Amy: Welcome to Breaking Down Patriarchy! I’m Amy McPhie Allebest. Every year on my birthday since about fourth grade, when my birthday cake is brought out and I blow out my candles, I have thought, “I wish for my mom to get better.” All these years later that’s still what I wish for, every single year. My mom has dealt with chronic pain for her entire life, and there were some years as I was growing up that she was in bed with the lights out with a violent migraine for half of the week, every week. She has also suffered from back pain, jaw pain, and stomach pain among other things, and her doctors’ inability to help her, despite their best efforts, was a huge source of discussion and anguish in my house, growing up. So when I heard the title Unwell Women: Misdiagnosis and Myth in a Man-Made World, I knew this was a book we had to add to our reading list. And then I immediately knew who I wanted to read it with me, and that’s Cassy Christianson, from my master’s program. So I’m excited to welcome you to the show today Cassy! Thanks for being here!
Cassy: It’s a pleasure!
Amy: We met in Anne Firth Murray’s class, etc., invite to share bio.
Cassy: I am a therapist working in pediatrics and maternal health and inclusion specialist but like you, I also went back to school and graduated from Stanford with a focus on the history of medicine. We met there in Anne Firth-Murray’s seminar on Global Women’s Health-- that's a subject I am really passionate about and on which much of my writing focuses on. My research involves the history of medicine, especially women’s health in the Early Modern period in France. I talk and write about this alongside covering current research in both pediatrics and maternal health and am currently working on an exhibition on Women in Science and Medicine during the Renaissance that will be at Stanford in the Fall of 2023.
So I’ve happily been on the West coast for a long time now but I grew up in Florida, living for quite a while on the island of Key West. My family, originally midwesterners, came from strong Scandinavian roots so I’m a mix of that and the Latin culture so prevalent in Florida. Now, I’m also French, through marriage and raising three bilingual, bicultural boys.
Amy: Tell me your thoughts about the term “Breaking Down Patriarchy”
Cassy: I’m very excited to be with you today both as a fan of your own work exposing patriarchy and as a feminist who sees the difficulties in the history of women’s health as being largely attributable to patriarchy. Much of my research has been searching for collaboration and exchange between medical women and men. It's been hard to find! So my writing is often unpacking the hows and whys surrounding the early modern masculinization of work surrounding women’s sexual and reproductive health.
Amy: Intro of the author:
Elinor Cleghorn has a background in feminist culture and history, and her critical writing has been published in several academic journalsAfter receiving her PhD in humanities and cultural studies in 2012, Elinor worked for three years as a postdoctoral researcher at the Ruskin School of Art at the University of Oxford on an interdisciplinary arts and medical humanities project. She now works as a freelance writer and researcher and lives in Sussex. Her own pain and other symptoms were dismissed for seven years before she was finally diagnosed with lupus.
Throughout much of history, a woman's worth depended on having children: whether it was through forging alliances by producing heirs, continuing the family line or producing children to assist their parents in the fields or household. Within a society that viewed reproduction as the primary role of a woman, medical men reduced women’s illness entirely to being attached to their reproductive organs. Throughout the book, Cleghorn often brings us back to this point.
As a feminist cultural historian, Cleghorn exposes gender biases as she looks at the history of medical disparities through the lens of gender and she provides readers a faciniating side-by-side description of medical history and the women's movement all while exposing bias in medicine.
...medicine has inherited a gender problem. Medical myths about gender roles and behaviors, constructed as facts before medicine became an evidence-based science, have resonated perniciously. And these myths about female bodies and illnesses have enormous cultural sticking power. Today, gender myths are ingrained as biases that negatively impact the care, treatment and diagnosis of all people who identify as women. (3)
Endometriosis, a chronic, incurable disease whereby endometrial tissue grows and spreads in other places in the body, is an object lesson in male-dominated medicine’s historic failures. This disease was named in the 1920’s, but it has existed in medical literature for centuries. Across those centuries, so many punitive fictions and fantasies have been projected onto women’s blood and pain. Its symptoms - including excruciating pelvic, back and stomach pain, pain during sex, and heavy bleeding - have an extremely long history of being pathologized as physical expressions of emotional distress. In the nineteenth century, women’s pelvic and abdominal pain, as well as their menstrual ‘derangements’, was met with aggressive, butchering surgeries, hysteric accusations and spells in asylums. Today, women are frequently dismissed as neurotic, anxious, depressed, hypochondria and even hysterical when they report the early symptoms of endo. For too long, menstrual and gynecological pain has been minimized as the ‘natural’ and inevitable consequence of being female. (8)
This quote struck a chord for me because I have a few friends with endometriosis, and it has been so debilitating and disruptive to their lives, and I grieved that it isn’t better understood.
Speaking out about your own body is profoundly feminist. It is generous and courageous to revisit and recall the trauma of pain, and a radical gesture in a culture skewed towards doubting and disbelieving women. It’s a risk- but at the same time it’s an act of defiance against those power structures in the man-made world that would prefer us not to speak. (12)
Throughout the book there are examples of men who violently abuse and silence women, and we will tell some of those stories of misogyny. But Cleghorn also mentions the softer side of patriarchy - the fact that men (and women themselves!) were ignorant about women’s bodies because religious patriarchy had taught women to be so embarrassed of their bodies that they wouldn’t/couldn't talk about them!! (Story of my Pfeifferhorn hike with my dad - I couldn’t bring myself to tell him what was going on with me, even at my age! He would have been soooo embarrassed, and my picking up on his embarrassment throughout my life is what continues to make me too embarrassed to talk about it. It’s not his fault… he was taught that way. It’s not my fault…. I was taught that way. But if I don’t want to pass that along to my kids, I **have** to be willing to break the cycle. So next time I have an opportunity like that I am going to say to myself “Speaking out about your own body is profoundly feminist” and I am going to withstand my own and whatever man’s embarrassment, asserting that a woman’s body is nothing to be ashamed of. (And this is one of the themes that will keep coming up in the book!)
Amy and Cassy: Chapter 1: Wandering Wombs
Amy: Read pp 23-25, from “On the Greek island of Cos”... “women’s health was entirely defined by their uteruses.” (25)
The cure for Hippocratic uterine pathologies - from the madness of suppressed menstruation to the horrors of womb suffocation - was as much social as it was medical. Marriage, ideally by the age of fourteen, regular sex with one’s husband - who was usuallly aroudn the age 0f thirty - and multiple pregnancies.
Women were under the dominion of male authority, and medical discourse legitimized this by making women’s bodies subordinate to the whims of the very organ that defined their social purpose. Whether these physicians believed the womb literally wandered, or just imagined it did, the idea that all women with uteruses were susceptible to becoming unwell because their bodies were hell-bent on making babies persisted for centuries. (28-29)
The ancient Greeks had blamed all the sickness of the world on Pandora, the mythological first woman, who was too weak to resist opening the forbidden jar of evils that her husband Epimetheus was taking care of. Chrsitianity spun a different story about women and their bodies being responsible for all the sin in the world. The Book of Genesis decreed that Eve, the original woman, imperfect and incomplete from the get-go - and an afterthought spawned from Adam’s rib - ruined everything because of her desirous and disobedient ways. Medical writings that survived the fall of Rome were closely sanctioned by the Church, so those very men who proselytized that women were universally deviant were also the ones in charge of teaching texts that claimed the female body was inferior, defective and always governed by the whims of the womb. (29)
I want to note that I don’t personally know any men or any doctors who think “women are universally deviant” and “the female body is inferior and defective.” However, as a student of history, I do think it is extremely useful to look back at the timeline to see what influences are still guiding the course of our beliefs and assumptions. It’s like the analogy that I used on the very beginning of the podcast of the modern town that is still built on a medieval street grid so the streets are too narrow for cars… sometimes those ancient foundations keeps things stuck in a way that is really hard to get out of.
Medieval Christian moral laws forbade medici from physically examining any woman. The female body was shrouded in secrecy and shame, and not only to the eyes and hands of male physicians. Women themselves wouldn’t have dared reveal intimate details to men about what was going on in their own bodies. Some medical writers of the time echoed these sentiments, including one who referred to a woman’s gynecological complaints as ‘her disgrace.” (31) “Hippocrates and later Pliny the Elder, thought menstrual blood could make men ill, ruin crops, kills bees and drive dogs mad.” (Ch 2, 43)
In addition to the poisonous powers attributed to ‘impure’ menstrual blood, shame permeated much of what was said about women’s health problems historically. Even in the anatomical vocabulary used. Early modern French medical texts divided women’s organs into les parties nobles et parties honteuses which means the noble parts such as the brain and liver or in the case of her sexual and reproductive organs, the shameful parts. So most physicians rarely interacted with women’s bodies, relying on a woman to self-report her problems if she felt comfortable or they left the manual work to midwives or in the case of birth emergencies, to surgeons. Cleghorn highlights that these myths set the stage long ago for medical disparities which continue to affect women today, even more so women of color. I had a meeting with a physician recently to determine if some symptoms I’ve been experiencing could be GI related or something closer to asthma. The male doctor spent quite a bit of time sharing his viewpoint but nearly no time examining me and then explained that he did not see the point of conducting the uncomfortable tests that would be necessary to rule out one diagnosis or the other. Instead, he posed the question if I might be experiencing anxiety that could be the ‘cause of my symptoms”. While this is a legitimate question, I don’t think it should be one of his first questions and he should have offered the tests. I really question how he might have approached this situation with a male patient, or what would he have asked a woman of color.
By the fourteenth century, women physicians were prohibited from practising professionally across Europe. (34) [But]...even when medical men were forbidden to touch women’s bodies, it was male-authored knowledge that determined how they might be healed. (32)
Unfortunately, this was largely the case. Male physicians and surgeons went on to use the power of the printing press to make their reputations and accrue position as authors. Cleghorn goes on to mention Trota of Salerno, a rare exception to this male dominance. An 11th-century medical woman, she’s thought to be the author of the Trotula, a treatise on women’s health. Although not mentioned in the book we read, it’s interesting to note that in the 12th century Hildegard of Bingen authors another text sharing her experience with healing women but we have to wait until 1609 for another authoritative text authored by a medical woman, the French midwife Louise Bourgeois to appear. Access to academic medical knowledge and knowledge-sharing was nearly exclusively a male domain although predominantly midwives did much of the manual work caring for women’ health.
Cassy: Chapter 2 SO moving on to ch 2
So in looking at religious doctrine and medical discourse, both claimed that women's bodies and minds were inferior, defective and dangerous. Women carried the added burden of suffering painful childbirths as punishment for original sin. As if this was not enough to control women already, Cleghorn now walks us through how the church used this medical idea of female inferiority to show that women were susceptible to channeling demonic forces and committing evil deeds meriting their destruction.
“13th century Italian physician d’Ascoli wrote that women “menstruate every month because they are by nature imperfect beings.” Medieval physicians and natural philosophers upheld the traditional wisdom that female biology was universally weak and inferior because of its difference to the male ideal….medical men were putting a new theological spin on the ancient teachings. All human women were daughters of Eve who had to endure God's Punishment by submitting to their husbands and suffering the pain of childbirth. But the problem... wasn’t God, but mortal men who manipulated Christianity’s foundational myths to justify society’s subjugation of women.” (38).
(I might argue with Cleghorn that these myths didn’t need manipulating to subjugate women but that subjugation was their original intent). This sacralization of women’s pain not only strongly influenced period perspectives on childbirth but had long standing continuing influence on how medical men perceived--and importantly--whether or not they treated women’s pain. A 17th century French text on what we would now refer to as obstetrics, related that a woman experiencing pain during a typical birth was “just what was normal as was foretold to her for her sins...she should accept her suffering with patience” (Guillemeau, De la Grossesse 1609, 168, 208). Later we’ll talk about the physicians who experimented on slave women (read story of perfecting surgery for prolapse and fissures) or total mastectomies. These medical men were still under the influence of these patriarchal myths that had now become sacred myths.
Going back to this idea that we opened with that society viewed (and on some level still views?) women’s primary role as procreation, Cleghorn makes a convincing case that women who deviated from this role or helped others to gain power over their own bodies had to be controlled and stopped----witch hunts were one form of this control. She explains that as great plagues decimated the European population at times by nearly 50%, “women--the very vessels of conception, birth and new life-- had to be scrutinized, regulated, surveilled and controlled. Men not only had “the power to determine how women should live and behave”(44)….they had medical control over women’s physical bodies. This theme will reappear again in later chapters as Cleghorn exposes how medical men vigilantly inspected women for signs of syphilis, although it was often spread by male soldiers, etc (find this section along with other examples she gives) or signs that a woman may have had an illegal abortion but in chapter 2 Cleghorn ties this scrutiny to witchcraft accusations in the Middle ages. She says, “Suspicion around women’s deviant and demonic potential rose stealthily across Europe, especially through the teachings of Catholic churchmen who upheld the religious and social sanctity of marriage.One such man was Henrich Kramer.” (45) according to Cleghorn, Kramer believed that the devil needed agents on earth to afflict people with evils on his behalf...in order to infect a woman with witchcraft, she must have any one of three specific vices: infidelity, ambition and lust.” (47) No surprise, Just the sort of women that the Church and state would want to control and possibly eliminate. Besides some interesting anecdotes about supposed witches collecting men’s penises in bird boxes and feeding them corn and oats, the book shows a direct line between witchcraft accusations and women’s health through the treatment of midwives in Northern Europe in the 15th century. Official regulation and licensing of midwives did not start until much later, for instance, around the mid-1500s in France, so midwives functioned as part of an informal network often trained through an apprenticeship model. University educated medical men already marginalized midwives and had begun taking their place in even uncomplicated or what they referred to as natural births (when the child presented by the head first or to a lesser extent, feet first). Despite the vital role midwives served in preserving women’s health, midwives were in a precarious position. Now Kramer has published his ideas which quickly spread through Europe. Referring to his views on midwives, Cleghorn tells us that “Kramer crafted a narrative of secrecy and deviance around their practices childbirth at the time was perilous and fraught with dangers women and their babies frequently died during labor Kramer attested that the infant death and miscarriage wasn't a natural occurrence but the devil working through possessed midwives to slaughter innocents among his more egregious tales of witches stealing newborns drinking their blood devouring them and offering them to the devil as a sacrifice he strongly implied that any instance of failed pregnancy and a woman attended by a midwife should be suspected as witchcraft in an abortion after all was one of the seven methods of witchcraft Kramer defined no one does more harm to the Catholic faith than midwives he wrote towards the end of the malleus Kramer declared that which midwife surpass all other which is in their crimes and that such evil is so rife that there is scarcely a tiny hamlet in which one has not been found” (48). While it's difficult to quantify, by most accounts the rate of maternal and infant mortality in early modern...