Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick

by Maya Dusenbery

Women’s symptoms are not taken seriously because medicine doesn’t know as much about their bodies and health problems. And medicine doesn’t know as much about their bodies and health problems because it doesn’t take their symptoms seriously.

Since the turn of the twentieth century, women have lived longer than men, on average. But the gap has been narrowing since the eighties, when men’s life expectancy began increasing at a faster clip than women’s, largely thanks to a decline in deaths from cardiovascular disease. And the additional 4.8 years of life expectancy that women currently have do not come with better health. Women report poorer health, both physical and mental, and are hospitalized more than men throughout adulthood. In their later years of life too, women are worse off than men. When it comes to “active” life expectancy—the number of years living free from significant limitations that prevent you from doing everyday tasks—men have overtaken women over the past three decades. Women still live longer, but men live better longer.

women have higher rates of debilitating but not life-threatening chronic diseases.

More than half of all American women have at least one chronic health condition, and women are more likely than men to have multiple chronic problems.

The Baltimore Longitudinal Study of Aging, which began in 1958 and purported to explore “normal human aging,” didn’t enroll any women for the first twenty years it ran.

The Physicians’ Health Study, which had recently concluded that taking a daily aspirin may reduce the risk of heart disease? Conducted in 22,071 men and zero women.

An NIH-supported pilot study from Rockefeller University that looked at how obesity affected breast and uterine cancer didn’t enroll a single woman.

Since 1977, the agency had had in place a policy forbidding women of “childbearing potential” from participating in early-phase drug trials.

One of the advocates’ important claims was that, to the extent that medicine paid attention to women’s unique needs at all, it had been myopically focused on the parts of women’s bodies that most obviously differed from men’s.

This kind of “bikini medicine” overlooked the fact that women had the same top three causes of death—heart disease, stroke, and cancer of all kinds—as men did, and also suffered disproportionately from many nonreproductive health conditions that had been long neglected.

two-thirds of women use four to five medications

“Until recently, medical emphases on differences—such as those between women and men or between black people and white people—were closely linked with social notions of superiority and inferiority. By treating variations between genders and races as something fixed in the body, medical theorists helped to reinforce the perception that social inequalities were a straightforward reflection of the natural order of things.”

The word hysteria derives from the Greek word for uterus, hystera. Although it’s a modern myth that ancient Greek medicine described a single distinct disease called hysteria, early Western medical texts did attribute an array of physical and mental symptoms—from menstrual pain to dizziness to paralysis to a sense of suffocation—to the effects of a restless uterus roving about the body; treatments were aimed at either enticing or driving the organ back into its proper place in the pelvis. Since a womb that “remains barren too long after puberty” was especially prone to wandering, the philosopher Plato explained, prompt marriage was another recommended cure. Even as later writers began to doubt the anatomical possibility of a “wandering womb,” they continued to see the organ as the source of many mysterious complaints. One of the Hippocratic medical texts from the fifth century BC put it simply: “The womb is the origin of all diseases” in women—a hypothesis that would remain influential in Western medicine for millennia.

One doctor explained, “The functions of the brain are so intimately connected with the uterine system, that the interruption of any one process which the latter has to perform in the human economy may implicate the former.” In short, women were inherently prone to nervous disorders because their reproductive functions—menstruation, pregnancy, lactation, menopause—took a great deal of energy away from their relatively small brains.

was the ovaries that “give woman all her characteristics of body and mind.” Whichever was blamed, the treatments gynecologists offered during heroic medicine’s reign were brutal. Almost any symptom in women would get a “local treatment” of the reproductive organs, including injections of various concoctions into the uterus, leeches placed on the vulva, and cauterization of the cervix.

For a good decade leading up to the twentieth century, an estimated 150,000 oophorectomies—the removal of perfectly healthy ovaries—were performed in the United States for such afflictions as “troublesomeness, eating like a ploughman, masturbation, attempted suicide, erotic tendencies, persecution mania, simple ‘cussedness,’ and dysmenorrhea.” The trend came to an end mainly because doctors became uncomfortable sterilizing women—or, as one put it, being “the destroyer of everything that makes a woman’s life worth living.”

For several weeks, the patient would be confined to bed in a dimly lit room, allowed to see only the doctor and a nurse, and forbidden from reading, writing, or doing anything else besides eating fattening foods and receiving a daily massage. The theory went that the cure was such “bitter medicine” that when Mitchell commanded the patient to get better at the end of it, she would bend to his will.

While women continued to be seen as prone to nervous disorders because of “something fundamental in their nature, something innate, fixed or given,” among elite gentlemen, the same symptoms were often attributed to overwork and the stresses of urban, industrial modern life.

The uterine-nerve theory of hysteria proved especially useful for keeping women in their proper place; one might even suspect it was designed to. The precarious balancing act between the reproductive organs and brain meant that great swaths of a woman’s life—puberty, menstruation, pregnancy, and menopause—were all considered periods of “ill health” when her body could easily be thrown into dangerous disorder—by any activity, really, but especially by mentally taxing ones. So, Mitchell warned, “It were better not to educate girls at all between the ages of fourteen and eighteen, unless it can be done with careful reference to their bodily health.” In the midst of debate over allowing women to attend Harvard, Dr. Edward H. Clarke, a professor at the school, published Sex in Education; or, A Fair Chance for the Girls, in which he reviewed the medical literature and concluded that higher education would cause women’s uteri to atrophy. As for pursuing a career, another doctor noted, “One shudders to think of the conclusions arrived at by female bacteriologists or histologists at the period when their entire system, both physical and mental, is, so to speak ‘unstrung,’ to say nothing of the terrible mistakes which a lady surgeon might make under similar conditions.”

But, of course, many women didn’t make lucrative patients. Conveniently enough, nineteenth-century “science” showed that black women and working-class white women were magically resistant to the health problems that plagued well-off white women. One physician noted, “The African negress, who toils beside her husband in the fields of the south, and Bridget, who washes, and scrubs and toils in our homes at the north, enjoy for the most part good health, with comparative immunity from uterine disease.” In a remarkably lucky boon to the new medical profession, it was only those women who had the time and the money to be treated who were prone to perpetual illness and in need of their services. And it was only women trying to push into professional work—those aspiring bacteriologists, histologists, and surgeons—who faced such dire health consequences from working.

“One finds an underlying logic running through popular books by physicians on women’s diseases to the effect that ladies get sick because they are unfeminine—in other words, sexually aggressive, intellectually ambitious, and defective in proper womanly submission and selflessness.”

They tended to highlight the fact that by the end of the nineteenth century, doctors seemed to be labeling as “hysteria” any behavior in women they disliked—particularly rebellious claims to autonomy and equality. In other words, women weren’t actually sick; doctors were just saying they were.

So to the extent that hysteria seemed to become less common during the first half of the twentieth century, it was because this bloated diagnostic category inevitably shrunk as medical knowledge grew. In a process that Micale called “diagnostic drift,” what would have been called hysteria a generation ago was likely to instead fall into one of numerous newly recognized diagnoses, creating only “the retrospective illusion of a disappearance of the pathological entity itself.”

But even as many conditions drifted out of the hysteria category as they were recognized as distinct diseases, the psychological concept of hysteria remained.

“the tendency to experience and communicate psychologic distress in the form of somatic symptoms that the patient misinterprets as signifying serious physical illness.” “Somatizing” mental distress was considered common, but it became a psychological disorder when patients kept insisting they were sick though doctors had concluded that they were not.

it considered some diseases to be more influenced by the mind than others—such “psychosomatic disorders” included asthma, ulcers, and hypertension—and they tended to be those that medicine didn’t yet know much about in biological terms.

But medicine wasn’t just “responding to” a stereotype that was in the air; it was also perpetuating it.

“Women’s illnesses are assumed psychosomatic until proven otherwise.”

the surest way to tell whether the source of the symptom was physical or psychological was to consider the question, “Does the patient accept herself as a woman?”

If a woman attempted to resist her feminine role, this mental conflict could emerge in a number of symbolic ways—particularly in disorders affecting her reproductive system. According to the textbook, in cases of dysmenorrhea (painful menstruation) “a thorough study of the woman’s attitudes toward femininity is often necessary.” Nausea during early pregnancy—the morning sickness experienced by the vast majority of pregnant patients—“may indicate resentment, ambivalence and inadequacy in women ill-prepared for motherhood.” Just as in the nineteenth century, women were still thought to bring illness upon themselves by failing to be properly womanly—only

And yet, many doctors do apparently believe that they can somehow intuit whether a patient’s symptoms will turn out to be “medically unexplained”—and do so quite quickly. In a 2016 Dutch study, family physicians reported that they suspected patients’ symptoms were MUS if they had many symptoms and had had lots of previous doctor’s visits and referrals. They also considered the “subtle feelings” the patients provoked in them to be a clue. One of those feelings was confusion. One doctor explained, “I believe I know what is going on within 30 [seconds], like many of us. When I think within 2 [minutes] ‘I do not have a clue of what is going on here,’ then I start to think ‘This can be [MUS].’” The other feeling was “irritation” at the patient. Most of the respondents “stated that when they did not feel empathy for their patients, they were more often inclined to recognize symptoms as [MUS].”

a psychogenic diagnosis is a particularly sticky one because the only exonerating evidence that could show it to be false—proof of an organic pathology—is exactly what doctors have now ceased looking for.

Indeed, there’s a circular logic built into psychogenic theories that ensures that once a doctor has decided the symptoms are psychogenic, pretty much anything the patient does will just reinforce that perception. According to the medical literature, some of the “red flags” that suggest patients may be suffering from a somatoform disorder include repeatedly seeking medical care—described as “doctor shopping”—despite assurances that they have no organic disease and denying that their symptoms are psychogenic.