Margaret Lock
University of California Press, Berkeley
Paperback, 440 pages, illustrated

(Reviewed by Ann Bradford, EJOM Vol. 1 No. 6)

This scholarly work of medical anthropology by Margaret Lock reveals the complexities of trying to compare one culture’s approach to menopause with another. Through interviews and discourse with large numbers of middle aged Japanese women, she gives a detailed analysis of attitudes to menopause and ageing.

To begin with she must define menopause to be sure that the subject under discussion is the same for both interviewer, and interviewed. This is no easy matter, but the term most women were familiar with was konenki which is defined in the Japanese dictionary as ‘the turn (change) of life; the critical age’. For Japanese women however this term encompasses more than a series of symptoms which happen at the end of menstruation, and appears to include the whole ageing process, so konenki for these women is seen as 'a process and not an event'.

Her starting point is the approach to menopause prevalent in the West, much of which is taken as understood. She then goes on to build a picture of life and attitudes in Japan using her own observations, and those of the women themselves. She looks behind the cultural platitudes to the realities of life for middle aged women, both socially and politically. She deals with individual narrative about ageing, and the subjective experience of middle age. This includes the medical aspects, and approach to treatment, and the politics of ageing.

Lock makes it clear that there are fundamental differences in attitude to this mid-life change. She makes the statement that ‘In North America we worship at the altar of youth..... The middle aged and elderly are seen as a deviation from the norm’. Further on she also says ‘Ageing female bones.... are defined by the WHO as abnormal’, so menopause stands for that which has been lost i.e. youth and good health.

In contrast in Japan normality for society is seen as ‘fulfilling a set role for gender, family obligations, and social order, these have priority over individuals and biology alike’. Individuals, especially older people are aware of this continuum as part of a larger cycle, there being no straight dichotomy between pathology and normality. The onset of konenki (menopause) for many women signals a release from some of the constraints society places upon them, and allows them more freedom and respect. Another states, she thinks of konenki as ‘Mother's time of rebellion’ and the phrase ‘finding oneself’ is currently in vogue among women.

This aspect is illustrated best in the interviews, honest and revealing, giving insights into the lives of these women. As workers, mothers, housewives, wives and daughters-in-law there were many roles to fulfil, many attitudes to preserve, obedience, calmness, subservience being some of these. The women talking about themselves and their lives lift the book out of the textbook category and make it a fascinating and absorbing read.

Life for these women in post war Japan was very hard, working, bringing up a family, looking after the house and looking after the in-laws, they had no expectation of an easy life, and expected to work hard.

Most of the women interviewed thought that as long as they worked hard and thought of others instead of self then any problems to do with konenki would be small. The vast majority of women felt that only those ‘lazy’ women who did not work and did not have things to occupy their time would ‘suffer’ with menopause, although a comparison of responses from those women with jobs, and those who categorised themselves as housewives showed that the latter reported significantly fewer symptoms than did the rest.

One of the most fascinating aspects of this book was the discovery that the commonest physical feature of menopause in the West, ‘hot flushes’, figured hardly at all in konenki, where the commonest shared features for Japanese women were stiff shoulders and headaches. Also fascinating were the many interesting little asides, off the main topic but relevant. One example is the Japanese absorption with statistics (she calls it a number crunchers' paradise!) which has led some unidentified experts to estimate that if the birth-rate in Japan remains unchanged, in seven hundred years time only four hundred Japanese will remain!

Lock interviewed many doctors and gynaecologists about their approach to konenki. They saw this as a natural transition, one that made women more vulnerable physically and emotionally, but which would pass. These doctors when interviewed made it clear that their attitudes differed widely from those of doctors in the West, where HRT is commonly prescribed for menopausal symptoms. Japan has never licensed the contraceptive pill, and hormones are rarely prescribed, both women and physicians alike being very worried about side effects. As konenki is seen as an imbalance that happens at a particular stage in life, the main treatment seems to be traditional herbal medicine (kanpo) which works well, and rarely has side effects.

This book does assume a familiarity with previous studies, particularly those from Manitoba and Massachusetts, undertaken mainly in the 1980s, and the mythologies about menopause in North America are mentioned only briefly. This does not detract from the book however, nor its intentions of challenging the views taken as self evident and universal about menopause, and further, to question the responsibilities assigned to middle aged women by their respective societies. This book manages to be literate, full of insight, and an absorbing documentation of social relations.

Ann Bradford 
Ann Bradford is an acupuncturist and kanpo herbalist. She graduated from the LSATCM in 1989 and prior to this worked in the field of women's health.