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WELCOME TO CANCERLAND
Barbara Ehrenreich
Harper’s Magazine. 303.1818 (Nov. 2001): p43.
Copyright: COPYRIGHT 2001 Harper’s Magazine Foundation

Home

Full Text:
A mammogram leads to a cult of pink kitsch

I was thinking of it as one of those drive-by mammograms, one stop in a series of mundane missions including post office,
supermarket, and gym, but I began to lose my nerve in the changing room, and not only because of the kinky necessity of baring my
breasts and affixing tiny X-ray opaque stars to the tip of each nipple. I had been in this place only four months earlier, but that visit
was just part of the routine cancer surveillance all good citizens of HMOs or health plans are expected to submit to once they reach
the age of fifty, and I hadn’t really been paying attention then. The results of that earlier session had aroused some “concern” on the
part of the radiologist and her confederate, the gynecologist, so I am back now in the role of a suspect, eager to clear my name, alert
to medical missteps and unfair allegations. But the changing room, really just a closet off the stark windowless space that houses the
mammogram machine, contains something far worse, I notice for the first time now–an assumption about who I am, where I am
going, and what I will need when I get there. Almost all of the eye-level space has been filled with photocopied bits of cuteness and
sentimentality: pink ribbons, a cartoon about a woman with iatrogenically flattened breasts, an “Ode to a Mammogram,” a list of the
“Top Ten Things Only Women Understand” (“Fat Clothes” and “Eyelash Curlers” among them), and, inescapably, right next to the
door, the poem “I Said a Prayer for You Today,” illustrated with pink roses.

It goes on and on, this mother of all mammograms, cutting into gym time, dinnertime, and lifetime generally. Sometimes the machine
doesn’t work, and I get squished into position to no purpose at all. More often, the X ray is successful but apparently alarming to the
invisible radiologist, off in some remote office, who calls the shots and never has the courtesy to show her face with an apology or an
explanation. I try pleading with the technician: I have no known risk factors, no breast cancer in the family, had my babies relatively
young and nursed them both. I eat right, drink sparingly, work out, and doesn’t that count for something? But she just gets this tight
little professional smile on her face, either out of guilt for the torture she’s inflicting or because she already knows something that I am
going to be sorry to find out for myself. For an hour and a half the procedure is repeated: the squishing, the snapshot, the technician
bustling off to consult the radiologist and returning with a demand for new angles and more definitive images. In the intervals while
she’s off with the doctor I read the New York Times right down to the personally irrelevant sections like theater and real estate,
eschewing the stack of women’s magazines provided for me, much as I ordinarily enjoy a quick read about sweat-proof eyeliners and
“fabulous sex tonight,” because I have picked up this warning vibe in the changing room, which, in my increasingly anxious state,
translates into: femininity is death. Finally there is nothing left to read but one of the free local weekly newspapers, where I find,
buried deep in the classifieds, something even more unsettling than the growing prospect of major disease–a classified ad for a
“breast cancer teddy bear” with a pink ribbon stitched to its chest.

Yes, atheists pray in their foxholes–in this case, with a yearning new to me and sharp as lust, for a clean and honorable death by
shark bite, lightning strike, sniper fire, car crash. Let me be hacked to death by a madman, is my silent supplication–anything but
suffocation by the pink sticky sentiment embodied in that bear and oozing from the walls of the changing room.

My official induction into breast cancer comes about ten days later with the biopsy, which, for reasons I cannot ferret out of the
surgeon, has to be a surgical one, performed on an outpatient basis but under general anesthesia, from which I awake to find him
standing perpendicular to me, at the far end of the gurney, down near my feet, stating gravely, “Unfortunately, there is a cancer.” It
takes me all the rest of that drug-addled day to decide that the most heinous thing about that sentence is not the presence of cancer
but the absence of me–for I, Barbara, do not enter into it even as a location, a geographical reference point. Where I once was–not a
commanding presence perhaps but nonetheless a standard assemblage of flesh and words and gesture–“there is a cancer.” I have
been replaced by it, is the surgeon’s implication. This is what I am now, medically speaking.

In my last act of dignified self-assertion, I request to see the pathology slides myself. This is not difficult to arrange in our small-town
hospital, where the pathologist turns out to be a friend of a friend, and my rusty Ph.D. in cell biology (Rockefeller University, 1968)
probably helps. He’s a jolly fellow, the pathologist, who calls me “hon” and sits me down at one end of the dual-head microscope
while he mans the other and moves a pointer through the field. These are the cancer cells, he says, showing up blue because of their
overactive DNA. Most of them are arranged in staid semicircular arrays, like suburban houses squeezed into a cul-de-sac, but I also
see what I know enough to know I do not want to see: the characteristic “Indian files” of cells on the march. The “enemy,” I am
supposed to think–an image to save up for future exercises in “visualization” of their violent deaths at the hands of the body’s killer

Home

cells, the lymphocytes and macrophages. But I am impressed, against all rational self-interest, by the energy of these cellular conga
lines, their determination to move on out from the backwater of the breast to colonize lymph nodes, bone marrow, lungs, and brain.
These are, after all, the fanatics of Barbaraness, the rebel cells that have realized that the genome they carry, the genetic essence of
me, has no further chance of normal reproduction in the postmenopausal body we share, so why not just start multiplying like bunnies
and hope for a chance to break out?

It has happened, after all; some genomes have achieved immortality through cancer. When I was a graduate student, I once asked
about the strain of tissue-culture cells labeled “HeLa” in the heavy-doored room maintained at body temperature. “HeLa,” it turns out,
refers to one Henrietta Lacks, whose tumor was the progenitor of all HeLa cells. She died; they live, and will go on living until
someone gets tired of them or forgets to change their tissue-culture medium and leaves them to starve. Maybe this is what my rebel
cells have in mind, and I try beaming them a solemn warning: The chances of your surviving me in tissue culture are nil. Keep up this
selfish rampage and you go down, every last one of you, along with the entire Barbara enterprise. But what kind of a role model am I,
or are multicellular human organisms generally, for putting the common good above mad anarchistic individual ambition? There is a
reason, it occurs to me, why cancer is our metaphor for so many runaway social processes, like corruption and “moral decay”: we are
no less out of control ourselves.

After the visit to the pathologist, my biological curiosity drops to a lifetime nadir. I know women who followed up their diagnoses with
weeks or months of self-study, mastering their options, interviewing doctor after doctor, assessing the damage to be expected from
the available treatments. But I can tell from a few hours of investigation that the career of a breast-cancer patient has been pretty well
mapped out in advance for me: You may get to negotiate the choice between lumpectomy and mastectomy, but lumpectomy is
commonly followed by weeks of radiation, and in either case if the lymph nodes turn out, upon dissection, to be invaded–or “involved,
” as it’s less threateningly put–you’re doomed to chemotherapy, meaning baldness, nausea, mouth sores, immunosuppression, and
possible anemia. These interventions do not constitute a “cure” or anything close, which is why the death rate from breast cancer has
changed very little since the 1930s, when mastectomy was the only treatment available. Chemotherapy, which became a routine part
of breast-cancer treatment in the eighties, does not confer anywhere near as decisive an advantage as patients are often led to
believe, especially in postmenopausal women like myself–a two or three percentage point difference in ten-year survival rates,(1)
according to America’s best known breast-cancer surgeon, Dr. Susan Love.

I know these bleak facts, or sort of know them, but in the fog of anesthesia that hangs over those first few weeks, I seem to lose my
capacity for self-defense. The pressure is on, from doctors and loved ones, to do something right away–kill it, get it out now. The
endless exams, the bone scan to check for metastases, the high-tech heart test to see if I’m strong enough to withstand
chemotherapy–all these blur the line between selfhood and thing-hood anyway, organic and inorganic, me and it. As my cancer
career unfolds, I will, the helpful pamphlets explain, become a composite of the living and the dead–an implant to replace the breast,
a wig to replace the hair. And then what will I mean when I use the word “I”? I fall into a state of unreasoning passive aggressivity:
They diagnosed this, so it’s their baby. They found it, let them fix it.

I could take my chances with “alternative” treatments, of course, like punk novelist Kathy Acker, who succumbed to breast cancer in
1997 after a course of alternative therapies in Mexico, or actress and ThighMaster promoter Suzanne Somers, who made tabloid
headlines last spring by injecting herself with mistletoe brew. Or I could choose to do nothing at all beyond mentally exhorting my
immune system to exterminate the traitorous cellular faction. But I have never admired the “natural” or believed in the “wisdom of the
body.” Death is as “natural” as anything gets, and the body has always seemed to me like a retarded Siamese twin dragging along
behind me, an hysteric really, dangerously overreacting, in my case, to everyday allergens and minute ingestions of sugar. I will put
my faith in science, even if this means that the dumb old body is about to be transmogrified into an evil clown–puking, trembling,
swelling, surrendering significant parts, and oozing post-surgical fluids. The surgeon–a more genial and forthcoming one this time–
can fit me in; the oncologist will see me. Welcome to Cancerland.

Fortunately, no one has to go through this alone. Thirty years ago, before Betty Ford, Rose Kushner, Betty Rollin, and other pioneer
patients spoke out, breast cancer was a dread secret, endured in silence and euphemized in obituaries as a “long illness.” Something
about the conjuncture of “breast,” signifying sexuality and nurturance, and that other word, suggesting the claws of a devouring
crustacean, spooked almost everyone. Today however, it’s the biggest disease on the cultural map, bigger than AIDS, cystic fibrosis,
or spinal injury, bigger even than those more prolific killers of women–heart disease, lung cancer, and stroke. There are roughly
hundreds of websites devoted to it, not to mention newsletters, support groups, a whole genre of first-person breast-cancer books;
even a glossy, upper-middle-brow, monthly magazine, Mamm. There are four major national breast-cancer organizations, of which
the mightiest, in financial terms, is The Susan G. Komen Foundation, headed by breast-cancer veteran and Bush’s nominee for
ambassador to Hungary Nancy Brinker. Komen organizes the annual Race for the Cure [C], which attracts about a million people–
mostly survivors, friends, and family members. Its website provides a microcosm of the new breast-cancer culture, offering news of
the races, message boards for accounts of individuals’ struggles with the disease, and a “marketplace” of breast-cancer-related
products to buy.

More so than in the case of any other disease, breast-cancer organizations and events feed on a generous flow of corporate support.
Nancy Brinker relates how her early attempts to attract corporate interest in promoting breast cancer “awareness” were met with
rebuff. A bra manufacturer, importuned to affix a mammogram-reminder tag to his product, more or less wrinkled his nose. Now
breast cancer has blossomed from wallflower to the most popular girl at the corporate charity prom. While AIDS goes begging and
low-rent diseases like tuberculosis have no friends at all, breast cancer has been able to count on Revlon, Avon, Ford, Tiffany, Pier 1,
Estee Lauder, Ralph Lauren, Lee Jeans, Saks Fifth Avenue, JC Penney, Boston Market, Wilson athletic gear–and I apologize to
those I’ve omitted. You can “shop for the cure” during the week when Saks donates 2 percent of sales to a breast-cancer fund; “wear
denim for the cure” during Lee National Denim Day, when for a $5 donation you get to wear blue jeans to work. You can even “invest
for the cure,” in the Kinetics Assets Management’s new no-load Medical Fund, which specializes entirely in businesses involved in
cancer research.

If you can’t run, bike, or climb a mountain for the cure–all of which endeavors are routine beneficiaries of corporate sponsorship–you
can always purchase one of the many products with a breast-cancer theme. There are 2.2 million American women in various stages
of their breast-cancer careers, who, along with anxious relatives, make up a significant market for all things breast-cancer-related.
Bears, for example: I have identified four distinct lines, or species, of these creatures, including “Carol,” the Remembrance Bear;
“Hope,” the Breast Cancer Research Bear, which wears a pink turban as if to conceal chemotherapy-induced baldness; the “Susan
Bear,” named for Nancy Brinker’s deceased sister, Susan; and the new Nick & Nora Wish Upon a Star Bear, available, along with the
Susan Bear, at the Komen Foundation website’s “marketplace.”

And bears are only the tip, so to speak, of the cornucopia of pink-ribbon-themed breast-cancer products. You can dress in pink-
beribboned sweatshirts, denim shirts, pajamas, lingerie, aprons, loungewear, shoelaces, and socks; accessorize with pink rhinestone
brooches, angel pins, scarves, caps, earrings, and bracelets; brighten up your home with breast-cancer candles, stained-glass pink-
ribbon candleholders, coffee mugs, pendants, wind chimes, and night-lights; pay your bills with special BreastChecks or a separate
line of Checks for the Cure. “Awareness” beats secrecy and stigma of course, but I can’t help noticing that the existential space in
which a friend has earnestly advised me to “confront [my] mortality” bears a striking resemblance to the mall.

This is not, I should point out, a case of cynical merchants exploiting the sick. Some of the breast-cancer tchotchkes and accessories
are made by breast-cancer survivors themselves, such as “Janice,” creator of the “Daisy Awareness Necklace,” among other things,
and in most cases a portion of the sales goes to breast-cancer research. Virginia Davis of Aurora, Colorado, was inspired to create
the “Remembrance Bear” by a friend’s double mastectomy and sees her work as more of a “crusade” than a business. This year she
expects to ship 10,000 of these teddies, which are manufactured in China, and send part of the money to the Race for the Cure. If the
bears are infantilizing–as I try ever so tactfully to suggest is how they may, in rare cases, be perceived–so far no one has
complained. “I just get love letters,” she tells me, “from people who say, `God bless you for thinking of us.'”

The ultrafeminine theme of the breast-cancer “marketplace”–the prominence, for example, of cosmetics and jewelry–could be
understood as a response to the treatments’ disastrous effects on one’s looks. But the infantilizing trope is a little harder to account
for, and teddy bears are not its only manifestation. A tote bag distributed to breast cancer patients by the Libby Ross Foundation
(through places such as the Columbia Presbyterian Medical Center) contains, among other items, a tube of Estee Lauder Perfumed
Body Creme, a hot-pink satin pillowcase, an audiotape “Meditation to Help You with Chemotherapy,” a small tin of peppermint
pastilles, a set of three small inexpensive rhinestone bracelets, a pink-striped “journal and sketch book,” and–somewhat jarringly–a
small box of crayons. Maria Willner, one of the founders of the Libby Ross Foundation, told me that the crayons “go with the journal
for people to express different moods, different thoughts …” though she admitted she has never tried to write with crayons herself.
Possibly the idea is that regression to a state of childlike dependency puts one in the best frame of mind with which to endure the
prolonged and toxic treatments. Or it may be that, in some versions of the prevailing gender ideology, femininity is by its nature
incompatible with full adulthood–a state of arrested development. Certainly men diagnosed with prostate cancer do not receive gifts
of Matchbox cars.

But I, no less than the bear huggers, need whatever help I can get, and start wading out into the Web in search of practical tips on
hair loss, lumpectomy versus mastectomy, how to select a chemotherapy regimen, what to wear after surgery and eat when the scent
of food sucks. There is, I soon find, far more than I can usefully absorb, for thousands of the afflicted have posted their stories,
beginning with the lump or bad mammogram, proceeding through the agony of the treatments; pausing to mention the sustaining
forces of family, humor, and religion; and ending, in almost all cases, with warm words of encouragement for the neophyte. Some of
these are no more than a paragraph long–brief waves from sister sufferers; others offer almost hour-by-hour logs of breast-deprived,
chemotherapized lives:

Tuesday, August 15, 2000: Well, I survived my 4th chemo. Very, very dizzy today. Very nauseated, but no barfing! It’s a
first…. I break out in a cold sweat and my heart pounds if I stay up longer than 5 minutes. Friday, August 18, 2000:
… By dinner time, I was full out nauseated. I took some meds and ate a rice and vegetable bowl from Trader Joe’s. It
smelled and tasted awful to me, but I ate it anyway…. Rick brought home some Kern’s nectars and I’m drinking that.
Seems to have settled my stomach a little bit.

I can’t seem to get enough of these tales, reading on with panicky fascination about everything that can go wrong–septicemia,
ruptured implants, startling recurrences a few years after the completion of treatments, “mets” (metastases) to vital organs, and–what
scares me most in the short term–“chemo-brain,” or the cognitive deterioration that sometimes accompanies chemotherapy. I
compare myself with everyone, selfishly impatient with those whose conditions are less menacing, shivering over those who have
reached Stage IV (“There is no Stage V,” as the main character in Wit, who has ovarian cancer, explains), constantly assessing my
chances.

Feminism helped make the spreading breast-cancer sisterhood possible, and this realization gives me a faint feeling of belonging.
Thirty years ago, when the disease .went hidden behind euphemism and prostheses, medicine was a solid patriarchy, women’s
bodies its passive objects of labor. The Women’s Health Movement, in which I was an activist in the seventies and eighties,
legitimized self-help and mutual support and encouraged women to network directly, sharing their stories, questioning the doctors,
banding together. It is hard now to recall how revolutionary these activities once seemed, and probably few participants in breast-
cancer chat rooms and message boards realize that when post-mastectomy patients first proposed meeting in support groups in the
mid-1970s, the American Cancer Society responded with a firm and fatherly “no.” Now no one leaves the hospital without a brochure
directing her to local support groups and, at least in my case, a follow-up call from a social worker to see whether I am safely
ensconced in one. This cheers me briefly, until I realize that if support groups have won the stamp of medical approval this may be

because they are no longer perceived as seditious.

In fact, aside from the dilute sisterhood of the cyber (and actual) support groups, there is nothing very feminist–in an ideological or
activist sense–about the mainstream of breast-cancer culture today. Let me pause to qualify: You can, if you look hard enough, find
plenty of genuine, self-identified feminists within the vast pink sea of the breast-cancer crusade, women who are militantly determined
to “beat the epidemic” and insistent on more user-friendly approaches to treatment. It was feminist health activists who led the
campaign, in the seventies and eighties, against the most savage form of breast-cancer surgery–the Halsted radical mastectomy,
which removed chest muscle and lymph nodes as well as breast tissue and left women permanently disabled. It was the Women’s
Health Movement that put a halt to the surgical practice, common in the seventies, of proceeding directly from biopsy to mastectomy
without ever rousing the patient from anesthesia. More recently, feminist advocacy groups such as the San Francisco-based Breast
Cancer Action and the Cambridge-based Women’s Community Cancer Project helped blow the whistle on “high-dose chemotherapy,
” in which the bone marrow was removed prior to otherwise lethal doses of chemotherapy and later replaced–to no good effect, as it
turned out.

Like everyone else in the breast-cancer world, the feminists want a cure, but they even more ardently demand to know the cause or
causes of the disease without which we will never have any means of prevention. “Bad” genes of the inherited variety are thought to
account for fewer than 10 percent of breast cancers, and only 30 percent of women diagnosed with breast cancer have any known
risk factor (such as delaying childbearing or the late onset of menopause) at all. Bad lifestyle choices like a fatty diet have, after brief
popularity with the medical profession, been largely ruled out. Hence suspicion should focus on environmental carcinogens, the
feminists argue, such as plastics, pesticides (DDT and PCBs, for example, though banned in this country, are still used in many Third
World sources of the produce we eat), and the industrial runoff in our ground water. No carcinogen has been linked definitely to
human breast cancer yet, but many have been found to cause the disease in mice, and the inexorable increase of the disease in
industrialized nations–about one percent a year between the 1950s and the 1990s–further hints at environmental factors, as does
the fact that women migrants to industrialized countries quickly develop the same breast-cancer rates as those who are native born.
Their emphasis on possible ecological factors, which is not shared by groups such as Komen and the American Cancer Society, puts
the feminist breast-cancer activists in league with other, frequently rambunctious, social movements–environmental and
anticorporate.

But today theirs are discordant voices in a general chorus of sentimentality and good cheer; after all, breast cancer would hardly be
the darling of corporate America if its complexion changed from pink to green. It is the very blandness of breast cancer, at least in
mainstream perceptions, that makes it an attractive object of corporate charity and a way for companies to brand themselves friends
of the middle-aged female market. With breast cancer, “there was no concern that you might actually turn off your audience because
of the life style or sexual connotations that AIDS has,” Amy Langer, director of the National Alliance of Breast Cancer Organizations,
told the New York Times in 1996. “That gives corporations a certain freedom and a certain relief in supporting the cause.” Or as
Cindy Pearson, director of the National Women’s Health Network, the organizational progeny of the Women’s Health Movement, puts
it more caustically: “Breast cancer provides a way of doing something for women, without being feminist.”

In the mainstream of breast-cancer culture, one finds very little anger, no mention of possible environmental causes, few complaints
about the fact that, in all but the more advanced, metastasized cases, it is the “treatments,” not the disease, that cause illness and
pain. The stance toward existing treatments is occasionally critical–in Mamm, for example–but more commonly grateful; the overall
tone, almost universally upbeat. The Breast Friends website, for example, features a series of inspirational quotes: “Don’t Cry Over
Anything that Can’t Cry Over You,” “I Can’t Stop the Birds of Sorrow from Circling my Head, But I Can Stop Them from Building a
Nest in My Hair,” “When Life Hands Out Lemons, Squeeze Out a Smile,” “Don’t wait for your ship to come in … Swim out to meet it,”
and much more of that ilk. Even in the relatively sophisticated Mamm, a columnist bemoans not cancer or chemotherapy but the end
of chemotherapy, and humorously proposes to deal with her separation anxiety by pitching a tent outside her oncologist’s office. So
pervasive is the perkiness of the breast-cancer world that unhappiness requires a kind of apology, as when “Lucy,” whose “long term
prognosis is not good,” starts her personal narrative on breastcancertalk.org by telling us that her story “is not the usual one, full of
sweetness and hope, but true nevertheless.”

There is, I discover, no single noun to describe a woman with breast cancer. As in the AIDS movement, upon which breast-cancer
activism is partly modeled, the words “patient” and “victim,” with their aura of self-pity and passivity, have been ruled un-P.C. Instead,
we get verbs: Those who are in the midst of their treatments are described as “battling” or “fighting,” sometimes intensified with
“bravely” or “fiercely”–language suggestive of Katharine Hepburn with her face to the wind. Once the treatments are over, one
achieves the status of “survivor,” which is how the women in my local support group identify themselves, A.A.-style, as we convene to
share war stories and rejoice in our “survivorhood”: “Hi, I’m Kathy and I’m a three-year survivor.” For those who cease to be survivors
and join the more than 40,000 American women who succumb to breast cancer each year–again, no noun applies. They are said to
have “lost their battle” and may be memorialized by photographs carried at races for the cure–our lost, brave sisters, our fallen
soldiers. But in the overwhelmingly Darwinian culture that has grown up around breast cancer, martyrs count for little; it is the
“survivors” who merit constant honor and acclaim. They, after all, offer living proof that expensive and painful treatments may in some
cases actually work.

Scared and medically weakened women can hardly be expected to transform their support groups into bands of activists and rush out
into the streets, but the equanimity of breast-cancer culture goes beyond mere absence of anger to what looks, all too often, like a
positive embrace of the disease. As “Mary” reports, on the Bosom Buds message board:

I really believe I am a much more sensitive and thoughtful person now. It might sound funny but I was a real worrier
before. Now I don’t want to waste my energy on worrying. I enjoy life so much more now and in a lot of aspects I am much
happier now.

Or this from “Andee”:

This was the hardest year of my life but also in many ways the most rewarding. I got rid of the baggage, made peace with
my family, met many amazing people, learned to take very good care of my body so it will take care of me, and
reprioritized my life.

Cindy Cherry, quoted in the Washington Post, goes further:

If I had to do it over, would I want breast cancer? Absolutely. I’m not the same person I was, and I’m glad I’m not.
Money doesn’t matter anymore. I’ve met the most phenomenal people in my life through this. Your friends and family are
what matter now.

The First Year of the Rest of Your Life, a collection of brief narratives with a foreword by Nancy Brinker and a share of the royalties
going to the Komen Foundation, is filled with such testimonies to the redemptive powers of the disease: “I can honestly say I am
happier now than I have ever been in my life–even before the breast cancer.” “For me, breast cancer has provided a good kick in the
rear to get me started rethinking my life….” “I have come out stronger, with a new sense of priorities …” Never a complaint about lost
time, shattered sexual confidence, or the long-term weakening of the arms caused by lymph-node dissection and radiation. What
does not destroy you, to paraphrase Nietzsche, makes you a spunkier, more evolved, sort of person.

The effect of this relentless brightsiding is to transform breast cancer into a rite of passage–not an injustice or a tragedy to rail
against, but a normal marker in the life cycle, like menopause or graying hair. Everything in mainstream breast-cancer culture serves,
no doubt inadvertently, to tame and normalize the disease: the diagnosis may be disastrous, but there are those cunning pink
rhinestone angel pins to buy and races to train for. Even the heavy traffic in personal narratives and practical tips, which I found so
useful, bears an implicit acceptance of the disease and the current barbarous approaches to its treatment: you can get so busy
comparing attractive head scarves that you forget to question a form of treatment that temporarily renders you both bald and immuno-
incompetent. Understood as a rite of passage, breast cancer resembles the initiation rites so exhaustively studied by Mircea Eliade:
First there is the selection of the initiates–by age in the tribal situation, by mammogram or palpation here. Then come the requisite
ordeals–scarification or circumcision within traditional cultures, surgery and chemotherapy for the cancer patient. Finally, the initiate
emerges into a new and higher status–an adult and a warrior–or in the case of breast cancer, a “survivor.”

And in our implacably optimistic breast-cancer culture, the disease offers more than the intangible benefits of spiritual upward
mobility. You can defy the inevitable disfigurements and come out, on the survivor side, actually prettier, sexier, more femme. In the
lore of the disease–shared with me by oncology nurses as well as by survivors–chemotherapy smoothes and tightens the skin, helps
you lose weight; and, when your hair comes back, it will be fuller, softer, easier to control, and perhaps a surprising new color. These
may be myths, but for those willing to get with the prevailing program, opportunities for self-improvement abound. The American
Cancer Society offers the “Look Good … Feel Better” program, “dedicated to teaching women cancer patients beauty techniques to
help restore their appearance and self-image during cancer treatment.” Thirty thousand women participate a year, each copping a
free makeover and bag of makeup donated by the Cosmetic, Toiletry, and Fragrance Association, the trade association of the
cosmetics industry. As for that lost breast: after reconstruction, why not bring the other one up to speed? Of the more than 50,000
mastectomy patients who opt for reconstruction each year, 17 percent go on, often at the urging of their plastic surgeons, to get
additional surgery so that the remaining breast will “match” the more erect and perhaps larger new structure on the other side.

Not everyone goes for cosmetic deceptions, and the question of wigs versus baldness, reconstruction versus undisguised scar,
defines one of the few real disagreements in breast-cancer culture. On the more avant-garde, upper-middleclass side, Mamm
magazine–which features literary critic Eve Kosofsky Sedgwick as a columnist–tends to favor the “natural” look. Here, mastectomy
scars can be “sexy” and baldness something to celebrate. The January 2001 cover story features women who “looked upon their
baldness not just as a loss, but also as an opportunity: to indulge their playful sides … to come in contact, in new ways, with their
truest selves.” One decorates her scalp with temporary tattoos of peace signs, panthers, and frogs; another expresses herself with a
shocking purple wig; a third reports that unadorned baldness makes her feel “sensual, powerful, able to recreate myself with every
new day.” But no hard feelings toward those who choose to hide their condition under wigs or scarves; it’s just a matter, Mamm tells
us, of “different aesthetics.” Some go for pink ribbons; others will prefer the Ralph Lauren Pink Pony breast-cancer motif. But
everyone agrees that breast cancer is a chance for creative self-transformation–a makeover opportunity, in fact.

Now, cheerfulness, up to and including delusion and false hope, has a recognized place in medicine. There is plenty of evidence that
depressed and socially isolated people are more prone to succumb to diseases, cancer included, and a diagnosis of cancer is
probably capable of precipitating serious depression all by itself. To be told by authoritative figures that you have a deadly disease,
for which no real cure exists, is to enter a liminal state fraught with perils that go well beyond the disease itself. Consider the
phenomenon of “voodoo death”–described by ethnographers among, for example, Australian aborigines–in which a person who has
been condemned by a suitably potent curse obligingly shuts down and dies within a day or two. Cancer diagnoses could, and in some
cases probably do, have the same kind of fatally dispiriting effect. So, it could be argued, the collectively pumped-up optimism of
breast-cancer culture may be just what the doctor ordered. Shop for the Cure, dress in pink-ribbon regalia, organize a run or hike–
whatever gets you through the night.

But in the seamless world of breast-cancer culture, where one website links to another–from personal narratives and grassroots
endeavors to the glitzy level of corporate sponsors and celebrity spokespeople–cheerfulness is more or less mandatory, dissent a
kind of treason. Within this tightly knit world, attitudes are subtly adjusted, doubters gently brought back to the fold. In The First Year
of the Rest of Your Life, for example, each personal narrative is followed by a study question or tip designed to counter the slightest
hint of negativity–and they are very slight hints indeed, since the collection includes no harridans, whiners, or feminist militants:

Have you given yourself permission to acknowledge you have some anxiety or “blues” and to ask for help for your emotional

well-being? Is there an area in your life of unresolved internal conflict? Is there an area where you think you might
want to do some “healthy mourning”? Try keeping a list of the things you find “good about today.”

As an experiment, I post a statement on the Komen.org message board, under the subject line “angry,” briefly listing my own heartfelt
complaints about debilitating treatments, recalcitrant insurance companies, environmental carcinogens, and, most daringly, “sappy
pink ribbons.” I receive a few words of encouragement in my fight with the insurance company, which has taken the position that my
biopsy was a kind of optional indulgence, but mostly a chorus of rebukes. “Suzy” writes to say, “I really dislike saying you have a bad
attitude towards all of this, but you do, and it’s not going to help you in the least.” “Mary” is a bit more tolerant, writing, “Barb, at this
time in your life, it’s so important to put all your energies toward a peaceful, if not happy, existence. Cancer is a rotten thing to have
happen and there are no answers for any of us as to why. But to live your life, whether you have one more year or 51, in anger and
bitterness is such a waste … I hope you can find some peace. You deserve it. We all do. God bless you and keep you in His loving
care. Your sister, Mary.”

“Kitty,” however, thinks I’ve gone around the bend: “You need to run, not walk, to some counseling…. Please, get yourself some help
and I ask everyone on this site to pray for you so you can enjoy life to the fullest.”

I do get some reinforcement from “Gerri,” who has been through all the treatments and now finds herself in terminal condition: “I am
also angry. All the money that is raised, all the smiling faces of survivors who make it sound like it is o.k. to have breast cancer. IT IS
NOT O.K.!” But Gerri’s message, like the others on the message board, is posted under the mocking heading “What does it mean to
be a breast-cancer survivor?”

“Culture” is too weak a word to describe all this. What has grown up around breast cancer in just the last fifteen years more nearly
resembles a cult–or, given that it numbers more than two million women, their families, and friends–perhaps we should say a full-
fledged religion. The products–teddy bears, pink-ribbon brooches, and so forth–serve as amulets and talismans, comforting the
sufferer and providing visible evidence of faith. The personal narratives serve as testimonials and follow the same general arc as the
confessional autobiographies required of seventeenth-century Puritans: first there is a crisis, often involving a sudden apprehension
of mortality (the diagnosis or, in the old Puritan case, a stem word from on high); then comes a prolonged ordeal (the treatment or, in
the religious case, internal struggle with the Devil); and finally, the blessed certainty of salvation, or its breast-cancer equivalent,
survivorhood. And like most recognized religions, breast cancer has its great epideictic events, its pilgrimages and mass gatherings
where the faithful convene and draw strength from their numbers. These are the annual races for a cure, attracting a total of about a
million people at more than eighty sites–70,000 of them at the largest event, in Washington, D.C., which in recent years has been
attended by Dan and Marilyn Quayle and Al and Tipper Gore. Everything comes together at the races: celebrities and corporate
sponsors are showcased; products are hawked; talents, like those of the “Swinging, Singing Survivors” from Syracuse, New York, are
displayed. It is at the races, too, that the elect confirm their special status. As one participant wrote in the Washington Post:

I have taken my “battle scarred” breasts to the Mall, donned the pink shirt, visor, pink shoelaces, etc. and walked
proudly among my fellow veterans of the breast cancer war. In 1995, at the age of 44, I was diagnosed and treated for
Stage II breast cancer. The experience continues to redefine my life.

Feminist breast-cancer activists, who in the early nineties were organizing their own mass outdoor events–demonstrations, not races-
-to demand increased federal funding for research, tend to keep their distance from these huge, corporate-sponsored, pink
gatherings. Ellen Leopold, for example–a member of the Women’s Community Cancer Project in Cambridge and author of A Darker
Ribbon: Breast Cancer, Women, and Their Doctors in the Twentieth Century–has criticized the races as an inefficient way of raising
money. She points out that the Avon Breast Cancer Crusade, which sponsors three-day, sixty-mile walks, spends more than a third of
the money raised on overhead and advertising, and Komen may similarly fritter away up to 25 percent of its gross. At least one
corporate-charity insider agrees. “It would be much easier and more productive,” says Rob Wilson, an organizer of charitable races
for corporate clients, “if people, instead of running or riding, would write out a check to the charity.”

To true believers, such criticisms miss the point, which is always, ultimately, “awareness.” Whatever you do to publicize the disease–
wear a pink ribbon, buy a teddy, attend a race–reminds other women to come forward for their mammograms. Hence, too, they
would argue, the cult of the “survivor”: If women neglect their annual screenings, it must be because they are afraid that a diagnosis
amounts to a death sentence. Beaming survivors, proudly displaying their athletic prowess, are the best possible advertisement for
routine screening mammograms, early detection, and the ensuing round of treatments. Yes, miscellaneous businesses–from tiny
distributors of breast-cancer wind chimes and note cards to major corporations seeking a woman-friendly image–benefit in the
process, not to mention the breast-cancer industry itself, the estimated $12-16 billion-a-year business in surgery, “breast health
centers,” chemotherapy “infusion suites,” radiation treatment centers, mammograms, and drugs ranging from anti-emetics (to help
you survive the nausea of chemotherapy) to tamoxifen (the hormonal treatment for women with estrogen-sensitive tumors). But
what’s to complain about? Seen through pink-tinted lenses, the entire breast-cancer enterprise–from grassroots support groups and
websites to the corporate providers of therapies and sponsors of races–looks like a beautiful example of synergy at work: cult
activities, paraphernalia, and testimonies encourage women to undergo the diagnostic procedures, and since a fraction of these
diagnoses will be positive, this means more members for the cult as well as more customers for the corporations, both those that
provide medical products and services and those that offer charitable sponsorships.

But this view of a life-giving synergy is only as sound as the science of current detection and treatment modalities, and, tragically, that
science is fraught with doubt, dissension, and what sometimes looks very much like denial. Routine screening mammograms, for
example, are the major goal of “awareness,” as when Rosie O’Donnell exhorts us to go out and “get squished.” But not all breast-
cancer experts are as enthusiastic. At best the evidence for the salutary effects of routine mammograms–as opposed to breast self-
examination –is equivocal, with many respectable large-scale studies showing a vanishingly small impact on overall breast-cancer
mortality. For one thing, there are an estimated two to four false positives for every cancer detected, leading thousands of healthy
women to go through unnecessary biopsies and anxiety. And even if mammograms were 100 percent accurate, the admirable goal of

“early” detection is more elusive than the current breast-cancer dogma admits. A small tumor, detectable only by mammogram, is not
necessarily young and innocuous; if it has not spread to the lymph nodes, which is the only form of spreading detected in the
common surgical procedure of lymph-node dissection, it may have already moved on to colonize other organs via the bloodstream.
David Plotkin, director of the Memorial Cancer Research Foundation of Southern California, concludes that the benefits of routine
mammography “are not well established; if they do exist, they are not as great as many women hope.” Alan Spievack, a surgeon
recently retired from the Harvard Medical School, goes further, concluding from his analysis of dozens of studies that routine
screening mammography is, in the words of famous British surgeon Dr. Michael Baum, “one of the greatest deceptions perpetrated
on the women of the Western world.”

Even if foolproof methods for early detection existed,(2) they would, at the present time, serve only as portals to treatments offering
dubious protection and considerable collateral damage. Some women diagnosed with breast cancer will live long enough to die of
something else, and some of these lucky ones will indeed owe their longevity to a combination of surgery, chemotherapy, radiation,
and/or anti-estrogen drugs such as tamoxifen. Others, though, would have lived untreated or with surgical excision alone, either
because their cancers were slow-growing or because their bodies’ own defenses were successful. Still others will die of the disease
no matter what heroic, cell-destroying therapies are applied. The trouble is, we do not have the means to distinguish between these
three groups. So for many of the thousands of women who are diagnosed each year, Plotkin notes, “the sole effect of early detection
has been to stretch out the time in which the woman bears the knowledge of her condition.” These women do not live longer than
they might have without any medical intervention, but more of the time they do live is overshadowed with the threat of death and
wasted in debilitating treatments.

To the extent that current methods of detection and treatment fail or fall short, America’s breast-cancer cult can be judged as an
outbreak of mass delusion, celebrating survivorhood by downplaying mortality and promoting obedience to medical protocols known
to have limited efficacy. And although we may imagine ourselves to be well past the era of patriarchal medicine, obedience is the
message behind the infantilizing theme in breast-cancer culture, as represented by the teddy bears, the crayons, and the prevailing
pinkness. You are encouraged to regress to a little-girl state, to suspend critical judgment, and to accept whatever measures the
doctors, as parent surrogates, choose to impose.

Worse, by ignoring or underemphasizing the vexing issue of environmental causes, the breast-cancer cult turns women into dupes of
what could be called the Cancer Industrial Complex: the multinational corporate enterprise that with the one hand doles out
carcinogens and disease and, with the other, offers expensive, semi-toxic pharmaceutical treatments. Breast Cancer Awareness
Month, for example, is sponsored by AstraZeneca (the manufacturer of tamoxifen), which, until a corporate reorganization in 2000,
was a leading producer of pesticides, including acetochlor, classified by the EPA as a “probable human carcinogen.” This particularly
nasty conjuncture of interests led the environmentally oriented Cancer Prevention Coalition (CPC) to condemn Breast Cancer
Awareness Month as “a public relations invention by a major polluter which puts women in the position of being unwitting allies of the
very people who make them sick.” Although AstraZeneca no longer manufactures pesticides, CPC has continued to criticize the
breast-cancer crusade–and the American Cancer Society for its unquestioning faith in screening mammograms and careful
avoidance of environmental issues. In a June 12, 2001, press release, CPC chairman Samuel S. Epstein, M.D., and the well-known
physician activist Quentin Young castigated the American Cancer Society for its “longstanding track record of indifference and even
hostility to cancer prevention…. Recent examples include issuing a joint statement with the Chlorine Institute justifying the continued
global use of persistent organochlorine pesticides, and also supporting the industry in trivializing dietary pesticide residues as
avoidable risks of childhood cancer. ACS policies are further exemplified by allocating under 0.1 percent of its $700 million annual
budget to environmental and occupational causes of cancer.”

In the harshest judgment, the breast-cancer cult serves as an accomplice in global poisoning–normalizing cancer, prettying it up,
even presenting it, perversely, as a positive and enviable experience.

When, my three months of chemotherapy completed, the oncology nurse calls to congratulate me on my “excellent blood work
results,” I modestly demur. I didn’t do anything, I tell her, anything but endure–marking the days off on the calendar, living on Protein
Revolution canned vanilla health shakes, escaping into novels and work. Courtesy restrains me from mentioning the fact that the
tumor markers she’s tested for have little prognostic value, that there’s no way to know how many rebel cells survived chemotherapy
and may be carving out new colonies right now. She insists I should be proud; I’m a survivor now and entitled to recognition at the
Relay for Life being held that very evening in town.

So I show up at the middle-school track where the relay’s going on just in time for the Survivors’ March: about 100 people, including a
few men, since the funds raised will go to cancer research in general, are marching around the track eight to twelve abreast while a
loudspeaker announces their names and survival times and a thin line of observers, mostly people staffing the raffle and food booths,
applauds. It could be almost any kind of festivity, except for the distinctive stacks of cellophane-wrapped pink Hope Bears for sale in
some of the booths. I cannot help but like the funky small-town Gemutlichkeit of the event, especially when the audio system strikes
up that universal anthem of solidarity, “We Are Family,” and a few people of various ages start twisting to the music on the gerry-
rigged stage. But the money raised is going far away, to the American Cancer Society, which will not be asking us for our advice on
how to spend it.

I approach a woman I know from other settings, one of our local intellectuals, as it happens, decked out here in a pink-and-yellow
survivor T-shirt and with an American Cancer Society “survivor medal” suspended on a purple ribbon around her neck. “When do you
date your survivorship from?” I ask her, since the announced time, five and a half years, seems longer than I recall. “From diagnosis

or the completion of your treatments?” The question seems to annoy or confuse her, so I do not press on to what I really want to ask:
At what point, in a downwardly sloping breast-cancer career, does one put aside one’s survivor regalia and admit to being in fact a
die-er? For the dead are with us even here, though in much diminished form. A series of paper bags, each about the right size for a
junior burger and fries, lines the track. On them are the names of the dead, and inside each is a candle that will be lit later, after dark,
when the actual relay race begins.

My friend introduces me to a knot of other women in survivor gear, breast-cancer victims all, I learn, though of course I would not use
the V-word here. “Does anyone else have trouble with the term `survivor’?” I ask, and, surprisingly, two or three speak up. It could be
“unlucky,” one tells me; it “tempts fate,” says another, shuddering slightly. After all, the cancer can recur at any time, either in the
breast or in some more strategic site. No one brings up my own objection to the term, though: that the mindless triumphalism of
“survivorhood” denigrates the dead and the dying. Did we who live “fight” harder than those who’ve died? Can we claim to be “braver,
” better, people than the dead? And why is there no room in this cult for some gracious acceptance of death, when the time comes,
which it surely will, through cancer or some other misfortune?

No, this is not my sisterhood. For me at least, breast cancer will never be a source of identity or pride. As my dying correspondent
Gerri wrote: “IT IS NOT O.K.!” What it is, along with cancer generally or any slow and painful way of dying, is an abomination, and, to
the extent that it’s manmade, also a crime. This is the one great truth that I bring out of the breast-cancer experience, which did not, I
can now report, make me prettier or stronger, more feminine or spiritual–only more deeply angry. What sustained me through the
“treatments” is a purifying rage, a resolve, framed in the sleepless nights of chemotherapy, to see the last polluter, along with, say,
the last smug health-insurance operative, strangled with the last pink ribbon. Cancer or no cancer, I will not live that long of course.
But I know this much right now for sure: I will not go into that last good night with a teddy bear tucked under my arm.

(1) In the United States, one in eight women will be diagnosed with breast cancer at some point. The chances of her surviving for five
years are 86.8 percent. For a black woman this falls to 72 percent; and for a woman of any race whose cancer has spread to the
lymph nodes, to 77.7 percent.

(2) Some improved prognostic tools, involving measuring a tumor’s growth rate and the extent to which it is supplied with blood
vessels, are being developed but are not yet in use.

Barbara Ehrenreich is a contributing editor to Harper’s Magazine. Her last two essays for the magazine were the basis for her best-
selling book, Nickel and Dimed: On (Not) Getting By in America, published by Henry Holt.

Ehrenreich, Barbara

Source Citation (MLA 8th Edition)
Ehrenreich, Barbara. “WELCOME TO CANCERLAND.” Harper’s Magazine, Nov. 2001, p. 43. Academic OneFile,

http://link.galegroup.com/apps/doc/A79665310/AONE?u=uniwater&sid=AONE&xid=7c3bad03. Accessed 6 Mar. 2018.

Gale Document Number: GALE|A79665310

Undoing gender? The case of complementary and
alternative medicine
Joslyn Brenton and Sinikka Elliott

Department of Sociology and Anthropology, North Carolina State University, USA

Abstract Despite a rich body of sociological research that examines the relationship between
gender and health, scholars have paid little attention to the case of complementary
and alternative medicine (CAM). One recent study (Sointu 2011) posits that men
and women who use CAM challenge traditional ascriptions of femininity and
masculinity through the exploration of self-care and emotions, respectively.
Drawing on 25 in-depth interviews with middle-class Americans who use CAM,
this article instead finds that men and women interpret their CAM use in ways that
reproduce traditional gendered identities. Men frame their CAM use in terms of
science and rationality, while simultaneously distancing themselves from feminine-
coded components of CAM, such as emotions. Women seek CAM for problems
such as abusive relationships, low self-esteem, and body image concerns, and
frame their CAM use as a quest for self-reinvention that largely reflects and
reproduces conventional femininity. Further, the reproduction of gendered
identities is shaped by the participants’ embrace of neoliberal tenets, such as the
cultivation of personal control. This article contributes to ongoing theoretical
debates about the doing, redoing and undoing of gender, as well as the literature
on health and gender.

Keywords: alternative medicine, gender, neoliberalism

Introduction

Once considered a rogue faction of therapies and medicines, complementary and alternative
medicine – popularly dubbed ‘CAM’ – has gained a foothold in Americans’ health care prac-
tices. Complementary medicine, like chiropractic and acupuncture, is generally used together
with conventional medicine and may even be covered by insurance (National Center for Com-
plementary and Alternative Medicine 2011). Alternative medicine, like reiki and homeopathy,
is typically used in place of conventional medicine and is considered less amenable to the
rigours of evidence-based testing (see Winnick 2005 for a review). The lines separating com-
plementary from alternative medicine are not always clear-cut, however, and both generally
share themes of holism and empowerment (Barrett et al. 2003, Pawluch et al. 2000) and enjoy
widespread popularity. Since 1990 surveys have revealed that approximately 40 per cent of
Americans report having used CAM in the past year and that people use CAM to manage
chronic illness, because they distrust biomedicine or are unhappy with their lack of control in
traditional medical settings, and as a form of preventative health care, among other reasons
(Barnes and Bloom 2008, Eisenberg et al. 1998, Institute of Medicine 2005). CAM is
© 2013 The Authors. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.
Published by John Wiley & Sons Ltd., 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Maiden, MA 02148, USA

Sociology of Health & Illness Vol. 36 No. 1 2014 ISSN 0141-9889, pp. 91–107
doi: 10.1111/1467-9566.12043

especially popular among middle-class white Americans with women (42.8%) using CAM
somewhat more than men (32.5%) (Barnes and Bloom 2008).

Despite a rich body of sociological research that examines the relationship between gender
and health, scholars have paid little attention to the case of CAM. Yet CAM is considered a
socially feminised form of health care and does not enjoy the scientific legitimacy afforded to
standard biomedical practices (Sointu 2011). Examining the use of CAM by men and women
can thus offer insight into contemporary constructions of masculinity and femininity and their
implications for health practices. In her study of middle-class CAM users, Eeva Sointu (2011)
argues that CAM use reflects gender detraditionalisation because men and women who use
CAM defy traditional enactments of masculinity and femininity. These findings are relevant to
current theoretical debates about gender, especially the potential for ‘undoing gender’ (Deutsch
2007, Risman 2009). Drawing on 25 in-depth interviews with middle-class men and women,
we found that CAM users are not undoing, but rather are doing and redoing gender in ways
that reflect social class position and in response to current neoliberal gender-blind imperatives.
To develop this analysis we first discuss current debates among gender scholars on the use of
West and Zimmerman’s (1987) classic theory of ‘doing gender’ and situate our study in a
sociopolitical context, reviewing the links between neoliberalism and CAM use. We then
present our study methods and findings and conclude with a discussion of this article’s
contributions to the sociology of gender and alternative medicine.

Doing health as doing gender

Our analyses are guided by West and Zimmerman’s (1987: 126) conceptualisation of gender
as a ‘routine, methodological, and reoccurring interactional accomplishment’, whereby perfor-
mances of femininity and masculinity simultaneously reflect and reinforce socially constructed
ideas about inherent differences between men and women (e.g., women are nurturing; men are
tough). Sociologists draw extensively on gender theory to understand how men and women
experience health and illness. This literature is heavily influenced by Courtenay’s (2000) rela-
tional theory of health. Building on the work of West and Zimmerman, Courtenay contends
that health-related beliefs and behaviour are resources people use to perform masculinity and
femininity. Men generally tend to avoid seeking help for mental and physical health issues
(Addis and Mahalik 2003), for example, and men with strong masculinity beliefs are less
likely than men with weak masculinity beliefs to engage in preventative health care (Springer
and Mouzon 2011). Further, men’s gendered health behaviours often reinforce and reproduce
gender inequality whereby ‘rejecting what is constructed as feminine is essential for
demonstrating hegemonic masculinity’ (Courtenay 2000: 1389). A key feature of men’s health
behaviour is the denial of weakness and emotional hand-holding (Courtenay 2000, Dolan
2011, Evans et al. 2007) – characteristics stereotypically associated with femininity – and
Noone and Stephens (2008) find that during doctor’s visits, men affirmed a masculine identity
by contrasting their use of health care as serious and women’s as ‘trivial’.

Research offers a complex understanding of the relationship between gender and health in
traditional medical settings, yet we know far less about how gender plays out in unconven-
tional health care settings (Flesch 2007). Heelas and Woodhead (2005) hypothesise that
women are drawn to the holistic or wellbeing culture because they are more likely than men
to develop the subjective self in relation to others, which is also a focus of many CAM thera-
pies. And Flesch (2007) goes a step further to ask how women’s participation in CAM, as
practitioners and users, may reinforce their status as a subordinate group. Some research finds
that men with potentially terminal conditions, such as cancer and human immunodeficiency

© 2013 The Authors
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92 Joslyn Brenton and Sinikka Elliott

virus (HIV), more readily embraced the emotional and physical benefits of CAM (Foote-Ardah
2003, Pawluch et al. 2000). Yet Evans et al. (2007) observe that male cancer patients were
sceptical of alternative therapies that emphasised emotions and Boudioni et al. (2001) find that
men with cancer were less open to CAM than women cancer patients. These studies suggest
that men’s and women’s involvement in CAM is influenced by social expectations surrounding
masculinity and femininity, but do not systematically develop this argument.

More recently, in her study of 44 middle-class CAM users, Sointu (2011) suggests that
holistic health settings may be spaces in which men can safely explore their emotions (Sointu
2011) and thus challenge socially proscribed feeling rules (Hochschild 1979) that expect men
to be tough and stoic (Oransky and Marecek 2009, Sattel 1976). Sointu finds that while men
sometimes described their CAM use in ways that reinforced an image of conventional mascu-
linity, for example, emphasising physicality, competitiveness, and achievement, they also
embraced emotional honesty and intimacy and used CAM to explore their emotions and weak-
nesses. Similarly, although some women’s narratives of CAM use reflected and reproduced
traditional aspects of femininity, such as using CAM to deal with the stress of caregiving,
women also embraced a discourse of self-care that emphasised prioritising and defining the
self apart from the needs and expectations of others. Thus Sointu asserts that CAM use under-
scores a detraditionalisation of femininity and masculinity.

Sointu’s findings are timely considering recent debates over West and Zimmerman’s theory
of doing gender. Scholars such as Deutsch (2007) and Risman (2009) question whether the
rote application of West and Zimmerman’s theory leads researchers to overlook instances in
which gender is being undone; for example, when people’s actions challenge gender binaries
and hierarchies. Instead of focusing exclusively on how gender is done, these scholars urge
researchers to also examine how social interactions may become less gendered or instances in
which gender may be irrelevant (Deutsch 2007). In response, West and Zimmerman (2009)
argue that people are continuously held accountable for their membership to a sex category.
The tenacity of this phenomenon undergirds their position that gender is ‘not undone, so much
as redone’ in ways that may reflect changes to gender accountability structures but do not fun-
damentally undermine the gender order (West and Zimmerman 2009: 118).

By situating middle-class men’s and women’s CAM use within the context of a postmodern
society, we argue that CAM users are doing and redoing, but not undoing, gender, and that their
gender enactments are shaped by an embrace of neoliberal tenets, such as self-reinvention, health
consumerism and the cultivation of personal control. To develop this argument, we briefly review
the links between neoliberalism and CAM use.

CAM and neoliberalism

Several scholars argue that a rise in postmodern values has paved the way for CAM’s popularity
(McQuaide 2005, O’Callaghan and Jordan 2003, Siahpush 1998, Winnick 2005). Postmodern
societies are marked by drastic changes in economic and cultural arrangements. Manufacturing
jobs, once considered ‘jobs for life’ (Ringrose and Walkerdine 2008: 228) are being rapidly
replaced by low-paid and part-time service jobs that often have no benefits such as health insur-
ance or pensions. A shift in cultural values parallels these economic changes, and entails a
‘deprivileging of rationality in general and science in particular’ and concomitant emphasis on
relativism and pluralism (McQuaide 2005: 289). Contemporary Western societies are also char-
acterised by a ‘massive subjective turn’ whereby subjective experiences become a ‘unique
source of meaning and authority’ (Heelas and Woodhead 2005: 3). The response to economic
instability coupled with a postmodern emphasis on difference, cultural diversity and the

© 2013 The Authors
Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd

Undoing gender with complementary and alternative medicine? 93

importance of subjective experience has been an emergent neoliberal rationality or discourse,
emphasising individual choice, self-management, and personal responsibility for health (Cren-
shaw 2007, Ringrose and Walkerdine 2008). Neoliberal discourses are inextricably tied to the
capitalist agenda of consumption. The self is now developed through consumption. Through the
purchase of clothing, education, homes and leisure experiences, as well as health practices, peo-
ple ‘consume themselves into being’ (Ringrose and Walkerdine 2008: 230).

Within this sociopolitical context, CAM’s eclectic mix of science and spirituality give it
what Kaptchuck and Eisenberg (1998: 1060) call ‘persuasive appeal’, helping health consum-
ers expand the possibilities for behavioural options, identity, experience and meaning-making.
Editors of eight British health and lifestyle magazines describe promoting CAM as a way to
deal with the ‘existential dis-ease’ of the 21st century (Doel and Segrott 2003: 135). Congruent
with a neoliberal emphasis on self-reinvention and personal responsibility, people report using
CAM because they have an interest in spirituality and personal growth (Astin 1998) and feel
empowered using holistic therapies that put them in the driver’s seat of their healthcare experi-
ences (Barrett et al. 2003). Survey research finds that postmodern values, such as a belief in
natural healing, rejection of authority, and a desire for control, predict positive attitudes about
CAM (Rayner and Easthope 2001, Siahpush 1998) as well as actual CAM use (O’Callaghan
and Jordan 2003).

A neoliberal emphasis on self-reinvention has important implications for the production of
gendered identities. Neoliberal discourses emphasise individual choice and autonomy while
explicitly ignoring persistent institutional inequalities that shape the amount and type of self-
construction and reinventing people can do. Our analyses of the narratives of women and men
who use CAM demonstrate that despite embracing several ostensibly genderless tenets of
neoliberalism, such as personal responsibility and the importance of self-reinvention, gender
continues to play a key role in CAM users’ decisions for and explanations of CAM use. We
argue for caution in interpreting men’s and women’s CAM use as a sign of undoing gender
and discuss the implications of our findings for contemporary debates about doing gender, and
gender and health.

Methods

The data and analyses presented in this article come from 25 in-depth interviews with 14
women and 11 men who use CAM. The participants were recruited from two yoga studios
(n = 17), an acupuncture clinic (n = 2), a tai chi studio (n = 4) and an advert placed in a local
independent newspaper (n = 2), all located in three small cities in the south-eastern USA.
Eligibility for the study required that participants had used three or more therapies or practices
in the past 12 months – a time frame consistent with past studies of CAM use (Eisenberg
et al. 1998). The participants had used an average of seven therapies in the past year, repre-
senting a wide range of modalities. The National Center for Complementary and Alternative
Medicine groups CAM into four modalities. In the previous year, 52 per cent (n = 13) of the
participants in this study had used ‘natural products’ like herbs and vitamins; 100 per cent
(n = 25) had used one or more ‘mind-body medicines’ such as acupuncture, yoga and tai chi;
80 per cent (n = 20) had used at least one ‘manipulative or body-based’ practice such as chi-
ropractic, reiki and massage therapy; and 72 per cent (n = 18) had used one or more practices
grouped as ‘other’, which include homeopathy, craniosacral therapy and Chinese medicine.
Roughly equal numbers of men and women used practices from the first three categories listed
above, however women were more likely to use ‘other’ therapies than men (women = 14;
men = 4). Mirroring the findings of national surveys on CAM use (Eisenberg et al. 1998),
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94 Joslyn Brenton and Sinikka Elliott

most participants identified as white (n = 22). The average household income was $70,000. In
all, 22 of the participants had a 4-year college degree or higher, while the remaining three
reported completing some college. The average age of women was 40 years; for men, the
average age was 52 (see Table 1).

The interviews averaged one and a half hours, took place in local libraries, business offices
and participants’ homes, and were digitally recorded and transcribed verbatim. Each interview
began with an open-ended question: ‘Tell me how your journey with CAM use began?’ allow-
ing participants to frame their CAM use in ways that were meaningful to them. We developed
our analyses following the main tenets of grounded theory (Charmaz 2006). The first author
conducted all the interviews and coded the data, identifying key themes such as ‘transforma-
tion’ or ‘science talk’. The initial focus of the project was to broadly explore the appeal of
CAM for those who use it. By simultaneously conducting interviews and writing analytic
memos, the first author noticed several themes in her early interviews clustering around the
topic of gender. To explore these in more detail, she began asking questions around these
themes and, following purposive sampling (Charmaz 2006), she recruited and interviewed
more men to elaborate on gendered processes. Subsequent rounds of focused coding involved
a synthesis and refinement of the role of gender in participants’ narratives using gender theory

Table 1 Interviewees’ characteristics

Pseudonym Age Race/ethnicity
Highest
degree

Occupation or industry
of employment

Marital
status

Household
income (‘000$)

Angie 48 White/Native
American

Bachelor Registered nurse/
yoga teacher

Married Over 150

Cameron 29 White Master’s Massage therapist Single 20–29
Erika 24 Black/White Bachelor Grant writer Single 30–39
Gloria 50 White Some college Administrator Married 80–89
Grace 57 White Some college Artist Married 100–149
Layla 36 White Bachelor Computer technologist Single 30–39
Margo 51 White DDS Dentist Married Over 150
Mickey 46 White Bachelor Business owner Partnered 60–69
Miriama 37 White Bachelor Engineer Single 70–79
Nancy 51 White Master’s Archival manager Married 30–39
Robyn 27 White Bachelor Business owner Divorced 30–39
Shree 41 White Master’s Massage therapist Married 100–149
Terri 35 White Master’s Physician’s assistant Divorced 80–89
Yolandra 30 Greek/Puerto

Rican
Master’s Student Divorced 10–19

Bodhi 60 White PhD Martial arts teacher Married 50–59
Dustin 58 White Bachelor Peer support specialist Single 30–39
Edward 51 White Bachelor Business consultant Divorced Over 150
Gregory 53 White Master’s Museum archivist Divorced 30–39
Harry 55 White Master’s Consultant Divorced Over 150
Kenneth 56 White Master’s Optometrist Divorced 100–150
Kyle 36 White Master’s Administrative assistant Single 30–39
Liam 51 White Bachelor Information worker Married 100–149
Patrick 29 White Some college Technology consultant Single 100–149
Paul 63 White PhD Professor Married Over 150
Victor 49 White Bachelor Yoga teacher Married 60–69

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Undoing gender with complementary and alternative medicine? 95

and research as a guide. Both authors wrote and discussed memos to develop the present
analysis.

Women and men in our study described using CAM to deal with strikingly similar health
issues. Equal numbers of men and women said they used CAM to deal with depression as
well as chronic health conditions such as neck and back pain. More women reported using
CAM for acute problems like pelvic or uterine pain or unpredictable issues like sudden numb-
ness in the body. One male participant was using CAM to deal with a life-threatening illness
(cancer). Overall, participants shared similar experiences with and a disdain for conventional
medicine. Congruent with postmodern values, many expressed scepticism of mainstream
science and medical authority, like Layla, who said, ‘America’s health-care system is commer-
cial and money-driven’. The participants generally felt doctors were overeager to prescribe
powerful medication and had ‘become nothing more than agents for pharmaceutical compa-
nies’ (Dustin). Their narratives emphasised the importance of individuality – a hallmark of a
neoliberal discourse – as exemplified by Robyn’s critique of conventional doctors: ‘I am not
going to be treated like a symptom that is walking around. It’s like, see me for who I am!’
Although most participants felt there was a time and a place for conventional medicine, engag-
ing in alternative health practices was central to their identities as individuals and as responsi-
ble health consumers. Despite these commonalities, however, men and women described
markedly different reasons for their CAM use, as well as the meanings they attached to it.

Men’s narratives of CAM use

Given the potential for CAM to undermine men’s performances of conventional masculinity
(Sointu 2011), it is reasonable to wonder why men turned to CAM in the first place. Unlike
working class men, who are often unwilling to seek medical help (Addis and Mahalik 2003,
Noone and Stephens 2008), the narratives of middle-class men in this sample suggest that
seeking help for health-related mental and physical issues is the norm. In fact, all but two men
spoke of regularly visiting a therapist and referenced influential self-help literature, such as
8 Weeks to Optimum Health (Weil n.d.) (Victor), The Necessity of Mourning (Harris 2003)
(Paul), and EnlightenNext (n.d.) (Dustin). Yet the men’s narratives also reveal a persistent ten-
sion between being responsible health consumers and asserting masculine selves. Men
employed several discursive strategies to resolve this tension.

Justifying CAM use
Although work stress or health problems underlay most men’s participation in CAM, many
men justified their CAM use saying they were cajoled by a female partner to try it. For
instance, Gregory said, ‘The first time I took a class was because the woman that was living
with me was taking yoga and she said, “You ought to take yoga”’. Similarly, Edward
explained his entr�ee into CAM:

When I was in college I thought about taking tai chi and yoga … then over that like 6 to
9 months my ex [wife] kind of said, ‘You should do this, you would like this’. And so at
some point I took a [yoga] class.

By suggesting he was initially ambivalent, Edward positioned himself as a person who was
not too eager to try yoga but instead eventually acquiesced to his wife’s insistence that he
should try it (see Evans et al. 2007). Victor went to even greater lengths to explain his reluc-
tance to try yoga:
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96 Joslyn Brenton and Sinikka Elliott

My wife said, ‘You should come to yoga class with me’. And I was like, ‘Eh’. I never was
one for group classes. I always liked physical activity and more solo stuff than group things.
Team sports like softball [and] volleyball are one thing. But doing – just exercising and not
competing never was a group thing for me. But I said, ‘OK, I’ll try it’. [This] was gym
yoga. It wasn’t meditation-type yoga. It was like a power yoga class. I was moving all the
time and building heat and trying to get flexibility and stuff.

Like Victor, other men’s narratives of entr�ee into CAM suggest a process of justification – a
particular kind of accounting in which ‘one accepts responsibility for the act in question, but
denies the pejorative quality associated with it’ (Scott and Lyman 1990: 220). Victor negoti-
ated the pejorative nature of yoga as feminine and introspective by downplaying the meditative
aspect and instead emphasising the masculine-coded location (gym), and physical nature of the
class. Victor’s narrative is in keeping with the expectation that real men engage in competitive
and sometimes aggressive group activities such as football (Messner 1990) or are stoically
independent in their pursuits.

Men also justified their use of feminine-coded CAM practices by presenting themselves as
responsible and informed consumers of health care. At the same time, they suggested that
women are primarily concerned with superficial health issues, such as bodily appearance. For
example, Kenneth, who professed a long term ‘interest in health care’ said he was drawn to
CAM when he picked up Prevention magazine in the grocery store and read an article about
using antioxidants to ward off macular degeneration:

Kenneth [Prevention’s] one of the first [magazines] that’s kind of ahead of the curve. It’s
mostly for women, but they have men’s parts in it too and there’s some things
that go for both sexes.

Interviewer What makes it mostly for women?
Kenneth Well I mean that just seems to be its focus. When you look on the cover it’s

always a woman. It’s always about various diets and things. A lot of them
[feature] women – so you have to – but Andrew Weil always writes for it too …
he’s a Harvard-trained physician.

Despite perceiving Prevention as ‘mostly for women,’ Kenneth positioned it as acceptable
because men of science like Andrew Weil1 write for the magazine, thus nullifying the associa-
tion with feminine health behaviour and establishing himself as a masculine and well-educated
consumer of these products. Kenneth’s desire to be seen as a responsible health consumer –
one who is ‘ahead of the curve’ – reflects the construction of a responsible healthy male citi-
zen (see Crenshaw 2007) as well as a trend in medical consumerism among the middle-class
(Cockerham et al. 1986, McQuaide 2005)

Downplaying emotions
Men also generally distanced themselves from the emotional components of CAM. Liam, a
devoted student of tai chi, explained that he does not use CAM for emotional issues: ‘I guess
I feel like I’m pretty even-keeled. When I feel like I need some emotional healing I go for a
long walk in the woods somewhere’. While Liam did not deny that he sometimes needs emo-
tional healing, his statement nonetheless reveals a stoically independent, masculine-coded
approach to dealing with emotions. Some men connected emotions to the body and saw emo-
tional benefits in CAM but did so in ways that suggested this connection is straightforward
and commonsensical, as illustrated by Edward’s response to the question: ‘So, does yoga do
something for your emotional state or being?’:

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Undoing gender with complementary and alternative medicine? 97

Well yeah. I think – well there’s the obvious … being better connected with the body affects
where I’m at, where you’re at emotionally, because if you’re overweight and sick and what-
ever, well it’s gonna affect how you feel emotionally. That seems to me kind of self-evident.

Edward’s language suggests a demystification of the role of emotions. Like Edward, other
men downplayed the role of emotions in CAM, even as they said CAM provided emotional
benefits. When asked what role alternative therapies play in staying healthy, Harry replied:

Medium [role]. I mean I’m not into – my body is not my temple and I don’t live to be fit.
But to the extent that it [yoga, tai chi and meditation] can allow me to experience – I
haven’t thought about it this way, but … as long as it can allow me to experience joy, some
sense of serenity and contentment, if not happiness – I think happiness is overrated – but
um, but all the other kind of – I mean, sounding corny, feel good emotions.

Harry would like to experience joy through his CAM practices, yet his counterstatement, that
‘happiness is overrated,’ and his pejorative description of ‘corny, feel good emotions’ suggests
an effort to differentiate his own use of CAM from the stereotypical CAM user.

Other men were more equivocal in discussing the role emotions play in health and healing.
Paul described the limits of expressing emotions through expressive writing therapy – a prac-
tice he used to work through years of debilitating depression:

So it was a reality check for me, you know, writing about what was actually happening,
making the journal not a place where you just dump all your emotions and let it be cathar-
tic … I mean I had been doing that for years. But as Pennebaker [a male expert on writing]
warns, if you find yourself writing about the same thing, with the same intensity, using the
same words, you’re in a rut and you need to move on, because you’re just re-traumatising
yourself.

Here Paul differentiated between emotions and reality by suggesting that emotions are not
‘what was actually happening’. Paul also constructed his emotions as potentially dangerous.
Later he described the importance of moving on to the next phase – writing your desires into
existence – thereby suggesting that at some point emotional experiences need to be discarded
and replaced with taking control. Similarly, in response to a question about what he hopes to
get out of tai chi, Patrick replied:

My objective has been to maintain an equanimity, sort of a balance in life … but more
importantly, it’s learning a mental fortitude … I’m able to speak to people from the heart;
live rationally rather than by impulse or irrationality … And I suppose I separate intuition
from impulse. Intuition has a greater wisdom behind it, an inner wisdom, or a wisdom from
outside, an external wisdom but nonetheless, it’s something that’s not whimsical or emo-
tional.

Cultivating the self reflects a core feature of the neoliberal project of self-discovery and rein-
vention. For Patrick, however, self-development is synonymous with masculine terms like
‘mental fortitude,’ which he juxtaposed with qualities commonly associated with femininity,
such as living by impulse and irrationality (Connell 1995). Other research finds that men
display masculinity in health contexts by rejecting therapies associated with emotional
hand-holding (Evans et al. 2007). By downplaying the role of emotions and emphasising

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98 Joslyn Brenton and Sinikka Elliott

rationality, men thus engaged in a process of self-discovery and reinvention that affirmed con-
ventional masculinity.

Emphasising science, logic, and scepticism
The use of complementary and alternative therapies may pose a threat to men’s masculinity
because these practices are deemed to be illogical (Sointu 2011) or, as Edward called aroma-
therapy, ‘loosey goosey’. Perhaps in an effort to fend off pervasive stereotypes that CAM is
nonsensical, men’s narratives involved a great deal of what we term ‘science and logic talk’.
For example, some men stressed the ‘mechanics’ of CAM and employed the language of
science to explain what these therapies do for them physically. Patrick said:

My first yoga class was a fantastic experience. It’s funny, I’d probably not enjoy that same
yoga class nearly as much anymore because I found a yoga now that has, I think, a better
approach to the biomechanics.

Similarly, Paul said:

I subscribe to the whole mind-body connection … I think breathing involving the diaphragm
really does help release some toxins in the body and it sends signals to the immune system
to work.

Referring to chemicals such as ‘toxins’ and processes such ‘biomechanics’ not only emphasises
the physical effects of CAM use, but reinforces the idea that men are logical, scientific, and
mostly concerned with ‘practical’ bodily issues (Boudioni et al. 2001, Connell 1995). Dustin
used the language of science to account for his belief in the tenets of homeopathy:

The AMA edged out the advocates of naturopathy/homeopathy – what has become now
known as alternative medicine. But the research was just as ardent and empirically derived
back then, in the 1800s – very solid research. It seems like it all makes sense to me.

Men also routinely emphasised their scepticism of CAM’s efficacy. Their narratives suggest a
tension between subscribing to a masculine paradigm of scientific inquiry and acknowledging
the potential efficacy of therapies often discredited by the advocates of biomedicine (Freedman
2011). Liam interpreted his positive experience with reiki, an alternative therapy premised on
the manipulation of bodily energy, in the following way:

It [the ankle injury] was better within a week or so after that [reiki session]. I can’t say –
I’ve got too much Western scientist in me. That’s not a statistically significant sample to
say anything. On the other hand, it felt better. So I really don’t care.

In discussing his friend’s successful treatment via acupuncture, Harry literally put himself in
the role of a scientist:

[My] friend had allergies … nothing worked … [She] went to the acupuncturist and would
say, ‘I’m going to the witch doctor’. And it fixed her allergies. Now again, sometimes I
think we look at those things and we go ‘Okay, a scientist would say, oh, it’s just [a] pla-
cebo effect’.

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Undoing gender with complementary and alternative medicine? 99

Whereas men’s narratives suggest preemptive accounts to explain away the effects of a ther-
apy, most women readily accepted the interpretations of CAM practitioners and at times
appeared to be looking for effects of healing.

Women’s narratives of CAM use

Women’s narratives of CAM use closely reflect the neoliberal project of self-reinvention and
exploration and also underscore the role of gender in this project. For a start, many women
sought CAM and its healing properties to deal with problems women in the USA dispropor-
tionately bear, including low self-esteem, abusive and controlling heterosexual relationships,
and eating disorders and body image concerns (Bordo 2003, Tjaden and Thoennes 2000). Our
data suggest that CAM offers women an empowering rhetoric of individualism and agency via
the self-as-project, but that this individualistic approach often reinforces traditional expecta-
tions around femininity.

Discovering the gendered self
The women’s narratives suggest that many not only embraced CAM from the beginning but
that CAM use is tied to a gendered project of self-discovery and improvement. For example,
Nancy framed her use of guided mediation as a search for her ‘inner goddess’ and Erika said
that yoga was a remedy for feeling like a ‘bad woman’ because it helped her get in touch with
her body. Other women described using CAM to rediscover the self outside intimate relation-
ships with men. In fact, both men and women described using CAM in the context of break-
ups or divorce. Gregory started taking classes when he and his ex-wife started talking about
separating. For him, ‘taking yoga classes helped tremendously, just to kind of get out of my
head’. However, whereas men often described using CAM to distract themselves from the
stress of work, break-ups and divorce, women used CAM to explore the meaning of relation-
ships gone bad and to discover the ‘true’ self. For instance, Margo said she took a yoga class:

[R]ight after I was single again, after many years [in a relationship] … it was the time in my
life when I needed something different … it just sort of helped me get in touch.

Margo’s desire to ‘get in touch’ suggests that CAM use can help a person discover an osten-
sibly authentic self. Some women described losing sight of their selves while in relationships
with men. Leaving the relationship offered women an opportunity to reconnect with the self.
Yet these women still referenced the importance of being in a relationship. For example, Shree
took up yoga because:

I had just gotten out of a relationship and I wanted to do something for myself … This
relationship had ended and I realised that this relationship was very similar to the first
relationship I ever had. And I was just kind of like, ‘Why am I repeating myself?’ and
‘Why did I choose this person?’ and ‘Will I ever meet anyone?’

As Connell (1987) notes, the dominant form of femininity in Western culture is organised
around performing femininity to and for men. Shree’s focus on meeting someone, a theme
repeated throughout her interview, suggests that meeting a man was, and is, central to her pur-
pose in life. In turn, her project of self-discovery was centred on understanding and improving
herself to attract a better male partner. Shree and other women talked at length about their

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100 Joslyn Brenton and Sinikka Elliott

struggles with low self-esteem and dating men who were not positive influences in their lives.
These women said they used CAM post-relationship to not only discover the self but also to
remedy the flawed self they identified as the cause of their suffering.

Cultivating ‘good’ emotions
The role of emotions was another prominent theme in women’s narratives. Women frequently
attributed their ability to achieve ‘positive’ and ‘thankful’ emotions to their use of therapies
such as yoga, meditation and craniosacral therapy. For some women, emotions were literally
embodied. For example, Cameron said that during one acupuncture session her ‘muscle
grabbed every needle and was twitching. Like my whole right side was angry at me or some-
thing. I mean it’s bad’. As Sointu and Woodhead (2008: 265) note, holistic therapies are typi-
cally premised on the idea that ‘the body provides privileged access to the inner life of the
emotions and the spirit’. The narratives of women in our study suggest they share this
assumption. However, they also reveal women’s explicit use of CAM to transform bad feel-
ings – embodied or otherwise – to good feelings. As Cameron implied, angry feelings are not
appropriate for a woman to embody. Similarly, Layla described the process of rediscovering
an authentic and ‘happy’ self:

[Yoga and meditation] are things that have gotten me back to the person I was before … I
feel so restored now … I feel back in touch … when I was really happy, really free … I think
that when people are going through hard times they identify with a lot of negative things in
the world, the bad. You know, it’s like self-medicating though bad things, or whatever. So
instead of being on a bad path, it’s like being on a good path.

For Layla the experience of happy and carefree emotions signified her authentic self – a youn-
ger self that she sought to ‘get back to’. She explicitly identified happy emotions as ‘good’
emotions and ‘bad’ emotions as negative ones – and her experiences of the former signified
that she had reconnected with her true self. Like Layla, women CAM users consistently asso-
ciated positive emotions with successful self-transformation. Some described using CAM to
get rid of negative feelings. Nancy said her experiences with guided meditation, which
involved tapping into spiritual realms that correspond with directional points ‘would pretty
much knock all this negativity away’. Similarly, Miriama described using CAM to temper neg-
ative feelings:

If I go for a few days without practicing yoga, it’s not good, I get real bitchy … all of the
negative emotions that you feel about yourself, they are [on the] back burner whenever I am
having a good practice. If I go a few days without practicing, those emotions start creeping
back into my life.

Some women described cultivating ‘good’ emotions in the context of their struggles with low
self-esteem. Robyn said ‘yoga helped me to move from an attitude of lack and unworthiness
to the opposite, to thanks and gratitude’.

For women in this study, then, emotional experiences were not only signifiers of finding an
authentic self – women framed the authentic self as one that embodies traditionally feminine
characteristics such as happiness, caring, and forgiveness. One woman even policed her emo-
tions during her interview. When asked if it was a turnoff when alternative therapists seemed
inconsistent in their advice, Shree responded:

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Undoing gender with complementary and alternative medicine? 101

Yeah, it is. I think people should be focused on – listen to me that sounds so judgmental –
[but] I kind of wondered if I was spending a lot of money for nothing.

Women have historically been encouraged to police their internal states, subjecting themselves
to a self-scrutiny that benefits the emotional needs of others (Hochschild 2003).

Finding control: being empowered
Cultivating positive emotions was linked to another process women spoke of frequently: find-
ing control. A centrepiece of neoliberal discourse is the idea that individuals have the ability
to, and thus should, exercise control over their lives. Yet this expectation conveniently ignores
the way in which structural arrangements shape people’s lives. Many women’s narratives
reflected the tension found at the intersection of lived experience and cultural ideals. Nine of
the 14 women recounted their experiences with abusive male partners and/or eating disorders,
and body image concerns. The women’s narratives revealed how they used CAM to negotiate
tensions resulting from feeling like a victim yet wanting to feel in control. For example, sev-
eral women with histories of disordered eating described using CAM as a tool to gain control
of their eating and their weight. Having battled with anorexia for over 8 years, Cameron noted
wistfully that she hoped acupuncture treatments would help her deal with a ‘looming sort of
self-hatred eating disorder thing’. Cameron was unsure how acupuncture would help resolve
this issue, yet others were more explicit about this connection. Terri said:

Terri The biggest thing I got out of yoga was that I stopped caring so much about
being skinny.

Interviewer What was it about yoga that made you stop worrying about being skinny?
Terri I’ll never be somebody who can eat whatever they want … but with yoga, I’m

less of an emotional eater. The more I am practising the more likely I am to
stop eating because I’m no longer hungry rather than stop eating because my
pants are about to bust.

While it could be argued that CAM offers women spaces to cultivate greater self-acceptance,
Terri’s narrative suggests a relentless, and all too common, desire to be like ‘somebody who
can eat whatever they want’ and still be thin. Her narrative reveals a theme of the self-as-
continuous-project – a quest rooted in entrenched gender discourses that posit women as
imperfect beings who must strive to change their physical appearance (Bordo 1993). Terri did
not reject hegemonic expectations of thinness, but instead identified her own emotional state
as the problem and the self-control she gains from yoga as the solution.

Similarly, six of the 14 women in our study reported being formerly, and in one case cur-
rently, involved in abusive relationships and described using CAM to fix their own emotional
states that resulted from this abuse. This number is higher than national statistics, which report
that one in four women experiences domestic violence in her lifetime (Tjaden and Thoennes
2000). Gloria described a history of relationships with controlling men, including an ex-husband
who she said would not let her attend college. Perhaps because she could not control the
abusive men in her life, at the time of our interview Gloria was working at controlling herself:

I am working on … my state of consciousness and energetically working on having those
thoughts of forgiveness and love and that’s creating a greater healing. And I am also learn-
ing about non-interference. Because karmically you can – you are not supposed to interfere.
You can share and help and give or whatever, but not interfere in other people’s states of
consciousness.

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102 Joslyn Brenton and Sinikka Elliott

Using karma, a discursive resource found in many types of energy therapies (Kaptchuck and
Eisenberg 1998), Gloria’s words reveal an embrace of behaviour traditionally linked to femi-
ninity, such as helping and giving, but also suggest the healing process involves not interfering
– or perhaps silencing herself. Mickey spoke of using yoga to intentionally reinterpret and
transform her emotions in the context of a verbally abusive relationship with her current hus-
band:

He is horrible to live with, but it’s still my choice to be miserable or not … I think that’s what
yoga taught me, is that there’s nothing that we ever need to be miserable about … You need
a little time sometimes to get to grateful. But yeah, I don’t live with any regret for anything
because it just takes you to the next place.

Linking her ideas about suffering and choice to yogic philosophy, Mickey identified herself as
both the source of suffering and the solution to the problem. Such philosophies may be
resources that help middle-class women construct a sense of choice, and thus control, in
response to issues that have social, not individual, origins. Some women described attracting
their own problems – presumably through misdirected energy, as Robyn notes:

I used to get down – be down on myself, you know. And my marriage was certainly a
product of that mentality. Because [my husband] was psychologically abusive to me. And I
would take everything that he said, and really believe it, and take it to heart. He’d call me
names and things. So, you know, it’s just what I was attracting in my life and the lessons
that I had to learn.

Robyn’s statement implies that a certain law of energy was at work in her abusive relationship.
Her narrative reveals the tension that exists between wanting to make sense of one’s problems
and to feel agentic. Energy healing therapies may help women resolve this tension. Women
using energy therapies said they were learning that individuals unknowingly create their own
suffering, and how to control their energy to produce more positive life outcomes.

Conclusion

In this study we examine how gendered identities are produced in unconventional health set-
tings that offer the potential to disrupt the gender order (Sointu 2011, Sointu and Woodhead
2008). Our analysis is guided by West and Zimmerman’s (1987) concept of doing gender and
thus contributes to current debates about the usefulness of this theory in interpreting contempo-
rary gender relations. Some scholars urge us to consider how people may be undoing gender
(Deutsch 2007, Risman 2009), while others maintain that as long as people are accounting for
their behaviour as men and women, gender is not being undone (West and Zimmerman 2009).
In the context of this debate we can ask of our own findings: do the narratives of the men and
women in our study who use CAM indicate a detraditionalisation (Sointu 2011) that is, the
undoing of traditional masculinity and femininity, respectively?

Our data led us to turn a critical eye toward interpretations of CAM use as a sign of female
empowerment or of men’s liberation from hegemonic gender norms. Men’s CAM use may
appear to challenge conventional masculinity through its emphasis on self-care, yet our find-
ings suggest a more nuanced process of gender performance at work. We argue that the men’s
narratives reveal a process of doing, and at times redoing, rather than undoing, gender. In their

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Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd

Undoing gender with complementary and alternative medicine? 103

narratives of CAM use, men were doing gender by emphasising a discourse of science and
rationality, while simultaneously rejecting aspects of CAM associated with femininity, such as
emotional experiences. Men were also redoing gender, which occurs when men and women
adapt their behaviour in response to changes in the gender accountability structures (West and
Zimmerman 2009). Our analyses demonstrate that the men used classed knowledge of health
to present themselves as informed health consumers while simultaneously positioning their
CAM practices in masculine-coded ways. In the context of a neoliberal emphasis on self-rein-
vention, self-control and consumption, the way middle-class men are held accountable for
doing gender through their health practices has shifted. Taking charge of health and gaining
control over the body may be a new way to assert a middle-class masculine self. As others
note (e.g., Pyke 1996), middle-class men can use socially valued resources, such as education,
to perform conventional masculinity.

Similarly, the women’s narratives reveal they are doing and redoing, but not undoing, gen-
der. In line with doing gender, women described an ongoing process of monitoring and scruti-
nising the self for physical and emotional imperfections and cultivating feminine-coded
emotions such as love, acceptance and forgiveness. Many women interpreted the legitimation,
comfort and meaning they received through their CAM practices as feelings of control and
strength, implying a challenge to the gender order. We argue, however, that women’s interpre-
tations of strength and empowerment through CAM use reflect a process of redoing gender.
The accountability structures around femininity have shifted somewhat. The rhetoric of female
empowerment through transformation and consumption resounds within the context of neolib-
eral societies that emphasise personal responsibility and self-reinvention. Yet women’s descrip-
tions of their reasons for using CAM – abuse, low self-esteem, and so on – mirror wider
trends in women’s experiences of living in patriarchal systems. Although some have suggested
that CAM’s emphasis on putting the self first offers ‘subversive potential’ (Sointu and Wood-
head 2008: 267), we find that through their CAM use, middle-class women identified their
own selves, negative emotions and misdirected energy as the source of their problems, not per-
sistent gender inequalities. Part of CAM’s persuasive appeal (Kaptchuck and Eisenberg 1998)
to middle-class women thus lies in its treasure trove of discursive resources that help resolve
the tension between neoliberal discourses of self-reinvention and personal responsibility and
structural inequalities.

In sum, within the context of a neoliberal emphasis on self-reinvention and responsibility,
CAM appeals to middle-class men and women – the largest group of CAM users – who are
invested in creating and maintaining healthy bodies. Attempts to remedy chronic health issues
or to boost strength and flexibility were common reasons that both men and women cited for
their CAM use. However, our data reveal that women were also using CAM to make sense of
gendered life experiences in ways that support a distinctly feminine identity and that men’s
interpretations of their CAM practices were markedly gendered in ways that supported rather
than undermined their claims to normative masculine selves. Our sample is limited by its race
and class homogeneity, thus future research should explore the meanings of CAM for
working-class men and women who use it as well as men and women across racial and ethnic
categories. Only one participant in this study identified as gay and, given the linkages between
gender and sexuality, another important future direction would be to examine how gay men
and lesbians make sense of CAM. It is also important to explore why some men and women
do not embrace CAM. Despite these limitations, our findings lend credence to critics of CAM
who argue that holistic medicines ‘provide individualist solutions to problems of health by
focusing on changing the individual rather than on altering the social structure that promotes
an unhealthful environment’ (McKee 1988: 775). At the intersection of gender and class, and
in the context of the neoliberal call for informed, empowered health consumers, we find that
© 2013 The Authors
Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd

104 Joslyn Brenton and Sinikka Elliott

men and women used CAM in ways that reflected gendered experiences and reproduced
gendered selves, ultimately contributing to gender inequality.

Address for correspondence: Joslyn Brenton, North Carolina State University, Sociology &
Anthropology, 10 Current Drive Campus Box 1807, Raleigh, NC 27695, USA
e-mail: jjbrento@ncsu.edu

Acknowledgements

The first author would like to thank Michael Schwalbe for his valuable guidance throughout this project.
Both authors thank Corinne Reczek, Sarah Rusche and Emily Cabaniss for their comments on earlier ver-
sions of this article, as well as the anonymous reviewers for their helpful guidance.

Note

1 Andrew Weil is a physician, author, self-proclaimed health advisor and popular advocate of integra-
tive medicine. His website includes information about supplements and herbs, balanced living, and
his ‘optimal health plan’ Weil (n.d.).

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