Atlas›Domain XVI · Historical, discredited & harmful›Guide 042
Guide XVI-042

Gynaecological treatment of melancholia

Isaac Baker Brown, Robert Battey1866London
A 30 · L 57 · M 1318 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the nineteenth-century "gynaecological psychiatry" of Britain and North America as historians document it: Isaac Baker Brown's London operations and his 1867 expulsion (Patnaik 2024; Arnold-Forster 2014), Robert Battey's "normal ovariotomy" of 1872 (Brooks 2020; Lawson 2020), and asylum gynaecology at the London Asylum for the Insane, Ontario, in the 1890s (Western University Archives exhibit). The "Mayer's pessary, 1870" attribution is [uncertain: not verified].

This guide covers a historical belief, not a therapy anyone should give. Many Victorian doctors held that a woman's reproductive organs were tied to her emotional life and were the most likely cause of her mental illness. From this it followed that treating or removing a womb, ovaries or other genital organs would cure "melancholia", "hysteria", "mania" or "ovarian insanity" [source: Western University Archives, The Hysterical Female; Brooks 2020]. The idea of how change happened was reflex theory: the body was seen as one connected nervous system, so irritation or disease in a pelvic organ was thought to cause disorder in the brain by reflex [source: Patnaik 2024, drawing on the historian Sarah Rodriguez]. The treatments that followed ranged from mechanical supports for a "displaced" womb to major surgery. Many women were sterilised or mutilated, some died, and many were operated on without their own consent (see the Harm account).

The term "Mayer's pessary" is unclear. The Science Museum Group holds india-rubber supportive ring pessaries made by the London instrument makers Mayer and Meltzer, dated 1870–1930. The catalogue entries say nothing about mental illness [source: Science Museum Group, Ring pessary A612124]. Whether a physician named Mayer published an 1870 claim that pessaries treated melancholia is [uncertain: not verified]. The Munich surgeon Ludwig Mayer (1839–1878) published nothing on this subject [source: Deutsche Biographie]. This guide does not describe how any pessary or operation was used.

The psychotherapist's own work is what this guide covers. That means historical literacy; working with clients whose ancestors were treated in asylums, or who carry this legacy themselves (distress written off as "hormonal", coerced reproductive surgery, medical mistrust); recognising today's echoes of the idea; safeguarding; and advocacy. [synthesis]

2. Framework

Historical phases of the practice, in outline [source: Patnaik 2024; Arnold-Forster 2014; Brooks 2020; Lawson 2020; Western University Archives]:

  • 1850s–1860s, the theory takes shape. Reflex and "nervous exhaustion" theories link women's pelvic organs and sexuality to fits, hysteria and insanity. In 1858 Baker Brown founded a surgical home for women in London. In 1866 he published On the Curability of Certain Forms of Insanity, Epilepsy, Catalepsy, and Hysteria in Females, claiming cures by genital surgery.
  • 1866–1867, censure in Britain. Colleagues questioned his results and his ethics. He was expelled from the Obstetrical Society of London in spring 1867. The reasons recorded were that women were not told what the operation would mean for them, that he operated without the agreement of their usual doctors, and that his publicity amounted to quackery [source: Patnaik 2024]. Arnold-Forster (2014) notes that the BMJ later called the operation "odious and unscientific" (1895).
  • 1872–1890s, ovarian surgery for nervous and mental conditions. Battey removed ovaries that were not diseased to bring on an artificial "change of life" in conditions he called otherwise incurable. Other surgeons took up the operation, and it was performed on women who did not meet even his own indications [source: Lawson 2020; Brooks 2020].
  • 1890s, asylum gynaecology. Superintendents had operations performed on asylum patients. At the London Asylum, Ontario, R. Maurice Bucke and the gynaecologist Dr. Hobbs carried out more than 200 operations. Bucke claimed improvement in 71 of the 106 cases from 1895 to 1898. Critics called the work "mutilation of helpless lunatics" [source: Western University Archives]. In Pennsylvania a state committee condemned the operations at the Norristown State Hospital in 1893 [source: Lawson 2020].
  • Decline. Professional opposition, poor results and the deaths of key advocates ended the practice. Operations at the London Asylum dropped sharply after Bucke died in 1902 [source: Western University Archives; Lawson 2020].

Phases of the psychotherapist's work [synthesis]:

  1. Orientation and recognition. Notice how this history enters the room: genealogy and asylum records, a client's own experience of having distress put down to reproductive causes, coerced or regretted reproductive surgery, mistrust of gynaecology or psychiatry, or interest in "womb" explanations from wellness sources. You move on once the theme and its emotional weight are named.
  2. Assessment and safety. Assess current mood (including melancholic depression and suicide risk), trauma symptoms, medical needs (route to the client's doctor), and any current coercion or safeguarding concerns, including genital cutting (cross-refer to guide 099). You move on once risk is assessed and medical questions have been routed.
  3. Meaning-making and processing. Work with the historical facts, family narratives, grief, anger and shame. Address medical trauma with trauma-informed methods. You move on once the client can hold the history as a coherent account and distress is lower.
  4. Repair, advocacy and follow-up. Support the client to self-advocate in healthcare, to commemorate, and to use complaint routes. Fulfil your own duties when you encounter colleagues or institutions repeating the error.

Format: individual work, sometimes with family members. Set the number of sessions by clinical need. Phases overlap and you can return to earlier ones.

3. Guiding principles

  • Women's distress is not reducible to their reproductive organs. In practice, build a biopsychosocial formulation and never accept "it's just hormones" as a complete explanation. [synthesis, informed by Western University Archives, The Hysterical Female]
  • Respect real reproductive-related conditions too. Route possible perinatal, premenstrual or menopausal mood problems to medical assessment without dismissing them either way. Never advise starting, stopping or changing a medicine. [synthesis]
  • Consent is the historical fault line. The 1867 censure turned on consent and disclosure [source: Patnaik 2024], and the asylum operations were done on people who could not consent [source: Lawson 2020]. In practice, put the client's informed consent at the centre of every discussion of treatment. [synthesis]
  • Name the history accurately and attribute it. Use historians' accounts and say plainly where something is uncertain (for example, "Mayer's pessary"). [synthesis]
  • Context, not caricature. Historians tie these operations to Victorian ideals of the "true woman" and to women's limited power [source: Western University Archives]. Help clients see the forces involved without demonising every individual ancestor or clinician. [synthesis]
  • Do not describe procedures. Name operations only as historians name them. Give no procedural detail, and keep any graphic content out of sessions unless the client brings it and wants to process it. [synthesis]
  • Watch for intersections. Class, poverty, disability, race and asylum confinement shaped who was operated on. Ask about these dimensions in family histories. [synthesis]
  • The therapist never takes part in, endorses or refers to unsupported gynaecological or genital interventions for mental distress. [synthesis]
  • Safeguard where present-day harm appears. This includes coerced sterilisation of adults at risk and genital cutting of girls. Follow local child-protection and adult-safeguarding routes. [synthesis]
  • The profession's own history is part of the work. Acknowledge psychiatry's and gynaecology's role openly when clients raise it. [synthesis]

[source for section: Patnaik 2024; Arnold-Forster 2014; Brooks 2020; Lawson 2020; Western University Archives; Science Museum Group]

4. Intervention inventory

The interventions below are the psychotherapist's own work; steps not drawn from a cited source are marked [synthesis]. None of them are steps of the historical practice.

4.1 Historical-literacy preparation

  • Purpose / when: Before working with clients raising asylum, gynaecological or "women's nerves" history. Lets you respond accurately rather than from myth.
  • Steps: (1) Learn the outline: reflex theory; Baker Brown's 1866 claims and 1867 expulsion; Battey's 1872 operation; asylum gynaecology in the 1890s; the decline. (2) Note what is uncertain, such as "Mayer's pessary", and do not overstate it. (3) Read historians, not sensational retellings (for example the historians Patnaik cites: Moscucci, Sheehan, Darby, Rodriguez). (4) Keep a short reference list to share if a client asks.
  • Example language (illustrative): "Historians have documented that some Victorian doctors believed women's mental illness came from the reproductive organs, and some operated on that basis. Would it help to look at what's known about it?"
  • Watch for: Repeating popular myths as fact. You know it's working when you can answer factual questions and also say clearly what remains unclear.

4.2 Recognising the theme when it arrives

  • Purpose / when: At intake or when it comes up. The legacy shows up in genealogy, in medical experiences, and in the client's own beliefs.
  • Steps: (1) Listen for cues: an ancestor in an asylum with "uterine" or "ovarian" causes in the records; the client's own distress repeatedly put down to "hormones"; reproductive surgery the client regrets or felt coerced into; fear of gynaecology. (2) Reflect the cue back and ask whether to explore it. (3) Note how much it weighs for the client.
  • Example language (illustrative): "You mentioned your great-grandmother's admission record blamed her 'womb'. What was it like to read that?"
  • Watch for: Over-reading the theme into every presentation. It's working when the client confirms its relevance and chooses the pace.

4.3 Supporting family-history and asylum-records research

  • Purpose / when: For a client tracing an ancestor admitted to an asylum or treated surgically.
  • Steps: (1) Clarify what the client hopes to find and what they fear finding. (2) Suggest legitimate routes: county or state archives, hospital record collections, university archives such as the Western University London Asylum material. Check local access and privacy rules. (3) Prepare the client for distressing language and for case notes that may describe treatment. (4) Agree a plan for reading records with support, for example bringing extracts to session. (5) Debrief after each find.
  • Example language (illustrative): "Records from that era can use harsh words for patients. Shall we plan how you'll look after yourself when you read them?"
  • Watch for: Re-traumatisation, intrusive images, preoccupation. It's working when the client builds a fuller, humane picture of the ancestor.

4.4 Psychoeducation on reflex theory and its errors

  • Purpose / when: When a client holds the belief that their mood is "caused by" their womb or ovaries, or when the history confuses them.
  • Steps: (1) Explain in plain language what reflex theory claimed [source: Patnaik 2024]. (2) Explain that colleagues at the time disputed the results and ethics, and that the profession abandoned these operations [source: Patnaik 2024; Arnold-Forster 2014; Western University Archives]. (3) Separate the discredited reflex model from real, medically assessed reproductive-related mood conditions, and route those to the client's doctor. (4) Check understanding.
  • Example language (illustrative): "The old idea was that a pelvic organ could 'irritate' the brain into madness. That theory was dropped. Hormonal changes can affect mood for some people, and that is something your doctor can assess, alongside everything else going on in your life."
  • Watch for: The client hearing "it's all in your head". It's working when the client holds a multi-factor view.

4.5 Biopsychosocial assessment of current distress

  • Purpose / when: Always, and especially for melancholic or depressive presentations in women, where the historical reflex was to look only at the pelvis.
  • Steps: (1) Assess mood, sleep, appetite, anhedonia, and duration. (2) Assess life stresses, relationships, roles, power and autonomy (historians link women's limited power to depression and anxiety in that era [source: Western University Archives]). (3) Take a trauma history, including medical trauma. (4) Ask about physical health and route medical questions to the GP or physician. (5) Formulate with the client.
  • Example language (illustrative): "Let's look at the whole picture: your body, your circumstances, your relationships, and what has happened to you."
  • Watch for: Diagnostic overshadowing in either direction, whether everything is put down to hormones or physical causes are ignored. It's working when the formulation is shared and the medical questions are routed.

4.6 Suicide-risk assessment in melancholic presentations

  • Purpose / when: Whenever depression, hopelessness or a family history of asylum admission or suicide is present.
  • Steps: (1) Ask directly about suicidal thoughts, intent, plans and past attempts, using your service's standard risk framework. (2) Explore protective factors. (3) Make a collaborative safety plan, including lethal-means safety (storage and removal only). (4) Give crisis resources: 988 Suicide & Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland). (5) Escalate per protocol if risk is high. Follow safe-messaging principles: no method detail, and no romanticising of ancestors' deaths.
  • Example language (illustrative): "Sometimes when people feel this low they think about ending their life. Has that been on your mind?"
  • Watch for: Hopelessness tied to a sense of family 'inheritance'. It's working when a safety plan is agreed and the client can name supports.

4.7 Validating experiences of dismissal and medical gaslighting

  • Purpose / when: For a client whose symptoms were dismissed as "hormonal", "hysterical" or emotional.
  • Steps: (1) Listen and validate the experience of not being believed. (2) Place it in historical context if the client wants that, for example the Victorian "hysterical female" diagnosis [source: Western University Archives]. (3) Separate validation from medical judgement: you don't diagnose physical illness. (4) Plan next steps, such as a second opinion through their doctor.
  • Example language (illustrative): "Being told it's 'just hormones' when you're struggling can feel like being erased. That pattern has a long history, and your experience deserves to be taken seriously."
  • Watch for: Feeding mistrust of all medicine. It's working when the client feels heard and still engages with care.

4.8 Preparing the client for informed-consent conversations in healthcare

  • Purpose / when: When a client faces gynaecological treatment or surgery while distressed, or feels pressured.
  • Steps: (1) Help the client list their questions: what the procedure is for, the alternatives, the risks, effects on fertility, and the right to decline or delay. (2) Rehearse asking these questions. (3) Discuss bringing a support person. (4) Do not advise for or against any medical treatment; that decision belongs with the client and their doctors.
  • Example language (illustrative): "It's your right to understand what's proposed and to take time. Which questions matter most to you?"
  • Watch for: The therapist steering medical decisions. It's working when the client goes into appointments prepared and feeling more in control.

4.9 Trauma-informed work with medical and reproductive trauma

  • Purpose / when: For a client who experienced reproductive surgery as coerced, non-consented or traumatic, or who regrets loss of fertility.
  • Steps: (1) Stabilise first: grounding and emotion-regulation skills. (2) Use an evidence-based trauma therapy you are trained in, with consent and pacing. (3) Address grief over fertility and body integrity, plus shame and anger. (4) Offer referral for complaint or legal advice if the client wishes. (5) Any body-focused work only with consent before and during, a clear right to stop, and never sexual.
  • Example language (illustrative): "We'll go at your pace. You can stop at any point, and we'll check in as we go."
  • Watch for: Dissociation, flashbacks during medical appointments. It's working when symptoms reduce and the client can attend necessary care.

4.10 Safeguarding: coerced reproductive procedures today

  • Purpose / when: When an adult at risk (for example a disabled woman, or someone under coercive control) discloses pressure towards sterilisation, contraception or gynaecological procedures without free consent.
  • Steps: (1) Assess immediate safety and capacity. (2) Explain the limits of confidentiality. (3) Follow your local adult-safeguarding procedure and consult your safeguarding lead. (4) Refer to independent advocacy or legal advice. (5) Document facts and actions.
  • Example language (illustrative): "No one should make decisions about your body without your agreement. I'd like to talk with you about who can help protect that."
  • Watch for: Fear of retaliation, capacity questions. It's working when a safeguarding route is in motion and the client feels supported.

4.11 Recognising links to genital cutting and safeguarding girls

  • Purpose / when: When a client's family or community history includes female genital cutting, or a girl may be at risk. Historians draw explicit links between Victorian clitoridectomy and present-day FGM [source: Arnold-Forster 2014].
  • Steps: (1) Use respectful, non-judgemental language and ask about the client's own experience and any daughters. (2) If a girl may be at risk, follow mandatory reporting and child-protection routes in your jurisdiction. (3) Refer to specialist FGM clinics and services. (4) Cross-refer to guide 099 for detail. Name WHO types only, with no anatomical description.
  • Example language (illustrative): "Some families have traditions that affect girls' bodies. Is there anything like that I should know about, for you or for anyone in your family?"
  • Watch for: Shame, fear of stigma, family loyalty conflicts. It's working when risk is assessed and specialist support is offered.

4.12 Working with a client drawn to "womb-centred" explanations of mood

  • Purpose / when: When a client turns to wellness products or practitioners claiming that the womb or reproductive organs are the root of their depression or anxiety, and that a device, insert or procedure will fix it. [synthesis]
  • Steps: (1) Explore what draws them: being heard, a body-based explanation, distrust of mainstream care. (2) Share the historical parallel without ridicule. (3) Encourage medical assessment for gynaecological symptoms and evidence-based treatment for mood. (4) Respect autonomy while naming physical risks qualitatively, and advise the client to check anything invasive with their doctor.
  • Example language (illustrative): "I can see why an explanation rooted in your body appeals. Can we look at what's known about these claims, and make sure your doctor is in the loop?"
  • Watch for: Delayed treatment of depression, physical injury, financial exploitation. It's working when the client gets proper assessment.

4.13 Narrative and commemorative work with an ancestor's story

  • Purpose / when: After records research, or when an ancestor's asylum or surgical treatment weighs on the family.
  • Steps: (1) Invite the client to tell the ancestor's story as a whole person, beyond the diagnosis. (2) Offer optional forms: an unsent letter, a family account, visiting a graveside or memorial. (3) Work with grief, anger and inherited shame. (4) Consider sharing the story with family members, with care.
  • Example language (illustrative): "If you could tell her what you now understand about what happened to her, what would you say?"
  • Watch for: Overwhelm, family conflict about disclosure. It's working when the client feels connected to the ancestor and less ashamed.

4.14 Exploring intergenerational messages about women's bodies and minds

  • Purpose / when: When family beliefs ('women in our family are nervous', 'it's her time of the month') shape the client's self-view.
  • Steps: (1) Map family messages across generations, for example with a genogram. (2) Link them to historical beliefs where relevant [source: Western University Archives, The Hysterical Female]. (3) Help the client decide which messages to keep or revise.
  • Example language (illustrative): "Where do you think the idea that women in your family are 'fragile' came from?"
  • Watch for: Blaming individuals for cultural beliefs. It's working when the client gains flexibility in their self-narrative.

4.15 Intersectional assessment of the history

  • Purpose / when: When a client's ancestor was poor, disabled, confined to an asylum, or from a racialised group. Who was operated on was shaped by power and consent [source: Lawson 2020 on asylum patients who could not consent].
  • Steps: (1) Ask about class, disability, race and institutional status in the family story. (2) Acknowledge structural injustice. (3) Connect the client with community history or disability-history resources if wanted.
  • Example language (illustrative): "Her being in an asylum meant she had little say. How does that sit with you?"
  • Watch for: Your own assumptions. It's working when the client feels the full context is acknowledged.

4.16 Duties when a colleague or institution repeats the error

  • Purpose / when: When a colleague attributes a woman's mental illness solely to reproductive organs and promotes unsupported gynaecological or genital interventions for mental distress, or a service pressures patients toward reproductive procedures without valid consent.
  • Steps: (1) Raise concerns directly where safe. (2) Consult your supervisor or ethics lead. (3) Use your service's reporting route and, if needed, the licensing or registration body's published complaints process. (4) Ensure affected clients have access to independent advice. (5) Never take part in, supervise or refer to such practice. Ethics points here are [synthesis]; consult the APA Ethics Code and your own body's code.
  • Example language (illustrative): "I'm concerned this plan treats her depression as a gynaecological problem without an assessment of her mood. Can we review it?"
  • Watch for: Hierarchy and fear of retaliation. It's working when the concern is formally recorded and patient care is reviewed.

4.17 Using the history in training and supervision

  • Purpose / when: In teaching, supervision or team reflection on gender bias in diagnosis.
  • Steps: (1) Present the documented history, attributed. (2) Draw the lessons the sources suggest: consent, scepticism toward single-organ explanations, publicity mistaken for evidence [source: Patnaik 2024 on the charges against Baker Brown]. (3) Invite reflection on current biases.
  • Example language (illustrative): "What would a modern equivalent of this mistake look like on our ward?"
  • Watch for: Presentism and complacency. It's working when the team identifies concrete practice changes.

4.18 Repair when the client feels the therapist is dismissive

  • Purpose / when: After a rupture in which the client felt their distress was being put down to their body, or not believed.
  • Steps: (1) Name the rupture. (2) Take responsibility for your part without defensiveness. (3) Invite the client's perspective. (4) Adjust your approach.
  • Example language (illustrative): "When I asked about your cycle, it sounded like I was saying it was all hormones. I'm sorry. That's not what I think. Can you tell me how it landed?"
  • Watch for: Silent withdrawal. It's working when the client re-engages and trust deepens.

5. Handling problems

All guidance below is [synthesis].

  • The client is stuck in rage at medicine. Validate the anger as proportionate to documented harms. Then help them separate past from present clinicians so they can still get the care they need. Offer complaint and advocacy routes as a channel for the anger.
  • The client resists any biological factor after past dismissal. Don't push. Acknowledge the history of misuse, keep the formulation open, and leave medical questions with their doctor.
  • Overwhelm reading asylum records. Pause the research, return to stabilisation, read with the client in session, and set limits on exposure.
  • Non-adherence to medical care through mistrust. Explore the fear and help the client prepare questions (4.8). Never advise starting, stopping or changing medicines. Encourage the client to raise their concerns with the prescriber.
  • Ruptures over perceived dismissal. Use repair (4.18). Check your own assumptions about gender and bodies in supervision.
  • Family conflict over disclosure of an ancestor's story. Work on the client's choices about what to share. Consider a family session with consent from everyone involved.
  • Uncertain facts. If a client cites a claim such as "Mayer's pessary cured melancholia", say honestly that the attribution has not been confirmed in historical sources. Avoid filling gaps with speculation.
  • The client is drawn to an invasive "womb" remedy. Use 4.12. Name physical risks qualitatively and route to a doctor. If the client is at risk of injury or exploitation, discuss safety plainly.
  • Suicidal crisis. Follow 4.6 and your service's crisis protocol. 988 (US); Samaritans 116 123 (UK and Ireland).
  • Safeguarding disclosures (coerced procedures; a girl at risk of genital cutting). Follow 4.10 and 4.11 without delay. Explain confidentiality limits, consult your safeguarding lead, and act.
  • Your own distress. The history can provoke strong reactions in the therapist. Use supervision and peer support.

Harm account

What was actually done

In the mid-to-late nineteenth century, doctors in Britain and North America performed gynaecological and genital surgery, and used other gynaecological measures, on women to treat mental and nervous conditions. They based this on the belief that the reproductive organs caused insanity [source: Western University Archives; Patnaik 2024]. In London, Isaac Baker Brown, founder of a surgical home for women (1858), performed genital surgery (clitoridectomy, as historians name it) for insanity, epilepsy, catalepsy and hysteria. He set out his claims in his 1866 book and published patient testimonies [source: Patnaik 2024; Arnold-Forster 2014]. From 1872 the American surgeon Robert Battey and others removed healthy ovaries to induce artificial menopause for nervous and mental conditions, including "ovarian insanity" [source: Brooks 2020; Lawson 2020]. In asylums, operations were performed on patients, including those who could not consent. At the State Hospital for the Insane in Norristown, Pennsylvania, operations were done without patients' consent until a state committee condemned them in 1893 [source: Lawson 2020]. At the London Asylum, Ontario, Superintendent R. Maurice Bucke and Dr. Hobbs performed more than 200 gynaecological operations, including hysterectomies, in the 1890s [source: Western University Archives]. No procedural detail is given here.

How it caused harm

  • Death. Some of Baker Brown's patients died after surgery from post-operative bleeding [source: Patnaik 2024]. Battey reported 2 deaths in 94 published cases. Lawson (2020) calls this likely an undercount and reports that George Engelmann estimated mortality at around 30–33 percent. Lawson's estimate of about 105,000 women operated on worldwide, with 10–25 percent mortality, is [uncertain: secondary, not verified against a primary count].
  • Sterility and loss of bodily integrity. Removing the ovaries induced menopause and ended fertility by design [source: Brooks 2020; Lawson 2020]. Genital surgery mutilated women for conditions it could not cure. Many of Baker Brown's patients remained, by his own estimate, incurable, and some sued him [source: Patnaik 2024].
  • Absence of consent. In 1867 colleagues charged that women were not told what the operation would mean for them [source: Patnaik 2024]. Asylum patients were operated on without consent [source: Lawson 2020]. Critics in Ontario called the asylum surgery "mutilation of helpless lunatics" [source: Western University Archives].
  • Misattribution of distress. Women's depression, anxiety and stress, which historians connect to their limited power and independence, were treated as organ disease [source: Western University Archives]. Success was judged partly by whether a woman could do housework [source: Brooks 2020].

Recognising it today

  • Family records or stories of an ancestor's asylum admission attributed to "uterine", "ovarian" or "reflex" causes, or of surgery during admission.
  • A client's mental distress repeatedly and solely put down to hormones or reproductive organs, without assessment of mood or life circumstances [synthesis].
  • Pressure on women, especially disabled or institutionalised women, toward reproductive procedures without free and informed consent [synthesis]; for the history of compulsory sterilisation, see guide 058.
  • Commercial or wellness claims that a womb-focused device or procedure cures depression or anxiety [synthesis].
  • Female genital cutting, which historians link to this history [source: Arnold-Forster 2014]; see guide 099. For compulsory sterilisation under eugenic laws, see guide 058.

What to do instead and how to help those harmed

  • Offer an evidence-based assessment and treatment of depression and anxiety through appropriate services. Route gynaecological symptoms to medical assessment, and leave all medicine decisions to the client and prescriber [synthesis].
  • For people harmed by coerced reproductive procedures: trauma-informed therapy (4.9), validation, independent advocacy and legal or complaint routes (4.10) [synthesis].
  • For descendants: records support, narrative and commemorative work, and intergenerational work (4.3, 4.13, 4.14) [synthesis].
  • For girls at risk of genital cutting: mandatory reporting and child-protection routes, and specialist FGM services (4.11) [synthesis].
  • For the profession: honest acknowledgement of psychiatry's and gynaecology's history, and consent-centred practice [synthesis].
  • Crisis resources: 988 (US); Samaritans 116 123 (UK and Ireland).

Sources

← Previous · XVI-041Asylum hydrotherapyNext · XVI-043 →Kellogg's Battle Creek Sanitarium regime