Medical gaslighting: when your doctor says it's all in your head.

The word hysteria derives from the Greek hystera. Uterus. Hippocrates believed women's distress originated from a displaced womb that wandered through the body causing symptoms wherever it settled. The treatment was either pregnancy or fumigation of the vagina with pleasant odors to lure the uterus back into position.

I realize that sounds absurd. It should. But I need you to hold that absurdity alongside a modern reality: in 2024, Elizabeth Comen published All in Her Head, tracing the direct line from Hippocratic hysteria to contemporary medical dismissal. The terminology evolved. The mechanism did not. Where a 19th-century physician at Charcot's Salpetriere would diagnose hysteria, a 21st-century physician diagnoses generalized anxiety disorder or functional neurological symptom disorder or medically unexplained symptoms. The patient's experience, in every century, is identical: she described a physical experience, and a professional told her it originated in her mind.

Diane Hoffmann and Anita Tarzian shattered any remaining doubt about the gender dimension in 2001 with "The Girl Who Cried Pain." The title alone is a punch. Their analysis of decades of research found that women's pain reports are systematically undertreated and more frequently attributed to emotional causes than identical reports from men. A man with chest pain gets an EKG and a cardiologist. A woman with chest pain gets a conversation about stress management and a prescription for Ativan. I am simplifying, but not by much. Gender disparities in cardiovascular diagnosis have been documented by Weisman and Teitelbaum, by El Bassiri and colleagues, by Sinha and colleagues. The data is so extensive and so consistent that at this point, denying the pattern requires more effort than acknowledging it.

And yet. Twenty-four years after Hoffmann and Tarzian, the pattern persists. Women still wait longer for pain medication. Women still receive more referrals to psychiatry for somatic complaints. And women in perimenopause occupy a uniquely dangerous diagnostic position because their symptoms genuinely include emotional and psychological components. The anxiety is real. The mood lability is real. The problem is not the presence of these symptoms. The problem is that their hormonal origin is invisible to a physician who was never taught to look for it.

Actually, let me correct that. The physician was taught. Just not about menopause. Medical curricula dedicate substantial hours to male-pattern conditions. Erectile dysfunction alone commands more curricular attention than the entirety of female menopause. I find that comparison useful not because it is clever but because it reveals something about institutional priorities that is very difficult to explain away.