Most (In)Famous Researcher

By placing pseudopatients within a mental hospital to see if they were distinguishable by staff, David Rosenhan sought to expose staff’s reliance on diagnoses over patient symptoms and actions within 1970s American psychiatric facilities. His research focused on validity, but his results were anything but. 

In 1973, Rosenhan published “On Being Sane in Insane Places” in Science, a well-regarded scientific academic journal. He begins his piece by asking the reader how, or if, one is able to “tell the normal from the abnormal”, or the sane from the insane. Thomas Szasz likens mental illnesses to diseases, writing in his 1961 The Myth of Mental Illness, “We are accustomed to believe that diseases have ‘causes,’ ‘treatments,’ and ‘cures.’ If, however, a person speaks a language other than our own, we do not usually look for the ‘cause’ of his peculiar linguistic behavior.” Rather than pathologizing behaviors and searching for a cure, Szasz argues that clinicians and psychiatrists should rather ‘learn’ from the patient and find ‘meaning’ within their actions “[t]o understand such behavior”. However, Rosenhan wished to go a step further than learning from the patient—instead attempting to live from the perspective of one. He assigned eight pseudopatients (that is, people Rosenhan deemed sane and unneeding of psychological treatment) with differing jobs, ages, and lifestyles to be admitted into mental hospitals by speaking of identical symptoms of “hearing voices” that only said the words ‘empty’, ‘hollow’, and ‘thud’. Upon their admittance, the individual was to cease their falsified delusions and act just as they would in their daily lives. Rosenhan, who participated himself as one of the eight, was influenced by the growing popularity of the concept of anti-psychiatry. He includes in the introduction to his article, “Psychiatric diagnoses, in this [anti-psychiatry] view, are in the minds of the observers and are not valid summaries of characteristics displayed by the observed.” Thus, he set out to determine the connections between clinicians’ reliance on specific symptoms of psychological illnesses and the possible distortion of the patient’s behaviors by the staff that cared for them. David Cooper was the first to use the term ‘anti-psychiatry’, speaking at length in his 1971 Psychiatry and Anti-Psychiatry of the harm that therapeutic and psychiatric treatment had upon individuals. The anti-psychiatry movement stemmed from ideas of oppression and power misuse in the relationship between the doctor and the patient. “For the first time in American history”, writes Norman Dain, ex-psychiatric patients of mental health facilities:

created their own organizations; they openly expressed their anger and hurt; they denied that the therapies offered them were either effective or appropriate; they insisted that they were the best qualified to pass judgment on how they were or should be treated; they sought to establish their own programs as alternatives to hospitals or community mental health facilities. 

Writings and studies by psychiatrists embracing these ideas of both power imbalance as well as operational change, Nick Crossley writes, were a “‘revolt from above’; that is, a revolt within the ranks of psychiatrists themselves.” Rosenhan was one of the figureheads within this sphere of thinking, and by his (in)famous study “appearing in the most prestigious of places” such as Science magazine, it was more accessible to laypeople and the greater public. It was also mentioned in “at least 70 newspapers”. However, 2019 revisitings into the realities of this study have greatly shifted the academic view of Rosenhan from a psychiatric trailblazer into a “thoroughly dishonest, scientific scam”. How did Rosenhan’s work within the anti-psychiatry space affect approaches to modern mental health treatment, and how did his practices warp just the thing he set out to change?

In his well-known ‘anti-psychiatry’ text Asylums: Essays on the Social Situation of Mental Patients and Other Inmates, Ernest Goffman discusses the types of ‘total institutions’ that exist throughout society. Like Rosenhan, Goffman was a self-proclaimed ‘sane’ man who placed himself in a mental hospital in order to observe the facility from the perspective of a patient. Total institutions are defined by, writes Dr. Seamus Mac Suibhne, “social settings in which every aspect of the inmates is dictated and controlled including, as well as the asylum, prisons, boarding schools, ships and monasteries.” 

Rosenhan’s stint in a total institution led him to the conclusion that diagnoses are unreliable, that patient behaviors are warped by clinicians who are “influenced by their [the patient’s] initial diagnoses”. Rosenhan likened this phenomenon of an inability to detect sanity to “what statisticians call the type 2 error”, wherein the clinician provides assistance based only on the patient’s diagnoses, rather than their actions or behavior. A type 2 error is also known as a false positive.

Fifty years after the publication of Being Sane in Insane Places, investigative journalist Susannah Cahalan began to pick apart the validity of Rosenhan’s story. While it began as a biography, her 2019 book The Great Pretender came to fruition when she found herself unable to obtain records of the existence of any of the pseudopatients. After searching within Rosenhan’s own office, questioning his attendants and partners on the study, and searching various archives, Cahalan was able to track down only two of the supposed eight (while he listed seven pseudopatients within his actual study, one of those who was tracked down was originally a participant, but Rosenhan had “excluded him from the study for falsifying biographical information during his admittance examination”).

A major part of Rosenhan’s study was testing how treatments would differ when a patient was admitted. The controlled variable for this experiment was the use of the script he provided to his pseudopatients. However, Dr. Frank Barlett, who was responsible for Rosenhan’s diagnosis and admission, “revealed that he significantly violated this script”, claims Richard Griggs. Rather, Rosenhan exorbitantly exaggerated in his entrance meeting, including fabrications of a rough home life as well as placing “copper pots over his ears” while he complained about sound wave interference affecting his thoughts. 

Harry Lando, the man behind the pseudonym of the ninth pseudopatient, partook in the study, spending an entire period incarcerated within a public mental hospital. He “reported his positive hospitalization experience”, but after Rosenhan’s piece was published, Lando was banished to a footnote notifying the reader of the removal of the ninth patient. Cahalan argues that Rosenhan’s omission of Lando’s findings was purely due to its contradiction with Rosenhan’s thesis. Lando was released from the study, according to Rosenhan, for lying about his personal information during his entrance appointment. The observant reader will be able to note that Rosenhan committed this offense, arguably to a further extent than Lando did. The final layers of Rosenhan’s supposed hoax are heavily supported by Cahalan’s findings (or lack thereof). Griggs writes: 

Cahalan’s failure in her exhaustive search to identify any of them, and Rosenhan’s misrepresentations of other aspects of his study in the 1973 Science article led Cahalan to conclude that it is definitely possible that Rosenhan fabricated some (or all) of the pseudopatients and their data, making them pseudo-pseudopatients.

Upon Catalan’s searches of Rosenhan’s field, she discovered multiple partial manuscripts, assumably for a book deal that he had signed with Doubleday around the time of his rise to popularity. However, Griggs narrates, “Doubleday sued him [Rosenhan] in 1989… because he was already 7 years late in delivering the book. The book was never delivered. Why?”. Griggs argues that this is because Doubleday requested that he “add more detail to his vague descriptions of pseudopatients. If they did not exist, this would be difficult to do”.

“Too few psychiatrists and psychologists, even those who have worked in such hospitals, know what the experience is like. They rarely talk about it with former patients, perhaps because they distrust information coming from the previously insane,” Rosenhan writes as he introduces his study. One is almost able to see his thought patterns as they formed (if the perspectives of ex-patients are not reliable, then that of the psychologist must be!). Rather than advancing psychiatric knowledge, Rosenhan’s experiment set the study of mental health arguably decades back. In Ken Kesey’s well-known novel One Flew Over the Cuckoo’s Nest, a staff member of the mental facility that houses protagonist Randle McMurphy coldly refers to the latter as “simply a shrewd con man, and not mentally ill at all”. The same could be said for Rosenhan, if Cahalan’s findings are correct. 

9 November 2023

Writing as Rebellion: The Role of Detachment within Psychiatric Patient Memoirs

After the public outcry following the suicide of famed author Primo Levi, William Styron wrote, “the pain of severe depression is quite unimaginable to those who have not suffered it”. Therefore, how is the experience of mental illness condensed and consumed by historians, physicians, and laypeople alike who have not had first-hand occurrences of neurological or mental disorders? Through the “mood memoir”, answers Katie Rose Guest Pryal, which she defines as “narrative-based responses to the rhetorical exclusion suffered by the psychiatrically disabled”. Psychiatric differences, even if not physically visible, “mark a person as unreasonable or incapable of rational thought”. Their writings either done while incarcerated at a mental hospital or about their time there can therefore be easily be misconstrued as ‘hysterical’ ramblings rather than “subjective accounts” on mental illness. Rather, mood memoirs serve as a way to “describe their illnesses… seizing the authority inherent in the act of describing for themselves—implying that patients, not just doctors, are capable of describing symptoms and their attendant suffering”. In Susanna Kaysen’s 1993 memoir Girl, Interrupted, she analyzes her time in the mental hospital, where she spent nearly two years between the ages of 18 and 20. She describes the atmosphere of the hospital as a “parallel universe” that “exist[s] alongside this world and resemble[s] it, but [is] not in it”. In this special realm, every behavior is pathologized: 

They had a special language: regression, acting out, hostility, withdrawal, indulging in behavior. This last phrase could be attached to any activity and make it sound suspicious: indulging in eating behavior, talking behavior, writing behavior. In the outside world people ate and talked and wrote, but nothing we did was simple. 

Kaysen uses symbols throughout her text to display the angst of both herself as the narrator and of the girls around her. She describes the ‘seclusion room’, its walls worn “as though somebody had been at them with fingernails or teeth”. She describes the scene of nurses and onlookers viewing the user of the seclusion room “like looking at a cake through the glass of the oven door”. Continually, Kaysen returns to methods of distraction or detachment from either the present or from the individual self during inpatient treatment. Symbolism and deriving meaning through objects serve as vessels for the “content expert” to explain their feelings and experiences to those who cannot comprehend the internal behaviors and sufferings of one whose life is ruled by mental illness. How are the themes of dissociation and detachment, and established and manifested throughout psychiatric patient memoirs by meaning conversion through symbolism? Does the meaning shift when the writer has recovered?

In retelling psychiatric narrative, the writer’s detachment from their pain is essential in order to show a personal gained insight and establish a frame of reference. Psychiatric mood memoirs help bring together the storyteller, who has experienced great psychological pain, and the further education of clinicians so will use these details to advance their own study. In Lizzie Simon’s memoir on her struggle with mental illness, she interviewed many other people worldwide who have been diagnosed with bipolar disorder, like herself. On this, Simon writes, “We do not share the same illness, for we each experience it differently. But we do share the same diagnosis”. Angela Woods’s work on first-person stories featured in Schizophrenia Bulletin highlights memoir fragments from people with schizophrenia. “The constellation of schizophrenic symptoms includes experiences of depersonalization and derealisation, hallucinations and delusions, and disorders in the realms of perception, sensation, cognition and emotion”, Woods writes, revealing that every case of schizophrenia or schizophrenia-like activity portrays itself differently. Detachment, though, as seen in the writings of current patients, can be forced by way of medication, with the goal of silencing the patient. K. Pushpa, one of the patient memoirs featured in “First Person Accounts”, notes that she and others in her circle are given “coma injections” medication with the goal “to make a patient disappear!” Pushpa also backs up her indication of medication as a tool of distraction rather than of assistance by noting that she will wake up after an unknown amount of time, unaware of where she is or what has happened in the period between taking the medication and the present. Woods comments on Pushpa’s story that she “would be viewed by clinical readers as lacking insight and still in the ‘grip’ of delusional thinking”. Here, detachment from Pushpa’s situation is evident, but it is forced by way of chemicals. 

This contrast helps to establish a difference between the mood memoir that serves to “inscribe herself, represent herself in the text” and “mad writing”, as Woods referred to Pushpa’s piece. In order to be classified as a mood memoir, Woods claims that the piece must contain an “awakening moment” where the author realizes their mental illness or even that they need to seek out treatment. Woods also highlights the concept of ‘grand rounds’, a medical school exercise of closely examining a case study in a group setting. In this analysis, Marcia Murphy is asked to leave just after sharing her story of “bec[oming] psychotic”, while doctors and medical students debate on whether she has been ‘cured’ or not—she is therefore inserted as the object within the telling of her own story. Here, Murphy is forced to disconnect herself from her own narrative, with Woods adding that grand rounds “requires that the patient take up a position of clinical scrutiny and detachment with respect to her own experiences”. Rather, the audience (which is made up of either working psychiatrists or psychiatric students) debates and decides upon the meaning of Murphy’s story. In these two cases of Pushpa and Murphy, methods of detachment are seen. However, Pushpa, who at the time of writing was still in inpatient treatment, sees medication as a form of silencing, while Murphy is using it as a tool to further medical education. 

In Charlotte Perkins Gilman’s “The Yellow Wallpaper”, the unnamed narrator is suffering from “temporary nervous depression” and “a slight hysterical tendency”. Her husband, John, is a doctor and is often out of the house on work, sometimes until late at night. The narrator reports, “John says the very worst thing I can do is to think about my condition…. So I will let it alone and talk about the house.” She goes on to write of the beauty of the property that the couple are renting for the summer, the elegant gardens and woods surrounding the estate that she sees from the window, but barely ever explores. Rather than focus on her mental illness, the narrator decides to center her obsessions onto the atmosphere around her. This has an inverse effect, however. John chooses a room for the narrator to sleep in, ignoring her pleas for one of the prettier rooms downstairs, believing that “nothing was worse for a nervous patient than to give way to such fancies.” The chipped and shredded yellow wallpaper that coats its walls leaves her with an instant distaste, as she writes, “The color is hideous enough, and unreliable enough, and infuriating enough, but the pattern is torturing”. After a month or so spent nearly locked inside the summer house, she notices that the curious patterns in the wallpaper are because a “woman behind shakes it”. All night, the narrator watches the woman move the wallpaper around, losing sleep so that she may catch sight of the culprit. She also claims, “I can see her out of every one of my windows!” The narrative ends with the protagonist stripping off all of the wallpaper that she is able to reach, in her mind freeing the woman trapped inside who is being forced to create these patterns, but also freeing herself, as she no longer has to concern herself with the grotesqueness of the decoration. This action serves as an example of the consequence of the narrator’s being told to ignore her depression, as John believes that her feelings will dissipate in time. Like Pushpa, the narrator’s treatment is a rotation of pills that she is instructed to take “for each hour in the day”, the only effect of which is to make her tired. The yellow wallpaper stands as a physical reminder of her husband’s stubbornness in distracting herself from her illness rather than actively working to get better, and ripping it down serves as a practice of retaliation. 

On Gilman’s short story, Diana Price Herndl argues that the narrator “begins to retreat to the dyadic, hallucinatory realm of the pre-linguistic imaginary” as she is continuously not being taken seriously by her husband or family members. Given that she rarely leaves the confines of the ‘ancestral hall’, the passing of her days is only apparent when her husband leaves in the morning and returns in the evening. Other than that, there exists no change in her daily schedule. John forbids her from interacting with “stimulating people” such as her cousins or passersby, so she seems to have no contact with those in the outside world other than Mary, a woman who watches over the couple’s baby.

Kaysen uses the act of dissociation dually—through both the perspective of the current patient as well as the afterthoughts of herself as the writer. She writes that, as an individual suffering from suicidal ideology, “it’s important to cultivate detachment. One way to do this is to practice imagining yourself dead, or in the process of dying.” In order for a ‘successful’ suicide, one must work to “achiev[e] the proper distance” between oneself and the world. The presence of detaching oneself from reality is evident in the experiences of others in the same ward as Kaysen. Polly, one of Kaysen’s acquaintances, has scars all over her face and body from a ‘failed’ suicide attempt. Kaysen, in her first remarks upon entering the ward, notes that Polly acts happier than any of the other girls. However, about a month into Kaysen’s stay, it seems as though Polly looks at herself for the first time since the incident, her person disfigured from burn tissue. In this episode, she realizes the permanency of her actions, and screams continually “‘My face! My face! My face!’”. Kaysen notes that while she and others around her have no physical marks of mental illness, Polly is “locked up forever in that body”. Polly will never have the opportunity to separate herself from her past actions, and Kaysen, who tried to overdose with painkillers and survived, does and has. 

Additionally, Kaysen sees the student nurses, who only stay for a few weeks at a time, as foils of herself and the other girls in the ward. She writes, “when we looked at the student nurses, we saw alternate versions of ourselves. They were living out lives we might have been living, if we hadn’t been occupied with being mental patients.” Rather than treat the student nurses with angst and aggression as they do the aides (who are often older and stricter), the girls ‘controlled’ themselves and worked to have conversations of care. The ability to control themselves around the young nurses, whom the girls see similarities in, further calls attention to the component of detachment. Whether the detachment in Kaysen’s case due to traits of her diagnosis borderline personality disorder or the gap of almost thirty years between her inpatient stint and her writing on it, she is able to look back on her experiences with both insight and integrity. 

The element of selflessness involved in detaching oneself from their own narrative of mental illness or inpatient treatment creates a “reliable observer of experiences”. The aforementioned mood memoirists have employed an intuitive view upon their own experiences which allows for their stories to, firstly, be told and shared, but secondly, used for bettering clinical understanding of psychiatric illness. Additionally, there is no third party (either doctor, psychologist, or sociologist) that could interfere with or misconstrue their past situation. In a newspaper article published twenty years after “The Yellow Wallpaper”, Charlotte Perkins Gilman wrote briefly on what had driven her to share this story. When she consulted a “noted specialist in nervous diseases, the best known in the country”, she was prescribed what she refers to as ‘the rest cure’. The clinician defined this as to “live as domestic a life as far as possible…, have but two hours’ intellectual life a day…, and never to touch pen, brush or pencil again as long as I lived”. For three months, she obeyed his orders, but, five years later, in 1892, “The Yellow Wallpaper” was published, based on Gilman’s own life but with “embellishments and additions to carry out the ideal”. In this article, she notes the significance of her short story: “It has to my knowledge saved one woman from a similar fate—so terrifying her family that they let her out into normal activity and she recovered.” Gilman, when writing, intended its interpretation as not a work of feminine hysterical fantasy, but instead as a device to show others that mental illness is common and “to save people from being driven crazy, and it worked.” In the creation of these stories, “Writing separates her from the unbearable presence of experience by representing it as other, as that which is written”, adds Herndl. When the writer creates from their own personal experience, embodying their role as the protagonist within their own narrative, the act of detaching oneself from their narrative serves dually as remedy but also as empowerment.

2 November 2023

“A silent tug of war”: An Exploration into the Duality of Illness Narrative and Psychiatric Records

During the late nineteenth century, asylums served as a place of rehabilitation for those who were unable to survive on their own. Typically, the inhabitants of these institutions were deemed ‘insane’ or ‘mad’, due to their differences—even if their problems were not neurological, as those labels suggest. The patients of mental hospitals were often ostracized from their original communities due to their unordinary actions or activity. However, the treatments they would receive in these facilities would vary. Benoit Majerus’s “The Straitjacket, the Bed, and the Pill” establishes that the study of material culture of objects within asylums must be contextualized with historical records or narrative accounts. The item, often of restraint, cannot stand alone to shed light on life in nineteenth-century mental hospitals. An object such as a straitjacket, without corresponding interpretation, might be used to tell a story of insubordination and violence rather than fear or even confusion on behalf of the patient. Majerus writes, “Psychiatric textbooks and historians’ written accounts, however, remain largely silent on practices – duration of confinement, patient’s personal experiences, therapeutic goals – involving the straitjacket”. Academic literature alone cannot tell the full story. In John Haslam’s 1810 writings on ‘medical tortures’, his long-tenured patient James Tilly Matthews noted that the negative thoughts that he experienced, stemming from his mental illness, are due to “one of these villains sucking at the brain of the person assailed”. Dr. John Conolly, amidst his 1842 study of the patients at Hanwell Asylum, proclaimed that his work could only continue if restraints were removed, “thus permitting the student to contemplate disorders of the mind in their simplicity, and no longer modified by exasperating treatment”. Restraint, either by physical or chemical means, in these facilities served as a way to silence patients, or coerce them into enacting certain behaviors. In the late twentieth century, discourse erupted among historians “centered on whether the development of the asylum in the nineteenth century represented the apogee of enlightened care for people afflicted with ‘madness’ or whether it reflected the desire to impose social order on an increasingly disorderly and unstable society”. With the officers and medical staff acting as controllers of the hospital and its surrounding environment, reprimanding and strictly governing patients through record-keeping and restraint was a tool of domination over the residents. In archives today, the majority of what physically remains from these institutions is these notes penned by the asylum staff. However, these notes fail to include information from the patient’s perspective. In order to properly analyze the experiences of these patients in their own words, Hazel Morrison writes that one must “look past the cultural framing of insanity, towards the interpersonal relations that exist between object and onlooker”. So, in order to gain insight into the worldview that loomed within these enclosed asylums, there exists a further, yet related, query: which should be relied upon for information on the occurrences and feelings of patients who dwelled in these hospitals, the personal journal entries of those individuals or the medical notes and records kept by their captors?

John Thomas Perceval, the son of British Prime Minister Spencer Perceval, was once deemed insane, but was released on good behavior after a three-year sentence in various asylums. At age nine, he personally witnessed his father’s assassination inside Parliament, the only incident of a sitting Prime Minister ever to be murdered. Perceval’s own siblings, who were not present for their father’s death, believed that this experience led to his descent into madness. “I dare not in a lunatic asylum express my feelings as my nature requires, for fear of misconstruction or calumny, from dread of being called lunatic, and having my dreadful confinement lengthened”, Perceval writes in his 1840 memoir, describing his first few days spent incarcerated. He includes passages on physically harming himself in order to “be delivered from various demons”, the result of which he states is to be “raised to life again”. To Perceval, surviving these injuries but becoming neurologically impaired would provide the same ease as death: his madness would cease. He provides further descriptions of his treatment: rarely being provided water to wash up or bathe, being beaten with sticks, switches or forcefully thrown against walls, and near-constant restraint in shackles and ‘straight-waistcoats’ for a period of around eight months. However, Perceval remains unsure of what his immediate family was actually informed about in regards to his condition and treatment. He notes that he “twice made water of a morning in my bed up-stairs; I suppose my brother was informed of this—but not that I was confined hand and foot, and tied down in my bed, so as to make it impossible for me to use a chamber-utensil” for the entire ten hours where he was allowed to sleep. In his 1840 text An Inquiry Concerning the Indications of Insanity, Dr. Conolly wrote that if restraint is overdone by the asylum staff, then the behavior is continued, and “the case becomes chronic”. In Hanwell Asylum, he found that “every attendant used [restraints] at will”. Dr. Conolly also assisted with promoting the study of insanity in asylum settings, believing that actually speaking to or observing asylum patients is more useful than reading the notes of their doctors. 

In his analysis of James Tilly Matthews, Haslam lists the dozens of ways that Matthews believed that either medical staff or an ‘outside gang’ would “extract his existing sentiments”, such as by “sudden-death-squeezing” or “bomb-bursting” (the procedures that these routines entail tend to match the grotesqueness of their names). To Matthews, various gasses were being forced into his system through a long-distance “air-loom machine” which could involuntarily ‘bomb-burst’ him. Further, Matthews informed Haslam of “brain-sayings” that were sent to him by the gang, a way of remote communication through brain waves by way of the insertion of “magnetic fluid” into the brain. Additionally, Matthews experienced “dream-workings”, where the torment of his mind continued, even in sleep. Matthews, however, was able to verbally describe the air-loom machine, which Haslam illustrates and recounts in his book. While Matthews seemed to be eloquent or even well-read, Haslam concludes his book by declaring that Matthews, and other “mischievous lunatic[s]” with similar illnesses “ought not to be at large”. While Haslam refrains from diagnosing Matthews within his piece, his visions and delusions seem to be reminiscent of today’s concept of paranoid schizophrenia. While his hallucinations were not corporeal occurrences, the usage of Haslam’s platform to spread the content of Matthews’ episodes allowed scholars and historians to learn of schizophrenic visions and behavior in detailed description for the first time. Similar to Matthews, Charlotte Murray, posthumously analyzed by Hazel Morrison, exhibited “schizophrenia episodes”, where she would rapidly flip between periods of “variable” behavior. During her introductory physical upon her admission in 1929, she spat on the medical assistant and nun who were conducting her exam, then sat calmly and spoke of the “coming of Heaven, [she] said this was a preparation for Heaven”. Morrison argues that the interpretation of Murray’s experiences will forever be censored through the perceptions of the staff, writing, “From within pivotal moments in a patient’s confinement, such as the physical and mental examination, the actions, emotions and volitions of patients such as Miss Murray were therefore bound to the narrative structures and routine techniques of psychiatric case note taking”. An essential element of psychiatric study is the inclusion of the narrative from the perspective of the person experiencing the affliction. Therefore, historians and doctors alike are more easily able to view the patient as a fellow human instead of a case study.

“It is true, a Doctor may be blind, deaf and dumb, stupid and mad,” Haslam wrote, “but still his Diploma shields him from the imputation of ignorance”. Racist theories or personal biases were both threaded within and accepted as medical language during the time of Haslam’s work. No two asylums of the late nineteenth century were run in exactly the same manner: their routines, instruction, social organization, and culture were wholly determined by the ideals of the officers or wardens who managed the hospital. Martin Summers writes that asylums could be perceived as “vehicles for ‘state racism’”. During this time of discussions of insanity amongst Africans, sociologists believed that madness in black people stemmed from a “lack of civilizational advancement” that made them more susceptible to mental illness. After the emancipation of enslaved peoples, physician W. M. Bevis offered that the shift from the “primitive level” to “an environment of higher civilization” was “more traumatic for enslaved blacks than enslavement had been for Africans”. However, in William A. F. Browne’s 1837 What Asylums, Were, Are, and Ought to Be, he writes that “derangement is no longer considered a disease of the understanding, but of the centre of the nervous system…. The brain is at fault and not the mind”. While the usage of medical records to analyze historical cases of mental illness is more convenient, traditional narratives and firsthand patient experiences must also be utilized. The details of their accounts may be tainted by delusions of madness, but the retelling of patient narratives helps to broaden clinical understanding of mental sanity through the mind that actually lives the illness, not just by those who study it.

26 October 2023

“The Clash of His Two Worlds”: Psychiatric Dominance Under Colonization

During Britain’s attempts to infiltrate the culture and beliefs of multiple African countries during their colonial reign, English officers tried to shift the people’s perception of illness, both mental and physical, through decades of medical assimilation. Two categories of treatment seem to exist that were provided to mentally unwell individuals in the African colonies by the British administration – either providing rehabilitation to those in need or placing them inside a prison-like asylum. Frantz Fanon exists as an example of the former, with Richard Keller referring to him as, “a figure who embraced the most subaltern of the subaltern – the colonial insane – and attempted to guide them back to humanity and to community in a hostile world”. Fanon was a psychiatrist and thinker from the island of Martinique, a colony of France. While receiving medical training in Lyon, France, he realized how rampant racism had been engrained within the practice of medicine in Europe and Northern Africa:

He [Fanon] noted with dismay his teachers’ frequent reference to a vague, generalized malaise that they saw as common among North African immigrants, which they considered to be imaginary symptoms of malingering subjects rather than signs of true illness. Fanon argued instead that the illness was a somatic manifestation of psychological pressures placed on a marginalized population suffering in a contemptuous host society. 

Here, Fanon suggests that the psychological effects of colonialism are so strong that the colonized not only physically or emotionally suffers (from physical pain or stress) but also mentally. In Erika Bourguignon’s analysis of differences in cultural treatments for multiple personality disorder, she quotes George Devereux’s idea of the “psychic unity of mankind”, saying, “in a given ethnic group, a particular idea can surface unconsciously and be culturally implemented, while in another it occurs only on the unconscious level and finds no direct cultural expression”. In what ways did colonization affect mental illness and mental health care, specifically in early twentieth-century Africa under British colonial rule? And how did it differ from that of the British/European colonizers? 

An anti-African prejudice is common in primary literature on colonial psychiatry which, during its time, was explained away as medical vocabulary. One of these examples is that of the “normal” versus “abnormal” verbiage that exists in determining the “two cultures” that existed within a single community. The madness exhibited by the ‘normal’ African is, as Megan Vaughan notes, “relatively harmless. If he thought himself possessed by evil spirits, or the victim of witchcraft…this was only an extension of the beliefs and ‘irrationality’ of his own society”. Whereas, the ‘abnormal’ African person, also deemed “detribalized” by J. C. Carothers in his 1955 assessment of the Mau Mau rebellion, was seen in the eyes of the colonizers as “[t]he real problem… whose ‘brains had been turned by a little schooling’, the idioms of whose madness were motor cars, bicycles, kings of England, and silver mines; who flung back at the conquerors their own images of superiority in disturbingly distorted forms”. 

Widening these determinants beyond the scope of madness, the dilemma between following either Christ or Mwari could be seen along these same guidelines. Here, Christ represents the ‘detribalized’, who were often educated by missionaries passing through, while Mwari of the Shona religion represents those who continue to follow the spiritual rituals of their ancestors. In his anthropological narrative of a South African man named John, Wulf Sachs refers to this split as “the black man’s conflict”. “On the one hand he loved the white man’s life, loved civilization,” Sachs writes. “On the other hand, he was bound by his profession to his past, for he was destined to perpetuate his father, the great nganga.” In his analysis of Sachs’ book, Black Hamlet, Saul Dubow notes that John’s double life was “particularly severe” in comparison to others around him, as John’s father is “a very famous witch doctor” and he was expected to take up his father’s profession. In the eyes of the British colonial administration, “the normal African is a ‘lobotomized European’”. Rather than a mental hospital, patients seeking mental health treatment were “incarcerated” in prison-like wards, where the “over-excited minds soon calmed down”. Instead of offering rehabilitation, the attendants in these wards, who were often prison officers, neglected and undernourished their inhabitants, and “were taught to ‘deal with patients as sick individuals who can usually be humoured into doing what is wanted of them’”.

The Zomba Lunatic Asylum first served as an annex of the nearby prison where both criminal and non-criminal patients were “kept in separate cells”. When a patient acted disagreeable or violent, they were “locked in special rooms or restrained with handcuffs fastened to leg irons” or were treated with sedatives. Additionally, the asylum functioned without a psychiatrist on duty for the first forty years, “though he didn’t stay long”. Rather, “most cases of mental disturbance continued to be treated by Africans themselves in traditional ways”. Vaughan notes that Shelley and Watson, researchers of the time on colonial psychiatry, believed that the root cause of mental disturbance within the African colonies was “the presence of absence of European interests”. Similarly, the “collective instability” amidst the “mania of 1911” was observed to have been brought on by solely the sight of Europeans clad in pith helmets: “natives in the neighborhood of Machakos tried to avoid the attacks – when they saw a European in the distance – by wrapping their blankets over their faces till he had gone by”. The association by the colonized of Europeans with violence seemed to have been so strong that it resulted in epileptic-like episodes upon simply catching sight of the enemy, however, ethnologist Gerhard Lindblom believed that the collective mania was a tool “directed specifically against the government”. Further, Sloan Mahone writes in their essay on the psychology of colonial dissent that the “the colonial administration’s inability to recognize such ‘rebellious types’ for what they were ultimately led to the British government’s famously ‘psychologized’ interpretation of the Mau Mau rebellion”. The interpretation referenced here, penned by Carothers in 1955, portrayed the Kikuyu people that led the revolt as people with a “tremendous power for good or evil”, spurred on by their “bitterness” and “insecur[ity]” in the wake of a loss of land, and therefore, loss of power against the British. Carothers also writes of the harshness with which Kikuyu men treat their wives as well as their use of witchcraft “as powers of evil for personal ends”. Instead of being viewed as an act of nationalism and protection against the European colonizers, the rebellion was perceived as “the incidence of mental disturbance” abruptly shut down, with the colonial administration committing mass executions by hanging. 

Examining the collision of worlds experienced by many peoples under colonial rule in Africa, the acts of both violence and attempts of assimilation led the ‘normal’ and ‘detribalized’ individuals to “stradd[le] conflicting worlds leaving them virtually on the brink of madness”. This struggle can be viewed in tandem with the deculturation thesis, on which Dubow writes, “This suggested that African psychopathology resulted from an inability to cope with the breakdown of ‘tribal’ restraints, and the strains imposed by the demands of western education and cultural values”. In John’s confrontation, Dubow notes that his “sense of frustration is greatly exacerbated by the efforts on the part of whites to ‘keep him down’”. The dominance that the colonial administration held over the African colonies was so substantial that public opposition to imperialism was considered a form of mania, “in which such behaviours could become infectious, even epidemic” in the eyes of the British. The mental wellness of African people living under British colonization was affected unquantifiably by the pressures of assimilation, the risks of speaking out, and the immense burden of oppression.

19 October 2023

Now I Know How Joan of Arc Felt: Retrospectively Examining the Relationship Between Medieval Neurological Impairment and Religion

When retroactively diagnosing historical figures, we must first explore how physical illness was approached and defined during the Middle Ages. Hippocrates’ De Morbo Sacro, which was written around 400 B.C.E., was one of the first written medical works to steer away from the idea that illness, especially (what we know today as) epilepsy, is induced by a god or by spiritual encounters. Rather, the author writes that diseases are natural occurrences and that epilepsy, while differing from other ailments, is caused by the brain. He also notes that the powers of wind and air may lead to an epileptic episode: “But the air which enters the veins is of use (to the body) by entering the brain and its ventricles, and thus it imparts sensibility and motion to all the members, so that when the veins are excluded from the air by the phlegm and do not receive it, the man loses his speech and intellect…”. Harold W. Miller, in his analysis of De Morbo Sacro, says, “At this point we must note that the doctrine of De Morbo Sacro very strongly suggests that its author almost certainly conceived of another natural force or element as “divine,” even though he does not anywhere in his work specifically define it at such. This natural element is Air”. Miller likens this take to Diogenes’ theory that “Air, with God, thus express[es] a new conception of the Divine”. While disease is spread through natural methods, Hippocrates and Diogenes both argue, the Air that assists with life is created by God, therefore defining it as not strictly divine, yet of godly creation. Almost two millennia after De Morbo Sacro was written, the application of religious thought to neurological disorders was still in practice in the sixteenth century. In the case of Saint Teresa of Avila, who seemed to have suffered from a seizure disorder, believed as a young girl that her episodes “might have been induced by the devil” and that “she might go to hell if she died from her illness”. Later, she referred to her episodes of fainting and unconsciousness as ‘raptures’ which she used to interpret messages from God. In the realm of retrospective diagnoses, there exists a “host of creative religious thinkers suspected or known to have epilepsy” – the raptures of Saint Teresa sit as just one example. So, how were neurological diseases, such as epilepsy or migraine, understood and managed by followers of the Christian religion?

Comparing historical records or personal writings of these figures to the criteria of modern-day neurological findings illustrates that some of the received divine visions experienced by early religious thinkers could have been epileptic episodes. The experience of these visions (specifically of those that result from neurological disease) was also viewed, during the times of occurrence, as a vessel for transcendent spiritual thought, uncontaminated by human or societal influence. In Joan Jacobs Brumberg’s research of anorexics in history, she notes that “the lives of women saints were characterized by extensive fasting and passionate devotion to the eucharist”. During the late Middle Ages, the female saints deprived themselves of food to both prove their faith and to gain an untampered and pure insight from God. 

Saint Theresa, who was born in 1515, described her episodes as ‘ecstasies’ which assisted her in “seeking God”. On this, she later wrote: “For when [God] means to enrapture this soul, it loses its power of breathing, with the result that, although its other senses sometimes remain active it cannot possibly speak. At other times… the body grows so cold that the body seems no longer to have a soul”. She also describes a secondary experience where she is receiving visual cues such as letters or words, but she is unable to verbalize them (or make any sense of them in the moment). However, her descriptions of being unable to breathe, losing consciousness, or lacking a sentient pattern of thought lead the twenty-first-century reader to believe that these actions are actually symptoms of seizures in the temporal lobe, argues Marcella Biro Barton. Her episodes, while at times physically harmful to her, assisted the internal development of her spiritual connection as well as fueled her mystical insights.

Joan of Arc, as a pious thirteen-year-old girl in 1425, was guided to “raise the siege which is being made before the City of Orleans” by, as she later recounted, “this Voice to my right, towards the Church… I recognized it as the Voice of an Angel.” This Voice was the main charge that led her, the poor daughter of farmers, to captain the French army against the English invasion. She was untrained in battle, warfare, or strategy and never received formal schooling, but was rather commanded forward by the Voice, as well as “apparitions of saints who advised her daily during her military career.” Joan’s reported happenings of both auditory and visual hallucinations could be linked to musicogenic epilepsy, writes Elizabeth Foote-Smith in her analysis of her visions: “Often when she was in the fields and heard the church bells ring, she would fall to her knees”. Further, during her public trial for betrayal, Joan of Arc recounted the times that the Voice would reach out to her, saying, “once in the morning at Matins, once at Vespers, and again when the Ave Maria rang in the evening”. If her supposed seizures were indeed induced by auditory signals, it would make sense that the timed ringings of church bells acted as a trigger, especially when Joan noted that she heard the Voice every day, without failure. The interpretation of these possible epilepsy-induced visions as insight or divine messages strengthened the spiritual devotion of the individual rather than leaving them to ponder the potential of physical hindrance.

Reexamining and navigating retrospective diagnoses is a difficult undertaking, as one must be aware of over- or under-pathologizing certain symptoms. We must also be wary, as historians, so as not to “mark an individual in a particular way”, thereby diminishing the individual purely to one facet of their identity. In his diagnosis of Saint Hildegard of Bingen as a victim of chronic migraine, Charles Singer writes that to logically detect illness using historical data and writing, one must “interpret the past in the light of present knowledge”. However, some of the processes, beliefs, and illnesses that were known in the past will never be fully understood today. The answer to what conditions or diseases that the previously mentioned historical figures suffered from will, disappointingly, remain unknown. Forever, claims can be made about what drove people of the past to make decisions, but it will be in tandem with a sense of skepticism.

Like us historians today, these saints were also unsure of the cause of their ailments. Physician and missionary David Landsborough asserts that Saint Paul of Tarsus, one of Jesus’ twelve disciples, may have suffered from temporal lobe epilepsy due to his physical descriptions of his body and the depth of his visions, which could be perceived as seizures. In the Bible, Landsborough writes that “Paul prays many times to be relieved of his infirmity, but his request is not granted. Paul accepts his infirmity (“weakness”): his spiritual resources make him strong”. Through God, Paul accepted his physical flaws, going on to use his attacks as a medium to “proclaim the glories of God”. Although she too experienced visions, which Singer diagnosed “as being migrainous in origin”, Hildegard ‘interpreted her illness as divine punishment”. Could she have viewed her pain as a trial from God, testing her strength? Did she believe that her illness could be redeemed, or possibly cured, if she continued to follow him? Again, historians will eternally remain unsure. Religion could have been perceived as a method towards a cure for their certain ailments, seeking answers through the only concept they could accept as truth – the Lord. 

12 October 2023

Nonconformity as a Diagnosis: Perception of Female Mental Illness in Victorian Asylums

For this paper, I drew from two chapters in Sources in the History of Psychiatry, From 1800 to the Present: “Psychiatry’s Material Culture: The Symbolic Power of the Straitjacket” by Sarah Chaney and “Patients, Practioners, and Protestors: Feminist Sources and Approaches in the History of Psychiatry” by Sarah Crook.

 In her piece, Chaney expands upon how written records (such as physical hospital reports and letters penned by patients or attendants) from Victorian asylums offer only paltry insight into the treatment and reality of life inside these institutions. In 1840, only half of English women and two-thirds of English men were literate, although partial literacy was fairly common during this time as well. Therefore, most surviving records only portray the perspectives of those who were able to read and write. Further, Chaney says, “Women and working-class residents – including attendants – did not usually write down their stories or leave reports or publications. However, the tools they worked with in laundries and workshops remain. So too does their needlework, from the uniforms they mended to the decorative samplers they worked”. This led me to wonder what the experience of mental illness was like from the point of view of the women held in these institutions, whose stories are rarely shared. How has the perception of female mental illness shifted over time? I have chosen to approach this topic in two separate yet similar ways both outlined in Sources in the History of Psychiatry: through a feminist lens as shown by Crook and through the analysis of material culture as featured by Chaney.

The term ‘hysteria’ itself derives from the Greek word hystera, meaning ‘uterus’. From its inception in the fifth century BCE, the illness has been directly associated with strictly female actions, with Plato noting that hysteria occurred when the uterus “became angry”. Women in Victorian asylums were often noted as having rowdy or manic tendencies – in mixed facilities, the “Female lunatics are less susceptible to control than males”, stated one patient at Glasgow Royal Asylum. Frederic C. Skey described hysteric characteristics in an 1867 study: “a female member of a family exhibiting more than usual force and decision of character, of strong resolution, fearless of danger, bold riders, having plenty of what is termed nerve”. The root of hysteria, scientists and doctors of the time decided, was the female reproductive organs. Further, pregnancy was almost a certain link to diagnoses of madness. Medical authorities of the time determined that ‘puerperal insanity’ occurred due to a weakened immune system after childbirth. Today, the symptoms of puerperal insanity would be similar to post-partum depression. 

In retrospect, the diseases of hysteria and puerperal insanity had such a grasp over Victorian culture due to the disruption to the domestic order that came in tow with madness. The nineteenth-century woman was, idealistically, the keeper of the children and household, in charge, but at the same time, lacking any power in comparison to her husband.

In Sigmund Freud’s 1905 Fragment of an Analysis of a Case of Hysteria, he writes of his conversations with and treatment cycles of his eighteen-year-old female patient, referred to by her pseudonym, Dora. In the introduction to Fragment of an Analysis, Dora is described as “suffer[ing] from a confusion of inclination toward men and women” and “unconscious Lesbian tendencies”. Freud diagnoses her with hysteria, due to her sexual urges and her inability to concentrate when retelling her dreams to him.

The treatment of Dora came to an end when she refused to accept Freud’s interpretation of her dreams – that her erratic behaviors stemmed from an inner jealousy of her father’s new relationship with another woman. On the infamous case study, Elaine Showalter writes that Freud was truly as an unreliable narrator in the telling of Dora’s story, saying, “He never understands her story at all and simply tries to bully her into accepting his version of events…. She never becomes a subject, only the object of Freud’s narrative”. The reader is never given any of Dora’s thoughts or dialogue – the piece is entirely told through Freud’s assumptions. Although the diagnosis of hysteria has been gendered since its establishment, a majority of received insight is through the reports of medical authorities, i.e. well-educated (and assumably white) men. “In the traditional discourse of psychiatric theory and therapy,” Mary C. Rawlinson writes on Freud’s ideas of phallocentricity, “the woman appears not as herself, but as the other for male experience, the mother of the object of desire”. 

The medical authorities of the time, almost often men, held such a position of power over people (who were either mentally ill or just diagnosed as such). The caretakers or doctors who worked in these facilities were entirely responsible for the well-being, lifestyle, and freedom of the patients. Further, women were “more liable to psychiatric diagnosis but were also more likely to be prescribed psychopharmaceuticals and were vulnerable to being sexually abused by their psychiatrists”. During the 1800s, women suffering from mental illness were basically never in control of their own freedom, whether it was at home under the spell of domesticity or at a mental hospital with a rigid routine and varied physical treatment.

As written records or letters from the asylums of the Victorian period rarely surface, historians may depend upon interpreting objects either left behind at or later unearthed from these institutions. Even with everyday objects such as hairbrushes or writing materials that would be common in mid-1800s homes, one must examine an object under the “shifting contexts through which it acquires meaning”. The shifting contexts in this case means that a specific object could incur different significance depending on the individual, and the situation that they were in. For patients who were held in mental hospitals for long periods, common things like soap bars were “begged for from friends and relatives as well as carefully guarded.” Erving Goffman argues that this practice of storing personal goods, either on their person or in small crannies around their room, helped to “generat[e] a sense of self for patients”, as they had items that belonged to only them and did not have to be shared with the masses as so many communal goods at these facilities often were. 

In a journal article on her exhibition of material culture at the Medical History Museum at the University of Melbourne, Catharine Coleborne explains her curating choices: “In order to explore my sense that writing about patients was an aspect of asylum bureaucratic control of them”, she chose to include “the ‘Lunatic Asylum Seal’, a ‘letter spike’ used to file papers…” as well as a “reproduced case-notes… the physical nature of these books, their size and obvious age”. The ability of authorities to write about and report on patients was an immense position of power, being that their prescriptions or observations did not necessarily have to be based on fact. Additionally, the exhibition contained a handful of leisure items, such as a few worn balls (assumably for sport) and tobacco paraphernalia. 

Another key piece included in this exhibit, however, was “A reproduction of a Patient Discharge Book from Beechworth Lunatic Asylum in the 1900s showed that patients, when finally discharged, were encouraged to write something about their stay in the institution. Some did not write their own ‘response’ but signed below a paragraph that agreed that the asylum had been a place of kindness and cure”. After their freedom into the outside world had been granted, the single goal that all patients had assumably been yearning for since their initial arrival, it is interesting to note that some individuals had nothing unique that they wished to share about their experience.

In the mid-1800s, the number of English asylums had rapidly multiplied in order to cater to the poor, not just to those who could afford quality psychiatric treatment. However, with the gap in cost also came a gap in standards of care. An 1872 census revealed that, due to this expanse, a little more than half of the people held in psychiatric asylums were women. However, men still “predominated among private patients of all categories and in registered hospitals, which were more expensive and selective than the asylums”. 

Inside the asylums, female hysteria patients who were deemed non-compliant were either silenced with a chemical like chloroform or ether, isolated, or fitted with some form of restraint. After the banning of mechanical restraints such as straitjackets around 1850, the usage of secluded padded rooms and physical handling by staff members took their place. For hysteria specifically, female patients were treated with vibrotherapeutics – including forced fondling by a vibratory massager, electropathic belt, or a hand-cranked electric coil device. Other options for treatment included marriage or sexual intercourse (but only with one’s spouse!). Hysteria, at this time, was thought to occur due to the “turgescence of blood in the uterus or in other parts of the genital system occasion[ing] the spasmodic and convulsive motions which appear in hysteria”, according to physician William Cullen in his 1796 First Lines of the Practice of Physic.

While the remedies offered from facility to facility were quite similar, the interior look of the mental hospitals varied extensively. Private asylums were much more costly than public facilities, therefore the former often appeared visually more attractive in contrast to the latter, which received much less funding due to its low (or lack of) cost. On private asylum interiors, Showalter writes:

In single-sex private asylums, ladies encountered a decor and a regime designed to remind them of home or school. The bedrooms [of an unnamed facility], according to an anonymous observer in 1850, ‘would be very much after the fashion of a ladies/boarding-school, with white dimity curtains and chintz hangings at the windows.’

While the inside description sounds elegant, the observer does not mention what the treatment consisted of, or if it contrasted with the glamorous furnishings. For a 2013 project commemorating the two-hundredth anniversary of the facility, Allan Beveridge examined over one thousand patient letters sent out of Royal Edinburgh Asylum. One of the most concerning letters is from a twenty-two-year-old woman referred to only as Miss Edilla D., which was written only three weeks into her stay. She writes:

I feel I cannot stand this place a minute longer and soon I shall lose the brains I had, and not be able to interest myself in others and everything that goes on in the world. The monotony and routine simply drives me wild… I feel I shall go on degenerating in this environment into an animal, that only lives to eat – as we do here! – and has not though beyond. For really that is all the ‘treatment’ consists of.

While it is unknown what Edilla D. was suffering from during her stay at Royal Edinburgh, her takeaways were not uncommon among other female patients. Royal Edinburgh was a private asylum and her assessment of her experience seems striking when compared to the stunning interiors as mentioned in other patient letters. Additionally, it was one of the more expensive mental hopsitals for the time, costing from ten to twelve shillings for a three-month stay, which in current day is about £1,278. However, one must also consider the potential for any mental illness they may have suffered influencing their perceptions of their environment and treatment. 

In 1963, Betty Friedan published The Feminine Mystique, criticizing the cult of domesticity and the prevalence of female oppression in the mid-twentieth century. She writes that women “were taught to pity the neurotic, unfeminine, unhappy women who wanted to be poets or physicists or presidents. They learned that truly feminine women do not want careers, higher education, political rights…. All they had to do was devote their lives from earliest girlhood to finding a husband and bearing children”. Rejecting the path of wifehood, motherhood, and care was not seen as an option for women during this period or any prior era for that matter. As Crook writes in “Feminist Sources and Approaches”, “Living in a culture that hailed the (white) suburban housewife as the apotheosis of feminine achievement… these women felt a quiet, low-level despair”. Friedan offered that, rather than the root of the problem being the minds of the women themselves, it was the culture that restricts women to an unfulfilling existence of subservience and acceptance of cultural norms.

Gendered treatment is still in existence in present-day psychiatric facilities, either through primary retellings, media coverage, or literature. In a 2017 study at a mental hospital in northern England, staff member John says about his experience restraining patients, “I think women are a bit more dramatic and they carry things on. Your male clients, they have an incident and it's finished, where the women could carry things on”. Rebecca Fish, one of the researchers on the project, notes, “Despite the described low-level risk of physical aggression, restraint was being used regularly with the women who participated in this study… All of the women commented that restraint did not help them to calm down”. All of the women interviewed by Fish about their past episodes that involved restraint described the experience as humiliating.

Another recent shift in societal approach to female mental illness is its invalidation or, even further, exploitation. A strong example of this is the case of pop star Britney Spears, who began her career as a teenager in 1998. She was harassed by photographers incessantly, who sold these pictures to newspapers, who would then write seemingly baseless articles about how she dressed, her partying and drug habits, or whom she was with. In 2007, she quite famously shaved off her full head of brown hair, then beat a nearby car with the end of an umbrella. “Spears' ‘erratic’ behaviour subsequently revealed, rather than covered,” film professor Milly Williamson writes, “this gendered paradox and made her an easy target for the celebrity-orientated media… female pop stars today are constrained in their image construction by a focus upon their sexuality that is not the case for their male counterparts”. The media at large seemed to be more interested in Spears’ turbulent life, mental breaks, and sexuality than her music.

On approaching the history of psychiatry with a feminist lens, Crook writes, “One debate is whether mental illness is a social construct that polices women’s behaviours in differentiated ways or if women’s mental illness is a result of their oppression in a patriarchal society”. In actuality, diagnosing mental illness in females during the 1800s to 1900s was so heavily dependent on whether or not one acted in accordance with social norms that the line was barely ever drawn between medical analysis and casual misogyny. Consistently in the medical field, women have been perceived solely through the eyes of the men who govern their existence.