I spent six years in weekly therapy for a chemistry problem. I want to be careful about what I am and am not saying. The therapy was not wasted. I like my therapist. She is a good clinician and a decent person and she and I worked, in good faith, on the interior life of a woman who was, as it turned out, running on a thyroid that had quietly stopped keeping up. Everything we discussed was true. The story we were writing about it was wrong.

The symptoms had names in my chart. Persistent low mood. Fatigue not otherwise specified. Difficulty concentrating. Weight change. Sleep disturbance. Reduced libido. That list, presented to any general practitioner in the country, is the differential for depression, and I met the criteria, so we treated it as depression. Two SSRIs, in sequence, at increasing doses. The second one made me sicker. The first one made me numb. Both were prescribed by doctors who did not run a full thyroid panel because I did not know to ask for one, and because, as far as I can tell from the notes I later paid to have released to me, the assumption in the room was that a woman in her early thirties presenting this way was almost certainly presenting a mood.

The way medicine defaults to the interior explanation for a woman’s symptoms is not a personal accusation of the six clinicians who saw me. It is a training. The stereotype that women’s bodies and moods are essentially governed by hormones flatters itself as folk wisdom and functions as a diagnostic shortcut. It sends the workup one way and not another. It moves your file toward the psychiatry column and away from the endocrinology column before anyone in a white coat has actually decided which one you belong in.

The diagnosis came from a nurse practitioner at a Minute Clinic in a strip mall in Cleveland, because I had walked in for a sinus infection and mentioned, offhandedly, that I had gained twenty pounds without changing anything. She did not know me. She had no chart to lean on. She said, huh, and ran a panel that I later learned cost forty-two dollars. My TSH was 11.4. Reference range tops out at about 4.5. She called me the next morning with the number and said, I want you to see an endocrinologist this week, and I want you to know this is not in your head.

This is not a story about therapy failing. This is a story about the interior explanation getting reached for first because the interior explanation is what a certain kind of clinician has been trained to expect from a certain kind of patient. The therapist herself had asked me, twice, whether anyone had checked my thyroid. I said yes. What I meant was, someone drew blood at some point and no one said anything so I assumed it was normal. It was not normal. It had not been checked in the way she meant. It was another version of the misheard sentence. I said one thing. It was heard as another. The gap between the two took six years to close and a stranger in a strip mall to notice.

I do not want to end on the strip mall as a punchline. I want to say the thing that is harder to say. I was easier to treat as a woman with a mood than as a woman with a body. My mood was the room the medicine already had a chair in. My body was going to require a chair to be brought in from the hallway. Nobody had time. So I sat in the chair that was already there for six years, and I did the work of that chair, in good faith, and it was the wrong chair. If your bloodwork is coming back “essentially normal” and you have been told to try journaling, please take our guide to recognizing when you are being gaslit into your next appointment, ask for the actual numbers, and ask for the panel they didn’t run.