Every day we are more aware of the gender bias in medicine when it comes to knowledge of the female body and pathologies. As a result of the hierarchy that has remained undisturbed for so long in Western society, women’s diseases, or their particularities in disorders common to the entire population, are less known. Science, far from being neutral, responds to the interest of power, always in the hands of the wealthy white man. Becoming aware of the imbalance not only allows us to investigate in other directions, but also to review the past with new eyes.
The latter is what Joyce Carol Oates (Newport, New York, 1938) does in her new novel, Butcher (Alfaguara, 2024, trans. Núria Molines Galarza), in which he puts himself in the shoes of Silas Aloysius Weir (1812-1888), known as the father of modern neurology and “gynopsychiatry”, a doctor who experimented with methods controversial issues in a women’s psychiatric center. The prolific and versatile author, who over six decades of career has received, among others, the National Book Award, the PEN/Malamud Award, the Prix Fémina étranger, the BBK Ja! Bilbao and the Pepe Carvalho Prize, narrates, as in the masterful blonde (2000), the life of a controversial historical figure.
If in his recent novels he tended, even in the longer ones, to direct narration, with short sentences and short fragments (A book of American martyrs, Babysitter), in this he is inspired by the literary techniques of the 19th century, in particular by Wilkie Collins of The moonstone (1868) and The lady in white (1860), to build a complex, multi-faceted, evocative and immersive story. The approach takes an (imaginary) book edited by the doctor’s eldest son after his death, in which he copies extracts from his father’s memoirs, complemented with testimonies from those who knew him and some notes from his harvest, to dismantle the hagiographies that obituaries were dedicated to him.
Portrait of a shy man
The son did not understand his father, so he contrasts the vision that the doctor gives of himself in his writings with the experiences that those who treated him had with him: the patients, with their crude stories, but also some colleagues and even a woman who gave him pumpkins in his youth. They remember him in his beginnings as a young man who stood out neither for his intellect, nor for his talk, nor for his attractiveness. Medicine ran in his family, but, given that he was not the firstborn – for whom privileges were reserved – and that he did not stand out as a student, he had to train at a second-rate school.
As a recent graduate, he was clumsy, awkward, and insecure, especially with women. He was terrified of blood, although when he was the one applying the bleeding he revealed himself to be cold and bloodthirsty. However, the ineptitude that others see contrasts with the image that he has of himself in his chronicle: although he admits certain hesitations, he justifies himself, does not accept reality, and points the finger at others. He has an unwavering confidence in his potential, that anger at knowing that he is ignored by everyone (family, marriageable young people, colleagues) fuels his desire for social advancement. Because he is not satisfied with being a good doctor, no: he wants to be a research pioneer. And learn to take advantage of adversity.
Bad times to be sick
The lack of scientific evidence of many widespread practices, such as bleeding (“when in doubt, bleeding”), together with the social inequalities and the puritanism prevailing in American society at the time, were the ideal breeding ground for a medicine that Seen today, it is chilling. It all started with training: medicine was not considered a prestigious professional practice, but a trade; and it was taught both in important universities and in less prestigious schools, with worse materials and internship programs. The protagonist, due to his meager qualifications, goes to one of these, where he barely touches a real patient during his training.
Ignorance of the human body, because it is not enough to know it with illustrations or dissected remains to treat a sick person, together with social segregation and the lack of public healthcare, meant that a poor person had less chance of being cured than someone of high birth. The least qualified doctors were assigned to impoverished areas, where they treated workers who were more prone to workplace accidents and poor health in general due to malnutrition. In the book, Silas Weir cowers before the rich; On the other hand, perceiving the slaves as inferior, he acts more decisively (and less cautiously). A circle of precariousness that feeds on itself.
Women’s (mental) health
The situation is complicated when the patient is a woman: the young doctor has not seen any naked female body, and even the veteran from whom he learns the trade is used to treating them, the more dressed the better. Christian ideas that relate the body to sin – Eve’s original sin resides in the sexual organs of women, Silas Weir often repeats – make both doctors and patients shy. They delay, out of embarrassment, the moment of making an appointment. It was a time when it was a sin to look naked in the mirror and they did not even undress in privacy; They had relations covered by a chaste nightgown.
There are also pathologies exclusive to women, such as pregnancy. For Silas Weir, however, everything changes when he is relegated to the care of some immigrants: he has less squeamishness with these women, and dealing with them helps him toughen himself up. One day he is called to the Trenton State Lunatic Asylum, a turning point in his career: he treats an albino girl – albinos were associated with the devil – a deaf-mute for whom he must perform an abortion. Despite his clumsiness – the nurse is the one who guides him – at the hospital they are satisfied with his service and later make him their regular doctor. By then he is already obsessed with the young albino girl.
The women interned in said center were the outcasts of the outcasts, and became the target of his experiments, which he wanted to investigate their psyche, a branch that he called “gynopsychiatry.” Thanks to the secrecy with which the hospital operated, he was able to try out the most savage practices at will (it was during that first abortion that he held the first “butcher” knife in his hands); One of the witnesses in the novel is the gravedigger in charge of making some bodies disappear. With the albino, he also maintains an ambiguous relationship, between rejection and attraction; That thread marks the line of tension of the novel.
In a troubled mind
Butcher It is a novel, not a biography. Oates does not expose what he has discovered through research, but rather relies on it to create the character according to his point of view. And the Silas Weir that she proposes is a challenge, for her as a writer and for the reader: he is an unreliable narrator, someone whose sanity must be questioned. To what extent is he an honest man, who only acts in accordance with the education and values that have been instilled in him? To what extent does it exceed? Can you be considered a sadist? Other points of view are of great interest there: testimonies that share his same principles, but that do not judge him as he judges himself.
Silas Weir married, was the father of a large family who, starting from beginnings in which he depended on family money, rose to make a name for himself as a pioneer for his experiments. Outwardly, a successful doctor with an exemplary family life. However, as readers we know the dubious nature of his practices, his lack of charisma, those fears that never completely went away. In some way, when portraying him, the author does not limit herself to remembering him as a historical curiosity, but rather warns of what it means for society when someone like that, self-conscious, without scruples, succeeds. And the risk of ignoring him, of making fun of him; Anger is not always channeled in the best way.
Institutionalized violence
Oates is known for narrating violence without euphemisms: violence against women, against black people, against the poor, domestic violence, bullying. Throughout his career he has captured the divided American society like no one else, for example in A book of American martyrs (2017), where he recounts the murder of a pro-abortion doctor at the hands of a fanatic, a starting point that helps him fully enter into the differences between their families. She says she doesn’t write about violence on purpose, but rather finds that the topics she wants to discuss inherently carry violence. This is what happens in Butcher.
Social violence, sexist violence, physical and psychological violence, all with its characteristic crudeness (the stories of the victim-patients are horrifying). He likes to provoke the reader, as if to say: do you buy this doctor doing what he does because really Do you believe in it? Do you buy that progress, in other times, was this? As he immerses himself in an agitated mind, he outlines a social x-ray of the 19th century, with its customs, its hierarchies, its contrasts. He does not forget his commitment to the most vulnerable (women, immigrants, blacks); reading it is going down to the battlefield. She too short in writing; but his instrument is fine as a scalpel. There are no gratuitous stabs, and there is a chance for redemption.
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