Why Have Historical Medical Biases Against Women Been Able to Persist?

Women’s alleged propensity to hysteria has become a way to explain away the gaps in knowledge inevitably created by decades of studying mostly men.

Why have some historical biases against women (like the concept of hysteria) been able to persist? originally appeared on Quora, the place to gain and share knowledge, empowering people to learn from others and better understand the world. You can follow Quora on Twitter, Facebook, and Google Plus.

I think the biggest reason for the historical biases against women (like the concept of hysteria) is that “the trust gap” and “the knowledge gap” are so perfectly mutually reinforcing. As I mentioned in response to the question about why women’s symptoms are more likely to be minimized or dismissed, the knowledge gap helps perpetuates the stereotype that women are prone to “hysteria”: the more women report symptoms that doctors can’t explain—whether that’s because they weren’t well-trained on women’s conditions in med school or the biomedical research just hasn’t yet been done to explain them—the more it reinforces the notion that women’s symptoms are often “all in their heads.”

And, in a very vicious circle, that stereotype, in turn, perpetuates the lack of knowledge. After all, why invest in scientific research to explain women’s “medically unexplained symptoms” if you think they are already adequately explained by the long-accepted fact that women are prone to psychogenic symptoms? This has created a stubborn catch-22 that’s especially clear when it comes poorly understood “invisible” conditions that disproportionately affect women, such as fibromyalgia, vulvodynia, interstitial cystitis, myalgic encephalomyelitis/chronic fatigue syndrome, chemical intolerance, and others: These conditions are poorly understood largely because medicine hasn’t tried to understand them because it’s been content to assume they’re psychosomatic. But this dynamic can be seen throughout the medical system. Women’s alleged propensity to hysteria has become a way to explain away the gaps in knowledge inevitably created by decades of studying mostly men and extrapolating results to women and prioritizing men’s health concerns. It serves as an alternative explanation that, by filling in these knowledge gaps, manages to erase them.

I think the persistence of these problems can also be blamed on the conservative tendencies within medicine. While we tend to associate medicine very closely with the sciences—and the medical profession has certainly benefited from many scientific advances over the last century—it actually takes a rather long time for medical knowledge to evolve in light of new science. In my book, I discuss a number of myths that were able to persist as widely-accepted medical “facts” for decades, even centuries, in part because, once accepted, they become self-fulling prophecies: endometriosis was thought to be “the career women’s disease,” ovarian cancer was labeled “the silent killer” because it was thought to lack early symptoms, ME/CFS was “yuppie flu” thought to affect largely “educated white women.” None of these myths are true at all.

The concept of psychogenic illness is perhaps the biggest myth of all—one that seems to be based entirely on received wisdom, rather than scientific inquiry. Chloe Atkins described it as “a cultural artifact masquerading as a medical truth” in her book My Imaginary Illness, and I think that’s right. The current generation of medical professionals believes in the concept—and believes that women are especially prone to psychogenic symptoms—because that’s what they were taught by the last generation of medical professionals, who were taught it by the generation before that—and so on all the way back to Freud’s theory of hysterical “conversion.”

Finally, I think a major reason that these problems persist—and with alarmingly little recognition within medicine of how pervasive they are—is that there aren’t good feedback systems in place to ensure that doctors learn of their diagnostic errors. This was a very helpful insight I gained from experts studying such errors (like those associated with the Society to Improve Diagnosis in Medicine) during my book research: Most doctors significantly underestimate how often they personally make a mistake and this overconfidence is not (necessarily) due to individual arrogance—it’s just they assume they got the diagnosis right unless they hear otherwise. And in our current system, they usually only hear otherwise if the patient takes it upon themselves to go back and tell them that they misdiagnosed or missed their condition.

So for example, consider a very typical diagnostic journey among the estimated 50 million Americans, 75 percent of whom are women, with an autoimmune disease: A woman goes to four doctors over four years complaining of fatigue and other subjective symptoms and is told test show nothing wrong and maybe it’s “stress” before the last doctor finally diagnoses her with an autoimmune disease. But those first doctors who determined she was “just stressed” often don’t hear when she’s ultimately properly diagnosed. That lack of feedback reinforces both “the trust gap” and “the knowledge gap,” because the lesson for those first doctors remains “Gee, seems like there are a lot of stress-out women convinced they’re seriously sick in my practice” when the take-away should actually be: “Gee, a lot of my female patients are ultimately getting diagnosed with autoimmune diseases, so I guess I need better training on how to diagnose these conditions.”

So I think there’s a lot of potential to start to turn things around and halt the self-perpetuating nature of these problems by putting better feedback systems in place. Right now, I think a lot of health care providers don’t have any idea just how common it is for women to see multiple providers and have their symptoms minimized or attributed to psychological problems or disbelieved entirely before they are accurately diagnosed (if they ever are).

This question originally appeared on Quora. More questions on Quora:

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