مدیریت یائسگی: تجزیه و تحلیل کیفی ادبیات خودیاری برای زنان در میانسالی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|33873||2003||14 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Social Science & Medicine, Volume 56, Issue 8, April 2003, Pages 1629–1642
This article reports on a qualitative social constructionist analysis that aims to examine the ways in which menopause and women's bodies are represented in self-help texts. In particular, we aim to compare texts with a more traditional ‘medical’ approach and others taking a more ‘woman-centred’ perspective. Four diverse self-help books on menopause and HRT available in England were analysed to examine the ways in which women, menopause and midlife were portrayed, and to investigate the construction of notions of knowledge, expertise and responsibility. The selected texts were published between 1992 and 1996 and covered a range of perspectives, including medical, alternative and feminist. Results showed that menopause was constructed as a ‘deficiency disease’ in all four texts, although in three of the texts this ‘disease’ discourse was counterposed by the simultaneous use of a ‘menopause as natural’ discourse. Menopause was also constructed as inherently complex and confusing, as were women's bodies. A discourse of ‘change’ was drawn upon in which menopause was portrayed as only one of the stressful events women must cope with at midlife. Finally, most of the texts drew on a discourse of ‘management’ rather than one of ‘treatment’ or ‘cure’ when discussing how menopause, and women's relationship to menopause should be handled. The medical profession was constructed as the primary source of expertise on menopause and women's bodies, although responsibility for the ‘management’ of menopause as a chronic condition lay solely with individual women. Although there were a number of differences in representations of menopause in medically oriented self-help texts and those adopting a more woman-centred perspective, our analysis also revealed several areas of similarity and overlap with regard to the construction of menopause and its ‘management’. The implications of these findings for the construction of menopause in self-help texts for women are discussed.
The term menopause refers to the point at which a woman ceases to menstruate and signifies the end of fertility. It occurs during a gradual, transitional stage, when hormonal changes and menstrual irregularities are taking place for many women. However, menopause is usually used as a vague, blanket term which covers a range of meanings (Hunter & O’Dea, 1997). There are a variety of differing perspectives on menopause that continue to be hotly debated (Logothetis, 1993), and there is widespread disagreement concerning what menopause is, whether it should be treated, how it is best treated, and what influence it has on (what is becoming reified as) the ‘postmenopausal condition’, health and disease. It is now relatively commonplace to acknowledge that the paradigms through which menopause has been represented have varied considerably. Gannon and Ekstrom (1993) cite McCrea (1983) and Formanek (1990) in referring to Western constructions of the menopausal woman during the Victorian era as an ageing woman with a decaying body and a sinful mind, suffering from dizziness, stupidity and vulnerability to insanity. Gannon and Ekstrom contrast this overwhelmingly negative representation of the menopausal woman with the more positive construction of menopause in Asian cultures as associated with a sense of liberation and freedom from pregnancy (Maoz, Dowty, Antonovsky, & Wijsenbeck, 1970). It is also commonplace to argue that the dominant theoretical perspective on menopause at the turn of the 21st century is the biomedical view that menopause is a disease caused by oestrogen deficiency (see Gannon, 1999; MacWhannell, 1999; Hunter & O’Dea, 1997). The emerging dominance of this medical discourse of menopause is associated with the production of inexpensive synthetic oestrogens during the 1940s. That is, the ‘medicalization’ of the menopause as a discourse of oestrogen deficiency has been linked to the emergence of synthetic oestrogens that can be prescribed to ‘treat’ this apparent ‘deficiency’ throughout women's middle and later life (Gannon & Ekstrom, 1993; Mishell, 1989; Studd, 1989). Although the medical approach to menopause is seen as the dominant if relatively recent perspective, it is not the only discourse through which menopause has been constituted. According to Dickson (1993) there are four main scientific paradigms of menopausal research, of which the biomedical paradigm is the most dominant. In this paradigm menopause is constructed as a negative event which requires medical intervention. In contrast, the sociocultural paradigm views ‘the experience of menopause’ as a developmental, natural event in which social and cultural meanings and contexts are important. In a related approach, researchers working within the feminist paradigm view menopause as yet another biological experience which has been used to suppress women's positions and led to the social control of women via medicalisation. Menopause is seen as a natural female process which often has social and class implications. Finally in the postmodern paradigm, researchers assume that menopause is a physiological transition, and that the experience of this transition varies greatly across individual women. Physiological, social, historical and cultural dimensions of knowledge about menopause are attended to in this paradigm, and no one form of knowledge (i.e. empirical) is privileged above another (see Dickson, 1993, for a fuller discussion of these paradigms and their underlying assumptions). It has also been argued that what Dickson terms the biomedical paradigm is associated with primarily negative constructions of menopause, whereas the various ‘alternative’ paradigms are associated with a more positive approach to menopause (Gannon & Ekstrom, 1993). Much of the literature cited above implies that the biomedical model of menopause as a deficiency disease operates in direct contradiction to an alternative, more ‘woman-centred’ approach informed (to different extents) by what Dickson (1993) referred to as the sociocultural, feminist and postmodern paradigms. One might therefore expect this contradiction between different constructions of the menopause and women's bodies in the academic, scientific and clinical literatures to be reflected in the extensive popular literature on menopause aimed at women. Recent research indicates that women obtain much of their information about menopause from the media and other forms of popular culture. For example, a recent study carried out in the USA found that women obtained information about menopause and HRT from healthcare providers, friends and mothers, but that their primary source of information was from women's magazines (Clinkingbeard, Minton, Davis, & McDermott, 1999). Indeed, 76% of women reported obtaining information on menopause from magazines specifically. Similar findings have been obtained in the UK, where in interviews and focus groups, midlife women report that their major sources of information regarding HRT and menopause are the media and social contacts (Griffiths, 1999). Thus the media are important sources of information on menopause and HRT for midlife women. Alongside this information, however, often comes a range of messages about womanhood which primarily concern the deterioration of the psychological and physical well-being of women as they age. As in scientific and academic writing, the biomedical perspective is dominant in popular media accounts of menopause. For example, Shoebridge and Steed (1999) examined articles relating to menopause in 10 years’ worth of two daily newspapers and four women's magazines. They identified 302 such articles, and their discourse analysis of this material highlighted that with few exceptions, ‘discourse about menopause drew on and reinforced schemata of ill-health, psychological disturbance, vulnerability, decrepitude, biological determinism and disease management’ (p. 475). Similarly, Gannon and Stevens (1998) examined the portrayal of menopause in the British media over the past 15 years, and found that almost all articles on menopause focussed on this time of life as a negative experience or as a disease, which was in need of medical treatment. Investigations into representations of menopause in the media, such as the two studies described above, can be extremely valuable (see Lyons, 2000; Lyons & Griffin, 2000 for discussions of the benefits of analysing media representations). Such analyses provide more than a simple critique of texts, but enable us to investigate in a systematic manner the way in which menopause is constituted in such texts. It is particularly useful as a means of examining how such discourses are drawn on to represent menopause, such that certain concepts and perspectives are emphasised, whilst others may be overlooked or marginalised (Kaufert & Lock, 1997). However, while there are often articles on menopause in newspapers and women's magazines, women wanting explicit information on menopause and/or HRT may also gain information from other places, such as books and public health leaflets. One site women may well turn to is the self-help genre. Self-help books are often a first source of information for people experiencing life changes, and changes in health. This genre is booming, suggesting more and more people do use such books to assist in their understandings of specific conditions, life stages and relationships, as well as for advice on ‘self-development and improvement’. Their relatively low cost, easy availability and accessibility, and their relevance to everyday problems all contribute to their popularity (Rimke, 2000). Indeed, self-help literature has become ‘an enduring, highly fashionable non-fiction genre, especially within the past 25 years’ (Rimke, 2000, p. 62). A number of researchers have examined the growth of popular self-help texts on issues relating to health, personal growth and the ubiquitous area of ‘lifestyle’ (e.g. Allwood, 1996; Rimke, 2000). The present research is based in part on Robin Allwood's useful discourse analytic study of five self-help texts on depression (Allwood, 1996). Allwood's study indicates that self-help texts perform a number of related functions. Self-help texts encourage readers to regulate our bodies and ourselves; they are aimed primarily at women; and they offer accessible accounts of a range of psychological and medical theories and practices or treatments. Allwood also argues that the growth of the self-help literature in the health field does not necessarily imply a loss of faith or confidence in more traditional ‘experts’ amongst readers. The literature cited above indicates firstly that the biomedical model of menopause as a disease of oestrogen deficiency dominates both the popular and the clinical domains; and that this discourse implies a negative view of menopause and of women's bodies. Secondly, the biomedical discourse is contrasted with the various alternative approaches to menopause represented by the sociocultural, feminist and postmodern paradigms, which tend to represent menopause as a ‘natural’ event with more positive connotations. In the present study, we aim to use a social constructionist form of discourse analysis to examine the representation of menopause and women's bodies in self-help texts, especially those taking medical and more alternative ‘woman-centred’ approaches. Do the different discursive constructions of menopause map neatly onto self-help texts that adopt a biomedical or ‘woman-centred’ perspective, or is the picture rather more complex? According to Palmlund (1997), there are three main types of self-help books on menopause: ‘wisdom’ books, concerning women's wisdom and power beyond 40 years of age, ‘flashy trendy’ books, describing women's successes and threatening what may occur if women neglect that menopause affects power and sex appeal, and finally ‘medical’ books, written by M.D.s. She points out that most of the books describe menopause as a milestone which ‘demarcates a land of darkness for a woman [who is] used to brightness’ (p. 89). However, Palmlund (1997) was primarily concerned with ‘the marketing of oestrogens for menopausal and postmenopausal women’, and her aim was not to present a systematic textual analysis of the discourses through which menopause and women's bodies are constituted. In the present study, we aim to devote particular attention to similarities and differences in representations of menopause as a deficiency disease and as a natural event in self-help texts that adopt primarily medical and alternative ‘woman-centred’ perspectives. Our aims are to undertake a discourse analysis of four diverse self-help books on menopause and HRT, to investigate the construction of women, menopause and midlife, and to examine issues surrounding the representation of knowledge, expertise and responsibility in different approaches to the ‘management’ of menopause.