Medicine

Hystera // Hysteria // Medical Gaslighting | by Bakhtawar Ali | Dec, 2023

The term medical gaslighting is used to describe healthcare practitioners who undermine, ignore or invalidate the existence, severity and perception of a patient’s own illness, particularly of those living on the margins including women and gender minorities.

According to the call for evidence survey under the recent women health strategy for England, 84% of the respondents reported that they felt they weren’t being heard by the healthcare professionals. 1 The research revealed that physicians were more inclined to attribute women’s pain to a mental health condition rather than a physical one.2

According to a report published in the AHA journal in 2022, women presenting in the Emergency Department experienced an 11-minute longer wait than men for the initial evaluation of their chest pain.3 Additionally, a study revealed that women had to wait 16 minutes longer to receive analgesics for acute abdominal pain and are 15 to 25 percent less likely to be prescribed opioid analgesics. 4

Research has shown that women tend to be more sensitive to pain than men and are more likely to express it. As a result, their pain is frequently perceived as an overreaction rather than a genuine experience, according to Roger Fillingim, Director of the Pain Research and Intervention Centre of Excellence at the University of Florida. Regardless, he said, you treat the pain that the patient has, not the pain that you think the patient should have.5

While there’s significant emphasis on empowering patients, especially those from vulnerable communities, to combat medical gaslighting, it is essential to recognize that the true solution lies in addressing the underlying reasons for the existence of medical gaslighting in the first place.

Medical Gaslighting stems from patriarchal power structures reinforcing the stereotypical beliefs that perceive men experiencing chronic pain as ‘brave’ and ‘stoic’ while they tend to view women experiencing chronic pain as ‘emotional’ and ‘hysterical’. It’s not unexpected that the term hysteria originates from the Greek word hystera, which translates to uterus. As early as in medical texts such as the Hippocratic Corpus, hysteria was attributed to uterus wandering within the female body, however, by the 19th century it was viewed as a neuropsychiatric condition owing to the instability of the female reproductive system. (Today, hysteria is largely discredited in modern medicine)

The fact that women are disproportionately the victims of medical gaslighting can also be attributed to gross underrepresentation and exclusion of women in clinical trials leading to a lack of comprehensive understanding and under-diagnosis of gender specific diseases like autoimmune and female reproductive disorders, for instance PCOS, vaginismus and endometriosis resulting in suboptimal health outcomes for them. Cardiovascular disease, for example, is the number one killer of women in the USA, but only about a third of participants in clinical trials for new treatments for cardiovascular disease are female, Chloe Bird, professor of policy analysis at Pardee RAND Graduate School

Not only is there gender bias in clinical trials, but there’s also underfunding of research in women’s health related issues. Diseases affecting women primarily receive much less funding relative to male dominated diseases like HIV/AIDS when compared with the disease burden. Likewise, gynecological cancers, such as ovarian cancer, demonstrate a significant disparity in funding relative to their lethality. 7 However, initiatives are being taken to counterbalance the gender disparities in funding, for instance, NIH has devoted 10 million dollars to set up an Autoimmune Disease Research and in US, a bill calling for doubling of funding in women’s health research was brought forward in the year 2022 by Congress. Nonetheless, significant changes are yet to be seen.

It’s crucial to acknowledge that not every misdiagnosis stems from prejudices. Given the constraints of consultation time, the multitude of potential conditions, and the inclination to prioritize the most common diagnosis, delays and misjudgments in the diagnostic process can occur even when healthcare professionals have the best intentions. Having said that, understanding that individuals affected by medical gaslighting are often among the most vulnerable in society, and aren’t affected arbitrarily, it becomes imperative that healthcare practitioners question their assumptions, knowledge and the gaps therein that may be conducive to bigotry.

It’s our duty as healthcare providers to not let bias influence and drive our practice. We owe this to our oath and our patients.

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1- (Women’s Health Strategy for England, 2022)

2- Samulowitz, A., Gremyr, I., Eriksson, E., & Hensing, G. (2018). “Brave men” and “emotional women”: A theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. Pain Research and Management, 2018.

3- Banco, D., Chang, J., Talmor, N., Wadhera, P., Mukhopadhyay, A., Lu, X., … & Reynolds, H. R. (2022). Sex and race differences in the evaluation and treatment of young adults presenting to the emergency department with chest pain. Journal of the American Heart Association, 11(10), e024199.

4- Chen, E. H., Shofer, F. S., Dean, A. J., Hollander, J. E., Baxt, W. G., Robey, J. L., … & Mills, A. M. (2008). Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Academic Emergency Medicine, 15(5), 414–418.

5- Bever, L. (2022). From Heart Disease to IUDs: How Doctors Dismiss Women’s Pain. The Washington Post, 13.

6- Rush, S. et al. Gynecol. Oncol. 162 (Suppl. 1), S322–S323 (2021).


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