Academic journal article Canadian Psychology

"Your Heart Is Never Free": Women in Wales and Ghana Talking about Distress

Academic journal article Canadian Psychology

"Your Heart Is Never Free": Women in Wales and Ghana Talking about Distress

Article excerpt

Abstract

In this paper we document women's own constructions of their psychosocial health and the way they trace the problems they experience to the social and material conditions of their lives. We report on two qualitative studies: one in which 35 women in South Wales were interviewed about their main health concerns and a similar study in Ghana, West Africa which included interviews with 75 women. Women's accounts of their distress are set in the context of three key issues: money problems, relationships with men and motherhood. Despite cultural differences in the expression of distress, the common themes point to the influence of gender relations and women's roles in production and social reproduction. We argue for greater documentation of the material and social circumstances of women's lives and their effects on women's health. In so doing, it is important to incorporate women's own accounts of their health.

Our focus in this paper is on women's own constructions of their psychosocial health: the ways in which they define their health problems and understand them in terms of the material and social circumstances of their lives. This is quite different from the dominant approach to women's health which has often emphasized the clinical definitions of experts, reflecting a biomedical model and underlining the value of medication in the treatment of problems such as depression (Stoppard, 1997; Walters, 1991). In contrast, we focus on what women themselves consider to be their main health problems. These typically include tiredness, stress, disturbed sleep, lack of time for self, anxiety, depression and thinking or worrying too much (Avotri, 1997; Walters, 1992) and, in seeking to understand them, women develop alternative constructions of psychosocial health which often emphasize the social bases of ill-health. Women's accounts of their health have received relatively little attention (Stoppard, 1998, 1997; Walters, 1991), yet they can show what women consider to be important and illuminate women's everyday experiences. At the same time, they can help to show how health, gender and class are socially constructed.

Women describe their psychosocial health problems in several different ways and, while referring to similar experiences, they might speak of stress, anxiety, depression, tiredness, "nervios" or "thinking too much," the terms varying crossculturally (Doyal, 1995). The challenge we faced in writing this paper was to chose a collective noun to refer to the different problems women described. Most of the terms in common use, such as depression, have specific clinical connotations and we hoped to avoid the misunderstanding that can arise by using terms that have different meanings for lay and professional audiences and for different disciplines. In the interviews which form the core of our analysis, women used a range of different words and phrases and we have chosen to refer to these collectively as "distress" and "psychosocial health problems." Neither of these terms has a precise definition yet they generally signify a lack of well-being and incorporate a range of health problems which are not exclusively physical in nature, though even this distinction can be somewhat arbitrary (Blaxter, 1990). We are interested, then, in women's constructions of the ways in which their psychosocial health is impaired. In developing these understandings, women reflect the circumstances of their lives and the ways in which these create or exacerbate feelings of distress, and they draw on available discourses which help to give expression to their experiences and render them more meaningful. Some of these will be culturally specific, though they may be grounded in similar constraints arising from material circumstances and gender relations.

Research suggests that in making sense of their health, women combine various models -- biomedical and individualistic cultural/behavioural explanations, as well as models which focus on the broader culture and social structure. …

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