‘I tormented the doctors to operate again’

“My first treatment was medicine to try to strengthen my nerves. The personal influence of my doctor induced me to exert my will, but any good effect was but temporary. The next thing tried was cutting the clitoris but it grew again. The relief from this lasted only six weeks. I tormented the doctors to operate again, but they were afraid it would kill me.” (Morrison, 1885, p. 535)

This excerpt comes from an 1885 article in the Philadelphia Medical Times, which reprinted the letter of a woman describing her symptoms, diagnoses and treatments to her doctor. Printed alongside the letter, the doctor describes her as suffering from nymphomania and hysteria, among other difficulties.

What stands out strongly in her own narrative is the active role that she took in her own treatment: She researched her symptoms and sought physicians who would perform the treatments she desired. Even more surprising is that she requested various sexual surgeries.

The gynecological claim on female insanity

At the time, sexual surgeries were thought to relieve both the physical and mental symptoms associated with these organs. For instance, a procedure known as “Battey’s operation,” in which a woman’s healthy ovaries were removed, was performed to induce menopause, thus negating the ill effects of monthly menses. Clitorectomies — the act of removing a portion of or the entire clitoris — were also performed to give women relief from urges, temptations and “inappropriate” sexual desires.

Male sex organs were also subjected to sexual surgeries, including castration. These somatic treatments for psychological ailments brought the emerging professions of gynecology, neurology and alienism (the precursor to psychiatry) together in an uneasy relationship during the 19th century.

Regardless of the profession, the prevailing mode of treatment was to search for the site of a person’s “insanity” (the term for mental illness at the time): Alienists were known to perform autopsies on the bodies of their deceased patients to look for tumors, cysts or discolorations in the brain or body; gynecologists associated some mental symptoms with the sex organs; neurologists focused on regulating the nerves. Although each profession focused on different causal agents in the body, the rising trend in the second half of the 19th century was to think of insanity in an embodied manner.

Despite the focus on the body, insanity was not generally believed to affect one sex more than the other. However, because male and female sexual organs are different, a small subset of disorders were thought to be sex-specific, or to affect one sex more often than the other. For instance, men were considered to be more likely than women to fall victim to insanity as a result of masturbation. Conversely, women were believed to be at greater risk for hysteria than men. Moreover, only women could suffer from ailments such as “menstrual madness” or those associated with childbirth, such as “puerperal insanity.” Some symptoms, too, were specific to one sex or the other: a woman’s feeling that her womb was “wandering,” for example.

Sexual surgeries, while actively promoted and performed by some professionals, remained controversial even during the peak of their popularity in the second half of the 19th century. Some considered the practice to be a process of de-sexing that was no better than castration. Still, hundreds of operations were performed. Perhaps more so than other treatments for insanity, these procedures revealed the tensions among the developing professions of gynecology, alienism and neurology.

The role of patients

By the end of the 19th century, however, sexual surgeries had largely gone out of vogue. In 1888, the American Gynaecological Society officially condemned the use of Battey’s operation as a treatment for insanity. This shift in practice allowed the treatment of insanity to fall chiefly to alienists and neurologists. However, to view the rise and fall of sexual surgeries purely in professional terms misses the contributions of yet another group of actors: the patients.

In historical discussions of treatments, particularly sexual surgeries, it can sometimes seem as though patients were passive victims. However, as was depicted in the opening quotation, some actively researched available treatments and sought out the physicians most likely to give them their desired result. Sexual surgeries were no exception — some women suffering from a variety of symptoms sought out these invasive procedures, while others refused them. The important question then becomes: Why?

To gain insight into why patients selected one treatment over another, a number of factors need to be considered, including the relationship between patients and their physicians during the 19th century; the status of medicine and related professions; the role of politics, the law and shifting societal norms; the influence of friends or family; and the intersections of gender, race, class and other social categories on patient decision-making. This process was very individual and certainly varied depending on which combination of factors influenced the particular person most.

Patients sought out sexual surgeries because, from within their own personal context, they seemed to be the best treatment options available to them. Appreciating the complexities of situations such as these gives new insights not only into psychology’s past, but also into how modern-day psychology interacts with its consumers. Listening to these rare patient narratives, such as the one quoted at the beginning of this article, can thereby inform both historical research and current practice.

Laura C. Ball and Jennifer L. Bazar are graduate students in the York University history and theory of psychology program. Katherine Milar, PhD, of Earlham College, is historical editor for “Time Capsule.”