CAITLYN BURFORD


Hurt a Little Harder:
On "Faking It" and the Gendered Experience of Pain

 

I set my appointment to get an IUD for ten o’clock in the morning on an arbitrary Tuesday. To describe an IUD in hollow medical terms, it is an “intrauterine device that’s inserted into the uterus for long-term birth control...The T-shaped plastic frame has copper wire coiled around the stem and two copper sleeves along the arms that continuously release copper to bathe the lining of the uterus.”[1]


As a young woman on the outskirts and looking to move into the professional world of academia, I am required daily to prove my legitimacy and capability of working at this public institution.


To describe an IUD in my own terms, it is more of a “tiny doll hammer with a piece of floss, shoved up your vagina so you don’t have to think about babies for ten years.”

While I was rather enthusiastic from the visual of “two copper sleeves” getting together to “bathe the lining of my uterus,” I was not prepared to deal with the immediate onset of constant internal cramping that would last for the next seventy-two hours. My ten o’clock appointment let out just in time for me to make it to work to prepare for my lecture at noon.

In retrospect, I realized that I should have taken the day off as I stood up from the sterile lab table in the clinic and realized I couldn’t walk. I should have cancelled my class as the two Advil’s I’d popped beforehand did little to help navigate the pain and I called a friend to drive me to work for fear of passing out. We stopped at a bar along the way so I could have a stiff mid-morning drink.

I should have taken a sick day. At the time, however, I was employed in a tenuous and temporary instructor position teaching at a university. As a young woman on the outskirts and looking to move into the professional world of academia, I am required daily to prove my legitimacy and capability of working at this public institution. I wasn’t “accidentally” hired as has been suggested before. As genetics have determined that I will look barely older than a majority of my students, I am required to perform a far more organized and sometimes illogical character to be taken seriously. Believe me, I don’t enjoy wearing a button-up. As such, I am given little leeway in how I move within an institutional system.

To put it simply, I don’t have sick days to spend on IUDs.

Courtesy: Carlota Guerrero

More often than not, my experiences of pain are initially doubted, as though my reaction is exaggerated and the pain itself is never as severe as I portray it to be. My experience is not uncommon to many women. Rather, it is the prevalent narrative present in how the medical industry acknowledges and treats the experiences of women. Although many women experience pain in a very physical and tangible way, in contrast, we are told to experience pain as though it were an emotional reaction to a psychological weakness.


My hope is that beginning to unpack the social problem may highlight who is still ignored in the medical industrial complex.


It is important to note here that the medical studies and journals I cite often use the term men and women interchangeably with male and female. There is little attention given to gender identity apart of biological assumptions. No attention is given to race or ethnicity and how experiences of pain differ under intersectional gendered experiences. Realizing that there are deeply evident conventions written into the data, it is insufficient and filled with holes. My hope is that beginning to unpack the social problem may highlight who is still ignored in the medical industrial complex.

Nearly a decade ago, the Journal of Law and Medical Ethics published findings of a study that shows women are more likely than men to visit a doctor and seek treatment for pain. Conversely, they are less likely than men to receive any treatment. [2] One proposed explanation, and I believe the most likely one, is that women’s reports of experiencing pain are initially questioned, thought to be exaggerated, and, in some cases, entirely made up.

The unwillingness to take women’s pain seriously is not a new routine in the medical industry. Rather, it is a pattern deeply rooted in the history of modern western medicine. Molly Caldwell Crosby writes a though-provoking narrative about her own experience with gender and visits to particular doctors and intertwines a brief history of gender bias in modern medicine. [3] She begins with the diagnoses of hysteria, a sad remnant of Victorian-era medicine, which created a “catchall for women’s ailments” by attributing many complex women’s health issues to psychological disorders. To put it simply, the male-dominated medical industry of the early twentieth century did not believe us. There were wide accusations that accounts of pain including menstrual cramps, PMS, and even pain in childbirth were completely fabricated.

A particularly disturbing study was carried out in 1948 as doctors felt the need to scientifically measure women’s pain in childbirth, many believing that it was indeed overstated and imagined, and that our own personal reports of pain in childbirth were not to be trusted. In the study, women in labor were first asked to self-report their pain levels on a typical 0-10 scale (10.5 if we’re being specific). The follow-up test similarly tested women in labor, but this time applied intense heat to their hands, some women even receiving second-degree burns. These women, too, were asked to rate their pain levels. Interestingly enough (or not at all) scores were similar between groups with no significant pain difference being attributed to the burns, “proving” that yes, childbirth is indeed very painful.[4]


Out of patients who reported the same pain intensity levels to medical professionals, women were prescribed less than half of suggested pain treatment to men.


This is concerning, first, because of the way women’s pain is often ignored. In a clinical study of people diagnosed with AIDS, while reporting experiences of pain, women were significantly less likely than men to receive adequate analgesic therapy. [5] Another study reports that men who report pain to a doctor are more likely than women to be referred to a specialty pain clinic.[6]

To reference one more study, in a last-ditch effort to provide statistically credibility to our already present narratives of pain, women with cancer were diagnosed and treated differently than men for reporting similar levels of pain. Out of patients who reported the same pain intensity levels to medical professionals, women were prescribed less than half of suggested pain treatment to men. [7]

Courtesy: Carlota Guerrero

So, on a scale of 1-10, why is my pain rating of a 6 more suspicious than my male counterparts? Historically, women have been portrayed as hysterical and emotional, rather than logical and rational, when it comes to reporting pain. Today, our narratives are still viewed as exaggerated subjective feelings rather than objective experiences.

It is not only concerning that women’s pain is often ignored. What may be more alarming is the way gender bias influences the treatment of pain. In one clinical study addressing chronic pain, women were often diagnosed with “histrionic disorder, excessive emotionality, and attention-seeking behavior” as opposed to men were prescribed treatments that directly addressed physical pain.[8] Women are also twice as likely than men to be prescribed anti-depressants to deal with pain. The issue is not the use of anti-depressants or prescription medications – it’s the use of them as a diagnosis to ignore and overshadow women’s health issues.

There is indeed a pattern, from Victorian-era bouts of hysteria to common prescriptions of Valium, where women’s experiences are explained away as our wild imaginations that alter our perceptions of reality.

But this could all be refuted with one simple, albeit naïve, statement: What if women actually are exaggerating their pain? I hate to burst this medically ill-informed bubble, but a thorough and comprehensive review of dozens of significant pain studies uncovers a well-documented conclusion. Women feel most measurable forms of pain more severely than men. There is “abundant evidence from recent epidemiologic studies [that] clearly demonstrates that women are at substantially greater risk for many clinical pain conditions, and there is some suggestion that postoperative and procedural pain may be more severe among women than men.”[9] In most measures, from migraines to irritable bowels syndrome, women actually do feel pain more acutely than men.

Gender-blindness is deeply entrenched in the medical industry. More specifically, it influences how we come to treat, understand, and empathize with the experience of pain. If we adhere to dangerous stereotypes that women are both mentally and physically weak, then our experiences will continue to be mistrusted, and we will continue to be medically diagnosed with the new hysteria.

As a response, knowing that my pain is rarely viewed as legitimate and I will be, in many ways, expected to “prove” myself, I have been taught to hide my pain. I have been socially informed that being “strong” is oppositional to admitting pain. I have learned, without consciously realizing it, that I am expected not to take sick days for IUDs.


Women take statistically more sick days, but less sick days for their own health. 


I am not expected to take sick days for myself in general. Recent data has shown, and been widely referenced, that women are 42% more likely to take sick days than men. [10] As if we needed to add more fodder to the fire of gender employment discrimination, it’s important to look at why this statistic is true. A study from the Benenden Healthcare Society explains that women are actually less likely than men to take a sick day from work for their own health.[11]

What does this leave us with? Women take statistically more sick days, but less sick days for their own health. One explanation would note that women are more often than not seen as the primary caretaker for a sick child or elderly relative, and when workplaces offer little time off for family or emergency leave, sick days become the bargaining chip. Women are expected to make arrangements for others’ health, at the expense of their own.

My point is simple. I am asking that my personal experiences of pain be seen as genuine. My pain is real. It does not need to be verified, tested, or proven. I should not have to prove that my hurting, aching body is not a side effect of a psychological condition. I should not feel that sick days are unavailable to me, only to be cashed in if I occupy a traditional role of a child’s caretaker. Perhaps most significantly to this story, I should not have felt a need to hide the pain of an IUD procedure in the morning from my class that the afternoon, for fear of my pain being taken as a condition of my “weakness.”

To begin dismantling the power of gender bias in the performance of pain, I’ll start by calling in sick. And I would hope that you believe me.


Notes:

[1] Mayoclinic.com, “ParaGard.”

[2] Hoffmann, D.E., Tarzian, A. J. (2001). The girl who cried pain: a bias against women in the treatment of pain. Journal of Law, Medicine, & Ethics, 29, 13-27.

[3] Crosby, M. C. (2014, May 2). That’s hysterical. A short history of sexism in medicine – and hope for the future. Verily Magazine. Retrieved from: http://verilymag.com/thats-hysterical-sexism-in-medicine/

[4] Ibid.

[5] Breitbart, W., Rosenfeld, B.D., Passik, S.D., et al. (1996). The undertreatment of pain in ambulatory AIDS patients. Pain, 65 (2), 243-249.

[6] Weir, R., Browne, G., Tunks, E., et al. (1996). Gender differences in psychosocial adjustment to chronic pain and expenditures for health care services used. The Clinical Journal of Pain, 12 (4), 277-290.

[7] Gender disparities seen in cancer pain treatment. (2001). Oncology News International, 10 (5), 58.

[8] Hoffmann, D.E., Tarzian, A. J. (2001).

[9] Roger, B. F., King, C.D., Riberio-Disilva, M., C., Rahim-Williams, B., Riley, J. L. (2009). Sex, gender, and pain. A review of recent clinical and experimental findings. Journal of Pain, 10 (5), 447-485.

[10] Swinford, S. (2014, February). Women are almost 42 per cent more likely to take sick days than men. The Telegraph. Retrieved from http://www.telegraph.co.uk/news/health/10660612/Women-are-almost-42-per-cent-more-likely-to-take-sick-days-than-men.html

[11] Hope, J. (2011). Women have more days off sick than men, but they’ll often work when they’re ill. Dailymail.com. Retrieved from http://www.dailymail.co.uk/news/article-1390595/Women-days-sick-men--theyll-work-theyre-ill.html

 

BIO

CAITLYN BURFORD is a lecturer at Northern Arizona University in Flagstaff, Arizona. She teaches in communication studies, with an emphasis in environmental communication, gender studies, decolonial/post-colonial theory, and social movement theories. Her research focuses on environmental advocacy and justice, mapping the interconnections between race, class, gender, and privilege, with a particular interest on food systems and food security, and urban sustainable landscapes. She can be found at http://caitlynburford.com .

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