For Her Own Good: Two Centuries of the Experts Advice to Women

by Barbara Ehrenreich

  In the rhetoric of the medical profession, the midwife was no more human than her clientele. She was a foreign “micrococcus” brought over, as was supposedly the case with other germs, in the holds of ships bearing immigrant workers. The elimination of the midwife was presented as a necessary part of the general campaign to uplift and Americanize the immigrants—a mere sanitary measure, beyond debate.

  Certainly the midwives were “ignorant” according to the escalating standards of medical education; possibly some also deserved the charge of being “dirty” and “incompetent.” The obvious remedy for these shortcomings was education and some system of accountability, or supervision. England had solved its “midwife problem” without rancor by simply offering training and licensing to the midwives. Even the least literate midwife could be trained to administer silver nitrate eye drops (to prevent blindness in babies whose mothers have gonorrhea) and to achieve certain standards of cleanliness. But the American medical profession would settle for nothing less than the final solution to the midwife question: they would have to be eliminated—outlawed. The medical journals urged their constituencies to join the campaign:

  surely we have enough influence and friends to procure the needed legislation. Make yourselves heard in the land; and the ignorant meddlesome midwife will soon be a thing of the past.51

  In fact, the doctors were not prepared, in any sense of the word, to take over once the midwives were eliminated. For one thing, there were simply not enough obstetricians in the United States to serve the masses of poor and working-class women, even if the obstetricians were inclined to do so. According to historian Ben Barker-Benfield, “even a hostile obstetrician admitted in 1915 that 25 percent of births in New York State outside New York City would be deprived entirely of assistance when the midwife was eliminated.”52

  Then too, obstetricians introduced new dangers into the process of childbirth. Unlike a midwife, a doctor was not about to sit around for hours, as one doctor put it, “watching a hole”; if the labor was going too slow for his schedule he intervened with knife or forceps, often to the detriment of the mother or child. Teaching hospitals had an additional bias toward surgical intervention since the students did have to practice something more challenging than normal deliveries. The day of the totally medicalized childbirth—hazardously overdrugged and overtreated—was on its way.53 By the early twentieth century it was already clear even to some members of the medical profession that the doctors’ takeover was a somewhat dubious episode in the history of public health. A 1912 study by a Johns Hopkins professor found that most American doctors at the time were less competent than the midwives they were replacing.54 The physicians were usually less experienced than midwives, less observant, and less likely to even be present at a critical moment.

  But, between 1900 and 1930, midwives were almost totally eliminated from the land—outlawed in many states, harassed by local medical authorities in other places. There was no feminist constituency to resist the trend. In the eighteen thirties, women in the Popular Health Movement had denounced the impropriety—and dangers—of male assistance at births. But this time, when female assistance at births was in effect being turned into a crime, there was no outcry. Middle-class feminists had no sisterly feelings for the “dirty” immigrant midwife. They had long since decided to play by the rules laid down by the medical profession and channel their feminist energies into getting more women into (regular) medical schools. Elizabeth Blackwell, for example, believed that no one should assist in childbirth without a complete medical education.

  There may have been some resistance to the male takeover within the immigrant communities, but we have no evidence of this. Most women no doubt accepted male, institutional care in the interests of their children. With the elimination of midwifery, all women—not just those of the upper class—fell under the biological hegemony of the medical profession. In the same stroke, women lost their last autonomous role as healers. The only roles left for women in the medical system were as employees, customers, or “material.”

  * Even at the time, this plan smacked too overtly of middle-class self-interest to gain much support. Edward A. Ross, the founder of American sociology and a leading advocate of an expanded role for experts, was forced to retreat in 1920 with the defensive rejounder that, “There is of course no such thing as ‘government by experts.’ The malicious phrase is but a sneer flung by the scheming self-seekers who find in the relentless veracity of modestly-paid investigators a barrier across their path.”5

  THE REIGN OF THE EXPERTS

  FOUR

  The Sexual Politics of Sickness

  When Charlotte Perkins Gilman collapsed with a “nervous disorder,” the physician she sought out for help was Dr. S. Weir Mitchell, “the greatest nerve specialist in the country.” It was Dr. Mitchell—female specialist, part-time novelist, and member of Philadelphia’s high society—who had once screened Osler for a faculty position, and, finding him approvingly discreet in the disposal of cherry-pie pits, admitted the young doctor to medicine’s inner circles. When Gilman met him, in the eighteen eighties, he was at the height of his career, earning over sixty thousand dollars per year (the equivalent of almost in a million today’s dollars). His renown for the treatment of female nervous disorders had by this time led to a marked alteration of character. According to an otherwise fond biographer, his vanity “had become colossal. It was fed by torrents of adulation, incessant and exaggerated, every day, almost every hour.…”1

  Gilman approached the great man with “utmost confidence.” A friend of her mother’s lent her one hundred dollars for the trip to Philadelphia and Mitchell’s treatment. In preparation, Gilman methodically wrote out a complete history of her case. She had observed, for example, that her sickness vanished when she was away from her home, her husband, and her child, and returned as soon as she came back to them. But Dr. Mitchell dismissed her prepared history as evidence of “self-conceit.” He did not want information from his patients; he wanted “complete obedience.” Gilman quotes his prescription for her:

  “Live as domestic a life as possible. Have your child with you all the time.” (Be it remarked that if I did but dress the baby it left me shaking and crying—certainly far from a healthy companionship for her, to say nothing of the effect on me.) “Lie down an hour after each meal. Have but two hours intellectual life a day. And never touch pen, brush or pencil as long as you live.”2

  Gilman dutifully returned home and for some months attempted to follow Dr. Mitchell’s orders to the letter. The result, in her words, was—

  … [I] came perilously close to losing my mind. The mental agony grew so unbearable that I would sit blankly moving my head from side to side … I would crawl into remote closets and under beds—to hide from the grinding pressure of that distress.…3

  Finally, in a “moment of clear vision” Gilman understood the source of her illness: she did not want to be a wife; she wanted to be a writer and an activist. So, discarding S. Weir Mitchell’s prescription and divorcing her husband, she took off for California with her baby, her pen, her brush, and her pencil. But she never forgot Mitchell and his near-lethal “cure.” Three years after her recovery she wrote The Yellow Wallpaper4 a fictionalized account of her own illness and descent into madness. If that story had any influence on S. Weir Mitchell’s method of treatment, she wrote after a long life of accomplishments, “I have not lived in vain.”5

  Charlotte Perkins Gilman was fortunate enough to have had a “moment of clear vision” in which she understood what was happening to her. Thousands of other women, like Gilman, were finding themselves in a new position of dependency on the male medical profession—and with no alternative sources of information or counsel. The medical profession was consolidating its monopoly over healing, and now the woman who felt sick, depressed, or simply tired would no longer seek help from a friend or female healer, but from a male physician. The general theory which guided the doctors’ practice as well as their public
pronouncements was that women were, by nature, weak, dependent, and diseased. Thus would the doctors attempt to secure their victory over the female healer: with the “scientific” evidence that woman’s essential nature was not to be a strong, competent help-giver, but to be a patient.

  A Mysterious Epidemic

  In fact at the time there were reasons to think that the doctors’ theory was not so farfetched. Women were decidedly sickly, though not for the reasons the doctors advanced. In the mid- and late nineteenth century a curious epidemic seemed to be sweeping through the middle- and upper-class female population both in the United States and England. Diaries and journals from the time give us hundreds of examples of women slipping into hopeless invalidism. For example, when Catherine Beecher, the educator, finished a tour in 1871 that included visits to dozens of relatives, friends, and former students, she reported “a terrible decay of female health all over the land,” which was “increasing in a most alarming ratio.” The notes from her travels go like this:

  Milwaukee, Wis. Mrs. A. frequent sick headaches. Mrs. B. very feeble. Mrs. S. well, except chills. Mrs. L. poor health constantly. Mrs. D. subject to frequent headaches. Mrs. B. very poor health …

  Mrs. H. pelvic disorders and a cough. Mrs. B. always sick. Do not know one perfectly healthy woman in the place.…6

  Doctors found a variety of diagnostic labels for the wave of invalidism gripping the female population: “neurasthenia,” “nervous prostration,” “hyperesthesia,” “cardiac inadequacy,” “dyspepsia,” “rheumatism,” and “hysteria.” The symptoms included headache, muscular aches, weakness, depression, menstrual difficulties, indigestion, etc., and usually a general debility requiring constant rest. S. Weir Mitchell described it as follows:

  The woman grows pale and thin, eats little, or if she eats does not profit by it. Everything wearies her,—to sew, to write, to read, to walk,—and by and by the sofa or the bed is her only comfort. Every effort is paid for dearly, and she describes herself as aching and sore, as sleeping ill, and as needing constant stimulus and endless tonics.… If such a person is emotional she does not fail to become more so, and even the firmest women lose self-control at last under incessant feebleness.7

  The syndrome was never fatal, but neither was it curable in most cases, the victims sometimes patiently outliving both husbands and physicians.

  Women who recovered to lead full and active lives—like Charlotte Perkins Gilman and Jane Addams—were the exceptions. Ann Greene Phillips—a feminist and abolitionist in the eighteen thirties—first took ill during her courtship. Five years after her marriage, she retired to bed, more or less permanently. S. Weir Mitchell’s unmarried sister fell prey to an unspecified “great pain” shortly after taking over housekeeping for her brother (whose first wife had just died), and embarked on a life of invalidism. Alice James began her career of invalidism at the age of nineteen, always amazing her older brothers, Henry (the novelist) and William (the psychologist), with the stubborn intractability of her condition: “Oh, woe, woe is me!” she wrote in her diary:

  … all hopes of peace and rest are vanishing—nothing but the dreary snail-like climb up a little way, so as to be able to run down again! And then these doctors tell you that you will die or recover! But you don’t recover. I have been at these alterations since I was nineteen and I am neither dead nor recovered. As I am now forty-two, there has surely been time for either process.8

  The sufferings of these women were real enough. Ann Phillips wrote, “… life is a burden to me, I do not know what to do. I am tired of suffering. I have no faith in anything.”9 Some thought that if the illness wouldn’t kill them, they would do the job themselves. Alice James discussed suicide with her father, and rejoiced, at the age of forty-three, when informed she had developed breast cancer and would die within months: “I count it the greatest good fortune to have these few months so full of interest and instruction in the knowledge of my approaching death.”10 Mary Galloway shot herself in the head while being attended in her apartment by a physician and a nurse. She was thirty-one years old, the daughter of a bank and utility company president. According to The New York Times account (April 10, 1905), “She had been a chronic dyspeptic since 1895, and that is the only reason known for her suicide.”11

  Marriage: The Sexual-Economic Relation

  In the second half of the nineteenth century the vague syndrome gripping middle- and upper-class women had become so widespread as to represent not so much a disease in the medical sense as a way of life. More precisely, the way this type of woman was expected to live predisposed to her sickness, and sickness in turn predisposed her to continue to live as she was expected to. The delicate, affluent lady, who was completely dependent on her husband, set the ideal of femininity for women of all classes.

  Clear-headed feminists like Charlotte Perkins Gilman and Olive Schreiner saw a link between female invalidism and the economic situation of women in the upper classes. As they observed, poor women did not suffer from the syndrome. The problem in the middle to upper classes was that marriage had become a “sexuo-economic relation” in which women performed sexual and reproductive duties for financial support. It was a relationship which Olive Schreiner bluntly called “female parasitism.”

  To Gilman’s pragmatic mind, the affluent wife appeared to be a sort of tragic evolutionary anomaly, something like the dodo. She did not work: that is, there was no serious, productive work to do in the home, and the tasks which were left—keeping house, cooking, and minding the children—she left as much as possible to the domestic help. She was, biologically speaking, specialized for one function and one alone—sex. Hence the elaborate costume—bustles, false fronts, wasp waists—that caricatured the natural female form. Her job was to bear the heirs of the businessman, lawyer, or professor she had married, which is what gave her a claim to any share of his income. When Gilman, in her depression, turned away from her own baby, it was because she already understood, in a half-conscious way, that the baby was living proof of her economic dependence—and as it seemed to her, sexual degradation.

  A “lady” had one other important function, as Veblen pointed out with acerbity in The Theory of the Leisure Class. And that was to do precisely nothing, that is nothing of any economic or social consequence.12 A successful man could have no better social ornament than an idle wife. Her delicacy, her culture, her childlike ignorance of the male world gave a man the “class” which money alone could not buy. A virtuous wife spent a hushed and peaceful life indoors, sewing, sketching, planning menus, and supervising the servants and children. The more adventurous might fill their leisure with shopping excursions, luncheons, balls, and novels. A “lady” could be charming, but never brilliant; interested, but not intense. Dr. Mitchell’s second wife, Mary Cadwalader, was perhaps a model of her type: she “made no pretense at brilliancy; her first thought was to be a foil to her husband.…”13 By no means was such a lady to concern herself with politics, business, international affairs, or the aching injustices of the industrial work world.

  But not even the most sheltered woman lived on an island detached from the “real” world of men. Schreiner described the larger context:

  Behind the phenomenon of female parasitism has always lain another and yet larger social phenomenon … the subjugation of large bodies of other human creatures, either as slaves, subject races, or classes; and as a result of the excessive labors of those classes there has always been an accumulation of unearned wealth in the hands of the dominant class or race. It has invariably been by feeding on this wealth, the result of forced or ill-paid labor, that the female of the dominant race or class has in the past lost her activity and has come to exist purely through the passive performance of her sexual functions.14 [Emphasis in original]

  The leisured lady, whether she knew it or not and whether she cared or not, inhabited the same social universe as dirt-poor black sharecroppers, six-year-old children working fourteen-hour days for sub-subsistence wages, young men mu
tilated by unsafe machinery or mine explosions, girls forced into prostitution by the threat of starvation. At no time in American history was the contradiction between ostentatious wealth and unrelenting poverty, between idleness and exhaustion, starker than it was then in the second half of the nineteenth century. There were riots in the cities, insurrections in the mines, rumors of subversion and assassination. Even the secure business or professional man could not be sure that he too would not be struck down by an economic downturn, a wily competitor, or (as seemed likely at times) a social revolution.

  The genteel lady of leisure was as much a part of the industrial social order as her husband or his employees. As Schreiner pointed out, it was ultimately the wealth extracted in the world of work that enabled a man to afford a more or less ornamental wife. And it was the very harshness of that outside world that led men to see the home as a refuge—“a sacred place, a vestal temple,” a “tent pitch’d in a world not right,” presided over by a gentle, ethereal wife. A popular home health guide advised that

  …[man’s] feelings are frequently lacerated to the utmost point of endurance, by collisions, irritations, and disappointments. To recover his equanimity and composure, home must be a place of repose, of peace, of cheerfulness, of comfort; then his soul renews its strength, and will go forth, with fresh vigor, to encounter the labor and troubles of the world.15

  No doubt the suffocating atmosphere of domesticity bred a kind of nervous hypochondria. We will never know, for example, if Alice James’s lifelong illness had a “real” organic basis. But we know that, unlike her brothers, she was never encouraged to go to college or to develop her gift for writing. She was high-strung and imaginative, but she could not be brilliant or productive. Illness was perhaps the only honorable retreat from a world of achievement which (it seemed at the time) nature had not equipped her to enter.