Health and Medicine: Feminist Perspectives

Research has shown that women are often given short shrift in the physician's office and are often on the receiving end of paternalism, their symptoms and suffering being dismissed as minor or imaginary. Feminists decry paternalism toward women in all its forms, firmly believing that women and men are intellectually equal and that they should be given equal treatment and respect. Feminists are also concerned that the health-care system tends to medicalize many normal female bodily processes, viewing them as aberrations that need to be treated rather than celebrated. In addition, feminists note that there are often subtle differences between the sexes in how various diseases and illnesses present and how they are best treated, yet these differences are not always taken into account during diagnosis and treatment. Feminists are also concerned that many clinical trials do not take into account the different physiological reactions of women and men to drugs and treatments, sometimes leaving women with treatments that are insufficient or inappropriate. Although progress has been made in most of these areas, much work is yet to be done.

Keywords Clinical Trial; Feminism; Gender; Gender Identity; Gender Inequality; Gender Stereotype; Hypochondriasis; Paternalism; Reinforcement; Reproductive Technology; Sex; Sexism; Sexual Discrimination; Socialization; Society

Sociology of Health & Medicine > Health & Medicine: Feminist Perspectives

Overview

Going to a new physician can be a rather frustrating and intimidating process in general, requiring patients to reiterate a family medical history, establish insurance credentials, and the like. Women, however, often view these visits to be particularly off-putting, especially when a man (or even a woman) in a white coat walks in and says something like, "Hi, Susie. I'm Dr. Smith." Many women accept such paternalism, however, rather than snapping back a reply such as, "Hi, Bob. I'm Ms. Jones," in an attempt to set the course of the following conversation as a dialogue between adults rather than between an all-knowing expert and an ignorant supplicant. Unfortunately, despite all the 21st-century rhetoric regarding patient advocacy in general and a patient being his or her own advocate in particular, many physicians still maintain a paternalistic attitude, a holdover, perhaps, from the kindly-doctor medical shows of the mid- to late twentieth century. Although such an attitude is not universal, feminists note that it is all too frequent. They also note that frequently women's symptoms are dismissed as hypochondriasis, resulting in wrong diagnoses and insufficient or improper treatment.

Sexual Discrimination

Sexism and sexual discrimination in the health-care system and medical community is a well-documented phenomenon in the literature. Wyndham, for example, cites several studies that reveal sexual discrimination in the way women are treated by their physicians (1983). One study found that when patients presented with chest pain, low back pain, fatigue, dizziness, or headache, the male patients' symptoms were taken more seriously than were the female patients' symptoms. A study performed by the American Pain Society found that women not only make up the majority of pain patients studied but also tend to suffer from chronic pain longer than men. In addition, they tend to receive different treatment from men, who were typically given painkillers for their pain, whereas women were more likely to receive other treatments, including tranquilizers, shock treatments, or even, in one case, a proposed lobotomy. Wyndham concludes that physicians tend to view men's pain as "real" but women's pain as imaginary, a symptom of hypochondriasis or some other mental disorder. It is important to note, of course, that not all physicians treat women this way, and it is also important to note that sexism is not only limited to male physicians. Female physicians can also be sexist in their treatment of female patients.

Feminists view sexism in a medical practice as a reflection of sexism in the society at large. They also note that medical schools often teach sexist attitudes and ideas and reinforce them. Lewin, for example, relates the story of a female physician who was in a gross anatomy class in which the instructor told the class to cut off the breasts of the female cadavers and discard them (1992). Although such an action may have made the subsequent procedures easier to perform, it also gave students the impression that women's breasts were unimportant, an attitude that might be carried over in later years into the treatment of breast cancer. Wyndham also notes that medical school instructors continue to make sexist remarks regarding female patients, attitudes that are often learned by medical students along with lessons on anatomy and health.

Socialized Ideas

One of the reasons for sexism and paternalism in the medical profession is socialized ideas regarding gender that are still at least partially supported by society. Failure to realize this can lead to sexism, sexual discrimination, and gender inequality. Social scientists note that there is a difference between gender and sex. Failure to make this distinction in the health-care setting can lead to a lower standard of care for women.

Sex refers the biological aspects of being either female or male. Genetically, females are identified by having two X chromosomes and males by having an X and a Y chromosome. In addition, sex can typically be determined from either primary or secondary sexual characteristics. Primary sexual characteristics comprise the female or male reproductive organs (i.e., the vagina, ovaries, and uterus for females and the penis, testes, and scrotum for males). Secondary sexual characteristics comprise the superficial differences between the sexes that occur with puberty (e.g., breast development and hip broadening for women and facial hair and voice deepening for men).

Gender, on the other hand, refers to the psychological, social, cultural, and behavioral characteristics associated with being female or male. It is largely a learned characteristic based on one's gender identity and learned gender role. Gender is a society's interpretation of the cultural meaning of biological sex. These interpretations often give rise to gender stereotypes, or culturally defined patterns of expected attitudes and behavior that are considered appropriate for one gender but not the other. These stereotypes are typically simplistic and based not on the characteristics or aptitudes of the individual but on overgeneralized perceptions of one gender or the other. For example, in the medical profession, one common stereotype, at least traditionally, has been that women are more subject to "imaginary" symptoms and illnesses than are men. This has resulted in the misdiagnosis of many patients who were believed to have psychological symptoms rather than physical ones. As a result of such gender bias, women may be consigned to suffer for years from an ailment before finding a physician who can see beyond her gender and diagnose and treat the underlying problem.

Clinical Drug Trials

Another problem that has been widely noted is the use of only male test subjects in clinical drug trials. Putatively, men are used because they are not at risk of becoming pregnant during the study, and therefore it is only the individual and not an unborn child who may be harmed by an untested drug, but in practice this means that any differences between how men and women react to the drug being tested remain unknown. For example, earlier studies have found that the prophylactic use of aspirin may help prevent a heart attack in men. However, since women were not included in the study, it was impossible to say whether or not the same held true for the use of aspirin by women. The Women's Health Study, sponsored by Brigham and Women's Hospital, was designed to redress this major shortcoming of the initial study (http://clinicaltrials.gov/ct/show/NCT00000479). Results published in 2005 indicated that, "surprisingly, aspirin's impact on [heart attacks] in women was quite different than that previously reported in men" (Ridker & Beller, 2005, p. 2). While the prophylactic use of aspirin did appear to reduce women's risk of stroke, it had no significant effect on their risk of a heart attack, thus illustrating the necessity of performing drug trials on both women and men.

It is also important to note that women and men may exhibit different symptoms for the same medical condition. For example, it is becoming increasingly widely recognized that women do not present with the same symptoms for a heart attack as do men (e.g., Pashkow & Libov, 1993). When physicians are looking for the symptoms experienced by males for a disorder, they are more likely to dismiss the symptoms of women as imaginary or hypochondriacal or to look for another cause.

Reproductive Health

Another area of women's health that is of particular concern to feminists is reproductive health. Although there are many commonalities, women's bodies are also obviously different from men's in many ways. While believing in equality for women in areas of treatment and ability, feminists also celebrate the physical differences. As a result, many feminists are concerned that the medical professions are increasingly treating natural processes of the female body, such as menstruation, childbirth, breastfeeding, and menopause, as diseases to be cured rather than part of the normal female life cycle. For example, what used to be considered premenstrual syndrome (PMS) is, in some cases, increasingly being called premenstrual dysphoric disorder (PMDD) instead. The difference, according to psychologists, is that the symptoms of PMDD are severe enough to impair normal functioning in both social and work situations. Although some women do experience such severe symptoms, the pharmaceutical industry actively promotes medication for these symptoms with the implication that it is appropriate for less severe symptoms as well. Further, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association (APA) in 2013, lists PMDD as a disorder, a trend toward medicalizing a natural process that worries many feminists (and can be interpreted to mean that menstruating women are mentally ill). Many feminists also decry the medicalization of childbirth and the trend to deliver in large, sterile medical facilities with a physician rather than more naturally at home or in a birthing center with a midwife. (This is not to suggest, however, that the medical equipment is never needed or that a midwife is competent to handle every emergency.) Many practitioners, and many women themselves, have often taken a medicalized approach to menopause, with hormone or other supplements, injections, creams, and even surgery being used to help women look as if they were decades younger. Feminists see this as putting undue emphasis on the physical attractiveness of a woman and disregarding her greater wisdom, maturity, and abilities in her later years. These things are not just a problem within the medical community; they reflect the values and attitudes of the society as a whole.

Applications

Technology

Technology has affected most of our lives in a wide variety of ways, ranging from the light switch on the wall to the personal computer on the desk, as well as countless other applications of science too numerous to mention. Technology is also widely used in the medical professions both for diagnostic purposes (e.g., MRIs and CAT scans) and as tools to help perform medical procedures (e.g., colonoscopies and laparoscopic procedures). One area in which medical technology has made significant advances is in the treatment of infertility. Assisted reproductive technology is the use of medical techniques to enhance fertility and increase the probability of a woman conceiving a child. These technologies have been successfully used to help many women conceive who were not able to do so before. Although they do not necessarily reject the use of such technologies to increase the probability of conception, feminists do question the underlying reasons why so many women turn to such technologies in seeming desperation to conceive.

Infertility is often considered to be a major life crisis not only by the couple involved but also by their family and friends. Given the fact that there is increasing overpopulation in many areas of the world, many feminists question why this is so. Most physicians today believe that infertility stems from physiological causes and, therefore, apply medical solutions to the problem. This attitude has led to the medicalization of infertility, just as many other natural processes of the female body have been medicalized. Many feminist theorists dislike this trend, believing that it views the natural processes of the female body as things needing medical intervention in the same way that diseases and illnesses do.

The medical community focuses almost exclusively on the clinical aspects of the problem, including immediate causes (e.g., endometriosis, pelvic scarring, low sperm count) or those things that led to the immediate causes (e.g., postponement of childbearing until the thirties, sexually transmitted diseases). Therefore, the medical community tends to focus on fixing the underlying cause, sometimes using assisted reproductive technology to help a woman conceive a child of her own. Although assisted reproductive technology can help a woman achieve her goal, many feminists take a dim view of such procedures. On the one hand, some feminists view assisted reproductive technologies as a way to reinforce traditional views that stress the importance of bearing children as part of a woman's role and depreciate the value of women who are not mothers. This attitude has traditionally formed the basis of discriminatory practices that limit the opportunities for women in society, particularly at work, an approach antithetical to the feminist ideals of gender equality. Many feminists also see the use of reproductive technology as reinforcing this attitude by allowing women to ignore their bodies in the hope of achieving a supposed ideal that does not support them in maximizing their own potential. Some feminists also believe that the contemporary emphasis on assisted reproductive technology shifts the locus of control for conception from the woman to the physician, thereby taking from these women power over their own bodies. Some feminists believe that this may harm women collectively even while it helps women individually. From this perspective, the problem of infertility lies not in the inability of a woman to bear a child but in the expectations of a society that views childbearing as necessary for a woman's fulfillment.

Conclusion

Most physicians consider themselves to be scientists who look at objective data concerning illness and disease and rationally prescribe treatment in order to reduce or eliminate suffering. Unfortunately, although this may be true in some cases, in others it is not. In particular, women are often given short shrift in the physician's office, and their symptoms and suffering are often dismissed as being minor or imaginary. Interactions between physicians and their female patients are often marked by paternalism, even in the 21st century. Some of this has to do with the sexism of society at large as well as the historical hierarchy of the medical professions in which men were at the top. No matter the reasons, however, feminists decry paternalism toward women in all its forms, firmly believing that women and men are intellectually equal and should be given equal treatment.

Gender inequality in the medical arena does not only take place in the physician's office. Women's and men's bodies have obvious differences, and feminists are concerned that the things that are different are often medicalized and seen as aberrances that need to be treated rather than celebrated. Similarly, feminists are concerned that the use of reproductive technologies in particular to treat natural processes, often unsuccessfully, reinforces in many women the belief that they are unfulfilled if they do not become mothers. In addition, there are also subtle differences between the sexes in how various diseases and illnesses present and how they are best treated, and these differences are not always taken into account. Many clinical trials and research studies regarding treatment do not account for the different physiology of women, sometimes leaving them with treatments that are insufficient or inappropriate.

Progress has been made in most of these areas, but much work is yet to be done. Although education of medical students and physicians in these areas can help reduce bias against women, it is unlikely to be eliminated until it is eliminated from society at large.

Terms & Concepts

Clinical Trial: A controlled scientific experiment that is designed to investigate the effectiveness of a drug or treatment in curing or lessening the symptoms of a disease or disorder.

Feminism: An ideology that is opposed to gender stratification and male dominance. Feminist beliefs and concomitant actions are intended to help bring justice, fairness, and equity to all women and aid in the development of a society in which women and men are equal in all areas of life.

Gender: Psychological, social, cultural, and behavioral characteristics associated with being female or male. Gender is defined by one's gender identity and learned gender role.

Gender Identity: A person's individual sense and experience of being a particular gender, based on both biological and psychosocial considerations.

Gender Inequality: Disparities in the treatment of individuals based solely on their gender rather than objective differences in skills, abilities, or other characteristics. Gender inequalities may be obvious, such as not receiving the same pay for the same job, or subtle, such as not being given the same subjective opportunities for advancement.

Gender Stereotype: A culturally defined pattern of expected attitudes and behaviors that are considered appropriate for one gender but not the other. Gender stereotypes tend to be simplistic and based not on the characteristics or aptitudes of the individual but on overgeneralized perceptions of one gender or the other.

Hypochondriasis: A mental disorder in which the patient is preoccupied with his or her symptoms and the fear or belief that they may be serious, based on an incorrect or unrealistic interpretation of the symptoms. Hypochondriasis persists despite reassurance from medical personnel that the patient's self-diagnosis is incorrect and may interfere with patient's functioning in other areas of life, such as work or social settings.

Paternalism: Attitudes, practices, or policies on the part of those in authority that are designed to override the free will of others. The rationalization for paternalism is typically that it is necessary for the protection of the individuals against whom it is used.

Reinforcement: Increasing the likelihood of a person repeating a certain behavior by either rewarding the behavior or punishing other types of behavior.

Reproductive Technology: The use of medical techniques to enhance fertility and increase the probability of conceiving a child. Also referred to as assisted reproductive technology. Methods of reproductive technology include artificial insemination, gamete intrafallopian transfer (GIFT), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), surrogacy, and zygote intrafallopian transfer (ZIFT).

Sex: The biological aspects of being either female or male. Genetically, females are identified by having two X chromosomes and males by having an X and a Y chromosome. In addition, sex can typically be determined from either primary or secondary sexual characteristics. Primary sexual characteristics comprise the female or male reproductive organs (i.e., the vagina, ovaries, and uterus for females and the penis, testes, and scrotum for males). Secondary sexual characteristics comprise the superficial differences between the sexes that occur with puberty (e.g., breast development and hip broadening for women and facial hair and voice deepening for men).

Sexism: Discriminatory or prejudicial beliefs or practices against one but not the other of the sexes. Sexism is most typically directed against women.

Sexual Discrimination: The differential treatment of individuals based on their sex. Although sexual discrimination can occur against either sex, in most cases in today's society it occurs against women. Sexual discrimination can manifest in such actions as paying one sex lower wages than the other for performing the same work, discounting the characteristics or attributes of one sex in comparison with the other, or following hiring or promotion policies that are biased against one sex.

Socialization: The process by which individuals learn to differentiate between what society regards as acceptable and unacceptable behavior and act in a manner that is appropriate for the needs of the society.

Society: A distinct group of people who live within the same territory, share a common culture and way of life, and are relatively independent from people outside the group. Societies include systems of social interactions that govern both culture and social organization.

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Suggested Reading

Angel, K. (2012). Contested psychiatric ontology and feminist critique: 'Female Sexual Dysfunction' and the Diagnostic and Statistical Manual. History of the Human Sciences, 25, 3–24. Retrieved November 14, 2013, from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=82507025&site=ehost-live

Correa-de-Araujo, R. (2006). Serious gaps: How the lack of sex/gender-based research impairs health. Journal of Women's Health, 15 , 1116-1122.

Crawford, B. M., Meana, M., Stewart, D., & Cheung, A. M. (2000). Treatment decision making in mature adults: Gender differences. Health Care for Women International, 21 , 91-104.

Davidson, C. V. & Abramowitz, S. I. (1980, Spr). Sex bias in clinical judgment: Later empirical returns. Psychology of Women Quarterly, 4 , 377-395.

Hatala, R. & Case, S. M. (2000). Examining the influence of gender on medical students' decision making. Journal of Women's Health and Gender-Based Medicine, 9 , 617-623.

Lee, E. (2006). Medicalizing motherhood. Society, 43 , 47-50. Retrieved October 31, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=22251756&site=ehost-live

Mahowald, M. B. (1987). Sex-role stereotypes in medicine. Hypatia, 2 , 21-38.