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Female Pain
April 14, 2014 7:30 PM   Subscribe

Grand Unified Theory of Female Pain. "The pain of women turns them into kittens and rabbits and sunsets and sordid red satin goddesses, pales them and bloodies them and starves them, delivers them to death camps and sends locks of their hair to the stars. Men put them on trains and under them. Violence turns them celestial. Age turns them old. We can’t look away. We can’t stop imagining new ways for them to hurt."

What's Wrong With Sentimentality? A conversation with Leslie Jamison, author of The Empathy Exams

An Interview with Leslie Jamison

Leslie Jamison previously: Fog Count

A Medical Actor Writes Her Own Script
posted by homunculus (62 comments total) 120 users marked this as a favorite

 
I am speechless at how good this is. Utterly aghast.

Thank you, homunculus.
posted by emjaybee at 8:53 PM on April 14 [8 favorites]


"The pain of women turns them into kittens and rabbits and sunsets and sordid red satin goddesses, pales them and bloodies them and starves them, delivers them to death camps and sends locks of their hair to the stars. Men put them on trains and under them. Violence turns them celestial. Age turns them old. We can’t look away. We can’t stop imagining new ways for them to hurt."

Turgid words like these belong at the open mics of this country.
posted by Ironmouth at 9:09 PM on April 14 [2 favorites]


Fascinating things in here. Read her review of "Short Term 12" in LARB and went back after watching the film myself. Not surprised that she is the niece of Kay Redfield Jamison, also an intrepid explorer of deep feelings. Open and eloquent wrestling with complicated and often uncomfortable ideas.

From the conversation on "Sentimentality": "We have this idea that 'authentic empathy' is the empathy that you feel immediately in response to a person or a situation, and I’m actually interested in the kind of empathy that’s willed into being by practice or intention."

Thanks for posting.
posted by emhutchinson at 9:13 PM on April 14 [3 favorites]


I'm only part way through this; it deserves a more thorough read than I can give it tonight. But I wanted to comment on where she speaks about women's pain not being viewed as seriously and men's pain. Even by other women. I have a pain disorder, and I see this all the time both directed towards myself and towards other patients. Even though doctors have gotten better about directly blaming women, there is still and undercurrent that it's the women's fault, or its "just" psychological. That it's not as serious or as real as a man's pain. Even those that "understand" still seem content to say, if not in words than inaction, that you're at least partially to blame.

Which reminded me of a story. In the process of trying to discover the root cause of my own pain, I spent a lot of time researching local doctors in hope of finding someone who pays more attention to new research as opposed to what they learned in school. And in doing so, I found the blog of a woman who was seeing the doctor I was interested in. I go back to read all her posts. Her blog starts with her pain and fatigue and search for an answer. She's diagnosed with a number of things, each doctor having a different opinion. She sees the doctor I'm researching. At first this discover that her hormones are all over the place. But after a few visits, I get to a heart wrenching post where she describes coming to terms with being anorexic, how that was making her hormones all crazy, and how thanks to doctor X, she can now acknowledge that, and that her problems stemmed from that. She is going to a 6 week in patient treatment for anorexia.

And the blog stops.

It was a few years old, and it was published under her real name. So I start looking her up, thinking maybe I can find the end of the story or even her email address and ask her about said doctor.

What I found was her obituary. She died of brain cancer. From what I could find, it was discovered shortly after her in-patient stay begin.

The DDX for anorexia is brain cancer. Yet her she was, made to believe her problems were an eating disorder and her fault. She wholeheartedly believed the doctors and was blaming herself. And she wasn't anorexic, she was dying.

Because, I assume it's easier to blame her for her pain than consider maybe she really was sick and it was not a disorder she inflicted on herself.
posted by [insert clever name here] at 9:20 PM on April 14 [126 favorites]


I spent 10 years of my life going from doctor to doctor, complaining of numbness and tingling in my hands and feet, extreme fatigue, headaches, and dizziness. I was told that I was depressed, a hypochondriac, looking for attention, and that my being overweight was the root of all my problems, if I could just discipline myself and lose the weight I would feel much better. I was put on anti-depressants and sent to therapy, but the problems persisted. By then I was actually depressed, because I felt like crap and it was all my fault. I began to believe what the doctors were telling me about myself, that I was neurotic and over-reporting my symptoms, and anything that I was actually experiencing was either in my sad little head or due to what they perceived as an unhealthy lifestyle.

Finally, 7 years ago, I went completely numb from the ribcage down. By then I was dating my future husband, who actually bellowed at an ER doctor, "WHY AREN'T YOU DOING ANYTHING TO HELP HER!?" After blood tests, MRIs, and a lumbar puncture, it turned out I had Multiple Sclerosis, and it had been chewing holes in my brain and spinal cord for 17 years. If just ONE doctor had taken me seriously, I might still have the use of my left leg and the full vision in my left eye, not to mention it would have spared me years of anguish and self-loathing.

The frustrating moral of this story is that I used to work in a hospital lab, and I heard this exact same story time and time again from patients, and every single one of them was female.
posted by evilcupcakes at 10:06 PM on April 14 [90 favorites]


Turgid words like these belong at the open mics of this country.

Congratulations on only reading the pull quote, but still feeling you needed to say something dismissive.
posted by stoneandstar at 10:08 PM on April 14 [37 favorites]


To be fair to Ironmouth, the turgidity of the pull quote is not representative of the otherwise very interesting article as a whole. Poetic it may be, but it's a crummy lede for the overall piece.
posted by chimaera at 10:24 PM on April 14 [3 favorites]


I know it's not nice to get all meta, but it seems like it's a good time for a reminder: judging an article by the pullquote is a terrible idea. Please don't comment if all you're going to do is quote the pullquote and talk about its style. I haven't gotten very far into this article at all, but it's extraordinarily nuanced and it'll take me a bit to digest. It's worth doing it justice.
posted by koeselitz at 10:31 PM on April 14 [9 favorites]


(And maybe I need to say: I'm totally guilty of judging pullquotes, too, and of commenting on them because they're sitting right in front of me and if something sticks out it feels like I ought to say something about it. I just wanted to say that, in the particular case of this article, it feels like it's a good idea to digest it a bit and judge it on its own merit. The pullquote is only meant to entice you to read it, not encapsulate the whole thing.)
posted by koeselitz at 10:34 PM on April 14 [1 favorite]


(Oh, and: that bit is supposed to be turgid.)
posted by koeselitz at 10:35 PM on April 14 [1 favorite]


Turgid words like these belong at the open mics of this country.

The pull quote - which is the sixth paragraph of the article and the final paragraph of the introduction - summarizes a series of direct quotations regarding various female literary figures whose suffering has transformed them, in the descriptions of the original authors as kittens (Mina, Bram Stoker, Dracula), rabbits (Maria, Hemingway, For Whom the Bell Tolls), sunsets (Mimi, Illica and Giacosa, the libretto of La Boheme), sordid red satin goddesses (Blanche Dubois, Williams, A Streetcar Named Desire). Pales them (Mina and Mimi), bloodies them (Mina and others) and starves them (Mimi and others), delivers them to death camps (Sylvia Plath, of herself, Daddy) and sends locks of their hair to the stars (Belinda, Pope, The Rape of the Lock). Men put them on trains (Plath again) and under them (Anna Karenina, Tolstoy). Violence turns them celestial (Belinda again). Age turns them old (this could be purely factual but is instead an allusion to Miss Havisham, Dickens, Great Expectations).

Apart from the conclusion of the last two sentences ("We can't look away. We can't stop imagining ways for them to hurt.") there is nothing in that paragraph that isn't a precise and literal reference to one or more of the quotations. So blame Stoker, Hemingway, Williams, Plath, Pope, Dickens, and Tolstoy for their turgor, not Jamison, who's just the testifying witness.
posted by gingerest at 10:40 PM on April 14 [71 favorites]


Yeah it's a marked contrast how women get treated versus how men get treated. I took the wife to the ER once for double-you-over-while-crying level pain in her abdomen and they ran a few tests and after ruling out appendicitis they sent her home with some Motrin. By contrast, I went in for some abdominal pain that was just "I might've just pulled a muscle but let's be sure this isn't something serious" and got The Good Stuff and more Good Stuff to take home when it wasn't appendicitis.
posted by Ghostride The Whip at 10:42 PM on April 14 [9 favorites]


being overweight was the root of all my problems, if I could just discipline myself and lose the weight I would feel much better.

I heard this from doctor after doctor for 20 years. It's already hard enough to deal with RA, especially when you have doctors who tell you that it would go away if you would just lose weight. Add in the stress of KNOWING something else is wrong and getting the same bullshit answer...it made me feel homicidal.

Turned out to be MDD and PTSD. Cried with relief to have a doc listen and help.

I'm so sorry your docs didn't listen. I hope you'll keep sharing your story, though, so other women will scream a their doctors and demand they do their fucking jobs.
posted by MissySedai at 10:46 PM on April 14 [4 favorites]


[At this point, let's consider the point about the pullquote to be made; thanks.]
posted by LobsterMitten at 10:55 PM on April 14 [1 favorite]


Great article. Pretty horrified to hear the personal stories told here.

A statistician friend was involved in a study looking at mortality rates from heart attacks in women compared with men (this would have been for Victoria, Australia, if memory serves -- recollection is hazy as his story was recounted over a boozy dinner!).

It turns out in the population studied, women died from heart attacks at a rate orders of magnitude higher than men because when they turned up at the doctor or at the ER they were told to take a panadol (paracetamol) and go home and rest. A bit like the old "Bex and a lie down"!

If I recall correctly (and I could be overreaching here) in the population studied, the response they got from doctors and ERs over time actually reduced the likelihood of reporting which in turn increased the mortality rate.
posted by prettypretty at 11:15 PM on April 14


No! I was wrong... and my memory possibly a bit influenced by what I was reading here.

The thing they were studying was mortality rates of people arriving at hospital by ambulance. So, one of the overwhelming trends found for this population was that women tended to die of heart attacks more often than men. Whereas men arriving at hospital by ambulance with heart attack symptoms were significantly more likely to survive than their female counterparts.

This was because they left it too late (a) because the doctor had told them to go home and have a rest when they turned up to the GP office in pain and (b) because they "didn't want to make trouble".
posted by prettypretty at 11:42 PM on April 14 [8 favorites]


What's (darkly) funny is that pain really does happen exclusively in your brain - of course framing that in terms of science is different than framing it as a culturally coded moral judgement. The brain can generate pain without nociception; it can also express no pain with extreme levels of nociception.

What I'm getting at above has been known since the mid 80s or so, and it's an interesting and scary example of how medicine sometimes still operates on a level that is no different than reading directions out of the bible, and this is regarding an issue for which science provided a coherent model 30 years ago.
posted by MillMan at 11:48 PM on April 14 [4 favorites]


Prettypretty, there's American data that say that women are less likely to be diagnosed with an acute cardiovascular event after reaching the hospital, in addition to the delays in seeking care (which have been found in the US, UK, and Australia, and probably other places too). Some of that is likely because the symptom profile is different for women, but some of it is probably sexism. (I would cite but it's a good-sized and diverse body of literature outside my field and it's not so on-topic I want to spend a bunch of time on it now.)
posted by gingerest at 11:53 PM on April 14 [2 favorites]


I wonder how much of this is about being cared for? Women are the primary and culturally defaulted caregivers for so much pain. Women listen, make emotional and physical space, give physical comfort in tending and touching the sick, and that's something incredibly good to receive when you're in pain.

And if you took a healthy woman and a healthy man, over their lives just because of periods and pregnancies, a woman would experience more pain. Maybe even more, given that women live longer. To give equal care, women would require more caretaking hours and days. So women gradually internalise that their pain needs to be far worse to get any help, while their bodies are telling them that the pain is real.
posted by viggorlijah at 12:34 AM on April 15 [8 favorites]


The DDX for anorexia is brain cancer. Yet her she was, made to believe her problems were an eating disorder and her fault. She wholeheartedly believed the doctors and was blaming herself. And she wasn't anorexic, she was dying.

Because, I assume it's easier to blame her for her pain than consider maybe she really was sick and it was not a disorder she inflicted on herself.


Here is the story of a professor/Rhodes Scholar--engaged to a doctor--who was told repeatedly that her symptoms were anxiety and depression. By the time due diligence was done, it was stage IV lung cancer. This quote is the heartbreaker:

"For the last year I'd been battling a range of bizarre and seemingly disparate symptoms that had forced me in September 2011 to go on sick leave from my job as a lecturer (assistant professor). The diagnosis at the time was anxiety and/or depression. And while I was both anxious and depressed, this was due to the increasingly disabling symptoms that my doctor kept insisting were purely psychological. So I was actually grateful for a medical diagnosis that confirmed there were objective, physical reasons behind my illness. While in some ways this was a terrible surprise, in another it was a huge relief."

Here is another story, linked from that one, of a school girl who was diagnosed with "lovesickness" instead of tuberculosis.

And these are just the stories I've read in the last couple months. It's too raw to share the personal stories of friends, and my own. I'll just say that I've had key moments--like too many of us--where a critical medical diagnosis would have come months or years earlier if my narrative report had started with, "Patient is a middle aged, professional white male." And most recently, I ended a friendship with an elderly man who argued with me passionately--demeaningly--that lingering exhaustion and GI symptoms months after exotic travel must be explained by the fact that I had to be experiencing lingering trauma from being exposed to third world conditions (delicate flowers that we ladies are, of course). I told him I knew my own body enough to know that something was physically wrong, and he still insisted I didn't have the insight he did on the "real" roots of my othostatic hypotension, muscle weakness, and inability to gain back weight despite eating hundreds of extra calories per day.

Once I finally got someone to run tests....it was giardia, motherfucker.
posted by blue suede stockings at 12:38 AM on April 15 [37 favorites]


Last month, I, a woman, saw a new spinal surgeon, a woman, who asked about pain. I was like /shrug yeah it's bad /shrug weed helps so if it's legalized get me a scrip, okay.

The doc said, 'yeah, we have a lot of people we have to talk out of suicide, the pain is so bad.'

I laughed my head off (in recognition) and the doctor stared at me like I was insane. I had to explain that it felt so fucking good to hear somebody acknowledge that nerve pain, which is basically untreatable, is of the variety that quite often one wonders about the value of life in such a state.

Dunno about the gender roles there, but the fact that the doc was a woman didn't hurt.
posted by angrycat at 1:11 AM on April 15 [16 favorites]


Angrycat, I was just wondering that--it seems clear that women will frequently minimize their own pain, and that male medical professionals tend to attribute a woman's pain to, essentially, hysteria. I'd love to see the data, though, on women who see female doctors, etc--if their mortality rate is lower, if they express higher satisfaction with quality of care, etc.

I was reading an article recently, quite probably linked from here, and it made a note that when you're asked by a doctor how much pain you're in, you should always slightly overstate it, because the doctors will assume that you're doing that anyhow, and when you're asked how much you drink or smoke, you should slightly understate for the same reason. It was a moment of odd clarity for me, because my whole life, I've done the exact opposite, mostly for fear that the actual answers wouldn't be believed, and because I didn't want to be that person who shows up and...what, self? Expresses the reasons that you've gone to the doctor? Admits that chronic pain is, in fact, both chronic and painful? But I didn't want to be a bother.
posted by MeghanC at 2:43 AM on April 15 [9 favorites]


The story about scarring her knee made me think of the now faded scars on my torso, which made me feel whole and complete because of how my depression left so little visible mark.

And these stories make me wonder if the times I've fucked up my back and ended up in urgent care would've actually gotten useful painkillers if I'd been a man.
posted by NoraReed at 3:15 AM on April 15 [1 favorite]


I wonder if Jamison would be surprised at these Mefi comments being predominantly about the medical disparity. I was.

I found the comments valuable in the context of me trying to make a conscious effort to improve my own empathy.

The pain is real, seems to be the point of the comments, and one of her points about emotional pain too.

Regarding her writing... I liked her story about the crazy Brushy Mountain endurance race (previously). I wonder how many other essays in the Empathy Exams collection don't have what one ungenerous Amazon critic called "MFA" writing.
posted by surplus at 4:28 AM on April 15 [4 favorites]


Stories like this are why I'm skeptical about the so-called "overtreatment epidemic". How can there be a monolithic phenomenon of patients getting too much treatment when there are these huge sex- (and also race-) based disparities? It seems like the go-to example in all the stories I read about overtreatment is an overanxious woman who just needs to do some meditation and yoga, or learn to accept death quietly if it's really bad, while her well-meaning but misinformed relatives berate doctors for not doing enough.
posted by Ralston McTodd at 4:43 AM on April 15 [3 favorites]


Leslie Jamison. The UK edition of The Empathy Exams is not due out till June.
posted by Segundus at 5:02 AM on April 15


I wonder if Jamison would be surprised at these Mefi comments being predominantly about the medical disparity. I was.

Me too, and although I think it's an important point to make, focusing on anecdotes where the pain is physical (and therefore more "real") ignores Jamison's point that emotional pain is real, too, even when it presents no physical symptoms.

I used to have an eating disorder. I used to cut myself. How stereotypically female of me, I know. Both were an attempt to make whatever I was feeling more real, for myself more than for other people. Not just in an attempt to prove that my suffering was authentic and valid, but because I could actually understand physical pain. It was immediate, demanded my attention, and couldn't be thought away by reason or optimism - just like my depression, though I wouldn't come to realize that for another ten years.

I admit that, even now, sometimes when I'm mentally exhausted I wish I would just collapse, so I could prove that it's "real." Even purely physical ailments confound me when I can't present evidence of them: if my ankle hurts but I'm not actually limping, it's okay, right? Which ties back in with all the stories of women getting dismissed at the doctor's office. Whether it's physical or emotional in origin, we so often do poorly with pain that is felt but not seen.
posted by Metroid Baby at 5:03 AM on April 15 [23 favorites]


I get migraines from time to time and I usually downplay the pain. Unpleasant, sure, but I can power through the pain for a long time before it gets what I consider to be actually incapacitating. So that's not so bad, right? A month ago I was driving home and a migraine started kicking in, but I really had no choice but to keep going so I filed it under "not that bad". Slowly I realized that every time I saw headlights coming the other way, I started crying. This is a level of pain I file under "unpleasant, sure, but totally manageable."

I have a feeling my self-assessment of pain may be a bit off.
posted by Karmakaze at 6:33 AM on April 15 [12 favorites]


The hard part is that underneath this obscene fascination with representations of women who hurt themselves and have bad sex and drink too much, there are actual women who hurt themselves and have bad sex and drink too much.

It's an obvious point, but it's still frustrating to see this sort of suffering celebrated when depicted by a man (the above quotation made me think of Hemingway), but when a woman writes about her pain it's dismissed—and there's no way around it. If it's blunt it's seen as self-pitying, but if it's self-conscious then it's criticized as narcissistic; and damned if there's anything funny about it—even if the humour just makes the hurt more acute—because then you can say it's "twee" and call it a day. I understand the resistance: it's hard reading about someone else's suffering, and more difficult still when you don't glorify it, but I'm completely with Jamison when she calls for an openness no matter how trite or raw the pain, and I'd argue further that embracing others' suffering might just help us accept our own and possibly even to heal.

The comments here about doctors treating women's pain as something they're responsible for are sobering; my girlfriend is going through some weird digestive stuff right now and with all of the tests coming up blank so far she's been told to just take some fiber pills and watch her diet. I am myself embarrassed to say I was wondering if it might not be connected to her anxiety, but I think now I'll be careful to take a more critical approach.
posted by onwords at 6:42 AM on April 15 [10 favorites]


Jamison: "Post-​wounded women know that postures of pain play into limited and outmoded conceptions of womanhood. Their hurt has a new native language spoken in several dialects: sarcastic, jaded, opaque; cool and clever. They guard against those moments when melodrama or self-​pity might split their careful seams of intellect, expose the shame of self-​absorption without self-​awareness."

An interesting observation. Thanks for posting this, homunculus.
posted by MonkeyToes at 6:50 AM on April 15 [4 favorites]


When discussing differences between the sexes, it seems like it would be more helpful to talk about the different ways in which we are wounded than to argue about college majors and mental acuities.

Regarding physical health: unfortunately, it seems like medical practice is vigilant about heart attacks for men and certain cancers for women, and not much else beyond that. Advances in medical testing to make fuller spectrums of tests more frequent and affordable are promising, and hopefully will make diagnoses more accurate and objective.
posted by michaelh at 7:32 AM on April 15


I worked at the linked publication for some years, and based on this piece, things must be mighty different there these days. (The entire staff quit in mid-2010.) We never would have run a story like this, to the frustration of the staff. Back then, there was a strong focus on masculinity, especially through the lens of war. I recall something like 5 issues in a row with pictures of (male) soldiers on the cover. I haven't picked up the magazine since I left—frankly, it's too painful—but now I think I'll have to.
posted by waldo at 7:38 AM on April 15 [5 favorites]


Over the course of about 20 years, every single one of my major diagnoses -- thyroid disease, two forms of cancer, a rare bleeding disorder, a connective tissue disorder, and autoimmune disorders -- was delayed up to several years due to the open dismissal and sometimes outright derision from (male) doctors. In fact, I am convinced that had a particular doctor taken me more seriously when I was complaining of certain symptoms, my colon cancer would have been diagnosed at stage 1 rather than stage 2, thus saving myself a couple of surgeries, months of radiation, months of chemo, and a couple of years of post-treatment complications and pain (not to mention half a million dollars for my insurance company). Ultimately, the colon cancer and my bleeding disorder were only finally diagnosed by two female doctors after I had essentially been blacklisted by their male colleagues for hypochondria.
posted by scody at 9:17 AM on April 15 [21 favorites]


There are so many pieces of this article to love. This,

I was once called a wound-​dweller. It was a boyfriend who called me that. I didn’t like how it sounded, and I’m still not over it. (It was a wound; I dwell.)

And this,

We don’t want to be wounds (“No, you’re the wound!”) but we should be allowed to have them, to speak about having them, to be something more than just another girl who has one. We should be able to do these things without failing the feminism of our mothers, and we should be able to represent women who hurt without walking backward into a voyeuristic rehashing of the old cultural models: another emo cutter under the bleachers, another hurt-​seeking missile of womanhood, a body gone drunk or bruised or barren, another archetype sunk into blackout under the sheets.

Especially.
posted by likeatoaster at 9:26 AM on April 15 [11 favorites]


There are so many comments I keep trying to make about how deeply this essay has touched me, and I just can't figure out how to express my experiences any better than she already has. Thanks for posting it.
posted by likeatoaster at 9:47 AM on April 15 [5 favorites]


Very, very powerful. The urge to cry "Pain!" crashes headlong in the desire to feel/be strong and therefore to hide/deny/minimize the pain. Much truth.
posted by Sophie1 at 10:02 AM on April 15 [2 favorites]


Woke up this morning still thinking about this piece. Thanks so much for posting it. I'll try to get to the other links today.
posted by rtha at 10:09 AM on April 15 [3 favorites]


Woke up this morning still thinking about this piece.

Yeah, me too. Thanks, homunculus.
posted by clavicle at 10:35 AM on April 15 [2 favorites]


Yeah. I think this is a piece that's going to percolate in my head for a while. And I can just tell I'm going think about it when I'm next in pain from whatever.
posted by rmd1023 at 10:40 AM on April 15


Pain to the point of suicide. Physical. That was my new year's "gift". If I hadn't flipped the bit, as it were, on the general invisible tugtruck of depression, suicide would have been extremely tempting.

But I lucked out. I've got a few care providers who are open to listening to both me and my whacky internet sourced ideas of help or meds (within the restraints of their professional guidance which has worked out so far, and in passing me on to a trusted colleague specialist if not). So when I came to them, in tears, in pain, and crying for relief, it was very believed and very cared for. Then I lucked again, in that the first few attempts at relieving that pain were successful.

So many of my friends aren't that twice lucky. Especially my brain finally doing me a solid with earliest "luck", in flipping the bit on depression. So I could look at my pain as "so bad that if I were depressed I'd go inpatient for my safety" and not "enough already, where can I source a method of adequate suicide". I could hold on for the week of tests and heavy yuccky temporary drugs, and the two months of (sorry) painfully slow pain amelioration.

And now I get to figure out how to deal with physical pain without the use of pain meds except in extreme need. Now, "lucky me", pain meds do verrry nearly more harm than good. Whee. What a drag it is getting old.
posted by breve at 11:30 AM on April 15


I don't think I know a woman over 40 who hasn't had her physical ailments dismissed as anxiety or hypochondria at some point. And once that's on your records, anything more subtle than a compound fracture is going to be diagnosed with some kind of dogwhistle for hysteria.

For me, though, it was only after some time being outraged at the 'anxiety' diagnosis from a doctor who missed my (in hindsight, pretty obvious) life threatening medical condition that it occurred to me that it wasn't just negligent because my condition was physical. It would have been dismissive even if my symptoms had been psychosomatic or outright made up. Sending someone home to drink herbal tea and get some rest when they're exhibiting or even just claiming real, serious physical symptoms is always dangerous, dismissive, and wrong.
posted by ernielundquist at 11:53 AM on April 15 [6 favorites]


What strikes me is that women are taught to be empathetic. It is our job to care for each other and our families. We provide emotional labour as teachers, nurses, retail workers and waiters.

Does this make us somehow primed to need empathy? I'm an endless pit of empathetic need. I'm always so relieved and happy when I interact with medical people who provide me with empathy. I want them to feel my pain. It makes me feel valued, understood, cared for. I've always known this about myself but hadn't considered the disdain we have for sentiment and the need for empathy. And so I add myself to Jamison's group of friends that worry about "secret misogyny." Where is the line between whingeing or whining and assessing our own emotional reality? Is my own distrust of my symptoms and feelings a signal of my disdain for femininity?
posted by Gor-ella at 12:34 PM on April 15 [1 favorite]


I liked her story about the crazy Brushy Mountain endurance race (previously).

I'd missed that one, thanks for pointing it out.
posted by homunculus at 12:41 PM on April 15


A relative of mine was having issues with severe headaches for a few years and saw multiple doctors who all told her the issue was "just in her head", and she should seek therapy or meditation since the most obvious prescription drugs didn't seem to work. Finally one doctor, almost grudgingly, scheduled an MRI for the following week because she was also suffering some minor hearing loss in one ear.

That weekend she suffered a major seizure, was rushed to the ER where scans showed a massive brain tumor. She survived, the tumor was benign, and she has thrived since then. Looking back on it, she feels strongly that her doctors truly believed she was a hypochondriac and that her gender and general way of presenting herself ("stereotypically feminine", "girlish", and quiet) were a major factor in the lack of urgency regarding her treatment.
posted by cell divide at 12:52 PM on April 15 [1 favorite]


The emphasis on relatively-provable, diagnosable physical pain in this thread just underscores her point about the stigma and unprovability of emotional pain, even in relatively safe-ish spaces. This has been a great thread but I think it absolutely proves her point.

Fantastic post, thanks homunculus. I've been thinking about these pieces all day.
posted by dialetheia at 12:58 PM on April 15 [2 favorites]


The flip side of this is, if you do have anxiety, coexisting with health problems it can be very difficult to want to reveal it in a medical setting.
posted by typecloud at 1:52 PM on April 15 [3 favorites]


The emphasis on relatively-provable, diagnosable physical pain in this thread just underscores her point about the stigma and unprovability of emotional pain

But no pain is provable; that's the problem. There are no tests for pain, emotional or physical. That's why even for physical pain we have to have things like pain scales and such. Pain is always a matter of trust, which is exactly the problem. Pain isn't a 'real' thing, which is exactly the problem.

I thought the article was generally sprawling and definitely too heavy on the literary references and Iowa-esque stylization for my taste, but I think it's hard to disagree that everyone, especially women, would be better off if everyone had a bit more empathy and a bit less dismissive-ness about what other folks are dealing with.
posted by Lutoslawski at 2:00 PM on April 15


Yes, forbid you have co-morbid physical and emotional pain. Getting treatment for just one is a challenge, getting acknowledgement and treatment for both? Better be a man.
posted by stoneweaver at 2:34 PM on April 15 [3 favorites]


But no pain is provable; that's the problem ... Pain is always a matter of trust

Well, yes, of course, in a reductive sense. Yet some sources of pain eventually yield e.g. cancer diagnoses, and thus that pain is validated by our respective communities as being "real", or at least having been grounded in reality, while psychosomatic pain remains "unreal" (and thus "fake" or "untrustworthy") to nearly everyone except the person experiencing it.

Womens' pain tends to be dismissed as mental in nature and therefore unreal and not worth acknowledging until unavoidably proven otherwise, as seen many times in this thread, but she was also talking about a patient having psychosomatic seizures from the loss of her brother; my point is that only talking about the cases where the pain eventually had a provable physical cause unintentionally minimizes the other half of her argument, which is that the other kinds of pain are meaningful and "real" and lived as well despite having no diagnosable physical cause. I disagree with your assertion that pain is unreal in any but the most trivial of senses, unless you feel that way about every sensory experience you have, which I guess is possible. This gets at the root of the issue, though - why should I disbelieve someone's account of pain any more or less than I believe their account of perceiving hunger or the color blue? I "trust" people to self-report their experiences with most everything else - why would this be this different? Why are we so skeptical of others' (and specifically women's) pain by default, when we aren't similarly distrustful about their other sensory experiences?
posted by dialetheia at 3:21 PM on April 15 [1 favorite]


The emphasis on relatively-provable, diagnosable physical pain in this thread just underscores her point about the stigma and unprovability of emotional pain, even in relatively safe-ish spaces.

I don't think so, necessarily. I think it's two aspects of the same problem.

Women are told, constantly, that we're unreliable narrators, that we don't know what we're feeling, and that we're by default just sort of 'crazy.' Not mentally ill, not suffering, just general purpose 'crazy' by virtue of being female.

A lot of women, probably most, internalize that to some degree. Some embrace it for themselves, some affirm it and declare themselves exceptions to the rule. For most of us, I'd guess, it just kind of sits around in the back of our brains telling us to second guess our perceptions and to ignore things until we can't anymore, because hey, maybe we are just sort of generically crazy.

But rejecting the 'generic crazy' characterization isn't the same thing as being dismissive of real emotional pain. If we go see someone for a physical ailment, it is not dismissive of women's pain to simply point out that most of us know the difference between physical and emotional pain, and to demand to be taken at our word. We all deal with the stereotype threat, and any admission of emotional pain carries with it a very real risk that our physical problems won't be taken seriously. All you have to do is have one unqualified medical doctor 'diagnose' you with anxiety or depression based on a twenty minute visit, and that becomes your default diagnosis for anything short of a compound fracture.

But these are not real psychological diagnoses, nor are they sincere acknowledgements of psychic pain. They're usually nothing more than dogwhistle 'hysteria' diagnoses, which is as dismissive of psychological pain as it is of women.

And it all really comes back to the same thing: People don't trust women's perceptions, so we're constantly having to prove ourselves and jump through hoops to get any type of help at all.

That is a lot of different flavors of bullshit, and we should be calling it that from every possible angle.
posted by ernielundquist at 3:57 PM on April 15 [27 favorites]


I disagree with your assertion that pain is unreal in any but the most trivial of senses, unless you feel that way about every sensory experience you have

I actually do, more or less (with exceptions for say, time). But alas, that's a digression.

Thinking more about this, I was taken back to my youthful days in Christianity, and how so much emphasis was put on the idea that part of the punishment of the Fall was that women would now feel pain in childbirth, that before Eve sinned there was no pain in childbirth. So it was very much a "see, women brought this on themselves! Deal with it!" kind of mentality. Which like, that's fucked up.
posted by Lutoslawski at 4:25 PM on April 15 [2 favorites]


What strikes me is that women are taught to be empathetic. It is our job to care for each other and our families.

I'm not entirely sure that it's that women are taught to be empathetic and not that men are taught not to be. I mean, clearly it's both, and clearly the emotional labor you talk about is feminized because if it wasn't it would be monetarily and socially valued. But I think that there's a lot of social conditioning for men to be unempathetic, especially to women.
posted by NoraReed at 4:30 PM on April 15 [4 favorites]


This is a tremendously captivating essay, and one that I'll be turning over in my head for quite some time. Thanks for posting it.
posted by Greg Nog at 5:53 PM on April 15 [1 favorite]


From the Atlantic interview:

"It makes me realize that sometimes I’m guilty of using a “we” that actually applies to a very small, self-aware, artistically inclined subgroup where I think privileging singularity of feeling is really huge."

I do find her brand of navel-gazing rather baffling.

The Female Pain essay didn't really do anything for me. I really don't even understand her point. I'm interested in the idea of idealized female suffering in literature and society, I guess, but I can't relate at all to the stuff about Ani Di Franco and Carrie.

And I say this as a woman who has endured a fair amount of pain - dysthymia since my teens, menstrual cramps so bad in my twenties they made me vomit and cry curled up on the bathroom floor, migraines from my twenties up til now, my forties, so bad they make me vomit and miss days of work I can't spare. Chronic bronchitis, asthma, and sinus infections. And yet, I'm really not sure what the essay is trying to say.
posted by Squeak Attack at 6:24 PM on April 15


Thanks for posting this, Homunculus. I'm reminded of an Angela Carter novel in which the main character idolizes a female actress named Tristessa, known and beloved for her various performances of anguish on-screen. Her pain is connected to her femininity, for, as the protagonist finds out, Tristessa is really a biological man performing femaleness. There is something (cultural) that insists that femininity must contain pain.

I was also recently listening to The Shining Girls through Audible. The app lost my place in the book yesterday, and I think I'm pretty okay with this because even though this is a book written by a woman in which one of the would-be-victims survives and eventually seeks revenge, after the third description of a woman being murdered and the killer finding this arousing I was pretty much done. Even though the book itself refers to the killer's crimes a "femicide" and it does seem to acknowledge a feminist perspective, I'm just burned out on consuming the suffering of women as such an unexamined undercurrent in culture. I'm not saying this to discount the real experiences of women, but rather as a response to the idea that throwing a dead (usually naked) woman into your book/tv show/movie adds instant pathos. It would be all too easy to completely avoid any depiction of a woman other than as a mute victim.
posted by Kitty Stardust at 6:40 PM on April 15 [5 favorites]


I've been fighting daily severe headaches (and I say this as A Migraine Person; my "severe headache" is probably your "doubled over in pain sobbing" headache but as noted above, you just power through as best you can). I've also been stupidly tired. I made a comment to my doctor that maybe the chronic pain from the headaches was causing the exhaustion.

He completely blew me off and said chronic pain doesn't cause fatigue. Let that one sink in for a second, fellow chronic pain of all types-sufferers. *facepalm*

Now I'm being tested for sleep apnea because they're REALLY running out of ideas. Modern medicine is a joke.
posted by bitter-girl.com at 7:01 PM on April 15 [9 favorites]


It's not just pain. In my experience, medical people (nurses, doctors) tend to disbelieve women when they report any symptoms at all. I once told an OB/GYN that there was absolutely no possibility that I was pregnant, so why am I having some pregnancy symptoms? His first words after my examination were, "Well, you can stop worrying. You are not pregnant." DUH. I told you I was not pregnant. Why am I considered an unreliable witness as to whether I could be pregnant?

Weight gain, lethargy, dry skin, hair falling out, feeling cold all the time? It's not hypothyroidism (even though these are all symptoms and your medical history includes thyroid issues), you're just middle-aged, approaching menopause, lazy, and eat too much. When you finally INSIST on a test, they will grudgingly admit you are hypothyroid, but act like it's somehow your fault. Meanwhile you are jubilant because a test finally proved it's NOT YOUR FAULT.

Years later, when the thyroid meds you worked so hard to get are not handling the weight gain of 10 lbs. per year, they'll say something like "No one gained weight at Auschwitz" (I am not making this up, that is verbatim what my endocrinologist said to me). If you throw a fit and point out that he is treating the test results and not your symptoms you may get a result, such as trying a different drug. But it's not likely.
posted by caryatid at 7:29 PM on April 15 [16 favorites]


Metroid Baby: "Me too, and although I think it's an important point to make, focusing on anecdotes where the pain is physical (and therefore more "real") ignores Jamison's point that emotional pain is real, too, even when it presents no physical symptoms."

For several years now, "pain is the fifth vital sign" has been a mantra in medicine, particularly emergency medicine (the other four being temperature, blood pressure, pulse rate and respiration rate). There is a growing realization within medicine that pain, whatever the source, is a major modifier for almost all other symptoms: it masks symptoms, it worsens outcomes, it decreases mental status and worsens decisionmaking, etcetera, etcetera.

The biggest problem with managing pain in female patients is sexist and misogynistic attitudes. By a country mile. But there's also a physiological component: women have a higher pain tolerance than men, and tend to wait much longer before seeking help. It's a statistically significant problem with cardiac events, for example: women are far more likely to delay seeking care for heart attacks, and to minimize their discomfort when they do seek care.

And then, on top of that, you add American society's pervasive sexism: if you tough it out, you're being a Difficult Person, but if you complain, you're being a Whiny Bitch. Yet again, even in life and death, women can't win for losing.
posted by scrump at 11:29 AM on April 16 [7 favorites]


I've been tentatively diagnosed with Fibromyalgia, because doctors can't find the source of my pain. Now, I do not doubt that for some people, Fibromyalgia is a real disorder. It isn't what I have. Fibromyalgia is the bucket they've put me and countless other women who are being disregarded. Early in my diagnostic experiences, an nurse pulled me aside told me "do not let them put Fibromyalgia in your chart. No matter what." But after 18 months, that's exactly what happened when doctors cam up empty handed.

On particular doctor I challenged his assertion, and he explained how absolutely positive he was that I had Fibromyalgia, even though it had an atypical presentation. Nothing other than pain matched Fibromyalgia; not type, character or history. But he was 100% certain it had to be Fibromyalgia. I followed up this discussion asking for him to write a letter indicating such for my disability case. What I got was the opposite of what he argued to me; a mealy-mouthed, uncertain guess. So putting his signature on an official document made him whither, but he was happy to hand down the diagnosis when just a silly girl was doubting his diagnosis.

And that's the problem. Doctors are certain it's Fibromyalgia if they can wash their hands of you. Now I realize men can be diagnosed with Fibromyalgia too, but it's primarily a woman's disease. And even as the medical establishment says it's doing away with the woman blaming, the more I'm "in it", the more I see it's a female problem. Yesterday's hysteria is replaced by today's Fibromyalgia or Chronic Fatigue. Even the prevailing theory of Fibromyalgia is blame-y; that the cause is a pain centralization disorder because we women did something to make our bodies process pain wrong. It's not too far from our wombs causing all our trouble again. Hysteria by another name.

I am now having issued with my hands and wrists. I'm convinced it's not related; everything about the type of pain, when it occurs, treatments that work and don't, and a whole slew of other problems vastly unlike the supposed fibromyalgia diagnosis. Yet the first doctor to look at my hands was just not taking it seriously. I mention my experience with a pain disorder, and could see him trying hard not to recoil at the notion of treating someone with a difficult problem like fibromyalgia.
posted by [insert clever name here] at 10:10 PM on April 16 [10 favorites]


These threads are hard to read, but please keep them coming. I wish I'd had access to such conversations twenty years ago.
posted by sandettie light vessel automatic at 4:38 PM on April 21 [1 favorite]


Reading List: Leslie Jamison, Author of “The Empathy Exams”
posted by homunculus at 2:11 PM on April 27 [1 favorite]


I was thinking back to this article after my family got to talking about my mom's mom for something unrelated.

A large part of how she interacted with the world, a large part of her identity, was formed through the lens of pain. She was diagnosed as diabetic around age 10; she was told she'd be dead by 16. She had lifelong complications from the diabetes; she could and would top anyone's complaints about their own health. Like, "I hate these chicken pox, I've had them a week!" would get, "I was in a coma for three days."

Toward the end, when she was having multiple diabetic complications and couldn't keep food down, all she wanted to talk about was how much pain she was in and how skinny she had gotten. It was so weird, like, this late-life anorexia, where she wanted to twirl in sweatshirts that hung off her emaciated frame. And she refused opioid painkillers even to the end because she "didn't want to get addicted." Like if she got a little morphine in her IV, she'd be out the next day stealing TVs to feed her habit.
posted by klangklangston at 11:58 AM on April 28 [1 favorite]


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