A trailer for the new DC Comics supervillain movie Suicide Squad offers a quick summary of each character’s powers. Deadshot: “He shoots people.” Killer Croc: “He’s a crocodile, he eats people.” Enchantress: “Possessed by a witch.” Finally, we land on Harley Quinn, played by Margot Robbie: “She’s just crazy.”

What kind of “crazy” is Harley Quinn? There are, after all, currently 157 mental illnesses listed in the DSM-V, from schizophrenia to obsessive-compulsive disorder, each with a wildly different and highly specific list of symptoms. You would think filmmakers might give it a read before making a lead character mentally ill. But this is Hollywood, and Harley Quinn is a woman, so we already know what her diagnosis is going to be. Harley Quinn is a “Crazy Bitch.”

This tragic, untreatable illness is suffered exclusively by fictional women in pop culture. A character with Crazy Bitch Syndrome will conform to one of three stereotypes: the cute and quirky child-woman; the kinky sex doll; or the violent monster. Sometimes, as with Harley Quinn, the character may be all of the above. This is a problem not just for women with mental illness, who are subject to the same ludicrous stereotypes driven by male fantasy, but for neurotypical women who are also tagged with the same diagnoses every day.

Which brings us back to Harley Quinn. She wears pigtails and a shirt that says “Daddy” on it and is prone to adorably silly non-sequiturs. But she also does mid-air yoga, licks things provocatively at random, strips in full view of her co-workers, and wraps her legs around men’s faces as a means of combat. Not to mention she’s a violent killer who delights in carnage and death, which is why she’s on a team of supervillains in the first place. So, you know, all the totally non-contradictory qualities you’d expect to find in one woman with an imbalance in her brain chemistry.

Women whose mental illness is expressed primarily through kinky sex and wacky dialogue abound throughout genre fiction.

The problem is hardly limited to her character. Women whose mental illness is expressed primarily through kinky sex and wacky dialogue abound throughout genre fiction. Joss Whedon, the king of nerd culture, has created two notable iterations. On Buffy the Vampire Slayer, there is the moon-eyed, masochistic vampire Drusilla, who plays with dolls and pouts that her lovers “won’t hurt me even a little bit.” The series Firefly features the even more heavily infantilized River Tam, a woman in her late teens who is treated as a small child by everyone around her. If triggered, she becomes a one-man murder engine. In Neil Gaiman’s book Sandman, we have Delirium, the literal personification of madness, who (of course) takes the form of a teenage girl with colorfully dyed hair and a propensity to express herself in adorable-child malapropisms.

Granted, comic books and fantasy fiction are not known for their realism. But the stereotypes about women and mental illness are so embedded in our culture that they also show up in “realistic” works—even those with overtly feminist intentions.

The Netflix series Orange is the New Black, for example, has three major mentally ill characters. Only one of them, the schizophrenic Lolly, even has a diagnosis. The remaining two, Lorna Morello and Suzanne “Crazy Eyes” Warren, each have plotlines featuring their overabundant, scary sexuality: Morello is a stalker who threatened a man’s life on multiple occasions after one date, and Suzanne fixates intensely on her fellow inmate Piper Chapman.

All three are childlike and quirky. (Suzanne, in particular, acts so young that she collects stuffed animals in her 30s and can’t understand why it’s wrong to invite a small child to her house for a sleepover.) All three have outbursts of sometimes-lethal violence. And, although all three are depicted as sympathetic, the show isn’t particularly interested in depicting them as people with real medical illnesses rather than amusing freaks.

Cultural notions of madness make female sexuality—or simply being female—a pathology.

Such stereotypes have deep historical roots. The idea of a nebulous, indefinable female madness characterized by an overflow of sexuality is more or less the definition of “hysteria,” the 19th-century pandemic that resulted in forced institutionalizations, medicalized rape (doctors believed that stimulating patients to “paroxysm,” or orgasm, was the best treatment) and clitoridectomies. Erotic images of “hysterics” flourished during this period. Paintings like Tony-Robert Fleury’s Pinel Liberates the Madwomen of Salpetriere depicted “mad” women as, primarily, women who liked to show their breasts to strangers. And “hysteria” expert Jean-Martin Charcot specialized in taking provocative photographs of his patients in their underwear. His most famous subject, Louise Augustine Gleizes, had been raped by her employer, who locked her in an institution after the attack. She was 14 years old.

This phenomenon rested upon the Victorian belief that women were basically large children: innocent, fragile, incompetent, and therefore best served by being put forcibly under male authority. Women who acted out against these constraints were necessarily mad. To this day, our “crazy” women overflow with deviant desires yet look and act like little girls. So “craziness,” in women, is not just sometimes evidenced by hypersexuality (and some disorders genuinely do cause ebbs and flows in sex drive) but historically defined by it. Which makes female sexuality—or simply being female—a pathology.

We are supposedly at the beginning of a new era of mental-health depictions. Shows Mr. Robot or BoJack Horseman tackle mentally ill characters with dignity, respect, and even some measure of interest in showing how mental illness can add more human complexity to its protagonists. Yet these are overwhelmingly shows centered on troubled men—and men have never been the people who suffered most from mental-health stigma.

It’s women, who are uniformly stereotyped as “irrational” and are called “crazy” every time they leave a bad relationship or voice an unwelcome opinion, who suffer from misconceptions about mental illness whether they are neurotypical or ill. The single most troubling fact about “hysteria” is that some doctors honestly claimed that 75% of women had it. Hysteria wasn’t an illness. It was a medical way to penalize people for being female.

And our wrong-headed ideas about mental illness still work that way. Which is to say: Harley Quinn may have Crazy Bitch Syndrome. But the problem isn’t Harley Quinn, and it never was. The problem is that in real life, if you’re a woman, and you behave in a way that some people don’t like, a man may very well decide you’re a Crazy Bitch, too. It’s the diagnosis our culture uses to excuse ignoring a person’s humanity. And it’s just another means of locking women away.