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cassie7e 's review for:
The Lady's Handbook for Her Mysterious Illness
by Sarah Ramey
challenging
dark
emotional
sad
slow-paced
This could have been a very compelling memoir of the self in the face of illness and a dispassionate medical system. In this context, the author's dive into the feminine divine and mythology to map a new narrative onto her experience fits reasonably well. I do think women who have faced medical discrimination, trauma, and dismissal will find Ramey's story troublingly relateable and validating, and bringing these sorts of stories into the public eye is important.
However, the author has grand aspirations to "save all women", and under this lens, fails to be adequately inclusive of trans women facing the same medical misogyny, or trans men experiencing similar illnesses, or recognize her own insane privilege as the daughter of two wealthy doctors who could gain her access to all of the medical institutions and procedures she tallies off in this book. She rails against her horrifying mistreatment, which will be unfortunately familiar to many women and otherwise marginalized people, without putting much consideration into why or how the system is that way. She sees a philosophical failing in Western medicine, which isn't wrong, but diverts her attention merely to alternative medicine, which has many of the same flaws of misogyny, racism, ableism, etc plus snake oil saleship. She does not question her ability to access whichever kind of care she wants to try, or how the average ill person is supposed to access care if even the standard she receives is woefully inadequate.
In "saving all women" she thinks a lot about what it means to be feminine (from a biological but also mythological perspective) that fails to account for non white, non privileged, non cis-heterosexual women, and thus fails to account for most other women that share her predicament. In "saving all women" she writes a prescriptivist account of the very strict individual measures that worked for her, and very little if anything about:
- advocating to change the system as a whole to be less dismissive of women and otherwise marginalized ill people,
- encouraging research into medical research about women's bodies (which often excludes women for menstruation and pregnancy as "confounding factors"),
- addressing structural inequality that means most people can't receive a fraction of the care she does,
- providing advice that may be relevant to all the other conditions she lumps under "mysterious illness" that she doesnt have (like EDS) and therefore can't universally advise on,
- considering that keeping ourselves healthy is not even an individual task but a collective one (which she comes so close to recognizing when describing the role of others in her mental and physical health).
-----Further detailed disconnected ramblings below. -----
Strange that despite Ramey's recognition of medicine being inadequate at a systemic and sexist level, her discussion on HSP's (which feels too vague to be a useful category for people) leaves out discussion on systemic stressors, like racism and ableism, that also affect cortisol levels and inflammation that she spends so much time on. Again no acknowledgement of constant stressors people just cannot remove, like racism and ableism, plus the exclusion from access to resources those things come with, when explaining the solution to cortisol and stress system issues is: "You have to fully reset, and you have to do it in the right ways, with a good guide." Ramey recognizes that this is hard to do when chronically ill and chronically dismissed, and she recognizes the normalization (if not glamorization) of a high stress modern lifestyle. But she doesn't take the next step of noticing how systemic marginalization contributes to that in an unavoidable way, nor investigate whether people of marginalized identites (aka not rich white cis-hetero people like herself) have higher rates of "mysterious illness" or autoimmune diseases.
I found the scientific breakdowns of body systems fascinating and compelling, and so was extra rubbed the wrong way by causal usage of phrases like "sugar addiction" and "adaptogens" without any critical analysis or in-text scientific support, especially given her skepticism for other areas of medicine. I also missed deeper questioning on Ramey's part as to *why* there are disparities with women. She delves into the science of *what* happens differently in women's brains but not anything about how women (and AFAB folks) are socialized differently and placed under different stressors than men, which could influence brain development. Or that living as the wrong gender also creates deep stress. When she points to environment as the main influence for so many things (inflammation/internal stress response, childhood adverse experiences and literal environmental contaminants contributing to susceptibility), why are gender factors presented as inherent? With so much focus on HSP's, why no discussion on how neurodivergence in women, femme, or AFAB people also goes undiagnosed and undetected? This again is another axis of marginalization that intersects with sexism and misogyny that goes unexplored.
Ramey spends much time in chapter 19 grappling with fitting her life to a narrative. Specifically the hero's journey, the format of much of the media she appears to love (evidenced by the frequent reliance on references to LOTR and Harry Potter, which I could do without). She realizes surprisingly late in life how important female representation in stories is, vs how lacking those are in the media we consume. This to me is another symptom of her privilege protecting her from much of the stress and discrimination other women and people face. She recognizes that humans use stories to make meaning of our lives and world. Instead of questioning who makes the stories, she wonders, "is there a heroine's journey?" and studies myths of descent and rebirth and femininity as turning inward. She also compares this heroine's journey to the experience of trauma, where everything is "suddenly upside down" after the initial event, and this stage says the story "looks the same for everyone;" but for many marginalized people, that's how life has always been. She references systemic oppression and acknowledges that marginalized people may think "welcome to the club" but her analysis doesn't convey that she really gets it. Things only flip if you have privilege and normalcy to fall *from*, and only the privileged "don't teach our kids many underworld survival tips." (This isn't to say traumatic events aren't still an upheaval for already-marginalized people, or that everyone knows how to navigate them if they've experienced other trauma or oppression. I just think Ramey's perspective inherently lacks nuance or depth.)
I kept wanting her to make the connection that myths are stories people *tell*, unlike modern media which is *consumed*. Life doesn't change form to fit myth but myth is told to fit life. Meaning comes from the narratives we weave from patterns we see in our own lives after the fact, not from trying to cram our lives into the mold of classic myths as we are still experiencing the events. I do think there's value in presenting alternative narratives, and perhaps this is necessary before you can craft your own (like writing a memoir?). But I also think such narrow focus on narrative arcs can leave one unfulfilled and feeling "meaningless" when life doesn't behave like a story (like she felt about not fitting the hero's journey). Her conclusion that the heroine's journey means trauma survivors come back as healers and guides could leave others despairing they aren't able to make their experience useful, or could place undue external pressure on marginalized people to be wise mentors. This is the context in which she mentions "the LGBTQ community, the AIDS community, the BLM movement, DREAMers, all civil rights activists, all disability advocates, all advocates for survivors of rape and domestic abuse, [and veterans]" - as traumatized groups that help each other, without ever recognizing how systemic oppression *is* the baseline for most of these groups. Her conclusion also still envisions a story as an individual endeavor, when these things are really about patterns of collective support in the face of collective harm! That meaning doesn't just come from oneself or one's own attempt at a story! Again, the lens feels too zoomed in.
In chapter 21 Ramey reclaims the feminine. She rightly points out that previous versions of feminism focused on presenting women as equal, just as capable of success as men, just as able to have masculine traits and behaviors like assertiveness and bravery and ambition. And this focus doesn't resolve the issue that traits associated with femininity, like nurturing and empathy, were still placed second, if not disdained. Ramey shares the useful insight that her own strivance for gender neutrality was born of internalized misogyny, this very fear of disdain, rather than a true sense that she didn't identify with femininity. And she even notes that the gender binary (as in most binaries in Western culture) bears a hierarchy that prioritizes the masculine. (These are all things I learned in my college literature classes.)
But her discussion of gender feels implicitly (and later, explicitly) bioessentialist despite her acknowledgment that femininity and masculinity exist in a different balance in each person and that gender neutrality as a deconstructive movement is still worthwhile.
There's the suggestion that women are inherently more sensitive because the modern "gender neutral" (aka masculine-by-default) life goes against our bodies and instincts. That cis female bodies just arent compatible with masculine drives. That women are inherently linked to feminine traits we are all repressing rather than those traits just being *associated* with women, and being repressed in any gender. But imbalance is unhealthy for men too, not just the exceptions she makes for male HSP's/sensitive men. (Unclear whether "certain male bodies" refers to these sensitive male HSP's, or also is intended to inappropriately include trans men in her discussion of female body systems being disrupted. And are trans women just ignored entirely here, or are they again inappropriately included as "certain male bodies"?) Again Ramey misses an opportunity to examine how systemic oppression places an additional layer of stress on women's bodies, not because of something bioessential but because of being treated as lesser, and therefore this also applies to and is compounded by being queer, black/hispanic/of color, disabled, etc. She consistently acknowledges that marginalized people exist and share the experience of trauma, as an aside, and doesn't integrate them into her discussion that veers toward TERF territory, the way paved with good intentions. The lack of intersectionality by default makes her thoughts almost exclusively relevant and relatable to cis straight white women of means. She thinks it is her pointed acknowledgment that there are biological sex differences that will raise hackles, and not this conflation of sex with gendered associations, and failure to account for any physical trans experience. And would not trans people especially feel this pressure to fit gender ideals that don't align with their natural inclinations, just like women being equal doesn't mean adopting male ideals as "neutral"?
Very useful reviews: Review by izbrews - The Lady's Handbook for Her Mysterious Illness: A Memoir
Review by cuteasamuntin - The Lady's Handbook for Her Mysterious Illness: A Memoir
Review by roanfrancis - The Lady's Handbook for Her Mysterious Illness: A Memoir
https://www.goodreads.com/review/show/3094472196
https://www.goodreads.com/review/show/3846529740
Review of adaptogens as their own concept: https://www.mcgill.ca/oss/article/covid-19-critical-thinking/problems-adaptogens
However, the author has grand aspirations to "save all women", and under this lens, fails to be adequately inclusive of trans women facing the same medical misogyny, or trans men experiencing similar illnesses, or recognize her own insane privilege as the daughter of two wealthy doctors who could gain her access to all of the medical institutions and procedures she tallies off in this book. She rails against her horrifying mistreatment, which will be unfortunately familiar to many women and otherwise marginalized people, without putting much consideration into why or how the system is that way. She sees a philosophical failing in Western medicine, which isn't wrong, but diverts her attention merely to alternative medicine, which has many of the same flaws of misogyny, racism, ableism, etc plus snake oil saleship. She does not question her ability to access whichever kind of care she wants to try, or how the average ill person is supposed to access care if even the standard she receives is woefully inadequate.
In "saving all women" she thinks a lot about what it means to be feminine (from a biological but also mythological perspective) that fails to account for non white, non privileged, non cis-heterosexual women, and thus fails to account for most other women that share her predicament. In "saving all women" she writes a prescriptivist account of the very strict individual measures that worked for her, and very little if anything about:
- advocating to change the system as a whole to be less dismissive of women and otherwise marginalized ill people,
- encouraging research into medical research about women's bodies (which often excludes women for menstruation and pregnancy as "confounding factors"),
- addressing structural inequality that means most people can't receive a fraction of the care she does,
- providing advice that may be relevant to all the other conditions she lumps under "mysterious illness" that she doesnt have (like EDS) and therefore can't universally advise on,
- considering that keeping ourselves healthy is not even an individual task but a collective one (which she comes so close to recognizing when describing the role of others in her mental and physical health).
-----Further detailed disconnected ramblings below. -----
Strange that despite Ramey's recognition of medicine being inadequate at a systemic and sexist level, her discussion on HSP's (which feels too vague to be a useful category for people) leaves out discussion on systemic stressors, like racism and ableism, that also affect cortisol levels and inflammation that she spends so much time on. Again no acknowledgement of constant stressors people just cannot remove, like racism and ableism, plus the exclusion from access to resources those things come with, when explaining the solution to cortisol and stress system issues is: "You have to fully reset, and you have to do it in the right ways, with a good guide." Ramey recognizes that this is hard to do when chronically ill and chronically dismissed, and she recognizes the normalization (if not glamorization) of a high stress modern lifestyle. But she doesn't take the next step of noticing how systemic marginalization contributes to that in an unavoidable way, nor investigate whether people of marginalized identites (aka not rich white cis-hetero people like herself) have higher rates of "mysterious illness" or autoimmune diseases.
I found the scientific breakdowns of body systems fascinating and compelling, and so was extra rubbed the wrong way by causal usage of phrases like "sugar addiction" and "adaptogens" without any critical analysis or in-text scientific support, especially given her skepticism for other areas of medicine. I also missed deeper questioning on Ramey's part as to *why* there are disparities with women. She delves into the science of *what* happens differently in women's brains but not anything about how women (and AFAB folks) are socialized differently and placed under different stressors than men, which could influence brain development. Or that living as the wrong gender also creates deep stress. When she points to environment as the main influence for so many things (inflammation/internal stress response, childhood adverse experiences and literal environmental contaminants contributing to susceptibility), why are gender factors presented as inherent? With so much focus on HSP's, why no discussion on how neurodivergence in women, femme, or AFAB people also goes undiagnosed and undetected? This again is another axis of marginalization that intersects with sexism and misogyny that goes unexplored.
Ramey spends much time in chapter 19 grappling with fitting her life to a narrative. Specifically the hero's journey, the format of much of the media she appears to love (evidenced by the frequent reliance on references to LOTR and Harry Potter, which I could do without). She realizes surprisingly late in life how important female representation in stories is, vs how lacking those are in the media we consume. This to me is another symptom of her privilege protecting her from much of the stress and discrimination other women and people face. She recognizes that humans use stories to make meaning of our lives and world. Instead of questioning who makes the stories, she wonders, "is there a heroine's journey?" and studies myths of descent and rebirth and femininity as turning inward. She also compares this heroine's journey to the experience of trauma, where everything is "suddenly upside down" after the initial event, and this stage says the story "looks the same for everyone;" but for many marginalized people, that's how life has always been. She references systemic oppression and acknowledges that marginalized people may think "welcome to the club" but her analysis doesn't convey that she really gets it. Things only flip if you have privilege and normalcy to fall *from*, and only the privileged "don't teach our kids many underworld survival tips." (This isn't to say traumatic events aren't still an upheaval for already-marginalized people, or that everyone knows how to navigate them if they've experienced other trauma or oppression. I just think Ramey's perspective inherently lacks nuance or depth.)
I kept wanting her to make the connection that myths are stories people *tell*, unlike modern media which is *consumed*. Life doesn't change form to fit myth but myth is told to fit life. Meaning comes from the narratives we weave from patterns we see in our own lives after the fact, not from trying to cram our lives into the mold of classic myths as we are still experiencing the events. I do think there's value in presenting alternative narratives, and perhaps this is necessary before you can craft your own (like writing a memoir?). But I also think such narrow focus on narrative arcs can leave one unfulfilled and feeling "meaningless" when life doesn't behave like a story (like she felt about not fitting the hero's journey). Her conclusion that the heroine's journey means trauma survivors come back as healers and guides could leave others despairing they aren't able to make their experience useful, or could place undue external pressure on marginalized people to be wise mentors. This is the context in which she mentions "the LGBTQ community, the AIDS community, the BLM movement, DREAMers, all civil rights activists, all disability advocates, all advocates for survivors of rape and domestic abuse, [and veterans]" - as traumatized groups that help each other, without ever recognizing how systemic oppression *is* the baseline for most of these groups. Her conclusion also still envisions a story as an individual endeavor, when these things are really about patterns of collective support in the face of collective harm! That meaning doesn't just come from oneself or one's own attempt at a story! Again, the lens feels too zoomed in.
In chapter 21 Ramey reclaims the feminine. She rightly points out that previous versions of feminism focused on presenting women as equal, just as capable of success as men, just as able to have masculine traits and behaviors like assertiveness and bravery and ambition. And this focus doesn't resolve the issue that traits associated with femininity, like nurturing and empathy, were still placed second, if not disdained. Ramey shares the useful insight that her own strivance for gender neutrality was born of internalized misogyny, this very fear of disdain, rather than a true sense that she didn't identify with femininity. And she even notes that the gender binary (as in most binaries in Western culture) bears a hierarchy that prioritizes the masculine. (These are all things I learned in my college literature classes.)
But her discussion of gender feels implicitly (and later, explicitly) bioessentialist despite her acknowledgment that femininity and masculinity exist in a different balance in each person and that gender neutrality as a deconstructive movement is still worthwhile.
There's the suggestion that women are inherently more sensitive because the modern "gender neutral" (aka masculine-by-default) life goes against our bodies and instincts. That cis female bodies just arent compatible with masculine drives. That women are inherently linked to feminine traits we are all repressing rather than those traits just being *associated* with women, and being repressed in any gender. But imbalance is unhealthy for men too, not just the exceptions she makes for male HSP's/sensitive men. (Unclear whether "certain male bodies" refers to these sensitive male HSP's, or also is intended to inappropriately include trans men in her discussion of female body systems being disrupted. And are trans women just ignored entirely here, or are they again inappropriately included as "certain male bodies"?) Again Ramey misses an opportunity to examine how systemic oppression places an additional layer of stress on women's bodies, not because of something bioessential but because of being treated as lesser, and therefore this also applies to and is compounded by being queer, black/hispanic/of color, disabled, etc. She consistently acknowledges that marginalized people exist and share the experience of trauma, as an aside, and doesn't integrate them into her discussion that veers toward TERF territory, the way paved with good intentions. The lack of intersectionality by default makes her thoughts almost exclusively relevant and relatable to cis straight white women of means. She thinks it is her pointed acknowledgment that there are biological sex differences that will raise hackles, and not this conflation of sex with gendered associations, and failure to account for any physical trans experience. And would not trans people especially feel this pressure to fit gender ideals that don't align with their natural inclinations, just like women being equal doesn't mean adopting male ideals as "neutral"?
Very useful reviews: Review by izbrews - The Lady's Handbook for Her Mysterious Illness: A Memoir
Review by cuteasamuntin - The Lady's Handbook for Her Mysterious Illness: A Memoir
Review by roanfrancis - The Lady's Handbook for Her Mysterious Illness: A Memoir
https://www.goodreads.com/review/show/3094472196
https://www.goodreads.com/review/show/3846529740
Review of adaptogens as their own concept: https://www.mcgill.ca/oss/article/covid-19-critical-thinking/problems-adaptogens
Content Warnings
Graphic: Chronic illness, Sexual assault, Medical trauma, Gaslighting
Moderate: Suicidal thoughts, Blood, Medical content
Minor: Drug use, Fatphobia