The post has been edited and additions have been made

Patriarchy, feminism and principled insubordination

“Sometimes progress happens by happy accident, but more often a courageous person defies social norms…. More often than not, dissent yields progress. Outlaw dissent and you slow the speed of cultural evolution….”  Todd B. Kashdan

“Women’s rights are a part of human rights.” Pauli Murray

“… human rights are women’s rights and women’s rights are human rights once and for all.”  Hillary Clinton

“I hid by revealing, since that was the only way one could be saved through art” (Helen, or a Nobody / Rea Galanaki)

“I, too, deciding that morning in a foreign city to sit an exam as a man, possibly to live like this for a few years, gave birth to myself as a Nobody…” (Ελένη, ή ο Κανένας / Ρέα Γαλανάκη)

Part one

I have recently been re-engaging with a variety of material on how patriarchy has since antiquity, and is also, currently traumatizing and shaping women’s, children’s, and ultimately everyone’s reality, not to mention the natural environment across the globe. I have mostly been reading things, but by chance I came across a recent series on national television, with the title Dangerous (women) / Επικίνδυνες – ΕΡΤ2 (https://www.ertflix.gr/vod/vod.180531-epikindunes).  I have put women in brackets because in Greek we have male, female and neutral articles and endings for nouns and adjectives; so we don’t necessarily need to add the noun after an adjective to know if it is referring to women or men, for instance. This is actually, as one of the interviewees mentioned, something we could take advantage of when speaking and writing in order to address patriarchy and sexism in our discourse. The show talks about gender inequalities and the position of women in Greece today. It gives the floor to different women of different ages and experiences from multiple paths and visibility to “invisible” women, and it also, gives space for difficult and unspeakable issues to be articulated. The thirteen episodes are an exploration of feminist issues across a wide range of human experience.

The show touches upon multiple aspects, raises many important questions and is informed by an intersectionality approach, all of which are necessary to raise awareness and awaken everyone to underlying inner and systemic realities and dynamics, and especially, to enable women and LBGTQ people to protect themselves and others and bring about changes in their own lives, their families’ and the world at large. It provides a good overview of issues to do with gender inequalities and oppression in all the basic areas of life. I began with the last episode on women and art, which addresses questions like: Why do not so many women artists come to mind? Is the resounding absence due to the multiple oppressions that women have suffered in history, or were there important artists, but they did not receive much publicity? In this final episode they talk about the centuries of invisibility of women artists, but also about how we can increase the visibility today, not only of contemporary artists, but also of those who have passed and deserve to be remembered.

In this episode there is reference to the Greek female artist Eleni Bakoura Altamoura (1821-1900), who supported by her father, disguised herself in men’s clothes in order to be able to sit exams and study art in Italy. Rea Galanaki, a Greek writer, has written a novel based on the artist’s life with the title, Helen or a Nobody / Ελένη ή ο Κανένας.

Extract from the cover of the book:

“In her youth, Eleni Boukoura from the island of Spetses dressed as a man so that she could study painting in Italy, married the painter Francesco Saverio Altamura, gave birth to her (three) children (her son is the seascape painter Ioannis Altamoura), returned to Athens abandoned by her husband, where she worked as a painter. In her old age she lived for two decades alone and confined to the seaside house of Spetses, a decommissioned painter and a mourning mother, surrounded by whispers for magic and madness. The life of the first Greek painter, for which we do not yet have all the keys, was dramatic, provocative, with many upheavals and contradictions. The novel “Eleni or the Nobody” tries to approach the life and the myth of this existing, and always relevant Eleni, with its own keys.” (FROM THE PRESENTATION  ON THE BACK COVER OF THE BOOK)

Excerpt from Rea Galanaki’s book: The Masquerade

http://ebooks.edu.gr/ebooks/v/html/8547/2218/Keimena-Neoellinikis-Logotechnias_G-Gymnasiou_html-empl/index09_08.html

And as I am working on this post I am making my way through the rest of the episodes that touch upon defining patriarchy and the ways that it has intersected horizontally with every economic system from feudalism to capitalism; issues of how education should be more inclusive; inequity, sexism, language and discourse; mansplaining; the myths and realities of women’s friendships and the need for a culture of solidarity; the current political space and women, and the feminist movement; definition of gender and visibility for all genders and identities; taboos and misinformation around women’s sexuality; how the media can change the way violence against women is presented and victim blaming; the societal pressures that women experience in general, and more specifically, in their work environment in relation to motherhood; the higher rates of unemployment for women; women and poverty; sexism in the workplace and inequity in work pay and opportunities; the glass ceiling; every day harassment and sexism and how this shapes gender stereotypes and how to neutralize this; sexual harassment, abuse, control and domestic violence; the need to adopt an intersectionality approach; the need for women to awaken to the structures and theories that keep them disenfranchised and marginalised, and much more.

In parallel I’ve also been reading Todd B. Kashdan’s book: The Art of Insubordination, which I mentioned in the previous post, which in many ways is connected to the material above in relation to the current urgent need to create cracks in the status quo and bring about social changes. As Kashdan puts it, the book will interest people who understand the value of non-conformity and recognize that we desperately need free thinkers willing to disrupt unhelpful norms for the sake of progress, who believe that at least some elements of conventional wisdom and practice require improvement and who yearn to see more justice, freedom, humanity, community and financial stability in the world.

He urges people who might have an exceptional idea or who occupy an outsider position of any kind, to speak up without asking for permission from the powers that be. He encourages people to help change the world, but to be smart about it and do what Darwin did, for instance, who managed to remain safe while promoting and publishing his work and ideas through deploying specific strategies for selling his theories to mainstream audiences.  He ends his first chapter with three basic steps to achieve this. He suggests a) we be deliberate and disciplined and look for support and strategies that can get us where we need, b) we become aware of the difference between reckless and principled insubordination, which involves taking action from a place of authenticity with the aim to contribute to society, and c) not to take rebels for granted because principled rebellion has always been vital for improving society, and is part of what makes our life and the lives of those around us richer and more fulfilling.

Throughout history questioning orthodox beliefs can make you an outsider, a threat, or a heretic deserving of assault, torture and even death. Women, for instance, have the right to vote today, so we may forget that something that we take for granted and consider natural today had serious consequences for suffragettes, who were often sent to prison where they continued their protests by engaging in hunger strikes. Imagine what our life would be like if earlier scientists, astronomers, politicians, women activists, revolutionaries, artists, education reformers and others had never taken the risk to bring their work and ideas to light. Kashdan uses Charles Darwin to show how others before him with similar theories paid a steep price for their ideas and boldness, and how he was able to be more successful due to a variety of factors. Darwin’s predecessors paid the price that many, if not most, dissenters, deviants, revolutionaries and outliers pay for the sake of progress. For example, a thousand years before Darwin, in the year 860 Al-Jahiz was arrested and banished from his native land, while his patron was executed inside an iron maiden. Overall, it is hard to be different, to dissent, to deviate from traditional thinking. On the other hand, fitting in, offers a short-term respite from the turmoil of being the target of animosity and rejection. Kashdan says that if we’re suffering in an unjust system, sometimes all we want is a break from thinking about it, but ultimately sticking by the problematic system compromises our own and others’ well-being over the long term.

The book includes research findings and more recent work from social psychologists and others that have chronicled how powerful our tendency to conform is and why we struggle to muster the courage to buck convention. Kashdan writes: the aim is to disobey effectively, which requires we know one of our enemies, which is the human motivation to fit in, stick to the herd, accept conventional ideas and beliefs and as he says “go along to get along.” Various studies have found several reasons why we do this. One reason being that people blindly assume that the prevailing system or practice is better; especially, if it’s been around for a long time. Also, we tend to support the systems in which we function, even if those systems harm us. He refers to the theory of system justification, which suggests that people feel internally conflicted when the systems of which they’re a part treat them indifferently or oppressively, and they will rationalize and protect a social system that harms them. Disadvantaged people will often do just as much (or more) to affirm a system’s validity than those who occupy privileged positions within the same system. Kashdan writes: “Dr. Chuma Owuamalam at the University of Nottingham explained, rejecting an entire system is a big deal, a step that often goes too far even for the most disadvantaged people existing within it.” Doing so can invoke much greater uncertainty and threat, and so, people who are invested in their group identities and interests may choose to explore all options before considering the revolutionary role of system rejection. There seems to be a large body of research supporting system justification theory, which sheds light on our tendency to conform and uphold and support systems that oppress us because we feel reassured by the status quo familiarity. Kashdan writes: “Defending oppressive social arrangements makes sense if, as a member of a disadvantaged group, you feel psychologically vulnerable. It’s difficult to embrace an aspirational vision of the future when you’re coping with imminent dangers, when you find it impractical to escape a group…..”

Researchers have found that conformity doesn’t only intensify as we become more dependent on a system, but also, when we feel hopeful, we not only tolerate the existing system, but accept, defend, justify, and protect it. However, Kashdan claims that hoping for better days and persevering through hardships, buckling down, working harder, and hoping that the future will reward us, which is particularly pronounced in people from disadvantaged backgrounds, takes a physiological and psychological toll on people. In addition, when the group on which we depend on faces threat, there is the tendency to motivate our defensive reaction. Kashdan writes: “Our initial impulse is to protect what we care about, especially if the perpetrator of the attack is an outsider. Few elements are more effective at bringing people together than a common nemesis. We become upset at the outsider.” Leaders, for instance, know that people swept by patriotic fervor will easily forget that sometimes the system they are justifying might be the same as the one that has been harming them. Also, fitting in gives us a sense of belonging and safety, but sooner or later we realise that it is neither true nor safe belonging. Brene Brown suggests “Fitting in is about assessing a situation and becoming who you need to be to be accepted. Belonging, on the other hand, doesn’t require us to change who we are; it requires us to be who we are.”

A great part of the book focuses on how to go about dissenting and fighting for change in more effective ways, while becoming aware of the emotional dynamics that cause us to conform, even when we are oppressed and on the receiving end of injustices. It also focuses on why it’s an uphill battle to convince others to question outdated, undesirable norms and practices. I might return to the how to go about dissenting more effectively in the next post, but for the time being I would like to end this piece by making a brief reference to the chapter on how to raise children that feel inclined and empowered to dissent and take a stand on behalf of progress. Kashdan writes that science has revealed principles that parents and teachers can use to train youth to disagree, defy, and deviate from problematic norms and standards. In brief, we should lead or teach by example; foster a sense of empowerment and agency in our children and help them believe that they can make a difference in their own lives and in the lives of others. As parents and teachers we need to be responsive when children share explorations or future plans, help them regulate their emotions, and let them know that anxious thoughts and feelings are natural when trying new things and taking on challenges.

It is also important to help build their critical thinking skills. This is somewhat not encouraged in most mainstream educational systems, but I think it is now more important than ever considering that we are bombarded by information and disinformation. Kashdan writes: “Principled insubordination hinges on a person’s ability to sift through information at their disposal, filter out useful stuff from the bullshit, and convince others to accept the useful stuff as well. Youth must become comfortable asking questions and distinguishing between high and low quality data. They must make a habit of suspending judgment, slowing down their analytical process and letting critical analysis run its course.” Finally, we need to expose our children to various forms of courage and give them the language to describe their own bravery.

Part two                                                                                                          Edited and updated

Menopause: science and feminism and a poem

A. It’s Esater here in Greece, so in today’s post I will post my quick translation of a  poem by an important Greek poet.  Mary’s monologue expresses the love and pain mothers experience when their children suffer for their “principled insubordination”, to use a term from Todd Kashdan’s book (about which I might be writing about in the next post), and for speaking truth to power.

The pains of Our Lady by Kostas Varnalis (1884-1974)

The poem belongs to the first part of the poetic composition of Kostas Varnalis, Slaves under Siege, which was published in 1927. The poet uses the archetype of the Virgin Mary to express the feelings of mothers and the injustice of this world. In Mary’s monologue there are verses that express the tender feelings of the mother and others that reflect her bitter realizations about our unjust world. The radical poet Κostas Varnalis chooses the Virgin Mary as a timeless symbol of maternal love, but also of the pain a mother experiences when she sees her child sacrificing their safety, even their life for the common good. Mary expresses all her tenderness towards her unborn child and her intentions to do what she can to protect him from the suffering of this world. She is aware that the humanitarian messages that her child will bring to the world, will be the reason why the powerful will want to kill him, in order to put an end to his effort to awaken the poor and powerless.

The poem was made into a song in 1980. A more contemporary rendition by Maria Papageorgiou at: https://www.youtube.com/watch?v=ZzMqGzUhqaQ

Excerpt … ..

Where shall I hide you, my son, so that the bad people cannot reach you?

On which island of the Ocean, on which deserted peak?

I will not teach you how to speak and shout against injustice.

I know that you will have a heart so good, so sweet,

but captured in the nets of rage, you will soon be torn to pieces.

You will have blue eyes, a tender little body,

I will keep you away from the evil eye and from bad weather

From  the very first surprises, of your awakening youth.

You are not meant to battle, you are not meant to be crucified

You’re to become a young householder,  not a slave or a traitor.

At night I will get up and quietly tiptoe,

Bend over to listen to your breathing,  my warm little bird,

to make you milk and chamomile on the fire.

And then outside the window with my heart beating I will look

while you go to school with a slate and (slate) pencil …

And if ever in your mind Justice, (like) thunderbolt light,

and Truth hit you, my child, do not speak of them.

People are wild beasts, they cannot bear the light.

Truth is not as golden as the truth of silence.

Even if you are born again a thousand times,

a thousand times again, they will crucify you……

B. Also, in today’s post I will again draw on Dr Jen Gunter’s book: The Menopause Manifesto. A big part of the book is of course dedicated to health related information and how to become more aware and knowledgeable, in order to navigate this period of life, and also, engage with prevention of disease processes more generally. I will not focus on the medical information and options women might have. One needs to read the book for that and then perhaps explore areas of interest further. In this post I will only expand on a few points made in some of the chapters I didn’t refer to in the previous post.  Overall, Gunter situates women’s experience in systemic structures and asks for a more holistic and respectful approach towards women in the field of medicine. She analyses how there are many converging factors that can cause or / and increase the risk of health problems and how some of these factors can impact the range of options that women have.  So, it is always important to view the broader contexts in which we try to navigate our lives. As Rick Hanson said in last week’s meditation-talk (https://www.rickhanson.net/meditation-talk-what-to-do-when-you-get-triggered/): “It’s really helpful to connect the personal to the political… many of the factors that have traumatized and stressed us over our life and many of the factors that make our life harder… Many, many, many of the sources of our feeling bad inside our homes really originate on the other side of our door. They’re out there in society, in our history, economy, culture…We live in a society that’s speeding up, that’s invasive…”

Gunter provides many examples throughout the book to support this point. For instance, she claims that hysterectomy rates are higher in the United States versus other industrialized countries. Specifically, in the early 2000s, 54 percent of premenopausal American women having a hysterectomy for noncancerous reasons had their ovaries removed versus 30 percent of Australian women and 12 percent of German women. She writes: “That’s atrocious and unacceptable. Women in Australia and Germany have a longer life expectancy than American women, so keeping their ovaries isn’t exactly holding them back. In fact, it is almost certainly helping. What’s even worse is in America rates of surgical menopause are higher for African American women …” She explains that while some of this is driven by some gynecologists who recommend surgery over medical therapies and even racism, it’s important to remember that American women have to pay far more for their medical care compared with their British and European counterparts to whom they are often compared in studies on the rate of hysterectomies…..  In the United Kingdom every therapy listed in this chapter has no out of pocket expense and in most European countries there is universal health care that covers some or all of these expenses.”

In terms of women’s physical strength and fitness Gunter invites us to think back to the grandmother hypothesis.

The grandmother hypothesis:

In a nutshell, in her book, The Social Instinct, Nichola Raihani discusses menopause from an evolutionary perspective to answer questions like:  Why do women experience this sharp, non-linear decrease in our fertility in our late thirties? And why do we then persist as sterile vessels, when it would seem that we have become reproductive dead ends? By going back in time and through this lens, Raihani claims we come to realise that menopause is the outcome of a necessary evolutionary process. She refers to data that shows that when a grandmother bred alongside her daughter-in-law, all of the children suffered, and the costs were heavy because children were less than half as likely to survive to the age of fifteen when there was competition between breeding females in the extended family groups. She writes data shows that co-breeding was exceedingly uncommon. And what was more common was a case of what looks like altruism: the older females concede to the younger ones in these reproductive battles. She asks: But how might grandmothers possibly benefit from curtailing their own reproduction and allowing younger females to breed unhindered? She writes: “This puzzle can be solved by considering the ways in which the younger and older females are related to one another’s offspring. The mother-in-law has a vested genetic interest in any children produced by her son’s wife….. The benefits that grandmothers confer are well documented and can provide the selective impetus needed to favour the increased post-reproductive lifespan. From the ashes of an evolutionary conflict, grandmothers rise up. When all we have to go on are records of births, deaths and marriages, it is very difficult to infer how, exactly, grandmothers helped their grandchildren to survive. It is likely that these ancient grandmothers acted as repositories of knowledge, passing vital information on everything from breastfeeding to dealing with infants’ illnesses…… It has also been shown that increased distance between mothers and their daughters corresponded with decreased survivorship of the daughter’s offspring.”

So, it seems that the process of ageing – is not just a biological inevitability, but something that might be under the control of natural selection. Gunter writes that historically, grandmothers were helpful because they were physically active gathering food and helping to care for grandchildren. She refers to a study of postmenopausal Hadza women, which revealed they spent almost 37 hours a week foraging for food (moderate exercise according to the World Health Organization ), so being physically active not only allowed grandmothers to contribute, but also helped them remain healthy so they could continue to contribute.” She invites us to consider the imagery our societies often presents about women as we age. “Frail, delicate, standing on the side lines cheering, and yet humanity has long depended on physically fit grandmothers.”

In relation the changes that often occur in strength, size, and shape, Gunter writes that one of the sentinel physical changes of aging is loss of muscle mass, which actually starts in our thirties with some individual variation, and this progressive loss of muscle mass is associated with the slowing of the metabolism with age, or insulin resistance, which causes the body to produce more insulin to compensate, to increasing hunger and potential weight gain, which cumulatively can lead to women’s risk of type 2 diabetes. Other related concerns are limitations in movement. The diagnosis is sarcopenia and women develop it earlier than men and often suffer more because women generally start with less muscle mass, have an accelerated loss of muscle during the menopause transition, and also live longer than men. It is suggested that the best way to slow the decline of muscle mass, and even reverse some of the loss, is through physical activity. Through her own story Gunter talks about how many women have had horrible experiences regarding exercise as children at school, which can often have lasting effects in relation to how they view exercise, but exercise as one ages becomes even more important.

Chapter eight begins with the phrase: “One woman dies every five minutes from cardiovascular disease (CVD). Gunter writes: “it’s so important that women and their providers expand their concept of menopause beyond the symptoms that get the most attention in the media and on social media, such as hot flushes, mood changes,….,” She claims that there are tragic differences between the management of CVD for women versus men and that 42 percent of women die within one year of a heart attack versus 24 percent of men. Also, women under 55 who have a heart attack while in the hospital have two to three times the risk of dying compared with men of the same age. She adds that although some of this difference may be due to the biology of heart disease in women often it’s death by misogyny, either because studies have excluded women, so when women are getting what is referred to as the “best therapy” what they’re really receiving is the best therapy for men or due to the incorrect belief that women— especially young women— don’t develop CVD.  Other reasons are the fact that women receive less counseling about heart disease or the fact that women are less likely to be prescribed medications that can lower the risk of heart attack and stroke. She adds that black women are especially less likely to receive medication. She notes that women often have their symptoms brushed off as anxiety or hot flushes since there’s significant overlap in symptoms of anxiety, hot flushes, and a heart attack, and it takes a dedicated health care professional to make sure all three are being considered, not just the two that aren’t fatal. She talks about systemic gaslighting when it comes to women’s health.

In the chapter on vasomotor symptoms and on the variations found in different cultures Gunter writes that it is important to take into account how cultural factors may affect what some women are either willing to report or what they feel, and to distinguish whether women in some cultures or countries truly have fewer vasomotor symptoms, whether they have the symptoms but aren’t bothered by them, or whether they have hot flushes and night sweats and there are cultural barriers to reporting these experiences even in a medical study. She concludes that without objective monitoring of symptoms, studies reporting different rates of hot flushes by culture or ethnicity may lead to under-reporting for some groups. She also raises awareness that typical menopause related symptoms could be due to other causes. For instance, women can have two medical events that have converged at once, and therefore, a deeper exploration and knowledge allows women to make informed choices, and also, women feel more at ease if they know that their experience is typical. She also discusses the normalization of “typical” symptoms.  One example she uses is bladder health issues. She claims that even though it’s typical for women to develop bladder conditions with both menopause and age, it’s not normal, and that there is an ocean of difference between those two words. She writes: “Typical means it’s no surprise that a medical condition happens, but it doesn’t mean that condition is safe or unproblematic or needs to be tolerated. In contrast, normal sounds as if the experience is something to be tolerated.”

Gunter also discusses the need to raise awareness about the significance of osteoporosis and its devastating impact for many women, the screening process and fracture prevention. She provides information about screening options, things to do and medication options, as well as, references to studies and risks. She writes: “It feels as if there’s a cultural acceptance of osteoporosis, which is tragic and fills me with rage. Perhaps society just expects women to get frail, so why be concerned about something that’s “normal”? Maybe the needs of women as they age are irrelevant….. There’s also a false belief among some that prevention is ineffective or medications to treat osteoporosis are too risky. …… And finally, who wants to talk about a disease that we associate with crones, hags, and little old ladies? Even if women have concerns or are aware of their risks, they may not feel a space has been created for discussion. Whatever the reason, it’s women who suffer.”

Finally, throughout the book Gunter sets out to bust myths around relevant issues and remedies and point out that often there are claims about certain products without any substantial research data to back these claims. These were interesting bits to read since a lot of conflicting information is found in the media. One example is the claim that various foods or diets can provide hormone fixes, cures, and resets for women in the menopause continuum. Gunter believes that food doesn’t change hormone levels in an eat-this change-that-hormone kind of way because if plants contained hormones that could be digested and used by humans, then we’d know by now because these foods wouldn’t just improve symptoms of menopause they’d also cause premature puberty, irregular menstrual cycles, infertility, breast development for men, and vegetarians and vegans would have more of these health concerns. She writes: “But that isn’t the case. Humans don’t get hormones from plants and we’re not able to convert plant compounds into hormones. We make all our estrogens, testosterone, and progesterone from cholesterol. This is a complex, multistep process…”

All in all, in this book Gunter gives a lot of medical information, pros, cons and risk factors of medications and medical interventions, but also raises many questions to set us thinking about complex issues that will hopefully contribute to more informed and conscious choices. Towards the end of the book she writes that she hopes the book will help people take in the bigger picture of menopause, in order to reframe the experience and to consider ways to optimize health along the menopause continuum. This she says can only happen with accurate information and without the prejudice of the patriarchy. Finally, she dedicates a chapter to her own Reproductive Reckoning. I will end with a short extract from this chapter: “The source of my rage was this reproductive reckoning. The realization that menopause was just one more way that the burden of perpetuating the species is unequally borne by women and one more way that our biology is weaponized against us. It is the ultimate gaslighting because it’s this biology— from puberty to grave— that literally birthed humanity as we know it.”

Menopause: science and feminism

Part One

“The story I want you to remember is about value, agency, and voice and the knowledge to keep yourself in the best of health while demanding an equal seat at the table. That’s my manifesto.” Jen Gunter, MD

“It shouldn’t require an act of feminism to know how your body works, but it does. And it seems there is no greater act of feminism than speaking up about a menopausal body in a patriarchal society.” Jen Gunter, MD

Today’s post will be informed by Dr Jen Gunter’s book: The Menopause Manifesto. This is a topic I’ve been considering writing for some time, but kept putting it off. Actually, today’s post was going to be about psychometric tools, their pros and cons. However, my purchasing Gunter’s book brought this topic to the forefront. Her book is informed by science and feminism because as she notes feminism can help women see the biases in society and how these biases may have informed their own beliefs, which can enable them to reframe menopause not as a terminal event, but as another phase of life. I too can relate to a lot of what is discussed in the book, and also believe that it is time to finally de-stigmatize all natural developmental stages of life. Menopause is not an illness, nor should it be a death sentence. After all, we get to experience menopause and ageing in general only if we are lucky enough to still be around on this planet. It does have downsides like many other biological experiences, but it is one more evolutionary adaptation and part of the cycle of life. Gunter writes: “Menopause is not a disease. It is an evolutionary adaptation that is part of the survival of the species, like menstrual periods or the ability to suppress the immune system during pregnancy so the body doesn’t attack the fetus. Like these other biological phenomena, menopause is associated with downsides — in this case, its bothersome symptoms for some women and an increased risk of several medical conditions. But menopause also occurs while a woman is aging, so it’s equally important not to brush off every symptom as hormone related. It’s vital that women know about menopause, but also everything that is menopause adjacent, so they can understand what is happening to their own bodies, put that in perspective, and advocate for care when indicated.”

The absence of menopause from our discourse leaves women uninformed with serious consequences for their health and well being, reinforces ignorance and allows outdated beliefs form antiquity to continue influencing our way of thinking and view of women’s health, roles and value. I believe that knowledge can be empowering and that as a collective we have accumulated so much knowledge in so many areas and discovered so many amazing things that it is only fair for the wider public to be informed and educated, especially when it comes to things like our well being and the function of the human body. Gunter comments: “The absence of menopause from our discourse leaves women uninformed, which can be disempowering, frightening, and makes it difficult to self-advocate. Consequently, many suffer with symptoms or don’t receive important health screenings or therapies because they have been dismissed with platitudes like “This is just part of being a woman” or “It’s not that bad.” But the issues with menopause even go beyond these knowledge gaps and the medical neglect….”

There’s a chapter with the title The Knowledge Gap, in which Gunter claims that despite the universal nature of menopause, most women aren’t well informed about the symptoms, the physical changes, the medical concerns, or their treatment options, and that this information vacuum has been created by a toxic combination of medical providers being unable to meet the educational needs of their patients and medical misogyny, meaning medicine’s long history of neglecting women. She concludes that there is an additional matter of misinformation and even disinformation as the silence about menopause and the gaps in knowledge are exploited by various industries. The silence and taboo around menopause could be viewed as ridiculous if it weren’t for the negative consequences for so many women around the planet. The silence also keeps biases and inequality between the sexes in place and prevents women from receiving the medical care or support they need. Gunter writes: “The culture of silence about menopause in our patriarchal society is something to behold…. Apparently there is nothing of lower value than an aging woman’s body, and many in our society treat menopause not as a phase of life, but rather as a phase of death. Sort of a pre-death. What little that is spoken about menopause is often viewed through the lens of ovarian failure — the assertion that menopause is a disease that exists because women and their ovaries are weak.”

Gunter notes that menopause is puberty in reverse, a transition from one biological phase of ovarian function to another. She claims that although we manage to discuss puberty without framing it as a disease and framing being a child as the gold standard for health, we fail to do this when it comes to menopause. She adds that “Even though menopause is a universal experience for every woman with ovaries, who lives long enough, unlike puberty menopause is shrouded in secrecy. There is no menopause curriculum in schools, and providers rarely discuss it in advance.” Menopause doesn’t happen in a vacuum. This is the title and theme of one of the chapters in the book. Actually, as I discussed in the several previous posts nothing occurs in a vacuum. Our lived experience is situated and the result of many intersecting threads and causes. To begin with, Gunter explains that one of the complexities of menopause is that it happens as we age, and thus, sorting out hormone-related from age-related issues can be hard. For instance, she picks the issue of sleep disturbances during menopause to show how teasing out the root causes can become a medical Gordian knot. She suggests that the medical provider and the patient must ensure they’ve considered all the contributing factors and how they may be interrelated before assuming a symptom that develops during the menopause transition or during post-menopause as simply or truly hormonally related.

Then there are other layers of complexity.  As we age our health and how we age is not only related to the changes in our ovaries, but to everything in our macro-environment, like our diet, levels of exercise, stress, personal relationships, whether we’ve had children and if we have breastfed, etc. Additionally, we need to take into consideration various social determinants of health, like the socio-economic conditions in which people are born, grow up, live and work, which all affect health and quality of life. Gunter thinks of these factors as the microenvironment. She writes: “They produce unfair and preventable differences in health status via many mechanisms, such as lack of access to adequate medical care and education, unsafe work conditions, crowded living conditions, racism, and poor nutrition. How these socioeconomic factors affect health is complex because these are often intertwined and may be additive. Social determinants of health are linked to the age of menopause as well as many of the symptoms and health conditions associated with menopause.” Finally, another very important social determinant of health is exposure to childhood adversity, known as ACEs / Adverse Childhood Experiences (See more on ACEs in post 15/08/2019).  Gunter writes: “There’s a growing body of literature that shows adverse childhood experiences lead to many negative health outcomes by triggering a dysregulated stress response that affects the developing brain as well as the endocrine and immune systems.*** This is known as the toxic stress response, and it can have profoundly negative complications. Exposure to four or more adverse childhood experiences increases the risk of many conditions intertwined with menopause such as heart attack, stroke, sleep disorders, Alzheimer’s disease, diabetes, depression, and breast cancer. Trauma literally rewires the brain and the body.”

***In this week’s Being Well podcast (https://www.rickhanson.net/being-well-podcast-understanding-and-managing-stress) /Rick and Forrest Hanson discuss the various biological mechanisms involved in stress, how our endocrine system and nervous system respond to stress, the amygdala response, and the challenges presented by chronic exposure to it. They talk about the cumulative effects of chronic stress and allostatic load and why zebras and other mammals in the wild, for instance, don’t get ulcers….

The book also contains a brief history of menopause and how the word menopause was coined. Both narratives help us understand current realities. Gunter highlights the fact that medicine, like everything else, primarily existed to satisfy the needs (and hence secure the patronage) of the male elite who were likely not interested in the aging female body. Menopause was not recently uncovered due to increases in life span, as some like to believe, and symptoms of menopause have been recorded in Western medicine since the 1500s.  The loss of menstruation as a woman ages and an understanding that this signified an end of fertility is noted in ancient Chinese and Greek medical writings. Gunter writes: “Missed menstrual periods in ancient Greek medicine — the foundation that led to ancient Roman, Persian, Arabic, and then to modern Western medicine — were considered concerning as they were a sign of a potential fertility problem as well as a dangerous buildup of fluid. This helps to explain much of the ancient medical obsession with menstrual periods— many of the 1,500 pharmaceutical recipes in the Hippocratic corpus, 80 percent of them are related to menstruation.” Gunter claims that according to the thinking of the time, men were in balance with the world; however, it was believed that women absorbed excess fluid from their diet as if women were walking defective plumbing.

I will not refer to all the historical figures mentioned in the book.  One person mentioned is Dr Liébault, who was considered to be ahead of his time in many ways, Gunter writes: “While Liébault was clearly a medical Renaissance man with his observations about women’s health, most physicians of the day were hampered by their belief that women were an inferior version of men as well as by their lack of knowledge of female anatomy and a complete lack of understanding of menstruation.” In a nutshell, for many centuries menstrual blood was considered toxic, the cause of a vast array of illnesses and even though Western medicine was aware of the medical concerns experienced in the menopause transition, symptoms were viewed primarily as a consequence of retained toxins. Gunter adds: “Many medical textbooks from the time of De Gardanne were like his — short on medicine, but dripping with patriarchy.”  There were notable exceptions like the English physician, John Fothergill, who challenged these notions in his paper On the Management Proper of the Cessation of Menses in 1776. For him menopause was a normal progression.  Similarly, in an 1857 text, Dr. Edward Tilt, also didn’t view menopause as a disease.

The French physician Dr. De Gardanne coined the term la ménèspausie as a combination of two Greek words, μήνας or mois in French (month in English), and παῦσις or cessation in French (cessation in English), which he states is taken from παύω that he translates as je finis or je cesse— I stop or I cease in English. Gunter asks: And how might the word menopause affect what we think of the experience? She claims that the first problem is the word pause, which in today’s world feels negative given the general societal view that women should hold back or that they should diminish as they age. Another issue is that the end of menstruation is a symptom, not the cause, and focusing on the final menstrual period ignores the fact that many women have symptoms and health conditions associated with menopause starting years before menstruation ends. She also thinks it’s misogynistic to tie a description for one-third or possibly even one-half of a woman’s life to the function of her uterus and ovaries. We don’t define men as they age by their physical changes. The term menopause came to be before science knew hormones existed. Gunter writes: “It was never meant to signify a pause. It was invented by a man who felt women should cover their arms and not wear blush— whose book on the subject contributed nothing valuable to the body of knowledge except it left a term that ties women forever to menstruation.”

Concerning language and the terms used it is important to remember that words influence our thoughts. Gunter writes that language isn’t a passive descriptor, but rather, it’s an active participant. She cites Dr. Lera Boroditsky’s  work and TED Talk “How language shapes the way we think” at: https://www.youtube.com/watch?v=RKK7wGAYP6k

What I didn’t know and found interesting is that in many cultures the word menopause is not used at all. For instance, in Dutch the word is overgang, meaning the passing way or road from “A to B.” In Finnish the term is vaidhevoudet, change of year, in Swedish it’s klimacterium, change or stages of life, and in Japanese the word is kōnenki, which translates to change of life. Gunter mentions research that suggests that women who live in cultures that use terminology that references a change of life instead of menopause tend to be less bothered by common symptoms of menopause. Also, words influence our perceptions and medical terminology is constantly changing as new information is gathered, so as Gunter notes: “the idea that it’s too difficult to change the word menopause just doesn’t fly.”

I will write a bit more on this topic and book in the next post. For the time being I will end this piece today with a sentence from the book: “The story I want you to remember is about value, agency, and voice and the knowledge to keep yourself in the best of health while demanding an equal seat at the table. That’s my manifesto.”

Continued……..