Frailty -Thy Name is Woman?

There seems to be no end in the struggle to differentiate men from women. You’d have thought that by now, we would have settled the boundary disputes, agreed on who owns what, and set up market stalls on anything remaining. It’s all shared territory anyway. Of course, maybe that’s naive. Maybe there are fundamental discrepancies that admit to only superficial comparisons. Relativities…We are, when all is said and done, different from each other not in terms of value, or worth, or intelligence -or anything like that- but physiologically. And there’s the wonder.

That we complement each other seems so adaptive, so perfect… And yet, do others that interact with us -microorganisms, for example- see it the same way? Are infections as unbiased, fair and equal as we are striving for in our societal evolution? Human laws be damned -do they see us as the same, or do their rules change depending on our sex? Do they discriminate?

We’ve all sniggered about the unequal fury of ‘man colds’ and the like, but whatever evidence supported or rejected this contention has always been subject to the confirmation bias of those studying it. An article in the BBC News seems to have uncovered yet another layer of the Matryoshka doll:

They have reported on a 2016 article in Nature Communications by Ubeda and Jansen which suggests that ‘Viruses can evolve to become more aggressive in men than in women’. This has usually been attributed to hormonal differences, and the effects these might have on the immune response, and no doubt this does play an important role. But suppose one were to examine this from a different perspective?

‘Viruses have ways of spreading that are unique to women – such as to a child in the womb, during birth or breastfeeding.’ From the invading organism’s point of view, this is important. ‘Scientists at Royal Holloway University in London used mathematics to model whether this altered the way viruses behaved. Their findings suggest there may be an advantage to infections being less aggressive in women as reducing the risk of killing the mother increases the chance of infecting the child.’

They’re not meaning to suggest some form of microbial intelligence of course -other than that those who happen upon a better way to survive and more successfully propagate their kind will be able to continue passing on their genes. ‘”Viruses may be evolving to be less dangerous to women, looking to preserve the female population, the virus wants to be passed from mother to child, either through breastfeeding, or just through giving birth.”’ The Selfish Gene kind of thing -survival of the most adaptive.

All this is very interesting, but for me, it also raises the question of the nature of intelligence, and whether we have truly cornered the market. Without becoming unduly tautologically entangled, how should we define intelligence -and therefore decide who, or what, possesses it?

I suspect it is no longer sufficient to equate mentality (to use an obviously autological word) with brain size, and neuronal density… Or maybe even neurons –trees, for example, have interconnecting root systems, often associated with fungal networks, that are able to communicate after a fashion. Trees and plants are also often able to signal to each other about threatening insect infestations, allowing the production of defensive chemicals. But they live in a different Magisterium almost -they cannot run or hide, so another mechanism was required for survival in an ever-changing environment.

Humans, with our recently evolved Weltanschauung, tend to frame the capacity of other organisms in terms of our own, and their intelligence by what we judge they have accomplished in their own environment. The fact that they have been successful at survival has often been seen as irrelevant to the discussion. Whether an organism can reason –if we can ever peel away the inbuilt hubris implied by the word- is surely another way of saying, ‘learns from its mistakes and adapts appropriately’ -even if that is only in terms of the next generation enabled by the survivor. We have adjusted in our fashion, and they in theirs.

Still, I don’t mean to attribute our characteristics to microorganisms who could care less what we think. Sometimes, it is enough to survive and create the next generation; sometimes adaptation-whether over time and generations, or in one lifetime- can be seen as a goal achieved. So, is it too much to believe that there may be an effective strategy that is gender-modifiable? And is it too much to call it a strategy? Is this such stuff as dreams are made on…?

However much we hesitate to anthropomorphize an issue, a change of perspective is often heuristic. It may well lead to a new understanding and hence a novel approach to a hitherto unsolvable problem. Although this is purely speculative at this stage, the researchers in that article suggest ‘that eventually it may be possible to use drugs to trick viruses into thinking they were infecting women in order to make them less aggressive.’

What an exciting prospect that we may no longer feel a need to completely ignore gender in our dealings with the world -that we may finally be able to shed the guilt of being unable to meld the two into a seamless fabric, and feel embarrassed that, like a poorly executed pentimento, traces of the discrepancy continue to persist.

Recognition and concession of difference does not imply censure or stigmatization -rather, it invites a celebration of the unique patterns each can offer. A realization that a recipe with only one ingredient is uninteresting and bland. And, given the conjecture in the Nature and Communication paper, it’s an awareness of something suspected since antiquity: that our remedies oft in ourselves do lie.

Sometimes, like Robert Frost we just have to take the road not taken:

I shall be telling this with a sigh

Somewhere ages and ages hence:

Two roads diverged in a wood, and I—

I took the one less traveled by,

And that has made all the difference.


Trippingly on the Tongue

I’ve always liked the poetry of metaphor with its imagery revealing nuances hiding shyly in the background. Words alone sometimes convey their meanings too narrowly, whereas metaphors allow imagination to roam more freely, only loosely tethered to definitions. After all, depending on the context of its use, meaning is often reliant on Weltanschauung. Such is communication; language is only the messenger.

Usually one can imprison meaning, of course -confine it in a cramped little box from which, should it ever escape, it would cease to be useful. Indeed, it would be a Pandora’s box from which it escaped. And yet, even there, what remained inside after all the mischief and malevolence had escaped, was Hope. Maybe that’s what metaphors are: unexpected colours leaking from behind the bars… Liberations.

Of course, metaphor is value-laden as well as culture-dependent. One society’s metaphors do not always translate into that of another -hence the difficulty of truly understanding and appreciating the poetry of another nation, especially if it must be converted into a different language. It made me wonder whether there may be similar disparities with gendered interpretations of metaphor.

There was an interesting article in BBC Future a while ago that caught my eye: It made me realize that there are many ways the genders differ. Of course, it may be that when we hear an unusual expression for the first time, we (either sex) cling too firmly to denotative -definitional- aspects of the words for interpretational safety, when the more imaginative and unexpected connotative sense is what was intended all along. And it’s in the connotation -the metaphoric significance- where we differ…

For example, what is a ‘glass ceiling’? ‘Originally popularised by Gay Bryant at the height of the feminist movement in the 1980s, it’s a widely used term today that describes an invisible barrier that keeps women from occupying executive positions. The metaphor suggests that women should aspire to ‘break through’ the ceiling – but the problem is that it describes only the women reaching up, rather than, say, the men that are peering down from the top. This arguably places unfair responsibility on women to smash the ceiling, rather than focusing on the role of men in creating and maintaining it.’

There are other metaphors in use of course, often involving glass -presumably to convey the idea of invisible barriers to movement for women. So, the ‘glass cliff’ which depicts the idea of  ‘how senior women are often hired for risky and precarious roles at times of crises’ and therefore making them look bad if they fail to succeed. Or, the non-glass example of the ‘sticky floor’, which describes how women often feel stuck in low-wage jobs where career ascension is unlikely.’ 

But, handy as they are in explaining often complex topics, metaphors -in these contexts anyway- tend to oversimplify the problems ‘offering only a specific angle or viewpoint that isn’t the full picture.’ They confine us to viewing the world through a narrow aperture -a spotlight that illuminates only one small part of the stage. ‘“Women are the effect to be explained,” says Michelle Ryan, a psychology professor at the University of Exeter. “We never talk about men being overconfident, we always talk about women being underconfident. And we never talk about men having privilege or finding it easy; we always talk about women finding it difficult.” Ryan believes that the metaphors we’re using to describe women at work reflect the world’s androcentricism [sic] – our insistence that, even in 2017, we consider the male experience as “the norm”’

The issue is not entirely one-gendered, though. There is the concept of the ‘glass escalator’, a term occasionally applied to men in female-dominated industries that ascend to upper ranks more quickly than women. And yet, as Caren Goldberg of Bowie State University in Maryland points out, metaphors are employed when there is an “exception” to the rule or gender stereotype.’ So in the example she cites, it was applied to a male nurse (in a predominantly female dominated profession at the time) and implied that he probably chose nursing because he wasn’t able to get in to medical school.

‘The obvious upside of any these metaphors, however, is that they highlight social phenomena that might otherwise remain invisible and therefore impossible to resolve. But in order to address the circumstances that lead to women being held back, and men rising seamlessly, it shouldn’t be forgotten that metaphors simplify complexity.’

In an admittedly convoluted way, it reminds me of a woman I met the other day at a bus stop. I suppose I only met her by default, really -nobody would stand beside her because she was exhibiting a rather odd behaviour -probably Tourette’s syndrome, I’d thought at the time. She would be standing quietly at the curb, and then suddenly bend forward and seem to be vigorously cleaning and polishing something above her. This would last for a few seconds, often becoming more and more frantic, and then subside, leaving her once again peaceful, although by the look on her face, perhaps not content.

She was in her thirties, I would guess, and dressed quite respectably in a blue pant-suit, with a spotless white blouse and short stubby earrings that would be unlikely to achieve any unwanted momentum during her seemingly randomly timed tics. Her auburn hair was sensibly short and her makeup intact as far as I could tell. Apart from her odd movements, she seemed like a typical business woman on her way home from work.

And, when she moved beside me in the now-disrupted line up, she smiled apologetically. “I’m sorry, sir,” she said -hurriedly, I thought, in order to explain herself before she was once again overcome by the movement. “It’s just my latest tic…”

At that point and without any obvious warning, she launched into another bout of scrubbing something invisible over her head. I tried to pretend I didn’t notice, but she wasn’t fooled.

“I think stuff at work must have kicked this one off,” she said and then blushed.

“What do you mean?” I asked, genuinely interested.

She stared at me for a moment, perhaps wondering if it was something appropriate to confess to a stranger at a bus stop. Then her smile returned briefly before the tic arrived again.

“They’re all used to me at work,” she explained when she was able to. “But the boss isn’t.” She risked a sigh to indicate her frustration. “I mostly just repeat words to myself so they’re not as disruptive. But occasionally a movement takes over, and that’s what he doesn’t understand… Or like. I think he wonders if I’m actually mentally handicapped, or something.

“Anyway, even though I’ve been working there as an accountant for almost ten years, he’s never promoted me. I’m well regarded by my colleagues, and they’re almost all men…but…”

I could see a sudden change in her face as she leaned over the curb and the tic began again.

“But my friend Amrita thinks it’s just the glass ceiling that’s holding me back,” she said, once again in temporary control. “And yet, I’m not certain that reassures me…”

Her bus pulled up suddenly, and she stepped onto it like any other passenger, and was gone. I saw her smile at me through the window when she found a seat though, and I nodded in a friendly recognition of what she’d shared with me. But, like her, I’m not sure her friend was right -ceilings are not the only battles.

A Gift of Age

Is philosophy a reward of age, or is age itself a gift that metaphysics merely opens: Weltanschauung? Is it just that there is a time when thoughts flow along different and unaccustomed neurons? Or are they maybe shunted to the diminishing residua of nerve cells that are still firing? I ask myself these questions sometimes when night closes in and stimuli flee. At times like this, I wonder if the weight of years are more hindrance than benefit. Less a present, more a penalty.

When viewed from outside the prevailing ethos, age –especially its accumulation- is a gift. A bonus on the journey from which only the very young think they are exempt. And despite the mounting detritus of discarded cells and greying hair, it is a book whose pages, although well-thumbed and sometimes soiled with regret and torn by mistakes, are nevertheless extant, and readable. They are stories told without a plot and written, often, for the author with little hope or even desire for publication.

And yet, congratulations are sometimes lip-serviced  -the words mere decoys to disguise a different meaning: better you than me. In underestimating the years attained, the truth is seldom spoken except casually, as a joke –retractable, and yet echoing uneasily in the room long after it is uttered. Age is a gift, and yet shoddily packaged, the ribbon askew and poorly tied, the paper faded and rumpled with constant handling. Still, it is something at least… A recognition if nothing else.

But I’m making aging sound like night thoughts: a punishment rather than the achievement that it is.

We were talking about this, a patient and I, when she came in for a renewal of a hormonal therapy that helped her cope with one of the gendered ravages of her wealth of years.

“The young just don’t seem very thankful for what we’ve done for them, do they?” she said with a maudlin sigh when the subject came up.

I sat back as well as I could in my creaking chair, and smiled that gently exasperated smile that old folks are allowed. “But we look back; they look forward, don’t you think? Retrospective analysis is the domain of the experienced. Why do you think we have memories?”

“I suppose,” she said shrugging her shoulders in polite acknowledgement of a point with which she was evidently not in complete agreement. “We always seem to criticize generations other than our own when they do things differently, don’t we?”

I nodded. “But if each generation didn’t change a little, we’d probably still be chipping away with stone axes…”

A tiny smile crept onto her lips in spite of her attempt to remain pessimistic. “Speaking of the youth looking forward, I remember thinking of that when I had my first child. You probably don’t remember, but I had a rough pregnancy –high blood pressure, gestational diabetes, and then Melissa not growing as fast as she should in the womb…”

I actually did remember. “She was born prematurely – I induced labour about 34 weeks gestation or so, didn’t I? I recall being rather worried…”

Her face lit up with the shared experience, but her eyes stared far off into the past. “I remember thinking that she should be so thankful she was born. So thankful she was healthy.” I nodded again. “Anyway, a friend who came to see me while I was still in the hospital said that as well as getting presents on her own birthday, Melissa should give me a gift each time. A celebration of how lucky she was.”

I sat up straighter on my chair. “What a great idea, Melanie. And..?”

Her eyes twinkled at me. “Yup –all three of my kids. It’s a sort of family tradition now. Some of their friends are trying it as well, they tell me.”

The idea struck me as terribly innovative. Maybe others had done it, but I hadn’t heard about it. “Think it’ll catch on?”

She shrugged. “It’d be sort of like an accessory nipple in a way don’t you think?  I mean, I suppose that’s what Mother’s Day is for…”

I thought about it for a minute. “Mother’s Day is a bit generic, though. A child’s birthday is unique -an acknowledgement of its own presence in the world… and all because of its mother. It’s not a national day, it’s a personal day. And that’s what makes it so special.”

She stared at her hands she’d folded in her lap and was silent for a moment. We were both quiet. “Why do we think about these things more as we get older?” she said finally, breaking the silence almost reluctantly. “Or is it just me?”

I shook my head slowly. Absently. I was also lost in my own questions. She was right; it did seem to matter more nowadays that we poked around in the past, stirring the embers. But why? Did we really need the fire? The heat? The light? Were we awakening memories, or searching for something else? Looking, perhaps, for ourselves..? As if in the ashes of the dying fire there were patterns. Clues which, if properly mixed, could tell us where we, the lighters of the fire, had gone.

I could feel Melanie staring at me. “I can see you rummaging around in there, doctor,” her voice said, rustling through the room and bursting past the opaque curtain my eyes had drawn across it. “Come out again. I still need you…”

I had forgotten to write her the prescription for more hormones, yet somehow I only heard the words ‘I still need you’. But they were enough. I suddenly realized that the most satisfying gift of all, the most welcome treasure of age, was presence, not presents. And despite anything else that might go amiss, I was needed. Isn’t this what we all work for? When all is said and done, does anything else really matter?

To Have, or not to Have

There are two worlds out there, two Magisteria. Two contrasting inclinations that pass each other on the street without a wave. Strangers who sometimes know each other well. They sit, unwittingly close to each other, in the waiting room of my office. They chat and smile obligingly, trusting that their ignorance of the other is no impediment to friendship, however brief. Indeed, there is no barrier, only a perspectival boundary: Weltanschauung.

And yet, I don’t want to make too much of the difference; it is often in flux, and can mutate even as we watch –Time has a way of adjusting viewpoints,  justifying decisions. We all try to vindicate ourselves in the end. Validation requires exculpation, does it not? Absolution in the eyes of those who matter…

So the stronger the tradition, the societal apologue, the more the justification and guilt assigned to those who stray from it. There is a sort of canniness in the collective –or at least strength. Acceptance… And it is easier to regress to the mean, than defy the group. Especially when it comes to attitudes towards pregnancy –or more specifically, the decision whether or not to have a baby.

I’ve just read an incredibly powerful  book, whose title captures some of the agony and guilt attending those who dare to deviate from societal expectations: Selfish, Shallow, and Self-Absorbed. It is a collection of 16 well-written and generally thoughtful essays -13 from women, and 3 from men- about choosing not to have children. None are from paedophobes; and only a few are from those who decry the notion of pregnancy in others. They are not outliers –except perhaps on a carefully constructed Bell Curve- nor could they be construed as deviant. Each has merely made a personal decision not to accept the tyranny of the Norm.

The essays took me back to the early days of my practice, when, as a newly minted obstetrician, the very idea that someone would not want to have a child at some stage in her life, was anathema… Well, perhaps curious would describe it better –memorable, at any rate. And yet, it was not unknown. It was always a difficult decision in those faraway times to accede to a request for sterilization in a young woman. Contraception, yes, and although this closed the door effectively, it did not lock it. We were suffocatingly parental in those days: we knew she might change her mind –she was young and inexperienced, after all. Like a child, she had to be protected; it was our responsibility to keep her future mutable and open. We –society- were the guardians of that door…

But there are surely two issues at play here. It is one thing to criticize a decision made prematurely –before the kaleidoscope of life has fully displayed, when the future is more chiaroscuroid, more obscure and uncertain- and another developed in that fullness of time when a considered, even retrospective analysis of the factors leading to the choice can bear fruit.

This, too, can seem arbitrary, I realize. Is there a difference between a thoughtful twenty-five year old woman who -in her mind at any rate- has weighed the risks and benefits of having a baby and decided against it, and a forty-five year old who, on looking back at the way her life has unfolded, is grateful and reconciled to never having a child? It is a vexing question on several levels, I think.

In these days of autonomy and non-maleficence when it is considered medically paternalistic and politically incorrect to suggest that a decision need not be vetted by experience, we forget the other ethical duty of a health care provider at our –her- peril: beneficence –serving the best interests of the patient. It seems to me that this entails both a mature and non-directive dialogue and a list of other, more malleable options that would not only adequately serve her needs, but would also allow for change at any stage. Some form of reliable and non-intrusive contraception, for example, might respect her desire to avoid pregnancy, and yet enable some flexibility should she change her mind, or harden her decision for a permanent solution.

But I have to confess that I am still troubled. On the one hand, it seems to me that wisdom is the ability to judge a situation based both on knowledge of what it entails, as well as experience of how it usually turned out in the past. It is why elders were revered in the days before the plethora of information technology that assails us today. I am trying not to be Ludditic here but what the elders contributed, that Google often does not, is digestion. Analysis over time and place. Evaluation. Information can be coloured by current trends and bent by traditional assumptions –but of course so can needs. We must not forget that.

I have always been leery of ‘facts’ divorced from context. Are they then still facts or do they inhabit some terra incognita we have yet to fully occupy? A territory of collation, a thesaurus that is able to list endless variations on whatever theme we decide applies to us, so we can pick and choose the reality we prefer?

It is not the decision to have, or not to have a child that should preoccupy us, but rather the reason it has been chosen. And for such an important life-changing resolution, the depth and –dare I say- maturity of  thought that has gone into the consideration is paramount. It is not, nor should be allowed to fall under, the purview of political correctness and thereby escape a more cautious and examined approach. There is no correct answer, no unquestionable myth that can justify any position. We may have a spur to prick the sides of our intent, to paraphrase Hamlet, but it is a different one for each of us. We must take care that we, and those we counsel, are not –Hamlet again- hoisted with our own petards.