The language of emasculation: implications for cancer patients.
Subject: Cancer patients (Care and treatment)
Authors: Cushman, Mitchell A.
Phillips, JoAnne L.
Wassersug, Richard J.
Pub Date: 03/22/2010
Publication: Name: International Journal of Men's Health Publisher: Men's Studies Press Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 Men's Studies Press ISSN: 1532-6306
Issue: Date: Spring, 2010 Source Volume: 9 Source Issue: 1
Product: Name: Viagra (Medication)
Accession Number: 228120953
Full Text: Language can be used both literally and metaphorically. In this article, we explore the metaphorical use of terms including impotence, castration and neutered, to better understand how these words are interpreted by both the public at large, and by the approximately half a million men in North America who, at one time or another, take chemically castrating drugs to control prostate cancer. Specifically, we examine contemporary, publicly accessible sources for keywords related to emasculation; i.e., the Internet, jokes, films and printed news reports. We find that these terms are almost always employed negatively. We conclude that the language of emasculation often faults the subject and implies general dysfunction and powerlessness--socially, politically, and sexually--adding to the shame and "othering" felt by cancer patients who are castrated out of medical necessity. In addition, we show that recent efforts to refer to sexual impotence more narrowly as erectile dysfunction fail to separate the metaphorical from the physical meaning of impotence, and do not solve the problem of the shame associated with medical castration. Society's failure to recognize that castration is still common adds to the stigma of those who are emasculated for medical reasons.

Keywords: masculinity, impotence, castration, eunuch, shame, stigma, prostate cancer

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According to Deborah Cameron's study, "Naming of Parts: Gender, Culture, and Terms for the Penis among American College Students" (1992), it took a small group of young males only half an hour to list 144 common monikers for the penis. The vast majority of these names--"Excalibur," "jackhammer," and "morning missile" are a few examples--identify the male member as an icon of potency and power. Such conceptualizations reflect negatively on those who find themselves with a flaccid penis. As Cameron summarizes: "the penis is recurrently metaphorized as a person, an animal, a tool, a weapon" (p. 369). Based on the rubric constructed by this language, a man with an erectile dysfunction (ED) is left respectively dehumanized, unnatural, impractical, and defenceless. As Susan Bordo (1999) writes: "these metaphors [...] set men up for failure. For men don't really have torpedoes or rods or heroic avengers between their legs. They have penises" (p. 64).

Despite the power implicit in its slang names, the penis, like the rest of the human body, is fallible--and about a third of all prostate cancer (PCa) patients will experience that as residual ED after primary treatment. If the disease progresses they will go on androgen deprivation therapy (ADT), which will guarantee partial, if not full, ED in greater than 85% of all recipients.

John Oliffe (2005) reports that "impotent men are marginalized and subordinate" (p. 2254) and blames the media, at least in part, for that positioning. He does not, however, examine how the vernacular itself may promote this marginalization. This is the topic we explore here. Cameron (1992) illustrates the prevalent suggestive and metaphorical nature of the many slang terms for the penis. But just as the language of masculinity carries with it certain expectations, the language of emasculation may connote equally entrenched imagery. Here we examine the media's use of terms such as impotent, castrated, neutered, and eunuch, and explore the thesis that in contemporary Western discourse, these words have come to imply far more than simply sexual dysfunction. The social and political weakness implicit in expressions such as "the neutered electorate," "emasculated Senate," "impotent figureheads," and "intellectual eunuch," (all recent quotes from the popular press) align actual emasculation with global dysfunction in ways that neither psychologically nor historically reflect the realities of androgen deprivation (reviewed in Aucoin & Wassersug, 2006; Wassersug, 2007, 2008, 2009).

In order to explore the meaning and message in the language of emasculation, we first ask: What is the language of emasculation that biologically impotent individuals face? We are particularly interested in individuals who are impotent as a result of their treatment for cancer, as this is a demographic whose gender, sexual, and personal identity may already be in crisis (Fergus, Gray, & Fitch, 2002; Oliffe, 2006; Wassersug & Johnson, 2007).

Modern Day Eunuchs

As noted above, when first line therapies for PCa fail, patients are offered ADT via surgical or chemical castration. Approximately 40,000 PCa patients in North America begin long term ADT each year (Aucoin & Wassersug, 2006). Given an average survival time approaching a decade, there are approximately half a million medically "emasculated" men in North America at any time (Smith, 2007). Clinical effects of pharmacological ADT are identical to those of physical castration: loss of erections, reduced libido, penile shrinkage, loss of body hair, and, for some, gynecomastia (Higano, 2003; O'Connor & Fitzpatrick, 2006; Sprenkle & Fisch, 2007; Wassersug & Oliffe, 2009).

Prostatectomy and radiotherapy--common primary treatments for PCa--often leave patients with permanent ED, even if they are not androgen-deprived. The personal responses of PCa patients to these changes are almost uniformly negative, exemplified by the quote in Chapple and Ziebland (2002): "I've lost all masculinity, I'm not a man any more" (p. 833). Many similar quotes from castrated patients in other studies (Boehmer & Clark, 2001; Fergus et al., 2002; Gray, Wassersug, Sinding, Barbara, Trostzmer, & Fleshner, 2005; Navon & Morag, 2003; Oliffe, 2006) raise questions about what it means to these men to live with the loss of the predominant physical and psychological signifier of masculinity. The literature suggests that the vast majority of men fear the side effects of PCa treatment and are challenged and stressed by the changes they experience on ADT.

Purpose

This article is part of a larger research program that aims to help men live as well as possible with androgen deprivation. Ultimately we would like to know how PCa patients (and others) feel and react when they encounter the language of emasculation. How does this language influence PCa patients' choice of and willingness to accept treatment? How does it affect the treatment outcome? How does this language impact on patients' psychosocial well-being and quality of life? All of these issues are relevant to patients, their families, supporters, and health care providers. However, we begin here with a study of the language itself.

The goal of this article is to elucidate public perceptions of the sexual and social characteristics of the androgen-deprived individual as revealed by the common use of the language of emasculation in the media, movies, Internet and other popular sources. As well, we explore how the "Viagra Culture" has affected society's conception of ED in its promotion of it as an easily treatable medical affliction. Objective knowledge of the metaphorical versus medical meanings of these words and expressions, particularly when contrasted with the history of emasculated men, could ultimately help contest negative stereotyping of castration, and perhaps help PCa patients better adapt to ADT.

As a whole, this article explores the idea that the problems androgen-deprived PCa patients face when adjusting to their new lives are rooted not solely in their altered bodies, but also in the public's skewed perception of their condition. This hypothesis is supported by Finger's assertion that "The barriers to the sexual expression of disabled people are primarily to do with the society in which we live, not the bodies with which we are endowed" (as cited in Shakespeare, 2000, p. 161).

Background: Masculinity and Metaphor

In order to fully understand the barriers that castrated individuals face, it is important to first look at pervading perceptions of masculinity, against which the language of emasculation draws its power. In most societies today, a "man" is expected to deny all weakness and vulnerability (Gannon, Glover, & Abel, 2004; Halpin, Phillips, & Oliffe, 2009) and present an exterior of control and independence (Gill, Henwood, & Mclean, 2005). He is defined by his virile muscle mass and physical well-being, but also his rejection of narcissism and vanity (Gill et al., 2005), and a general disinterest in "self-health" activities (Courtney, 1998, 2000; Oliffe & Thorne, 2007). This benchmark is reinforced by notions of "male camaraderie," a term which evokes images of tough, macho men gathering to discuss their normative sexual conquests (Wentzell, 2006). Men are supposed to be successful but stoic (Halpin et al., 2009), and occupy societal positions of leadership and cultural authority (Oliffe, 2005). Although few men measure up to these mythic standards, many remain complicit in sustaining them as masculine ideals (Connell, 2005).

Even at the microscopic level, these traditional signifiers of masculinity pervade. In her essay "The Egg and the Sperm" (1991), Emily Martin studies how the language of masculinity has invaded biological descriptions of the reproductive process: "It is remarkable how 'femininely' the egg behaves and how 'masculinely' the sperm" (p. 489). She analyzes how sperm are described as "penetrating" the egg, and how sperm and the men who produce them are depicted as the active agents in almost all textbooks, despite the fact that fertilization is clearly a collaborative process. Such a use of language aids in solidifying the dominant conception of men as aggressive, conquering beings.

It follows that young, healthy, heterosexual men are most likely to embody the traditional perception of masculinity. Such a profile seems particularly alien to chemically castrated individuals. The side-effects of ADT typically include an average 10% gain in weight, mostly as fat in the abdominal and hip region, an average 3-4% loss of lean muscle mass, mild anaemia and fatigue (Alibhai, Gogov, & Alibhai, 2006; Higano, 2003; Pirl, Greer, Goode, & Smith, 2008; Smith, 2004; Sprenkle & Fisch, 2007). As a result, subjects may no longer feel like they live up to society's macho expectations. One PCa patient, fearing ADT, described what a loss of libido would mean to him: "Now if I didn't have my libido, I don't know how I'd be. I wouldn't want to be like that. That's almost like neuter [...] I wouldn't be a man, not in my eyes" (Fergus et al., 2002, p. 311).

Like any individual who is on medication for a chronic illness, ADT patients may find it difficult to feel completely in control and independent (Beck, Robinson, & Carlson, 2009; Halpin et al., 2009), as they struggle to adapt to the restrictions and limitations imposed by their treatment and its impact on both their form and function. In addition, our society's tendency to equate male prowess with the ability not simply to please, but to impregnate a woman (Gannon et al., 2004), may cause castrated individuals to feel that they no longer measure up to what is expected of them sexually. As a result, many PCa patients suffer humiliation and despair (Burns & Mahalik, 2007; Fergus et al., 2002; Navon & Morag, 2003) and may even "second-guess" their treatment for the fear that it may compromise their masculinity and thus, their sense of self-worth (Beck et al., 2009; Powel & Clark, 2005).

Sociolinguists recognize that words have the ability to shape how we perceive reality (Wardhaugh, 2006; Fairclough, 1992), including conceptions of sexuality and gender (Foucault, 1980), as well as illness and treatment (Carr, 1996; Frank, 1991; Hodgson, Hughes, & Lambert, 2005; Sontag, 1979). As Fairclough writes: "when we signify things through one metaphor rather than another, we are constructing our reality in one way rather than another" (1992, p. 194). The transformative effect that these metaphors have on their subjects has been studied at length (Fairclough, 1992; Frank, 1991; Sontag, 1979). For example, the media's tendency to use the language of war when depicting political campaigns has altered the way these campaigns are conducted, leading them to increasingly resemble strategic warfare (Fairclough, 1992). Not only is the subject "political campaigns" reshaped by the metaphor "war," but so too is the identity of the metaphor tainted by the subject. The result is that our construction of war becomes influenced by our notions of political campaigns. Thus, expressions such as "neutered electorate," and "emasculated Senate," may do more than simply present these political entities in the unfavourable light of penile dysfunction--they may also paint those men who identify with the terms "neutered" and "emasculated" as politically powerless.

For this reason, the medical profession has formally altered the language used when referring to penile failure: the medical condition of "impotence" officially became more narrowly defined as "erectile dysfunction" at the National Institute of Health's 'Consensus Development Conference on Impotence' in 1992 (Marshall & Katz, 2002). But as Cameron writes: "Whatever changes in perception and expression we manage collectively to bring about, we will always carry with us the baggage of history in the domain of language" (1990, p. 11). The medicalization of the language of ED, we argue, has not corrected its damaging effect. In the public's perception, impotency is still equated with both political and sexual powerlessness. Implicit here is the definition of impotence--powerlessness (OED Online, 2005). So, although the label changes, the connotation prevails (McLaren, 2007).

Methods

Our study is focussed on the analyses of five key terms--castrate, emasculate, neuter, impotent, and eunuch, as well as their derivatives (e.g., emasculate, emasculation, emasculated). All of these terms are often used metaphorically. In addition, we examined the phrase "no balls," which is often used to connote a loss of power and confidence. We then reviewed contemporary, publicly-accessible sources for the terms, beginning with the Oxford English Dictionary. (OED) definitions for each. Table 1 gives the definitions of our five chosen terms (OED Online, 2005). Note that impotent refers to lack of sexual power in only one of four entries, and, as mentioned above, its original meaning is "... powerless, helpless; ineffective." Hence impotent and impotence appeared much more frequently in the sources we examined than other terms that are more castration-specific.

We used the Internet to search for our key terms and phrases in webpages, and explored the contexts in which they were used online. We also explored the use of the same terms in popular quotations and jokes. A large part of our analysis was drawn from film, television and print media.

Our approach to the large data set provided by the Internet was semi-quantitative, i.e., based on the number of "hits" in Google. Many emerging themes were derived and interpreted using descriptive qualitative methods. Predominant themes are illustrated here with representative quotes and citations. We focused on the English language, and consulted English language sources almost exclusively.

To examine the language of emasculation on the Internet, we searched for our key terms with Google, currently the most widely used Internet search engine (Sullivan, 2004). In order to separate metaphorical from medical uses, we performed numerous Boolean searches. Here the webpages were filtered using logical operations (AND, OR, NOT) to insure that only the desired material was returned (see Table 2). We considered webpages that used key terms in an anatomical or physiological context, or within dictionary entries, to be "technical hits." In contrast, "metaphoric hits" represent those webpages using the expression in an abstract or metaphorical context. An estimate of metaphoric hits was calculated by subtracting "technical hits" from "total hits."

In addition to webpage hits, we obtained additional data from a search of Global.factiva.com, a Dow Jones Reuters database that included an archive of articles published in The Globe and Mail (Canada's largest national newspaper) from the 1960s to the present, for terms of emasculation (including alternative endings -s, -ed, -tion, -ing).

In recent years, ED has been covered in the media extensively and there has been intense marketing of phosphodiesterase 5 (PDE-5) medications, such as Viagra, Cialis and Levitra, Consequently, the majority of articles employing impotent and impotence referred to ED and associated treatments. In order to examine the use of these terms in a non-medical context, we excluded articles referring to ED for the purposes of this search. However, the impact that PDE-5 inhibitors have had on contemporary conceptions of ED is examined in the Results and Discussion.

In addition to non-medical contexts, we avoided contexts that PCa patients in North America would consider anthropological and/or archaic with respect to geography and daily life. For example, in searching articles with the term castrate, we eliminated those articles that also mentioned Hijra (a South Asian third gender category, some of whom are castrated), and Castrati (a male singer castrated before puberty), because they were purely foreign within our Western context in the first example, or strictly historical in the second. Examples of such search queries are shown in Table 3.

Lastly, we examined works of fiction submitted by individuals to eunuch.org, a website for adults interested in castration (Johnson, Brett, Roberts, & Wassersug, 2007). We searched 4115 archived stories authored by 800+ individuals (based on Internet ad dresses) for five key terms related to submissive and inferior social status as presumed outcomes of castration: slave, servant, submissive, maid and sissy. We acknowledge that contributors to eunuch.org do not represent a general cross-section of the population, but instead a cohort who by and large are both better informed on and more interested in the subject of castration than most (see Johnson et al., 2007; Wassersug & Johnson, 2007). We included their narratives in our analysis as their use of the language of emasculation provides insights to the receptivity of these labels and dominant ideals of masculinity.

Results and Discussion

As expected, our search confirmed that terms of emasculation were typically employed to criticize and denigrate within domains that are traditionally associated with masculinity and power, and therefore used to signify loss of maleness and authority. All aspects of government, politics, and the media, as well as sports and the military were subject to emasculating language. The use of such language reinforces the "gender" of these domains and the conception that power is inherently male, excluding those who are female, or those who do not exhibit stereotypical male characteristics--including some ADT patients. We found further evidence of this language of marginalization in the books, jokes, films and newspapers we examined.

Books

Emasculatory language appears in the titles of popular books such as Germaine Greer's "The Female Eunuch" (1971), Robert Glimer's "The Sensuous Eunuch" (1972), Linda McQuaig's "The Cult of Impotence: Selling the Myth of Powerlessness in a Global Economy" (1998), and Melanie Phillips' "The Sex-Change Society: Feminised Britain and the Neutered Male" (1999). All of these titles equate emasculation with the absence of both political power and associated male privilege.

The Internet

While webpages referring to ED predominated in our query for impotent OR impotence, 10% of search results applied these terms to indicate both physical and metaphorical powerlessness (see Table 4). Comparatively, half the search results employed emasculate and its derivatives in a metaphoric sense, again often attacking the power structures of religion and the military (e.g., "emasculation of Bible English"; "American military emasculated"), traditional areas of male authority. Neuter and its derivatives were used proportionately far less often in a metaphoric sense than emasculate (17% vs. 45%, respectively). However, when it was used, it was often to denigrate an opponent in a prototypically masculine sphere, such as technology or politics (e.g., "Microsoft neuters Bluetooth"; "neutering of politics"). While castrate and its derivatives had more hits than either neuter and emasculate, it was used predominantly to describe castration of animals, or punitive measures for sexual offenders. Such associations, however, only served to further negatively connote the term when it was used metaphorically, for examples when mockingly referring to the Canadian Broadcasting Corporation as the "Canadian Broadcorping Castration," or in the headline "Guess who castrated FEMA?" [USA's Federal Emergency Management Agency].

Humour

We often joke about topics that make us uncomfortable, or that we fear. The sheer volume of jokes on castration reveals the tension we experience with the subject. Gershon Legman, who analyzes hundreds of jokes in his folkloric study, "Rationale of the Dirty Joke" (1975), describes castration as one of the three most feared topics of the last five hundred years of Judeo-Christian middle class society (the other two are venereal disease and homosexuality). Jokes also provide us with an easy, and a seemingly harmless, environment in which to assert dominance in daily life, and the "success or failure of a joke marks the boundary within which power and aggression may be used in a relationship" (Lyman, 1987, p. 150). Humour has the power to legitimize and standardize our perceptions of different individuals' shortcomings. While some patients on ADT do employ humour as a coping strategy (Boehmer & Clark, 2001 ; Fergus et al., 2002; Navon & Morag, 2003; Oliffe, Ogrodniczuk, Bottorff, Gregory, & Halpin, 2009), there are important differences between joking about oneself and being the target of jokes by others.

Many jokes show that to castrate a man is to ridicule him and to undermine his status. Historically, both Jews and blacks have been common subjects. In the last century, both groups were targets of actual castrations--Jews in Nazi "medical experiments" and American blacks from torture and lynching by mobs. Here are two such jokes we found that prey on these historical atrocities:

On Martin Luther King, Jr., Nobel Laureate: "Maybe they ought to castrate him, so he can win the No-Ball [Nobel] Prize." (A quip circulating in Arlington, Texas, 1966, as quoted in Legman, 1975, p. 481).

Allied army song of the Second World War: "Hitler had only one ball. And Goballs [Minister of Propaganda Josef Goebels] had no balls at all." (From a war songbook compiled by Martin Page: Kiss the Goodnight, Sergeant Major, 1973, as quoted in Legman, 1975, p. 491).

Such quips help to perpetuate the assumption that castration universally undermines its subjects. Moreover, they associate castration with the war crimes of the Nazis and the hate crimes of the Ku Klux Klan, which is devastating imagery for any ADT patient to be associated with.

In many jokes we looked at, it was implied that castration was an accidental result of stupidity, either on the part of the patient or the medical staff:

Steve goes to the doc asking for a castration. The doctor warns him it is against his better judgment but upon his patient's insistence, performs the operation. Afterwards, Steve meets another patient in the same hospital section who tells him he is there to be circumcised. Steve cries, "Shit! THAT's the word!" (Adapted from jokes.comedycentral.com, accessed June 30, 2005).

The nurse chases the fleeing patient with scissors, while the doctor shouts, "Nurse! I said 'Slip off his spectacles!'" [contra: "snip off his testicles"] (Legman, 1975, p. 513).

These jokes depict castration as a by-product of miscommunication that only occurs because of a catastrophic mistake and supreme misunderstanding, as opposed to medical need.

Other jokes included misrepresentations of biology, such as the suggestion that castration produces a high-pitched voice in adult men:

The patient asks (falsetto): "Doctor, may I have my balls grafted back on?" Doctor [a disguised female nurse] (basso profundo): "Impossible!" (From London, 1953, as quoted in Legman, 1975, p. 465).

Since castration after puberty does not result in a high-pitched voice, this joke only adds to the misconception that castration transforms a man into a woman, contributing to the stigma felt by ADT patients.

This joke also displays another common trope through the presence of the "female castrator," who emasculates the male subject. Many jokes employ this character to suggest metaphorical, if not physical castration:

A flasher accosts an elderly Jewish woman on the streets of Miami Beach. He throws open his raincoat and stands there fully exposed. She takes a look, shakes her head disapprovingly, and snaps at him "You call that a lining!?" (Shafer, 2001, p. 288).

The woman's failure to acknowledge the flasher's genitalia, the very thing he is attempting to present to her, symbolically castrates him. His masculine identity is rendered powerless, as he fails to live up to his name of "flasher" (Schafer, 2001). The powerful emasculating image of the "female castrator" is one that appeared frequently in our searches of most mediums.

Film

A search of the Internet Movie Database (IMDb.com) revealed the use of our search terms in a wide range of genres, including: crime, thriller, documentary, drama, romance, action, science fiction, and musical. However, we found that by far the largest genre to feature castration-related language was comedy (59% of the 82 films we looked at). Like castration's presence in jokes, the predominance of comedic contexts of castration and emasculation in film underlies our dependence on humour to relieve tension. Without the use of humour, the topic of castration in film would doubtlessly appear less frequently. However, despite the predominance of comedies, not a single quote from the films we found employed any of our key terms in an entirely positive light.

Stereotypes of the harem eunuch (Oh! What a Lovely War, 1969) and the eunuch with a "lovely singing voice" (Pirates of the Caribbean: The Curse of the Black Pearl, 2003) appeared in many films, depicting castrated individuals as a novel commodity. Like in the jokes above, there was also many examples of the "castrating female," as in "high-powered, neurotic, castrating, Manhattan career bitches" (The Stepford Wives, 2004) and "Oh, Women's Lib do not automatically mean castration" (Woody Allen's Bananas, 1971). Associations with imprisonment and slavery were also again present, such as "You might think I'm [an] impotent prisoner, handcuffed and shackled, locked in a eight by seven cell each night and day" (Just Cause, 1995) and "As far as I can see, American men have been totally emasculated--they're like slaves!" (It's a Mad Mad Mad Mad World, 1963). This latter quote, again, implies that women are responsible for the act of emasculation.

Thirteen percent of quotes involving variations of eunuch, castrate and neuter were used in the context of direct threats. For example, "Try this again and I will kill your mothers, [...] and turn your brothers into eunuchs!" (Mobsters, 1991); "You screw this up again--I'll flat-out castrate you" (The Butterfly Effect, 2004). "I say we take the sword and neuter him right here!" (Shrek 2, 2004). (1) Here we see castration being depicted as retribution one administers to one's enemies, or punishment for a misdeed, leaving castrated PCa patients to feel guilty by association.

Sixty-two percent of quotes involving variations of eunuch, castrate and neuter were cast in a hypothetical context, often playing on fear, as in the following two examples: "Cooper: 'What about you, Spoon?' [What scares you most?] Spoon: 'Castration.' Cooper: 'There's no argument there'" (Dog Soldiers, 2002); "Dr. Hubbins: 'Are you afraid it'll disappear? Are you afraid that it'll fall off? That a woman will castrate it and take it away?'" (Giving It Up, 1999). In this last quote we again see this fear of the hypothetical specifically being rooted in the 'female castrator.' Contrastingly, only 20% described emasculation in a way that implied it had actually taken place, and even then almost always in a metaphorical sense: e.g., "You don't have the balls to take me on any more. Ariel's got you neutered." (Grumpier Old Men, 1995).

Quotes referring to impotence were particularly harsh: "Agency Director: 'Everything to distract them from the fact that they're bored, meaningless, impotent nothings waiting to die'" (Split, 1989); "Helen: 'I know all about you. You're just a sad, second rate, boring, impotent little copycat'" (Copycat, 1995). Both of these quotes imply that an impotent individual leads an insufferably banal lifestyle, without any real reason to live.

In all the films we looked at, only two used castration language to express pride or affirmation. The characters speaking, however, were a psychotic inmate of a mental asylum in the drama/mystery Shock Corridor (1963): "Psycho: 'I am impotent ... and I like it!'" and a prude in A Dirty Shame (2004): "Marge the Neuter: 'I'll say it loud, I'm a neuter and I'm proud,'" a comedy that mocks those who hysterically condemn sexual activity. While these endorsements seem to be reclaiming the language of emasculation, in fact the low social status of the speakers stigmatizes the language even further.

Few films depict castration as actually having taken place. We suggest this is because the castrated man is no longer considered to be of any value or interest. Whether the emasculated subject is being punished, intimidated, subjugated or trivialized, the message these films imply is that in the event of castration, a man could not go on living and would be "better off dead." Even when not verbally explicit, such messages are powerful and significant.

News Articles

Overall, the use of terms of emasculation in The Globe and Mail closely reflected their dictionary definitions. There were, however, still numerous examples where the terms were used metaphorically and for purely negative purpose. They fell into three major categories: attacks on traditional male domains, threats, and assumptions about sexuality.

Emasculation in Traditional Male Domains

Positive qualities and capabilities such as power, ambition, independence, and honesty were subject to emasculating terms, undermining traditionally male-dominated fields: e.g., military officers ("unarmed Bosnian soldiers look about as potent as eunuchs in a brothel," 30 May, 1998), and sports--especially football and hockey. In one news item, a Mississippi football coach had a bull castrated during a practice to "motivate his players" (14 November, 1992), dragging castration into the realm of barbaric sacrifice. In hockey news, a Fair Play Commission was accused of looking for ways to "emasculate hockey" (22 December, 1991), suggesting that "real" men use brute force. In one story about baseball, a player was described as having an "impotent bat" (05 April, 1991). In an article about the International Olympic Committee and prohibited drug use, a physician stated, "You feel castrated sitting there when the IOC asks you what these medications are and you can't tell them" (05 October, 1988), linking castration with incapacitation.

News articles discussing both local and national government commonly included our keywords. Administrations, agencies, the Senate, UN Security Council, etc., were all, at times, described with terms of emasculation. The same was true of bills, legislation, laws, etc. Speakers used emasculation-related words to characterize leadership, regimes, and institutions. Regions, countries, cities and communities were similarly described as emasculated: examples include Germany ("Germany was divided, thus emasculated," 22 February), Finland (as a "worldwide synonym for appeasement and emasculation," 14 March, 1990), Britain ("leaving Britain a neutered lion," 31 May, 1987), and Ottawa ("Quebec wants to castrate Ottawa," 17 January, 1992).

Even the media itself was often the target of emasculating language. Numerous articles described the Canadian Broadcasting Corporation with terms of emasculation: "CBC will turn itself into an intellectual and social eunuch forever safe from controversy or significance" (14 November, 1992). This suggests that castrated men are rendered too complacent and neutralized to be consequential; once again, loss of erectile function is equated with a general loss of the power that defines men as "masculine." This global disempowerment of males (and the normative understanding of the dominant male) is described in quotes such as "family court is male castration" (31 March, 1998), "... emasculated him, upsetting his 'natural' authority" (film review, 04 June, 2003) and in an article describing men feeling emasculated by being instructed on how to barbecue by a female cooking instructor (16 June 2001).

This figure of the "female castrator" was again continually present in the news articles we found. While men could emasculate ("emasculating tyranny of the studio boss," 20 July, 1988), descriptions of the "female castrator" were far more prevalent: "the frigid, castrating, ball-breaking female partner" (20 November, 1999); the "frigid, castrating WASP matron" (20 December, 1986); and "feminism in the late seventies ... [seen as] an emasculating, dictatorial force" (10 October, 1986). Women in the public view, especially politicians and educators, were themselves subject to the language of emasculation, highlighting the metaphorical use of these terms.

Threats, Insults, and Shame

We found that brutality was commonly associated with the language of emasculation in the media. Actual incidents of human genital destruction were frequently portrayed as violent mutilations in news reports, and were generally horrifying: botched surgeries, including one to a boy who was raised as a girl (29 January, 2000). Discussions of actual castrations included those of sexual offenders, atrocities in Rwanda (14 July, 1994), charred torsos of murder victims in Johannesburg (26 February, 1994), and tortures in Nicaragua (03 June, 1980). Occasional articles mentioned the castration of farm animals.

Castration was not only depicted in terms of physical violence, but also as a humiliating threat to identity. Many examples of castration used as a threat were found: "back off on [a particular issue] or we'll ... neuter you good" (19 November, 1998); "Cowboy parking only. Violators will be castrated" (03 July, 2002). To emasculate was shameful: "[I]t's infantilizing, therefore emasculating" (27 March, 2004); or at least anti-heroic "good old tradition of Canadian anti-heroes in which fat emasculated gentility, self-pity ... are pre-requisites" (11 July, 1981).

As well, direct insults were framed by terms of emasculation: "Dagwood and Blondie ... typified ... the emasculated North American male and his super-competent wife" (22 April, 1989); two women shouting "impotent eunuch" at a Quebec Education Minister (23 October, 1969); a female CEO told male executives that they were eunuchs and yelled, "How can your wives stand you? You've got nothing between your legs" (09 December, 1997).

The term "impotent," which alone means powerlessness, was regularly coupled with other negative words (see Table 5), linking impotence with futile rage, pain, or frustration. It is because of these negative non-medical meanings that health care professionals have formally replaced the medical term "impotent" with the more anatomically specific term "erectile dysfunction." This attempt to change the language has met with limited success, however, as "impotence" and its denotation of "powerlessness" continues to be associated with "erectile dysfunction" (48% of > [10.sup.7] webpages mentioning "erectile dysfunction" also included the term "impotent" or "impotence").

In general, the language of emasculation was used to discredit its subjects by implying global dysfunction: "why [would anyone] find this neutered old goat or his sentimental jottings offensive[?]" (26 March, 1990); "intellectual eunuch" (06 March, 2004); "political eunuch" (14 November, 2002); "impotent dwarf" (12 July, 2003); and "impotent pawn" (26 August, 1983). In such quotes, emasculation is equated with obsolescence, as if the castrated or sexually impotent individual has nothing to offer society.

The only mention of castration we found in the news that could be seen as positive was reported within fashion, and this was perhaps closer to an androgynous, rather than emasculating language: "neutered chic" and "sexless prettiness" (3 November, 1987). Many PCa patients, however, would have difficulty extracting a positive sentiment from this use of the language.

Emasculation Implies Inactive Sexuality

Often the language of emasculation was used to imply that a surgically castrated individual should have no interest in sexual activity. President Clinton's sexual improprieties prompted the following article: "Is it time for a eunuch in the White House?" (28 January, 1998). In a film review, the following quote is retold: "He was ordained, Papa, not castrated" (16 December, 1988). Emasculatory language was also used to describe the absence of sexiness: "When it comes to flaunting what one's got, most straight men would rather stick to their eunuch-style boxer trunks and let the women do all the work" (9 June, 1994).

There is an implicit assumption that eunuchs in history did not, and thus contemporary androgen-deprived males do not, engage in sexual activities. This, in turn, creates the presumption evident in these news reports, that castrated men must be sexually undesirable and totally sexually disinterested. This is neither substantiated by history nor necessarily correct for all contemporary androgen-deprived men (Aucoin & Wassersug, 2006; Brett, Roberts, Johnson, & Wassersug, 2007; Warkentin, Gray, & Wassersug, 2006). When presented in the media, these misconceptions send messages to patients that with ADT they will not only lose the ability to have erections, but lose their sexuality altogether. Wassersug and Johnson (2007) have presented data suggesting that personal expectations can influence whether or not contemporary androgendeprived males can still have sexual desire and be sexually active.

Although an orchiectomy strictly denotes the removal of the testicles (while a penectomy is the amputation of the penis), Freud "silently redefined" the term castration to mean loss of more than just the testicles (see discussion in Taylor, 2002, p. 61). When the term castration is now used in public discourse, it is not always clear whether it applies to a penectomy, an orchiectomy, or both. Since ADT leads to both ED and penile shrinkage (Higano, 2003), an orchiectomy constitutes a non-physical, yet nevertheless functional loss of the penis. Given the multiple meanings of castration, plus the physiological link of testicular loss with penile dysfunction, it is likely that many males with untreatable ED perceive references to castration as applying to them. In our society today, to be labelled as castrated in one sense is to be labelled castrated in all senses.

Modern Castration Subcultures

Linking castration with submission and servitude is particularly prevalent among individuals with castration paraphilia (Johnson et al., 2007; Roberts, Brett, Johnson, & Wassersug, 2008). Of several of the thousand narratives posted on eunuch.org, 26% included at least one of our five terms relating the castrated condition with servitude, weakness, or domination. According to a 2004 study by Wassersug, Zelenietz, and Squire, among the most common reasons for a modern male to seek voluntary castration is feeling a "deep desire to be submissive to a partner" (p. 436). This linking of castration with servitude and loss of power reflects a commonly held belief that equates eunuchdom with slavery, i.e., physical, political and social impotence. Ironically, eunuchs in history had considerable social, political, and military power, depending on the time and culture (Aucoin & Wassersug, 2006; Wassersug, 2008).

The Language of Health Professionals

Health professionals often shy away from terms with negative connotations when conversing with patients (Beck et al., 2009). Thus, doctors don't typically say that they "castrate" their patients, and certainly don't refer to the treatment they provide as "neutering" or "emasculating." Notably, "androgen deprivation therapy" is offered to patients as "hormonal therapy," a label that doesn't hint at the treatment's side-effects. "Hormonal therapy" implies that the patient is being given something, and skirts the reality that they are actually losing part of their normal male endocrine system, as implied by the term androgen-deprivation. Health professionals may avoid using terms such as castration accurately because they feel that the negative connotations these words have acquired will affect a patient's decision to accept or reject the treatment. One may argue, however, that euphemistic descriptions of a medical treatment may interfere with a patient's ability to properly assess risks and deal with the side effects when they arise (Beck et al., 2009; Carr, 1996; Hodgson et al., 2005).

The Culture of Viagra

Fuelling the stigma of ED to ADT patients is the pharmaceutical industry and its promise of a cure. Since its introduction, Viagra has consistently been one of the leading drugs in terms of spending on "Direct-to-Consumer" advertising (Marshall & Katz, 2002; Rosenthal, Berndt, Donohue, Frank, & Epstein, 2002), and has become "the fastest selling pharmaceutical in history" (McLaren, 2007, p. 242). It is noteworthy that the staggering prevalence of advertisements for Viagra and related PDE-5 inhibitors, as compared to treatments for more deleterious medical conditions, depicts ED as the ultimate attack both on a man's health and sense of masculinity (Brubaker & Johnson, 2008). While most of these advertisements employ non-verbal communication, the message they present functions in an analogous way to the printed text we have examined. The industry's success, as noted by Melchiode and Sloan (1999), rests upon the presumption that: "No malfunction of the human apparatus--not even cancer or heart disease--can be more painful to the male ego or catastrophic to the male psyche than sexual impotence" (p. 17).

Viagra not only fuels our society's ardent fear of ED, but it also promotes the message that no one need live with this "painful" and "catastrophic" condition. Viagra has quickly changed our society's conception of sexual impotence from an eventuality for all men, to a completely preventable affliction, no matter what your age (Loe, 2004; Marshall & Katz, 2002). As McLaren (2007) explains "Pfizer [manufacturer of Viagra] astutely recognized the need to replace the word "impotence" with the term "erectile dysfunction." By doing so it told its potential clients that they suffered simply from a vascular problem, not from any character flaw" (p. 241). While "impotence" sensu lato may be permanent and untreatable, a condition one simply must learn to live with, ED, we are told, though certainly undesirable, is both preventable and reversible.

While Viagra is a medical drug, designed to treat the specific problem of ED, the manner in which it is marketed implies a general rejuvenation of every area of a man's life. It is noteworthy that advertisements for PDE-5 medications never focus specifically on penile function. Rather, these commercials show men dancing down the street to upbeat music, befriending total strangers and engaging in impromptu athletic activity. Erections are never explicitly mentioned; instead these men are shown as exuberant, macho and successful. These advertisements suggest that a man's entire life will improve overall with these drugs. In other words, the implicit claim is more than a cure for ED; the message is that Viagra cures global impotence. In fact, Viagra has been shown to have positive results in boosting the self-esteem of men who do not suffer from ED (Gruenwald, Leiba, & Vardi, 2009; Jones, Klimber, McMurray, Padula, Tseng, & Stecher, 2008).

But what about those suffering from ED which cannot be cured? While Viagra may eradicate ED on bus ads and billboards, the way it is promoted exacerbates the suffering of those the drug cannot help (McLaren, 2007). Viagra is aiding many demographics, including boosting the athletic potency of professional athletes (Hsu, 2006); but it is largely ineffective in treating ED in those who have been chemically castrated as a treatment for PCa (McLaren, 2007). Instead, it simply adds to the "othering" of these men, as they are left afflicted with a condition that society has been led to believe is, not only "entirely treatable," but is also detrimental to a healthy, normal existence. In the age of Viagra "the erect penis becomes a visible index of masculinity, emotional health and physical health" (Marshall & Katz, 2002, p. 59).

Much has been written about the marginalizing effect that Viagra has had on the disabled community at large (Mamo & Fishman, 2001; Wentzell, 2006). The Viagra Culture further stigmatizes castrated and other differently-abled demographics by discrediting alternative forms of sexual interplay still available to these individuals. Viagra actively attacks the sexual practices of those it cannot help, by equating sexual satisfaction with penetration (Castro-Vazquez, 2006; Marshall & Katz, 2002; McLaren, 2007). In this way, Viagra both upholds and renews our society's pervading heteronormative conception of sex, alienating those individuals to whom such interplay is either undesirable or inaccessible. This can induce fear of abandonment for ADT patients (Navon & Morag, 2003).

Conclusion

Many PCa patients treated with ADT perceive themselves as "unmanly" due to their loss of traditional gender signifiers, including the decline of sexual function, and because of the development of feminine physical traits that often accompanies this hormone therapy. There are, however, many elements of the stereotypical male gender identity which ADT has no effect upon. For example, there is no medical evidence to suggest that castration in any way affects leadership ability. On the contrary, history supplies us with many examples of eunuchs in positions of great political power (Penzer, 1993; Ringrose, 2003). But today terms such as emasculation and castration have become synonymous with global dysfunction, especially in traditionally masculine arenas. The traits commonly associated with masculinity have become solidified into a contingent package, such that castration's elimination of certain gender signifiers can have a neutering effect on every aspect of a subject's identity.

We believe that this is due, in part, to the media's patriarchal utilization of the language of emasculation, which reinforces the association of power with stereotypical masculinity, further stigmatizes castration, and shames those who are androgen-deprived. When faced with this language about themselves, PCa patients are likely to internalize negative self-conceptions and feel obsolete. Such language may also influence the way in which they are perceived by those around them--their families, supporters and health care providers. It is thus conceivable that the language could affect the course and success of treatments for PCa patients, as well as the choice of treatments in the first place.

For PCa patients facing castration, a non-disparaging, neutral use of castration-related language would be affirmative and extraordinary. But this is far easier said than done. Efforts to expunge "impotence" from the medical literature, although laudable in principle, may be ineffective in protecting patients from the denigration implicit in the broader term impotence. It may even be a disservice to patients if it leads medical professionals to simplistically ignore the psychosocial impact of ADT and focus solely on the mechanistic problem of erectile function. A clear understanding of the language of emasculation and the physiological realities of ADT may be the best protection that androgen-deprived patients have from the humiliation implicit in the terminology.

Future longitudinal studies of both a qualitative and quantitative nature need to be undertaken to assess directly how this language is understood by both the consumers and providers of medical care. If, as we hypothesize, such studies confirm that this language is detrimental to PCa patients, the next question is what to do about it. We believe the answer lies in awareness. What can be overshadowed by the historical resonance of words such as "castrate," "eunuch," and "emasculate," and what is paramount to realize, is that these are not simply archaic terms. Rather, men are castrated today; men do identify with the term "eunuch"; men are suffering from the stigma attached to this language of emasculation. The average person who uses castration as metaphor is likely not cognizant of the fact that they are actually referring to existing individuals. We believe that the negative metaphorical use of language associated with emasculation is not fundamentally malicious, but may instead be simply ignorant--and thus, changeable through education.

There is a simple reason why the public is unaware of the sizable population of castrated men: these "emasculated" individuals hide (Johnson et al., 2007; Wassersug & Johnson, 2007). We surmise that they are driven underground largely because of a stigmatization perpetrated by the metaphorical language used by those unaware of their existence. The invisibility of the medically emasculated leads to further ignorance on the part of the public, causing the use of this offensive language to go unchecked, and driving castrated individuals deeper into hiding. It is this troublesome cyclical process that we hope to halt by exposing this problematic language, and illuminating the malice intrinsic in these metaphors. It is necessary that we reclaim the language of emasculation for the individuals to whom it refers, so that men diagnosed with PCa can consider treatment options free from the fear of stigma, and so that those men already androgen-deprived do not feel the need to hide.

DOI: 10.3149/jmh.0901.3

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Mitchell A. Cushman (a), JoAnne L. Phillips (a), Richard J. Wassersug (a)

(a) Dalhousie University.

The authors thank Jennifer Epp, Tom Johnson, Tucker Lieberman, Emma McKenna, and Letitia Meynell for much helpful discussion about the ideas expressed in this paper. For critical comments on the manuscript, we thank Barbara Marshall, John Ollffe, Virginia Braun, Gary Dowsett, J. Mary Burnet, and Midori Yamamoto. Lesley Roberts and Midori Yamamoto assisted with library searches. Access to data at eunuch.org was provided by "Talula," the site coordinator. Funded by Dalhousie Medical School.

Correspondence concerning this article should be addressed to Richard Wassersug, Australian Research Centre in Sex, Health & Society, La Trobe University, 1st Floor, 215 Franklin Street, Melbourne, Vic. 3000, Australia. Electronic mail: richard.wassersug@dal.ca
Table 1
Primary and Selected Secondary. Definitions for Search Terms in the
Order in Which They Appear in the Oxford English Dictionary (OED
Online, 2005)

The OED strives to give the oldest definition first and the newest
one last.

Impotent

Having no power or ability to accomplish anything; powerless,
helpless; ineffective

Physically weak; without bodily strength; unable to use one's
limbs; helpless, decrepit

Wholly lacking in sexual power; incapable of reproduction

Obsolete Not master of oneself; unable to restrain oneself;
unrestrained, headlong, passionate

Emasculate

To deprive of virility, to castrate (a male person or animal)

To deprive of strength and vigour; to weaken, make effeminate and
cowardly; to enfeeble, impoverish (language)

To take the force out of (literary compositions) by removing what
is supposed to be indecorous or offensive

Obsolete and rare example: "emasculated or turned women"

Castrate

To remove the testicles of; to geld, emasculate

To deprive of vigour, force, or vitality; to mortify

Obsolete To mutilate, 'cut down'

Neuter

To castrate or spay (an animal, esp. a cat). Also in extended use,
of a person.

To render of indeterminate gender. Also (esp. in a political
context): to render harmless or ineffectual, to neutralize.

Eunuch

A castrated person of the male sex; also, such a person employed as
a harem attendant, or in Oriental courts and under the Roman
emperors, charged with important affairs of state.

A male singer, castrated in boyhood, so as to retain an alto or
soprano voice. Cf. castrato.

Rare Emasculated "a mind wholly eunuch and ungenerative in matters
of literature and taste"

Table 2
Examples of Boolean Search Strategy Used to Determine "Technical"
Hits

Only pages in English were searched. All searches were done between
August 20 and September 30, 2005. Similar exclusive searches were
performed for castrate, neuter, no balls.

impotent OR impotence

impotent OR impotence sex OR sexual OR sexuality OR drug OR drugs
OR pill OR pills OR erectile OR dysfunction OR erection OR smoking
OR Dr OR medical OR cure OR treatment OR health OR testing OR
definition OR research OR reference

emasculate OR emasculated OR emasculating OR emasculation

emasculate OR emasculating OR emasculated sex OR sexual OR
sexuality OR drug OR drugs OR pill OR pills OR erectile OR
dysfunction OR erection OR smoking OR Dr OR medical OR cure OR
treatment OR health OR testing OR definition OR research OR
reference

Table 3
Two Examples of Search Queries Excluding Irrelevant Terms from the
Factiva Globe and Mail News Article Database Search

Database includes articles from the 1960s to 2005. Other terms
searched were impotent, castrate, emasculate (and their
derivatives).

neuter, neuters, neutered, neutering

Excluded: spay, pet, cat, dog, cats, dogs, pets, vet, kittens,
kitten, definition, grammar, veterinarian, etc.

eunuch, eunuchs

Excluded: China, Chinese, India, Indian, Hindu, Hindus, Hindi,
Hijra, bible, biblical, Shakespeare, opera, musical, theatre,
Greer.

Table 4
Number of Google Hits for Key and Comparison Terms

Key terms                 Technical    Metaphoric   % Metaphoric
searched          Total      (#)          (#)           (#)

Impotent * (a)     300       270           30            10
Emasculat * (b)    140        77           65            45
Castrat * (c)      210       200           10             5
Neuter * (d)       150       120           24            17
"no balls"          11         8.7          2.3          21

(#) All values are x [10.sup.4]

(a) impotent OR impotence

(b) emasculate OR emasculates OR emasculated OR emasculating OR
emasculation

(c) castrate OR castrates OR castrated OR castrating OR castration

(d) neuter OR neuters OR neutered OR neutering

Comparison terms were used to compare "no balls" with similar
expressions that indicate the lack of a body part. Webpages were
considered "technical" if the term was used in the context of
medicine, science, or dictionary entries. "Metaphoric" hits were
estimated by subtracting the number of "technical" hits from the
total hits.

Table 5
Selected Words Coupled with impotent in The Globe and Mail News
Articles from 1986 to 2002

    aged         futility     out of control
    angry          grief         outrage
    angst       humiliation        pain
   apathy       indignation       pathos
 defilement       malaise         penury
    fear        melancholy         poor
 frustration     obsolete        poverty
    fury        oppression      self-doubt
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