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

by Elizabeth Comen

Much of the early medical advice on remaining disease-free is addressed to men and breaks down along a gendered binary that imagines men as sufferers, and women as contaminators.

variants of this line of thinking have continued to reinfect the collective medical consciousness with the insidious conviction that women are contaminators, harborers of infection, and inherently untrustworthy.

It was called the American Plan, and under its auspices, vast numbers of women were essentially kidnapped, imprisoned, and forcibly treated with dangerous drugs in the name of the common good.

medical authorities stalked, arrested, and imprisoned women who were engaged in activities that marked them as likely STD carriers (said activities included sitting in a restaurant alone, changing jobs, or just looking suspicious).

In theory, the law allowed the detention of any person, irrespective of sex, who was suspected of spreading disease; in practice, virtually all those impacted were women.

the notion that the women detained under the American Plan represented a genuine health threat was belied by the behavior of the authorities who targeted them: police and public health officers routinely forced these supposedly diseased women to have sex with them.

One possible reason why the American Plan went so underscrutinized for so long was that one of its chief architects, Dr. Thomas Parran, became notorious for his involvement in a much more famous medical atrocity: the Syphilis Study at Tuskegee,

Parran would later serve as U.S. Surgeon General.

Under his watch, a powerful and toxic idea wove its way into the fabric of government, of medicine, and of American society: when it came to the spread of disease, women were always to blame, and never to be trusted—not with their freedom, not with their healthcare, not even as authorities on what was happening in their own bodies.

the avoidance of research on female subjects stems from a belief that their fluctuating hormone levels make them too complicated to study, even though this same biological variability directly impacts the efficacy and effects of medicines in women’s bodies as compared to men’s.

Women are the other, the variable, the weird and slightly defective riff on a norm defined by—and inclusive only of—men.

Many of these diseases are “undifferentiated,” which is to say, not classifiable—and because of the way the medical apparatus currently functions, a disease without an official diagnosis becomes a patient without a path forward. Those who suffer from undifferentiated diseases are not included in clinical trials or other policy measures;

Indeed, few ideas have held more sway over women’s lives—in medicine, in culture, in politics, and in society—than the pseudoscientific archetype of the hysterical woman.

the human nervous system is a communications network, conveying the signals that regulate everything from heart rate to organ function to feeling—not

But when it comes to medical history, the nervous system plays a particularly unique role: it has been the scapegoat at the center of virtually every theory as to why women’s brains were fundamentally different, deranged, and broken in comparison to the male “ideal.”

Indeed, throughout history, a hysteria diagnosis proved remarkably adaptable to whatever medical and cultural mores happened to be in vogue at the time.

lobotomy was positioned as a cure for mental problems: nervous disorders, hysteria, deviant thinking or behaviors. Unsurprisingly, they were disproportionately used on women,

Today, the same forces that once spurred the barbaric practices described in these pages remain subtly embedded in neurology and psychiatry.

familiar litany of older, toxic beliefs: Women are drama queens (so don’t treat their pain; it’s not really that bad). Women can’t handle the intellectual and emotional rigors of equal participation in society (so when they develop a degenerative disease that leaves them unable to think or even move, we don’t need to be urgent about it). Women who behave in difficult or frustrating ways aren’t just annoying, they’re abnormal (so let’s pump them full of mood stabilizers; it’ll be doing us all a favor).

Every human body, regardless of sex, is internally awash in hormones; every human being, regardless of sex, produces the sex hormones associated with both male and female bodies. And yet, despite both the ubiquity of hormones and the breadth of the functions they perform, somehow only women have ever been saddled with the suggestion that their hormones make them unpredictable, incompetent, and unfit for certain types of work—and only women are commonly dismissed as “hormonal” when their emotions or behavior become inconvenient.

the scientific community’s unshakeable belief in a male-female hormone binary made it all too easy to disregard results that contradicted it.

But when it came to imagining similar solutions for women, something interesting happened: the notion of a cure was replaced by a vision of control.

Until quite recently, virtually all the medical literature agreed that menopause was a serious problem. But it wasn’t a problem because of the debilitating symptoms it inflicted on women; it was how it impacted their behavior in ways that were irritating to men.

In medicine, we jockey for control over women’s bodies by manipulating their hormones yet simultaneously write off their health problems as “just hormones,” and hence not worth investigating.

Culturally, women receive the message that hormones make them moody, volatile, and incompetent—while also receiving little to no real education about the impact of hormones on their bodies.

two-thirds of all breast cancers are estrogen-driven, feeding on the hormone in order to grow and metastasize.

But when it comes to women’s health, medicine still struggles to weigh the costs and benefits of survival—or the question of quantity over quality of life—in the same way it has always done for men.

The perception of women’s bodies as deformed variations on a male ideal persisted through centuries, with particular misunderstanding and scrutiny focused on women’s genitals and reproductive organs.

the greatest source of mystery, misinformation, and anxiety for medical men through the ages was not the uterus (which, for all its alleged evils, nevertheless served an undeniable biological purpose when it came to propagating the human race). It was the clitoris, an organ whose sole purpose is to provide sexual function and pleasure in women—and whose existence so thoroughly unnerved the medical establishment that for a long time, doctors refused to acknowledge it at all.

But in every case, the heroic work of these doctors has a darker side, one that betrays a complete lack of understanding of women at best, and at worst, a deep contempt for them.

And with the influx of male doctors into the field of gynecology, the sexually amorous woman became not just stigmatized socially but pathologized medically, a problem in need of a scientific solution.

The way Dana ping-ponged around the system for more than a decade before finally being diagnosed is the natural outgrowth of a culture—and in turn, a medical apparatus—that views pelvic pain in women as normal. Skepticism of endometriosis symptoms is inculcated in doctors early.

Indeed, the notion that women are biologically destined to be mothers still holds an unsettling sway over this area of reproductive medicine:

Even now, the medical system operates from the same presupposition it always did: that a woman’s health, her happiness, and even her freedom from pain are all secondary to her biological destiny to become a mother.

Historically, doctors have too often viewed their female patients’ health as secondary to the needs of others—the men they’re married to, the babies they carry.

There’s ignorance and fear and, underlying it all, a pervasive sense of shame: over the course of a thousand years of toxic messaging and manipulation, we have taught women that if something goes wrong with their sexual health, it’s because something is wrong with them, personally.

The increasing gender parity in who is practicing medicine has not led medicine itself to be feminized. Indeed, the medical establishment continues to be a place in which more “feminine” aspects of medicine—personalized care, patient relationships, nurturing, peacekeeping, and a whole-life approach to wellness that goes beyond simply curing disease—are consistently undervalued.

The purpose of this book is not to ruin your faith in medicine, nor to point fingers at the men who made it what it is, but to illuminate the narratives that began with them and still surround us today: about women’s bodies, women’s health, women’s needs and desires.

Among my greatest hopes in writing this book is that it will give women the tools they need to demand the care they deserve.

I believe there is room for a medical system that balances efficiency with humanity. That values doctors who nurture as much as it values the ones who discover.