Friday 8 March 2024

Book Review: Unwell Women, Elinor Cleghorn

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Cleghorn’s acclaimed exploration of the gender inequalities in the medical sphere is a fascinating, horrifying read. The period covered is broad but we see how there is still such a long way to go. For many centuries women were excluded from medicine, healers and midwives were burnt as witches, ostracised and their knowledge ignored, to the detriment of the women they were helping. Female experience of pain has repeatedly been dismissed, more weight being given to the opinion of male ‘experts’. Symptoms have been brushed aside as hysterical or all in the patient’s head. To this day, women are more likely to be prescribed anti-depressants than painkillers. Men don’t have the same problem. 

Keeping women from knowledge about their own bodies led to centuries of embarrassment and misunderstanding. The sexual revolution allowed women to have the words to describe what they were experiencing, and to feel ownership over their bodies. In the nineteenth century it was particularly common to carry out procedures on women without their knowledge or consent. Clitoridectomies were common, with Isaac Baker Brown being their most enthusiastic practitioner. He believed that female masturbation was the cause of many health issues, and clitoridectomy would be the cure. His barbaric surgery was carried out on women we would now recognise as suffering from the likes of endometriosis, epilepsy, or MS. Naturally, it wasn’t successful. Even at the time his practice was considered barbaric, he drew the line only at operating on girls under the age of ten(!) but performed huge numbers of operations on women and girls who hadn’t consented. The other side of this was that girls and women who had been raped were also subjected to this ghastly procedure, indicating the social view that the blame landed squarely with them. As with many of the practices described in the book, the ‘treatments’ were not really designed to help those suffering, but to control them, ultimately making their lives harder.

Control was also wielded in sterilisation practices. Forced sterilisation was legal in the US from 1907 and it led to young women under the age of 18 who were suffering with mental illness or epilepsy being sterilised. Again, it was also used on those who had been victims of sexual assault. There were racist undertones to forced sterilisation, with women of colour being subjected to it in far higher numbers. It is sad that the rise of birth control, ostensibly a positive move for women, giving them more control over their reproductive rights, was turned against them to such a horrifying degree. Cleghorn does not shy away from the racial disparities in the treatment women receive, with worse outcomes much more likely in maternity care for women of colour. She explores the history of racism in medicine, discussing the horrific experiences enslaved women endured as they were experimentally operated on repeatedly without anaesthesia. Only recently has the misconception that people of some ethnicities have a much higher threshold for pain been questioned. 

In a sea of shocking tales of mistreatment and abuse, one that stands out is the prevalence of lobotomies in the twentieth century. Again, used as a form of control for any woman who didn’t conform to the happy housewife image that was considered their natural state. There was no argument that it would cure their ailments, merely that it would sever the emotional tie. The measure of success was how obediently they went back to their domestic roles. Sadly, many women became suicidal as a result of this barbaric practice, and even those who didn’t would often die within a few years of the surgery. A truly chilling practice that is hard to believe was ever sanctioned.

This is a well researched book which covers a lot but acknowledges what has been omitted. If you are an unwell woman struggling through the healthcare system it might help you feel less alone, but also acutely aware of the need to persist and be your own advocate. Having studied some medical history, especially related to mental health, during my undergraduate studies, a lot of what was included was familiar, yet still shocking. Cleghorn draws out the voices of women who were silenced in their own time and highlights the sacrifices of the past which have brought us as far as we have come now. Essential, albeit difficult, reading.

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