On September 23, 1989, the fifth season of Golden Girls opened with a two-episode arc entitled “Sick and Tired.”1 The show as a whole focuses on the fictional comedic escapades of four older women sharing a home in Miami, Florida. The story line that opened the fifth season, however, was deeply autobiographical in nature, as show-creator Susan Harris’ recreated her own experiences trying to find treatment for a series of debilitating symptoms, which a specialist eventually diagnosed as Chronic Fatigue Syndrome (CFS).2 The script, which Harris later called “[a] way at getting back at all the doctors who didn’t believe me,” offers a powerful example of the ways in which modern medicine perpetuate and normalize ancient assumptions about women’s bodies and their pain in both medical and popular culture.
In “Sick and Tired,” Dorothy Zbornak, played by Bea Arthur, stands in for Harris. Her symptoms of exhaustion, confusion, and pain are those that Harris experienced. Doctors insist that Dorothy’s symptoms are a result of her age and gender, disregarding her assertions that something is very wrong with her body. It is only after a series of degrading clinical visits that she finds a doctor capable of hearing her suffering and providing the diagnosis of CFS.
The first recorded outbreak of CFS, or myalgic encephalomyelitis, was in 1934 in Los Angeles, although it was not until 1987 that the Center for Disease Control (CDC) recognized and named the condition.3 The causes of CFS remain undetermined, and its presentation varies widely, with patients suffering a range of physical and mental symptoms, from muscle pain and weakness to problems with memory and speech. According to a 2015 Institute of Medicine report, an estimated 836,000 to 2.5 million Americans suffer from CFS; however, most remain undiagnosed. This is not only because the condition itself represents a challenge, but also because of physicians’ assumptions regarding their patients’ — specifically, their women patients’ — understanding of their own bodies and minds.
There is a common public perception of CFS sufferers as “fakers” or “hysterics,” despite evidence of distress and widespread attempts from CFS advocates to educate the public. Such assumptions of CFS as an illegitimate diagnosis has led even the CDC, the very organization meant to investigate and aid CFS sufferers, to “misplace” funds meant for CFS research. But doctors, and medicine as a whole, do not occupy a cultural vacuum; they are subject to the misperceptions of their surrounding culture, including ideologies of gender and race.4 As historian Amy Koerber notes, despite the progress that medical science appears to have made since “hysteria” fell out of favor, the field continues to perpetuate women’s problematic “body-brain relationships…whereas for men this relationship is assumed to be seamless and unproblematic.”5
In modern medicine, “hysteria” is no longer a valid diagnosis in either neuroscience or psychology. It has disappeared with the advent of a new, more biologically-based schema. “Somatization disorder” fills hysteria’s shoes in psychological circles, while doctors apply the label “chronic fatigue” to patients with mysterious symptoms who refuse to accept a psychological diagnosis. Both disorders result in extensive physical symptoms that have no obvious organic cause. Both conditions also, curiously enough, have higher rates of women diagnosed than men, which further enforces the legacy of hysteria. But hysteria also left another, more insidious legacy behind in the way that women continue to experience disproportionate hatred and anger for their declarations of suffering, not only from the medical community but also within general culture, including television shows, films, and even basic colloquialisms.
Within popular and medical culture, CFS remains a direct successor to the legacy of hysteria, and patients suffering from the condition have to pull double duty to be seen as a “worthy patient.”6 They must convince not only a cynical public but also skeptical doctors that their symptoms and suffering are legitimate. Both are somewhat nebulous diagnoses with a wide range of symptoms that can deeply affect quality of life. Yet over and over again, doctors stigmatize patients with CFS by calling them lazy, or assuming their symptoms are the result of an array of scapegoats like dehydration, stress, or mental illness.
Such stigmas are even more damaging to patients already enduring increased medical scrutiny as a result of their race, class, and age. This clinical practice denies patients the closure of a firm diagnosis and a treatment plan that would help them move forward. Doctors force women to undergo rigorous scrutiny and endure suspicion from the people meant to provide care. Women cannot simply be ill or in pain, they must prove without a doubt that the pain they are feeling is real in a way men rarely do — just receiving a diagnosis is a victory.
Women’s pain has a long and very substantiated history of being dismissed by the very doctors that are meant to help them. This type of dismissal is on full display in The Golden Girls when Dorothy contacts a neurologist for help. Studies have found that doctors regularly prescribe less pain medication to women than to men. Moreover, doctors are also more likely to prescribe sedatives rather than painkillers when women report pain as compared to men reporting similar complaints.7
By doing so, medical professionals act as though the pain is not the real problem, but rather women’s reporting of that pain, effectively gaslighting women by presuming they cannot know their own bodies or pain well enough to successfully identify when there is a problem. Such a tactic becomes increasingly egregious when intersectional stigmas such as race and class cause doctors to doubt their patients’ declarations of suffering, and female patients’ to doubt their own reality and experiences.
There are consequences when anyone dismisses women’s experiences within their own bodies. Jennifer Brea, a filmmaker who documented her own experiences of CFS in her film, “Unrest,” explains that despite the progress that modern medicine espouses, the notion of the “hysterical woman” was an ever-present ideology in her treatment. Such assumptions had, and continue to have, deadly results:
Cognizant of this history, the goal of many CFS sufferers and advocates is to reclaim the power that has been denied them. To quote from Brea, “We need to think in more nuanced ways about women’s health. Our immune systems are just as much a battleground for equality as the rest of our bodies.”
Susan Harris’ “Sick and Tired” ends with Dorothy confronting the doctor who told her that her symptoms were hysterical. He had already forgotten their exchange, but Dorothy unequivocally reminds him:
Women are never truly free of the historical context of their own bodies, whether in the context of their gender, race, or perceived tendency towards over-emotionality. From the “hysterical” women of the nineteenth century to Susan Harris’ and Jennifer Brea’s depictions of their treatment today, the legacy of hysteria, the common misunderstanding of women’s expressions of pain, and the general perception of a woman faking illness for attention has never truly left the medical field, or our cultural lexicon. Now, it continues to wound those who are in the most need of help.
- Golden Girls, “Sick and Tired, Part 1,” Episode 103. Directed by Terry Hughes. Written by Susan Harris. NBC, September 23, 1989. Return to text.
- Though Harris later explained that it has been determined that she suffers from an adrenal condition, rather than CFS, this does not diminish the power of her script, or the reality that patients with CFS suffer in attempting to secure a diagnosis and adequate care. Return to text.
- Outside of the US, the condition is frequently referred to as myalgic encephalomyelitis, or ME. J. Gordon Parish, “Early Outbreaks of ‘Epidemic Neuromyasthenia,’” Postgraduate Medical Journal, 54 (1978): 711. Return to text.
- Another example of the disparities in medical treatment of white women and black women is in the realm of childbirth. Over the past 30-40 years, US doctors have consistently performed cesarean sections at higher rates on black women as compared to white women. Return to text.
- Amy Koerber, From Hysteria to Hormones: A Rhetorical History (University Park: The Pennsylvania State University Press, 2018), 16 Return to text.
- Robin T. Higashi, Allison Tillack,Michael A. Steinman, C. Bree Johnston & G. Michael Harper, “The ‘Worthy’ Patient: Rethinking the ‘Hidden Curriculum’ in Medical Education,” Anthropology and Medicine 20, no. 1 (2013): 13-23. Return to text.
- Diane E. Hoffman and Anita J. Tarzian, “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain,” Joumal of Law, Medicine & Ethics 29 (2001): 13-27. Return to text.
- Golden Girls, “Sick and Tired, Part 2,” Episode 104. Directed by Terry Hughes. Written by Susan Harris. NBC, September 30, 1989. It should be noted that when Dr. Budd attempts to interrupt, his wife, in a pitch-perfect moment of solidarity, yells “Shut up, Louis.” Return to text.
This is an interesting article..I realize that this takes a historical perspective on “hysteria’ and how women’s pain and fatigue issues are often dismissed by the medical profession, because they are women and thus are “weaker”and more prone to “psychogenic ” illnesses…( not true, of course…and women actually have a higher tolerance for pain than men!). However, as a woman lucky enough to have a female doctor who quickly diagnosed me with Chronic Fatigue Syndrome..I realized the medical community had no answers for me…research led me to a new and different perspective of CFS, and of chronic illness in general…I recovered, the medical profession had nothing to do with it. We must not make ourselves victims here…I think Jennifer Brea is a classic example of the “victim” mentality that often goes hand in hand with the diagnosis of Chronic Fatigue Syndrome…we must not put our fate, our faith, and our healing in the hands of medical doctors…these things must come from an inner, individual drive for health and healing. There is a problem within the CFS community that perpetuates a victim stance and will not accept that health is not just medical diagnoses and treatments…health is an interplay of mind body and soul…when that relationship is distorted, then disease occurs.
Thank you for this insightful article.