Moya Bailey and the 'Specter of the Black Woman’s Body'
Black women find their bodies “caught in the crux of what science says exists and what society says should be, with little regard for what actually is.”
Women account for two-thirds of people with Alzheimer’s disease, the third leading cause of death in the U.S. behind heart disease and cancer, and three-quarters of those with autoimmune diseases. Women are twice as likely to have chronic pain conditions, and conditions such as fibromyalgia, chronic fatigue syndrome, chronic Lyme disease and multiple chemical sensitivities are 70% to 80% female dominated.
These conditions are so under-researched, however, that patients often endure years of misdiagnoses and ineffective treatments before being able to put a name to their suffering. Women are often dismissed by doctors as “unreliable reporters” who exaggerate medical complaints and their symptoms are deemed “psychogenic,” all in their heads. This “knowledge gap” and concomitant “trust gap” in health care cost women earnings due to sick days and disability, their savings and homes due to exorbitant medical bills, and worse: the Society to Improve Diagnosis in Medicine estimates that 40,000 to 80,000 people in the U.S. die every year due to diagnostic errors.
When reading about these failings of the U.S. medical system in Doing Harm by Maya Dusenbery, my heart started to race, my cheeks flushed and I felt my scalp prickle. Goosebumps rippled down my arms and legs, emanating out from a fist of fear lodged in my abdomen. Being mistreated and misdiagnosed by medical professionals terrifies me, as I’m sure it terrifies many people. After all, Western culture venerates medicine as the antidote to pain, venerates doctors as geniuses and gods, such that a misdiagnosis feels like a profound violation of trust.
I am a white woman, though, and my privilege means I am more likely to receive effective health care throughout my lifetime. Lupus is three times more common in Black women than in white women, and more than half of lupus patients wait at least four years and see three or more doctors before getting a proper diagnosis. In Kaiser Permanente’s Pathways study assessing breast cancer outcomes in 4,505 multi-ethnic women, Black women had an 81% increased relative mortality risk, compared with white women, after adjusting for age and cancer stage. At least half of maternal deaths in the U.S. are preventable, but Black women are almost four times more likely than white women to die in childbirth.
Health care in the U.S. has a well-documented gender problem and a well-documented race problem, and the health of Black women suffers from the double jeopardy of misogynoir. Moya Bailey of Northeastern University coined the term in 2010 to describe the “co-constitutive, anti-Black and misogynistic racism directed at Black women, particularly in visual and digital culture.” Bailey notes that noir carries film and media connotations; she first used the term in a Crunk Feminist Collective essay about violence against Black women in hip hop.
Bailey is an assistant professor of Africana Studies and Women's, Gender and Sexuality Studies at Northeastern and is currently an MLK Visiting Professor at MIT. (When I read about the courses Bailey teaches as Northeastern, including “Digital Feminisms,” “Gender & Black World Literature: Feminist Futures,” and “Gender, Race, and Medicine,” my breathing slowed and my shoulders relaxed as warm anesthetizing honey calmed the muscles in my arms and legs, emanating out from a well of trust in my chest. Faith in the good work of good scholars.)
Bailey is interested in how race, gender and sexuality are represented in media and medicine, and how marginalized groups use digital media to promote social justice, self-affirmation and health. In this essay, I'm focusing on a 2016 article Bailey published in Catalyst: Feminist, Theory, Technoscience titled “Misogynoir in Medical Media: On Caster Semenya and R. Kelly.”
In “Misogynoir in Medical Media,” Bailey first discusses the 2009 controversy surrounding South African runner Caster Semenya, whose genitalia, sexual organs and hormone levels became the subject of international media and medical scrutiny because she didn’t fit Western ideas of what a woman should look like. Semenya’s privacy was invaded as the world tried to determine if she was “really a woman;” she was compared with images of white feminine beauty as if fake-tan skin, bottle-blonde hair and augmented breasts would make her a real woman.
A magazine gave Semenya a makeover to put her back in the box of appropriate femininity while the International Association of Athletics Federations offered to medically “correct” her intersex anatomy, illustrating how medicine and the beauty/media industry link up to police non-normative bodies.
Many people, my past self included, see biomedical science as separate from or above social structures such as gender and beauty since it is associated with the objectivity of empirical data. But, throughout the history of medicine in the U.S., societal expectations about femininity influenced the kind of health care women received. Black women and their bodies threatened the dominant binary of white male doctor and white female patient because they represented a non-normative or transgressive femininity.
According to Bailey, the “specter of the Black woman’s body” found itself at the “intersections of socially constructed and medically reinforced hierarchies of biological difference […].” From the beginning, biomedical science and the practice of medicine helped the white patriarchy justify racial hierarchies and police gender norms.
When the U.S. was just colonies trying to build a nation on the backs of Black people atop stolen land, women were the “healers” since tending to the sick and dying fell squarely within the domestic sphere. Medicine comprised natural remedies and a good amount of superstition, but the wisdom was solid since it was the wisdom of mothers. Perhaps fearful of women having valued (and therefore powerful) positions in communities as healers (burn the witch), men turned medicine into a profitable occupation and pushed women out.
According to Barbara Ehrenreich and Deirdre English, authors of For Her Own Good: Two Centuries of the Experts’ Advice to Women, the move from communal medicine to professional medicine “has often been told as an allegory of science versus superstition: on one side, the clear-headed, masculine spirit of science; on the other side, a dark morass of female superstition, old wives’ tales, rumors preserved as fact.”
That’s not really how it went down, though. Professional medicine wasn’t any more evidence-based or outcomes-based than the “superstitious” medicine practiced by women: the “regular” doctors, as they called themselves, sold procedures and treatments that were 100% bullshit (bloodletting, enemas, chemical inhalation, leeches) but appeared more effective than an herbal tincture or healing salve because they produced a dramatic effect.
The rest is history, if history is several centuries of white men making up rules about how something should work and then building schools to teach the rules, writing laws to enforce the rules, squashing opposition to the rules and fabricating a cultural framework to make the rules seem natural.
In 1910, the Carnegie Foundation reviewed the state of U.S. medical schools and the resulting report concluded that there were too many doctors and too many were poorly trained, which caused about half of the country’s medical schools to close or merge. There were a handful of women’s and Black medical schools at the time, but in the aftermath of the Carnegie report many of them closed. Additionally, a new requirement of two years of college education before medical school made medical education accessible only to the upper classes.
The slow bend, backlash, bend, backlash of progress has moved medicine forward since then. The 1972 passage of Title IX of the Education Amendments and other legal victories expanded women’s access to medical education, but mostly white women. According to data compiled by the Association of American Medical Colleges, only about 9% of the 48,530 women enrolled in U.S. medical schools for the 2020-2021 year identified themselves as Black or African American.
If medical students become doctors and specialists and professors who conduct drug trials and advise pharmaceutical companies and apply for research grants and go on to write textbooks and author prescribing guidelines and allocate research funds and edit scientific journals and launch biotech IPOs and hold powerful positions in the AMA and AHA and NIH and FDA and CDC… then a majority-white medical student population today means the four-trillion-dollar health care industry will continue to cater mostly to white bodies tomorrow.
Ultimately, is it not only the lack of Black women in medical schools that causes medicine to overlook Black women’s health.
In the second part of “Misogynoir in Medical Media,” Bailey discusses how didactic models and figures within medical media normalize and standardize the white body, meaning all other bodies are seen as irregular or even pathological. This type of educational media is assumed to be objective, unlike cultural media such as magazines, and yet the influence of racial hierarchies and gender expectations seeps in.
Bailey discusses a criminal trial in which jurors watched a video of R. Kelly and a 13-year-old Black girl engaged in sexual activities. Some of the jurors doubted the victim was really a minor despite the 13-year-old’s family members, friends and teachers testifying that she was the girl in the video. The prosecution brought in a forensic physician who used the Tanner Scale—a visual scale that illustrates the five stages of human physical sexual maturation—to “prove” that the girl was a minor based on how her body looked in the video. “By attempting to estimate chronologic age through observable sex characteristics, biomedical visualization is privileged over testimony by people in the girl’s life,” Bailey writes.
The use of the Tanner Scale failed to “prove” anything and only fueled the “sexually mature for her age” discourse that is so deeply dangerous to Black girls. The scale was developed in 1962 based on examinations of children of “European and North American” ancestry, and though several studies have since shown that Black girls and white girls begin puberty and develop primary and secondary sex characteristics at different ages, medical professionals still assume the scale is universal.
Bailey argues that the Tanner Scale, along with other biased medical rubrics such as diagnostic manuals and pain scales, are tools that biomedical discourse uses to solidify societal norms and render them objective science. They invite comparisons between bodies that don’t need to be compared: the standardization of the white body allows medical professionals to say “Black children mature earlier than white children” instead of “white children mature later than Black children.”
Since the medical system in the U.S assumes a white standard of health and normality, Bailey argues that marginalized groups such as Black women find their bodies “caught in the crux of what science says exists and what society says should be, with little regard for what actually is.” For health care to be deployed equitably and effectively, medical professionals need to look at a patient and see her as she actually is.
False beliefs about Black bodies infiltrate the practice of medicine, from the bottom to the top, and cause harm to Black patients across age and economic groups. One site of harm that must urgently be addressed by the medical community is the under-treatment of pain in Black patients. Kelly Hoffman of the University of Virginia led a study published in Proceedings of the National Academy of Sciences in 2016 that examined “beliefs associated with racial bias in pain management,” finding a sizable number of white laypeople and medical students hold false beliefs about biological differences between Black and white people.
Hoffman et al. found that 58% of 92 white laypeople surveyed believe “Blacks’ skin is thicker than whites,’” compared with 40% of 63 first-year medical students and 25% of 28 medical residents. They found 20% of white laypeople believe “Blacks have a more sensitive sense of smell than whites,” compared with 10% of first-years and 7% of residents. Twenty-three percent of laypeople agreed that “Blacks age more slowly than whites,” compared with 14% of medical residents.
As discussed earlier, the creation of scientific knowledge as an empirical pursuit is relatively recent; medical knowledge was and largely still is based on politics, religion, social norms and so on. Many false beliefs about Black people, including that they have thicker skin, a stronger immune system and less sensitive nerve endings, were proliferated by scientists, physicians and slave owners to justify the inhumane treatment of enslaved people as well as the exploitation of Black bodies for medical research. Rooting misogyny and racism in “biological” differences allows the oppressor to wash his hands of the moral and spiritual implications of his actions.
Hoffman et al. connected medical students’ levels of false beliefs about Black bodies (residents were far less likely than laypeople to hold false beliefs across the board, but when it comes to beliefs deeply rooted in racism such as “Black couples are significantly more fertile than white couples,” 7% is still an unacceptably high proportion) with their ability to provide proper health care to Black patients.
Participants who endorsed more false beliefs rated a hypothetical Black patient as feeling less pain than a hypothetical white patient, and they were less accurate in treatment recommendations for Black patients. The researchers quoted Dr. Samuel Cartright, who wrote in a surgical journal in 1851 that Black people have a “disease [making them] insensible to pain when subjected to punishment.” It was a commonly held belief—and one believed to be scientifically “true” because it was printed in a medical journal—that the Black body is more resilient than the white body, allowing white people to sleep easy after a long day of violence against Black men and women.
The fact that shadows of this belief remain in medicine—and that they lead to the under-treatment of pain in Black patients to this day—should be alarming to medical professionals and laypeople alike.
The similarity between Bailey’s example of how standardizing the white body leads to racial attitudes about the Black body—“Black children mature faster than white children”—and the examples of false beliefs given in the Hoffman study—“Blacks’ skin is thicker than whites’”— shows that this problem isn’t just about representation in medicine but about discourse. More Black students in medical schools would mean more Black doctors and more Black researchers, but if the structure of biomedical education doesn’t change, the discourse that allows false beliefs to persist won’t change.
Bailey argues that “a more collaborative effort between the biomedical sciences and humanities might lead to different sites of inquiry that are much more beneficial to the project of creating a socially just world.” This means that the push to make medicine as objective, empirical and science-based as possible isn’t enough. As we can see from looking back at the development of the medical industry in the U.S., more structure doesn’t always mean better outcomes, especially for women and people of color.
As Bailey highlights in her discussion of medical media, there is a feedback loop between medicine and culture. Medicine is venerated in American culture so medical knowledge influences cultural norms, but cultural norms also influence doctors and how they practice medicine.
Two examples come to mind: anti-abortion activists cling to a handful of biological facts (and medical images) about how fetuses develop in-utero in their attempt to take away women’s medical autonomy. On the other hand, trans activists and the broader move toward trans visibility caused “gender-affirming surgery” to be accepted as the proper medical term in place of terms such as “sex reassignment surgery.” Since the tide goes both ways, changing the medical-industrial complex can begin with laypeople realizing that doctors aren’t gods but fallible individuals with false beliefs and biases. Medicine isn’t a sacred rite far above our heads; we have the power to bend it to our will, recreate it in our image.
As discussed in last month’s essay on l’ecriture feminine, I think the antidote to patriarchy’s insistence on phallic singularity (one right answer, one right body, one god, one truth) is feminine abundance, multitude, subjectivity. The re-introduction of nuance and empathy, the fusion of multiple theoretical perspectives, in order to bring back the ancient feminine spirit of communal healing that was crushed by the commodification of health.
Bailey calls for a Black feminist health-science discipline that incorporates “epistemic frames outside the West, particularly African diasporic understandings of health, the body, and healing that explode the already faltering binaries endemic in Western thought.” Modes of inquiry used in the humanities can be applied to medicine to make it more equitable and transparent; feminist activism and demands for the end of monumentality can be as useful in the sciences as in politics.
If you got to the end of this long essay, thank you thank you thank you. I want to end with a call to action/benediction from Bailey’s conclusion of “Misogynoir in Medical Media”:
“What if we drew on multiple epistemic frames in discourse of the body? What if we did not privilege Western dualisms? We might create a community of scholars attuned to issues on the global and local levels, with the collaborative strength to push for the changes they wish to see.”
Bailey, Moya. “Misogynoir in Medical Media: On Caster Semenya and R. Kelly.” Catalyst: Feminism, Theory, Technoscience 2, no. 2 (2016): 1–31. https://doi.org/10.28968/cftt.v2i2.28800.
Bailey, Moya. “They Aren't Talking about Me...” Crunk Feminist Collective, March 14, 2010. http://www.crunkfeministcollective.com/2010/03/14/they-arent-talking-about-me/.
Dusenbery, Maya. Doing Harm: The Truth About Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick. New York, NY: HarperCollins, 2017.
Ehrenreich, Barbara, and Deirdre English. For Her Own Good: Two Centuries of the Experts Advice to Women. New York, NY: Anchor Books, 2005.
Fausto-Sterling, Anne. Sexing the Body: Gender Politics and the Construction of Sexuality. New York, NY: Basic Books, 2000.
Hoffman, Kelly M., Sophie Trawalter, Jordan R. Axt, and M. Norman Oliver. “Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs about Biological Differences between Blacks and Whites.” Proceedings of the National Academy of Sciences 113, no. 16 (2016): 4296–4301. https://doi.org/10.1073/pnas.1516047113.
Amazing work, Emily. Thank you....
It's, " ...good work by good scholars."