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Sex and Gender in Psychiatry: A View from History

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Abstract

Although physicians have attempted for centuries to uncover the biological differences between men and women with regard to mental illness, they continue to face the challenges of untangling biological factors from social and cultural ones. This article uses examples from history to illustrate three common problems in trying to establish biological differences: identifying factors as sex-based when they are really gender-based; overlooking changes in masculine and feminine roles over time; and placing too great an emphasis on hormones. By using the benefit of hindsight to identify problems from the past, we can think more critically about these issues in the present and the future.

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Notes

  1. This paper was originally presented at the Advances in Psychiatry at the University of Michigan in November 2008. Many thanks to Tamara Gay for supporting and encouraging the topic. My research for this paper was supported in part by a grant from the NIH National Library of Medicine. I have no ties (financial or otherwise) to industry and no conflicts of interest to report.

  2. H.A. Tomlinson, “The Puerperal Insanities,” American Journal of Insanity 56 (1899): 69–88.

  3. A.S. Kraditor, The Ideas of the Woman Suffrage Movement, 1890–1920 (New York: Columbia University Press, 1965).

  4. G.N. Grob, Mental Illness and American Society, 1875–1940 (Princeton: Princeton University Press, 1983).

  5. M.H. Green, Women’s Healthcare in the Medieval West: Texts and Contexts (Aldershot: Ashgate, 2000); M.E. Fissell, Vernacular Bodies: The Politics of Reproduction in Early Modern England (New York: Oxford University Press, 2004).

  6. R. Bleier, Science and Gender: A Critique of Biology and Its Theories on Women (New York: Pergamon Press, 1984); N. Tomes, “Historical Perspectives on Women and Mental Illness,” in Women, Health, and Medicine in America, ed. Rima D. Apple (New York: Garland Publishing, Inc., 1990), 143–72.

  7. V.W. Pinn, “Sex and Gender Factors in Medical Studies: Implications for Health and Clinical Practice,” JAMA 289 (2003): 397–400.

  8. M.S. Kimmel, Manhood in America: A Cultural History (New York: Free Press, 1996); S.M. Rothman, Woman’s Proper Place: A History of Changing Ideals and Practices, 1870 to the Present (New York: Basic Books, 1978); P.G. Filene, Him/Her/Self: Sex Roles in Modern America, 2nd ed. (Baltimore: Johns Hopkins University Press, 1986).

  9. J.W. Scott, “Gender: A Useful Category of Historical Analysis,” American Historical Review 91 (1986): 1053–75.

  10. T.G. Morton, “Removal of the Ovaries as a Cure for Insanity,” American Journal of Insanity 49 (1892): 397–401, emphasis in the original.

  11. The practice of removing ovaries from mentally ill women continued well into the twentieth century. See J.T. Braslow, “In the Name of Therapeutics: The Practice of Sterilization in a California State Hospital,” Journal of the History of Medicine & Allied Sciences 51 (1996): 29–51.

  12. E. Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York: John Wiley & Sons, 1997).

  13. Early twentieth-century psychiatrists’ focus on sex was remarkable since other kinds of difference were capturing public and professional attention, especially race and ethnicity relating to fears of increasing American insanity. See I.R. Dowbiggin, Keeping America Sane: Psychiatry and Eugenics in the United States and Canada, 1880–1940 (Ithaca, NY: Cornell University Press, 1997).

  14. A. Gordon, “Psychoneuroses, Psychoses and Mental Deficiency in 2000 Cases Considered Especially from the Standpoint of Etiological Incidents and Sex,” American Journal of Insanity 73 (1917): 721–36.

  15. Ibid., p. 726.

  16. For a history of clinical symptoms over time, see G.E. Berrios, The History of Mental Symptoms: Descriptive Psychopathology since the Nineteenth Century (New York: Cambridge University Press, 1996).

  17. S.M. Evans, Born for Liberty: A History of Women in America (New York: Free Press, 1989).

  18. P. Lerner, Hysterical Men: War, Psychiatry, and the Politics of Trauma in Germany, 1890–1930 (Ithaca, NY: Cornell University Press, 2003); C. Cox, “Invisible Wounds: The American Legion, Shell-Shocked Veterans, and American Society, 1919–1924,” in Traumatic Pasts: History, Psychiatry, and Trauma in the Modern Age, 1870–1930, ed. Mark S. Micale and Paul Lerner (New York: Cambridge University Press, 2001), 280–305.

  19. For a classic discussion of the similarities and differences between neurology and psychiatry in this time period, see C.E. Rosenberg, Trial of the Assassin Guiteau: Psychiatry and Law in the Gilded Age (Chicago: University of Chicago Press, 1968).

  20. For more on neurasthenia, see C.E. Rosenberg, “George M. Beard and American Nervousness,” in No Other Gods: On Science and American Social Thought (Baltimore: Johns Hopkins University Press, 1976), 98–108 For an outstanding analysis of nervous illness and men, see M.S. Micale, Hysterical Men: The Hidden History of Male Nervous Illness (Cambridge: Harvard University Press, 2008).

  21. W.L. Babcock, “On the Treatment of Acute and Curable Forms of Melancholia,” International Medical Magazine 9 (1900): 1.

  22. F.G. Gosling, Before Freud: Neurasthenia and the American Medical Community, 1870–1910 (Urbana: University of Illinois Press, 1987).

  23. G. Bederman, Manliness and Civilization: A Cultural History of Gender and Race in the United States, 1880–1917 (Chicago: University of Chicago Press, 1995); N.E. Stubbs, “Theodore Roosevelt and Ernest Hemingway: A Study in Two Strenuous Lives,” Theodore Roosevelt Association Journal 25 (2002): 9–14.

  24. For the history of psychoanalysis in America, see N.G. Hale, The Rise and Crisis of Psychoanalysis in the United States: Freud and the Americans, 1917–1985 (New York: Oxford University Press, 1995). For gender and psychoanalysis, see for example, C. Bernheimer and C. Kahane, eds., In Dora’s Case: Freud-Hysteria-Feminism, Second ed. (New York: Columbia University Press, 1990).

  25. Boston psychiatrist Abraham Myerson did a survey in 1939 that indicated that few in psychiatry, psychology and neurology were fully committed to Freud, though many were sympathetic to some of his ideas. A. Myerson, “The Attitude of Neurologists, Psychiatrists and Psychologists Towards Psychoanalysis,” American Journal of Psychiatry 96 (1939): 623–41.

  26. E. Lunbeck, The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America (Princeton: Princeton University Press, 1994).

  27. R. Bayer, Homosexuality and American Psychiatry: The Politics of Diagnosis, Revised ed. (Princeton: Princeton University Press, 1987).

  28. H.L. Minton, “Femininity in Men and Masculinity in Women: American Psychiatry and Psychology Portray Homosexuality in the 1930s,” Journal of Homosexuality 13 (1986): 1–22.

  29. E.R. Spaulding, “The Importance of Endocrine Therapy in Combination with Mental Analysis in the Treatment of Certain Cases of Personality Deviation,” American Journal of Psychiatry 78 (1922): 375.

  30. E.B. Saunders, “Association of Psychoses with the Puerperium,” American Journal of Psychiatry 85 (1929): 677.

  31. For more information on Zilboorg, see G. Mora, “Early American Historians of Psychiatry: 1910–1960,” in Discovering the History of Psychiatry, ed. Mark S. Micale and Roy Porter (New York: Oxford University Press, 1994), 53–80.

  32. G. Zilboorg, “The Dynamics of Schizophrenic Reactions Related to Pregnancy and Childbirth,” American Journal of Psychiatry 85 (1929): 733–67.

  33. Ibid., 767.

  34. L.M. Terman and C.C. Miles, Sex and Personality: Studies in Masculinity and Femininity (New York: McGraw Hill, 1936).

  35. B. Bosselman and B. Skorodin, “Masculinity and Femininity in Psychotic Patients: As Measured by the Terman-Miles Interest-Attitude Analysis Test,” American Journal of Psychiatry 97 (1940): 699.

  36. Ibid., 700.

  37. S. Robertson, “Separating the Men from the Boys: Masculinity, Psychosexual Development, and Sex Crime in the United States, 1930s–1960s,” Journal of the History of Medicine & Allied Sciences 56 (2001): 3–35.

  38. On the ease of interaction of these apparently disparate systems of thought, see J.H. Sadowsky, “Beyond the Metaphor of the Pendulum: Electroconvulsive Therapy, Psychoanalysis, and the Styles of American Psychiatry,” Journal of the History of Medicine & Allied Sciences 61 (2006): 1–25.

  39. See D.B. Doroshow, “Performing a Cure for Schizophrenia: Insulin Coma Therapy on the Wards,” Journal of the History of Medicine & Allied Sciences 62 (2007): 213–43; N. McCrae, ““A Violent Thunderstorm“: Cardiazol Treatment in British Mental Hospitals,” History of Psychiatry 17 (2006): 67–90; E. Shorter and D. Healy, Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness (New Brunswick: Rutgers University Press, 2007).

  40. For more on the history of estrogen use in medicine, see E.S. Watkins, The Estrogen Elixir: A History of Hormone Replacement Therapy in America (Baltimore: Johns Hopkins University Press, 2007).

  41. N. Oudshoorn, Beyond the Natural Body: An Archaeology of Sex Hormones (New York: Routledge, 1994).

  42. M. Bliss, The Discovery of Insulin (Chicago: University of Chicago Press, 1984).

  43. E.A. Strecker and B.L. Keyes, “Ovarian Therapy in Involutional Melancholia,” New York Medical Journal 116 (1922): 30.

  44. C. Sengoopta, The Most Secret Quintessence of Life: Sex, Glands, and Hormones, 1850–1950 (Chicago: University of Chicago Press, 2006); L.D. Hirshbein, “The Glandular Solution: Sex, Masculinity, and Aging in the 1920s,” Journal of the History of Sexuality 9 (2000): 277–304.

  45. B.R. Tucker, “The Internal Secretions in Their Relationship to Mental Disturbance,” American Journal of Psychiatry 79 (1922): 260.

  46. C.E. Gibbs, “Sexual Behavior and Secondary Sexual Hair in Female Patients with Manic-Depressive Psychoses, and the Relation of These Factors to Dementia Praecox,” American Journal of Psychiatry 81 (1924): 53–4.

  47. E. Kraepelin, Clinical Psychiatry (New York: Macmillan, 1907).

  48. J.A. Houck, Hot and Bothered: Women, Medicine, and Menopause in Modern America (Cambridge: Harvard University Press, 2006).

  49. S.W. Jackson, Melancholia and Depression: From Hippocratic Times to Modern Times (New Haven: Yale University Press, 1986).

  50. K.M. Bowman and L. Bender, “The Treatment of Involution Melancholia with Ovarian Hormone,” American Journal of Psychiatry 88 (1932): 869.

  51. M.J. Casper and A.E. Clarke, “Making the Pap Smear Into the ”Right Tool“ For the Job: Cervical Cancer Screening in the USA, Circa 1940–1995,” Social Studies of Science 28 (1998): 255–90.

  52. H.S. Ripley, E. Shorr, and G.N. Papanicolaou “The Effect of Treatment of Depression in the Menopause with Estrogenic Hormone,” American Journal of Psychiatry 96 (1940): 905–13.

  53. H.S. Ripley and G.N. Papanicolaou, “The Menstrual Cycle with Vaginal Smear Studies in Schizophrenia, Depression and Elation,” American Journal of Psychiatry 98 (1942): 567.

  54. C.C. Ault, E.F. Hoctor, and A.A. Werner, “Theelin Therapy in the Psychoses” Journal of the American Medical Association 109 (1937): 1786–8.

  55. See for example, C.C. Ault, E.F. Hoctor, and A.A. Werner, “Involutional Melancholia: Additional Report,” American Journal of Psychiatry 97 (1940): 691–4; A.A. Werner, E.F. Hoctor, and C.C. Ault, “Involutional Melancholia: A Review with Additional Cases,” Archives of Neurology and Psychiatry 45 (1941): 944–52; H.A. Sears et. al., “Blood Estrin Level in Schizophrenia,” American Journal of Psychiatry 93 (1937): 1293–303.

  56. A.E. Bennett and C.B. Wilbur, “Convulsive Shock Therapy in Involutional States After Complete Failure with Previous Estrogenic Treatment,” American Journal of the Medical Sciences 208 (1944): 170.

  57. Bureau of the Census, Statistical Abstract of the United States, 1942 (Washington, DC: United States Government Printing Office, 1943), 95–6.

  58. See for example, J.A. Bianchi and C.J. Chiarello, “Shock Therapy in the Involutional and Manic-Depressive Psychoses,” Psychiatric Quarterly 18 (1944): 118–26; E. Davidoff and A. Raffaele, “Electric Shock Therapy in Involutional Psychoses,” Journal of Nervous and Mental Disease 99 (1944): 397–405; P.E. Huston and L.M. Locher, “Manic-Depressive Psychosis: Course When Treated and Untreated With Electric Shock,” Archives of Neurology and Psychiatry 60 (1948): 37–48; I.L. Fishbein, “Involutional Melancholia and Convulsive Therapy,” American Journal of Psychiatry 106 (1949): 128–35; See also, J.T. Braslow, Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century (Berkeley: University of California Press, 1997), 95–124.

  59. L.D. Hirshbein, “Science, Gender, and the Emergence of Depression in American Psychiatry, 1952–1980,” Journal of the History of Medicine & Allied Sciences 61 (2006): 187–216.

  60. Joel Braslow and Leslie Starks have pointed out that the larger number of women treated with lobotomy was due to the perception that women could better benefit from the procedure. J.T. Braslow and S.L. Starks, “The Making of Contemporary American Psychiatry, Part 2: Therapuetics and Gender Before and After World War II,” History of Psychology 8 (2005): 271–88.

  61. P.J. Caplan, They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal (Reading, Mass.: Addison-Wesley Publishing Company, 1995).

  62. C. Barrus, “Gynaecological Disorders and Their Relation to Insanity,” American Journal of Insanity 51 (1895): 477, emphasis in the original.

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    Laura Hirshbein

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Hirshbein, L. Sex and Gender in Psychiatry: A View from History. J Med Humanit 31, 155–170 (2010). https://doi.org/10.1007/s10912-010-9105-5

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