Paper presented at the 3rd Annual Qualitative Methods Conference: "Touch me I'm sick"
8 & 9 September 1997, University of South Africa Regional Office, Durban


Witches and women in medicine

Jo Wainer

Monash University Centre for Rural Health, Australia

jow@med.monash.edu.au

Women have been systematically excluded from the construction of knowledge base which constitutes Western medicine. Women in Europe were punished, burned, terrorised and killed in the Middle Ages for daring to practice the healing arts. This has had a profound effect on the way medicine has developed and its relationship with healing, and with women. Today, women in many countries are insisting on a place at the table of medicine, and beginning to ask why it is as it is.

"It is clear that all is not well between women and their doctors" (Koutroulis 1990:73)

I speak from the limitations of my own culture.

first world

allopathic medicine

. may not apply to traditional healing

the question of women's voice in the construction of knowledge and the public domain is universal Beijing, WHO

Western medicine is in deep trouble

It is based on science and theory which excludes the knowledge, experience and world view of half the world - the half called women. Yet it calls itself 'scientific'. It has been co-opted to serve unseemly ends - the control and subjugation of women - yet it calls itself a 'healing art'. It has been bribed into collusion with the capitalist order, - yet its members believe they are healers who act for their patients.

Science developed in part as a reaction to the limitations of knowledge based on intuition, ritual and relationship. This way of knowing dominated for most of the history of the human race, and reflected well the central place of the feminine but was not exclusively hers. Pre-patriarchy, and we are talking about 3000 years ago in Europe, the sorcerers and priests drew on the same relationship to truth as the wise women, bound by the cycles of the seasons, the cycles of fertility, and the monthly cycles of the moon. These and the relationship to creation through birthing constitute women's embodied knowledge.

In the pre-patriarchal world women as well as men defined the cosmos.

Pythia, the Oracle at Delphi, was:

consulted to tell of the future by those who sought to align themselves with the gods

drew her knowledge through trance and vision

. attended by priestesses and guarded by the python

overthrown by Apollo and the priests began to translate the visions. thus began the silencing of women which has continued until today.

I want to tell a little of a story about how the feminine was overthrown, about how women were silenced, particularly as healers, and about some of the consequences of that for medicine as it is constructed today.

Until not very long ago women were excluded from medicine, as from most of public life, and yet

Women have always been healers

Ancient mythology tells of the role of the goddess and of her incarnation, woman, in birthing the world and in birthing human life.

This was pre-patriarchy, when gods and goddesses shared the heavenly pantheon, when the Amazons roamed the steppes on horseback and in Crete there was a peaceful society without battlements where women and men ruled together.

It was a time of deeply earthed instinct, of honouring of cycles, of Mother Earth, of harmony with nature. It was pre-scientific and non-rational and instinctual. It was a time which was overthrown by the patriarchy when the goddesses withdrew and left the world to 5000 years of masculine dominance. This manifested immediately as fear and hatred of women.

The conquering of the feminine lodges deep in antiquity. In Joseph Campbell's terms "It is the conquest of a local matriarchal order by invading patriarchal nomads, and their reshaping of the local lore of the productive earth to their own ends. It is an example of the employment of a priestly device of mythological defamation, which has been in constant use .. ever since."

This process turns the defeated people's gods into demons, and binds their rituals into new rituals for the new all-powerful god. It is a process which was implemented by Christianity in reconstructing the goddess into the servant Mary, and was repeated in Europe in the Middle Ages with the burning of the witches.

Back to Campbell's story of the defeat of the feminine. He says that the "battle that we are about to view, as though of gods against Titans before the beginning of the world, actually was of two aspects of the human psyche at a critical moment of human history, when the light and rational, divisive functions, under the sign of the Heroic Male, overcame .. the fascination of the dark mystery of the deeper levels of the soul."

This is one description of how the feminine was overcome.

Tiamat is all-mother and ruler at a time when the gods were female. She requires no male to beget offspring. She made a mistake and had one son fathered by a man. Her supremacy is challenged by that son, whose name is Marduk. She responds to the challenge and they go to battle.

This is the battle scene.

"Tiamat became as one possessed. She lost her reason; uttered wild, piercing screams; trembled; shook to the roots of her limbs; pronounced an incantation; and all the gods of the battle cried out. Then Tiamat advanced; Marduk, as well: they approached each other for the battle. The Lord spread out his net to enmesh her, and when she opened her mouth to its full, let fly into it an evil wind that poured into her belly, so that her courage was taken from her and her jaws remained opened wide. He shot an arrow that tore into her, cut through her inward parts, and pierced her heart. She was undone. He stood upon her carcass .. now paused, gazing upon the dead body, considering the foul thing, to devise an ingenious plan. Whereafter, he split her, like a shellfish, in two halves; set one above, as a heavenly roof, fixed with a crossbar; and assigned guards to watch that her waters above should not escape." (Campbell 1976:82-83)

Women as foul creatures

The savagery of that battle is played out again and again through subsequent history as men wreak vengeance against the bodies of women for being foul and evil creatures of woman born.

Mary Daly documents how this continues to be played out in the relationship between women and medicine. "In the Gynecological Age, as in the past, women are identified as filthy and impure beings in the most radical sense. That is, we are stigmatized as ontologically impure and are therefore targets of hatred on this fundamental and all-pervasive level.... Ultimately, the intent of The Gynecologists is to purify women and society of our Selves." (Daly 1978:237)

Although Western history has ignored their role and contribution, women did the birthing and much of the healing.

There were also learned and upper class women who learnt astronomy and chemistry, and instructed men in matters of science.

According to Erenreich and English "The earliest doctors among the common people of Christian Europe were women who cultivated and prepared herbs, who tended births and deaths, and who were the original anatomists and scientists and healers. The famous medical works of Paracelsus were only compilations of the knowledge of these "wise women" and he acknowledged this in 1527 when he burned his text on pharmaceuticals, confessing that he 'had learned from the Sorceress all he knew". (Ehrenreich & English 1973:33)

For thousands of years the knowledge of medicine, and it practice among the poorer classes, was almost entirely in the hands of women and many discoveries in science are due to them, even surgery.

The elimination of the feminine from worship and from public life began in earnest with the coming of the sky god religions represented in Europe by Christianity and in the Middle East by Islam.

The Church forbade women to take part in its office and banned all external methods of knowledge to women. According to Matilda Joslyn Gage, writing in 1893, the church "was profoundly stirred with indignation at (women) having through her own wisdom, penetrated into some of the most deeply subtle secrets of nature" (Daly 1978:217)

Burning the wise women

And so with the encouragement of the developing professions of medicine and law, the Hags, the wise women, were systematically eliminated in an orgy of fury and terror and vengeance paralleled in this century only by the actions of Hitler, Pol Pot and the Bosnian conflict.

Estimates of the number of women killed in Europe during the fourteenth to the seventeenth century vary from hundreds of thousands to 8 million. In many villages only one or two women remained. Women carried out mass suicide by drowning to escape the sadistic tortures of the Inquisition which crushed, dismembered, boiled, stretched, flayed, cut to pieces and burned alive the women healers of all Europe. And often forced their daughters to give evidence against them, and to watch the torture and death, so that they might never feel the urge to freedom and autonomy within themselves.

The fear and loathing of women behind this savagery is captured in a description of a meeting of the Sabbat: "To some peak of the Brocken or lonely Cevennes they haste, to the orgies of the Sabbat, the infernal Sacraments, the dance of Acheron, the sweet and fearful fantasy of evil. Hell seems to vomit its foulest dregs upon the shrinking earth; a loathsome shape of obscene horror squats huge and monstrous upon the ebon throne; the stifling air reeks with filth and blasphemy; faster and faster whirles the witches' led lavolta; shriller and shriller the cornemuse screams; " (Summers 1994:2)

The Rev. Montague Summers expresses his own loathing of women in the following terms "I have endeavoured to show the witch as she really was - an evil liver; a social pest and parasite; the devotee of a loathly and obscene creed; an adept at poisoning, blackmail, and other creeping crimes; a member of a powerful secret organization inimical to Church and State; a blasphemer in word and deed; swaying the villagers by terror and superstition; a charlatan and a quack sometimes; a bawd; an abortionist; the dark counsellor of lewd court ladies and adulterous gallants; a minister to vice and inconceivable corruption; battening upon the filth and foulest passions of the age." (Summers 1994:xvi)

This is current language, and it manifests itself in our time in the thinking of the fundamentalist churches and particularly in the titanic struggle over abortion.

Accusations against witches

There were three core accusations against women which structured the witch burnings. They centred on:

- women were sexual beings

- women were organised

- women had magical powers to affect health

According to the handbook on witch hunting, Malleus Maleficarum - or the Hammer of Witches - written by two priests, Kramer and Sprenger "All witchcraft comes from carnal lust, which in women is insatiable".

Witches were empirical at a time when the Catholic church was mystical, empiricism challenged the very notion of God. The church was also anti-sensual, sensuality being the work of the devil, and witches drew on empirical senses eg smell, taste, feel.

At the political level witch covens were peasant based organisations with a direct line to the god force unmediated by the church, and in direct connection with the people through their healing skills. They represented a political, religious and sexual threat to the Protestant and Catholic churches alike, as well as to the state.

At the level of the soul the torture and elimination of the witches was carried out systematically with the intent to break down and destroy strong women; in Mary Daly's terms," to dis-member and kill the Goddess, the divine spark of be-ing in women. The intent was to purify society of the existence and of the potential existence of such women" ( Daly 1978:183).

It was focused on women who had rejected marriage, (spinsters) or survived it (widows) what Mary Daly calls the ""indigestible" elements - women whose physical, intellectual, economic, moral and spiritual independence and activity profoundly threatened the male monopoly in every sphere." ( Daly 1978:184).

Women healers attacked

Women were particularly attacked as witches if they were healers. As an English witch burner put it at the time "It were a thousand times better for the land if all Witches, but especially the blessing Witches, might suffer death." (Ehrenreich & English 1973:29)

William Perkins, a Cambridge preacher, declared that the "good witch (was) a more horrible and detestable monster than the bad" so that "if death be due to any.. then a thousand deaths of right belong to the good witch" (quoted in Daly 1978:193)

It was the combination of spiritual and medical knowledge which made good witches so evil to the Christian.

The church saw its attack on peasant healers as an attack on magic, rather than on healing. The greater the power of the peasants to heal themselves - with Satanic power - the less their dependence on Church and State.

Doctors were strongly implicated in protecting their professional turf by complicity in the destruction of the witches. They were part of the trial process, and were explicitly empowered to identify whether a sickness was caused by witchcraft. According to Maleus Maleficarum "And if it is asked how it is possible to distinguish whether an illness is caused by witchcraft or by some natural physical defect, we answer that the first (way) is by means of the judgement of doctors". "If a woman dare to cure without having studied she is a witch and must die". (Ehrenreich & English 1973: 35)

As women were banned from study at the time, this made 'woman as healer' a dangerous occupation.

So when women work as healers today, they have instinctive knowledge of how dangerous that can be. And when women look critically at medicine as it has been constructed and is taught in our medical schools, they see there much which is damaging to women, because is it deeply stained by the persecution and torture of the witches, and the exclusion of women from the development of the scientific body of knowledge which underpins medical practice.

Women burned

The fear and loathing of the female which drove the witch burnings still lies under the surface of contemporary life, while the burnings themselves have continuing consequences. Many women are afraid to claim their full power for fear of being burnt, and an aspect of the female has ever since been contaminated by association with the masculine projection of the female as witch.

Indeed, women are still being attacked for witchcraft. A newspaper report in May of this 1996 outlined how Valerie Van Winkle, a spiritualist, has been accused of being a witch in Lincolnville, Maine. She has been thrown out of her job, subject to a campaign of vilification and accosted daily by fundamentalist Christians who accuse her of doing the Devil's work. (The Age:1996)

Women in rural South Africa are also being burned as witches as punishment for taking power when the men have to leave their communities in search of work.

Consequences for medicine

The burning of the witches also has consequences for medicine which are reflected in the structure of its teaching, in the content of the curriculum, and in the experience of women as health practitioners and patients.

After systematically destroying the women healers medicine was transferred from the fields into colleges, and women excluded from those colleges. It has taken until the 20th century for women to regain access to the study of medicine. The intervening 3-400 years saw an explosion of scientific knowledge about the human body which is the foundation of medicine as we know it. That foundation has been defined exclusively by men and that is important for men and women.

The collusion of the medical profession with the Inquisition was, according to Thomas Szasz," among other things, an early instance of the 'professional' repudiating the skills and interfering with the rights of the 'non-professional' to minister to the poor" (Szasz:1971)

We see this repudiation repeated today in the fierce struggle for access to safe abortion, and between obstetricians and midwives for control of birthing.

Abortion was criminalized in the United States as a response to the demand by the medical profession that they control the provision of health services, and in particular as an attack upon midwives. Midwifery itself as an independent profession was outlawed in America between 1910 and 1920 as the final chapter in the exclusion of women healers.

The construction of medicine

With the women finally out of the way, the fear and loathing of the feminine, and particularly the creative process, became an aspect of the relationship between women and medicine.

The "Father of Gynaecology" was Marion Sims, a nineteenth-century American surgeon who developed the Sims speculum still in use today. Honoured by malestream medicine, Sims reflected the values of his times, which were largely misogynist. He developed a valuable technique for vesicovaginal repair by experimenting on slave women, and other surgical techniques by experimenting on poor and indigent women in New York.

From 1845 to 1849 the "Father of Gynaecology" kept seven slave women in a backwoods 'hospital' where he operated on them, without anaesthesia, up to 30 times each. In his own words the operations were so painful that "none but a woman could have borne them." (Scully 1980:42)

In order to keep the women biddable, and to ameliorate the pain, he addicted them to opium.

Sims was part of a tradition which used surgery to keep women under control. In the late nineteenth century and even up until 1946, there was extensive use of ovariectomy for psychological disorder. Indications included epilepsy, nymphomania, hysteria and 'ovarian insanity'." (Scully 1980:49)

The tradition linking female sexual organs to our brains goes back to Hippocrates and was used to justify castration of women who got out of hand. An American doctor, Dr David Gilliam, writing in 1896, outlined the case for castration by declaring that as a result "the moral sense of the patient is elevated, that she becomes tractable, orderly, industrious, and cleanly... My own experience in this line has been most happy." (Scully 1980:51)

This "wholesale unsexing of women" was at times at the behest of husbands or fathers to enforce the submission of their women.

During this time clitoridectomy was also used to control women's sexuality, a custom which remains widespread in Africa and some areas of the Middle East.



Current use of surgery

The widespread use of hysterectomy, caesarean section and mastectomy today may be the natural successor to the overtly hostile and damaging surgery of the nineteenth century.

radical mastectomy

prophylactic mastectomy

breast implants

> 20% of post-menopausal women in Australia have had a hysterectomy

variation in rate of caesarean sections

However, there has been an international shift of energy and everywhere the feminine is rising, and women are coming back to reclaim their rightful place at the heart of healing.

Women critique the system

In Australia as elsewhere, there is a vigorous and theoretically well grounded women's health movement which continues to critique malestream medicine and push for change in the structures and values of the system in order to incorporate women's experience. Women's health in Australia grew out of the resurgence of the feminist movement in the 1970s and continues to draw its intellectual nourishment from feminism. (Wainer & Peck 1995)

Ehrenreich and English also note the connection between feminism and the women's health movement in the United States. They point out that "The peak of the Popular Health Movement (in America) coincided with the beginnings of an organised feminist movement, and the two were so closely linked that it is hard to tell where one began and the other left off. "( Ehrenreich & English 1973:43)

Mary Daly would agree, arguing that the express purpose of gynaecology is to suppress the possibility of the continued rise of feminism.

Women are also overcoming the centuries of banishment from formal study of medicine, and this will have profound consequences for the discipline in time.

There is another aspect of the development of medicine which continues to have profound consequences.

Medicine was developed to win the war

Marilyn Waring has articulated the perverse consequences of national economic accounts being developed "to win the war" (Waring 1988). Medicine was also developed to "win the war", and along with the exclusion of the feminine, this has had radical consequences for the way in which medicine is conceptualised and taught.

Putting back together soldiers torn apart by the savagery of war has been a major impetus for the development of medicine.

Florence Nightingale was tolerated in her drive to reform nursing because she was contributing to the Crimean War effort, as was Dorothea Dix in the American Civil War.

The first English-speaking woman doctor was Dr James Miranda Barry, the medical officer and inspector-general of the British Army hospitals between 1813 and 1865. In order to survive, like Joan of Arc she dressed, behaved and lived as a man. She disguised her gender, concealed her identity, and obscured her real self in order to obtain, in her own words, 'the privileges of manhood, the greatest of which was a doctor of medicine degree' (Hojat, Gonnella & Xu 1995:305)

The militarisation of medicine has resulted in many of the forms which seem so perverse today. The medical profession is totalitarian and controlling of its membership in a way no other profession tolerates.

Hierarchy and seniority dominate relationships. The training of young doctors includes hazing, intimidation and trials by fire. The ability to stay at your post for days and nights at a time without complaint is a core component of training. The language of medicine is militaristic. It is at war with disease, it fights battles to survive, it conducts campaigns and it is unable to conceptualise death as anything but defeat.

It is no wonder young women have a struggle to feel comfortable in this culture, especially because many of the men do not want them there, any more than they want women in the army.

A survey of graduating physicians carried out in America and reported in 1994 found that "At each stage, significantly more women than men reported experiencing negative discrimination or harassment.. with more women than men experiencing discrimination and harassment as training progressed.. The most common forms of discrimination reported were: differential treatment, sexist attitudes; derogatory, patronising or sexist comments and receiving less attention from doctors or nurses." (my italics) (Redman, Saltman, Straton, Young and Paul 1994:366)

Sixty eight percent of the women in the survey reported discrimination or harassment, which may lead them to move out of hospital-based medicine.

The authors point out that "these problems are exacerbated by the strong status hierarchy in medicine and the 'hidden' nature of much of the interaction between staff and students during clinical attachments." (Redman , Saltman , Straton , Young and Paul 1994:370)

Consequences of exclusion of women

The invisibility of women in the development of the body of knowledge we call medicine has been enforced by the burning of the witches, the exclusion of women from formal medical training until this century, and the military model on which it is based.

It has profound consequences.

One of these consequences is the assumption that the male body and experience is the norm, and the female is the other, is abherrent.

Within medicine there is a secret understanding that the normal body, in fact the normal person, is male, and a white, middle class male at that. This is not articulated, which makes it difficult to challenge, but is a hidden assumption behind the construction of the medical curriculum, the definition of illness, the setting of research priorities, and behind therapy.

In Dorothy Broom's terms there is a "deeply held cultural conviction that the normal, healthy body is the male body, and that the female body, even in its 'natural' state, is defective. The existence of the speciality of gynaecology (where there is no cognate speciality for males) is testimony to the symbolically problematic and morbid nature of the female body." (Broom 1991:128) "The permeability of female bodily boundaries is thought to conflict with the integrity of the body of the free individual which is actually the male body."

"An emphasis on separation rather than connection, on rationality rather than emotion, and on control rather than co-operation, all characterise contemporary Australian training for masculinity, and it is exactly these qualities which are implicated in the interventionist approach to medical care." (Broom 1991:128)

Medicine has been used to reinforce the notion of masculine as norm, and female as aberrant. The treatment of pregnancy as a disease and childbirth as a surgical event illustrates the pattern.

Broom points out that many attributes of illness are the same as those socially attributed to women, and contends that while medicine is male, illness is female. She suggests that "illness and femininity are constituted as aberrations or deviations: health is the norm from which illness is the deviation; masculine humanity is the norm from which femininity is the deviation. It has been suggested that the very concept of a 'healthy woman' is.. a contradiction in terms' (Broom 1991:130)

An article by the Council on Ethical Affairs of the AMA notes "Historically, societal perceptions regarding women's health status have often disadvantaged women. Throughout the mid-19th and well into the 20th century, women's perceived disposition toward both physical and mental illness was used as a rationale for keeping them from worldly spheres such as politics, science, medicine, and the law. For women, behaviour that violated expected gender-role norms was frequently attributed to various physical or mental illnesses and in turn often was treated in a variety of ways, including gynaecological surgeries, such as hysterectomies and, occasionally, clitoridectomies." (American Medical Association. 1991:561)

Australian gynaecologist Dr Judith Lumly has suggested that the use of surgery to whip out pelvic organs from women may be a response to castration anxiety. "If women are indeed fatally flawed by not having a penis, then taking away more parts of their bodies makes little difference to them." (Lumly: 6)

In Australia, women are taking part in a titanic struggle to be re integrated as decision makers in health care. Today, women comprise half the intake of medical students. More women are training as specialists, and women's health is slowly being integrated into the curriculum. There is a long way to go, but the changes are everywhere.

Women and women's experience must be incorporated into the values of the medical system to avoid the distortion of the overvaluing of some aspects of human experience, and the undervaluing of others.

Conclusion

There is an aspect of the masculine which is deeply fearful of and antagonistic toward women. The burning of the witches was an example of this. The collaboration of the medical profession at the time serves to keep women of today wary in their interactions with medicine.

Women owe it to themselves and their sisters to keep a keen eye on developments.

At the same time, the medicine which men have developed has done much to alleviate pain and suffering and enhance physical well-being. In Mali, one in seven women die from the consequences of pregnancy. In Australia that figure is one in 14,000. The women in Mali would gladly trade their medical system for ours.

Women and men experience their bodies and the medical system differently. That difference is now being acknowledged as the women's health movement challenges existing paradigms, and as women increasingly move into medicine.

Medicine as we know it today is a masculine construct, built on a military model. It is hierarchical, rational, scientific and technological. Medicine as women knew it was healing. It was an interaction between two whole people of equal value. Men and women will benefit from medicine which incorporates the best of both systems.

The art of medicine differs from the science of medicine. The art comes from the feminine listening to the feminine.

References

Age, The Melbourne, Australia, May 1996

American Medical Association (1991) Gender Disparities in Clinical Decision Making Council on Ethical and Judicial Affairs, July 24 Vol. 266 No.4

Australian Medical Association Victorian Branch News March 1996 p.33

Belenky M, Clinchy B, Goldberger N, Tarule J. Women's Ways of Knowing: The Development of Self, Voice and Mind Basic Books, Harper and Collins, New York 1997

Broom, Dorothy Damned If We Do: Contradictions in Women's Health Care Allen & Unwin, Sydney 1991

Campbell, Joseph Occidental Mythology : Masks of the Gods Penguin Books New York 1976

Daly, Mary Gyn/Ecology The Women's Press London 1978

Ehrenreich, Barbara and English, Deirdre Witches Midwives and Nurses: A History of Women Healers Writers and Readers Publishing Cooperative 1973

Hojat M., Gonnella J & Xu G. Gender Comparisons of Young Physicians' Perceptions of Their Medical Education, Professional Life, and Practice: A Follow-up Study of Jefferson Medical College Graduates Academic Medicine, vol. 70 No. 4 April 1995

Koutroulis, Gina The Orifice Revisited: Women in Gynaecological Texts Community Health Studies, Vol. XIV, Number 1, 1990

Lumly, Judith Gender and curriculum in medicine Monash University

Redman S, Saltman D, Straton J, Young B and Paul C. Determinants of career choice among women and men medical students and interns Medical Education 1994:28

Scully D (1980) Men Who Control Women's Health Houghton Mifflin Company Boston

Szasz, Thomas (1971) The Manufacture of Madness: a comparatiave study of the Inquisition and the mental health movement Routledge & Kegan Paul, London

Summers, Rev. Montague The History of Witchcraft Studio Editions Ltd, London 1994 (first published 1925)

Wainer, J & Peck, N. By Women for Women: Australia's National Women's Health Policy Reproductive Health Matters, London No.6 November 1995

Waring, M Counting for Nothing : What Men Value & What Women are Worth Allen & Unwen, New Zealand 1988



Jo Wainer is a medical sociologist and Senior Lecturer at Monash University Centre for Rural Health. She has a long-term interest in the intersection of the culture of women and the culture of medicine and has developed a curriculum unit for medical undergraduates covering issues for women in rural medical practice. Jo is a member of the Women in Surgery committee of the Royal Australasian College of Surgeons, and deputy chair of the Women in Rural Practice committee of the Australian College of Rural and Remote Medicine. She was a member of the Australian Delegation to the United Nations Commission on the Status of Women in 1996.


Paper presented at the 3rd Annual Qualitative Methods Conference: "Touch me I'm sick"
8 & 9 September 1997, University of South Africa Regional Office, Durban
critical methods society - www.criticalmethods.org - info@criticalmethods.org