Andrew O'Hehir

Head case

Paula Kamen has had a headache for 14 years. Her unlikely and often hilarious memoir explores the secret history of women and pain, and introduces us to a new (but very old) social phenomenon: The Tired Girls.

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Head case

Paula Kamen has a headache. On the day I call her in Madison, Wis., where she’s made a stop to promote her new book, “All in My Head,” which is a memoir and a cultural history and a comic odyssey through the licensed and unlicensed health professions and a lot of other things besides, she rates the headache a 3 or 4 on a scale of 10. For most of us that would be a pretty bad day, possibly requiring three or four ibuprofens, a couple of grande Starbucks concoctions, dark sunglasses and a lot of grumbling.

But Kamen says she’s feeling great. See, she got this headache when she was putting in her contacts in a Chicago hotel bathroom — in 1991. Over the last 14 years it’s been her constant companion, waxing and waning like the phases of the moon — sometimes so intense she can’t function at all, sometimes barely noticeable — but never completely going away.

On one level, this is ludicrous: A woman gets a headache and writes a book about it. Kamen is able to appreciate the joke, up to a point. (She’s not so delighted that a New York Times critic cited her book, without reading it, as an example of the glut of self-indulgent memoirs.) But Kamen’s headache is enough to make you suspect there might be a God. If Jehovah chose Job to persecute because he knew that upright man’s faith would never waver, maybe he had his own reasons for afflicting Paula Kamen with a never-ending headache. She was already a first-rate reporter on feminist issues as well as an aspiring humorist with a wry, sardonic tone.

That combination of elements has produced an improbable book, indeed almost an impossible one. “All in My Head” dramatizes Kamen’s suffering without wallowing unduly in self-pity, and her journey along the highways and back roads of both Western and alternative medicine, while often hilariously rendered, will provoke anguished cries of recognition from anyone who’s dealt with chronic pain (and the medical establishment’s general befuddlement by it). More than that, as a reporter Kamen marshals most of what is now known or suspected about headaches and related disorders, and as a feminist she drags into daylight a half-hidden social phenomenon we all recognize but rarely talk about: the Tired Girls.

If you’re one of the Tired Girls, you already know what I’m talking about (although you may not have known you belonged to a newly founded identity group). If you’re not, then there’s probably one or more T.G.’s somewhere in your life — in your family or your circle of friends. A Tired Girl is that youngish woman, probably in her 20s or 30s, stuck in a cycle of pain and fatigue she may not talk about openly, even with her closest friends. She is known to cancel long-planned social engagements at the last minute, to disappear early in the evening, to oversleep, to spend beautiful Saturdays alone in bed. Like Kamen, she’s constantly trying some new drug, some new massage or chiropractic technique, some new combination of Chinese herbs, some new diet.

A Tired Girl may suffer from migraines or depression or chronic fatigue syndrome (now called CFIDS) or fibromyalgia or bipolar disorder or the persistent, mixed-headache syndrome called chronic daily headache (CDH), which is Kamen’s diagnosis. It’s quite possible she has more than one of these conditions; scientists are now inclined to believe that these ailments (along with epilepsy and other seizure disorders) are related at the neurological level, and people who suffer from one are exceptionally likely to have the others.

Tired Girls are nothing new, and if you view the phenomenon with some suspicion, that’s understandable. Victorian women fainted and had the “vapors”; the desperate housewives of the ’60s self-medicated with Chardonnay and Valium. Medical testing couldn’t “see” any organic source for these diseases, so they were often regarded as psychological in origin — the result of female “hysteria” or sexual repression. These cut-rate Freudian theories found their way into the postmodern age, too: Feminists defined these female-coded illnesses as a form of political resistance to patriarchal oppression, while deconstructionists saw a cultural virus bred of millennial angst and spread by media overload.

I probably shared that skepticism myself, a dozen or so years ago. I never get headaches unless I drink too much or have a sinus infection. But for more than a decade I’ve lived with a woman who has 10 to 20 severe migraines in a typical month. In general terms, Leslie’s diagnosis is similar to Kamen’s, if less severe; she has CDH, but headaches are sporadic rather than constant. Like many other women, Leslie got significant but probably temporary relief from the massive hormone surges associated with pregnancy and breast-feeding (our twins were born a year ago). Leslie has taken many of the same prescription medications as Kamen — mostly powerful psychiatric drugs with whopping side effects — and been subjected to a lot of the same goofball psychologizing. (My favorite was the shrink who thought that because I was giving Leslie massages at night to relieve her pain-induced insomnia, I was a controlling boyfriend who was causing her headaches.)

Along the way, I’ve had to question my own preconceptions about these stereotypically female ailments, especially as I’ve learned that new, more sensitive brain scans now seem able to pinpoint their neurological source. As Kamen explains, it now appears that disorders like migraine and CDH result from a kind of wiring malfunction deep in the brain stem. Migraine, for instance, was recently described by one medical researcher as “a chronic-progressive disorder that may cause permanent changes in the brain.”

Of course men suffer from chronic pain and fatigue as well; millions of sports fans got an instant education in this issue when Denver Broncos running back Terrell Davis had to leave the 1998 Super Bowl game with a severe migraine. (After an intranasal dose of a drug called DHE and a locker-room nap, he returned to score the winning touchdown.) But for reasons that aren’t entirely clear, women are several times more likely to have these diseases, which has clearly contributed to the centuries-old perception that they’re fragile and untrustworthy creatures, both physically and emotionally.

Paula Kamen thinks it’s time for the Tired Girls to come out of the closet (or the darkened bedroom, as the case may be). Individual women can admit to pain and fatigue, she argues, without stigmatizing their entire sex. Hardly anyone argues that men should be excluded from the workplace as a group, despite their pronounced tendency to schizophrenic breakdown and random shooting sprees.

As I know very well, Tired Girls can be tough — and Kamen has the scars to prove it. In her medical odyssey she’s endured painful and useless surgery, gained and lost an enormous amount of weight, beaten a dependency on Xanax with large doses of “Antiques Roadshow.” She’s tried Botox, fig tea, a burlap sack from Peru (purported to retain energy from the baby who was born on it), “healing stones,” a Russian masseuse who “beat the living crap out of me” and a vibrating hat from a TV infomercial.

In the long run, Kamen, 37, actually found the mental and emotional pain associated with her endless headache harder to deal with than the physical discomfort, as bad as that has sometimes been. She writes about the details of her personal life with considerable restraint (an example more memoirists should follow), but it’s clear that her ordeal has made her love life very difficult. She’s had boyfriends over this 15-year stretch, but none stays in the story for long. It has also strained and fractured friendships, made her financially dependent on her parents for a time (a humiliation for any adult), and rendered her unfit for any normal workplace.

Perhaps that last part was a backhanded blessing. If the headache literally disabled her, it also liberated her to research and write “All in My Head” as well as her previous volume, “Her Way: Young Women Remake the Sexual Revolution.” (On that subject, Kamen reports that for many women, including herself, a headache is not an impediment to sex; if anything, the endorphin rush associated with a good romp tends to provide some relief.)

Almost none of the mainstream or alternative therapies Kamen has tried have worked, or at least not much and not for long. She still has her headache and, tragically, Jane Pauley’s producer declined to put her on the air absent a miracle cure. But if “All in My Head” isn’t the classic American narrative of How I Utterly Demolished All Obstacles in My Way, it might be something far more valuable. It’s the story of learning to live now, with limitations and ambiguity and, yes, pain — and not waiting until some future date when those things will be vanquished.

In Kamen’s book, she describes her constant companion in various ways; sometimes it’s like having ground glass in her eye, sometimes like having a railroad spike driven through her head, sometimes like having a barbed fishhook twanging at her optic nerve. (Yowtch.) Suffice it to say that her left eye and left temple always hurt (these days the right side can be pretty bad too), and 3 or 4 out of 10 is, as she says, “a great day.” She’s cheerful, funny and upbeat; she doesn’t sound anything like that dreaded cultural icon, the Woman With a Headache.

This seems like such an important book to me — it connects the dots on this issue of women and chronic pain in a way nobody else has done, and it’s a remarkable personal story as well. I’m surprised that the media isn’t all over you.

Well, it’s still an invisible disability and there’s still a lot of misunderstanding. People think it’s just something silly, or something neurotic people have. William Grimes of the New York Times didn’t read the book, but he did a story with the headline “We All Have Lives — Must We All Write About Them?” It was about how there are too many memoirs, and he used mine as the prime example: I just had a headache and I’m so self-absorbed that I wrote a whole book about it. I must be an idiot.

Then there was this review in the Chicago Tribune where the critic wanted it to be more like a sex memoir. She thought I was just trying to write about an Important Issue, and that was why I did all that reporting. I really felt like that was essential. This issue is so misunderstood. If I just wrote about myself — “I’m having a lot of pain” — with no explanation of what chronic daily headache is, people would just think that I’m nuts. And then the issue really is about me, which I didn’t want.

For a lot of people — for a lot of women and, I predict, a lot of the men in their lives — your “Tired Girls” chapter is going to be an epiphany. It’s going to describe them, or someone they know, and connect them to this larger medical and social phenomenon. Have you heard that from people already?

I think it’s just the beginning of people coming out about things like this. Someone e-mailed me the Web site of Rebecca Wells, who wrote “Secrets of the Ya-Ya Sisterhood,” and she writes about having some form of chronic fatigue where she can barely lift a pen some days. Laura Hillenbrand, the bestselling author of “Seabiscuit,” is now writing a book about chronic fatigue. So it’s just the beginning of writing about these things that have been very, very stigmatized. It’s almost the last thing to come out about: having weakness and vulnerability. It’s one of the last taboos in our society.

Your book isn’t one of those disease memoirs with a grand, dramatic solution. You parody that genre at one point: You’re going to have a miraculous surgical procedure, marry the handsome doctor, and win the Tour de France six times. None of that happens. Basically this is the story of how you learned to live with this headache, rather than get rid of it.

Exactly. It’s a lot about acceptance. It took me 15 years to accept that I had any kind of a disability, even though I obviously do. It goes against our culture so much to actually accept something. We mistakenly think that if you accept something then you’re, like, dooming yourself. You’re resigning and totally giving up. It’s actually the opposite. In accepting it more, I can now live around it better. I can schedule things more efficiently and not cancel on people, the way I did when I was in denial about it. Acceptance of pain, in the last hundred years or so, has been discouraged by a lot of medicine. Pain has been considered fundamentally a psychological thing — if you accepted it, that meant you were mentally attaching yourself to it.

Right. There’s the Freudian concept, which you write about, that people with persistent or chronic pain are getting some kind of “secondary gain” from having it.

Exactly. It’s so amazing that in 2005 that’s still out there. That legacy of Freud, especially with chronic headache pain, has really lingered. I could go off on many tangents here: It’s mainly experienced by women, it’s literally in the head, where the mind is, and female hormones, which are known as the “crazy chemical,” sometimes make it worse.

Let’s talk about the gender issue, which is maybe the $64,000 question here. You go at this very directly in your book. People are going to have the reaction, whether they admit it or not, that this whole question of chronic pain and fatigue is a chick thing. It’s a women’s issue, shrouded in mystery and superstition. And you’re saying, well, it’s time to face that there’s some truth to this stereotype.

Right. For this reason, I had a little hesitation in writing about this. But not much. One of the main justifications for excluding women from society has been that they’re neurologically weaker, that they’re “hysterical” and suffer more pain. Historically, that’s how women were portrayed. Now, in recognizing the reality that women do get more pain and fatigue, it might sound like I’m anti-feminist. Actually, it’s the opposite.

The time now seems to be right for us to be secure enough to talk about this. The women’s movement has proven itself; we’re strong and confident, we’re in the workplace and the WNBA. It’s also important to recognize that we’re fully human. We’re not superwomen. This generation believes that we’re entitled to equal rights even if we’re not perfect. It was a more delicate time in the ’70s, and the job of the women’s movement was to say, “No, we’re not weak! We can be athletes! We can beat Bobby Riggs in tennis and run marathons and become astronauts! The body is truth!” That was an important mission, and now, with the third wave of feminism — which I’ve written about since its beginnings in the early ’90s — we’re recognizing a lot of issues we couldn’t talk about as easily before.

Anyway, it’s irrational for people to use this against women, this argument about us having more pain and fatigue, because men, neurologically speaking, have their own share of stuff. They’re much more likely to have personality disorders, to have schizophrenia.

We have a pronounced tendency to kill people, don’t we? That’s posed something of a problem over the years.

That’s true. So if you took that same logic — that women have more pain, so they shouldn’t be allowed to vote — you might want to lock every man up as a preemptive strike. You wouldn’t allow them even to enter a workplace, because of the risk that they’ll go on a shooting rampage.

More seriously, the larger point is that everybody’s different and there’s huge variation. Not every woman has pain and fatigue, and not every man is a serial killer. [Laughter.] But we’re defensive about it because of this history of it being used against us.

Can you summarize the current thinking as to why it appears that women are more likely to have these pain and fatigue illnesses?

Neurologically, women seem to process input differently, and it’s more likely to translate to physical pain. It’s not just hormones, because 14 percent of women in their 70s have a chronic headache problem. That shows that it isn’t just the monthly hormone fluctuation, although for some women that’s clearly a major trigger. For others it isn’t as much. You have to understand that chronic daily headache or chronic migraine is basically a disorder where the brain is overreactive to stimuli, be it hormone fluctuation, stress, the weather or whatever. That’s translated into pain; it’s an oversensitivity.

It’s complicated, but I should add a major point, which is one of the main reasons I did all this reporting. Just in the last several years, there have been these advanced types of brain scans, the PET scans and functional MRIs. With fibromyalgia and migraine and chronic daily headache, those scans show differences in the brains of people who have these things. So it’s fascinating, because these things that were always considered to be invisible, and thus in some way not real, are now more and more considered visible. It’s not like you can shine a PET scan on someone and see their pain, but they do detect measurable differences in the brain.

That’s the beginning of a huge change, isn’t it? As these diseases become visible, in terms of medical testing, that’s almost an epistemological shift in the way they’re understood.

Exactly. It’s a major point. I’ve been to a lot of medical meetings, and on the highest level, neurologists are taking this very seriously. But then you find a lot of skepticism from doctors who haven’t been in medical school for 40 years or whatever, and are tied to an older model of thinking.

Sure. I know very well, from my wife’s experience, that some physicians — and most shrinks — still assume that chronic headaches have a psychological basis, or are rooted in the patient’s personality. You write about this very movingly; you went through a period of self-doubt on that issue, basically doubting whether your symptoms were “real” or you were just inflicting them on yourself.

Oh yeah, definitely. You know, this is what our culture tells us, so much: It’s really a question of mind over matter. You can overcome any sort of weakness through force of will. If you can find whatever the emotional block is, that’s all it takes. It can be very hard to overcome that whole notion.

For a long time there was this whole medical conception of the “migraine personality,” the overstressed, type-A, self-tormenting individual, generally a woman, who was sort of inviting these headaches. Has that idea finally been banished?

Well, in medical school today, they teach that that’s totally not true. I interviewed a brain researcher, Dr. Nahib Ramadan, and he says there is no migraine personality. But it is true that if you have chronic headaches, a “co-morbidity” is often anxiety and depression. So it is more common to see those things in headache patients, but that’s not their personality causing the headaches.

Well, I’d be anxious and depressed if I had headaches every day. I realize it’s not quite that simple, but come on — constant pain is going to change your “affect,” as they say.

That’s a problem when you go to doctors or shrinks — you come in and you’re visibly depressed because your whole life is falling apart due to chronic pain. So they blame it on depression. It’s extremely common. There’s very little understanding of this concept. Chemically, a lot of these things seem to be close to each other, and that’s why some of the same drugs are used for depression and chronic daily headache.

Right. So the current thinking is that there’s some neurological connection between a whole variety of disorders that include migraine and chronic daily headache, depression, epilepsy and bipolar disorder. Is that right?

Very good. You did your homework.

So people with one of these illnesses are more likely to have one or more of the others?

Yes, by far. If you have chronic daily headache, you’re twice as likely to be bipolar than the average person. You’re still talking about only 8 percent of people with CDH who have bipolar disorder, but that’s twice the rate of the general population. That’s a big focus of studies in the last few years, and I didn’t know about any of that until I started doing research for the book. I just thought I was this freakish thing out in my own little world. I didn’t know about the neurological connections. I didn’t know if it was neurological. That’s why I wrote the book.

Wow. So the whole time you’re going to all these doctors and other health practitioners, you didn’t really understand the science behind your headache?

Right. Because a headache becomes like an inkblot test to every doctor you see. You go to an alternative doctor and of course the problem is that you’re eating wheat. I’m not even kidding. I heard this from many people: It was wheat, or dairy products, or toxins in the environment. The massage therapist insists it’s a muscle contraction disorder; the chiropractor insists that it’s all because of a spinal irregularity. Once I started going to medical conferences and interviewing people about all the new research and the new scanning technologies, it finally became a lot clearer.

Let’s talk about your specific case. Even though you start your story by putting in your contacts on that particular summer morning in 1991 and getting a raging headache that never went away, you now don’t exactly see it that way. In fact, you’d been building up to it for quite a while.

That’s true. In reading books about people with chronic illness of all kinds, it’s really common for people to point to one dramatic incident where it finally sunk in that something was wrong. In reality, for most people, it’s something that develops under the surface. In my case, the nerves were becoming more and more sensitive over the years, and it got harder every year to put in my contacts. Finally it caused physical pain.

Right. And that pain launched you on this incredible odyssey. You see many kinds of physicians, you undergo useless and painful surgery, you take this amazing catalog of pharmaceuticals, including one that gets you addicted. You see several psychiatrists and psychologists. You visit every kind of alternative health practitioner I’ve ever heard of, and some I haven’t. How many health practitioners, in total, have you consulted in the last 15 years?

Well, I have a list in one of the last chapters. I’d say it was at least 100, easily.

To anyone who’s been through this, your litany of “off-label” drugs is going to seem grimly familiar. Klonopin, Paxil, Neurontin, Nardil, Depakote — every few pages I would slap myself on the forehead and say, “Leslie took that one too!” Your experience, and hers, would not seem to be uncommon: You go to doctors and they nod and act all confident. They give you powerful drugs with all kinds of unpredictable side effects, and — for a lot of people — they just don’t work.

That was a huge shock to me. I had grown up thinking doctors always had the answers. It sounds naive, but this was a time when alternative medicine wasn’t big and questioning doctors wasn’t really in the culture. I kept thinking it was just a matter of a few weeks. And I also thought for most of the last 15 years that I was the only person all these drugs didn’t work for. It was a revelation to see studies that only about 50 percent of people with CDH respond to drugs, and to understand how crappy — excuse me, how limited — the options are.

There’s been very little testing with CDH in general, so a lot of it is just anecdotal. Doctors prescribe things with very little explanation. I’ve had people read this book and tell me they had no idea the pill they were taking every day was actually an antidepressant. It’s just so bizarre: You might be taking a blood-pressure medication one day and an anti-epileptic drug the next. And there are huge side effects.

You had a lot of dramatic side effects. What drug was it that made you gain so much weight?

That was Nardil, an old-fashioned antidepressant. It actually worked for about eight months, but without warning I became the Incredible Hulk. I was bursting out of my clothes, almost. For a single woman in her 20s, that was especially fun. It was like chick lit gone mad! You know, Bridget Jones complains when she gains seven pounds.

Then there are the drugs that just wrapped you in a mental fog, right?

Yeah, I started taking Klonopin without knowing what it was. I didn’t know it was a major tranquilizer until I saw “Behind the Music” with Stevie Nicks many years later, and I was like, “Oh my God!” I thought I was neurotic because it was so hard to get off that stuff, and she’s on TV saying, “Yeah, I was institutionalized for three months getting off it, and then I went into seclusion for two years on my ranch.” So it wasn’t just me.

Then you had nasal surgery. You went to an ENT specialist, and he decided you had a deviated septum and that was the cause of all this.

And two others agreed with him almost completely. It was just black and white with them.

And that made your pain dramatically worse in the short term — but only slightly worse in the long term!

Yeah. That was the bright side. [Laughter.]

Then you actually became so dependent on a drug that you had to come up with your own rehab program.

Yeah, just flipping back and forth between three PBS channels. “Antiques Roadshow,” that was perfect for my rehab. That was the worst, by far. That made Klonopin seem like nothing. That was Xanax. I was on a very low dose, so I thought it was just me, but that’s even more addictive than Klonopin. It was pure hell, because a lot of doctors don’t understand how difficult it is for people with pain to get off these drugs. When you try to lower the dose, the pain gets 10 times worse. It was like a chain saw cutting through my head. That was a low point, worse than the surgery, probably.

People may hear Xanax and think I’m a drug addict or whatever. I want to make clear that I never abused it, and I was the advocate for getting myself off of it. Nobody was telling me to.

You write that you never tried street drugs or recreational drugs to relieve the headache. You must have heard, anecdotally, that marijuana helps a lot of people.

Yeah. I don’t know how much I should say on Salon.

You’re among friends.

I never used it habitually. Like everybody else, you go to a party and somebody has it … Like anything that’s relaxing, cannabis has been used to relieve pain. It was a legitimate headache drug in the 19th century.

In my wife’s case, for a while it was the only thing that really worked. We took this infamous trip to Quebec once, and the whole way north through New York state it was like being in a Cheech & Chong movie. I was driving through the Adirondack forests with this tremendous contact high, with the person next to me baked out of her mind. She finished off the dope before we got to the border, and there we were, greeting the Canadian immigration officer with this ganja stench billowing out of the car. But her neurologist told her that it helped a lot of people, and that he’d definitely prescribe it if it were legal.

Wow, that’s all news to me. It was never prominent in my mind as a choice. But I am in Madison right now, so it’s fortunate you brought it up here! [Laughter.]

Yeah, look into that. Although I should observe there are obvious downsides to consuming that much cannabis. Speaking of alternative medicine, you spent a lot of time in that world and you come back with a mixed report. What I got out of it is that you learned some valuable coping skills in that realm.

Right, it’s not black and white. You see a lot of stuff now about how alternative medicine is totally great. They did a segment about chronic pain on the “Today” show recently, and all the sound bites were like: “Alternative medicine is great! Science says it helps!” In reality, you get what you can out of it, and there’s some stuff to really be cautious about.

It was a turning point in terms of basic philosophies of coping. It’s going to sound trite; a lot of it is obvious. But I had to learn the concept of detachment, and learn the difference between physical pain and mental and emotional pain. Before, when the pain got worse, I got all depressed and emotionally upset. Now I’ve learned to distance myself. I mean, easier said than done, and a lot of days it’s just not possible. But in general my life is a lot calmer, it’s not, like, this emotional roller-coaster ride. That has been extremely helpful.

You write about that very movingly: The hardest thing for you, in many ways, was not the physical pain itself but the way it made you feel and the way you judged yourself.

There’s so much suffering, and so much of it is emotional and mental. You feel incredible guilt, you feel like you’re the only one who has this. It’s the opposite of hysteria, which is supposedly caused by all the openness, all the media attention that makes everybody believe they have these things. This is the opposite, where you believe you came up with this on your own, you invented it. These drugs should be working, so you’re unresponsive. The alternative medicine should be working, so you’re not thinking positively enough or working hard enough.

That’s the type of suffering that I can help to relieve. I’m not a neuroscientist, so I’ll leave the physical part to them. But I can help reduce that incredible guilt and shame and frustration.

Let’s talk about the things that actually helped you, that had enduring benefits. A lot of those were really simple and commonsensical, right?

The most important thing for me now is exercise. Something free and simple! I get massage and acupuncture sometimes. It doesn’t always do much, but it sometimes takes the edge off. And then, like, the most basic things: cold compresses, heating pads. I have this one heating pad that draws moisture out of the air, it’s like the Cadillac of heating pads. An elastic band around the head.

You also found aromatherapy very helpful, right? Specifically the combination of lavender and peppermint oils.

It’s absolutely incredible. At the cost of $50,000 and 12 years of my life, but it was probably worth it. Yeah, I always carry it with me. It has to be a high grade of oil, I didn’t realize that in the beginning.

I had to put the book down and run into the other room to tell my wife about that. She goes everywhere with a little vial of essential oils.

There have been studies suggesting that it might go right to the limbic part of the brain, especially in women. It’s great in the bathtub, I immerse myself in it constantly — but the main thing is applying it right to the temple. I do that compulsively.

And just about the only medication you take at this point is pseudoephedrine, your basic over-the-counter sinus decongestant, right?

Right. It’s like caffeine in that it’s a good short-term solution that sort of calms things down. But it loses its effectiveness if I take it more than twice a week. I don’t allow myself to take any pain medication more than twice a week, total.

So the triptan drugs that have helped so many people with migraines, like my wife? Drugs like Zomig or Imitrex, those do nothing for you?

Right. That’s why doctors are researching chronic daily headache at last. A lot of migraine people have really been helped by those drugs, and people like me are left in a different category.

So these days you take no prescription medications at all.

No. I’ve made a choice to be lucid and in pain all the time. Usually I’ll take Tylenol Sinus twice a week — acetaminophen and pseudoephedrine. That’s it.

Of course I should say that everybody’s different. I use lavender oil and that might not do a thing for someone else. Some drug I hated might be the cure-all for another person. Everybody has to go through their own journey. But the thing I really learned from alternative medicine was to be aware of my own body — what makes it worse, what makes it better.

What was the single craziest or dumbest thing you tried?

[Laughter.] It’s so hard to narrow that down. The surgery was clearly the worst, but it was also inevitable. If I hadn’t had it, I would have wondered the whole time if that would have done it. That and Xanax, definitely, were the disasters. In terms of alternative medicine? I don’t know, there was just so much.

You did have a guy pour fig tea in your eyeball. May I just say that?

[Extended laughter.] Alternative medicine, unlike Western medicine, didn’t harm me physically. It was more a case of the “mind-wallet connection,” lots and lots of money. You know, you see somebody for 12 visits at $50 a pop, and it starts to add up. Then there was the vibrating hat I bought off a TV infomercial.

That was good too. This book is often very funny, even though it’s about someone who’s in pain almost the whole time. Did you have any hesitation in approaching it that way?

None at all. I started out wanting to be a comedy writer. The feminist stuff just sort of happened accidentally. It was always my main interest, and I didn’t have to impose it here because it was inherent in the situation. There’s such absurdity in having a disability that people can’t see and don’t believe is a disability, in going to all these doctors who are overpromising, the desperation that leads you to do anything, no matter how illogical, if it might get rid of the pain. The humor was also a coping mechanism too. Irony, for better or worse, is a distancing tool. When you get into the worst situations with this disability, and you’re embroiled in it with no external perspective, a sense of humor is really helpful.

At a certain point you began to make contact with other people who had chronic pain, in some cases as bad as or worse than yours. That obviously changed your perspective.

I was sorry to see all this suffering that takes place in secret in people’s lives. But it was extremely validating to see some of the same exact paths that I had taken. I thought I was a total freak in even having it, and then to meet people who had taken the same drugs and pursued the same therapies was amazing. You can become less self-absorbed when you see that, you can begin to see the bigger picture.

What’s the one thing you would tell someone who’s suffering from chronic pain, maybe in secret, and doesn’t know what to do or where to turn?

That’s a good question. It’s like dating; you can’t be totally desperate, because then you’re likely to make bad choices. You have to make peace with it and accept it, and believe that you can go on with it. That makes you less vulnerable to charlatans and to invasive and dangerous procedures. And you have to live your life in the meantime. For years I always thought I would start living life after I was cured.

It’s a balance; I’m not saying give up on getting relief. I’m still trying, definitely. But just see that a lot of life is lived with uncertainty and ambivalence. Having no pain doesn’t always equal happiness, and having pain doesn’t always equal sadness. A lot of disabled people come to realize that you can be happy and in pain at the same time. All of this is easier said than done! But don’t put everything in your life on hold. It takes time to learn management techniques, and there will be inevitable chaos. It’s not easy.

Are you at peace with the possibility that your pain might never really be cured?

I’m not totally at peace with it, but a lot more so. The odds are that I’ll have this the rest of my life. The more research I’ve done, the more I see that pain that’s constant, and that’s gone on for years, sort of becomes programmed into the brain. There is a chance for, like, the Prozac of chronic daily headache to be invented. I do have some hope that there’s going to be a drug someday that hits exactly the right neurotransmitter. But I have accepted that I can go on. There’s a lot I can do, even in the worst-case scenario. There is the fear that it could get worse, and I’ll deal with that if it happens. But the way it is now, I’ve figured out how to live with it. It’s taken me a lot to get to this point.

Pick of the week: Haunting, gorgeous “Oslo, August 31st”

Pick of the week: "Oslo, August 31st" is a wrenching voyage of discovery in Norway's suddenly trendy capital

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Pick of the week: Haunting, gorgeous

“Oslo, August 31st” is, as the title suggests, an evocation of one day in the Norwegian capital, as experienced by a troubled young man who’s facing the end of summer and the end of his youth. It’s a marvelously constructed personal journey, both wrenching and bittersweet, whose emotional ripple effects stay with you for days and weeks afterward. While much of international art cinema can seem overly talky or conceptually alien to American viewers, this second feature film from Norwegian director Joachim Trier is a dynamic, even breathtaking visual experience without much dialogue or any philosophical heavy lifting, following the bony, handsome, exceedingly vulnerable Anders (Anders Danielsen Lie) through coffee shops, nightclubs and bodies of water, en route to an ambiguous final destination.

I saw “Oslo, August 31st” last year at Cannes and found it powerfully affecting, but I never would have guessed that this small movie from a small country would have touched an international nerve the way it apparently has. In the wake of a breathless profile of doctor-turned-actor Lie and his supermodel wife, Iselin Steiro, in the New York Times’ style magazine — which made the film sound rather like a fashion accessory, or a handbook to Oslo architecture — I almost feel the need to dial back expectations a little. Yes, there are drugs and dance clubs and traveling shots but, honest to Pete, we’re not talking stylish, scenic, lovable hipster romp here, people. While “Oslo, August 31st” definitely has the dynamism and street-level energy of, say, an early Godard picture, and may indeed leave you eager to visit Norway, it’s first and foremost an intimate tragedy about a likable young man who has wandered off the path of life into some very dark woods, and isn’t necessarily finding his way back.

As in Trier’s equally wonderful first film, the 2006 “Reprise” — I’m pretty much the president of the cult on that one — the director is interested in exploring the existential dark side of Scandinavian social democracy, with its largely homogeneous character and devotion to equal opportunity. When I talked to Trier about that film, which featured Lie and Espen Klouman-Hoiner as a pair of arrogant, doomed aspiring novelists, he observed that in Norway “there are a lot of people with a lot of choices. It sounds wonderful but there’s a darker side to that. Lots of people are not dealing with those choices very well.” Anders in “Oslo, August 31st” is something like the worst-case outcome for Lie’s character in “Reprise”; he’s a guy from a loving, middle-class family who’s got looks, health, intelligence and education, but for unknowable reasons finds himself on the edge of middle age as a penniless, unemployable, supposedly recovering junkie.

Trier and co-writer Eskil Vogt adapted their central premise from “Le Feu Follet,” a 1930s novella about alcoholism by Pierre Drieu La Rochelle, but “Oslo, August 31st” could really be set anywhere at any time. It’s about the painful necessity of adapting to change, every single day that we’re alive, and if we identify with Anders even as we rage against his despair, it’s because every living human has at some point considered the possibility that it’s just too much and the struggle isn’t worth it. Anders is doing well in drug rehab, and has cautiously been granted a one-day leave to visit Oslo friends and apply for a job. But we can tell from the first moments of the film that his agenda is more complicated than that; Anders is in the position of a certain Danish prince, evaluating the reasons for being against the reasons for ceasing to be. (Trier, by the way, is cousin to another famous Dane, “Melancholia” director Lars von Trier, and one could argue their visions of the world are related as well.)

“Oslo, August 31st” runs a lean, mean 95 minutes, and not one second seems unimportant. Anders moves through the streets of Oslo looking for reasons to live and reasons to die, and even though we don’t know those streets as he does, we can tell that they’re haunted with memories and private agonies. The city is dotted with construction cranes and demolition sites, remorselessly regenerating itself while he appears to stand still. Indeed, Anders’ family home will soon be sold, and one of his personal missions is to pay a final visit. (The fluid, poetic cinematography is by Jakob Ihre.) He insults a prospective employer, refuses to make peace with his alienated sister, falls off the wagon — at first tentatively, and then enthusiastically — and leaves increasingly pathetic messages for his lost love, a woman who’s now in New York. (It’s the voice of Steiro, Lie’s real-life spouse.) On the other hand, he flirts with a younger girl who seems affectionate and charming, and who seems to open for him the promise of a new beginning. Their scene together at an Oslo swimming pool that has just closed for the season, so suggestive of both death and rebirth (and, literally, of baptism) is so gorgeous I wanted to cry. OK, I did cry, and that wasn’t the only time.

But none of that, not even the scenes where we feel that Anders is in imminent danger of taking his own life, are quite as painful as his visit with Thomas (Hans Olav Brenner), an old friend and veteran of long literary discussions and booze-and-drug sessions. Thomas has a wife and a kid now, and his vices involve an occasional bottle of beer. In the manner of one-time bohemians who’ve more or less grown up, he’s kind of an ostentatious jerk about it — but then admits to Anders, when they’re alone, that he’s desperately unhappy. Perhaps that’s the “ordinary unhappiness” Freud wrote about, the unhappiness we all have to accept to get from the last day of August into the first day of September, in Oslo or anywhere else. But is that enough? Is that ever enough, for anybody? And can we forgive those who decide that it isn’t?

“Oslo, August 31st” opens this week at the IFC Center in New York, and June 1 at Laemmle’s Playhouse 7 and Laemmle’s NoHo 7 in Los Angeles, with more cities and DVD release to follow.

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“Moonrise Kingdom”: Wes Anderson’s mid-’60s love story

Bruce Willis and Ed Norton are at their best in the rapturous summer fantasy "Moonrise Kingdom"

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Tilda Swinton, Bruce Willis and Edward Norton in "Moonrise Kingdom"

All the details of Wes Anderson’s rapturous and hilarious mid-1960s New England summer romance “Moonrise Kingdom,” taken one at a time, are plausible. Indeed they are more than plausible; they’re perfect, from the fitted uniforms and yellow canvas tents of the troop of “Khaki Scouts” headed by cigarette-smoking Edward Norton to the achingly picturesque island home where the brood of children belonging to Bill Murray and Frances McDormand sit around listening to the Leonard Bernstein recording of “A Young Person’s Guide to the Orchestra.” (I’m not going to bother questioning whether that record existed in 1965; some production intern probably spent half a day tracking down its history.)

Yet, as usual with an Anderson movie, this meticulous and convincing detail does not add up to realism but — depending on your perspective — to something either much less or much more than that. Something that could be described, and has been, in all kinds of ways: As fantasy or fairytale; as a whimsical miniature under glass; as a diorama created by a brilliant, obsessive-compulsive child. All reasonable descriptions, at least up to a point — and I’m on board for all of it. I’ve pretty much been on Anderson’s wavelength from Day One — or at least from “Rushmore,” which isn’t quite Day One. That’s not the same thing as saying that I think all his movies work equally well, or that he doesn’t occasionally lapse into laziness or self-indulgence. (I’ll have to give “The Life Aquatic with Steve Zissou” another chance one of these days, but I feel pretty confident that was a misstep.)

I understand why Anderson’s films drive some viewers nuts, in fact, and I would simply respond that it should be clear by now that his vision of cinema and the world is idiosyncratic and not to everyone’s taste and that there’s no point sitting around hoping he’ll become more normal. But here’s what I reject completely: The idea that the artificiality or hyperrealism (a better word, I think) of Anderson’s worlds — which is admittedly cranked up pretty high here — is fundamentally pretentious and insincere, or that it reflects some kind of “kidult” refusal of grown-up emotion. Yes, Anderson’s principal subject, and arguably his only subject, is the collision between the emotional lives of adults and children and the paradoxical tragicomedy it can so often produce. But if Anderson’s adults yearn for the comparative simplicity of childhood while his children long for the big, important feelings they believe (wrongly) go with growing up, that in itself is a distinctly adult perspective.

“Moonrise Kingdom” takes place at the tail-end of summer — that season which is more charged with a rueful sense of passage than any other. Its preteen lovers, Sam and Suzy (played by newcomers Jared Gilman and Kara Hayward, respectively), most certainly aspire to the grand passions of Tristan and Isolde or Abelard and Heloise, and it’s entirely possible they’ve heard of them. They first met backstage during a performance of Britten’s “Noye’s Fludde” at the island of New Penzance’s only church, when Sam was in his Khaki Scout uniform and coonskin cap, and Suzy was wearing a bird costume. (The use of Britten, of all possible composers, as this film’s musical muse is wonderfully unlikely, and totally Andersonian.) After a hot and heavy epistolary romance, they conspire to run away together — as it happens (so we are told by on-screen narrator Bob Balaban), just three days before a major hurricane will hit New Penzance.

As irresistible as our young lovers are — Sam with his corncob pipe and camp-tested scouting skills, Suzy in her saddle shoes and with her dangerous pre-Lolita sexuality — this isn’t a movie about kids, and they are Potemkin protagonists. Against the certainty and clarity of the childhood world, we see the real heroes of New Penzance: Norton’s upright Scout Master Ward, who confesses his secret fears to a reel-to-reel tape recorder in the depths of the night; Bruce Willis’s Captain Sharp, the island’s only cop, who’s in love with Kara’s artsy, bespectacled mother, Laura (McDormand); Murray as the gentle, lawyerly Walt (Laura’s husband and Kara’s dad), who knows he is being cuckolded but can’t quite bring himself to do anything about it. All these lonely people are portrayed with wonderful delicacy and sensitivity, right in the middle of an artificial construction that contains plenty of shtick. I honestly don’t think I’ve ever seen Norton and Willis, in particular, be better than they are here.

Sam and Suzy’s tempestuous love affair, along with that looming act of God that’s boiling up out there in the Atlantic, will not merely bring all these people together but will give them an excuse to escape their everyday routine and their ingrained fears. In that sense, and in others too, “Moonrise Kingdom” is a deeply romantic film, perhaps the sweetest and most compassionate Anderson has ever made. What has evidently confused some viewers is the fact that it’s also an obsessively curated re-creation of an era that never quite existed, a meticulous storybook version of 1965 that’s more perfect than the original. In real life, Boy Scout tents of that era were made of canvas but were never yellow, and government social workers never wore Salvation Army-style uniforms, as Tilda Swinton’s officious character (whose only name appears to be “Social Services”) does here. And so on.

I suspect that people conflate the artificiality of Anderson’s movies with inauthenticity or insincerity (different things, to be sure) because his artificiality is obvious and worn on the surface, whereas the highly mannered films of, say, Martin Scorsese masquerade as realism. I’m not picking that example at random, by the way; Scorsese has identified Anderson as his favorite among younger American directors, I suspect because he sees a kindred spirit. The two men have very different aesthetics, but both are visionaries who see the world through a personal lens, and both are technical virtuosi concerned with managing every detail of their created universes. You’re free to prefer one director’s work to the other’s, of course, but “Raging Bull” and “Goodfellas” are every bit as obsessed with style and production design as any Anderson film. (The cinematography in “Moonrise Kingdom” is by Robert D. Yeoman, who has shot all of Anderson’s live-action films. The production designer is Adam Stockhausen, the art director is Gerald Sullivan and the spectacular costumes are by Kasia Walicka-Maimone.)

To the extent that “Moonrise Kingdom” can be described as nostalgia, it isn’t personal nostalgia, since Anderson himself was not born until 1969. Very likely it’s an attempt to create a fantasy version of the lost world of his own parents. I wonder whether Scout Master Ward, when the magical summer of ’65 fades into memory, will get married, move to Texas and have a son. The island cabin of Walt and Laura feels like a creation out of a classic children’s novel, but it is imbued with the sadness of a failing adult marriage. In the third act, it feels like Anderson and co-writer Roman Coppola get a little lost in plot shenanigans, and they introduce several extra characters (Jason Schwartzman, Harvey Keitel and Swinton all show up in small roles) to little effect. But all of “Moonrise Kingdom” — from Sam’s miniature stolen canoe to the Benjamin Britten excerpts to Captain Sharp’s heartbreaking bachelor trailer home — is a labor of love, as pure and sweet as the lovelorn letters of its young runaways. Wes Anderson can fool some people, maybe, but he’s not fooling me.

“Moonrise Kingdom” opens this week in New York and Los Angeles, with wider release to follow.

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“The Intouchables”: Racial comedy, French style

"The Intouchables" is the biggest foreign-language film of all time. Some critics say it's also racist

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A still from "The Intouchables"

Here’s a startling news item: “The Intouchables,” a lively if largely predictable Parisian comedy about a wealthy quadriplegic and his ne’er-do-well immigrant caretaker, has become the biggest international success in the history of French cinema. Indeed, according to some sources — and these things are notoriously difficult to measure on a global and historical scale — “The Intouchables” is now the biggest non-Anglophone film of all time, with a worldwide gross approaching $300 million.

But beyond the business headlines, what’s really fascinating about “The Intouchables” is the way it exposes the gulf in racial attitudes between France and the United States, along with another gulf that’s just as wide, the one that has film critics and cinephiles on one side and popular audiences on the other. Viewers in numerous countries have eagerly devoured this feel-good fable about two men of different races and classes who forge an improbable friendship (dubbed by some wags “Driving Monsieur Daisy”). While the audience for foreign-language film is inherently limited in America, there’s no reason to believe it won’t do well here also. At the same time, heated transatlantic debate has erupted over whether “The Intouchables” traffics in offensive racial stereotypes, with Variety critic Jay Weissberg writing an uncharacteristically angry review that accused the film of “Uncle Tom racism” and compared the Senegalese caretaker character to a “performing monkey.”

When Harvey Weinstein first acquired “The Intouchables” in the wake of its smash success in France, he clearly imagined another dark-horse Oscar contender, in the wake of “The Artist.” The film has racked up audience awards at film festival after film festival, and currently stands at No. 93 on IMDb’s user-generated “Top 250″ list. Omar Sy, the charismatic Afro-French actor who plays Driss, the caretaker, won this year’s César award (the French Oscar equivalent) for best actor, beating out actual Oscar winner Jean Dujardin. But with the looming possibility that “The Intouchables” could spark a divisive, soul-searching racial debate — which was precisely what squelched the Oscar hopes of “The Help” — those expectations have been downplayed. (That isn’t why “The Intouchables” is being released this week, with Weinstein and most of the film-biz aristocracy in Cannes, but the coincidence is oddly useful.)

Let me come clean right now and tell you that I enjoyed “The Intouchables” quite a bit. If you’re looking for a lightweight summer change of pace, with just a smidgen of Continental flair, here it is. Both Sy and co-star François Cluzet (of the hit thriller “Tell No One”) are marvelous, the former playing a guy who’s constantly in motion, both physically and psychologically, and the latter playing a depressed and repressed guy who literally can’t move, but whose real imprisonment has more to do with his spirit than his spinal cord. Don’t go expecting serious French art cinema, please; those who have described this movie as something like a mid-’80s Eddie Murphy comedy dressed up with classy Parisian settings are correct. But here’s the question, and I can’t answer it for you: Is that such a bad thing, in itself?

Once is not enough for a movie that’s made this much money, of course, and Weinstein already has an American remake in the works, possibly to star Colin Firth as stick-up-butt wheelchair dude. The real Eddie Murphy has gotten too old to play the loosey-goosey, pot-smoking sidekick, but there’s no shortage of guys who could do it: Jamie Foxx is the default setting these days, but I’d go for the suddenly hot Kevin Hart from “Think Like a Man.” I’m not claiming it’s aesthetically or sociologically valid to remake a French movie that already feels like a reheated Hollywood throwback, by the way. I’m saying it’s a cruel reality, like Dutch elm disease or Adam Sandler, and there’s no way to stop it.

To get back to the case at hand, I do understand what the haters find so offensive about “The Intouchables.” (The infelicitous English title, by the way, reflects the fact that they couldn’t really get away with calling it “The Untouchables,” could they?) I was pretty taken aback by Weissberg’s vituperative review, and I tend to believe that “Uncle Tom” is one of those expressions that white people should pretty much never use. On the other hand, I can only applaud him for abandoning the balanced, analytical mode of trade-magazine criticism and saying exactly what he damn well thinks. (As for comparing a black man to a monkey — well, I understand what Weissberg was getting at, but it’s an error of rhetoric, the sort of comment that makes nuance and context disappear.) And I know for sure, from hearing friends and acquaintances in and around the movie business complain about this film, that Weissberg is not alone.

I believe that Olivier Nakache and Eric Toledano, the writing-directing duo who made “The Intouchables,” are innocent of any bad intentions. In fact, “innocent” isn’t a bad word overall, for this movie and the worldview it represents. The French may pride themselves on being the most worldly and sophisticated of all people, but the debate in France about race and immigration and multiculturalism — which ramped up sharply after the suburban riots of 2005 — can sometimes sound strikingly naive to American ears. Until very recently, mainstream French opinion has resisted thinking about the nation in anything except homogeneous terms, despite growing Arab and black minorities (both immigrant and native-born) and evident social problems with segregation and discrimination. (The French census, for instance, is prohibited from collecting data on race or religion, so no one really knows how many French people are black or Islamic.)

There can be no question that the characters in “The Intouchables” are stereotypes, in the broad sense. Cluzet’s character, Philippe, is an aristocratic zillionaire who lives in an astonishingly luxurious flat in central Paris. Since being injured in a paragliding accident, he’s lived inside a cocoon of money and privilege, surrounded by antiques and modern art and a bevy of assistants. Sy’s character, Driss, is easygoing, good-hearted, lustful and uncultured, and his passions run toward pretty girls, getting high and vintage American R&B. Philippe hires Driss specifically because Driss doesn’t particularly want the job — he only shows up to get a signature for his benefits card — and feels no pity for Philippe.

Which is actually a pretty good reason. You get where this is going, most likely: Driss is a pretty inept caretaker, at least at first, but is the only person Philippe knows who will relate to him man to man. There’s a bit of borderline-homophobic humor about their enforced intimacy; there are interludes with hookers and fast cars and late-night conversations fueled by booze and marijuana. Driss learns to like Mozart and modern art; Philippe learns to get down with Earth Wind & Fire and gets some valuable tips about chicks. It’s probably fair to summarize this movie as being the story of a paralyzed white man who needs the help of a younger, stronger, more virile black man to reconnect with his own masculinity, and if you want to say that narrative reflects an underlying latticework of racist attitudes, I won’t argue with you. Then there’s the complicating factor that in the real-life story on which “The Intouchables” is based, the caretaker was of Algerian origin, and hence Arab rather than black. (The filmmakers have said they wanted to cast Sy, and built the story around him, but it’s certainly possible to render other interpretations.)

But one can concede all of that while still agreeing with French historian and multicultural activist François Durpaire, who has responded to Weissberg by arguing that the huge success of “The Intouchables” is likely to have positive effects in Europe’s emerging discussion of race and culture, even if the movie relies on crude generalizations. (Durpaire adds that if “The Intouchables” is offensive, so were the “Beverly Hills Cop” movies.) Movies are not meant to be seminars in sociology, after all, and most viewers will receive “The Intouchables” as an upbeat story about two guys from vastly different circumstances who turn out to have a lot in common and help each other, etc., rather than a lesson in racial semiotics.

Perhaps the strongest endorsement for “The Intouchables” has come from aging French ultra-nationalist Jean-Marie Le Pen, who has described it as an allegory about how the future of his nation depends on disenfranchised young immigrants from the suburbs. He thinks that’s a “dreadful” vision, mind you — but, seriously, who knew that guy was so smart?

“The Intouchables” opens this week in New York and Los Angeles, with wider national release to follow.

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Male grooming: The movie

From beard contests to ball cream, Morgan Spurlock's "Mansome" goofs through modern-day male narcissism

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Male grooming: The movieJack Passion in "Mansome"

American men are bewildered about their place in the cosmos, or so we have been told repeatedly over the last 20 years. They don’t know whether to thread their eyebrows or wield a welding torch, and end up trying to do both at once (which is inadvisable). As comedian Adam Carolla laments in a scene from Morgan Spurlock’s documentary “Mansome,” the old-time certainties of gender identity have melted away: Women are flying fighter jets and men work at the hair salon; there are no longer “chick jobs and guy jobs.”

I get that Carolla is just cracking wise, from inside the bubble of his own lame version of post-rockabilly guy-shtick — he is interviewed inside a garage, with what looks like an orange Camaro behind him in the middle distance — and that if you brought up the fact that those old-time “chick jobs” paid 40 to 80 percent less than “guy jobs,” he’d get all irritated with you for being a drag. He’s still an idiot, though, even if he’s an idiot in quotation marks. That’s kind of the problem with “Mansome,” which tries to tackle the enormous subject of contemporary male vanity as an assemblage of whimsical anecdotes, which are often entertaining in themselves but studiously avoid any semblance of intelligent analysis or historical understanding.

It’s pointless to come down too hard on a film like “Mansome,” because like all Spurlock’s work (including “Super Size Me” and “Where in the World Is Osama bin Laden?”) it’s driven by a good-hearted frat-boy humor that seems fundamentally sincere. It’s more first-person journal and travelogue than it is cultural archaeology, and as such it’s basically OK. Spurlock gets to interview some of his celebrity pals about their attitudes toward masculinity and grooming: Paul Rudd is slightly ill at ease, Judd Apatow is charming, and Zach Galifianiakis steals the show, of course. (When asked to rate his looks on a scale of 1 to 10, Galifianakis responds confidently that some people find him “a strong 2.”)

Spurlock documents his own decision to shave off his trademark porn-star ‘stache, thereby reducing his 5-year-old son to torrents of tears. (It was definitely a mistake, Morgan.) He meets various kooky characters who have some tangential relationship to his theme, including a California suburbanite named Jack Passion who describes himself as a professional “beardsman,” meaning he travels the world exhibiting his Hagar-the-Horrible facial thatch in competitions. (Anthrax rhythm guitarist Scott Ian responds: “Beard and mustache competitions, for want of a better word, are kind of gay.” I laughed, and I know that’s wrong.) Then there’s the elegantly coiffed and tailored Manhattan clothing buyer who describes himself as the “dictionary definition of a metrosexual,” perhaps making up for his teen years as a Sikh immigrant outcast in middle America. And the entrepreneur who has introduced a lotion-y product called Fresh Balls: The Solution for Men. (Yes, it is what you think it is.)

In fairness, Spurlock is at least half aware that all the jokes and episodes of “Mansome” never add up to anything, except perhaps the conclusion that neither male narcissism nor male grooming is anything new, but that they have been coded in different ways at different times. Masculinity is no less a troubled construction than is femininity, and it’s just as easily whipped about by the tides of commerce and fashion. The aristocratic dandies of the 18th century make Spurlock’s New York Sikh metrosexual look like a shoeless Dust Bowl farmhand, and every Important Man of the 19th century, regardless of background or affiliation — King Leopold II! Karl Marx! The pioneering Ambrose Burnside! — had his own tonsorial signature that required extensive maintenance.

Now, I’m not denying that there’s something specific and contemporary about the version of male narcissism wrought by consumer capitalism, with its tendency to turn things once seen as immutable, such as gender or sexual identity, into fluid and exchangeable commodities with no fixed meaning. (Speaking of Karl Marx, it was he who wrote that, under capitalism, “all fixed, fast frozen relations, with their train of ancient and venerable prejudices and opinions, are swept away … All that is solid melts into air, all that is holy is profaned.”) It was to address that question on a pop-sociological level that the term “metrosexual,” first introduced to America a decade ago in this Salon article by Mark Simpson, was originally invented. (Simpson’s coinage was instantly stolen by marketers, of course, and turned into a pretty-boy Frankenstein monster who was, in turn, burned by the resentful villagers.)

Some of that big-picture stuff comes up almost by accident in “Mansome,” but Spurlock doesn’t even pretend to pay attention. He’s just a guy! He’s confused like the rest of us! He makes his little boy cry and watches pro wrestler Shawn Daivari (a Minnesota native who plays the anti-American “heel” called Sheik Abdul Bashir) shave his back all the way down to his butt crack. He sticks for far too long with an embarrassing framing device in which Jason Bateman and Will Arnett go to a spa and engage in uneasy homoerotic banter. He chops up the movie into irrelevant chapters about beards, mustaches, hair and so on, as if those things were unrelated. When he goes to get his own hair cut, it’s at some pseudo-old-fashioned place in downtown Manhattan where the wood fixtures are way too polished and the barbers are conspicuously overdressed. It’s kind of endearing and kind of asinine.

“Mansome” is now playing in Atlanta, Boston, Chicago, Cincinnati, Dallas, Detroit, Houston, Los Angeles, Minneapolis, New York, Philadelphia, Portland, Ore., San Francisco, Seattle and Austin, Texas, with more cities to follow.

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Maggie Gyllenhaal on sexual liberation

The beloved indie star tells Salon about her "vibrator movie" and why she loves playing transgressive women

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Maggie Gyllenhaal on sexual liberationMaggie Gyllenhaal (Credit: Reuters/Mark Blinch)

When I met Maggie Gyllenhaal about six weeks ago, she was enormously and gloriously pregnant, stretching out on a sofa with her shoes off and feet up in a Manhattan office building. (Since that time, Gyllenhaal and husband Peter Sarsgaard have welcomed their second daughter, Gloria Ray, to the world.) We were there to talk about “Hysteria,” the charming, lightweight feminist farce from director Tanya Wexler that explores a key event in the history of female sexuality: the invention of the vibrator by Mortimer Granville, a Victorian doctor who was seeking to cure the mysterious “female malady” that lends the movie its title.

While I wouldn’t assume there’s a vast amount of historical and social accuracy to “Hysteria,” it’s a lot of fun, and could definitely provide a viable moviegoing alternative for adult women eager to move on from “Iron Man” and “Captain America.” Gyllenhaal’s character, the crusading feminist and social worker Charlotte Dalrymple, who becomes the comic and romantic foil to Hugh Dancy’s stuffy, stammering Granville, might be described as a supporting character who takes over the movie. Charlotte effectively becomes the modern viewer’s window into the world of “Hysteria,” insisting as a matter of course that women indeed enjoy sexual pleasure (but are often plagued with partners who don’t know how to deliver it) and espousing then-outrageous views about women’s right to vote, go to college, work outside the home and so on.

Although still best known for her roles in independent films like the 2002 spanking-liberation manifesto “Secretary,” Spike Jonze’s “Adaptation” and the underappreciated “Sherrybaby” (not to mention her early role opposite real-life brother Jake Gyllenhaal in “Donnie Darko”), Gyllenhaal has also appeared in several major Hollywood productions, including “The Dark Knight,” “Crazy Heart” and the forthcoming “Won’t Back Down,” in which she stars with Viola Davis as parents trying to rescue a failing public school. Her prodigious on-screen charm is matched by a reputation as one of the most genuine and easygoing people in the movie business, and although I’d never met her before, this was one of the most relaxed interviews I’ve ever conducted.

We began our conversation, in fact, by talking about the Park Slope Food Coop, the legendary Brooklyn collective grocery store where we are both members. Unlike some celebrity members I could name, Gyllenhaal and Sarsgaard perform their assigned Coop work shifts personally. (She works in the basement, wearing a kerchief and packing nuts, teas, spices and cheeses, although like any other new mom she now has a one-year work exemption.) Is the Coop’s produce both better and cheaper than the pretty but nosebleed-expensive stuff for sale at Manhattan’s outdoor markets, we asked each other rhetorically? It is. Then we moved on to “Hysteria.”

So it seems like this must have been a fun character to play. You get to be the totally uninhibited character in a movie where everybody else has the 19th century hanging over them. You’re the liberated woman at a time when there almost weren’t any.

Right. Sometimes, a movie is set up where you’re meant to be winning, you know what I mean? I’ve certainly played a lot of characters who were really flawed and did horrible things, and where the challenge is to ask the audience if they can be compassionate enough to still have empathy for you. That’s really important to me, and I think that’s a really interesting thing to do with film — play a character who’s really flawed and ask the audience to practice being compassionate. Or who does things that are really outrageous that the audience might have judgments about, and make them question where their judgments come from.

This is completely different. This is like, you walk in and the movie doesn’t work if Charlotte isn’t winning. But the one thing I really did think — I mean, the script was so great, and so much of the tone of the movie was in place. I didn’t think it needed to be shifted almost at all. But one thing that I think comes from me is that I didn’t care at all about her being historically accurate. About her not having the 19th century over her, like you said. I think the movie is served better if she seems wild even now, if she seems so full of life that she could come from any time. Or any planet!

Because what she’s talking about in the movie — the actual politics — is very simple. The movie doesn’t have room for a complicated discussion of socialism. She says, “Socialism is a lot of people working together.” Well, you know, I mean — there’s a lot more to say about it! (Laughter.) Or, you know, women should have the right to vote, women should be able to go to college. We’re good with that here! So because her politics are so simple, and because the things that were so outrageous that she was saying do not sound outrageous now, she needs to be more outrageous in her spirit. So, yeah, it was fun to be able to just go, “You guys are constricted and constrained by all these things, and I just don’t feel them!”

I have to say the question of historical accuracy, or lack thereof, really never bothered me. It’s not that kind of movie.

Yeah. I think you’re on the wrong track if that’s what you’re worried about!

But one thing the writers really got right — or maybe this is your theatrical background and English-lit education at work — is that Charlotte feels like the heroine of a George Bernard Shaw play that Shaw never got around to writing.

Right! Right! She fits into a history of great wild women, you know? Even, like, ’40s women, screwball women, who you love even though they’re pissing you off. So, yeah, I agree with that. I liked that about it. I thought it would be fun!

You know, I probably can’t push this analysis of your career too far, but you do have a pattern of playing transgressive women, women who are defying social norms. Do you see it that way?

Well, I guess I think — and this might not be true either — but if you think about who might be interesting to watch, is it interesting to watch someone who’s absolutely following the norm and the pattern you’re used to watching? Sometimes people write those characters and they’re much more secondary characters meant to give you some exposition or whatever. Usually, the interesting character in a movie is either making a big change or transgressing somehow — making you think about how you live. So, yes, that is what appeals to me, but I also think it appeals to many people.

But no, I think maybe you’re right. When I think about Chekhov’s “Three Sisters,” for example — did you happen to see the production that we did last year?

No. I really, really wanted to. I love that play.

Well, so, of the three sisters, the transgressive one is Masha, and that’s who I played. But of course Olga is such an interesting character, and she’s not really transgressing at all. And in the movie I did after this, which is called “Won’t Back Down,” I’m also fighting against everything. It’s coming out in September, I think. I’m so pregnant! I’m all like, “It’s coming out sometime! I’ll talk to people about it!” Then there’s my character in “Crazy Heart” — she’s transgressive too, in a way. In her heart.

And of course everybody’s going to bring up “Secretary,” which, although it’s quite a different movie from “Hysteria,” is also about liberating female sexuality.

Well, yeah. That’s why people think about me that way. It’s always about what your first big movie is, that anybody knows about. And that movie is about transgression. I mean, that movie is overtly about what it means to transgress, and how it feels, and how you can live as a transgressor. But maybe it’s true: I am interested in people who are thinking — although the girl in “Crazy Heart” definitely isn’t thinking, or she wouldn’t do a lot of the things she does! I don’t know, you probably can’t tie them all together.

No, I wasn’t arguing that they all fit into that template. I’m always curious about the effect of having appeared in a really big movie. Do people see you on the street now and recognize you just because of “The Dark Knight”?

Some people do, yeah. It’s funny, because I’ve moved back and forth a lot. Even last year, I made “Hysteria” and then I made “Won’t Back Down,” which is a studio movie. There’s such a different feeling in terms of schedule, in terms of time, in terms of subject matter. I used to find it much easier to work on little movies: the pace and the way of working was just better for me. But I think I’m starting to change. I think I work the same way now on a smaller movie as I did on “Won’t Back Down.” It depends on the style of the movie. It’s harder when you’re in and out, like on “Dark Knight” or “World Trade Center.” I find that difficult. You’re not going to work and working for two months, going into the tunnel and just getting in your body who you are.

How has moving into your 30s changed your career? Don’t get me wrong, you’re still young! I was actually thinking it might have opened up some different possibilities.

Yeah, I actually feel like getting older has opened up a spectrum of roles to me. When I was younger, a lot of the roles that were coming to me were like, especially from a more Hollywood standpoint, the wacky girl. (Laughter.) Now I feel really drawn to playing grown-up women. I’m 34, and maybe it’s the way people age now or whatever, but I still feel like some roles I play are not grown-up women and some roles are. In “Won’t Back Down” she’s a child. In “Hysteria” she’s a woman, and in “Crazy Heart” she’s kind of half and half. You know, I have one foot in and one foot out. But thank God I’m done with, like, the wacky 25-year-old girl! That never worked that well for me. Plus, it’s so interesting to see a crop of really talented new actresses who are in a different generation.

Tell me who you especially like.

I love Rooney Mara. I was absolutely blown away by her performance in “Girl With the Dragon Tattoo.” Absolutely blown away. And to be honest, when you’re an actress, you go in and say, “All right — show me what you can do!” And every turn of that performance was excellent, and not just excellent in the way that some young actors are, where they’re just working on instinct and they have no craft. That was a crafted, excellent, beautiful performance. So to root for someone younger, that’s new for me. (Laughter.) You know, I’m sort of not in that young group anymore! I’m in another group now, but I like seeing talented young women come along. It’s exciting! What are they like? What I loved about Rooney Mara in that movie was that she wasn’t asking for anyone to love her. That’s hard to do!

“Hysteria” opens this week in New York and Los Angeles, with wider national release to follow.

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