Anushree Rath, Anshu, Srishti, Moxa Shah, Shivanshi Saxena, Shubhashree S, Radhika Garg, Harpreet Kaur, Keerti Nair 

 

Abstract

This study looks at the long-term evolution of gendered medical discourse, focusing on how female psychological pain has been systematically constructed and handled throughout history. The major goal is to deconstruct the long-standing frameworks that have traditionally neglected women’s health by emphasising the masculine body as the normative standard of physiological and psychological health. By looking at the move from supernatural explanations to modern clinical categories, the present study hopes to uncover the fundamental power dynamics that continue to influence modern medical encounters. The study is structured around four central objectives: tracing the historical progression of diagnostic labels from medieval theological constructs to Victorian clinical categories and modern psychogenic labels; advocating for a paradigm shift that restores the credibility of the patient’s testimony; analyzing non-clinical narratives to identify structural stressors frequently omitted from medical records; and evaluating the current transition toward gender-sensitive healthcare frameworks. The methodology uses a qualitative approach called Qualitative Content Analysis (QCA) to analyze a stratified corpus of textual artifacts such as historical medical treatises, 19th-century literary works, and modern clinical case studies. This analysis is based on Feminist Standpoint Theory and an Epistemic Injustice framework, with additional Foucauldian concepts of institutional control and behavioral regulation. The result reveals that, despite considerable terminology changes, the core processes of exclusion, such as the ‘unreliable narrator’ stereotype and diagnostic overshadowing, remain in modern healthcare settings. While legislative milestones have attempted to close the research gap, data show that systematic biases continue to result in considerable inequities in treatment wait times, funding, and clinical trial participation. The paper contends that meaningful improvement requires a rethinking of clinical knowledge to favor lived experience over androcentric baseline measurements.

Keywords:  Androcentricity, Gendered Pathologisation, Epistemic Injustice, Female Distress

“When facts do not fit with the available frames, people have a difficult time incorporating new facts into their way of thinking about a problem. These women’s names have slipped through our consciousness because there are no frames for us to see them, no frames for us to remember them, no frames for us to hold them.” 

                          – Kimberlé Crenshaw, The Urgency of Intersectionality

 

For centuries, if a woman was upset, overwhelmed, or ‘acting out of line’, doctors had a one-word answer: Hysteria. The word comes from the Greek word for uterus. Back then, it was a popular thought that a woman’s womb could detach and wander around her body, causing madness. Even as that largely unfounded theory faded, the core idea remained, that the cause of women’s supposed instability is biological, almost inherent. This paved the way for the ‘rest cure’, where women were locked in rooms and forced into silence just to make them docile and easier to manage (Chesler, 1972). The historical pathologisation of female distress is fundamentally rooted in the medical construct of hysteria, a term derived from the Greek hystera (uterus).

Historically, medical discourse suggested that female psychological instability was a direct consequence of reproductive anatomy, specifically the theory of the wandering womb, establishing an antecedent where women’s mental health was viewed as inherently biological rather than situational. This perspective facilitated the implementation of the rest cure, a 19th-century clinical practice that utilised forced isolation and silence to enforce domestic docility (Chesler, 1972). This not only highlights the lack of consideration of a holistic framework to understand women’s distress but also showcases how little was known about female anatomy in the first place.

In contemporary medicine practices, this pattern persists through the default man syndrome, a paradigm in which the male body and psychological profile are treated as the universal human standard.

Fast-forward to today, and evidence shows that medicine continues to rely disproportionately on male physiological baselines. Criado Perez (2019) documents extensively how the ‘reference man’, a 70 kg, 20–30 year old male, has historically served as the default in drug dosing, symptom profiling, and clinical trial design, systematically excluding female-specific biological variation. This is what is now commonly referred to as the ‘default man syndrome’. The persistence of this standard is further confirmed by the World Economic Forum (2025), which notes that sex-disaggregated data remain absent from large portions of global health research, resulting in significant evidence gaps for women.

Research into clinician bias has shown that healthy traits, such as logic and independence, are often aligned with masculine archetypes. On the other hand, traits associated with femininity are frequently categorised as submissive or clinically immature (Broverman et al., 1970). These patterns set in place a male-normative standard of conduct leading to pathologisation of feminine traits and behaviours.

This systemic exclusion of female biology from clinical research has resulted in significant pharmacological risks; for example, the over-prescription of Ambien to women persisted for two decades because original safety trials were conducted exclusively on male subjects (FDA, 2013). Research indicates that because female biology has been systematically treated as a secondary consideration in medical research and clinical design, women spend approximately 25% more of their lives in poor health compared to men (World Economic Forum, 2025).

This morbidity disparity is attributed in part to the persistent underrepresentation of women in clinical trials—particularly in cardiology and oncology, where the European Parliament (2025) reports that only approximately 41.2% of early-stage trial participants are female. The World Economic Forum (2025) further identifies the absence of sex-disaggregated data as a systemic driver of this inequity.

Non-representation of female participants in drug trials shows the ill-consideration of critical uniqueness of their physiology and over-utilisation of only male narrative in medicine.

The medical marginalisation of women is further characterised by the unreliable narrator pattern, which reached a clinical peak during the mid-20th century. During this era, approximately 75% of lobotomies were performed on women, often to treat moodiness or non-compliance with domestic roles (Chesler, 1972). This was often done for things as simple as being moody or not sleeping well. This gendered pattern is corroborated by Rossman and Agroia (2024), who document that psychiatric interventions of the mid-twentieth century were disproportionately applied to women whose behaviour deviated from domestic norms, and by CMAJ (2018), which notes that women were institutionalised at higher rates than men throughout this period, frequently for non-clinical social infractions.

The female’s narrative of their own experiences were not considered reliable and treatment was given based on pre-conceived notions about female anatomy.  A repetition of this bias remains prevalent in the modern world; experimental data indicates that when presenting identical facial expressions of pain, female patients are perceived by observers as experiencing significantly less pain than male patients (Zhang et al., 2021). For instance, the average diagnostic delay for endometriosis is currently seven years, as patients are frequently misdiagnosed with anxiety or told their physical pain is a standard biological experience (De Corte et al., 2025). Due to persistent biases in research and inadequate conclusions about female anatomy and their experiences, such medical mishaps continue to take place which prevents them from receiving appropriate treatment on time.

Empirical data from emergency departments further quantifies this disparity, showing that women wait approximately 30 minutes longer for care than men and are 10% less likely to have their pain scores formally recorded by nursing staff (Guzikevits et al., 2024).

Nurses are 10% less likely to record a pain score for female patients (Doshi et al., 2022), a finding that reflects broader documentation of the systemic underassessment of female pain in emergency and acute care settings. This pattern of procedural neglect has been characterised as a structural form of erasure by Hoffmann and Tarzian (2001), who argue it constitutes a measurable clinical bias against women independent of individual practitioner intent.

 Furthermore, while women are frequently over-diagnosed with depression, neurodevelopmental conditions and greater functional impairment, such as ADHD and autism are often missed due to diagnostic criteria based on male-dominant samples (Criado Perez, 2019; Eriksen & Kress, 2008). Eriksen and Kress (2008) specifically highlight how the DSM diagnostic criteria for conditions such as ADHD were developed and normed on male samples, creating systematic blind spots in the recognition of female presentations. Becker et al. (2017) further document that women are significantly more likely to receive mood disorder diagnoses relative to men presenting with comparable functional impairment profiles.

While some critics argue that these disparities are purely a result of historical data gaps rather than active bias, the persistent pathologisation suggests a deeper structural cycle of medicating women into docility to maintain traditional social roles.

The study aims to connect the dots between the lobotomies of the past and the waiting rooms of today. It depicts that as long as we keep using a male-centered default for medicine, women’s health will continue to be a series of missed signs, ignored pain, and misunderstood lives. The goal remains to examine the causal links between historical psychiatric interventions, such as the lobotomy, and contemporary clinical disparities in emergency and diagnostic medicine.

Theoretical Background

Historically, psychological studies of women’s suffering have been informed by epistemological, medical, and sociocultural perspectives that individualise pain and repress its structural roots. Epistemic injustice (Fricker, 2007) is one of the foundational perspectives that can be used to understand this phenomenon. Epistemic injustice can be defined as the systematic de-legitimation of certain knowers and certain knowledge. Women’s knowledge of emotional suffering has been considered to be unreliable, overstated, or nonsensical, leading to testimonial injustice (Fricker, 2007), and the lack of interpretive frameworks that can be used to interpret gendered suffering is an example of hermeneutical injustice. This is empirically observable in clinical settings: Zhang et al. (2021) found through controlled experiments that observers consistently rate women’s facial pain expressions as indicating less pain than identical expressions in men, demonstrating that the discounting of women’s self-reports is not merely historical but operates as a measurable cognitive bias in contemporary medical interactions.

Michel Foucault’s ideas of the medical gaze (1973) and bio-power (1978) help to further explain the ways in which women’s distress has been constructed within power relations of institutions. The medical gaze (Foucault, 1973) removes symptoms from their social context, objectifying suffering, while bio-power controls populations through the establishment of norms of health, productivity, and emotional control. This has served to historically categorise women’s expressions of emotion, constructing distress pathologically as an individual problem rather than a response to social conditions such as gendered violence, reproductive rights, and labor.

From a social-cognitive perspective, the attribution theory (Heider, 1958) can be used to understand fundamentally as to why there is a tendency for biased interpretations of women’s distress. It has been found that there is a tendency for observers to interpret women’s psychological problems in terms of internal and stable attributes (for example, emotional instability) rather than external and situational factors. This explains why there has been more focus on the “wandering womb” than actual psycho-social stressors that were possibly the source of women’s distress.

Gender Schema Theory (Bem, 1981) offers another theoretical explanation with its demonstration of the impact of culturally learned schemas on the perception of appropriate behaviour and emotion. Gender schemas influence both self-perception and professional perception, making it impossible to understand women’s suffering outside of stereotypically feminine frameworks such as relational dependency or emotional intensity, (Bem, 1981) without the use of stereotypically feminine perspectives, such as relational dependency or emotional intensity. This has been demonstrated in clinical settings by Özel et al. (2025), who found that psychiatrists displayed measurable gender bias in their application of Borderline Personality Disorder diagnoses, attributing emotional expressiveness more readily to female patients regardless of diagnostic criteria. Broverman et al. (1970) similarly demonstrated that clinicians applied distinct and contradictory standards of psychological health to men and women, reflecting the direct clinical operation of gender schemas.

Labelling theory (Becker, 1963) emphasises the social implications of psychiatric labelling. The traditional female psychiatric labels of hysteria or borderline personality disorder are seen not only as a means of labelling but also as a tool of social control. These labels rebrand women’s pain by converting problems caused by structural inequalities into personally caused issues. This feminist argument revolutionised the way psychiatric diagnosis of women was looked at, directing readers to question systemic errors rather than blaming and pathologising a natural response to those injustices.

Finally, intersectionality (Crenshaw, 1989)  and the feminist perspective theory (Harding, 1991) also suggests that the knowledge regarding psychological experiences of women should be sculpted by actually considering the experiences of women, especially those, who generally face oppression at the hand of intersecting cultural systems, as they provide a much more nuanced and descriptive stance of women’s psychological distress and state of mind.

Thus, these theories collectively offer a holistic understanding of distress of women, taking in account the power, context, and inequality as significant components of psychological explanation. This encompasses the feminist view holistically.

Review of Literature

Existing literature across psychology, sociology, and gender studies has consistently examined the medicalisation of women’s psychological distress.

For centuries, when women have expressed psychological distress, the world has preferred to fix the woman rather than the world around her. Instead of seeing her pain as a meaningful response to what she’s been through, society has often medicalised it, moralised it, or simply brushed it off as an innate part of being a woman. Literature across psychology, sociology, and gender studies shows that these labels have been used to keep women’s behaviour in check, poke holes in their credibility, and hide the real, structural causes of their suffering.

A massive amount of research suggests that what we call mental illness in women is often a survival response to discrimination, violence, and social isolation. Hosang and Bhui (2018) point out that psychological distress is tied tightly to gender-based victimisation. This directly challenges the biomedical model, which tries to find the problem solely inside a person’s brain chemistry. Similarly, (Carliner et al., 2017) found that gender discrimination leads to real-world health issues, including substance use. This conveys the idea that women aren’t broken; they are reacting to a chronic, stressful environment.

Medical institutions haven’t always been supportive in this area, as Lindheim and his team found; they document a frustratingly common experience: women’s physical and mental pain being dismissed or judged, especially if they don’t fit a certain ideal image. This turns women into unreliable narrators of their own lives. It feels like a modern echo of hysteria, where a woman’s testimony was ignored simply because she was a woman (Lindheim et al., 2018). This shows how years after years, the negligent pattern keeps repeating where women’s distress is not seen from an empathetic lens but rather forcibly tried to fit into a medical and pathological perspective.

Eriksen and Kress (2008) highlight how official manuals like the DSM and ICD have historically pathologised female anger or sadness without looking at the context of their lives. This labeling doesn’t stay in the doctor’s office but also follows women into their jobs affecting both their personal and professional identities. Tang and Xu (2023) show that discrimination at work crushes job performance and self-esteem. The important thing to note here is that this isn’t because women are emotionally fragile. It’s because the psychological cost of constant discrimination is exhausting. Historically, this fragility was the exact excuse used to keep women out of leadership roles, which in turn became one of the other contributing factors to their hardships hindering them from playing an active and respectable role in the society.

Rao and Tandon (2015) argue that you can’t talk about a woman’s mind without talking about domestic violence and the heavy lifting of caregiving and housework. Direct or indirect impact of such hardships can be observed in their experienced emotional lives. Aziz et al. (2025) explain that for women in abusive situations, distress is actually a survival tool, yet it’s often mislabeled as a mental disorder. In the past, these women were called unstable; today, we risk doing the same if we ignore the trauma behind the symptoms. Diagnosis without consideration of psycho-social context can put us at risk of repeating the same negligent patterns. The legal system often doubles down on these biases. Tyagi (2024) shows that women who do not  act in accordance with socially prescribed expectations are frequently judged as manipulative or morally deviant, reflecting deeply ingrained gender norms that regulate acceptable behaviour. Such characterisations are not neutral but serve as mechanisms to justify  control and punishment, reinforcing existing power structures. In this way, legal interpretations often shift attention away from the structural and contextual realities shaping women’s actions and instead individual blame. Kroehn-Liedtke et al. (2025) extended this argument in their analysis of female sex workers, demonstrating how legal precarity, social stigma and institutional marginalisation actively contribute to psychological distress. Their work highlights that such sufferings are produced through political, legal and social arrangements that constrain agency and reinforce vulnerability.

History shows us that diagnoses have often been tools of social control. Hooper (2019) views Victorian hysteria as a way to punish women who did not conform to dominant gender roles, illustrating how medical categories were used to enforce normative behaviour under the guise of treatment. To this day, these biases continue to permeate contemporary scientific practices. (Ruiz-Cantero et al., 2007) argued that gender blind research perpetuates these inequalities by treating male experiences as the default standard, thereby rendering women’s specific health needs and experiences invisible. As a result, what appears to be objective and neutral knowledge production may in reality reproduce longlasting gender biases within medical and scientific discourse.

Hartnett et al. (2025) call for a shift toward trauma-informed care; practices that actually validate a woman’s experience instead of diagnosing her for having it. While we have plenty of studies on specific moments in time, there is still a gap in understanding how these patterns have stayed the same over centuries

Much of the literature available on the subject focuses primarily on systemic pathologizing of women’s suffering from emotional distress, with some studies investigating how they might be better understood through perspectives that are not just biased or systemic in nature. Some researchers argue that much of the reason for why diagnoses and treatments differ from each other today are related to gaps in knowledge regarding the body’s biology that were established throughout the history of biomedical research (where men’s bodies tended to be over represented in much of the available biomedical literature), rather than merely continuing the intentional bias that may have existed in the past.

Additionally, there are biological and hormonal differences that appear to affect the outcome of persons diagnosed with a mental illness, suggesting that at least some of the differences between women and men in this regard cannot be explained using only a sociocultural lens.

In order to provide consistency and reliability with regard to the application of standardized diagnostic guidelines, those standards will continue to play an important role in clinical practice, while there may be instances where the application of standardized diagnostic criteria also leads to general models of treatment. There have been recent changes to policies around medicine, and in greater numbers of persons advocating for women receiving equal access to care, and more women being included in clinical research trials, that seem to indicate that we are moving towards more gender-sensitive health care.

However, even though multiple studies have demonstrated that there continues to be patterns of being dismissed from receiving care (due to biased interpretations of emotional distress), delays in receiving a diagnosis (due to biases against women’s ability to be objective and/or rational), and interpreting female patients’ symptoms in a biased manner, all of this points toward the need for more clearly identified and inclusive practices with regard to how women’s mental health care is approached.

Research Gap and Rationale

Women’s mental distress has historically been interpreted through medical, cultural and social frameworks that reflect gendered assumptions rather than women’s lived psychological experiences (Ussher, 2011). Across time and societies, women’s suffering has frequently been explained as a natural consequence of femininity or emotional fragility (Showalter, 1985). Such interpretations have rarely been neutral; instead, they have functioned as mechanisms that regulate women’s behaviour and reinforce prescribed social roles (Foucault, 1965). Prior research indicates that women continue to experience diagnostic overshadowing (Becker et al., 2017), delayed treatment (Guzikevits et al., 2024; Doshi et al., 2022), and the systematic misattribution of physical symptoms to psychological causes (Hoffmann & Tarzian, 2001; De Corte et al., 2025). Doshi et al. (2022) provide a synthesis of emergency care data confirming that women presenting with pain are less likely to receive timely analgesia, while De Corte et al. (2025) document that psychogenic labelling constitutes the primary mechanism of diagnostic delay in conditions such as endometriosis.

In ancient medical traditions, women’s psychological and emotional distress was commonly attributed to reproductive physiology, most notably through concepts such as hysteria and the wandering uterus (Micale, 1995). These explanations reduced complex experiences of fear, grief, and anxiety to bodily dysfunctions, thereby denying women psychological agency (Ussher, 2011). Rather than being discarded, these ideas were reshaped and institutionalized over time. During the Victorian era, the rise of psychiatry lent scientific authority to earlier gendered assumptions. Diagnoses such as hysteria, neurasthenia, and nervous disorders were disproportionately applied to women who deviated from ideals of domesticity, emotional restraint, and obedience (Showalter, 1985). Medical discourse thus legitimized institutionalization and framed social nonconformity as pathology.

Despite the formal abandonment of contemporary psychology based overtly gendered diagnosis, the influence of historical bias remains evident in modern mental health practices. Prior research indicates that women continue to experience diagnostic overshadowing and delayed treatment, often having their physical symptoms misattributed to psychological causes (Khan et al., 2021). Furthermore, empirical evidence suggests a persistent ‘gender-pain exaggeration bias,’ where female distress is interpreted as emotional hypersensitivity rather than a response to legitimate structural or physical stressors (Guzikevits et al., 2024; Zhang et al., 2021). In addition to that, the historical exclusion of women from clinical research has produced major and persistent gaps in understanding gender-specific manifestations of mental illness (Criado Perez, 2019). This exclusion was formally institutionalised by the 1977 FDA policy banning women of childbearing potential from Phase I and Phase II trials, which remained in effect until 1993, when the NIH Revitalisation Act mandated the inclusion of women and minorities in federally funded research (Gately, 2025). Despite these reforms, the European Parliament (2025) reports that women remain underrepresented in early-stage clinical trials in critical specialities, including cardiology and oncology, as of 2025, indicating that legislative mandate has not fully corrected decades of accumulated research deficit.

As a result, women’s psychological suffering is often recognized only when it becomes severe or chronic, rather than being addressed early and contextually. Alongside the dominant western biomedical models, Ancient Indian traditions of mental wellbeing and alternate perspectives like so conceptualized distress in terms of ethical living, self regulation and balance between mind and body (Sharma, 2014). Although such frameworks remained marginalized within mainstream psychological discourse.

While existing literature has examined women’s mental distress within historical periods, a significant research gap remains in studies that trace the continuity of gendered interpretations across time even integrating non-western frameworks. This research addresses that gap by critically examining the medicalization of women’s distress in historical setting and advocating a more inclusive, sensitive understanding of mental health

Methodology

Philosophical Roots

The study is situated in a Feminist Constructivist Ontology, placing pain and medical concerns as psycho-physiological realities and the medical interpretation of the same as a social construction shaped by historical power dynamics. The study rejects the biological essentialism characterising women’s distress, both historically and in contemporary times as an inevitable consequence of reproductive function. On the contrary, it draws upon Simone de Beauvoir’s conception of the female body as ‘the other’, defined only in its deviation from the normative standard based on the male body. The reference to the man is not treated just as a statistical baseline but as an ontological gatekeeper- women’s existence in the medical sphere is by default seen as ‘atypical’ or unreliable (Beauvoir, 1949). This research aims to challenge the ontological assumption that female suffering is a natural state of being, by constructively criticizing the medical construction of the female subject from the Victorian ‘hysteric’ to the modern ‘anxious’ patient and revealing this schematic framing as a product of clinical neglect stemming from patriarchal conditioning.

Epistemologically, the research has its grounds in Feminist Standpoint Theory originating from the works of Nancy Harstock (1983) and further developed by other feminist writers (Smith, 1987; Harding, 1991). Following Harding’s concept of strong objectivity, the research posits that the historical marginalization of women’s voices has created a deficit in medical knowledge. The patient’s subjective testimony is hence superseded by the clinician’s objective measurement.  By utilizing Miranda Fricker’s concept of Testimonial Injustice, the study contests the very hierarchy inherently present in the violent dismissal of women’s voices, explaining the cause of deficit of credibility in women’s self reports to be situated in identity prejudice. Further, it acknowledges the value of ‘situated knowledge’ (Harding, 1991), arguing that the lived experience of pain is a valid epistemological site, historically marginalized. By centering the research around the voice of the ‘unreliable narrator’ this study seeks to reclaim the epistemic authority of the female voice, positioning the patient not as a passive object of inquiry, but as a knower who is credible and understanding of her own physiological reality.

The philosophical foundations underline the importance of employing Qualitative Content Analysis as the key methodological approach. If medical truth is shaped by language and institutional narratives, as posited by Foucault, then a thorough examination of these texts is necessary to unpack it. Content analysis facilitates the discovery of underlying themes, such as dismissal, pathologization, and gendered stereotyping, found within both historical literary works and modern clinical case studies (Krippendorff, 2018). This approach resonates with the key principles of the critical feminist tradition by transcending superficial medical explanations to uncover the deeper issue of hermeneutical injustice, or the collective inability of the medical field to meaningfully understand women’s pain due to insufficient conceptual frameworks (Fricker, 2007). Consequently, this method serves as a link between the philosophical examination of medical bias and the real-world experiences of women facing inadequate treatment.

Study Design

In order to dissect the historical and clinical framing of women’s suffering across three different eras, the Middle Ages, the Victorian Era, and the Contemporary Period, this study used a qualitative study design and Qualitative Content Analysis (QCA). The main source of data was textual artifacts, which were chosen through selective sampling according to their historical authority, diagnostic impact, and representation of prevailing gender beliefs. Three temporal categories are used to stratify the data corpus: (1) The Middle Ages, with an emphasis on religious and humorous writings that present female suffering as a moral or spiritual shortcoming (such as treatises on witchcraft or humorism); (2) The Victorian Era, with an analysis of literary narratives and medical literature pertaining to the rest cure and the diagnosis of hysteria; and (3) The Contemporary Period, examining research articles, emergency medical procedures, and contemporary clinical case studies pertaining to medical gaslighting and the undertreatment of pain.

Graneheim and Lundman’s (2004) inductive/deductive hybrid technique is used in order to gain a comprehensive grasp of the background. The approach starts with an immersion phase that involves reading a few chosen works several times. The next step is to identify meaning units, which are particular phrase or sentence combinations related to the pathologization, rejection, or understanding of female suffering. In order to maintain the essential content while lowering volume, these units are then reduced into meaning units. These condensed units are then abstracted into codes. By use of continuous comparison, codes are classified according to common traits, thereby revealing the text’s hidden meaning. Ultimately, these classifications are combined into broad themes that demonstrate the systemic persistence of prejudice over many generations.

The study, which is based on feminist standpoint theory, analyzes these motifs to reveal the epistemic injustice that permeates medical discourse. The study creates a longitudinal trajectory of dismissal by methodically following the development of these codes from medieval theological literature to contemporary triage guidelines. In addition to highlighting the evolving language of exclusion, from ‘demonic possession’ to ‘hysteria’ to ‘psychosomatic’, this multi-layered analysis challenges the enduring power structures that give the ‘reference man’ priority and silence the female sufferer. This research aims to advance the disciplines of medical sociology, women’s health psychology, and bioethics by fusing critical feminist theory with historical content analysis. 

Primary Research Question

How has the conceptualisation and discussion of  psychological distress in females evolved across various historical periods?

Objectives

1. To map the evolution of clinical responses to female distress, tracing the transition from early pathologization (e.g., hysteria) to modern-day psychosomatic and anxiety-based misdiagnoses.
2. To evaluate how historical perceptions of female instability continue to influence modern clinical credibility, specifically regarding the normalization of pain and the seven-year diagnostic delay for conditions like endometriosis.
3. To examine how the historical exclusion of female biology from clinical trials (as seen with Ambien) and emergency room protocols contributes to current health inequities and the over-medication of women for domestic compliance.
4. To critically assess the paradigm shift from historical reductionism toward a patient-centered model that validates the subjective lived experiences of women as legitimate clinical knowledge.

Ethical Considerations

1.Representation and Authenticity

Feminist Standpoint Theory emphasizes the ethics of restoring the epistemic authority of the female voice. Research should not allow the subjects’ situated knowledge (historical diaries, contemporary case studies, etc.) to be further objectified/‘othered’ through the researcher’s lens.  

2.Sensitivity toward Vulnerable Historical Subjects

The data corpus contains narratives from women held in Victorian asylums and those who underwent Rest Cure or lobotomies. These narratives require dignity and sensitive ethical care to address the historical trauma and violent dismissal of these women, without sensationalizing their suffering.

3.Integrity of Data and Contextual Accuracy

While researching clinical case studies and triage guidelines, there is a risk of hermeneutical injustice, i.e., the misinterpretation of data due to the absence of adequate conceptual frameworks. This involves a form of strong objectivity, explaining the need to position herself and the imbalances of power that are present in the discourse around medicine.

4.Impact and Advocacy

From the perspective of feminist ethics, there is an expectation that ethically oriented research does not stop at the description of a problem, but outlines a ‘positive, nuanced and rich’ impact on the field of medical sociology and bioethics. The study seeks to address the ‘modern medical gaslighting’ and ‘undertreatment of pain’ by exposing the systemic manifestations of such prejudices.

Result Analysis

Table 1

Objective 1: To map the historical timeline of how women’s distress has been dismissed, shifting from medieval demonic possession to Victorian hysteria and finally to modern psychosomatic or anxiety labels.

Theme	Categories	Prominent Codes
The protomedical and supernatural construction of female distress	1.1 Wandering womb leading to hysteria	1.1.1 Uterine mobility cause hysteria
		1.1.2 Uterus position dictates recovery
	1.2 Role of abstinence and procreation in hysteria	1.2.1 Sexual deprivation produce toxic humours
		1.2.2 Reproductive inactivity weakening uterus
	1.3 Supernatural explanations of mental illness	1.3.1 Evil influence cause hysteria
		1.3.2 Demonic possession cause hysteria
	1.4 Preventive effects of rest, comfort and abstinence.	1.4.1 Rest and care can prevent illness.
		1.4.2 Abstinence can be curative
Structural neglect and health consequences	2.1 Health Outcomes	2.1.1 Morbidity Disparity
		2.1.2 Gendered Profiling
		2.1.3 Procedural Neglect
		2.1.4 Adverse Drug Reactions (ADR)
		2.1.5 Metabolic Blindness
	2.2 Treatment Disparity	2.2.1 Therapeutic Inertia
		2.2.2 Wait Time Disparity
		2.2.3 Sedatives vs. Analgesics

 

Table 2

Objective 2: To advocate for a patient-centered model that restores the credibility of women’s own reports of their pain, moving away from seeing them as unreliable narrators and toward validating their lived experiences as legitimate knowledge.

Theme	Categories	Prominent Codes
Epistemic Injustice: Gaslighting and the Unreliable Narrator	1.1. Medical Gaslighting and Neglect	1.1.1. Gendered Bias in pain management
		1.1.2. Delayed medical response for women
		1.1.3. Erasure of female pain reports
	1.2. Systemic Nature	1.2.1. Universal Physician Bias
		1.2.2. Interpretive Bias
	1.3. Stereotyping	1.3.1. Discounting Women’s Reality
		1.3.2. Behavioural Trap

 

Table 3

Objective 3: To examine historical literary works and personal diaries to uncover the structural realities of women’s lives, such as gendered violence and labor that traditional medical records often pathologize or ignore.

Theme	Categories	Prominent Codes
Institutional control and pathologization of non conformity	1.1 Clinical diagnostic bias	1.1.1 Masculine-centric health standards.
		1.1.2 Pathologizing female behavior as Borderline.
		1.1.3 Gender-biased definitions of health.
	1.2 Institutional control and misconduct	1.2.1 Coercive medical interventions.
	1.3 Institutional control & social conformity	1.3.1 Heteronormative success metrics.
		1.3.2 Gender disparity in invasive surgery
		1.3.3 Domesticity as a health metric.
	1.4 Systematic pathologization	1.4.1 Political nature of psychiatric labels.
Diagnostic inequity: overshadowing and profiling	2.1 Mental health disparities	2.1.1 Gendered diagnostic patterns.
		2.1.2 Prevalence of female mental health conditions.
	2.2 Pharmacological disparities	2.2.1 Marketing of docility via drugs.
	2.3 Diagnosis error	2.3.1 Lifestyle attribution
		2.3.2 Consequences of error
		2.3.3 Psychogenic labeling

 

Table 4

Objective 4: To critically trace a paradigm shift analyzing the transition from historical reductionism to contemporary frameworks prioritizing agency and gender sensitive clinical practices

Theme	Categories	Prominent Codes
Androcentric Standards and Biological Exclusion	1.1 Health Outcomes	1.1.1 Morbidity Disparity
		1.1.2 Mortality Gap
		1.1.3 Prescription Disparity
		1.1.4 Metabolic Blindness
		1.1.5 Adverse Drug Reactions (ADR)
	1.2 Resource Allocations	1.2.1. 1% Funding Allocation
		1.2.2 Reinforcing Cycle of Ignorance
	1.3 Interceptive Bias	1.3.1 Underestimation of Pain
2. Reform, Advocacy and Clinical Agency	2.1 Reform	2.1.1 1993 NIH Revitalization Act
		2.1.2 20-Year Delay
		2.1.3 1977 FDA Ban
		2.1.4 Advocacy & Reform
	2.2 Intervention plans	2.2.1 Role of timely Clinical Intervention
		2.2.2 Diagnostic Tool

 Discussion

Objective 1

Scholars working to understand the long history of women’s medicalization have increasingly turned to Labelling Theory  (Becker, 1963) and Michel Foucault’s (1965) concepts of the medical gaze and bio-power. From medieval beliefs in demonic possession to the Victorian diagnosis of hysteria and today’s psychosomatic labels, a remarkably consistent pattern emerges where institutions have repeatedly exercised power by classifying and managing women’s suffering rather than addressing its causes.

The medical gaze works by stripping women’s distress of its social context such as domestic confinement, the pressures of childbearing, experiences of violence, and recasting it as something internal, biological, or psychological. Through bio-power, the structural harms produced by gender inequality, unpaid labour, and medical authority are quietly filtered out and reframed as individual pathologies, to be managed within psychiatric systems rather than challenged at their roots.

This study critically examines that process. It draws on Miranda Fricker (2007) and her concept of epistemic injustice and Nancy Hartsock (1983) proposed feminist standpoint theory to interrogate the historical construction of women as unreliable narrators of their own suffering. It also engages with  attribution theory by Saul McLeod  (2023) and gender schema theory by Sandra Bem (1981) to explore how cultural biases encourage clinicians and institutions to interpret women’s distress as a stable internal flaw, rather than a reasonable response to structural conditions. Taken together, these frameworks illuminate how medical institutions have systematically individualised and depoliticised women’s pain, in ways that consistently reinforce gendered power relations.

What emerges, ultimately, is not simply a story of changing terminology. The continuity between the Victorian ‘rest cure’ and contemporary medical gaslighting suggests something more troubling: an enduring pattern of epistemic and institutional injustice. The treatment of the male body as the medical default continues to marginalise female experiences, contributing to delayed diagnoses and the quiet normalisation of avoidable pain. In response, this study advocates for a model of mental healthcare that is more holistic and context-sensitive, one that genuinely recognises the relationship between social structures and psychological distress, and restores women’s credibility as knowers of their own bodies and lives.

Objective 2

What the existing literature reveals, is a persistent and troubling pattern wherein women’s accounts of their own pain are routinely dismissed. Where this dismissal was once articulated through labels like hysterical or neurotic, it has since evolved into a more subtle but equally damaging assumption that women are unreliable narrators of their own experience. Miranda Fricker’s concept of epistemic injustice offers a useful framework here. What women encounter in clinical settings is, in Fricker’s terms, a form of testimonial injustice, in which their credibility is structurally undermined. It is compounded further by hermeneutical injustice: medicine has often lacked the interpretive tools to make sense of gendered suffering, and in the absence of those tools, it has tended to pathologise rather than contextualise.

 Feminist standpoint theory by Nancy Hartsock (1983) reminds us that lived, situated experience carries genuine epistemic value. Yet, within clinical practice, the subjective knowledge of female patients is frequently overridden by the supposedly objective authority of the clinician. This is not simply a matter of individual bias but is an extension of the institutional power embedded in the medical gaze itself. The result is a system in which women’s accounts are not merely doubted but structurally invalidated, positioning them as others within the very spaces meant to care for them.

The empirical evidence makes clear that this is widespread rather than incidental. Research by Hoffmann and Tarzian shows that nurses are less likely to record pain scores for female patients, that women wait longer for emergency care than men, and Khan and Basnet identified cases of serious conditions such as cardiovascular disease that are chronically underdiagnosed in women . Physical symptoms are disproportionately attributed to psychological causes, and in conditions like endometriosis, the diagnostic delay can stretch across years. These patterns are not accidental. They reflect attribution biases shaped by broader cultural assumptions about women’s emotional reliability and their tendency to exaggerate.

Women, in this context, face a particular kind of double bind. Stoicism may cause their suffering to go unnoticed, while visible emotional distress is read as dramatisation. There is, it seems, no mode of expression that reliably earns them credibility. This study argues that the dismissal of women’s pain is therefore not a failure confined to individual clinicians, but a symptom of deeper epistemic and structural inequalities embedded in the healthcare system. Addressing it meaningfully requires more than sensitivity training or adjusted protocols. It requires a genuine shift toward a model of care that treats lived experience as a legitimate source of knowledge, and that actively works to identify and challenge the institutional biases shaping how women’s suffering is heard, interpreted, and addressed.

Objective 3

These findings have also revealed how there was institutional control and pathologisation of non-confirmity. Earlier diagnostic practices have historically relied on masculine-centric standards of health. These standards made women’s emotional expression appear deviant, wherein deviation from masculine normative expectations of rationality and emotional restraint were appraised to be pathological. Expression of anger or sadness has been inferred as manifestations of a disorder rather than a relevant response to the context. Such instances gave rise to the  gender-biased definitions of pathology. The emergence of coercive medical interventions played an essential role in enforcing normative behaviour with an aim to restore compliance. It indicates how medical authority functions as a regulatory force to discipline behaviours through norms of health and productivity (Hooper, 2019; Eriksen & Kress, 2008). This dynamic can be theoretically situated within Foucauldin notions of biopower and the regulation of bodies through institutional practices. Medical authority, in this sense operates not merely as a system of care but as a mechanism of social control that defines, categorises, and disciplines deviance. The pathologisation of women’s emotional expression reflects the internalisation of dominant norms that privilege masculine ideals of rationality, thereby reinforcing gendered hierarchies within diagnostic frameworks.

Women’s distress have been overdiagnosed or under-interpreted in several cases resulting in misrecognition and inappropriate treatment. Such practices often resulted in errors in diagnosis caused due to attribution biases wherein their distress was attributed to lifestyle choices and personality traits whereas the structural stressor and traumatic experiences remained away from the explanations altogether. This located the interpretation of their suffering within themselves rather than in situational and structural factors (Hosang & Bhui, 2018). After categorising the presenting problems, subsequent symptoms had been misinterpreted through a similar outlook leading to diagnostic overshadowing. This not only limited the understanding of their psychological experiences but perpetuated the inequality in the guise of clinical neutrality (Eriksen & Kress, 2008). From the perspective of hermeneutical injustice, it reflects the absence of adequate interpretive frameworks to make sense of women’s gendered experiences. Women’s distress has been continuously  filtered through dominant narratives of emotional instability which restricts the scope of understanding. Such explanations fail to incorporate contextual experiences of discrimination, violence, or caregiving burdens . In alignment with gender schema theory, these patterns further demonstrate how culturally embedded schema shapes both perception and interpretation within clinical settings, thereby sustaining systemic bias. Addressing these issues necessitates the development of more inclusive interpretive resources that acknowledge the interplay between individual experiences and broader sociostructural conditions.

Objective 4

While tracing the shift from the ancient to the contemporary period, a critical yet unfinished transition from historical reductionism to reform and advocacy is noted. Historically, the landscape was defined by androcentric standards that fostered a systematic morbidity disparity. However, certain reforms, such as the 1993 NIH Revitalization Act  or the 1977 FDA ban reversal, signify a meaningful paradigm shift towards gender sensitive practices. Nevertheless the implementation of these reforms has been hampered by a persistent reinforcement of the cycle of ignorance. Despite these mandates, recent 2024 and 2025 reports indicate that women still remain under-represented in early stage trials (World Economic Forum, 2025), particularly in critical areas like cardiology and oncology where only about 41.2 percent of participants are female. The gender pain gap has widened in recent years (Arthritis Action, 2025), a trend that Arthritis Action (2025) attributes to the continued underrecognition and undertreatment of chronic pain conditions disproportionately affecting women, compounded by persistent delays in help-seeking driven by the normalisation of female pain. Only 7% of healthcare research is dedicated to conditions exclusively affecting women (European Parliament, 2025), a figure that reflects a structurally reproduced cycle in which low research investment perpetuates knowledge deficits, which in turn limit the clinical tools available for treating female-prevalent conditions (World Economic Forum, 2025).

This incomplete transition can be theoretically understood through Foucauldian principles of medical gaze and bio power. The medical gaze traditionally objectifies the patient, often disregarding the sociostructural context, thereby reinforcing androcentric norms within medical practice. In this sense the historical exclusion of women from research and clinical trials reflects a broader exercise of biopower, where institutional control over population is maintained through the establishment of norms based norms based prominently on male traits.

Furthermore, gender schema theory provides an additional explanatory framework for understanding the persistence of such disparities. It explains how schemas that are culturally learned continue to influence the perception of appropriate behaviour, roles and even medical priorities. Meaningful reform requires not only policy level changes but also a restructuring of these underlying schemas. This involves recognizing psychological and health related issues as a dynamic interplay between stable internal attributes and external sociocultural stressors.

Conclusion

In weaving together historical accounts and modern evidence, this study reveals how the chronic dismissal of women’s pain has merely donned new guises over time. Even today, the echoes of hysteria persist in clinical encounters: women’s accounts of their own symptoms continue to be underweighted relative to clinician judgment, and their legitimate distress is systematically recast as emotional excess. Zhang et al. (2021) demonstrate this through experimental evidence showing that identical pain expressions are rated as less severe when attributed to a female face, while Doshi et al. (2022) confirm the clinical translation of this bias in emergency care settings. Özel et al. (2025) further establish that contemporary psychiatric diagnosis retains measurable gender-based patterns, particularly in conditions historically associated with the pathologisation of female emotion. Through feminist frameworks, we see how deeply the medical gaze has absorbed a male-default bias, filtering out social context and reinforcing an epistemic injustice that leaves female patients unheard. Our analysis shows that outdated labels and subtle biases work in concert to undermine women’s credibility in clinical settings whether through the documented double bind in which stoicism conceals suffering while emotional expression is flagged as dramatic (Doshi et al., 2022; Hoffmann & Tarzian, 2001), or through the structural invisibility produced by female-underrepresented research designs (Criado Perez, 2019; European Parliament, 2025). Becker et al. (2017) confirm by saying that both mechanisms operate simultaneously and interactively with each other, producing a compounding disadvantage that individual practitioner awareness alone cannot be the remedy.

The upshot is a healthcare system where structural power gaps remain unchallenged, and women’s voices struggle to be restored as authoritative evidence of their own lives. However, this narrative also points to openings for change. By applying intersectional and feminist standpoint perspectives, we have traced a trajectory from historical reductionism toward models that champion patient agency. Early reforms like policy mandates for gender‑equitable research and advocacy for women’s health hint at progress, but also underscore how deeply entrenched the cycle of ignorance is. We conclude that closing this gap requires more than new protocols: it demands a reconceptualization of medical knowledge around women’s lived realities. In other words, transforming medicine to genuinely value women’s experience means dismantling patriarchal frames at the heart of diagnosis and treatment.

Limitations

Several limitations should be acknowledged. Our study relies on literature and historical texts, which means its scope reflects the voices that have been recorded and preserved often Western, often middle-class. First-person experiences in non-English contexts or among marginalized communities may not be fully captured by these sources. Similarly, without primary interviews or experimental data, this analysis cannot measure incidence or prove causality; it interprets themes across existing studies. While feminist theory illuminates structural injustice, some nuances of medical practice may be simplified by this broad lens. These constraints suggest that future work should include more diverse voices and empirical studies to fully validate and extend our findings.

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