The entrenched health inequalities women face is a result of centuries of the medical field being developed with a male bias — including the roots of the term “hysterical”.

The classic stereotype of the unhinged or emotionally unstable woman is well-established in history and popular culture. Even beyond the problematic implied judgement made upon mental health and the misogyny behind assuming all women are too emotional — and, indeed, emotion being negative — behind all this underlies the entrenched sexism of Western medicine. Part of this may well be attributable to misogyny, but part of this is a simple offshoot of the days when ‘respectable women’ did not have professions, and doctors were most certainly only men.

The term “hysterical” — which most of us use now to describe something that’s very unusual or funny — comes from “hysteria”, a catch-all “mental disorder” diagnosed exclusively in women who were perceived to be too emotional, with additional connections to repressed sexuality. Ask any woman whether they have had issues with being “too emotional”, and you will likely receive an answer in the affirmative.

Societal understanding of mental health has largely evolved from those days, but the issue of the “unstable woman” and male bias is very much still an issue.

With the national COVID-19 vaccine rollout, there were great concerns about blood clots being a potential — albeit rare — side effect of the AstraZeneca vaccine. Whilst any side effects are a concern, many noted the irony of the panic and worry caused by this news compared with the apparent nonchalant acceptance of women taking the combined contraceptive pill, which carries a far higher risk of blood clots.

Calls to research how to improve the safety of the pill have joined emerging discussions about why exactly it is that, aside from condoms, most forms of contraception involve some burden upon women, often with extremely inconvenient and uncomfortable — sometimes even life-threatening — side effects.

The book Invisible Women by Caroline Criado Perez OBE pushed the gender bias in data and research firmly into the public discourse, where it belongs, but awareness is only as impactful as we make it. Some forms of medical bias are so established and insidious that we don’t even recognise their presence.

The ‘hysterical woman’ is still very much a problem for the many women who have gone through unimaginable suffering, all because they were not believed when they sought medical attention for their pain, or when they told doctors that their medical history negated the possibility of the diagnosis that they were being told was correct.

There is a multitude of conditions that only affect women that are still inadequately researched and understood, such as polycystic ovarian syndrome (PCOS), which is “one of the most common hormonal conditions in women” even though many people have never heard of it.

Society is still weighed down by the idea of the crazy female patient. In a society that has conditioned women to be demure, not complain, refrain from expressing excessive emotion, and not cause any inconvenience, it is very difficult for women to have their voices heard — and taken seriously. Yet another recent example of this is reignited discussions about the excruciating pain caused by insertion of the coil, which is ostensibly dismissed or expected to be accepted.

This is even more so the case for minoritised ethnic women, who are further ‘othered’ by society and may already be marginalised — whether by society or through cultural norms.

Maternal mortality illustrates this disparity, as Asian and Black women are likelier to die in childbirth, or from complications during pregnancy, than White women, with Black mothers likeliest to die by far. There is, of course, an element of intersectionality here as minoritised groups are likelier to live in deprived areas and have lower incomes, but other factors alone cannot compensate for such a massive disparity.

Intersectionality also emphasises the health inequality faced by minoritised women, as there is both the presence of entrenched discrimination and the erroneous belief that somehow White people and Black people are fundamentally biologically different in a way that means Black people don’t feel as much pain — and therefore require less pain relief. This is without then accounting for the impact of gender.

The problem of sexism in medicine goes back to and beyond the idea of ‘hysteria’, but it’s certainly not hysterical for women.

Health inequalities have come to the fore during the pandemic with the disproportionate impact of COVID-19 on minoritised groups. At JAN Trust, we have long spoken out about the need to address persistent structural inequalities that result in discrimination, which has devastating consequences when it comes to healthcare. We must all work together to combat the societal biases and stereotypes that result in people being treated differently on matters of life and death, beginning with improving representation within the healthcare sector and research, and fighting against unhelpful tropes.