Featured in the Making of the Modern World (MMW) Writing Showcase​ 2020. Awarded to the top <5% (out of over 4,000) of research papers written for the MMW course series at UC San Diego.

In 1885, Henry James, a renowned British author and sociologist, used his novel The Bostonian and its antifeminist character Basil Ransom as a vehicle to describe his and normative society's opposition of feminism, writing masculinity is “passing out of the world” and there is consequent ushering in of a “feminine, nervous, hysterical, chattering, canting age” (Miller 20). James’s characterization of the 19th century as both “feminine” and “hysterical” captured the reactionary and backlash medicalization of gender that marked 19th century England. Doctors disproportionately institutionalized women, connecting nonconformist behavior to hysteria or nymphomania. This paper will thus focus on how doctors and society attempted to explain womanhood and feminism through madness-tinted glasses, exposing the misogyny and the covert and overt methods employed to silence Victorian women. While the position that Victorian ideals were constructed to control women is well-written, there remains a research gap in medicine’s distinct role in physically and socially confining women (McKnight 38). With these ideas in mind, I have developed the question, “how did traditional conceptions and expectations of Victorian women and gender structures shape English medicine, mental institutions, and perceptions of madness in the 19th century?” to address the methods society and medicine employed to suppress female individuality and progress. Although argued to be the ideal way of life and a shield for women against psychiatric institutionalization, Victorian gender ideals in 19th century England were, in actuality, the significant drivers behind the medicalization of gender through establishing an imbalanced gender dynamic within the medical field, a standard of behavior and appearance, and a ‘biological’ link between feminism and madness. 

Before delving into the methods of medical oppression employed by doctors to assert male dominance, one must first establish the sociocultural and political context to develop an informed position and foundation. Writing on the values of Victorian wives in her manual The Wives of England, Sarah Ellis declared a wife should “make up her mind to be forgotten…[and] to many rivals too,” calling for women to stay obedient and withhold personal desires or opinions (221). Ellis also reveals a disparity in social freedoms, where a husband could have relationships with his wife’s “rivals”–other women. Also, John Ruskin, a 19th century English sociologist, saw a “true wife” as one that stays within the home because it protects her from illness (148-149). Ruskin framed ambitious women as vulnerable to hysteria and believed female ambition translated to a failure in being a “true wife.” Historically, this era was fraught with false dawns of progress, such as the 1857 Divorce Act, which stipulated husbands “had to prove simple adultery” but wives “had to prove adultery” and “cruelty or desertion” (Savage 103). While seemingly granting women greater access to legal counsel, the act bolstered traditional values and perpetuated female servitude to men, as we will see in Mary Shaw’s story. The 19th century also marked the rise of science and fall of what Benedict Anderson calls the “dynastic realm” and “religious communities” (12). Science and medicine ended religion’s monopoly on how we comprehend history and logic, assuming a credible and powerful role in determining what’s rational and true. Thus, when acclaimed gynecologist Dr. William Acton described the perfect Victorian wife as one who reveres childbearing and lives to serve men, this was understood as a medical fact (135). It is therefore the abuse of medicine’s role as a source of rationality and objectivity that we will henceforth examine. 

To start, Victorian society drove the medicalization of gender through establishing an imbalanced gender dynamic in the medical field, making women the permanent patient. Purely looking at 19th century British psychiatric institutions’ enrollment numbers, the gender disparities are clear: “by 1872, out of 58,640 certified lunatics…31,822 were women” (Showalter, “Victorian” 160) and over 50% of the patients in Buckinghamshire County Lunatic Asylum, a typical asylum, were female (Wright 161). Through the mass institutionalization of women, psychiatric internment became genderized, creating an automatic association between insanity and women, thereby making the words “woman” and “patient” synonymous with each other (Ussher 64). Furthermore, traditional gender roles stipulated women were naturally dependent upon men and therefore couldn’t take care of themselves. Tradition thus conditioned society to always see women as the helpless, distressed patient. Additionally, doctors rationalized blocking women from the medical profession by claiming it wasn’t feminine and was “disgusting to women,” implying men know women better than women know themselves (Ussher 68). By framing the pursuit of medicine as breaking from the natural female role, it became easy to label aspiring women as anti-feminine and anti-society. Further, society felt women pursuing male-dominated professions were trying to be men and in turn trying to stop being feminine, an unnatural and incomprehensible concept to society. Gender roles drove establishing women as the permanent patient by arguing women required constant care and surveillance, assuming the most subservient and least independent role in every sphere. Tradition thus made the patient the only ‘natural’ role for women in medicine. 

In addition, women were barred from the medical profession because society labeled girls “desiring to escape from home, [and become] a nurse in hospitals” as insane (Brown 15). Inhibiting women’s intellectual agency through domestication ensured only men practiced medicine, allowing men to control the female body. Seymour Hayden’s report to the Obstetrical Society in 1871 further reveals this male practitioner-female patient dichotomy, claiming women were “not in a position to dispute anything we [male doctors] say to them…we…have them at our mercy” (Showalter, “Victorian” 179). In addition, the Commissioners of Lunacy, a governmental body that oversaw all British lunatic asylums, decided in 1859 they were “granting new licenses only to medical men, and women applicants were…discouraged” (Showalter, “Victorian” 164). These blatant attempts to keep women out of medicine reinforced the imbalanced gender dynamic and made medicine a distinctly male discipline, excluding women “from power through the dominance of the…masculine scientist” myth (Ussher 66). Educated women stood in direct defiance of traditional medical theory, which believed women were incapable of learning because they “were never…able-bodied; their reproductive organs…made them dependent on others for survival” (Levine-Clark 128). Women’s biological inability to learn beyond homemaking was a common argument propagated by medicine, contending a woman who wants to learn has a flawed mind and body because woman’s only natural, evolutionary role resided in the home. Even midwifery, a previously respected job, came under scrutiny in the 19th century by male doctors who condemned midwives as “dangerous and ignorant by comparison with surgeons and physicians,” two distinctly male positions (Ussher 68). Blocking women from academia was driven by the Darwinian psychiatric model, which argued man is “more courageous, pugnacious, and energetic… and has a more inventive genius” (Darwin 557). By following the findings of Charles Darwin, an esteemed and trusted scientist, medicine gained more credibility and legitimized their misogynistic policies. Thus, by keeping women out of medicine, men could uncontestably determine biological facts and use traditional gender roles to influence and manufacture medical diagnoses. 

Second, Victorian gender roles aided the medicalization of gender by determining the standard of behavior and appearance women must conform to, drawing a line between the sane and insane. Starting with the eternally obedient wife ideal, Mary Shaw’s story perhaps best captures the total control this standard held over psychiatric diagnoses. After the death of her one-week old baby, Mary Shaw’s husband physically assaulted her (Fig. 1). Mary tried obtaining a divorce but, at the request of her husband, was quickly diagnosed with anxiety and placed in West Riding Asylum. Mary’s story exposes tradition’s influence on medicine because she resisted her husband and was subsequently termed mentally ill. Furthermore, her husband used institutionalization and medicine as tools to silence and prevent her from exercising the rights given to women by the Divorce Act of 1857. Recognizing the potential of dress in suppressing personal expression and controlling women, Dr. Joseph Granville, in 1875, wrote “dress is woman's weakness, and in the treatment of lunacy it should be an instrument of control” (53). Thus, by focusing too much on appearance or dressing outside the norm, women defied tradition and resisted social control. For example, an unnamed female patient was taken to West Riding Asylum for wearing clothes that society felt were too young for her and sporting jewelry too ostentatious for her social standing (Fig. 2). As a visual rejection of society, she was quickly stigmatized and hidden from society–classified as immoral and crazy for wearing the wrong clothes. 

Further, doctors tried to tie down ambitious women by claiming hysteria manifested in women who exhibit “more than usual force and decision of character, of strong resolution, fearless of danger,” which Dr. Frederic Skey declared during a lecture to St. Bartholomew’s Hospital’s medical students in 1866 (53). The women Dr. Skey described desired to pursue lives of education, and professional and civil freedoms. Society feared ambitious women because women leaving the home were no longer under the control of men and were instead autonomous. By claiming women ruled by their own desires and inclinations led to the destabilization of both the female mind and society, medicine prevented women from being allowed to venture outside the domestic sphere. According to tradition, a woman wanting a life that did not involve a man was a total aberration and unnatural. Thus, the only explanation science could provide for female independent behavior was that independent women must be hysterical. Furthermore, mental asylums attempted to train out behaviors incompatible with tradition by having female inmates perform “work more suited to their sex and habits,” such as cleaning, cooking, and wearing traditional Victorian dress (Showalter, The Female 84). Also, Dr. Skey asserted “hysteria brings into action…strength…which is greatly in excess of her apparent strength” (59). Following Darwin’s theory, Dr. Skey believes women should not be capable of exhibiting physical strength and when they do, it can only be explained as an error in female biology or cognitive processing. Further, even norms on how women should speak and the subjects they’re allowed to discuss pervaded medicine. In Dr. Houston’s article on madness from the 18-19th century, he discussed how “law and social convention inhibited women from speaking about insanity” (317) in civil court inquests on a patient’s psychiatric diagnosis because it was improper and unfeminine for women to speak on such a topic. Women subsequently had no political or social agency to challenge their diagnosis. Men, on the other hand, were not only able to speak on their own behalf if diagnosed with a mental illness, but also often spoke on the behalf of women. This consequently gave husbands attempting to institutionalize their rebellious wives total legal power. Additionally, the gender roles played a significant role in institutionalizing pauper women, where “medical practitioners…expected poor women to work…while still believing in the inherent fragility of the female body and the ideal of domesticity” (Levine-Clark 128). Poor women were thus in a double bind, being unable to fulfill both social expectations without being either anti-tradition (if they worked) or anti-society (if they adhered to tradition and did not work). Either way, the result was the same: a psychiatric diagnosis. 

Finally, Victorian social ideals and culture furthered the medicalization of gender through drawing a purported biological link between insanity and feminism and femininity. Science made feminism synonymous with madness through framing feminist principles as moral insanity–those who held beliefs in opposition to societal norms are immoral and ill. A frequent tool psychiatry used to stifle the feminist agenda was Darwin’s theory of hereditary evolution, which asserted mental illnesses and disease could be passed on to future generations and those children would “be born already deficient” (Fauvel & Yeoman 43). This theory was especially damaging to women’s status because giving birth was the quintessential female role in Victorian society. Women who fought against societal norms were thus seen as a threat to the present and future because if they had children, their radical ideas would be passed down. Medicine thus confined women “who behaved in a manner contrary to nature… [to protect] the evolutionary process” (Fauvel & Yeoman 47). Suffragettes were especially targeted because their egalitarian ideas epitomized what Victorian society saw as radical and absurd. Also, since the refusal to eat or a loss of appetite was a common symptom of hysteria, indicted suffragettes performing food strikes were believed to be hysterical and were consequently bound to a chair and force-fed to cure their hysteria (Pankhurst). 

Inspired by the Darwinian models of psychiatry and hereditary evolution, doctors became convinced female genitalia and biological development could explain all female health issues. It was even argued “female adolescence is a state of miniature insanity,” insinuating insanity and madness were natural parts of growing up as a woman (Showalter, “Victorian” 172). Moreover, doctors such as Dr. Edward Tilt in 1853 argued “menstruation was…disruptive to the female brain” and should be put off (Showalter, The Female 75). Delayed menstruation subsequently became the essence of high moral character and an essential part of being a woman in Victorian society. In addition, Dr. Acton claimed women aren’t “troubled with sexual feeling,” setting the stage for the rampant diagnosis of nymphomania, which condemned any woman who expressed sexual feelings (133). Paradoxically, symptoms of hysteria in women could be having sexual desires or a lack thereof, meaning women who expressed libidinous desires or rejected male sexual advances were hysterical. Inspired by Dr. Acton’s teachings, husbands were told to withhold sexual stimuli and to refer their nymphomaniacal wives to psychiatrists for corrective treatment (Showalter, The Female 75). Also, believing nymphomania stemmed from a defect in female reproductive organs and that the brain and clitoris were uniquely interconnected, Dr. Isaac Baker Brown recommended the use of clitoridectomies as a cure for female insanity (Fleming). Dr. Brown’s suggestion of clitorectomies as effective treatment of mental illness reinforced the Darwinian hereditary model by suggesting the female nervous system was directly linked to their reproductive organs. Further, this procedure prevented masturbation and tamped down sexual desires, socially defined amoral behaviors and examples of instability, highlighting how Victorian norms swayed medical practice. 

Despite the significant evidence demonstrating how Victorian gender norms manipulated medicine and psychiatric diagnoses, scholars argue Victorian society protected women “from the conditions which might induce mental problems” (Houston 316). Interestingly, Houston’s 21st century viewpoint parallels Ruskin’s 19th century writings on the home’s role in protecting women “from all injury…terror, doubt, and division” (148). Written accounts of life within this so-called protective bubble, however, undermine Houston and Ruskin’s argument. For example, Florence Nightingale described life in the Victorian home as mundane and repetitive, resulting in “the accumulation of nervous energy” and oftentimes madness (43). Nightingale provides an alternate viewpoint, claiming gender norms themselves caused mental instability in women. Dr. Levine-Clark’s research supports Nightingale’s account, finding “women’s dependency on their husbands”–a dependency enforced by tradition–led to distress and madness (135). Even Dr. Brown’s contemporary, Horatio Donkin, believed Victorian ideals, such as sexual repression and female passivity, were significant risk factors of hysteria (Showalter, The Female 131). 

While scholars argue for the merits of Victorian gender norms and their supposed neuroprotective effects, traditional gender norms ultimately manipulated the medical system and psychiatric treatment of women. This was achieved by creating a male-dominated medical field, using social norms to separate the sane and insane, and utilizing science to connect women to insanity. As women pushed back against the separate spheres of Victorian society, men felt the precarity of their positions of power and responded through genderized diagnoses. The feminine struggle against 19th century medicine reveals the paradox of progress in an age of industrialization, universalization, and modernization. Through modernization, science gained greater control and authority over society, becoming a trusted source of information. The oft-celebrated progress of the 19th century must therefore be redefined as progress for the privileged few, women not included.