Book Review: Unwell Women

unwell women

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.

Jackie Law

Book Review: Admissions

Admissions, by Henry Marsh, is a searingly honest memoir by the retired brain surgeon who brought us Do No Harm (I have yet to read this earlier book). It is a somewhat regretful looking back on cases the author has worked on, mistakes made, and the balance neurosurgeons must acquire between confidence in their abilities and concern for the patients whose lives can be so drastically altered by their interventions.

Marsh resigned from his position as a senior consultant at a large London hospital when he felt the respect that doctors once enjoyed had been undermined by the target culture and petty rules imposed by bureaucrats granted the power to allocate funds and decide who gets treated in the modern NHS. Marsh continued to travel to Nepal and the Ukraine, where he assisted colleagues who ran private teaching hospitals, although he was questioning the usefulness of his roles here as well. This is a tale of facing up to a life approaching its end, for the author as well as his patients.

Although enjoying many successes, brain surgery carries the risk of patients surviving but with a questionable quality of life. Decisions on whether to operate must take into account the probability of such outcomes. Saving a life may leave relatives burdened with round the clock care of a loved one who has little awareness or, perhaps even worse, aware but catastrophically damaged. Modern sensibilities have made honest discussions about the benefits of death difficult. There is a reluctance to accept that medical intervention merely postpones the inevitable.

Having watched his parents die, from cancer and dementia related illness, Marsh has a pragmatic view of his own mortality. He also struggles with what certain colleagues may regard as professional arrogance and ponders what he will become when he is no longer a renowned surgeon. He recognises that he has, at times, made poor decisions and behaved badly. Even the satisfaction found in his work has been lessened by what he has learned of the reality of patient outcomes over his long career.

Marsh’s musings on the way the brain works and the effect on the body are fascinating. His views on psychosomatic illnesses, whilst in line with well researched medical opinion, are likely controversial amongst patients who demand a physical explanation for their very real suffering. In the chapter, Lawyers, he discusses whiplash injuries.

“An English woman had been involved in a minor car accident in the USA while on holiday, and had subsequently seen me as a patient about her ‘whiplash’ symptoms. I had confirmed with an MRI scan that there were no significant injuries to her neck […] Patients develop an array of aches and pains and altered sensations in their necks and arms which do not correspond to any known pathological processes […] It is well known that these syndromes do not occur in countries which do not have any legal recognition of whiplash injury as a consequence of minor car crashes.

I used to see many of these patients every year in my outpatient clinic and it was clear to me that most of them were not consciously malingering […] With ‘whiplash injury’, the possibility of financial compensation for the victims, combined with the powerful suggestion that they have suffered a significant injury, can result in real and severe disability, even though it is, in a sense, purely imaginary. […] It is the modern equivalent of the well-attested phenomenon of a witch doctor in tribal socity casting a spell on somebody, causing the victim to fall ill, merely through the power of suggestion and belief.”

In his work in Nepal the author encounters many women suffering debilitating headaches which, when scans show no physical problems in the brain, he suggests may be down to some unhappiness they harbour in their personal lives. He explains that pain occurs in the brain but can manifest anywhere in the body, and can have a psychological rather than physical cause. Patients are unhappy if they are not offered a cure involving surgical intervention or costly medication. The suggestion that psychiatric treatment may be more effective does not go down well.

Most of the cases discussed, though, involve the removal of brain tumours. Marsh intersperses the detail of these with anecdotes from his personal life, at the time and throughout his past. What emerges is a picture of a flawed but determined individual who wishes to honestly portray how he got to where he is now.

An interesting medical memoir from an author who is not afraid to state his views, however terse or contentious. It offers a window into the world of brain surgery, and the difficulty of ageing after a brilliant career.

Book Review: Greatest Hits

“Larry knows what it is to lose oneself for hours – days, even – in the act of creation; and to only understand, when the mind and body are finally calm once more, what it is that has been created. What, in that act, the artist is trying to make sense of, even though no sense can ever truly be made of this dizzying, maddening, impossible, beautiful life; and, of course, of its culmination, its crescendo and its inevitable loss.”

Greatest Hits, by Laura Barnett, tells the story of fictional singer-songwriter, Cass Wheeler, from her childhood growing up the only child of a London vicar and his depressed wife, through her rise to the heady heights of international fame, and then to her retirement from the music scene following personal tragedy. Along the way are exhausting months on the road, abandoned friends, broken marriages, and the apparently requisite over-indulgence in drugs of all kinds.

The structure of the story is wrapped around a series of sixteen songs representing Wheeler’s life. The lyrics – written by the author and real life singer-songwriter Kathryn Williams – have been put to music and will be released as a studio album to coincide with the publication of the book. This is not the first time publishers have collaborated to create associated music – I am aware of singles from Fahrenheit Press and Orenda Books. It is still, however, an interesting idea.

The story is set over the course of a day as Wheeler decides on the tracks to be released from her back catalogue in a new album being planned to enable her to emerge from retirement. As each song is selected the timeline moves to describe the events that provided their inspiration. Hints are dropped in the contemporary setting and then explained in these flashbacks. With a cast of characters spanning more than six decades it took concentration to remember who was who between the time periods.

Although polished and fluid I was not fully engaged until near the end. The contemporary sections felt like interruptions in what was an otherwise compelling tale. I did question why anyone would want fame, something that Wheeler herself noted when she saw the life an old friend was leading. Much is made of how artistic creatives cannot stifle their urges, even those that carry risk of self-destruction.

There is a poignancy to any life story as, over time, family and friends will inevitably be lost to abandonment, disagreement, and death. Words will be spoken that cannot then be forgotten, resentments form that damage all involved. Wheeler makes choices, repeats mistakes, holds grudges and must live with the consequences. The depiction of her as a daughter – to both the women charged with her care – and then as a mother, made for interesting reading. There was little new in this but it was perceptively portrayed.

Wheeler’s life with its hurts and privileges is rendered to demonstrate that success happens moment by moment and can be measured in many ways. Even if not convinced by the construction, this tale is well written. I will listen out for the album when it too is released.

My copy of this book was provided gratis by the publisher, Weidenfeld & Nicolson.

Book Review: The Life and Death of Sophie Stark

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The Life and Death of Sophie Stark, by Anna North, tells the story of the eponymous, fictional, film maker. It is told in the form of a series of personal vignettes written by people she was once close to. These are interspersed with increasingly polished reviews of her films written by a critic whose career developed alongside her own. It is a beguiling approach although with dark undertones, demonstrating as it does how little any individual can understand another, even those they may claim to love.

The book opens with the making of Sophie’s second film, as told by Allison on whose life the script is based. Allison becomes Sophie’s lover and, thanks to her part in this low budget film, an actress. Sophie recognised in her traits and skills that others could not see. It was this perceptiveness that gave Sophie’s films the art house edge for which she became known.

The second vignette is written from the point of view of Robbie, Sophie’s brother. From this we learn more of Sophie’s background, how and why she started to make her films. As an outsider in life Sophie used her art to express thoughts and feelings. Her first creation, a documentary about a college basketball player, was stuttered and amateurish yet showed flashes of the talent that would later disturb, enchant and enthrall.

Sophie’s third, more polished, film was also based on a story from a lover’s past, an approach which drew down the ire of her subjects. Sophie accepted the anger and hurt she generated as a necessary sacrifice for her art, despite the fact that it was others who had to pay. As her fame grew so too did her confidence, although much of this turned out to be as big an act as those which she captured on screen.

From the title of the book it is obvious how Sophie’s story will end. By the time the reader gets to this, past further music videos and another full length film, the cause comes as no surprise. The denouement provides a satisfying explanation for the form and layout of the tale.

The writing is thought provoking and poignant offering an unflinching critique of the conceits of the world. The desire to be noticed and admired affects all. Even Sophie, as removed as she was from most everyday experiences, could not avoid the damage she wrought in her quest to be recognised as an artistic success.

An intriguing yet always entertaining read this is a book to be pondered as well as enjoyed. Amongst the food for thought, it tells a cracking story.

My copy of this book was provided gratis by the publisher, Weidenfeld and Nicolson.