For about five to seven days of every month, a woman may as feel as though she were a different person. A person she doesn’t like. Things come out of her mouth that she normally wouldn’t say, cruel things, directed at the people she loves. A soundtrack of self-loathing thoughts loop in her head. Any rejection during this period has the ability to wreak fearsome terror on her psyche. She may have sudden outbursts of sobbing, overwhelming sadness or an oceanic feeling of anxiety. One woman described the several-day sensation as though she were “being forcibly held underwater” — and every time she came up for air, a “boot was pushing” her back down. Then, suddenly, the melancholic fog lifts, the fatigue evaporates and she is herself again. All because she got her period.
Doctors and psychiatrists at work on the newest version of the Diagnostic Manual of Mental Disorders — the American Psychiatric Association’s bible for mental-health professionals — describe this confluence of symptoms as Premenstrual Dysphoric Disorder (PMDD). The revised version of the DSM, just the fourth new edition in 52 years, will be published next year.
Since 1987, PMDD has lingered in the ghetto of the DSM: the appendix pages where proposed diagnoses are deemed in need of “further study.” But right now, it appears as though PMDD will ascend in the ranks from a hypothetical ailment to illness to become a full-blown depressive disorder; taking a place alongside Major Depression and Bi-Polar Depression. The upgrade in status — which will be determined in the next several months — has become the latest flash point in an ongoing controversy between psychiatrists, academics, activists, pharmaceutical giants and women who insist they suffer from the disease, as well as doctors and women who refute the existence of PMDD all together.
PMDD is not just PMS, says Dr. Kimberly Yonkers, a professor at the Yale School of Medicine and Psychiatry. “It’s more complicated than that,” she says. “It involves emotional symptoms … Women with PMDD have significant impairment,” she adds, that can interfere with going to work, school or being able to participate in a household.
Yonkers is a champion of PMDD research, and she also sits on the committee that will either greenlight or ax PMDD’s placement in the DSM.
It’s important because the DSM remains the medical doctrine that separates the sad from clinically depressed, the neurotics from the normals and, potentially, the bloated from those with a mood disorder. Besides practitioners and patients, another huge stakeholder in the debate is pharmaceutical companies. When a new diagnosis makes its way into the book, drug companies such as Pfizer and Eli Lilly set off to manufacture a drug to alleviate the symptoms. Or in the case of PMDD, they can just rebrand an old drug to do new tricks.
So what is PMDD? The current criteria being proposed for PMDD includes mood swings, marked irritability or anger or increased interpersonal conflicts, feelings of hopelessness, marked anxiety and decreased interest in usual activities. Also: a subjective sense of difficulty in concentration, lethargy, a marked change in appetite, insomnia, a subjective sense of being overwhelmed and other physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” weight gain.
Those physical ailments are the most controversial of the new proposed criteria. Some argue this would shove physiological or gynecological issues into the psychiatric realm, scrambling a mind and body separation that keeps mental health issues discreet from physiological ones. If the newest proposal makes it into the DSM a woman will need to have had five of the symptoms during the past year, including the physical ones.
The debate has created unlikely allies. Pharmaceutical companies are eager to provide new drugs to treat PMDD. In 1999, the year Prozac was set to expire, Eli Lilly, the manufacturer of Prozac, went to the Food and Drug Administration to seek approval for Prozac as a treatment for PMDD.
The FDA approved the patent extension (in contrast, the European counterpart to the FDA found there was not enough research to establish PMDD as a medical diagnosis because of fuzzy criteria and shoddy self-reporting on behalf of women who had to track their daily moods for two months straight). It is the only time the FDA has approved treatment for a diagnosis that has not been recognized by the American Psychiatric Association. Eli Lilly then repackaged Prozac as pink and purple gel capsules and rechristened it Sarafem.
This matters because once a patent expires, a doctor can write a prescription for Prozac and the patient can get a cheaper generic brand. However, in the case of a patent extension to treat a new specific illness, there is no generic option. So when a woman gets a prescription for Sarafem, she can only get Sarafem.
Sarafem ran advertisements directly to consumers on TV and in women’s magazines. One ad featured an ordinary-looking woman in plain clothes angrily trying to pull a grocery cart from a row. The tag line read: “Think it’s PMS? Think again … It could be PMDD.” In the first six months Lilly reported $19 million in Sarafem prescriptions. By 2001, it had raked in $85 million, then sold the patent to Galen pharmaceutical company for $259 million.
PMDD skeptics argue that this debate is about selling drugs, not science.
“PMDD is an invented ‘mental illness,’” argues Dr. Paula J. Caplan, a research associate at the Du Bois Institute at Harvard University, and author of “They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal.”
Caplan, who chaired a DSM work committee during its fourth revision, said she was appalled not only by the aggressive lobbying done by Eli Lilly to push PMDD through the committee, but also how much hard cash the company put into the research and trial groups. Caplan and others contend that PMDD has too much overlap with other mood disorders, such as depression. Creating a new diagnosis, they fear, would mostly benefit big pharma and not suffering women. Caplan argues that women “learn to pathologize themselves, often ignoring the real causes of their upset,” such as a failing relationship, a history of abuse or depression.
Additionally, critics of PMDD believe that the diagnosis is just another way to medicalize the female experience. PMDD, it’s argued, plays into ancient notions of women as overly emotional and unpredictable and needing to be contained by forces other than themselves. From puberty to PMS to PMDD to pregnancy to postpartum depression to menopause, opponents argue that throughout history there has been a one-sided conversation between doctors and women about the female body.
Indeed, public medical authority on women’s health does not have a sterling track record. In the 1800s, when issues surrounding the luteal phase (the week before menses begin) of a woman’s menstrual cycle began to be documented, there’s been a ridiculous parade of treatments. Dr. William DeWees of University of Pennsylvania coined the expression “melancholies of menstruation” in 1843 and promoted the idea “that the uterus exerts a power over every body system.”
Through the 1900s, psychoanalysis became the main treatment for women who felt not only emotional distress but physical symptoms, such as breast tenderness, bloating, food cravings and headaches during their luteal phase. In 1931, Dr. Robert Frank championed medicinal treatments for women who suffered from what he called premenstrual tension and for the next 50 years women who sought treatment for pain and distress during their luteal phase were given diuretics, saline cathartics, caffeine, calcium, Vitamin B, antispasmodics, laxatives, enemas, alcohol tonics, and in severe cases hysterectomies. Now the cure being proposed is antidepressants. Other psychotropic drugs such as Zoloft and Paxil have also gained approval by the FDA to treat the symptoms of PMDD.
In a 1997 study of 200-plus women who were diagnosed with PMDD, conducted by Yonkers, 60 percent of women said their symptoms improved when they were given the antidepressant Zoloft. This raises an obvious question: What if these women were just depressed already?
Caplan argues that women who self-diagnosis themselves as having bad PMS or PMDD are suffering from depression for internal or external reasons, not because their menstrual cycle is wonky. In an article from the Journal of Women and Therapy, Caplan cited the experiences of an obstetrician who treated women who complained of severe PMS :
Ian Tummon an obstetrician-gynecologist who has suggested (Tummon & Kramer, 1994) that even the term “PMS” no longer be used, reported that when his women patients begin an office visit by saying, “Doctor, I have terrible PMS,” they never again mention PMS during the rest of the session. Instead, he wrote, they spend the whole time talking about the way their husbands abuse them or about their 14-year-old children who won’t come home at night. To label these women mentally disordered – and send the message that their problems are individual, psychological ones – hides the real, external sources of their trouble.
Then what to do with a problem like Elise? Elise is a graduate student, petite, blond, with a Brigitte Bardot pout. She has never been abused. Has thrived in a healthy relationship with a female partner. Doesn’t have kids or a household to manage. Yet for years, she was incapacitated for at least seven days out of the month.
“Right before my period I would get incredible fatigue and cramps that would cripple me,” she says. “I guess I wasn’t myself, because ‘myself’ isn’t usually in such terrible discomfort. So yeah, of course, I’m more irritable and easily overwhelmed.”
Elise was diagnosed with a mood disorder before she sought treatment for her menstrual distress. She takes Zoloft for her moods and birth control for her periods. She skips the row of sugar pills every month on her birth control packet, meaning she doesn’t get her period at all now. “Breast cancer runs in my family, and taking the birth control I’m on ups my rate for breast cancer but it’s a risk I have to take. Otherwise I’m essentially an invalid for seven to 10 days. For Elise, all the solutions have seemed imperfect.
Those in favor of PMDD being absorbed into the mood-disorder section of the DSM argue that the mood swings and irritability and depressive symptoms amount to a separate diagnosis from regular depression because it is linked to the menstrual cycle and only appears days before the uterine lining is shed and disappears days afterward. “The timing is exquisite,” says Dr. Jean Endicott, professor of clinical psychology at Columbia University’s College of Physicians and Surgeons. Endicott also worked with Yonkers on the 1997 study.
If PMDD were to make it into the DSM, it’s possible that women could have a bona fide medical excuse for missing work or school during those days. Women need to report distress, not just discomfort, to their doctors to be diagnosed under the proposed criteria. The treatment regime as it exists now is antidepressants, not pain killers, anti-psychotics or tranquilizers.
Historically, differences in the sexes have been used as a tool of oppression, there is no doubt of that. However, what if there is a difference between men and women when it comes to the way hormones affect their moods and bodies? Even if women are the only ones who can get diagnosed with PMDD, even if people call it sexist, does that make it less real?
“One of the things I find frustrating about modern feminist critique,” Elise says, “is that I’m expected to be tough no matter what my body deals me, otherwise I’m giving in to patriarchy. What if sometimes, I’m in pain and I can’t do it on my own. What has to happen to make that acceptable?”
It occurred to me, days into being haunted by the most recent “Mad Men,” that there was some oblique foreshadowing to Joan’s terrible choice. “Why do they get to decide what’s going to happen?” That’s what Pete Campbell demanded several weeks ago in an episode titled “Lady Lazarus.” “They just do,” Harry Crane responded.
Campbell, frustrated at his inability to pull off a longer-term affair with Beth Dawes, was talking about women as sexual gatekeepers. Despite having all the trappings of privilege and power in his world, Pete is not only unsatisfied, he’s enraged by the belief that this erotic capital somehow makes women more powerful than men.
But we’re talking about a man who blackmailed a scared au pair into having sex with him – rape, to my mind – and, when he showed up at Beth’s home with her husband after she rejected him, seemed to be trying for a repeat. In Pete’s turn this week as Joan Harris’s pimp, stacking the deck to make her choice all but inevitable, he is trying to restore a sexual order where women have very little decision at all. No wonder the selling point of the Jaguar is whether you can truly own something beautiful — this episode is all about men trying to own women.
This is entirely in character for Pete – and also for the morally weak men of Sterling Cooper Draper Pryce, prostitution-client and client-bedder Don Draper included. But I’m disturbed by the suggestion in many reactions – including in Salon’s excellent recap – that we should be disappointed in Joan as a character. Nelle Engoron argues that “seeing Joan allow her body to be used in this fashion is worse because of what it suggests about her character. We’re not long past the time when all women who gained a position of any power were accused of sleeping their way into it. To literalize that degrading accusation in Joan renders her less than we’ve always thought her to be.”
But in striking a deal that involves an ownership stake in the company that seems to matter more to her than her own family, Joan doubly takes possession of the means of production. It’s not “empowering,” and it’s a partly coerced decision – she’s not even given accurate or full information about the partners’ response, who were in turn misled about her position, and she believes they think she’s a whore anyway — but it’s a rational choice that will give her much more autonomy than anything else available to her.
As Amanda Marcotte put it in the comments of her excellent video recap, “this episode really exposes how people see sex work, especially the perplexing … belief that selling is worse than buying … or pimping. Which is pure, unadulterated misogyny.” It’s true that Joan has plenty to offer the firm beyond her gorgeous breasts, but after 13 years and one brilliant but unappreciated turn as a script reader, the men at the firm still see her as either the seductress or the tough mom figure. (Peggy managed to de-sexualize her image, but she has become professionally invisible at the company.) Meanwhile, after an on-again, off-again relationship with Roger that definitely was on the prostitution spectrum regardless of her feelings for him, Joan has clearly come to believe that she can’t rely on him either emotionally or financially.
Most relevant of all is the fact that finally taking the respectable route of marriage – itself traditionally transactional — has failed Joan. It has not protected her in any sense – not from sexual or emotional harm, or from her “honor” being besmirched, or from financial instability. The men at SCDP seem to feel like they vaguely need to put up a fight not because Joan is a human being who should be in charge of her own bodily autonomy, but because of a chivalric urge that either puts women on a pedestal or concedes them as the property of another man, as Don Draper tries to do by saying Joan is married. Of course, not only does he know full well that her marriage is over, he’s been an active perpetrator of the undermining of marriage as an institution of either protection or respect.
Yes, Don is trying to change with his marriage to Megan, in which he not only has been faithful (so far as we know) but also no longer holds all the cards. In this week’s episode, Michael Ginsberg’s awed declaration that Megan Draper comes and goes as she pleases echoes Pete’s bitterness about women calling the shots. For a brief minute there, Megan seemed to be pulling off a rare balance for the office – a conventionally beautiful and sexually confident woman whose ideas are actually taken seriously. But she only got there by marrying well, and while she may be wielding a lot of power in the relationship now, she still essentially serves at Don’s pleasure. Joan, on the other hand, owns something that will last as long as the firm does.
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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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I don’t think I’m breaking any news if I tell you that “The Avengers,” Joss Whedon’s ensemble action-adventure that unites an entire posse of Marvel Comics superheroes, will be far and away this weekend’s No. 1 film at the box office. (In fact, “Avengers” is already the eighth-highest grossing film of 2012, with more than $260 million in global revenue before its North American release.) Or that a large majority of those ticket buyers will be teenage boys and young men. Like most summer “tent-pole” productions — those designed to support franchises, and ensure the financial future of major studios — “The Avengers” is aimed squarely at guys under 35, long the demographic, psychological and economic bulwark of the movie industry. In the weeks ahead, we’ll see a whole bunch more male-centric, big-budget releases: “Battleship,” “The Dictator,” “Men in Black III,” “Prometheus,” “The Amazing Spider-Man” and “The Dark Knight Rises,” potentially the biggest of all.
All this is standard operating procedure in 21st-century Hollywood, where the industry is dominated by post-boomer males reared on the comic books, TV shows and blockbuster movies of the ’60s, ’70s and ’80s, and the audience is understood in almost Pavlovian terms as a slavering horde of permanent adolescents. Audience familiarity and “pre-awareness” are greatly prized, so nearly all these guy-oriented movies derive from superhero comics or video games or other decades-old pop franchises. (It is, of course, possible to go too far into the pop-culture past. Let’s observe a moment of silence, once again, for “John Carter.”) We can certainly argue about which of these movies create an interesting twist on existing formula and which are cynical crap, but I don’t think we can argue that it makes much difference to the bottom line. “The Avengers” will make a kazillion dollars, and so did “Transformers: Dark of the Moon.” The differences between the two are mostly a matter of fine-grained detail; they’ve both got cartoonish male bonding, a lot of stuff blowing up, and hot-chick eye candy.
If you’re female and you’re interested in any or all of the above pictures, by the way, I apologize for making it sound as if you don’t exist. But in marketing terms, you don’t. There’s no end of paradox in Hollywood’s patronizing attitude toward female viewers, especially given the long-held marketing truism that in a date-night situation, the woman’s vote typically holds more sway than the man’s. (It’s a standard sitcom joke, right? She persuades him to go see “The Notebook,” and he has to pretend he didn’t cry at the end.) But broadly speaking, women are supposed to be satisfied with the mid-budget, low-prestige romantic comedies made on the Hollywood margins, many of which are so phoned-in and formulaic — hello, Garry Marshall! — they make Michael Bay look like Fassbinder. (Actually, Michael Bay is kind of like Fassbinder. But let’s not get distracted.)
Of course, the Hollywood suits have no objection to making enormous piles of money off female moviegoers, whom they rediscover every few years. (See also: “Ghost,” “Pretty Woman” and the careers of Meg Ryan and Hugh Grant.) But even enormously profitable franchises like “Sex and the City” and “The Twilight Saga” exist in a sort of pink-hued ghetto, and are widely understood both inside and outside the industry as being silly and second-rate. As opposed to the movies about muscular guys in colored costumes who fight evildoers from outer space, which attract the biggest budgets, the biggest stars and the highest possible production values. When feminist critics argued, for example, that “Sex and the City 2″ received far more scathing treatment from male reviewers than did guy-oriented movies that were every bit as wretched, I at first resisted. I now think they were correct: Critics make allowances for dumb, macho action movies, because they conform to unconscious norms and expectations, in a way they don’t for silly, superficial “vagina movies.” I have long contended that if you construct a Venn diagram showing the best of the (universally derided) “Twilight” movies and the worst of the (universally praised) “Harry Potter” movies, there’s way more overlap than fans of the latter would easily admit.
All of this reflects deeply ingrained social and cultural ideas about gender, which are present in people of both sexes. Maybe men’s preference for violent action yarns and women’s preference for sappy love stories — and our tendency to understand one as more “serious” than the other — are hard-wired in some biological way, although that falls a long way short of scientific truth. But despite the torrent of male-centric franchise flicks we’ll see this summer, and next summer, and for all the summers into the foreseeable future, the tide in the Hollywood gender wars has begun to shift, slightly but perceptibly. As I said earlier, “The Avengers” will be No. 1 this coming weekend. But the top-grossing film for the preceding six weeks was a female-oriented picture: Four weeks of “The Hunger Games,” followed by two weeks at the top for surprise hit “Think Like a Man,” whose principal audience was not just women but African-American women, who make up about 6 percent of the United States population. (Clearly a lot of other people went to see it too.)
Those six weeks aren’t statistically meaningful by themselves. But when added to the big numbers rolled up last year by “The Help” and “Bridesmaids,” and the $1.7 billion taken in so far by “The Twilight Saga” around the world, they begin to suggest the contours of a new reality, one in which films aimed at girls and women are high-end blockbusters on an equal footing with guy-flicks. This year, “Hunger Games” will be somewhere near the top in global box-office returns, alongside “The Avengers” and Chris Nolan’s final Dark Knight film. While I don’t think “Hunger Games” is likely to be remembered as a cinematic breakthrough, it’s an important movie in other ways. Its canny blend of science fiction, action flick and love story nosed it out of the pink ghetto in various ways; it was presented by industry insiders as a high-stakes gamble and a worthy successor to the Harry Potter franchise, and male critics were mostly respectful, not reacting as if they were being flooded with icky estrogen. If the film’s audience was predominantly female, the film’s ethos — the cultural narrative surrounding it — was more butch.
Maybe it’s coincidental that two of the biggest female-oriented films we’ll see this summer — Pixar’s animated “Brave” and “Snow White and the Huntsman,” with Kristen Stewart and Chris Hemsworth — are genre-mixing action pictures with independent-minded heroines. But when it comes to the sluggish, reactionary and massively over-thought process of making Hollywood movies, I don’t believe in coincidence. Some of you with long cultural memories may be wondering whether this could mark the beginning of a long-arc trend that brings us back to big-budget Hollywood movies that aren’t so niche-marketed and gender-specific, that are meant to appeal to all ages and both sexes. One answer to that question is “Hey, Tim Burton and James Cameron and Peter Jackson,” and another answer is “only sort of.” In the meantime, it’s business as usual: “Battleship,” which is based on “the classic Hasbro naval combat game,” will open directly opposite “What to Expect When You’re Expecting,” which is based on a series of lecturey and divisive pregnancy advice books. I honestly can’t decide which one to see first.
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It started around February, when Republicans were still eager to talk about contraception. The Obama administration, or so Mitt Romney charged in Colorado, was forcing religious institutions to provide “morning-after pills –in other words abortive pills — and the like, at no cost.”
It was, of course, a lie. Romney was conflating two different pills: emergency contraception, known as the morning-after pill, which prevents a pregnancy; and chemical abortion, or mifepristone, which ends a pregnancy of up to seven weeks’ gestation and isn’t covered under the new guidelines. Since both pills were marketed in the U.S. around the same time, even some pro-choicers have gotten confused. But Colorado happens to be the epicenter of people confusing them on purpose. It’s the birthplace of the Personhood movement and home to Focus on the Family, both of which have strategically called emergency contraception “abortion” on the scientifically unproven basis that they could block a fertilized egg from implanting.
There are a host of ironies here. Obama has earned the renewed support of reproductive-rights advocates by requiring health insurers to cover contraception, but the Center for Reproductive Rights is still taking him to court – with oral hearings being held this week before a New York federal court -– for overruling the FDA’s recommendation to lift the prescription requirement on emergency contraception for women under 17. That litigation has been winding its way through the system for over a decade, throughout the Bush-era politicization of the FDA, eventually resulting in a federal judge concluding that “the FDA repeatedly and unreasonably delayed issuing a decision on [the emergency contraception pill] Plan B for suspect reasons.” The FDA was ordered to explain why Plan B shouldn’t be available over the counter for girls 13 and up. When the Obama administration overruled the FDA’s recommendation to make it over the counter, U.S. District Judge Edward Korman suggested the Center for Reproductive Rights reopen its case.
“It seems to me that what we’re going through is a rerun of what happened before,” Korman remarked, referring to politics trumping the recommendations of medical professionals.
The Obama administration’s unspoken but unmistakable fear was of an election-cycle attack line that Michele Bachmann would use anyway: That teenage girls would be able to get Plan B from “the grocery store aisles next to bubble gum and next to M&Ms.” That was, in fact, an echo of the language President Obama himself used to invoke a highly unsupported bogeyman: that “a 10-year-old or 11-year-old going to a drugstore would be able to, alongside bubble gum or batteries, … buy a medication that potentially if not used properly can have an adverse effect.”
But there is another twist, so far mostly overlooked: Emergency contraception won’t be covered by insurance for everyone, since it’s available over-the-counter for those who can show I.D. proving that they’re 17 or older. They’ll still have to fork over around $50 a pop. But as long as girls 16 and younger need a prescription for the morning-after pill and they have insurance, it will be fully covered — effectively free. The same goes for women older than 17 who decide to jump through the hoops of getting a prescription, either for over-the-counter Plan B or the prescription-only generic and Ella versions.
As much as pro-choice advocates want to lift the barriers that make emergency contraception hard to get — because it’s more effective the faster you use it — one of those barriers, the prescription requirement, also mitigates another, the high cost. Said Adam Sonfield, a senior public policy associate at the Guttmacher Institute, of this catch-22, “It presents a tradeoff between cost and access.”
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Part of the reason people get confused about emergency contraception and abortion is because lots of people are confused about the basic biology of pregnancy: specifically, that it doesn’t necessarily happen instantaneously and that sperm can live in the body for several days, during which time a woman can ovulate and an egg can potentially be fertilized and implant. Regular use of hormonal contraception prevents ovulation and the chance for fertilization; emergency contraception essentially works the same way except that it’s taken after sex, by which point ovulation may have already happened. But according to recent studies, there is no evidence that taking emergency contraception after ovulation and fertilization will stop the egg from implanting.
But the misinformation and misunderstanding have created a contradictory public health picture when it comes to emergency contraception. In some ways, it’s become more accessible. In 2010, the U.S. approved a longer-acting French variant of Plan B, known as Ella, and there are scattered experiments in convenient delivery, from a birth-control vending machine at Shippensburg University in Pennsylvania to a new bike messenger service in London, both of which caused minor news sensations. The annual “Back Up Your Birth Control” campaign has been promoting the line “EC=BC,” emphasizing that emergency contraception is birth control, not abortion — just in case that is a barrier for women who are considering taking it. And the Center for Reproductive Rights’ petition did manage to lower the age restriction from 18 to 17.
But there are more disturbing suggestions that misinformation is triumphing. A recent Boston Medical Center study found that many pharmacists were still often misinformed about the age requirement and were even more likely to wrongly refuse emergency contraception to 17-year-olds in low-income neighborhoods, where the rate of unintended pregnancy is higher. In Honduras, the Supreme Court upheld the criminalization of emergency contraception, which means women who use it could be jailed. Personhood initiatives, which oppose the morning-after pill, have so far failed in Colorado, Mississippi and Oklahoma, but they’ve introduced false doubts by providing even more opportunities for pundits and candidates to say “the morning-after abortion pill.”
It’s a problem that dates back decades: When, throughout the ’90s, the U.S. considered approving a French chemical abortion pill known as RU-486, it was widely called the “morning-after abortion pill,” including, often, in the New York Times. The distinction wasn’t pressed by the pro-choice community itself. “At the time, the prevailing medical wisdom was that there is a continuum rather than a bright line between EC and mifepristone,” said Gloria Feldt, who was president of Planned Parenthood at the time, with the benefit providing more options for women who did not wish to be pregnant. “It was also assumed that a formulation of mifepristone would eventually be made for use as a true ‘morning-after’ pill.” The widespread belief, she recalled, was that a chemical abortion pill would “solve all the abortion debate problems and guarantee privacy.”
Another problem was that although doctors and non-professionals had been giving women high dosages of regular birth control pills for decades as a form of emergency contraception, the science of exactly how emergency contraception worked remained unclear. The medical definition of pregnancy remains “implantation of a fertilized egg,” but let’s say you believe, as the Catholic Church does, that fertilization itself creates a human life. Anti-choice advocates obsess over what would happen if a woman who took emergency contraception did happen to ovulate anyway and an egg potentially was fertilized, which is enough reason for some of them to call postcoital contraception “abortion.” They have claimed that hormonal contraception makes the lining of the endometrium inhospitable to a fertilized egg, constituting “murder.” Even the official packaging for Plan B, the single-step version of emergency contraception, suggests that “in addition” to blocking ovulation and fertilization, “it may inhibit implantation (by altering the endometrium).”
Except that we now know it doesn’t, even if you walk down the path of remote maybes, which requires you to believe that a zygote, which may not implant for unknowable reasons, has the same rights as a living woman who doesn’t want to be pregnant. As Princeton’s Kelly Cleland pointed out recently, “The science has evolved considerably in the last 13 years. Newer evidence, published since the Plan B label was approved, provides compelling evidence that levonorgestrel EC (LNG EC) works before ovulation, but not after.” The International Consortium for Emergency Contraception and the International Federation of Gynecology & Obstetrics also note that two new studies have shown conclusively that if a woman has ovulated and an egg has been fertilized, it’s too late for emergency contraception to work. They recommended that the language on the product labeling be changed.
Of course, scientific evidence has rarely had much place in this debate. In the meantime, even the most non-ideological news sources keep making the mistake alongside the ideologues. Last week, a furor erupted after the Associated Press reported that “Women seeking to take emergency contraception like the so-called ‘morning after’ pill would have to do so in the presence of a doctor under a bill before the Alabama legislature.” That is, until Erin Gloria Ryan from Jezebel read the actual bill and saw that it was, in fact, a law meant to limit chemical abortion, not emergency contraception. (A spokesperson for the AP said a correction was being prepared). “The confusion over this issue is probably one of the reasons emergency contraception hasn’t had as positive an impact as hoped when it comes to lowering the abortion rate,” wrote Amanda Marcotte at RH Reality Check. “If women think it is some kind of abortion-ish thing, they probably think taking it is a big deal, instead of thinking of it more like taking the pill, since it’s basically the same thing.”
But talk about moved goalposts. If ’90s-era advocates had hoped that the ability to end a pregnancy in the safety of your home with RU-486 — the actual abortion pill, not the morning-after one — would defuse the abortion debate, their more recent counterparts hoped to take it to the next technological level by providing “tele-med” abortions. They would involve doctors seeing a woman over webcam with a nurse practitioner physically present, helping women in remote areas with ever-dwindling options for safe abortions to access them. But four states have already passed requirements meant to undercut these options by forcing a doctor’s presence, and the bill the Associated Press misreported was aiming to add Alabama to the list. All in all, there have been fewer gamechangers, and more cases of one step forward, two steps back.
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The Playlist doesn’t break news all that often, merely seeing fit to be a one-stop shop for the movie news that everyone else breaks during the day (I don’t mean that as an insult, the Playlist is the site I go to if I only have time to surf one movie news site in a given day). So it’s somewhat of a big deal that the Playlist broke a pretty major story last week, confirming that director Gary Ross will not be back to helm the second and/or third films in the “Hunger Games” franchise. There had been rumblings all week about contract negotiations, and Ross has now politely passed. The site chalks it up to Ross’ lack of desire to stay in the same universe for the next several years combined with a somewhat low-ball offer from Lionsgate. Whatever the case, Ross is gone and the hunt for a new director is on.
While editing my “John Carter” obituary a few weeks ago, I removed a large paragraph dealing with the trend of giving young white male filmmakers with barely a feature credit to their name the keys to $100 million-$300 million franchise films while seasoned pro women and/or minorities remain noticeably absent from the “wish list” (yes, I was glad to see F. Gary Gray on the Marvel wish-list for “Captain America 2″). And while I wouldn’t consider “The Hunger Games” a “female film,” it would be a great opportunity to make a point that female directors can indeed handle the kind of big-scale filmmaking that studios are all too willing to offer to mostly untested male directors as a matter of course. So, perhaps arbitrarily, perhaps to prove a point about how inaccessible the wish list is for female directors, here are nine directors who happen to be women who also belong on the wish list as Lionsgate hunts for a second director. These are in alphabetical order, with the exception of the final entry who would be my top choice.
Kathryn Bigelow
Duh. In fact, she’ll probably make the wish list as a token nod to gender diversity, and all she had to do was become the first female in history to win a best director Oscar. I don’t really have to explain this pick. She’s been directing hard action pictures for 30 years. She’s helmed the likes of “Near Dark” (a dusty vampire thriller that still holds up 25 years later), “Point Break” (which is really better than its camp-fueled reputation), the underrated “Blue Steel,” “Strange Days,” “K19: The Widowmaker,” the two-part guns-ablaze sixth-season finale of “Homicide: Life on the Street,” and of course the Oscar-winning “The Hurt Locker.” If Lionsgate wants instant critical respectability without breaking a sweat, Bigelow will be at the top of the list, regardless of gender.
Niki Caro
“North Country” is the definition of the kind of movie they just don’t make anymore. As recently as 2005, Warner Bros. gave Caro the reins to an all-star drama detailing a landmark 1984 sexual-discrimination/harassment suit. Lead Charlize Theron and supporting actress Frances McDormand both justifiably received Oscar nominations for the little-seen October 2005 release. The picture is a straight-up social issues drama, filled with character turns from Richard Jenkins, Sean Bean, Sissy Spacek, Woody Harrelson and then-unknowns Amber Heard, Michelle Monaghan and Jeremy Renner. In 2005, it was one of any number of big studio dramas battling it out for Oscar glory. Today, it would be a front-runner purely by virtue of its existence. Caro’s picture personifies the sort of high-quality big-studio adult drama that is all but an endangered species, and she also helmed the dynamite “Whale Rider” back in 2002 as well. If every studio release were at least as good as “North Country,” I imagine most of us wouldn’t feel the need to constantly whine about the state of studio movies these days.

Catherine Hardwicke
Yes, “Red Riding Hood” was an entertaining whiff. I like it even while admitting it’s pretty bad (it’s certainly never boring and Gary Oldman is a hoot). But go back and watch the first “Twilight.” Here’s a dirty secret: It’s actually pretty good. It’s light on its feet, quirky, self-deprecating and utterly aware of its melodramatic nature. Unlike the self-serious sequels, which treat their respective source material like holy tombs (and probably would have cut “vampire baseball” out of fear of irreverence), the first “Twilight “is genuinely fun, willing to change little details and add character beats to keep the film engaging. Kristen Stewart is quite compelling as a more self-aware Bella while Robert Pattinson is allowed to be just a little goofy in the opening act (his biology class freak-out is pretty hilarious). Most important for the purposes of this current franchise, the supporting characters are wonderfully fleshed out and brought to life, giving the film a pulpy lived-in quality that none of the sequels can match (Bella’s friends are actually charming and have their own lives). Point being, if you’re among the many critics who wished that even a few of the supporting characters were a little more fleshed out in the first “Hunger Games” installment, why not bring on someone who knows how to build an aggressively lively supporting cast, one that arguably superceded the stars in at least one film? She wouldn’t be my top choice, but there would be some poetic justice to it nonetheless.
Mary Harron
Has any movie made in the early 2000s, save perhaps ”Requiem for a Dream,” aged as tragically well as ”American Psycho”? The film got mixed reviews in its day, with many critics unable to look past the grotesque subject matter (and the even more grotesque source material) to notice that the film’s sex and violence were all but beside the point. Christian Bale turns in what will probably be the best performance of his career (certainly Patrick Bateman is as defining a turn as Robert De Niro’s Travis Bickle) in a brutal satire of the 1980s “greed is good” corporate mind-set that tragically proves even more topical today as the ghosts of Reagan came back to haunt us in the guise of George W. Bush and corporate giants like Goldman Sachs. Had the film been better received in its time, perhaps Harron wouldn’t have just now helmed a theatrical follow-up, the upcoming ”The Moth Diaries” (she directed an HBO Bettie Page biopic in 2005). Not to repeat a theme (and it won’t be the last time I bring this up), but had “she” been a “he,” Harron probably would have a half-dozen features to her name by this point.

Patty Jenkins
She was supposed to be the mold-breaker. Hired late last year to direct Marvel Comics’ “Thor 2,” Jenkins was supposed to become the first female director to helm a mega-budget comic book tent pole (Lexi Alexander’s “Punisher: War Zone” cost just $30 million). But the rather mysterious “creative differences” excuse sent her packing, replaced by longtime television director Alan Taylor (director of the heartbreaking “Homicide: Life on the Street “series finale and the “Mad Men” pilot), which in turn led to a national grumbling among feminist film pundits and a very pissed-off Natalie Portman. Jenkins’ career is a perfect demonstration of the gender disparity in Hollywood. In an age where Marc Webb is handed the reins to “The Amazing Spider-Man ” after directing one moderately successful low-budget romantic comedy (“500 Days of Summer”), Jenkins has barely worked since directing the Oscar-winning “Monster” nine years ago. She recently won an Emmy for directing the pilot for AMC’s “The Killing,” but that’s pretty much all she’s done since 2003. If you haven’t seen “Monster” in a while, it’s a pretty great movie, and it’s certainly more than just Charlize Theron’s deservedly-Oscar-winning star turn (Christina Ricci is just as good). Call it poetic justice or merely good sense, but Lionsgate would be wise to snap up Jenkins and give her the keys to an even bigger franchise.
Mimi Leder
In the late 1990s, Mimi Leder was on her way to becoming one of the biggest female directors in modern history. But while male directors get whiff after whiff until their eventual “comeback film” (think Scorsese in the 1980s, from “Raging Bull “to “Goodfellas”), Leder was out after just one high-profile miss. Never mind that “The Peacemaker” was a frighteningly ahead-of-its-time action drama (and a painfully underrated one at that), never mind that “Deep Impact” was at the time the highest grossing film in history directed by a woman. The critical and artistic disaster of “Pay It Forward” pretty much killed everyone involved, ending the film careers of Helen Hunt and Haley Joel Osment while fatally damaging Kevin Spacey’s prestige. Leder hasn’t directed another theatrical feature since that 2000 disappointment (she helmed the 2009 Morgan Freeman/Antonio Bandaras direct-to-DVD action flick “Thick as Thieves”). She just started preproduction on a remake of “All Quiet on the Western Front,” which, if it comes to pass, will be her first theatrical release in 12 years. If you want a female director who knows how to craft top-notch action, why not hire Leder?
Lynne Ramsay
In a gender-neutral world, Lynne Ramsay would be on all of the wish lists right now. After all, she made a splash last year with the fantastic “We Need to Talk About Kevin,” coaxing a career-peak performance from Tilda Swinton and crafting a powerful psychological horror drama that defies easy description or even common interpretation. It’s a powerful and gripping picture, her third feature no less. If “Chronicle’s” Josh Trank can end up with a dozen high-profile choices after making one terrific film, then Ramsay deserves her pick of the litter as well. Of course, the fact that Trank made his mark with a superhero deconstruction and was then offered a bunch of comic book superhero films is in itself a sign of Hollywood’s lack of imagination, which is why Debra Granik (who would also be on various wish lists in a just world) won’t be on this list. There is no escaping the several similarities between “Winter’s Bone” and “The Hunger Games” and I’d argue that choosing the helmer of the former is every bit as lazy as choosing Jennifer Lawrence to basically reprise her Oscar-nominated character in the first place. But Ramsay would be an inspired and outside-the-box choice, and arguably someone who can bring suspense and intensity to a franchise that lacked requisite tension the first time around.
Jennifer Yuh
With all the seemingly justified hubbub about Brenda Chapman getting canned from Pixar’s “Brave” last year, no one seemed to notice that Dreamworks (who hired Chapman to direct “The Prince of Egypt” 14 years ago) gave one of its prize franchises to a South Korean female director who promptly knocked it out of the park. I assume you don’t need me to remind you how much I loved “Kung Fu Panda 2.” It was my favorite film of 2011 and a splendid action dramedy that absolutely stands with “Toy Story 2,” “The Dark Knight” and “X2: X-Men United” on the list of all-time great genre sequels from the last 15 years. The only reason she isn’t my top pick is because I wouldn’t want her taking the “Chasing Fire” gig to stand in the way of her directing “Kung Fu Panda 3.” But she absolutely deserves a spot on every genre wish list from now until she retires.
And my personal pick…

Kasi Lemmons
Yes, it would be groundbreaking/cool/etc. if the reins to today’s biggest new franchise were handed off to an African-American woman. But it would also be just-plain-cool if “Chasing Fire” were handed to the person who happened to direct “Eve’s Bayou” and “Talk to Me.” She directed three features between 1997 and 2007 (the middle one being the not-that-great “The Caveman’s Valentine” in 2001, which still featured a fine star turn from Samuel L. Jackson). But “Eve’s Bayou” is a terrific period drama that features one of Jackson’s best performances, period. ”Talk to Me” is a fine and thoughtful biopic about 1960s Washington, D.C., radio DJ Ralph “Petey” Greene (played by Don Cheadle), which features strong supporting work from Chiwetel Ejiofor (his pool hall conversation with Cheadle is the stuff of acting-class gold), Taraji P. Henson and Martin Sheen (even if Sheen’s best scene ended up on the DVD deleted scenes reel). I don’t pretend to know why she has worked so little in the last 15 years, but her lack of output has always (to me) personified the difficulty that minority and female filmmakers face in terms of having a steady output of movies even after they’ve had one or two successes. Tokenism and/or affirmative action accusations aide, Lemmons has made two awfully good films and deserves a shot at the big leagues at least as much as the likes of Josh Trank and Marc Webb.
OK, your turn to pick. Who would you want to see helm the next “Hunger Games” film? It doesn’t have to be a woman or a minority, but try to be a little creative.
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