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Women’s symptoms are often interpreted through emotional regulation.

Nineteenth-century hysteria and modern care share a persistent diagnostic pattern.

Clinical authority shapes what counts as real and what is dismissed.

Dismissal leads to delayed care, mistrust, and patients leaving treatment.

Nearly two hundred years and different diagnoses separate these two cases: One patient was advised to rest; the other patient was advised to relax. One’s symptoms were attributed to heightened sensitivity to stimuli and failure to regulate emotion; the other’s symptoms are often dismissed as signs of stress, anxiety, and heightened bodily awareness. One’s treatment focused on limiting what might provoke an emotional response; the other’s clinical experience shifts attention from symptoms toward the patient’s responses to them.

The first case is about 19th-century hysteria and the second is about contemporary vulvovaginal disorder, but they nonetheless 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 Rest” to “Just Relax”

In 1853, Robert B. Carter attributed a woman’s hysteria to a failure of willpower. Fainting, trembling, and unable to regulate her responses to the shocks of the world, the hysterical woman was, he argued, simply too impressionable (1). In mid-19th-century hysteria discourse, physicians understood a woman’s sensitivity to her environment as her constitutive vulnerability—the condition that made her susceptible to illness in the first place. As Marshall Hall argued, women were, by their nature, “far more sensitive and susceptible than the male,” and it was this constitutional fact, rather than any identifiable pathology, that explained their suffering (2).

Within this framework, emotional responsiveness itself became explanatory. A woman’s symptoms were understood as expressions of her inherent susceptibility. The cure was clear: remove her from exciting circumstances, let the household’s quiet restore her nerve-power, and teach her to manage her affect. Rest would improve her “resisting power” (3).

In 2025, a cross-sectional study by Moss et al. published in JAMA surveyed 447 patients with vulvovaginal disorders before their first visit to a specialty referral clinic. The study explicitly framed medical gaslighting as a form of epistemic injustice, which it defined as the dismissal of a patient’s knowledge of her own experience within a relationship structured by clinical authority. Patients had seen, on average, 5.5 prior clinicians for pelvic or vulvar pain, suggesting that dismissal was not a single failed encounter but often part of a prolonged search for care.

Researchers found that 39.4 percent of women patients had been made to feel “crazy” by a clinician, 41.6 percent had been told to “just relax more,” 28.4 percent had been told their symptoms were caused by high anxiety, and 20.6 percent had been referred to psychiatry rather than offered medical treatment for their physical symptoms. More than half considered stopping care because their concerns were not being addressed. Patients described clinician knowledge gaps, dismissive behavior, lack of investigation, and a recurring shift from physical symptoms to mental state.

The authors note that such forms of epistemic injustice may be especially consequential in gynecologic pain, where discriminatory structures already contribute to under-treated pain, delayed diagnosis, and psychological distress. Although the study’s sample was predominantly White and therefore cannot fully capture the role of race and other intersecting identities, a substantial body of research has shown that women of color, particularly Black women, are disproportionately subject to dismissal and under-treatment in clinical settings.

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What is striking about Moss et al.'s 2025 data is this continuity. Forty percent of surveyed patients were told to relax. Hovell wrote in 1867 that the “object of treatment should clearly be restoration of nerve-strength” and recommended, alongside physical remedies, the importance of “removing any sort of worry from the patient’s mind” (4). The sentence belongs to a different century, but its clinical spirit is recognizable. In both cases, the woman’s distress meets with a prescription for a different inner emotional and psychological state. The problem, as the physician construes it, lies not in what is happening to her body but in how her mind is responding to it.

Who Gets to Decide What’s Real?

Elinor Cleghorn traces this pattern with precision in Unwell Women: Misdiagnosis and Myth in a Man-Made World (2021). Across centuries of medical history, she identifies a persistent pattern in which women’s physical distress is treated as excess (of emotion, sensitivity, and/or attention) rather than as a problem requiring sustained physiological investigation. The continuity here is not diagnostic but interpretive. If the Victorian hysteric was understood as too impressionable, the contemporary woman is often understood as too anxious, too focused on her symptoms, or too reactive to them.

Cleghorn’s own experience with lupus, during which her symptoms were repeatedly reframed as psychological, underscores how this pattern operates in practice. What she ultimately demonstrates is that the terms through which women’s bodies are known have consistently filtered and reshaped what women are permitted to say and be. Women who fall ill have long been distrusted as narrators of their own bodies and pain.

Jennifer Sebring helps us to see how this pattern is embedded within the structure of clinical authority. She argues that medical gaslighting “is not simply a personal exchange, but the result of deeply embedded ideologies underpinning health-care services” (5). The diagnostic encounter is not a neutral space of discovery. When a woman’s account of her symptoms conflicts with what the clinical framework is prepared to recognize, her account is often reclassified or redirected. Clinicians retain the power to determine which forms of suffering are recognized as legitimate and which are reclassified as problems of perception.

This, finally, matters beyond the question of diagnostic error in the conventional sense. Cleghorn is careful to note that the misdiagnosis of women runs through medicine’s history as a consequence of women’s systematic exclusion from clinical research and their persistent construction as unreliable witnesses to their own experience. What Victorian hysteria discourse and contemporary clinical dismissal of vulvovaginal disorders share runs deeper than a set of symptoms. Both rest on the same assumptions: Women feel too much, report too insistently, and require psychological management.

Pierre Janet observed in 1901 that “every epoch has given to it [hysteria] a different meaning” (6). He meant this as an opening toward clarity, concluding: “let us try to find out what meaning it has to-day” (7). What history suggests is that the meaning has actually been less variable than the name. The woman who fainted from too much feeling and the woman told to just relax more are separated by 170 years of medical progress, yet they are held together by something older than the diagnoses themselves: the conviction that the problem, in the end, is her.

Carter, Robert Brudenell. On the Pathology and Treatment of Hysteria. J. Churchill, 1853.

Cleghorn, Elinor. Unwell Women: Misdiagnosis and Myth in a Man-Made World. Dutton, 2021.

Hall, Marshall. Commentaries: Principally on Those Diseases of Females Which Are Constitutional. Sherwood, Gilbert, and Piper, 1830.

Hovell, Dennis de Berdt. On Pain and Other Symptoms Connected with the Disease Called Hysteria. John Churchill & Sons, 1867.

Janet, Pierre. The Mental State of Hystericals. G. P. Putnam’s Sons, 1901.

Moss, Chailee F., et al. “Experiences of Care and Gaslighting in Patients With Vulvovaginal Disorders.” JAMA Network Open 8.5 (2025): e259486.

Sebring, Jennifer C. H. “Towards a Sociological Understanding of Medical Gaslighting in Western Health Care.” Sociology of Health & Illness 43.9 (2021): 1951–1964.​​​​​​​​​​​​​​​​

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