Unwell Women by Elinor Cleghorn (2021)
Unwell Women by Elinor Cleghorn (2021)
Introduction
When clinical research exempts women from studies and trials on the grounds that female hormones fluctuate too much and upset the consistency of results, medical culture is reinforcing the centuries-old myth that women are too biologically erratic to be useful or valuable (7).
For centuries, medicine has claimed that women are defined by their bodies and biology. But we have never been respected as reliable narrators of what happens to our bodies (10).
Globally, it is estimated that twice as many men as women are dying from COVID-19. Although the reasons aren’t clear yet, some researchers speculate that this so-called COVID gender gap has to do with biological variables between male and female immune systems. “Something about being a woman is protective, and something about pregnancy is protective,” explained Dr. Sara Ghandehari, an intensive care physician at Los Angeles’s Cedars-Sinai hospital, “and that makes us think about hormones.” In an article for the New York Times, Roni Caryn Rabin revealed how doctors at Cedars-Sinai and the Renaissance School of Medicine, on Long Island, New York, have been conducting trials of the “female” sex hormones, estrogen and progesterone, on male and female COVID-19 patients. Both hormones are thought to have anti-inflammatory and protective immunological properties. Women, it’s assumed, have hardier immune systems than men do. The capacity of female biology to mount more robust immune responses is one possible explanation for why more women are diagnosed with autoimmune diseases. It’s also fairly intriguing to think that the very aspect of female biology that has exempted women from many clinical trials-our erratic hormones-is now being valued and marshaled to treat a virus more prevalent in males. The gender prevalence of COVID-19 has sparked a flurry of controversy and debate. Many people don’t believe that biological maleness is quite as straightforward a precipitating factor. Some have pointed out that men diagnosed with COVID-19 are dying given their social and lifestyle factors, including higher rates of smoking, rather than their essential biology. It seems the unerring focus on biological sex might actually hinder, rather than help, the emerging-and vital-understanding of COVID-19 and gender. “When in doubt, look to social factors first, not biology,” declared three women directors of the GenderSci Lab, at Harvard University, in a recent essay for the New York Times (12-13).
Part One: Ancient Greece-Nineteenth Century
8: Rest and Resistance
Earlier in the 1870s, an American neurologist named Silas Weir Mitchell had been busily concocting theories about the threat intellectual activities posed to “future womanly usefulness.” Mitchell thought coeducation ridiculous, and the possibility of girls receiving “masculine” education before the age of seventeen appalled him. “Nervous maladies,” in his opinion, were so endemic among American girls and women that even without education they were “physically unfit” to fulfill their duties as wives and mothers.
While working as a surgeon during the Civil War, Mitchell observed how nerve pain caused by bullet wounds exhausted the minds and bodies of soldiers, making them near hysterical. He devised a treatment of bed rest, a fat-heavy diet, massage, and electric muscle stimulation to restore depleted nerves. After the war, Mitchell suffered a breakdown and diagnosed himself with “neurasthenia,” a term made popular by American neurologist George Miller Beard in 1869 for nervous exhaustion exacerbated by the stresses of modern living. Although “neurasthenia” could affect both men and women, its causes were decidedly gendered. Men developed the condition by working too hard, while in women it was usually linked to domestic and family pressures, or the inevitable fallout of studying too hard when they should have been obeying the limits of their biological destiny. Mitchell treated his own bouts of neurasthenia, or “a rather nervous temperament,” as he put it, with “rest and recreation” in the 1860s and 1870s. But although he recognized that men and women alike benefited from physical rest to “cure” their addled minds and nerves, his fundamental belief in women’s physiological, mental, and social inferiority meant that his proposed treatment for them was more moral conditioning than medical care. After Mitchell turned his attentions to women’s nervous illnesses in 1873, he promoted his infamous “rest cure” as a two-birds-with-one-stone remedy for improving the delicate female constitution and making women toe the domestic line.
Mitchell insisted that women with nervous exhaustion and “hysteric” symptoms-especially if they were young, thin, and anemic-should be kept in bed for about two months, fed rich foods including raw beef soup and four pints of milk a day, massaged regularly, given electrotherapy, and forbidden any activity whatsoever apart from teeth cleaning. “Nothing is more common in practice,” he wrote in 1877, “than to see a young woman who falls below the health standard, and is tired all the time, by and by has a tender spine, and soon or late enacts the whole varied drama of hysteria.” For Mitchell, hysteria was nothing more than a litany of complaints dreamed up by pampered middle-class girls to perplex physicians and garner sympathy. His methods were designed to break an unwell woman’s resolve and make her snap out of her attention-seeking ways. “To cure such a case,” he advised, “you must morally alter as well as physically amend.”
Miss B, a “sturdy, handsome girl,” age sixteen, suffered convulsions, stomach problems, and limb paralysis before she entered Mitchell’s “care.” He considered her “a child who to be made well had to be calmly and firmly ruled.” Other girls apparently loved to play the good patient because they were flattered by Mitchell’s attention. Not Miss B. She was isolated at the Philadelphia Infirmary for Nervous Diseases, where Mitchell was lead physician, with one nurse to attend her. She was banned from using her hands for any reason, even to feed herself. She loved to knit, sew, and read, but all were forbidden. She hated milk and vomited after being made to drink it. “One or two scoldings, some show of disgust, and the promise that she would soon feed herself if she obeyed my wishes, helped us through this,” Mitchell wrote. He was not above force-feeding patients through the nose or rectum if they refused to eat. After a year of rest cure, Miss B was so weak she could barely walk with crutches. “This is what it means to treat hysteria,” he wrote. “There is no shortcut, no royal road.” Mitchell’s medical “expertise” consisted of humiliating and abusing girls and women. But his methods were deemed so effective that his popularity and eminence spread across Britain and America.
In 1892, Charlotte Perkins Gilman brought the rest cure to public attention through a short story in The New England Magazine. “The Yellow Wallpaper” is about a woman with severe depression whose mental health deteriorates further after she is confined by her physician husband to a gaudily wallpapered bedroom. For three months she is made to rest and abstain from all intellectual and creative activity. Her husband thinks nothing is wrong with her, save a “slight hysterical tendency.” “Bless her little heart!” he exclaims. “She shall be as sick as she pleases!” “The Yellow Wallpaper” reflected Gilman’s views about the deleterious effects of marriage on women’s bodies and minds. And it was inspired by her own experience of being subjected to the rest cure in 1887 by Mitchell himself.
After the birth of her daughter Katherine, in 1885, Gilman suffered “a growing melancholia . . . that consists of every painful mental sensation . . . utter weakness” and “a steady brain-ache that fills the conscious mind with crowding images of distress.” She couldn’t read, write, paint, talk, or listen. Pain consumed her mind. She held and nursed her daughter but couldn’t feel love. When Katherine was five months old, Gilman left her with her mother and a nurse and traveled from her home in Connecticut to visit friends in California. On returning home, the “dark fog rose again.” Her mother’s friend gave her $100 to “go away somewhere and get cured.”
Gilman had heard of Mitchell-“the greatest nerve specialist in the country”-and wrote to him explaining how desperately she needed help. “I am a teacher by instinct and profession,” she wrote. “I am a reader and thinker. I can do some good work for the world if I live. I cannot bear to . . . linger on this wretched invalid existence . . . There is something the matter with my head. No one here knows or believes or cares . . . but you will know.” Mitchell treated Gilman with the rest cure at the Philadelphia Infirmary, which she found “agreeable enough.” After a month he found nothing wrong with her. He sent her home with this prescription: “Live as domestic a life as possible. Have your child with you all the time . . . Lie down an hour after each meal. Have but two hours intellectual life a day. And never touch pen, brush or pencil as long as you live.”
Gilman obeyed Mitchell’s instructions for months. But soon she felt “perilously close to losing [her] mind.” “The mental agony grew so unbearable that I would sit blankly moving my head from side to side-to get out from under the pain,” she wrote. “Not physical pain . . . just mental torment, and so heavy in its nightmare gloom.” In the fall of 1887, she separated from her “devoted” and “loving” husband. “It was not a choice between going and staying, but between going, sane, and staying, insane.” Over the next years she continued to write and lecture, but she was exhausted by her “wilted nerves.” “To do anything . . . is incredible effort, as if trying to rise and walk under a prostrate circus tent, or wade in glue.” Her friends didn’t believe she was unwell because she seemed so capable; but how could they understand what she might have achieved if she hadn’t been so broken?
In “The Yellow Wallpaper,” the narrator’s husband threatens to take her to Mitchell if she doesn’t “pick up faster.” After the story was published, Gilman sent a copy to Mitchell, but he never responded. It wasn’t until 1902, when Gilman met Mary Putnam Jacobi, that she began to recover. Putnam Jacobi had developed a groundbreaking theory that hysteria, which she saw as a disorder of the nervous system, should be treated by stimulating patients’ senses and intellects and not by diminishing them with constant rest. Where Mitchell dismissed the reality and severity of Gilman’s mental illness, Putnam Jacobi listened, and believed her.
At the time, Gilman’s depression was so severe that she found it impossible to write. Over several months, Putnam Jacobi prescribed tasks to gradually restore her brain’s “capacity for action.” First, she built structures with kindergarten blocks; she read; within a few months she could write a little. “All this intelligent care helped me much,” she reflected in her memoir, in 1935. Years later, in an article titled “Why I Wrote ‘The Yellow Wallpaper,’” she explained that she wanted to reach wives and mothers who were vulnerable to punishing medical interventions, and to empower them to challenge their male physicians. “It was not intended to drive people crazy,” she wrote, “but to save people from being driven crazy, and it worked.” The rest cure had sent Gilman “so near the borderline of utter mental ruin that [she] could see over.” Her healing came from the “joy and growth and service” of writing, where she regained “some measure of power.” Today “The Yellow Wallpaper” is one of the most important and widely read texts for feminists arguing against medicine’s control over women’s bodies and minds.
Mitchell’s attitudes toward women and his treatments were horrendous. His rest cure became popular because it offered a solution to a problem that medicine itself had created. In his twisted way, Mitchell rightly questioned the validity of hysteria. By the late mid-nineteenth century, it had evolved into a spurious diagnosis for almost all pathologies of women’s bodies and minds. Mitchell described hysteria as “the nosological limbo of all unnamed female maladies” and argued that it should “be called mysteria for all its name teaches us of the host of morbid states . . . crowded within its hazy boundaries.” For a few years, gynecologists and physicians, especially in Britain, had been admitting that the term had become as unruly and undefined as the women it was meant to pathologize. In 1866, surgeon and anatomist Frederick Carpenter Skey announced that diagnosing “hysteria” was like trying to discern an “object floating in the sky . . . or an early star in the evening.” A few years later, Edward Tilt declared that hysteria had become a “‘will-o-the-wisp,’ misdirecting . . . attention from the real cause of nervous symptoms.”
Hysteria was losing its legitimacy as a diagnosis for physiological disorders, but this didn’t mean that the term was consigned to the historical wastebasket. Over hundreds of years, it had become a shorthand for aberrations of idealized femininity (116-20).
Introduction
When clinical research exempts women from studies and trials on the grounds that female hormones fluctuate too much and upset the consistency of results, medical culture is reinforcing the centuries-old myth that women are too biologically erratic to be useful or valuable (7).
For centuries, medicine has claimed that women are defined by their bodies and biology. But we have never been respected as reliable narrators of what happens to our bodies (10).
Globally, it is estimated that twice as many men as women are dying from COVID-19. Although the reasons aren’t clear yet, some researchers speculate that this so-called COVID gender gap has to do with biological variables between male and female immune systems. “Something about being a woman is protective, and something about pregnancy is protective,” explained Dr. Sara Ghandehari, an intensive care physician at Los Angeles’s Cedars-Sinai hospital, “and that makes us think about hormones.” In an article for the New York Times, Roni Caryn Rabin revealed how doctors at Cedars-Sinai and the Renaissance School of Medicine, on Long Island, New York, have been conducting trials of the “female” sex hormones, estrogen and progesterone, on male and female COVID-19 patients. Both hormones are thought to have anti-inflammatory and protective immunological properties. Women, it’s assumed, have hardier immune systems than men do. The capacity of female biology to mount more robust immune responses is one possible explanation for why more women are diagnosed with autoimmune diseases. It’s also fairly intriguing to think that the very aspect of female biology that has exempted women from many clinical trials-our erratic hormones-is now being valued and marshaled to treat a virus more prevalent in males. The gender prevalence of COVID-19 has sparked a flurry of controversy and debate. Many people don’t believe that biological maleness is quite as straightforward a precipitating factor. Some have pointed out that men diagnosed with COVID-19 are dying given their social and lifestyle factors, including higher rates of smoking, rather than their essential biology. It seems the unerring focus on biological sex might actually hinder, rather than help, the emerging-and vital-understanding of COVID-19 and gender. “When in doubt, look to social factors first, not biology,” declared three women directors of the GenderSci Lab, at Harvard University, in a recent essay for the New York Times (12-13).
Part One: Ancient Greece-Nineteenth Century
8: Rest and Resistance
Earlier in the 1870s, an American neurologist named Silas Weir Mitchell had been busily concocting theories about the threat intellectual activities posed to “future womanly usefulness.” Mitchell thought coeducation ridiculous, and the possibility of girls receiving “masculine” education before the age of seventeen appalled him. “Nervous maladies,” in his opinion, were so endemic among American girls and women that even without education they were “physically unfit” to fulfill their duties as wives and mothers.
While working as a surgeon during the Civil War, Mitchell observed how nerve pain caused by bullet wounds exhausted the minds and bodies of soldiers, making them near hysterical. He devised a treatment of bed rest, a fat-heavy diet, massage, and electric muscle stimulation to restore depleted nerves. After the war, Mitchell suffered a breakdown and diagnosed himself with “neurasthenia,” a term made popular by American neurologist George Miller Beard in 1869 for nervous exhaustion exacerbated by the stresses of modern living. Although “neurasthenia” could affect both men and women, its causes were decidedly gendered. Men developed the condition by working too hard, while in women it was usually linked to domestic and family pressures, or the inevitable fallout of studying too hard when they should have been obeying the limits of their biological destiny. Mitchell treated his own bouts of neurasthenia, or “a rather nervous temperament,” as he put it, with “rest and recreation” in the 1860s and 1870s. But although he recognized that men and women alike benefited from physical rest to “cure” their addled minds and nerves, his fundamental belief in women’s physiological, mental, and social inferiority meant that his proposed treatment for them was more moral conditioning than medical care. After Mitchell turned his attentions to women’s nervous illnesses in 1873, he promoted his infamous “rest cure” as a two-birds-with-one-stone remedy for improving the delicate female constitution and making women toe the domestic line.
Mitchell insisted that women with nervous exhaustion and “hysteric” symptoms-especially if they were young, thin, and anemic-should be kept in bed for about two months, fed rich foods including raw beef soup and four pints of milk a day, massaged regularly, given electrotherapy, and forbidden any activity whatsoever apart from teeth cleaning. “Nothing is more common in practice,” he wrote in 1877, “than to see a young woman who falls below the health standard, and is tired all the time, by and by has a tender spine, and soon or late enacts the whole varied drama of hysteria.” For Mitchell, hysteria was nothing more than a litany of complaints dreamed up by pampered middle-class girls to perplex physicians and garner sympathy. His methods were designed to break an unwell woman’s resolve and make her snap out of her attention-seeking ways. “To cure such a case,” he advised, “you must morally alter as well as physically amend.”
Miss B, a “sturdy, handsome girl,” age sixteen, suffered convulsions, stomach problems, and limb paralysis before she entered Mitchell’s “care.” He considered her “a child who to be made well had to be calmly and firmly ruled.” Other girls apparently loved to play the good patient because they were flattered by Mitchell’s attention. Not Miss B. She was isolated at the Philadelphia Infirmary for Nervous Diseases, where Mitchell was lead physician, with one nurse to attend her. She was banned from using her hands for any reason, even to feed herself. She loved to knit, sew, and read, but all were forbidden. She hated milk and vomited after being made to drink it. “One or two scoldings, some show of disgust, and the promise that she would soon feed herself if she obeyed my wishes, helped us through this,” Mitchell wrote. He was not above force-feeding patients through the nose or rectum if they refused to eat. After a year of rest cure, Miss B was so weak she could barely walk with crutches. “This is what it means to treat hysteria,” he wrote. “There is no shortcut, no royal road.” Mitchell’s medical “expertise” consisted of humiliating and abusing girls and women. But his methods were deemed so effective that his popularity and eminence spread across Britain and America.
In 1892, Charlotte Perkins Gilman brought the rest cure to public attention through a short story in The New England Magazine. “The Yellow Wallpaper” is about a woman with severe depression whose mental health deteriorates further after she is confined by her physician husband to a gaudily wallpapered bedroom. For three months she is made to rest and abstain from all intellectual and creative activity. Her husband thinks nothing is wrong with her, save a “slight hysterical tendency.” “Bless her little heart!” he exclaims. “She shall be as sick as she pleases!” “The Yellow Wallpaper” reflected Gilman’s views about the deleterious effects of marriage on women’s bodies and minds. And it was inspired by her own experience of being subjected to the rest cure in 1887 by Mitchell himself.
After the birth of her daughter Katherine, in 1885, Gilman suffered “a growing melancholia . . . that consists of every painful mental sensation . . . utter weakness” and “a steady brain-ache that fills the conscious mind with crowding images of distress.” She couldn’t read, write, paint, talk, or listen. Pain consumed her mind. She held and nursed her daughter but couldn’t feel love. When Katherine was five months old, Gilman left her with her mother and a nurse and traveled from her home in Connecticut to visit friends in California. On returning home, the “dark fog rose again.” Her mother’s friend gave her $100 to “go away somewhere and get cured.”
Gilman had heard of Mitchell-“the greatest nerve specialist in the country”-and wrote to him explaining how desperately she needed help. “I am a teacher by instinct and profession,” she wrote. “I am a reader and thinker. I can do some good work for the world if I live. I cannot bear to . . . linger on this wretched invalid existence . . . There is something the matter with my head. No one here knows or believes or cares . . . but you will know.” Mitchell treated Gilman with the rest cure at the Philadelphia Infirmary, which she found “agreeable enough.” After a month he found nothing wrong with her. He sent her home with this prescription: “Live as domestic a life as possible. Have your child with you all the time . . . Lie down an hour after each meal. Have but two hours intellectual life a day. And never touch pen, brush or pencil as long as you live.”
Gilman obeyed Mitchell’s instructions for months. But soon she felt “perilously close to losing [her] mind.” “The mental agony grew so unbearable that I would sit blankly moving my head from side to side-to get out from under the pain,” she wrote. “Not physical pain . . . just mental torment, and so heavy in its nightmare gloom.” In the fall of 1887, she separated from her “devoted” and “loving” husband. “It was not a choice between going and staying, but between going, sane, and staying, insane.” Over the next years she continued to write and lecture, but she was exhausted by her “wilted nerves.” “To do anything . . . is incredible effort, as if trying to rise and walk under a prostrate circus tent, or wade in glue.” Her friends didn’t believe she was unwell because she seemed so capable; but how could they understand what she might have achieved if she hadn’t been so broken?
In “The Yellow Wallpaper,” the narrator’s husband threatens to take her to Mitchell if she doesn’t “pick up faster.” After the story was published, Gilman sent a copy to Mitchell, but he never responded. It wasn’t until 1902, when Gilman met Mary Putnam Jacobi, that she began to recover. Putnam Jacobi had developed a groundbreaking theory that hysteria, which she saw as a disorder of the nervous system, should be treated by stimulating patients’ senses and intellects and not by diminishing them with constant rest. Where Mitchell dismissed the reality and severity of Gilman’s mental illness, Putnam Jacobi listened, and believed her.
At the time, Gilman’s depression was so severe that she found it impossible to write. Over several months, Putnam Jacobi prescribed tasks to gradually restore her brain’s “capacity for action.” First, she built structures with kindergarten blocks; she read; within a few months she could write a little. “All this intelligent care helped me much,” she reflected in her memoir, in 1935. Years later, in an article titled “Why I Wrote ‘The Yellow Wallpaper,’” she explained that she wanted to reach wives and mothers who were vulnerable to punishing medical interventions, and to empower them to challenge their male physicians. “It was not intended to drive people crazy,” she wrote, “but to save people from being driven crazy, and it worked.” The rest cure had sent Gilman “so near the borderline of utter mental ruin that [she] could see over.” Her healing came from the “joy and growth and service” of writing, where she regained “some measure of power.” Today “The Yellow Wallpaper” is one of the most important and widely read texts for feminists arguing against medicine’s control over women’s bodies and minds.
Mitchell’s attitudes toward women and his treatments were horrendous. His rest cure became popular because it offered a solution to a problem that medicine itself had created. In his twisted way, Mitchell rightly questioned the validity of hysteria. By the late mid-nineteenth century, it had evolved into a spurious diagnosis for almost all pathologies of women’s bodies and minds. Mitchell described hysteria as “the nosological limbo of all unnamed female maladies” and argued that it should “be called mysteria for all its name teaches us of the host of morbid states . . . crowded within its hazy boundaries.” For a few years, gynecologists and physicians, especially in Britain, had been admitting that the term had become as unruly and undefined as the women it was meant to pathologize. In 1866, surgeon and anatomist Frederick Carpenter Skey announced that diagnosing “hysteria” was like trying to discern an “object floating in the sky . . . or an early star in the evening.” A few years later, Edward Tilt declared that hysteria had become a “‘will-o-the-wisp,’ misdirecting . . . attention from the real cause of nervous symptoms.”
Hysteria was losing its legitimacy as a diagnosis for physiological disorders, but this didn’t mean that the term was consigned to the historical wastebasket. Over hundreds of years, it had become a shorthand for aberrations of idealized femininity (116-20).