Tracing The Complex History Of Women’s Mental Health Care & Treatment

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. Understanding a bit more about the history of women’s health care (particularly mental health care) may help clarify both the progress and the challenges seen in this field today. For individual mental health support, meeting with an in-person or online therapist may be helpful. 

The view of women’s mental health in ancient times

In some ancient civilizations, such as early Egyptian, Incan, 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. 

Hippocrates and “hysteria” in women

While the person who coined the term “hysteria” 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" in women patients.

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 suggest 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 in the Middle Ages through the rise of psychiatry

During the Middle Ages, women experiencing mental health conditions or psychiatric symptoms were often labeled as witches and subjected to persecution, sometimes even being killed. 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 for 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, though a wealth of research has since been done on various methods to improve their effectiveness for different conditions.

Modern 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 symptoms traditionally associated with hysteria as not exclusive to women, allowing a scientific view to prevail. Researchers began to study other mental health conditions that may affect women’s lives, such as depression during the postpartum period (which people of any gender can experience). The gap between men's and women's mental health began to close somewhat as more researchers found that there seemed to be 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 environmental factors in an individual’s 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 about how to best treat women, and ineffective, dangerous, and often unethical methods such as 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. Together, all of these complex historical developments lead us to the current landscape of women’s mental health care.

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 a person’s experiences, including their mental health experiences. This perspective emphasizes the need for inclusive and culturally sensitive approaches to mental healthcare as well as methods for dealing with and redesigning systems that were built on prejudice.

Common mental health concerns among women today

People of all genders may experience mental health concerns. That said, certain life experiences that many women have may affect an individual’s risk of developing certain mental health challenges. If you’re experiencing mental health concerns, you might consider working with an in-person or online therapist to address them.

Emotional challenges related to menstruation and menopause

Many cisgender women and individuals assigned female at birth experience a menstrual cycle, which may sometimes bring certain emotional challenges. For example, mood swings, irritability, and intensification of any existing psychiatric symptoms can be common in those who experience premenstrual syndrome (PMS). A person’s mental health could also be impacted by chronic pain associated with conditions like endometriosis, or by various emotional symptoms associated with conditions like premenstrual dysphoric disorder (PMDD). 

Later in some people’s life cycle, menopause can bring an increased risk of mood challenges, sleep disorders, and increased intensity of any psychiatric symptoms (such as those associated with bipolar disorder, depression, or other conditions).

Mental health and pregnancy

For women and people of other genders who choose to have biological children and are the birthing parent, the hormonal changes and stressors of pregnancy may also increase certain mental health risks. Conditions like prenatal or postpartum anxiety or depression affect some parents before, during, or after the birth of their child. Other related challenges that may also cause emotional distress and affect mental well-being include:

• Infertility
• Pregnancy-related complications
• Pregnancy loss
• A traumatic birth 

Social influences on mental well-being

Environmental factors could also influence the mental health of a woman or a person of another marginalized gender. Systemic sexism still affects people who aren’t men in many different settings across their lifespan. 

For instance, one study recognizes the “social and economic inequalities more commonly experienced by women” which may contribute to poorer overall health outcomes among this population worldwide. Specifically, it mentions:

• “Lower rates of schooling and employment
• Less pay for similar jobs
• Underrepresentation in leadership positions
• A higher level of psychosocial stressors and problems, from caregiving burden to intimate partner violence”

Also, each of these challenges may be intensified for people living under intersecting forms of oppression—including but not limited to BIPOC women, disabled women, queer and trans women, and neurodivergent women. Certain lived experiences (such as discrimination and prejudice) of an individual with intersecting identities may increase their risk of developing mental health challenges like depression and other mood disorders, trauma, anxiety, and more.

When should you seek mental health support?

Symptoms of untreated mental health challenges may worsen and might put a person at risk of developing additional concerns. It may be important to reach out to a therapist if you’re living with symptoms like the following, especially if they’re causing distress or impacting your daily life:

• A loss of interest in activities once enjoyed
• Significant changes in sleeping or eating patterns
• Overwhelming emotions or stress levels
• Persistent worry that’s hard to control
• Unhealthy coping mechanisms like excessive spending, risky behavior, or substance use
• Thoughts of self-harm or suicide

That said, showing symptoms of a diagnosable condition isn’t the only reason a person might try to find support for their mental health. In general, anyone may seek in-person or online therapy at any time of life, even if they’re not showing signs of a diagnosable illness. A therapist can also help a person address challenges like stress, low self-esteem, relationship challenges, and more.

Therapy and other approaches for supporting mental health

A therapist may offer a safe space where you can feel heard and supported. They may use various talk therapy approaches to help you shift your thought patterns, boost self-esteem, develop healthy coping mechanisms, and more. 

Your therapist may also suggest practicing healthy habits to support prevention, stress management, mood management, and physical health and to help make your care more effective. Examples include getting enough sleep, eating nutrient-dense meals, and exercising regularly. Leaning on family and friends and connecting with support groups may be helpful as well.

Options for finding care

The mental health care and treatment options available to you may depend on various factors, such as where you live. To connect with healthcare providers, psychiatrists, or clinicians for in-person mental health appointments, you might check with your insurance company for a list of in-network providers. If you do not have insurance, you can contact your local community health clinic or the Department of Health and Human Services to learn about any free or low-cost care options.

Another option for receiving mental health care is online therapy through a platform like BetterHelp. It allows you to get matched and then meet with a licensed therapist virtually, from home or anywhere you have an internet connection.

BetterHelp aims to connect you with a therapist according to the preferences you outline in your onboarding questionnaire. If you’d prefer to meet with a counseling professional who identifies as a woman, for example, you can share this in the questionnaire.

Is online therapy effective?

On the matter of effectiveness, research suggests that online therapy can often be just as effective as traditional in-person sessions for treating many mental health challenges that a person may experience (anxiety, depression, trauma, and more). That means it may represent a viable alternative for people who face barriers to receiving traditional, in-person care or who simply prefer to participate in a therapy visit from the comfort of home.

What to expect from your first therapy appointment

During your first therapy session with a new provider, they’ll typically ask questions about your mental health history and why you’re seeking care. They’ll likely start laying the foundation for you to transition into a strong and trusting therapeutic relationship over time, and they may also be able to connect women to additional health-related resources as needed. If, after a few sessions, you believe your therapist isn’t the right fit for you, it’s okay to switch providers. With BetterHelp, you can change therapists at any time for no additional cost.