“The Yellow Wallpaper”: the new, century-old voice calling for representation in clinical research

“Never touch pen, brush, or pencil as long as you live.”

This was an official prescription from Dr. Weir Mitchell, a man recognized by his 19th century contemporaries as one of the greatest nerve specialists in the country. The recipient of this particular callous command was Charlotte Perkins Gilman, an American author also known for her pivotal role as an influential feminist.

As one can imagine, telling a prolific writer “never to touch pen” for the rest of her life did not go well. Gilman noted the instructions brought her “Near the borderline of utter mental ruin.” Only when she “cast the noted specialist’s advice to the winds and went to work again” did she recover from both her initial presenting symptoms – depression – and the “mental ruin” brought about by Dr. Weir Mitchell’s treatment.

This experience motivated Gilman to author a  gothic short story now listed in high-school English syllabi across the country: “The Yellow Wallpaper.” While we can’t officially confirm it’s Gilman, as it is written from the perspective of its unnamed narrator – hereafter referred to as “the diarist” – she relays her experience with symptoms suggestive of postpartum depression with psychotic features. The primary physician involved in her treatment insists she remains confined to an old, yellow-wallpapered nursery with the instruction to avoid work and writing at all costs.

To make the parallel even more obvious, Gilman all but confirmed the connection between her fiction and reality by triumphantly sending a copy of the story to “the physician who so nearly drove [her] mad.”

While “The Yellow Wallpaper” can be approached as an eerie example of gothic literature or as an American feminist text, this parallel also renders it a poignant example of narrative medicine (despite its publication long before the official field was defined).

In my article, “The Modern-Day ‘Rest Cure’: ‘The Yellow Wallpaper’ and Underrepresentation in Clinical Research,” I propose the value of literature as case studies eliciting strong emotional responses that can be leveraged to imbue current healthcare issues with renewed attention and importance.

Gothic literature – known for harboring themes such as madness and psychological terror – offers avenues to explore how psychiatric patients perceive the world. As “The Yellow Wallpaper” demonstrates, the story’s roots in Gilman’s real experience with Dr. Weir Mitchell’s treatment augment its relevance as commentary from a patient’s perspective.

My article proposes a novel interpretation of this short story, suggesting that it can be read as a call to action from the standpoint of treatment development.

How can “The Yellow Wallpaper,” written over a century ago and featuring a treatment long discontinued, be relevant to modern-day clinical research in treatment development?

Both Gilman’s and her fictional diarist’s needs were minimized in favor of the generally accepted treatment at the time: the rest cure. Therefore, their suffering could be linked to the development of the rest cure. Dr. Weir Mitchell’s evidence supporting his treatment lacked a diverse patient population, neglecting to consider the intersectionality of future patients – how would a patient’s gender, illness identity, disability status, family situation and occupational status mitigate the effects of treatment?

If the rest cure was researched for use across various indications and considerations for patients of different backgrounds, presentations and priorities, would the treatment prescribed for the diarist (and Gilman herself) have been different?

While we can’t change the rest cure research of the past, the emotional impact elicited by “The Yellow Wallpaper” can fuel physicians’ and researchers’ attentions toward future endeavors. Reading the short story in this way strengthens the current call to action for increased representation and intersectional considerations in modern-day treatment development.

By Camille Francesca Villar, a medical student at Baylor College of Medicine


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