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

by Barbara Ehrenreich

  If the patient did not yield to Mitchell’s erect figure at the bedside, he would threaten to bring out his own, literal phallus. For example, according to a popular anecdote, when one patient failed to recover at the end of her rest cure:

  Dr. Mitchell had run the gamut of argument and persuasion and finally announced, “If you are not out of bed in five minutes—I’ll get into it with you!” He thereupon started to remove his coat, the patient still obstinately prone—he removed his vest, but when he started to take off his trousers—she was out of bed in a fury!81

  Subverting the Sick Role: Hysteria

  The romance of the doctor and the female invalid comes to full bloom (and almost to consummation) in the practice of S. Weir Mitchell. But as the anecdote just cited reveals, there is a nastier side to this affair. An angry, punitive tone has come into his voice; the possibility of physical force has been raised. As time goes on and the invalids pile up in the boudoirs of American cities and recirculate through the health spas and consulting rooms, the punitive tone grows louder. Medicine is caught in a contradiction of its own making, and begins to turn against the patient.

  Doctors had established that women are sick, that this sickness is innate, and stems from the very possession of a uterus and ovaries. They had thus eliminated the duality of “sickness” and “health” for the female sex; there was only a drawn-out half-life, tossed steadily by the “storms” of reproductivity toward a more total kind of rest. But at the same time, doctors were expected to cure. The development of commercial medicine, with its aggressive, instrumental approach to healing, required some public faith that doctors could do something, that they could fix things. Certainly Charlotte Perkins Gilman had expected to be cured. The husbands, fathers, sisters, etc., of thousands of female invalids expected doctors to provide cures. A medical strategy of disease by decree, followed by “cures” that either mimicked the symptoms or caused new ones, might be successful for a few decades. But it had no long-term commercial viability.

  The problem went deeper, though, than the issue of the doctors’ commercial credibility. There was a contradiction in the domestic ideal of femininity that medicine had worked so hard to construct. Medicine had insisted that woman was sick and that her life centered on the reproductive function. But these are contradictory propositions. If you are sick enough, you cannot reproduce. The female role in reproduction requires stamina, and if you count in all the activities of child raising and running a house, it requires fullblown, energetic health. Sickness and reproductivity, the twin pillars of nineteenth-century femininity, could not stand together.

  In fact, toward the end of the century, it seemed that sickness had been winning out over reproductivity. The birth rate for whites shrank by a half between 1800 and 1900, and the drop was most precipitous among white Anglo-Saxon Protestants—the “better” class of people. Meanwhile blacks and European immigrants appeared to be breeding prolifically, and despite their much higher death rates, the fear arose that they might actually replace the “native stock.” Professor Edwin Conklin of Princeton wrote:

  The cause for alarm is the declining birth rate among the best elements of a population, while it continues to increase among the poorer elements. The descendants of the Puritans and the Cavaliers … are already disappearing, and in a few centuries at most, will have given place to more fertile races.…82

  And in 1903 President Theodore Roosevelt thundered to the nation the danger of “race suicide”:

  Among human beings, as among all other living creatures, if the best specimens do not, and the poorer specimens do, propagate, the type [race] will go down. If Americans of the old stock lead lives of celibate selfishness … or if the married are afflicted by that base fear of living which, whether for the sake of themselves or of their children, forbids them to have more than one or two children, disaster awaits the nation.83

  G. Stanley Hall and other expert observers easily connected the falling WASP birth rate to the epidemic of female invalidism:

  In the United States as a whole from 1860–’90 the birthrate declined from 25.61 to 19.22. Many women are so exhausted before marriage that after bearing one or two children they become wrecks, and while there is perhaps a growing dread of parturition or of the bother of children, many of the best women feel they have not stamina enough.…84

  He went on to suggest that “if women do not improve,” men would have to “have recourse to emigrant wives” or perhaps there would have to be a “new rape of the Sabines.”

  The genetic challenge posed by the “poorer elements” cast an unflattering light on the female invalid. No matter whether she was “really” suffering, she was clearly not doing her duty. Sympathy begins to give way to the suspicion that she might be deliberately malingering. S. Weir Mitchell revealed his private judgment of his patients in his novels, which dwelt on the grasping, selfish invalid, who uses her illness to gain power over others. In Roland Blake (1886) the evil invalid “Octapia” tries to squeeze the life out of her gentle cousin Olivia. In Constance Trescot (1905) the heroine is a domineering, driven woman, who ruins her husband’s life and then relapses into invalidism in an attempt to hold on to her patient sister Susan:

  By degrees Susan also learned that Constance relied on her misfortune and her long illness to insure to her an excess of sympathetic affection and unremitting service. The discoveries thus made troubled the less selfish sister.…85

  The story ends in a stinging rejection for Constance, as Susan leaves her to get married and assume the more womanly role of serving a man. Little did Dr. Mitchell’s patients suspect that his ideal woman was not the delicate lady on the bed, but the motherly figure of the nurse in the background! In fact, Mitchell’s rest cure was implicitly based on the idea that his patients were malingerers. As he explained it, the idea was to provide the patient with a drawn-out experience of invalidism, but without any of the pleasures and perquisites which usually went with that condition.

  To lie abed half the day, and sew a little and read a little, and be interesting and excite sympathy, is all very well, but when they are bidden to stay in bed a month and neither to read, write, nor sew, and to have one nurse,—who is not a relative,—then rest becomes for some women a rather bitter medicine, and they are glad enough to accept the order to rise and go about when the doctor issues a mandate.…86

  Many women probably were using the sick role as a way to escape their reproductive and domestic duties. For the woman to whom sex really was repugnant, and yet a “duty,” or for any woman who wanted to avoid pregnancy, sickness was a way out—and there were few others. The available methods of contraception were unreliable, and not always that available either.87 Abortion was illegal and risky. So female invalidism may be a direct ancestor of the nocturnal “headache” that so plagued husbands in the mid-twentieth century.

  The suspicion of malingering—whether to avoid pregnancy or gain attention—cast a pall over the doctor–patient relationship. If a woman was really sick (as the doctors said she ought to be), then the doctor’s efforts, however ineffective, must be construed as appropriate, justifiable, and of course reimbursable. But if she was not sick, then the doctor was being made a fool of. His manly, professional attempts at treatment were simply part of a charade directed by and starring the female patient. But how could you tell the real invalids from the frauds? And what did you do when no amount of drugging, cutting, resting, or sheer bullying seemed to make the woman well?

  Doctors had wanted women to be sick, but now they found themselves locked in a power struggle with the not-so-feeble patient: Was the illness a construction of the medical imagination, a figment of the patient’s imagination, or something “real” that nevertheless eluded the mightiest efforts of medical science? What, after all, was behind “neurasthenia,” “hyperesthesia,” or the dozens of other labels attached to female invalidism?

  But it took a specific syndrome to make the ambiguities in the doctor–patient relationship unbearable, and
to finally break the gynecologists’ monopoly of the female psyche. This syndrome was hysteria. In many ways, hysteria epitomized the cult of female invalidism. It affected middle- and upper-class women almost exclusively; it had no discernible organic basis; and it was totally resistant to medical treatment. But unlike the more common pattern of invalidism, hysteria was episodic. It came and went in unpredictable, and frequently violent, fits.

  According to contemporary descriptions, the victim of hysteria might either faint or throw her limbs about uncontrollably. Her back might arch, with her entire body becoming rigid, or she might beat her chest, tear her hair or attempt to bite herself and others. Aside from fits and fainting, the disease took a variety of forms: hysterical loss of voice, loss of appetite, hysterical coughing or sneezing, and, of course, hysterical screaming, laughing, and crying. The disease spread wildly, not only in the United States, but in England and throughout Europe.

  Doctors became obsessed with this “most confusing, mysterious and rebellious of diseases.” In some ways, it was the ideal disease for the doctors: it was never fatal, and it required an almost endless amount of medical attention. But it was not an ideal disease from the point of view of the husband and family of the afflicted woman. Gentle invalidism had been one thing; violent fits were quite another. So hysteria put the doctors on the spot. It was essential to their professional self-esteem either to find an organic basis for the disease, and cure it, or to expose it as a clever charade.

  There was plenty of evidence for the latter point of view. With mounting suspicion, the medical literature began to observe that hysterics never had fits when alone, and only when there was something soft to fall on. One doctor accused them of pinning their hair in such a way that it would fall luxuriantly when they fainted. The hysterical “type” began to be characterized as a “petty tyrant” with a “taste for power” over her husband, servants, and children, and, if possible, her doctor.

  In historian Carroll Smith-Rosenberg’s interpretation, the doctor’s accusations had some truth to them: the hysterical fit, for many women, must have been the only acceptable outburst—of rage, of despair, or simply of energy—possible.88 Alice James, whose lifelong illness began with a bout of hysteria in adolescence, described her condition as a struggle against uncontrollable physical energy:

  Conceive of never being without the sense that if you let yourself go for a moment … you must abandon it all, let the dykes break and the flood sweep in, acknowledging yourself abjectly impotent before the immutable laws. When all one’s moral and natural stock-in-trade is a temperament forbidding the abandonment of an inch or the relaxation of a muscle, ’tis a never-ending fight. When the fancy took me of a morning at school to study my lessons by way of variety instead of shrieking or wiggling through the most impossible sensations of upheaval, violent revolt in my head overtook me, so that I had to “abandon” my brain as it were.89

  On the whole, however, doctors did continue to insist that hysteria was a real disease—a disease of the uterus, in fact. (Hysteria comes from the Greek word for uterus.) They remained unshaken in their conviction that their own house calls and high physician’s fees were absolutely necessary; yet at the same time, in their treatment and in their writing, doctors assumed an increasingly angry and threatening attitude. One doctor wrote, “It will sometimes be advisable to speak in a decided tone, in the presence of the patient, of the necessity of shaving the head, or of giving her a cold shower bath, should she not be soon relieved.” He then gave a “scientific” rationalization for this treatment by saying, “The sedative influence of fear may allay, as I have known it to do, the excitement of the nervous centers.…”90

  Carroll Smith-Rosenberg writes that doctors recommended suffocating hysterical women until their fits stopped, beating them across the face and body with wet towels, and embarrassing them in front of family and friends. She quotes Dr. F. C. Skey: “Ridicule to a woman of sensitive mind, is a powerful weapon … but there is not an emotion equal to fear and the threat of personal chastisement.… They will listen to the voice of authority.” The more women became hysterical, the more doctors became punitive toward the disease; and at the same time, they began to see the disease everywhere themselves until they were diagnosing every independent act by a woman, especially a women’s rights action, as “hysterical.”

  With hysteria, the cult of female invalidism was carried to its logical conclusion. Society had assigned affluent women to a life of confinement and inactivity, and medicine had justified this assignment by describing women as innately sick. In the epidemic of hysteria, women were both accepting their inherent “sickness” and finding a way to rebel against an intolerable social role. Sickness, having become a way of life, became a way of rebellion, and medical treatment, which had always had strong overtones of coercion, revealed itself as frankly and brutally repressive.

  But the deadlock over hysteria was to usher in a new era in the experts’ relationship to women. While the conflict between hysterical women and their doctors was escalating in America, Sigmund Freud, in Vienna, was beginning to work on a treatment that would remove the disease altogether from the arena of gynecology.

  Freud’s cure eliminated the confounding question of whether or not the woman was faking: in either case it was a mental disorder. Psychoanalysis, as Thomas Szasz has pointed out, insists that “malingering is an illness—in fact, an illness ‘more serious’ than hysteria.”91 Freud banished the traumatic “cures” and legitimized a doctor-patient relationship based solely on talking. His therapy urged the patient to confess her resentments and rebelliousness, and then at last to accept her role as a woman. Freud’s insight into hysteria at once marked off a new medical specialty: “Psychoanalysis,” in the words of feminist historian Carroll Smith-Rosenberg, “is the child of the hysterical woman.” In the course of the twentieth century psychologists and psychiatrists would replace doctors as the dominant experts in the lives of women.

  For decades into the twentieth century doctors would continue to view menstruation, pregnancy, and menopause as physical diseases and intellectual liabilities. Adolescent girls would still be advised to study less, and mature women would be treated indiscriminately to hysterectomies, the modern substitute for ovariotomies. The female reproductive organs would continue to be viewed as a kind of frontier for chemical and surgical expansionism, untested drugs, and reckless experimentation. But the debate over the Woman Question would never again be phrased in such crudely materialistic terms as those set forth by nineteenth-century medical theory—with brains “battling” uteruses for control of woman’s nature. The psychological interpretation of hysteria, and eventually of “neurasthenia” and the other vague syndromes of female invalidism, established once and for all that the brain was in command. The experts of the twentieth century would accept woman’s intelligence and energy: the question would no longer be what a woman could do, but, rather, what a woman ought to do.

  * It is unlikely that the operation had this effect on a woman’s personality. It would have produced the symptoms of menopause, which do not include any established personality changes.

  FIVE

  Microbes and the Manufacture of Housework

  At the turn of the new century, the invalid languishing on her chaise longue was at last about to end her morbid existence as a feminine ideal. Female invalidism, the gynecologists’ solution to the Woman Question, had always been too exclusive and too demanding. Now a new spirit of activism gripped the women as well as the men of the middle class: American business was expanding into markets all over the world, and at home lay the formidable task of assimilating twenty million immigrant workers on the one hand and civilizing the robber-barons on the other. Teddy Roosevelt’s rise from an asthmatic boyhood to an obsessively activist manhood stood as an inspiration to the most debilitated and listless veterans of the fin de siècle. Everyone wanted to be “on the go,” “in the swim,” and even the most privileged women were not about to sit out the Ameri
can Century with a sick headache.

  In a burst of pent-up energy middle-class American women were now loosening their garments, riding bicycles, and leaving their homes to organize women’s clubs, charities, civic reform groups. But they were not, by and large, ready to reject the basic assumptions of domesticity. They were looking for a new version of the domestic ideal—something more democratic than invalidism, something healthier, more activist.

  The new ideal carved out in the first decade or so of the century would not be the political activist or social reformer but the housewife. She would be bound to the home just as securely as the invalid had been—not because she was too weak to do anything else, but because she had so much to do there. Bustling, efficient—intellectually as well as emotionally engaged in her tasks—the housewife could stand as a model for all women, not just the wealthier ones. Men could be bank presidents or hod-carriers, professors or coal miners; women, henceforth, would be housewives.

  The idea of housekeeping as a full-time profession was elaborated by a new set of experts who were, unlike the doctors, largely women themselves. Making domestic work into a profession meant, of course, making it into a science. Between the late eighteen nineties and the teens of the twentieth century, women organized, discussed, experimented, and drew prodigiously on the advice of male experts in an attempt to lay the basis for a science of child raising and a science of housework. In the two chapters which follow this one, we will trace the development of “scientific child raising” and its gradual takeover by male experts, doctors, and psychologists. In this chapter we focus on the domestic science, or home economics, experts—their efforts to redefine women’s domestic tasks, and to “sell” the new, scientific, housework.