“Hysteria,” the Greek-derived term for symptoms of a “wandering uterus,” became a catch-all diagnosis for women in prior generations who experienced a wide range of largely psychological symptoms.

It took until 1980 before hysteria lost its formal DSM recognition, but even so, the dismissing or downplaying of women’s health issues continued. Physicians can avoid falling into this trap by considering the whole of their female patients’ medical history and lifestyle.

 

A brief history of hysteria

The centuries-old notion that women can be “hysterical” is one that even Hippocrates subscribed to. According to an article published by the American Journal of Psychiatry, hysteria was associated with the presence of a uterus.

Cassady M. Hysteria to functional neurologic disorders: a historical perspective. Am J Psychiatry Residents’ Journal. 2019;15(1):15-15.

 

This “condition” manifested in a variety of symptoms that ranged from psychological to medical. In modern terms, such symptoms would be considered as pertaining to trauma, anxiety, dissociation, and personality disorders.

It was not uncommon for doctors (who were, for a time, almost universally male) to diagnose women with hysteria whenever they’d display “inappropriate” emotions, too. Sexual desire, anger, and anxiety were all commonly attributed to hysteria.

Some clinicians may see the relationship between the history of hysteria and how women’s emotions are treated today.

“How often does a woman get angry, only to be asked if she’s about to get her period?” said Stephanie Trentacoste McNally, MD, in an article published by Northwell Health.

Gaslighting in women’s health: No, it’s not just in your head. Northwell Health. 2022.

“How often does a perimenopausal woman go to her doctor’s office to complain about weight gain, only to be told that it’s related to hormones?"

 

Our hormones aren’t making us anxious or upset—these condescending attitudes are.

 

Medical gaslighting puts women at risk

The act of attributing a woman’s health issues to hysteria is now understood by medical scholars to be a form of gaslighting. Doctors engage in medical gaslighting today by dismissing women’s symptoms, or assuming there’s an emotional root cause instead of a physical one, as noted in an article published by the Canadian Family Physician.

Fraser S. The toxic power dynamics of gaslighting in medicine. Can Fam Physician. 2021;67(5):367–368.

 

Aside from the element of psychological abuse in such behavior, there are real consequences for women whose symptoms are downplayed or unaddressed.

Researchers gathered data pertaining to patients admitted to the ED in Florida from 1991–2010. They noted the patients’ diagnosis, gender, and if the physician treating them was of the same gender or not. Results showed that women who were treated by male doctors were less likely to survive AMI.

This study’s findings highlight the survival cost of gender bias in medical practice and the implications of considering certain conditions (like heart disease) as male-centric. Female patients may pay the price.

 

Addressing medical gaslighting

How can you break the culturally ingrained habit of dismissing women’s health issues? Experts say one way to achieve this is by being as thorough as possible in the exam room.

At the Katz Institute for Women’s Health, explained Bella R. Grossman, MD, PhD, in an interview with Northwell Health, “We have integrated programs that take all aspects of a woman into account—her medical history, symptoms, nutrition, and other lifestyle factors.”

When women are treated by integrated teams, they are much less likely to have their complaints treated as solely ‘emotional.’

Making an effort to see the bigger picture of a female patient’s health and lifestyle helps doctors abandon the “one size fits all” approach to disease management. In revising their approach to diagnosis and treatment, they can be guided by emerging evidence that shows how gender and sex affect different illnesses.

“Medicine and care plans should be a careful dialogue between a provider and the patient,” Dr. Trentacoste McNally told Northwell Health. “I think this helps patients feel empowered because they’re an integral part of the management process.”