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Book Review: For Her Own Good
by Nora Mitchell
For Her Own Good: 150 Years of Experts Advice to Women
by Barbara Ehrenreich and Dierdre English (New York: Doubleday, August 1978)
One of America’s first physicians could not convince his patients that they should pay for his services. They thought it appropriate to pay for the drugs that he supplied, but not for his attention and time. It seemed natural for one person to care about another, not to charge for it. This incident, related in Barbara Ehrenreich’s and Deirdre English’s new book, For Her Own Good· 150 Years of the Experts’ Advice to Women (Doubleday; August, 1978), stands at the center of their history.
Rather directly, this anecdote demonstrates that our present understanding and experience of the
medical establishment is unique to our time and place. Modern medicine, as the authors show, is not an objective given that we must accept. It has its roots, its biases and its historical limits. For a start, medicine has not been a profession for very long; physicians had to fight to make it one, as opposed to a concern of the community and of the home.
With particular reference to women Ehrenreich and English detail the development of the “helping
professions” in the United States. They focus on the conflicts raised by caring adequately for people in a money economy, and on the interaction between ideology, theory and economic pressure. This history is preceded by a clear, if brief, summation of their feminist and historical outlook in the opening chapter.
Among feminist theorists their approach would be considered socialist, because it is rooted in socioeconomic analysis – although what type of social change they advocate is not altogether clear. They insist that patriarchy pertains to the feudalistic order that was overthrown in Europe and America by the Eighteenth Century revolutions, and that what emerged from the upheaval of those times and of the Industrial Revolution was a masculinist order which was paralleled by an ideology the authors call sexual romanticism. Its tenets were quite straightforward. Women should be situated
in the home and men in the marketplace. Working women are therefore valued less and thus their labor is cheaper. The home should balance the marketplace by proferring the emotional and physical sustenance denied outside. The private and public spheres are separate. All of these factors contributed to an overall belief-system that reduced women and buttressed the new economic order.
Under the old patriarchal order the woman had an important economic role in society. She ran a center of manufacture. The essentials of family life had to be made: clothes, butter, soap, bread. She also cared for the sick, using knowledge of remedies that had usually been passed down from mother to daughter, along with what she knew of each patient. Certain women who were particularly skilled or knowledgeable might tend to the more serious cases.
These healers had no formal education, but did have experience. The remedies they used had no rational explanation to back them; instead the healers based their craft on empirical evidence. Although their facility was limited, they rarely harmed patients, and they did not take dangerous chances. Their patients were their neighbors and they were accountable in a personal sense.
The herbal brews the female healer might prescribe were, for the most part, gentle, and she knew when to draw back and wait out a difficult delivery or an obstinate fever. Knowing her patients as neighbors, she knew also the disappointments, the anxieties, and the overwork which could mimic illness or induce it. If she could not always cure, neither could she do much harm, and very often she was able to soothe.(p. 39)
History portrays them as witches and their remedies as “old wives’ tales”. The healers themselves have been recorded as threatening and mysterious figures and yet their skills have been dismissed as superstitious nonsense. Under the new masculinist order, the woman lost many of her economic functions in the home as they were supplanted by industry. With the new pressures she also lost her role as healer, as medicine moved into hands of men in the marketplace to become a profession.
The Medical Model
As medicine migrated from the community into the marketplace, it underwent some startling changes. Healing became a commodity. Since it was a profession in an unsettled society and economy rather than a social duty, doctors had to make a living. And thus they had to convince a stubborn clientele to pay for services rendered rather than just for drugs. This pressure, in combination with the rational theory of disease, spawned what is known as “heroic” medicine. It was not based on the empirical data of lay healers, but on scientific theories. For example, if a patient was sick, the blood was bad — so logically, rid the patient of some of that bad blood. Bloodletting, leaching, and plastering are all techniques that had widespread use among early professional men of medicine.
These drastic remedies served an economic function. They made it clear that the doctor was doing something and that he was working hard. Also they were different than the old remedies and based on scientific principles of the day. The doctors could charge for their services.
It is important to note though, as the authors often fail to, that medicine was far more than an economic enterprise, but a well-meaning one as well. Very few of the doctors would have designed practices just to ensure their own welfare. They must have considered the practices of lay healers antiquated and insufficient, and hoped to use their scientific training to develop a more systematic approach to healing. While medicine’s development as a profession allowed doctors to devote full time to it, this changed their social status and removed them from easy access to those they hoped to serve. Preventive and holistic medicine did not fit into this new professional structure and did not develop; doctors saw patients at crises, increasingly divorced from the contexts of their lives. Sickness came to be treated rather than the person, and the medical model we know now gained hold: the patient was sick, the doctor healthy; the patient ignorant, the doctor knowledgeable. Moreover, medical men assumed underneath it all that the cause for sickness could and would be found, understood, and conquered. They did not assume as the lay healers did that you used what worked and afterwards pulled back to let the body and nature do their own work. As the authors point out, nature was for those doctors something to be struggled against and overcome.
The biases of society in conjunction with the biases of medicine operating within a competitive market made women of the middle and upper classes the particular targets of medical attention. Sexual romanticism dictated that women were separate and different, and thus an enigma to medical men. Moreover, they were objectified by this ideology. Whereas any patient entered into an unequal relationship with a physician, women were already considered inferior as women. With this double indemnity, women were peculiarly vulnerable to doctors.
This vulnerability was most marked in women who were better-off financially. For one thing, they, or their husbands, could pay for medical services. Furthermore, these women were filling a specific economic function in the home and family. They did not work, but created the home atmosphere for men and children. In Victorian times this lack of an active economic role came to be linked with frailty, both mental and physical. Despite this supposed physical weakness women were still considered to be ruled by physical laws, while men were ruled by mental ones. And because all her other options had been ruled out, a women’s primary function was reproductive and emotional.
Femininity as Disease
The ideology of rationality prevalent in medical circles required causal explanations, so women came to be explained in terms of a series of overriding principles that were primarily sexual and reproductive. For instance, during much of the 19th century women’s emotional and nervous “disorders” were attributed to the influence of the womb. We still use the words that emerged from that theory: hysteria, hysterics, hysterical. Not surprisingly in a society that reinforced its belief in female frailty with enforced inactivity and physically harmful corsets, women acted out their parts. Frailty often resulted in perpetual invalidism. Women’s bodies had become one locus of conflict concerning the role of women in society: corporeal conditions supposedly created female nature, and the control of reproductive and sexual organs had to be enforced. Femininity itself came to be considered a disease.
The belief that women were by nature frail and sickly supported the medical profession. The fact that lower class women continued to work hard, and thus defied explanation within the paradigm, mattered as little as their welfare in a society ruled by profit. But, medical theories were foiled by invalidism itself. Women, despite the learning and best efforts of doctors. did not get better, indicating that their defined nature did not suit them. It has even been suggested that invalidism was one means of rebellion: one could resist the doctor and one’s family by failing to improve.
This whole area of sexual politics is the specialty of these two authors. In two previous studies. Witches, Midwives and Nurses and Complaints and Disorders , many of the abuses which arose from the interaction of romantic ideology, medical theory and medical practice were explored. Their familiarity with and control over the primary material is astounding, just as some of the facts are astonishing and disturbing. Perhaps what is most emphasized here is the capacity of morality and values to be twisted and to twist themselves and people; they do not shake free of the times, nor of the pressures of bigotry and self-centeredness. Medical practices of the time seem incredible today, and yet they were carried out by principled as well as unprincipled men.
Following the medical history the book focuses upon other experts – home economists, child-raising experts and psychologists – in the lives of women. The direction of the book also becomes less clear. In a way there are two books, the first on medicine in which the authors’ grasp and analysis of the material are powerful, and the second in which they chart new territory with less certainty. The authors attempt to make sense out of a diverse range of material – from social-Darwinism and economic development to the 20th-century crisis of masculinity.
The medical model, however, is a unifying concept with its conflict between benevolence and authority, between patients’ interests and economic forces. The opposition between doctor and patient, particularly the female patient, served as the model for generations of experts that followed. For all these experts women were the objects to be studied and worked on, not because of individual problems or concerns, but because they were women. Indeed, women have been treated by experts of many sorts as though they had problems that they could not solve for themselves. Their lives have served as raw material for many fields.
In our own century, the inherent sickness of femininity has been considered to be an inherent part of the psyche itself. Rather than her body, her psychological make-up became the locus of conflict of ideology, theory, morality and practice. And because the effects are not physical, the abuses are often more subtle and less easily described.
Ehrenreich and English give Freud little attention. It is the application of neo-Freudian theory to women in America that is under scrutiny. With startling abandon professionals have expounded upon what women should be, what they should feel, what they should do. Focus upon the home as emotional sanctuary for the working man altered slightly: home should be clean, healthy and efficient, but mother herself is supposed to be the succor for her children, rather than the home she creates. Psychoanalytically, this was explained in terms of the woman’s psychological needs: to be a mother was the ultimate satisfaction and fulfillment for all women. Every other type of achievement for women paled beside motherhood, their biological, psychological destiny. If a woman was unhappy, or even if she was happy but employed full-time, she was resisting her feminine nature. She was sick. Complaints themselves were symptoms, and even without such outward signs to give her away, a woman could always be her own best accuser. All of these psychic demons still have their holds.
Psychology has taken some extreme turns. Since World War II women have been extolled for self-sacrificing, total motherhood, and then condemned for overprotecting their children and for hidden hostility.
Underneath, the medical model has remained at work. Psychologists, like doctors, are considered sources of wisdom and authority. They have even been likened to priests – a telling indication of the overlap of theory and morality.
In the final section Ehrenreich and English undertake the analysis of the contemporary popular psychology and self-improvement movements on the one hand and the backlash towards sexual romanticism, the right-to-life and anti-ERA movements on the other. In this section some underlying assumptions of the book that were not spelled out become clearer. While their analysis of these movements is valuable, the force of their argument comes to rest finally upon a moral imperative. The authors are morally outraged.
This clarified other aspects of the book that had been somewhat confusing and even disturbing: what may seem like belief in conspiracy theories, intimations of evil, a drift away from structural socio-economic analysis. In seeking a solution, they abandon their own structural analysis and place too great an emphasis upon a finer moral system – one that would make the helping professions genuinely caring, one that would not be oppressive but uplifting. They also seek to make medicine, psychology and other professions discussed truly social and public. Since the effects are social, not just private and isolated, they must be placed in the forum for public debate and removed from the market.
The moral call which constitutes their conclusion is stirring, even inspiring, but it weakens on examination in the terms they themselves have used. Morality throughout their study reflects the biases and systems of the times. It can never be an absolute aside from some fundamental commitments; moral outrage will not suffice. The struggle to understand, to communicate, and to change what harms people is more important. Despite its forcefulness their conclusion is really a departure from the overall direction of the book. The study is above all a fine attempt to examine and to understand powerful influences in the lives of women, and to stretch the reader’s understanding to question existing structures.
Nora Mitchell is a feminist and radical who has participated actively in the women’s movement and the larger movement for social change. For several years she has been a participant in and helped plan Northfield Conference. a yearly ecumenical conference for people of all ages. She lives in Somerville, MA.