Lisa R. Rubin

Whatever feels good in my soul: body ethics and aesthetics among African American and Latina women.

Ethnicity-specific differences in body aesthetic ideals and body satisfaction have been cited as a potential explanation for interethnic differences in the prevalence and presentation of eating disorders. It has been widely hypothesized that such ethnically based differences in aesthetic body ideals mitigate cultural pressures that contribute to body disparagement and disordered eating among white women. However, mechanisms by which a cultural milieu may be protective against the development of disordered eating remain poorly understood. This study investigated relationships among ethnicity, self-representation, and body aesthetic ideals among 18 college-educated black and Latina women through analysis of focus group discussion data. Rather than confirming body aesthetic ideals different from those of white culture, study respondents reframed the discussion about body aesthetics to one of body ethics. That is, study subjects both contested ideologies defining thinness and whiteness as inherently beautiful and espoused a body ethic of self-acceptance and nurturance that rejects mainstream cultural pressures to reshape bodies to approximate aesthetic ideals promulgated in the media. We conclude that understanding body image concerns from the standpoint of body ethics, rather than body aesthetics, may be a more productive and inclusive approach to the study of ethnically diverse womens embodied experience. Ultimately it is anticipated that this will better illuminate the complex relationships among ethnicity, culture, and risk for body image and eating disorders.

Understanding normality: a qualitative analysis of breast cancer patients concepts of normality after mastectomy and reconstructive surgery.

Background: As survival rates increase, many people have to adjust to life after cancer. This includes adjusting to life after surgery. While previous research suggests that patients commonly strive to be ‘normal’ after mastectomy and reconstructive surgery, research surrounding individual perceptions of normality is lacking.

Measuring and managing patient expectations for breast reconstruction: impact on quality of life and patient satisfaction

The goal of postmastectomy breast reconstruction is to restore a woman’s body image and to satisfy her personal expectations regarding the results of surgery. Studies in other surgical areas have shown that unrecognized or unfulfilled expectations may predict dissatisfaction more strongly than even the technical success of the surgery. Patient expectations play an especially critical role in elective procedures, such as cancer reconstruction, where the patient’s primary motivation is improved health-related quality of life. In breast reconstruction, assessment of patient expectations is therefore vital to optimal patient care. This report summarizes the existing literature on patient expectations regarding breast reconstruction, and provides a viewpoint on how this field can evolve. Specifically, we consider how systematic measurement and management of patient expectations may improve patient education, shared medical decision-making and patient perception of outcomes.

“Does That Make Me A Woman?” Breast Cancer, Mastectomy, and Breast Reconstruction Decisions Among Sexual Minority Women

Feminist scholars and activists writing about breast cancer care among women have highlighted the sexist and heterosexist assumptions often embedded in the medical management of breast cancer, and of mastectomy in particular. Despite these contributions, and some speculation that sexual minority women may be less interested in breast reconstruction, limited research explores sexual minority women’s lived experience of mastectomy and decision making about reconstruction. Thirteen lesbian and/or bisexual women who had undergone mastectomy for treatment of breast cancer participated in individual qualitative interviews exploring decisions to have, or not have, breast reconstruction. Reasons for/against reconstruction reflected themes identified in prior studies among heterosexual women. Although participants described sexual, gender, and political identities and orientations as influences on their decision making, for most participants, experiences with physicians who encouraged reconstruction and concerns about stigmatization of illness in romantic, professional, and social contexts were also central. Findings are interpreted through feminist dis/ability, medicalization, and existential frameworks.

'Use what God has given me': difference and disparity in breast reconstruction.

African-American women are significantly less likely to undergo postmastectomy breast reconstruction compared to white women in the USA. These observed differences have been interpreted as evidence of a healthcare disparity. The current study examines breast reconstruction decision-making among African-American women, locating reconstruction decisions in a context of culture, racial inequality and biomedicalisation. Semi-structured interviews were conducted with 27 African-American women who underwent mastectomy for breast cancer to add patient-centred perspectives to existing conceptualisations of racial/ethnic differences in reconstruction. Participants were socio-demographically diverse, and resided in the New York metropolitan area. Data analysis was informed by grounded theory. Spiritually and culturally informed body ethics often guided surgery decisions. Participants expressed reservations about breast implants, preferring autologous procedures that use ‘what God has given’. For some, breast reconstruction restored a sense of normalcy after cancer; others challenged an imperative to reconstruct. Several participants redirected our focus on access to reconstruction toward access to alternatives, noting the low reimbursement for prostheses, or their unavailability in patients’ skin tones. We suggest that a framework of ‘stratified biomedicalization’ better addresses the complexities of race, class and gender that inform preference, access and recommendations for breast reconstruction, and focuses attention on access to high and low-tech interventions.

Advocacy and Empowerment: Group Therapy for LGBT Asylum Seekers

In countries worldwide, LGBT individuals are subject to persecution and discrimination, including grave human rights violations based on their sexual orientation or gender identity. Asylum provides a mechanism for LGBT individuals fleeing such persecution to legally remain in the United States. However, asylum is not guaranteed, and the asylum-seeking process may be particularly challenging for individuals with complex trauma histories. Although many LGBT asylum seekers are referred to individual psychotherapy by their legal counsel to prepare for the asylum process and to mitigate risks for retraumatization, many decline due to fear, shame, and cultural barriers, among other factors. Thus, we offer a model of group therapy for LGBT asylum seekers, rooted in multicultural and empowerment frameworks, which aims to address the unique concerns and challenges faced by LGBT asylum seekers. These include recovery from the effects of complex trauma, managing the stress of immigration and acculturation, minimizin...

HIV/AIDS-related institutional mistrust among multiethnic men who have sex with men: Effects on HIV testing and risk behaviors

OBJECTIVE To investigate relationships between institutional mistrust (systematic discrimination, organizational suspicion, and conspiracy beliefs), HIV risk behaviors, and HIV testing in a multiethnic sample of men who have sex with men (MSM), and to test whether perceived susceptibility to HIV mediates these relationships for White and ethnic minority MSM. METHOD Participants were 394 MSM residing in Central Arizona (M age = 37 years). Three dimensions of mistrust were examined, including organizational suspicion, conspiracy beliefs, and systematic discrimination. Assessments of sexual risk behavior, HIV testing, and perceived susceptibility to HIV were made at study entry (T1) and again 6 months later (T2). RESULTS There were no main effects of institutional mistrust dimensions or ethnic minority status on T2 risk behavior, but the interaction of systematic discrimination and conspiracy beliefs with minority status was significant such that higher levels of systematic discrimination and more conspiracy beliefs were associated with increased risk only among ethnic minority MSM. Higher levels of systematic discrimination were significantly related to lower likelihood for HIV testing, and the interaction of organizational suspicion with minority status was significant such that greater levels of organizational suspicion were related to less likelihood of having been tested for HIV among ethnic minority MSM. Perceived susceptibility did not mediate these relationships. CONCLUSION Findings suggest that it is important to look further into the differential effects of institutional mistrust across marginalized groups, including sexual and ethnic minorities. Aspects of mistrust should be addressed in HIV prevention and counseling efforts.

Cosmetic surgery and neoliberalisms: Managing risk and responsibility

The practice and culture of cosmetic surgery has proliferated in the past two decades. While much feminist scholarship has investigated women’s surgical stories, as well as the gendered sociocultural and sociopolitical contexts surrounding, and promoting, the ‘choice’ of surgery, very little research has examined material and symbolic risks associated with cosmetic surgery. This study employs a feminist interpretative phenomenological (IPA) approach to investigate cosmetic surgical risk experiences, as narrated by seven women who underwent aesthetic facial surgery. Our analysis focuses on how participants confront, and manage, medical, consumer and self-presentation risks associated with cosmetic surgery, under the political ethos of neoliberalism. The implications of these risk experiences are discussed in relation to the increasing normalization of cosmetic surgery and patriarchal/neoliberal obligations to construct a ‘feminine’ body through socially sanctioned practices.

Support needs and resources of sexual minority women with breast cancer

The current paper utilizes qualitative methods to better understand the support needs and resources of sexual minority women (SMW) breast cancer patients.

Incorporating Information Regarding Preimplantation Genetic Diagnosis Into Discussions Concerning Testing and Risk Management for BRCA1/2 Mutations A Qualitative Study of Patient Preferences

Studies have shown that BRCA1/2 mutation carriers are interested in learning about reproductive options such as preimplantation genetic diagnosis (PGD) to prevent passing their risk onto their children. However, attitudes vary widely, and the procedure raises complex ethical and psychosocial issues. This complexity, plus the highly technical nature of PGD, makes it difficult to integrate PGD information into genetic counseling sessions that already cover probabilistic, emotionally charged risk information.