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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.
In Not 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 Tonight 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, and how knowledge about disease is produced.
About the Author
Joanna Kempner is associate professor of sociology and an affiliate of the Institute for Health, Health Care Policy, and Aging Research at Rutgers University.
“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.”
— 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.”
— 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
“Kempner shows great understanding and compassion for those with headache disorders, but looks at the disease from an objective, scholarly viewpoint that may empower us to better understand the battles we fight in the legitimization of migraine and headache disorders. This understanding is a path to equipping us to know how to interact with doctors and society and to develop strategies for decreasing stigma. . . . It may not be a quick or easy read, but it’s one most people will find fascinating and eye-opening.”
— Health Central
“Well documented and widely researched, this informative and valuable book is densely written and demands close and careful reading. It will be especially valuable to researchers, professionals, and very literate headache sufferers.”
“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.”
— Medical Anthropology Quarterly
“A key strength of Not Tonight is that it is written with great passion and purpose. As a Migraine patient and advocate, Kempner’s inclusion of her own and others’ personal experiences strengthens the narrative and adds great depth. . . . Kempner casts a bright light on the ways in which a painful condition is delegitimized through gendered assumptions and practices—playing, in the process, into wider social discourses that undermine the (illness) experiences of women.”
— New Genetics and Society
“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
“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
“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
“Kempner crafts an engaging narrative likely to help capture the attention of students in both undergraduate and graduate courses. . . . This case study would serve as an excellent, empirically grounded jumping off point for class discussions of any number of broader themes one might cover in medical sociology courses, including stigma, medicalisation, the social construction of illness, how practitioner and pharmaceutical interests influence the practice of medicine, and how inequalities shape everything from our ideas about biology to individual illness trajectories. . . . Kempner’s science studies approach allows for an expansive and nuanced analysis of how a particularly complex and intractable health problem has been understood socially and scientifically, with significant ramifications.”
— Sociology of Health & Illness
“Overall this is a compelling, clearly written, holistic analysis with a strong central argument: although it is now widely accepted that migraine is a neurobiological disease of the brain rather than an illness of an anxious female mind, assumptions about gender still undermine migraine’s legitimacy as a serious disease. . . . This book provides an important corrective to any tendency to assume that the rise of neuroscience means the death of mind-body dualism or of the dismissive psychologizing of women’s pain.”
“Discussion of the migraine has been sorely missing from sociological discussions of health and illness, and in this book, Kempner has delivered an enlightening glimpse of the intricate social nature of the diagnosis, its treatment, and its consequences. . . . Kempner has written an evocative monograph about the gendered politics of the migraine. This book will make a very interesting adjunct to courses on sociology of health and illness, but it also can serve as an important heuristic as it assists practitioners and sufferers to consider the social and political framing of common disorders.”
— Contemporary Sociology
“Thoroughly engaging. . . . Not Tonight allows us to see how gender and illegitimacy intersect, and how the character of people with migraine, most of whom are women, is questioned in ways that render their diagnosis and treatment less important.”