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This article reveals how Elizabeth Keckley framed American citizenship as a psychiatric rather than political category. In Behind the Scenes (1868), Keckley emblematizes Mary Todd Lincoln’s “scandalous” behavior to describe and critique what I call the psychiatric republic: a politico-economic paradigm that paradoxically condemns women as mad, often for expressing the very traits required of men elected to public office, while simultaneously positing feminine virtues as foundational for republican citizenship. Focusing on how notions of civic femininity were originally linked to psychiatric nosology, I show how nineteenth-century women were circumscribed temporally in a seemingly inescapable loop of diagnosis, treatment, and moral refinement. The spectacular case of Mary Todd Lincoln is an extreme example of how women were considered mentally unstable enough to merit exclusion from civic life but were also forced to perform in cure cultures that would ostensibly ready them for civic duties predicated on rational democratic subjecthood.