Pathologizing Women’s Pain: The Tyranny of the Experts

Review of Barbara Ehrenreich and Deirdre English, For Her Own Good: Two Centuries of the Experts’ Advice to Women. New York: Second Anchor Books Edition, 2005. Paperback ISBN 1400078008, 410 pages, $ 14.00.

If ever I held doubt that the medical profession holds power over its patients, a client I call Terry dispelled it. She had been taking anti-depressant medication for years despite her ambivalence about doctors and its benefits. She was also in psychotherapy, making progress with significant issues in her life. Even though she felt much better, the prescribing physician advised her to continue with medication. Three days before Christmas Terry ran out of the pills and did not renew the prescription. By Christmas Eve, she was experiencing symptoms—heart palpitations and anxiety—and on Christmas Day she sought out a pharmacy hoping to get even one pill to carry her through to the next day when her usual pharmacy was open. A pharmacist cooperated and gave her a supply. Terry left the store, got into her car, and

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swallowed a pill. It was only halfway down her throat when her symptoms disappeared.

As she related the story to me, Terry expressed amazement. She realized that it was impossible for the pill to have such an immediate effect and was stunned at the impact of taking it. She concluded that her doctor’s words—his cautions about staying on the antidepressants over winter and weaning off them very gradually—had the greatest impact on her. She believed she should not have disobeyed and that her recovery was a direct result of re-compliance with his instructions.

Terry’s story is a modern one, filled with hope for she went on to make choices that felt right to her, including becoming medication-free. In For Her Own Good Barbara Ehrenreich and Deirdre English present a history that lurks behind Terry’s experiences. They write about women’s experiences with the advice they have received from experts, most of whom were male medical doctors and scientists.

The authors trace the evolution of medical practice to the present from a period they call the “old order” when women were the producers of food, clothing and household goods, and the healers, administering herbal remedies to their families. The Industrial Revolution changed women’s lives dramatically. With husbands who became the monied middle class, the women’s traditional contributions were outsourced. Stripped of their roles as producers and healers the women fell under the long shadow of another product of the era, the newly minted male physician-scientists who began to treat the women’s increasing ennui and sense of purposelessness as pathology. Clamoring for relief the women sought out those who offered the promise of help even though it meant normal functions such as menstruation and childbirth were reclassified as illnesses. Doctors who armed themselves with so-called scientific findings offered the latest “cures” and acquired a celebrity status while women embraced them as a way to enhance their own status and demonstrate their up-to-the minute knowledge. Unwittingly contributing to their own oppression, the women complied with such bizarre “cures” as leeches in their uteruses, clitoridectomies, and the “rest cure” that kept them immobile in darkened bedrooms eating bland diets for months on end.

Physicians took every opportunity to treat the social problem of what to do with women as a commodity, by offering various cures at fees that were within the reach only of women of the middle and upper classes. Intent on wiping out all competition for fee-paying patients they even usurped the jobs of midwives for the lower classes who were no competition for them in the medical marketplace. With the rise of the profession of obstetrics-gynecology, lower class women were needed in the charity hospitals since no women of a higher class could be expected to serve as raw material for the student physicians, and the midwives’ work became redundant. Some black female slaves were kept exclusively for surgical experimentation. A particularly zealous surgeon operated on one of them thirty times in four years. Lower class women might have been spared any exposure to these machinations had it not been for the scientists’ need for human subjects to test out their theories and practice their skills as surgeons.

The experts’ rise to power over women is startling. It involved destroying or discrediting the networks through which women had learned from each other. They did this through the promotion of science, fortified by wealth and women—especially educated women—who went along with the notion that to ignore science was to live in the Dark Ages. The ironies abound. Women were infantilized but bought into the system in order to appear knowledgeable by siding with the experts. Doctors were revered while practicing in ways that must surely have raised some eyebrows. Women who challenged the all-male education system and won places in it became educated in men’s science and consequently, were no help liberating women from the grip of the experts.

Women were unfulfilled, unhappy and vulnerable. An unexpected result of the women’s discontent was a declining birthrate among the privileged classes. Women were either too sick to have sex, or they used illness as a reason to avoid it. This was viewed as an alarming trend by the likes of psychologist G. Stanley Hall and Theodore Roosevelt: the President said it meant disaster for the nation because poorer specimens were still propagating. Hysteria, a new trend, emerged in women’s illness and was to be the straw that fi-

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nally broke the hold of the gynecologist over women. It seems that women began to use the notion of illness for their own purposes to the frustration of a medical profession that was losing control of them. There was speculation in medical journals that women were utilizing illness to avoid work and responsibility as well as to gain power over their husbands, children, and doctors. Hysteria was a logical outcome of the “cult of female invalidism.” The medical answer was psychoanalysis. Malingering was reassigned illness status and women were encouraged to confess their resentment in psychoanalysis and accept their role as women.

As a new spirit of activism gripped America in the early 20^th century, women loosened their garments and became more mobile. A new era was ushered in, one in which housekeeping, conceptualized as a full-time profession, was described by a new set of experts, domestic scientists, many of whom were women. In time, motherhood was pathologized and child-raising was subjected to scientific scrutiny. Dr. Spock emerged as the expert on children, overriding mothers’ and grandmothers’ inclinations based on knowledge of their offspring.

In their valuable book, Ehrenreich and English present a powerful argument against compliance with experts. A new “Foreword” and some additions to the “Afterward” bring this edition up to 2004 while the analysis remains as clear and compelling as in the first edition (Anchor Books, 1979). They advise women to think for themselves and dig deeper than the degrees and studies that modern experts present to them.

There are, however, a number of omissions. They do not address the creation of the depression phenomenon of which women are the primary—acknowledged—sufferers. They do not address the fact that pharmaceutical companies educate the first line of contact with patients, the family doctor, and so have become the experts behind the experts. Neither do they probe the emotional and sometimes physical disfigurement of women in the name of beauty through plastic surgery. Aging has become the new women’s problem to be exploited by the battery of medical experts and yet it rates not a mention in this volume.

The authors seem inimical to psychology, and I am uncomfortable with their discussion of it. Ehrenreich and English cast practitioners in the same damning role of experts. Early psychologists worked within the range of interpretation available to them, which also happened to be the language of women’s oppression so it may deserve bad press. The current trend towards sound-bite answers to complex problems is disturbing. But theory and practice have been evolving and we therapists are not all slick-tongued shamans as they imply. Psychology, used in the service of liberation can help women, men, and children to develop the strengths they require to face intense pressures to comply and conform.

It is important to be cautious with interpretations of events not lived through and impossible to reproduce. The authors write a history of female oppression bordering on the sensational. Yet there were strengths and movements that carried women through. The experts may have destroyed networks, but women formed others, as they continued to make their ways in the world. Ehrenreich and English reserve most of their comments on women’s activism to the feminist movement of the past half-century. They note that it was feminism that exposed the problems but state that feminists are now holding back in uncertainty. They recognize that the woman question has yielded to a much larger one, how women and men together can manage civilization.

This history book is a valuable resource for laywomen and experts alike. If we all dig deeper, remember the past, and reflect on the present, we may avoid a repetition of the suffering documented within it.

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