Laura: One in four women in the US will have an abortion. 80% of Black women will develop fibroids. Up to 90% of all women will suffer from a debilitating gynecologic issue. So why does the medical system still treat these as niche problems, or worse, as 'hysteria'? Sophia: Wow. When you put the numbers like that, it's staggering. These aren't rare conditions; they are the majority experience. The disconnect between how common these issues are and how little they're taken seriously is just… wild. Laura: It’s the central paradox, and it’s the explosive question at the heart of It's Not Hysteria by Dr. Karen Tang. Sophia: And Dr. Tang isn't just an author; she's a board-certified gynecologic surgeon with a Master's in Public Health. She's in the trenches, seeing this every single day. Laura: Exactly. And she published this book in 2024, right in the middle of this incredibly fraught political moment for reproductive health. It makes her message of self-advocacy feel less like friendly advice and more like an essential survival guide. The book has been incredibly well-received, a finalist for major reader awards, because it’s hitting a nerve that has been ignored for centuries. Sophia: A survival guide. I like that. It feels urgent. So where does this all begin? Why the disconnect? Laura: Well, the book’s title is a direct shot at the oldest, most persistent myth in all of medicine. It starts with a concept that is so bizarre it’s almost funny, until you realize its ghost still haunts modern medicine.

Sophia: Okay, I’m intrigued. What is this ancient, bizarre concept? Laura: Get ready for this. The ancient Greeks, including Hippocrates, believed in something called the "wandering womb." Sophia: The… wandering womb? You mean they thought the uterus could just… pack a bag and go on vacation around the body? Laura: Pretty much! They described it as an 'indwelling creature' that, if it wasn't kept happy with sex and pregnancy, would get restless and wander through the body, blocking passages and causing everything from anxiety and shortness of breath to seizures. Sophia: So the uterus was basically a rogue pet that you had to appease? That is absolutely absurd. But come on, how on earth does a 2,000-year-old bad idea still affect my doctor's appointment today? Laura: That's the insidious part. The idea evolved. By the 19th century, the wandering womb was gone, but the core idea—that a woman's problems originate from her uterus—remained. It was rebranded as "hysteria," from the Greek word for uterus, hystera. But it was no longer seen as a physical problem. It became a psychological one. A catch-all diagnosis for any woman who was too emotional, too anxious, too defiant. Sophia: Ah, so the problem wasn't a physical organ anymore. The problem was the woman herself. Laura: Precisely. Dr. Tang brings up the story of Charlotte Perkins Gilman, the author of the famous short story "The Yellow Wallpaper." Gilman suffered from what was likely postpartum depression, and her doctor prescribed the "rest cure." Sophia: I’ve heard of this. It sounds relaxing, but I have a feeling it wasn't. Laura: It was a nightmare. She was confined to her bed, forbidden from working, writing, or any intellectual activity. She was basically told not to think. The cure drove her, in her words, to the brink of "mental ruin." Her story, "The Yellow Wallpaper," is about a woman who is slowly driven mad by this exact treatment. Sophia: That’s the root of it, isn't it? The idea that our physical pain, our emotional distress, is actually a mental or emotional failing. It’s not a real medical issue; it’s just you being… hysterical. Laura: Exactly. And that’s the ghost that Dr. Tang is trying to exorcise. The book argues that this legacy of dismissal is why, even today, women's pain is so often minimized. It's why a patient can go to the doctor with debilitating symptoms and be told it’s just stress, or that she’s exaggerating, or that she should just learn to live with it. Sophia: It’s the modern-day "rest cure." Instead of a bed, you're just sent home with a pat on the head and a prescription for "calm down." Laura: And that dismissal has a measurable, devastating cost. Which brings us to the book's most powerful modern example of this legacy in action.

Laura: The book uses endometriosis as its prime case study. And it opens with a statistic that should stop everyone in their tracks. It takes the average endometriosis patient seven years and visits to five or more doctors to receive a correct diagnosis. Sophia: Seven years? That can't be right. That’s almost a decade of someone's life. What is happening in that time? It can't just be waiting. Laura: It's not waiting; it's an active, painful journey of being dismissed. Dr. Tang tells the archetypal story of this patient. She’s a young woman with debilitating pelvic pain, heavy periods, fatigue, and bowel issues. She goes to her first doctor and is told, "Oh, that's just bad periods. It's normal for women to have pain." Sophia: "Common" is not the same as "normal." That's a line from the book that really stood out. Laura: Exactly. So she tries to live with it. But the pain gets worse. It affects her work, her social life. So she sees another doctor, maybe a gastroenterologist for her bowel issues. They run some tests, an ultrasound, blood work. Everything comes back "normal." She gets a diagnosis of Irritable Bowel Syndrome, or IBS. Sophia: Which is another one of those catch-all diagnoses that can sometimes feel like a dismissal in itself. Laura: Right. So she's trying treatments for IBS, but they don't work because that's not the root problem. Years go by. She sees more specialists. She's frustrated, exhausted, and starting to believe maybe it is all in her head. Maybe she's just weak. Sophia: This is heartbreaking. Is this just a case of a few bad, dismissive doctors, or is the whole system broken? Laura: Dr. Tang argues it's the system. First, there's a massive gap in research and funding. She points out that in 2022, the National Institutes of Health allocated more money to research smallpox—a disease eradicated from the US in 1949—than it did to endometriosis or fibroids. Sophia: Hold on. More money for smallpox than for a condition that affects one in ten women? That’s not a bug in the system; that's a feature. That's a choice. Laura: It's a choice rooted in that history we just talked about. Medical problems that primarily affect women are just not prioritized. There's no simple blood test or scan for endometriosis. The only definitive way to diagnose it is through laparoscopic surgery. So without objective data, and with this historical bias to see women's pain as psychological, the default response is dismissal. It’s why so many readers have said this book made them feel "seen" for the first time. Sophia: Okay, this is infuriating and, honestly, feels a bit hopeless. If the system is this broken and biased, what does Dr. Tang say we can actually do about it? We can't all wait seven years. Laura: We can't. And this is where the book shifts from diagnosis of the problem to a powerful, practical solution. It’s about flipping the script.

Laura: Dr. Tang’s core solution is that you have to become the lead investigator and primary advocate in your own case. She says that while labs and imaging are important, and I quote, "your story provides your doctor with the road map to understanding your health." Sophia: I love that. The idea that our personal narrative is actually a critical piece of medical data. A 'road map' sounds great, but what does that actually look like in practice? What do I write down before my 15-minute appointment to make sure I’m heard? Laura: This is the most practical part of the book. She provides a framework. It’s not enough to say, "I have bad cramps." You need to provide specific, quantifiable data. Sophia: Give me an example. What's the difference between a "bad" story and a "good" road map? Laura: A "bad" story is, "My periods are really painful and I have bowel problems." A "good" road map is, "For the last six months, during the first three days of my period, I experience sharp, stabbing pelvic pain that I would rate an 8 out of 10. This pain prevents me from going to work. It's accompanied by diarrhea and painful bowel movements. Outside of my period, I have a constant, dull ache that is a 3 out of 10." Sophia: That is a world of difference. One is a subjective complaint; the other is a set of data points that a doctor can't easily dismiss. You're essentially building a case file for your own body. Laura: You are. You're tracking your cycle, the type of pain, the location, the timing. You're tracking how it impacts your quality of life. Are you missing work? Canceling social plans? Is sex painful? Dr. Tang says to come prepared with your top three concerns written down, and to be explicit about your goal for the visit. Is it a diagnosis? Is it pain management? Is it discussing fertility? Sophia: You're essentially becoming the CEO of your own health. You're walking in with an agenda, data, and a clear objective. It shifts the power dynamic. Laura: Completely. It moves you from being a passive recipient of care—or dismissal—to an active participant. It forces the conversation to be grounded in your lived experience, which, as Dr. Tang argues, is the most important evidence of all.

Sophia: It’s so much more than just getting a diagnosis, then. It’s about reclaiming the narrative. We're moving from being the subject of a medical mystery, where we're told our feelings aren't real, to being the lead author of our own health story. Laura: Exactly. And Dr. Tang's ultimate message is that this isn't a solo fight. She wrote the book to break the cycle of misinformation and suffering. She urges readers to share their stories, to talk to their friends and family, to break the stigma that keeps these issues in the shadows. Sophia: Because if 90% of us are dealing with this, it's not a personal failing. It's a public health crisis that's been ignored. Laura: It is. The book ends with this powerful idea, a quote from comedian Ali Wong about childbirth: "I have suffered enough." Dr. Tang applies that to all of these conditions. Just because something is a biological function doesn't mean the pain is acceptable or that you must continue suffering. Sophia: That’s the perfect takeaway. It makes you wonder, how many of us are tolerating something 'common' that is absolutely not 'normal'? And what would change if we all decided we've suffered enough? Laura: A powerful question to end on. This is Aibrary, signing off.