Many have heard of the term “female hysteria,” a pejorative, outdated, catch-all term that refers to any complaints a female has about their health. The implication in this so-called diagnosis is that the health concerns are invented in the patient’s head. Symptoms attributed to female hysteria have varied throughout history, from anxiety and tremors to convulsions and paralysis. As explained in a 2012 review conducted by Cecilia Tasca and colleagues, the causes of female hysteria were attributed to anything from a wandering uterus to a lack of orgasms. In fact, the term “hysteria,” first used by Hippocrates, is derived from the Greek word hysteron, or uterus. The use of such a term inextricably links the female gender and body to the tendency to fall into “hysterics.”
“When a female presenting patient goes to their doctor with their complaints, are those complaints being taken seriously?”
Notably, the concept of hysterical neurosis was removed from the DSM, or Diagnostic and Statistical Manual of Mental Disorders, in 1980. Nowadays, one does not get explicitly diagnosed with female hysteria. However, that does not mean that this misogynistic label has been eradicated. The condescension and paternalistic attitudes it rears are, unfortunately, still present in modern medicine. So how does this term, while no longer accepted as a valid diagnosis, still manifest in the clinical world today?
The answer lies in the sacred relationship between doctor and patient. When a female-presenting patient goes to their doctor with their complaints, are those complaints being taken seriously? In an ideal world, the answer would always be yes. Yet this is not always the case. In a 2003 study conducted by Anne Werner and Kirsti Malterud, the accounts of 10 women with chronic pain were studied via interview. It was found that the women took particular care to make their symptoms appear visible and real — and themselves not too strong or too weak — when meeting with their physicians. Living with chronic pain is a difficult enough feat, yet these women were forced to expend energy trying to gain credibility in medical encounters.
This phenomenon doesn’t develop overnight. Rather, the behavior of these women reflects the, perhaps subconscious, notion of “the difficult patient, mostly portrayed as a woman.” Great care must therefore be taken to appear as agreeable as possible, while not too agreeable as to reduce the credibility of the reported symptoms. One participant reported she feels that she should “look groggy” and “wear no makeup,” in part to avoid comments she had previously received from her doctor saying, “You certainly don’t look ill!” Furthermore, on the subject of agreeability, another subject recounted that “you have to tread rather softly, because once you antagonize them it’s not certain that you are any better off.” These statements reflect the careful balance female patients must maintain to have their ailments taken seriously without being written off as “difficult.”
“The causes of female hysteria were attributed to everything from a wandering uterus to a lack of orgasms.”
In a 2013 study by Ruby Nguyen and colleagues, stereotyping of women with chronic vulvar pain was studied. This study is of particular interest due to the sexual connotation that it carries. Just as female hysteria has its roots in the female sexual organ, the stigmatizing of women in medicine today retains its sexist origins. In this study, subjects were asked if “doctors think that people with chronic pain exaggerate their pain” and if “people believe that vulvar pain is used as an excuse to avoid having sex.” While these notions may seem absurd to the modern eye, the results said otherwise. Women with this particular chronic pain condition were more likely to believe that people think their condition is an excuse to avoid intercourse. Despite these women knowing acutely the validity of their own suffering, the stigma they face from others affects their own pain perception. Half of the women in the study did not seek treatment, and those who did were more likely to perceive stereotyping from their doctors. Especially with such a sensitive area of healthcare, one would hope that empathy would be properly conveyed by physicians.
While the terminology of female hysteria has left the medical field, the impression it leaves is enduring. It is not simply an artifact of the past meant to evoke literary works like “The Yellow Wallpaper.” Rather, the misogynistic undertones of its usage are present in the ongoing struggle for women to be taken seriously in healthcare. Whether in the painstaking care to appear “just sick enough” or avoiding care due to fear of sexist stigmas, the notion of female hysteria is alive and well. Until such “hysterics” (valid medical concerns) are taken seriously, the onus is on the medical community to continue to dismantle them.
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