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Melissa Harris-Perry: Thanks for sticking with us on The Takeaway, I'm Melissa Harris-Perry. Hysteria, that dramatic emotional excess of women. Well, this so-called condition was included in psychological diagnostic manuals until 1980. The diagnosis rested in nearly ancient assumptions about women's bodies and minds. The most influential theory coming from Dr. Freud who believed that women suffered from "characteristically feminine anxiety," a distress which could be cured only by marrying a man and bearing children.

Although no reputable physician would now prescribe marriage to women, studies continue to reveal that medical care is far from gender equitable. Stroke, heart attack, lung disease, even cancer are life-threatening conditions which physicians are significantly more likely to misdiagnose in women. We wanted to know if you have felt that your gender affected how healthcare providers treat you. Here's some of what you shared.

Patricia: Hi, my name is Patricia. I'm from Richmond, Virginia. I had a lot of pain for a few months. It was somewhat dismissed period pain, a lot of other things, and it turned out to be cancer.

Jenna: My name's Jenna. I'm calling from Federal Way, Washington. I had been going to doctor after doctor, trying to get a diagnosis for the ongoing gut pain and constipation I'd been suffering. One doctor said that I was just anxious and tried to put me on anti-anxiety medication. I turned down the medication and was so discouraged that it was a couple more years before I saw a doctor. That happened when I ended up in the ER with diverticulitis and a fist-sized ulcer.

Jean: My name is Jean. I'm calling from Minneapolis, Minnesota. My mother was having repeated episodes of being unable to breathe so we took her to the ER where they diagnosed her with histrionic. I was so furious that that diagnosis that I refused to allow to discharge her until we got a referral to the ENT. When they scoped her, they discovered that she had paralyzed vocal cords which were preventing her from breathing. If I hadn't been insistent, she would've probably died because the people in the ER thought she was just a crazy woman.

Melissa: Hi, my name is Melissa. I spent years in the Marine Corps on active duty. We were playing combat soccer as marines would do, and one of my cohorts tackled me and injured my knee. He didn't do it on purpose. It wasn't anything like that. As I tried to pursue treatment, I was asked over and over again if I just wanted to get out of the Marine Corps. I was asked this on paper. I was asked this by the physician's assistant that was treating me. Finally, thank goodness, I was literally taken by another doctor who had heard about my situation and was able to get me treated.

It took me requesting an MRI three times before they actually just sent me to another office to get a brace where that doctor found me.

Melissa: Transgender and nonbinary people also often report being dismissed by their healthcare providers, and we heard from some of you directly about this.

Kat: This is Kat from St. Paul, Minnesota. I'm nonbinary. Every time I go into a doctor's office, I make sure I know as much as I possibly can about all the complications that might come into it.

Melissa: We've lost some of Kat's call here, but data show that at least half of transgender people report they've had to educate their own healthcare providers about transgender care. Here's what Carol called and told us.

Carol: As a woman, I have had a lot of difficulty with regard to medical care, mainly with male physicians, male OB-GYNs, and male psychiatrists. You shouldn't have to battle a doctor to get your fallopian tubes tied. When you tell them that you're having issues and you feel depressed, they shouldn't tell you that you're hysterical and that what you're saying doesn't really mean anything.

Melissa: This battle to be taken seriously is part of a pattern some journalists and researchers referred to as medical gaslighting of women, transgender, and non-binary people. With me now is Dr. Karen Lutfey Spencer who is professor of health and behavioral sciences at the University of Colorado Denver and Dr. Jamila Taylor who is director of healthcare reform and senior fellow at the Century Foundation. Dr. Spencer, Dr. Taylor, thank you both for joining us today.

Dr. Karen Lutfey Spencer: Thank you for having us.

Dr. Jamila Taylor: Thank you for inviting us.

Melissa: Now, Dr. Spencer, I want to start with you. What does medical gaslighting mean? What does that experience like?

Dr. Spencer: Sure. Many people, just like Carol in the clip, women and people of color in particular are describing in social media this frustrating experience where they go to the doctor to complain about a physical symptom and are basically dismissed. They're told either that it's psychological, it's all in their head, or it's because they are overweight or out of shape or that's just not something they should worry about. People are calling this medical gaslighting.

Melissa: Dr. Taylor, you and I were chatting before we got started here that it is Black Maternal Health Week. Yesterday, here on The Takeaway, we talked a little bit about the experience that Serena Williams had in the context of giving birth to her daughter and how she was repeatedly dismissed as she was trying to express what she was feeling after giving birth, and she is Serena freaking Williams. I'm wondering about the role the medical gaslighting might be playing in our nation's maternal health crisis.

Dr. Taylor: To be quite honest, this phenomenon is something that is normal and that we see quite a bit, particularly among Black women in the maternal health context. There are many factors that play into our maternal health crisis. As you mentioned, Black women are disproportionately impacted where we see them dying three times the rate of

white women from pregnancy-related causes.

It's not only due to a lack of access or inconsistent access to healthcare, but also these dynamics between them and their doctors. Women may be presenting with issues during the birthing process or even during pregnancy. Under this concept of medical gaslighting, they are told, "Oh, you're fine. Just ignore it. This isn't something you need to be worried about." We've seen from the stories of countless women, again, in this context of maternal health that it's been deadly for them. This has actually led to higher rates of maternal mortality and morbidity among a Black women.

Again, we see this in countless stories. Serena Williams is a celebrity and it's something that we tend to go to because she's been so gracious with sharing her story, but we can see this across the spectrum of regular women, Kara Johnson, Dr. Shalon Irving, Amber Rose Isaac. For me, it's important to also say their names when we talk about this issue.

Melissa: During 2021, my mom who's in her 70s, had a bit of a medical crisis. She have had repeated hospitalizations around heart issue. I would just stand there stunned at the ways that physicians would talk to my mother as an older woman. She's not dumb. She's actually quite brilliant. Yet, I would just see them talking over and around her in ways that I have to say honestly made me quite angry.

Dr. Spencer: Oh, well, that's a terrible story and unfortunately, it's ubiquitous. There are a lot of well-intentioned doctors out there, but they are working in systems that create a setup for some of these problems. In terms of other identities, straight out of the gate, number one, we have much less research on women's biologies. For a long time, we kept women out of clinical trials all together out of fears that they might be pregnant and that there could be harm to a fetus if they participate in research.

This can lead to things being missed or misunderstood in women, and heart disease is one of the classics, the idea that women present with "atypical symptoms" and therefore, get misunderstood and fall exactly into this gap. One study I did, we had actors portraying patients and created video vignettes. All of the people were showing the exact same signs and symptoms that should have triggered a cardiac diagnosis and treatment.

We could vary, whether they were male or female or 55 years old or 75 years old. Then we showed it to a bunch of doctors and asked them what diagnoses they came up with and how certain they were and what they would do about it. Then we turned on the microphone and just asked them, "Walk me through your reasoning about how you came to this diagnoses." Some of these transcripts came back to me and doctors were saying, "Well, this sounds just like this thing out of the Netter encyclopedia I learned in medical school. I was like, "What is the Netter encyclopedia?"

I went and looked it up. I go to the angina entry, and there is a full page, color-illustrated picture of a white man with silver hair coming out of a restaurant into the blustery, cold and snow clutching his chest. That's literally the picture attached to angina diagnosis. I was just stunned. Well, no wonder, people think it's confusing when women show up with symptoms that are anything short of that exact picture that's out there. Women tend to present with slightly different symptoms. They may not have the clutching chest pain. They may show up with fatigue or feeling sick to their stomachs or just generally malaise for a few days.

Melissa: When we look at these differential outcomes for diagnosis and treatment for women and particularly for women of color, is it about these kind of implicit biases or are there more explicit aspects of inequality baked into our system of healthcare?

Dr Taylor: I think it's both hand. Racism is a foundational aspect of how the medical establishment was built in this country. If you look at the treatment out of enslaved Black folks in this country, you see these egregious, harmful practices, experimentation on our bodies to advance medicine in this country. Particularly in the context of obstetrics and gynecology, we see this root of racism following up until the current day is leading to disproportionate health outcomes.

I think that's important to contextualize the issue, but absolutely, the implicit biases are common as well as these are built around these racist myths. I think another thing to mention too, this mindset that Black and brown people are better able to tolerate pain is another piece of this, leading doctors to oftentimes underestimate or neglect or not acknowledge a patient's reported pain is also a key aspect of the conversation and the issue that we're discussing today.

Melissa: Dr. Spencer, as you were framing up for us, there may in fact be some meaningful differences in how symptoms present, for example, in women that we don't even know about because of exclusion from medical studies. Are there now studies that help us to understand how women experience pain, how they feel it, and maybe how they're discussing it with their healthcare providers that again, might not fit that image that medical students are getting in their training?

Dr. Spencer: Really important questions. I'm really glad that pain came up. I think we're making progress on these things, but at the same time, there is this very long history. Even in that clip from Carol at the beginning, she used the word hysteria and we have a very long history of explaining away certainly the gender piece by saying that women had hysteria and that was tied to a problem with their uterus sometimes floating around their bodies. Really, a lot of ways of explaining this over time. Similarly with pain management, we have a long history of saying all sorts of racist things about how pain operates and how people are sensitive to pain and people being drug seekers.

I think we have a long ways to go on improving that, but since 1993, we are now requiring NIH to include women in studies and to have racial diversity. Hopefully, we are getting closer to making progress on these things, but I think we have a long way to go.

Melissa: It's interesting, even as we're talking about this and the idea that people are told, women in particular are told, "Oh, it's all in your head. It's not real." Dr. Taylor, I guess I want to leave space for the idea that emotional pain is also pain, and that part of what also happens in the misdiagnosis of particularly Black women, women of color is the idea that not only can we maybe withstand more physical pain, but that we also don't experience emotional pain. In other words, that we're not emotionally vulnerable in the same way. I'm wondering if this kind of medical gaslighting also happens around our ability to be psychologically and emotionally fragile like human.

Dr. Taylor: I think not only in the medical context, I think just generally, there's the myth around the strong Black woman, we can withstand and hold all the things, and that's just not the case. Oftentimes, it doesn't give us the space to be vulnerable and to lay our emotions down. We're always looked at as being the strong one and having to take on not only I think in terms of different environments that we're in, whether it's work, personal, there's always this this impression that Black women should be holding it all for everyone. That's just not the case. I can absolutely see the concept around medical gaslighting not only be applicable to physical pain, but also mental and emotional pain and health as well.

Melissa: Dr. Spencer, I'm wondering about change and improvement. I guess I want to really approach it from two different directions, both what individuals and families can do in this moment with the system that we have, and then also how we can begin to make or the ways that we've already begun to make some systemic changes. Talk to me about, look, I really just got angry without how doctors were talking with to my mother and had some experiences with friends, Black women who were giving birth who are like, there's just some yelling ensued, but I'm wondering if there are productive ways that families, that loved ones, and that patients themselves can self-advocate and ensure that they're getting the right kind of care.

Dr. Spencer: Oh, excellent question and so important. One of the things I really like about the story with your mom is that you were there being an advocate. I think that's a really important thing if you can take someone with you to the doctor, if you can go with someone you care about to the doctor. Sometimes, yelling is tempting. I appreciate that sentiment also. I think often just being there on behalf of someone that you care about, it sends a message that someone else is watching what's happening with this person and is invested in what comes out of their healthcare.

I think also people need to feel free to speak up. They need to ask questions, they need to feel free to move on to a different doctor. If that's one who looks more like you, then I think that is also valuable. In a way, that's a really disheartening kind of answer because it puts the onus on people and patients and families to try to do extra work to compensate for a system that has a lot of racist as qualities baked into it from the start.

At a system level, I think we need continued research that diversifies our language and our knowledge about biologies and disease and treatments. That's a foundation level. I think there are things about the healthcare system that we can do to alleviate bad decision-making. Just like the rest of us, doctors are more likely to make biased decisions when they're cognitively stressed or uncertain. Our healthcare system has a lot of time and financial constraints to see patients in short periods of time.

Precipitate uncertainty and decision-making under pressure, which can lead to things gain misunderstood or missed. Advocating for a healthcare system that puts less pressures on providers is another thing that we can do politically and advocating for more diverse research.

Melissa: Dr. Taylor, I want to give those same questions to you about both individuals' self-advocacy and advocacy on behalf of those we love and care about as well as system change.

Dr. Taylor: I agree with everything that was just said. I think feeling empowered in the first place to even speak up to yourself can be a challenge, particularly for Black and brown people. Part of that is because the healthcare professions are dominated by white men. Most of our physicians in this country are white men. I think definitely, we need to do more to diversify the workforce. I think, particularly in the context of maternal health, there is work being done by advocates across the country to help diversify the workforce, particularly when it comes to having more doulas and midwives of color available.

I think that also goes with physicians. I think another piece about diversifying the workforce that we need to think about is that we need to remove the barriers that actually keep people of color from entering the healthcare workforce, from being physicians, from being doulas and midwives. Part of the Black maternal health Momnibus does that, a bill that's included there, the Perinatal Workforce Act would help do all of those things.

I think that's a key piece. I think also too, it's so important to have an advocate when you can, going into healthcare settings with you. Again, want to advocate for doulas in the context of maternal health. A doula can be life-saving for pregnant and birthing people. Research shows that when a woman has a doula, she's more likely to have positive birth outcomes and a positive birthing experience overall, as well as better maternal and infant health outcomes.

Melissa: Dr. Jamila Taylor is director of healthcare reform and senior fellow at the Century Foundation and Dr. Karen Luftey Spencer is professor of health and behavioral sciences at the University of Colorado Denver. Again, thank you both so much for speaking with us today.

Dr. Spencer: Thank you.

Dr. Taylor: Thank you for having us.

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