A 2011 survey completed by faculty at forty-four medical schools in the United States and Canada indicated that 70% of institutions did not have “a formal sex- and gender-specific integrated medical curriculum,” failing to provide adequate instruction on specific health topics for which sex- and gender-based evidence exists.1 This striking statistic, coupled with a personal experience of autoimmune disease, represents the impetus for Maya Dusenbery’s investigation of how attitudes towards sex and gender have long shaped the medical care that women receive. In Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick (2018), Dusenbery draws on her background as an editor and author at Feministing, in combination with her previous work at the National Institute for Reproductive Health, to unpack the unconscious, systemic, and deeply historical gender biases that have created and sustained a range of divergent health outcomes for American women and men.
Drawing on both historical and contemporary evidence, Dusenbery deftly demonstrates how a multitude of factors, including the underrepresentation of women in medical school faculties and as medical researchers, as well as the positioning of the male body as the universal norm in the bulk of National Institutes of Health-funded research, have created two “mutually reinforcing” gaps when it comes to women’s health. In Part 1 of the book, Dusenbery critically interrogates these gaps.
First, she identifies a persistent “knowledge gap” fuelled by a long-standing conceptualization of women’s medicine as so-called “bikini medicine” primarily focused on the breasts and reproductive system, a simplistic “add women and stir” model of inclusion, and the slow movement of medical knowledge from the laboratory bench to the patient bedside.2 Here, Dusenbery is careful to highlight the dangers of fragmenting “women’s health” into its own distinct specialty, an approach that runs the risk of further marginalizing women’s care and health concerns.
Dusenbery then turns her attention to what she calls the “trust gap,” a symptom of a broader — and historically-rooted — culture of distrusting and delegitimizing women’s reports of their own symptoms and corporeal experiences. Beginning with a brief discussion of hysteria, which Dusenbery describes as a “bloated diagnostic category [that] inevitably shrank as medical knowledge grew,” Dusenbery traces the long history of mainstream medicine’s dismissal of women’s physical complaints as psychogenic in origin.3
The second and third sections of Doing Harm see Dusenbery weave the stories of individual women into a broader analysis of sociocultural, and indeed, historical attitudes towards women’s health. Focusing in Part 2 on “invisible women” in a male-model medical system, Dusenbery explores how gender biases shape the medical treatment of women experiencing heart and autoimmune diseases. The initial conceptualization of heart disease as a “male ailment” — evinced, for example, by the fact that the first American Heart Association conference on women and heart disease, held in 1964, was organized around the theme of “Hearts and Husbands” — continues to represent a persistent obstacle to the diagnosis and care of women who suffer strokes, heart attacks, and other life-threatening emergencies. Put simply, in the words of one interviewee, “doctors think that men have heart attacks and women have stress.” The mention of individual stressors or anxieties by women in the emergency room, Dusenbery suggests, sparks a “meaning shift” whereby women’s physical symptoms become reimagined as psychological.4
Race, class, education, location, and age intersect with sex and gender to shape the ways in which the medical profession perceives women’s efforts to access care. Physicians and other healthcare practitioners, for example, all too often characterize black women and women from other marginalized communities as exhibiting “drug-seeking” behavior in endeavoring to have their health complaints adequately treated by the medical system.
Part 3 of the book focuses on what Dusenbery identifies as “neglected diseases,” ailments that would have, in all likelihood, been previously diagnosed under the catchall category of hysteria, including pain disorders, endometriosis, and so-called “fashionable” illnesses including chronic fatigue syndrome and Lyme disease. Here, in particular, Doing Harm complements a body of work that includes memoirs like Abby Norman’s recent Ask Me About My Uterus, calling upon the medical profession to “believe” in the legitimacy of women’s pain and suffering.
Concluding with a return to the “circular logic” that characterizes much of the medical research on women’s health, the chapters in Doing Harm demonstrate the multifaceted ways in which medical myths construct their own realities. Though new technologies can create community for women patients isolated by their experiences with the medical profession, Dusenbery’s work demands an acknowledgment of the paradoxical nature of “asking individual women to compensate for the medical system’s failures.”5
As Dusenbery evocatively demonstrates throughout the book, medical and scientific dismissals of subjective bodily experiences represent “a deeply invalidating form of gaslighting” at the individual level, and, more broadly, persistent gaps in medical knowledge “have impoverished us all.”6
- Marjorie R. Jenkins et al., “Sex and Gender in Medical Education: A National Student Survey,” Biology of Sex Differences 7, Supplement 1 (2016): 45. Return to text.
- Maya Dusenbery, Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick (New York: HarperOne, 2018), 26, 33. Return to text.
- Dusenbery, Doing Harm, 71. Return to text.
- Dusenbery, 110, 122. Return to text.
- Dusenbery, 317. Return to text.
- Dusenbery, 312, 315. Return to text.