Gender and disability explained

In keeping with Intersectionality theory, the perception of disabled people, diagnoses they receive, and treatment available to them is linked to the way they present their gender, both from a historical and a modern perspective.

Medical misogyny

Historical

Hysteria

"Hysteria is undoubtedly the first mental disorder attributable to women, accurately described in the second millennium BC, and until Freud considered an exclusively female disease."[1] Since Ancient Greek times, the idea that a woman can go mad in a way that effects exclusively women was not an uncommon one, and until Sigmund Freud it was believed that often the reason for this madness was an improper sex life, with Plato arguing that the cure for hysteria was to "join with the male and... give rise to a new birth." Hippocrates wrote that the cause of hysteria was the buildup of putrefied humors which caused various disorders within the body and could only be expunged through regular sexual behavior.

In the Middle Ages, Trota of Salerno approached the idea of hysteria from a different perspective, offering the explanation that "the suffering related to gynecological diseases was “intimate”: women often, out of shame, do not reveal their troubles to the doctor." Later, hysteria was a common reason for innocent women to be tried as witches and put to death.

Freud recontextualizes the theory of hysteria, arguing instead that it is related to a dysfunction within the brain and not contained within the uterus, but that it is still a woman's disease, only serving to bring the concept of the "possessed woman" into the modern age.

Modern

Many disabilities, such as Fibromyalgia, are vastly disproportionally diagnosed in female patients compared to male patients even though there is no known cause for this gender disparity.[2] However, disorders involving the female reproductive system are often unnoticed, under-diagnosed, or reported to have diagnostic processes involving dissatisfactory amounts of delay or labor on behalf of the patient. These include Endometriosis[3] [4] and Polycystic ovary syndrome.[5]

Disabilities common to both females and males, especially developmental disabilities, often favor male patients in ease of diagnosis, with studies done on both autism[6] [7] [8] and attention deficit hyperactivity disorder[9] [10] suggesting that "masculine defaults" [11] in healthcare influence diagnosticians by creating a mental platonic ideal diagnostic case, which is often exclusionary towards women who present the same symptoms as men.

Interactions with racism

Stemming from Medical racism, there is a common phenomenon experienced by people of color who seek medical attention where because their bodies are believed to be fundamentally different than those of white people by white people who work in medicinal fields.[12] One such particularly pervasive belief is the idea that "blacks have thicker skin than do white people," which leads to the idea that Black patients have a higher innate pain tolerance than white patients.[13]

Similarly to the seen-above idea of the male default, there exists a parallel white-as-default [14] which influences medical practice. Medical devices such as the Pulse oximeter are calibrated to white skin, causing them to read improperly when used on Black patients.[15] Diagnostic tests, such as kidney function screens, read Black patients as having higher risk when tested.[16] Often, medical training itself is oriented around light skin as a standard: "Medical training failed to teach one of us, Tamika Lasege, a Black physician, how to diagnose local inflammation and vasculitis on her own brown skin." These and additional factors, when amplified across an entire anti-Black medical system, end up treating Blackness itself as a chronic condition.

Black patients have described the way their concerns about themselves and their family members are dismissed by the medical profession as Gaslighting.[17] For example, ALS, on average, is diagnosed later in Black patients than equivalent white ones,[18] if not missed entirely. Studies have found systematic barriers to breast cancer diagnosis in Black women.[19] Ethnic minority patients diagnosed with fibromyalgia report higher levels of sleep and mood disturbances than white patients.[20]

In following with the concept of misogynoir, Black female patients suffer both from racism and sexism within healthcare and often find that the combination of the two synthesizes into something separate from each on their own. College-educated Black mothers are nearly six times as likely to die from pregnancy-related complications, and as the rate of fatal complications decrease in white patients correlating with education level, it stays nearly the same among Black patients.[21]

Significant parts of the profession of Gynaecology are reliant on information that was obtained by using the bodies of Black women as testing equipment, only to dispose of them after the information had been gleaned, often without medical treatment. "For pioneering gynecological surgeons, black women remained flesh-and-blood contradictions, vital to their research yet dispensable once their bodies and labor were no longer required."[22] J. Marion Sims, often referred to with the epithet "Father of Gynecology", was notorious for operating on enslaved women without anesthesia, a practice which was not uncommon among medical professionals at the time.

In transgender people

Transgender patients seeking medical care, especially those on Hormone replacement therapy, are often subject to what is known as Trans broken arm syndrome, a phenomenon in which "a provider incorrectly assumes that a medical condition results from a patient's gender identity or medical transition."[23]

Transgender people are nearly twice as likely to be disabled when compared to cisgender people.[24] In studies of trans youth, it has been reported that trans people are more likely to have Ehlers–Danlos syndrome[25] and Psychosis,[26] among other disabilities.

Citations

  1. Tasca . Cecilia . Rapetti . Mariangela . Carta . Mauro Giovanni . Fadda . Bianca . 2012-10-19 . Women And Hysteria In The History Of Mental Health . Clinical Practice & Epidemiology in Mental Health . en . 8 . 1 . 110–119 . 10.2174/1745017901208010110 . 1745-0179 . 3480686 . 23115576.
  2. Yunus . Muhammad B. . 2001-03-01 . The role of gender in fibromyalgia syndrome . Current Rheumatology Reports . en . 3 . 2 . 128–134 . 10.1007/s11926-001-0008-3 . 11286669 . 1534-6307.
  3. Davenport . Sophie . Smith . Diane . Green . Dan J. . 2023-07-13 . Barriers to a Timely Diagnosis of Endometriosis: A Qualitative Systematic Review . Obstetrics & Gynecology . 142 . 3 . 571–583 . en . 10.1097/AOG.0000000000005255 . 37441792 . 0029-7844.
  4. Ballard . Karen . Lowton . Karen . Wright . Jeremy . November 2006 . What's the delay? A qualitative study of women's experiences of reaching a diagnosis of endometriosis . Fertility and Sterility . 86 . 5 . 1296–1301 . 10.1016/j.fertnstert.2006.04.054 . 17070183 . 0015-0282.
  5. Gibson-Helm . Melanie . Teede . Helena . Dunaif . Andrea . Dokras . Anuja . December 2016 . Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome . The Journal of Clinical Endocrinology & Metabolism . 102 . 2 . jc.2016–2963 . 10.1210/jc.2016-2963 . 0021-972X . 6283441 . 27906550.
  6. Cruz . Sara . Zubizarreta . Sabela Conde-Pumpido . Costa . Ana Daniela . Araújo . Rita . Martinho . Júlia . Tubío-Fungueiriño . María . Sampaio . Adriana . Cruz . Raquel . Carracedo . Angel . Fernández-Prieto . Montse . 2024-01-29 . Is There a Bias Towards Males in the Diagnosis of Autism? A Systematic Review and Meta-Analysis . Neuropsychology Review . en . 10.1007/s11065-023-09630-2 . 38285291 . 1573-6660. free .
  7. Hull . Laura . Petrides . K. V. . Mandy . William . 2020-12-01 . The Female Autism Phenotype and Camouflaging: a Narrative Review . Review Journal of Autism and Developmental Disorders . en . 7 . 4 . 306–317 . 10.1007/s40489-020-00197-9 . 2195-7185. free .
  8. Lockwood Estrin . Georgia . Milner . Victoria . Spain . Debbie . Happé . Francesca . Colvert . Emma . 2021-12-01 . Barriers to Autism Spectrum Disorder Diagnosis for Young Women and Girls: a Systematic Review . Review Journal of Autism and Developmental Disorders . en . 8 . 4 . 454–470 . 10.1007/s40489-020-00225-8 . 2195-7185 . 8604819 . 34868805.
  9. Mowlem . Florence . Agnew-Blais . Jessica . Taylor . Eric . Asherson . Philip . 2019-02-01 . Do different factors influence whether girls versus boys meet ADHD diagnostic criteria? Sex differences among children with high ADHD symptoms . Psychiatry Research . 272 . 765–773 . 10.1016/j.psychres.2018.12.128 . 0165-1781 . 6401208 . 30832197.
  10. Bruchmüller . Katrin . Margraf . Jürgen . Schneider . Silvia . 2012 . Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. . Journal of Consulting and Clinical Psychology . en . 80 . 1 . 128–138 . 10.1037/a0026582 . 22201328 . 1939-2117.
  11. Cheryan . Sapna . Markus . Hazel Rose . November 2020 . Masculine defaults: Identifying and mitigating hidden cultural biases. . Psychological Review . en . 127 . 6 . 1022–1052 . 10.1037/rev0000209 . 32804526 . 1939-1471. free .
  12. Hogarth . Rana Asali . October 2019 . The Myth of Innate Racial Differences Between White and Black People's Bodies: Lessons From the 1793 Yellow Fever Epidemic in Philadelphia, Pennsylvania . American Journal of Public Health . en . 109 . 10 . 1339–1341 . 10.2105/AJPH.2019.305245 . 0090-0036 . 6727282 . 31415198.
  13. Hoffman . Kelly M. . Trawalter . Sophie . Axt . Jordan R. . Oliver . M. Norman . 2016-04-19 . Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites . Proceedings of the National Academy of Sciences . en . 113 . 16 . 4296–4301 . 10.1073/pnas.1516047113 . free . 0027-8424 . 4843483 . 27044069.
  14. Petsko . Christopher D. . Rosette . Ashleigh Shelby . February 2023 . Are leaders still presumed white by default? Racial bias in leader categorization revisited. . Journal of Applied Psychology . en . 108 . 2 . 330–340 . 10.1037/apl0001020 . 35467925 . 1939-1854.
  15. News: Moran-Thomas . Amy . August 5, 2020 . How a Popular Medical Device Encodes Racial Bias . Boston Review.
  16. Sederstrom . Nneka . Lasege . Tamika . March 2022 . Anti-Black Racism as a Chronic Condition . Hastings Center Report . en . 52 . S1 . S24–S29 . 10.1002/hast.1364 . 35470878 . 0093-0334.
  17. Carter . Chelsey R. . November 2022 . Gaslighting: ALS, anti-Blackness, and medicine . Feminist Anthropology . en . 3 . 2 . 235–245 . 10.1002/fea2.12107 . 2643-7961.
  18. Brand . David . Polak . Meraida . Glass . Jonathan D. . Fournier . Christina N. . 2021-02-09 . Comparison of Phenotypic Characteristics and Prognosis Between Black and White Patients in a Tertiary ALS Clinic . Neurology . en . 96 . 6 . e840–e844 . 10.1212/WNL.0000000000011396 . 33372030 . 0028-3878.
  19. Jones . Claire EL . Maben . Jill . Jack . Ruth H. . Davies . Elizabeth A. . Forbes . Lindsay JL . Lucas . Grace . Ream . Emma . 2014-02-01 . A systematic review of barriers to early presentation and diagnosis with breast cancer among black women . BMJ Open . en . 4 . 2 . e004076 . 10.1136/bmjopen-2013-004076 . 2044-6055 . 3927711 . 24523424.
  20. Marr . Nicole C. . Liew . Charles Van . Carovich . Tessa F. . Cecchini . Gianna A. . McKinley . Lauren E. . Cronan . Terry A. . 2020-04-16 . The Effects of Racial/Ethnic Minority Status on Sleep, Mood Disturbance, and Depression in People with Fibromyalgia . Psychology Research and Behavior Management . English . 13 . 343–353 . 10.2147/PRBM.S242699 . free . 7174195 . 32368163.
  21. Web site: 2020-12-16 . Maternal Mortality in the United States: A Primer . 2024-10-17 . www.commonwealthfund.org . en . 10.26099/ta1q-mw24 . Declercq . Eugene . Zephyrin . Laurie .
  22. Book: Owens, Deirdre Cooper . Medical Bondage: Race, Gender, and the Origins of American Gynecology . 2017-11-15 . University of Georgia Press . 978-0-8203-5303-6 . 10.2307/j.ctt1pwt69x. j.ctt1pwt69x .
  23. Wall . Catherine S. J. . Patev . Alison J. . Benotsch . Eric G. . 2023-03-01 . Trans broken arm syndrome: A mixed-methods exploration of gender-related medical misattribution and invasive questioning . Social Science & Medicine . 320 . 115748 . 10.1016/j.socscimed.2023.115748 . 36736052 . 0277-9536.
  24. Smith-Johnson . Madeline . 2022-10-01 . Transgender Adults Have Higher Rates Of Disability Than Their Cisgender Counterparts: Study examines rates of disability among transgender adults and cisgender adults. . Health Affairs . en . 41 . 10 . 1470–1476 . 10.1377/hlthaff.2022.00500 . 36190882 . 0278-2715. free .
  25. Jones . Jordan T. . Black . William R. . Moser . Christine N. . Rush . Eric T. . Malloy Walton . Lindsey . January 2022 . Gender dysphoria in adolescents with Ehlers–Danlos syndrome . SAGE Open Medicine . en . 10 . 10.1177/20503121221146074 . 2050-3121 . 9806399 . 36600979.
  26. Barr . Sebastian M. . Roberts . Dominic . Thakkar . Katharine N. . 2021-12-01 . Psychosis in transgender and gender non-conforming individuals: A review of the literature and a call for more research . Psychiatry Research . 306 . 114272 . 10.1016/j.psychres.2021.114272 . 34808496 . 0165-1781.

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