Menopause
as Metamorphosis
"I better feel
damn good because listen, I'm forty-three now. I've given my body an ultimatum.
Mind over matter. When I'm forty-five, I'm going to be set and done…I'm
taking on the world. I'm outta here". (Rebecca, on her expectations
of menopause)
The menopausal transition itself is a time of metamorphosis for many women.
This is when women learn from their subjective experiences and reclaim
menopause for themselves by making it a personal, spiritual, reflective
process independent of any outside (medical) intervention. The medical
model tries to rob women of a potentially powerful, enlightening experience
during this time by defining it as disease and scaring pre-menopausal women
of its negative associations. In fact, several studies have shown that
pre-menopausal women exhibit more anxiety about menopause than do post-menopausal
women (Gannon and Ekstrom 1993). They may also tend to be more depressed
(Avis and McKinlay 1991). Martin (1987) came to the same conclusion through
her interviews with women. Older women who had already experienced menopause
tended to regard menopause more positively, they did not think of it as
a time of loss, and saw that is a conglomeration of multiple changes. Furthermore,
menopause was a time to reflect on the past, plan for the future, and thereafter
enjoy renewed zest and vigor for life.
Martin suggests that younger women more thoroughly internalize the medical
model of menopause and thus are more anxious about the process. The dominant
messages they are reading in women's magazines simply mimic the message
in the medical discourse: menopause should be a dreaded event because it
brings with it disease, unattractiveness, uselessness, depression, and
emotional, social and psychological problems. Women are also being told
that menopause requires rigorous medical intervention that is costly, time-consuming,
and despite its precariousness, should be pursued in all instances where
no contraindication exists. The latest edition of Novak's Gynecology,
a popular gynecology textbook used in most medical school curricula, states:
"Because of the health risks associated with estrogen deficiency, replacement
therapy should be offered to all postmenopausal women who do not
have a contraindication" [emphasis mine] (1996: 995).
The study of North American women's perceptions of menopause by Gannon
and Ekstrom (1993) illustrate that when thought of in the medical context,
menopause is more likely to be characterized in negative terms. The medical
model thus can be viewed as strongly informing women's experiences. Many
women will use the language and metaphors supplied by the medical model
to describe and understand their own experiences. Those who chose to invent
their own language open the possibility for experiencing a potentially
positive and life-altering menopause. The use of language other than that
supplied by the medical model is what I will refer to as the "re-appropriation"
of menopause.
Reappropriation as a form of resistance is a central theme among the women
in this study. Most of the women were able to transform menopause into
a positive experience because they viewed it as a natural and necessary
process. With this basic assumption, they are able to perceive menopause
as a process bringing with it a plethora of positive changes and opportunities
for self-introspection. The informants commented on the nature of menopause
in the following ways:
This is a change
of life, a change of the way I live and the person I am in largely positive
ways. (Pamela)
It's a wonderful voyage of
discovery and I feel very positive about it…it is a time with which we
are blessed in order to get ready to enjoy the rest of our life. It needs
to be used. (Jasmine)
I think it's an individual
thing…my life was good before. It's as good if not better now. (Simone)
I think it's going to have
a very liberating meaning if I get through it and I've lived through it
and I'm in my mid-fifties and my life settles down to where all the days
are roughly the same…I suspect it will be as nice as when I was ten or
eleven or twelve before all this started. (Lindsey)
…I have finally put 'aside
childish things.' I see myself as a person first and foremost, no longer
a docile woman. I no longer see men as 'the other'. (Jasmine)
…It's a natural transition
in a woman's life, and nothing to be feared. (Margaret)
As it is associated with the beginning of aging, menopause is a time when
one can reflect on the past and future. Many women also use this time to
confront any fears and expectations of aging. Women can ponder their own
mortality, as difficult as it may be, and perhaps also change in fundamentally
existential ways. Pamela sees menopause as important precisely because
one is forced to think about and plan for aging. She says: "One of the
things I've actually appreciated about this part of my life. It makes you
think
about some stuff that may not be real pleasant to think about, like 'I'm
going to die someday.' You either come to grips with it or you don't. I
feel like I've pretty well come to grips with it."
It is interesting how the bodily changes occurring during this time - reductions
in levels of estrogen and progesterone, changes in the shape and texture
of certain tissues, cessation of menstruation - serve as powerful reminders
that one's body is changing and continuously maturing. There is something
about the process of physical aging, the adaptation of the body for a new
phase of life, which is naturally tied to the larger aging process. The
body triggers the mind to do a sort of life inventory during which one
evaluates values, quality of life and existence. Rebecca remarks: "…I'm
taking stock of a lot of stuff that I've done in the past. The way I've
lived my life in the past and how I want to live for the second half of
my life." Pamela also sees a connection between the mind and body, with
the body as signaling to the mind that one's life is changing. She says:
"I don't want to try to sanctify menopause itself as some sort of spiritual
experience. It's just what our bodies go through. But as our bodies go
through this sort of disruption, it can be an opportunity for real fundamental
personal change." For many women, menopause can bring about the union of
the mind and the body. It is a time for rejection of the Cartesian duality
dominant in medical discourse.
Sometimes reflection on the past brings one to the realization that certain
things are not as important as they once were. Lia experienced a reordering
of priorities once she realized her freedom and the importance of a good
quality of life:
…I had to do a lot
of self-evaluation. This was a very positive experience for me. I had to
deal with a lot of things, physically and emotionally and now I feel like
the remainder of my life is going to have some true meaning. Things that
were important to me five years ago, ten years ago, that had priority,
like keeping the house clean. I can give a hoot whether my house is clean…
The notion of menopause as "my time," a time to focus on oneself and grow
as a person, is common for many women. Personal growth can have multiple
forms: emotional, social, intellectual or psychological. When Lia was researching
the literature on menopause in order to educate herself, she discovered
her love for learning. Whereas she now has a voracious appetite for knowledge
and books, there once was a time in her life when Lia hated reading. Her
newfound thirst for knowledge is part of a larger project to improve herself.
Lia says:
I see myself active.
I see myself as a role model to my friends or anyone who wants to talk
to me…I see myself as someone who wants to be young in spirit…I see myself
as a light where people are drawn to and I like that. I see myself as always
growing. I don't ever want to stop learning. There is so much to learn,
so little time left…
Lia has a clear conception of herself in the future. She defies the stereotypical
images associated with menopausal women by staying active (she is able
to walk faster and farther than her husband), young at heart, and constantly
learning.
Lia was perhaps most vocal about menopause being a positive experience
because she had a difficult time confronting her advancing age and the
fact that she could no longer have children. She struggled through these
issues with the help of a counselor and by reading and educating herself.
She also involved her husband in redefining their relationship and re-establishing
their relationship as friends. On her fiftieth birthday, Lia's husband
gave her a birthday card. Inside the card was written "happy metamorphosis."
The symbolism behind turning fifty, in addition to the physical changes
she was experiencing, caused Lia to embrace the future and look positively
at the many changes she would experience:
I called it my metamorphosis…I felt like I was changing from like a caterpillar
into a butterfly because I was learning…I learned more about myself and
grew about my whole self in the past few years than I have my whole life.
Because I had to look and reflect on what had happened to me and what was
going to happen to me. That it wasn't the end of the world, that I did
have a future, and more importantly now than ever, what I do with my time…I
think this is the best time of my life now. This is my time.
With the burden of fertility
lifted, menopause is a time of liberation from previous duties. At the
time of menopause, a woman's children have usually left the house, leaving
the couple alone for the first time in years. Having the children outside
the house means less housework and responsibilities. In addition, without
out the fear of unintended pregnancy, a woman may feel sexually liberated.
Madeleine had a hysterectomy in the mid-1970s and was surgically forced
into menopause. She describes the period after her surgery as the best
time of her life:
It's just another
stage. I would say my life was better after that [hysterectomy], looking
back now. It freed you up…I felt that I could keep up with my husband…the
kids were bigger and that too. But it was another stage of my life that
I felt I was freer…not having to worry about pregnancy…that's the main
thing I think…It really is a relief. You feel like you're beginning to
live again. You're part of the rest of the human race.
Following her surgery, Madeleine was put on a regimen of estrogen replacement
by her physician. Even though she reports having felt wonderful, once she
heard about the possible link between estrogen and breast cancer, she discontinued
the hormones.
Jasmine feels as though menopause allows for her to defy certain gendered
expectations. Perhaps because reproduction is no longer an issue, the menopausal
woman enjoys certain freedoms and rights the fertile woman is denied. It
is the status of the menopausal women as aged and past her prime that frees
her from the category of other women. Jasmine states that menopause is
"…a time of liberation from feeling any need to conform with societal expectations."
On a similar note, Lia enjoys her freedom to act however she pleases because
she is menopausal. She feels powerful because so many men are intimidated
by the notion of the "menopausal woman." Lia is the assistant manager of
her department at the rubber factory and supervises several men. She sees
the menopausal label as an excuse to act and speck freely, without inhibition:
I've turned it into
a positive thing for me. I work with all men and I've told them 'I'm going
through menopause and I'm milking this baby for two years'. I say what
I want, do what I want, and I can get away with anything when I behave
this way because I'm going through menopause. I'm going to blame it on
menopause.
The physiological changes associated with menopause can be physically and
psychologically grueling for many women. The negative expectations women
are taught to have of menopause also adds to the difficulty of the process.
Once it is over, however, one may feel accomplished and proud. The experience
of menopause can very much be a test of one's stamina (physical and mental)
and psychological well being. It may be a true feat to "survive" menopause
and define one's experiences positively despite all the negative messages
in the collective imagination of society. For example, Pamela feels extremely
proud of herself and sees menopause as a test of her strength as an individual:
I really feel now,
more than I used to feel, that I can take just damn near anything. If this
didn't bother me, if this didn't stop me in my tracks, if this didn't make
me quit my job and go on and hibernate, than I can take anything. I think
that's a very useful thing to have in your personal toolbox if you are
an aging human being and particularly if you are an aging single woman.
Pamela looks forward to the end of menopause because she has grown and
continues to grow so much during the process. Her single most important
expectation of the process is to be a woman to whom others come for help
and support. She says: "I have this sort of idea of myself as an old wise
woman. That's what I'd like to grow up to be." By interacting with women
on the Internet, in a forum where one's identity can remain anonymous,
Pamela rehearses her new persona. She believes that one can become what
one practices, and many women have already told her they envision her as
a "wise woman." Pamela states: "I think I'm starting to get wise. What
I really mean by that, and I have to credit my experiences on-line with
a lot of this…over the past several years…I am less judgmental, less quick
to anger, more likely to try to help people…". Lia turned aging into a
positive process when she realized that she was more respected by younger
people. She remarks: "…young people would ask me for wisdom and I thought
'this is kind of a neat thing - getting old.' People come and ask you because
you have experience."
For Rebecca, menopause has allowed her to rediscover old interests. Before
she was married, Rebecca was active in the feminist movement. With a family
to take care of and her work responsibilities, she was forced to put her
interests on temporary hold. Now, with one daughter in college, the second
daughter in high school, and a part-time work schedule, Rebecca has the
time and energy to do what she is passionate about: "…passions that they
[women] had in the past and were put on hold because they were looking
after the kids, careers, whatever, all come back out and they all sort
of resurface again. The feminist side of me was put on hold when I became
a wife."
Conclusions
The biomedical conceptualization of menopause as an estrogen disease is
the dominant model in Western society. It is powerfully influential not
only because of its ubiquity in many cultural mediums but also because
of the degree of medical hegemony embedded in our institutions and everyday
practices. If unchallenged, the biomedical model provides the language
and metaphors for understanding and experiencing menopause. When imagined
as a disease, menopause becomes a negative life process and the midlife
woman becomes a patient for the remainder of her existence. When the biomedical
model is questioned, however, the menopausal woman has the potential to
both define and experience menopause on her own terms.
This paper examines the biomedical model of menopause - its history, its
language, and its metaphors. It also looks at the negative ramifications
of viewing menopause as a disease rather than as a natural life process.
The most important purpose of this paper, however, is to demonstrate how
women are active and fully engaged agents in their experiences. An individual
is not simply a blank slate that is, over time, marked by his or her culture.
Rather, an individual has an active say in what does and doesn't get put
on the slate. However, this process of resistance is inherently limited
because sometimes certain unwanted marks slip by the individual's attention
and get put on the slate. For the menopausal woman, she can actively define
her experiences and transform them into positive events. Certain constructions,
however, slip through and affect her despite her resistance. This explains
why several of the informants, even though they considered menopause to
be a natural, positive, and liberating process, simultaneously expressed
a profound fear of aging and loss of control over their bodies. Darke (1996)
argues that resistance is inherently limited because it is antithetically
tied to that which is being resisted. Rejection of the medical model of
menopause entails that a woman must be conscious of the model; a certain
level of consciousness confers an unavoidable level of acknowledgement.
Nevertheless, resistance to biomedical hegemony and the medicalization
of natural female life processes is a crucial concept. Resistance, in all
its forms, should be continued and encouraged by women of all ages. How
the female body is imagined and controlled are issues that affect all
women. The necessity for rejecting the medical model is articulated by
Coney when she writes:
Women need to reject
the medical definition of menopause as a disease, for it is not only unsubstantiated
and inaccurate but also damaging to our collective and individual psyches.
Women should be able to make the passage through menopause like captains
of their own ships, under their own control. For most women, this would
mean simply incorporating menopause into their lives, rather that allowing
it to define their identities or their experiences of life (Coney 1994:
122).
In order to become "captains of their own ships," women need to extend
the "community of femininity" (Stimpson 1982). Women must also continue
to share their menopause narratives. By teaching one another and making
women's experiences the center of information on menopause, exogenous labels
and categories can be shunned and women can begin to name themselves. Once
women take control of the understanding and experience of menopause, more
holistic and individualistic models for understanding this process will
emerge. Hormone replacement therapy will become an individual decision
rather than an assumed therapeutic plan for all menopausal women. Perhaps
most importantly, challenging the medicalization of menopause is part and
parcel of challenging the medical profession's growing control over the
female reproductive cycle. By denying medical intervention in menopause,
the midlife woman may inadvertently empower other women of all ages to
become conscious of the weaknesses and contradictions of medical hegemony
itself. Once this awareness occurs, the possibly for resistance is strongest
and most effective. |