Durham and London: Duke University Press, 2013.
The medicalization and marketing of pharmaceuticals linked to men’s health uses specified bodily imagery and discourses, more often than not evoking stereotypes of ‘manliness’ and hegemonic ideals of masculinities (Connell & Messerschmidt 2005). It is thus no surprise that the first chapter of Maturing Masculinities reveals that the medicalization and marketing of Viagra in Mexico plays with tropes of machismo which men ascribe to, rework, or reject in various degrees, often in relation to notions of Mexicanidad (35ff). It is against this background of how and why men use biomedicine and technology that Emily Wentzell’s fascinating anthropological work is to be situated.
Wentzell’s ethnography is centred in Cuernavaca, the capital city of the state of Morelos, in Mexico, at the IMSS hospital Unidad de Investigación Epidemiológica y en Servicios de Salud (UIESS). Using a government hospital as her main fieldwork site, Wentzell “interviewed 254 urology patients, 48 along with their wives or other family members’” as well as witnessing patient and professional interactions in public and private settings. The patients were mostly older, working class Mexican men coping with various urological issues inclusive of chronic conditions of different aetiology; such as cancer or high blood pressure. Several times the men she interviews explain that in order to speak about such deeply personal issues, such as coping with aging, having a chronic condition and being diagnosed erectile difficulties or dysfunction (ED,) one needs to have a relationship of confianza or trust, which Wentzell inspires. Many of the accounts are moving and almost confessional in nature, dealing with changing notions of masculinity, embodiment, relationships and sexuality across the life-course.
In order to understand these accounts in their cultural context but also theoretically, Wentzell draws on the work of Annemarie Mol (2002). She reworks Mol’s ideas about ‘composite objects’ and ‘coordination work’ to define ‘composite masculinities’ as, “contingent and fluid constellations of elements that men weave together into masculine selfhoods” (26). In this way Wentzell situates her work alongside more dynamic understandings of masculinities focusing on “emergence, change and processuality” (i.e. Inhorn 2012, Padilla 2011) (25). According to Wentzell:
“Using erectile difficulty as a starting point for understanding gender as a dynamic composite, I have sought to demonstrate how men coordinate changing sets of elements into attempts to be particular kinds of men, through a range of narrative, embodied, and interpersonal practices. This book is intended to reveal the often purposeful, ever-changing ways in which men revised their composite masculinities in response to ongoing changes in their bodies, social worlds, and structural settings,” (163).
These narratives of gender, selves and relationships may seem contradictory and contingent were it not for the coherence work or the coordinating practices that men relate, embody and practice to ensure the continuity of a ‘selfhood’. So, while one might assume that aging Mexican men would use Viagra in keeping with ideas of machismo, many of Wentzell’s informants related complex histories where these practices were not in keeping with mature masculinities. How maturing masculinities were understood was influenced by myriad factors such as religion, politics, socio-economic situation, humoral understandings of the body, personal and familial relationships and/or machismo ideals such as having multiple girlfriends or risky sexual relationships.
Finding the theoretical tools to understand the messiness of life and the ways in which people understand themselves, sometimes in contradiction, is complex but Wentzell incorporates gender studies, science and technology studies, as well as the medical anthropological literature convincingly. I was a little disappointed that she did not go into further philosophical detail, for example, linking Mol’s work to thinkers such as Deleuze or Guattari or situating it in Latin American philosophical thought. However, such moves might have detracted from the readability of this book. Criticisms will focus on the study’s heteronormativity, and its lack of attention to the disability studies literature and to issues of ethnicity — which appear only in the form of historical and political reflection. I know from reading Wentzell’s other work that she is familiar with some of this literature (i.e. Wentzell 2006, 2011) and is attentive to intersectionality. I wondered if some of the literature (i.e. Robertson 2006, Shuttleworth et al. 2012) on the visibility and embodiment of intersectionality, cognitive impairment or the politicizing of the disability identity would have problematized her theoretical framework? However, the very fact that this book prompts such critical questions about whether we can refine these tools and apply them to differing contexts suggests that Wentzell is working on the ‘cutting edge’.
Connell, R. W. and Messerschmidt, J.W. (2005) Hegemonic Masculinity: Rethinking the Concept. Gender and Society, 19 (6): 829-859.
Inhorn, M.C. (2012) The New Arab Man: Emergent Masculinities and Islam in the Middle East. Princeton University Press.
Mol, A. (2002) The Body Multiple: Ontology in Medical Practice. Durham, NC: Duke University Press.
Padilla, M.B. (2011) From Sex Workers to Tourism Workers: A Structural Approach to Male Sexual Labor in Dominican Tourism Areas. IN Globalization Reproduction and the State, Browner, C.F. and Sargent, C.F. Durham, NC: Duke University Press.
Robertson, S. (2006) “I’ve been like a coiled spring this week”: Embodied Masculinity and Health, Sociology of Health and Illness, 28 (4): 433-452.
Shuttleworth, R., Wedgewood, N. and Wilson, N.J. (2012) The Dilemma of Disabled Masculinity. Men and Masculinities, 15: 174-194.
Wentzell, E. (2006) Bad Bedfellows: Disability Sex Rights and Viagra. Bulletin of Science Technology & Society, 26: 370-377.
Wentzell, E. (2011) Marketing Silence, Public Health Stigma and the Discourse of Risky Gay Viagra Use in the US. Body & Society, 105-125.
Maria Berghs is an anthropologist and research fellow at the University of York in the United Kingdom. She is currently working on National Institute for Health Research-Research for Patient Benefit project examining conceptions of informed decision-making for men being invited to test for sickle cell during antenatal care.