When Kathy tried to seek medical attention for abnormally heavy periods that were leaving her feeling so faint that she was unable to stand, four different medical professionals said it was all in her head. They concluded she was simply struggling with anxiety and perhaps even had a serious mental health disorder. She says her primary care doctor repeatedly told her, “All your symptoms are your imagination.”
It took nine months for Kathy to be diagnosed with potentially life-threatening uterine fibroids that required surgical intervention. And that was only after she took it upon herself to demand an ultrasound. She was suffering from anemia, not anxiety.
“I was left to my own ability to recognize what was happening and defend myself,” Kathy, who didn’t want to print her last name along with details about her sensitive medical information, told ThinkProgress. “I was being treated as a mental incompetent and as a mentally ill hypochondriac.” She added that she doesn’t believe she would have received the same type of treatment if she were a man.
Kathy’s experience isn’t unique. It can be difficult for female patients to convince health professionals to take their symptoms seriously — which, in turn, makes some women hesitant to speak up about their medical concerns in the first place, for fear of being told they’re overreacting. Ultimately, this complicated interplay between gender roles and the health care system could be putting lives at stake.
Other women have also recounted visiting dozens of doctors for help with painful periods, only to be offered anti-anxiety medication and sent home. In March, the New York Times reported that this is one major reason why the symptoms of endometriosis go ignored in young girls. “I knew something was wrong when I was 15, but no one listened to me,” one woman told the Times.
The issue extends beyond the female reproductive system. There’s a particularly well-documented gender gap in the treatment of pain. Even though women are more likely to suffer from chronic pain — fibromyalgia, for instance, almost exclusively affects women — they’re less likely than their male counterparts to receive appropriate treatment for it. Multiple studies have found that medical interventions to manage pain, ranging from knee surgeries to opioid prescriptions, are less likely to be recommended for female patients. The widely-cited study “The Girl Who Cried Pain” found that medical professionals are more likely to tell women that their symptoms are psychosomatic, a term defined as “a physical disorder that is caused by or notably influenced by emotional factors.”
This means that, just as Kathy experienced, many female patients are told that it’s just in their head. According to a National Pain Report survey conducted last year, a staggering 90 percent of women with chronic pain feel that the health care system discriminates against them. “There seems to be an ‘Oh she’s so neurotic’ attitude towards female chronic pain patients,” one survey respondent said.
This approach toward female patients fits into a long history of attributing women’s behavior to mental health disorders. In fact, the modern-day stereotype that women are dramatic, irrational, and crazy has its roots in a gendered approach to health.
CREDIT: Public domain via Wikimedia Commons
Stretching back to at least as early as 1900 B.C., when ancient Egyptians attributed hysterics to the misplacement of the womb, women’s reproductive systems have been linked with irrational emotions. (The term “hysteria” comes from the Greek hystera, which literally means uterus.) Since then, the notion of female hysteria has persisted, often as a method of deploying health professionals to keep women in line. During the 1800s, for example, the women who attempted to rebel against the Victorian-era domestic expectations for their gender were labeled hysterical and placed in mental asylums and, in some extreme cases, were forced to have hysterectomies.
“Hysteria” was officially removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980, and psychiatrists now consider it to be a pejorative term. However, in this context, it’s not hard to see how gendered stereotypes about women’s emotions may continue to color their experiences as they try to explain how they’re feeling. In fact, some doctors believe that “psychosomatic symptoms” has become the modern-day equivalent of “hysteria” — a catch-all term for physical symptoms that can’t be explained, and are therefore written off as neurological.
In the 1970s, feminist critiques of the health care system started to connect the dots and expose the role that sexism can play in the doctor’s office.
“I think it’s the same deeply rooted sexism that we see in other realms, like when it comes to not believing rape survivors. We don’t trust women to be the experts on their own bodies, or to be reliable narrators of their own lives,” Maya Dusenbery, the editorial executive director at Feministing and the author of a recent piece about gender bias in health care, told ThinkProgress. “But when that comes into the medical system, it’s really dangerous.”
Not every woman is as persistent as Kathy, whose symptoms were finally diagnosed after she kept following up with emergency room, urgent care, and primary care doctors. Particularly since women have been socialized to be passive and deferential to authority, they’re less likely to push back on a doctor who’s telling them that their symptoms are all in their head — and more likely to internalize the message that their issues must be imaginary. In fact, one recent study found that young women sometimes delay potentially life-saving treatment for heart attacks because they’re worried about being told they’re overreacting.
So, just as Sheryl Sandberg of Lean In fame has encouraged women to speak up at work, some medical experts want to empower women to find their voice at their doctor’s appointments. “This is an ongoing issue in the medical field, and we all have to empower women patients, so they know that they need to not be so worried about going to the hospital if they’re afraid there’s something wrong,” Dr. Jennifer Tremmel, a cardiologist at Stanford University, told NPR after the results from that heart attack study were published.
Dusenbery isn’t convinced that’s the solution. She recounted accompanying a close friend to a series of doctors’ appointments before she finally got to the bottom of her mysterious health symptoms. For six months, specialist after specialist told her friend it was probably just anxiety — a process that Dusenbery said left her feeling “enraged.” Both of them, she noted, are already pretty empowered feminists.
“It’s not a problem we can solve on our own,” she said. “There really are these two levels of gender bias happening. There’s the level of actual interactions with doctors and providers, where there’s this unconscious bias that makes them quicker to dismiss problems as psychological in women. But more broadly, there’s the bias in the medical and clinical research that means women’s health is underresearched.”
In a recent piece published at Pacific Standard, Dusenbery argues that these issues need to be addressed at a much deeper level than women’s individual behavior. In fact, one of the big reasons that women’s symptoms baffle doctors is because the research in the medical field hasn’t taken their bodies into account. Clinical trials have overwhelmingly been comprised of men, which means that our current medical research is skewed against the information that may be more accurate for women.
There’s an emerging body of research in cardiology, for instance, confirming that heart attack symptoms present very differently in women than they do in men. Medical professionals simply haven’t been adequately trained in those differences — so women suffering from heart attacks are being sent home from the hospital because their doctors don’t recognize what’s happening to them.
“Doctors are trying to do the right thing. It’s not that they’re trying to be mean or dismissive,” Dr. Janice Werbinski, the executive director of the Sex and Gender Women’s Health Collaborative (SGWHC), told ThinkProgress. “Gender differences just are not in the training, which is what our organization is trying to work on.”
SGWHC advocates for bringing a sex and gender perspective to clinical practice. While the research into gender-specific health issues has recently been progressing, that information can be slow to make it into medical schools’ curricula, so it doesn’t always trickle down to doctors in the field. Werbrinski and her colleagues believe more work needs to be done to integrate this knowledge into medical education.
According to Werbinski, that could even include information explaining to doctors why it’s not helpful to tell female patients their health problems are in their head — and pointing out that, in fact, women may be presenting symptoms that aren’t yet well-recognized by the medical establishment. “It needs to be in the curriculum of caregivers so that we don’t jump to the conclusion that it’s psychosomatic, and at least validate her symptoms and tell her that we just don’t know what’s wrong,” she said.
Dusenbery said that, as a young woman, she’s “never been more aware of patriarchal authority” than when she’s trying to interact with the health care sector. She’s surprised this aspect of gender relations isn’t discussed more broadly, especially since many of her female friends have similar stories about struggling to diagnose their symptoms. “It feels like one of those things where once you start talking about it, everyone has their story and that really opens the floodgates,” she said.
“We need women to document their experiences and share them so society becomes aware,” Kathy agreed. “This has been going on for centuries…. conversion, hysteria, the name changes but it’s the same and it’s still happening today. No woman should have this experience in today’s day and age.”