We need to open this article with a disclaimer:
The history of mental health treatment for women is not a history to celebrate. It’s a history that relegates women to second-class status, identifies their purpose in society as being either in service to/or the property of men, assigns the cause of many mental illnesses to being female, and includes treatments that are not only counterproductive for mental health/mental illness, but also have negative physical consequences, up to and including death.
We also need to add something else:
Elements of this history impact the shape of mental health treatment for women today.
We’ll take a moment to explain by discussing one specific component of modern mental health treatment. Then we’ll return to the primary topic and share a timeline that traces the history of mental health treatment for women from prehistory to the present day.
Our explanation involves discussing an aspect of mental health treatment almost everyone knows about: medication. In the middle and latter half of the 20th century, the medical establishment adopted the position that mental health disorders were the result of chemical imbalances in the brain, and those imbalances could be resolved, i.e. symptoms improved, by developing and prescribing medication that addresses those chemical imbalances.
Overall, that shift has been positive, because it included the idea that mental health disorders are medical conditions, rather than the result of a moral failure, personal/psychological weakness, or a deficit in personal responsibility, motivation, or character.
But we need to take a closer look at what happened in the latter half of the 20th century to understand how the shift to a medical model of mental health still left women underserved, and perpetuated inequity in mental health care.
Women, Research, and Psychiatric Medication
That shift from the moral/personal to the medical is part of the reason we have modern psychiatric medication in the form of antidepressants, antipsychotics, and anxiolytics (anti-anxiety medication). However, that shift, with regard to medication, also foregrounds how the history of mental health treatment for women impacts mental health treatment for women today.
Consider this information, published by the National Institutes of Health Office of Research on Women’s Health, established in 1990:
“In 1977, a Food and Drug Administration policy recommended excluding women of childbearing potential from Phase I and early Phase II drug trials. The policy was broad and recommended excluding even women who used contraception, who were single, or whose husbands were vasectomized.”
That policy led to the exclusion of women from early-stage drug trials. This means at least two things, which are very important:
- Researchers never collected direct initial clinical trial data on how a wide range of psychiatric medications help women, compared to men.
- Researchers never collected direct initial clinical data on the possible negative side-effects of psychiatric medication on women, compared to men.
The exclusion of women from those trials, however, did not prevent physicians from prescribing those psychiatric medications to women. In fact – despite the fact that almost all clinical research on standard psychiatric medications excluded women – women receive mental health diagnoses and treatment, including medication, at significantly rates higher than men.
Consider this data from the publications “Mental Health Treatment Among Adults: United States” from the Centers for Disease Control (CDC) and the 2023 National Survey on Drug Use and Health (2023 NSDUH)
Mental Health Diagnosis and Treatment Differences: Women Compared to Men
Prevalence of any mental illness (AMI):
- Women: 26.4%
- Men: 19.0%
Received mental health treatment:
- Women: 28.5%
- Men: 17.2%
Received psychiatric medication as part of mental health treatment:
- Women: 21.1%
- Men: 11.2%
This demonstrable gender disconnect between the patients who receive treatment and medication and the research that led to approval and use of those treatments and medications led to widespread protest and activism by women, which culminated in a change at the federal funding level. In 1993, The NIH Revitalization Act established these rules for clinical trials in NIH-funded research:
- Women and minorities must be included in all clinical research trials
- Trials should be designed so that it is possible to determine impact of variables on women and minorities
- Excluding women and minorities from trials because of cost is unacceptable
- NIH must recruit and women and minorities as volunteers in clinical studies
The following year, the NIH revised the guidelines to include the language “…NIH will not fund any grant, cooperative agreement, or contract or support any intramural project unless it complies with [these guidelines].”
In 2025, we can report that this change has had a significant impact on research worldwide. But we still have a long way to go with regards to equity for women in mental health care: one reason is that the medications women still receive almost twice as often as men are the same medications that excluded women from initial clinical trials.
Although research such as “Sex Differences in the Psychopharmacological Treatment of Depression” help add to our knowledge of the impact of psychiatric medication on women, and editorials such as “Keep In Mind Sex Differences When Prescribing Psychotropic Drugs,” this statement from the introduction of the former– published in 2024 – is telling:
“It has been largely demonstrated that women are the majority of patients with psychiatric diagnoses and also the largest users of psychotropic drugs. There are differences between men and women receiving psychotropic drugs, in terms of response, efficacy, side effects, long-term treatment outcome. There is still a lack of psychopharmacological research focusing on these differences in male and female patients.”
It’s clear that the history of mental health treatment for women is filled with inequity: we’re slowly correcting this fact, but – as that expert opinion from 2024 shows – we still have work to do to meet the standards set over 30 years ago. With that in mind, let’s look at a timeline of the history of mental health treatment for women, as reported in the article “Disparities in Mental Health Diagnoses and Treatments Among Women: A Historical and Theoretical Review” published in 2024 in The international Journal of History.
History of Mental Health Treatment for Women: A Timeline
Early History Through the Renaissance/Colonial Period (5000 B.C. – 17th Century)
Between 5000 B.C. and the early 1600s the term mental illness included mental problems, psychological problems, and spiritual issues such as demonic possession. For these disorders specifically, women received diagnoses more often than men. Treatments were physical, and neither physiological, spiritual, or related to thoughts and emotions:
Until the creation of asylums in the 1500s, doctors often treated patients with a method called trepanation, or drilling a hole in the skull to release demons.
Asylums for the mentally ill appeared in Europe in the early Renaissance, first in Europe, primarily as a place to sequester people with mental illness from the general civilian population.
Facts from this period:
- Doctors considered female reproductive function/ organs the cause of mental health problems in women
- This connection has a negative impact on women’s mental health treatment to this day
- Around 2000 BC, records show a significant number of women beginning to receive a diagnosis for hysteria, thought to be caused by wandering uteri
- Hysteria is the first known medical diagnosis applied to women
The term hysteria was coined by Hippocrates in the 5th century BC, derived from the Greek word for uterus. Hippocrates suggested this mood disorder was caused by hysteron, or movement of the uterus.
The connection of mental illness in women to female reproductive organs dominated medical research and knowledge about mental health in women from the Renaissance to the Modern Era, i.e. around 15th century to the mid-19th century.
Colonial Period to 18th Century
During this period, particularly during the Victorian Era, any behavior by a women identified by men as non-feminine, disobedient, or non-conforming was grounds for receiving a diagnosis of insanity, and included risk of being committed to an asylum.
Aspects of treatment in an asylum during this period:
- Submission by women to patriarchs – i.e. male physicians – was a component of treatment. Accepting domination was considered healing and therapeutic.
- This patriarchal domination aligned with moral treatment for mental illness, which revolved around the concept that a woman with a mental health disorder should be “treated like a child rather than an animal.”
- Physicians during this era considered women to be fragile and prone to nervous breakdowns.
In the Victorian Era, when an unmarried woman showed signs of hysteria, the most prescribed treatment was to find a husband.
We see an emblematic example of the type of treatment problematic, non-conforming women received by analyzing the events in Salem, Massachusetts in 1692 known as The Salem Witch Trials. During this tragic event, men jailed over 100 women and executed almost 20 after accusing them of practicing witchcraft and putting spells on other women in the community.
Contemporary commentators offer more probable causes for the events in Salem, in contrast to demonic possession or the presence of witches:
- Ergot poisoning, leading to paranoia and hallucinations among accusers
- Shared belief in occult/occult practices among accused
- Community-level jealousy and rivalries
The Salem incident is an example of how women with mental health issues were treated during the 17th-18th century. Innocent or guilty, women who acted in ways men in power deemed unacceptable could face severe consequences, up to and including death by hanging. Small point of history: the women of Salem were not burned at the stake. Records show they were killed by hanging.
Early Whistleblower Makes Good Trouble: Treatment of Women in Asylums
In 1887, journalist Nellie Bly faked a hysterical episode in order to get sent to an asylum to expose rampant misogyny and mistreatment of female patients. Her first-hand, eye-witness account from inside an asylum demonstrated that non-conforming women were often institutionalized, where they were:
- Verbally abused
- Physically abused
- Exposed to life-threatening treatment methods
- Poorly fed
- Poorly clothed
In her report, after witnessing inhumane treatment of women she was certain were not mentally ill, Bly asserted the purpose of these methods was to “…control women’s thoughts, beliefs, and behaviors, and bring them into line with the current expectations for women in the home and in society.”
Eighteenth to Nineteenth Centuries
In 1840, Thomas Laycock, an early neurologist, published “An Essay on Hysteria: Being an Analysis of Its Irregular and Aggravated Forms; Including Hysterical Hemorrhage, and Hysterical Ischuria. With Numerous Illustrative Cases.”
A contemporary review of this paper published in 2019 offers this commentary:
“For those investigating… institutionalized sexism, this monograph is an exquisitely rich vein to tap.”
In his paper, Laycock asserted that:
- Hysteria is the natural state for women
- Hysteria is exclusive to White women
- Among affluent white women, hysteria develops because of unstable lives characterized by:
- Privilege
- Decadence
- Softness
- Debility, a.k.a. weakness
- Nervousness
- Periodic depressions
- Daily worry
The major problem created by these characteristics was an increase in hysteria that weakened childbearing ability.
In addition, the attitudes of this era appear in a lecture delivered to the London Anthropological Society in 1869 by James MacGrigor Allan, where he asserted that menstrual excitement caused infirmities that prevented women from any of the following:
- Physical labor
- Mental labor
- Education
- Voting
Here’s an excerpt of his speech:
“What is meant by the glib assertion, that woman is the equal of man? Is she equal in size? No. In physical strength? No. In intellect? Yes, replies the advocate – and if she received the same training as man, she would demonstrate her intellectual equality and her moral superiority to her masculine tyrant. I deny this assertion and proceed to show why woman is incapable of receiving a training similar to that of man. My position is, that there must be radical, natural permanent distinctions in the mental and moral conformation, corresponding with those in the physical organization of the sexes.”
This worldview contributed to inequity for women in mental health care, and in society and culture in general.
Twentieth and Twenty-First Centuries
In the early 20th century, doctors held on to the connection between female hormones and mental health disorders, a belief that still informs our view of:
- Depression
- Pregnancy
- Postpartum Depression
- Eating Disorders
- Menopause-Related Disorders
In books like On the Physiological Idiocy of Women, German neurologist Paul Julius Mobius asserted that treatment of women was necessary to “maintain the social order and guard against the social and cultural problems caused by women’s emancipation.”
Notable developments in mental health treatment for women in the early 20th century included:
- Sigmund Freud’s proposal that hysteria was the cause, rather than the result, of not conceiving a child
- Freud assigning hysteria to a daughter’s repressed sexual feelings for her father
- Freud’s assertion unresolved repressed feelings for the father figure caused decreased libido and hysteria
As we can see, these ideas still relegate women to second-class status, which is no different than attitudes in prehistory – but the 20th century saw additional significant changes in mental health treatment. The development of psychotherapy by figures like Freud and his disciples was an important step in mental health treatment overall, and led to a revolution in psychotherapeutic approaches from the 1960s onward. But another 20th century development was just as crucial: one which both caused problems for and benefitted women.
The Arrival of Pharmaceutical Treatment
In the mid-20th century, these mental health treatments were prescribed to women far more often than men:
- Frontal lobotomies
- Insulin coma therapy (ICT)
- Electroconvulsive therapy (ECT)
- Amphetamines
- Neuroleptics
- Anxiolytic drugs
Over the last 50 years, in the period straddling the end of the 20th and the beginning of the 21st centuries, mental health treatment has shifted to a focus on biopsychology, biopsychiatry, and psychoneurology. The 1990s, known as the Decade of the Brain, facilitated this shift in mental health treatment with the continued development of various types of medication initiated in the 70s and 80s, including second-generation antipsychotics and antidepressants, which are now first-line treatments for a wide variety of mental health disorders
Another development increased the proliferation of psychiatric medication among women:
Changes in diagnostic criteria for some mood and anxiety disorders allowed providers to write prescriptions for psychiatric medication – often for “vulnerable or unhappy women” – at far higher rates and for more patients than ever before.
This occurred despite the fact that many medications included serious side-effects, and as we mentioned in the beginning of this article, the fact that the impact of those side effects on women is not completely understood.
Nevertheless, throughout the 20th century, women were more likely than men to receive prescriptions for:
- Psychotropic medications without evidence for effectiveness/side-effects in women
- Antidepressants not tested on women
- Neuroleptics not tested on women
- Antipsychotics not tested on women
- Medication with high potential for misuse, i.e. sedatives and/or benzodiazepines
- Electroshock therapy: up to 67% of EST
In the 21st century, we’re working to bring equity to mental health care for women. As we mention above, we still have a long way to go. Evidence-based treatments involving psychotherapy, noninvasive therapies, women’s therapy groups, women’s residential treatment centers, and women’s peer support groups offer a level of support unparalleled in history. We observe that when women join together to support and empower one another, real healing happens. When we educate as many people as we can about evidence-based support for women, we know we can keep improving. We have the knowledge. the will, and the framework to help women overcome mental health issues, from the simple to the complex.
Advancing Equity in the History of Mental Health Care for Women: Where Do We Go Now?
The authors of the paper we draw on throughout this article, Disparities in Mental Health Diagnoses and Treatments Among Women: A Historical and Theoretical Review, identify outcomes for demographic groups that experience significant historical mistreatment and oppression, such as women:
- Learned sense of helplessness/inferiority
- Default passivity, as compared to default assertiveness
- Loss of personal agency
- Loss of self-belief
Here’s how they describe the impact of these outcomes on women:
“All these consequences may place women at greater risk for symptoms of and/or mental health diagnoses of anxiety disorders, depression, PTSD, eating disorders, and sleep disorders.”
As we move toward the middle of the 21st century, mental health professionals, policy experts, and other concerned parties continue to work to bring equity to mental health treatment for women, where equity has been notably absent throughout history.
In 1990, The National Institutes of Health (NIH) Office of Research on Women’s Health (ORWH) created a strategic plan to advance research on women’s health issues, based on six achievable goals. We’re still working under this framework today, after two decades of improvement and revision:
Goal 1:
Increase research on gender differences
Goal 2:
Incorporate new information on gender differences in the design and application of new technology, medication, and treatment
Goal 3:
Operationalize improved prevention, diagnosis, and treatments for women
Goal 4:
Establish partnerships to enhance the impact of women’s health research worldwide
Goal 5:
Create new information and communication technologies to expand understanding of women’s health research
Goal 6:
Create a robust, well-trained, and well-educated generation of scientists to engage in research on women’s health issues
The fact we’re still working on these goals 35 years later shows the scope of the task before us, but we are undaunted. We’re committed to reaching these goals 100 percent – and we’ll share any new news or developments on mental health care for women here as soon as they’re available.
