What role might the myth of “female hysteria” play in women’s health disparities?
For thousands of years, women’s health complaints were often diagnosed as “female hysteria” – a catch-all term that basically implied “it’s all in her head.” The condition was sometimes believed to be caused by a wandering uterus and/or sexual frustration. Doctors treated the condition using various regimens involving herbs and cold water, or by prescribing regular sexual encounters with the patient’s husband, a vibrator, or horseback riding. Should those cures fail, the insane asylum was always an option.
Although multiple sclerosis is three to four times more common among women, until the 1920s, men were diagnosed with MS more often than women – when symptoms were the basis for diagnoses, before today’s MRI – because women presenting with the same symptoms were diagnosed with hysteria.
Today, many doctors still act as though women’s physical symptoms are exaggerated, all in their heads, or arising from an emotional or mental disturbance.
Even now, people who present with unexplained neurological complaints may be diagnosed with conversion or somatoform disorders, the modern terms for female hysteria [pdf]. The assumption is that if current technology can’t find the cause, then symptoms must be psychological or psychosomatic. Women are up to 10 times more likely to receive the diagnosis than men.
Women report worse health than men in the US and most other countries, despite living longer on average. Recent trends in mortality (maternal and overall) among women in the US are troubling. In fact, the prevalence of chronic conditions, activity limitations, disability, and chronic pain are all greater among women than men. Depression is diagnosed twice as often among women. Women get three times as many migraines as men. And then there’s menstruation — for some women, almost as painful as a heart attack.
Women with lupus, fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome, and even Parkinson’s disease still typically face long periods of misdiagnosis, undertreatment, and referral delays before they receive appropriate care. In one American emergency department, women were more likely to present with abdominal pain, but less likely to receive analgesics and waited longer to get them when they were prescribed.
Women in the US with cardiac diseases are also less likely to receive appropriate treatment than men. Women and girls are only now starting to get appropriate diagnoses and treatment for autism because their symptoms are usually “atypical” – meaning, different from boys’ and men’s symptoms.
The fact that women and girls were excluded from most clinical trials before 1990 probably contributes to many of the persistent health disparities we still see today.
Other theorized reasons for women’s health disparities include hormones, differences in the likelihood of seeking care, differences in pain perception, differences in risk factors, differences in response styles [pdf], hostile and “benevolent” sexism and misogyny, and gendered social inequities and imbalances in social power. Other stressors may contribute to the cycle of toxic stress, inflammation and its many sequelae, including criminal victimization, childhood trauma, and poverty — all more common among women.
And yet, there is still a huge gap in our knowledge and understanding. One study found that only 30% of the inequality in health status between men and women could be explained by differences in a range of factors.
The healthcare system could serve women better.
- Clinicians need more training in implicit bias and listening skills.
- Patients may benefit from innovative programs led by health navigators and community health workers – programs that focus on health literacy, disease management, connecting patients to social supports, and navigating the complex web of healthcare providers and systems.
- Healthcare administrators can implement checklists and other standards of care, which could help overcome individual clinicians’ lapses.
- Funders of research should insist that researchers conduct analyses on sex-related differences. Researchers should include women and girls in their studies in appropriate proportions based on the disease or condition.
The echoes of the myth of female hysteria can still be heard and may help explain persistent women’s health disparities. These inequities demand that we do what we can to better address the huge gaps between what can be explained, and what we still do not understand, about women’s health.
Note: this post originally appeared, in slightly modified form, at Medium on International Women’s Day, March 6, 2018, and on this blog on March 22, 2018.
Lisa M. Lines