TRANSCRIPT
"Notice how mother seems to become angry herself because of Jeff's anger. Perhaps she shouldn't, but anger is a violent emotion and we often see an induction of behaviour or spread of emotion to other persons."
A 1950s public service announcement suggesting how women should behave.
We might have come a long way since these ideas about women but what barriers do women, trans and gender diverse people continue to confront in our health system today?
This is the first episode of 'Hysterical' - a new podcast series by SBS News.
I'm Catriona Stirrat and in this series, I'll be exploring how women, trans and gender diverse peoples navigate, and often battle, our health system.
You'll hear stories from people whose pain has been dismissed, or worse, shamed and stigmatised in our health system.
"I have surgery on my left foot, went back about my second foot, and I was told I was like a hypochondriac because he couldn't work out where the pain was coming from."
"Um once when I was having trouble with my period, I did go to a male doctor and he explained it was quite normal. I got my period again the next week, and went to a female one. And she said 'no, no, let's get you to a gynaecologist'."
"I just don't think that I left feeling heard... so I don't think any of my symptoms or if I'm suffering in any way it's not really taken seriously."
And stories from others left traumatised by their experiences of dismissal and coercion.
"And that was one of my biggest fears that I had even gone to the head of obstetrics at my hospital and said, I don't want him to be transferred away from me and may not be able to go with him because it's such a ingrained thing I think in indigenous women and mothers of that fear of having a child taken away."
We'll also explore experiences of health professionals and patients who have discovered what it means to be listened to and respected in a system that many argue is designed by men for men.
"I think that level of openness is what's really important and that's really nice to see and that's what feels safe if I go to a doctor and they're able to tell me what they can offer and what they can't and where to go."
But in this first episode we go right back to where it all started... and look at how many of those ideas around medicine and the female body still persist today.
The term 'hysteria' was first coined by Hippocrates in the 5th century BC, and used by other ancient Greek and Roman physicians and philosophers such as Plato.
But what does 'hysteria' actually mean?
Professor Jane Ussher is a Professor in Women's Health Psychology at Western Sydney University, and has written extensively in the areas of gendered health.
"There were discussions of hysteria going back to Greek and Roman times when it was believed that the woman's womb travelled around the body. And all sorts of ailments and ills were blamed on the womb - from psychological phases a woman might experience to any sort of physical changes. And when you look at some early medical manuscripts and medical books, there were literally pictures of the womb that was believed to travel."]]
It wasn't until the 19th century when the term hysteria became a psychiatric issue, or the pathologisation of a woman's body, as Professor Ussher describes.
"And what we saw there was really the reproductive organs being seen as the cause of women's, I would say, madness and badness. So women who were discontented with their lives, women who didn't want to be contained in the very strict way that women were expected to be as wives and mothers, and who were discontented with that, women who might have wanted to work to be independent, were often positioned as mad and often locked in asylums. And hysteria was the diagnosis. And some people have argued that hysteria was a catch-all diagnosis that really allowed any sort of symptomotology that was negative, and was seen as not fitting the particular very narrow version of femininity, was attributed to hysteria."
It's this medical history of hysteria which inspired the title of author Katerina Bryant's memoir.
"So I started writing the book as I was experiencing symptoms both that I couldn't understand, and the medical professionals I sought help from couldn't understand. Because I was kind of navigating the Australian medical industry and receiving I don't think adequate help, and not very affordable help, I sought historical narratives of other women during their times of distress and illness, all centring around the experience of hysteria."
Katerina says she was experiencing what is now categorised as functional neurological disorder or non-epileptic seizures.
"I experienced body numbness, simple visual hallucinations, not being able to speak for certain periods of time, noises being quite... so a lot of sensory processing issues."]]
The one place she could find solidarity, as she struggled to find answers for the symptoms she was experiencing, was among the women referenced throughout her research into hysteria.
"So finding all these women's stories who were connected to hysteria was really, it felt like a community when I wasn't able to have one. But I learnt mostly that, when it comes to bodies and minds and brains, there is so much that we don't know. And often, or almost always, the onus is on the individual experiencing symptoms and distress, to find answers. You are seen as an unknown - simply put it becomes your problem."
Professor Ussher explains how some women have reclaimed the term 'hysterical' - but it's one that she says originated with the purpose of demonising women.
"I think it's generally a damaging term, it's used pejoratively. You know, women described as 'oh you're just hysterical', and often the 'just' is before it. So it's implying, you know, it's your hormone, it's your womb. And it's also describing femininity in a pejorative way. There's no sense of it being powerful."
And for many women those experiences unfortunately continue today.
I took to Sydney's CBD to ask women of various ages and ethnicities, about their interactions with healthcare professionals in Australia.
Sixty-three year-old Tracey's experience of pain was certainly pathologised.
INTERVIEWER: "And can you tell me have you ever been called hysterical or made to feel hysterical by a health practitioner?"
TRACEY: "Yes, I had surgery on my left foot, went back about my second foot, and I was told I was a hypochondriac because he couldn't work out where the pain was coming from. And I know where it was coming from, and I know where it was coming from. So I actually left crying saying I'll just put up with the pain."
Younger women also shared experiences where they were being made to feel naive when it comes to their own bodies.
Twenty-two year old Mariam described a lack of reassurance when seeking mental health-related care.
"I think that when it was my first time reaching out for mental health it kind of just felt like, like I was a bit overwhelmed because I didn't know what I was doing, I was quite young. I was being told, like it wasn't comforting it was more like attacking me. And you know you need to go to this person and fix it over here, he's your mental health plan. Not really letting me know it's normal and stuff like that."
And for 56-year-old Kim, unfortunately it's been an ongoing issue in the health system.
She says most recently it's been for menopause-related symptoms, but before and after having her children, there was always a feeling of being dismissed.
"I've been to GPs and stuff like that, most recently with menopause symptoms. It's very vast, and every woman is individual, as I'm finding with my friends. And they're just not really listening to the symptoms."
INTERVIEWER: "Is that really frustrating?""Yes, considering they just want to give you a drug, rather, you just want to go the natural way first anyway to try and help yourself out."
Perhaps it's unsurprising that Kim has encountered barriers at every stage of her life, when women's bodies are still seen as somewhat taboo.
Professor Ussher explains.
CATRIONA: "Issues that are particular to a female body or a person with a uterus. So endometriosis or menopause or menstruation, they're often kind of branded as mysterious. And I know you obviously have written a lot about madness as well and the links there.
USSHER: "Yeah, no, absolutely. I think it's about both mysterious and monstrous. So it's something we don't know about, but it's something that's also quite monstrous and something that's, if you look at the amount of money that's spent on research around the female reproductive body and other aspects of behaviour, it's minuscule. And it's interesting with endometriosis, that is an area that has actually received a lot of funding recently in Australia, but there's very little research on other aspects of the reproductive cycle that impact on women such as premenstrual distress until recently. Very little attention to menopause. Really little attention to postnatal issues. And I wouldn't say these are issues that are just located in the reproductive body because there's a whole psycho-social aspects of those experiences which are really important and which we know impact on women's experiences and also the way that they're framed in society as something that's quite taboo to talk about. Something that is somehow monstrous and somehow that the woman who experiences those behaviours or reports those behaviours is mad or bad or both."
This has positioned the male body as the norm in medicine.
"I think historically women have been positioned as more animalistic than men, and so the male body and the male mind as the norm, and women as other, women as more animalistic and the reproductive body, but the womb in a sense being the centre of that because women menstruate, because women bleed, because women give birth. Then that makes them other, and that makes them somehow more animalistic than men and that goes back centuries. What's interesting in terms of medical research is that a lot of research until quite recently has been done on male bodies and then just extrapolated to women's bodies when it might not be appropriate. So you've kind of got a double-edged sword happening here. Women excluded because of reproduction, but at the same time, those drugs apply to women where, because there may be differences in terms of physiology, some of it might be to do with reproduction. Those treatments are not appropriate."]]
I spoke to 25 year-old Mina in Sydney's CBD.
She didn't specify which women's health issue she visited a GP for, but she said the advice given was inappropriate for her circumstances.
"I did see a specialist at one point for a women's health issue per se, and he kind of gave me advice that would be given to somebody who has had children. So I feel like in that case, it wasn't really tailored to my specific situation being a young female that has not had children yet. So again, sort of similar to Eleni, not really heard, didn't feel like it was a tailor made situation or advice given, even though I didn't see a specialist."
Her 32-year-old friend Eleni has felt similarly dismissed.
"I just don't think that I left feeling heard or really had a solution to my problem. And even simple things like if I'm sleep deprived or not sleeping well, I don't feel comfortable going to the doctor regarding that, and I feel like I'd just be dismissed or given something advice that I am already taking personally, like meditate or do what I need to do. So I don't think a lot of my symptoms or if I'm suffering in any way, it's not really taken seriously."
Katerina has certainly felt othered in many of her interactions with health practitioners.
"In some ways, my worst experiences were not when I was in the deepest of distress just going to get a refill for antidepressants, and the GP at the time I'm prompted said, oh, this is nothing to be ashamed about. When I had been on antidepressants for years, I didn't mention being ashamed. So that kind of assumption underlies a lot of interactions as well as being told multiple times that with surprise that I was smart or I understood what I was experiencing. So the assumption being that people who experience ill health cannot be smart or are not smart or cannot understand what's happening to them."
In the end, it wasn't medical research or specialists that helped Katerina make sense of what she was experiencing.
Rather, it was looking way back to the past to women like Blanche who lived a life in a French hospital in the hysterical ward, but who Katerina says left a legacy of immense bravery, aiding in the research of radiation at the cost of her own life.
"So when I was looking, trying to find information about what I was experiencing, that's what led me to these women's stories, because I was really hungry to find stories about people rather than about broad groups of people or medical journals. They weren't as engaging to me, I kind of needed that lived experience. So finding all of these women's stories who were connected to hysteria was really, it felt like a community when I wasn't able to have one."
These stories might be hundreds of years old, but Katerina says the dire consequences of isolation and abandonment for women branded with the term should still be treated with gravity today.
"The way we use the term hysteria now, I'd like to kind of connect it to, I think it's more of a tongue in cheek term to how women were perceived or can be perceived, but I just want to iterate that these experiences are not of women and their pain and being locked up in some ways experimented on are very real. There is a humour in the term nowadays, which I think is disconnected from a lot of the history of a lot of women's pain. So I'd like to push back on that a little bit."
But in 2024, these experiences of isolation and exclusion are often exacerbated for trans and gender diverse peoples.
Max is a non-binary person who experienced being misgendered by a GP in Melbourne.
They visited a clinic to receive a referral to commence their journey in micro-dosing testosterone, but were shocked when they took a closer look at the referral form.
"So it seemed like it was going well. The GP said that they would give me a referral letter to be able to proceed, so that was great. I left feeling quite heard and quite positive about the experience and I think that's what made it really jarring. When I opened the letter, the referral letter and the first line of that letter was Max is a lady experiencing gender dysphoria. It was just really one of those slides down the wall moments."
Max, whose story we will explore in a later episode, said it was a sad reminder that they couldn't trust every health professional.
"It was just really one of those slides down the wall moments, which even the term lady, of all the terms you could have used, a woman, female, it felt so patronizing and it felt so, it just kind of zapped all the hope out of me in terms of what this experience is going to be and where I'm safe and who I'm safe telling my story to."
Professor Ussher has researched health outcomes for trans and gender diverse communities - and says there's a huge gap in knowledge.
"There's hardly any research on these issues and issues around reproductive health and trans and gender diverse people. It's almost invisible. People are almost invisible. And there has been, I think, a real shift probably in the last four or five years to actually talking about menstruated rather than talking about women who menstruates, talking about people with the cervix when we are looking at issues around reproductive health, and I think that's really important, but I think unfortunately, a lot of people who were non-binary and gender diverse don't come forward to take part in research on what would traditionally have been seen women's reproductive health, because the researcher's often not seen as inclusive. And often researchers talk about women. They don't talk about people with a cervix or menstruated. Often in their collecting demographics on research, they just assume everybody's a woman. So it invisibilise trans and non-binary people."
Katerina says while her research into the past showed a brutal medical system, there's so much to learn from these women today.
"But also it shows the women of the past and their strength and resilience and what they experienced too in their stories are really valuable. So I think there's also a lot of hope to be gleaned from the past, which is funny. You don't always think about, people can frame these stories as tragic, but I don't see them that way. They gave me a lot of hope when I was in distress, and they continue to give me hope. So I think there's something quite beautiful in that."
In our next episode of 'Hysterical', join me as we unpack efforts by Australian governments to address what many describe as a gender bias in our health system today.
And... is everyone included in this fight?
