Overview

"Pain. Vomiting. Hours and days spent lying in the dark. Migraine is an extraordinarily common, disabling, and painful disorder that affects over 36 million Americans and costs the US economy at least $32 billion per year. Nevertheless, it is frequently dismissed, ignored, and delegitimized. InNot Tonight, Joanna Kempner argues that this general dismissal of migraine can be traced back to the gendered social values embedded in the way we talk about, understand, and make policies for people in pain. Because the symptoms that accompany headache disorders-like head pain, visual auras, and sensitivity to sound-lack an objective marker of distress that can confirm their existence, doctors rely on the perceived moral character of their patients to gauge how serious their complaints are. Kempner shows how this problem plays out in the history of migraine, from nineteenth-century formulations of migraine as a disorder of upper-class intellectual men and hysterical women to the influential concept of ""migraine personality"" in the 1940s, in which women with migraine were described as uptight neurotics who withheld sex, to contemporary depictions of people with highly sensitive ""migraine brains.""Not Tonightcasts 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, and how knowledge about disease is produced."

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Reviews

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)

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

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

Author Information

Joanna Kempner is assistant professor of sociology and an affiliate of the Institute for Health, Health Care Policy, and Aging Research at Rutgers University.

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