Abstract
In this article, the author demonstrates how a phenomenological approach may be used to describe the changes of women's bodies at menopause. In Korea, the middle age of Korean women has been referred as the golden age and autumn season, and which means Korean thing highly of internal mature rather than external facts. When Korean women experience menopausal, they feel they are in the middle of storm, and just have passed by in the time. They can expert and feel tomorrow's weather by the changes of their body. While the experience menopausal, they can extremely perceive changes of their body, and at the same time, incidence rate of breast cancer is no the increase. Mastectomy has serious effects on both women's body and spirit.
Phenomenological analysis on the changes of body shows that the middle age women of Korea feel “Evidently visible scratches of years”, “My body is a live weather forecaster”, “Khi is getting weaker”, “Being fearful suddenly but too late”, “The more aged, the more precious life becomes”, “Being comfortable is better than being beautiful”, “Wish to go back to their past”, “Intense desire for re- challenging life”, “Better friends than husband”. In conclusion, there of no way to fully understand someone without knowing one's lived experience within the cultural context. To understand artificial changes by surgery as well as natural ones, and even to do holistic nursing, qualitative research is essentially required.
Woman's health is an important factor not only for herself but also for her family. To fully understand women's health, comprehension of the unique socio-cultural characteristics of one's culture should be considered, particularly in Korea, despite its westernized lifestyle. Understanding how women perceive changes of their body is important, yet in Korea culturally relevant health theory which explains changes of women's body does not exist. So theory development through qualitative research is urgently required.
The Phenomenological and Hermeneutic Approach
This study was a phenomenological and hermeneutic perspective of Korean women who experienced menopause. After exploring the literature, I reflected on artistic depictions of mid-life women and conversations with menopausal women in Korea.
Between July and November 1999, phenomenological conversations were conducted with six menopausal women, including two in-depth, tape-recorded interviews and observations. During the initial meeting with participants, the researcher explained the purpose of study and then interviewees gave their informed consent to participate in the study. All participants were guaranteed anonymity.
Van Manen's (1990) thematic analysis, line-by-line approach, by which every statement of the participants is thoroughly examined, was used to find what their words or sentences imply about their experience. Followings are the findings on the meaning of bodily changes to them.
Menopause
Menopause is a unique experience in the lives of all women. Despite the fact that the change in the body is an inevitable process of life for middle aged women, they have recognized it negatively as ‘the climacterium’, ‘depression’, and ‘pain’ through the preconception learned from academic or nonacademic media and books. In general, women undergo changes in hormone accompanied by menopause. They are likely to associate these changes with a uniform self-image of an uncontrollably fat body and regard themselves as something useless, or ‘ajumma‘, a contemptuous term for an old wife in Korean.
Korean nursing education, based on the mechanical philosophy and western medical model, has viewed ‘body’ categorized into ‘physical’ ‘psychological’ and ‘cultural‘. Human body has been thought as a congregate system of organs such as circulatory organs, urinary organs, digestive organs and so on. And medical practitioners have responded negatively to the changes in body as something to be repaired as if they were the parts of machine. When many women talk about the change in their bodies during illness, most medical staffs are likely to give them medicine of which they do not know well, or injections for several days' treatment instead of listening to what they are saying.
What drew this particular theme to my attention was my 16 years of experience as a nurse (1977–1992) in U.S.A. The longer I was engaged in nursing, the more limited I felt in understanding patients from all over the world, and I felt that nursing without the understanding of their lives would be similar with the blind's description of an elephant after touching only some parts of it. Since coming back to Korea, I have been devoted to nursing education. In the curriculum, there was a subject concerned with “assessing pains of myocardial infarction (MI)”, and it stated that while assessing it, see that there are feelings such as “their chest is being trodden by horseshoes”. However, in Korea, most patients who feel MI pain described the same as “tingling of hands after working long hours with powdered red pepper”. When menopausal women decide to change their mind and see medical staff, their psychological health is examined with Center for Epidemiological Studies-Depression Scale (CES-D) to measure their level of depression. Depression, however expressed in the development of CES-D has its limitation to measure the “conflict between mother-in-law and daughter-in-law”, the most serious factor of Korean menopausal women's depression.
In other words, without the understanding of traditional, cultural, and philosophical background of the objects of nursing, here ‘women’ in this study, nursing applied to them would be no more than a ‘ready-made’ suit tailored for the convenience of nurses, not one designed for them.
Recently much study has been done on menopause, and pathologic physiology, estrogen therapy, and health promotion in Korea (Yoon, Sung-ae, 1992), but more in-depth study is required to find what the changes in body mean to women who ought to experience various bodily changes, and what effects they have on them.
Therefore this study aims to seek for the essence of women's experience of bodily changes caused by menopause, and thereby to provide useful ground for women's health promotion education program and theory development.
Eastern and Western Body Paradigm
In Eastern philosophy, the letter “
” refers to body, a physical form which works as a vessel that contains life and soul. It is also a life form functioning in invisible ways to breath air, digesting food, and thinking. In other words, it is a life form into which a visible form and invisible functions are integrated. Human body is at once a biological entity and philosophical being, itself as a small universe. Apart from other life forms, human body embraces a cultural life in it, so it is regarded as a historical being with religion, art, and principles in it.
A human body is composed of “shin”, “khi”, “hyul” and “jong”. A human body has a cyclical rhythm according to the rhythm of nature, and women's menstruation is one of examples of it. This rhythm is maintained by the harmony of Yin and Yang of the body components (Kim, Hyun-je, 1984) (See figures 1 and 2)
This means that human ‘body’ is a life form constantly changing minute by minute. In the folk belief, human body is related to transcendental and supernatural beings and is inseparable from nature and community. It is also a space where nature and supernature contact each other and transcendental power and supernatural power interact actively. Also pain and joy of a community mingle together in it. In brief, it is considered an organic and integral being in the relationship of supernature, human and human community.
Eastern Body Paradigm
In the oriental Yin-yang theory, middle age means gold, and the time when all things are ripened waiting to be gathered. Also it falls to autumn and dusk when sun sets to the west. In other words, as gold is the symbol of estate and economy middle age counts livelihood and economy most, and is called the age of gold.
Comparison of Eastern-Western Body Paradigm
<Picture 1>
Twenty years after marriage, husband constantly requires woman to be as fresh, and beautiful as they first married even though she is now in her menopause.
<Picture 2>
Woman in this age has to be conscious of what others think of them more than their own life, and while they are out, they cannot forget about the household chores. This is expressed by a kettle instead of necklace, and spoons instead of earrings.
<Picture 3>
Woman in this picture must take care of her husband from the beginning to the end even if he is aged enough.
Findings
(1) Visible scratches of years evident
“My heart is just the same as the day I got married but my body experiences so many changes even before I noticed it. I felt sad that I couldn't even notice it. What made me more lonely was the time when I opened my closet to find out a dress to go out, I found nothing to wear. I could not buy any good dress because life was so busy for me. Nothing fits although I feel like I can wear everything. I became so fat . I was always confident about myself but now I feel so lonely… .”
“I hear the clicking sounds of my bones around arms and knee, and I cannot sit or stand as freely as before. Sometimes I feel anger and sometimes grief. I lose every suppleness in my body.”
“I could maintain my strength even though I didn't sleep much in the past, but now one sleepless night makes me exhausted” “I forget everything, I couldn't find the bankbook your father had given me yet, and I couldn't think up where I did put it. Once I could remember everything, but as I grow old, it becomes totally different. I feel so empty and sad.”
“I can't see the objects near me clearly, and I felt stuffed. Time to urinate is getting shorter and shorter, and it gets harder to contain my urine. Then I feel everything is so bothersome, and this brings back to me the thought of my agedness.”
(2) My body is a live weather forecaster
“Body” during and after menopause is likely to detect the changes in weather or the changes in nature and this is expressed as follows. This is different from western views.
“In the past, the old in my country hometown said that they felt pain throughout their body when the weather got bad and I doubted it and thought it would not be possible. However, now after I gave birth, when I feel pain throughout my body like being hit by someone or if I feel pain in my leg, I will know it will be rainy or cloudy, too. I can tell it so well. Well, I remember seeing a television program that said in the low pressure, body might feel something. When it rains, pain becomes more severe. So I go to sauna and the hot vapor recovers my body. And I drink a bowl of seaweed soup, and I feel much better.”
“At first only one spot was aching, but after a while whole waist is aching, and I cannot even stretch my back…Maybe it is because I have sat in so bad posture from my youth…. As my back aches, I cannot but bend my back slightly‥ and it seems my height is shortened. Of course, I don't feel this pain every day…one or two times a week, but once it starts aching, the pain is so severe. Anyway, my back hurts, and I cannot straighten up. I saw a picture of one with bone porosity…holes are here and there in the bones…so terrible. Sometimes I feel pain in my back like winds blow into it and then it rains the next day without fail. ”
(3) Khi is getting weaker
As their body lose strength gradually, they postpone things to do to the next day and lose self-confidence.
“When I was young, I thought I could do everything well, and actually I could do it anyway. However, now it was all gone. I just do what I have to do…and life is so busy with only those works. I cannot understand how I was so powerful in the past. Now I cannot do like that even if one ask me to do that. When I was young, I believed this would improve my life. I challenged everything, but now I just think what this can bring to me. So meaningless. This will not change much. In my twenties, I was an idealist, but now I am a realist. I take a rest because I am sick, and I just manage to live my day.”
(4) Being fearful suddenly but too late
Encountering menopause, they begin to take care of their body and are surprised at the changes in their body which they overlooked in the past.
“Well, I am aged enough, and naturally I take more care of my health. In the past, If I was sick, I just thought it would recover anyway. However, now if I get sick, I fear it will develop into a serious disease. I cannot trust my own body. Although I become more relaxed before, I sometimes think negatively. I try to eat three meals a day and I feel dizzy if I skip just one meal. I think I have to eat three meals. So when I meet my friends, unlike past when we gathered at a coffee shop, we often goes to a restaurant where we can eat hearty meals. So I guess it's aging, and it's natural that I am called “ajumma (old maid)”
(5) The more aged, the more precious life becomes
They stated that their body lost strength after menopause, but in contrast, they became aware of the preciousness of life.
“Well they say, the value of women depreciates over time. Gold is the freshman, silver the sophomore, bronze the junior, and nothing is the senior. It's the same in the society. It wants only the young and beautiful. It refuses to admit that the young and beautiful will also decay.”
“When I was young, to be old seemed so awful. But after I reached this age, aging is just the same as the changes of season. My life… .what I have done, and am doing‥ all becomes so precious. Look at the wrinkles of the old woman. Think how much experience and life are contained in each wrinkle. Can you understand me?”
(6) Being comfortable is better than being beautiful
In the past, they gave priority to how they would look to others. However, as their body line changes, they prefer comfortableness and safety to prettiness.
“In the past, when I got to buy a dress, I tried to buy a pretty one. However, I prefer warm clothes, and comfortable clothes. Maybe it's because I got old, or my interest changed compared to past. I used to stand the pain when I wore a high heel shoes, however now I couldn't even think of wearing them. Of course, I like pretty stuffs. So I wear makeup, and accessories, but they become less important matter now than past. ”
(7) Wish to go back to their past
Participants admitted the changes in their body and menopause as a natural way of life in one hand. In the other hand, however, they wish to maintain their beauty of past, and keep them from disappearing.
“My kid are all grown up, and left me doing their jobs. That gives me a lot of free time. So I'd like to wear makeup, and pretty dresses as I used to, and do whatever I wanted to do. Want to challenge something as if I were a young girl. As free time increases, those feelings come back to me. Like a adolescent girl, clear and awesome weather makes my heart leap. I hope to have my hair done in the most fashionable style. I miss my slim body in the past. I just wish to go back to that time. But I have nothing to do, and I feel somewhat angry for my husband and children who only do their job and care nothing about me. Whenever they make fool of me calling ‘pig’, I just smile but think how much my heart aches”
(8) Intense desire for rechallenging life
They tend to be in a hurry to prepare themselves for their second life. However they are likely to try to learn things once they tried to in the past, rather than completely new things.
“At this age, some friends gather together to gamble, some go to learn aerobics to be slimmer, and some find other ways. Now the evident difference of their personality appears. In the adolescence, we challenge a new thing, but now after menopause, we try to find something that we have known and try to complete it. In other words, we seek self-fulfillment and self-development. After menopause we often experience psychological conflicts. You can go to many ways, to go to singing class, to start study again, or to learn flower arrangement. ”
(9) Better friends than husband
Participants in this study said that they prefer having time with friends, say high school alumni or university alumni.
“Feelings go away. I used to ask love and care from my husband like a child, but now I like my friends better. Furthermore, I am getting tired of my husband day by day. Sometimes I have moments to wish I were alone. I heard that it is one of six good lucks that you lose your husband after 60. He is just my fence that keeps me from being ignored by my children. If he passes away earlier than I, children will not take care of me as they would if their father were alive. Women in their fifties feel that it is best that their husband is far way and meets once in a while because of his job. Gradually we lose our interest in him and at first this gives us the feeling of isolation.”
Discussion
In this study menopausal women experience the changes of body coming without any conspicuous sign. Their body betrays their will and their heart is laded with emptiness, loneliness and sorrow. They just wish to put an end to this situation but they are not sure when. Both the beginning and end are vague and their situation around this time is so unclear that they feel as if they are wandering in the fog. They recognize it as a time of dusk when daylights fade away and darkness creeps over. Also at this time they become aware of the fact that they have always been alone, and begin to think of death staring at their grey hair and wrinkled face. They feel thoroughly left alone from the path they used to walk with their husbands and children, and recognize it as a empty field after reaping. Furthermore, they, who are alone in this lonely field, are anxious about being caught with a disease like dementia. This anxiety is widely experienced by women who go through sudden changes of body now that senile dementia and menopause by stress greatly increase along with the lengthened life.
In addition they are likely to have ambivalent feelings that although they are released from the monthly visit of irregular changes in body caused by menstruation, and from the fear of unwanted pregnancy, they also feel the loneliness and emptiness, thinking they have no more hope. In other words, in Korean culture which puts a great emphasis on childbirth which enables generation to continue, menstruation means a hope and life for women. Therefore, the end of menstruation is a significant turning point of their life to let them look back on their life, and brings them the feeling of emptiness.
Changes after menopause perceived by women include; they feel aching pains throughout their body; they don't feel like doing works; their vision becomes dim; and even their taste for food changes. This urges the development of individual-based nursing intervention for women.
On the other hand, while they perceive that their body gets weaker and weaker, they value their wisdom and experience obtained through their life. They are so valuable that they cannot be exchanged with youth. This period is also the early fall with the bright and warm sunlight. From the dark period of ‘fighting with devils’ buried under the lives of their children and husband, they go forward toward the early morning. They are relaxed and begin to understand all things around. They feel that they are changing like a warm and lovely sunlight. The participants, particularly, confessed that they were more likely to listen to their elders and see the seniors with a changed vision. From those statement, it can be concluded that they are in the process of constructing their future image.
Menopausal women try to find their changes in the growth of their children, and while their children grow up and their spouse succeeds in life, in return they get to have grayed hair and wrinkles. At the same time, they give one more thought to their own mother as a mirror that reflects their own image.
Menopausal women has lived their life only for others, but now they look back on their own dreamless life, and seek to regain the meaning of their life. In Korean culture, they were often spending more time with their female friends or alumni than their husband, and they described their body was in the process of return to nature through the harmony of body and nature.