Elinor Cleghorn - Unwell Women: A Journey Through Medicine and Myth in a Man-Made World

We are taught that medicine is the art of solving our bodys mysteries. And we expect medicine, as a science, to uphold the principles of evidence and impartiality. We want our doctors to listen to us and care for us as people. But we also need their assessments of our pain and fevers, aches and exhaustion, to be free of any prejudice about who we are. We expect, and deserve, fair and ethical treatment regardless of our gender or the color of our skin. But here things get complicated. Medicine carries the burden of its own troubling history. The history of medicine, of illness, is every bit as social and cultural as it is scientific. It is a history of people, of their bodies and their lives, not just of physicians, surgeons, clinicians, and researchers. And medical progress has not marched forward just in laboratories and benches, lectures and textbooks; it has always reflected the realities of the changing world and the meanings of being human.

Gender difference is intimately stitched into the fabric of humanness. At every stage in its long history, medicine has absorbed and enforced socially constructed gender divisions. These divisions have traditionally ascribed power and dominance to men. Historically, women have been subordinated in politics, wealth, and education. Modern scientific medicine, as it has evolved over the centuries as a profession, an institution, and a discipline, has flourished in these exact conditions. Male dominanceand with it the superiority of the male bodywas cemented into medicines very foundations, laid down in ancient Greece. In the third century BCE, the philosopher Aristotle described the female body as the inverse of the male body, with its genitalia turnd outside in. Women were marked by their anatomical difference from men and medically defined as faulty, defective, deficient. But women also possessed an organ of the highest biologicaland socialvalue: the uterus. Possession of this organ defined the purpose of women: to bear and raise children. Knowledge about female biology centered on womens capacityand dutyto reproduce. Being biologically female defined and constrained what it meant to be a woman. And being a woman was conflated with, and reduced to, the female sex. Medicine validated these social determinants by constructing the myth that a woman was her biology; that she was ruled by it, governed by it, at the mercy of it. Womens illnesses and diseases were consistently related back to the secrets and curiosities of her reproductive organs. The mystical uterus influenced every conceivable disorder and dysfunction of her body and mind. And ever since, medical knowledge about womens susceptibility to illness and disease has been shaped and distorted by prejudiced beliefs that possessing a uterus defines our inferior position in the man-made world.

Of course, not all women have uteruses, and not all people who have uteruses, or who menstruate, are women. But medicine, historically, has insisted on conflating biological sex with gender identity. Over centuries, medical knowledge about the organs and systems marked female have been imbued with patriarchal notions of womanhood and femininity. As medicines understanding of female biology has expanded and evolved, it has constantly reflected and validated dominant social and cultural expectations about who women are; what they should think, feel, and desire; andabove all elsewhat they can do with their own bodies. We understand, today, that our biology does not determine our gender identity. For centuries, feminism has fought for the rights of all people to not have their lives limited by their basic biology. But 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.