| Challenging
Physicians
Another way in which women challenge the medical model of menopause is
by not treating their physicians as their primary sources of information
and by refusing to accept their authority. Seven of the eight informants
regularly see a physician, either a gynecologist or a general practitioner.
The one woman not regularly seeing a physician stated that it was for insurance
reasons. Three women see a female physician. One of these women, Lia, switched
to seeing a female physician when her previous physician condescendingly
told her to "bear with it [menopause]." Lia states: "I didn't like the
answers that the doctor gave me. He literally patted me on the hand and
said 'my dear, in a couple of years it will all be over'. He didn't want
to work with me or help me." When she saw her female physician, Lia said
she "treated the whole person…I feel very grateful for that."
Six of the eight women conduct research on their own, either by speaking
to other menopausal women (in real space and on the internet), reading
recent studies in medical journals, or researching on the Internet. Most
of the women obtain information by utilizing a combination of these methods.
Pamela states that when she initially experienced signs of peri-menopause,
her physician (a general practitioner) admitted to not knowing much about
hormone replacement therapy. In fact, she simply handed Pamela the insert
to a commonly prescribed hormone replacement therapy and sent her on her
way. After some intensive research into the subject, Pamela returned
to her physician and educated her on the benefits and risks of hormones.
Needless to say, Pamela's physician no longer automatically recommends
hormone replacement therapy. In regards to the relationship she has with
her physician, Pamela states: "I directed my own medical care. I tell
my doctor what I want. I don't let her tell me what to do."
Rebecca comments on her personal approach to medical care:
Some women feel
very secure in having a doctor who tells them exactly what they should
and shouldn't do and they just go with it and they don't want to question.
They don't want to read up on their own. They just feel secure that this
person is taking charge of their health…myself…I never take anything at
face value. I always questions and question. I've always been like this.
Rebecca is a registered nurse by training and it is perhaps this unique
glimpse into the workings of the medical profession that gives her the
advantage of being an informed patient. Lia, on the other hand, not only
educates and empowers herself, but thinks all women should do the same:
"I get impatient with some women who just say 'my doctor says' and they
don't read up on anything because I think this is your body. You know it
better than anybody else…know what you're dealing with and empower yourself
by reading up on different things." Directing one's own health care and
making one's own choices about treatment are concrete expressions of agency.
Not all physicians blindly promote hormone replacement therapy nor do all
physicians consciously perpetuate the medical model of menopause. Those
that do are not bad or evil intending; many simply repeat what they were
taught during medical training and never question or become conscious of
any underlying assumptions and cultural constructions. Lock (1982) argues
that physician's invent their own models for commonly encountered problems.
She calls these "folk models" and says they are based on factors ranging
from the physician's personality to his or her knowledge of the available
literature on a particular subject. While physicians are often perpetuators
of medical hegemony, they are also potential resistors. They can and do
challenge taken-for-granted assumptions in medicine. Those who do, while
often in the minority, are often respected and remembered by their patients.
Pamela states:
…doctors do what
they are taught to do. The medical schools that a lot of these guys, mostly
guys, but that these people went to, the party line for the last thirty
years or so has been when women get to a certain age they need to take
hormones because they don't have enough hormones. It's the view of menopause
as deficiency state. It is not a deficiency state. You know, it's the way
our bodies are designed to work after a certain…it's not a deficiency state
any more that childhood is a deficiency state. So it's that mindset that
wants to turn anything that's painful or uncomfortable into a curable disease.
That comes out of medical schools in my opinion. The doctor who can resist
that and find a different approach is the unusual doctor I think. At least
among the doctors I've had the privilege of meeting.
Whereas there once was a time when patients blindly trusted their physicians
with all decisions, nowadays more people are active participants in their
own medical care and often question the physician's authority. Part of
the 1960s feminist health movement was the anti-physician attitude and
the importance of women educating each other by sharing their experiences
(Voda 1992). Both of these concepts emphasize the importance of what Griffen
(1982) calls the "community of femininity" - women coming together, sharing
narratives, and educating each other outside the expertise of the medical
profession.
The concept of social support is relevant to this study and has been shown
to greatly influence women's experiences during menopause. Seven of the
eight women in this study utilized some sort of support group of friends.
Six belonged to internet-based support groups in which the women have space
to post comments, questions, and concerns. One woman attends regular "rap
sessions" with other women where they discuss issues ranging from menopause
to sex, among others. Lia has a group of women from her workplace with
whom she meets regularly. They call themselves the "Madams of Menopause"
and they also discuss a wide range of issues related to menopause and aging.
For Lia, the "Madams" offer invaluable support and humor during this tumultuous
time. She recalls how she used to not enjoy the company of other women
but now feels differently: "I now enjoy the company of women. I think women
my age have so much to offer. Our life experiences. We appreciate youth.
We appreciate so many things we took for granted then we were younger…I
really shocked myself because I never enjoyed the company of women before."
The knowledge that other women are experiencing similar psychological and
physical signs can be reassuring, especially when you are not sure what
is happening to your body. Rebecca experienced peri-menopausal signs at
the age of thirty-eight and was alarmed at the thought that they she may
be undergoing premature menopause. She researched on the Internet and also
discovered that her neighbor was in a similar situation. She believes having
a support group of friends "keeps your sanity" and reassures you of yourself
and your body. She states:
If you don't have
a support group of friends that are undergoing the same situation that
you've got going you feel so alone because you feel isolated. You feel
you're going absolutely crazy. You're not even sure what's happening with
your body. And when I speak to other women that are undergoing the same
thing it's like 'wow, such a relief! I'm not the only one. I'm not going
nuts. I'm not the only one. My body is not falling apart'
Identification with other women is central to the concept of social support.
Women gain reassurance, exchange anecdotes, and share information. Social
support among menopausal women is a form of resistance because it allows
women to bypass their physicians when seeking information. Physicians are
no longer the gatekeepers of medical information. Other women, usually
ones who have already passed through peri-menopause, are considered experts
within small communities of menopausal women. These are the "wise old women"
that others contact with questions and concerns. For example, the director
of one on-line menopause education site, www.power-surge.com, goes by the
nickname "Dearest." Her nickname evokes an image of a kind, wise, and experienced
matriarch dispensing information and advice to other women.
The Internet is an especially important resource for support and research.
It is a virtual gold mine for all types of information and many women have
become experts at locating and disseminating information to other women.
Web sites such as www.power-surge.com host weekly live chats to which experts
in various fields are invited to exchange comments with interested women.
A woman can sign her name on the mailing list and receive a free, weekly
information newsletter containing the latest information related to menopause.
The Internet is revolutionary in that tons of information is available
in the privacy and convenience of the home and for little to no cost. The
Internet also enables diverse groups of people to get in contact with one
another and exchange information. One result of this is the creation of
"on-line worlds," where all the members share a common interest or experience
and use that commonality as their identity. These virtual communities often
also have political and social agendas: they seek to educate, challenge
and change. They are often at the center of resistance, acting as marketplaces
of information and arenas where women support and encourage one another.
The menopause bulletin board through which several of the informants were
contacted is a good example of how a community of (mostly anonymous) women
can take a strong stand on a particular issue and influence other women.
The women who post on the site self-identify as being adamantly anti-hormone
replacement therapy. Women who comply with the medical model or express
interest in hormone replacement therapy are the minority and often got
criticized and challenged by the other women. This is why Lia decided to
stop posting on the bulletin board and now just reads the postings by other
women. When she told the women on the bulletin board that she was looking
into hormone replacement therapy, she was "slammed": "I voiced my opinion
that I'd read a lot and I still decided to take hormone replacement therapy.
They could not believe if you read everything they've thrown at you, you
are an absolute fool and stupid to opt to do that." She adds that "when
women post for hormone replacement, they tend to get quizzed almost as
though they were taking a medical exam." Thus, the bulletin board is a
source of anti-hormone replacement therapy information and resistance.
Women who are not staunch resistors of the medical model are ostracized,
challenged, and scared away, as was Lia. Frustrated at the lack of diverse
opinion, she once invited a woman who had inquired about hormone replacement
therapy to email her privately instead of subjecting herself scrutiny and
discrimination by other women. She now has several women who email her
regularly with questions on hormone replacement therapy.
Anger
as Resistance
For the menopausal woman, the phenomenological body is at the center of
a struggle between personal experience and medical discourse. The dominant
message women are receiving in the medical and popular literature is that
menopause is a disease. The disease label constructs the body as out of
control, failing, and in need of being "fixed". Although not directly,
menopause, like other diseases, is to be dreaded. On the other hand, many
women going through menopause on their own are learning about themselves
and their bodies. As shown, the women I interviewed view menopause, for
the most part, as a positive process. It is often a period of increased
freedom and energy. On a phenomenological level, menopause feels natural.
It can even feel good. Thus the experiential understanding and the medical
model are in direct conflict. A menopausal woman may feel good and natural
but society is telling her she is diseased and abnormal. P remarks on this
issue: "I think a lot of women still have damn good reason to be pissed
off by the time they reach middle age. In some cases, some women who get
hysterical or depressed are reacting to a lifetime of things that would
make anybody who's sensible angry or depressed."
Several of the women I interviewed admitted to experiencing uncontrollable
anger once they became menopausal. It is speculated, but not empirically
proven, that lower levels of estrogen may affect one's mood and memory
(Minton 2000). Estrogen and progesterone are needed by the brain for certain
functions and women may notice impairment of function when levels are lower
than they once were. American Women often describe feel "possessed," like
someone else is living in their body. These feelings of possession and
displacement came up in my interviews. Rebecca describes how she would
instantaneously shift personalities and become negative, irritating, and
angry. She would become like a mythical monster with two personalities:
I just felt this
change…my headache would start, my neck would tighten, and my mood would
totally change. And I would change from…pleasant and friendly mood to a
snarling, sniveling, irritating personality. And I turn right around and
start nit picking, screeching about something or other. I'd change that
fast. Boom. Day and night. Jekyll and Hyde.
Another informant, Lia, had her job pay for one year of counseling when
she first became menopausal. Lia described to me how she would fall into
fits of rage, sometimes directed at her husband, sometimes directed at
nothing in particular. She and her therapist addressed her anger problem
and Lia did a lot of reading on her own on how to temper her anger. Interestingly,
Lia had never before had problems with anger and sounded to me like a soft-spoken,
composed, and gentle woman.
There is undoubtedly a physiological component to the anger felt by many
of these women. This is why many women report feeling more even-tempered
once on hormone replacement therapy. The existence of a biological basis
does not exclude the possibility of a different mechanism at work. In her
work on premenstrual syndrome, Martin (1987) explores the issue of what
she terms "unnamed anger." She argues that similar feelings of rage and
possession by pre-menstrual women is partly a result of their "malfunctioning"
bodies as well as a product of their subtle awareness of the larger social
order: male authority. Women become hyper-aware of their subordination
at the time just before they menstruate because they are being medicalized
at this specific point in time. It is a reaction to their medicalization
that causes or magnifies their anger because the process of medicalization
is itself a way to extend control over female bodies. Women's awareness
of their own medicalization is usually an unconscious process. Martin speculates
that:
…the sources of
this diffuse anger could well come from women's perception, however inarticulate,
of their oppression in society: of their lowered wage scales, lesser opportunities
for advancement into high ranks, tacit omission from the language, coercion
into roles inside the family and out that demand constant nurturance and
self-denial…(1987: 177).
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