Monday 23 September 2019

Does women's pain matter less? The Yentl syndrome suggests so

Women in pain: Streisand's character had to masquerade as a man to get an education in Yentl
Women in pain: Streisand's character had to masquerade as a man to get an education in Yentl
Catherine O'Mahony

Catherine O'Mahony

The satirical site Waterford Whispers reported this week that Irish women were tuning in to the dystopian TV series The Handmaid's Tale - in which women are subjugated by a brutal patriarchal order - for light relief from the grim reality of their own lives.

It was a joke, of course, but a good one.

Because what a week it has been to be a woman in Ireland. We have had bad ones before, of course; I have been around long enough to remember a roll-call of nasties: the Kerry Babies trial, the lonely death of Ann Lovett, the Eamon Casey/Annie Murphy saga, the Tuam babies, the sad demise of Savita Halappanavar.

But what a unique delight it has been this week to behold the procession of besuited men on the radio and TV, professing their intense distress and concern for women's health, even as a drip feed of ever-more horrific information about a monstrous gap in the information given to women about their personal medical histories emerged from the health services.

How heartwarming it has felt to know how women's health is really viewed by those in the know, to realise that the head of the national cancer control programme confidently informed Health Minister Simon Harris that the experiences of Vicky Phelan - whose case is at the heart of the present crisis - did not add up to a "patient safety" matter.

This assessment is technically correct, I am sure. But oh, how slippery our language can be. And how easy it is to feel safe when you are not the one in peril.

I doubt Vicky Phelan would agree that the case was not a patient safety matter. I suspect the 17 women who have died of cervical cancer would not have agreed that being denied full information about their own personal medical histories was not a "safety" matter.

I personally don't feel at all safe now that I know that the smear test that I - and most other women, I would guess - had always thought was an actual "test", is not one at all; it's only a "screening" test, with a fairly large - and apparently wholly acceptable - margin of error. If it's all so fallible, why have we not been getting the tests more often?

But this is not a "patient safety" matter in the eyes of the Powers That Be and that is what matters, it would seem.

There is a term in medicine that has been on my mind all week as events unfolded: it's the Yentl syndrome. The name is from the 1983 film Yentl starring Barbra Streisand in which the main female character has to masquerade as a man to get an education.

The phrase was coined in 1991 by a cardiologist called Dr Bernadine Healy, in a paper called 'The Yentl Syndrome', published in The New England Journal of Medicine, to refer to the depressingly different responses by medics to a woman's pain than to a man's, especially when it comes to coronary issues.

There is a proper reason for it: medical research has focused primarily on the symptoms of men's heart attacks, and thus women have died as a result of misdiagnosis because their symptoms can present differently.

And so Healy, who was the director of the National Institutes of Health in the US at the time, said a woman had to experience a full-scale heart attack before she could get treatment equal to a man's.

Another study in 2001, 'The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain', published in The Journal of Law, Medicine & Ethics, found an even broader expression of Yentl. They found that women were generally "more likely to be treated less aggressively in their initial encounters with the healthcare system until they 'prove that they are as sick as male patients'."

There are worse studies. In 1982 a paper called 'Women with Pain' found that women with chronic pain are more likely to be misdiagnosed with mental-health conditions than men, because doctors dismiss women as hysterical. On the other hand, when men say they're in acute pain, doctors take their pain as having a "legitimate" source.

It boils down to this chastening conclusion: if you are a woman, your pain will be taken less seriously by the medical profession than that of a man.

It's a theory that casts a cold light on the events of the past 10 days. And on the events of the past 10 years. And on the decades before that.

But, let's be fair here, what would I know anyway?

Victorian medics were happy to espouse the theory that all women were either crazy, potentially crazy, or at the very least hysterical - in thrall to the demands of their bodies. Perhaps those theories have proved more enduring than we women ever suspected.

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