science

Unwell Women by Elinor Cleghorn review – battle for the female body


During the recent anxieties about the AstraZeneca Covid vaccine and its possible link to blood clots, many women felt obliged to point out, on social media and in the press, that the risk of fatal thrombosis was significantly higher from using hormonal contraception, and yet this continues to be prescribed to millions of women without anything like the level of concern or scrutiny that the vaccine has received. The potential danger of a medication that only affects women is less of a headline-grabber, it seems. In fact, when the pill was first licensed in the US in 1960 it contained more than three times the levels of synthetic hormones than the modern version, and the side-effects – including fatal pulmonary embolisms and thrombosis – were deliberately downplayed. It took a sustained grassroots campaign by women’s groups to bring the issue to the attention of a congressional hearing in 1970. “From the beginning, the pill was couched as a way for women to take control of their bodies and fertility,” writes cultural historian Elinor Cleghorn in her debut book, Unwell Women. “But this also means that the costs – physical and mental – remain women’s burdens.”

The history of the pill is just one fascinating episode in this richly detailed, wide-ranging and enraging history of how conventional medicine has pathologised, dismissed and abused women from antiquity to the present. A male-dominated medical establishment, influenced by religious, cultural and political ideas about women’s bodies – particularly with regard to sexuality and reproduction – has inflicted immeasurable suffering on women and girls, often with a sense of righteous zeal. Some of the cases Cleghorn unearths could come straight from The Handmaid’s Tale. There’s the 19th-century London surgeon Isaac Baker Brown, an avid proponent of clitoridectomy to cure the hysteric and nervous disorders thought to be brought about by excessive masturbation in young middle-class women. Or the American neurologists Walter Freeman and James Watts, who pioneered the craze for lobotomies in the 1930s and 40s – by 1942, 75% of their patients were women. “In an era when a mentally healthy woman was a serene wife and mother, almost any behaviour or emotion that disrupted domestic harmony could be interpreted as justification for a lobotomy.”

Elinor Cleghorn
Elinor Cleghorn: ‘There is a sustained note of anger running through the book.’ Photograph: Lara Downie

The belief that a woman’s natural state was to be an obedient wife and devoted mother, and that any deviation from this was either a cause or effect of a disordered body and mind, is repeated depressingly throughout the history of androcentric western medicine. Cleghorn is at pains to point out the extent to which race and class also played a part in diagnosis: the persistent idea that women were susceptible to unexplained pains and nervous illnesses because they were more delicate and weaker than men only held true for middle- and upper-class white women. “The more civilised a woman was, the more pain she was capable of feeling.” This belief underlay some of the book’s most horrific case studies; the history of medical experimentation on enslaved women and sex workers.

Cleghorn marshals her ambitious quantity of material with clarity and often with dry humour, but there is a sustained note of justified anger running through the book. She approaches her subject not only from a historical perspective but also a personal one; she suffers from the autoimmune disease lupus, which predominantly affects women. In a final chapter, she tells her own story: the persistent unexplained pain through her 20s, dismissed as “just your hormones” by a male GP; the congenital heart block in her developing son, caused by her undiagnosed disease; the rush to A&E when she developed heart problems, only to be sent home with ibuprofen and rushed back two days later. Altogether it took seven years to receive a diagnosis and treatment. Like so many women, “I started to believe I must have been making it up, that the pain was all in my mind”.

Her conclusion is a passionate call to arms: by speaking out and sharing our stories, women can empower one another to challenge the stigma that has historically attached to female experience. “To be an unwell woman today is to fight against ingrained injustices against women’s bodies, minds and lives; but we no longer have to live in silence and shame,” she writes. Unwell Women is not just a compelling investigation, but an essential one.

Unwell Women: A Journey Through Medicine and Myth in a Man-Made World by Elinor Cleghorn is published by Weidenfeld & Nicolson (£16.99). To support the Guardian order your copy at guardianbookshop.com. Delivery charges may apply



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