For Her Own Good, by Barbara Ehrenreich and Deirdre English

For Her Own Good

When I picked up For Her Own Good: Two Centuries of the Experts’ Advice to Women, I expected a book about wrongheaded scientific/medical/psychological/social/etc. theories about women. It turned out to overlap considerably but not completely with that.

It’s a feminist book, so of course it highlights instances of sexism and of women being treated particularly badly. But then again, a fair amount of what’s talked about are ideas and practices that seem not to have been motivated by sexism, nor to have needed to occur in a social context of sexism to have the effects they had. So, much of the book fits comfortably in a feminist framework, but some requires a fair amount of stretching, as it’s really about harms and myths and such concerning people in general (or parents or people of certain social classes or what have you) rather than women specifically.

It seems at times that the impact on women is kind of a hook to work a topic into a feminist book, where then some of the points made about that topic, while interesting and worthwhile in and of themselves, might be tangential to feminism.

For what it’s worth, I found For Her Own Good to be mostly “good” feminism. I’m on the side of feminists more often than not, but there is plenty that comes under feminism—or at least that is sometimes presented as such—that I either oppose or am undecided about. I even find certain elements of it to be insulting, emotional polemics, which I don’t just disagree with but regard as disgusting.

So I’m mostly sympathetic toward feminism, but with plenty of exceptions and caveats.

As I was reading For Her Own Good, I was conscious of numerous opportunities for the authors to take things in the direction of the kind of angry and logically fallacious advocacy that can sometimes so turn me off about feminism, but generally they remain quite sensible. I don’t mean they are “objective” in the phony sense of pretending all issues have an equal amount of merit on both sides, or of remaining completely uncontroversial and passionless—this is an unabashedly feminist book by authors who believe women have long gotten a raw deal in numerous ways, and who have strong feelings about that—I mean the positions they take seem generally right-headed and well-supported by evidence. So, “good” feminism in that sense, not in the sense of watered-down feminism or non-feminism.

I think, for example, they’re largely on the money in their general attitude toward science. This isn’t, to my mind, an anti-science book. Certainly a feminist or leftist take on science often degenerates into that, with its relativism and/or celebration of all things not associated with the “patriarchy.” As in, modern science and medicine—bad; alternative medicine, midwives, indigenous folk medicine, Wiccan healers, alternative “ways of knowing,” etc.—good.

But thankfully Ehrenreich and English avoid the “logics and facts are male and therefore bad” nonsense. I see For Her Own Good not as anti-science, but as anti-bad science, anti-beliefs and practices falsely claimed to be science, anti-misuses of science, anti-institutions and individuals within science not behaving scientifically, etc.

To their credit, the authors do not present the “experts” that they are roasting in this book as wrong because they’re people of science and science is wrong, but as wrong precisely because they deviated from scientific thinking and the scientific method.

Irrational ideas and practices are not defended simply because they are non-mainstream, championed disproportionately by women or non-white people, etc. For instance, they present homeopathy not just as wrong, but as obviously ridiculous (which it is).

Actually in one sense they do defend certain alternatives to mainstream science and medicine like that, but their position is perfectly plausible.

The point they make is that even though homeopathy (and you could add “therapeutic touch,” and countless other woo woo stuff) basically constitutes doing nothing and has no benefits beyond a placebo effect, for much of medical history most people would have been a lot better off doing nothing than undergoing the treatments of even the most highly regarded physicians. There are numerous grisly examples of things patients, especially women, were put through by medical professionals that constituted torture (literally, not hyperbolically), and not uncommonly caused permanent damage or disfigurement if not premature death. People who didn’t have access to such state-of-the-art medicine and had to make do with the local female healer chanting a prayer over them or giving them some herb were the lucky ones.

A strength of For Her Own Good is that instead of just listing objectionable phenomena, there is an attempt to explain how they came about, which facilitates learning from them and maybe not making analogous mistakes now and in the future.

For example, why did physicians deviate from ideal scientific methods, even when doing so meant causing horrific suffering and sometimes death to their patients? Why did certain practices become mainstream medicine, with others relegated to the “alternative” fringes? (The answer to the latter question of course should be “Because they were the practices best supported by the scientific evidence,” but the problem is precisely that this was often not the case.) And how are these flaws connected to issues of concern to feminists? (Sometimes essentially, and sometimes incidentally or tangentially, as noted above.)

A lot of it was a matter of economics. It may not have been crass capitalism on a conscious level (though I’m sure sometimes it was), but doctors are still human and all else being equal they act in their economic self-interest. Certainly that’s true on a collective level, even if there are altruistic doctors who are exceptions.

And it tends to be in doctors’ financial self-interest to do something.

Let’s say that there are two plausible treatment options for a patient. On the one hand, you can intervene with something active that is awful to experience (say, some kind of drastic surgery, or some experimental drug, or maybe “bleeding”). On the other hand you can do basically nothing, and just try to keep the patient comfortable and hope the condition runs its course.

Let’s further say that there is some clinical evidence for both the radical intervention and the passive approach. Assume that patients who get the intervention live on average another nine months and suffer greatly, whereas patients who are left alone live on average another year and suffer considerably less, but that that’s a lot clearer in hindsight than it would have been at the time when there was considerably more ambiguity about what works best.

If it’s even a close call, you would hope that doctors would choose the less painful, less drastic course of action unless and until the evidence clearly supports it. But this is where the economics comes in. If you as the doctor provide the (possibly neutral or worse) treatment rather than doing nothing, you can bill for it. You get the credit if the patient recovers, which helps your reputation and your future earnings, whereas if the patient dies you probably won’t get much or any of the blame, since the very fact that you were using some extreme treatment indicates the patient was in a bad way and would likely die soon regardless.

There’s also the psychological factor that you (and the patient, the patient’s family, etc.) can feel like “I did all I could.” Imagine instead that in such circumstances you admitted you had no treatment better than doing nothing and so you didn’t treat. Then it would be like you’re giving up on the patient. “For heaven’s sake, doctor, try something!” one can imagine the loved ones exclaiming imploringly or angrily.

Another institutional factor that influences things in the direction of doctors’ self-interest is the attempt to shape laws and customs to favor only their type of expertise, and to keep the ranks of their profession from growing too quickly (i.e., with competitors). This may be fine if the people being favored as the only elite that can charge for providing medical services really are the ones who have the most thorough and scientific education and training, and who provide the most effective treatments. But for much of the history of medicine, that simply wasn’t the case.

In a rather disturbing and eye-opening section, the authors describe how for a long time becoming a doctor was far, far more about belonging to the right social class and proving yourself the right kind of “gentleman” than about any kind of genuine medical education. Even to the very limited extent that there was some training in science, it was mostly abstract stuff and laboratory stuff of dubious relevance to treating real patients.

The elite didn’t consist of geniuses who had worked to become experts in providing medical care, but of rich assholes who came from the right families and attended the right schools and parties and such to be accepted as suitable for a high position in society.

Then the ranks of such doctors were kept under control by influencing law and public opinion to regard only people who had gone through this kind of preparation to be “real” doctors, in spite of the fact that the preparation was far more social than clinical.

The discussion of this issue is an example to me of where the book extends well beyond feminism. These economic factors are not a matter of sexism, but of greed, selfishness, and other human vices and foibles that are not gender-specific.

So does it not belong in a feminist book at all? No, I wouldn’t say that. There are at least two significant connections.

One, limiting the approved practice of medicine to those who had had this kind of formal training and credentialing favored males in the sense that universities, medical schools, and most paths to elite or authority positions in society were fully or partly closed to females. Two, the people practicing in the “alternative” ways that came to be increasingly looked down upon and marginalized were disproportionately female. So these institutional historical developments lifted up an overwhelmingly male set of people, and pushed down a more female set of people.

But I would think those were largely incidental consequences. That is, I doubt many of the people making the key decisions that resulted in these developments were motivated by anything like: “I hate women and want to keep them down. Let’s pretend their way of healing sucks, and this way that mostly men practice is the only proper way to do medicine, and let’s keep women from getting the education they would need to become the favored kind of doctor.” No, as noted, you’d have to think it was mainly motives of greed and self-interest (and in some cases an honest opinion that the increasingly mainstream version of medicine that they favored really was best for patients and society) that led people to push for these changes.

Maybe most of the people practicing non-mainstream medicine were female, but I suspect doctors would have been equally inclined to squeeze them out if they were Jews, dwarves, or bisexuals. The relevant point is that they were rivals for the patient/consumer dollars, not that they had a vagina.

A sizable portion of For Her Own Good concerns psychological theories about the genders, family, parenting and such. Not surprisingly, most of these come across as laughably outdated, if not offensive or bizarre.

As the authors point out, the scientific justification for most of these ideas was minimal at best. It’s not like these theories were the best science had to offer with the evidence available at the time; they were typically bad science even then.

Furthermore, the social and psychological theories in question largely ignored anyone other than middle class and above white folks in intact marriages, and they tended to be the sort of ideas that fit with the already existing worldviews of the higher classes. These were the people who mattered after all, and perhaps more importantly who had the resources and the inclination to buy books, attend public lectures, pay college tuition, undergo therapy, etc. So if the ideas made little or no sense when generalized beyond this subgroup of the population, few people noticed or cared.

Ehrenreich and English also note that the descriptions and prescriptions offered by the various “experts” who achieved the highest influence and popularity routinely conflicted with each other, putting contradictory pressures on people, especially women, who were expected to conform to them. If women stayed home and didn’t earn money they were moochers; if they sought jobs outside the home they were objectionably competing with men instead of fulfilling the family role that God or evolution had shaped them for. However they parented they were ruining their children—especially the all-important sons—either by coddling them or by being overly cold and harsh. And so on.

I think the authors are on a bit shakier ground here, just in the sense that a culture never speaks with one voice on anything. Of course there are contradictory pressures if you try to simultaneously do everything one or another “expert” (or just author of a marketable book or nowadays TV show) recommends. There always are. It’s not about being a woman or a mother; everybody in every area of life receives mixed messages like that from society.

One thing I found interesting and informative is the authors’ discussion of changing gender roles within the family in the 1800s. Superficially there seemed to be little change in that husbands continued to work primarily outside the home and wives continued to work primarily inside the home. But the difference was that the amount of legitimate work that was needed in the home decreased drastically in the late 1800s and into the 1900s, so anyone limited to that sphere became increasingly useless.

In the olden days, women were not only raising children, but typically making clothes, cooking every meal from scratch, washing clothes by hand, etc. But in time, a lot of that work shifted to factories, or it became much less time-consuming due to the invention of various labor-saving devices.

But “saving labor” was a mixed blessing for people who had nothing else to do. Women were still excluded from the productive areas of life they had previously been excluded from, while the few productive areas of life that they were not excluded from were declining in relevance.

The gender roles that had been more or less separate but equal became separate but unequal.

This brought on a social and psychological crisis that, according to the authors, damaged the health of women. This was the Victorian era, where the stereotype of women—again, middle class and above white women in intact marriages—was that of the fragile, sensitive damsel who suffered from various vague and mysterious disorders such as hysteria and fainting spells. But this was one instance where a stereotype was not far off. Some women of that time were bedridden for months and years for no clear reason. Basically they were bored to death.

One response to the increasingly superfluous nature of women’s work was to create new make-work. If vacuum cleaners and washing machines and such meant one could clean the house in one-tenth the time, then the key was to convince women they needed to clean the house ten times as often.

The germ theory came in handy here as a marketing tool. Even if there was no visible dirt or vermin or anything, you could never be sure how much of the even more dangerous stuff that was invisible to the naked eye was lurking in your home, so it was always safest to clean some more.

There are plenty more points like that that I could bring up that I took from For Her Own Good. It’s a solid read, including on the not uncommon occasions that it strays from what one might expect from the title and description of the book into related areas.

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