Were you aware that there are tremendous disparities in mental health diagnoses? Well, there are. There’s a long history of using psychiatrisation as a weapon against ‘undesirables,’ as demonstrated in the use of diagnoses of schizophrenia to institutionalise Black men and the use of a broad array of psychiatric diagnoses to pathologise women.

Long before psychiatry was an accepted medical speciality, women were being classified as ‘neurasthenic’ and ‘hysterical.’ It was assumed that women were mentally more ‘delicate’ than men, susceptible to certain mysterious ‘female disorders’ that incapacitated them and rendered them unable to participate fully in society. This was about far more than sexism; while presumed delicacy was used to exclude women from public spaces, it was also used to control women. Women were kept at home as ‘delicate,’ they were not allowed to make choices for themselves, they were denied positions of authority. Doctors prescribed a variety of dubious ‘treatments’ and the simple state of being a woman was treated as a woeful affliction.

A diagnosis of a condition like ‘neurasthenia’ would be used to justify forcing a woman to remain unmarried. To stay under the control of a male guardian. Such women could not, of course, inherit property or run their own households. Queen or commoner, a woman’s place was under the thumb of a man. Notably, women most commonly targeted with such diagnoses were ‘troublesome’ or ‘nuisances’ or ‘uppity.’ They had ideas about how the world should be and they were not afraid to voice them. Fewer silencing methods are more effective than locking someone in a house away from the rest of the world.

With the advent of psychiatry came an entirely new array of methods for oppressing women. Instead of keeping such women confined in the back rooms of the home, they could be sent to institutions! Women who engaged in ‘socially undesirable’ activity like lobbying for the right to vote, having children while single, being poor, and refusing to comply with orders from men could be handily dumped into institutions and left there.

Involuntary commitment was nothing more than a public service for such women and their families, you see. ‘Unfortunates,’ they were called, locked away for their own good as well as the protection of society. Brutal interventions like force feeding, crude lobotomies, ice-cold baths to ‘shock’ women into appropriate behaviour, sensory deprivation, and starvation were all treatments. The people who offered these ‘treatments,’ invariably men, were heralded as heroes. How selfless of them, to run institutions to house ‘unfortunates’ and provide them with ‘care.’ Such women were literally referred to as ‘creatures.’

Oh, surely involuntary commitment doesn’t happen anymore, right? Women are never committed for being ‘troublesome.’ Brutal methods are not applied as treatments in psychiatric facilities. Wrong, wrong, and wrong. It happens all the time, and equally sinisterly, psychiatrisation is used on an entirely new level. Women are routinely saddled with labels like ‘borderline personality disorder’ (BPD) and ‘narcissistic personality disorder’ and other ‘personality disorders.’ Men who exhibit the same ‘symptoms’ do not receive these diagnoses. Indeed, in men, some of these ‘symptoms’ are actually viewed as desirable traits.

Men who experience trauma have post traumatic stress disorder. Women who experience trauma and have the exact same set of symptoms have BPD. That’s a pretty stark disparity, wouldn’t you say? When you look at mental health statistics and you see that women are more likely to have certain psychiatric conditions, something that gets left out is disparities in how these conditions are diagnosed, and how people with the same symptoms will receive a different diagnosis not just on the basis of seeing a different doctor, but on the basis of their gender identities.

The use of psychiatry to marginalise women is, honestly, rather brilliant. People fear mental illness, they fear ‘crazy,’ at the same time that they take psychiatry as an entirely reliable science, something that cannot be questioned or doubted. Once the crazy label is applied, it is remarkably different to peel off, and treating perfectly normal behaviours as ‘crazy’ when they occur in women reinforces the commonly held idea that ‘all women are crazy.’ That women are irrational. That, again, women do not know what is good for them and cannot be trusted to make decisions for themselves.

Women who speak out, women who go against the grain, women who question the system, women who have emotions, women who express themselves, can be very easily tagged with a psychiatric diagnosis that can be extremely difficult to get rid of. Many of the diagnoses applied to women involve conditions considered ‘dangerous.’ A woman might be a ‘danger to herself and others,’ so she can be committed, yes, involuntarily. Family members, guardians, law enforcement, all of these people can make the decision to commit a woman on the basis of her psychiatric history, even if a diagnostic label was not applied properly.

Many people are surprised to learn about the tangled and complex history of psychiatrisation and the ways in which it has been used to silence, marginalise, and oppress women. Unfortunately, many of these same people are unaware that the same tactics used in 1600 are still being used today, albeit under different names. Sexism is embedded into the structure of a number of psychiatric diagnoses and it causes real harm today, right now, quite possibly in your very community.

Perhaps even in your very household. The thing about psychiatrisation is that it has an insidious hold. If you are told enough times that you have a ‘disorder’ and your behaviour is ‘abnormal’ and you need treatment, you are going to be believe it. You are going to stop believing your emotions. You are going to stop trusting your responses to the world around you. You will agree that, yes, of course, it is all for your own good.

For all of the real benefits in recognising and treating actual mental health conditions, there are hidden costs that are not commonly addressed. We need to be talking about why it is that there are such significant racial and gender disparities in psychiatric diagnosis, and we need to be discussing the fact that, clearly, racism and sexism play a role in how psychiatrists and other mental health professionals interact with their patients.