‘Maturing Masculinities: Ageing, Chronic Illness, and Viagra in Mexico’ by Emily A. Wentzell (Duke University Press, 2013). 

MM2013Maturing Masculinities highlights how erectile dysfunction co-exists with, and is understood to be the result of, a number of chronic conditions of biomedical and social origin including diabetes, hypertension, prostate surgery, sour relationships with wives and financial stress. Boundaries between these multiple chronic conditions of the body and society are thus blurred. By taking us into the thoughts and feelings of Mexican men, particularly in the first chapter, Wentzell enables a deep engagement with the ubiquitous term “machismo” and forces us to reconsider our taken for granted assumptions. Questioning and delving into the intricacies of such clichéd terms is a classic goal of anthropological research and writing – a goal this book clearly achieves.

One example is the easily-made assumption that the quantity of advertising for Viagra and the less than subtle portrayals of male sex-obsession within them (many very interesting examples of these advertisements are included in the book) equates to an uncontested norm of sexuality. However, Wentzell’s analysis highlights how ideas about sex, ‘mexicanness’, and masculinity changed throughout the lifespan for the majority of her interviewees. This change is captured in what Wentzell terms “mature masculinity” in which most of the men she interviewed normalized and accepted their changing sexual function when they perceived this to be just one of many chronic conditions of aging. While you might expect a book with the words ‘Mexico’ and ‘Viagra’ in the title to be about the widespread use of the drug, an intriguing starting point for the book is that, in actual fact, there were so few users of Viagra in Wentzell’s study population that the book is more about their ideas about Viagra and what it is to be a man, than about their actual use of the drug. Interestingly, most men perceived the drugs to be dangerous because they were seen to enable a kind of youthful masculinity and associated set of practices that were no longer consistent with a “mature masculinity” they, and often their partners, wanted to live-out.

I was impressed by the openness of the participants vis-à-vis the topic, and particularly their descriptions of their sexual function and their relationships with their wives and mistresses. The author describes also being surprised at first by the openness of her participants in sharing the stories of their sexual lives and changing bodies and provides a welcomed reflection on why her position, gender, nationality, identity and decision to undertake a predominantly clinic-based study may have helped create the conditions for such candid openness. There are many elements of the “composite masculinities” they describe which resonate with gendered constructions of coping with chronic obstructive pulmonary disease in Uruguay where I worked, and I think Latin Americanists will find the gender analysis in this book important and useful in thinking through the similarities and differences regionally. One re-occurring theme that seemed to point towards a particular aspect of ‘mexicanness’ that I hoped to find more explicit analysis of was ‘work’. Men in this study saw their lives of ‘excess’, not just in alcohol and sex in their youths, but also excess work, as a predisposing risk factor for the chronic conditions they faced as they aged.

Despite finding the data and its presentation in this book engaging and thought provoking as a rich case study, I remain unfortunately uncertain of the theoretical contribution of this work as it relates to the concept of ‘composite.’  From the very beginning of the book through to its final pages the word ‘composite’ appears and re-appears but in too many compositions (no pun intended) to be clear and potentially useful to others. The reader bounces between ‘composite approach’, ‘composite perspective’, ‘composite analysis’, ‘composite framework’, ‘composite masculinities’, and ‘composite illness’, to such an extent that I found myself losing all concrete grasp of its meaning. Is saying ‘composite…’ simply another way of saying ‘composed of many things/elements/characteristics/experiences?’ How is this different from other terms like ‘complex’ and ‘multi-faceted’, which are employed within the text when ‘composite’ is not and which, from my perspective, seemed interchangeable with ‘composite’ both theoretically and semantically. Wentzell is clear that she is borrowing from Annemarie Mol’s idea of medical entities as “composite objects” but she could have helped the reader see her original contribution more clearly. In my search for understanding I could see three possibilities: 1) that ‘composite masculinities’ was a finding 2) that ‘composite approach’ was a methodological approach to fieldwork or 3) that a composite perspective/analysis was a framework for writing-up.

My feeling throughout the book was that ‘composite masculinities’ was not an ‘approach’ or even a ‘perspective’ but a central finding of the analysis. From the participants’ narratives it became clear that, from their perspective, masculinity was made up of many elements that were both individually and culturally constituted and this complex web was re-spun throughout the lifespan and in collaboration with others, such as spouses and health professionals. It was after all they (both men and health professionals) who had “composite understandings of the causes of illness” (p.125), or who “…created composite explanations” (p.133), not the author.

That ‘composite masculinities’ be a finding and not an ‘approach’, an ‘analysis’, or a ‘perspective’, does not preclude there from being such a thing as a ‘composite approach’ embedded in this work. I wonder if it could have been framed more clearly as a methodological approach. For example, was it the author’s way of doing fieldwork, of asking questions, or of making space in interviews for a broader focus than simply erectile dysfunction, which enabled men to express these composite masculinities? Was the ‘composite approach’ an approach to designing the study and carrying-out interviews which welcomed rather than restricted complexity? As anthropologists, we generally support the idea that life is complicated, or reality is complex. However, I do believe that as researchers we can be more or less skilled at making room for this complexity to present itself. Making space for complexity has to do with our approach to people, to time, to space and to our research questions. It seems to me that Wentzell took an approach to discussing this topic with participants that was skillful and as a result very productive in enabling men to express how they themselves compose and re-compose their masculinities in a variety of ways through time, often challenging their own stereotypes of the generic Mexican man. If a methodological approach is what was meant by a ‘composite approach’ than a more explicit discussion of this would have cleared some of the ambiguity.

When ‘approach’ was not evoked, ‘framework’, or more commonly ‘composite perspective’ appears and re-appears. While this could refer to the participant’s perspective, it seemed that when the ‘composite perspective’ term was used, it was in reference to the analytical approach of the researcher. I wondered whether what constituted the ‘composite perspective’ was in fact the author’s strategic choice of style in which to write-up this ethnography. She herself re-composes the narratives she listened to, and engaged with, by using a combination of her own paraphrasing, interpretation and mostly short quotes under thematic headings or individual case studies. For those readers who enjoy reams of first-person narrative, the writing style of the book may disappoint. However, one distinct advantage of Wentzell’s re-composing of peoples’ complex stories, instead of the more space-demanding presentation of first hand narrative, is that she was able to concisely bring together the multiple elements of the story which may have been disjointed in the actual conversation. One must also keep in mind that Wentzell interviewed more than 250 men! By recomposing narratives she clearly laid-out the contradictions which made these men’s understandings of themselves, their bodies and their relationships so interesting. This approach to writing (and thus to analysis) may have been what Wentzell meant by a ‘composite perspective’ or ‘composite analysis.’

Reviewed by Dr Megan Wainwright, who holds a PhD in Medical Anthropology from Durham University. She has a particular interest in chronic conditions from phenomenological and political-economic standpoints, and she has carried out fieldwork in the UK, Canada and Uruguay. Megan is currently an Honorary Research Associate at Durham and a Visiting Fellow in the Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine at the University of Cape Town.

Correspondence to Dr Megan Wainwright


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