Wednesday, June 6, 2007
Women in Lu Xun's "Selected Stories" and Amy Tan's "The Joy Luck Club"
Female characters play a significant part in both Amy Tan's The Joy Luck Club and the short stories of Lu Xun. William Lyell notes that women make up the second largest group of characters that appear in Lu Xun's short stories and suggests that Lu Xun had a fondness for women, embodying them with kindness and humanity, traits his male characters often lack[1]. Amy Tan's book The Joy Luck Club is all about women and, in contrast to Lu Xun's stories, narrated by women. The authors also differ markedly in the style of characterisation they employ, which can be traced back to the restraints of the different genres they worked in, the different audiences their work appealed to and the different purposes they had for writing.
Nature of characterisation
Working in the genre of the short story, Lu Xun is usually makes no more than brief sketches of his female characters. These women in the third person, usually through the narrator or another male character, and they range from being the focus of the story to supporting characters hovering in the background, or mere literary function, serving as mouthpieces to communicate as realistically as possible those details which are somehow hidden from the narrator or other characters. The amount of detail that Lu Xun fits into his sketches also varies. Where women are the central characters in the story they are not necessarily also described explicitly. It is often left up to the reader to infer a sense of personality from the circumstances and events the character is entangled in. Where the women are not the central characters they are often left as outlines, perhaps just a name or a short description.
Although Amy Tan's characters, like Lu Xun's, are contained within a series of short stories, the stories that combine to form the novel The Joy Luck Club are interlinked and interdependent. Characterisation is almost the entire purpose of this novel. Society and place are just backdrop to the personal drama of the individual lives of four ex-patriot Chinese mothers and their Chinese-American daughters. With the exception of Suyuan Woo, each woman's story is told by herself, in the first person. The similarity of the general shape of their lives and the manner of storytelling means that the four older women and the four younger women tend to collapse into one older woman and one younger woman to the first-time reader. Amy Tan's characters are also reflective and introspective – they question their situation, identity and relationships with other characters, unlike the characters in Lu Xun's stories, whose inner thoughts the reader is not privy to at all.
Types of characters
In a broad sense, the women in Selected Stories are a passive, unreflective lot, victims of traditional society, swept along by events without questioning their lot. Tthe women of The Joy Luck Club are much more active, introspective and in charge of their destiny. Unlike Lu Xun's characters The Joy Luck Club women are a homogeneous group with respect to their social position and background. In Selected Stories the characters may be much less detailed, but they come from a far wider range of backgrounds than do Amy Tan's women. However their social position does not necessarily dictate the type of character Lu Xun creates for them.
Selected Stories
Although Lyell, in his analysis of Lu Xun's fictional work, lumps all women characters together in the one category, differentiating only between the men (whom he classifies as either intellectuals, service people or peasants)[2], there do appear to be several distinct types of women in Lu Xun's short stories. There are nosy neighbours, tragic women and unbroken women[3]. There are also women who are not really characterised at all, but appear as sort of conceptual placeholders – the conventions of realism demand that they exist, but not that they differentiate themselves from a stereotype. Some of the characters are predominantly literary devices whose sole purpose appears to be transmitting vital story details.
Hsiang Lin's Wife (“New Year's Sacrifice”), Fourth Shan's Wife (“Tomorrow”) and Ah Shun (“In the Wine-Shop”) are all examples of tragic women. Hsiang Lin's Wife and Fourth Shan's Wife are central characters in their respective stories. With the exception of Fourth Shan's Wife, whose son dies, each woman dies in during the course of the story – Ah Shun succumbs to tuberculosis, while Hsiang Lin's Wife dies “of poverty”[4]. All of these women are presented as virtuous, their selfless dedication to hard work benefiting others more than themselves. Neither Hsiang Lin's Wife nor Ah Shun are presented to the reader directly and often the circumstances they find themselves in are further detached from the reader by being told through another character in the story, whose speech is passed on to the reader through the narrator.
Yi-tsi Mei Feurwerker comments that the women in Lu Xun's short stories are doubly subordinate, being both women and poor[5]. Furthermore, they are subordinate as female characters. In the case of Hsiang Lin's Wife, the important details of her life are broadcast to the reader and the other characters in the story by other female characters, such as Old Mrs Wei, before Hsiang Lin's Wife has the chance to speak for herself. However the tragic women are not necessarily passive women. Hsiang Lin's Wife repeatedly runs back to the Lu family, the first time in an attempt to escape a bad marriage and second time in an attempt to escape pauperism. It is hinted at that Ah-shun finally succumbed to illness in part to escape a bad marriage. And Fourth Shan's Wife leads a menial but independent life, supporting herself and her son on her cotton spinning. But ultimately, while they may have a measure of initiative and independence, these women are not free from the traditional society and mean-spirited people that seem to conspire together to bring about their downfall[6].
But not all the central women characters in Selected Stories are tragic. Ai-ku (“The Divorce”), Mrs Sevenpounder (“Storm in a Teacup”) and Mrs Ssu-min (“Soap”) are examples of characters whose circumstances have not broken them, but at worst made them a little bitter and cynical. These women speak to the reader in their own words, there is no explicit narrator presenting them to us or other character summarising their condition. Their speech comes straight to us, in the case of Ai-ku and Mrs Sevenpounder, in all its crude glory as they berate their husbands and others who have wronged or annoyed them. Mrs Ssu-min is a somewhat more refined person than Ai-ku or Mrs Sevenpounder, being the wife of an intellectual. But her early indications of passive obsequiousness toward her husband are cast in a new light when, after inanely supporting his ranting, she suddenly turns on him to berate him for his nagging at the dinner table and failure to realise his own lecherous intentions in the purchase of the soap[7].
Nosy neighbours are never central characters, but they do come in two different guises, one more inquisitive and the other more informative. Mrs Yang (“My Old Home”), Old Mrs Wei (“New Year's Sacrifice”), Mrs Tsou (“The True Story of Ah Q”) and Ninth Aunt Wang (“Tomorrow”) are all examples of the inquisitive nosy neighbour, whose active participation in events as well as communication of relevant information is a vital part of the story. The dubious honour of nosiest neighbour goes to Mrs Yang of the beancurd shop across the road. While the Lu family is moving out of their home, she wanders over whenever she likes, steals anything that takes her fancy and both gossips about and shares gossip with the narrator and his mother. Old Mrs Wei and Mrs Tsou are sources of information for their scholar-family neighbours. Mrs Wei introduces Hsiang-Lin's Wife to the Lu family, while Mrs Tsou tells Mrs Chao about the fine clothing Ah Q has been peddling around town and which lucky villager got what desirable item at bargain prices.
Informative nosy neighbours have less personality than their counterparts, who often come across as scurrilous gossips. Indeed most of these characters are little more than plot devices to communicate information between characters as realistically as possible. They are often allowed to tell this information in their own words, which does allow a little of their personality to come through. These informative neighbours include the anonymous landlord's mother in “The Misanthrope”, who relates the story of her tenant Wei Lien-shu's last days to his friend the narrator, and Old Mrs Fa, owner of the firewood shop opposite Ah Shun's house, who tells the narrator's friend Wei-fu what happened to Ah Shun in the two years since he last saw her.
The Joy Luck Club
As mentioned earlier, two kinds of characters stand out in The Joy Luck Club – the older generation and the younger. Aside from the fine detail of their lives, the older women, like the younger women, could practically be the same character. All four older women grow up in rural China in relative affluence, suffer misfortune and later migrate to America after having spent some time living in one of the larger cities in China. Once in America they are nearly all reduced to poverty and work menial jobs. They are married and have children in America, including at least one daughter. All four younger women are born in America, speak both Chinese and English and are highly educated with more or less established careers. Each struggles with her cultural heritage and relationship with her mother. Of those who are married, each has relationship problems with their husbands.
The women of the older generation are portrayed as active, courageous, resourceful, insightful and independent. Suyuan Woo organises a mahjong club in war-torn Kwellin, making do with what little she and her friends have to create some joy in their lives. Lindo Jong uses superstition to escape an arranged marriage. Likewise, An-Mei Hsu's mother (although she is not a major character, being told through the story of An-Mei's childhood in China) uses superstition to manipulate her children's circumstances, committing suicide on such a day that her husband will be forced to honour her and favour her children. Of the four women, Ying-Ying St Clair is portrayed as the most passive, but even she goes on to forge her own life and career as a shopgirl before marrying an American and emigrating.
In comparison to the older women, their daughters are portrayed as passive and confused. Each sees their mother as manipulative, with the exception of Lena St Clair, who talks about how she and her father manipulated her mother, putting words into her mouth when she couldn't express herself. The daughters see their mothers as using superstition against them in their younger years, to scare them into proper behaviour. In their later lives they try to be modern and American, but it doesn't really work out for them. Except for Waverley Jong, real professional success eludes them all. Jing-Mei floats between university studies but never completes a course, ending up as a secretary and then a copywriter. Rose Hsu Jordan marries while at university; her husband goes on to be a dermatologist while she works from home as a freelance graphic artist. She leaves her husband to make all the decisions and have the better career. Lena St Clair also marries a man in a better professional position than herself. She tries to have a marriage of equals, splitting expenses and investments equally, or at least proportional to each other's income. But while Lena's relationship with her husband seems fair on the surface, she gradually realises how she has let him take advantage of her and stifled her professionally, refusing to promote her or make her a partner in the architectural firm they established together.
Relationship of characters to Lu Xun and Amy Tan's purpose
Lu Xun's stories generally try to communicate something about Chinese society rather the plight of any one person it is for this reason that the level of characterisation varies so dramatically. While the actions and natures of the individuals he creates are important, the real focus in on the sum of all the little decisions, thoughts and events that his characters are caught up in. In addition to this, the women he writes about are not unusual or extraordinary people. His readers would already be familiar with the kinds of characters he creates in Old Mrs Wei or Old Mrs Fa and ty leaving a lot of detail about these characters out, they are better matches with the real life women they knew, such the neighbourhood gossips and the poor women and maids they saw going about their business. Having the characters ring true to real life helps convey Lu Xun's message about the absurdity and inhumanity of the society he described and make it more relevant and immediate to the reader.
Amy Tan's characterisation is rich and detailed, but a crucial difference between the characters in The Joy Luck Club and Selected Stories is that the women all start out equal, occupying more or less the same social position as each other, their lives differing only in the details of their experiences. The characters in Selected Stories represent a broader cross-section of society; their personalities are shaped by their social circumstances and the resultant life experiences that go with it.
However Tan's purpose is not to highlight to the reader the passive cruelty perpetuated by traditional society but to introduce to a largely non-immigrant audience the experience of immigrant and first-generation Americans. The readership of The Joy Luck Club may not be familiar with Chinese culture at all, nor have met many people of Chinese descent or background. By exploring in detail the lives of a few women in the context of their family relationships, especially the relationship between mother and daughter, Amy Tan is trying to promote understanding and acceptance of immigrant and first generation Americans to an audience that is unfamiliar with them. It must be said, though, that The Joy Luck Club hardly corrects any misconceptions that a person unfamiliar with Chinese culture might have, but focuses on the women's reaction to hardship and adversity and their loving yet uneven mother-daughter relationships as indicators of a shared, universal human experience to which people of any background can relate.
Conclusion
While women are not usually the central characters in Lu Xun's Selected Stories, they are nevertheless important ones. Lu Xun depicts a range of characters from many different walks of life in his stories in order to show the reader something about the society he was writing about. Lu Xun assumes his audience is already familiar with his characters to some extent and consequently does not give away a lot of detail about their thoughts and feelings. In contrast, Amy Tan focuses on only two kind of characters, mothers and daughters, in order to show the reader their personal experiences of migration and multiculturalism and to create a sense of familiarity and empathy for these characters within an audience that is unfamiliar with them in real life.
Bibliography
Feuerwerker, Y M (1998) Ideology, Power, Text. Stanford University Press, Stanford.
Lu X, trans Yang H & Yang G (1972) Selected Stories of Lu Hsun. Foreign Language Press, Peking.
Lyell, W A (1976) Lu Hsün's Vision of Reality. University of California Press, Berkeley.
Tan, A (1989) The Joy Luck Club. William Heinemann, London.
[1] William A Lyell, Lu Hsün's Vision of Reality, p. 209.
[2] Ibid, p. 140.
[3] “These women have been bent somewhat by the weight of the burdens traditional society imposes on them, but they are far from broken.” William A Lyell, Lu Hsün's Vision of Reality, p. 219.
[4] Lu Xun (1972) Selected Stories, p. 129.
[5] Yi-tsi Mei Feuerwerker (1998) Ideology, Power, Text, p. 83.
[6] Ibid, p. 84.
[7] Wiliam A Lyell, Lu Hsün's Vision of Reality, p. 211
De-medicalising opiate addiction in the USA
The complementary processes of medicalisation and de-medicalisation can shed light on the history of opiate addiction in the USA from its acceptance as a proven therapy at the turn of the century to a proscribed substance by 1914. The changing demographic of the average addict, from inadvertent middle-class habitué to transient, antisocial hedonist made the care and treatment of opiate addicts less appealing to the medical profession, whilst making the social problem of opiate addiction the perfect cause for adversarial politics, fresh from the success against Chinese immigration. In this way opiate addiction came to be passed on from the medical sphere to the political.
Understanding reasons why opiate addiction was at first the domain of the medical profession may help us understand why it was then passed on. At first, the majority of addicts were from the respectable middle class, affluent enough to afford medical care and addicted inadvertently as a side effect of treatment for pain or other ills (Jonnes, 1995). Given the wide availability of such drugs as morphine, cocaine and heroin, and that those who were addicted were no doubt well able to afford them, drug addiction could be constructed as relatively harmless and addicts as non-threatening to society at large. Where doctors and pharmacists were also addicts, there was the reputation of scientific medicine and the public's faith in it to uphold. In addition, there was no doubt money in it for doctors with addict patients, who would of course be expected to supervise them. Thus, while there remained money and the professional reputation of medicine to uphold, opiate addiction would continue to be medicalised.
However, when the average addict was no longer a member of middle class, addicted accidentally as part of routine medical treatment, reasons for keeping opiate addiction in the medical domain were less convincing to the medical profession. The new addicts were pleasure-seekers and hardly likely to hold medicine responsible for their habit or to seek the help and advice of doctors. With no money and less prestige on offer for curing what many people thought of as a disease created by medicine to begin with (Jonnes, 1995), medicine had little reason to hold on to drug addiction as tightly, especially when political interest in this new social group was growing.
According to Jonnes (1995), Americans were introduced to recreational drug use in opium dens established by Chinese immigrants. Anti-Chinese sentiment was high in America and Australia, especially after the Boxer uprisings of 1900, and “a racist rhetoric of loathing and fear, with talk of “mongolization,” tainted blood, and disease, became part of political electioneering” (Spence, 1990; p.8). From the 1880s barriers to Chinese immigration were established in the United States, culminating in total exclusion of Chinese immigrants by the 1900s. Having successfully dealt with the problem of Chinese people, it would seem reasonable for politics to target opiate addiction as a legacy of Chinese vice which needed to be dealt with harshly, thereby making opiates and opiate use prime candidates for legislation and restriction. Doctors still retained the right to prescribe opiates, at least at first, but a sharp distinction was drawn between medical use of opiates and the illegal recreational use. Thus it was not so much the drug that was de-medicalised, but the addict.
In the case of opiate addiction around the turn of the twentieth century, the processes of medicalisation and de-medicalisation can help us understand why medicine's proprietary interest in opiate addicts waned to the extent that addiction was criminalised and opiates proscribed. The changing demographic of the average addict meant it became less necessary and much less profitable for doctors to protect the reputation of opiate users, who were instead recast by political institutions first as having fallen into vice and degenerate behaviour, and eventually (with the sole exception of medical addicts) as abnormal and fundamentally different to respectable people (Jonnes, 1995).
References
Jonnes, J (1995) 'The rise of the modern addict', American Journal of Public Health. 85(8):1157-1162.
Spence, J (1990) 'Western perceptions of China from the late sixteenth century to the present', in Heritage of China: Contemporary Perspectives on Chinese Civilisation, ed. Paul S Ropp. University of California Press, Berkeley. pp. 1-14.
Differences in the British and United States penicillin efforts during WWII
This essay will examine the British effort at penicillin manufacturing during WWII with respect to the following claims; a) that British pharmaceutical companies did the best they could; b) that British pharmaceutical companies displayed less cooperation than American companies and, compared to the Americans, were not willing or prepared to adopt fermentation, and; c) that the roles of the respective governments and their agencies were the critical difference. Given that Britain was not just at war but under direct attack, and lacking any evidence to the contrary, we can reasonably assume that the first statement is correct and that those involved in producing penicillin did the best they could as dictated by their expertise and resources. The remaining two claims are more contentious. Instead of assigning credit or blame, it would be more enlightening to examine these claims in light of the different circumstances the penicillin effort was conducted under in the United States and United Kingdom.
As far as cooperation is concerned, the organizations involved in the cooperative efforts in the US and UK were quite dissimilar. Antitrust laws in the US made self-organisation of an industrial cooperative group such as the British Therapeutic Research Corporation (TRC) impossible, even if they were willing to cooperate in the first place. Consequently, the penicillin effort in the US was organised by government agencies, who hand-picked the participating companies (Neushul, 1993). This meant that it was not just the leading pharmaceutical companies that were involved, but other firms such as Pfizer, who had experience in biological production using the fermentation process (Pfizer Inc, 2006). Moreover, the American effort was structured exclusively around penicillin, which was not the case with the TRC, whose purpose was to coordinate and distribute research more generally, mostly based around replacing existing German products. Whether British pharmaceutical companies were better or worse at cooperating than American companies is immaterial, because the legal conditions extant in each country largely determined the form the cooperative effort took – a government-led hierarchy in America and a self-selected group of peers in Britain. In turn, the network structures would have had an effect on the speed of information transfer throughout the network. The willingness to cooperate itself was probably not as influential on the final outcome as the organisational form the respective cooperative efforts took.
Similarly, the willingness and preparedness of firms to adopt fermentation methods was probably not significantly different between the US and UK and did not constitute a major influence on the final production outcomes. Both sides originally pinned their hopes on synthesising penicillin rather than producing it biologically by any method (Neushul, 1993; Liebenau, 1987). It was American government research that applied existing knowledge of fermentation processes to the production of penicillin and the War Production Board (WPB) that advocated the fermentation process and arranged incentives for firms to commit to it (Neushul, 1993). No such equivalent of the American government’s agricultural research laboratories existed in the UK (Liebenau, 1987) and the non-hierarchical TRC lacked anyone with the equivalent authority of the WPB to advocate and arrange the introduction of the fermentation process. With respect to biological production methods, both the UK and US firms, with the exception of Pfizer, were equally inexperienced. The key differences between the British and American commercial adoption of fermentation technologies had little to do with either party’s willingness or preparedness.
As already mentioned, the American government’s role in the penicillin effort was to some degree necessitated by the antitrust laws. In addition to this, research from the Peoria lab meant that the government had knowledge and expertise to share with the firms they were relying on to mass-produce penicillin for them. The British government was in no such position, having neither legal reason to intervene nor expertise to offer. The role that was appropriate for the government to play in the penicillin effort was therefore different in America compared to Britain and this underlying reason is, in my view, much more important than any action either government took or didn’t take.
References
Liebenau, J (1987) ‘The British success with penicillin’, Social Studies of Science. 17:69-86.
Neushul, P (1993) ‘Science, government and the mass production of penicillin”, Journal of the History of Medicine and Allied Sciences. 48:371-395.
Pfizer Inc (2006) ‘Exploring our history: 1900-1950’ http://www.pfizer.com/pfizer/history/1900_1950.jsp (accessed 25 August 2006).
Amphetamine and culture
HPSC2665 short essay (week 6), S2 2006
New behaviours, attitudes and ideas don't just sweep through a population and become entrenched in popular culture overnight. Before any trend gains currency, the ground needs to be prepared somehow. For this reason, it is not particularly enlightening to view the amphetamine epidemic of the 1960s as a psychological maladjustment or other cultural disorder, but rather a phenomenon made possible by pre-existing aspects of culture. These include attitudes toward drugs and drug use, ideas about health, happiness and 'normal' and 'impaired' mental states. Ideas about the roles of business and government and the power of the state to dictate such things as the health and private behaviour of its citizens would also play a part in shaping any kind of 'drug epidemic', not just the 1960's amphetamine epidemic.
Anglophone culture has always been ambivalent on the subject of drugs and drug supply. The freedom to conduct commerce very nearly trumps the moral and ethical concerns that crystallise around the issue of drugs. It is this trade-off between profit and propriety that led to such memorable events as the Opium Wars between Britain and China. Despite being proscribed in China and its use as a pleasure-drug considered immoral back home, the British discovered that opium was the only thing the Chinese were willing to buy and the value of this trade was considered so important for the Empire that they were eventually willing to go to war to keep it open. Contrast this with the behaviour of the Smith, Kline and French company, who were perfectly well aware that their Benzedrine nasal inhaler (released in 1932) was being used for non-therapeutic reasons (Jackson, 1971). A cynic might attribute their eventual willingness to replace the amphetamine with a non-amphetamine nasal decongestant in 1949 as a decision to cut their losses, with governments threatening legislative restrictions on the inhaler and a mere three years exclusive profit left on their patent anyway. But until quotas on amphetamine production were enforced[1] the production and wholesale supply of amphetamine was not regulated, although its retail supply and medical use was. This laissez-faire attitude to amphetamine production therefore undermined the effective restriction of its use to medical purposes[2], an available supply of the drug being an essential precondition for any drug epidemic.
But the availability of the drug for illegal use was just one side of the coin. The theoretical primary use of amphetamine was therapeutic and its initial production was for this purpose. Once production is in place it became a matter of supply and demand, where there was no way of telling how much demand stemmed from the medical uses of the drug and how much from the recreational. The therapeutic value of amphetamine came from cultural assumptions about health, happiness and normal behaviours and feelings. As well as being shaped by the medical profession (especially psychiatry), other ideas and assumptions played a part. Happiness was equated with variety, action, productivity and excitement. An unexcited person was thought to be an unhappy person. Unhappiness, in turn, began to be viewed as symptomatic of a disease, namely depression. Once happiness becomes associated with normality, there is a social pressure to be happy to fit in and get ahead. Thus positive feelings become equated with normality and negative with abnormality. And once medicine comes up with a solution to this kind of abnormality, it could even be seen as socially irresponsible not to choose to be medicated. Part of the myth of progress is, after all, that nobody is left out or left behind. However, for those many who felt they were failed or cheated by society and progress, happiness was still available chemically through amphetamines. By prescribing massive amounts of amphetamine for unhappy patients, the medical establishment could thus be seen to be picking up the pieces for a culture that worships progress and shuns those who haven't managed to secure themselves a piece.
Existing aspects of culture, rather than a disorder of culture, can help explain how the amphetamine epidemic of the 1960s arose. On one hand, our culture's emphasis on capitalism, the manufacture of goods and the right to sell them to some extent conflicts with the responsibility of the government to protect its citizens' interests and protect them from harm. In the case of amphetamine production, this created a situation that meant while the personal non-medical consumption was proscribed, the drug was made available in response to wholesale demand, which in the 1960s encompassed both legal and illegal use. On the other hand, cultural ideas of progress meant that general happiness and welfare was supposed to be markedly better than ever before. This was the groundwork for later characterising unhappiness as not just abnormal or socially unacceptable, but a symptom of disease, namely depression. When amphetamine became available as an effective medication to alleviate unhappiness, it was only to be expected that it would be widely prescribed and, almost by definition, widely enjoyed.
References
Grinspoon, L and Hedblom, P (1972) 'Amphetamines Reconsidered', Saturday Review. 55:33-46 (8 July 1972).
Jackson, C O (1971) 'The amphetamine inhaler: a case study of medical abuse', Journal of the History of Medicine and Allied Sciences. 26 (2):187-196. [Online: http://jhmas.oxfordjournals.org]
[1] Grinspoon and Hedblom (1972) do not have a specific date for the introduction of amphetamine production quotas in the United States, but I guess it would have been sometime after 1971, at least 20 years after SKF stopped producing the amphetamine inhalers.
[2] cf. the case of Jay McMullen's drug procurement experiment, as reported in Grinspoon and Hedblom (1972, p.39?).
Tranquillizer consumption in 1970s America
Pellegrino's (1976) suggestion that over-prescription can be a function of the symbolic needs of doctors, but this alone cannot explain the massive consumption and prescription of minor tranquillizers in America during the 1970s, especially given the issue of non-compliance (Pellegrino, 1976; Speaker, 1997). The part prescription plays in helping doctors reinforce their power over disease and social authority, as well as providing tangible evidence of the fulfilment of the healing contract between doctor and patient was certainly as significant in the 1970s as it ever was in the history of medicine, but the doctors and patients of the 20th century were different people compared to their historical counterparts. In addition to this, Pellegrino's extremely narrow conception of the object of prescription (the chemical) limits the usefulness of this symbolic view of the prescription[1], but understanding how such a narrow view could come about in the context of Western medicine might also help us understand issues such as the high levels of minor tranquillizer consumption in the 1970s.
Speaker (1997) also mentions many valid theories on the origins of the 'medicated society' of the 1970s and suggests that while minor tranquillizer prescription and consumption was considerable, the perceived undesirability of a 'medicated society' could also have been due to political agendas and a backlash against society itself, rather than an inherent fault of the medical profession or pharmaceutical industry. Speaker, too, does not go into historical changes to the doctor-patient relationship and significance of the prescription to that relationship. However, a significant point that she does note is that implicit in the political critique of minor tranquillizer prescription and consumption was that, rather than less medical care, or alternatives to the mainstream system, everyone should have access to more and better health care (Speaker, 1997 p. 372-373). I believe it is largely this view that has lead up to such scandals as the minor tranquillizers and other issues of medical incompetence and social irresponsibility.
So how did the prescription become so widely perceived to be abused or perverted by profiteering pharmaceutical companies that the public viewed doctors as no better than pushers? I believe that it has to do with the complex activity of prescription itself. It is unlikely that the issue of patient non-compliance is a recent phenomenon or that doctors throughout history have not realised that by issuing prescriptions that are unlikely to be followed, they are putting their patient's health and their own reputations (and finances) at risk. The prescription has therefore never been purely scientific or medical, but has always to some extent taken into account the willingness and ability of the patient to follow a treatment regime.
Whereas once doctors were at liberty to prescribe things like exercise regimes, a change of diet or climate and other non-chemical therapies, the changing nature of their patients, combined with the success of the pharmaceutical industry in adding to the range of effective medications inevitably made drugs the preferred prescription. It is only in recent times that the ideal of affordable and equitable health care meant that nearly everyone in developed nations has access to a physician. Before then, those who could afford to engage the services of a physician were also the most likely to be able to undertake the regime they would prescribe, whether it be to relocate somewhere sunnier or reduce one's working hours, and so forth. The inevitable truth is that the fewer a patient's resources are, the less treatment options are open to them. Thus, throughout the 20th century, doctors were increasingly treating patients with less and less realistic therapeutic options. For the working poor and others of little affluence, their ability to change things that influenced their health, such as diet, working conditions or even the climate to which they were subject, was limited.
Moreover, once pharmaceuticals became recognised as effective treatments for certain diseases, the comparative ease with they could effect a cure compared to non-pharmaceutical prescriptions would have made them more desirable to patients regardless of their means. Doctors might have been more willing to prescribe drugs rather than other treatments because they felt that the drug regime was more likely to be followed. The question of what the patients themselves want is also an issue, medicine being a commercial as well as healing exercise. As Pellegrino (1976) points out, when visiting the doctor it is the patient's idea of illness and health that the doctor must deal with. Further barriers to non-pharmaceutical prescriptions include the new location of the consultation with the physician, from the home of the patient to the doctor's office, and the new nature of the consultation itself, removed from the context of disease, with emphasis on the communication of symptoms. Diagnosis made on this basis, rather than investigation of any reasons underlying the physical manifestation of disease, would lend itself to the treatment of symptoms rather than behavioural or occupational changes.
In conclusion: while the symbolic function of the prescription makes its overuse possible, in the case of the minor tranquillizers in the 1970s the changing nature of patients and their treatment options, as well as the location of the medical consultation and doctor's perception of what treatments were most likely to inspire compliance, were more significant factors in the massive consumption of prescription tranquillizers than any symbolic meanings of the drugs or prescriptions in socially recognising and legitimising illness.
References
Pellegrino, E (1976) 'Prescribing and drug ingestion symbols and substances', Drug Intelligence and Clinical Pharmacy. 10: 624-630.
Speaker, S (1997) 'From “happiness pills” to “national nightmare”: changing cultural assessment of minor tranquillizers in America 1955-1980', Journal of the History of Medicine and Allied Sciences. 52: 338-376.
[1] But this view makes more sense when we consider his article is written for a pharmaceutical audience.
The Pharmaceutical Industry and the Pill
To blame the pharmaceutical industry for actively dragging its heels over the development of a female contraceptive pill is to ignore the overriding influence of the wider social and political climate that existed before WWII. On one hand, obscenity laws made the distribution of information and scientific research on contraception illegal (Marks, 1999). On the other, with respect to fertility and heredity, personal choice and planned parenthood were not as powerful arguments as eliminating 'bad stock' from the breeding population of the nation. This meant that in the United States surgical sterilisation was the preferred contraceptive method, employed on an institutional scale by state government authority, practised on those individuals (male or female) who were judged to meet the criteria for compulsory sterilisation (Kevles, 1995). The remainder of the 'fit' population were encouraged to have large families, and no doubt the dearth of safe and reliable contraceptives was considered essential to this end. Under these circumstances, it becomes clear that the pharmaceutical industry in isolation was not to blame for the lack of effort to develop a contraceptive pill, but that such a prospect was viable neither morally, legally nor commercially.
'Population control' before WWII would have been guided by the principle that a high birth rate was indicative of superior national racial stock, tempered by the eugenic notion that the high birth rate of the poor and other undesirable classes of humanity was outstripping that of the desirable honest, hard-working middle classes, a situation that clearly had to be reversed if any kind of national progress was to continue. Only after WWII did an idea of the world's limited resources gain political currency and with it the perspective that a smaller population meant less poverty. But as with the previous sterilisation policies, the assumption by those in power was that those who they least desired to breed were not able to make that decision or stick to it by themselves and that intervention was necessary for results to materialise. Advocates of population control, like advocates of eugenics before them, identified the poor as those whose fertility needed to be managed and described them as the group with the least ability to manage their fertility[1]. The stereotypes of the unemployed welfare mother, relying on the state to feed her unwholesome brood, is alive and well today. Implicit even in the name of 'population control' is the idea of management over the group, not individuals controlling their own reproduction. Thus I imagine that it came as quite a shock to governments and the pharmaceutical industry alike to realise that women were capable and desirous of controlling their fertility.
The most successful application of the contraceptive pill was for effective family planning, generally in a middle-class environment. It is doubtful that even Margaret Sanger or Katharine McCormick envisaged this outcome when they imagined the pill, focussed as they were on the plight of poor women (Marks, 1999). To expect the pharmaceutical industry to have been aware of the future commercial potential of oral contraceptives before they were actually released to the public is to credit them with an impossible prescience. In addition to this, they were not in a position to advance the idea of the contraceptive pill, with the law against them and (before WWII) a strong program of surgical sterilisation already medicalising fertility. Fertility and contraception as lifestyle choices were, as evidenced by the experience of the 1930s (Watkins, 1998), more to do with the changing role of women in society rather than the availability of contraceptive methods.
References
Kevles, D (1995) In the Name of Eugenics. Harvard University Press, Cambridge.
Marks, L (1999) 'Human guinea pigs? The history of the early oral contraceptive clinical trials.' History and Technology. 15: 263-288.
Watkins, E S (1998) On the Pill. John Hopkins University Press, Baltimore.
[1] c.f. Elizabeth Watkins' (1998) description of the president of Planned Parenthood, Alan Guttmacher's views on contraception for the developed and developing worlds. He envisaged the contraceptive pill as a superior method for a discerning and motivated population, who were also in a position to expect and demand reliability. However for the vast majority of women, he believed that the IUD was more appropriate (not to mention more economical) despite the reduced reliability. “No contraceptive could be cheaper, and also, once the damn thing is in the patient cannot change her mind. In fact, we can hope she will forget it's there and perhaps in several months wonder why she has not conceived” (Guttmacher, quoted in Watkins, 1998, p.70).
Degeneration and the taxonomic image
The idea of degeneracy, degenerates and degeneration was pervasive in European scientific and political culture from the Enlightenment onward. Photography was instrumental in the efforts of many nineteenth century scientists and doctors who attempted to identify and classify the processes of degeneration and physical differences of the degenerate body. Using photography meant that the medical and statistical taxonomic project centred on the degenerate (and later, the eugenically 'unfit') could claim greater fidelity to the truth of degeneracy than similar taxonomic projects attempted by physiognomy or phrenology, which were largely begun before the technology of photography became widespread. The realism of photography allied degenerate classification and description to less controversial taxonomic projects like botany and zoology. The standardisation of photographic images was meant to reinforce the notion of the objective scientific image, distancing it from the fiction or distortion of art. To achieve the look of a scientific image, however, often meant departing from the reality that the images tried to capture. Ironically, this was just as much a problem for the established visual taxonomic cultures of botany and zoology as for those who tried to chart the many faces of human degeneracy.
(Human) degeneration in natural history
The scientific notion of degeneracy in relation to mankind was primarily used to describe the existence of the different races of mankind. Climate was considered to be the defining factor – Europeans, inhabiting the best climate of fewest extremes, were thus the best of the races of man, while other races were often assumed to have degenerated in proportion to the harshness of the climate they were subject to (Eze, 1997). For taxonomy, the question was whether mankind as a whole was one species, or whether the different races were species in themselves. For most naturalists, this would have been a question of Creation. The French naturalist Buffon, however, formulated a secular concept of species that was influential both in his time and after, especially for those who sought a non-religious basis for their science (Farber, 1972). His conception of a species as a group of organisms that could interbreed to produce offspring was a major part of his philosophy of natural history, although the practical reality of this definition changed considerably over the years as Buffon discovered more and more animals capable of successfully interbreeding. First applied to humanity in 1764, then in 1766 logically extended to include other animals, Buffon postulated that a genus was an extended 'natural family', made up different but related forms, descended from an often extant “premier souche that through time had degenerated into several recognisable varieties... For example, the horse is considered the premier souche of the horse family, and the ass and zebra as recognisable degenerations,” (Farber, 1972; p.276). And while foreign climates might degenerate an animal, returning it to the original climate of the premier souche and carefully controlled breeding would bring the animal back to the original form.
Degeneration as a social and political concept
The political concepts and rhetoric of degeneration and regeneration were present for both the First and Third French republics, but managed to acquire almost opposite meanings. While the ambition of the eighteenth century revolutionaries was political regeneration and the rectification of the political, physical and moral natures of the French people (de Baecque, 1997), nineteenth century republicans weren't entirely sure that revolutions weren't the cause of degeneration (Pick, 1989). Cause and effect is also reversed between the First and Third republics – while in 1789 moral and political regeneration is believed to effect physical regeneration,
The least moral revolution occasions a physical upheaval... I imagine... two peoples in the same climate, one free and the other slaves; the men of the free nation will be physically larger, more handsome, more courageous; morally they will be virtuous and better... Make man free if you desire his happiness, if you wish to see him handsome, strong, and virtuous. (Pétion, February 1789, quoted in de Baecque, 1997; p.139)
by the 1870s physical regeneration is instead trumpeted as the solution to society's ills, almost an injunction to 'make man handsome, strong and virtuous if you wish to see him free'. But Third or First Republic, it was still the civilisation of antiquity that the French sought to emulate (de Baecque, 1997).
Signifiers of degeneration
Until the French defeat by the Prussians of 1870-1871, France's population decline was seen by the political establishment as a positive sign, that living standards were bound to improve for all (Quinlan, 1998). Immediately after the war the slowing population growth was recast as a symptom of the morbidity of the French race. The term 'degeneration' became widespread in French psychiatry while the concept informed a plethora of research, both scientific and cultural, between the 1870s and 1890s (Pick, 1989). While some were skeptical about the visibility of degeneracy, especially considering the failure of phrenology to reliably identify the criminal (Pick, 1989), people such as Charcot, Galton and Lombroso were each, as part of their own projects, engaged in charting the visible differences of the degenerate in an attempt to come up with a useful taxonomy of degeneration that would enable scientists, doctors or policemen to sort the dregs of humanity from the pure. While journals such as La Culture Physique documented the French race's return to the premier souche of the ancient Greeks, publications like Iconographie photographique de la Salpêtrière and Nouvelle Iconographie de la Salpêtrière charted its degeneration. But while La Culture Physique could and did simply refer to the artistic tradition of ancient Greece for the context and legitimation of its images, those who produced images of degeneration needed to refer to science and taxonomy to convince their audiences of the truth of their depictions.
Taxonomies of degeneration
Some images of the body record attempts – always failed, always hopeless – not to alter the body, but to show it as it is: neither cut, nor injured, nor tortured, nor even passionate, but rather simply there. The body becomes a fact, an object, or even a specimen, that can express itself merely by being seen. (Elkins, 1999; p.155, emphasis in original)
That an essentialist taxonomy can discovered and applied to nature as a true and accurate reflection of nature's laws is a fantasy. The various assumptions about the world we live in are remarkable persistent; the same ideas crop up again and again, clothed in different theory. Where a Buffonian scholar might attribute the difference between races as the effect of climate, the Darwinian or Lamarckian might argue that non-whites represent a lower stage of human development – either way, the racial hierarchy itself remains unchanged. Allen (1983) suggests that very little study of taxonomy and natural history has been attempted in part due to the lack of theory that it has produced. I would argue that a large part of taxonomy has been the application of theory from other areas, for example philosophy, religion or even politics. Some theories, for example Darwin's theory of evolution, can even be assimilated wholesale into taxonomy without any change or addition to the practice taxonomy itself (Dean, 1979). The purpose and method of taxonomy persist, but new interpretations of meaning become possible.
Figures 1, 2, 3 and 4 could all be called examples of specimens. Specimens are not real, they are invented, but good specimens are and remain useful for practical purposes. The specimen is the embodiment or (more usually) visual existence of that which Mary Winsor calls “the method of exemplars” (2002). Whether used to lessen the burden of identification or description, this method was successfully used in both botany (with the Linnaean system) and zoology (for example, Cuvier's classification of fishes and other vertebrates) (Winsor, 2002). Knowing what a good exemplar looked like in order to construct (or select, or both) a good image was the task of the expert, the doctor or scientist, not the artist - “producing images of this type required more skills than merely observing and documenting nature,” (Nickelsen, 2005; p.7). By the same token, using exemplars also required skill and experience – exemplars were meant to be practical objects, not essential definitions, and the ability of the viewer to recognise immediately the natural group of things to which the exemplar related was a key assumption that their existence was based on. Constructing good exemplars also often meant departing from the reality of the specimen the taxonomist wished to depict in order to show it better as a model – in botany this could mean distortion of the relative sizes of parts of the plant, or showing two different structures of a plant present together in the picture that would never have been present simultaneously in reality, but which were essential for the purposes of taxonomic identification (Nickelsen, 2005). This unreality would not have been obvious to non-botanists, and certainly was not the subject of discussion or debate within botany.
The visual representation of specimens in accordance with the requirements of botanists and taxonomists led to a distinct style and set of conventions in botanical illustration (fig. 1), which then filtered down to other types of taxonomic images (fig. 2), especially those of the Iconographie photographique de la Salpêtrière and Nouvelle Iconographie de la Salpêtrière (fig. 3). I believe the use of this style was essential for Jean-Martin Charcot's project at the Salpêtrière, both to associate his productions with the productions of plant and animal taxonomy and to distance it from the discredited theories and images of physiognomy and phrenology. Lavatar's Essays on Physiognomy contained a huge jumble of styles and techniques, from line drawings to engravings, in the styles caricatures, medallions and busts. In contrast, the iconographies of the Salpêtrière relied almost exclusively on photographic images. The blank walls of the hospital or its photographic studio do not anchor the subject to its surroundings, but for reference a measure or other comparative object (in fig. 3, the subjects brother) are placed within the frame. But the inclusions of these points of reference do not imply statistical exactitude – Charcot's exemplars are for the use of practitioners, those who work with the sick and degenerate and will be able to instinctively draw knowledge from these images to apply to their own practice and experience. It is a memory aid – the real manifestation of the pathologies that are documented by the photographs lies in the clinical descriptions that accompany them, in the theory and text. In this way as well the use of exemplars parallels their use in botany*.
Statistical exactitude was the domain of Francis Galton, but his methods were somewhat different to Charcot's. Instead of an exemplar, Galton wished to discover an average (or ideally, the essence) of the classes of people he dealt with, such as consumptive, criminal or healthy individuals (fig. 4) (Sekula, 1992). His method of composite photography was arguably hit-and-miss with respect to the characterisations it produced, but he believed the theory behind it to be sound. Galton's method is interesting because it is through this photography that he expected to be able to discover the common traits of various degenerates, rather than having already consciously conceived an exemplar or set of common features. Instead of drawing the authority of these images from the styles and methodological precedents of other kinds of taxonomy, like botany or zoology, Galton invents a method entirely his own, but still scientifically valid through his application of mathematics and the technical use of photography, and taxonomically valid in that the categories he used were well established in the public consciousness, if not accepted scientific 'natural families'. By comparison, Charcot and Paul Richer attempted to legitimate their concept of hysteria and disease through the historical evidence, publishing two books, one describing The Demoniacs in Art (1887) and another on The Deformed and Diseased in Art (1889). By pointing out the cultural precedents of diseases in art, they could simultaneously show the accuracy of their diagnoses and reinforce the notion that their system of disease classification had a firm basis in history and reality (Guillain, 1959).
To conclude: the identification and classification of degenerate individuals was an important part of the intellectual basis of the discourse of degeneration that pervaded France and the rest of Europe during the 1800s. With the rise of eugenics it became important to be able to distinguish the 'fit' from the 'unfit'. Various people made projects out of describing and distinguishing degeneracy in scientific terms. An important part of their success came from using scientific style or techniques or both. The adoption of photography as the preferred method of creating images was probably both practical and strategic – it meant that the new typologies of the body that were being created were not so easily confused with the discredited disciplines of physiognomy and phrenology, and also gave these images an extra claim to reality and truth.
References
Allen, D E (1983) 'Life sciences: natural history', in Information Sources in the History of Science and Medicine, ed. P. Corsi and P. Weindling. Butterworth Scientific, London. pp.349-360.
de Baecque, A, trans. Mendell, C (1997) The Body Politic: Corporeal Metaphor in Revolutionary France, 1770-1800. Stanford University Press, Stanford.
Dean, J (1979) 'Controversy over classification: a case study from the history of botany', in Natural Order, ed. B. Barnes and S. Shapin. Sage Publications, London. pp.211-230.
Elkins, J (1999) Pictures of the Body. Stanford University Press, Stanford.
Eze, E C (ed.) (1997) Race and the Enlightenment. Blackwell Publishers, Cambridge MA.
Farber, P L (1972) 'Buffon and the concept of species'. Journal of the History of Biology. 5 (2):259-284.
Guillain, G, trans. Bailey, P (1959) J.-M. Charcot: His Life-His Work. Paul B. Hoeber, New York.
Nickelsen, K (2005) 'Draughtsmen, botanists and nature: constructing eighteenth-century botanical illustrations'. Studies in the History and Philosophy of Biological and Biomedical Sciences. 37:1-25.
Pick, D (1989) Faces of Degeneration. Cambridge University Press, Cambridge.
Quinlan, S (1998) 'The racial imagery of degeneration and depopulation: Georges Vacher de Lapouge and “Anthroposociology” in fin-de-siècle France'. History of European Ideas. 24 (6):393-413.
Sekula, A (1992) 'The body and the archive', in The Contest of Meaning: Critical Histories of Photography, ed. R. Bolton. The MIT Press. pp. 343-389.
Winsor, M P (2002) 'Non-essentialist methods in pre-Darwinian taxonomy'. Biology and Philosophy. 18:387-400.
Fig. 1. Pierre-Joseph Redouté, Rosa rubrifolia (1817-1824)
Source: http://www.rosarian.com/graphics/images/redoute/rosa_rubrifolia.jpg (accessed 10/8/06)
Fig. 2. 'Mammals', plate 53 from Cuvier's Animal Kingdom
Source: http://platemark.com/images/products/187.jpg (accessed 10/8/06)
Fig. 3. Gigantism.
Source: Nouvelle Iconographie de la Salpêtrière, reproduced in Brauer, F (2005) 'Dangerous doubles: degenerate and regenerate photography in the eugenic imagination', in Image and Imagination, ed. M. Langford. McGill-Queen's University Press, Montreal. pp. 91-103 (fig. 4.3, p.98)
Fig. 4. Criminal composites
Source: Pearson, The Life, Letters and Labours of Francis Galton, reproduced in Pick, D (1989) Faces of Degeneration. Cambridge University Press, Cambridge. (fig. 10, p. 164)
1764 Winckelman's “History of Art Among the Ancients” published
1764 Buffon's theory of the 'natural family' and 'premier souche' applied to humans
1766 – 1788 French revolutionary rhetoric of degeneration and regeneration (de Baecque, 1997)
1776 Blumenbach's “Natural Varieties of Mankind”
c. 1770 Lavatar's physiognomy fragments published
c. 1806 Germany's defeat by Napoleon – Jahn and the German physical regeneration effort
1800 – 1810 Gall's phrenology books published
c. 1853 Belgian Quetelet establishes academic statistical societies
1857 Morel's “Treatise” on degeneration published
1859 Darwin's “Origin of Species” published
1862 Charcot starts career at Salpetriere
c.1870 French defeat in Franco-Prussian War
c. 1876 French regeneration effort
1875 Iconographie photographique de la Salpêtrière starts publication
1883 Galton's “Inquiries into Human Faculty” with composite photography and term “eugenics” published
* cf. Winsor, 2002; p.393. “A competent botanist was expected to hold in his memory all the Linnaean genera, which did not mean that he had to remember all the species that had ever been described, but that he had to be so familiar with one exemplary species for each genus, that upon seeing an unfamiliar plant, he would recognize which genus it probably belonged to.” Likewise, a doctor is expected to remember all the kinds of diseases, but not necessarily the clinical descriptions of every illness.