04Chapter 3. The Wandering Womb: Woman as a Diagnosis

August 17, 1872. Georgia, operating room. On the table lies Julia Ormberg, twenty-three years old. Seizures. Pelvic pain. And what her doctor described as “mental confusion” — episodes that come and go with her menstrual cycle. Surgeon Robert Battey takes up his scalpel. He opens her abdominal cavity and removes both ovaries. Both. Healthy ovaries. No tumor, no cyst, not the slightest damage. The ovaries were intact — and that’s precisely why he removed them. Because they were functioning. Because they were working. Battey’s logic was as simple as it was merciless. If a woman’s “madness” returned every month with her menstrual cycle, then the source of that madness must be menstruation itself. Therefore, take away that possibility. Stop the cycle. Induce artificial menopause. Castrate her.

Over the next few decades, around one hundred and five thousand women worldwide underwent what Robert Battey called a “normal ovariotomy,” and what the medical community later termed the “Battey Operation.” The mortality rate ranged from ten to twenty-five percent. Nearly a quarter of the women who went under the knife never left the operating table.

The indications were vague. The list of diagnoses for which Bettie’s operation was recommended ran for pages. Menstrual mania. Neurasthenia. Nymphomania (pathological sexual desire). Masturbation. Epilepsy. Hypochondria. Melancholia. Hysteria. And—the crowning touch—“all cases of insanity.

In 1876, Robert Battey co-founded the American Gynecological Society.

He was hailed as a “great innovator of medicine.” So was Dr. John Marion Sims. Both were celebrated as pioneers who changed the world. That’s what the history of medicine tells us today. Now. Over a hundred years later. But ask yourself one question. Just one. Objectively. Who were they, really? Not “innovators.” Not “pioneers.” Surgeons. Who for thirty years operated on healthy women. Removed healthy organs. Induced artificial menopause. And called it the cure for madness. Thirty years. Healthy organs. Healthy women. Madness that may not even have existed. That’s it. That’s the “great innovation.”

Imagine it through the eyes of a young woman from Boston, London, Moscow, or Paris in the 1880s.

You’re twenty-five. You’re married. You may have children. You suffer from what today is called depression, an anxiety disorder, perhaps premenstrual dysphoric disorder. You cry at night. You feel anxious. You can’t concentrate. Life is hard for you.

You go to see the doctor. The doctor is a man, dressed in a black frock coat, with a professorial beard. He listens to you attentively. Nods. Says, “Madam, you have ovarian insanity—ovarian madness. It’s not your fault. It’s an illness. I have a method. I can help.

You are admitted to the clinic. Chloroform. A mask presses against your face. Anesthesia is still in its infancy — you breathe unevenly, slipping into the void in fits and starts, and someone’s unfamiliar fingers grip your wrists. While you’re unconscious, they open your abdomen. A scalpel. Both ovaries—gone. You feel nothing. You don’t yet know. If you survive, you’ll get what they call “artificial menopause.” Hot flashes that scorch your skin. Osteoporosis that eats away at your bones from within. Lifeless libido. Infertility. Every word a sentence. If you don’t survive — a chance as high as twenty-five percent — you won’t be counted. You’ll become one of thousands of women whose names no one will record. The cause of death? One line, summarizing your life, your pain: “consequences of nervous disorders.”

A month after the operation — if everything has gone “successfully” — your attending physician comes in and proudly announces: “You are now doing all your family’s housework.” In a gynecology journal article, this will be listed as a “brilliant outcome.

Read the academic reports on the “Battey Operation.” Open Battey’s own 1881 article in the British Medical Journal. Read it. Look closely. What lies behind those dry lines? Salvation? Healing? What was the measure of success for this operation? Relief from her suffering? No. Restored joy in life? No. Emotional recovery? Again, no. The ability to cook. To clean. To care for her family. That’s the brutal conclusion. Branded in iron: the woman is fit again for domestic labor.

The woman was treated by being disconnected from her own body—all for the sake of better serving her family.

Operation Betty is just one episode in the long, shameful history of how psychiatry and gynecology treated women over the past two centuries. To grasp this history, it’s essential to understand its roots.

The notion that the female body—and particularly the uterus—is a source of psychological suffering predates Western medicine. In the Kahun Papyrus, written around 1900 BCE—nearly four millennia ago—there are already references to “women’s diseases” being linked to the “wandering womb,” an idea that the uterus supposedly moved within the body, pressing on other organs and causing symptoms.

In the dialogue Timaeus (around 360 BC), Plato developed this idea into a full-fledged natural philosophy:

The uterus in women is a living entity within, yearning to bear children. When it remains infertile for too long after the prime of life, it grows angry and resentful, wandering throughout the body, blocking airways, hindering breathing, and giving rise to various illnesses—until the union of male and female forces is restored.

This is the ancient myth of hysteria—from the Greek ὑστέρα, meaning “womb.” The term persisted into the 20th century and was officially removed from diagnostic classifications only after 1980.

Hippocrates, despite his remarkable materialism regarding epilepsy, shared the belief in the “suffering womb” and referred to menstruation as the “bloody tears of a disappointed uterus.” Soranus of Ephesus in the 2nd century CE partly disputed the theory of the “wandering womb”—but instead proposed that the uterus “grew agitated,” causing the same symptoms. Galen, whose authority in Western medicine remained unchallenged for 1,500 years, cemented the idea of “female sexuality as a source of disease.”

And so—millennia later—we find this belief alive in the 19th century clinics, in the operating theaters of Battey and Sims, within the walls of Paris’s Salpêtrière, and in the notes of psychiatrists from Charcot to Freud.

Jean-Martin Charcot. 1825–1893. A great French neurologist. Founder of a scientific school. The direct predecessor of Freud. But what did he create at Paris’s Salpêtrière Hospital in the late 1870s and early 1880s? A veritable theater of hysteria. Every week. On Tuesdays. In the grand hall, Charcot presented his students and the public with female patients experiencing epileptiform seizures. He called them “grand hysterical crises.” Bodies collapsed to the floor. Spines arched into a “bridge.” Screams shattered the silence. Muscles froze into strange contortions. A mystery of nature? No—anatomical precision. Charcot analyzed these states with a trained eye. He developed a complex classification of the “stages of hysterical fits”: “epileptoid phase,” “clownism,” “passionate poses,” “delirium.”

Medical historians would later shudder—at a simple yet chilling realization. Many of those “fits” were staged. Intentionally or not. Patients who had suffered for years at Salpêtrière had observed other patients—and learned the “correct” language of pain firsthand. How to survive? How to be heard? Only this way. Twisting in anguish according to a meticulously rehearsed script. All for a precious sliver of attention from the great master. And so, the haunting question: Why were such attacks never seen outside the walls of Salpêtrière? The answer is cruel. The illness was born from the clinic itself. And then came 1893. Charcot died. And the “grand hysterical crises” vanished instantly from his wards. Disappeared. As if they had never existed.

Unlike many, Charcot did not resort to surgery. He hypnotized. He observed. He classified. That was his role. But across the Atlantic, in Canada and the United States, other doctors were crafting something entirely different from this material.

Richard Maurice Bucke (1837–1902), a Canadian psychiatrist and superintendent of the London Asylum in Ontario, was an even more radical proponent of the “gynecological theory of insanity.” Bucke performed hysterectomies, ovary and fallopian tube removals on his female psychiatric patients—systematically, for years. He was convinced that the majority of mental illnesses in women were linked to “abnormal pelvic organ function.” In his reports, he published “successful cases”—women who, after being deprived of their ability to bear children, “became calmer and more docile.”

According to various estimates, Buck operated on anywhere between two hundred and five hundred female patients at his hospital. Many of them couldn’t legally refuse—they were undergoing involuntary psychiatric hospitalization.

Others working in the same era were not interested in the uterus or the ovaries, but rather the clitoris.

Isaac Baker Brown (1811–1873), an English gynecologist, practiced clitoridectomy—the surgical removal of the clitoris—in London during the 1860s as a “treatment” for epilepsy, hysteria, catalepsy, and, in a particularly shameful chapter, female masturbation. Baker Brown was convinced that masturbation by women was the root cause of all “nervous and mental disorders of the female sex” and that its surgical eradication would cure patients of their ailments.

The procedure was straightforward: chloroform, a scalpel, and no routine pain relief during the postoperative period. Baker Brown wrote about “remarkable outcomes”: his patients “became meek,” “returned to obeying their husbands,” and “ceased to display unnatural excitability.

1867. The London Obstetrical Society. Baker Brown—a surgeon whose name had been on everyone’s lips for years. Scandal after scandal. And now—expulsion. Struck off. Cast out. For what? He mutilated women. Cut them. Disfigured them. Isn’t that so? No. Read the records carefully. Ponder the language. The real violation lay in an entirely different dimension. He failed to obtain full informed consent—from their husbands. He didn’t always seek the approval of the patriarchy. That’s where the true problem lay. The procedure itself? Critics within the medical community didn’t view it as evil. Controversial—yes. But a potentially beneficial practice. Women’s flesh—mere material. Men’s word—absolute law.

Medically indicated clitoridectomy continued to be performed in Western Europe and the United States as a “therapeutic procedure” for another half-century — at least until the 1930s.

Don’t comfort yourself with the illusion that this only happened across the ocean—whether in the New World or the Old. The same practices took root on Russian soil, extending into the early Soviet period. The early 20th century. The pages of Russian psychiatric journals are marked by a chilling phrase: “ovariotomy as a treatment for epileptoid and hysterical conditions in women.” Read it carefully. Ovariotomy. Removal of the ovaries. Treatment? Or surgical suppression of unruly female nature? The scalpel cuts into living flesh to subdue seizures. And these were not clandestine experiments. Such operations were openly performed on operating tables in several of the largest clinics in Moscow and St. Petersburg. Yes, the scale was different—smaller than in the U.S. or Canada. But don’t be deceived by the numbers. The principle was the same. The body—guilty. Surgery—the sentence.

And here’s the crucial point: none of these practices were carried out by self-taught amateurs, charlatans, or renegades. These were respectable professors. Members of academies. Heads of departments. People whom the entire medical establishment of their time regarded as authorities.

The question that keeps haunting us: Who was truly disconnected from reality—the woman diagnosed with “hysteria,” or the surgeon who, in response to her tears and distress, removed her healthy ovaries and called it medicine?

Hysteria’s reign as an official diagnosis came to a long and agonizing end.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-I) published by the American Psychiatric Association in 1952 no longer included hysteria. However, in 1968, it reappeared in DSM-II under the name “hysterical neurosis.” It wasn’t until 1980, in the third edition, DSM-III, that the term was finally removed from official psychiatric nomenclature.

1980. Still within my lifetime. Many of my colleagues were already working back then.

Nearly a century passed from the time Charcot performed “hysterical seizures” on the stage of the Salpêtrière hospital to the moment the world’s leading psychiatric classification acknowledged: this diagnosis no longer existed. A full century of psychiatric practice during which women were treated for an illness they did not have.

What lay behind the word “hysteria”? Not a diagnosis. A label. A stigma that 19th-century physicians attached to women. And behind that stigma—an entire universe of suffering. Today, that universe has names. Panic attacks. Conversion disorders. Somatoform disorders. Psychotic episodes. Postpartum depression. Post-traumatic stress disorder. Especially after sexual and physical abuse. And abuse was rampant in the lives of 19th-century women. Temporal lobe epilepsy. Autoimmune neurological diseases. And—far more often than we’d like to admit—simply a natural emotional response to unbearable life circumstances. These were the circumstances. No legal rights. No economic independence. No control over their own bodies. Nothing. Just a label. And the universe of suffering behind it.

When a nineteenth-century woman fainted, sobbed, screamed, or felt suffocated and burning in her chest—it wasn’t always “hysteria.” Often, it was a reaction to her life. A reaction that the medicine of the time was unable to recognize as a normal human response to abnormal circumstances. Instead of listening to her, they sent her to the operating room.

Now, allow me to pose a question, without which this chapter would feel incomplete.

Have we learned our lesson?

It seems so. We no longer remove women’s ovaries due to anxiety. We don’t excise the clitoris for “hysteria.” We don’t parade patients in “poses of passion” in Parisian lecture halls.

But the rhythms of discrimination in medicine don’t fade as quickly as one might hope. A wealth of contemporary research reveals a shocking pattern: a woman goes to the doctor with the same symptoms as a man. What does she get? Less attention. A delayed diagnosis. And a psychological interpretation. Instead of a proper diagnosis, she’s told: “It’s just your nerves.” Myocardial infarction. In women, it’s diagnosed later on average than in men. Why? One reason lies in a grim irony: women’s symptoms are too often dismissed as “anxiety” or a “panic attack.” Her heart is crying out in distress, but the doctor sees only hysteria. Chronic pain? A woman is more likely to be handed a psychiatric label than to have her medical cause investigated. But the absolute pinnacle of cruelty is endometriosis. On average, seven to ten years. That’s how long a woman lives with debilitating pain before hearing the correct diagnosis. Seven. Ten. Years. All because complaints of pain are ignored for years.

The old notion of the “wandering womb”—the idea that women’s suffering originates somewhere deep within the female body and is a matter of emotional whims rather than genuine illness—is still very much alive. It has simply migrated out of gynecology and into subtler forms of cultural bias.

And there’s one more crucial point we can’t overlook.

The modern woman. Disillusioned. Desperate. Real medicine hasn’t given her answers. The pain remains. And so, she crosses the threshold of a “family constellation therapist” or a “past-life regressionist.” She falls into the same trap. Once again, she’s told that her suffering stems from her “feminine nature.” From “generational trauma.” From the “abortions of her great-grandmother.” From “karmic guilt.” Once again, she’s blamed for her own pain. Once again, she’s offered a ritual instead of a diagnosis.

From the “wandering womb” to “wandering karma” — two and a half millennia. And we are still on our way.

When I was at the Baku Psychiatric Hospital in the early 2000s, observing women in the chronic psychosis ward, one thought wouldn’t leave me: how many of them were here not because they truly suffered from schizophrenia, but because their families or husbands couldn’t handle their temperament, depression, or refusal to conform to their assigned role?

Here’s a question that hits where it hurts. In Soviet psychiatry—and in post-Soviet psychiatry as well—one phenomenon persists to this day. It even has a name: “domestic psychiatry.” Behind this clinical term lie hospitalizations where the reason wasn’t medical, but conflict. A woman’s conflict with her own family. Just look how simple it is. The woman is stubborn. One. The woman “doesn’t listen.” Two. The woman cries at night. Three. The woman doesn’t want to cook. Four. Four points. Not one from a psychiatry textbook. All four from a family scandal. They bring her in. They diagnose her. They treat her.

The practice never reached the scale of nineteenth-century American ovariotomies. But the logic behind it was exactly the same: if a woman fails to fulfill her social role, something must be wrong with her. And medicine was called in to correct the “error.

This isn’t a story that has ended. It’s a story that we—21st-century medical professionals—will be dealing with for a long time to come. Page by page.