Tracing The Complex History Of Women’s Mental Health Care

Tracing the history of the mental health of people who identify as women and those of other marginalized genders is complex. One reason is that the definition of what’s considered to be a diagnosable mental illness over the centuries has changed significantly, influenced by culture, religion, societal context, and other factors. 

Regardless, one thing is consistently clear: Throughout history, the mental health of women and others who do not identify as men has frequently been misunderstood, stigmatized, neglected, and worse. Although progress has been made, there are still challenges and problems to address as we continue to move forward. This article provides a brief, non-exhaustive overview of some key historical developments on this topic as well as how this history impacts us today.

Ancient origins of women’s mental health

In ancient civilizations, including early Egyptian, Greek, and Roman cultures, mental health conditions in general were often attributed to supernatural or divine causes. “Treatments” aimed at driving out evil spirits—such as bloodletting, purging, exorcism, and trepanation—were common. Over time and with advancements in medicine, ancient physicians looked for more scientific explanations for symptoms. Still, some archaic treatments continued to be used, particularly for women and those of other marginalized genders. 

Women with behavioral, emotional, or mental features that deviated from established norms were often diagnosed as mentally ill—whether they actually had a clinical mental health condition or not. It was around this time that the concept of "hysteria" (derived from "hystera,” which is Greek for uterus) first became popular as a sort of catch-all term for mental health symptoms in women. 

While who coined the term is still up for debate, most attribute it to Hippocrates in the fifth century. Whether he popularized it or not, Hippocrates did publish extensive work on the “disorder,” describing hysteria as "a restless and migratory uterus" caused by "poisonous stagnant humors." He surmised that the restless uterus "not only produces toxic fumes but also takes to wandering around the body, causing various disorders such as anxiety, sense of suffocation, tremors, and sometimes convulsions and paralysis."

Hippocrates cited an inadequate (heterosexual) sex life as the cause of these troubles, claiming that the poisonous stagnant humors couldn’t be expelled without the widening of the birth canal and the "cleansing" properties he believed to be offered by semen. Other Hippocratic treatments suggested for hysterical disorders included acrid or fragrant fumigation of the vagina and the face, depending on where in the body the womb had “wandered.” The Greek physician Claudius Galen would later add more techniques for treating hysteria, including purges, the application of various medicinal herbs, and "marriage or [other ways of] repressing stimuli that could excite young women." 

While hysteria would be the first proposed mental disorder associated with such “treatments,” it would not be the last. Women’s mental health has been tied to sex and sexuality throughout history, and some argue that the attitude is still highly prevalent today.

Women’s mental health from the Middle Ages to the Victorian era

During the Middle Ages, women experiencing mental health conditions or symptoms were often labeled as witches and subjected to persecution. Eventually, mental illness in women became almost synonymous with witchcraft, sorcery, and demonic possession, with treatment continuing to revolve exclusively around the woman’s body. If she exhibited symptoms of a mental health condition and was not accused of being a witch, the local physician would likely follow the traditional medical treatment for hysteria. 

The Enlightenment period saw some advancements in understanding mental health, such as a retreat from the idea that sorcery or witchcraft is intrinsically connected to mental health conditions. The idea of hysteria as a problem of the uterus also began to draw skepticism from scientists during the late Renaissance era. By the 18th century, hysteria became more closely associated with the nervous system and less with the uterus. 

However, women's experiences were still marginalized, and hysteria continued to be labeled as a condition unique to those who did not identify as men. As such, the treatments remained largely the same. For example, just as foul-smelling potions and herbs were used to treat symptoms of hysteria in ancient Greece, Victorian women were encouraged to use smelling salts to treat symptoms such as fainting spells and other emotional behavior. As in previous ages, sex and orgasm also played a prominent role in treatment. Victorian doctors used "stimulation" of the uterus via pelvic floor massage and tools (the first vibrators) to induce "hysterical paroxysms" as a form of treatment for emotional challenges or symptoms of a mental illness. 

The late Victorian era then saw the rise of traditional psychotherapy in treating mental health conditions in women, with Freudian and Jungian methods leading the way. Psychotherapy grew in popularity throughout the 19th and 20th centuries and is still regarded as one of the cornerstones of modern therapy.

Modern and contemporary views on women’s mental health

The 19th and 20th centuries saw a gradual change in attitudes toward women's mental health, largely because women began to emerge as mental health experts themselves. Mary Whiton Calkins is one of the most notable examples. She completed the doctoral program and presented her thesis on psychology at Harvard University in 1901 (although because women weren't allowed formal admission to Harvard at the time, she didn't officially receive her degree). She later became the first woman president of the American Psychological Association in 1905. 

During this time, scientists began to declare hysteria as not exclusive to women, finally allowing a more scientific view to prevail. Researchers began to study other mental health conditions that affect women, such as postpartum depression (which people of any gender can experience), but the gap between men's and women's mental health began to close as more researchers found that there seemed to be little to no physiological difference between men and women regarding the neurological causes of mental health conditions. This was also when scientists began to draw on transcultural psychiatry ideas, which allowed a greater understanding of the role of an individual's environmental factors in their mental health.

With the women's suffrage movement in the early 20th century came more advocacy for women's mental health. However, there was still much ignorance and confusion about how to best treat women, and ineffective, dangerous methods such as electroconvulsive therapy (ECT), institutionalization, and forced sterilization were still popular. In the 1960s and 1970s, the feminist movement spotlighted women's mental health in a new, more socially aware context—the result being a closer examination of the role of gender discrimination. The field of psychiatry migrated towards more understanding and quantitative, evidence-based treatments by including women in research studies for medications and therapeutic methods. 

How the history of women’s mental health impacts us now: Progress and challenges

In recent decades, there has been a growing recognition of the importance of considering intersectionality in women's mental health. Intersectionality acknowledges that multiple factors—including race, ethnicity, socioeconomic status, sexual orientation, gender identity, and other identities—shape mental health experiences. This perspective emphasizes the need for inclusive and culturally sensitive approaches to mental healthcare.

However, there is a growing awareness of these issues, and efforts are being made to promote mental health literacy and address systemic barriers.

The role of online therapy

One of the advancements that technology has brought about in recent years has been the relatively widespread popularity of online therapy, which allows more women and people of other genders to overcome barriers to treatment commonly associated with conventional therapy. For example, virtual therapy allows individuals to speak with a licensed mental health professional from home or anywhere with an internet connection via phone, video chat, and/or in-app messaging. 

Research suggests that online therapy can be just as effective as traditional in-person sessions for treating many mental health conditions and challenges, such as anxiety, depression, trauma, and more. That means it can represent a viable alternative for people who face barriers to receiving traditional, in-person care, or who simply prefer to engage in therapy from the comfort of home.