It is a truism that an anthropologist’s favorite word is often ‘complex:’ social life is complex; gender is complex; health is complex. Perhaps a bit tongue and cheek, but Emily Wentzell’s Maturing Masculinities: Aging, Chronic Illness, and Viagra in Mexico offers a much welcomed theoretical framework for understanding complexity over time. Building on Annemarie Mol’s (2002) concept of diseases as composite objects, Wentzell develops a composite framework for understanding masculinity, gender, aging, and chronic illness. As gender scholars and medical anthropologists have long established, both gender and illness experience require a perspective that is emergent, which accounts for the sedimenting and changing quality of selfhood. Wentzell takes this insight further by exploring how gendered selves are created in relation to chronic illness.

Based in Cuernavaca, Mexico, Wentzell conducted fieldwork in a urology department of a regional government hospital. Situated within a hospital, which attracts a diverse patient population, Wentzell interviewed 254 patients as well as the 48 wives or other family members who accompanied those patients. She complemented these interviews with observations of doctor visits in the hospital and the local family practice. She also analyzed Viagra and related product advertisements in the Mexican media. Through lucid, hospital-based ethnography, Wentzell explores a central paradox: if penetrative sex is central to Mexican masculinity, why then do most of the men she interviewed refuse viagra and its alternatives? In unraveling this paradox, Wentzell ethnographically and historically situates cultural ideas about Mexican machismo. She shows how these essentialized notions of machismo are both critiqued and reified through individual descriptions of good ways of being men. By illuminating cultural ideas about maturing masculinities, Wentzell examines why pharmaceutical interventions for erectile dysfunction are not attractive. In doing so, she provides an analysis of the fluidity of gendered selfhood as it shifts in relation to bodily change, age, and illness. Locating gender in relation to other aspects of the life course, Wentzell advances the argument that “composite masculinities [are] contingent and fluid constellations of elements that men weave together into masculine selfhoods” (26).

There are three prominent contributions of this book: 1) the composite approach to gender, aging, and chronic illness; 2) analysis of projects of selfhood-in-the-making; 3) how medicalization is selectively engaged with and at times resisted. First, the composite approach renders intelligible the ways individuals selectively draw from their own life experiences, interpret and respond to structural constraints and articulate cultural ideals in relation to their own masculinity, sexuality, and relationships. Individuals weave together beliefs, narrative, memories, practice, relationships, in sometimes conflicting ways, into composite masculinities. If anthropologists understand that selves are never as coherent as they are presented, a composite approach offers an ethnographically grounded way to explain how this happens in everyday life. By extension illness can be understood through a composite approach where disease etiologies are multifactorial and healing options selectively chosen.

Second, in each chapter Wentzell brings to light individual projects of self-making. She delicately balances shared cultural ideas about body, gender, and aging against individual lifeworlds. In this process, she “stresses that people continuously create multifaceted selves by linking together different practices, emotions, and experiences through practice as they live out individual takes on culturally intelligible ways of being men or women” (27). Bodily change, structural constraints, cultural ideas about gender, and health beliefs, form the context from which selfhood is animated.

Finally, this ethnography also contributes to emerging discussions in medical anthropology about the incompleteness of medicalization through an in-depth analysis of resistance to the medicalization of erectile dysfunction. Wentzell makes clear through vivid descriptions of individual stories that opting out of medicalizing erectile dysfunction does not suggest a disinterest in biomedicine but a selective engagement with a particular domain of medicalization. She illuminates the structural disincentives at the hospital that make access to Viagra and other pharmaceuticals difficult, including the high costs of drugs and relatively impersonal and fast doctor visits.

Overall, this ethnography illuminates a cultural model of masculine aging in Mexico. Wentzell suggests that despite structural constraints, physicians and patients operate within a cultural system where erectile dysfunction is considered part of the “natural” and “normal” processes of aging. It is not only considered “natural” but can be valorized as a new time in life to refocus masculine energies on the home, on wives, and children. Medicalization of erectile function poses a challenge to this notion of natural aging and refocusing of intimate energies towards the domestic sphere. While most men opted to avoid drugs for erectile dysfunction because it disrupted notions of appropriate maturing masculinities, those men that did choose pharmaceuticals did so within a “broader project to become a different and better kind of man” (136).

The book is eminently teachable for multiple reasons and is well suited for both undergraduate and graduate audiences. First, Wentzell illustrates a number of medical anthropology fundamentals such as illness narratives and local etiologies as well as examining the meanings of changing bodies and everyday embodied practice through ethnographic vignettes. In particular her narrative style of highlighting individual men is memorable. Second, Wentzell does more than merely point to structural constraints but also shows how these structural constraints in individual life stories and hospitals influence healthcare, disease etiologies, and health behaviors. Making structural constraints visible in clear examples makes this text valuable to a variety of medical anthropology, global health, anthropology of the body, gender, and aging courses. Although not highlighted as such, this book offers a counter to emerging ideas about “successful aging” in the United States by investigating what is considered “natural” for aging in Mexico.

Overall, this engaging book combines institutional ethnography with patient interviews to present a thoroughly readable account of how men imagine their own masculinity and the measures through which they evaluate themselves and others. This book summarizes the literature on masculinity and machismo in an accessible way that will appeal to scholars and students.

Works cited

Mol, Annemarie

2002    The Body Multiple: Ontology in Medical Practice. Durham: Duke University Press.

Jessica Hardin is a PhD candidate at Brandeis University in the Department of Anthropology. She holds a joint MA in Women’s and Gender Studies and Anthropology from Brandeis University. She has conducted ethnographic research in Samoa, which focuses on the interrelated processes of the medicalization and spiritualization of chronic diseases, including type II diabetes and hypertension. She is the co-editor (with Megan McCullough) of a Berghahn volume titled Reconstructing Obesity Research: The Meaning of Measures and The Measure of Meanings.

 

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