Georgia Poplett talks to author Elinor Cleghorn about her book Unwell Women, and explores the history, beliefs, and language surrounding the all-pervasive culture of medical misogyny in the West.
CW: This feature discusses sexual and medical violence.
September 1780. Military officer’s wife and socialite Peggy Shippen learns that her husband has betrayed the Revolutionary cause. “It was the most affecting scene I ever was witness to,” none other than Alexander Hamilton later wrote. “She for a considerable time intirely [sic] lost her senses [and] fell into a convulsion … We have every reason to believe she was intirely unacquainted with the plan.”
Shippen, of course, later professed herself the mastermind behind it all; a master spy in her own right, her hysterics were no more than a clever ruse. Part of the success of her deceit lay in historical understandings of hysteria, whose symptoms ran the gamut from hallucinations to fits to blindness, and which has arguably become one of the foremost cultural reference points for medical misogyny today – even going viral on Twitter from time to time.
Shippen evaded the noose by weaponising this vague and complex diagnosis within the broader framework of women’s place in the world, a mammoth history expertly chronicled by Dr Elinor Cleghorn in Unwell Women: A Journey Through Medicine & Myth in a Man-Made World. The book is a pathbreaking dissection of the hand that Western medicine has dealt women since the first womb wandered in the fourth century BCE.
Unwell Women initially grew out of Cleghorn’s experiences within the UK healthcare system after her 2010 lupus diagnosis, seven years after first noticing symptoms. “Once I had my diagnosis, it spun all this history of my body differently to me,” she says over Zoom. “I thought: well, yes, I did know what was happening, I was right, I did have correct intuition. It was this revisionist idea that I could look back through a different lens, and a different story could reveal itself.” The experience galvanised Cleghorn’s budding interest in medical history, having previously specialised in visual culture and women filmmakers in the first 50 years of cinema. “I started just literally Googling ‘lupus 19th century’,” she explains. “I found case studies of women who had lupus at different points in history, and I was just stunned by the similarities between [our] experiences.”
One particular case stuck with Cleghorn. Grace was an eighteen-year-old patient at the London Hospital – now the Royal London Hospital – in 1902, who had suffered from rheumatic symptoms, migraines, and mental health issues before finally being diagnosed with lupus. “She died after exactly the same symptoms that precipitated my own diagnosis. But yet she had been through about six years of pain that was clearly ignored or not acted upon.” Cleghorn reflects that, although medical science has moved on exponentially in the 120 years since Grace’s death, attitudes towards women’s pain have not. “It is a really important story to be told, about the history of medicine that zeroes in on these people whose bodies and experiences actually created knowledge. Because without a woman like Grace, they wouldn’t have produced the biomedical knowledge that then saved my life.”
While medical misogyny may have inadvertently saved Shippen’s neck, it spared others after the fact. Anne Greene was a twenty-two-year-old domestic servant when she was raped by her employer’s grandson in 1650. She became pregnant, miscarried, was convicted of infanticide under the Concealment of Birth of Bastards Act, and hanged. Within a few hours of being cut down, however, she was still alive. “The next morning,” Cleghorn writes in Unwell Women, “Anne could speak, drink and even laugh a little,” demonstrating a markedly better sense of humour than one might expect under the circumstances. Greene was subsequently pardoned.
These case studies scattered throughout Unwell Women form an integral part of the book, adding vital context and colour to a medicolegal history which otherwise risks impersonality. Crucially, too, Cleghorn holds the record to account by demystifying the euphemistic archival language of sexual violence. While the seventeenth-century legal transcript stated that Greene “consented to satisfy his unlawful pleasure”, Cleghorn swerves to correct it: “She was raped”.
This intersection of law and medical misogyny has always been a troubled junction. ‘Rape’ originates from the Latin raptus, meaning ‘seized’. Raptus became an umbrella term for all and any property crime in early Western legal history, firmly locating women’s bodies as men’s property, and setting a lamentable legal precedent which persists in rape cases even today. Medieval lawmakers further ruled that conception was impossible without a female orgasm which, by definition, precluded the possibility of rape. In the thirteenth century, the author of the treatise Fleta wrote, “Without a woman’s consent she could not conceive.” In 2012, Senator Todd Akin said, “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.”
Cleghorn notes how Akin’s words also eerily echo those of nineteenth-century gynaecologist Robert Lawson Tait: “No man can affect a felonious purpose on a woman, [because] you cannot thread a moving needle”. For Cleghorn, Tait’s appropriation of the language of textiles here to metaphorise violation is particularly striking. “That he was exploiting and abusing such a feminised image as needlework in the home – hand crafts, house crafts – was shocking.”
Elsewhere, Unwell Women further underlines the pressure points where language and medical misogyny meet. While pregnant, Cleghorn tested positive for the antibody anti-Ro, named for the woman it was first found in, a Mrs Robair. I was struck by the archive’s failure to record her own first name, and a prolonged Google dive on my part threw up no whisper of it. The parallels with Henrietta Lacks’s case are not lost on Cleghorn here. The HeLa cell line was originally cultured using a uterine tumour taken from Lacks during a biopsy, without her consent, without compensation, and without due recognition. “History is not a linear road to good,” Cleghorn adds. “Yes, there’s progress – but at what price? Who paid for this with their bodies and their lives?” As in so many cases, the semantic exclusion of the woman whose body underpinned the foundations of medical research trickled down into socioeconomics.
On a textual level, Unwell Women itself is full of powerful, gut-punch phrases, not least: “Female biology was regarded as reproductive first, human second”. Cleghorn parses murky medical language to excavate the meaning of a death ‘in childbed’ during the long nineteenth century, when 45.5% of all women between 20 and 29 years old died during or within six weeks of childbirth. The scholar and philanthropist Mary Wollstonecraft was one of them, after her physician “reached his hand inside her and extracted her placenta,” causing a fatal infection. For Cleghorn, that such a life could be snuffed out so rapidly, in such a preventable way, is “a haunting thing to think about.”
Her word choice here is telling. “Haunting encapsulates this notion of history casting a long shadow,” she explains. “When our culture denies or devalues women’s pain, we are haunted by antiquated ideas [and] mythologies about who women are, how they should live, what they should do with their bodies, which is really the root of things like hysteria … Hysteria has no basis in medical fact. It has no origin in the body. It’s a piece of language that served male physicians very usefully.” Its usefulness stemmed partly from the fact that it was “very expansive, and it could mean anything,” allowing male physicians to wield absolute authority over their female patients with more troublesome ‘personality quirks’, such as political engagement or intellectual ambition.
For Silas Weir Mitchell, American gynaecologist and Rest Cure inventor, if a woman’s “thoughts, desires, emotions and life choices were strictly policed,” then hysteria was “easily overcome”. Reading these words, I’m reminded of the 2021 #FreeBritney movement, which campaigned to release Britney Spears from an oppressive 13-year conservatorship overseen by her father. Comparably, the Rest Cure – like many medical treatments for women throughout history – positioned women as biologically infirm and mentally flammable by default. It preserved a patriarchal order by isolating women from meaningfully engaging in public life and encouraging an Angel-in-the-House existence. It was also prohibitively expensive, demanding women 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] banned from using her hands for any reason”. While well-to-do hysterics were banned from the workforce, working-class women had always formed a crucial part of it; they were therefore confined to state-run institutions, often subject to unimaginable abuses.
Hysteria, Cleghorn writes, became “a cultural leitmotif for feminine temperament unbound, untamed, unbidden”. It was not until the publication of Charlotte Perkins Gilman’s groundbreaking The Yellow Wallpaper that the devastating effect of the Rest Cure on women’s minds and bodies was truly made known. (Satisfyingly, Gilman sent a copy to Mitchell, but never heard back.) The history of women and medicine is almost inextricably bound up with the words used to contain it – and, crucially, whose words they are.
In the course of researching the book, Cleghorn gained “a really interesting insight into how these medical chaps were seen as authorities in wider culture around women’s behaviour.” Case studies in particular provided a valuable window into the characters of surgeons and gynaecologists, as well as their patients; as Cleghorn laughs, “They don’t half like to talk about themselves, those white guys!” She does an unerringly perfect impression of British bulldog cigar-puffery: “Of course [women] can’t go to work, they menstruate, rah-rah-rah!” Back in her own voice: “These men were looked upon to justify and endorse societal restrictions placed on women’s lives and ability to participate in public life, and they were often seen as the ultimate word.”
This ultimate word had drastic implications, enforcing a cishet, androcentric order which both fetishised and punished women’s biology. It was also a majoritively white order. The 1870s education debate – perhaps unwittingly – revealed the interlocking systems of oppression which underpinned this ideology: “Open the doors of your colleges to women, and you will accomplish the ruin of the Commonwealth,” one pundit raged.
Importantly, Unwell Women emphasises that the bodies of Black women and women of colour have paid a harrowing price for centuries of medical misogyny. The first gynaecological ‘operations’ were conducted in 1845 on three enslaved women – Anarcha, Betsey, and Lucy – by James Marion Sims. The women endured procedures naked, often on their knees, and always without anaesthesia (99). For Cleghorn, researching Sims’s brutal methods was by far the most emotionally affecting part of the writing process.
“He takes such pride in his cruelty,” she explains. “This is what is so violent about it: he didn’t see it as cruelty, because he didn’t regard [the] women that he experimented on as humans. To him they were nothing more than specimens, nothing more than objects. And so even in his writing he doesn’t afford them any humanity.” Stomach-turningly, Sims – like many other men throughout medical history – saw these women’s suffering only as a career-making opportunity. Cleghorn pauses before recounting one particularly awful episode, in which Sims mentions a woman screaming in pain. “You see a lot of this subtle, not-so-subtle violence in this writing by men about women’s experiences, but that was so explicitly violent and vicious that it was really hard to read and really difficult to write about.”
While no record of their experiences in their own words survives, Cleghorn stresses that we cannot look away from what Anarcha, Betsey, Lucy, and numerous other women endured at Sims’s hands. “It’s horrendous and it’s brutal but we have to think about it as these women created knowledge, and they need to be honoured. And if that violence is part of their story and part of restoring them to their place in the archive and given dignity, then that is an important part of this story to tell.” Sims’s cruelty partly leveraged off the back of racist ideologies which, Cleghorn writes, “echo insidiously through medical practice today”. A 2021 study found that Black women are four times more likely to die in pregnancy and childbirth than white women, with similarly chilling statistics for biracial and Asian women.
One of Unwell Women’s great strengths is that it does not shy away from these skeletons in medical history’s closet. Cleghorn exposes the eugenicist beliefs at the core of the UK and US birth control movements, highlighting how Puerto Rican women were experimentally prescribed the first Pill without their informed consent, and with a callous disregard for the potential risks. (One eugenicist and birth control campaigner, Katharine Dexter McCormick, referred to the women as “a cage of ovulating females to experiment with.”) In stark contrast, Cleghorn also illuminates the groundbreaking contributions of LGBTQ+ medical pioneers such as Dr Harry Benjamin, who implored other medical professionals to treat gender non-conforming patients. The fight for medical equity also owes much to the work of women of colour like Mary McLeod Bethune, whose labour goes unrecognised in many medical spheres, something which Cleghorn hopes Unwell Women goes some way to correct. Medical history, she explains, is so often whitewashed “in innovation after innovation, discovery after discovery, without the part of it that actually enables those discoveries which is human experience, human lives.”
Despite the progress of the last century since women won the vote, Cleghorn notes that we are not out of the gender bias woods yet. The suffragists, she writes, “were the modern-day scolds, the disorderly hags, the deviant witches”. The insults lobbed at many prominent nineteenth-century women are reminiscent of those used today: Megyn Kelly has “blood coming out of her wherever,” Greta Thunberg is “mentally ill,” Alexandria Ocasio-Cortez a plain old “fucking bitch”.
Gail Kern Paster builds on the cultural implications of this medical misogyny in her ‘Leaky Vessels’ theory, which points to the female ‘incontinence’ of early modern comedy; women necessitate patriarchal intervention by way of leaking, not only bodily fluids such as breastmilk and menstrual blood, but more dangerous substances like free speech and independent thought. It’s a culture we still see today in damaging and exaggerated PMS myths, for example. The fact that these stereotypes still carry weight is a cause for alarm, says Cleghorn. “Men in positions of political power articulating biological or pseudo-medical theories, as if this kind of biologically essentialist scheme is the ultimate form of knowledge, [sets] lots of very, very dangerous precedents.”
Correspondingly, Unwell Women has an urgency to it, as part of a growing body of evidence illuminating how recent debates have their roots in problematic (and often fundamentally incorrect) medical beliefs. US Supreme Court justice Amy Coney Barrett’s troubling voting record and the November riots following Poland’s near-absolute abortion ban both spotlight the terrifying real-life implications for women unable to access crucial healthcare. However, the present day also offers vital and previously inaccessible safe spaces for unwell women.
“Social media has created these really valuable communities for discussion, for solidarity, for information sharing and education,” Cleghorn says. “It mobilises unwell people to understand that they’re not alone, and that can mean so much.” She highlights particularly valuable channels such as endoQueer, which expands definitions of the experience of endometriosis, and Ache Magazine, which gives voice to unwell creatives. Cleghorn’s diagnosis was an isolating experience, with few resources available. Now, thanks in part to social media, a new culture around women’s health is emerging.
Increasingly, however, wellness culture ideology overlaps with right-wing conspiracy. “The common point is the denial of medical science,” Cleghorn explains. “People who sit in wellness camps think it’s because Big Pharma has a control over our lives and is making us sick and we need to return to often co-opted and appropriated forms of knowledge about bodies and medical culture in order to be well. And the other [denies] medical science because it’s a mechanism of political and social control. So they intersect really well, which means that within the wellness and health culture space, this sort of conspiracy information can really flourish.”
In some respects, wellness culture has enabled people to access the vocabulary to articulate their pain. But it operates along the same lines of exclusion which have characterised so much of medical history. “It’s a capitalist project,” Cleghorn confirms. “You need a lot of money to access that kind of regime … So it exempts 99% of the global population. And every human being should have access to being well, to being cared for.”
Wellness culture is particularly active on Instagram, where many subscribers engage with it via pseudo-psychiatric accounts almost unilaterally focused on the needs of white, wealthy, cishet women. Their content is dominated by sweeping soundbites about energy vampires and dark triad boyfriends. Perhaps most alarming is the rate at which serious mental health conditions are pronounced by online strangers: trolls are swift to diagnose ADHD, OCD, or BPD from a 140-character tweet.
Frustratingly, such slogans often contribute to undermine women’s credibility in the doctor’s surgery. “I worry about [wellness culture] exploiting that language,” Cleghorn says. “I really worry about terms like gaslighting. Gaslighting is … very real and very important. But there’s this tendency at the moment to pathologise everything, every experience [as] gaslighting.” Diagnostic language like this also locates the source of ill health entirely within Western medicine, ignoring other powerful factors at play.
For Cleghorn, wellness culture is a particularly complex issue; it can be compelling as “a branch of thinking or practise that purports to believe you and trust you.” It is distressing that conventional Western medicine does not always extend this approach. And, as Cleghorn knows, being able to advocate for your own health is a very personal matter.
“How well you can advocate for yourself depends on so many factors: your relationship to your illness or your pain, your feelings about being in a doctor’s surgery type situation, your ability or preparedness to put words around what you are experiencing, and your confidence in pushing, in asking again,” she explains. “We’re very socialised – especially women, especially marginalised people – to accept what we’re told by a patriarchal system of power [like] medicine.” Advocacy is further complicated by the structure of the NHS itself, as Cleghorn explains. “We don’t have a choice-based medical system. We have one that works incredibly well for very serious illnesses that need urgent treatment like cancers. We have an incredible response to injury and acute infection. We’re not very good at the chronic illnesses that sit in between these two models, that are impossible to cure, difficult to treat, hard to diagnose and very individuated and multi-symptomatic.”
Getting chronic illness recognised is further complicated by absurd time constraints. Appointment times have shrunk to just eight minutes in recent years. “How can you communicate potentially years of ill health in 8 minutes?” Cleghorn exclaims – let alone when you don’t have the vocabulary to accurately express your pain. She warns that one eight-minute appointment may be the first of many and suggests some simple, practical steps to have your pain acknowledged by a medical professional, such as a symptoms diary. You can also ask your doctor to write down what they say, and take somebody with you who makes you feel supported. Ultimately, however, Cleghorn stresses the importance of understanding that when it comes to medical professionals, “they do not on the whole want to hurt you. They don’t want to humiliate you, they don’t want you to leave the surgery in tears. That happens, and it happens too much, but the majority of GPs do not want that.”
Later in life, Charlotte Perkins Gilman wrote that part of her healing came from the “joy and growth and service” of writing. As a self-professed “ill historian,” was the process of writing the history of unwell women like herself similarly healing for Cleghorn, I wonder? In some ways, she says, yes. “It was healing in the sense that it made me understand that there is something really powerful and meaningful in being unwell.” Case studies involving unwell women in early 20th-century archives, Cleghorn found, “almost read as a profile of a character … I did feel real kinship with them. That was what was healing.”
Being unwell also gels with Cleghorn’s writing life; not only does it give her “a different way of seeing, different ways of thinking,” but it adapts to chronic illness on multiple, more practical, levels. “You can create your own methods and do what you love to do. There are limitations, of course, on your concentration, your energy; but it gives you something to live inside that’s very nourishing.”
Second only to her writing is Cleghorn’s reading life. Her book of the year is Nana Darkoa Sekyiamah’s The Sex Lives of African Women, which collates first-hand experiences of sex and sexuality from African women and nonbinary people across the diaspora, and of which she is in “complete awe”. Her other recommendation is Saidiya Hartman’s Wayward Lives, Beautiful Experiments. “Wayward Lives kind of lives by my bedside,” she says, calling it “a kind of forever book.”
A ‘forever book’ is what I think of when it comes to Unwell Women, too. It is a staggering work of scholarship that draws back the curtain on some of the most harrowing asides of medical history, giving sorely overdue recognition to the women and marginalised individuals who suffered in the creation of knowledge. It is not only an essential cultural touchstone, but a rallying cry for women well and unwell alike.
“This medical stuff is difficult,” Cleghorn acknowledges. The history of sickness can be sickening. But if we can learn anything from the experience and endurance of unwell women, it is that your body is always your own. “Keep going, keep persisting,” she urges. “And remember … nobody can speak for you and your experiences in the way that you can. Nobody has the right to nullify or negate what you feel.”
Unwell Women: A Journey Through Medicine and Myth in a Man-Made World by Elinor Cleghorn is published by Weidenfeld & Nicholson, and is available to order online.
Georgia Poplett and LucyWriters would like to extend their warmest thanks to Dr Elinor Cleghorn for her time, knowledge, and generosity in this interview.
Feature image courtesy of Elinor Cleghorn.
About Georgia Poplett
Georgia Poplett is a former bookseller, publisher, writer and PhD candidate in Creative Writing and Medical Humanities at Durham University. Originally from Kent, she now lives in Southwest London. Her research considers the implications of birth trauma and postpartum psychosis in the contemporary Gothic. She is currently working on her first novel. Follow Georgia on Twitter @GeorgiaPoplett.
This feature was commissioned as part of our latest mini-series, Our Body’s Bodies
Everything is written on the body – but what does it mean to write about our bodies in the era of Covid-19? And is it possible to write about bodily experiences in the face of such pervasive and continued violence? Using different modes of writing and art making, Lucy Writers presents a miniseries featuring creatives whose work, ideas and personal experiences explore embodiment, bodily agency, the liberties imposed on, taken with, or found in our bodies. Beginning from a position of multiplicity and intersectionality, our contributors explore their body’s bodies and the languages – visual, linguistic, aural, performance-based and otherwise – that have enabled them to express and reclaim different forms of (dis)embodiment in the last two years. Starting with the body(s), but going outwards to connect with encounters that (dis)connect us from the bodies of others – illness, accessibility, gender, race and class, work, and political and legal precedents and movements – Our Body’s Bodies seeks to shine a light on what we corporally share, as much as what we individually hold true to.
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