It's Not Hysteria

It's Not Hysteria Plot Summary

Introduction

Imagine a woman in ancient Greece, experiencing severe abdominal pain. Her physician explains that her womb has wandered from its proper place and is now pressing against her liver. Fast forward to Victorian England, where a woman showing signs of irritability or sexual desire might be diagnosed with "hysteria" and subjected to surgical removal of her ovaries. These aren't fictional scenarios but actual medical practices that shaped women's healthcare for centuries. Throughout history, misconceptions about female bodies have led to treatments that often caused more harm than healing, while genuine conditions went unrecognized and untreated. This historical journey reveals how medical understanding of women's bodies has been profoundly influenced by cultural beliefs, social control, and gender bias rather than scientific evidence. From the ancient theory of the "wandering womb" to the exclusion of women from modern clinical trials, we'll explore how medical misconceptions have evolved yet persisted across cultures and eras. By understanding this troubled history, readers will gain insight into why women's symptoms are still frequently dismissed, why racial disparities in healthcare remain so stark, and how patient advocacy has finally begun to transform women's healthcare into a more evidence-based and respectful practice.

Chapter 1: Ancient Origins: The Wandering Womb Theory (400 BCE-200 CE)

The history of gynecology begins in ancient Greece, where physicians like Hippocrates developed theories about women's bodies that would influence medical thought for millennia. Central to these early understandings was the concept of the "wandering womb" - the belief that the uterus was not fixed in place but could move throughout a woman's body, causing various ailments as it traveled. Hippocrates, often called the father of Western medicine, theorized that this mobile organ could cause symptoms ranging from suffocation to mental disturbances when it strayed from its proper position. Plato elaborated on this concept, describing the womb as "an animal within an animal," with desires and needs of its own. In his dialogue Timaeus, he wrote that when the womb "remains without fruit long beyond the due season, it is vexed and takes it ill; and by straying all ways through the body and blocking up the passages of the breath and preventing respiration it casts the body into the uttermost distress." The wandering was believed to be prevented through pregnancy and sexual intercourse, which would "satisfy" the womb and keep it in place. These ideas weren't merely academic - they formed the basis for treatments that included placing sweet-smelling substances near the vagina to "lure" the womb back to its proper position, or foul-smelling substances at the nose to repel it upward. Beyond Greece, ancient Egyptian medical papyri show that gynecological care was practiced as early as 1800 BCE, with treatments for fertility issues and contraception. In ancient Rome, Soranus of Ephesus wrote extensively on gynecology and obstetrics, offering more practical and sometimes less mythological approaches. However, the Greek concept of the wandering womb persisted throughout the Roman period and beyond, deeply embedding itself in medical thought. The Hippocratic Corpus, a collection of medical texts, contained detailed observations about women's health issues, but these observations were filtered through a fundamental misunderstanding of female anatomy and physiology. The deeper significance of the wandering womb theory lies in how it positioned women's bodies as inherently unstable and prone to disorder. While men's bodies were considered the stable, perfect standard, women's bodies were viewed as deviant and problematic, requiring control and management. This perspective wasn't merely a medical theory but a reflection of broader social attitudes that viewed women as less rational and more governed by their bodies than men. The womb was seen as the source of women's supposed emotional instability and intellectual limitations, providing a biological justification for restricting women's roles in society. The legacy of these ancient theories cannot be overstated. They established a framework that viewed women's bodies as fundamentally flawed and mysterious, requiring control and management. This perspective would continue to influence medical approaches to women's health for centuries, with the womb consistently positioned as the source of women's physical and mental distress. The wandering womb theory may seem absurd by modern standards, but it represented an early attempt to explain the complex relationship between reproductive organs and overall health - a relationship that modern medicine continues to explore, albeit with vastly improved understanding.

Chapter 2: Victorian Era: Surgical Solutions for 'Hysteria' (1800-1900)

The Victorian era marked a dramatic shift in gynecological care, as medicine became increasingly professionalized and surgical interventions gained prominence. By the mid-19th century, the ancient concept of the wandering womb had evolved into the diagnosis of "hysteria" - a catchall condition attributed to women's reproductive organs that supposedly caused symptoms ranging from anxiety and irritability to sexual desire and rebelliousness. The word itself derived from the Greek hystera (uterus), maintaining the ancient connection between women's mental health and their reproductive organs. Prominent gynecologists of the era developed surgical "cures" for hysteria and other female complaints. Dr. Isaac Baker Brown, president of the Medical Society of London, advocated clitoridectomy (surgical removal of the clitoris) to treat not only hysteria but also epilepsy and catalepsy. He believed that masturbation caused these conditions, and removing the clitoris would prevent this "moral failing." In America, Dr. Robert Battey pioneered the "normal ovariotomy" - the removal of healthy ovaries to treat various conditions including hysteria, epilepsy, and "menstrual madness." Between 1872 and 1906, thousands of women underwent these procedures, often without truly informed consent. The development of surgical anesthesia in the 1840s facilitated these invasive procedures, as did the invention of specialized instruments like the speculum. Dr. J. Marion Sims, often called the "father of American gynecology," developed surgical techniques for repairing vaginal fistulas by experimenting on enslaved Black women without anesthesia. Anarcha, one of these women, endured 30 operations before Sims perfected his technique. This horrific exploitation highlights how race and class intersected with gender in the development of gynecological care. Sims later used his techniques to treat wealthy white women, who received the benefit of anesthesia that he had denied to his enslaved patients. This dual standard of care established patterns of racial inequality in women's healthcare that continue to this day. Victorian gynecology was deeply intertwined with prevailing social attitudes about women's proper role. The female body was viewed as designed primarily for reproduction, and any deviation from this purpose - including education, political participation, or sexual pleasure - was considered potentially harmful to reproductive health. Dr. Edward Clarke's influential 1873 book "Sex in Education" argued that higher education would damage women's reproductive systems by diverting energy from the ovaries to the brain. These medical theories conveniently reinforced the social restrictions placed on women during this period. Women who sought education or independence could be labeled as suffering from "hysteria" and subjected to treatments that would force them back into traditional roles. By the late 19th century, Dr. Silas Weir Mitchell's "rest cure" became a popular treatment for hysteria among upper-class women. This regimen involved complete bed rest, isolation, forced feeding, and prohibition of all intellectual activity. Charlotte Perkins Gilman, who underwent this treatment, later described its psychological torture in her famous short story "The Yellow Wallpaper." The protagonist, confined to a room and forbidden to write or think, eventually descends into madness - a powerful critique of how medical treatments for women often caused more harm than the conditions they purported to cure. The Victorian era's approach to women's health reveals how medical practice can become a tool for social control, pathologizing normal female experiences while causing immense suffering.

Chapter 3: Freud's Impact: Psychologizing Women's Physical Symptoms (1890-1930)

As the 19th century gave way to the 20th, a revolutionary shift occurred in the understanding of hysteria through the work of Sigmund Freud and his contemporaries. Moving away from the purely physical explanations of the Victorian era, Freud proposed that hysteria's physical symptoms had psychological origins - specifically in repressed memories and sexual desires. This represented a pivotal moment in medical history, as it acknowledged the connection between mind and body while still maintaining the focus on women's sexuality as the primary source of their ailments. Freud's journey to this conclusion began under the tutelage of Jean-Martin Charcot at the Salpêtrière Hospital in Paris. Charcot, a neurologist, had been studying hysteria through hypnosis and public demonstrations where women patients would be induced to display dramatic symptoms - convulsions, fainting, and strange postures that Charcot meticulously categorized. These theatrical presentations, often photographed and widely distributed, created a visual vocabulary of female hysteria that permeated medical and popular culture. While Charcot believed hysteria had neurological origins, Freud would take these observations in a different direction. In collaboration with Josef Breuer, Freud published "Studies on Hysteria" in 1895, introducing the "talking cure" - the predecessor to psychoanalysis. Through case studies like that of "Anna O." (Bertha Pappenheim), they argued that hysterical symptoms could be resolved when patients verbalized their traumatic memories and associated emotions. Freud initially believed these traumas were often sexual abuse in childhood, but he later abandoned this "seduction theory" in favor of his more controversial theory that hysteria stemmed from repressed sexual fantasies and desires. This shift had profound implications for how women's accounts of their experiences would be interpreted by the medical establishment. Freud's theories had complex implications for women's healthcare. On one hand, they acknowledged that women's physical symptoms deserved serious attention and treatment, rather than dismissal. On the other hand, they continued to locate the problem within women themselves - in their psychosexual development and unconscious desires - rather than in external social conditions or genuine physical pathologies. This framework made it easy to dismiss women's physical complaints as "all in their heads," a dismissal that continues to affect medical care today. Women with unexplained physical symptoms were increasingly referred to psychiatrists rather than gynecologists. While this spared many from unnecessary surgeries, it often meant that legitimate physical conditions went undiagnosed. The psychoanalytic approach to women's health spread rapidly through medical institutions in Europe and America in the early 20th century. The diagnosis of "hysteria" gradually gave way to new classifications like "psychosomatic disorder," "conversion disorder," and eventually "somatization disorder" - terms that still appear in diagnostic manuals today and are disproportionately applied to women. This psychological framing of women's physical symptoms created a new form of medical gaslighting, where women's bodily experiences were interpreted as manifestations of psychological issues rather than legitimate physical conditions requiring investigation and treatment.

Chapter 4: The Research Gap: Women Excluded from Clinical Trials (1950-1990)

The post-World War II era saw unprecedented growth in medical research and pharmaceutical development, yet women's health remained remarkably understudied. From the 1950s through the early 1990s, a systematic exclusion of female subjects from clinical trials created a massive knowledge gap that continues to affect healthcare today. This exclusion wasn't merely an oversight - it was official policy, codified in FDA guidelines issued in 1977 that explicitly barred "women of childbearing potential" from early-phase drug trials, ostensibly to protect potential fetuses from experimental drugs. The consequences of this exclusion were far-reaching. Medications were developed and dosed based on studies conducted primarily on men, typically white men weighing around 70 kilograms. This led to inappropriate dosing recommendations for women, who often metabolize drugs differently due to hormonal fluctuations, body composition differences, and other sex-specific factors. Women experienced more adverse drug reactions than men, with some drugs later found to cause serious gender-specific side effects that weren't detected in male-only trials. For instance, the sleeping medication zolpidem (Ambien) was eventually discovered to affect women much more strongly than men, requiring sex-specific dosing recommendations that weren't implemented until 2013 - decades after the drug's approval. Even conditions that predominantly affected women received minimal research attention and funding. In 1990, a Government Accountability Office report revealed that only 13.5% of the National Institutes of Health (NIH) budget was dedicated to women's health research, despite women making up half the population. Conditions like endometriosis, which affects approximately 10% of women of reproductive age, received a fraction of the research funding allocated to comparably prevalent conditions affecting both sexes or predominantly men. This neglect meant that diagnoses were delayed, treatments remained limited, and women's suffering was prolonged unnecessarily. The exclusion extended beyond clinical trials to basic science research. Animal studies, the foundation of biomedical research, routinely used only male animals based on the assumption that female hormonal cycles would complicate results. This practice ignored the fundamental biological differences between sexes that might affect disease processes and treatment responses. As a result, our understanding of diseases, from cardiovascular conditions to autoimmune disorders, was built on an incomplete and male-centric foundation. This had particularly severe consequences for conditions like heart disease, where women's symptoms often differ from men's "classic" presentation, leading to misdiagnosis and delayed treatment. This systematic neglect began to change only in the early 1990s, following advocacy by women scientists, physicians, and patients. The Women's Health Equity Act of 1990 and the NIH Revitalization Act of 1993 mandated the inclusion of women and minorities in federally funded research. The FDA reversed its exclusionary policy in 1993, acknowledging that protecting potential fetuses had come at the cost of endangering actual women. These policy changes marked the beginning of efforts to close the knowledge gap, though decades of neglect had created deficits that would take generations to fully address. The research gap of 1950-1990 stands as a powerful example of how social biases can become embedded in scientific practice, with profound consequences for health and healthcare.

Chapter 5: Racial Disparities: Unequal Treatment in Reproductive Health (1800-Present)

The intersection of race and gender has created particularly stark disparities in reproductive healthcare, with women of color experiencing compounded forms of medical discrimination. Throughout American history, the reproductive bodies of Black, Indigenous, and other women of color have been subjected to exploitation, experimentation, and control in ways that reveal how racism and sexism operate together within medical systems. These historical patterns continue to shape healthcare experiences and outcomes today. The development of modern gynecology itself is inextricably linked to racial exploitation. Dr. J. Marion Sims, celebrated as the "father of American gynecology," perfected his surgical techniques by experimenting on enslaved Black women without anesthesia in the 1840s. While only three of these women's names are known to history - Anarcha, Betsey, and Lucy - Sims operated on at least eleven enslaved women, with Anarcha enduring 30 painful surgeries. Sims justified this torture by promoting the racist belief that Black people experienced less pain than white people, a myth that research shows continues to influence medical treatment disparities today. This historical foundation established patterns of exploitation and unequal care that would persist for generations. Throughout the 20th century, women of color were disproportionately targeted for sterilization programs. Between the 1930s and 1970s, approximately one-third of Puerto Rican women of childbearing age were sterilized under government policies, many without full informed consent. In the United States, state-sponsored eugenics programs sterilized thousands of women deemed "unfit" to reproduce, with Black, Latina, and Native American women targeted at higher rates. As late as the 1970s, an estimated 25-50% of Native American women of childbearing age were sterilized by the Indian Health Service, often without proper consent. These programs reflected both racist population control ideologies and the devaluation of these women's reproductive autonomy. Contraceptive research has similarly reflected racial disparities. When oral contraceptives were first developed in the 1950s, they were tested on Puerto Rican women at doses 20 times higher than eventually approved, resulting in severe side effects that were largely ignored. More recently, long-acting contraceptives like Norplant were aggressively marketed to low-income women of color, sometimes with coercive incentives tied to welfare benefits, reflecting ongoing efforts to control the fertility of marginalized women. These historical patterns reveal how reproductive technologies have been deployed differently based on race and class, with white women's fertility protected and encouraged while women of color's fertility was controlled and limited. These historical patterns manifest today in persistent reproductive health disparities. In the United States, Black women are three to four times more likely to die from pregnancy-related causes than white women, with similar disparities seen in maternal morbidity, preterm birth, and infant mortality. These gaps persist even when controlling for education and income, pointing to the role of racism rather than simply socioeconomic factors. Studies show that medical providers are less likely to take Black women's pain and symptoms seriously, leading to delayed diagnoses and treatment. As tennis star Serena Williams revealed about her near-fatal postpartum experience, even wealth and fame don't protect Black women from medical dismissal. Organizations led by women of color, like SisterSong and the Black Mamas Matter Alliance, have emerged to advocate for reproductive justice - the human right to maintain personal bodily autonomy, have children or not have children, and parent those children in safe and sustainable communities. These movements recognize that addressing reproductive health disparities requires not just equal access to healthcare but transforming the systems that have historically devalued the bodies, experiences, and reproductive decisions of women of color. Their work represents a crucial counterforce to centuries of medical exploitation and neglect.

Chapter 6: Breaking Silence: Overcoming Stigma in Women's Healthcare (1970-2000)

Cultural taboos surrounding women's bodies and reproductive functions have created a pervasive silence that has profoundly impacted healthcare. Throughout history and across cultures, menstruation, sexuality, and female reproductive organs have been shrouded in shame, embarrassment, and secrecy. This stigma has created barriers to open discussion, education, and medical care that continue to delay diagnoses and treatment for millions of women worldwide. The feminist health movement that emerged in the 1970s directly challenged this culture of silence. Works like "Our Bodies, Ourselves," first published in 1970 by the Boston Women's Health Book Collective, pioneered the radical idea that women should have accurate information about their bodies and participate actively in healthcare decisions. The book included frank discussions of topics previously considered taboo, from menstruation and sexuality to childbirth and menopause, along with detailed anatomical drawings. Women gathered in consciousness-raising groups to share experiences and knowledge that had previously been suppressed. These conversations revealed how common certain symptoms and conditions were, contradicting the isolation many women felt when experiencing health problems that weren't openly discussed. Feminist health clinics established during this era modeled patient-centered care practices that have gradually influenced mainstream medicine. The Women's Community Health Center in Cambridge, Massachusetts, and similar clinics across the country offered services like cervical self-exam workshops, where women learned to use speculums to view their own cervixes. This practice demystified female anatomy and challenged the medical monopoly on knowledge about women's bodies. These clinics also pioneered more respectful approaches to gynecological exams, abortion care, and childbirth, emphasizing informed consent and women's agency in medical decisions. The silence around conditions affecting women's reproductive organs has had devastating consequences. Endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus, affects approximately 10% of women of reproductive age yet takes an average of 7-10 years to diagnose. This delay occurs partly because menstrual pain is normalized - women are told that severe pain is simply what they must endure as part of being female. The stigma around discussing menstruation prevents many from seeking help or even recognizing that their pain is abnormal. Similar patterns occur with conditions like vulvodynia (chronic vulvar pain), lichen sclerosus, and various pelvic floor disorders, where shame about discussing genital symptoms leads to suffering in silence. Sexual and reproductive health education has been limited by these taboos. Many schools provide minimal or abstinence-only sex education, leaving young people without basic knowledge about their bodies. A 2020 survey found that 46% of women couldn't correctly identify the vagina on a diagram, and knowledge gaps were even larger regarding internal reproductive anatomy. Without understanding what's normal, women cannot identify what's abnormal, leading to delays in seeking care for concerning symptoms. This educational gap affects healthcare providers too; medical schools have historically provided limited training in women's health, with some gynecological conditions receiving minimal coverage in standard curricula. By the 1990s, the movement to break silence around women's health issues gained mainstream momentum. Organizations like the Society for Women's Health Research, founded in 1990, advocated for increased research on conditions affecting women. Public figures began speaking openly about previously taboo topics - Gloria Steinem wrote about her experience with endometriosis, Gilda Radner shared her ovarian cancer journey before her death in 1989, and Betty Ford's candor about her breast cancer diagnosis in 1974 had already helped destigmatize the disease. These public conversations helped normalize discussion of women's health issues and encouraged others to seek care rather than suffering in silence.

Chapter 7: The Modern Revolution: Evidence-Based Care and Patient Advocacy (2000-Present)

The past few decades have witnessed a remarkable revolution in women's healthcare, driven by a powerful combination of patient advocacy, feminist health movements, scientific advances, and increasing numbers of women in medicine. This transformation represents a fundamental shift toward evidence-based care and women's bodily autonomy, though significant challenges remain in fully realizing these ideals for all women. Patient advocacy has been a driving force in this revolution. Organizations focused on specific conditions like endometriosis, PCOS, and maternal health have raised awareness, pushed for research funding, and challenged medical dismissal of women's symptoms. Social media has amplified these efforts, creating spaces where women share experiences, information, and support. Hashtag campaigns like #EndoWarrior and #PCOS have helped destigmatize these conditions while building communities that collectively advocate for better care. These grassroots movements have successfully pressured medical institutions and funding bodies to increase attention to previously neglected women's health issues. Scientific advances have transformed understanding of women's health conditions. Improved imaging technologies have made it possible to better visualize conditions like endometriosis. Genetic research has revealed the complex hereditary components of conditions like PCOS and certain gynecological cancers. The growing field of sex-based biology has documented the myriad ways that biological sex affects disease processes and treatment responses throughout the body, not just in reproductive organs. These scientific developments have legitimized conditions previously dismissed as psychosomatic and opened new avenues for treatment. The increasing presence of women in medicine has been transformative. Women now make up the majority of OB-GYN practitioners in many countries and are increasingly represented in medical leadership positions. Research shows that female physicians spend more time with patients, are more likely to adhere to clinical guidelines, and achieve better patient outcomes in many contexts. Women physicians and researchers have often championed previously neglected women's health issues, bringing both professional expertise and sometimes personal experience to their advocacy. The diversification of medicine has begun to challenge the male-centric approaches that dominated healthcare for centuries. Policy changes have supported these advances. The NIH Revitalization Act of 1993, which mandated the inclusion of women in clinical research, marked a turning point in addressing the research gap. The Affordable Care Act's provisions for women's preventive services, including contraception without cost-sharing, expanded access to essential care. Organizations like the Society for Women's Health Research have successfully advocated for sex-specific analyses in research and sex-based dosing recommendations for medications. These policy changes have created a framework for more equitable and evidence-based women's healthcare. Despite these advances, significant challenges persist. Racial disparities in women's healthcare remain stark, with Black, Indigenous, and other women of color experiencing worse outcomes across numerous measures. Rural women and those with low incomes face substantial barriers to accessing specialized care. Political contestation over reproductive rights threatens access to essential services in many regions. The medicalization of normal female processes like menopause continues alongside the dismissal of abnormal symptoms as "just part of being a woman" - a contradictory pattern that reveals ongoing ambivalence about women's bodies. The path forward requires building on recent advances while addressing persistent gaps. This means continuing to increase diversity in medical leadership, expanding research on conditions that predominantly affect women, implementing trauma-informed care practices, and ensuring that advances in women's healthcare reach all women regardless of race, class, geography, or gender identity. Most fundamentally, it means centering women's lived experiences and bodily autonomy in all aspects of healthcare delivery and policy.

Summary

Throughout history, medical understanding of women's bodies has been profoundly shaped by cultural beliefs and social control rather than scientific evidence. From the ancient Greek concept of the "wandering womb" to Victorian surgical interventions for "hysteria" to the exclusion of women from modern clinical trials, medical misconceptions about female bodies have caused immense harm while delaying progress in treating genuine conditions. These misconceptions weren't merely scientific errors but reflections of deeper societal attitudes that viewed women's bodies as inherently problematic, mysterious, and in need of control. The intersection of gender with race and class created compounded forms of medical exploitation, with women of color subjected to experimentation and reproductive control that continue to shape healthcare disparities today. The revolution in women's healthcare over recent decades demonstrates how medical practice can evolve when patient advocacy, scientific advances, and increased diversity in medical leadership converge. The shift toward evidence-based care, informed consent, and respect for bodily autonomy represents a fundamental transformation in how medicine approaches female bodies. Yet this revolution remains unfinished, with persistent disparities in care based on race, class, and geography. Moving forward requires not only continuing to advance scientific understanding of women's health conditions but also addressing the structural inequities and implicit biases that perpetuate unequal care. By understanding this troubled history, we gain crucial context for current healthcare challenges and a roadmap for creating more equitable, effective, and respectful care for all women.

About Author

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Karen Tang

KAREN TANG, MD, MPH is a board-certified gynecologist and minimally invasive gynecologic surgeon who is an internationally recognized leader in reproductive health. As @KarenTangMD on TikTok, Instagram, and YouTube, she reaches millions of viewers each month with her educational videos about period health, pelvic pain, and reproductive rights. Dr. Tang has been featured in the Washington Post, Self Magazine, NBC.com, and NPR, amongst others. She lives outside of Philadelphia with her husband and three children.

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