If You Give a Neurasthenic Milk (and a Cookie): Revisiting “The Yellow Wall-Paper” and the Rest Cure through the “Milk Diet”

The narrator’s sense of confinement and suffering without access to intellectual activity reflects Gilman’s own negative experience of Mitchell’s treatment in 1887, which she addresses in an essay, “Why I Wrote the Yellow Wallpaper?” (1913). After detailing her time with Mitchell, Gilman describes his “solemn advice” after sending her home. He instructed her to “live as domestic a life as far as possible” and to limit her professional life by sticking to “two hours’ intellectual life a day.” He expects Gilman, a writer, to “never to touch pen, brush or pencil again as long as [she] lived.” Attempting to follow these directions, however, brought Gilman to the brink of a mental breakdown, so she quickly disregarded Mitchell’s advice in favor of returning to work. What resulted is her “touching pen” to critique the rest cure in embellished short story form.

Interestingly, in her searing depiction of the rest cure, Gilman does not incorporate Mitchell as a central character within the story. She briefly directly references him once. She writes, “John says if I don’t pick up faster he shall send me to Weir Mitchell in the fall. But I don’t want to go there at all. I had a friend who was in his hands once, and she says he is just like John and my brother, only more so!” (Gilman, 650). In this passage, the narrator’s opinionated friend is the mouthpiece for Gilman’s own less than glowing review of Mitchell. In a similar way, the character of John is a stand-in for doctors who followed Mitchell’s advice for the rest cure. Gilman represents the entire patriarchal medical institution of which Mitchell was a part through the more anonymous, representative character John. In this role, the character holds an almost comically, hyperbolic level of power through his profession and gender, allowing Gilman to emphasize the unethical treatment of patients through tactics of dominance and submission used by doctors like John and Mitchell.

Yet the most notable element in her embellished portrayal of the rest cure is her divergence from the conventional rest cure practice, in which Gilman omits a concrete explanation of the rest cure’s prescribed diet. She makes only a few oblique references to the narrator’s diet, such as the following: “So I take phosphates or phosphites—whichever it is, and tonics, and journeys, and air, and exercise, and am absolutely forbidden to ‘work’ until I am well again” (Gilman, 648). The inattention to feeding and eating stands in stark contrast to Mitchell, who makes diet central in his instructions for treating patients. In Fat and Blood (1877), his tome on treating neurasthenia and hysteria, Mitchell’s longest chapters by far are not on seclusion or rest, but on dietetics and therapeutics. He spends eighty pages on diet, compared to six on seclusion and twenty-two on rest.

 

Taking up the discrepancy in attention to diet, my essay’s questions solidify what does revisiting the story through its historical medical context reveal anew about its integral critique of patriarchy’s oppression of white women? And more specifically, based on Mitchell’s declaration that “It is difficult to treat any of these cases without a resort at some time more or less to the use of milk” (119), what is the significance of the so-called “milk diet”? My essay complements past feminist political readings focusing on the story’s symbolic qualities by providing a grounded historical understanding of the role of milk and diet in the methods of domination and discipline.

Inspired by the multidisciplinary fields of medical humanities and disability studies, I contend that more attention to the medical history and the embodied experience of the rest cure will give us a fuller picture of its dominating and disciplining nature, supplementing classic feminist critiques of the story that, to this point, often tend to rely on symbolic or metaphorical elements in the text. Consider how Tom Lutz studies literature of the turn of the century and finds that texts like Gilman’s feature “explicit narrative representations of neurasthenia” as a method for critiquing aspects of society, like gender oppression. For Lutz, neurasthenia is “especially attractive as an explanatory metaphor.” But which is it—an explicit representation? An explanatory metaphor? Or both? David Mitchell and Sharon Snyder caution against disability as metaphor in Narrative Prothesis (2000). Too often in literature, disability is used as a narrative prosthesis—or a “crutch,” a metaphor or symbol upon which the narrative hinges. This figurative use of the body and disability does not account for an individual’s embodied experience with “social and political dimensions.”

While much feminist scholarship attends to the madness as metaphor trope, in Conflicting Stories (1991), Elizabeth Ammons provides an interesting approach to the story’s symbolism that also considers experience of the body. Ammons reads the prescription of milk as part of the infantilization of adult women. She unpacks the “dramatic” symbolism of the milk diet: “Fattened, purified . . . the recovering Victorian patient of Mitchell’s rest cure blows up to resemble a woman steadily and unchangingly six-months pregnant, or a pudgy baby that yet cannot walk . . . Endlessly with child and at the same time a child.” She takes up milk symbolically to understand the power dynamic of the doctor’s dominance and the patient’s submission, achieved through infantilization. Milk, then, is a fitting symbol—as something of mothers fed to children. The rest cure paradoxically treats women as children to get them back to physical health so that they can go back to their domestic duties, which include getting pregnant, giving birth, and producing milk of their own.

I supplement such symbolic analysis of milk with a historical, grounded approach to the materiality of milk in the rest cure and in Gilman’s story. In what follows, I show how the rest cure began with a largely liquid diet of milk, draining patients of their energy, making them sleepy and supplicant, following that, controlling the patient through a strict regimen of diet, primarily focusing on achieving physical recovery rather than mental, to get the patients back to work as mothers capable of future reproductive labor.

Part 1: Drink Your Milk (and Maybe Eat a Cookie)

According to Mitchell, the rest cure begins with the milk diet “given alone by Karell’s method for a fortnight or less” which “enormously simplifies our treatment” (119). Later, Mitchell mentions Karell’s method again but still neglects to explain in full. What is Karell’s method? Examining medical writings by Mitchell’s contemporaries, including Karell, sheds fascinating light on this strange medical method. In “On the Milk Cure,” Doctor Philip Karell, physician to the Emperor of Russia, argues that, for several illnesses—including dropsy, neuralgia, liver diseases, faulty nutrition, inflammation of the stomach and intestines—he views “milk as the best and surest of remedies” (101). His cure entails milk being “scrupulously administered, and in strictly measured doses” (102).

Years later, in 1916, Doctor Edward Goodman remarked that the Karell diet may be for treating cardiac, renal, and hepatic dropsies. His study details the exacting regimen. First, feed the patient 200 cubic centimeters (a little under ¾ cup) of “raw or boiled milk, warm or cold” at 8 a.m., 12 p.m., 4 p.m., and 8 p.m. And nothing else. Though if the patient complains of hunger, you might give them a single zwieback (a kind of brittle German cookie) or a piece of dry toast.

The length of the diet depends on the patient’s condition. In Goodman’s context, the primary concern is an “edema,” or the swelling of the body caused by too much fluid trapped in the body, which can be treated by, amongst other things, limiting sodium intake. The milk-only diet length also relies on the patient’s “plea for more food.” Unsurprisingly, Goodman notes that the course of this “strict diet sometimes, nay, many times, meets with violent opposition from the patient.” So, after about one week of only 800 cubic centimeters (or 3 and 1/3 cups) of milk each day, increasing the diet with “salt-poor” solid foods begins. Goodman specifies after a week, try giving the patient an egg in the morning and a cookie at night. The next day, a piece of bread. After which, gradually increase the food over the next two to four weeks, but never let the patient consume more liquid than the 800cc of liquid each day.

How might a patient react to the Karell method as such, besides the aforementioned violent opposition and pleas for sustenance? According to Mitchell, the patient sleeps. He describes how the strict milk diet “gives rise to a marked sense of sleepiness” (125). Gilman captures a patient’s sleepy response to the rest cure, with the narrator struggling to write, even though she thinks it would “relieve” and “rest” her. Unfortunately, she reflects that “I find I get pretty tired when I try” (Gilman, 649). Later on, she notes, “Half the time now I am awfully lazy, and lie down ever so much” (Gilman, 651).

It is not surprising that nearly starving a patient would cause them to sleep, because their energy supply, food, is so drastically limited. This enforced diet begins the treatment in a way that makes the patient supplicant to the doctor—with what energy could they protest this aggressive lack of nutrition? In theory, starting the “rest” cure off with rest sounds good, ideal even, but sleep caused by lack of sustenance is not the same as healthy sleep that replenishes energy.

Not terribly long after Mitchell’s and Goodman’s publications, in 1927, Doctors Smith, Gibson, and Ross critiqued the Karell diet for its noted lack of proper nutrition. “While this [Karell] diet greatly promotes the elimination of excess fluid, it is obviously inadequate because of its low energy value. Various modifications of the Karell diet have been recommended, but in each instance the caloric value has not been sufficient to maintain a normal metabolism” They continue describing that, during cardiac failure, “not only the heart but the entire body is in an exhausted condition.” Therefore, the patient’s diet must “not impose an excess load but still provide sufficient energy” (emphasis mine). Note that the language of energy and “caloric value” frame the issues of nutrition, hunger, and bodily functions. The calorie is a unit of measurement intended to signal the amount of energy provide by food according to Nick Cullather’s history of the calorie. Food can be transformed into its units, calories, and those units to their corresponding energy supply—low, high, sufficient, insufficient.

The calorie became popular in the early twentieth century, corresponding to a larger cultural understanding of energy that emerged in the nineteenth century alongside the creation of fossil fuel systems and an increase in energy use as Cara New Daggett explains in The Birth of Energy (2019). Work came to be governed through metaphors and physics of energy. The calorie is one such energetic metaphor used to understand an individual’s capacity for work. Think of the popular adage that “food is fuel,” in which fuel takes on greater meaning with the context of the pervasive discourse of energy. Considering the very real embodied experiences and consequences of diet, which the language of calorie and energy makes clear, reflection on the exclusive milk diet of the rest cure allows us to appreciate anew the truly negative valences of the rest cure. When so much of the rest cure relies on the patient’s total submission to the doctor, it’s notable that this opening tactic drains them of energy.

Part 2: Eat Up and Obey!

After the strict under-feeding diet of milk, and with the patient essentially starving, Mitchell switches his tactics to over-feeding. He notes that the patient “may be made,” that is, forced, to eat more than they otherwise might by “being fed by her attendant” (139). He also permits the patient to drink a small amount of alcohol each day because “a small amount is a help towards speedy increase of fat” (141). He slowly introduces the following large quantities of food.

After about a week of the exclusive milk diet, the patient may have a light breakfast. A couple days later, a mutton chop for lunch. In another couple of days, bread and butter three times a day. Within ten days, the patient is up to three meals a day, alongside 3-4 pints of milk (6-8 cups). At that ten-day marker, Mitchell adds 2-4 ounces of fluid malt extract each day. From here, the patient has some freedom in the meals, but Mitchell notes he likes to provide items with fat, like butter and cocoa and, of course, milk. The tenth day is also when he orders a bizarre but fascinating entrée, raw beef soup. The recipe for this delicacy entails an entire pound of raw beef transformed into soup overnight. By the third week, the patient begins to take cod-liver oil, given by mouth or, if it causes nausea or loss of appetite, by “enemata” or an enema, which is “doubly valuable” (141). At the time the patient is eating real food is also the time Mitchell likes to add “iron in large doses” (142). He notes that many patients are constipated by iron, so he again provides advice for supplements ranging from fruit to “enemata of oil, or oil and glycerin, or a glycerin suppository” (143).

Though they might seem too strange to be believed, Gilman’s narrator names many of these exact food items, including cod liver oil, raw beef, and alcohol: “John says I mustn’t lose my strength, and has me take cod liver oil and lots of tonics and things, to say nothing of ale and wine and rare meat” (Gilman, 651). Reading that the narrator is “made” to ingest items she is not even fully aware of, as seen through her unsureness in the phrase “lots of tonics and things,” reminiscent of her confusion over “phosphates or phosphites,” makes clear how in complete control John, her husband and doctor, is over her body and what goes in it.

This is a strategy straight from Mitchell. He addresses the issue that some patients simply don’t want to take iron, in which case, you might add it to their fluid malt for about a month before informing them that they were taking iron the whole time. Or, if patients complain of iron-induced headaches or a feeling of fullness, you might just follow Mitchell’s advice that, “as a rule, I disregard all such complaints” (143). Mitchell ends his detailed explanation of the rest cure diet by bragging about how much food he can force his patients to eat: “Probably no physician will read the account I have here detailed of the vast amount of food which I am enabled to give . . . without some sense of wonder” (143). 

That Mitchell’s practices raise many ethical concerns perhaps goes without saying. Suffice it to say: Mitchell’s deceitful, patriarchal tactics of submission here are particularly glaring and are not purely mental, but physiological. He forces patients to ingest things into their bodies; of that food and the accompanying medicine, the patient is not always informed of what they are taking. Other orifices are invaded as well, such as with the common use of enemas or vaginal douches in the course of treatment. In American Breakdown, Jennifer Lunden describes this kind of top-down, manipulative treatment as a medical colonialism, in which bodies are treated as territories to be surveyed and claimed by doctors, rather than treating patients as subjects with agency and full partners in their treatment.

Gilman depicts this uneven power dynamic in the husband/doctor’s insistence that he knows best despite the narrator’s attempt to share her thoughts about her own illness, that she fears she is better in body but not in mind. In response, he insists she really is getting better and pleads, “Can you not trust me as a physician when I tell you so?” (Gilman, 652). I hope readers of my essay recognize by now just how highly ironic this request is, considering deceit and manipulation are baked into the rest cure, as far as Mitchell is concerned. In sum, Mitchell’s rest cure relies on violent governance of bodies. For this reason, the diet component of the rest cure is an integral, if not the primary, method of conquering the patient and as such, diet is a necessary context for future readings of “The Yellow Wall-Paper’s” examination of the patriarchal, exploitative doctor-patient dynamic.

 

Further Reading:

Page numbers in text refer to Mitchell’s Fat and Blood unless otherwise specified from “The Yellow Wall-Paper.”

Elizabeth Ammons, Conflicting Stories: American Women Writers at the Turn into the Twentieth Century (Oxford University Press, 1991), 35.

Nick Cullather, “The Foreign Policy of the Calorie,” The American Historical Review 112, no. 2, (April, 2007), 337-364.

Cara New Daggett, The Birth of Energy: Fossil Fuels, Thermodynamics, and the Politics of Work (Duke University Press, 2019), 4.

Charlotte Perkins Gilman, “The Yellow Wall-Paper,” New England Magazine 18 (1892), 647-656.

—.“Why I Wrote the Yellow Wallpaper?” The Forerunner 4 (October, 1913), 271.

Edward Harris Goodman, “The Use of the ‘Karell Cure’ in the Treatment of Cardiac, Renal and Hepatic Dropsies,” Archives of Internal Medicine 17, no. 1, (1916), 810.

Philip Karell, “On the Milk Cure,” Edinburgh Medical Journal 12, no. 2, (1866), 97-122. (Quotes from 101 and 102)

Jennifer Lunden, American Breakdown: Our Ailing Nation, My Body’s Revolt, and the Nineteenth-Century Woman who Brought Me Back to Life (Harper Wave, 2023), 67.

Tom Lutz, American Nervousness, 1903 (Cornell University Press, 1991), 6 and 24.

David T. Mitchell and Sharon L. Snyder, Narrative Prothesis: Disability and the Dependencies of Discourse (University of Michigan Press, 2000), 205.

Silas Weir Mitchell, Fat and Blood: An Essay on the Treatment of Certain Forms of Neurasthenia and Hysteria 1877, 8^th ed. (J. B. Lippincott & Co., 1911). 

Fred M. Smith, R. B. Gibson, and Nelda G. Ross, “The Diet in the Treatment of Cardiac Failure” JAMA 88, no. 25, (1927), 1943-1947.

 

This article originally appeared in February 2025. 

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Alexis Schmidt is a PhD candidate of English at the University of Illinois Urbana-Champaign. She studies work, energy, and exhaustion in turn-of-the-century US literature, primarily written by or about women. Her dissertation is tentatively titled “American Exhaustion: Energy, Bodies, and Literature in the Progressive Era.” Her scholarship has appeared in the Edith Wharton Review and Edge Effects and is also forthcoming in Studies in American Naturalism.