Sigmund Freud had a print of the painting Une leçon clinique à la Salpêtrière (1887) by André Brouillet in his office.

Une leçon clinique à la Salpêtrière depicts one of Jean-Martin Charcot’s weekly public demonstrations of female hysteria at the Salpêtrière hospital in Paris that started in the 1870s. The hospital was essentially a dumping ground for Paris’s undesirable women: a home for beggars, prostitutes, criminals and anyone considered deviant. It hosted Charcot’s social event that was highly sought after; tickets were bought by doctors, scholars, and, surprisingly, artists, writers, journalists, or by any person whose interest was piqued. The premise of the event was to induce his female patients into hysterical states through hypnosis, displayed for the audience to observe. It was almost like a clinically framed voyeuristic spectacle; in their male-orchestrated crisis, the women displayed an almost erotic passivity and even behaviour that could be interpreted as ecstasy. In this theatre of hysteria, was the woman performing insanity in front of a male audience real research, or veiled sexual entertainment? Under the guise of research, the exploitative content remained publishable and legitimate.

When he attended one of the demonstrations in 1885, Freud left Salpêtrière deeply impacted by the experience. As a psychoanalyst, he was very aware of the position he inhabited in the patients' lives. The origins of desire were a recurring topic in his studies; the subjects were prompted to reveal their deepest thoughts, desires and lay down their sexual lives for the analyst to interpret. Within this profession, there was a constant anxiety for possible erotic feelings being developed by either person involved due to the intimate dynamic of those studies. The history of psychoanalysis is full of cases where that professional boundary collapsed. Carl Jung had a long affair with his patient Sabina Spielrein, who later became a psychoanalyst herself. The erotic charge of therapeutic encounters was so present that the entire structure of psychoanalytic ethics was built around restraining it.

There is an inherent power imbalance in medical encounters that is informed by the dynamic between the observer and the observed. The doctor, almost always male, is authoritative and active in interpreting the patient, while the patient is passive, sometimes undressed when being interpreted. The former is the bearer of knowledge whose purpose is to fix, or even save, the dysfunctional latter. The subject of inquiry is at a physical or mental disadvantage. Although it is a natural, almost unavoidable way of dealing with malady, contextually, it's an extension of how women are already treated on a societal scale. Women are already in a position of systemic subordination, and human interactions do not exist in a vacuum, so whether it intends to or not, the encounter exaggerates the pre-established feminine lack of agency. The hierarchy makes medical abuse all the more likely.

Rachel Maines, in her 1999 book The Technology of Orgasm, argues that hysterical women’s treatments were oftentimes orgasmic pelvic massages performed by doctors. She believes the vibrator was developed specifically to automate that treatment to more effectively cure female hysteria through sexual stimuli. In recent years, that thesis has been refuted; many experts claim the evidence for the origins of the vibratour as a medical tool is very thin, and that the practice was not at all widespread. Regardless of its accuracy, the cultural life of Maines’ claims remains significant. The thesis is still often cited, and even turned into the movie Hysteria (2011). That story was so widely believed and circulated because it confirmed something people already sensed: that the medical treatment of female sexuality was a form of disguised erotic encounter that medicine refused to acknowledge as such. The story rang true because the dynamic was real, despite the actual history being overstated.

It is worth asking, since the female figure was already culturally interpreted as defective, isn’t it more likely that feminine illness was entirely fabricated based on that assumption? Nellie Bly’s 10 Days in a Madhouse is an interesting consideration of the question. Bly was an undercover journalist who feigned insanity to get admitted into a women’s asylum in hopes of documenting mental health institutions from a more immersive perspective. She observed several women she was convinced were entirely sane and noted that these women were forced into the asylum not because of real cognitive problems, but because they were poor, immigrant, or inconvenient. The most damning observation Bly makes is about the impossibility of proving your sanity once committed. From the moment she entered the ward, she made no attempt to keep up the role of insanity; she talked and acted as she did in ordinary life. Weirdly, the more normally she behaved, the crazier she was thought to be. Any protest of confinement was proving the women’s irrationality; the whole institution ran on confirmation bias, which made the place inescapable. It was pure neglect and cruelty framed as charity.

That institutional behaviour is not so surprising when thinking about the origins of conventions in psychiatry. Ismatu Gwendolyn, a former stripper and clinical therapist, meditates on what defines insanity within a socioeconomic framework in her essay The Strip Club Did Indeed Make Me Bonkers. She believes sanity is defined by compliance with capitalism, and in a broader sense, it's defined by compliance with the hegemonic status quo. Therapy pathologizes all and any deviation from productive behaviour that abides by the power structures. Gwendolyn realized she was being clinically trained to intervene when a client's distress interfered with their ability to work. She was essentially teaching clients to cope with overwork rather than question the conditions producing the distress. The strip club was where she developed a different relationship to money and time; she stopped being motivated by capital and started measuring wealth in time autonomy. In that sense, she became mad. She explains: “In this iteration of the world (that we all keep choosing to live in), sanity keeps us coloring within the prescribed lines of thought by design”. The female hysterics in history who refused domestic compliance and the contemporary person whose distress makes them unable to work are being managed by the same logic across two centuries. Psychiatry is susceptible to ideology.

The origins of those ideologies are found in pre-modern Europe, where the Church was the primary institution managing bodies. In the 18th and 19th centuries, when medicine got secularized, instead of replacing religious authority, it appropriated its moral structure and doctors stepped into the role of the priest. Foucault refers to this as the shift from pastoral power to disciplinary power. Confessors give corrections based on the extracted truth from their subject about their inner life, and the psychiatrist does the same thing, only with medical apparatus. The doctor acts as an authoritative enforcer of the hierarchical status quo. Health is perceived as an indicator of moral purity, being institutionalized infers personal failure and an almost intentional ethical wickedness. We associate goodness with anything natural because its opposite, artifice, is fake and therefore necessarily wrong. Consequently, the deviancy from mental and physical vigor is corrupt.

In 1835, James Coweles Prichard coined the diagnosis of moral insanity, which was defined by a morbid perversion of the natural feelings and temper without any notable lesion of the intellect. Mental illness was defined by the deviation from established so called “natural” social norms despite being a perfectly rational person. Plain social control was camouflaged under the guise of medicine. Because psychiatry was so moralized, its rehabilitation institutions worked the same as those of the justice system; asylums are essentially prisons. In both cases, the treatment is behavioral therapy to conform to bourgeois norms of self-control and industriousness. The failure of self-governance is therefore madness.

The simple fact of women existing in a natural state that transgressed puritanical norms was pathologized. The belief in the naturally asexual woman seeped into medical normative expectations, even though on a biological level this is completely unfounded. That’s why diagnoses like nymphomania have no real equivalent, women’s sins were reinforced through psychiatry. During the purity movement of the 19th century, religious purity organizations and medical hygiene movements shared personnel and funding. Their rhetoric was the same, the campaign against masturbation, prostitution, and female sexual autonomy was conducted jointly by church and clinic. Prostitutes were simultaneously sinners in the eyes of the Church and vectors of disease within medicine. Britain’s 19th-century Contagious Diseases Acts allowed police to forcibly examine any woman suspected of prostitution for venereal disease inspection. The woman's body was subject to state-sanctioned medical invasion justified by the moral and hygienic ideals in power. Josephine Butler campaigned against this medicine-religion-state authority over women's bodies. Women’s sexuality was a threat to the social order because the free woman is ungovernable. However, the ill woman was subject to societal control, which is how it became the end-all label for any lady who dared to be at liberty.

Bly, Nellie. Ten Days in a Mad-House. Norman L. Munro, 1887.

Brouillet, André. Une leçon clinique à la Salpêtrière. 1887, Université Paris Descartes.

Butler, Josephine. Personal Reminiscences of a Great Crusade. Horace Marshall, 1896.

Foucault, Michel. Madness and Civilization: A History of Insanity in the Age of Reason. Translated by Richard Howard, Pantheon Books, 1965.

Freud, Sigmund. Studies on Hysteria. Translated by James Strachey, Basic Books, 1957.

Gwendolyn, Ismatu. "The Strip Club Did Indeed Make Me Bonkers." Threadings, 13 Aug. 2025, www.threadings.io/the-strip-club-did-indeed-make-me-bonkers.

Maines, Rachel P. The Technology of Orgasm: "Hysteria," the Vibrator, and Women's Sexual Satisfaction. Johns Hopkins UP, 1999.

Prichard, James Cowles. A Treatise on Insanity and Other Disorders Affecting the Mind. Sherwood, Gilbert, and Piper, 1835.