Hysterical history: Medical misogyny, gaslighting and trauma in women’s healthcare Part 1
“There is to this day a pattern of dismissal that is compounded by a lack of value placed on the female patient's lived experience and a distinct bias and inequality when it comes to research and precision guidelines for women. This is not a hysterical statement. The heartbreaking statistics don’t lie.”
- Ericka Thomas
Transcript
Ep 191 Hysterical history:
Medical misogyny, gaslighting and trauma in women’s healthcare
Part 1 of 2
There’s nothing harder than being sick and I think we can all agree that modern medicine today, as miraculous as it can be, is more of a sick care system than a health care system. But we all deserve to have informed consent when it comes to making decisions about our health. The bigger issue in modern medicine is the loss of partnership with our health care providers. Gone are the days when you had an actual relationship with your doctor. We have sacrificed compassion, curiosity and communication for copays and codes. Physicians are quicker to reach for the prescription pad for symptom suppression rather than to engage patients in sustainable health and behavior change opting for pharmaceuticals over personal responsibility. Medicine is now big business where patients are churned through the office without a second glance. Unless you’re a man. There is to this day a pattern of dismissal that is compounded by a lack of value placed on the female patient's lived experience and a distinct bias and inequality when it comes to research and precision guidelines for women. This is not a hysterical statement. The heartbreaking statistics don’t lie.
Our work IN today is a mix of healthcare history and a rebellious call to action for women everywhere to stand up, challenge the establishment and raise the standards of care for themselves and our daughters.
I like to believe that on the rare occasion that I need to seek medical care those medical professionals have my best interest at heart. I want to believe that they are fully present and actively listening to what I am telling them. That when they respond to my questions and symptoms it’s with an open mind and the very latest in medicine. That they base their recommendations on current science rather than the last pharmaceutical rep brochure. And that if they aren’t comfortable with the issue at hand that they’re willing to say so and refer me to someone who is. I want to believe that my doctors are not limited by insurance codes and time constraints. That if I don’t feel well sitting in that office they will do their best to be part of the solution.
Sadly I know these things are naive expectations. And it’s not that doctors and nurses don’t care about the health of their patients. It’s simply the nature of the beast. Our healthcare system is in crisis for many reasons that it is unrealistic to expect will change anytime soon. And for that reason we as consumers of healthcare need to be more savvy about getting what we need from it. It’s even more important that we take responsibility for our own health so when we do need medicine we can navigate that system. It’s terrible when you feel sick and need help and don’t have an advocate to help you wade through the insurance, medical jargon and red tape to get what you need. But it’s even worse when you suspect that you’re being dismissed out of hand.
For women this is common.
Let’s look at some history.
Excerpt from an online article in Confluence Medicine and Misogyny: The Misdiagnosis of Women
by Ally Greenhalgh Posted on December 6, 2022
“The origins of Western medicine can be traced back to Ancient Greece. One of the most notable figures was Hippocrates. Considered “the father of medicine,” he is widely recognized for his role in establishing standards of ethical conduct within medicine, known as the Hippocratic oath. However, he was also the first to use “hysteria” as a formal diagnosis, and in doing so, set a standard of unequal medical care on the basis of gender. Derived from the Greek word hustera, meaning “womb,” hysteria was thought to be caused by “a uterus moving through a woman’s body, eventually strangling her and inducing disease.”1 “This “disease” had no distinct set of symptoms, and it was subsequently used to explain essentially any display of emotional volatility, deviancy, or “strange behavior” in women. The female reproductive organs, therefore, were understood as the physiological cause of psychological illness.
This is the beginning of the belief that men are biological and women are psychological It’s hard to believe that there still remains an unconscious bias that women somaticize symptoms but you can trace the medical evidence through history.
“Hysteria, although no longer a legitimate diagnosis, is still used to describe “overly emotional” women and has led to their unfair characterization as inherently unpredictable or untrustworthy. “
Hysteria as a diagnosis enjoyed pride of place in the DSM up until 1980 when it was removed.
All of western medicine, textbooks and theories are based on beliefs that women are more vulnerable and weaker than men. I’m not making that up. It is in the history.
Fast forward to today… when we can measure through statistics the differences in how men and women are treated for various illnesses. Fun fact…Women wait longer and are less likely to be prescribed painkillers when presenting with pain in the ER. In a preprint study on gender differences in time to diagnosis Among 112 acute and chronic diseases, women experience longer lengths of time between symptom onset and disease diagnosis than men for most diseases regardless of metric used, even when only symptoms common to both genders are considered. This was across the board no matter what kind of insurance they had.
In an article by Laura Simmons for IFLscience
A team of scientists from the US and Israel studied medical records pertaining to more than 21,000 patients who had attended hospital emergency departments complaining of pain. The picture that emerged was one of notable sex-based disparities in treatment.
Women were 10 percent less likely than men to have a recorded pain score – the number from one to 10 that helps patients give medical staff an indication of pain severity. The women also had to wait in the department for an average of 30 minutes longer than the men; and even when adjusting for pain scores and other variables, women were less likely than men to be prescribed painkillers.
One co-author of that study, Dr Alex Gileles-Hillel said , “Women are viewed as exaggerating or hysterical and men are viewed as more stoic when they complain of pain.”
Why are female bodies being under researched.
Women - the weaker sex or too complicated for us to figure out?
Women are not little men. But historically (all the way back to ancient Greece and still today) in medical research the male body was deemed the “norm” and could easily represent the general public in clinical trials. All clinical trials on humans are trying to control for as many variables as possible. And I will concede to possibility that excluding women from clinical trials might have some kernel of best safety intentions, that argument falls short in reality as we’ll soon see.
In a quotes From an Article on the website medidata on the history of women in clinical trials
“Despite the historical perspective that the male experience represents the ‘norm’, we now know that disease presentation, pathophysiology, and therapeutic response are all influenced by a person’s sex. For example, it has been indisputably shown that the pharmacokinetics of a drug are distinct depending on whether it is given to a male or female patient. This essentially means that drugs may be distributed, metabolized, or excreted differently in women compared to men. Measuring a treatment’s safety, efficacy, and/or side effects in patients of one gender, therefore, does not provide a representative picture of the effect it will have on the other.”
SImple example: Alcohol metabolism differences between men and women.
A more life and death example is the difference in heart attack symptoms between men and women
In comparison to men, women are 50% more likely to be misdiagnosed with a heart attack even though they carry the same risk of developing CVDs as men [4]. It has been known for over two decades that women experience CVDs differently to men [5,6]; yet both genders are still considered the same by healthcare professionals despite the presence of gender-specific requirements in many guidelines [7-13]. Moreover, mortality linked to CVDs is higher globally in women [14].
What are those weird symptoms in women?
atypical symptoms including abdominal pain, dyspnoea (short of breath), nausea, back and neck pain, indigestion, palpitations and unexplained fatigue; as opposed to a well-defined chest pain,
In this article other reasons for this disturbing statistic was that women tend not to report those symptoms delaying treatment and also under diagnosis due to misconception that heart attacks are mens disease. When actually women have a sharp increase in risk after the age of 60. Put a pin in that statistic as it will be important later.
Do not get me started on the use of statins in women. That’s a whole other podcast but if you want to check out the book the great cholesterol myth to understand the statistics that allow them to legally pull the wool over your eyes it’s a great read.
“The exclusion of women from clinical trials can be traced back to the early 1970s when men were still viewed as the ‘dominant’ gender and few women were working in the field of medicine. The prevailing belief at the time was that Caucasian males constituted a ‘normal’ study population, alongside concerns about females’ fluctuating hormone levels making them a more complex group to study, leading to their exclusion from biomedical research.
Many clinicians also voiced concerns about pregnant women being a ‘vulnerable’ group and these fears were only magnified by incidents such as the thalidomide tragedy, in which expectant mothers who were given the drug gave birth to babies with severe limb defects. This led to the Food and Drug Administration (FDA) issuing guidelines in 1977 which banned expecting mothers from participating in phase I/II clinical trials4. However, this ruling also applied to single women, those using contraception, or those whose husbands were vasectomized.”
A popular sleep drug (approved in 1992, can you guess the name?)was only tested on men and then unleashed on the general population. It wasn’t until reports of a disturbing number of women involved in vehicle accidents (more than men) the night after taking the drug did anyone think to check that out. Turns out women had 2x the active concentration of the drug. This led to cutting the dosage for women in half. That would not have happened had women been included in that drug trial.
It wasn’t until 1993 that the NIH established standards requiring the inclusion of women in drug trials.
From Medidata the authors state “it is ironic that the exclusion of women from research trials, which is done in an attempt to make the data less variable and therefore more easily applicable to the general public, is what causes the data to be unreliable and extraneous.” And I 100% agree.
Medical research is the foundation of our healthcare system and modern medicine today. We need it. But more importantly we need it to be precise and applicable to both males and females. Because we are made differently. We have all the same parts As Dr. Emily Nagoski says in her book Come as you are, organized in different ways. And those ways are important to understand. The only way to do that is through study so we can apply that understanding to real people for greater health and wellness.We need more curiosity, common sense and cash to actually ask the questions that need to be answered. Sadly research into all things female is sorely lacking in interest and funding and that seems to be a factor in the ongoing implicit bias in modern medicine that smacks of misogyny.
That’s next week when we look at sexism in medicine. So I hope you’ll tune in!
In the meantime you can check out all the links from this episode at savagegracecoaching/theworkin.com
If you're looking for ways to handle the effects of stress, physically, mentally and emotionally through the body head over to savagegracecoaching.com/theworkin you’ll find all the show notes for this and other episodes plus lots of free resources. And if you’re in a place where you are ready for more and you live in the Dayton Ohio area I’m taking private clients for trauma informed yoga and trauma release exercise in person and online. So you can book a discovery call and we can have a real life conversation. And of course I’d be ever so grateful if you would take a moment to like and subscribe to this podcast wherever you’re listening.
Thanks again everyone and as always stop working out and start working IN.
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Hey there!
I’m your host Ericka Thomas. I'm a health coach and trauma informed yoga professional bringing real world resilience and healing to main street USA.
I offer trauma release + yoga + wellness education for groups and individuals…regular people like you.
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