Though on questioning, women everywhere would probably admit to subjective sensations, known to be associated with climacteric physiological changes, few actively complain of any discomfort these produce. ‘Climacteric symptoms’ are confined to the West. Their absence elsewhere has hitherto been explained by the stress-free-climacteric women enjoy in most other cultures. The rewards of middle life in these cultures are, however, generally limited to women who have raised sons. Others are as liable to stress as Western women. This article suggests that the absence of climacteric symptoms among them is because middle-life stress is not associated in these cultures with illness but is expressed in practical social counteraction. The expression of climacteric stress in medical terms also depends on the manner the climacteric is reached and its general relationship to the menstrual history. The onset of the climacteric tends to have a much higher profile when families are limited, a social custom almost confined to the West. Avoidance of pregnancy and promiscuity also result in troublesome morbid changes at this time. In fact it was these which first brought climacteric women to doctors. As this occurred when, coincidentally, care of the sick became an important aspect of Western culture, the welding of climacteric disturbances and medicine became inevitable. Biologically ‘worthless’, a climacteric woman is regarded as ‘nothing’ in most cultures. Her social standing depends entirely on her sons. Childless women have, however, evolved various compensatory strategems. They manage to obtain social children or, at times, even profit by their very worthlessness. The climacteric expression resembling the menopausal syndrome most, in non-Western countries, is the almost universal fear, throughout the southern and eastern Mediterranean, that a husband may discover the climacteric sterility of his wife and marry a second young and fertile woman. Nonetheless neither this syndrome, nor other behavioral disorders at this time, utilize the physiological sensations of the climacteric as symptoms.
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