The Glass Box: Strength Of the Modern Women

One of the core components to suppression and oppression is the singular stereotyping and labeling of a demographic, or in other words, to “put them in a box.” Because when the narrative of a demographic is singular, possibly negative, it is much easier to control to dehumanize and differentially treat them. We talk about the glass ceiling all the time. Yet arguably, women have been put in a glass box when it comes to how they must handle their pain - whether it be physical, emotional or psychological. A box further complicated by the fact that each wall represents a 10-foot brick-walled barrier towards pain relief and management. While its dimensions and space available may shift with time, the “acceptable” expressions of pain are always determined by this ambiguous entity. Some of these walls are rooted in historical medical racism. Some are rooted in the dual problem women+ face of being more likely to endure chronic conditions yet also more likely to be labeled a “hysteric”. Some of these walls are rooted in spoken and unspoken gender norms. And yet all of these walls must be analyzed for the ways they confine and suppress women+ and broken down to deliver equitable medical care to women. 

One reason is the notion that women are hysterical and complain too much about their health (without consideration of how women are more prone to chronic illness than men). Whether it's by nature of having complex reproductive organs, the incredibly long diagnosis time for chronic conditions such as endometriosis (4-11 years) and fibromyalgia (2 years according a study published in BMC Health Services Research), or the taboos and stigmas surrounding women’s health, the European Journal of Medicine reports that women on average suffer from a higher number of chronic conditions and therefore rate their health as lower quality. Yet despite the simplicity in the correlation between higher number of chronic illness and lower-rated health, women have been labeled as whiners, complainers, “too weak to handle a little pain”, and “hysterics.” Hysteric. The irony is that this term, meant to tell women they are being weak and overly dramatic about their pain, is derived from the root “hyster”. “Hyster” translates to “womb” in Ancient Greece and alludes to one of the ultimate expressions of strength - childbirth. And yet, as science writer Abby Norman details in her novel “Ask Me About My Uterus”, the makers of history have weaponized the term as a catchall for symptoms that couldn’t be explained psychologically and have used it to invalidate concerns of physical pain in women . This leaves women in a classic catch 22. Scaling the wall means being hounded by the thorns and biases associated with being viewed as a “hysteric” so women settle for being the silent soldier no matter how intense and bloody the battle inside of them is raging. 

In addition to this double standard, the age-old gender norms that women must live up to can create a suffocating 4-wall barrier. One of these norms is the expectation that every action a woman performs should be in service to another - whether it’s enduring dyspareunia for a man’s pleasure or staying silent about physical or mental turmoil as not to be a burden on others. Drawing on the interactions she has had with her own patients, Nisha McKenzie, PA-C, CSC, NCMP, IF and Founder and Owner of the Women’s ⁺ Health Collective says that women often have a hard time being selfish. While selfish has gained a negative connotation in our society, she argues that breaking it down into “self” (you!) and “ish” (kind of), it’s simply advocating we take some time for ourselves. If women are negatively conditioned not to be selfish, seeking medical care for pain can seem like a selfish act further complicating their access to pain management.

And then there’s the wall built from unspoken gender norms that arise. As women begin working in traditionally male-dominated spaces, faulty definitions of equality and equity can begin to come about - including the fact that gender equity/equality means that a woman should be the physical equivalent of a man. This can make actions such as stepping away from work to handle bleeding and painful cramps or any expression of pain related to gynecologic conditions be interpreted (unjustly) as a sign of weakness. Researchers in a 2015 Indiana University study have found women in traditionally male dominated environments/workplace have a statistically significant higher level of the long-term stress hormone cortisol in their saliva. In addition to the mental health consequences, such long-term stress can manifest in lower cardiovascular health and higher risk of adverse birth outcomes during pregnancy according to Health Disparities in the United States 3rd Edition. Additionally, Pew Research Center estimates that women spend 9 hours/week more than men caring for children and attending to household duties. The stress and demands of handling work and domestic duties can create a constantly “go-go-go” mindset that doesn’t give them time to express pain and fatigue. Fostering this silent suffering and “soldiering on” among women is this “community of menstrual suffering” that is often created. A culture of endurance of gynecological conditions that encourages silence around pain emanating from “taboo” parts of the body. This culture likens the use of enduring pain/lactic acid burn in exercise as a yardstick for physical strength to the endurance of pain in women as an indicator for her overall strength. As empowering as it may seem to create a community bonded in overcoming hardship, this culture crosses a toxic line when it makes medical hardship an inevitable and routine part of life rather than the occasional and unwelcome guest that it can be managed as.

Unsurprisingly and unfortunately, the glass box for Black women has an added side of historical racism. Despite the end of the days of slavery and nonconsensual gynecological experimentation on Black women, perceptions of the higher pain tolerance and the increased physical strength of a Black woman remain. A 2016 study published in PNAS reports 40% of medical trainees believing that the skin of Black people is thicker than White people while a 2012 meta-analysis reports that Black women are 22% less likely to receive pain medications than their White counterparts. They are expected to live up to an archetype of a “strong Black woman” who society portrays as being able to withstand an amount of physical and psychological hardship that would never be expected of their White counterparts. It becomes an infuriating double-edged sword when expressing any anger and frustration causes them to be labeled as “crazy” or an “angry Black woman” that may further invalidate their pain in the eyes of medical providers. The stress of this frustration can lead to higher rates of severe, treatment-resistant depression not to mention more long-term pain, exhaustion and disenfranchisement with the medical system in Black populations as noted in Dr. Barr’s Health Disparities in the United States 3rd edition.  Considering the daily racially-motivated microaggressions and discrimination Black women must endure along with the added pressure of not being able to express their emotions and pain the way they want, it’s no wonder that their bodies bear the brunt of this added stress, anxiety, and frustration. This manifests in increased levels of stress hormones and a maternal death rate three times higher than in White populations as noted in a report published in a 2010 issue of Psychological Trauma. 

Within American culture, endurance of strength and hardship has a tendency to be glorified. This is highlighted within the struggles of marginalized individuals like the working class and ethnic minorities as Cody Delistray writes in “Why the Rich Romanticize the Working Class”. It’s why the “rags-to-riches” stories about the American dream or “poverty porn” about the victory of the underdog do so well. While this empowerment and motivation is understandable, they inadvertently apply that survival and struggle is a one-time, linear process and doesn’t account for the daily struggles and battles that people with chronic emotional, physical and psychological pain face. So as tough as it may be, let’s stop acting like enduring menstrual pain and bleeding is a rite of passage that indoctrinates one as a woman. Let’s support more representation of women in all arenas of work to create cultures that give women space to express and share all types of pain in ways they are comfortable. Let’s examine our own implicit biases of how marginalized populations - women+ and especially Black women - should manage pain. Because at the end of the day, these are the only hammers strong enough to shatter the glass box confining women’s strength.

Written by Akansha Das, WHC Pre-med Student Volunteer