The problem is not that women’s bodies are a matter of medicine. It’s rather that women’s bodies are not a matter of medicine beyond sexist norms that stem from patriarchy which are projected on diseases/conditions particular to women.
In this article, I will mainly try to demonstrate how the historical development of medicine is linked to the birth of patriarchal capitalism – and thus, its intrinsic connection to patriarchal prejudices – and how it feeds off patriarchy as an ideology and consent apparatus and reproduces patriarchal prejudices.
It is beyond any doubt that aesthetics, beauty industry and nutrition fall under the domain of women’s health for their connections to the medical industry, media, and patriarchy. Medicine feeds off from the media, which is another consent apparatus like itself, and sustains sexist prejudices in the media. Nevertheless, they fall beyond the scope of this article since I intend to focus on the links between women’s health, its invisibility, and the historical roots of patriarchal capitalism.
Witch hunts and the history of estrangement of women from their bodies, and the birth of medicine
Healer women, who obtained medicines from plants by observing nature since the 1300s, possessed the knowledge on how to heal wounds, relieve pain, stop bleeding, treat labor pains, vulvar abscesses, prolapsed uteri, infertility, and prepare pregnancy prescriptions, and germicidal lotions. They treated the sick and witnessed births and deaths. During the Middle Ages, midwifery was designated only to women.
The healer women were massacred between the 14th and 17th centuries. This Witch Hunt includes the Renaissance, and lasted until 1775. In Germany alone, 100,000 “witches” were burned. It has been documented that more than 200,000 women have been killed across Europe.
In 1486, the book “Malleus Maleficarum” [Hammer of Witches] was published by two inquisitors, in which they accused women and described ways to torture them. 30 editions were made of the book that suggested it is more plausible that women are witches because they are not as intelligent or as strong as men; their faith is easily corruptible, and they are prone to conversion; and they enjoy carnal pleasures while being insatiably lustful.
Although women possessed the knowledge of their bodies first, they were estranged from it through witch hunts and kept away from medical education until 1850. It was said that women were very good nurses and midwives, but could not practice medicine (Achterberg, 2009). The witch hunts that continued throughout the Renaissance and ended with the murder of hundreds of thousands of women, most of them healers, weakened women’s control over their bodies and pregnancy, and institutionalized state control over the female body necessary for the reproduction of labor power.
It was inevitable that birth control and abortion would be linked to witchcraft during the categorization and criminalization of witchcraft as a threat to capitalism. Witches, according to the state and the church, were trying to take away the reproductive power of humans and animals, perform abortions and sacrifice children to the devil. The period was particularly alarming for economists and statisticians that observed the European population and the labor power that the capitalist system required to function. This alarmism had a direct influence on the witch hunts and encouraged them (Mies, 2008). As the witch hunts were spreading across Europe, laws were enacted that sentenced adultery with death, deemed extramarital birth illegal, criminalized abortion by including it in the category of death row crimes. The intent was to prohibit all kinds of sexuality that did not comply with capitalist rationality, that is, did not have reproductive purposes, and stigmatize them as an enemy of society and demonic activity.
The determination of women’s duty as reproduction, that is, motherhood, also meant that women were excluded from the production process. By confining women to housework, a gender-based division of labor emerged. In this way, a capitalist patriarchy was constructed that made women dependent on both capital and men.
One of the pillars of the historical transition experienced in the 18th century was the egalitarian ideology of the Renaissance and French Revolution. By breaking away from the social hierarchies, patriarchy/male dominance, as a form of social status inequality, could not be defended anymore. Within the framework of modern/capitalist patriarchy, male domination had to exist within a legal organization that relied on equal rights. Within the discourse of equality, it was through the development of natural differences discourse that gender hierarchy could be legitimized. Therefore, both genders were constructed as fixed, natural categories (Acar Savran, 2009).
Medicine construes its own ideology through various branches of science that lays its foundational rhetoric. Ideology -which is partial and distorted to a certain extent- as the totality of beliefs serving to certain private social interests, reproduces power relations (Bourdieu, 2007:101). This reproduction is the oppression exercised upon a social agent with his or her complicity through an instrument that does not involve physical violence. Bourdieu calls this phenomenon “symbolic violence”. To paraphrase Bourdieu’s definition of symbolic violence, under certain conditions and in return of paying for its price, it can serve as a more effective tool than political-police violence. (Bourdieu, 2007: 166, 171).
Gender and all relations of inequality are internalized and accepted as natural in the hierarchical society’s mind, through the meanings and perceptions engraved on bodies.
If we were to perceive the masculine power of medicine independent from social and economic relations, we would be confronting its self-proclaimed abstract power free from these connections. That would lead to assigning a role of power to medicine that is independent from the political power itself, which then will inevitably bring us to an ahistorical position. No science that comprises modern medicine is independent from ideologies, or class and gender relations. Perceptions and attitudes that contribute to submission of individuals are reproduced and re-reproduced through ideological apparati of the state (Althusser, 2003).
Gender constructs hierarchical relations and it gets continuously reproduced through capitalist constructs such as family, education, religion, and science institutions (Acar-Savran, 2004: 233).
“Passive, childbearing, waiting”: these definitions are based on stereotypical gender perceptions of women and are reconstructed through biology. Even in a number of scientific findings, the woman is described using passive elements whereas the man is assigned active ones. For instance, in the scientific description of fertilization of an egg, the egg is assigned female characteristics by waiting passively, whereas the sperms are active, adventurous, and masculine agents that fertilize the egg (Mutlu, 2018).
However new findings demonstrate that the egg cell almost orders sperm cells to stick and penetrate via the proteins and molecules it produces. Projecting the patriarchal social order on animal behavior, and then reprojecting nature on roles of women and men lay the foundation to accept these roles as natural (Kılınç, 2007: 48).
Medicalization or invisibilization of the woman’s body?
Medicalization is the definition of a non-medical or social issue as a medical problem, illness, or condition that needs to be treated. In other words, medicalization is the expression of a subject, problem, or situation as a condition to be treated with medical intervention, in medical terms using a medical language, within a medical framework (Sezgin, 2022).
Medicalization defines the authoritarian and masculine medical institution established as an independent and self-appointed power. Thus, both patriarchy and capitalism, which affects medicine ideologically, become invisible. The subject simply becomes the medical institution. However, the medical institution, like institutions such as education, media, family, and religion, is a consent apparatus established and developed under the conditions of patriarchy and capitalism, following its historical development as mentioned above. By definition, medicalization presupposes an eternal “natural” that “becomes the subject of medicine which was not considered as such beforehand”. While many “naturals” were not the subject of medicine in the past, they have become the subject of medicine as a result of scientific developments.
For instance, infectious diseases became a matter of medicine during the pre-antibiotics era when it was “natural” for people to die from infections. Complications at birth and various pregnancy-related pathologies that used to kill women can now be prevented. The problem of medicalization is that it has turned a blind eye to women’s health– that is it became invisible alongside these advancements. The problem is not that women’s bodies are a matter of medicine. It’s rather that women’s bodies are not a matter of medicine beyond sexist norms that stem from patriarchy which are projected on diseases/conditions particular to women.
We should not be raising our voice against the fact that whatever was then considered to be “natural” for women is now becoming a matter of medicine. We should stand up against the fact that they are not getting stripped from sexist prejudices for the welfare and health of women. In sum, the problem does not lie with whether a subject or women’s body is a matter of medicine or not; it lies with the types of gender inequalities it encompasses, the economic system that engendered it and the class inequalities it produces.
For years now, physicians have called women’s health “bikini medicine” since the assumption is that the important part of women is their bikini area, that is reproduction and “reproductive hormones”. This conception of sex and the human body begot the idea that “women’s health” is only about reproductive health (Atlı, 2022).
The field of medicine related to women’s health was limited to reproduction, and puberty and menopause problems, women-specific conditions arising from working and living circumstances were rendered invisible. Heavy and repetitive working conditions required by domestic labor, child, patient, and elderly care, that cause lower back pain; nutritional deficiencies and menstrual bleeding experienced by a large portion of women with anemia have only been recently included in the curriculum in gender-related classifications despite their frequency.
The fact that most women experience painful periods and various mood swings during their menstrual period is considered “natural”, delays the diagnosis of endometriosis, which is common in women, by 8.5 years. According to Ballard, this is because physicians have “normalized” it. It’s common that women have to normalize it. It is also common to think that women exaggerate and fabricate pain. Findings of an academic study from 2007 quite match Ballard’s, and states that 63 percent of 4,334 women diagnosed with endometriosis had at some point heard from their doctor that there was “nothing” wrong with them. It is thought that there are currently 176 million women with endometriosis in the world. That is one out of every 10 women…
The belief around women exaggerating and fabricating pain leads to women patients not being taken seriously. Women also end up internalizing this attitude around non-female organs such as the uterus. Women who were hospitalized with a heart attack say that even if they had a heart attack, they preferred not to talk about it, so as not to look like they were sick. The Australian Heart Foundation states that although the number of men who have a heart attack every year is twice as high, the number of men and women who die is equal, and attributes this fact to the undiagnosed heart attack in women (Willow, 2015).
A study published in the New England Journal of Medicine found that women were seven times more likely than men to be misdiagnosed and discharged in the middle of a heart attack.
Women are four times more likely to have migraines and chronic fatigue, three times more likely to have autoimmune disorders, and twice as likely to have Alzheimer’s, depression, and rheumatoid arthritis. Women who don’t smoke are three times more likely to develop lung cancer than men who don’t smoke, according to the comprehensive 2014 report “Women’s Health Can’t Wait” by Brigham Women’s Hospital in Boston. A study from February 2017 predicts that over the next 20 years, cancer rates will increase in women about six times faster than in men.
Overall, women are 1.5 to 1.7 times more likely than men to experience medication side effects. Studies say that women metabolize drugs differently than men and therefore may require different doses, but dosages are rarely gender-segregated (Adler, 2017).
The ancient Greeks saw the female body as a mutilated male body. Since white men have been accepted as the norm throughout history, women are not included in anatomy books today. Historically, the “default size” is the male size. Women are not included in the surveys either. The reason for this is that the estrogen cycle is interpreted as an obstacle and that female bodies are too complex and burdensome to test (Liu AK, 2016; Atlı G, 2022).
Medicine and psychiatry, which developed under male domination, saw women as the “source of the problem” as a “secondary” gender, the female brain and mind were pathologized. Women were expected to control the diseases in their bodies with their minds by changing their “lifestyles” to adopt gendered wife and mother roles. Those who oppose this were tried to be suppressed with moral discourses, shown as irrational, irresponsible; pushed beyond the limits of “acceptable femininity” (Jackson G, 2020), these women, who were “incompatible” with the standards of society, were labeled as “crazy” (Baysak, 2021).
The premenstrual period, which was previously called premenstrual dysphoric disorder in the psychiatric diagnosis system (DSM), and causes serious mental distress, depression, and loss of work force for 5.5 percent of women, was named PMS (premenstrual syndrome) not until 2013 (Miller, 2021).
The structure of female hormones, which always required a state of balance, was distinguished from men not because it was pathological, but because of its complexity. However, instead of trying to understand this complexity, masculine medicine preferred to attribute the existing ailments to the “sensitive” personality and “weaknesses” of women.
Labeling periodic disorders such as PMS as syndromes occasionally drags women into dilemmas. Torn between sexist portrayals of these disorders and being exposed to them to the extent that limits their wellbeing, women often reject the attribution of the disorder to gender in a wholesale fashion. However, this rejection itself contributes to the invisibility of women’s health (Üstel, 2021; Mutfak Cadıları, [Kitchen Witches] 2010).
Because it is often seen in women, another common disease that has been pathologized and associated with female sensuality and weakness is fibromyalgia. The physiological cause of fibromyalgia was not understood until very recently. Therefore, there was no clear cure. It was called “stress-induced” because it was not known, and it was believed that it affected “sensitive women” more frequently, and antidepressants were often used in the treatment (Üzeltüzenci, 2020).
If the matter at hand is a disease that affects women, it’s commonplace that the causes are attributed to stress, character, obsession, that is, the alleged weakness that comes with being a woman, which is just one of the thousands of ways to publicly infantilize women in everyday life. This sexist view begets that the problems that women experience both at home and at work, childhood traumas, injustices and silences remain invisible, and the disease is reduced to a simple matter of nature and disposition.
Women’s fertility is also utilized as a control method against them. The Independent reported that one in seven women in the UK have been bullied either for getting pregnant or for having an abortion. A large-scale study found that 14 percent of women experience reproductive pressure, either forced to become pregnant or have an abortion. A poll reported that eight percent of women were under pressure to become pregnant, while seven percent had been forced into abortion (Oppenheim, 2019).
We have known for 10-15 years that removal of the ovaries or uterus increases the risk of dementia in women (Jamshed N, Ozair FF et al.; 2014). There is a strong link between early menopause and an increased risk of Alzheimer’s in women. In fact, hormones do not only have a reproductive function, but also have a great protective effect over a range of organs from the brain to the heart, vessels and bones, and this effect disappears with menopause. As a result of the surgical removal of the ovaries, the risk of Alzheimer’s increases to 70 percent.
There are studies showing that the risk is increased in cases where only the uterus is removed. Once the uterus is removed, the blood flow to the ovaries weakens and its nutrition is impaired. Perhaps one of the most important invisibility of women in the field of health is that they have been subjected to surgical removal of their uterus and ovaries simultaneously for years. Even if they have not entered the menopause, if they have given birth to a child, if there is a problem in one of the uterus or ovaries, it is considered normal to surgically remove the other organ in order not to put the other organ at risk against possible disease development. Since female organs and hormones were viewed only as reproductive mediators, loss of the uterus or ovaries was not seen as organ loss, and it was never thought that ovarian nutrition would decrease and could lead to early menopause (Rocca AW, Grossardt RB et al.; 2012).
Gender inequality produced as a result of male domination attributes the following meanings to menopause: loss of beauty and attractiveness, the end of sexuality, and desexualization for women. This role of being “out of the game” is internalized by most women. Feelings of worthlessness may be experienced (Atasoy, 2019). While there are many solutions developed for a man who can’t get an erection, the fact that women’s health is fixed only on reproduction and that the hormones that affect women’s entire bodies from their brains to their veins and that are in fact found in men to some extent, are perhaps an indication of how medicine does not care about women’s health.
Just like PMS, saying that menopause is medicalized by medicine not only hides male dominance, but also prevents women from getting the help they need due to menopause by assuming an unrealistic “natural” and reinforces the invisibility of women’s health in medicine (Üstel, 2021).
Although getting thyroid hormone treatment for thyroid hormone deficiency, insulin treatment for insulin deficiency, and treating high blood pressure and cholesterol with medication is not questioned and accepted as normal, it can be “natural” for women to spend most of their long life without hormones.
Hormone replacement therapy does not assume that women’s lives are dependent on reproduction, on the contrary, it claims to emphasize that they have a body, mind, heart, vein, and mental health outside of reproduction and when reproduction ends.
These hormones, which are narrowly defined under the name of “sex hormones”, take on vital functions in every cell in the male and female body, from the brain to the bone, from bone to psychology, from cancer to cancer prevention. However, in the prevailing understanding of medicine, such a vital issue is approached with superficial and memorized information (Atasoy, 2019; Henderson EB, Paganini A et al., 1991; Bayer U, Hausman M, 2011; Rasgon LR, Geist LC et al., 2014).
In the WHI research, which is full of errors that led to this “insensitivity”, synthetic hormones were used for women (horse estrogen instead of estrogen, progestins instead of progesterone), although no synthetic hormones were used in any other area of the human body. These hormone-like substances caused some side effects because they were administered orally, assigned randomly to women of all ages, and were foreign molecules to the body. Even today, it does not occur to anyone to ask why these hormones cannot be measured in the blood, while thyroid hormone or insulin can be done so if they were to be administered. Years later, even the self-criticism of the scientist who was leading the research could not change the outrage caused by the research in the media and women’s ongoing deprivation from effective treatment (Atasoy, 2018).
Universality of scientific information cannot override the unique personal experiences of each woman. It’s crucial to recognize the sexist judgments/prejudices inherent to medicine, strip them away and be careful as not to fall into their trap and internalize them. It is necessary to use scientific medical knowledge for the benefit of women and to improve their health and well-being. Every woman’s body, health is her own, and her personal experience is valuable. Undoubtedly, women are the ones who will make the right decision regarding their health and bodies. It is only possible to realize sexist judgments/prejudices when women talk more about their subjective experiences and share them. If it were not for these unique personal experiences, I would not have been able to realize how and in what ways scientific knowledge can be in favor of women, and I would not have been able to write this article. I am grateful to all the women who shared their experiences in the feminist media (Çatlak Zemin and 5Harfliler) and social media.
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 Louis Althusser, (Althusser, 2003). State power maintains its existence not only through coercion and force, but also by legitimizing its power for subjects. In this sense, ideology is a set of symbols that individuals attribute meaning to and partially or completely believe in their correctness. Religious institutions, family, school, law, media, unions serve as the ideological apparatus of the state
Translator: Deniz İnal
Proof-reader: Müge Karahan