Crying to be heard: women in emotional pain

I am struck by how often crying is overlooked or trivialized by doctors despite its therapeutic value and need for recognition. Crying can play a significant role in healing and overall well-being. Research has shown that crying serves as an emotional release, provides pain relief, reduces stress, improves mood, and enhances communication. Encouraging a culture of acceptance and understanding around crying in medical settings can contribute to holistic and empathetic patient care.

Women are more prone to crying than men, and this does not always benefit them when distressed and seeking care. Crying women are often labeled “hysterical” or “emotional.” Their complaints are taken less seriously, and their fears are often diminished. Women may feel vulnerable and may need more time with a caregiver to help process their concerns, yet they are afforded less time, either because the caregiver is unsure how to react to a crying woman – and retreats from sight – or because they view providing solace to a woman in tears is someone else’s job. Male physicians are highly likely to turn their backs on crying women, reacting out of bias, without showing a modicum of bedside manner.

British humanities and women’s rights scholar Elinor Cleghorn demonstrates in her book Unwell Women how the medical profession is mired in myth and misbeliefs about women. The history of medicine shows that men donning white coats have controlled the fate of women, and doctors’ knowledge about women’s susceptibility to illness and disease has been shaped and distorted by prejudicial beliefs dating back to ancient Greece.

For example, centuries ago, it was believed that a disconnected and “wandering womb” (uterus) was to blame for a variety of ailments, including excessive emotion, or hysteria. Hence, hysterectomy, from the Greek word hysterika, meaning uterus, became a viable cure for physical and mental disorders in women. Contemporary medical research has shown that women are less likely than men to survive traumatic health episodes like heart attacks when under the care of male doctors. Women are considerably more likely to say they prefer treatment by a female physician.

My wife and I witnessed first-hand just how callous and unsympathetic some male physicians can be. Prior to and after the birth of our son in 1986, my wife had suffered several miscarriages. In 1988, we discovered she was pregnant again and in her first trimester. The fertility specialist she was seeing suggested we come into the office to confirm the pregnancy by ultrasound. The ultrasound technician turned to me and asked, “Would you be upset if I told you I think I see two heartbeats?” Miracle of miracles! Twins!

We were elated, and my wife began to cry happy tears. We returned to the waiting room to see the doctor. Tears continued to flow down my wife’s cheeks, and I hugged her tight. No one in the busy waiting room inquired what was happening. None of the staff came to check on us. No one offered my wife a box of Kleenex. No one – anyone – asked if everything was alright. They simply assumed my wife had miscarried – after all, it was a fertility clinic accustomed to delivering bad news. (Even under those circumstances some consolation should have been forthcoming.)

My wife blurted out: “We’re having twins!” People came over to congratulate us, sharing in the joyous occasion. It was only then that kindness and good wishes were bestowed upon us. The doctor was nonplussed by everyone’s reaction, attributing the outcome to “good science.”

Several years later, we suffered an agonizing loss: fetal demise. Everything was going well until the OB/GYN informed my wife that, at 20 weeks’ gestation, he did not hear a heartbeat on his exam, and it was subsequently confirmed by ultrasound. Later that night labor was induced to deliver the baby, a dead baby boy whom we had already named. The doctor let us view him briefly, and then they – the doctor and our baby – vanished. The nurses unemotionally took care of my wife while both of us wept. We were handed the discharge instructions with barely a “goodbye.”

Let me be clear. This essay is not meant to be a battle of the sexes. Not all male doctors are indifferent to the plight of female patients – women physicians can show disregard too – and it’s not only women whose symptoms may not be taken seriously. Men’s ailments may be ignored by physicians of either gender, and men tend to suffer silently and are more reluctant to seek care in general. It’s just that I’ve heard more accounts from women about how dispassionately male doctors have treated them.

My colleague’s wife, a psychologist, nearly bled to death after a complicated delivery. Once stabilized, she was left alone for hours with unimaginable thoughts and without her doctor checking in on her. She was permanently traumatized by the experience. Along with her (then) husband (my colleague), the psychologist decided to write a textbook: Managing the Psychological Impact of Medical Trauma. The book was the first to conceptualize medical trauma and provide health care practitioners with best practices for treating trauma in health care settings, trauma ranging from neglect to near-death experiences.

I commend my colleagues for producing a textbook on trauma-informed, patient-centered care, and I lament that it had to be written in the first place. Why has it taken countless stories from grieving women to have their feelings validated? How is it that some medical professionals cannot identify or deal with patients who suffer and cry, patients who are then at risk for PTSD and other mental health disorders due to aversive medical encounters? Such encounters can arise so easily, and they occur too often.

Worse yet, why, when I tried to find out more information about physicians’ reactions to crying patients by googling the topic on the Internet, was the first hit an article titled “Should Doctors Cry at Work?” Give me a break!

Crying holds a significant therapeutic value in medicine. Crying is a natural response to many feelings created by the hardships and uncertainty associated with physical and mental illnesses. Crying can be incorporated into comprehensive patient care plans and inform treatment. But women should not have to cry a river of tears to be accurately diagnosed, tended to with empathy, recognized for courage, and treated respectfully.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.


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