Readings — March 6, 2018, 1:29 pm

Women’s Troubles

By Abby Norman, from Ask Me About My Uterus, which was published last month by Nation Books. Norman is an editor at Futurism, a science and technology website.

The novelist Hilary Mantel began experiencing pelvic pain, nausea, and fatigue, like I did, when she was a teenager; she had a hysterectomy when she was twenty-seven. In her memoir Giving Up the Ghost, she describes being repeatedly misdiagnosed with what she recalls as “stress, caused by overambition,” for which she was given tranquilizers. “Little Miss Neverwell,” one doctor called her. “The more I said that I had a physical illness, the more they said I had a mental illness,” she writes. “The more I questioned the nature, the reality of the mental illness, the more I was found to be in denial, deluded.” One psychiatrist suggested that if she wanted to feel better, she should stop writing.

Mantel had endometriosis. Like many sufferers, she recognized the disease in a medical textbook and was diagnosed only after she told her physicians about it. Endometriosis, she notes, had a reputation for plaguing high-achieving women. People called it “‘the career woman’s disease’: the implication being, there now, you callous bitch, see what you get if you put off breeding and put your own ambitions first?”

This dismissive and victim-blaming attitude has a long history. In a study published in 1941, the American physician Joe Vincent Meigs argued that the condition was the result of delayed maternity. Women had the same physiology as apes, he wrote, and “it must be wrong to put off childbearing until fourteen to twenty years of menstrual life have passed.” Meigs also suggested that endometriosis was more common among the upper class. Wealthy women seemed to have “a difference in attitude” toward motherhood; if they wanted to be cured of endometriosis, the implication went, they should have more babies. His theories provided the foundation for decades of research that erroneously considered the disease to befall mainly well-educated white women and to affect fertility above all else.

Endometriosis is no longer understood to be the result of a woman’s choice to delay childbirth, but it is still widely believed to cause infertility. The link between endometriosis and infertility, however, is correlative, not necessarily causative. About a third of women with the condition are infertile, but it is not known that one leads to the other. Endometriosis is widespread, affecting between 2 and 10 percent of women of reproductive age. It is characterized by the growth of uterine tissue outside the uterus, which causes bleeding, inflammation, and scarring. Diagnosis is by no means straightforward; some lesions are clearly visible in the body, but others are detectable only with a tissue biopsy. Most women begin having symptoms a few years after their first period. Chronic pelvic pain is a typical complaint, but other symptoms are inconsistent. Many are difficult to articulate, or embarrassing. It’s not easy to speak freely about pain during penetrative sex, say, or about diarrhea.

Endometriosis is sometimes called an invisible illness, because a person may show no obvious sign that she is sick. Sufferers don’t lose their hair; their skin doesn’t turn gray. They are not wheelchair-bound or walking with a cane. They may well get up every day, wash their hair, put on makeup, get dressed, and go to work. But they are in great discomfort, far more than even those closest to them are likely to know.

When I first got sick, a persistent ache took up residence between my midriff, hip bones, and lower back. Sudden, breathtaking nausea would overcome me after just a few bites of food. At night, I would lie half-awake on the bathroom floor, trying to hold my breath because the movement of my diaphragm and lungs intensified the nausea. I was constantly exhausted. I became unusually prone to spilling things, knocking things over, running into walls. I lost nearly fifty pounds. During my periods, I bled profusely.

The prevailing theory of the disease, developed by the gynecologist John Sampson in the Twenties, when endometriosis was first recognized as a medical condition, is the theory of retrograde menstruation: menstrual effluent “backwashes” from the uterus through the fallopian tubes and out into the pelvic cavity, where it then implants itself as endometrial tissue.

This theory, though formed nearly a century ago, has never been adequately proved. And although recent research has found evidence of endometriosis in embryos, suggesting that it is genetic, we still know little about the disease’s etiology. Why do some women get endometriosis and others do not? Why do some women suffer for a relatively short period of time? Why do some women with few lesions experience debilitating symptoms and others with many lesions feel fine? We don’t know the answers to these questions. Most medical textbooks seem to consider the condition uninteresting, or not of sufficient weight to demand attention. Even books devoted entirely to reproductive endocrinology or gynecologic surgery contain only brief passages on endometriosis. If you enter “endometriosis” into PubMed, the search returns 25,000 results. Diabetes, which affects a comparable portion of the global population, returns 600,000.

Doctors and surgeons who have not extensively treated or operated on women with endometriosis often discuss the disease as though it isn’t serious. They might offer patients birth control or a course of the injectable hormone Lupron, or advise a patient to get pregnant—because they believe, incorrectly, that pregnancy is curative, and because they think endometriosis always leads to infertility. Some, not knowing what else to do, will inform a patient that a complete hysterectomy is her only option—but the surgery comes with numerous side effects, and endometriosis can in fact recur; removal of the uterus does not definitely cure a disease that exists outside the uterus. Many doctors who see patients with endometriosis say nothing at all, I suspect, simply because they aren’t familiar enough with the condition to identify it. On average, seven and a half years will elapse from the time a woman experiences first symptoms until she receives a diagnosis.

Even doctors who have experience treating the disease still view it primarily as a problem of fertility, not of debilitating pain. A 2003 study of how the condition is represented in the media found that anecdotes follow a similar pattern: women getting diagnosed are devastated because they believe they have become, or may become, infertile; the doctors counseling them encourage them to get pregnant as soon as possible.

In my own case, it seems clear that my intention to remain childless influenced how I was treated. During my first operation, my doctor discovered a blood-filled endometrioma, or cyst, that was at risk of rupturing. She chose not to remove the cyst because it was attached to one of my fallopian tubes and she was afraid surgery would cause damage. My doctor emphasized to me that any procedure involving my reproductive organs could threaten my fertility. I didn’t want to have children, so damage to my fallopian tube didn’t concern me. The costs that did concern me—the pain, the nausea, the loss of activities I loved (eating, dance, sex)—didn’t seem to concern my doctor. Why didn’t my plight hold as much weight as that of a woman who wanted to have children?

Those suffering from endometriosis struggle to explain in definite terms what it feels like. The pain is just similar enough to pain arising from other sources—such as severe cramps or irritable bowel syndrome—to be confused with them. Sometimes the sensation is all-consuming, at other times peripheral. It took only a few years for my own discomfort to become a part of me. I began to notice not the flare-ups but rather their rare absence. Even now, it’s been so many years that I’ve lived in some agony that I hardly remember what it feels like to be without it.

Most people are familiar with the pain scale, which asks patients to rate their pain numerically: 0 for no pain, 10 for the worst pain you can imagine. But the application of the scale is not as simple as it would seem. Presumably, patients rate their sensations by comparing them with sensations they’ve experienced in the past. (“It’s not as bad as late-stage labor,” a woman might say.) And since pain is subjective and people tolerate it to varying degrees, the scale can be arbitrary—especially when you take into consideration the biases of the administering doctor. Indeed, women and girls are frequently perceived as anxious instead of in pain. A 1990 study found that after operations, women are more likely to be given sedatives, whereas men are more likely to be given pain medication. When women do receive pain medication, they get a lower dose (even controlling for differences in weight). The same goes for children. One study showed that after operations, boys were more likely than girls to be given codeine; the girls were given acetaminophen. (Women are affected by bias when it swings the opposite way, too. Recent studies have found that doctors who perceive women as less capable of coping with pain are more likely to prescribe them opioids.)

Women are taught to keep their pain private—when they don’t, they are ignored or disbelieved. Nineteenth-century doctors knew little about the workings of the nervous system and didn’t find it reasonable for a woman to proclaim that she felt her uterus. The harder she tried to explain it, the more unhinged they thought she was. Doctors today often refer to the diseases that exclusively befall women—ovarian cancer, endometriosis—as “silent” and “unseen.” This is unsurprising; those who are doing the describing are frequently men. Women might use different language. When you talk to the women who have had endometriosis, you will find that it isn’t that the disease is silent but that no one is listening.

Single Page

More from Abby Norman:

Get access to 168 years of
Harper’s for only $45.99

United States Canada



October 2018


The Printed Word in Peril·

= Subscribers only.
Sign in here.
Subscribe here.

In February, at an event at the 92nd Street Y’s Unterberg Poetry Center in New York, while sharing the stage with my fellow British writer Martin Amis and discussing the impact of screen-based reading and bidirectional digital media on the Republic of Letters, I threw this query out to an audience that I estimate was about three hundred strong: “Have any of you been reading anything by Norman Mailer in the past year?” After a while, one hand went up, then another tentatively semi-elevated. Frankly I was surprised it was that many. Of course, there are good reasons why Mailer in particular should suffer posthumous obscurity with such alacrity: his brand of male essentialist braggadocio is arguably extraneous in the age of Trump, Weinstein, and fourth-wave feminism. Moreover, Mailer’s brilliance, such as it was, seemed, even at the time he wrote, to be sparks struck by a steely intellect against the tortuous rocks of a particular age, even though he labored tirelessly to the very end, principally as the booster of his own reputation.

It’s also true that, as J. G. Ballard sagely remarked, for a writer, death is always a career move, and for most of us the move is a demotion, as we’re simultaneously lowered into the grave and our works into the dustbin. But having noted all of the above, it remains the case that Mailer’s death coincided with another far greater extinction: that of the literary milieu in which he’d come to prominence and been sustained for decades. It’s a milieu that I hesitate to identify entirely with what’s understood by the ringing phrase “the Republic of Letters,” even though the overlap between the two was once great indeed; and I cannot be alone in wondering what will remain of the latter once the former, which not long ago seemed so very solid, has melted into air.

What I do feel isolated in—if not entirely alone in—is my determination, as a novelist, essayist, and journalist, not to rage against the dying of literature’s light, although it’s surprising how little of this there is, but merely to examine the great technological discontinuity of our era, as we pivot from the wave to the particle, the fractal to the fungible, and the mechanical to the computable. I first began consciously responding, as a literary practitioner, to the manifold impacts of ­BDDM in the early 2000s—although, being the age I am, I have been feeling its effects throughout my working life—and I first started to write and speak publicly about it around a decade ago. Initially I had the impression I was being heard out, if reluctantly, but as the years have passed, my attempts to limn the shape of this epochal transformation have been met increasingly with outrage, and even abuse, in particular from my fellow writers.

As for my attempts to express the impact of the screen on the page, on the actual pages of literary novels, I now understand that these were altogether irrelevant to the requirement of the age that everything be easier, faster, and slicker in order to compel the attention of screen viewers. It strikes me that we’re now suffering collectively from a “tyranny of the virtual,” since we find ourselves unable to look away from the screens that mediate not just print but, increasingly, reality itself.

Photograph (detail) by Ellen Cantor from her Prior Pleasures series © The artist. Courtesy dnj Gallery, Santa Monica, California
Among Britain’s Anti-Semites·

= Subscribers only.
Sign in here.
Subscribe here.

This is the story of how the institutions of British Jewry went to war with Jeremy Corbyn, the leader of the Labour Party. Corbyn is another feather in the wind of populism and a fragmentation of the old consensus and politesse. He was elected to the leadership by the party membership in 2015, and no one was more surprised than he. Between 1997 and 2010, Corbyn voted against his own party 428 times. He existed as an ideal, a rebuke to the Blairite leadership, and the only wise man on a ship of fools. His schtick is that of a weary, kindly, socialist Father Christmas, dragged from his vegetable patch to create a utopia almost against his will. But in 2015 the ideal became, reluctantly, flesh. Satirists mock him as Jesus Christ, and this is apt. But only just. He courts sainthood, and if you are very cynical you might say that, like Christ, he shows Jews what they should be. He once sat on the floor of a crowded train, though he was offered a first-class seat, possibly as a private act of penance to those who had, at one time or another, had no seat on a train.

When Corbyn became leader of the Labour Party, the British media, who are used to punching socialists, crawled over his record and found much to alarm the tiny Jewish community of 260,000. Corbyn called Hez­bollah “friends” and said Hamas, also his “friends,” were devoted “to long-term peace and social justice.” (He later said he regretted using that language.) He invited the Islamist leader Raed Salah, who has accused Jews of killing Christian children to drink their blood, to Parliament, and opposed his extradition. Corbyn is also a patron of the Palestine Solidarity Campaign and a former chair of Stop the War, at whose rallies they chant, “From the river to the sea / Palestine will be free.” (There is no rhyme for what will happen to the Jewish population in this paradise.) He was an early supporter of the Boycott, Divestment, and Sanctions (BDS) movement and its global campaign to delegitimize Israel and, through the right of return for Palestinians, end its existence as a Jewish state. (His office now maintains that he does not support BDS. The official Labour Party position is for a two-state solution.) In the most recent general election, only 13 percent of British Jews intended to vote Labour.

Corbyn freed something. The scandals bloomed, swiftly. In 2016 Naz Shah, Labour MP for Bradford West, was suspended from the party for sharing a Facebook post that suggested Israel be relocated to the United States. She apologized publicly, was reinstated, and is now a shadow women and equalities minister. Ken Livingstone, the former mayor of London and a political supporter of Corbyn, appeared on the radio to defend Shah and said, “When Hitler won his election in 1932, his policy then was that Jews should be moved to Israel. He was supporting Zionism before he went mad and ended up killing six million Jews.” For this comment, Livingstone was suspended from the party.

A protest against anti-Semitism in the Labour Party in Parliament Square, London, March 26, 2018 (detail) © Yui Mok/PA Images/Getty Images
Nothing but Gifts·

= Subscribers only.
Sign in here.
Subscribe here.

If necessity is the stern but respectable mother of invention, then perhaps desperation is the derelict father of subterfuge. That was certainly the case when I moved to Seattle in 1979.

Though I’d lived there twice during the previous five years, I wasn’t prepared for the economic boom I found upon this latest arrival. Not only had rent increased sharply in all but the most destitute neighborhoods, landlords now routinely demanded first, last, and a hefty security deposit, which meant I was short by about fifty percent. Over the first week or so, I watched with mounting anxiety as food, gas, and lodging expenses reduced the meager half I did have to a severely deficient third. To make matters even more nerve-racking, I was relocating with my nine-year-old son, Ezra. More than my well-being was at stake.

A veteran of cold, solitary starts in strange cities, I knew our best hope wasn’t the classifieds, and certainly not an agency, but the serendipity of the streets—handmade for rent signs, crowded bulletin boards in laundromats and corner grocery stores, passersby on the sidewalk; I had to exploit every opportunity that might present itself, no matter how oblique or improbable. In Eastlake, at the edge of Lake Union between downtown Seattle and the University District, I spied a shabby but vacant one-story house on the corner of a block that was obviously undergoing transition—overgrown lots and foundation remnants where other houses once stood—and that had at least one permanent feature most right-minded people would find forbidding: an elevated section of Interstate 5 just across the street, attended by the incessant roar of cars and trucks. The house needed a new roof, a couple of coats of paint, and, judging by what Ezra and I could detect during a furtive inspection, major repair work inside, including replacing damaged plaster-and-lath walls with sheetrock. All of this, from my standpoint, meant that I might have found a solution to my dilemma.

The next step was locating the owner, a roundabout process that eventually required a trip to the tax assessor’s office. I called the person listed on the rolls and made an appointment. Then came the moment of truth, or, more precisely, untruth, when dire circumstance begot strategic deception. I’d never renovated so much as a closet, but that didn’t stop me from declaring confidently that I possessed both the skills and the willingness to restore the entire place to a presentable—and, therefore, rentable—state in exchange for being able to live there for free, with the length of stay to be determined as work progressed. To my immense relief, the pretense was well received. Indeed, the owner also seemed relieved, if a bit surprised, that he’d have seemingly trustworthy tenants; homeless people who camped beneath the freeway, he explained, had repeatedly broken into the house and used it for all manner of depravity. Telling myself that inspired charlatanry is superior to mundane trespassing—especially this instance of charlatanry, which would yield some actual good—I accepted the keys from my new landlord.

Photograph (detail) © Larry Towell/Magnum Photos
Checkpoint Nation·

= Subscribers only.
Sign in here.
Subscribe here.

Laura Sandoval threaded her way through idling taxis and men selling bottles of water toward the entrance of the Cordova International Bridge, which links Ciudad Juárez, Mexico, to El Paso, Texas. Earlier that day, a bright Saturday in December 2012, Sandoval had crossed over to Juárez to console a friend whose wife had recently died. She had brought him a few items he had requested—eye drops, the chimichangas from Allsup’s he liked—and now that her care package had been delivered, she was in a hurry to get back to the Texas side, where she’d left her car. She had a …
Checkpoint on I-35 near Encinal, Texas (detail) © Gabriella Demczuk

Acres of crossword puzzles Americans fill in each day:


In Burma, a newly discovered noseless monkey was assumed to be critically endangered because—despite its efforts to keep its head tucked between its legs on rainy days—it sneezes whenever rain falls into its nasal cavity and thereby alerts hunters to its presence.

Paul Manafort accepts a plea deal; Brett Kavanaugh accused of sexual assault; Jeff Bezos gets into the kindergarten racketon the clock

Subscribe to the Weekly Review newsletter. Don’t worry, we won’t sell your email address!


Happiness Is a Worn Gun


Illustration by Stan Fellows

Illustration by Stan Fellows

“Nowadays, most states let just about anybody who wants a concealed-handgun permit have one; in seventeen states, you don’t even have to be a resident. Nobody knows exactly how many Americans carry guns, because not all states release their numbers, and even if they did, not all permit holders carry all the time. But it’s safe to assume that as many as 6 million Americans are walking around with firearms under their clothes.”

Subscribe Today