Not Tonight

Book excerpt: “[An] insightful and eloquent account of our evolving understandings of migraine, from a condition of weak-nerved women, to a ‘real’…disease” (Elizabeth Mitchell Armstrong Princeton University). Pain. Vomiting. Hours and days spent lying in the dark. Migraine is an extraordinarily common, disabling, and painful disorder that affects over 36 million Americans and costs the US economy at least $32 billion per year. Nevertheless, it is a frequently dismissed, ignored, and delegitimized condition. In Not Tonight, sociologist Joanna Kempner argues that this general dismissal of migraine can be traced back to the gendered social values embedded in the way we talk about, understand, and care for people in pain. The symptoms that accompany headache disorders—like head pain, visual auras, and sensitivity to sound—lack objective markers of distress that can confirm their existence. Therefore, doctors must rely on the perceived moral character of their patients to gauge how serious their complaints are. Kempner shows how this subjective dimension of diagnosis has shaped the history of migraine. In the nineteenth-century, migraine was seen as a disorder of upper-class intellectual men and hysterical women. In the 1940s, the concept of “migraine personality” developed, in which women with migraine were described as uptight neurotics who withheld sex. Even today, we see depictions of people with highly sensitive “migraine brains.” Not Tonight casts new light on how cultural beliefs about gender, pain, and the distinction between mind and body influence not only whose suffering we legitimate, but which remedies are marketed, how medicine is practiced, and how knowledge about disease is produced.