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Minds That Matter


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Minds That Matter

  1. 1. Minds that Matter and Hearts that Don’t: How the Perception of Female Minds and Mental States Affects Women’s Health Care and the Perception of Heart Disease
  2. 2. Introduction <ul><li>Origins: </li></ul><ul><li>The Invisible Gender </li></ul><ul><li>Modern medicine has come a long way in the last century . . . or has it? In one area at least, modern health attitudes have not shown significant progression. Although medical diagnosis procedures, treatments, and technology have demonstrated tremendous evolution, gender bias continues to adversely affect treatment of women. </li></ul><ul><li>In medicine, women have constituted the invisible gender. The nineteenth century established the white male as a medical “norm” (Nechas and Foley 13-17). Consequently, “because women’s bodies differed from men’s, what was natural for women was seen as unnatural . . . everything from menstruation to menopause was viewed only in the context of reproduction” (Nechas and Foley 15). </li></ul>
  3. 3. Introduction <ul><li>Medical Standard: </li></ul><ul><li>White Men </li></ul><ul><li>Women and Men and Women of other races: unseen subjects </li></ul><ul><li>Medical Standard </li></ul><ul><li>? </li></ul>
  4. 4. Introduction <ul><li>Still Invisible Today </li></ul><ul><li>Research Discrimination: Women, as both researchers and patients, have been neglected in medical research studies. Examples: </li></ul><ul><ul><li>“ In 1989, 12,485 men sought funding from NIH [National Institutes of Health]; only 2,929 women did” (Nechas and Foley 32). </li></ul></ul><ul><ul><li>“ According to the New York-based National Council for Research on Women, in 1990, less than 6 percent of all foundation dollars – $165.8 million out of $3.25 billion – were spent on programs that directly benefit women and girls” (Nechas and Foley 32). </li></ul></ul><ul><li>Education: Medical school consistently preferences the average white male as a norm, neglecting differences between races and genders. Additionally, female medical students suffer from discriminatory practices and an atmosphere of discrimination and harassment. Medicine is still a male-dominated field both in terms of practitioners and in attitudes towards patients (Nechas and Foley 39-53). </li></ul>
  5. 5. Introduction <ul><li>Medical School: Problems with Visibility </li></ul><ul><li>Medical school perpetuates stereotypes of women patients in two ways: the knowledge and techniques conveyed and the attitudes instilled in future doctors. </li></ul><ul><li>Phillips and Ferguson (in a study suggesting small positive changes in physician’s attitudes towards women) observe that: </li></ul><ul><li>Both within and outside the medical establishment many have expressed concern that physicians stereotype women, wish to control decision-making of female patients, ‘pathologize’ their normal bodily functions, are oblivious to diversity issues or treat women as abnormal because they are not men. Numerous examples exist of how anatomy texts, language and medical practice have defined the male body as the prototype of the human organism and women as aberrations from the norm. If a medical school reinforces social stereotypes, graduates may enter medical practice with fixed views that restrict communication, shape medical care, and affect the health of women. (358) </li></ul>
  6. 6. Introduction <ul><li>Patient Care Consequences: </li></ul><ul><li>Hysteria Meets Hypochondria </li></ul><ul><li>While the “norm” for patient diagnosis and treatment remains that established by the nineteenth-century – the white male – similarly outdated and prejudicial attitudes towards the female body and women’s health care also continue to persist. </li></ul><ul><li>In effect, because women’s bodies do not correspond to the male standard, differences have been diagnosed as disease. Additionally, women’s own perceptions of their bodies have been questioned. Considerable medical attention has been paid to the diagnosis of women’s mental debilities. Rather than acknowledge gender differences, doctors of the nineteenth, twentieth, and even twenty-first centuries have focused on “female maladies” in which the physical complaint is either imagined or attributable to the frailties of the female mind. </li></ul>
  7. 7. Introduction <ul><li>Hysteria to Hypochondria: Working Definitions </li></ul><ul><li>Definition: “ Hysteria is a disease more particularly manifested through the nervous system and is, almost without exception, peculiar to females between the age of puberty and the fiftieth year of life . . . Hysteria in the female is unquestionably closely connected in sympathy with the womb and its functions, and few cases, perhaps, occur in which there cannot be traced some disorder of this important organ as the exciting cause” (Thomson qtd in “The Good Old Days: Hysteria” 31). </li></ul><ul><li>Definition: “Hypochondria is a psychological disorder. In it, a person has real or imagined minor physical symptoms. The person believes that these symptoms are a sign of serious illness. Even when several doctors assure the person otherwise, a hypochondriac is convinced that he or she has a serious disease” (Alan). </li></ul><ul><li>Context: “Woman is a pair of ovaries with a human being attached, whereas man is a human being furnished with a pair of testes” (Virchow qtd. in Nechas and Foley 15). </li></ul>
  8. 8. Introduction <ul><li>Anna O. (Bertha Pappenheim), whose symptoms were (mis)construed by Freud as hysteria </li></ul><ul><li>The modern face of hypochondria: a diagnosis taken seriously by women, not giraffes and Hollywood </li></ul>
  9. 9. Introduction <ul><li>Hysteria becomes Hypochondria </li></ul><ul><li>This project examines the prevailing attitudes towards women and health issues in the nineteenth and twentieth centuries and suggests ways in which those attitudes may be positively changed. </li></ul><ul><li>We focus on the progression of these attitudes in women’s health care, examining the stereotypes established by the diagnosis of “hysteria” in the nineteenth century and their perpetuation in the dismissal of female symptoms in the twentieth-century as due to “hypochondria.” </li></ul><ul><li>Finally, we investigate a particular women’s health issue, heart disease, and the problematic relationship established between this real disease and the perception of hypochondria in both female patients and their doctors. </li></ul>
  10. 10. Context: The Nineteenth Century <ul><li>How Did Women Become Unseen Subjects? </li></ul><ul><li>The Industrial Revolution </li></ul><ul><li>Prior to the Industrial Revolution women and their work were highly prized. Women’s responsibilities included: “plant the garden, breed the poultry, care for the dairy cattle…transform milk into cream, butter and cheese, butcher livestock…cook meals…slate, pickle, preserve, and manufacture…beer and cider…clothe the colonial population [plie the needle, operate wool carders and spinning wheels}, medicines of her manufacture restored the family to health…her handwrought candles lit the house” (Ehrenreich and English 8). </li></ul>
  11. 11. Context: The Nineteenth Century <ul><li>Effects of the Industrial Revolution </li></ul><ul><li>Since women and woman’s work were such an integral part of survival, women could hardly think of themselves as “misfit[s] in a world which depended so heavily on her skills and her work” (Ehrenreich and English 9). </li></ul><ul><li>Therefore, the Woman Question of “what is a woman to do” was unimaginable prior to the nineteenth century. </li></ul><ul><li>As the United States moved into the Industrial Revolution, work was transferred into factories and “the Old Order production [which] had been governed by natural factors-human needs for food and shelter, and the limits of the labor and resources available” was outdated (Ehrenreich and English 9). </li></ul><ul><li>The Old Order of unity between work and home as well as production and family life was broken. With production occurring in the factories, the home was now only used for “personal biological activities-eating, sex, sleeping, care of small children” (Ehrenreich and English 10). </li></ul>
  12. 12. Context: The Nineteenth Century <ul><li>Effects of the Industrial Revolution </li></ul><ul><li>This division resulted “into two distinct spheres: a ‘public’ sphere of endeavor governed ultimately by the Market; and a ‘private’ sphere of intimate relationships and individual biological existence” (Ehrenreich and English 10). </li></ul><ul><li>Women became lost in this new public sphere of the Market. “Their traditional productive skills…textile manufacture, garment manufacture, food processing” were moved into the factories (Ehrenreich and English 11). </li></ul><ul><li>“ The womanly skills which the economy of the Old Order had depended on had been torn away-removing what had been the source of women’s dignity” (Ehrenreich and English 11). </li></ul><ul><li>“ At the same time, the forces which divide life into ‘public’ and ‘private’ spheres threw into question the place and function of women.” Hence, the birth of the Woman Question (Ehrenreich and English 11). </li></ul><ul><li>New interpretations of women’s roles led to new “illnesses” and treatments of women. </li></ul>
  13. 13. Context: The Nineteenth Century <ul><li>“ Woman/Womban”: </li></ul><ul><li>The History of Hysteria </li></ul><ul><li>Derivation: hystera , Greek, meaning “uterus” </li></ul><ul><li>Association: “It was formerly believed to be solely a disorder of women, caused by alterations of the womb. The association of hysteria with the female generative system was in essence an expression of awareness of the malign effect of disordered sexual activity on emotional stability” (Veith 1-2). </li></ul><ul><li>Significance: The prevalence of the “disease” in the nineteenth century indicates women’s social position and the attitudes towards women who did not conform to expected roles. The “diagnosis” of hysteria also reveals a power relationship between the doctor and his patient and prevailing medical views of the frailty of women’s minds and the deceptiveness of female bodies and symptoms. </li></ul>
  14. 14. Context: The Nineteenth Century <ul><li>History of Hysteria Continued </li></ul><ul><li>Before hysteria became a common illness of women, numerous ‘diseases’ were common. These included “nervous prostration,” “cardiac inadequacy,” “dyspepsia,” and “rheumatism.” </li></ul><ul><li>The symptoms included “headache, muscular aches, weakness, depression, menstrual difficulties, and indigestion” (Ehrenreich and English 103). The woman lacks an appetite, becomes pale, and grows tired by any form of activity. </li></ul><ul><li>Although the ‘disease’ itself was never considered fatal, numerous women, such as Mary Galloway, committed suicide as a means of relief from the symptoms (Ehrenreich and English 104). </li></ul><ul><li>These illnesses were rampant in middle to upper class women only. </li></ul><ul><li>A sickly woman became the icon of the middle and upper classes. “The way this type of woman was expected to live predisposed her to sickness, and sickness in turn predisposed her to continue to live as she was expected to” (Ehrenreich and English 105). </li></ul>
  15. 15. Context: The Nineteenth Century <ul><li>Hysteria and Women’s Social Place </li></ul><ul><li>The diagnosis and treatments of hysteria directly correspond to the female social position. First, the disease is a specifically female one, not shared by males. Indeed, the only men connected to hysteria are those who diagnose and “cure” it in their patients – their female patients. The disease thus positions women within a patriarchal system of authority and dependence; women suffering from hysteria are wholly dependent on their male doctors for treatment and, in the case of the rest cure, human contact. </li></ul><ul><li>Second, hysteria itself is produced by female social status; emotional distress for many women, including Charlotte Perkins Gilman, is tied to their “social inequality” (Tomes 153). Other specific expressions of female mental illness, such as anorexia nervosa, are also tied to changing social trends and modes of expression for women (Tomes 152). </li></ul>
  16. 16. Context: The Nineteenth Century <ul><li>What caused the mysterious illnesses and symptoms rampant among middle and upper class women? </li></ul><ul><li>Charlotte Perkins Gilman explained that “the affluent wife appeared to be a sort of tragic evolutionary anomaly, something like a dodo. She did not work: that is, there was no serious, productive work to do in the home, and the tasks which were left-keeping house, cooking and minding the children-she left as much as possible to the domestic help” (Ehrenreich and English 105). </li></ul><ul><li>In essence, a woman’s role was none other than that of sex. </li></ul><ul><li>“ Marriage had become a “sexuo-economic relation” in which women performed sexual and reproductive duties for financial support” (Ehrenreich and English 105). </li></ul><ul><li>Sickness became a “part of life, even a way of filling time” for women who were limited to a life of leisure. A middle and upper class wife was to be a trophy; an adornment on the arm of her successful husband. By working, a woman diminished society’s respect for her husband because the wife no longer lived a life of luxury (Ehrenreich and English 107). </li></ul>
  17. 17. Context: The Nineteenth Century <ul><li>Rules for Diagnosing Women </li></ul><ul><li>Late Victorian society assumed that women were more prone to nervous disorders than men; typical diagnoses included anorexia, hysteria, or neurasthenia (nervousness). Regardless of the particulars of the diagnosis, however, doctors followed an unwritten set of rules: </li></ul><ul><li>1. Doctors assumed from the first that the patient was pretending/shamming and her symptoms were not real (Showalter 137). </li></ul><ul><li>2. Patients were thought to produce “pretend” symptoms in order to gain something; “punitive treatment,” not sympathy, was the correct response to such women (Showalter 138). </li></ul><ul><li>3. Psychiatric treatment of female patients reinforced “the complete submission of the patient to the physician’s authority” (Showalter 137). </li></ul>
  18. 18. Context: The Nineteenth Century <ul><li>The nineteenth century French neurologist Jean-Martin Charcot shows off one of his favorite hysteria patients, Blanche Wittman. The woman is supposedly suffering a hysterical fit. </li></ul>
  19. 19. Context: The Nineteenth Century <ul><li>Applying the “Rules”: </li></ul><ul><li>All They Need is Rest </li></ul><ul><li>The so-called “Rest Cure” put into practice all of the unwritten assumptions about women and their mental states. A patient was completely dependent upon her doctor: she was “isolated from her family and friends, confined to bed, forbidden to sit up, sew, read, write, or to do any intellectual work, visited daily by the physician, and fed and massaged by the nurse. She was expected to gain as much as fifty pounds on a diet that began with milk and gradually built up to several substantial meals a day” (Showalter 139). </li></ul><ul><li>from A Dictionary of Domestic Medicine and Surgery , published in 1882: </li></ul><ul><li>“ Hysteria thrives on sympathy and attention and it is wonderful how much good may be derived from a little wholesome neglect” (Thomson qtd in “The Good Old Days: Hysteria” 31). </li></ul>
  20. 20. Context: The Nineteenth Century <ul><li>Stranger than Fiction </li></ul><ul><li>Charlotte Perkins Gilman wrote a fictionalized account of her experience with the rest cure in her short story, “The Yellow Wallpaper.” After Gilman divorced her husband, she took her daughter and became a sexual rationalist activist. Gilman “mocks the patriarchal myths of female inferiority, denounces modern “sex roles” as arbitrary social inventions, and dreams of a social order in which women and men will be not equal…functionally interchangeable” (Ehrenreich and English 20). </li></ul>
  21. 21. Context: The Nineteenth Century <ul><li>Charlotte Perkins Gilman (m. Walter Stetson 1884) wrote the story “The Yellow Wallpaper” in response to the rest cure prescribed to her by the famous physician Dr. Weir Mitchell. His “cure” nearly precipitated her descent into the madness described in the short story. </li></ul>
  22. 22. Context: The Nineteenth Century <ul><li>In response to the mysterious female illnesses, doctors concluded that the female anatomy was to blame and as a result, coined women as in a constant abnormal state. “Medicine “discovered” that female functions were inherently pathological. Menstruation…provided both the evidence and the explanation” (Ehrenreich and English 110). </li></ul><ul><li>Doctors expected women to avoid all types of labor and activity during menstruation. </li></ul><ul><li>In addition, doctors attributed “mental and physical suffering…caused by her monthly periods, which it has pleased her Heavenly Father to attach to woman” (Ehrenreich and English 111). Therefore, any mental or physical discomfort as a result of menstruation was attributed to religion and not viewed as a valid medical issue. This does not mean, however, that doctors did not attempt to treat these problems. </li></ul><ul><li>Medicine soon defined “the evolutionary theory of women…which put woman’s mind, body and soul in the thrall of her all-powerful reproductive organs” (Ehrenreich and English 120). </li></ul>
  23. 23. Context: The Nineteenth Century <ul><li>Dr. F. Hollick wrote, “The Uterus…is the controlling organ in the female body” (Ehrenreich and English 120). This became the evolutionary theory of women in which medicine used as their guide. Doctors attributed every disease, stomach, lever, kidneys, etc. as “merely the sympathetic reactions for the symptoms of one disease, namely, a disease of the womb” (Ehrenreich and English 122). </li></ul><ul><li>Therefore, in order to treat any symptom the reproductive organs were targeted. </li></ul><ul><li>The “local treatment” was commonly used for indigestion, backaches, irritability and basically any female complaint. This included four parts: </li></ul><ul><li>- a manual investigation </li></ul><ul><li>- leeching </li></ul><ul><li>- injections </li></ul><ul><li>- cauterization with a “white-hot iron instrument…with no anesthetic but a little opium or alcohol” (Ehrenreich and English 122). </li></ul><ul><li>One doctor stated the following quote while a female patient was enduring leeching, “I think I have scarcely ever seen more acute pain than that experienced by several of my patients under these circumstances” (Ehrenreich and English 123). </li></ul>
  24. 24. Context: The Nineteenth Century <ul><li>Cures that Kill: </li></ul><ul><li>Treating the Mind in order to kill the (Sexual) Spirit </li></ul><ul><li>How to prevent or delay menstruation: </li></ul><ul><ul><li>daughters should remain in the nursery, take cold showers, and wear drawers </li></ul></ul><ul><ul><li>daughters should not partake of a) soft beds, b) novels, or c) meat </li></ul></ul><ul><ul><li>(Showalter 75) </li></ul></ul><ul><li>How to “cure” menopause: </li></ul><ul><ul><li>Inject ice water into the rectum </li></ul></ul><ul><ul><li>Place ice in the vagina </li></ul></ul><ul><ul><li>“ Leech” the labia and cervix </li></ul></ul><ul><ul><li>(Showalter 75) </li></ul></ul><ul><li>How to prevent menstruation and cure any other female “insanities”: </li></ul><ul><ul><li>Surgically remove the clitoris (clitoridectomy) </li></ul></ul><ul><ul><li>(Showalter 75) </li></ul></ul>
  25. 25. Context: The Twentieth Century <ul><li>Cures that Kill: </li></ul><ul><li>Schizophrenia in the 1930s -1950s </li></ul><ul><li>Facts </li></ul><ul><li>Unlike “female maladies” such as hysteria, schizophrenia occurs equally in men and women. However, schizophrenia has been medically regarded as a female problem and has been treated as such. Indeed, “the schizophrenic woman has become as central a cultural icon for the twentieth century as the hysteric was for the nineteenth” (Showalter 204). </li></ul><ul><li>Treatments for schizophrenia depend more on the disease’s association with femininity than with actual medical science: “the treatments for schizophrenia have strong symbolic associations with feminization and with the female role” (Showalter 205). </li></ul><ul><li>Real Treatments include (and still include): insulin shock, electroshock, lobotomy (Showalter 205). </li></ul>
  26. 26. Context: The Twentieth Century <ul><li>“ Real” Hypochondria </li></ul><ul><li>Hypochondria exists as a verifiable condition but can also affect management and diagnosis of real symptoms. Patients with “real” hypochondria can be distinguished from those with disease symptoms, but hypochondria is sometimes used to dismiss symptoms of other conditions. </li></ul><ul><li>from Caremark’s website on Hypochondria: </li></ul><ul><ul><li>“ The DSM-IV (its most recent edition) defines hypochondria as a preoccupation with the belief that one has an illness, based on a misinterpretation of bodily symptoms. To qualify as hypochondria, this preoccupation must cause distress in the person's daily life and persist for at least six months -- despite medical evidence discounting the perceived illness. The immediate concern over, say, a headache, would not be how to treat it, but what underlying condition that headache suggests. This train of thought often leads the hypochondriac to a dire conclusion: This headache is the symptom of a brain tumor.” </li></ul></ul><ul><ul><li>“ About 1 to 5 percent of the population suffers from hypochondria, and the disorder is believed to strike men and women equally. But Deirdre(she declined to give her last name), the moderator of Health Anxiety Support, an Internet bulletin board for hypochondriacs, says the vast majority of people who post on the Web site are women.” </li></ul></ul>
  27. 27. Context: The Twentieth Century <ul><li>Hypochondria and Heart Disease </li></ul><ul><li>“ If I have to see another woman who thinks she is having a heart attack, I’ll scream ” (qtd. in Miracle 209). </li></ul><ul><li>While hypochondria exists in some patients, others have verifiable medical conditions that may go untreated because of a doctor or nurse’s dismissal of symptoms. </li></ul><ul><li>Doctors and nurses reproduce nineteenth-century stereotypes and assumptions in their treatment of women: </li></ul><ul><li>1. Women are viewed as more prone to mental illness and doctors are more ready to treat women’s than men’s symptoms of mental illness with drugs. </li></ul><ul><li>Medical professionals are conditioned to dismiss women’s actual physical symptoms because women are associated with “pretend” illnesses and hypochondria. </li></ul><ul><li>Heart Disease, its prevalence among women, and the myths associated with it reveal these stereotypes and prejudices. </li></ul>
  28. 28. Context: Heart Disease <ul><li>The Hollywood Heart Attack </li></ul><ul><li>“ Individuals have been synthesized over time by movies and television to the ‘Hollywood heart attack’: that is, to the middle-age, white male clutching his chest in acute severe pain and, subsequently, dropping to the floor. This has resulted in a cardiac stereotype that continues to affect us even today, as heart disease has been conceptualized, through time, as a man’s disease” (Lefler 20). </li></ul><ul><li>The Image of the Hollywood Heart Attack </li></ul>
  29. 29. Context: Heart Disease <ul><li>The “Real” Heart Attack Victim: </li></ul><ul><li>Helen J. Ginsburg </li></ul><ul><li>HerStory: </li></ul><ul><li>Mother of two </li></ul><ul><li>a sculptor </li></ul><ul><li>cholesterol level near 400 </li></ul><ul><li>Heart disease </li></ul><ul><li>Helen never suspected that she had heart disease – and neither did her doctor. </li></ul><ul><li>I thought only men got heart disease, says Helen. I never thought it could happen to me. And my family doctor kept telling me I was fine, so I put my faith in him. It almost killed me. </li></ul><ul><li>(Nechas and Foley 57-59) </li></ul>
  30. 30. Context: Heart Disease <ul><li>Facts about Heart Disease </li></ul><ul><li>Many women, especially those over 50, don’t know that heart disease kills women, too </li></ul><ul><li>“ Coronary heart disease has been the leading cause of death in women since 1908” (Nechas and Foley 59) </li></ul><ul><li>“ Half of the 520,000 people who die from heart attacks each year are women” Nechas and Foley 59) </li></ul><ul><li>Coronary heart disease IS different in women than men </li></ul><ul><li>African-American women are more at risk for heart attacks than white women (Nechas and Foley 60). </li></ul>
  31. 31. Context: Heart Disease <ul><li>Because of the myths about heart disease, women often “do not seek treatment immediately after the onset and symptoms” of a heart attack (Lefler 18). </li></ul><ul><li>The myth affects women and their doctors. </li></ul>
  32. 32. Context: Heart Disease <ul><li>“ Atypical Symptoms” </li></ul><ul><li>Women with symptoms of heart disease may be ignored by their doctors because they are women . Symptoms of heart disease in women are frequently not recognized as such because they do not correspond to the male standard. </li></ul><ul><li>“ What’s not generally known by most doctors is that women who have coronary artery disease and the corresponding angina may experience different symptoms than their male counterparts, symptoms that doctors call atypical. Because doctors are trained to recognize typical symptoms – in other words, men’s symptoms – such as chest tightness or pain in the left arm, women’s symptoms may go unrecognized for what they are . . . . A woman who is able to describe her chest pain in the same terminology as a man may still be dismissed with advice to ‘take it easy’ or reduce her stress load” (Nechas and Foley 67). </li></ul>
  33. 33. Context: Heart Disease <ul><li>The Framingham Problem: </li></ul><ul><li>Study “Proves” Women Don’t Have Heart Attacks but Do Have Hysteria </li></ul><ul><li>(Except that it doesn’t prove this at all.) </li></ul><ul><li>The Framingham Heart Study: This study began in 1948; early sets of findings suggested that “of all the men who showed any signs of heart disease, 70 percent dropped dead; in contrast, of all the women with any sign of heart disease, 69 percent had chest pain that, by all available measures, looked benign – that is, did not lead to heart attacks or sudden death” (Healy 332). </li></ul><ul><li>Consequently, “The [Framingham] results above seemed to confirm an already disturbing, centuries-old view of women as hysterical and hypochondriacal (while men are strong and stoic.) They were moaning and groaning about nothing, turning small physical annoyances into large, unwarranted fears of heart attacks. The Framingham studies provided the hard data to support the stereotype of the complaining woman, a being to be heeded little, if at all, when she reports physical discomfort. The data appeared to prove that chest pain in women is harmless in nature and possibly psychosomatic in origin” (Healy 332). </li></ul>
  34. 34. Context: Heart Disease <ul><li>Framingham Flaws and Far-Reaching Problems </li></ul><ul><li>However, the Framingham studies must be “understood in the context of the times” – times that neither knew a great deal about heart disease nor were very proficient at either recognizing it (in the absence of death) or treating it (Healy 332-333). Significantly, heart disease in women strikes later than in men (Healy 333). </li></ul><ul><li>The Framingham Heart Study did succeed at one thing, though: it created and perpetuated the medical myth that only men suffer from heart disease. </li></ul>
  35. 35. Context: Heart Disease <ul><li>Discrimination Continues after the Heart Attack </li></ul><ul><li>“ A very large study of 138,956 patients was conducted to determine whether women were treated differently than men after an MI [myocardial infarction]. They found the following: 1) women were less likely to undergo coronary arteriography; 2) women were less likely to receive thombolytic therapy; 3) women were less likely to receive aspirin; 4) both men and women equally received beta-blocker therapy; 5) women were less likely to receive angiotensin-converting enzyme (ACE) inhibitors; 6) women were more likely to have a do-not resuscitate order; and 7)the 30-day mortality rate was equal among both sexes . . . . Women are less likely to receive aggressive treatment, be referred for further testing, and have longer delays in treatment (by their own choice or others). However, once a woman receives treatment, her likelihood of survival is good, although there are some differences between men and women” (emphasis added Miracle 211). </li></ul>
  36. 36. Context: Heart Disease <ul><li>Myths about Heart Disease </li></ul><ul><li>Heart disease is a man’s disease. </li></ul><ul><ul><li>False. It is a leading killer of women. </li></ul></ul><ul><li>Heart disease symptoms are the same in men and women. </li></ul><ul><ul><li>False. Women’s symptoms manifest differently than men’s symptoms. </li></ul></ul><ul><li>Rates of heart disease in men and women are falling equally for both sexes. </li></ul><ul><ul><li>False: rates are falling, but not as sharply for women (Nicholson 43). </li></ul></ul><ul><li>Heart disease is linked to stress. </li></ul><ul><ul><li>False. Studies have not shown a conclusive link between angina and stress; any reported link could either be “causative or due to biased reporting” (Nicholson 43). </li></ul></ul><ul><li>Treatments for heart disease work equally well in men and women. </li></ul><ul><ul><li>False: “It is not possible to be certain that treatments work as well for women as men because women have often been seriously under-represented in, or even excluded from, clinical trials” (Nicholson 45). </li></ul></ul>
  37. 37. Context: Heart Disease <ul><li>Outside Link </li></ul><ul><li>Video: </li></ul><ul><li>Heart Disease in the Female Population: Prevalence, Presentation and Pathophysiology </li></ul><ul><li> </li></ul><ul><li>(Plays with Windows Media Player) </li></ul><ul><li>Dr. Mary Zasadil </li></ul>
  38. 38. Analysis <ul><li>Linking Hysteria and Hypochondria </li></ul><ul><li>The connections between hysteria and hypochondria were already implicit in the nineteenth century conception of the terms. Ironically, hypochondria was at first considered almost a male version of hysteria. </li></ul><ul><li>In a collection of his observations on hysteria, the seventeenth-century doctor Thomas Sydenham stated: </li></ul><ul><li>. . . antiquity may have laid the blame of hysteria upon the uterus, hypochondriasis (which we imputer to some obstruction of the spleen or viscera) is a like it, as one egg is to another. True, indeed, it is that women are more subject than males. </li></ul><ul><li>(qtd. in Veith 141) </li></ul><ul><li>By 1822, hypochondria achieved its present definition of “false beliefs about an impaired state of health” (Veith 145). Hypochondria was still considered a “sister condition” to hysteria (Veith 189). </li></ul>
  39. 39. Analysis <ul><li>Treating the Mind (Badly) . . . </li></ul><ul><li>Hysteria as a diagnosed condition has been replaced by depression, the “‘female malady’ of the late twentieth century” (Tomes 147). Women have a “special vulnerability” to this condition that may, like its predecessor hysteria, be associated with “the conditions of subordination that characterize traditional female roles” (Carmen, Russo, and Miller qtd in Tomes 147). </li></ul><ul><li>Significantly, doctors are quick to pronounce a diagnosis of depression in women. Unlike male patients suffering from the same symptoms, “women are more likely than men to receive drug treatment, and if they are white, to have longer lengths of stay in psychiatric facilities . . . . studies [have also suggested) that therapists often encouraged women struggling with psychic and practical consequences of discrimination to conform to their prescribed gender roles rather than question them (Tomes 147-148). </li></ul>
  40. 40. Analysis <ul><li>. . . and Ignoring the Body </li></ul><ul><li>“ I am a medical specialist who cares for patients with blood diseases, cancer, and aids. Several years ago, I was a consulting oncologist for a woman who had developed breast cancer. The tumor had been found early and was removed by surgery. I saw her only once or twice a year, but her internist had told me that she was a severe hypochondriac. At each visit, she unloaded a series of complaints, but almost always mentioned having a queasy feeling in her stomach. Her husband sometimes accompanied her to my office; once, when I asked her how long she had suffered from the stomach symptom, he interrupted and said, ‘‘Since I married her.” The couple had been together for thirty years. I looked at him from the corner of my eye and we exchanged a dismissive look. Some weeks later, I was called by the patient’s primary-care doctor, who told me that she had almost died from sepsis owing to an infected gallbladder. I was distraught that I had treated her complaints with such a cavalier attitude. Sometimes, even a hypochondriac’s complaints are valid” (Groopman). </li></ul>
  41. 41. Analysis <ul><li>“ Women have AMI’s [Acute Myocardial Infarctions] that are never identified or treated and there are many possible reasons for this. First, they may not have identified the signs of a cardiac condition in themselves, and therefore never sought medical attention. They may also not have had chest pain or discomfort at the time of the cardiac event, or their symptoms may have been minimal and easily related to something other than a cardiac problem. Historically, chest pain has been a concern of men and has not been perceived to be of great prognostic value in women. Chest pains in women were simply explained as being caused by anxiety or stress due to busy lifestyles, yet no research supports this theory “(Efre 49). </li></ul>
  42. 42. Analysis Findings <ul><li>Certain diseases are stereotyped, against proven statistics, as more closely linked to men or women. Bodily illnesses are associated with men; mental illnesses with women. For example, heart disease continues to be stereotyped as a “male” problem, while depression or schizophrenia are considered “female maladies.” </li></ul><ul><li>Twentieth and twenty-first century medical views of women’s mental and physical health continue to perpetuate stereotypes established in the nineteenth-century. </li></ul><ul><li>Unbalanced power relationships between the patient and her doctor continue to affect dissemination of health information and adequate testing and treatment. </li></ul><ul><li>Heart disease, despite ubiquitous medical evidence to the contrary, is still stereotyped as a man’s disease; because of stereotypes associated with women and illness, women’s cardiovascular health continues to be neglected. </li></ul>
  43. 43. Conclusions <ul><li>Doctors are at fault . . . and so are women. </li></ul><ul><li>Both the medical community and female patients continue to perpetuate stereotypes associated with female mental illness and with heart disease. While doctors may overlook valid physical symptoms or dismiss them as due to hypochondria, women may also ignore their own symptoms or fail to adequately emphasize their own medical care. </li></ul><ul><li>In order for stereotypes and prejudice associated with women’s minds and bodies to be changed and dealt with, both the medical community and individual women must be educated and informed – both about women’s bodies and about diseases. </li></ul><ul><li>Further investigation is needed in the intersection of race, sexuality, and medicine. </li></ul>
  44. 44. Conclusion Still hidden: female biological differences
  45. 45. References <ul><li>Alan, Rick. “Hypochondria (Hypochondriasis).” Conditions & Procedures InBrief . 1 November 2006. Consumer Health Complete. GALILEO. 1 October 2007. <>. </li></ul><ul><li>Caremark. “Hypochondria.” 1 October 2007. <>. </li></ul><ul><li>Ehrenreich, Barbara and Deirdre English. For Her Own Good. New York: Doubleday, 1978. </li></ul><ul><li>Efre, Andrea J. “Gender Bias in Acute Myocardial Infarction.” Nurse Practitioner 29.11 (2004) : 42-55. </li></ul><ul><li>Fausto-Sterling, Anne. “Hormonal Hurricans: Menstruation, Menopause, and Female Behavior.” Feminist Frontiers. Eds. Verta Taylor, Nancy Whittier, and Leila Rupp. McGraw( 2006): 351-364. </li></ul><ul><li>“ The Good Old Days: Hysteria.” GP: General Practitioner . 21 April 2006: 31. Consumer Health Complete. GALILEO. 1 October 2007. <>. </li></ul><ul><li>Groopman, Jerome. “Sick with Worry.” The New Yorker . 11 August 2003. Ret. 1 October 2007. <>. </li></ul><ul><li>Healy, Bernadine, M.D. A New Prescription for Women’s Health: Getting the Best Medical Care in a Man’s World . New York: Viking, 1995. </li></ul><ul><li>Lefler, Leanne L. “Perceived Risk of Heart Attack: A Function of Gender?” Nursing Forum 39.2 (2004) : 18-26. </li></ul><ul><li>Miracle, Vickie A. “Coronary Artery Disease in Women: The Myth Still Exists.” Dimensions in Critical Care Nursing 25.5 (2006) : 209-15. </li></ul><ul><li>. </li></ul>
  46. 46. <ul><li>Nechas, Eileen and Denise Foley. Unequal Treatment: What You Don’t Know about How Women are Mistreated by the Medical Community . New York: Simon & Schuster, 1994 </li></ul><ul><li>Nicholson, Christopher. “Cardiovascular Disease in Women.” Nursing Standard 21.38 (2007) : 43-47. </li></ul><ul><li>Phillips, Susan P. and Karen E. Ferguson. “Do Students’ Attitudes Toward Women Change During Medical School?” CMAJ 160.3 (1999) : 357-361. </li></ul><ul><li>Showalter, Elaine. The Female Malady: Women, Madness, and English Culture, 1830-1980. New York: Pantheon Books, 1985. </li></ul><ul><li>Tomes, Nancy. “Historical Perspectives on Women and Mental Illness.” Women, Health, and Medicine in America: A Historical Handbook . Ed. Rima D. Apple. New York: Garland Publishing, 1990. </li></ul><ul><li>Veith, Ilza. Hysteria: The History of a Disease . Chicago: U of Chicago P, 1965. </li></ul>