For 19th century physicians, especially physicians dealing with emotional disorders, treating hysteria in female patients had to be one of the most profitable ways to make a living. For thousands of years, the widespread belief that medical problems in the uterus led to various emotional and physical complaints in women remained a core belief in Western medicine (hysteria comes from the Greek word for uterus). Believed to affect only women, hysteria was diagnosed in as many as one-fourth of all female patients who sought medical opinions for any complaint. The dizzying range of symptoms linked to hysteria included physical weakness, depression, crying episodes, anxiety, irrational thoughts or behaviour (including women who insisted on pursuing "unwomanly activities" such as higher education), as well as sexual complaints of any kind.
Not that male patients were completely ignored, mind you. Prominent 19th century neurologist George Miller Beard first described the syndrome he termed "neurasthenia" (literally, nervous weakness) in an 1869 paper and later popularized his ideas with two best-selling books. Various symptoms of neurasthenia included irritability, forgetfullness, apathy, depression and generalized loss of energy. According to Beard, neurasthenia was caused by depletion of electrical energy in the nervous system. Possible causes included immersion in strenuous modern life. Male patients who Beard described as "brain workers" belonging to the "higher orders" of American life were regarded as being especially vulnerable to neurasthenia. Beard also argued that lower-class workers (including "Negroes and savages") were largely immune. While women could experience neurasthenia symptoms as well, Beard argued that this was caused by excess education and intellectual activities. Beard and his supporters viewed women as being particularly vulnerable to neurasthenia and hysteria since they lacked the mental resources of men.
The treatments that women could receive following a hysteria diagnosis ranged from relatively benign therapies such as pelvic massage and Mesmerism to potentially life-threatening surgery such as Robert Battey's radical oophorectomy operation (which involved removing a woman's ovaries). Even for women who avoided dangerous opeerations, receiving a hysteria label often meant becoming chronic invalids, sometimes for the rest of their lives.
Which is a fate that Charlotte Perkins Gilman was determined to avoid...
Born in 1860 in Hartford, Connecticut, Charlotte Perkins and her family were left in poverty after her father abandoned them. Her mother was emotionally remote and prone to frequent illness which made her unable to care for her children. Fortunately, Charlotte's family on her father's side, including famed suffragist Harriet Beecher Stowe inspired her to pursue a career in writing. After marriage to the artist Walter Stetson and the birth of her only child in 1885, Charlotte began experiencing a range of emotional problems. As she wrote in her diary in 1887, being sick with "some brain disease" led her to feel that her "mind had given way". While post-partum depression would be the most likely diagnosis she might receive today, Charlotte had few options available to her but to consult the eminent physician Silas Weir Mitchell for help.
Long recognized as an authority in the treatment of neurasthenia and hysteria, Mitchell was a well-known writer who, in addition to monographs on various medical topics, was also the author of many well-known historical novels, short stories, and poetry. While dividing his time between his literary work and medical practice, Mitchell was also a fervent supporter of George Beard's theories involving neurasthenia and hysteria in women. When Charlotte Gilman consulted him in 1887 concerning her emotional problems, he prescribed what would become infamously known as the "rest cure treatment". Spending nine weeks in Mitchell's care, Gilman was sent home after being advised to given up writing completely and to "live as domestic a life as possible. Have your child with you all the time... Lie down an hour after each meal. Have but two hours’ intellectual life a day. And never touch pen, brush or penacil as long as you live."
If Mitchell's advice seemed reasonable to him, it likely appalled Charlotte Gilman. Although she tried to follow Mitchell's prescription for a few months after returning home, her depression only grew worse and she came close to a total emotional collapse. Separating from her husband in 1888, Charlotte moved with her daughter to California where she became involved with the fledgling feminist movement and pursued a career in writing. Though she published extensively including short stories, fiction and non-fiction books, and lectures, she never forgot Silas Weir Mitchell and his recommended rest cure.
In 1892, Charlotte Perkins Gilman published her most famous short story, "The Yellow Wallpaper" in New England Magazine. Written from a first-person perspective, the 6,000-word story describes a woman's descent into madness after being diagnosed by her physician-husband with a "temporary nervous depression – a slight hysterical tendency". The husband in the story was likely based on Silas Mitchell and the "rest cure" that the husband forces on his wife in the story is almost identical to what Mitchell prescribed for Charlotte Gilman. Taking its title from the yellow wallpaper in the room to which the heroine is confined, the story unflinchingly describes her slow descent into madness. The story ends with the heroine's final psychotic break and the husband's horror at what has happened to his wife.
Although now praised as a classic in 19th century feminist literature, The Yellow Wallpaper faced very mixed reviews. Horace Scudder, then-editor of The Atlantic Monthly, refused to publish the story and sent Gilman a brief note stating that "I could not forgive myself if I made others as miserable as I have made myself [in reading the story]". The fact that Silas Weir Mitchell was a regular Atlantic contributer and a personal friend of editor William Dean Howells likely did not help either. Upset over the rejection, Gilman the turned the story over to an agent who placed it in New England Magazine (she was never paid for it).
Still her best-known work, Charlotte Gilman would later describe The Yellow Wallpaper as a blatant attempt to convince Silas Weir Mitchell of "the error of his ways" in advocating his bed-rest cure. As she would later state, her story was "not intended to drive people crazy, but to save people from being driven crazy, and it worked." After the story was published, she sent Mitchell a copy but never received a response from him. Although she met with Mitchell several times and seemed optimistic that she was able to persuade Mitchell to change his treatment methods for depressed women, she was ultimately unsuccessful. Mitchell continued to recommend his bed-rest cure for women patients up until his death in 1914.
As for Charlotte Gilman herself, she later divorced her first husband (which was almost unheard-of in the 19th century) and married her first cousin, Houghton Gilman in 1900. This marriage was long and happy but ended tragically when Houghton died suddenly of a cerebral hemorrhage in 1934. Already terminally ill from breast cancer, Charlotte Gilman committed suicide in the following year by taking an overdose of chloroform (she was also passionate advocate of euthanasia). The suicide note that she left behind stated that she chose "chloroform over cancer."
Long after Gilman's passing, The Yellow Wallpaper continues to have a cult following with numerous adaptations for stage, television, Internet multimedia, and even a full-length gothic movie. They story continues to provide an uncompromising look at how poorly the male-dominated medical profession of the 19th century dealt with "female complaints" such as hysteria. Though Silas Weir Mitchell's bed rest cure represents only one extreme example of medical malpractice, women relegated to insane asylums, Magdalene institutions, and locked hospital wards often fared far worse than Charlotte Gilman did.
Both as a warning about unfeeling physicians and the very clear need for proper support in dealing with mental illness, The Yellow Wallpaper is still a masterpiece.