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.
