This summer my research collided with one of my favorite TV shows, The Bear, in which talented, sexy, and emotionally tortured chef Carmy returns home to Chicago to run a sandwich shop with his family and (eventually) chosen-family staff. In the much watched and highly rated second season this June, the team closes the shop, working to transform it in record time into a fine dining restaurant, The Bear. Along the way, Carmy starts to date Claire and a tender relationship blossoms. In the final episode, on a night that could make or break the future of the restaurant, Carmy ends up locked in the walk-in fridge. Physically incapacitated, he nosedives into an hysterical tailspin, viciously questioning himself and his professional commitment, agonizing over the time and energy he devoted to Claire instead of focusing exclusively on the restaurant.

I immediately recognized his personal castigation from my current research on popular sports psychology books and from my own life, too. In many competitive and high-performing fields – be it fine dining, professional and Olympic sports, or academia – it’s not unusual, in fact it’s encouraged, to obsessively focus on our professional goals and to achieve them at all costs. But the costs can be great, especially to our relationships with ourselves and one another. What’s more, pop sports psych manuals endorse their advice not just for elite athletes but for anyone and everyone. The “athlete mindset” promises a leg up in competition, but when adopted wholesale and across every facet of our lives, it can also fray our social fabric and mental health.

In his review in The New York Times, James Poniewozik rightfully categorizes the second season of The Bear as a sports story, especially as Coach K’s Leading with Heart makes multiple appearances. As we root for the underdog, the season’s sports-based narrative structure serves viewers numerous delectable tropes in each episode: practice montages of The Bear’s staff tasting dishes and learning new culinary skills, scenes of inspirational teamwork, the tension of racing against the clock, and (we hope) celebrating a well-earned victory, surrounded by cheering crowds. Like the pressure to win Olympic gold or set world records, the creative and bureaucratic hurdles for opening The Bear are many with sky-high financial stakes. The Bear’s athletic tenor boils over in its final episode as it centers a perhaps necessary, but nevertheless insidious, aspect of elite sports: a focus upon winning so intense that it risks annihilating everything else in one’s life.

Duke University head coach Mike “Coach K” Krzyzewski talks to his team during a timeout in 2012. (Photo by D. Myles Cullen)

Popular sports psychology books’ authors and endorsements promise to help readers win by applying a laser-focused athlete’s mindset in order to achieve their best at work and in life. Take for example, how in his introduction to The Mindful Athlete: Secrets to Pure Performance, mindfulness consultant George Mumford writes, “Life is a marathon. … In order to run this marathon, we need to train in the same way any other athlete trains to compete effectively in a sport.”^[1] Alpine skier and Olympic gold medalist, Phil Mahre, endorses sport’s psychologist Jim Afremow’s The Champion’s Mind: How Great Athletes Think, Train, and Thrive, telling readers in his blurb that an athlete’s mindset “holds a wealth of insight as to how you can become a winner in your everyday life.”^[2] Financial management executive David Highmark enthusiastically blurbed sport psychology consultant Gary Mack’s Mind Gym: An Athlete’s Guide to Inner Excellence, gushing, “Whether it’s the board room or locker room, the formula for success is the same. Mind Gym not only should be required reading for every aspiring athlete but for everyone who wishes to excel in their chosen field.”^[3] These books unequivocally recommend an elite athlete’s competitive intensity to all of us, whatever our goals. As a professor, I worry that more than one book explicitly targets students to fuel their academic achievement in high school and college just as one would train to compete at an elite level.

These books undeniably share some useful guidance. Some have even pumped me up as I find myself feeling a bit defeated as I research and write my second book. These authors remind us to believe in ourselves, to think positive thoughts rather than negative ones, to set ambitious but reasonable goals, to dream big, to attend to the present, to improve one small step at a time, to concentrate on what we can control and let go of what we can’t, to use the power of our minds and senses to visualize our performance and eventual success, and so on.

But beneath this advice courses the overall ambition to “go for gold,” to dominate, to be the greatest of all time – and to readily commit all that such achievement demands. The most exaggerated example I’ve run across so far is Tim Grover’s Relentless: From Good to Great to Unstoppable, which defines the greatest athletes as “Cleaners.” Grover writes, “Your whole life is essentially dedicated to one goal, to the exclusion of everything else. Whether you’re focused on business, sports, relationships, anything, you have to be committed to saying, ‘I’m doing this, I’ll give up whatever I have to give up so I can do this, I don’t care what anyone thinks, and if there are consequences that affect the other parts of my life, I’ll deal with them when I have to.’”^[4] It’s no coincidence that Grover offers examples of only male athletes, uses only masculine pronouns throughout the book, and casts Cleaners as role models with proudly toxic-masculine traits.

Similarly, in The Bear, Carmy has worked in the world’s most famed kitchens and has been indoctrinated into an all-or-nothing and win-at-all-costs mindset fueled, in part, by the culinary world’s patriarchal norms and gender inequities. As he sits inside the walk-in fridge, Carmy berates himself: “What the fuck was I thinking, like I was going to be in a relationship? I’m a fucking psycho! That’s why I’m good at what I do. That’s how I operate. I am the best because I didn’t have any of this fucking bullshit, right? I could focus and I could concentrate.” He’d been taught and had believed that to be great, he must remain fixated upon his professional success with no room for a romantic relationship.

I recognize these intense demands from my own life. As academics, we must “publish or perish” and are routinely fed destructive advice about prioritizing our work. A tweet went viral recently about an artist who didn’t go to parties, instead staying home to paint, to practice his craft with obsessive dedication. Academics on Twitter were quick to align the story with their own grad student and early faculty experiences. Some in the Twitter thread held up the productive “lone warrior” as an academic exemplar. Others critiqued it, calling for kinder, warmer, and slower academic cultures that cultivate new knowledge and social connections.

Competing in sports at the highest level does require some grave commitments. But the tactics and strategies that help professional and Olympic athletes to achieve nearly impossible feats are typically employed over limited periods of time, given the short nature of most competitive careers, which depend upon our fallible human bodies. For better or worse, the rest of us need to keep on truckin’ for many years longer than the typical sports career. Popular sports psychology’s individualistic, ultra-competitive messages are incompatible with our extended professional trajectories, which necessitate balancing our goals and aspirations with the people in our lives and within our social and cultural worlds. And as professional athletes, like Michael Phelps, Naomi Osaka, and Simone Biles (among many others), have addressed, elite performance – the kind venerated by popular sports psychology books – isn’t sustainable for athletes either, taking a considerable toll on their mental health, without proper support.^[5]

Tim Grover concedes that one can’t relentlessly pursue multiple goals “because achieving excellence in any one of these areas requires you to say, ‘I don’t give a damn about anything else.’”^[6] The Cleaner’s hyper-focused mindset is far from healthy for society more broadly, let alone for individuals. And yet, in The Bear, this unhealthy mindset is exactly what Carmy’s fine dining career fostered. He fears that by pursuing romantic love alongside his dream of opening his restaurant, he’s dropped the ball, that he’s taken his eye off the culinary prize, fears encouraged by an athletic mentality. By being fully human, Carmy worries he’s no longer good enough. For reasons both personal and professional, Carmy hasn’t found the balance between work and life, to mix romantic love into ambition.

Jeremy Allen White as Carmen “Carmy” Berzatto in The Bear. (Courtesy FX)

Carmy’s struggles speak not just to the pressures of the culinary arts at the highest level but to a larger American cultural message about success, which professional sports embody and amplify. If we want to be successful, we’re told, we must adopt a mindset like an elite athlete’s that exercises a singular focus and steadfast commitment to our goals to the exclusion (and detriment) of all else and all others in our lives. To make it, to win, to be the greatest, we have to be willing to give (and give up) key parts of ourselves and our connections to other people.

Despite the extreme nature of such a proposition, it makes sense that sports psychology has gone mainstream as “the science of success.” Everyday people want, and often need, something extra – such as a strong “mental game” – to give them an edge in their careers, given the growing scarcity of secure, fulfilling, and justly-compensated jobs. But pop sports psych principles applied over an entire population can be destructive to society at large, and to our relationships with one another. Athletes themselves are raising awareness about how intensely focusing on performance alone and without proper support can harm mental health. To go for gold and actually thrive afterwards, we need to help one another, to create a culture where communities strive together, rather than obsessing over personal performance alone.

The Alabama Senate recently passed a bill that expands Safe Haven Laws, which permit the surrender of newborns at designated sites like fire stations and hospitals, to allow the use of “baby boxes” across the state. Supporters argue that these “baby boxes,” which look like mail slots equipped with cushions and alarms inside, offer safer options for surrendering an infant than the traditional drop-off sites because they offer more anonymity and, therefore, decrease the chances of unsafe abandonment or infanticide. As Lee Marshall, founder of the local foster care nonprofit Kids to Love, told local news station WSFA, “You look at women now not having the choice to have an abortion, we want to give them another choice if they choose to carry that baby full term to be able to place that baby in a box, if they still choose not to parent.” The boxes will be installed in fire stations near college campuses throughout the state. By installing such boxes, Alabama joins seven states in the South and Midwest, where a total of 145 baby boxes are currently installed (though Safe Haven Laws currently exist in all fifty states).

Since their rapid adoption in the early 2000s, Safe Haven Laws have enjoyed bipartisan acceptance nationwide. Yet, as the Alabama law makes clear, these laws also reflect the anti-abortion movement’s emphasis on adoption as an alternative to abortion and the ways anti-abortion “culture of life” rhetoric, which blurs distinctions between pregnancy and motherhood and fetus and child, has become mainstream enough to seem a relatively uncontroversial framing for these laws. Marshall’s quote above demonstrates this slippage. She argues that baby boxes offer women “another choice” than abortion “if they still choose not to parent” [emphasis mine] after birth, in which the desire to abort during pregnancy and the choice to surrender an infant are both issues of parenting, rather than two distinct yet interconnected experiences with their own set of physical, social, and economic concerns.^[1] In every state, Safe Haven Laws, as they’re currently construed, prevent us from looking beyond the pro-life/pro-choice debate to consider ways of addressing unwanted pregnancy, infant abandonment, and infanticide that respect and care for both the birthing parent and the child.

While there is no systematic data collection, the National Safe Haven Alliance estimates that about 4,000 babies have been left at Safe Haven sites across the country since their inception. The first Safe Haven Law was enacted in Texas in 1999. Known colloquially as the “Baby Moses Law,” it purported to help “mothers in crisis” safely surrender their infants. Though the specifics of each law vary by state, they all designate a variety of safe surrender locations, including police stations and hospitals, where a parent can leave their newborn in the care of the state anonymously and without legal consequence. After a certain period, usually a couple of days, their parental rights are terminated, and the child is formally placed into state custody.

A “safe surrender site” at a San Francisco fire station. (Courtesy Wikimedia)

After the first Safe Haven Law passed in Texas, other state legislatures were able to get similar laws passed between 1999 and 2008, often with bipartisan support.^[2] In North Carolina, for example, the bill was first proposed by a pro-choice representative and supported by the local chapter of Planned Parenthood.^[3] Discourses surrounding these laws focused on rare but tragic cases of infant death resulting from abandonment, and the rhetoric emphasized beliefs in the sacredness of life.^[4] As legal scholar Carol Sanger has argued, Safe Haven Laws have successfully built upon a foundation of anti-abortion “culture of life” ideology and rhetoric, which has worked to blur the distinction between pregnancy and motherhood, fetus and child, and abortion and infanticide in popular culture.^[5] Safe Haven Laws are positioned as the obvious solution to help a “mother in crisis” make the best choice for “her child.”^[6] Anti-abortion activists and lawmakers frequently frame infant surrender and adoption as a functionally comparable yet morally superior alternative to abortion. Most recently, during oral arguments in the Dobbs v. Jackson Health Organization case, Justice Amy Coney Barrett claimed that existing Safe Haven Laws allow women to avoid “the burdens of parenting.” The leaked and final decision similarly cited these laws among the arguments for opposing Roe v. Wade. In addition to the politically loaded term “choice,” anti-abortion activists and lawmakers may prefer to talk about “options” and “potentials.” Regardless of terminology, the point remains the same – the anti-abortion movement is touting Safe Haven Laws and the surrender of children to the state as a moral alternative to abortion in a post-Roe world.

In Alabama, proponents of the bill to expand Safe Haven Laws emphasized its direct connection to the fall of Roe v. Wade. As Alabama Department of Human Resources Nancy Bruckner told AL.com, “Being a pro-life state there needed to be a next step. We’re encouraging these mothers, don’t abort your baby, have your baby.” Rep. Donna Givens, the bill’s sponsor, explained: “Number one and most important, saving baby’s lives. Number two, it’s saving the mother from making the mistake of her life that she will regret for the rest of her life. And number three, it’s putting a baby in these loving couple’s arms that desperately wants a baby.”

These arguments are flawed in several ways. Issues of pregnancy and childbirth should be understood separately from questions of parenting. The idea that these laws offer women choices is particularly galling considering the fall of Roe and the narrowing of options for those who are pregnant (though it is vital to remember that even before the Dobbs decision, access to reproductive care was limited or inaccessible for many people in this country). And as feminist scholar Laury Oaks has shown, Safe Haven Laws create a good mother/bad mother dichotomy in which parents who do not have access to social and economic resources and safety can “do the right thing” by relinquishing their parental rights. Within this framework, birthing parents can avoid abortion and infant abandonment by performing a final, absolving act of motherly love. This supposed selflessness is thought to unburden a mother in crisis from parenthood. This claim assumes that the experience of pregnancy, birth, and surrender will leave no lingering emotional or physical consequences on the birthing person.^[7]

The wide acceptance of Safe Haven Laws for over twenty years shows us what can be lost in a binary pro-choice/anti-abortion debate that does not attend to the fuller context of reproductive justice. Because the discourse around Safe Haven Laws focuses on “mothers in crisis” and their infants, not pregnant people or fetuses, they appear to avoid the issue of abortion entirely, making them easy opportunities for bipartisan collaboration. Yet, according to Loretta Ross and Rickie Solinger, reproductive justice has three primary principles: 1) the right not to have a child, 2) the right to have a child, and 3) the right to parent children in safe and healthy environments.^[8] These laws fail to provide reproductive justice support to pregnant people and distract us from finding more equitable and just solutions.

Safe Haven Laws offer a narrow solution to the problem of unwanted pregnancies. They do not address root causes, nor do they ensure the safety and well-being of either the birthing parent or the surrendered infant. And while the specifics of Safe Haven Laws vary by state – including time limits and age restrictions – they all share the same critical omissions: These laws do nothing to prevent unwanted pregnancies, provide support or resources for victims of domestic violence or assault, or ensure access to contraception or abortion services for those who do not wish to be pregnant. They don’t offer medical care for pregnant people who cannot afford the costs of pregnancy or childrearing, nor do they offer resources for pregnant people who wish to parent their children but fear they can’t due to lack of resources, safety, or employment. Further, they don’t account for the emotional and psychological toll of infant surrender and adoption on either the parent or the child. Even though these laws putatively prioritize the child, they do nothing to ensure that the children involved will find themselves in a safe and caring environment as they grow.^[9]

Scholars and reproductive justice activists have attempted to draw attention to these issues for decades. Scholars, for example, have challenged the laws based on their vagueness and lack of efficacy or demographic data, which makes it impossible to determine whether Safe Haven sites are disproportionately used by any particular racial, ethnic, or socioeconomic group. Activists on Native American reservations have criticized Safe Haven Laws as a violation of the Indian Child Welfare Act (ICWA), which provides tribes the federal right to participate in child custody proceedings involving Indian children and that extended family or adoptive parents from within the tribe should be prioritized first.^[10] And reproductive justice advocates have pointed to the ways Safe Haven Laws fail to address the physical and mental health needs of the birthing people and infants involved in Safe Haven surrenders.

The expansion of Safe Haven Laws in Alabama is just one iteration of anti-abortion activists and lawmakers normalizing anti-abortion ideology through “child-saving” and “right to life” rhetoric. In the wake of Dobbs, it’s essential to recognize these strategies for what they are and to fight for policies that prioritize reproductive justice alongside legal access to abortion.

“Tujhe dekh ke goriye, Beyonce sharma jaayegi” – Your beauty, o fair skinned girl, puts even Beyonce to shame.

Such were the lyrics to a 2020 Bollywood song, as the Economic Times explained, before popular backlash brought about a re-writing of the lyrics. The director and actors initially attempted to justify their intentions, claiming the use of “fair skinned girl” or goriye was merely formulaic and not racist. This is hardly surprising given the long history of using goriye as a synonym for “beautiful” and “good” in Bollywood. Take, for example, a song from the 1965 film “Gumnaam” that depicts the hero, whose skin has been visibly darkened (perhaps to denote a lower economic class origin), dreaming of the fair (goriye) – and, by extension, virtuous – heroine. In his dream, he asks, “Kaale se dar gayi kya? Hum kaale hain toh kya hua, dilwale hain” – “Did my dark skin scare you? Although I am dark, I am good of heart.”

Vidya Balan in 2023. (Courtesy Wikimedia)

Yet another longstanding issue inherent in Bollywood is undoubtedly that of fatphobia. For decades, fat women’s bodies were treated as the source of comic relief and one-liners, juxtaposed against slender female leads to highlight their alleged comparative loveliness and romantic worth.^[1] Even off-screen, popular Bollywood actresses such as Vidya Balan and Sonakshi Sinha are subjected to fatphobia, despite their attempts to normalize a wider variety of body types. This use of light skin and a slender body to denote beauty and virtue is at least as old as Bollywood itself – and, as this essay will argue, in some ways much older.

This article intends to highlight the prevalence of such biases with regard to heroines in the Natyashastra – an ancient Sanskrit treatise that stipulates what constitutes “correct” and “good” theater. This is exacerbated by the rise of right-wing and nationalist politics in India, which equate being Indian to being Hindu, as The Guardian explains. Both school and college syllabi have undergone changes to reflect what is construed as “Indian,” such as an emphasis on the works of ancient Sanskrit scholars. This has also resulted in the removal of chapters on democracy from high school textbooks.^[2] While Bollywood perhaps does not directly draw on the Natyashastra, the text continues to remain an aesthetic ideal in the world of performance.^[3]

Introduction to the Natyashastra

The Natyashastra, attributed to the sage Bharata, is an encyclopedic text on dramaturgy and other performing arts. Like most texts of its period, both the date and the author of the text remain uncertain. However, as Natalia Lidova points out, most scholars argue that it reached its extant form between c. 200 BCE to 200 CE.^[4] Although the text’s origins are not entirely certain, the fact that it comes from an elite, male section of society is evident from in-text references, as I argue elsewhere.^[5] An analytical look at its content offers valuable insight into the standards of beauty and morality among the ancient Indian social elite. Hence, this article will attempt to ascertain what biases the Natyashastra betrays against the female body in its discussion of various types of heroines.

The text constantly creates character types identified by various physical and moral characteristics. It is important to note that, while this character typing extends to both male and female characters (the latter in greater detail), male characters and other genders sometimes alluded to in the text will not be discussed in depth in this essay, due to the possibility of mistranslation and hence, misgendering. Economic considerations, social status, and employment are certainly present in the text – for example, only women of high birth may be termed a “superior female character”^[6] – but these issues are not the focus of this analysis. Instead, I will emphasize what the Natyashastra says about female actors, characters, and their bodies.

Female Character Types

While the text disqualifies women with “all kinds of diseases” from acting in the first place, those who get the opportunity must play characters slotted into certain types as determined by their bodies.^[7] All upper-caste characters (i.e. Brahmins and Kshatriyas) are meant to be “reddish yellow” or fair in complexion, while lower-caste characters are to be “dark or deep blue.”^[8] Those who are diseased or of inferior birth are also to be made brown or, as Manomohan Ghosh explains, not fair.^[9] Female character types encompass a wide spectrum from mythical beings, such as divine or demon-like creatures, to various types of animals, including (but not limited to) tigers, monkeys, elephants, and fish.^[10] Divinity is associated with a woman who possesses “delicate limbs” and, interestingly, “takes moderate food.” The woman of divine type also “emits very little sweat” – making evident the degree to which the female body is being controlled in its representation. On the other hand, the demonic character types such as the asura, rakshasa, or pishacha are associated with “large and broad limbs,” hairy bodies, and a penchant for liquor and meat.

Sitara Thobani demonstrates a classical dance as described in the Natyashastra. (Courtesy Wikimedia)

Coming to the animal types, there are clear attempts to correlate perceived characteristics of the animal to various body parts of women. A “fleshy and bulky” woman with a “large chin and forehead” is rather unimaginatively classed as being of the elephant type. “Long, large and high breasts” qualify a woman to be deemed fish-like, while a “large back, belly and mouth, hairy and strong body” as well as “black teeth and ugly face, large thigh and thick hairs” is slotted into the “swine type.” Each of these types, both mythical and animal, has associated sexual behaviors and moral attributes. For example, women of the monkey type are said to be violent in their expression of sexuality, a woman of “ass type” is jealous of her co-wives, while buffalo type women are perceived as “hater[s] of men.” These associations between the non-human and women’s body parts are clear examples that women’s physical features are believed to represent their characters and even sexual qualities and the implicit “correctness” thereof.

Conclusion

The reason each character type has been stereotyped is not made explicit in the text, nor have the character types been hierarchized. However, keeping in mind that both the author(s) and the intended audience were elite men, their function in controlling women’s sexualities and bodies becomes evident. When seen in conjunction with social beliefs that continue today – revering the goddess, but fearing the demoness – the text establishes the pale, delicate-limbed woman as an object of devotion while condemning the dark, hairy bodied, large-limbed woman to be the source of disgust and fear. In depicting itself as the authoritative text on dramatics, the Natyashastra leaves little room for such stereotypes to be subverted, creating a vicious cycle of biased representation of women.

Bollywood, as mentioned before, does not declare direct allegiance to the Natyashastra.

Colorism in India can be traced back to diverse roots. One obvious source is undoubtedly the privileging of fairer skin as part of colonial subjugation and, more recently, through globalization. Crucially, scholars have also focused on the interrelations of colorism and caste biases in Indian society.^[11] There are belief systems that construe darker skin as being symptomatic of historical racial inferiority. In tandem with colonial scholars, who grouped Indians into races in accordance with their own racist biases, such theories still proliferate, despite being disproved repeatedly by historians.^[12]

Bollywood carries forward these legacies of discrimination through far more insidious ways. Films, unlike the Natyashastra, are not explicit injunctions. Instead, they are mute accomplices of societal biases such as colorism and fatphobia, depicting the fair, slender woman as the object of male desire and as the correct woman enough times to cement such a notion in popular perception. This is exacerbated by vicious ad campaigns for fairness products and slimming aids helmed by leading actors and actresses, taking the ideal of fairness and slenderness out of the big screen and into the lives of the audience.

Whether through matrimonial profiles where fair and slender brides are sought after^[13] or the constant idealization of fair skin and lithe bodies at family gatherings and other social events, women are encouraged, if not expected, to use various skin-lightening agents and creams, to the extent that skin lightening procedures now constitute a medical concern. Bollywood actors and actresses contribute significantly to this issue by serving as brand ambassadors for beauty products and weight loss regimes.^[14] Despite attempts to rebrand themselves – Fair and Lovely, one of the most iconic skin-lightening products, is now Glow and Lovely – such products continue to be marketed as a way to achieve the fair-skinned, slender ideal. An awareness of the deep roots of such biases is a prerequisite to seeing through their idealization and, ultimately, breaking their dominance – whether it is in the Natyashastra, in the current Bollywood hit, or on the shelves of your local store.

What started as a straightforward reference question at the National Archives and Records Administration (NARA) provoked an unmistakable volley in the culture wars – and as I fled from the battlefield via the Archives shuttle, the first woman appointed as Archivist of the United States (AOTUS) saved the day.

The first full week of summer break from my full-time job as a classroom teacher, I headed to the NARA facility in College Park, Maryland, for some long-awaited research for my forthcoming book, tentatively titled Dear Miss Perkins: A Story of Frances Perkins’s Efforts to Aid Refugees from Nazi Germany.

Frances Perkins (1880–1965) was the first female Cabinet Secretary and longest-serving Secretary of Labor in US history. Many people know her as a key architect of the New Deal. My book project adds a new dimension to her story: Perkins enabled the immigration of thousands of refugees from Nazi Germany when the Immigration Naturalization Service (INS) was in the Labor Department from 1933 to 1940.

“Dear Miss Perkins,” wrote countless individuals on the topic of refugee policy between 1938 and 1940. These letters fill boxes at NARA College Park. I spent two days revisiting these incredible sources and finished them on the third morning. Since I was still looking for how the Children’s Bureau fit into children’s refugee policy, I turned next to the Children’s Bureau boxes. A yellow slip redirected me to “Immigration – Refugees.”

Archive boxes in a storage area at NARA. (Courtesy Wikimedia)

After finishing with more boxes of documents, I happily scampered upstairs to Reference to ask what I thought was a straightforward question: Where was this file on immigration and refugees? The Children’s Bureau pointed me to Immigration – Refugees, but I had just finished looking through Immigration, and there was nothing labeled Immigration – Refugees within the Frances Perkins subject files. This should have been a routine question for an archivist, who are generally super helpful and have ample knowledge about materials.

At Civilian Reference, I was directed to a NARA staff member named Tom, who performed a few searches but also told me that I should not try the related record groups, State Department and Children’s Bureau – which I’d suggested from secondary research – because they might take too long to examine. I found this disconcerting, as research inherently takes a long time.

I tried to explain my project, thinking some context might help, but Tom didn’t know who Perkins was, making discussing relevant content challenging. Throughout the conversation, he repeatedly used he/him pronouns for Perkins, even though I kept using she/her. An older woman, likely another researcher, sat down next to us, so I used the entrance of a third party as an opportunity to clarify: “Frances Perkins was a woman.”

This information didn’t seem to faze Tom, who replied, “My great-grandfather was named Francis.” We continued this relatively unproductive conversation, during which he continued to discuss Perkins as if she were male. I was confused and getting increasingly irritated.

I repeated, “Frances Perkins was a woman. She’s she/her.”

The other woman chuckled, “Oh, Tom.”

Tom, still clearly unfazed, retorted, “I don’t care.”

Empowered by having a witness – in the sense that at least I wasn’t imagining that something was off here – I pressed further. Maybe he just didn’t understand what I was trying to research. “Frances Perkins was the first female Cabinet Secretary. Isn’t that interesting?”

Tom doubled down. Perkins’s gender was, apparently, “not important.”

But he wasn’t done. He babbled that he was “happy for her mother” and mumbled something about an alien and a baseball, though at this point he was throwing around more words than I retained. I wasn’t sure what was happening. All I needed was the correct file folder.

Then Tom commented, “Maybe she was gender-confused.” This is when I really became uncomfortable – that last statement signaled to me that he was taking out his bigoted position in the culture wars on my research.

My confusion and irritation coalesced into a conviction that this conversation had become ridiculous. Perkins was a hugely important historical figure as a woman. Tom interpreted my use of “she/her” as “trans person” rather than accepting that women are capable of important positions in US government and history.

If this interaction was difficult for me, a cisgender woman, what would it have been like for a trans researcher, or someone researching trans history? Tom’s response to being corrected on Perkins’s pronouns suggested a complicated overlap of transphobia, misogyny, and a broader bigotry.

After all that, no one was willing to point me toward the “Immigration – Refugees” files I was seeking. I had repeatedly tried to communicate with Tom that they were not in the boxes I’d already viewed, and that all I needed were fresh ideas for where to look. But ultimately, I was left empty handed, and my research was hampered.

Throughout this conversation, I never mentioned that I have a PhD and a book deal, or that I was a finalist for the National Archives’ 2022 Cokie Roberts Fellowship for Women’s History. After all, Reference should take all researchers seriously, regardless of accolades, degrees, or status. But I was certain that when Tom looked at me, he saw no possibility that I was doing something important or interesting. And I’m not alone among researchers with any marginalized status – as others soon made clear on Twitter.

I summed up the frustrating conversation in a tweet and continued to my locker, planning to leave the facility. I realized that it was 2:05 p.m., meaning that I had just missed the 2:00 p.m. shuttle. So I did what any frustrated historian with a Twitter might do: I settled in at the café and continued sharing this story with a Twitter thread.

Screenshot of the Twitter thread. (Courtesy of the author)

I concluded with a call to action. I tweeted that although I expected prejudice toward me as a young woman, I was surprised by the indignant refusal of Tom from Reference to acknowledge that Perkins was, regardless of what he wanted to believe, a woman who used she/her pronouns. I hoped that the US National Archives – and I tagged them – could work toward gender equity and accessibility of records, especially under the first woman AOTUS.

My tweets quickly gained traction. Historians on Twitter recognized and related to several aspects. They shared their own frustrating archival experiences, conveyed their interest in Perkins, and expressed solidarity.

This was when the thread moved from commiseration to action. Dr. Colleen Shogan, the Archivist of the United States, replied to me directly: “I will address this, Rebecca. Thank you for telling us.”

I took the next shuttle to DC, then took the Metro to Tenleytown. By the time I got to American University, I received a phone call from the chief operating officer (COO) of the National Archives. We had a reassuring conversation. He grasped the nuances and the severity of what occurred, and he also understood what I really wanted: to blow open barriers to entry, overcome obstacles to research, and simply find an answer to my research question. The next day, I received supportive follow-up emails from the COO, the head of Research Services, and a supervisory archivist. I’m grateful to all of them. As my husband observed, I was taken seriously by people in power, which gave me hope that this experience might bring positive change for other researchers.

The National Archives is one of my favorite research institutions. While this incident wasn’t my first experience with disregard and misogyny in the Research Room – and historians on Twitter shared a seemingly endless slew of similar examples – this was the first time that I received such an effective response. The positive change, I believe, came from the first female AOTUS because, as a fellow woman scholar, she personally understands the experience that I had.

As a friend pointed out on Twitter: “If this was the reception you – a white, feminine, straight woman – got from him, imagine how he’d treat someone like me.” She identifies as queer and doesn’t present as white. “There’s no way his mistreatment of you today was without precedent,” she added, and she’s right. Imagine if a researcher corrected Tom on their own pronouns rather than a historical figure, a safe distance away in time.

Tom from Reference misunderstood why the first woman in a position matters. To some people, the fact that Perkins was the first woman Cabinet Secretary or that Dr. Shogan is the first woman appointed AOTUS remains underappreciated. But that made Shogan’s response extra powerful to me. By now, I trust that Tom has begun learning that the first woman to hold a powerful office exerts a measurable effect.

Being the only woman in the room was a formative part of Perkins’s experience. Critics of her immigration policy sent her hate mail with misogynistic slurs and threats. She navigated gender politics every day, from how she spoke to what she wore: a signature tri-cornered hat that signaled respectable femininity. Perkins advocated for women in many cases, such as working on the issue of material mortality because she herself almost died in childbirth.

Shogan didn’t need to act on a junior scholar’s Twitter thread. She undoubtedly has bigger fish to fry. But she did respond, and then followed through on her promise, because she likely has firsthand experience of not matching a common preconceived notion of “scholar.” She understands that who has research access is important, and that people of all backgrounds and all marginalized statuses must have equitable access to the records of the US federal government. Who has access to archives affects whose stories are told and who gets to tell them.

This day at the National Archives at College Park turned out to be more eventful than I anticipated. But thanks to Dr. Shogan, what could have been a terrible day ultimately made me proud to be a woman historian, prouder than ever to be researching women’s history, and thrilled to be conducting that research at the US National Archives.

In the years before Roe v. Wade, and in a context of severe stigma of out-of-wedlock pregnancies, maternity homes in the United States housed residents who, upon giving birth, often relinquished their children for adoption. One consequence of the legalization of abortion in 1973 was that fewer American women and girls were “sent away” to maternity homes for the duration of their pregnancies. Far from a relic of the pre-Roe past, though, maternity homes in the 1980s and 1990s remained a feature of the US’s landscape, albeit still well hidden. These institutions differed from their predecessors, however, for many of these newer homes were explicitly affiliated with the anti-abortion movement. Indeed, numerous post-Roe maternity homes enjoyed close relationships with local crisis pregnancy centers (CPCs) – right-to-life institutions that similarly worked to dissuade women from terminating their pregnancies. Post-Roe maternity homes also partnered with state and private adoption agencies to make adoption a viable alternative to abortion, and some were sponsored by Religious Right spokespeople such as Jerry Falwell, Billy Graham, and Pat Robertson.

In the hopes of “saving” those “at risk” of terminating their pregnancies, anti-abortion maternity homes advertised themselves as safe havens, offering housing and other resources to women and girls experiencing crisis pregnancies for little or no fee. While some pregnant people may have found much-needed comfort and security in these services, other residents’ stays were marred by abuse. Deliberately hidden from public view, little is known about these ever-elusive institutions. Nevertheless, the evidence we do have from residents’ testimonies and anti-abortion literature offers a glimpse into the anti-abortion movement’s evolving strategies in the 1980s and 1990s and sparks pertinent questions about women’s reproductive agency.

Political scientist Laura Hussey describes maternity homes as part of the anti-abortion movement’s “service” branch because, like CPCs, they worked to challenge the accusation that anti-abortion activists did little to temper the financial and emotional burdens of pregnancy and childrearing.^[1] Operating against a backdrop of welfare cuts, maternity homes hoped to provide an attractive alternative to abortion by providing the comfort and security necessary to make carrying one’s pregnancy to term possible. For instance, Bayard House, an independent maternity home in Wilmington, Delaware proclaimed that many of its residents felt “deprived of a free choice in deciding whether or not to keep their pregnancies because they lack[ed] necessary support or resources.”^[2] As this appropriation of the feminist language of reproductive “choice” makes clear, maternity homes sought to demonstrate their concern for pregnant women as well as fetuses: an increasingly salient anti-abortion tactic in the 1980s and 1990s.

As well as offering material services, maternity homes promised the discretion some pregnant people desired. An advertisement for Gentle Shepherd Child Placement Services in Olathe, Kansas stated, “If you have no place to turn, we have housing available for you during your pregnancy. This could be of special interest to you if you want to ‘go away’ to have your baby.”^[3] And testimony from an anonymous resident at Regina Residence in Port Jefferson, New York expressed relief that, since relinquishing her child for adoption and returning from the maternity home, “I’ve been out with my friends who knew nothing [about my pregnancy or adoption]… No one looks at me suspiciously.”^[4] Post-Roe maternity homes were thus depicted as sanctuaries for women who wished to keep their pregnancies private and thus free from potential judgment if they decided to give birth and put their child for adoption.

While some anti-abortion activists celebrated maternity homes for their ability to “prove” their movement’s commitment to supporting pregnant women, others worried that some homes’ below-board practices would threaten the integrity of the larger fight against abortion. Certainly, a slew of malpractice lawsuits against maternity homes, CPCs, and Christian adoption agencies in the late 1980s and 1990s left some anti-abortion sympathizers wary of these institutions, all of which had long been criticized by pro-choice activists. In 1987, the Alpha Center for Women in Sioux Falls, South Dakota was found guilty of false advertising, placing minors in unlicensed homes, and coercing residents into placing their children for adoption.^[5] And a Cosmopolitan article from the same year reported that A Free Pregnancy Center, a San Francisco-based CPC, arranged for a 14-year-old girl to stay in a “foster home” without her parents’ knowledge or consent under the pretense that “she’d been accepted for an overseas scholarship.”^[6] Further still, a 1994 article alleged that women and girls were “often isolated in the protective care of so-called Christian Shepherding families, then guilt-tripped and badgered… until they sign[ed] papers irrevocably terminating their parental rights.”^[7] Although adoption was not a prerequisite for residency in all post-Roe maternity homes, it appears that many residents were misled or coerced into relinquishing their children for adoption without the appropriate counseling. Interestingly, a promotional leaflet for the New Beginnings maternity home in St. Cloud, Minnesota boasted of an apparent rarity: “After screening many” maternity homes, one woman favored staying at this home because, here, “there was no pressure put on the women to choose adoption.”^[8] Indeed, many anti-abortion maternity homes were effective feeders for private Christian adoptions: a lucrative industry in a country where, with abortion recently legalized, young white American adoptees were a rarity.

One maternity home that came under particular scrutiny was Our Father’s House in Pensacola, Florida. John Burt, a former KKK member with connections to the anti-abortion movement’s most violent extremists, and his wife Linda ran what Linda called “a tight-ship” at Our Father’s House, with a strict set of house rules dictating residents’ dress code and restricting their communications with the outside world. Alongside mandatory church attendance, residents were encouraged to join John Burt on “field trips” to protest local abortion clinics. In December 1995, Linda Burt relayed that Morris Dees and the Southern Poverty Law Center (SPLC) had “filed a vicious, unjust, anti-life lawsuit against Our Father’s House.”^[9] The lawsuit was not, as Linda Burt claimed, a direct attack on Our Father’s House, but instead concerned John Burt’s involvement in the 1993 murder of abortion provider Dr. David Gunn by violent extremist Michael Griffin. Nevertheless, as Our Father’s House was funded by the Burts, the legal repercussions of John Burt’s anti-abortion extremism were sure to affect the maternity home. In July 1996, John and Linda Burt informed their supporters that they had settled out of court due to fears the case would leave them bankrupt. Although Our Father’s House was not implicated in the SPLC lawsuit, less than a decade later, John Burt was found guilty of molesting a teenager in his care. Clearly, at Our Father’s House, the claim that anti-abortion maternity homes had pregnant people’s best interests at heart was a façade.

As sites that blur coercion and care, post-Roe anti-abortion maternity homes have left a complex legacy, offering much-needed support and discretion to some women and girls while exploiting their concealment from the outside world to inflict great harm onto others. Although, like CPCs, the services offered by maternity homes helped the anti-abortion movement depict itself as concerned with pregnant people as well as fetuses, untold abuses occurred in some of these institutions, and many homes appeared more interested with providing anti-abortion supporters with adopted children than caring for their residents. In a now post-Dobbs United States, anti-abortion maternity homes may come to play an even bigger role, making an exploration of their 1980s and 1990s resurgence timelier than ever.

1. Laura S. Hussey, The Pro-Life Pregnancy Help Movement: Serving Women or Saving Babies? (University Press of Kansas, 2020), 2. ↑
2. “Bayard House: A Community Resource,” Bayard House (n.d.). Papers of Therese Hester Vaughn, 1971-2009, Schlesinger Library, Radcliffe Institute, Harvard University, Cambridge, MA. ↑
3. “Pregnant? In need of a friend? We care about you!!!” Gentle Shepherd Child Placement Services, Inc. (n.d.). Papers of Bill Baird, 1930-2015 (inclusive), 1963-1999 (bulk), Schlesinger Library, Radcliffe Institute, Harvard University, Cambridge, MA. ↑
4. “Unmarried and Pregnant?” Regina Residence (n.d.). Papers of Bill Baird, 1930-2015 (inclusive), 1963-1999 (bulk). Schlesinger Library, Radcliffe Institute, Harvard University, Cambridge, MA. ↑
5. The Alpha News, The Alpha Center for Women (June 1987); Papers of Bill Baird, 1930-2015 (inclusive), 1963-1999 (bulk), Schlesinger Library, Radcliffe Institute, Harvard University, Cambridge, MA. ↑
6. Jacqueline Austin, “I Went (Undercover) to an Anti-Abortion ‘Clinic,’” Cosmopolitan (March 1987). Takey Crist papers, 1944-2002, n.d., David M. Rubenstein Rare Book and Manuscript Library, Duke University, Durham, NC. ↑
7. Marc Cooper, “Robbing the Cradle,” The Village Voice (July 26, 1994); Takey Crist papers, 1944-2002, n.d., David M. Rubenstein Rare Book and Manuscript Library, Duke University, Durham, NC. ↑
8. “A Home for Single, Pregnant Women,” New Beginnings (n.d.), Papers of Bill Baird, 1930-2015 (inclusive), 1963-1999 (bulk), Schlesinger Library, Radcliffe Institute, Harvard University, Cambridge, MA. ↑
9. Letter to supporters from Linda Burt (December 1995), Hall-Hoag Collection of Dissenting and Extremist Propaganda, John Hay Library, Brown University, Providence, RI. ↑

In January 2022, my Instagram feed was flooded with posts mourning Aubrion Rogers, a 30-year-old Black woman who died after her endometriosis went untreated for years. When she was rushed to emergency surgery, doctors removed a burst right ovary, appendix, endometriosis, and fibroids. In 2021, she shared on Facebook: “At what point will my situation be considered an emergency?” Though Rogers died in 2022, her story felt like it belonged in the Black Panther newspaper, a source that privileged the stories of Black people and indicted the healthcare system for its inability to “serve the people body and soul.” Panther Lula Hudson was one woman’s story detailed in the Black Panther, highlighting the medical racism she experienced in response to her pelvic pain. Hudson’s story demonstrates what disability scholar Sami Schalk defines as Black disability politics, “disability politics that are articulated (in text, speech, political platforms, and ideologies) or enacted (in activism, organizing, lobbying, art, and interpersonal dynamics) by Black cultural workers.”

@endo_black’s Instagram post honoring Aubrion Rogers (left) and her husband, Anthony Fidelis Rogers (right).

In March 1972, six years into the Black Panther Party’s existence and shortly before its centralization in Oakland, the Party updated its Ten Point Platform to include Point 6: “We want completely free health care for all Black and oppressed people.” This change marked the solidification of the Party’s health politics, which included free health clinics, a free ambulance service, free sickle cell anemia testing, participation in the 504 Sit-Ins, and challenging the creation of UCLA’s Center for the Study and Reduction of Violence.^[1]

The Party also engaged with issues of reproductive rights and family planning in the early 1970s, as more Panther families were having children. Panther women were at the forefront of these conversations, which were shaped by larger discussions of the women’s health movement, the Party’s communal structure, historical associations between birth control and Black genocide, and children’s role in the future of the Party.^[2]

Lula “Smokey” Hudson began her organizing in Baltimore in 1969. She eventually followed the Party to Oakland during its centralization and worked with the Party’s legal services.^[3] A July 15, 1972 article in the Black Panther recounts Hudson’s experience with medical racism and hospitalization for lower abdominal pain. Her words stand as the article’s headline: “They Told Me I Had to Be Sterilized or Die,” with the subheadline, “Racist Doctors Try to Give Black Panther Party Comrade Genocidal Hysterectomy.” The article invokes several key features of Schalk’s Black disability politics.

Although not naming gender or sexism, the article takes an intersectional approach, foregrounding Hudson’s positionality as a Black woman. The Party’s rhetoric in the early 1970s was influenced by the Black nationalist belief that birth control was genocidal, a tool of the state to exterminate Black people.^[4] By invoking “genocidal” in the article’s title, the Party historicized and contextualized  Hudson’s experience within the history of forced sterilization on Black communities, a key feature of Schalk’s Black disability politics. Simultaneously, the Party viewed Panther children as proof of the Black community’s survival and as autonomous actors with a role in the revolutionary struggle. Thus, any state attempt to curb the growth of the Black community, whether through police violence or genocidal birth control, was a threat to the Party’s future.

The article further contextualizes Hudson’s experience at Moffitt Hospital, a University of California teaching hospital in San Francisco. The Panthers describe the hospital as “an experimental haven for ‘Dr. Frankenstein’ personalities who don’t mind testing their theories on Black and oppressed people.” At the end of the article, Hudson speaks in her own words: “I was going to be used so that they could observe.” The Party historicized Hudson’s experience, linking her experience with ways medicine has historically relied on Black communities to advance medical research. Schalk cites examples of this medical experimentation, including Dr. Marion Sims’s development of gynecological methods on enslaved women, the use of poor and racialized committees as “living educational tools at teaching hospitals” (like Hudson), and the use of Black bodies as cadavers in medical schools.^[5]

In Hudson’s story, the Party employed a key characteristic of their health politics: political diagnoses of medical cases in their newspaper. Politically diagnosing medical cases was a tactic the Party borrowed from the revolutionary psychiatrist and political philosopher, Frantz Fanon. Fanon detailed medical case histories from the Algerian war in The Wretched of the Earth, “diagnosing” disease and illness as deriving from social or political rather than biological origins.^[6]

Providing a political framing of Panther and Black community members’ health experiences also gave credence to the necessity of the Party’s survival programs in local communities.^[7] Through Hudson’s story, the Party demonstrated the importance of its “self-help reproductive health practices.” They taught health cadre and community members how to perform their own examinations, Pap smears, and blood tests in an attempt to privilege the experiences of people’s own bodies, demystify medical authority, and expose the “deficiencies…of the U.S. welfare state.”^[8]

Black Panther Lula Hudson in 1972, then twenty-three years old. (Black Panther (Oakland, CA), July 15, 1972, 4-5.)

While taking an intersectional approach, this article focuses on race and is “a classic study in racism and Black genocide.” Initially, a doctor told Hudson her uterus was “retroverted” and bound by scar tissue. The doctor stated that her right tube and ovary were so severely diseased that those organs must be removed “to stop the recurrence of infections.” The following day, a senior doctor concurred and then reversed his decision, claiming he wanted to do an “exploratory surgery.” After the FBI arrived, the doctors rescheduled and then canceled Hudson’s surgery. When Hudson questioned the diagnosis and asked to speak to a supervisor, the doctors claimed a “hysterectomy may not be necessary,” and a pelvic short-wave heat treatment may be the best option.

Historically, Black women like Hudson have been subject to more invasive surgical procedures in response to their pain. Hudson’s fears, and by extension, the Party’s claims of “genocidal hysterectomies,” were not unfounded. Between 1970 and 1980, sterilizations in the U.S. increased from 200,000 to 700,000 cases. Many teaching hospitals were responsible for performing these unnecessary hysterectomies on poor Black women, and they became so routine they were known in the South as “Mississippi appendectomies.”^[9]

At the same time, doctors have historically and continue to be more likely to underestimate Black people’s pain because of racist assumptions dating back to slavery, claiming Black people do not feel as much pain as other races. Moreover, Black people are more likely to be accused of drug seeking or have their chronic pain and disease written off as sexually transmitted infections (STIs). A 1976 study found that 40% of Black women who were diagnosed with pelvic inflammatory disease actually had endometriosis. The consequences of medical racism and sexism are not only irreversible but deadly for Black women, as in the case of Aubrion Rogers.

The medical racism and sexism Hudson experienced were compounded by the FBI’s harassment at the hospital. As Hudson describes, “Two members of the FBI were escorted to this room by a member of the staff.” Doctors used the FBI as an excuse to cancel Hudson’s surgery, stating that they “don’t want to get mixed up in the middle of this.” External repression from law enforcement was not uncommon for Panther cadres and had long-lasting effects on their well-being. The threat (and reality) of potentially disabling police violence only amplified the medical surveillance of Black women’s bodies.

In telling Hudson’s story, the Panthers highlighted the dual trauma on body and mind that were (and are) often present for Black people in the medical system, particularly the Party cadre. Schalk stresses that Black disability politics are holistic, because of their focus on the whole bodymind, attending to well-being from physical, psychological, and emotional needs, what the Panthers saw as “serving the people body and soul.”

In the article, Hudson never explicitly identifies herself as disabled. However, the opening describes her history of lower abdominal pain and reproductive infections. As Schalk explains, one feature of Black disability politics is that it is not always based in disability identity. Black people may not claim disability identity, as in the case of Hudson, because disability identity may be contentious. While Hudson may not have identified as disabled, the political diagnosis of her medical experience still grapples with the Party’s health framework, which understood disability alongside and at the intersection of race, gender, class, and geography. Naming the absence of disability identity in Hudson’s case is important because it allows us to recover Black disability politics in Black history we might otherwise overlook because it appears different from white disability politics.

The Panthers’ demand for entirely free healthcare for all Black and oppressed people has never been more prescient. Though experiencing different facets of medical racism and sexism, Hudson and Rogers were both neglected by the U.S. healthcare system which has historically relied on the abuse of Black people to advance medicine. The Panthers emphasized the importance of collective power to liberation, privileging the people’s perspective in that path forward. As the Panthers stated at the end of every article in the pages of the Black Panther, “All power to the people.”

Recently, literary scholars have demonstrated how the works of William Shakespeare can serve as a fantastic tool for teaching and analyzing social justice: his plays offer significant commentary on many categories of marginalized personal identity, including gender, sexuality, and race. I am a disabled scholar and teacher of Shakespeare, so I’m interested in the depiction of disability in his plays—a topic that has, over the last decade or so, also garnered considerable critical attention. But in the last few years, I stumbled into an even deeper appreciation of Shakespearean disability, in a rather unexpected place: the emotion of disgust in Shakespeare.

In the last two decades, psychology and neuroscience have revealed that disgust can be central to how people respond to non-normative bodies—and disgust, more specifically, has been shown to serve as potent fuel for discrimination against people with disabilities. But while scientists are discovering more evidence for this linkage, I think that Shakespeare anticipated their findings by depicting the association of disability and disgust in his drama. When Shakespeare’s characters encounter people with non-normative bodies, their response is often framed in the rhetoric of revulsion. Shakespeare, it seems, knew what modern science would go on to tell us: disgust is central to how many observers respond to people with disabilities. And we can use this awareness, I suggest, to both better understand the depiction of disability in his works, and to ultimately help approach them through the lens of disability justice.

Scientists theorize that disgust is an emotion of regulation and avoidance, designed to help protect us from getting too close to substances that might cause us harm. Though the things that cause disgust differ from culture to culture, there are some consistencies around things that have been sources of danger across human history, specifically behaviors related to things like food, disease, hygiene, animals, bodily injury, and sex. This is because those things might place us in proximity to harmful entities, like disease-causing pathogens. But while the emotion helps us avoid contact with dangerous substances, there are also some unintended consequences: because the disgust system is designed to keep us safe, it errs on the side of caution, and is thus biased toward identifying things as threatening even when they’re not. This, in turn, has a tremendous effect on how humans interact with one another: unfortunately, the mechanism of disgust is fundamentally conservative, and often interprets signs of human difference as signs of potential danger.

Though it doesn’t always happen, when the disgust system encounters someone with certain kinds of physical and behavioral differences, it can erroneously attribute those differences to the presence of pathogens and trigger a disgust response. Accordingly, research suggests that disgust plays a role in forms of social discrimination and stigmatization, when people categorized as “other” (because of things like race or sexual orientation) become associated with a negative avoidance response. Indeed, it has been explicitly argued that disgust may play a central role in disability prejudice, as the ostensibly abnormal bodies and behaviors of disabled people are mistakenly identified as dangerous by an observer’s disgust system. This effect is strong: humans have evolved the tendency to implicitly associate any deviation from standard morphological norms as a sign of potential disease, which may trigger the avoidance response against non-normative bodies, even when no actual danger is present. Though this reaction can be modulated and dampened by conscious thought, it is largely experienced as an immediate, automatic feeling – and while the effect is negligible on some, others are highly disgust-sensitive and respond with powerful aversion to other kinds of people.

I believe Shakespeare anticipated these findings some four centuries before they would be established by modern research. When he presents characters with non-normative bodies, they often become associated with language linking them to disgusting or offensive matter. We may think, for instance, of Falstaff, famously defined by his diseased, overweight body. Across the plays in which he appears, Falstaff’s physical being is associated with explicit disgust elicitors: one doctor notes that he “might have more diseases than he knew for,” and the Lord Chief Justice catalogs the symptoms of his declining health, noting that he has “a moist eye, a dry hand, a yellow cheek, a white beard, a decreasing leg, an increasing belly” (2 Henry IV, 1.2.5; 177-79).^[1] He is notably characterized as suffering from syphilis—a malady, Shakespeare liked to point out, that could render the body repulsive—and is described as an “unclean knight” who suffers from the “dissolute disease” (The Merry Wives of Windsor, 4.4.57; 3.3.184). And his weight, of course, is presented as a continual point of ridicule, as when Hal in 1 Henry IV deems him an “obscene greasy tallow-catch” (2.4.223)—that is, a repulsive mass of congealed animal fat. In turn, Falstaff’s body comes to serve as an index of his moral failings; not only are his diseases attributed to “lust and late-walking” (Merry Wives, 5.5.143), but the newly crowned King Henry V explicitly links his friend’s unseemly behavior to his size, bidding him to “make less thy body hence, and more thy grace” (2 Henry IV, 5.5.51).

Falstaff at Herne’s Oak in a print by Michele Beneditti, after Henry William Bunbury, 1793. (Courtesy Wikimedia)

But it’s not just Falstaff. As Jeffrey R. Wilson demonstrates in his work on early modern stigmatization, Shakespeare routinely links a character’s non-conforming body with moral compromise. Modern research reveals that disgust underpins an aversive response to disfigurement and deformity, and this linkage can be seen throughout Shakespeare’s plays. The classic example is King Richard III, whose evil is explicitly linked to his disgusting physical disability: he is declared a “foul indigested lump, / As crooked in thy manners as thy shape” (2 Henry VI, 5.1.157-8). Foul is one of the central terms in the early modern lexicon of disgust, signaling something of visceral or moral offense. Richard wickedly encompasses both, and it’s impossible to separate his repulsive behavior from his repulsive form.

Finally, Shakespeare’s disabled characters also intersect with other vital matters of social identity, in the sense that disability is an intersectional issue. Disgust has also been shown to fuel racist discrimination against outgroup members; in the last twenty years, dozens of studies have established the link between disgust and xenophobia, with results suggesting that “disgust sensitivity [is] a relatively standard predictor of prejudice.” In Shakespeare, the specific consequences of the intersection of racial disgust and disability disgust emerge with The Tempest’s Caliban, whose body is marked as “other” in multiple ways. As with Richard, Caliban’s body,which is tellingly described as “not honoured with / A human shape” (The Tempest, 1.2.283-4), is negatively linked to his behavior. Prospero describes him as being “as disproportioned in his manners / As in his shape” (5.1.291-2). But this allegedly off-putting appearance becomes racialized in Trinculo’s response to him. His disgusting physical form (he is “a strange beast” that “smells like a fish”) is entwined with his racial otherness (he is “an islander that hath lately suffered by a thunderbolt”), ultimately collapsing the distinction between his morphologically non-normative body and his non-European body, and presenting him as doubly stigmatized (2.2.31; 26; 36-37). The connection is most explicit when Prospero declares him to be descended from a “vile race” (1.2.359)—vile, like foul, was another crucial word in the early modern lexicon of disgust.

As I encountered again and again in my larger project, Shakespeare was quick to utilize the rhetoric of disgust in instances when someone is being stigmatized, either by another character or by the playwright himself. We find a clear pattern in which characters inhabiting non-normative bodies are painted with the language of either physical or moral disgust—in many cases, simultaneously. It seems, then, that Shakespeare anticipated a body of scientific research that would emerge some four hundred years later, which demonstrates the profound connection between disgust and discrimination against disabled people.

But this prescience, however, does not necessarily mean that Shakespeare was progressive: on the contrary, he seems to invite his audience to feel disgust at many of his disabled characters. Accordingly, as modern readers and viewers of his plays, we must be attuned to the fact that to the fact that he leverages, for dramatic ends, the same process of disgust-based aversion that underwrites discrimination against people with disabilities today.

This awareness can be repurposed towards the goal of disability justice. The theorizations of psychologists and neuroscientists are intended to explain, not excuse, the role of disgust in social discrimination – and indeed, scientists actively discuss how this awareness might be utilized to combat stigmatization in today’s world. So too with Shakespeare: when discussing and teaching his works, we can draw purposeful attention to the insidious ways that characters with disabilities are characterized by the language of revulsion, to draw attention to the larger psychological dynamics of disgust that seem to fuel disability discrimination at large. Shedding light on how dehumanization works is a vital step in combating it – and here, Shakespeare can be extremely helpful, perhaps in spite of himself.

In the fall of 1918, seven young people were photographed wearing masks lined up near a railroad track in Mill Valley, California. One woman wore a sign around her neck: “Wear a Mask or Go To Jail.” The catalog record associated with the photograph lists the date, November 3, 1918, the photographer, Raymond Coyne, the title, “Locust Avenue, Masks On,” and a caption: “A group of people standing outdoors wearing masks over their mouths. This was probably during the Spanish Flu epidemic of 1918.”

In late spring 2020, in the first phase of the Covid-19 pandemic, this photograph, available from the Mill Valley Library Historical Reading Room, as well as the phrase, wear a mask or go to jail, circulated widely through social media and in other publications. Masks and shirts with this slogan were available for purchase from numerous online vendors. The photograph and phrase have also been referenced in articles examining masks in 1918 as examples of health policy and resistance to mask wearing.

Locust Avenue, Guy’s shack. (Photo by Raymond Coyne. Courtesy of Lucretia Little History Room, Mill Valley Public Library © The Annual Dipsea Race)

When we began our research on flu masks in May 2020, we hoped to contribute to scholarly discourse endorsing the use of masks to prevent the spread of Covid-19. Our research on mask mandates in American cities, on enforcement measures, on popular responses, and on the role of public health officials used empirical evidence and scholarly analysis to reinforce the essential message in summer and fall of 2020 that wearing masks in indoor spaces would slow the spread of disease, improve public health, and shorten the pandemic.

As we approach the third anniversary of the first widespread mask requirements in American history since 1918, we find ourselves rethinking the connections between historical analysis and contemporary behavior. Whereas three years ago we looked for ways to use history to urge changes in public behavior, the most recent debates about masks have raised questions about effectiveness that we thought had been resolved early in the pandemic. We now look back to the history of 1918 with a different question: how can we use history to understand collective and individual behaviors that are inconsistent with, and even directly oppositional to, scholarly consensus about best practices? This photograph of seven masked individuals, one wearing a sign, “Wear a mask or go to jail,” suggests more complex meanings to us now as the question of masking shifts from dealing with the current pandemic to anticipating the next one.

A close examination of this photograph reveals important connections between masking now and a century ago. This photograph was taken at a time when the people of Mill Valley were living under a mask mandate, imposed about two weeks after the epidemic first reached coastal California. In this small community, as across the United States, the epidemic began slowly and then accelerated quickly. On October 19, the weekly Mill Valley Record republished a circular from the US Surgeon General, which included a graphic comparing the epidemic to serving on the front lines of the war. On October 26, Health Officer Thorndike and the Board of Health were “actively taking measures to prevent the spread of the epidemic.” By this time, fifty-four cases and two deaths were attributed to the epidemic; grade schools were closed, church services canceled, and all public gatherings prohibited.

On October 28, Mill Valley imposed a mask ordinance declaring “that the spread of said disease may be arrested and materially abated and prevented by means of the wearing of the mask…and that the public health and safety require that such masks be so worn by all persons within the town of Mill Valley until such epidemic shall have been wholly abated.” This ordinance was published on November 2, the day before these seven people gathered on the train tracks.

By this time, they would likely have been exposed to numerous reports of mask ordinances in the surrounding communities. On October 25, the Oakland Tribune declared, “Wear Mask, Says Law, or Face Arrest.” On October 26, the San Jose Evening News used the same language as the sign depicted in the photograph: “Wear a Mask, or Go to Jail, is Order.” Newspapers from Oakland and San Francisco, which likely circulated across the Bay Area, reported dozens of arrests, with some individuals sentenced to ten days in jail for violating the mask ordinance.

Enforcement of mask ordinances also occurred in Mill Valley. The Mill Valley Record reported on November 9 that four men had been arrested: Chris Armbuster, Frank Mackenzie, R. I. Wisler, and Walter Hinckly. These four were summoned before a judge and fined $30 each (the equivalent of about $600 now).

The sign worn by the masked woman standing by the train tracks in Mill Valley was thus likely inspired by the repeated warnings in regional newspapers that citizens must wear masks or face consequences, including the possibility of arrest. “Wear a mask or go to jail” was, in fact, an accurate summary of the law and a description of common patterns of human behavior in the Bay Area during the epidemic.

Yet a second photograph of the same group on the same day suggests a contrasting interpretation relevant to our own experience of living with the Covid-19 pandemic. This second photograph depicts the same seven men and women, with one additional man now positioned in the center of the image. The most important difference is that all the masks have been removed from faces: four masks are pushed below chins, two are dangling from an ear, and one has been fully removed. The “wear a mask or go to jail” sign is gone.

Examining these two photographs together provides a different perspective on the meaning of mask wearing and specifically the warning of “wear a mask or go to jail.” By removing their masks, these eight people are defying the city ordinance while also flouting public health guidelines to maintain social distancing. Standing close to each other unmasked is behaving in a way that spreads disease, as was well documented in 1918 and again in 2020.

Comparing these two photographs suggests yet another interpretation of the meaning embedded in mask wearing in the context of an epidemic. “Wear a mask or go to jail” appears less as an exhortation to good behavior or a warning against transgressions, and more as an ironic commentary of what people know they should be doing even as they selectively decide to obey or defy these legal requirements. Wearing a mask and displaying a sign thus appear as a form of performance, a way of recognizing what is expected, allowed, or required while also affirming a desire, willingness, or commitment to behave differently.

We have been involved in performative masking since the first stages of Covid-19. Well-publicized reports early in the pandemic of individuals not wearing masks, defying requests to wear masks, or attacking those who made these requests illustrated unusual, yet seemingly widespread, forms of mask performance. Mask mandates during pandemics are attempts to regulate personal conduct to protect the health of others; defying these regulations by refusing to wear masks heightens the danger to others. While we may question how much importance to assign to somewhat isolated examples of this behavior, these incidents are reminders of the complicated relationship between health policy, behavioral mandates, and individual actions. Viewing these two Mill Valley photographs in the context of Covid-19 leads to a more nuanced judgment of the motivations of these individuals. Flaunting unmasked faces suggests that they are not seriously concerned about the epidemic’s threat to public health or the impact of their behavior on other members of the community. Their behavior is certainly more consistent with those who have for the past three years enthusiastically brandished their non-compliance with mask mandates (including the former president).

Yet this interpretation of how people behaved a century ago is clearly shaped by our own experience with Covid-19, when mask defiance was embraced by the same political movements that falsify evidence, deny scientific findings, and reject health policies. We feel threatened by these behaviors that present a heightened risk of infection as we live our own lives: how should we respond when we research how people behaved in similar ways in a different historical context? Whereas before spring of 2020 we may have welcomed this photographic evidence of individuals defying government mandated restrictions of personal behavior, now we recognize the costs of individuals prioritizing their own wishes over the well-being of their larger community. As we prepare for the next outbreak of infectious diseases, the history of masks in 1918 as well as 2020-2023 provides lessons about the need for improved public health communication, careful consideration of effective mandates, and necessary adjustments in personal behavior.

In August 1889, an English woman named Charlotte S. experienced a depressive episode marked by religious delusions. Convinced there “was no hope for her in Eternity,” the once “strong, healthy [and] active” fifty-five year old was certified insane^[1] and institutionalized at Holloway Sanatorium.^[2] When patients were admitted to Holloway, staff recorded their personal details in hefty leather casebooks. As treatment progressed, staff noted updates and, in about one third of all cases, affixed a photograph of the patient to their chart.^[3] The casebooks are now fully digitized and available online through the Wellcome Trust. Although some patients recovered, the casebooks contain many tragic accounts of those who did not, and whose struggles surface in an archive that renders them “dirty” and “incoherent.”^[4] One patient, a twenty-eight year old schoolteacher named Emily E., told doctors that it “would be better to her if she were at the bottom of the sea.”^[5] She is long deceased, but the Holloway archive remains. Who should have access to the record of private pain? Ought we to consign the Holloway archive, and the suffering it contains, to oblivion?

When Holloway Sanatorium was founded in 1885, the co-ed institution positioned itself as a humane and modern asylum – an alternative to the madhouse for those who could afford it. Situated on twenty-two acres of lawns and gardens in Virginia Water, the sanatorium’s Gothic Revival campus was equipped with amenities like a bathhouse and chapel. Patients engaged in activities appropriate to their bourgeois social class, such as strolls on the grounds, dances, concerts, and excursions to stores in London.^[6] The medical superintendent even hired a few same-gender companions for patients with the aim of encouraging “normality and socially acceptable behavior.”^[7] While doctors at Holloway provided care based on their best abilities and the science of the time, 19th century understandings of mental illness were different from our own. There was little agreement about the causes of, much less cures for, mental illness.^[8] Accordingly, etiologies in the casebooks are often circuitous (e.g. “the supposed cause of…attack is previous attack”)^[9] or barely attempted (e.g. “the supposed cause being absolutely unknown”).^[10]

Unlike the frontal, mug-shot style photographs taken directly upon admission at most asylums, photographs at Holloway were not systematized and presented subjects in a range of poses. Often borrowing from the dialect of Victorian family photo albums, staff cut the photos into shapes (an oval, or perhaps a square with trimmed edges) before pasting them into the patient’s file (below).^[11] Their distinct visual register, which slips between the aberrant and the normative, has generated new scholarship examining these images more closely.^[12] However, the photographs also surface key issues related to consent, privacy, and the potential for voyeurism in terms of both their original production and our current access to them. This concern is not just a modern ethical hang-up. At the 1901 meeting of the Medico-Psychological Association of Great Britain, one doctor asserted that “he did not think that anyone had a right to photograph insane patients.”^[13] Yet the photos also present an opportunity to bear witness to how, even at a reform minded institution for the upper middle class like Holloway, attempts to cure the mentally ill involved control and coercion.

Nineteen-year-old Eva M., MS.5158 23. (Courtesy Wellcome Trust)

For example, the first page of the entry for Constance C., a nineteen year old from Winchester, shows her being held by two nurses to be photographed – much like a butterfly pinned for display in a glass case (below). Although the nurses are sliced out of the photo, the book’s spine and the margin of the page do the same work of keeping Constance in line. The notes reveal that she “had to be subjected to slight restraint” and was confined to sleep in a padded cell rather than a general dormitory.^[14] She was also given what were called “continuous baths,” in which the patient would sit for hours in a tub of hot water and have cold water poured over their head.^[15] Physically restraining patients within the bath was not an uncommon practice, and the casebooks report that Constance C. had a “strong aversion” to this treatment. Considering this evidence, the camera can be seen – to borrow the words of the casebook chronicler – as a “slight restraint.” The “slight restraint” of photography was used at Holloway alongside forms of physical restraint such as sleeve jackets, locked gloves or leather mitts, padded rooms, hypnotic/sedative drugs like chloral and sulfonal, central nervous system depressants like paraldehyde, and electrotherapy.^[16]

Nineteen-year-old Constance C., MS.5158 192. (Courtesy Wellcome Trust)

Evidence of coercion can also be located in images that, at a quick glance, appear to eschew such forms of control. These photos show patients posing outdoors in fashionable clothes. In one such image, a woman named Elizabeth M. dons a fur trimmed coat and glances away from the camera (below).^[17] It is tempting to read her stylish appearance as an expression of individual agency and identity. However, the casebooks suggest the opposite. They observe that Elizabeth M. was “incapable of saying how long she has been here or where she lives”^[18] while another patient, Hélène P., “invariably required about 10 nurses to dress + undress her.” ^[19] It is thus likely that many patients were dressed by staff. The effort to dress and photograph patients is consonant with the “moral treatment” favored by 19^th-century asylums.

Elizabeth M. (age unknown), MS.5158 35. (Courtesy Wellcome Trust)

The prominence of photography in the Holloway casebooks might be viewed as part of a wider effort to cure patients by assimilating them to the very image of bourgeois normalcy. This interpretation is supported by the fact that the casebooks often associate the recovery of female patients with their resumption of gender-appropriate behavior. For instance, notes marking an improved mental condition comment that Eva M. “begins to take an interest in her appearance, keeps her dress and hair tidy.”^[20] Some patients thoroughly resisted being dressed. For instance, forty-five year old Mary J. repeatedly destroyed the dresses she was given, and instead accessorized herself with “pieces of wool + odd scarfs [sic] of paper.”^[21] There is poetry in how her casebook portrait has slowly curled in on itself, disdaining to represent her in an outfit she did not want to wear (below).

Although the camera was used as a tool of restraint and conformity, it also often reveals what the written treatment histories cannot: the patients as distinct people. For example, in a photo of Henriette C., the patient at first appears to be sleeping (below). However, upon closer examination, she is looking directly at the viewer. The thirty-one-year-old mother was subjected to electrotherapy and either force fed or fed with a tube up to three or four times daily. She figures in the casebook as “very troublesome” for her physical resistance (“struggling, kicking + shouting”) to these forms of treatment.^[22] Yet here we can glimpse an aspect of her personality – her particular, wakeful attention. She is laid out in bed like a supine Christ on his tomb, but she is not dead. Nor will she be surveilled passively; instead, she attends to us looking at her and even orchestrates our gaze with the raised placement of her hands. In contrast, the casebooks often fail to link Henriette C.’s affect with any deeper significance. For instance, they observe that she “is emotional, will burst into tears for no obvious reason.”^[23] Yet as modern viewers, we can assume that every facial expression and bodily gesture has meaning, even when we cannot read the emotional iconography. Our task, in viewing these photos today, is to restore the coherence and integrity of the patients they depict.

Thirty-one year old Henriette C., MS.5158 191. (Courtesy Wellcome Trust)

The stakes for doing so are all the higher given that these images are easily accessible online. The risk of voyeurism is exemplified by a recent incident, in which two historians of medicine found psychiatric records offered for sale on eBay. This, they write, is part of a wider, “stigmatizing subculture around madness and disability, intended to evoke prurient curiosity, fear, and disgust.” Their concern is duly noted. Indeed, some of the Holloway images have already found their way onto Pinterest boards. At the same time, perhaps we can see the internet not just as a liability, but as an asset too, making it possible to share debates about sensitive images and histories with the broad public – something historians of medicine have called for.^[24] After all, we are the heirs of Charlotte S., Emily E., Constance C., Elizabeth M., Mary J., and Henriette C. What they lived through is ours to contend with now, in a society in which ‘mental health’ has become an omnipresent buzzword, but the crisis of mental illness only continues to worsen. Furthermore, the language of psychology has increasingly entered the mainstream, with the dubious effect of pathologizing normal behavior and diagnosing relational conflict as toxic. While the Holloway photographs present neither easy solutions nor tidy narratives of recovery, they do offer an opportunity to nuance contemporary discourse around mental health. They ask: how do we attend to our vulnerable past? In looking closely at these photos, we do perhaps run the risk of disturbing the dead but for good reason. Through our attention, we wish to do them justice.

1. In the 19^th century, insanity was both a medical and legal category. Carla Yanni, The Architecture of Madness: Insane Asylums in the United States (University of Minnesota Press, 2007), 162. ↑
2. “Females no. 2: Certified female patients admitted January-September 1889,” MS.5157 101, Wellcome Collection, London ↑
3. Susan Sidlauskas, “The Medical Portrait: Resisting the Shadow Archive,” nonsite.org, no. 26 (November 11, 2018), https://nonsite.org/the-medical-portrait/ ↑
4. For instance, in MS.5157 321, Mary J. is “dirty + untidy + slovenly” while, in MS.5157 21, Eva M. “rambles off into flippant irrelevant nonsense…remains very incoherent, untidy + dirty.” My point here is not to contest that patients neglected their physical appearance or talked in ways that were hard to make sense of, but rather that this is frequently the extent of their representation within the casebooks. ↑
5. MS.5157 101 ↑
6. Susan Sidlauskas, “The Medical Portrait: Resisting the Shadow Archive” ↑
7. Anne Shepherd, “The Female Patient Experience in Two Late-Nineteenth-Century Surrey Asylums,” in Sex and Seclusion, Class and Custody: Perspectives on Gender and Class in the History of British and Irish Psychiatry, ed. Jonathan Andrews and Anne Digby (Amsterdam, NL: Rodopi, 2004), 241. ↑
8. Yanni, The Architecture of Madness, 7. ↑
9. As in the case of Eva M. in MS.5157 21. ↑
10. As in the case of Constance C. in MS.5157 191. ↑
11. Susan Sidlauskas, “The Medical Portrait: Resisting the Shadow Archive” ↑
12. See Katherine DB Rawling, “‘The Annexed Photos Were Taken Today’: Photographing Patients in the Late-Nineteenth-Century Asylum.” Social History of Medicine 34, no. 1 (2019): 256–84; Susan Sidlauskas, “The Medical Portrait: Resisting the Shadow Archive”; Katherine DB Rawling, “‘She Sits All Day in the Attitude Depicted in the Photo’: Photography and the Psychiatric Patient in the Late Nineteenth Century.” Medical Humanities 43, no. 2 (2017): 99–100; and Susan Sidlauskas, “Inventing the Medical Portrait: Photography at the ‘Benevolent Asylum’ of Holloway, c. 1885–1889,” Medical Humanities 39, no. 1 (2013): 29–37. Sidlauskas suggests the need to develop an art-historical methodology that can attend to the formal qualities of medical photos. By reading agency into the Holloway photos (noting, for example, patients who close their eyes or cross their arms), embedded as they are within the repressive pole of portraiture, she resists what Allan Sekula called “the shadow archive” comprising photos of “the poor, the diseased, the insane, the criminal, the nonwhite, the female.” Rawling, meanwhile, focuses on how the photographs challenge the stereotype of the passive, victimized psychiatric patient. At times, she elides the practice of physical restraint in order to advance her view of the medical portrait as a site for affirming or re-fashioning identity. ↑
13. Quoted in Katherine DB Rawling, “’The Annexed Photos Were Taken Today,’” 102. ↑
14. MS.5157 192 ↑
15. MS.5157 193 ↑
    Anne Shepherd, “The Female Patient Experience,” 242. ↑
16. The handwriting denoting her first name is illegible, so I am calling the patient by her middle name. ↑
17. MS.5157 33 ↑
18. MS.5157 342 ↑
19. MS.5157 22 ↑
20. MS.5157 322 ↑
21. MS.5157 192 ↑
22. MS.5157 193 ↑
23. As part of a wider reflection on the use and potential abuse of historical images, Jordanova writes, “It’s vital that these conversations are shared with audiences that are as broad as possible. It will never be feasible now to restrict the availability of digital imagery, but we can share widely our ideas about how to handle and interpret them. It will always be worth developing our self-awareness as historians, and as attentive, skilled interpreters of the visual culture generated in relation to medicine and health.” Jordanova, Ludmilla. “Attentive Looking.” Web log. AboutFace (blog), July 29, 2020. https://aboutfaceyork.com/2020/07/attentive-looking/ ↑

Nursing Clio is thrilled to announce our five Writers-in-Residence for 2023–24: Clement Masakure, Jakob Burnham, Jonathan Kuo, Kera Lovell, and Nikita Shepard . Our Writers-in-Residence will each contribute four essays over the course of the year, sharing insights from their research and experiences in the worlds of gender and health. 

Clement Masakure

Clement Masakure is a Senior Lecturer in the Department of History at the University of the Free State in, South Africa. His research interests are on the histories of hospitals and their workers and, histories of diseases, health, and healing in southern Africa. Clemente is author of African Nurses and Everyday Work in Twentieth-Century Zimbabwe, published in 2020 by Manchester University Press. He is also one of the co-editors of Historia, the Journal of the Historical Association of South Africa. Clemente will be writing on public health programs, racial integration in health care settings, and health policies in Ssouthern Africa. 

Jakob Burnham

Jakob Burnham’s work will be familiar to Nursing Clio readers from his essays “A Tale of Two Deaths: Chronic Illness, Race, and Medicalization of Suicide” and “Healing on Credit: Medical Bills and the Politics of Medicine in Eighteenth Century Pondichéry.” Jakob is a PhD candidate at Georgetown University. His dissertation, “Producing Pondichéry: Notaries, Social Lives, and Urban Development in French India, 1699–1757,” examines the history of French settlements on the Indian subcontinent. By analyzing the social practices of daily life in French India using archives in France, England, India, Réunion, and the United States, he argues for the centrality of domestic economies to French colonization across the Indian Ocean. As a Writer-in-Residence, Jakob will continue to explore how these same archives can uncover dynamic questions about the histories of race, gender, and medicine in the eighteenth-century Indian Ocean world.

Jonathan Kuo

Jonathan Kuo is an MSc student at the University of Manchester, where he is studying the history of science, technology, and medicine. His academic work focuses on the history of twentieth-century health activism across the political spectrum, with particular interest in the fluid boundaries of identity in relation to race, gender, sexuality, nationality, and belief in the Anglosphere and its global connections. He is also interested in writing creative nonfiction and personal essays. His current MSc project examines AIDS activism, race, and diasporic networks in the UK. After Manchester, Jonathan will begin an MD/PhD in the History of Medicine at Johns Hopkins University. Jonathan will be writing about histories and cultural depictions of anxiety as well as sharing his observations on funeral practices in different cultures. 

Kera Lovell

Kera Lovell is an associate professor of history at the University of Utah Asia Campus, where they teach courses on US history, women’s history, and global citizenship. Kera earned their PhD in American studies at Purdue University in 2017 and is working on a book project that traces an undocumented method of postwar urban protest in which activists challenged police brutality and urban renewal by insurgently converting vacant lots into parks. This research has been recognized with numerous awards including fellowships from Dumbarton Oaks, the Graham Foundation, the Hoover Institution, and Purdue University’s Research Grant Foundation. You can find their research in a variety of outlets, including Women’s Studies Quarterly, American Studies Journal, Black Perspectives, and Gender Issues. Kera will be writing for Nursing Clio about protest and police violence in the modern United States. 

Nikita Shepard

Nikita Shepard is a PhD student at Columbia University, where they study the histories of gender, sexuality, LGBTQ communities, social movements, and radical politics in the twentieth- century United States. Nikita is committed to public scholarship, and has published a variety of articles integrating historical research, personal experience, and current events intended for broad audiences in the The Washington Post, Spectrum South, and beyond., They also haveand has made media appearances speaking on gender, sexuality, health, and politics, such as with the ACLU’s podcast about antitransgender legislation. Nikita will draw on their research on LGBTQ history to write essays blending historical narrative with reflections on current events and personal experiences.

We’re so happy to have these new writers join the Nursing Clio community to help us bring new histories of gender, sexuality, and health to our readers!

Eating disorders are complex processes to live with and recover from – I know firsthand from my struggle and subsequent healing from one. They begin for multifaceted reasons, including genetic factors, trauma, the media’s fascination with thin bodies, and the medical community’s false belief that thinness equates to health. Treatment and support for eating disorders are vital, but due to the dysfunctional, inequitable, and profit-driven healthcare system in the United States, even when treatment is possible, there is no consensus on what high-quality care is.

Sir William Gull, c. 1860. (Courtesy Wikimedia)

Anorexia nervosa is an eating disorder first conceptualized in the nineteenth century by British physician William Withey Gull. In 1952, the Diagnostic and Statistical Manual for Mental Disorders, first edition (DSM-1), categorized anorexia as a “psychogenic reaction,” and in 1968, the DSM-2 classified it as a “feeding disturbance.” Anorexia and other eating disorders were misunderstood and little discussed until 1983, when the American singer Karen Carpenter died of heart failure as a result of her prolonged battle with anorexia. Since then, anorexia has received considerably more attention from the medical community and the general public, leading to greater interest in treatment, research, and recovery.

Nevertheless, there is still significant debate among specialists regarding treatment for anorexia nervosa. Nowhere has this been more evident than in the recent work of Dr. Jennifer L. Gaudiani, a medical doctor and Certified Eating Disorder Specialist. In February 2022, Gaudiani was the lead author of an article published in the Journal of Eating Disorders that was the first to propose the idea of “terminal” anorexia nervosa.^[1] Gaudiani’s concept of “terminal” anorexia asserts that a small number of individuals with anorexia who have persistently and unsuccessfully engaged with eating disorder treatment, may be permitted to decline treatment if they accept death as the natural outcome of their eating disorder, and if certified healthcare provider deems them in possession of decision-making capacity. Gaudiani also asserts that the use of medical aid in dying should be an option for individuals with anorexia in places where such aid is generally legal. This essay will examine the proposed diagnostic category of “terminal” anorexia and express my concern about linking eating disorders, treatment futility, and terminal diagnoses.

Anorexia nervosa

Anorexia nervosa, commonly referred to simply as anorexia, is a mental illness and one of several eating disorders. Characterized by a distorted perception of body weight or shape, fear of weight gain, and restriction of caloric intake, anorexia affects how individuals see, think, and feel about themselves, and it has the potential for severe medical complications. Although anorexia may be the most culturally visible eating disorder, it is actually less common than other disorders such as bulimia nervosa and binge eating disorder.

Treatment for anorexia typically aims to restore weight (if necessary) and improve eating disorder thoughts.^[2] Current data on recovery from anorexia suggests that 30 percent of individuals with anorexia will recover in ten years, and an additional 40 percent will recover after another ten years.^[3] Although up to 20 percent of individuals may eventually die from medical consequences associated with anorexia, it was previously not described or understood as potentially terminal because anorexia is psychiatrically treatable, and its medical consequences are reversible with medical stabilization and nutrition.

A proposed definition for terminal anorexia nervosa

In the article, Gaudiani and her co-authors propose that terminal anorexia nervosa is characterized by the following “clinical characteristics”: 1) a diagnosis of anorexia nervosa, 2) an age of 30 or older, 3) a prior persistent engagement in high-quality multidisciplinary eating disorder care, and 4) a consistent, clear expression by an individual who possesses decision-making capacity that they understand further treatment to be futile, and that they subsequently choose to stop trying to prolong their lives, instead accepting that death will be the natural outcome.

Gaudiani et al. include three case presentations—all former patients of Gaudiani’s—to illustrate their conception of terminal anorexia. The individuals in the case studies are described as having “severe and enduring anorexia nervosa” (abbreviated as SE-AN), a subset of anorexia nervosa that is not well defined or understood. Consequently, there may be variable use of the term among researchers, mischaracterizing some individuals as having a lesser chance of recovery.^[4] Even individuals with SE-AN often do not have medical complications that are “imminently life-threatening” and “with no treatment at all, patients may still survive for prolonged periods of time.”^[5] Still, a terminal phase, applied to some cases of anorexia, may seem at face value to make sense, given that anorexia has the second highest mortality rate of any mental illness after opioid use disorder, and memoirs, documentaries, and publications all describe the impact that eating disorders have on quality of life and health.

Gaudiani’s conception of “terminal” anorexia, however, contains ethical considerations which require further examination. While she argues that an individual must have the mental capacity to decide that further treatment will be futile, there is considerable debate about whether people with anorexia have the capacity to decline treatment and life-saving medical care, let alone be capable of understanding treatment as “futile.”^[6] Medical decision-making is described as “task-specific,” so a person may have the capacity in one arena but lack it in another.

Futile eating disorder treatment: who decides?

In the case of anorexia, treatment futility is a relatively novel and difficult-to-define concept because no clinician (or the person experiencing anorexia) can say with certainty that there is no chance for any improvement in the trajectory of the eating disorder. Generally, treatment futility is the idea that people who have had anorexia for years have cycled within higher levels of care without recovering and, therefore, additional treatment will likely be ineffective.^[7] Higher levels of care are often life-saving, and many people fully recover, but there are no “gold standard” psychotherapies for treating adults with anorexia.^[8] Given the seriousness of eating disorders, people might assume that hospital-based or residential treatment is readily available for those who need it. However, there are financial, cultural, and geographic barriers to eating disorder treatment, with eight out of ten people never receiving specialized treatment. Additionally, there is a lack of clinicians in the community with expertise in eating disorders, making consistent care outside a treatment program difficult.^[9] I am thus strongly of the belief that clinicians should strive for more accessible and effective treatment rather than advocate for a terminal anorexia prognosis.

My experience

Trauma is known to be a predisposing factor for eating disorders, and I cannot help but think that was the case for me. When I was eleven years old, I experienced a traumatic medical event, one of many such events subsequent to the surgeries and distressing follow-up appointments related to my intersex variation. My struggle with eating disorders—first anorexia nervosa, then bulimia—started in seventh grade, and I was entrenched in and dedicated to my eating disorder for many years. Due to my co-occurring anxiety and depression, multiple inpatient treatments, and my inability to follow treatment recommendations, my doctors frequently described my prognosis for recovery as “poor.” ​

Even though I never explicitly set out to “recover” from my eating disorder, I stumbled upon recovery after realizing much of my identity centered on anorexia.^[10] My eating disorder felt like a vital sense of who I was, a friend, something I could turn to in times of doubt. Eating disorders can, at times, feel comfortable and safe, but they can also be lonely, cold, and painful, having a paradoxical effect in that they drain other aspects of life, creating a distressing one-way world that makes the future seem hopeless. Eating disorders also thrive off secrecy and competitiveness, which can result in one not recognizing the severity of their illness or comparing it to others’ eating disorders. As a result, recovery from an eating disorder often seemed like it could only function as a dichotomy: Either I am struggling with an eating disorder, or I have recovered from one.

Over time, however, I have seen that there can be a middle ground and that eating disorder recovery is not all or nothing. Connecting with my intersex support group allowed me to think about the intersex part of my identity and manage my life of medical trauma I had suppressed and also begin to manage my eating disorder. Drawing from these experiences, I have come to the conclusion that individuals with SE-AN should be afforded the hope that trauma resolution may mitigate the cyclical nature of eating disorders, particularly when they are the foundation of the eating disorder.

My concerns about labeling anorexia nervosa as terminal

I have read the proposed framework for terminal anorexia many times since its publication in 2022 after its subsequent spread on social media. When I first encountered Gaudiani’s article, I felt sad and confused that clinicians had deemed the recovery potential of the individuals in her study to be futile. Rather than continuing to instill hope for recovery and life, a doctor permitted the individuals’ eating disorders to continue unmitigated, eventually leading to their deaths. The article argues that the diagnosis of terminal anorexia nervosa should only apply to a subset of people. However, it is demoralizing to a host of people with active or recovered eating disorders to know that providers in this field believe that some of their patients are beyond hope.

It is unclear to me how someone with SE-AN can objectively understand treatment as futile and “accept” death. I believe the idea of terminal anorexia nervosa is counterintuitive for everyone: most medical complications from anorexia are reversible; there is no consensus on the definition of recovery from anorexia; and those with eating disorders often feel hopeless about recovery. Some people with anorexia will not recover, but that does not equate to a predictable and inevitable death within six months. Eating disorders are complicated, for both those with the disorder and for their families and friends, and the proposal of terminal anorexia only makes experiencing and recovering from an eating disorder more difficult. We need providers to have hope for our recovery from eating disorders, even – and especially – if we may at times feel hopeless.

“The medical industry is always trying to preserve women’s ovaries to have a baby,” lamented Erin Barnett, a woman with endometriosis and polycystic ovarian syndrome (PCOS). “But I want them to put the same amount of effort into helping me be pain-free.” In an article in the Canberra Times and in her book, Endo Unfiltered, Barnett describes how, for decades, doctors completely disregarded her level of pain and discomfort while dealing with PCOS in favor of preserving her fertility. This is the case for many women living with PCOS and other related conditions. Doctors need to start focusing on the whole-body impact PCOS has on the many women with the condition and to prioritize patients’ stated desires above the preservation of their fertility. Physicians often deprioritize and belittle women’s quality of life, and PCOS is an excellent case study through which we can see the prevalence of this issue within the medical community.

Although not immediately life-threatening, PCOS is a chronic, incurable condition affecting at least 1 in every 10 women. This number is likely inaccurate, because researchers at the Robinson Institute of the University of Adelaide estimate that up to 70% of women with PCOS around the world remain undiagnosed. With PCOS, women can suffer from several symptoms: a highly irregular and especially painful menstrual cycle, facial hair, male-pattern baldness, cystic acne, dark and velvety patches of skin, obesity, extreme difficulty losing weight, insulin resistance and diabetes, sleep apnea, a higher risk of uterine cancer, and ovarian cysts that vary in size and severity. But most doctors only focus on one thing: PCOS can also cause infertility.

This focus on infertility has emerged from a historical contestation over defining PCOS. Doctors have historically disagreed about what causes PCOS. There is a popular rumor that it is caused by a modern culture that promotes obesity and eating processed foods, but studies have found this probably isn’t true. In fact, some scientists believe that PCOS has been around since the Paleolithic era and remained prevalent because it gave women certain advantages, such as sturdiness, strength, and lower mortality rates. In 1721, doctors began investigating polycystic ovaries and hyperandrogenism, concentrating their studies on whether the women in question were able to successfully conceive after experimental treatments. They mostly focused on the abnormal physical appearance of the ovaries and infertility. In the following centuries, doctors and other medical researchers reported on the presence of cysts and enlarged follicles on women’s ovaries. Only in 1935 did two gynecological researchers, Irving Freiler Stein and Michael Leventhal, report on the different effects these types of ovaries could have on the female body. The illness was dubbed Stein-Leventhal Syndrome, and the researchers’ work constituted the first significant investigation into PCOS. Since then, however, there has been a serious lack of research into the condition as well as a lack of public knowledge about its existence.

A 1973 copy of Our Bodies, Ourselves from the Boston Women’s Health Collective. (Courtesy Our Bodies Ourselves)

Over the course of the 20th century, the medical community took an increased interest in and performed more research into women’s health. Our Body, Ourselves, originally published in 1970 by the Boston Women’s Health Collective, was one of the first books that comprehensively detailed conditions and illnesses facing women. The publication began as a pamphlet on women’s health and grew into a book as its authors researched more medical conditions affecting women. In the 1998 edition, PCOS is mentioned only once. It would make sense for PCOS to be mentioned in other sections relevant to the symptoms the condition causes, such as insulin-related conditions, menstrual cycles, or hirsutism. But it isn’t mentioned in those places at all. Rather, it is given two sentences in the section entitled: “A woman may experience infertility because…”^[1] Our Bodies, Ourselves is a groundbreaking text intended to provide women with detailed medical information about their bodies amidst a male-dominated culture of dismissal and secrecy. But even this book was not infallible and was infected by the cultural standard of over-focusing on women’s fertility.

Formal diagnostic criteria for the condition were not created until the 1990s. This is due to many things, including the fact that the pain and discomfort of women have consistently been ignored or dismissed by medical professionals. In addition, many women with PCOS retain the ability to become pregnant, putting the issue even further down the medical field’s list of priorities. Today, most doctors go by the Rotterdam Criteria and will diagnose patients if they meet at least two out of the three listed points. The list includes irregular or absent periods, physical or chemical signs of hyperandrogenism, and polycystic ovaries as shown on an ultrasound. This list is not at all comprehensive and leads to ignorance about other markers of PCOS, such as acanthosis nigricans (dark, velvety patches of skin), obesity, and insulin resistance.

For many women, PCOS is seen as a curse. Many women with PCOS have internalized societal beliefs about what makes someone really a woman. When interviewed, many women with PCOS reported feeling “freakish” and like their womanhood had been stolen from them. Some have posited that PCOS has a biological component that causes depression and anxiety, but the plurality of data suggests that women with PCOS suffer from depression and anxiety at a greater rate than the rest of the population because of the social stigma surrounding the condition.

The ambiguity of whether a woman with PCOS is truly a woman and the focus doctors have on preserving fertility are related issues. To many, a woman’s fertility is the defining characteristic of her sex and gender. Kate Morris, who spoke about her experience with PCOS in front of the UK Parliament’s Petitions Committee, recounted how devastated she was when she found out she would never naturally have regular periods: “But periods are what make me a woman!” Patients are not the only people who feel this way. Historically, medical research regarding women’s health has been hyperfocused on fertility and pregnancy, while ignoring many of the other important concerns affecting women. If the most important — if the only important — aspect of a woman is her ability to give birth, why bother focusing on anything else?

“If the most important — if the only important — aspect of a woman is her ability to give birth, why bother focusing on anything else?” (Courtesy Kat Smith on Pexels)

Just as doctors disagree about the causes of PCOS, they also disagree about how it can be treated. Many doctors promise that patients will find symptom relief once they become pregnant, or that their symptoms will disappear after menopause. Neither of these claims has been proven. In the last twenty years, doctors have come to a consensus that birth control pills are the best treatment for the condition, and can be supplemented with Metformin, a medication that regulates insulin production and ovulation. But if patients don’t want to endure the long list of side effects from these two medications, many doctors have no idea what else to offer. No doctors specialize in PCOS, and patients often find themselves seeing multiple doctors in order to find help, including general practitioners, gynecologists, and endocrinologists. Many women are dismissed and disregarded when they describe symptoms, being told that they are to blame for their own health issues or that they are overreacting.

The historically-myopic view of women’s health helps us to understand why serious women’s health issues, such as PCOS, go under-researched and misdiagnosed. In the future, the medical community must make a massive shift toward researching chronic women’s health issues outside the narrow scope of fertility research. Without this change, doctors will continue to dismiss and disbelieve a significant percentage of women when they explain their legitimate health concerns. Doctors must work against their own biases so they can listen to the complaints of their female patients and take them seriously. Kate Morris put it best: “Fertility is only one part of a woman’s lifelong journey with PCOS. Progress has clearly been made there, but the part of the journey that goes from teenage diagnosis to failure to conceive is ignored.”

In the United States and around the world, public health has taken center stage in recent years to investigate how we treat infectious disease and, more importantly, how we contain its spread. However, less attention has been given to the development of the public health systems we benefit from today and the now-eradicated ailments that once affected large populations of Americans.

One such ailment was hookworm. Physicians deemed the hookworm, a parasite that thrived in damp and humid conditions, as responsible for the lethargic behavior that had come to characterize Southerners in the early part of the twentieth century. However, hookworm eradication efforts, along with the development of institutionalized public health, often neglected the health of the Black community.^[1]

What is Hookworm?

In 1902, Dr. Charles Stiles identified hookworm, an intestinal parasite, as the cause of the lethargy that had come to stereotype poor white Southerners. Stiles coined the scientific term for the parasite Necator americanus, meaning “the American Murderer,” which is a bit of a misnomer since it rarely was the direct cause of death.^[2] Hookworm became more popularly known as “the germ of laziness” due to symptoms of anemia, thin blood, and being “addicted to the habit of eating dirt.”^[3] Exposure to hookworm was most common through contact with human feces, often occurring while walking outdoors barefoot or while using unsanitary outhouses. Hookworm was so widespread across the southern region of the U.S. that it infected as much as 40 percent of the white population.^[4]

A 1909 McClure’s Magazine article, “The Vampire of the South,” claimed, “there are today two millions of these poor whites – our native born whites – suffering with anemia, and hardly one of those two million knows, or even suspects, that he is really suffering from an internal parasite.”^[5] The author’s attention to the prevalence of hookworm specifically in “our native born whites” reflects the development of viewing hookworm as particularly a problem for poor white communities, a view bolstered by white physicians and philanthropists.

However, investigations regarding the prevalence of hookworm in Black communities were neglected by physicians. White physicians like Stiles knew that hookworm also impacted Black communities, but deliberately chose to focus their eradication efforts on white populations. These physicians believed that “although their ancestors brought hookworms to North America, Southern Blacks proved less susceptible to hookworm,” mainly due to generational exposure to the hookworm in Africa.^[6] Southern doctors used this rhetoric as reasoning to exclude Black communities from eradication efforts.

In fact, some white people blamed Black Americans for the prevalence of the parasite itself. As a 1928 article in the Black newspaper The Chicago Defender noted, white officials like Navy Rear-Admiral E.R. Stitt were quick to blame Black people for hookworm, when he stated that “there was no doubt that Africans introduced hookworm” to the United States.^[7] Not only did white writers blame Black people for spreading these diseases, but they believed that white people suffered more from the illnesses. Even when white physicians did spread public health education to the Black community, it was self-interestedly and paternalistically aimed at protecting whites.

Physicians examining specimens for the presence of hookworm under a microscope, Cumberland County, Virginia. (Unknown, “Examining Specimens, Cartersville, Cumberland County, Virginia.” Photograph. Folder 1372, Hookworm, Box 60, Series 248: Tennessee. Courtesy of Rockefeller Archive Center.)

Eradication Efforts Begin

In 1909, John D. Rockefeller allocated a million dollars to the founding of the Rockefeller Sanitation Commission for the Eradication of Hookworm Disease, the first philanthropic public health effort in the United States. The Sanitation Commission sought to determine the prevalence of infection across the South, treat those who were infected, and educate communities on the importance of sanitation. Eradication efforts through proper sanitation included building outhouses and providing education about limiting the spread of the parasite. These eradication goals primarily focused on poor white communities. Sociologist Matt Wray suggests that “through the rhetoric of the hookworm campaign, poor white trash were partially refigured as pure white Americans, as a group that deserved higher status and greater prestige than that accorded to southern Blacks.”^[8] Physicians focused their eradication efforts on a specific group who they deemed worthy of a cure, while neglecting hookworm infection in Black communities.

The construction of hookworm as a problem physicians believed only directly affected poor white Southerners is evidenced in Dr. Stiles’s presentation at the 1909 “Negro Conference” at Hampton University in Virginia. Stiles spoke to a largely Black congregation about the dangers of hookworm even though he argued it was white people who were more likely to suffer symptoms of the parasite. Stiles then proceeded to explain what they could do to limit the risk of hookworm contamination to the white population.

Stiles noted that no studies had yet been conducted comparing the hookworm infection rate between white and Black people, despite the large sums of money the Rockefellers had allocated to the study of the prevalence of the disease. However, Stiles did present a study he completed on the number of sanitary outhouses based on race in lower Southern states. In total, three hundred and seventy farmhouses were surveyed, and 46.7 percent of farmhouses owned by whites had no privy, while 79.5 percent of Black-owned farmhouses had no outhouse.^[9] It is likely that regardless of physicians’ perceptions at the time, Southern Black communities were likely to encounter hookworm at the same rate if not more than Southern white communities, due to the lack of sanitary outhouses and therefore exposure to excrement.

In Stiles’s presentation, he lacked evidence of hookworm in Black people, but warned that they should practice sanitary habits to prevent further contamination of white people. He did this by relating hookworm to tuberculosis (TB), a disease that was three times more likely to kill Black people than white. Since hookworm causes severe anemia and weakens its victim, Stiles argued that hookworm doubled the chances of dying from TB.^[10] It is important to note here that Stiles appealed to Black self-interest by putting hookworm into the context of a disease that disproportionately affected Black communities. Stiles explicitly said that if “the Negro wishes to reduce his death rate from TB, one method of doing so is to eradicate hookworm disease not only by treatment but also by improving the sanitary conditions under which he is living.” This same sentiment was reflected in the 1910 Flexner Report, regarding the “Medical Education of the Negro” in the United States. This report stated,

Not only does the negro himself suffer from hookworm and tuberculosis; he communicates them to his white neighbors, precisely as the ignorant and unfortunate white contaminates him. … The negro must be educated not only for his sake, but for ours.^[11]

This rhetoric directly aligns with the paternalistic attitudes of the Rockefeller Sanitation Commission and physicians, by establishing that whites were the principal concern as victims of hookworm, and that Black people had an obligation to prevent the disease from contaminating the white population even though every race was subjected to disease in poor areas.

Beyond the Hookworm

The Rockefeller Sanitation Commission and white doctors constructed hookworm to be an infection that only directly affected white Southerners. This rhetoric neglected the indirect effects of hookworm in Black communities who were also suffering from the parasite. In 1914, the Rockefeller Sanitation Commission ended without successfully eradicating the parasite. However, in 1933, twenty-four years after the Rockefeller Sanitation Commission began, the commission did claim total eradication. Dr. Stiles responded to this claim in an article, “Is It ‘Fair to Say That Hookworm Disease Has Almost Disappeared from the United States?’” In it, Stiles refuted the Rockefeller claim that hookworm no longer existed in the American South by stating that tracking the number of people treated is not a fair estimate of the disease because without proper sanitation or shoes, people could become reinfected. He noted that “the fundamental problem in hookworm control is not a question of bookkeeping or microscopic examinations, but requires a change in the daily habits of hundreds of thousands of rural whites, Indians, and negroes.”^[12] Here, Stiles argued that while attempts could be made toward public health education and sanitation, individuals must take it upon themselves to follow health guidelines to end the infection. Stiles stated that of 121,388 tests done in 1929, 28 percent were positive for hookworm.^[13]

Even though hookworm eradication was not completely successful in the American South, attention turned toward other preventable diseases specific to the South such as malaria and pellagra. Overall, examining hookworm eradication efforts in the early twentieth century shows the disproportionate focus on the health of white communities and the focus on health in Black communities only insofar as they could prevent the spread of disease to white people. Racial health disparities still affect minority communities in the United States today such as high infant mortality, heart disease, and access to healthcare, and even though hookworm is now considered eradicated in the United States, it is still prevalent in a few other countries. The question of who is deemed “curable” and given access to public health measures still remains.

In November 2022, a group of physicians filed a lawsuit against the U.S. Federal Drug Administration (FDA) seeking to revoke their approval of mifepristone, one of the medications in the abortion regimen that accounts for more than half of abortions in the U.S.

The plaintiffs argue that the FDA was remiss in approving the drug in 2000 through its accelerated approval process. This rushed process, they assert, did not allow sufficient time to investigate the side effects of the drug, side effects that have harmed women’s health in the two decades since its approval. Moreover, the plaintiffs continue, mifepristone should never have been eligible for the accelerated process, which is reserved for drugs that treat “serious or life-threatening illnesses,” because “pregnancy is not an illness.”^[1]

This latter part of the lawsuit’s argument—whether or not pregnancy should be classified as an illness—is a linchpin of the plaintiffs’ case. As an historian of ancient Greek and Roman medicine, I’m keenly interested in the historical precedent of this question. Especially since the plaintiffs, medical professionals who call themselves the Alliance for Hippocratic Medicine, self-consciously position themselves as heirs of a long-standing medical tradition. Their name suggests that their stance aligns with medical precedent, but does it?

Is Pregnancy an Illness?

In their complaint, the mifepristone plaintiffs define “illness” as a condition that affects day-to-day functioning; a condition that, if left untreated, will progress from a less to a more serious condition; or a condition that threatens one’s survival. HIV, tuberculosis, and cancer, the plaintiffs argue, meet these criteria. Pregnancy, on the contrary, merely involves “normal physiological processes.”^[2]

The U.S. District Judge Matthew J. Kacsmaryk who heard the case in early April 2023 agreed with the plaintiffs. Although Kacsmaryk acknowledged that complications sometimes arise from pregnancy, he ultimately concluded that “pregnancy is a normal physiological state most women experience one or more times during their childbearing years — a natural process essential to perpetuating human life.”^[3]

And in the May 2023 appeals court hearing, Judge Ho—one of the three judges hearing the appeal—seemed to indicate his agreement when he asked: “We just celebrated Mother’s Day. Were we celebrating illness?”^[4] As we wait for the determination of the appellate court, it’s clear that their ruling will hinge on whether or not to categorize pregnancy as an illness.

Ancient Medicine’s Depiction of Pregnancy

Terracotta figurine of a pregnant woman seated on a birthing stool, Alexandria (Egypt), 1st c. BCE. (Courtesy British Museum 1992,0811.1 © The Trustees of the British Museum)

When we turn to ancient Greek and Roman medicine, we find wide acknowledgment that women’s health takes a sharp turn downward when they become pregnant. The 6th-century medical writer Aëtius of Amida, for example, detailed numerous symptoms of pregnancy that affected women’s health. Beginning around forty days after conception, he explains, pregnant people experienced an upset stomach, nausea, and aversion to food that, in turn, can cause pain, vomiting, and feelings of anxiety.^[5] Moreover, dozens of Hippocratic case histories documented additional health risks. For example, one case described the experiences of a woman who hemorrhaged in the tenth month of her pregnancy and again shortly before childbirth.^[6] In another case, the sister of Harpalides experienced swelling around her ankles and feet in her fourth or fifth month of pregnancy, as well as breathing troubles that lasted for nearly two months of her pregnancy.^[7] Many ancient medical case histories document pregnancies that resulted in death. One case describes the debilitating nausea, heartburn, lack of appetite, weakness, and fever that seized the wife of Antimachus about fifty days into her pregnancy. Soon thereafter, the case reports, “She died in the middle of the night.”^[8]

Interestingly, Aëtius refers to pregnancy as an affectio, which we might translate as “condition,” rather than more common terms for “illness” or “sickness” (νόσος in Greek, morbus in Latin). That said, most ancient physicians agreed that pregnancy was an unhealthy state. The 1st/2nd c. CE physician Soranus of Ephesus says that “it is quite clear from the obvious evidence that pregnancies lead to stunted growth, lack of strength, and premature aging.” Why? Because the nutrition the pregnant woman takes in is redirected to the fetus, and this “deprivation [to the pregnant woman] is not healthy, and neither is pregnancy good for her health.”^[9]

But even in antiquity, some argued that pregnancy was “natural” and “useful” and thus must also be healthful. Soranus scoffs at this imprecise reasoning: “even if a [physiological] function is useful, it does not follow that it is also always healthy. For instance, pregnancy is useful for the creation of human beings, but not healthy for childbearing women.”^[10]

So although some ancient physicians, like the mifepristone plaintiffs, did not use the dominant terms for “illness” or “disease,” they recognized the health risks pregnancy imposed on women. Moreover, ancient medical descriptions of pregnancy fit neatly within the plaintiffs’ own definition of illness: a condition that affects day-to-day functioning; a condition that, if left untreated, will progress from a less to a more serious condition; or a condition that threatens one’s survival.

Ancient Medicine’s Mobilization of “Illness”

The mifepristone plaintiffs can’t claim medical precedent in their argument that pregnancy should not be understood as an illness. That said, the plaintiffs do engage in a rhetorical strategy that is remarkably similar to a strategy employed by ancient physicians. Like the mifepristone plaintiffs today, ancient physicians similarly mobilized the category “illness” and a stated concern for women’s health in order to meet their own societal-political agenda. Specifically, they created a category of “women’s illnesses”^[11] to serve the reproductive interests of the state and its elite men.

Ancient physicians claimed that women suffered from two main types of illnesses, both stemming from the belief that women lacked the heat to fully “cook” the food in their stomachs. Their undigested food was converted, not into the manly byproducts of urine, feces, sweat, and semen, but into a thick blood that could only pass from their bodies through the excessive effort of monthly menses. The first illness was caused by this menstrual blood backing up in the body when a woman’s vagina was not wide enough, the exit was blocked, or the uterus lacked the strength to contract and coil with sufficient force to push out the blood.^[12] Backed-up blood was thought to cause pain where it amassed (such as in the abdomen) and was most dangerous when it collected around the organs, disrupting their proper functioning. For instance, blood pressing against the lungs made it hard to breathe, while blood surrounding the heart—where the mind was thought to be located—caused mental and emotional distress.^[13]

Votive of a pregnant woman, Roman, 200 BCE-200 CE. Votives, made in the shape of the afflicted body part, were offered to the gods either in the hope of a cure or as thanks for a cure. This pregnant female terracotta figure suggests that a woman was worried about the health risks of her pregnancy or grateful for having completed her pregnancy safely. (Courtesy Wellcome Collection)

According to ancient physicians, the second illness related to menstrual blood was called “uterine suffocation,” or what has come to be known as the “wandering womb.” As the uterus worked to evacuate thick menstrual blood, the uterus became overheated and dry.^[14] When this happened, the organ detached from its proper place, roamed around the body, and attached to neighboring body parts to soak up their moisture. Like the problems associated with backed-up blood, so too the roaming uterus was thought to cause pain and disrupt the functioning of the organs––for example, restricting respiration when attaching to the lungs, causing painful urination when crowding the bladder, or causing dizziness or loss of consciousness when moving toward the head.^[15] Moreover, because the opening of a roaming uterus became misaligned from the vaginal exit, menstrual blood could not be evacuated, triggering the myriad ailments related to backed-up blood.^[16]

To combat these illnesses, ancient medical writers prescribed sexual intercourse, pregnancy, and childbirth as the most effective treatments. Sexual intercourse and childbirth, they argued, widened the vagina making it easier for women’s blood to pass during her monthly evacuation.^[17] Semen from intercourse heated—and thus further cooked and refined—the menstrual blood in the uterus, making it easier to purge. Semen also moistened the uterus so that it didn’t need to seek moisture elsewhere in the body.^[18] And once a woman was impregnated, the fetus weighed down her uterus, anchoring it in place. Pregnancy also accustomed the woman’s body to being “full” so it wouldn’t react so strongly to backed-up blood in the future.^[19]

These ancient medical ideas about women’s illnesses—and especially the treatments prescribed to remedy such illnesses—served the reproductive interests of elite households who needed progeny to pass on their family name and wealth. They also buttressed the reproductive interests of ancient Mediterranean societies, which were constantly dealing with demographic instability and in need of bodies to fill the ranks of the army or work in agriculture. By framing pregnancy and childbirth as “remedies” to women’s “illnesses” physicians created an incentive for women to engage in behaviors that threatened their health, under the guise of a concern to protect women’s health. In other words, ancient physicians pitted the health risks of these supposed illnesses against the real risks of pregnancy and childbirth that ancient physicians knew all too well.

Echoes of Antiquity in The Mifepristone Case

Ancient physicians clearly recognized and meticulously documented the health risks of pregnancy. Yet they mobilized the category of “illness” to serve the reproductive interests of society, men, and the state, prescribing medical “treatments” that put women’s health in jeopardy.

This ancient medical precedent should cause us to pause and scrutinize how definitions of “illness” function in the mifepristone case. The mifepristone plaintiffs understand pregnancy to be “normal” and “natural,” without regard to the unhealthful symptoms that many pregnant people experience nor to the outsized maternal mortality rates in the U.S. The plaintiffs’ inattention to these health risks in their categorization of pregnancy as illness might lead us to wonder if indeed women’s health is their primary concern, or if they, like ancient physicians, are merely using women’s health as cover for other guiding interests, such as an anti-abortion agenda.

1. Alliance for Hippocratic Medicine v. Food and Drug Administration, C.A.5 (Tex.) 2023. U.S. District Court For the Northern District of Texas, Amarillo Division. Plaintiffs’ Complaint, pages 3, 95. November 18, 2022. The FDA acknowledges that they used the regulation (Subpart H) in the approval of mifepristone, but explain that they used the part of Subpart H regulation to add safety use restrictions not the part of the Subpart H regulation related to accelerated approval (at 54:08 and 1:46:55 of the oral arguments before the panel of appellate judges). ↑
2. Alliance for Hippocratic Medicine v. Food and Drug Administration, C.A.5 (Tex.) 2023. U.S. District Court For the Northern District of Texas, Amarillo Division. Plaintiffs’ Reply Brief in Support of Motion for Preliminary Injunction, page 16. February 24, 2023. ↑
3. Emphasis added. Judge Kacsmaryk arrives at this conclusion by comparing definitions of “illness” and “pregnancy” from dictionary.com, Merriam-Webster.com, and Wikipedia. Alliance for Hippocratic Medicine v. Food and Drug Administration, C.A.5 (Tex.) 2023. U.S. District Court For the Northern District of Texas, Amarillo Division. Opinion, pages 40, 43-44. April 7, 2023. ↑
4. Starting at 56:48 of the oral arguments before the panel of appellate judges. ↑
5. Aëtius of Amida, Four-Volume Compendium 16.10 (trans. Lesley Bolton, Medicine, Health, and Healing in the Ancient Mediterranean [Oakland: University of California press, 2023], 356-57). ↑
6. Hippocratic Corpus, Epidemics 5.13 (Loeb Classical Library 477:152-53). ↑
7. Hippocratic Corpus, Epidemics 5.6 (Loeb Classical Library 477:290-91). ↑
8. Hippocratic Corpus, Epidemics 5.18 (Loeb Classical Library 477:156-59). ↑
9. Soranus of Ephesus, Women’s Health 1.13 (trans. Molly Jones-Lewis, Medicine, Health, and Healing in the Ancient Mediterranean [Oakland: University of California press, 2023], 351). ↑
10. Emphasis added. Soranus of Ephesus, Women’s Health 1.13 (trans. Molly Jones-Lewis, Medicine, Health, and Healing in the Ancient Mediterranean [Oakland: University of California press, 2023], 350). ↑
11. γυναικείων νούσων in Greek ↑
12. Hippocratic corpus, Illnesses of Women 1.1-2, 1.4, 2.37 (Loeb Classical Library 538: 8-13, 24-27, 358-59); Hippocratic corpus, Nature of Women 7 (Loeb Classical Library 520: 202-3). ↑
13. Hippocratic corpus, Illnesses of Women 1.2 (Loeb Classical Library 538: 18-19); Hippocratic Corpus, On Illnesses of Young Girls (Loeb Classical Library 509: 360-61). ↑
14. Hippocratic corpus, Illnesses of Women 1.2, 1.7 (Loeb Classical Library 538: 14-15, 32-33). ↑
15. Hippocratic corpus, Illnesses of Women 2.14-21, 2.28, 2.31-32, 2.40 (Loeb Classical Library 538: 298-311, 344-45, 350-51, 360-61). ↑
16. Hippocratic corpus, Places in Human Anatomy 47 (Loeb Classical Library 482: 92-95); Hippocratic corpus, Illnesses of Women 2.24, 2.32 (Loeb Classical Library 538: 312-15, 350-51). ↑
17. Hippocratic corpus, Illnesses of Women 1.1, 1.2, 1.4 (Loeb Classical Library 538: 8-11, 14-15, 28-29); Hippocratic corpus, Nature of Women 2-3 (Loeb Classical Library 520: 194-95); Hippocratic Corpus, On Illnesses of Young Girls (Loeb Classical Library 509:358-59). ↑
18. Hippocratic corpus, Illnesses of Women 1.7 (Loeb Classical Library 538: 32-33). ↑
19. Hippocratic corpus, Illnesses of Women 1.1 (Loeb Classical Library 538: 8-11); Hippocratic Corpus, On Illnesses of Young Girls (Loeb Classical Library 509: 362-63). ↑

In 1863, US Surgeon General William Hammond published a Treatise on Hygiene, perhaps the most influential medical text of the Civil War. Noting that a soldier’s age had a great deal to do with his health and fitness to serve, Hammond bluntly declared that “Boys do not make good soldiers.” The minimum enlistment age of eighteen “is altogether too low,” he cautioned, urging that it should instead be placed “at twenty to twenty-two.”^[1] Although Congress ignored this recommendation, Hammond’s voice was neither solitary nor ineffective. Dozens of other medical texts and recruiting manuals decried youth enlistment on similar grounds during the Civil War, as did parents who sought the discharge of underage sons. Even politicians took note, setting the conscription age at twenty rather than eighteen in 1863, in deference to medical opinion.

Today, most people assume that the military service of boys was relatively uncontentious during the Civil War, only coming to be seen as problematic in the twentieth century. But as we show in Of Age: Boy Soldiers and Military Power in the Civil War Era, this was not the case. Although the Civil War included a higher proportion of underage enlistees than any other conflict in US history (most of whom signed up illegally), it was also fought at a time when concerns about the hidden physical frailties of youth were more widespread than either before or since.^[2]

Courtesy Oxford University Press.

These concerns were new. In the early nineteenth century, people rarely suggested that males below a given age were intrinsically unqualified to serve. While they opposed enlisting boys who were evidently feeble or unhealthy, they did not imagine that age-specific weaknesses lurked within the bodies of healthy-looking youths. A general disinterest in the relationship between age and health also characterized medical texts of the era. Understandings of age remained nebulous, and physicians did not yet seek to correlate the number of years lived with mental or physical benchmarks.

This situation only began to change as the transformation of warfare encouraged the study of aging and physical development across the Anglo-European world. As national armies ballooned in size and battlefield tactics grew increasingly complex, armies required soldiers capable of marching in lockstep for long distances, carrying heavy weapons and packs that usually weighed more than sixty pounds—tasks that required strength and stamina. Searching for factors that would enable their armies to maneuver with maximum speed and efficiency, military theorists tried to quantify how soldiers’ height and physical capacity changed as they aged.^[3]

Interest in building more standard and efficient armies was one of several ways that war-making encouraged the study of aging and physical development. Throughout the eighteenth century, the near constant fighting and economic disruption across Europe had led rulers to prioritize the identification of every taxpayer who might fund future wars and every man who might be put into the ranks. States that had introduced centralized systems of national conscription also needed to count and measure the military-age population, while noting distinguishing features that might identify future deserters.^[4] In addition, from the mid-eighteenth century onward, population studies undertaken in multiple countries revealed alarming levels of ill health and debility, especially in working class populations.^[5] These works spurred interest in the question of precisely how the body developed and why growth rates varied between regions and countries.

The bulk of research to take up this question was conducted on men in uniform; such studies in turn became the primary evidence for proponents of enlistment standardization. Among the leading figures to argue that imposing strict age limits and other restrictions would enhance military efficiency was William Aitken, a physician who had investigated the medical condition of British troops during the Crimean War. Convinced that enlistment officers’ lack of training in “physiological principles” had played a key role in the military’s spectacular public health disaster during that conflict, he wrote a series of lectures that were later published as On the Growth of the Recruit and Young Soldier (1862). Mincing no words, he admonished that armed forces should exercise at least as much judgment in selecting recruits as that “which a gentleman thinks judicious and proper to bestow upon a useful dog or a valuable horse.”^[6]

On the Growth of the Recruit and Young Soldier sought to assist army physicians by providing a physiological primer charting the development of the average male body. Aiken first identified “normal growth” in weight and stature at different ages before moving on to describe age-based changes in the skeleton, organs, ribs, arm bones, leg bones, breast bones, vital capacity, and the relationship between the growth of muscles and bones. Each discussion drove home a simple point: all males below age twenty should be disqualified from military service because their growth was incomplete. The skeleton had not fully formed; the long bones in the arms and legs were still “in a soft, cartilaginous growing state;” the ribs remained incompletely developed; the bones had only partly fused to their shafts, and so on. Age was written on every body part, such that a “skillful anatomist” could read it with “considerable accuracy.”^[7] Of course, despite these confident assertions, military doctors could not determine any individual enlistee’s precise age with certainty; Aitken spoke of averages, while actual humans were less predictable. Nonetheless, his work was one of numerous studies in this period to assert that using scientific principles to assess enlistees’ ages would greatly enhance military efficiency.

An unknown young drummer boy in Union uniform. (Courtesy Library of Congress)

These studies had multiple effects during the Civil War. For one, they shaped the concerns of parents and underage soldiers themselves. Edward Edes, who enlisted as a drummer in the 33^rd Massachusetts Volunteer Infantry at age sixteen, frequently worried about maintaining his health. “I don’t want it to be said that I am one of those that went too young & are filling up the hospitals,” he wrote, expressing the common belief that underage enlistees were particularly prone to illness and therefore a drain on scarce military resources.^[8] Letters from parents who sought the discharge of young sons also focused on how war taxed young bodies (even as they focused not at all on war’s potential psychological impact on young minds). Begging for the release of her only son because “his health has failed,” one widow told officials that he had earnestly tried to do his duty for over a year, but “a boy 17 years old is not fit for such hardships as they must undergo in the Army.”^[9] Such sources reveal the extent to which ordinary Americans shared military physicians’ views about the relationship between youth and stamina during the Civil War.

The same assumptions about the relationship between youth and debility informed congressional debates over the Enrollment Act, which established a draft in March 1863. Senator Henry Wilson of Massachusetts argued that men below age twenty were “as a general rule” unfit for military service. “Go into the hospitals in the country,” he urged, “and you will find that a very large portion of the sick consist of the young men under twenty years of age, or of men over forty years of age.” Senator James A. McDougall of California agreed that the “experience of the world” had proved that men “do not acquire the hardiness that fits them for severe campaigning at an age much earlier than twenty-five.” The problem with younger men, according to McDougall, was that “tendinous substance has not grown into bone and sinew,” so they could not endure “the fatigues of a hard campaign” or “march with heavy weights, twenty, or thirty, or forty miles a day.” Neither of these congressmen had any medical training, but they had clearly received the message that underage soldiers were a military liability. Although the acceptance of eighteen-year-olds for volunteer service was an established reality by this point in the war, politicians were determined not to compound the problem by forcing reluctant youths into the ranks.

In recent decades, as modern wars have spotlighted the huge number of military personnel who return home physically or mentally wounded, historians have begun to examine the long shadow the Civil War cast on individual lives.^[10] One study based on EIP records, for instance, has found that veterans who served below the age of eighteen were 93 percent more likely to experience physical and mental diseases than those who had enlisted at age thirty-one or older. “Mortality risk was significantly associated with age at entry into service,” the authors conclude, with the youngest enlistees at “greatest risk for early death.”^[11] Another study determined that Union soldiers who were taken prisoner at young ages subsequently suffered much higher rates of mortality and morbidity compared to those who were confined at the age of thirty or above.^[12]

As it turns out, nineteenth-century commentators who railed against youth enlistment were on the mark: the enlistment age mattered a great deal. It played an outsized role in determining how soldiers fared, not only during but also after the war. Among the multitude of seemingly hale and buoyant young soldiers were many for whom wartime service would spell an adulthood marred by chronic ill health and suffering.

1. William A. Hammond, A Treatise on Hygiene with Special Reference to the Military Service (Philadelphia: J.B. Lippincott & Co., 1863), 20, 25. ↑
2. Frances M. Clarke and Rebecca Jo Plant, Of Age: Boy Soldiers and Military Power in the Civil War Era (New York: Oxford University Press, 2023), chap. 3. ↑
3. Clarke and Plant, Of Age, chap. 3. ↑
4. J.M. Turner, A History of the Study of Human Growth (Cambridge, UK: Cambridge University Press, 1981), 142. ↑
5. For instance, A. Quetelet, Sur l’homme et la Développement de ses facultés, ou Essai de Physique Sociale, 2 vols. (Paris: Bachelier, 1835); Louis René Villermé, Tableau de l’état Physique et Moral des Ouvriers Employés dans les Manufactures de Coton, de laine et de Soie (Paris: J. Renouard, 1840); and Edwin Chadwick, Report on the Sanitary Condition of the Labouring Population of Great Britain (London: R. Clowes & Sons 1843). ↑
6. William Aitken, On the Growth of the Recruit and Young Soldier, with a view to a Judicious Selection of ‘Growing Lads’ for the Army, and a Regulated System of Training for Recruits (London: Griffin, Bohn, and Company, 1862). This work was issued at least six times between 1862 and 1887, x. On Aiken’s background, see: J.B. Nias, “Aitken, Sir William (1825-1892),” Oxford Dictionary of National Biography, Oxford University Press, 2004. http://www.oxforddnb.com/view/article/257. ↑
7. Aitken, On the Growth of the Recruit, vii-ix, 25, 35. ↑
8. Edes to his parents, November 24, 1862. Edes Family Papers, Ms. N-1159, Massachusetts Historical Society, Boston, MA. ↑
9. Letters contained in RG94, Records of the Adjutant General’s Office, Letters Received, Enlisted Branch, Entry 408. Sophia Allen to President Abraham Lincoln, November 14, 1863 (Box 1); and John O’Connor to Provost Marshal General James B. Fry, November 15, 1864 (Box 200). National Archives and Records Administration, Washington DC. ↑
10. Most recently, Holly A. Pinheiro Jr., The Families’ Civil War: Black Soldiers and the Fight for Racial Justice (Athens, GA; University of Georgia Press, 2022); Sarah Handley Cousins, Bodies in Blue: Disability in the Civil War North (Athens: University of Georgia Press, 2019); and Diane Miller Somerville, Aberration of Mind: Suicide and Suffering in the Civil War Era South (Chapel Hill: University of North Carolina Press, 2018). ↑
11. Judith Pizarro, Roxane Cohen Silver, JoAnn Prause, “Physical and Mental Health Costs of Traumatic War Experiences Among Civil War Veterans,” Archive of General Psychiatry 63:2 (2006): 193-200. ↑
12. Dora L. Costa and Matthew E. Kahn. “Surviving Andersonville: The Benefits of Social Networks in POW camps,” American Economic Review 97:4 (2007): 1467-1487. ↑

The intersection of gender identity, faith, and cultural heritage is a complex and often fraught one, particularly for trans individuals living in the American South. As a society and a culture, it’s important that we explore the ways trans people are often excluded from traditional religious spaces, and how this exclusion can lead to a sense of disconnection from one’s community and cultural heritage. However, some trans people like myself are working to reclaim our connection to Christianity in a variety of different ways: some of us are taking up space in traditionally conservative denominations, others are finding new affirming faith communities, and many are interpreting religious texts through a queer lens.

Many religious institutions, particularly those in the South, have historically been places of exclusion for LGBTQ+ individuals, with church teachings and cultural values often promoting rigid gender roles and heteronormativity – all while emphasizing sin and damnation for those not conforming to these rigid roles. These messages can be especially damaging for trans people, who may already be struggling to reconcile their gender identity with societal expectations.

As a transsexual woman and practicing Christian who has spent a significant portion of her life in the South, I am all too familiar with the ways in which religious institutions and people can be unwelcoming to LGBTQ+ individuals. I remember sitting in church as a child, feeling like an outsider as the preacher talked about the importance of traditional gender roles and the evils of homosexuality. Particularly painful for me was the fact that my grandmother was an extremely religiously conservative woman with a scathing tongue. I wanted her approval and her love, but only felt her disapproval and her rejection. Her religious convictions were the reason for her response: church leadership established a culture of poor biblical exegesis, little emphasis on pastoral care, and Christian elitism that fostered these harmful, unloving, and un-Christian views.

As I grew older and began to understand my own gender identity, I felt increasingly disconnected from my faith community and my cultural heritage. I struggled to reconcile my Christian upbringing with my own experiences as a trans person, and it wasn’t until I found affirming faith communities that I was able to start the process of healing and reconnecting with my roots.

Trans individuals seeking to reclaim their connection to Christianity and their cultural heritage often face significant obstacles. Many traditional Christian spaces overtly exclude trans individuals, making it difficult for them to find a sense of connection and belonging within their faith communities. This disconnection can be particularly acute for trans individuals with southern roots because church is a bastion of southern regional identity, where traditional gender roles and conservative values are often strongly emphasized. Of course, this type of “southern belonging” also excludes most people who don’t measure up to a Christian elitist worldview. The southern Christian ethos has historically demonstrated antisemitism, denied the humanity of Black people, and even questioned whether Native People had souls – so trans exclusion is no surprise. Nevertheless, this exclusion can have real consequences for trans people’s mental health and wellbeing, leading to feelings of isolation, disconnection, and even depression and anxiety.

For many trans individuals, this has resulted in walking away from Christianity altogether, an understandable response focusing on survival and wellbeing.The sad reality is that many people have experienced great pain inflicted by those whom they believe should have instead been acting as disciples of love. I and many others feel that the church has surely been a place of terrible betrayal to the principles of Jesus. And still, others leave the church simply disillusioned or unbound from belief, rejecting the various premises of Christianity/religion/divinity.

One of the ways such a betrayal has occurred is through the church’s emphasis on sexual “sins,” targeting LGBTQ+ people with stinging rebukes that ravage individuals’ self worth, hope for the future, and desire to be a part of an organism greater than just themselves. I believe that this inability to adhere to Jesus’ simple distillation of the law in Matthew 22:36-40, where he teaches that the most important thing is loving God and neighbor, is perhaps the single greatest fault of the modern church. This great fault has led to the popular axiom “there’s no hate like Christian love,” often seen on Reddit, Twitter and entire blog threads.

Despite these challenges, however, many trans people are working to reclaim their connections to Christianity. This work is not easy, and often requires significant effort and courage, but it can be incredibly rewarding and healing. One of the key ways that trans people are reweaving their connection to Christianity is by taking up space in conservative evangelical Christian communities. By staking a claim within these spaces, we are creating change through longevity and continuity of trans and queer presences in the congregational body. It is important that we simply exist within these sometimes hostile spaces, but it is even more so when we actively engage with the community and work towards creating a more inclusive and affirming environment.

Another, less contentious and less dangerous, route many trans people pursue is by finding already affirming faith communities, which exist even in the South. These are religious institutions that explicitly welcome and affirm LGBTQ+ individuals, often through statements of inclusion or ministries specifically designed for LGBTQ+ people. Such churches may have rainbow flags outside their doors or include affirming language in their mission statements. These symbols of inclusion can be incredibly powerful for trans people who may have felt excluded or unwelcome in traditional religious spaces.

A sign outside Glendale United Methodist Church in Nashville, Tennessee. (Courtesy Glendale United Methodist Church)

Perhaps the most pivotal way that trans people are reclaiming their connection to Christianity is by developing new work in queer theology. This means reading the Bible, for example, with an eye toward queer themes and interpretations, rather than simply accepting the traditional understanding of the text. For example, some scholars have argued that Jesus’ teachings on love and compassion can be read as affirming of LGBTQ+ identities and relationships, even though traditional interpretations may suggest otherwise. By interpreting religious texts in this way, trans people are able to find meaning and connection in their faith, even in the face of exclusion and rejection. This is cardinal because it creates cultural clashes, which precipitate positive changes and more holistic takes on doctrinal and ecclesiastical life.

Of course, this work is not without its challenges. Trans people who attempt to reclaim their connection to Christianity in this way may face pushback or even outright hostility from more conservative religious communities. They may also struggle with feelings of guilt or shame, particularly if they have been taught that their gender identity is a sin or a moral failing. However, for many trans people, the rewards of this work are worth the effort.

For me personally, finding affirming faith communities and interpreting religious texts through a queer lens have been essential in my journey as a transgender person. Through this work, I have been able to reclaim my connection to Christianity and my cultural heritage, while also affirming my gender identity and my place in the LGBTQ+ community. As a trans person, I am deeply committed to the process of reclaiming Christianity for the trans community. Through my work and advocacy, I hope to create a more inclusive and affirming space within Christianity for all individuals, regardless of their gender identity or cultural heritage.

As a public theologian, I am also engaged in broader activism and advocacy work aimed at advancing the rights and visibility of trans individuals. I believe that advocacy work is essential to creating systemic change and improving the lives of trans individuals. This includes advocating for policies and laws that protect the rights of trans individuals, speaking out against discrimination and violence directed towards trans individuals, or working to increase visibility and representation of trans individuals within broader society.

The intersection of gender identity, faith, and cultural heritage is a complex and often fraught one, and presents unique challenges for trans individuals living in the American South. However, despite the significant barriers to inclusion and affirmation that exist in many religious spaces, trans people are finding ways to reclaim their connection to Christianity and their cultural heritage through finding affirming faith communities and interpreting religious texts through a queer lens. This work is not without its challenges, but it is also incredibly rewarding and healing – healing for the individual, for the broader LGBTQ+ community, for Christian culture and for the church as a body.

My twentieth high school reunion is this summer, and I can’t decide if I want to go or not. Enmeshed in ambivalence, I’m weighing my more-bitter-than-sweet high school memories alongside how those years undeniably influenced me. What’s more, our society performs a collective myth-making around high school culture that’s immortalized in the films and TV shows of my youth. From crushes and BFFs to unforgettable parties, homecoming game touchdowns, and prom night, high school is constructed as not just a rite of passage, but “the best years of your life.” Whether rosy or regrettable, our high school experiences can’t be rewritten, but as adults, we could reinvent reunions to be more inclusive and intentional, more worthwhile and fun. While social media fosters surface-level connections for us on a daily basis, once-a-decade gatherings could be socially transformative, if we embrace the opportunity to reimagine them.

When I first saw the announcement for my reunion several months ago on Facebook (of course it was on freakin’ Facebook), I was surprised by the rush of warm feelings that coursed through me because I never considered going to my ten-year reunion. But over the last decade, I’ve found myself yearning for the company of fellow life travelers. Adulthood as an “elder millennial” leaves much to be desired. Neil Howe and William Strauss coined the term Millennial in 1991.^[1] Because I was in first grade, I had no awareness of the term till much later and no idea that an existential generational specter would hang over us and shape our lives, often not for the better. As high school classmates, we aren’t bound by just our birth years. We’re yoked by our collective experience of Millennial adulthood, its joys and triumphs but also its distinct struggles and dissatisfaction.^[2]

Given the built-in and potentially powerful solidarity a high school reunion could cultivate, I was immediately drawn to the prospect of gathering with people who’ve weathered the same number of years as me. We’ve trod a path that started at the same origin—in Billings, Montana, in a kind of run-down red brick building that celebrated its 60th year in 1999, when we started our high school journey. It was the year of Y2K, the end of the twentieth century, the start of something else.

It’s likely true that no one has an overall happy high school experience, but some of my classmates seemed to enjoy hijinks in the halls, pool parties, and dances with dates, even if the DJ at our senior prom closed the night with Digital Underground’s “The Humpty Dance.” Some classmates had (and still have) close friends from those years. They have good memories, inside jokes, treasured stories.

I, on the other hand, had a pretty awful time in high school. Bookish from the start, I was raised on friendships like Anne of Green Gables and her kindred spirit Diana Barry and the feisty members of The Baby-Sitters Club. I yearned for close friends, but I never had many.

Even more than bosom buddies, I wanted a boyfriend. Oh my word, how I wanted a boyfriend. As a feminist today, it pains me how large male adoration loomed for me, but perhaps it was because I grew up during not only a cinematic explosion of iconic romantic comedies—like Notting Hill (1999), Bridget Jones’s Diary (2001), The Wedding Planner (2001), and How to Lose a Guy in 10 Days (2003)—but also a boom of ones specifically set in high school—10 Things I Hate About You (1999), She’s All That (1999), A Walk to Remember (2002), and be still my ballet dancer heart, Save the Last Dance (2001). Unlike Kat or Laney or Jamie or Sara, I was asked on one date in all four years of high school, an occasion so notable that even my teachers gossiped about it. And after one fun evening, that boy socially ghosted me in real life, before ghosting was even a popularly-used term.

Needless to say, I graduated deeply disappointed by how sharply my experience diverged from the American high school mythology. Being a textbook overachiever may have caused my social problems, but it was my authentic self. Think of Anne Hathaway co-hosting the Oscars in 2011: puppy-dog eager, over-exuberant, vulnerably earnest, trying so damn hard, but also genuinely talented. That’s me, then and now. In high school, I studied long and hard, and trained in classical ballet even longer and harder. It set the course for who I am two decades later: a tenured professor of media studies, working to untangle the narratives threaded through our consumer culture that shape our identities, who we are and desire to be, how we wish to be seen and understood. My high school self knew who she was, but the prospect of a high school reunion still would’ve filled her with anxiety and dread.

Film and TV shows offer examples of what happens at high school reunions, but it’s not always pretty. Attendees feel pressured to invent more prestigious careers and affluent lifestyles, like inventing Post-Its in Romy and Michele’s High School Reunion (1997), one of the most beloved of this movie subgenre. People try to seduce or reconnect with former crushes with varying results, as in Grosse Pointe Blank (1997) and Zack and Miri Make a Porno (2008). Folks connect with old friends and unveil new identities, like Dwayne Johnson’s transformation in Central Intelligence (2016) from a high school “nerd” into a muscular CIA agent, or they honestly share their struggles with a few laughs along the way, as in American Reunion (2012). On streaming TV, a high school reunion sets the stage for late-night antics that turn into a murder mystery, notably in The Afterparty (2022).

The theatrical release poster for Romy and Michele’s High School Reunion. (Courtesy Wikimedia)

What if we ditch the tropes and reimagine what a high school reunion can be? Too often these gatherings are conceived (and represented in films and TV shows) as moments to repeat and restore our high school experiences and social arrangements. I have zero interest in that. And some of my classmates bear far deeper scars than I do; attending a traditional high school reunion is the last thing they’d subject themselves to.

What if we chose to gather as a group of peers? As an academic, I often think of that word within the context of peer review, that is, scholars in my field who share the same expertise. But peers are also people who share a similar life expertise. What if we gathered as peers who just want to know, understand, and support one another? The older we get, the harder it is to make new friends. What if we didn’t have to?

I’d go to a high school reunion where no one was competitive about our jobs or houses or cars, where no one worried about the weight we’ve gained, the hair we’ve lost, or the gray hairs and wrinkles we’ve sprouted.

I’d go to a high school reunion where we didn’t just circle up with whoever our friends were from before to the exclusion of everyone else.

I’d go to a high school reunion where we genuinely wanted to engage with each other. Our generation doesn’t need small talk or more surface level interactions. We’ve had Facebook since college for that. For many of us, social media has fully replaced what used to comprise the bulk of high school reunions, a checklist of social questions: Who’d you marry? What’s your job? How’s your family? Gosh, are any of us famous? We don’t need that anymore. We’ve already exchanged pleasantries. If we’re going to gather in person, we should do something more than that.

We could do something more than that.

What if we show up and celebrate who we are today and the strange wonderfulness that is the ties that bind us? Not who we were in high school, but the fact that we were there together, and that we’ve journeyed through time—decades of it!—linked as a group ever since.

We could be real, honest, genuine, and vulnerable with one another. We could be all the things we were perhaps too afraid to feel and do in high school. We could be and share beyond the curated selves that social media invites and rewards.

No matter what happens in the movies, no matter who we appear to be on Facebook or Instagram, no matter what we experienced or remember from high school, we can write our reunion story differently and better, charting a path of mutual support into the years to come.

* * * * * * * * *

For once, I want to read the comments on my essay, so hello, dear readers. Here are my questions for you. I can’t wait to hear your thoughts and about your experiences.

If you’ve already hit a big High School Reunion milestone, did you go to yours? Were you glad that you did? Had enough years passed that folks were open and interesting, or did the cliques just circle up? If it wasn’t a good time, what do you wish had been different about your reunion?

If you had a great high school experience, how have those memories (and, ha, maybe actual friends!) helped you throughout your adult life?

If you had a less than great high school experience, have you healed from that hurt? What steps helped you?

In this essay, I pondered how film and TV represent high school (particularly high school romance) and high school reunions, and how they shaped my hopes and fears for what actually happens. What media examples shaped yours?

My earliest days in healthcare were at abortion clinics. First as a counselor and then as a nurse, I cared for hundreds of patients seeking abortion care. At clinics, I learned how to perform ultrasounds with the screen angled away from my patient; I learned how to tell which patients would be relieved in the recovery room and want high fives, and how to tell which patients would need gentle, low-voiced post-procedure instructions, and tissues.

The off-Broadway revival of Lightning Rod Special’s “The Appointment” was an emotional and celebratory homecoming–both as a former abortion nurse and as a lover of theater. This devised musical was originally performed in 2019. Its timely return to the stage in 2023, exactly at the time of the 50^th anniversary of the Roe v. Wade decision, came less than a year after the Dobbs v. Jackson decision that overturned Roe. This essay reflects on the experience of attending this show, from the perspective of a former abortion care provider, and explores how art imitates and parodies life in this important play.

The show, while clearly positioned as a pro-choice, pro-access project (a portion of proceeds went to the National Network of Abortion Funds), addresses the complex realities of both accessing and providing abortion services in the clinic setting, and does it through American style show tunes and a stylized method of clowning. These over-the-top parts of the show are contrasted with the quotidian and functional aspects of clinic-based abortion care. The required warnings, the repetition, and the waiting. So much waiting.

Rather than the abortion “debate,” this satirical play presents an abortion-themed variety show, with cooing, demanding, singing, and dancing fetuses, which takes place almost entirely separately from the pregnant people whose bodies they occupy, while music is performed by a live band dressed in abortion clinic escort outfits.

When I was a newly licensed registered nurse at Planned Parenthood of Rhode Island in 2006, I routinely had to walk through the parking lot and across a small crosswalk to get to the clinic while I was subjected to the screaming and pleading of our “regular” anti-abortion protestors. They believed I went there as a patient—for the first few weeks, anyway. Upon realizing that I worked there, they changed their pleas from “Save your baby!” to “You can get another job!”

On my days off, I liked to take my toddler to the children’s museum that was just around the corner. I chose to take a longer route to shield my child from the gory signs. Our protestors brought the typical, iconic posters, including images of fetuses with translucent skin and sealed-shut furry eyelids, juxtaposed next to a quarter for scale. The urge to protect my child from those images and people who claimed to also protect children was a discomfiting irony.

That same child, in 2023, sat with me in the audience at the WP Theater in New York City. The curtains opened to reveal a single actor, dressed in a skin-tight bodysuit, salmon-colored with faint blue and red lines crisscrossing the body, a fleshy head covering, and a prominent and dangling knotted cord of material hanging from her abdomen. The actor moved her limbs in exaggerated aquatic motions, as though swimming– in amniotic fluid. She was a fetus, and she cooed: “Hello Mommy. Can you see me? I’m your little bean. Hiiiiii!”

The cast of Lightning Rod Special’s 2023 production of The Appointment. (Courtesy Michael Kushner Photography)

This scene reminded me of my first confrontation with fetal tissue—or “products of conception,” as I learned to call it as an abortion worker. It was both more and less overwhelming than those familiar poster images that anti-abortion protesters wanted people to believe. The pathologist kindly showed me fetal tissue from a range of gestational ages, including one 22-week anencephalic fetus with an eerily natural stillness. It was helpful to be able to clinically correlate what I was measuring on those ultrasounds—volume all the way off, screen turned away from the patient—with what was being removed from my patients’ bodies.

The confrontation with the stage fetus—crying for its mommy, its daddy, snacks, and demanding both to be named and to be rated for “hotness” through playful and pointed teasing and taunting of the audience—was a much different and, in some ways, more emotional encounter. This fetus—and the whole cast of campy, vampy, cranky, and snarky fetuses—was conceived for this piece in the performance tradition known as bouffon, developed by French theater educator Jacque Lecoq in the mid-twentieth century. Bouffon characters and bodies are meant to be viewed as exaggerated, grotesque, and even disturbing—and do not adhere to stage conventions, even for clowning or improvisation. As Lecoq writes, “In a bouffonesque body, the person who mocks can say the unsayable, going so far as to mock what ‘cannot’ be mocked: war, famine, God,” and in the case of the Lightning Rod Special chorus of bouffon fetuses, abortion.^[1] In the “womb world,” as the creators call it, nothing is off limits.

Conversely, in the “clinic world” of “The Appointment,” a physician calmly describes his responsibilities to one of the patients we meet during the show. These include having to “just write something down” while she tries to describe what the shadowy image on the ultrasound screen looks like to her, and describe the risks of the procedure even though he acknowledges that much of the information “is actually false, but in order for me to continue providing this service in this state, I am required by law to share with you all of the following information.” Having worked as an abortion counselor in Pennsylvania, which requires a 24-hour waiting period and a physician speech similar to the one in the play, I felt the tense and frustrated contradiction: I must share this with you; it is false; it is harmful; but without it, we all risk the greater harm of even less access to abortion care. This scene is calm and functional. The providers, all men, are kind in the show. This kindness easily masks the indignity of the state requirements, because they are executed so gently and with matter-of-fact paternalism. The three male actors sing “What Have I Done?,” a dark and maudlin song about abortion regret, at the end of the scene.

Meanwhile, in the middle of the show, one fetus plays “Pastor Grant,” an over-the-top, charismatic, and slightly sleazy evangelical preacher. This character has a pasted-on handlebar mustache, a swinging umbilical cord, and a passion for saving fetal lives that includes the declaration that “I would kill for you!” Immediately after his song, another fetus stumbles onto the stage, disoriented and trembling, wearing a torn black plastic trash bag and a conspicuously bloody menstrual pad stuck to the side of his head—understandably, the others all run away in fright. This fetus painstakingly and painfully makes his way to the abandoned keyboard to play his swan song, crooning “I never learned the distance between the tips of my toes and the top of my head/I never learned right from wrong/But I learned how to feel the way I gotta feel to write this song.” The Billy Joel-style ballad by a fetus about his own abortion (and never knowing his own crown-rump length, a measurement commonly used to estimate gestational age) is both moving and absurd.

These two scenes capture the essence of what is so wonderful, weird, and resonant about this play. The exaggerated fervor of Pastor Grant, along with the inaccurate (but frequently believed) “baby in a trash can” portrayal of the disposal of the products of conception, brings all the worst suspicions and fears from both anti-abortion and pro-abortion believers to the surface. As an abortion nurse, I laughed in the way I do when I see nasal cannulas used as peripheral intravenous lines on TV—a misrepresentation almost comical in its wrongness. But there was something more, in this scene, that I only realized once the character of “Katie Fetus” was in her Pastor Grant leather jacket and swagger: Katie Gould, the actor playing Katie Fetus/Pastor Grant, was visibly pregnant.

This realization made my experience of the show even more personal: as an abortion nurse, I became pregnant with my first child. I knew that once I was showing, there would be no way to hide this difference between my choice—an intentional pregnancy that I was fortunate enough to continue—and my patients’ choice: most often an accidental pregnancy, or sometimes a wanted one reconsidered, ending. I took more care with my recovery room high-fives; but I also had many patients smile, congratulate me even as I was performing their ultrasound, and ask the usual questions: How far along? When are you due? Are you having a boy or a girl? These contrasted with the questions they—like the patients in “The Appointment”—were asked repeatedly: first name, last name,  date of birth, date of last menstrual period? But somehow, we were able to coexist, room enough in our clinic world for their choices and mine.

Dr. Hanne Blank Boyd is a writer, editor, and consultant whose published work lies at the intersection of bodies, selves, and cultures. Publishing under the name Hanne Blank, she is the author or editor of ten books that include Straight: The Surprisingly Short History of Heterosexuality (Beacon Press), Virgin: The Untouched History (Bloomsbury), and most recently FAT (Bloomsbury, 2020). Formerly on the faculty of the Women’s and Gender Studies department at Denison University, she lives in Decatur with her spouse, a liberal distribution of dogs and cats, and ever-expanding collections of books, fountain pens, lipstick, and yarn. You can find her on Twitter at @hanneblank; she publishes a Substack at https://hanneblankboyd.substack.com/

FAT is a brilliant short book that blends Blank’s own experience of living as a fat person with the history of all things having to do with fat, including our compulsion to contain and control it. She examines the concept of the calorie, for example, and the history of the BMI (body mass index), as well as the emergence of the fat acceptance movement. She also critiques the diet industrial complex that she herself confronted as a child. As I read the book, I had questions and wanted her to elaborate. Here are some highlights from our conversation:

FAT is out now from Bloomsbury.

Lizzie: We hear so much about how unhealthy it is to be fat, but that point of view obscures how medical providers and institutions discriminate against fat people in all sorts of unhealthy ways. We’ve all heard stories about physicians overlooking serious medical conditions because they couldn’t see beyond the patient’s weight.

Hanne: There are thousands of horror stories out there about this. I’ve never met a fat person who didn’t have a tale of medical awfulness to tell. It’s been a factor in my own life. I have polycystic ovarian syndrome (PCOS), which went undiagnosed until I was in my 30s despite a classic presentation, at which point I was told to lose weight and it’d go away. (Surprise! It didn’t! Because it doesn’t work like that!) Also, at one point I had to have emergency surgery because my GP wrote off recurrent abdominal pain as “food sensitivities” that she thought were “probably beneficial in the big picture” because I dropped 75 pounds in less than 6 months–because I could barely eat because eating anything triggered terrible pain. As I discovered when I finally landed in the emergency room, I had very bad gallstones, one of which had lodged in my common bile duct, and a whopping infection had developed. Had things gone south from there, I easily could’ve died of sepsis. When I confronted my GP about this after my surgery, she said that she’d realized that it was possible I had gallstones, but “you were doing so well with the weight loss that I figured if it ain’t broke, don’t fix it.”

There is also an issue here of healthcare practitioners falling victim to severe logic errors around fat and disease. With the caveat that there’s still much we don’t know about how bodies work, the relationship between fat and health is not a one-to-one correspondence. Fat is rarely disease-causative. It is rarely injury-causative. We do not have evidence of a link between fat and the development of specific diseases, the way we do with, say, cigarette smoke being carcinogenic, or lack of vitamin D causing rickets. We also don’t have evidence of fat causing specific injuries. Sure, a fat person may experience greater forces of stress on a knee, for instance, due to greater weight. But fat by itself can’t cause a dislocated kneecap. Yet we have been taught to believe that fat causes both illness and injury, all by itself.

Lizzie: You have some very snappy come-back lines for when someone says something insensitive to you about being fat. I’ve heard from my disabled friends that they frequently hear the same hurtful comments. When someone said to you, “I would kill myself if I were as fat as you,” you retorted, “Why wait?” What motivates this hostility and callousness that so many people seem to share regarding fat people?

Hanne: Power, status, and the fear of losing them or being tainted by proximity to those who do not have them are the motivators here, so far as I can tell. It’s a similar dynamic to what lies behind racism, ableism, ageism, etc. People who are raised in a kyriarchy are repeatedly taught (tacitly and explicitly), from infancy onward, who the powerful and high-status are and what their attributes are. They are taught that being one of those people is the best thing you can possibly be and that having that power and status is what makes life worth living. The next best thing is to attain close proximity to that kind of power and status. We are also taught what attributes can get a person into that kind of proximity to power and status, and that having those attributes is thus also something that makes life worth living.

Those who don’t have those attributes, who neither have primary power/status nor proximity to it? That’s scary and dangerous and not fun and we’re taught to avoid it however we can. We’re also taught to avoid being in solidarity with those who don’t have those attributes, because solidarity with those who have been written out of the power/status equation means that attention, care, and other important resources are flowing in the “wrong” direction. That would threaten to upset the whole power/status paradigm in which resources and access to resources always flow upward to those with the greatest power/status. Can’t have it go the other way, everyone will want some!

This is why I have no compunctions about telling the “Oh my God I’d kill myself if I had to be like you” folks not to wait on my account, because I have hope that maybe it’ll shock them out of their unexamined complicity for half a second. I mean, a girl can dream.

p.s. This dynamic is also the reason that people have such a hard time believing that fat people can be romantically and sexually attractive. Expressing attraction to traits that do not serve the power/status hierarchies is stating that those traits (and people who have them) have worth and value. And, as I note above, we can’t be having with that or it betrays the arbitrariness of the status quo, which makes it vulnerable. Better to resist that temptation to experience feelings that might lead to solidarity with the less- or un-powerful, the low- or no-status, because you a) jeopardize your own power/status and b) threaten a paradigm run by people with lots of power and status who can and will obliterate you in order to obliterate that threat.

p.p.s. And yet these attractions still exist, far more widely than anyone typically likes to acknowledge.

Lizzie: You mention here that you were in the last generation of kids being prescribed weight loss stimulants. What are your thoughts about the new weight loss guidelines from the American Pediatric Association (APA)?

Dr. Hanne Blank is a writer, editor, and consultant. (Courtesy Hanne Blank)

Hanne: If I were even more cynical about the medical “care” created to be deployed on fat people than I already am, I would say that the APA has done a bang-up job of creating a set of medical guidelines that will ensure that children never, ever escape the clutches of the medical-industrial complex as adults. We know that the long-term realities of bariatric surgeries are serious and complex, and can include (but aren’t limited to) malnutrition, dumping syndrome, hypoglycemia, chronic vomiting, bowel obstructions, hernias, ulcers, perforations, pulmonary and cardiac problems, syncope, tremors, flushing, micronutrient deficiencies, folate deficiencies, alopecia, delayed wound healing, and so on.

These complications often require lifelong management, and it’s not always just a matter of “take some vitamins.” Even managing something as “simple” as iron deficiency anemia, which is very common in people who’ve had gastric bypass (up to 50% of people with Roux-en-Y and sleeve gastrectomy methods end up with it) may not be so simple as “just take an iron pill.” For those who can’t absorb enough iron through oral supplements, treating their anemia can involve trips to an infusion center for IV iron. I bring this up because it sounds simple, but in practical terms it’s terrifically disruptive: think about how much of your daily life you’d have to rearrange to go sit in an infusion center all afternoon on a regular basis. But I’m sure there are people out there prepared to argue some medical version of the old “nothing tastes as good as thin feels” cliché, something like “no amount of medical intervention is as inconvenient or unpleasant as being fat.” (Spoken like someone who has no experience from which to judge, I’d say!)

Sure, we all want to assume that children are resilient and they’ll be fine after whatever medical interventions we impose on them. We know that this is not the case because we have ample evidence that children are not always as resilient as we imagine they are, and that children can be harmed by medical care even when it is well-meaning and competent.

We also want to assume that doctors are well-meaning and would never do anything to harm a patient, especially a child. We know that this is not true, because we have ample historical evidence of medical wrongdoing, including wrongdoing in the name of benevolent care.

It’s easier to tell ourselves that we have a magic bullet to stop a horrible thing from happening to children than it is to admit “Wow, our culture’s broken and we need to try to change it so horrible things won’t happen to children so often” and then try to fix it. I get that. But fat isn’t smallpox and eradicationism is neither an effective nor an ethical approach in this case.

Lizzie: COVID-19 has brought new attention to fat people. On the one hand, so many people who were able to maintain their weight before the pandemic are now confronting their new and different bodies, which might make them more sympathetic to others. On the other hand, if obesity is listed as a risk factor for COVID, people assume that fat people are to blame for getting sick. We can’t get away from blaming!

Hanne: Human beings are fragile little creatures who desperately want to believe that we have the means to transcend our vulnerability and prevent our own deaths. We don’t. We never have. Good deeds and clean living have protected precisely ZERO human beings, ever, from experiencing the body’s inherent tendency to get sick or hurt. No one gets out of this alive.

This is a desperately hard thing to truly acknowledge and live with.

So we find things on which we can blame illness, injury, and death, as if this way we can forestall the inevitable. We impose corresponding regimens and limitations on ourselves. We also like to tell ourselves that *other* people may not be able to exert sufficient… Self-discipline? Sophistication? Power of will?… to do these things that will surely appease both entropy and fate, but we can and do and thus we are superior.

So are we going to blame fat people for getting sick with COVID? Sure. We blame fat people for everything else that ever goes wrong with them; why should this be different? It doesn’t matter that the blame is wrongly placed. It almost always is.

Lizzie: Would you be willing to share with our readers something about your new memoir?

It’s a work in progress called Flesh Wounds. I swore for decades that I’d never write a memoir, so that’ll teach me to say “never.” The book is about my processes of learning how to navigate life as a person whose body has failed society’s expectations and standards in multiple ways. More specifically it is about growing up and living as a person who is and has always been fat, to whom polycystic ovarian syndrome (PCOS) and treatment-resistant depression have been lifelong companions, and whose neurochemistry is clinically non-standard. For all these reasons my bodymind has been considered difficult, intransigent, unlikeable, demanding, unwanted, strange, and unlovely by others and often by me as well.

I have lived my whole life in an odd middle space where my bodymind isn’t and never has been well-accommodated…but also hasn’t always gone egregiously unaccommodated. Much of the time I fit the “normal” mold, or can make do with the things I was offered, enough to get by. But it’s always a struggle. It’s always been a struggle. Do I try to fit in? Do I say screw it and let the chips fall where they may? What’s the price, or the potential reward, for each? What about the parts of this struggle that are painful and inconvenient and humiliating, and the parts other people loathe and denigrate to my face? How to cope with that? What about the parts that make it impossible to do the things I want to do, or to be in the world in ways I would like to be? How do I build a sense of self or a sense that I am worth keeping alive when I (my bodymind) am so often the problem, the thing that doesn’t work right and doesn’t fit in?

There is no tidy transcendent ending to the story I have to tell. I’m mostly trying to illuminate this very common human experience of living in and with a bodymind that is, in various ways, often hard to deal with.

On Friday, June 24th, 2022, the United States Supreme Court overturned Roe v. Wade. A contested court case that faced controversy since it was decided in 1973, Roe v. Wade was the only constitutional protection for abortion rights in the United States. According to the Supreme Court ruling, the 14th Amendment protects a constitutional right to abortion.^[1] Because interfering with a pregnant patient and their doctor would violate their privacy rights, the Supreme Court legalized abortion throughout the United States. Unfortunately, these protections are no longer guaranteed. The Dobbs decision reevaluates abortion in light of other factors that allow it to invalidate Roe.^[2] It was a devastating blow to the nation and shook the foundation of our rights as Americans.

In the summer of 2022, in the wake of the Dobbs v. Jackson ruling, I began my research project on women’s health in the Greater Boston area. I was especially interested in feminist organizing and how this activism changed over time. After Dobbs, I became more interested in how women operated in a pre-Roe vs. Wade country. What did women do to support their health and healthcare? What could that tell us about our post-Roe nation? What did they do, and what could we do about it? Boston in the 1970s can act as a critical case study, creating a blueprint for essential intersectional activist strategies. As modern women and feminists, we can learn a lot from the interdependence and collaboration of feminist organizations during this time.

Throughout the 1970s, feminist activists in Boston concerned themselves with women’s health issues. They organized rallies, protests, and clinics to support abortion access and reproductive justice. Boston sat at a unique epicenter of reproductive rights activism. At the time, it was illegal to get an abortion in Massachusetts.^[3] To circumvent these unjust policies, women began organizing feminist collectives. These ranged from consciousness-raising groups to newsletters and even a woman-run cafe.^[4] The ultimate goal was to create space for women, by women, and to engage in active political organizing. Many of these activities were part of a broad movement in feminist organizing that included abortion as a central issue but was not limited to it.

There was also a significant rise in evangelical Christian, anti-abortion activism, which coincided with the implementation of homophobic practices and policies by the local government.^[5] For example, Anita Bryant^[6], a New Right activist, began a campaign to ban abortions and “gay activities.”^[7] Though Bryant was not from Boston, she became the face of the opposition within the city. According to multiple articles in the Gay Community News, one of the first LGBT newspapers in the country and the first in Boston, Bryant’s rhetoric sparked oppositional organizing, making the city unsafe for many LGBT people.^[8] There was an urgent need for support as people’s rights began slipping away. Boston-area activists acknowledged that people needed more than just abortion care; they had to have all their rights met to succeed in society.

The Cambridge Women’s Center

One organization that became central to these efforts was the Cambridge Women’s Center (CWC) in Cambridge, Massachusetts. The Cambridge Women’s Center began in 1971 after activists took over an abandoned Harvard building.^[9] There, these women built one of the longest-standing women’s centers in the country. I had the pleasure of interviewing Libby Bouvier, the archivist for the center and a longstanding member of the group. Together, we discussed the organization’s founding, how they supported women’s healthcare access, and what women did to support one another.

I interviewed Bouvier in June 2022 at the archives of the Massachusetts Supreme Court. It was about a week before the Dobbs vs. Jackson decision, and questions about the future were at the forefront of our minds. We first discussed the center’s history and how and why it was created. From there, she discussed many of the programs at the center, which typically involved consciousness-raising groups and community networks. Bouvier described these groups as discussing “many issues,” such as “women under 30… lesbian groups…” and how some of them “ran for years.”^[10] During consciousness-raising groups, women would come together to share their feelings about an issue and discuss ways they could solve it. They also set the groundwork for developing other organizations. Many major players in the feminist movement developed at the Cambridge Women’s Center. Bouvier described how the “Rape Crisis Center” and the “Abortion Action Coalition” both had origins at the center.^[11] The “Rape Crisis Center” (now called the Boston Area Rape Crisis Center) adopted many techniques earlier feminists used to engage in pro-abortion work.

Cambridge Women’s Center in its early days. (Courtesy Cambridge Women’s Center)

During our talk, I was struck by the Cambridge Women’s Center’s community-based work. In addition to their work regarding abortion care, which included phone lines that could give women information about how to access abortion care in states where it was legal, they also provided significant support for rape crisis work, lesbian healthcare, and workplace discrimination.^[12] During a separate interview, feminist activist Professor Rochelle Ruthchild acknowledged how these “phone lines” at the CWC would set the groundwork for community organizing nationwide.^[13] Not only did it become a tangible method to conduct activist work, but it set a precedent for inclusive leadership. As Professor Ruthchild noted, many of the phone line workers from the CWC “were lesbians.”^[14] They acknowledged that, for women to be healthy, they needed to have their needs met. Every feminist concern was also a health care concern. These women paid attention to the complexities and intersectionalities of women’s lives and empowered them to use that in their activism.

The CWC often encouraged women to seek healthcare outside of traditional medicine, taking a more holistic approach. Many of the organization’s newsletters referenced community-based support and encouraged women to work with one another (some example newsletters can be found here). In the first issue of the newsletter from 1971, writers encourage their readers to seek feminist-based medical care.^[15] They describe various “women’s health collectives” and “feminist study groups” that allow women to access accurate gynecological information.^[16] They also described different “lesbian groups” that could provide a less straight-centric focus on women’s health.^[17] These organizations shifted the power dynamic back into the hands of women and empowered them through knowledge and information.

Why Women Needed the CWC

In Boston during the 1970s, it was common for women to have difficulties finding good health care. According to the women I interviewed, gynecologists tended to be white and male, which complicated getting the needed support.^[18] Women often described feeling dismissed by male medical professionals.^[19] Professor Amy Hoffman, a feminist activist from this period, described feeling “attacked” and “unheard” by medical professionals, especially as a lesbian.^[20] Paula Garbino, a former Cambridge-based abortion provider and educator, told me about a lesbian patient who had worked with Catholic Charities after not being allowed to terminate her pregnancy.^[21] Paula mentioned how the patient had been gang-raped and how “becoming pregnant was not something on her mind…she was not sexually involved with men.”There was an increased need for more inclusive and women-dominated healthcare practices.

As tensions began to hit a boiling point, many women took their health into their own hands. The Boston Women’s Health Collective was famously formed during this time, publishing the seminal text Our Bodies, Ourselves. A multitude of women’s groups began forming coalition-based feminist organizations. These groups would organize clinics and support groups called “consciousness-raising groups” and produce publications of women’s writings.^[22] They were places for women by women and allowed them to discuss their concerns and plans for creating a better future. Many of these organizations called themselves “women’s centers.” They began breaking down the barriers that complicated access to proper healthcare.

What Can We Learn?

Studying the Cambridge Women’s Center and the broader Boston-area feminist movement allows us to reflect on how we understand reproductive rights today. Reproductive rights are not solely an abortion-only issue but a part of a much larger conversation around women’s rights and equality. We can create more robust care networks by considering reproductive justice through that lens. It can also provide an opportunity for the community while facing a rise in religious-based misogyny, something we desperately need today. Though it may feel like it, we are not alone. Women have always been doing the necessary work to provide essential care, and we can continue that path. If we curate networks that generate accurate and supportive healthcare information, we can mitigate some of the effects of misogynist legislation. While it may not be the final solution, it is at least a strong start.