Ehrenreich & English - The Sexual Politics of Sickness

For Her Own Good
TWO CENTURIES OF THE EXPERTS'
ADVICE TO WOMEN
Barbara Ehrenreich
AND Deirdre English
ANCHOR BOOKS
A Division of Random House, Inc.

New York
l
FOUR
The Sexual Politics

of Sickness
hen Charlotte Perkins Gilman collapsed with a "nervous dis-

W order," the physician she sought out for help was Dr. S. Weir
Mitchell, "the greatest nerve specialist in the country." It was Dr.
Mitchell-female specialist, part-time novelist, and member of
Philadelphia's high society-who had once screened Osler for a fac-
ultyposition, and, finding him approvingly discreet in the disposal
of cherry-pie pits, admitted the young doctor to medicine's inner cir-
cles.When Gilman met him, in the eighteen eighties, he was at the
height of his career, earning over sixtythousand dollars per year (the
equivalent of almost in a million today's dollars). His renown for
the treatment of female nervous disorders had by this time led to a
marked alteration of character. According to an otherwise fond biog-
rapher, his vanity "had become colossal. It was fed by torrents of adu-
lation,incessant and exaggerated, every day, almost every hour .... "1
Gilman approached the great man with "utmost confidence." A
friend of her mother's lent her one hundred dollars for the trip to
Philadelphia .apd Mitchell's treatment. In preparation, Gilman
methodically wrote out a complete history of her case. She had
observed, for example, that her siclmess vanished when she was
awayfrom her home, her husband, and her child, and returned as
112 • FOR HER OWN GOOD The Sexual Politics of Sickness • 113
soon as she came back to them. But Dr. Mitchell dismissed her pre- pening to her. Thousands of other women, like Gilman, were find-
pared history as evidence of "self-conceit." He did not want infor- ing themselves in a new position of dependency on the male med-
mation from his patients; he wanted "complete obedience." Gilman ical profession-and with no alternative sources of information or
quotes his prescription for her: counsel. The medical profession was consolidating its monopoly
over healing, and now the woman who felt sick, depressed, or sim-
"Live as domestic a life as possible. Have your child with you ply tired would no longer seek help from a friend or female healer,
all the time." (Be it remarked that if I did but dress the baby but from a male physician. The general theory which guided the
it left me shaking and crying-certainly far from a healthy doctors' practice as well as their public pronouncements was that
companionship for her, to say nothing of the effect on me.) women were, by nature, weak, dependent, and diseased. Thus
"Lie down an hour after each meal. Have but two hours would the doctors attempt to secure their victory over the female
intellectual life a day. And never touch pen, brush or pencil healer: with the "scientific" evidence that woman's essential nature
as long as you live."2 was not to be a strong, competent help-giver, but to be a patient.
Gilman dutifully returned home and for some months at-

tempted to follow Dr. Mitchell's orders to the letter. The result, in A Mysterious Epidemic
her words, was-
In fact at the time there were reasons to think that the doctors' the-
... [I] came perilously close to losing my mind. The mental ory was not so farfetched. Women were decidedly sickly,though not
agony grew so unbearable that I would sit blankly moving my for the reasons the doctors advanced. In the niid- and late nine-
head from side to side ... I would crawl into remote closets . teenth century a curious epidemic seemed to be sweeping through
and under beds-to hide from the grinding pressure of that the middle- and upper-class female population both in the United
distress .... 3 States and England. Diaries and journals from the time give us
hundreds of examples of women slipping into hopeless invalidism.
Finally, in a "moment of clear vision" Gilman understood the For example, when Catherine Beecher, the educator, finished a
source of her illness: she did not want to be a wife; she wanted to be tour in 1871 that included visits to dozens of relatives, friends, and
a writer and an activist. So, discarding S. Weir Mitchell's prescrip- former students, she reported "a terrible decay of female health all
tion and divorcing her husband, she took off for California with her over the land," which was "increasing in a most alarming ratio." The
baby, her pen, her brush, and her pencil. But she never forgot notes from her travels go like this:
Mitchell and his near-lethal "cure." Three years after her recovery
she wrote The Yellow Wallpaper 4 a fictionalized account of her own Milwaukee, Wis. Mrs. A. frequent sick headaches. Mrs. B.
illness and descent into madness. If that story had any influence on very feeble. Mrs. S. well, except chills. Mrs. L. poor health
S. Weir Mitchell's method of treatment, she wrote after a long life of constantly. Mrs. D. subject to frequent headaches. Mrs. B.
accomplishments, "I have not lived in vain."5 very poor health ...
Charlotte Perkins Gilman was fortunate enough to have had a· Mrs. H. pelvic disorders and a cough. Mrs. B. always sick.
"moment of clear vision" in which she understood what was hap- Do not know one perfectly healthy woman in the place .... 6
Doctors found a variety of diagnostic labels for the wave of inva- run down again! And then these doctors tell you that you will
lidism gripping the female population: "neurasthenia," "nervous die or recover! But you don't recover. I have been at these
prostration," "hyperesthesia," "cardiac inadequacy," "dyspepsia," alterations since I was nineteen and I am neither dead nor
"rheumatism," and "hysteria." The symptoms included headache, recovered. As I am now forty-two, there has surely been time
muscular aches, wealmess, depression, menstrual difficulties, indi- for either process. 8
gestion, etc., and usually a general debility requiring constant rest.
S. Weir Mitchell described it as follows: The sufferings of these women were real enough. Ann Phillips
wrote, " ... life is a burden to me, I do not lmow what to do. I am
The woman grows pale and thin, eats little, or if she eats does tired of suffering. I have no faith in anything." 9 Some thought that
not profit by it. Everything wearies her,-to sew, to write, to if the illness wouldn't kill them, they would do the job themselves.
read, to walk,-and by and by the sofa or the bed is her only Alice James discussed suicide with her father, and rejoiced, at the
comfort. Every effort is paid for dearly, and she describes her- age of forty-three, when informed she had developed breast cancer
self as aching and sore, as sleeping ill, and as needing constant and would die within months: "I count it the greatest good fortune
stimulus and endless tonics .... If such a person is emotional to have these few months so full of interest and instruction in the
she does not fail to become more so, and even the firmest knowledge of my approaching death." 10 Mary Galloway shot herself
I women lose self-control at last under incessant feebleness. 7 in the head while being attended in her apartment by a physician
l'
and a nurse. She was thirty-one years old, the daughter of a bank
The syndrome was never fatal, but neither was it curable in most and utility company president. According to The New York Times
cases, the victims sometimes patiently outliving both husbands and account (April 10, 1905), "She had been a chronic dyspeptic since
physicians. 1895, and that is the only reason lmown for her suicide." 11
Women who recovered to lead full and active lives-like Char-
lotte Perkins Gilman and Jane Addams-were the exceptions. Ann
Greene Phillips-a feminist and abolitionist in the eighteen thirties- Marriage: The Sexual-
first took ill during her courtship. Five years after her marriage, she Economic Relation
retired to bed, more or less permanently. S. Weir Mitchell's unmar-
ried sister fell prey to an unspecified "great pain" shortly after tak- In the second half of the nineteenth century the vague syndrome
ing over housekeeping for her brother (whose first wife had just gripping middle- and upper-class women had become so wide-
died), and embarked on a life of invalidism. Alice James began her spread as to represent not so much a disease in the medical sense as
career of invalidism at the age of nineteen, always amazing her a way of life. More precisely, the way this type of woman was
older brothers, Henry (the novelist) and William (the psychologist), expected to live predisposed to her siclmess, and siclmess in tum
with the stubborn intractability of her condition: "Oh, woe, woe is predisposed her to continue to live as she was expected to. The del-
me!" she wrote in her diary: icate, affluent lady, who was completely dependent on her husband,
set the ideal of femininity for women of all classes .
. . . all hopes of peace and rest are vanishing-nothing but Clear-headed feminists like Charlotte Perkins Gilman and Olive
the dreary snail-like climb up a little way, so as to be able to Schreiner saw a link between female invalidism and the economic
situation of women in the upper classes. As they observed, poor concern herself witl1 politics, business, international affairs, or
women did not suffer from the syndrome. The problem in the middle the aching injustices of the industrial work world.
to upper classes was that marriage had become a "sexuo-economic But not even the most sheltered woman lived on an· island
relation" in which women performed sexual and reproductive detached from the "real" world of men. Schreiner described the
duties for financial support. It was a relationship which Olive larger context:
Schreiner bluntly called "female parasitism."
To Gilman's pragmatic mind, the affiuent wife appeared to be a Behind the phenomenon of female parasitism has always lain
sort of tragic evolutionary anomaly, something like the dodo. She another and yet larger social phenomenon ... the subjuga-
did not work: that is, there was no serious, productive work to do tion of large bodies of other human creatures, either as
in the home, and the tasks which were left-keeping house, cook- slaves, subject races, or classes; and as a result of the exces-
ing, and minding the children-she left as much as possible to sive labors of those classes there has always been an accumu-
the domestic help. She was, biologically speaking, specialized for lation of unearned wealth in the hands of the dominant class
one function and one alone-sex. Hence the elaborate costume- or race. It has invariably been by feeding on this wealth, the
bustles, false fronts, wasp waists-that caricatured the natural fe- result of forced or ill-paid labor, that the female of the dom-
male form. Her job was to bear the heirs of the businessman, inant race or class has in the past lost her activity and has
lawyer, or professor she had married, which is what gave her a claim come to exist purely through the passive performance of her
to any share of his income. When Gilman, in her depression, fumed sexual functions. 14[Emphasis in original]
away from her own baby, it was because she already understood, in
a half-conscious way, that the baby was living proof of her economic The leisured lady, whether she knew it or not and whether she
dependence-and as it seemed to her, sexual degradation. cared or not, inhabited the same social universe as dirt-poor black
A "lady" had one other important function, as Veblen pointed sharecroppers, six-year-old children working fourteen-hour days
out with acerbity in The TheortJ of the Leisure Class. And that was to for sub-subsistence wages, young men mutilated by unsafe machin-
do precisely nothing, that is nothing of any economic or social con- ery or mine explosions, girls forced into prostitution by the threat of
sequence.12 A successful man could have no better social ornament starvation. At no time in American history was the contradiction
than an idle wife. Her delicacy, her culture, her childlike ignorance between ostentatious wealth and unrelenting poverty, between
of the male world gave a man the "class" which money alone could idleness and exhaustion, starker than it was then in the second half
not buy. A virtuous wife spent a hushed and peaceful life indoors, of the nineteenth century. There were riots in the cities, insurrec-
sewing, sketching, planning menus, and supervising the servants tions in the mines, rumors of subversion and assassination. Even
and children. The more adventurous might fill their leisure with the secure business or professional man could not be sure that he
shopping excursions, luncheons, balls, and novels. A "lady" could be too would not be struck down by an economic downturn, a wily
charming, but never brilliant; interested, but not intense. Dr. competitor, or (as seemed likely at times) a social revolution.
Mitchell's second wife, Mary Cadwalader, was perhaps a model of The genteel lady of leisure was as much a part of the industrial
her type: she "made no pretense at brilliancy; her first thought was social order as her husband or his employees. As Schreiner pointed
to be a foil to her husband .... "13By no means was such a lady to out, it was ultimately the wealth extracted in the world of work that
enabled a man to afford a more or less ornamental wife. And it was with "sick headaches," "nerves," and various unmentionable "female
the very harshness of that outside world that led men to see the troubles," and that indefinable nervous disorder "neurasthenia" was
home as a refuge-"a sacred place, a vestal temple," a "tent pitch'd considered, in some circles, to be a mark of intellect and sensitivity.
in a world not right," presided over by a gentle, ethereal wife. A Dr. Mary Putnam Jacobi, a female regular physician, observed
popular home health guide advised that impatiently in 1895:
... [man's] feelings are frequently lacerated to the utmost ... it is considered natural and almost laudable to break
point of endurance, by collisions, irritations, and disappoint- down under all conceivable varieties of strain-a winter dis-
ments. To recover his equanimity and composure, home must sipation, a houseful of servants, a quarrel with a female
be a place of repose, of peace, of cheerfulness, of comfort; friend, not to speak of more legitimate reasons .... Women
then his soul renews its strength, and will go forth, with fresh who expect to go to bed every menstrual period expect to
vigor, to encounter the labor and troubles of the world. 15 collapse if by chance they find themselves on their feet for a
few hours during such a crisis. Constantly considering their
No doubt the suffocating atmosphere of domesticity bred a kind nerves, urged to consider them by well-intentioned but
of nervous hypochondria. We will never lmow, for example, if Alice short-sighted advisors, they pretty soon become notlung but
James's lifelong illness had a "real" organic basis. But we lmow that, a bundle of nerves. 17
unlike her brothers, she was never encouraged to go to college or to
develop her gift for writing. She was high-strung and imaginative, But if siclmess was a reaction, on women's part, to a difficult situ-
but she could not be brilliant or productive. Illness was perhaps the ation, it was not a way out. If you have to be idle, you might as well be
only honorable retreat from a world of achievement which (it sick, and siclmess, in tum, legitimates idleness. From the domestic
seemed at the time) nature had not equipped her to enter. perspective, the sick woman was not that far off from the ideal
For many other women, to various degrees, siclmess became a woman anyway.A morbid aesthetic developed, in which siclmess was
part of life, even a way of filling time. The sexuo-economic relation seen as a source of female beauty, and, beauty-in the high-fashion
confined women to the life of the body, so it was to the body that sense-was in fact a source of siclmess. Over and over, nineteenth-
they directed their energies and intellect. Rich women frequented century romantic paintings feature the beautiful invalid, sensuously
resortlike health spas and the offices of elegant specialists like S. drooping on her cushions, eyes fixed tremulously at her husband or
Weir Mitchell. A magazine cartoon from the eighteen seventies physician, or already gazing into the Beyond. Literature aimed at
shows two "ladies of fashion" meeting in an ornately appointed female readers lingered on the romantic pathos of illness and death;
waiting room. 'What, you here, Lizzie? Why, ain't you well?" asks popular women's magazines featured such stories as "The Grave of
the first patient. "Perfectly thanks!" answers the second. "But what's My Friend" and "Song of Dying." Society ladies cultivated a sickly
the matter with you, dear?" "Oh, nothing whatever! I'm as right as countenance by drinking vinegar in quantity or, more effectively,
possible dear." 16 For less well-off women there were patent medi- arsenic. 18 The loveliest heroines were those who died young, like
cines, family doctors, and, starting in the eighteen fifties, a steady Beth in Little Women, too good and too pure for life in tlus world.
stream of popular advice books, written by doctors, on the subject Meanwhile, the requirements of fashion insured that the well-
of female health. It was acceptable, even stylish, to retire to bed dressed woman would actually be as frail and ornamental as she
looked. The style of wearing tight-laced corsets, which was de of loyal clients. Yet the doctors' constant ministrations and inter-
rigueur throughout the last half of the century, has to be ranked ventions-surgical, electrical, hydropathic, mesmeric, chemical-
somewhere close to the old Chinese practice of footbinding for its seemed to be of little use. In fact, it would have been difficult; in
crippling effects on the female body. A fashionable woman's corsets many cases, to distinguish the cure from the disease. Charlotte
exerted, on the average, twenty-one pounds of pressure on her Perkins Gilman of course saw the connection. The ailing heroine
internal organs, and extremes of up to eighty-eight pounds had of The Yellow Wallpaper, who is being treated by her physician-
been measured. 19 (Add to this the fact that a well-dressed woman husband, hints at the fearful truth:
wore an average of thirty-seven pounds of street clothing in the
winter months, of which nineteen pounds were suspended from John is a physician, and perhaps-(! would not say it to a living
her tortured waist.20 ) Some of the short-term results of tight-lacing soul, of course, but this is dead paper and a great relief to my
were shortness of breath, constipation, weakness, and a tendency to mind)-perhaps that is one reason I do not get well faster.22
violent indigestion. Among the long-term effects were bent or frac-
tured ribs, displacement of the liver, and uterine prolapse (in some In fact, the theories which guided the doctor's practice from the
cas!;ls,the uterus would be gradually forced, by the pressure of the late nineteenth century to the early twentieth century held that
corset, out through the vagina). woman's normal state was to be sick. This was not advanced as an
To be sure, the nineteenth-century romantic spirit put women empirical observation, but as physiological fact. Medicine had "dis-
on a pedestal and ascribed to her every tender virtue absent from covered" that female functions were inherently pathological. Men-
the Market. But carried to an extreme, the demand that woman be struation, that perennial source of alarm to the male imagination,
a negation of man's world left almost nothing for women to actually provided both the evidence and the explanation. Menstruation was a
be: if men are busy, she is idle; if men are rough, she is gentle; if serious threat throughout life-so was the lack of it. According to Dr.
men are strong, she is frail; if men are rational, she is irrational; and Engelmann, president of the American Gynecology Society in 1900:
so on. The logic that insists that femininity is negative masculinity '
necessarily romanticizes the moribund woman and encourages a Many a young life is battered and forever crippled on the
kind of paternalistic necrophilia. In the nineteenth century this ten- breakers of puberty; if it crosses these unharmed and is not
dency becomes overt, and the romantic spirit holds up as its ideal- dashed to pieces on the rock of childbirth, it may still ground on
the sick woman, the invalid who lives at the edge of death. the ever-recurring shallows of menstruation, and lastly upon
the final bar of the menopause ere protection is found in the
unruffled waters of the harbor beyond reach of sexual storms.23
Femininity as a Disease
Popular advice books written by physicians took on a somber
The medical profession threw itself with gusto on the languid figure tone as they entered into "the female functions" or "the diseases of
of the female invalid. In the home of an invalid lady, "the house women."
physician like a house fly is in chronic attention" 21 and the doctors
fairly swarmed after wealthy patients. Few were so successful as It is impossible to form a correct opinion of the mental and
S. Weir Mitchell in establishing himself as the doctor for hundreds physical suffering frequently endured from her sexual condi-
tion, caused by her monthly periods, which it has pleased her concern about prenatal nutrition than they did about prenatal
Heavenly Father to attach to woman .... 24 "impressions.") Finally after all this, a woman could only look for-
ward to menopause, portrayed in the medical literature as a termi-
Ignoring the existence of thousands of working women, the doctors nal illness-the "death of the woman in the woman."
assumed that every woman was prepared to set aside a week or five Now it must be said in the doctors' defense that women of a
days every month as a period of invalidism. Dr. W C. Taylor, in his hundred years ago were, in some ways, sicker than the women of
book A Physician's Counsels to Woman in Health and Disease, gave a today. Quite apart from tight-lacing, arsenic-nipping, and fashion-
warning typical of those found in popular health books of the time: able cases of neurasthenia, women faced certain bodily risks which
men did not share. In 1915 (the first year for which national figures
We cannot too emphatically urge the importance of regard- are available) 6i women died for every 10,000 live babies born,
ing these monthly returns as periods of ill health, as days compared to 2 per 10,000 today, and the maternal mortality rates
when the ordinary occupations are to be suspended or mod- were doubtless higher in the nineteenth century. 27 Without ade-
ified .... Long walks, dancing, shopping, riding and parties quate, and usually without any, means of contraception, a married
should be avoided at this time of month invariably and under woman could expect to face the risk of childbirth repeatedly
all circumstances .... 25 through her fertile years. After each childbirth a woman might suf-
fer any number of gynecological complications, such as prolapsed
As late as 1916, Dr. Winfield Scott Hall was advising: (slipped) uterus or irreparable pelvic tear, which would be with her
for the rest of her life.
All heavy exercise should be omitted during the menstrual Another special risk to women came from tuberculosis, the
week ... a girl should not only retire earlier at this time, but "white plague." In the mid-nineteenth century, TB raged at epi-
ought to stay out of school from one to three days as the case demic proportions, and it continued to be a major threat until well
may be, resting the mind and taking extra hours of rest and into the twentieth century. Everyone was affected, but worn'en,
sleep. 26 especially young women, were particularly vulnerable, often dying
at rates twice as high as those of men of their age group. For every
Similarly, a pregnant woman was "indisposed," throughout the hundred women aged twenty in 1865, more than five would be
full nine months. The medical theory of "prenatal impressions" dead from TB by the age of thirty, and more than eight would be
required her to avoid all "shocking, painful or unbeautiful sights," dead by the age of fifty.28
intellectual stimulation, angry or lustful thoughts, and even her So, from a statistical point of view, there was some justification
husband's alcohol and tobacco-laden breath-lest the baby be for the doctors' theory of innate female frailty. But there was also,
deformed or stunted in the womb. Doctors stressed the pathologi- from the doctors' point of view, a strong commercial justification for
cal nature of childbirth itself-an argument which also was essen- regarding women as sick. This was the period of the profession's
tial to their campaign against midwives. After delivery, they insisted most severe "population crisis." (See Chapter 3.) The theory of
on a protracted period of convalescence mirroring the "con- female frailty obviously disqualified women as healers. "One shud-
finement" which preceded birth. (Childbirth, in the hands of the ders to think of the conclusions arrived at by female bacteriologists
medical men, no doubt was "pathological," and doctors had far less or histologists," wrote one doctor, "at the period when their entire
124 • FOR HER OWN GOOD The Sexual Politics of S·ickness • 125
system, both physical and mental, is, so to speal<,'unstrung,' to say cult of invalidism. Employers gave no time off for pregnancy or
nothing of the terrible mistakes which a lady surgeon might make recoveiy from childbirth, much less for menstrual periods, though
under similar conditions." 29 At the same time the theoiy made the wives of these same employers often retired to bed on all these
women highly qualified as patients. The sickly, nervous women of occasions. A day's absence from work could cost a woman her job,
the upper or middle class with their unending, but fortunately non- and at home there was no comfortable chaise longue to collapse on
fatal, ills, became a natural "client caste" to the developing medical while servants managed the household and doctors managed the ill-
profession. ness. An 1889 study from Massachusetts described one working
Meanwhile, the health of women who were not potential woman's life:
patients-poor women-received next to no attention from the
medical profession. Poor women must have been at least as suscep- Constant application to work, often until 12 at night and
tible as wealthy women to the "sexual storms" doctors saw in men- sometimes on Sundays (equivalent to nine ordinary working
struation, pregnancy, etc.; and they were definitely much more days a week), affected her health and injured her eyesight.
susceptible to the hazards of childbearing, tuberculosis, and, of She ... was ordered by the doctor to suspend work ... but
course, industrial diseases. From all that we know, sickness, exhaus- she must earn money, and so she has kept on working. Her
tion, and injuiywere routine in the life of the working-class woman. eyes weep constantly, she cannot see across the room and
Contagious diseases always hit the homes of the poor first and hard- "the air seems always in a whirl" before her ... [she] owed
est. Pregnancy, in a fifth- or sixth-floor walk-up flat, really was debil- when seen three months' board for self and children ... She
itating, and childbirth, in a crowded tenement room, was often a hopes something may be done for working girls and women,
frantic ordeal. Emma Goldman, who was a trained midwife as well for, however strong they may be in the beginning, "they can-
as an anarchist leader, described "the fierce, blind struggle of the not stand white slaveiy for ever."32
women of the poor against frequent pregnancies" and told of the
agony of seeing children grow up "sickly and undemourished"-if But the medical profession as a whole-and no doubt there
°
they survived infancy at all.3 For the woman who labored outside were many honorable exceptions-sturdily maintained that it
her home, working conditions took an enormous toll. An 1884 was affluent women who were most delicate and most in need of
report of an investigation of "The Working Girls of Boston," by the medical attention. "Civilization" had made the middle-class woman
Massachusetts Bureau of Statistics of Labor, stated: sicldy;her physical frailty went hand-in-white-gloved-hand with her
superior modesty, refinement, and sensitivity.Working-class women
... the health of many girls is so poor as to necessitate long were robust, just as they were supposedly "coarse" and immodest.
rests, one girl being out a year on this account. Another Dr. Lucien Warner, a popular medical authority, wrote in 1874,
girl in poor health was obliged to leave her work, while one "It is not then hard work and privation which make the women
reports that it is not possible for her to work the year round, of our country invalids, but circumstances and habits intimately
as she could not stand the strain, not being at all strong. 31 connected with the so-called blessings of wealth and refinement."
Someone had to be well enough to do the work, though, and
Still, however sick or tired working-class women might have working-class women, Dr. Warner noted with relief, were not
been, they certainly did not have the time or money to support a invalids: "The African negress, who toils beside her husband in the
fields of the south, and Bridget, who washes, and scrubs and toils in fied them for lengthy medical treatment anyway. The theory of
our homes at the north, enjoy for the most part good health, with innate female sickness, skewed so as to account for class differences
comparative immunity from uterine disease." 33 And a Dr. Sylvanus in ability to pay for medical care, meshed conveniently with_.the
Stall observed: doctors' commercial self-interest.
The feminists of the late nineteenth century, themselves deeply
At war, at work, or at play, the white man is superior to the concerned about female invalidism, were quick to place at least
savage, and his culture has continually improved his condi- part of the blame on the doctors' interests. Elizabeth Garrett
tion. But with woman the rule is reversed. Her squaw sister Anderson, an American woman doctor, argued that the extent of
will endure effort, exposure and hardship which would kill female invalidism was much exaggerated by male doctors and that
the white woman. Education which has resulted in develop- women's natural functions were not really all that debilitating. In
ing and strengthening the physical nature of man has been the working classes, she observed, work went on during menstrua-
perverted through folly and fashion to render woman weaker tion "without intermission, and, as a rule, without ill effects." 37
and weaker. 34 Mary Livermore, a women's suffrage worker, spoke against "the
monstrous assumption that woman is a natural invalid," and
In practice, the same doctors who zealously indulged the ills of denounced "the unclean army of 'gynecologists' who seem desirous
wealthy patients had no time to spare for the poor. When Emma to convince women that they possess but one set of organs-and
Goldman asked the doctors she knew whether they had any contra- that these are always diseased." 38 And Dr. Mary Putnam Jacobi put
ceptive information she could offer the poor, their answers in- the matter most forcefully when she wrote in 1895, "I think, finally,
cluded, "The poor have only themselves to blame; they indulge it is in the increased attention paid to women, and especially in
their appetites too much," and 'When she [the poor woman] uses their new function as lucrative patients, scarcely imagined a hun-
her brains more, her procreative organs will function less."35 A Dr. dred years ago, that we find explanation for much of the ill-health
Palmer Dudley ruled out poor women as subjects for gynecological among women, freshly discovered today .... "39
surgery on the simple ground that they lacked the leisure required
for successful treatment:
- Men Evolve, Women Devolve
... the hardworking, daily-toiling woman is not as fit a sub-
ject for [gynecological surgery] as the woman so situated in But it would be overly cynical to see the doctors as mere business-
life as to be able to conserve her strength and if necessary, to men, weighing theories of female physiology against cash receipts.
take a long rest, in order to secure the best result.s.36 The doctors of the late nineteenth century were also men of sci-
ence, and this meant, in the cultural framework that equated sci-
So the logic was complete: better-off women were sickly ence with goodness and morality, that doctors saw themselves
because of their refined and civilized lifestyle. Fortunately, how- almost as moral reformers. They (and members of the new field of
ever, this same lifestyle made them amenable to lengthy medi- psychology) saw it as their mission to bring the clear light of scien-
cal treatment. Poor and working-class women were inherently tific objectivity to the Woman Question, even when all others were
stronger, and this was also fortunate, since their lifestyle disquali- gripped by passionate commitments to one answer or another. "The
most devoted patron of woman's political and educational advance- proportions-"proved"-to no one's great surprise-that if the eth-
ment," wrote psychologist George T. Patrick: nic groups were ordered in terms of their distance up the ladder of
evolution, WASPs would be in the lead, followed by Northern Euro-
would hardly deny that the success and permanency of the peans, Slavs, Jews, Italians, etc., with Negroes trailing in the far rear.
reform will depend in the end upon the fact that there shall This was the intellectual framework with which nineteenth-
be no inherent contradiction between her duties and her century biologists approached the Woman Question: everyone must
natural physical and mental constitution. 40 have an assigned place in the natural scheme of things. Attempts to
get out of this place are unnatural and in fact diseased. By the eigh-
It was the self-assigned duty of the medical profession to define "her teen sixties, natural scientists could pinpoint woman's place on the
natural physical and mental constitution," no matter how galling the evolutionary ladder with some precision-she was at the level of
facts might be to any interest groups or vocal minorities. In 1896, the Negro. For example, Carl Vogt, a leading European professor
one physician asserted peevishly that the feminist influence had of natural history, placed the Negro (male) as follows:
become so powerful that "the true differences between men and
women have never been pointed out, except in medical publica- ... the grown-up Negro partakes, as regards his intellectual
tions."41 But with great determination-and we might add, imagina- faculties, of the nature of the child, the female, and the senile
tion-the doctors set out to elaborate the true nature of woman, the White. 42
sources of her frailty, and the biological limits of her social role.
The groundwork had already been laid in the natural sciences. (Where this left the Negro female one shudders to think, not to
Nineteenth-century scientists had no hesitation in applying the mention the "senile" female of either race.)
results of biological studies to human society: All social hierarchies, But it was not sufficient to rank women on a static evolutionary
they believed, could be explained in terms of natural law. Nothing scale. A full response to the Woman Question required a dynamic
was more helpful in this intellectual endeavor than the Theory of view, including not only where woman was now, but where her evo-
Evolution. Darwin's theory proposes that man had evolved from lutionary destiny was taking her. Darwin's theory postulates a drift
"lower," i.e., less complex, forms of life to his present condition. toward ever greater biological variation and differentiation among
Nineteenth-century biologists and social commentators, observing the species. Where once there were a few formless protozoa, now
that not all men were the same and that not all were in fact men, there were porcupines, platypuses, peacocks, etc.-each one spe-
hastened to conclude that the variations represented different cialized to survive in a particular environmental niche. Nineteenth-
stages of evolution which happened to be jostling each other within century medical men read this loosely to mean that everything is
the same instant of natural history. Some went so far as to declare getting more "specialized," and that "specialization" was the goal of
that rich men must be in the evolutionary vanguard, since they evolution-an interpretation which was no doubt influenced by the
were obviously so well adapted to the (capitalist) environment. ongoing formation of the academic disciplines (and within medi-
(Andrew Carnegie was an ardent subscribe.r to this theory.) cine, the medical specialties and subspecialties).
Almost all agreed that the existing human races represented dif- The next step in the logic was to interpret sexual differentiation
ferent evolutionary stages. A vast body of research-consisting within a species as a kind of "specialization" and mark of evolution-
chiefly in measurements of brain weights, head sizes, and facial ary advance. As G. Stanley Hall, a founder of psychology and lead-
• FOR HER OWN GOOD The Sexual Politics of Sickness
ing child-raising expert of the early twentieth century put it in his tionary possibilities. (G. Stanley Hall leaped quickly to the implica-
famous book Adolescence: tions for the professions: "The male in all the orders of life is the agent
"In unicellular organisms the ~onjugating [mating] cells are of variation and tends by nature to expertness and specialization,
alike, but forms become more and more dimorphic. As we go without which his individuality is incomplete. ")45 [Emphasis added.]
higher [up the evolutionary ladder] sexes diverge not only in pri- Suddenly the professional differences among middle-class men rep-
mary and secondary sex characteristics, but in functions not associ- resented the "variations"required for evolution, as if natural selection
ated with sex."43 Thus the difference between the sexes could be would be picking between psychologists and mathematicians, gyne-
expected to widen ever further as "man" evolved, and since evolu- cologists and opthamologists! It followed in his line of reasoning
tion was commonly equated with progress, this must be a good that women could not be experts because they represented a more
thing. As natural history professor Vogt saw it, "the inequality of the primitive, undifferentiated state of the species and were incapable
sexes increases with the progress of civilization."44 of "specialization": "She is by nature more typical and a better rep-
What was this difference between the sexes which was widening resentative of the race and less prone to specialization." 46
with every evolutionary leap? The answer rested on a certain mas- But of course in the post-Darwinian scientific value system,
culinist assumption about the process of evolution itself. Evolution- - "specialization" was good ("advanced"); de-specialization was bad
ary change occurs as environmental conditions "select" for certain ("primitive"). Now put this together with the fact that the species as
variants in the species. For example, in an arctic environment the a whole was getting ever more "specialized" sexually as part of its
fox which is accidentally born with white fur has a survival advan- general evolutionary advance: it followed that men would become
tage over its red sisters and brothers, so white foxes tend to displace ever more differentiated, while women would become progres-
red ones over time. We lmow now that the variations that allow for sivelyde-differentiated, and ever more concentrated on the ancient
change occur through the random and unpredictable process of animal function of reproduction. Taken to its extreme conclusion,
genetic mutation. But to nineteenth-century scientists, who lmew this logic could only mean that for every rung of the evolutionary
nothing whatsoever about genes, heredity, mutations, etc., the abil- ladder man ascended, woman would fall back a rung, as if, in some
ity to vary in potentially successful ways (as the white fox had done) Elysian future, a superman would stand at the top of the ladder, a
seemed to require a degree of cleverness and daring. It must, blob of reproductive protoplasm at the bottom.
therefore, be a male trait. So in the grand chain of evolution, males Hall backed off from this conclusion with a diversionary out-
were the innovators, constantly testing themselves against the harsh burst of chivalry, calling for
environment while females dumbly passed on whatever hereditary
material they had been given. Males produced the variations; ... a new philosophy of sex which places the wife and
females merely reproduced them. mother at the heart of a new world and makes her the object
From there it was only a hop, skip, and jump to a theory of con- of a new religion and almost of a new worship, that will give
temporary human sexual differences. Males were made to "vary,"that her reverent exemption from sex competition [i.e., competi-
is, to fill a variety of functions in the social division of labor. Females, tion with men] and reconsecrate her to the higher responsi-
being more primitive, were non-varying and identical in evolutionary bilities of the human race, into the past and future of which
function, and that function was to reproduce. Woman represented the the roots of her being penetrate; where the blind worship of
ancient essence of the species; man represented its boundless evolu- mere mental illumination has no place .... 47
132 • FOR HER OWN GOOD The Sexual Politics of Sickness • 1 33
The fact was, as Charlotte Perkins Gilman observed too, but with a that is voluptuous, tender, and endearing; that her fidelity,
very different set of emotions, that society was channeling women her devotedness, her perpetual vigilance, forecast, and all
(or at least the more affluent of them) into the "sex function." If the those qualities of mind and disposition which inspire respe.ct
natural scientists were right, she would evolve to become ever more and love and fit her as the safest counsellor and friend of
exclusively consecrated to sex, shedding "mere mental illumina- man, spring from the ovaries,-what must be their influence
tion" and other artifices, as she strode-or, more likely, crawled and power over the great vocation of woman and the august
toward her evolutionary destiny. purposes of her existence when these organs have become
compromised through disease/ 51 [Emphasis in original.]
The Dictatorship of the Ovaries According to this "psychology of the ovary'' woman's entire person-
ality was directed by the ovaries, and any abnormalities, from irri-
It was medicine's task to translate the evolutionary theory of women tability to insanity, could be traced to some ovarian disease. Dr.
into the language of flesh and blood, tissues and organs. The result Bliss added, with unbecoming spitefulness, that "the influence of
was a theory which put woman's mind, body, and soul in the thrall the ovaries over the mind is displayed in woman's artfulness and
of her all-powerful reproductive organs. "The Uterus, it must be dissimulation."
remembered," Dr. F. Rollick wrote, "is the controlling organ in the It should be emphasized, before we follow the workings of the
female body, being the most excitable of all, and so intimately con- uterus and ovaries any further, that woman's total submission to the
nected, by the ramifications of its numerous nerves, with every "sex function" did not make her a sexual being. The medical model
other part." 48 Professor M. L. Holbrook, addressing a medical soci- of female nature, embodied in the "psychology of the ovary," drew
ety in 1870, observed that it seemed "as if the Almighty, in creating a rigid distinction between reproductivity and sexuality. Women
the female sex, had taken the uterus and built up a woman around were urged by the health books and the doctors to indulge in deep
it." 49 [Emphasis in original.] preoccupation with themselves as "The Sex"; they were to devote
To other medical theorists, it was the ovaries that occupied cen- themselves to developing their reproductive powers and their
ter stage. Dr. G. L. Austin's 1883 book of advice for "maiden, wife maternal instincts. Yet doctors said they had no predilection for the
and mother" asserts that the ovaries "give woman all her character- sex act itself. Even a woman physician, Dr. Mary Wood-Allen wrote
istics of body and mind." 50 This passage written in 1870 by Dr. (perhaps from experience), that women embrace their husbands
W. W. Bliss, is, if somewhat overwrought, nonetheless typical: "without a particle of sex desire." 52 Hygiene manuals stated that the
more cultured the woman, "the more is the sensual refined away
Accepting, then, these views of the gigantic power and in- from her nature," and warned against "any spasmodic convulsion"
fluence of the ovaries over the whole animal economy of on a woman's part during intercourse lest it interfere with concep-
woman,-that they are the most powerful agents in all the tion. Female sexuality was seen as unwomanly and possibly even
commotions of her system; that on them rest her intellectual detrimental to the supreme function of reproduction.
standing in society, her physical perfection, and all that lends The doctors themselves never seemed entirely convinced,
beauty to those fine and delicate contours which are constant though, that the uterus and ovaries had successfully stamped out
objects of admiration, all that is great, noble and beautiful, all female sexuality. Underneath the complacent denials of female sex-
ual feelings, there lurked the age-old male fascination with woman's It being beyond doubt that consumption ... is itself pro-
"insatiable lust," which, once awal<ened, might tum out to be duced by the failure of the [menstrual] function in the form-
uncontrollable. Doctors dwelt on cases in which women were ing girls ... one had been the parent of the other ·with·
destroyed by their cravings; one doctor claimed to have discovered interchangeable priority. [Actually,as we know today, it is true
a case of "virgin nymphomania." The twenty-five-year-old British that consumption may result in suspension of the menses.] 55
physician Robert Brudenell Carter leaves us with this tantalizing
observation of his female patients: Since the reproductive organs were the source of disease, they
were the obvious target in the treatment of disease: Any symptom-
... no one who has realized the amount of moral evil backaches, irritability, indigestion, etc.-could provoke a medical
wrought in girls ... whose prurient desires have been in- assault on the sexual organs. Historian Ann Douglas Wood describes
creased by Indian hemp and partially gratified by medical the "local treatments" used in the mid-nineteenth century for
manipulations, can deny that remedy is worse than disease. I almost any female complaint:
have ... seen young unmarried women, of the middle class
of society, reduced by the constant use of the speculum to This [local] treatment had four stages, although not every
the mental and moral condition of prostitutes; seeking to case went through all four: a manual investigation, "leech-
give themselves the same indulgence by the practice of soli- ing," "injections," and "cauterization." Dewees [an American
tary vice; and asking every medical practitioner ... to insti- medical professor] and Bennet, a famous English gynecolo-
tute an examination of the sexual organs.53 gist widely read in America, both advocated placing the
leeches right on the vulva or the neck of the uterus, although
But if the uterus and ovaries could not be counted on to sup- Bennet cautioned the doctor to count them as they dropped
press all sexual strivings, they were still sufficiently in control to be off when satiated, lest he "lose" some. Bennet had know
blamed for all possible female disorders, from headaches to sore adventurous leeches to advance into the cervical cavity of the '
throats and indigestion. Dr. M. E. Dirix wrote in 1869: uterus itself, and he noted, "I think I have scarcely ever seen
more acute pain than that experienced by several of my
Thus, women are treated for diseases of the stomach, liver, patients under these circumstances." Less distressing to a
kidneys, heart, lungs, etc.; yet, in most instances, these dis- 20th century mi:ri.d,but perhaps even more senseless, were
eases will be found on due investigation, to be, in reality, no the "injections" into the uterus advocated by these doctors.
diseases at all, but merely the sympathetic reactions or the The uterus became a kind of catch-all, or what one exasper-
symptoms of one disease, namely, a disease of the womb. 54 ated doctor referred to as a "Chinese toy shop": Water, milk
and water, linseed tea, and "decoction of marshmellow ...
Even tuberculosis could be traced to the capricious ovaries. When tepid or cold" found their way inside nervous women
men were consumptive, doctors sought some environmental factor, patients. The final step, performed at this time, one must
such as overexposure, to explain the disease. But for women it was remember, with no anesthetic but a little opium or alcohol,
a result of reproductive malfunction. Dr. Azell Ames wrote in 1875: was cauterization, either through the application of nitrate of
silver, or, in cases of more severe infection, through the use One might think, given the all-powerful role of the ovaries, that
of much stronger hydrate of potassa, or even the "actual an ovaryless woman would be like a rudderless ship-desexed and
cautery," a "white-hot iron" instrument. 56 directionless. But on the contrary, the proponents of ovariotomy
argued, a woman who was relieved of a diseased ovary would be a
In the second half of the century, these fumbling experiments better woman. One 1893 advocate of the operation claimed that
with the female interior gave way to the more decisive technique of "patients are improved, some of them cured; ... the moral sense of
surgery-aimed increasingly at the control of female personality the patient is elevated ... she becomes tractable, orderly, industri-
disorders. There had been a brief fad of clitoridectomy (removal of ous, and cleanly.""59 Patients were often brought in by their hus-
the clitoris) in the eighteen sixties, following the introduction of the bands, who complained of their unruly behavior. Doctors also
operation by the English physician Isaac Baker Brown. Although claimed that women-troublesome but still sane enough to recog-
most doctors frowned on the practice of removing the clitoris, they nize their problem-often "came to us pleading to have their
tended to agree that it might be necessary in cases of nymphoma- 60
ovaries removed." The operation was judged successful if the
nia, intractable masturbation, or "unnatural growth" of that organ. woman was restored to a placid contentment with her domestic
(The last clitoridectomy we lrnow of in the United States was per- functions.
formed in 1948 on a child of five, as a cure for masturbation.) The overwhelming majority of women who had leeches or hot
The most common form of surgical intervention in the female steel applied to their cervices, or who had their clitorises or ovaries
personality was ovariotomy, removal of the ovaries-or "female cas- removed, were women of the middle to upper classes, for after all,
tration." In 1906 a leading gynecological surgeon estimated that these procedures cost money. But it should not be imagined that
there were 150,000 women in the United States who had lost their poor women were spared the gynecologist's exotic catalog of tor-
ovaries under the lrnife. Some doctors boasted that they had tures simple because they couldn't pay. The pioneering work in
removed from fifteen hundred to two thousand ovaries apiece. 57 gynecological surgery had been performed by Marion Sims on
According to historian G. J.Barker-Benfield: black female slaves he kept for the sole purpose of surgical experi-
mentation. He operated on one of them thirty times in four years,
Among the indications were troublesomeness, eating like a being foiled over and over by post-operative infections. 61 After
ploughman, masturbation, attempted suicide, erotic tenden- moving to New York, Sims continued his experimentation on indi-
cies, persecution mania, simple "cussedness," and dysmenor- gent Irish women in the wards of the New York Women's Hospital.
rhea [painful menstruation]. Most apparent in the enormous So, tl10ugh middle-class women suffered most from the doctors'
variety of symptoms doctors took to indicate castration was a actual practice, it was poor and black women who had suffered
strong current of sexual appetitiveness on the part of women. 58 through the brutal period of experimentation.
The rationale for the operation flowed directly from the theory of
the "psychology of the ovary": since the ovaries controlled the per-
sonality, they must be responsible for any psychological disorders: "It is unlikely that the operation had this effect on a woman's personality. It
conversely, psychological disorders were a sure sign of ovarian dis- would have produced the symptoms of menopause, which do not include any
ease. Ergo, the organs must be removed. established personality changes.
Woman Question were being fought out on the dissecting table:

The Uterus vs. the Brain ~n the one hand, the brain-aggressive, calculating; on the other
hand, the uterus-moistly receptive, nurturing, still governed by the
The reign of the uterus (and ovaries) was never entirely as tranquil ancient tempo of the moon and tides.
and secure as the doctors might have wished. There was the con- The possibility of peaceful coexistence between the two organs
stant threat of subversion by sexual feelings, arising from God was ruled out by the basic laws of physiology. Medical men saw the
knows what disorders of the brain or genitals. Doctors warned that body as a miniature economic system, with the various parts-like
vice in any form could derange the entire woman, flesh and spirit. classes or interest groups-competing for a limited supply of
Nothing alarmed them more than masturbation-known at the resources. Each body contained a set quantity of energy which
time as self-abuse or simply "the vice"-which could lead to men- could be directed variously from one function to another. Thus
strual dysfunction, uterine disease, lesions on the genitals, tubercu- there was inevitably a tension between the different functions, or
losis, dementia, and general decay. organs-one could be developed only at the expense of the others.
With the fervor of public health officials battling plague germs, Strangely enough, doctors saw no reason to worry about conflicts
the doctors pursued "the vice" into its dark and solitary hideouts. between the lungs and the spleen, or the liver and the kidneys, or
Parents were urged to watch their children for the first symptoms other possible pairs of combatants. The central drama, in bodies
(pallor, languor, peevishness) and if necessary to strap their hands male or female, was that great duel between the brain and the
to their sides at night. Patients of both sexes were urged to "con- reproductive organs.
fess." In women even amorous thoughts inspired by reading, par- Needless to say, the desirable outcome of this struggle was quite
ties, flirtations, or "hot drinks" could upset the entire physiology. different for the two sexes. Men were urged to back the brain, and
Doctors acknowledged a stem duty to oppose the reading of to fight the debilitating effects of sexual indulgence. Since the mis-
romantic novels "as one of the greatest causes of uterine disease in sion of the male (the middle-class male, anyway) was to be a busi-
young women." 62 nessman, professor, lawyer, or gynecologist-he had to be careful to
As the century wore on, the hegemony of the uterus appeared to conserve all his energy for the "higher functions." Doctors warned
grow ever shakier. More and more women were rejecting the doc- men not to "spend their seed" (the material essence of their energy)
tors' passive, sickly model of femininity and carving out activist recklessly in marital relations, and of course not to let it dribble
roles for themselves. The suffrage movement had grown to nation- away in secret vice or prurient dreams. Historian Barker-Benfield
wide proportions and was waging highly organized campaigns state suggests that the doctors' fanatical dread of female sexuality reflected
by state. More and more middle-class women were seeking college the constant, uphill struggle to preserve the male fluids for male
educations either in the burgeoning women's colleges, like Smith endeavors. The "oversexed" woman was seen as a sperm-draining
(opened in 1875), Wellesley (1875), Bryn Mawr (1885), and Mills vampire who would leave men weak, spent, and effeminate.
(1885), or in all-male institutions like Cornell, Williams, and Har- In reverse but almost parallel terms, women were urged to tlrrow
vard. 63 To the doctors it seemed as if a new organ had entered the their weight behind the uterus and resist the temptations of the
scene to contest for power-the female brain. Nineteenth-century brain. Because reproduction was woman's grand purpose in life,
gynecology became absorbed in the combat between the brain and doctors agreed that women had to concentrate all their energy
the uterus for dominion over the female persona. It was as if the downward toward the womb. All other activity should be slowed
140 • FOR HER OWN GOOD
The Sexual Politics of Sickness •
down or stopped during the peak periods of uterine energy demand. Women beware. You are on the brink of destruction: You
At puberty, girls were advised to take a great deal of bed rest in order have hitherto been engaged in crushing your waists; now you
to help focus their strength on regulating their periods-though this are attempting to cultivate your mind: You have been mere!y
might take years. Too much reading or intellectual stimulation in the dancing all night in the foul air of the ball-room; now you are
fragile stage of adolescence could result in permanent damage to the beginning to spend your mornings in study. You have been
reproductive organs, and sickly, irritable babies. incessantly stimulating your emotions with concerts and
Pregnancy was another period requiring intense mental vacuity. operas, with French plays, and French novels; now you are
One theory had the brain and the pregnant uterus competing not exerting your understanding to learn Greek, and solve
only for energy, but for a material substance-phosphates. 64 Every propositions in Euclid. Beware!! Science pronounces that
mental effort of the mother-to-be could deprive the unborn child of the woman who studies is lost. 66
some of this vital nutrient, or would so overtax the woman's own sys-
tem that she would be driven to insanity and require "prolonged Dozens of medical researchers rushed in to plant the banner of sci-
administration of phosphates." Menopause brought no relief from ence on the territory opened up by Clarke's book. Female students,
the imperious demands of the uterus. Doctors described it as a "Pan- their studies showed, were pale, in delicate health, and prey to
dora's box of ills," requiring, once again, a period of bovine placidity. monstrous deviations from menstrual regularity. (Menstrual irregu-
But it was not enough to urge women in the privacy of the office or larity upset the doctor's sensibilities as much as female sexuality.
sickroom to side with the beleaguered uterus. The brain was a pow- Both were evidences of spontaneous, ungovernable forces at work
erful opponent, as the advance of the women's movement and the in the female flesh.) A 1902 study showed that 42 percent of the
growing number of educated women showed. It must have seemed women admitted to insane asylums were well educated compared
to the doctors that only they had the wisdom and courage to cham- to only 16 percent of the men-"proving," obviously, that higher
pion the poor uterus, who was, by her nature, not so nimble and clever education was driving women crazy.67 But the consummate evi-
as her opponent. So the doctors were led, beginning in the eighteen dence was the college woman's dismal contribution to the birth
seventies, into the ongoing public debate over female education. rate. An 1895 study found that 28 percent of female college gradu-
Dr. Edward H. Clarke's book Sex in Education, or a Fair Chance ates married, compared to So percent of women in general. 68 The
for the Girls was the great uterine manifesto of the nineteenth cen- birth rate was falling among white middle-class people in general,
tury. 65 It appeared at the height of the pressure for co-education at and most precipitously among the college educated. G. Stanley
Harvard, where Clarke was a professor, and went through seven- Hall, whose chapter on "Adolescent Girls and their Education"
teen -editions in the space of a few years. Clarke reviewed the med- reviewed thirty years of medical arguments against female educa-
ical theories of female nature-the innate frailty of women, the tion, concluded with uncharacteristic sarcasm that the colleges
brain-uterus competition-and concluded, with startling but unas- were doing fine if their aim was to train "those who do not marry or
sailable logic, that higher education would cause women's uteruses if they are to educate for celibacy." "These institutions may perhaps
to atrophy! come to be training stations of a new-old type, the agamic or agenic
Armed with Clarke's arguments, doctors agitated vociferously [i.e., sterile] woman, be she aunt, maid-old or young-nun, school-
against the dangers of female education. R. R. Coleman, M.D., of teacher, or bachelor woman." 69
Birmingham, Alabama, thundered this warning: The doctors and psychologists (for we should acknowledge
Hall's inRuential contribution to the debate) conceded that it was expect the brain to have an easy victory. The struggle between the
possible for a woman, if she were sufficiently determined, to dodge brain, with its die-hard intellectual pretensions, and the primitive,
the destiny prepared for her by untold eons of evolutionary strug- but tenacious uterus could tear a woman apart-perhaps des-troy-
gle, and throw in her lot with the brain. But the resulting "mental ing both organs in the process. So in the end all that awaited the
woman," if we may so term this counterpart to the natural, "uterine brain-oriented woman was in most cases sickness, which of course
woman," could only hope to be a freak, morally and medically. "She is precisely what awaited her if she remained a "good," uterine
has taken up and utilized in her own life all that was meant for her woman. S. Weir Mitchell smugly expressed to a graduating class at
descendants," Hall complained. "This is the very apotheosis of self- Radcliffe his hope "that no wreck from these shores will be drifted
ishness from the standpoint of every biological ethics." Physically, into my dockyard"-but, really, what hope was there? 72
the results were predictable: "First, she loses her mammary func- The medical warnings against higher education did not go
tion." Hall wrote, 70 since lactation seemed to represent woman's unheeded. Martha Carey Thomas, president of Bryn Mawr Col-
natural unselfishness. lege, confessed that as a young woman she had been "terror-struck"
Some medical writings suggested that the loss of the mammary after reading the chapters relating to women in Hall's Adolescence,
function would be accompanied by an actual loss of the breasts. "In lest she "and every other woman ... were doomed to live as patho-
her evening gown she shows evidence of joints which had been logical invalids ... " as a result of their education. 73 Martha Carey
adroitly hidden beneath tissues of soft flesh," wrote Arabella Thomas survived her education and pursued a full and demanding
Kenealy, M.D., of the "mental woman," "and already her modesty career (no doubt serving to the doctors as a repulsive example of
has been put to the necessity of puffing and pleating, where Nature muscular, brain-dominated woman), but there were also casualties.
had planned the tenderest and most dainty of devices," i.e., the Margaret Cleaves, M.D. of Des Moines ended by confessing the
breast. Doctors agreed that the brain-dominated woman would futility of her own attempts at a career. In her own description she
be muscular, angular, abrupt in her motions. Dr. Kenealy, who had been a "mannish Maiden" from the start and had let her mas-
directed many of her writings as polemics against Olive Schreiner, culine ambition draw her into a medical education. But no sooner
described the new woman thus: had she achieved her goal than she developed a galloping case of
neurasthenia, or "sprained brain" as she diagnosed it. "It may be
Where before her beauty was suggestive and elusive, now it true," she admitted in her book The Autobiography of a Neuras-
is defined .... The haze, the elusiveness, the subtle sugges- . thene:
tion of the face are gone .... The mechanism of movement is
no longer veiled by a certain mystery of motion .... Her As emphasized by [S. Weir] Mitchell and others, that girls
voice is louder, her tones are assertive. She says everything- and women are unfit to bear the continued labor of mind
leaves nothing to the imagination. 71 because of the disqualifications existing in their physiological
life.74
Uterine woman had been indistinct, mysterious, like a veil over
the harsh face of industrial society. The real horror of the brain- Similarly,Antoinette Brown, America's first female minister, dropped
dominated woman was that she left man with no illusions. out of the ministry after being converted to the "scientific" theory of
Even the woman who opted for the sexless, mental life could not woman's nature. 75
As the century wore on, fewer and fewer women were willing to supposed to result in a daily weight gain. The massages lasted for
take the doctor's advice seriously, though. Feminists vigorously one hour a day, covering the entire body, and increasing in vigor as
attacked the idea that women did not have the stamina for higher the cure wore on. .
education, and even satirized the medical injunctions, as in this The cure became immensely popular-largely because, unlike
poem, "The Maiden's Vow": other gynecological treatments, this one was painless. As a result of
the rest cure, Philadelphia (where Mitchell practiced) was soon
I will avoid equations "the mecca for patients from all over the world." 77 Jane Addams
And shun the naughty surd underwent the rest cure, but it was apparently unsuccessful since it
I must beware the peifect square had to be followed with six more months of rest during which
Through it young girls have erred Addams was "literally bound to a bed" in her sister's house. 78 Char-
And when men mention Rule of Three lotte Perkins Gilman underwent the cure before being discharged
Pretend I have not heard. 76 to "live as domestic a life as possible"-the results of which we have
already recounted. But the majority of the patients seem to have
come out of the cure filled, if not with health, with a sycophantic
The Rest Cure worship of Dr. Mitchell. Ex-patients and would-be patients plied
him with small gifts and admiring letters, such as this one, which
The notion of the female body as the battleground of the uterus and contrasts the writer's continued invalidism with the virile strength
the brain led to two possible therapeutic approaches: one was to of the physician:
intervene in the reproductive area-removing "diseased" organs or
strengthening the uterus with bracing doses of silver nitrate, injec- Whilst laid by the heels in a country-house with an attack of
tions, cauterizations, bleedings, etc. The other approach was to go grippe, also an invalid from gastric affection, the weary eyes
straight for the brain and attempt to force its surrender directly. of a sick woman fall upon your face in the Century [maga-'
The doctors could hardly use the same kind of surgical techniques zine] of this month-a thrill passed through me-at last I
on the brain as they had on the ovaries and uterus, but they discov- saw the true physician!79
ered more subtle methods. The most important of these was the
rest cure-the world-famous invention of Dr. S. Weir Mitchell. The secret of the rest cure lay not in the soft foods, the mas-
The rest cure depended on the now-familiar techniques of sages, or even, ultimately, in the intellectual deprivation, but in
twentieth-century brainwashing-total isolation and sensory depri- the doctor himself. S. Weir Mitchell must be counted as one of
vation. For approximately six weeks the patient was to lie on her the great pioneers, perhaps the greatest, in the development of the
back in a dimly lit room. She was not permitted to read. If her case twentieth-century doctor-patient relationship, or more generally,
was particularly severe, she was not even permitted to rise to uri- the expert-woman relationship. His personal friend and colleague
nate. She was to have no visitors and to see no one but a nurse and Sir William Osler came to represent for posterity the masculinist
the doctor. Meanwhile, while the unwary brain presumably drifted ideal of the healer. But it was Mitchell, blessed with an endless sup-
off into a twilight state, the body would be fortified with feedings ply of female invalids and neurasthenics, who perfected the tech-
and massages. The feedings consisted of soft, bland foods and were nique of healing by command.
Mitchell was, by his own description, a "despot" in the sickroom. side, he would threaten to bring out his own, literal phallus. For
Patients were to ask no questions (or, like poor Gilman, attempt to example, according to a popular anecdote, when one patient failed
volunteer information). His manner would be gentle and sympa- to recover at the end of her rest cure:
thetic one moment, abrupt and commanding the next. Now mag-
nify Dr. Mitchell's authoritarianism by the conditions of the rest Dr. Mitchell had run the gamut of argument and persuasion
cure: the patient has been lying in semidarkness all day. She has not and finally announced, "If you are not out of bed in five
seen any other man, and no person but for the nurse, for weeks. She minutes-I'll get into it with you!" He thereupon started to
is weak and languid from lying still for so long. Perhaps the long remove his coat, the patient still obstinately prone-he
massage has left her with inadmissible sensations which she hesi- removed his vest, but when he started to take off his
tates to localize even in imagination. Enter Dr. Mitchell. His lack of trousers-she was out of bed in a fury!81
physical stature makes no difference to a prostrate woman. He is
confident, commanding, scientific. He chides the patient for her
lack of progress, or predicts exactly how she will feel tomorrow, in Subverting the Sick Role: Hysteria
one week, in a month. The patient can only feel a deep gratitude for
this particle of attention, this strange substitute for human com- The romance of the doctor and the female invalid comes to full
panionship. She resolves that she will get better, as he has said she bloom (and almost to consummation) in the practice of S. Weir
must, which means she will try to be a better woman, more com- Mitchell. But as the anecdote just cited reveals, there is a nastier
pletely centered on her reproductive functions. side to this affair. An angry, punitive tone has come into his voice;
It is as if Dr. Mitchell recognized that in the battle between the the possibility of physical force has been raised. As time goes on and
uterus and the brain, a third organ would have to be called into the invalids pile up in the boudoirs of American cities and recircu-
play-the phallus. The "local treatments" of earlier decades had late through the health spas and consulting rooms, the punitive
already recognized the need for direct male penetration to set tone grows louder. Medicine is caught in a contradiction of its own
errant females straight. Nineteenth-century doctors universally making, and begins to tum against the patient.
expected sick (or cantankerous) women to spread their legs and Doctors had established that women are sick, that this sickness
admit leeches, "decoctions," the scalpel-whatever the physician is innate, and sterns from the very possession of a uterus and
. chose to insert. But these were mere adolescent pokings compared ovaries. They had thus eliminated the duality of "sickness" and
to the mature phallic healing introduced by S. Weir Mitchell. He "health" for the female sex; there was only a drawn-out half-life,
deplored "local treatments," foreswearing physical penetration tossed steadily by the "storms" of reproductivity toward a more
altogether (unless you count the constant oral ingestion of soft total kind of rest. But at the same time, doctors were expected to
foods). The physician, according to Mitchell, could heal by the cure. The development of commercial medicine, with its aggres-
force of his masculinity alone. This was, of course, the ultimate sive, instrumental approach to healing, required some public faith
argument against female doctors: they could not "obtain the that doctors could do something, that they could fix things. Cer-
needed control over those of their own sex."80 Only a male could tainly Charlotte Perkins Gilman had expected to be cured. The hus-
command the total submissiveness which constituted the "cure." bands, fathers, sisters, etc., of thousands of female invalids expected
If the patient did not yield to Mitchell's erect figure at the bed- doctors to provide cures. A medical strategy of disease by decree,
followed by "cures" that either mimicked the symptoms or old stock lead lives of celibate selfishness ... or if the mar-
new ones, might be successful for a few decades. But it had no ried are afflicted by that base fear of living which, whether
term commercial viability. for the sake of themselves or of their children, forbids thelll
The problem went deeper, though, than the issue of the r1r.,nt,-..~ '<'
0
to have more than one or two children, disaster awaits the
commercial credibility. There was a contradiction in the nrnma,,hn. nation. 83
ideal of femininity that medicine had worked so hard to construct.
Medicine had insisted that woman was sick and that her life cen- G. Stanley Hall and other expert observers easily connected the
tered on the reproductive function. But these are falling WASP birth rate to the epidemic of female invalidism:
propositions. If you are sick enough, you cannot reproduce. The
female role in reproduction requires stamina, and if you count in all In the United States as a whole from 1860-'90 the birthrate
the activities of child raising and running a house, it requires full. declined from 25.61 to 19.22. Many women are so exhausted
blown, energetic health. Sickness and reproductivity, the twin pil- before marriage that after bearing one or two children they
lars of nineteenth-century femininity, could not stand together. become wrecks, and while there is perhaps a growing dread
In fact, toward the end of the century, it seemed that sickness of parturition or of the bother of children, many of the best
had been winning out over reproductivity. The birth rate for whites women feel they have not stamina enough .... 84
shrank by a half between 1800 and 1900, and the drop was most
precipitous among white Anglo-Saxon Protestants-the "better" He went on to suggest that "if women do not improve," men would
class of people. Meanwhile blacks and European immigrants have to "have recourse to emigrant wives" or perhaps there would
appeared to be breeding prolifically, and despite their much higher have to be a "new rape of the Sabines."
death rates, the fear arose that they might actually replace the The genetic challenge posed by the "poorer elements" cast an
"native stock." Professor Edwin Conklin of Princeton wrote: unflattering light on the female invalid. No matter whether she was
"really" suffering, she was clearly not doing her duty. Sympathy,be-
The cause for alarm is the declining birth rate among the gins to give way to the suspicion that she might be deliberately malin-
best elements of a population, while it continues to increase gering. S. Weir Mitchell revealed his private judgment of his patients
among the poorer elements. The descendants of the Puritans in his novels, which dwelt on the grasping, selfish invalid, who uses
and the Cavaliers ... are already disappearing, and in a few her illness to gain power over others. In Roland Blake ( 1886) the evil
centuries at most, will have given place to more fertile invalid "Octapia" tries to squeeze the life out of her gentle cousin
races .... 82 Olivia. In Constance Trescot (1905) the heroine is a domineering,
driven woman, who ruins her husband's life and then relapses into
And in 1903 President Theodore Roosevelt thundered to the nation invalidism in an attempt to hold on to her patient sister Susan:
the danger of "race suicide":
By degrees Susan also learned that Constance relied on her
Among human beings, as among all other living creatures, if misfortune and her long illness to insure to her an excess of
the best specimens do not, and the poorer specimens do, sympathetic affection and unremitting service. The discover-
propagate, the type [race] will go down. If Americans of the ies thus made troubled the less selfish sister .... 85
• FOR HER OWN GOOD The Sexual Politics of Sickness ..
The story ends in a stinging rejection for Constance, as Susan leaves invalids from the frauds? And what did you do when no amount of
her to get married and assume the more womanly role of serving a drugging, cutting, resting, or sheer bullying seemed to make the
man. Little did Dr. Mitchell's patients suspect that his ideal woman woman well?
was not the delicate lady on the bed, but the motherly figure of the Doctors had wanted women to be sick, but now they found
nurse in the background! In fact, Mitchell's rest cure was implicitly themselves locked in a power struggle with the not-so-feeble
based on the idea that his patients were malingerers. As he explained patient: Was the illness a construction of the medical imagination, a
it, the idea was to provide the patient with a drawn-out experience figment of the patient's imagination, or something "real" that nev-
of invalidism, but without any of the pleasures and perquisites which ertheless eluded the mightiest efforts of medical science? What,
usually went with that condition. after all, was behind "neurasthenia," "hyperesthesia," or the dozens
of other labels attached to female invalidism?
To lie abed half the day, and sew a little and read a little, and But it took a specific syndrome to make the ambiguities in the
be interesting and excite sympathy, is all very well, but when doctor-patient relationship unbearable, and to finally break the
they are bidden to stay in bed a month and neither to read, gynecologists' monopoly of the female psyche. This syndrome was
write, nor sew, and to have one nurse,-who is not a relative,- hysteria. In many ways, hysteria epitomized the cult of female inva-
then rest becomes for some women a rather bitter medicine, lidism. It affected middle- and upper-class women almost exclu-
and they are glad enough to accept the order to rise and go sively;it had no discernible organic basis; and it was totally resistant
about when the doctor issues a mandate .... 86 to medical treatment. But unlike the more common pattern of inva-
lidism, hysteria was episodic. It came and went in unpredictable,
Many women probably were using the sick role as a way to and frequently violent, fits.
escape their reproductive and domestic duties. For the woman to According to contemporary descriptions, the victim of hysteria
whom sex really was repugnant, and yet a "duty," or for any woman might either faint or throw her limbs about uncontrollably. Her
who wanted to avoid pregnancy, sickness was a way out-and there back might arch, with her entire body becoming rigid, or she might
were few others. The available methods of contraception were beat her chest, tear her hair or attempt to bite herself and others.
unreliable, and not always that available either. 87 Abortion was Aside from fits and fainting, the disease took a variety of forms: hys-
illegal and risky. So female invalidism may be a direct ancestor of terical loss of voice, loss of appetite, hysterical coughing or sneez-
the nocturnal "headache" that so plagued husbands in the mid- ing, and, of course, hysterical screaming, laughing, and crying. The
twentieth century. · disease spread wildly, not only in the United States, but in England
The suspicion of malingering-whether to avoid pregnancy or and throughout Europe. ·
gain attention-cast a pall over the doctor-patient relationship. If a Doctors became obsessed with this "most confusing, mysterious
woman was really sick (as the doctors said she ought to be), then the and rebellious of diseases." In some ways, it was the ideal disease
doctor's efforts, however ineffective, must be construed as appro- for the doctors: it was never fatal, and it required an almost endless
priate, justifiable, and of course reimbursable. But if she was not amount of medical attention. But it was not an ideal disease from
sick, then the doctor was being made a fool of. His manly, profes- the point of view of the husband and family of the afflicted woman.
sional attempts at treatment were simply part of a charade directed Gentle invalidism had been one thing; violent fits were quite
by and starring the female patient. But how could you tell the real another. So hysteria put the doctors on the spot. It was essential to
• FOR HER OWN GOOD The Sexual Politics of Sickness • 153
their professional self-esteem either to find an organic basis for the and threatening attitude. One doctor wrote, "It will sometimes be
disease, and cure it, or to expose it as a clever charade. advisableto speak in a decided tone, in the presence of the patient,
There was plenty of evidence for the latter point of view. With of the necessity of shaving the head, or of giving her a cold sho:"er
mounting suspicion, the medical literature began to observe that bath, should she not be soon relieved." He then gave a "scientific"
hysterics never had fits when alone, and only when there was some- rationalization for this treatment by saying, "The sedative influence
thing soft to fall on. One doctor accused them of pinning their hair of fear may allay, as I have known it to do, the excitement of the ner-
,,90
in such a way that it would fall luxuriantly when they fainted. The vous centers ....
hysterical "type" began to be characterized as a "petty tyrant" with Carroll Smith-Rosenberg writes that doctors recommended suf-
a "taste for power" over her husband, servants, and children, and, if focating hysterical women until their fits stopped, beating them
possible, her doctor. across the face and body with wet towels, and embarrassing them in
In historian Carroll Smith~Rosenberg's interpretation, the doc- front of family and friends. She quotes Dr. F. C. Skey: "Ridicule to
tor's accusations had some truth to them: the hysterical fit, for many a woman of sensitive mind, is a powerful weapon ... but there is
women, must have been the only acceptable outburst-of rage, of not an emotion equal to fear and the threat of personal chastise-
despair, or simply of energy-possible.BB Alice James, whose life- ment. ... They will listen to the voice of authority." The more
long illness began with a bout of hysteria in adolescence, described women became hysterical, the more doctors became punitive
her condition as a struggle against uncontrollable physical energy: toward the disease; and at the same time, they began to see the dis-
ease everywhere themselves until they were diagnosing every in-
Conceive of never being without the sense that if you let dependent act by a woman, especially a women's rights action, as
yourself go for a moment ... you must abandon it all, let the "hysterical."
dykes break and the flood sweep in, acknowledging yourself With hysteria, the cult of female invalidism was carried to its
abjectly impotent before the immutable laws. When all one's logical conclusion. Society had assigned affluent women to a life of
moral and natural stock-in-trade is a temperament forbid- confinement and inactivity, and medicine had justified this assign-
ding the abandonment of an inch or the relaxation of a mus- ment by describing women as innately sick. In the epidemic of hys-
cle, 'tis a never-ending fight. When the fancy took me of a teria, women were both accepting their inherent "sickness" and
morning at school to study my lessons by way of variety finding a way to rebel against an intolerable social role. Sickness,
instead of shrieking or wiggling through the most impossible having become a way of life, became a way of rebellion, and med-
sensations of upheaval, violent revolt in my head overtook ical treatment, which had always had strong overtones of coercion,
me, so that I had to "abandon" my brain as it were.B9 revealed itself as frankly and brutally repressive.
But the deadlock over hysteria was to usher in a new era in the
On the whole, however, doctors did continue to insist that hys- experts' relationship to women. While the conflict between hyster-
teria was a real disease_:_a disease of the uterus, in fact. (Hysteria - ical women and their doctors was escalating in America, Sigmund
comes from the Greek word for uterus.) They remained unshaken Freud, in Vienna, was beginning to work on a treatment that would
in their conviction that their own house calls and high physician's remove the disease altogether from the arena of gynecology.
fees were absolutely necessary; yet at the same time, in their treat- Freud's cure eliminated the confounding question of whether or
ment and in their writing, doctors assumed an increasingly angry not the woman was faking: in either case it was a mental disorder.
154 • FOR HER OWN GOOD
Psychoanalysis, as Thomas Szasz has pointed out, insists that

"malingering is an illness-in fact, an illness 'more serious' than
hysteria." 91 Freud banished the traumatic "cures" and legiti:r_nized
a
doctor-patient relationship based solely on talking. His therapy
urged the patient to confess her resentments and rebelliousness,
and then at last to accept her role as a woman. Freud's insight into
hysteria at once marked off a new medical specialty: "Psychoanaly-
sis," in the words of feminist historian Carroll Smith-Rosenberg, "is
the child of the hysterical woman." In the course of the twentieth
century psychologists and psychiatrists would replace doctors as the
dominant experts in the lives of women.
For decades into the twentieth century doctors would continue
to view menstruation, pregnancy, and menopause as physical dis-
eases and intellectual liabilities. Adolescent girls would still be
advised to study less, and mature women would be treated indis-
criminately to hysterectomies, the modem substitute for ovari-
otomies. The female reproductive organs would continue to be
viewed as a kind of frontier for chemical and surgical expansionism,
untested drugs, and reckless experimentation. But the debate over
the Woman Question would never again be phrased in such crudely
materialistic terms as those set forth by nineteenth-century medical
theory-with brains "battling" uteruses for control of woman's
nature. The psychological interpretation of hysteria, and eventually
of "neurasthenia" and the other vague syndromes of female inva-
lidism, established once and for all that the brain was in command.
The experts of the twentieth century would accept woman's intelli-
gence and energy: the question would no longer be what a woman
could do, but, rather, what a woman ought to do.

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For Her Own Good

TWO CENTURIES OF THE EXPERTS'

A Division of Random House, Inc.

The Sexual Politics

hen Charlotte Perkins Gilman collapsed with a "nervous dis-

Gilman dutifully returned home and for some months at-

Woman Question were being fought out on the dissecting table:

Psychoanalysis, as Thomas Szasz has pointed out, insists that

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