White Coat Underground

Paternialism is not patriarchy

I keep pandagon.net on my google reader. I don’t agree with everything I read there, which is a good thing, but I do respect Amanda Marcotte’s opinions (and they are always well-written).

I must take some exception with her recent analysis of the octuplet fiasco. It’s not just that I have a problem with blaming everything bad on Teh Patriarchy (which I do), but I think that sometimes dealing with patriarchy distracts from other real issues. Yes, sexism and patriarchy are important in society, but not everything is that simple. Let’s take a look (emphasis mine):

At this point in time, I had the stunning realization that the octuplets mom, who is being lambasted from every corner of the planet, might be on the sane side of over-fertile. She has certainly exposed how the pro-patriarchal arguments about the glories of unemployed, fertile femininity and the embracing of human life were all 100% empty—in the end, it’s all about having a man, and that was the difference between hero and villain.

I’ll admit I see through a different lens than Amanda. But while there are certainly a lot of people out there talking about how bat-shit insane the mom must be, much of the anger also seems to be directed appropriately at the fertility clinic, which violated the ethical and medical standards of its profession.

There’s no doubt in my mind that the reaction to Suleman is hostile for sexist and possibly racist reasons, because if you do think she’s off her gourd to have so many kids (especially at once), then the proper response is compassion and not anger. …if she was married, the question of sanity would never come up in polite company…

Yes, it would be better if we all felt only compassion for the mom rather than anger, but some anger is inevitable. Part of my anger, which is mostly directed at the fertility clinic, is reserved for the horrid state of mental health care in the U.S. Frankly (and when am I anything other than frank) most parents would recognize her as nuts, married or not. Raising one kid is hard enough—but fourteen? I’m not so sure I see this cult of fecundity Amanda’s talking about. There certainly is, in parts of our society, a cult of fetus-worship and a desire to control female fertility (meaning controlling access to birth control, abortion, etc.), but this movement seems ultimately about control rather than fertility. They don’t care how many babies you have, as long as you do it the way they think is right.

The danger of putting one probably troubled woman under a lens covered by a patriarchy filter is that we’ll fail to see other societal problems. I don’t believe this woman was pushed toward her choices by “the man”; I believe she is ill, and that no one stepped in to help her. Our society failed her, and she found succor in fecundity. It’s not the worst outcome, but it’s not a good one either.

Sometimes it’s OK to point out that someone is mentally ill. You don’t have to be bouncing-off-the-walls crazy to need help. The fertility clinic had an opportunity to intervene. When they had a patient in need walk in their door, they could have found a reasonably non-threatening way to get her some psychiatric help. Some might argue that this would be a horribly paternalistic attitude, but people with mental illness often lack insight, and need a little paternalism.

Comments

  1. #1 Rose Colored Glasses
    February 9, 2009

    Supposedly she missed out on something important in her own childhood, and she seeks to get the missing element (what, nurturance?) through her relationships with her children. One child, not enough. Two, not enough. Three didn’t work either, so she tried four. No go. Okay, five. Nope. Well, then six ought to do it.

    When six didn’t work, she decided to get done in nine months what it would taken her eight years to achieve.

    So, you see, by becoming the OctoMom, She now has fourteen consecutive failures. Fourteen children cannot nurture one adult, nor can six, three, two, or one. Neither can none at all.

    Will you be surprised by her next pregancy?

  2. #2 Dianne
    February 9, 2009

    A couple of random thoughts on this post.

    1. The fertility clinic is the one that made an ethical violation. As far as I know, there is no ethical requirement for patients’ requests or even demands to be reasonable. To some extent, paternalistic or no, part of the job of the practitioner is to evaluate whether the patient’s desires and goals in treatment are realistic. So the blame is more to the clinic and doctor who treated her than to the patient.

    2. For a fertility clinic to decide for a woman how many children is enough and then cut her off is, indeed, parternalistic. Should clinics say that they will no longer treat after a patient has two children? Three? Does income, relationship status, etc matter? Not really simple questions, IMHO.

    3. The patient is getting more crap than she probably would have if she were married. Remember the two sextuplets in Iowa a few years ago? Was the doctor who implanted 6+ embryos in each of their mothers acting in an ethical manner? It’s by no means the standard of care. (Though, to be fair, that was in the 1990s when the standard was different: I don’t think that 6 would be routine even then, though.) And if rumor was correct (which it may or may not be), at least one of the mothers involved was effectively a single mom, even though she was married-her husband was behaving more like another child that she had to take care of than a partner.

    4.Women are praised for having children and for “sacrificing” for their children. If the mother of the octuplets thought that she’d get a lot of praise and attention for having 8 kids at once, she was right. She may not have counted on the backlash (though she should have: everyone in the world has an opinion on how any given woman choses to reproduce or not and it’s generally negative), but she has gotten praise for “chosing life” for being “brave”, “motherly”, etc. In short, her decision to bear as many children as embryos implanted (plus two after twinning) did not occur in a vacuum. To some extent, she did what she was told by society to do.

    So I do see the patriarchy and cult of fertility at work here. However, I don’t think that it is by any means the only factor at work here. Conversely, I think that the doctors who treated her in some ways failed ethically because they did not act in a sufficiently paternalistic manner. But as you said, paternalism is not the same as patriarchy. One might call it maternalism just as easily. Either way, they failed to explore the question of whether her request was reasonable and, if not, why she was making these requests and how to serve her best. Which was not by blithly implanting six embryos and hoping for the best.

  3. #3 Anonymous1
    February 9, 2009

    It’s scary to me that when someone makes a choice you disapprove of, your first reaction is that they’re mentally ill. I’m assuming you think that everyone at the fertility clinic she used is mentally ill, too?

  4. #4 PalMD
    February 9, 2009

    No, I don’t think that that the fertility docs are mentally ill (although they may be); they are unethical and expoitative.

    I am making a guess about the mother, which may or may not be true. It is also possible that she had the kids for other reasons, say, an intense desire to have octoplets that is somehow not pathological. The point is that it is very far outside normative behavior to have six kids and then want a octitude—but it is also possible that she was given very very bad advice (actually, it’s likely that she was).

  5. #5 Greg Laden
    February 9, 2009

    I don’t know why I think this, but it seems to me that if someone is being treated for infertility, then has six kids, then further treatment for infertility is not necessary.

    When this story first materialized and the public vitriol started to burn, I started thinking about the hypothesis that this was a non-white woman having non-white kids, and that this was a factor. I’m not throwing out that idea yet, but it seems to be unlikely. People are just mad at her because she has 14 +/- kids.

    The current down turn in the economy could also be adding an edge to this. The ultimate bailout would be felt by some as cuckoldry. Or should I say, the ultimate bailout IS cuckoldry, and some people have a problem with that.

  6. #6 Anonymous1
    February 9, 2009

    Thanks for clarifying that you’re making a guess and that you’re open to the possibility that her desires weren’t pathological. It’s not clear that she was seeking octuplets, though; I was under the impression that fertility clinics routinely use more embryos than they expect to reach birth (although in this case it sounds like the clinic went overboard, unethically so– we agree about that!). It is clear that her desire for more than the six children she already had is very far outside normative behavior; but it’s a big leap from that to “it’s OK to point out that someone [by implication, her] is mentally ill.” It might be okay to casually think “That sounds crazy to me,” but it’s a little less okay to say “My guess is that she’s mentally ill,” and it’s emphatically not okay for someone with medical authority to “point out” that someone they don’t know needs psyhiatric help. (Which, to be fair, you didn’t quite do.)

    Also, I think you’re not fully appreciating the sexism angle. A man who intentionally fathered eight children in, say, a week, probably wouldn’t be seen as a hero; in fact, he would probably be despised– but would your first guess be that such a man was mentally ill?

  7. #7 Jonathan Simmons
    February 9, 2009

    In reply to the last comment, yes, I would identify that guy as bat shit crazy. I recognize that it’s probably an irrational reaction, but it makes me feel better about living in a world populated by other people.

  8. #8 Dianne
    February 9, 2009

    In fairness to both the clinic and the patient, one should point out:

    1. Her previous children were born by IVF. It’s possible that as many embryos were implanted each time and that usually only one or two implanted. So it is possible that neither she nor her doctors ever expected all six embryos to implant muchless for two of them to twin, based on her history. Possibly she even had a history of failed pregnancies when only one or two embryos were transfered, making an exception to the usual no more than 2 or 3 rule seem logical in her case.

    2. Women who risk their lives* having children when they could chose to abort fetuses in situations where the pregnancy is obviously high risk to the mother are lauded in some circles as heros. Why should a woman with cancer who delays treatment to bring a fetus to term (thereby increasing the risk that she will die–and leave the infant motherless) be a hero but a healthy woman with a very high multiple pregnancy be considered crazy?

    *All pregnancies are, of course, life threatening. But in this case I mean those in which death or debility is virtually certain.

  9. #9 Danio
    February 10, 2009

    You hit the nail on the head as usual, Pal. I also interpret the facts in evidence as suggestive of mental illness, and this is not merely due to the number of children she has chosen to bear. The emerging picture of her pre-octuplet home and employment situations, the circumstances of her job-related disability, depression, her reliance on her parents for support of the older set of children, as well as numerous things she has said to the press to justify or explain her choices, all paint a picture of someone in dire need of counseling. It is regrettable indeed that her fertility doctor(s) did not recognize this and steer her toward help before she ‘self-medicated’ with still more offspring.

  10. #10 Mike
    February 10, 2009

    As the old adage goes, if you have a hammer, everything looks like a nail. For those looking to destroy the patriarchy, every reaction is due to the evil of patriarchy.

    Would there be less anger directed at the woman if she were married or in a committed relationship? Yes, because then there would be the potential for someone in the relationship to work to provide for the children. That is not patriarchy.

  11. #11 Dianne
    February 10, 2009

    Would there be less anger directed at the woman if she were married or in a committed relationship? Yes, because then there would be the potential for someone in the relationship to work to provide for the children.

    What if she were married to an unemployed deadbeat who didn’t work, help her with the kids, or do anything much except act like a 15th kid for her to take care of? Would she get criticized for having more kids when she had a time consuming case of arrested development to take care of? Would he, the husband, get criticized for being a burden rather than a help? Probably not. So while it is perfectly reasonable to say that her choices were at best unwise in the absence of a support system (and for 14 children I would think that two adults would be inadequate so would be inclined to find a married but isolated couple inadequate too), there is still a hint of the patriarchy about it all.