Women's Health and Social Change

Ellen Annandale

• Publisher: Routledge
• Year: 2008
• ISBN:
  9781134655519
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Shortlisted for the BSA Sociology of Health and Illness Book Prize 2009

Traditional distinctions between the experiences of women and men are breaking down and being reconfigured in new, more complex ways. The long-established life expectancy gap between men and women appears to be closing in many affluent societies. Many men appear to be far more 'body and health conscious' than they ever were in the past and there are perceptible changes in women's 'health behaviours', such as increases in cigarette smoking and alcohol consumption.

Ellen Annandale provides a comprehensive and persuasive analysis of the contemporary social relations of gender and women's health, arguing that the once all important sex/gender distinction fosters an undue separation between the social and the biological whereas it is their interaction and flexibility that is important in the production of health and illness. New theoretical tools are needed in a world where the meaning and lived experience of biological sex and of social gender, as well as the connections between them, are far more fluid. This book takes a step forward, outlining what an adequate feminist analysis of women's health might look like.

Women's Health and Social Change will be of interest to academics and students working in sociology, women's studies, gender studies, social medicine, social policy, nursing and midwifery.

1 Recovering gender and health in history

Introduction

Historian Edward Shorter (1982: xi) maintains that women were ravaged by ill health between 1600 and 1900 and that, as long as they were vastly more enervated than men, any conception of personal autonomy was meaningless. He suggests that feminism depended on – effectively waited for – improvements in women’s health. Certainly women died at younger ages than men over much of this period, and living in ill health could have dampened political activity. Far more controversial is Shorter’s insistence that it was the combination of the rise of (male dominated) modern medicine and new ties of sentiment between men and women that delivered women from superstition by dissolving the need for a women’s healing culture and, in the process, improved their health and made feminist politics possible. In other words, ultimately it was men who were important for the development of feminism. An alternative explanation of the association between health and the rise of feminism emphasises the potential of male ideologies and practices to restrain rather than to liberate women. Throughout history patriarchal ideology has construed women’s illness as inherent biological weakness. Moreover, it has been bourgeois women – the women most often in the position to pose a feminist threat – who have needed to be told that they would become ill if they ventured outside of the conventional female role. Catch 22, then: ‘one way or another, by remaining in the female role or attempting to get out of it, the demon disease would attack’ (Duffin 1978: 31). It is reasonable to suppose that in such a climate many women might have thought twice before risking their personal health and well-being by demanding political and social rights. But an analysis of women’s writing and actions in the pursuit of health reveals that, across history, many have done exactly that: that is, both in sickness and in health, they have been far from passive subjects awaiting the enlightenment of men.

Dichotomies such as reason/emotion, mind/body and man/woman are much more than innocent contrasts (Prokhovnik 1999). Rather, they represent deep-seated polarities within Western philosophy. Heralding the new scientific age, the proposition put forward by Descartes (1596–1650) that the mind is wholly distinct from the world of matter overturned pre-modern holistic conceptualisations where illness was conceived as disharmony between the patient and their social world, and inaugurated the mechanistic conception of the body that was to underpin ‘modern medicine’. Descartes’ philosophy is founded on an alignment between the bodily and non-rational, distinguishing corporeal from intellectual matters (Lloyd 1993). The mind, he asserted, is entirely distinct from the body and would not fail to be what it is even if the body did not exist – hence his dictum ‘cogito ergo sum’ (I think therefore I am). Existing contrasts between men and women were extended to stark polarisations as a by-product of the distinction between reason and its opposites. Qualitatively different from everyday practical thought, reason concerned ‘a highly rarefied exercise of intellect, a complete transcendence of the sensuous’ (ibid.: 46). In principle, this purely intellectual activity was open to all, but in reality the lives of most women meant it was hardly an option for them. Women became associated with the irrational body and men with the rational mind. Expressed as hierarchical power relations, mind–body dualism and all that accompanied it sanctioned patriarchy by permitting men to associate themselves with the positive and socially valued (the rational–mind–reason– health) and women with the negative and devalued (the irrational–body– emotion–illness).

It is widely maintained that the legacy of philosophical dualism inhibited the development of an embodied sociology in general, and health sociology in particular. The belief of the nineteenth-century ‘founding fathers’ that social interaction – the principle object of enquiry – could not be reduced to biology or to physiology is understood to have produced a heavy emphasis on the social consequences of health and illness, and to have fostered a disembodied sociology during most of the twentieth century. For example, Bryan Turner maintains that ‘the legitimate rejection of biological determinism in favour of sociological determinism entailed … the exclusion of the body from the sociological imagination’ (1996: 61). There is no reason to single Turner out for taking this position; it is common enough in various guises across sociology and the social sciences generally. Thus, among others, Chris Shilling (2003, 2007) claims that the body was not so much neglected in nineteenth-century sociology as an ‘absent presence’. In other words, to the extent that theorists dealt with the structure and function of societies and human action, embodiment could not be ignored entirely. The argument is that the body was accorded less prominence than it deserved if a fully ‘embodied sociology’ was to develop. It is also widely believed that early sociologists were not interested in matters of health. In her history of the intellectual origins of medical sociology, for example, Uta Gerhardt remarks upon ‘how remote in nineteenth-century sociology was the idea that a person’s organic functioning was not to be taken for granted’ (1989: xii). This stance will ring true for most readers. The sociology of health that we have known until very recently has not been ‘embodied’, nor has the wider parent discipline. But this interpretation is partial to say the least.

Given the equation of men and the social it is hardly surprising that sociology took flight from the biological body, since not to have done so would have risked its association with the natural–the emotional–illness, in other words, with woman. The flight from the body then was also a flight from supposedly female ways of being. A similar compulsion led ‘the founding fathers’ to neglect those women thinkers who offered an embryonic embodied sociology and fostered a collective amnesia from that point on. Harriet Martineau and Charlotte Perkins Gilman, for example, were contemporaries of Auguste Comte, Émile Durkheim, Herbert Spencer, Max Weber and others – the very sociologists for whom the body was, so it has been argued, an ‘absent presence’. A consideration of their writing provides a glimpse of what could have been, had the intellectual roots of sociology been allowed to be different. This means substantially more than recovering the ‘elision of the biological and social’ (Fuller 2006: 81) or the corporeal in the classics (Shilling 2003; Williams and Bendelow 1998) (from which Martineau and Gilman are left out). It suggests an alternative to the conventionally disembodied origins that were embodied from the start but rendered invisible, not only by the twin problems of male dominance of the academic agenda and the philosophical dualism that sustained it, but also by a failure to recognise that this had even happened.

Early feminists of the seventeenth, eighteenth and nineteenth centuries are often portrayed as patriarchy’s imitators who, by prioritising mind over matter and reason over emotion, lacked the conceptual wherewithal to mount an effective challenge to the dualistic thinking that sustained women’s oppression. Certainly few commentators draw matters of health and the body into the discussion of their politics. No doubt this is why the standard starting place for accounts of feminist interest in health and the body is typically ‘second wave’ feminism of the 1960s and 1970s. It seems to be assumed that the endeavours of their forebears to secure political emancipation and women’s access to education and the professions by arguing that women are ‘just as rational as men’ pretty much kept health and the body off the agenda until well into the twentieth century. Yet, even though they could not fail to be influenced by the prevailing political liberalism that deflected attention from bodily concerns, issues of health were always a forceful political undercurrent that, on occasion, rose to the surface with a vengeance in a manner that casts strong doubts over Shorter’s (1982) contentions. This chapter undertakes to show that an embryonic embodied sociology and an embodied feminist politics existed as far back as the seventeenth century through women thinkers whose work collectively stretches from around the mid-seventeenth to the early twentieth century: Mary Astell, Mary Wollstonecraft, Harriet Martineau and Charlotte Perkins Gilman. Of course, these thinkers did not stand alone. Apart from the obvious reason – their attention to health – they have been chosen over others partly because of their prominence and therefore their ability to exert an influence in their own time, partly because of the accessibility of the corpus of their work to me and to readers of this book, and partly because of the breadth and depth of their work.

Reason’s disciples or the body’s emissaries?

Although the term ‘feminist’ did not come into language until the 1890s, what we now conceive as feminist thought existed well before this time and was variously known as the woman question, women’s emancipation, or woman’s rights (although for ease of presentation I will simply use the term feminism throughout the book). Feminism’s erasure from the annals of scientific knowledge limits our ability to reconstruct women’s early criticism of medicine and the ‘new science’ and their related attempts to understand women’s circumstances and their health. However, recent feminist scholarship makes clear that criticisms of the stories the ‘fathers’ of the medical and social sciences wanted to tell were available even as they were being told (Keller 1997). Muted though it was, a voice of opposition was available from the start.

Feminism has a longer history than regularly is supposed. It is conventionally dated from around the mid-eighteenth century and associated with Mary Wollstonecraft. This is not the place to join the cavalcade of debate on ‘who was the first feminist’. Rather, what matters is that there were women writers who, through the medium of health and illness, troubled the mind–body dualism that sustained women’s oppression and made this the basis for embodied health activism. Moreover this interest was sustained – albeit in different guises and with twists and turns along the way – right through to the 1960s, the point at which ‘women’s health activism’ and sociological interest in matters of health is usually assumed to have taken off. One of the earliest and most prominent of these women writers was Mary Astell (1666–1731).

Astell maintained that there was nothing inevitable about women’s inferiority. It is ‘the custom of the world’, she wrote, that ‘has put women, generally speaking, into a state of subjection’ (Astell in Hill 1986: 72). Her treatise, A Serious Proposal to the Ladies, published in the 1690s (Astell 2002 [1694]), advised women to invest in much more than personal adornment. What a pity it is, she wrote, that:

whilst your beauty casts a lustre around about, your souls which are infinitely more bright and radiant … shou’d be suffer’d to over-run with weeds, lye fallow and neglected, unadorn’d with any grace! … Let us learn to pride ourselves in something more excellent than the invention of a fashion’ and the attraction of a man.

(Astell 2002 [1694]: 54, 55)

The description of Astell as a ‘dedicated Cartesian’ (Smith 1982: 119) seems confirmed by such remarks as that the body ‘ought to be kept in such a case as to be ready on all occasions to serve the mind’ (Astell 2002 [1694]: 210). Yet she also maintained that human nature consists of the ‘Union of a rational soul with a mortal body’ and made it clear that it is a mistake:

to consider either part of us singly, so as to neglect what is due the other. For if we disregard the body wholly, we pretend to live like angels whilst we are but mortals; and if we prefer or equal it to the mind we degenerate into brutes.

(Ibid.: 211)

The problem, she maintained, is that ‘the body very often clogs the mind in its noblest operations, especially when indulg’d’ (ibid.: 210). Consequently:

The animal spirits must be lessen’d, or rendered more calm and manageable; at least they must not be unnaturally and violently mov’d, by such a diet, or such passions, designs, and divertissements as are likely to put ’em in a ferment. Contemplation requires a governable body, a sedate and steady mind, and the body and the mind do so reciprocally influence each other, and that we can scarce keep the one in tune if the other be out of it.

(Astell 2002 [1694]: 161, emphasis added)

The fact that governing ‘natural and unavoidable’ passions to which the temper of the body inclines – such as desire, fear, sorrow, hope and, above all, love – is not at all easy elevates the struggle between body and mind in Astell’s work. Her ‘serious proposal for the ladies’ was the renunciation of sensual indulgence – including the rejection of marriage, where possible – for a chaste life of Christian stoicism. The conventional interpretation is that Astell meant women’s colleges to provide the protective quarantine necessary for the cultivation of reason. However, she may also have intended them to protect women’s health. Her poem On the death of Mrs Bowes contains the lines:

• Lost when the fatal Nuptial Knot was tie’d,
  Your Sun declin’d, when you became a Bride.
  A soul refin’d, when like your’s soar’d far above
  The gross Amusements of low, Vulgar love.

(Astell quoted in Perry 1979: 2)

Mrs Eleanor Bowes died aged fifteen, just three months after her marriage to a wealthy mine owner. In the opinion of Ruth Perry (1979, 1986), Astell’s writing shows an awareness of the abiding association between sex and death for women and, therefore, the lurking dangers in relations with men. Every time a woman underwent the ordeal of pregnancy and childbirth in the late 1600s through to the early 1700s, she risked her life. It is very difficult to estimate maternal mortality rates for England before civil registration, which began in 1837. But drawing on the London Bills of Mortality for the lying-in hospitals (the first was established in 1739, eight years after Astell’s death), Perry estimates that for every sixty safe deliveries, one woman died. If a woman delivered six children (which was not uncommon among the wealthy), she had at least a 10 per cent chance of dying, probably higher. And there was not only death to be feared but also in the wake of birth there was the prospect of life-long pain and chronic illness from infection or from a ruptured or prolapsed uterus. Puerperal fever, a newly recognised disease of unknown aetiology, was a particular cause for alarm. Reporting on a mid-eighteenth-century outbreak in the Jordanne Valley of France, one doctor found it made women so fearful that ‘young girls recoiled from marriage’ (cited in Gélis 1991:246). The seclusion of life with other women therefore ‘had the real utility of sparing life and health’ (Perry 1979:36). In sum, the twin problem of the conventional association between men and reason and male power over women’s bodies meant that Astell had to work hard to establish women’s right to reason by actively engaging with bodily concerns even at the same time that she shunned what she saw as the burdens of the flesh. This brought women’s bodily health into – rather than excluded it from – her vision.

Astell was staunchly conservative and opposed to class levelling, her advocacy of education for women extending only to people like herself (Perry 1986). Born almost thirty years after Astell’s death, Mary Wollstonecraft (1759–97), combined the ‘woman of reason’ with a decidedly radical politics. Her Vindication of the Rights of Woman (1992 [1792]) was published more than a hundred years on from Astell’s Serious Proposal and in a markedly different social and economic climate. By the late eighteenth century, the Enlightenment had bequeathed a new attitude to educated Europeans, a new questioning of authority, the application of reason through the new science and a seemingly unwavering belief in social progress and improvement. At first glance, the appeal of the following changes for women seems self-evident:

They experienced an expansive sense of power over nature and themselves: the pitiless cycles of epidemics, famines, risky life and early death, devastating war and uneasy peace – the treadmill of human existence – seemed to be yielding at last to the application of critical intelligence. Fear of change, up to that time nearly universal, was giving way to fear of stagnation; the word innovation, traditionally an effective term of abuse, became a word of praise … There seemed to be little doubt that in the struggle of man against nature, the balance of power was strongly in favour of man.

(Gray quoted in Hamilton 1992:40)

Yet, as this quotation inadvertently signals, the balance of power truly was in favour of man (not woman), for even though the Enlightenment raised the possibility of a brave new world for women, by the turn of the nineteenth century it was widely maintained that biological difference made human rights sex-specific and inapplicable to women. Wollstonecraft’s work was a powerful attack on this conviction. Although she shared the political views of radical male thinkers of her time, she vehemently opposed their treatment of women. Jean-Jacques Rousseau in particular was subject to strident criticism. How could he argue that inequalities are socially created and in the same breath, so to speak, also claim that the inequalities between men and women – and male superiority – are natural? Wollstonecraft specifically challenged Rousseau’s views on moral education expounded in the book Émile (1966 [1762]), which advanced the belief that women should not be educated, except in virtue and in the care of men. If women’s condition is natural, then why, she asked, do they have to be trained into this ‘non productive vacuousness’?

Since the body posed an immanent risk to reason there is an inevitable tension in the mind–body relationship in Astell’s work. For Wollstonecraft the body is far more flexible, poised to be fit for the (rational) mind, but hindered by social convention. The bodily strength that supposedly gives man a natural superiority over woman is to all intents and purposes irrelevant. It is how we respond socially to these differences that really matters. Thus, she asks, why does it follow that it is natural for woman ‘to labour to become still weaker than nature intended her to be?’ Why are women ‘so infatuated as to be proud of a defect?’ (Wollstonecraft 1992 [1792]: 125, 127). Her answer lies in the social conventions that induce women to ‘feign a sickly delicacy’ in order to ensure their husbands’ affections (ibid.: 112). Wollstonecraft was particularly concerned to rehabilitate those bourgeois women whose once productive role in the domestic economy had been replaced by economic dependence with the rise of capitalism (Eisenstein 1981). Since she believed that ‘dependence of body naturally produced dependence of mind’, there was little hope for women who, quite literally and so unnecessarily, were not only made slaves to their bodies but gloried in their subjection (Wollstonecraft 1992:130). She was adamant that ‘sedentary employments render the majority of women sickly – and false notions of female excellence make them proud of this delicacy, though it be another fetter, that by calling attention continually to the body, cramps the activity of the mind’ (ibid.: 171). Thus:

confined … in cages like the feathered race, they have nothing to do but to plume themselves, and stalk with mock majesty from perch to perch. It is true that they are provided with food and raiment, for which they neither toil nor spin; but health, liberty, and virtue are given in exchange.

(Wollstonecraft 1992 [1792]: 146)

She exhorted those responsible for the education of girls not to destroy their constitutions with mistaken ideals of female beauty and manners. We should hear nothing of women’s fragility, she wrote, ‘if girls were allowed to take sufficient exercise, and not confined in close rooms till their muscles are relaxed and their digestion destroyed’ (ibid.: 154). The ability to educate women for independence is therefore intimately connected with their bodily well-being for Wollstonecraft.

The tag ‘reason’s disciples’ in the heading to this section of the chapter is borrowed from the title of Hilda Smith’s (1982) book on seventeenth-century feminists (though I believe the spirit of the expression carries through to t...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Acknowledgements
• Introduction
• 1 Recovering gender and health in history
• 2 Making connections: feminism, sociology and health
• 3 Women and health status
• 4 Women and reproduction
• 5 Thinking again about sex, gender and health
• 6 The making of women’s health: diversity and difference
• 7 Health in transition
• Notes
• References