All in Her Head: The Truth and Lies Early Medicine Taught Us About Women's Bodies and Why It Matters Today

by Elizabeth Comen

But the emotion I encounter most in the examination room, more potent and insidious than fear, is shame. The list of things for which patients have apologized to me over the years is both endless and obscene: these women are sorry not just for sweating, but for being sick, for having to seek treatment at all.

I cannot recall a male patient ever expressing this sort of shame.

The women who apologize to me for being sick are part of a medical legacy, passed down over hundreds of years and still visible today. From that legacy, a story has emerged. It’s a story about what a woman’s body should look like and how it should feel, in work, in play, in learning and thought, in sex, in motherhood, in sickness and in health—and yes, even on her deathbed.

The problem is, the story is not true.

Western medical storytelling has largely eschewed the discussion of women’s bodies, let alone elevated them as powerful, capable, or of equal worth to men’s. In the medical history that defines women’s “normal” bodily functions—as well as their pain, pleasure, strength, and intellectual capacity—the voices of women themselves are notably absent.

To empower women with the tools they need not just to survive but to thrive.

The role of women was proscribed in medicine as in society, bolstered by the stereotype of the female nurturer: Doctors cured. Nurses cared.

Women remain underrepresented and overlooked in medical research, even though many treatments interact differently in a female body than in a male one.

Today, we are burdened not only by the legacy of ignorance, indifference, oppression, and subjugation toward women’s medical issues but also an entire system built around it:

In too many fields, the pathologies specific to women remain underfunded, under-researched, and frequently misdiagnosed.

One recent study revealed that women operated on by men have significantly worse outcomes, including death, than when operated on by women. (As for the men, their outcomes were the same whether a man or woman operated on them.)

Rather, it is to ask for a medical world that is more human, more holistic, more capable of seeing the patient as a whole person and not just a series of broken parts.

We need to stop apologizing for our medical needs, and start asking the questions that lead to better knowledge, better health, and better lives. We need to ask how to cultivate a relationship with our bodies that is not just comfortable, but joyful; how to know when something isn’t right and to advocate, not apologize, for our needs; how to navigate a healthcare system that will never be perfect but could be better; how to be as assertive, as informed, and as confident in the care we deserve in a doctor’s office as we are in the rest of our lives.

The integumentary system is the body’s largest: its surface.

system whose sole purpose is to protect what’s inside from the outside.

Unlike other chapters in this book, this is not a history of women’s health issues going overlooked, ignored, or misdiagnosed

it’s a physician’s preoccupation with women’s bodies, women’s beauty, that has driven many of the advancements in the field—and sometimes without much concern for what the women themselves think about it.

Today, the practice of cosmetic medicine is one that walks the line between empowering women to control their bodies and trapping them in a gilded cage of punishing beauty standards.

The idea of a medical link between health, well-being, and beauty—a broken heart on the inside, a busted face to match—soon became central to the practice of elective cosmetic interventions on otherwise healthy women.

The equation of female ugliness with the type of life-altering disfigurement that left former soldiers requiring surgery just to live normally only works in a world where a woman’s social value is inextricably tied to her physical appearance—and not only that, but to her sex appeal.

As a result, the history of plastic surgery is primarily a story about male doctors operating on female patients. But perhaps more importantly, it’s a story about men with the power to make women beautiful, and the authority to decide what “beautiful” looked like.

a long tradition whereby a physician’s stamp of approval serves to lend a seriousness, a legitimacy, to beauty treatments:

But the legacy of those early days is still with us—including in the process whereby a woman’s normal, healthy body is pathologized as a deformity in need of a surgical fix, and where the “ideal” is based as much as on what men desire as what women want.

it remains the case that plastic surgery trends are closely tied to male desire, male notions of beauty—and

But while a medical education teaches doctors to recognize the diversity of “normal” shape and size when it comes to other body parts—including, notably, men’s penises—there is no analogous recognition of the normal diversity of women’s genitals, nor is that information available to anyone who might try to seek it out.

And yet we are still no closer to disentangling what women want for their faces and bodies from what doctors, or husbands, or social pressures might tell them they’re supposed to want.

oncology and other fields of medicine have much catching up to do when it comes to how we weigh the impact of treatments on our patients’ quality of life—in which psychological and cosmetic concerns are just as meaningful as adverse health effects or toxicities.

the female skeletal system differs in certain crucial ways from the male’s.

The study of anatomy seems to have been permeated early on with a double standard: the depiction of men’s bones conveyed medical knowledge about the human body, while the depiction of women’s bones conveyed aesthetic, cultural, and social concerns.

Since the time of the ancient Greeks, medicine had been captive to the idea of the male default: men’s bodies were the healthy standard.

As is so often the case in medical history, where racism took root in the scientific community, misogyny was not far behind.

The more the scientific community understood about evolution, the more vital it seemed to simultaneously prove that women were less evolved, even if one had to indulge in pseudoscientific quackery and human skull–collecting to do it.

Between the lines of this extremely nineteenth-century conflict lies a far more familiar, and timeless, frustration: one of women being lectured to by doctors who did not listen to them, even when the women possessed information, and firsthand experience, that the doctors did not.

And perhaps this is why the history of medicine and the female skeletal system is not just particularly objectifying, but particularly paternalistic.

it became impossible to separate notions of health from those of morality, and of beauty.

As always, the beliefs that shaped the study of bones back in the 1800s are still embedded in the specialty today. The notion that women are not built to move has long since given way to the related one that women don’t like to move, that physical activity isn’t important or essential to their lives in the way it is to a man’s.

In addition to the idea that being immobilized was no big thing for women, patients suffering from frozen shoulder also appear to have been up against another form of prejudice that is by now familiar to any student of medical history: the notion that any problem mainly afflicting women must have a psychosomatic component.

Meanwhile, the science is still struggling to catch up when it comes to skeletal problems that genuinely afflict women differently.

the consensus that exercise in general (and bicycling in particular) was deleterious and dangerous to the health of women was a complete fabrication.

But when it came to the existence of elite female athletes, the scientific community was generally in agreement: nature did not intend for women to excel at competitive sports—and if a woman did excel, it was because she was, herself, a perversion.

But in too many cases, this conversation devolved into crude stereotyping rooted not in science but in sexism. And doctors, tasked not with diagnosing disease but rather enforcing the boundaries of femininity, too often erred on the side of stigmatizing strength.

The way doctors approached women’s physical fitness was of a piece with a broader medical paternalism, and a tendency among physicians to assume that if a woman was unhealthy, it was her own fault.

All of the information she should have known, information that is even more essential to her healing now, after a life-altering surgery, is information no doctor ever told her. And the result of having been deprived of this information is something worse than simply not knowing: everything she believes about exercise is either needlessly terrifying, woefully inaccurate, or both.

What lingers on is the myth that women and muscular development don’t mix,

Women, on the other hand, carry more fat but also carry it differently than men do, which makes the BMI chart a markedly ineffective measure of what’s happening inside their bodies.

but because even once the taboos surrounding exercise faded away, the ignorance created by those taboos persisted.

The physicians working to transform the relationship of the medical establishment with women’s bodies suggest a new paradigm: one that measures improvement not by how much weight a woman loses but by what she gains in strength, in speed, in power.

And once it had been established that women were simply too fragile, whether anatomically or morally, to care for their health, the cure was obvious: they needed to cede control of their blood, their bodies, and their lives to men.

this conflation of good health with good etiquette—and of feminine propriety with an absence of appetite—created

As a result, the prescribed treatments for chlorosis in the hundred years or so leading up to 1920 were not just morally charged but often hilariously self-contradictory.