Feeding the Hand that Bit You: Lesbian Daughters at Mid-Life Negotiating Parental Caretaking

SUMMARY

Like other women in our culture, lesbians find parental caretaking is a gendered expectation that often falls to them. This article explores how we negotiate competing demands and integrate our parents' needs into our lives. The daughter/parent relationship may have been strained by parental homophobia, exclusion of our partner, “splitting” between our lesbian and birth family lives, and physical distance. We may recall feelings of metaphorical and physical caretaking not offered to us when we came out, when lack of parental support may have brought financial abandonment and emotional upset. Inversion of the relationship into the child as parental caretaker, fraught with mixed emotions, can bring resolution of long-held resentments and pain.     

In This Together

SUMMARY

Both epidemiologically and psychologically, the reigning self-interest paradigm of HIV prevention is growing increasingly obsolete, which will likely only increase with wider use of combination therapies. While self-interest notions form the core of most American HTV prevention theory and practice, data indicate that self-interest models increasingly fail both negative and positive gay men. There is an urgent need for broader, more emotionally-resonant prevention concepts. Diverse consistent, and significant data on behaviors including condom use, partner choice, volunteerism, and caretaking imply that values jof altruism and other-centered motivators may play central, strong roles in gay men'S HIV safety decisions. Values of “prevention! altruism” remain little understood, researched, or appreciated. Data show that sexual risk is inherently dyadic, gay men'S risk is increasingly relational, and a clear majority of gay men consistently manage sexual risk. Yet we understand little of the values of men who are largely safe, instead of those most risky, and less about how their values of nurturance and caretaking, ethics, hopes for collective survival, or relations with friends and community help support them in staying safe. A wide range of implications of prevention altruism are suggested and diverse research directions proposed to define a new domin of “Prevention caretaking.”     

Relationship among differentiation of self, relationship satisfaction, partner support, and depression in patients with chronic lung disease and their partners

The purpose of the present study is to test the relationships among differentiation of self, relationship satisfaction, perceived partner support, and depression in a sample of patients with chronic lung disease (CLD) and their partners. The sample consisted of 52 patients with CLD and their partners. Hierarchical multiple regression was used for data analysis. The results indicate that (a) patients' differentiation of self is significantly lower than partners' differentiation of self, (b) patients' relationship satisfaction is positively correlated with partners' relationship satisfaction, (c) patients' relationship satisfaction predicts perceived partner supportive behavior, (d) perceived partner unsupportive behavior predicts patients' depression, (e) partners' differentiation of self predicts partners' relationship satisfaction, (f) partners' relationship satisfaction predicts partner supportive behavior, and (g) partners' differentiation of self and relationship satisfaction predicts partners' depression. The study serves to highlight the fact that the patient is part of a system, and that taking the system into account is relevant to the well-being of both the patient and the partner, in particular for patients with CLD, a heretofore unstudied population. The results of such studies have significant implications for couple and family therapists.     

Staying strong: gender ideologies among African-American adolescents and the implications for HIV/STI prevention

This paper explores adolescents' definitions of what it means to be a man and a woman, the psycho-social context surrounding the formation of gender ideologies and their relationship to HIV/STI prevention. Semi-structured, in-depth interviews were conducted with fifty African-American adolescents living in Baltimore, Maryland. Female gender ideologies included economic independence, emotional strength and caretaking. Male gender ideologies emphasized financial responsibility, toughness and sexual prowess. Findings suggest that stronger adherence to male gender ideologies related to toughness and sexual prowess is influenced by male participants' perceived inability to fulfill their primary gender role as economic providers and the importance of gaining approval from male peers in the absence of adult male role models. Stronger adherence to female gender ideologies related to emotional strength and caretaking may be linked to a heightened desire for male intimacy and tolerance of male sexual risk behavior. Implications of the gender ideologies documented and their commonalities are discussed in terms of HIV/STI prevention.     

Staying Strong: Gender Ideologies among African-American Adolescents and the Implications for HIV/STI Prevention

This paper explores adolescents' definitions of what it means to be a man and a woman, the psycho-social context surrounding the formation of gender ideologies and their relationship to HIV/STI prevention. Semi-structured, in-depth interviews were conducted with 50 African-American adolescents living in Baltimore, Maryland. Female gender ideologies included economic independence, emotional strength and caretaking. Male gender ideologies emphasized financial responsibility, toughness and sexual prowess. Findings suggest that stronger adherence to male gender ideologies related to toughness and sexual prowess is influenced by male participants' perceived inability to fulfill their primary gender role as economic providers and the importance of gaining approval from male peers in the absence of adult male role models. Stronger adherence to female gender ideologies related to emotional strength and caretaking may be linked to a heightened desire for male intimacy and tolerance of male sexual risk behavior. Implications of the gender ideologies documented and their commonalities are discussed in terms of HIV/STI prevention.     

A commentary on the role of the female sexological examination and the personnel who should perform it

The sexological examination of the female patient, as performed in our Center, has proved to be an essential and almost indispensable diagnostic and therapeutic tool for the treatment of female sexual dysfunction. When performed by an adequately trained gyneco‐sexologist, in the presence of the patient's sexual partner (if available), this examination helps the patient to proceed through the process of gradually assuming self‐responsibility in searching and feeling for her specific “sexual nerve endings,” also enhancing communication between the spouses. The format and technique of the “female sexological examination” is described and the scientific background, indications, results, and reservations are discussed. Special emphasis is placed on the personnel who should carry out such an examination.     

More than just pain?! A systemic compass for working with people with chronic pain

Over one in four people in Belgium experience severe physical pain. One in 10 people develop chronic pain every year worldwide. Treatment of chronic pain is based on the biopsychosocial model. Scientific views state, among other things, that pain is a threat to the social self, which is an interesting point of entry for (mental) health-care providers. Conversations with people with chronic pain are always about more than just their pain; they are interesting and cover a lot of ground. Talking about feelings of being hard done-by, clarifying the complexity of the situation, examining the body as an autonomous entity, offering psychoeducation as a hypothesis, and a general attitude of not-knowing form a compass that allows us to attune to the patient and not take up an advisory position. Living with chronic pain requires negotiating with the outside world, being allowed to care for and consider the body, and being allowed to differ from the norm and still fit in enough in a world where the body is just a background figure. An identity transformation and the effects of trauma are described. We meet Eddy and Anne, both dealing with chronic pain, who bring theory alive. The author gives an insight into her personal search and struggles as a psychotherapist introducing systemic psychotherapy in chronic pain patients.     

Chronic pain and depression.

Because of the increased incidence of chronic disease and other health problems associated with aging, chronic pain is a common companion for the elderly. Pain is of great clinical importance, often associated with disability, loss of independence, and reduced quality of life. A fact that is of interest to psychiatric nurses is that many elderly with complaints of chronic pain also exhibit signs and symptoms of depressive disorders. Treating chronic pain conditions is complex and difficult, and health-care professionals are increasingly recognizing that psychological factors are often involved in the development and continuation of chronic pain problems. Depression is one of these influential variables. Increased understanding of the role of depression in the etiology and maintenance of chronic pain can improve assessment and intervention for the elderly with chronic pain complaints.     

The Meaning of Crying Based on Attachment Theory

Crying is inborn attachment behavior which, according to attachment theorists John Bowlby and Margaret Ainsworth, is primarily an appeal for the protective presence of a parent. Infant crying triggers corresponding caretaking behavior in the parents. These reciprocal behaviors help establish and maintain the parent-child attachment bond. Crying continues throughout life to be a reaction to separation and loss, to carry an attachment message, and to trigger caretaking responses. Crying can be classified according to the stage of the grieving process to which it corresponds: protest or despair. The absence of crying when it would be expected or appropriate corresponds to an unresolved grief reaction representing detachment. Each type of crying and noncrying elicits different caretaking responses with interpersonal, clinical, and cultural implications.     

WORDLESS PAIN

Current health care discussions often deal with issues such as self-determination, consumer orientation, civil rights and choices for patients and people with disabilities. Other experiences of illness and disability, such as pain and suffering are often avoided in these discussions because these expressions seem to confirm the public prejudice of tragic victimhood of people with disabilities. Various scholars have sought to reintroduce the enactment of the sick and disabled body into the discourses around disability. This essay is a part of that endeavour. Drawing on ethnographic fieldwork from a centre for physical rehabilitation, this article questions the idea that suffering turns people into passive victims of their bodies. By articulating the ways in which participants deal with suffering during the day-to-day activities of rehabilitation practice, the paper seeks to demonstrate that people do not passively sink into their suffering, but actively deal with it in the multiple settings and conditions of their embodied living. Three different ways in which rehabilitation participants deal with suffering will be unravelled. First, suffering is translated in the sense that it is transformed and transferred. Second, people actively manage their situation and balance different kinds of misery. Finally, people create a space where suffering is allowed to exist.     

Utility of Hospital Emergency Department Data for Studying Intimate Partner Violence

The authors examine 12 months of emergency department visit data (N= 2,521) from the National Electronic Injury Surveillance System All Injury Program and explore its utility for measuring and studying intimate partner violence. Given the dearth of national data on intimate partner violence–related injury and its potential value for public health surveillance and prevention, the data set appears promising for estimating national rates of emergency department visits. Missing perpetrator‐patient relationship data limit estimation of intimate partner–related hospital visits for injury and pain, which precludes national rate estimation at this time, but the data are still useful for describing documented intimate partner violence cases and may be helpful in designing prevention strategies.     

Intimate partner aggression perpetration in primary care chronic pain patients

This study examined the prevalence and correlates of partner aggression perpetration in 597 primary care chronic pain patients. Approximately 30% of participants reported perpetrating low-level aggression, 12% reported injuring their partner, and 5% reported engaging in sexual coercion. Women reported more low-level aggression perpetration than men, and men reported more engagement in sexual coercion than women. Substance use disorders (SUD) were associated with all outcomes, and both aggression victimization and lifetime ratings of posttraumatic stress disorder (PTSD) were associated with low-level aggression and injuries. In multivariate analyses, gender, aggression victimization, PTSD, and SUD evidenced associations with one or more outcomes. Findings indicate a need for aggression screening in this population and highlight avenues for intervention.     

Siblings as Providers of Support and Care during Middle Childhood: Children's Perceptions

This article describes some of the findings of a study undertaken to seek the views of 69 Scottish primary school children of their sisters and brothers. The study found that siblings were perceived to be a significant source of support and help to the children. Sibling support was particularly important to children with few other supportive relationships. Sibling caretaking which was viewed primarily positively both by the caretaking and looked after children, was found to be a common experience among the nine to 12–year-old children. Negative consequences of sibling caretaking included annoying, domination and abuse by siblings. Although over a quarter of the children's siblings were not living in the Same household, the majority of children perceived siblings to hold a special importance in their lives. Issues raised for parents and professionals concern the maintenance of relationships between siblings who do not live together; how to enhance the supportive aspects of sibling relationships, while offering protection against the negative aspects of sibling dichotomy; and facing the reality of sibling caretaking. Much more needs to be known about children's everyday experiences of growing up with their sisters and brothers, if we are to understand more fully the complexities of sibling relationships.     

Court orders and custody evaluations in Israel

Seven categories of concern entered into custody judgments--continuity, emotional welfare, support systems, children's wishes, parental agreement, caretaking, and child abuse. The literature points to the first four categories and caretaking as vital considerations for children's best interests. Beyond these findings, visiting rights were granted in all cases for the noncustodial parent, the family was always seen together, and the children were involved in discussion in the majority of cases. It is hoped that this study of social work practice in one country will add insight into the complex issue of custody and aid in the improvement of care for all children.     

Male Responsibility in Sexual Activity and Family Planning: Perspectives of a College Mental Health Professional

Abstract

Social movements of the previous two decades have forced a reevaluation of the traditional male role in sexual activity and family planning. Men are now expected to be active, responsible participants in decisions and actions concerning contraception, child care, pregnancy, partner satisfaction, and emotional bonding. While a number of rational “shoulds” have been advanced as guidelines for healthy, responsible male functioning, the actual behavior exercised is often a function of more irrational or conflicted motivations. The focus of this paper is an examination of motivations underlying maladaptive decisions by college males in the areas of sexual intercourse, contraception, and partner pleasure. The motivations involved in decisions to engage in sexual intercourse are classified and discussed along interpersonal and intrapersonal dimensions. The motivations involved in the use or nonuse of contraceptives are classified and discussed through use of Horney's interpersonal nomenclature. The motivations involved in the failure to give pleasure to one's partner are classified and discussed through use of sexual character types adapted by the author from Millon's personality typology. A societal influence on male lovemaking is also addressed. Concluding remarks address the difficulty of precisely defining male responsibility in sexual activity and family planning.     

Home Alone: Children as Caretakers in León,Nicaragua

This article seeks to explore and understand the life situations of sibling caretakers in poor areas in León, Nicaragua. The every day lives for caretakers were studied through observations and interviews with children, informants and parents. The children themselves were satisfied and proud to be trusted as caretakers and felt useful in contributing to their families’ livelihood. However, in a life course perspective the caretaking role implies a narrowing of life options. Early on they seem to acquire essential life skills but as they grow older many are at risk of falling behind due to their marginalised situation and lack of basic education.     

“I always expected to have grandchildren some day”: The long road from sense of loss to gradual acceptance

ABSTRACT

This paper explores, through the use of narrative data, ways in which older parents respond to the realization that they never will become grandparents. Stated reactions range from unresolved grief and anger to happily finding substitute ties to relief in having a retirement free of caretaking and gift giving expectations. While the research literature and popular media focus on the importance of grandparent roles from the perspective of the child, little attention is paid to either the importance of this role to the grandparents themselves or the magnitude of grandparent deprivation of this role in the lives of older adults.     

Functional disability among chronic pain patients receiving long-term opioid treatment

This study of 2,163 adult chronic, non-cancer-pain, long-term opioid therapy patients examines the relationship of depression to functional disability by measuring average pain interference, activity limitation days, and employment status. Those with more depression symptoms compared to those with fewer were more likely to have worse disability on all 3 measures (average pain interference score >5, OR = 5.36, p < .0001; activity limitation days ≥ 30, OR = 4.05, p < .0001; unemployed due to health reasons, OR = 4.06, p < .0001). Depression might play a crucial role in the lives of these patients; identifying and treating depression symptoms in chronic pain patients should be a priority.     

A Little Pain Never Hurt Anyone: Athletic Career Socialization and the Normalization of Sports Injury

How do pain and risk of injury come to be accepted as a normal part of an athlete's role-identity? Through an examination of the career history of Sam, an amateur wrestler, the normalization of injury is seen as a traditional form of role socialization. Sam learned to define pain and injury as a routine part of his sports career by observing and interacting with a variety of significant others. As he progressed into higher levels of competition, he encountered successful athletes and coaches who had endured considerable pain and injury in their own careers. Sam eventually gained acceptance from these elite athletes and became a role model for others through conformity to a demanding sports ethic, but he suffered progressively more serious injuries. Sam's career not only reveals the socialization processes that normalize sports injury, it also demonstrates how sports participation can become a significant health risk.     

Sibling Interactions in Married and Divorced Families:

One hundred twenty-eight sibling dyads, 64 from married families, and 64 from divorced, were observed on two separate occasions while playing a structured and an unstructured game. Half of the sibling dyads within each family form were from higher socioeconomic status (SES) families and half from lower SES families. The frequency of caretaking (e.g., directing, teaching, helping), negative, and positive behaviors were coded. Results revealed that sibling interactions in divorced families are both more negative and less positive than in married families. Siblings in divorced families also engage in more caretaking behavior. Similar differences were detected between lower and higher SES families, yet differences in sibling interactions in married and divorced families were not exacerbated by socioeconomic status. Younger siblings were more likely to be the recipient of caregiving behavior and to be more positive in their interactions. However, both older and younger siblings' behavior was influenced by the game context.