Medicine practice is an ever-changing part of society. Archives and previous research provide doctors with the knowledge needed to make such changes. Successes and failures have been documented, but sometimes a doctor may be blind to the faults in his practice and someone else must point it out. Dr. Silas Weir Mitchell, a well-known M.D. and neurologist of the nineteenth century, designed a treatment that has been shown to have flaws. It was not until one of his former patients, Charlotte Perkins Gilman, spoke out against his treatment that Mitchell and others realized something was missing. Mitchell’s cure produced negative results for Gillman, thus encouraging her to write a short story about her experience under his care, revealing its flaws and her results. Her story illustrates the attitude towards women and mental health care during the nineteenth century. While Mitchell’s treatment consisted of flaws, the fallacy in his practice has influenced medicine to modern day; however, the knowledge of his treatment and relationship with patients shows that mental health treatment continues to be experimental at best.

Neurasthenia, “a lack of nervous strength,” was Mitchell’s main focus of study. He studied ways to cure mental illnesses, thinking that they would soon be able to be totally cured. With this belief and the idea that the mind and body are closely related, Mitchell developed a cure for nervous disorders. His well-known treatment, “The Rest Cure,” was specifically designed for women, aiming to reorient them to their social duty of a domestic life. The cure consisted of five parts: rest, seclusion, diet, massage, and electricity. Patients were asked to stay away from their home and family and remain in bed for six to eight weeks. Their diet was highly specific, often consisting of milk and given on a timely schedule. Exercise for the women was given through the use of massage and electricity which allowed the muscles to contract and become loose with no actual physical activity being done. Mitchell insisted that patients did not read nor write, as such strenuous brain activity and deep thought interfered with a woman’s natural duties. He designed this treatment for patients who were sick from overwork, studying too much, caring for ill family members, or staying out too late, thus resulting in nervous exhaustion. Though the rest cure appears to be well thought out and reasonable, its biggest flaw is the lacking in assessment of the patient’s individual needs.

Mitchell’s treatment was highly rigid in construction and schedule. He drew the difference between those who recovered and those who did not as those who listened to him and those who would not, explains Suzanne Poirier in her article on Mitchell’s cure. She adds that Mitchell wrote, “Wise women choose their doctors and trust them. The wisest ask the fewest questions” (Poirier 26). His domineering personality also included the belief that education was not of value for women. It is shared that he believed that the most effective way to cure women of mental disease and nervousness was to “reorient them to domestic life” (19). He believed that the natural and healthy parts of a woman’s life are motherhood, daughterhood, and wifehood, while any other goal in life is unnatural (30), such as pursuing a professional career in education, art, or literature. These notions were combined with that of his idea that the body is cured and then somehow the mind is also cured. Gilman disagreed and found that her body’s health was improving, but her mind’s was not, as she explains in her breakthrough captivity narrative of her experience under the rest cure.

Gilman’s story, “The Yellow Wallpaper,” was written and published shortly after her lift from depression and nervousness. In the short story, the woman slowly goes mad by the rest cure’s isolation from intellectual and social activity. She described the tale as “’a description of a case of nervous breakdown beginning something as mine did, and treated as Dr. S Weir Mitchell treated me with what I considered the inevitable result, progressive insanity’” (Gilman 299). Gilman was opposed to Mitchell and his practice, giving credit to disregarding his advice for her escape from insanity. Writing “The Yellow Wallpaper” allowed her to communicate to Mitchell that forbidding her from work was nearly the cause of her madness. The story illustrates the authoritarian essence of medicine and female suppression during the time (Martin 738).

The absence of work of any type in the treatment was a flaw, producing negative results for Gilman during her treatment. In her narrative she exclaims, “Personally, I believe that congenial work, with excitement and change, would do me good” (Gilman 300). Doctor of Medicine, Karl Menninger, argues in his article titled “The Abuse of Rest in Psychiatry” that rest as treatment embodies neglect or misunderstanding of the true condition of the patient (1088). He explains that it is no question that neurasthenic patients show fatigue, as it is a symptom of neurosis, adding that over-exertion and “all other excess expenditures of energy” are not the cause of psychiatric illness, but merely the expression of it (1088). Thus, the cure consists of “the removal of that which impels the individual to make such depletions of his own strength, to waste so much of [her] energy” (1088). Gilman exhausts herself keeping her writing from her husband. She describes writing what she feels and thinks as a relief, “but the effort…greater than the relief” (Gilman 305). This extra effort tired Gilman, fueling her illness. This exhaustion could have been avoided had Gilman been allowed to write under the treatment. 

Menninger continues to explain that patients under such specific assigned treatments only experience great difficulty, inefficiency, and dissatisfaction. One must discover what “blockade of energy” is occurring and how it can be directed to meaningful work for the patient (Menninger 1088). Modern hospitals seek to help the patient find an outlet for his or her instinctive impulses in work, with the objective to turn the impulses outward, avoiding any harm towards oneself (1089). Patients must be properly taught to channel their impulses, keeping in mind the patient’s specific needs and interests. Mitchell’s rest cure enforced the exact opposite, proving to be ineffective and irrational. Menninger finds his treatment as “deleterious.” Failure to properly handle the patient’s impulses can result in a “virtual suicide,” described as “the accumulation of hostile feelings associated with self-destructive energy” (Menninger 1089). Menninger states that physical exertion is known to combat this virtual suicide, while enforced rest tends to support it (1089). Gilman agrees that work would do her good as prohibition from it is a major flaw in Mitchell’s practice.

Mitchell left out in his writings many of his patients who defeated the Rest Cure on their own. These women knew what was wrong with his cure, adds Poirier. It is found that these patients were following a very similar strict treatment that Gilman followed. Former patient in Mitchell’s Hospital of Orthopedic and Nervous Diseases, Jane Addams, found herself relieved of back pain, but continually battling depression. She discovered that orders forbidding her from reading made her realize how much she truly depended on it. She complained about treatment under Mitchell and explained fifty years later in an autobiography the delight reading brought her after treatment (Poirier 26). Another patient, Virginia Woolf, was forbidden paper and ink to write. It was not until later in her treatment that she was allowed to work for a few hours a day on a novel. She was excited when it came to writing during the treatment and did not find herself over-exhausted from work. Addams, Woolf, and Gilman found importance in meaningful activity and had to engage in such activity outside Mitchell’s orders (28). “These women acted with an awareness that their life needed to focus on personal satisfaction,” exclaims Poirier. They observed that they were never completely cured and found faults in his methods. These women are perhaps the true survivors of the rest cure, as they sought individuality and importance of their own needs, acting against parts of the treatment’s requirements. 

Although there were strict limits on reading and writing for most women under the Rest Cure, there are accounts of patients under Mitchell’s treatment who were allowed such activity. David Schuster, author, explores doctor-patient relationship during the nineteenth century, specifically between Mitchell and his patients. Schuster includes in his writing two of Mitchell’s intellectually active neurasthenic patients and how their ability to read and write led them on the successful road to recovery. Amelia Gere Mason, a neurasthenic patient of Mitchell, gave credit to being under his treatment for “restoring ‘value’ to her life,” says Schuster (705). Mitchell encouraged Mason to think and write and the two shared a friendly and supportive doctor-patient relationship for nearly thirty-two years (Schuster 705). They corresponded through letter about each other’s writing and Mason described him as the “perfect person with whom women could share their problems and secrets” (706). Gilman mentions the idea that having such companionship would be good. She explains how “It is so discouraging not to have any advice and companionship about [her] work” (Gilman 302). Both patients sought care under Mitchell, but both experienced different results to their problem. 

Sarah Butler Wister, another neurasthenic patient and cousin of Mitchell, was also intellectually active under his treatment. In his writing, Schuster explains Mitchell and Wister’s relationship as relying on each other for “professional aid” (711). He adds that Mitchell looked to Wister for help with editing his novels, while Wister looked to Mitchell for medical advice. She was prescribed breaks and vacations, as was Gilman; however, Mitchell advised Wister to spend time painting, taking breaks from domestic work. Gilman was also required to take breaks from housework, as she was not allowed to look over her own child, but she was never allowed to stimulate the brain doing creative and intellectually engaging activities as Mason and Wister. Gilman says she “sometimes fancy that in [her] condition if [she] had less oppositions and more society and stimulus” (Gilman 300). She fathomed with the idea that even writing a little “would relieve the press of ideas and rest [her]” (302). Her thoughts on this were not wrong and speaking up earlier could have saved her the wasted energy of keeping her writing a secret.

Schuster proposes the question of why Mason and Wister were encouraged to pursue intellectual and artistic activities but Gilman was not (719). This question alone has helped doctors study medicine and develop new practice since Mitchell’s time. Schuster continues that the answer found is a common one in medicine and is that Gilman was likely misdiagnosed and therefore mistreated. He adds a claim from Gilman’s autobiography saying that Mitchell never understood her condition, that “she was neither of the two types of patients… ‘exhausted from too much work’… ‘exhausted from too much play’” (Schuster 718). 

Gilman and Mitchell’s relationship began in a deterioration. The two had trouble relating to each other and their encounter was “antagonistic from the start,” describes Schuster (720). She was not comfortable working with him and perhaps sensed Mitchell’s hostility towards women, adds Dr. Diana Martin in her commentary on the rest cure. Mitchell did believe that falling back on traditional roles for women was to bring benefit and health to their treatment. 

Martin adds an account of Mitchell forcing a patient from bed by threatening to crawl in with her (738). His personality was harsh and autocratic, often bringing forth his unorthodox tactics. 

Mason and Wister did not accept this authoritarian and sexist side of Mitchell and were comfortable enough to challenge his ideas and take charge when it came to personalizing their own treatments. Gilman followed his rigid orders and did not experience success. She claims in her short story that perhaps one reason she does not get better sooner is because she is under the care of a physician (Gilman 299). Schuster concludes that a critical part of Mason and Wister’s recovery was their tendency to reconsider Mitchell’s opinions, which Gilman failed to do (720). The stories of Mitchell and these three women illustrates a very personal disease these patients experienced, as it required a personally crafted treatment fit for their needs (Schuster 721). Gilman’s misdiagnosis and mistreatment proves the experimental nature of medicine.

 When examining these three cases, it is significant to note that the two personalized treatments of Mason and Wister were successful, while Mitchell’s strict treatment for Gilman produced opposite results. They show the importance of doctor-patient relationships, especially in mental health cases. Schuster’s writing, published nearly ten decades after Mitchell’s recorded cases, argues that the most effective relationships when it comes to therapy are those with a strong bond between doctor and patient, “in which the patient feels as though her ideas are being taken seriously” (720). This idea is prevalent in modern medicine as it helps patients access the best treatment to the doctor’s knowledge. Such a flaw in Mitchell’s treatment has allowed the study of medicine to advance. 

Charlotte Perkins Gilman’s “The Yellow Wallpaper” highlights the rest cure, revealing the authoritarian nature of medicine and attitude towards women during the nineteenth century. The story’s release opened the eyes of many, specifically Mitchell, to the fallacy in his cure. Studying the failure of Mitchell’s designed rest cure influenced medicine for over ten decades. Recognizing the lack of personalization in treatment, the abuse of rest, and the need for a healthy doctor-patient relationship, his treatment formed a stepping stone for the study of medicine today. However, medicine is a constantly evolving part of society. It changes as we adapt and discover new diseases and successes and flaws in treatments. The personalized treatments for mental health patients continue to be a result of experiment at best, as the brain evolves and relationships must adapt. Mitchell undoubtedly helped a number of women using his rest cure, bringing the study of medicine and mental health disorders a step closer to today.
