By: Lindsey Grubbs
These complaints are minor in the face of the devastating stories and research compiled in journalist Maya Dusenbery’s first book, Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick. Dusenbery, the editorial director of feministing.com, has written about women’s relationship to medicine for years, publishing essays on abortion, maternity leave, Alzheimer’s Disease, myalgic encephalomyelitis/chronic fatigue syndrome, and more in venues like Pacific Standard, Cosmopolitan, and Feministing.
In Doing Harm, Dusenbery’s extensive research provides evidence of the problem of medical sexism, and partners this analysis with interviews with women who have it firsthand. She convincingly demonstrates that medical care can go seriously awry as a result of sexism not just at the individual level but also at the structural one, as medical agencies and funders have failed to support adequate research in women’s health.
The trust gap arises from bias, whether conscious or unconscious, against taking women’s reported symptoms seriously. The women interviewed by Dusenbery stress their difficulty being taken seriously by their medical team. When women in immense pain cried or winced, they were viewed as dramatic, hysterical, or drug seeking. On the other hand, though, women who remained stoic about pain to be taken seriously were dismissed as totally fine—if they were truly in so much pain, they would be crying, dramatic, hysterical.
Combined, the knowledge and trust gaps can be deadly for women, as Dusenbery shows. Women in the midst of having heart attacks, for instance, are routinely dismissed as having anxiety attacks, both because much research into heart disease focused on male physiology and symptoms and because women’s complaints are disproportionately attributed to anxiety. Ovarian cancer patients’ claims that they did, in fact, have abdominal symptoms prior to diagnosis were overruled researchers and physicians who claimed that it was a “silent killer” with no symptoms—and once patterns in symptoms did eventually become clear, there was resistance to educating women about the symptoms lest they cause women to worry unnecessarily.
One particularly devastating study showed that, given hypothetical male and female patients with the same risk of heart disease experiencing clear heart attack symptoms, physicians were equally able to identify heart attack for both patients. However, when the text included a reference to a recent stressful event, 56% of physicians still gave the men a heart disease diagnosis, while only 15% gave it to the woman. Almost half recommended heart medication for the man; thirteen percent suggested it for the woman. In general, when a woman describes a symptom, that symptom is viewed through whatever stereotyped lens is most readily available. Dusenbery shows how serious and even fatal medical conditions are ignored because serious symptoms are attributed to anxiety, fatness, trans identity, or drug-seeking behavior, especially for women of color.
I found myself wishing, though, that Dusenbery would address the stigma against mental symptoms and illnesses that makes psychological explanations so utterly invalidating. For many of those Dusenbery interviewed, these explanations were frustrating because they were wrong—but the rhetoric sometime seemed to pose legitimate organic disorders with illegimate psychiatric or otherwise invisible ones. Similarly, she uses “psychogenic” as a rough synonym for psychological, hysterical, or made-up—a misperception in both public and medical circles that has not been corrected at least in part because of the same sexist dynamics Dusenbery articulates. Spending a chapter with psychiatric or psychogenic disorders, both so highly stigmatized and so gendered, then, would have given her even more fuel for this important fire.
I strongly recommend this book to anyone who works or hopes to work in healthcare and related fields, and also recommend to patients both perpetual and occasional. I’ve already had conversations with other women about how this book has encouraged us to advocate for ourselves in medical settings. I hope, though, that the book will be read by anyone who is a woman with a body or knows a woman with a body (so everyone). Intellectually, Dusenbery makes a strong case for needed reforms in medical school curricula, medical research, and patient care. Emotionally, she captures the anger and determination needed to inspire advocacy for those reforms. Here’s to hoping many in healthcare answer that call.