… Growing Older without aging
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August 1998

CyberHealth Index


CONTENTS:

  1. More bone mysteries: estrogens for men and women
  2. Food and mood: raising serotonin without getting fat
  3. Care of the Soul: The Underworld Goddess, Part II

Bone mysteries: estrogens and testosterone

A recent issue of the Journal of Clinical Endocrinology and Metabolism has a long, fascinating article on the role of estrogens and testosterone in bone health of men and women. Besides being a research report, this is also a thorough review of scientific literature on the subject, with 53 references cited.

Unless women are put on estrogen replacement, they undergo acute bone loss in the decade following menopause. Later the bone loss proceeds at a slower rate. In men bone loss is gradual and progresses at a slow rate; only if a man is castrated (because of prostate or testicular cancer, for instance) does he experience a phase of rapid bone loss comparable to the first decade after menopause (malnutrition, extreme fat deficiency, and certain diseases and/or their treatment with glucocorticoids may also lead to osteoporosis in men). Nevertheless, men do show a substantial decrease in bone mineral density with age.

Thus, while osteoporosis is chiefly a common problem of elderly women, and women typically do lose more bone tissue with aging, elderly men are by no means exempt from it. The fact that they too suffer from fractures is finally getting attention.

At one level, the answer seems extremely simple. Even elderly women respond to estrogen replacement. Thus even if a woman is past eighty, her bone loss can be arrested. When the levels of estrone and estradiol are sufficiently restored, the levels of parathyroid hormone (the hormone that draws calcium out of bones) go down, and the markers of bone formation go up. The same reliably happens when men are put on testosterone replacement. Hence the temptation to conclude that the sexes are different in their hormonal requirements for bone health: women need only estrogens while men need only androgens. In fact, until recently no one questioned the “obvious” assumptions that male bone tissue relied on androgens, chiefly testosterone, and that estrogens played only a marginal role, if any, in bone turnover and new bone formation in men. As for estrogens’ crucial role in calcium absorption and metabolism, as well as in lowering the levels of bone-destroying cytokines (immune hormones) such as interleukin 6, maintaining the necessary number of osteocytes (mature bone cells), restraining the osteoclasts (cell that “deconstruct” old bone) and stimulating the activity of osteoblasts (cells that build new bone), well, that’s how things work only in women, right?

Because of previous findings that total testosterone does not reliably correlate with bone mineral density in men, this Mayo Clinic study checked the BIOAVAILABLE (unbound to protein and biologically active) testosterone and “estrogen” (defined by the authors as combined estrone and estradiol) in 346 men between the ages of 23 and 90, and in a parallel sample of 304 women between the ages of 21 and 94. Surprisingly, it was the bioavailable (“free”) estrogen that turned out to be the best predictor of bone mineral density (BMD) not only in postmenopausal women, but also in MEN at any age.

In premenopausal women, on the other hand, free testosterone was the best independent predictor of BMD. In postmenopausal women, however, just as in men, free estrogen was by far the best predictor, followed by DHEA sulfate.

The authors cite another study which also found that in both elderly men and women it was free estrogen that correlated with BMD more strongly than free testosterone.

In addition, we know that women who have low bone density show low levels of ALL the sex steroids, whether before or after menopause.

This study found that while total testosterone declined by only 30% from youth to old age, and while total estrogen (estradiol plus estrone) declined by a mere 12%, free testosterone declined by 64% and free estrogen declined by 47%. Thus by the time they could be classified as “elderly,” the men lost almost two-thirds of their free testosterone and almost half of their free estrogen.

How does that happen? Why is the loss of biologically active sex steroids so much greater than the loss of total serum sex steroids?

The answer lies in a hormone-binding protein called the sex-hormone-binding globulin (SHBG). As men age, their levels of SHBG go up considerably. With more protein available to bind the steroids, the levels of bioactive testosterone and estrogen drop dramatically.

Women’s levels of SHBG show relatively little change over the adult lifespan, comparatively speaking. For women, dramatic loss of steroids is due to menopause or ovariectomy.

There is now no doubt that men of all ages strongly rely on estrogen (a reminder: defined here as estrone and estradiol combined) for bone formation and probably also for all kinds of other important physiological functions. But let us limit our attention to bone tissue. It has been discovered that men who have a genetic defect that makes them deficient in aromatase — the enzyme that converts androgens to estrogens — end up with poorly formed bones and low BMD. Such men respond to estrogen supplements. And in another study normal elderly men likewise showed an increase in bone density when treated with 2mg Estrace (oral estradiol tablets).

The authors point out that testosterone replacement in fact constitutes both testosterone and estrogen replacement. The genetic defect causing aromatase deficiency is extremely rare; the average man converts testosterone to estradiol and estrone with great ease. Bone tissue contains an abundant supply of aromatase. Thus not only testosterone but also DHEA and androstenedione (a weak androgen) can be utilized for bone building by being converted to estrone and estradiol.

One of the ironies of aging is that older men are known to have higher serum estradiol levels than those women of the same age who are not on replacement. Now this is beginning to be seen is one important factor that keeps older men’s bones in better shape than women’s.

The authors conclude: “In contrast to traditional beliefs, age-related bone loss may be the result of estrogen deficiency not just in postmenopausal women, but also in men”; and “Additional longitudinal studies should be made to compare the effects of testosterone and estrogen on bone and calcium homeostasis in men and to test the hypothesis that estrogen deficiency is a major cause of bone loss in aging men.”

It is certainly fascinating to be discovering the importance of estrogens in men’s health (bones are not the only target tissue where estrogens have turned out to be important for both men and women), but what about the role of testosterone? Surely the existence of testosterone receptors in bone tissue is significant?

No one doubts that, though at this point we simply don’t know how testosterone as testosterone affects bone formation in both men and women. Let’s not forget that in premenopausal women, it was free testosterone that turned out to be the best predictor of bone mineral density. And it is well known that hyperandrogenic women have thick strong bones even if their hormonal imbalance has progressed to the point where they don’t ovulate. This excellent bone thickness is particularly true of hirsute women, i.e. those who are the most virilized.

And I need hardly point out that men have thicker bones than women, even if we control for the difference in height. A healthy young man’s bones have the strength comparable to that of reinforced concrete. No one doubts that this has something to do with testosterone.

For one thing, we know that androgens also lower the levels of interleukin-6, a cytokine which seems crucial in the pathogenesis of bone loss. Slowly, other pieces of the puzzle ought to fall into place.

5-alpha-reductase is one of the enzymes present in bone tissue, so there is probably conversion of testosterone to DHT.

Overall, it seems that both androgens and estrogens are required for bone health by both sexes, but — I apologize if you’ve heard this phrase many times before — we need more research.

Sources:

Khosla S et al. Relationship of serum sex steroid levels and bone turnover markers with bone mineral density in men and women: a key role for bioavailable estrogen. J Clin Endocrinol Metab 1998; 83: 2266-74;

Anderson FH. Osteoporosis in men. Int J Clin Pract 1998; 52: 176-80;

Riggs BL et al. A unitary model of involutional osteoporosis: estrogen deficiency causes both type I and type II osteoporosis in postmenopausal women and contributes to bone loss in aging men. J Bone Miner Res 1998; 13: 763-73;

Slemenda CW et al. Sex steroids and bone mass in older men. Positive associations with serum estrogens and negative associations with androgens. J Clin Invest 1997; 100: 1755-59;

Bellido T et al. Regulation of interleukin-6, osteoclastogenesis, and bone mass by androgens. The role of the androgen receptor. J Clin Invest 1995; 95: 2886-95;

Manolagas SC, Jilka RL. Bone marrow, cytokines, and bone remodeling. Emerging insights into the pathophysiology of osteoporosis. N Engl J Med 1995; 332: 305-11;

Dagogo-Jack S et al. Augmentation of bone mineral density in hirsute women. J Clin Endocrinol Metab 1997; 82: 2821-25)

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Gail comments:

This is really interesting and unexpected. . . . I notice no mention of progesterone in this article . . . I am really wondering about the role of progesterone in osteoporosis and wish we had some clearcut answers.

Ivy replies:

Arguably, there is now an emerging consensus that continuous combined HRT results in more bone growth than treatment with estrogens alone, or cyclical E+P regimens. The very existence of the progesterone receptor in bone tissue implies a role for progesterone. Most likely, estrogens, androgens, and progesterone all synergize in the control of bone turnover and bone formation. (Grey A et al. Medroxyprogesterone acetate enhances the spinal bone mineral density response to estrogen in late postmenopausal women. Clin Endocrinol 1996; 44: 293-96)

Lynne comments:

Loved the bone piece — especially the factoid about older men having more E than women. Isn’t running the world enough? They also have to monopolize the endogenous estrogen supply in our golden years?

Ivy: Smart women fight back by keeping their steroid levels high enough to prevent any bone loss. If a woman can’t or doesn’t wish to use estrogen products, DHEA and progesterone, combined with good Ca/Mg/boron/Vit D supplements and exercise, may be enough to prevent osteoporosis once a woman is in the slow phase of bone loss. There is also a new product in health food stores containing ipriflavone, a phytoestrogen, shown in European studies to increase bone mass.


FOOD AND MOOD; HOW TO RAISE SEROTONIN WITHOUT GETTING FAT

Bess writes:

Fascinating about obesity and cancer. And now the government has just lowered the standard for obesity. But we are a nation of over-eaters, at least half of whom are probably eating for mood adjustment, I will bet. And probably many of them are pre- and post-meno women. I see it in my office every day, and we all joke about eating to put us in a better mood, or because we are stressed out.

Ivy comments:

According to the new government standards, now in line with international standards, 55% of Americans are obese. This makes Americans the fattest people in the world and in the entire history of the world.

But in terms of health risks, merely looking at BMI (body mass index) is misleading. It’s the waist-hip ratio that is a better indicator of morbidity and mortality. Fat is like real estate: location, location. That’s a big reason why almost half of American men don’t live to their 75th birthday. Men, not women. Men, who with rare exceptions all tend to be “apples.” An obese apple is a “ticking time bomb”– in terms of risk of heart disease, diabetes, cancer, and more — primarily heart disease.

Heart disease starts mowing men down already in their forties. For women, unless they are smokers, heart disease is still rare before the age of sixty. So if you are a mildly obese pear, don’t panic — though you may want to ponder my points about raw vs cooked carbohydrates and medium-chain triglycerides and other good fats. ATTENTION PEARS: don’t get complacent about age-related weight gain. No, not even pears can afford to keep overeating, especially when it comes to refined carbohydrates (bread, pasta, pastry, cereal). With the minimal rather than optimal estrogen replacement that is now standard practice, even pears tend to round out into apples as aging progresses.

But Bess is concerned with something else here: the reason why so many women are constantly munching on junk food. It’s a common observation that when women are stressed out and depressed, they turn to food for comfort; men are more likely to say, “I need a drink.” I’ve also seen alcoholism and overeating go hand-in-hand: in some families, the men tend to be alcoholics and the women overeaters, and sometimes you see a switch: an alcoholic quits drinking and becomes an overeater. And of course it’s possible to be both an alcoholic and an overeater; while many male alcoholics tend to be very skinny, emaciated even, living as they do on “a liquid diet,” I’ve seen some pretty enormous women alcoholics. More likely, though, a woman with a family predisposition to alcoholism is going to settle for overeating as her favorite self-medication for stress, anxiety, frustration at work and/or in love, sexual and emotional starvation, and just plain depression.

One overeater told me, “When I get rattled, I’ll eat everything in the house.” If that doesn’t “settle her nerves,” she’ll go to buy a huge supply of candybars, ice cream, and the like. There’s always a box of Cheetos under her bed for eating herself into oblivion should she feel anxious after going to bed.

But I don’t mean to get into overeating as a serious emotional disorder, the kind that results in out-of-control binging. I am interested in the common kind: when stress hits, we are likely to start munching on whatever is at hand: candy, nuts, crackers, raisins. We start, and can’t seem to stop. Call it “compulsive snacking.” Well, it’s safer than drinking, less exhausting than workaholism or compulsive housecleaning, and cheaper than gambling or compulsive shopping! And you don’t need a prescription for candy the way you do for Prozac or Paxil.

On top of it, here come the Wurtmans, the serotonin researchers, and they pour gasoline on the fire: “Stressed out? The best thing is a bagel! No, don’t put cream cheese on it! You want pure carbohydrate to create an insulin spike, so that more tryptophan gets into your brain and you can make more serotonin!”

They also advise eating cereal DRY, as milk dampens the insulin surge. A bowl of dry cereal, a bagel, a few rice cakes — it’s so soothing, they coo. Mellow out your brain, give yourself a break . . .

Fruit will not work, they warn. Too much fiber, and fructose rather than glucose. It will not raise insulin enough, much less produce an insulin surge. You must reach for pure processed carbohydrates (Do the Wurtmans own any stock in bagels? Their “bagel instead of Prozac” motto sounds a tad odd. . . .These are also the people who were trying to get the FDA to ban melatonin.)

What they fail to say is that after the insulin spike there follows a blood-sugar crash, and you feel awful: weak, irritable, depressed, headache-y. So you reach for sugar or processed carbohydrates again . . . and again . . . Now you’re in carbohydrate hell, and there is no bottom to this pit.

And the excess glucose is converted into triglycerides, and then escorted into fat cells. Meanwhile insulin resistance increases, creating the risk of diabetes. The excess insulin also overstimulates the adrenals and the inner core of the ovaries, leading to an overproduction of testosterone, DHEA, and androstenedione, and the whole hyperandrogenic syndrome.

And yet, due to stress, aging, low estrogen levels, and who knows what else, the SEROTONIN DEFICIENCY SYNDROME is becoming extremely common among middle-aged baby boomers. It manifests itself not only as irritability and reduced ability to cope with stress, but also as insomnia (including inability to maintain sleep for more than 4-5 hours), migraines, depression, and those bottomless carbohydrate cravings that ultimately result in obesity.

Surely there must be ways of raising serotonin that aren’t as self-destructive as eating refined carbohydrates. And of course there are. The more you learn to raise serotonin without reaching for refined-carbo snacks, the healthier you will be, and the easier it will be to stay slender.

WAYS TO RAISE SEROTONIN THAT DO NOT RELY ON RAISING INSULIN

  1. Spend time outdoors, at least in your backyard or patio. Simply getting out into intense light (and daylight outside, even in the shade or on an overcast day, is many times as intense as the light indoors) increases serotonin. Getting enough light exposure is essential to correct serotonin-melatonin metabolism. We ought to get into the habit of LIGHT-BATHING for a certain minimum amount of time every day.
  2. Engage in MILD RHYTHMIC EXERCISE, such as non-strenuous swimming or simply strolling on the beach (or elsewhere, but natural settings are particularly serotonin-friendly).
  3. Increase your exposure to NEGATIVE IONS. Negative ions raise serotonin — that’s why forests and beaches and places around streams and waterfalls are so good for you.

    Cotton and other natural fabrics attract negative ions; artificial fibers supposedly attract positive ions.

    Computers and other electromagnetic devices emit positive ions, so taking frequent breaks is highly recommended. One little trick is to keep sipping water; this will force you to go to the bathroom more often, providing a much-needed break (not to mention better hydration, which is very important for brain function).

    As for the little gadgets that are supposed to emit negative ions, I don’t know. It seems that people use them for a while, swear they are great, then stop using them. Walking on the beach works a lot better, it seems.

  4. Learn to MEDITATE. Meditation raises serotonin and other beneficial hormones; it “de-excites” our nervous system and our whole body.
  5. Listen to RELAXING MUSIC. Listening to soothing music is an excellent way to raise serotonin. For me it’s Chopin’s nocturnes and slow movements from various Mozart concerti. For someone else, it may be mysterious New Age music. If you’re not too sure about which type of music raises serotonin, you can’t go wrong with Baroque adagios.

    I’ve read somewhere that high-pitched sounds is more effective in raising serotonin — try the slow movements of violin concerti for that pure, ascending sound that can lift you into bliss. Music can have a very powerful healing effect. Use this incredible tool as often as you can.

  6. Get a MASSAGE. Getting a massage produces relaxation and raises serotonin. Even affectionate touch, a little hugging and stroking, can do wonders for the mood. Self-stroking works too; when putting on your lotions and hormone creams, use slow, caressing touch. Pamper yourself. Acupuncture is also a proven way to raise serotonin.
  7. Do whatever it takes to get enough SLEEP. Getting enough sleep raises serotonin. Part of the reason while we feel so bad if we don’t get enough sleep is that our serotonin levels are lower than usual. And sometimes the main reason we don’t get enough sleep is that our serotonin levels are too low. Talk about a vicious circle. Here taking a potent supplement of 5-hydroxytryptophan may work. See #16.
  8. Have a glass of WINE with dinner. Wine raises serotonin. Moderation please! For women, that means one glass; for men, two glasses is OK. (Nicotine also raises serotonin, but its negative side precludes application. Hopefully, though, a non-addictive nicotine analogue could be developed, delivered through a patch.)
  9. Spend more time READING. Reading positive, uplifting books can be wonderful for raising serotonin. Just quietly reading for pleasure. As with music, only you know the type of reading material that fills you with that peaceful, Zen-like feeling. The requirement here is that the reading should give you pleasure. Content is not as relevant as the fact that you are reading in a relaxed manner, at a slow pace. ANYTHING YOU DO FOR PLEASURE AND WITHOUT RUSHING IS LIKELY TO RAISE SEROTONIN.
  10. Spend time working on a favorite hobby, CREATIVE PROJECT etc. Give yourself permission to do what you love doing. Basically, having pleasure raises serotonin.
  11. MAKE LOVE AND EXPRESS AFFECTION. If you don’t have a partner, there is always “safe sex”– I don’t need to explain, do I? Orgasm is good for you. And if friends are not around, you can write them affectionate messages. Talk to your pet and your plants. Smile at a neighbor.
  12. Go to a good restaurant and have A GOURMET MEAL once in a while. The French maintain that good-tasting food is less likely to make you overweight than bad-tasting food. Since the pleasure of tasting fine food increases serotonin, the French are probably correct.
  13. Get good hormone replacement. ESTRADIOL AND DHEA raise brain serotonin; at higher doses of DHEA, people have reported a relaxed, oceanic feeling.
  14. If you are a serotonin-depleted type A person who’s always rushing, repeat to yourself — hundreds of times every day, if need be — SLOW IS BEAUTIFUL. Ideally, you should mentally repeat it like a mantra during your meditation, but also at other times, even while brushing your teeth. Design other serenity affirmations to “reprogram” yourself so you enjoy life more and rush less.
  15. Spend time with relaxed, high-serotonin people and avoid the “toxic” types. How can you tell if someone’s serotonin levels are high? Trust your “sixth sense.” Those “good vibes” are unmistakable. Just standing close to such a person, you begin to calm down. Such people are often called “natural healers,” even though they don’t use any special techniques. Dogs and cats adore them. Small children try to climb into their laps. The whole world is attracted to a high-serotonin individual.
  16. Yes, St. John’s Wort does work, but you have to be willing to spend money for a good brand, such as Enzymatic Therapy HyperiCalm. This kind is so potent it can even produce side effects (it did for me). Personally, I prefer a high-potency standardized KAVA extract. Magnesium also helps preserve serenity, and thus spare serotonin. I like the reversed magnesium:calcium formula from NOW.

    There is also a new supplement called 5-hydroxy-tryptophan (5-HTP). You’re supposed to take 50 – 100 mg 20 minutes before each meal, and/or take 100 mg 45 -30 minutes bedtime, if you need help with insomnia, whether it’s falling asleep or staying asleep. Michael Murray says his patients have had much better success with it than with melatonin.

    There is an enteric-coated product from Solaray that seems more advanced than others. 5-HTP is expensive, and I suspect only the best kind is worth the money.

    I’d like to hear from anyone who’s tried good-quality 5-HTP.

  17. As a last resort, you may want to try pharmaceutical antidepressants. While I favor listening to Mozart over Prozac, I can understand that for some people Prozac is a godsend. Almost anything beats relying on junk food. Because if you start relying on junk food to feel good, soon you are in carbohydrate hell, and, as Barry Sears points out, “there is no bottom to that pit.” And you feel worse and worse.

Serotonin isn’t just a natural tranquilizer that keeps us peaceful and focused. It’s also an antioxidant, a neuroprotector, and apparently plays a role in the immune function. And you can increase its levels in the brain by doing something that makes you feel good. Each person knows best what makes him/her feel relaxed and content. Whatever it is, do it, and do it often. If you need an excuse, remember that PLEASURE IS THE BEST MEDICINE.

Fine, you may say, but you’re still missing the point raised by Bess: work stress depletes serotonin, which leads women to “self-medicate” with junk food. Taking a break to walk on the beach is not a feasible solution when you’re in the office. That’s why women reach for a candybar instead.

Agreed. This is where stress reduction techniques come in. A good recent book on this subject is Richard Carlson’s “Don’t Sweat the Small Stuff.” Fairly short, sweet, easy to read, inexpensive. Just leafing through it will raise your serotonin.

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Lynne comments:

I’m so glad you’ve brought up the Wurtmans. They don’t seem to acknowledge that blood sugar drops, which I find rather bizarre given that they have devoted their careers to the carbohydrate. The only thing they have said that seems to even hint at an understanding of insulin is their claim that carbs will put you to sleep. So, they acknowledge, if you are staying up late studying for an exam, eat protein.

Also, carbohydrates make you hungry. If you want to whet your appetite, go ahead, eat that unadorned Wurtman bagel for breakfast. It will make you wolf down the rest of the bag before noon. I am ashamed to say, I speak from experience here.

Ivy replies:

That’s the meaning of “carbohydrate hell”: you feel chronically hungry. I certainly was, in my high-carbo days. I became an eating machine. Natch, obesity followed. If at least the carbohydrates made me feel relaxed. But they only made me feel chronically tired and hungry.

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* * * CARE OF THE SOUL* * *

THE UNDERWORLD GODDESS, PART II

Brief recap of Part I: We focused mainly on the Descent of Inanna and its parallels to menopause and aging, particularly the metaphor of being stripped of everything. We also began to discuss Persephone’s transformation from victim to queen. If you didn’t receive Part I and would like to read it, please write me.

Miriam Robbins Dexter is a feminist scholar who teaches at UCLA and Antioch University. She has a Ph.D. in linguistics.

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Ivy: Do you see the Underworld in terms of creativity and dreams?

Miriam: Yes, there is definitely a connection to our deeper consciousness — creativity, dreams — of course. I’ve been concentrating on the aspects of the Underworld which frighten western folks, but yes, it’s all there.

Ivy: Persephone isn’t sexless either. When visiting her mother in the Upper World she appears virginal, frozen in her primaveral young-girl stage, but as the Queen of the Underworld she’s a mature, sexual woman. If the pomegranate is a symbol of sexuality, then I think she wanted to eat it, even if it meant knowing the “dark side” of existence; she didn’t want to stay her mother’s little girl forever.

But to me Persephone is a creative muse because she descends, then ascends again. I think of creative work as withdrawing from the world into solitude and deep meditation to digest and transform experience into something you can then offer to the world as you ascend again into the bustle of activity and communication.

Persephone is the goddess of the inner world, but one who knows how to emerge into the outside world, enriching it with her beauty and her gifts.

Then in truly creative work there’s also an aspect of being seized and having to surrender. It’s agony and ecstasy. For others around someone who’s doing creative work, it may be difficult to witness this marriage to the Underworld, when the person is not available to them, not only in terms of being busy with a project, but also emotionally, because the work appears larger and more fascinating than a mother’s or a mate’s need to chat over breakfast.

Persephone seems to know how to handle both worlds, so she’s a role model to me. And of course she embodies the fascinating idea that the Queen of Death is also the queen of new life — of springtime. To put it even more emphatically, the Goddess of Life is the same as the Goddess of Death.

Miriam: No, indeed, Perephone isn’t sexless. In fact, I strongly suspect that it wasn’t the pomegranate seeds at all which kept her in the Underworld — it was the fact that she had had sex with Hades. And you’re right — nowhere does she say that she doesn’t want to be in the Underworld.

And her descent/ascent is like Inanna’s — another reason I see Inanna and Ereshkigal as two parts of a whole.

I love your ideas about the creative withdrawal — so true!

Ivy: There is an interesting contrast between the Inanna/Ereshkigal duality and the Kore/Persephone unity. Inanna is the glorious queen of heaven, while Ereshkigal is her dark sister, a rather unsympathetic character — a sadistic hostess, you might say, who fixes “an eye of death” on her guests.

On a primitive emotional level, this makes sense to me: the Goddess of the Underworld as horrific. But Persephone is beautiful, and apparently kind in welcoming and guiding the souls, and rather a promotion from her maidenly self. So it seems to me that both Isis and Persephone in both their upperworld and Underworld functions reflect the loving Great Mother.

In one version of the myth, Persephone actually is a mother — the mother of Dionysos, the god of ecstasy.

I’m interested in this glorious sister/dark sister dichotomy vs having the same goddess nurture the living and the dead — how it might reflect on the cultures that created the stories.

Of course the very fact that Inanna and Ereshkigal are sisters indicates a close kinship between the Goddess of Life and the Goddess of Death.

Is there a substantial difference between the Sumerian and Babylonian versions of the Descent? Especially in regard to the personality of Ereshkigal?

Ereshkigal with her power to strip us of attributes we value and ultimately of life itself is scary. I think the underworld goddesses have been somewhat neglected even in feminist scholarship — we are scared of them.

For me the Goddess is empowering, and that no doubt has a lot to do with being a woman and desperately needing that kind of empowerment. You once said that Judaism is hugely empowering to men; this could of course be extended to the whole Judeo-Christian tradition and to another offshoot of Judaism, Islam. In those traditions, there is no female figure to equal Moses, even if Deborah is rah-rah-rah, a Biblical Mrs. Thatcher, more daring and aggressive than male military leaders, and there are minor prophetesses and mothers, sisters, and wives of prophets and kings.

Maybe if in Catholicism Mary were elevated to the status of co-savior, as has been suggested, what with her standing at the foot of the cross . . . If Mary Magdalen were elevated to the status of a major apostle . . . But even then, I’m not sure if these traditions could do as much for providing role models and sustaining women’s self-esteem as they do for men.

But Isis as a savior figure, or Demeter searching for her daughter — these speak to me. And of course the stripping of Inanna at each gate, that’s a fantastic parallel to some life experiences, including menopause. Or the rape of Persephone, which I see in the broad term: a diagnosis of a serious illness, for instance, can be that kind of “rape” and abduction into hell. Or an accident. Or, for that matter, the shock of a relatively early menopause. The woman still sees herself as young and sexy, men still look at her “in that way,” she’s still in the meadow picking flowers, and suddenly the ground opens up under her feet and she is seized by Lord Death.

Miriam: Kore/Persephone is certainly a unity — more reason to suppose that Inanna/Ereshkigal forms a unity as well.

There are several differences between the Sumerian and Babylonian versions of the Descent. The primary difference, for me, is Inanna’s aggression — almost anger. One of these days perhaps I can show you the two Descent myths. Ereshkigal isn’t substantially different. I’ll have to study the two myths more, in order to see the more subtle variation of Ereshkigal’s character.

The Underworld goddesses have been quite neglected — the Western world’s fear of the shadow side…

In other poems about Ereshkigal — other than the Descent — she is an interesting heroine. I don’t see her as particularly malevolent. She just represents the rules of the underworld.

I do see the sisters as a unity — two sides of the same coin, as it were. And both very sexual, very “alive.”

Ivy: In his movie “Orpheus,” Jean Cocteau presented an image of Death as a beautiful young woman, very seductive. This makes me think of Persephone in her eternal youth and beauty.

Miriam: My feeling is that the death goddess is a shape changer — that she can be young or old — usually both. I too thought of Persephone — young indeed, for the Queen of Death. Ereshkigal too — a sexy woman.

Death in Greek is thanatos — although personified as Hades, coupled with Persephone. Perhaps it is most natural to personify death as both genders — since mortals of both genders undergo death.

Ivy: Persephone is incredibly young. Perhaps she is that part of us that doesn’t age: the part that is always youthful, at the height of vitality and picking flowers– the sixteen-year-old I still sometimes glimpse in my mother, who’s turning 86.

In her pioneering book “Goddesses in Every Woman,” Jean Shinoda Bolen talks about the transformation of Persephone from victim to a powerful Queen. That’s an important aspect of the Persephone story to remember, especially for women who identify with being “raped” into the Underworld by a life-threatening illness, accident, betrayal by a mate, or a similar disaster.

Miriam: Although Persephone, undergoing her rape and Descent, is not as autonomous as the Sumerian Inanna, who volitionally descends to visit her sister Ereshkigal, nonetheless, Persephone, through her marriage to Hades, does indeed become individuated, a mature woman separate from her mother, and a queen as well. After her Descent, Persephone embodies both Kore and married woman

Ivy: Yes! The Kore lives! The “maiden” lives on even in the mature woman. Persephone is simultaneously Virgin and Crone, I’m tempted to say. Since she’s not presented in a motherly role, it’s easy for me to perceive her as a postmenopausal woman, a wise woman. Virgin and Queen is of course more accurate, and interestingly these days some feminist are suggesting that the stage following menopause should be called “Queen,” not Crone, to suggest the power of maturity.

I think we can always connect to that “virginal,” Kore personality we had before we started molding ourselves to please a man or men, and put on masks and play various roles in the world. I think we need to hold on to that youthful Kore because she knew how to love herself, how to make herself happy all by herself — a very important tool for self-rescue.

When menopause started, I was in such shock about the rapid aging that for a while I lost touch with that non-aging part of me — some would call it our creative core, others the Deep Self. But she came back.

I know this sounds mystical — the part of us that doesn’t age. Myths, art, poetry — they all help us deal with the ambiguity and unsolved mysteries of existence. A Swedish poet, Transtromer, has given us these lines:

I know the depths where one is both prisoner and ruler, like Persephone.

There are two other Underworld myths involving female characters: Psyche’s descent and ascent as part of her effort to regain Eros, and Eurydice’s failure to be rescued by Orpheus.

Psyche’s story again seems to be particularly relevant to menopause: if Psyche (Soul) is to accomplish her goal, she has to refuse the pleas of the hungry dead. Then she makes the mistake of opening the jar of the “beauty salve,” and falls into deathly sleep.

To me the hungry dead are those “gimme-gimme” people who don’t profit by ordinary nurturing. Nothing you give is ever enough. And in the end they manage to subvert your giving, to reject all your knowledge and wisdom. So the lesson is learning when to say no, and being able to give proper place to self-care and one’s own projects.

The deathly sleep is a perfect image of the “beauty trap.” If the postmeno woman puts most of her energy into appearance, she won’t develop in more important ways. There is a healthy attention to one’s appearance, and then there is neurotic obsession. Persephone’s gift of beauty has nothing to do with facelifts and $100/oz “youth serums.”

I agree that this is a late patriarchal myth and Psyche is a wimp compared to the powerful early goddesses. But there is this one saving feature: she has enough strength of character to do something very unfeminine-seeming — she refuses to stop and feed the hungry dead. In effect, she will not be devoured by them. She stays focused on her goal, which is to press into the depths to meet Persephone and get a gift from her. And this seems a postmenopausal strength to me. I’ve seen women at this time of life discard those old friendships that are now merely draining. Because now these women know what they want to do with their time. Postmenopause is big time, it must not be wasted.

The figure of Eurydice stands as a reminder that you can’t wait for a man to rescue you. Orpheus fails thru lack of sufficient faith and patience. Actually I have a feeling that if it happened to be Eurydice trying to save Orpheus, she’d have the faith and patience, the way Isis manages to find the pieces of Osiris, or the way some mothers manage, through immense patient labor, to rehabilitate brain-damaged children. In life, the happy ending of the Eurydice-type scenario is for the woman to discover she herself has what it takes to rescue herself — both through her own labor (patience) and through reliance on her spiritual resources (faith and courage).

The more I think about it, the more I see the Underworld myths as predominantly female, with a wealth of wisdom for women. If I ever get to write my wisdom book, “The Serpent and the Dove,” I sense there’ll be a lot Underworld lore in it.

The merging of life and death seems to be embodied also in the Norse Hel and in Black Kali. Are you going to talk about these goddesses as well?

Miriam: I haven’t thought about doing Hel and Kali. I may indeed. I want to do Nirrti, into whose lap one goes at death. I like Hel a lot, and I like translating Snorri’s Edda, so I’ll ponder her. Sometimes I just let the work carry me along; I figure that whoever has to be in the book will find Her way there.

Ivy: Nirrti? Icelandic? Does she remind you of the Neolithic Great Mother?

Ah, yes, another thing. The Underworld was also seen as a place of great riches. This again could serve as a metaphor for psychic riches when we withdraw from the Upper World and “sink” into the depths.

Persephone is definitely the goddess of wealth — of real wealth, which is within.

But patriarchal religions have tried to remove any positive connotations of the Underworld and the connection with the feminine. They substituted something like “resting in the bosom of Abraham.”

Miriam: Nirrti is an Indic goddess; she appears as a black bird, and you go to her lap when you die. I haven’t been able to find very much information on her — some in the Atharvaveda. As often, she is half of the Great Mother, since she is death only. Devi, with her multiple personifications — Parvati, Uma, Durga, Kali, and so many more — is much more the equivalent of the Great Goddess.

Good metaphor on the Underworld riches. Yes, of course you’re right.

Ah, yes — to rest in the bosom of Abraham — seems to me, too, like a patriarchal takeover. So aggravating. A friend made a tape of a PBS program for me — on Iraq, ancient and modern — good for showing to my students during our Mesopotamian section. The narrator talks a lot about Abraham, but not at all about Sarah. And from whose womb did Judaism emerge? Abraham’s?

Ivy: What a beautiful image Nirrti creates: death coming as a black bird, rather than the hideous Western image of the Grim Reaper.

As for Sarah: it’s delightfully ironic that a religious tradition so strongly associated with patriarchy is actually matrilineal: it insists that to be Jewish you need to have a Jewish mother. The mother archetype is simply too primary and powerful to be repressed.

Death as returning to a loving mother seems such a comforting image that I’m somewhat surprised that it ever managed to be eclipsed. But I guess the patriarchal order demanded reward and punishment in the afterlife, rather than all-encompassing acceptance. But these days a lot of people seem inclined again toward the more maternal idea of acceptance. Maybe our thinking has shifted toward the perception that we’ve been punished enough, and that love would in fact be a better “rehabilitation” for lost souls. Do you think that shift in attitudes may be one of the main reasons for the resurgence of interest in the Great Goddess?

Miriam: Yes, I think so.

Ivy: These days the Mother Goddess may present a certain problem for women who have not experienced motherhood. The ancient connection to fertility may be somewhat alienating. But Robert Bly came up with an interesting quaternity: the physical life and death goddesses, and then the Dancing Goddess, the goddess of ecstasy and creativity and a sort-of “saying yes to life,” and the Teeth Mother, the goddess of Psychic Death, or depression. I wonder if this is strictly modern, or if there is already a foreshadowing in various mythologies of the Dancing Goddess and the Teeth Mother. Maybe Kali has both faces.

Do you have any thoughts on that?

Miriam: My thought on the term “Mother Goddess” is that it’s too confining; female figures were crafted depicting every life phase of woman, from pre-puberty through old age. For goddesses (at least the historic ones) who represent many different functions, my favorite term is “Great”-Goddess.

The “fanged” goddess appears very early — perhaps in the earliest Neolithic. One of Marija’s [Ivy: Marija Gimbutas, a pioneering Neolithic Great Goddess scholar] illustrations in the forthcoming book presents a “Gorgon”-type figure dating to the sixth millennium. (although there is some controversy over whether she was dreaming too much into the figure).

With regard to the Dancing Goddess, does Bly mean Kali (or other Shaktis), dancing Shiva into life? This is an Indic phenomenon. Although I’m not sure Kali has both faces, Devi, who (as I said) syncretizes so many goddesses, certainly represents both life and death.

Ivy: What saddens me is that so many women are still unfamiliar with the Neolithic Great Goddess and with the various goddess myths in mythologies all over the world.

Now that we have a sort of global outlook on religions, and are not confined to one system as before, it is fascinating to see the similarities: how the images of the serpent and the bird crop up everywhere in association with the divine feminine. Or the dragon, which is a winged serpent. And how those images speak of beauty and strength and creativity and freedom, and the interdependence of the inner and the outer, the upperworld and the underworld; how Eve, the Mother of All Living, is also the Mother of all Dead.

I sense that somewhere here is a message that the Universe is unfolding just as it should, and that we need not be afraid.

I am so happy that you are working on another book that will expand women’s image of the feminine. I wish you wonderful creative adventures as you write that book.

I think women need to come to terms with the Underworld Goddess, which is to say with mortality; on another level, this could mean coming to terms with the cycles of withdrawal and “ascent,” or being more active in the world. There is a beautiful passage by the contemporary American poet Gerald Stern:

I was worshipping

light, it led me

astray, I never saw it was a flower

and darkness was the seed.

Miriam: When I think of the “Great”-goddess of birth, death, and rebirth, I have a sense that she is nurturing.

I think that it’s very important for people to think about the Underworld goddess — what she represents, how she is the great round of life, how she reflects a perfectly balanced and complete phenomenon: birth, death, and rebirth. This “Great”-goddess is centered in herself. If she is frightening in her death aspect, one will soon find her in labor, giving birth to life: loving, nurturing, fanning the dead with her wings and bringing to them the breath of life.

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Bess comments:

The idea of aging as being stripped resonated with me, as I have a couple of women friends around my age who have “bag lady” fears. Both women own homes and have more than adequate savings, but their biggest fear is having nothing, having nowhere to go, no one wanting them, and having to sleep outside on the sidewalk, at the mercy of the world.

The idea that we can sense a female presence “down there” in the earth brings to mind the “Gaia theory.” The earth as an intelligent and female organism.

I like the image of a sexy Underworld goddess . . . a “juicy” goddess . . . full of life in the Underworld!

Menopause as a harbinger of death — yes, this part came as a surprise for me. How menopause is such a “marker” for aging, decline, “it’s all downhill from here”– at least that was my thinking a few years ago. Maybe the blessing for me was the sudden awareness that time was passing faster than I realized, and I had better start enjoying my life to the fullest. I do feel more confident and assertive — although sometimes it’s merely “why not” or “what is there to lose at this point?” But it is so different from my younger self that sometimes I look back and wonder what I was waiting for.

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Ivy replies:

It amazes me again and again how many women seem to go through the same psychological process that seems to be initiated by menopause. When my mother entered her postmenopausal years, she said to me, “The difference between you and me is that I am no longer waiting.” I thought I understood what she was saying back then, but now I really understand. It shows itself in big things and small. Like writing about the things I want to write about rather than waiting for someone to hire me as a staff writer or whatever. Or wearing the clothes I love without waiting for a special occasion, or even having oyster and shiitake mushrooms even though they are more expensive, or making my wine jello. I light the candles more often, I listen to my favorite music. Because if not now, when? And that, I feel, has been a great gift of the Underworld Goddess.