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Clio Women, Gender, History
37 | 2013 When Medicine Meets Gender
Nicole Edelman and Florence Rochefort (dir.)
Electronic version URL: http://journals.openedition.org/cliowgh/276 DOI: 10.4000/cliowgh.276 ISSN: 2554-3822
Publisher Belin
Electronic reference Nicole Edelman and Florence Rochefort (dir.), Clio, 37 | 2013, « When Medicine Meets Gender » [Online], Online since 15 April 2014, connection on 25 September 2020. URL : http:// journals.openedition.org/cliowgh/276 ; DOI : https://doi.org/10.4000/cliowgh.276
This text was automatically generated on 25 September 2020.
Clio 1
How has medicine contributed to shape bodies, from Antiquity to the present day? Can it be said that illnesses such as cancer, have a gender? When English women were banished to mental asylums in the nineteenth century, how did they rebel? Are our ideas about hormones and the menopause gender-related? In this issue of Clio, we discover a new history of the practice and discourse of medicine. Comment la médecine a-t-elle contribué à fabriquer les corps de l’Antiquité à nos jours ? Comment les maladies, tel le cancer, ont-elles, elles-mêmes, un genre ? Comment les aliénées anglaises du XIXe se sont-elles rebellées ? Comment les conceptions des hormones ou de la ménopause sont-elles liées au genre ? À travers ce numéro de Clio, c’est une nouvelle histoire des pratiques et des discours médicaux que l’on découvre.
EDITOR'S NOTE
Editor for the English online edition: Siân Reynolds Clio’s book reviews [“Clio a lu”] are not translated into English. They are available in French on the website of Clio. Femmes, Genre, Histoire : https://journals.openedition.org/ clio
Clio, 37 | 2013 2
TABLE OF CONTENTS
To our readers
Editorial Nicole Edelman
Male and female bodies according to Ancient Greek physicians Jean-Baptiste Bonnard
Crazy brains and the weaker sex: the British case (1860-1900) Aude Fauvel
The gender of cancer Ilana Löwy
Sexing hormones and materializing gender in Brazil Emilia Sanabria
Andropause and menopause: sexuality by prescription Véronique Moulinié
Current Research
Medicine and sexuality, overview of a historiographical encounter: French research on the modern and contemporary periods Sylvie Chaperon and Nahema Hanafi
Writing the history of the relations between medicine, gender and the body in the twentieth century: a way forward? Delphine Gardey
Testimony
The anthropologist, the doctors and the transgender experience: an interview with Laurence Hérault Sylvie Steinberg and Laurence Hérault
Varia
The reconfiguration of gender relations in Syrian-American feminist discourse in the diasporic conditions of the late nineteenth century Dominique Cadinot
“As long as the absence shall last”: proxy agreements and women’s power in eighteenth- century Quebec City Catherine Ferland and Benoît Grenier
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To our readers Translation : Siân Reynolds
1 The same format, the same layout inside, but a new sub-title – Femmes, Genre, Histoire [Women, gender, history]. A modified cover, but one that preserves the visual identity of CLIO, Histoire, Femmes et Sociétés. Together, these features indicate both the continuity of our journal and its new direction.
2 CLIO HFS was launched in 1995, in a context marked both by the creation of similar journals in several European countries, and by the publication of the five volumes of Histoire des femmes en Occident (1991-1992) [History of Women in the West], providing an impetus to be followed up. The University of Toulouse-Le Mirail had been since the 1970s one of the few centres of women’s studies in France. Its University Press (PUM) took on the journal, and handled it efficiently and sympathetically for the18 years (36 issues) during which we worked together, gradually positioning the journal in the French and international intellectual context.
3 The term genre (gender) was not originally included in our subtitle, for fear that in France it would not be readily understood. When the editorial board later raised the question of introducing it, our publishers found it difficult to agree, largely because of the problems it would generate for title indexes. With issue No 37 we have taken this step: but for the editorial team, today as in the past, women’s history, gender history, and the histories of masculinity and sexuality remain complementary and inter-related fields of study.
4 In the years since 2000, the fields of women’s/gender history, previously marginalized in France, have acquired intellectual and institutional legitimacy. In this changed environment, CLIO HFS recently received twofold recognition of its standing from the CNRS (Centre national de la recherche scientifique). First, the journal has been granted a full-time post of editorial secretary, as from 1 January 2013. Cécile Thiébault, who was already sharing her expertise with us, has been appointed to this position. Since the editorial secretariat now has an institutional base in Paris,1 it became desirable, for logistical reasons, to move to a Parisian publisher. From now on, CLIO Femmes, Genre, Histoire will be handled by the publishing house of Belin. Several members of the editorial committee have already worked with this publisher on a previous venture: the textbook for schools and universities edited by the Mnémosyne collective: La Place des
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femmes dans l’histoire: une histoire mixte [The Place of Women in History: a mixed history] (2010).
5 Secondly, the journal has been granted the financing to become a bilingual publication, with versions in French and English. In view of this major change, five new members have joined the enlarged editorial board: a sociologist, a political scientist and three historians, including one British-based and one American-based colleague. The French version will continue to be issued twice a year in a paper edition – we remain attached to this identity and format – and in digital form on the website revues.org to which we have been linked since early in its existence. The English version of which Clio 37 is the first to be translated will be digital only, and will be published on English-language portals on the internet, with the aim of moving quickly towards self-financing. It will make Clio. Femmes, Genre, Histoire better known internationally, including in countries where English is accessible but not the main language. At the same time this will bring us new contributors.
6 Publishing our journal in two languages is exciting, but it is also a challenge. CLIO has always aimed, in its thematic issues, to tackle all historical periods and a range of geographical territories, as well as to be open to early-career researchers. Since the journal’s beginnings, we have also set out to make known research from abroad, by translating articles from different historiographical traditions and other methodological or theoretical approaches. In this spirit, the workshop held to celebrate our first 15 years was dedicated to global history, as one way of indicating this. At different stages in its development, such intellectual interchange has considerably enriched women’s/ gender history, through mutual borrowings, transpositions and adaptations, while maintaining critical awareness and not avoiding controversy. With the translation of our articles into English, we expect to be able to take an even greater part in the debates ranging across national and disciplinary frontiers, and in the many interactions that go to make up scholarly dialogue. We hope thereby to increase further the intellectual interest arising from our field of research – one which is deeply engaged in key issues in society. To our new readers : welcome ! The editorial board
NOTES
1. In the Groupement d’Intérêt Scientifique: Institut du Genre, created in 2012 by the Institut des Sciences Humaines et Sociales of the CNRS.
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Editorial
Nicole Edelman Translation : Siân Reynolds
1 This issue of Clio aims to look at the history of medicine through the lens of gender, covering several geographical areas and several periods, from Antiquity to the present. The 1970s saw the emergence in France both of the history of medicine1 and of women’s history, which has never neglected medical topics, either in the early days,2 or in the context of the new social history of medicine which developed in the 1990s.3 Initially, historians both of women and of medicine focused on the persistent identification of women’s bodies as “natural”, and on the ways in which medical publications considered them to be inferior in status; other early fields of interest were sexuality,4 and the history of women as carers. And while in France gender history was for some time overshadowed by women’s history, the approach through gender has now been opened up for some decades: works on gender and medicine have become numerous.5 They are often associated with anthropological and sociological research, and are prepared to rub shoulders with philosophy, as the articles collected here suggest. They concentrate in particular on Antiquity and the nineteenth and twentieth centuries (regretfully, it was not possible to cover Clio’s usual broader chronological range.)
The rich seam of gender studies
2 The articles by historians and anthropologists in this issue raise questions about medical knowledge and practice, revealing how, and to what extent, they have participated (or not) in creating biological, ethical and political norms that validated hierarchies between the sexes, since the days of Antiquity. The contributors pinpoint certain trends and complex developments in scientific knowledge, associated with medical and technological discoveries, many of them dating from the early years of the twentieth century. They offer surveys of the field from a methodological and historiographical point of view; they demonstrate how visions of the body and sexual identity have changed; and they also underline the fact that medical science is not neutral, all the less so since its object of study is the human being, and the scientist-
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physician has therefore been both the subject and the object of his/her own research. Some historians and sociologists have, to be sure, been pointing out for years that doctors, whether male and female, shaped by the modes of thought of their times and sensitive to contemporary demands, may differ on many issues, participating, at whatever their degree of power, in the construction of interpretative systems and representations likely to be subjects of controversy and debate.6 Gender is therefore a very rich seam of thought with which to study, analyse, and question medical practice and knowledge, doctors and their patients, since gender is a way of thinking of the world, and a concept whose introduction has enabled us to bring to historical research conceptual tools aiming to strip the veil from the social construction of sex differences, and thus to grasp the political dimension of domination as between men and women.7
Interdisciplinarity: a necessity
3 Historians of medicine, of both sexes, have combined this conceptual approach with the epistemological contribution of other disciplines. In France, philosophy has played an important role, since Georges Canguilhem shifted the history of science in France away from the pure terrain of mathematics, physics and astronomy where Gaston Bachelard had located it, and towards medicine and biology: he advanced the proposition that there was a discontinuity between different forms of rationality, rather than a single concept of reason as an invariant anthropological entity. Michel Foucault reappropriated this legacy, and he too abandoned the idea of history of science as a history of truth, developing the idea of discourses purporting to tell the truth; in his Histoire de la folie à l’âge classique (1961) [English trans. Madness and Civilization, 1965] Foucault provided a template for the analysis of such discontinuities, by studying the case of insanity. He highlighted the network of connections between the sequestration of the insane and political power, while also drawing attention to the social and economic conditions on which it was based. In a study that remains important for historians of psychiatry, Foucault argued that the alienists of the nineteenth century did not usher in an age of progress by comparison with the practices of the ancien régime: on the contrary, they prolonged, under cover of a medical approach, the process of exclusion first begun in 1656 when royal authorities began locking the insane away. This thesis was forcefully challenged in 1977 by the psychiatrist Gladys Swain in Le Sujet de la folie, naissance de la psychiatrie, and further in her Dialogues avec l’insensé (1994), co- authored with the philosopher Marcel Gauchet. Both of these writers considered, unlike Foucault, that the founder of the discipline of psychiatry in France, Philippe Pinel, had genuinely sought to find the conditions in which a dialogue with insanity would be possible, believing that there was always a human core within the insane individual. And if Pinel’s disciples did indeed lock up the mentally ill by creating asylums after 1838, it was primarily in order to treat them and to prepare them for re- entering society.
4 This debate underlined the participation of doctors in political power in the eighteenth and nineteenth centuries, a phenomenon which Foucault continued to analyse in what he called “bio-power”, showing how closely politics adhered to the behavioural norms dictated by doctors, and the demographic control they allowed. We might recall that obstetrics was the first specialism of choice for French doctors, slightly ahead of psychiatry. Foucault developed this line of thought in his lectures at the Collège de
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France,8 where in 1970 he inaugurated a course on sexuality, a course of which gender specialists have noted both the great richness and the near-total absence of a gendered dimension.9 This domain was revisited by the American philosopher Judith Butler, who went to the heart of the problematics of “gender trouble”. For historians of medicine and gender, two of her books have been particularly influential: Gender Trouble and Bodies that Matter,10 which question the idea of binary sex difference and the materiality of the body. Returning to Foucault’s analysis of the role of discourse in the production and destabilization of subjects, Butler insisted further on its importance, by referring to discourse as a performative act – defined as a speech act which brings into being the thing it names. That is the moment when discourse becomes productive in a particular manner. “I have therefore tried,” she wrote, “to think of performativity as the dimension of discourse which has the ability to produce what it names.”11 While certain philosophers have therefore have helped us not only to re-think the history of medicine, but also to go back to primary sources, one should also mention a number of other French writers: anthropologists, such as Maurice Godelier, Françoise Héritier and Nicole-Claude Mathieu,12 the biologist Anne Fausto-Sterling whose recently translated book is reviewed in this issue, and the neurobiologist, Catherine Vidal.13 These scientists have raised dissonant voices in the medical world, where the dominant discourse continues to divide human beings very distinctly into two sexes.
Constructing difference in bodies and identities
5 Following on from the expression of these ideas, our approach to history allows us to shed light on the way medical knowledge has configured the contours of what constitutes the normal or the healthy, approving or rejecting the nature of individual human beings, imposing on them an identity at once political, biological and official. It makes it particularly clear how everywhere, and in every period, there has been a hierarchy between men and women, male and female, masculine and feminine, a hierarchy formulated by way of arguments that have evolved over time, from Antiquity to the present, interacting with the demands or the taboos of the political, economic and social authorities. Ancient Greek medicine thought of male and female bodies as profoundly different. As Jean-Baptiste Bonnard explains in his article: This difference is both a given from the beginning (in utero) and an ongoing, never- finished process. […] In this context, male and female bodies are clearly contrasted according to criteria that carry connotations; in particular, the woman’s body is more moist than the man’s. But this difference in moisture is presented as an excess in relation to the norm of the happy medium, […] In fact, the abnormal female body is almost always thought of by comparison to a normative male body.14
6 Thus the female body is always perceived as more or less wanting by comparison with the male, and women as being imperfect men. The important contributions by Thomas Laqueur to this debate, as well as criticisms of his work, have often been referred to in past issues of Clio.15
7 In the first decades of the nineteenth century, medical discourse was concerned to re- define a hierarchy between men and women in the context of the clinical revolution and the new discoveries in physiology, anatomy and pathology. It tended for instance to represent sex as the essential basis for a specific pathology, in a marked dimorphism. “Women’s diseases”, linked exclusively to the genital organs and their functions, were given special prominence, although this idea was not immutable, since the term
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disappeared from French medical dictionaries after 1877. The gap was filled by the emergence of other illnesses, not specifically female, but considered predominantly so, such as nervous diseases, including hysteria and cancer. In her article below,16 Ilana Löwy shows that cancer was seen as almost exclusively a female disease in the nineteenth century, and that this notion persisted well into the twentieth century. As for insanity, in the nineteenth century it veered between being considered a male or female malady: sometimes it was viewed as affecting women more than men, at other times the opposite.17 But psychiatry was one of the disciplines which formulated the most sexist norms, and remains so today, along with neurological science. Aude Fauvel18 provides evidence in support of this, by recalling the extent to which psychiatrists not only encouraged a discourse about the inferiority of the so-called weaker sex, but also contributed in very practical terms to the exclusion of women from society, by agreeing to institutionalize those who refused to conform to masculine norms. Taking the British example as her subject, she argues however that this history can be viewed differently, by reflecting on the repercussions this sexist position had on the presentation of medical knowledge, and inversely on representations by and of women patients themselves.
8 The birth of psychology as a discipline in the 1880s, largely as a result of knowledge developed in psychiatry and neurology, did not modify these views, and while the emergence of psychoanalysis a decade later no doubt profoundly altered the criteria for differentiation, it by no means resolved problems relating to differentiation and to the hierarchy between men and women. Psychoanalysis laid particular emphasis on sexuality and this theme was the subject of issue no 32 of Clio: “Érotiques”.19 The article below by Sylvie Chaperon and Nahema Hanafi returns to the question, by reviewing the circumstances in which a history of sexuality in the 1970s was developed in France, using medical sources. This historiography lays stress on the pioneers, male and female, of this history in the modern and contemporary period, and the sources on which they drew. From another angle, Delphine Gardey also considers the relation between the body, gender and medicine in the twentieth century. Her focus is the field of social and cultural studies of science.20 She analyses the way in which recent research can suggest a new reading of the history of very contemporary bio-medical advances, stressing the importance of the scientific, economic and social contexts in which they have been produced, as social and gender issues are updated.
Body, gender and medical discoveries
9 While medical knowledge is intimately linked to social, cultural and political power, and while an approach through gender makes it possible to reveal these articulations, medical discoveries are themselves part of the context: they never spring from nowhere. But they may quite suddenly modify the view or idea of the body, whether held by doctors or patients. For example, the discovery of ovulation in the late 1820s made it possible to posit as separate entities – egg versus spermatozoon – the male and female organs of reproduction. By contrast, the discovery of the glycogenic function of the liver in 1857 made it clear that the physiology of this organ was identical in man and woman. The historian’s task can then be to analyse the transformations of medical knowledge and the way in which reconstructions of inequality are re-thought (because they always are reformulated). In the twentieth century, the disciplines of biology,21
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histology and embryology were greatly advanced and the spectrum of our knowledge of the body became more complex and detailed. In the 1950s, the discovery of hormones22 revealed a possible distinction between biological sex and gender, and made it possible no longer to consider the existence of a mismatch between body and sexual identity as pathological. The historical and anthropological study of the emergence of these discoveries, their reception and their social and scientific consequences is therefore greatly enriched when it uses the focus of gender.23 Analysis of the reception, use, effects and representations of hormones is particularly interesting. Research carried out by Emilia Sanabria in Bahia in Brazil has shown the complexity of the understanding there about what hormones are: the term used in Bahia is the singular hormônio, a term which does not entirely coincide with the French or English “hormone”, since it suggests a homogenous fluid quality, making hormones hybrid objects on the borderline between sex and gender. This hormônio, produced by pharmaceutical synthesis, is conceived of as a substance which can circulate between bodies, revealing a relative flexibility between sex and gender. In a different context, that of menopause and andropause, Veronique Moulinié’s article underlines how these terms, the former being invented in the late nineteenth century and the latter in the late twentieth century, have had the effect of increasing the medical supervision of ageing male and female bodies and more particularly on sexuality in later life. She shows, nevertheless, that this medical control has only been able to succeed because of very active support from women and the inability of men to resist it.
10 The same could be said of other forms of new technology which may inflect how we see sexual difference: in the nineteenth century, photography in some ways reconfigured certain norms of the masculine and the feminine. The photographs of hysterical subjects from the 1870s to the 1890s for example, reinforced the dichotomy between male and female patients.24 In the 1980s, ultrasound scans led to the possibility of identifying the sex of a fœtus, something which had been impossible earlier, but which led to fœticidal practices in some countries.25 The various screening processes which have made it possible to visualize cancers of the internal organs also brought to an end the identification of this illness as particularly affecting women.26
11 The historian or anthropologist who approaches the medical sphere with an awareness of gender thus draws on many threads which criss-cross each other and bring to light hitherto unthought-of human profiles, bodies and identities. The result of this process of investigation and publication reaches beyond the medical into the social, cultural, economic and political spheres.
12 This number of Clio therefore reminds us that since Antiquity, the relations between science and power, medicine and human beings, have forever been changing, but that there have always been doctors ready to proclaim the inequality of the sexes and to define a hierarchy in which men are dominant. By invoking natural – and therefore immutable – causes, these doctors have played a part in validating social, economic, cultural and political inequalities, since “these inequalities were not only explained but justified, and the scientific approach became an ideological one”. And yet, for several decades now, more and more discordant voices have been heard, coming from different disciplinary horizons, to challenge this ideology both subtly and radically. By questioning and analysing new ways of envisaging the body, the historians and anthropologists of gender contributing to this issue expose the instability of the old frontiers which still too often divide humanity into two unequal halves.
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NOTES
1. Léonard 1978. 2. Kniebiehler 1976a, 1976b and 1983; Kniebiehler & Fouquet 1983; Gélis 1988; Thébaud 1986; Leroux-Hugon 1992; Faure 1995. 3. Carol 1995; Faure 1994; Vigarello 1993; Porter 1996; Porter & Teich 1994. 4. See the article by Sylvie Chaperon and Nahéma Hanafi in this issue. 5. Chaperon 2007; Dorlin 2006; Edelman 2003; Edelman, Montiel & Peter 2009; Gardey & Löwy 2000; Pomata 1994 and 1998; Oppenheim 1991. 6. Pestre 1995; Velle 1998. 7. Riot-Sarcey 2012: 14; see also Varikas 2006. 8. Foucault 1999 and 2003. 9. Foucault 1976. 10. Butler 1990 [2005a], 1993 [2009]. 11. Butler 2005b: 17-18. 12. Godelier 2005a; Héritier 1996 and 2002; Mathieu 1991. 13. Fausto-Sterling 2000 [2012]; Vidal & Benoît Browaeys 2005. 14. From Jean-Baptiste Bonnard’s article in this issue. 15. For the opposition between the idea of a unisex body and then of two sexes, see Laqueur 1990, and for critical readings of Laqueur: Jaulin 2001; Harvey 2010; Steinberg 2001a, 2001b, 2008. 16. See the article by Ilana Löwy below. 17. Coffin 2000. 18. See Aude Fauvel’s article below.
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19. See chapter 7 in Sylvie Steinberg’s book La Confusion des sexes, in which she examines representations of the body between the sixteenth and eighteenth centuries in medicine and its auxiliary study, physiognomy, Steinberg 2001a. 20. Social Studies of Knowledge, feminist critiques and Cultural Studies. 21. Fausto-Sterling [2000] 2012. 22. Stoller 1968; Oakley 1972. 23. See the articles by Véronique Moulinié and Emilia Sanabria in this issue. 24. Edelman 2003. 25. See Delphine Gardey’s article in this issue. 26. See Ilana Löwy’s article in this issue.
AUTHORS
NICOLE EDELMAN Nicole Edelman is honorary fellow in contemporary history at the University of Paris Ouest- Nanterre La Défense. Her research has been into movements marginalized by political, scientific and religious authorities, sometimes described as esoterism or the paranormal: somnambulism, hypnosis, trances, etc. Her publications include: Voyantes, guérisseuses, visionnaires en France, 1785-1914 (1995); Les Métamorphoses de l’hystérique (2003 e-book); Histoire de la voyance et du paranormal: XVIIIe s. à nos jours (2006); Histoire de la maladie et du somnambulisme de Lady Lincoln (with L. Montiel et J.-P. Peter, 2009). [email protected]
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Male and female bodies according to Ancient Greek physicians
Jean-Baptiste Bonnard Translation : Lillian E. Doherty and Violaine Sebillotte Cuchet
1 If health and sickness belong to a universally shared experience, the ways in which they are lived, and a fortiori the ways of treating the questions they pose – to the individual as well as to the society – vary from age to age and from place to place. It is one of the distinctive features of Greek thought to have given, before any other western tradition, a rationalistic response to these questions. It was in the Greek world, in fact, that at the end of the archaic age, medicine was established as a technē, a term that can be translated simultaneously as “art” and “science.”1 This evolution took place principally in Ionia and is inseparable from a broad intellectual movement that affected many areas of knowledge. It was in this region that in the space of two or three generations there flourished most of the thinkers whom nineteenth-century historiography classified as “Presocratic philosophers,” although strictly speaking not all were chronologically prior to Socrates, and although in many ways they can rather be considered “learned men” or “scholars,” savants. As the ancient term for them, physiologoi (or physikoi), indicates, they produced a logos, i.e. a rationalistic discourse, on nature (phusis) in general. Geoffrey Lloyd has shown that the emergence of this rationalistic discourse was inseparable from the rapid development and professionalization of the practice of rhetoric; this phenomenon in turn, according to the hypothesis of Jean-Pierre Vernant, was related to a major political development, the emergence of the polis.2 The proximity of some of these Greeks of Asia Minor to eastern cultures (Babylonian and Egyptian in particular) must also have played a decisive role. These thinkers’ vast field of study – nature as a whole, as the title often given to their works, On Nature, indicates – led them to take an interest in areas as far apart, to our way of thinking, as astronomy, physics, biology, or mathematics, all interrelated because they belong to a common current of philosophic thought. At the beginning of the classical era, the production of this rationalistic thought underwent a form of specialization. Just as the field of history became autonomous with the work of Hecataeus of Miletus and most importantly Herodotus of Halicarnassus, that of
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medicine was formed and associated with the name of Hippocrates of Cos (ca 460-370). There is no reason to doubt the historical existence of this physician and author, born into a family of Asclepiadai (i.e., a lineage claiming descent from the god Asclepius, associated with medicine) in which medical knowledge was transmitted. But this is by no means to say that he was the author of all the works handed down under his name. The sixty-odd works in Ionic dialect that form the Hippocratic corpus were in fact written between the second half of the fifth century BCE and the Roman era, and with the exception of two that are in some sense “signed,” the authors of these works are unknown to us. So it is for the sake of convenience and by convention that we speak of the Hippocratic corpus or collection. This series of treatises, which is far from comprising the majority of Greek medical literature, is important not only for its novelty but for its foundational character. It contributes greatly to the construction of a professional identity for the physician (especially the treatise entitled On the Physician). In particular, it provided the framework for western medical thought until the eighteenth century. Finally, it is of considerable interest for the historian of gender. Medical discourse speaks primarily of an object that has a sex, the body, but although it takes a rationalistic form, Greek medical discourse is nonetheless an ideological construction, like all scientific (or in this case, prescientific) discourse, as has been shown by, e.g., Delphine Gardey and Ilana Löwy.3 I propose an account of the way in which Greek biological and medical texts contributed to the fashioning of the categories of male/masculine and female/feminine by constructing a male body and a female body. While based on the Hippocratic corpus, this study aims to consider the majority of Greek biological and medical writings. Thus Aristotle, for example (himself the son of a physician), whose curiosity extended to nearly all fields of knowledge and who applied to all disciplines the rigor of his logical analyses, was greatly occupied with biology, to the point that his biological treatises constitute nearly a third of the surviving Corpus Aristotelicum, and some have seen him as a founder of the science of biology.4 Among the Greek physicians whose writings have come down to us in part, we will also consider Herophilus and Erasistratus, who lived in Alexandria at the beginning of the Hellenistic era, as well as Soranus of Ephesus (early second century CE) and Galen of Pergamon (129-216). Even thus delimited, the corpus is extensive, and the approach of gender studies has been applied to it for about thirty years, notably in the English- speaking world. This has resulted in an already sizeable bibliography, of which I propose to give a synthetic and dynamic overview. Ancient Greek biology5 and medicine as a whole conceive of male and female bodies as profoundly different. This difference is both a given from the beginning (in utero) and an ongoing, never-finished process.
Construction of the female and male in embryogenesis and the development of the fetus
2 The physiologoi of the late archaic and early classical periods took an interest in biology or medicine and some of them (Empedocles, Pythagoras, Alcmaeon and Philolaus of Croton, Archelaus, Democritus of Abdera, Hippo of Samos and perhaps Diogenes of Apollonia) can be considered physicians or were accepted as such. They were especially preoccupied with the question of generation, reflecting on the origin of “seed,” on whether or not a maternal “seed” existed, on the formation of the embryo (and more
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specifically on the determination of its sex), and on heredity. Since their books have not come down to us, it is difficult to reconstruct their thought. It is only by means of multiple intermediaries, and in particular thanks to Aristotle’s critiques of them, that we can arrive at an understanding – very partial and decontextualized – of their doctrines. It seems that the theories of these thinkers have in common that they place the male and female principles in opposition to each other, coupling them with attributes such as heat and cold (Empedocles), fast and slow, strong and weak, right and left (Parmenides), which are given positive or negative connotations.6 Moreover, the theories seem clearly to imply that the most desirable situation is the production and then the birth of a boy who resembles his father.7
3 In contrast to most of their Presocratic predecessors, the Hippocratic physicians admitted the existence of a maternal seed that participated in the process of generation. Several Hippocratic treatises are concerned with embryogenesis and the development of the fetus, notably The Seven-Month Fetus and The Eight-Month Fetus, two short works published separately in the ancient editions but forming in reality a single treatise devoted to embryology, and dating from the end of the fifth century BCE or the beginning of the fourth.8 The most complete work in this area is On the Nature of the Child, a continuation of On Generation (a single treatise of the late fifth/early fourth century which was artificially split in the manuscript tradition). This treatise contains the affirmation that male fetuses, which are stronger, are more rapidly formed than female fetuses: “Here is the child already formed: the girl reaches this point in forty- eight days, the boy in thirty days at most.”9 According to the same logic, male fetuses quicken sooner: When the extremities of the child’s body have branched out externally and the nails and the hair are rooted, it begins to move; this happens for the boy at three months and for the girl at four. (Nature of the Child 20.1)
4 The explanation for this chronological differentiation in embryogenesis is to be sought in the set of correlations already observed in the Presocratics: The boy moves sooner because he is stronger than the girl, just as he coagulates sooner, because the male originates in a stronger and thicker seed than the female.
5 We should not therefore be surprised to see that the sex of the embryo she carries is described as having important repercussions for the future mother. As another contemporary treatise says (Diseases of Women 216 = Sterile Women 4): The women who while pregnant have spots on their faces are carrying a girl, while those who have a good complexion are most often carrying a boy; when the nipples are turned upward, it is a boy; when turned downward, a girl.
6 This downward orientation of the nipples must have negative connotations, since elsewhere a Hippocratic aphorism makes it a sign of spontaneous abortion in a woman carrying twins.10 In general, “a pregnant woman has a good color if she is carrying a boy, bad if she is carrying a girl” (Aphorisms 5.42). The Aphorisms, one of the most famous treatises in the collection (the most often read and commented on, and one which served as a handbook for western physicians until the eighteenth century) is a compilation no older than the fourth century. It is traditionally divided into seven sections, the fifth of which includes several aphorisms on women.
7 Aristotle took a great interest in generation. His general conception of “seed” and of the process of generation is in keeping with three other aspects of his thought: the Aristotelian theory of the four causes (the mother being only the material cause of
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generation while the father is both its formal and efficient cause); a general economy of interchangeable body fluids; and the prescientific assumption which Bachelard called the myth of the concentration of substance. The woman produces a seed that only serves as food for the embryo. The fashioning of the embryo is a form of coction that in a famous metaphor Aristotle compares to the curdling of milk.11 Aristotle’s theories on heredity are quite complex and rather confused.12 For the Stagirite, it is not only common but in a way desirable that the child resemble its parents, insofar as that belongs to the natural order of things: the birth of children who do not resemble their parents in their individuality may not come under the heading of teratology (the study of abnormality), but it constitutes a departure from the essence. It is very revealing, moreover, that in the context of his exposition of this general rule on the frequency of resemblances, and more precisely when he has just been speaking of teratological departures from nature, Aristotle arrives at the affirmation that “the first departure [from nature] is the birth of a female instead of a male.”13
8 We have little information about what the Alexandrian physicians knew about theories of generation. We have only indirect and fragmentary information about Herophilus of Alexandria (ca 325 – ca 255), who studied medicine, probably in Cos, and taught at Alexandria, the cultural and scientific capital of the Greek world of his day. Thanks to the work of Heinrich von Staden, we nonetheless have an idea of his opinion on the present topic.14 In regard to male seed, we know more about his understanding of its circulation in the male genital organs than about his view of spermatogenesis. At the most we recognize that like Aristotle, Herophilus thought that sperm came from blood. Doubtless, Herophilus had more to say about female seed in his Obstetrics, but this work is almost entirely lost.
9 The Greek physicians of the second century of our era are particularly important because they have had an enduring influence. Soranus of Ephesus, who can be considered the genius of ancient gynecology, examined the formation and development of the embryo in a lost work entitled On Generation and in the first book of his Diseases of Women. In addition to his personal experience, he relies on a magisterial knowledge of the medical literature and levels serious criticisms at some of his predecessors. A propos of the Hippocratic assertions about the external signs by which it was thought possible to recognize the sex of a pregnant woman’s child, Soranos described these as opinions “based on belief rather than truth” (Diseases of Women 1.15) and noted that they were belied by common experience.15 He nevertheless believed that the principle of generation resided in the male. In his view, only the sperm is active. Its mobility permits it to enter the uterus, where it is retained and can coagulate to form an embryo. To be sure, the woman emits a kind of seed,16 but this is useless for generation and as a result is evacuated by means of the bladder: The seminal duct, which begins in the uterus, passes through each ovary and after following the flanks of the organ as far as the bladder, empties into the neck of the latter. Observations indicate that the female seed does not seem to be collected for the purpose of conception, since it is discharged externally; I have taken a position on these facts in my treatise On Seed (Diseases of Women 1.4.93-98).
10 Finally, Galen of Pergamon devoted to embryology several of the hundreds of treatises he wrote in the course of his long career: De semine, De uteri dissectione, De foetuum formatione, De septimestri partu. In spite of his reverence for Aristotle, he has the idea that the woman produces a seed useful for generation; but it is nonetheless inferior to the male sperm, notably in terms of agility and heat. For him too, the creative principle
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resides in the male sperm, and when Galen reflects on the determination of the embryo’s sex, he adopts an explanation based on the criterion of sides: if the seed falls into the right side of the uterus it will give birth to a boy, but on the left a girl. In this criterion we see once more the prejudices we noted in the Presocratics, whose positive and negative connotations have long been shown by anthropologists.17 The construction of female/ feminine and male/masculine by the Ancient Greek physicians thus begins with the fetal stage. It continues for the rest of the life course.
A medicine based on physiology: the economy of bodily fluids and the production of female and male
11 One of the peculiarities of Hippocratic medicine is the importance it gives to physiology at the expense of anatomy; the latter can thus look like a still-embryonic branch of Greek medicine, of which the Hippocratic corpus gives no systematic description.18 Instead, the corpus puts forward an explanatory system of physiology based on a general economy of bodily fluids, one of whose best-known aspects is the theory of the humors (anticipated as early as the work of the sixth-century physician Alcmeon of Croton, a Pythagorean). The Hippocratic theory of the humors is not itself unified; important differences are to be found among the treatises, and in particular on the question of the number and qualities of the humors.19 In this system, internal medicine considers the different organs as so many containers, which is why Robert Joly described this medicine as “a physics of the container.”20
12 In this context, the male and female bodies are clearly contrasted according to criteria that carry connotations; in particular, the woman’s body is more moist than the man’s. 21 But this difference in moisture is presented as an excess in relation to the norm of the happy medium, the mesotēs, which is the privilege of the male body.22 In fact, the abnormal female body is almost always thought of by comparison to a normative male body, as the analogies used by the Hippocratic physicians show; for example, “If the uteri fall completely outside the genitals, the ensemble hangs like a scrotum.”23 It should be added that Geoffrey Lloyd has demonstrated the importance of analogical reasoning in the whole of Greek thought, not only in medical thought.24 The variation in the amount of moisture, which is found even in the texture of the flesh – that of women being thought of as spongier than that of men25 – is linked to the quantity of blood in their bodies, which is represented (incorrectly, since the opposite is true) as more abundant in the woman than in the man from puberty onwards.26 The menses, whose exact composition was not understood, were thought necessary to evacuate the excess moisture. Much attention was paid to the menses.27 Their absence, outside of pregnancy, was considered morbid, very worrisome, and often a forewarning of hemorrhages.28 The alternative menses/hemorrhage can be seen especially in the Prorrhetikon, a collection of clinical aphorisms attributable to an itinerant physician who probably lived in the mid-fourth century: “Tremors in the head and ringing in the ears produce a hemorrhage or precipitate menstruation.”29 In the least pernicious cases, amenorrhea is thought to produce epistaxis (nosebleed): according to the Aphorisms, “In a woman who does not menstruate, it is good for the blood to flow out through the nostrils.”30 The absence of menses may signal a stasis of the blood in another container-organ, with harmful consequences. Thus “in women, a congestion of blood in the breasts is a sign of impending madness.”31 Conversely, the return of
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menses is a sign of healing and one of the physician’s objectives. But their presence in ‘bad’ amounts or appearance, as in the case of displacement of the uterus or of its orifice, is also considered very negative: “If the uteri move toward the hip, the menses stop,” and “If the orifice of the uteri withdraws, the menses do not come, and if they come, they are sparse and bad,” according to the treatise On the Nature of the Woman.32 In this context of the physiology of containers and humors, the woman’s body is distinguished by its remarkable faculty of intercommunication between organs: from the mouth to the vagina by way of the uterus, liquids – but also vapors or fumes – can and should circulate freely.33 The male body does not have these problems of excessive moisture and as a result is protected against certain diseases, except in the case of men whose constitution does not conform to the perfect type of their gender, as two aphorisms indicate: “If the winter is dry and boreal and the spring rainy and austral, there will necessarily follow in summer acute fevers, ophthalmia, and dysentery, especially in women, and among men in those whose constitution is moist;” “but if the autumn is boreal and without rain, it is good for men of moist constitution and for women.”34 Thus while the female body is by nature subject to diseases because of its excessive moisture, the male body, as long as it is sufficiently masculine, is healthy and has no need to eliminate regularly any excess moisture. This is because it is less spongy and hotter.
13 Heat is another of the many polarities that structure this conception of female and male bodies. The greater heat of the male body is attributed, by altogether circular reasoning, to the fact that it is less moist. For Aristotle, this difference in vital heat also serves to explain spermatogenesis. For the Stagirite, whose physiological system is based on the postulate of the fungibility of all bodily fluids, semen comes neither from the brain via the marrow, as Plato, the Pythagoreans, and (probably) Empedocles thought, nor from all parts of the body, as the atomists and the Hippocratic physicians claimed, but rather from the blood – or rather, the hot part of the blood, aerated like foam, hence the white color of sperm. Just like milk, the menses, or fat, the seed, passing through the intermediate stage of blood, is a “useful residue” (perittôma) of food. It is in fact the most subtle, concentrated, and complete of the residues of food, that which has undergone a coction of superior quality and intensity, “a residue of food in its final degree of elaboration.”35 Such a coction could only be produced by a perfectly hot body. This is why the blood of women, who are colder by nature, produces a residue that is insufficiently cooked, useless unless the woman is pregnant, and thus voided by the menses. If the woman is impregnated, this residue provides only the matter of the embryo, the nourishment for the fetus during the pregnancy, and finally the milk after the birth. The difference in the quality of the residue at once puts the male and female in a hierarchical relationship: This is why, wherever possible and to the extent possible, the male is distinct from the female. For the principle of movement, i.e. the male, is the best and most divine thing for beings who are born, while the female is the matter.36
14 The male body, a perfect machine, is alone capable of producing the sperm, a perfect product.
15 The difference between the sexes is thus not, for these writers, merely a polarity; it derives from a difference of nature, resulting from a process that continues throughout the life course. It results in a vicious cycle in the female body, where the excessive moisture is maintained, and in a virtuous cycle in the male body, where – except in case of illness or constitutional defect – the proper equilibrium between heat and cold,
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moisture and dryness, persists and continually renews masculinity. This difference of nature is still more visible in the branch of Hippocratic medicine concerned with female anatomy: the gynecological treatises.
The distinctive features of female anatomy and the importance of the uterus
16 Although Hippocratic medicine is essentially physiological, a part of the Hippocratic corpus nonetheless gives some attention to female anatomy. Known as the Hippocratic gynecological treatises, these are of different eras; the majority are attributed by the tradition to the Cnidean school of medicine. They represent the female and male bodies as profoundly dissimilar. The essential difference between the two anatomies is the existence in the woman of a supplementary container-organ, the uterus, whose distinctive feature is to be perceived as a sort of mobile living creature. It is animated, actually endowed with movement, and in particular can open or close. It is naturally inclined to move toward sources of moisture. Some of its movements are attributable to its will, for it is endowed with a will of its own. Thus the treatise on The Nature of Women explains, in regard to a case of prolapse, that the uterus “no longer wants to return to its place.”37 This gluttonous zôon inside another animal, i.e., the female body,38 is avid to conceive.39 Plato, a contemporary of Hippocrates and acquainted with him, develops this aspect in the Timaeus: “That which in women we call for the same reasons matrix and uterus is an internal animal subject to the desire to make children.”40 This conception leads to the idea that the female body is structurally hysterical,41 and that is certainly the way Plato represents it: When [the uterus] has remained sterile for a long time after having passed the suitable age, this organ becomes impatient; it does not accept this state, and because it begins to wander throughout the body, obstructing the orifices by which the breath goes out and preventing respiration, it throws the body into the most extreme states and provokes illnesses of all kinds.42
17 This takes us back to the very distinctive perspective in which the female body is nearly always seen: with reproduction as its goal.43 Evidence for this view is to be found in the vocabulary used by the corpus when it speaks of the woman’s body even outside the gynecological treatises,44 as well as in the metaphors used by the Hippocratic gynecologists.45 The contrast with the male body is clear; the latter is never considered in this perspective alone. As for Aristotle, who clearly knew more about the anatomy of female animals than of women, he has left us no description of the female human body, which would have had little utility for him in any case, since his objective is not medical.
18 Herophilus, by contrast, clearly had more extensive knowledge of anatomy than his predecessors, especially due to human dissection, which he seems to have been the first to practice in the Greek world. He even practiced vivisection on criminals condemned to death, if we are to believe the possibly malicious testimony of the Latin encyclopedist Celsus (1.21), who lived at the beginning of the Christian era. But while it is almost certain that he identified, in the human reproductive apparatus, the spermatic canal, the ovaries, and the Fallopian tubes, it is unlikely that he understood their workings.46 His discoveries, taken up by his successors, notably Demetrius of Apamea, and probably enlarged upon by the use of the speculum, are nonetheless
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important and opened the door to a reconsideration of the difference of nature between male and female bodies. In fact, these discoveries obliged the physicians of the Roman era to undertake laborious readjustments of their doctrines.47 It is significant, nonetheless, that he represents the organs of generation in the woman according to the model of the male body, contributing to the construction of what Thomas Laqueur has called the model of the unisex body.48
19 Four centuries later, Soranus took an interest in female anatomy and more specifically in the uterus in the first book of his Diseases of Women.49 Although he still thinks of it as a living container, hence the source of uterine contractions, he does not attribute an autonomous will to it and makes fun of the physicians who equated it with a wild animal (3.5). Soranus’ presentation of the female body, translated into Latin by Celius Aurelian and Moschion, was to become the bible of gynecology for centuries. Galen, one or two generations later, picked up and developed the medical concepts of his predecessors in a synthetic and critical spirit, with a clearly Aristotelian orientation. Drawing on the anatomical discoveries of the Alexandrian physicians, he interpreted the female body in light of the male body. The difference between the sexes is seen in the development of the reproductive organs: those of women are identical to those of men (analogies are drawn between the ovaries and testicles, between the uterus and the scrotum);50 they have simply remained inside the body due to a lack of vital heat. Anatomy is thus merely a reflection of a difference between the sexes which originates in physiology; but this difference is now only a difference of degree and is no longer thought of as a difference of nature. Thus the woman differs from the man only in a lesser perfection: Just as the human species is the most perfect of all the animals, within the human the man is more perfect than the woman, and the reason for his perfection is his greater heat, for heat is the first instrument of nature.51
20 While for Aristotle female nature was a mutilated kind of male nature and more or less monstrous, perceived in any case as very negative, for Galen its relative incompleteness is positive. In a teleological perspective, the Pergamene physician sees in it the design of nature: to permit the assurance of reproduction.
21 The model of the unisex body studied by Thomas Laqueur was thus constructed beginning with Aristotle and formalized by Galen, who simply substituted a hierarchy of degree to a hierarchy of nature. Beginning in Antiquity, this hierarchy of bodies has had direct implications for medical practice. It is reflected in a gendered construction of the classification of diseases and of therapies, especially since the vast majority of doctors were men. Ancient theories on the female and male bodies are of considerable importance because they have had a long afterlife. With the advent of Christianity, theological considerations are intertwined with them, since Eve is thought to have arisen from an excess rib of Adam (at least in one of the versions given in Genesis). Throughout the medieval period and part of the modern era, medicine considered the two bodies in a hierarchical relation, perceiving the female body as more or less handicapped by comparison with the male body, because of its moisture, its insufficient heat and its disturbing uterus. As a medieval medical saying puts it, “The hottest woman is colder than the coldest man.”
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BIBLIOGRAPHY
Sources
Note : This article was written before the decision to produce the online English version of Clio : the Greek sources are therefore listed here in their French editions, to which the notes refer.
[Aristotle], G.A : Aristote, De la génération des animaux, ed. and trans. Pierre Louis, Paris, Belles Lettres, 1961.
[Aristotle], Probl. : Aristote, Problèmes, ed. and trans. Pierre Louis, Paris, Belles Lettres, 1991.
[Galen], De sem. : Galien, De semine, ed. Karl Gottlob Kühn, Hildesheim, G. Olms, 1997 (reprod. of vol. IV of Leipzig edition, 1821, cf. online edition: Paris, Bibliothèque Interuniversitaire de Médecine, Collection Médic@, 2003).
[Galen], Ut. part. : Galien, De uteri dissectione, ed. Karl Gottlob Kühn, Hildesheim, G. Olms, 1964 (reprod. of vol. II de Leipzig edition, 1821, also online: Paris, Bibliothèque Interuniversitaire de Médecine, Collection Médic@, 2003).
[Hippocrates], Aph. : Hippocrate, Aphorisme, trans. Émile Littré, Paris, J.-B. Baillère, 1844 (1973).
[Hippocrates], Épid. : Hippocrate, Épidémies V et VII, ed. and trans. Jacques Jouanna, Paris, Belles Lettres, 2000.
[Hippocrates], Nat. puer. : Hippocrate, De la nature de l’enfant, ed. and trans. Robert Joly, Paris, Belles Lettres, 1970.
[Hippocrates], Nat.mul. : Hippocrate, Nature de la femme, ed. and trans. Florence Bourbon, Paris, Belles Lettres, 2008.
[Hippocrates], Prorrh. : Hippocrate, Prorrhétique, trans. Émile Littré, Paris, J.-B. Baillère, 1861 (1973).
[Plato], Tim. : Platon, Timée, trans. Luc Brisson, Paris, Flammarion, 1992.
[Soranos], Gyn. path. : Soranos, Maladies des femmes, ed. and trans. w. notes by Paul Burguière, Danielle Gourevitch and Yves Malinas, Paris, Belles Lettres, 1988-2000.
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DEAN-JONES, Lesley. 1994. Women’s Bodies in Classical Greek Science. Oxford. Oxford Clarendon Press.
DI BENEDETTO Vincenzo. 1986. Il Medico e la malattia. La scienza di Ippocrate. Turin. G. Einaudi.
GARDEY, Delphine, and Ilana LÖWY. 2000. L’Invention du naturel. Les sciences et la fabrication du féminin et du masculin. Paris. Éd. des archives contemporaines.
GERLACH, Wolfgang. 1938. Das Problem des “weiblichen Samens” in der antiken und mittelalterlichen Medizin. Archiv für Geschichte der Medizin und der Naturwissenschaften XXX/4-5: 176-193.
GIRARD, Marie-Christine. 1983. La femme dans le corpus hippocratique. Cahiers des Études Anciennes XV : 69-80.
GOUREVITCH, Danielle. 1992. Les lectures hippocratiques de Soranos d’Éphèse dans son traité Des maladies des femmes. In Tratados hipocraticos (Estudio acerca de su contenido, forma e influencia), Actes du VIIe Colloque international hippocratique (Madrid, 24-29 sept. 1990), ed. Juan Antonio LÓPEZ FÉREZ, 597-607. Madrid. Universidad nacional de educación a distancia.
HANSON, Ann Ellis. 1991. The restructuring of female physiology at Rome. In Les Écoles médicales à Rome. Actes du IIe colloque international sur les textes médicaux latins antiques (Lausanne, sept. 1986), ed. Philippe MUDRY, and Jackie PIGEAUD, 255-268. Geneva, Droz.
HANSON, Ann Ellis. 1992a. Conception, gestation, and the origin of female nature in the Corpus Hippocraticum. Helios XIX/1-2: 31-71.
HANSON, Ann Ellis. 1992b. The logic of the gynecological prescriptions. In Tratados hipocraticos (Estudio acerca de su contenido, forma e influencia), Actes du VIIe Colloque international hippocratique (Madrid, 24-29 sept. 1990), ed. Juan Antonio LÓPEZ FÉREZ, 235-250. Madrid. Universidad nacional de educación a distancia.
HERTZ, Robert. 1970 [1st ed. 1928]. La prééminence de la main droite : étude sur la polarité religieuse (1909). In Sociologie religieuse et folklore, 84-101. Paris. Presses universitaires de France.
JOLY, Robert. 1966. Le Niveau de la science hippocratique. Paris. Les Belles Lettres.
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JOLY, Robert. 1968. La biologie d’Aristote. Revue philosophique CLVIII: 219-253.
JOUANNA, Jacques. 1992. Hippocrate. Paris. Fayard.
KING, Helen. 1998. Hippocrates’ Woman: reading the female body in Ancient Greece. London – New York, Routledge.
KING, Helen & Véronique DASEN. 2008. La Médecine dans l’Antiquité grecque et romaine. Lausanne. Bibliothèque d’histoire de la médecine et de la santé.
KLIBANSKY, Raymond, PANOFSKY, Erwin & Fritz SAXL. 1989. Saturne et la Mélancolie. Études historiques et philosophiques : nature, religion, médecine et art. Paris. Gallimard (translation of Saturn and Melancholy. Studies of natural Philosophy, Religion and Art. 1964).
KRELL, David Farrell. 1975. Female parts in Timaeus. Arion II/1 : 400-421.
LAQUEUR, Thomas. 1990. Making Sex: body and gender from the Greeks to Freud. Cambridge Mass. Harvard University Press.
LLOYD Geoffrey Ernest Richard. 1966. Polarity and Analogy: two types of argumentation in Early Greek thought. Cambridge. Cambridge University Press.
LLOYD Geoffrey Ernest Richard. 1990. Origines et développement de la science grecque : magie, raison et expérience, Paris. Flammarion (translation of: Magic, Reason and Experience: studies in the origin and development of Greek science. Cambridge. Cambridge University Press, 1979).
LLOYD Geoffrey Ernest Richard. 1983. Science, Folklore and Ideology: studies in the life science in Ancient Greece. Cambridge. Cambridge University Press.
MALINAS, Yves, BURGUIÈRE, Paul & Danielle GOUREVITCH. 1985. L’anatomie gynécologique de Soranos d’Éphèse. Histoire des Sciences Médicales XIX: 161-168.
MANULI, Paola. 1980. Fisiologia e patologia del femminile negli scritti ippocratici dell’antica ginecologia greca. In Hippocratica. Actes du colloque hippocratique de Paris (4-9 sept. 1978), ed. Mirko DRAZEN GRMEK, 393-408. Paris. Éditions du CNRS.
ROUSSELLE, Aline. 1980. Observation féminine et idéologie masculine : le corps de la femme d’après les médecins grecs. Annales ESC XXXV/5: 1089-1115.
VERNANT, Jean-Pierre. 1962. Les Origines de la pensée grecque. Paris. Presses universitaires de France.
VERNANT, Jean-Pierre. 1965. Mythe et pensée chez les Grecs. Études de psychologie historique. Paris. La Découverte.
VON STADEN, Heinrich. 1989. Herophilus: the art of medicine in Early Alexandria. Cambridge. Cambridge University Press.
ZARAGOZA, Gras Joana. 1992. El léxico ginecológico de las Epidemias hipocráticas, In Tratados hipocraticos (Estudio acerca de su contenido, forma e influencia), Actes du VIIe Colloque international hippocratique (Madrid, 24-29 sept. 1990), ed. Juan Antonio LÓPEZ FÉREZ, 479-489. Madrid. Universidad nacional de educación a distancia.
NOTES
1. For a clear basic introduction to ancient medicine, see King & Dasen 2008. 2. Lloyd 1983 and 1990; Vernant 1962 and 1965. 3. Gardey & Löwy 2000.
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4. Byl 1980. 5. I use this term for linguistic convenience, although biology as a discipline does not exist in the ancient Greek world. The term itself is not part of the Ancient Greek vocabulary; it was a neologism coined in the nineteenth century. 6. For a detailed analysis of the biological theories of these thinkers, see Bonnard 2004, ch. 4. 7. Bonnard 2006: 308-312. 8. See especially Hanson 1992a. 9. Hippocrates, On the Nature of the Child, 18.1. Unless otherwise indicated, translations are based on the French in the Collection des Universités de France (Belles Lettres), or for Hippocratic texts not in the CUF collection, that of Littré. 10. Hippocrates, Aphorisms 5.38. 11. Aristotle, GA 1.20.729a 11-13; 2.3.737a 15; 2.4.739b 21-26; 4.4.771b 23-27; 4.4.772a 23-25. 12. See Joly 1968 and Bonnard 2006: 313-318. 13. Aristotle, GA 4.3.767b 8. Cf. Aristotle, GA 1.20.728a 17-18; 2.3.737a 27-28; 4.6.775a 15-16; 5.3; and Probl. 10.8.891b 23. 14. See von Staden 1989: 291-296. 15. Gourevitch 1992: 597-598. 16. Gerlach 1938: 186. 17. Gerlach 1938: 188 and Boylan 1986. On the respective value of the right and left from an anthropological perspective, see Hertz 1909. 18. See Di Benedetto 1986: 225-247, and Bratescu 1992. 19. See Jouanna 1992: 442-445, and on the afterlife of this theory, Klibansky, Panofsky & Saxl 1989: 31-45. 20. Joly 1966: 75-80. 21. See Girard 1983 and Hanson 1992b: 48-52 (“IV. Manipulating the Wet”). 22. On the female body deprived of mesotēs, see Manuli 1980: 402 and Hanson 1992b: 245. 23. Hippocrates, Nat. mul. 5. See Manuli 1980: 393. 24. Lloyd 1966. 25. King 1998: 28-29. 26. Hanson 1992b: 247. 27. Dean-Jones 1989 and 1994: 86-103; Bodiou 1999 and 2006: 153-157. 28. Manuli 1980: 402; Hanson 1992b: 236; and Bonnet-Cadilhac 2002. 29. Hippocrates, Prorrh. 1.143. 30. Hippocrates, Aph. 5.33. The case of Leonides’ daughter (Epid. 7.123) is seen as an exception that proves the rule. On this subject see King 1998: 54-74. 31. Hippocrates, Aph. 5.40. 32. Hippocrates, Nat. mul. 8 and 7. On menses that are too copious or too sparse, see King 1998. 33. Hanson 1992b, especially 239. 34. Hippocrates, Aph. 3.11 and 14. On the homology between women and “moist” men, see Dean- Jones 1994: 123. 35. Aristotle, G.A. 1.18.726a 26-27. 36. Aristotle, G.A. 2.1.732a 6-9. 37. Hippocrates, Nat. mul. 5. 38. King 1998: 222-231; Bodiou 1999: 65-85. 39. Rousselle 1980: 1098 and Dean-Jones 1994: 65-79. 40. Plato, Timaeus 91c, based on the translation of J.-B. Bonnard. See Krell 1975 & Bonnard 2004: ch. 6. 41. Manuli 1980: 397. 42. Plato, Timaeus 91c, based on the translation of L. Brisson. 43. Manuli 1980: 394; Rousselle 1980: 1092; Dean-Jones 1994: 47.
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44. See, for example, Zaragoza-Graz 1992 on the Epidemics, especially on the verb tiktô (“give birth”). 45. Hanson 1992a: 36-41 (“II. Analogs for the Adult Female: Mother Earth and the Upside-Down Jar”). 46. Von Staden 1989: 165-168. 47. Hanson 1991a. 48. Laqueur 1990. 49. See Soranus, Gyn. path. 1.4 and Malinas, Burguière & Gourevitch 1985: 161-165. 50. Galen, De sem. 2.1 (= K. 4, 596). 51. Galen, Ut. part., K. 2.630 (trans. based on Laqueur 1990).
ABSTRACTS
This article which surveys the medical literature from the Presocratics to Galen, shows how Greek biological and medical texts constructed a particular conception of male and female bodies. According to Ancient Greek biologists and physicians, the differentiation begins at embryogenesis and continues during foetal development. In a medical thought dominated by physiology, male and female bodies were assumed to be in obvious opposition, according to certain suggestive criteria : in particular the female body was seen as wetter and cooler than the male body and moreover marked by an anatomical peculiarity: the uterus was thought of as a living being. The difference between male and female bodies, whether described as radical (difference in nature) or relative (greater or lesser degree of perfection), is always presented in these texts by reference to the male body, compared with which the female body is thought of in terms of incompleteness or inversion. Such difference also carries connotations of hierarchy.
INDEX
Keywords: body, ancient Greek medicine, gender, Presocratics, Hippocrates, Erasistratus, Herophilus, Soranus, Galen
AUTHORS
JEAN-BAPTISTE BONNARD Jean-Baptiste Bonnard teaches Greek history at the University of Caen in Normandy. He is a member of the research group ANHIMA (UMR 8210: Anthropologie et histoire des mondes anciens) and of the editorial board of Genre&Histoire. His research interests are gender, kinship and the body, and recent publications include Le Complexe de Zeus. Représentations de la paternité en Grèce ancienne (2004). [email protected]
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Crazy brains and the weaker sex: the British case (1860-1900)
Aude Fauvel Translation : Jane Yeoman
1 In 1895, Henry Lanchester learned that his daughter Edith had fallen in love with a man who was not only poor, but also socialist and Irish; worse, she was intending to live with him out of wedlock. Thrown by the situation, Lanchester turned to the psychiatrist George Fielding Blandford,1 who decreed that Edith’s “free love” was tantamount to “social suicide” and that his daughter could now be viewed as a “monomaniac” whose brain had been “turned by socialism”.2 Lanchester was reassured. Edith was hospitalised “as a matter of ugency” – a radical means of curbing her tendencies towards revolt.3
2 This story, like many of its kind, serves to illustrate a classic thesis upheld by many women historians,4 that psychiatry probably qualifies as the sexist science par excellence. Psychiatrists not only nourished the discourse on the inferiority of the “weaker sex”, they also literally contributed to the exclusion of women, by agreeing to hospitalise those who, like Edith, refused to bend to the wishes of men. Since the 1970s and the entry of feminist criticism into the human sciences, writers from Phyllis Chesler5 to Lisa Appignanesi,6 by way of Elaine Showalter7 have all stressed the biases of the “mind sciences”8, an area where knowledge is actually very limited and thus all the more open to conventional opinion. Put differently, experts of the mind have had a troubling tendency to confuse a rejection of social conventions with mental illness. As a consequence, in the same way that homosexuals and dissidents (Communards, anti- Franco-ists, anti-Putinists, etc.) have been viewed as “sick” and in need of “treatment,” recalcitrant women have suffered the prejudices of a profession whose institutions were until relatively recently directed by men.9 The “mad-doctor” – he with the power to intern – was thus the same sex as the father, the brother or the husband. As a result, the psychiatric world was for a long time conducive to a kind of masculine connivance, with Edith’s case (and hers is far from being the most dramatic10) clearly demonstrating how some men deliberately turned to psychiatric services in order to stifle the desires of their daughters, mothers or sisters.
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3 The aim of this article is certainly not to question those observations regarding the frankly detestable role certain mind-specialists have played in the repression of women, but rather intends to reread that particular history from another angle, by considering, with reference to the British case,11 how the taking of a sexist stance has played on doctor/patient interactions, altering the “knowledge” of the one and the discourse of the other. It is true that “psychiatric power12” is often viewed as an indivisible whole, where all doctors always shared the same type of discourse relating to women and madness. Yet this was not the case: psychiatrists only started to theorise about the inferiority of the “feeble brain” and the idea that it was “natural” to intern more women, from the 1860s on, and even then, such beliefs were not unanimously held. Moreover, if writers have exaggerated the inflexibility of the medical profession, so, conversely, have they underestimated the capacity of patients, in particular women patients, to counteract the pronouncements of the doctors. And yet, to be specific (and here lies the whole interest of the example) if in the nineteenth century Britain was a country where psychiatrists pronounced the harshest words on the “weaker sex,” it was also the setting for the first great feminist and anti-psychiatry triumphs – the one being profoundly motivated by the other.
4 How can this paradox be explained? What theoretical contortions produced the idea of the “feeble brain” in the nineteenth century? And how did British women like Edith Lanchester manage to fight it? As we investigate these questions, we will take a different perspective on the relationships between psychiatry and (anti-)feminism, and subject to scrutiny the mechanisms of construction (and deconstruction) of the categories of medical knowledge; we will also examine how the objects of this knowledge – women patients – managed to modify from “below” the theories and practices that concerned them.
Women and the Female Mind under Psychiatry’s Gaze
Madness: from universal moral affliction to gendered degeneration
5 Contrary to what is sometimes claimed, the idea that madness was typically female did not appear in conjunction with early psychiatry (“mental treatment” or “alienism,” to employ the nineteenth-century terms). The discipline’s founding fathers believed that even if mental problems were undoubtedly linked to the physical, it was essential, when treating the mad, to remember that their troubles usually stemmed from a “moral” problem,13 such as bereavement, bankruptcy, or other kinds of severe shock. In consequence, it would suffice to administer a proportionately “moral treatment,” in order to distract – in its strongest sense – patients from their affliction: either through a talking cure, or by providing them with healthy occupations and, most importantly, by isolating them in a secure medical environment (an asylum). From this point of view, the process leading to alienation (and to its cure) was seen as basically the same for both men and women. Certainly, psychiatrists thought that the reasons that caused the male or female of the species to become unbalanced might be different, as could the form of their madness. Women were more sensitive to the loss of a child, men to professional reversals; women often had religious obsessions, while men had political fantasies, etc. However, if the ways the two sexes manifested madness were different, there was nothing to indicate which was the more disposed to losing his/her mind. In
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consequence and contrary to what has been claimed,14 in practice the first psychiatrists interned the same number of women as men, having detected the same levels of abnormality in the one as in the other.15
6 However, this situation changed dramatically in the second half of the nineteenth century, with a change in direction from the moral vision towards an increasingly physicalised conception of the bases of madness – a change which came largely out of the disappointments encountered by psychiatry as early as the 1860s. Despite the optimism expressed by the field’s pioneers, from that time on – some twenty years after the opening of public asylums in several European countries16 – it became clear that asylums were not “healing machines”: success rates rarely exceeded 5%.17 Asylum patients did not get better, and more were admitted every day: in barely twenty years the number of psychiatric patients had multiplied ten times over, on both sides of the Channel, an exponential increase18 which rapidly put an end to initial hopes for the therapeutic control of madness.
7 What conclusions might contemporaries have drawn from this set of circumstances? That mad-doctors were mistaken and that asylum-based treatment was perhaps a misguided moral response to insanity? Some alienists went precisely that far, and argued for research into other types of therapeutic care outside the asylums. However, with occasional exceptions,19 they were not heeded; the majority of doctors preferred to find other explanations for the failure: if it was not possible to cure the insane, it was simply that their complaint was more serious than thought, and had doubtless profoundly affected not only the mind, but also the body. At the same time as Paul Broca and other neurologists were stressing the link between behavioural problems and brain injury, psychiatrists thus concluded that they too should further study the physiology of alienation. Moreover, in addition to the neurological discoveries, there was further backing for psychiatrists’ change in attitude towards the somatic to be found in evolutionism. Had not Jean-Baptiste Lamarck and above all, Charles Darwin, shown that evolution was governed by heredity? It now seemed logical to postulate that those whom evolution had deprived of their sense and reason – the insane –, conversely suffered from an inherited defect. Or so concluded Henry Maudsley20 in Britain and Valentin Magnan21 in France, who replaced the moral explanations with the term, “degeneration”.22 The impact of this theory was not quite the same on the two sides of the Channel, given Darwin’s deeper imprint on British thinking. But in broad terms, these particular alienists postulated that when an individual damaged his or her body, by drinking too much alcohol, say, or through contracting a venereal disease, he or she would pass on the hereditary consequences to the children, who would consequently be born already “deficient” (the nineteenth century was aware of the principle of evolution, but not of the laws of genetics). Thus unless the process were to be blocked at the outset through anti-alcohol and venereal disease policies, or by dissuading the healthy from marrying “inheritors,” medicine was left powerless. Once defects were acquired, they were indelible, a fact that led to the incurability of the majority of the insane; their bodies and brains were irremediably “injured”.
8 As well as justifying the asylums’ failures (if the alienated did not get better, it was not the doctors’ fault, but because the patients were incurable), this doctrine of degeneration pushed psychiatry towards a more defeatist view of mental illness. Now the issue was not so much to cure the mad but to protect the healthy: some even began to think that it would be best to sterilise (even to eliminate) the degenerate. But in
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addition to opening the way towards the eugenic strain of thought later seen in the twentieth-century interwar period, the spread of this theory provoked a further consequence. By placing the emphasis on somatic function, it triggered a marked sexualisation of psychiatric problems. For if the body were judged to be all-important, thus enabling heredity and individuals’ mental characteristics to be read in “stigmata,” so men and women, with their dissimilar physiques, must also, logically, possess sexually differentiated psychologies.
The weaker sex, sickly and insane
9 In accord with the logic of the new doctrine, alienists now set about establishing the boundaries of women’s mental ability according to their physique, since the “best way to know the differences between the male and female intellect” was “to consider the differences that exist between their bodies”.23 And given that the most obvious difference was to be found below the waist, that was where the experts first focussed their attention. Those who believed in an unassailable bond between body and mind believed that the whole mystery of the female psyche was to be found precisely there, in the ovaries, uterus and vulva. British gynaecologists were also fully in agreement with this idea:24 they concluded that since treating a woman’s lower abdomen was equal to treating her mind, they were the ones best placed to do so. Notably, they advocated the practice of sexual operations such as ovariectomy and clitoridectomy,25 not to cure gynaecological problems but to treat troubles of the mind. In this situation, alienists now found themselves at risk of being overtaken by the gynaecologists, precisely because they themselves had insisted overly on the pubic region. Accordingly, they stressed a further point: it was not only the woman’s reproductive organs that were different, but also their brains.
10 In Britain, James Crichton-Browne,26 co-founder of the renowned journal, Brain, directly posed the question of the specificity of the female brain in 1879 in a celebrated study based on 400 dissected brains taken from the insane.27 Crichton-Browne noted in particular a fact already observed by Broca in France: in humans, whether or not insane, men's brains were on average heavier than women’s. From this, Crichton- Browne argued, two things could be deduced. Firstly, given that the human species was clearly at the peak of evolution, the difference in weight demonstrated that from every standpoint, cerebral included, females and males were destined to be different, the natural course of evolution showing a tendency to accentuate the characteristics of the sexes. He deduced in addition that since the size of cerebral mass indisputably (in his view) indicated intellectual strength, then women, who were known to have less muscle than men, were similarly disadvantaged in their powers of reason. Taken together, according to Crichton-Browne, these factors amply justified references to women as the “weaker sex”.
11 Thus, in sum, evolutionary alienists believed that the possession of a uterus and a brain short of a few hundred grams defined the basic characteristics of a woman’s body and in consequence, her psychology. Indeed, to follow their reasoning, since the sole purpose of the female sexual organs was to bear children (doctors considered that for women to find pleasure was of secondary importance, bordering on the pathological)28 and that in addition the female brain was ill-suited to effort, then nature clearly destined women for one thing only: to be mothers. To remain healthy, it was enough
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for them to adhere to three rules: 1) protect their reproductive ability; 2) favour indoor occupations, their parenting nature disposing them towards creating homes; 3) avoid energetic activities which ran contrary to maternal gentleness.
12 To break any of these rules was considered, a contrario, an abuse of the fundamental nature of a woman’s body and mind. Firstly, were a woman to indulge her senses (an act contrary to her nature), or, even worse, seek pleasure outside any reproductive goal (through protected sex, masturbation, lesbianism, etc.), her reproductive system would inevitably be deregulated, in which case it would be masculinised29 or overheated to the point of madness and/or death.30 Marital continence was therefore demanded, while any encouragement of contraception or abortion was clearly quite unthinkable. Further, in the same way that a young woman’s lower abdomen – particularly susceptible to acquiring unnatural practices at a transitional stage of maturity – had to be protected from temptation, it was also necessary to protect her other sensitive mental organ: her brain. Thus while educating girls to become good wives and mothers was seen as useful, it was seen as dangerous to submit them to intense intellectual stimulation, since their brains were not equipped to handle it, and that, moreover, they could not “...bear, without injury, an excessive mental drain as well as the natural physical drain...”.31 Finally, it was thought that any such gentle and fragile creatures who dared practise a sport, or, worse, handle weapons, would almost inevitably succumb to dementia, so alien was the female body to such activity.32
13 Women who took the risk of living contrary to the “tyranny of their organisation”33 would thereby suffer the inherent consequences, from simple fatigue to the most severe forms of madness. Any woman manifesting any such character traits (a lack of modesty, intellectual passion, etc.) was to be considered sick and in need of treatment, without which her own health and beyond that, the health of her species, would be compromised. According to the hereditary doctrine, those who were “deregulated” risked passing on their abnormalities – a danger made greater by the fact that “defects” were most easily transmitted from mother to child in utero. Within the framework of such medical reasoning, to wish that a woman vote, study or work at the same level as a man, became totally illogical. The “inferiority of constitution” of both body and mind of the “weaker sex” was a given piece of “physiological”34 evidence which it would be absurd to deny. And above all, to work towards an artificial equality between men and women would implicitly compromise both the naturally differentiating evolution of the sexes, and ultimately, the future of the species. Would-be reformers were warned: to enable women to become more like men would lead, at best, to a society of “sexless”35 individuals, similar to that of ants, and at worst to a generalised degeneration of humanity, dragged down by female “vampires”.36
Rise and fall of a theory
14 Many authors have stressed the ruthless nature of this reasoning which relied on so- called “physiological truth,”37 not only to justify a certain Victorian society’s expectations of women’s propriety, but also actively to promote the repression of non- conformists by encouraging husbands to hospitalise all those who behaved in a manner “contrary to nature,” in the name of protecting the evolutionary process. Although it was not the only factor, it was perhaps this encouragement which in part explains the statistically-noted tendency to lock up greater numbers of women towards the end of the nineteenth century.38 The effect of the message was the more devastating in Britain
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in that it was borne by some of the most renowned names in psychiatry. George Fielding Blandford, mentioned earlier, felt that any “amoral” idea signalled madness,39 thus justifying the confinement of women such as Edith Lanchester precisely because they contested the validity of conformity to convention. Furthermore, in 1877, Blandford was President of nothing less than the Medico-Psychological Association (M- PA, the professional association of British alienists) – a title which alone demonstrates his renown. But no doubt the purest line of psychiatric evolutionism is seen in two other persons, also earlier named: Henry Maudsley and James Crichton-Browne are certainly the most famous British alienists to have defended the weaker sex thesis. Maudsley and Crichton-Browne were not only close to Darwin, the principal figure in the field of evolutionist thought, but were themselves prominent members of the intelligentsia of the age: Maudsley’s lectures at University College were always packed, while Crichton-Browne was a leading contributor to the journal Brain. When we consider that in addition, these two doctors were elected to head up the M-PA (in 1871 and 1886), and that Crichton-Browne additionally became Inspector-General of Asylums, we may begin to understand, without entering into their full career details, the extent of their institutional and practical, as well as theoretical dominance in the medical world.
15 There is little doubt, then, that both Maudsley and Crichton-Browne’s opinions as experts had a significant impact, the more so since their views reached both the scientific world and the wider public. Among many examples of their influence, we see that in 1878, the decision of the British Medical Association (BMA, the association of general practitioners) to refuse women was founded on the ideas of the two men, with objections being raised about the ability of the female psyche to withstand the profession’s exigencies. Or perhaps yet more significant, when in 1884 the authorities sought to evaluate reforms to be undertaken in London schools, they decided to consult a specialist in cerebral development and turned to none other than Crichton-Browne. Naturally, Crichton-Browne took full advantage of the situation to warn of the impact that women’s schools would have on girls’ health.40 All things together, it seems certain that by the end of the nineteenth century, both the medical and general British authorities had been convinced of the infirmity of the female mind.
16 Nevertheless, looking more closely at this seeming success of the notion of the weaker brain, we see that the moment of triumph in Great Britain was actually very short- lived; some fifteen years after being validated by the scientific profession, the theory was, if not disproved, at least put aside. Thus while the date of women doctors’ exclusion (1878) is always cited as proof of the reign of British medical misogyny, the moment in 1893 when the BMA reversed its decision, now not only accepting women, but even encouraging them, is often forgotten. Crichton-Browne himself had sensed something of this wind change one year earlier: he had again stressed the limits of the female brain in a paper delivered at the 110th Congress of the Medical Society of London (later published in the British Medical Journal)41, but on this occasion, to his great surprise, the eminent doctor found himself harshly attacked.42 And again, when in 1894 his own alienist colleagues from the M-PA were to vote in their turn, they aligned themselves with public opinion and admitted women after very little debate. Without going so far as to say that in Britain in 1894, no doctor still believed in the mental inferiority of women (this was far from being the case), these votes nonetheless clearly showed that such a thesis had lost its consensual aspect. As for Maudsley, he too
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realised that things had changed: at about this time, a disappointed man, he ceased to frequent British medical circles, their institutional choices having constituted an implicit rejection of his theoretical position.
Psychiatrists as Seen by Women
Patients versus medical authority
17 Just as historians have largely focused on deciphering the way theories of female inferiority managed to permeate all scientific, public and private areas (to a point where women came to convince themselves of their own inferiority – the ultimate symptom of alienation) so they have similarly devoted little attention to the inverse process, which led, on the contrary, to the loosening of those theories’ hold. More specifically, we may ask what happened between the years 1870 to 1890 that prompted certain doctors to distance themselves from these ideas in the way they did? The fact was that, in Britain, unlike elsewhere, the theories prompted both a strong and organised reaction on the part of patients, a phenomenon which was by no means the sole cause of their rejection, but was certainly a significant contributory factor. Historians have already described the importance of the waves of protest that followed the 1864 Contagious Diseases Act.43 Effectively, this enabled the police to arrest women they judged to be prostitutes and authorised doctors to then forcibly examine them and to hold them in custody for as long as they saw fit; male clients, for their part, incurred no penalty whatsoever. The Act was to incite an unprecedented wave of anger against the medical profession, with some people, mostly women,44 organising pressure to revoke it and to discredit the unhealthy tendencies which lay, as they saw it, behind its instigation. Had the Act been passed in order to limit the threat of venereal disease, these sceptics argued, doctors would have also targeted men.45 If they attacked only women, it was undoubtedly because they were not so much concerned with health, but with an “unbridled medical desire to manipulate and dominate women”.46 The campaign also incited woman patients to make themselves heard, thus revealing the magnitude of their discontent and notably providing an occasion for some to speak of doctors’ excessive taste for examinations of a questionable nature.47 The role of this struggle in the constitution of feminist thinking in Britain is quite well known, but its link to another important battle has been little explored – and for a reason: who could have imagined that one of women’s greatest victories would have been won against psychiatrists, surely the ne plus ultra of all medical authorities?
18 Influenced by the image of an overwhelmingly strong “psychiatric power,” historiography has generally viewed the nineteenth century as the one where the voice of the insane was crushed, being suppressed by doctors and confined to asylums. Consequently, when instances of the insane managing to make themselves publicly heard despite all the odds have been uncovered, they have been viewed as remarkable exceptions of “survivors”48 and been studied case by case, without the possibility of the existence of a collective counter-culture among the insane ever having been evoked.49 Yet it is not by chance that publications by “invalids” have been more abundant at certain times and in certain places: it turns out that patients’ silence has in fact been relative, Foucault’s analysis in this instance applying more strongly to France than to Great Britain. English law automatically provides the right of appeal to habeas corpus
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and to be heard by the judiciary. And precisely this procedure, customarily rare, was used by those labelled insane to bypass the silence of the asylum, and was so often and ably employed that in order to avoid its occurrence, in 1845 the authorities actually instituted committees of laymen charged with hearing patients’ complaints, without doctors having the right to oppose the measure.50 As a result of these legislative particularities, British people were more accustomed to hearing the voices of patients than was the case elsewhere; this doubtless explains why it was also in Britain that the very first association of psychiatric patients was founded: as early as 184551 it sought to affect political policy (similar societies did not appear in France until the 1970s). Given that context, it is not surprising that when alienists began to take a particular interest in the weaker sex, a second association appeared: the Lunacy Law Reform Association was started by Louisa Lowe in 1874.52 It is therefore with Lowe and her associates that the first signs of a women’s enterprise of deconstruction of psychiatric discourse are to be found – much more than with hysterics, in whom some writers have preferred to see unexpected resisters to medical authority.53 For not only did these “mad women” start to speak up, but they even won their case, with Parliament finishing by amending the Asylum Law according to the women's recommendations, as we shall see.
On the incompetence and stupidity of male doctors
19 Whether gynaecologists or psychiatrists, those British doctors who were the most deeply convinced of the debility of the weaker sex thus came up against the opposition of women, who counter-attacked on three different fronts. Firstly from within the associations, activists fought to make cases of medical abuse known. We have already mentioned witness statements regarding inappropriate gynaecological examinations during the campaign against the 1864 law; in similar vein, the tabloid press and sometimes very well-known editors such as John Lane,54 also set about communicating the stories of women who had had experiences with the professionals of the mind. Both Louisa Lowe and Georgina Weldon,55 the most famous recruit in her association, publicised the horrific accounts of their encounters with psychiatry in books56 and articles and through lectures and publicity tours; indeed, Weldon finished by generating a considerable income through her anti-alienist activities.57 And to return to Edith Lanchester, with whom we introduced this article, she for her part turned to her socialist friends, who alerted the press and organised demonstrations on her account.58 Moreover, following the example of the novelist Charles Reade,59 a close friend of Louisa Lowe, these women knew exactly how to play on British taste for the gothic and stories of mad scientists. It was through recounting terrifying anecdotes and playing the role of martyrs to an unnatural male science that women managed to attract public attention and shatter the myth of medical impartiality.
20 In addition to these rather sensational types of campaign, patients played a more positive role by voicing their opinions about what could constitute good mental health treatment for women. While psychiatrists and gynaecologists stressed the role of physiology, women instead signalled the importance of social factors in the emergence of female insanity. They declared that it was not so much menstruation, heredity, or the size of the brain that explained why women were frequently subject to nervous problems, but rather the expectations of society. Pulled between the reality of their desires and the restraints imposed by society, women lived in a state of constant tension and were in consequence more likely to crack. In that context, doctors were of
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no help whatsoever: by declaring the social inferiority of women to be natural in origin, they contributed at best inappropriate therapeutic treatment and at worst, reinforcement of the collective hypocrisy, through assisting with the subjugation of recalcitrants: sexual operations, confinement and “rest-cures”60 indeed acted more as punishments than veritable treatments. To remedy the problem, it was thus necessary to ensure a stricter surveillance of doctors (hence the campaigns to change venereal and asylum legislation), achieved by listening more carefully to female patients and ultimately, through the feminisation of the medical profession, given that only a women could understand another woman. As to the question of whether the female body was so weak as to need the care of a guardian, some chose to respond with humour. For after all, as the wife of one Winston Churchill remarked, if women were so completely handicapped, why did doctors not simply suggest they be “abolished”?61
21 Lastly, the most efficient way to challenge psychiatric theories was to disprove them in practice, and demonstrate that women could undertake unnatural activities without degenerating or triggering an explosion of the brain. In consequence, most women patients who were critical of psychiatry were also fervent partisans of women's education and economic independence; Weldon herself directed a school and at every chance presented herself as living example of a woman's ability to live life on her own, in good health and without supervision by a husband. More generally, doctors’ views on female fragility also had the paradoxical effect of pushing many women towards taking up studying (in particular, the study of medicine), in order to prove the opposite was true. Sophia Jex-Blake and Elizabeth Blackwell62 admitted that their commitment to a medical career had been primarily to fight against the “misdeeds” of male doctors, rather than out of true interest in medicine.63 As for Mary Corinna Putnam Jacobi,64 the first ever British woman to become a doctor (having exiled herself in France in order to so do) it was not by chance that she subsequently chose to practise psychiatry. In doing so, she was able to fight the discipline’s prejudices as an expert on the inside, while leaning on the words and experience of one particularly well known patient: Charlotte Perkins Gilman.65
Towards a different version of female psychology?
22 Faced with such a wave of contestation, doctors’ responses swung initially between condescension and frank hostility. Those women students who forced open the doors of British universities found themselves being insulted and sometimes even subject to abuse. The female patients who complained were simply accused of making it up. But the medical profession slowly had to revise its stance. Indeed, it is notable that several striking instances occurred where psychiatrists were publicly repudiated by the authorities. Among such cases, Georgina Weldon succeeded in having the unlawfulness of her confinement recognised, Edith Lanchester left the asylum, while the extraordinary Ann Pratt somehow managed from the other end of the Empire (Kingston, Jamaica) to initiate an administrative enquiry into the whole colonial asylum system.66 More impressive still, the 1864 Act was abandoned in 1886, following women’s concerted pressure, while in 1890, the Asylum Law was modified by the government in accordance with Louisa Lowe’s recommendations: these changes stand as weighty indications of the influence women patients had by then achieved in the public sphere. As the century closed, it was clear that if psychiatrists wanted to stop being continually challenged, they had to take a step in the direction of their women patients. Doctor
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Forbes Winslow67 probably offers the most spectacular example in this respect. After being dragged through the courts for having agreed to intern Georgina Weldon at her husband’s request without even having seen her, Winslow then performed a radical U- turn: he began by personally apologising to Weldon, then moved to become her close friend. Finally, he went so far as to pen the preface of a book by Marcia Hamilcar,68 another woman to have suffered at the hand of psychiatry.
23 Even if Winslow’s example is somewhat extreme, it is nonetheless true that from the 1890s on, the entire medical world began to adopt a far more prudent attitude towards women. Together with the repeated anti-psychiatrist campaigns, such an evolution in medical thinking was furthered by the fact that increasing numbers of doctors began to encounter colleagues who were female. For, as several doctors were to remark during the annual meeting of the Medico-Psychological Association in 1893, the women present had not only succeeded in their medical studies, but had proved themselves to be excellent practitioners, all without any signs of degeneration.69 It had thus become necessary to face up to the evidence: the female brain was undoubtedly not quite as feeble as had been thought and there was probably no clear evidence to suggest that women could not undertake “men’s occupations”. Naturally, the change in thinking was not universally accepted. We have spoken of Maudsley’s vexation, cut off in total silence; Crichton-Browne reiterated his convictions until death, while Almroth Wright70 (a biologist and partisan of traditional evolutionist psychology) became an anti- suffrage leader.71 Nevertheless, it should perhaps be noted more firmly than has been done hitherto, that the increasingly extravagant comments of these men were prompted, to a large extent, by their perception that their colleagues had begun to think twice about female inferiority, as indeed the voting at the BMA and M-PA in 1893 and 1894 had demonstrated, together with the association’s acceptance, while they were at it, of some forty women doctors. A few years later, Thomas Claye Shaw,72 another well-known alienist, summed up the state of mind of many doctors at that time, saying that they had to admit that the skilled achievements of women had exposed their shortcomings; final proof that women had a “special psychology,” had indeed been provided, a psychology of a particularly unpredictable and progressive nature and one which had to be entirely reconsidered.73
24 Studies of the relationship between psychiatry and women’s history have often been conducted in an accusatory tone, with feminist researchers in particular stressing the employment of the so-called mind sciences to repressive ends, and some, such as Phyllis Chesler, going as far as to support judicial lawsuits against psychiatrists. But while such militant foregrounding of doctors’ victimisation of women might be a useful and even necessary thread of historiography, it has nonetheless led to the eclipse of another side of the question: the way in which patients endeavoured, sometimes with success, to respond to those doctors. Thus in line with a history of science which at present stresses the interaction between lay and expert discourses, we have tried to show here that even psychiatric knowledge has not been impermeable to patient reaction: in Britain, women patients even managed to rock psychiatry’s vision of the female mind. But we should not go so far as to reverse the equation; the British example is an exception. Moreover, even if women succeeded in challenging the theories of the weaker mind, this did not mark those theories’ total disappearance: they remained the backdrop to representations of women. When the suffragettes launched their more militant movement at the beginning of the twentieth century,
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these ideas quickly returned as the common way of thinking. Women were treated as hysterics,74 their behaviour was said to illustrate the imperfections of the female brain, and naturally, doctors were called on as backup. As a result, activists were interned and the order issued that in the event of hunger strikes, women should be force-fed in the same way as some of the insane had been. The episode illustrates yet again the collusion between psychiatry and the subjection of women. Yet here too the situation turned itself around. For not only were psychiatrists unhappy about being so openly requisitioned, they were confronted with fresh demonstrations of the gaps in their thinking. For if women were truly a weak and nervously fragile sex, how could they ever have succeeded in organising themselves and even holding the government to ransom? Acting on the obvious conclusions, some doctors at this point switched sides and supported the suffragettes;75 thus, in short, certain psychiatrists became feminists, an unthinkable state of affairs thirty years earlier and one which brought an unexpected turnaround in the prolonged doctor/woman-patient exchanges. Once more, this particular feature of British history cannot be transposed. Nevertheless, it illustrates a further aspect of the link between feminism and psychiatry, in which medical excesses sometimes played a somewhat paradoxical role, serving as much to construct as to destroy the women's movement.
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NOTES
1. George Fielding Blandford (1829-1911); see below for further bibliographical information. 2. Extract from a letter Blandford sent to the press in his own defence (Anonymous, 1895). 3. Lanchester 1983; Showalter 1987: 146-147. 4. Authorship in the field of psychiatric history is quite mixed, except with respect to the different treatment of the sexes, where almost all the work has been by women historians (Tomes 1994). 5. Chesler 1972. 6. Appignanesi 2008. 7. Showalter 1987. 8. In French, les “sciences psys,” an umbrella term often used to cover psychiatry, psychology, psychoanalysis, etc. 9. By way of example, the first woman to become Chief Medical Officer in an asylum in France only did so in 1920 (Constance Pascal in Prémontré). 10. As we will see, Edith Lanchester was finally released. Speaking more generally, we may note as illustration the fact that women were among other things, much more frequently lobotomised than men. (Showalter 1987). 11. As footnotes 16 and 19 explain, Scotland has its own independent Health Service; nevertheless, since the debate over women extended over all British territory, we will use the term “Britain”. 12. Foucault 2003. 13. “Moral” is understood here as antonym to the physical (the physical and the moral). 14. Chesler 1972; Showalter 1987: 3. 15. Tomes 1990; Fauvel 2010. 16. In France, a law of 1838 requireded that every départment take responsibility for all psychiatric patients within its boundaries by financing the relevant institutions (asylums). In England and Wales, a similar ruling was adopted in 1845, while Scotland had an independent system. 17. Scull 2004. 18. The numbers of those interned by the public sector in Britain grew from approximately ten thousand in the 1840s to 50,000 in the 1860s, moving to almost 70,000 in 1871 and then to more
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than 100,000 in 1900 (Scull 2004): an evolution similar to that of France (Chapireau 2007, Fauvel 2010). 19. The Scots and the Belgians took distinctive approaches here, deciding to run large-scale tests based on following up the insane who were “at liberty” within small organisations such as host families. A century before the setting-up of similar activity in France, a third of Scottish patients were already benefiting from treatment outside institutions. 20. A brilliant orator, Henry Maudsley (1835-1918) was Professor of Medical Jurisprudence at University College, London, from 1869 to 1879. From 1866-1874, he directed a small mental health residence for women, Lawn House. 21. Valentin Magnan (1835-1916) was Medical Director of Admissions at Sainte-Anne’s Hospital in Paris throughout his working life. 22. Pick 1989. 23. Crichton-Browne 1892: 949. 24. Moscucci 1990; for an example of gynaecological analysis of mental problems: Barnes 1890. 25. Kingsley Kent 1990; Moscucci 1990; Oppenheim 1991; Sheehan 1997; Scull 2006. 26. Descendant of a family of Scottish doctors, James Crichton-Browne (1840-1938) was director of the Wakefield Asylum (1866-1875), then named Chief Inspector of the Asylum Service in 1876, a post he occupied for 45 years. 27. Crichton-Browne 1879. 28. Maines 2009. 29. Nineteenth-century medical manuals churned out fantastic descriptions of the clitoris being enlarged by pleasure to penis-like proportions (Laqueur 2005). 30. In this manner, according to nineteenth-century doctors, nymphomania was “often” linked to the death of patients (Fauvel 2012). 31. Maudsley 1874: 466-467. 32. Vertinsky 1990. 33. Maudsley 1874: 468. 34. Maudsley 1874: 479. 35. Maudsley 1874: 477. 36. Mitchell, cited by Scull (Scull 2009: 99). 37. Maudsley 1874: 479. 38. In the inter-war period, some asylums admitted up to 30% more women than men (Chesler 1972, Chapireau 2007). This tendency has reversed, with more men being hospitalised at the present time in closed institutions. 39. Blandford is known for his concept of “moral insanity”: the notion that even if rational, anyone who defended amoral ideas could be considered as sick. 40. Crichton-Browne 1884. 41. Crichton-Browne 1892. 42. The debate became prolonged in the BMJ between May and July. Notably, Crichton-Browne was challenged for not having taken women’s smaller build into account in calculating the ratio of men’s/women’s brain matter and for not having considered the influence of social factors on women’s nervous fragility. 43. Walkowitz 1980; Kent 1990. 44. Notably Josephine Butler (1828-1906) and Elizabeth Wolstenholme-Elmy (1833-1918), in the Ladies’ Association Against the Contagious Diseases Act, founded in 1869. 45. Butler 1896. 46. Wilkinson 1870: 15. 47. Kent 1990: 127-135. 48. The word is employed for example in the bibliography of testimony from patients compiled by Gail Hornstein (Hornstein 2011).
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49. Fauvel 2005. 50. Mellett 1981. The Lunacy Commission was made up of eleven Metropolitan Commissioners (the “Commissioners in Lunacy”): three medical, three legal and five laymen. 51. Created by John Perceval (1803-1876), The Alleged Lunatics’ Friend Society operated from 1845 to 1863 (Hervey 1986). 52. Although the name of Louisa Lowe is known to historians (Bennett, Nicholson & Porter 2003; Owen 1989; Bland 1995), this association has yet to be studied in detail. We thus do not know how many members it had, nor the composition of its membership, although its first report shows that it attracted mainly women (Lowe 1874). 53. On the idea that the hysteric transposed her revolt against masculine and medical authority into the body by way of her pains and convulsions see Cixous & Clément 1975, Foucault 2003. The thesis has been much criticised by English/US writers: Showalter 1987; Caminero-Santangelo 1998. For a summary of the debate, see Tomes 1994. 54. A politically active editor, John Lane (1854-1925) had great influence on the avant-garde. He enabled publication of The Yellow Book and also Professor Hieronimus (Skram 1899), a work written inside an asylum by the Norwegian novelist, Amalie Skram (1846-1905). 55. A music-lover, teacher and militant spiritualist, Georgina Weldon (1837-1914), having succeeded in escaping from the confinement requested by her husband in 1878, spent the rest of her life battling against the collusion between doctors and husbands. 56. Lowe 1883; Weldon 1882. 57. Owen 1989; Walkowitz 1992; Bennett, Nicholson & Porter 2003. 58. Lanchester 1983; Owen 1989; Bland 1995. 59. Charles Reade (1814-1884) was among other things the author of Hard Cash (1863), the history of arbitrary confinement, a work that was republished seven times up until 1914. 60. The “rest-cure” is associated with the American, Weir Mitchell (1829-1914). It consisted of forcing women who were “intellectually exhausted” to follow a weight-gaining diet over several weeks with enforced rest. One woman to be submitted to the treatment was Virginia Woolf. 61. C.S.C. (Churchill) 1912, in response to an article by Almroth Wright (Wright 1912). 62. Sophia Jex-Blake and Elizabeth Blackwell belonged to the “group of seven” – the first women to have attempted to enrol together in a British university (Edinburgh). Following their ultimate rejection, Jex-Blake opened a medical school for women in London in 1874. 63. Kent 1990: 131-132. 64. Born in London, Mary Corinna Putnam Jacobi (1842-1906) lived in the United States before returning to Britain, then moving to Paris, where she gained her medical doctorate in 1871. She then returned to America. 65. The American, Charlotte Perkins Gilman (1860-1935), is famous for having shown through a book (Gilman 1892) how the “rest-cure” could in actual fact provoke madness (a story inspired by her own experience). For the bonds and reciprocal inspiration between Perkins Gilman and Jacobi, see Bittel 2009. 66. Following a seven-month confinement, Ann Pratt, a simple “mulatto” woman, circulated throughout Kingston a pamphlet describing the cases of torture she had witnessed while in an asylum (Pratt 1860). This prompted a local enquiry in 1861, then an investigation across the Empire in 1883 (Jones 2008). 67. Lyttelton Stewart Forbes Winslow (1844-1913), who had taken on his psychiatrist father’s clinic, became famous following the Weldon affair, but will be remembered by posterity for having investigated the case of Jack the Ripper, in whose crimes he showed so great a interest that he himself was suspected of being the murderer. 68. Hamilcar 1910. 69. Anon. 1893: 598-602. 70. Almroth Wright (1861-1947) is known for having developed an anti-typhoid vaccination.
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71. Wright 1913. 72. Thomas Claye Shaw (1841-1927) practised in various asylums (Colney Hatch, Leavesden, Banstead). In addition to a successful psycho-surgical experiment on a general paralytic, he is recognised for his analyses of the links between crime and madness. 73. Claye Shaw 1908. 74. Wright 1912. 75. As examples of this, Thomas Claye Shaw, who was by no means revolutionary in his ideas, challenged the diagnosis of madness (Claye Shaw 1913), while Charles Mansell Moullin (1851-1940) and Agnes Savill (1875-1964) criticised force-feeding as being physical and mental torture (Savill, Mansell Moullin & Horsley 1912).
ABSTRACTS
Psychiatry is sometimes described as a particularly sexist science, having contributed in the past to derogatory discourses on the inferiority of the so-called “weaker sex”, and colluded in practice with the consignment of women to mental institutions. The “mad-doctors” agreed to hospitalize “abnormal” women who dared to rebel against male desires. This article does not question the link between psychiatry and anti-feminism, but considers this history from another angle, by analysing the repercussions of this sexist standpoint on the shaping of medical knowledge, and conversely, on representations of female patients. The British case demonstrates that not all physicians accepted theories about women’s mental inferiority, and that such theories were sometimes contested by the patients themselves. “Psychiatric power” was not all-powerful, nor did it necessarily speak with one voice. By exploring the debates surrounding the “weaker brain” theory in nineteenth-century Britain, this paper aims to shed fresh light on the construction (and deconstruction) of psychiatric ideas, and to help understand how the subjects of such ideas – women patients – sometimes succeeded in challenging the views of their doctors, “from below”.
INDEX
Keywords: history, psychiatry, 19th century, women, gender, Great Britain, feminism, medical misogyny, Maudsley (Henry), Crichton-Browne (John), Lowe (Louisa), Weldon (Georgina)
AUTHORS
AUDE FAUVEL Aude Fauvel is based at the Institut universitaire d’histoire de la médecine et de la santé publique (IUHMSP) in Lausanne. Her thesis was on the history of French psychiatry (EHESS, 2005) and she has also studied British mental institutions. Recent publications include: “A world-famous lunatic. Baron Raymond Seillière (1845-1911) and the patient’s view in transnational perspective”, in W. Ernst & T. Mueller (eds), Transnational Psychiatries. Social and Cultural Histories of Psychiatry in Comparative Perspective c. 1800-2000 (2010) and “Women and psychiatric
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institutionalisation in France”, in P. Bourdelais and J. Chircop (eds), Vulnerabilities, social inequalities and health in perspective (2010). [email protected]
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The gender of cancer
Ilana Löwy
1 While some cancers are strictly sex-specific, the overall incidence of cancer is nevertheless considered broadly similar in both sexes.1 This ‘gender-balanced’ view is a relatively new development. Until mid-twentieth century, cancer was viewed as a disease that affected mainly women. This view reflected the greater visibility of breast cancer and cancers of the female reproductive organs. Before the advent of modern diagnostic technologies, doctors often failed to diagnose malignant tumors of internal organs. People suffered from digestive troubles, jaundice, “fits,” shortness of breath and “the ailments of old age,” rather than from stomach, colon, liver, brain or lung cancer. On the other hand, it was difficult to miss the dramatic changes in a cancer- affected breast, or the massive blood loss and abundant vaginal secretions in advanced uterine cancer. In the nineteenth and early twentieth century, mortality statistics in France and England – while far from accurate – recorded nearly three times more cancer deaths among women than among men. The tide turned only in mid-twentieth century, with the increase of accurate diagnoses of malignancies of internal organs and the rapid rise in deaths from lung cancer among men.
2 This article focuses on the period when experts and organizations active in the area of cancer prevention and treatment area spoke mainly about and to women.2 Drawing on both primary and secondary research concerning Europe and North America, it explores both the medical discourse and the practices related to the treatment of women’s cancers.3
Mothers and sinners: female cancers in the nineteenth century
3 In the nineteenth century, doctors offered a variety of explanations for the high incidence of uterine cancer among women. For some, immorality and sexual excess explained the appearance of malignancies.4 The Canadian doctor Guillaume Vallée affirmed in 1826 that lower-class women who lived in cities suffered more often from uterine cancer than those who lived in the countryside, a difference best explained by
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the greater moral laxity of city-dwellers.5 Other physicians noted, however, that prostitutes were no more prone to uterine tumors than “honest” women. Still, many physicians enumerated among causes of such tumors masturbation, excessive sexual activity and inordinate sexual desire, syphilis and other venereal diseases, abortion, as well as disorders of women’s “critical age” (menopause).
4 In 1842, a surgeon from Padua, Domenico Rigoni-Stern, demonstrated that nuns rarely suffered from cancer of the womb, while they had higher than average frequency of breast tumors.6 The observation that the same group of women was unusually susceptible to one kind of malignant tumor and unusually resistant to another kind, challenged the widespread belief that the principal cause of cancer was a moral propensity or a hereditary predisposition to develop malignancies (“cancer diathesis”). Rigoni-Stern’s observations also suggested that cancer of the womb might be linked with sexual activity. The British physician J.W.C. Lever similarly stated in 1839 that unmarried women rarely suffered from cancer of the uterus, suggesting7 that the development of this pathology might be favored by childbirth. By the late nineteenth and early twentieth century, this opinion had become widespread, and many gynecologists became persuaded that uterine cancer was linked not to sexual excess, but to the damage produced by multiple pregnancies and traumatic childbirth.
5 For much of the nineteenth century, doctors talked about a single type of cancer, that of “the matrix”, but by the later years of the century, experts were making a distinction between cancer of corpus uteri (later known as endometrial cancer), and – the then much more frequent – cancer of the uterine cervix (cervical cancer). They believed that only the latter disease was linked with low socio-economic status and with post-partum damage. Cervical cancer was more frequently found in poorer women, because they had more children and had less means of access to proper medical care when they gave birth, so were likely to suffer from more severe cervical tears.8 Poverty was also linked to faulty hygiene, higher frequency of sexually transmitted diseases, miscarriage and abortion, all of which facilitated the development of chronic inflammation of the cervix, seen as a precursor lesion of cervical malignancy. Sexuality was not entirely absent from the argument on links between poverty and uterine tumors, since sexually transmitted diseases and abortions were seen as the consequence of the supposedly more lax sexual mores of lower-class women. However, in the first half of the twentieth century, numerous gynecologists believed that a higher occurrence of cervical cancer among poor women was chiefly the result of frequent pregnancies, inadequate medical care, and harsh living conditions. This cancer had become the scourge of the poor mother.
Detecting and treating female malignancies
6 In the early nineteenth century, many physicians assumed that they could prevent at least some of the suffering produced by uterine cancer through the treatment of cervical lesions (“squirrhus”) before they became an irreversible “cancer”.9 In 1836, the French gynecologist Pierre Téallier compared this preventive treatment of suspicious gynecological lesions with the prevention of social unrest through the repression of its first manifestations, both being more effective the earlier they were tackled.10 Téallier, like other cancer experts, emphasized the importance of medical consultations as soon as women observed suspicious symptoms, such as irregular bleeding. This was,
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however, a difficult task. Women were reluctant to consult for minor gynecological troubles, and most women did not have the financial means to do so. As a result, they often saw a doctor only when their tumor induced more serious symptoms. At that stage, specialists wrote, the illness was incurable and the physician could only observe its inexorable progress.11
7 With the development of surgical ablation of the uterus (hysterectomy) in the late nineteenth century, doctors were finally able to propose a therapy for uterine malignancies. Hysterectomy was at first a very hazardous form of surgery with a high mortality rate, but gynecologists believed that it should be attempted when possible, given the alternative of a slow and painful death. In the early twentieth century, survival rates of hysterectomy had improved, but this operation was ineffective if the cancer had already spread to other parts of the body.12 Physicians continued therefore, this time with more solid arguments, to urge women to consult a doctor as soon as they observed any suspicious gynecological symptoms. Their goal was to increase the proportion of tumors detected in an “operable” stage, that is, those limited to the uterus only.13
8 Anti-cancer organizations in Europe and North America energetically promoted the slogan, “if detected early, cancer can be cured”. If one reads this phrase carefully, it merely states that while some localized malignant tumors are curable, all the disseminated ones are deadly. The usual interpretation of this slogan was, however, different. It strongly hinted that a patient who knows what early signs of cancer are, and who promptly consults a competent doctor on observing such signs, has a good chance of being cured. It also indirectly implied that patients who died from cancer might have been at least partly responsible for their fate.14 Educational campaigns organized by cancer experts and anti-cancer organizations often focused on female cancers (of breast and uterus), which were considered “treatable”. Such campaigns promoted an upbeat message and downplayed the harsh realities and uncertain results of cancer treatment.15
Early detection of cancer of the uterus
9 Thanks to the “early detection” campaigns for cervical cancer, many women became persuaded that they should see a physician rapidly if they observed symptoms such as irregular bleeding.16 In the inter-war period, gynecologists discovered, however, that not infrequently a woman who consulted them immediately after noticing suspicious gynecological symptoms had a disseminated, that is, incurable malignancy. The “early” medical visit was sometimes too late. The next step was to persuade “asymptomatic” (that is, healthy) women to undergo regular gynecological examinations, in order to detect “silent” cervical lesions.17
10 In 1938, the Philadelphia gynecologist Catherine Macfarlane began a pilot program for an early detection of cervical cancer. M Macfarlane’s original project was to provide free gynecological examinations in poor areas of the city. Poor women, especially black women, had the highest frequency of uterine tumors. Since they could not afford visits to a gynecologist, they were often diagnosed with advanced, incurable malignancies. The local medical community, and the administrators of Women’s Medical College to which she was affiliated, strongly opposed Macfarlane’s project, because physicians were afraid that a free distribution of medical services would reduce their private
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practice and introduce a dangerous percentage of “socialized medicine”. The Women’s Medical College finally approved the project, but on condition that Macfarlane would examine only women referred by their physicians – that is, those who could afford private health care. Macfarlane’s program provided important insights into the natural history of cervical tumors but was of no assistance to women who had the greatest need for early detection of this malignancy.18
11 In the 1950s, physicians developed a cheaper and simpler alternative to regular gynecological visits: the cervical smear (Papanicolau or PAP test). The test was labor- intensive and difficult to standardize, but was nevertheless successfully transformed into a “workable” tool in screening for the presence of anomalies of the cervix.19 Cancer specialists and organizations in North America and Europe strongly promoted cervical smears. The UK campaigns had a direct public health dimension. Educational films produced in the UK in the early 1960s specifically targeted working class and migrant women. These films sought to eliminate women’s fear of “the test” and of the treatment involved if suspicious cervical lesions were found. They encouraged women to take responsibility for their own health, but above all stressed their duty, as mothers, to be healthy for the sake of their children and partners. The films explained that treatment of precancerous cervical lesions was simple and without danger for woman’s fertility or sexual life. The latter affirmation was designed to persuade husbands, who sometimes opposed testing for cervical tumors. Another argument directed at husbands was that a spouse’s serious disease would disrupt their lifestyle: “no more nights out at the pub, no more football on Saturdays, just staying home with all those noisy kids.”20
12 In the US, cervical cancer was not presented as a public health issue or a pathology linked with a lower socioeconomic status, but as an individual problem: every woman, these films explained, was at risk from this disease. Accordingly, educational films in the US on the importance of screening for cervical malignancies mainly showed middle-class women in a middle-class setting. These films explained that regular PAP smears offered women security, personal happiness and freedom from the threat of cancer.21 At the same time, US educational materials also emphasized a woman’s duty to herself and her family to undergo regular tests, and hinted that women who developed cervical cancer were, at some level at least, responsible for their fate.
Early detection of breast cancer
13 Breast cancer was another malignancy presented as curable if detected early. Specialists urged women to be vigilant about changes in their breasts, and if they discovered a lump or other suspicious change, to consult a doctor immediately. “Delaying” a medical consultation, even by a few weeks, was presented as highly irresponsible behavior, which deprived the “delaying” woman of any chance of a cure. After World War II, the “do not delay” message was reinforced by the introduction of breast self-examination technique (BSE); women were urged to do this monthly. The American Cancer Society published posters and leaflets in the 1950s and 60s explaining the dangers associated with the neglect of BSE, illustrating its argument with testimonies by women who claimed that the examination had saved their lives or, occasionally, that they were dying from cancer because they had failed to perform BSE regularly.22 These educational materials transmitted an implicit message that advanced
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breast cancer was a self-inflicted disease. BSE was advocated in Europe too, although it was less widely adopted there than in the US.23
14 Women who practiced BSE remained strongly attached to this method even when clinical trials conducted in the 1990s had shown that it was not very efficient, perhaps because this technique allowed them to believe that they could protect themselves from a dread disease.24 Mammography screening was developed in the 1960s and 70s, and was massively diffused from the 1980s on, in spite of persistent controversies about the efficacy of this approach. Its rapid spread may be partly explained by women’s intense attachment to this method, which gave them the impression, once more, that they could themselves control the risk of getting breast cancer.25 Debates on the benefits of mammography remained, in the main, confined to specialists, and had limited visibility in the public space.26 The majority of anti-cancer organizations enthusiastically supported mammography screening, and women have tended to entertain very exaggerated ideas about the capacity of this technique to reduce breast cancer mortality.27 In a survey carried out in 2009, 2% of French women gave an accurate estimate of the effectiveness of mammography, 15% exaggerated its efficacy 10 times; 22%, 50 times; and 45%, 100 times or more (16% answered that they did not know).28
15 Before the 1980s, women were invited to follow their doctor’s advice. Posters and propaganda films from that period frequently show a subdued and conservatively dressed woman attentively listening to a male medical practitioner. By contrast, educational materials from the last 30 years emphasize women’s self-empowerment, and show energetic, youthful and smiling women who proudly proclaim they take good care of themselves through a regular screening of their breasts.29 In spite of great differences of language and style, the message promoted in the 21st century is not very different from the one propagated in the pre-women’s liberation period. Women are asked to submit themselves to external control, and, at the same time, to appeal to clinical specialists. In the apt expression of the sociologist Ann Robertson, they are urged to “swallow the panopticon.”30
Women doctors and female malignancies
16 In the nineteenth and early twentieth century, the only cure for cancer was surgery, often of a radical kind. At the time, there were not many female doctors, and even fewer female surgeons. Women who chose a surgical career often specialized in “female diseases,” including cancer. One of the early pioneers of surgical treatment of cancer of the uterus in the US was Mary Dixon-Jones. Dixon-Jones had a far from orthodox career. First trained in general medicine, and practising homeopathy and hydrotherapy, she retrained as a surgeon in her late forties. She then founded the Women's Hospital of Brooklyn, specializing in surgical treatment of gynecological diseases. Mary Dixon-Jones was the first US surgeon to perform an ablation of the uterus in 1888, and believed that this surgery should be proposed not only to women with confirmed cancer, but also to those at risk of this disease.31 In the late nineteenth century, doctors concurred that many of women’s health problems were linked to their reproductive functions. Nevertheless attitudes towards surgical ablation of female reproductive organs, uterus and ovaries, as a cure for “female diseases,” varied greatly. Some gynecologists strongly supported this therapeutic approach, while others
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strongly criticized it.32 The controversial reputation of gynecological surgery coupled with high mortality rates, and in the case of Dixon-Jones a suspicion attached to women surgeons, produced an explosive mix.
17 In 1889, Dixon-Jones was accused of second degree manslaughter after the death of her patient Ida Hunt. The historian Regina Marantz Sanchez, who has studied Dixon-Jones’s tumultuous career, presents evidence that Ida Hunt was a chronically ill young woman, probably as a consequence of venereal disease acquired from her husband. Her surgery may have been a last ditch effort to regain her lost health. Some women, Marantz- Sanchez argues, sought Dixon-Jones’s clinic precisely because she advocated radical surgical measures.33 This was, however, a risky practice. Dixon-Jones was acquitted of manslaughter, but a local newspaper, The Brooklyn Daily Eagle published a series of articles accusing her of gratuitous cruelty to her patients, performing ill-advised operations, and being guilty of negligence and incompetence. Dixon-Jones unsuccessfully sued The Brooklyn Daily Eagle for libel in 1892. Unable to clear her name in a highly publicized trial, Dixon-Jones was obliged to abandon the directorship of her hospital and her surgical practice.34
18 Surgical ablations of the uterus performed by the British surgeons Louisa Garrett Anderson and Kate Platt were less controversial. Between 1901 and 1914 Anderson and Platt co-directed the surgical ward of the London’s New Hospital for Women, which specialized in gynecological operations. They strongly advocated radical surgery for uterine tumors, a practice they developed in the late 1890s, and expanded in the first decade of the twentieth century. In the 1880s, a quarter of all women who underwent an ablation of the uterus died from its immediate effects or from post-operative infections. By 1908, Anderson and Platt could boast that this surgery had become much less dangerous; the mortality rate at their hospital was only 6.6%. They admitted that the chance of a permanent cure of cancer through this operation was not very high, but, they argued, even a low chance of cure was better than a certainty of a lingering, painful death.35
19 Female surgeons such as Mary Dixon-Jones or Louisa Garrett Anderson embraced the male surgeons’ ethics of daring behavior and willingness to take risks. This choice may have been motivated by an aspiration to demonstrate that, as professionals, women were no different from men. Other women physicians chose a different approach. They saw themselves as spokespersons for their sex, and promoted treatments which they believed were less harmful and more acceptable for women. Thus in Britain, women played an important role in the development of radiation therapy for gynecological malignancies, above all cancer of the cervix. In 1929, the British Medical Women’s Federation provided funding for the Marie Curie Hospital, dedicated to radiation therapy of gynecological cancers and staffed exclusively by women doctors. Leaflets presenting the new hospital explained that women nervous about consulting a male doctor would be able to talk to another woman, who would able to understand the precise nature of their complaint. The literature also reassured poorer people, who were often apprehensive about operations in charity hospitals, fearing that doctors would use their bodies to test experimental surgical techniques. Radiation therapy did not generate such fears.36
20 Women physicians were also attracted to radiation therapy for cancer because this domain opened new professional opportunities for them. In interwar France, a woman doctor had no chance whatever of achieving prominence in the French medical
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hierarchy, of becoming an agrégée de médecine, or head of department in a university hospital, or of being appointed to a university chair. Institutions such as the Curie Foundation in Paris, and the Villejuif Cancer Institute, at the margins of the official academic medicine system, were more able to promote women’s careers. Several women physicians became pioneers of “curietherapy” – the French term for radiation therapy. One of them, Simone Laborde, head of the radiation therapy service at the Villejuif Cancer Institute, developed in the 1930s an innovative approach to radiotherapy. Cancer, Laborde argued, is not an alien enemy but a diseased part of the body. The destruction of healthy tissues through excessive radiation not only produced more severe side effects, but reduced the body’s ability to deal with malignant cells. Laborde strongly opposed therapeutic strategies grounded in the belief that in the “war against cancer” more is always better.37 Her objections to “heroic therapies” may have been grounded in awareness of the concrete experience of her patients. Some women feared secondary effects of radiation more than the cancer itself. One Canadian woman who refused to undergo radiotherapy for cancer of the uterus in the 1930s explained that, three of my friends had similar treatment and they told me they were dying a death of a fiery internal furnace. Knowing of their untimely deaths and awful agony, I was determined to die comfortably, if needs be by the inroads of cancerous growths.38
Preventive surgery and women: from the nineteenth to the twenty-first century
21 Laborde’s physiological understanding of cancer was a minority view. The majority of experts viewed cancer as a particularly dangerous enemy, and many saw the preventive elimination of “precancerous” tissues and organs as an especially efficient way to fight this enemy.39 This approach was, however, limited almost exclusively to women’s cancers. The accessibility of these cancers explains in part why they became targets of preventive surgery. Another and perhaps even more important reason was the existence of a long tradition of surgical excision of women’s reproductive organs, whether diseased or healthy.40
22 Feminists have often criticized doctors’ lack of sensitivity to women’s needs, and their wish to control female reproductive functions. Already in the nineteenth century, activists protested against the surgical ablation of ovaries (“the de-sexing of women”) and unnecessary hysterectomies. They presented these operations as typical expressions of the brutal treatment of women by the medical profession.41 Recent scholarship has nuanced this interpretation, however, suggesting that radical surgery was directed more against tumors than against women. Writing about the medical culture of breast cancer treatment in the nineteenth century, Erin O’Connor has argued that the nineteenth century discourse about breast cancer reflected the harsh reality of suffering induced by advanced breast malignancies. Doctors who watched women die painful deaths desperately tried to do something to prevent such deaths.42 The feminist sociologist Barbara Rothman has similarly concluded that surgeons who opposed conservative surgery for breast cancer were not driven by misogyny but by a concern to do the best for their patients while limiting their own risk of making medical mistakes.43
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23 Attitudes towards radical surgical treatment of already existing and invasive malignancies were indeed not very different for both sexes. Men also had a full share of “heroic” and mutilating surgeries, notably for the treatment of head and neck tumors. The latter tumors, linked to smoking and to alcohol consumption, were more frequently found in men. On the other hand, surgery for the elimination of a cancer risk – that is preventive ablation of breasts, ovaries and the uterus – was almost exclusively practiced on women. One exception was a rare hereditary form of colon cancer, familial adenomatous polyposis, treated by preventive removal of the colon. However, in the latter case, prophylactic surgery was proposed only to people (of both sexes) who were almost certain to develop colon cancer. Breast cancer was a very different case. Doctors recommended preventive surgery to women even for lesions whose probability of becoming cancerous were unknown: e.g., women with precancerous transformations of breast tissue (ductal carcinoma in situ, or DCIS), and carriers of mutations of the BCRA gene which increased their chances of developing breast and ovarian tumors.44
24 American epidemiologists claimed that women presenting with a small tumor in the breast, or genetic predisposition to this cancer were increasingly opting for preventive removal of both breasts.45 Such a radical decision was linked to the never-ending awareness campaigns that have left many women in perpetual fear of the disease […] Because breast cancer is a disease that is so emotionally charged and gets so much attention, I think at times women feel almost obligated to be as proactive as possible - that’s the culture of breast cancer.46
25 Preventive treatment of cancers of the female reproductive organs – which may be contrasted with the more conservative treatment of risk of cancer in the male reproductive organs – may have been encouraged by the greater visibility of these pathologies.47 Such visibility probably reflects the long tradition of debates and public campaigns focused on women’s cancers. Breast cancer is omnipresent in the media and in the public space. It has also became a quasi-ritualized literary topic, with a flood of “pathographies” (personal narratives of diseases), essays, novels, photographs and other art works. This is not the case for prostate cancer. In spite of its high incidence, prostate cancer is rarely discussed in the media and popular books, and is seldom noticeable in the public space.48 In spite of its “official” image as a disease that strikes indiscriminately at both sexes, in the twenty-first century too cancer remains a gendered pathology.
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NOTES
1. Banks et al. 2006. Their data deal only with overall frequency of cancers, and not with the distribution of specific cancers. 2. Reagan 1997; Moscucci 2005; Jansen 2011. 3. Aronowitz 2001; Gardner 2006; Löwy 2009 and 2011. 4. Nolte 2008. Breast cancer was less strongly linked with specific lifestyle elements than cancer of the womb. 5. Vallée 1826: 10. 6. Scotto & Bailard 1969. 7. Lever 1839. 8. Laudon 1988: 183-228. 9. Meigs 1859: 333. 10. Téallier 1836: 108. 11. Rossignol 1806: 23; Legoux 1826: 35. 12. Moscucci 2005. 13. Bloodgood [ca 1916]. 14. Patterson 1987; Lerner 2001. 15. Gardner 2006: 53-92. 16. Milligan 1907; Pichevin 1912. 17. Annual rapport of the Curie Foundation for 1932. Minutes of meeting of the foundation’s administration council of 4 May 1934. Curie Institute Archive, Paris. 18. Catherine Macfarlane papers. Medical College of Philadelphia archive, account 47, Box 2, Folder 23, typed ms “The inside history of periodic pelvic examination research”; Macfarlane, Sturgis & Fetterman 1953. 19. Casper & Clark 1998.
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20. Wellcome Library, Archives and Manuscripts Dept, series SA/MWF, Documents of the Medical Women Federation, File F.13/10. Documents from the Meeting of the “Film Working Party of the Women’s National Cancer Control Campaign,” 13/12/67. 21. Cantor 2007. 22. Aronowitz 2001; Gardner 2006. 23. Wardle et al. 1995; Eisinger et al. 1999. 24. Green & Taplin 2003; Hackshaw & Paul 2003. 25. The diffusion of mammography coincided with a reduction in breast cancer mortality in many industrialized countries. However, the spread of this technique also coincided with the development of important therapeutic innovations. It is therefore difficult to evaluate the mammography’s contribution (if any) to this decline in breast cancer mortality. Welch 2004. 26. Jorgersen & Gotzsche 2004. 27. Nekhlyudov, Ross-Degnant & Fletcher 2003. 28. Gigerenzer, Mata & Frank 2009. Women also had exaggerated perceptions of the contribution of mammography to the reduction of the number of mastectomies. 29. Gardener 2006; Toon 2008. 30. Robertson 2001: 293-309. 31. Dixon-Jones 1893. 32. Moscucci 1990. 33. Morantz-Sanchez 2000: 301. 34. Morantz-Sanchez 1999. 35. Garrett Anderson & Platt 1908. 36. Moscucci 2007: 158. Radiotherapy for cancer was introduced in the 1910s; by contrast chemotherapy for breast and uterine tumors became routine treatment of these malignancies only in the 1980s. 37. Quoted by Hugenin 1946: 166. 38. Clow 2001: 301. 39. Siddhartha Mukherjee’s bestselling book, The Emperor of all Maladies: a biography of cancer illustrates the continued popularity of the concept of a “war against cancer”. Mukherjee 2010. 40. Moscucci 1990. 41. Walkowitz 1980; Moscucci 1990. 42. O’Connor 2000: 78-99. O’Connor is aware of the misogyny of nineteenth-century surgeons, but argues that it did not play an important role in their choice of cancer treatments. 43. Rothman 1998: 154-158. 44. Burstein et al. 2004; Aronowitz 2007: 257-282. 45. Lerner 2001. 46. Parker-Pope 2013. 47. E.g., Groopman 2000; Klotz 2006. 48. On the political underpinning of breast cancer charities activities see e.g. King 2006.
ABSTRACTS
Today cancer is seen as a disease that affects both sexes roughly equally. This is, however, a relatively recent development. Until the mid-twentieth century, cancer was viewed as a
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pathology mainly affecting women, because female malignancies produced typical symptoms, and were easier to detect. In the twentieth century, women’s cancers – of breast and uterus – became the principal targets of public campaigns to promote the early detection of malignant tumours. From the 1950s on, the development of more efficient diagnostic methods and the increase in the prevalence of lung cancer, a disease found more often in men, put an end to the image of cancer as a female pathology. On the other hand, cancers of female reproductive organs continue to be more visible in public discourse and the media than those of male reproductive organs, and preventive – and mutilating – forms of surgery are more often proposed for women at risk from these pathologies.
INDEX
Keywords: malignant tumours, breast cancer, cervical cancer, mastectomy, hysterectomy, PAP smear, early detection, preventive surgery, cancer charities, propaganda films
AUTHOR
ILANA LÖWY Ilana Löwy is a biologist and historian of science and directs research at the Institut national de la santé et de la recherche médicale (INSERM/ CERMES) in Paris. Her own research is on the interaction of bio-medecine and gender studies in a number of fields. Her many publications include Preventive Strikes: Women, Precancer and Prophylactic Surgery, (2009); A Woman’s Disease: A History of Cervical Cancer, (2011); with Catherine Marry, Pour en finir avec la domination masculine : de A à Z (2007). She has co-edited with Delphine Gardey, L’Invention du naturel. Les Sciences et la Fabrication du masculin et du féminin (2000), and with Hélène Rouch, La Distinction entre sexe et genre. Une Histoire entre biologie et culture, special number of Cahiers du genre (2003). [email protected]
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Sexing hormones and materializing gender in Brazil
Emilia Sanabria Translation : Regan Kramer
1 Hormones have become central to contemporary understandings of sex. They are quintessentially hybrid, complex objects, cutting across political and sexual economies. Their use opens interesting avenues of reflection concerning conceptualizations of “sex” and “gender.” This article builds on historical work on the development of endocrinology1 and on ethnographic research carried out in medical congresses and amongst diverse hormone users to show how sexual dimorphism has been re-inscribed within endocrine practices. I begin with two mutually illuminating cases that speak for the many other instances in which hormones are made to perform gendered tasks. I show how testosterone use in women is increasingly legitimated as Brazilian doctors discuss the clinical applications of androgens in gynecology congresses while “female” hormones are only available to transsexual and travestis through informal means in Bahia and information on appropriate regimens remains unavailable. Together, these two ethnographic cases illustrate the constraints that are set out by the social context in which sex hormones come to be used. They also reveal that although some aspects of “sex,” which are synthesized and manufactured into drugs, can now circulate outside bodies, specific norms and prescription regimens continue to re-inscribe their uses within a dualistic model of sex.
2 In the course of my research, I conducted in-depth interviews with women, gynecologists and travestis2 in Salvador. I also did participatory observations in family planning centers, private clinics and a blood-donation center; and I attended medical congresses, as well as weekly meeting of the Bahian Association of travestis.3 This research allowed me to shed light on the specificity of the Bahian notion of hormônio. I propose that hormônio is understood as a kind of fluid or substance, not unlike blood. This substance is understood to have the capacity to accumulate in the body’s cavities, producing growths or swellings. Its circulation reveals that the body is understood to be fairly malleable. This opens the way for a discussion of hormônio as a gendered substance that circulates between bodies. Based on this data, I examine the extent to
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which my informants’ idea of hormônio simply re-inscribes sexual dimorphism, with estrogen emblematizing activities and characteristics of femininity, and testosterone signifying masculinity, and ask whether, in practice, hormônio exceeds such dichotomizations. In this way, I show that the theoretical distinction between “sex” and “gender” in social sciences is called into question by hormonal practices. In this sense, prescribed and informal uses of these pharmacotherapies enact both a troubling of sex/gender and of the distinction between them. This nevertheless occurs in a highly contested arena.
A brief history of sex hormones
3 Historian of science Nelly Oudshoorn shows that hormones need not have been framed within such a binary model of sex. She argues that the “the chemical model of sex,” brought about by early twentieth-century developments in endocrinology might have led to a break with the anatomical model of sex, which associated sexual identity with the possession of particular organs.4 The formulation of research questions and activities were shaped by scientists’ assumptions concerning the essence of sex, as located in an organ, a gland or in a chemical substance. The chemical model of sex that was uncovered implied a radical break with previous understandings, in that sex, as a chemical agent, was understood to circulate throughout the entire body. Quoting from their correspondence, Oudshoorn describes the wonderful puzzlement of early sex hormone researchers when they gradually realized that not only did male hormones occur in female bodies and female hormones in male bodies, but that estrogens were necessary in emblematically male organisms such as the stallion to enable the androgenizing effects of the male hormones. Without the feminine “substance,” these males couldn’t masculinize! Oudshoorn shrewdly explains that scientists’ disproportionate interest in female sexual hormones was due to the existence of a long- standing gynecological tradition that dichotomized the process of knowledge production around these molecules. Her approach is important because it demonstrates that endocrine sex does not reflect a natural order of things, but was, and indeed continues to be, the product of clinical and experimental practices. Biologist and medical historian Anne Fausto-Sterling goes even further in revealing the extent to which early endocrinologists operated within a heavily gendered understanding of sexual identity. She argues that: “steroid hormones need not have been divided into sex and non-sex categories.”5 Doing so, she argues has meant that “the signs of gender – from genitalia, to the anatomy of gonads and brains, then to our very body chemistry – [have been integrated] more thoroughly than ever into our bodies.”6 In this sense, Fausto-Sterling demonstrates that the chemical model of sex developed by endocrinology – and shaped by the gendered assumptions that orientated their work – actually drove the inscription of gender deeper and more pervasively into the body. The implication of this is two-fold. First it effectively “sexes” the whole body, including organs such as the brain, or behaviors that have come to be interpreted as indexes of sexual identity. Second, it obscures the far-reaching non-reproductive and non-sexual effects of steroid hormones by granting excessive attention to their “sexual” characteristics or by sexualizing their non-sex functions. In what follows, I examine the extent to which the local idea of hormônio simply re-inscribes sexual dimorphism and ask whether, in practice, hormônio exceeds such dichotomisations?
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Making sex exogenous
4 Since the 1950s, hormones have been synthesized and manufactured as pharmaceutical products. This innovation has had powerful concrete implications, because it meant that hormones could circulate, as it were, outside bodies. The radical nature of this possibility undoubtedly explains the fact that the norms and prescription regimens for these substances still massively inscribe their use within a dimorphic model of sex. The question of how hormones are involved in the gendering of bodies dawned on me with particular force during a period of extended fieldwork: shortly before I attended the Congress of the Brazilian Society for Gynecological Endocrinology, which was held in the luxurious Othon Palace in Salvador, I had been wrapping up a series of interviews with several travestis on their use of hormones. It is precisely this juxtaposition of situations and the ensuing discussions that took place over the course of this particularly busy week that afforded the specific insights I hope to convey here.
5 As part of their bodily transformation projects, travestis adopt both oral contraceptives and other methods, such as hormonal contraceptive injections that they obtain in informal ways.7 Hormones designed for physiological females are used according to specific ideas about sexuality and embodiment. Their use is founded on extremely detailed informal knowledge about the effects of hormones. Homemade hormone- therapies of these kinds often double or triple the recommended dosages for physiological females, producing very blatant effects. Such homemade treatments are particularly appreciated by travestis for their effects in producing a feminine disposition and figure, in reducing bodily and facial hair, softening the voice and changing the quality of the skin. They are said by travestis to “quebrar o machão dentro da gente” (lit. “break the macho inside us”). Travestis frequently note their preference for injectable methods, sometimes referring to their milky color and quality. When oral contraceptives are used, they’re generally crushed and mixed into a milkshake, as travestis explain that if they swallow the pills whole, a paste-like deposit accumulates in their stomachs, causing nausea.
6 In the course of my interaction with ATRAS (lit. “behind”), the tongue-in-cheek acronym chosen by the Association of Travestis of Salvador, I was made aware of the political dimension of the struggle to obtain proper medical recognition and assistance.
7 The struggle was twofold. The first step was securing access to basic health care, as – given the high levels of prejudice towards travestis (who are regularly assimilated to prostitutes) and the disjunction between their physical appearance and the names on their identity documents – travestis often find themselves excluded from medical institutions. But their struggle also involved securing recognition of their specific medical needs and obtaining hormônio in the right dosage.
8 Until recently, there had been no medical provision in the Brazilian public health sector for “gender reassignment”, i.e. treating people the medical profession designated as trans-. ATRAS leaders explained to me that although Brazilian travestis are actually different from trans-, Brazilian institutions modeled their position on those established in Europe and North America, where hormone therapy for gender reassignment is dispensed only to individuals wishing to undergo genital surgery. In 2009, the first outpatient service for travestis and transsexuals in Brazil was inaugurated in São Paulo (by the HIV/STD Reference Centre). Protocols in place include orientations and
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definitions of hormonal dosages for the development of so-called “secondary sexual characteristics.” According to the official press release distributed by the center six months after its inauguration, 45% of consultations were for hormonal therapies, 37% for sex-change surgery and 14% for the removal of industrial silicone implants. Manuela, one of ATRAS’s leaders, explained to me in an interview: For us, hormônio is a necessary evil. We have a female identity, we want to assume a female identity, but because of medical prejudice, hormonal therapies are only given to those who are preparing for surgery. We are fighting for the right to be feminine and to have access to the medical care we need in order to assume our identity, but without the obligation to undergo surgery, because we want to retain our penis.
9 This question came up often during the weekly ATRAS meetings I attended. In one such meeting, the question of which medical specialist should be sought was raised. One travesti thought that a gynecologist would be most appropriate, given their knowledge of female hormones. She directed the question to me, but the chair cut in, exclaiming: Are you crazy? What gynecologist? A gynecologist won’t resolve anything! You don’t have a uterus and ovaries, you have a prostate and testicles! What gynecologist is going to look after your prostate, you crazy bitch?
10 This states the problem in its acute form, for in Salvador there is to this day no medical assistance for travestis, a fact that generates concerns about the massive, informal uses travestis make of pharmaceutical hormones. For ATRAS, this question has been singled out as one of political importance, a position that Manuela relayed to me in her commentary on travestis’ refusal to submit to the binary gender norms that are reproduced within bio-medical practice, according to which individuals wishing to effect changes in their sexual identity must do so entirely, or not at all. As a result, she explained, travestis make use of hormones in an unsupervised manner, raising substantial concerns over the long-term effects of this practice for their health. There is no epidemiological data available about the long-term effects of high-level doses of estrogen and/or progesterone on the male reproductive system.
11 My meeting with Manuela finished late that evening, and the next morning I walked into the first panel of the Gynecological Endocrinology Congress entitled: “The Use of Androgens in Gynecology” and presided by the highly controversial Elsimar Coutinho.8 The congress is a thoroughly official affair that is televised and attracts doctors from all over Brazil as well as from other Latin American countries. Panel members present the different types of sub-dermal hormonal implants available in Brazil, their composition and clinical uses. In their presentations, participants move seamlessly from bio- chemistry to risk management for hormones’ side effects to comments about the hormones’ gendered characteristics, such as the self-confidence conferred by testosterone and the maternal instincts associated with progesterone… Coutinho’s presentation on testosterone was immediately followed by the screening of a documentary made for Britain’s Channel 4, entitled: “Testosterone: Are You Man Enough?” This documentary explores the uses made of testosterone by both men and women, not only as a treatment for declining libido but also, increasingly, as a means of boosting assertiveness and self-confidence. Some extracts from the narration are reproduced here: 9 Narrator: Imagine a drug that made you younger, richer, sexier, and all you had to do was rub it on. […] The testosterone revolution is coming. Will you be able to resist? Dr Tedde Rinker, Anti-ageing specialist: […] I call testosterone the “yes”
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hormone. Narrator: Herthoghe is 45. He’s been self-medicating testosterone for 15 years.[…] Herthoghe believes the male hormone could even help cut the divorce rate. He claims to have rescued relationships with testosterone alone. Dr Thierry Herthoghe: I think that a lot of couples that want to divorce because of sex problems, or low love problems, are just hormone deficient persons.[…] Narratior: Testosterone isn’t for men only. Its most dramatic effect is as an aphrodisiac for women. […] Dr Thierry Herthoghe: My wife takes testosterone, I have a sister who takes testosterone. Even my mother takes small doses of testosterone. […] Grace Ross: The fact that I take testosterone […] has given me more insight on how men think, and I can understand why they think about sex all the time. Narrator: Yes, testosterone makes you feel sexy, but it also makes you feel powerful. Malcolm Whitehead, Gynaecologist: I have patients who may have started testosterone because of poor sexual response, but they realise that the major benefit to them is the psychological boost they get in terms of being able to cope more effectively in a male dominated environment. Claude Mahaux: I take testosterone when I have to act like a man. It’s amazing to see how you can be like a man for a few hours, and to stay a real woman after. […] The world is so demanding to us, you know, we have a life in our – with our family, we have a life with our husband, work, leisure, sex, it’s so many different activities, and testosterone gives you maybe the power and energy to put your limits in all these little domains. […] Narrator: Until now, extra testosterone has been a luxury for the rich and powerful. Not any more. US prescriptions for the drug are doubling each year, and like Viagra, a booming black market makes it readily available. […] Once, natural selection put a cap on natural hormone levels, now we can cheat biology.
12 This was a very surprising way to conclude a panel at a medical congress. During the question period that followed, Coutinho stood up, microphone in hand, and addressed the overflowing hall of gynecologists, transforming what might have been a more scientifically informed discussion into a statement about “the patient’s right to choose.” Such a formulation clearly reveals the tension between the logic of choice and the logic of care in health.10
13 “Woman,” Coutinho proclaimed, “can now be dona (mistress) of her own body, and no longer needs to be subjected to the “rules” established by society.” Coming from an advocate of menstrual suppression, the statement is a deliberate pun, since the word for rules also means “period” in the sense of “menstruation,” in Portuguese. Continuing his diatribe, he asked his public to imagine – in the subjunctive, throughout – that his friend Marta Suplicy (the former mayor of the megalopolis of São Paulo, who had recently remarried) had come to him to ask for something to “spice up” her honeymoon. After a pause for effect, frowning and cocking his head to the side, he asked his partly enchanted, partly skeptical audience: What is one to do? Refuse to give her testosterone on the basis of a few potential and ill-explored risks? Tell her, ‘No Marta, stop being silly, what do you think a woman, of your age is doing taking on the largest city in Latin America? Go back to your grandchildren and your knitting, and what’s this business about honeymoons? You’re too old for that nonsense.’ Is that what you would have me tell her? No my friends, I will not do that. But if you want to adopt that attitude, that’s fine, but don’t tell your patients that it can’t be done, tell them you won’t do it and send them to us instead!
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14 Taken together these cases illustrate that whilst sex hormones appear to be reproducing sexual dimorphism, in the manner in which they are coded as “female” and “male,” when we turn specifically to an analysis of their uses, something else is revealed. Androgens have been adopted without noticeable difficulty; both by doctors, who prescribe them, and by women, who use them to create new forms of femininity. With testosterone, women can be like men and yet remain women, we are told. They can become superwomen. Super-desiring and desirable. And perhaps, above all, superproductive. Having seen that the attribution of sexual characteristics can become partially exogenous to the body through the production of hormones in the form of pharmaceutical products, I propose to analyze the way in which these hormones have come to be understood as a kind of substance that circulates between bodies, producing gendering effects. And while the absorption of masculine substance into women’s bodies has been medically and socially legitimized, the opposite is not true.
The fluid properties of hormônio
15 The meaning of the term hormônio is not fully captured by the English term hormone. Hormônio occupies a semantic gap that was opened by humoral ideas about bodily capacities, which derived from seventeeth-century versions of Hippocratic medicine brought to colonial Brazil by European physicians. This humoral understanding of bodies is based on ideas about the flow and transmutability of bodily substances. The common usage, in Bahia, of the singular form – hormônio – gives it a fluid, homogenous quality that is absent in the plural form. Further, the most commonly reported side effects of hormônio are weight-gain and swelling (inchaço); this reinforces the idea of hormônio as a physical substance that saturates the body’s cavities. In this representation, hormônio is seen essentially as a substance rather than as a chemical entity, as one might expect in such a highly medicalized context.
16 These terminology issues and their semantic content emerged with particular clarity in the answers received to the question about hormones in my question guide. “If you had to explain to someone how hormones work, what would you say?” My interview subjects were often thrown by that question, or else they would answer in terms of the hormones’ clinical effects, like weight gain or headaches.
17 The first example came from Antonia, a nurse who works in a plastic-surgery clinic. Antonia, uses Depo-Provera, a contraceptive injection that has allowed her to suppress her period for 10 years. She answered my question with reference to the effects of Depo- Provera in her body: A lot of people think you get fat when you take hormônio. But I didn’t notice anything, no change whatsoever. Actually, my life improved. There were no disadvantages to not getting my period. Except for the fact that it took me three years to get pregnant because of the hormônio… But I don’t know anything about how hormônio works. I can tell you about the advantages of hormônio, but I haven’t got a clue about how it works! I’m not really that interested in that sort of thing.
18 Rosedete is a 27-year-old patient I met in the medical center where she was trying to have a contraceptive implant removed. It had been inserted by a gynecologist who hadn’t explained that it was a hormonal method. She said that all he had told her was: It’s just a thing that goes under the skin […]. I didn’t realize it was hormônio until I noticed the effects. As the months went by, I started putting on a lot of weight.
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Since I stopped Depo-Provera because of the weight gain, how could that doctor have thought I’d want an implant if I had known it was hormônio? He said I should try “shutting my mouth” because food, not hormônio, is what makes people fat. I know it’s the hormônio because I didn’t start gaining weight until I started using hormônio. I don’t know how hormônio functions in my body, but it sure does have an effect!
19 Tatiana is a journalist. She answered my question about hormones by talking about the sense of pleasure and relief she gets from the flux of menstrual blood during her periods. Moving seamlessly from a detailed description of the experience of monthly bleeding to hormônio, she said: I wanted to find out more about that hormonal thing, so I typed “pineal gland” into Google. Apparently it’s a portal of connections. When I pushed the question a little further, she replied: I don’t know anything about hormônio! […] I don’t even know what those bichinhos (little things/animals) are called!
20 Similarly, in the answer I got from Nanda, a communications consultant, gave the connection between hormônio and the relief she gets from monthly bleeding is also quite explicit: I see the function of hormônio in women – the oscillation of hormônio – as the antithesis of the rational. It’s kind of a funny way of looking at it! But the hormonal person is completely surrendered to her body and under its sway. She does things she doesn’t want to do rationally; she loses control. Woman is a being completely full of hormônio, and she has to deal with that. With menstruation, I feel renewed. I don’t think it’s dirty, I feel like it’s a cleansing, an evacuation. It comes out because it has to come out, you know? Why accumulate all that in your body? But I’m talking like a leiga (layperson) now.
21 The association these women make between hormônio, blood and the relief afforded by menstrual bleeding is striking. It came up repeatedly over the course of my research in Bahia and led to more in-depth questions about the local notions of bodily substances. Why did my questions about hormones trigger so many answers about blood?
Hormônio, blood and substance
22 These different examples show that in Bahia, hormônio is sometimes understood as a sort of substance, not unlike blood itself in certain respects. Like blood, hormônio has both specific physiological features and the capacity to accumulate in the body, lodging in its cavities and producing swelling. In order to better understand these local conceptions of blood, and following several people’s advice, I contacted a blood- donation center and explained my research to the staff. They opened their doors to me far more easily that I would have thought; and the health professionals had endless stories to tell about the population’s ideas about blood.11 The main manner in which hormônio is understood to act on blood is through its effects on the flow of menstrual blood. In Bahia, many women have adopted hormonal contraceptives, whose advantages are frequently touted in the media. But these products lead to suppression of the menstrual cycles (which is presented as one of their advantages), and many women eventually give the products up because they are worried about the blood accumulating inside their bodies. For instance, Joseneide, a young blood donor, explained that she had been diagnosed with a fibroma. Since she uses Depo-Provera, she interprets the appearance of the fibroma as a sign that hormônio accumulated in her uterus, forming the growth. Although in Brazil most doctors opt for a surgical
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treatment of fibroids (and in many cases hysterectomy) the last doctor she saw prescribed a hormonal treatment to reduce the size of the uterine growth. Joseneide is particularly skeptical about the doctor’s prescription, given that she understands hormônio accumulation to have produced the growth in the first place. She is actively seeking a doctor who would be willing to perform a hysterectomy, and she jokes that, for any woman who has “had all her children,” the uterus is descartável (disposable), an expression that I often heard in Bahia. Given that I was asked to wear a white lab coat (required in order to have access to the medical centers where my research took place), Joseneide asked me if I could find a doctor who would be willing to operate on her.
23 The chain of associations that Joseneide makes between hormonal contraception, prophylactic hysterectomy and the iatrogenic origin of her fibroma suggests that the impressive popularity of surgical procedures in Brazil can be interpreted in terms of notions about the local conceptualizations of humoral accumulation. Joseneide’s account revealed the associations that are commonly made between fibromas and the notion of a pathological accumulation of blood related to the retention of the flow of menstrual blood and the use of hormônio. Her case is particularly striking, because it reveals that the body is understood as a kind of recipient that can be filled and purged. These actions in turn have implications for the body’s ontological status.
24 The anthropological literature on substance is vast and has a complex historiography.12 For present purposes, I would simply like to draw attention to the way in which, in a range of contexts, transmutations in bodily substances such as blood, semen, mother’s milk and menstrual blood are understood to produce differences in persons’ sexual capacities or physical attributes. The analogies or asymmetrical evaluations made between different bodily substances are at the basis of a number of gender- differentiation systems13. These models are founded on an understanding that – while they are associated with one or the other gender – bodily substances are transformable, and exchangeable between bodies. For the Samo of Burkina Faso – as Françoise Héritier described them in her work – semen is understood to turn into blood in a woman’s body: blood that she loses during menstruation. Maurice Godelier accounts for masculine domination among the Baruya partly through the conceptions they have about bodily substances.14 He argues that for the Baruya, breast milk is in fact understood to be semen that has been transformed within the mother’s body. All substances thus have a masculine origin. Strathern considers this asymmetry in a radically different light.15 In her analysis of Melanesian exchange, gender is not an attribute of a body but rather of relations which involve the detachment, elicitation or exchange of substances. Carsten has shown how the term “substance” has been used to achieve markedly different goals in anthropological work on kinship systems. This polysemy in part explains how the term substance was effectively used to signify such divergent meanings.16
“One-sex” thinking in a “two-sex” world
25 The most explicit interpretations of the relationship between hormônio’s substantive properties and issues of sex and gender come from the research I did with travestis. During one of the weekly meetings I attended, one of ATRAS’ leaders asked if the members present would be willing to talk about their experiences with different types of hormônio and their effects. The discussion that followed was very lively. Several
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travestis spoke of their experience with these drugs in terms of feeling “cheia (full, in the feminine)” of hormônio. Others pointed out that in the periods during which they injected themselves regularly, their bodies were so full of hormônio that it oozed at the spot where they had injected it, like a fluid that has reached the watermark. A similar example of hormônio’s substantive properties is given by Kulick: …travestis also believe think that it is unwise for them to ejaculate while they are taking hormones, because they think that hormones are expelled from the body in that way. Each ejaculation, therefore, means progressively smaller breasts.17
26 During one particularly memorable ATRAS meeting, a lively debate arose regarding the use of different brands of hormones to “give birth” to breasts (fazer nacer o peito). Travestis’ breasts are often the product of repeated injections of hormones, which are used prior to the injecting of liquid industrial silicone. Hormônio is said to shape the body from the inside, creating a space that can then be filled with silicone.
27 Tensions surrounding issues of identity politics, which I had not at first grasped, were latent within this debate about using hormones to “beget” breasts. Marlene, one member of the group, stated that “My chest is (é) Depo-Provera,” a comment that echoes the Brazilian idea that someone’s chest is silicone (“seu peito é silicone”). This formulation reinforces the idea of hormones as a kind of material that is understood to quite literally fill the body according to a specific fluid mechanics. Tensions arose when Marlene explained that when she was injecting Depo-Provera regularly to give birth to her breasts, her body was so saturated with hormônio that her breasts had oozed milk. Drawing a pointy little breast out from under her top, she exclaimed: “I was so full of hormônio that milk was dripping from this breast.” At that point, another, particularly aggressive participant turned to her and snapped, “That wasn’t milk, you crazy bitch, that was sperm!”
28 Marlene, with whom I subsequently carried out an extensive interview, later gave me the context within which to understand this exchange. She explained that, unlike the other members of ATRAS, she thought of herself as a trans- rather than a travesti, so she was stigmatized at meetings. Unlike the travestis, whom she described as vulgar and scandalous, she dressed in smart office apparel. Her scathing challenger, who “lives and works in the street,” is provocative and aggressive. The challenge to Marlene’s assertion to (full) femininity – breasts dripping with milk – through the reassertion of her concomitant masculinity – emblematized by sperm – illustrates the way in which hormônio is adopted to speak of bodily capacities to transmute fluids. This altercation points to the religious tenor of the issue in evoking “exuding” miracles (such as the miraculous lactation of icons of the Virgin), common in Latin American Catholicism. This reveals something of the potency of religious imagery in the definition of gendered norms. In alluding to the image of the Nursing Virgin, Marlene is claiming for her own a specific representation of the feminine which is at odds with the highly sexualised representation that most of the other ATRAS meeting participants aspire to.
29 The possibility of synthesizing hormones and making them available as pharmaceutical products creates a kind of disjunction between sexed substance and sexed body. I am analysing here the way in which this disjunction leads to a regulation of the use of diverse synthetic hormones depending on the patient’s identity. This regulation becomes more complex when prescribed or informally adopted hormonal regimens trouble gender norms. We have seen that the use of testosterone in therapies prescribed for women poses fewer problems than do the use of estrogen in men. By
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describing the experimentation that sexual identity is submitted to in Salvador through the lens of the reorientation of the flow of sexual substances, I am querying the issue of those sexual identities that are caught between the sexual dichotomies still widely operational within biomedicine. This notion of a re-channeling of sexual substances is further illustrated by a final ethnographic example that reveals a highly idiosyncratic Judeo-Christian origin for the idea of substance transmutation. Referring to the importance of estrogen in clinical practice, one locally prominent female gynecologist (who is published in international reproductive journals) made explicit reference to the Bible when she addressed the Congress of Endocrine Gynecology: Estradiol is the feminine soul; estradiol is what allows us to attract males. It’s a fundamental hormônio. And I will add that without estradiol, testosterone is nothing! Just as Eve came out of Adam’s rib, estradiol is synthesised out of testosterone. It’s such a physiological hormone that no one pays any attention to it. We women have had our period of reclusion, we were our husband’s property; then we had to become macho (male). Now we can be more competitive: mothers, professionals and feminine. Women today want to improve their sex lives and their self-confidence. […] So E2 lets women get to where they want to be. It’s a very old hormone, but it’s totally modern. It combines femininity and activity.
30 Aside from the serious implications that a representation like that has on the hierarchical evaluation of hormones and the social identities they are imagined to produce, this statement provides a view of the body and of sexual identity that fits what Laqueur18 called the “one-sex” body. In his history of the “making of sex” (or of the two sexes), Laqueur argues that before the Enlightenment, the bodily bases of gender were understood analogically. That is, the difference between the sexes wasn’t thought of as grounded in biology. According to Laqueur, during that period, gender derived from a single, paradigmatic non-sexed body, and bodily facts did not lend themselves to the same kind of ideological investment as they did with the advent of the new, empirically based anatomy. His distinction is useful from a heuristic point of view, insofar as it reminds us that the categories masculine/feminine have a history.19 The model he proposes is useful precisely because it provides a frame that reveals more clearly the phenomena that do not neatly fit into it. Hormônio, in the Bahian context, clearly troubles the binary version of sex, revealing the extent to which regulatory and legal practices ascribe the two-sex model as normative.
31 In the Bahian context, the lack of regulation of the medical and pharmaceutical sectors leaves the door open to the possibility of unauthorized experimentation (by both doctors and patients) and usages that would be impossible in other national contexts. In 2010, a series of press articles revealed that in many Brazilian gyms, women were using contraceptive implants containing testosterone in order to build their muscle mass, get the most out of their workout, and “increase their libido.” Although they addressed the issue critically, the articles that circulated on the chipadas as they’re called – women, who have an integrated circuit implanted – provided plenty of details on the existing methods and how to obtain them. This shows how some of the masculinizing effects afforded by testosterone are adopted in the production of new forms of femininity. Thus the sexualization of the body isn’t seen as something entirely immutable.
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Reassembling sex
32 An ethnographic analysis of hormonal practices in Bahia allows us to highlight the way in which hormones are involved in materializations of sex. It offers a partial answer to the issue raised by Butler in Bodies That Matter, when she asks, “How do tacit normative criteria form the matter of bodies?”20 Butler’s emphasis on the performative aspects of gender in Gender Trouble was critiqued for supposedly disavowing the constraints imposed by “sex” and the body’s materiality. Her following book, Bodies That Matter, specifically attends to the ways in which norms materialize the body. Bulter shows that the concept of materiality is itself sexed. Sex, she argues, acquires its naturalized effects through the sedimented effect of reiterative practices. Yet this reiterative aspect of materialization is precisely that which opens up the “constitutive instabilities” that have the power to undo “the very effects by which ‘sex’ is stabilized.” 21 This article offers an ethnographic exploration into how sex hormones are implicated in specific “matterings” of bodies. Although hormones continue to be sexed in both scientific and popular imaginaries within a binary model of sex, the ethnographic materials presented here imply ways in which the reiteration of “sex” through hormonal practices are subject to the kinds of instabilities and excesses that Butler calls attention to.
33 Bahian notions of hormônio also show that bodies are not seen as fixed, which partially accounts for the ease with which medical practices are adopted to transform the body. This has specific implications for “sexual identity” insofar as the conceptualization of hormones as a substance reveals the relative plasticity of the sex/gender relationship. What is generally understood to constitute “sexual identity” (specific bodily characteristics) or gender (appearance or behavior) is partially dissociable from the body or associable to another body through the use of gels, injections or drugs that bestow new identities. It is in this sense that I propose that prescribed and informal uses made of these pharmacotherapies enact both a troubling of sex/gender and of the distinction between them. As I have argued, the continuity between genital sex and the circulation of gender does not depend on the ineluctability of the facts of nature. Given the many biological and social elements that are required to make “sex” (and not just “gender”), efforts need to be constantly deployed to re-assemble these with the consistency that makes us blind to the manufactured aspect of “sex.”
BIBLIOGRAPHY
BUTLER, Judith. 1990. Gender Trouble: feminism and the subversion of identity. New York, Routledge.
BUTLER, Judith. 1993. Bodies That Matter: on the discursive limits of “sex”. New York. Routledge.
CARSTEN, Janet. 2001. Substantivism, antisubstantivism, and anti-antisubstantivism. In Relative Values: reconfiguring kinship studies, ed. Sarah FRANKLIN & Susan MCKINNON, 29-53. Durham. Duke University Press.
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CARSTEN, Janet. 2004. After Kinship. Cambridge. Cambridge University Press.
CEBRAP, 2008, Pesquisa Nacional de Demografia e Saúde da Criaça e da Mulher – PNDS 2006: Relatório Final. Brasília, Ministério da Saúde. http://bvsms.saude.gov.br/bvs/pnds/img/relatorio_final_pnds2006.pdf
FAUSTO-STERLING, Anne. 2000. Sexing the Body: gender politics and the construction of sexuality. New York. Basis Books.
GODELIER, Maurice. 1982. La Production des grands hommes. Paris. Flammarion.
GREGOR, Thomas, and Donald TUZIN. 2001. Gender in Amazonia and Melanesia. Berkeley. University of California Press.
HÉRITIER, Françoise. 1996. Masculin, Féminin. La pensée de la différence. Paris. O. Jacob.
KULICK, Don. 1998. Travesti: sex, gender, and culture among Brazilian transgendered prostitutes. Chicago. The University of Chicago Press.
LAQUEUR, Thomas. 1990. Making Sex: body and gender from the Greeks to Freud. Cambridge, Mass. Harvard University Press.
MOL, Annemarie. 2008. The Logic of Care: health and the problem of patient choice. Abingdon. Routledge.
MOSKO, Mark. 1985. Quadripartite Structures: categories, relations, and homologies in Bush Mekeo culture. Cambridge. Cambridge University Press.
OUDSHOORN, Nelly. 1994. Beyond the Natural Body: archaeology of sex hormones. London Routledge.
PARK, Katherine, and Robert NYE. 1991. Destiny is Anatomy. The New Republic 3970 : 53-57.
SANABRIA, Emilia. 2011. Pourquoi saigner ? Menstruations, dons de sang et équilibre corporel au Brésil. Terrain 56: 42-57.
SCHNEIDER, David. 1980 [1968, 1st edn]. American Kinship: A Cultural Account. Chicago. University of Chicago Press.
STRATHERN, Marilyn. 1988. The Gender of the Gift. Berkeley. University of California Press.
NOTES
1. Fausto-Sterling 2000; Oudshoorn 1994. 2. Travesti is an ambiguous identity category that is self-adopted by physiological men who transform their bodies into feminine ones without resorting to gender-reassignment surgery. 3. This research was carried out between 2005-2009 as part of my doctoral research on contraceptive choices and professional and lay conceptions of menstruation. I later did post- doctoral work on local conceptions of the body and bodily substances. 4. Oudshoorn 1994: 145. 5. Fausto-Sterling 2000: 28. 6. Ibid. : 147. 7. Although hormonal contraceptives are sold in packaging that specifies “by prescription only,” in practice, only psychoactive medications are regulated in Brazilian pharmacies, which dispense all other drugs freely. It is estimated that 75% of hormonal contraceptives are obtained directly from pharmacies, usually without a prescription (CEBRAP 2008).
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8. Coutinho, a doctor from Bahia, is popular with the media. He is known for his controversial opinions about connections between crime, race and overpopulation; about abortion and menstruation suppression, and for his biologized view of women’s social role. 9. A complete transcription of this documentary is available from: http://www.abc.net.au/cgi- bin/common/printfriendly.pl?/catalyst/stories/s964127.htm (accessed on 17 Jan. 2011). 10. Mol 2008. 11. Sanabria 2011. 12. See Carsten 2004. 13. Particularly in the ones described by Gregor & Tuzin 2001; Héritier 1996; Mosko 1985. 14. Godelier 1982. 15. Strathern 1988. 16. Carsten 2001. For Schneider (1968) substances, particularly blood, stand for that which is “unalterable and indissoluble.” On the other hand, in Indian and Melanesian ethnography, the term was adopted to speak of the mutability and fluidity underpinning notions of the person. 17. Kulick 1998: 66 18. Laqueur 1990. 19. His model has been the subject of a great deal of criticism, see for example Park & Nye 1991. 20. Butler 1990. 21. Butler 1993: 10.
ABSTRACTS
Pharmaceutical sex hormones are hybrid, complex objects, which cut across political and sexual economies and are located at the boundary between sex and gender. In pharmaceutical form, they confer sexual characteristics on the body, in part exogenously. It follows that their clinical use is socially regulated according to the dominant norms of gender. Through an ethnographic analysis of the various contexts of hormone use observed in Bahia, Brazil, this article shows that sexual dualism is the product of biomedical practices which regulate the circulation of hormones. The meaning of the locally adopted term “hormônio” is not fully captured by that of “hormones”. The use made in Brazil of the singular term “hormônio” confers upon it a fluid and homogenous quality. In the Brazilian context, hormones are understood as a kind of substance that can circulate between bodies. This conceptualisation of hormones as a substance has implications for the ontological status of the body and reveals the relative plasticity of the sex/gender relation.
INDEX
Keywords: sex hormones, gender, sex, Brazil, medicine, blood, humours
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AUTHORS
EMILIA SANABRIA Emilia Sanabria is an anthropologist at the École Normale Supérieure, Lyon, and holds the INSERM chair education and health at the Triangle research institute. Her research has focused on the body, contraception and medicine in Brazil, and her forthcoming book on the body and sex hormones in Brazil, will explore new areas in the political anthropology of public health, education and diet there. [email protected]
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Andropause and menopause: sexuality by prescription
Véronique Moulinié Translation : Regan Kramer
1 The thought process that preceded writing these pages brought back the memory of something that happened a long time ago. In the mid-1980s, when I was in high school in Saint-Pierre,1 a small industrial town in the southwest of France, only a few students took German. While we all acknowledged that Mr. Letourneau was a great teacher, we also thought he was a bit of a weirdo. Very tall and thin, with an emaciated face hidden by dark glasses, he never smiled and always looked serious. We thought of him as someone distant whose mind was filled with dark thoughts; and we loved to speculate about what those thoughts might be. One day, Rémi, who was a little older than the rest of us, thought he’d figured it out. Although I can’t remember his exact sentences, a few of the words he pronounced still echo in my mind. Mr. Letourneau had “problems with his wife.” He had married an “old lady,” who was 10 years older than he and had “been through menopause,” and “had it all taken out” recently. So she was “all dried up,” and “couldn’t do it anymore.” Consequently, he had to “keep his pants on” from then on. I remember how uncomfortable the whole little group suddenly felt. It wasn’t so much because of the crudeness of Rémi’s speech per se, it was because of how doubly incongruous his explanation was. To begin with, the tone was absolutely incongruous. We would have applauded if our classmate had used vocabulary from the science of the psyche that we were discovering with pleasure in philosophy class, but we weren’t ready for – in fact we totally rejected – this bodily medicine, or more like bodily mechanics, that he was spreading out so brazenly before our eyes. And then the place where he said it, and the audience he said it to were incongruous as well. We all knew – more or less – what the words “menopause” and “having it all out” meant. We had overheard them in conversations between women like our mothers and grandmothers – who didn’t, by the way, necessarily agree about them. But they were still deeply foreign to us, and they didn’t belong in a conversation between young near-adults – in high school no less!
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2 Yet Rémi wasn’t the foulmouthed blackguard we accused him of being. All he was doing was echoing a representation that was widely accepted, at least in that rural region, about how bodily and sexual norms evolve with age.2 They imposed abstinence in “the autumn of life,” as the somewhat old-fashioned but still common expression goes.3 This representation has come into being over the course of the last two centuries, through complex relationships, resulting from reformulations and exchanges between science and common sense, between popular lore handed down by women over the ages and academic science, between medical innovation and traditional social practices.
Words and Woes
3 For centuries, doctors granted only a few lines to menstruation in general, and to its definitive cessation in particular, as part of broader treatises about female physiology. To the point that there was no medical terminology for the phenomenon. That all changed during the nineteenth century. The word “menopause” appeared for the first time in the 1810s-1820s.4 Along with the word, a phase of life was invented, conceived as a turning point in a woman’s existence, one that is marked by a cohort of ailments and strange behaviors, which doctors, in a stream of theses,5 articles and other publications, described, probed, analyzed and pondered endlessly. And that is the key: “menopause” explicitly became a woman’s “disease,” which, by definition, needed treatment. In addition, throughout the second half of the nineteenth century, taking advantage of progress in anesthesia and asepsis, surgery explored women’s abdomens, developing first ovariotomies6 then hysterectomies. These operations had long been known about well beyond the operating theatre, as Rémi’s comment shows. Men were concerned too. Their turn just came later, you could say. It wasn’t until the 1940s that the first research on the “male menopause” was published, although it soon acquired a more specific, serious and scientific-sounding name: andropause. Associated with a disappearance or at least a severe loss of sexual potency that needed to be treated seriously – in all the term’s polysemy – it too became a matter for doctors.
4 Thus throughout the nineteenth and twentieth centuries, the medical establishment gradually took control of the bodies and sexuality of women and men of advancing years. It is time to take a look at how this slow-motion medical coup d’état, if I may be so bold, took place, as well as the circumstances and reasons that made it possible.7
Women’s Bodies: Women’s Words
5 The interviews I performed in the early 1990s8 brought out an obvious sexual division: women’s verbosity about the ailments related to both men’s and women’s change of life were equaled only by men’s silence or irony on the same subject.
6 The women I spoke to described in great detail the ills that afflicted their bodies from “a certain age”:9 night sweats that made sleep difficult, exhausting even the sturdiest constitutions; erratic menstruation that might appear twice in a single month then not at all for weeks on end; “hemorrhaging” that “drained all their blood,” which they interpreted as the first symptoms of a “fibroma;” hot flashes that overwhelmed them suddenly, forcing them to remove clothing; mood swings that tossed them from laughter to tears, “without knowing why;” “dark thoughts” that led some of them to “consider the unthinkable;” “nerves on edge” that caused incomprehensible outbursts
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of anger, upsetting their nearest and dearest. They were sure of one thing though: all of this upheaval, both physical and psychological – not despite but precisely because of how polymorphous it was – was the signature of what the most advanced in age called the “change of life”, a term that seemed old-fashioned to the younger ones, often their own daughters, who preferred to talk about “menopause.” But they all agreed in the belief that the time had come for them to “get operated on” to “have it all out,” as the only way to put a stop to the physiological chaos. By the time they went in for an “appointment,” their minds were already made up, their self-diagnosis already established. Doctors rarely contradicted them, yielding instead without a fuss to their requests for the almighty scalpel. There’s nothing surprising about this harmony between women and doctors as to the need for removal. After all, didn’t they share the same perception of menopause and of the disturbances it necessarily led to?
7 For the older women I interviewed, the “change of life” was essentially about blood. After having stayed on track – a term that should be understood almost topographically – unimpeded for decades, their blood was going back to the erratic wandering it had been prone to in their childhood and youth,10 seeming to be lost inside their bodies, desperately seeking a way out, knocking at the most unexpected spots and causing a host of problems. Still, over decades, the explanations seemed to have aged poorly. Out with the stories about “boiling blood” that “goes to your head” and that’s suddenly “darker and thicker than it used to be,” which the older women told – with a touch of embarrassment sometimes, as they were all too aware of the condescending smiles their tales elicited. The younger women preferred a more “scientific” dissertation about “male” and “female” hormones whose “levels” were suddenly too high or low, depending – abnormal, in any case. It would be more precise to say that, without abandoning the discourse about blood in the least, they supported it, completed it and justified it by resorting to a hormonal discourse. However, if you didn’t get taken in by the medical jargon, which the women often handled with disconcerting ease, you realized that the two types of discourse shared many resemblances. What’s more, the women’s knowledge was strangely close – in fact, practically identical – to the doctors’. It would be tempting to think that this represented nothing more than a banal phenomenon of transmission or “popularization” of knowledge, which, escaping from medical circles, gradually trickles down, with a slight time lag, into society. Yet it seems to me that the system we are seeing is subtler than that. The women I interviewed drew as much of their knowledge from day-to-day conversations with other women as from medical encyclopedias intended for everyone, articulating with ease the theories of each repository of information, as though, rather than being divergent, these kinds of knowledge created a coherent whole. Indeed, in many ways, you could think that “scholarly” medical knowledge had latched onto women’s popular wisdom wrapped it up in theories and covered it with obscure medical jargon, giving it a scientific veneer; then given it back to women, who couldn’t help but recognize and appreciate it. Finally, it seemed clear that knowledge was circulating between women and doctors on a closed circuit, each side feeding into the other. What follows will amply confirm that impression.
Men’s bodies: men’s silence, women’s words
8 While it wasn’t hard to get women to talk about women’s complaints, getting men to talk about andropause was something else again entirely.11 To begin with, the term
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itself was unfamiliar to them. And those who did know it were snide about it. “That’s a load of crap,” was the basic message. I wasn’t much more successful when, dropping the term that bothered them so much, I tried to get them to discuss the pathologies associated with men and aging. The interviews were deplorably deficient. One could obviously think the fact that I’m a woman contributed to the problem. After all, “talking about women’s problems with other women,” even if one of them just happens to be an ethnologist with a tape recorder, is more common. It could be seen as a type of female bonding or socializing. But it’s clearly trickier for a man to talk openly about the consequences of prostate surgery, or even, though less so, about an attack of gout, suddenly resulting in a painfully swollen toe, to a representative of the “fair sex,” who, to make matters worse, wasn’t even a doctor! It goes without saying that resorting to jokes, often bawdy ones, was a theoretically efficient conversation-avoidance strategy. It was also a way of playing down worrisome aspects of the issue. Clearly these subjects were not easy to talk about. But my interviewees weren’t much chattier when it came to discussing medical issues that were a priori less private, like cholesterol levels or strokes, to name but two. Once again, they didn’t have much to say. While they felt these afflictions deep inside them, they were, for the most part, unable to elaborate upon them. So they turned to their wives for help, confiding to them the task of “saying the body”. Wives who were never far off, as though they had known from the start that their assistance would soon be required. In a nutshell, the men suffered the ailments in their bodies, leaving to their spouses the task of describing the cause, and of contextualizing their specific case within a more general theory of male physiology.
9 And what did the wives talk about? Explanations like “rushes of blood,” “attacks” that the older ones feared might be the last, and the gout that confined to bed some “bon vivant” husbands who enjoyed the simpler pleasures, like good food and wine, were no longer up to date. They had given way to more technical ones like cerebrovascular accident and “infraction”12 as well as references to cholesterol and the mysteriously worrisome triglycerides. But you couldn’t pull the wool over the women’s eyes. They weren’t thrown by the somewhat obscure meaning of all that terminology. As far as the women were concerned, all those ailments had to do with blood, its condition and flow. Due to advancing age, their husbands’ blood had become both thicker and dirtier and, when all was said and done, as erratic as their own. Their words conjured up an image of male blood subjected to severe turbulence – just like female blood. They made no bones about it, either. “Well, if that’s how it is for us, it must be the same for them,” “Their blood is acting up on them too, they just don’t like to talk about it,” or even, “People think only women go through the change of life, but men get it too.” Those were the comments – dripping with meaning between the lines – that best summed up their point of view.
10 Yet these learned feminine explanations didn’t suit the men at all. Having called on their spouses for help, they then tried to shut them up, with a few well-chosen phrases, intended to prove that they shouldn’t be believed: “What are you talking about? That’s utter nonsense!,” “Since when did you go to medical school?,” “So what do you know about all that? Huh, you should know, I guess!” But the husbands protested in vain, because not only did the wives ignore their objections, but at the end of the day, even the men themselves wound up recognizing the truth of what the women said. The men had no way out: with no knowledge of their own bodies, they had to let the women proclaim “truths” that they could or would not hear… but for which they had no
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alternatives to offer. They were cornered! And sick at heart, of course. What was so hard to swallow was that the women’s diagnosis went well beyond a few pills or medications. The men knew what was really at stake. The fact was that to explain their husbands’ change-of-life ailments, the women drew inspiration from their own bodies, and specifically from the actions of their own blood that had marked out the stages of their lives: from its appearance at puberty that was the first step towards motherhood, to its monthly visit, and finally its disappearance, synonymous with the end of both their fertility and their sexuality. This female periodicity was the point of view from which they saw the afflictions of their husbands’ bodies. But the effects of their point of view were obvious: sending a warning signal about the men’s libido and sexuality. It should be noted that, once again, women and doctors were in perfect agreement, because the earliest treatises devoted to andropause founded the reality of that state on the disappearance of sexual function.
For whom the bell tolls
11 By “inventing” first menopause, then andropause, doctors could be thought to have imposed a death sentence on both men’s and women’s sex lives. But that probably wasn’t very hard to do, since it coincided so neatly with long-established habits. To put it another way, couples had been practicing sexual abstinence in the autumn of their lives long before doctors began advising it. The Pierre Rivière parricide is well known in France. The long text he wrote to explain his act has been widely commented on. One interesting detail that didn’t get much attention, however, was that in order to shield herself from her husband’s assaults, Pierre’s mother had her two younger children, Jules and Victoire, sleep in the marital bed.13 The couple fought constantly, and often violently. Yet it hardly seems necessary to arrive at such a state of marital disenchantment in order to cease carnal relations. Thus, in the late nineteenth century, an observer in the area of Toulouse condemned, in no uncertain terms, men’s tendency to “put away their tools,” much too early in his opinion, and for no good marital or emotional reason.14 By the same token, the women I interviewed made it clear that, as they reached menopause, they had imposed sexual abstinence on their spouses. They used colorful but clear expressions to let me know. They had “put up a fence in their bed” (literally: “put a wooden shoe in the bed”) or had “sent him to see the woman next door.” Some of those who had not managed to impose abstinence on their husbands had been terrified when their periods first disappeared, dreading that the absence announced the arrival of the ‘baby of the family’, who would be far younger than his or her siblings. The possibility of such a late birth was unanimously seen as scandalous, even as something to be ashamed of! And what they had feared for themselves, they criticized roundly in other women, referring in damning terms to women who had given birth after their own daughters were old enough to procreate – or even worse – were already married and had one or more children of their own. So-and-so had announced her pregnancy on the day of her youngest daughter’s wedding! Someone else had had a baby when her oldest son was nearly 20! And a third had been in the hospital at the same time as her own daughter – and they were both there for the same reason: to give birth! The women systematically stigmatized families in which the order of the generations had been overturned, and the nephew was older than the uncle. They weren’t surprised when families with jumbled generations had problems (sterility, suicide, unmarried children, “deviant” sexuality, etc.). They were all perfectly
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logical consequences, in their book, of the unspeakable behavior of those “wayward mothers”. The fact was that those women, at once recent mothers and young grandmothers, were breaking a taboo that may not have been clearly formulated, yet which governed couples’ sex lives nevertheless, as the historian-demographer Jean- Claude Sangoï has shown.15 Mothers should cease to be fertile – or at least shouldn’t be flaunting manifest signs of fertility – when their children have reached the age to become parents themselves. They should embrace the role of “grandmother” fully. Two generations of the same family couldn’t and shouldn’t be indulging in fertility the same time. In a nutshell, Little Red Riding Hood should eat her grandmother, as Yvonne Verdier has explained with different words and in a different context.16 And what more efficient way to avoid these untimely, “shameful” births than to cease all sexual relations? “A fence in bed” having limited effectiveness, it’s easy to see how the women I interviewed were relieved by their hysterectomies. Thus, both menopause and andropause, which are founded on a pathologization of bodies that leads to the death of sexuality, turn out, upon analysis, to be the direct descendants of extremely old social taboos that they have both medicalized and legitimized.
Sexuality under surveillance
12 But that’s so outdated, you might say. The women I interviewed were “little old ladies from the country” who perpetuated behaviors that in other places – particularly urban centers – and social milieus had disappeared or were at least evolving. Besides, 20 years have passed since I started my research, and things have changed profoundly in that time. People in their 50s and 60s are no longer seen as elderly. While they may not have said, like the singer Tino Rossi, that “life begins at 60,” couples assure us that they are still enjoying a satisfying lifestyle, and insist that their sex lives carry on into old age. By 2012, we’ve come a long way since those dark and painful hours that doctors described and the women I interviewed had lived through! Should we then believe that the barrage, whose patient construction over more than a century I had studied, has suddenly given way? I wouldn’t count on it. While the discourse about bodies of advancing years is evolving, 50- and 60-somethings’ sex lives still isn’t accepted as well as people think.
13 It is true that “having it all taken out” is no longer popular amongst women in their 50s today. Instead of seeing it as a relief, it is now considered to be an unacceptable mutilation. Nowadays, women prefer hormone replacement therapy to the scalpel. But going on “HRT” isn’t like drinking herbal tea!17 While the latter is a strictly personal decision (no prescription necessary), the former is firmly in the hands of the medical profession, which evaluates the necessity, determines the dosage, writes the prescription and keeps track of the effects through regular check-ups. Particularly since the publication in the early 2000s of two studies focusing on the side effects of these treatments on certain specifically female organs,18 women have been particularly motivated to get proper medical supervision. Furthered by doubt and anxiety, medicalization has in fact grown and spread, sticking to the trajectory that started 200 years ago. Nothing new, in sum, as far as women go. The same cannot be said about men, however
14 In 1975, the French writer Romain Gary published a novel with a singular title, to say the least: Au-delà de cette limite, votre ticket n’est plus valuable (“(Beyond this Point) Your
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Ticket Is No Longer Valid”). It recounts the love story between Jacques Rainier, 59, and Laura, a beautiful Brazilian woman who is 30 years younger. It also describes the physical difficulties the almost 60-year-old man encounters in this passionate affair. Difficulties that upset him so much that he considers committing a kind of suicide by proxy so as not to have to confront what feels to him like a disaster: not only is his sex life going down the drain, but to his mind, his whole life is going down with it. Seventeen years later, Georges Debled, a urologist whose name is closely associated to andropause,19 published a book too. The title is clearly modeled on Gary’s, although it contradicts the former directly: Au-delà de cette limite, votre ticket est toujours valable, ( “Beyond this Point Your Ticket Is Still Valid”). And just in case anyone doesn’t get the allusion, the sub-title is Comment vaincre le vieillissement de l’homme ? (“How Can We Conquer Male Aging”)20 The point seems to be that, as far as Debled is concerned, Jacques Rainier’s anguish and distress at the decline of his virility are baseless, a pure novelistic invention. Except that a quick glance at the table of contents of Debled’s book would be enough to unsettle the most swaggering but graying Don Juan. Won’t he find that, “Andropause concerns all men over 40” and that “Eunuchs are a model for andropause”?21 Doesn’t the book address “Erectile Dysfunction,” “Prostate Problems,” “Wrinkled Skin,” “Anemia,” “Shortness of Breath,” “Renal Insufficiency,” “Arteriosclerosis,” “Angina pectoris and Cardiac Infarction”? The novel and the urologist’s book unanimously assert that, “beyond a certain age,” sexuality declines. But the similarities stop there. Romain Gary’s novel features a hero whose love affair escaped medical attention, because Jacques Rainier soon turns from the amused gaze of the doctor he consults early in the tale. Georges Debled, on the other hand, believes that although an active love life is still both possible and desirable, it can only exist under strict medical supervision. By 2012, it must be admitted, Gary has definitively lost, and Debled has won. How else could it be?
15 When it comes to keeping a watchful eye on male bodies, women’s attention has never waned. While back in the 1980s and 1990s, they did it almost clandestinely, things are quite different now. That role has practically been officially attributed to them. But by whom? To find the answer, go to a newspaper stand. Men’s magazines don’t talk about men’s health very much, to put it mildly. Often quite specialized, they would rather talk about eroticism, sports, mechanics or DIY. Anything but medicine! To learn about that, you have to go to health magazines for the general public (i.e. not doctors) such as, in France, Top Santé; or to women’s magazines (Femme Actuelle and Maxi, among others). And both of those kinds of magazines are bought almost exclusively by women. In the same way, while radio and television programs (particularly Magazine de la santé on France 5) have no qualms about discussing andropause, they are aimed at an almost exclusively female audience.22 Their outlook is determinedly upbeat. They endlessly repeat the injunction, but in a cheerful, we’re-old-friends tone of voice, that it’s out of the question to give up on sex in your 50s, and that it’s still perfectly possible for a couple to have a satisfying sex life after that milestone. On one condition: you must “keep an eye on your health.” That is the keystone to the whole system. Among the many roles that Femme Actuelle and suchlike assign to women is guardian of the whole family’s health, including, in fact particularly, their husband’s, as he is presented as being either too careless or too unaware of these crucial issues, too reserved or too proud to raise the topic. In any case, it’s up to them to “take care of their man,” which includes convincing him, as diplomatically as necessary, to go for regular check-ups, especially when he is approaching his 50s or 60s. This constant medical supervision,
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this subjection of the virile body to the medical gaze, is the price to pay in order for the couple’s sex life to continue to exist. In a nutshell, through these media mouthpieces aimed essentially at women but very concerned with the health of “mature men,” doctors have delegated the responsibility for medical supervision to wives.
16 Are men resisting this “medical-media-matrimonial” pressure? Seems unlikely. Granted, not many are likely to admit they’re going through andropause. But even fewer of them dare argue when their spouse says she’s worried about some ailment or other and that they should “make an appointment to see the doctor.” At most, they may try to put it off, to delay subjecting themselves to the doctor’s gaze. But they all know that they’re going to have to “bite the bullet.” Nowadays, as in the past, they know perfectly well what concerns are lurking behind the check-ups. They know it’s about their virility. Not without a certain skepticism, which the men themselves share. If there was any doubt about that, listening to men’s jokes will put paid to it. Putting it crudely, if you analyze “dirty jokes,” you’ll see that, far from denying it, they focus on the gradual, progressive disappearance of the sex drive with age. Let’s look at a sampling of them. The first one features an elderly couple. After years of sexual indifference, they’re suddenly frolicking like newlyweds in a field. Monsieur’s newfound enthusiasm surprises and thrills Madame, who thinks he’s discovered the fountain of youth. But, as he is forced to admit, that’s not it at all: it’s because he’s sitting on an electrified fence. In another one, two old men are sitting on a park bench. One of them is boasting about how his strength has miraculously decupled with age. The proof: when he was younger, he couldn’t “bend” his member, and now he can do it just like that! As for Viagra, whose very existence on the market is significant, it has been an inexhaustible source of inspiration for jokes and puns on chemistry’s capacity to more or less replenish 50-somethings’ flagging sex drive. The fact is, men’s own humor acknowledges the failings of their bodies loud and clear. And when all is said and done, they have discreetly but completely surrendered, accepting their wives’ and doctors’ verdict: in order to maintain a love life, men have to “keep an eye on things,” and, even more importantly, let doctors “keep an eye on things” for them.
17 Since Ancient Greece, but with increasing speed since the eighteenth century, medicine has been controlling the female body, leaving its mark on it. All the talk, first of “menopause” and then of “andropause,” is just one among many elements of proof of this. Nevertheless, these expressions also invite us to qualify that comment. This medical takeover wasn’t pulled off against women’s will, nor even, more simply, without them. On the contrary, they were powerful and efficient relays for the message. They participated in it rather than being subjected to it. For that matter, they weren’t alone. Men haven’t escaped it either, caught between their spouses and the medical establishment. Although the techniques that would today be considered cruel and unnecessary, like hysterectomies, are disappearing, medical supervision, far from fading, is being reinforced instead. And actually, while the sex life of people in their sixties is no longer considered problematic, as long as it is framed, fettered and supervised by Medicine, the sexuality of the “very old” is simply not supposed to exist. For instance, in 1992, a multidisciplinary team made up of epidemiologists, demographers, psychologists, psychiatrists, sociologists and economists, among others, launched the large-scale Analyse des Comportements Sexuels en France (“Analysis of Sexual Behaviors in France”), which is generally referred to nowadays as the “ACSF Study”. The population studied was divided into age groups. The oldest one was “60-69 years old”.23
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Message received, loud and clear! The norm has been established. The cut-off date is still there. It just falls a little later than in the past.
BIBLIOGRAPHY
DEBLED, Georges. 1988. L’Andropause : causes, conséquences et remèdes. Paris. Maloine.
DEBLED, Georges. 1992. Au-delà de cette limite, votre ticket est toujours valable. Paris. Albin Michel.
DELANOË, Daniel. 1997. Les représentations de la ménopause : un enjeu des rapports sociaux d’âge et de sexe. Contraception, Fertilité, Sexualité 25(11): 853-860.
DELANOË, Daniel. 2001. La ménopause comme phénomène culturel. Champ psychosomatique 24: 57-67.
DELBES, Christiane, and Joëlle GAYMU. 1997. L’automne de la vie. La vie sexuelle après 50 ans. Population 6: 1439-1484.
DIASIO, Nicoletta. 2002. L’inverno delle donne. La costruzione del concetto di menopausa tra scienza e metafisica. In Il Vecchio allo specchio. Percezioni e rappresentazioni della vecchiaia, ed. Antonio GUERCI, and Stefania CONSIGLIERE, 310-325. Genova. Erga edizioni.
DIASIO, Nicoletta, and Virginie VINEL. 2010. Temps et passages de la vie féminine : l’exemple de la ménopause. In Des Sciences sociales dans le champ de la santé et des soins infirmiers. À la rencontre des âges de la vie, des vulnérabilités et des environnements, ed. Louise HAMELIN-BRABANT, Louise BUJOL, and Nicolas VONARX, 59-80. Québec. Presses de l’Université Laval.
DIASIO, Nicoletta, and Virginie VINEL. 2007. Il Tempo incerto. Antropologia della menopausa. Milan. Franco Angeli.
FABRE, Nadège. 2003. Étude démographique en pays cordais de 1793 à 1913. Master’s thesis supervised by Jean-Claude Sangoï. University of Toulouse-le Mirail.
FABRE, Nadège. 2004. Fécondité et sexualité des femmes dans le Sud-Ouest de la France au XIXe siècle. DEA [short dissertation] supervised by Agnès Fine & Jean-Claude Sangoï. Paris, EHESS.
FINE, Agnès, MOULINIÉ, Véronique, and Jean-Claude SANGOÏ. 2009. De mère en fille. La transmission du pouvoir génésique. L’homme 191: 37-76.
GARY, Romain. 1975. Au-delà de cette limite, votre ticket n’est plus valable. Paris. Gallimard.
HÉRITIER-AUGÉ, Françoise. 1998. Anthropologie de la ménopause. In Stéroïdes, ménopause et approche socio-culturelle, ed. Claude SUREAU et al., 11-21. Paris. Elsevier.
LAVIGNE, Bertrand. 1875. Histoire de Blagnac : sa baronnie, ses barons, ses châteaux, son prieuré, ses églises. Toulouse. L. Capdeville.
MOULINIÉ, Véronique. 1998. La Chirurgie des âges. Corps, sexualité et représentations du sang. Paris. Éditions de la Maison des sciences de l’homme.
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MOULINIÉ, Véronique. 2000. Corps d’hommes, mots de femmes. In Sexes, espaces et corps. De la catégorisation du genre, ed. Monique MEMBRADO, and Annick RIEU, 207-221. Toulouse. Éditions Universitaires du Sud.
MOULINIÉ, Véronique. 2004. De l’âge critique à l’andropause : réflexions sur la “validité du ticket”. In Vous avez dit « Âges de la vie » ?, ed. Noël BARBE, and Emmanuelle JALLON, 134-171. Vesoul. Conseil général de la Haute-Saône. Coll. « Texte (Pluriel) ».
RIVIÈRE, Pierre. 1973. Moi, Pierre Rivière ayant égorgé ma mère, ma sœur et mon frère… Un cas de parricide au XIXe siècle, présenté par Michel Foucault. Paris. Gallimard-Juillard.
PAUCHET, Victor. 1932. L’Automne de la vie. L’Homme et la femme à l’âge critique. Paris. Éditions J. Oliven.
SCULL, Andrew, and Diane FAVREAU. 1987. Médecine de la folie ou folie des médecins ? Controverse à propos de la chirurgie sexuelle au 19e siècle. Actes de la Recherche en Sciences Sociales 68: 31-44.
TILLIER, Annick. 2005. Un âge critique. La ménopause sous le regard des médecins des XVIIIe et XIXe siècles. Clio. Histoire, femmes et sociétés 21: 269-280.
VERDIER, Yvonne. 1978. Grands-mères, si vous saviez… Le Petit Chaperon rouge dans la tradition orale. Cahier de littérature orale 4: 17-55.
VERDIER, Yvonne. 1980. Le Petit Chaperon rouge dans la tradition orale. Le Débat 3: 31-61.
VINEL, Virginie. 2002. Les représentations de la ménopause dans des documents français contemporains. In Il Vecchio allo specchio: percezioni e rappresintazioni della vecchiaia, ed. Antonio GUERCI, and Stefania CONSIGLIERE, 326-337. Genova. Erga edizioni.
VINEL, Virginie. 2004a. La ménopause : instabilité des affects et des pratiques en France. In Corps et affects, ed. Françoise HÉRITIER, and Margarita XANTHAKOU, 221-236. Paris. Odile Jacob.
VINEL, Virginie. 2004b. Ménopause et andropause à la lumière du ‘dispositif de sexualité’. Le Portique (online) 13/14 (http://leportique.revues.org/index628.html).
VINEL, Virginie. 2005. Présentation des recherches sur ménopause et andropause dans la France contemporaine », Le Portique (online), Archives des Carnets du Genre, Carnet 1, (http:// leportique.revues.org/index712.html)
VINEL, Virginie (ed.). 2007. Féminin, masculin : anthropologie des catégories et des pratiques médicales, Strasbourg. Éditions du Portique. Coll. « Les cahiers du Portique » 4.
VINEL, Virginie. 2008. Pluralisme thérapeutique de femmes françaises en période de ménopause. Revue Internationale du Médicament 2/1 : 96-138 (http://chaine.uqam.ca/revue_RIM/RIM2/PDF/RIM2-4-Vinel96-138.pdf).
NOTES
1. Names of people and places have been changed. 2. This reflection constitutes the core of my thesis, which was about such common contemporary surgical operations as tonsillectomies, adenoidectomies, and appendectomies during childhood and adolescence, and hysterectomies and procedures performed on the prostate around the change of age. See Moulinié 1998. 3. It seems to have survived the twentieth-century without difficulty. In 1932, Dr. Victor Pauchet wrote L’Automne de la vie. L’homme et la femme à l’âge critique [The Autumn of Life: men and women at a
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critical age] and 80 years later, in March 2011, the European Center for the Study and Teaching of Ethics organized a conference in Strasbourg called: “The Autumn of Life: the ethical stakes of ageing.” 4. The word “ménespausie” was first used by Charles de Gardanne, in his Avis aux femmes qui entrent dans l’âge critique (“Advice to Women Entering a Critical Age”), published in 1816. Five years later, the word “ménopause” appeared in the title of the second edition of the book. See Tillier 2005 and Delanoë 2001 and 2007. 5. Annick Tillier has come up with 200 of them for the nineteenth century alone. See Tillier 2005. 6. For more about the “ovariotomy trend,” see Scull & Favreau 1987. 7. Social sciences, particularly ethnology, have only recently begun to take an interest in menopause and andropause. While research and publications devoted to them were very rare in the 1990s (Delanoë 1997; Héritier-Augé 1998), they are somewhat more frequent now. In Europe, there is, most notably, the work of Virginie Vinel and of Nicoletta Diasio, among others (Diasio 2002; Diasio & Vinel 2007 and 2010; Vinel 2002, 2004a, 2004b, 2005, 2007, 2008). 8. These interviews took place essentially between 1991 and 1995. They were performed in and around Saint-Pierre, in a rural area, with both men and women who were then aged 50 to 80, and who belonged to what is called – in a convenient but imprecise term – les classes populaires: factory workers, farmers, shopkeepers and civil servants. 9. It is less the age per se (47, 50, 51) than events such as the birth of a grandchild, that establish entry into menopause or pre-menopause (Moulinié 1998: 139-143). 10. During childhood and the teenage years, blood seems to wander around the body, looking for a way out, popping up in all sorts of places. So it needs to be channeled, so to speak, and prevented from reaching certain areas (the nose and throat, for example) the better to assign it to its rightful place (the genitals) and keep it there. This explains the success of the minor surgical removals that are performed on young people, such as tonsillectomies, adenoidectomies and appendectomies. See Moulinié 1998: 85-110. 11. See Moulinié 2000. 12. In most conversations, “infarctus,” the French medical term for “infarction” or heart attack, became “infractus,” probably because the latter – with its proximity to “fracture” or “rupture” of a vein, artery or even the heart – expressed the deeper nature of the problem better. 13. In 1835, Pierre Rivière killed his mother, sister and brother. In France, the confession he wrote in jail has been published, extensively studied, notably by Michel Foucault, and made into a film. Rivière 1973 : 135-136. 14. Lavigne 1875 : 372-373. 15. Research carried out by Jean-Claude Sangoï and one of his female students, Nadège Fabre, into the Bas-Quercy and Val d’Aran regions of the Pyrenees in the nineteenth-century, showed that women of reproductive age whose daughters were married were considerably less fertile than those whose daughters were still single. See Fine, Moulinié & Sangoï 2009 and Fabre 2003 and 2004. 16. Verdier 1978 and 1980. 17. I am thinking, to name just one example, of the Ménophytéa herbal-tea range – with its explicit name – which had an absolutely spectacular ad campaign on French radio in the spring of 2012. 18. The results of two epidemiological studies, the Women’s Health Initiative (WHI) in the USA and the Million Women Study in the UK, were published in 2002 and 2003, respectively. They drew attention to the risks related to hormonal replacement therapy, including strokes, and breast and uterine cancer. 19. He wrote a book that was published in 1988 whose title speaks for itself: L’Andropause : causes conséquences et remèdes. 20. Debled 1992.
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21. One can read in its pages: “Post-andropausal men look like eunuchs who were castrated after puberty. Many of them go bald.” (Debled 1992: 33). 22. For more about the role of women’s magazines, see Moulinié 2004. 23. Delbès & Gaymu 1997.
ABSTRACTS
The invention of the female menopause in the nineteenth century and of the male menopause in the latter part of the twentieth century resulted in greater medical attention being paid to ageing male and female bodies and in particular to sexuality at this stage in life. If this medical coup d’état was so successful, it was because it benefited from very active support from women and from the inability of men to resist it. It was also because it fitted well into the prolongation of very ancient social practices which it legitimized. Far from relaxing, this medical control has been positively strengthened. Men, who long attempted, without great success, to escape such supervision, have today ended up submitting to it, implicitly accepting the entire silent discourse concerning the supposed decline of their virility.
INDEX
Keywords: menopause, male menopause (andropause), hysterectomy, man, woman, doctors, sexuality, transfer of generative power
AUTHORS
VÉRONIQUE MOULINIÉ Véronique Moulinié is an anthropologist and research director at the LAHIC laboratory in Paris, part of the Institut interdisciplinaire d’anthropologie du contemporain (IIAC) of the CNRS. Her doctoral thesis was on the connection between age-related surgical operations, such as tonsillectomy and hysterectomy, and representations of blood, the body and sexuality, which remained unchanged or were even validated by modern medical discoveries. See http:// www.iiac.cnrs.fr/lahic/ for her publications. [email protected]
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Current Research
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Medicine and sexuality, overview of a historiographical encounter: French research on the modern and contemporary periods
Sylvie Chaperon and Nahema Hanafi Translation : Regan Kramer
1 Since the 1980s, the history of medicine in France has undergone a major renewal of its approaches, subjects and narratives. Women’s history, gender history and the history of sexualities, which have all been expanding rapidly over this same period, have contributed significantly to this renewal by focusing on medical sources that had been ignored by traditional history of medicine. Pervaded with the positivist attitude inherited from the nineteenth century, the history of medicine, like the history of science in general, had for many years produced a series of narratives about the progress of knowledge, leading from great men and major discoveries to the scientifically-recognized truths of the contemporary era, while shunting mistakes, obscurantism and obsolete theories to the ignored margins.
2 Being relatively self-contained, these narratives tended to ignore or minimize the social, political, and ideological influences that were woven into and informed scientific discourse, focusing instead on the epistemological advances made possible by progress in theoretical thinking or technology.1 Over the last thirty-odd years, and due to a range of factors (the challenges to medical authority, and critiques of the history of science by sociologists, anthropologists and philosophers) “traditional history of medicine gradually made way for a social and cultural history of sickness and health”.2 Our aim here, however, is not to trace all of these many evolutions; we will limit ourselves to the example of sexuality. The word, which first appeared (in French) in the 1830s, had a range of different meanings. It was used variously to refer to sexuation (differentiating the sexes), procreation, and eroticism. Historically, these three meanings have tended to become dissociated. We will use it here strictly in the sense of practices and discourses pertaining to sexual pleasure, a definition which excludes
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broad fields of research such as birth control, childbirth, and medical beliefs about the differences between the sexes. By limiting our scope to the modern and contemporary periods, we should like to focus on the pioneers of the encounter between history and medicine and the history of sexuality, stricto sensu: their questions and conjectures, and the sources they used.
The Pioneers: historians from the 1970s
3 Recently, while being interviewed by Baptiste Coulmont and Marianne Blidon, Michel Bozon declared that: In France, you can’t say that academic interest in sexuality started with feminists or the homosexual-rights movement, as is often said about the USA. Historians like Philippe Ariès, Jean-Louis Flandrin and Alain Corbin were the key figures.3
4 This assessment, which needs to be qualified somewhat, is nevertheless relevant. Researchers’ interest in sexuality was undoubtedly stimulated by protest movements related to sexuality – with feminist and homosexual-rights campaigns at the forefront – but it is also true that it took a long time for the feminist studies and gay and lesbian studies that developed in their wake to affect French academic spheres, which remained impermeable.
5 In the early 1960s-1970s, the history of sexuality, or of “sexual behavior” was still primarily studied through the prism of historical demography, which recorded numbers of unmarried couples, age at marriage, birth and marriage rates, and intergenesic intervals, but above all sought to explain the early drop in the French birth rate4. This opened up various avenues of investigation, to which historians of mentalities flocked. In the wake of that research, a new generation of historians, influenced by the sexual campaigns of the 1970s, pioneered the history of sexuality (in the narrow definition we have adopted), in response, one could say, to Alain Corbin’s request in the introduction to his book Les Filles de noce (1978) (later translated as “Women for Hire”): …it’s about time that historians of contemporary France should be able to go into couples’ bedrooms without being accompanied by someone from the registry office. 5
6 In France, Philippe Ariès, Jean-Louis Flandrin, Alain Corbin, as well as André Bejin, Pierre Darmon, Yvonne Knibiehler and Georges Lanteri-Laura, led the way in this new history of sexuality.
7 Source materials from moral theology were often drawn upon to support the theory, in the wake of work by Norbert Elias (1969) and Jos Van Ussel (1970),6 that between the sixteenth and the eighteenth century, sex drives were repressed. Although he did draw attention to some forms of pre-marital sexuality, Jean-Louis Flandrin made abundant reference to these sources in both L’Église et le contrôle de naissances (The Church and Birth Control) (1970)7 and in his later work. The issue of Annales ESC (1974) entitled “History and Sexuality,” edited by André Burguière, returned to the hypothesis of repression, leaving the medical viewpoint on the sidelines, and focusing once again on demographic studies, religious interpretations and legal sources. Philippe Lejeune’s contribution, however, was an exception to this rule, no doubt because he was dealing with one of the subjects that led historians to examine medical sources: masturbation.8 Referring to Jean-Jacques Rousseau’s masturbatory confession, he studied Samuel-
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Auguste Tissot’s L’Onanisme and recalled Tissot’s influence on nineteenth century French and German doctors. In an even more novel way, he examined the relationship between the philosopher and the doctor, by analysing the shame of the confession and Jean-Jacques Rousseau’s refusal to connect his masturbation with his later troubles. Attentive to writing about the self, which lay at the heart of his research, Philippe Lejeune pointed the way towards studying how medical precepts in terms of sexuality are received, although that path would not be followed for several decades more.
8 The influence of Michel Foucault’s La Volonté de savoir (1976) [The Will to Knowledge] – the absolute reference in both Britain and the USA – was not particularly decisive in France, at least not at first. Michel Bozon, in the above-mentioned interview, considers that: …perhaps Foucault’s propositions about sexuality have had a much larger impact in the United States than in France because they represented a greater novelty there, since the habit of ‘deconstructing’ categories and institutions from a historical point of view was not highly developed there yet.9
9 The theory that the ubiquitous appeal to “Saint Foucault” in the United States corresponded to a kind of legitimation strategy for the burgeoning field of gay and lesbian studies is an attractive one.10 All the same, Michel Foucault’s work on the genesis of a scientia sexualis and his considerations on bio-politics also opened up the way to a variety of approaches later adopted by a large number of historians, in France and elsewhere: female desire, through the “hysterization” of women’s bodies, solitary sexuality, and consequently the pathologization of sexuality and the “pedagogization of children’s sex,” eugenics and hence the control of procreative practices, as well as the psychiatrization of perverse pleasures, via the elaboration of a nosology (classification) of sexual problems.11 His rejection of the repression theory, as well as his insistence on the connection between discourse and power were also widely adopted. His work further led to the greater recognition of medical sources for the history of sexuality, and historians began to use them more frequently by the late 1970s.
10 For women’s history, which was beginning to emerge at that time as well, the study of medical theories offered an opportunity for highlighting the “naturalization” of women, based on anatomical and physiological descriptions which indicated an incommensurable sexual difference.12 Since her earliest articles on women’s history (1976), Yvonne Knibiehler has also long been concerned with the question of women’s apprehension of sexuality, their experience of sexual desire, pleasure and procreation. It was while writing her thesis on François Mignet, which she began in 1964, that she became a feminist – first upon learning about the tribulations of Princess Belgiojoso, and then by reading Engels, Bebel and Beauvoir. Yvonne Knibiehler was determined to demonstrate the depth and value of medical sources (particularly dictionaries), which she used to analyze both the putative difference between the sexes – and women’s inferiority – and sexuality.13 She drew on them extensively in her many books and articles devoted to the history of motherhood, fatherhood, sex education, social workers, nurses and women in the colonies.14
11 The same themes of generation, women, and more generally of sexuality drew the attention of Pierre Darmon, a former research director of the Centre Roland Mousnier at the CNRS. His position is an anomalous one. A multi-facetted historian, he opened up several paths in the history of sexuality, yet he has been singularly under-recognized by his peers. With Le Mythe de la procréation à l’âge baroque (1977), Le Tribunal de
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l’impuissance, virilité et défaillances conjugales dans l’ancienne France (1979) and Mythologie de la femme dans l’ancienne France, XVIe-XVIIIe siècle (1983), he could be described as specialist in the medicalization of sexuality – had he not published on a range of other subjects as well (the history of smallpox and cancer, and Pasteur – but also criminology, Algeria, the Great War, cinema during the Occupation, and more). While most of his first book was devoted to the “baroque” science of generation, its first chapter, “The Instruments of Procreation,” outlined a history of the penis and its erection, as well as of the clitoris, based on medical treatises. All of these ideas would be reprised considerably later by a new generation of historians.15 Was it because of those risqué pages that the book was first published by Jean-Jacques Pauvert, a publisher known for having fought against censorship of pornography? At any rate, Darmon’s study was republished four years later by the more mainstream publisher Seuil, as were his later books. Based on a thesis directed by Robert Mandrou, Darmon’s Le tribunal de l’impuissance (“The Tribunal of Impotence”), centered on medico-legal procedures in court cases pronouncing marriage annulments. Darmon reiterated his interest in sexuality through medical sources in his re-edition of La femme criminelle et la prostituée (1991) by the nineteenth-century Italian physician and criminologist Cesare Lombroso, 16 shedding light on criminal anthropology’s views of female sexuality and prostitution.
12 The history of sexuality also owes a lot to literary historians who began to study erotic and pornographic literature, but who also turned to medical texts in the late 1970s. For the most part, they revisited writings from the modern period, in particular the eighteenth century. Jean-Marie Goulemot, for instance, proposed a new edition of De la Nymphomanie, ou Traité de la fureur utérine by the eighteenth-century physician M.D.T. Bienville.17 Goulemot also edited the “Representations of Sexual Life” issue of the journal Dix-huitième siècle (1980), based on seminars at the University of Paris VII in the years 1974-1976, as well as on the conference “L’Amour en France” (1977). Of the twelve contributions to that issue, four are based on medical sources; and most of them refer to Michel Foucault’s works. Some of them draw on literary texts – in particular obscene publications, as well as works of medical popularization and marriage manuals (Venette and Lignac),18 or even anatomical diagrams (Gautier-Dagoty). 19 Marginal sexualities prompted the greatest interest among the authors: hermaphroditism (Michel Delon), nymphomania (Jean-Marie Goulemot)20 and masturbation (Theodore Tarczylo),21 because these were the subject of a medical discourse which implicitly reasserted sexual norms. In that collection, literary historians were the ones who made most use of medical sources, revealing the wealth of information they contain.
13 Contributors to the very successful “Western Sexualities” issue of the journal Communications (1982) – it was translated into several languages – focused essentially on religious discourse.22 That also applies to Michel Foucault, who submitted an article on chastity in the works of Cassius, which was to form part of the third volume of his Histoire de la sexualité.23 Based on Philippe Ariès’s seminar at the EHESS (1979-1980), the journal issue was co-edited by André Béjin, who played a key coordinating role while remaining relatively discreet. A sociologist – he studied with Edgar Morin, who directed his thesis entitled Crises de la société et crises de la sexualité (1975) – Béjin later joined the EHESS’s Centre for Transdisciplinary Studies and its journal, Communications. Since then, André Béjin has regularly published articles on the history of sexuality and particularly of sexology; he has also edited new editions of several key works of medical discourse about perversions for the publishers Payot.24
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14 We should also stress the major role played by Alain Corbin, who encountered the historical figure of the prostitute while doing research on migrants to Paris from the Limousin region (his thesis, defended in 1973, was initially called “Limousins migrants, Limousins sédentaires”). He then embarked upon an extensive analysis of mercenary sexuality, based on a wide range of sources, including those produced by doctors who favored regulating prostitution, like the hygienist Alexandre Parent-Duchâtelet.25 From that time on, he has contributed continuously to the history of sexuality (venereal disease, private lives, and sexual violence) including his recent Harmonie des plaisirs which is based as much on medical sources as on religious and pornographic ones.26
15 Finally, Georges Lanteri-Laura (1930-2004), psychiatrist and historian of his own discipline, can also be seen as a pioneer of the history of sexual perversions. He resituated the writings of Freud in the psychiatric and psychological context of turn-of- the-century Europe, although without focusing on France in particular.27
16 The new subjects proposed by historians of sexuality in the 1970s attracted interest from the media and from the general public, because they resonated with topics that were then current in France (debates about contraception and abortion; the movements and campaigns of feminists, homosexuals and prostitutes), but they offended some fellow historians, who specialized in more traditional subjects. William Monter, who contributed a study of sodomy in the late modern era to the “History and Sexuality” issue of Annales ESC (1974), pointed out that the theme was still “somewhat taboo in academia, at least among historians”.28 Pierre Darmon’s first two books clearly disconcerted the historical community and received few reviews in scientific journals and none in the major historical ones.29 Feminist studies, which were really taking off at that time, got a more enthusiastic reception.30 Even today, Pierre Darmon’s contribution to the renewal of medical historiography does not seem to be truly recognized, except perhaps by historians of criminology.31 The vast majority of historians were men (…). Several of them became indignant at reading analyses of medical texts about genitals, coitus and orgasm, vapors and hysteria in a scholarly history journal,
17 Yvonne Knibiehler recalls about her first articles.32
18 One can’t help noticing that except for Georges Lanteri-Laura, this research was more concerned with the history of heterosexuality and conjugality than with homosexuality, which was considerably more visible in the United States. Homosexuality studies did exist in France, but they were found outside of academia, in activist books and publications. The border between social movements and recognized scientific knowledge is much less permeable in France.33 In contemporary history, the first doctoral theses were defended in the late 1970s and early 1980s, and were granted scant academic recognition. Marie-Jo Bonnet defended her thesis about love between women in 1979,34 while, following the study by Jean-Paul Aron and Roger Kempf: Le Pénis et la démoralisation de l’Occident (1978),35 Christian Bonello and Patrick Cardon examined medical discourse about inversion in the late nineteenth century (they both defended in 198436). None of them had an academic career.
19 Once these pioneering efforts became known, many others followed. The writings of doctors were chosen as guides for these explorations of the past because, like the clergy, they had sought to supervise their contemporaries’ sexuality. Research has taken off in many directions – studying medical prejudice against contraception, the struggles engaged in by doctors against masturbation or other sexual practices deemed
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deviant, their role in forensic medicine and as expert witnesses about deviances and sexual violence, hygienist doctors’ supervision of prostitution, the spread and perception of venereal disease, disorders connected to sexuality (like hysteria), marital counseling, sex education, and more. Within the framework of this short article, it would be impossible to list all the publications that have been enriching knowledge up to the present.37 In conclusion, we will simply indicate the different ways in which these sources have been used.
Medical sources: a gold mine
20 “Medical thought has turned out to be a gold mine, a stunningly rich vein of sources,” Yvonne Knibiehler was pleased to report.38 These sources are indeed extremely abundant and go well beyond the field of health (to which sexuality is considered one of the keys), since doctors offered their enlightened opinions on just about everything. Produced by medical students (theses), by doctors in the course of their regular activities (teaching manuals, scholarly treatises, books aimed at the general public, correspondence, expert witness reports, articles for medical journals), and by various institutions (medical schools, hospitals, psychiatric wards, clinics, scholarly societies), as well as by caregivers, patients or laymen and women (recipe books, self-medication books, epistolary consultations), these sources are both varied and innumerable. All of these different types of documents have been pressed into service to compose a history of sexuality based on medical viewpoints, complementing the religious, literary and judicial sources, as well as private writing.
21 Initially concerned with tracing the progress of knowledge, medical historians have essentially used printed sources like theses, dictionaries, and major treatises that summarized medical knowledge, as well as books intended for the general public. These have been of particular interest to historians of conjugal sexuality, who studied the advice given to spouses to facilitate generation and produce healthy children, preferably males.39 Yvonne Knibiehler and Alain Corbin were the first to provide a comprehensive overview of sources for conjugal hygiene, particularly for the nineteenth century.40 Certain texts dating from the late eighteenth century have been discussed endlessly by historians, especially Samuel-Auguste Tissot’s Onanisme and Bienville’s La Fureur utérine.41 These medical publications also fed a debate about the limits of the speakable, and the use of Latin or French, for example, to refer to sexuality.42 Research focused on the dynamics of professionalization and specialization has relied more on professional journals, and on the work of the learned societies which proliferated throughout the nineteenth and twentieth centuries. Historians of sexual perversions (which included homosexuality) soon identified works by professors of forensic medicine, psychiatric expert witnesses and criminologists, who were responsible for this “medical appropriation”.43
22 Historians have noted the intense gender asymmetry in these sources. Produced by men (women did not enter medicine until quite late), they tell us more about male domination than about women’s condition. In addition, these sources tend largely to ignore the views of patients (whether sick or well) about the medicalization of sexuality and their own sex lives.
23 In Britain, the emergence of a history of medicine “from below,” which includes laypersons’ representations and practices, owes much to the work of Roy Porter,
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carried out in the 1980s. His work had a relatively late influence on French-language history of sexuality.44 It wasn’t until the mid-1990s that historians began to pay attention to different “writings about the self,” in connection with a growing interest in private writings, thereby overthrowing the asymmetry caused by the abundance of professional sources. Daniel Teysseire’s study, Obèse et impuissant (Obese and Impotent) (1995)45 is representative of this concern for rediscovering first-person, lived sexual experience. Based on epistolary consultations sent by the lawyer Elie de Beaumont to the doctor Samuel-Auguste Tissot, the author examines the sexual frustrations of a man who desired a second son, but was pressed for time by his wife’s advancing age and fettered by his own impotency. These sources, which were then picked up by other historians,46 made it possible to study the role of sexuality in the therapeutic relationship, as well as everyday practices and how they were experienced, ways of speaking or keeping silent, recognition of caregivers’ skills in this field, and the impact of professional discourse on practice.47
24 Doctors also encouraged their patients or “deviants” to write their own autobiographies. Philippe Artières has methodically explored “gutter writings,” particularly those from the archives of Lacassagne, the doctor who founded the French School of Criminology: correspondence with “inverts,” criminals’ autobiographies, collections of song lyrics, slang dictionaries, writings by inmates in Saint Paul Prison in Lyon, collections of palimpsests and tattoo tracings. These sources, produced by the object of knowledge who has become an agent of knowledge, have greatly contributed to reflections about agency, subjectivization, and the crossroads of power, resistance and consent.48
25 This renewal of the history of medicine from below invites us to relativize doctors’ influence on their contemporaries; lay people, both men or women, might challenge, adapt or get around the theories… when they didn’t just simply ignore them.
26 Certain sources, at the intersection of learned and lay knowledge, would bear looking at again, especially collections of medicinal recipes and advertisements for therapeutic products. The former, essentially found within the domestic sphere, pose the question of everyday knowledge being applied to peoples’ sex lives ([in]fertility, venereal disease, etc.) and how it articulated with medical competency for that field. Advertisements developed later, along with the press, from the eighteenth century onwards, thereby contributing to the growth of the therapeutic market. Many of them, such as remedies for venereal diseases or sexual disorders, concern sexuality. These advertisements reveal that there was a consumption of medical products aimed at sexuality: the mechanisms of supply and demand served to integrate the history of medicine and sexuality into the broader market economy, which raises the question of the real extent of professionals’ expertise – whether official or parallel – i.e. in fields where they purported to provide an effective response.
27 Other sources surely remain to be discovered in the archives, and one can only hope for new investigations. Research tools do exist for the history of medicine, but they do not tend to focus particularly on archives dealing with sexuality. The guide to the Bibliothèque nationale de France (BnF, National Library of France), is particularly helpful for the excellent presentation it provides to its own collections (incunabula, theses, treatises and journals).49 The historical archives of the Bibliothèque interuniversitaire de Santé (BIUSanté, Inter-Universitary Health Library) are extremely rich, surpassing the BnF for the nineteenth and early twentieth centuries (and for
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foreign documents).50 The library of the Académie nationale de Médecine also has an important archive constituted in large part by its first librarian Charles-Victor Daremberg, who was also a doctor, Hellenist and medical historian. Composed along classic history of science lines, Morton’s Medical Bibliography provides an annotated inventory of over 8,000 major medical texts, from Antiquity to the 1980s, classifying them chronologically for each field of medicine.51 The guide to scientific archives in France,52 which inventories the personal archives of scientists from the sixteenth to the twentieth century, includes a great number of doctors. And finally, the search engine Bora, for private archives kept in public services, lists some 15 or so doctors’ archives. These results are bound to increase as more and more archives are donated and digitized.53
28 Digitization of documents facilitates access to them and accelerates searches by search engines. Twenty-five per cent of the scientific and technical corpus of the digital library Gallica concerns the medical sciences. Mandragore, the image database of the BnF’s Manuscripts department, also includes a great number of images related to medical sciences.54 BIUSanté’s Medic@ site makes part of the collection available in digital form: monographs, theses, dictionaries, periodicals and medical manuscripts and publications from the Middle Ages through the nineteenth century.55 Research by key-word can therefore be performed simultaneously on entire dictionaries and periodicals, or can be focused on parts of them. Various American and British institutions offer medical-history portals and a great number of digital resources, most notably the National Library of Medicine (NLM, Bethesda, Maryland, USA).56 In addition to bibliographic references and a range of catalogues, the NLM’s website includes an image database containing nearly 70,000 portraits, photographs, caricatures, posters and other pictorial representations from the fifteenth to the twenty-first century. London’s Wellcome Library proposes a catalogue to – and in some cases the digitization of – its archives, which date from Antiquity to the present day: medical manuscripts, personal and scientific documents, professional journals, recipes, photographs and more. Its annex, Wellcome Images, allows for extremely advanced image searches.57
29 The range of available sources and the new tools created for making use of them should sustain interest in the elaboration of a history of sexuality as seen through the prism of medical points of view. Forty years after the first pioneering research work about medicine and sexuality, the singularity of its development in France, particularly in comparison with American studies, can be highlighted. The orientation and time-scales of research into these issues are due to continuity between issues raised by historical demography, history of mentalities, women’s and literary history, and by renewals inspired by gender and cultural history. From the study of theological – or judicial – sources to those coming from medicine, a history of normative discourses about sexuality has been elaborated, and it has now been further enriched with lay representations and perceptions.
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VELLE, Karel. 1998. Pour une histoire sociale et culturelle de la médecine. Sartoniana 11: 156-191.
WENGER, Alexandre. 2005. Lire l’Onanisme. Le discours médical sur la masturbation et la lecture féminine au XVIIIe siècle. In « Utopies sexuelles », ed. Sylvie CHAPERON, and Agnès FINE. Clio. Histoire, Femmes et Sociétés 22: 227-243.
NOTES
1. For an overview of these changes in the history of the sciences in general, see Pestre 1995; for a historiography that is more focused on medicine in particular, see Jones 1987, Porter & Wear 1987, Velle 1998. 2. Velle 1998: 161. 3. Coulmont & Blidon 2010. 4. Cf. particularly the work about birth control edited by Helène Bergues (1960), with contributions from Philippe Ariès, Louis Henry and Alfred Sauvy. 5. Quoted by Corbin 2000: 41. 6. It should be noted that John Van Ussel refers to the medical point of view about masturbation, which he contrasts with that of moral theology. 7. Flandrin 1970. This book is directly influenced by the research of the American jurist and theologian John Noonan, cf. Noonan 1966. Several references to doctors or to major medical developments affecting the theologians’ point of view are worth noting. For Jean-Louis Flandrin’s contribution to the history of sexuality, cf. Corbin 2003. 8. Lejeune 1974: 1015-1021. 9. Coulmont & Blidon 2010. 10. Halperin 1995. 11. Foucault 1976: 137. Cf. particularly – and with no claim of being exhaustive – the works of Anne Carol, Nicole Edelman, Sabine Arnaud, Thomas Laqueur. See also Artières & Da Silva 2001. 12. Borie’s pioneering work (1973) should be mentioned here. 13. Knibielher 1976a and 1976b; Knibielher & Marand-Fouquet 1980. 14. See Bernos & Bitton 2004. 15. Laqueur 1989; Park 1997; Chaperon 2012b. 16. Lombroso 1991. 17. Bienville 1980 [1886]. 18. Delon 1980. 19. Guicciardi 1980. 20. Goulemot 1980. 21. Tarczylo 1980, cf. also Tarczylo 1983 in which the author intertwines religious, medical and literary discourses on masturbation. 22. Philippe Ariès mentions love, marriage and homosexuality with extremely marginal references to medical sources, cf. Ariès 1982. Jean-Louis Flandrin, who contributed to both
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special issues (the journals Dix-huitième siècle and Communications) cites moral theology only when detailing sexual positions. In Le Sexe et l’Occident (1981) in which he aims to write a “history of sexuality,” he studies fiction and popular proverbs, but without taking the evolution of the medical sciences and their influence into consideration. François Lebrun, in La Vie conjugale sous l’Ancien Régime (1985), does the same while examining such condemned practices as sodomy and homosexuality. Nevertheless, he does mention medical theories in a short paragraph about masturbation, cf. Lebrun 1985: 95. 23. Foucault 1982. 24. Béjin 1990 (collected articles); Binet 2001 [1887]; Krafft-Ebing 2010 and 2011. 25. Corbin 1978. 26. Corbin 2007. On this theme, see also Robert Muchembled’s book, which uses medical sources more marginally, but which, concerning the nineteenth century, contains a chapter called “La nouvelle religion médicale,” Muchembled 2005: 224-227. 27. Lanteri-Laura 1979. 28. Monter 1974: 1023. 29. Except for Roger Darquenne in the Revue belge de philologie et d’histoire (1980, 58/3, p. 741); François-André Isambert, for example, provides only a few very skeptical allusions, in the Archives des sciences sociales des religions (1980, 49/2, p. 248-249). 30. See Vandelac 1977. 31. He is frequently quoted in the articles, files and bibliographies on Criminocorpus: http:// criminocorpus.cnrs.fr/ and http://criminocorpus.revues.org/. 32. Knibiehler 2010: 225. 33. Chaperon 2002. 34. Bonnet 1981. 35. Aron & Kempf 1978. 36. Bonello 1984; Cardon 2008. 37. For a broader historiographical overview, see Chaperon 2002; Corbin 2003; Rebreyend 2005; Revenin 2007; Tamagne 2007 and Harvey 2010. 38. Knibiehler 2010: 226. 39. Cf. particularly Fischer 1991. 40. Corbin 1984; Knibiehler 1980 and 1996. 41. Cf. esp. Tarczylo 1980 and 1983; Stengers & Van Neck 1982; Carol 2002; Laqueur 2003; Wenger 2005. 42. Cf. Bracher 2012, and the special issue « Pudeurs… », Histoire, médecine et santé, Spring 2012. 43. Aside from the previously mentioned work of Lantéri-Laura, Bonello and Cardon, we could also refer to Rosario 1997, Oosterhuis 2000, Tamagne 2000, Murat 2006 and Chaperon 2012a. 44. Porter 1985; Porter & Teich 1994. 45. Teysseire 1995. 46. On the epistolary consultations sent to Auguste-Samuel Tissot connected to sexuality, cf. Stolberg 2000, Barras 2005, Pilloud 2008, Hanafi 2012. Many other archives of epistolary consultations exist, which would be worth studying from this angle. 47. Cf. particularly on the reception of medical discourse and its limits, Barras 2005 and Sohn 1996. 48. Artières 2000 and 2003; Apitzsch 2006. 49. Boyer 2008. 50. Cf. http://www.bium.univ-paris5.fr/ 51. Garrisson & Morton 1991. 52. Charmasson 2008. 53. Cf. http://daf.archivesdefrance.culture.gouv.fr/sdx-222-daf-bora-ap/ap/ 54. Cf. http://mandragore.bnf.fr/html/accueil.html
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55. Cf. http://www.bium.univ-paris5.fr/histmed/medica.htm 56. Cf. http://www.nlm.nih.gov/hmd/index.html 57. Cf. http://library.wellcome.ac.uk
ABSTRACTS
This historiographical article retraces the context in which a history of sexuality based on medical sources first appeared in France in the 1970s. It lays particular emphasis on the pioneers of this history for the modern and contemporary period (including English-speaking historians) and the sources they used. In conclusion, it draws attention to the recent renewal of this field, thanks to history “from below”.
INDEX
Keywords: medical history, history of sexuality, Ariès (Philippe), Corbin (Alain), Porter (Roy)
AUTHORS
SYLVIE CHAPERON Sylvie Chaperon is professor of contemporary gender history at the University of Toulouse – Le Mirail. She has published on French feminism: Les Années Beauvoir (2000), and is currently working on the history of sexology. Recent publications include her edition of Jules Guyot’s Bréviaire de l’amour expérimental (2012); Les Origines de la sexologie 1850-1900 (2nd edn 2012) and La Médecine du sexe et les femmes. Anthologie des perversions féminines au XIXe siècle (2008). [email protected]
NAHEMA HANAFI Nahema Hanafi has a doctorate in modern history from the Universities of Toulouse II – Le Mirail and Lausanne. Her thesis, Le Frisson et le Baume. Souffrantes et soignantes au siècle des Lumières (France, Suisse), revisits medical history from the perspective of women patients’ accounts. She has set up an information website on hypotheses.org, entitled Corps et Médecine. Recherches en sciences humaines et sociales : http://corpsetmedecine.hypotheses.org/ [email protected]
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Writing the history of the relations between medicine, gender and the body in the twentieth century: a way forward?
Delphine Gardey Translation : Siân Reynolds
1 The historical approach has perhaps not been uppermost in the recent turn taken by the social sciences towards analysing how the body and gender relate to science and medicine.1 When, in the 1980s, unprecedented medical technologies were developed, having far-reaching medical, cultural and social effects – ultra-sound scans in obstetrics and IVF in the sphere of human reproduction, for example – they initially provoked, especially in North America, a body of feminist literature concerned with such changes and their “consequences” for women in terms of emancipation. The expressions “test-tube women”, or “the mother machine” began to be heard, and questions were asked about “the future of motherhood”.2 From a feminist perspective, the overall verdict was scepticism about the transformations taking place and their effects.3 These publications often convey a historical narrative which tends to identify a “before and after”, and which simplifies, sometimes by idealizing it, the situation obtaining before the introduction of new technologies, which were reckoned detrimental to women’s autonomy.
2 Danielle Chabaud-Rychter and I have previously suggested that this literature typically took the form of keeping the analysis of medical practices in a separate category from that of social relations. For some time, the new technology was not studied as a subject in itself. “Commentators are not interested in its emergence, its development, or its ultimate significance and ‘mode of existence’”.4 Characterized by taking the “view from nowhere” and by the “naïve technological determinism” prevalent in the social sciences at that time,5 these publications were missing a dimension, in the sense that they failed to investigate the direction taken by the new practices, and the ways in which bodies and identities might be implicated in this close encounter with bio-
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medical technology. But this deficiency has been addressed in more recent studies, which have posed questions, from both inside and outside the scientific and medical community, about the contemporary features of the relation that individuals, as social and gendered beings, may have with these innovations.
3 In this article, I would like to return first of all to the contribution made by three strands of research (which sometimes combine), and which have made decisive contributions to the renewal of the study of relations between the body, gender, science and medicine since the 1980s: namely the “feminist critique of science”; Cultural Studies; and the field known as ‘Social Studies of Knowledge (SSK)’ [or Social Studies of Science]. My intention is to review the methods, objectives and viewpoints developed by these approaches, so as to identify their strengths and weaknesses. Having assumed this post-structuralist age of “studies” as a context (a historically contingent one no doubt), my next step will be to identify what a historical approach could or might contribute, and to suggest some desirable directions in which research might go, when we come to write the history of the relations between the body, gender, and science in the twentieth century.
Science, medical technology and gender relations as a subject of contemporary study
The feminist critique of science and technology
4 During the 1980s and 1990s, there emerged in the United States what might be termed a “generalist” feminist critique of science and technology, chiefly directed against contemporary biological developments and practices. Responsibility for this current of thought no doubt lies in part with a broader social movement, the Women’s Health Movement, which was particularly significant in the US in the 1970s, and which witnessed campaigning by many feminists and activists on the subject of health and women’s control over their own bodies. Acting as a kind of lobby, while simultaneously developing self-help health techniques and clinics, such groups were foremost in criticizing science both as a form of knowledge and as an institution, and contributed to the awareness or practice of alternative forms of health care.6
5 This first wave of feminist critiques of science7 gradually defined its own field of study, preparing the way for a broader epistemological program, which would lead on one hand to “standpoint theory”,8 that is identifying the position from which knowledge was gained and delivered, and on the other hand to a large number of empirical studies concentrating on scientific and/or bio-medical objects, questions and situations, and issues relating to gender.
6 In parallel with this movement focusing largely on science, other feminist approaches to science and medical technologies accompanied and contributed to the emerging field of Cultural Studies. This literature drew on anthropology and post-modern philosophy, and essentially proposed an analysis of technology as text or medium. It found expression in many works, notably on the dominant social and cultural phenomena of the period, for example techniques of visualizing/scanning of the body, and human reproduction.9 A dominant feature of the cultural studies approach has been to concentrate the analysis more firmly on discourses and images, but also on the employment and “consumption” of bio-medical techniques, rather than on the logic of
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origins and innovation, or the logic governing the working assumptions of professionals engaged in the bio-medical sphere.
7 In this literature, since many feminists were then working on the history and anthropology of the sciences, identities and bodies were no longer considered as given, pre-existing frameworks, or simple facts, but as acting and acted upon, in their relation to technology. Donna Haraway, who worked at the intersection of these various currents, played a key role in opening up the spectrum of what might be deconstructed in terms of “the natural”, but also because she proposed a reading of bio-medical technologies as tools for the renegociation of identities. She was one of the first feminist writers to realize the scale of the transformations that were taking place in the life sciences, as these new bio-techniques were developed, and to link these changes to other orders: technological, material, economic and symbolic. Her work interrogates the forms of experience in the techno-scientific context, and considers the ways in which the definition of the subject and his/her environment, of sex and gender, of the human and the artefactual, is renegotiated in the context of genetic engineering and the new technology of reproduction and virtual reality.10 She was also a pioneer in pointing out the path towards seizing the opportunities made possible by such changes, by reading the de-stabilizing of sex and gender as a space for “promise”, agency, and possible emancipation’.11
8 The “deconstruction” of bodies and identities has been been on the agenda for historical, anthropological and/or feminist thought in a general sense since the 1990s.12 Women historians, especially those working on the modern period,13 played a key role in deconstructing the idea that the body is biologically given, and in revealing how “natural facts” about bodies and sexual identities are sometimes directly produced not only by medical discourses and practices, but also by medical institutions. The work of Nelly Oudshoorn, Lara Marks and Bernice Hausman has provided striking examples from the twentieth century, of which more below.
The “descriptive turn” in social sciences: the Social Studies of Knowledge and the plasticity of the theory of gender
9 The 1990s saw the end of grand narratives and macro-social interpretations. Haraway’s prophecies, fabulations and fictions, which proposed a political reading of the contemporary, were in this sense highly unusual, and differed from the dominant trend in social science. During the 1990s, the nebulus known as Social Studies of Knowledge (SSK) contributed to exploration of the way in which bodies, and to a lesser extent gender identities, could be transformed in their relation to medical technology and knowledge. Becoming objects in themselves, these states of bodies and gender are above all envisaged as work-in-progress, negotiable conditions, configurations which have to be decoded by fine contextual analysis, borrowing from ethnomethodology or developing its own analytical methodologies, as is the case for example with the development of the approach in terms of of actor-network theory (ANT).14 Here the focus is on the actors, (patients, women, health professionals) and on the medical arrangements (the network) as technical arrangements. The perspectives developed in the wake of these programs in the 1990s and 2000s have been essentially presentist. Their deep significance lies in the analysis of activities and the distribution of the capacities to act, in the thick description of the complexity of human/technological
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relations, and in the attention they have paid to the first appearance of individual techniques (the dynamics of innovation). Interpretative redeployment of this kind is always situated and localized in this work, being attentive to the plural registers of meaning, as can be seen for example in Bénédicte Champenois Rousseau’s study of prenatal diagnosis, and the brilliant work of Rayna Rapp on amniocentesis.15
10 In the same way that bio-medical technology in the area of procreation and trans- sexuality has created the possibility of rendering bodies (and sexual identities) more fluid, theories and conceptualizations of gender have also become more “plastic”. This can be seen in West and Zimmerman’s Doing Gender, or the conceptualization of gender as “performance” by Judith Butler.16 This notion of a plasticity in individuals’ conditions and experiences is interesting in terms of what it makes possible in the way of emancipation and agency. The “pragmatic and descriptive turn” in the social sciences has thus contributed to producing studies which lay emphasis on local and situated versions of the empowerment of agents, even in restrictive configurations, as proposed for example by Madeleine Akrich, who examined the relation of women giving birth with the technical apparatus surrounding childbirth. This tool would therefore be an appropriate one with which to describe a certain historical reality in which there would be a wide range of possibilities (inevitably bio-technological and social) for the lived experience of parenthood/kinship, sexuality, and handicap.
11 The reversal of stigma, and the use of the “precarity”17 of a condition, as a resource enabling people to act and work together –whether the precarity is the result of a “choice” (of sex or sexuality, in the cases of trans-sexualism and homosexuality) or linked to a health problem (as in the case of campaigns by handicapped people, or patients linked by a serious or rare illness) appears to be a new phenomenon emerging in the late twentieth century. It means focusing the debate on the wider medical, social and political arena, as much as on the content of the scientific knowledge which can or ought to be produced. It may also concern the types of therapy or treatment with which the patient may or should be treated, and finally the social and political rights which may result from a “precarious” condition.
Agency, neoliberalism and post-modern promises?
12 It is possible to imagine another reading of these very contemporary transformations, as much in the way they have been investigated as in the way they have been lived collectively, since structurally, they have broadly coincided with a certain conjuncture of economic and social relations, which has also become identified as an age of managerialism and capitalism.18 Bio-technological promises are promises made to the individual: they appear to be resources which he or she may or may not employ, to enhance his/her sexual performance or fertility, to extend the limits of fertility, or of the sexual characteristics of one’s body.19 Studies produced in the framework of SSK have not aimed to take account of more structural questions of power or imbalance. They are not concerned with envisaging the benefits of technology as they affect the groups concerned: particular groups of patients for example, groups of health professionals, or individual bio-medical companies.
13 Nor has the eminently localized and Western-centric, and later de-localized and centripetal nature of the rise of bio-medical technology of the last thirty years been questioned by the “Cyborgian” turn characteristic of certain authors in the field of
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cultural studies of the 1990s and 2000s. The “cyborg” moment (which occurs in feminist theory too) outlines a fictional or futurist version of the contemporary, in which new forms of disembodiment are praised, as are the joys of the redeployment of sexual identities, the challenging of the heterosexual and reproductive matrix, and disturbances to sexuality, reproduction, and parenthood.20 This was a time when transvestism, plastic surgery, prostheses (including those of a sexual nature), sex changes, and the “commodification” of the self, became more open and frequent. The “cyborg” moment – and one should recognize that it had a socially effective impact, notwithstanding some actual fiction – appears as a moment, an unusual one, true, in the deconstruction of the discursive and material limits of gender and the body, and therefore one of opportunities; but it also coincided with a phase of neoliberalism in which the enhancement, commodification,21 or indeed productivity of the individual became economic and social imperatives. In this contemporary age of relations between gender, body and bio-medicine, it becomes the individual’s responsibility to “draw on” technological “resources” or “solutions”, whose genealogy and configurations are not necessarily questioned, but which are redefining, normatively and in a very powerful way, what social existence (and the gender relations within it) can and ought to be.22
The normative, the political, and the current transformations
14 This period is therefore paradoxical. Essentially, the literature so far produced around the subject of bio-technology has been agnostic as to the collective consequences that might be expected, and has refrained from formulating normative hypotheses about the current transformations it has brought about. This desire to suspend judgment as overly global or macro-social comment on what is happening is assumed for example in the work of anthropologist Marilyn Strathern,23 when she applies herself to the “reconfigurations of kinship” as a result of the development of new technologies of reproduction. This manner of relativizing the nature of the transformations at work emerges from observation itself, since Marilyn Strathern shows that in spite of a focus on technology and bio-genetics, the new forms of reproduction tend to create situations disconnected from biological parenthood, and thus to widen kinship relations.
15 Apparently holding little interest for the social sciences specializing in the study of science and biomedical technology, normative questions have essentially been handled by the field of bio-ethics, which tends to define the limits of “the right questions” in sometimes rather exclusive ways. Whether concerned with the regularizing of sperm donation, organ donation, the treatment and care of terminal patients, or medical practices consequent on the development of pre-natal diagnosis, the bio-ethical approach may completely abstain from considering social or gender relations, or the question of power.24 One can however point to a tradition in French moral sociology, and in particular the research by Simone Bateman.25 Her work has developed an empirical approach to ethical questions on assisted reproduction, on which she is one of the leading French specialists. Although questions to do with gender have not been a central focus of her work, they are tending to become more apparent. Additionally, and out of step with “traditional” feminist attitudes towards abortion, the positing of the sociology of engendering based on a (moral and political) reflexion on the foetal
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condition, as proposed by Luc Boltanski, no doubt marks a significant moment of reconfiguration in a double perspective, historical and normative.26
Beyond the present situation of gender-body- medecine relations: the arguments of history
16 Reviewing the strengths and limitations of these different literatures, situating them and giving them a place in the history of social science, and of history itself, means reviewing the conditions in which it might be possible to write a history capable of giving a substantial account of the transformations affecting bodies and gender identities in the long twentieth century. It also entails reminding ourselves that, no more in history than in other disciplines, is there any form of questioning or standpoint which is completely detached from an intellectual and epistemological context, itself linked to a given social and political environment. One feature of contemporary life is that social and sexual identities are, more than in the past, conditioned by bio-medical resources and technology. The transformation of what is defined and counts as society, the taking into consideration of science and technology in the make-up of social relations, is one of the most obvious contributions of SSK and the social history of science and technology.27 How are we to give a historical account of such a transformation, and to do so using a gendered perspective? What would it change in society and in gender relations, if bio-medical technologies were increasingly engaged in what defines the social? How can one describe the place of science and technology in the everyday life of men and women in the twentieth century, without over- or under- estimating the importance of the turning taken in the 1980s and its possible radical charge? And how can we do all this by maintaining not only a gendered perspective but a feminist one?
Tracing genealogies, describing new events
17 Historical research can firstly offer the chance to redefine the dynamics of the subject of study; making it possible to see lines of descent and genealogies, and to locate the subject in a longer chronology (la longue durée); this enables us to distinguish between transformation, irreversibility, and mere adjusting of former practices and behaviour. As the study of transvestism/cross-dressing has suggested,28 the chief interest of the historian is both to question the “natural” character of the evidence presented, and to question the certainty every generation feels of the novel character of its experiments. And yet there are contexts in which a historical break occurs. In this case, Bernice Hausmann has argued, with a convincing amount of detail, that “transsexuality” embodies a clear break with the repertoire of previous practices. The medicalization of transsexuality between the world wars, followed by the medical takeover of the condition in the US in the 1950s, are part of the emergence of the medical technology for and knowledge about sex change, as well as the social condition of the transsexual individual. Both the physical intervention and the psychiatric and medical treatment concerned are unprecedented (which is not to say that they do not result from decades of previous medical experiment.) And in that sense, they have a double effect: the experience of transsexuality, as a condition produced by medical intervention, is a new one; and the condition of the “trans” or “intersex” individual is modified, since the
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“medical and social supply side” also becomes a normative constraint, leading for example to an increase in the number of operations of “reattribution” of the sex assumed at birth. In this case, unquestionably, certain frontiers have been moved and resituated. It is true that experience of these new forms of subjectivity is still confined to a limited number of individuals, but its social impact, and what it has helped to redefine, from the strict point of view of gender history, may be regarded over the long term as a distinct event.
18 Among the lines of research which such history could propose and develop would be: locating and explaining the repetition of “events”, the accumulation of expertise, the convergence of practice, the hybridization of the technology, the diversification and specialization of professional fields and medical specialisms, but also the simultaneous emergence of supply and demand (for contraception, treatment of the menopause/ HRT, sexual dysfunction problems, and plastic surgery for aesthetic reasons).29 This history would be concerned with the content of scientific and medical practices and aims, to the extent that they are handled by professional milieus, yet are at the same time matters of wider social and cultural debate. Adele Clarke’s work,30 although at first sight principally limited to the institutional, professional and cognitive dynamics shaping the new field of reproductive science, in fact fits very well into such a program, from the point of view of women’s and gender history. This research shows – and the evidence had not been studied before – that the first test-tube baby did not come from nowhere, but was the result of scientific investment beginning as early as 1910, and of alliances implicating wider circles, with contributions made not only by the relevant sciences and the disciplines one would expect, but by other branches of medicine ( among them veterinary science, which was particularly important between 1920 and 1960, or eugenics, which brought together certain demographers and biologists in the inter-war period), as well as non-scientific milieux (philanthropic, business, neo- Malthusian, feminist) – all contributing to the social, political, and eventually epistemological context for IVF research. Lara Marks’s work31 on the history of the contraceptive pill has been complementary to some of the situations and issues pinpointed by Adele Clarke. Both of them have for example underlined the significance of Margaret Sanger32 in the invention of the idea of a “universal contraceptive”, the quest for institutional, intellectual and financial resources and alliances as well as purely scientific ones, and her contribution to the shaping of scientific agendas and environments which might aid the feminist cause, as well as a certain conception of social emancipation.
Stating temporalities and contexts, reconsidering certain topics, producing new narratives
19 Genealogical analysis carried out on certain very contemporary subjects can enable us to analyse the contexts in which they first saw the light, and to describe what has really been transformed in the period dating from the late twentieth century. We can see for example, how an “industrial time” in the reproductive sciences (1950-1970), dominated by the imperatives of norm-creation, regulation and treatment, gave way, once IVF technology had been launched, to an unprecedented expansion of interventionist processes and products in the domain of human reproduction. The rapid expansion of actions and capacities in the way of manipulating living beings, is a question well worth
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exploring beyond the central themes of reproduction and sexuality, especially from a feminist perspective.33
20 Symmetrically, this “fin de siècle” moment prompts us to think about the preceding periods. Should we identify a different “industrial” period of relations between bodies/ products/medical technologies, and if so what should we call it? Should we speak of an “endocrine” period, starting in the 1920s and becoming visible through the proliferation of medications in the inter-war period?34 And then of a “chemical” time, during which not only endocrinal applications but also major industrial developments with vaster environmental consequences would come into play, for example those associated with the agro-alimentary industry, or the more general modification of the environment though toxic substances (such as hormone changing chemicals). This reading (via a history of toxicity) has been proposed in the US by Nancy Langston.35 She has drawn attention to certain health scandals (e.g. the Distilbene years) which had gendered effects that have remained in people’s memories.36 An approach of this kind would make it possible to reconcile different historiographies: the classic history of industrial hazards, and the way both men and women have been affected by them, depending on the sectors in which they have worked, a history which has yet to be written, in large part, for the long twentieth century;37 and a new social history of health which would have gender as one of its central axes.38
21 The spectrum of subjects that might be reconsidered in this perspective is very wide. What for instance would the chronology look like of the social and medical history of the conditions of maternity (pregnancy and childbirth) in twentieth-century Europe? How would we, these days, write the history of male and female sterility?39 How should we re-examine the histories of the major aetiological changes of the twentieth century from a gendered perspective? What is the significance of revisiting the history of an illness defined as feminine in the nineteenth century (phthisis) but which had no gendered indication or specificities when it was redefined as tuberculosis in the twentieth century? How should we consider, over the long term, the place taken by medical treatment and institutions in people’s daily lives? How should we envisage the relationship between bodies, gender and medicine in the twentieth century, taking account of the development of public health policies, and the way they target and define certain sectors of the public. Research into the “control of bodies”40 means considering the State, hospital infrastructures, medical institutions, and types of public intervention. It questions the roles of the various actors/agents engaged in the definition of medical supply and health policy (the public authorities, health professionals, industrialists supplying these sectors.) The economy of these relations was profoundly transformed in the course of the twentieth century, and this history directly concerns the possibilities of access to treatment, or to medical infrastructures: examples would be the termination of pregnancy, and whether or not it is reimbursed; campaigns to prevent the spread of AIDs; or the need to apply to private agencies or to a hospital establishment to benefit from sperm donation.41 The history of the market in sex hormones tells us that hormonal solutions started becoming available to a “public” consisting of menopausal women as early as the inter-war period, but what is there to say about contemporary practices now witnessing the emergence of markets for “consumers” rather than patients, markets which have been directly shaped by the pharmaceutical industry in the sense of the “commodification” of female desire and the medicalization of treatments for sexual dysfunction?42
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22 It is clear that there is a strong case for undertaking many more micro-historical surveys in the French and European context, so as to be able to account for the dynamics at work, and for what is specific about them. The topic of the circulation and appropriation of medical practices and techniques (e.g. the history of the contraceptive pill, the prevalence of “medical tourism” in the history of abortion, or of surrogate motherhood today, the possibility of access to some medication via the internet) reminds us of the complexity of contexts which remain basically anchored in legal and institutional frameworks conditioned by specific scientific, political, economic and social factors.
Revealing what is at issue in normative and political terms
23 While we need more case-studies, we need them to be carried out in a way that recognizes the contribution of contemporary social science. It seems desirable to avoid as far as possible simplistic readings, or the logic of “effects” and determining factors and to avoid repeating a division between a separate artificial field covering the social (or gender), and a different (sacrosanct) field of “hard science” and technology. Historical research can and should draw on resources from the social study of science and medicine, and critical and feminist theory. Researchers will find that these offer valuable tools to help identify or analyse the logic peculiar to the different agents, the contingent and local meaning that scientific facts may hold for certain human groupings, and the way experience is modified by contact with medical technology.
24 A historical approach in any case has its own resources to draw on. By seeking to locate key contexts, moments, and turning-points, by identifying differentiated “regimes” in which economic and political questions are taken seriously,43 by uncovering the genealogy of certain practices, by studying the scientific and social controversies aroused by certain innovations, history enables us to see the alternative paths which existed in the past, and thus those which exist in the present. Opening up space for alternatives, by revealing the social and gender issues which are present when scientific or medical choices are made, or inversely, showing how medical and technological responses appeared in the course of the twentieth century as socially acceptable responses, is a legitimate aim both for academic research and for the wider society. Donna Haraway suggests that the ability to produce narratives that help us define the boundaries of choice is one of the normative constraints which we are entitled to expect from academic science and scientific pronouncements.
25 I have attempted in this article to show how the “descriptive turn” in the social sciences, and the crisis in more structuring systems of interpretation, has probably weakened critical readings of certain phenomena, and that history should therefore have a place in the new reconfiguration of knowledge, because it can help reveal the alternative pathways, the local significance of case studies, but also the wider global framework in which individual and social experience can be inscribed into the long term of the history of the relation between human bodies on one hand, and medical knowledge and institutions, political and economic life, and medical practices on the other.
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NOTES
1. For a suggested historical synthesis on this theme see Gardey 2013. 2. Arditti et al. 1984; Corea 1985. 3. Corea (ed.) 1985; Katz 1982 and 1989. 4. Chabaud-Rychter and Gardey 2002: 32. 5. Wajcman 2000. 6. Löwy 2005; Fausto-Sterling 2000. 7. Ardener (ed.) 1978; Birke 1986; Bleier (ed.) 1984; Fausto-Sterling 1985; Fox-Keller 1984; Gardey and Löwy 2000; Gardey 2005. 8. Haraway 1988a; Hartsock 1997; Harding 1991 and 2003. 9. Adams 1994; Cartwright 1995. 10. Haraway 1985, 1988a, 1988b. 11. Gardey 2012. 12. Gardey 2006. 13. Duden 1993; Park 1996; Jordanova 1989; Schiebinger 1989; Akrich & Laborie 1999. 14. Akrich, Callon & Latour, 2006; In this tradition, see work by Akrich & Pasveer 1998 and Mol 2002.
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15. Champenois Rousseau 2003; Rapp 2000. 16. West & Zimmerman 1987. 17. Butler 2009. 18. Boltanski & Chapiello. 19. More generally on the productivity (psychic and physical) of subjects deemed necessary in the late twentieth century, Ehrenberg (1991) and Queval 2004. 20. Balsamo 1992 and 1996; Featherstone & Burrows 1996; Braidotti 1996. 21. Commodification, in the sense of transforming something into a commodity: marketing of the self, as in genetic engineering. 22. Akrich et al. 2008. 23. Stratherm 1992. 24. Unlike in the United States, there is not (yet) in France a recognized field of feminist ethics or bioethics. 25. Bateman 1991 and 1998. 26. For a discussion of Boltanski’s ideas, see the debate which I edited in Travail, Genre, Sociétés, 2006. 27. A pioneering article in French was Pestre’s (1995). 28. Bard & Pellegrin 1999. 29. Fishman 2004; Hirt 2009; Löwy 2006. 30. Clarke 1998. 31. Marks 2001 32. Margaret Sanger (1879-1966) was an American birth control campaigner who played a decisive role in the history of the movement, and in the coming of the contraceptive pill. 33. Franklin & Ragoné 1998 34. Oudshoorn 1994. 35. Langston 2010. 36. In 1971, researchers in Boston uncovered the link between cancers in very young women whose mothers had taken during pregnancy the drug Distilbene, which contained a synthetic oestrogen Des or diethylstilbestrol. Among the 2 to 5 million children exposed to DES in the womb, it has been estimated that 95% later suffered reproductive abnormalitites, such as irregular menstruation, infertility and the risk of cancer, ibid., p., 18. 37. For recent contributions to new studies on these subjects see Clark? 1997; Bruno & Omnès 2004. 38. See the interesting synthesis on the US by Apple 1990. 39. Pfeffer 1993. 40. Fassin & Memmi 2004. 41. Becker 2000 42. Fishman 2004. 43. Pestre 2003.
ABSTRACTS
This article reviews recent work in the social study of science (Social Studies of Knowledge or SSK), as well as in cultural studies and feminist criticism of the physical sciences, in order to
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demonstrate the contribution made by these fields of study, and their reading of the history of very recent bio-medical innovations in the spheres of human reproduction and sexuality. In particular, publications in SSK have suggested a dense and complex reading of human- technological relations, and of the ways in which social and gender relations are implicated in them. Considering the parallel between some of these approaches (themselves part of the “descriptive turn” in the social sciences) and broader economic and social change (the reconfiguration of the self through biotechnologies as an individual promise in a neo-liberal context) the article seeks to envisage how a revitalized historical approach might contribute to these subjects. It might, for example, make more explicit the density of the social and scientific context within which certain technological change occurs; demonstrate the historicity of what is at stake for gender and social relations; and propose a new set of narratives which would recognize the normative political and economic dimensions of technological change.
INDEX
Keywords: gender, science, medicine, body, bio-technical innovation
AUTHORS
DELPHINE GARDEY Delphine Gardey, historian and sociologist, is currently professor of contemporary history at Geneva University, and director of the Institut des Études Genre. Her research has been on social and gender history, employment in the tertiary sector (La Dactylographe et l’expéditionnaire, 2001) and feminist and gender theory. Her most recent publication is the edited collection: Le féminisme change-t-il nos vies ? (2011). [email protected]
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Testimony
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The anthropologist, the doctors and the transgender experience: an interview with Laurence Hérault
Sylvie Steinberg and Laurence Hérault Translation : Ethan Rundell
1 Laurence Hérault is an anthropologist and specialist on the transgender experience. She is an Assistant Professor at Aix-Marseille University and a member of IDEMEC1, the research center of the Maison Méditerranéenne des Sciences de l’Homme. Her research has led her to carry out observations of transgender persons and hospital doctors. Clio asked to interview her regarding the circulation of medical knowledge and the impact of theoretical debates within the triangle formed by the anthropologist, “patients” and medical personnel – surgeons, endocrinologists, psychiatrists and psychologists. Lawyers, associations and collectives also have a role in this context. The interview is the result of written exchanges and was carried out in winter 2012-2013 by Sylvie Steinberg.
Clio: As an anthropologist, you work on the medical experiences of transsexual and/or transgender individuals. Can you describe these experiences within the medical world as well as the various therapies that exist? First of all, I would like to say that my work on medical experiences is only one part of my research into contemporary transgender experiences; I also address other dimensions such as those of kinship/parenthood and family ties, for example. Regarding medical trajectories in France, trans-identified individuals can turn to the protocols offered by specialized hospital teams (there are six of these) or instead choose an “extra-protocol” path by consulting private practice doctors for part of the transition and having surgery (particularly genital operations) performed abroad – in, for example, Thailand, Belgium, the UK, Spain or Canada. Some individuals also combine the two, either beginning with the hospital path and at one stage or another abandoning it, due to waiting periods or the quality of care that is offered, or by beginning with private practice consultations and entering the hospital path for
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operations, since in France, genital surgery can only be reimbursed by the social security system if it is carried out in this framework. Regarding the actual content of the experience, several points touching upon the pathological definition of trans identity must first be specified in order to understand the particularities of these medical protocols. Transsexualism, or Benjamin’s Syndrome, was developed in the mid-twentieth century and has since been given a fixed definition in international diagnostic manuals such as the DSM (Diagnostic and Statistical Manual of Mental Disorders) and the ICD (International Classification of Diseases) under the heading Gender Identity Disorder (GID). It is defined by four main criteria: strong and persistent identification with the other sex, a persistent discomfort with his or her sex, the absence of physical intersexual attraction and “clinically significant distress”. This disorder is therefore essentially conceived as a psychiatric disorder based on the idea of an inconsistency between sex and gender, that is, fundamentally on an essentialist and dualist conception of the sexual identity of individuals: the trans individual belongs to one sex but claims to be of the other gender. Logically enough, therapeutic offerings have been aimed at re-harmonizing these two dimensions and there was for a time controversy over the proper site of intervention: was it necessary to act on the mind or on the body? Since the psychotherapies that were attempted did not prove effective, in contrast to the endocrino-surgical treatments that were simultaneously developed, the latter gradually became widespread. GID nevertheless continues to be referenced as a psychiatric disorder. The protocols available in France, generally adapted from international care standards (defined among others by the World Professional Association for Transgender Health), thus before all else provide for a psychiatric evaluation at the request of the patient. For hospital teams, this evaluation fairly often plays a sort of gatekeeping role, even though the evaluation is multidisciplinary and the final decision requires joint agreement of the psychiatrist, the psychologist, the endocrinologist and the surgeon. When a patient calls upon a hospital team, he/she is thus received on several occasions by the psychiatrist and the psychologist (the latter submits him/her to various classic personality tests like the Rorschach and the MMPI, Minnesota Multiphasic Personality Inventory), who see to it that the criteria defined in the framework of GID are met and that associated psychopathologies are absent. He/she also meets the endocrinologist and the surgeon, who for their part ensure that there are no contra-indications for hormone treatment and surgery. This phase of evaluation can last from several months to one or two years, before the team reaches a decision on the case and offers or refuses to include it in the protocol. When the request is accepted, the “treatment” then begins with a hormone regimen that lasts around one year before surgery can be contemplated (the object of a second decision on the part of the medical team). The surgical operations that are generally suggested are mammoplasty and vaginoplasty for MtF (male to female), mastectomy, hysterectomy, ovariectomy, phalloplasty and, more recently, metoidioplasty2 for FtM (female to male); other plastic surgery operations can also be suggested and/or performed at the same time (facial surgery, hair removal, etc.). It should be underscored that these operations are not all equally desired by trans individuals, with many FtM, for example, opting not to have a phalloplasty (because they do not think it is useful to have a neo-penis or because it involves extensive surgery of
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uncertain outcome), nor even a hysterectomy or ovariectomy (either because they want to limit the number of operations or because they want to retain their reproductive capacity). Yet performing these genital operations remains important if one is to subsequently change one’s civil status. Doing so is only authorized [in France] on condition that one can demonstrate the irreversibility of the transformation, something that judges have become accustomed to associating with vaginoplasty for MtF and hysterectomy and ovariectomy for FtM (though a recent circular from the Ministry of Justice requests that judges above all take the effects of hormone treatment and the individual’s social integration into account). In a way, this legal procedure, which is thought of as the end result of the medical experience, serves to authenticate the latter. But it also clearly imposes its vision of what a trans body must be, by implicitly requiring that a certain number of transformations be carried out beforehand, changes which result in the sterility of the individual. In both cases, one may wonder whether that should really be its role. In contrast to the choice recently taken by other countries such as Argentina, for example, the medical and the legal domains in France remain closely dependent on one another and one of the major issues in the years to come will no doubt concern the redefinition of their relationship.
Clio: What characteristics are specific to the medical “terrain” for an anthropologist of contemporary Western society? First, the term you suggest, “field,” can be understood in two ways: in a broad sense (that of the medical approach to trans identity in general) and a narrower one referring to the site of study (i.e., my presence in a specialized hospital service). In both cases, the place of the anthropologist is not to be taken for granted, even if it takes different forms. First, to work on the medical approach to trans identity is to re-contextualize the classic Western approach to the transgender experience, which has long been defined in pathological terms. It is thus to venture upon very well- charted territory, with many specialists and an extensive literature (the vast majority of which is psychiatric and psychological in nature). The anthropologist is considered to have some deficit of legitimacy, and is more or less obliged to make up for it: you are constantly asked to justify your interest in the question and above all to define your approach in terms of complementarity. Indeed, the idea – more or less explicitly stated by many of the doctors among my interlocutors – is that an anthropological approach is only legitimate and relevant if it takes an interest in the “narrowly” social aspects of the trans issue (an individual’s social inscription, professional or family integration, etc.) and serves to in some way complement theirs. Few expect it to examine the very manner in which this issue has been understood in our societies, to specifically question the pathological definition it has been accorded, or actually to take an interest in the manner in which they themselves work. Furthermore, if one understands “terrain” in the second, narrower sense, one comes up against the fact that a “concrete” medical system for admitting observers is generally not provided and it is difficult to occupy any of the normally available places (impossible to be a doctor, nurse or psychologist, difficult to be a “patient”). Unlike other sites where I have conducted research, one is as a result unable to melt into the woodwork and so is extremely visible. In fact, in this fieldwork close to home, the anthropologist can be as obviously out of place as in more exotic contexts and his/her incongruous position also makes it difficult for interlocutors to
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understand him/her. The perception people have of the anthropologist’s objective and stance is often full of misunderstandings: they wonder what you are doing there and what possible use you can be. I therefore find myself up against one of the well- known difficulties of practicing classic anthropology: being at once welcome and unwelcome, familiar and foreign, useful and in the way. Moreover, the ethical questions involved in the inquiry proper are more salient here than in other types of fieldwork. It is important to consider these questions beforehand and that is what we did with the medical team with whom I worked, laying down rules as to data confidentiality and personal anonymity. But at the same time, things are never settled once and for all. And what I discovered when doing this fieldwork – something that had not presented itself to me in this way in my earlier research – was that the ethical requirement my interlocutors and I shared was ever present and most often played out in context, which obviously is not easy. Given this complexity, it is not surprising that the anthropologists who have put forward well- developed thoughts on ethical questions in anthropology have generally long worked on health-related issues, and when I discovered this terrain for myself, their thoughts were of great value to me. In fact, this type of terrain forces you into reflexivity; more than others, it obliged me to wonder about my place: the place that I could / wanted to take, the place that one group or another gave or refused me. Asking these questions can be productive too: for example, doing so allowed me to see and understand essential aspects of the medical system.
Clio: What are the specificities of the anthropologist’s gaze vis-à-vis other approaches and, in particular, medical ones? Do you have the impression that these specificities are perceived by the various actors with whom you work? I believe that the specificity of the anthropological gaze stems from its associated capacities of translation and perspective. It is always a matter of showing a world and understanding it as it is, one way among others of seeing, doing, acting, etc. I try to hold on to these two things in my research on the Western trans experience by conducting, on the one hand, fieldwork on the medical approach – that is, on one of the main sites of the production of “transsexuality” (understood as the medical version of this experience) – and, on the other, by offering comparisons between ways of understanding the trans experience in France and ways of understanding it elsewhere, particularly in historically and/or geographically remote societies. The effect of these two dimensions of my approach has obviously been to deconstruct the dominant conception of the trans question and in particular its medical conception, since that amounts to demonstrating certain of its characteristics, showing the manner in which it operates, both theoretically (by questioning well-developed pathological categories) and practically (what do these categories become in practice? What does GID become in an actual medical system? How is it used? etc.). This amounts to bringing to the surface questions that are not usually raised: for example, why is the transsexualism clinic so interested in trans individuals’ sexuality, when this syndrome has precisely been defined as a gender identity disorder, not a sex disorder? Why are we ready to more or less explicitly require a hysterectomy of someone to whom this might not be either necessary or desirable, without even considering that we are depriving that person of the possibility of being a parent?
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It is clear that, depending on their positions, interests and objectives, this deconstruction is capable of interesting and/or disconcerting my interlocutors. Moreover, they often misunderstand it somewhat, either because they think that demonstrating the manner in which their version of the trans experience has been constructed is enough to discredit it – whereas they are understandably attached to a version which took time to develop and is useful to them, since it supports their action on a daily basis; or because they interpret the alternative conceptions found in other societies as simple models to imitate, something they are obviously not ready to do, and which fairly often leads to either defensive cultural relativism (“they’re that way, we’re this way, and their conception is of no use to us”) or towards an ethnocentric re-interpretation which preserves the essence of the subject: (“trans experience is a pathology in all universes, but elsewhere this pathology is simply treated differently”). A way must thus be found to dispel these misunderstandings and it is here that the attention given to translation is important. One must try to capture the specificities of non-Western trans experiences, showing for example that they are based on a conception of gender that is different from ours but is not, for all that, foreign to us, in such a way as to communicate or at least try to communicate that other ways of understanding and living the trans experience are not “solutions” to our problems, nor even responses to our questions, but rather occasions to formulate those questions differently, which is also to say to transform them. Moreover, the anthropological translation of medical practices that I propose also tries to respect the positions and points of view of my various interlocutors: it is not enough to show what they do from a different perspective, they must also recognize themselves there, it must also do them justice. If my translation is successful, my interlocutors must at once recognize themselves in the descriptions that I offer of their practices and world – without which I have lost something of the experience I am seeking to convey – yet at the same time render them capable of seeing in another light unexamined certainties and expectations, as well as the constraints to which they are subject, and from which they might free themselves.
Clio: There is an accumulation of rapidly evolving knowledge regarding transsexuality. But this knowledge is also a matter of constant debate. How do you work with these parameters? Since the very birth of “transsexualism,” controversies and debates have pitted against one another, among others, psychoanalysts, sexologists and psychiatrists. These debates have not completely died out but they are much less fierce than they once were, since the definition in terms of identity disorder has on the whole triumphed. Roughly put, the sharpest debates today pit trans collectives against doctors and, in particular, psychiatrists, over precisely this definition of trans identity, as well as relating to the knowledge held by one group or the other, a sort of conflict of expertise: Who is an expert on this question? Health professionals or the individuals concerned? This new debate is part of a more general movement to take the patient’s experience into consideration, and also reflects the growing influence that trans activist associations have enjoyed in France since the 1990s and particularly over the last decade, which has witnessed the birth of several dozen associations in the space of just a few years. This activist movement, like many others, is at once local and global: the associations are solidly anchored at the regional level (often in relation to local help and support) but also maintain national and international ties in order to support larger causes – for example, the “Stop trans
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pathologization campaign”. At the same time, what can be seen as a form of “professional activism” has very recently taken shape on the occasion of ministerial consultations and reports (HAS /Haute Autorité de Santé; IGAS/Inspection Générale des Affaires Sociales) concerning the trans question, with the creation of two associations of health care professionals and lawyers over the course of the past two years. Working in this context therefore requires constant adaptation, for everything is changing very rapidly – approaches, positions, conflicts, debates and so on – to such an extent that I can say that the field in which I got my start less than ten years ago has completely changed. The other difficulty is to avoid losing sight of the complexity of positions in the context of high stakes debates that are generally extremely intense. The very contentious character of these debates can lead the scholar down the dangerous slope of typification, especially as the opposing actors themselves tend to typify their “adversaries”. Faced with blocs that can too easily appear monolithic, it requires considerable vigilance to keep in mind the full complexity of the positions, the full complexity of the debates and their ramifications. For example, there are many areas of disagreement within the trans activist movement as well as within the associations of professionals. Finally, the third point that seems important to me in such a framework is the place of my own productions. It is easy to see how the remarks I may make here or there at colloquia and the papers I may write have no chance of remaining confined to the academic universe but will on the contrary be read, commented upon, criticized and generally get “mixed up” in ongoing debates and controversies. It is obviously not a problem in itself, and in a general way, moreover, I help to make my texts publicly available by putting them on open access archival sites. But this also means that I need to reflect on their content in ways that go beyond the usual academic requirements.
Clio: In various types of knowledge that have accumulated regarding transsexuality, what place did medical expertise occupy in the past? What place does it occupy today? How might you describe the state of the various types of knowledge and their circulation? In general, medical expertise has occupied a significant place and still does, due both to the pathological definition of trans identity and the bodily transformations that are offered and desired. But you are right to speak of ‘types of knowledge’ in the plural and, to answer your question, one must distinguish between the various types along disciplinary lines, because the psychiatrist, the endocrinologist and the surgeon, for example, occupy different positions in terms of legitimacy, evolution and use. Since it contributed to conceptualizing GID, psychiatry has played a central role and is still important since its expertise is always required in contemporary protocols. Yet at the same time its legitimacy has been called into question, particularly by activist demands for depsychiatrization. Psychiatric knowledge on the trans question is therefore at once strong and weak, and its future is uncertain; moreover, attempts to modify GID in the framework of the present reform of the DSM, with new proposals followed by changes of mind and a retreat to the old version, are entirely symptomatic of its paradoxical and uncomfortable position. The other forms of knowledge that are involved, endocrinological and surgical, pose less of a problem because they are more immediately perceived as “technical”: they offer molecules and operations, and their representatives, like those who call upon them, see them in terms of competence, often even in terms of individual competence. Their legitimacy is therefore never called into question but their manifestations can
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be, as we see when someone criticizes a colleague or when individuals or trans collectives cast doubt upon or, on the contrary, praise the competence of a given surgeon. The future of these forms of knowledge/expertise is not in doubt and their essential task consists in improving and becoming more refined (better mastering hormonal treatments and their effects, improving operating techniques, offering operations that render neo-organs more sensitive and aesthetic, etc.). Due to this situation, the question of their coordination, which had been consolidated in the framework of the protocols, implicitly becomes an open question once again. At present, psychiatric evaluation still makes it permissible to guarantee the legitimacy and well-foundedness of a surgical intervention that might in certain conditions be understood as mutilation, but does this evaluation allow for a reliable diagnosis when its foundations are themselves a matter of controversy? Could it be dispensed with, and, if so, how and on what conditions? Should we continue to refuse requests for partial transformation because psychiatrists do not approve of them? The question of the legitimacy of forms of knowledge also arises in another way with regard to their internal and external appropriation. There are thus conflicts of legitimacy regarding the diagnosis and the recommendations made within or outside of the hospital protocol: for some people, for example, GID cannot properly be treated outside of specialized teams, and private practice doctors, even if well- informed, are not seen as legitimate independent consultants. Moreover, these types of medical knowledge are not solely the preserve of professionals and, as in other places, they are the object of “profane”/“lay” – but nevertheless expert or knowledgeable – appropriation. A number of trans individuals have become very competent in the area, and they are sometimes in a position to make proposals permitting their transformation. There are, for example, lively and knowledgeable discussions of hormonal treatments on forums and at associative meetings, where experiences are shared, and discussions take place with consulting doctors. Elsewhere, the appropriation of these forms of knowledge is more strategic and takes the form of exploiting knowledge that is a priori seen as illegitimate and without foundation: there are thus many exchanges concerning the criteria of GID and what one should tell a psychiatrist in order to receive authorization for the operations one wishes to have performed. In these cases, the individual is not seeking to discuss with a professional the well-foundedness of his or her diagnosis, but rather to meet expectations in order to get what he or she wants.
Clio: The place occupied by transsexuality in the theoretical elaboration of the concept of gender is well-known. Has your anthropological work led you to reconsider this concept? As you underscore, the notion of gender was born in the clinic of transsexualism and intersexuality before being adopted by the social sciences and feminist scholarship. That obviously had an impact on my own work, since gender is not simply an available tool of analysis but also a notion that my interlocutors and I have in common. The fact that we share this notion is not evidence of agreement because, while everyone or nearly everyone uses it, it must be noted that it is not necessarily to refer to the same thing, nor even to do the same thing. Crudely put, two major references to gender are to be found in the framework of trans identity: the transsexualist version of gender, and the queer version of gender, both of which are
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at the origin of, and fundamental to, grasping the possible versions of the contemporary trans experience. In the transsexualist version, gender fundamentally remains a characteristic and property of the person. It denaturalizes less than it complicates the possible description of persons. In this version, transsexual persons are conceivable because sex and gender are different things, and it is possible to describe their situation in terms of incoherence: their sex and gender are in contradiction but one can/must re- harmonize them. In the historically later, queer version, there is on the contrary a clearer desire to denaturalize and de-essentialize the question, going beyond the sex/ gender distinction (understood as a distinction between nature and culture). When what we might call first-wave queer thought seized hold of sex/gender, it was not to say, as psychology and sexology had done before, that gender identity is as important – if not more important – than biological sex (which historically allowed transsexuations to develop). Queer thought seized hold of sex/gender to say that sex- gender identity does not exist, that there are only sex-gender performances. But this first queer performativity was doubtless very/too discursive and many criticized it, particularly trans scholars and activists, who emphasized that the body had been left out of this account. Judith Butler, for example, tried to respond to this with Bodies That Matter (without always convincing her critics, it must be said) and in her most recent work the body is also present via the question of vulnerability. Whatever the case, later queer perspectives made an effort to move beyond this sex/gender distinction in non-discursive ways, particularly by attending to the multiple “technologies of gender” that go beyond drag, by showing how, via hormones, Viagra and the knife, we all fabricate our sex-gender. At the same time, this new approach remains based on the notion of performativity and is actually still a matter of making something oneself in order to produce one’s gender identity. The subversive use of these technologies moreover allows one to constitute multiple alternative identities, presented as so many ways of escaping the man/woman binary pair. In order to do this, it seems to me that, in a number of cases, one has simply reproduced that which one seeks to overcome – that is, an identity-based version of gender – by way of multiplication. It is true that one escapes from the binary pair, but less than anticipated from the notion of gender identity. Moreover, I also see a difficulty in conceiving what is unperceived by the subject (what lies beyond the performance) otherwise than via a paradoxical recourse to biology (“the power of hormones” is sometimes praised, for example) or an often abstract reference to norms. It seems to me that the relational approach that developed in anthropology on the basis of Marilyn Strathern’s work3 is less of a dead end from this point of view. It was developed on the basis of a comparison of genuinely alternative conceptions of the person, conceptions developed in other societies in which, as the volume edited by Catherine Alès and Cécile Barraud shows,4 one is less attached to categories (man/ woman) than to status (brother, spouse, mother, etc.). In these societies, individuals are conceived neither as simple products of other bodies nor for that matter as the products of ego-centered performances. Rather, they are the products of relations. Relations are not secondary here in the sense of being activities in which individuals already provided with an identity engage (whether it be by exo- or auto- identification); on the contrary, relations are at the basis of the individual, including their very materiality (the body). Organs and substances jointly supply the basis of
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these relations, for the body is not only what individuates us, it is also what ties us to others. This is how Marilyn Strathern can say in Gender of the Gift that “Western women make children, Melanesian women do not.” By preferring the status to the category, moreover, the relational approach seems to me better capable of grasping the instability of individual engagements. Queer thought presents itself or is sometimes presented as the last manifestation of modern individualist ideology, to the degree that it is said to be a refusal of assignment (“I am not what you say I am”), a demand for mobility (“I am this but I can/want to/will change”) and an assertion of plurality (“I am this but I am also that”). This sometimes provokes angry protest from many opponents who say that identities are much more solid than that, and/or that this disruption of identity is undesirable. Yet the demands attributed to queer thought are finally no more or less than the everyday stuff of any social life. To recognize this, however, one must abandon the identity-based version, discard the performance/norms opposition, and enter into the instituted play of expectations and possibilities. In all societies, status does indeed make us mobile, plural beings and also offers us diverse possibilities of involvement: acceptance, refusal, negotiation. In other words, our theory does not describe our practices, and gender is for us also a form of action and relation: it is a “factish” in Bruno Latour’s sense of the term, that is, something that makes us do things and act in a certain manner, at once “like” and “as”. I have found this way of understanding things to be very useful, for example, in grasping the particular – and on the face of it disconcerting – experience of Thomas Beatie and other pregnant men who have given birth “as men in the manner of women.”
NOTES
1. Institut d’Ethnologie Méditerranéenne et Comparative. 2. Or metaoidioplasty: an operation that consists in freeing the clitoris, which has grown under the influence of testosterone, making it appear as a micro-penis. 3. The Gender of the Gift, Berkeley & Los Angeles, University of California Press, 1990. See also Irène Théry, who developed this relational approach, particularly in her book La Distinction de sexe, Paris, Odile Jacob, 2007. 4. Sexe relatif ou sexe absolu ?, Paris, Éditions de la Maison des Sciences de l’Homme, 2001.
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AUTHORS
LAURENCE HÉRAULT Laurence Hérault, is an anthropologist at the University of Aix-Marseille and a member of the Institut d’ethnologie méditerranéenne, européenne et comparative (IDEMEC), Maison Méditerranéenne des sciences de l’Homme, Aix-en-Provence. Her research is on contemporary transgender and trans-sexual experience. For her publications in this field, see the website http://halshs.archives-ouvertes.fr/. [email protected]
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Varia
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The reconfiguration of gender relations in Syrian-American feminist discourse in the diasporic conditions of the late nineteenth century
Dominique Cadinot Translation : Jeffrey Burkholder
1 The prejudices concerning Arab-Muslim civilization that have become so ingrained in popular imagination began to be perpetuated in the United States at the end of the Barbary Wars, fought by the Americans against the Ottoman regencies of North Africa between 1801 and 1815. This first US victory over the Arab world was perceived by Americans as a sign from Providence, confirming the superiority of their values and ideals over those of their adversaries. It is from this era that the image of the Arab woman begins to be associated with that of the odalisque of the harem, a sexual object, or with that of the ignorant wife reduced to servitude under her veil.1 However, in the United States of the early twentieth century, immigrant women from the Middle East took advantage of their exile and their contact with American society to start breaking away from traditional social practices, thus demonstrating their will to free themselves from these gender stereotypes. These women, who came from a mainly Christian social and intellectual élite, were very active within their small immigrant group, developing a feminist discourse which was part of a redefinition of collective identity, and which simultaneously echoed the voices of their female compatriots remaining in the Middle East.2
2 Up to 1997, the year that saw the publication of Evelyn Shakir’s book Bint Arab: Arab and Arab American Women in the United States, the history of Arab-American women was a blind spot for American scholarly research into the ethnicisation of the Arabic- speaking community in the United States. To be sure, since the tragic attacks of 11 September 2001, we have seen an abundance of work on the stigmatization or the
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political engagement of members of this community; but French historiography by contrast has remained summary at best – if not totally silent on the role women played in the integration and the visibility of the group in question.3 The objective of this article is therefore to propose, drawing on a synthesis of the principal Anglo-American works having examined the subject, some lines of inquiry regarding the conditions in which Arab-American feminism appeared and matured around the turn of the twentieth century. The idea is to study the emancipatory path of “Syrian-American” women and to identify the strategies put into place to take advantage of the different aspects of their diasporic condition. After analyzing the motivations that led Arab women to emigrate toward the United States, I shall turn my attention to the processes of integration and emancipation of these immigrant women, as well as the mechanisms accompanying the awakening of a feminist consciousness. Finally, I shall seek to understand how the transition from a general feminist discourse to a specifically “Syrian-American” discourse was made.
The emigration of “Syrian” women: features and factors
3 The history of emigration from the Middle East toward the United States began in the second half of the nineteenth century. Immigration flowed mainly from the region of the Middle East known in Arabic as Bilad al-Shâm, which included the “Syrian” provinces of the Ottoman Empire, composed of the present-day territories of Lebanon, Israel, western Syria and Palestine. We need to clarify straight away the terminology that will be used to discuss the group in question. Until 1899, American immigration services (e.g., the US Census Bureau, Immigration and Naturalization Services) used the expression “Eastern Turks” to distinguish Arabic-speaking peoples from Ottoman- Turkish populations. After 1900, these services adopted the term “Syrian” to designate all newcomers from the Middle East. This term, which was taken up by the members of the Arabic-speaking immigrant community, will therefore be used to refer to immigrants of Arabic culture who came to the United States prior to 1918, the date that marks the final stage of Ottoman Empire’s dismemberment. To refer to members of the second or third generation of this community, I shall use the term “Syrian-American”.
4 The first researchers interested in this immigration often described it as an exclusively masculine phenomenon.4 The more recent research of Evelyn Shakir, however, has established that “Syrian” women represented between 1901 and 1910 more than 31% of Arab immigrants, while during the same period Italian women made up only 22% and Greek women barely 5% of their immigrant communities.5 It has moreover been demonstrated that, in contradiction to the usual image of the submissive and dependent Eastern woman, it wasn’t rare for immigrant women to be unaccompanied (that is to say, not under the guardianship of a husband or other male family member). The case of Camilla Gibran – mother of the future Syrian-American writer Khalil Gibran – who came to the United States with her children but without her husband, is a well-known example of an unaccompanied woman.6 How should one explain the very significant presence of women within this immigration group from the Middle East?
5 The political context of the Ottoman provinces constitutes one explanation. The recurrence of religious conflicts that pitted Christians against Muslims, aggravated by
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Western powers, was certainly a powerful reason to emigrate. The 1860 civil war in Mount Lebanon between the Maronites and the Druze, responsible for several thousand deaths, has indeed been often cited as one of the main causes of this emigration.7 Even if numerous legends circulated in the East about American cities whose streets were paved with gold, the primary motivation was not only to make one’s fortune in America, but to escape with one’s family from religious persecution and subjugation by Ottoman power.
6 However, all specialists agree that the most powerful driving force was the role played by American Protestant missionaries who, as early as 1820, landed in the city of Beirut.8 Inspired by the millenarian tradition, these Presbyterian missionaries considered the conversion of heretics and “infidels” as the prerequisite to Christ’s future reign on Earth. Upon arriving, they noticed that European missionaries benefited from a considerable head start. To distinguish themselves from their French and English competitors, the Americans made two important decisions. They undertook a new Arabic translation of the Bible and, secondly, they sought to spread their evangelist proselytism to Christian women: “The mothers of Syria will exert our influence in the homes of backward nations.”9 That the Christian women of the East should become the Protestant apostolate – such was the goal of American missionaries. They began offering young Arab women the opportunity to enter the classroom. In order to do so, they organized and financed the construction of schools first in Beirut and then in the surrounding villages. In 1835, the wife of the Reverend Smith founded the American School for Girls in Beirut, the first girls’ school in the Ottoman Empire.10 In the following years, more than thirty schools (for girls or coeducational) opened their doors. In 1866, a new milestone was reached with the foundation of the first coeducational university: the Syrian Protestant College, renamed the American University of Beirut (AUB) in 1920. Young “Syrian” women could, in this institution, receive education to be teachers, engineers or nurses. Although the young women graduating were at first mostly Christian, the reputation of the American college quickly encouraged the Druze community to send its share of female students as well.
7 One of the effects of American missionary zeal was thus to give rise – by means of education and the possibility of the upward social mobility that this education seemed to promise –to a passion for the New World. This is Evelyn Shakir’s conclusion: Through their textbooks and curriculum American missionaries helped plant the US in the imagination of thousands of people throughout Syria.11
8 So American missions appear to have promoted an American social model among “Syrian” women, helping them to attain greater gender equality in particular. This promotion of a more egalitarian society unintentionally provoked a process of emigration.
9 But did this new Promised Land keep its promises?12 In what context did these “Syrian” women coming from the Eastern coasts of the Mediterranean integrate into the United States, and what possibilities of emancipation were offered to them there?
From economic integration to political struggle
10 Even though, at the end of the nineteenth century, there was already a neighborhood called Little Syria around Washington Street of New York City, it was on the road that the greatest number of “Syrians” could be found. Pack peddling was most common
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trade adopted by Arab immigrants. Comprising religious objects (known as Jerusalem products) at first, and soon after that clothing, jewelry and hardware, their merchandise was easily transportable from Manhattan Island to the surrounding countryside. Thanks to travelling sales, a commercial network developed that ensured the financial independence of newcomers to the trade. Distribution centers were soon created, first in the largest New England cities and then across the entire East coast. The women of the community participated greatly in this activity; nearly 80% of them worked as peddlers, often autonomously.13 How can one explain this self-emancipation of “Syrian” women from the family sphere, in a foreign country no less? One explanation is that American customers, who often lived in isolation, were for prudence’s sake more willing to open the door of their home to women. The nature of the goods being sold might be another explanation. However, one should also bear in mind that the pioneers of immigration from the Middle East came, for the most part, from very modest social classes (farmers, artisans, simple laborers). Consequently, many of them lacked the capital necessary to set up their own business. But more importantly, peddling was a particularly lucrative activity. According to Alixa Naff, peddling could generate an annual income of $1,000 while the manufacturing sector only brought in $600 on average.14 Recognizing the opportunity for enrichment, the men of the community may have authorized their wives and daughters to exit the domestic sphere and may then have simply gone along with their success.
11 However, women’s participation in this commercial activity as well as the degree of freedom that peddling afforded them gave rise to criticism. Discordant voices were heard in the very heart of the immigrant community. In 1899, for example, one could read in the pages of the New York-based Arabic newspaper Al-Huda,15 an article by the “Syrian” journalist Layyat Barakat who, while encouraging her fellow countrywomen to pursue a professional activity, warned against the dangers and disgraceful character of pack peddling: It is often dangerous for good, simple-hearted girls who [can become]… exposed to evil and whoredom.16
12 The journalist goes on to encourage young women to take jobs rather as housemaids in order to do the tasks traditionally reserved to their sex: She will learn virtue and housekeeping, becoming fit to manage her own home and children in the right manner.17
13 In the same way, Eastern Catholic authorities in the United States sometimes condemned the behavior of immigrant women. The following, for example, is what the priest of the Greek Orthodox Cathedral of Brooklyn declared on the subject: It is disgraceful the way Syrian women overstep their boundaries on the pretext that they are living under free skies.18
14 The role and the success of women in the pack peddling trade also attracted the attention of certain American journalists who denounced the immorality of female peddlers. They sometimes take their babies with them, but more often they leave them behind, to be looked after by their idle husbands. It is not the custom in this country to let the women work and have the men remain idle at home.19
15 One thus observes that, in spite of the distance from their homeland, working class “Syrian” women involved in pack peddling were exposed both to the conservatism of more elite Syrian immigrants and to the xenophobic prejudice of American public
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opinion; to the middle-class Syrians who held onto traditional family values, women peddlers seemed to overstep their natural place; to the Americans, women’s peddling appeared as a sign of cultural or even racial inferiority. Source of controversy though it was, peddling nevertheless contributed to a redefinition of gender relations. As Akram Fouad Khater affirms: “Women’s experience as peddlers gave them a greater sense of control.”20
16 Nevertheless, if this professional niche gave immigrant women opportunities for emancipation, by the early twentieth century peddling was no longer the principal activity of Syrian Americans. Men and women of the first group of immigrants eventually settled down to run inns or small business, having harvested the fruits of their labor, or having been overcome by competition from mail-order businesses. Additionally, the US economy was entering a phase of exceptional growth. New mechanized factories came to replace old workshops and Syrian Americans constituted a cheap source of labor. The Ford River Rouge factory complex in Dearborn Michigan, a symbol of American entrepreneurial energy, hired hundreds of Arab workers during its opening year of 1917. Similarly, in New England, gigantic industrial complexes tapped immigrant populations for their workforce. The textile industry, dating back to the eighteenth century in the state of Rhode Island, began to attract groups of young Lebanese Maronites who settled in Providence, as well as many Greek-Orthodox Christians originally from Damascus or Aleppo. Here as well, women seized the opportunity to support their family economically and to emancipate themselves from the traditional patriarchy. In fact, the need for a female workforce was such that in 1910, in Fall River, Massachusetts, practically all the young unmarried girls of Arabic origin were employed in cotton mills.
17 Yet, in this period, the American labor movement was affected by a new current that supported the unionization of foreign workers. The leaders of the Industrial Workers of the World considered division between American workers and immigrant workers to be the result of a strategy by employers seeking to weaken the strength of unions. The activism of the labor movement thus incited Arab workers to get involved in the power struggle between the industrialists and the working class. In 1912, during the famous strike in the textile factories of the American Woolen Company in Lawrence, Massachusetts, Arab women joined their fellow workers, who were mostly of Italian origin, in demanding wage increases and the abolition of discrimination between Americans and immigrants. Syrian Americans were all the more involved since it was the execution of the young John Rami, an immigrant from Beirut, that sparked the events.21 For over ten weeks, thousands of Arab women organized picket lines, raised funds for solidarity and confronted police forces with banners bearing the slogan “We want bread but we want roses too.” Considered one of the most important events of the American labor movement, this strike is also known for being the first example of successful mobilization of immigrants and women in the history of union militancy. Although, owing to their lower numbers and their inexperience, Syrian American women never equaled the activism of their Italian peers, their efforts in favor of collective interests gave them an additional legitimacy that allowed them to participate more in the public arena.22
18 In a general way, the range of demands made by Arab women was still very large and concerned the class divisions and relations between newcomers and those long since
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established in the United States. How did Arab women address the question of gender relations? Here again, the social context in the United States played a decisive role.
The premises of a feminist discourse
19 When the earliest female immigrants settled in the United States around 1860, the condition of women was a major subject of debate. For over a decade already, following the famous Seneca Falls convention of 1848, American feminists, whose figureheads were Elizabeth Cady Stanton and Lucretia Mott, had been organizing new annual conventions the main goal of which was obtaining the right to vote. Though, at this period, gender equality was still far from being established, a certain number of advances are perceptible, notably as regards education. New schools reserved exclusively for women were created, such as Wellesley College in 1870 or Radcliffe in 1874, and allowed American women access to occupations that had formerly been forbidden to them. But there was one domain in which women had recognized experience and enjoyed a space of unprecedented freedom. This was community groups and philanthropic works. In the early nineteenth century, following the second Great Awakening,23 the women of the American bourgeoisie initiated a reform movement and tackled a certain number of political and social questions. Slavery, of course, alcoholism and poverty, were so many battles thanks to which American women entered the public space and progressed toward greater emancipation.24
20 Following the model given by the dominant culture, Arab women who had recently integrated into the middle classes or who had issued from the “Syrian” social elite, also undertook to create their own charitable organizations. Founded in 1896, the Syrian Women’s Union in Boston organized events whose profits were donated to the poorest Arab families. Similarly, in 1917, the Syrian Ladies’ Aid Society of New York was also founded with the goal of financially, medically and morally assisting those who arrived in the port city. At the same time, certain Anglo-American associations provided assistance to newly arrived immigrants. Denison House, a famous settlement house25 created in Boston in 1892, financially supported several Syrian clubs by organizing charitable works. Within these associations, bonds were built up between Anglo- Americans, Syrian Americans and immigrants, each group learning to discover one another. The ambitions of the heads of certain of these associations went well beyond the immediate needs of immigrant populations. The founders of Denison House, Emily Greene Balch and Helena Dudley, who were very involved in the mobilization of American women to demand the right to vote, gave their Arab protégées many opportunities to join the suffrage movement. Between 1909 and 1913, the city of Boston was the scene of harshly repressed feminist demonstrations, during which Syrian women activists marched next to their Anglo-American counterparts. This is what was reported in the archives of Denison House: Today in the streets of Boston, women from Lebanon, Tripoli, Damascus and Albania marched proudly through the city, alongside American women.26
21 The American charitable tradition and the philanthropic movement therefore offered Arab women the possibility of appropriating new codes of behavior and of getting involved in social questions. In the early twentieth century, the wives and daughters of the Arab middle classes were active in most sectors of public life: aid to the poor, education and culture were some of the areas in which they gained greater margins of autonomy. But above all, in contact with American feminists, they took hold of issues of
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sexual discrimination and civil rights. But how was the step between American feminism and Syrian American feminism taken? How did an Arabic feminist discourse get articulated on American soil?
22 As we have seen, American missionaries had a significant influence on their students, many of whom subsequently immigrated to the United States in order to pursue an education. The crystallization of feminist aspirations and the definition of a “gender and ethnicity” paradigm was the work of these intellectuals, particularly by means of the press and what was called Mahjar literature – the literature of the diaspora.
The feminism of the Mahjar
23 The United States between 1901 and 1910 accepted a record number of eight million immigrants. Unlike their predecessors, the “new immigrants” were mostly from Southern Europe, the Balkans and the Eastern Mediterranean region.27 The population of the large American metropolises was thus composed of a multitude of foreign communities that equipped themselves with cultural structures, one of the cornerstones of which was the ethnic press. The Syrian Americans, though comparatively less numerous than the Italians or the Slavs, turned out to be particularly productive in this area. In 1892, the Maronites of New York City founded the first Syrian newspaper, called Kawkab America (“The Star of America”). In 1899, the Greek Orthodox community in turn created their own daily newspaper. By 1910, there were more than fifteen Arabic journals in the United States.
24 The main function of this ethnic press was to keep readers informed of events happening in their home countries. At the same time, however, these papers sought to help new immigrants with the integration process. As a general rule, the spirit of this press was rather conservative and its tone largely sectarian. Having for the most part succeeded in their integration into American culture, the Syrian Americans were more concentrated on making the most of their new lives than in defending their cultural heritage. More significantly, the massive influx of these new immigrants provoked increasing xenophobia in public opinion. Though few in number, Syrian Americans were nevertheless subject to racist attacks and sometimes referred to as “Mediterranean trash.”28 They were also accused of being political agitators; this was the view of the historian Herman Feldman in 1908: Employers regard Syrians unfavorably because they’re a lot of trouble makers, much too fond of radical labor movements.29
25 This was clearly not a favorable time for any exhibition of ethnic pride. Such is the conclusion of Sharon McIrvin Abu-Laban in her comparative study of different migratory groups: “In the community, there was an emphasis on low-profile acculturation and adaptation to the dominant patterns.”30
26 Yet, around the turn of the twentieth century, there was a resurgence of fervent nationalism in the original homeland of these immigrants. Related to the Arab Renaissance (Nahda) that had developed in the Syrian provinces of the Ottoman Empire a few years earlier, this movement advocated the unity of all Arabic-speaking “Syrians” and defended an ecumenical conception of group identity. A new milestone was reached in 1905 with the publication of Nagiv Azoury’s book The Awakening of the Arab Nation, in which Azoury, a Syrian Lebanese Maronite, denounced the mechanisms of Turkish oppression which used cultural and religious specificities to weaken the unity
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of the Arabic-speaking people. Feminist activists in the Middle East seized this opportunity to bring to light the multiplicity of forms of Turkish oppression.31 They claimed that their cause had to be heard; in their eyes, the status of women and the nationalist platform were intimately connected. Throughout the Middle East, new publications addressed to women began to appear, such as al-A’rus in Damascus in 1910 and al-Kitadir in Beirut in 1912. Simultaneously, articles and books were written by men for whom national renaissance was inseparable from the emancipation of women. The Egyptian writer Amin Qasim remains the best known of these reformers. In his pioneering 1899 work called The Liberation of Women, Qasim pleaded for the education of women, for the reform of divorce laws and for the abandonment of the Islamic veil. More importantly, Qasim developed the idea that the subjection of the Arab people and the cultural paralysis that resulted from it could not be fought without a balancing of gender relations: When the status of a nation is low, reflecting an uncivilized condition for that nation, the status of women is also low, and when the status of the nation is elevated, reflecting on the progress and civilization of that nation, the status of the women in that country is also elevated.32
27 Syrian American intellectuals were inspired by these elites in the Middle East, and began to define and defend a secular Arab identity in the United States. Their ambition was to bring together the various Arabic-speaking religious communities and to protect their common cultural heritage. At this time, the ethnic press opened its columns to nationalist militants as well as to feminist intellectuals. This last group attempted to make the voices of women in the diaspora community heard, and to take advantage of the focus on identity to reform the hierarchy of social roles. The novelist and journalist Afifa Karam was, in this context, a pioneering figure. After marrying at the age of fourteen, she immigrated with her husband to the United States in 1897 and was hired as a reporter by the weekly Arabic newspaper Al-Hoda. In 1913, she founded a magazine of her own titled al-‘Alam al-jadid an-nisa’iya (The New World for Women) whose ambition was to offer a critical perspective on the status of Arab women in general: My main intention here is to show the status of most Oriental women and the way they are treated. Oriental women are the most unfortunate creatures. They are the least knowledgeable and the last to be informed of their God-given rights which men have wrongfully usurped.33
28 Beside portraits of famous women, one finds articles on the necessity of educating girls. Afifa Karam asks her readers: Is education vile or virtuous? The answer, no doubt, is virtuous. So what sin have women committed to be deprived of it? And for what reason? And according to what law?34
29 Similarly, Karam rebelled against the tradition of arranged marriage which she did not consider a family affair, but an infringement of women’s rights. She then set out upon a vigorous critique of traditions directed at both the Syrian American community and her compatriots in Syria and Egypt. Whatever their social condition and their origin, and whether they are urban or rural dwellers, Karam writes: Arab women are victims of the traditional misogyny of Eastern Mediterranean peoples where the rights and social role of women are generally denied or minimized.35
30 Consequently, Afifa Karam’s reputation quickly reached the Middle East, where her views met with an immediate echo from her women readers. In the Egyptian
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newspaper for women al-Mara al Jadida, she wrote a column called “Hadith al-Mahjar” (Words from immigrants) that she inaugurated in the following terms: “Would you permit me – oh, the daughter of my less developed country – to tell you something about your emigrant compatriot?”36 Though her commentaries sometimes seem condescending, her purpose was to establish a dialogue between the women who had immigrated to America and those who had remained in the East. In fact, she sought to present herself as an example of successful emancipation, since emigration from her homeland and integration into the United States had liberated her from “husbandly commands”.37 Far from the traditional social constraints, Karam encouraged her female compatriots in the East to take inspiration from the progress made by Syrian American women.
31 Take another example, that of Hanna Kasbani Kourani. A teacher at the American School for Girls in Tripoli before turning toward journalism, Kourani settled in Chicago in 1893. In that year, she participated in the International Women’s Meeting organized by American feminists. She gave a rather conservative speech that accepted the cult of domesticity of certain women of the bourgeois class: “The domestic plan is natural for women and they must not overstep it.”38 However, after several years during which she gave lectures, participated in conventions, and noted the emancipation of earlier immigrants, Kourani eventually cast away the inherited dogmas and radicalized her positions. In 1901, a short time before her premature death at 29 years old, Kourani made a trip to Beirut where she bore witness to her experience in America. She gave a speech that, on the one hand, illustrated the experience she had had, and on the other, attested to the influence of Syrian American feminists: “Our knowledge of the greatness that women in the West have accomplished and are accomplishing should exhort us to follow suit here in the East.”39
32 As was the case in Arab countries, this struggle for the liberation of women was, in the United States, led by men who took advantage of the diasporic condition to undertake a more comprehensive critique of society in the Middle East. The Lebanese-born writer and poet Khalil Gibran published in 1908 a work entitled Rebellious Spirits, in which he denounced the injustices suffered by women. Composed of four tragic love stories, the book confronts head-on the problem of the condition of Arab women and their position in Lebanese society. In the first story, “Wardé El-Hani (Freedom to Love, translated as “Madame Rose Hanie”), Gibran depicts a young girl who, having been married against her will, has fled the family home to live with the man she loves. Through this portrait, the Syrian American writer makes heard the voice of Lebanese women who suffer under the yoke of tradition: “I have been a faithful woman since I stopped selling my body for shelter and my days for clothes.”40 Gibran goes further to claim that the subordination of women is contrary to divine laws: “I have freed my love from the enslavement of corrupt human laws, so that I may live as God wants.”41 The penalty for this audacity came swiftly: in Lebanon, the book was severely criticized by the Maronite Church which judged it an unacceptable attack against the clergy and an incitement to the moral degradation of women. The work was condemned as heretical, and Gibran was excommunicated by the Maronite Patriarch.
33 The formulation of a feminist Arab American discourse was the work of the elite immigrant intellectuals, since their diasporic condition allowed them to reevaluate traditional institutions and practices critically, without fear of censorship. Faced with
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pressure to assimilate to American culture, women’s emancipation was closely associated, in the United States, with the defense of a new collective identity.
34 The confrontation with the different socio-cultural patterns of the United States inevitably provoked a questioning of the traditions of the societies that Syrian Americans had left behind.
35 Whether simple street peddlers or industrial workers, whether single or married, Arab women of the lower and middle classes gained greater financial independence and the possibility of being politically active. The prestige of this social mobility had the effect of reconfiguring their role in society. As they participated in the reform movements then taking place in the United States, their integration into the American middle class allowed them to redefine their roles and responsibilities within their own community as well. Finally, it has been demonstrated that, in the course of the twentieth century, ideological conflicts in the Middle East were echoed by members of the diaspora who were questioning their identity. In particular, the “Syrian” nationalist movement in the Middle East gave new life to Syrian American feminism, allowing women of the intellectual elite to articulate a collective discourse that contributed to the defense of a cultural identity and thus to the visibility of the diaspora.
36 Supported and inspired by the women of Syria or of Egypt, Syrian American activists fed their nationalist aspirations with new ideas about the condition and role of women in the United States. One can thus observe how the emancipatory logic present at the turn of the twentieth century was enriched by the contributions of women activists who shared the same cultural heritage but worked in a transnational space. Far from the clichés that see Arab women as belly dancers or veiled and silent statues, the women of the Arab community were, during the period preceding the First World War, at the forefront of social, political and cultural mediation. Although their positions were diverse and changing, these women nonetheless tended to demonstrate how diaspora can inspire a reconfiguration of the symbolic features of collective identity and a reworking of gender relations.
BIBLIOGRAPHY
BENCIVENNI, Marcella. 2011. Italian Immigrant Radical Culture: the idealism of the Sovversivi in the United States, 1890-1940. New York. New York University Press.
CADINOT, Dominique. 2006. Les Arabo-Américains. Processus de construction identitaire, Paris. Le Manuscrit. Coll. « Le Manuscrit Université ».
CLINTON, Catherine. 1999. The Other Civil War: American women in the nineteenth century. New York. Hill and Wang.
DEGLER, Carl N. et al. 1980. Histoire des États-Unis. La Pratique de la démocratie. Paris. Economica [Translated from: The Democratic Experience: a short American history, Glenview, Illinois, Scott, Foresman. 1973].
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GABACCIA, Donna. 1995. From the Other Side: women, gender, and immigrant life in the US, 1820-1990. Bloomington. Indiana University Press.
GIBRAN, Khalil. 1980. L’Esprit rebelle. Dangles. Saint-Jean-de Braye [Translated from: Al-Arwah al- mutamarridah. New York. Al-Mohajer. 1908; Spirits Rebellious, transl. H.M. Nahmad. New York. Knopf. 1948].
GINZBERG, Lori D. 2000. Women in Antebellum Reform. Wheeling, Illinois. Harlan Davidson.
GUALTIERI, Sarah. 2004. Gendering the chain migration thesis: women and Syrian Transatlantic migration, 1878-1924. Comparative Studies of South Asia, Africa and the Middle East 24/1: 69-81.
HITTI, Philip K. 1924. The Syrians in America. New York. George H. Doran.
KHATER, Akram F. 2001. Inventing Home: emigration, gender, and the middle class in Lebanon, 1870-1920. Berkeley. University of California Press.
LATRACHE, Rim. 2006. Les Arabo-Américains et l’affaire de Munich en 1972. La discrimination au nom de la sécurité nationale était-elle légitime ?, Hommes & Migrations 1261: 145-155.
MAZID, Nergis. 2002. Western mimicry or cultural hybridity: deconstructing Qasim Amin’s “Colonized Voice”. The American Journal of Islamic Social Sciences 19: 42-66.
MCIRVIN ABU-LABAN, Sharon. 1989. The coexistence of cohorts: identity and adaptation among Arab- American Muslims. In Arab-Americans: continuity & change, ed. Baha ABU-LABAN, and Michael W. SULEIMAN, 45-64. Belmont, Mass. Association of Arab-American University Graduates (AAUG).
NAFF, Alixa. 1981. Arabs. In Harvard Encyclopedia of American Ethnic Groups, ed. Stephan THERSTORM, 12-136. Cambridge, Mass. Harvard University Press.
NAFF, Alixa. 2002. New York: the mother colony. In A Community of Many Worlds: Arab Americans in New York City, ed. Kathleen BENSON, and Philip M. KAYAL, 3-11. New York, NY. Museum of the City of New York/Syracuse University Press.
PARRS, Alexandra. 2005. Construction de l’identité arabe-américaine. Entre invisibilité et mise en scène stratégique. Paris. L’Harmattan.
SHAKIR, Evelyn. 1997. Bint Arab: Arab and Arab American women in the United States. Westport, CT. Praeger.
TARAUD, Christelle. 2011. Les femmes, le genre et les sexualités dans le Maghreb colonial (1830-1962). In « Colonisations », ed. Pascale BARTHÉLÉMY, Luc CAPDEVILA & Michelle ZANCARINI- FOURNEL. Clio. Histoire, Femmes et Sociétés 33 : 157-191.
WATSON, Bruce. 2005. Bread and Roses: mills, migrants, and the struggle for the American dream. New York. Viking.
YOUNIS, Adele L. 1995. The Coming of the Arabic-Speaking People to the United States. New York. Center for Migration Studies.
NOTES
1. On representations of the harem and of Arab women, see Taraud 2011. 2. The methodological variations of counting systems, subject to the will of administrations, have made it hard to compile and compare statistics on the demographics of the early Arab immigrants. Nevertheless, my research shows that this immigration began in the second half of
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the nineteenth century, only concerned a few hundred people in 1887 and accelerated rapidly to attain 20,000 people in 1898 (Cadinot 2006: 92-93). 3. To my knowledge, there has been no Francophone research done on the question of Arab feminism in the United States. The Arab-American group has however been the subject of a few scientific publications in the form of monographs or articles. See for example Parrs 2005, or Latrache 2006. 4. See Hitti 1924 or Younis 1995 5. Shakir 1997: 202. 6. On the social integration of “unaccompanied” female European immigrants, see Gabbacia 1995. 7. See Naff 1981: 110 or Younis 1995: 47. 8. See Younis 1995: 52; McIrvin Abu-Laban 1989: 49. 9. Quoted in Younis 1995: 64. 10. The participation of missionaries’ wives was encouraged by the regulatory authorities, as is testified by a declaration made by one of heads of the American Board of Commissioners for Foreign Missions: “A lady with a missionary spirit can be quite as useful as her husband – often more so”, quoted in Clinton 1999: 44. 11. Quoted in Shakir 1997: 23. 12. The expression “Promised Land” is used by the Reverend Henry Jessup when he regretfully takes note of the massive emigration of his students toward the United States: “The Promised Land is no longer each side of the Jordan River, but each side of the Mississippi”, quoted in Younis 1995: 125. 13. Naff quoted in Gualtieri 2004: 7. 14. Naff 2002: 7. 15. This weekly Arabic newspaper was created in 1898 in New York and published until 1993. 16. Quoted in Shakir 1997: 11. 17. Quoted in Shakir 1997: 41. 18. Quoted in Gualtieri 2004: 7. 19. Quoted in Shakir 1997: 40. 20. Khater 2001: 121. 21. Watson 2005: 111. 22. Syrian Americans’ political awareness was less sharp than that of immigrants from the Italian peninsula where Marxist or anarchist ideologues had been organizing a big part of the working class since beginning of the twentieth century. As early as 1902, socialist activists led by Giacinto Menotti Serrati founded the first Italian socialist federation (Federazione Socialista Italiana) in New York. On the political commitment of Italian women workers, see Bencivenni, 2011. 23. A movement of spiritual revival that began in 1830 in the Midwest and the south of the United States. 24. On American women’s involvement in community groups, see Women in Antebellum Reform by Lori B. Ginsberg (Ginsberg 2000). 25. A sort of social center which also promoted the Americanization of immigrants. 26. Quoted in Shakir 1997: 60. 27. The expression “new immigrants” is used for example by Degler et al. 1980: 435. It is used to bring out the contribution, between 1900 and 1920, of new source countries. 28. Younis 1995: 218. 29. Quoted in Younis 1995: 219. 30. McIrvin Abu-Laban 1989: 51. 31. See for example the writings of the “Syrian” journalist Hind Nawfal, who founded in 1892 the Egyptian newspaper al-Fatat (“Young Woman”). 32. Quoted in Mazid 2002: 59. 33. Quoted in Khater 2001: 159.
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34. Quoted in Shakir 1997: 56. 35. Quoted in Shakir 1997: 105. 36. Quoted in Khater 2001: 157. 37. Quoted in Shakir 1997: 30. 38. Quoted in Khater 2001: 165. 39. Quoted in Khater 2001: 167. 40. Gibran 1980: 18. 41. Gibran 1980: 23.
ABSTRACTS
The conditions of the diasporic experience are often associated with a culture shock which forces exiled populations to redefine the symbolic markers of their identity. The case of Syrian- American women exiles in the late nineteenth century shows that transplantation to another community may offer an opportunity to reshape collective identity and to negociate a transformation of gender relations. Encouraged and supported by their counterparts from other Middle-Eastern countries, Syrian-American feminists of this period enriched their nationalist aspirations with fresh reflections on the status and role of women in the host society.
INDEX
Keywords: collective identity, ethnic feminism, Arab identity, diaspora, Syrian-American women
AUTHORS
DOMINIQUE CADINOT Dominique Cadinot teaches American civilization in the Département d’Études du Monde Anglophone (DEMA) at the University of Provence, Aix-Marseille 1. He is the author of a number of articles and a thesis: Les Arabo-Américains : processus de construction identitaire (2006), and co- editor (with M. Prum and G. Teulié) of Guerre et race dans l’aire anglophone, 2009). [email protected]
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“As long as the absence shall last”: proxy agreements and women’s power in eighteenth-century Quebec City
Catherine Ferland and Benoît Grenier Translation : Melissa Wittmeier
1 We are in Quebec City, on the afternoon of 17 October 1727, in the office of the notary Pinguet de Vaucour. A man is conscientiously initialing a document, a young woman by his side. The couple are Denis Constantin and Élisabeth Hevé, married five days previously. By means of this official act, the young wife has just been granted the full right to represent her husband, a long-haul sea-captain by trade, who is getting ready to sail before ice blocks the Saint Lawrence River. This proxy agreement allows Constantin to confer on his young wife, who is twenty years old that very day, “all power to act for him and in his name” in order to “manage generally all of the affairs that pertain to him,” demonstrating an apparently absolute trust in her. As his proxy (procuratrice), Elisabeth Hevé will therefore have latitude to act in all areas in the name of her principal (mandant), despite her status as a married woman.1
2 The economic activity of Canadian women and, more broadly, the question of “female power” at the time of New France is a territory as yet under-explored by historiography.2 We have, therefore, only a very limited understanding of the room for manœuvre that women had during this period, and this understanding is often limited to a place or to a specific group. Some previous research has shed light on the socio- economic activity of widows, insofar as the deaths of their husbands freed them from the tutelage of marriage and afforded them new possibilities.3 Female shopkeepers, often widows moreover, have also been studied, both individually and collectively.4 Mention should also be made of female religious congregations, a subject on which several historians have conducted rich case studies over the long term, thanks to the often remarkable conservation practices of monastic archives.5 Married women, who made up the majority of the female population in New France, remain much more
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difficult to study, precisely because of their condition as spouses: exercising their activities in association with their husbands, they participated in production without leaving any trace in source documents as to their specific role.6
3 In this context, the written proxy agreement, or grant of power of attorney, represents a document of inestimable value to remedy the silence of the archives, by allowing us to detect and analyse the moment when power was delegated to women. This article presents the results of research conducted on proxy agreements granted to women in the city of Quebec and the surrounding countryside between 1700 and 1765.7 By cross- referencing data taken from notarial registers with resources on historical Canadian demography, we were able to carry out a prosopographical study of the female proxy holders, documenting for each one the moment in her life when the proxy was granted, her relationship to the principal and, in most cases, the context that rendered this circumstantial transfer of power necessary.8 Light can therefore be shed on questions of complementarity and of trust within the couple, in the context of male absence from home. Several works have suggested the relevance of this direction of study, or have used this primary source9 but, to our knowledge, no study has taken power of attorney as a specific object, with the goal of revealing the historical circumstances during which Canadian women acquired power: a particular episode of female empowerment.
The absence of men and the power of women: proxy agreements in Quebec City
Quebec, capital city of New France in the eighteenth century
4 In the eighteenth century, New France was a society in full economic expansion. Whereas during the previous century, the colonial population had been marked by an overpopulation of males, the situation had largely balanced and stabilized itself during the years around 1700. Its resolutely colonial character pervaded every sphere of daily life and contributed to structuring families as well as commercial relationships. Quebec was the principal city and the port of entry into the French Empire in North America. As capital of New France, it was also the place where the representatives of civil, religious and military power resided. This symbolic importance was however based on a small population, if one were to compare it to French cities from the same period: Quebec City numbered 2,573 inhabitants in 1716, 5,207 in 1744 and barely more than 7,000 at the time of the Seven Years War (French and Indian War).10
5 The close ties that the inhabitants of the colony maintained with France as well as with other French colonies in America led to a great deal of travelling by its population – by its male population, to be more precise. The strategic position of Quebec City facilitated relationships toward the east (with the Fortress of Louisbourg and across the Atlantic with mainland France), toward the south (with Louisiana and the French Antilles) and toward the west (with the territories of the Upper Country, especially for the fur trade and the mobilization of the army in the various forts of this region). Year after year, hundreds of men were obliged to leave the Saint Lawrence Valley for an indeterminate length of time, to serve in their professions or transact business. In this context, the implication of women as legally appointed proxies proved to be a strategy that was not only effective, but necessary. This relationship between men’s enforced absence and
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women’s power, in the context of inter-colonial mobility represents a major element in the socio-economic reality of New France.11
Power of attorney: a source through which to observe the power of women
6 New France was subject to a French legal framework. From 1664 onward, the system known as the Custom of Paris prevailed in the Saint Lawrence Valley. By virtue of this customary law, the age of majority was fixed at 25 years: before this age, men and women were considered minors and were subject to parental authority. Subsequently, their situations would differ considerably depending on their sex, since marriage had the effect of shifting a woman from the tutelage of her parents to that of her husband. Only those who remained single (by choice or circumstance) would be considered adults and mistresses of themselves. Moreover, since most women married before reaching the age of majority, the female population of New France was, in the main, composed of women considered as minors before the law12. This legal incapacity would not come to an end until the death of one’s spouse.
7 It is important to highlight that for lawyers of the time, the legal incapacity of married women was not founded on their presumed lack of “reason”: rather, it was considered necessary in order to rank power within the family. “A married woman does not have any weaker reasoning capacity than spinsters and widows, who do not need authorization”, specified the eminent jurist from Orléans, Robert-Joseph Pothier.13 Women’s status as minors was nevertheless very limiting. Only a proxy agreement drawn up before a notary would allow them to obtain, circumstantially, the power to make decisions of a certain importance. These female proxy-holders constitute an exemplary illustration of the paradox according to which married women were deprived of any legal capacity while still being considered “capable” when necessary.
8 At the end of the seventeenth century, Claude Joseph de Ferrière defined a power of attorney contract as follows: [an act] by which he who cannot attend to his business himself, gives power to another for him, as if he were himself present, either because he is unable to manage or to take care of some good or some affair, or in order to deal with others. 14
9 The person who delegates power by proxy is called the mandant or “principal”. The person who receives the power is the authorized representative or proxy. One also finds the expression “authorized power” or “authorized proxy,” which technically refers back to the same reality; that is, that the person is invested with the power of tangible substitution.15 By the powers that the agreement conferred on her, the married woman proxy escaped the tutelage of her husband. In his Treatise on the power of the husband, Pothier affirms that “customs have put the wife in such a state of dependency on her husband that she can do nothing valid, & that has any civil effect, if she has not been enabled and authorized by him to do so”.16 From a strictly legal point of view, the husband must therefore appoint his wife in order that she act in his absence.
10 The study of power of attorney agreements presents certain methodological limitations, of which the most important is representativity. It is in fact illusory to think that the archives contain the totality of proxy contracts. First of all, unlike
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minuted contracts, established and recorded, the originals of which were kept in the minute-book of the notary, some compacts were judged less important and were granted by a less formal agreement. This is the case for many proxies: as J.-P. Poisson underscored, these agreements, judged to be of limited importance, have not always been conserved.17 It is possible that this deficit is accentuated when female representatives were concerned.18 Furthermore, proxy agreements were not necessarily registered at the notary’s office: they may have been drafted under private signature, or even agreed to verbally. It is not rare to find in notarial archives transactions undertaken by proxy… for which, however, one finds no proxy contract. And inversely, a proxy agreement did not necessarily entail a formal written act before the notary or before the law. Finally, as we shall see below, the incidence of duly notarized proxy contracts was more frequent amongst certain social and professional groups. Despite the limits of this source insofar as representativity is concerned, it nonetheless reveals precious information which it is appropriate now to analyse.19
Analysis of the agreements
11 We identified and indexed 265 notarized proxy contracts in Quebec City between 1700 and 1765 for which the authorized representative was a woman. At first glance, this may appear to be a modest corpus for such a long period, even on the scale of a population numbering barely several thousand inhabitants. It is, however, a very enviable collection compared to the small number found by Josette Brun.20 It is legitimate to wonder what proportion of contracts were granted to women, relative to the overall number of powers of attorney recorded in Quebec City over the period. To the extent that we were able to identify a total of 1,271 notarized agreements,21 it appears that at least one in five was accorded to a woman. This proportion varies greatly between the 46 notaries active during the period studied. For example, in the office of Jacques Barbel, one third of the proxy contracts were registered in the name of a woman, while in the office of Louis Chambalon, they accounted for only 12%. Although these numbers do not at all allow us to claim that New France was living a golden age for women, they do nonetheless reveal that granting power to a woman, far from being marginal, was a relatively frequent occurrence in the cultural landscape of the colony.
12 Power of attorney agreements were more or less systematically defined as “general and special”. This expression, which seems somewhat contradictory a priori, signified that the power granted to the authorized representative pertained not only to those activities deemed habitual, but also extended to more exceptional actions that might become necessary according to circumstances. The use of such wording allowed actions to be targeted as a whole, including those that would otherwise require specific designation. This distinction can however conceal some specific features and precise mandates entrusted to female proxies. Without claiming to have compiled a finely- graded typology, reading the documents does indeed make it possible to identify certain missions granted to women standing proxy. Examples of such were to recover debts, receive payments,22 sell or acquire a property23 or a domain,24 act as guardian,25 have an inventory drawn up after a death,26 represent the principal before the law27 or be executor for an inheritance. But most often, beyond these precise missions, the authority that was granted to them seems to have been complete, witness an example
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from June 1724, which presents itself as a standard proxy agreement. The notary Dubreuil defined the nature of the power as follows: [René Brisson] has made and constituted his special and general authorized representative demoiselle Marie Josephe Doyon his spouse to whom he gives full and complete power for him and in his name to manage and govern all of their affairs and goods [and] even, the notary continued, a whole series of potential but not exclusive tasks. The power of the female proxy was virtually absolute, as the frequently found formula “without exception or reserve whatsoever” indicates.
13 How were notarized proxy agreements distributed chronologically in Quebec in the eighteenth century? Let us recall that the period in question includes the longest interlude of peace in the history of New France, between the end of the War of Spanish Succession (1713) and beginning of the repercussions in the colonies from the War of Austrian Succession (1744). Figure 1 shows that the frequency of proxies seems to follow this dramatic curve. The number of powers of attorney remained modest until 1740, then grew regularly over the course of the following years, especially after 1744, leaping spectacularly during the last decade of the French Regime. This can be explained of course by the increase in total population, but also and above all by the context of near-continuous warfare that prevailed in the colony from 1744 to 1760. The historian Louise Dechêne indeed speaks of a “Sixteen Years War” to characterize this period, which ended with the British conquest.28 This situation clearly accentuated enforced male absence.
Figure 1 – Distribution of proxy agreements by decade (265 notarized agreements).
Source: BAnQ.
14 Figure 2 shows the annual distribution of proxy agreements. Note that the number of proxies dropped in 1759, the year that Quebec City was taken, only to increase again in 1763 when the Treaty of Paris officially ceded New France to Great Britain. Several of
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the agreements recorded in 1763, 1764 or 1765 were directly tied to a return to France following the conquest, and bear witness to the role played by the women of the colonial elite, who stayed behind in Quebec City and were often mandated to liquidate the family’s goods.
Figure 2 – Annual distribution of proxy agreements (265 notarized agreements).
Source: BAnQ.
15 In a very large number of cases – 80% of the 265 powers of attorney in the corpus – the notary specified the reason that motivated the individual to call upon his services29. Some motives were only infrequently invoked. Invalidity, for example, was mentioned on three occasions (1.1%); one principal was in prison; another signed a proxy agreement “in case of death”, in the imminent context of the arrival of the English in Quebec City in 1759. Twenty cases or so concerned Frenchmen travelling temporarily to Quebec City, who had an agreement drafted in favor of a woman (often a mother or a sister) who remained in France.30 It was, however, the imminent departure of the principal that was, by far, the most recurring motive invoked in these contracts, accounting for 69%. The 184 principals on the point of leaving were men, with the one exception of one merchant, Catherine Damien. Approximately 60 years old, this woman left Quebec City in 1732 for the “islands of America” in order to manage her affairs there; she delegated her power to Angélique Chesnay, “adult spinster”. This case is as revealing of the rarity of lone women’s mobility, as of this quite unusual case of the female duo Chesnay and Damien, who were business associates for decades, in addition to living together.31 Finally, let us highlight that only five proxy agreements were issued to married women leaving for France to take care of business there, which demonstrates the degree to which mobility concerned men more than women in eighteenth-century Canada.
16 Knowing that the clear majority of contracts were drafted because of the absence of the principal, we sought to discover their destinations. Had it to do with travel within the colony, or was it related to inter-colonial or transatlantic voyages? In fact, departure for “old France” was invoked in 33% of cases, the port of destination being otherwise
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rarely specified. More than 17% of the principals – often officers or merchants – were leaving for the Upper Country (the Great Lakes region) or toward other forts situated in the interior. Acadia and the Ile Royale and Ile Saint-Jean accounted for approximately 10% of the trips, while 6% of the principals were embarking for the “American Islands” (the French Antilles).
17 To these long-haul expeditions must be added travel within the region of the Saint Lawrence Gulf (7.6%)32 or sometimes more modest trips (for example between Montreal and Quebec City or from Quebec City to Saint Paul Bay) which represent 8.2%. of cases. Finally, the place of destination remains unknown for 31 of the contracts (16.8%): in these cases, the notary mentions simply that the agreement was valid “during [the] absence from the country”, that the principal “was readying to leave for a long journey”33 even, perhaps, “to serve the king”, without however specifying the direction of these journeys.
18 Considering the time necessary for transatlantic travel and even for travel to the interior, journeys that justified appointing a proxy were often very long. The duration was only rarely specified in the documents, but whenever it was mentioned, it was always a matter of several months or even several years. The power conferred on women in the absence of men was, as a consequence, significant. Let us cite the example of Louise Cartier, whose husband, the merchant Charles-René de Couagne, signed a proxy document in May 1745 while preparing to leave “for several years” in the region called the Upper Country,34 or the similar case of Louise-Madeleine Dusautoy, authorized representative of her son-in-law who had also gone to the Great Lakes region “for a time of three years”.35 If the notary at times took care to specify that the proxy contract was valid “as long as long the absence shall last”36 or “for the time that it will take to defend the country”,37 it was understood that such a delegation of power would end upon the return of the principal.
19 An examination of the seasonal incidence of proxy documents also reveals a strict correlation with climatic colonial realities. The long winter and the difficulty of navigation between November and May meant that transatlantic communications and shipping in general were only possible during approximately six months of the year. Since proxy requests were closely associated to the absence of men, it was foreseeable that one would find a correlation between their numbers and seasonal traffic: figure 3 demonstrates this reality, with spikes in spring and fall, that is, after the opening of the river to shipping, and just before the departure of the last vessels before winter. From December to March, requests for powers of attorney were significantly rarer, and concerned primarily movement in the interior of the colony.38
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Figure 3 – Seasonal trend of proxy agreements (265 notarized proxy contracts).
Source : BAnQ.
20 From these data, can one (as has been suggested by Susan C. Boyle for Sainte-Geneviève in the Illinois country,39 and Emmanuelle Charpentier in her work on the wives of Breton sailors in the eighteenth century) envisage the absence of men as a moment of liberation for women?
The authorized representatives: socio-demographic and familial characteristics
21 Behind these notarized acts with their repetitive wording, a multitude of individual and familial realities can be glimpsed in outline. One cannot claim to understand questions about the delegation of power and man/woman complementarity in this preindustrial society without exploring at least some of the characteristics of the women who acted as proxies.40 To the 265 agreements studied correspond 221 women, since some were appointed on more than one occasion over the course of their lives. Still, 187 only received this power once (nearly 85%), 26 obtained it twice (11.8%), while a mere eight saw conferred on them more than two episodes of power of attorney. Amongst this last group, Louise Albert was granted power of attorney five times between 1703 and 1715, each time that her husband prepared to leave for France on business.41 Given the under-recording evoked earlier, it is plausible that these women received delegations of power on other occasions too.
Canadian bourgeois women
22 Because this study focusses on the eighteenth century, a period characterized by a decrease in the founding immigration and a strong natural increase, a clear majority of women proxies (76%) were born in Canada, as compared to only 20% of French birth.42 Three women were of Acadian origin or from Terre-Neuve [Newfoundland], separate Canadian colonies during this period, while only one of the women was born in the
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English colonies.43 The place of birth of six of the 221 authorized representatives is unknown (3%).
23 Taking into account the hierarchy that characterized New France as it did the home country, the socio-professional categories to which the 221 authorized representatives belonged were identified.44 One observation suggests itself immediately: the female proxy-holders belonged to the privileged strata of this colonial society (figure 4). It was bourgeois women who were most often involved in this type of legal act, with a total of 105 authorized representatives. Under the vague heading of “bourgeoisie” and for lack of a better term,45 we have grouped the women gravitating around the world of large- scale commerce and trade, but also the wives or daughters of lawyers or non-noble seigneurs.46 To this category we added wives of long-haul mariners, essentially sea- captains, totaling 18 women. This “bourgeoisie” of New France belonged, therefore, to those milieus situated somewhere between the colonial nobility and less prestigious social groups (artisans, peasants). That said, it is largely a question here of a merchant bourgeoisie. This stratum of the population exercised considerable influence in Quebec City, playing a leading role in colonial and inter-colonial affairs.47 In the absence of the men, women of the families of merchants, traders and sea-captains had to ensure the continuation of business.
Figure 4 – Social category of the female proxies (265 notarized proxy agreements and PRDH).
Source: BAnQ.
24 Thirty-seven authorized proxies belonged to the select group of the Canadian nobility.48 That represents 17% of all the women proxies, a proportion well above that of the aristocracy within the Saint Lawrence Valley population, bearing in mind however that this social stratum was overrepresented in Quebec City, a place of power and the seat of the colony’s government. Members of the Canadian nobility most often fulfilled military or administrative functions which were the reason for delegations of power of attorney. Figuring notably amongst the proxies is Louise-Élisabeth de Jouybert, wife of
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the marquis de Vaudreuil, who was then governor of New France. Residing in his château Saint-Louis, she was granted power of attorney on two occasions.49 Also in this elite group are several wives of ennobled Canadians, such as Françoise Bourolle, who was granted power of attorney in 1744, when her husband, Charles Boucher de Boucherville, was preparing to spend the winter in Labrador.50
25 We also found 17% of the proxies originating in the milieu of artisans and small shopkeepers, which translates into 38 women.51 While the identical percentage indicated an overrepresentation of the nobility, it rather demonstrates here an underrepresentation of this social group. Should it be concluded that the artisanal milieus made little use of power of attorney? In fact, while fewer numbers in this category may have gone to the notary’s office to sign an official contract, there is no doubt that close collaboration between spouses was necessary in this professional milieu, and that business had imperatively to be taken care of, no matter what the circumstances. One can also suppose that these jobs required less professional travel. Among the thirty-odd cases inventoried, let us mention that of the wig merchant, Jacques Guéroult, or of the inn-keeper, Jean Burau, who mandated their wives to ensure the continuation of their businesses in their absence.52
26 Finally, amongst the individuals of more modest condition (peasants, soldiers, day- laborers), recourse to power of attorney is rarer still: they account for only 9% of the corpus. The absence of men must also have affected these habitants,53 in particular in the context of war, but it seems that the activities they undertook allowed more easily for their replacement by family members, without it being necessary to have recourse to a formal document. Some habitants in the area around Quebec City did nonetheless take precautions by delegating their power, as did Jean Baugis in favor of his wife, Marie Drouin, when he prepared to leave the domain of Beauport to winter on Jésus island, near Montreal, in February 1750.54 Finally, it was not possible to identify with certainty the social milieu of 21 of the women proxies.55
The wife: a natural authorized representative
27 The principal had to have full trust in his authorized representative and had to be persuaded that she would make the right decisions, because once the power of attorney was signed, his power was transferred completely to her. By signing the document, the principal undertook to validate the actions that would be taken in his name. In power of attorney documents, one finds systematically the following formula, or its equivalent: “approving and ratifying from this moment everything which may be done by the said lady proxy (dame procuratrice)”.56 Over 70% of the proxy powers were conferred from husband to wife, which reinforces the idea that the collaboration was essentially one within the couple. As for the 30% remaining, other than 16 proxies for which it was not possible to establish the tie (6%), and 4 that resulted from a business relationship (or at least from a non-family relationship), 20% involved an intra-familial dynamic. The authorized representative was sometimes a mother, other times a sister or a daughter. The business that they had to manage reveals a level of trust between close relatives. The example of Marie-Thérèse Grenet well illustrates the prime significance of the family: it was to her that her recently widowed son-in-law Martin Chennequi turned, in the fall of 1764.57 This sea-captain, a native of Bayonne, had to leave at that time for Saint-Jean Island: his wife having passed away several weeks
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earlier, he entrusted to her mother, his only living relative on this side of the Atlantic, the task of “managing all of the goods and affairs that he has in this colony”.58 Limited as it might be, the family network appears to have taken precedence over other types of relationships when it came to entrusting the governance of one’s business to another. It would be fascinating to continue a study on the networks of each of the principals in our corpus in order to reconstitute the range of possibilities. It is a likely bet that such analysis would strengthen the hypothesis of the strong cohesion of the family as institution.
28 In order better to distinguish the familial context within which the power of attorney was located, we established a family index for each of the 221 female proxy holders in our corpus. Marital status, age, as well as the number of children living at the time of the agreement were noted, making it possible to characterize these women and identify any constant features. First of all, the authorized agents were overwhelmingly married women (80%), followed by widows (15%) and by several “adult spinsters” or separated women (3%). Marital status is unknown for only four of the women (2%). Figure 5 presents the distribution of authorized representatives according to age. More than 70% were under 50 years old and it is amongst the 30-somethings (32.5%) that we find the largest number, followed by women in their twenties (20%), then by those in their forties (18%). At one end of the spectrum, three of the proxies were not yet 20 years old, among them Louise Martel de Brouage, wife of the royal engineer, Gaspard-Joseph Chaussegros de Léry: she was only 17 years old.59 At the other end, barely 17% were over 50 years old, amongst them a fair number of widows. There remain approximately 30 women for whom the date of birth is unknown. These data regarding age make it necessary to qualify the observations of Susan C. Boyle, according to which it was more mature women who exercised a predominant influence on the affairs of the couple and of the family. Our sample shows that in Quebec City, some young and even very young authorized representatives were considered capable of taking over during the absence of their husbands.
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Figure 5 – Age of women at the time of the power of attorney agreement (265 notarized proxy agreements and PRDH).
Source: BAnQ.
29 Cross-referencing the 265 powers of attorney with the family indexes allowed us to determine the number of living children for whom these women had responsibility at the moment of drawing up the contract. By excluding the 32 women for whom the information could not be verified, we calculated that the proxies, without regard to age, had on average three children living on the day that the document was signed. But it should also be noted that 62 of them (23%), the largest contingent, had no children at all, and that 33 women (12.5%) had only one child (see figure 6). This is indeed a remarkable phenomenon, particularly in a group constituted, to the tune of more than 85%, by married women or widows. Confining the analysis only to those proxies who were mothers, the average number of living children per woman went up from 3 to 4.
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Figure 6 – Number of living children at the moment of the proxy agreement.
Source: PRDH.
30 One must be careful not to interpret these numbers according to current values and to see in these numbers an indication that their delegated power was facilitated by the absence or limited number of children, a phenomenon that characterizes contemporary societies. These demographic data, notably those regarding women with no children or with a single child, reveal first and foremost the high rate of infant and child mortality. On the scale of New France, it is estimated that half of all children died before the age of ten.60 Indeed, as we shall see, the women in our sample, independent of their social status, did not escape this sad reality.
Powers of attorney and mutual trust: a few conclusions
31 Understanding that granting power of attorney to a woman was located primarily within the dynamics of the family, it is possible to take the reflection a step further, as to the relationship of trust implied, in particular between spouses. First of all, the departure of the husband obviously necessitated a pragmatic approach, and their spouses were required to rally round regardless of other circumstances. Enforced personal mobility took no account of the vicissitudes of family life. The wife, despite all of the circumstances that one could imagine to be constraining and little suited to this temporary taking of power (pregnancy and infant mortality in particular), was nonetheless at the heart of the decisions concerning the family, as is revealed by cross- analysis of powers of attorney contracts and the civil registers.
32 At least twenty-five women were pregnant at the moment of the agreement, which represents about 15% of the married proxies. While a few of them were only at the beginning of their pregnancies, others presented themselves at the notary’s office at seven, eight or even nine months pregnant. For example, Marie-Josèphe Doyon gave birth three weeks after her husband had departed on a “long haul voyage”, while the pregnancy of Françoise Barolet came to term one week after her husband and principal, the merchant Jean-Antoine Bedout, embarked for Saint-Domingue. In
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another case, Louise Albert gave birth to her fourth child five days after having received power of attorney from her husband, the merchant Pierre Plassant.61 For these women, wives of traders or artisans, the imminent birth of a child does not appear to have constituted an impediment, even if it involved considerable responsibility. Although there may possibly have been assistants, apprentices or even other family members upon whom the proxy holder could call for help in her functions, nonetheless these situations clearly illustrate the need to reconcile the role of mother and that of wife and partner, in a society characterized by the absence of partitions between the world of the family and that of work, and by the dovetailing of what would later be defined as the public and private spheres.62
33 Other examples reinforce the impression that wives were ready to take over, whatever the cost. At times, the birth of a child was very recent (13 cases), at other times it was the death of a child that had just occurred (10 cases) or was to occur in the days or weeks following the signing of power of attorney (5 cases). The example of Françoise- Charlotte Blais illustrates these difficult situations, which nevertheless did not exclude women of New France from managing family businesses. She gave birth on 26 September 1749 to her ninth child, a little girl called Marie-Anne. The following month, on 9 October, she was granted power of attorney by her husband who was leaving for France for an undetermined time.63 Five days later, on 14 October, the child died – the fifth child this woman had lost. The case of Françoise-Charlotte Blais is not unique, but testifies to the necessity of combining the role of mother and that of stand-in for her husband. Still, we would need more information about the practices regarding wet- nurses64 in order to know whether the women in this sample truly had responsibility for their new-borns. What was the situation of Madeleine Vermet, wife of the inn- keeper Jean Bureau, who gave birth to twins several months before the departure of her husband?65
34 A second assessment invites us to speculate as to the exact nature of the link of trust between spouses. Although proxy holders had been, on average, married for ten years at the time that they were designated by their husbands, some of them had been married for so short a time that one might query the existence of a relationship of trust. These latter, however, despite their married life having been very recently begun, do seem to have been the “natural” stand-ins for their husbands. Figure 7 shows the distribution of authorized representatives according to the length of their marriage.
35 What might seem surprising is the fact that 18 women had been married for less than a year, and half of that group had been married for less than one month. In August, 1730, Marie-Anne Cluzeaux, 20 years old, was appointed the authorized representative of her husband, whom she had married in January of that same year.66 The time between the wedding and the departure of the husband was sometimes even shorter, witness the case of Marie-Madeleine-Régisse Chaussegros de Léry, who married Louis Legardeur de Repentigny barely ten days before the latter left for the Upper Country, entrusting his new wife, at the age of 26, with the responsibility to “govern and administer all of their goods and affairs”.67
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Figure 7 – Length of marriage at the moment of the proxy agreement.
Source: PRDH.
36 It was a similar situation for Marie-Élisabeth Blais, whose husband, the merchant Jean- François Jacquelin, embarked for France barely fifteen days after the wedding ceremony.68 The record belongs, however, to Madeleine-Louise Juchereau Duchesnay, who had been married for only two days when her husband, an officer of Basque origin, Michel de Salaberry, prepared to return to the command of his vessel: the “young” wife was, however, nearly forty years old and belonged to a pre-eminent family of the Canadian aristocracy.69 Do these cases relativize the notion of trust? Can one interpret as a testimony of matrimonial esteem a power of attorney granted only a few days or months after the wedding? If the appointment of the wife appears to be so apparently “natural”, even when the unions were so recent, we believe that the reason is a fundamental factor in the formation of couples: homogamy.
37 The choice of marriage partners and the socio-professional milieu from which the women proxy-holders came (often the same as that of their husbands) contributed in all likelihood to nourishing this trust, despite the absence of a mutual, well-established familiarity between the newly-weds. It is reasonable to believe that this capacity for action and for decision-making which the proxies were assumed to possess testifies to a degree of competence acquired from the bride’s family circle of parents and relatives even before the wedding. The motivations presiding over the choice of a wife, in particular within elite groups, certainly include this factor of “competence”. While these hypotheses remain difficult to verify, a socio-demographic analysis of proxy holders very clearly reveals a high level of dynamism among the women of New France, a dynamism which was perhaps stimulated by the context of enforced male absence.
38 In New France as in most preindustrial societies, conjugal relationships were structured according to patriarchal norms that dictated the rules of the game and put the wife in a subordinate position. Once they were widowed, women gave proof of a business
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capacity that had its roots long before in their previous conjugal life, and indeed often in the years of their youth when living with their parents and relatives. Collaboration between spouses and the participation of married women in business dealings remains nonetheless a nebulous question on account of the relative silence that surrounds them. By studying the women proxy holders of Quebec City for the period 1700-1765 from notarial registers and the civil record, it is possible to penetrate at least partially the cloak of darkness which has obscured the memory of women. This type of delegation of power is unique neither to ancien régime France nor to the French colonies in America. Similar attitudes have been observed at different periods in the English- speaking world, on both the European and American sides of the Atlantic.70 In pre- industrial societies, the women of the family were undoubtedly counted upon to contribute to the family business; when the proxy holder was a wife, mother or daughter, the choice “testifies to trust in her and to [the] will to keep business management within the linear family”.71 This statement certainly applies to eighteenth-century Quebec City.
39 In observing seventeenth-century Canada, some historians have had a tendency to see in it a society if not emancipatory, at least one allowing a wider margin of manœuvre to women.72 Is it an idealized image to represent New France as offering its female population a broader range of possibilities?73 Or, on the contrary, have researchers underestimated the place women occupied in economic activities there?74 Whatever the case may be, there can be no doubt that after the first founding decades, colonial society tended increasingly towards a normalization of masculine and feminine roles in the eighteenth century, as a result of the demographic equilibrium that had been reached. Recent works have seriously relativized the “privileged” status of Canadian women under the French regime and have reaffirmed the strength of the patriarchy that structured this colonial society.75 The debate, however, is far from being concluded as concerns the nature and limits of the exercise of power by women, as is highlighted in a recent article by Jan Noel.76 As Allan Greer notes in his Brève histoire des peuples de la Nouvelle-France, taking the measure of the impact of the men’s absence on the activities of women is essential if one is to make a case for the originality of female power in Canada.77 By focusing our study on the power of substitution that a power of attorney (or other proxy agreement) conferred, it is possible partly to lift the veil hiding the degree to which wives were implicated, and to observe that they often proved themselves to be much more than mere “helpmates” for their husbands. The challenge of reconciling work/family, to use a very current expression, was part of daily life for women in eighteenth-century Canada.
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NOTES
1. Bibliothèque et Archives nationales du Québec, centre de Québec (Library and National Archives of Quebec, hereafter BAnQ): notary J.-N. Pinguet de Vaucour, power of attorney conferred by Denis Constantin, sea-captain, on Elisabeth Hevé, his wife (17 October 1727). 2. We should however acknowledge the significant and virtually pioneering contribution made by France Parent to this question (Parent 1991) and an influential article by Susan Boyle (1987). 3. Brun 2006. 4. Plamondon 1977; Young 1996; Brun 1995 & 1997; Englebert 2008: 70. 5. For example: D’Allaire 1986 and, more recently, Gray 2007. 6. See the remarks of Beauvalet-Boutouyrie 2003: 138. 7. This article is the result of research supported by the Social Sciences and Humanites Research Council for Canada and follows up on a preliminary text on the question: Ferland & Grenier 2010. We thank in particular Josette Brun, Claire Dolan and Sylvie Steinberg for their valuable comments. Finally, we would like to acknowledge the work of our research assistants at Sherbrooke during this project: Maryse Cyr, Camille Martin, Mathieu Perron and Jessica Barthe. 8. The identification of agreements for powers of attorney can be carried out easily by means of the research tool, Parchemin, which inventories and summarizes all notarial acts for the period prior to 1789. Société Archiv-Histo, Parchemin – Banque de données notariales du Québec ancien (1635-1789), consulted at the Library and National Archives of Quebec. 9. Among others: Michon & Dufournaud 2006; Brun 1997 and 2006: 17-20; Parent 1991: 134; Thatcher Ulrich 1983. Finally, let us mention two very recent articles on a similar context: Ouellet 2010 and Charpentier 2010. 10. Among the numerous works on the history of Quebec City, consult in particular: Vallières 2008 and Gauvreau 1991. 11. This was notably highlighted by Boyle 1987: 779 and more recently by Englebert 2008: 70. 12. Under the ancien régime, the only exceptions to this state of fact were, therefore, women who remained single (described as “adult spinsters”), women who were public shopkeepers, widows and, to some extent, women who had been married under the regime of separate property holding, or who were separated from their husbands. 13. Cited in Beauvalet-Boutouyrie 2003: 34. 14. Claude-Joseph de Ferrière, La science parfaite des notaires ou moyen de faire un parfait notaire, contenant les ordonnances , les arrest et reglemens rendus touchant la fonction des notaires, Paris, 1692, p. 423. 15. For a discussion of this power of substitution, see Riot-Sarcey 1993: 22. 16. Robert-Joseph Pothier, « Traité de la puissance du mari sur la personne et les biens de la femme », in Traité de droit civile et de jurisprudence françoise, tome III, 1781, p. 456. 17. Poisson 1985 [1968]: 589-592. 18. Perrot 1998: iv. 19. Furthermore, official actions taken by women proxies (before a notary or in court) for which there exists no actual contract of power of attorney can also constitute valuable indications of the activity of women in the absence of men.
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20. Josette Brun discovered only three proxies among the wives of some 150 merchants from the fortified city of Louisbourg and five proxies in 137 couples from Quebec City: Brun 1995: 60 and 2006: 19-20. 21. Of these, 22 power of attorney agreements between couples were not kept in the analysis, since they contained too little information about the way power was articulated within the couple. 22. BAnQ, notary J.-N. Pinguet de Vaucour, power of attorney conferred by Louis Denis de la Ronde, knight of the military Order of Saint-Louis and Captain of a company of troops of a Marine detachment, on Louise Chartier, his wife, from Quebec City (4 May 1734). 23. BAnQ, notary G. Boucault de Godefus, power of attorney conferred by Jean-Louis Allegrin, on Angélique Petit, his wife, from Trois-Rivières (21 May 1756). 24. BAnQ, notary G. Boucault de Godefus, power of attorney conferred by Pierre Trostier aka Dezauniers et al. on Madeleine Desaulniers, their sister [for the sale of the domain of l’île-aux- Hérons] (8 November 1746). 25. BAnQ, notary Pierre Parent, deposit of power of attorney conferred by François Bédouin, day labourer, on Ursule Toupin, his wife (15 August 1753). 26. BAnQ, notary P.-A.-F. Lanouiller-Desgranges, power of attorney conferred by Jean-François Jacquelin on Marie-Élisabeth Blais, his wife (5 November 1753). 27. BAnQ, notary Florent de Lacetière, power of attorney conferred by René Rainville, of Quebec City, on Elisabeth de Lagaripierre, his mother (16 September 1716). 28. Dechêne 2008: 287-307. 29. Either it is explicitly indicated, or it was possible to deduce it from other information contained in the document or from knowledge of the family and professional situation of the parties. 30. Although these women were not Canadian, we chose to include these proxies in the corpus since they were notarized in Quebec City and testify to the tie between male mobility and the recourse to proxy agreements. 31. BAnQ, notary J.-E. Dubreuil, power of attorney conferred by Catherine Damien on Angélique Chesnay (13 September 1732). The two women also made a mutual donation of all of their goods to each other in 1729. 32. This includes Terre-Neuve, the posts of la Côte-Nord, Labrador and Gaspé. 33. One example: BAnQ, notary Jean-Étienne Dubreuil, power of attorney conferred by René Brisson on Marie-Josèphe Doyon, his wife (9 June 1724); BAnQ, notary Jacques Barbel, power of attorney conferred by Michel Lamy, merchant, on Marie-Anne Petit, his wife (17 August 1732). 34. BAnQ, notary J.-C. Panet, power of attorney conferred by Charles-René de Couagne, tradesman, on Louise Cartier, his wife, from Quebec City (28 May 1745). 35. BAnQ, notary Claude Barolet, power of attorney conferred by Louis Liénard de Beaujeu de Villemonde, squire and Captain of the infantry, relict of Louise-Charlotte Cugnet, from Quebec City, rue Saint-Louis, guardian of Louise-Julie de Beaujeu de Villemonde, their only child, on Louise-Madeleine Dusautoy, widow of François-Étienne Cugnet, senior counsel to the Conseil supérieur, maternal grandmother of the said minor (12 February 1757). 36. BAnQ, notary François Genaple, power of attorney conferred by Jacques Barbel, bourgeois, on Louise-Renée Toupin, his wife, from the city of Quebec (6 July 1700). 37. BAnQ, notary Claude Barolet, power of attorney conferred by Guillaume-Joseph Besançon, bourgeois, on Françoise-Charlotte Blais, his wife, from the city of Quebec (9 October 1749). 38. These were usually trips to the Upper Country. For example: BAnQ, record P.-A.-F. Lanouiller- Desgranges, power of attorney conferred by Jacques Dufaut on Josèphe Clermont, his wife, from the city of Quebec (20 February 1756). 39. Boyle 1987.
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40. We used a prosopographical approach to identify the women proxies and to reconstitute their families. This work was made possible thanks to the data of the Program in historic research and demography (PRDH) at the University of Montreal, which has inventoried the population of Old Quebec, from its origins until the nineteenth century. (www.genealogie.umontreal.ca). 41. This example tends to prove the necessity of a new proxy agreement for each absence of the principal. 42. Of the 43 French female proxies, 20 still lived in France but were named in a proxy agreement enacted in Quebec City. Only 23 of these French women actually lived in Quebec City, barely 10% of the group. See supra, note 30. 43. She had been taken captive during the war and then integrated into French Canadian society: Marie-Catherine Parsons, who married the lord Claude Bermen de la Martinière. 44. Identification of the women’s socio-professional origins was made on the basis of the occupations declared as well as of known titles of nobility: this was made possible by family reconstitution. Since the women rarely declared themselves as having an occupation, we used that of the husband for married women and widows, and that of the father for single women. Beyond that, taking into account the propensity for socio-professional homogamy, the social milieu of origin was generally the same as that of the husband. 45. For a discussion of the concept of social groups under the Old Regime, see: Nassiet 2006. 46. In New France as in France, possession of a seigneurial domain did not automatically imply nobility. The colony was nonetheless notable for a good number of non-noble owners of seigneurial estates, and, amongst them, some were of very modest extraction. These families belonged to a world clearly different from that of the grand seigneurial families of the colonial nobility. On the specificity of the seigneurial regime in Canada: Grenier 2012. 47. Mathieu 1981. 48. On the Canadian nobility: Gadoury 1992; Ruggiu 2008. 49. BAnQ, notary Jacques Barbel, power of attorney conferred by Philippe de Rigaud de Vaudreuil […] Governor and Lieutenant General for the king in all of New France to Louise-Elisabeth de Jouybert, his wife, from the city of Quebec (14 November 1709 and 6 November 1712). 50. BAnQ, notary C.-H. Dulaurent, power of attorney conferred by Charles Boucher de Boucherville de Montarville, squire, on Françoise Bourolle, his wife, from the place Royale du Marché of the lower city of Quebec (7 October 1744). 51. We distinguished wealthy merchants and traders from those who associated the title of merchant with an artisanal status, for example: marchand-cabaretier (wine shopkeeper), marchand-boucher (butcher), marchand-perruquier (wig maker). These occupations are clearly those of artisans or shopkeepers of lesser status. 52. BAnQ, notary C.-H. Dulaurent, power of attorney conferred by Jacques Gueroult, “merchant wig-maker”, on Marie-Angélique Guenet, his wife, from the city of Quebec, rue Couillard (25 September 1754); notary C. Rageot de Saint-Luc, power of attorney conferred by Jean Bureau, innkeeper, on Madeleine Vermet, his wife (13 October 1701). 53. Habitants was the term used to indicate peasants in New France. 54. BAnQ, notary Pierre Parent, power of attorney conferred by Jean Baugis of the seigneurie de Beauport on his wife, Marie Drouin (15 February 1750). 55. Essentially those who lived in France. 56. BAnQ, notary J.-C. Panet, power of attorney conferred by Denis Goguet, tradesman, on Louise Ferey called Duburon, his wife, from the city of Quebec (11 October 1747). 57. Suzanne Rollet died on 26 August 1764 in Quebec City, leaving behind two young children. PRDH # 158786. 58. BAnQ, notary C. Louet, power of attorney conferred by Martin Chennequi, sea-captain, from the city of Quebec, on Thérèse Grenet (10 September 1764). Furthermore, when he remarried in
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1768, it would be to a niece of his mother-in-law, a cousin of his first wife. See PRDH, file # 45058: marriage of Martin Chennequi and Marie-Louise-Angélique Grenet (8 February 1768). 59. BAnQ, notary Claude Barolet, power of attorney conferred by Gaspard-Joseph Chaussegros de Léry, squire and lieutenant of the infantry, on Louise Martel de Brouage, his wife, from the city of Quebec (22 June 1756). 60. Mathieu 2001 [1991]: 80. 61. BAnQ, notary J.-E. Dubreuil, power of attorney conferred by René Brisson on Marie-Josèphe Doyon, his wife (9 June 1724); notary J.-C. Panet, power of attorney conferred by Jean-Antoine Bedout, merchant, on Françoise Barolet, his wife, from the city of Quebec (18 October 1747); notary Jacques Barbel, power of attorney conferred by Pierre Plassant, bourgeois merchant, on Louise Albert, his wife, from the city of Quebec (15 November 1703). 62. Beauvalet-Boutouyrie 2003: 103. See also Tilly & Scott 1978; Juratic & Pellegrin 1994. 63. BAnQ, notary Claude Barolet, power of attorney conferred by Guillaume-Joseph Besançon, bourgeois, on Françoise-Charlotte Blais, his wife, from the city of Quebec (9 October 1749). 64. On this question, see Gauvreau 1987. 65. BAnQ, notary C. Rageot de Saint-Luc, power of attorney conferred by Jean Bureau, innkeeper, on Madeleine Vermet, his wife (13 October 1701). 66. BAnQ, notary J.-N. Pinguet de Vaucour, power of attorney conferred by Jacques Daniaux, on Marie-Anne Cluzeaux, his wife, from the city of Quebec (5 August 1730). 67. BAnQ, notary J.-A. Saillant de Collégien, power of attorney conferred by Louis Legardeur de Repentigny, squire and officer in the troops of a Marine detachment, on Marie-Madeleine- Régisse Chaussegros de Lery, his wife, from the city of Quebec (30 April 1750). 68. BAnQ, notary P.-A.-F. Lanouiller-Desgranges, power of attorney conferred by Jean-François Jacquelin, merchant, from Quebec City, rue Saint-Pierre, on Marie-Elisabeth Bled, his wife, former wife of Jean-Baptiste Huppé called Lacroix (5 November 1753). 69. BAnQ, notary C.-H. Dulaurent, power of attorney conferred by Michel Sallaberry, Flute Captain, on Madeleine-Louise Juchereau-Duchesnay, his wife (1 August 1750). On the family of this proxy, in particular her mother, see: Grenier 2005. 70. For example: Ewan 1992; Van Kirk 1992. 71. Michon & Dufournaud 2006: 7. 72. Witness the debate on this subject between Micheline Dumont and Jan Noel in the early 1980s: Noel 1981; Dumont 1982; Noel 1982, as well as Susan C. Boyle’s work on Sainte-Geneviève in Illinois in the eighteenth century (Boyle 1987). 73. Noel 1981. 74. Hufton 1984; Young 1996. 75. Greer 2000; Brun 2006; Gray 2007; Grenier 2009. 76. Noel 2010. 77. Greer 1998: 94.
ABSTRACTS
In pre-industrial societies, the exercise of power within the family was closely linked to the legal context and to patriarchal norms. The role played by women, particularly married women, in the family’s economic activity is often hidden from history. The study of women entitled to act by
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proxy in Quebec City, the capital of Nouvelle-France in the eighteenth century, allows a better understanding of the way the couple could function in a colonial context often characterized by the physical absence of males. The analysis of agreements authorizing wives to stand proxy for their husbands, combined with a prosopographical study, reveals the context and the issues at stake in this circumstantial transfer of power. This approach shows that it is possible to penetrate, at least in part, the silence of history concerning the activity of married women, and to shed light on the complex question of complementarity and trust within the couple.
INDEX
Keywords: proxy, proxy agreements, power, couple, complementarity, family, trust, Nouvelle- France (Canada), Quebec City, eighteenth century (1700-1765)
AUTHORS
CATHERINE FERLAND Catherine Ferland is associate professor in the history department at the University of Sherbrooke, Montreal, specializing in the cultural history of seventeenth- and eighteenth- century Canada, with particular reference to the consumption of food and drink. Recent publications include: Bacchus en Canada. Boissons, buveurs et ivresse en Nouvelle-France (2010) and a collection of conference papers: Femmes, culture et pouvoir. Relectures de l’histoire au féminin XVe-XXe siècles (2010), co-edited with Benoît Grenier. [email protected]
BENOÎT GRENIER Benoît Grenier is professor in the history department at the University of Sherbrooke, Montreal. His research is on pre-industrial Quebec. Publications include Seigneurs campagnards de la nouvelle France (2007) and Brève histoire du régime seigneurial (Boréal, 2012). He was awarded the Hilda Neatby Prize (Canadian Historical Society and Canadian Committee on Women’s History) for best article on women’s history (2012) for his research on seigneuresses [women seigneurs] in the Saint Lawrence Valley. The present article results from joint research with Catherine Ferland on women in Quebec in the eighteenth century. [email protected]
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