In 2003, Diane Hoffman and Anita Tarzian, academics of the University of Maryland published a paper called the ‘The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain’, a study of the ways in which gender discrimination manifests itself in clinical pain management. They found that female patients with symptoms akin to their male counterparts were more likely to be given sedatives, while the men were given painkillers. Several studies in the past echo a similar bias. In a 1994 study of 1,308 outpatients with metastatic cancer, it was found that of the 42 percent who were not adequately treated for their pain, women were significantly more likely than men to be undertreated (an odds ratio of 1:5). In another study of 366 AIDS patients, women were significantly more likely than men to receive inadequate analgesic therapy. This inadequate treatment of women stems from mislabelling a woman’s pain as anxiety and hysterical behaviour instead. According to the stereotypes, men are stoic and gruff, so when they express pain, they must really be very uncomfortable while women are emotionally strung hypochondriacs and their expressions of pain are exaggerated. The authors of ‘The Girl Who Cried Pain’ attribute this gap to “a long history within our culture of regarding women’s reasoning capacity as limited”. But this is a global, cross-cultural problem. In India too, about one in five women (18 percent) reported gender‐based discrimination when going to a doctor or health clinic. In her book, “Heal Me: In Search of a Cure”, freelance journalist and survivor of Ehlers-Danlos syndrome Julia Buckley writes about how she travelled the world in search for a cure and was gaslighted by doctors across the globe. The book is “Raising vital questions about the modern medical system, this is also a story about identity in a system historically skewed against ‘hysterical’ female patients, and the struggle to retain a sense of self under the medical gaze.” All these testaments are consistent with the evidence reviewed by the American Medical Association’s Task Force on Gender Disparities in Clinical Decision-Making. Physicians were found to consistently view women’s (but not men’s) symptom reports as caused by emotional factors, even in the presence of positive clinical tests.

According to Amy M. Miller, Ph.D., president and CEO of the Society for Women’s Health Research (SWHR), the dismissal of pain women experience combined with brief pain management research inclusive of women lends itself to the predictability of chronic pain conditions with no direct treatments being common or exclusive to women. Patients of painful female conditions such as polycystic ovarian syndrome and endometriosis, which have been limitedly researched, are dealt with the rawest end of this biased system. One in ten women suffer from endometriosis, and yet it takes an average of seven to eight years for them to be diagnosed, with cases often being dealt with more sincerity when women are trying to conceive. Women’s pain in cases where impregnation isn’t involved is often overlooked. A study in the journal of Fertility and Sterility links the mishandling of endometriosis to ancient conceptions of hysteria — “the centuries-old notion linking chronic pelvic pain to mental illness exerted tremendous influence on attitudes about women with endometriosis in modern times, contributing to diagnostic delays and chronic indifference to their pain for most of the 20th century.” What are these notions?

This recurring pattern of women’s pain being relegated to emotional instability and hysteria has ancient roots. The word hysteria comes from the Greek word ‘Hystera’ meaning uterus and so hysteria has long been exclusively associated with female bodies. As early as in 1900 BC, Eber Papyrus, an ancient medical document delineates hysterical disorders as effects of abnormal movements in the womb. Argonauto Melampus was the first one to bring forth this explanation of hysteria. He spoke of the virgins of Argo who fled to the mountains, leaving the men behind, disgracing the phallus. They were declared insane, for refusing to have desires for a penis. Hence propounded a theory of women deprived of orgasms going mad. Philosophers like Araeteus and Plato described the uterus as a living entity, an animal blinded by its hunger.  In 5^th Century BC, Hippocrates, the father of modern medicine, coined the term ‘hysteria’ and attributed this exclusive female condition to problems of the ‘wandering womb’. He built upon Plato’s idea of the womb as a living being that felt dejected upon being denied its male counterpart, causing it to wander and create chaos within the body in search of satisfaction, resulting in women becoming mad. The wandering womb was therefore believed to be caused by sexual inactivity, abstinence, dissatisfaction or lack of sexual interest and the obvious cure was a robust sexy time in the marriage. Female pain and emotional expression are thus reduced to their sexual track records and women to sexual objects. In the essay Once Upon a Text: Hysteria from Hippocrates, Helen King elaborates on how women were subjugated by the threat of the wandering womb. Men were seen as offering them a favour in order to quell disease when they bedded them, regardless of the woman’s consent. An appropriate solution was to keep the womb occupied with a foetus and thus women were forced into reproduction. All of a woman’s weakness was traced back to her womb hysteria, and so having babies would cure women of all pathologies. This helped perpetuate the status quo as women were dismissed as lunatics whenever they posed a threat.

Aristotle’s claim — ‘a woman is a failed man’ was a popular theory at the time, conforming to Christianity’s idea of the ‘original sin’. The uterus was the beast of femininity. The conception of uterine madness resulted in women being viewed as fundamentally inadequate beings, failing to have a meaningful existence, incapable of taking care of themselves and in need of a dominant male partner, throwing all ideas of female independence out the window. When women were diagnosed with hysteria, they were guilty of the sin of not procreating. Sex was medicine, the semen was thought to have healing properties and children were the fulfilment the womb desired. Through the centuries, hysteria was also blamed on unnatural spiritual possessions of women to all sorts of other voodoo that caused them to be volatile, an explanation often plastered upon disorderly women in society. This was the edifice behind the famous witch hunts of the middle ages. In fact, even the first vibrator developed by Dr. J Mortimer Granville was conceived as a way to help women orgasm and hence, calm their hysteria quicker. Well, there’s at least one good thing that came out of this hysteria obsession.

Hysteria in the present day is defined as “Exaggerated or uncontrollable emotion or excitement” in the Oxford dictionary. It is no longer classified as a pathological condition, but more of a symptom of underlying pathologies. The term itself didn’t disappear from the medical domain till the early 1950s when it was removed by the American Psychiatric Association from the Diagnostic and Statistical Manual of Mental Disorders.  Freud, the father of psychoanalysis was the first to translate the physiological causes of hysteria into the domain of psychology, even as he maintained the link with sexuality. It still remains a historically gendered diagnosis, acting as the scapegoat term using which doctors defer a woman’s clinical condition as mental instability when they can’t identify an illness. The core idea is that women are still perceived to be less in control of their mind and bodies. The history of hysteria has resulted in implicit biases where men are still viewed as cognitive beings, whereas women are irrational. This becomes clear when we observe mental health diagnostic statistics.

According to the World Health Organisation, “Overall rates of psychiatric disorder are almost identical for men and women but striking gender differences are found in the patterns of mental illness.” Plausibly these are patterns of diagnosis, with WHO pointing out that women are more likely to be treated for depression than men even though the rates of depression don’t differ greatly between the genders. The diagnosis that is closest to the classical definition of hysteria today is Borderline Personality Disorder. So more explicitly related to our argument are the diagnosis patterns of BPD which seem to be clearly skewed towards women. An article in Mad America elucidates how women are treated for BPD 75% more often than men. Is it merely a coincidence that the symptoms of BPD resemble those of hysteria throughout history? This runs the risk of overmedicating women and neglecting men in issues related to mental health. This propends from the stigma associated with mental illness in society, it being viewed as signs of weakness and abnormal behaviour and thus naturally associating it with women as being the weaker sex. The Aristotle-ian idea of women as fundamentally defunct often drives a diagnosis of mental illness in women. Thus, we can draw clear parallels between the history of hysteria and its manifestations in modern day medicine. In this odd paradox, women are not taken seriously when in chronic physical pain and taken rather too seriously when in mental pain. Sexism has very real-life implications, affecting life and death, health and happiness. The key to ridding the healthcare systems of this bias is to first recognise it and involve more women in clinical trials and for women, in turn, to be pushier , persistent and assertive about what they feel.

Ananya Gupta is an undergraduate student at Ashoka University , pursuing a major in Political Science and a minor in Creative Writing