It’s all in your head

The term hysteria is derived from the Greek word for uterus.  It was thought in ancient days that women’s wombs would travel around their bodies causing a host of maladies. Faintness, nervousness, insomnia, hallucinations, sexual desire and even a ‘tendency to cause trouble’ were all believed to be part and parcel of this disorder. While the days of diagnosing women with ‘Hysteria’ may be behind us, I think it’s important to acknowledge that our gender still colors the care we receive. Even recent studies show that women are given less pain medication than their male counterparts and more sedatives. We’re also twice as likely to be told that a medical condition is all in our head.

This is especially evident in the field of neurology. Psychogenic illness .. also referred to as conversion or functional disorders are still offered as an explanation for symptoms that aren’t easily identifiable. What makes this especially troubling is that women are three times more likely to be affected by autoimmune related neurological disorders than men. Ironically, these diseases may be the most challenging to diagnose. A catch twenty two if ever there was one.

There’s no question that there’s a segment of neurology patients whose symptoms are manifestations of anxiety, trauma or depression. It’s said that between 10 -30% of those seen by neurologists have symptoms for which there is no physiological explanation. There are clues here that doctors are trained to look for … symptoms that don’t follow the distribution of anatomical pathways or have patterns of movement that don’t correspond to any part of the nervous system.

An important concept to consider on both sides of the exam table is overlay. Organic diseases and disorders without question cause stress and anxiety. Which means that even in the presence of psychogenic symptoms there may very well be an underlying disease.

A responsible neurologist will consider the possibility of an organic basis for symptoms even in the face of potential functional symptoms. Just as a responsible patient should be open to the idea of a psychogenic basis for their potentially organic symptoms.

These are, in some ways, still early days. The epidemic of neurological disorders continues to rise, as we see in the skyrocketing cases of Autism, Parkinson’s and Alzheimer’s disease. The World Health Organization found in a recent study that 80% of the highest classed disabilities were neurological. As disturbing as this is, it’s important to remember that research has also continued to advance.

As women and as patients we not only have the right to expect professional, responsible medical care. We have the responsibility to be active participants. It’s true that we’ve come a long way, baby, but we have far to go.

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