The medical conception of mental illness in women has changed over time, but for decades the (overwhelmingly male) artistic representation remained surprisingly consistent: messy hair, disjointed speech, glassy eyes, inappropriate nudity. For centuries, men have reframed mental illness as something romantic, even sexy. Based in the antiquated diagnosis of "hysteria," men's representation of women's mental illness has overshadowed the stories of their (often non-consenting) muses.
It's not a coincidence that Hamlet's Ophelia cleaves perfectly to this stereotype. Her characterization heavily influenced the first psychologists. "Every mental physician of moderately extensive experience must have seen many Ophelias," wrote Dr. John Charles Bucknill, the president of the UK's Medico-Psychological Association, in 1859. Dr. Hugh Diamond, the superintendent of the Surrey County Asylum women's ward, even dressed his patients as Ophelia for photographs; the most famous of these images depicts an inmate in his asylum wrapped in a cloak with a garland of laurel he has placed on her head. Dr. Diamond used portraits of his patients in therapy—it was believed that photographs could "shock" the patient into wellness, the theory going that being confronted with their own face would bring them back to reality. Actresses who were portraying Ophelia on stage were also invited to visit asylums to observe "Ophelias" in their domains, presumably for artistic inspiration.
One place where actresses, medical students, artists, socialites, and other slack-jaws gawpers could observe hysterical women was at the Pitié-Salpêtrière Hospital in Paris. At the time, hysteria was defined as a disease of the reproductive organs. Excessive desire—for sex and/or childbirth—was considered the likely root of the disease. Deception, mood swings, and emotional outbursts were widely recognized symptoms. Suggested cures included horseback riding and childbirth. Physician Jean Martin Charcot, director of the Salpêtrière and father of neurology, was one of the first doctors to advocate that the cause of hysteria was in the brain and not the loins. Still, his work on the disease was still highly sexualized.
Every Tuesday, Charcot would show off his patients like a lion tamer at a circus. Patients with twitches were given caps with long feathers that would jerk wildly with every tremor. Patients with hysteria were put through "experiments" that more closely resembled stage hypnotism than anything with medial merit. Charcot played hysterical patients like someone playing the Jurassic Park theme on melodica, inducing hysterical fits on command. If the patient didn't act hysterical in the way expected of her, she risked being thrown into the general population of so-called insane women where the cure rate was less than 10 percent.
One "skit" deemed a big hit by interns at the hospital and recounted by Asti Hustvedt in her book Medical Muses was called the "mariage a trois." In it, a hysterical patient was hypnotized and "told that each side of her body, her left side and her right, had its own husband and was reminded that it was her duty to be faithful to both of them," Hustvedt writes. The two husbands would then fondle their respective half, which the patient received with "marked pleasure," according to one of the gropers. "But if one dared encroach on the side of the other, watch out! When I ventured too far, I received a whopping slap." Any physical or mental discomfort the women of the Salpêtrière suffered took a backseat to the spectacle of the Tuesday lectures and the titillation their suggestibility provided.
Charcot also partnered with artist Paul Richer to document the poses a hysteric goes through during attacks in a series of etchings. These artists renderings were cribbed not only from Charcot's observations, but from representations of religious ecstasy in early medieval art. In the preface to his and Richer's book of hysteric poses, Charcot draws a line St. Catherine of Sienna to his era's hysterics, trying to create a so-called "universal" theory of hysteria. Many of these poses were, of course, captured in states of semi-undress.
The hysteria diagnosis fell out of favor in the 20th century, in part due to the activism of feminists and mental health advocates, but the romantic mythology of the mentally ill woman remained very much intact. Film became the site of a ubiquitous stock figure figure—the tragic, beautiful, woman struggling with some highly gendered form of mental illness, which I'll refer to as the Sexy Doomed Sad Girl.
Postwar Hollywood liberally used the Sexy Doomed Sad Girl in films like Vertigo and Lilith, where a woman's allure was equal to her grim predestined fate. "The twist is, she's beautiful," explains Bechdelcast co-host Jamie Loftus when asked about this archetype. "She's so sad, but she's beautiful. Any time a mentally ill character is not attractive, when is that character saved? When is that character given the correct amount of attention in the plot, or by anyone in the movie?" These films are more about the men who love a Sad Girl, and less about real mental illness. At the beginning of Vertigo, for instance, James Stewart's character is told that his blonde ice queen has been possessed by the spirit of her suicidal grandmother. Stewart isn't deterred by this frankly bonkers pronouncement. Rather, he becomes so enamored of his doomed heroine that he molds his next girlfriend into her suicidal image.
Sexy Doomed Sad Girls are more like puzzles than fully formed characters. Like the hysterics of old, they are a collection of symptoms and an alluring figure. "In general, movies would rather look at women than analyze them — except when the lady in question is (at least apparently) a little screwy," writes Terrence Rafferty in his review of A Dangerous Method. Rafferty argues that that film, as a medium, tends to concern itself with the inner thoughts of a beautiful woman only if she's insane, and to only care about the insane if they are beautiful women. Examples he cites include Olivia de Havilland in The Snake Pit, Jessica Lange in Frances, Naomi Watts in Mulholland Drive, and Natalie Portman in Black Swan.
"Some of the movies' disturbed women get the proper treatment — psychiatric and cinematic — and many do not," he argues, "but even when the analysis fails, the looking remains." Loftus agrees with his characterization, citing the dreamy aesthetic of The Virgin Suicides as a notable example. "Film is visual medium, and it's got to look like something," she says. "But it's always going to look too nice. The Virgin Suicides looks too nice. It's very gauzy… there's a lot of millennial pink in there, slow motion, an indie soundtrack. Mental illness shouldn't be scored with The Shins."
"Any time a mentally ill character is not attractive, when is that character saved? When is that character given the correct amount of attention in the plot, or by anyone in the movie?"
Our tendency to focus on "the looking" has continued to the modern day, and proliferated into other forms of media: The Netflix original series 13 Reasons Why, which came out earlier this year, specifically frames a girl's sexual assault (and ensuing PTSD and suicide) as a scavenger hunt for the male protagonist. "Instead of showcasing the tragic ending to a life, we witness a school become captivated by the drama of suicide," writes Alexa Curtis in Rolling Stone.
There are, of course, portrayals of women's mental illness that do not fall into stereotypes that should have died with the hysteria diagnosis. And when women who struggle with mental illness tell their own stories, they can bring unprecedented nuance to the subject. In the second half of the 20th century, many mentally ill women took control of their own stories through memoir. Sylvia Plath's semi-fictional The Bell Jar, the poems of Anne Sexton, and works like Prozac Nation by Elizabeth Wurtzel and The Center Cannot Hold by Elyn Saks chronicled the experience firsthand; here, women are able to break free of the constraints of the centuries-old Ophelia trope and assert their own narratives on their own terms.
The resulting works finally give women authorship over their own experiences: In Susanna Kaysen's memoir Girl, Interrupted, for instance, she fights back against her borderline personality disorder diagnosis and hospitalization. While admitting that she needed help and was, in her own words, "insane," she doesn't let her doctors off the hook for taking away her agency. A chapter called "Do You Believe Him Or Me" is devoted to proving her doctor was lying when he said he spoke to her for three hours before recommending institutionalization. Works like this force the reader to confront mental illness and all its messy complications. As more women write and produce their own shows, the representation of their experiences will also improve. "Lady Dynamite gets it as right as I've seen it," says Loftus, referring to Maria Bamford's semi-autobiographical Netflix comedy. "Even though it's represented in a silly, manic way, at least it's represented as a process and not a phase."
Mental illness isn't a phase. It can be silly, painful, gross—any number of descriptors. ("Sexy" isn't a good one.) It's a deeply complex topic; anyone rearing Girl, Interrupted understands that Kaysen's life isn't all flower garlands and staring off into the middle distance. Hysteria sufferers at the Salpêtrière didn't get to tell their stories, and were instead relegated to actors playing themselves in someone else's account of their purported "madness." When women are in control of their own story, the truth comes through in all its unsexy, messy glory. That is a different kind of beauty.