Feminist Critiques of Medicine

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What is the main ideas in the feminist critiques of medicine?

The basic elements of feminist critiques of medicine have been similar in Britain, the United States and Australia. However, both writing and campaigning on women’s health issues appear to have declined in the UK. This stems in part from a broader concern about current changes in the NHS and an understandable reluctance to challenge existing practice. However, it also reflects a shift of direction within feminism itself, away from campaigning issues towards a concern with theory, emphasising the social construction of gender discrimination rather than its empirical documentation (Graham & Oakley, 1981).

These developments in the wider feminist agenda have involved not only a more theoretical orientation but also a process of differentiation and deconstruction. As a result, it is now difficult to identify a single feminist critique of medicine. Instead, a variety of feminist approaches to health and health care have emerged. Black women, for instance, have focused on the racism often inherent in their experiences of health care as well as the eugenic assumptions implicit in many fertility control policies. They have contrasted their own experiences of pressure to accept abortion or sterilisation with those of many white women concerned only about lack of access to fertility control. Similarly, lesbian women have pointed to the heterosexist assumptions inherent in many of their experiences of medical care (Graham & Oakley, 1981).

There have also been major debates about particular aspects of medical practice between women who would all identify themselves as feminists. In the area of new reproductive technologies, for instance, some women have campaigned to end the use of techniques such as IVF, seeing them as potentially genocidal and of no value to women. Others have taken a rather different approach, acknowledging potential problems but calling for greater female control over the technologies and wider access for those who could benefit. Any attempt to understand how women are challenging medicine must therefore take account of the growing diversity of feminist theory and practice (Graham & Oakley, 1981).

To add still further to this complexity, a number of the most sustained criticisms of medicine have come from women who would not describe themselves as feminists at all. Many of the campaigners for women-centred obstetric care, for instance, would probably come into this category, as would many of the women involved in self-help and other support groups. It is also significant that an increasing number of women are defining health issues in individual terms, focusing on ‘life-style’ and consumer issues rather than collective action to change the nature of health care. It is important, therefore, to adopt the broadest possible definition of feminism to include a variety of activities unified not by their political label but by their potential for increasing women’s autonomy and enhancing their health and well-being (Graham & Oakley, 1981).

Who is associated with the feminist critique of medicine?

There is growing evidence that women experience particular difficulties both in getting enough information and being able to act on it. This applies especially to black and working-class women, many of whom are given very little time and attention. Many doctors appear to be reluctant to let women speak for themselves and many women feel unable to assert their wishes. Women’s own experience is devalued by comparison with that of doctors’ expert ‘knowledge’ and too many doctors are unwilling to admit ignorance or uncertainty (Graham and Oakley, 1981). As a result female patients frequently become the passive victims of doctors’ ministrations (Akrich & Pasveer, 2000).

Consumers may have fuelled the growing acceptance of CAM, yet their dramatic consumption patterns may lead to commercialisation that could have negative consequences for the movement. First, anyone marketing these techniques could exaggerate results in order to attract consumers. Reissman provides the example of vitamin B-12, which has been marketed as being a way to increase energy. He says this ‘is based essentially on the fact that it has this effect on highly anemic individuals-an example of extrapolating from the extremes to the masses’. It would be detrimental to the movement if consumers begin to use these techniques inappropriately, because this could lead to a lack of results and frustration. Second, there is the possibility that these techniques could become co-opted as they enter the mainstream. More physicians are seeking training in CAM. An estimated 3,000 American physicians integrate acupuncture into their practices, and an estimated one-third of homeopaths are physicians or osteopaths. If these physicians do not use these techniques in accordance with the beliefs outlined above, some respondents believe they ‘won’t get results’. If this proves true, then this could frustrate consumers and do more harm than good for the movement. Co-optation occurs in other forms (Akrich & Pasveer, 2000).

It was a slip, really a misdiagnosis of an emergent chronic-pain syndrome. But when the misdiagnosis was followed by a raft of new symptoms, what started out as a little mistake grew bigger. The new symptoms were misinterpreted as part of the disease and then mistreated with a therapeutic plan that did not fit the problem. When the mistreatment failed to work and the debilitating new symptoms grew worse, threatening the patient’s mind, dreams, and life, she went nearly mad. By the end of the eight-month ordeal, a small mistake by a doctor had undone the patient’s life.

What are the critic’s main ideas?

All feminist critiques of medicine give the recognition that women lack power in formal health care systems. This disadvantages those women who work in the health sector but also has a profound effect on all women using its services. Doctors-the majority of whom are male-continue to exercise a high degree of control over the research and development effort in medicine, the allocation of scarce medical resources and the quality of treatment given to individual women. Despite their greater use of medical services, their numerical preponderance in the health labour force, and their responsibility for unpaid caring, most women still have relatively little say in their own health care or that of their dependants. Thus the organisation of the NHS, like that of most other health care systems, reproduces a wider pattern of patriarchal power. Women make up about 75 per cent of NHS workers, but most control remains with doctors and senior administrators, the majority of whom are men (Akrich & Pasveer, 2000).

The traditional power of doctors in decision making in the NHS has increasingly been transferred to a broader arena as other chapters in this volume demonstrate. However this has not increased the participation of women. The relative scarcity of women in senior positions in medicine and in the management structure of the NHS is in itself the object of feminist criticism. It is a result both of structural obstacles and also of more diffuse factors associated with ‘male’ occupational cultures. Hence medicine, like most of the other professions, is in need of major reform to ensure equal opportunities for all. But the implications are, of course, much wider than concern about the occupational advancement of a few women. Women’s lack of authority and power also contributes to a situation where female users of the NHS continue to be constrained in the exercise of their own autonomy, as well as risking inappropriate diagnosis and treatment.

There are two main strands in the renewed attack on the morality of modern medicine, both new versions of old themes. One is the idea of the corrupting, desensitising influence of the practice of vivisection, destroying the natural and healthy ‘squeamishness’ of the neophyte through intense pressure to conform. This may lead to ‘the “cut, burn, poison” approach’ to patient care and could be a step towards experiments on humans. The literature is again full of invitations for humans to empathise with animal victims, especially in the eco-feminist critiques of medical research which posit a natural affinity between women and animals (Akrich & Pasveer, 2000)

Why are these ideas important to understanding health today? Example how is there ideas relevant in biomedicine today.

Health communication scholars have approached illness narratives as psychosocial maps, revealing the storytellers’ emotional and cognitive journeys. These narratives challenge the voice of medicine as the primary means of understanding health and disease. To interweave both the voice of medicine and the voice of the life world into a consistent, mutually agreed upon story that functions as the basis for clinical care and decision-making is a primary communicative goal, albeit one that is often difficult to achieve (Adeyi & Morrow, 1997).

The conceptual foundations and research debates of the past decades demonstrate that for understanding health communication, “social support” is not a single, unified construct. Greater value exists in viewing social support as an umbrella term for a providing a sense of reassurance, validation, and acceptance, the sharing of needed resources and assistance, and connecting or integrating structurally within a web of ties in a supportive network. Adeyi & Morrow (1997)

Many people with low health literacy are ashamed of their predicament and undertake efforts to hide it. One study at a large urban hospital, for example, found that only two thirds of people with low health literacy admitted that they have trouble reading and understanding health-related materials. Therefore, one third of the people with low health literacy denied that they have a problem. Of those who did acknowledge that they have low health literacy, more than two thirds reported that they never told their spouses or children about their problem, and approximately 40% admitted feeling shame over their lack of literacy ability. The researchers concluded that low health literacy carries serious stigma and can foster feelings of fear, inadequacy, and low self-esteem. One consequence of these perceptions is that some people may avoid or underutilize the health care system when they are ill to avoid being discovered or embarrassed by their low health literacy (Adeyi & Morrow, 1997)

A number of studies have found that people with low health literacy have difficulty understanding health information and instructions, which can lead people to ignore disease warning signs, misuse medications, fail to comply with treatment regimens, incorrectly manage a disease, or fail to get needed care within an appropriate period of time. For example, in a study of people with diabetes mellitus it was found that only 50% of those with low health literacy were able to recognize the symptoms of hypoglycaemia, as opposed to 94% of those with adequate health literacy.

What examples can you use to illustrate your ideas?

In addition, early feminist critics associated the new reproductive technologies with the glorification of traditional motherhood. Thus women who chose to use these technologies so as to fulfil a motherhood wish were often depicted as having “false consciousness” or being “cultural dupes”. In feminist thought of the 1980s, motherhood was often criticized for its barriers to personal development and freedom, certainly not worthy of a high-stakes medical quest. Yet this feminist discourse proved oppressive in its own right: feminist or otherwise “emancipated” women who were experiencing infertility problems found it difficult to reveal their child desire and were forced to hide their infertility treatment seeking from others. Some feminist scholars who were undergoing high-tech infertility treatments found themselves in the hypocritical position of denouncing the new reproductive technologies in lectures and at conferences.

Feminist writings critical of reproductive technologies must be understood as having grown out of and in turn developing several themes that were core parts of second wave feminist scholarship on science, medicine, childbirth, and reproductive rights.

Thus, while in some ways the time period covered by phase 1 saw the mainstreaming of feminist critiques of reproductive technologies, many of the social justice issues of radical feminists remained unaddressed by greater public accountability. The expression of these concerns sustained the impasse between the infertile and radical feminists, because solutions to inequalities seemed to require that infertile couples suffer personally so as to prevent the perpetration of public wrongs for which they were hardly responsible (Adeyi & Morrow, 1997).

References

Abplanalp, Judith (1983) ‘Premenstrual Syndrome: A Selective Review.’ In Sharon Golub (ed.), Lifting the Curse of Menstruation. New York: The Haworth Press

Allen, Hilary (1984) ‘At the Mercy of Her Hormones, Premenstrual Tension and the Law.’ m/f 9:19-44

Aurelius, G., and E. Ryde-Blomqvist (1978) Pregnancy and delivery among immigrants. Scandinavian Journal of Social Medicine 6: 43-48.

Adeyi, O., and R. Morrow. (1997) Essential obstetric care: Assessment and determinants of quality. Social Science and Medicine 45(11): 1631-1639

Akrich, M., and B. Pasveer (2000) Multiplying obstetrics. Techniques of surveillance and forms of coordination. Theoretical Medicine (in press).

Baumrind, Diana (1980) “‘New Directions in Socialization Research.’” In American Psychologist 35(7): 639-52

Becker, Howard (1963) The Outsiders. New York: Free Press

Berger, Peter, and Hansfried Kellner (1970) “‘Marriage and the Construction of Reality.’”

In Hans Peter Dreitzel (ed.), Recent Sociology, No. 2. New York: The MacMillan Company

Berger, Peter, and Thomas Luckmann (1967) The Social Construction of Reality. New York: Anchor Books

Boston Women’s Health Collective (1976) Our Bodies, Ourselves. New York: Simon and Schuster

Graham, H. and Oakley, A (1981) ‘Competing ideologies of reproduction: medical and maternal perspectives in pregnancy’, in Roberts, H. (ed.) Women, Health and Reproduction, London: Routledge & Kegan Paul.

Petersen, Alan, and Deborah Lupton (1996) The New Public Health: Health and Self in the Age of Risk. London: Sage.

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