Counter, Withhold, Trivialize, Denial, Divert, Stereotype.
The conversation about pain bias in health care and the dismissal of women and the marginalized
queer-trans community’s symptoms has been ongoing for decades. Science and evidence have
emerged to show how sex and gender impact various diseases, yet our healthcare delivery model
lags. Some medical practitioners still practice medicine based on the problematic "one-size-fits-
all" approach to diagnosis and treatment. A sex- and gender-based approach to disease
management is not even on their radar.
Female hysteria was once a common medical diagnosis for women, applied whenever women
displayed "inappropriate" emotions such as anxiety, anger, and even sexual desire. There’s this
pervasive belief in the medical community, that every time a woman or gender-nonconforming
individual complains about health, it is either related to hormones or all in the head. For women,
how often she gets angry, only to be asked if she’s about to get her period? Or how often she complains about weight gain, only to be told that it’s related to hormones. It isn’t the hormones
making them anxious or upset but the condescending attitudes. For centuries, it was believed that
the uterus itself was the cause of a woman’s "hysterical" symptoms as the word "hysteria" is
derived from the Greek word "hysteria" which means uterus. Even Hippocrates believed that the
womb traveled throughout the body causing hysteria, a psychological diagnosis that was only
removed with the updated Diagnostic and Statistical Manual of Mental Disorders, 3rd ed, in
Within cisnormative social and cultural structures, there is a large amount of hate speech,
exclusion, and trickery, as well as institutional, structural, cultural, and interpersonal dominance,
and control against the trans and gender-diverse community using the tool of gaslighting. Several
recent studies have highlighted that transgender people experience high levels of identity-related
abuse. Identity-related abuse can involve physical, emotional, and/or financial abuse concerning
gender and gender presentation. More specifically, this may involve denying someone is
transgender, commenting negatively about a person’s appearance or body, or intentionally using
the wrong pronoun and/or name. Asking someone to not disclose they are transgender to others,
threatening to tell other people that someone is transgender, and withholding medicine or money
for medicines or surgery in the medical setting invalidates their mere existence. The HIV/AIDS
intervention approach led to a lasting wrongful portrayal of queer-trans individuals as solely
being held responsible for the epidemic. There hasn’t been a conversation regarding the health of
people with a compromised immune system, queer-trans-friendly mental healthcare, queer/trans-
friendly staff, and caretakers. Queer/trans people, who are already discriminated against, are still
socially seen as disease-carrying individuals to be avoided and isolated at all costs. They are 49
times more likely to be HIV infected than the general population (Baral et al 2013). In India, the
estimated queer/trans-HIV prevalence (9%) is 20 times that of the cis-population, the highest
being among sex workers (NACO 2014a).
Gaslighting can be differentiated from other forms of bullying in medicine because it does not
involve public humiliation, specific threats, or blatant insults. It is more subtle and private. While
it might not result in full-blown delusions or misshaping of memory, this abuse can have lasting
effects on the self-esteem and mental health of the people seeking help.
Gaslighting is entrenched in power structures. Women often lack the cultural, economic, and
social capital to effectively gaslight men, hence patriarchal power structures are exacerbated by
intersecting issues of age, social class, race, and gender.
Research suggests that diagnostic errors occur in one out of every seven encounters between a
doctor and patient, most of these mistakes driven by the physician’s lack of knowledge. India has
encountered several experimental practices of gender-transforming procedures. Patients have
been gaslighted into doing so, without being consulted about the process.
For the most part, doctors aren’t intentionally dismissive. Doctors often work under immense
pressure and are overburdened. With only so much time to allot to each patient in a day,
oversight is easy and mistakes do happen. They get so deep into pure facts and figures that they
tend to forget the human aspect of it. They stop paying attention to what each individual is
saying and mentally start running through the disease checklist they have memorized all the
years. A doctor’s visit or getting medical attention is a collaborative experience, and one deserves
to feel listened to. If the provider is being dismissive, one needs to push back to come up with a
diagnosis and treatment plan together, else finding another doctor is suggested.
• Women in Bihar initiated a campaign " pass the safety pin " to raise a call for dignified
healthcare and voice a collective demand to create safe spaces where they can seek
treatment without judgment. They shared their stories of gendered discrimination while
accessing medical care. The safety pin was chosen because of its accessibility for women
from all walks of life.
• World-famous tennis champion Serena Williams has dealt with medical gaslighting that
nearly cost her her life. In a Vogue interview, Williams opened up about her medical
complications post-delivery. With a history of pulmonary embolisms, she knew
something was wrong. It took insisting on convincing on her part to get the medical team
to take her seriously.
• Another case had been reported against the SNR Carnival hospital, Kalyani. The
institution supposedly performed a hysterectomy on a woman in 2013, even though there
was no direct indication of malignancy in the uterus or ovary of the patient who then
suffered post-hysterectomy Vesicovaginal Fistula (VVF). Eventually, the patient
underwent a further operation at CMC, Vellore that incurred huge expenditure. The
council claimed that the couple was not suggested alternative methods, and the procedure
was performed without informed consent, which violates the principle framed by the
Medical Council Of India and other organizations. The case is being actively reviewed
and a decision will be made accordingly.
• Several cases have been recorded where patients especially women and the minority
community who already struggle to access medical facilities have not been taken
seriously when they shared their painful experiences. They are more likely to receive
sedatives rather than the pain medication they need.
• Obstetric violence – abusing pregnant women is common in Indian Medical System and
hardly discussed. There have been records during childbirth, where women were
mistreated and did not feel heard. Due to the social norm stating women as child bearers
can endure pain with ease, the medical practitioners denied mothers' reality. They are
expected to feel the pain and not complain, or else they face abuse.
One such case happened to take place in Keonjhar, Orissa. A pregnant lady died due to
negligence and poor treatment by the District Headquarters Hospital, Keonjhar on
23.03.2016 while undergoing a cesarean operation. According to the reports, her
expected date of delivery was 23.03.2016. On 22.03.2016 she felt labor pain and was
immediately rushed to the hospital, but was sent back home as the doctor in charge of
examining her claimed it was a false pain. She had to be admitted to the hospital again
within a few hours due to severe pain. Eventually, after delivering her infant, she passed
away because of the mere negligence of the authority and the medical staff. Although
they compensated the family, we cannot overlook the lost life. Unfortunately, cases like
this occur too often.
When it comes to the people from the marginalized community - the queer-trans, parents, and
doctors act in what they believe is in the best interest of the child. They operate on the infant to
conform the body to the "normal" male or female. For instance, a baby with dominantly female
characteristics and a clitoris larger than 'normal' could appear like a small penis. Parents go for
surgery to cut the clitoris to the normal size. This amounts to female genital mutilation, a
grievous human rights violation.
Sometimes in dignifying the "social norm" too much, medical practitioners end up ignoring
crucial issues like providing screening and diagnostic tests for the queer community.
Written by : Manisha Bhaduri
Supported by : Tanisha Das