The Myth of Female Hysteria and Health Disparities among Women

For thousands of years, women’s health complaints were often diagnosed as “female hysteria” – a catch-all term that basically implied “it’s all in her head.” The condition was believed to be caused by a wandering uterus and/or sexual frustration. Doctors treated the condition using various regimens. Sometimes they would prescribe treatments with herbs and cold water. They also advised patients to go horseback riding, use a vibrator, or have regular sexual encounters with their husbands. Should those cures fail, the insane asylum was always an option.

Although multiple sclerosis (MS) is three to four times more common among women, until the 1920s, men were diagnosed with MS more often than women—when symptoms were the basis for diagnoses, before today’s MRI—because women presenting with the same symptoms were diagnosed with hysteria.

Today, many clinicians still act as though women’s physical symptoms are exaggerated, all in their heads, or arising from an emotional or mental disturbance. Even now, people who present with unexplained neurological complaints may be diagnosed with conversion or somatoform disorders, the modern terms for female hysteria—the assumption being that if current technology can’t find the cause, then symptoms must be psychological or psychosomatic. Women are up to 10 times more likely to receive the diagnosis than men.

Women report worse health than men in the United States and most other countries, despite living longer on average, and recent trends in mortality (maternal and overall) among women in the U.S. are troubling. In fact, the prevalence of chronic conditions, activity limitations, disability, and chronic pain are all greater among women than men. Depression is diagnosed twice as often among women. Women get three times as many migraines as men. And then there’s the monthly curse — for some women, as painful as a heart attack.

Women with lupus, fibromyalgia, chronic fatigue syndrome, and even Parkinson’s disease still typically face long periods of misdiagnosis, undertreatment, and referral delays before they receive appropriate care. In one American emergency department, women were more likely to present with abdominal pain, but less likely to receive analgesics and waited longer to get them when they were prescribed. Women in the United States with cardiac diseases are also less likely to receive appropriate treatment than men. Women and girls are only now starting to get appropriate diagnoses and treatment for autism, because their symptoms are usually “atypical”—meaning, different from boys’ and men’s symptoms. The fact that women and girls were excluded from most clinical trials prior to 1990 probably contributes to many of the persistent health disparities we still see today.

There are a number of other theories about the reasons for these health disparities, including hormones, differences in the likelihood of seeking care, differences in risk factors, differences in response styles, differences in pain tolerance, sexism and misogyny, and imbalances in social power. Other stressors, also more common among women, may also contribute to the cycle of toxic stress related to inflammation and its many sequelae: criminal victimization, childhood trauma, and poverty. And yet, there is still a huge gap in our knowledge and understanding. A recent study found that only 30 percent of the inequality in health status between men and women could be explained by differences in a range of factors.

There are many ways the health care system could serve women better:

• Clinicians need training in implicit bias and listening skills
• Patients may benefit from innovative programs led by health navigators and community health workers—programs that focus on health literacy, disease management, connecting patients to social supports, and navigating the complex web of health care providers and systems
• Health care administrators can implement checklists and other standards of care, which could help overcome individual clinicians’ lapses
• Funders of research should insist that researchers conduct analyses on sex- and gender-related differences and include women and girls in their studies in appropriate proportions based on the disease or condition.

The echoes of the myth of female hysteria can still be heard, and may help explain persistent health inequities. These inequities demand that we do what we can to better address the huge gaps between what can be explained, and what we still do not understand, about women’s health.