As anthropology at its best can do, this book exposes hidden cultural assumptions about the nature of reality. Martin has produced a powerful study of the dialectic between medical metaphors for women's reproductive processes and women's own views of those processes. She and her associates interviewed 165 white and black women, seeking a balance between the three life stages of puberty, childbearing, and menopause. 43% of her interviewees were working-class; 57% middleclass. Early on Martin came up against one of the greatest dangers of studying one's own society. Hearing women discuss uterine contractions as separate from the self and labor as something one "went through," and reading the same in medical texts, she at first thought that her interviews had turned up views of the body that simply reflected actual scientific fact. It took her some time to realize that such scientific views are not "fact" but culturally grounded statements of an underlying ideology.
To get at this ideology Martin studied medical texts for the "grammar" that scientific medicine uses to describe female bodies. In this medical grammar, she finds industrial society writ small. The female reproductive tract is a machine designed to produce a baby; accordingly, menstruation represents failed production, connoting both a productive system that has failed to produce and one that produces only useless waste. Such metaphors, disturbing to a society whose existence depends upon continued production, lead to menstruation's description in medical texts in highly negative terms:
The fall in blood progesterone and estrogen, which results from regression of the corpus luteum, deprives the highly developed endometrial lining of its hormonal support . . . Disintegration starts . . . The endometrial arteries dilate, resulting in hemorrhage through the weakened capillary walls; the menstrual flow consists of this blood mixed with endometrial debris. . . . (quoted on p. 48)
(Martin contrasts this with a description of male reproductive physiology which speaks of the "remarkable" cellular transformation from spermatid to mature sperm, its "amazing" nature and "sheer magnitude.") Confronting the argument that the above is not value-laden but simply a factual description of menstruation, Martin examines medical descriptions of the analogous regular shedding and replacement of the lining of the stomach, finding in a number of texts no references to degeneration, but instead a stress on the periodic "renewal" of the stomach lining. Concluding that writers can choose to depict what happens to the lining of stomachs and uteruses either negatively as breakdown and decay or positively as continual production and replenishment, Martin suggests an alternative medical description of menstruation:
A drop in the formerly high levels of progesterone and estrogen creates the appropriate environment for reducing the excess layers of endometrial tissue. Constriction of capillary blood vessels causes a lower level of oxygen and nutrients and paves the way for a vigorous production of menstrual fluids . . .
Such a description would far more accurately reflect women's own more positive assessments of the menstrual fluid as the desired product. Viewing pregnancy as the sole purpose of female reproductive organs and despising menstruation as a "waste" ignores the reality that most women do not intend to get pregnant most of the time (and so are often joyful when menstruation begins), and conceals "the true unity women have . . . [Menstruation is] the one thing we all share" (p. 112). In spite of ambivalence about the "disgusting mess," most interviewees felt that menstruation defines them as women and insisted that they wouldn't want to give it up. Teens spoke of the joy of getting their periods so they could be part of the in-group that shared the women's "special secret," of mothers and sisters greeting their first menstruation with "You're a woman now!"
Clear class differences emerged in women's conceptions of menstruation. Middle-class interviewees always explained menstruation in medical terms, but expressed frustration that this explanation bore little relevance to daily experience. (One such girl, although she understood "the mechanics," was panicked that she would flood the bed during the night. She got her first tampon only halfway in, thought she had to leave it there, and spent some agonizing hours.) Working class women never stated the medical explanation (although they had been exposed to it in school) and rarely reported such menstrual mystification-their mothers, sisters, and aunts usually told them exactly what to do. Working class women explained menstruation in terms of life change and actual experience: "It's just part of life. Your body's changing and you're becoming a woman"; "You bleed . . . to clean out your insides"; "It's just red blood." Pointing out that these women often express book knowledge in other domains, Martin suggests that they resist the scientific view in part because they find it so irrelevant to daily experience, a realm in which the middle-class women who internalize the medical view are often left floundering.
In an enlightening chapter on PMS, Martin points out that definitions of menstruation as debilitating have historically fluctuated with the need for women's participation in the work force, (much as abortion laws have changed according to society's perceived needs for the production of more or fewer babies). Because her interview data revealed only four women out of 165 who reported PMS symptoms, Martin sees PMS not as a proven disability that affects 3/4 of all American women, as some medical reports have held, but as a culturally constructed disease that reflects the intensive work discipline of industrial society and its structural lack of adjustment to women's cyclical changes. Exploring the PMS literature, Martin finds women stating that they feel more creative just before their period, more sensual, more in touch with their feelings and empathetic toward the world-a mode that, were it accommodated in the workplace, might result in the creation of many improvements and new ideas. Many women report the surfacing of rage. Here Martin provocatively suggests that being premenstrual may simply reduce the usual emotional controls women place on themselves in order to fulfill their socially prescribed roles-may be, in fact, the one time in the month that women are able to express their true feelings about those roles.
Turning to birth, Martin shows, as I have often pointed out in my own work, that its medical interpretation is based on the metaphor of the female body as a machine producing a highly valued product. Medical texts see the uterus as a mechanical involuntary muscle producing "efficient" or "inefficient" contractions; judge good or poor labor by the "progress" made in certain amounts of time, and hold Friedman's curve to be a good measure of the overall efficiency of the machine. The woman is viewed both as a passive host for the contracting uterus and a laborer to be supervised, controlled, and exhorted to further effort, while the physician acts as the supervisor or foreman of the labor process. This set of metaphors fundamentally opposes mother and child: the perfect baby is the desired product, while the motherlaborer is such a threat to that product that delivery by Cesearean comes to seem inherently desirable.
Extending the metaphor of birthing women as laborers, Martin compares resistance-oriented birth organizations such as C/sec and NAP-SAC to the solidarity of organized labor. She see various cases of women's resistance to hospital birth-staying home as long as possible, refusing episiotomies-as analogous to the efforts of factory workers to slow down production rates and retain some autonomy over the production process, while staying at home to birth is analogous to striking or to becoming your own boss. (Here Martin fails to note that, like many workers, most laboring women neither resist nor protest but are content to work within the current system.) As in the industrial world, working class and especially black women report being ignored, devalued and disapproved of by white physician-managers. In the hospital as in the factory, ever more sophisticated machines (e.g. EFM) take more and more control away from workers, until the workers themselves begin to disappear (witness the new reproductive technologies). Then the doctor-technicians, previously the managers, become corporate employees, producing babies that have less and less to do with women while themselves losing autonomy and control over their working conditions.
From her interviews, Martin distills the central image women held by the women in the bodies: "Your self is separate from your body." Menstruation, menopause, labor, and birthing "are states you go through or things that happen to you (not actions you do)." They are "the contractions," "the hot flashes"; they "come on"; women "get them." Martin finds that such sensations of fragmentation are increased by medical procedures such as epidurals and Caesareans that leave women feeling "sectioned" and alienated both from their bodies and from their babies. She stresses the compelling need for new key metaphors, new core symbols of birth, citing as examples of such imagery Rahima Baldwin's "life force," Gayle Peterson's "journey," Claudia Panuthos' "dance" and Marilyn Moran's "intimate husbandwife love encounter." All such images, whether they hold the woman to be a passive channel for life energy or an active participant "riding" that energy, emphasize wholeness, seeking "to reintegrate the whole person from the jigsaw of parts created by modern scientific medicine" (p. 159). While Martin applauds the powerful images of women giving birth at Michel Odent's former clinic in Pithiviers, she laments what she sees as the cost of such images-that Odent regressively asserts a view of women as animal-like:
Instead of seeing the Pithiviers women as engaged in a "natural" lowerorder activity, why can we not see them as engaged in a higher-order activity?.... Here, perhaps, are whole human beings, all their parts interrelated, engaged in what may be the only form of truly unalienated labor now available to us (p. 164)
The advent of menopause was viewed very positively by most of Martin's post-menopausal interviewees, who saw it as a welcome relief from the inconvenience of their periods, as liberation from the need for birth control, and as a "milestone" spurring them to take stock and reach for greater happiness. In dramatic contrast, the dominant medical metaphor of the body-as-machine interprets menopause as a breakdown of authority in the body's hierarchical information-processing system. Ovarian "decline" is caused by the "decreasing ability of the aging ovaries to respond to pituitary gonadotrophins"; follicles 'Tail to muster the strength" to reach ovulation, breasts and genital organs "gradually atrophy" and "wither." Although younger premenopausal women tended to share this medical view that menopausal women are out of control, menopausal women themselves experienced feelings of strength, independence and "a release of new energy and potentiality." Most reported no major problems with menopause, describing it in simple, purely experiential terms: "It just stopped."
Among those who did experience symptoms, the "hot flash" was the most common. Interviewees reported turning red, sweating (often profusely), and confusion, stating that this seemed to occur least frequently in private places where they were relaxed, and most frequently in public interactions, especially with superiors like bosses and physicians. From such reports Martin suggestively deduces that the primary emotion associated with hot flashes is not the latent rage unleashed in PMS but an embarrassment that expresses the stress of ongoing social subordination.
American society is organized around a basic distinction between the realms of home and the outside workaday world. General cultural conceptions place menstruation, pregnancy, and menopause in the realm of home and family, but women themselves see them as inextricable from life at work and school. How to find time and private space to change tampons in high school? on the job? How to conceal exhaustion or hot flashes from your business associates? Women are asked to do the impossible-to conceal and control their bodily functions in institutions that do not heed their needs. Significantly, although Martin's interviewees recognized the incompatibility between their bodily processes and the world outside the home, no woman discussing the hassle or embarrassment went so far as to ask why the outside world does not legitimate the functions of women's bodies. Alone among major industrial countries, the U.S. lacks a national insurance plan that pays women's expenses for childbirth, and is one of few that does not compensate women for lost earnings. "This lack of institutional support makes it very difficult for women to be whole peopleproductive and reproductive at the same time" (p. 100).
Martin concludes by suggesting that women's concrete experiences "can evoke . . . alternative visions . . . powerfully different from the reality that now holds sway" (p. 213). As she brings to consciousness women's fragmentation in the medical and social realms and our potential for creative self-reintegration, Martin offers us new opportunities to free ourselves and our bodies from the metaphorical limitations imposed on us by our society, and to expand our self- and social definitions through the power of these alternative visions.