Revenge of the she-devil

In demonising a woman with psychiatric problems, however, Bronte was guilty of performing what is probably the greatest disservice to mental health in literature. That, certainly, is the view of writer and broadcaster Viv Parry, who has studied the way women and their mental health are portrayed in 19th-century novels, and who next month joins psychiatrist Dr Raj Persaud and St Andrews University lecturer Sarah Dillon at an Edinburgh International Science Festival event titled Madwomen In The Attic. Considering also Wilkie Collins's The Woman In White (who today would be regarded as having learning difficulties), and Dickens's eccentric recluse, Miss Havisham, Parry highlights the way in which medical orthodoxy at the time held that women were mentally as well as physically frail and prone to a collection of symptoms termed "hysteria". This fed through into damaging literary representations of mental illness and restrictive attitudes towards women.

Today, in theory, we live in more enlightened times, yet echoes of those old assumptions remain, to the detriment of women and those living with mental health problems. Paradoxically, however, it is probably men rather than women who are most disadvantaged by such misconceptions.

The assumption about women's propensity to hysteria has persisted for so long, it would be surprising if remnants of it did not linger on. It began with the Greeks, 24 centuries ago. The Hippocratic texts in the fourth century BC held that the womb ("hysteros" in Greek) wandered around the body cavity of a discontented woman, bringing about symptoms such as sleep difficulties and gnashing of teeth. This was thought to be caused by dryness of the womb, and sexual intercourse was believed to help alleviate it.

That notion, or versions of it, persisted in the Middle Ages and received a new lease of life in the 19th century. After Charles Darwin put forward his "survival of the fittest" theory, it came to be believed that women's bodies were "innately inferior to men's", according to Dr Ali Haggett, a lecturer at Exeter University's centre for medical history. By then it was universally assumed that women were prone to nerve weakness and mental breakdowns, particularly hysteria, a catch-all term applied to women behaving strangely or in a heightened emotional state. (Men, notes Parry, were rarely labelled in this way. They might have been eccentrics, but were never hysterics or neurotics.) The influence of the ancients can still be seen in the 19th-century understanding of hysteria; physicians, preoccupied with the connection between hysteria and women's sexuality, held that relief from it was best achieved by bringing a woman to "paroxysm". For married women, the prescription was intercourse; for unmarried or widowed females, manual stimulation by a midwife or physician. (The vibrator was invented in the latter half of the 19th century as a medical instrument for this very purpose.)

Hair-raising as such beliefs might seem today, they were solemnly held. Not all women could be "cured" of hysteria, however, and many were consigned to asylums, unregulated places where abuse was rife. These institutions, according to Parry, came to be a solution for dealing with women who would not conform to what was expected of them. A man could request that his wife be committed to one and she was powerless to prevent it. The 19th-century politician and writer Edward Bulwer-Lytton put his troublesome wife in an asylum after she publicly denounced him; she was released only after a campaign by friends. Charles Dickens tried to do the same to his wife Catherine, and William Thackeray's wife Isabella, who had severe postnatal depression, was confined to a home.

Belief that women's mental frailty stemmed from their gender continued right up until the early 20th century. Since then, perceptions have, of course, altered. First came Sigmund Freud, who recognised that mental health problems were often rooted in personal experiences, though he continued to focus most of his attentions as a psychoanalyst on women. Then came the first world war, which left hundreds of thousands of soldiers suffering the effects of shellshock (post-traumatic stress disorder), shattering the myth that men could not suffer from mental ill-health.

Better medical understanding of the fact that traumatic experiences could contribute to poor mental health was reflected in literature. In F Scott Fitzgerald's Tender Is The Night (1934), Nicole Driver receives treatment when she develops mental illness following childhood sexual abuse by her father. However, by the 1960s, feminists were accusing psychiatrists of perpetuating Victorian prejudices about mental illness. They argued that the drug diazepam – nicknamed "mother's little helper" – was being used to control women, just as asylums had been in the 19th century, without addressing the environmental and social factors contributing to women's anxiety and depression.

Today, hysteria still exists as a word in the dictionary, but not as a formal medical diagnosis. Greater understanding about the causes of mental health problems has taken the focus off gender. In literature, authors have revisited sexist Victorian attitudes to mental health, but this time through the eyes of its victims. In Michel Faber's The Crimson Petal And The White, for example, genteel wife Agnes descends into serious depression, though given that she is being kept away from her child and sexually abused by her physician, this is hardly surprising.

Yet beliefs about women's greater tendency to mental instability still linger, undermining their standing in public life and the world of work. At a time when females are still significantly under-represented in the boardrooms of large companies and at the top of fields such as science, residual societal doubts about their mental fortitude are unhelpful, to say the least.

Such assumptions are found in the language used about women and in diehard stereotypes about what defines a man and what defines a woman. Consultant psychiatrist Alex Yellowlees, medical director at The Priory in Glasgow, believes "there are still vestiges of prejudice against women".

"In the lay public's mind," he says, "mental illness is laid more at the feet of women than the feet of men." Haggett agrees. "Plenty of jokes abound about hormonal, emotional women," she says, citing the phrase "desperate housewives" as a case in point.

Such jokes are made at the highest levels. A year ago, Prime Minister David Cameron was upbraided for telling Labour MP Angela Eagle to "calm down, dear" in the House of Commons, after she heckled him. His comment was met with booming laughter on the Tory benches, but viewed by many female MPs as a patronising rebuke to a silly, shrieking woman who was getting all het up about nothing. The Prime Minister eventually apologised.

Women's greater readiness to show their emotions may have fed the idea, formulated by male physicians through the ages, of their tendency to hysteria. Shows of emotion, such as anger or fear, have always been central to the concept of hysteria, which the 2003 Collins English dictionary defines as "a mental disorder characterised by emotional outbursts", among other things.

Today, shows of emotion – especially crying, which women do more readily than men – are still often viewed as embarrassing. "Rather than seeing crying as a healthy sign that a person is able to express and vent their emotions appropriately," says Yellowlees, "some people see it as a sign of weakness and vulnerability."

Likewise, women showing anger are often spoken of in derogatory language that implies they are mentally unstable. Yellowlees explains: "You hear phrases like 'she went crazy at me' or 'she went aff her heid at me', meaning, 'she expressed her feelings about me coming in late from the pub again'." Many men, he believes, still feel bound to conform to the stereotype of the "tough guy who doesn't let things get to him", while women, being more willing to show their feelings, are regarded as more mentally vulnerable.

So is there any truth in the view that women are more prone to mental ill-health than men? A superficial analysis of the statistics might seem to suggest there is. About twice as many women as men are diagnosed with depression, according to the World Health Organisation (WHO). More women experience anxiety, too.

Yet that is only part of the story. Certain other mental health problems predominantly affect men. For instance, more than twice as many men as women have problems with alcohol. In Scotland, furthermore, about three-quarters of suicides are by men. (As for severe psychiatric disorders such as schizophrenia and bipolar disorder, the WHO notes, "there are no marked gender differences".)

Taken together then, according to the WHO, rates of mental disorders overall are actually roughly equal between men and women, but as the figures suggest, mental ill-health manifests itself differently according to gender. So why are more women diagnosed with depression and anxiety? The answer seems to lie in a mixture of sociological and cultural factors, and a higher rate of reporting by women.

A history of domestic violence, rape and sexual abuse, being poor and earning less than men, lacking social status and having unremitting responsibility for the care of others, are all listed by the WHO as risk factors for mental disorders that disproportionately affect women. In Scotland, women are the victims in four-fifths of reported domestic abuse cases (though nearly 9000 men also reported being abused in 2009-10); Government figures published last month show that twice as many women as men are losing their jobs in the recession; and British women are already disadvantaged by being paid, on average, 15% less per hour than men, according to the Fawcett Society. Women also continue to do the majority of unpaid caring work, both for children and older relatives. All this helps to explain why more women than men are being diagnosed with depression.

According to Yellowlees, men are equally vulnerable to the condition, but are afraid to be seen as weak by seeking help for it and do not as readily recognise the signs. Not only does this mean they are under-represented in the depression statistics, it is also likely to be contributing to higher rates of alcohol and drug abuse among men, as drink is used to mask feelings of low mood or despair.

And what about the WHO's claim that "doctors are more likely to diagnose depression in women compared with men, even when they have similar scores on standardised measures of depression or present with identical symptoms"? Yellowlees believes a "slight bias" still exists in the medical profession in Scotland, influenced by residual prejudices about male and female mental health in wider Scottish society.

So 165 years after the publication of Jane Eyre, women are still, erroneously, seen as more likely than men to require psychiatric support. Yet they may not be the ones who suffer the most as a result of this misconception. Women, after all, are more likely to seek help for a mental health problem, get an appropriate diagnosis and receive relevant support. Men, however, are still living with the echoes of a Victorian world view in which they were thought to be virtually impervious to mental ill-health. In other words, they are now victims, rather than beneficiaries, of wrong-headed ideas about gender and mental health, as society continues to underestimate the extent to which they are affected by depression and anxiety. "We have tended to neglect them," says Haggett.

If mental illness is being overlooked in males, they are unlikely to be receiving the support they need. As Parry points out, the character of Bertha Rochester is thought to have been inspired not by a woman, but by Charlotte Bronte's brother Branwell, who was addicted to alcohol. In creating the feral Bertha, Bronte influenced perceptions about women and mental illness for generations to come. But it may ultimately have been her brother's sex, not hers, that suffered the greater disservice.