At the outset, Appignanesi develops this work as a feminist tract, clearly identifying the biases that forced misconceptions about women being more prone to mental illnesses than men, even though evidence pointed to the contrary. This may have something to do with the Victorian ideal of a "delicate woman, prone to "nerves". Appignanesi challenges these stereotypes by showing how women over the ages, from Mary Lamb to Alice James, have tried to delineate their suffering, often at the cost of inviting social ridicule.
By including specific cases and the language that female patients used to address their problems, Appignanesi points to the development of a relationship between nascent psychiatry and the courts. She quotes the case of one Henriette Cornier, a Parisian nursemaid who obsessed greatly over the infant daughter of her master. One night in 1825, in a fit of insanity, she sliced off the head of the girl and threw it out the window. Because of the sheer inexplicability of the crime, this was the first case in the history of criminal law when a doctor was called in to testify on the mental health of the accused.
Another case that draws Appignanesi's attention is of Celia Brandon, who requested to be admitted to the Royal Edinburgh Hospital in 1915. This was the first documented case of a woman expressing a relationship between childhood brutality and sexual perversion. Brandon complained that she often fantasized about pain being inflicted on her during sex, and linked it to the beatings she received as a child from her aunt. The hospital records term her case 'Freudian'.
The best takeaway from Appignanesi's book is the realization that the mentally ill are not all that different from those on the other side of the divide. Thanks to the advancement in psychoanalytic procedures and psychiatry, mental illness has come to encompass a broad array of disorders. Which is why it is surprising that rage combined with hysteria could be the ground for lunacy in the 18th century.