Hysterical. Melancholic. Has the "baby blues". Neurotic. Hormonal. Complaining. Hypochondriacal. Nervous. Loose. Maladjusted. Emotional. Anxious. Obsessive. Psychosomatic. Fragile.
Since the dawn of medicine, labels such as these have been slapped upon women in (often lazy) attempts to explain away their symptoms. If you are a woman, chances are you have been described by at least one of these terms, probably more, during the course of your life. I know I have.
About a year ago, I was listening to an episode of the podcast Breaking Down Patriarchy, where the host (Amy McPhie Allebest) and her guest were discussing the issue of the dismissal of female patients in medicine. They were having a conversation over a new book called Unwell Women by a Dr. Elinor Cleghorn of Oxford. I had never heard of this book nor of Elinor Cleghorn, but I had certainly experienced this dismissal firsthand on a plethora of occasions. As the episode went on, I found myself feeling increasingly validated in my own personal encounters within the medical community. I had to read this book!
It wasn't until many months later that I got my hands on a copy. I dove right into it and very soon discovered that I was far from alone in my mistreatment and misdiagnoses. From Hippocrates of Kos -the "father of medicine" himself- we get the oath sworn by all physicians to this day to "do no harm". Conflictingly, in The Hippocratic Corpus (medical discourse based on the teachings of Hippocrates), physicians and followers seem to attribute all women's diseases to their reproductive functions. After all, in ancient Greece, what other purpose did women serve beyond the reproductive and domestic spheres?
In Unwell Women, Dr. Cleghorn takes us on a medical journey from this point in history up to the present day (publication 2021), seamlessly weaving both anecdotal evidence and statistics to paint a picture of "misdiagnosis and myth in a man-made world". It truly is an unbelievable trip: from the "wandering wombs" of ancient Greece to the sadistic torturing of women bearing a "witches mark" (ex: blemishes such as scars, moles, birthmarks, warts, pocks, etc.); from the sickening experimentation on enslaved women in the American South, to the complete dismissal of a woman's cry for help as she experienced acute postpartum depression; from the non-consensual sterilization of women of color, to the equally non-consensual lobotomies of women who "didn't behave". Since there have been women, there has been medical discrimination, often with unspeakable consequences.
Throughout the book, Cleghorn returns time and again to the theme that "medicine must hear unwell women when they speak -- not as females weighed down by the myths of the man-made world, but as human beings". She argues "patriarchal ideologies have clung insidiously to medical culture, practice, and knowledge. The health and lives of all unwell women today are profoundly affected by this historical mythologizing. It's there when our pain is minimized, our symptoms dismissed, our illnesses and diseases misdiagnosed, and our own bodies and voices distrusted". The histories that she shares are both mind-blowing and heartbreaking.
So many of the common "women's ailments" that we hear of today are under-researched, leading to the dismissal of their symptoms as anxiety, psychosomatic, or even hypochondriacal. Endometriosis, cystic fibroids, fibromyalgia, and lupus, rank high among these enigmatic diagnoses. Autoimmune diseases -such as Multiple Sclerosis- serve as comprehensive examples of the gender bias so pervasive in modern medicine. Today, we know that MS is three to four times more common in women than in men. Yet "medicine assumed, for most of the late nineteenth and early twentieth centuries, that MS predominantly affected men. Of course, this was a misapprehension caused by medicine's insistence that men's neurological and motor symptoms were deserving of diagnostic attention, while women, with their delicate female nerves, must be manifesting such symptoms in their minds. Gender bias still affects diagnoses of MS. The disease begins with nonspecific symptoms that relapse and flare, including pain, fatigue, and muscle weakness, and it can be incredibly difficult, and long-winded, for sufferers to be correctly diagnosed. Women with MS are particularly vulnerable to having their 'unexplained' pain and neurological symptoms misdiagnosed as somatization disorder, a mental illness manifesting in physical symptoms for which no cause can be found".
Perhaps the most disturbing example that Cleghorn provides is that of heart disease. "In the mid-1980s, it was revealed that women were more likely to die from heart diseases than men. Too often, this was because their diseases were misdiagnosed -- and even completely overlooked. By 1989, heart diseases were the leading cause of women's deaths in the US and UK. And many were dying because they were not presenting the typical chest and left-arm pains of the male 'Hollywood heart attack'. Studies have since found that women often have no chest pain at all but rather referred pain in their stomachs, neck, and shoulders. The onset of a heart attack in women is often accompanied by nausea, fatigue, and breathlessness, symptoms that were historically dismissed as emotional and hysterical. Angina is more likely to be written off as 'nonspecific chest pain' in women. Chest pain, by the way, along with palpitations, dizziness, and difficulty breathing were all labeled 'hysteric' in the early somatization criteria".
We have come a long way in medicine since the times of leeches and blood-letting. Even Dr. Cleghorn acknowledges that medicine saved her own life. For those of us who have been belittled, infantilized, dismissed, berated (yes, it happens), butchered, humiliated, gaslit, or sent away in tears (I can say yes to all of those...) this book is perhaps the most validating thing we could read. It covers a lot of ground, far more than I could hope to even mention briefly in this review but, for only 321 pages, it is densely packed with impressive and exhaustive research. While I can't say that I am in complete agreement with everything Cleghorn presents, she hits the nail right on the head when it comes to women needing to be heard by their physicians. Sadly, I know all too well that this is not the case for many of us and feel that Unwell Women is a book that every person -woman or man- should read.
Cleghorn ends her book this way, and I'd like to follow her lead: "To paraphrase the great Maya Angelou, when a woman tells you she is in pain, believe her the first time".
