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How the Problematic History of “Hysteria” Lead to Changes in Women’s Mental Health Care

In the mid-1800s, the French physician, Jean-Martin Charcot described a type of neurosis primarily seen in women, he called it “hysteria” and spent much of his life studying and writing about it.

The concept of hysteria was not entirely new. For centuries before, many different civilizations had terms to describe women who lived with mental health disorders. Ancient Egyptians believed psychological issues in women were caused by her uterus moving inside her body and would use aromatherapy as a treatment. Other civilizations throughout time considered women with mental disorders to be witches or possessed by demons.

Charcot was a pioneer in bringing the idea of female-specific mental health disorders into the medical realm. It’s true that the term “hysteria” and some treatment options that doctors used at the time turned out to be problematic in many ways. However, the idea that a person’s biological sex would impact their mental health paved the way for improvements to mental health care that we still see today.

This is an example of how women have overcome so much to be stronger and healthier than before. Understanding this story pays homage to the women who have come before while making everyone think about how mental health care can be better for generations of women to come.

Understanding Biological Sex as a Variable in Mental Health

Believing the ovaries might be responsible for the disorder, Charcot employed a device called an “ovary compressor,” which applied pressure to the patient’s abdomen to trigger or arrest hysterical episodes. The device did not appear to be an effective treatment for episodes of hysteria, but he may have been one of the first physicians to recognize the contribution of ovarian hormone fluctuation to the development of mood disorders in women.

Substantial advances in our understanding of the strong influence of sex hormones on women’s mental and physical health led to a new subspecialty in the field of psychiatry. Referred to as “reproductive psychiatry,” the subspeciality is focused on how fluctuating levels of reproductive hormones can manifest as premenstrual, perinatal, and perimenopausal psychiatric disorders in women who are sensitive to these fluctuations.

This increased understanding, along with the availability of effective treatment options and strong demand from patients, created a specialized niche for clinical programs focused on providing specialized treatment for women with hormone-related mood, anxiety, and sexual health disorders.

As we move towards more personalized approaches for treating mental illness, consideration of sex as a biological variable should be a key piece in understanding how reproductive hormones modulate behavioral responses and contribute to mood disorders.

The Mid-1980s: The Task Force for Women’s Mental Health

In the mid-1980s a public health service task force recognized that there were significant knowledge gaps related to women’s health and called for an expansion of research focused on health concerns more common in or unique to women. Women had historically been left out of clinical research because researchers claimed that female physiology, specifically the variability in their menstrual cycle hormones, seemed to impact research data making data analysis difficult.

In response to the task force recommendations, the National Institutes of Health (NIH) created a policy encouraging the inclusion of women in clinical research, but it wasn’t broadly adopted until the mid-1990s when Congress passed legislation mandating fair inclusion of women and minorities in clinical research.

It’s been nearly 35 years since the task force made those recommendations and, in that time, we have seen a dramatic increase in our understanding and knowledge of women’s specific health concerns, including mental health disorders.