Mad Men, Esalen, and spiritual privilege

—Marion Goldman

The online community is still pulsing with speculation about the final close up of Don Draper meditating on the edge of the Pacific at Esalen Institute—where he found bliss or maybe just an idea for another blockbuster ad campaign.

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The writers and set decorators of Mad Men got 1970s Esalen spot on: from the lone outside pay phone at the run-down central Lodge to the dozens of long-haired hippies, former beatniks and spiritual seekers revealing themselves to each other in encounter groups. The images are so accurate that an alternative cyber universe of old Esalen hands has been speculating about how the writers were able to depict the old days so well—and whether the morning meditation leader was supposed to be Zen trailblazer Alan Watts or edgy encounter group leader Will Schutz.

None of these debates matter much to the entrepreneurs who have transformed Esalen from a rustic spiritual retreat to a polished destination resort that serves gourmet meals and offers workshops with themes like ‘capitalism and higher consciousness.’ Soon after the last episode of Mad Men aired, Yahoo Travel published an article promoting a “Don Draper Weekend Getaway” for fortunate consumers who could foot the tab. The rates vary, but on a weekend, a premium single room at Esalen costs $450 per night and the prices go way up for luxurious accommodations overlooking the sea. In a throwback to the old days, there is a ‘hardship policy’—making it possible for up to a dozen people who take weekend workshops to spend ‘only’ about $200 a night to spread out their sleeping bags in meeting rooms that they must vacate between 9:00 in the morning and 11:00 at night.

When Esalen opened its gates in the 1960s, visitors and residents traded work for housing or paid what they could afford. The founding generation believed that everyone was entitled to personal expansion and spiritual awakening through the growing Human Potential Movement. My book, The American Soul Rush chronicles how Esalen changed from being a mystical think tank, sacred retreat and therapeutic community into a wellness spa dedicated to de-stressing affluent customers with challenges at work or in their relationships.

In the late 1960s and early 1970s very different kinds of people drove along Highway 1 to Esalen, hoping to create better lives for themselves and often hoping to repair the world as well. They were spiritually privileged, with the time and resources to select, combine and revise their religious beliefs and personal practices. However, many of them were far from wealthy, because Esalen opened at a time of economic abundance that extended far down into the white middle class and there was widespread faith in unlimited possibilities for every American.

People in small towns and distant cities read long articles about Esalen and human possibilities in Life Magazine, Newsweek and other popular periodicals. Its key encounter group leader briefly became a celebrity when he appeared regularly on the Tonight Show Starring Johnny Carson. And during Esalen’s glory days, movie stars like Natalie Wood, Cary Grant and Steve McQueen regularly drove north from Hollywood to discover more about themselves and to soak in the famous hot springs baths. But once they arrived, they stayed in simple rooms, they were called only by their first names and other workshop participants tried to honor their humanity by treating the stars as if they were just like them.

Esalen was dedicated to opening the gates to personal and spiritual expansion to everyone and it fueled a Soul Rush. It popularized many things that contemporary Americans have added to their lives and can practice almost anywhere: yoga, mindful meditation, holistic health, humanistic psychology and therapeutic massage.

But most people can no longer afford to visit Esalen itself. A leader who left Big Sur to counsel clients in disadvantaged neighborhoods summed up how much the Institute has changed over the decades: “Damn,” she said, “I guess we got gentrified just like everybody else.”

Marion Goldman is Professor of Sociology and Religious Studies at the University of Oregon, and author of The American Soul Rush: Esalen and the Rise of Spiritual Privilege (NYU Press, 2012).

C-sections and vaginal births: Not the same thing

—Theresa Morris

On December 15, Kim Simon posted a piece on Huffington Post entitled, “10 Ways C-Sections and Vaginal Births Are Exactly the Same.” I saw this posted on Facebook and many people seemed to applaud it, but I have to say I am disturbed by it, especially the title. Simon’s argument boils down to the assertion that women shame each other over birth and fail to embrace the notion that birth, regardless of how it is accomplished, leads to motherhood. Who can argue with that message?

I will, because equating C-sections and vaginal births is problematic. I have conducted research on the high U.S. C-section rate in the U.S., and I can say unequivocally that giving birth by C-section and giving birth vaginally are not the same for babies or for moms.

The 2013 C-section rate of 32.7 percent is over double the World Health Organization’s maximum recommended rate of 10-15 percent. Women are 3.5 times more likely to die in a C-section than in a vaginal birth. This helps to explain why a World Health Organization report finds that the U.S. maternal mortality rate has been increasing since 1995 such that now the proportion of deaths among women of reproductive age that are due to maternal causes has more than doubled since 1995. There is no doubt that C-sections contribute to this trend and that women are unnecessarily dying. If this is not the canary in the coalmine indicating our current birth practices in the U.S. are harming women, I don’t know what is. I agree with Simon that women are shamed for how they give birth and they shouldn’t be, but making that a central issue draws our attention away from the structural causes of the high U.S. C-section rate and perpetuates the notion that women are the problem.

Simon’s third point in the blog, “You’re in charge,” really shows the illusion of the blog’s argument. Women are most certainly not in charge, although I agree that woman should be. Doctors and nurses are bound by strict protocols that determine how women will be treated. Can women eat during labor? Probably not, because a nurse will only give her ice chips and clear fluids. Can she walk around during labor? Maybe—that depends on whether she has an epidural (most women do), whether the nurse insists on continuous electronic fetal monitoring (most nurses do), and whether the hospital has a functioning telemetry unit to remotely monitor the fetal heart (many hospitals do not). In other words, women are not in control, even if we agree that they should be.

This point is drawn home with two telling examples, both of which indicate how many women are not in charge of their births. First, 91 percent of women in the U.S. who give birth following a C-section have a repeat C-section, even though as many as half would like to have a vaginal birth. Why? This happens because hospitals and providers deny women a chance to have a vaginal birth and condemn them to another C-section. The risks of C-sections accumulate with each additional C-section, including the risks of secondary infertility, hemorrhage, and an unplanned hysterectomy. Second, some women are forced to have C-sections—read about the recent case of Rinat Dray. This can even approach a legal mandate. When women refuse a doctor’s recommendation to have a C-section, doctors sometimes bring in lawyers and judges, and women are court ordered to have C-sections. For an example, watch Laura Pemberton talk about her experience. These women were not in charge of their births.

In short, C-sections and vaginal birth are vastly more different than they are the same. No, women should not be shamed about their births, but focusing on this as the most important issue around birth draws our attention away from the harm of a high C-section rate and how many women do not have a choice in the matter.

Theresa Morris is Professor of Sociology at Trinity College in Hartford, Connecticut and the author of Cut It Out: The C-Section Epidemic in America. She is the mother of two children, the first born by c-section and the second by vaginal delivery.

Embracing spreadability in academic publishing

—Sam Ford

The world of academic publishing was built on a model of scarcity. The specialist knowledge of an academic discipline was considered too limited for general commercial publication, so a niche industry was built to support the development and publication of essay and book-length academic publications. Academic presses played a vital role in this model and built their infrastructure to protect and make available academic essays for university libraries and specialists in a particular field. And, in return, the system for evaluating success among academics has been built in tandem with this publishing model—so that publishing milestones have become the logic on which tenure processes are built.

I had the pleasure of being invited to speak to the American Association of University Presses last summer on a panel about “reaching the world.” At it, I advocated that university presses have to rethink their raison d’être in the 21st century.

In a world where information is now overabundant rather than scarce, might it make sense that publishers have to change their logic dramatically in order to stay relevant? Rather than protecting and bringing information to circulation inside academia, as had been the old model, might not the role of the press be to curate and further cultivate the most important content in that vast field—and, equally as important—to focus on bringing that content to new audiences outside university libraries and professionals within one discipline?

I cited—as example—my experiences with Spreadable Media, the book I published this year (co-authored with Henry Jenkins and Joshua Green) with New York University Press. There were few arguments or examples in this book that weren’t, in some form, published or presented somewhere previously: various white papers, blog posts, online articles, academic essays, keynote speeches, and so on. And we have published excerpts and examples from the book in a variety of places since it came out. Further, the overall project included more than 30 essays, available freely online, in addition to the book we co-authored.

As far as I can tell, the availability of all that material hasn’t hindered interest in our book. For whatever few people who would have bought the book but were instead sated by finding the information available online, there were many more that discovered the book through these various materials and purchased it.

Writing more than a decade ago about piracy, Tim O’Reilly said, “Obscurity is a far greater threat to authors.” The same can be said for concerns of “self-cannibalization.” And the logic of at least some presses’ acquisition editors underscore this. Consider this statement from Harvard University Press: “prior availability doesn’t have a clear relationship to market viability.”

An early version of a piece Peter Froehlich (with Indiana University Press) published in Learned Publishing in October highlights the model now employed by Harvard Business Review Press as a potential way forward: the press embraces multiple-platform publishing, thinking about the connection among its blog, its magazine, and its books as varying tiers of publication and embracing authors who share their ideas elsewhere—in the process developing a reputation as a catalyst for thinking and then curating the best of that thinking in more increasingly formal ways.

In this model, the book acts as a thoroughly edited articulation of an idea at a moment in time: the culmination of work up to that point, the launching point of work to come. And the press helps take that idea and make it accessible, in reasonable fullness, to those who haven’t been following the development of the argument all along the way. In other words, the press’ role is about curating the information that most needs to be preserved and then making that information more visible to people outside the narrow field from which it came.

A similar model might be understood by publications like Fast Company. Authors like me write online pieces, with Fast Company receiving 24-hour exclusivity for our writing, followed by it being shared elsewhere. The magazine may pull together and curate its deepest, most considered pieces. Meanwhile, thoughts I initiated at Fast Company may end up eventually showing up elsewhere (properly attributed and sourced, of course). Such is a publishing model that still provides windows for a viable business model without being focused on locking content down.

This is a vital problem to be figured out, for not just the current and next generation of academics but, crucially, for the next generation of college students and all of us who benefit when ideas from within the academy spread throughout the culture and our professional worlds. It’s not just an issue niche university presses need to solve but rather a crucial question for us all.

Sam Ford is Director of Audience Engagement with Peppercomm, an affiliate with both MIT Comparative Media Studies/Writing and the Western Kentucky University Popular Culture Studies Program, and co-author of Spreadable Media: Creating Value and Meaning in a Networked Culture (NYU Press, 2013). He is also a contributor to Harvard Business Review and Fast Company.

 

Vaginal birth for twins as safe as c-section delivery

—Theresa Morris

A study published in the New England Journal of Medicine (NEJM) on October 3rd examines what is safer for the delivery of twins: planned vaginal or planned cesarean section? A summary of the study was written by the Associated Press and distributed widely through many news outlets, including National Public Radio. The title of the AP article—“Most Twins Can Be Born Without a C-Section”—gets at the major finding of the study. The authors randomly assigned women with twin pregnancies between 32 weeks 0 days gestation and 38 weeks 6 days gestation and with the first twin in a head-down (cephalic) position to planned cesarean section (1398 women) or planned vaginal delivery (1406 women). There was no significant difference in outcomes between these two groups. That is, a planned vaginal twin delivery posed no greater risk to women and babies than a planned cesarean section twin delivery.

This study is notable. As the authors of the NEJM study observe, the rate of vaginal twin delivery has plummeted in recent years. There is no doubt that part of this decrease is due to publication of findings from The Term Breech Trial, which discovered worse outcomes for babies presenting in breech (head up) position who were delivered vaginally. Although in a follow-up study published in 2004 the outcomes at age 2 of the babies born vaginally were no different from the outcomes at age 2 of babies born by c-section, planned vaginal breech delivery had already been greatly curtailed worldwide.

The Term Breech Trial affected twin deliveries because many second twins (i.e. the twin that is delivered second) present in a breech position. Although the Term Breech Trial only included singleton pregnancies, maternity clinicians I interviewed for the research in my book indicated that many obstetricians stopped offering vaginal twin deliveries when the second twin was presenting in a breech presentation because, with the publication of findings from the Term Breech Trial, if there were to be a bad outcome, they believed they would be sued for malpractice. The NEJM study published on October 3rd, which includes five of the authors of the Term Breech Trial publications, is a good redress to obstetricians’ defensive practice of delivering most twins by c-section.

This study is good news for women pregnant with twins. If vaginal delivery is not being presented to them as an option, they should bring this publicly available article to their next prenatal appointment.

Theresa Morris is Professor of Sociology at Trinity College in Hartford, Connecticut. She is the author of Cut It Out: The C-Section Epidemic in America (NYU Press, October 2013).

Fall books available on NetGalley

We’ve got quite a few gems in our NetGalley catalog this fall, all available for advance review now. Book reviewers, journalists, bloggers, librarians, professors, and booksellerswe welcome you to submit a request!

Not familiar with NetGalley? Learn more about how it works.

 
Buzz: Urban Beekeeping and the Power of the Bee by Lisa Jean Moore and Mary Kosut (September 27, 2013)

We think Booklist said it best: “In this fascinating blend of sociology, ecology, ethnographic research, and personal memoir, the authors range through all of the aspects of the human relationship with the honeybee.”

Ever thought of honeybees as sexy? You might after watching Mary Kosut discuss the sensual nature of beekeeping.

 

Cut It Out: The C-Section Epidemic in America by Theresa Morris (October 7, 2013)

In Cut It Out, Theresa Morris offers a riveting and comprehensive look at this little-known epidemic, as well as concrete solutions “that deserve the attention of policymakers” (Publishers Weekly starred review).

C-sections are just as safe as vaginal births, right? Not true, says Theresa Morris. Watch her discusses this and other misconceptions on our YouTube channel.

 

Hanukkah in America: A History by Dianne Ashton (October 14, 2013)

Hanukkah will fall on Thanksgiving this year for the first time ever—and the last time for another 70,000 years. Brush up on your knowledge of the holiday in time to celebrate the once-in-an-eternity event. Publishers Weekly, in another starred review, promises a “scholarly but accessible guide to the evolution of the Festival of Lights in America.”

Stay tuned for our interview with the author!

 
Browse all of our e-galleys available for review on NetGalley.

Does money motivate doctors to do more c-sections?

—Theresa Morris

On August 30th, NPR reported on a National Bureau of Economic Research (NBER) working paper that suggested physicians perform c-sections in order to maximize their pay. The NBER authors state this assumption and then go on to use it to explain why physician-patients are less likely than non-physician-patients to have a c-section birth in non-HMO hospitals. They argue that the different likelihood of c-section is due to physician-patients’ having information necessary to avoid unnecessary c-sections (that are due to physicians’ maximizing their incomes).

In my book, Cut It Out: The C-Section Epidemic in America, I argue that making assumptions about individual motivations is very problematic if one has not talked to the individuals being analyzed. The question, “Do physicians perform c-sections to make more money?” is not explored. Further, to argue that financial incentives are at the root of the c-section epidemic in America, one would have to delve into how physicians are paid for deliveries. Health insurance companies typically pay a global fee for prenatal care and delivery. This fee is a few hundred dollars higher for c-sections, but how the fee is divided among obstetricians in a practice (and few obstetricians practice in solo practices) is complex. Many obstetricians are not paid simply for the births they attend. Rather the global fees are aggregated and then paid to physicians according to the number of call hours they complete. Thus, it is hard to see how physicians have much of a financial incentive to perform a c-section because the increase in pay is not direct and is likely split among obstetricians in the practice.

My research, based on fifty in-depth interviews with maternity clinicians, suggests that a viable competing explanation for the NBER finding is that physicians often have a low threshold for performing c-sections during the course of labor because of liability concerns. Physician-patients may have the information necessary to negotiate with physicians to allow them to continue to try to deliver vaginally and/or physicians may not be as concerned that physician-patients will sue them in the case of a bad outcome and, thus, give physician-patients more latitude during labor.

Also problematic is that that NPR report focused on the assumption of the NBER paper that physicians perform c-sections due to economic incentives, rather than the main empirical finding of the NBER paper. The main empirical finding of the NBER paper is that physician-patients have a different likelihood of c-section than non-physician-patients. The authors focus their conclusion on the finding that “physician-mothers are approximately ten percent less likely to have a C-section.” They conclude, “This paper demonstrates that 10 percent of C-sections represent overuse of healthcare, and that this overuse is not only costly but may have an adverse impact on patients.”

The title of the NPR story—“Money May be Motivating Doctors to Do More C-sections”—and its focus is something that sounds exciting and leads to blaming physicians for the high c-section rate. This is an easy claim to make because it seems to have some kind of intuitive appeal. However, it is has no basis in empirical data analyzed in the NBER paper.

Theresa Morris is Professor of Sociology at Trinity College in Hartford, Connecticut. She is the author of Cut It Out: The C-Section Epidemic in America (NYU Press, October 2013).

 

‘Women programmers’ and the gender bias in science

—Sue V. Rosser

After reading the recent opinion piece “How to Be a ‘Woman Programmer’” by Ellen Ullman in the New York Times Sunday Review, I had two primary thoughts and reactions. Particularly as I neared the end of the article, where the barriers faced by women in technology were discussed, I was reminded of the interviews I had conducted in Silicon Valley and the metro New York area that reinforced exactly what Ullman said about why women patented at vastly lower rates than men. The percentage of women granted patents ranks significantly lower than that of their male peers in all disciplines, countries and sectors; it also ranks very low relative to the percentage of women in a specific scientific or technical field.

Ullman’s description of the encounters with sexist, clueless, or resistant men bosses brought to mind my interview with Rick Foot*. Rick Foot currently serves as president and founder of a very successful IT innovation company. In the past he has headed several research and development operations. Friendly and generous with his time for the interview, he began by explaining the patenting process.

He told me that he didn’t think there was a gender gap in patenting in the industry but that it must result from the persistently low numbers of women in the industry. When I explained the National Center for Women and Information Technology (NCWIT) study and the data showing that women patented at much lower rates than their participation in the IT workforce, he challenged the data with other questions about sector, publication rates, incentives, and age.

When he finally accepted that the data for the gender gap might be solid, he said, “I’m pretty sure that the women in R&D in my company patent at the same rate as their many male counterparts.” He did admit though, that he had never thought about gender or checked the data for his company which now he was intrigued to examine. Rick Foot was quite convinced that his view of the world—that there could not be a gender gap in patenting or if a gap did exist, it was proportional to the low number of women in IT—was absolutely true.

In contrast to the men I interviewed, all of the women knew what I meant right away when I raised the issue of the gender gap in patenting. They also understood how the gap served as a deterrent for women’s career advancement. Software engineer Joan Jetma* expressed the impact particularly well.

Joan works at a very large global IT company that prides itself on innovation and rewards its employees for patenting innovative discoveries. She had observed that very few women in the company where she worked obtained patents. When she did some research to determine whether her observations were correct, she discovered that about 10 percent of the women obtained patents at her company. When her own patent came up for review, she realized that all of the reviewers were men.

Because of the impact that obtaining patents have on women’s careers, some interviewees described the positive steps they had taken to enhance opportunities for women to patent in their company. One woman I interviewed, after observing the gender gap in her own company, started a support community for women. She sent an e-mail to about twenty women in the company and received immediate responses. In two years, the community has grown to 600 women who represent all sectors and all countries where the company is located.

This positive approach reflects the other major reaction I had to the article by Ullman. Despite all of the obstacles she had faced and the clear recognition that many other women might not wish to remain in technology, Ellen Ullman showed a clear passion for technology.  Her love of software engineering made her lash back, tough it out or change jobs to be able to pursue programming, no matter what.

During the last thirty years my studies of women in STEM have enabled me to interview more than 450 women scientists, technologists, engineers and mathematicians. As shown in Breaking into the Lab, the overwhelming finding that emerges from these interviews is the love and passion most women have for their work. They love science and technology and will do whatever it takes to pursue their passion. Just imagine how much more productive and creative they could be if the barriers were removed.

Sue V. Rosser is Provost and Vice President for Academic Affairs and Professor of Women and Gender Studies and Sociology at San Francisco State University. She is the author of Breaking into the Lab:  Engineering Progress for Women in Science (NYU Press, 2012).


* Names have been changed.

Genetic testing, cancer risk, and Angelina Jolie’s choice

Angelina Jolie’s New York Times op-ed announcing for the first time that she underwent a double mastectomy to reduce BRCA-related breast cancer risk was welcome news in several respects. She is very specific, for instance, regarding the exact estimation of her risk, the kind of detail you do not often see in news reports and other public testimony about BRCA.  (BRCA-related risk is highly variable: 45-90% for breast cancer, 10-60% for ovarian cancer.)

Jolie also mentions the high price-tag associated with just the test itself, a point that has been raised for some time, and a topic that will be addressed this summer as the Supreme Court decides whether to accept Myriad Genetics’ (the company that owns the patents to the BRCA1 and BRCA2 genes) argument for patent protection. And finally, Jolie observes that BRCA mutations explain just a small percentage of breast and ovarian cancer cases. What she does not say, but is worth pointing out, is that more than half of all breast cancer cases remain unexplained. As the organization Breast Cancer Action has often noted, we need to fight for true “prevention” of breast cancer, which would include a radical shift in the way we regulate toxic chemicals.

Jolie understands herself to be acting not just as a mother but also as a role model for other women. This would make sense if BRCA testing were relatively new. However, it is anything but—BRCA tests have been around since the mid-nineties, and mastectomies much longer than that. In fact, women have been electing to receive prophylactic mastectomies due to familial risk well before the BRCA genes were described by researchers and a test for mutations was developed. Yet in 2013, the choices for high-risk women are the same: surveillance, surgery, or cancer drug therapy. Placed in this historical context, the question should not be “Why aren’t more women getting tested and acting on that knowledge?” but rather, “Why are the interventions the same almost twenty years after the genetic test became commercially available?”

Although new ways for reducing BRCA risk have failed to materialize (even if the plastic surgery methods associated with breast reconstruction have improved dramatically), what has occurred over the last twenty years has been a subtle yet indelible shift in what “risk” means. Indeed, BRCA mutations can hardly be said to infer “risk” at all, since the interventions women undergo are the same, or in the case of double mastectomy, even more extreme than what many women with breast cancer actually undergo.

“Risk,” then, really means “disease” in the post-BRCA age—marked as it is by an ethical obligation to act on cancer risk even if that action increases risk in other ways (as in the case of BRCA related ovary removal and subsequent fatal heart disease risk that early surgical menopause can entail). This, too, is an age of the successful feminist argument that there is nothing “natural” to femininity (thus enabling the claim that one is rejecting conventional notions of beauty and gender by undergoing mastectomy and oophorectomy), and the creation of an entirely new citizen-patient: the “previvor.”

With the development of better breast reconstruction techniques, the conceptual shift to “risk” being something you act on as if you actually had breast cancer, and the emergence of a new discourse of the empowered “previvor,” it is hard to imagine how any woman with a BRCA mutation will have a choice in any meaningful sense of the term. Can living with BRCA risk ever be thought of as an informed, empowered course of action? Will we see new ways of ameliorating BRCA risk that do not entail major and risky operations? Breast cancer is indeed an epidemic. Yet epidemics, as Paula Treichler wrote, too often close off critical, theoretical discussion that is often needed in order to properly evaluate and contextualize developments in medicine and in the broader culture. All the more important, then, that we continue to understand BRCA testing and mastectomy, and the choice to undergo one or both. After all, the choice is constrained as much by culture as it is by biology.

Kelly E. Happe is Assistant Professor of Communication Studies and Women’s Studies at the University of Georgia. She is the author of The Material Gene: Gender, Race, and Heredity after the Human Genome Project (NYU Press, 2013).