Elinor Cleghorn’s Unwell Women: Misdiagnosis and Myth in a Man-Made World is an intriguing exploration of the history of women’s health, specifically how women are perceived as individuals and members of a larger healthcare system. The theme, across countries and time periods, is centered on disbelief. The female body, long-held in a place of simultaneous mystique and disgust, is still poorly understood compared to the male body. Whether it is the concept of women as weaker and inferior to men, the uterus as being the seat of all illnesses, or the undue burdens of chronic pain and autoimmune conditions, the system has always been stacked against women when it comes to receiving adequate medical care. And as Cleghorn shows, this problem is ongoing and continues to be fought, often by other women.
Cleghorn acknowledges in her introduction that her narrative, while broad and historical, is focused on Western medicine (mainly that of the UK and US). While a global perspective would be illuminating, one understands the need for appropriate limitations for brevity’s sake. Cleghorn also acknowledges that when unpacking health outcomes in the US and UK, incorporating the disparate experiences of people of color is all too necessary. It is to Cleghorn’s credit that she acknowledges atrocities, such as experiments on American slaves to develop the field of gynecology, as well as the lack of informed consent given, for example, to Puerto Rican women in the development of the oral contraceptive. These are stories that do not receive the time and attention they deserve, and while much of the narrative does focus on white women, Cleghorn does make earnest efforts towards intersectionality in her research. Similar is her acknowledgement of the unique concerns of LGBTQ individuals in healthcare, particularly trans and non-binary people. While this aspect could have been furthered in more detail beyond the introduction, a little gesture towards inclusion is arguably better than none.
Cleghorn structures her work by first defining eras then assessing the status of women’s health through a variety of subtopics. From the ongoing puzzle of the ‘wandering womb’ to family planning to the impact of the labor force, Cleghorn sifts through countless reports, papers, and historical data to craft a cohesive narrative. The language is clear and readable to the layperson, and informative enough to fascinate those that work in women’s health. Although there are some digressions in this narrative that may seem noncontributory at the surface, they contribute to an accurate telling of how women’s health has evolved over time. For example, acknowledging the white feminism of the early suffragettes helps to set the stage for health systems in which advocacy for women of color is still lacking.
Cleghorn’s writing is at its best as she informs us of the movers and shakers in the world of women’s health. She unpacks controversial figures such as Margaret Sanger, who advocated for reproductive autonomy on one hand and perpetuated racism, ableism, and eugenics on the other. She brings to light lesser known figures such as Clelia Duel Mosher, a professor at Stanford and women’s medical adviser, who performed one of the first large-scale research studies on menstruation, helping to dismantle ideas of incapacity during this ‘time of the month’. Male healthcare providers are placed in the context of their eras, but as we come to find, some of their outdated beliefs linger on far past expiration date.
In the early sections Cleghorn takes her time, and as a result is left to compress all the health concerns of modern womankind in just a few pages. Perhaps longer length, or more even pacing, would aid the balance of this project. Cleghorn also spends time establishing her own diagnostic odyssey, having been diagnosed with Systemic Lupus Erythematosus after her second pregnancy. This autobiographical element adds an element of passion to this otherwise historical account and could have been explored further to flesh out the book’s themes—thereby adding a current name that stands on the shoulders of the dozens of other women forced to advocate for themselves throughout history. To explore all these ideas, however, would likely require a heavy tome on the subject rather than a moderate-sized book. To provide my own personal context, as an oncology genetic counselor, I frequently find myself as one of many patient advocates. Urging women to speak to providers about pain in their breasts or uncertain results, to talk about family history with loved ones, to ask questions. I take this lens to my reading of Unwell Women, and at times wanted the inclusion of genetic and genomic health to be acknowledged in the book (such as the discovery of the BRCA1 breast cancer predisposition gene by Dr. Mary-Claire King, a discovery that has saved thousands of lives to date and has revolutionized an entire field). However, the greater impact my experience has on reading this book is the ability to recognize patients. If this book evokes any feelings, it’s anguish. Anguish for the millions of women misheard, disregarded, exploited, and wronged. Some are in this book. Many more are lost to time. Unwell Women by Elinor Cleghorn shows us that without acknowledgment and understanding of these issues, these ills will continue on into new generations and in untold eras. We owe it to ourselves as a society to understand.
Unwell Women: Misdiagnosis and Myth in a Man-Made World
By Elinor Cleghorn
Published June 8th, 2021
Malavika Praseed is a writer, book reviewer, and genetic counselor. Her fiction has been published in Plain China, Cuckoo Quarterly, Re:Visions, and others. Her podcast, YOUR FAVORITE BOOK, is available on Spotify, Apple Podcasts, and various other platforms