All in Her Head: The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters Today – A Memorial Sloan Kettering MD's History of Healthcare and Agency

By Elizabeth Comen

14 min read

Why does it matter? Because the dismissiveness you've experienced from a doctor isn't bad luck — it's the downstream effect of two thousand years of deliberate mythologizing.

A woman is dying — tubes in her chest, fluid filling her body, four daughters she'll never see grow up — and she uses one of her last coherent moments to apologize for sweating on her doctor. Sit with that for a second. Not because it's shocking, but because it probably isn't. You've felt that reflex, or watched someone you love perform it: the instinct to shrink, to preemptively excuse your own suffering, to make your illness more convenient for the room. Elizabeth Comen spent years assuming this was a personality trait, maybe a cultural one. Then she realized it was a curriculum — two thousand years of medicine deliberately teaching women that their bodies are burdens, their pain is theater, and their role is to be grateful for whatever attention they receive. This is where that apology came from.

The Reflex to Apologize for Your Own Suffering Wasn't Learned by Accident

A woman named Ellen was dying. Metastatic breast cancer had spread through her bones, her liver, her lungs, and now fluid was filling her body faster than the tubes in her chest could drain it. Her skin had gone yellow with jaundice. Her oncologist, Dr. Elizabeth Comen, held her hand, answered questions about what the end would feel like, and then leaned in for a final hug. Ellen's last memorable words: "I'm so sorry for sweating on you."

Comen had heard this before. Not once — constantly. Women in her practice apologize for being sick, for their surgical scars, for stress sweat at a diagnosis appointment, for missing mammograms while managing jobs and children and aging parents. One patient, a 75-year-old who had raised thirteen children and worked a cattle farm her whole life, showed up after her mastectomy with a flesh-colored adhesive nipple covering her scar. She'd ordered it online, she explained, because she didn't want to make her doctor uncomfortable. In decades of practice, Comen has never heard a male patient apologize for anything comparable.

This gap was built. Centuries before the AMA formalized women's exclusion from medical schools in 1847, the process had been far more violent: a 15th-century church document called the Hammer of the Witches was used to brand female healers — midwives, herbalists, practitioners of the only medicine most women could access — as witches, resulting in mass executions that effectively cleared women out of medicine entirely. The institutional architecture that followed didn't invent the shame so much as inherit and ratify it.

The shame Ellen carried into that final hug had a precise origin. It was the residue of an institution that spent five hundred years teaching women that their bodies were not theirs to understand, treat, or speak about without apology.

The Medical Establishment Didn't Just Ignore Women's Bodies — It Invented Diseases to Control Them

It's 1856, and a twenty-four-year-old woman we know only as Mrs. B is sitting across from a young Boston physician named Horatio Storer, confessing her symptoms. She has vivid, erotic dreams. She wakes from them flushed and aching. She loves her husband and enjoys intimacy with him. Storer listens, takes careful notes, and then summons her mother and her husband for their accounts — because in his framework, Mrs. B is not the authority on her own experience. She is evidence to be catalogued.

His diagnosis: nymphomania. His treatment: rough horsehair bedding to reduce the pleasures of sleep, cold baths, no alcohol, no novels, no sex. Every night, she is to dab a corrosive borax solution between her legs. And if she fails to comply, Storer tells her directly, he will have her committed to an asylum. Her condition appears to have resolved not long after this conversation.

What Storer was treating was not a disease. It was desire. The borax, the deprivation, the threat of institutionalization — these were instruments for extinguishing the fact that Mrs. B liked sex. That this was dressed in clinical language, complete with a diagnosis and a treatment regimen, was the point. The medical establishment did not merely fail to understand female sexuality; it invented pathologies to suppress it. When Storer founded the first American gynecological society thirteen years later, he was celebrated as a champion of women's health. Three years after that, his own wife died in the asylum where he had placed her for what he called menstruation-induced insanity.

The same machinery operated outside the doctor's office. When plastic surgeons in the 1980s wanted to expand the market for breast implants — the procedure Frank Gerow had pioneered by coercing a patient named Timmie Jean Lindsey into surgery she explicitly declined — they needed a medical rationale. So they coined one: "micromastia," a clinical term for having small breasts. The American Society of Plastic and Reconstructive Surgeons then petitioned regulators to classify small breasts not as a physical variation but as a disease causing psychological dysfunction and a diminished sense of femininity. A normal body became a diagnosis. The surgery became a cure.

The pattern runs from 1856 to the Reagan administration: find something about women's bodies that falls outside male-defined ideals, give it a clinical name, treat the woman until she conforms. It was prescribed.

'The Patients Do Not Die' — How One Sentence Shaped a Century of Cardiac Medicine

William Osler is the father of modern medicine. He created the residency model that trains every doctor in North America today. His most quoted line, 'listen to your patient, he is telling you the diagnosis,' is carved into the pedagogy of virtually every medical school on the continent. So when Osler sat down in 1897 to write the field's defining text on cardiac disease and declared that women's heart complaints were 'pseudo angina' — false symptoms induced by neurosis and emotional excitability — he wasn't offering a personal opinion. He was issuing a founding document.

The language he chose was surgical in its dismissiveness. The classic heart patient, in Osler's telling, was 'a well-set man from 45 to 55 years of age, with a military bearing, iron-gray hair, and a florid complexion.' Women who presented with identical symptoms were suffering from their feelings, not their hearts. And then he wrote the sentence that would quietly govern a century of medicine: 'The patients do not die.' Female cardiac patients, he assured the doctors he was training, were never in mortal danger. They were simply nervous.

Miss C came to Osler that same year, a 22-year-old from upstate New York who had been living with chest pain and arm numbness since she was twelve. She had traveled to Baltimore specifically because he was considered the best diagnostician alive. He examined her carefully, wrote detailed notes — and sent her home with a shrug. 'The patient was evidently very neurotic,' he recorded. Her heart spasms, he concluded, were caused by 'excitement and emotion,' probably from studying too hard. This is the same man who preached patient-centered listening. But you can't really listen to a patient whose symptoms you've already decided don't exist.

The medical system calcified around his verdict. A 1982 cholesterol study and a 1995 aspirin trial between them enrolled more than thirty-four thousand men and zero women. These weren't oversights — they were the logical extension of a framework in which women's cardiac health simply wasn't a research question worth asking.

What that framework costs in human lives becomes visible in a single night at the Elmhurst Hospital ER in January 2004. Paula, a 38-year-old nurse's aide and mother of three with a newborn at home, arrived with swollen legs and worsening shortness of breath. She apologized for taking up space. She was triaged as non-urgent. By the time someone connected her symptoms to her recent pregnancy and ordered an echocardiogram, her heart was pumping at twenty percent capacity. She died that night of peripartum cardiomyopathy — a condition with a name, a known symptom profile, and a treatment. 'The patients do not die,' Osler had written. Paula's autopsy form says otherwise.

The Same Logic That Jailed Typhoid Mary Set Every Male Carrier Free

Who was Typhoid Mary, really? You probably know the name as shorthand for someone who carelessly spreads disease. What you may not know is that the woman behind it — Mary Mallon, an Irish immigrant cook — was one of several hundred identified typhoid carriers living in New York City in the early twentieth century. She was the only one ever imprisoned for life.

Mallon never became ill herself. She was an asymptomatic carrier, a concept so new at the time that the doctors pursuing her couldn't fully articulate it — and apparently never tried to explain it to her in terms she could understand. Instead, a sanitary engineer named George Sober tracked her to her workplace and demanded she hand over samples of her blood, urine, and feces. When she refused — a response that would seem entirely reasonable to anyone who had never been told why strangers were following her — he and a colleague tracked her home. Eventually, a public health official named S. Josephine Baker arrived with five police officers. Mallon fled and hid. When they dragged her out, Baker compared the scene to wrestling an angry lion into a cage, describing her captive with the kind of contempt that made clear the medical system had already decided what kind of woman it was dealing with.

Now consider Tony Labella. Also a food worker, also an asymptomatic typhoid carrier, responsible for roughly twice as many cases as Mallon. He was never imprisoned. His name never became a synonym for anything. The difference between them was not danger — it was that Mallon was a woman, an immigrant, and poor, and Labella was not.

The doctors who hunted Mallon down weren't operating from ignorance. They were operating from a framework with a two-thousand-year pedigree — one that located contagion specifically in the female body. Medieval physicians had written about vaginas full of 'putrid matter' capable of rotting a man's flesh. By the time Mallon was arrested in 1907, this idea had been dressed in the authority of modern public health. Under the American Plan, a government program that ran from World War I through World War II, agents could detain women simply for eating alone in a restaurant or looking suspicious, then force them into treatment centers where mercury and arsenic were injected into their bodies. Men spread disease too, of course. The program technically applied to them. In practice, virtually every person detained was a woman.

This wasn't a mistake that better science would have corrected. Better science arrived — and the arrests continued. The logic was the interest.

Naming the Skeleton as Male Was a Political Act, Not a Scientific One

The first anatomical drawing of a 'human' skeleton that most European doctors ever studied was, in fact, a drawing of a male skeleton. Andreas Vesalius published it in the 1540s and labeled it simply 'Human.' That label wasn't an oversight. It was a position.

The deliberateness becomes impossible to ignore when you look at what came next. In 1796, a German anatomist named Samuel Thomas von Sömmerring produced what was celebrated as the definitive illustration of the female skeleton. He gave her a skull so small it barely looked capable of housing adult thought, a pelvis so wide it looked built for one purpose, and a rib cage too narrow to contain much of anything else. Some contemporary doctors actually objected — the proportions were anatomically wrong, and they said so. The response from Sömmerring's defenders was remarkable: he was an artist, not an anatomist, so accuracy was beside the point. This was considered a satisfying answer. A generation of physicians trained on a female skeleton whose dimensions had been deliberately distorted to argue that women were designed by nature for reproduction rather than reasoning, and that argument was considered too beautiful to correct.

The caricature wasn't the product of limited data — Sömmerring had access to actual female bodies. It was the product of a conclusion drawn in advance. The illustration didn't describe women; it instructed them. Wide hips meant motherhood was destiny. A small skull meant thinking was someone else's job. A doctor trained on those images and sent into practice didn't just carry a skewed picture — he carried a clinical framework. He knew, in the way you know things you've never had to question, that a woman who wanted to reason was working against her own anatomy.

That framework outlived the illustrations. Its residue is still measurable: women today tear their ACL at ten times the rate of men in comparable sports, yet research into why remains chronically underfunded, and professional sports medicine is staffed almost entirely by men. The skeleton got relabeled. The assumptions behind the label didn't.

The Pill That Liberated Millions Was Tested on Women Who Had No Choice

Think of any technology you trust completely — a vaccine, a surgical technique, an everyday medication. Now imagine learning it was perfected on people who were threatened into participation, and that the deaths it caused were quietly attributed to other causes because no autopsies were ordered. Your trust doesn't evaporate, exactly. But something shifts.

That's the position the birth control pill puts us in.

The story most people know is true as far as it goes: Gregory Pincus, a Harvard-trained endocrinologist, partnered with gynecologist John Rock and bankrolled by heiress Katharine Dexter McCormick to create a hormonal contraceptive that would give women unprecedented control over their own reproduction. The pill they produced changed the world. What the story leaves out is who absorbed the cost of producing it.

Because federal law banned birth control research in the United States, Pincus moved his trials to Puerto Rico, where the population was impoverished enough, and distant enough from regulatory scrutiny, to be useful. When women in the trials reported bleeding, blood clots, nausea, and migraines and tried to drop out, researchers didn't revisit their protocols. They got creative about retention. A pharmacology professor named David Tyler, who had recruited female medical students for the trials, wrote to Pincus explaining that women who tried to quit would find it reflected in their grades. Three women died during the trials. No autopsies were performed. When critics raised the side effects after publication, Pincus had a ready answer: the complaints were psychogenic. The women were imagining it.

That word — psychogenic — is the tell. It's the same move the field had been making for centuries, just applied to a new context. The research wasn't shaped by ignorance about female suffering. It was shaped by indifference to it. Pincus knew exactly what was happening to the women in Puerto Rico. He decided it wasn't the relevant variable.

The same logic governed what came after. When Robert Wilson promoted hormone replacement therapy in his 1966 book as a cure for the 'deficiency disease' of menopause, his central argument wasn't that women deserved relief from their symptoms. It was that their husbands deserved pleasanter company. He had treated the wife of a man who arrived in his office with a loaded gun, set it on the desk, and said he'd kill her if Wilson couldn't fix her disposition — and Wilson later described the man as 'completely rational.' Hormones as a management system for female behavior, not a subject of genuine medical inquiry. That framing has never fully left the building.

'Hysteria' Was Struck from the Medical Textbooks in 1980. The Diagnosis Never Left.

In 2023, in a New York City hospital, a woman crouches in a shower stall and gnaws her own fingers down to bone. Staff watch. Doctors observe from the doorway, scribbling notes, considering labels. Nobody says the word that hangs in the air — the one removed from the medical textbooks forty years ago — because they're modern physicians in a modern hospital. But the thing that word described, the reflex to find psychological explanation for a woman's physical crisis, is exactly what governs their next move. The charts eventually land on anxiety.

The word 'hysteria' was formally retired in 1980. The operating logic beneath it was not. Henry Cotton, medical director of a New Jersey state hospital in the early twentieth century, believed mental illness was caused by hidden bacterial infections and that removing infected tissue would produce cures. He started with teeth — sometimes a few, usually all of them — then worked through tonsils, colons, gallbladders, stomachs, and ovaries. His reported cure rate was eighty-five percent. The actual death rate among his patients was thirty. The investigations into his methods were led largely by women — a female psychiatrist commissioned one inquiry, female nurses and former patients testified against him — and each time the warnings were buried. Cotton was a genius, his supporters insisted. The women saying otherwise were just difficult.

The lobotomy era followed the same script. When husbands reported that their wives were 'more normal than they've ever been' after surgeons inserted picks through their eye sockets and into their frontal lobes, doctors recorded this as a positive outcome. The vacancy in the patient's eyes, the flatness — these were understood as the abnormality finally stripped away, not as evidence of damage.

The mechanism hasn't changed. Today, conditions like POTS and lupus — which disproportionately affect women and involve complex, difficult-to-pin symptoms — are routinely filed under panic disorder, anxiety, or hysteria's current euphemism: 'functional,' the shorthand for symptoms medicine can't explain and doesn't quite believe. A neurologist describes women arriving in her office carrying incorrect anxiety diagnoses that other physicians had applied to what were, on examination, verifiable neurological conditions. The system isn't starting from the patient's account and working outward. It's starting from a centuries-old prior — that a woman's reading of her own body is the least reliable data point in the room — and working backward to confirm it. The word changed. The verdict didn't.

Even the Doctor Writing This Book Changed Her Correct Diagnosis to a Stranger's Wrong One

It's New Year's Eve, 2022. Dr. Elizabeth Comen — oncologist, breast cancer specialist, and, at this particular moment, a woman lying on her friend's kitchen counter in agony — already knows what is wrong with her. She had self-diagnosed it in the car on the way to the party: a cerebrospinal fluid leak following spinal surgery weeks earlier, a known complication with a telltale signature. The pain at the base of her skull, the way it vanished completely the moment she lay flat, the crushing pressure when she sat upright — these symptoms fit her diagnosis perfectly. She had already begun drafting the email to her surgeon.

Then a celebrated male plastic surgeon materialized above her and declared it impossible. He had a different diagnosis — occipital neuralgia — and he wanted her to know it immediately, scrolling through photographs of opened skulls on his phone as if this were a perfectly normal thing to do at a party. Comen laughed and spent the rest of the evening horizontal.

The next morning, she sent her surgeon the email she'd been drafting. Except she had changed the subject line. Where she'd originally written her own correct diagnosis, it now read, simply: "Occipital neuralgia?"

She hadn't lost her medical training overnight. She hadn't forgotten her symptoms. An MRI would later confirm the CSF leak she'd identified herself, and a procedure to repair a small tear in her meningeal lining would fix it entirely. What the encounter at the party had taken from her, in a single conversation, was the confidence to trust what she already knew — and she's a working oncologist who was literally writing a book about exactly this phenomenon when it happened to her.

That's the point Comen lands hardest at the close of her book. Individual knowledge is not the solution to a bias that operates beneath the level of conscious reasoning. The system won't be fixed by better-educated patients or more vigilant women. It will only change when medicine restructures what it rewards — when listening earns as much prestige as operating, when a correct patient history counts for as much as a published paper, when the doctor who spends an extra hour on a difficult diagnosis is celebrated alongside the surgeon who removes the tumor. Until then, even the most informed woman in the room is one swaggering stranger away from doubting herself.

What You Owe Your Own Symptoms

Ellen apologized for sweating on her oncologist while she was dying. You now know that apology had authors — church documents, anatomy textbooks, clinical trials run on women who couldn't say no, diagnoses invented to keep desire quiet. That reflex to minimize, to preface your symptoms with