I’ve been looking for anything to take my mind off of 2020. During these tumultuous times of COVID-19, racial injustice, social unrest, and outright political upheaval, I’ve found myself turning back the clock to one of my favorite pastimes: reading.

As I settled down into my favorite comfy chair on that rainy, quarantine-filled April day, I was reminded of some unsettling themes I’d discovered back in 2012. At that time, I was a happy, chipper senior in college, writing my thesis on Charles Dickens and his novel Bleak House. But as I dove into that dreary novel this past April, I again noticed an overarching, but central, theme: men are superior to women, especially in terms of health. In 2012, that theme wasn’t the focus of my paper, so I put the issues it raised aside and read on. Now, in 2020, Bleak House and all it represented came crashing down, and I realized I’d missed an opportunity to explore those biased, gender-based portrayals back in 2012. Now was time to face them head-on.

Bleak House tells the Jarndyce family’s story and their struggles involving a legal settlement and fortune owed to them. At 912 pages (Dickens was never one for brevity), Bleak House brings up quite a bit more besides criticism of the courts and legal system. Throughout all Dickens novels, especially Bleak House, one central theme is how men suffer from disease and women suffer from illness. For instance, a central character in Bleak House, Esther Summerson, contracts a vague, smallpox-like malady after tending to a poor, sick boy: “And now come and sit beside me for a little while, and touch me with your hand. For I cannot see you, Charley; I am blind.” Yet, Esther regains her sight shortly thereafter, without seeking medical attention. On first glance, this re-found sight looks to be great news. Dickens’ depiction of Esther, however, is very tongue-in-cheek. With an undertone of understood flightiness, placed alongside awe and this supposed miracle of sorts, Dickens uses Esther as a prototype for the everyday perception of women at the time of his writing. For Dickens, women were connected to illness, with their fluctuating health and unpredictable, indiscernible predicaments. On the other hand, men suffered from disease, or real, permanent, easily identifiable mishaps.

Casting Bleak House aside, I started combing through other books on my shelf and soon realized I was in for a long, perplexing day.

In By the Shores of Silver Lake, Laura Ingalls Wilder describes a character named Mary, sickly and devoid of her beautiful golden locks following a bought of scarlet fever (historically and in reality, viral meningoencephalitis). Ironically enough, Mary is then compared to a boy in her looks and her blindness becomes permanent, showing again how disease is often attributed to men and illness to women. In Anne of the Island, L.M. Montgomery describes the plights of Ruby Gillis and her ultimate bought with consumption: “Heaven could not be what Ruby had been used to. There had been nothing in her gay, frivolous life, her shallow ideals, and aspirations, to fit her for that great change, or make the life to come seem to her anything but alien and unreal and undesirable . . . Mrs. Rachel Lynde said emphatically after the funeral that Ruby Gillis was the handsomest corpse she ever laid eyes on.” After falling victim to and dying from her consumption, Ruby ultimately becomes masculine in her presentation and portrayal, lending voice again to the notion of the differences between masculine disease and feminine illness.

Turning to Charlotte Bronte’s Jayne Eyre, I noticed my discomfort as I read about such passionate, but sickly, female protagonists: “Mr. St. John came but once: he looked at me, and said my state of lethargy was the result of reaction from excessive and protracted fatigue. He pronounced it needless to send for a doctor: nature, he was sure, would manage best, left to herself. He said every nerve had been overstrained in some way, and the whole system must sleep torpid a while. There was no disease.” Again, with Mr. St. John describing what Jane is feeling as anything but a disease, Bronte brings up this feminine notion of illness.

Fumbling toward Jane Austen at the end of the day and her Sense and Sensibility, I was soon reminded that Austen, like Dickens, wrote in a very tongue-in-cheek manner. Continuing the trend of portraying women as sickly, Austin describes Marianne, a central character in her novel, as an obtuse nitwit who contracts a fever after walking in the rain to pursue a man of interest. Like Esther Summerson, Marianne too eventually recovers, thus marking her fever as more of an illness than a disease.

The list of examples goes on and on.

Coffee in hand, I decided to try and collect my thoughts. I realized that a large portion of the literature we grew up reading has in many ways tried to implant this subconscious bias that contributes to gender disparities and these ideas about women that have continued to ruminate throughout parts of society to this day. Literature in and of itself is a reflection of the times in which it is and was written. Sadly, examples of stark contrasts in comportment, demeanor, and overall health and well-being amongst men and women are nowadays ever-present and are all around us.

It is of paramount importance that we as physicians now take a step back and analyze how subconscious bias affects us in all aspects of medicine.

Theodore Klug is a clinical research fellow. Sarah Yeakel is an operations manager. Joshua Wiedermann is an otolaryngologist.

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