Sweating it Out
Hot and Bothered: Women, Medicine and Menopause in Modern America
By Judith A. Houck
Cambridge, MA: Harvard University Press, 2006, 328 pp, $39.95, hardcover.
Reviewed by Susan E. Bell and Susan M. Reverby
Feminist scholarship about the contentious relationship between women and the American health care system has come a long way since the 1970s, when an overgeneralized narrative of controlling doctors and helpless victims both fueled and reflected the anger that sparked the era’s feminist health activism. This story of a professionalizing juggernaut that needed women’s bodies to do its work was popularized by authors Barbara Ehrenreich and Deirdre English in several pamphlets and a bestselling book, For Her Own Good, which is still in print. However, it failed to differentiate between the advice of experts and the actual practice of medicine, or between what women said and what actually happened during clinical encounters. It turned out to be a useful guide neither for individual women seeking to understand their embodied experience nor for political organizers aiming to transform women’s healthcare. Women’s perceived and actual needs and desires were more complex, medicine’s power less hegemonic, and the doctor-patient relationship more often negotiated than this history admitted. Indeed, both of us returned to graduate school from health activism—Susan Bell to sociology in 1974 and Susan Reverby to American studies/history in 1975—because we envisioned a more nuanced feminist scholarship of women’s health.
In a second revisionist round of investigations, historians, sociologists, and anthropologists paid more serious attention to the spoken and written words of practitioners and patients, both inside and outside the consulting room. With this scholarship, the simplistic notion of the all-powerful physician and the hapless female patient began to blur. The historical picture became more complicated with concepts such as control and agency, words such as “nuanced,” “mapping on the body,” and “negotiation,” and attention to differences of race, class, and sexuality. Historians discovered that, in the name of women’s agency, some nineteenth-century women opposed birth control, while some early twentieth-century women demanded anesthesia during deliveries—mirror images of the positions taken by mid-twentieth-century “second wave” health activists. In the new scholarship, accuracy and context mattered. A more useful, though more complicated, history of women’s encounters with the healthcare system began to emerge. As Judith Houck rightly insists in Hot and Bothered, “Feminist scholars cannot claim that women have agency only when they make choices that we like.”
Houck’s attention to menopause fits well within this recent scholarly tradition. As historians are wont to do, she has organized twentieth-century debates over menopause into three periods. Between 1897 and 1937, emerging “new women” raised questions about the implications of menopause for social roles and family life. During the second period, from 1938 through 1962, with expanding medical prowess, debate intensified about hormones and their impact. Finally, from l963 through the present, feminists and physicians have engaged in a wide-ranging tussle. The publication of Robert Wilson’s bestselling Feminine Forever (1966), which pushed lifelong hormone treatment for women, marks one milestone in the debate. A second occurs in 1975, when articles about the link between hormones and cancer first appeared, and doctors, researchers, feminists, and women generally began contending in earnest over the long-term impact of hormone “therapy” for menopause.
Houck understands that a journal article by a medical school gynecologist may have little effect on the actual behavior of a small town general practitioner toward his or her patients, and that different medical specialties have advocated various positions over time. She understands that popular writings both reflect and shape cultural expectations. She reads the menopausal body as a “cultural canvas for delineating some of the larger questions about the nature of women, the breadth of women’s roles, and the nature of medical practice.”
Within this context of cultural and medical “judgments,” she traces the “continuity and change that reflected, created, and supported” twentieth-century, white, middle-class women’s menopausal experiences. Drawing upon several archival surveys, she provides insight into what these women actually thought about the “change of life,” and she provides thoughtful readings of works by medical experts, regular practitioners, popular authors, feminist activists, and scholars—as she uses them to illustrate how women “forced physicians to share their authority.” She criticizes previous scholars’ assumptions that medicine spoke in one voice, that technology overcame caring, and that physicians were out to control women with hormones or sedatives.
We applaud Houck’s effort to provide a nuanced account, yet found ourselves exhausted by the density of her arguments. In her discussion of the 1963-1975 period, for example, she forces the reader to work hard to find her “take away” message. At the beginning of the chapter, she says, “[T]he popular literature did not overwhelmingly support long-term hormone therapy, the disease model of menopause, or the antiaging aspects of estrogen.” Three pages later, we learn that “the popular literature largely reduced the significance of menopause to a debate over whether it was a debilitating disease or a natural process and whether it required treatment forever or not at all.” Ten pages after that, Houck concludes that this literature “generally denied that menopause was a debilitating disease.” Without a carefully laid-out explanation of the disease model, we were left trying to figure out the differences among “didn’t support it,” “debated it,” and “denied it.”
Houck uses sociologist Irving Kenneth Zola’s definition of “medicalization”: the “process whereby more and more of everyday life has come under medical dominion, influence, and control.” This is a fine beginning for a discussion of medicalization, but Houck devotes only a few sentences to this complicated and contested topic before leaping into a reductionist summary of feminist scholarship, which she characterizes as “claiming that when physicians defined menopause as a disease or syndrome, women automatically assumed a passive role and deferred to their physicians’ authority.” This does justice neither to the capacious concept of medicalization—within which scholars have carefully distinguished dimensions and degrees—nor to the range of feminist thought about the medicalization of menopause. Houck has selected easy targets for her criticism, while providing such a thin definition of the concept that it is difficult to discern just what, exactly, her findings about the medicalization of menopause are, and thus how they can contribute to feminist understandings.
We were surprised to find that Houck makes errors in the disciplinary identification of individuals. We may seem picky to express this concern, but Houck then uses the mislabeled scholars to critique the mislabeled field. For example, she should not use the work of physician-bioethicist Edmund Pellegrino to critique the history of medicine. Similarly, she should not cite an article by psychologists Sharon Rostovsky and Cheryl Travis to criticize the sociological construction of medicalization theory. Paula Weideger, whose Menstruation and Menopause (1977), Houck rightly notes, was important to activists in the l970s, is a popular travel writer, not a medical anthropologist. These mistakes, easily corrected with a quick Internet search, suggest testiness on Houck’s part with the scholarly literature that is not conducive to subtle reading and critical review.
Houck disagrees with accounts of recent feminist history by activists, arguing that before 1975, “the evidence indicates that feminists did not overwhelmingly dispute either the disease model of menopause or the use of ERT [Estrogen Replacement Therapy], at least in print.” Feminist activists did not always use terms such as “deficiency disease,” “medicalization” or “disease model” as scholars would. But at conferences, in pamphlets, and in feminist newspapers, they raised concerns about the dangers of hormone treatments for menopause—concerns they had previously raised in relation to birth control pills and DES. While Houck is right that menopause was less important to young feminists than birth control, sexuality, and childbirth practices, her reading of the activist literature suggests much less of a critique than we find in it. For example, our re-examination of the chapter on menopause in the 1973 edition of Our Bodies, Ourselves, sees more concern about estrogen than she admits. Given this, Houck’s book will probably not assuage the current health activists, whom, she acknowledges, had an “impassioned reaction” to her manuscript—reminding us of the difficulty of writing this kind of contemporary history.
Houck takes white, middle-class women’s experiences and the complexity of medicine seriously. Activists will find her historical analysis provocative and scholars will be particularly interested in the sources she has identified and examined. Houck’s view of menopause certainly complicates both medical and feminist history, proof that this story from the past can still generate heat.
Susan E. Bell teaches in the department of sociology and anthropology at Bowdoin College. Susan M. Reverby teaches in the women’s studies department at Wellesley College. Their last article together was “Vaginal Politics: Tensions and Possibilities in The Vagina Monologues,” Women’s Studies International Forum 28 (2005): 430-44.
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