Autonomous and Insane: The Gendered, Classed, and Raced Pathologization of Women’s Minds

Johanna Foster is a senior sociology major at Grinnell College in Grinnell, Iowa. Her post-graduation plans involve working in education and the consumption of copious amounts of coffee.

Modern pop culture loves to pathologize women’s behavior. Does this seem like a questionable assertion? A quick dive into the murky waters of the popular website,, suggests otherwise: search for PMS (premenstrual syndrome), and you’ll find a whole host of unflattering descriptions of women and their supposed uncontrollable need to rampage madly during their menstrual cycles. Meanwhile, a search for the same three letters on Google results, among other things, in a flurry of dating advice websites that caution ostensibly clueless men against assuming that if a woman is angry, it just means she’s on her period. In many ways, menstruation has become the contemporary vehicle for writing women off as irrational, overemotional beings who can’t be taken seriously.

However, the tendency to approach women’s behavior as symptomatic of medical problems is not new. Quite the contrary – there is a long, complex, and often sinister history of gendered pathologization. Throughout the nineteenth and twentieth centuries in particular, American women considered deviant or morally corrupt were deemed mentally unwell and subjected to medical institutionalization. Superficially, this may have looked like a product of early psychiatric innovation; however, the pathologization and institutionalization of deviant women actually functioned as a heavily classed and raced form of social control designed to preserve the gender roles of the time. Specifically, women’s mental health and minds were medicalized, with traditional domesticity viewed as the perceived cure. At the same time, the very fact that the patriarchal establishment considered it necessary to medicalize nonconforming female behavior suggests that women of various backgrounds were indeed challenging and creating resistance to gendered expectations. The medical act of framing female autonomy as a form of mental illness sought to obstruct women from having the agency to make social change in terms of gender.

During the latter half of the nineteenth and into the early twentieth century, morality was heavily dictated by Victorian values. The pervasiveness of Victorian morality was evidenced in psychiatric diagnoses, which often quite directly targeted presumed immoral activity – such as unconventional sexual activity or intellectual independence – as a source of mental illness. Although specific mental illnesses were recognized and sometimes individually diagnosed, as seen in the probably bipolar Zelda Fitzgerald’s (likely inaccurate) diagnosis of schizophrenia,[1] “insanity” was often simply the pathologization of female divergence from domestic norms.

Notably, diagnoses of insanity centered on morality in a way that allowed the medical establishment to exert complete control over the patient’s mental and physical health. Indeed, nineteenth-century culture and literature studies Professor Benjamin Reiss argues that while “asylum physicians insisted that insanity was at its roots a disease of the brain that called for medical intervention, they also believed that mental illness had a psychological or ‘moral’ etiology, and that a carefully controlled environment was as essential to the cure as the administration of medical treatment.”[2] Insanity, as physicians thought of it, was the dual product of a sick mind and personal moral failings.

This categorization allowed doctors to maintain high levels of personal authority by claiming an inaccessible expertise in allegedly necessary medicines. At the same time, the medical establishment sharply restricted the day-to-day activities of institutionalized individuals to morally “appropriate” undertakings such as drawing, writing prescribed poetry, or doing nothing at all for hours at a time.[3] This last was experienced by a number of intellectually inclined middle-class women, such as well-known writer Charlotte Perkins Gilman, who wrote in 1913 that her doctor gave her “‘solemn advice to… have but two hours’ intellectual life a day, and to never touch a pen, brush, or pencil again.’”[4] In her famous short story, “The Yellow Wall-Paper,” Gilman vividly depicted the stifling and ironically maddening effects of the rest cure for supposedly neurasthenic women. Though Gilman, like numerous other educated and affluent women deemed excessively independent, was restricted to her own home rather than a formal institution, she was still subjected to the frustrations of medical treatment that sought to govern each aspect of her daily life. In addition to the prescription of the rest cure, physicians endeavored to gain authority over women’s physical and spiritual bodies through a wide spectrum of pathological and clinical venues. These included the Taylorist medicalization of the female orgasm, appropriated by doctors through the invention of the vibrator, as a cure for hysteria.[5]

The morality championed by so many physicians was staunchly middle-class. According to historian Carroll Smith-Rosenberg, contemporary discussions of idealized femininity described women who were “weaker in body, confined by menstruation and pregnancy… both physically and economically dependent upon the stronger, more forceful male, to whom she necessarily looked up to with admiration and devotion.”[6] Morally “healthy” women were defined by the frailty of their bodies through the perception that physical weakness signified private, gentle, wise personalities geared towards homemaking. Such perceptions pathologized uniquely female bodily processes such as pregnancy and menstruation by ascribing weakness and dependency onto them. Through the constructed association of these characteristics, physical and mental health became associated as well, solidifying the notion of women as irrational and easily excitable as a result of physical features.

Such an outlook precluded many working-class and otherwise marginalized women from fitting the mold of morally upright femininity. In less affluent families, women often had to participate in industrial labor – whether or not they happened to be pregnant or menstruating.[7] But because lower-class women often had different lifestyle obligations, including jobs away from home and residences in poorer neighborhoods, than their wealthier counterparts, they were frequently more visible to authorities interested in policing moral behavior. That is, lower-class women and women of color were often viewed as being morally corrupt because they didn’t stringently follow middle-class social and cultural norms. Governmental and medical authorities specifically searched poorer urban neighborhoods for signs of moral delinquency. As historian Ruth Alexander argues, this focus on certain neighborhoods meant that “the young women arrested were not necessarily the most promiscuous on city streets, or those most experienced in prostitution, but those least able to evade police surveillance and apprehension.”[8] Women of color in particular were often mistaken as sex workers and arrested as a result of contemporary prejudices surrounding race, including the stereotype that women of color were more sexually licentious and promiscuous than white women.[9] For working-class and poor women, institutionalization was not necessarily a result of mental illness. Instead, it was often the pathologization of poverty.

Poor women and women of color were especially pathologized with respect to Victorian sexual norms. Reformatory institutions such as the still-operational Bedford Hills employed the theory that sexual deviance, among other “insane” psychiatric behavior, was in part the result of a bad upbringing and home life. Because these reformatories institutionalized disproportionately many marginalized women, assumptions that lower-class life led directly to moral deviance ran rampant amongst doctors and administrators. The overlap of Victorian morality and Progressive Era social reform became visible in the institutional microcosm because, as Alexander argues, “although the reformatories resisted liberal sexual values, they adopted modern psychological testing procedures and made selective use of mental hygiene principles, for example, the principle that ‘antisocial’ behavior was related to poor parenting and antagonistic relations at home.”[10] Consequently, when female sex workers who relied on their professions as a source of income were arrested, authorities were able to point to individual and internal characteristics as the source of deviance.[11] In the view of the establishment, individual moral insanity – caused by racial or immigrant status and reparable through domesticity – was to blame for prostitution. This perception allowed authorities to disregard the prevalence of poverty-inducing social structures.

However, institutions and their strict moral dictates were not designed to aid inmates in gaining class mobility. Rather, they sought to do the opposite – impose middle-class values as the ideal whilst making sure that the lower classes stayed where they were. Mental asylums broadly endeavored to inhibit women from rocking the boat of classed and gendered expectations. In the words of archeological researcher Susan Piddock, they were functionally “‘moral’ environments where the understood moral values would be impressed upon the inmate by the regime imposed, leading to their reformation and acceptance back into society in their appropriate place.”[12] Supposedly reformed working-class and poor women were expected to return to low-income, low-resource lives, and to strive to achieve middle-class social norms of quiet domesticity within these constraints.

Below the surface of the establishment’s forcefully medicalized push for traditionally domestic femininity, though, lay significant resistance to these very expectations. In many ways, medical emphasis on female insanity and the supposed need for institutionalization reflected a fear of the real social change that was gradually underway. Through writing, organizing, and demands for suffrage and improved educational access, women interested in political and intellectual pursuits sought to redefine what it meant to operate within middle-class values. Across classes, women resisted purely domestic expectations by exploring social and economic options. These included a variety of professions and allowed for the exploration of consensual sexual relationships outside of marriage.[13] Despite prevailing Victorian morality, the imposition of middle-class standards upon poorer women also meant that gradual increases in middle-class sexual autonomy also extended to working-class women.[14] Such autonomy additionally involved a growing interest in safe and accessible abortive and contraceptive measures.[15]

Women within institutions also pursued social and political change. From behind the gates of various courtrooms and asylums, well-known institutionalized activists and writers such as Elizabeth Packard and Zelda Fitzgerald issued publications portraying women whom feminist and queer theorist Mary Elene Wood describes as “rational yet ‘feminine,’ authoritative yet victimized, autonomous yet selfless, politically-minded yet maternal.”[16] In largely lower-class reformatories, resistance often took the arguably subtler but still significant form of non-heteronormative and frequently interracial sexual relationships with other inmates. Deemed both criminal and insane for alleged prostitution, and institutionalized with the goal of sexual reformation, women responded instead by forming and embracing romantic and sexual same-sex relationships. Such relationships alarmed and befuddled doctors and wardens, who termed them “harmful intimacies.”[17] Furthermore, once on parole, women often sought to retain their relationships. As Reiss writes, perhaps such choices illustrated “not so much a desire to be cured as a desire to stay, and thus to resist the designs of [their] doctors.”[18] Consequently, women endeavored to redefine both social expectations and, more directly, what it meant to be insane.


For Further Reading

Abrams, Laura S. “Guardians of Virtue: The Social Reformers and the ‘Girl Problem,’ 1890-
1920.” Social Service Review 74, no. 3 (September 2000): 436-452.

Bly, Nellie. Ten Days in a Mad-House. New York: Ian L. Munro, 1887.

Geller, Jeffrey L. Women of the Asylum: Voices from Behind the Walls, 1840-1945.
Massachusetts: Anchor Press, 1995.


[1] Mary Elene Wood, The Writing on the Wall: Women’s Autobiography and the Asylum (Champaign: University of Illinois Press, 1994), 155.

[2] Benjamin Reiss, Theaters of Madness: Insane Asylums and Nineteenth Century American Culture (Chicago: University of Chicago Press, 2008), 4.

[3] Ibid, 5.

[4] Helen Lefkowitz Horowitz, Wild Unrest: Charlotte Perkins Gilman and the Making of “The Yellow Wall-Paper” (Oxford: Oxford University Press, 2010), 3.

[5] Rachel P. Maines, The Technology of Orgasm: “Hysteria,” the Vibrator, and Women’s Sexual Satisfaction (Baltimore: Johns Hopkins University Press, 2001), 11.

[6] Carroll Smith-Rosenberg and Charles Rosenberg, “The Female Animal: Medical and Biological Views of Woman and Her Role in Nineteenth-Century America” The Journal of American History 60, no. 2 (September 1973):338.

[7] Ruth M. Alexander, The Girl Problem: Female Sexual Delinquency in New York, 1900-1930 (New York: Cornell University Press, 1998), 38.

[8] Ibid, 151.

[9] Cheryl D. Hicks, “‘Bright and Good Looking Colored Girl’: Black Women’s Sexuality and ‘Harmful Intimacy’ in Early-Twentieth-Century New York” Journal of the History of Sexuality 18, no. 3 (September 2009):438.

[10] Alexander, The Girl Problem, 152.

[11] Hicks, “Bright and Good Looking Colored Girl,” 437.

[12] Susan Piddock, A Space of Their Own: The Archaeology of Nineteenth Century Lunatic Asylums in Britain, South Australia and Tasmania (Berlin: Springer Science & Business Media, 2007), 7.

[13] Hicks, “Bright and Good Looking Colored Girl,” 434.

[14] Alexander, The Girl Problem, 2.

[15] Rosenberg et al., “The Female Animal,” 334.

[16] Wood, The Writing on the Wall, 27.

[17] Hicks, “Bright and Good Looking Colored Girl,” 454.

[18] Reiss, Theaters of Madness, 47.