2013 Anthropology Undergrad Research Journal

PROBLEMATICS Undergraduate Journal of Anthropology Volume 6: Spring 2012 -13

Behind the Scenes Editorial Board Briana Evans ‘13 Elizabeth Rosen ‘13

Staff

April Flores Emily Bishop

Special Thanks

The Department of Anthropology The Online Journal Systems staff Liisa Malkki

In this Issue 1 2

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Letter from the Editors

The Once and Future Sprinkler: Traditional Irrigation in the Developing World

by Elizabeth Rosen ‘13

Prescribing Assent: The Debate Over Antipsychotic Drug Use in Nursing Homes

by Kelly Vicars ‘13 Physically Active Is Less Attractive

by Anna Nti-Asare ‘14

The Missing Statistic: Gender Bias and the Neglect of Male Eating Disorders

by Amanda Rost ‘14

America’s Ultimate Fantasy: the Inner-City Classroom in Hollywood Film and National Policy

by Megan Winkelman

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Letter from the Editors Dear Readers,

While reading the submissions for this issue, a common theme emerged from a series of articles on what might seem like disparate topics. That theme is the changing perception of historically well-defined relationships – between women and athletics, men and eating disorders, and indigenous peoples and Western technology. Given the seemingly unrelated topics of these articles, we find it significant that the theme of critically rethinking institutionalized relationships appeared so frequently in this year’s submissions. Each of these articles takes note of a problem with a well-defined solution, and then focuses not on the production of new solutions but on rethinking the problems themselves.

At the beginning of this year, with several strong submissions and a lot of enthusiasm, we decided to stage a comeback for Problematics. The journal had lapsed from its normal schedule under stress from changing leadership and uncertainty about its mission. We apologize sincerely to our readers and our contributors for that lapse. However, as we began organizing this year’s articles, we recognized a choice between rushing to put out three issues and taking the opportunity make this a sustainable, long-term project. We decided not to sacrifice quality for quantity.

Going forward, we aim for Problematics to embrace a more concrete mission: to present rigorous anthropological work in a manner accessible to readers from a range of backgrounds. This journal has the potential to illuminate what often seems, to the uninitiated, like an enigmatic field. Undergraduate research can explain anthropology to the lay reader on a practical level and demonstrate its relevance to other disciplines. As this issue proves – with articles from not only Anthropology, but also from the Departments of Human Biology and Gender Studies – these themes are useful in thinking through problems across many fields.

We certainly hope this journal will help researchers consider new questions and analyses. But more than that, we want readers to take a cue from this issue’s contributors and use anthropological themes to examine everyday problems and solutions. We support the accessibility and believe in the broad applicability of academic perspectives, particularly as anthropology can help us question and better understand the forces that shape our professional, personal, political, and economic interactions every single day.

Warmly, Briana and Elizabeth

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The Once and Future Sprinkler: Traditional Irrigation in the Developing World

By Elizabeth Rosen ‘13 In the field of agricultural development, a great chasm exists between conservationist and preservationist camps. While conservationists value efficiency and propose continual agricultural intensification to support human existence and quality of life, preservationists focus on long-term ecological concerns and support a return to traditional, often organic and local, agriculture. The “tradition versus technology” debate is far too broad a topic to address effectively here. As such, this research considers how scientists and policymakers can reconcile traditional and modern irrigation technologies to increase productivity while promoting sustainable energy consumption and environmental stewardship in developing nations.

The archaeological record indicates that agriculture (or at least plant domestication) arose independently in at least seven locations, the earliest being 11,000 years ago in the Near East’s “Fertile Crescent,” and the most recent being 4,000 years ago in Eastern North America (Diamond, Guns 100). Irrigation to augment and control naturally available water sources – primarily rainfall, rivers, and the water table – would have quickly followed plant domestication, because a region with long-term irrigation has an abundant supply of good water, well-drained soil on a regional scale, and a consistent supply of fertilizer (“Ancient Irrigation”). Material records of early Mesopotamian, Egyptian, and North and South American irrigation works are still visible today (Mays).

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Although these ancient systems supported relatively large economies, providing for a global population of approximately 6.5 billion people hardly seems like a task for often less efficient, organic, or traditional irrigation technologies. Since the Green Revolution of the 1970s, water has taken the place food as the next big shortage in agricultural production (Ridley). According to the World Water Council, although food security has been significantly increased in the past thirty years, water withdrawals for irrigation represent 66 % of the total withdrawals and up to 90 % in arid regions (“Water”). According to biologist Matt Ridley’s calculations, extrapolated from those of the 1960s economist Colin Clark, agricultural intensification methods such as hydroponic crop production and large-scale drip irrigation, may allow us both to feed the world at a continually higher standard while gradually reducing farmland area, making it the most appropriate future direction for food producers to take in the coming years.1 Not all those opposed to reliance on traditional methods are, however, as staunchly in favor of technologically powered intensification as Ridley. There exists a moderate contingent of agriculturalists and energy experts who advocate using low technology, such as micro-drip and photovoltaic drip irrigation, to reconcile environmental and humanitarian goals.

1. hy•dro•pon•ics: \ˌhī-drə-ˈpä-niks\ : the growing of plants in nutrient solutions with or without an inert medium (as soil) to provide mechanical support. See “Hydroponics.”

Study began as early as the 16th century on the use of traditional farming techniques in Spain, Mexico, and North America. Gabriel Alonso de Herrera, often considered the father of modern Spanish agriculture and a precursor of today’s sustainable agriculture movement, studied the agricultural techniques of the Moors in Spain – amending the soil with compost, green manure, and animal manure, as well as the construction of irrigation ditches – and in 1513 published Obra de Agricultura (Herrera 11). Herrera’s work in the 1500s and the dissemination of those studies in the 21st century have not been directly responsible for measurable steps in technology or policy towards reconciliation of the traditional methods. However, recent attention paid to its translation and republication both testifies to growing public interest in the potential present-day benefits of traditional agriculture, or at least a serious examination thereof.

More recently, studies in the Middle East have scientifically demonstrated and published the benefits of revitalizing traditional irrigation systems, especially in arid areas of the world where irrigation is most needed. In Oman, the majority of the nation’s farmland receives only 100-200 mm of annual rainfall, and so approximately half of the nation of Oman’s crop-producing land is irrigated using traditional aflaj method of tapping underground water and directing it through manmade channels to nearby villages (Norman, Shayya, Al-Ghafri, and McCann). About 11,000 of these systems still exist in Oman, some of which date back to 500 B.C., and about 3,000 are constantly flowing and currently in use by Omani farmers (“Ancient Irrigation System”; “The Traditional”). The main structure of a falaj (aflaj sing.) consists of a “mother well,” a main irrigation channel, and access shafts built every 20 to 60

meters along this channel to provide ventilation and debris removal. With an average water flow of about 9 gallons per second, a falaj is more than capable of permanently providing great quantities of water for irrigation and domestic purposes.

In the past 25 years, however, rapid social and economic fluctuation in Oman has profoundly impacted the viability of falaj systems by introducing cheaper (but often less environmentally sound) wells and boreholes across the desert. In many aflaj communities, people are prioritizing greater economic returns on labor through non-agricultural and urban jobs, decreasing investment in system maintenance and lowering the water tables. As agriculture in Oman accounts for 80 to 90 percent of the nation’s fresh water use, the government has focused on the potential for improving traditional, already prevalent on-farm surface irrigation. Indigenous Omani farmers have long understood how to effectively manage water with traditional surface irrigation, and developing on their embedded knowledge may be the key to maximizing crop produc-

Figure 1: Schematic of a PVDI system, such as those used by SELF. Spring 2013 PROBLEMATICS | 3

tion while and minimizing wasteful resource use in arid croplands. (Norman, Shayya, Al-Ghafri, and McCann)

in the fall of 2006; by 2007, the technology had been implemented. The advantages of PV technology are its immunity to fuel shortages, a lower long-term cost In Benin, on the other hand, scientists are attempting than traditional diesel generators, and saved human to integrate modern technologies into local irrigation labor. The project showed incredible results: all three practice to intensify crop production and mitigate installed systems produced 1.9 metric tons of produce hunger (Burney; Solar; “Wewe”; Zubair). According per month, vegetable intake increased to 3-5 servto a study by Jennifer Burney, a postdoctoral scholar ings per day during the dry season, and 17 percent of at Stanford’s Program on Food Security and the Envi- people living in the villages reported feeling less “food ronment, photovoltaic drip irrigation (PVDI) systems insecure.” Additionally, families using the systems inin sub-Saharan Africa may creased their income by sellprovide a viable, long-term As a core resource for many ing a large portion of their exsolution to the nutritional cess produce, the size of plots livelihoods, environmental cultivated experienced a draand economic insecurities brought on each year by the matic visual difference, the efquality, and intercultural brutal six-month dry season. fort needed to cultivate them Burney has spent the past relations, water and irrigation decreased, and nutrition imthree years studying the efcan act as useful agents for proved dramatically. Overall, fectiveness of a pilot project the study indicates that thorinvolving PVDI installations in discussion of larger questions ough technological and cultwo villages in rural Benin’s regarding the environment tural integration of PVDI into Kalalé district, where 95% of local agricultural systems can and development the 104,000 person populabe immensely beneficial ecotion depends on subsistence nomically, nutritionally, and farming as their primary livelihood. During the dry environmentally to populations in the Sudano-Sahel season, the region may receive as little as 20 or fewer region of sub-Saharan Africa—far more so than reinches of rain, which takes an enormous toll on crop maining with traditional, seasonal, unhealthy, and unproduction, income, health, and nutrition. It can also sustainable methods (Burney, Woltering, Burke, Naycause community dislocation when families are forced lor, and Pasternak 1853). to relocate to urban areas and search for jobs. Burney, who spent most of 2007 working in Benin, became in- As Dr. Daanish Mustafa asked during his study of Pakivolved with the project through her involvement with stan’s traditional karez irrigation systems, “Are techthe Solar Electric Light Fund (SELF), a non-profit or- nological transitions from the traditional to the modganization whose purpose is to fight “climate change ern desirable and/or part of the inexorable process of and global poverty with solar power” (Solar). Funding development?” This question lies at the heart of the the installation of solar-powered drip irrigation began entire sustainable development philosophy and indus4 | Spring 2013 PROBLEMATICS

try. As a core resource for many livelihoods, environmental quality, and intercultural relations, water and irrigation can act as useful agents for discussion of larger questions regarding the environment and development—unfortunately, given even this brief examination of change and continuity in developing nations’ irrigation systems, one can clearly see that no universally applicable answer to the sustainability question has yet come to light. This is unsurprising, as the same ambiguity applies to almost any endeavor with the potential to vary depending on local environmental and cultural contexts. While revitalizing long-standing systems in the arid Middle East may be a viable solution to inefficient water distribution, the same principles may not apply to more seasonally variable areas sub-Saharan Africa, not to mention the externalities born of the social, economic, and political differences between these areas. One conclusion, however, does seem to echo throughout the past several decades of research in agricultural sustainability and technology: Despite claims by the Matt Ridleys of the world, that our future lies in no-holds-barred agricultural intensification to match an expanding population, such strategies will only exacerbate environmental degradation, speed up the depletion of finite energy resources, and ultimately result in a Malthusian dilemma where we find ourselves with too many mouths to feed and not enough energy or land to produce the food with which to feed them. We must achieve balance between revitalizing traditional agricultural methodologies that favor sustainability over efficiency, with the efficient energy use and production necessary to meet a perpetually increasing global demand for fuel and calories.

Does tradition hold all the answers? No, but they do have much to teach us about the relationship between

humanity and its environs, and the clarity granted us by hindsight should not be taken lightly.

Bibliography “Ancient Irrigation.” MyGeologyPage. UC Davis Geology Department, May 1999. Web. 30 Sept. 2010. <http:// mygeologypage.ucdavis.edu/cowen/~GEL115/115CH1 7oldirrigation.html>.

“Ancient Irrigation System (Oman) and Palaces of Genoa (Italy) among Ten New Sites on World Heritage List.” UNESCO World Heritage Centre. UNESCO, 13 July 2006. Web. 08 Dec. 2010. <http://whc.unesco. org/en/news/267>.

“Community Watershed Management and Rainwater Harvesting Using Ancient Irrigation Technologies and Community Managed Protected Area Conservation in Sigiriya World Heritage Site.” Waterwiki. net. Web. 30 Sept. 2010. <http://waterwiki.net/ index.php/Community_watershed_management_ and_rainwater_harvesting_using_ancient_irrigation_technologies_and_Community_managed_protected_area_conservation_in_Sigiriya_World_Heritage_site>.

Berkes, F. 1999. Sacred Ecology: Traditional Ecological Knowledge and Resource Management. Philadelphia, PA: Taylor & Francis. Print.

Burney, Jennifer, Lennart Woltering, Marshall Burke, Rosamond Naylor, and Dov Pasternak. “Solarpowered Drip Irrigation Enhances Food Security in the Sudano–Sahel.” PNAS 107.5 (2010): 1848-853.

Web. 17 Oct. 2010. <http://www.pnas.org/content/ early/2010/01/13/0909678107.full.pdf>.

Clyma, Wayne, Muhammad S. Shafique, and Jan Van Schilfgaarde. “Irrigated Agriculture: Managing toward Sustainability.” Encyclopedia of Water Science.

London, UK: Taylor & Francis Group, LLC, 2008. 54247. CRCnetBASE. Web. 12 Oct. 2010. <http://www. crcnetbase.com/doi/pdf/10.1201/NOE0849396274. ch130>.

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Diamond, Jared M. Collapse: How Societies Choose to Fail or Succeed. New York: Viking, 2005.

Grayson, Chelsea. “Times Have Changed, but Farming Hasn’t.” International News. GlobalPost, 22 Sept.

2010. Web. 24 Sept. 2010. <http://www.globalpost. com/dispatch/study-abroad/100920/vietnam-farmers-farming-agriculture-hue>.

Grover, Sami. “Unglazed Clay Pots Create Efficient Drip Irrigation (Video).” TreeHugger. 20 Sept. 2010.

Web. 23 Sept. 2010. <http://www.treehugger.com/ files/2010/09/unglazed-clay-pots-irrigation.php>.

Habtu, Solomon, and Kitamura Yoshinobu. “Traditional Irrigation Management in Betmera-Hiwane, Ethiopia: The Main Peculiarities for the Persistence of Irrigation Practices.” Journal of Mountain Science 3.2 (2006): 139-46. Springerlink. Web. 13 Oct. 2010. <http://www.springerlink.com/content/ k051400u50382384/fulltext.pdf> Herrera, Gabriel Alonso De. Ancient Agriculture: Roots and Application of Sustainable Farming. Comp. Juan Estevan. Arellano. Layton, UT: Ancient City, 2006.

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Khan, Muhammad, and Muhammad Nawaz. “Karez Irrigation in Pakistan.” GeoJournal 37.1 (1995): 91-100.

SpringerLink. Web. 8 Dec. 2010. <http://www. springerlink.com/content/v773325344336457/fulltext.pdf>.

Mays, Larry W. “Irrigation Systems, Ancient.” Water: Science and Issues. Web. 30 Sept. 2010. <http://www. waterencyclopedia.com/Hy-La/Irrigation-SystemsAncient.html>.

Mustafa, Daanish, and Muhammad U. Qazi. “Karez versus Tubewell Irrigation: the Comparative Social Acceptability and Practicality of Sustainable Groundwater Development in Balochistan, Pakistan.” Contemporary South Asia 16.2 (2008): 171-95. Informaworld.

Web. 8 Dec. 2010. <http://www.informaworld.

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com/smpp/section?content=a794424500&fullte xt=713240928>.

Naylor, Rosamund L. “Energy and Resource Constraints on Intensive Agricultural Production.” Annual Review of Energy and the Environment 21 (1996): 99-123.

Annual Reviews. Web. 12 Oct. 2010. <http://www. annualreviews.org/doi/abs/10.1146/annurev.energy.21.1.99?prevSearch=traditional%2BAND%2Birriga tion&searchHistoryKey=>.

Norman, W.R., W.H. Shayya, A.S. Al-Ghafri, and I.R. McCann. “Aflaj Irrigation and On-farm Water Management in Northern Oman.” Irrigation and Drainage Systems 12.1 (1997): 35-48. SpringerLink. Web. 12 Oct. 2010. <http://www.springerlink.com/content/ k771814730131788/>.

Ridley, Matt. The Rational Optimist: How Prosperity Evolves. New York: Harper, 2010. Print.

Rosegrant, Mark W., Claudia Ringler, and Tingju Zhu. “Water for Agriculture: Maintaining Food Security under Growing Scarcity.” Annual Review of Environment and Resources 34 (2009): 205-22. Annual Reviews.

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“The Traditional Aflaj Irrigation System - An Omani Heritage.” OmanInfo.com. Oman Information Center.

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“Water Crisis.” World Water Council. Web. 07 Dec. 2010. <http://www.worldwatercouncil.org/index. php?id=25>.

Prescribing Assent: The Debate Over Antipsychotic Drug Use in Nursing Homes

By Kelly Vicars ‘13 The administration of atypical antipsychotic medications to nursing home residents for off-label use raises questions concerning how and why prescription pharmaceuticals are used to “treat” behavioral problems within vulnerable populations. Because antipsychotics are designed to suppress abnormal mood and behavioral conditions, their effect upon elderly patients who are not mentally ill demands investigation. For whom or what is the medicine truly prescribed? Beyond calls for increased oversight on the part of the government or the medical community, this situation necessitates consideration of how efforts to “normalize” the elderly patient may be symptomatic of a broader distortion of the concept of normalcy, particularly as it pertains to the elderly and memory-impaired.

Historical dimensions Discovered by chance in the 1950s, antipsychotic drugs were lauded for their effectiveness in relieving positive symptoms of chronic psychotic disorders such as schizophrenia and bipolar disorder. While the first antipsychotic, chlorpromazine, effectively revolutionized schizophrenia treatment, the drug also came with a dangerous side effect profile. In the 1990s, a second generation of antipsychotics termed “atypical” sought to alleviate chlorpromazine’s adverse effects (Meyer & Simpson 1138). These new drugs were deemed safer than their predecessors, yet atypical antipsychotics still posed the risk of significant, sometimes fatal side effects. The understanding that atypical antipsychotics were in some way better and safer than their prede-

cessors, however, has continued to color their reputation into what is now a highly profitable career.

Atypical antipsychotics found favor among physicians and gradually came to replace the original class of drugs within psychiatric treatment regimens. Seen to have powerful effects without affecting addiction (Szalavitz), antipsychotics were also increasingly prescribed to patients within nursing homes. Part of the reason for increased use in this sphere can be attributed to nursing homes’ increased alignment with the field of medicine. Beginning in 1954, a change in federal law encouraged the construction of nursing homes “in conjunction with a hospital” in an attempt to raise the quality of care. Nursing homes were increasingly modeled not only physically, but also procedurally after hospitals. What were formerly almshouses providing welfare to poor and unsupported elderly transitioned into institutions that fell within the bounds of the health-care system (“The Evolution of Nursing Home Care in the United States”).

This fundamental shift to a medical model of nursing home design and practice brought with it changes in the degree of care available to patients. While homes began to provide patients better medical resources and hospital-like around the clock care, this also had an effect on resident physicians and staff, who themselves came to bear responsibilities resembling those of hospital doctors and nurses. With this expanded scope of medical care came both increased responSpring 2013 PROBLEMATICS | 7

sibility and increased power, as doctors could assess patients within the confines of the home and prescribe medication accordingly, and nurses could report back about patients’ responses. This system of treatment within a secured setting may also have influenced a loosening of scrupulousness in prescribing medications. Physicians, who understandably were often unable to attend to all patients within a facility, provided leeway to nursing home staff to administer medications on an “as needed” basis and oftentimes for offlabel purposes.

Some degree of flexibility exists surrounding the prescription of most medications. It is estimated that around 20 percent of prescriptions are used for off-label purposes (Radley et al., 1021). Within the context of antipsychotics, off-label uses are those other than the treatment of schizophrenia or bipolar disorder. The most common off-label uses of antipsychotics include the treatment of depression, obsessive-compulsive disorder, posttraumatic stress disorder, personality disorders, Tourette’s syndrome, and autism. Most importantly, antipsychotics have a powerful sedative effect, and are also used to quiet agitation resulting from dementia (AHRQ).

This wide array of off-label uses may be part of the reason that by the 1970s, federal studies reported that nearly half of nursing home patients were prescribed antipsychotic drugs (Bishop). This practice continued, even as complaints began to surface about the misuse of antipsychotics in homes. In 1988, a study published in the Journal of the American Medical Association on practices in Massachusetts nursing homes found that nearly half of prescriptions for antipsychotic drugs 8 | Spring 2013 PROBLEMATICS

within nursing homes were written by doctors to be used ‘’as needed,’’ or for “off-label” uses for which the drug was not explicitly advertised.

As mentioned previously, while the medical community viewed atypical antipsychotics as an improvement upon chlorpromazine, they still bore the risk of serious side effects. Risks associated with these drugs include nervous system issues, movement difficulties, high blood sugar, diabetes, and low blood pressure resulting in dizziness and fainting. Especially prominent is the increased risk of death associated with use by elderly persons with dementia.

The FDA requires that drugs with life-threatening risks be labeled with a boxed warning (also known as a ‘black-box warning’) – the agency’s most serious medical alert - to signal patients and prescribers of a lethal risk associated with the drug (FDA). Figure 1 is an example of a boxed warning for an atypical antipsychotic (the brand name removed).

The FDA issued black box warnings for antipsychotics in 2005 warning of the risk of increased mortality when elderly patients with dementia use these drugs (Dorsey et al.). Yet while serious risk of mortality is clear, antipsychotics are persistently prescribed to individuals for whom such medication is explicitly banned. While federal regulations allow doctors to prescribe a drug to patients who have the conditions stated in the drug’s boxed warning, the fact that a large percentage of elderly patients receiving the drug do not suffer from the psychotic disorders for which they are intended points to a gross distortion in the objective of administration. A 2009 study of patients in the Department

of Veterans Affairs health care system concluded that 60 percent of patients who received an antipsychotic drug had no record of a diagnosis for which the drug was approved (Leslie et al., 1175). This highly troubling practice continues in spite of large improvements in past decades in federal standards for care within nursing homes (“Evolution of Nursing Home Care”).

to nursing home residents who are unable to consent to the use of those drugs within their regimen of care.

While informed consent is a universal stipulation of scientific trials on human subjects and a normal requirement of patients under medical care, the lines of informed consent blur when the decision-making capacity of individual subjects or patients is called into question. Determinants of ability to WARNING consent vary within Increased Mortality in Elderly Patients with Dementia-Related Psychosis—Elderly populations. It is patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an striking, however, increased risk of death compared to placebo. Analyses of seventeen placebo-controlled trials (modal duration of 10 weeks) in these patients revealed a risk of death in the that patients within drug-treated patients of between 1.6 to 1.7 times that seen in placebo-treated patients. Over mental hospitals the course of a typical 10 week controlled trial, the rate of death in drug-treated patients cannot be adminiswas about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the tered antipsychotic causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. [this drug] drugs without inis not approved for the treatment of patients with dementia-related psychosis. formed consent (“Riese v. St. Mary’s Hospital and MediFigure 1: Black-box warning cal Center”). There In light of the history of antipsychotic use, many re- is no universal standard for consent for those with desearchers have concluded that intended off-label use mentia, largely because the condition progresses diffor such prescriptions is used as a form of ‘’chemical ferently for each individual. The diagnosis of dementia restraint’’ (Bishop). The use of any type of restraint, does not automatically confer decisional incapacity be it physical or chemical, is expressly forbade by the (Jayasekara), yet self-advocacy for treatment inter1987 Nursing Home Reform Act. This study thus points ests becomes a near impossibility as memory loss adto the covert continuation of a prohibited practice, vances. It is therefore understood that the capacity to disguised behind a veneer of prescribed medication obtain informed consent should be assessed for each within an institutionalized field of care. individual (American Geriatrics Society). Often, legal provisions enable a relative or caregiver to make deciEnlarging the Issue: Ethical Considerations of Vulner- sions on behalf of the patient, yet within the nursing ability, Profit, and Misuse home setting, oversight and decisional capacities pass A dimension to this issue not explicitly mentioned in into the domain of resident physicians and staff (Harthe 2011 study is the administration of powerful drugs ris).

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While necessary to ensure that memory-impaired pa- home physicians prescribe antipsychotics off-label and tients receive adequate care, the transfer of decision- as needed may be a lack of other options, especially in making capacities to nursing home physicians be- homes trying to keep costs down by minimizing their comes further obscured when those doctors prescribe staff. While the FDA has warned doctors of the lethal medications for off-label uses and on an “as needed” side effects of antipsychotic drugs in elderly patients basis. This is a standard practice, and gives nursing with dementia, doctors may knowingly continue the home caregivers the freedom to administer dosages practice because they have few other alternatives, for a variety of symptoms and as frequently as they see said Dr. Daniel Carlat, editor in chief of The Carlat Psyfit. Herein lies the main explanachiatry Report, a medical education for the misuse and overuse tion newsletter for psychiatrists It is more convenient and (Harris). This places both docof antipsychotics: their sedating effects help quell unexpected less expensive to medicate tors and staff in a position of emotional and behavioral outethical compromise that may bursts of patients with demen- than it is to hire additional violate the Hippocratic oath to tia. which they have sworn. staff, or to better train The prevalence of this practice staff. Nonpharmacological A lack of financial resources in nursing homes across the intervention and care is within nursing homes may therecountry can be attributed to fore account for a large share of simply more expensive several intersecting factors. As antipsychotics written for offmentioned, the sedating effect label use. The economic imperaof these drugs may aid nursing home staff in calming tive driving prescriptions is of key importance. “This upset patients. There is speculation that understaffed happens in the name of profit,” writes Alzheimer’s homes may even administer antipsychotics as a pre- blogger Bob DeMarco. His words express a stark realventative measure in homes, especially on weekends ity of this picture: “It is more convenient and less exwhen homes may be shorter staffed (Bishop). Victor pensive to medicate than it is to hire additional staff, or Molinari, a geropsychologist at the University of South to better train staff. Nonpharmacological intervention Florida, has spoken out about the shortage of psychol- and care is simply more expensive.” ogists trained to provide behavioral support in nursing homes. Many nursing home staffs are also untrained This statement is corroborated by the fact that the in providing nonmedical responses to behavioral out- pharmaceutical corporations that produce and distribbursts, so in tense situations they may turn to anti- ute these drugs reap outrageous financial rewards. psychotics for help (Price). Part of the reason nursing Antipsychotics bring in close to $14 billion a year, and

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atypical antipsychotics (those most commonly used sight as suggested by the government audit may prove in nursing homes) make more money than any other necessary, deeper consideration must be paid to the class of medication on the market in America (Szala- underlying structural forces of production and profit vitz). Pharmaceutical companies heavily advertise an- that sustain these practices. Contemplation of these tipsychotic drugs, particularly to nursing homes: the factors, however, necessitates examination of an even CMS suggests that some of the inappropriate use of broader conception of medically sanctioned drug use antipsychotics is a result of “drug makers’ paying kick- and normalcy, and how these factors may contribute backs to nursing homes to increase prescriptions for to the ubiquity of a medicalized paradigm of care. the medicines” (Harris). In addition, pharmaceutical companies Good/Bad: Concepts of Drugs, It is ironic that we are have marketed these drugs for Normalcy, and Old Age illegal or “black-boxed” usage fighting a drug war in the America’s two million nursing by dementia patients within home residents are among the streets, while in nursing nation’s most intensely medinursing homes, according to Daniel Levinson. This practice, homes no one is given the cated individuals (Bishop). Yet a Levinson said in an interview drug reliant elderly population after the release of the 2011 au- opportunity to know what is viewed by the general public dit, is a blatant example of such drugs they are being given as a necessary reality. Drugs are companies “putting profits begood when they apply within the and why fore safety” (Harris). It is especontext of medical care and imcially egregious considering the provement of life. Compared to already exponential profits being made from the sale common conceptions of illegal addiction and abuse, leof these drugs. gal medicalization is largely sanctioned and approved of. Yet the case of the legal administration of drugs How do these factors comprise “off-label” uses of an- to those unable to protest, or even in some cases rectipsychotics in a broader sense? It is clear that cost, ognize their intake at all, begins to problematize the efficiency, and power underlie what may appear as good/bad paradigm of drug use in America. “It is ironic a purely medical practice. Indeed, structural barriers that we are fighting a drug war in the streets, while may present the largest barrier to improving this situ- in nursing homes no one is given the opportunity to ation. “Nursing homes are not just straightjacketing know what drugs they are being given and why,’’ obresidents with medications as a matter of course, but serves Morton P. Cohen, a professor at Golden Gate because there are a host of barriers to giving them op- University School of Law’s constitutional law clinic timum care” (quoted in Price). While increased over- (quoted in Bishop). Indeed, a troublesome paradox

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underlies the widespread use of these dangerous prescription drugs.

The persistent reliance upon antipsychotics in American nursing homes may owe itself to the marketability and apparent harmlessness of this category of drug.

As mentioned in the first section of this paper, atypical antipsychotics were from their conception seen as an improved and safer version of existing medications.

Furthermore, atypical antipsychotics are not associated with addiction, which is part of the reason drug companies have been able to market these brands so heavily. And unlike traditional sedatives, there is essentially no recreational market for antipsychotics (Szalavitz). In the public eye, they fall snuggly into the category of the “best” pharmaceutical, free from the ultimate side effect of addiction and thus free from “bad” usage by a pleasure-seeking public.

Addiction, then, would be a worse alternative than death, the clearly indicated risk associated with atypical antipsychotics in memory-impaired populations.

The simultaneous fear and disregard of the black box label represents what Emily Martin calls “a form of displacement” (283) where “the bad effects of drugs are displaced into the fine print and into black boxes” (286). In a larger sense, this is representative of the concept of the pharmakon, which means both remedy and poison (Martin 183). Recent news reports on the misuse of antipsychotics paints the drugs as dangerous, if not evil substances within the context of nursing homes, and yet still they belong to a category of prescription pharmaceuticals that in itself is largely unchallenged within the public consciousness.

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The medicalization of an elderly and impaired population raises a simple yet profound question concerning the purpose of drugs in our society. We generally think of pharmaceutical drugs as improving people, of helping, fixing, or restoring them to functionality. Philosopher and physician Georges Canguilhem has dedicated much thought to the concept of normalcy as it relates to a larger social understanding of medication and disease. Canguilhem points out the ambiguity of the term “normal”: “it designates at once both a fact and [citing Lalande’s Vocabulaire technique et critique de la philosophie] ‘a value attributed to this fact by the person speaking, by virtue of an evaluative judgment for which he takes responsibility’” (125). That normalcy may represent a judgment reveals the subjectivity inherent to the term. A larger cultural conception of health is visible through its fabric: Canguilhem writes, “It is true that in medicine the normal state of the human body is the state one wants to reestablish… we think that medicine exists as the art of life because the living human himself calls certain dreaded states of behaviors pathological” (126). Fear itself thus underwrites the common conception of normalcy. This is obvious in the case of dementia and especially Alzheimer’s, conditions that are widely pathologized in American society. Indeed, the term “pathological” implies either pathos, a sensation of suffering, or of “life gone wrong” (137). Pathologized conditions thus vio-

The pathological mu one type of normal, not what is not n constitutes an

late a life of perfect health. And yet, Canguilhem points out that a life of perfect health is itself abnormal, so the experience of living by default includes disease.

His conclusion offers a profound challenge to our understanding of health as an optimum state requiring persistent policing and medication. “The pathological must be understood as one type of normal, as the abnormal is not what is not normal, but what constitutes another normal” (203).

Discourses of medical decline that pit “good” health against “bad” disease stand in the way of Canguilhem’s conception.

Old age is increasingly seen as an accumulation of adverse conditions, and dementia and Alzheimer’s have been conceptualized as diseases of the brain requiring treatment with a pill. Lawrence Cohen, an anthropologist concerned with the medicalization of Alzheimer’s in the West, warns that this dichotomized conception of aging exists in opposition to the experience of normal aging and “denies the complex experience and the personhood of the old,” shifting attention “away from the social origins” of aging (303). The extent to which a medicalized approach may rob the individual of personhood seems almost caricatured by the use of atypical antipsychotics to treat signs of age-related dementia. Patients are not medicated for their own sake, but for the sake of ease of care, institutional efficiency, and, certainly, cost.

ust be understood as , as the abnormal is normal, but what nother normal

It becomes increasing clear that a drug itself is not bad.

Instead, the system through which the drug is administered distorts conceptions of goodness and normalcy.

Reliant on the conception of pharmaceutical drugs as sanctioned and therefore “good,” and on a societal mindset acquiescent with a medical paradigm intent on policing signs of disease, aging has been shuttled into a space of abnormalcy in which the realities of growing old are distorted and medicated for, sometimes with fatal effects. Not just patients’ health, but also the place of compassion and authentic care for the elderly is risked by subscription to a paradigm of medicalization. As this paradigm pervades our current medical system and culture, nuanced examination of its role within specific medical debates will be necessary if we are to understand the true implications of this model of medication.

Looking Forward On May 24th 2012, legislation proposing the standardization of protocols for obtaining informed consent before administering antipsychotics for off-label use failed passage in the U.S. Senate. A spokesperson for the Senate Special Committee on Aging reported that “the amendment was filed to help bring some needed attention to the widespread problem of the misuse of antipsychotics among frail elders,” and that going forward, the bipartisan team of Senators who proposed the regulation will look for other vehicles or even standalone legislation (McKnight’s).

On May 30th, CMS announced a new plan to reduce the use of antipsychotics among nursing home residents by fifteen percent by the end of 2012. The initiative

Spring 2013 PROBLEMATICS | 13

aims to implement new training programs for nursing home staff that emphasize quality care, publish data on individual nursing homes’ antipsychotic use, and “emphasize nonpharmacological alternatives for nursing home residents as alternative to antipsychotics” including consistent staff assignments, monitoring of pain, and increased exercise and activities (Walker).

About 150 homes in the country have already eliminated these drugs (Power). Hopefully these changes establish a precedent for more critical consideration of the preconditions and effects of these drugs extending beyond the sphere, and instigate exploration of nonpharmacological options of elderly care.

Bibliography American Geriatrics Society. “Position statement: Informed consent for research on human subjects with dementia.” AGS Ethics Committee. 2007.

Bishop, Katherine. “Studies Find Drugs Still Overused To Control Nursing Home Elderly.” The New York Times. 13 March 1989.

Canguilhem, Georges. The Normal and the Pathological.

1991. New York: Zone Books. DeMarco, Bob. “Overprescribed: Antipsychotics in Nursing Homes for Dementia Patients.” Alzheimer’s Reading Room. 1 December 2011.

Dorsey, E.R., Rabbani A., Gallagher S.A., Conti R.M., Alexander G.C. “Impact of FDA black box advisory on antipsychotic medication use.” Arch Intern Med. 11 Jan 2010. Vol. 170 No. 1. 96-103.

FDA. An FDA Guide to Drug Safety Terms. http://www.fda. gov on May 29, 2012. Harris, Gardner. “Antipsychotic Drugs Called Hazardous for the Elderly.” The New York Times. 9 May 2011.

Jayasekara, Rasika. “Evidence Summary: Dementia: Informed Consent.” The Joanna Briggs Institute. 11 14 | Spring 2013 PROBLEMATICS

October 2009.

Leslie, D.L., S. Mohamed & R.A. Rosenheck. “Off-Label Use of Antipsychotic Medications in the Department of Veterans Affairs Health Care System.” Psychiatric Services. 2009. Vol. 60, No. 9. 1175–1181.

Levinson, Daniel R. “Medicare Atypical Antipsychotic Drug Claims for Elderly Nursing Home Residents.” U.S. Department of Health and Human Services Office of Inspector General. 4 May 2011.

Martin, Emily. The Pharmaceutical Person. 2006. 273–287.

McKnight’s Staff. “Nursing Home Antipsychotic legislation set aside.” McKnight’s. 29 May 2012.

Meyer, Jonathan M. and George M. Simpson. “From Chiorpromazine to Olanzapine: A Brief History of Antipsychotics.” Psychiatric Services. September 1997. Vol. 48, No. 9. 1137-1139.

Power, Allen. “More on Antipsychotics in Nursing Homes.”

Allen Power’s Blog on ChangingAging.org. 1 May 2012.

Price, M.. “Antipsychotics overprescribed in nursing homes.” American Psychological Association. September 2011. Vol. 42, No.8. 11.

Radley, D.C., S.N. Finkelstein, & R.S. Stafford. “Off-Label Prescribing Among Office-Based Physicians.” Archives of Internal Medicine. 2012. Vol. 166. 1021–1026.

“Riese v. St. Mary’s Hospital and Medical Center.” Treatment Advocacy Center.

Szalavitz, Maia. “Drugging the Vulnerable: Atypical Antipsychotics in Children and the Elderly.” Time. 26 May 2011.

“The Evolution of Nursing Home Care in the United States.”

PBS.org.

Walker, Emily. “CMS Seeks to Cut Antipsychotics in Nursing Homes.” MedPage Today. 6 June 2012.

Physically Active Is Less Attractive

By Anna Nti-Asare ‘14 Women are told from an early age how to act based simply on our gender, which often leads to a need to improve our appearance to prove to others and to ourselves that we are beautiful by adhering to hetero-normative social rules. We are given a definition of femininity by nearly everyone we encounter. If we fail to adhere to this definition, we are reminded of our flaws and told we are in need of “enhancing.” Quite often our roles are explained as stemming from biological truths that make our bodies naturally weaker than men’s. Therefore, when feminine roles are challenged, action is taken to restore “natural” order.

The treatment of female athletes in Western culture is a perfect illustration of the idea that women require “fixing” to restore womanhood. This paper analyzes cases in the history of women’s sports participation in which, in order to keep them from deviating too far from the norm, women are explicitly taught how to remain true to their gender. These teachings have come in the form of required attendance at beauty and charm schools as well as other training that feminizes and sexualizes the female athlete. Because female athletes have dealt with this “paradox” since the beginning of their participation in sports, we will look at early examples in American history as well as more recent attempts to fit female athletes fit into America’s contemporary ideas of the “correct” definition of a woman.

The concept of beauty schools stems from Western culture’s definition of femininity and the discomfort

that arises among both men and women in seeing a female who does not follow the definition. There are specific characteristics that women should exhibit which are meant to be separate from those displayed by men. As mentioned, there have been several efforts to support this separation with biological “facts”.

These efforts are highlighted in “The Female Animal,” which critiques the 19th-century position that “women’s ideal social characteristics…have a deeply rooted biological basis” because a woman’s “muscles [are] more delicate” and her “nervous system [is] finer” (Rosenberg and Rosenberg, 334). Remnants of these beliefs remain in the contemporary discussion of gender roles.

Vikki Krane’s “Living the Paradox” illustrates the divide between athletic reality and the feminine image for athletic women: “Western Culture emphasizes a feminine ideal body and demeanor. Sportswomen, therefore, live in two cultures, the sport culture and their larger social culture” (Women in Sports 81). The article continues to display the problems which arise for athletic women not only with inner conflicts about their physical appearance (82) but, on a larger societal scale, with acknowledging that adherence to a specific definition of feminine garners them more positive attention than excellent athletic performance alone (83).

In 1930, Florence A. Somers, an early female sports writer and activist, published her book Principles of Women’s Athletics, in which critiques conventional Spring 2013 PROBLEMATICS | 15

wisdom of specific male and female characteristics.

Somers criticizes parents for enforcing the idea that a daughter is “more suitably occupied in playing with her dolls while [her brother] roams the neighborhood with his companions” (5). At a time when her opinion would have been controversial, Somers argued for women to be able to participate in sports, writing: “the increasing participation of girls and women in athletic activities, coincident with the improved position of women in society and her greater freedom and acceptance in public life, points to the fact [that athletic participation] has not acted as a hindrance to her progress” (132).

In 1986, when women’s participation in sports was better established, Helen Lenskyj published Out Of Bounds, which highlights the paradox of women becoming more physically active while still adhering to specific rules of femininity. She shows how a few forms of exercise—like swimming, tennis, and horseback riding—gained acceptance as women’s activities due to the contemporary ideal of women being “beautifully strong and fit” (128).

While this would seem like progress from the norms in 1930, the emphasis on gender roles persisted. Women now exercised for the aesthetics. Lenskyj writes on the developing definition of femininity: “The new requirements included thinness, muscularity and shapeliness, enhanced by fashionable and expensive sportswear” (129). Women’s involvement was about an appearance; it became another way to fit a mold of the time.

Following the findings of Rosenberg, Krane, Somers, and Lenskyj, we are left with some of the basic societal expectations of women: Women are to be passive and 16 | Spring 2013 PROBLEMATICS

docile, more concerned with appearance and male attention rather than performance. If women decide to be active, they must follow certain guidelines of femininity. With this in mind, we will begin examine two sports that directly challenge these principles.

Using the examples of the All-American Girls Professional Baseball League (1943-1954) and what many refer to as the first women’s professional basketball league (1978-1981), we will examine the paradox of feminine athletes and the solutions offered for this paradox. I will analyze the reasons for mandating beauty school attendence by studying what was taught and why the teachings were viewed as necessary for these women. I will show how, through beauty schools and other forms of instructed femininity, American society displays a belief that female athletes are defective because they defy their womanhood and therefore need to be fixed. I argue that this belief remains in place today and actions to “fix the problem” persist through “makeovers” and the hyper-sexualization of female athletes.

As men’s minor league teams fell apart in the face of the World War II draft, team owners decided to form the All-American Girls Professional Baseball League (AAGPBL) to avoid closing stadiums (2). Though the idea of a women’s league was empowering and progressive, league managers heavily emphasized gender roles. In order to participate, the women needed to avoid becoming too masculine. For the AAGPBL, “femininity was a high priority[...] After their daily practices the women were required to attend Rubensteins [Beauty Salon] evening charm school classes” (“League History” 10). These classes taught “the proper etiquette for every situation and every aspect of

personal hygiene. In an effort to make each player as physically attractive as possible, each player received a beauty kit and instructions on how to use it” (10).

The women were also required to follow “Rules of Conduct” which stated, among other things, that players needed to “ALWAYS appear in feminine attire [...], Boyish bobs are not permissible [...] Lipstick should ALWAYS be on” (“Rules of Conduct”, AAGPBL Official Website). It is hard to ignore the emphasis on displaying the players’ femininity.

Evaluating AAGPBL rules and Porter’s representation of an early women’s professional basketball league, we continue to build our understanding of what it takes to be feminine. To be feminine, we apply makeup properly to be “as physically attractive as possible” and we act appropriately in every situation, showing how docile and doll-like we can be. However, neither of these things is intrinsically female. Each is part of a large list of learned behaviors women are trained to follow by their surroundings. In Beauty Secrets: Women and the Politics of Appearance, A similar story, documented Wendy Chapkis illustrates the Being female is based on in Kara Porter’s Mad Seasons, deception of these ideals, notemerges from one of the first our two x-chromosomes and ing that “[d]espite the fact women’s professional bas- female reproductive organs; that each woman knows her ketball leagues. In “Make-up own belabored transformation it’s a biological fact. On the from female to feminine is arGame,” a chapter on enforced rules of femininity on players she harbors the secret other hand, being feminine tificial, in the league, Porter quotes conviction that it should be efone player’s recollection of the is socially constructed; it is a fortless” (5). Women feel they charm school: “Here you have a should be “naturally feminine” choice one makes. bunch of jocks who don’t know and thus hide their use the the first thing about modeling available “tools of transformagoing in there. They taught us how to walk down the tion” as they remedy their “flaw[s]” (5). little runway and turn around, and how to get in and out of a car with a dress on. They showed us prettier Chapkis exposes the assumption that all women ways to cut our hair” (Porter 96). Some team owners, should automatically be feminine. Being female is like California Dreams owner Larry Kozlicki, thought based on our two x-chromosomes and female reprothe players would be “grateful for the chance” to ductive organs; it’s a biological fact. On the other hand, learn important skills such as “make-up techniques” being feminine is socially constructed; it is a choice one (96). Kozlicki’s words expose a belief that female ath- makes. Female and feminine are separate concepts. In letes had missed out on important features of being addition, Chapkis shows how certain feminine qualities women, like putting on makeup. The fact that these fail to come naturally to any woman. This is not to say basketball players were strong and competitive be- that being feminine is wrong, only that some women came a mistake they needed to make up for. are more comfortable adapting to their society’s constructed definition than others.

Spring 2013 PROBLEMATICS | 17

Recognizing that being feminine is a social choice, we now return to the issue of beauty schools and trainings. A woman who wears makeup to empower herself to feel more confident or to express her creativity is different from the one who is told she must do so in order to participate in her area of interest and to gain the appreciation she deserves. When a woman’s choice of how to construct her own identity is taken away from her, all women are told to follow a set societal definition regardless of their individual aspirations.

In the aforementioned baseball and basketball leagues, the decisions were made by the coaches, league owners, and spectators. Even in these developed examples where women are allowed to participate in sports and pursue their athletic goals, we have not moved far from Somers’ time when she wrote: “the character of woman…[has] arisen as an expression of the wishes of society. The characteristics which the woman possesses are characteristics which man throughout the ages has wanted woman to have” (29). Men made the choices concerning an American woman’s identity in the 1930s and, if the examples presented in this paper are believed, they still do. In all these examples, a woman has been told how she is supposed to act and, if she deviated from the norm, reminded of the essentials she had missed out on, and 18 | Spring 2013 PROBLEMATICS

what she was therefore lacking. We now see, however, the only thing lacking is conformation to someone else’s ideal of femininity.

Today we still regularly see female athletes being told how they should look, what they should wear in and out of competition, and how they should act. Consider Caster Semenya, a middle distance runner from South Africa who competed in the 2009 World Championships. Semenya easily beat her competition and won gold in the women’s 800 meters (Levy 2009).

Following her victory, however, she was withdrawn from competition and was subjected to gender testing (1). She was unable to compete again until 2010 when it was decided that she was truly a woman. In the midst of the controversy, South Africa’s You magazine published a new image of Semenya which gained positive feedback and world popularity. On the magazine cover, Semenya wears a black dress with gold jewelry, her nails and hair are nicely done, and she also has applied makeup. She looks feminine, embodying the “belabored transformation” Chapkis describes. Although Semenya was not explicitly told she had to dress this way in order to compete, like members of the AAGPBL, she felt femininity forced upon her when her ability to compete was taken away. She too was pushed to con-

form to a more acceptable image of a woman by spectators and sport organizers.

It is not uncommon to see other female athletes receive sexualizing “makeovers.” This is another iteration of women being pushed to conform to a societal standard in order to compete and gain the recognition she deserves. Only the definition of femininity has changed. When the AAGPLB existed, a proper woman was docile, well-mannered, and lady-like. Today, the definition of femininity also encompasses sexual and barely-clothed. As Semenya shows, contemporary female athletes who present themselves as hyper-feminine gain positive media feedback, a larger fan base, and more monetary support.

While this paper has focused on women, men are equally pressured to conform to their own set of rules.

These rules are examined in A New Psychology of Men, which states: “traditional norms for the male role, such as the emphasis on competition, status, toughness, and emotional stoicism, [result in…] certain male problems such as aggression, violence, homophobia, misogyny, detached fathering, and neglect of health” (Levant and Pollack 1). The authors note that “[p]roblems alluded to above have long had a negative impact on women, men, children, and society” (2). I have focused on women for just this reason: though men also struggle to form their identities, the characteristics associated with men are empowering while those associated with women are submissive. Thus, these socially constructed male characteristics have only furthered the domination and control of women.

While the “problem” with athletic women has been defined as one where women have failed to meet re-

quirements of femininity, the actual problem is the idea that women can be told how to define our own identities. Rather than “fixing” women, we should focus on fixing backwards beliefs and practices which have been, and continue to be, unfair to our gender.

Bibliography Chapkis, Wendy. Beauty Secrets: Women and the Politics of Appearance. South End Press, 1986. 1-214. Web. <http://books.google.com/books?hl=en&lr=&id=ceV6 HyL3FhsC&oi=fnd&pg=PA1&dq=beautysecretsbelabo redtransformation&ots=2bbYeDzZZm&sig=iGCMFsPe 8uc_PvOCTlcxfRDXGyo> Krane, Vikki et al. “Living the Paradox: Female Athletes Negotiate Femininity and Muscularity.” Women and Sports in the United States. Ed. Jean O’Reilly and Ed. Susan K. Cahn. Boston: Northeastern University Press, 2007.

Print.

Lenskyj, Helen. Out of bounds: Women, sport, and sexuality.

Toronto: Women’s Press, 1986. Print.

Levant, Ronald, and William Pollack. A New Psychology of Men. New York: Basic Books, 2003.1-416. eBook.

Levy, Ariel. “Sports, Sex, and the Case of Caster Semenya.” New Yorker. 30 Nov 2009: n. page.

Web. 6 Dec. 2011. <http://www.newyorker.com/ reporting/2009/11/30/091130fa_fact_levy>.

Official Website of the AAGPBL. 2005-2011. All-American Girls Professional Baseball League Players Association. 1 Nov. 2011. <http://www.aagpbl.org/> Porter, Karra. Mad seasons: the story of the first Women’s Professional Basketball League, 1978-1981. Lincoln: University of Nebraska Press, 2006. 336. Print.

Rosenberg, Carol , and Charles Rosenberg. “The Female Animal: Medical and Biological Views of Woman and Her Role in Nineteenth-Century America.” Journal of American History. 60.2 (1973): 332-356. Web. 8 Dec. 2011.

Somers, Florence . Principles of Women’s Athletics. New York: A.S. Barnes and Company, 1930. 1-151. Print.

Spring 2013 PROBLEMATICS | 19

The Missing Statistic: Gender Bias and the Neglect of Male Eating Disorders

By Amanda Rost ‘14 “Parity between the genders … may now exist.”

-Murray, Rieger, Touyz, and García (2010)

Taken at face value, this is a statement to be celebrated. However, when this quote is placed in its larger context the message is not quite as hopeful: “The last 20 years have witnessed dramatic increments in the prevalence and severity of male body image disturbance to such an extent that parity between the genders in this regard may now exist.” The increasing prevalence of eating disorders among males is beginning to chip away at the depiction of these debilitating mental illnesses as a uniquely female burden. Unfortunately, this particular achievement for gender equity is overshadowed by the negative implications for the mental wellbeing of our society as a whole.

Murray et al. (2010) also go on to discuss how this parity in body image dissatisfaction has not gained proper recognition. “Yet the prevalence of recognized eating disorders in males during this same period has not increased, which is perhaps not surprising given the absence of an eating disorder diagnosis geared towards the male experience of eating pathology” (Murray et al.). More and more men and boys are affected by eating disorders, but they have not yet achieved enough attention in the medical community nor in society to overthrow the assumption that eating disorders are a “woman’s disease.” Not only are men less likely to seek treatment because of this stigma, but doctors are 20 | Spring 2013 PROBLEMATICS

also less likely to recognize eating disorders in males than females because eating disorder screenings cater to girls and women (NEDA.org).

Two pressing questions arise in this context. First, why have men with eating disorders not been recognized from the outset? If eating disorders truly originated among women, what cultural changes have caused more men and boys to develop eating disorders? And second, what is keeping men and boys with eating disorders from receiving adequate treatment and the attention they deserve? Men and boys could benefit immensely if the reality of eating disorders in males was reconciled with our cultural perception of this phenomenon.

To be a centerfold today, a Playgirl centerfold model from 1976 would need to lose 12 pounds of fat and gain 27 pounds of muscle, and male models are not the only ones under pressure to conform to today’s body image ideals (Gregor). As Maine & Bunnel wrote in the 2008 Eating Disorders journal, “if women turn to their bodies as the way to modulate and resolve these stressors and mixed messages [about body image], it is only logical that men would also express some of their distress through their bodies and would be at greater risk to develop eating disorders.”

In the past, the stereotypical masculine alpha male was characterized entirely by the ability to provide securi-

ty in some manner, primarily monetary, but that was not embodied in a certain physique. As women have emerged from their domestic spheres of the Good Housekeeping days, men are beginning to lose their monopoly on providing security. Not surprisingly, research indicates that western men’s body image dissatisfaction has tripled in the previous 25 years, from 15% to 45% (International Health, Racquet & Sports Club Assocation). This trend accompanies the 37% increase in sales for the men’s cosmetic and grooming industry between 1991 and 1996. More shockingly, British health service figures show a 66% increase in men admitted to hospitals for eating disorders in the past 10 years (IHRSA).

While it is not possible to ascertain the exact time when male body image standards began to exert the same pressure as female standards, all trends indicate that this shift is certainly underway. The issue is not when this change happened, but why the medical community has yet to catch on.

The current circumstances regarding men and women with eating disorders seem to reflect a feedback loop.

This process does not reflect the point at which this cycle began, but rather offers a snapshot of the current circumstances. Under the umbrella of cultural norms,

the beauty, sports, entertainment, and other similar industries propagate unrealistic body ideals for both men and women. Namely, these ideals demand very muscular and trim male figures alongside ultra-thin women with only enough body fat for large breasts.

The general public internalizes these pressures, and given certain biological or environmental circumstances, develops an eating disorder as a way to cope with these unreachable standards.

Here, we reach a fork in the road. While cultural norms encourage girls to seek help for their eating disorders, men and boys with the same issue face stigma and are less likely to try and deal with their eating disorder if it is not medically necessary. As a result, more women and girls seek clinical treatment, which in turn influences research priorities and results in treatment and knowledge being predominantly focused on female populations. Ultimately, the process solidifies the societal perception that eating disorders are a “female” disease and continues to deprive men and boys of the help they need.

One of the most commonly cited statistics regarding eating disorders is that an estimated one out of every 10 affected individuals is male. Yet the validity of such statistics is called into question by the process described Spring 2013 PROBLEMATICS | 21

above. Of the students at Stanford University with eating disorders, 13% are estimated to be male. Even Megan Jones, the director of the Stanford Healthy Body Image Program where this research is conducted, is skeptical of these numbers. “The real prevalence is likely much higher but unfortunately, fewer men with EDs seek treatment” (e-mail correspondence, 3/15/12).

Recent research indicates that the sex ratio for most eating spectrum disorders is smaller than that in treatment-seeking samples and significantly smaller than the 9:1 ratio stated in the DSM-IV (Swanson, Crow, Le Grange, Swendsen, Merikangas, 2011). Although Swanson et al. acknowledge that this difference may be the result of the methods of the present study, they suggest instead that the numbers reflect a true lack of a sex difference in eating disorders in adolescence.

Rethinking Concepts and Theories The existing body of research regarding eating disorders is based on frameworks and categorizations that largely reflect disorders exclusively among women.

As the Gendered Innovations project highlights, inaccurate research concepts have the potential to send research down the wrong path. In the case of eating disorders, concepts and theories based on female populations have resulted in a series of studies that have consistently neglected men and boys.

The medical community’s understanding of eating disorders has historically been based on the two “classic” disorders, Anorexia Nervosa (AN) and Bulimia Nervosa (BN). The current DSM-IV defines AN, BN and Eating Disorder Not Otherwise Specified (EDNOS), to accommodate the variety of eating disorders individuals develop that do not fit under the strict definitions in the DSM. The DSM (Diagnostic and Statistical Manual of 22 | Spring 2013 PROBLEMATICS

Mental Disorders) is the unofficial “bible” of mental health professionals who make psychiatric diagnoses, published by the American Psychiatric Association.

The new DSM-V, to be released in May 2013, will include diagnoses for Binge Eating Disorder (BED). Additionally, it will relax the criteria for AN and BN since many patients in clinical studies are found to have “below-threshold” eating disorders, meaning they have a disorder but technically do not meet the criteria of the DSM diagnosis. The inclusion of BED in the DSM-V is not only helpful to expand the overall understanding of eating disorders, but also because research indicates that BED is as prevalent in men as it is in women (Striegel, Bedrosian, Wang, & Schwartz 2012). Revisions of the DSM eating disorder categorizations are oriented towards reducing the number of EDNOS diagnoses in order to provide more specific, effective treatment. Men are estimated to constitute 35% of EDNOS patients, and roughly 60% of eating disorder cases are estimated to fall under EDNOS (Murray, Rieger, Touyz, & García 2010). As more EDNOS are identified, presumably more male-specific eating disorders will be recognized in the process. Furthermore, Binge Eating Disorder is estimated to be as prevalent as males as it is in females but the nature of the illness is different in men than it is in women. For example, men generally have higher thresholds for what qualifies as a binge episode in terms of quantity of food (Arikian et al. 2012).

Rethinking eating disorder concepts and theories requires the acknowledgement of differences in symptomatology between males and females along with recognition of the similarities. For instance, Muscle Dysmorphia, also called Bigorexia, highlights a main sex difference. The disorder is characterized by exces-

sive exercise and unhealthy regulation of diet. Muscle Dysmorphia is prevalent in males who are preoccupied with increasing their muscle mass and decreasing their body fat percentage. While girls with anorexia generally overestimate the size of their thorax, waist and hips, boys with anorexia tend to overestimate the size of their shoulders, hips and thighs (Darcy et al. 2012).

Boys with Muscle Dysmorphia, however, underestimate the size of their shoulders and overestimate the size of their waist. Muscle Dysmorphia does not have an established symptomatology, and it is currently classified in the DSM-IV as a Body Dysmorphic Disorder despite the call from many mental health specialists to include it as an eating disorder category of its own.

ences.

A clinical comparison of males and females with Anorexia Nervosa indicated that the Eating Disorder Examination, a standardized interview assessment, more accurately evaluates females with eating disorders rather than males. Males with AN scored lower on subscales such as Shape Concern and Weight Concern.

While this result can be interpreted as portraying less severe AN among males, it is more likely due to items specific to female body image issues such as â&#x20AC;&#x153;Empty Stomach, Social Eating, Eating in Secret, Flat Stomach and Desire to Lose Weightâ&#x20AC;?. About half of males with eating disorders have a desire to be bigger, but these male-specific body image dissatisfactions are not identified in eating disorder symptomatology (Darcy et al. 2012). Many eating disorder assessments were designed for females but are being administered to males, potentially interfering with accurate diagnoses.

If standard eating disorder assessments do not accurately capture the nature of the male eating disorder experience, the result may be that males are wrongly classified as having less severe eating disorder experi-

Ultimately, males develop and exhibit eating disorders in a manner different from females. The evidence, however, does not indicate that the severity of the effects is any less among males. For example, crosssectional data from 21,743 men and 24,608 women with Binge Eating Disorder indicated that the groups had equal levels of impairment1 (Striegel et al. 2012).

The differences among males and females with eating disorders must be explored without diminishing the ramifications in either population. The current concepts and theories regarding eating disorders refer mostly to the female population, falsely implying that men with eating disorders do not suffer consequences on par with females.

Regarding Bulimia Nervosa, typical models of the illness suggest that body image dissatisfaction and stress can lead to dieting behaviors. In turn, these dieting behaviors have the potential to evolve into bulimic behaviors. However, a recent study of adolescent boys and girls aged 12-15 years found a correlation between dieting behaviors and bulimia in girls but not boys. The results still indicated equal levels of bulimic symptoms in boys and girls (Salafia & Lemer 2012). This implies that the pathways leading up to eating disorders such as BN may differ across genders, potentially because of differences in stress regulation in adolescence.

Sex & Gender If researchers neglect to recognize factors intersecting 1. Impairment refers to the inability to fulfill the activities associated with a major life role such as employee, parent, or student.

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with sex and gender, they run the risk of drawing false conclusions about gender differences and missing out on the potential differences between the sexes. In the case of eating disorders, the prominent factors that have an influential role on eating disorder susceptibility aside from sex and gender include; comorbid mental dispositions, age, social norms, and sex hormones.

The development of an eating disorder involves the confluence of a wide array of biological and social factors that differ greatly within individuals. Thus, predisposition to other mental illnesses plays an immense role in the development of eating disorders. Significant comorbid factors that generally co-occur with eating disorders include depression, obsessive-compulsive disorder, impaired decision-making and perfectionism (Maine & Bunnell 2008). Swanson et al. (2012) also found that the majority of individuals with eating disorders met DSM-IV criteria for at least one other lifetime disorder out of the following list: mood disorder, anxiety, behavioral disorder and/or substance abuse/dependence.

When eating disorders are parsed into their different psychological components, the gendered assumptions of eating disorder patients seem less significant. For example, the National Eating Disorder Awareness organization website narrates the story of a heterosexual male who developed an eating disorder as the result of being a perfectionist athlete in high school (NEDA. org). Perfectionism hardly holds the same stigma for males that an eating disorder does. Recognition of the comorbid mental dispositions that contribute to eating disorders will help reduce the stigma that has pigeonholed eating disorders as a womenâ&#x20AC;&#x2122;s disease. The aforementioned genetics studies have further broken 24 | Spring 2013 PROBLEMATICS

down what factors predispose individuals to these mental illnesses by identifying certain sequences in the genome that are found among eating disorder patients. Unfortunately, this work has been carried out in female populations and thus cannot shed light on gender differences.

Age is another intersecting factor that influences whether or not an individual develops an eating disorder. Generally, boys develop eating disorders later in life than girls and research indicates that this is due to the role that puberty plays in the onset of these illnesses. Puberty in girls activates genetic risk factors for eating disorders because of sex hormones that are released during this time. A combination of hormonal activation and heightened psychosocial risk may contribute to gene-environment interactions and increased heritability2 in girls during puberty. This theory is corroborated by the fact that heritability among girls pre-puberty is 0% and then increases to 50% postpuberty (Klump, Culbert et al. 2012). Animal studies with rats also demonstrate that females display more binge eating behavior after puberty whereas males display an equal amount of bingeing pre- and postpuberty (Klump, Suisman, et al. 2011).

Meanwhile, heritability in boys is 50% prior to and following puberty (Klump, Culbert et al. 2012). Early testosterone exposure has major organizational effects on the brain and may protect against the development of disordered eating. Testosterone may organize genetic risk for disordered eating in boys and contribute to the stability in genetic risk across adolescence and 2. Heritability refers to the percent of variation in a population due to genetic factors.

into adulthood. Research with monozygotic twins also indicates that in male-female twin pairs, the concordance of eating disorders among twin pairs is only 50%. This suggests that the genetic factors that lead to eating disorders in males are different from those that lead to eating disorders in females (Klump, Culbert, et al.). If sex hormones cause girls to develop eating disorders earlier in life, it is possible that this has garnered more attention for female eating disorders simply because of a difference in timing. This phenomenon is similar to how osteoporosis has been overlooked in men because women develop the bone disease earlier in life (genderedinnovations.stanford.edu).

A third confound on the relationship between eating disorders and gender is socially conditioned behavior.

As Klump, Culbert et al. (2012) wrote in their study on adolescents with eating disorders, “Girls are exposed to more sociocultural (e.g. pressures for thinness) and peer (e.g. affiliation with weight-focused peers) factors that increase risk for eating disorders during puberty. . . Increased exposure to these risk factors may activate genetic risk and increase the heritability of disordered eating in girls versus boys.” Although body image pressures directed at boys are beginning to match the pressures for thinness that Klump, Culbert, et al. describes, the past few decades have seen a disproportionate amount of sociocultural and peer pressures directed at girls rather than boys. While the boys are just catching up, this would explain why girls with eating disorders have so heavily outnumbered boys with eating disorders up until now. Furthermore, recent research at the London School of Economics has found evidence that eating disorders, specifically anorexia nervosa, are “socially transmitted.” Among the LSE’s survey of 3,000 individuals across Europe, peer pres-

sure was found to be the single most influential factor on body image. Nevertheless, all of the individuals surveyed were female.

The medical community is increasingly recognizing more factors that influence the development of an eating disorder, to the point where eating disorders are no longer seen as one illness but rather the confluence of several mental instabilities and environmental factors.

Next Steps In order for men and boys with eating disorders to receive recognition on a larger scale, the current cycle contributing to this neglect will have to be broken.

This can be done on a variety of different levels. First, raising awareness of male eating disorders will cause cultural norms to gradually recognize both men and women with eating disorders. Eating disorder and body image campaigns, particularly those held by national organizations such as NEDA, must target men and women alike.

If national organizations gain attention for men with eating disorders, it will be easier to restructure research priorities and make more progress to include men in clinical studies. In turn, more clinical studies that include men will lead to more accurate diagnoses and assessment instruments for men. Furthermore, if the medical community begins to pay attention to males with eating disorders then the stigma of eating disorders being a “women’s disease” will start to disappear. This, in turn, will encourage more men to seek treatment.

In his book Crazy Like Us: The Globalization of the Spring 2013 PROBLEMATICS | 25

American Psyche, Ethan Watters describes how symptom pools, put forth by physicians, allow diseases to begin “the feedback loop by which the disease goes forward and claims new victims’’ (Watters). Mental illnesses can be equally as debilitating as any other illness, and the “symptom pool” for eating disorders has certainly taken hold of the Western hemisphere and is seeping into other parts of the world. Ultimately, degendering eating disorders is not about achieving equity for equity’s sake; it is about achieving equitable treatment for men and women so that body image among the greater population can be restored.

Bibliography Arikian, A., Peterson, C., Swanson, S., Berg, K., Chartier, L., Durkin, N., & Crow, S. (2012). Establishing thresholds for unusually large binge eating episodes. The International Journal Of Eating Disorders, 45(2), 222-226. doi:10.1002/eat.20930 Blodgett Salafia, E., & Lemer, J. (2012). Associations Between Multiple Types of Stress and Disordered Eating Among Girls and Boys in Middle School. Journal Of Child & Family Studies, 21(1), 148-157. doi:10.1007/ s10826-011-9458-z Cunningham, G. R., Matsumoto, A. Patient’s Guide to Low Testosterone. Hormone Foundation, 2003. Print.

Darcy, A. M., Doyle, A., Lock, J., Peebles, R., Doyle, P., & Le Grange, D. (2012). The eating disorders examination in adolescent males with anorexia nervosa: How does it compare to adolescent females?. International Journal Of Eating Disorders, 45(1), 110-114. doi:10.1002/eat.20896 Gregor, S. (2004). The Man Behind the Mask: Male Body Image Dissatisfaction. 14 InPsych, web publication: http://www.psychology.org.au/publications/ inpsych/body_image/ “IHRSA - Research.” IHRSA. International Health, Raquet 26 | Spring 2013 PROBLEMATICS

& Sports Club Association, 2011. Web. 16 Mar. 2012. <http://www.ihrsa.org/research>.

Klump, K. L., Culbert, K. M., Slane, J. D., Burt, S. A., Sisk, C. L., & Nigg, J. T. (2012). The effects of puberty on genetic risk for disordered eating: evidence for a sex difference. Psychological Medicine, 42(3), 627-637. doi:10.1017/S0033291711001541 Klump, K., Suisman, J., Culbert, K., Kashy, D., & Sisk, C. (2011). Binge eating proneness emerges during puberty in female rats: a longitudinal study. Journal Of Abnormal Psychology, 120(4), 948-955.

Maine, M., & Bunnell, D. (2008). How do the Principles of the Feminist, Relational Model Apply to Treatment of Men with Eating Disorders and Related Issues? Eating Disorders, 16(2), 187-192. doi:10.1080/10640260801887428 Murray, S. B., Rieger, E., Touyz, S. W., & De la Garza García, L. (2010). Muscle dysmorphia and the DSM-V conundrum: Where does it belong? A review paper. International Journal Of Eating Disorders, 43(6), 483-491.

“Reflections Body Image Program.” Reflections Body Image Program. Tri Delta, 2012. Web. 16 Mar. 2012. <http:// thecenter.tridelta.org/our-programs/reflectionsbody-imageprogram>.

Striegel, R. H., Bedrosian, R., Wang, C., & Schwartz, S. (2012). Why men should be included in research on binge eating: Results from a comparison of psychosocial impairment in men and women. International Journal Of Eating Disorders, 45(2), 233-240. doi:10.1002/eat.20962 Swanson, A. S., Crow, S., Le Grange, D., Swendsen, J., Merikangas, K. (2011). Prevalence and Correlates of Eating Disorders in Adolescents. Archive of General Psychiatry, 68(7), 714-723. doi:10.1001 Wang, K., Zhang, H., Bloss, C. S., Duvvuri, V., Kaye, W., Schork, N. J., Watters, E. (2010). Crazy like us: the globalization of the American psyche. United States of America: Free Press.

America’s Ultimate Fantasy: the Inner-City Classroom in Hollywood Film and National Policy

By Megan Winkelman ‘13 Baby you my everything, you all I ever wanted We can do it real big, bigger than you ever done it You be up on everything, other hoes ain’t never on it I want this forever, I swear I can spend whatever on it.

–Drake, “Best I Ever Had”, 2009

Drake’s music video “Best I Ever Had” features the popular rapper coaching a women’s basketball team.

As the song plays, Drake buys the girls sequined, lowcut, pink jerseys for their championship game. Halfway through the big game (after the gorgeous, bumbling girls have fallen significantly behind), Drake calls a time out. He lectures, “I don’t know what to say. I don’t know what’s happening here. Okay, we are falling apart. Now I swore the new uniforms would be encouragement. The Mighty Ducks didn’t disappoint Emilio Estevez, you know what I’m saying?” One player interrupts, “But Drake, all you taught us how to do was stretch!” After this “pep talk”, the team returns to the court and dramatically loses the game.

On its face, such sexed-up silliness seems entirely unrelated to America’s public education policy and rhetoric. Yet the self-deprecating humor embedded in Drake’s failed uniforms and the team’s embarrassing loss implies that the video’s producers recognize and embrace the ironic gap between the song’s message and the video’s representation. (For instance, in the lyrics he seems to be directing all his attention to one perfect woman, but in the video he has an entire lineup

of beautiful females at his feet.) It is possible to discern some surprising lessons about the rhetoric of American secondary education from Drake’s sly production.

In this paper, I want to suggest that “Best I Ever Had” accidentally critiques a gap the federal government must finally close: the devastating gulf between the federal rhetoric of inclusion on the one hand and the effectively exclusionist policies regarding America’s inner-city public schools on the other. Drake tells his girl that she’s the only one, just as policymakers recycle speeches about working “for the children,” even as students only learn remedial reading and mathematics, the equivalent of only learning to stretch. It should be no surprise, then, that once American inner-city students get to the real game—federal testing situations, or more importantly, their adult lives—they often fare no better than Drake’s team.

With this paper I will establish the historical and psychological context of urban education in America. I will begin this journey by considering America’s long, strange relationship with school reform and rhetoric (up to the No Child Left Behind Act of 2001), as I work to establish the urgency of the problem of educational inequity. Recruiting the “shared fantasy” communication theories established by Ernest Bormann and Steven Thomsen, I will offer a theoretical model for showing how Hollywood media, and in particular, its specific advertising practices, has become a profound force in

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driving our educational rhetoric. As a result, substantial benefits for analyzing Hollywood’s advertisements will arise: Here we can uncover the values that sell and underlie a common enjoyment, a marketplace which functions as a gateway for seeking pleasure in the political, without the trappings and tedium of actual political dialogue. I believe that by analyzing the racially fraught politics of education through the specific subgenre of Hollywood film advertising, the personal nature of the education policy battle will emerge.

Birth of a Fantasy: A History of Education Rhetoric Sylvia Barrett: The theme of MacBeth is that too much ambition can lead to ruthless ambition, and end up in disaster.

That’s what words are for - to be used. Who can tell me what “ruthless” means? Joe? [Gets no response, decides to ask...]

Sylvia Barrett: Eddie?

Eddie Williams: Steps all over.

Sylvia Barrett: Use it in a sentence.

Eddie Williams: Steps all over, like white people. I know because I’m colored.

-Up the Down Staircase (1967)

America’s public education system is in crisis. In 1997, educator Stephen Arons decried the education system as “weakened by teacher-bashing, administrative overload, and massive resource and racial inequalities; and continuously subjected to the moralistic rhetoric of local and national demagogues—public schooling seems moribund” (1). According to Arons, America’s education system isn’t just losing the war; it’s on its deathbed, bleeding from its wounds. From the cumulus of educational research and history, investigating

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controversies over vouchers, testing, home-schooling, censorship, and curricula, this paper will specifically explore the equity gap in inner-city schools.

The battle to create and maintain an equitable school system must surmount more than a history of slavery, immigration, and the inherent complications of running a complex institution for millions of Americans; this battle engages the very fabric of the American psyche. Arons writes: Looking backward to a history of individualism weakly restrained by collective needs and forward to the specter of social fragmentation and individual isolation, Americans seem perpetually predisposed to look to reform of the common schools as a means to help create cohesion and unity out of self-absorption and diversity (2).

Arons’ analysis indicates that American schools bear the weight of the melting pot, meritocracy, and the American dream. Somehow, Americans trust that the ideal school system promises the antidote to capitalism’s inherent social inequality. Throughout 400 years of developing education policy, “Americans have not only tolerated the politicization of public schools, they have reveled in it and sought its spoils” (Arons 2).

Conflicts over race, religion, nationalism, and industrialization in the system have gradually weakened the schools. The search for the “one true morality” that can save our schools and future generations transformed public education into an ideological warzone.

Arons evaluates this “reveling” in the real world, but it is never so clearly magnified as when reflected in Hollywood, the kingdom of revelry. Hollywood appro-

priates the egalitarian ideals of America’s educational past and inflates them into fantastical dimensions.

The No Child Left Behind Act of 2001 (NCLB) is the most recent in a long string of federal schemes to improve America’s faltering schools. Educator Gerald W. Bracey’s chapter on NCLB in “Education Hell: Rhetoric v. Reality: Transforming the Fire Consuming America’s Schools” describes the law’s mandates for schools across the country. First standardized testing, beginning in third grade, must be administered to determine whether students are proficient in reading and mathematics. Despite this absolute reliance on testing, no psychologist or cognitive scientist accepts the score that distinguishes between proficient and failing (Bracey 112). If Adequate Yearly Progress (AYP) in test scores is not made within two years, students can choose to transfer to other, “successful” schools.

By 2007 it became clear that the highest-performing students leave the condemned schools, draining underperforming schools and their students of federal resources (Bracey 114). In the third year of failing to meet AYP, schools must provide free tutoring. Bracey argues that it is illogical to offer extra resources (with federal money draining to for-profit education firms) after students have already been allowed to change schools (Bracey 114). In the fourth year the district can take control of the school’s management and in the fifth year the schools must “restructure,” introducing new teachers, administrators or private management firms (Bracey 113). Bracey and others criticize this timeline as impractical and ineffective. Bracey’s chapter about NCLB is titled “No Child Left Behind: The Beatings Will Continue Until the Morale Improves.”

This cleverly captures one important ideological problem with the law: the belief that somehow threats and punishments will improve education.

NCLB presents another, broader, philosophical quandary. NCLB allows no consideration of why students might not be fitting into the system. It quantifies their abilities to take tests, but provides no context for their success or failure. The American public, through our democratic representation, effectively turns a blind eye to the difference between demanding success and facilitating success. NCLB exposes the tension between education rhetoric and reality, as explored in the remainder of Bracey’s book. Former Assistant Secretary of Education Susan B. Neuman famously criticized NCLB: In [the most disadvantaged schools] in America, even the most earnest teacher has often given up because they lack every available resource that could possibly make a difference. [. . .] When we say all children can achieve and then not give them the additional resources … we are creating a fantasy (1).

Neuman perceives the fantasy at hand as insisting children can learn without resources. I argue an even more precarious fantasy looms in the expectation that teachers alone have the ability and responsibility to correct hundreds of years of inequality through standardized testing preparation, an absurd assumption both accepted and touted throughout the United States. NCLB publicly celebrates the “back to basics” approach, focusing only on remedial and rudimentary math and reading skills. I posit that the psychological

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justification for “back to basics” lies in a perhaps unconscious disregard for the culture and experiences of low-performing children. Instead of promoting a broader liberal arts curriculum that includes science, history, and visual and performing arts, and accounts for the individual stories and circumstances of each child, NCLB effectively advocates that the best way to teach children asks them to ignore their past and interests and willfully regurgitate rudimentary, disconnected material. By connecting education policy, critical theory, film advertising and the student voice, I hope to suggest that the movie posters publicizing the “Education Intervention” subgenre reveals an important American psychological phenomenon and may have implications in the non-rhetorical world of policy.

Hollywood’s “Classroom” Sub-Genre: An American Fetish [Taking an assessment test] “There’s always something wrong with these tests. These tests paint a picture of me with no brain. These tests paint a picture of me and my mother, my whole family as less than dumb. Just ugly black grease, need to be wiped away, find a job for.”

-Precious, 2010

“Best I Ever Had” recalls another dynamic beneath the cracking veneer of education rhetoric. Drake references The Mighty Ducks, questioning why buying new uniforms always leads to sports success in the movies, but doesn’t work in his “real life” situation. This scene alludes to the sexiness of Hollywood, screenwriters’ reliance on deus ex machina to create a happy ending in the span of two hours. Here the director winks

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at the audience; we understand that Drake acts in a movie himself, a fantasy in which new uniforms could transform a team if the director so chose. This agreement makes Drake’s confusion facetious rather than pathetic.

But how absurd, really, is Drake’s feigned belief in The Mighty Ducks promise? As renowned psychologist Ernest Bormann asks, “[Could the most persuasive communicators] design dramatizing messages with an eye to a target audience and deliver those messages in such a way that others were brought into participation in the fantasy?” Under Bormann’s theory, Drake’s character isn’t ridiculous; he participates with the Mighty Ducks such that he incorporates the fantasy into life. Steven Thomsen elaborates: By participating, the audience would become a part of a rhetorical, myth-making vision resulting in a new realm of reality, a psychodramatic fantasy world that may even seem more real than the real world. […] The shared myth, in effect, becomes a part of the user’s new symbolic reality or vision of how the world really is. Individuals who share the rhetorical vision become a part of a “rhetorical community,” a form of “public” which participates in the drama (133).

Thomsen applies this theory to understand the impact of education films on public perception of the teaching profession. He argues that audiences integrate Hollywood stereotypes about teachers, both good and bad, into their understanding of real-world teaching across America. I believe a more volatile application lies in the portrayal of the student, particularly inner-city, minority students. Thomsen describes teachers depicted in

movies either as outliers working against an inequitable or inefficient system, or as terrible, insipid and cruel individuals. If the public uses films to understand teaching, the profession’s credibility declines, because teachers, either individually or systematically, are depicted unfairly and unrealistically. Thomsen links the national decrease in teacher ratings to the poor public image concocted in Hollywood. While this undeserved judgment is certainly undesirable, if the public uses films to understand poor minority students (and not just their teachers), there are drastic implications for all future race and class-relations in this country. For instance, a public unexposed to poor or minority students may misinterpret a film like Precious (Lions Gate Entertainment, 2009): generalizations can result from the repetitive image of overweight black teen girl who suffers extraordinary abuse and illiteracy. As a consequence, Hollywood may change the way the general American public understands and treats failing students.

Gallup/Phi Delta Kappa polls originated to “identify and report national trends in public opinion on questions and issues of interest to education policy makers.” From the project’s inception in 1969, the polls have measured a decline in the public’s perception of the quality of national school systems, even though subjects consistently ranked their local schools higher than the national average. Thomsen suggests that the media portrayal of public schools influences the understanding of the national spectrum of schools, whereas local schools are evaluated based on individual, realworld experiences. This analysis implies that media, including Hollywood films, is interpreted as if it was attempting to accurately capture the school environ-

ment, and not simply to entertain. Film critic Roger Ebert’s review of the movie Up the Down Staircase presents an excellent example of the problematic way American culture perceives these Hollywood films as reports on school environments. Ebert writes, I don’t know if Coolidge High is representative of most ‘problem’ schools, but I have a feeling it might be. The process of education goes round and round, but the students are hardly ever involved. Frustrated or defeated, teachers use inane tactics to hold attention. […] Here is an honest film about one aspect of life as it is lived in our large cities” (2).

Ebert clearly believes that Hollywood’s portrayal of inner city public schools is authentic. Whether or not audiences truly believe the portrayal of these students, Ebert’s writing might stand in for the thoughts of a wider audience. As a movie critic, his writing caters to the movie-going public, and thus represents the perspective of individuals watching movies not as directors, screenwriters or actors, but as moviegoers seeking entertainment. Ebert makes it plausible that audiences may internalize Hollywood’s depiction of the diverse American classroom. Thus, Hollywood’s high school comes to replace the real high school.

There is no way—and perhaps no desire—to understand the real experience.

Why do audiences literally buy the Hollywood portrayal of public education? “Where can we grasp ‘enjoyment as a political factor at its purest?” (Zizek 1). Philosopher Slavoj Zizek begins his essay “From Sarajevo to Hitchcock…and Back,” with this question, immediately answering his own query with a photo of Nazis Spring 2013 PROBLEMATICS | 31

frightening a young Jewish boy (1). He argues that the enjoyment, equal parts horror and pleasure, on the young Nazi faces is “the primordial generative element, with its metastases spreading out...” (1) I believe no dynamic better deserves the application of Zizek’s psychoanalytic observation than American films about the inner-city school experience. Zizek writes: Sarajevo is not an island, an exception within the sea of normality; on the contrary, this alleged normality is itself an island of fictions within the common warfare. This is what we try to elude by stigmatizing the victim—that is, by locating the victim in the blemished domain between the two deaths: as if the victim were a pariah, a kind of living dead confined to the sacred fantasy-space (2).

Perhaps Zizek’s argument explains the recurrence of the education film genre. It’s difficult to ignore the reality of inequity in this country, particularly reflected in the public school system. Introducing this social problem into Hollywood enables Americans to locate “underprivileged” school children in the “sacred fantasyspace” of the film. Once located as “an island within the sea of normality” Americans can elude the horror and thus the responsibility of these schools because they have been safely contained in a false, fantastical realm beyond the world of the everyday. This allows the audience to dismiss the possibility that the actions of all Americans, not only those living or experiencing inner-city schools, are part of the “common warfare” of class, race, and unequal opportunity. This fantasy disempowers both students and viewers.

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1955 to 2009: Selling the Genre to America “Who are these kids, rejects from hell?”

-Dangerous Minds (1995)

Nothing captures Zizek’s notion of horrific pleasure as applied to America’s public schools better than the advertisements designed to promote Hollywood’s movies about education. Within my narrowly defined “American Education Intervention” sub-genre are seven films, each marketed with a different film poster design. The way Hollywood drafts these posters provides a vivid picture of the elements of this dynamic that are so appealing to American audiences, and thus of what constitutes this peculiar American fantasy of inter-city public education. In his book Ways of Seeing, John Berger describes advertising as the production of glamour and the manipulation of wish-fulfillment. His final chapter argues that advertising targets envy. He writes: Publicity is always about the future buyer. It offers him an image of himself made glamorous by the product or opportunity it is trying to sell. The image then makes him envious of himself as he might be (132).

Berger’s perspective makes it important to explore what the posters of the Education Intervention films are selling and exactly what aim they are fulfilling. In this section I will assess a chronological accumulation of my advertisements and extract the similarities and differences within this family of related posters.

In 1954, the Supreme Court ruled in Brown v. Board of Education that establishing separate public schools for different races was unconstitutional; it is appropriate, then, that our investigation begins with a poster released only a year after this influential decision. As early as 1955, Hollywood advertisers capitalized on America’s simultaneous fear and obsession with innercity schools and schoolchildren. A movie poster for Blackboard Jungle (Metro-Goldwyn-Mayer, 1955) features a pretty blonde girl in a library, face contorted with fright, as she appears to back away from a menacing dark shadow looming in the foreground. With a single image, Hollywood has transformed the public school into a horror film set. The blind fear usually reserved in film for vampires and werewolves mirrors white America’s fear of the young, black student. The poster directs the audience’s sympathies to align with the victims: idealistic white teachers.

This racist portrayal of inner-city schoolchildren in Hollywood film promotional material is not a dynamic of the past. In the poster for Dangerous Minds (Hollywood Pictures, 1995) Michelle Pfeiffer (who plays a white high school teacher) with her red lips, blond bob and sharp cheekbones graces the foreground like a tough, golden goddess. A pack of “underprivileged” students slouch behind her, almost blending into the background. Beneath Pfeiffer the tagline is printed in red letters: “She Broke the Rules. And Changed Their Lives.” With this poster we recognize a shift from a focus on the “monstrous” or fearful qualities of the students to the unconventional yet divinely heroic actions of the teacher. This shift represents the beginning of an era in which racialized messages are made politi-

cally correct by posing the white teacher as a savior to “underprivileged” schoolchildren. Unlike similar movie ads of the 50s and 60s, this poster demonstrates the control of the white teacher with a mass of students dutifully following, as represented by Pfeiffer’s position in the foreground, nearly obscuring her students.

Our Modern Case Study: Freedom Writers Marcus: No, that don’t fly Ma. Erin Gruwell: First of all I’m not anybody’s mother.

Andre: No, that’s not what it means.

Eva: It’s a sign of respect... for you.

-Freedom Writers, 2007

Twenty years later, in the main promotional poster (figure 6) for Freedom Writers (Warner Bros., 2007), an angelic, blown up image of Hilary Swank’s pale face dominates the page, drawing attention to the white and noble protagonist.

However, the tagline reads: “Their story. Their words. Their future.”

Freedom Writers’ tagline might suggest that Freedom Writers, it would be marketed difadvertisement. 2007. ferently from other education intervention films that focus on either the chaos

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of the classroom or the saintliness of the white teacher. Instead, the tagline promises to focus on student expression. Further investigation of the visual rhetoric emphasizes the image’s contradiction with those words. Another poster (figure 3) shows Hilary Swank in a classroom, eyebrows knotted, looking away from the camera. Her figure is in focus, and printed in color.

Around her swirl blurry, black and white bodies of students. No faces can be distinguished. In comparison, she is crystalclear. Again, the image challenges its tagline. Dangerous Minds, The students (and their advertisement. 1995. stories) are secondary to Swank’s commanding figure, and her story. Though the written advertising alleges to be focusing on the students, this advertisement implies that the image of the white woman as a savior is more likely to attract audiences than parallel, full-sized images of her struggling black and Latino classmates.

Freedom Writers was released during the height of the criticism surrounding the No Child Left Behind Act. In backlash to the NCLB era, are films attempting to change their rhetoric? One tagline created for Freedom Writers asserts, “Don’t pretend you know our story.” Although the images reflect a different

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focus than the words, there still seems to be some progress towards greater representation of students’ voices. The taglines imply not only that there is something valuable in the history and expression of the students, but also that these stories are actually engaging enough to attract consumers to the box office. It’s unclear precisely where and when that shift occurred, but it is possible that the overwhelming criticism directed at NCLB’s failure contributed to this advertising evolution through a shift in the wishes of the American public.

The Rhetoric of Rebirth and Hollywood’s Failure “For an individual to create a life, even a half-way decent one, he’s gotta go beyond what he knows. Go beyond the poverty, the dope, the disease, the degeneracy. Go beyond the oceans to the alps...Stick with what you think, and that’s what you’re gonna be stuck with.”

–Up the Down Staircase (1967)

This excerpt from the 1967 film perfectly utilizes what I will call the “rhetoric of rebirth.” In this scene, a teacher lectures his students on their disinterest in the classroom, demanding that they move beyond common obstacles he attributes to their background. By default the teacher also ignores anything positive or unique about his students, demanding that they abandon their past. Parallel scenes can be found in both Freedom Writers (Warner Bros., 2007) and Dangerous Minds (Hollywood Pictures, 1995). In Freedom Writers (Warner Bros., 2007), the teacher played by Hilary Swank announces to her class: “the person you were before this moment, that person’s turn is over. Now

it’s your turn.” In Dangerous Minds (Hollywood Pictures, 1995), Michelle Pfeiffer’s character visits two students at their home in an attempt to convince them to come back to school. She finds them and says, “Haven’t seen you guys in a week. Thought maybe you got lost on your way to class. I wanted to help you find your way back.” But when their grandmother comes out, she announces, “My boys don’t go to your school no more and that’s gonna be it.” Pfeiffer’s character, shocked, asks: “You took them out of school?”

The wizened black woman responds, “Go find yourself some other poor boys to save.”

This scene in Dangerous Minds emphasizes the oftoverlooked tension between culture and education, a friction that has existed since religious education was used as a tool to strip slaves of their African heritage.

American educators, or at least American audiences, buy into the ideology that in order for “disadvantaged” students to succeed, they must abandon their previous selves, the selves they’ve developed with their friends and family. Even the terms “disadvantaged” or “underprivileged” imply that the only impact students’ out-of-school lives can have is negative.

In this way, entire cultures are demonized. Education thus operates as a secular baptism, wiping clean the past, metaphorically dying and rising with “Christ,” or as may be the case, the holy teacher. The grandmother of the students in Dangerous Minds seems to have recognized this parallel and directly tells Pfeiffer she cannot save “her boys.” The implication is that these boys already have a home, family, and identity. They have not sinned and don’t need cleansing; they’ve already been born and don’t need a resurrection. These

films abandon the former selves of the students in order to “save” them. As discussed earlier, NCLB’s “back to basics” policy and rhetoric effectively advocate the same cultural deficit approach. There is no recognition of the strengths, the skills, and the knowledge that minority and low-income students bring with them to school. Their stories are not on the standardized tests.

Their social and economic status is not celebrated and certainly not analyzed in the standards for U.S. History.

In practice, discrediting the life history and experience of the student fails the entire school system.

A Time article titled “How to Fix No Child Left Behind” chronicles the struggle of James G. Blaine Elementary, an all-black, inner-city Philadelphia school during its attempt to score highly enough on standardized tests to move off Pennsylvania’s “failing schools list.” The article focuses on a math teacher, Mr. Abdullah, who begins his third-grader math review session by yelling, “We believe that we can learn at high levels!” The children chant, “We believe we can reach our learning potential. [. . .] We believe that Blaine will become a highperforming institution!” Abdullah shouts: “I’ll never give up!” They repeat, “I’ll never give up!” Abdullah declares, “Even on the PSSA test! They repeat “Even on the PSSA test!” Together they yell “’Cause winners never lose, and I am the best!” (2).

With the Blaine anthem these 8-year-olds commit to working for the institution. They further link their selfworth (“winners never lose, and I am the best”) with testing results (2). This implies that identity is intrinsically linked with the redeeming power of educational success as proposed in the rhetoric of rebirth. Perhaps

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the movies accurately reflect at least one aspect of our increasingly test-obsessed education culture. In Stand and Deliver (Warner Bros., 1988), Principal Clark proclaims to his students before their skills test: I’ve got a message out there for those people who have abandoned you and written you off. You are NOT inferior. Your grades may be. Your school may have been. But you can turn all that around and make liars out of those bastards in exactly one hour, when you take that test, pass it, and win!

In this case, the fantasy debilitates the reality. Imagine the increased frustration of a struggling inner-city student who sees Stand and Deliver but doesn’t have the same redeeming circumstances, or a white suburbanite with no experience who leaves the theater believing that anyone who doesn’t succeed isn’t living up to the potential envisioned by Hollywood. Finally, there’s an implicit fallacy in both Clark’s and Abdullah’s argument; for most of these students, passing a state test only buoys the ethos of the institution. For minority and low-income students passing tests does not ensure a college education or automatic admission to the middle class. The daily experiences of racism, classism, and poverty do not vanish when the scores are posted.

As Thomsen acknowledges, it is difficult if not impossible to draw a causal link between public opinion and integration of fantasy themes into the public conscience.

Still, it is hard to ignore that the movie posters shift the focus from the student to the institution, as do NCLB policies and rhetoric. Clark and Abdullah use empty rhetoric to connect students to the testing because there’s no real way to engage them. Standardized

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tests and standardized test prep deemphasize critical thinking and individualized curricula. Both Hollywood and the federal government fail to recognize that each child is a product of society. The student doesn’t need to be tamed, fixed, or saved. The student isn’t broken, wounded, or dangerous. Hollywood films advertise saviors instead of a critical analysis of structural inequities to address unemployment or institutionalized racism. In the parallel universe of policy, NCLB penalizes teachers if they can’t make students jump through certain hoops, citing systemic failure as the fault of the inability of the teacher to become the academic crusader so widely touted in the Hollywood education intervention subgenre.

Works Cited Aronowitz, Stanley. Paulo Freire, Pedagogy of Freedom. Boulder: Rowman and Littlefield, 1998.

Print.

Arons, Stephen. Short Route to Chaos: Conscience, Community, and the Re-constitution of American Schooling. Amherst: University of Massachusetts, 1997. Print.

Baker Jr., Houston A. “Critical Memory and the Black Public Sphere,” Public Culture. 1994.

Blackboard Jungle. Dir. Richard Brooks. Perf. Sidney Potier and Anne Francis. Metro-Goldwyn-Mayer, 1955. DVD. Berger, John. Ways of Seeing; A Book Based on the BBC Television Series with John Berger. London: British Broadcasting Corporation, 1972.

Print.

Bracey, Gerald W. Education Hell: Rhetoric Vs. Reality.

Alexandria, Va.: Educational Research Service, 2009. Print.

Dangerous Minds. Dir. John N. Smith. Perf. Pfeiffer, Michelle. Hollywood Pictures: 1995, Film.

Dillon, Sam. “Obama Calls for Sweeping Overhaul in Education Law.” New York Times 13 Mar. 2010: A1. Print.

Giroux, Henry. “Rethinking Education as the Practice of Freedom: Paulo Freire and the Promise of Critical Pedagogy.” Truthout. 3 Jan. 2010. Web. 10 Mar. 2010.

Freedom Writers. Dir. Richard LaGravenese. Perf.

Swank, Hilary. Paramount Pictures: 2007, Film.

Manzo, Katherine K. “Reading Experts Offer Insights Into State, Federal Policies.” Education Week.

12 May 2004.

Neal, Mark Anthony. “…A Way Out of No Way’: Jazz, Hip-Hop, and Black Social Improvisation.” The other side of nowhere: jazz, improvisation, and communities in dialogue. Ed. by Daniel Fischlin.

2004. Wesleyan.

Tehrani, Alex. “How to Fix No Child Left Behind.”

Time. 24 May 2007. Web. 20 Feb. 2010.

Thomsen, Steven R. “A Worm in the Apple: Hollywood’s Influence on the Public’s Perception of Teachers.” Southern States Communication Association and Central States Communication Association Joint Annual Meeting (1993).

Education Resources Information Center. 15 Apr. 1993. Web. 28 Feb. 2010. <http://www. eric.ed.gov/>.

Verenne, Herve, and Ray McDermott. Successful Failures: the Schools America Builds. Boulder: Westview, 1998. Print.

West, Kanye. Best I Ever Had. Perf. Drake. Young Money/Cash Money Records, 2009. Youtube. 1 July 2009. Web. 20 Feb. 2010.

Zizek, Slavoj. The Metastases of Enjoyment. New York: Verso, 1994.

Advertisements Dangerous Minds. Advertisement. 1995. www.imdb. com. Web. 10 Mar. 2010.

Freedom Writers. Advertisement. 2007. www.imdb. com. Web. 10 Mar. 2010.

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Problematics

Is a peer-review journal designed to allow Stanford undergraduates to share, discuss, and reflect on anthropology-informed thought and research QUESTION? COMMENTS? GET INVOLVED! EMAIL: anth_problematics@stanford.edu OR stop in to the Anthropology Department!

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