Conversations: Elinor Cleghorn
SYNOPSIS
In the last few years, the medical profession has been grappling with the problem of gender bias in medicine, with how the symptoms of women are seen as atypical, or worse, are minimized, dismissed or ignored. But where did this problem come from? How far have we come and where should we go from here?
In this episode, Emily discusses these questions and more with Dr. Elinor Cleghorn, author of Unwell Women: Misdiagnosis and Myth in a Man-Made World.
LISTEN
GUEST
Elinor Cleghorn, PhD, is a freelance writer and researcher with a background in feminist culture and history. Her critical writing has been published in several academic journals, including Screen. Her fiction debut, Unwell Women, was published in June 2021. She lives in Sussex, UK.
CREDITS
Hosted by Emily Silverman.
Produced by Emily Silverman and Jon Oliver.
Edited and mixed by Jon Oliver.
Original theme music by Yosef Munro. Additional music by Blue Dot Sessions.
The Nocturnists is made possible by the California Medical Association, the Patrick J. McGovern Foundation, and people like you who have donated through our website and Patreon page.
TRANSCRIPT
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The Nocturnists: Conversations
Emily in Conversation with Dr. Elinor Cleghorn
Episode Transcript
Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.
Emily Silverman
You’re listening to the Nocturnists: Conversations. I’m Emily Silverman. In the last few years, the medical profession has been grappling with the problem of gender bias in medicine, with how the symptoms of women are seen as atypical, or worse, are minimized, dismissed or ignored. But where did this problem come from? How far have we come and where should we go from here? That is the subject of Dr. Elinor Cleghorn's book, Unwell Women: Misdiagnosis and Myth in a Man-Made World. Elinor is a freelance writer and researcher with a background in feminist culture and history. Her critical writing has been published in Screen and other academic journals. She's given talks and lectures at the British Film Institute, Tate Modern, and ICA London, and has appeared on the BBC Radio 4 show, The Forum. Her creative writing about her experience of chronic illness was shortlisted for the Fitzcarraldo Editions Essay Prize in 2017. And her nonfiction debut, Unwell Women, was published in June of 2021. She lives in Sussex in the United Kingdom. Before we spoke, I asked Elinor to read an excerpt from her book. Here is Elinor.
Elinor Cleghorn
"We are taught that medicine is the art of solving our body's 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 just marched forward 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 dominance—and with it the superiority of the male body—was cemented into medicine’s 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 "turn'd outside in." Women were marked by that anatomical difference from men and medically defined as faulty, defective, deficient. But women also possessed an organ of the highest biological—and social—value: the uterus. Possession of this organ defined the purpose of women: to bear and raise children. Knowledge about female biology centered on women's capacity—and duty—to 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. Women's 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 women's 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."
Emily Silverman
Thank you for the reading. And thank you, Elinor, for being with me today.
Elinor Cleghorn
Thank you so much for having me.
Emily Silverman
So, I have to tell you, I learned so much from this book. Even though I am a woman and even though I am a physician, I didn't know a lot of this history. So, I have to admit, I was disturbed by how deep and ancient a lot of this sexism is. I would love to hear a bit from you about what inspired you to write this book.
Elinor Cleghorn
Of course. I was diagnosed in 2010 with the most common form of the autoimmune disease called lupus. And before my diagnosis, I'd spent about eight years in pain. And this pain would wax and wane. It was in my joints. It would flare up my ankles and my knees. I had migraines, photo sensitivity, and mental health issues associated with being in pain for so much of the time. But every time I went to my doctor, my GP, to try to find answers for this pain, I was usually dismissed as being hormonal, or as being anxious, or work-stressed. Sometimes, presumptions were made about my lifestyle. Other times I was accused of being pregnant and not knowing. And I was never referred for further diagnostic tests and my pain was never taken seriously enough to warrant any further investigation. So, over the years, I internalized this idea that I was effectively an hysterical woman, that I was paying too much attention to my body, that I was conjuring symptoms in my mind. And my diagnosis was a real vindication and validation of my knowledge about my body, my intuition about my own pain. And I was a historian at the time I was diagnosed with lupus—I was working on my PhD thesis, where I was looking back through cultural history and uncovering hidden aspects of the lives of some women film artists. And I started to mine the annals of medical history to find out more about lupus—to find out why we still knew so little about it, why it was so difficult to diagnose, and also to try and establish why so many more women and people born female, got autoimmune diseases. 90% of sufferers of lupus are female. And these were the kinds of questions that my physicians and consultants couldn't answer. They could medicate me and cat for me, and save my life. But they couldn't answer what I thought were really fundamental questions about the disease. So, I looked back. And when I looked back, I found women like myself, across the centuries. I found one from 1902—a young woman who very unfortunately died of lupus of the same symptoms that I had had that triggered my diagnosis, which was pericarditis—fluid around my heart. And she had also endured about six years of misdiagnosed and dismissed pain. And I felt real kinship with these women that I was finding it usually in medical studies and case reports. And I felt as if we were a community of unwell women across history, and that there was something to be learned from those histories. And so, over the years since my diagnosis, I expanded my searching to look at histories of other conditions related to gynecological organs. And I built up this sort of picture of dismissal, denial, doubt, but also knowledge blind spots that seemed to be masked by strange stereotypes and mythologies about women's bodies.
Emily Silverman
Thank you so much for sharing your personal story with me just now. And also, in the book, you save it for the end of the book, and it just hits so much harder after reading all the history. And a lot of the themes that came up in this book are personal to me, too. I lived a life of pretty painful cramps. And then when I was in my medical residency, the symptoms really exploded. And I spent a year with a lot of pelvic pain. And as a physician myself, went to, say, five or six different doctors and dealt with a lot of the same issues that you described. And came out of it feeling incredibly shamed and unsure and didn't trust myself and ultimately ended up having surgery and getting the diagnosis of endometriosis. So, it was personal for me too. And I'm sure many of the people listening have themselves gone through an experience like this or know somebody who has. I do want to bring it all the way back to ancient Greece, because that's where you start. And you talk about this concept of the wandering womb. And it's actually a literal term—physicians back then believed that the uterus could travel to different parts of the body and wreak havoc on different organs. So, tell us a little bit about the wandering womb, and, specifically, this obsession that men had with the uterus.
Elinor Cleghorn
It actually was a condition that was documented and talked about in some of the earliest foundational tracts on human illness and healing. So, I begin Unwell Women in the time of Hippocrates, who we know today, because our physicians swear a form of the Hippocratic oath—to, first, do no harm. And, of course, the ancient Greek physicians were embedded in a very patriarchal society. And the difference between men and women was really defined often by what men and women did socially. So, men worked and were physical, and were strong, and women were reproductive and built for conception and pregnancy. And this really influenced how these physicians thought about how the bodies worked. So, when it came to thinking about women's illnesses, the Hippocratic writers understood that women's bodies were different. The people marked female had different kinds of organs, and that they also had different understandings of their bodies. But ultimately, they understood that women needed a different kind of healing and a different approach to medical care. But, unfortunately, that sort of ethical thinking is really where it ends, because women were primarily reproductive, the Hippocratics thought a lot about the uterus, about the womb. And it made sense to them that when a woman was conceiving, or when she was pregnant, or when she was having marital sex, that the uterus was being furnished with the right kind of moisture—that it was able to be healthy. And of course, pregnancy was imagined to be pretty much the healthiest state for a woman to occupy. And so, when they were thinking about the cause of different symptoms that women might exhibit—so, those could include fevers, choking sensations in the throat, chronic pain, convulsions, many different symptoms—these were often mapped onto what was happening with the uterus. And they really did believe that if a woman was not having marital sex, she was not pregnant, she was not conceiving, that her womb would sort of shrivel and, in search of moisture, would start to kind of roam up the body towards the other organs like the heart and liver, where it would suffocate them and compress them and start causing this raft of terrible symptoms. And this physiological notion that the womb could wander, was then taken off in poetry by Plato and in theories by physicians like Aretaeus, where it was kind of manipulated into being this, this creature, this animal within an animal—roaming around with all these sort of appetites and impulses of its own. Because what it basically hungered for, above anything else, was marital sex and pregnancy. So, there was such a primacy of this idea that the uterus, this highly precious organ that performed this service, had a kind of control over the woman and could exert its influence almost anywhere in her body. So that's where the obsession comes from. It's both a genuine physiological fascination and also a sort of mode of cultural and social control.
Emily Silverman
Sticking with the ancient history of this, you talk about myths from literature and religion, including the stories of Pandora and Pandora's box, and the story of Adam and Eve, and how they were the seeds of a lot of these sexist narratives. Talk to us about that. How do those myths flow into medical history?
Elinor Cleghorn
So, the ancient Greeks wrote all these foundational tracts and established a lot of understanding that was very influential over the centuries. So, after the fall of Rome, and with the rise of Christian theology around Europe, it was really the church—monks, churchmen who were allowed to possess this knowledge and the deeply misogynistic and patriarchal conditions of the early Middle Ages. And so, when they were retranslating this material from ancient times, they were re-spinning it in light of new myths. And many of those myths were laid out in biblical stories and theological ideas about women being the source of sin. So, in the sort of 13th-14th century, there was a lot of deeply misogynistic material written about women's bodies that really took women to be potentially defiling, potentially corruptive, potentially poisonous, because they all held this potentially simple biology. So, it was very easy for these myths to be manipulated into biological theories. Because these religious chaps were the ones who were doing the writing and the ones who are owning the material. And one of the sources of much mythologizing and fantasizing about the dangers and deficiencies of women's bodies was to do with menstruation. And menstruation was a defiling substance. It crossed boundaries. Women weren't supposed to bleed and survive, right? So, this was the source of some of the attitudes that then set the stage for events like the witch trials, or the accusations of women for acts of witchcraft that happened across Europe between the 15th and 17th centuries. So even though medical knowledge didn't cause the witch trials, or make society believe that women could actually consort with devils, it definitely contributed to a culture and climate of intense suspicion and intense stigma around what the dirty mess of women's bodies and organs could make them capable of. I mean, it's like the earliest possible version of “women can't be presidents because they press the big red button when they…” Women… it's kind of that idea that we're uncontrollable, because we're full of blood.
Emily Silverman
These ties from the religious myths, to these ideas about women in their bodies, is so interesting. And I was talking to my husband about it, and he pointed out that a lot of religious gods, their birth stories, avoid the topic of sex and vaginas altogether. So, he was saying to me that the goddess Athena is born out of Zeus’ head. Adam and Eve are made from the earth. Buddha was born out of his mother's side. Venus is born from the sperm of Kronos’ severed testicles, which fall into the ocean. Jesus, even, we’re told, was born without sex. So, what do you make of this? Are men afraid of sex? Are men, are men afraid of women and their body parts? Do men hate women? Like, what is going on here?
Elinor Cleghorn
That's so fantastic! I never thought about that at all. It's all this, the gods reproducing themselves in these really odd ways. And, like, not of women born, you know, no vaginas, no sex. Just kind of mutation and replication of the sort of God Himself. I haven't thought about that before. But that's so fascinating. I think that historically, you know, the authors of these kind of myths, I think, are afraid of the vagina, of the physicality of birth, of the necessity of women's bodies, to the earth, to the world. And I think there's something in that about having to cleave back power from women, because women do have this extraordinary physical power. And this utterly, at that point, anyway, magical capacity to grow baby and keep it alive and bear it. I mean, it's extraordinary. And I think there's something about those myths that have to set up that women don't have the power, that ultimately the procreative power is in the ingenuity of a male deity—in the in the kind of transformative thought of a thing that's male—because it just removes that power, and it takes it away from women's bodies completely. But it's just so great and I never thought about that before.
Emily Silverman
I was thinking about this term "penis envy". You know, the idea that women envy men for their penises, but it seems like there's quite a bit of uterus envy. And that that envy is sublimated into hate or something like that.
Elinor Cleghorn
I absolutely think so. I think that's completely right. I think you could also look at it as clitoris envy too, I mean, especially in the 16th and 17th century when anatomists were discovering how the organs were organized beneath the human skin. And when various different Italian anatomists, one of whom was named Colombo—and I don't know if you have this show over there, but we have this old detective show called Columbo... So, Colombo discovered the clitoris. He claimed to have discovered the clitoris. And it's so fascinating to think that this anatomist discovered... he thought he'd discovered this seat of female physical pleasure, right? This "knob", this, this sort of, the "center of physical pleasure", the "sweetness of Venus"—he used all these sick-making terms to describe it. But the idea that this tiny, or apparently... because they didn't know, of course, then about clitoral anatomy and how it reached back into the body. They just saw the little knob of the organ that that could be responsible for so much sensation and sensitivity was just kind of mind blowing and wild to them. And then of course, what happened afterwards, was that the clitoris was vilified and was demonized and was, you know, pathologized as the source of illness, of shame, of stigma. And into the 19th century, the removal of the glands of the clitoris was advocated by some very brutal Victorian gynecologists as a way to cure chronic illnesses that afflicted young women. So we see these kinds of moments in medical history where there's a deep fascination with figuring something out about the female body, delighting in that discovery, and then immediately trying to sort of banish it—take away its power, deny what it is and what it means, and take away knowledge about it from women themselves.
Emily Silverman
I want to move into the mind-body connection part of this. There's this term that comes up a lot in medical history, which is "hysteria", which according to one person in your book was defined as a disorder caused by women's excessive emotions. Men are immune because they are gifted with reasoning and intellect. So tell us more about hysteria and why it's so easy for physicians to attribute physical symptoms to mental causes in women.
Elinor Cleghorn
So, hysteria as a diagnostic category really emerged in the early 17th century. So at the tail end of the witchcraft craze across Europe. Some physicians were trying to find plausible reasons why women appeared to be possessed, why women appeared as if they might be consorting with devils. There are a group of physicians who are looking for more humane explanations, and wanted to argue that what was called witchcraft was, in fact, an organic disease that could be cured, rather than a crime that needed to be punished. So, one of the earliest tracts on hysteria was written by an English physician called Edward Jordan. And he had actually been a witness to defend a woman accused of witchcraft in the very early 17th century, and he decided that she was suffering from a sort of "wandering womb" affliction. And that because the uterus had such a profound influence on all the systems of women's bodies, and that included their emotions and their minds, that if the uterus was in any way, sort of disordered or disrupted, that it could cause symptoms so obscure that women appeared as if they were under the dominion of spells—they've been taken over, not by the devil, but by their own uterus. So, this is the beginnings of this concept of "hysteria", and that there's a kind of traffic or channel between the uterus and the mind. And as male physicians over the centuries began to get very keen on this idea of hysteria, they develop all sorts of different definitions for what it was. And usually what these definitions had in common was, a woman's emotions or women's sensibilities—her weak nerves, her emotional delicacy, her mental deficiencies—were so sort of out of control that they were able to manifest symptoms in the body. So, this really set the stage for the dismissal of women's pain and other symptoms, as all in the mind as emotional, as anxious, as hysterical indeed. So, it was a very diminishing diagnosis. It was a very feminized diagnosis. And it was also a way for physicians to blame illness symptoms and causes of illness that they didn't necessarily understand on a general sense of feminine body and mental deficiency.
Emily Silverman
And you talk about how in later years, it became about hormones. So instead of, "she's hysterical", it became, "she is hormonal". So tell us about that.
Elinor Cleghorn
So, when hormones were beginning to be theorized about the end of the 19th century, they weren't initially called hormones. They were called "internal secretions". And in the early 20th century, when endocrinologists and gynecologists began thinking about the influence of internal secretions on male and female bodies differently, we get a really strong sense that women's female internal secretions carry these very feminine traits and virtues. So, if a woman was properly furnished with internal secretions, she wanted to be a mother. She wanted to be domestic. She was placid and calm, and didn't want more for herself in life. She was quite happy because her secretions were furnishing her with the impulse to be very nurturing and nourishing. So, this is the early conception of why we think of estrogen, known as the primary female sex hormone, as having this feminizing effect. And there was a huge idea in the early 20th century that a woman was her secretions. And these secretions primarily came from the ovaries. And they defined who she was. If a woman had too much in the way of secretions, she was probably a little bit slutty. If she had too few secretions, or her secretions were measly, or paltry, then she might be more masculine in appearance. She might want to, heaven forfend, go to work, or try to think, or read a lot. So, there was this real kind of scale of healthy femininity that was defined by early conceptions of hormones that really defined this idea that a woman's health was intimately linked to her body's ability to allow her to be socially obedient. So, by this time, in the early 20th century, this didn't just mean being a brood mare and having babies. This also meant being more or less the kind of domestic goddess, and not wanting to push the boundaries of life and equality for herself, because that's what her biology was destined for. And if she was healthy, she wouldn't want more.
Emily Silverman
In the book, you talk a lot about menstruation, masturbation, childbirth. But I was very interested in this discussion around menopause, which, as you say, is still very under-researched, misunderstood, shrouded in myth, misconception. But this idea that once the hormones drop off later in life, what happens to the woman then? And it reminded me of this scene in a modern TV show called Fleabag, which you may or may not have heard of. But it's the scene where Phoebe Waller-Bridge and Kristin Scott Thomas are sitting at the bar. And Kristin Scott Thomas is this 58 year old business woman who's just received an award for the best woman in business. And she talks about how she views the Women's Award as infantilizing. And then she goes on this whole monologue about how women spend decades having periods and childbirth and then the menopause comes. And you think she's gonna say how horrible it is. But then she says, "And it's wonderful!" Because when the menopause comes, you're finally free. And I'm quoting here, "no longer a slave, no longer a machine with parts, you're just a person in business." So, I was wondering, have you watched that scene? And how did you respond to it, if so?
Elinor Cleghorn
I have watched it and it's completely iconic. I've watched it many times. It's also iconic for Kristin Scott Thomas's articulation of the whole of women's lives being defined by pain, like what it means to be a woman is to be in pain. And her relishing and celebrating not the invisibility, but the freedom from the social expectations that are tied in with having a female body is just so incredible. And it's also really fascinating and really script-flipping because so much of the medical discourse around menopause, especially from the early 19th century, through the 19th century, into the early 20th was that menopause was this time of deficiency and decrepitude where a woman literally degraded, and her femininity, you know, her hormone or secreted femininity depleted, and that she was just pointless in the eyes of medicine and in the eyes of society. She had no use anymore. And she could expect, you know, a horrific kind of time with her health, a "stormy climacteric", as some doctor put it, because the ideal state was for her to be in these kind of fecund, fertile years. But actually it's always time for that narrative to be revisited and completely changed up. And there were many women physicians, older women physicians and scientists in the 19 century who really pushed forward this idea of the accomplishment and the possibility of being free of this responsibility—of being free of having to obey some sort of biological imperative and destiny. That there's this, you know, whole other category of womanhood that's kind of beyond their understanding, and also beyond their control, to be honest. I think it also comes back to that thing, you know, like, the misogynistic and sexist medics didn't like what they couldn't control. And older women, or a community of people that sit outside of that system of control, because you can't tell them to go have babies for the good of their health, you can't tell them to go feather their nest or be very domestic for the good of their health. So, there is that sense of incredible power that that of course, again, gets vilified and gets pathologized and gets demonized in different ways.
Emily Silverman
And you talk about the witch trials in Europe and how many thousands and thousands of people were murdered, and how most of those people were women and how most of those women were older.
Elinor Cleghorn
Yeah.
Emily Silverman
It's just such an interesting history. I want to bring it into modern day a bit because we started this conversation talking about your experience, being diagnosed with lupus, after many, many years of being ignored and dismissed. Talk a little bit about how this ancient history, you know, Greece, Christianity, witch trials, primitive medicine, manifests today with reproductive health, autoimmune disease, things like endometriosis. Like where are we right now with this?
Elinor Cleghorn
I think the two major legacies that we've inherited from the primitive, early, early modern 19th century medicine, one is a lack of knowledge around, especially chronic diseases that primarily affect women and people born female. And the second thing is a general attitude that women's pain, that feminized pain, is more likely to have an emotional and psychological, rather than physiological or organic, cause that's what we have really inherited. And one is the set of knowledge blind spots. And the other is a set of social cultural attitudes that are so deeply embedded. Gender has such enormous sticking power. And it's one of the biases that is not just medical, it's societal. And in medicine, it's magnified because sex difference is important to the understanding of disease. Lupus existed in the medical history since the ninth century and had a very long and strange shape-shift in life as a human disease. But it was discovered to be autoimmune in the late 1940s. And there was a big concentration on what lupus was and defining its symptoms. And because women who presented with lupus, and were speaking first of pain, of fatigue, of maybe neurological symptoms, were assumed to be hysterical, were assumed to be overly emotional. And the concentration on those gender differences meant a huge amount of knowledge was missed at that really crucial time. So, these are the two areas: knowledge and attitude, that we really need to address the past in order to move on for the future.
Emily Silverman
You write, "I've often wondered if women's chronic diseases wouldn't be so enigmatic, if medicine accepted that they can't be understood through biological evidence alone. Maybe all that clinical and biomedical uncertainty about us is just medicine's failure to look for answers in the right places. Maybe our diseases are an example of the way women's bodies communicate and should be listened to differently." And I thought that was so beautiful. And I'm wondering what you meant by this.
Elinor Cleghorn
Thank you so much, first of all, and I think what I meant by this is that when I look back over my history and think about the medical histories of other women I know who have suffered chronic diseases and struggled to be correctly diagnosed, that oftentimes, what was really necessary in the understanding of that disease, was that healthcare provider would listen to what it felt like to be unwell. And that in that listening, there was knowledge to be gained. There is often little time or space for the subjective thoughts and feelings of patients. And of course, so many healthcare providers, a fantastic, offering humane connection and compassion in those rooms. And I just feel like if we could rethink the diagnostic process to accommodate some of that thinking and feeling, and to say, okay, you know, we use this as a way of furthering our understanding of these diseases that we might be able to reduce these long diagnostic times. I think it's still 10 years for a conclusive diagnosis of endometriosis. And six years for a conclusive diagnosis of lupus. I mean, this represents six or 10 years of a person's life. It also represents six to 10 years of medical resources and thinking and physicians' time and tests. And in order to have a healthcare system that works for everyone, I think it's time we faced up to the fact that ignoring or dismissing or disavowing subjective feeling is not helping us.
Emily Silverman
My last question is about some of the women characters in this book. You talk a lot about how it was women who made the changes that allowed us to get to where we are today. And some of these women have a shadow side. So we learned about a lot of the racism and the eugenics that was built into the birth control revolution and so that was really saddening and maddening to read about. But I'm curious, out of all of these women characters who pushed the conversation forward, was there one that stood out to you, maybe somebody that you felt especially connected to or who you were especially interested by?
Elinor Cleghorn
There were so many incredible women that I found in my research, ranging from patients, to researchers, to activists, to clinicians, to physicians and scientists. But the one that I really fell in love with was named Mary Putnam Jacobi. And she was an American physician working at the end of the 19th century. And it's no coincidence that at the time when many colleges in the US were opening their doors to women and admitting women on to the same degree in higher education programs as their male counterparts, the anti-feminist doctors went really double down on the idea that women's biology meant it was utterly impossible for them to even think about going to college and having a professional life when all their biology fitted them for was having babies. And one particularly egregious doctor, argued that menstruation was such a drain on a young woman's mental energy and energy reserves, that if she went to school, she would leave school completely with the old wandering womb and the old shriveled ovaries and no one would want to marry her. And she'd be a kind of zombie-like spinster and it would lead to the downfall of society. So, Mary Putnam Jacobi was incredibly smart and incredibly scientifically-minded. But she was also an experimental physiologist. And she decided to examine this question, "Do women really need to just rest and sleep when they're menstruating? Does menstruation have a significant impact on women's energy, on their minds, and on their bodies?" And she did this study that was published in 1877, called "The Question of Rest for Women During Menstruation," where she didn't just do quantitative work in the lab—looking at different women's body temperatures, energy reserves, blood pressure, circulation, respiration—she gave them the opportunity to talk about what it felt like to menstruate, what it was like to live in a menstruating body. And she decided that not only was rest unnecessary, unless a woman was ill, but it was kind of injurious to her as well. And she was always throughout her life, a real proponent of equal education for women, of medical education for women. She spoke in favor of suffragism. She was the physician of Charlotte Perkins Gilman, the author of The Yellow Wallpaper. She really saved her from postnatal depression and enabled her to write again. She died, unfortunately and sadly, of a brain tumor. But while she was dying, she wrote an account of her symptoms and her treatments so that her illness could then contribute to the understanding of the particular tumor that she had. So she really championed this idea, I believe, of subjective body experiences and lived experience of illness being so important to our understanding of, of bodies, and of disease, and of body functions. And she, you know, is just such a hero of mine.
Emily Silverman
I remember that part of the book and how I think a male physician had his mind blown when he heard that there was a woman who was menstruating and riding horses at the same time and, it was, like, inconceivable to him.
Elinor Cleghorn
Riding horses, going on rickety trains, going for long walks, talking, all these are quite unbelievable to a lot of these Victorian physicians—that women could actually do that.
Emily Silverman
And I love what you point out about her research and how it wasn't just focused on the data and the quantitative piece, but how she really brought storytelling and narrative to the fore. And here at The Nocturnists, we're all about storytelling and medicine. And so thank you for bringing her and her work to the attention of me and the audience. She's somebody in history who I think we should learn more about. That's all I have. I, you know, just wanted to say thank you again for coming on to the podcast to talk about this book.
Elinor Cleghorn
Thank you so much for having me.
Emily Silverman
Well, this has been wonderful. I am speaking with Elinor Cleghorn about her book, Unwell Women: Misdiagnosis and Myth in a Man-Made World, highly recommended to anybody in the healthcare profession or patients. Really, really illuminating history. Again, as I said at the beginning, I learned so much about the history of sexism in medicine and where we came from and where we need to go. So thank you again for writing it and for being here.
Elinor Cleghorn
Well, thank you so much for having me. It's been such a pleasure.