Introduction
For many women, gendered discrimination in healthcare is an unfortunate reality. Many recount their pain being dismissed by doctors as “emotional distress,” “psychosomatic” (a condition caused by mental factors like internal conflict or stress), and have been told that the pain is just a “normal part of being a woman.” More broadly, not just in healthcare, women are commonly told that their problems are “all in your head.” This dismissal of women’s genuine health issues as caused by their emotions is invalidating, dangerous, and the result of the myth of “female hysteria” espoused by physicians for centuries. Hysteria is broadly defined as “ungovernable emotional excess,” but for women throughout human history, it has served as a blanket diagnosis for any behavior deemed difficult or unappealing by men. Its symptoms were vague, and synonymous with simply being a woman. Rooted in rampant sexism, the effects of “female hysteria” remain in healthcare to this day.
Historical Background
The earliest accounts of these healthcare disparities are from ancient Egypt and Greece, where women’s health was described as “turbulent and troublesome.” It was common practice to write off women as “mad” instead of a legitimate diagnosis. In fact, even the word hysteria was coined in Greece from the word “hystera”— womb.
Prominent figures in ancient Greece, such as Hippocrates, theorized that the emotional distress from hysteria was the result of a woman’s uterus being “displaced.” This “wandering womb” theory essentially claimed that the uterus would move upward in the woman’s body in search of cool and moist areas when its original seat was too hot or dry. An account from Aretaeus of Cappadocia— seen today as one of the most celebrated Greek physicians— described the uterus as “closely resembling an animal.”
As a result of the uterus wandering around the body, women would experience the mental and emotional symptoms of hysteria. Physicians from this time would try to treat this “illness” by luring the uterus back using the sweet smell of honey. Other treatments included eating cloves of garlic, drinking potions, and taking a hot or cold bath, although pregnancy was viewed as the ultimate cure. This trend continued throughout the Middle Ages, all the way up to the 1980s when hysteria was finally removed from official medical texts.
As time progressed, other “cures” for hysteria began to pop up. These include the water cure, or hydropathy, where cold water was continuously poured over a woman’s head and chest until the woman “revived.” The treatment could go on for hours at a time. In the 19th century, a diagnosis of hysteria could land women in mental institutions. In the early 1900s, women with hysteria would be “treated” by being forced to remain bedridden, away from all mental and physical activity. This “rest cure” would continue until the woman’s father, husband, or brother saw fit for it to stop, and even if the women were not actually distressed, they certainly were after this “cure.” Other, more disturbing, treatments included electroshock therapy and a hysterectomy— or the removal of a woman’s uterus.
However, one of the most infamous treatments for hysteria was lobotomy (although it was also used to cure patients with depression, schizophrenia, psychosis, and more). Pioneered in the 1930s, the surgical procedure essentially severed parts of the brain from one another since it was believed that this disruption would stop abnormal stimuli (thought to cause aggressive behavior) from reaching the frontal area of the brain. The procedure was performed on a large range of patients, but women were targeted towards those deemed hysterical, too outspoken, too emotional, and those who questioned societal norms.
For instance, Rosemary Kennedy— the sister of President John F. Kennedy— was lobotomized at age 23 after her father’s decision to try and calm her moods, becoming “increasingly irritable and difficult.” The procedure left her permanently incapacitated and unable to speak intelligibly. Rosemary was institutionalized immediately, and her procedure was hidden from the rest of the Kennedy family for 20 years. Lobotomies were mostly discontinued by the 1960s.
Lingering Effects
Although hysteria is no longer an official condition, the adverse effects of this belief are still seen today. Hysteria has created an environment where women’s genuine health issues are chalked up to mental or emotional distress, menstruation, and being irrational. This type of “medical gaslighting” delegitimizes women’s lived experiences and has real-life, physical harm. In a survey of women suffering from chronic pain, an overwhelming majority— 83%— reported gender discrimination while seeking treatment. The result of this? Many women hesitate to seek help for serious conditions like heart attacks for fear of being labeled as “irrational” or even a “hypochondriac.” Their illnesses are ignored, or outright denied, by medical professionals. On average, women wait longer for pain medication and diagnoses, are 20% to 30% more likely to be misdiagnosed than white men, and their physical conditions are often still attributed to mental health issues. For actual mental health issues, women also face significantly higher rates of misdiagnosis for personality disorders, anxiety disorders, mood disorders, and more. Research has found that depression may be misdiagnosed in anywhere between 30% to 50% of women. Women undergoing diagnosis for autism spectrum disorder experience a greater delay in referral to mental health services, substantially delayed diagnostics, and a higher rate of misdiagnosis at first evaluation.
Another contributor to the high rate of misdiagnosis and gendered discrimination in healthcare (and another effect of female hysteria in medicine) is the dearth of research on the female body. The widespread acceptance of hysteria as a broad condition synonymous with femininity as a whole— as well as the categorization of women’s health as “turbulent and troublesome”— has discouraged genuine, in-depth research on women’s health, as doctors slapped the label of “hysteria” on nearly every ailment their female patients suffered from. Lingering beliefs that women are inherently unstable (i.e. hormones making women difficult to study) have also contributed to this trend.
In fact, the excuse of “hormones” was the basis of why women were excluded from clinical drug trials up to the 1990s. Although the National Institutes of Health (and later, the US federal government) have since issued mandates to include women in these trials, the vast majority of medical information discovered before then remains wholly unrepresentative of women’s health. Even to this day, women make up just 41.2% of clinical trial subjects despite representing more than half of the US population, and these newer studies still often fail to analyze sex differences.
Conclusion
Although the concept of female hysteria as a physical condition has (thankfully) been put to rest, it would be naive to assume that the sexism prevalent in healthcare is gone once and for all. Women are still feeling the effects of hysteria 44 years after it was officially removed from medical texts. Moreover, it should be deeply concerning that some of these so-called “cures” for hysteria— and the idea of hysteria as a legitimate illness— were even considered by the late 1900s and only officially removed by 1980. To truly dismantle the lingering effects of female hysteria in healthcare, we must continue to challenge gender bias and advocate for a system where women’s voices are heard, believed, and treated with the dignity they deserve.
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