As I hold my baby daughter at four in the morning, feeling the softness of her cheek against my own…
The gender gap in medical research affects all aspects of our health and wellbeing.
Women’s physical and emotional wellbeing has received a changing medical focus. Unfortunately the focus has not always been a positive or helpful one conducive to optimising our health and wellbeing. ‘Femaleness’ was often seen pejoratively, and women’s medical issues were too frequently dismissed as women’s emotional reactivity – hysteria.
The word hysteria draws its roots from ancient Greek and Latin. Initially associated with a ‘wandering womb’ it was later used to describe exaggerated or uncontrollable emotion or excitement. In the nineteenth century hysteria was a diagnostic term for female psychological disorder. Note that the word hysterectomy is derived from this – that by having a hysterectomy a woman will be less hysterical – and this was in fact used as a legitimate treatment for women with emotional issues (now termed mental health issues).
Thankfully female hysteria is no longer a recognised medical condition. In its time however, the condition of hysteria, excitability, or alternatively ‘fainting’, included multiple symptoms of stress and emotional reactivity converted into physical symptoms such as nervousness, shortness of breath, insomnia, loss of appetite, heaviness in the abdomen, and faintness. Insidiously, symptoms or behaviours thought unbecoming of women such as assertiveness and being opinionated, and other indicators of independent spirit which may lead a woman to have a tendency to cause trouble, were also included as symptoms of female hysteria. In such cases some women were forced to enter an insane asylum.
By the mid-to-late nineteenth century female hysteria was rife. Recall that it was at this time that the foundations were laid for Women’s Suffrage. Without the impassioned ‘hysterical’ emotional energy of these women we might not have the vote today. Imagine being told you have a psychological disorder because you want equality. Mind you – I would rather have been diagnosed with female hysteria in the nineteenth century than be classified as a witch in the seventeenth.
Diagnosis rates of hysteria declined in the twentieth century for a number of reasons. The criteria for female hysteria was so broad (with one particular doctor in this era prodigiously cataloguing seventy-five pages of possible symptoms of hysteria) that it captured multiple physical conditions. As a result hysteria as a diagnosis was becoming unacceptable and people demanded proper medical attention for their medical conditions.
A second major influence for the shift was increasing awareness of, or sensitivity towards, more discrete psychiatric conditions. Freud was fundamental in reclassifying many of the psychiatric symptoms of hysteria into a new breed of female neuroses. However these too have been subsumed or replaced with non-gender-specific diagnoses, increasingly sensitive medical investigative tests and measures, and improved language and decreasing stigmatisation.
Although the notion of hysteria has diminished over time, too many women today are still having their medical health needs dismissed as emotional reactions, or secondary to those reactions. For example, a woman recently saw me for cognitive assessment following chemotherapy after a mastectomy. She had made a remarkable recovery and had returned to work, but felt that her thinking speed was slowed, her memory reduced, and that she was less able to multi-task. She saw several doctors, however rather than listening to and validating her concerns they told her she was “being emotional because she had lost her breast”. These doctors were caught in the hysteria trap, attributing her reported difficulties as emotional reactivity rather than ‘objective medical issues’. However, there is medical research confirming changes in brain function following chemotherapy treatment. Although the difficulties remit over time, that woman would benefit from support and compensatory strategies to help her develop realistic expectations of medication side-effects and recovery. These positive interventions were effectively denied.
In another example, a female psychologist who felt that her cognitive function was deteriorating referred herself for assessment. She was patronisingly told she was probably depressed because she was caring for her husband and mother and that it would all resolve if she managed her stress better. She felt her concerns were not validated and that she was essentially being dismissed as an overwrought, emotional woman. At her behest she completed cognitive assessment which confirmed what she already intuitively knew – her brain was not working at normal capacity for her age. Despite the diagnosis of mild cognitive impairment, and although she understood the higher risk of developing dementia, she actually felt relief. Her difficulties were not emotional, and “in her mind”.
For both of these women, not only was their access to intervention denied – the lack of respect, empathic support, and medical response to what they were reporting undermined their very sense of themselves. When medical professionals continue to deflect, deny or denounce a woman’s subjective health concerns as ‘emotional’ they take medical practice back several centuries.
Aside from the prejudicial hysteria trap, there is another gender bias in medicine today. The significant gender gap in medical research affects all aspects of our health and wellbeing. The failure of medical research to include gender differences, or control for gender differences, means that research findings cannot be validly extrapolated from men to apply to women. Much research is still dominated by samples of men, which can result in poor practice. For example, guidelines on ‘safe alcohol consumption’ for women are generally less than men based only upon weight difference, but have often ignored how the oestrogen hormone interacts with alcohol and magnifies cancer risk.
Another area where women are potentially disadvantaged today is in reproductive medicine. The failure to develop and endorse an effective male oral contraception to curb male fertility is a case in point. Against this is research that indicates the potential harm to women from contraception – but this is often dismissed or watered down. This year a population study of one million Danish women emerged that indicated the contraceptive pill was linked to a higher incidence of depression – however the findings and the study were criticised. Some external researchers attributed the results to women’s hormones, not the contraceptive pill, and the findings were dismissed.
Whilst it may be possible to discount such population research (as it indicates an association and not necessarily a causation) it is impossible to ignore individual stories where women are still having their symptoms and experiences invalidated and ignored as ‘emotional reactions’ by medical professionals.
Helpfully, medicine is increasingly being individualised and the field of gender medicine is developing. We need to make sure that our reproductive status, menstrual cycle, and contraceptive history become a significant focus for health, disease diagnoses, and treatment, including pharmacology.
If you feel your medical or treating health practitioner is caught in the hysteria trap, seek a second opinion. It is your right to be respected and to have your health concerns taken seriously.