Recognition of women’s contributions to reproductive medicine has been a long time coming. And the contributions of enslaved women were considerable and until recently, largely unheralded.
But Charly Evon Simpson’s play, Behind the Sheet (playing at Ensemble Studio Theatre in New York until March 10), makes an admirable start. In this remarkable piece of theater, Simpson retells one of medicine’s most painful origin stories and skillfully reframes a wrenching history into an utterly modern tale about consent, the power of physicians, and the need to heed Black women’s voices and human rights.
Set in the 1840s U.S. South, the play shows how enslaved women were systematically seen as subhuman and deprived of autonomy. Yet the Black bodies that were often viewed with disgust and as fundamentally different from those of whites were used for experiments that advanced the medical field. Gynecology’s cornerstone achievements were made by using enslaved women to investigate the female reproductive system. Operating on them without anesthesia, physician and onetime president of the American Medical Association J. Marion Sims figured out how to repair vaginal tears called fistulas by using silver stitches and invented the double-bladed speculum that’s still used to examine the vagina and cervix. Known as the father of modern gynecology, Sims was celebrated in a statue outside the New York Academy of Medicine until activists questioned its place. It was removed last April.
Enslaved women also played a key role in assisting in the surgeries, securing the cooperation of the women, and providing whatever after-care was offered. Without their work and supervision, this research would have been extremely difficult. Behind the Sheet stands out as the first theatrical piece to honor enslaved women for their dual roles as both guinea pigs and workers who moved gynecology forward.
Sex. Abortion. Parenthood. Power.
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A fictional version of Sims, a Dr. George Barry, figures in Simpson’s play. But the play is not a triumphant vehicle for the doctor’s achievements.With reverence and care, Simpson’s script and Colette Robert’s direction of Behind the Sheet let viewers understand how thoroughly slavery demolished any notion of bodily consent—and, in fact, was built on lack of consent. Though modern ideas of consent didn’t exist for anyone during the period, enslaved women were chattel and had no choice in whether their bodies would be cut, sutured, and cut and sutured again; Sims performed as many as 30 gynecologic surgeries on a single woman—without anesthesia.
Anesthesia, it should be said, was relatively new at the time, and Sims claimed he wanted to know more about it before using it widely. He did, however, use it on some white women and believed that Black women simply didn’t feel pain like white women during childbirth and surgery.
During the play, women scream in agony and groan offstage. Audience members are bystanders to their suffering. I wished that I could jump out of my seat and help. The visceral experience of hearing women’s anguish asks us to think about how we witness Black women’s pain—and argues that we should trust their testimony. Two of the women have plenty to say about being forced to go through many surgeries that did not heal their fistulas. They dread another surgery, as they lumber across the stage slowly, fearing that Dr. Barry will force it before they have healed. Surgical damage leaves them with even more bad aromas, and they devise a new perfume to manage the smell.
In a talk-back session after the show, Simpson acknowledged that she is drawn to writing about topics that scare her and indicated that she has gynecological worries of her own. She connects many of her fears to the way Black women were treated in Sims’ time, questioning whether gynecology has really progressed and whether it’s come around to view Black women with dignity. A recent tweet shares her own fears:
perhaps TMI but…
them: why do you write about gynecology so much?
but also because today i should not be bleeding but i am and so i'm told this is not "normal" but since no one can tell me why i'm told this is "normal" but like whats happening to my body?! pic.twitter.com/56IDV3ILIO
— Charly Evon Simpson (@CharlyESimpson) March 4, 2019
It’s easy to see why Simpson’s gynecological problems scare her. Centuries of disregard for Black women have landed us in a maternal health crisis, where Black women are the most likely to die from pregnancy-related causes. Last year, Serena Williams’ experience taught us that when Black women can sense that they are in danger during and after childbirth, even celebrity can’t shield them from doctors’ reluctance to trust them. We have a lot to learn about listening to Black women in health care. Behind the Sheet provides an artistic reckoning, centering the early medical research on disenfranchised subjects who were operated on and doubled as surgeons’ confidants and aides.
Naomi Lorrain, who plays Philomena, ably portrays the horrific burden of being enslaved by the operating doctor while functioning as his assistant, sometimes undergoing surgery, and enlisting the cooperation of other enslaved women. At times, Dr. Barry praises her and gives her special privileges. But he also forces her and the other slaves who are his property to hold women down during surgery.
When the play opens, Philomena is also pregnant with Dr. Barry’s child. When the baby is born dead, Philomena is traumatized. She develops a fistula, which the doctor has not yet figured out how to treat successfully. The experience awakens Philomena, and she shows far more solidarity with the other enslaved women. She transitions to a much better understanding of what women go through and how they cope with harms connected to childbirth and surgery.
In the epilogue, we learn that Sims was not known to have sex with any of the enslaved women, but history tells us that sexual violence was at the heart of slavery. This plotline doesn’t feel like a stretch.
We also know that many enslaved people practiced lay medicine or helped “regular physicians”—what passed for trained doctors in their time—ply their trade. But in the many years I have written about medicine, I have been struck by the portraits of white male doctors filling the hallowed halls of medical schools and hospitals. Only rarely do you see women or people of color pictured. As we watch films such as The Wife and Hidden Figures, as we observe efforts to increase diversity in scientific fields, we need to think about the women who worked alongside doctors of the past, were skilled in their own rights, and often paid a cost just for being in the room with celebrated men. Behind the Sheet offers a beginning.