By: Cara Lewis
Art by: Asya Ulger
Introduction
Francis Gall’s doctrine of phrenology has always been heretical. By claiming that external features of the cranium indicated behavioral traits, Gall contradicted the contemporary Christian belief that all white men are born equal, discarded neuroscientific localization of function, and preyed upon pervasive prejudices. The governing body of Austria was so offended by Gall’s claims that he was prohibited from lecturing on his theory in 1802, but this only increased Gall’s notoriety. Despite its egregious claims, phrenology’s legacy of physical bias and sexism continues to infiltrate and degrade public health by propagating bias in biomedical research.
Phrenology quickly became a household topic and a widespread belief in the Western world. Johann Kaspar Spurzheim, who lectured in Ivy League halls, brought phrenology to North America, where a feverish following latched onto the easily accessible insight into personality and mind via the concrete and visible. Phrenology readings became common prerequisites for job openings, hairstyles shifted to display covetable phrenological features, and phrenology storefronts offering readings for employment credibility crowded into major cities. Phrenology won the hearts of lay-people because it was “magic” dressed up as science.
Gall’s pseudoscience, shrouded in parlor-game mystique, clung tightly to confirmation bias and prejudice. Post-mortem analysis of figures such as Aaron Burr only corroborated what was commonly known about their public prominence, renowned phrenologist Charles Carwell derived a “tamablenss” and need to “have a master” from the generalized skulls of African people. Physiologist Samuel Morton used phrenology to justify the removal of Native Americans by indicating as a whole they were “adverse to cultivation, slow in acquiring knowledge.” Lorenzo Fowler built strict gender roles and expectations into his books’ phrenological charts, often indicating a female lack of intelligence due to an overactive organ for loving and focusing on family. Phrenology flourished because it allowed prejudice to become a self-fulfilling prophecy and offered lay-people a potential insight into the minds of those around them.
Even with pragmatic arguments and evidence against this pseudoscience, phrenology lingered at the forefront of Western culture for the better part of a century. Feverish followers and phrenology societies avidly drowned out critics until proponents of reason finally prevailed, debunking the practice in the 20th century with accounts of obvious error, criticisms over the lack of reputable evidence, and the sheer variability of methods. In 1888, The Britannica published a rebuttal to the practice which included a heavily prophetic caveat that “[phrenology], based, like many other artificial philosophies, on an admixture of assumption and truth, certain parts will survive and become incorporated into scientific psychology, while the rest will in due course come to be relegated to the limbo of effete heresies.”
Results
While phrenology as an explicit practice has faded into the background, its implicit biases permeate into biomedical research of the 21st century. In 2013, an infamous article titled “Attractiveness of women with rectovaginal endometriosis: a case-control study” by Paolo Vercellini et al. was published in Fertility and Sterility, one of the most reputable journals for doctors and scientists studying infertility and human reproductive disorders. This article, peer-reviewed and published, utilized a scale for physicians to subjectively assess the attractiveness of female patients about to have surgery to treat endometriosis. In the conclusions Vercellini et al. delineate a correlation between more aesthetically attractive female patients and severe endometriosis, adding that these more attractive women should have altered patient care to accommodate them. Explicitly the article stated that “women with rectovaginal endometriosis were judged to be more attractive… they had leaner silhouettes, larger breasts, and an earlier coitarche [first sexual encounter].” Reportedly, the women in the study were not asked for their consent to be judged for their attractiveness, non-Caucasian female patients were excluded completely from the study, and patients were required to strip in front of the physicians so that they could assess aesthetics and take breast measurements. While this study did not explicitly claim to use phrenological arguments, it borrowed from the paradigm that physical appearance can lend insight into internal systems while using subjective measures based on racial and sexist ideologies.
Methods
Even with their biased methodology, Vercellini et al. completed the standard steps for planning and executing biomedical research. Vercellini et al.’s study used female patients from the University of Milan’s OB/GYN department. The “local institutional review board” approved the research design. All participants signed an “informed consent” waiver, yet “to limit potential unintentional seductive behaviors that might have swayed the rater’s judgment, information on the specific hypothesis of different degrees of attractiveness was not given in advance of the physical assessment.” Astonishingly, the article underwent intensive peer review and editing before publication in Fertility and Sterility. After seven years of criticism, outrage, and letters that were met with strict silence from the publisher, Fertility and Sterility retracted the article at the request of the authors. How is it that every layer of ethical review and bureaucratic red tape failed to arrest the miscommunication of blatant, sexist pseudoscience?
Vercellini et al. were able to publish their objectifying and misogynistic paper because sexism’s prevalence in biomedical research transcends explicit pseudoscience and prejudice. Across nine biomedical journals, Geller et al. found that only 37% of studies included both male and female participants. Kannan et al. reported a cross-sectional study of biomedical research recruitment and found that the underrepresentation of women in clinical trials is due to recruitment bias and not a lack of female volunteers. Additionally, due to the combination of false assumptions that the estrous cycle increases the heterogeneity of the studied population and that sexes are affected identically by diseases, female subjects such as cells, mammals, and humans are systematically left out of biomedical research. The average reports for adverse drug effects are higher for women based on the fact that the majority of research processes are tested on male subjects. An article from Nature states that an average of 22% of papers submitted for open-access title eLife publication place female authors as the last authors (a sign of rank) and that only 20% of peer reviewers are women. Each level of biomedical research is riddled with inequity, often stemming from misinformation and pseudoscience that work against women’s health.
Discussion
Phrenology and other pseudosciences are detrimental to health. The misinformation and prejudices that they support extend past party tricks and into the real science needed for biomedical research. Phrenology has left a lasting impression that physical attributes can reveal traits that support prejudices. This ideology is implicitly employed in many biomedical studies, including that by Vercellini et al. Dr. Kate Young, an OB/GYN, commented that the Vercellini et al. paper is “a really good example of what happens when we do research about women but not for them… We need research to be influenced by the people who it is for.” Additionally, we need biomedical research to be influenced by the ailments themselves and not visual bias. Phrenology’s legacy is an immensely harmful fallacy that prejudiced perception of appearance can give insight into underlying biological processes. The most dangerous and societally parasitical pseudoscience are the ones that stand on the foundation of prejudice.
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