Beyond 'Crazy': How The Housemaid Exposes the Stigma Against Women’s Mental Health

In January 2023, Lindsay Clancy, a labor and delivery nurse from Massachusetts, was accused of killing her three young children before attempting to take her own life. Clancy had reportedly been struggling with postpartum psychosis, a severe mental illness that left her consumed by delusions and intrusive thoughts. Her tragic case ignited nationwide discussions about maternal mental health, the stigma surrounding postpartum disorders, and the need for better psychiatric care. Clancy’s story underscores a painful reality: society is often quick to judge women experiencing mental health struggles, labeling them “crazy” instead of extending empathy and support. Freida McFadden’s The Housemaid echoes this reality in its portrayal of Nina Winchester, a woman stigmatized and dismissed for her mental illness.

Through Nina’s harrowing journey, McFadden vividly captures the devastating impact of mental health stigma on women. As a psychiatrist, I found the novel to be not just a gripping psychological thriller but also a powerful commentary on how societal biases perpetuate harm, silence women, and enable abuse.

In the first half of The Housemaid, Nina Winchester is seen through the perspective of Millie, the protagonist. Despite her own history of incarceration, Millie reacts with discomfort upon learning that Nina had been institutionalized after nearly harming her child during an episode of postpartum psychosis. Rather than empathy, her response reflects a societal instinct to judge mothers who struggle with severe mental illness. Her reaction is blunt: "Nina tried to kill her daughter. She tried to kill herself. God, no wonder she’s on an antipsychotic." While Millie briefly considers that Nina may not have been in control—"Maybe she didn’t have any idea what she was doing"—her underlying suspicion remains: "Still. As much as I worried about Nina’s mental status, I never truly believed she had the capacity for real violence. She’s capable of much more than I thought." Through Millie’s conflicted observations, McFadden illustrates how stigma toward maternal mental illness persists, fostering both skepticism and isolation—even among those with their own history of marginalization.

This reaction underscores the societal stigma surrounding severe mental health conditions like postpartum psychosis, which affects approximately 1 to 2 out of every 1,000 mothers[1]. Rather than eliciting empathy, Nina’s history becomes a source of revulsion.

This judgment isn’t unique to Millie. The other women in the book also dismiss Nina as “crazy,” a label that strips her of credibility and humanity. Once a woman is deemed mentally ill, society is quick to dismiss her struggles as personal failings and to overlook the circumstances that may have contributed to her condition. Even Millie, with her own experiences of societal judgment, uses Nina’s mental health history as validation for her growing relationship with Andrew. In her mind, Andrew “deserves better,” and Nina’s supposed instability makes Millie feel justified in her betrayal. 

The book’s most poignant critique lies in how Nina’s “craziness” is weaponized against her. Once labeled as unstable, no one believes her when she tries to expose the horrors she is enduring at home with Andrew. He is perceived as the loving, stable husband, while she is dismissed as a hysterical wife. This dynamic is painfully real. Women with mental health challenges are often socially devalued and perceived as less credible, making their accounts easier to dismiss[2], and likely more so when their accusations challenge the façade of a seemingly “perfect” man.

In reality, stigma surrounding postpartum psychosis isolates women and delays critical intervention.[3] Untreated postpartum psychosis is associated with an estimated 4% infanticide rate[4]. Yet many women avoid seeking help, fearing judgment or the potential loss of their children[5].

The second half of the novel reveals Andrew’s abusive and manipulative nature, and casts Nina’s earlier actions in a new light. What was once seen as “crazy” is now understood as a response to sustained psychological trauma. This transformation is emblematic of the power of reframing: when we stop labeling and start listening, we begin to see the truth.

The book also highlights a deeper problem: how women, conditioned by societal norms, are often quick to judge one another. Millie’s initial horror at Nina’s institutionalization reflects this ingrained bias. But what if, instead of being appalled, she had extended empathy? What if the women around Nina had supported her instead of dismissing her? McFadden’s narrative reminds us that solidarity among women is not just ideal but necessary, especially in today’s political climate, where women’s rights, particularly around healthcare, face constant threats. 

The Housemaid holds a mirror to our world, where stigma and judgment still dominate conversations about mental health. Postpartum psychosis, though rare, is a very real and serious condition. Yet, instead of fostering understanding, society often reacts with fear and condemnation. Sensationalized media portrayals of infanticide overshadow the reality that, with timely treatment, many women recover fully and resume their lives[6].

Nina’s story resonates because it reflects countless untold realities. It challenges us to reconsider our assumptions and biases and to foster a culture where women feel safe to seek help without fear of judgment.

Freida McFadden’s The Housemaid is not just a thriller; it’s a call to action. As a psychiatrist, I see this book as an opportunity to spark conversations about the stigma surrounding mental health, particularly for women. By understanding and supporting one another, we can dismantle the judgments that divide us and build a world where no one faces these struggles alone. Nina’s story reminds us that solidarity, compassion, and understanding are not just ideals, they are lifelines.

References:

[1] Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 5. (2023). Obstetrics and gynecology, 141(6), 1262–1288. https://doi.org/10.1097/AOG.0000000000005202

[2] Frieh E. C. (2020). Stigma, trauma and sexuality: the experiences of women hospitalised with serious mental illness. Sociology of health & illness, 42(3), 526–543. https://doi.org/10.1111/1467-9566.13034

[3] Fusar-Poli, P., Estradé, A., Mathi, K., Mabia, C., Yanayirah, N., Floris, V., Figazzolo, E., Esposito, C. M., Mancini, M., Rosfort, R., Catalan, A., Baldwin, H., Patel, R., Stanghellini, G., Ratcliffe, M., & Maj, M. (2025). The lived experience of postpartum depression and psychosis in women: a bottom-up review co-written by experts by experience and academics. World psychiatry : official journal of the World Psychiatric Association (WPA), 24(1), 32–45. https://doi.org/10.1002/wps.21264

[4] Alford, A. Y., Riggins, A. D., Chopak-Foss, J., Cowan, L. T., Nwaonumah, E. C., Oloyede, T. F., Sejoro, S. T., & Kutten, W. S. (2025). A systematic review of postpartum psychosis resulting in infanticide: missed opportunities in screening, diagnosis, and treatment. Archives of women's mental health, 28(2), 297–308. https://doi.org/10.1007/s00737-024-01508-3

[5] Button, S., Thornton, A., Lee, S., Shakespeare, J., & Ayers, S. (2017). Seeking help for perinatal psychological distress: a meta-synthesis of women's experiences. The British journal of general practice : the journal of the Royal College of General Practitioners, 67(663), e692–e699. https://doi.org/10.3399/bjgp17X692549

[6] Burgerhout, K. M., Kamperman, A. M., Roza, S. J., Lambregtse-Van den Berg, M. P., Koorengevel, K. M., Hoogendijk, W. J., Kushner, S. A., & Bergink, V. (2017). Functional Recovery After Postpartum Psychosis: A Prospective Longitudinal Study. The Journal of clinical psychiatry, 78(1), 122–128. https://doi.org/10.4088/JCP.15m10204