Red,Hot,Healthy Mommas

Reflexively Connected Cultural Conceptions and Medical Pathology

Culture and medicine perpetuate a linked metanarrative reinforcing a system of interlocking oppressions depriving women of a voice in today’s society. These oppressions include the reproduction of sexism, ageism, and ableism that maintain barriers to social and environmental access to healthcare. According to Ehrenreich and English (2005), the female body, “as a site of sickness,” has been subjected to the microscopic gaze of both medicine and culture. As this site of sickness becomes defined and named within the medical community, it begins to inform our cultural perceptions of a certain group in society associated with this stigma (Goffman, 1963). The self-reinforcing cycle of these conditions has implications for women.

Some scholars have worked to expose these binds by contextualizing women’s issues emphasizing feminist standpoint epistemology. Alternative stories created by women who emphasize their own perspective in society may offer other ways for constructing knowledge surrounding aging. According to Arnold (2005), women transitioning from their 40s to their 50s employed strategies including figuring out what was important to them, letting go of material things and unrealistic expectations, living for the here and now, creating new paths of life interests, redefining roles and meanings in relationships, and being free to just be. Even so, difficulty still surrounds the ways individual stories are reconnected back into the health meanings we attribute for ourselves.

Harris (2008) reminds us that “we all age differently as we journey from womb to tomb” (p. 963). However, meanings from these transitory stages of life are often concealed due to cultural conceptions of aging and medical pathology reinforcing one another in order to sustain a cycle of silence. For example, a double standard exists where one party is privileged due to social, economic, and political inequalities and treated differently from another group in society (Sontag, 1972). Aging women and persons with disabilities concerns regarding pain assessments and medication are not taken as seriously as male patients (Ruhl et al., 2006; Yorkston, Johnson, Boesflug, Skala, & Amtmann, 2010). Consequences ensuing from such unequal treatment affect not only one’s identity but also one’s health status. Women have often been known to withhold information regarding pain. Rather than perpetuate the cycle of silence, scholars have urged both women and healthcare providers to be aware of this reluctance to disclose information when communicating with their patients (Ruhl et al., 2006). Treating each patient individually also involves contextualizing historical, cultural, economic, political, and social conditions in order to avoid reproducing inequalities in healthcare.

Individual stories are helpful and empowering but still may serve to reinforce cultural and medical norms dominating the meanings that inform the aging process. In continuing to explore how women transitioning through phases of aging come to understand themselves, it is necessary to interrogate cultural conceptions and medical pathologies. By understanding how counterstories can inform women’s sense of aging and available healthcare practices, we may comprehend better the complexities intertwined within the metanarrative that perpetuates the status quo and stigmatizing identities.

Integrating Aging Bodies and Minds

Although mind/body dualism has been debated since Descartes, how the connection between the two is understood in modern discourse is of growing interest in contemporary health communication studies. Largely absent from the literature is how the body in the biomedical healthcare model is broken down into a “thing,” a commodity, something that needs to be fixed when damaged. This line of thinking separates the mind from the body by focusing on the physical problem or issue associated with the disease (Frank, 1995). However, when exploring further the mind/body duality, one may find that this disconnection is not easy to reconcile.

As previously discussed, cultural conceptions and medical pathology often serve to produce and reproduce a hierarchy of knowledge that superimposes meanings upon the self. Conway and Hockey (1998) address some of these issues in an article identifying the synonymous relationship our culture puts on the terms (dreaded) old age and (declining) health. In their view the two concepts intertwined to compose an inevitable part of the aging process. Consequently, illness is looked upon negatively by individuals who see it as a sign of weakness in aging. As a result, what often occurs is a distancing of the body from the self, whereby one is constantly negotiating the meanings connecting past, present, and future senses of self in order to reduce this distance.

During this renegotiation, some women employ counterstories in order to redefine and resist mind/body impediments. Feldman (1999) shared how one participant in her study requested not to be called “dear.” Women take on new forms of transgressions by disrupting discourses used to create obstacles to self-fulfillment. In exploring barriers to access among older women, Tannenbaum, Nasmith, and Mayo (2003) found that there is a need for an integrated approach to healthcare. Their approach addresses the language barriers that hinder acquiring health information. The main issues participants discussed included the “importance of being validated as a person,” “recognizing fears and anxieties” surrounding aging, and being supportive of “education for health maintenance” (Tannenbaum et al., 2003, p. 8).

The ways in which the biomedical paradigm seeks to fix a broken body has implications for how one comes to terms with one’s own sense of self. This is because a stigmatized individual tends to internalize beliefs originating from accepted norms (Goffman, 1963). Favorable mind/body interconnection is an ongoing negotiation with the self informed and influenced by our connections with others.

Participation as a Site of Resistance

Historical, economic, political, and social conditions inform the ways we interact with each other on a day-to-day basis, which also come to inform interactions between patients and their healthcare providers. According to Roberts (2004), “older women, because of their historic powerlessness and silence, may be at even higher risk for passivity in critical interactions about their health” (p. 665). Healthcare programs sponsoring the active participation of aging women like that of Red, Hot, Healthy Mommas (to be discussed below) offer a space for encouraging dialogue between patients and providers contributing to improving one’s competence and confidence during healthcare encounters.

Research has found that participation in collective activities increases one’s sense of self-esteem, activism, and overall quality of life (Nummela, Sulander, Karisto, & Uutela, 2009; Hutchinson & Wexler, 2007; Son, Kerstetter, Yarnal, & Baker, 2007). Hutchinson and Wexler (2007) explored how elderly women’s roles in Raging Grannies, ranging from 50 to 90 years of age, positively contributed to health and aging. Participation in these organizations empowers women to create places of resistance and increase self-confidence and self-worth, positive social identity, and purpose (Hutchinson & Wexler, 2007). Son et al. (2007) explored how the Red Hat Society, ranging in age from 50 to 90, provided a space for individuals to relate to one another. Experiences of care-giving, resistance to negative stereotypes, and personal transformation were among the themes that contributed to their newly reconstructed senses of self (Son et al., 2007). These communal activities foster collective identities that serve as bases for transformative change.

Narrative Analysis

Storytelling contributes to ways in which women informed by lived experience can counter cultural/medical norms, mind/body dualism, and actively partake in shaping their own healthcare practice. Stories have the ability to transgress societal barriers and create a space for renegotiating a sense of self. By beginning to narrate the self, Harter, Japp, and Beck (2005) explain, “we embody what we call our self and its actions, reflections, thoughts, and place in the world” (p. 10). The vulnerability of those facing challenges, life-threatening disease, addiction, or abuse issues can be a daunting struggle in what was once the normalcy of one’s life. Coping during stressful periods of change is often a process that involves the telling of stories that shape and reshape life.

Narrative as a method of inquiry provides an in-depth description of another’s lived experience. Narratives invite a space where participants are able to discuss events as they unfold in story, thus emphasizing what matters to the narrator. Narrative analyses involve a dialogic process where interpretations of self, others, and society are understood through exploring agents, plots, sequences of events, themes, and scenes (Gubrium & Holstein, 2009; Lindlof & Taylor, 2002). Meanings that evolve in story are then interpreted as they are connected to the individual teller as well as to the larger social context.

Nelson (2001) characterized counternarratives as stories that oppose metanarratives. Metanarratives are stories that presuppose one meaning by reducing fragmented pieces of knowledge while simplifying and suppressing other meanings (Lyotard, 1984). Nelson (2001) identified two types of counterstories. One type of counterstory is “reidentification,” in which one engages in a journey of self rediscovery in order to change one’s own internalized perception of oppression. The second type of counterstory is “resistance,” in which one recognizes oppression and reacts by changing the perceptions of others. According to Nelson (2001), one must address identity, oppression, and resistance in order for a counterstory to be effective and enable moral agency. However, because of the mystification that metanarratives possess, how one responds to identification, oppression, and resistance varies. Nelson’s (2001) reidentification and resistance counterstories are useful; nevertheless, stories also may be used to negotiate the tension between an oppressive metanarrative and the storied self. Because the reidentification and resistance counterstories fail to account for the contradictory positions we hold, I call forth a negotiated story. I refer to this as a “negotiation” story in which one may conform to one meaning, consequently reinforcing a metanarrative, while simultaneously embracing a plurality of meanings that do not force a fixed position of the self.

I explore these three types of counterstories in order to understand how woman reidentify, resist, and negotiate the aging process. Counterstories open up possibilities for understanding self and other differently in an effort to potentially emancipate one’s moral agency. I also seek to understand how woman employ counterstories to combat the reflexive trap of cultural conceptions and medical pathology and negotiate mind/body dualism. Keeping this in mind, the present study addressed the following research questions:

Narrative Collection

After receiving IRB approval, I interviewed six women who regularly attended a program aimed at fostering active participation in their own healthcare conversations. Red, Hot, Healthy Mommas was founded in 2009 at a local, Midwest hospital in the United States with the overall goal of providing resources and education for women going through changes as they age. Originally, the local hospital paid for the rights of the nationally recognized program called Red, Hot, Mommas. However, because the national programming failed to address the unique needs of the local community, Red, Hot, Healthy Mommas was formed. Red, Hot, Healthy Mommas added more programs to provide a space that integrated local community members’ personal health testimonials along with healthcare provider education. The improved focus from national to local better served the needs of the women experiencing transitional stages of life as well as introduced topics such as premenopausal and postmenopausal issues. The program ran for 2 years and then discontinued due to organizational changes and costs. On average there were approximately 30 women in attendance, ranging in age from 50 and upward. About half of the participants provided me with contact information, with half of this number agreeing to meet with me within the time frame prior to the discontinuance of the annual programming. These programs provided a variety of resources, from holistic and alternative medicine to nonholistic medicine.

Sample

The women in this study ranged in age from 50 to 65. This demographic is unique due to the transitioning stages of life through premenopausal, menopausal, and postmenopausal years. Research indicates that women who are approached by healthcare providers during these transitional states are more likely to be proactive about their health instead of reactive (Smith-DiJulio, Windsor, & Anderson, 2010). In addition, more information is needed from this demographic to understand how health risks are negotiated (Smith-DiJulio et al., 2010).

Each interview began with a few warm-up questions asking the participants when and how they first heard about the program, Red, Hot, Healthy Mommas. Next, I asked the participants to provide a story about their experiences with the aging process. The participants were then asked to share their story about the educational programming of Red, Hot, Healthy Mommas. Finally, I inquired about each participant’s encounter with her healthcare providers prior to and following her involvement with the Red, Hot, Healthy Mommas program. The narrative meaning-making process involves linking these six women’s experiences through their transitory stages of life while embarking on a journey to untangle often complicated patient-provider interaction.

Meet Barb, Karen, Susan, Betty, Lucy, and Joy ¹

I will present each of these women who sat down with me individually to share their experiences of health, aging, and the Red, Hot, Healthy Mommas program. Each conversation took approximately 1 to 2 hours, averaging 50 minutes per interviewee. Their stories ranged from feeling healthy, to unhealthy, to experiencing a time that marked serious reflection about their own health habits. Each individual’s perspective provides insight into the ways the woman makes sense of her healthcare.

“The wakeup call” for Barb, a 65-year-old former teacher, came last January. Barb’s blood work results indicated that she was prediabetic. Barb explained to me that her blood work increased from 100 to 116 and that when “you hit 125, you are diabetic.” Barb said she had been dealing with high blood pressure for several years now and is currently taking new medication to lower her levels. Barb attributed her poor health to a lack of exercise and failure to follow a healthy diet. She said that she was aware of her own weight gain “but didn’t want to face it.” Barb gave birth to four children, with one born every 2 years, gaining approximately 10 pounds per child. Over time, Barb came to understand her health as a similar experience, comparing her own process of aging as analogous to the experiences of childbirth. Weight from childbirth slowly crept up on Barb, which also slowly increased her risks for diabetes.

Karen, 57 and employed as a sub cook for a local school district, described herself in her doctor’s words as “one of the healthy ones.” Karen had not yet experienced a major health issue. She did describe her experience with a urinary tract infection as painful, yet not as painful as childbirth. Because Karen regarded herself as healthy, she distanced herself from other members of the group who had experienced serious health issues. Karen expressed that her “inexperience with major health issues” made it difficult for her to relate to the other women, although she learned a great deal about how to better communicate her future needs to her doctor.

Susan, 60 and employed as a hospital unit secretary, portrayed herself as fulfilling the caregiver role for family members and friends. Upon Susan’s 16th birthday, her mother and father placed a red ribbon on the forehead of her baby brother indicating that she would become an active participant as his caregiver. Susan shared with me that during her teenage years she sacrificed time with her friends to care for her younger brother. However, she still expressed affection for the bond she was able to build with her younger brother. Susan, never bearing her own children, places the needs of others before her own, a role she became socialized into at the age of 16. Throughout Susan’s life, she continued to fulfill the caregiver role, helping to raise a friend’s son, caring for her father experiencing cancer, and as a health advocate now for her husband.

Susan’s brother died of AIDS at the age of 35 in 1996, her mother died of an unexpected aneurism at the age of 54, and her father died of cancer at 73. Susan said she often thinks about her family’s health experiences when she reflects on her own. Susan, who has been diagnosed with Type 2 diabetes, came to understand her own health as inseparable from the health of her family members for whom she has cared.

Betty, 57 and employed full-time in a factory, stated, “I don’t go to the doctor unless I have to!” Betty’s occupation as a factory worker informs the meanings she uses to make sense of her own health experiences. Betty has been diagnosed with fibromyalgia, a condition with common symptoms of aches and pains all over the body, and feels that this diagnosis masks the symptoms for her other health concerns. Because of the uncertainty that surrounds fibromyalgia, Betty said, “They [doctors] blame everything on that.” Betty’s overall impression of the Red, Hot, Healthy Mommas program was, “I wish I would have known that [education and resources available for women] beforehand.”

Lucy, 68, is a full-time grandma who believes in “aging gracefully.” Lucy understands aging as a natural part of life and states that the only thing certain is that “life is uncertain.” This epigraph serves as Lucy’s motivation to maintain an active lifestyle, including mobility and endurance, during the process of aging. As an active grandmother, Lucy attributes everyday lived routines such as the ability to bend over and pick up her grandchild as a health concern.

Joy, 54 and employed as a part-time office assistant, often considered herself as shy and taciturn in general. She even mentioned near the end of the interview how surprised she was to open up to me. When asked if she felt anxious at the Red, Hot, Healthy Mommas meetings, Joy responded that the facilitator used humor as a technique to make the women feel comfortable at the beginning of the program. Joy explained that everyone mingled a little at the beginning of each program. After the presenter spoke, the women attending were able to engage in dialogue with one another. When asked if she raised a question, Joy responded, “No, not in a group setting.” However, Joy learned through the program that when it came to her own health, she would “be proactive, confront the doctor, and not be shy.”

Each of these brief excerpts provides insight into how these women cope with their own experiences of aging. Some participants discussed placing their health needs after others. Other participants emphasized the importance of engaging in a healthy lifestyle in order to attend to the needs of others. Major health experiences (health events that disrupt one’s daily routine) varied across these participants’ stories. Some participants experienced major health events, while others regarded themselves as healthy. Even so, all of the participants discussed their health in relation to other persons—whether to find their own voice, resist dominant meanings of aging, or negotiate a meaning of self even if this conforms to gendered notions of caregiving. Their counternarratives that reidentify, resist, and/or negotiate their health conditions will be explored in the following sections concerning culture and medicine, mind/body duality, and participation and empowerment.

Cultural Conceptions and Medical Pathology

Cultural conceptions and medical pathology superimpose a linked metanarrative upon members of society because each serves to reinforce the other. Nelson (2001) asserted that our moral agency is contingent upon the interrelationships between “practices and institutions,” “material and imaginative” conditions, “freedom and constraints,” and by addressing “ourselves and others” (p. xi). When asked about their own individual experiences during the aging process, some of these participants reidentified by creating an alternative story, others resisted norms, while still others continued to negotiate meanings between self and society.

When asked about the aging process, Barb responded, “I try to look at it positively. It is something everybody does. Embrace the process and make lemonade out of lemons.” However, Barb mentioned her disgust with our culture’s persistent use of young models, who are “slim and trim,” suggesting that “there should be more acceptances of women of different sizes.” She referred to the Fruit of a Loom and Dove campaigns as examples of advertisements that provide more diversity. Barb employed a resistance counterstory by actively rejecting female body images portrayed by mass media. When Barb discussed her personal narrative concerning weight control, she began to negotiate the tensions between herself and society. Perhaps the importance of weight control for the self becomes paramount when one feels one’s own health is threatened, as with Barb’s diabetes diagnosis. Popular culture portrayals of weight control are resisted; however, Barb magnifies and internalizes issues concerning weight control for the self during the process of aging. A negotiated counterstory began to emerge that rejects societal notions of aging yet accepts personal responsibility for one’s health.

Lucy described cultural perceptions of the aging process as changing. She said, “Perceptions of aging isn’t what it used to be. Women color their hair and receive botox injections.” Lucy described these changes as positive; however, these perceptions stem from our culture’s obsession with women looking younger in an attempt to defer the aging process. Lucy employs a negotiated counterstory that conforms to dominant gendered norms of appearance, yet her personal narrative conveys acceptance for technological advancements that provide women with alternative ways of embracing the self during the aging process. Practices that mask age-related changes in appearance escalate internalized shame arising from the self’s complicity with social images perpetuating a stigma associated with aging. Although Lucy may find happiness in changing her appearance, her story still reinforces the metanarrative that youth is valued and aging is not.

Susan shared a story about the first time she considered herself different from other women due to the effects of aging. Susan explained, “Now that I have difficulty walking and climbing stairs, I do look for elevators more often. I remember going to a concert with some coworkers that were all younger than I. One woman stopped me and said, ‘You know you can go on the elevator’ … because I was trying to keep up with these people. So keeping up with the younger age is a challenge from time to time. Susan’s emphasis on herself as the ‘aging person’ signifies a change in her perspective. Susan engaged in a reidentification counterstory by naming environmental and social barriers to women her age. Older women are more likely to experience disability (Guralnik et al., 1997; La Croix et al., 1997; Tabloski, 2004), yet our society fails to accommodate the needs of these women. Susan, being the caregiver that she is, recognizes this deprivation of equality.

Aging women are also likely to experience barriers to good healthcare. Research has shown that women are less inclined to voice their health concerns during the patient-doctor encounter (Roberts, 2004; Ruhl et al., 2006). Furthermore, when women find the courage to discuss how they feel, their health concerns may not be taken seriously. Susan shared a story about a health encounter with a physician who told her that she was “faking,” which supports evidence that women’s health concerns are trivialized. Susan said:

I woke up one day and all the sudden couldn’t move my arms above my head … and do most bodily functions. I went to a neurologist and he said, ‘Oh, I was just faking it and go back to work.’ Went back to work the next day and a coworker who was a nurse said, ‘This isn’t right.’

As Susan shared her story with me, I sensed Susan’s frustration and sadness when she expressed that no one would listen to her. Medical culture pathologized Susan by employing stereotypes surrounding aging women. Rather than accept the doctor’s indifference to her health needs, Susan finally trusted her own intuition, with the help of a coworker, that something was wrong. Through this social support, Susan was able to reidentify herself and mustered the courage to seek a second opinion. Reidentification in this instance transpired as Susan became aware of herself through another’s eyes.

Joy, like Susan, also felt uncertainty about her body. Joy kept referring to herself as abnormal. Not understanding what she meant by abnormal, I asked her to explain. Joy said:

I went to see my doctor and he tested my hormones. My doctor said, ‘I was not going through menopause.’ I said, ‘What is happening to me?’ I knew it wasn’t me. My husband knew it wasn’t me. Then, he kept asking me questions like, ‘Are you having vaginal dryness, have you missed your period?’ And I said, ‘No.’ But, I still felt that something wasn’t right. So, he put me on stuff for periods. He wasn’t too much help. The doctor wasn’t.

When asked how the issue was finally resolved, Joy said:

He put me on medicine to start my period and it didn’t start. He said, ‘Hmm, I am going to give you more medicine.’ I still didn’t start. He said, ‘Well maybe you are going through menopause.’ So, I took another blood test and sure enough I was postmenopausal. But I knew in my heart that something wasn’t right. He was looking at the symptoms. He kept asking me if I was having hot flashes. I said, ‘No.’

Even though Joy knew something was not right, she remained obedient to her doctor. This is an example of what Frank (2002) refers to as “disease talk”: “[I]n disease talk my body, my ongoing experience of being alive, becomes the body, an object to be measured and thus objectified” (p. 12). Joy explained her frustration with her doctor’s unrelenting attempt to symptomize menopause rather than listening to her experience. At this time in Joy’s life, Joy was desperately trying to reidentify herself but lacked the words and knowledge to be proactive about her health during the patient-physician encounter.

These narratives convey how moral agency is contingent not only upon our cultural and medical norms but also negotiated with others in specific situations. As the stories unfolded, some participants reidentified with a present self in light of the past, others resisted dominant norms, while still others negotiated tensions between self and society. According to Nelson (2001), damaged identities are repaired by recollecting past events in order to select fragments that mend broken pieces in retelling a new story. However, several of the narratives these women shared remained chaotic—at times resisting the metanarrative yet at times reinforcing it. This was accomplished two ways. First, participants may have conformed to the prevailing metanarrative in important aspects while still retelling a different story for the self. Second, participants may have resisted the metanarrative while still harboring guilty feelings inside for the defiant positions they narrated. Just as both uses of narrative are problematic, they also are helpful in understanding the ways these women experienced the process of aging. Their worlds are colored by occurrences layered with multiple meanings informed by personal, communal, and societal relations.

Mind/Body Dualism

Stories can offer a way of reconciling mind/body duality. But this process is not as simple as one would think. Ideally, we strive for a holistic connection between our minds and bodies; however, it is not uncommon to rely on one’s mind to overcome physical barriers. In reconstructing personal identity, one experiences constant struggles over autonomy with mind/body duality situated at the center of this negotiation (Lewis, 2007; Shakespeare, 2006). This desire resembles a similar parallel to aging women’s feelings of normality and abnormality that continue to be expressed as ongoing negotiations among past, present, and future selves.

Karen, “the healthy one,” has experienced a family trauma that now informs her perspective on aging. Karen’s husband was killed unexpectedly on the job when her two daughters were 3 and 5 years old. In a single instant, Karen became the sole provider for her family. When asked about her experiences of aging, Karen responded:

Can I say mind over matter? … I remember when I turned 40 and I thought this is really bad. Well then 50 comes and you think this is bad and make it through and now I am 3 years away from turning 60. I am well past my lifetime. Do I worry about it? I don’t. At one time, we thought that was old and that’s not old anymore.

Karen did not have time to mourn the past or worry about the future when it came to meeting the immediate needs of her family. She expressed, “Life has given me plenty to battle and you make life what it is.” For Karen, age is but a number, not a defining aspect of the self. Her counterstory addresses both resistance and reidentification. Through her personal experience of aging, Karen is able to resist cultural conceptions of aging. Karen relies on her mental ability to create a connection with her body rather than popular culture characteristics of aging.

Reflecting about the aging process, Susan said, “As a teenager you think you know everything and then you think … ‘Oh, yeah mom was right about some things.’ … It’s best to take care of yourself while you are young.” Susan has experienced several serious health issues, which required back and hand surgeries. When reflecting back on her embodied experience, she said, “You don’t realize how much you use a certain part until you lose it… . You think you live forever but nobody gets out of this world alive.” Susan continued to explain the aging process:

Well, I think we grow into it … is what I would say. We grow from babies to toddlers to being able to walk to being able to coordinate things… . Then I think your body reaches a peak where things just start to tire out… . You go up to the peak and start slowly going down.

Susan understands embodiment as contingent upon her past selves yet disconnected through negation of what used to be. For Susan, her mind/body duality becomes an existential crisis, a process where she is faced with the realization that “nobody gets out of this world alive,” yet the meanings of this fate are contingent upon her layered experiences of herself.

Scholars suggest different ways for making sense of this embodied experience of aging. For example, Frank (2002) suggested saying goodbye to the younger self in order to embrace changes that occur to the body during the process of aging. This alternative way for understanding embodiment also resembles Nelson’s (2001) ideas on reidentification. In both conceptions, persons change their own internal perceptions of what was in order to redefine what is and what can be. Even so, for women who are aging, making sense of the present body is an ongoing negotiated counterstory reconciling past, present, and future selves. As Young (2005) articulated, the younger self comes to inform the older self, offering multiple layers of meaning to experience. Mind/body duality is understood as an ongoing struggle where one continues to redefine changes to the body while also feeling empowered by the wisdom that follows from experience.

When I asked Joy to further explain her embodied sensations, Joy responded, “I was going through a lot of anxiety, depression, insomnia, moody as all get out … ups and downs, ups and downs … my body was changing. Things started shifting … [laugh] … down … [laugh]… .” While Joy was trying to understand her body, other crises in her life began erupting. In 2007, she began experiencing difficulty sleeping. During that same year, Joy lost her father, and her new son-in-law was involved in a serious accident, leaving him paralyzed for the rest of his life.

During this time in Joy’s life, traumatic experiences generated layered meanings that came to inform changes to her body. Rather than coping with the natural processes of aging, Joy believed her body was reacting to grief from lived experiences. As more time passed, Joy came to realize that these changes were normal for a woman experiencing menopause.

When I asked Joy to share a time when she felt most vulnerable about her health, Joy replied:

Dealing with not sleeping and dealing with depression … I was having a terrible time with my husband. I just thought he did not understand what I am going through. He’s not a talker. He’s not a good listener. I just felt so alone … I thought what is wrong with me … I was not happy… . And I even had thoughts of suicide… . That’s when I was about my lowest… . Then I come to find out that menopause does affect depression and things like that … to a point you need help… . I think it was a vicious cycle.

Joy mentioned that she learned through the Red, Hot, Healthy Mommas program to listen to her body as a communicative process. This process entails reflecting upon bodily responses such as mood swings and depression when interacting with others. Joy asserted:

I think if women know what to expect through their bodies and minds through this transition, they will be better prepared… . I kept thinking something was wrong with me… . If you know that you are normal and this is a part of life … you can cope with it better.

At the time of our interview, 3 years had passed since this depressing period, and Joy described improved relationships with her body and her husband.

Each of the participants offered a unique understanding of mind/body duality. Some participants came to understand their body from a place of being strong in the past and becoming vulnerable in the present, while others redescribed the present as a place of strength. The process of aging for still other participants is an ongoing negotiation among past, present, and future selves. Ways of understanding the body also informed one’s identity that either conforms to or resists cultural and medical norms. For instance, when the aging process is understood as abnormal, internalized guilt for failure to maintain a healthy body obscures the facts of aging as a natural process, thereby reinforcing cultural and medical norms discrediting women. In contrast, other participants understood aging as a normal, communicative process, which helped them to resist dominant norms.

Participation and Empowerment

Research suggests that narratives offer a way of healing (Charon, 2006, 2009; Frank, 2002; Harter et al., 2005; Pennebaker, 2000; Roberts, 2004), and participation in health education programs allows for empowerment (Hutchinson & Wexler, 2007; Nummela et al., 2009; Son et al., 2007). As each participant reflected on her past experience in a narrative fashion with others, she created room for her identity to be reconstituted. During this process, the question then becomes, Is the individual responsible, or are we as a society responsible for meeting the health needs of aging women? In the following section, I illustrate the ways that sharing health knowledge through dialogue with others in the Red, Hot, Healthy Mommas program provided resources to empower these women during patient-provider interactions.

Barb explained that during the meetings, she was able to “sympathize” with the women and no longer feel like an “odd ball.” The meetings offered a space that allowed the women to share their stories and open up to one another about their health experiences. The program also empowered them to prepare for future healthcare encounters with their doctor. Barb explained, “The older women were raised to go in, see the doctor, and then go home. Whereas now, women take more control of the doctor’s visit and ask questions.” Barb commits to a reidentification counterstory of the self that rejects the historical silencing of women during patient-provider interaction. Barb said that since she has attended Red, Hot, Healthy Mommas, she feels more empowered to ask the doctor questions, whereas before, she would have passively listened to the doctor and taken his advice.

Although Karen regarded her own health as not noteworthy, she still acquired tips for communicating with her healthcare provider. She said, “Don’t always expect your doctors to come up with the answers. You have to also tell them how you feel and do your part. The doctors can’t always mend everything. You just have to be honest with them.” Karen, like several of the participants, discussed taking personal responsibility to advocate for her own healthcare. In order to empower oneself, a person must first recognize the inequalities that she faces prior to the medical encounter. This also points to a lack of trust and listening on behalf of the physician during a medical interaction. This negotiated counterstory challenges one to face her own oppression while at the same time transforms into a resistance counterstory that changes the ways others (doctors) perceive the self.

Betty shared with me a confrontation she experienced with her healthcare provider who waited 2 years to order blood work. After listening to her talk, I said, “It sounds as though you empowered yourself when you demanded that your own doctor take your blood work.” Betty replied, “I thought that was pretty bad though. That’s one thing too my boss says about me at work, if there is a problem you say something about it.”

Betty continued to express her disappointment with her doctor, which included time constraints, not listening, and ignoring her questions. However, she learned from the program how to resist dominant norms that occur during the patient-provider interaction. Betty mentioned that she has a right to ask questions during physician visits and the right to ask the doctor to reinterpret her concerns.

Joy’s participation in Red, Hot, Healthy Mommas made her feel “normal,” and it was a “time for me.” Joy learned the importance of finding the right doctor for her at this age. She also learned to take questions with her and prepare herself for the encounter. During past healthcare encounters, Joy said:

I took the doctor’s word for granted and I didn’t contradict him. I should have said, ‘I don’t think you are right or are you sure?’ … You know doctors know all … so it’s hard to question the doctor … so I just took what he said. In the future, I plan to take notes … prepare myself on what to ask and make sure I get the answer before I leave. I want to be honest and not hold anything back. Sometimes, you get into the personal stuff and you don’t say anything … and in the past I have learned that you need not be afraid.

When I asked Joy to explain what she meant by the personal stuff, Joy said:

Well, when I was going through my depression and not sleeping … and … people kept saying … my husband and I were having problems … so there was no sex … and the doctors would say, “How is your sex life? Does it hurt when you have intercourse?” Because that’s one of the things they are trying to find out if you have menopause. Well. How do you tell them that “No we are not having intercourse because I am not getting along with my husband” … you know what I mean … I kind of fibbed when I said I am not having any problems, but I didn’t want to tell the whole truth—that we aren’t having sex because we are fighting. I need to get that information to them… . How can they help me if I don’t share?

Although Joy considered herself shy, she shared very personal information with me about her health experiences. As she reflected upon this discussion, Joy explained that the program taught her to become more outspoken and detailed about her health concerns. Joy learned how to reidentify herself through listening to others who also mentioned that transition through aging is “normal.” Through this reidentification, Joy was able to resist dominant norms that take place between female patients and their physicians.

All of the participants maintained that the failure to communicate their needs is a major obstacle for women who are aging. Several pointed to the historical silencing of women during the medical interaction and used a reidentification counterstory to understand the self in the present. In addition, these participants shared the importance of finding a good doctor, one who is sympathetic and attends to their health needs. Several also employed resistance counterstories in order to find the courage to communicate with their doctors as opposed to passively complying to doctor’s orders.