Medicine, Myths, and Mystification: On Elinor Cleghorn’s Unwell Women
Thousands of years ago, a teenage girl walked the streets at night, suffering from pain, high fever, and disturbing hallucinations. In fact, her symptoms were so severe that she considered taking her own life, just to escape them. The famous physician, Hippocrates of Cos, (of Hippocratic Oath fame) was called to help. His diagnosis was that as the girl had gone through puberty but was not yet married; her body must be overfilled with menstrual blood, such that it had oozed into her veins and turned her mad. His prescription? Marriage and penetrative sex to release the blockage. It would take a man’s pleasure to fix this unwell woman.
Shocking—and true—stories like these pervade medical historian Elinor Cleghorn’s non-fiction debut, “Unwell Women: Misdiagnosis and Myth in a Man-Made World,” which reveals the history of gendered medicine in a way that is at once scientifically evidenced, personal, and intersectional. The book challenges medicine’s long-held delusion of a gender binary in which the (white) male body is taken as standard, and the ‘female’ body—defined by the presence of a dangerous and unruly womb—is viewed as essentially pathological, and the consequences of this for all women, trans men, and non-binary people. This troubling androcentrism is presented in a way that is compelling, enraging, but ultimately hopeful.
Cover, Unwell Women: Misdiagnosis and Myth in a Man-Made World by Elinor Cleghorn, Published by Dutton, 8 June 2021 | Fair Use.
Cleghorn begins in Ancient Greece, where the foundations of Western medicine were formed, exposing how its gender biases evolved up until the late 19th century. She provides a terrifying overview of where medicine went wrong when it came to women, and particularly women who lived in poverty, enslaved women, and women of color, exploring the work of ancient physicians, clitoridectomy, the invention of the speculum, the dissection of enslaved women, the impact of Darwin, and ‘steel rape’—state-endorsed gynecological examinations of working-class women, which continued until the late 19th century.
A key problem throughout this period was the assumption that the experience of womanhood can be reduced not just to the presence of but the action of the womb. Unwell women existed, it was believed, because their wombs were ‘wandering’ madly around their bodies, ‘suffocating’ lack of air, or whatever other fiction took the male physician’s fancy. The womb, argued the celebrated second century physician Aretaeus, is ‘an animal within an animal,’ which, according to the anonymous male author of the infamously inaccurate “Secrets of Women,” drove them to hysteria and acts of madness, such as inserting iron into their vaginas then seducing men with the aim of mortally wounding their penises.
By personifying the womb, Cleghorn explains, these male physicians simultaneously objectify the woman herself while reducing her to nothing but a puppet of her own unstable biology. Throughout this period, women had been acting as midwives for each other, performing obstetric and gynecological care at home. But, as Cleghorn points out, as the field became more professionalized and more male, such early midwives’ knowledge was not only disregarded, but they themselves were labeled witches and punished accordingly.
Part Two begins with the suffrage movement, where even as they were being force-fed by male doctors ‘for their own good’, suffragettes refused to accept gender oppression in medicine and beyond. Cleghorn then explores the fascinating—and almost unbelievable—history of menstruation and the menopause. For instance, she reveals that it was widely believed that women menstruate because they are ‘too wet,’ with generally too much blood in their bodies. She then explores many misguided attempts to lift the ‘curse’ of menopause to keep women ‘pleasingly feminine’ for including the use of dangerous x-rays directed at the ovaries, the provision of carcinogenic oestrogen in extremely high doses, which form the foundations of modern hormone replacement therapy, and how feminists like Professor Clelia Duel Mosher fought against menstrual myths and gender bias in medicine.
Part Three begins with the end of World War II in September 1945 and explores the far-reaching effects that wars have on medicine, including the normalization of tampons in the UK. This is where Cleghorn delves into more contemporary issues, including the over-prescription of anti-anxiety medication for ‘neurotic housewives,’ the misunderstanding of vaginismus, the thalidomide scandal and its implications for pharmaceutical safety, the forced sterilization of women of color, the legality of abortion, and the invention of pap smears.
Cleghorn also writes of the invention of the pill, and it does not make easy reading. On the journey to achieving what is still a deeply flawed, little understood oral contraceptive—with its mental health effects only recently being taken seriously—medical researchers experimented on women of color in Puerto Rico without informed consent, often via coercion. In the aftermath, feminist health campaigners fought against the suppression of the drug’s side effects. It is this section of the book that Cleghorn particularly focuses on the historical and ongoing intersection of racism and misogyny in medicine, and its horrific results.
Throughout the book, Cleghorn provides a wealth of examples of (often nameless) female bodies, theorized about by male doctors. In the earliest cases, it is only through Cleghorn’s imagination that these pathologized bodies are given life and their subjective experiences considered; male medics at the time did not think them worth noting. Alongisde feminist progress across society more broadly, first-hand accounts by ‘unwell women’ emerge, medicine responds to them, and the misogynistic lens of medicine weakens; “Speaking out about your own body,” Cleghorn argues, “is profoundly feminist.”
The most detailed and engaging unwell woman’s story makes up the penultimate chapter of this book. Cleghorn tells of her own journey from unexplained pain in 2002, through doctors’ smirks, eye rolls, and crushing dismissals of her experiences as “probably just your hormones,” to finally being diagnosed with lupus in October 2010. This personal story is all the more powerful because of the stark contrast with the lack of female voices in the preceding chapters.
While Cleghorn does not shy away from criticizing the medical establishment, she avoids vilifying evidence-based medicine itself. This makes her argument even more convincing; Cleghorn herself comes from an academic background with a PhD in medical history, and the book itself has a strong list of references to back up its claims. Yes, there are villains in this story: advocates of clitoridectomy, perpetrators of forced sterilizations, dissectors of enslaved women. And yes, there are heroes: the various feminists throughout history who have fought against medical gender bias. But mostly, those responsible for perpetuating gender bias in medical treatment are well-meaning, and merely misinformed.
Cleghorn does not demonize doctors or advocate turning towards alternative medicine; rather, she advocates for the limiting lens of misogyny to be lifted and for medicine to become more scientific, more evidence-based, and more egalitarian. Ultimately, she argues, it is about time that the medical establishment admitted that, in the words of Josephine Butler, “we are human first, women secondarily.”
Author’s note: I was lucky enough to receive a proof of Unwell Women ahead of release, courtesy of the publisher. All quotes in this article are from that proof copy, and do not necessarily appear in the finished book.
Image credit: Female figure, deep dissection to show kidneys, uterus, etc. Science Museum, London. Adapted to show close up of internal organs. CC BY 4.0
