The Horrible History of Medical Misogyny

When Elizabeth Packard married a Calvinist minister named Theophilus in 1839, it seemed the start of a peaceful marriage. The couple had six children together, and moved from Massachusetts to Ohio, then Iowa, then Illinois. But around the time they arrived in Illinois, things began to sour. Elizabeth argued with Theophilus on his views of child rearing, religion, and even slavery. In 1860, Theophilus had his wife committed to the Illinois Hospital for the Insane against her will. 

For the next three years, Elizabeth struggled against the doctors at the asylum. She recorded instances of near-drownings and other abuses. She proved so resistant to their “treatment” that she was discharged in 1863 and labeled “incurably insane.” But back in her husband’s custody once more, Elizabeth ended up locked in their house with the bedroom window nailed shut. 

This, however, was deemed to be illegal, and a judge ordered a trial to determine Elizabeth’s sanity. Friends and neighbors testified on her behalf against physicians. In the end, the jury decided Elizabeth was sane. Her husband left her (though they never divorced) and she went on to dedicate her life to the rights of patients in these asylums. Her efforts resulted in several laws being passed to make conditions more tolerable for these people. 

Elizabeth’s story may sound shocking to a modern audience, but for 18th- and 19th-century women, medical mistreatment for patients with physical maladies or mental illnesses was all too common. What truly makes Elizabeth unique is that she successfully advocated for her rights and was able to share her story with others. 

For centuries, Western medicine had been built upon the foundation that women (and their bodies) were inferior to men. When witch hunts grew vicious during the Reformation era in Europe, women with epilepsy, leprosy, or any maladies whose source proved impossible to identify could be credibly accused of witchcraft. 

With the advent of professional medicine in the 18th century, these historical foundations proved to be continually deleterious for women’s wellbeing. The diagnosis of hysteria boomed in popularity. “For every one man affected with hysterical fits, [Edinburgh professor James Gregory] postulated that 10,000 women suffered from such attacks,” writes historian Guenter Risse. 

The diagnosis was conferred on women with a number of symptoms: fainting, weakness, vomiting, amnesia, paralysis, pain, spasms, and convulsive fits. It was seen as a multi-organ illness, something that affected both body and mind. Because of that, it could be treated in hospitals, or in mental asylums.

Sometimes, the afflicted women sought treatment of their own accord. Sometimes family members, who struggled to provide care at home, sent them to be admitted for short stays. Sometimes, women who were considered “troublesome domestic workers” were sent by their employers. And sometimes, they were committed involuntarily, like Elizabeth Packard. 

Once in the hospital or an asylum, these women faced inhumane treatment at the hands of doctors and staff. Treatments for hysteria, for example, included bloodletting, purgatives and laxatives, applying caustic salves on the skin to raise blisters, electroshock therapy, lobotomies, and insulin coma therapy. In this last, patients were injected with insulin until they entered a coma, then slowly revived. They could be subjected to 30 to 50 insulin comas over the course of their treatment. 

Women were not always passive victims in these scenarios; we have records of the more educated upper-class corresponding with doctors about different treatments for their maladies. Stories like Elizabeth Packard’s became part of the public record. 

But women had little recourse when it came to expressing themselves or fighting unjust treatment. As the historian Heather Meek writes, “In a sense, the doctors’ treatments were a means of silencing or punishing patients — of committing violence to that which they could neither contain nor understand.” 

While hysteria was only one of a plethora of illnesses from which women might suffer, it proved to be a lasting catch-all for symptoms that didn’t easily fit into other disease categories. The disorder was listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) until 1980. 

The ghosts of these women and their treatments at the hands of medical professionals continue to haunt us to this day. Multiple studies in the U.S. and U.K. have found that women’s symptoms are routinely dismissed as psychological or exaggerated. Studies show women face more misdiagnoses than men, and a significantly longer wait time for effective treatment. 

“The longstanding and misguided belief that women are excessively emotional is one reason why the healthcare industry has a record of invalidating and disregarding women’s concerns even today,” said Judith Leithich, a nurse practitioner interviewed by Psychology Today. “The belief that women are weak has wrongly rationalized that their troubles are inflated and their reactions are exaggerated.” 

But the problem goes far beyond the Anglophone world. Data from the United Nations suggests this problem extends across the world, with women living longer but not better lives. Though women live slightly longer than men, they spend more years in poor health: an average of 11 years versus 8 years for men. Researchers suggest that disparity is in large part because of the history of medical misogyny. 

How else does this manifest? Well, women have lower survival rates for cardiac arrest than men because they are less likely to have their heart disease recognized. For years, men’s symptoms were considered the standard for how heart attacks presented: chest pain that radiates down the left arm. But these symptoms can be much subtler in women. Men were also thought to be more likely to suffer from heart attacks than women, even though heart disease is the leading cause of death for men and women. The American Heart Association didn’t release its first statement about heart attacks in women until 2016. 

Multiple studies have found that women experience worse pain than men, but are less likely to receive pain relievers or adequate treatment. A shocking podcast series by Serial Productions and The New York Times found that multiple women experienced severe pain during egg retrieval surgery and were dismissed when they complained of the pain — only to learn that pain relief drugs were being diverted by an opioid-addicted nurse. They had been receiving saline solution in its place. And health outcomes are even worse for Black women, Asian women, and Latina women. 

Though I’m white, insured, and upper-middle class, I too, have been affected by medical misogyny. Doctors of all genders have dismissed my pain, ignored my symptoms, and refused treatment for what would end up being serious medical issues. One doctor, after detailing why she couldn’t help me, noticed I was on the verge of tears and asked, sarcastically, if I needed a tissue. Time and again I was made to feel that my suffering not only didn’t matter, but that it wasn’t even real. 

“Framing the women as ‘hysterical,’ ‘anxious,’ ‘overreacting,’ or the inference that their account of their symptoms was the product of some kind of ‘mass hysteria’ allowed the [healthcare professionals] to explain away the symptoms women sought help for,” write the authors of a study on medical misogyny in the U.K. Doing so placed the burden on women — as if the pain were somehow their fault, possibly even their imagination — releasing doctors from having to do the difficult work of figuring out the underlying issue.

When Virginia Woolf wrote her essay “On Being Ill” about the ways sickness had been neglected as a subject for major works of literature, she could have just as easily been writing about the ways women’s sickness specifically continued to be neglected. 

All of this is just a starting point for change, and raises the question of what we should do with what we now know. I have a few ideas.

We need to focus on collecting data and doing research specifically on women — especially women of color. Until 1993, women were largely excluded from clinical trials, and data was only collected on men’s bodies. Medical practitioners also need to be specially educated on the impact of biases and centuries of medical neglect so that they might identify and rectify it in practice. 

There’s also the larger culture of patriarchy and surveillance that is reproduced by the government. In the U.S., that happens on both the state and federal level. For cisgender women, there are numerous laws about reproductive care and abortion access. For transgender women, there is limited access to gender-affirming care, as well as laws about restroom use and IDs. To protect all women’s health, we must preserve their ability to access healthcare, in whatever form it takes. 

Unfortunately under the current administration, federal research that relates to diversity, equity, inclusion and accessibility has been slashed — and that includes studies on disparities in healthcare. The federal government has also enacted historic cuts to Medicaid (disproportionately affecting women and children), increased the costs of Affordable Care Act insurance plans, and erased important health information that used to be accessible to the public. Cutting most USAID programs also negatively affects the health of women globally. To improve life for all people, but especially women, the U.S. should move towards a single-payer system that doesn’t tie people’s healthcare to their employment status.

Stories alone can only do so much. But in this moment, when the U.S. government seems more set on harm than help, using our voices can be a way for women to push back against the regime, collaborate with doctors, and work to undo the many prejudices that have long existed in healthcare. 

We have more power together than as individuals–but every single voice matters. Bringing a friend to appointments, recording conversations, and explicitly stating when you’re being dismissed might all help you get the care you need.