By Karen and Erica

If you are anything close to our age, your experience of doctors has had its ups and downs.

When we were young, the idea of a woman doctor was unimaginable. Remember the riddle about the doctor who was killed in an accident with his son. The son was rushed to the hospital, where the surgeon said ”I can’t operate on him, he’s my son.” Absolutely no-one figures out the surgeon is the boy’s mother.

We were brought up to think of doctors as all-knowing gods to whom we should give blind adherence. Sometimes that seemed off the mark. Like when a doctor seemed to think that a sprained ankle required close examination of our chests. Or that we couldn’t really be having so much menstrual pain. Or that we might not have fully thought through our decision to take the Pill.

In 1970, when some of us were in college, Our Bodies, Ourselves was published. A revelation. The book concerned itself with health issues exclusive to women, and offered the almost scandalous idea that health issues exclusive to women should be taken seriously. And could be the subject of open discussion.

At around the same time, women were going to medical school in large numbers. When they graduated, they practiced medicine. Not without a fight, but they fought to remain in the profession they loved. We started to think, once we encountered a few women doctors, that medicine must have turned the corner.

Then we met Stacey Rosen of The Katz Institute For Women’s Health. Dr. Rosen is a cardiologist, and she had begun to realize as a young doctor that cardiac issues were not the same in women as in men. (Her first insight was that women had cardiac issues, a new thought to many.) We were stunned to learn that sex bias in medicine was actually much deeper than we realized. Scientists tested medicines only on male rats, because female rats had pesky hormones? And they never considered whether their results could possibly be right for women who also had pesky hormones? Or whether drug dosages recommended for big men running on testosterone should be the same for small women running on estrogen and progesterone? Really?

Well, about ten years ago some people did realize that drug research was failing women, after women taking Ambien exhibited side effects much more severe than those exhibited by men. Seems like the dosages, determined after experimentation on males, were too large for women.

Since then, a number of books have been written about women and medicine. None of them addresses in any detail how medicine deals with aging. That’s the next project, perhaps.

The most expansive is Unwell Women: Misdiagnosis and Myth in a Man-Made World, review here. The book relates the origins of androcentric medicine—beginning with Hippocrates. Men are the norm and everyone else is just anomalous. Women are defined solely by the organs involved with child bearing, and their illnesses are defined solely by diseases of those organs. Having those organs can make women weak—but, oddly, can also make them powerful witches when they menstruate. Women don't have diseases of other organs, like the heart, and if they say they do they are likely suffering from hysteria and should be advised that getting pregnant will put everything to right. Whether they are 7 or 70. And it goes on from there.

Less academic and more experiential is Pain and Prejudice: How the Medical System Ignores Women—And What We Can Do About It. The author, who suffered from long undiagnosed endometriosis, explains her own treatment by reference to the general inability to recognize pain and illness in women. She relates the shame of menstruation, the marker of the beginning of women’s usefulness, and the horror of menopause, the marker of the end of a woman’s usefulness. The invention of rest cures for hysteria. Sexual stereotyping, sometimes heightened by race. And lots more. Similarly, the author of Ask Me About My Uterus—A Quest To Make Doctors Believe In Women’s Pain, suffered years of pain caused by undiagnosed endometriosis, and was impelled to write a book to demand that the medical profession recognize pain in women.

A fourth book, not a medical history but an observation of design bias everywhere, is Invisible Women: Data Analysis In A World Designed For Men. Amusingly written, it will change the way you see your world. As far as medicine, the author notes that even now medical schools do not teach much about women’s health, though we know now that sex differences are found in every tissue and organ system, even in our cells. She chronicles some of the misfires when sex differences are not taken into account. One example is the confusion that was created by two studies that reached opposite conclusions about the same question (concerning heart attacks, which women were assumed not to have anyway). Ultimately, the researchers realized that one project had evaluated only male mice and the other only female mice.

Finally, a classic text confronts these biases specifically in the psychotherapeutic professions. The thesis of Women and Madness, first published three decades ago, is that women are perceived as more or less in need of psychiatric help based upon their acceptance of their role in a patriarchal society. The author posits that the profession is based upon sexist ideas so deeply embedded in the profession that it is hard for even therapists of good will to overcome.

The ethos described in these books is rendered exquisitely by a painting at the Yale Center For British Art: Gynaecology Chair, by Julie Roberts. Huge, blue, and chilling.

These books, and the painting, are not cheerful, but they are eye-opening, and hopefully mark the beginning of change. We may not be where we need to be just yet, but we are on the way. Brava to those who have moved us forward.