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Unwell Women

Misdiagnosis and Myth in a Man-Made World

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On sale Jun 07, 2022 | 400 Pages | 978-0-593-18297-0
A trailblazing, conversation-starting history of women’s health—from the earliest medical ideas about women’s illnesses to hormones and autoimmune diseases—brought together in a fascinating sweeping narrative.
 
Elinor Cleghorn became an unwell woman ten years ago. She was diagnosed with an autoimmune disease after a long period of being told her symptoms were anything from psychosomatic to a possible pregnancy. As Elinor learned to live with her unpredictable disease she turned to history for answers, and found an enraging legacy of suffering, mystification, and misdiagnosis.
 
In Unwell Women, Elinor Cleghorn traces the almost unbelievable history of how medicine has failed women by treating their bodies as alien and other, often to perilous effect. The result is an authoritative and groundbreaking exploration of the relationship between women and medical practice, from the "wandering womb" of Ancient Greece to the rise of witch trials across Europe, and from the dawn of hysteria as a catchall for difficult-to-diagnose disorders to the first forays into autoimmunity and the shifting understanding of hormones, menstruation, menopause, and conditions like endometriosis.  

Packed with character studies and case histories of women who have suffered, challenged, and rewritten medical orthodoxy—and the men who controlled their fate—this is a revolutionary examination of the relationship between women, illness, and medicine. With these case histories, Elinor pays homage to the women who suffered so strides could be made, and shows how being unwell has become normalized in society and culture, where women have long been distrusted as reliable narrators of their own bodies and pain. But the time for real change is long overdue: answers reside in the body, in the testimonies of unwell women—and their lives depend on medicine learning to listen.
“In Unwell Women, the British scholar Elinor Cleghorn makes the insidious impact of gender bias on women’s health starkly and appallingly explicit.... It’s impossible to read Unwell Women without grief, frustration and a growing sense of righteous anger.”
—Janice P. Nimura, The New York Times

“The book is a call to arms for any woman who feels that doctors have not adequately addressed her illness or pain.”
—The Washington Post

“Researcher Cleghorn provides an essential history of misogyny in health care.... This clear-eyed assessment is both a catalog of how medicine has been complicit in female oppression and a call to action for drastic reform.”
Scientific American

“An intriguing exploration of the history of women’s health. . . . Unwell Women by Elinor Cleghorn shows us that without acknowledgment and understanding of these issues, these ills will continue on into new generations and in untold eras. We owe it to ourselves as a society to understand.”
The Chicago Review of Books
 
“[An] eye-opening new book. . . . Cleghorn meticulously constructs an often enraging framework to evince how and why the patriarchal medical world has been so detrimental to women, especially underserved women and women of color.”
The Guardian

“[A] fascinating new book. . . . At once an enraging, meticulous history and an intimate personal story, Unwell Women is an exploration of women's unique and (often fatally) misunderstood treatment in medicine, and a call to change our deeply engrained assumptions about healthcare.”
Salon

“Okay, raise your hand if you've ever had your symptoms totally dismissed by a doctor! . . . Well, Elinor Cleghorn's eye-opening book takes a deep dive into the history of how the medical system has failed women (all the way from Ancient Greece to modern day problems like getting Endometriosis diagnosed) and how women are often seen as unreliable sources for what they're feeling in their own bodies.”
Cosmopolitan, "26 Feminist Books Every Person Should Have on Their Reading List"

“Thoughtful and often disturbing, this exhaustively researched book shows why women—including minority women and Cleghorn herself, who has lupus—must fight to be heard in a system that not only ignores them, but often makes them sicker. Powerful, provocative, necessary reading.”
Kirkus, starred review

“Seamlessly melding scholarship with passion, Unwell Women is the definition of unputdownable.”
The Telegraph

"Not just a compelling investigation, but an essential one"
The Observer

“[Cleghorn] combines her own story with a feminist history of illness and a plea for better listening. It shows how centuries of ignorance and condescension led to failings that endure today.”
—The Economist

“A deeply stirring book about women’s illnesses.... Personal and impactful and brings to light the compelling need to do right by all the unwell women.”
—Book Riot


“Elinor Cleghorn has written a sprawling history about women’s health and the various ways it was misunderstood and sidelined within medicine, and the lingering impact of decisions made centuries ago. Treat Unwell Women as if it’s a textbook. You’ll be armed with the necessary information to advocate for yourself with all of the medical practitioners tasked with treating you.”
—Bitch Magazine
 
In Unwell Women, Cleghorn provides an extensive history of how feminine anatomy, physiology, and psychology have been studied and manipulated—mainly by men—and how they have often been used to oppress the female sex. . . . Meticulously researched. . . . Cleghorn’s final message should be heard loud and clear: Believe women.”
—Science Magazine

“[A] powerful history of misogyny and racism in health care.”
Nature

Unwell Women is a powerful and fascinating book that takes an unsparing look at how women's bodies have been misunderstood and misdiagnosed for centuries. From wandering wombs to demonic explanations of menopause, Elinor Cleghorn packs each page with disturbing historical details that will haunt your psyche for days and weeks to come.”
—Lindsey Fitzharris, author of The Butchering Art

“Cultural historian Cleghorn’s meticulous and wide-ranging debut examines the links between patriarchy, misogyny, and the mistreatment of women’s health needs…a deeply informed and passionately argued call for change.”
Publishers Weekly

“If doctors have ever misdiagnosed you, disbelieved your symptoms, or discriminated against you, then Unwell Women is the holy grail of answers you have been waiting for. Elinor Cleghorn has written a decisive, comprehensive, well-researched, and fascinating book about the ways in which medicine has failed women throughout history until now, and what that neglect has cost us—including our lives. I wish I’d had this book in 2018 when I was fighting with my gynecologist to remove my fibroids, but I am glad to have it as I navigate two chronic illnesses. As we continually negotiate power dynamics with doctors, Unwell Women will instantly become an invaluable addition to the arsenal of tools we need to fight for the care we deserve.”
—Evette Dionne, author of Lifting as We Climb

“An epic yet accessible social, cultural and scientific history of women's health traces the roots of sexism and racism in modern Western medicine from ancient texts through to the present day.... A powerful and necessary work of social and cultural history.”
Shelf Awareness

“A new book by British historian Elinor Cleghorn that’s equal parts fascinating and infuriating.... ‘The lives of unwell women depend on medicine learning to listen,’ Cleghorn concludes. And reading this immaculately researched and written book is an excellent place to start.” 
PureWow

“Feminist historian and academic Cleghorn, herself a victim of medical misdiagnosis, brings first-hand knowledge of the gender bias endemic in the medical profession to this scholarly yet personal, specific yet comprehensive study of dangerously outdated medical practices and attitudes.”
Booklist

“An insightful account that is especially recommended for those interested in the history of medicine where it intersects with women's health, as well as readers interested in women's and gender studies.”
Library Journal

"If you live in a female body, and if you've ever thought to yourself, ‘Why-oh-why are doctors not taking my legitimate health concerns seriously,’ this book answers that question definitively. This history of the female patient is the one I was searching for the entire time I was writing my own book, and I cannot recommend it highly enough. One thousand more books like this, please."
Sarah Ramey, author of The Lady’s Handbook for Her Mysterious Illness

"Unwell Women is one of the most important books of our generation. I read it in a rage, and recognized myself in its pages."
—Fern Riddell, author of Death in Ten Minutes

“This book will make you angry. And so it should! Just like their brains, women’s bodies have been treated as defective and deficient for centuries. This book shows how women’s biology has been historically stigmatised, how a combination of ignorance, mythology and misogyny has conspired to deprive women of the medical support they have needed. But women have fought back, and this book is also a testament to their courage and resilience in the face of stereotypical views about women’s place in society and how that is determined by their biology. Even in the 21st Century Cleghorn uncovers harsh truths about medicine’s continuing biases, especially in the intersection between gender and race. Hopefully this book will be a wake-up call to a profession that can still refer dismissively to ‘women’s problems.’”
Gina Rippon, author of The Gendered Brain

“A searing, brilliant investigation, an intricate and urgent book on how women's health has constantly been misunderstood and miscast throughout history, how men invented  theories that plunged women into misery, pain and even death - from Anne Greene hanged for a miscarriage to the 1940s housewives lobotomised or subject to other operations to treat their depression, from drugs intended to 'control' women's health that were rushed to market to women experimented upon in the name of science, the cruel differential treatment of women of colour. Cleghorn unmasks with devastating clarity how so much of 'women's health' has been tied into efforts to control women, inculcate what was proper feminine behaviour and slot them into patriarchal culture as happy reproductive units.”
—Kate Williams, author of Rival Queens

"At once grand in scope and deeply personal, Unwell Women is a powerful and important exploration of the history of Western medicine. Elinor Cleghorn lays bare centuries of unnecessary suffering in this meticulously researched, scorching indictment of how male-focused medicine has failed women – and shows us how far we still have to go."
—Emily Brand, author of The Fall of the House of Byron

“This is a fascinating look at history, Unwell Women is both captivating and enraging - a worthy voice for so many women who have been silenced for so long.”
—Catherine Cho, author of Inferno: A Memoir of Motherhood and Madness

© Lara Downie
Elinor Cleghorn is a freelance writer, researcher, and author living in Sussex. After receiving her PhD in humanities and cultural studies in 2012, she worked for three years as a postdoctoral researcher at the Ruskin School of Art at the University of Oxford on an interdisciplinary arts and medical humanities project. She has given talks and lectures at the British Film Institute, Tate Modern, and ICA London, and she has appeared on the BBC Radio 4 discussion show The Forum. In 2017, she was shortlisted for the Fitzcarraldo Editions Essay Prize, and she has since written creatively about her experience of chronic illness for publications including Ache (UK) and Westerly (AUS). View titles by Elinor Cleghorn

1. Wandering Wombs
 
On the Greek island of Kos many centuries ago, a girl was taken ill. At first, she felt strangely weak, her chest heavy and tight. Soon she began to shiver with fever; pain gripped her heart; terrifying hallucinations swarmed her mind. She was found wandering the streets, so consumed by heat and hurt that she wanted to end her life. Throwing herself down a well or hanging from a tree by a noose would have been pleasant compared with the torment that wracked her body and mind. Her father called for the physician-a man trained in the arts of healing. The physician had seen this illness before in girls who had started to menstruate but hadn't yet married. As they developed into puberty, their plentiful female blood had been used up by growing. Once they had grown into women, all that extra blood accumulated in their wombs, ready to spill out every month. All physicians knew that this was how the female body stayed healthy. This girl was drowning in her own blood. It had no way to flow out, so it had traveled from her womb back through her veins, inflaming her heart and poisoning her senses. The physician urged the girl's father to marry her off without delay. Intercourse would open her body so that her blood would flow out, and pregnancy would make her healthy.
 
In another home on the island, an older married woman was seized by a violent convulsion. Her eyes rolled back, she ground her teeth, and saliva foamed in her mouth. Her skin was deathly cold; her abdomen wrenched with pain. Her husband called for the physician. This malady often befell women of her age who had stopped having sex and bearing children. He watched the woman writhe and sob and noted that her skin was clammy. The woman's womb, empty and dry because it wasn't being filled, had crept toward her liver in search of moisture. From there it had blocked her diaphragm and robbed her of breath. The woman was being suffocated by her own womb. Soon, the physician hoped, phlegm would flow from her head to moisten her womb and weigh it down. The physician listened to the woman's belly for the gurgling sounds of the womb returning to its rightful place. If it lingered too long near her liver, she would choke to death. If only she had been having sex regularly, she might have been spared this misery.
 
Women like this haunt The Hippocratic Corpus, a collection of medical discourse attributed to Hippocrates of Kos, the Greek physician known as the father of medicine, from the Classical era-the fourth and fifth centuries BCE. As a teacher and physician, Hippocrates revolutionized medicine. He debunked centuries-old superstitions that diseases were punishments doled out by vengeful gods. He taught that ill health arose from imbalances in the body, and he invented the patient case study, writing careful notes about the symptoms and course of a person's illness and prescribing herbal recipes as treatments. He vowed to treat all illness, in all people, to the best of his ability and to never abuse the body of any man or woman. Whether his patient was freeborn or enslaved, he promised to do no harm: Hippocrates's oath became the cornerstone of patient ethics, and it is still sworn by medical graduates today.
 
Hippocrates emphasized how women's bodies and illnesses needed to be dealt with very differently from those of men. He stressed how important it was for physicians to "learn correctly from a patient the origin of her disease" by questioning her "immediately and in detail about the cause." Many women, he remarked, suffered and died because physicians proceeded to treat their diseases like "diseases in men." But even though he acknowledged that the diseases of women required special and specific approaches to healing, Hippocrates was not exactly championing women's right to body autonomy and informed medical choice. The Hippocratic Corpus was written at a time when most women had few, if any, civil or human rights. In the patriarchal social order of ancient Greece, girls were the property of their fathers, and women of their husbands. They had no ownership over land, property, money, or even their own bodies. They were seen as weaker, slower, smaller versions of the male human ideal, deficient and defective precisely because of their difference to men. But in their difference, women possessed the most useful and mysterious organ of all: the uterus. Since women's sole purpose was thought to be to bear and raise children, their health was entirely defined by the uterus. Medical ideas reflected and legitimized society's control over the female body and its precious procreative power. Right at the very beginnings of Western medical history, in writings that would become the foundations of scientific medical discourse and practice, unwell women emerged as a mass of pathological wombs.
 
The Hippocratic Corpus was based on the teachings of Hippocrates, but it was actually written down by different physicians who followed him. In treatises like Diseases of Women, Nature of Women, and Diseases of Young Girls, Hippocratic physicians described many different symptoms that afflicted women, from puberty and the beginnings of menstruation to conception, pregnancy, and menopause. The idea that all women's diseases were related to their reproductive functions seems, today, like the worst kind of misogynistic conspiracy. But in ancient Greece, where women's entire social existence was defined by their uteruses, it made perfect sense that the disorders and dysfunctions of their bodies and minds would be too. And the Hippocratics didn't have much else to go on. Human dissection was prohibited, so they had no knowledge about where organs were precisely located, how blood circulated, or how respiration occurred. They didn't know about cells, hormones, or neurons. Their understanding of female physiology decreed that women's bodies were overly wet because they had too much blood. They came to this conclusion because women menstruate.
 
Physicians could interpret what was making a woman ill only through what they could see and feel. Limited knowledge and prevailing social attitudes led to a concoction of theories about the influence of the uterus on every aspect of women's health. Sometimes it was diseased; other times it caused diseases in different parts of the body, including the mind. It was both a channel and a vessel, and a woman was kept healthy if it was either releasing moisture or being filled with it. The cure for Hippocratic uterine pathologies, from the madness of suppressed menstruation to the horrors of womb suffocation, was as much social as it was medical: marriage, ideally by the age of fourteen, regular sex with one's husband-who was usually around the age of thirty-and multiple pregnancies. "I assert that a woman who has not borne children becomes ill from her menses more seriously and sooner than one who has borne children," wrote the author of the first tract of Diseases of Women. For the uterus would always start causing mischief if it was stifled by virginity, dried up for wont of male "seed," or not weighed down with child.
 
Women in ancient Greece were no more in control of their uteruses than they were any other aspect of their lives. The womb hungered for intercourse and pregnancy in a way that was always beyond the control of the woman it resided within. To govern women's biological destiny, physicians pushed the message the womb wants what the womb wants. From Hippocratic diagnoses such as "suffocation of the womb" came the idea that an unfulfilled, unemployed uterus could move out of place, wreaking havoc on the organs it reached, including the heart and liver, and causing a startling array of symptoms. Convulsions that resembled epileptic fits. Delirious visions. Loss of breath. Pain and paralysis.
 
Just after The Hippocratic Corpus was laid down, around the middle of the third century BCE, Plato, the great philosopher of Athens, described the womb as a living creature that became "vexed and aggrieved" if its desires for childbearing were not met. In his famous dialogue Timaeus, about the world, the universe, and everything in it, Plato conflated women's biological purpose with their apparently untamable sexual impulses, creating a mythology of a womb that wandered "throughout the body," blocking "the channels of the breath," bringing the sufferer to "extreme stress," and causing "all manner of disorders."
 
Around the second century CE, Aretaeus, from the Roman province Cappadocia, took Hippocratic teachings on "womb suffocation" further by proclaiming that the uterus was like "an animal within an animal." Its capacity to move "hither and thither" and its responsiveness to sweet and fetid smells meant Aretaeus decided it had appetites and inclinations all of its own. Herbal fumigations were often used as remedies to entice displaced uteruses back to their rightful place. An animalistic womb was erratic, its movements sudden and violent. It could float up and down and "incline to this side and that, like a log of wood." If a womb wandered enough to compress a woman's intestines or choke her throat, she lost all her strength, her knees collapsed, her head ached and swam with vertigo, and the veins in her nose pulsed with pain. If her womb was actually choking her, her pulse might weaken, and she could lose her speech and breath. In extreme cases, she suffered "a very sudden and incredible death" in which she didn't actually look dead but somehow remarkably brighter than she did when she was alive.
 
Medical writers of ancient Greece and Rome held many different views on the wandering womb. But the uterus, as the dominant force behind so many illnesses, diseases, and symptoms of women, was woven into them all. Women were under the dominion of male authority, and medical discourse legitimized this by making women's bodies subordinate to the whims of the very organ that defined their social purpose. Whether these physicians believed the womb literally wandered or just imagined it did, the idea that all women with uteruses were susceptible to becoming unwell because their bodies were hell-bent on making babies persisted for centuries.
 
As human civilization lumbered into the Middle Ages, the womb wandered with it. The decline of the Roman Empire plunged Europe into the Dark Ages. With the rise of Christian theology and mythology across the Western world from the first century CE, interpreted and spread through the gospel of Saint Paul, new punitive beliefs about women and their bodies ushered forth. The ancient Greeks had blamed all the sickness of the world on Pandora, the mythological first woman, who was too weak to resist opening the forbidden jar of evils that her husband, Epimetheus, was taking care of. Christianity spun a different story about women and their bodies being responsible for all the sin in the world. The book of Genesis decreed that Eve, the original woman, imperfect and incomplete from the get-go-and an afterthought spawned from Adam's rib-ruined everything because of her desirous and disobedient ways. Medical writings that survived the fall of Rome were closely sanctioned by the Church, so those very men who proselytized that women were universally deviant were also the ones in charge of teaching texts that claimed the female body was inferior, defective, and always governed by the whims of the womb.
 
Latin translations of ancient books on the diseases of women, housed in monastery libraries, taught male physicians-medici-about the influence of the uterus on women's illnesses. For most women of the common classes in the early Middle Ages, medical care was provided by female healers or midwives within their communities, who tended ailments and provided remedies along with delivering babies. But when a woman did see a medici, her symptoms were generally blamed on the "manifold and diverse" forces of the womb. Thankfully, some of the sources on women's diseases at least tried to offer a less dramatic view. One of the most popular volumes at the time was Gynecology, an exhaustive text attributed to Soranus of Ephesus, a Greek physician practicing in Rome around the first or second century, and first translated into Latin in the sixth century. Part practical guidebook for midwives, part treatise on the many and various disorders of the uterus, Gynecology derived from Soranus's more balanced, holistic view of human health. He didn't subscribe to the notion that women's biological differences meant they were naturally inferior and defective creatures, and he departed from the Hippocratic idea that women needed an entirely separate branch of medicine. This meant he didn't promote menstruation, sex, and pregnancy as catchall cures for women's diseases, although he did believe that a proper understanding of gynecological complaints was crucial when caring for women.
 
Illness, for Soranus, was a universal human condition caused by different states of relaxation and constriction within the organs and systems of the human body. He found the notion of the wandering womb fairly implausible: "For the uterus does not issue forth like an animal from a lair." Attributing such impulses to the womb was, in his teaching, an impediment to women's healing. He found the ancients' belief that the uterus would return to its rightful place if a woman inhaled "bad odors"-including cedar resin, burned hair and wool, extinguished lamp wicks, charred deer horns, and squashed bedbugs-faintly ridiculous. And he held a dim view of the ancient Greek philosopher Xenophon, who, around the time of Hippocrates, suggested banging metal plates together and making a huge racket so the uterus would flee back in fright. Diseases like "womb suffocation" were caused by the uterus being constricted with inflammation from menstrual problems, difficulties in childbirth, miscarriages, and menopause. This could cause intense sympathetic pain in the abdomen, fevers, weakness in the limbs, and "convulsive contractions" that "seized the senses." But it didn't drive a woman into a fit of apoplectic mania resembling epilepsy, as the Hippocratics claimed. In fact, Soranus thought that the whole fumigation business actually caused many of the symptoms associated with womb suffocation, like torpor, and that remedies including "forcing air by means of the smith's bellows into the vagina" damaged rather than healed "the inflamed parts." His suggested treatments were altogether more sensible. He recommended laying the woman down in a bright, warm room "without hurting her," placing warm compresses on her belly, and gently straightening out her cramped limbs. If the "paroxysm" continued, he didn't send her off for a roll around the marital bed. He encouraged restoring her health through exercise and "promenades," light gymnastics, baths, anointments with oils, various "pungent" foods, vocal exercises, and reading aloud.

Medieval Christian moral laws forbade medici from physicallyexamining any woman. The female body was shrouded in secrecy and shame, and not only to the eyes and hands of male physicians. Women themselves wouldn't have dared reveal intimate details to men about what was going on in their own bodies. Some medical writers of the time echoed these sentiments, including one who referred to women's gynecological complaints as "her disgrace." In the foundational Hippocratic writings in Diseases of Women, the shame felt by women patients, especially those who were young and lacking in experience, was identified as a barrier to their receiving accurate care and treatment. Although the Hippocratic authors advised physicians to ask women about the cause of their illnesses, they also believed that their sense of shame-coupled with their ignorance about medical matters-meant they should not necessarily be trusted as reliable narrators of what was happening in their own bodies. The "diseases of women . . . are dangerous . . . and difficult to understand because of the fact that women are the ones who share these sicknesses . . . For women are ashamed to tell even if they know, and they suppose it is a disgrace, because of their inexperience and lack of knowledge." Without the kind of intense questions that only the authoritative male physician could ask, a young woman's disease might well become incurable. But if she was older and had a decent amount of experience with "diseases that come from the menses," then her own testimony might be taken more seriously. But ultimately, even when medical men were forbidden to touch women's bodies, it was male-authored knowledge that determined how they might be healed.

About

A trailblazing, conversation-starting history of women’s health—from the earliest medical ideas about women’s illnesses to hormones and autoimmune diseases—brought together in a fascinating sweeping narrative.
 
Elinor Cleghorn became an unwell woman ten years ago. She was diagnosed with an autoimmune disease after a long period of being told her symptoms were anything from psychosomatic to a possible pregnancy. As Elinor learned to live with her unpredictable disease she turned to history for answers, and found an enraging legacy of suffering, mystification, and misdiagnosis.
 
In Unwell Women, Elinor Cleghorn traces the almost unbelievable history of how medicine has failed women by treating their bodies as alien and other, often to perilous effect. The result is an authoritative and groundbreaking exploration of the relationship between women and medical practice, from the "wandering womb" of Ancient Greece to the rise of witch trials across Europe, and from the dawn of hysteria as a catchall for difficult-to-diagnose disorders to the first forays into autoimmunity and the shifting understanding of hormones, menstruation, menopause, and conditions like endometriosis.  

Packed with character studies and case histories of women who have suffered, challenged, and rewritten medical orthodoxy—and the men who controlled their fate—this is a revolutionary examination of the relationship between women, illness, and medicine. With these case histories, Elinor pays homage to the women who suffered so strides could be made, and shows how being unwell has become normalized in society and culture, where women have long been distrusted as reliable narrators of their own bodies and pain. But the time for real change is long overdue: answers reside in the body, in the testimonies of unwell women—and their lives depend on medicine learning to listen.

Praise

“In Unwell Women, the British scholar Elinor Cleghorn makes the insidious impact of gender bias on women’s health starkly and appallingly explicit.... It’s impossible to read Unwell Women without grief, frustration and a growing sense of righteous anger.”
—Janice P. Nimura, The New York Times

“The book is a call to arms for any woman who feels that doctors have not adequately addressed her illness or pain.”
—The Washington Post

“Researcher Cleghorn provides an essential history of misogyny in health care.... This clear-eyed assessment is both a catalog of how medicine has been complicit in female oppression and a call to action for drastic reform.”
Scientific American

“An intriguing exploration of the history of women’s health. . . . Unwell Women by Elinor Cleghorn shows us that without acknowledgment and understanding of these issues, these ills will continue on into new generations and in untold eras. We owe it to ourselves as a society to understand.”
The Chicago Review of Books
 
“[An] eye-opening new book. . . . Cleghorn meticulously constructs an often enraging framework to evince how and why the patriarchal medical world has been so detrimental to women, especially underserved women and women of color.”
The Guardian

“[A] fascinating new book. . . . At once an enraging, meticulous history and an intimate personal story, Unwell Women is an exploration of women's unique and (often fatally) misunderstood treatment in medicine, and a call to change our deeply engrained assumptions about healthcare.”
Salon

“Okay, raise your hand if you've ever had your symptoms totally dismissed by a doctor! . . . Well, Elinor Cleghorn's eye-opening book takes a deep dive into the history of how the medical system has failed women (all the way from Ancient Greece to modern day problems like getting Endometriosis diagnosed) and how women are often seen as unreliable sources for what they're feeling in their own bodies.”
Cosmopolitan, "26 Feminist Books Every Person Should Have on Their Reading List"

“Thoughtful and often disturbing, this exhaustively researched book shows why women—including minority women and Cleghorn herself, who has lupus—must fight to be heard in a system that not only ignores them, but often makes them sicker. Powerful, provocative, necessary reading.”
Kirkus, starred review

“Seamlessly melding scholarship with passion, Unwell Women is the definition of unputdownable.”
The Telegraph

"Not just a compelling investigation, but an essential one"
The Observer

“[Cleghorn] combines her own story with a feminist history of illness and a plea for better listening. It shows how centuries of ignorance and condescension led to failings that endure today.”
—The Economist

“A deeply stirring book about women’s illnesses.... Personal and impactful and brings to light the compelling need to do right by all the unwell women.”
—Book Riot


“Elinor Cleghorn has written a sprawling history about women’s health and the various ways it was misunderstood and sidelined within medicine, and the lingering impact of decisions made centuries ago. Treat Unwell Women as if it’s a textbook. You’ll be armed with the necessary information to advocate for yourself with all of the medical practitioners tasked with treating you.”
—Bitch Magazine
 
In Unwell Women, Cleghorn provides an extensive history of how feminine anatomy, physiology, and psychology have been studied and manipulated—mainly by men—and how they have often been used to oppress the female sex. . . . Meticulously researched. . . . Cleghorn’s final message should be heard loud and clear: Believe women.”
—Science Magazine

“[A] powerful history of misogyny and racism in health care.”
Nature

Unwell Women is a powerful and fascinating book that takes an unsparing look at how women's bodies have been misunderstood and misdiagnosed for centuries. From wandering wombs to demonic explanations of menopause, Elinor Cleghorn packs each page with disturbing historical details that will haunt your psyche for days and weeks to come.”
—Lindsey Fitzharris, author of The Butchering Art

“Cultural historian Cleghorn’s meticulous and wide-ranging debut examines the links between patriarchy, misogyny, and the mistreatment of women’s health needs…a deeply informed and passionately argued call for change.”
Publishers Weekly

“If doctors have ever misdiagnosed you, disbelieved your symptoms, or discriminated against you, then Unwell Women is the holy grail of answers you have been waiting for. Elinor Cleghorn has written a decisive, comprehensive, well-researched, and fascinating book about the ways in which medicine has failed women throughout history until now, and what that neglect has cost us—including our lives. I wish I’d had this book in 2018 when I was fighting with my gynecologist to remove my fibroids, but I am glad to have it as I navigate two chronic illnesses. As we continually negotiate power dynamics with doctors, Unwell Women will instantly become an invaluable addition to the arsenal of tools we need to fight for the care we deserve.”
—Evette Dionne, author of Lifting as We Climb

“An epic yet accessible social, cultural and scientific history of women's health traces the roots of sexism and racism in modern Western medicine from ancient texts through to the present day.... A powerful and necessary work of social and cultural history.”
Shelf Awareness

“A new book by British historian Elinor Cleghorn that’s equal parts fascinating and infuriating.... ‘The lives of unwell women depend on medicine learning to listen,’ Cleghorn concludes. And reading this immaculately researched and written book is an excellent place to start.” 
PureWow

“Feminist historian and academic Cleghorn, herself a victim of medical misdiagnosis, brings first-hand knowledge of the gender bias endemic in the medical profession to this scholarly yet personal, specific yet comprehensive study of dangerously outdated medical practices and attitudes.”
Booklist

“An insightful account that is especially recommended for those interested in the history of medicine where it intersects with women's health, as well as readers interested in women's and gender studies.”
Library Journal

"If you live in a female body, and if you've ever thought to yourself, ‘Why-oh-why are doctors not taking my legitimate health concerns seriously,’ this book answers that question definitively. This history of the female patient is the one I was searching for the entire time I was writing my own book, and I cannot recommend it highly enough. One thousand more books like this, please."
Sarah Ramey, author of The Lady’s Handbook for Her Mysterious Illness

"Unwell Women is one of the most important books of our generation. I read it in a rage, and recognized myself in its pages."
—Fern Riddell, author of Death in Ten Minutes

“This book will make you angry. And so it should! Just like their brains, women’s bodies have been treated as defective and deficient for centuries. This book shows how women’s biology has been historically stigmatised, how a combination of ignorance, mythology and misogyny has conspired to deprive women of the medical support they have needed. But women have fought back, and this book is also a testament to their courage and resilience in the face of stereotypical views about women’s place in society and how that is determined by their biology. Even in the 21st Century Cleghorn uncovers harsh truths about medicine’s continuing biases, especially in the intersection between gender and race. Hopefully this book will be a wake-up call to a profession that can still refer dismissively to ‘women’s problems.’”
Gina Rippon, author of The Gendered Brain

“A searing, brilliant investigation, an intricate and urgent book on how women's health has constantly been misunderstood and miscast throughout history, how men invented  theories that plunged women into misery, pain and even death - from Anne Greene hanged for a miscarriage to the 1940s housewives lobotomised or subject to other operations to treat their depression, from drugs intended to 'control' women's health that were rushed to market to women experimented upon in the name of science, the cruel differential treatment of women of colour. Cleghorn unmasks with devastating clarity how so much of 'women's health' has been tied into efforts to control women, inculcate what was proper feminine behaviour and slot them into patriarchal culture as happy reproductive units.”
—Kate Williams, author of Rival Queens

"At once grand in scope and deeply personal, Unwell Women is a powerful and important exploration of the history of Western medicine. Elinor Cleghorn lays bare centuries of unnecessary suffering in this meticulously researched, scorching indictment of how male-focused medicine has failed women – and shows us how far we still have to go."
—Emily Brand, author of The Fall of the House of Byron

“This is a fascinating look at history, Unwell Women is both captivating and enraging - a worthy voice for so many women who have been silenced for so long.”
—Catherine Cho, author of Inferno: A Memoir of Motherhood and Madness

Author

© Lara Downie
Elinor Cleghorn is a freelance writer, researcher, and author living in Sussex. After receiving her PhD in humanities and cultural studies in 2012, she worked for three years as a postdoctoral researcher at the Ruskin School of Art at the University of Oxford on an interdisciplinary arts and medical humanities project. She has given talks and lectures at the British Film Institute, Tate Modern, and ICA London, and she has appeared on the BBC Radio 4 discussion show The Forum. In 2017, she was shortlisted for the Fitzcarraldo Editions Essay Prize, and she has since written creatively about her experience of chronic illness for publications including Ache (UK) and Westerly (AUS). View titles by Elinor Cleghorn

Excerpt

1. Wandering Wombs
 
On the Greek island of Kos many centuries ago, a girl was taken ill. At first, she felt strangely weak, her chest heavy and tight. Soon she began to shiver with fever; pain gripped her heart; terrifying hallucinations swarmed her mind. She was found wandering the streets, so consumed by heat and hurt that she wanted to end her life. Throwing herself down a well or hanging from a tree by a noose would have been pleasant compared with the torment that wracked her body and mind. Her father called for the physician-a man trained in the arts of healing. The physician had seen this illness before in girls who had started to menstruate but hadn't yet married. As they developed into puberty, their plentiful female blood had been used up by growing. Once they had grown into women, all that extra blood accumulated in their wombs, ready to spill out every month. All physicians knew that this was how the female body stayed healthy. This girl was drowning in her own blood. It had no way to flow out, so it had traveled from her womb back through her veins, inflaming her heart and poisoning her senses. The physician urged the girl's father to marry her off without delay. Intercourse would open her body so that her blood would flow out, and pregnancy would make her healthy.
 
In another home on the island, an older married woman was seized by a violent convulsion. Her eyes rolled back, she ground her teeth, and saliva foamed in her mouth. Her skin was deathly cold; her abdomen wrenched with pain. Her husband called for the physician. This malady often befell women of her age who had stopped having sex and bearing children. He watched the woman writhe and sob and noted that her skin was clammy. The woman's womb, empty and dry because it wasn't being filled, had crept toward her liver in search of moisture. From there it had blocked her diaphragm and robbed her of breath. The woman was being suffocated by her own womb. Soon, the physician hoped, phlegm would flow from her head to moisten her womb and weigh it down. The physician listened to the woman's belly for the gurgling sounds of the womb returning to its rightful place. If it lingered too long near her liver, she would choke to death. If only she had been having sex regularly, she might have been spared this misery.
 
Women like this haunt The Hippocratic Corpus, a collection of medical discourse attributed to Hippocrates of Kos, the Greek physician known as the father of medicine, from the Classical era-the fourth and fifth centuries BCE. As a teacher and physician, Hippocrates revolutionized medicine. He debunked centuries-old superstitions that diseases were punishments doled out by vengeful gods. He taught that ill health arose from imbalances in the body, and he invented the patient case study, writing careful notes about the symptoms and course of a person's illness and prescribing herbal recipes as treatments. He vowed to treat all illness, in all people, to the best of his ability and to never abuse the body of any man or woman. Whether his patient was freeborn or enslaved, he promised to do no harm: Hippocrates's oath became the cornerstone of patient ethics, and it is still sworn by medical graduates today.
 
Hippocrates emphasized how women's bodies and illnesses needed to be dealt with very differently from those of men. He stressed how important it was for physicians to "learn correctly from a patient the origin of her disease" by questioning her "immediately and in detail about the cause." Many women, he remarked, suffered and died because physicians proceeded to treat their diseases like "diseases in men." But even though he acknowledged that the diseases of women required special and specific approaches to healing, Hippocrates was not exactly championing women's right to body autonomy and informed medical choice. The Hippocratic Corpus was written at a time when most women had few, if any, civil or human rights. In the patriarchal social order of ancient Greece, girls were the property of their fathers, and women of their husbands. They had no ownership over land, property, money, or even their own bodies. They were seen as weaker, slower, smaller versions of the male human ideal, deficient and defective precisely because of their difference to men. But in their difference, women possessed the most useful and mysterious organ of all: the uterus. Since women's sole purpose was thought to be to bear and raise children, their health was entirely defined by the uterus. Medical ideas reflected and legitimized society's control over the female body and its precious procreative power. Right at the very beginnings of Western medical history, in writings that would become the foundations of scientific medical discourse and practice, unwell women emerged as a mass of pathological wombs.
 
The Hippocratic Corpus was based on the teachings of Hippocrates, but it was actually written down by different physicians who followed him. In treatises like Diseases of Women, Nature of Women, and Diseases of Young Girls, Hippocratic physicians described many different symptoms that afflicted women, from puberty and the beginnings of menstruation to conception, pregnancy, and menopause. The idea that all women's diseases were related to their reproductive functions seems, today, like the worst kind of misogynistic conspiracy. But in ancient Greece, where women's entire social existence was defined by their uteruses, it made perfect sense that the disorders and dysfunctions of their bodies and minds would be too. And the Hippocratics didn't have much else to go on. Human dissection was prohibited, so they had no knowledge about where organs were precisely located, how blood circulated, or how respiration occurred. They didn't know about cells, hormones, or neurons. Their understanding of female physiology decreed that women's bodies were overly wet because they had too much blood. They came to this conclusion because women menstruate.
 
Physicians could interpret what was making a woman ill only through what they could see and feel. Limited knowledge and prevailing social attitudes led to a concoction of theories about the influence of the uterus on every aspect of women's health. Sometimes it was diseased; other times it caused diseases in different parts of the body, including the mind. It was both a channel and a vessel, and a woman was kept healthy if it was either releasing moisture or being filled with it. The cure for Hippocratic uterine pathologies, from the madness of suppressed menstruation to the horrors of womb suffocation, was as much social as it was medical: marriage, ideally by the age of fourteen, regular sex with one's husband-who was usually around the age of thirty-and multiple pregnancies. "I assert that a woman who has not borne children becomes ill from her menses more seriously and sooner than one who has borne children," wrote the author of the first tract of Diseases of Women. For the uterus would always start causing mischief if it was stifled by virginity, dried up for wont of male "seed," or not weighed down with child.
 
Women in ancient Greece were no more in control of their uteruses than they were any other aspect of their lives. The womb hungered for intercourse and pregnancy in a way that was always beyond the control of the woman it resided within. To govern women's biological destiny, physicians pushed the message the womb wants what the womb wants. From Hippocratic diagnoses such as "suffocation of the womb" came the idea that an unfulfilled, unemployed uterus could move out of place, wreaking havoc on the organs it reached, including the heart and liver, and causing a startling array of symptoms. Convulsions that resembled epileptic fits. Delirious visions. Loss of breath. Pain and paralysis.
 
Just after The Hippocratic Corpus was laid down, around the middle of the third century BCE, Plato, the great philosopher of Athens, described the womb as a living creature that became "vexed and aggrieved" if its desires for childbearing were not met. In his famous dialogue Timaeus, about the world, the universe, and everything in it, Plato conflated women's biological purpose with their apparently untamable sexual impulses, creating a mythology of a womb that wandered "throughout the body," blocking "the channels of the breath," bringing the sufferer to "extreme stress," and causing "all manner of disorders."
 
Around the second century CE, Aretaeus, from the Roman province Cappadocia, took Hippocratic teachings on "womb suffocation" further by proclaiming that the uterus was like "an animal within an animal." Its capacity to move "hither and thither" and its responsiveness to sweet and fetid smells meant Aretaeus decided it had appetites and inclinations all of its own. Herbal fumigations were often used as remedies to entice displaced uteruses back to their rightful place. An animalistic womb was erratic, its movements sudden and violent. It could float up and down and "incline to this side and that, like a log of wood." If a womb wandered enough to compress a woman's intestines or choke her throat, she lost all her strength, her knees collapsed, her head ached and swam with vertigo, and the veins in her nose pulsed with pain. If her womb was actually choking her, her pulse might weaken, and she could lose her speech and breath. In extreme cases, she suffered "a very sudden and incredible death" in which she didn't actually look dead but somehow remarkably brighter than she did when she was alive.
 
Medical writers of ancient Greece and Rome held many different views on the wandering womb. But the uterus, as the dominant force behind so many illnesses, diseases, and symptoms of women, was woven into them all. Women were under the dominion of male authority, and medical discourse legitimized this by making women's bodies subordinate to the whims of the very organ that defined their social purpose. Whether these physicians believed the womb literally wandered or just imagined it did, the idea that all women with uteruses were susceptible to becoming unwell because their bodies were hell-bent on making babies persisted for centuries.
 
As human civilization lumbered into the Middle Ages, the womb wandered with it. The decline of the Roman Empire plunged Europe into the Dark Ages. With the rise of Christian theology and mythology across the Western world from the first century CE, interpreted and spread through the gospel of Saint Paul, new punitive beliefs about women and their bodies ushered forth. The ancient Greeks had blamed all the sickness of the world on Pandora, the mythological first woman, who was too weak to resist opening the forbidden jar of evils that her husband, Epimetheus, was taking care of. Christianity spun a different story about women and their bodies being responsible for all the sin in the world. The book of Genesis decreed that Eve, the original woman, imperfect and incomplete from the get-go-and an afterthought spawned from Adam's rib-ruined everything because of her desirous and disobedient ways. Medical writings that survived the fall of Rome were closely sanctioned by the Church, so those very men who proselytized that women were universally deviant were also the ones in charge of teaching texts that claimed the female body was inferior, defective, and always governed by the whims of the womb.
 
Latin translations of ancient books on the diseases of women, housed in monastery libraries, taught male physicians-medici-about the influence of the uterus on women's illnesses. For most women of the common classes in the early Middle Ages, medical care was provided by female healers or midwives within their communities, who tended ailments and provided remedies along with delivering babies. But when a woman did see a medici, her symptoms were generally blamed on the "manifold and diverse" forces of the womb. Thankfully, some of the sources on women's diseases at least tried to offer a less dramatic view. One of the most popular volumes at the time was Gynecology, an exhaustive text attributed to Soranus of Ephesus, a Greek physician practicing in Rome around the first or second century, and first translated into Latin in the sixth century. Part practical guidebook for midwives, part treatise on the many and various disorders of the uterus, Gynecology derived from Soranus's more balanced, holistic view of human health. He didn't subscribe to the notion that women's biological differences meant they were naturally inferior and defective creatures, and he departed from the Hippocratic idea that women needed an entirely separate branch of medicine. This meant he didn't promote menstruation, sex, and pregnancy as catchall cures for women's diseases, although he did believe that a proper understanding of gynecological complaints was crucial when caring for women.
 
Illness, for Soranus, was a universal human condition caused by different states of relaxation and constriction within the organs and systems of the human body. He found the notion of the wandering womb fairly implausible: "For the uterus does not issue forth like an animal from a lair." Attributing such impulses to the womb was, in his teaching, an impediment to women's healing. He found the ancients' belief that the uterus would return to its rightful place if a woman inhaled "bad odors"-including cedar resin, burned hair and wool, extinguished lamp wicks, charred deer horns, and squashed bedbugs-faintly ridiculous. And he held a dim view of the ancient Greek philosopher Xenophon, who, around the time of Hippocrates, suggested banging metal plates together and making a huge racket so the uterus would flee back in fright. Diseases like "womb suffocation" were caused by the uterus being constricted with inflammation from menstrual problems, difficulties in childbirth, miscarriages, and menopause. This could cause intense sympathetic pain in the abdomen, fevers, weakness in the limbs, and "convulsive contractions" that "seized the senses." But it didn't drive a woman into a fit of apoplectic mania resembling epilepsy, as the Hippocratics claimed. In fact, Soranus thought that the whole fumigation business actually caused many of the symptoms associated with womb suffocation, like torpor, and that remedies including "forcing air by means of the smith's bellows into the vagina" damaged rather than healed "the inflamed parts." His suggested treatments were altogether more sensible. He recommended laying the woman down in a bright, warm room "without hurting her," placing warm compresses on her belly, and gently straightening out her cramped limbs. If the "paroxysm" continued, he didn't send her off for a roll around the marital bed. He encouraged restoring her health through exercise and "promenades," light gymnastics, baths, anointments with oils, various "pungent" foods, vocal exercises, and reading aloud.

Medieval Christian moral laws forbade medici from physicallyexamining any woman. The female body was shrouded in secrecy and shame, and not only to the eyes and hands of male physicians. Women themselves wouldn't have dared reveal intimate details to men about what was going on in their own bodies. Some medical writers of the time echoed these sentiments, including one who referred to women's gynecological complaints as "her disgrace." In the foundational Hippocratic writings in Diseases of Women, the shame felt by women patients, especially those who were young and lacking in experience, was identified as a barrier to their receiving accurate care and treatment. Although the Hippocratic authors advised physicians to ask women about the cause of their illnesses, they also believed that their sense of shame-coupled with their ignorance about medical matters-meant they should not necessarily be trusted as reliable narrators of what was happening in their own bodies. The "diseases of women . . . are dangerous . . . and difficult to understand because of the fact that women are the ones who share these sicknesses . . . For women are ashamed to tell even if they know, and they suppose it is a disgrace, because of their inexperience and lack of knowledge." Without the kind of intense questions that only the authoritative male physician could ask, a young woman's disease might well become incurable. But if she was older and had a decent amount of experience with "diseases that come from the menses," then her own testimony might be taken more seriously. But ultimately, even when medical men were forbidden to touch women's bodies, it was male-authored knowledge that determined how they might be healed.