American Medicine and Sexism

“The personal is political”

Betty Dodson, PHD

The Yellow Wallpaper, written by Charlotte Perkins Gilman, exemplifies how medicine in Western culture oppresses women.

While no small secret, the reality of Western history is that women are barely emerging from millenniums of a pervasive oppression which shaped every sphere of personal, social, cultural,

and political life. After barely over a century of activism and social change, it is hardly surprising that the United States is struggling to adopt a more comprehensively gender-inclusive norm in medicine and politics. Unfortunately, a major contributor to this cultural reticence to change is the lack of social awareness on the issue of how modern medicine continues to carry forward a legacy of myths, superstitions, sexism, and domination.

In the United States, women are diagnosed with depression more often than men, and diagnosed with other mental illnesses more often than men. The source of this dichotomy is

treated as a mystery by the medical community, or hazily attributed to little-understood neurological anatomical differences. Unfortunately, as exemplified by Gilman in The Yellow Wallpaper, distinguishing between psycho-emotional maladies induced by cultural-gender hardships or biased treatment, those aggravated by biased attitudes and methods within treatment, and incidences of unrelated cause is insurmountably difficult and virtually unresearched.

Based on studies from the United States Centers for Disease Control, there is a strong correlation between social status and the incidence of depression. The CDC statistics for 2006 and 2008 report that the groups more likely to suffer from depression were as follows: women, minority races (“blacks, Hispanics, non- Hispanics persons of other races or multiple races”), people with less than a high-school education, divorced or separated individuals, people out of work, and people who lacked health-insurance coverage. While more research would need to be done to clarify the relationship between lower social status, personal hardship, and depression, this correlation does raise a red flag suggesting the need for further investigation.

Furthermore, the National Institute for Mental Health, or NIMH, reports on their website (http://www.nimh.nih.gov/statistics/1mdd_adult.shtml ) that women are seventy percent more likely to suffer from depression in their lifetime than men. There is a major ongoing difference in the incidence of depression among men and women also, exemplified in their comparison of four years of statistics, respectively: 2005 5.2 % of men, 9.3% of women, 2006 5.3% of men, 9% of women, 2007 5.3% of men, 9.5% of women, 2008 4.6% of men, 8.1% of women suffering from depression. According to this statistics, in any given year, nearly twice as many women suffer from depression as men.

In truth, there is little evidence to demonstrate true anatomical-neurological differences between women. On the contrary, many recent neurological gender-based studies have found that while there are some observable differences between the brains of men and women, they are few and account for far less behavioral, emotional, and social differences than most people assume. Instead, these differences are commonly attributed to the effects of wide-spread social conditioning.

Is it rash to assume that some of the differences in diagnoses and treatment in psychology may be related to the fact that fore-runners of modern psychology were primarily “fathers” instead of “mothers,” and were largely party to the patriarchal misogyny of their respective generations? Freud, the “Father of Modern Psychology” is a fitting example of this issue. While concession may be made for the positive possibilities opened up by Freud's theories, his systematic misogyny is blatant through out the entirety of his work. The idea that woman is a human being, a person in equal measure mentally and physically to man was foreign to Freud, and indeed to the majority of his contemporaries. In the 18^th, 19^th, and early 20^th centuries, prior to revelations about the role of the brain in psychology, most of psychiatry was directed at “behavioral issues” in women, and often attributed to the activities of feminine reproductive organs in the body. This is where the term “hysteria” originated, the word etymologically

referring to the womb, it described the phenomenon of the womb roving around inside a woman's body, inducing madness. Indeed, the main character of “The Yellow Wallpaper” is being treated in similar keeping with this diagnosis.

Both modern medicine and legislation currently function in different way to maintain control over women's reproductive faculties. In legislation, the conservative and religious movements in American politics have reached in American women's pants, and indeed into their bedrooms, to limit access to not only abortion, but also to birth-control and sex-education. For followers in the foot-steps of Margaret Sanger, the founder of planned-parenthood, and other pro-choice feminist leaders, this backsliding in modern society is appalling. The fact that our legislators have put aside the question of whether politicians should have a say medical practice as an ethical one, and steam-rolled through in attempts to change current policies, is baffling. When it comes to pregnancy, as long as men can walk away with out consequence, and a woman can't, there will never be gender-equality.

The obsession with control over women's bodies is not limited to sexual behavior or the choice about maintaining or terminating a pregnancy, however. Modern obstetrics exemplifies the idealization of control in favor of convenience for the physician, largely disregarding what is ideal for the mother, and to a lesser extent, the child. Despite the fact that for centuries pregnancy and birth care was administered by women, for women, in modern medicine most obstetrics doctors are male, and have little to no training in midwifery. Most obstetrics doctors coming out of medical school have witnessed one or fewer unassisted, non-medical intervention births before entering practice. American culture suffers from a huge misconception that unassisted natural birth is impossible for human beings, or at the very least, that it is far from ideal. However, according to American midwife Ina May Gaskin, countries that engage midwives and the traditions of midwifery, integrated with modern emergency interventions and knowledge, which allow healthy women with healthy pregnancies to progress through labour and birth naturally, have the lowest rates of infant-maternal death in the world. Sadly, the United States is not among those nations yet. Despite the fact that in the 1960's the Cesarian rate was less then 7%, in 2010, due to advances in technology making this surgical method of delivery more convenient and less fatal, the Cesarian rate in the U.S. Had risen to 35%. The impact on

maternal death, long-term complications for women, and negative health impact on infants and children, is largely unresearched and undocumented. While the United States does have a federal format for death certificates, there are no laws demanding that states comply in use of this format, and most states use their own format of death certificates. There is little to no regulation on how, or by whom, death certificates are filled out, and very little detail is included in the cause of death. For this reason, many maternal deaths go unreported, or under-reported, preventing a comprehensive understanding of the impact of various issues including medical intervention on maternal mortality. While the U.S. Officially reports a 12.7% maternal mortality rate, the lack of quality control in reporting acts to at least partially discredit this statistic.

The mantra of modern feminism is “the personal is political.” This is to say that women's roles as reproductive agents, mothers, wives, etc. is in not a seperate issue from their value and freedom in public life. Instead, personal autonomy in the familial sphere is paramount to advances in society. This means that for women to truly be equal, they must have the right to govern their own bodies, and make their own choices about the roles they play in family life, and whether or not to participate in motherhood. Some areas of feminist bio-ethics put forward that for a woman to truly have autonomy, she must be given active choice regarding all medical treatment and intervention, including during pregnancy and labour, and that to fail to grant her explicit choice in these situations is to rob her of her autonomy.

Autonomy is also a large issue in historical context in American psychology regarding women. The major problem suffered by the character in The Yellow Paper, an indeed, by Gilman herself, was the lack autonomous participation in discerning the nature and treatment of mental illness. The Yellow Paper painfully exemplifies the excruciating consequences of this lack of autonomy.

Rife with controversy from the day it was published. So controversial, in fact, that Gilman wrote Why I Wrote The Yellow Wallpaper in the Forerunner. The article describes her own bouts with melancholy and failed attempts to garner help from prominent physicians in the area. She mentions a piece of advice given her the most prominent of these doctors, to “never touch pen, brush, or pencil again.” She responds in this writing to that piece of advice by saying she had utterly rejected the suggestion.

Gilman shared the fact that this piece of fiction was based on her own experiences, and it is widely thought that she may have suffered from a bout of post-partum depression following the birth of her child. This mental condition, however, was intensely exacerbated by the fact that her husband dominated decision-making in her treatment and care, corroborating with her doctor and virtually leaving her out of the treatment process. Despite the fact that it was taboo, a shameful act, often a basis for complete rejection, Gilman eventually petitioned for a divorce from her domineering husband. In her explanation for writing The Yellow Wall Paper, she states that she felt it was her moral obligation to tell and share this story because she felt that it was a common issue among women. Later in life, after her emancipation from her husband, after

discontinuing her relationship with her abusively domineering doctor, and becoming married to a progressive-thinking man, she resumed writing and began to embrace early feminist ideals. Through this autonomous self-realization, and the benefit of her art, literature, as a coping mechanism, she over came her mental illness.

There are countless cases like this in both psychology and medicine, where providers, instead of helping, hinder the progression of their patients towards recovering because of the imposition of their, frequently subtly sexist ideals on the cause and nature of the condition. This is not to say that medicine is not life-saving and potentially beneficial in general health care, reproductive care, and mental health. However, women's autonomy and choice in their care is crucial to fully maximize the benefits of medicine.