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Yentl Syndrome: A Deadly Data Bias Against Women

Illustration by Homestead

Caroline Criado Perez | An excerpt adapted from Invisible Women: Data Bias in a World Designed for Men | Harry N. Abrams | 22 minutes (5,929 words)

In the 1983 film Yentl, Barbra Streisand plays a young Jewish woman in Poland who pretends to be a man in order to receive an education. The film’s premise has made its way into medical lore as “Yentl syndrome,” which describes the phenomenon whereby women are misdiagnosed and poorly treated unless their symptoms or diseases conform to that of men. Sometimes, Yentl syndrome can prove fatal.

If I were to ask you to picture someone in the throes of a heart attack, you most likely would think of a man in his late middle age, possibly overweight, clutching at his heart in agony. That’s certainly what a Google image search offers up. You’re unlikely to think of a woman: heart disease is a male thing. But this stereotype is misleading. A recent analysis of data from 22 million people from North America, Europe, Asia and Australasia found that women from lower socio-economic backgrounds are 25% more likely to suffer a heart attack than men in the same income bracket.

Since 1989, cardiovascular disease has been the leading cause of death in US women and, following a heart attack, women are more likely to die than men. This disparity in deaths has been the case since 1984, and young women appear to be particularly at risk: in 2016 the British Medical Journal reported that young women were almost twice as likely as men to die in hospital. This may be in part because doctors aren’t spotting at-risk women: in 2016, the American Heart Association also raised concerns about a number of risk-prediction models “commonly used” in patients with acute coronary syndrome, because they were developed in patient populations that were at least two-thirds male. The performance of these risk-prediction models in women “is not well established.”

Common preventative methods may also not work as well in women. Acetylsalicylic acid (aspirin) has been found to be effective in preventing a first heart attack in men, but a 2005 paper found that it had a “nonsignificant” effect in women aged between forty-five and sixty-five. Prior to this study, the authors noted, there had been “few similar data in women.” A more recent study from 2011 found that not only was aspirin ineffective for women, it was potentially harmful “in the majority of patients.” Similarly, a 2015 study found that taking a low dose of aspirin every other day “is ineffective or harmful in the majority of women in primary prevention” of cancer or heart disease. Read more…

This Month In Books: ‘Look at the World, and Not at the Mirror.’

Plate 3, French Fashions, Il Corriere delle Dame, 1831. (DEA / Biblioteca Ambrosiana / Getty)

Dear Reader,

This months books newsletter is about seeing the big picture. It’s about that moment when you glance around a corner to figure out what you’re missing, and how sometimes you don’t like what you find.

Try to see, Leonel had said. It was what he was always asking me to do,” activist-poet Carolyn Forché writes in her memoir, What You Have Heard Is True. “Try to see. Look at the world, he’d say, and not at the mirror.” Instead of looking at a mirror, Forché became one. As Melissa Batchelor Warnke points out in her review, Forché’s memoir is barely about Forché herself: it’s a record of what she saw and heard in El Salvador — the atrocities, the brewing war, and the resistance; it’s about her mysterious mentor and guide, Leonel; and, most importantly, it’s a facsimile of the conditions, the mood, the tense aura of censorship under which she saw and heard these things. Forché bears witness not just to the facts but to the feeling of living under dictatorship.

“When you are in a very controlling religion like this, one of the ways that they keep people inside is by painting the world outside as a very scary place,” Amber Scorah tells Jacqueline Alnes in an interview about her memoir Leaving the Witness. For Scorah, leaving the Jehovah’s Witnesses was simply a matter of not being able to pretend she believed anymore. When she looked in the mirror, she saw someone she didn’t recognize: “When you’re indoctrinated, your true self is secondary to the persona that you have to adopt to exist in the world in which you live.” Living as that second person became unbearable. She could not unsee herself.


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In Eve Ewing’s book of poetry, 1919, she attempts to see clearly events that happened very close to her in space, but far away in time: Chicago’s Red Summer “riots,” when whites terrorized blacks across the city. In an interview with Adam Morgan, she says, “I think of the people in this book as our neighbors, right? They happen to be our neighbors across the span of a century, but they’re our neighbors. They’re our fellow Chicagoans.” Ewing relates that she was consistently surprised by the fact that she did not already know the things that she was learning. “It shows how compressed history really is.”

Darcey Steinke was similarly motivated to write her new memoir, Flash Count Diary, by the idea that there was a fuller story that she had not been told. In an interview with Jane Ratcliffe, Steinke says that, once her menopause symptoms hit and she tried to educate herself about the process, she found that most menopause memoirs “end with this come-to-Jesus moment of, ‘Then I accepted hormones.’ I’m not against it, but when they accept hormones, they say all their menopausal symptoms go away, so then the journey through menopause kind of stops. … I wanted to hear what it’s like for other women.” Steinke had to write a book of her own just to find out what the natural process is like.

While writing a review of two recent books about, respectively, Jewish history in Canada and the history of antisemitic conspiracy theories, Jordan Michael Smith had a revelation about his past. In his youth, when his family lived in the exurbs of Toronto, he wanted to — and did — become friends with classmates who bullied him with antisemitic slurs. “One of the awful things about oppression is that sometimes you can’t bring yourself to hate your oppressors. You want them to like you too badly.” He had forgotten all about it — “It was strategic forgetfulness, acting like I remembered less than I did. It was more convenient that way, for them and me.” — and had likewise forgotten that he himself had also once bullied a fellow student with a racial slur, a horrifying revelation. “A few years later, the kid we bullied and I became friends, too. I wonder if he forgave me, or just strategically forgot about what I’d done.”

It’s always a good idea to remember the things you’d rather forget, to see the things you’d rather not see. As Ewing puts it, “These kinds of violent histories are all around us… We have to take the time to stop and seek them out…”

Dana Snitzky
Books Editor
@danasnitzky

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We Still Don’t Know How to Navigate the Cultural Legacy of Eugenics

Illustration by Tom Peake

Audrey Farley | Longreads | June 2019 | 13 minutes (3,381 words)

 

On May 28, Justice Clarence Thomas issued an eyebrow-raising opinion. It concurred with the Supreme Court’s decision to uphold an Indiana law that requires abortion providers to follow a certain protocol to dispose of fetal remains and prohibits abortions on the sole basis of a fetus’s sex, race, or disability. It wasn’t the justice’s position that caught attention, but rather his method. In speaking to the law’s second provision on selective abortions, Thomas launched into a history of eugenics, the debunked science of racial improvement that gained popularity in the early decades of the 20th century.

Arguing that abortion is “an act rife with the potential for eugenic manipulation,” the justice offered a lengthy discussion of the origins of the birth-control movement in the United States. In this discussion, written for the benefit of other courts considering abortion laws, Thomas explains how Planned Parenthood grew in tandem with state-sterilization campaigns, providing the foundation for the legalized abortion movement. (As historians corrected, legal abortion preceded birth control, as it was not regulated until the 19th century.) The justice cites the disturbing rhetoric of Planned Parenthood’s founder, Margaret Sanger, who wrote in The Pivot of Civilization that birth control was a means of reducing the “ever increasing, unceasingly spawning class of human beings who never should have been born at all.” While conceding that Sanger did not support abortion, Thomas nonetheless argues that “Sanger’s arguments about the eugenic value of birth control in securing ‘the elimination of the unfit’ apply with even greater force to abortion, making it significantly more effective as a tool of eugenics.”

Thomas does not offer concrete evidence that American women actually abort fetuses solely because of sex, race, or disability. Nor does he explore the possible reasons for abortions related to these criteria, such as financial hardship or the lack of societal support for individuals with chronic conditions. His grievance with abortion boils down to this point: the practice is ill-borne. This claim is inaccurate, for reasons that historians swiftly noted; it also obscures the fact that eugenics did in fact initiate many traditions in this country, not all of which are perceived to be heinous today. Thomas’s incautious opinion, which echoes other voices in the abortion debate, unwittingly invites a more nuanced discussion of eugenics’ legacies.

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All the Obstacles in a Mother’s Way

AP Photo/Vadim Ghirda

In Issue 71 of The Dublin Review, Dominique Cleary shares the myriad ways coworkers, family, and strangers overstepped their bounds by giving her mothering “advice,” and ultimately the way in which she was forced to choose between her job and raising her children. Spanning the time before and after she gave birth, each section is titled with a different offender — boss; male colleague; husband; mother — so that the essay’s structure recreates the neverending, exhausting cycle of obstacles put in womens’ paths, and the ways society tries to undermine female autonomy. People tell Cleary how to dress, how to structure her days, how her career will tank and how breastfeeding will cause her breasts “to sag before their time.”

Getting from Monday to Friday was like swimming the length of an Olympic-sized pool without coming up for air. I hated having to wait to see my children at the end of the day when they were tired and cranky. I was missing their milestones. First words and first steps were reported to me by the staff in the crèche, along with more perfunctory accounts of what they had eaten, whether they had napped and for how long, and the number and consistency of their bowel movements.

Under the Parental Leave Act my husband and I were entitled to eighteen weeks unpaid leave each for each child under the age of eight: seventy-two weeks in total. My husband didn’t want to avail of his rights. Men weren’t taking parental leave – not back then, anyway. He would lose traction at work, as well as income.

The leave was designed to be taken in large chunks, but it could also be taken piecemeal with the agreement of the employer. I sounded my boss out and made a formal request to take every Wednesday afternoon off, unless a case of mine was listed in the Four Courts on that afternoon. I could afford to do it this way, and it would ensure that I’d be present at my desk every day of the week.

My boss reacted with a low-grade vibration of disapproval. He cited ‘business exigencies’ and ‘inconvenience’, but in the end he let me take a small part of my entitlement in that way. I suggested I could take the rest of my entitlement in short blocks during court recesses. Months went by without a reply and I found the uncertainty stressful. Meanwhile, an employment agent called me out of the blue and offered me a job interview with a competitor. He made it sound like I was being headhunted, but I suspected that attempts were being made internally to move me out of the way. The thought of starting from scratch somewhere new was exhausting, so I declined the opportunity.

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Don’t Come Around Here No More

Chris Radburn/PA Wire URN:20884959

Rebecca Lehmann | Copper Nickel | Spring 2019 | 11 minutes (2,188 words)

 

I rediscovered the music video for Tom Petty’s “Don’t Come Around Here No More” in the fall of 2015. My son was less than a year old, and I’d just returned from maternity leave to my job as an English professor in upstate New York. On Fridays, I’d put in my headphones, walk to campus, keep the light in my office turned off so nobody knew I was in, and write poems.

Sometimes a song I listened to on my walks would get stuck in my head, an earworm, playing over and over. This was the case with “Don’t Come Around Here No More,” and watching the song’s accompanying music video on YouTube only pulled me in further. The video, like many of Petty’s music videos, has seemingly little to do with the song. The song, from the 1985 album Southern Accents, tells the story of a breakup. Petty croons about a relationship gone bad, imploring a former lover to stay away, leave him alone: “I don’t feel you anymore. You darken my door. Whatever you’re looking for — Hey! — don’t come around here no more!” A creeping sitar riff repeats throughout the piece.

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‘Brokenness and Holiness Really Go Together’: Darcey Steinke on Menopause

Nefertiti, 14th century B.C., dark granite bust.(Universal History Archive/Getty Images)

Jane Ratcliffe | Longreads | June 2019 | 19 minutes (5,308 words)

By the time I finished reading Flash Count Diary: Menopause and the Vindication of Natural Life I had over nine pages of questions for author Darcey Steinke. She does, after all, explore a variety of topics through the lens of menopause: Sex; grief; the patriarchy; whales, gorillas, horses, and elephants; God; art; the transgender community; and, of course, women’s bodies, along with our minds, our spirits, our anger, and our animalness. She braids all of this into sparse, patient prose that’s somehow lush and explosive, not to mention formidable and exquisitely sensitive to all beings. [Read an excerpt from Flash Count Diary on Longreads.]

I first met Darcey back in the day, when I was a newbie writer and she was my scorchingly cool teacher. Dirty blonde hair, black tights, oozing brilliance, confidence and a bit of the daredevil, she kind of scared me. As it turns out, she is all of that — and also gigantically kind, funny, generous, and wise. The perfect combination to pull off a book like this.

Darcey’s menopausal journey begins with hot flashes so intense she, a minister’s daughter, believes God must be visiting her and ends with the bone-deep realization of her place within the divinity of nature. “I pray to the body, I pray to the lake, I pray to the whale,” she writes. In between she explores why there is so much scarcity and shame around menopause. Read more…

Bearing the Weight of My Grandfathers’ Old Clothes

Illustration by Homestead

Aram Mrjoian | Longreads | June 2019 | 13 minutes (3,320 words)

The first time I was mistaken for my father on the phone, I feigned annoyance. It was around 2004, I was 14 or 15 years old, and my family’s main form of communication was still the cordless phone mounted to the wall at the threshold of the kitchen, important numbers listed in thick pencil on a faded pad of yellow paper taped to the inside of the neighboring cabinet door. My mother and father also had cell phones, single-function dull silver models with green calculator screens and pixelated numbers, but these devices were strictly for work or emergencies. I was too young for my own phone, which was still an uncommon luxury among my friends, especially those still without a driver’s license. At home, the majority of calls we received were from telemarketers, and by my adolescence my parents had trained me to decline the onslaught of polite, prodding inquiries from unknown numbers, so that once or twice a day I hung up on an unfamiliar voice the moment they butchered our last name.

This time, though, it was a number I recognized, from a family member, someone who knew both my dad and me well enough to identify the distinct tones and cadences of our voices. She confused us anyway. I remember the static over the line, my momentary pause as I tried to make sense of this error. How could I be mistaken for my father? How could there be any confusion given the unsure wavering in my adolescent voice? Even as a teenager, I understood one distant moment of misidentification was neither some portentous sign of manhood nor a hint that I had matured in a more physical sense of the word. At least, I didn’t see it that way. Today, the feeling of being lost in adulthood is as constant as ever, like I am still an anachronistic version of my younger self, winging it day to day, uncertain of who I am and what the hell I’m doing. This mood was intensely magnified in my adolescence. My conceptions of masculinity and adulthood were out of whack with my perception of myself. It wasn’t simply that I wasn’t a man yet, but a larger question of how could I ever be half the man my father is, at all?
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It’s Not You, It’s Me: A Breakup Reading List

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A late bloomer as far as relationships go, my first encounter with heartbreak came from the track. It was junior year. The district meet: all big Texas sky and girls next to me adjusting hair ties and heat waves shimmering ahead. At that point in my life, I had devoted myself entirely to running. I had skipped every pool party and social gathering for three years to chisel myself into a faster time, a college scholarship, or something I couldn’t quite put my finger on — something that would finally indicate to me I had succeeded. I had won handily the year before, and everyone in the stands anticipated I’d win again. But when the gun went off, and I eased into a pace that should have felt easy given the rigor of my training, my legs stiffened. With each of the eight laps, I grew slower. Girls passed and I watched their ponytails sway across their thin frames. No matter how much I cajoled myself forward, no matter how many times I reminded myself of the years of work I’d put in, my body didn’t respond. I came in close to last.

Usually, at the end of a season, I jumped right back into running, but that loss felt like an irreparable fissure between me and first love. Heartbreak tasted like Coca Cola and boxes of Sour Patch Kids, and sounded like Coldplay’s “Fix You” repeated for melodramatic effect on the bus ride home. Too sad to study splits at night, and having ignored all social situations for years, I found myself reaching for something to fill what felt like a hunger inside me, a gnawing that reminded me of the ways I’d failed, the potential I’d lost. Those nights, I began a ritual of reading in my closet. I devoured books until one or two in the morning. At first, there was an escapist tendency to my reading; I wanted to forget the world I was living in and enter another. But, after weeks and a stack of novels, I realized that the words were guiding me back to solid ground. In reading about the nuances of another’s life, I was far enough removed to engage with what felt like the losses in my own. Slowly, I began to heal. I returned to running and pursued longer distances and faster times, my muscle evolving through training cycles; I’m sure there’s a metaphor for love buried somewhere in there.

Recently, over a decade after that track race, I experienced heartbreak again, but this time with someone I thought I might spend a life with. Just as I had after my district race, I mourned the possibilities of what could have been. I reviewed my own shortcomings. I doubted in my capacity to feel that sweet burn of distance again, the ache of muscle that indicates you are moving through the world as well as the bounds of your body will allow. I wondered if I would ever be able to trust again, to love. In the weeks that followed, as if grooved into some map of memory, I found myself reading a book a day, disappearing from the world for a few hours before surfacing again. I read and I ran and I read and I ran until I sloughed away the dead parts of the past, and trusted that the beautiful parts of the relationship — the parts that taught me compassion and made deeper my vulnerability and nurtured me toward growth — remained with me, even if the person who had fostered them did not.

Here, in case you, too, are experiencing any variety of heartache, is a reading list of essays that have allowed me to grieve. They’ve been friends telling me exactly what I needed to hear, and ultimately, have given me hope that there are new and unexpected futures ahead, even if now I only have a glimpse.

1. On Nighttime (Hanif Abdurraqib, May 15, 2019, The Paris Review)

Hanif Abdurraqib ruminates on places he has spent a series of nights: watching over a hospital bed, working at a hotel, waiting up for a long-distance love. By holding his experiences of heartache up to the light and carefully considering Lucy Dacus’s song “Night Shift,” Abdurraqib explores the liminal space that exists between hearts that are whole and broken, and moments that bleed between darkness and light.

In those days, I imagined daylight hours as no time to build a graveyard for memory. I couldn’t do what I needed to among the waking, forcing myself to run errands or pulling the shades down against the sun.

2. The Perfect Man Who Wasn’t (Rachel Monroe, April 2018, The Atlantic)

Finding true love amid the slush of online dating profiles often feels like a fantasy, which is why, when about a dozen women connected romantically with a man who called himself “Richie,” they felt lucky beyond measure — but only at first. Rachel Monroe, in this riveting read, reveals how Derek Alldred deceived so many women, explores the history of the con man, and, in a most satisfying turn, explains how his victims banded together after heartbreak to ensure he would never have the chance to con again.

Even Derek’s victims, who understand better than anyone else how these things work, repeatedly questioned one another’s choices when speaking with me: How did she let it go on that long, why did she let him move in when she barely knew him, how did she not see through this or that obvious lie?

3. When I couldn’t tell the world I wanted to transition, I went to Dressbarn (Katelyn Burns, May 23, 2019, Vox)

But by March of the following year, my dysphoria became too much to bear. My wife did her best to come to terms with my coming out, but we broke up when I told her I was starting estrogen, and I moved out shortly afterward.

After divorce, Katelyn Burns reflects on her relationship with a “little black Calvin Klein dress with stripes” that reminds her both of past heartbreak and a new world of possibility that opened when she first tried it on.

4. Love Running (Joseph Holt, March 2019, The Sun)

Joseph Holt’s ex-girlfriend was the reason he began running, but after their breakup, he continues on his own. Solo, running becomes both a reminder of their past as well as a salve for heartbreak.

I think about her every time I run, and I run every day. I feel her loss like a phantom limb, yet somehow this, too, is beautiful. And I run now with deep, propulsive gratitude for her influence.

5. How to Be Heartbroken (Brittany K. Allen, March 20, 2018, Catapult)

How much is the way we grieve the end of relationships influenced by portrayals of breakups in popular culture? Is there comfort to be had in performing different stages of heartbreak? How do we know when we’re ready to move on? Brittany K. Allen addresses these questions and more in this gorgeous exploration of “halving” herself from a former partner.

Isn’t it funny how the language we reach for when describing the real, wretched thing itself smacks of commercial copy? Heartbreak, heartbreak. It’s a pop song. It’s something you buy at Claire’s, or in the candy aisle.

6. The Breakup Museum (Leslie Jamison, Spring 2018, Virginia Quarterly Review)

Married for two-and-a-half years, Leslie Jamison peruses the exhibits featured in The Museum of Broken Relationships, a place where people from around the world send otherwise banal objects — “a toaster, a child’s pedal car, a modem handmade in 1988” — that somehow represent love lost. Jamison ruminates on what it means to separate from a partner, what we carry with us after a relationship is over, and how objects can conjure memory.

Which is all to say: I grew up believing that relationships would probably end, but I also grew up with the firm belief that even after a relationship was over, it was still a part of you, and that wasn’t necessarily a bad thing.

7. Her Fiance’s Mountain Bike Crash Was a Tragedy. What She Did After Was a Miracle (Gloria Liu, February 14, 2019, Bicycling Magazine)

Just three weeks before Will Olson was supposed to move from Colorado to Vermont, where his longtime girlfriend, Bonnie McDonald lived, he perished in a freak trail biking accident. Gloria Liu tenderly chronicles McDonald’s grief in this deeply moving piece, but also notes how heartbreak, over time, can evolve into some kind of hope.

As Bonnie spoke more about the experience, she came to use the term “heart opening” instead of heartbreaking. ‘I never knew my heart could feel this much loss and this much love,’ she says. ‘I never knew my heart had this much capacity.’

 

***

 

Jacqueline Alnes is working on a memoir about running and neurological illness. You can find her on Instagram and Twitter @jacquelinealnes.

 

 

Time To Kill the Rabbit?

Stringer / Getty, Collage by Homestead

Lily Meyer | Longreads | June 2019 | 10 minutes (2,725 words)

Jordan Peele’s second horror movie, Us, is full of rabbits. They twitch and hop through his underground world, their innocence a strange affront. Both Us and its predecessor, Get Out, are interested in innocence; Peele is expert at skewering the American habit, particularly present and noxious among liberal white Americans, of pretending to be blameless. The rabbits in Us serve as reminders of what true blamelessness looks like: animal, unknowing, and helpless, which is to say extremely vulnerable.

John Updike may have had a similar idea when he named his most famous protagonist Rabbit Angstrom. Rabbit — real name Harry — clings hard to the idea of innocence. Rabbit is an adult man, and not an especially kind or wise one, but in his head, he’s a high school basketball star, praised and beloved no matter how he behaves. Throughout his four-book life, Rabbit remains averse to adulthood. He wants to be a good boy.

Given his habit of sexualizing women, it’s easy to imagine Rabbit as an early reader of Playboy, that icon of male misbehavior. Where Peele’s rabbits signify goodness, the Playboy Bunny represents a certain kind of bad — though Hugh Hefner claimed not to think so. In a 1967 interview, he told Oriana Fallaci that “the rabbit, the bunny, in America has a sexual meaning, and I chose it because it’s a fresh animal, shy, vivacious, jumping — sexy… Consider the kind of girl that we made popular: the Playmate of the Month. She is never sophisticated, a girl you cannot really have. She is a young, healthy, simple girl.” Innocence was key to Playboy’s version of sexiness, and yet everyone knew — you only had to look at the centerfold — that innocence was feigned. Read more…

We Could Have Had Electric Cars from the Very Beginning

An advertisement depicts a Baker Electric automobile, the Baker Queen Victoria, driven by a young woman, 1909. (Stock Montage/Getty Images)

Dan Albert | An excerpt adapted from Are We There Yet? : The American Automobile Past, Present, and Driverless | W. W. Norton & Co. | June 2019 | 25 minutes (6,750 words)

Most people reasonably expect the story of the evolution of the automobile to begin with the invention of the automobile itself. I’ve disappointed enough people in my life already, so I give you the Jesuit Rat Car of 1672. In that year, missionary Ferdinand Verbiest created a steam wagon to bring the Emperor of China to Jesus, but the car was only big enough to carry a rat.

If you don’t like the Jesuit Rat Car as an automotive first, you might consider Nicolas-Joseph Cugnot’s cannon hauler of 1769. A product of the French army’s skunk works, it was canceled in beta testing. In 1790, Nathan Read got the first American patent for a steam-powered wagon, a remarkable feat because the US Patent Office itself had yet to be invented. Perhaps that counts. In London, Richard Trevithick set a Georgian coach body atop a steam boiler and eight-foot wheels, creating the first giraffe-less carriage. In 1805, American Oliver Evans drove his harbor dredge, the Orukter Amphibolos, down the streets of Philadelphia in hopes of enticing investors for a car business. Philadelphia cobblestone street paving gave horses purchase but shook the Orukter so violently that the wheels broke. Let’s call his the first amphibious car. Read more…