Once they gathered critical insights into the coercive side of the mystique of femininity, feminists proceeded to challenge its “scientific” basis. Where sociologists saw “roles” and “institutions,” psychiatrists saw “feminine adjustment,” and medical authorities saw “biological destiny,” feminists saw the subordination of women. The terms of the debate were those that the experts had long ago chosen themselves—the rules and logic of science. In pamphlets, books, underground newspapers, and scholarly articles, women chipped away at received notions of female frailty to reveal the masculine self-interest at their core. In consciousness-raising groups, in women’s study groups, and in college classrooms women held the shibboleths of mid-century psychomedical theory up to their own experiences. Woman’s naturally submissive proclivities, her ever-present motherly instincts, the primacy of vaginal orgasms, the child’s need for exclusive maternal care, the theory of female masochism, all of these old “facts” went up in smoke when subjected to a feminist interrogation.
Without much encouragement from the mainstream media, which for the most part either ridiculed or ignored the rebellion, the feminist assault on the experts was soon traveling by word of mouth from kitchens to clinic waiting rooms. By the mid-seventies, the “Freudian” label was enough to seriously damage a would-be therapist’s practice or discredit a child-raising expert. At the same time, the often patronizing attitude that masked the ideology dispensed by the gynecologists came in for a blistering reappraisal. Women began to question their doctors’ opinions on their basic physiology, not to mention his ideas about sexuality, marriage, or femininity.*
The great romance between women and the experts ended because the experts had betrayed the trust that women had put in them. Claiming the objectivity of science, the experts advanced doctrines of domesticity. For all their talk of data, laboratory findings, and clinical trials, they turned out not to be scientists but apologists for the status quo. Confronted with something closer to real scientific thought—the critical and rationalist spirit of the new feminism—they could only bluster defensively. Within less than a decade, the entire edifice of domestic ideology—with its foundation of biological metaphors, its pillars of Freudian dogma, its embellishments of medical paternalism—tumbled down like an ornate Victorian mansion in the face of a hurricane. It had no intellectual grounds on which to resist the feminist assault.
The organized feminist movement also refuted all moral distinctions that judged women according to the role they played—or didn’t play—in a man’s household. Feminists condemned the sexual double standard and the lack of respect for single women. Out with valuations based on marital status went any privileging of heterosexuality over lesbianism as well. Women’s new sense of collective identity was reflected in language: the neutral word “woman” replaced “lady” or “girl,” and the term “Ms.” helped erase status distinctions based on marriage. Gloria Steinem insisted on it, it was the name of the movement’s premier magazine, and in 1986 it finally became standard usage in The New York Times.
Many women who lived in that era remember experiencing it as an enormous release, as if the female energy once channeled toward home was finally free to pour out in all directions. Mothers organized day-care centers, and women all over the country found ways to provide access to contraception and abortion for women of all classes and circumstances. In the universities, a new discipline, Women’s Studies, took shape, and scholars in every field started research that would eventually write stories of once-forgotten women into history. Making the nightly news, baseball-playing girls joined the Little League, presaging the phenomenal surge of energy into women’s sports (an unheard of concept as recently as the fifties, when doctors had ruled out strenuous physical exercise for women and girls). Women workers stopped being subservient: clerical workers joined unions, secretaries refused to be good-humored about getting chased around their desks anymore, stewardesses declined to offer “coffee, tea, or me” and retitled themselves flight attendants, thank you very much.
Personal relationships, too, were transformed: women told husbands and boyfriends not to expect to be picked up after anymore—and where they didn’t find understanding there was often separation or divorce. Many men offered solidarity and support, and some took to vacuuming floors and caring for babies. Experimenting with changing roles gave them more opportunities to discover the sensitive side of their natures, and they were happy to explore sex with women who were finally figuring out for themselves how their bodies actually worked.
Women created a new ethic of collective empowerment, deciding that they and their peers made the best experts on their own experience and the way life should be lived. In collectives, classes, and clinics, they passed around information on everything from vibrators and female sexuality to martial arts and Volkswagen repair. They intended to remodel everything from government to family; they wanted nothing less than a new civilization, designed as if women mattered.
Ever since the women’s liberation movement began, life has been amazingly different for women. Despite setbacks, backlash, and frequent rumors of its demise, the women’s movement persists with steady determination—a multimillion-woman march toward a utopian ideal. Feminist jurisprudence led to the end of employment discrimination, and to a greater recognition of the crimes of rape and domestic abuse (though violence at the hands of a boyfriend, husband, or male partner is still the leading cause of female injury). In 1986, the Supreme Court ruled that sexual harassment is a form of illegal job discrimination, and since Anita Hill stood up to Supreme Court nominee Clarence Thomas in congressional hearings in 1991, and her supporters plastered “I believe you, Anita!” bumper stickers on their cars, that law is more likely to be enforced.
Nowhere is women’s progress more evident than in the areas of health and medicine. Women applied to medical schools as quickly as the barriers to entry came down. Nurses demanded more respect as professionals and healers in their own right, not mere handmaidens of medicine. Midwives have steadfastly managed to document and prove their efficacy. Books like Our Bodies, Ourselves, first published in 1970 and later reprinted in multiple versions and editions, reflected rapid changes in consciousness about the female body. Speaking up to psychologists, pediatricians, and other doctors, formerly passive “patients” reintroduced themselves as clients: active participants in their own health-care decisions. Led by pioneers such as Cindy Pearson and helped by elected officials such as Senator Pat Schroeder, activists were successful in lobbying to change research protocols that left women out of federally funded health studies of heart disease and ignored female diseases like breast cancer.
To press for continuing improvements in health care, the women’s health movement created nonprofit watchdog agencies such as the Women’s Health Network, the Black Women’s Health Imperative, and the National Latina Institute for Reproductive Health. Other independent advocates for women’s health operate in government, universities, and public-interest journalism. These groups’ agendas gradually have expanded from sexism in the medical profession to the practices of all the components of Big Medicine: pharmaceutical companies, insurance firms, Health Maintenance Organizations (HMOs), and hospitals. Over the years, the movement has contributed to many exposés of highly dangerous drugs, such as DES, a drug prescribed to almost five million pregnant women to prevent miscarriage that in fact damaged the reproductive systems of female offspring, who were called “DES daughters.” Another target was the Dalkon shield, once a frequently prescribed intra-uterine device. Put into production with almost no testing, the device caused massive internal infections, and after thousands of lawsuits were filed, women were told to have them removed. (As Mother Jones magazine reported in the eighties, even after it was pulled off the American market, it continued to be distributed in lesser developed countries for years.)
Since 1970, when they demanded patient participation at Senate hearings on the birth control pill, women’s health advocates have persistently cha
llenged the way hormones are prescribed. Refuting doctors’ arguments that women were too suggestible to handle knowing the health risks, they demanded that the FDA force drug manufacturers to include individual package inserts for customers explaining the known effects and side effects of birth control pills, so that women could at least make their own decisions. Soon fact-inserts were mandated for other hormone-based drugs (and eventually for most prescription drugs).
The first major spur to the widespread use of hormones for menopause began in the pre-feminist era, with the then highly influential and now infamous 1966 book Feminine Forever, by Dr. Robert Wilson. A classic old-school chauvinist, Wilson left a rich trove of sexist quotes, such as his statement that without hormones a woman “becomes a dull-minded but sharp-tongued caricature of her former self” but with hormones she becomes “adaptable, even-tempered and generally easy to live with.” The book was excerpted in Look magazine, the title phrase was popularized in drug company ads and promotions, and according to Barbara Seaman’s 2003 expose, The Greatest Experiment Ever Performed on Women: Exploding the Estrogen Myth, sales of Premarin, then containing a much higher dose of estrogen than in later years, doubled or even tripled soon afterward. Seaman reveals what Wilson did not: that his research foundation and book were backed by pharmaceutical companies, including Wyeth-Ayerst, the makers of Premarin.1 (In 2001 alone, forty-five million prescriptions for Premarin [estrogen-only pills] were written, which along with Prempro [estrogen plus progestin] collectively cost women well over two billion dollars.)2
For decades, women’s health advocates protested the promotion of long-term use of what medicine called hormone replacement therapy (a term that implies indefinite consumption). Doctors prescribed hormones not only for menopausal symptoms, like hot flashes, but also for unproven purposes, like the prevention of heart disease, Alzheimer’s, and other forms of dementia—uses the FDA had never approved, due to the lack of scientific data. Yet in one mass-market paperback published in 1996, The Super Hormone Promise, Dr. William Rugelson advises women who are already on hormones for menopause to go back to their doctors to get even more estrogen for their hearts.3 Doctors also made unsupported suggestions that hormone replacement therapy (HRT) would keep women beautifully soft-skinned, sexually vital, and emotionally even-keeled.
Finally, in 2002, after ending the experiment early out of concern for the subjects’ health, a federal study called the Women’s Health Initiative (WHI), funded by the National Institutes of Health, released some of its results. They were shocking: women on long-term combination hormone regimes suffered higher rates of breast cancer, and had worse cases of it, than women not taking hormones. The hormones offered no protection from heart disease at all and they caused increased rates of strokes and blood clots, as well. A year after the first announcements, the WHI released its finding that older women taking hormones were twice as likely to develop Alzheimer’s or other forms of dementia.4
One of the most heavily promoted medicines—and one of the largest selling drugs in America—was revealed as “a dangerous drug” in the words of Dr. Deborah Grady, a well-known women’s health researcher.5 The HRT scandal ranks among the worst examples of medical experimentation on women we found in our researches across two centuries of American medicine. It vividly demonstrates the continued vulnerability of women to the marketing of unsubstantiated and, yes, sexist medical advice. It should serve as a wake-up call to the many women gynecologists who entered the field thinking they were chasing the misogyny out of it, and are now being asked what they were thinking in going along with the overmedicalization of menopause. Among a number of reappraisals of HRT by women clinicians and educators now being published, The New Truth about Menopause, by Carol Landau and Michele G. Cyr, acknowledges that the HRT episode is a challenge to any woman’s assumption that her medical care has been evidence-based. The new view announces (surprise) that it is a myth that menopause is a disease, that most women find hot flashes bearable and that menopause does not make them depressed or crazy. (Depression and mental illness, in fact, are more correlated with youth than middle age.)
Increasingly, women want to know why basic research on health is so often unavailable—especially about the side effects of heavily prescribed drugs such as antidepressants, sleeping pills, and pain-killers. Most drug trials reported in established medical journals are paid for by the drug manufacturers themselves, and independent scientists have criticized them for frequent methodological flaws.6 At the same time, pharmaceutical companies actively market new products to doctors with advertisements in medical journals, product giveaways, and other freebies. These companies often spend more money on marketing than on research and, between 1998 and 2003, doubled the amount they spent on advertising.7
Reformers also confront discrimination in health insurance coverage. The male potency drug Viagra, for example, was quickly approved for reimbursements when it was introduced in 1996, even in health insurance plans that had denied coverage of contraceptives for forty years. Consequently in some states women’s rights defenders spurred lawmakers to pass legislation to require contraceptive coverage in employee drug plans at last.8
In the meantime, according to the Harvard Women’s Health Watch newsletter,9 the amazing commercial success of Viagra has made women’s sexuality a high-profile research target, and given rise to an effort to establish female sexual dysfunction as a new disease category. More drugs and the mass marketing of them are sure to follow.
In the realm of public policy, women’s reproductive rights, especially the right to abortion, have been under fierce attack since the seventies. Planned Parenthood, the National Abortion Rights Action League (NARAL), The Feminist Majority, and other groups have continuously parried these assaults. Their vigilance is necessary at a time when members of Congress and the Supreme Court are intent on a total ban on abortion, while government programs simultaneously limit information on contraception and promote abstinence.
An Ambiguous Liberation
At this early stage in a new century, despite many advances in women’s rights, women’s liberation remains an incomplete revolution. Women who went into professions such as medicine received their education mostly from male professors, whose professional expectations were based on a traditional male life pattern, complete with a wife at home. This still-unreconstructed training prototype barely allows time for sleeping and eating, let alone childbearing and raising. Today, when the enlightened new woman doctor sits across from the new empowered client, they are all too often two stressed-out working women meeting under circumstances that prevent either of them from experiencing their collaboration as a satisfying achievement in women’s health-care rights.
Like the doctor, the client may be one of the many women who entered the new equal-opportunity job market eagerly and with the reasonable expectation that, if she was married, her income would elevate her family’s standard of living and earn herself some extra status and appreciation. Unfortunately, women sought to prove themselves in the labor force at a time of increasing global competition, leading to demands for greater productivity from employees, and ever-lengthening workdays. According to economist Juliet Schor in the 1992 book The Overworked American: The Unexpected Decline of Leisure, the average full-time employed person now works a solid month per year more hours than the average full-time worker in 1969.10 Both men and women have less time for leisure and family life.
Then there’s the money problem. For most Americans it now takes two incomes to afford a typical middle-class home and way of life—which once was possible on the male “family wage” alone. Maddeningly, the bar gets ever higher, driven up by the escalating prices of houses in the “better” neighborhoods where the good schools tend to be located. With the rising costs of insurance and health care, child care, and tuition savings for college-bound teens as well, parents are caught in what scholars have called the “two-income trap.” It is a frustrating trap, with all its extra costs for products that make work possi
ble (that second car, the professional wardrobe) and services (house cleaners and restaurant meals, for example) that help people cope with lack of time. Women—even those who work full-time outside the home—make lower incomes than men and still do the majority of the housework, child care, shopping, and family management. (A 2004 Labor Department study of 21,000 full-time workers, reported in The New York Times, showed that two-thirds of women said they prepared meals and did housework on an average day, compared with only 19 percent of men who said they did housework and 34 percent who said they helped with meals or clean-up.)
The effect on working women has been twofold: they are now permanent fixtures in the workplace; most of them truly can’t go home again, even while the kids are young, or when a sick relative or aging parent needs care. And since their husbands are often working harder at their jobs than ever before, the ideal of two equal wage earners who would fairly share child care, housework, and some extra leisure time has been widely supplanted by a life of anxious striving to keep from falling out of the middle class.
Still, the “two-income trap” may look good to a woman without even the security of a second breadwinner’s income. The predicted divorce rate is about 50 percent for first marriages of women under forty-five, according to the Census Bureau in 2002.11 Today, in about one third of families with children, one parent is absent, almost always the father.12 Alimony, except for the very rich, is a thing of the past. Although mandated child support payments have increased the amount of support absent fathers provide, only 25 percent of noncustodial fathers provide health insurance for their children. The fastest road to poverty in America is to become a single mother: divorced, separated, or never-married mothers are vastly overrepresented among the poor. In the credit-card holding, home-owning middle class, single mothers are the most likely to declare bankruptcy.13
For Her Own Good: Two Centuries of the Experts Advice to Women Page 37
