The icon of the female hysteric is one woven into the fabric of modern patriarchy.
Once a legitimate medical diagnosis, it became a catch-all phrase for any women’s health problems which doctors couldn’t figure out.
For thousands of years, flummoxed physicians wouldn’t just admit they didn’t know what was happening – medical science was still in its prime, and back then we didn’t know a fraction of what we know now – but would diagnose their female patients with hysteria.
The list of symptoms for this condition could extend to almost anything, such as anxiety, insomnia, abdominal pain, tremors, and “tendency to cause trouble”.
For many women, however, these trips still see regularly see them dismissed, mollycoddled, or outright ignored by those who are supposed to provide them with care.
It’s a fact widely acknowledged that women tend to have to fight harder than their male peers to have their pain reviewed and treated. Medical research has historically focused on the pathology of men rather than women, even though substantial biological differences contribute to responses to pain relief between the sexes.
An oft-cited study in discussions of this nature, 2001’s ‘The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain’, published in The Journal of Law, Medicine & Ethics, states that:
Women are more likely to seek treatment for chronic pain, but are also more likely to be inadequately treated by health-care providers, who, at least initially, discount women’s verbal pain reports and attribute more import to biological pain contributors than emotional or psychological pain contributors… i.e., Women are more likely to be treated less aggressively in their initial encounters with the healthcare system until they ‘prove that they are as sick as male patients’.
Essentially, if you are a woman in pain, your symptoms will most likely be taken less seriously than if they were the symptoms of a man.
Doctors of days gone by believed the female hysteric would weep and wail as her womb detached itself from its usual spot to roam around her body, leaving a trail of destruction in its wake. The impact of this perception lives on in our hospital corridors.
Endometriosis is a condition where endometrium, tissue which is meant to grow inside the womb, ends up growing throughout the abdomen, typically around the ovaries, fallopian tubes, bladder, and bowel. These excess growths then bleed, most heavily when the sufferer menstruates but with the potential to do so at any time. The blood has nowhere to go and builds up inside of the body, causing intense pain and cysts.
Sharon Hewitt, 53, had symptoms of endometriosis from the age of 14, but found she was ignored by GP’s until she was 26, when she read a magazine article about the condition. She took the magazine to the doctors, who after twelve years pieced together her symptoms and made a preliminary diagnosis of endometriosis (the illness cannot be officially diagnosed without an ultrasound or keyhole surgery). This was after over a decade of severe stomach cramps and bleeding which left Sharon crippled double, not just when she was on her period but all month.
“I took lots of painkillers, which didn’t work,” Sharon says. “One doctor sent me to a homeopath, one to a psychiatrist, and one to a Reiki healer. All because they thought I was making it up. I used to go to work with a hot water bottle in a brown envelope and hide it under my desk.”
After the birth of her two children, Sharon opted for a hysterectomy aged just 32, which she says allowed her to finally lead a normal life. This was following six laparoscopic treatments to cauterise the excess endometrial tissue growing inside her – these became something of a vicious circle, as each surgery left behind multiple adhesions, which endometrial tissue has a tendency to stick to.
In September 2017, the National Institute for Health and Care Excellence issued guidelines urging medical professionals to revise their approach to women with the condition. As NICE’s guidelines director, Dr Mark Baker explains: ‘Women are too often told by doctors that they are making a fuss about normal period pain, leading to years of unnecessary distress and suffering.’
An estimated one in ten women has endometriosis. Recent research has indicated that period pain can be on par with the pain experienced during a heart attack, and the pain of endometriosis is that in triplicate. Meanwhile, men wait an average of 49 minutes before being treated for abdominal pain, while women with identical symptoms wait for 65 minutes.
It’s a cynical way to look at it, but it’s hard to imagine a world where one in ten men’s guts are littered with displaced, growing, bleeding lesions and it isn’t considered a public health crisis.
This healthcare disparity isn’t just reflected in gynaecological issues.
Allison Harley, 26, has Multiple Sclerosis (MS), a disease which impairs the functioning of the central nervous system. It presents more commonly in women than men. She had experienced the early warning signs of MS in the past, having dealt with numb feet, feeling extra clumsy, and a period of Bell’s palsy. This was followed by an episode of optic neuritis – blurred vision, alongside intense head and eye pain – which was initially written off as migraines.
“I felt stupid because to me it wasn’t migraines, but being told by the eye doctor in A&E and then by two GPs is was made me believe it,” she says.
A neurologist eventually confirmed the neuritis diagnosis, but withheld a diagnosis of MS on the grounds that it could have been an isolated episode.
But it wasn’t long until Alison started experiencing symptoms again. She had a period of extreme dizziness, feeling and walking like she was drunk. When she went to her GP, she was told to stop being such a “worried mother hen.”
Despite having experienced the early warning signs of MS, and continuing to present with symptoms of the condition, her doctor perceived her as overreacting, fussy, overprotective of her own health. She was told she had catarrh and signed off work for 3 days.
It was only once Allison started experiencing numbness from the waist down that she visited a GP again, this time at a different practise, and was immediately referred to the neurologist. It was then that she was finally diagnosed with MS.
Women are taught not to make a fuss, to smile and nod and keep quiet. Far too often, women put up with incredible pain which significantly impairs their daily life, for fear of being seen as dramatic or whiny.
Or perhaps, they simply feel ashamed to talk about “women’s problems”.
It’s my own experience of such which inspired this piece, and which affirmed my belief that pain should not be routinely dismissed as the figment of an overactive imagination, nor that how common a condition is correlates with how significantly it impacts one’s quality of life.
I spent over a year struggling to find appropriate birth control, with my concerns repeatedly dismissed by medical professionals. Of the various different methods I trialled, I experienced, in no specific order: depression, nausea, vomiting, a three month long period, and best of all, recurrent yeast infections which took several times the typical dose of OTC medication to clear, and were so severe I had to stop going into university every time it flared up because sitting down for an hour in a lecture was too painful.
That latter and most pressing issue, I was repeatedly assured by numerous GP’s and gynaecologists, could not possibly be a side effect of the numerous pills I’d trialled, despite being listed as a “common” side effect on the leaflet which came with every box. I had one doctor ask me if I was cleaning myself properly after using the toilet, another suggest I only wear white cotton underwear to see if I was allergic to fabric dye, and I was finally informed that this was just “normal for me” now.
I eventually swapped to a copper IUD, which gives me agonisingly painful periods which usually last over a week. This is still a better option, because I’m actually able to sit down to write this article.
There is such a large degree of stigma when it comes to talking about “gross” health issues, and being dismissed when you do so doesn’t do much for the humiliation. Yet somehow the belief remains, that women will confess all range of embarrassing, awkward symptoms to their doctors, subject themselves to physical examinations which see their dignity flying out the window, and still not be telling the truth.
Hayley Burdett, 30, has IBS. She found herself unable to go to the toilet for 8-10 days at a time and was left with severe stomach cramps and backache which kept her up at night. The embarrassment, fatigue, and pain of the condition were affecting her mental health too.
After repeat visits to numerous doctors, one GP took blood tests to see if she was suffering any deficiencies and tested her for coeliac disease. Once those came back clear, it was just a process of elimination to say she had IBS, and she was advised to follow the Low FODMAP Diet.
“They wouldn’t refer me to a dietician for help with the diet, they wouldn’t refer me to a gastroenterologist for a colonoscopy to see if there was a deeper problem. They also wouldn’t do the SIBO hydrogen breath test or refer me for that,” Hayley comments.
The Low FODMAP diet is extremely restrictive. The acronym stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols, and it seems considerably quicker to list what those on the diet can eat, compared to what they can’t.
But this is a fairly standard procedure to treat cases of severe IBS such as Hayley’s – what isn’t acceptable is expecting her to go on such a restrictive diet without the input of a qualified dietician.
To restrict oneself so significantly without the guidance of a nutritionist to make sure you’re getting everything your body needs can be dangerous. The IBS Network recommend that anyone following the diet should do so under the supervision of a qualified FODMAP trained registered dietitian.
Hayley believes it’s a restrictive diet which triggered her IBS in the first place, and was initially reluctant to try another one, with good reason. Restrictive eating has been linked to the development of food intolerance, so if a Low FODMAP diet is managed poorly it could easily worsen the IBS symptoms of the sufferer.
These testimonies have not been compiled with intent to say that medical mismanagement is an exclusively female problem, but it’s impossible to deny it affects women far more often than it does men. And a hysterical dramatist, going weak at the knees in response to a manageable ailment, is far more convenient for doctors deal with than acknowledging that something is seriously wrong. We may have closed down the insane asylums but so many women have been left locked inside, and the keys seem to have mysteriously gone missing.
Women aren’t pretending to be sick – they’re pretending to be well. But the negligence, complacency, and sheer apathy of the male-dominated medical profession lead so many to be perceived as swooning fantasists, unprepared for the realities of the world, for public life, quaking in our impractical boots at the thought of popping a few ibuprofen and getting on with it. But this is not reality, and the current state of affairs is entirely unacceptable. It can only be fixed by women who stand up to be counted, who make a fuss, and demand to be seen. It’s time to give in to the tendency to cause trouble. Isn’t that what they’ve been expecting all along?