Integrative Care
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Women´s Diaries Bridge Diverse Medical Systems

20 September, 2013 by David Finer

DiaryWomen do not integrate conventional and alternative medicine because they think it is a romantic or rebellious thing to do. They do it because they must. Health providers, after all, do not build any bridges. A diary study from Australia reveals the pragmatic approach of older women towards medical pluralism. Researchers view them as role models for all of us as consumers of the future.

Researchers from University of Queensland and University of Technology, Sydney, Australia have carried out a sociological study based on the diary entries of elderly women, who have used CAM (complementary and alternative medicine).

Studying diaries is a well-established method in the social sciences, but has rarely been applied to CAM research. The advantage of diaries is that mirror everyday activities and reflections. Keeping a diary may also be experienced as strengthening, empowering, in itself.

Wrote for One Month
The study comprised 30 women who had consistently kept a diary for at least one month. They were recruited among a group of 60 women who had been interviewed. These 60 women had in turn been randomly selected among 1800 women aged 60-65 from alla over Australia who used CAM.

The participating women were instructed to be frank and to write down both positive and negative feelings as well as documenting all conversations and other contacts with friends, relatives, physicians or CAM practitioners. They were also asked to take note of any physical treatment effects they might experience. If some day they did not have the energy to make any entry, that was fine too.

The diary narratives were analysed using interpretative traditions within qualitative research.

Networks of Knowledge
The investigators discovered that the women used extensive networds of knowledge to navigate in a sea of health information and medical treatment methods, both allopathic and alternative. In the process, the women built bridges between different bodies of medical knowledge, thus in essence constructing, producing new knowledge.
The women are seen as manufacturing knowledge in three areas – by experimenting with various treatments themselves and by – in communication with other people – respectively, disseminating and integrating treatments and information.

Reclaiming Control
In this process, women to a great extent reclaimed control and decision-making from the healthcare providers they consulted. To this end, they also sought out information from a variety of sources – on the one hand from mass media such as the Internet, books, magazines and dvd films, on the other hand from personal contacts such as friends, relations, strangers, health store attendants and pharmacy staff.

The women also utilized advice and home remedies from “old wives´ tales” in a systematic way. As well as soliciting knowledge from other medical experts. The diaries show them being critical of both biomedicine and the alternatives but also accepting of features of both..

Conscientiously employing methods of “trial-and-error”, they also integrated parts of these various forms of knowledge into their everyday lives. The women are described as pragmatic pathfinders in a pluralistic medical universe, characterized by the co-existence of various traditions side by side.

Deromanticize Activism
But the researchers also seek to deromanticize lay activism. On the one hand, such activism may be emowering, on the other hand it may simply be seen as the way out of a desperate situation. Lacking health care providers in command of “both worlds” as well as being capable and willing to bridge various medical traditions, the women had no choice but to find their own solutions.

The conclusion is that the everyday experiences and activities of the women may challenge medical experts but should not necessarily be understood as “resistance” towards medical authorities, which has been a common mode of understanding in the scientific literature. Hence, the women are pragmatic rather than ideologically driven. They neither challenged the need of formal experts not took a stand for och against conventional or alternative medical knowledge.

Through their approach they may rather be seen as somewhat of a role model for the medical pluralists of the future, a kind of enlightened type of person, who integrate medicine within themselves.

Few Everyday Studies
In the introduction, the researchers give an overview of the scientific literature and theories of women and CAM. According to previous studies, CAM is used by up to 80 percent of Australian women. Social scientists have offered a number of hypothetical explanations for the uneven distribution between the sexes in terms of interest in CAM. There has however been a dearth of in-depth studies on women´s everyday practices and motivations.

Research also shows that rationales and experiences vary with time and place, indicating the need for long-term studies from different countries and environments.

In the last decade, many studies have been devoted to the relationship between CAM use and gender. One line of inquiry has been to view sex/gender as simply one of several characteristics of CAM users. Another line of thought has specifically linked CAM use to various femininities, various understandings of the feminine. In this context, for e.g., some scholars have reasoned that women´s use of CAM may be associated with women´s views of the body, of the subjective and “closeness to nature”.

The fact that CAM may facilitate self-care, taking responsibility and achieving self-actualizing – aspects less commonly associated with conventional health care – may also increase the individuals´ experience of authenticity, independence and wellbeing.

Taking Care of Oneself
In western countries, especially in the West, e.g., Australia, these qualities may particularly appeal to women and coincide with a trend away from being externally directed and taking care of others towards taking care of oneself.

The fact that women and the female body has been medicalized to such a degree, may also theoretically explain the resistance of many women to biomedicine, and make the emphasis on active agency and personhood within CAM particularly attractive.

Finally, approaches and explanatory models of alternative medicine regarding the body and health/disease have a greater natural affinity to the subjective and to narrative than those of biomedicine with its greater reliance on large-scale population trends and epidemiological studies.

Woman as Decision-Maker
But even though there may be aspects of sex/gender in CAM use, these patterns may also be seen as apart of broader social structures determining health. These include e.g. the fact that women everywhere tend to be the primary decision-makers in the family on health matters. Men often display a greater resistance to seeking help from others and generally do not to the same extent take responsibility for the health of the whole family (obviously, the picture here is complex, and there may be many exceptions to the rule).

Furthermore, the sex/gender aspect may be seen as being embedded in specific cultural settings, characterized by a propensity towards the individual and freedom of choice. This may be coupled with the desire for more individualized or personalized medicine even if these concepts (as we have critically discussed in several articles, link) have come to be hijacked in an unfortunate way by biomedicine and redefined as synonymous with diagnosis/treatment based on biomarkers and genetic profiling.

Optimizing Opportunity
Finally, CAM might be viewed as simply another tool, which women use as part of their everyday health or self-care activities, rather than as an ideological stand or social movement away from biomedicine (towards CAM).

Rather, we might yet again be dealing with how women juggle different possibilities to optimize opportunities for themselves and their loved ones. Here, the picture is also complicated by – in the age of neo-liberalism – forces in society encourage more self-care in the interest of thrusting the responsibility for health care back onto the individual, with the concomitant risk of negative side effects.

The authors define the trend as a form of lay activism, a useful concept they assert “that helps illuminate the dialectical process between autonomy/ empowerment and duty/responsibility”. While on the one hand affording more opportunities to greater lay responsibility, it also reveals various failures of the formal structures of society. It is an example of what the sociologists Beck and Beck-Gernsheim refer to as one of humankind´s ”precarious freedoms”.

David Finer

Alex Broom, Carla Meurk, Jon Adams and David Sibbritt. Women’s self-care practices and everyday lay expertise. Networks of knowledge or just old wives’ tales? A diary-based analysis of women´s everyday self-care practices and everyday lay expertise. Health (London). DOI: 10.1177 /1363459313497610 published online August 28, 2013.

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