Disentangling gender and racial myths from clinical descriptions of female prevalent symptoms

我的博士研究发现，歇斯底里女性的神话无意中影响了医生、研究人员和公众讨论、分类和治疗女性普遍症状的方式。我将专家（医学和学术）和患者对经前综合症的描述与有关周期性症状的现有科学数据进行了比较。主要发现是，与“歇斯底里”相关的持续的性别神话影响了参与者的描述。尤其是，健康的女性身体（首先是子宫，现在是女性性激素）会导致严重的心理健康问题，这一不真实但令人惊讶的普遍信念，强烈地反映在对经前症候群的描述中。不幸的是，这种假设错误地将“所有女性”定位为生理上倾向于非理性信仰和行为（包括夸大、发明或想象症状和其他痛苦经历）（King, 2020）。这种性别迷思似乎导致了对典型的轻度经前情绪变化的不科学区分和优先考虑，以及对更常见和严重的（周期性）疼痛体验的忽视和不优先考虑。与白人顺性别女性相比，黑人和其他种族化的患者似乎更不相信自己的症状，这表明性别和种族神话如何结合在一起，加剧了歧视性的信仰和做法。另一个重要发现是，教育资源（从高中生物学到专业妇科教科书）将月经周期简化为“激素变化”。由于忽略了关于女性生殖系统的关键信息，一个更可能导致周期性症状（炎症）的原因在过去的100年里被忽视了。这种教育上的差距无意中再现了荷尔蒙/歇斯底里女性的神话，并导致了“伪科学”——研究人员错误地认为症状的时间意味着它们一定是由荷尔蒙变化引起的（而不是与排卵、子宫内膜增厚和月经相关的炎症）。许多临床经前症候群研究试图证明女性性激素和周期性症状之间的因果关系，但都失败了。引人注目的是，医学经前症候群专家将这些一贯消极的研究结果定位为女性生殖身体“神秘”本质的证据，而不是其他科学解释的暗示。事实上，医学（以及更广泛的社会）中“女性”和“激素”的配对似乎严重限制了研究人员和临床医生以任何其他方式解释以前女性普遍存在的症状和状况的能力。我的博士论文最后提出了一个建议，将有问题的周期性症状重新定义为PMI（月经周围炎症），以帮助引导社会和医学话语从持久的性别/种族神话和隐喻转向更准确的解释。希望这将有助于解释和照顾个体患者的需求，而不会意外地使整个性别和/或种族化的少数民族群体蒙受耻辱。我已经与布里斯托大学出版社签订了一份合同，为学术和公众读者写一本科普书。我现在需要在一些有影响力的医学和学术期刊上发表我的作品，以获得更大的专业信誉。如果我想获得进一步的研究资金，并说服学校和医学教科书的出版商整合有关健康月经周期的目的和功能的更全面的信息，这将是必要的。最终，我希望能帮助提高患者和医学对月经健康（以及女性普遍症状）的认识，改善治疗方案和患者的治疗效果，并揭露以前社会神话阻碍人们了解这些信息的方式。

My PhD research found that the myth of the hysterical female unintentionally influences the way in whichdoctors, researchers, and the public discuss, categorise, and treat female-prevalent symptoms.I compared expert (medical and academic) and patient accounts of PMS (Premenstrual Syndrome) with theavailable scientific data regarding cyclical symptoms. The main finding was that persistent gender mythsassociated with 'hysteria' were affecting participant descriptions. In particular, the untrue but surprisinglycommon belief that the healthy female body (first the womb, now the female sex hormones) causes seriousmental health issues was strongly reflected in the way in which PMS was described. Unfortunately, thisassumption wrongly positions 'all women' as biologically prone to irrational beliefs and behaviours (includingthe exaggeration, invention, or imagination of symptoms and other distressing experiences) (King, 2020).This gender myth appears to have contributed to the unscientific separation and prioritisation of typically mildpremenstrual mood changes, and the dismissal and de-prioritisation of far more common and severeexperiences of (cyclical) pain. Black and other racialised ethnicity patient participants appeared to be subject toeven higher levels of disbelief in their symptoms than White cisgender women, demonstrating how gender andrace myths may combine to worsen discriminatory beliefs and practices.Another major finding was that educational resources (from high school biology to specialist gynaecologytextbooks) reduce the menstrual cycle to just 'hormonal changes'. By omitting key information about thefemale reproductive system, a more likely cause of cyclical symptoms (inflammation) has been overlooked forthe past 100 years. This gap in education unintentionally reproduces the myth of the hormonal/ hystericalfemale and has led to 'bad science'- in that researchers have mistakenly assumed that the timing of symptomsmeans that they must be caused by hormonal changes (rather than the inflammation associated withovulation, thickening of the womb lining, and menstruation).Many clinical PMS studies have tried but failed to prove a causal relationship between the female sexhormones and cyclical symptoms. Tellingly, these consistently negative study findings were positioned by themedical PMS experts as evidence of the 'mysterious' nature of the female reproductive body rather thansuggestive of alternative scientific explanations. In fact, it appears that the pairing of 'women' and 'hormones'in medicine (and wider society) has severely limited the ability of researchers and clinicians to account forfemale-prevalent symptoms and conditions in any other terms.My PhD thesis concluded with a proposal for redefining problematic cyclical symptoms as PMI (PerimenstrualInflammation) to help steer societal and medical discourses away from persistent gender/ race myths andmetaphors towards more accurate explanations. It is hoped that this will help to account for, and attend to, theneeds of individual patients without accidentally stigmatising an entire gender and/ or racialised ethnicpopulation. I already have a contract with Bristol University Press to write a popular science book for academic and publicaudiences. I now need to publish my work in some influential medical and academic journals to gain greaterprofessional credibility. This will be needed if I am to secure further research funding and persuade thepublishers of school and medical textbooks to integrate more comprehensive information about the purposeand function of the healthy menstrual cycle. Ultimately, I hope to help boost patient and medical knowledge ofmenstrual health (and female-prevalent symptoms), improve treatment options and patient outcomes, andexpose the way in which societal myths have prevented this information from being taught before.