An unanticipated source of hope: stigma and cervical cancer in Brazil

In this article, I argue that although cervical cancer is an often stigmatized condition in Brazil, women with cervical cancer in Recife, Brazil, did not simply endure the stigma, they also perpetuated it. I draw on narrative theory and 18 months of ethnographic research in Recife to argue that rather than resisting the stigma associated with their disease, women in Recife used stigma to construct illness narratives that affirmed that they were still held to the same norms and values as the nonill. In turn, those narratives, and the healing narratives constructed along with them, provided women with hope for a future free from cervical cancer and free from the "imperfections" associated with that disease. Thus, women with cervical cancer used stigmatizing narratives both as links back to the "normal" world they inhabited before they became ill, and as bridges forward to the future they hoped to attain.     

Between a Rock and a Hard Place: The Power and Powerlessness of Transnational Narratives among Gay Martinican Men

In Martinique, self-identified gay men often tell each other stories about gay communities in other societies. France and Martinique are central characters in these stories but their presence is largely negative: life in the former is criticized for its economic or racial hardships and life in the latter is criticized for homophobia, hypocrisy, and smallness, creating a frustrating catch-22 for these men. However, in these narratives Quebec often emerges as an ideal destination of racial and sexual freedom. In this paper, I argue that Quebec is signified as utopic in terms that are antithetical and therefore profoundly connected to impressions of social life in France and Martinique. At the same time, however, I maintain that these narratives also reveal common threads in the African-pan-American diasporic experience. Furthermore, these men's experiences of "gay" life in other countries demonstrate their awareness of a "global gay" identity, albeit one that is commercially and ideologically centered in Euro-American societies, [homosexuality, Martinique, transnationalism, diaspora, race]     

Body positions and movement patterns in female patients with congenital adrenal hyperplasia

Female patients with congenital adrenal hyperplasia (CAH; N = 33; 11-41 years), simple-virilizing (SV) patients (N = 19), salt-wasting (SW) patients (N = 13), and sister controls (N = 14) were compared with regard to their body positions and movement patterns. Data collection comprised both self assessments and mothers' assessments using 20 sex-dimorphic items with corresponding "more masculine" and "more feminine" versions for each variable, represented in photographs (forced-choice approach). Primarily based on mothers' assessments, single-item results suggested slightly more masculine positions and patterns for female CAH patients compared to sisters, for SW patients more distinct than for SV patients. Results from an 11-item scale ("motor behavior", alpha = 0.59) revealed differences between SW (more masculine) and SV patients for self assessments (P, one-tailed, < 0.09); sisters were in an intermediate position closer to the SV patients. According to mothers' assessments, the CAH patient group as a whole differed (more masculine) from sisters (P < 0.06); this finding was mainly accounted for by the SW group (P < 0.04). Complex analyses on the relationship of motor behavior and intervening variables (e.g., postnatal androgenization, onset of puberty, menarche, height, weight, sexual orientation) revealed very few significant results. Findings rather suggested organizational hormonal effects on body positions and movements prenatally; they are in line with main results from the interview section of the Hamburg CAH study (e.g., "Gender-related behavior"). An approach of this kind seems to be justified for investigating motor behavior in future psychoendocrine studies.     

Claiming respectable American motherhood: homebirth mothers, medical officials, and the state

Based on ethnographic research regarding public policy and grassroots organizing for midwifery in Virginia, this article explores how medical discourses around appropriate health care practices intersect with state discourses about what practices are considered "respectable" versus "pathological" for its citizens. In recent legislative debates about the legalization of direct-entry midwifery, medical officials have extended their criticism of midwifery and homebirth to mothers who resist state-sanctioned childbirth practices. This article examines how medical officials challenge the respectable mothering practices of homebirthers by linking them with women they deem pathological--child abusers, negligent mothers, and drug users--and placing them outside the cadre of "normal" American mothers who acknowledge the "logical" and "natural" superiority of biomedical childbirth practices. I also address homebirth mothers' responses, which assert that their political advocacy for midwives is a respectable mothering practice because they are responsible citizens who desire what they deem the best care for their children.     

Zygosity diagnosis in young twins by questionnaire for twins' mothers and twins' self-reports.

The present study deals with the determination of zygosity in twins of childhood age by simple questionnaire. The subjects were 224 twin pairs and their mothers, consisting of 159 monozygotic and 65 same-sex dizygotic pairs, identified by genetic markers including DNA samples. Mothers of twins responded to 19 questionnaire items dealing with twin similarity in 16 items about physical features and 3 items about the degree of similarity and frequency of being mistaken (confusion of identity) when twins were about 1 year of age. The twins themselves responded to three questionnaire items dealing with only confusion of identity items. The results of stepwise logistic regression analysis were as follows: the total accuracy of the mothers' questionnaire was 91.5% when using only the items dealing with confusion of identity. This accuracy was slightly lower than that obtained by twins' self-reports dealing with nearly the same question items of confusion of identity, answered by both twins separately with 93.3% accuracy. The total accuracy of mothers' questionnaire responses rose to 95.1% when we used all 19 items. In addition to "the frequency of being mistaken", two physical features, namely "shape of fingers" and "shape of eyebrow", were very informative. In conclusion, twin zygosity can be estimated by the use of the mothers' simple questionnaire with sufficient accuracy even in very young twins about 1 year of age.     

Pluralism and pragmatism: knowledge and practice of birth in Morocco

This article examines knowledge and practice surrounding birth in Morocco, using women's narratives of their recent birth experiences, observations of medical encounters, and statements about prescribed behaviors during pregnancy and birth, as well as the vocabulary used to refer to physiological processes, disease conditions, and social relationships. The analysis shows that the three major themes that define the traditional Moroccan ethnophysiology of birth--conceptions of hot and cold, the symbolism of blood, and the metaphors of openness and obstruction--are not inconsistent with the precepts of biomedicine and public health and do not in themselves constitute obstacles either to safe home births or the use of formal health services. Women integrate biomedical and local knowledge and practices and simultaneously seek care from "traditional" and "modern" practitioners, creatively combining elements in accordance with their situations and the means at their disposal. Birth narratives show the eclecticism and flexibility that characterize women's attitudes and behaviors regarding pregnancy and birth. Women's decisions are shaped by two overriding considerations: incertitude about what can happen during the last phase of a pregnancy and ambivalence toward the available alternatives for care, both of which reflect a realistic assessment of their situations. By showing how women make decisions in response to these considerations, this article seeks to clarify some of the links between beliefs and practices and to contribute to ongoing discussions regarding the relevance of local knowledge for patterns of health care.     

Schizophrenia,Narrative and Change: Andalusian Care Homes as Novel Sociocultural Context

This study explores qualitative changes in the life narratives of persons diagnosed with paranoid schizophrenia who were receiving recovery treatment in special care homes in Andalusia, Spain. These narratives are related to patients’ construction of social identity and the recovery process. Initially, 10 narrative interviews were performed. The first five patients (Group 1) had lived at the homes for only 3 months, while the other five (Group 2) had been there for 61.4 months. Two years after the initial interviews, three patients from Group 1 were interviewed once more. The qualitative analysis focuses on two topics: experience of illness and personal relationships. Long-stay patients create their identities by using more categories related to relationships and make fewer references to illness than Group 1 subjects. They also make fewer delusive or hallucinatory utterances, and their narratives have more elements that can be shared in the community than Group 1 narratives. Moreover, long-stay patients show significant language resources and greater capacity for agency. Results suggest that special care homes provide important emotional support and a rich, new network. These results are related to the sociocultural characteristics of special care homes and suggest that the analysis of life narratives could be a very useful instrument for assessing the recovery process.

“Traveling Pains”: Embodied Metaphors of Suffering Among Southern Sudanese Refugees in Cairo

This paper presents the results of a larger study conducted among Southern Sudanese refugees in Cairo, Egypt. "Illness talk" and body metaphors are the focus of the present work, which is based mainly on an analysis of the illness narratives of people attending a church-run medical clinic. The findings suggest that refugees use certain narrative styles in discussing their illnesses that highlight the interconnection of bodily ills and refugee-related trauma. The refugees narrated the histories of their illnesses in terms consistent and coterminous with their refugee histories, and articulated illness causes in terms of threatening assaults on their sense of self as human beings and as part of a distinct community and culture. The use of embodied metaphors to understand and cope with their current and past traumatic experiences was echoed in narratives that were nonillness related. Metaphors such as "the heart," "blood," and "body constriction" were consistently used to discuss social and cultural losses. Understanding the role that the body plays in experience and communication within a given cultural context is crucial for physicians and others assisting refugees.     

A Qualitative Study to Appraise Patients and Family Members Perceptions,Knowledge, and Attitudes towards Venous Thromboembolism Risk

Objective

This study aimed to examine perception, knowledge and concerns developed by patients and their family as regards venous thromboembolism (VTE) risk.

Methods

We conducted a qualitative study. Participants were: (1) patients with unprovoked VTE with either factor V Leiden mutation or G20210A prothrombin gene mutation or not; and (2) their first-degree relatives. Interviews took place mostly at Brest University Hospital. Participants produced narratives of the patient’s illness, stressing their perception of the disorder, its mechanisms, etiology, circumstances and risk factors. Interviews were audiotaped and transcribed verbatim. On an ongoing basis, central themes were identified and data from narratives were categorized by these themes.

Results

A total of ten patients and 25 first-degree relatives were interviewed. Analyses of patient’s narratives suggested 4 main themes: (1) concerns about initial symptoms and suspicion of VTE. The longer the duration of the initial phase, the more likely anxiety took place and persisted after diagnosis; (2) underestimation of potential life-threatening episode once being managed in emergency; (3) possible biographical disruption with inability to cope with the event; and (4) secondary prevention attitudes motivated by remains of the episode and favoring general prevention attitudes. Analyses of the first-degree relatives narratives suggested 3 main themes: (1) common interpretation of the VTE episode shared within the family; (2) diverse and sometimes confusing interpretation of the genetic status; and, (3) interpretation of clinical signs linked to VTE transmission within the family.

Conclusions

Construction of the risk of VTE is based on patient’s initial experience and shared within the family. Collection of narratives illustrates the gap between these perceptions and current medical knowledge. These results support the need to collect the perceptions of the VTE episode and its consequences, as a prerequisite to any health education process.     

The “Other” in Film: Exclusions of Aboriginal Identity from Australian Cinema

Throughout the latter half of the past century, cinema played a significant role in the shaping of the core narratives of Australia. Films express and implicitly shape national images and symbolic representations of cultural fictions in which ideas about Aboriginal identity have been embedded. In this article, ¹ This article is based on a paper presented at the Australian Sociological Association's Annual Conference, in Auckland, 2007. The author wishes to thank the University of Wollongong and acknowledges its support in the presentation of this material. exclusionary practices in Australian narratives are analyzed through examples of films representing Aboriginal identity. Through these filmic narratives the articulation, interrogation, and contestation of views about filmic representations of Aboriginal identity in Australia are illuminated. The various themes in the filmic narratives are examined in order to compare and contrast the ways in which Australian films display the operation of narrative closure and dualisms within the film texts.     

Narratives Reflecting the Lived Experiences of People with Brain Disorders: Common Psychosocial Difficulties and Determinants

Background

People with brain disorders - defined as both, mental disorders and neurological disorders experience a wide range of psychosocial difficulties (PSDs) (e.g., concentrating, maintaining energy levels, and maintaining relationships). Research evidence is required to show that these PSDs are common across brain disorders.

Objectives

To explore and gain deeper understanding of the experiences of people with seven brain disorders (alcohol dependency, depression, epilepsy, multiple sclerosis, Parkinson’s disease, schizophrenia, stroke). It examines the common PSDs and their influencing factors.

Methods

Seventy seven qualitative studies identified in a systematic literature review and qualitative data derived from six focus groups are used to generate first-person narratives representing seven brain disorders. A theory-driven thematic analysis of these narratives identifies the PSDs and their influencing factors for comparison between the seven disorders.

Results

First-person narratives illustrate realities for people with brain disorders facilitating a deeper understanding of their every-day life experiences. Thematic analysis serves to highlight the commonalities, both of PSDs, such as loneliness, anger, uncertainty about the future and problems with work activities, and their determinants, such as work opportunities, trusting relationships and access to self-help groups.

Conclusions

The strength of the methodology and the narratives is that they provide the opportunity for the reader to empathise with people with brain disorders and facilitate deeper levels of understanding of the complexity of the relationship of PSDs, determinants and facilitators. The latter reflect positive aspects of the lives of people with brain disorders. The result that many PSDs and their influencing factors are common to people with different brain disorders opens up the door to the possibility of using cross-cutting interventions involving different sectors. This strengthens the message that ‘a great deal can be done’ to improve the lived experience of persons with brain disorders when medical interventions are exhausted.     

Applying Aristotle's Doctrine of Causation to Aboriginal and Biomedical Understandings of Diabetes

Aristotle's doctrine on causationidentifies four distinct types of cause: formal, efficient,material, and final. Science is said to have differentiateditself from philosophy by concentrating solely on efficientcauses. Nonetheless, when applied to narratives of causation,Aristotle's doctrine provides a useful heuristic to explore theissues such as Aboriginal and biomedical perceptions of causalfactors for non-insulin dependent diabetes mellitus (NIDDM) onManitoulin Island, Ontario. This paper also outlines twodivergent causal stories for NIDDM and the associated moralpositions regarding the righteous pursuit of health. Biomedical narratives emphasize the role of lifestyle factors,particularly the impact of obesity, in causation. In the case ofdiabetes, the moral course of action is pursued through lifestylechoices. In contrast, Aboriginal narratives emphasize the roleof genetics in causation. These narratives describe diabetes ascollectively affecting Aboriginal people – thus identifyingAboriginal people as different. Aboriginal frameworks for healthventure beyond the efficient cause of biomedicine and thus themoral pursuit of health within this framework involves returningto an initial state of health and purity through traditionalknowledge.     

"You Are a Number, Not a Human Being": Israeli Breast Cancer Patients'' Experiences with the Medical Establishment

In the course of interviews with Israeli women who had recently been treated for breast cancer, we found that our informants tended to offer us "treatment narratives" rather than, or sometimes in addition to, the "illness narratives" made famous by Arthur Kleinman. For the women we interviewed, treatment narratives constitute verbal platforms on which to explore what it means to be human during a period in which one's body, spirit, and social identity are undergoing intense transformations. A central theme in these narratives is the Hebrew word yachas, loosely translated as "attitude," "attention," or "relationship." The women consistently contrasted the good yachas of medical staff who treated them "like humans" or like "real friends" with the bad yachas of staff who treated them like numbers, machines, or strangers. We argue that the women used language (in various contexts) as a means of resisting the medical culture's pattern of treating patients as "nonhumans."     

Reliability and stability of mothers' reports about their pregnancies with twins.

The objective of this study was to determine if mothers' retrospective reports about events in their pregnancies with twins are reliable and stable. Six hundred and twenty-four mothers completed psychiatric interviews about their twins. These interviews also contained questions about the mothers' pregnancies, the perinatal period, and the child's early development. The mothers reported first on one twin and then on the other with interviews spaced from 3 days to 2 weeks apart. Thus mothers reported on the same pregnancy twice. Of these mothers, 47 were re-interviewed 6 to 18 months later by raters blind to the results of the initial interview. The twin design allowed us to compare the short-term reliability of the 624 mothers' reports of the same pregnancy. The re-interview of the 47 mothers enabled us to compare the stability of reports over a longer time period. Agreement between the reports was measured with the kappa statistic. Kappas were good to excellent for the short-term reports of pregnancy for each twin for the 624 mothers. Kappas were equally high for the 47 mothers that were re-interviewed 6 to 18 months later. Mothers show good reliability and stability of reporting about events during pregnancy.     

Brazilian mothers' beliefs, attitudes and practices related to child weight status and early feeding within the context of nutrition transition

With the rapid pace of the nutrition transition worldwide, understanding influences of child feeding practices within a context characterized by the co-existence of overweight and undernutrition in the same population has increasing importance. This qualitative study describes Brazilian mothers' child feeding practices and their perceptions of their association with child weight status and explores the role of socioeconomic, cultural and organizational factors on these relationships. Forty-one women enrolled in the Family Health/Community Health Workers Programme were selected from rural, urban, coastal and indigenous areas in Ceara State, north-east Brazil, to participate in four focus group discussions. Content analysis identified fourteen emergent themes showing mothers' child feeding practices in this setting were influenced by economic resources, mothers' immediate social support networks (e.g. neighbours and family members) and participation in nutrition assistance programmes. Child malnutrition was the most common nutritional concern; nevertheless, mothers were aware of the negative health consequences of obesity but misunderstood its causes (e.g. foods filled with fat would make a person fat; others thought that birth control pills and stimulants given to children were causes of obesity); several reported their own struggles with overweight. Food assistance programmes emerged as an important influence on children's dietary adequacy, especially among mothers describing dire economic situations. The findings have implications for targeting food assistance as well as health and nutrition education strategies in low-income families undergoing the nutrition transition in north-east Brazil.     

Dynamics of Inclusion and Exclusion: Comparing Mental Illness Narratives of Haredi Male Patients and their Rabbis

By comparing versions of mental illness narratives – told by Haredi (Utraorthodox Jews) male patients of a mental health clinic in Israel and by their rabbis – this paper relates to two distinct, yet interrelated, theoretical questions: the place and agency of narrators, and the tension between experience and representation. A pair of narratives exemplifies a pattern in which the patients (Talmudic students) tell a narrative of a sudden breakdown related to a dramatic meeting with a non-human figure (often, a woman) or force. Their rabbis, by contrast, tell a narrative that emphasizes their students' mundane symptoms, ``abnormal' and ``immoral' behavior, and use a local adaptation of a Western psychological explanatory model. A dynamic of inclusion and exclusion emerges as students are seeking legitimization and avoidance of stigma, while their rabbis are silencing themes that challenge social and cultural orders. The different narratives are further interpreted in the context of the micropolitics of the interviews and of identity politics between the Haredim and secular Israelis. This social dynamics shows how differently placed social actors-narrators-interpreters construct differently contested and diverse cultural narratives of a seemingly shared reality.     

Mothering, Work, and Gender in Urban Asante Ideology and Practice

Conventional Asante gender roles in Ghana emphasize biological motherhood for women, but Asante assume mothers' loyalties and schedule conflicts will interfere with equally female gendered expectations within marriage, not with fulltime paid work. Asante express their maternal devotion most by working tirelessly to meet their children's financial needs, not by staying home with them. In this paper I analyze urban Asante ideals and practices about gender and parenting, drawing on life histories and fieldwork with Kumasi traders since 1978. Market trading is ideal "nursing-mother work" because it generates the steady income needed to raise children successfully to adulthood, not because it is compatible with childcare. Marriage depends directly on women's intimate domestic work, creating structural tension with motherhood. Concepts about motherly fathers, manly women, and fools of both genders show how the distribution of income and capital defines gender and kin role performance. Asante have accommodated historical changes in gender expectations about work, parenihood, and marriage within their general positive emphasis on negotiability and renegoiiability of relationship content, [ gender, work, Asante, traders, parenting ]     

Street smarts and urban myths: women, sex work, and the role of storytelling in risk reduction and rationalization

Storytelling has a strong tradition in inner-city American communities. In this article, we examine patterns of storytelling among a sample of drug-using women from New York City who engage in street-based sex work. We consider two particular formats of storytelling for analysis: "street smarts" and "urban myths." Street smarts are stories of survival, and urban myths are compilations of street legends spread by word of mouth. The narratives are filled with tales of extreme risk across situations. The women used the stories to delineate the boundaries of risk as well as to rationalize risks they deemed to be inevitable but temporary in their lives. Few of the women capitalized on the greater instructive quality of the stories toward increased risk reduction, which may relate to the women's distance from an identity of "sex worker." If properly harnessed, the strength of storytelling suggests new avenues for risk-reduction interventions.