About two hundred years and different diagnoses distinguish these two conditions: One patient was advised to rest; another patient was advised to rest. A person’s symptoms were related to hypersensitivity to stimuli and dysregulation feeling; the symptoms of others are often dismissed as symptoms stress, worryand increased body awareness. Treatment for a person is aimed at limiting what may trigger an emotional response; another’s clinical experience varies attention from symptoms to patient responses to them.
The first case is about 19th-century hysteria, the second about modern vulvovaginal disorder, but they nevertheless share a pattern of interpretation: When women’s physical symptoms resist easy explanation, they are often understood in terms of: emotional regulation and management.
From “Just relaxing” to “Just relaxing”.
In 1853, Robert B. Carter brought a woman’s hysteria to failure will power. He claimed that the hysterical woman who fainted, trembled and could not regulate her reaction to the shocks of the world was simply. very impressive (1). In the discourse of hysteria in the mid-19th century, doctors understood a woman’s sensitivity to the environment as her constitutional weakness—a condition that predisposed her to disease in the first place. As Marshall Hall pointed out, women were by nature “more sensitive and sensitive than men,” and this was not some identifiable pathology, but a constitutional fact. their sufferings (2).
In this context, emotional sensitivity itself became an explanation. A woman’s symptoms were understood as an expression of her unique sensibility. The treatment was obvious: remove him from exciting situations, allow the peace of the household to restore his nerve, and teach him to control his emotions. Rest will make it better “Resistance to the Force” (3).
in 2025, A cross-sectional study by Moss et al. Published in JAMA conducted a survey of 447 patients with vulvovaginal diseases before their first visit to a special referral clinic. The study has a clear medical basis gas lighting is a form of epistemic injustice, defined as the denial of the patient’s knowledge of his or her experience within a relationship structured by clinical authority. Patients saw an average of 5.5 clinicians for pelvic or vulvar pain, suggesting that attrition is often part of a long-term care-seeking process rather than a single failed encounter.
The researchers found that 39.4 percent of patients felt “crazy” by the clinician, 41.6 percent were told to “get more rest,” 28.4 percent had symptoms of high anxiety, and 20.6 percent sought medical attention. psychiatry instead of offering medical treatment for their physical symptoms. More than half considered discontinuing care because their concerns were not addressed. Patients described gaps in clinician knowledge, denial behaviors, lack of investigation, and repeated transitions from physical symptoms to mental states.
The authors argue that such forms of epistemic injustice can be particularly consequential in gynecological pain, where structures of discrimination already contribute to untreated pain, delayed diagnosis, and psychological distress. Although the study sample was predominantly white and thus may not fully reflect the role of race and other intersectional identities, numerous studies have shown that women of color, particularly black women, are disproportionately dismissed and undertreated in clinical settings.
What is striking about the 2025 data from Moss et al is the continuity. 40% of patients surveyed said they needed to be sedated. Howell wrote in 1867 that “the aim of treatment should be to restore nervous strength” and recommended that, in addition to physical treatment, it was important to “remove all anxiety.” the mind of the patient” (4). The sentence belongs to another century, but its clinical spirit is recognizable. In both cases, a woman’s grief meets a prescription for another internal emotional and psychological state. As the doctor pointed out, the problem was not what was happening in his body, but how his mind was reacting to it.
Who decides what is real?
Elinor Cleghorn traces this pattern with precision Dirty Women: Misdiagnosis and Myth in a Man-Made World (2021). In centuries of medical history, she identifies a persistent pattern in which women’s physical distress is treated as an excess (of emotion, sensitivity, and/or attention) rather than as a problem that requires constant physiological investigation. Continuity here is interpretive rather than diagnostic. If Victorian hysteria was understood as highly affective, the modern woman is often understood as overly anxious, overly focused on, or overly reactive to, her symptoms.
Gaslighting Essential Reads
Cleghorn’s experience with lupus, whose symptoms were repeatedly referred to as psychological, highlights how this pattern works in practice. Ultimately, she suggests, terms for knowing women’s bodies have continually filtered through and changed what women are entitled to say and be. Ill women have long been mistrusted as narrators of their bodies and pain.
Jennifer Sebring helps us see how this pattern is embedded in the structure of clinical competence. He argues that medical gaslighting is not just a personal exchange, but the result of deeply embedded ideologies. health services” (5). The diagnostic encounter is not a space of neutral discovery. If a woman’s account of her symptoms contradicts what the clinical system is willing to acknowledge, her account is often reclassified or redirected. Clinicians reserve the right to determine which forms of distress are recognized as legitimate and which are reclassified as cognitive problems.
The pattern continues
This is finally beyond the question of diagnostic error in the traditional sense. Cleghorn points out that the misdiagnosis of women occurs throughout the history of medicine as a result of the systematic exclusion of women from clinical research and their continued construction as unreliable witnesses to their own experiences. The Victorian discourse of hysteria and the modern clinical denial of vulvovaginal disorders goes deeper than a series of symptoms. Both are based on the same assumptions: that women feel too much, report too strictly, and require psychological control.
Pierre Janet wrote in 1901 that “every period has given way to it (hysteria). another meaning” (6). Intending this as an opening to clarity, he concluded: “Let’s try to figure out what that means. there is today” (7). History shows that the meaning has actually been less volatile than the name. 170 years of medical progress separates a woman who faints from overwhelming emotion and a woman who is simply told to get more rest, but what holds them back is something older than the diagnosis itself: the belief that the problem is, ultimately, the self.
