Updated Nov. 19, 2024 at 3:30 p.m.*
BERLIN — Wednesday afternoon, on the fourth floor of a large German hospital. While I’m donating blood, I strike up a conversation with the young doctoral student beside me. I ask her, “Have you heard of the hashtag #Frauenticket (Woman’s Ticket)?” She gives me a blank look, so I jump into a short lecture on medical gaslighting.
“Medical what?” she says, clearly puzzled. Turns out, she hasn’t heard a whisper about it in all her years of medical school.
[shortcode-Women-worldwide–Sign-up-box]
Here’s how it goes: when medical professionals play down your symptoms, brushing them off as “stress-induced” or “psychological,” you’ve just been handed the infamous Women’s Ticket.
Annika Hofman shared on X (formerly Twitter), “A friend called emergency services on a Sunday because she’d been suffering from severe chest and back pain since Friday night. The doctor arrived, clearly annoyed, gave her a quick once-over, and said it wasn’t her heart, so there was no need to panic. Well — guess what? It was a heart attack.”
Delaine Summer has a story too: “I was in the hospital with a whole range of symptoms — stomach pain, diarrhea, nausea — and I’d lost a lot of weight. The doctor’s response? ‘Are you sure you’re not anorexic?’ I had Crohn’s disease.”
On the account Privatfrau, someone wrote: “‘Stop whining. You’re young, you’re healthy. Maybe just a little dramatic, but there are painkillers for that.’ That’s what the gynecologist told me. Sixteen years later, I finally got diagnosed with endometriosis.”
“Madness” and “nonsense”
Women or other non-cis-male individuals are more likely to experience misdiagnosis or gaslighting, and the phenomenon has also been scientifically investigated. For example, in a comprehensive U.S. study on strokes, in a large analysis of heart attacks or in a smaller study on adrenal insufficiency.
The American Heart Association released a paper showing that women are generally treated worse and later for heart attacks, which leads to more deaths than men. In the UK, it was shown that men are on average diagnosed with cancer more quickly after the onset of symptoms. A comprehensive 2021 study using data from across Europe found that women with traumatic brain injury are less likely to be treated in intensive care and are discharged more quickly — as a consequence, six months after the injury, they are on average worse off than men. There is a significant gender gap in medical gaslighting, but similar findings exist for people of color.
Kleinschnitz describes the illnesses as “madness,” “nonsense,” bordering on “delusional.”
The hashtag #Frauenticket comes from an episode of the ZDF Magazin Royale journalistic-satirical late-night show on German public broadcaster ZDF: “Try drinking some tea: when you are chronically ill and nobody believes you.” It was about the serious, neuroimmunological disease myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which can result from long COVID, and the often inhumane treatment of patients like me who suffer from it.
Here too, gender differences abound: women are disproportionately affected by ME/CFS and long COVID — about twice as often as men. And that’s precisely why, when it comes to ME/CFS, there are hundreds of documented cases of gaslighting.
The hashtag is to a certain extent a hostile takeover — or rather, an appropriation. Originally, the phrase came from neurologist Christoph Kleinschnitz, director of the Neurology Clinic at University Hospital Essen. On his show ZDF Magazin Royale, Jan Böhmermann called Kleinschnitz a troll, since the neurologist has publicly mocked, belittled, and dismissed people affected by long COVID and ME/CFS, as well as researchers in the field, for years. Kleinschnitz describes the illnesses as “madness,” “nonsense,” bordering on “delusional,” and a “medical parallel universe.”
Psychologization of symptoms
Kleinschnitz publicly describes those affected as “aggressive” — and asks a patient on X: ” Where did you get the strength to post? No more ME/CFS?”. Shortly before the broadcast, the neurologist deleted 97 of his tweets and then even his account – but the internet does not forget: those affected collect the insulting tweets that trivialize the disease on a platform. ZDF Magazin Royale quoted some of Kleinschnitz’s posts, including the most famous one: “I’ve been hearing the same panic stories for 4 years. It’s basically the women’s season ticket.” Böhmermann borrowed the women’s ticket quote, made it his hashtag of the week and thus started a movement that, while not as big as #metoo, shows similar structural problems.
Doctors are more likely to attribute women’s physical complaints to psychological causes
Gaslighting is a form of psychological violence in which victims are manipulated through lies, denial, distraction and intimidation tactics and are made to doubt their own perceptions. The term is derived from Gas Light, a play that has been made into a film several times, in which a woman is driven insane by her husband.
Within a power relationship between patients and doctors, this form of manipulation is called medical gaslighting: the inability or willingness of doctors to respond appropriately to the suffering of patients by downplaying, ignoring and ridiculing symptoms.
Medical gaslighting is closely interwoven with the psychologization of illnesses. Here, too, there is a gender gap: “It is a well-known phenomenon that doctors are more likely to attribute women’s physical complaints to psychological causes than they would do with men,” says Georg Schomerus from Leipzig University Hospital. The psychiatrist has been researching stigma in the medical field for years. In an experiment in the U.S., for example, 123 doctors diagnosed psychological causes for physical conditions with women twice as often as with men, which can lead to misdiagnosis and incorrect treatments.
“Corrupt female organs”
The tendency to psychologize women’s symptoms isn’t new. In the 13th-century medical text Secreta Mulierum (Secrets of Women), women’s bodies were described as having “corrupt female organs” with a “devilish influence on character and temperament.”
For centuries, women’s pain has been trivialized, female bodies mystified, and depicted as “flawed and dangerous” in religious and medical narratives, writes British cultural historian Elinor Cleghorn. By the 19th century, doctors claimed ovarian disorders arose due to “moral failings” or “states of excitement.” This rather absurd assumption — that female pain stems from emotions rather than physical causes — perpetuates the stereotype of women as hypochondriacs and attention seekers, says Cleghorn.
The trivialization of long COVID and ME/CFS similarly reflects a legacy of prejudice. Despite the WHO recognizing ME/CFS as a neurological illness since 1969, the condition has been structurally sidelined for decades. In 1970, two psychoanalysts speculated in the British Medical Journal that conditions like these might be “mass hysteria,” largely because women are most affected. In 1987, Time Magazine called it a form of hysteria and a “yuppie disease.”
Misdiagnoses, social isolation, fear
Since those affected often don’t “look sick,” even friends, family, and healthcare providers struggle to believe them. The toll is severe: misdiagnoses, social isolation, anxiety, and lowered quality of life, with some patients experiencing suicidal thoughts. Kleinschnitz commented on a report about the increased suicide risk for ME/CFS patients: “Yes, it’s tragic when people with depression commit suicide. But it’s equally tragic that in 2024, psychiatrists and neurologists treat #ME/CFS and #LongCOVID as real conditions. THAT is the scandal.”
Sure, due to the stress experienced during the pandemic or after a COVID infection, people can develop psychological illnesses such as depression, anxiety disorders or post-traumatic stress disorder. But the fact that long COVID and ME/CFS have physical causes and can cause organic damage is internationally undisputed. Let’s be clear about this: hardly any doctor or affected person would deny that these illnesses can also have psychological components. But psychosomatic is not the same as imaginary. Severe physical and disabling illnesses can be accompanied by mental illnesses.
An ENT doctor said to his receptionist after I fainted: “Oh, she’s a sensitive soul.”
The delegitimization of long COVID and ME/CFS has been a topic of discussion among patients on social media platforms such as X for years. Olga Öhler collects hundreds of cases in her archive of the lack of care on Instagram, plus the posts with the hashtag #Frauenticket.
I also shared my own, relatively harmless, #Frauenticket moments — as I myself am affected by long COVID and ME/CFS: “I remember when a doctor said to me, even though I had not even been able to go to the bathroom alone that day: ‘Everything is fine.’ A cardiologist said, despite visible cardiac arrhythmias: ‘Perhaps you need to relax more.’ An ENT doctor said to his receptionist after I fainted: ‘Oh, she’s a sensitive soul.'”
Another form of sexism
The cultural historian Cleghorn calls the phenomenon behind delegitimization, stigmatization, psychologization and medical gaslighting “medical sexism.”
It’s structural: in 1993, the US Food and Drug Administration (FDA)demanded that both sexes be taken into account in clinical trials: until the 1990s, there were hardly any medical studies involving women. And only this year did the University of Graz become one of the first to include ME/CFS in regular human medicine studies. In addition, for decades hardly any research funding was made available to research the disease. Many of the illnesses that had previously been psychological were only understood when technology was advanced enough for a physical diagnosis. Multiple sclerosis, for example, was considered a psychosomatic hysteria by parts of the medical profession until the 1960s.
Capitalist and neoliberal pressures to perform and monetize also exacerbate medical gaslighting
But to what extent can discriminatory structures be changed? In order to combat sexism in medicine, we need awareness of the complex power relationship between doctors and patients. Capitalist and neoliberal pressures to perform and monetize also exacerbate medical gaslighting; medical staff in hospitals, for example, are often heavily overworked due to privatization and austerity measures, which leaves little time for complicated diagnoses, training on new illnesses, and empathy.
In addition, doctors need to individually admit that they do not always know everything. As Cleghorn puts it: “The depressingly frequent reaction to women whose symptoms did not correspond to any ‘objective factors’ was not: ‘I don’t know’, but rather: ‘I don’t care’”. The doctor and author Natalie Grams, who has written a book about her illness, wishes that her ME/CFS symptoms “were taken as seriously as a broken arm.” And Cleghorn makes a request that is as simple as it is urgent: if a woman — or a non-cis male person — “says that she is in pain, just believe her.”
*Originally published Nov. 12, 2024, this article was updated Nov. 19, 2024 with enriched media.
