Archive for February, 2009

On Medicine and Objectification

Usually when we women’s studies types worry about objectification, we mean sexualized objectification: a (usually male) gaze that sees the other as a means to an end, where the end is sexual pleasure. I think sexualized objectification is actually more complex and ambivalent, but for now I’d like to set that aside. Sex is by no means the only area where objectification occurs, and insofar as means-to-an-end logic is always part of it, those other areas ought to draw our concern, too. And so I’ve been thinking about the relationship between medicine and objectification – partly in honor of today being Rare Disease Day (h/t Shakesville) but mostly in light of my recent experiences.

Modern, scientific medicine has historically objectified people as patients. Indeed, the “modern” and “scientific” elements of it rely on objectification. Modern medicine is founded upon objectification: People become case studies. Their complicated life stories are aggregated into statistics. They’re assigned to control or experimental groups, and their individuality melts away.

Medical research as we understand it would be unthinkable without objectification. The techniques I just mentioned are necessary to doing science right, following professional standards. The alternative – drifting in a sea of anecdata – would yield few useful results.

Actually, the alternative might look a lot like the journal articles written a century ago by long-dead German gynecologists. (For my dissertation research, I happily squandered months of my life leafing page-by-page through all the major German medical and gynecological journals and some of the minor ones, spanning about 1905 to 1935.) Typical articles included:

  • An outline of a new (and by our lights, scarily unsuccessful and brutal) technique for cesarean section or symphysiotomy.
  • Case reports of a needle left behind during surgery.
  • Descriptions of rare deformities of the pelvic organs.
  • Pictures of pickled uteri.

In other words, the journals reflect a fair amount of objectification but with very little systematization or, well, science. This started to change after 1900. By the 1920s there were more statistical analyses and fewer appeals to the author’s “experience.” Patients were still objectified, but there’s an occasional glimmer of scientific method. We’d still consider most of these studies piss-poor science, but the trend, at least, was toward research beginning to yield benefits for patients, as opposed to mostly boosting the author’s career.

(And yes, I joined the objectification party while I was working on these journals. I got so I could distance myself from even the photos of disembodied organs, which were mercifully in black and white. I could down a Snickers bar while looking at this stuff. So I experienced from the inside how medical training can create a distance from the suffering person and at least temporarily suspend empathy.)

Singling out medical research would distort the picture, because patients also came to be treated as objects in ordinary practice. This was especially true in teaching hospitals. I’ve written about how pregnant women in early-twentieth-century Germany were forced to undergo repeated exams by clumsy medical students, and how they were paraded naked in front of a whole auditorium full of observers while in labor. American obstetrics was no better: Women were strapped down while in labor and knocked out, whether they wanted it or not.

Over the past 40 years, under pressure from consumer advocates, feminists, and medical ethicists, medical researchers and practicing doctors have become a lot more sensitive to problems of objectifying patients. Patients with cancer are no longer kept ignorant of their diagnosis and prognosis. These days, expectant mothers are often encouraged to write birth plans – and yes, I realize those plans aren’t always heeded, but that doesn’t negate the sea change.

One index of objectification is condescension. They’re not the same thing, but condescension generally grows out of the practitioner’s conviction that he’s in a hierarchical relation to the patient; that he’s the subject and the patient is the object. And personally, I’ve seen a major decline in patronizing attitudes among medical practitioners. In the late 1980s, as a young graduate student, I went to my family doctor with complaints of fatigue, nausea, and dizziness. He told me, dismissively, that I was neurotic and overambitious and just needed to chill. (Another doctor diagnosed me with chronic fatigue syndrome, and after roughly 18 months I felt substantially better.) He projected the person of a folksy old-time GP, but I was just a case to him, and as such, he felt free to load me up with stereotypes about smart, ambitious young women. This doctor ultimately got in trouble for inappropriately touching young female patients – demonstrating that medical objectification and sexual objectification can occasionally overlap. He’s now long retired, thank goodness.

My recent experiences at the Cleveland Clinic and the OSU MS clinic were the polar opposite. The doctors listened to me and took my complaints seriously. No one implied that I was hysterical or tense or simply a head case. Overall, I’d describe my relationship with my family doctor, ob/gyn, endocrinologist, and the kids’ pediatricians as a partnership. We talk to each other frankly, and they listen to me just as much as I listen to them. The kids’ doctors are also wonderful about addressing the kids directly and asking them about their preferences. (A penicillin shot or liquid antibiotics? Gee, that’s a tough choice for a four year old!)

I realize I’m likely to get better care than average because I’m white, educated, medically literate, fully covered by insurance, and (heaven help me) sometimes a little pushy. But that’s not the whole story. For instance, there’s one doctor in our pediatricians’ group practice who’s still completely old-school. He was on duty in the hospital the day the Tiger was born, and he would not shut up about circumcision. In the end he had to respect my refusal to snip. I know he’s very condescending toward people who he assumed are less educated. But this fellow is the exception that proves the rule. He’s slouching toward retirement, and all the parents I know avoid him whenever possible. He’s a relic of the medical past. Patronizing doctors like him are on a gradual path toward extinction.

One notable exception to this general trend away from objectification is medicine’s ambivalence toward sexuality. As I’ve argued before, too many doctors are embarrassed to discuss sexual problems with their patients. This weekend’s Well feature in the New York Times offers a fresh example: a prominent ED specialist reports that one in four of his patients who’ve had a prostatectomy was not aware until after the surgery that he’d never ejaculate again! This embarrassed silence also interferes with patients getting the full scoop on the sexual side effects of antidepressants. The failure of medicine to deal with sexuality is an effect of shame, embarrassment, and ignorance, as these examples show, but it’s also a legacy of medical objectification. Seeing someone as merely as a “case” makes it very difficult to view a patient as a whole person with complex needs and desires. The result is condescension, fragmentation, and silence.

While pressure from our culture as a whole are pushing medicine away from condescension and objectification, there are countervailing structural forces. The most obvious of these is pressure to contain costs, which comes from all directions: insurers and HMOs, employers, and the state. Spending time really listening to the patient – as my doctors have done for me recently – doesn’t come for free. The specialists will be better able to recoup this; the MS neurologist I saw, for instance, routinely budgets an hour and a half for new patients, and I assume he’s got a billing mechanism that will cover his time. I’m pretty sure my family doctor, by contrast, will not be able to bill for all of the time he’s given me. Adding insult to injury, just yesterday my university (the only big employer in town) announced they won’t consider his clinic in-network anymore as of July 1. While this is likely a gambit to negotiate new rates, the net effect will be to place even more pressure on local primary-care doctors to curtail the time they spend with patients. Rushed appointments are not conducive to seeing the whole “case,” much less the whole person.

Another structural counterweight to more enlightened, anti-objectifying medical attitudes is the march of medical technology. Again, the history of obstetrics provides lots of examples. Chief among them is the fetal monitor. Quite apart from the large body of evidence that suggests routine fetal monitoring increases interventions without improving outcomes, fetal monitors also objectify the laboring woman. Her experience – and the well-being of her child – are reduced to lines and squiggles. I’m not a Luddite about this, because I know that fetal monitoring has legitimate uses, even though it’s vastly overused. Yet I know it’s not just doctors and nurses who sometimes fixate on a mere artifact – the monitor’s output – rather than on the whole person. Laboring women and their partners sometimes do the same.

The MRI is a further example of medical technology that can supplant the person, substituting a series of images that risks turning the person into an object. One example of this, ironically enough, is that study of sexual objectification that made a splash in the media earlier this month. While I’m fascinated with functional MRI, I also know that fMRI just shows brain activity in certain areas. What that means is still up to interpretation. And if the researchers are reducing their volunteers to mere images and not conducting lengthy interviews with them (only a questionnaire was mentioned in the media reports), then we can confidently saw that the research subjects are being rendered objects.

Does all of this mean medicine is evil and we should reject medical objectification whenever and wherever it occurs? Not at all. I’m in favor of medicine being more evidence-based. As I mentioned at the start, today is Rare Disease Day, and all of those orphan diseases cry out for more research. (My dad has had Crohn’s for 50 years; my husband had an encounter with an obscure but devastating autoimmune neurological disease called MADSAM. My recent brush with the possibility of MS taught me that the unknowns still vastly outweight the knowns, even for such a relatively common disease. So I hope for more research, not less, and I recognize that scientific approaches to medical research will always tilt toward objectification.

But I also favor acknowledging the legacy of unexamined objectification in medicine. We can look at how it operates in specific contexts and weigh whether its costs are worth its benefits. We can analyze the potential of new technologies to fragment and objectify the patient. Simply bringing objectification out of the shadows tends to mitigate its effects: talking about it can make both doctors and patients more aware of it, and this will tend to promote more equal partnerships. And finally, we can hope and lobby for meaningful health-care reform that would limit the power of insurers to dictate that doctors practice medicine in five-minute increments guaranteed to obscure, fragment, and objectify the whole person.

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Caturday, Philip Glass Style

I don’t know how I missed this. Apparently over 12 million viewers have seen Nora the Piano Cat, and yet – despite my 100% Felinity rating – I was totally ignorant of her existence, until now.

Just in case you missed her, too, here’s Nora performing what seems to be an original composition. I’m guessing Philip Glass was one of her formative influences.

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Has anyone else noticed this irony: that a lot of the people who reject well-grounded science (evolutionary theory, climate change, etc.) hold exactly the same stereotypical ideas about gender that pop up repeatedly in evolutionary psychology? Obviously many of the denialists have religious reasons for rejecting sound science, while evolutionary psychologists and sociobiologists are overwhelmingly secularists. Yet they share the idea that men are the pursuers, women the pursued; that men are naturally dominant; that homosexuality is somehow aberrant.

Strange bedfellows, huh? Logically, we can be pretty sure no one working in the field of ev psych or sociobiology believes in creationism. These are disciplines that have spawned some of our most outspoken atheists. Many of these scientists them see their work as progressive, in fact. Many believe their research exposes the roots of human nature, allowing us to mold a kinder, more ethical society. In The Caveman Mystique, Martha McCaughey portrays this impulse as a quasi-religious reformist zeal that arose as practitioners of ev psych and sociobiology moved into the void left by the post-Darwin decline of religion.

To be fair, ev psych and sociobiology often look more regressive than they are because the media skews their findings to match existing gender stereotypes. However, the actual science is still too often rife with speculation and gendered assumptions (as figleaf shows today in a smart post on how these assumptions skew findings). And so it meshes all too easily with the stories that religious fundamentalists tell about our gendered “nature.”

On the flip side, I’d be interested to know if there’s a subset of creationists who also embrace ev psych. Seems to me that the “ev” part of it would be anathema to them. But otherwise the “psych” half would work pretty well for them, if they could only find a way to compress it into the past 6000 years.

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My First Shivering Crocus

Here’s my first lonely crocus of the year. It popped up a day ago, rising above the brown and trodden grass. This morning, it refused to open in the damp grey air. It’s holding out for a few more rays of sun, and I can’t blame it. My daffodils, too, are sending up their first tentative shoots, but they’re still nothing but hope and promise.

And then there are my ornery pansies, under ice ten days ago, now stubbornly trying to bloom. They’re not a thing of beauty, are they? But that’s beside the point. The point is, they’re still here. They persist. Despite sub-zero temperatures.

Just because a metaphor is obvious doesn’t mean it’s any less true.

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Stymied milk-slurping kittehs from I Can Has Cheezburger?

So the Denny’s in Asheville, North Carolina, is just the latest in a long line of businesses where some twit took it upon himself to tell a nursing mama she couldn’t feed her baby where everyone else was dining. Daisy at Daisy’s Dead Air reports on the brouhaha – in which the restaurant manager threatened to call the cops! – and the resulting protest. North Carolina law guarantees the rights of mothers to breastfeed anywhere and anytime, but I guess lactophobia trumps the law.

Among all this absurdity, what jumped out at me is that the manager was going to call the police unless the mother covered herself.

In my experience, the demand for “discretion” while nursing may sound like a compromise, but in fact it’s completely unreasonable.

My two little creatures partook of mama-milk until they were each about ten months old. As newborns, they wiggled a bit while nursing but mostly concentrated at the business at hand. It can’t be easy to drink and breathe at the same time, but they practiced and practiced (oh, did they practice! about every hour and a half! for weeks on end!) until they’d mastered the task and grew large and fat. (Each of them gained about 5 1/2 pounds in their first six to seven weeks. Seriously.) Even as novices, they weren’t exactly inert, but I could usually arrange a blanket around them and not feel too exposed.

And then one day, they discovered that mealtime was for socializing, not just for sustenance. They’d drink a little, and then blop! They’d pop off the nipple, look around, smile, drool, and flirt with everyone in the room. I’d be left with my breast waving at the world, chilly and exposed, until their Royal Babyness deigned to latch on again. If we were in a public place, I could be grateful if a jet of pressurized milk didn’t spray any innocent bystanders.

Now, I’ll admit I never went in for those “nursing” clothes that promise discretion. You know, those goofy, dowdy shirts with flaps and buttons that oh-so-discreetly announce “I’m lactating.” That didn’t matter, though, because once a baby pops off the boob, no flap in the world is gonna hide you.

There are blankets, you say? And the mama can artfully drape her nursing baby in flannel and fleece? My guys saw the mealtime blanket as a fun challenge. Grabbing and wadding up and throwing it probably did wonders to develop their motor and visual skills. But coverage? The net effect of a blanket was probably negative, because if you relied on it, you’d end up flashing even more skin once the kid wrestled it to the ground.

Besides: In order to fully cover your breast, you’ve got to swaddle your baby’s entire head, too. Last I checked, infants need air as much as they need milk.

The standard feminist response to lactophobia is to say that men have issues with naked breasts that aren’t displayed for their express pleasure. There’s surely some truth to that. Prudery and prurience are often two sides of a single coin.

But the other thing about naked lactating breasts is that they bluntly remind us of our animal nature. Mammaries make it impossible to deny that we’re mammals. There’s no way to cover that up when you’ve got a baby at the breast, no matter how uncomfortable it may make some folks.

Update 12 noon, 2-27-09: Vanessa at Feministing alerts us to an example of how these two forms of lactophobia can intersect: Milwaukee hate-radio talk-radio host Mark Belling recently called breastfeeding mothers “sows” on his program, saying, “It’s..it’s what a pig does and it does it in public, right?” Just goes to show that misogyny and disgust at our animality make a happy, harmonious match.

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So here’s what I made for dinner tonight:

That’s, um, aluminum soup on the burner. I’d had a burst of energy and decided to make quiches for dinner – one with artichoke hearts, the other with asparagus. I put the pot on the burner, cranked it up to high, chopped the asparagus, and went to dump it into the pot.

That’s when I saw the pot was empty. I’d neglected to add water. (What was that about my beautiful brain?)

I picked up the pot to rescue it from the heat, and the aluminum soup spilled out in a big glop. The aluminum layer sandwiched between two layers of stainless steel had liquified, expanded, and popped the bottom off the pan.

The blobular aluminum was shiny and pretty, in a perverse way:

Now, the good news is that this stove is 25 years old. It bakes unevenly and I’ve been jonesing for a new one ever since we bought this house nearly seven years ago. I know we could just replace the burner, but maybe this is the nudge I need to do a little research and buy a new range. Any suggestions? Past negotiations on this have always hit a stalemate because I long for a gas stove, while my husband wants something like a ceramic top that’s easy to clean. As you can see, he’s not being unreasonable – not at all.

The other reason I can’t be upset about this is that I’m ecstatic about the surge of energy behind this kitchen fiasco. Yesterday I rode my bike to work and was pretty useless for the rest of the evening. Today I felt strong enough to bike to work again, and I still had enough oomph to embark on cooking a real dinner for just the second time since I fell sick on January 20.

As for the quiches? They were delicious.

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My Beautiful Optic Nerve

I learned two things at OSU’s MS clinic this morning:

1) My optic nerves are beautiful.

2) I almost certainly do not have multiple sclerosis.

I feel like my life was just handed back to me, in its entirety, fresh and new.

(Gratuitous daylily from last July’s garden, just because I am so happy.)

As in Cleveland, I had a wonderful experience with the doctor at OSU. He was smart and kind. He had a great sense of humor. His wife studies the social history of medicine (which is my research field, too); I’d love to have dinner with both of them.

He spent an hour talking with me and performing a neurological exam that involved vibrating tuning forks and the Ministry of Silly Walks. All normal except that my reflexes are a bit exaggerated.

He looked at my brain MRI and told me that I also have a beautiful brain – and that my scan is normal. Normal. Those extra spots? A mystery of nature. He showed me pictures of brains afflicted with MS, and the difference was evident even to me.

I don’t have to go back again unless I have a repeat performance of my symptoms, which the doctor thinks is extremely unlikely. I don’t have to get a spinal tap. I’ll get a repeat MRI sometime six or twelve months from now, just to be safe. That is all.

I feel incredibly lucky. Incredibly blessed.

So what went kaflooey with me? Maybe a virus; maybe the Bactrim after all; maybe something wonky with my thyroid (and I’ll still talk to an endocrinologist about that). As long as I keep getting slowly better, I can live with the mystery.

I may still blog about some of the thoughts I’ve had lately about disability, “passing” as normal, and the relation between body and mind. But I hereby declare an end to blogging about my day-to-day health (unless I get an answer someday, after all).

You can assume, along with me, that I’ll keep getting better, and that I’m wallowing in the amazing good fortune of having a beautiful brain.

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Fear, Loathing, and the MS Clinic

I haven’t posted much about my health this week. This is partly a denial and avoidance tactic. I’ve got an appointment very early tomorrow morning at OSU’s multiple sclerosis clinic. While I don’t expect to get any definitive verdict, simply making the trip puts me face to face with my fears again.

Best case: The doctor will order a slew of tests and tell me my brain MRI is not especially damning. Worst case: He’ll order a slew of tests and tell me I’m at high risk of developing MS. Either way, I’ll march through the tests, and then I’ll wait. Diagnosing MS is always a waiting game. The very definition of the disease requires either deterioration over time on an MRI or two attacks on separate parts of one’s nervous system that are at least a month apart.

I’ll post on tomorrow’s visit as soon as I get a chance.

The other reason I’ve been quiet about my health is that my brain fog has lifted most of the way. I’ve finally felt able to write about other topics, at least when I’m not too tired. It’s not just a pleasure to have a working brain; it’s a privilege. Remind me of that if I ever forget it again.

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Photo of North Dakotan Badlands by Flickr user JJSchad, used under a Creative Commons license. This somewhat gratuitous picture is included lest you think North Dakota boasts nothing but snow and gophers and pro-life zealots.

North Dakota’s new “personhood” law, which made it halfway through the legislative process on Tuesday, may no longer be the reproductive folly du jour, but it’s still preoccupying me. Why would my home state even consider such a silly law – one that, much like Colorado’s failed Proposition 48 last fall, could criminalize not just abortion but also most forms of birth control, IVF, and even normal miscarriage and menstruation? How the heck did this happen?

My husband said to me, “Curb your patriotism.” But it’s not just loyalty that’s got me wondering. North Dakotans are churchgoing and God-fearing, yes; but they’re also deeply pragmatic. Or at least they used to be when I lived there.

That’s not just childish nostalgia speaking, by the way. Not even the abortion controversy has historically negated North Dakotan’s basic pragmatism. Faye Ginsburg’s wonderful ethnography, Contested Lives: The Abortion Debate in an American Community looked at activists on both (or actually, all!) sides of the issue in Fargo during the 1980s. While she found plenty of drama and conflict, she also found that activists of all stripes shared a basic set of values regarding family and women as nurturers.

Perhaps the growing season in North Dakota is just too short for extremism to thrive.

Leslie Unruh, you say? Nope. She belongs to South Dakota.

So what planet did HB 1576 come from? How did a bunch of part-time legislators dream up the idea of conferring legal personhood on fertilized eggs even prior to implantation? Because that’s what the text of the bill does:

[F]or purposes of interpretation of the constitution and laws of North Dakota, it is the intent of the legislative assembly that an individual, a person, when the context indicates that a reference to an individual is intended, or a human being includes any organism with the genome of homo sapiens.

If this language is eerily reminiscent of the Colorado referendum, that’s because this is not an indigenous product of North Dakota. It’s written and promoted by the same people who brought us the Colorado foolishness.

In other words, the Colorado referendum wasn’t a one-off. It has spawned an apparently new tentacle of the pro-life movement, Personhood USA, whose ultimate aim is to pass “personhood” laws in as many states as possible, ultimately setting up a judicial confrontation with Roe v. Wade. Here’s their call to arms:

The fight for life is raging nationwide right now like never before and we wish to thank you for your conscientious decision to support every preborn child’s right to life. We are Personhood USA and our goal is simple: Together, we will glorify Jesus and then stop the dehumanizing of and destruction of preborn people.

The organizers that got personhood on the ballot in Colorado, would like to help in North Dakota as well. By getting personhood on the ballot, we force the question that the pro-death side does not want to answer, “when does life begin”?

Personhood USA claims grassroots support, and I have no doubt that North Dakota has its fair share of pro-lifers (even if the North Dakota League for Life’s website is pretty rinky-dink and years out of date). Here’s how Personhood USA describes its campaign in North Dakota:

“North Dakotans have gotten used to cold temperatures like -44 degrees, but they haven’t gotten used to child-killing. We applaud and support their efforts to protect every baby by love and by law,” commented Cal Zastrow, who, along with his family, worked on the North Dakota bill on the grassroots level.

Reading this, you might reasonably believe that Cal Zastrow is part of a burgeoning pro-life movement among North Dakotans. That’s the implication, right? But Zastrow would be a mighty unusual name among all those grandchildren of Germans and Norwegians. So I couldn’t resist googling Cal Zastrow. He’s from Michigan – two states over! No, Personhood USA didn’t lie about this; it just used the term “grassroots” to insinuate. Here’s how Michigan Citizens for Life describes him:

Cal Zastrow resides in Kawkawlin [Michigan] with his wife, Trish, where they homeschool their children. They are missionaries to the preborn who speak in churches, schools, and on the streets. Cal trains pro-life activists and conducts seminars to make the killing of preborn children unthinkable and unavailable through peaceful means.

Ordinarily I include links to groups like this just for substantiation, not because I think you need to waste any time going there, but Cal Zastrow has a such a dorky, douchey picture that he’s worth a visit if you’re in a snarky mood. Also, maybe you’ll discover WTF it means to be a missionary to the preborn. I’m still mystified.

So the success of the personhood bill in North Dakota depended crucially on the work of a provocateur from out of state.

I have to admit, though, that the bill’s sponsor, Dan Ruby, is a completely homegrown zealot who claimed “This language is not as aggressive as the direct ban legislation that I’ve proposed in the past.” Nor can I claim that the 51 legislators who voted for the bill (against 41 opponents) were bussed in from out of state.

What are the prospect for this bill actually becoming law? According to Kay Steiger at RH Reality Check, the bill’s introduction caught Planned Parenthood – the only pro-choice group with any presence in North Dakota – by surprise. That surely won’t still be the case when it comes before the state senate in a few weeks. At that point, Tim Stanley, senior director of government and public affairs for Planned Parenthood Minnesota, North Dakota, and South Dakota, hopes for a better outcome:

The personhood bill will go on to the state Senate by the end of the week, and Stanley says it is likely not to be voted on until the end of the legislature’s session, in April. Stanley believes that ultimately North Dakotans may not want to draw national attention with a challenge to Roe. If the bill does pass, Planned Parenthood’s affiliate will begin reaching out to the medical and religious community to begin building a coalition of support to fight the measure.

“My experience had been that this legislature is grounded in reality, as opposed to some other legislatures,” Stanley said. “South Dakota is not the most rational legislature when it comes to this kind of stuff. They’re known as being slightly out there and willing to take those high-profile risks to fight this fight. My feeling is that North Dakota is just slightly more reticent to do that. To their credit they’re not a state that looks [for] and seeks undue attention.”

(Source: RH Reality Check)

See, North Dakota doesn’t just have the prettier badlands, it also has a more level-headed legislature than South Dakota. And again – Dan Ruby is no Leslee Unruh! I’m hoping the state senate is rational enough to realize how ruinous it would be to litigate the “personhood bill” all the way to the Supreme Court, as required by the bill’s second paragraph.

But even assuming this bill dies before the tulips are blooming in Bismarck, Personhood USA won’t stop its quest. According the the American Life League, similar “personhood” legislation is pending in 15 other states. Even if there’s good reason to be relatively sanguine about the North Dakota state senate stopping this foolish bill, odds are good that it will pass somehow, somewhere, and ultimately land in the laps of the SCOTUS.

Another ominous aspect of this: the “personhood” movement is trying to shift the discourse. To some extent, they’re already succeeding. Just look at how RH Reality Check and I are both repeatedly referring to the bill and the movement within their frame: “personhood.” Repeat it often enough, and people may start believing that a fertilized egg is indeed a person.

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A friend and colleague (who just happens to be both gay and Catholic) recently sent me this, brimming with blasphemic glee.

I’m still trying to figure out how this ad will sell insurance. If you have a theory, let me know in comments. Otherwise, just enjoy.

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Look. I never thought Sarah Palin should get a free pass on 1) using motherhood as one of her chief qualifications for public office and then 2) telling America we had no right to know anything about her family. I sharply criticized Palin for getting on an airplane while leaking amniotic fluid. I thought it was reasonable for people to criticize her for marketing herself as a perfect mother when, clearly, she’s not.

But back in September, when Bristol Palin turned up pregnant, I also wrote that criticizing her was out of bounds:

There’s no room for schadenfreude. She shouldn’t be made the poster child for the failure of abstinence-only approaches to teenage sexuality; we have too many such poster children already. She’s going to face the difficulties of early motherhood with the added burden of publicity. She’ll also find deep joy in her baby, I’m sure – a point too rarely mentioned for all the moralizing about “teenage mothers.” She’s embarking on an amazing adventure in one of the hardest ways possible. I wish her well.

Now that Bristol has given an interview and basically said, yes, it’s hard but I love my baby, I don’t really have anything more to say about her – except that I really feel for her when she lets slip that she mourns a chance to just be herself, for herself.

But darn it, too many people that I otherwise like and respect are amplifying the Bristol interview and making her into, well, the poster girl for the bankruptcy of abstinence-only education. Sure, Bristol herself said it doesn’t work. That’s worth reporting. But Rebecca Traister at Salon goes on to comment:

Bristol went on to make more (perhaps unwitting) feminist points about what, exactly, the responsibilities and consequences are for young women who choose (or are forced down) the path she took.

At Pandagon, Amanda Marcotte quotes Traister’s article approvingly, adding:

For the rest of us [non-prolifers], of course, the whole thing is a horror show.

Both Rebecca and Amanda then go on to give Sarah Palin the drubbing she deserves. I’m all for that. I just wonder: Can’t we call out Palin on her hypocrisy and failed policies without dragging Bristol any deeper into it? I mean, Amanda sees the problem when it’s coming from the opposite direction:

Abstinence-only had been sold to the country as a teenage pregnancy prevention program, but the right wing reaction to Bristol made it clear that it was a teenage pregnancy inducement program, and Bristol was the poster child for its intended effects. [my emphasis]

Analytically, I agree with Amanda 100 percent on what the ‘wingers were up to. Yet I think we can make this argument without making Bristol the poster child for a feminist critique of wingnutty views on sexuality. Otherwise, we’re reversing the terms, not redefining them.

And we can certainly condemn the failures of abstinence-only without endorsing statements that hold Bristol up as a “perfect example ” and assume we know just what went down between Bristol and her mother. In fact, we don’t know whether Sarah Palin forbade Bristol to have an abortion.

Let’s not make Bristol pay for the sins of her mother.

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Tucked away in the stimulus bill that Obama just signed is a provision that will fund research to compare medical treatments head-to-head. As the New York Times reported last weekend, funding will underwrite research to answer questions such as:

Is it better to treat severe neck pain with surgery or a combination of physical therapy, exercise and medications? What is the best combination of “talk therapy” and prescription drugs to treat mild depression?

This is basically a good idea. Having studied the history of childbirth, I’m vividly aware of how many interventions, from routine episiotomy to fetal monitoring, have been adopted without solid evidence to back up their effectiveness. By now, research has shown both of these interventions to cause a great deal more mischief than good: routine episiotomy increases the number of severe perineal tears, and near-universal fetal monitoring has helped drive the c-section rate into the stratosphere.

And yet, while I welcome policy that would both encourage and enable evidence-based medicine, I worry about how this comparative research will be used. The Times article mentions the problem of factoring cost into calculations of “effectiveness.” Knowing how insurers work, I would expect them to refuse to cover more expensive procedures and drugs unless their benefits were overwhelming.

The Times article also highlights the problems of generalizing such research to everyone without regard to racial or sex differences:

“Some drugs appear to be more effective in women than in men, while other medicines are more likely to cause serious complications in women,” said Phyllis E. Greenberger, the president of the Society for Women’s Health Research. “It’s important to look for these sex-based differences.”

But beyond this, health policy needs to recognize that individuals can respond to different drugs in very individual ways. For instance, I’ve been reading up on the drugs used in multiple sclerosis. This isn’t a purely theoretical concern for me, because odds are good that I’ll be put on one of them if the neurologist I see next Monday judges me to be at high risk of developing MS. Some people don’t respond at all to the basic MS drugs (interferons that try to down-regulate the immune system). Others suffer from side effects that force them to try out medications in a different class. It’s really kind of a no-brainer that people with MS need to be able to choose among all the drugs currently on the market, including a couple that can have very grave side effects. Yet it’s easy to imagine an insurance company using comparative research to deny coverage of all but the cheapeast drug. This problem will only grow more acute as the experimental MS drugs currently in the pipeline (hopefully) reach the market over the next few years.

I’m not arguing that comparative research shouldn’t go forward. We need medicine to be anchored more firmly in scientific evidence. I’m just insisting that we equally need guarantees in law that insurance companies can’t use the results of such research to keep tightening the scews on sick people who need treatment.

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Ohio’s Baffling Sexual Politics

Ohio politics mystify me. I’ve lived here for over eight years now, and the contradictions still leave me spinning. We may be known as a swing state, but don’t be fooled. Ohio is often immoderate, a patchwork of extremes. My own little town is a progressive island in the midst of Appalachia, surrounded by the tattered traditions of trade unionism, Bible-thumping fundamentalism, and plain disenfranchisement and despair.

Ohio’s sexual politics are just as contradictory. On the one hand my adopted state made the news a few days ago with an abstinence-only sex ed curriculum that promotes rape culture. My county isn’t quite within this particular program’s scope, but the curriculum does cover the large Columbus market – and public schools along with private ones. Jill at Feministe has all the gory details, including “in the end they all get STDs,” which sounds about right. One of my former students told me about a sex ed program at his high school that warned kids if they had sex, they’d likely wind up addicted to drugs, passed out in a New York train station, and possibly missing a kidney to boot.

Ohio is also the home of Derek the Abstinence Clown, another fabulously wise use of your federal tax dollars. ‘Nuff said.

On the other hand, Ohio’s Presbyterian Church just took a strong progressive position by voting to open the clergy to persons in same-sex relationships. According to this morning’s Columbus Dispatch:

The Presbytery of Scioto Valley of the Presbyterian Church (USA) voted 115 to 88 to delete language from the church constitution that says clergy must be in a faithful marriage between a man and a woman or be chaste.

In order for policy to change, a majority of presbyteries nationwide would have to vote to remove the old language, and so far the the results don’t look promising. If the new policy fails, unmarried but sexually active heterosexual clergy stand to lose, too. The policy change promotes sexual freedom – and removes the incentives to hypocrisy – for everyone, irrespective of sexual orientation.

Whatever happens, I’m glad that in a state where the Reverend Rod Parsley often seems to dominate the religious landscape, Presbyterians have taken a step toward the equality that any just or merciful God would demand.

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There’s a bit of a kerfuffle about a new study by Susan Fiske of Princeton that, according to the Guardian, shows men are hard-wired to objectify women. Young male volunteers were shown images of women in bikinis and their brains were scanned with MRI to measure their responses. Their scans showed activity in regions of the brain normally activated when using tools.

As Vanessa at Feministing points out, while the study corroborates a long-standing feminist contention – that ubiquitous images of scantily-clad female bodies encourage the objectification of women – arguments for the hard-wiring of men’s responses can hurt women more than help them:

[S]uggesting that men are hardwired to objectify women is really dangerous, and for obvious reasons. Simply taking naked women out of the picture (figuratively and literally) is not going to resolve the problem, and implying that “men can’t help it” will just be used to contribute to the same sexist customs and rape culture that we’re fighting against.

However, even the Guardian’s exceedingly shallow reporting reveals that the studies’ findings are more complicated than that. Only men who scored high on a questionnaire measuring basic sexist attitudes had MRI scans indicating a lack of empathy toward the women whose images they viewed:

In the final part of the study, Fiske asked the men to fill in a questionnaire that was used to assess how sexist they were. The brain scans showed that men who scored highest had very little activity in the prefrontal cortex and other brain regions that are involved with understanding another person’s feelings and intentions. “They’re reacting to these women as if they’re not fully human,” Fiske said.

(Source: The Guardian)

Hmmm. In other words, the MRI revealed what parts of the brain remain dormant when a man fails to perceive another person as a human. But does that prove hard-wiring? Perhaps, but only after years of socialization. The research subjects are college students. Their brains are the product of two decades’ worth of learning about how the world works. The brain is an amazingly plastic organ, and its functions are not all inborn; they are shaped in response to environmental stimuli. The fact that not all men responded the same – and that objectification correlated with sexist attitudes – undermines the interpretation that all baby boys will inevitably grow up to regard women as objects. Upbringing and society must play a role.

How solid is this research? Figleaf frets that there’s no original study available online to back this up, and he’s right: the study has only been presented at a conference (the American Association for the Advancement of Science meeting in Chicago), and it’s not yet published in any journal. So we can’t dissect it properly.

On the basis of a report in the National Geographic, however, we can pinpoint some of the study’s limitations: It was small, with only 21 experimental subjects. It only looked at hetersexual men (no women were tested at all). And all of the subjects were college students, which means that the sample would not measure responses of men at various stages of learning over their life course.

In one respect, the study is actually more disturbing than either Vanessa or figleaf notes (again, because the Guardian article was so flimsy). The sexist subjects didn’t just regard women as tools to their pleasure; they went beyond mere objectification in to a much scarier realm. This comes out in how The Independent described the study’s findings:

The study focused on a region of the brain called the medial pre-frontal cortex, just above the eyes, which, when activated seems to damp a man’s tendency to express hostile sexist thoughts about women, Professor Fiske said. Men who express the strongest sexist tendencies tend to have a less active medial cortex. It becomes decactivated in men who are the most hostile to women, but only for women in bikinis, she said.

“So basically they are particularly likely to treat these women as objects, at least that is the interpretation of the data we have so far. It is a preliminary study but it is consistent with the idea that they are responding to these photographs as if they were responding to objects rather than people.”

It was “shocking” to find that the pictures of scantily clad women deactivates the medial pre-frontal cortex, Professor Fiske went on. “The only other time we’ve observed the deactivation of this region is when people look at pictures of homeless people and drug addicts who they really don’t want to think about what’s in their minds because they are put off by them.”

In other words, subjects prone to sexism didn’t just objectify women; they dehumanized them.

That’s a crucial distinction. We all objectify people we don’t know well but find attractive. Women do this too: We look at someone and think to ourselves, “Yummy!” That’s not a response to someone’s stellar character or personality. But there’s a big difference between one-dimensional appreciation of sexiness and reducing the object of your lust to less than human. It’s only the dehumanizing response that nurtures rape culture and other potential violence.

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More Lattes for Me

Lately Kittywampus has been mostly quizzes, LOLcats, and me me me. Today follows in that vein, though minus the felinity, with a quiz I took (via Blue Gal):

What Breed of Liberal Are You?

How to Win a Fight With a Conservative is the ultimate survival guide for political arguments

My Liberal Identity:

You are a Reality-Based Intellectualist, also known as the liberal elite. You are a proud member of what’s known as the reality-based community, where science, reason, and non-Jesus-based thought reign supreme.

Take the quiz at www.FightConservatives.com

I obviously need to up my latte intake.

Actually, I have resumed drinking coffee again without any apparent ill effect. (I’d dropped down to homeopathic amounts of Diet Pepsi, hoping that reducing caffeine would help tame my tremor.) My hands aren’t any shakier for it, and my brain is definitely less jello-like.

I still lack the energy for writing much of substance, although I’m stewing in thoughts about octuplets and reproductive rights and kinky sex and feminism and the authority of experience. (I wasn’t planning to roll all of that into a single post … but hmmm, it might be entertaining. Kinky octuplets, anyone?)

I rode my bike to work today, which I’m afraid overtaxed my limits. I taught my class, wobbled home, and spent the rest of the day on the couch, gobsmacked with fatigue. Last time I felt anything like this, I had altitude sickness after a long hike in Yosemite.

At moments like these, I sort of get why people migrate out of the reality-based community. Where’s Ernest Angley when I need him? (Click on that link at your own peril.)

As always, I’m curious to see how you came out on the quiz.

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Kissing kittehs from I Can Has Cheezburger?

One of the hallowed traditions of Valentine’s Day is polishing up all the old chestnuts about men, women, and romance. So when I saw a headline in yesterday’s Columbus Dispatch proclaim “Kissing a stress-buster for both men, women,” I was pleasantly surprised not to get a rehash of the usual stereotype – that girls and kissing go together like, well, love and marriage, while boys view kissing as a necessary step toward getting what they really want. Which of course nice girls like me wouldn’t want. Right?

The study behind the article – led by Wendy Hill, a professor of neuroscience at Lafayette College – didn’t stop at busting just that one stereotype:

Kissing, it turns out, unleashes chemical changes that ease stress in both sexes and encourage bonding in men, though not so much in women. …

In an experiment, Hill explained, pairs of college students who kissed for 15 minutes while listening to music experienced significant changes in their levels of oxytocin, which affects pair bonding, and cortisol, associated with stress. Their blood and saliva levels of the chemicals were compared before and after the kissing.

Both men and women had a decline in cortisol after smooching, an indication their stress levels declined.

For men, oxytocin levels increased, indicating more interest in bonding, while oxytocin levels went down in women. “This was a surprise,” Hill said.

But what a cool surprise! For the past few years, conservative hand-wringers have told us that young women are screwing around like bonobos, and that oxytocin – the bonding chemical – sets them up for heartbreak. Women produce more oxytocin than men, and therefore our biochemistry programs us to be devastated emotionally by casual sex. Or so worry scolds like Laura Sessions Stepp. (In lieu of a direct link to her, here’s a critical overview of her argument at Campus Progress.)

While I don’t share Stepp’s concerns that young women are permanently messing up their lives through casually hooking up with guys, I do think that brain chemistry matters. Oxytocin provides a pretty compelling explanation for the instability of friends-with-benefits relationships. And it’s true that women produce more of it.

I’ve just never been convinced that only women are vulnerable to our hormones and biochemistry. After all, most men eventually want a committed relationship. I’ve wondered if men’s pair-bonding impulses might be more sensitive to low amounts of oxytocin, much like women’s libidos are more sensitive to low amounts of testosterone. I’m not a biochemist, so all I can do is speculate, but I’d love to see a study on this.

Conservative fretting about women’s unique vulnerability to the emotional hazards of sex doesn’t hold up well to scientific evidence suggesting that men, too, might be wired to feel that sometimes, a kiss is not just a kiss. (No word on whether a sigh is always just a sigh. The experiment was conducted in a student health center, so frankly, I’m amazed that any love chemicals were measurable.)

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Like a Virgin

No, I’m not talking about me. (I can hear some of my readers laughing all the way from California.)

Nor am I referring to my husband’s crush on Madonna, who ranks with Sandra Bullock and me in his pantheon of hot women.

I mean this cool blog I discovered recently: The American Virgin. Did you know the Virgin Mary was recently sighted on a doggie door? Yes, really! Along with seriously amusing weirdness, they’ve also got serious analysis of sexuality and religion, abstinence crusaders, and all things virginal in American culture.

So pop on over and visit Trixie and her co-bloggers. You’ve nothing to lose but a smidgen of innocence.

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All right, I’ll admit it: I like getting flowers every once in a while. I don’t believe they should be mandatory for a particular day, and I think the commercialization of Valentine’s Day is about as sexy as the commercialization of Christmas. It’s just capitalism revving its internal motor.

But still. I got flowers today and I adore them. Their backstory is pretty cool. My husband bought a raffle ticket from one of the administrative assistants in his department. He just figured he was donating $5 to one of the poorly-funded schools that borders our own relatively fortunate district. Instead, he won a dozen roses in a vase.

These are the lucky roses. (The keen eye will note the Ants in the Pants game in the background, which tells a whole ‘nother story about my life.)

I love the idea of winning anything. It makes me feel lucky in general. I am totally reading this as a good omen for my whole life.

And yet, these roses pale next to to the real gift I got this Valentine’s Day. My husband was supposed to spend most of the week at a conference in Germany. He didn’t go. He stayed home with me instead. When he could have been reconnecting with old friends and basking in scholarly acclaim, he drove me up to Cleveland and held my hand and promised we’d get me healthy again. He didn’t think twice about his decision.

That line about “in sickness and in health”? This is part of what bell hooks is getting at, I think, when she writes that romance is a fickle and a shaky foundation for a life, while love is solid but demands that we consciously choose it over and again. (I realize I keep harping on this idea of hers, maybe because its ramifications are more complicated than they first appear.)

I’ve been on both sides now, the sickness and the health. Both exact a higher cost than most of us imagine when we utter a vow in the flush of youth. If we’re wise – or at least lucky – we keep choosing love anyway.

I see no reason to swear off romance: the butterflies, the flirtation, the vase full of red roses. Love ought to be fun, too, after all. But when the petals shrivel and fall, it’s love that remains – with its constant demand to choose – challenging and sustaining us.

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Kittywampus has suffered a severe frivolity shortage lately. Today’s antidote: taking the “What LOLcat Are You?” test.

I came out as Happy Cat, the original “I Can Has Cheezburger?” kitteh.

Your result for The Which Lolcat Are You? Test

Happy Cat

64% Affectionate, 55% Excitable, 60% Hungry

Happy Cat

Compared to other takers

  • 65/100 You scored 64% on Affection, higher than 65% of your peers.
  • 63/100 You scored 55% on Excitability, higher than 63% of your peers.
  • 83/100 You scored 60% on Hunger, higher than 83% of your peers.
  • 50/100 You scored 100% on Felinity, higher than 50% of your peers.

May I just brag briefly about my felinity score? Last time I scored 100% it was on the peripheral vision test I took on Monday. Time before that was probably the final exam for Intro to Material Science in spring 1983.

Obviously, neither vision nor the material world are as vital as felinity.

My kids took the quiz, too. This created a slight moment of Bad Mommydom, as I had to rush the Bear past a response featuring “buttsecks.” I’m not quite ready to explain that one to a nine-year-old.

The Bear also came out as Happy Cat, which made him, well, happy. The Tiger came out as Sad Cookie Cat. He burst into tears at this result. Truth told, though, the grammar, the kind impulse, and the behind-our-backs gluttony all fit him perfectly.

Sad Cookie Cat

Both kids also scored 100% on felinity, I’m proud to say.

Now it’s your turn. Go take the “What LOLcat Are You?” test and report back, please. (If you post your results on your blog, toss us a link.) And yes, I’m talking to you, my dearly loved lurkers. :-)

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Rockin’ Cleveland

No, I didn’t get to go to the Rock and Roll Hall of Fame, but I still rocked Cleveland. Or it rocked me. And all in a good way.

The doctor I saw at the Cleveland Clinic, Rula Hajj-Ali, was brilliant in every way. She listened attentively and asked loads of questions. You could see her mind work as she pieced the puzzle together. I think she’s among the smartest people I’ve ever met. She was also incredibly generous with her time, spending close to an hour with me. Not least, she had a calm, warm demeanor.

Her judgment: I don’t have vasculitis of any flavor. Lots of factors went into her assessment, but the bottom line is that I’m feeling better without treatment. That shouldn’t happen with vasculitis. She ordered tests for a few even more exotic ailments, just to make sure we don’t miss something. She also says I need to see a neurologist and get a spinal tap (yes, I’ll be sure to insist on the one that goes to eleven) but she’d be surprised if that yielded any abnormalities.

While she obviously can’t guarantee anything, she thinks I’ll most likely continue to improve and be okay.

As for my slightly mutant MRI? A few days ago my mom and sister started wondering about an episode when, as a young toddler, I had a severe reaction to a smallpox vaccine. Fever convulsions sent me into a continuous seizure for an hour and a half straight. Everyone was afraid I had brain damage. (You may be the judge of that!) When I came out of it, I immediately said “cookie,” to my parents’ and doctor’s great relief. I did have to re-learn how to walk again, so evidently some sort of damage occurred.

Anyway, both my local doctor and the specialist I saw today think that the multitude of bright spots in my brain could well be the result of that unusual seizure.

Or we could just say that I’m brighter than we thought. No? Okay, I’ll settle for being happily home, reunited with my kids (who managed not to scare off their sitter’s hopes of having her own children someday), and less worried than I’ve been in quite a while.

Oh, and if anyone ever considers going to the Cleveland Clinic for treatment: Do it. I encountered so much kindness and competence. They even had a huge brown bear Newfoundland named Teddy Bear hanging out in the lobby as a “greeter.” His actual job was as a therapy dog, visiting sick kids. It’s the small things that count – or sometimes, the mammoth furry ones.

This is not the actual Newfoundland I met today, but it gives you a general notion; this gal’s name is Jill and the photo is by Flickr user 2-Dog-Farm (used under a Creative Commons license). Now picture this mountain of a dog in a hospital lobby …

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