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Introduction
Zelda Fitzgerald was diagnosed with schizophrenia in 1930 by no less an expert than Eugen Bleuler, the clinician who originally coined the term. 1 Schizophrenia is currently defined 'by abnormal social behavior and failure to recognize what is real. Common symptoms include false beliefs, unclear or confused thinking, auditory hallucinations, reduced social engagement and emotional expression, and lack of motivation'. 2 But Zelda Fitzgerald, wife of American writer, F Scott Fitzgerald, and a celebrity in her own right, remained socially engaged throughout life; her emotional expression was not reduced, and she never lacked motivation. The same is true of many women diagnosed with psychotic illness; their voices, however, are rarely heard. 3 Zelda's voice, 67 years after her death, is heard because both she and her famous husband and their many literary friends were prodigious letter writers and keepers of journals. Some of the personal correspondence between Zelda and Scott has been preserved. 4 In addition, both Fitzgeralds wrote semiautobiographical novels 5 6 that detail the specifics of Zelda's mental problems. 7 Hospital records from her several psychiatric hospitalisations are also extant.
Aim
New discoveries in genetics and brain imaging have broken down old demarcations among the various subcategories of psychotic illnesses. 8 The aim of this paper, therefore, is not to examine, as others have done, 9 whether Zelda Fitzgerald suffered from schizophrenia 10 11 or from another psychosis, but rather to point to the elements that differentiate men and women, whatever the psychosis.
Method
Information about Zelda's illness comes from the many articles and letters and books written about her and her husband. The most recent references on gender differences in psychosis were selected from the multidisciplinary Google Scholar database, on entry of the following search terms: 'gender or sex' plus 'psychosis or schizophrenia or bipolar disorder'. Many excellent papers were omitted because of space limitations.
Characteristics of Zelda's illness
Zelda Fitzgerald was first hospitalised for psychiatric problems when she was 30. The course of her illness until her death at age 48 was marked by recurrent unrealistic beliefs, transient auditory hallucinations and occasional acts of unprovoked violence, usually directed at herself. Notable about her illness, and characteristic of many women with psychosis, are her excellent premorbid function, the late start and...