Review: Susan Mattern's "The Slow Moon Climbs: The Science, History, and Meaning of Menopause"
What are old women good for, anyway? Derided and maligned as witches, greedy widows, ignorant “granny” healers, and overbearing mothers-in-law, women who outlive their reproductive phase have long been viewed with suspicion. But the very fact that women often do live many years after they are no longer able to have children, something that very few other animals do, is a puzzle that has spurred the creation of detailed scientific and social theory, and according to historian Susan Mattern, could be the key to understanding the unique history of our species. In her upcoming book, The Slow Moon Climbs: The Science, History, and Meaning of Menopause, due out in September 2019 from Princeton University Press, Mattern takes the widest possible view on this puzzle of human life histories, as she considers the evolutionary, social, and cultural aspects of menopause as part of a larger theory of its crucial role in human life. From the emergence of modern humans nearly half a million years ago to the cultural history of menopause in the 21st century, Mattern identifies the components of a unified theory of menopause that accounts for both our biology and our social and cultural lives.
The Slow Moon Climbs is divided into three parts: Evolution, History, and Culture. Mattern deals first with the evolution of menopause and theorizes the long post-reproductive lives of modern humans as an adaptation that balances the benefits of continued productivity and the experience of post-reproductive women for foraging societies in times of growth and decline. Because of the scope and scale of Mattern’s project and the inherent uncertainty of many of the evolutionary theories of prehistoric humans she discusses, she spends a good deal of time on caveats. But emerging from the melee is a cogent articulation of the evolutionary value of older, post-reproductive women to the foraging societies of early humans.
Freed from reproductive duties, post-menopausal women contributed to the residential band of foragers in many ways. They consumed less food than they produced, for example, and were able to pass that surplus on to their own families. Their experience as mothers made them excellent babysitters, freeing up reproductive age women to “stack” children while still ensuring the same level and length of intensive childcare that distinguishes modern humans from other apes. In this way, grandmothers helped populations grow in times of plenty. But in leaner times, their post-reproductive status reduced competition for resources with younger women who were still having children. Some researchers have even argued that older women’s experience with technology—making and using tools for food preparation, clothing production, and other tasks—made them important repositories for such knowledge and its advancement. Menopause, with its attendant post-reproductive lifespan, was a huge boon for early humans as they spread and adapted to new territories, and, in Mattern’s view, it is a critical component of the success of the species.
The second part intersects most fully with Mattern’s own expertise as a historian of agrarian societies and extends the evolutionary “Grandmother Hypothesis” into the complex, highly gendered social organization of horticultural and farming groups through the end of the early modern period. Many of the advantages of menopause continued into the agrarian period of human history. Mattern’s analysis ranges over almost every geographic area, from China to Mexico to the family farms of Russia. What Mattern calls “peasant economies” became much more patriarchal when humans began intensive cultivation in which land and the inheritance of property became central. In many traditional societies, women went to live with her husband’s family, so sons tended to inherit property, keeping it in the male line. As in paleolithic society, fertility played an important role in controlling mortality by balancing a population’s size against available resources. In agrarian life, Mattern notes the easiest time of family life was likely after menopause, when children were old enough to produce more than they consumed and no new children could consume the surplus that older family members could provide in their post-reproductive life. Agrarian families were often large, multigenerational groups, where resources were passed from older generations to the younger. Ultimately, Mattern must thread a tricky needle in discussing ideas of fertility control and population, exploring the ways that demographic changes in human history have occurred and their effects. Fertility control— distinct from social engineering programs such as eugenics—could become important in a future that faces the kinds of natural catastrophes that devastated populations and resources in the past.
The most interesting part of The Slow Moon Climbs concerns the cultural meanings of menopause. In the final section, Mattern explores the experience of menopause for women in different times, places, and societies to understand the cultural components of menopause. The first of these chapters, which examines the history of menopausal syndrome in Western medicine, outlines the medicalization of menopause in early modern Europe and its later refinement in the 19th and 20th centuries. Mattern then turns to the symptoms of menopausal syndrome itself, and the ontology of symptoms more generally, and she concludes that menopause behaves in important ways like a cultural syndrome.
In Chapter 9, Mattern traces the history of the idea of menopause as a syndrome, and shows how it was largely a construction of Western medicine. This chapter contains Mattern’s most interesting claims. She draws menopause into the history of other syndromes that have historically affected women, such as hysteria, greensickness, and neurasthenia. Particularly in the 18th century, as new theories of nervous disorders gained popularity, menopause came to be less understood in terms of classical medical theories of “plethora” (too much blood) and more in terms of “nervous” theories of agitated reproductive organs. Noting also that menopausal syndrome seemed to be more or less contained to white, upper- and middle-class women, with doctors noting that hardworking lower-class women seemed not to suffer from menopause, Mattern outlines an intriguing theory of the social and cultural functions of the syndrome in European life. In the 20th century, with the isolation of estrogen, menopausal syndrome came to be understood as an estrogen deficiency, which could be treated with hormone replacement therapy. But the evidence that the decline in estrogen at menopause is actually harmful is not as conclusive as one might think.
The last two chapters dig deeper into what we mean when we talk about menopausal syndrome, and Mattern offers examples of studies of nonwestern cultures in which researchers were unable to establish that women understood menopause as something harmful or that women even marked its passage in any meaningful way. Drawing on a long discussion from earlier in the book about the inconclusive results of studies of depression associated with menopause, Mattern offers the idea of a cultural syndrome in place of the highly medicalized, supposedly universal description of menopause that most of us are familiar with. A cultural syndrome, she is careful to articulate, is not made up or even isolated, and the symptoms people experience are not all in their heads. Rather, she writes, “...cultural syndromes can be described as a class of phenomena characterized by the kind of feedback loop that amplifies symptoms, combined with culture-specific beliefs about how the body works and what diseases exist.” She uses the example of anxiety, which is often described as a symptom of menopause. In cultures where women are told that menopause is a result of a deficiency in a vital bodily substance and is integral to their health and gender expression, sex lives, and mental state, would we not expect the onset of menopause to bring with it some anxieties?
Mattern’s purpose in The Slow Moon Climbs is expressly to help explain some of the features of menopause that have become naturalized in our cultural and medical discourses. By historicizing menopause the syndrome and showing how the long lives of post-menopausal women may have been a crucial factor in the success of our species, Mattern offers a counternarrative to the harridans and hags of our cultural consciousness. Perhaps my only regret in this formulation is that it has become necessary to argue with incredible depth the “value” of women who can no longer give birth.
In her unified theory of menopause, Mattern’s conclusions on the usefulness of old women runs counter to the long history of biological and medical discourse on the condition. The post-menopausal woman is not, as psychologist Helene Deutch wrote, a sad specter of femininity whose “service to the species” had ended, but a fulcrum for human adaptability and survival. Ours, Mattern affirms, is a world with grandmothers and, thus, filled with both their potential and that which they can cultivate in others.