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Examining Cross-Cultural Perceptions of Women’s Mental Health

March 20th, 2009

My weekly research into the subject of global mental health perceptions and interventions has converged on a common theme: the need to prevent, acknowledge and treat this highly stigmatized issue with unique, community-born formats. Funding and support would be best directed to local figures and institutions who sufficiently understand the nature of mental illnesses and their implications for community members. Formal psychology may play an underlying role in such interventions but is not necessarily an explicit component. Often successful programs help women to cope effectively but do not require a comprehensive understanding of the mental illness itself. Perhaps more critical than intervening is the task of preventing—a mission that has its roots in altering the way women worldwide are perceived and treated. We will now examine these ethical considerations and many of the practical innovations already underway.

To establish the baseline facts: women across the globe are more likely than men to suffer from specific disorders including unipolar depression, anxiety, and somatic ailments. There exist biases in diagnosis and treatment, as well, with women more likely to be diagnosed with mental illnesses than symptomatically-comparable males and more likely to be prescribed psychotropic drugs[1]. Stemming from social disempowerment and lack of resources, women throughout their lives are exposed to a variety of gender-specific risk factors for mental illness.

The bleak sky is not without its stars, however. Studies in Pakistani communities indicate tremendous potential for effective, economically-feasible interventions. Cognitive-behavioral theory seems to be quite promising as a psychological method that can be adapted and applied to various cultural contexts. Local health workers can reasonably undergo basic training and still be remarkably powerful in helping depressed women to cope. In fact, only 23% of participants in the study’s intervention group continued to meet the criteria for major depression six months after receiving the course of therapy.[2]

In a related approach, studies of Asian Indian women highlight the perceived appropriateness of utilizing family and religion versus psychiatric care as a means of coping[3]. Other studies similarly indicated that African American women utilize family, community and religion as reliable coping forums but were also willing to utilize psychiatric care[4]. These findings dovetail into a controversial discussion: when treating members of various cultural backgrounds in the, do health practitioners provide potentially sub-par medical care in efforts to be culturally sensitive? A careful balance is needed. We should value these findings as promoting culturally-aware adaptations of clinical methodology. To combat mental illness in an effective and culturally-sensitive manner, health care providers need to be familiar with the unique perceptions and stigma associated with mental illness in the populations they are treating but should ultimately focus on the individual patient’s beliefs and needs.

Women in post-conflict settings present a new degree of mental health concerns. They are bombarded with numerous injustices and stripped of basic and essential human rights. As such, mental health initiatives would wisely take a comprehensive approach to recognizing the traumas and helping individuals develop a positive, empowered outlook as they move forward. The steps taken to accomplish this are dependent on the violations and culture: “focusing” has been identified as an effective coping technique for Afghani women, whereas community-based healing, such as the post-conflict counseling networks and support groups developed in Gaza, may be more robust for that population of women[5]. The common trait between these methods is their emergence from culturally-competent sources within each community.

While it is essential to consider effective treatments, we cannot ignore the other end of the spectrum in discussing mental illness. The social factors associated with higher rates of mental illness deserve serious attention and resources as modes of preventing new cases. For example, Dr. Gbolahan Obajimi, M.D., describes how stigma surrounding infertility in certain African communities carries social punishments that may alienate women and make them more vulnerable to depression, low self-esteem and anxiety[6]. The mental distress that correlates with infertility highlights the much larger need to redefine women’s role in all societies as more dynamic and comprehensive than child-bearing entities.

Mental illness infiltrates every community on the globe, from rural villages in Pakistan to our very own Stanford community. As with so many topics from this class, this is inarguably a human rights concern that exposes the injustices in women’s lives prior to developing and experiencing illness. The precipitating social factors and the way in which we support those who suffer are thus critical considerations that deserve unrelenting attention and action at all systematic levels. Finally, we would wisely place our confidence in community-inspired strategies if we hope to see this issue effectively remedied.

[1] “Gender and women’s mental health”. 2009. World Health Organization. 11 March 2009. http://www.who.int/mental_health/prevention/genderwomen/en/

[2] Rahman, A, Malik, A, Roberts, C, Creed, F. 2008. ”Cognitive behaviour therapy-based intervention by community health workers for mothers with depression with their infants in rural Pakistan: a cluster-randomised controlled trial”. School of Population, Community, and Behavioural Sciences, University of Liverpool. 11 March 2009. http://www.ncbi.nlm.nih.gov/pubmed/18790313

[3] Suthahar, J. and Elliott, M. “Asian-Indian Women’s Views on Mental Health and Illness” Paper presented at the annual meeting of the American Sociological Association, Hilton San Francisco & Renaissance Parc 55 Hotel, San Francisco, CA,, Aug 14, 2004. 11 March 2009. <http://www.allacademic.com/meta/p110072_index.html>

[4] Ward, E. “African American Women’s Mental Health” lecture on 06/28/2007, Cultural Diversity in Healthcare (CDH) Research Symposium. 11 March 2009. http://videos.med.wisc.edu/videoInfo.php?videoid=279

[5] Ghosh, N., Mohit, A., Murthy, R.. Nov 2004. Mental health promotion in post-conflict countries. Vol 124. The Journal of The Royal Society for the Promotion of Health. Mar 11 2009. http://www.bvsde.paho.org/bvsacd/cd41/neill.pdf

[6] Obajimi, G., MD. “Infertility & Women’s Mental Health”. 22 January 2009. halftribe.com. 11 March 2009. http://www.halftribe.com/index.php/life-matters/health-first/464-infertility-a-womens-mental-health-in-africa.html

“You Say Beauty. I Say Duty”: A Not So Superficial Challenge of Aging

March 14th, 2009

(week 9)

In my research this week, I came across another blog on beauty and aging, that included this insight: “As we begin to age, the society in which we live wants us to deny old age. It is to be hidden, scraped or cut away. It is not surprising that so many desperately try to hold onto what they think is youth… but can they?” (http://rainydaythought.blogspot.com/2009/02/aging-and-beauty.html)  In our discussion on aging and the particular challenges of older women, we brainstormed stereotypes about what it meant to be old.  Some of the stereotypes of old people that were mentioned were slow, decrepit, tired, disabled, etc.  An aspect that we didn’t particularly talk about and that I wanted to bring up in my blog this week was how these perceptions of elderly women effect them, and how much of these negative stereotypes hey internalize to become self-perceptions.  The other blogger brought up how in our world, the terms elderly and beautiful must by necessity be antonyms, as no longer do we seem to believe that they can exist harmoniously.  Unfortunately, from our readings this week and what we discussed in class, this does in deed seem to be the general perception.
I came across another article in the New York Times (from which I borrowed the title of my blog for this week) entitled “You Say Beauty, I Say Duty” by Marcia Byalick which was published just a couple of weeks ago on February 22nd.  I thought that touching on it was doubly appropriate given its relevant topic and the fact that it was written just the week before we as a class discussed aging, indicating and reinforcing the idea that clearly modern women face a unique set of challenges as they age.  The author writes this: “For my 59th birthday, my husband gave me a certificate for a ‘day of beauty,’ entitling me to an age-intervention facial, a brow wax, a salt glow and a paraffin body wrap. In April, it will celebrate its third year residing under my nightgowns at the bottom of my drawer. […] And yet here in the well-manicured suburbs of Long Island, I’ve come to feel that a regular trip to the nail salon is as essential to passing muster as mowing the front lawn.”  I thought that her personal experiences were extremely telling of the huge importance and value we place on superficial beauty today.  Her story was sad today, and yet completely unsurprising as it maintaining the standard of beauty as set out by western society is not only deemed important for women, but of vital necessity.
This example I believe illustrates the lessons we learned this week that as women age, they do not get to rest and relax, but rather are forced to maintain the same standards and lifestyles expected (and often demanded) of them as young women, yet without the same resources and energy.  Although my blog topic throughout this quarter has looked at relatively less brutal issues in women’s health, clearly the same trend that we see in graver issues, such as domestic violence, are also seen in the standards set by our largely patriarchal western society, which are then forced upon and/or internalized by women to become the basis of assessment and judgment for their own self-perceptions.  The huge pressure women feel to change themselves to fit these standards, which often results in a reprioritization of values and perceptions, is a shameful reflection of our own society’s values, which we have transmitted and/or imposed on the rest of the world.  Byalick goes on to say that, “Today’s little girl is part of a generation cursed by a precocious hyper-awareness of the necessity of upkeep. The much longer list of mandatory body parts she has grown to believe need grooming seems oppressive.”  Unfortunately, I think that most of us would have to agree with this statement.
For myself, I see evidence of it even in my own life.  Although I am mostly able to ignore the constant pressure due to my education and strong feminist beliefs, this certainly was not the case in my formative years as a teenager.  Even today, I am blatantly warned and pressured that I must do a laundry list of things (including waxing, facials, plucking, tanning, etc.) not only to “maintain myself”, but I am directly told my sales assistants that I need to do so.  When I first came to Stanford, I went to the Target in Mountain View to stock up on supplies, as well as to buy face wash products.  While I was perusing the facial products aisle, the beauty sales assistant approached me and told me that I needed to start investing in anti-aging/anti-wrinkle creams.  I told her I was only 21, but she said now was the time that I needed to start.  Frankly, I was rather insulted, but moreover I found the concept ludicrous.  What is so awful about getting wrinkles?  Does it not show that you’ve lived a full and long life?  I have wrinkles around my eyes even now as a young woman, but that’s because I love to laugh, and laugh whole-heartedly.  Why is this treated like a dire health hazard that I need to be warned against?  It’s a small example I know, but I believe one can use this anecdote as a microcosm for how society treats aging in regards to women.  And I say women because society clearly doesn’t have these same overwhelming expectation and perceptions about men.  In fact, rather interestingly, when I googled “aging and beauty” every article that came up for the first 3 pages exclusively was for women.  None of them mentioned men.  Funny that again I am not surprised.  And I would bet that you weren’t either.

Perceptions and Self-Perceptions of Girls’ Education

March 11th, 2009

chosen extra book for this class.  We’ve been discussing, in part, differential access to education and food, and so I wanted to tie in this extremely relevant example.

In the United States today, the top performing students are often the females.  In my public high school, the honors classes always had a larger percentage of females than males, and by the time it got to senior year, the were heavily weighted with the females significantly outnumbering the males in the class.  A telling example is perhaps my AP English Language class, which we fondly referred to as “Women’s Lit” because out of a class of approximately 30 students, there only 5 boys.  I premise my blog this week with that small anecdote to show just how glaring the disparity is in developing countries today.  It is often hard for many Americans to imagine such attitudes, beliefs, and practices characterizing whole nations today, as we here in our privileged existence we tend to think things like son preference and not allowing girls an education to be relics of a long-forgotten past.

Hosseini’s A Thousand Splendid Suns is set in modern day Afghanistan, weaving the stories of two women, Mariam and Laila, from their childhood in the 1970s and 80s to today.  Mariam, a bastard girl child, is told by her mother at a very tender age that, “ ‘What’s the sense schooling a girl like you? It’s like shining a spittoon. And you’ll learn nothing of value in those schools. There is only one, only one skill a woman like you and me needs in life, and they don’t teach it in school.  Only one skill.  And it’s this: tahamul. Endure.”  Doubly cursed as both an illegitimate child and a girl, Mariam is taught extremely early on that she is not valuable enough to justify sending her to school over the menial labor she could provide at home.  As a girl, she is denied any opportunity to gain some measure of control over her life (which can be attained with an education), and so she is doomed to a subservient, second-class life without options.  Moreover, it is her own mother, a woman, that makes it painfully clear how little she is valued.  And yet her mother is only transmitting the oppressing, sexist attitudes and beliefs of the society and culture that they live in, attitudes and beliefs that are by no means limited to Afghanistan or even the Middle East in general.

We see these same practices—denying girls’ right to an education—throughout the developing world, and in the developed world there is merely a more muted, subtle form of this gender-based discrimination.  For example, a common belief in many western countries is that boys are smarter at math and science than girls.  While we know there is no scientific evidence for such an outrageous claim, the statistics show that indeed, boys generally do outperform girls in those subjects, and often by a wide margin.  But this is not an inherent difference between boys and girls, but rather one developed by and perpetuated by our society.   Just as girls are told that they are supposed to like pink and given dolls to play with, where boys are supposed to like blue and given trucks to play with, so our children learn and believe that boys are smarter at math and science.

Returning back to A Thousand Splendid Suns, Hosseini illustrates how these beliefs about girls’ inferiority are institutionalized by governmental decrees.  Laila, the other primary character and second wife to Mariam’s husband, has two children: an older girl named Aziza and a younger boy named Zalmai.  When the Taliban took over Afghanistan, Laila and Mariam’s husband, Rasheed, lost his job. When they went out shopping, “In grocery stores, he [Rasheed] carefully pocketed canned ravioloi, which they split five ways, Zalmai always getting the lion’s share.”  With this example, we clearly see son preference at work.  Even though Zalmai is younger and smaller than Aziza, as the son his welfare is prioritized over the daughter’s. Without an income, there was no longer enough food to keep everyone in the family from literally starving.  So, Rasheed declared that the girl child, Aziza, then would be given up to an orphanage, blunting valuing the boy over the girl.  At the orphanage, “Aziza said Kaka Zaman made it a point to teach them something every day, reading and writing most days, sometimes geography, a bit of history or science, something about plants, animals.  ‘But we have to pull the curtains,’ Aziza said, ‘so the Taliban don’t see us.’  Kaka Zaman had knitting needles and balls of yarn ready, she said, in case of a Taliban inspection.  ‘We put the books away and pretend to knit.’”

For me it is so very saddening to read these passages knowing that although this is a fictional novel, this kind of shocking and overt discrimination and outright prejudice against girls continues to permeate societies around the world.   The question is then, who do we hold accountable and how?  I think that the first step to seeing change is showing people that girls’ education (etc.) is not just a women’s issue, but an issue that touches everyone.  We need to make people see the relevance of girls’ education to their own lives and pockets of the globe that they live in.

Appearance Concern and Stigma in Older Women

March 5th, 2009

While much of our discussions surrounding body image and appearance within this blog have revolved around the current, warped media image of women, I wanted to take a moment to reflect on how this same double-standard often creates certain stigma’s for older women as we finish our week on women and aging. In my research for this post, among others, I found a thoroughly well researched article that documented interviews with older women about their bodies and their appearances. Written only three years ago in 2005, this paper gives time to a subject that is often neglected in favor of the problems facing the youngest generations, but is worthwhile ad interesting nonetheless. The paper investigates how “women negotiate, interpret and access their no longer youthful appearance in a consumer culture where ageing bodies are devalued.” Forty-four British women aged 75-85 were interviewed about their thoughts and experiences.

All of the women interviewed were aware of such a doubled standard, speaking of their “special” responsibility, their duty and their obligation as a woman to “retain high standards of appearance.” There was, “no excuse” for women not to do so, otherwise, one “[forfeited] one’s femininity, self-respect, and pride.” At the same time, there is a balance: “the physical appearance of older women should not emit, or be seen to be emitting any signals of sexual interest or availability.”

One of the most interesting aspects of the report was that most women used “combative” language to describe their bodies, often using clichés such as “soldiering on” and “fighting to stay on top of it” and “fighting an uphill battle.”  Many of the women expressed dissatisfaction and frustration with their bodies, but were always trying to “make the most of what they had.” It is interesting that, in this case, many of the women interviewed held other women to this same standard. Keeping up your appearance and your physical good looks was vitally important to their own sense of identity, and they expected other women to do the same, more than other men.

The author thus states: “While both men and women bear the stigma of their bodies as bearer of low symbolic value, it is argued that the ageing female body is particularly devalued through the notion of a ‘double standard’ where physical signs of ageing are more harshly judged in women than in men.”
While I appreciated this perspective, as I had never troubled myself to think about the body image issues of elderly women, I also was left wondering how much of this effect was culture-specific as well as limited to this generation. Perhaps the more liberal, “hippie” generation of women feel less limited or subject to this same double-standard. Perhaps the simple cultural emphasis on beauty and self-improvement will continue to have an effect on even the lives of the elderly. Will we ever reach a stage when women’s looks are not valued as commodities, and when elderly women are not stigmatized more heavily than men? I am doubtful of the responses, but as always, hope is essential.

As I wrap up my posts, I’d like to go back to the original definition of stigma: as Goffman has pointed out, stigma reduces an individual in our minds “from a whole and usual person to a tainted, discounted one.” Stigma is a universal phenomenon that almost every indivual experiences, according to “The Social Psychology of Stigma;” however, the types and kinds of stigmas that women experience tend, by and large, to be more debilitating and harmful than those experienced by men. When dealing with any women’s health or human rights issue, it is important to be aware of these stigmas, where they come from, and how they affect women and their communities.  If we do not, we are missing a large part of what informs the cultural environment of the struggles that women undergo around the world.

How do we combat stigma? These are movements that must be initiated on the indiviaul, communal, and global level. From psychology interventions to media campaigns to gender-equality based legislation, stigma-facing women must be combated.  I hope that you have enjoyed reading my posts, and find yourself more enlightened about both the effects and possible causes of the various stigma’s facing women around the globe.


Post-Conflict Mental Health Interventions in the Eastern Mediterranean Region

March 5th, 2009

A 2004 Report in The Journal of The Royal Society for the Promotion of Health  (“Mental Health Promotion in Post-Conflict Countries”, N. Ghosh, A. Mohit, MD, R. Murthy, MD) describes the existing mental health needs and interventions in the eastern Mediterranean region (EMR). I will outline a few examples cited in the report, which together illustrate themes consistent with my past weeks’ research.

To provide some background on the eastern Mediterranean region (EMR): 85% of the countries in the region (15 of the 22) have been in conflict during the past 2 decades, yielding extremely high rates of psychological trauma. The population is predominately Islamic (90%), speaks mostly Arabic, and is disproportionately represented by youth under the age of 15 (40%).

Various mental health interventions have been implemented in EMR nations, some targeting mental health directly while others address related environmental factors.

Efforts in Afghanistan, for example, promoted a technique called “focusing” to assist Afghan Aid workers in dealing with psychological traumas. According to the authors, this is a quiet, internal practice with some obvious similarities to meditation; it also provides freedom to integrate Sufi imagery and poetry. In a culture where it is considered taboo to openly communicate personal feelings and emotions, this technique has had many valuable implications for coping with psychological distress.

In Gaza the UN Relief and Works Agency developed an infrastructure for increased counseling resources to be used by refugees of the 2002 Second Intifada. Counselors focus on preventive measures and refer clients to medical personnel as needed, depending on the extent of the psychological distress.

An education-based approach was integrated into Lebanese schools, providing child war survivors with a supportive environment in which psychological traumas could naturally heal. A more medically-based endeavor was conducted in Afghanistan to increase the quality and number of medical personnel trained to deal with mental illness.

Yet another avenue was taken to support youth in Iran. Students receive life skills training through their school system as a means of boosting self-esteem and developing sustainable coping skills, but do not deal with mental illness head-on.

As we can see, there are a variety of culturally-sensitive approaches that may be taken to address mental health concerns. Even with this extensive menu of interventions, however, there are recurring themes in such efforts, regardless of the population in which they are conducted. Those factors which must be considered include the role of family/community, possible stigma around the existence/treatment of mental illness, the role of media in shifting perceptions, the use of other institutions as an avenue for mental health promotion, and the power of ground-up inspiration for sustainable interventions. In my nugget paper, I will delve further into the specific criteria cited by various global health organizations that should be considered in the design and implementation of mental health programming.

Thank you all for your excellent weekly feedback—it has been thought-provoking and insightful!

Women organizing for social change

March 3rd, 2009

How can women break their social place as “inferior to men” and create change?  How can women, such as the mother in law in the New Yorker article we are reading for next week, create a source of internal strength with which to battle the various sexist systems of oppression, be they legal, social, internal, etc?

This has a lot to do with self-perception.  For women to create a movement to speak out against or fight back against something that is damaging, it likely will have to start with them.  They will have to organize, respond, etc.  How do they get that initial energy (like activation energy)?

It seems as though one place from which women can draw some amount of strength is in morals.  If they fight knowing that they are “morally right”, then they can keep going, even when it seems hard.  Or if the law is on their side, they can operate under the mindset of upholding law and order.  Finally, if they are pressed to break a system of oppression simply to survive (or help their children survive), then it’s easy to operate under the mindset of “I need to do this to survive, obviously”.

Of course, maybe I’m the only one out there that needs a set frame of mind and such before I can act in a determined and calculated way, but my guess is that no, many people draw internal strength by knowing that what they are doing is right in some way, even if society considers it wrong.

Anyway, it is probably best if people aren’t forced to the point of fighting for survival before they work and organize to create social change.  And the immediacy of life/death might lead to hasty, not perfect solutions.  That leaves the idea frameworks being self-empowerment with the guise of morality or with the guise of the law.

Should it be anyone’s place to try to inspire these sorts of internal shifts in self perception (changing from society member to agent of “rights” or of “law”)?  Does this fundamentally change people?  Is it manipulative to try to get people to join a potentially dangerous movement by changing how they view themselves?  From everything I’ve done domestically, I haven’t felt like it was inappropriate.  But here, the risks are substantially lower than they may be in some communities.  Training people to be advocates for disabled folk and getting them to break their comfort levels by talking to managers of stores with too-narrow-by-ADA-standard aisles is not as risky as personally blocking an honor killing from occurring.

But can anyone truly act unless they have some sort of internal rationale or strength for doing this?

I guess this blog is more obscure than most I’ve written.  I’ve just been thinking about what keeps people going and gets them through the fear of very tough resistance.  The only thing that keeps me going is some internal sense of morals – no matter when it’s something as small as choosing what to eat or as big as sitting-in at intersections where I’m likely to get arrested.  Perhaps this is what keeps women going through bigger, more institutional oppression.  Any thoughts?

From Foot Binding to Breast Implants

February 27th, 2009

In beginning this blog, my goal was to compare harmful beauty practices that are prevalent in different cultures around the world.  I have found it difficult though to find practices outside of Female Genital Mutilation internationally, and so most of my blog has focused on domestic issues in the perceptions and self-perceptions of women.  I would, however, greatly appreciate it if any of you have suggestions for research, particularly in Latin America, South Asia, and Europe.

And on to today’s topic…

Historically, the best example of a harmful, yet pervasive beauty practice that I could find was footbinding in China.  Footbinding began as a practice in China in the 10th century, and was not banned until 1912.  In searching for a more personal account of footbinding, I came across this article (http://www.npr.org/templates/story/story.php?storyId=8966942) published by NPR today in fact about a 79 year-old Chinese woman who had her feet bound at the age of 7, after the practice had been officially banned.  Even after her mother died, this woman continued binding her feet and breaking her bones of her own accord.  Today, that would seem outrageous, but “At that time, bound feet were a status symbol, the only way for a woman to marry into money. In Wang’s case, her in-laws had demanded the matchmaker find their son a wife with tiny feet. It was only after the wedding, when she finally met her husband for the first time, that she discovered he was an opium addict.” I think it’s interesting to point out the eventually self-inflicted torture this woman underwent for the sake of marrying into a respectable household, and yet the man and his actions seem completely umhampered.  It is indeed an apt illustration of gender relations and another aspect of the son preference.

In this village, there were 300 other women with bound feet as of seven years ago.  One woman, Zhou Ghuizen, comments on how much events and values of the world at large have shifted her own world: “Values have been turned upside down since her childhood. Then, she says, bound feet were seen as a mark of class. Now, they stand for female subjugation. ‘I regret binding my feet,’ Zhou says. ‘I can’t dance, I can’t move properly. I regret it a lot. But at the time, if you didn’t bind your feet, no one would marry you.’”

At first glance, the contrast between these attitudes and those of our society today seem greatly different.  After all, we neither demand nor expect our women to begin having their bones broken as little girls in order to grow into the ideal of feminity as dictated by men.  And yet, upon closer inspection, we haven’t truly come that far.  Instead of footbinding, we have an entire array of cosmetic surgeries targeted toward the rich, but that trickle their way into the poorer communities as well.  In watching MTV show “My Sweet Sixteen,” one girl received a check from her father to have breast implants for her 16th birthday.   According to an article on Respect Rx, “From Extreme Makeover to I Want a Famous Face to Dr. 90210, nipping and tucking are coming across as a totally mainstream option for girls who don’t like what they see in the mirror. Celebrities—many girls’ top models—seem to celebrate when they’ve gotten a facelift, breast implants or Botox. It’s as if plastic surgery is now being thought of like a trip to the beauty salon. Girls are picking up on this attitude: Hey, if you don’t like how you look—or *who* you are—you can easily recreate yourself with an extreme makeover (forget just getting a new outfit or haircut).”  I think most would agree with the validity of that.  In large part due to the issues I brought up last week, more and more of our girls are physically transforming their bodies through risky (and entirely unnecessary) surgical procedures an impossible standard of beauty.

So really, the difference boils down to now we have trained professionals doing these painful aesthetic procedures, as opposed to women themselves.  A real improvement huh.  We need to start preaching natural beauty and letting girls know that they are perfect just as they were made.  These “beautifying” procedures are not only unnatural, but dangerous to the girl’s body.  Even more importantly may be the impact on mental health, as these girls are not finding inherent value and beauty in who they are, but rather how they look.  And when how they look doesn’t match up to what our society/media says is beautiful and therefore valuable, they reject themselves instead of rejecting the grossly out of proportion, idealized figures society/the media give them.

Booming sex “industry” in China, Stigma, and HIV/AIDS

February 26th, 2009

While reading various articles on the stigma (or lack of, in some cases) of prostitution, I came across a shocking article on the case of China. As we’ve read and heard in class, the rates of human trafficking and sexual slavery are increasing across the world, and, apparently, China is no exception. Although intravenous drug use was previously the main cause of HIV infection in China,  sexual transmission is now, as of 2008, the main cause. One solution, proposed Dr. Wan Yanhai, is to legalize prostitution and the sex industry: “We have to recognize the human rights of sex workers,” he said as he explained his latest plan to hold a seminar to study the legalization issue. “We must establish their legal rights, before we can effectively organize them and conduct sex education and health education among them.”

In a separate report by Beijing’s health director, “more than half of the city’s prostitutes said they still shun the use of condoms;” furthermore, the “most recent survey of the city’s prostitution industry shows that the nation’s capital has some 90,000 commercial sex workers, of whom only 46.5 percent used condoms.”
It appears that there is a serious lack of health education in this population, particularly surrounding HIV/AIDS: how do you get the disease, anyways?

“According to the latest nationwide survey conducted by UNAIDS, more than 48 percent of Chinese thought they could contract HIV from a mosquito bite, while 18 percent thought they could get infected if an HIV-positive person sneezed or  coughed on them.”

In another survey, “a total of 57 percent said they had never talked about HIV/AIDS with their relatives, friends, schoolmates or colleagues.” Stigma surrounding HIV/AIDS is also extraordinarily high, and perhaps even more extreme than in the United States or other countries:

Two- thirds of respondents to the UNAIDS survey said they would not want to  live with an HIV-positive person, while nearly 48 percent would be unwilling to have meals with the infected person. In a further hint of stigma, about 41 percent said they would be unwilling to work or share tools with the person who was     HIV-positive, and 12 percent would not even touch a family member or relative with the infection.”

Also revealed in the same population survey was the statistic that “only 19 percent of the survey respondents said they would use a condom with a new sex partner, while 30 percent did not know how to use a condom correctly;” furthermore, “as many as 57.2 percent of young respondents, aged between 15-24, said they did not know how to use condoms correctly.” (source)
While these statistics may not necessarily to be unique to China, and may be even higher in less developed countries, I was personally shocked at these numbers regarding the lack of sexual education, particularly because of the one child policy and the low birth rates.

I am torn on the issue of legalizing prostitution and the sex industry. This could evolve into a whole separate discussion regarding the psycholinguistics of how we label prostitution, or the industry of sex for money, but  what this article leaves directly out is any discussion of human trafficking and/or sexual slavery and how this figures into the equation. If you were to legalize the “sex industry,” then traffickers would have an even easier time concealing their activities. This also gives legitimacy to the brothel owners and customers, so that sex and women’s bodies fully become official commodities in the eyes of the law. As another article noted, in some ways, this would confirm that “the making of money has become an acceptable moral justification in itself.”

At the same time, HIV/AIDS is spreading at an alarming rate in China through these activities, and there needs to be some action taken to reduce the epidemic. Perhaps if sex education efforts could be done, underground, by an NGO or other organization to reach these women, this could have a positive impact. There also need to be other steps taken to educate the general public about sexual health, how to use protection properly, how HIV/AIDS is transmitted, and to combat the enormous stigma surrounding individuals with the disease.

African American Women Report on Mental Illness: What They Believe and How They Cope

February 26th, 2009

This week I came across a video of Dr. Earlise Ward, Ph.D. lecturing on “African American Women’s Mental Health: Beliefs, Perceived Stigma and Coping Behaviors” at the CDH Research Symposium in 2007. Her research focused on a sample of African American women from three age categories defined as young, middle-aged, and older women. These women were not targeted for having mental illnesses; the survey-based research was instead focused on understanding their perceptions of mental illness, how they cope, and stigmas associated with seeking treatment. Efforts were also made to discover whether a relationship exists between beliefs and coping in this population of women, as well as to detect potential age differences in any of the above areas.

Dr. Ward’s research was designed around the Common Sense Model (CSM), a theory suggesting that people’s ideas about illness drive their coping behaviors. People form such ideas about the causes, timing, outcome, controllability and curability of illness and use these ideas to identify the illness. Using various questionnaires to gauge participants’ beliefs, Dr. Ward’s team acknowledged the following results:

  1. African American women identified logical symptoms for mental illness, with hostility, anxiety, and depression as key indicators.
  2. In terms of believed causal factors for mental illness, women rated punishment from god and germs/illness as unlikely causes. Women were uncertain about the role of their own behaviors, smoking, pollution, and aging. Likely causal factors were traumatic childhood, family problems, stress, violence, genetics, racism and discrimination, work stress, alcohol and drug use.
  3. These women believed that mental illness can result in serious consequences, that mental illness can be cyclical, that such illnesses can be treated, and that personal motivation can help to treat the condition. Women were less certain of whether they had a solid understanding of mental illness and whether they were being negatively affected by mental illness.
  4. These women indicated that they would definitely use religion as a coping strategy and would likely use an informal support network of friends and family. They would probably seek professional help, and would probably not use avoidance coping.
  5. There were only slight correlations found between beliefs and coping, and even these could be due to chance or to an improper fit of the theoretical model for this particular study.
  6. With regard to perceived stigma around seeking treatment, approximately 80% of women said they would feel comfortable, and 60% said they would not be embarrassed for friends and family to be aware of their illness. Overall the women reflected a low level of perceived stigma, and it has been shown that the lower the perceived stigma, the higher the rates of seeking treatment.
  7. Significant age differences were present, particularly in the coping strategies. Older women were more likely to seek treatment and to use religious coping, as well as less likely to use avoidance coping as compared to young and middle aged women. No age differences were found with regard to perceived stigma or representations of beliefs around mental illness.

This study was very interesting and heartening in the fact that it reflected African American women as aware of and comfortable addressing mental illness. As African Americans in the United States typically report lower health and less frequent use of health services than other groups, I had assumed that mental health would be especially stigmatized. This study suggests otherwise and paints a relatively optimistic, rational approach to mental illness and coping strategies.

A final intriguing point: the women for this study were recruited primarily through churches. We must then consider whether the religious influence in their lives has promoted the beliefs and coping strategies that were indicated in the above study. I would be very interested to see a study designed to incorporate groups of African American women with and without strong religious affiliations to examine a possible correlation between religion, the incidence of mental illness, and the types/efficacy of coping mechanisms.

Who can use what language?

February 25th, 2009

Language is powerful.  I think we can all agree there.  I just came from my dorm’s Crossing the Line, and in the discussion afterwards there was a lot of talk about if it’s ok to make racist/homophobic/etc jokes as long as you are in company of people who “get” your intentions.  My belief is that no, it’s not, because it’s dangerous and you never know who you may be offending – or who you may be giving license to go say these things elsewhere.

But then I started thinking about words like “bitch” and other antifeminist and sexist statements.  The queer community uses them all the time in a self-affirming way.  Think about drag queens.  They say stuff like “Bitch, you are FIERCE” as a gendered compliment.

For the queer community, gender is a massive issue.  We are pretty much all gender minorities as queers because we break our gender/sex standards in some way (gender identity, who we like to date, do we have effeminate mannerisms, etc).  So the concept of gender and how we don’t fit in is always present in our minds.

But does that give us license to call each other “bitch” or anything like that?  In particular, it seems that effeminate men use that word.  So they are breaking their norms and adopting a feminine viewpoint – but it’s not really the same as actually being a female.  If this statement affirms an oppressed community – but is also used to oppress another group – is it fair to use?

My gut feeling is no.  The queer community is made of women as well.  And this word carries a history of violence that even some men may have horrible histories with.  Think of a man who came from an abusive family where this word was an attack, or indication of a pending attack.  It is completely possible to affirm a non-normative gender identity by using feminine words that aren’t necessarily violent words.

But it’s so ingrained in the culture, it might be hard to stop.  Especially since gay culture can be so oppositional to what straights say – and gay men and queer women of any sorts often do not get along well.  Or at least, they discount each other heavily.

The ways that feminism and queer culture intersect are fascinating – and often divisive.  What other complicated similarities do you folks see?  Where do queer folk hurt women folk by trying to live their identity in an oppressive world?  Where do women folk hurt queer folk by working out gender for themselves?  I’d love to hear your thoughts.