The Hystericization of “Garbage Bag Diagnoses”

On April 24, 2014, radio and TV personality Dr. Drew Pinsky, a board-certified internist and Assistant Clinical Professor of Psychiatry at the University of Southern California, fielded a question on the syndicated radio show Loveline from a man named Kelan whose fiancée had what he called a “multitude of conditions”: endometriosis, interstitial cystitis, lactose intolerance, and “no stomach lining” (0:30:07 to 0:32:51). Before the caller could ask his question, Pinsky interjected:

These are what we call sort of functional disorders. Everything you mentioned, everything you mentioned, are things that actually aren’t discernibly pathological. They’re sort of — they’re what we call “garbage bag diagnoses,” when you can’t think of anything else, you go, “Eh, well it’s that.” So, it then makes me question why is she so somatically preoccupied that she’s visiting doctors all the time with pains and urinary symptoms and pelvic symptoms, and then that makes me wonder, was she sexually abused growing up?

Pinsky clarifies the perhaps unexpected link between so-called “garbage bag diagnoses” and sexual abuse by explaining, or — as Yahoo’s femmy offshoot “Yahoo! She Philippines” called it — mansplaining:

When people have unexplained pain, particularly pelvic pain, it’s called somatoform dissociation, and the only way her body, which was suffering during those early experiences, can tell its tale of woe is with pain. And she really needs to see a trauma specialist, not a urologist. Know what I’m saying?
Dr. Drew, (CC) Randy Stewart, blog.stewtopia.com.

To answer Pinsky’s question: No. As someone who researches the relationships between endometriosis, sexuality, and disability, I have no idea what he is saying, and neither do quite a few other people. While the content of Pinsky’s commentary, not to mention the aggressive joking about sexual assault from the host that follows, deserves all of the incensed criticism it received, if not more, my first reaction was pure delight. Of course, I felt justifiably indignant at what Pinsky said, but friends were emailing me and posting about it on my Facebook wall. Endo was trending.1

Indeed, this whole debacle opened up a dialogue that I never imagined possible when I first started researching this so-called “enigmatic” condition in 2009. Popular feminist pop culture blog Jezebel’s Erin Gloria Ryan labels the controversy a “massive shitstorm.” Women’s Health magazine jumps in to explain what Pinsky got wrong about endometriosis. Writing for the Daily Mail’s pink-themed “Femail” section, Annabel Fenwick Elliot adds to Pinsky’s faux pas with a scathing indictment of his ignorance of his own daughter’s seven-year struggle with bulimia. A Change.org petition even circulated, demanding he recant and apologize. And, of course, the endo blogosphere had plenty to say about Pinsky’s dismissal of endometriosis as a “garbage bag diagnosis.”

But in an age of Internet discussions about nearly any imaginable topic, what makes this discussion about endometriosis significant? My first answer: the fact that it’s being talked about publicly at all. Despite being labeled a modern epidemic that affects at least two to four percent of the female population worldwide (not to mention those who do not identify as female who have the condition), endometriosis is poorly understood and little discussed.2

Despite a recent increase in endo web presence, there is still a nearly decade-long diagnostic delay between the onset of symptoms and diagnosis. With symptoms such as painful periods, pain with sex, bloating, digestive troubles, food sensitivities, and infertility, it’s coded as a “women’s issue,” but it’s certainly not a sexy one. Nevertheless, endometriosis can cause disastrous personal and financial problems as well as a considerable social burden. While this dialogue has done little to rectify any of these significant problems, it has focused much needed public attention on the subject, and the strength of feedback suggests that an important shift is happening: those with endometriosis are speaking out, sharing their experiences, and responding publicly, despite attempts to keep them silent.

"Doctor Hand," Jared Rodriguez / t r u t h o u t)
“Doctor Hand,” Jared Rodriguez / truthout)

Though I am deeply pleased by the critical response to Pinsky, an analysis of his response, as well as that of his co-host Mike, can tell us how gender intersects with power in discourses about women’s health. Pinsky offers a non-apology (2:22 to 10:08), positioning himself as a victim of an unjustified attack and rewriting the (recorded) interaction on the original call by making errors, such as calling the caller’s fiancée a new girlfriend and manufacturing an intense anxiety from both the caller and his fiancée that are absent in the original call.

Even more jaw-dropping, though, is the fact that Pinsky’s apology is often drowned out by aggressive, demeaning, and highly sexualized behavior from the co-host, Mike. Mike refuses to apologize for his comments, calls Pinsky’s critics “endometriosis lady walkers” and “twats,” and suggests that those complaining should “take my balls, put them in their mouth, and eat them.” When a caller with endometriosis accepts Mike’s invitation to call in, she is repeatedly interrupted, talked down to, and urged to see things from their position. Mike’s portrayal of Pinsky as the victim of incensed, irrational women affirms just how much the topic of pelvic pain challenges male authority, both sexual and medical.

Mike’s overtly hostile, sexualized comments maintain gendered power dynamics by re-establishing men as benign experts on as well as victims of women. This is why I argue that gender must be analyzed in health discourses. Pinsky’s initial claim that these chronic conditions, largely diagnosed in women, have no “discernible pathology,” delegitimizes these conditions as “real” or appropriately medical disorders. Writing off these conditions as “garbage bag diagnoses,” Pinsky constructs endo patients as hysterical, a trend which has haunted women’s health discourses for centuries. As feminist cultural critic Ella Shohat argues: “Women’s pain, particularly in the area of their reproductive organs, tends to be attributed to fantasy, to signs of a neurotic personality, or just to the melancholic fate of being a woman” (60).

By insisting that the caller’s fiancée’s condition is merely “somatoform disorder” (a psychological disorder that unites nineteenth-century diagnoses of hysteria and contemporary accounts of endometriosis) and suggesting that endometriosis is often a result of sexual trauma, Pinsky continues the narrative that “women’s conditions” are largely psychological and linked primarily to their sexuality and reproductive capabilities. Of course, he is not alone in this mischaracterization. For example, in 2011, researchers found that those with endometriosis “catastrophize” their symptoms, concluding that with “chronic pain in endometriosis … biopsychosocial variables, such as catastrophizing, play an important role in reported severity” (Martin et al., 3078). In this context, Pinsky’s Mike’s authoritarian, at times, violent response begins to make sense.

"Pelvic douche" was used as a treatment for hysteria in the 19th century.
“Pelvic douche” was used as a treatment for hysteria in the 19th century.

This male-dominated dialogue about an absent, invisible female specter represents what I see as the hystericization of endometriosis, a process by which pain is simultaneously coded as uniquely female and delegitimized in a way that maintains male authority and dominance. One way to hystericize women is through sexualization. Despite the caller’s claim that his fiancée has not seen a doctor in years, Pinsky delegitimizes her pain by first calling her “somatically preoccupied,” and then performs some rather skilled mental gymnastics to link her symptoms to previous sexual abuse. By referring her to a trauma specialist, Pinsky places responsibility with psychiatric, rather than somatic, intervention.

While there are many problems with medical treatment for endometriosis, the suggestion that it is not “real” makes it difficult for those with the condition to achieve a diagnosis in the first place. The decade-long diagnostic delay keeps those with endo symptomology from accessing necessary social legitimization and services.3 Despite Pinsky’s belief that the caller’s fiancée’s symptoms were caused by sexual abuse, the show’s co-host, Mike, nonetheless suggests: “another way someone could develop unexplainable pelvic pain is having sex with Alan Thicke …. You guys have both just torn women in half …. All over Pasadena, California, there are corpses of females, just absolutely split in half …. They call it ‘Pinsky’d.’”4 Mike’s “joking” is not merely distasteful. It is a rhetorical strategy to regain traditional gender power dynamics by rewriting women as abject and “female pain” as laughable and thus easily dismissed.

Dismissing a patient’s chronic pain as a result of childhood sexual trauma distracts from the issue at hand: medical interventions often fail to offer relief to those diagnosed with alleged “garbage bag diagnoses.” Rather than ask why that is, Pinsky, like many others before him, blames an abstract, abject, nameless, voiceless female patient. The caller never got to ask his question, but Pinsky mentions in his apology that the primary reason for the call was the caller’s fiancée’s experience of pain with sex (a classic symptom of endometriosis). Despite multiple diagnoses and possible treatments, her pain significantly affects their relationship. Thus, rather than dismissing endometriosis as a “garbage-bag diagnosis” that masks childhood sexual abuse, it needs to be understood as a pain disorder with significant somatic as well as biopsychosocial effects.

JGI/Tom Grill, Getty Images, 482136353
JGI/Tom Grill, Getty Images, 482136353

Understanding endometriosis as a pain disorder means that we must see it as potentially disabling. Doing so relocates them as public, even political, rather than private. As feminist disability scholar Susan Wendell notes, “Socially accepted definitions of disability determine the recognition of disability by friends, family members, and co-workers” (13). This is important “not only for receiving their help and understanding when it is needed, but for receiving the acknowledgment and confirmation of his/her reality, so essential for keeping a person socially and psychologically anchored in a community” (13). In other words, we need further exploration of the tension between subjective individual experience with pain and the political implications of that pain.

Continued critical dialogue about the relationships between gender, sexuality, and disability in health discourses is crucial in order to shift the masculinized discourse about women’s health. As part of his apology, Pinsky agreed to a dialogue with endometriosis specialist Dr. Tamer Seckin, but he still continued the trend of a male discourse about women. By defensively justifying his original comments, characterizing the response as a “grotesque mischaracterization,” and portraying himself as a well-meaning victim of cyber-bullying, he was counseling women to not challenge his authority.

Seckin attempts to change the discussion by emphasizing how crucial patients are in educating physicians about the disease. He highlights the power of social media in changing discourses about endometriosis, to which Pinsky responds: “They [patients] need to be careful. They become dangerous bullies at some point, and that’s not the way to create allies. It’s not. They need to; they need to….” Seckin’s congenial disagreement with Pinsky and insistence that patients are understanding when treated respectfully is a step towards rewriting gendered scripts and power dynamics about endometriosis, but much more needs to be done to ensure that those with endometriosis are neither portrayed as aggressive, dominant shrews nor passive and overly-feminine victims.

Further Reading

Martin, C.E., E. Johnson, M.E. Wechter, J. Leserman, and D.A. Zolnoun. “Catastrophizing: A Predictor of Persistant Pain Among Women With Endometriosis at 1 Year.” Human Reproduction 26.11 (2011): 3078-3084.

Shohat, Ella. “Lasers for Ladies: Endo Discourse and the Inscriptions of Science.” Camera Obscura 29 (1992): 57-90.

Wendell, Susan. The Rejected Body: Feminist Philosophical Reflections on Disability. New York: Routledge, 1996.

Notes

  1. While the caller mentions multiple conditions, the public response focused most strongly on his claims that endometriosis is a “garbage bag diagnosis.” This is patently false. A diagnosis of endometriosis requires surgical intervention; thus it is only through persistent medical intervention that most achieve a diagnosis of endometriosis. Return to text.
  2. Kate Seear, The Makings of a Modern Epidemic: Endometriosis, Gender, and Politics (Ashgate, 2014). Return to text.
  3. Kate Seear, “The Etiquette of Endometriosis: Stigmatisation, Menstrual Concealment, and the Diagnostic Delay,” Social Science & Medicine 69 (2009): 1220-1227. Return to text.
  4. Actor and game and talk show host Alan Thicke was a guest on the show that night. Return to text.