Week 6 Questions: Impact of Culture and Gender

Answer one of these two questions:

1.       Does/should happiness require the resolution of conflict? What are the implications of your answer to this question for the practice of medicine and public health? Be sure to make reference to this past week’s assigned readings and Professor Scully’s lecture material.

2.       How does shame factor into the practice of medicine and public health? Be sure to make reference to this past week’s assigned readings and Professor Scully’s lecture material. (As an aside, those of you looking into the concept of shame here might be interested in this short piece from CBC Radio:http://www.cbc.ca/radio/undertheinfluence/shame-the-secret-tool-of-marketing-1.2801801).

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15 Responses to Week 6 Questions: Impact of Culture and Gender

  1. Lucky Khambouneheuang says:

    For many cases, patients always aspire for control of their own health and therefore seek healthcare providers to provide an immediate solution to all health-related problems. Patients instinctively attach happiness to this sought after resolution.

    Nonetheless, happiness does not necessarily require direct resolutions. In Dr. Scully’s lecture, we attempted to unpack the different complicating layers of medical care for Vietnamese refugee population. There were fundamentally two scales for treatment: the individual level and the social community level. Following a more Westernize practice in medicine, physicians often treat these outside groups with a simplified healthcare model—that perhaps helping these patient-victims talk about their pasts will ultimately help them resolve their struggles.

    This pinpointing, singular approach however fails to evaluate the problem in a bigger scale that includes culture and social influences. Given the many entangling factors involved, another way of looking at happiness is the recognition of an uncontrollable conflict and the cultivation of resilience. It sustains an exercise of control over attitude, which we will always have regardless of circumstances.

    Shame significantly impacts the kind of care that patients will often seek from their healthcare providers. In “What is Sex For,” Alice Dreger warns about the danger of messages fueling a need to normalize benign genital variations (213). Ordinary people often feel pressure to seek surgery for corrections in order to fit the norm. Still, not only can this lead pressure people to seek medical care, but it can also discourage. For instance, Vietnamese raped victims were less likely to seek care because of a mutual social understanding that it was best to leave the traumatic experience in the past.

  2. Matthew Brandon Fine says:

    Conflict resolution in medicine is a very hot button topic, as in the western medicine model there is definitely this perceived need to fix every malady to consider a case resolved. It can be seen in much of medicalized treatment in the United States, for instance how children who are deemed hyperactive are immediately prescribed amphetamines in order to make them more manageable. Or in the pharmaceutical industry in general, where much of the research and development budgets are spent on drugs that will resolve everyday issues rather than more holistic treatments that will teach people to live with their malady or mental illness rather than turning them into patients.

    While in my opinion it is important to confront the underlying causes of an infirmity; however, consistently hashing out these wrongdoings can certainly cause more harm than good particularly when patients and clinicians do not share a common cultural background. I thought this was poignant in the case of the Serbian rape survivors support group, where the women originally confronted their experience by not talking about it and being their for their fellow survivors, and then came in the western feminists who tried to force this issue to be spoken about. While the Western ideal was to bring this to the foreground it completely clashed with this support model and likely caused much more harm than benefit to these women.

    Then in the case of the Vietnamese rape survivors I think the response was much more appropriate to conflict resolution, as it took into account the particular social structure of these people as well as a western therapeutic model. In this case it was definitely important to get the survivors to a mental state where they could live without shame and not be consistently traumatized by what had happened to them, but there was also the confounding case where the community had ostracized these victims due to religious ideals. It was now important to take into account the social context as it was needed for the community to heal and treating the individual rather than the community would have left the process incomplete.

    I think that this need to move from “there is a problem here is your solution” leaves the western medical system in a precarious place. As we discussed in the Engaging Ethics week, there are major reconstruction efforts that need to be undertaken in order to make the institution of medicine more holistic. There is going to be more need for a focus on “ecological public health”, a process which takes into account more social aspects of health rather than solely its medical determinants. And as this course has taught us it is going to require changing how we change our physicians to look at people as people rather than medical problems, value systems play a large role in people seeking out medical help. As the chapter on medical admission forms revealed they are meant to outline an entire person in this sort of cookie cutter everyone is the same fashion, rather than taking into account what makes people unique and this has a large effect in ostracizing people from medical care the world over

  3. Lauren Maryse McNaughton says:

    Happiness does not require the conflict being “solved”, in a literal sense. However, it does require some sort of acceptance or contentment with the issue to a point where it is no longer affecting their overall happiness. This leads me to question whether or not acceptance is, in its own weird way, “solving” the conflict, emotionally. If a person is happy despite what is perceived as an issue, do they necessarily still consider it a conflict in their life? One thing that made me think of this question is someone with a “conflict” but is still happy, such as a popular model today named Winnie Harlow. Though she suffers from a chronic skin disease, vitiligo, she appears happy and continues to fulfill her dream as a model despite what many may consider to be a major problem. While I do not know what she personally feels, this no longer seems to be a “conflict” in her life, and she seems quite content.

    I feel the other end of this argument can be seen in chapter 20 of the Health Humanities Reader. Genital variations may be viewed as a “conflict” by society as a whole. However, it’s totally possible for someone with this “conflict” to not view it as one, and to be completely happy with it. With that being said, it’s suggested that the person asking for the surgery on page 211 was not accepting of their situation; it was a “conflict” that needed to be “solved” for the sake of their happiness. Therefore, I believe whether or not some sort of literal resolution is needed for happiness really depends on the person. It is not necessarily needed, but it may be for some people. It gets a bit tricky when the field of health treats differences and characteristics straying from the norm as something that must be solved. This even traces back to the topic of disability. Just because someone is different, does that mean they need to be “fixed”? Many of us agreed that it depends on whether or not the person with the disability wants to be treated. Therefore, I believe when it comes to the healthcare field, such decisions depend on what the patient wants. This gets a bit messier if the person’s life is in danger, as we saw in the disability and ethics sections.

    Moving on to the second question, shame plays a huge role in healthcare. If a patient is ashamed of their disease and how they may be judged for having this disease, the likelihood of that person seeking medical attention will more than likely shrink. We definitely saw this in Dr. Scully’s lecture regarding the Vietnamese refugees. The shame many of the women felt from being raped, and then being blamed for their traumatic experience left many of the women feeling afraid. While culture and other factors kept the women from speaking much about this experience and seeking medical attention, this feeling of shame is still something that keeps people from getting treatment today. This has a negative impact on the overall health of our society if people are afraid to get necessary treatment.

  4. Kyle Arbuckle says:

    Shame is one of the most pervasive emotions in medicine. However, it manifests itself in various ways. From Dr. Scully’s reading and presentation, we learned that women were under the impression that they were paying for their ancestors’ sins, not their own as would be the common notion of rape culture in the west (i.e. “she was drunk” “she was wearing skimpy clothing”). The rape victims were led to believe that they deserved it because their ancestors did something absolutely terrible, because that can be the only justification for that would happen to them. This overwhelming shame is obviously structurally violent, as it leads victims to justify their own rapes which is similar to the aforementioned Western rape culture. What makes the Vietnamese refugee cases interesting is that there would be shame if the women did not get raped. As Dr. Scully pointed out, the perpetrators would ask who is willing to be a victim and there’s the shame of using someone else as tribute, but then there is obvious shame of it actually happening to you personally. A double-edged sword. Interestingly enough, Dr. Scully stated how culture is not static, and from the CBC article we see how socially constructed shame is through media over the years. As Alice Dreger points out patients feel the need to get surgery to correct benign genital differences, just as the article reiterates the idea of people correcting things like grey hair and dark skin. So while shame is often coupled with stigma as a limiting force in medicine, it can also be a catalyst for action, albeit the wrong one.

  5. Kristine Rosenberger says:

    A primary characteristic of the American culture is that a problem must reach a resolution. Be it in medicine or battle if a resolution cannot be reached the party involved typically feels as if it has failed. Therefore under the traditional western mentality happiness is fundamentally dependent on the ability to solve any and all problems. While this in theory can serve to encourage great effort and accomplishments, in reality it can prove detrimental to an individual’s mental well-being. Such a mentality can provide for trouble in the face of issues such as incurable diseases where a solution is impossible. In this instance, should happiness be dependent on the resolution of conflict, we are saying it is impossible for the afflicted individual to experience joy – that a part of a person that is so fundamental in their personal identity makes it impossible to live life to the fullest. Therefore the assertion that happiness requires the resolution of conflict diminishes the importance of the individuals story – as a society it is important to move towards a world where it is the norm for individuals to be able to experience joy even in the face of conflict.
    The way that American medical practices operate in today’s world sends the message that it is ultimately impossible to be happy in times of conflict, namely illness or injury. This thought process can be dangerous as it prevents the American people from considering another country’s explanatory model for various ailments and can cause them to act in ways that are not affective coupled with the society’s culture. The belief that happiness and conflict cannot coexist is not a universally supported belief; American aid acting on this notion can have a variety of repercussions for the health of a nation. As was mentioned in both Dr. Scully’s talk and the article about Vietnamese women and rape, culture is dynamic and is not merely a system of firm beliefs held by a group of people. The PTSD response protocol is predominately based on western values; it is believed by American respondents to be universal but does not take into consideration cultural factors that impact the expression of both despair and happiness. This case provides a crucial example for the importance of cultural therapies – it is impossible to aid a people without understanding the member’s meaning they assign to an event. The western model assumes everyone experiencing a form of psychological turmoil needs and would benefit from a form of counseling. Instead of immediately implementing western protocol to aid it perceived mental illness we must first understand the cultural significance of the event. Only then can the afflicted individuals regain their health.
    By intervening in other cultures without a profound understanding of that culture’s definition of conflict, American aid has the potential to be seen as unjustly pious. If the western requirements for happiness are exported to other nations we run the risk of greatly hurting a foreign nation or insulting its cultural belief, preventing the nation from being able to benefit from any type of aid. For example when trying to warn other nations against the dangers of female genital mutilation, American health workers failed to take into account the cultural and emotional significance of the procedure and focused solely on its relation to health. Though this intervention did aid to solve a health crisis, it stripped a people of their identity, taking their happiness along with it and further illustrating how health and happiness are not necessarily contingent upon one another. Female genital mutilation “is held up as one ‘proof’ of the primitiveness of certain parts of the world and the need for Western intervention to ‘rescue’ victimized women” (Levine-Clark 225). The exportation of the American view on happiness has a variety of repercussions for global health challenges as by acting in a way that would be of benefit to us, we neglect the definition of happiness found in other cultures. This is hence a crucial example of the negative connotations associated with the direct link between happiness and lack of conflict; in order to ameliorate the health of those all over the globe it is critical to find happiness even in times of conflict.

  6. Amelia Elizabeth Van Pelt says:

    Shame, a powerful feeling, arises from guilt, embarrassment, or failure that often stems from societal beliefs. For example, Vietnamese culture holds expectations of a virgin wife. If the woman violates this expectation, then society considers her “spoiled” and leaves the woman feeling ashamed. However, as discussed in the reading, on the ships fleeing the country, the pirates shifted the sense of guilt by requiring the men to select the women to be raped. As a way to cope with the guilt, the men justified their choices by shaming the women for believed past faults in their lives. As a result, once the survivors of rape reached the host countries, they developed a sense of mistrust with physicians and often refrained from seeking treatment. Moreover, this idea of a “blame culture” exists within the United States as well. For instance, as Kyle articulated, American culture expresses that the women asked for the sexual violence through their clothing, for example. Thus, society shames women, and the survivors forgo seeking treatment out of fear of stigmatization. Therefore, negative physical and mental health outcomes could occur. Moreover, society in the United States places guilt on people with other stigmatized diseases and illnesses as well. For example, people with sexually transmitted diseases often feel embarrassed, which results in them avoiding treatment. Furthermore, other cultures stigmatize HIV/AIDS, which hampered the attainment of the sixth Millennium Development Goal. Therefore, shame influences public health outcomes as well. Unfortunately, corporations have perpetuated the feeling of shame by capitalizing on social embarrassment. For instance, the attached article explains the use of shame in advertising antiperspirants. Thus, the idea of shaming an individual exists in various aspects of the medical and public health fields.

  7. Akanksha Samal says:

    Answering question one.

    No, I don’t think that happiness should require the resolution of conflict. We live in a time and a culture of instant, hedonic gratification in the Western world, which unfortunately takes away from the long-term, eudaimonic sense of happiness that is more purposeful despite the time and effort it takes to achieve it (I think of it as a sense of inner peace). This version of happiness might not result in conflict resolution, but it enables people to develop coping skills or a sense of acceptance that things will eventually be okay. I think a prime example of this was the women’s support group Dr. Scully mentioned where victims of sexual violence would come to the group to talk about everything but their experiences, which facilitated their transition back to normalcy. When other women attempted to impose the Western standard of psychological treatment on these victims, it was disastrous. While talk therapy is useful for some people, being forced to talk about a traumatic event can be triggering for others.

    Ultimately, achieving a state of wellness depends on the person and how they want others to help themselves. The Transcultural Psychiatry article we read for this week discusses how humanitarian aid groups tried to bridge the gap between Vietnamese cultural values with the individual thoughts and feelings of the female victims. While there was no clear resolution, I think the article highlights the importance of cultural therapeutics in patient care and the difficulty of compromise in such situations. The most important thing for the practice of medicine and public health is to stay open-minded and receptive to a patient’s sense of identity from their gender, religion, culture, and so on. Even if a clinician or therapeutic aid has not been in the same position as their patient, empathy is extremely important in the treatment process. If said clinician cannot find a way to help their patient help themselves, I think it is perfectly fine to help the patient find other sources of support that can.

  8. Jennifer Becerra says:

    One way that shame plays a role in medicine and public health is that it appeals to the insecurities of a person. One example is the one the article gave which linked a toothpaste ad to odor. If a person didn’t brush their teeth then their breath would smell and they would not be able to find a mate. In all societies people yearn to be accepted by their peers, and because of this people would rather look and act like their society’s “perfect person” than to be themselves. Knowing this companies within medicine and public health use a shaming mechanism to get people to do things. For example one thing a clinician can tell an overweight person is to do exercise in order to look healthy. By saying this there is a shame that is put on the person for not exercising. This shame then leads to insecurity which doesn’t leave until the person looks “healthy”.

    Shame also plays a role in shaping cultural norms. A good example was from the readings from Professor Scully’s lecture, in which the women from Vietnam were considered impure if they were not virgins before marriage. Later on when they were raped, the women were told that they would still be considered of a social stature since they were helping to protect their people. However once the people were forced by the pirates to choose with of the women were to be raped, the people needed a reason to justify their actions so they said that the rape victim’s ancestors must have done something bad and that was why the women now suffered the “consequences”. This then brought shame on the raped victims again, which prevented them from seeking medical attention once they reached their new country.

  9. Farida says:

    I’d like to refer to Lucky’s post on the scales of treatment, but break these scales down further to consider the individual, the family, and the society. All of these levels attribute to the stigmas associated with health, whether it is mental, physical, or spiritual health. As a human emotion and within the realm of public health, shame is a response to guilt. It’s not being able to show one’s face without feeling unworthy. This guilt comes with believing that a particular circumstance could have been avoided were an action or preventative measure been taken. From Dr. Scully’s lecture, we learned about how cultural ideals created stigmas around sexuality and gender. If women were revoked of their status as sexually pure, and men were revoked of their protective role, they were no longer considered worthy as members of a society. This evoked shame in victims of rape. However, in order to move past this, religion was used to validate certain actions against victims. Unfortunately, this transferred guilt and shame from the complicit to the victims and their ancestors. To consider whether happiness requires the resolution of conflict, we can see that in the case of the Vietnamese, such a solution did not necessarily breed happiness. Rather, individuals, families, and societies found comfort in the process of attaining happiness and overcoming conflict. Resilience, as mentioned by Courtni in class, brought about happiness. We cannot flourish by being given a solution. We must seek it for ourselves and in that journey, appreciate our potential to grow, thrive, and carry on.

    As we discussed in class, the idea that we ourselves are responsible for our health and well-being can evoke shame. Like Judy mentioned, medical and health practitioners follow a standard of medicine that is intended to work for everyone. Treatments of surgery, chemotherapy, or drug-therapy should be enough to control cancer. If this isn’t the case, I can imagine that a patient would feel that they should have been more attentive to their body to detect it earlier, or they shouldn’t have spent so much time using devices, which emit radiation, or perhaps they just have “bad blood.” All of these biases and perspectives affect attitudes towards health. Like Susan Squier mentioned in the Health and Humanities text, it is important to convert these negative stigmas into positive and more open conversations (Squier, 240).

  10. Courtni Alexis Andrews says:

    I would disagree. Happiness does not require the resolution of a conflict – Happiness comes about when we’re in a balance and can deal with the various stressors, ideas and life circumstances that each of us has to interact and engage with. And sometimes, these circumstances can’t be resolved in a way that erases the damage, as in the case of the Vietnamese women who were “chosen” and raped – they can’t go back in time and change their own history. Even moreso, as demonstrated by the feminists who came to the Serbian Support Group, people have different ways of coping and dealing with their own troubles, which can’t always be resolved by talking about it or being completely overt about it. However, as I believe that medicine and public health can do (as demonstrated by the approach made by the Transcultural Psychiatry article), people can deal with their lives and circumstances in a way that can utilize built-in resiliency and promote growth if their inner and outer worlds are catered and thought about – healthcare professionals can utilize public health in practice by thinking about how the environment affects the individual and how that same individual reflects back on that environment. Medicine can give ideas and tools for the physiological, psychological and emotional health of a person in an open-minded way, even if the doctor sees that patient only once. Their cultural, social, personal, sexual and individual identities should be thought of, but also reaffirmed and not dismissed. In addition, there is an idea of posttraumatic growth in positive psychology that highlights that posttraumatic growth is a step further than just resilience – it is not only the ability to adapt to life adversity, but it is also positively transforming as a result of the psychological stress. Essentially, “what doesn’t kill you makes you stronger”. This does not mean or advocate that people should go through straining life circumstances, but it highlights the importance of how people are strong in however they cope (whether that involves joining support groups and engaging in advocating for certain rights or being upset about the situation, but learning how to come back to baseline after some much needed time and reflection) and happiness is an on-going, lifelong process. If people can be resilient, gritty and work with themselves and the world around them, if there are parts of who they are that may not be in the mainstream, life may never be perfect, but it should promote an individual to live a sound life, with a sound soul and a sound body.

    However, as Dr. Scully mentioned in her lecture, there is a cultural and socio-historical dynamic with our outer world that pervades how we interact with people, how we see the world and how it affects our internal lives. Shame is something that can block or prevent us from getting the help we need. Shame may explain, for example, why some may feel the need to gain or lose weight. Shame may also be a tool that may cause those of us who don’t fit the gender or cultural norms of a “normal” body (which does not exist since there is no one standard body) to feel out of place. Individuals who have been raped and sexually assaulted may feel ashamed because they are often told they deserve it, that it was their fault or their history that lead to what happened as it was illustrated by the Vietnamese women and illustrated by the readings from the Health Humanities readings. While things are changing to promote getting rid of the stigma of sexual assault, rape, mental health and other important topics, until we disentangle the shame that is cultivated by perceived norms by dismantling what’s wrong with our current models of thinking, we can overlook a problem, dismiss someone or promote pain without meaning to.

  11. Aisha Omolola Morafa says:

    Shame is so engrained into society and how we interact with each other that we don’t even notice it. We indistinctly think that if someone does something abnormal or incorrect, that they should be ashamed, and that we should expect them to feel shame. The CBC Radio piece has shown how media and marketing uses that shame for profit for their products that can “fix” the reason for shame. But this causes a deeper psychological issue. We then unconsciously live our lives avoiding acts out of fear of embarrassment, such as putting on deodorant and whiting our teeth to avoid looking unattractive rather than doing it because we believe in good hygiene. If these routine things are plagued with stigmas and shame, how can we not be surprised that unplanned events cause life lasting shame?
    In our society we treat rape quite poorly by placing blame and shame on the victims of a sexual and violent act. In the presentation and readings, Professor Scully talks about the Vietnamese boat people escaping after the war. On the trip, many pirates hijacked, raped and killed the passengers. This became so known that they changed the cultural mindset of the community to even designate someone to be raped and “sacrificed” for the good of all. And once they were safe in other countries, mainly the US<, they were then shunned and ostracized for having been raped. This double-edged isolation was also religiously justified because they must’ve had some bad karma, and this was their punishment. Now obviously in times of war, the stressful environment brings the worst out of people, but when it comes to treating these individuals, common practices of medicine can’t always work.
    Aside from the example in the presentation, shame is still present in the patient – doctor relationship. Patients may avoid explaining to their health care provider how and why they have certain symptoms, because they have this patriarchal view of them and feel like they may disappoint them. But this can be problematic because it may prevent full treatment. One example is a patient not disclosing they had unprotected sex and may either be pregnant or have passed STI’s because of the social stigmas and shame they want to avoid. But then the healthcare provider won’t be able to treat and they may be putting others at harm. But obviously social shame cannot just be fixed in the observing room, but society must change.

  12. MacKenzie Jill Brosnahan says:

    One way that the cancer patients, or others with a disease that cannot be fully resolved, can achieve happiness is through acceptance of the situation. We do not have the power to cure cancer or Downs. However, these people can still be very happy. One example that I can use from my own family’s experience is my great-grandma. She lives for many years with an aggressive form of cancer, but she was still one of the happiest people I knew growing up. When I talked to my mom about her grandma, she told me that she had come to accept the cancer as a part of her being. She was able to take out the good and positive parts of the cancer – yes, I do believe that some good can come out of cancer. She was able to spend the rest of her time surrounded by people who loved her; she was able to get to know her great-grandkids, and she was able to do the things in life that gave her true happiness and joy.

    In a medical realm, this does not mean that we do not try to heal people. It ties back to our conversation a few weeks ago. We continue to try to “fix” what we can, but at some point, especially in cases of cancer or other diseases that we cannot fix or cure, we have to reach a level of acceptance or else we would have a lot of people who would not be happy, as we have so many cases of cancer.

    On another note, when I think about people saying that there needs to be a certain anything in order to have a certain outcome I question the validity of the claim. This relates to Professor Sully’s mentioning of the rape victims and how talking about the rapes did not necessarily resolve the issue in the American’s eyes. For the victims, the “have a problem, talk about it, and solve it” formula that we use here in the US does not apply. Instead they use their own coping methods to move on and still be happy without resolution of the problem. A very similar situation occurred in the study I mentioned in class. The victims of the natural disaster had more cases of PTSD when forced to go to the American provided therapists than did the victims who were left alone to deal with the processing and healing from the natural disaster with their own community.

  13. Kayleigh Jo Moss says:

    As we discussed in class on Thursday, the United States tends to function under a damage/repair paradigm that has infiltrated every aspect of society. We have self-help books galore and our healthcare system is designed the same way. You have a cut? Here’s a band-aid. You have diabetes? Here’s the insulin. But I wonder if our healthcare solutions aren’t more like band-aids than we realize. With this intense need to resolve an issue right away are we never really resolving the issue? If we prescribe medication and give insulin without addressing the causes are we ever actually treating the “wound” or are we just applying “band-aids?” I think our drive to resolve problems as soon as possible is, in many cases, actually hurting our quality of healthcare.

    Happiness does not require the resolution of conflict. As we discussed in disability ethics, this need for restoration often serves to stigmatize, isolate, and undervalue human variation. As Dr. Scully discussed on Thursday, some things (for instance, rape survivors) are not things or situations that can or should be “resolved.” Furthermore, who are we to impose our own perception of what the “resolution of conflict” is? It’s different for everyone. We all find happiness in different ways and that is often shaped by our cultural backgrounds.

    If we continue to work under this paradigm of happiness=cure=resolution, we are inherently fostering shame in countless patients. When we are made to believe that a given solution is THE solution and it doesn’t work for us, we often feel inferior – like we are the ones who have failed. For instance, the women in Yugoslavia who were told if they talked about their experiences they would feel better or the one seeking counselling who doesn’t feel better and thinks it’s their fault. Furthermore, shame plays a role in mental health and the mental health o a community. When people are made to feel ashamed and blamed for their actions or the actions of others (rape on Vietnamese boats), it will often affect their mental and physical health. Furthermore, stigma and shame around certain illnesses can prevent treatment and proper care.

  14. Olha Seredyuk says:

    I am answering question 2, in regards to shame.

    Let me start by referencing Dr. Pamela Scully’s lecture. As we recalled the article in Transcultural Psychiatry and the story of sexual violence experienced by Vietnamese women, I thought it was interesting how guilt that accumulated within their refugee community eventually “snowballed” into shame. From what I know, shame is much deeper than guilt, because while both are negative, guilt is associated with doing something wrong, as opposed to being wrong to the bone (as in: “I am bad, and I will always do bad things”). Based on this, I can assume and agree with several of my classmates that shame is socially constructed and a learned response to self, given the power to make judgments out of the fear of assuming responsibility. While shame is a by-product of culture and can certainly change culture (as in the case of the Vietnamese refugees), Professor Scully also mentioned something, which I found to be of great importance:
    “Vietnamese culture is “X” would not help us understand what happened to these women, because culture is not static.” – that is the concept of culture has a lot of moving parts. On the one hand this makes culture an overwhelming concept to tackle, but ultimately, because it has a lot of moving parts, it is malleable; it may be “changed back” or transformed into something else – something positive – ideally.

    Next, let me tackle the implications of shame on the practice of medicine and public health. Shame can be a big problem when it comes to healthcare. If healthcare’s purpose is to advance or improve health, shame can hinder progress. Shame is a hard thing to communicate and healing takes time. I liked Courtni’s comment in class about prioritizing resiliency for more intentional, compassionate practice of medicine. In our assigned reading, the chapter on comics in the health humanities impressed me, because comics are able to offer a more humanized perspective on sexual education, ethics, disability, and sexually transmitted diseases. Their ability to communicate between the lines of straight clinical talk makes people more receptive (Health Humanities Reader, 234). A couple of years ago, I assisted in teaching ‘sex ed’, and I observed that students were unfazed at the facts (for example, that 1 in 4 new HIV infections occur in youth 13-24 and that 60% are unknowingly passing the virus to others). However, when the instructors tried to get the students to imagine what it must be like to live with HIV, to live with stigma of the disease, to know someone at their school who has it, the students became more receptive and identified with the feeling of shame or how their classmate may feel shame, and what they can do to help them reintegrate into society, to be seen as a person with an identity rather than the identity of a disease, etc. Perhaps what I’m asking needs a little bit more development, but I’m interested in how might we transform shame into something positive in culture? How can we know and prevent guilt from becoming shame? How can we use shame, how can we represent it in such a way that it becomes a foundation for resilience?

    When I visited the CDC Museum for the first time last year I frankly did not expect so many things to be communicated through art and advertisements. In terms of public health, I think we need to be careful about what kind of messages our prevention communications send. Ultimately, it would be useful to understand the fine line between messaging that can elicit guilt as opposed to shame. This is clearly was an issue in the B.O. advertising of the 1920s in America (CBS Radio).

    Sometimes messages sent via the media or to the patient via physician than elicit shame can increase unhealthy and destructive behaviors, as this is often the case among alcoholics. Knowing the difference between guilt and shame a little like knowing the difference of positive v. negative wording (I want to be on time v. I don’t want to be late). Good/compassionate communication is a cornerstone of effective public health education and practice; I think aligning emotions and messages is important if we want to elicit the right responses.

  15. Emily Pieper says:

    I do not believe that happiness always requires the resolution of conflict. If a patient is content with their life and health but a medical professional believes that the patient has a health issue, is the perceived problem really an issue in the patient’s life? If they are content, does it or should it impact their happiness?

    I am part of Emory Miracle and we recently hosted our annual Dance Marathon event which benefits Children’s Miracle Network. Every year we invite families who are a part of the Miracle Network at Emory’s Children’s Hospital to come and share their stories. It never ceases to amaze me how strong and happy all of these children and their families are. Even though these children have debilitating conditions and in some cases physical differences, they appear to be happy children. One young boy Parker who is suffering from a persistent brain tumor ran around throughout the whole event, socializing with anyone he saw, helping the DJ play the music, and repeatedly telling everyone that he was our friend. The life and love radiating out from Parker leads me to question whether or not he is actually “suffering” from his condition. His conflict or medical condition may never be solved, but he appears to be happy with his life.

    The apparent need of society to completely resolve conflicts is also illustrated in chapter 20 of the Health and Humanities Reader. Society tends to view genital variations as unacceptable and things that should be taken care of. While medical professionals and some members of society might view genital variations as conflicts, individuals with these variations may be perfectly content with their bodies. Some people may feel the need to fix or cure their conditions in order to be happy while others may not. Conflict resolution and happiness therefore depend on the individual; even if their condition is viewed as a conflict, disability, or deformity, their happiness cannot be determined by the opinion of anyone else.

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