Gender. Hysteria. Architecture. | “When Did Care Become Confinement?”

Prelude

This work traces a genealogy of care that quietly mutated into confinement.

It begins with a refusal to treat “female hysteria” as merely a mistaken medical diagnosis of the nineteenth century. Instead, it approaches hysteria as the name given to a much older spatial logic—one that had already learned how to isolate, manage, discipline, and erase women long before psychiatry offered language to explain it.

Across centuries, women who did not subscribe to the norms of femininity—those who lived alone, grieved loudly, desired freely, laboured independently, aged visibly, or refused obedience—were not only socially condemned but spatially reorganised. Their bodies were relocated, hidden, narrowed, and enclosed through everyday architectural practices that made autonomy appear dangerous and dependence appear safe. These practices were informal at first: domestic restrictions, village margins, thresholds, cellars, and back rooms. Over time, they were formalised into institutions: workhouses, moral homes, asylums, and psychiatric wards.

This series follows that transformation through three chapters.

Chapter I examines the period before psychiatry, when fear had already become architectural. It traces how women’s autonomy was spatially managed through domestic regulation, witch hunts, informal confinement, and early institutional planning. It argues that architecture rehearsed containment long before medicine named hysteria, making later diagnosis feel inevitable.

Chapter II moves into the nineteenth century, where hysteria becomes formal medical language and architecture learns to speak it fluently. It explores how asylums, wards, and moral treatment spaces translated diagnosis into floor plans, surveillance systems, segregated wings, and disciplinary interiors. Here, hysteria becomes legible—not only through medical text but through corridors, beds, gardens, and locked doors.

Chapter III turns to the present. It traces the afterlives of hysteria in contemporary hospitals, domestic architecture, safety infrastructures, and urban design. It asks how fear continues to shape spaces that claim to care—and what an architecture grounded in dignity, agency, and relational ethics might look like if it were to refuse the spatial logics of control.

Together, these chapters do not treat architecture as a mere background. They treat it as a participant.

Tracing the Origins of Fear in Built Form

Long before psychiatry, before hospitals, before hysteria entered medical vocabulary, women were already being managed through space. Their movements were regulated, their visibility controlled, their bodies confined or displaced—not in the name of illness, but in the name of order, morality, and protection. Domestic interiors, religious institutions, moral homes, workhouses, and early charitable spaces functioned as architectures of supervision rather than care. These were not neutral environments; they were spatial scripts that anticipated disorder and encoded fear.

This chapter argues that care comes to look like confinement when the subject of care is already presumed dangerous. When women’s emotions, desires, mobility, and autonomy are framed as unstable or excessive, architecture responds not by supporting health, but by minimising risk—through enclosure, separation, surveillance, and control. Healing spaces begin to resemble prisons not because illness demands it, but because fear demands legibility and obedience. Walls become instruments of moral correction; thresholds become filters; interiors become sites of behavioural regulation.

Hysteria, in this context, does not emerge as a neutral medical diagnosis but as a derogatory and condemnatory label—one that retrospectively justifies spatial practices already in place. It marks certain women as unruly, excessive, or dangerous, rendering their containment not only acceptable but necessary. Architecture, having already rehearsed confinement, simply waits for medicine to provide the language that transforms control into care.

Rather than treating hysteria as a point of origin, this chapter traces how architecture anticipated pathology. Fear did not first appear in medical texts; it appeared in thresholds that limited movement, margins that hid women from view, interiors that enforced obedience, and exclusions that framed autonomy as risk. Diagnosis did not create confinement—it legitimised it.

By following these spatial practices before the advent of psychiatry, this chapter reveals how built form became a silent collaborator in the production of hysteria: not as a response to illness, but as a precondition for naming it.

Witch Hunts, Domestic Regulation, and Spatial Dispossession

Women’s autonomy has rarely been interpreted as neutral. Across cultural contexts, a woman who lived alone, owned property, practised healing, inherited land, or resisted domestic expectations was repeatedly framed as spatially “out of place.” Disorder here was not merely moral—it was architectural.

Domestic interiors functioned as primary sites of regulation. Women were expected to remain visible yet contained, productive yet immobile. Their homes were scrutinised for signs of excess, independence, or unsanctioned authority. Public space, meanwhile, was structured to limit women’s presence or subject them to surveillance. When women crossed spatial boundaries without male sanction, movement itself became suspicious. Autonomy was translated into spatial threat.

The witch hunts of early modern Europe formalised this logic through violence and dispossession. As Silvia Federici demonstrates in Caliban and the Witch, witchcraft accusations targeted women who disrupted emerging capitalist and patriarchal property regimes—widows, unmarried women, healers, and those who controlled land or reproductive knowledge. Accusation became a mechanism for redistribution. Homes were emptied, land was seized, and women were removed from economic participation.

A crucial ideological move accompanied this spatial violence: women were aligned with nature—fertility, unpredictability, excess—while men were aligned with order and rationality. The witch became a spatial classification, marking certain women as belonging outside the village, outside the home, outside social legitimacy itself.

Through these practices, autonomy did not require a medical explanation in order to be punished. Space became the medium through which fear, control, and economic expropriation were enacted. Long before hysteria was named, the conditions that made it plausible had already been built.

Informal Architectures of Fear to Formal Exclusion

Not all architectures are monumental. Many of the most effective systems of control are informal, temporary, and normalised. Cellars, thresholds, village edges, back rooms—these spaces formed what can be described as informal architectures of fear.

These environments did not require professional architects or centralised state planning. They relied instead on shared cultural assumptions about belonging and exclusion.

A woman confined to a cellar was not yet institutionalised, but she was already spatially erased. A woman pushed to the margins of a village was not formally imprisoned, but her displacement communicated punishment and warning with unmistakable clarity.

Crucially, space itself operated as a tool of power. Control did not depend on walls alone, but on proportions, distances, and access. Seemingly minor or redundant details—the width of a window, the height of a sill, the length of a corridor, the placement of a doorway—dictated who could see and be seen, who could hear and be heard, who could linger and who must pass through. These details shaped behaviour without ever needing to announce authority.

These informal architectures performed essential cultural work. They normalised the idea that women’s bodies could—and should—be relocated, narrowed, hidden, or exposed for the sake of order. By the time formal institutions emerged, the logic of confinement no longer required justification. It had already been learned, rehearsed, and accepted through everyday spatial practices.

The seventeenth century marks a turning point—not because fear emerged, but because it became planned, named, and administratively organised. In 1657, the establishment of the Hôpital Général in Paris institutionalised confinement as a solution to social disorder. Michel Foucault identifies this moment as the beginning of the “Great Confinement,”¹ when poverty, deviance, illness, and nonconformity were managed through enclosure rather than addressed through care.

This was not a medical reform. It was an administrative one. The Hôpital Général was designed to remove disorder from public view, not to heal it. Confinement acquired a pseudonym—care, protection, correction—while retaining its punitive function. Architecture became a technology of moral regulation, translating social anxiety into walls, locks, and regulated circulation.

What is crucial here is continuity rather than rupture. The institution did not invent exclusion; it formalised and legitimised it. The informal architectures of fear—cellars, village margins, thresholds, back rooms—were reorganised into corridors, wards, surveillance points, and locked rooms. What had once been temporary and tacit became durable, visible, and bureaucratically justified.

Visibility itself became a strategy. These institutions were not hidden; they stood as warnings. Confinement functioned as a cautionary landscape, signalling to society—particularly to women—the consequences of failing to conform. To step out of line was no longer merely to risk social suspicion, but to risk architectural removal.

Women, already culturally associated with emotional excess, moral instability, and bodily unpredictability, were easily absorbed into this system. Their confinement was framed as protection of themselves, their families, and the social order. Under this logic, care and control became indistinguishable, and spaces ostensibly dedicated to healing increasingly resembled prisons in form, circulation, and governance.

By this point, architecture no longer merely anticipated fear—it contained it systematically, producing environments where enclosure was normalised as benevolence. The stage was set for hysteria to enter not only medical language, but architectural space, fully prepared to receive it.

Was Architecture Waiting for a Diagnosis?

By the time hysteria emerged as a medical diagnosis in the nineteenth century, architecture had already internalised the assumption that women required supervision.² The asylum did not respond to hysteria; it provided a ready-made spatial script for it.

Hysteria functioned as a retrospective explanation. It named what space had already enacted. The cellars, thresholds, margins, and informal confinements of earlier centuries were not abandoned; they were refined, professionalised, and enclosed within institutional walls. Architecture did not wait to be instructed by medicine—it waited to be legitimised by it.

The asylum marks the moment when this spatial logic becomes explicitly gendered. While confinement had long been practised, diagnosis now feminised it. Emotional excess, resistance, fatigue, grief, desire, and nonconformity were reclassified as symptoms rather than responses. Women became not merely disruptive subjects, but pathological ones, their bodies rendered legible through medical authority and spatial control.

This is where the asylum differs from earlier forms of exclusion: it does not merely remove women from society; it claims to explain them. Architecture becomes an accomplice in this explanation. Wards, corridors, observation rooms, and isolation cells do not simply house patients—they produce the conditions under which hysteria appears coherent, visible, and manageable.

Care did not suddenly become confinement in the nineteenth century. It learned to look like confinement slowly—quietly—through domestic rules, village boundaries, informal cells, and architectural habits that taught society how to hide, narrow, and relocate women who exceeded what was considered acceptable.

By the time hysteria entered medical language, architecture was already fluent in containment.

The ward did not invent exclusion. It perfected it.
The asylum did not discover fear. It inherited it.

What medicine eventually named, space had already rehearsed.
Corridors had already learned how to separate.
Thresholds had already learned how to filter.
Rooms had already learned how to correct.

Hysteria did not require a new architecture.
Architecture was waiting for hysteria.

References

1. Le Coq, J., Miller, A., & Bouchard, L. (2016). From care of the poor to the great confinement: an exploration of hospital accounting in France. Social History of Medicine, 29(2), 345‑368.  ↩︎
2. Micale, M. S. (2012). Charcot and the idea of hysteria in the male: gender, mental science, and medical diagnosis in late nineteenth‑century France. Medical History, 34(4), 363‑411.  ↩︎