Sunday, June 12, 2016

Cultural History of Menopause

Menopause is generally described in terms of failure and deficiency.  Frances McCrea finds that “During the 19th century, Victorian physicians viewed menopause as a sign of sin and decay; with the advent of Freudian psychology in the early 20th century, it was viewed as a neurosis; and as synthetic estrogens became readily available in the 1960s, physicians treated menopause as a deficiency disease”.

Contemporary medical textbooks and books written for the general population provide evidence of menopause (and by extension, the female body) being viewed as a deficiency and disease-laden.  In these texts, menopause is defined in terms of “the breakdown of a system of authority. At every point in this system, functions ‘fail’ and falter.  Follicles ‘fail to muster the strength’ to reach ovulation.  As functions fail, the body declines: ‘breasts and genital organs gradually atrophy,’ ‘wither,’ and become ‘senile’”.  Menopause is apparently so dire and potentially dangerous to women that in 1981 the World Health Organization actually classified menopause as an estrogen-deficiency disease.  It is a sad state of affairs when a process that the majority of women a certain age will experience is labeled a disease.

Many nineteenth century scientists and doctors perceived the climacteric (the phase before menopause) as a crisis that was likely to bring on an increase of disease.  Interestingly enough, during most of the nineteenth century, practitioners usually believed that the climacteric affected both women and men.  In her book, Beyond Sixty-Five: The Dilemma of Old Age in America’s Past, Carole Haber documents the nineteenth century perception of old age as a disease known as the climacteric.  The “discovery” of the climacteric is generally attributed to Henry Halford.  Halford’s 1813 article entitled “On the Climacteric Disease” identified and characterized the disease; however, Halford’s work did not receive wide public attention until 1833.

Halford’s climacteric disease was conceptualized as a visible, abrupt transformation of the body that marked a specific age-related ailment.  Most practitioners of this era felt the “climacteric disease” was far worse for men than for women.  Ironically, in the case of the climacteric, menstruation was thought to actually assist women’s bodies.  Doctors and scientists believed that “the well-marked periodicity of the female cushioned her decline into senescence.  Over an extended time span, her body could adjust to the new stage of life”.  Although most agreed that menstruation would help women adapt to “old age,” there was no consensus regarding the cessation of the menstrual cycle in terms of the climacteric.  Some cited cessation of the menses as part of the climacteric; yet, others believed that menopause occurred before the general ailment. 

Surprisingly, because men’s bodies did not experience monthly changes, they were thought to experience much more erratic changes in their bodies; the climacteric was instantly apparent in men as witnessed by their change in weight, facial appearance, and temperament.  During the second half of the nineteenth century, Haber reports that U.S. physicians began to view the climacteric “less often as a disease and more often as a normal—though painful—stage of existence”. 

Although during the latter half of the nineteenth century the climacteric—as it occurred in both men and women—was thought to be more “normal,” the cessation of the menses continued to be singled out and discussed by physicians and scientists.  Physicians of this era described the effect menopause had on women as “a transition to the closing phase of her existence” and as the “decline toward the last term of existence, . . . [the mark that the female] has now become an old woman”. 

There were, however, other perspectives: Certain nineteenth century physicians regarded the time following menopause far more positively than some modern day physicians.  During this time, menopause was thought to be the “Indian summer of a woman’s life—a period of increased vigor, optimism, and even of physical beauty”. 

Dr. Edward Tilt noted that “flushes” (not “flashes” but “flushes”) were good for women as they were “compensating discharges beneficial to the body.”  This description suggests that in the mid-nineteenth century some members of the medical community and perhaps even some members of society welcomed “flushes” as evidence of strength, inner harmony, and balance.  Although a select number of physicians of the past chose to view menopause as a somewhat positive process, the majority of physicians (past and present) tend to think of menopause as a bodily failure or breakdown of sorts that renders women’s bodies in need of repair. 

Menopause is currently treated as a deficiency disease; however, with the invention of Estrogen and Hormone Replacement Therapy (E/HRT) the “symptoms” of menopause may now be treated.  In the first half of the twentieth century, menopausal women were given hysterectomies, either with or without their consent, and in the latter half of this century, women are now being offered a “miracle pill.”  E/HRT was first widely promoted in the 1960s by Robert A. Wilson, a prominent Brooklyn gynecologist.  Wilson founded the Wilson Foundation, which received $1.3 million in grants from pharmaceutical industry giants such as Ayerst Labs, Searle, and Upjohn.  It should be noted that these companies were interested in the large potential market of estrogen replacement therapy.  Wilson touted menopause as a “deficiency disease” similar to diabetes and thyroid dysfunction that could be “cured” with what was then known as Estrogen Replacement Therapy (ERT).  Wilson’s work has been identified as being crucial to the acceptance of menopause as a deficiency disease. 

Wilson’s first article appeared in 1962 in a volume of the Journal of the American Medical Association; in this article, Wilson claimed that breast and genital cancers along with other problems of aging could be “cured” by taking estrogen.  With the publication of this article, a campaign to promote estrogen for the prevention of menopausal symptoms was launched.  One year later, writing with his wife, Wilson penned an article titled, “The Fate of the Nontreated Post-Menopausal Woman: A Plea for the Maintenance of Adequate Estrogen from Puberty to the Grave.”  As the title indicates, Wilson and Wilson claimed that women should be given some combination of estrogen from the “puberty to the grave” to insure that a woman’s proper hormonal state would always be maintained.  Prescribing estrogen from the “puberty to the grave” marked the entire adult life of females as something that must be controlled and contained by the medical community.  Three years later Wilson published a book entitled, Feminine Forever.  Here he claimed that menopause was a malfunction and threatened the “feminine essence.”  In an article summarizing his book, Wilson also described menopause as “living decay” but noted that taking estrogen would save women from being “condemned to witness the death of their womanhood”.  Wilson’s book sold one hundred thousand copies in the first seven months following its publication and was excerpted in Vogue and Look magazines.  The marketing campaign continued and was extremely successful; some six million women started taking Premarin (Ayerst Labs’ brand name for estrogen), making estrogen the fourth or fifth most popular drug in the United States.

In 1976 Ayerst Labs blatantly used furthered its own interests by supporting the Information Center on the Mature Woman that, of course, promoted E/HRT.  While there has been considerable controversy over E/HRT, including the claim that E/HRT increases risk of breast cancer, endometrial cancer, atherosclerosis, myocardial infarction, gall bladder disease, and diabetes, in 1992, two million of the forty million menopausal women in the United States took Premarin and contributed to the $70 million grossed each year from the sale of this one type of E/HRT.
Given the medical community’s negative attitude toward menopause, in which this event is perceived as a bodily failure and as a physical disorder, and the cultural endorsement of the medical community’s views, this event common to almost every woman serves as a site where ideology, rhetoric, and performance intersect with real life consequences. 

Source: Dacia Charlesworth, from presentation at the 2003 annual meeting of the National Communication Association, Miami Florida.

Related Posts Plugin for WordPress, Blogger...