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Wilfrid Laurier University
Women & Gender Studies
Lorraine Vander Hoef

Lesson 10: Medicalization Where did these ideas come from ? The Greek father of modern medicine Hippocrates who lived from 460-377 BCE believed that females lacked the male ability to sweat out impurities.According to Hippocrates, the way in which the female body rid impurities was through menstruation which he described, in contrast to the sweet and gentle smell of male sweat, as “noisome.” The ideas of Hippocrates, aside from a few variations went, for the most part, unchallenged until the 19th century. The attitude, however that the female body is flawed has persisted to the present.As you will notice, the male body was always held as the perfect form (Michangelo’s famous statue of David was meant to re-create this perfect form). Hippocrates also believed that the uterus wandered throughout the body and at times as high as the throat. He held the notion that the womb was particularly “frantic” when it was not weighted by semen, explaining the heightened anxiety in young virgins. We can perhaps laugh at how wrong Hippocrates was in his analysis and excuse his errors, but what is critical to remember is that these so called “medical facts” determined the identity of girls and women and their position in society. Today we use Pre-menstural Syndrome as a way of accounting for women’s “emotionalism”. Six centuries later, another Greek physician and philosopher, Galen (129-203 C.E.) dramatically influenced the way in which the human body was viewed. His ideas, like those of Hippocrates and Aristotle, were rooted in the ways in which their societies viewed the differences between men and women.And like so many men of his time, Galen tended to view the female body as terribly inadequate against that of the male body. So, he believed that menstrual blood was the residue from food that had not been fully digested. Even today, our ideas in Western culture about menstruation are described in a flurry of negative terms. We call it the “curse”, a “nuisance”, “dirty”. Throughout history, menstrual blood has been described as having toxic qualities.At different points European and later even here in NorthAmerica, people have believed that menstruating woman could turn good wine sour, good meat into bad, cause bread dough fall, and of course pollute sacred spaces. Menstruating women were often (and are still sometimes) removed from the spaces where food was prepared or rituals performed. Women were isolated after child birth again in order not to pollute sacred spaces. The history of evaluating the female body as not simply inferior but having destructive qualities harmful to society is a long one. ForYour Consideration: Throughout history, women’s uteruses have defined them.Agood woman gave birth; a woman incapable of giving birth or choosing not to give birth was held in suspicion. The problem is what to do about those apparently female bodies that lack a uterus? Are they still female? Are they any less a woman? Wombs identify women’s role in society. The capacity to give birth bring with it a whole set of values and a job description like being able to cook, clean and sacrifice for one’s family. Now if we were to turn the tables does having a penis somehow mean that a man who has one will know automatically how to fix a car, put up dry wall, make a good living? We forget that these organs have a biological function but do not prescribe behaviour. Medicalization: We can trace the onset of a process we know today as medicalization to the 19th century. It begins as medical doctors replace other kinds of health providers (like midwives). Medicalization was the process by which a medical model was used to define and justify social practices around all biological events from birth to death. Medicalization is a rather difficult concept to grasp.As an example, instead of seeing pregnancy as a natural event, medicalization imposed an interpretation that demanded that every stage of pregnancy must be chronicled to see if the pregnancy was advancing according to what physicians viewed as normal. The problem in this process was multi-fold. First, physicians had little knowledge about women�s bodies in any stage and rejected women's own ideas. They also viewed the white, middle class, female body as distinct in its characteristics and functions from those of women of colour or poor women. The end result of the process of medicalization was women's reliance on male doctors to inform them of what was normal and what was diseased. In the 19th century, white middle and upper class women who were pregnant were told by their physicians to stay at home, to rest and certainly not to think or be active since doing so would only zap the energy needed to grow the foetus. This medical model imposed on pregnancy a particular social response and identity for white women. The same message was not delivered to women of colour or immigrant women who could not afford a doctor anyway. With no other health professionals available, poor women and women of colour often suffered alone or died. Here's a breakdown of what medicalization involves: 1. Certain behaviours or conditions are given medical meaning — as either being healthy/normal or unhealthy/ill. 2. Medical practise functions to get rid of problematic experiences seen as deviant (homosexuality) so that all activities or experiences adhere to what is assumed as the social norm. For people to build trust in doctors, a medical language evolved that defined various physical or emotional occurrences as deviant, abnormal or unhealthy. Medical language that used scientific research as its basis grew to hold tremendous credibility in society as a whole. Patients in the 19th century were unlikely to question the veracity of scientific ideas. I would contend that as a society, we are only beginning to learn how science can be wrong. Few of us today would dare to ask questions about how the research project was conducted or whether the questions were pertinent, who the subjects were and under what conditions was the research conducted, or if the conclusions can actually be derived from the actual results. We have learned over the past century that our doctors and researchers carry into their practises biases on gender, race, sexuality and class. For a long time, the male body was viewed as the norm and therefore much of the research was conducted on men while assuming that the female body would have similar responses. I have found it both alarming and fascinating to see the countless ways in which researchers have discovered that the female body exhibits different symptoms in terms of heart attacks, or responds differently to drugs from the male body. Doctors silenced women's voices in the 19th century by not allowing women to contribute their own analysis. The relationship was developed on a hierarchy of gender, class and race. In all three categories, women were rendered less powerful and with less authority to speak and have their own knowledge validated. The consultation developed into a diagnostic process that did not include the patient's own contributions. Unfortunately, the dismissal of women's concerns and their knowledge occurred not only with medicalization but spread into other areas of women's lives. The process of devaluing women's intellectual potential continued in the 20th century in their public and private activities. Women who stayed at home were viewed as being out of touch, or incapable of comprehending social, political and economic issues. Betty Friedan discovered in the 1950s, that magazine publishers "dumbed down" articles believing women were not intellectually bright enough to read in-depth analyses. Physicians gained dominance in the 19th century with help of a medical establishment that backed their assessments. Doctors could call on medical schools, research centres and pharmaceutical companies to affirm their diagnoses and practices. Their influence, as doctors, spread far beyond where they actually had knowledge or the ability to help. In the 19th century, Canada did not have a universal health care system. Doctors were for those who could afford to pay for them not for those without resources. The rise in the medical profession followed the illegalization of midwives and other forms of health practitioners. For women, any activity or behaviour that stood outside the so-called norm of femininity was held suspect by doctors. Women who engaged in sports, or who might enjoy sex, women who wanted to read and learn and discuss ideas all received a negative response from the medical profession. Some doctors were known to have tested women's "asexuality" by manipulating their clitoris. LearningActivity: Connect how women's exclusion from sports, education and work were connected to medical models of the female body. While many women did as they pleased regardless of the restrictions imposed on their lives, they did so against the authority of husbands, family, friends and society at large. Without these rebelling women, the vote would not have been won, girls would not have access to education and so much more. But it takes courage to go against belief systems and social pressures. The influence of the medical profession on identity: Medicalization emerged as physicians took over the health field. This incursion of males into women's medical lives disrupted usual practises with midwives and other providers who perhaps had a type of knowledge that doctors were missing.As other health practitioners were outlawed, women found themselves silenced in a restrictive relationship with doctors who dismissed women's knowledge of their own bodies. Doctors had several standards — one that was applied to white middle class and upper class women who were viewed as the highest on the evolutionary chart along, and other standards that were applied to immigrant women and women of colour, whose less valued status justified their omission from education systems and better work possibilities. Poor women could hardly afford to hire the services of a doctor but were still subjected to ideas of "femininity" that clearly did not mirror the reality of their lives. These women were to work, have numerous babies and still be able to feed them.All of this was impossible on the wages most received. Pregnancy and birth were risky and more so when the provincial government outlawed midwifery. Even into the early 1930s, conditions in many of Ontario's hospitals were so poor that the mortality rate remained high for babies and mothers. (See Cynthia Comacchio's book,Nations are Built of Babies). Doctors also feared women's sexuality. Canada in the 19th century was very Christian. Religious teaching emphasized women's association with either the evil Eve who would tempt men to commit devious errors against God, or with the virtuous and ever sacrificing virginal Mary — mother of Jesus. Theologians had long preached that women needed to be controlled in order not to ruin men or society as a whole. The only safe woman according to 19th century medical practise was one with no sexual desire at all.And yet, there continued the underlining fear that an insatiable lust could be released in women which would have devastating effects on society as a whole. The question of how to control women was resolved by the definition of femininity and this insertion of the definition in every nook and cranny of society including medical practise. Doctors saw it as their duty to tame so called high-strung women. "Hysteria" or the "cult of invalidism" kept white women isolated (for some women this worked to their advantage because this was one way of avoiding pregnancy or sex for that matter with husbands who they did not love) and therefore unavailable to compete with men in the public sphere or to challenge power structures (like the church or the government). Women's bodies were a terrain on which three different medical specialists battled amongst themselves for the authority to interpret women's bodies. These were: -- gynaecologists -- alienists (a version of modern day psychiatrists) -- neurologists (view the nervous system) All three groups sought to have control over defining the source of women's mental illness and nervousness. In the end it was the gynaecologists who won control contending all of women's problems could be traced to their reproductive organs! Many women believed gynaecologists did know more about their bodies than they did. Few traced the discontent of their lives to the physical pain they were experiencing. But there were some women who discovered feigning "hysteria" exempted them from marriage, sex, and pregnancy. All the various specialists listed above believed that women had a pre-condition to insanity. They also all agreed that women were vastly different from men. The defining feature of the female body was the dominance of nerves which were interpreted as leading to women's irrationality while the male body was associated with the musculature system and strength of body and mind. The few women physicians of the time knew that placing the blame of women's discontent on reproductive organs was wrong. Even with this knowledge, female doctors lacked the influence with their male colleagues to change perceptions. Women doctors had their own battles to fight that included biases that they were biologically unfit to be doctors. So when women contested the findings of their colleagues, they placed themselves and their reputations at risk within the medical establishment. While female physicians' ideas were also riddled with biases in terms of race and class, they did come closer to comprehending why women were so unhappy. For white middle and upper class women, they blamed women's hysteria on restrictive life choices. In assessing the problems faced by working and poor women, women physicians believed the fundamental problem was too much hard work! They missed the point entirely that in order to survive these women had to work as hard as they did and often in factories that exploited them.All doctors, regardless of their gender, missed the real social causes of women's lives. The medical meanings given to women's bodies were transferred to the development of political policies and laws. The definition of maternity was shifted according to race and class. The late 19th and early 20th centuries were dominated by concerns of race suicide by whites as the immigration of non-whites and non-English speakers increased. Concern was raised by the medical profession and by politicians of the number of white women who were choosing careers, or abstaining from sex in order to avoid what was then a terrible ordeal to be pregnant or raise children. White women who stayed at home were classified as the perfect mothers and wives. They epitomized not only a healthy femininity but a healthy family. (The same image rises powerfully in the 1950s and 1960s). In this climate, immigrant, aboriginal, and Black women were depicted as degenerate, with ideas and practises that would pollute the advancement of a civilized society.At all costs the sanctity and power of the white middle class family had to be supported in order to create in political terms a healthy nation. While the ideology of femininity was powerful especially when generated by medical practitioners and politicians, women did advocate compromises. For instance, with the pressure to have babies, women demanded drugs that would rid them of the terrible pains brought on by labour. The result was the development of the "Twilight Sleep" that quite literally put women to sleep for the course of the birth. Reformers believed this drug would allow working class women to "rest" up before the demands of children and factory work took over again while middle and upper class women were glad simply to free of pain. LearningActivity: As you read through this lecture, take a moment to examine how PMS is used to explain away women's issues and secondly how abortion or tubaligation procedures have been based on how well doctors were convinced that pregnancy and childbirth would endanger women's emotional stability. Are Biases Still Present? Canadian women have agitated for funding to breast cancer research, the legalization of midwifery, reproductive choice, better drugs, and more choice throughout the system. While progress has been made in terms of being more attentive to the reality of women's lives and experiences, we are still battling race and class biases within the medical system.Aboriginal and immigrant women continue to be served poorly with higher mortality rates. (Jo-Anne Kirk's article, "Gender Inequality and Medical Education" in your course package develops the theme of bias.) One of the hardest battles women have had to fight is in claiming the right to define their own identities
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