Unwell Women

Elinor Cleghorn, a cultural historian diagnosed with the autoimmune disease systemic lupus erythematosus (SLE), traces how Western medicine has pathologized the female body across more than two thousand years. She argues that since its foundations in ancient Greece, medicine has absorbed and enforced patriarchal gender divisions, treating the male body as the standard and defining the female body as "faulty, defective, deficient" (2). These centuries of myth, she contends, persist today as biases that delay women's diagnoses, dismiss their pain, and endanger their lives, with consequences compounded for Black women and other women of color.

The book opens in antiquity, where Hippocrates, known as the father of medicine, revolutionized patient care by rejecting superstition and inventing the case study. Yet his followers attributed virtually all women's illnesses to the uterus. Because human dissection was prohibited, ancient physicians lacked knowledge of organ placement or blood circulation. They concluded that women's bodies were excessively wet because women menstruate and prescribed marriage, intercourse, and pregnancy as cures for the uterus that allegedly wandered through the body causing convulsions and suffocation. As Christianity spread, the myth of Eve's original sin fused with these medical ideas, intensifying the association of women's bodies with contamination.

Cleghorn highlights exceptions such as Soranus of Ephesus, who rejected the wandering womb theory and recommended humane treatments, and the twelfth-century physician Trota, who authored practical guides in Salerno. By the fourteenth century, however, women were barred from practicing medicine across Europe. After the bubonic plague devastated Europe in 1346, superstitions about women escalated into accusations of witchcraft. Dominican inquisitor Heinrich Kramer published the Malleus maleficarum (The Hammer of Witches) in 1486, declaring that women who transgressed social boundaries should be executed. An estimated forty-five thousand people were executed for witchcraft during the sixteenth and seventeenth centuries, roughly 80 percent of them women. At the 1602 trial of Elizabeth Jackson, a woman accused of bewitching a shopkeeper's daughter, physician Edward Jorden argued that symptoms attributed to demonic possession stemmed from a natural disease of the uterus, but even this explanation reinforced the belief that women were inherently more susceptible to illness.

Renaissance anatomists mapped the female body through dissection, yet their interpretations remained patriarchal. Andreas Vesalius published the first illustrated anatomy in 1543 but depicted female genitalia as inferior inversions of male anatomy and neglected the clitoris. Cleghorn notes that the clitoris was misrepresented or omitted from anatomical literature until 2005, when Australian urologist Helen O'Connell revealed its full internal structure. In the seventeenth century, neurologist Thomas Willis proposed that women's symptoms arose from disorders of the nerves rather than the uterus. Yet Thomas Sydenham, Willis's contemporary, declared hysteria the most common chronic condition of the age, affecting nearly all women because of their "finer and more delicate constitution" (65). Mary Wollstonecraft challenged such views in her 1792 A Vindication of the Rights of Women, arguing that women's weakness was cultivated by social subordination. She died in 1797 of puerperal fever, a postpartum infection whose causes remained poorly understood until Hungarian physician Ignaz Semmelweis discovered that handwashing reduced infection rates.

The nineteenth century brought intensified debates over women's pain. Cleghorn recounts J.S., who endured pelvic pain for nearly fifty years; her posthumous autopsy revealed an abscess, tumor, and cyst, yet her physician attributed her suffering to her emotions. Racist hierarchies of pain became entrenched: US physician James Marion Sims developed surgical techniques by experimenting on enslaved women without anesthesia while reserving newly available pain relief for white patients. Victorian gynecologists pathologized female sexuality. Isaac Baker Brown performed clitoridectomies, the surgical removal of the clitoris, claiming masturbation caused paralysis and death; the Obstetrical Society of London expelled him in 1867 for operating without patients' consent. Meanwhile, menstruation became the primary justification for restricting women's education and careers. Boston physician Edward Hammond Clarke argued in 1873 that academic study caused menstrual disorders. Physician and researcher Mary Putnam Jacobi won the 1875 Boylston Medical Prize for proving that menstruation did not impair the female brain. Writer Charlotte Perkins Gilman underwent neurologist Silas Weir Mitchell's "rest cure" in 1887 and wrote "The Yellow Wallpaper" (1892) to expose its cruelty.

The suffrage movement directly confronted medicine's role in women's subordination. The Seneca Falls Convention of 1848 launched the organized women's rights movement in the United States, and abolitionist Sojourner Truth declared "I am a woman's rights" (127) at the 1851 Akron convention. Truth later spoke in 1867 about the exclusion of Black women from the broader movement. As campaigns escalated in Britain, the press labeled suffragists "hysterics," and from 1909, imprisoned hunger strikers were forcibly fed through rubber tubes. Campaigns for reproductive freedom became entangled with eugenic ideologies: Margaret Sanger opened the first American birth control clinic in Brooklyn in 1916, while Marie Carmichael Stopes opened Britain's first Mother's Clinic in 1921. Both women's legacies are complicated by their support for eugenic sterilization.

The discovery of hormones in the early twentieth century reframed femininity as a biochemical condition. Gynecologist William Blair Bell argued in 1916 that a woman with properly balanced secretions desired nothing beyond a husband and children. Anne Louise McIlroy, the first woman to earn a doctor of medicine degree from the University of Glasgow, challenged this fixation by showing that ovarian secretions affected women's broader metabolic health. She had served as a surgeon in World War I after the War Office told Scottish Women's Hospitals founder Elsie Inglis to "go home and sit still" (176). Physician Clelia Duel Mosher studied over 3,350 menstrual cycles, proving menstruation was a normal function, and showed that constrictive clothing, not anatomy, prevented women from breathing deeply. Physician Robert Frank defined "premenstrual tension" in 1931, describing one patient as an "unbearable shrew" (205) and attributing premenstrual symptoms to excess hormones.

Wartime pronatalism, the pressure on women to bear children for the state, further disciplined women's bodies. Physician John Sampson coined "endometriosis" in 1927 for a condition in which uterine-like tissue grows outside the uterus, causing chronic pain. Harvard gynecologist Joe Vincent Meigs framed the disease as a consequence of delayed marriage. In the postwar era, immunologists discovered the LE cell, a lupus-linked immune marker, in a patient's bone marrow, providing the first biomedical proof of autoimmunity. Studies revealed that many women falsely diagnosed with syphilis had undiagnosed SLE, with some subjected to electroshock therapy or lobotomies for psychiatric symptoms caused by their autoimmune disease.

In the 1950s and 1960s, tranquilizers were marketed to housewives, and Robert Wilson's Feminine Forever (1966) claimed menopause was preventable through Premarin, an estrogen drug derived from pregnant mare urine. Wilson's book was later revealed to have been funded by its manufacturer. The FDA approved the first hormonal birth control pill in 1960, but its initial large-scale trial was conducted on women in Puerto Rico who were not informed they were test subjects. Journalist Barbara Seaman's exposé inspired 1970 congressional hearings disrupted by feminist activists demanding transparency about side effects.

The women's health movement of the late 1960s and 1970s transformed medical culture. The Boston Women's Health Collective published Our Bodies, Ourselves (1970), empowering women to learn about their own anatomy and health. The Jane Collective in Chicago helped women obtain safe abortions before Roe v. Wade (1973). In Britain, the Organisation of Women of African and Asian Descent protested the disproportionate administration of the contraceptive Depo-Provera to African, Caribbean, and Asian women. Byllye Avery launched the National Black Women's Health Project in 1981. A 1977 FDA policy had excluded women of childbearing potential from clinical trials after diethylstilbestrol (DES), a synthetic estrogen, was found to cause cancer in patients' daughters. Dr. Bernadine Healy, the first female chair of the National Institutes of Health (NIH), coined "Yentl syndrome" in 1991 to describe how women received adequate care only when their diseases mirrored male patterns. The 1993 NIH Revitalization Act required inclusion of women in all federally funded research.

Cleghorn's personal narrative threads through the book. She recounts experiencing unexplained pain beginning in 2002, which doctors attributed to "just your hormones" (307). During a 2008 pregnancy, her baby was found to have congenital heart block, a condition in which the heart's electrical signals are disrupted. The cause was the anti-Ro antibody, an autoimmune marker that had crossed her placenta and damaged her baby's developing heart. Weeks after giving birth, Cleghorn was hospitalized with fluid engulfing her heart. After seven years of dismissed symptoms, a rheumatologist finally diagnosed her with SLE. She concludes that "the lives of unwell women depend on medicine learning to listen" (321).