Factually! with Adam Conover - How Modern Medicine Has Failed Women with Elinor Cleghorn

Episode Date: January 12, 2022

A deeply embedded idea in our culture is the sexist notion that men are the “default” human, and women the unknowable “other". Nowhere is this more visible than in the history of medicine, with disastrous consequences for women’s’ health. On the show this week to discuss her new book is Elinor Cleghorn, author of Unwell Women: Misdiagnosis and Myth in a Man-Made World. You can check out her book at factuallypod.com/books.  Learn more about your ad choices. Visit megaphone.fm/adchoices See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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So if all of that sounds good, if you want a big box of delicious snacks like this for yourself, use the code factually for $15 off your first order at Bokksu.com. That's code factually for $15 off your first order on Bokksu.com. I don't know the way I don't know what to think I don't know what to say Yeah, but that's alright Yeah, that's okay I don't know anything Hello and welcome to Factually, I'm Adam Conover.

Thank you so much for joining me again on the show. It's such a pleasure to do this show. It's the best part of my week every single week. And I thank you for being here as I talk to another amazing expert and have my mind blown. Hopefully your mind will be blown too. We're going to have a great time together. Let's talk about this week's episode. I don't know if you've noticed, but Western culture, or at least the version of Western culture I've grown up with here in the United States of America, is built around the idea that men are the default human. You know, you got man, as in mankind, the name we use for the entire species. And then you got woman, which is like a man with something else added to it, right?

Like a man plus some kind of weird kind of thing. The that's what makes a woman. The man is the default. A woman is a man plus wuh. It's even embedded in our origin myths. In the Judeo-Christian Bible, the first woman, Eve, was created from the rib of the first man, Adam. Adam, of course, was created directly by God, but then God was like, yeah, well, I already got the default human here, but I kind of want a different one. So let me just like grab part of this one's rib and I'll make a, make a weirdo, different kind of human, call it a woman. Now, of course, both of these ideas are bullshit, but they're deeply, deeply embedded in our culture. This idea that women are different from men and somehow kind of other, like some weird thing that you have to work to understand. And nowhere is this fucked up idea more obvious than in the history of medicine.

For literal thousands of years, as much as it has advanced, medicine has also fixated on the supposedly natural state of women as mothers and wives, assumed that they're inferior to men, that their pain is not to be taken seriously, and that even their horniness is something to fear, control, and manage, along with everything else that happens to their bodies. Male doctors, male scientists have treated women as some sort of strange creature driven by emotions and forces beyond male ken, with disastrous results for women's health. And it goes without saying that women even more marginalized in society,

such as poor and non-white women, have had it even worse every step along the way. Now, if you're a woman hearing this, you might not be surprised. If you're a man, you might be. But look, either way, unpacking these ideas and resolving these myths is a critical piece of making sure

that everyone in our society is cared for equally in the way that they need to be. So where did these ideas come from and how did they persist over the centuries? And who are the folks who are fighting against them all along the way? Well, to answer, our guest today is Eleanor Cleghorn. She's the author of Unwell Women, Misdiagnosis and Myth in a Man-Made World. Please welcome Eleanor Cleghorn. She's the author of Unwell Women, Misdiagnosis and Myth in a Man-Made World. Please welcome Eleanor Cleghorn. Eleanor, thank you ever so much for being here. Thank you so much, Adam, for having me. Well, okay, let's start at the basics here. If two people, if a man and a woman go to the

hospital today, how will they be treated differently? Or how have they been treated differently historically? Well, if they went to the doctors today, a man and a woman, then studies show us that they are very likely to be treated quite differently, especially if they were turning up to that doctor's office reporting some form of pain or another kind of subjective symptom that wasn't maybe immediately diagnosable. And the reasons for this are deeply historically rooted. You know, we talk a lot about gender biases in society and a major place in which gender biases kind of enacted and affect affect you know people's lives are within the medical system within the health care system which has really embedded some of

these biases over its really long history centuries long history so you know today man when we're walking to doctor's office both reporting chronic pain know, it's been bothering them for a couple of weeks. They don't know what's causing it. You know, according to studies, the guy, the man, is more likely to describe his pain really straightforwardly. You know, I've got a pain in my arm, it's hurt for two weeks. A woman is more likely to explain her pain in the context of her life or in the context of more kind of social factors like I'm in pain you know I can't get up in the morning I can't look after my children properly you know I'm worried about the impact on my relationship, etc. So these are the kind of masculine and feminine ways that we tend, not all of us, of course, but that we tend to relate to our pain.

And studies show, really recent studies show that the way women express their pain or, you know, sensations in their bodies, because they narrativize, because they tend to speak in more social, personal, and emotional terms, that means that often they are perceived as being less reliable when they report that pain. Whereas because men tend to be more straightforward, more sort of objective, less emotional in their articulation of something like pain, less emotional in their articulation of something like pain they are believed and this is a gender bias this isn't specific to medicine we notice it across society in different ways we see the ways in which women tend to be disbelieved when they tell stories about their bodies right but it's really magnified in a medical setting because you've got a you know it's a time pressurized situation

you've got a few minutes with that doctor or health care provider to sort of translate what is happening in your body very personal very subjective and hope to get some answers hope to get some explanations so when explanations and answers aren't immediately to hand, what tends to happen is that gender biases are fallen back on. So we'll assume, for example, that women are more emotional, that their pain is probably psychological in origin, and that men are more straightforward and their pain is physiological, physical in origin. So yeah, that's the basis really of the gender biases that persist in medicine today and that have been really ingrained

in medical attitudes across its long history. Well, yeah, I want to ask about, you know, the way you have been framing it so far is that, you know, men and women present, tend to present it differently. And so we have these deep biases, but the biases you're describing are largely societal. You know, they're very widely distributed across our society, but we're talking specifically about doctors, right, who are supposed to know better. I trust my doctor as much as the next person, that they're extremely highly trained. They've seen hundreds of thousands of people, and they're up to date on all the journal articles and et cetera. And so we expect them to bring a certain scientific rigor to the situation. And so just saying, okay, well, they have the biases that everyone else does. We expect to hold them to a higher standard. But you're also evoking that

these biases are built into medical training or medical practice to a certain extent. Tell me more about that. So to start with, I don't believe that the majority of doctors are in any way out to get women, right? Out to hurt them, out to harm them. I believe that these issues that have really come to the fore in the last couple of years around gender disparity in healthcare are systemic. They sit above the level of individual prejudice, right? And these biases tend to be unconscious. right? And these biases tend to be unconscious. And the issue that I explore in my book is where these biases come from and why they're so persistent even today, when, as you say, you would expect that our scientifically based medical system would know better, right?

So I'm not blaming individual doctors at all. And it's not, you know, a kind of misogynistic conspiracy on the part of healthcare professionals. But the issues that we come up against that are really illuminated when women especially are trying to get answers about less immediately identifiable health issues, is that a lack of knowledge can mean that these kind of gender biases raise their ugly heads because we do fall back on biases when we don't know the answer. And from the very beginning of medical history, so I put that at the beginning of Western medical history in the time of ancient Greece with physicians such as Hippocrates, who hopefully listeners would have heard of because from Hippocrates we get the Hippocratic Oath,

right? The very basis of doing no harm. You know, the medical ethical principle was formed in ancient Greece. But ancient Greece was also a deeply patriarchal society with very different ideas about how society was structured in relation to the roles of men and women in that society. And the Greeks also didn't have x-rays, right? They didn't have blood tests. They weren't able to monitor circulation. They weren't able to see what was happening in a person's immune system. They had to figure out what was happening in human bodies based on the knowledge that existed around them. And they applied that to the art of healing. So it made sense for the ancient Greeks to extrapolate that men and women were constitutionally different. Women existed labor, to fight, to build. So the understanding of bodies in terms of sex difference was very distinct do the kind of physical activities that helped them stave off

diseases of the body and mind. And they were also very much at the mercy of their bodies because they were primarily seen as being reproductive. You know, the reproductive cycle governed a woman's life in ancient Greece. It was the purpose of her existence, shaped her existence, defined what her body was for in society. And so we get this foundational idea from ancient Greece that women's bodies are really destined for a purpose, childbearing, and they don't have sort of rational control over this purpose. Women are not able to decide for themselves what is done with their bodies because they're predestined to reproduce. So it's really important, I think, to remember that although

a lot of the kind of misogynistic fairy tales about the body are rooted in ancient Greece, that actually, when you look at what ancient Greek society was like, this begins to make a little bit more sense. Yeah, I mean, it wasn't, you know, I've read, I read some Plato in my, you know, I was a philosophy major. I read Plato. There's some weird stuff about ancient Greek society. We don't need to get into it, but there's some odd detail you read like, oh, this is how the perfect site, this is how you guys are structuring things. Holy shit. So yeah, that's wild. But how did this look Hippocrates? I know the Hippocratic oath. I know he's the guy who like wound a snake around the stick or whatever. But in what way, this is also someone who took the first steps towards rationalizing the understanding of medicine and treating it more scientifically. So were there specific recommendations that he made that showed this in your view?

Yes, there were. And, you know, you're right. There are a lot of nuts things going on in ancient Greek society, especially where human bodies were concerned. And Hippocrates, indeed, was the guy who rationalized medicine. He really moved medicine from being a practice based in myth and legend and religion into being a pragmatic practice in which diseases and illnesses were diagnosed by looking at symptoms and thinking about what a body was going through rather than assuming, oh, you know, this dude's ill, so he's obviously been punished by some gods. So he moves medicine into this really rational space that mirrors what we know medicine to be today, a kind of bench side art, a bedside art, if you will. So yeah, it sounds good. So, so far, so good, right? So far, so rational.

And one of the stranger things that the ancient Greeks believed that to them was perfectly rational, were that women were defined by their wombs, their uteruses. So central organ of child bearing, right? And because women existed to bear children, their uteruses kind of hungered to perform this duty. They had this sort of impulse, the organ wanted what the organ wanted. And because of that, he believed that women's uteruses, if they were not, you know, in the act of conception or being weighed down with a fetus, would sort of shrivel and become, you know, hungry. Yeah. Yeah. Okay. This sounds like an A24 horror movie is what this sounds like to me. Like a hungry uterus that demands to be fed. The hungry uterus.

Revenge of the hungry uterus. Yeah, anyway. So, yeah, so the uterus, Hippocrates believed that the uterus needed to be pregnant, needed to carry children in order to be healthful. So he endowed it with an almost anima impulse, you know, an almost kind of sentient ability to go forth and get what it wanted. So he believed that when it wasn't performing this, you know, ordained sacred duty of being involved in the processes of reproduction,

that it would shrivel, that it would become hungry and start roaming around a woman's body in search of moisture what wait like sorry how literally did he mean roving around like like i said i'm just gonna take a trip into the right arm to see if i can find any see if i can find any moisture yeah i'm just gonna slip into a crevice in the brain and, you know, start controlling the movement. No, he believed that it could almost float up towards the liver and the heart. And that once it got there, that it would start compressing against those organs. And it could cause all manner of really strange symptoms, suffocation, pain, fainting, even psychological symptoms like hallucinations and, you know, convulsions. So he really believed that this organ had these kind of appetites

and that it had a really profound influence on women's health, that it was almost, you can imagine it in a sense as the kind of engine running the whole show, you know? Wow. Just almost like a second brain of some sort that needs to be grappled with, that needs to be pleased and sated or else the uterus will hop up and start driving you around like a robot body.

Pretty much, yeah. And I mean, maybe this is a silly question, but was this like, you know, was this a pseudoscientific belief on his part or did he actually have some, was this a poor dude in ancient Greece doing his best? You know what I mean? Or was this, where did this idea come from?

I guess is my question. Well, because the ancient Greeks didn't practice human dissection, so they didn't actually know. They didn't know that the uterus was tethered in place. They didn't understand. They just looked at symptoms and thought, this woman here is convulsing, hallucinating. She's got a raging fever. She's, you know, muttering about something. Oh, let's have a look. Okay. So it's probably the uterus and it's probably compressing against the heart. And they have really different understandings about human organs. You know, they endowed them with different characteristics. So, you know, it made sense to them.

So to our ears and minds, it just, yeah, sounds like a fiction or a horror movie or kind of zombie thing. But to them, this was rational and this made sense. And this was a pathway to making women healthier by, you know, treating the symptoms of a wandering womb. And some of the possible cures for a wandering womb, I mean, the main one you can imagine is sexual intercourse and conception, right? Number one, ideal treatment. That's not possible or doesn't work. They often used fumigations of different smells because they believed that the uterus was attracted to certain fragrances and that it would sort of, you know, smell, I don't know, a charred candle wick.

How to seduce a uterus back to its natural position. You can start with a lovely fragrance. They love the smell of rose hips. Bizarre. I mean, well, look, it's easy to laugh at. And as a comedian, it's almost like hack to make fun of what people thought of medical knowledge back in the day. But people were subjected to this. I mean, real people's lives are affected by this.

And as much as you say that it was rational for them to believe it to a certain degree based on what they knew, well, it was also based on this non-rational, more spiritual belief about what women were for, right? That like that's one of the premises of that belief of the idea of you have an angry, hungry uterus is because you a priori believe that women are designed for procreation, right? I mean, or was there any other basis? No, absolutely. That was completely right, that because women's bodies were destined for reproduction, were put on Earth for reproductive purposes. So it was a melding of a medical idea with a mechanism of social control, if you will,

like a way of endorsing, a way of justifying the sort of social law that destined women for this reproductive role in society. Yeah. And as much as, again, as much as it's easy to make fun of, you know, people a couple thousand years ago, like the basic thing that we're talking about, which is using the rational abilities they had at the time, the limited knowledge, but them doing their best jobs of trying to puzzle out the world, they still were basing their beliefs on these sort of deep rooted assumptions, which is the same thing that we're doing today. I mean, it's what you described at the beginning of the show about our beliefs about women characterizing things more socially being more unreliable, that strikes me as similarly just an unexamined belief that sort of like underlies a, you know, underlying a conclusion that we think of as rational. Or am I extrapolating too much? No, you're completely right. You're absolutely on the money. Women, you know, it seems really odd to suggest that

because Hippocrates espoused that women's wombs were hungry and wandering and mischievous, that women are, that's the basis of women being ignored, distrusted, doubted in the doctor's surgery today. Okay, so that seems odd. But in a sense, it's very true. Because from the minute we begin to have the foundations of medical knowledge in ancient Greece, the physicians of ancient Greece were suggesting that women's bodies were not really their own. So therefore, they were not the authorities over their bodies. They couldn't speak to what was happening in their bodies, over their bodies. They couldn't speak to what was happening in their bodies, not only because they were not the authorities, socially speaking, on anything, any form of knowledge, but also because how can you, you know, have any fidelity to something that isn't

under your control? So from the get-go, women are overly associated with bodiness, but it's not a bodiness that women own. They don't have rational control over. So that is what that sort of kernel of thinking is what set in motion the circumstances that we grapple with today, by which women are not regarded as reliable narrators of their bodies when they speak about them. And of course, many centuries between ancient Greece, Hippocrates' time and today have occurred and lots of medical knowledge has evolved and progressed. But some very foundational ideas about women's bodies being not their own, being out of control, being unruly, needing to be tamed, really persist. These myths have had real sticking power over the centuries, and they've

almost been baked into medical knowledge, even as it's progressed into the science that we know it to be today. One of the things that really fascinates me, before we move, I want to talk more about different periods of history, but something that really fascinates me is this idea of rather than controlling your body, your body controls you, your body is unruly and mysterious to you. Well, I think there's a lot of truth to that like when you're describing that to me i'm like it's stirring something in me of that feeling true that the you know the body is like to a lot of us is still like unexplored territory and you feel a way and you don't know why um and so there's there's a lot

of truth to that but i don't think that that's gendered or i don't think that's sex specific. It's, it's, you know, I think that's true of anyone. And to a certain extent, I don't know, to the, to the extent that, you know, women are subjected to that. It's also like a way of thinking about your body that, that women are granted more access to in a way. Does that make sense? I'm like, that seems like a way of thinking about the body that could also be potentially valuable in some contexts um and it's odd that it's that it's gender specific that way

i mean like i you know i don't know what the hell's going on with me half the time you know i have a mysterious pain i'm i have diarrhea today i don't know what's going on you know uh but but i'm not you know normally thinking of my body in this way. Yeah, I think that's so true. And it's definitely universal. I mean, we often don't think about our bodies until something's not quite right with them, right? Until we feel pain, until we get that mysterious twinge, until we get that stomach upset, until we get that fever. And then this sort of mysterious system that lurks beneath our skin, you know, pulsing away, doing its thing, suddenly makes itself present to us. And it's asking us to act upon it in some way.

It's asking for something. Otherwise, I think the body often goes ignored, really. You know, we go about our lives, we take for granted what our bodies are doing unless they start to malfunction. And yeah, sorry, go ahead. Oh, well, I was just going to say that it's this deep, this deep, like, confusion about what it is to be human because on the one hand you know i'm a materialist right i believe that like we are our bodies fundamentally the what the body is shapes the mind and the spirit and all that you know um and so it's this deep thing that we are at the same time we are we are meat but half of it is inaccessible to us right that we That we're like, oh, something is happening, but I don't know why. Or something happened, but I didn't notice it until it was going on for a little while.

And that's a very interesting thing about ourselves. I'm sorry, continue with your point, though. Yeah. So I think this is absolutely true in our relationships. I think in our intimate relationships to our bodies, right, these issues around gender disparity don't play out. I don't feel like they play out. I feel like you and I would have a very similar sense of living in our bodies on that kind of intimate level and that sort of personal unspoken level, you know, when you think about what your body is and what it's doing.

It's often really hard to articulate what it's like to live in a body. But when we go to the doctor's office because something isn't right, that's when we have to articulate what it's like to live in our bodies. That's when we have to try and put words around that really inarticulable experience of existing in a body. And it's then that the problem starts. It's then that the biases kick in because it's about how the articulation of life within a body is perceived. Yeah.

You just made the process of going to the doctor seem so philosophically fraught like when you go to the doctor you have to articulate what it's like to be a consciousness housed in a biological framework that you that you don't understand that feelings appear that are maybe connected to what's happening in your biology, but maybe not in this ineluctable way. And how could you possibly express it? Like, it's really stressing me out that next time I have a cough, like, how will I represent this? How will I bridge the gap between consciousnesses? But there's a truth to that. It's like, it is a very mysterious thing. I'm sorry for stressing you out. No, no, no, not at all.

It's actually stressing me out a bit now too. But I think the thing about pain, right, especially pain, is that it's universal human sensation. We all experience pain, but our relationship to pain is so subjective and so personal. And what is pain to one person is never the same to another. And there is no language that adequately expresses the universal condition of pain. And this is what a lot of the problem is in the kind of communication of that pain,

is that how do you accurately communicate something that's so personal, so subjective, that how do you accurately communicate something that's so personal, so subjective, so diverse, but yet it's, you know, it's something that makes us human, the experience of pain. But getting good care at a doctor's, for example, from a healthcare professional, it really depends on that moment of communication. It depends on communication. It depends on listening. It really hinges on that you know and yeah and it's so fraught i mean people talk about you know there's the pain scale where they say rate your your pain from one to ten and i've heard people say like that should be very clear and simple right okay we're trying to communicate very clear we're trying to make a difficult thing you know put

a framework on it but then i've heard people say oh you just got you got to say nine just say nine no matter what it is say not because 10 they won't believe you and anything less than nine they won't listen so just say nine you know and and i'm sure nurses who are hearing this have the same sort of like oh this guy came in he said 10 fuck him you know, or whatever. Like, it quickly becomes this negotiation over care rather than a real communication. It's a very difficult thing to do. Very difficult. And on the pain scale, the one to 10 pain scale, I think that a lot of women when asked, rate your pain on a scale of one to 10, would fear going too too high because they think, is this healthcare professional going to go nine? Are you hysterical? Nine, eight, nine. So you kind of go, is six?

Six probably seems reasonable. And then you think, am I pitching it too low? So again, something as simple as a one to 10 system then becomes fraught with a bunch of kind of judgments and assumptions and this anxiety about how you're going to be perceived. Am I going to be seen as a fusspot and then ignored? Am I going to be seen as exaggerating? Am I going to underplay it and not get the care I actually need? So again, it's so fraught. Yeah. Okay.

Well, we have a lot more to get into, but we got to take a really quick break. We'll be right back with more Eleanor Clyde Korn. Okay. We're back with Eleanor Clyde Korn. I want to learn more about, you know, the later history of medicine and its relation with women. But I do want to ask one thing first, which is that, you know, people who have, if you have a uterus, if you have ovaries, if you have all these things, you do have different biology than someone with a dick and balls. There are different hormones going on. There's different, there's, you know, there's monthly cycles. There's all these. There are different hormones going on. There's different, there's, you know,

there's monthly cycles, there's all these, there is different biology. And how much has the history of this sort of neglect, you know, caused women's, you know, actual issues to be neglected and ignored? You know what I mean? Like if you're, so again, you know, actual issues to be neglected and ignored. You know what I mean? Like if you're, so we're, again, you were talking about the Greeks thought of, you know, women as being ruled by their bodies, et cetera, et cetera, as being fundamentally different. But there is a,

there are fundamental biological differences. But it strikes me that probably the Greeks way of understanding it did not lead them to understand what those actual issues were and fix them, right? So, like, how does that piece of it come in? Well, different forces then act upon that knowledge as it moves through history. So, we get the Greeks, the ancient Greeks, the foundational medics saying, okay, women are all about their wombs, wombs move around if they're not, you know, having a great time and raising a kid. And then you throw different religious, social, political ideologies, forces into the mix upon that knowledge. So, once we get Christian theology in the Middle Ages, the extant knowledge from ancient Greece is still there. It's being translated and transmitted. The texts that survived the fall of Rome are being translated

and transmitted into this new era of human history. But of course, they're being respun according to new foundational beliefs about human bodies, about the difference between men and women. about human bodies, about the difference between men and women. And so you get the idea that a woman's womb is unruly, then quickly evolves into the belief that a woman's womb is dangerous, that it can lead her to do despicable, awful things, that because she has this womb that hungers for intercourse, she's depraved she's corrupting she's poisonous and of course that comes from the foundational biblical myth about the fall of eve you know women's bodies women's corruptible bodies are responsible for all the sin in the world so this is how these ideas evolve so one it's almost as if new learning is layered upon old. So you get the

residue of those old mythologies. They stick there. You know, a guy like Poctes was a very authoritative figure, and his ideas resonated across the centuries. So you get this kind of collage of ideas, where the central truth is there there and it's kind of impressed with a new sort of thinking and you get this up until about the 19th century really until the kind of dawn of biomedical health care scientific medicine yeah because medicine remains a very mythological and often quite speculative form of knowledge. Yeah. Yeah, you had these, you had people who were like, rediscovering the work of the Greeks. But then also, they suddenly had like the Garden of Eden story, and they had all these other things, and they were mixing them together. But yeah, tell me, I think the 19th century period

must be so fascinating because there was so much discovery all at once. And so, yeah, what was the situation with women's health at that time within our understanding of it? So by the time we get to the 19th century, we see the disciplines of women's health, 19th century, we see the disciplines of women's health, of female health, obstetrics and gynecology start to become of professional interest to male physicians. Because throughout much of history, professional physicians were not largely interested necessarily in female biology. A lot of reproductive care was conducted by women. It was a very feminine space. And of course, male physicians did write extensively about the uterus, extensively about women's reproductive bodies. But it didn't mean they were necessarily,

you know, wanting to hang their hat on that as their own discipline. You know, it would come up in their general books about health and illness. So by the time we get to 19th century, we get gynaecologists and obstetricians in the UK and the US, our medical histories are very aligned around this time, who are, you know, venturing into a brave new world, as it were, and really establishing themselves as obstetricians and gynaecologists with the capital letters, forming professional societies, you know, making a living from specialising in what was often called the diseases of women. And this included everything that you just mentioned within that biological sphere, Mark, female, the ovaries, the vagina, the vulva, the clitoris, the uterus, you know, this whole space, the diseases of women

encompass this whole biological space. And the 19th century, as you said, was a period of really intense medical progress and evolution. You know, we're moving from this realm of theory and speculation to surgical interventions, to new understandings of where disease might come from, to new conceptions of chronic disease and acute disease. And by the end of the century, you know, germ theory emerges. So we move, it's so fast and so rapid but over that period of time this is really when women's bodies became the objects of medical attention in the sense we know them to be today so doctors physicians gynecologists were specializing in trying to figure out those mysteries and mystifications that sort of lurked in you know within the female pelvis yeah i mean

this is this is like maybe an improvement of perspective but it's like moving from men like hippocrates being like ah the mysterious woman who's ruled by her emotions and her by her body and and who can know what her problems are and then a couple thousand years later, they're like, well, now we shall study the woman and we shall understand her mysteries and plumb her depths. But there's still like an othering there. There's a treating it as like, okay, this is like a dark continent that we're exploring. And, you know, there's a simplification and yeah, a paternalism there, certainly. So much. And you see this paternalism really come to the fore around certain new innovations that become popular in the care of the diseased women at the time. So, for example, in the early mid-19th century, the vaginal speculum became much more popular in gynecological practice. Now, the speculum has existed for centuries. There was a speculum discovered in the early mid-19th century that professional gynecologists started

using them to, as you say, explore this hitherto unknown dark continent of the vagina and cervix. But the use of the speculum provoked insane debates because we're still in the 19th century, we're still being governed by, you know, the beginning of Victorian social mores. And this idea that an upstanding man, an upstanding, dignified male physician would glance into a vagina, like very improper. You know, forget treating her illnesses and diseases, forget figuring out what's really going on in her body, you're risking your professional reputation. And, you know, and furthermore to this, you know, the physicians who believed that the speculum was just this abhorrent, indecent tool that had no place in upstanding medicine, also believed that women would become erotically excited by being examined with a speculum. And it would unleash...

Everyone's dream. Everyone's dream. And they would like, you can't, if you go around examining women with speculums, all they're going to do is go erotically insane and they're going to develop like an insane sexual hysteria and then their ovaries will shiver up and no one will want to marry them.

You know, don't do it. Bizarre. But I mean, the speculum is that this is a tool for peering inside, right? For getting an internal view. And this reminds me of reading, I read a couple years ago, a history of the stethoscope as being a huge, and I forget what year the stethoscope came into use, but the stethoscope as being a huge, and I forget what year the stethoscope came into use, but the stethoscope as being a huge advance in medicine because suddenly you could get an internal view

without having to cut somebody open. And that was like a big, you know, that was a watershed moment. But for the same thing, rather than for the heart, for the downstairs area, you know, to be treated as a horror or an object for debate, goes to show you the difference in how these organs were treated by medicine at the time, that it wouldn't be seen as an incredible, you know, advance. Yeah, some doctors did. Some physicians really understood that being able to properly look inside a woman's body

to see what was going on would enable diagnosis, would enable treatments. And a few of the more progressive doctors did say, you know, this will help us move beyond the ignorance and superstition of the past. Actually being able to get this objective view of what's going on inside the body. But the majority view was really pivoted around this kind of strange sexual politics where medicine is completely dominated by men, and men are completely governed by the social mores of the time that are still very much like women's bodies are shameful as a man you do not go near that part of a woman's body

and so this these social superstition social beliefs really trumped the need to create objective knowledge and create ways of healing and caring for women that, you know, so the shame is always imbued in it. It's imbued in those practices, even as they were developing. And that's then what impedes the progress from being objective and being straightforward is that it's always absorbing the social dynamics between men and women. Yeah. At whatever particular part in history these advances were taking place. place. I mean, this is almost a recurring theme for this show. We've talked about how, you know, you sort of inescapably, when you're trying to do this, do these things, you know, the progress of science in this abstract, rational way, you always end up importing the biases of your time. I believe our episode with Ruha Benjamin, we were talking about race and technology and about how there's

no such thing as technology that is not, you know, doesn't have a racial dimension to it because it's created by people who, you know, have, there's a racial dimension to social life and some, and it gets in there, you know, in ways that you don't expect if you're not cognizant of it. So this strikes me as sort of a similar process. You're talking about the background social relationships between men and women of whatever time, Hippocrates' time in the 19th century, and today, just getting sucked up into medical practice, because why wouldn't they? It's another sphere of human activity. Yep, very, very much. And it's not just that dynamic, you know, that sort of sexual dynamic, if you will, between men and women that does get really in there, really baked in

sexual dynamic, if you were, between men and women that does get really in there, really baked in to medical advances, medical progress, medical culture. It's also the perceptions of women's bodies that are a real hangover from ancient Greece. This idea of the unruliness, the untamable nature of a woman's body, but also a woman's mind. And so the idea that women are governed principally by their bodies, and that they also have a very strong emotional connection to their bodies, you know, they're not associated with the mind in the way that men have been historically. They're not associated with the sphere of ration and thought. They're very embedded in their origin, affects more women than men. But when it was first being documented, when women were presenting with the symptoms that we know are characteristic of this disease, they were assumed to be hysteric, because that was the precedent when you had almost any symptom affecting a woman's body.

This was the context in which these symptoms were read. So the hysterical precedent being something that really solidified this unruly emotional relationship between a woman's body and mind, in which we tend to think of women's symptoms physical symptoms as being somehow emotionally generated so it's the hysteric precedent that really did that and you know today we you know calling a woman hysterical it's a slur you know it's a gendered slur yeah that had its origin in a medical idea about this sympathetic connection between, you know, the delicate, fragile, and irrational female mind and the untamable, unruly, and depraved, you know, center of her body. Well, tell me a little bit more about that word, because I almost wish we had gotten to it earlier,

because I think it's like a central part of this story. Because, you know, I mean, look, as an amateur linguist, I can't help but notice that, you know, you've got hysterical, you're being hysterical, right? Then you've got hysteria, the sort of like pseudoscientific disease that women were said to suffer from. And then you have what we still call a hysterectomy, which is the removal of the uterus, correct? I think I've got it right. And, you know, this, you know, there's a period when all these words are being used like sort of simultaneously, these three different meanings, one very medical, one pseudo medical, and one,

you know, just purely emotional, right? And so where does that idea come from? And how do those come together? So one of the ancient Greek words for uterus, for womb, is hysteria. So, when the Greeks were talking about these movements of the womb, they were not talking about hysteria in the sense that we understand it today, in the sense of this very 19th century sort of delirious, fainting couch, you know, too tight corset situation of hysteria. They used that word because it meant uterus. And so the symptoms of the uterus were hysteric symptoms. Fast forward to about the 17th century and hysteria, it wasn't ever a disease. It was a diagnostic category invented by male physicians to explain the inexplicable symptoms that affected women. And hysteria could be anything a dude wanted it to be.

It meant, I don't know what it is. It meant this woman is suffering from something that I don't. Hey, it's not a rash. It's not a heart attack. It's something else. It's hysteria. That's the something that I don't, hey, it's not a rash. It's not a heart attack. It's something else. It's hysteria. That's the bucket for I don't know. Absolutely.

It was an umbrella diagnosis. It was a wagon with every conceivable twitch, faint, convulsion, mental symptom just piled on it. just piled on it. But it served male physicians really well because it essentially diminished women to their reproductive organs, to their crazy minds. It reduced women, all the complexities of the body that we were talking about earlier, all that incredible, inexplicable stuff going on underneath the skin. Hysteria reduced women to a gendered assumption that whenever they're unwell, whenever they're afflicted by mental or physical illness, it's purely because of the nature of being female, that there is something inherently unwell, something inherently defective going on in this channel between mind and reproductive system. And hysteria was,

you know, punitive. It could be a really punishing diagnosis. You know, it could result in a stay in an asylum if, you know, that's what one's husband thought was the best, right? But it also masked the true nature of a lot of diseases and illnesses and clouded the understanding of others too. And by the time we get to the end of the 19th century, many physicians working in the field of women's health are like, okay, the jig's up. You know, hysteria is a load of nonsense. It's a will-o'-the-wisp. It's a spectre. It's a star floating in the sky. They were very keen to debunk this because it was so dominant and it was time to move away from these narratives.

And that's when hysteria was really taken up by the psychoanalytical community. Many listeners might associate the word hysteria with someone like Sigmund Freud, who's saying the hysteric has these unbidden sexual impulses and she faints and screams and goes crazy because of them. And that's hysteria. So hysteria loses its power as a medical diagnosis around the end of the 19th century. But it regains this psychological currency. And it remained in use as a diagnostic category at least until the 50s and up until about the 1980s in some contexts. So it hovered around and of course, it never had a real origin. It's not like something like cancer, right, that has changed its meaning and has changed its context over the centuries. But it's always meant something that really existed in the body, you know, that tumour, that growth, something that was really going on. Hysteria is a category applied to women. You know, it's a form of discriminatory knowledge imposed upon them. And that is where we get this slur,

you know, call a woman hysterical, you are diminishing her, her ration, her control, her intellect. And that's how it sort of seeps into our cultural conversation in that way. Wild. Um, well, well, you know, you, you mentioned seventies, eighties, et cetera. Um, and what that makes me think is, again, it's so easy for us to make fun of, here's what people thought medically in the past. But as we've been talking about, our social beliefs today must leak into our medical knowledge in the same way. So bringing us up to

today, like what are the ways in which we're enacting this pattern today? You said at the beginning, women go in and they say, I'm feeling pain, their pain is not taken seriously. But let's dig deeper than that. Like, what are the, you know, what are the assumptions that the medical profession is still carrying out that or that, you know, we as civilians are carrying around with us? And what are the effects on women of those medically? civilians are carrying around with us, and what are the effects on women of those medically? I think these old mythologies, these old ideas impact our health as both men and women in really particular ways. And the most measurable ones are, as I talked about at the top of the program, the attitudes that tend to emerge when women and men express pain. And of course, the very real

effects of these assumptions of downgrading, belittling, diminishing female pain is that complex diseases often go misdiagnosed or undiagnosed. So we look at a disease, for example, like endometriosis. Okay, it takes between 10 and 12 years to be conclusively diagnosed with endometriosis. Yeah. You know, it affects a staggering number of people with uteruses across the globe. And it has been named, it was first named in 1927, but its symptoms have existed in medical history since before Hippocrates. But yet we still cannot diagnose this disease in a timely way, and it's still

shrouded in mythology. And the reason for this is that those gendered misbeliefs, which were very germane to the pre-war period, the pre-Second World War period, main to the pre-war period, the pre-Second World War period, have really stuck, you know, and they've impeded clear, objective understanding of what the disease is, how to diagnose it, how to treat it. And we see a similar pattern in diseases like lupus, which is a disease I have, affects 90% more women than men or 90% of sufferers are born female. Really? I didn't know that. Yeah. There are different forms of lupus, but on the whole, 90% of sufferers are female. And it takes between six and eight years to be diagnosed, depending where you are,

you know, in the UK or the US. And again, because a disease like lupus starts with non-specific symptoms. I go to a doctor's office and I say, I'm tired, I'm exhausted all the time, I'm aching, I might have mental health issues as a result of that. And these symptoms, that's when those biases and prejudices kick in, where the lack of knowledge exists. And why does the lack of knowledge exist? Because we have not prioritised diseases that disproportionately affect women. Because history has tended to fall back on gender biases, gender beliefs, very reflective of the era in which they emerge. So now really is the time to disentangle that sort of antiquated gendered stuff from medicine as a science and an art form.

You know, it's a time to face that and have a reckoning with it. Yeah. Endometriosis is one that I've recently been reading about. And by the way, could you tell us what endometriosis is? Yes. Endometriosis is a multi-symptomatic systemic disease, meaning that it can affect all the organs in the body that affects people who have uteruses and it also affects some men very small number of of male people have it too but it's where tissue that is similar not the same as but similar to the tissue that grows inside the uterus, grows in other parts of the body. And it can affect a person's fertility. It can affect the functioning of all the different organs. So the tissue can appear in the lungs, it can appear outside the uterus. It's a very poorly understood

multisymptomatic systemic disease that historically has always been associated with menstruation, with heavy menstrual bleeding, with fertility. And for this reason has either been stigmatized as something that women should just kind of deal with, oh, heavy periods, whatever, you know. Or it's been overwhelmingly associated with fertility and reproduction. So it remains very poorly understood. Yeah. I mean, well, so, you know, my understanding of endometriosis, I've read a little bit about it as this poorly understood disease. And it seems like there's a secular thing to what you're talking about where, you know there's this this belief or assumption of women as ruled by their bodies and you know the mysterious female body and then the conditions themselves are themselves poorly understood which lends to the feeling that the

female body is a mysterious terra incognita right um and so it sort of goes around and around like that. When if proper attention were simply paid to the disease and we understood it fully, we might have less of that assumption about it. Totally. contrary ideas because you know a woman is or for a long time throughout history was overwhelmingly associated with her body right her body was seen to be mysterious and inexplicable but yet her body was also very socially available and very discussed as a kind of social entity you know people always talking about women's, what women should do with their bodies. But yet the objective understanding that might result in care and well-being and understanding is lacking because it seems to me that the social notion of what women exist for, what women should do with their bodies, is always perceived to be more important than really carefully understanding what is happening in all that biological stuff that's labeled female. And so we've inherited such a lack of knowledge, these woeful gaps in knowledge that previously in our history have been filled in with old myths. I mean, endo is fascinating because when it was studied in

the 1940s by an American physician called Joseph Meeks, he assumed that it was becoming more diagnosed because women at that time were putting off having children until a little bit later in life. And the reason this was happening is because we're just coming out of the depression and more women are entering the workforce. You know, the stable industries are the ones that can employ women. And he's saying, okay, endometriosis is essentially a punishment for women who decide to keep on menstruating because they'd much rather go work than they would pop out a bunch of kids. And that is very of his time. That's completely rooted in the time in which he was

espousing this nonsense. That is wild to me. I want to bring in also, speaking about the discrimination that people of color face medically. And, you know, the layered, therefore, you know, experiences that women of color have in medical settings. Could you talk a little bit about that? Of course. I mean, women, of course, are not a monolith. And we, I as a white woman, risk being called hysterical when I speak about my pain. But for a black, ethnically diverse woman, they also face the double prejudice of racism and sexism. And medical racism spun quite a different narrative about the pain and illnesses of women of colour. about the pain and illnesses of women of colour. So if we go a little bit, go back briefly to the 19th century, and we see ideas, racist ideas from anthropology being absorbed into dominant

medical thinking. And a lot of these racist anthropological ideas were trying to classify a biological difference between the races, which of course we know now to be complete falsehood. But then it was trying to make these value judgments that were essentially all boiled down to being an apology for chattel slavery, right? It was these white dudes trying to justify the abhorrent and inhumane practices of chastisement of slavery. But what we get in medical thinking is this dire misbelief that white women who have access to colonial, you know, leisurely colonial treats and, you know, exist in the colonial world are very refined and they're capable of feeling all this pain. That doesn't mean they're being cared for better because they're seen as exaggerating, but they're perceived as being capable of feeling. They're refined and

civilized enough to feel. Black women, on the other hand, women of color, the falsehood was perpetuated that they were invulnerable to pain. And this is very rooted in the perception of humanity you know the humanizing or dehumanizing as it were of people who are enslaved people who are colonized people who are racialized and these ideas that people of color did not feel pain were also married to other racist falsehoods including people of color have thicker skin, fewer nerve endings, smaller brains. I mean, the list goes on. Racist biology is an awful, awful, has a horrible history. Yeah. But it had real ramifications as medical history progressed for the understanding of the way that diseases and illnesses affected women of colour. Now, an example, a good example is something like uterine fibroids. So fibroids that grow in the uterus. These were studied in

white women, you know, back in the early 19th century and, you know, surgical interventions and medical interventions were developed for them. But in black women, uterine fibroids were overly associated with sexually transmitted diseases because of the belief or prejudiced beliefs about black women's sexuality. So that's just one small example in which, you know, the racism that's also embedded in medicine has impeded the care of black women, of women of colour. And we see it as welled the care of black women of women of color and we see it as well in the woeful rates of maternal mortality in both the us and the uk where

often women of color are disavowed their pain you know they express pain and because of these persistent racist misbeliefs that people of colour experience less pain. You know, there might be assumptions of exaggerating or just the idea that a healthcare professional might undervalue or underplay that pain and not necessarily notice what is happening with that particular person. So, you know, we have an entirely different sort of strand of neglect, of devaluing, of harm that's been done because we have not adequately faced up to the legacy of medical racism that does persist today.

Yeah. Do you feel that any of these issues are getting better at all? You know, now that, I mean, we do have, you know, in the 19th century, I assume there were very few female doctors. We, you know, that's, that's changing now. Medical racism is something that we're at least having a conversation about in the medical community. I just did a segment of the show that I'm making that's going to come out on Netflix next year, where we talked to folks at the NIH and we talked about these issues. These are issues that they're working at the government's National Institutes of Health. You know, that there are important people taking these issues seriously.

So do you feel that progress is being made? Yeah. I do. I do feel that progress is being made. You know, the more we delve into this history and the more we see that it's, you know, roots are still with us, it still continues to affect people, it's easy to feel really hopeless and easy to feel like it's such an uphill battle. But I look at the way that conversations around, you know, structural racism, structural sexism, structural racism, structural sexism, the systemic neglect that happens within systems of power like medicine. The way that we're discussing them now, the way that these issues are being discussed

in the press, on podcasts like this, in the media, I feel revolutionary. And the more that people discuss these issues, the more that individuals face up to histories, but also share their personal experiences. It's very meaningful because it creates conversation and history has shown us that speaking out, you know, finding community, building together, vocalizing experiences, talking about histories has made legitimate and really significant progress and so I do feel really hopeful I think you know the conversations that are being had across the whole you know spectrum of healthcare are incredible at grassroots levels uh you know big government levels in the NIH as you say over, over here with the NHS. I really do feel like

we're reckoning with this stuff. I do. And it really makes me feel hopeful the more we can talk about it. And the more we can face those histories and understand where some of these issues have come from, the less likely we are to repeat the mistakes of the past. Do you have any thoughts for women who, you know, are in this situation? You know, I haven't wanted to tell anybody else's story on this podcast, but so many things that you've said have resonated for me with, you know, women in my life, right? Where I think, oh, someone I love has had an experience that resembles what you're talking about, where there's a medical, an issue where they go and they do not get resolution or

comfort from the medical community, from the experience that they've had. So do you have any words of wisdom for women next time they're sitting on the, on the, you know, piece of paper on the weird bench, you know, with the, with the weird medical smock on and the doctor comes in, you know, is there, is there something that can be done in that moment to make that go a little bit more smoothly? I think first and foremost, remember your body is your own. This is your body. Only you know what

it's like to exist inside it. You can be in that situation where you are either struggling to be diagnosed or struggling to communicate what's happening in your body and feeling frustrated and feeling that you're not being treated well. It can really help to take someone with you because when you're unwell, it's really emotionally taxing. It can be really traumatizing. It can help to take someone with you, not to speak for you, but someone who knows you, someone who can testify to what you've been going through. It can also really help if you're up to it and you feel like doing it to keep a list or a little diary of symptoms, because then you can almost cut out the emotion and just say,

read from your diary and say, look, I've been in pain for four months. I've been, you know, it can help. Little things like that can help. But above all, I would say that it's your body. And we're very conditioned, I think, to listen to doctors, accept what they're saying. I think to listen to doctors, accept what they're saying. And if we don't get the answers we want, internalize that as something that's wrong with us. I love that of, first of all, knowing that what you're experiencing in your body is real, but also bring along a friend or a loved one who can boost you up a little bit. Like, no, you listen here, motherfucker. She's in pain.

I'm sitting here. I got to sit here and watch this shit. So you do something. You know what I mean? Like just making a little bit of a team effort. Yeah, for sure. Because it's so hard. When we talk a lot about how do you advocate for yourself in life?

How do you push? How do you demand more? And it sounds great. It sounds great standing up and saying, I'm not going to take this. I need a second opinion. Get that other doctor in here. That is an experience that's available to many of us. And even when we do have choice in our healthcare providers, you're feeling unwell, you're in pain, you're up against a complex system. You're not going to start, you know, getting like your power pose on and kind of go, right, I'm not going to take this. So having some advocacy can happen in different ways. It can happen in ways that are much more accessible for us. Bringing someone with you who knows what you've been through who can just be

there for you you know it can mean such a lot and I do think it helps kind of cut through that almost antagonistic one-on-one dynamic that can happen where you feel like you can feel like you're being judged you're having to perform how bad is is this ache? You know, how terrible is this knee pain? Because if you've got someone with you, it sort of cuts through that. It undermines that them against you feeling that can sometimes come up when you're trying to, you know, seek treatment, seek diagnosis. So I think it's something really simple and that advocacy can be that. It can just be like being not alone you know make as you say making a bit of a team effort of it man that is that is wonderful advice and and i'm i also am really hopeful things are getting better in this regard and and i can't

i can't thank you enough for coming on the show to talk to us about it eleanor it's been really wonderful thank you so much for having me. I've really enjoyed our conversation. Me too. Well, thank you once again to Eleanor Cleghorn for coming on the show. If you enjoyed that, once again, check out her book at factuallypod.com slash books. That's factuallypod.com slash books. I want to thank our producers, Sam Roudman and Chelsea Jacobson, our engineer, Ryan Connor, and Andrew WK for our theme song. The fine folks at Falcon Northwest for building me the incredible custom gaming PC that I'm recording this very episode

for you on. You can find me online at adamconover.net or at adamconover wherever you get your social media. Thank you so much for listening, and we'll see you next time on Factually. That was a HateGum Podcast.