In her oft-cited essay ‘The double standard of aging’ (1972), a key text for questions of intersections between gender and ageing, Susan Sontag contrasts the ‘genuine’ condition of old age, which ‘men and women undergo in a similar way’, with growing old, the latter ‘an ordeal of the imagination – a moral disease, a social pathology’ which ‘afflicts women much more than men’ (Sontag 1972: 285). It is a truism that old age in men is seen to confer distinction and esteem, whereas in women it bespeaks confusion, frailty and physical decline. This inequality is compounded by the cultural constructions of age according to which youth is synonymous with beauty and personal value, and even virtue is tacitly (and perhaps increasingly explicitly) with associated physical health and attractiveness – again, associations that ‘afflict’ women in a manner disproportionate to men.

While Sontag's argument seems unfailingly true to contemporary women's experiences of ageing, her use of the metaphor of disease points up the dilemma explored in this chapter. One aspect of ageing in particular, the menopause, reverses the metaphor, being constructed socially as a literal instance of illness, such a definition itself reflecting attitudes that pathologise so many aspects of ageing for women. Menopause is in one regard ‘simply’ biology, the cessation of reproductive capacity at an age (for the majority) when one has long since renounced reproduction in any case. Yet this biological event has a cultural corollary: women who have fought to attain what Betty Friedan has called a ‘fully human personhood’ (Friedan, 1993: 496) beyond the biological role of bearing children (or feeding sexual desire) seem at this milestone to be newly and unquestioningly defined in relation to biology once more. A natural and inevitable process is conceived of as a disease, and a disease that reflects on the soul as well the body of the sufferer. The rise of psychoanalysis has only compounded this association of sexual identity crisis and psychic failure. Psychoanalyst Helène Deutsch famously observed that ‘Woman's last traumatic experience as a sexual being is an incurable narcissistic wound’ (Deutsch 1945: 457). Menopause is unique in the ageing process for Simone de Beauvoir, much influenced by Deutsch, in being a discrete event, an interruption of fertility, where the rest of ageing is a ‘continuous development’ (de Beauvoir 1997: 33); and it is also unique to women in this.