Christine Talbot on Elinor Cleghorn’s *Unwell Women: Misdiagnosis and Myth in a Man-Made World*

This probably won’t come as a shock, but doctors don’t take women seriously.  Not all doctors and not always, but overwhelmingly and sometimes with deadly consequences.  Elinor Cleghorn’s book Unwell Women: Misdiagnosis and Myth in a Man-Made World traces the gendered medical myths that have produced a long legacy of medical ignorance, arrogance, misapprehension, and misdiagnosis in relationship to women and their bodies.  While readers looking for a scholarly engagement with the historiography of medicine will be disappointed, those looking for a radical feminist perspective on the long history of Western medical mythology and misogyny harming women will enjoy (and be enraged by) this book.  Cleghorn’s work exhibits the 1960s feminist slogan, “the personal is political.”  As she tells readers, her book is driven by the inescapable sense that because of her gender her own physicians dismissed the symptoms of her auto-immune disease, leaving it un- or misdiagnosed for years.  She mines the origins of her personal experience in the history of Western medicine, arguing that whatever else Western medicine it may be, it “is also a system of power … that has always privileged male knowledge and professional expertise” (13).  For centuries, Cleghorn argues, medicine has treated women as reproductive objects that male practitioners made meaning of.  This constituted women as objects of a purportedly “objective” male medical gaze, women as bodies, but men as full human beings merely living inside a body.

For Cleghorn, medicine’s privileging of male expertise has led to a long history of pain and distress for women.  She begins in ancient Greece, where “unwell women emerged as a mass of pathological wombs,” a myth Cleghorn traces through several centuries (21).  As Western medicine professionalized, midwifery, community knowledge, and female-administered childbirth increasingly gave way to male-controlled medical mythologies that “for centuries decreed that women were at the mercy of their uncontrollable, unruly reproductive organs” (40).  As such, women’s experiences were routinely ignored, dismissed, or misdiagnosed.  For example, the diagnosis “hysteria” emerged in the early eighteenth century as a kind of empty signifier of women’s ill-health, becoming “whatever male physicians and writers wanted it to be.  The only definitive diagnostic sign was being a woman” (66).  Alongside this diagnosis emerged two related medical convictions: that women’s delicate constitutions prescribed confinement in the private sphere away from the difficult demands of work and politics, and that “less civilized” Black women were less delicate and so felt less pain than more “civilized” women.  The former was a helpful conclusion for those invested in extracting free domestic labor from wives and mothers, while the latter was a handy myth for those interested in keeping Black women enslaved or in conducting excruciating non-consensual backyard surgeries upon Black women’s bodies, as nineteenth-century American physician James Marion Sims did when experimenting with early anesthetics.

A few early dissenting voices, alongside a few benefits for some women, emerge along this trajectory of medical abuse.  Nineteenth-century English doctor Thomas King Chambers argued that women didn’t develop hysteria because of their wombs, but because the conditions of their domestic entrapment justifiably upset them.  Also in the nineteenth century, Sophia Jex-Blake, one of Britain’s first female physicians, argued for a woman’s place in the medicine.  She instructed her colleagues that sympathy and propriety required a woman’s ear for a woman’s problems.  Late nineteenth-century feminist physicians like Mary Putnam Jacobi and activists like Julia Ward Howe, both Americans, sought to end the male monopoly on medical knowledge by demanding education for women about their bodies.  Yet none of these voices affect Cleghorn’s overall narrative.

Cleghorn argues that the scientific revolutions of the twentieth century were never unambiguously good for women and most created more harm than benefit.  Research on anesthesia for the pain of childbirth, for example, began with Sims’ experiments on Black women and continued in the 1910s, when German physician Bernhard Krönig used a drug called scopolamine to erase women’s memories of the painful experience of childbirth.  His clinic reportedly left women straitjacketed and bound to their beds in darkened rooms for hours with the justification that the women wouldn’t remember it.  Writ large, the professionalization of medicine transformed childbirth and women’s authority over their own bodies shriveled.  Once a women-centered natural process experienced at home, childbirth became a “pathological process that required operative and narcotic intervention as the norm, not the exception” (152).  Women’s reproductive capacities became occupied by male expertise.

At the same time, early-twentieth-century birth control movements in the United States and England provided some women the means to control their reproductive destinies.  But those benefits were marbled in with eugenic programs that left thousands of women of color and poor white women forcibly sterilized.  In the 1950s, American physician Gregory Pincus conducted the experiments that developed the birth control pill on non-consenting Puerto Rican women living in housing projects, essentially treating them as medical specimens at his disposal.  Once developed, the birth control pill liberated many women from the reproductive consequences of sex, but it also burdened women with the responsibilities and costs of controlling reproductivity, costs medicine still does not entirely understand.

The discovery of hormones in the early twentieth century also left a legacy of harm.  If femininity was a substance, a hormone, physicians could manipulate it to make women more feminine and thus, doctors presumed, healthier.  No matter that by the 1930s synthetic hormones were known to cause cancer.  They are still prescribed for a variety of conditions, and for birth control and to help with “symptoms” of menopause (a natural process commonly characterized as an illness), even though the side effects are not well-understood.  Even the invention of tampons just before World War II left an ambiguous legacy.  While tampons made periods invisible, making people freer and more mobile while menstruating, they also “transformed women into instruments of labor, whose messy, unpredictable, defective bodies could be regulated to maximize efficiency” during wartime (208).

Alongside the discovery of hormones and invention of tampons, physicians developed the lobotomy in the 1930s to treat the emotional and mental and emotional pain women reported.  In the late 1940s and 1950s, use of the technique expanded to the treatment of chronic physical pain, with little attempt to identify and heal its cause.  After all, doctors believed, it was all in her head.  As lobotomies fell out of fashion, women began to see widespread advertisement of tranquilizers intended for similar purposes, to make the boredom of domestic life bearable.  “Mother’s little helper” essentially gaslit women into believing that the problem was not with post-war domesticity, but with the women themselves—they just couldn’t appropriately adjust to their “natural” role.

The publication of Betty Friedan’s wildly popular indictment of postwar domesticity The Feminine Mystique, was a symptom of widespread discontent among Western women that would soon emerge as a full-fledged movement on behalf of women.  The radical feminist ideas that circulated through that movement have enjoyed a renaissance in the wake of #metoo, #timesup, and a new era of trans visibility.  Thus, it is not terribly surprising that the heroes of Cleghorn’s narrative emerge from the women’s movement of the 1960s and 1970s.  Women’s health activists wrestled their health from the male medical monopoly and took their bodies into their own hands.  The movement produced the indispensable Our Bodies, Ourselves, the Jane Collective that offered women-performed abortions in rented apartments in Chicago, and an early self-abortion device, Del-Em.  The women’s movement also produced the feminist criticisms of male objectification and objectivity that, perhaps implicitly, ground Cleghorn’s analysis.  She builds on the tradition of radical feminists who showed decades ago that the objectification of women’s bodies has dangerous consequences for their occupants.  Like the women’s health activists and feminist thinkers before her, Cleghorn has seized reins of meaning making, taking as her object of study the history of male medicine, showing that male medicine hasn’t ever been objective at all, but profoundly shaped by centuries of medical mythology and misogyny.  Her book is a call to all medical meaning makers, physicians, assistants, and patients alike, to betray the centuries of medical misogyny we have all inherited and actually listen to women.  It’s about time we do.