Culture and Sexuality

     Why do we concern with sexuality nowadays? Why talking about sexual issues is a taboo in some cultures (Shefer, & Strebel, 2002)? It is as natural as food. I think perhaps it is because sexuality is more than physical aspect of sex. Sexuality includes more social and cultural meanings. So what does sexuality mean? Besides the way in which individuals perceive themselves as sexual human, in my understanding, it may also be socialized into the private relationship with others, as well as desires, and expectations. It would vary across cultures and contexts.

     I was enlightened by the assumption that sexually transmitted infections (STIs) are constructed through gender power relations and gender stereotype (Shefer, & Strebel, 2002). The balance state of power between male and female is always playing crucial role in sexuality and sexual practices. In the context where men are the dominant actors, women usually are lack of right and power to make decision on sexual matters. For instance, in the issues of condom use, contraception, pregnancy, and reproduction, female always are the victims. Why women are more vulnerable to unprotected sex, to HIV transmission, to malfunction? Perhaps it is partly due to the unbalance of gender power. Women have little resource and opportunity to decide for their own needs. They have to tolerant for men’s desire, because women depend on men to survive in some cultural context.

     As I was reading the article written by Schoepf (2001), the point, that spread of AIDS infections is influenced by political economy, social relations, reminded me of an example of sexuality in Japan. The government of Japan prohibits the use of oral contraceptives, because the government believes it would decrease the motivation of condom use for Japanese and increase the risk of transmission of AIDS. That might be an important explanation of why Japan has a comparably lower incidence of AIDS, even though in the society men are on the absolutely dominant position, even though men who are married usually seek pleasure from multiple partners. 

     I am thinking that culture should be utilized as a tool of engaging people in acceptable change practice with regard to health behavior, rather than merely as a barrier or a problem. Cultural lens potentially provides clear picture of people’s ways of thinking and behaving. The issues of sexuality are culturally sensitive to different degree in diverse social contexts. For health providers, I think respect is the basis for sexual matters, as well as sensitivity, rather than judging patients wearing colored glass of stereotype.

Culture, Health, and Resistance

     The ultimate goal of human is survival. However, the life is not easy, which is potentially full of risk, pain, struggle, and resistance. I am impressed by the term of “awakening” (Mallory, 2000). When people are awakening? Inspiring by knowledge of survival and evaluation of risk, people make practical decision and make changes to fit in the current situations, letting the life transform towards good. People always have the natural motivation to seek advantages and avoid harm. I was thinking, however, what people will do facing challenges and violence? Do people respond to the violence differently in different cultures? Female might be a specifically interesting issue in this case. Women in diverse cultures are situated in diverse positions. Cultural scenery draws different pictures for women in different roles, such as of mother, wife, daughter. The problem is that, in some culture, women have little access to obtain understanding of the risk and survival. How are women able to make subsequently behavior changes if they even do not realize the violence, let alone respond to it? Additionally, I think what elementary requirements for survival are as women perceived also vary as cultures vary. It reminds me of Maslow’s hierarchy of needs (Maslow, 1943). Basically, the need for physiological necessaries, including food, water, and sleep is in the first level (Maslow, 1943). So what if women determine they have to tolerant some risks in order to achieve these basic needs? They might be helpless when the life is lack of food and money because of economic constraints, feeling powerless to resist the violence. How do they pursue higher level of health, security, morality and family needs when the basic living needs are not accomplished? How are they able to make decision for themselves without power? Moreover, how is it different as a woman in the cruel world? Women historically are suffering from gender inequality in social roles and lived experience. They are struggling with and striving to resist more violence than men consistently, although it depends on different social settings. For health care practitioners, what can they do? What should they do? I assume it is more than an ethical issue. The lived experiences of women, as well as marginalized population, are the outcome of intertwining of structural process, power flow, and cultural system, I think. Thus a deeper understanding of these interactions would facilitate health care quality.

     Although it has been claimed that the order and the importance of Maslow’s hierarchy of needs vary across cultures in different regions (Tang, 1997), I think its basic assumption is reasonable in some circumstances. However, I agree with the statement in Martyn’s paper (2001), which claimed that parents who are under oppressing tend to communicate information to resist the power and violence with their children. Resistance is linked to challenging constraints from dominant power, issues of freedom, and empowerment. People not are merely bearing the risk, but also have the potential ability to negotiate, struggle with and resist the dominant roles, endeavoring to make social changes, and being empowered by power. How to be empowered through resistance? Initially, I was thinking perhaps involvement and take action of resistance make people gain control over their life. Also, people would feel they master the skills of survival required within a certain context, which helps with establishing a clearer identity based on the social roles. In this sense, people are able to resist the violence associated with the political and economic situation and feel empowered. Power is not stable. It is produced through discourse, I believe. Thus resistance would promote the flow of power and offer an alternate way to communicate and challenge the authority of powerful actors. However, the real challenge is that mere willingness to resist violence is not enough (Basu & Dutta, 2008). People are lack of partners. Who would help and support the marginalized? Maybe it is not political leaders, who have own political concerns. What can we researchers do? The first idea comes out is providing an opportunity for participation in making decision. And with more difficulty, create hope, confidence and trust for people for an ideal future. We are standing in the river, inevitably complying with the flow, but also resisting the flow, in order to maintain control over ourselves, and determine our own direction.

Reference

Basu, Ambar and Dutta, Mohan J. (2008).
Participatory Change in a Campaign Led by Sex Workers: Connecting Resistance to Action-Oriented Agency. Qualitative Health Research, Jan 2008; vol. 18: pp. 106 - 119.

Mallory, C., & Stern, P. (2000). Awakening as a change process among women at risk for HIV who engage in survival sex. Qualitative Health Research, 10, 581-594.

Maslow, A.H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–96.

Tang, T. L., & West, W. B. (1997). The importance of human needs during peacetime, retrospective peacetime, and the Persian Gulf War. International Journal of Stress Management, 4(1), 47–62.

Alternative Ways of Healing and Knowing

     When mainstream scientific methods do not work for patients, what would they do? When both conventional medical treatment and alternative medicine are available to patients, which therapeutic practice would they choose to seek help? I think it is largely relevant with cultural interest. Health, ideally, is a condition in accordance with our expectation and values. On the other hand, illness is a disturbance of this expectation. In this sense, how do people shape individuals’ expectation? I assume it maybe the outcome of historical purpose and culture cultivation. It suddenly comes to me that the term of “culture” is made up of “cultivation” and “nature”. Alternative medical traditions offer patients sense of trust and safe, because it comes from cultural ritual, corresponding with the ways of thinking and making meaning of patients. Culture not merely establishes belief pattern, but also have a function of sedatives which enable patients calm down. It is likely that cultural values are the foundation of human development, consistently playing a role on people’s growth over time. They are like the embrace of a mother, emotionally and cognitively upholding patients.

     As to alternative medicine, Traditional Chinese medicine (TCM) might be a classical example. The view of the world and the body in TCM has its conceptual root. The human body is viewed as an entity in which organs and other parts function variously and interdependently. In this case, health and disease refer to balance or imbalance of the functions, yin and yang energy, either within the body or between the human body and environment. The practice of TCM includes the use of acupuncture, diet, herbal remedies, physical movement, and massage. Likewise, I found Ayurveda also stresses the concept of balance and harmony. This ancient ways of healing emphasizes the mind-body-spirit connection. The phase “flower power” in Zimmerman (1992) is interesting. Based on what I have read, I think it means gentleness of the practice – such as healing through meditation, yoga and diet, together with strong power to manage violence in patient’s humeral system. Thus, these traditional ways of healing represent the cultural heritage of China and India. I was thinking some questions. Whether they would be, could be, or should be utilized in global health care system? Are they meaningful and beneficial to patients from diverse cultures as well? Are these unconventional medicines weird to other cultural group, or novel? Why western medicine is more popular in global society, because it is “scientific”?

     In addition, spiritual concern is another alternative way of knowing that requires notice. Patients who have spiritual beliefs tend to contribute healing to God’s will. Thus building connection between physicians and God facilitate adherence of patients. Various ways of healing and knowing bring complication to physicians and caregivers’ work. They need to obtain deeper understand of patients’ religious beliefs and cultural beliefs, and identify patients place which belief as chief concern. So, how to be more sensitive to these ways of knowing? I think physicians should learn appropriate ways to help patients from other cultures feel comfortable; be perceptive of patients’ cues; learn how to identify patients’ agenda and underlying motivation and expectation. Human are complex entities. Patients are complex further, since they are the population who are suffering from disorder and pain. The interior struggle is obscure, and even unrevealed. Furthermore, cultural norms make their ways of knowing more elusory. This is a long way to explore, and a fantastic journey to enjoy as well.

Culture, Health, and Ways of Knowing

     The dominant culture controls, oppresses and forms traditional ways of knowing and being, being an important impact on human health status, hope and expectation. Ways of knowing are as diverse as the cultures and the ways to knowledge understanding are not easily transformed. I found the issue of the naming of child in a family, mentioned in Airhihenbuwa’s book, is very interesting. Similarly, the naming has cultural meaning in China as in Africa. The name is a symbolic link of history with life of people. Chinese parents design the name of children aiming to place their aspiration, purpose and hope, especially involving health. For example, hoping children will be healthy, parents name children “Kang” (means health), or “Qubing” (far away from disease); female names are usually using flowers names, such as “Lan” means orchid with parents’ hope of beauty; to respect history or religion, people use “Xin” (belief) or “Mu” (revere) in their name; “Zhong” (loyalty) reflects a expected social ethos. Furthermore, according to the birth date and time of the child, it is speculated what element (Five Elements: metal, wood, water, fire, earth) the child lacks or conflicts with in the life. In this case, a corresponding word is added in the name to enable the five elements balanced, in order to keep the child healthy. The naming of children is a symbol of the attempt of family to follow the cultural ritual and reproduce themselves, making meanings within cultural meanings, to respond to the world. Thus, how this cultural issue is related to health? As Airhihenbuwa claimed, I agree that the survival of children depends on the survival of the family. The naming mirrors the role of children in the context of family, which is an aspect of expectations of parents. The expectations are shaped based on the perceived social structure and norms that people understand.

     The assumption that saying distress at menopause for Japanese women is inappropriately explained as natural and inevitable in both biomedical and psychosocial perspectives, which is proposed by Lock (1992), reminds me a question. How do we, researchers, or practitioners change their existed ways of knowing and being to improve patients’ health outcome? Or how do we deal with their ways of knowing? I think, may be the first step, before indigenous people actively engage in developing healthier life, is to acknowledge, face, and cure the wounds resulted from historical trauma, colonization, and inequality in health, as well as life experience. A sensitive identity is needed here, with respect, beneficence, and trust for each one in practice. Stepping to a further road, how to encourage health-related behavior change? Basically, I think there are some elements playing positive roles: awareness of the problem, skills to evaluate the environment and examine information, support of social network including family, friends and professionals, and more importantly, strengthened self-esteem, which increase the passion and willing to promote health status. Individuals obtain ability and power through acquiring the skills to deal with and manipulate the forces that influence the individual, although in fact it is very difficult, since sometimes people even are not conscious. It is the result of politics, economy, and culture forming the ways of knowing and wellbeing of indigenous people together. Indigenous people need to gain access to learning and being understood in a comfortable and respectful way. 

Narrative and Health

     Going through the readings, I obtain a general idea that at the personal level, narratives can be described as telling a story of the lived experience of the teller. Furthermore, I think in health care narrative also is formed at other levels. Specifically, at the interpersonal level, the interpretation of physicians towards patients’ stories, and co-constructing meaning in dialogue are narratives too. For example, I think the presentation of doctors’ prescription, including suggestion of changing life style, might be one kind of co-constructing narrative, which is based on hearing the narratives of patients. The narrative is a result of an interaction in which both of the actors are engaging. In addition, at the societal level, different social positions of physician and patient shape divergent narrative. They both tell stories with the sense of their positioning which is linked to the ethnicity. To understand the narrative, we need to understand the positional context. Locate ourselves within the story to obtain a meaningful sense.

     Basically, narrative is a way to make sense of the world. The process of constructing a narrative allows people to impart meaning to the life change, to address disorder. Thus, it seems that narrative is used to make sense of the disturbance in the life brought by the illness. The plot of narrative varies across tellers. Narrators arrange a set of events in their own particular ways, forming different development, and different results. The process involves different values and cultural norms. An individual may interpret some details as important parts that others may neglect. For example, I remember in an interview on SSB I conducted recently, the Chinese participant narrated her experience of consumption of SSB focusing on the concept of “moderation”. She described that she was aware to restrict the intake of SSB within the extent of moderation – neither too much, nor too less – even thought when she had strong desire to drink SSB. This perception is associated with the “moderation” ethos in Confucian thought. Moderation here means a harmony condition between ritual (Li) and desire, avoiding indulgence. Culture constitutes a structure of customs, ideas, and norms that offers individuals patterns for responding to the world. The selection of events in the narrative usually represents the teller’s personal idea of the issue.

     I was reminded of one question that how patients with painful experience construct narrative? Do they encounter difficulties? What if the narrative is absent for people without power? How is narrative created by power? And how is the narrative creating power? The process of narrative enables an individual to organize events in a coherent pattern and integrate thoughts. It provides people a sense of control over the chaotic, obscure, and silent life. Constructing stories lead to less rumination. On the other hand, painful experiences in some cases may not be put into a narrative form and therefore result in negative feelings and emotions. It might happen especially when patients have no access to narrate or without power, and awareness to tell others’ their stories and experiences. Illness is an event that creates chaos to the everyday life. If constructed, illness narrative plays a role in asserting responsibility of patients and producing a clear picture which reassesses identity, reevaluating their own position in the world. Maybe that is one avenue in which narrative creates power.

      Narrative is a basic mean of individual interaction. We communicate with other through telling stories in the daily life. It is a natural and acceptable way of communicating information and knowledge. Therefore, not only health professionals need to understand the ethical narratives of patients, but also we can use narrative approaches to promote health behaviors change. I am thinking that maybe different types of stories can be used for different goals. For example, tell culturally common stories to pervasive in a cultural atmosphere. Hence, narratives are not merely a personal method, but an attempt to engage with other actors to co-construct narratives within positional context, understanding the power structures that uphold them. Providing support for development of narratives, I think, also might be an important way to increase confidence and awareness of the marginalized.