The first accounts of the disorder known as hysteria date back to ancient Greek scrolls, characterizing the cause of various symptoms in women due to the uterus somehow migrating through the body and affecting other organs.
Over millennia, the proposed cause of hysteria shifted to psychological explanations, first rooted in psychoanalytic theory, then adapted further by other schools of thought. The term was used to explain a wide variety of what we now know to be normal reproductive functioning, confident assertive behaviors, and emotional expression, as well as actual clinical symptoms, such as the loss of appetite or pleasure associated with depression.
Looking back, we also see evidence of hysteria attributed to men. However, the history of hysteria as “emotional excess” has mostly involved unsuccessful attempts to explain aspects of women’s biology and behavior considered puzzling.
Ancient history, right? Not quite. Just as public laws can often survive decades after they are understood to be outdated, hysteria remained an entry in The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders until 1980. Although contemporary health providers have parted from these concepts, misperceptions about the occurrence and cause of symptoms continue, particularly regarding the health of women.
For example, heart disease is the greatest cause of death for both women and men in the United States. However, women are less likely than men to survive a first heart attack. One of the reasons for this is that women are more likely than men to show symptoms other than those considered “typical” by standard medical protocols and the public. These other symptoms — such as nausea, lightheadedness, shortness of breath, or pain in the jaw, arms, or back — can go unrecognized as signaling heart attack.
In fact, a study published in 2020 by the Journal of the American Heart Association found that women were significantly less likely than men to receive aspirin, cholesterol-reducing statins, and blood pressure medications — common treatments for cardiovascular disease.
In addition, women comprise 70 percent of Americans suffering from chronic pain. But research has shown that the pain women experience is often taken less seriously than the pain of men. A study from earlier this year found that people observing videos of female and male faces expressing the same self-reported amount of chronic shoulder pain would characterize the female patients’ pain as less severe and less in need of medication than the male patients’ pain.
For these and many other reasons, Women’s Health Research at Yale leads the way toward understanding how differences in sex, gender, and race influence health outcomes. It is why we have launched studies determining a more accurate way to diagnose heart disease in women and to understand the intersection of pain and analgesia in males and females. It is why we are testing an intervention to treat insomnia and its health consequences that addresses the high prevalence of this sleep disorder in women, notably in Black women.
Medicine certainly has come a long way from ancient eras. Yet, there’s so much more we need to investigate and understand about how health is influenced by our natural differences so that, together, we can change science to make life better for all.