The way women are treated within Western medical systems, namely their frequent misdiagnosis, can be attributed to the explicit gender bias within medicine.
Medicine and Misogyny: The Misdiagnosis of Women
As is the case with most other societal institutions, the American healthcare system is built upon patriarchal ideas. The way women are treated within Western medical systems, namely their frequent misdiagnosis, can be attributed to the explicit gender bias within medicine. This is complicated and made more powerful by the deeply ingrained, harmful beliefs about women and their bodies that have existed for centuries. However, feminist practices, especially the sharing of personal experiences, have historically been and can continue to be a powerful form of female resistance.
The origins of Western medicine can be traced back to Ancient Greece. One of the most notable figures was Hippocrates. Considered “the father of medicine,” he is widely recognized for his role in establishing standards of ethical conduct within medicine, known as the Hippocratic oath. However, he was also the first to use “hysteria” as a formal diagnosis, and in doing so, set a standard of unequal medical care on the basis of gender. Derived from the Greek word hustera, meaning “womb,” hysteria was thought to be caused by “a uterus moving through a woman’s body, eventually strangling her and inducing disease.”1 This “wandering uterus” syndrome, as it is often described in medical texts, was only thought to occur if a woman was not pregnant. This suggests that if they were not fulfilling what was often regarded as the female biological duty of having children, even their own bodies would rebel against them. It also supports the stereotypical gender expectations for women to be mothers, or risk being punished. This “disease” had no distinct set of symptoms, and it was subsequently used to explain essentially any display of emotional volatility, deviancy, or “strange behavior” in women. The female reproductive organs, therefore, were understood as the physiological cause of psychological illness. In other words, this diagnosis problematized female anatomy and sexuality, which remains an underlying influence in determining the way that Western doctors conduct themselves to this day. Hysteria, although no longer a legitimate diagnosis, is still used to describe “overly emotional” women and has led to their unfair characterization as inherently unpredictable or untrustworthy.
What is more, “women in ancient Western societies were commonly viewed as ‘incomplete’ males or as having inverted male sexual organs.”2 This pathologizing of the female body, as an object that men are obligated to complete or correct in some way, has impacted the way women are treated by Western medicine and, more broadly, society. Although evolutionary theory has since developed to disprove this hypothesis, the attitudes directed towards women, specifically their status beneath men in the theoretical hierarchy of species, have not. The misogynistic ideas of male superiority and the framing of the female body as an underdeveloped male body have contributed to the exclusion of women from medical research. This is not only unjust and evidence of the prejudice against women, but dangerous for their wellbeing. These age-old narratives have not disappeared; they remain ingrained in the healthcare system and continue to impact the way women are treated in medical contexts and the diagnoses they receive.
Before considering the societal and cultural factors that have supported the frequent misdiagnosis of women, it is important to understand that there exists an explicit gender bias within clinical research and data collection. Gender bias describes the phenomenon in which man, as in the gendered meaning of the word, acts as the measure for all of the human race.3 Gender bias is often an unconscious force, based on deep-rooted beliefs and stereotypes, that results in a discrepancy in the way that people of different genders are treated. While it has long since been recognized within the social sciences and humanities, it is only within the last half-century that gender bias within scientific research has begun to be understood as a threat to female health.
The gender bias in Western medicine has to do with its androcentricity, or male-centered focus and perspective. This presents itself both in the way that studies are conducted, most often regarding the makeup of research participants, and how the findings are published. The latter is detailed by the authors of the article Gender Bias in Medical Research, as they reference several studies that exhibited some form of gender bias in their research process. One that stands out tested the efficacy of a therapy treatment for individuals at high risk of having a heart attack. Its participant population was composed of 13,385 men, and yet, in its conclusion, the treatment was recommended for “all survivors.”4 The authors of the article argue that, given the biological differences between men and women, it was highly irresponsible for the researchers to make such a sweeping generalization. Especially given that heart attacks present such radically different symptoms between genders, the universal recommendation of this treatment without even one female participant is completely unfounded and potentially even dangerous. Often, this kind of demographic information is made difficult to find, only appearing in the description of a table or figure, and there are no cautionary statements alerting women of these discrepancies. While this study is a very explicit display of the androcentricity that exists within medicine, it also manifests in more subtle ways. It might mean less funding for the research of illnesses that primarily affect women, the underrepresentation of women in executive roles in medicine, or even the use of male pronouns in medical textbooks to describe all people. These varied expressions of gender bias are all important to identify as, in every instance in which men are the focus, the patriarchal institution of Western medicine is strengthened, and women are left in a subordinate position.
The justifications for women’s exclusion from clinical trials vary and are often contradictory. One reason, originating from the Ancient Greek beliefs that Western medicine was founded on, is that male bodies do an adequate job of representing female bodies. Because women are perceived as being developmentally and biologically inferior to men, including women in studies is argued to be superfluous. This understanding of women can be traced back to the idea that they are merely “incomplete males.” However, the other rationale for excluding women from medical research undermines this simplistic view of the female body. Women are regarded as being “too complex, too variable, and too costly” to be tested on.5 While it may be true that female bodies are more complex than male bodies, this is not a legitimate reason to exclude women from research. If anything, the intricate and sophisticated female physiology should be a reason for greater, more extensive study. Admittedly, this framing of women’s bodies as “complex” and “variable” originally came from a place of special consideration for their health. It was, “partially due to concerns of potentially damaging unborn fetuses, that medical trials—including drug trials— were conducted solely in men.”6 However, even this concern points out that society has only ever valued and prioritized women’s health when it relates to their ability to have children. To examine the “too variable” aspect further, the usual reasoning given is that “Using only males is simpler because it reduces in-group variability. However, by ruling out actual variability, the results become less reliable and are not generalizable.”7 As this author points out, it is ironic that the exclusion of women from research trials, which is done in an attempt to make the data less variable and therefore more easily applicable to the general public, is what causes the data to be unreliable and extraneous. This relates to what is called the “male norm” or “default male” phenomenon. Caroline Criado-Perez contextualizes this issue within the medical field, explaining that “The presumption that what is male is universal is a direct consequence of the gender data gap. Whiteness and maleness can only go without saying because most other identities never get said at all.”8 Both the “white male standard” narrative and the gender gap issue have a self-perpetuating relationship: women are excluded from studies, no new knowledge is acquired, and they remain undesirable test subjects because they are “unknown.” The only way that this mystification of the female body can be overcome is by increasing the number of studies that include, and even focus on, women.
There have been significant improvements in this area, especially since 1993 when the National Institute of Health implemented a policy establishing standards for the inclusion of women in clinical trials.9 However, there remain issues in the way that data is reported. When both male and female participants are included in the medical research, the data must remain separated by gender. Whether it is a result of culturally founded beliefs about the insignificance of women’s bodies or simply a lack of care, the results from these studies are sometimes compiled into one group. By not differentiating the symptoms experienced, responses to a certain medication, or whatever else was being tested, researchers are effectively erasing biological differences between men and women. The results are, therefore, completely unhelpful in furthering the knowledge surrounding the female body and reducing the data gap. Criado-Perez, author of Invisible Women, elaborates on this topic, writing that “when symptoms are listed in order of frequency for all patients rather than separated by sex, female-specific symptoms can be presented as less significant than they are in reality.”10 This excerpt highlights that these biases could still be influencing the way research is conducted, even if the participant group has been diversified. It also provides an explanation as to why doctors might be missing indicators of female illness. Even if data has already been collected, there is still room for human error in the way that it is reported and shared amongst the medical community and general public.
Doctor-patient dynamics are complex, especially considering the longstanding history of female oppression that has been justified using science. As such, the everyday interactions women have with medical professionals remain clouded by misogyny. First, Western medicine must be recognized for what it is: a patriarchal institution. The personnel, whether they are cognizant of it or not, therefore play a role in its continued operation as such. More specifically, the power relations and negotiations between doctors and their patients mimic the domination of women by men. The doctor takes on the role of “expert” and the patient, naive and uninformed, is forced into a position of submission. This is not necessarily only true of male medical professionals, as female doctors also take on this patriarchal power when given the opportunity. By uplifting and empowering themselves, doctors often diminish the intelligence of their patients and invalidate their experiences of pain. The Boston Women’s Health Collective describes this dynamic in their 1970 booklet on female health and inequality in healthcare, expressing their feeling that “We are considered stupid, mindless creatures, unable to follow instructions (known as orders) … Health is not something which belongs to a person, but is rather a precious item that the doctor doles out from his stores. Thus, the doctor preserves his expertise and powers for himself. He controls the knowledge and thereby controls the patient.”11 The exclusivity of medicine allows for this power imbalance to remain intact. This regulation of knowledge has encouraged female patients to do their own research, an action that should be applauded and seen as a sign of a patient’s proactiveness. However, it is more often interpreted by doctors as insulting and even inconsequential. A study conducted on eight women who had previously experienced medical misdiagnosis found that “when participants presented their research findings to their healthcare professionals, they were met with disbelief, cynicism, or dismissal.”12 If female patients come across such patronizing attitudes, it can be deeply disheartening and cause them to be less likely to speak up for themselves again in the future. The emotional and psychological toll of being dismissed by an “expert” deepens the insecurity that many women may already feel in such male-dominated spaces.
The way that practitioners of Western medicine perceive female patients is central to understanding their frequent misdiagnosis. Built upon historical characterizations of women as “hysterical” and over-emotional, doctors tend to view their female patients as exaggerating and unreliable reporters of their own pain. Women may be told “it’s all in your head” or be “positioned as mentally unwell rather than physically unwell.”13 Although it has been proven that sex and gender differences influence the way that illnesses appear in the body, female patients are often met with apprehension when they describe symptoms that differ from those known to belong to the “male norm.” Thus, due to the lack of understanding of the female body, they often go unexplained within the Western medical paradigm. The consequences of these varied, unrecognized symptoms can be dangerous and even fatal. For example, women show completely different signs of a heart attack than men. It may be “without any chest pain at all, but rather with stomach pain, breathlessness, nausea, and fatigue. These symptoms are often referred to as ‘atypical.’”14 Because female bodies are still shrouded in mystery, women are more likely to remain undiagnosed for a long period of time. Doctors have an especially difficult time determining the causes of female pain when it comes to chronic illnesses and diseases exclusive to women, such as endometriosis. This is not entirely surprising, seeing as “historically, chronic conditions with inexplicable symptoms that affect more women than men fell under the category of ‘hysteria’ and were not taken seriously by the medical community or considered legitimate medical conditions.’15‘ A delayed diagnosis not only puts women in danger and elongates their suffering, but it is also a demoralizing experience. Considering that women have, historically, not been believed by “experts,” having your pain acknowledged by a doctor as a female patient is extremely validating. Even just receiving a diagnosis grants a feeling of relief, and women are frequently denied this.
It would be an inadequate exploration into female misdiagnosis without acknowledging that other social identities contribute to the kind of care women receive. For one, there is virtually no medical research “when it comes to women of colour, disabled women, working-class women…the data is practically non-existent.”16 In addition, while all women are typecast as being emotional and sensational, white women are privileged in that they are often seen as fragile, delicate, or deserving of special care. This might grant them more attention in medical settings in comparison to women of color, and especially black women, who have been negatively impacted by the “strong black woman” stereotype. Along with race, class differences also play a role in how female patients experience medical care. Women who do not have access to the same resources, such as transportation or education, may be limited in their “ability to successfully self-advocate, or repeatedly visit a healthcare professional, or seek alternative or specialist treatment due to limited time, money, and resources.”17 Recognizing that gender is not the only social identity that determines how institutions of power, including Western medicine, treat individuals is important when considering how they might be restructured to be more advantageous for all people.
There is also a culture of shame and a stigma surrounding female bodies that have potentially silenced meaningful conversations. The Boston Women’s Health Collective is a testament to the feminist resistance that has existed for decades, working in opposition to Western medicine to unite, rather than disempower, women. Their first booklet, “Women and their Bodies,” encouraged female patients to stand up for themselves, shared potentially dangerous symptoms to be aware of, and gave advice on more taboo subjects based on personal experiences. In one essay, the authors warn female readers of the risks of sexually transmitted diseases: “Don’t depend on just one test. If the first test for gonorrhea or syphilis doesn’t show anything, make sure the doctor takes another one to be safe. Don’t just accept whatever he says. Some doctors aren’t careful enough, and it’s your life, not his.”18 By promoting self-advocacy and increasing women’s awareness of their bodies, The Boston Women’s Health Collective clearly exemplifies feminist ideology and practice. Their success with the subsequent books on this subject indicates that women were, and still are, actively searching for a sense of community to feel less alone in their struggles.
The complexity of female misdiagnosis is reflected in not only the causes but also the proposed solutions. The most meaningful changes would likely call for a complete restructuring of healthcare systems and medical institutions. However, a good place to start would be to teach doctors to be more aware of their personal biases and how to listen to women’s experiences as objectively and fully as possible, without dismissing any seemingly irrelevant details. In addition, female patients can empower themselves by becoming more confident in themselves and their individual experiences. On this subject, it has been found that “when successful, self-advocacy produces better health outcomes and improved interactions between patients and healthcare professionals.”19 Most broadly, there must continue to be an effort to increase the quantity and quality of research on the female body and the different ways illnesses manifest in women.
Western medicine has, since its inception, misunderstood the female body. Women are still somewhat mystifying to healthcare providers, and this relationship between lack of research and lack of accurate symptoms to diagnose is compounded by the historical and cultural standard of not believing women. Feminist practices offer female patients support and guidance as to how to exist within a system of healthcare that so often fails them.
- Lindsey Churchill, “Hysteria.” Encyclopedia of Gender and Society,” ed. Jodi O’Brien,1st edition (Sage Publications, 2009).
- Churchill, “Hysteria.”
- Margrit Eichler, et al., “Gender Bias in Medical Research,” Women & Therapy 12, no. 4, (1992): 61.
- Eichler, “Gender Bias,” 64.
- Caroline Criado-Perez, Invisible Women: Data Bias in a World Designed for Men (Abrams Press, 2019), 91.
- G. Bruinvels, et al., “Sport, Exercise and the Menstrual Cycle: Where is the Research?” British Journal of Sports Medicine 51, no. 6, (2017): 487.
- Eichler, “Gender Bias,” 64.
- Criado-Perez, “Invisible Women,” 20.
- Criado-Perez, “Invisible Women,” 95.
- Criado-Perez, “Invisible Women,” 99.
- Boston Women’s Health Collective, Women and Their Bodies: A Course (New England Free Press, 1970), 6.
- Jessica Thompson and Denise Blake, “Women’s Experiences of Medical Miss-Diagnosis: How Does Gender Matter in Healthcare Settings?” Women’s Studies Journal 34, no. 1/2 (2020): 28.
- Thompson and Blake, “Women’s Experiences,” 29.
- Criado-Perez, “Invisible Women,” 98.
- Thompson and Blake, “Women’s Experiences,” 29.
- Criado-Perez, “Invisible Women,” 10.
- Thompson and Blake, “Women’s Experiences,” 31.
- Boston Women’s Health Collective, Women and Their Bodies, 64.
- Thompson and Blake, “Women’s Experiences,” 28.