Photo of a bronze cast of an intrauterine device (IUD). Photo by Sarah Mirk, Flickr CC

Throughout history, concerns about women’s sexual behavior and reproduction have often been tied to mental health. For example, in the Victorian era, doctors believed that women’s bodies were incapable of physical exertion and mental activity, and they diagnosed many women — typically white women– with “hysteria.” Hysteria was a catch-all term often used to police women’s sexuality and bodies, and was characterized as a mental disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual until 1980. While diagnosing women with hysteria may seem like an outdated practice today, mental health professionals still exercise control over women’s sexuality and reproductive choices. A recent study finds that clinicians today use both coercive and non-coercive techniques in facilitating reproductive decisions for their clients — especially female clients — diagnosed with mental illnesses like schizophrenia and major depression.

Using interview data with 98 patients at two state hospitals and three community mental health centers, Brea Perry, Emma Frieh, and Eric Wright examine clients’ interactions with service providers and family members regarding their sexual behavior and contraceptive use. The authors find that mental health professionals use strategies ranging from full client participation (what the authors call “enabling”) to no input by the client (what the authors called “coercion”).  

Providers used coercive techniques more frequently with women than with men. In the most extreme cases, this took the form of unwanted and traumatic sterilization procedures. More frequently, providers and female clients’ family members did not include women in key decisions, provided misinformation, or did not gain consent for the birth control medications prescribed. For male clients, providers used education through classes or group therapy more frequently. While these sessions often framed sex as risky for male clients, this technique allowed men much more reproductive freedom than many women experienced. The researchers also found that providers used “enabling” strategies (those that included full client participation), like  providing condoms or sex starter kits, for both genders at similar rates.

These findings demonstrate that women’s mental health remains inextricably linked to concerns about women’s bodies and their sexual behavior. Gender norms and expectations, especially those regarding sexual behavior and reproduction, have enduring impacts on our understanding of mental illnesses, as well as the medical decisions made for or by people diagnosed with a mental illness. To avoid these patriarchal patterns in the the future, Perry and colleagues suggest providers focus more on sex positivity rather than risk avoidance for their clients.