Podcast Summary: unPAUSED with Dr. Mary Claire Haver

Episode: "From Hysteria to Medical Gaslighting and the Path Forward with Dr. Elizabeth Comen"

Release Date: January 13, 2026
Host: Dr. Mary Claire Haver
Guest: Dr. Elizabeth Comen, Author of It’s All in Her Head

Overview

This episode dives deep into the marginalized experience of women in medicine—historically and presently—with oncology expert Dr. Elizabeth Comen, whose book It’s All in Her Head traces the systemic roots of medical gaslighting and bias against women. Dr. Mary Claire Haver and Dr. Comen explore the legacy of female health myths, underfunding, and clinical neglect, connecting personal stories, medical education, and the urgent need for change in how women's health is prioritized and valued.

Key Discussion Points and Insights

1. Guest Background and Motivation for Writing (05:24–10:17)

• Dr. Elizabeth Comen’s Journey:
  • Grew up in Brookline, Massachusetts, with a curiosity fostered by her therapist mother and lawyer father.
  • Studied the history of science at Harvard, then attended Harvard Medical School before training in oncology at NYU (08:05).
  • Early exposure to breast cancer patients led her to oncology, driven by a fascination with patients’ stories and the existential questions illness raises.
• Motivation for Book:
  • Stories of women being dismissed across specialties spurred her research into the history and perpetuation of these gaps.
  • Realized the systemic nature of gender bias in medicine.

2. Systemic Biases: Medical Gaslighting, Shame, and Apologies (10:56–18:52)

• Perpetuation of Shame:
  • Women commonly apologize for their bodies even in clinical contexts, regardless of status or resources (00:00, 16:51).

    "Almost all women in a doctor’s office will apologize for something about their body. And I think that it’s terrible." — Dr. Comen [00:00, 16:51]

• Doctor-Patient Relationship Reflects Societal Norms:
  • Cultural conditioning leads women to internalize shame, even on their deathbed.

    "I went to give her a hug...and she said to me, 'Thank you and I’m so sorry for sweating on you.' And I thought, my God...she’s choosing to apologize to me for sweating." — Dr. Comen [14:21]

• Historical Context Matters:
  • The book combines patient stories with a historical examination to show how bias is baked into the structure of medicine, from curricula to reimbursement.

3. Financial and Structural Inequities in Medicine (19:26–21:15)

• Insurance Reimbursement Disparities:
  • Procedures for women, especially gynecologic surgeries, are reimbursed far less than identical male procedures.

    "Female surgeries tend to be a lot more complicated...yet they’re getting reimbursed so much more for an identical procedure." — Dr. Haver [20:23]

• Societal Devaluation of Women’s Health:
  • The undervaluation is systemic and affects who gets care and who remains unwell.

4. Medical Education: Blind Spots and Myths (23:19–34:36)

• Organ-System Approach to Bias:
  • Dr. Comen’s book provides a tour through organ systems, uncovering the unique ways each specialty marginalizes women (23:19).
• Plastic Surgery’s Origins and Beauty Bias:

  "Male doctors acted as both enablers and enforcers of women’s beauty, putting the stamp of medical legitimacy on the social pressure to be pretty." — Quoted from It’s All in Her Head, shared by Dr. Haver [25:06]

• Labia Myths and Cultural Mutilation:
  • The legacy of shaming women’s normal anatomy—whether via labiaplasty or FGM—demonstrates a lack of education on natural variation and harm caused by external ideals (28:59).
• The “Bicycle Face” and Exercise Myths:
  • Debates over female autonomy in physical activity were couched as concern for fertility, appearance, or imagined diseases in respected medical journals (30:01).

    "There was a debate in the medical community...is this going to be safe for them? Their uterus might fall out...[they] could contract 'bicycle face.'" — Dr. Comen [30:02]

5. Disease-Specific Gaps: Cardiology, Autoimmune, Endocrine, and More (35:07–40:35)

• Women’s Heart Disease:
  • Early risk markers like preeclampsia are overlooked (35:10).
  • Historical dismissal—“neurotic angina”—set a pattern for misdiagnosis.

    "[Osler] would attribute something other than a cardiac problem, psychological instead. He wrote, 'These women do not die.' And I thought, well, there it is. We are dying." — Dr. Comen [36:24]

• Gendered Symptom Presentation:
  • Women’s heart attacks are often missed or misdiagnosed as panic attacks due to non-classic symptoms (37:34).
• Autoimmune Disease Underfunding:
  • 80% of autoimmune diseases affect women, yet the field isn’t considered “women’s health,” and funding/study design lags (38:50).

    "If you have a patient coming to you, what knowledge do you have from pornography? It’s terrifying how many women are mutilating their bodies." — Dr. Comen [29:32]

6. The Roots of Medical Sexism: Anatomy, Motherhood, and Sexuality (47:29–50:02)

• Motherhood-Centrism and Anatomical Myopia:
  • Women’s value in medicine historically ties solely to reproduction, limiting clinical, research, and anatomical attention.

    "A woman’s health, her happiness, and even her freedom from pain are all secondary to her biological destiny to become a mother." — Dr. Comen [47:29] "Grey’s Anatomy...sometimes didn’t even have the clitoris in it in the 1940s. It was never missing from women’s bodies." — Dr. Comen [48:33]

• Delayed or Denied Diagnosis:
  • E.g., endometriosis diagnosed faster if tied to infertility rather than pain, showing continued bias in whose suffering is "counted" (49:21).

7. Sex, Ageism, and the Neglect of Women’s Sexuality (50:02–52:30)

• Sexuality in Aging Women:
  • Clinical neglect of sexual side effects of cancer treatment in older women persists.

    "You didn’t ask me about my special friend...It’s my vibrator, Dr. Coleman, and I’m not enjoying myself...You didn’t address these needs." — Dr. Comen’s patient [50:48]

• Normalized Ageism:
  • Sexuality in older women is often disregarded, leading to missed opportunities for care.

8. Generational Myths and the Path Forward (53:47–57:58)

• Destiny vs. Determinism:
  • Dementia and frailty are not inevitable; better attention and education can change outcomes.
• Historical Blind Spots:
  • Founders of gynecology institutionalized women for natural behaviors, influencing current attitudes toward women’s health and cognitive function (55:13).
• Call for Research and Funding:
  • Massive disparities exist in research dollars, perpetuated by biased priorities at every level (56:03).

9. Medical Culture, Female Physicians, and Hope (66:41–72:32)

• Female Clinicians’ Impact:
  • Female physicians spend more time, listen more, and achieve better outcomes, but these skills aren’t recognized or financially rewarded (66:41).
  • Studies document lower patient mortality and readmission, especially for female patients, when cared for by female clinicians (67:44).
• Education Gaps and Cultural Change Needs:
  • Medical education and continuing education must tackle sex differences for every specialty, not just OB-GYN (62:58).
• Hope and Unpausing:
  • Dr. Comen expresses optimism, highlighting new collaborative approaches, improved medical education, and cultural shifts.

    "As the history of medicine has showed us, when you change the cultural narrative, you will change these institutions as well." — Dr. Comen [70:08]

  • The conversation returns to empowering women of all ages to set boundaries, seek community, and refuse to apologize for seeking the care they deserve.

Notable Quotes

1. On systemic bias:

"This wasn’t about a few bad apples or a rare oversight. This was structural. It was baked into how we were trained, how research is conducted, how curricula are written, how the guidelines are weaponized, and how women are too often dismissed, minimized, or told their symptoms are all in their head."
— Dr. Mary Claire Haver [00:40]

2. On apologizing for womanhood:

"No matter where you're from, no matter what you do ... almost all women in a doctor’s office will apologize for something about their body."
— Dr. Elizabeth Comen [00:00]

3. On reproductive destiny:

"Even now, the medical system operates from the same presupposition it always did, that a woman’s health, her happiness, and even her freedom from pain are all secondary to her biological destiny to become a mother."
— Dr. Elizabeth Comen [47:29]

4. On missed heart attack diagnoses:

"Women are twice as likely to call an ambulance on their husband having a heart attack than they are to call for themselves ... They are far more likely to be misdiagnosed, to not even have an EKG done, to have their heart attack missed, and to die within their first year of having a heart attack."
— Dr. Elizabeth Comen [37:34, 38:05]

5. On hope for change:

"When you change the cultural narrative, you will change these institutions as well."
— Dr. Elizabeth Comen [70:08]

Timestamps for Important Segments

• [05:24] — Dr. Comen’s background and entry into oncology
• [10:17] — Origins of the book and editorial process
• [14:21] — Story of Ellen and embodied shame
• [19:26] — Systemic financial and insurance disparities
• [23:19] — Organ-system approach to bias in It’s All in Her Head
• [30:01] — “Bicycle face” and the medicalization of women’s bodies
• [35:07] — Cardiac bias, historical and contemporary
• [38:50] — Autoimmune disease prevalence and neglect
• [47:29] — Medicine’s reproductive focus and anatomical blind spots
• [50:02] — Sexual health, ageism, and survivor’s stories
• [53:47] — Challenging generational myths of decline
• [66:41] — The impact and undervaluation of female physicians
• [70:08] — Forward-looking hope: changing the narrative and institutions

Conclusion

Dr. Comen and Dr. Haver offer a rich, unvarnished look at the entrenched issues facing women in medicine—apologies for existing, institutional neglect, sexual double standards, and systemic underfunding—while pairing historical insight with actionable hope. Their discussion affirms the need for systemic, not just individual, solutions so that the next generations of women (as patients and physicians) can be seen, heard, and treated for their whole selves.

For more:

• Follow Dr. Comen on Instagram @DrElizabethComen
• Find Dr. Haver at @Doctormaryclaire and thepauselife.com

This summary excludes ad breaks and focuses on content depth, expert conversations, and memorable moments for listeners and newcomers alike.