health/medicine

One topic we cover in my sociology classes is the way the nature vs. nurture debate treats those two categories as though they are completely separate entities: “nature” is this fixed biological reality and “nurture” is all the social stuff we use to tinker around with nature as best we can. I point out to students that biology isn’t as fixed as we often think it is, and that seemingly “natural” processes are in fact often highly influenced by social factors.

One good example of this is the age at which girls have their first periods (menarche). In the U.S. today, the average age at menarche is a little over 12 years (see source here), and that seems normal to us. But historically, this is odd; until quite recently, girls did not begin menstruating until well into their teens. Because girls have to develop a certain amount of body fat in order to menstruate, access to food affects age at menarche. And access to food is generally an indicator of all types of social factors, including societal wealth and the distribution of wealth within groups. In general, economic development increases access to sufficient levels of food, and thus reduces average age at menarche.

This graph of average age at menarche in France from 1840-2000 (found on the French National Institute for Demographic Studies website here) shows a clear decline, starting at over 15 years and now standing at under 13:

Below is a bar graph showing average age at menarche for a number of countries (found here; age at menarche is the grey bar); we see the oldest average age is 13 and a half years, in Germany. Note that the data are not all from the same year, and while most report mean age at menarche, some report median age, so though they show a general trend, they are not stricly comparable:

However, these average ages obscure the fact that access to resources is not equal within nations, and as we would expect, though average age at menarche has fallen for most nations over the past century, we continue to see differences in average age among groups within nations that seem to mirror differences in wealth. For instance, this graph (found at the Museum of Menstruation website here) shows differences in average age at menarche between urban and rural areas in several countries:

The example of the quite dramatic fall in average age at menarche, as well as continued differences within societies, is a very helpful example for getting across the idea that biology is not fixed. I explain to my students that though we have many biological processes (i.e., the ability to menstruate), social factors such as economic development and social inequality affect how many of those processes are expressed (i.e., how early girls being to menstruate, on average). For other examples of how social factors affect biology, see this post on average lifespan and this post on increases in height over time.

I’m currently pairing these images with the chapters “The Body’s New Timetable: How the Life Course of American Girls Has Changed” and “Sanitizing Puberty: The American Way to Menstruate” from The Body Project: An Intimate History of American Girls, by Joan Jacobs Brumberg (1997, NY: Vintage Books) in my women’s studies course. Brumberg argues that the decreasing age of menstruation has created new social pressures as there is an increasing gap between girls’ biological maturity (that is, being able to get pregnant at age 12 or so) and their mental and emotional maturity (they’re still 12 year old girls), a point activists were trying to make in these misguided PSAs about statutory rape. Brumberg argues that just as this was happening, American cultural understandings of menstruation turned it into a hygiene problem, not a maturational milestone, meaning we give girls information about tampons and sanitary pads but not much about what these changes really mean.

Just for fun, here is “The Story of Menstruation,” an animated cartoon put out by the Disney company in 1946. Millions of girls learned about menstruation from it in the ensuing decades, including that they could throwing their schedules off by getting too emotional or cold and that it’s ok to bathe as long as the water isn’t too hot or cold. It illustrates Brumberg’s point about how discusses of menstruation turned to scientific explanations of what was happening and advice about what was and wasn’t ok to do while menstruating, while mostly ignoring it’s emotional or social significance.

I also like the explanation at the beginning of why we refer to “Mother” nature–because she does all her work without anyone even noticing, just like moms. How nice.

I recently heard that Marlboros were originally marketed to women.  Amy L. sent in these examples from the 1950s (found here).  She writes:

Notice how “in one picture the baby actually asks mom to have a cigarette instead of scolding him. It plays up the women-as-hysterical stereotype and also shows changing expectations about good motherhood.”

NEW! Vintage Ads featured this 1957 ad suggesting that a Zippo Slim-Lighter is the perfect gift for a modern mother:

I took these pictures at a Vons in Los Angeles, CA (Eagle Rock neighborhood):

Someone or someones somewhere made a conscious decision to hang candy bars on the outside of the freezer doors leading to the TV dinners marketed as healthy. I think it nicely illustrates how, in American culture, we are subject to incredible temptation and pressure to consume more calories than we need at the same time that we’re encouraged to look as if we do not submit to that temptation. This is good for the economy in that both the food industry and the diet industry are far larger industries than they would be were we to restrict our caloric intake according to need.

NEW (from Gwen): I took the following two photos in my office building at Nevada State College. We don’t have any food service program and there aren’t any places to eat within walking distance, so the only options faculty and students have are the vending machines. The other day my attention was drawn to this sign posted inside one of them:

Now, on the face of it, this seems all good–individuals should take responsibility for their food choices by choosing healthier options, and the vendor is even providing guidelines. How nice!

But then I stood back and looked at the products for sale in that same vending machine (there were a couple of rows of chips at the top that got cut off in the photo):

None of these products had nutritional information in view, so I couldn’t actually see how many of them fell within the guidelines helpfully posted along the side. I know, from looking at similarly-sized packages at a convenience store later, that all the chips had over 350 calories.

My guess would be that most people would choose the “yogurt apple nut mix” on the next-to-last row as the healthiest item, but I’ve found that mixes like that often have surprisingly high fat and calorie contents, particularly because they often come in multiple-serving packages. But without access to more information, the consumer is left to try to guess what would be healthiest and what might have lots of hidden calories (like those yogurt-covered nuts might).

I thought it was a great example of how concerns about unhealthy eating habits and obesity are often framed as failures of individual responsibility–people just eat too much and make bad decisions about food. The food industry likes this explanation because it takes the focus off of the types of products it makes available or the responsibility food companies might have for producing healthier options…or at least telling us more openly about what we’re eating. But this framing of the issue ignores the fact that it’s often very difficult to make better eating decisions; nutritional information is often lacking (I have on several occasions asked for nutritional information at restaurants, just out of interest, and usually found that employees have difficulty locating it; in one case they eventually found it posted on a chart hidden by a fake plant), and in other cases there simply aren’t better options (or they’re more expensive than the unhealthy ones). Providing platitudes about “making balanced choices” isn’t that helpful in the absence of specific information about and access to foods that are, you know…balanced.

In the U.S. today, when infants are born with ambiguous genitalia, surgeons often operate in order to bring the child’s body into accordance with our expectations for “correct” male or female genitalia, even when the actual morphology of their bodies causes no dysfunction or harm.

Some activists, such as those involved with the Intersex Society of North America, are trying to stop these surgeries.  The Phallo-O-Meter (found here) is a satirical ruler designed to draw attention to the way in which the surgeries force bodies existing in nature into social categories of our own invention (it is attributed to Kiira Triea here).  Here it is:

The ruler is satirical (as you can tell by the tongue-in-cheek “just squeeks by” etc.), but the measurements are based on the kind of decisions doctors actually make.  Indeed, if doctors decide that a penis is “too small” or a clitoris is “too big,” an infant is in danger of having corrective cosmetic surgery.  The point here is: When bodies don’t fit into our pre-existing notions of male and female, we will force them to, even if it involves a knife.  Clitorises that are longer than .9 cm and penises that are shorter than 2.5 must be fixed.  As Martha Coventry says in Making the Cut:

The strict division between female and male bodies and behavior is our most cherished and comforting truth.  Mess with that bedrock belief, and the ground beneath our feet starts to tremble.

In Creating Good-Looking Genitals in the Service of Gender, Suzanne Kessler found that clitorises that were seen as “too big” were often described by doctors in moral terms.  They were “defective,” “anatomic derangements,” “obtrusive,” “embarrassing,” “offensive,” and “troublesome.”

Surgery on intersex infants reflects a taboo on gender similarity; a moral objection to gender sameness.  We must be separated… by at least .6 cm.

This commercial I recently saw on Comedy Central for Progene male enhancement supplement warns men who are “not 20 anymore” that, without their product, they won’t be able to satisfy a woman.

[youtube]https://www.youtube.com/watch?v=tphU_5g1A-w[/youtube]

Here’s a screenshot of a graph from the video which purports to show how men’s sexual performance declines with age:

Of course, we women “know it’s not your fault,” “it’s natural.”

Obviously you could could use this for a discussion of the increasing scrutiny men’s bodies are put under (much as women’s long have). But it’s also a good example of the way sex is often discussed; the implication here is that the only way to satisfy a woman sexually is to be able to have sex like a 20-year-old man, and the emphasis is clearly on penile-vaginal intercourse as the main source of sexual pleasure (though it does come with the handy DVD about the female orgasm). I might also use it when I talk about the ways we construct biology and treat some “natural” processes as inevitable and unalterable while attempting to change others.

For the unbelievers, I know this ad may very well look fake, but I swear to you I saw it on TV. Multiple times, because it was during a show I’d recorded, so I had the opportunity to rewatch it to my heart’s content.

Gwen Sharp is an associate professor of sociology at Nevada State College. You can follow her on Twitter at @gwensharpnv.

Here’s another great one from Elizabeth over at Blog of Stench (image originally found at Ad*Access):

The text:

Send for a FREE BOOK telling about this grave womanly offense. Learn how no other type liquid antiseptic-germicide tested for the douche is so powerful yet harmless! Isn’t it a shame when a woman doesn’t realize how important it is to always put ZONITE in her fountain syringe? Failure to practice hygiene (internal cleanliness) often results in such needless tragedies–homes broken up, few social invitations, the feeling of being shunned without without knowing why. A modern woman realizes how important hygiene is to health, married happiness, after her periods, and to combat an offensive odor even greater than bad breath or body odor–an odor she herself may not detect but is so apparent to people around her. And isn’t it reassuring to know that NO OTHER TYPE LIQUID ANTISEPTIC-GERMICIDE TESTED FOR THE DOUCHE IS SO POWERFUL YET SAFE TO TISSUES AS ZONITE! Developed by a famous surgeon and scientist–the ZONITE principle was the first in the world to be so powerfully effective yet so harmless. ZONITE is positively non-poisonous, non-irritating, non-burning. Remember that ZONITE is SAFE! SAFE! SAFE! to the most delicate tissues. You can use ZONITE as directed as often as needed without the slightest risk of injury. ZONITE deoderizes by not ‘masking’–it actually destroys, dissolves and removes odor-causing waste substances. And ZONITE has such a soothing effect. It promptly relieves any itching or irritation if present. ZONITE gives BOTH internal and external protection, leaving one with such a refreshed, dainty feeling–so c-l-e-a-n! Complete douching directions come with every bottle. Buy ZONITE today! Get it at any drugstore.

So women who don’t douche face, as Elizabeth says, “sexless marriages, social ostracism and general disaster.” I like how horrified the woman in the ad looks now that she’s figured out the cause of all her problems. On a side note, I think this is the only instance I’ve ever seen of a man being referred to as “frigid.”

Here’s another Zonite ad that I found at the Museum of Menstruation (who knew such a thing existed?):

I’m too lazy to transcribe the full text, but it’s basically the same story–if only she’d known about Zonite, she wouldn’t have suffered such social humiliations (and notice the scowl on the woman’s face).

These will be great for illustrating the ways women were (and still are) told they need to douche regularly or they would smell bad, as well as to have a healthy vagina–although the douches themselves often destroyed normal, healthy vaginal bacteria, causing the problems they claimed to solve. I’m going to use these in my women’s studies course in conjunction with our discussion of Joan Jacobs Brumberg’s book The Body Project, which discusses the rise of the feminine hygiene industry and the increases pressure on women to keep more and more parts of their bodies under control, whether through sanitary pads, bras, or anti-acne products.

Thanks, Elizabeth!

In the comments, Abby says,

This also ties into lessons about contraceptive history.  Andrea Tone has written about how Lysol (yes, that Lysol) and Zonite were ostensibly marketed as douches for “freshness” but were understood to be useful for preventing pregnancy.  If I recall correctly the main era for this was the 1930s, when most contraceptives were illegal.  There is a double meaning when these ads say that women can “banish their fears” – not just odor, but also unwanted pregnancy. (Never mind that douching with these chemicals is NOT healthy!)

As an example, Holly Mac. sent in this ad for a Lysol douche:

Text:

A man maries a woman because he loves her. So instead of blaming him if married love begins to cool, she should question herself. Is she truly trying to keep her husband and herself eager, happy married lovers? On most effective way to safeguard her dainty feminine allure is by practicing complete feminine hygiene as provided by vaginal douches with a scientifically correct preparation like ‘Lysol.’ So easy a way to banish the misgivings that often keep married lovers apart.

 

Germs destroyed swiftly

 

‘Lysol’ has amazing, proved power to kill germ-life on contact . . . truly cleanses the vaginal canal even in the presence of mucous matter. Thus ‘Lysol’ acts in a way that makeshifts like soap, salt or soda never can.

 

Appealing daintines is assured, because the very source of objectional odors is eliminated.

Use whenever needed!

 

Yet gentle, non-caustic ‘Lysol’ will not harm delicate tissue. Simple directions give correct douching solution. Many doctors advise their patients to douche regularly with ‘Lysol’ brand disinfectant, just to insure feminine daintiness alone, and to use it as often as necessary. No greasy aftereffect.

 

For feminine hygiene, three times more women use ‘Lysol’ than any other liquid preparation. No other is more reliable. You, too, can rely on ‘Lysol’ to help protect your married happiness . . . keep you desirable!

Notice the way in which “feminine allure” is described as “fragile.” I guess just a few years ago that relentless male sex drive was believed to be easily interrupted!

Also note the threat of divorce (and likely economic ruin) and the use of “science” to sell this product.

Ben O. sent in a link to several ads for douches and feminine deodorants (all at Found in Mom’s Basement). This douche ad makes it clear that douching is about pleasing your male partner:

Notice this feminine deodorant is called Pristeen; it promises to help make “girls” attractive:

From the text:

The real problem, as you very well know, is how to keep the most girl part of you–the vaginal area–fresh and free of any worry-making odors…Whatever starts those those troublesome vaginal odors, Pristeen stops them–effectively. And nicely…Why take chances? Starting today, why not make Pristeen as much a part of your daily life as your bath or shower. It’s just as essential to your cleanliness. And to your peace of mind about being a girl. An attractive, nice-to-be-with girl.

Bidette Towelettes promise to give women “all-day daintiness”:

Thanks, Ben!

Kim D. sent us in another example, found at the Museum of Menstruation:

NEW! Taylor D. sent in a link to eleven more vintage Lysol douche ads, including this one:

This sign was posted in sight of the customer at the Days Inn (where I stayed when I failed to get out of Logan airport after the American Sociological Association meetings in August of 2008).  I have incuded three observations after the image and text.

Text:

At Days Inns…

We Promise…
“Service with a smile, a cheerful greeting, a pleasant Hello.”

We Mean It When We Say…
“It’s no trouble at all.”

We Want To Know…
“If you enjoyed your stay.”

Because At Days Inn…
“We look forward to seeing you again.”

That’s our promise to you from every member of the Days Inn family.

(1) It is a nice example of the kind of emotional work that employees are required to do.  It’s not just about getting customers into rooms efficiently and politely, it’s about a putting on a shit-eating grin and kissing their asses.  Or else you’re fired.

(2)  It’s also an example of a for-profit company calling itself a “family.”  You are supposed to do things selflessly for your family, but you work at a job for money.  Comparing a company to a family, I suspect, is one way to get employees to give to the company out of kinship-like duty instead of on contractual terms for money.  This, of course, and ironically, lines the pockets of executives quite nicely.

(3) The logic behind their use of quotation marks eludes me.

NEW: I took these picture in a Kaiser Permanente hospital in Hollywood in October 2008.  Close-ups and remarks below.

Like in the Days Inn example, employees at Kaiser are to do more than simply do their job effectively, they must do it “pleasant[ly]” and with “care.”  It is one thing to be instructed to “gather information with consideration for confidentiality,” and quite another to be asked to “convey trust and confidence.”  Scholars of emotion work note that the emotional part of jobs is (1) rarely seen as a skill or (2) a toll that makes your job trying and is, therefore, (3) undercompensated.  Yet, the ability to “convey trust and confidence” in strangers is certainly a special one and the health insurance employee that can do that is certainly valuable.  Unfortunately, like with other type of care work (i.e., nursing, teaching), that “value” is mostly lipservice and rarely translates into anything with exchange value (i.e., CASH).

For another example of emotion work, this one a sneak look behind the counter, click here.

The presence of lead paint on toys made in China this year brought the threat of lead poisoning to the forefront of the American mind. Parents, pundits, and politicians called on the U.S. government to DO SOMETHING. But lead poisoning was a problem for low-income families long before the China toy scandal and there was little to no outcry in the popular press.

Lead poisoning in children can increase the risk of cognitive delay, hyperactivity, and antisocial behavior. Many older homes and apartments available for rental in low-income neighborhoods still have lead paint and ingesting paint dust and paint chips is the most common way to get lead poisoning. Blood tests show that children living in poverty show much higher exposure to lead than other children.

According to William Ryan, if you are a landlord, renting out a residence with lead paint without making tenants aware of it is a crime. But, instead of enforcing compliance among landlords, the most common response to the threat of lead poisoning has been to warn mothers. Here is a representative poster:

Ryan writes that, while lead poisoning is often described as a problem involving negligent or ignorant mothers, it:

…is more accurately analyzed as the result of a systematic program of lawbreaking by one interest group in the community [landlords], with the toleration and encouragement of the public authority charged with enforcing that law.

So as long as the threat of lead poisoning was more-or-less restricted to the poor in the U.S., it was considered the problem of individuals (mothers) and the state refrained from doing much more than promoting individual responsibility. But, as soon as the lead poisoning threat affected middle class children through the toys from China, state intervention seemed appropriate.

Ryan again:

To ignore these continued and repeated law violations [by landlords who rent residences with lead paint], to ignore the fact that the supposed law enforcer actually cooperates in lawbreaking [by ignoring landlord infractions], and then to load a burden of guilt on the mother of a dead or dangerously ill child is an egregious distortion of reality. And to do so under the guise of public-spirited and humanitarian service to the community is intolerable.

CITATION: Ryan, William. 1998. Blaming the Victim. In Race, Class, and Gender in the United States. See also his book.