On Masculinity and Disease

Over the past few days I have, of course, been laughing very hard as we collectively watch Miss Rona skip through the White House staff like, well, a highly infectious virus because that is literally how it works? ANYWAY, while that is very very funny, it is not the thing I have been thinking about this week. Instead, what caught my attention was the interest from a huge swathe of Americans in relating to illness and the vanquishing thereof as a specifically masculine trait. By this, I mean, all the insistence that Trump can just man his way out of a disease and that other men are feminine for doing stuff like wearing masks.

Exhibit A

As we have discussed at length before, medieval (and indeed any pre-germ theory) conceptions of health and the body were very different to how we tend to think about them now. Medieval conceptions of health, like those of the ancients, and indeed those of most everyone in Europe up until the nineteenth century hinged on ideas of the humors. We aren’t going to go through all of that again, because I have already written on it (over and over and over again), but suffice to say the idea was that bodies have a balance of the four humors (blood, black bile, yellow, bile, and phlegm) which need to be kept in balance for an individual to be healthy.

Conceptions of what a “healthy” body was like depended on the balance of humors and their qualities: hot or cold, dry or wet. The balance of these qualities in any given person or group were part of what were referred to as the “complexion”. The theoretical healthy complexion was always up for debate, but in general it was certainly true that it was thought of as gendered. Within this system, men were by definition considered to be hot and dry. Women, defined in opposition to men, were therefore cold and wet. While the degree of moisture across gender was agreed, it was the heat that was most important. The very hottest woman would always be considered colder than the coldest man by virtue of their very nature.

The four personality types, as horsemen, according to humoral theory. British Museum object 1932,0611.1.

What is relevant to our purposes here as that this hotness had what was considered to be some bonus side effects for men in terms of health, in that it could be used to burn off excess or ill-balanced humors. Men were thus seen as a bit like a crucible that could burn off harmful illness before it became an issue. Men were thus seen as being “naturally” hale and hearty and better able to withstand sickness.

The heat of men also meant particular things for what was interpreted as the “natural” temperament of the average man. Pietro d’Abano, the thirteenth and fourteenth century natural philosopher and physician described that character thusly: “The males’ spirit is lively; given to violent impulse; [it is] slow getting angry and slower being calmed. He is long-suffering at the tasks of labor; in deeds eager, able, noble, magnanimous, fair, confident; less flighty and less assiduous and maleficent.” [1] Again here we see an emphasis on conceptions of strength and self-regulation. Men, to use a term from the sport of professional cycling, know how to suffer. They can put up with something that is uncomfortable and bear through it. Men are also confident and bold, willing to face issues head on in a brave manner.

There was, of course, a flip side to this in women, who were cold. Just like men they could have imbalanced humors, but as they weren’t hot their bodies couldn’t refine and burn off excess humors. As a result, it was theorised that menses existed in order to help purge the body of the excess humors that could not be refined. Menstruation therefore held an ambiguous position in terms of medieval thought. It was, all in all, a good thing because it allowed women’s bodies to purge themselves in order to maintain their health. However, it was also seen as a vaguely toxic attribute, and ancient philosophers such as Pliny the Elder claimed that menstruating women would cause crops to fail, iron to rust, wine to sour, and trees to lose fruit.[2] Medieval thinkers took this shit seriously, and it was therefore considered that all of that retained excess humor was much like a poison and even if women could get rid of it through bleeding it still retained its poisonous nature.

Even if they did eventually burn off the excess humors which could make them sick, women still carried them around, meaning that they were simply not as physically strong as men. Even blog fav Hildegard was very clear on her belief that men could just do more physical stuff than women as a result. She pointed out that, “A male who is of sound body is not much harmed if he walks or stays standing for a long time … a man who is weak should sit, since if he were to go or stand, he would be harmed. Woman, however, since she is more fragile than man, and since she has a divided skull, should walk and stand in moderation, but should sit more than she runs around, lest she be harmed.”[3] In other words, men are strong and women are not, and this is a natural way of considering them based on the humoral composition.

A man on his death bed, like a total girl. British Library, MS Additional 37049, f. 38v

All in all then a specific gendered conception of health and ability was very carefully built across the medieval period, with the help of all the dead Greek and Roman philosophers who were continuously wanking on about how men were “more perfect” than women. (I am looking at you Galen.) Being more perfect meant that men were more in balance day to day. Being more in balance meant an innate and in-built ability to simply ward of disease through natural heat alone. As men aged and crept ever closer to their inevitable deaths they cooled slowly, meaning that they would lose some of the ability to ward of disease that younger, more hale figures might have. But the more masculine and hot a man was, the better he would be able to ward off illness just though sheer manliness alone.

Of course, this is not, in fact, how diseases work. It was instead it was a theory that was based on centuries of observation work and refining, and also a way of attempting to give a “rational” explanation of men’s “natural” superiority and therefore fitness to continue to dominate all of society.

In theory, now that we know how viruses and bacteria work, and understand the role of the immune system in reacting to these things we could, then, discard our old conceptions about how one’s gender is a deciding factor in healthy. Again, and much like humoral theory, this theory is also incorrect because wow LOL a lot of you hoes seem to think you can just, like, out man a fucking disease? Just like be a manly dude and therefore avoid it?

 This has lead to a couple of gendered reactions during the whole COVID situation. First there is the idea that if one is frightened of contacting the disease they are behaving in a feminine manner. Because, you know, women are frightened of illness. They are frightened because they are simply predisposed to be frightened by virtue of their very bad personalities, yes, but also because since they are so weak they might actually get sick. What a shame! Who would do the second shift??? Therefore we see stupid gendered stuff when men do chose to take precautions like wearing a mask, or not licking the faces of everyone they see on public transport or whatever.

The Second thing that is going on here is the idea that even if a man did get sick from COVID if he was manly enough he would simply be able to overcome it. Because being a man means being strong and robust and able to overcome fluid in the lungs or something. IDK.

King David and a fool, which is what you look like when you pull this masculinity nonsense. British Library Royal MS 2 B VII, f. 150v

All of this is extremely interesting to me because while we have completely overhauled our scientific knowledge in an area we still want to keep the cultural messages around illness that are left over from the medieval period. We know perfectly well that we are living through a pandemic. We know how viruses work, and we understand that in order to combat them we have to keep on top of inoculations, and until we can do that we need to just try really hard not to come into contact with said virus. We also know that men actually have a significantly higher chance of getting a particularly serious case of COVID, and are 2.4 times more likely to die of it than women are. [4]

Despite all of our big knowledge, all of the science that people now looooovvveee to go on about to prove that we are so much smarter than medieval people were, we are absolutely desperate to keep the bit that says that Dudes Rock and anyone who comes down with the super virulent virus is actually just a girl and should have tried manning harder. This is stupid as hell. You can’t out manly a virus anymore than you can out woman a fucking rowboat. The two things just don’t equate to each other, but basics never miss an opportunity to point out that the worst thing you can possibly ever be is a woman, and that being one is shameful. So shameful, in fact, that you should avoid womanly stuff like trying not to catch a virus.

Conceptions of masculinity and health in the medieval period aren’t necessarily a monolith. As my colleague Erik Wade pointed out on Twitter the other day, there were instances where we have stories in which kings prayed to be inflicted with disease in order to stave off sexual desire, and this was presented as a worthy undertaking. Modern historians have reacted to this story as a way of talking smack about King Alfred after death because no man would wish to be thought of as ill and weak. As Erik pointed out, that probably says more about how we feel about masculinity than medieval people. However, I would also argue that a king’s willingness to suffer discomfiture in order to maintain his sanctity is absolutely a masculine move that modern historians are just misreading it because of our own cultural obsession with vigor. There are layers to it all, is what I am saying.

Having said all of this, my point is that one of the amusing features of our own society is a willingness to learn more scientifically and yet refuse to update our culture in order to reflect that fact. If we are the rational beings that we so desperately want to claim we are, it would theoretically be more masculine to be frightened of COVID because of the increased likelihood of death. Instead, we are choosing to stay with the old humoral theory of masculinity. Men are brave! They are strong! Their manliness on its own conquers disease!

So here we are, still in the middle of a pandemic and still in the midst of a self-perpetuating and self-destructive idea of masculinity. This isn’t helping anyone, least of all men. If we as a society want to pretend that we have somehow come a long way from the disease theory of the medieval period, I am afraid we are going to have to give up on the whole badgering men about their masculinity thing. And maybe admit viruses are real and probably don’t care about your posturing. IDK.

[1] Peterus de Padua, Liber compliationis physionomie, quoted in Joan Cadden, Meanings of Sex Difference in the Middle Ages, pp. 187-188.
[2] Pliny the Elder, Natural History, Book VII, chapter 15, 64-65.  
[3] Hildegard, Causae et curae, pp. 107-8
[4]  Jian-Min, Bai Peng, He Wei, Wu Fei, Liu Xiao-Fang, Han De-Min, Liu Shi, Yang Jin-Kui, “Gender Differences in Patients With COVID-19: Focus on Severity and Mortality”, Frontiers in Public Health, 8 (2020), 152.

If you enjoyed this, please consider contributing to my patreon. If not, that is chill too!

For more on medieval medicine, see:
On collapsing time, or, not everyone will be taken into the future
A Black Death reading list
Chatting about plague for HistFest
On individual blame for global crisis
Not every pandemic is the Black Death
On the plague, sex, and rebellion
On Medical Milestones, Being Racist, and Textbooks, Part I
On Medical Milestones, the Myth of Progress, and Textbooks, Part II
On medieval healthcare and American barbarism

Author: Dr Eleanor Janega

Medieval historian, lush, George Michael evangelist.

5 thoughts on “On Masculinity and Disease”

  1. Your observation
    “There are layers to it all, is what I am saying.”
    reminds me of my favorite quote from the late Susan Leigh Star:
    “There is no such thing, or place, as Underneath It All.”
    I don’t have the cite-possibly an article on brain localization, with the subtitle “How Universality Biases Get Started”–but that sentence has been one of my small collection of unforgettables since I came across it thirty-some years ago.


  2. Love it. I have also been thinking on this and might write something expanding on a few tweets I hastily sent out the other day.


  3. I’m glad you are addressing the social construction of masculinity. Socialization is a powerful tool, which is then codified by society. Hyper-masculinity is completely toxic and unhealthy for everyone. Great post. 🙂


    1. Yeah and I think it isn’t something we talk about enough. I think when people think of “gender” they think women, because the idea is that men are one thing and women are the gendered thing, as if our society isn’t constantly telling men extremely terrible and damaging things. This helps exactly no one, and I think we have to unpack it all.

      Liked by 2 people

  4. I grew up denying my illnesses and pain. why? dunno. my parents were just that way. once I met my late wife that changed. she suffered many conditions and she taught me it was ok for me to acknowledge my own. it’s not weakness. if you’re sick try to fix it. otherwise, deal. you do what you have to do

    Liked by 1 person

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