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Stories of the Past, Inspiration for the Present: Teaching Literature, History, Professional Identity, and Social Activism in the Narrative and Medicine Classroom

It always astonishes me when a young woman, powering her way through a demanding undergraduate degree on her way to becoming a physician or other health professional, moving through the city at all hours of the day to volunteer at a couple of charities and work 20 hours/week in a clinic or hospital – says, “I’m not a feminist.”

On the one hand, there’s something optimistic and triumphant in her mindset. She can study what she likes, pursue the careers and hobbies that matter to her; she can make a difference in the world; every woman her age that she knows is doing the same, mentored by female professors and clinicians who have paved the way in their own studies, careers, and personal lives, and who seem to Have It All as a reward for their efforts.  What does the educated, professional woman of today need feminism for?

Never mind that she has to be on her guard when she goes out, because everyone knows at least one girl who was drugged and raped at a college party; or that she calls a taxi to make a trip she could walk in 10 minutes, but won’t, because sometimes girls get assaulted in the neighborhood when they walk alone at night. Never mind that, despite the fact that women now account for nearly half of graduating MDs[1], men still outnumber women across the profession, and odds are that she will make less than her male colleagues, up to $50,000 less per year.[2] Or that if she has a family with a male partner and children, she might work 60+ hours at work each week and still spend more hours on housework and childcare than he does.[3] Never mind that she will face discrimination from patients, less favorable work reviews, possible harassment, and increased rates of burnout in her job.[4] Never mind that if she is sick or in pain herself, she’s very likely to be given less care and less sympathy – she’s less likely to be believed – by her own fellow practitioners…because she’s a woman.[5],[6]

Indeed: what does the educated, professional woman of today need feminism for?

Although she didn’t use the word “feminism” because it wasn’t yet in common usage, Annie Nathan Meyer had her fictional heroine ask that question, and answer it at length, in her 1892 novel Helen Brent MD[7]  – a novel which I and my students read in our undergraduate course on Narrative and Medicine. Meyer was impatient with many of the women in her upper-class social circle in New York, women whose lives were comfortable but vapid – despite the hard-fought battles to open higher education and professional work to women (getting the vote was also a goal, but was still decades away), too many mothers were still teaching their daughters that the ideal “career” was to land a well-off husband, and keep his home and children for him. Meyer’s protagonist, Dr. Brent, encounters all manner of opposition in both her professional and personal lives. She’s in love with a wonderful man who loves and respects her…but who is horrified by what she does for a living (touching and caring for the sick bodies of men, women, and children! that’s no work for a lady!) and can’t marry her unless she’s willing to give up her career to dedicate herself to being his wife. Other women in her social circle are even more judgmental of her career than her male love-interest. She alienates one wealthy patient, a society matron who wants Dr. Helen’s help to discipline a wayward daughter….wayward because rather than going husband-hunting at debutante balls, the girl wants to be left alone to study. Helen’s greatest regret is that she can’t save other young women from being preyed upon by a very rich, very eligible, very immoral, society playboy – he’s a privileged white man; he can do what likes, with whomever he likes, without consequence, and not only is he “ruining” young women by seducing them, he’s spreading syphilis everywhere he goes.

As a novel, Helen Brent MD isn’t especially artfully written, but I love to include it in my class on Narrative and Medicine for the story it tells. As Helen argues frequently throughout the novel, women need the world to change. Reinforcing many of the same points made by Mary Wollstonecraft a century before, and other early feminist writers of her own time, Helen insists that a woman who is raised to do nothing but be dependent first on her father, then on her husband, will never have the physical, intellectual, or moral health to be of any use to anyone – to care for her children, for starters, or to care for her community. Building on the rhetoric used throughout the second half of the 19th century to support the cause of women’s emancipation in the West, Helen doesn’t challenge essentialist notions that women are “naturally” meant to care and nurture; rather, she invokes that very essentialism to argue that women should be trusted to give that maternal power a broader scope, in fields like education, medicine, and public health. And Helen insists that the burden of change can’t be on women alone: echoing other fictional and non-fictional arguments of the day, she insists that women will never be able to succeed in new ventures without the support of a new kind of man who is comfortable enough in himself to be able to meet a woman as an equal.

In other words, over a hundred years ago, Annie Nathan Meyer used a novel – a story – to make the basic case for feminism. And to reinforce the point, I can direct my students to several other stories from that earlier period that highlight the same conflicts, and draw the same conclusions: the skill, talent, and dedication to their patients is the same whether the doctor is a man or woman, but the women have to work tirelessly to overcome the prejudices of family, male coworkers, the women around them who should be allies but aren’t, and the men who are drawn to them and intimidated by them at the same time:

A Country Doctor (Sarah Orne Jewett, 1884)

Dr. Zay (Elizabeth Stuart Phelps, 1882)

“The Doctors of Hoyland” (Arthur Conan Doyle, 1894)

Dr. Edith Romney (Anne Elliot, 1883)

Mona Maclean Medical Student (Margaret Todd, 1898)

Peace with Honor (Sydney Grier, 1897)[8]

My 21st-century health care students – about 70% of which are women – are struck by these 19th-century narratives, and what they have to say about the challenges awaiting them as they define their professional and personal identities. The students are taken aback when they read late 19th century novels, along with commentary from medical journals like the Lancet or JAMA, and are confronted with the confident, serious assertions by various experts that women lacked the mental and physical strength to be doctors or pharmacists.[9] Studying such novels prompts their curiosity about beliefs “back in the day” – the sexual double standard; the use of hysteria as a diagnosis to marginalize, pathologize, and control women’s emotions; the cultural resistance to those women who broke with convention to enter previously-male preserves of higher education and remunerative work; the very real physical and sexual dangers that women had to face everywhere they went; the seemingly-trivial, but significant, obstacles to mobility presented simply by their clothes. These stories – fictional, but written in earnest response to the social conflicts of the day – help the students to see how deeply entrenched sexist prejudices have been, and still are, in our culture. To someone who’s 20 years old in 2019, a novel from 1892 is old…yet how is it that women like Helen Brent – in fiction, in real life – had to work so hard to cultivate their intellectual gifts, to do nothing more than offer to care for others, and have to endure insult, loneliness, ostracism, for their pains…and how is it that women today are still facing many of the same struggles? Confronted with the reality of the profound inequality of the past, the students are forcefully moved to concede that yes, we needed change, we needed women and men to work to overcome prejudice and cultural inertia. We needed that change to become feminism then so that these students could all be sitting in a classroom together, at a university, contemplating their choice of health care careers, today.

 …And from these students make the logical connection: that the choices that they are privileged to make today matter – for the sake of their own professional and personal fulfillment, and for the sake of the women who come after them.

 

 

 

 

[1] “Distribution of Medical School Graduates By Gender.” Kaiser Family Foundation. 2017 https://www.kff.org/other/state-indicator/medical-school-graduates-by-gender/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

[2] Poorman, Elisabeth. “Why Does America Still Have So Few Female Doctors?” The Guardian. January 2018.

[3] Burkeman, Oliver. “Dirty Secret: Why Is There Still a Housework Gender Gap?” The Guardian. February 2018. https://www.theguardian.com/inequality/2018/feb/17/dirty-secret-why-housework-gender-gap

[4] Poorman.

[5] Pagan, Camille Noe. “When Doctors Downplay Women’s Health Concerns.” New York Times. May 2018. https://www.nytimes.com/2018/05/03/well/live/when-doctors-downplay-womens-health-concerns.html

[6] Hirsch, Aubrey. “Medicine’s Women Problem.” The Nib. July 2017.  https://thenib.com/medicine-s-women-problem

[7] Meyer, Annie Nathan. Helen Brent MD: A Social Study. 1892. https://archive.org/details/helenbrentmdaso00meyegoog/page/n8

[8] The full text of each of these narratives can be found for free online.

[9] The expectations for women, and the prejudices they faced, were very different depending on whether they were going into medicine or nursing. Nursing was a much less controversial profession for women because the work more neatly lined up with women’s “natural” domestic and maternal qualities…not to mention that nursing was lower in status, paid much less, and didn’t threaten to take business away from male practitioners: “It appears that it is most becoming and proper for a woman to discharge all those duties which are incidental to our profession [nursing] for thirty shillings a week; but if she is to have three or four guineas a day for discharging the same duties, then they are immoral and immodest, and unsuited to the soft nature that should characterize a lady” (Jex-Blake, Sophia. Medical Women: A Thesis and A History. 1886. P. 192)
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Professor of Medical Humanities, MCPHS, Massachussett College of Pharmacy and Health Sciences University, Boston

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