Getting Real
Page 14
The severe body rash and fatigue she develops after the second injection doesn’t help her confidence but nevertheless, she soon engages in sex, without condoms or contraception (the boyfriend didn’t want the former and Emma was too embarrassed to ask her mother for help with getting a script for the pill).
The sex wasn’t what she had imagined, the boy dumps her, she puts on weight again and feels distressed. The rash over her whole body gets worse including blisters after the third Gardasil injection. She is exhausted most of the time. Her once excellent school results plummet which leads to fights at home.
She panics when her period hasn’t arrived for the second time (the first time she ignored it), breaks down and tells her parents. Her mother takes her to a clinic where she is informed that her daughter who is eight weeks pregnant qualifies for a ‘medical’ abortion as she appears by now to be severely depressed (one of the indications for the limited use of the abortion pill, RU486, in Australia). The same day, Emma is given three pills and is told to come back two days later for the second part of the abortion (the prostaglandin). She becomes violently ill with stomach cramps and nausea. She passes the foetus that, although tiny, is quite well formed. This really upsets her. When the bleeding hasn’t stopped after two weeks she needs a D&C to remove the remaining foetal tissue. She is so scared that she asks for a general anaesthetic that makes her very sick when she wakes up. She has trouble sleeping and spends hours crying in her room.
By this time she is on an SSRI antidepressant. At school she has become the butt of jokes and gossip (including in cyberspace). She responds with outbursts of temper alternating with feelings of loneliness and bottomless despair. She sees her future as bleak, not worth living for. And she still has the rash all over her body. She thinks all of this must be her own fault and believes she is a total failure. Her mother is making lots of medical appointments for her and she is seeing a psychiatrist.
I sincerely hope that there will never be an ‘Emma’ who has to experience all parts of this unfortunate scenario. But this chain of events depicts the very real damage that early sexualisation followed by medicalisation can do to girls. I might have added self-harm (cutting) and a suicide attempt to ‘Emma’s’ story. Or the development of a serious eating disorder. An antipsychotic medication might have been prescribed in addition to her antidepressants. And, as it happened in the real life story of a sixteen-year-old girl known to me who ended up deeply distressed after early sex, a pregnancy and an abortion, and was put on multiple drugs, ‘Emma’ might have developed seizures and be diagnosed with schizophrenia within three years from these events. The ‘sickness industry’ acquires young consumers and keeps them for life (see Moynihan and Cassels, 2005). Importantly, such stories are not discussed in public but remain agonisingly hidden in families’ private lives.
Girls as medical consumers
Some readers might argue that this scenario and my assumptions about medicalisation as a consequence of early sexualisation are exaggerated.2 How many fourteen-year-olds really do have sex? Many will just be talking about it, or pretending that they are doing it. This may be so, but it doesn’t invalidate my point.3 The medical industry gets a hold on young girls as new consumers whether or not they are already engaging in sex.
The so-called cervical cancer vaccines Gardasil and Cervarix are a case in point. They are experimental vaccines against two strains of the human papillomavirus (HPV) that are associated with many, but not all cases of cervical cancer (Tankard Reist and Klein, 2007; Klein and Tankard Reist, 2007; Klein, 2008d, 2009). There are over 100 strains of HPV and 80 per cent of people have the virus at some point in their lives.4 The good news is that in 90 per cent of those who acquire HPV a healthy immune system disappears the virus infection in one to two years and no abnormal cells, let alone cancer, will develop (Lippman et al., 2007). The HPV vaccines remain unproven; it will be many years, if ever, before scientists are able to show whether they do indeed prevent cervical cancer as most cancers take ten to twenty years or longer to develop (Sawaya and Smith McCune, 2007). Meanwhile the vaccine manufacturers are raking in millions.
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2 Others might argue that some medications are life-savers—true—and that I am ‘doctor bashing’—not true. Most of us need good medical care at some point in our lives and this may include medication. And there are many doctors who are wary of ‘Big Pharma’ and over-prescribing. My argument is that when an obligatory ‘outsourcing’ of body/mind problems starts already in childhood, a critical distance to commodification and (over)medicalisation might never be developed.
3 There are no reliable data on the onset of sexual activity in western countries. The 2005 Adolescent Health Cohort Study in the State of Victoria found that ‘One in four Year 10 students [aged 15] and one in two Year 12 students [aged 17] have had sexual intercourse’ (in ARCSHS, 2005 p. 12). Anecdotal data from Joan Sauers’ 2006 web questionnaire of 300 Australian teenagers suggests that by the age of fifteen, one in five boys and one in six girls has had sexual intercourse (Sauers, 2007). Rachel Skinner has found a median age of fourteen for first experience of intercourse in her study of 68 teenage girls aged fourteen to nineteen in Perth. Skinner reports that ‘teenage girls regret having sex earlier’ and that they cite ‘peer pressure, coercion from sexual partners and being drunk’ as common reasons for ‘premature and unwanted first experience of sexual intercourse’ (in Insciences, May 19, 2009).
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When girls as young as nine5 are told they need this vaccine so that when they have sex in the future they will not get cervical cancer, they learn that their bodies can only avert disease with the help of a magic bullet from a medical expert. This is especially so when the message is bundled up with the politics of fear: girls are urged to get a vaccine for a disease the great majority will never get.6 It is capitalism generating new markets by commodifying, privatising and separating out girls’ body parts and offering them medical solutions to keep them healthy (see Hawthorne, 2008). Thus girls internalise early that their health is something that needs to be outsourced (an early gene test for family breast cancer or diabetes?). They can’t stay healthy by themselves. And, importantly, they are reassured that by going to an expert, they are making a ‘choice’ for good health. It’s the new version of being in control in the 21st century: ‘I hand over my body to you, the expert, but I do so because I want to; it is my choice.7 And I am being responsible.’ Sadly, the seemingly good idea of personal responsibility can be turned on its head. If adverse effects occur they are often blamed on the individual: ‘she had an undiagnosed genetic precondition…it’s not the medication’s fault.’
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4 There are children already born with an HPV infection which gradually disappears (Castellsague et al., 2009). It is sexual intercourse that makes females especially vulnerable to sexual transmission from males. The many strains of the human papillomavirus and their behaviour is far from being fully understood.
5 In 2006, Merck & Co in the USA and Commonwealth Serum Laboratories (CSL) in Australia achieved FDA and TGA approval for Gardasil to be administered to girls as young as nine although fewer than 1,200 girls under sixteen were included in Merck’s studies (see Lippman et al., 2007).
6 In western countries the incidence of women dying from cervical cancer is steadily declining. According to a WHO/ICO report, in 2006, 249 women died in Australia and cervical cancer mortality ranks seventeen out of all 23 listed cancers (WHO/ICO, 2007, p. 8). While every death is a tragedy, pre-cancerous cells are detected through screening programs.
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The disappearance of critical voices
What such early medicalisation does is prevent girls from developing a sense of a healthy embodied self. Sexualisation has already made many of them dissatisfied with their ‘outside’ bodies; medicalisation now colonises their ‘inside’ bodies—perfect material for the varieties of medical specialists who will take ownership of women’s reproductive lives when they
become pregnant, are pressured to agree that their foetus needs to be tested for any ‘defects’ and then possibly scared into a difficult late-term abortion (Tankard Reist, 2006). Or, if a woman can’t get pregnant, ahead lie donor insemination and then in-vitro fertilisation (IVF) where she will be given dangerous hormone-like drugs to assist the procedures. She might also be faced with the ‘choice’ of her own eggs, her own womb—or those of other women: an egg ‘donor’ and a so-called surrogate mother.8
For women who have been instructed to treat their body parts like household items in need of repair since they were young girls, such decisions will seem quite normal.
Unlike in the late 1960s to the mid-1990s when women’s health issues were frequently and critically discussed in the mainstream media,9 these days the topic has all but disappeared. Or, if it is mentioned, it is to glowingly promote a new product as in the case of the ‘cervical cancer’ vaccines. In the case of contraception, this issue too has receded from public discussion: it is now a private matter to be discussed in the GP’s office or the Family Planning Clinic. ‘Mustn’t get pregnant’ is the only instruction. The general public assumes that a cafeteria of contraceptive ‘choices’ is on offer: all efficient, easy to use and without problems. The minipill? A patch slapped on to your thigh? A pill called ‘Lybrel’ to get rid of messy periods altogether?10 A rod implanted in your arm that ‘protects’ you for three years (Monteiro-Dantas, 2007; Klein, 2008b)?11 An IUD with or without hormones? Or the resurrected Depo Provera injection that lasts three months (and girls are not told that they’ll lose bone mass they won’t ever fully recover, see Klein, 2008a).12
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7 I have long been a critic of the concept of ‘choice.’ True choice should be between choosing an apple cake or a chocolate cake and not between two options that are both problematic and may vary only by degree. If there is truly no better alternative then what you make is a difficult ‘decision’—not a happy ‘choice.’
8 For a detailed discussion of the problems with reproductive technologies see Klein, 2008c.
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Adverse effects aren’t mentioned: there is meant to be a ‘quick fix’ for every issue at hand and dangers are rarely mentioned. And many girls know so little about their bodies that they can’t be bothered with details, including information about possible health problems that might arise after many years’ exposure to potent hormone-like drugs. When they are worried, for instance after unprotected sex or when a condom breaks, they will go to the pharmacy for the over-the-counter morning-after pill. Or be taken by their school, as was exposed in 2007 in Melbourne when girls as young as thirteen were taken by their teachers ‘to get the “morning-after” pill without parents being told’ (in Houlihan, 2007). Most likely, they won’t be told that multiple exposures to one type of morning-after pill that uses Levonorgestrel (the synthetic progesterone used in Implanon) may triple their risk for multiple sclerosis and lead to an increased risk of breast cancer (Bennett and Pope, 2008, p. 275).
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9 The international Women’s Health Movement burst on the scene with books such as Our Bodies Ourselves (Boston Women’s Health Collective, 1969); Men Who Control Women’s Health (Scully, 1980/1992); How to Stay out of the Gynecologist’s Office (LA Feminist Women’s Health Center, 1981). The idea was for women to become holistic experts on our own health and lives.
10 At the time of writing (June 2009), Lybrel is not available in Australia but can be obtained in New Zealand, the USA and Europe.
11 A particular harrowing use of Implanon came to light in 2008 in Australia when a 52-year-old health worker took a fourteen-year-old girl to the local health clinic to have Implanon inserted before he started sexually abusing her. As Melinda Tankard Reist commented: ‘This is not about freedom of sexual expression. It is about branding girls for sex’ (May 6, 2008).
12 Hormonal contraception for men is as far away as ever. Despite a number of trials, men simply won’t put up with side effects. Women continue to do so.
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Promoting ignorance is early indoctrination into ‘naturally’ putting up with nausea, bleeding, weight gain, headaches, disturbance of the metabolism of nutrients, higher risk of strokes, heart attacks and cancer—all ‘side effects’ of contraceptives—in order to be sexually available 24/7 and reduce the chance of an unintended pregnancy. The highly accessible book The Pill. Are You Sure It’s for You? (2008) by Jane Bennett and Alexandra Pope is countering this information gap in the available literature and should be widely read. Not only do the authors discuss pros and cons of the pill and other contraceptives in great detail without shying away from their serious adverse effects, they urge girls and women to get in touch with their own bodies and not continue to be the ‘canaries in the mine’ for the increasing chemical load added to their bodies. An informative chapter introduces fertility awareness methods and how they can become an empowering part of girls’ and women’s lives. They also make the insightful comment that ‘[B]ooks on relationships and sexuality generally don’t discuss contraception’ but that ‘[If] you make these choices haphazardly or unconsciously—by following the crowd or based on insufficient advice—then this can lead to resentment and distance in your sexual relationship rather than sexual intimacy’ (p. 269). And, I would add, to severely compromised health.
Another example of insufficient—or wrong—advice is the normalisation of chemical abortion. When RU 486/prostaglandin abortion is promoted, it is said to be ‘easy’ and ‘natural.’ Apparent ‘power’ is conferred to a girl or woman because it is she who swallows three pills of mifepristone (and two days later takes the prostaglandin). It is not only unfair but dangerous to suggest this, because once the drugs are in her body, she has no control over whether she might be one of those girls or women who experience terrible nausea, vomiting, cramping and bleeding for up to six weeks, or worse (Klein, Raymond and Dumble, 1991; Klein 2006; for a harrowing account of an RU 486 abortion, see Dworkin-McDaniel, 2007). Because abortion is now seen as no big deal—and in Australia independent counselling before making a decision to terminate a pregnancy is not thought to be important—many girls aren’t even given the opportunity to consider if maybe, just maybe, they should at least try to find out what resources might be available if they decided to have the baby (see Tankard Reist, 2000).
Chemical citizenship
No wonder many girls who have to cope with the multiple demands of living in the sexualised real and cyberworld and who experience early medicalisation feel disconnected from themselves and begin to act strangely. Sometimes support is being offered by family doctors and a girl might find a sensitive counsellor to talk through the multifaceted problems upsetting her. But all too often she soon finds herself diagnosed with ‘depression’ and put on antidepressants. Indeed, these drugs have become so ‘ordinary’ and are used by so many people that hardly anyone questions their use.13 But they are not without danger. The SSRI antidepressant Zoloft, in particular, has been linked to an increase in suicidal thinking and behaviour when administered to children and adolescents. Following the FDA, in 2004, the Australian Adverse Drug Reactions Advisory Committee (ADRAC) issued a warning about the off-label use of selective serotonin reuptake inhibitors (SSRIs) in children and adolescents under eighteen years. ADRAC states that they are not approved for the treatment of depression in these age groups and have been associated with increased numbers of suicide and self-harm attempts (www.tga.gov.au/adr/adrac_ssri.htm). In spite of these warnings, off-label prescription for children continues and, as in the case of a fourteen-year-old girl, can result in suicide attempts (see Davis, 2008a, p. 28).
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13 Julie-Anne Davis reports that in 2007 ‘More than twelve million SSRI antidepressant scripts were subsidised by the Pharmaceutical Benefits Scheme’ (November 1–2, 2008b, p. 9).
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While public awareness campaigns about mental health issues have done much over the last decade to remove the stigma from peop
le with serious mental disorders, they have, inadvertently perhaps, contributed to a far too high acceptance that feeling sad, in turmoil after suffering loss or experiencing sexual assault, and, in the case of girls suffering from sexualisation’s excesses and feeling anxious and depressed, amounts to ‘mental illness’ and must be medicated. Sadness, as Janet Stoppard and Linda M. McMullen suggest (2003) needs to be seen within a social context rather than turning the young into ‘chemical citizens’ at an early age.14 Adelaide child psychiatrist Jon Jureidini, a long-term critic of inappropriate prescribing of antidepressants, believes that depression in children, adolescents and young adults can be safely treated ‘[T]hrough a combination of “watchful waiting” and physical and emotional rehabilitation…without reliance on medication or psychotherapy’ (2009, p. 275).
It is very worrisome to foreshadow the health of women at midlife after they may have faced, as young women, various chemical assaults from the HPV vaccine, the contraceptive pill, the morning-after pill, perhaps the abortion pill RU 486, maybe antidepressants, fertility stimulating hormone-like drugs, and later hormone replacement therapy (HRT). Abigail Bray’s term ‘chemical citizen’ couldn’t be more fitting: add some of the recreational drugs that many adolescents ply themselves with regularly and you don’t need to be scaremongering to worry how the immune system will cope—or not—with such overload. Indeed it is a ‘chemical economy of control’ (Bray, 2009, p. 98) that is taking over our lives.