All in Her Head : The Truth and Lies Early Medicine Taught Us about Women’s Body and Why It Matters Today wasn’t what I expected at first. Instead of just focusing on women’s traits like Emotional Labor: The Invisible Work Shaping Our Lives and How to Claim Our Power and Up to Speed:The Groundbreaking Science of Women Athletes, this book focuses on how medicine has often misunderstood, misdiagnosed, and mistreated women. Elizabeth Comen, MD lays out how our society’s views on women’s health, fitness, and medical care have been shaped over time. All in Her Head reveals the hidden dark disgrace past of how medicine has historically mistreated women.
Reading about how women were treated unfairly centuries ago in this book opened my eyes to the unchanging situation of women continuing to suffer. All in Her Head exposes on how some diseases that hurt women were let slide because the disease made women look beautiful. Women’s health was not a priority; attractiveness was. Some diagnoses were not made to save women but due to the selfishness of men. Women has been treated as disease carriers rather than victims. Women even villainized by public health officials, responsible for transmitting diseases. Women was abused as disease vectors rather than sufferers. Women’s mental health issues are wrongly accused and it makes women cannot get proper education.
Here, I provided you a glimpse of the history of medicine, as wrote by Elizabeth Comen MD, concentrating on various medical issues.
Women were not supposed to get fit and health
For centuries, women’s strength and fitness are debated among medical community. At first, it was a belief that women couldn’t handle exercise. Then, fears arose that exercise could harm their bodies and minds. Going further at professional level, elite female athletes faced skepticism that nature didn’t intend for women to excel in sports.
The first society’s foolish faith of women is how women should be slim, not having muscle, weak, and fragile. Some people think it’s pointless for women to exercise or use their energy that way. They believe a strong woman doesn’t look good or feminine. They think woman’s body has to be small. This stupid mindset hurts woman, like me, who have exercise as a hobby and find mental wellness at gym.
I would like to have more lean muscle proportions on my body. I would like to run marathon. But it is too common that people warn me not to run too far because it will hurt my body. People told me muscle will makes me look like a bulky body builder. Well, look at me, two years consistently running and strength training at the gym, happier with how fit my body is, participating in multiple running events, and enjoying better mental health.
A lot of research already shows that maintaining muscle mass is more crucial for overall health, even if it means having a higher weight. Resistance exercises, often overlooked in favor of cardio, are actually vital, especially for post menopause. Studies show that women with normal BMI but high body fat have increased breast cancer risk, emphasizing the need for exercise to build muscle.
Exclude women. They were hormonal.
At first, I thought women were getting praised when society sees women as unique. As I am getting older, learn more, and rethinking, isn’t this mindset may suggest that men are the standard humans and women are different? Is this uniqueness related to women’s high estrogen levels? What about high testosterone in men? Why aren’t society called men as the unique one instead?
Despite both men and women having hormones and performing various functions, women are unfairly labeled as unpredictable, incompetent, or unfit for certain jobs due to their hormones. Women are commonly dismissed as “hormonal” when their emotions or behavior are inconvenient.
Historically speaking, doctors believed estrogen, found mainly in women, had negative effects on them, while male hormones like testosterone were praised. A man with high testosterone was seen as strong, while a woman with too much estrogen was labeled as crazy. Later on, it was discovered that both estrogen and testosterone are present in both men and women. Still, the connection between estrogen and femininity remained strong.
The stereotype of a “hormonal” woman being stressed, moody, or menstruating is harmful and can lead to neglecting serious medical issues unrelated to the menstrual cycle. For example, thyroid disorders are more common in women but are often misdiagnosed or ignored because symptoms like fatigue, weight gain, and depression are ignored as stress-related. Postpartum depression, related to thyroid gland inflammation after childbirth, affects many new mothers but is not rarely mistaken for a mental health issue rather than a medical condition.
Plastic surgery, empowering or trapping women?
In the past, ugliness was pathologized, seen not just as an aesthetic issue but as a psychological condition. Women’s natural bodies were often considered as deformities in need of surgical correction, affected by male desires and societal pressures.
The history of plastic surgery reflects a power dynamic where men set the beauty standards for women. The development of cosmetic procedures were mostly depend on male doctors’ preferences rather than women’s desires. Even worse, female patients were treated as experimental subjects rather than informed patients.
Today, cosmetic procedures is on a line somewhere between empowering women to control their bodies and trapping them in unrealistic beauty ideals. Prioritizing beauty and health is a total different for woman who is living versus surviving. At the end of the day, pursuing beauty and health should enhance a woman’s life, not just meet societal expectations.
After women’s own heart
Women’s heart health has been forgotten for too long. Heart disease manifests differently in women compared to men, with different symptoms, risk factors, and underlying causes.
Based on Dr. Hafiza Khan, an electrophysiologist, a woman’s risk of arrhythmia fluctuates with menstrual cycle. When estrogen peaks during ovulation, heart rate rises by two to four beats. On the contrary, when estrogen and progesterone are at their lowest right before menstruation, women are more incline to arrhythmias. This finding means that the menstrual cycle is highly related to the risk of fatal arrhythmia. Meanwhile, Takotsubo cardiomyopathy, or Broken Heart Syndrome, primarily affects postmenopausal women. Then, there is Grinch Syndrome, or postural orthostatic tachycardia syndrome, often goes unnoticed in women because of their smaller hearts.
A lot of women are also do not realize that pregnancy or hormone supplements can put their hearts on risk. Autoimmune disorders and inflammation, more common in women, also predispose them to heart conditions. Symptoms like fatigue, nausea, and shortness of breath are commonly associated with heart attacks in women.
Today, one-third of women will develop heart disease, and for one in five, it will be fatal—more than breast cancer and all cancers combined. Despite progress, women’s heart health is still often overlooked until it’s too late. Thus, it’s not enough to include women in cardiac research; they must be studied specifically to understand sex-based differences.
Beauty was pain
Believe it or not, history says that tuberculosis once suited with beauty standards: pale, translucent skin, emaciation from lack of appetite, and a natural blush—signed of women under tuberculosis—were considered attractive. There was a belief that this disease made women beautiful and posed a particular threat to pretty girls. To worsen matters, doctors even romanticized the disease, praising its photogenic qualities.
Not only did women have to fight against societal standards of beauty, but we all know that women have historically had to fight for freedom, one of the ways were by trading it for the right to smoke. In 1929, cigarettes symbolized liberation from sexist norms, despite being seen as morally corrupt for women. Therefore, smoking became a status symbol for modern women. Even after the link between smoking and respiratory disease was known, cigarettes advertisers continued to promote smoking as a symbol of freedom.
Today, the awareness of women’s unique respiratory health risks remains low in the medical community. Doctors’ failure to inquire properly about women’s respiratory health leads to misunderstandings and sometimes fatal errors.
Women had to stick to veggies
Probably we are all familiar with the biblical story of women’s relationship with food when Eve’s temptation to pluck and eat forbidden fruit. Throughout history, women’s appetites were viewed as inherently dangerous.
From medieval religious communities, fasting was often a way for women to prove their spiritual devotion. The less women eat, the holier they were.
By the late 1800s, the idea emerged that women’s diets should be restricted in certain quantity and quality. People at that time believed that women were like children—emotionally driven and self-indulgent.
Fast forward to industrial revolution, meat was specifically offered to men with physically demanding jobs, while women were associated with smaller, sweeter foods. This is also the reason of the teatime food preferences where women were expected to indulge in sweet treats but also practice restraint to maintain a slim figure.
Funnily, they tried to justified this into science on why certain foods were deemed suitable or unsuitable based on gender, with women warned against stimulating foods due to supposed effects on their nervous systems and sexual appetites. Women were discouraged from eating meat or too much food, not for health reasons, but because appetite was seen as a vice they were less capable of controlling.
Now, talking about the science, women’s hormonal fluctuations, particularly during the menstrual cycle, affect not only reproductive functions but also the gastrointestinal tract. Hormonal changes can worsen symptoms of conditions like irritable bowel syndrome (IBS), leading to bloating, pain, and diarrhea. Unfortunately, IBS is often perceived as a woman’s disease, leading to misconceptions and soft sexism surrounding its diagnosis and treatment.
Understanding women’s dietary differences requires acknowledging historical biases and their impact on health perceptions. It’s crucial to address these issues to ensure equitable treatment and care for all.
Woman always wrong
History has some pretty wild way of building hypotheses about who’s to blame for spreading diseases, especially back when people had no idea about how they actually spread. Instead of blaming the real suspects, like germs, they pointed fingers at women. This led to a long history of women being unfairly blamed for diseases.
Let’s start with typhoid as an example. There was this lady named Mary Mallon, history let us know her as Typhoid Mary. When people did not understand how and why typhoid spread, Mary carried the disease but didn’t show any symptoms. People got scared of her and she ended up being locked up for over 26 years. She was one of several hundred of typhoid carriers but the only one ever to have been imprisoned, harassed, and persecuted. If you’re wondering why, a historian named Judith Leavitt identified the reason: because Mary was Irish, an immigrant, and a woman without family.
Then there was another thing named the American Plan, where lots of women were kidnapped and forced to undergo treatment for sexually transmitted diseases (STDs). They were arrested for doing things like eating alone or changing jobs, and if they tested positive for an STD, they’d be locked up and treated with dangerous drugs. That was not bad enough because the worst part was sometimes the authorities would even force these women into sex.
Autoimmune diseases are also another big issues, especially for women who are 80% more likely to get them than men. But doctors often brush off their concerns or blame it on women’s hormones without really listening to them. Some even say it’s because women don’t take care of themselves properly. And get this, back in the 1890s, a doctor thought weak immune systems were caused by emotional issues.
Let’s reflect, hundreds years later, does our society getting any better Even today, women with serious illnesses like breast cancer are sometimes told that they just need to stay positive to get better, as if it’s all in their heads. It’s like no matter what, when something goes wrong, people find a way to blame women.
Women were crazy
In the history of medicine, the nervous system has been central in explaining why people thought women’s brains were different from men’s.
Hysteria, a term for female mental issues, comes from an old Greek word meaning “womb.” Since ancient Egypt, it has been talked and writings mentioned how the uterus moving could affect a woman’s mind. Back then, they thought marriage and sex could cure it. During medieval times, doctors thought hysteria was either caused by demons or witchcraft.
Then, Jean-Martin Charcot, known as the father of modern neurology, thought hysteria had a neurological cause. He believed pressure on what he called hysterogenic zones could help. This method meant punching women in the ovaries.
One of Charcot’s students, Dr. Désiré-Magloire Bourneville, was more progressive. He looked into how childhood experiences affect physical and mental health. Sigmund Freud, who studied under Charcot, disagreed with the neurological idea. He thought hysteria came from sexual repression.
In the late 1800s and early 1900s, scientists believed women were intellectually inferior. Even Charles Darwin saw them as lesser beings. This led to the belief that hysteria came from women being inherently weaker. Dr. Edward Hammond Clarke from Harvard Medical School thought too much education could cause hysteria.
Some treatments aimed to keep women uneducated and passive, like the “rest cure” method proposed by Silas Weir Mitchell. This involved bed rest, overfeeding, and denying any mental stimulation. It didn’t treat women; it just made them obedient. Just like what men wanted.
Women in clinical research
The bias against including women in clinical research is widespread, even in studies that don’t involve human subjects directly.
The reluctance to study female subjects comes from the idea that their hormone fluctuations make them too complex to research. However, these very differences affect how medicines work in women compared to men. Unfortunately, proposed solutions often fall short. For example, some suggest conducting experiments on male mice first and then only testing female mice as a comparison to the male “standard.” This approach ends up eternalizing the same old belief that women’s bodies and biology are less critical.
To sum up
This book has touched me personally as a woman at so many levels. Research on deadly diseases often overlooks women’s perspectives, leading to preventable suffering. Women still go through a lot of pain, not because there aren’t ways to help them, but because society ask them to believe they have to endure it. They don’t realize that what they’re experiencing should be professionally checked, and nobody tells them otherwise. Plus, scientists avoid raising this issues that could help women, so we need to break those myths to help women live better.
At the end of the day, I realize that being called unique as the norm for women is not actually a praise. I feel, at least personally, this perspective will hurt women and society as a whole in the long run. Even though we are progressing, it is sad that we still don’t make it fair for women.
I think reading All in Her Head is a good start to reflect what happens when we prioritize women secondarily in society. Everyone, women and men, should realized and acknowledged this phenomena to build a better inclusive society.
My Favorite Bits
And yet we are still no closer to disentangling what women want for their faces and bodies from what doctors, or husbands, or social pressures might tell them they’re supposed to want.
Elizabeth Comen, MD, All in Her Head: The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters Today
Women continue to suffer—not for lack of treatments, but because they think they have to; because they don’t know, and nobody tells them, that what’s happening to them is not normal; and because the scientific community still shies away from the taboos that need to be shattered before we can empower women to live healthier lives.
Elizabeth Comen, MD, All in Her Head: The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters Today
Author: Elizabeth Comen, MD
Publication date: 13 February 2024
Number of pages: 368 pages
