Unwell medicine

If you are a person who has visited a gynaecologist in India -- congratulations, you have access to healthcare! -- you may have been lectured for wanting to end your pregnancy; or heard the doctor lecture the nurse on not asking the patient if she is “sexually active” but instead whether she is “married”; or had the doctor bark at you for asking any questions at all. If you are a young woman with unsettling symptoms, you may have been advised that “all this will stop when you get married”, and if you’re older, that “it’s normal, stop fussing.”

Patronising, ‘genteel’ sexism, impatience, negligence, and dismissals are features of a systemically entrenched patriarchal attitude towards women’s health. We’ve all experienced it. But if you want to get even madder about it than you are, read Elinor Cleghorn’s book, Unwell Women: Misdiagnosis and Myth in a Man-Made World -- a historical, social, sexual, medical, scientific, and political summary of the gender bias in medicine, from the dawn of medicine right up to the present. Cleghorn focuses on the Western world, and on binary women, but her work has universal resonance.

Unwell Women shows the thick, consistent line of medical gender bias through history, offering a breathtaking sense of its monstrous weight -- today’s attitudes toward women and their health are shockingly similar to those of ancient Greece or medieval Europe. There is a straight line between the ancient healer, who theorised that floating wombs send up vapours that addle women’s heads, and the present-day doctor who thinks that marriage will fix your palpitations. Medicine has come a long way, but it is still an androcentric system of power.

Female illnesses and ‘deviant’ behaviours have largely been seen in the context of a prescribed biological role as reproductive beings; and ‘fixing’ unwell women focused, for most of history, on trying to keep them, or stuff them back into, that box. Medicine has put theory into horrendous practice. Women with perplexing symptoms or behaviours have been burned as witches (for being solitary, unmarried, and childless among other things), had their clitorises snipped off (to prevent them from masturbating themselves into madness), been lobotomised (“Easier than curing a toothache”, said newspapers of the time), undergone hysterectomies and eugenic engineering through sterilisation and birth control (“By 1970, around a third of women in Puerto Rico had been sterilised, many without their express knowledge or consent”), and been experimented on like rats by pharmacological developers (the influential doctor pushing oestrogen therapy research and drugs was funded by the drug manufacturers; “a drug [DES, a version of the Pill] considered too dangerous for chickens and men was somehow perfectly acceptable for women”).

All this for being ‘unwell’ in ways that patriarchal society and medicine cannot tolerate and/or explain. Nobody paid much attention to the world of pain and discomfort they endure, instead putting women’s symptoms down to -- most famously -- hysteria, gaslighting them, and refusing them the indelicacy of a physical examination. Today, “our contemporary biomedical knowledge is stained with the residue of old stories, fallacies, assumptions and myths”. Even today, “nowhere near enough research and time has been spent on figuring out the cause of [endometriosis]”, which affects one in 10 women across the world. Forget that -- it was only in 2005 that the full size and shape of the clitoris was discovered.

Cleghorn, who herself suffered pain and medical mismanagement for years before being diagnosed with lupus, marshals telling details in her historical sweep, and keeps a careful critical eye on the class and race fault lines of the movement for better women’s health. (Medical feminism, for example, has had to move past its own eugenically-motivated problems.) Today, for all the advances in science, culture, and gender attitudes, we have a long, long way to go.

Don’t take it from me though -- I’m solitary, single, and childless, and therefore obviously a witch. Take it from this fascinating, infuriating book that everyone should read.