Not Tonight

Migraine and the Politics of Gender and Health

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Migraine is one of the most common, painful, and disabling disorders in the world, yet it is routinely considered, at best, unimportant or, at worst, a mere excuse for avoiding one’s expected duties in life. This remains true, even though researchers now believe that migraine is a neurobiological disease with potentially serious outcomes. In Not Tonight, Joanna Kempner grapples with this paradox, arguing that this “legitimacy deficit” can be traced back to migraine’s long-standing association with neurotic women. In other words, we often let who we assume experiences pain determine how we understand their symptoms and their suffering.

Kempner’s wide-ranging approach takes concepts from sociology, anthropology, literature, history, and science studies to explain how “old” ideas about effete men and hysterical, neurotic women with migraine have been replaced with “new” ideas about people who have a hypersensitive, neurotic migraine brain. She traces these highly feminized ideas about migraine to scientific journals, pharmaceutical advertisements, and even patient advocates’ arguments for why we should take migraine seriously. This analysis casts new light on how cultural beliefs about gender, pain, and the distinction between mind and body influence not only whose suffering we legitimate, but which remedies are marketed, how medicine is practiced, how knowledge about headache is and is not produced, and how we make policies about people in pain.

Not Tonight can be purchased here or here.

Awards

In 2016, the American Sociological Association’s Medical Sociology Section awarded Not Tonight the Eliot Freidson Outstanding Publication Award and the Society for Medical Anthropology awarded Not Tonight the Eileen Basker Memorial Prize for its contribution to anthropological scholarship on gender and health.

Reviews

“An important contribution to our understanding of the multi-dimensional process through which society perceives and construes pain and disability. Her study of headache and especially migraine powerfully demonstrates the way in which gender, stakeholder interests (including those of status-oriented physicians and profit-oriented pharmaceutical manufacturers), and the very elusiveness of pain interact to create that social entity we call migraine—an entity that shapes attitudes, self-perceptions, and access to care. Carefully researched and engagingly written, this study should be of interest to anyone concerned with the social aspects of medicine. And anyone who suffers from the curse of headache pain.”

(Charles E. Rosenberg Harvard University)

“This insightful and eloquent account of our evolving understandings of migraine, from a condition of weak-nerved women, to a “real” neurobiological disease, does far more than document the cultural framing of headache.  Kempner illuminates the complex, tangled relationship between medicine, morality, and meaning making in contemporary American society as she demonstrates that despite its biomedicalization and a shift from thinking of migraine as ‘all in the head’ to a genuine brain disease, migraine remains a disorder of personhood—and a particularly gendered one at that. The acuity of her sociological analysis is matched by her compassion for migraine sufferers and their fellow travelers on the quest for legitimacy and a cure.”

(Elizabeth Mitchell Armstrong Princeton University)

“Kempner’s incisive work analyzes migraine medicine and its gendered subtext as practitioners sought to make sense of the mind/body actions or interactions causing the common, yet devastating pain of sufferers. The book is beautifully written, with a moving preface in which Kempner locates herself as a fellow migraine sufferer as well as ethnographic observer.”

(Linda Blum Northeastern University)

“Kempner expertly illustrates how social legitimation of an illness is a multifactorial process and that effective recognition of a disease, which provides the basis for serious advances in research and treatment, can only result from a broad acknowledgment that persons who suffer from it are worthy of such interventions.”

(Carolyn Merritt Medical Anthropology Quarterly)

“A razor-sharp, feminist-minded, and much-needed book. . . . Kempner ’s scholarship is informed by her personal experience as a longtime sufferer from chronic migraine. . . . Still, most of Kempner’s observations are based on her painstaking scrutiny of medical texts, her attendance at numerous national and international migraine conferences, and her interviews with leading specialists.”

(Paula Kamen, Women’s Review of Books)

“The way we discuss, understand, and treat migraine and people with migraine is—as Kempner deftly shows—profoundly sociological. Specifi­cally, Kempner shows how the strong collective understanding of migraine as a disorder that affects mainly women goes far in trivializing it, despite a rise in neurological explanations and pharmaceutical treatments. She strikes a perfect balance in incorporating her personal experiences with migraine within her account of her research findings. . . . Sociologists of medicine and sociologists of gender should read this book and assign it to their students. It is a terrific case study of how understandings of dis­ease are shaped by the culture in which they are formulated and specifically by understandings of gender. Nuanced and yet highly accessible, it is appropriate for both graduate and undergraduate courses. Indeed, it is so well written and engag­ing that it will speak to non-academics as well. Migraine sufferers may find some comfort in understanding the social forces that explain why their suffering is so trivialized in contemporary US society.”
(Abigail Saguy, Social Forces)
“Fascinating. . . Kempner tackles such meaty topics as how pharma companies play on women’s guilt about failing at their family duties, how the recent shift to seeing migraine as a neurological spectrum disorder has legitimized both headache doctors and researchers, and the rise of the patient advocate.”

(Huffington Post)