How Women Have Been Taught That Being Sick Is "Normal"

Ellen got her period at age eleven, and, after a few years, the mild cramps she’d experienced at first began to morph into a different beast entirely. “The pain was shifting from my uterus to my hips, and it got worse and worse and worse. And it was a different kind of pain than I was used to. It felt like a burning, inflammatory pain, like if you had a hot coffee mug and pushed it against your joints.” Her back was painful and stiff, all the way up to her neck. “The result was that a lot of times I couldn’t really walk or stand or sit. It put too much pressure on that part of my body. I could basically only move back and forth in bed every so often to distribute the pain around.”

In high school, she started missing school, usually the one or two days right before her period began, which is when the pain peaked, and became a regular visitor at the nurse’s office. “I think they kind of thought that I was making it up a little bit. Because they were like, ‘Oh yeah, it’s you again.’ At least once a month, I’d have to be taken home from school by my mom and carried into the house, or just stay home from school altogether.” A couple of times she ended up in the hospital. “They didn’t really know what to do.

They didn’t really attempt a diagnosis. They just kind of gave me morphine, and the next morning they sent me home.”

Though the post-Freud shift to attributing unexplained physical symptoms to the mind has been perhaps the most important barrier to increasing knowledge of many women’s conditions over the last century, when it comes to disorders that affect women’s reproductive and sexual functions, an even older bias has been at play: medicine’s tendency to treat women’s illness as perfectly normal.

While women’s unexplained symptoms were at least treated as real by physicians in the late nineteenth century, they were also largely attributed to the unfortunate but inescapable fate of being a woman. Hysteria was considered an organic disease but one that was innate within all women. “As a general rule, all women are hysterical and . . . every woman carries with her the seeds of hysteria,” wrote the French physician Auguste Fabre in 1883. “Hysteria, before being an illness, is a temperament, and what constitutes the temperament of a woman is rudimentary hysteria.”

As all symptoms in women tended to be tied back to their reproductive organs, women’s routine reproductive cycles and states were considered somehow inherently pathological. In 1900, the president of the American Gynaecological Society explained, with great melodrama, that the life of a woman was medically treacherous: “Many a young life is battered and forever crippled on the breakers of puberty; if it crosses these unharmed and is not dashed to pieces on the rock of childbirth, it may still ground on the ever-recurring shallows of menstruation, and lastly upon the final bar of the menopause where protection is found in the unruffled waters of the harbour beyond reach of sexual storms.”

As Ehrenreich and English write, “The theories which guided the doctor’s practice from the late nineteenth century to the early twentieth century held that women’s normal state was to be sick.” When hysteria underwent its final shift to being seen as psychological, this led to a jarring pendulum swing in some respects. Many symptoms associated with women’s routine reproductive states and cycles that medicine had previously taken as evidence that women were physically abnormal and inferior—and touted to justify excluding women as a class from participating in public life—suddenly weren’t considered real at all.

Take menstruation: in the late nineteenth century, it was considered a time of ill health when it wasn’t safe for any woman to participate in normal activities—let alone pursue higher education or a career. The 1872 book A Physician’s Counsels to Woman in Health and Disease advised, “Long walks, dancing, shopping, riding and parties should be avoided at this time of month invariably and under all circumstances.” But post-Freud, pain and other symptoms associated with menstruation, like other unexplained symptoms, came to be considered largely psychological. One textbook in the 1970s declared that dysmenorrhea “is generally a symptom of a personality disorder, even though hormonal imbalance may be present.” Rather quickly, women went from having to resist medicine’s pronouncement that their periods were, as a rule, so disabling they disqualified women from being equal participants in the workforce to having to insist that some women did indeed experience debilitating periods.

To some extent there’s been a swing back to seeing women’s reproductive functions and transitions as pathological. With menopause, this shift was especially extreme. In 1966, Robert A. Wilson argued in his book Feminine Forever that menopause was a “curable” state that “no woman need suffer” thanks to treatment with supplemental oestrogen. As feminist critics noted, previously medicine had hardly acknowledged that any women suffered menopause symptoms at all. “Until menopause became big business, American women were always told their symptoms were all in their heads. With the new business of hormone replacement therapy, there’s been a complete flip-flop. Not only have the symptoms become ‘real,’ but all women are expected to experience all symptoms, and with the same degree of severity,” wrote Dr. Susan Love. “The movement is a breath- taking one,” Joan Callahan points out, “from ‘It’s all in your heads’ to ‘You are all ill and in need of medical intervention.’ ”

Indeed, these are the two contradictory extremes that medicine has tended to vacillate between: either women’s reproductive functions are pathologised as innately abnormal—in which case any symptoms they bring are “normal”—or else it is claimed that they’re normal, so if they cause symptoms, it’s only because an individual woman’s response to them is abnormal—she’s just especially sensitive or overreacting. In short, either all women are sick, or some women are crazy. Today, medicine seems to have generally settled into a position that manages to incorporate the worst of both worlds: it’s considered “normal” for women’s reproductive functions to be a bit abnormal—and if it’s really bad, well, maybe it’s all in your head.