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    Friday, May 25, 2007

    How News Travels About Periods

    What have I done??

    Honestly, I never expected this would happen. All I did was write a short comment on a post about the new birth control pill that stops menstruation, and I released a firestorm. If I had known my comment would be picked apart with a microscope, I might have elaborated my position more, clarified some sentences, etc. But now it's generally lost in the conflagration.

    One post here, a comment there, causes another post somewhere else, and more comments
    This is what happened, and I think it's incredibly interesting as a example of how the blogosphere undulates--if I can use that word--when something is added.

    First, Apoorva Mandavilli wrote about the new pill, Lybrel, at Spoonful of Medicine.

    This got me thinking about the issue, and I read the articles the post linked to. I thought that was the end of it.

    Second, Ann Althouse heard the news and posted a short question on her blog.

    Is there some deep psychological/sociological/feminist angle to this story or is it obvious that everyone should obviously want to avoid something that's so inconvenient and annoying and that the only serious question is whether the pill is safe?

    Well, maybe it didn't start with me, it started with her assertion that "the only serious question is whether the pill is safe?" (emphasis added). One commenter disagreed with the absolute nature of her question, and replied,

    menstruation, like childbirth, is just part of being a woman. If another woman would want to escape it, then sure, she should go for it. But, not being punny, it just wouldn't feel right to sidestep it.

    This got Eugene posting on The Volokh Conspiracy. He said,

    Again, concerns about long-term health effects are quite sensible. But I don't see any justification for the feeling that it's not "right to sidestep" something that's "part of being a woman." I suppose it could be some esthetic judgment that argument won't much drive; but setting aside esthetics, why on earth should we want to accept natural but painful or unpleasant things?

    At this point I jumped in. The Volokh Conspiracy gets so many comments, that I didn't think much about mine--subconsciously figured it would be lost in the proverbial sea, so to speak. I said,

    This is an example of how much medicine is an ART and a science. Ultimately, pills treat symptoms and change chemicals that produce a different state of being--but the ideal state of being differs from person to person.

    It's been amazing seeing my wife and other women deal with her first pregnancy. Immediately upon announcing to the world she's pregnant, my wife was part of the "in crowd." Every mother--whether she knew my wife well or not--could smile and talk about morning sickness, or finding out the baby's gender, or feeling bloated, etc.

    So, it is not aesthetic. Humanity derives meaning from shared experiences, and deleting one of the most universal and central of all female experiences can subtract perceived meaning from people's lives. In that regard it is very important.

    As a soon-to-be-doctor, I would never recommend such birth control without bringing up and discussing the social and emotional ramifications in addition to the physiological ones.

    Apoorva Mandavilli over at Nature's Spoonful of Medicine posted a little on it about two weeks ago.

    The blog post links to Mandavilli's good article on pros and cons in Women's Health. Check it out too.

    The other reason I felt this comment wouldn't be noticed, is because I didn't feel I said anything too inflammatory. It turns out I was wrong on two counts.

    I figured people were being too literal and misunderstanding my point when a commenter, UVAgirl, wrote,

    From the doctor, I get a condescending lecture that I'm missing out on the experience of being a woman if I choose to take this pill.

    Then, Eugene Volokh posted a response post, quoting my analogy to pregnancy and saying,

    Humanity does derive meaning from some shared experiences — but not all. Shared experience that you bond over: pregnancy. Shared experiences that you don't bond over: hangnails, nearsightedness, tooth decay.

    ...But let's hear from some people who actually menstruate, and have been pregnant. When you menstruate, do you feel that you're part of the "in crowd"? If you chose to stop -- not because of menopause, which is a marker of age and of lost fertility, but voluntarily and reversibly -- would you feel "out"? Do you smile and talk to your friends about the cramps, the mood swings, and the like? Do you feel you derive meaning from the fact that you share menstruation as an experience with other women? Would you feel meaning subtracted if you stopped menstruating, because menstruation is so "central" a "female experience[]"? Do you find menstruation to be similar to pregnancy in any emotionally positive way?

    Eugene posted a comment later where he defended his second post by saying,

    When someone says "menstruation and pregnancy are analogous, and pregnancy is A, B, and C," it seems sensible to explore the analogy by asking whether menstruation is A, B, and C, too.

    Is it that people didn't connect that my questions were just quotes from Triet's comment, aimed at showing that Triet's analogy was unsound?

    Well, obviously no analogy is perfect. And yes, you can sit and look at why the analogy might not work, but that's only half the issue--you should also look at why the analogy might work too. Some of the comments on the first post had basically agreed with me, but things changed. Taking just this quote, people became very polarized about whether or not you can derive meaning from a period. Now I sit here and wonder if the rapidity and severity of the response doesn't prove my point.

    Có tật giật mình.

    But that's not the end. Ann Bartow from Feminist Law Professors remarked on her blog that he needed to be educated. Someone defended him at Is That Legal? by saying,

    Some guy said something kinda stupid, and Volokh replied: "Oh, really? Lets ask actual women about menstruation. So, women, how about it? Is it a life affirming shared cultural experience?"

    That's an entirely reasonable response.

    So now, I've said "stupid" things, according to someone I'll never know. But that's not all people said. In the comment section to the second post, many women agreed with me, like the first one that said

    Is it a bonding experience? Sure; it can be. Especially if you live with the women in question, because then you all get cramps together.

    and of course other's disagreed

    A bonding experience? Puhleeze. Look men, would you want to spend five or six days every month with blood leaking from your body, sometimes coming on with little warning, and potentially putting a very embarrassing stain on your business suit?

    All I did was write a short comment ...but now it's ... lost in the conflagration
    Unfortunately, as often happens in comment threads (see Xanghe's post on Breeder's of Hate), the discourse tends towards the extremes instead of answering the question in a logical and amicable way. I noticed that people had now totally missed the point of Lybrel--to offer a way for women to take birth control without monthly periods, but that it still comes with it's own issues (one of which is random bleeding). Everyone is pontificating on how many periods are normal, etc. Another commenter, Falafalafocus, summed it up greatly, saying,

    I must say, this topic is like an incredibly large automobile collision. I can do nothing to help it along and there are parts that make me want to run and hide, but I find myself strangly [sic] fascinated by the discussion nonetheless.

    Since it was my comment that caused the "automobile collision," I felt obligated to respond and clarify. On the subject of bonding, I said,

    I believe it does derive meaning from all shared experiences, good or bad. Some may play a larger and more central role in a person's life, and the composite of experiences that people share changes from relationship to relationship, but we bond over the bad and the good, the trivial and the important.

    Haven't we all complained off the cuff about stubbing our toe or having a hang-nail and someone else said "yeah, that sucks." Such a small and arguably insignificant thing has demonstrated another level of understanding between the two people involved.

    And shared bonds that we may not want to endure still provide meaning to our lives. When my lung collapsed spontaneously as a high school student, I was introduced serendipitously to a girl in Minnesota who had the same thing. We became pen-pals and friends, bonding on many levels including the pain we suffered dealing with a collapsed lung. In addition to the bonding, I also gained a little more "meaning" to my life by realizing that I would be dead if not for some modern machines.

    And on my last sentence which caused such consternation, I said,

    This is not because women should be persuaded out of this pill--no, not at all!--but that all women should be advised of the physiological changes and risks taking the pill entails, as well as the lifestyle changes (including possible absence of monthly menstruation), so that they can decide with their doctor if taking the pill is in their best interest for their health, lifestyle, and vision of who they are.

    Another commenter, JM Hanes, totally misunderstood how humanity might derive meaning from common experiences and yet people can derive individually different meanings from experiences. Well, I'm going to use another analogy--which we all know are never perfect--that I think can illustrate the premise.

    When you learn about bacteria, there are many kinds. One for example, is Escherichia coli. E. coli is familiar to us because we get sick from it, typically if we eat an undercooked hamburger. But not all E. coli's are the same. In fact, there are broad categories of E. coli--ones that cause watery diarrhea, ones that cause bloody diarrhea, etc. And when you look even closer at one type (say, Enterohemorrhagic E. Coli, or EHEC, that causes bloody diarrhea) you will see numerous variations in its genetic code that gives attributes, such as increased susceptibility or protection from antibiotics.

    So also is humanity. We may gain meaning from shared experiences, but yet have differences. On a microscopic scale we may seem incredibly different from each other, espeically if just one issue, like menstruation, is looked at. But when we step back and look at the aggregate of our experiences, we start to have more and more in common.

    JM Hanes also said this about my last assertion to talk with the patient about all the consequences of a pill:

    I'll chalk up the unwitting condescension here to youth, and suggest that you pay your future patients the courtesy of keeping your ruminations on the subtractive nature and social raminfications of the decision at issue to yourself! There is simply no way you can inject questions about the symbolic, psychological, and social affects of womanliness without adding gratuitous, if not specious, judgmental freight to a decision which, per this discussion, women are perfectly capable of sorting out as they, themselves, see fit.

    to which I responded,

    And I'm sorry you groaned over my last comment, but you must have missed the point. How could I bring up any birth control pill without discussing the social and emotional ramifications with a patient? I have been taught repeatedly to do that in medical school and I believe it is a correct principle. If a woman came in wanting birth control, I am going to talk to her about ramifications such as:

    1. Social -- do you know this birth control causes random spotting and bleeding? If your job or lifestyle puts you in situations where this might be inconvenient, then I might recommend a different pill.
    2. Emotional -- do you feel a period is a part of being a woman you don't want to give up? If yes, then obviously I'm going to suggest a typical estrogen+progesterone pill. If no, then the new one might be right for her.
    3. Physiological -- as with all progesterone+estrogen pills, this one carries with it an increased risk of blood clots, heart attacks and strokes. Typically estrogen+progesterone pills do not carry the increased risk of cancer that progesterone only pills carry.

    Such a discourse in no way dictates condescendingly to a woman what pill she should take, but gives her the full knowledge so she can make an informed decision about what is best for her life.

    Oh, but that's not the end. For the furvor caused not only my first post on menstruation, and this second post, but a third post on The Volokh Conspiracy, those posts on Feminist Law Professors and Is That Legal?, and a post on Conglomerate by Christine Hurt. It is refreshing for a couple reasons.

    1. It is a real thoughtful response to his second post's questions, which the other commenters didn't do, and
    2. It agrees with me, which is very nice since my first comment got picked apart.

    She says, in part,

    1. Yes, pregnancy and childbirth make women part of a very large club whose members have something very important in common. Consider it like sports for men, or Dungeons and Dragons. Female culture doesn't have a common theme that most girls' youth revolves around that joins generations of women together other than fertility and childbirth. I remember finally having something in common with my grandma when I got pregnant. Menstruation is similar. When girls begin to menstruate, they do join sort of a club, but it's much more underground. Once girls begin to menstruate at school, their other friends want to also. No one wants to be left out of this growing up thing, obviously.

    2. Menstruation might be more of a bonding thing in this country if the culture were different. In the U.S., our culture is one of sanitizing and deodorizing must bodily functions. We shave a lot, bathe a lot, shampoo a lot, powder and perfume a lot, etc. Menstruation runs against that. So to some extent, especially among young girls, menstruation is embarrassing. The onset of menses also comes when girls are the most self-conscious they will ever be, adding to the secrecy and embarrassment. I'm not sure it has to be that way, though.

    It is a great post, so please click on the link and read the whole thing.

    Ultimately, I take you through this journey partly because I'm very interested in how YOU feel about the new pill and menstruation, but more because I'm fascinated by how discussion travels in waves around the blogosphere. One post here, a comment there, causes another post somewhere else, and more comments. Eventually people like me are reading blogs I would never have before (like Feminist Law Professors or Conglomerate) and different types of people are mingling. I'm sure some sociologists far smarter than I will or have already dissected this phenomenon and shed some light on it.

    [+/-] read/hide the rest of this post


    MGO said...

    Should've known you'd shoot the archduke...

    This is what I get with my head buried under 4 feet (no, literally) of bar books - that turned out to be a pretty interesting exchange, being called stupid by a feminist law professor notwithstanding

    Triet said...

    lol. it's taught me (or reminded me) of the perils that are attached to this great blessing of a blogosphere.

    I had a substitute teacher in AP History who, when the press was making a hullabaloo about Fuzzy Zoeller making a stupid "collard greens" comment to Tiger Woods when he won the Masters, said a quote that will stick with me forever:

    "He who looks for offense will find it."

    We had a few minutes before the end of class, and we were talking about the story when he walked by. Catching our conversation, he argued that we shouldn't defend someone for dumb or wrong words, but we should also look at ourselves. Then he said the quote.

    It's true. If we run around examining every sentence with a microscope for a syntax error, or a word with connotations not perfectly in line with our beliefs, humanity is fallible enough that we'll have ample ammunition to fire at anyone who doesn't share our deeply held and often myopic beliefs.

    For nothing else, this exchange has caused me to step back and look at the big picture after reading something inflammatory, to find out if it's really just me, before I move on.

    And I think that's wise advice for anyone.