Gender Bias in Health
Article and Artwork by: Xurian Dively
A woman could be making all the right decisions about her health and still be wronged by the medical community.
Two years ago, I came down with a debilitating viral cold while traveling in Asia. For three weeks I couldn't leave my bed, nor keep my eyes open. A fever lasted most of this time-I was so dizzy I had to grasp the walls to make it to the bathroom and back. Finally the friends I had made were kind enough to drive me to a clinic. However, I had to end my trip early to come home to America where I could-well I thought I could-receive better treatment.
I had a severe sinus infection, infection of both ears, and escalated bronchitis. Shocker. I received twenty days of antibiotics, fifteen days of steroids, as well as some other goodies. It took three more weeks of bed rest to mostly recover, but something was off. I went a month and half feeling fine, trying to ignore the remorse of having to lose money from my trip cut short. Suddenly, I got super sick again, and I never really got better.
Multiple infections, extreme reactions to almost all allergens, constant fatigue, fainting spells, cognitive decline, headaches, diminished vision, joint pain, panic attacks, light sensitivity, full body pain and muscle weakness ailed me amongst other ever-changing symptoms.
I thought maybe I was dying,
that I had some fucked disease.
I had always been healthy to this point.
Multiple visits to multiple doctors.
All my symptoms, even the physical ones, including the infections were psychological. I was diagnosed with anxiety/panic disorder, allergies, premenstrual syndrome, and reminded of my attention deficit disorder from childhood. All these were supposed to be responsible for my chronic pain. Many drugs were shoved in my face, everything to 'fix' my brain and keep it from making me physically ill.
I was told my mind was broken, that I was 'hysterical' and making myself sick. This narrative was pushed onto me so much that I started to believe it. Reluctantly I agreed to the prescriptions. I was given birth control for my pesky hormones, an antidepressant, a heavily sedating antihistamine, an anti-anxiety medication, and encouraged to 'relax'- to 'have a glass of wine' or 'try yoga'.
Never once was I tested for a physical cause to my mysterious suffering. Months passed. I remained sick, bedridden, and rapidly got worse until I took my health into my own hands- stopping all the treatments I was receiving, all of them for a diagnosis I didn't have. Life wasn't worth living at that point, depressed and scared, I was done.
Today my condition is still very bad, but not quite as impossible as it once was. I can ride a bike now, after a year, something most people don't celebrate. How much suffering could I have avoided? I have now been correctly diagnosed, but I still spend a lot of time in bed. Mostly likely I always will.
I want to be mad about what happened to me-but if I hadn't become this sick and subsequently failed by the medical profession, I wouldn't have realized that I was subjected to a quite large, gendered gap in the field of medicine. One rarely talked about.
See, it's not just me who has become a victim of a practice solely intended to benefit humankind.
There are deep, systemic problems that greatly affect the quality of healthcare a woman receives all over the world, especially in the West.
In the emergency room women wait longer to receive pain medication and to speak to a doctor-even dismissed mid-heart attack with a prescription for anti-anxiety meds. Others with autoimmune diseases (like lupus and rheumatoid arthritis) have been labeled as health hypochondriacs and wait years before being properly diagnosed.
Then there are women with endometriosis who have been told they are just overreacting to 'normal' premenstrual symptoms, finding out later that their organs have been fused together with surgery no longer being an option. Others have been told that illnesses like chronic fatigue syndrome and fibromyalgia (which affects majorly women) don't exist, and are chalked up to psychiatric patients.
This is horrifying.
In general, doctors have a poor reputation when it comes to believing and investigating women's concerns. If you have ever felt like you weren't heard by your doctor, most likely you weren't.
Females suffer because the medical community knows relatively little about our bodies. The research field has also neglected conditions that disproportionately affect women and purposely paid little attention to biological differences between the sexes for everything from how drugs are metabolized, to how females present symptoms for fatal diseases.
Meanwhile, there is a long history of viewing women as easily prone to 'hysteria' which reverberates to the present day. This leaves women battling against a stereotype that they are hypochondriacs, whose ailments are made up in their head.
This is going to be a three part series where I address these discrepancies in the medical field, starting off with a brief overview of hysteria and mental disease historically in women.
Basically it was the first mental disorder attributed to women and dates all the way back to the ancient Egyptians, who first described it in 1900 BC. The term 'hysteria' derived from the Greek word for the uterus, 'hysterika', and was coined by Hippocrates (a dude) to characterize a female illness caused by 'movement of the uterus' when it was unfruitful.
The cure was, of course, marriage. This idea has persisted through the centuries: in the 19th Century it became a go-to diagnosis amongst the male-centric medical profession. Millions of women with unexplained symptoms were slapped with this degrading label.
As a sufferer of ME (myalgic encephalomyelitis), a systemic neuroimmune condition characterized by post-exertional malaise, a reduction in functioning, and a severe worsening of symptoms after even minimal exertion which results in quite harsh decline of the immune, nervous, and energy metabolism systems: lt wasn't even seventy years ago that my illness was actually diagnosed as hysteria. The term was finally removed from the American Psychiatric Association's list of modern diseases in 1952, but was still occasionally used up until the eighties.
Even though the terms have changed over the past hundred years, the concept-that the unconscious mind can manifest physical symptoms- has remained alive and well in medicine.
While it is true that the mind is certainly strong enough to do this, there is a high risk of misdiagnosis lying within this concept; whether it's called hysteria or 'medically unexplained symptoms' due to something like stress. Unfortunately this term belongs solely to women, who bare harsh consequences.
Back in 1965, British psychiatrist Eliot Slater warned that too often a label of hysteria allowed doctors (who were almost all strictly male) to believe they'd solved the mystery when, in fact, usually they hadn't. Doctors of the time disliked being inadequate, of course. After following up with 85 female patients who'd been diagnosed with 'hysteria' at the National Hospital in London throughout the 1950s-including by Slater himself-he discovered that, nine years later, more than 60% had been found to have an organic neurological disease, including brain tumors and epilepsy.
A dozen of them had died. You might look to the past and remark how far we've come. However these numbers, unfortunately, aren't much better in the modern era of medicine. In fact being a woman automatically reduces the level of care you will receive in your lifetime, even less so if you have a history of mental illness.
The fact that women have higher rates of mood disorders is likely one reason that it's so common for women to be misdiagnosed as a psychiatric patient. In the US, women are about twice as likely to have a diagnosis of depression or an anxiety disorder as men.
' While it may be true that women naturally have a higher risk, the difference in prevalence rates could be partly a consequence of overdiagnosis in women and underdiagnosis in men. Studies also suggest that as many as 30-50% of women diagnosed with depression or anxiety, were misdiagnosed.
Furthermore, depression and anxiety are themselves symptoms of other diseases, which often go unrecognised in women (I will write about this in my next article.) Plus of course, I can tell you first hand the stress of suffering from an undiagnosed-and therefore untreated-disease often takes its mental toll.
Not being taken seriously enough to be treated, is frustrating enough.
But the biggest danger of having your symptoms dismissed, is that once doctors have settled on the conclusion that they are 'all in your head'-they stop searching for another explanation. Many studies show those who were initially misdiagnosed experience much longer diagnostic journeys, with the time greatly increasing depending on whether you are a male or female.
Women are more often referred to psychologists upon the beginning of their medical quests, whereas men are given tests to rule out organic conditions from the start. And, while being misdiagnosed with the wrong physical disease doubles the time it takes to get the right diagnosis, getting a psychological misdiagnosis extends ones time even more -by up to 14 times. Women have gone ten plus years before being diagnosed with a critical cardiovascular, autoimmune, or other chronic disease.
All these, and more, errors in the medical practice has had devastating effects on women worldwide-especially in the west (which has had a long history of sexist tendancies towards women and their bodies). The west also happens to be the world model of proper medicine, setting a standard for the world. Because this notion, women were never included in medical research or clinical studies for drugs, nor disease studies until roughly thirty years ago when most governments began making it mandatory. Unfortunately things can not change overnight.
Next article, l'll dive into sexism in the educational and research field of medicine, exploring the unfortunate consequences of 'bikini medicine'.
Note: This work was featured in the Uprizine Fall 2019 print edition.