The medical profession and the women's status in the victorian era
The medical profession and the women's status in the Victorian era
'The rise of the medical profession had dramatic implications for women's social status, though not necessarily affecting all groups of women in the same way'. Discuss with respect to women's madness and to the regulation of prostitution.
The Victorian era was possibly one of the periods which saw the most numerous and dramatic changes in society. Coinciding with the Industrial Revolution, the nineteenth century in England was also marked by several changes in social structures and in the way gender, class and race were perceived. One of the notable Victorian processes with dramatic consequences on women's lives was the masculinisation and professionalization of medicine. In this essay, I will discuss some representative ways in which women in general and specific groups in particular were affected by this change. The shifts in the mentality of the Victorians were not necessarily directly produced by the medical profession, but by the social constructs their theories helped develop at that time through legislation. Whilst the regulation of prostitution stigmatised working-class women, yet also provided the conditions necessary for middle-class women to emancipate and take action in the public sphere under the banner of the anti-regulation movement, the new approach to insanity affected working- and middle-class women in different negative ways. In any case, both processes affected women, not men. Hence, the first part of the essay will be dedicated to some of the implications the rise of the medical profession had in relation to the regulation of prostitution, and in the second section - with respect to women's madness.
The regulation of prostitution was one of the components of the state control of sexuality, a consequence of the masculinisation and professionalization of medicine which went on during the Victorian era, affecting mostly women. This approach to the medical field responds to the popular conceptions of that time with regard to gender and class, and also creates new social constructs. Newly established professional male doctors produced at the beginning of the twentieth century a number of treatises on prostitution, being 'eager to display their knowledge and to establish their professional status' (Nead, 1990: 141). Their theories and their focus on prostitution led to the introduction of three Contagious Diseases Acts (C.D. Acts) in 1864, 1866 and, respectively, 1869, applicable until 1886 when they were repealed, Acts which, in turn, produced changes of mentality. Hence, the medical profession influenced the authorities to tacitly adopt the acts which established that women identified as 'prostitutes' had to be subjected to a medical control performed by a male doctor and, if found unhealthy, to be interned into a hospital, but for no more than nine months (Walkowitz, 1980). McHugh offers an analysis of the double standard of sexual morality employed by the C.D. Acts:
The Acts were based on the premisses that women but not men were responsible for the spread of venereal disease, and that while men would be degraded if subjected to physical examination, the women who satisfied male sexual urges were already so degraded that further indignities scarcely mattered. Protection for males was supposed to be assured by inspection of females (McHugh, 1980: 17).
Therefore, the C.D. Acts 'reinforced existing patterns of class and gender domination' (Walkowitz, 1980: 4). In the remaining part of this section I will briefly look at how prostitutes were seen in society and how working-class women were generally affected by the regulation of prostitution.
Prostitution was a vague category in which innocent working-class women were also included because the working-class was considered to be inherently flawed. The C.D. Acts did not define 'prostitution' and, therefore, special policemen, in particular, and Victorian people, in general, were left to decide for themselves what made a woman a prostitute. The large number of prostitutes, even if data vary according to the sources (Mason, 1994), could be partly explained by 'repeated 'conquests' [of middle-class men, which] were a form of display intended to impress other males' (Tosh, 2004: 67) and to preserve the purity of their future wives (Mahood, 1990), partly by it being the only profitable alternative for working-class women in search for a source of money. However, the most important factor was represented by the fluid delimitations of the category of 'prostitution'. Mason discusses the ways in which working-class women were included in it: 'any woman who had an illegitimate child, in this instance, being counted as a prostitute' (1994: 74) and Mahood (1990) notes that any woman on the street who could not prove where her money came from could have been considered a prostitute. Furthermore, moral reformers ‘correlated certain forms of working-class behaviour which offended bourgeois norms - rough voices, garish dress, drinking and swearing - with another: sexual promiscuity, although there was no evidence that this lifestyle led to prostitution' (Mahood, 1990:72). Hence, the regulation of prostitution overcame the limits of the occupation itself. It mainly referred to the urban working-class women (Mason, 1994) who did not comply with 'middle-class standards of femininity' (Mahood, 1990: 3) and thus 'violated their gender role and relinquished their rights to the care and protection usually extended to the ‘weaker sex'' (Bartley, 2000: 157). Further, 'prostitutes' were considered the root of physical illness and moral, social evil. The 'prostitutes' used to spend their time in the unhealthy environment of the streets, Victorian towns being considered the source of physical illness, and therefore 'described as a 'pestilence', a 'sore', a cancerous growth, contamining and destroying society' (Nead, 1988: 122), being the bearers of venereal diseases. Not only were 'prostitutes' the sources of illnesses, according to the Victorian ideology, but they were also 'literally infecting the respectable world; unfettered, it seemed to many middle-class Victorians that prostitution would destroy the family, the home, the state and the empire' (Nead, 1988: 138) when having relations with respectable middle-class men, even if they were not necessarily their most numerous clients, according to Mason (1994). Seen as public perils by the Victorian society and excluded even by the fellow working-class people because, due to them, the whole social class came to be stigmatised, prostitutes had to acknowledge their deviant social role and subject themselves to degrading medical examinations by male professionals (Walkowitz, 1980).
The introduction of the C.D. Acts which stigmatized the working-class women in general because prostitutes came from their ranks, also led the way for Victorian feminists to fight in the public sphere for the rights and the 'rise' of the 'fallen' women into morality, wherein a woman's place should be (Walkowitz, 1984; Mahood, 1990). Judith Walkowitz (1980, 1984) casts her attention on the history of the opposition to the regulation of sexuality which was led, amongst other groups, by organisations handled by middle-class women, such as the Ladies' National Association (LNA) with Josephine Butler as its most renowned member. Their implication in the repeal movement was looked upon as unnatural at that time (Walkowitz, 1980, 1984), the authorities not knowing how to deal with such opposition. However, middle-class women succeeded in surpassing some of the contemporary prejudices about the women's role as 'the angel in the house' and actively engaged in the anti-regulation efforts. Nevertheless, they continued to believe in the morality, purity and domestic virtue which were thought to be intrinsic to Victorian women and which had to be recovered for the 'fallen' women, considered by them victims of the male desires. Moreover, through their actions they opposed the male authority which introduced the C.D. Acts and, at the same time, as Walkowitz (1984) notes, it reinforced the idea that working-class men had the duty to protect the feeble 'fallen' women. Furthermore, one of the approaches of the feminist repealers reinforced 'an authority relationship between older middle-class women and young working-class women that was hierarchical and custodial as well as caring and protective' (Walkowitz, 1984: 45). Hence, even if contradictory in some respects, partly defying and partly reinforcing Victorian ideologies, the repeal movement was an important moment in the history of women's emancipation, even if the focus when studying it is cast mostly on their actions about prostitution.
After having analysed a few relevant ways in which the social statuses of different groups of women were affected by the rise of the medical profession and, thus, by the C.D. Acts - the poor working-class women stigmatised, the prostitutes considered the root of all physical and moral evil and the middle-class women acceding a public role in this context - I shall now cast my attention on the implications of the new conceptual framework of madness on Victorian women of different social classes. According to Bartley, the link between prostitution and madness is very strong, yet unclear in terms of causal relations: '[i]n the case of women, 'feeble-mindedness' was associated with the crimes of immorality and prostitution. In turn immorality and prostitution were associated with 'feeble-mindedness', making it difficult to separate cause and effect' (2000: 125). The new understandings of lunacy were determined by the rise of the psychiatric medical profession, wherein 'doctors consolidated their sole authority in the field of lunacy' (Bartlett, 1999: 48). In the change of perspective they operated, the image of mad people shifted from beasts to humans which could be treated. Moreover, the focus moved from men to women, especially from the middle- and upper-classes, Victorian doctors considering 'that all the biological phases of a woman's life resembled ill health' (Oppenheim, 1991: 190, original emphasis). Therefore, women's sexuality, i.e. the very nature of women, was seen as the cause of madness and, therefore, had to be controlled. This was the one reason which could be applicable to most women, an advantage for the psychiatrists driven by economic interests, as Bartlett notes: 'medical men turned their authority to business advantage by opening profit-motivated private madhouses for the care of the insane' (1999: 48). Both the Act adopted in 1828 and the Lunatics Act of 1845 supported the theories of the psychiatrists and, thus, '[m]adness was placed firmly within the scientific discourse, the professionals (mainly medical) took control of the treatment' (Ussher, 1991: 67).
The new standards for madness affected women from all social classes, though not all in the same way: '[it] could just as well strike poor women, debilitated by want and hardship, as upper-class ladies, cushioned by luxury and attended in childbirth by the 'best' medical men available' (Marland, 1999: 138). If middle- and upper- class women had access to doctors and could be detained at home, working-class women did not have this opportunity and so were interned in asylums. While middle-class women were considered prone to madness because of their feebleness, working-class women, including prostitutes, were seen as diseased. It appears that 'madness was a disease of the highly civilized and industrialized' (Showalter, 1987: 24), where the poor women were prone to madness because of their bad living conditions and middle-class women mainly due to their sexuality. Furthermore, madness was seen as an outcome of the immoral actions of women but also as their natural condition (Showalter, 1987). Hence, baring similarities with the categorisation of prostitutes, mad women were identified as such by male doctors, who had absolute power in this area. Victorians judged as mad the women who gave birth to illegitimate children (Marland, 2004), who did not dress properly or gave too much attention to their physical aspect (Showalter, 1987), but mainly the ones who opposed the patriarchal authority, according to Russell:
Women who tried to engage in political activity ran the risk of committal to a psychiatric institution, and women who pressed for greater educational opportunities found that doctors were leading the debate against them - claiming that the risk of insanity was too great (Russell, 1995: 12).
Thus, insanity, like prostitution, was conceptualised in a highly patriarchal society 'as deviance from socially accepted behaviour, a failure to cope with poverty, the temptations of drink, domestic crises, disappointments in love, cruelty, mis-applied religiosity, or, in the case of puerperal insanity, the strains of childbearing' (Marland, 1999: 143). If the regulation of prostitution had benefic implications for middle-class women, dealing with women's madness reinforced male domination over women. Being under the control of their husbands at home, mad working-class women encountered the same type of authority in the asylums (Marland, 1999). If revolting against their subjection to men, in the form of 'talkativeness, violation of conventions of feminine speech, and insistence on self-expression' (Showalter, 1987: 81), middle-class women became part of the category of the mad. Therefore, whilst working-class women were considered mad if undergoing immoral activities for that time, upper- and middle- class madwomen were actually females who tried to find a way of protesting against the misogynistic patriarchal social order and therefore had to be controlled (Ussher, 1990). Hence, the rise of the medical profession in the psychiatric field contributed to subjecting working- and middle-class women to men, even if this happened in different ways and for simply not complying with the Victorian popular patriarchal social hierarchy.
Elaine Showalter asserts that there were also socio-economic implications of the new conceptualisation of madness, which was due to the theories of the recently established male psychiatrists: '[i]t was used as reason to keep women out of the professions, to deny them political rights, and to keep them under male control in the family and the state' (1987: 73). They were not excluded only from the medical profession, but also from 'any occupation which might challenge the authority of men' (Ussher. 1990: 69). Yet, this implication was according to the Victorian ideology which 'ensured that women were confined to the home and to their reproductive [and dangerous] role' (Ussher, 1990, 69). If women did not comply with this ideology and tried to surpass it, they had to be controlled in some way and the newly risen psychiatric medical profession offered this opportunity.
Both the regulation of sexuality and the conceptualisation of madness in the Victorian era represent pressing problems of the society of that time and both encompass far more complex implications than those I have discussed. In this essay I have looked at the different implications the rise of the medical profession had for various social groups of women, with regard to the regulation of prostitution and madness in the Victorian era. As I have emphasised, new medical theories led to changes in the mentality of the Victorians, yet were also determined by previous dogma. I have regarded these aspects of the Victorian society in relation to the different implications for working- and middle-class women and to what would nowadays be called 'Victorian social policies'.