Gender & Treatment | Quakers & Mental Health

Gender and Treatment

Photograph of the asylum's gymnasium
Friends’ Asylum for the Insane: Reports of the Board of Managers…. Philadelphia: George H. Buchanan and Company, 1894.

Medical Treatment and Diagnosis

For the most part it appears that male and female patients were admitted at similar rates, diagnosed with the same mental illnesses, and thought to be equally susceptible to insanity (Appendix B). However, there are some differences in what was listed as men’s and women’s causes of insanity. Women were much more likely to be admitted due to insanity caused by gynecological issues while men were more likely to be admitted due to insanity caused by intemperance or a lack of restraint, often caused by alcohol. Obviously, men were not diagnosed with insanity due to gynecological issues but it is rare for women to be admitted due to intemperance.

Moral Treatment

Moral treatment at Friends’ Asylum shows more differences based on gender. In 1835 the Managers wrote to other asylums seeking out advice on other forms of moral treatment (Seventh Month, 1835). One result of this correspondence was the establishment of classes for patients at Friends’ Asylum. Originally, the classes were started because the Managers felt that they would help the Asylum be more successful in treating mentally ill patients (Third Month, 1833). Often women were the first to be able to participate in these classes that Friends’ Asylum offered. See the occupational therapy page for more information on activities and how these factored into moral treatment.


In 1890 Carolyn Ladd Hall, a female doctor and Bryn Mawr College graduate, was hired to be the director of the Asylum’s gymnasium. She was responsible for teaching a class for the female patients and female attendants; it was not until a few months later that a similar class was created for the male patients (Third Month, 10th, 1890). It was typical for asylums to have “lectures or other entertainments in … gymnasium halls” (246). It is unclear what exercises were taught and if it was usual for classes for women to be established first. It was also common to hold academic lessons in asylums for both male and female patients. Amariah Brigham, the superintendent of the New York State Asylum, thought “schools should be established in every institution where patients could learn reading, writing, drawing, music, arithmetic, geography, history, philosophy, and the natural sciences” (236). In 1844 Friends’ Asylum followed suit and opened a school; however, the school was just for female patients. It was not until 1847 that the school began to include male patients once it was observed that it was a “decided advantage to a class of patients for whom it is always difficult to provide sufficient employment or amusement” (Third Month, 8th, 1847).


Male and female patients in the Asylum participated in different activities outside of classes. The men in the asylum did “light work in gardening, gathering fruits, and carpentering… -- and for the women, -- the usual sewing, knitting and similar housework” (Third Month, 9th, 1885). Women and men’s roles and activities in the Asylum are typical of the division of roles at other asylums at the time (Tuke), as well as in 19th century society more broadly. It is interesting that Friends’ Asylum followed other asylums in separating out activities that were appropriate for men and women while formally educating women first.

The Female Body, Desire, and Insanity at Friends Asylum

In the nineteenth century, American society began to shift from viewing female sexuality and desire as normal to seeing them as pathological departures from a woman’s “natural” passionless state.1 This shift had serious implications for women in every arena of their lives. Medicalizing female desire and the female body more generally allowed American society to justify women’s lesser societal status, and allowed for greater power on behalf of men broadly and physicians specifically in controlling women’s sexuality. Women were increasingly expected to derive pleasure solely from their roles as wives and mothers, roles which often limited their sexual agency as well as their social, political, and economic power.

As the female body and desire became more medicalized, the causes of mental illness were increasingly situated in reproductive organs. To combat mental illness in women when the source was suspected to originate in reproductive organs, physicians and psychiatrists tried a variety of different techniques, from the moral treatment that served as a standard for many asylum patients all the way up to the removal of those organs. Such was the case for Helen C., a patient at Friends Asylum admitted in 1897 whose “melancholia agitata” was attributed to childbirth and her ovaries. As her mental health declined, Helen became “suspicious of her family” and “turned against her husband.”2 Eventually, four weeks before her admission to Friends Asylum she was given a “double ovariotomy” (removal of both ovaries). The notes on the operation’s impact on her are short: Dr. Massey, who gave her history, writes only that she “has recovered from the operation. Results undetermined.”3 For Mary D., it was ambiguous “uterine troubles” that were allegedly the cause of her melancholia. In 1895, she had a hysterectomy, but it did not appear to have helped - when she was admitted to Friends Asylum in 1896 her husband claimed that while she was “usually cheerful,” she was now depressed, and had “not been fully clear in her mind since [the hysterectomy].”4 Despite their obviously mixed results, oophorectomies and hysterectomies were utilized frequently for women like Helen and Mary.

Female reproductive organs were connected to multiple types of mental illness, including an excess of desire, frequently called nymphomania. Nymphomania was not a novel concept to the nineteenth century; however, the commitment of nymphomaniacs to asylums was new, and the criteria for “excess of desire” was increasingly lowered, to the point where any expression of desire could be viewed as pathological.5 Deviance from sexual norms was viewed as a threat, and over time, the norm for women was no sexual drive at all. At Friends Asylum, women who were diagnosed with nymphomania or related mental illnesses were subject to long stays and even restraint to try to curb their sexual impulses. For a more in-depth examination of treatments given to nymphomaniacs, see the case history of Emily B.

1. Carol Groneman, "Nymphomania: The Historical Construction of Female Sexuality," Signs 19, no. 2 (1994).

2. Case History of Helen C., Case Histories, 1893-1899, Box 20, Folder 5, Friends Hospital Records, Quaker and Special Collections, Haverford College, Haverford, Pennsylvania.

3. Case History of Helen C.

4. Case History of Mary D., Case Histories, 1893-1899, Box 20, Folder 6, Friends Hospital Records, Quaker and Special Collections, Haverford College, Haverford, Pennsylvania.

5. Goldberg, Sex, Religion, and the Making of Modern Madness.

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