For example, repro health 101, thanks FDA!

Witness one of the important questions one has to fill out if taking Sotret...do men get these questions about their female partners? Do men have to announce the forms of birth control they and their partners are using? Do men have to proclaim abstinence? Or do their sperm remain uncorrupted? These are important questions.

Birth Defects and Pregnancy

Which of the following are signs you might be pregnant?

You miss your menstrual period.

You have nausea, sometimes referred to as morning sickness.

Your breasts feel tender, like at the beginning of a menstrual period.

Any of the above is a sign you might be pregnant.

My own research subject

A number of times in the last few years, I've found myself in the position of experiencing some of the very things I've set out to study. In a way, it's comforting that there's a very generalizable set of experiences that my friends and I have had, as women who have semi-regular contact with the medical system for preventive care. But it's also unnerving to theorize about something and to also experience it firsthand.

In the last week, I've been a bit of a guinea pig, as I've seen 3 doctors, for three different conditions/concerns, as well as taken more prescription and over-the-counter drugs than I've taken in years. I've also developed hives -- perhaps a secondary research effect, from working with so many holistic believers, I have started to feel uneasy about filling my body with pharma's best. In addition, I purchased an over-the-counter (pharmacist controlled) medication that I'd never taken before, and one that I've read an amazing theoretical article about. It's strange to find myself part of that very political struggle and to think about the significance and power of having access to certain drugs in certain contexts. This is perhaps a point that I'm uneasy writing about -- when do I reveal and discuss the personal in my own research? Does my own experience strengthen or diminish the power of the argument?

At one of the doctor's offices, a sports medicine practice, within a teaching hospital, I had to sign a waiver, giving up my right to claim any financial benefits should they discover anything commercializable with my tissues or genes (as I like to send you to The New York Times for good examples of these sorts of things, of course, I have an article to point to, about the "tissue industrial complex"), allowing the physicians to have student doctors accompany them, and a whole other slew of apparently waivable rights. What choice does one have? You can choose not to receive care there, but many of the other physicians have some version of these waivers. I did, in fact, get a couple of residents who accompanied my physician, as they watched him rotate my hips and my legs and expressed amazement at my range of motion. They each got to move my leg around and tried to re-capture the spot where it hurt me. All three were men, and I could tell the residents were uncomfortable. I kept thinking of Terri Kapsalis's really phenomenal book, Public Privates: Performing Gynecology from Both Ends of the Speculum, which is one my favorite social analyses of medical practice and culturally inflected experiences of the body. (The first few chapters, in particular, address gynecological practice and history like no other book or article I've read.)

At the ambulatory care center that I went to, two days after the sports medicine experience, I listened as a man couldn't get his insurance to admit that he had coverage under his wife's plan, and then for the offices to have closed before he could get approval for a much needed scan. The administrators decided to go ahead without pre-approval, since they said it was important. God knows how much that's going to cost this man. And then, I went in and found a lovely old doctor, who spent an amazing amount of time with me, wrote me extensive prescriptions for my bronchitis and any possible pain I might be in as a result, and he even gave me his card with his pager on it. What doctor allows you to contact him without an appointment these days?

Then, there was the dermatologist. The medication I'm on has (over the years, as I have taken it a couple of times in the past) grown increasingly strict about women not getting pregnant while on it. There are now many hurdles to getting access to the medication (also due to people committing suicide while on it), and all sorts of pre-approvals and blood tests. Because my pregnancy test was more than a week old, I had to go back and get a urine test. One of my favorite parts of the new "iPledge" system is that I have to announce my birth control methods. My dermatologist had wanted me to take the pill, but I refused. I have to have two birth control methods, and apparently it is totally within the realm of the system's logic for my first method to be "abstinence" and my second method to be the "diaphragm". Like with federal documents for identification, there is a hierarchy for birth control methods. The first method can only be a few things -- for example, one can't choose a barrier method as the "primary method" -- no condoms or diaphragms. Though I can choose abstinence, if I promise to also use a barrier method. The inanity is hilarious to me.

Anyway, it's strange as I swallow the various pills, take advantage of social advances, political gains, and my incredible wealth of knowledge and education around this topic, to have had this condensed week of medical adventures. None of them terribly serious or traumatic, but still revealing. It's not so bad being my own research subject.

Anthropology effaced

As I sit on a two-hour conference call, listening to them re-working the survey, it's amazing to me how much depth and attention surveys garner, and how little anyone actually cares about my methods. I know some of this is because few understand my research methods, but it's sort of like being the belle of the ball and then being usurped as quickly as I rose to attention. That's a bit melodramatic, but it is strange to realize that we've not yet given my methods the depth of attention that the survey has merited. I suppose it's ok, it's a way in which I get to be left alone to do what I need to do. But it's also incredibly discouraging.

Similarly, I was reading the CDC grant that I want to apply for, that's due in less than two months, and I feel a bit hopeless about it. I mean, what's the point of their gazillion page protocol when I probably won't get it anyway. Public health is purportedly multidisciplinary, but I've always felt that it has an ugly stepchild syndrome, feeling like it needs to prove its mettle to both medicine and science...I don't know where on the kinship map Anthropology would fall, maybe little matchstick girl begging for alms? (This metaphor is going to incur the wrath of HL, as she never lets me draw insane analogies, but they're so much fun. Someday, my dear, you will get to make an example out of me to your future students, and then, you'll be grateful.)

I was talking to another dear friend (why must these wonderful people be so far away from where I am?) -- and she was confronting the frustrations of fieldwork with people whose lives are quite messy and often get caught in the horrible web of incarceration and racism and poverty. There's an inexorability to their lives that can be very sad and painful to watch. I compared it to my work with men and women in a drug rehab center, and when you hear and follow these people's stories, it's very hard to feel that the work we are doing is meaningful. As fellow "qualitative" researcher extraordinaire (FQRE) put it, it's difficult to work with individuals with the goal of helping larger populations. The work you do with any individual and the theoretical and practical challenges that you're hoping to achieve won't actually line up. We are not helping any specific individuals in our work -- it's all abstracted with longer-term goals. That can be hard to accept. And, as FQRE also expressed, it's incredibly hard to find oneself losing the empathy and emotional reactions to some very upsetting circumstances. After 9 months talking to recovering addicts and drug dealers, I really wanted to say, yes, yes, yes, why wouldn't you turn to dope when life is so insurmountable and the problems keep piling up. Those very limited interviews that I conducted would drive me and my research partner to drink on a regular basis. And when you live in the same city and have to confront the huge social disparities by virtue of your own privilege, it can be extremely jarring and intense. It's not just abstract theorizing, rather, it's simultaneous lives in the same space, with vastly different experiences of the place.

And yet, in order to continue the work, you can't let yourself be distracted too much by the problems of people's lives. You can help as best you are able (and I think FQRE does an excellent job of following and helping people maneuver the systems as best she can), but it can only go so far. Of course, this is also why we're not in direct service work, as that approach to social problems has its own huge limitations. Really, what it comes down to, and as I pointed out to FQRE, is that no matter what tack we might have chosen, we would be limited by our methods. We cannot (sadly) rule the world and fix all the interconnected social problems. But that doesn't mean we should give up, either.

I attribute this brief glimpse of Pollyannaism to the fact that I no longer feel like Camille on her deathbed, and that I suspect it's not deadly tuberculosis after all. Amazing what Nyquil will accomplish.

More public health-anthropology face-offs

For those who inexplicably continue to read this blog, you may have well noticed I am doing little fieldwork at all. It's a bit shameful, as I believe I am a superhero and can move, get horribly sick, and start new research all simultaneously. In addition, I have started to look at a CDC grant for funding the next year of my life (which is proving daunting in its labyrinthian criteria and guidelines). It's all very exciting in its perilousness.

In the work that I've been contracted to do with the LA health department, there have been a number of frustrations in which the CDC people simply fail to have any interest or faith in the kind of work I do. As I've spent a good amount of time in the public health world, it isn't a huge shock, but it never fails to depress me. In spite of being hired to do "qualitative" research, there was a proposal to include an exit survey at the end of some of our research. Anthropologists don't really enjoy being reduced to the "qualitative" category, as it is usually used derogatively and implies a lesser research method than the more robust "quantitative" methods.

Surveys are usually quantitative. You take conceptual questions and you make them fit into binary responses. I hate this. Rarely do we have binary reactions to social phenomena. If you don't want to make it binary, you can use likert scales, which allow for a range of responses. I have never felt either option on surveys matched my feelings about anything. I'm always choosing the least bad choice. Further, the public healthians constantly ask me if my research methods will "bias" those we're observing, as though a survey with slotted answers don't intriniscally bias the respondent -- since one is given predetermined responses, rather than answering with your own terms. Clearly, such methods have utility, but I simply don't believe that any research method is fully sufficient, and thus, it's acceptable to choose a method that is different than the more standard one. Not because my method is superior (depending on what you value -- is it efficiency or nuance? Statistics or depth of information?), but because none is flawless, why assume that there is an actual hierarchy or value attached to the data collected?

Fortunately, on the LA side, my supervisor brought in an epidemiologist to consult on the survey, since I had no interest in it, have no skills to develop it, and think it's kind of a bullshit measure. Suffice it to say, meeting with the epidemiologist, I immediately hated her. Her way of framing questions and understanding the problems offended me and struck me as completely naive about the actual population with whom we will be working. She simply couldn't understand the nuances of the project that the project director and I had been trying to access through the qualitative methods. Not all epidemiologists are dense, and some do some fascinating and wonderful work. But it was kind of depressing to be confronted (again, for the millionth time) with the limitations of the public health methodology. I've very much wanted to bridge disciplines, but these few months working with the public health side of things makes me want to run in the other direction.

A mini-zeitgeist predictor

I have a knack for thinking about or being interested in stuff right before it becomes of more popular interest. Example -- babydoll dresses in the early 90s. In spite of terrible sewing skills, I kept searching for patterns for a high waisted short dress, and then a few months later, they were all the rage in the stores. My intellectual interests seem to follow similar patterns, and while I'd like to pretend that I'm a weather vane, or have some amazing predictive skills, I suspect I'm simply susceptible to marketing and priming and perhaps overly-aware of the early signs of new trends. That makes me feel like a vessel for corporate schemes and potential mind control experiments.

Regardless of this seeming unmarketable skill, I thought I'd point out that the Sunday NYT has an article about equal parenting efforts...see two posts ago and my concerns about mother-father responsibilities in raising children. Sigh. It can be so boring to be a know-it-all. If only I were better at predicting my own life. Then I really could take the dinghy out to the middle of the ocean and be done with it, as I proposed to a friend.

The lure of the unread

The first task, and the easiest, after moving is to unload the books. Bookshelves are such organizational delights. I found it kind of thrilling to think about how to organize my books, now that I have a larger bookshelf, and one that I plan to fill by sending all the books I'd left behind in Baltimore. I enjoy seeing the conceptual themes of my work reflected in the titles that I have chosen. It does worry me, however, that I have strayed quite a bit from my initial interest in cultural interpretations of sexuality. These books take up a lot of space on my shelves. It's disorienting to feel confident that the newer directions are the right ones, yet feel a longing for the topics I intended to pursue initially. I suppose this isn't much different from when certain parts of one's life need to be shedded, and there's the desire to stay with the familiar and predictable, even when it's clear that it no longer fits properly.

I wish I could say this theoretical shift has some neat parallel in my everyday life -- sometimes things like this line up well to personal shifts, but I actually feel quite the opposite. I'm a bit weary of all the newness (self-inflicted). Though perhaps some of the problem of seeking the not-new is that there's nothing left of the old, except nostalgic remanants. It's the sensation of going home, thinking you can fit easily back into your old childhood bed, comfortable routines at home, but realizing you've quite outgrown your parents' lives, the bed, or the interest in any of the routines. It's a bit of a shell, and I suppose that's why I've rarely been overly-sentimental about old things. All that to say -- it's still a bit uncomfortable to return to a place that has a past though not a past I'm particularly nostalgic for. It's familiar without having any predictable or real anchor points. It's rather bizarre. This may all be prompted from the irritation and fatigue from unpacking. Packing actually is a pleasure in contrast to the re-location process.

Somedays, fieldwork isn't so terrible

In stark contrast to last week's high-emotion interview with a mother who clearly needs a lot of help (I say this not tongue in cheek, but rather, quite sadly), I had a very useful and informative interview today. The mom had been a presenter at one of the group meetings I've attended, and she's one of the few mothers I've met who has kids old enough for the vaccine I initally started studying. She had been a bit flakey about nailing down an appointment time, and I stopped following up, since I feel that if someone wants to do an interview, usually they'll agree to a specific time. I hate harrassing people, and there is often a lot of back and forth emailing, regardless of a participant's willingness.

One issue that I keep hearing (and admittedly this is because I've only interviewed mothers so far) is the women's role in caring for the children. I know this isn't a huge shock, but the ways in which health care decisions or schooling decisions are made is usually quite imbalanced. The mothers tend to decide and then inform their partners/husbands. I realize I was raised in an alternate universe, for the most part, but it's disappointing to me to hear how little many things have changed. (This follows nicely with my last post -- the burden of motherhood and Rebecca Walker's disappointment in her own famous mother.) Most of the moms with whom I speak are fairly unconventional, at least on the surface. I find it fascinating to hear, what seem to be to me, though probably really aren't, the inconsistencies of resisting medical authority and standardized western medicine while still preserving very normative ideas of gender roles in the care of children, for example. Or maybe they don't seem inconsistent and they don't feel problematic to those who experience it. And I certainly don't mean to suggest that choosing to be the caregiver is a lesser choice. What I find intriguing is the process by which decisions are being made in these households. At the same time, I feel that there has been a note of wistfulness or even down-right resentment in many of the mothers' recounting of how health decisions happen in their household. Although one mother seemed to see it as a point of pride, having that level of power was important for her.

Anyway, having this interview in comparison to last week's gave me a bit more hope. I had been feeling so frustrated and disappointed with my work, but when I hear the recurrent themes emerge in an interview, especially when I have to ask relatively few pointed questions, I get a little more than pleased. It's kind of a great way to end the time in LA (soon I will have to update my blogger location) -- and I'm glad that this is how it wraps up.

The CDC struggles will continue, and I will return to LA every month or so for the next few months, so it's not goodbye for good. It's simply an extended hiatus. There are so many things I need to do -- I need to re-envision the project, I need to apply for funding, I need to spend 3 weeks at an institute, honing the last 2 years of focusing on one vaccine so that I can move forward with the rest of the project...I've been avoiding this laundry list, but once the move happens, it's time to be a little more disciplined with regular work hours and extended hours of concentration. I'm starting to feel a little antsy not having read anything in-depth for weeks or thought about long-term plans for the research. Living in the moment has never been my strong suit, even when it's necessary.

Rebecca Walker reflects on motherhood

Rebecca Walker has a piece in Britain's Daily Mail about being raised by a feminist and her subsequent estrangement from her mother.

I found her writing to be extremely moving and compelling, but I think her underlying premise, that her mother's disinterest in mothering is the fault of 2nd wave feminism to be wrong. Her mother, Alice Walker, of The Color Purple fame, among many other important feminist writings, sounds like a typical narcisstic parent. I may be projecting far too much, but I do think artists, especially ones that have had to struggle to get where they are because of racial, economic, gender prejudices, or being undermined by their families or communities, have a tendency to be incredibly egocentric, as parents, as partners, as friends. What saddens me, however, about R. Walkers' interpretation is that she attributes it to her mother's feminism. I think this is too simplistic.

While Alice Walker may have made many bad parenting choices (and I think it's important to try to resist using the term "mothering," as "fathering" has a totally different connotation, and there are central principles that I think mothers and fathers both share as people responsible for children), I think blaming feminism is a serious disservice on Rebecca Walker's part. At the same time, I understand how one might attribute one's parent's philosophical and social practices as the source of the problem for one's childhood, as that is what frames many of their actions. What is clear is that Alice Walker was deeply ambivalent about being a parent, and about being a mother, and Rebecca clearly suffered as a result. I do not think, however, that feminism is the cause.

Reflections on a tough week

This week of fieldwork was incredibly intense, even though I only had one interview and a mothers' meeting.

On Monday, I had an interview with a mom whom I'd met a couple of times before, and who had stood me up a few weeks ago (at the last minute) when we were supposed to meet. There was lots of evidence that she has some serious socialization issues, but I had tried not to judge her behavior too much. The first time we met one-on-one was at a park where a home-schooling group she's part of usually meets. Her son is still too young to be part of the home-schooling group, so I'm not entirely sure how she was affiliated with them, except perhaps aspirationally.

The details of the interview/meeting are kind of complex and lengthy, so it's hard to fully articulate why this was such a draining experience. But it set off an intense emotional reaction in me. She was initially 45 minutes late to our meeting, called me multiple times for directions to the park, at which she had suggested we meet and where I'd only been once before, so I was already feeling a bit angry at her. We ended up going back to her house (another 15 minutes away), and as I followed her car to her house, I reminded myself that I needed to be compassionate toward the people with whom I'm working. By the time we got to her house, I felt more calm about the frustrations, and throughout my many hours at her house, I felt that I had let go of my anger at her being so inconsiderate earlier on. However, the "interview" ultimately ended up being an intense processing session for her. A friend wisely pointed out to me, after I called her distressed, that it wasn't really an interview, since I didn't ask most of my questions.

What the experience raises for me, more importantly, is what do you do when someone decides to make the interview into a therapy session. I try to be open to my informants having a certain amount of control over the interview, in order to avoid behaving as though I were the one with all the power in the situation. I realize that the people to whom I'm speaking have been very generous to share their time and their knowledge with me. But I wonder if this openness has also meant that I'm susceptible to people like this woman, who decide to transform the interview into something totally different. In addition, I feel incredibly sad about this woman. She seems very dissociated from reality (in the ways she described her life, her expectations, her relationship with her husband) and seeing her life, close up, implicated me in these things. I know that I can over-identify with subjects, sometimes, but I haven't learned yet how to remain stoic in the context of very unsettling things about people's lives. It makes me feel both hollow and disturbed.

This mom was at the group meeting last night, and I watched her replicate some of the same over-sharing behaviors. It was almost worse last night, because it was so clearly inappropriate in this context. It also was a relief, because it showed to me how eager she was for having a willing ear for her problems, which it seems she does not get very often. When she had given me her guided tour through every room in the house, it felt like it was something she wanted her husband to appreciate, but since he proved indifferent, she desperately wanted someone to acknowledge all the work and thought she'd put into its feng shui colors and objects. The public performance of her problems and the attempts to center attention on her last night felt like more of the same.

The group activity involved an energy healer who allowed people to come up and explain a brief synopsis of their health problems that they thought she might work on. This mom's description was deeply intimate and strange in the context of a room of 20+ people, many of whom she didn't know. She also managed to interject multiple times even when she wasn't seated at the front of the room during the healer's explanations. In contrast, everyone else who got "worked on" tended to be modest about describing their health concerns, and they rarely sat in the seat for more than a couple of minutes, appreciative of the time spent on them, but not loitering, since everyone was supposed to get a turn.

It's now been three days since the interview, and I'm still trying to reconcile the experience. I finally sat down and fieldnoted it, and as I wrote, all sorts of details that contribute to her strangeness came back.

Some serious regret

The more I think about it, the more nauseous I feel that I saw the Sex and the City film. There are a lot of reasons to feel this way, but there is a small storyline in which one of the characters refuses to eat anything in Mexico except pudding cups. Even though they are staying at the poshest resort. She accidentally opens her mouth in the shower, gets water in her mouth, and then develops a horrible case of diarrhea. And this prompts the other three women to laugh hysterically. No one seems at all disturbed that she thinks only the pudding cups are "safe," though they do roll their eyes at her.

Clearly, there are a slew of other problems with this film, and I went because it was important to a friend of mine to have someone to do such 'girly' things with. But now I feel dirty. And shameful.

Jezebel has a good rant about the horror of the film, as well. Perhaps, though, we ought not give it so much media time and just turn our backs. At least I didn't pay to see it! That's a small consolation, I guess.