This review was written for and first published by Bookmunch.
I read my way through Unwell Women in a prolonged and barely suppressed rage. Women and girls the world over know we are routinely demeaned – effectively silenced – and this account of historical treatment lays bare the toll it has taken on our health, mental and physical. The author presents the facts clearly, maintaining engagement and never shying away from topics rarely discussed openly – ‘women’s problems’ and how we are expected to go through life quietly, grinning and bearing. I pondered if male readers would have any interest or dismiss this well researched and presented account as a rant, females still being regarded as overly emotional – hysterical – and in need of calming down, by whatever means.
Divided into three main sections, the first of these explores how medical knowledge developed from the time of the Ancient Greeks to the nineteenth century. Throughout most of this period, women’s bodies remained a mystery. Each month they would bleed. They grew babies. They complained of pains men didn’t experience so were probably imagined. As their father’s and then their husband’s property, it mattered that females remained amenable, attractive, modest and faithful. They were vessels for men’s sexual satisfaction and, most importantly, procreation.
“They were seen as weaker, slower, smaller versions of the male ideal, deficient and defective precisely because of their difference to men … in writings that would become the foundations of scientific medical discourse and practise, unwell women emerged as a mass of pathological wombs.”
The required modesty cost lives. Women were made to feel ashamed of their bodies – sinful temptresses. In the powerful Christian world it was, after all, the first woman, Eve, who ‘ruined everything because of her desirous and disobedient ways.’ Girls and women were expected to remain covered even when seeking medical treatment, untouched by the always male physician. Ingrained shame and ignorance in medical matters led to them being regarded as unreliable narrators of their own bodily suffering. An early pamphlet written in the thirteenth or fourteenth century stated ‘the female body is inherently flawed and defective in many of its functions.’
Female healers and midwives existed. Educated women worked tirelessly throughout history to improve care but were routinely dismissed by men who retained the power to effect change.
“the male writers espousing this nonsense understood only too well that women had to be exempted from the hallowed halls of medicine if they themselves were to maintain their stranglehold.”
A great many aspects are covered in this comprehensive and gripping history, much of it disturbing and, at times, horrifying. When physicians were eventually permitted to examine women (their reproductive physiology was considered an inverted version of men’s) treatments offered for a plethora of misunderstood problems included operations to cut off clitorises and crush ovaries. Alongside the need to suppress female excitability – bad for the nerves in already nervy creatures – the ideologies of eugenics were emerging in medical aims and practice.
The second section of the book, covering the late nineteenth century to the 1940s, saw the slow emergence of hard fought for advances in women’s rights as well as medical knowledge. Doctors still regarded women as sexual objects and child bearing machines. Birth control was frowned upon, abortions illegal and therefore carried out in secret. Women reporting gynaecological pain were regarded as overly sensitive – neurotic and requiring rest away from any form of stimulation. Typical treatments offered for common ailments such as uterine fibroids, and cancers in reproductive areas, were often as dangerous as the problems they claimed to cure. Doctors were keen to further their reputations – for financial reasons as well as ego. Women – particularly those not valued, such as sex workers and the criminalised – were useful subjects for experimental procedures. Troublesome wives and daughters were readily presented for surgical interventions.
The final section covers 1945 to the present day. Although much more was now understood about how a woman’s body functioned, many female complaints still couldn’t be explained and were dismissed as psychosomatic.
“In an era when a mentally healthy woman was a serene wife and mother, almost any behaviour or emotion that disrupted domestic harmony could be interpreted as justification for a lobotomy … And the success of the lobotomy was measured according to how obligingly she resumed her household duties.”
Although much of the book focuses on the way privileged, often white, women were treated by the medical establishment over the centuries, chapters also cover attitudes towards Black and ethnically diverse women. There are accounts of how slaves were believed to have higher pain thresholds, and how entire communities in economically deprived regions were enrolled in clinical trials without being informed of potential side-effects. There may have been a need for family planning to improve maternal health, but birth control was regarded as a means of limiting procreation amongst those deemed eugenically undesirable.
I mentioned the rage I felt reading this book. Despite the impressive progress in medical treatment and knowledge, so many of the attitudes detailed here are still recognisable and widespread. They manifest as: banter, mansplaining, paternalistic teasing, bafflement when women do not appreciate a well meant gesture, anger when men feel underappreciated or disrespected. Women want to be treated as fully human, not simply a vessel available for sex and procreation.
I pondered the choices parents around the world make when offered the chance to gender select an unborn child. Boys are still widely chosen more often than girls. Biomedical research funding focuses on finding treatments for ailments suffered by men. Clinical trial subjects have, over decades, mostly been white and male. Unexplained chronic pain reported by women – even that with testable biological markers – is often dismissed with ‘withering glances, eye-rolls, smirks and heavy sighs.’ It can take years of suffering before tests are offered and treatment made available.
The medical histories detailed here are mainly USA and UK based. In these supposedly forward thinking countries, women still struggle to maintain autonomy over their bodies. Access to abortion requires a doctor’s permission and is not available in certain places, such as Northern Ireland. Many of women’s illnesses remain a mystery and are not taken seriously.
The first step in finding a solution is recognising there is a problem, making this an important work. What we need though are advocates who will be heard, not silenced as shrill and hysterical. If history tells us anything it is that the treatment of unwell women is of little interest to men while their needs continue to be met.
Any Cop?: Read this book and be aware of how ingrained and widespread the prejudices are – then learn to listen when unwell women speak.