Maria Gurevich

(Con)Tested Identities: Bisexual Women Reorient Sexuality

Abstract This article, based on an ongoing Canadian study of women who self-identify as bisexual, explores what it means to claim a bisexual identity. Semi-structured interviews with 22 women were analyzed using thematic decomposition, an analytic technique that combines discursive approaches with thematic analysis. Women in this study constructed their sexuality as a succession of interrelated impediments and imperatives that act in tandem to both prohibit and potentiate bisexu-ality. Specifically, they resist adopting the bisexual label while simultaneously working for bisexual visibility; they strive for credibility in a cultural context in which bisexuality occupies an ambiguous position; and they negotiate the dilemma of “belonging” to lesbian communities. Although diverse, these narratives of interrogation can be read as efforts to confront the inadequacies of dominant discourses of sexuality rooted in monosexism.

What makes an incident critical for ambulance workers? Emotional outcomes and implications for intervention.

Abstract Ambulance workers use the term “critical incident” to refer to a category of workplace stressor. Developing an evidence-based approach to critical incident stress begins with identifying what makes incidents critical. The aim of this qualitative study was to characterize critical incidents as well as elicit suggestions for interventions. We interviewed 60 ambulance-based workers, both front-line and supervisors, and analysed interview transcripts. Having presented their suggestions for interventions more fully elsewhere (Halpern et al, 2009), here we characterize the incidents that emerged as critical and the emotional responses evoked by them. We found they suffered considerable distress from critical incidents and would welcome interventions. Incidents that were identified as critical commonly involved patient death, often combined with poignancy. These events appeared to evoke vulnerable feelings of inability to help and intense compassion, which led to further emotional, cognitive, and behavioural responses. Difficulty in acknowledging distress and fear of stigma presented significant barriers to accessing support. These barriers may be overcome by educating both ambulance personnel and their supervisors to recognize and tolerate the vulnerable feelings often evoked by critical incidents. While gender and length of service did not seem to impact on evoked emotions, recent recruits may be more open to this type of education.

HEALTH CARE SERVICES FOR LESBIAN AND BISEXUAL WOMEN: SOME CANADIAN DATA

Specific health needs and health services for lesbian and bisexual women are relatively invisible in existing research, with little Canadian data on these topics. To redress such gaps, data were selectively analyzed from a larger study with 98 lesbian/bisexual women living in a Maritime Province in Canada. As part of a semistructured interview, women were asked to indicate whether a particular health care service was important to them. General physical examination, Pap smear, breast examination, and holistic medicine were the four services chosen with the highest frequency. HIV/AIDS information/screening and safer sex information were judged important by over half of the participants. When asked to rank their top three services, however, participants chose the physical examination, holistic medicine, and psychological counseling. Our results are discussed in terms of barriers to basic health care, accessibility of services, and the importance of accurate information about AIDS and safer sex.

Disciplining bodies desires and subjectivities: Sexuality and HIV-positive women.

Very little is known about the sexuality of women who are living with HIV, outside the context of risk prevention and education. Available research in the first-world context shows that, although most women continue to be sexually active following diagnosis, decreased sexual functioning is very common and more prevalent than among HIV-positive men. The present multi-site Canadian study is concerned with the ways in which women’s sexuality is transformed by the experience of living with HIV. Semi-structured interviews with 20 women were analysed using thematic decomposition, an analytic technique that combines discursive approaches with thematic analysis. The women in this study construct HIV as inhibiting in relation to sexuality. A predominant discourse of disciplining bodies, desires and subjectivities emerges, which centers on the restrictions imposed by an HIV-positive diagnosis. The following discursive constructions, in particular, emerge from the women’s accounts: diminished spontaneity, foreclosed (provisional) sexual freedom, foreclosed power, foreclosed flirtation, inciting violence, (un)natural sex, responsibility imperatives, muted/mutated sexuality, and diminished intimacy. The women’s predominant positioning within AIDS discourses as conduits of transmission, the relative neglect of women’s psychological and sexual health concerns in both research and public health agendas, and women’s relatively anomalous standing in AIDS communities imposes limits on bodies, lives, and subjectivities. These are reflected in these women’s accounts, wherein a focus on protecting others frequently impedes access to fulfilling (and safe) sexual and emotional relationships.

Identifying risk of emotional sequelae after critical incidents

Background and purpose Ambulance workers could benefit from a method for early identification of incidents likely to result in long-term emotional sequelae. There is evidence that persistence of some measures of anxiety beyond the first week after an incident is associated with sequlae. In this study we test the hypothesis that persistence of self-identifiable components of the acute stress reaction as early as a few days post-incident is associated with sequelae. Method 228 ambulance workers volunteered to complete surveys on occurrence and persistence of physiological, behavioural and emotional responses to an index critical incident in the past, as well as symptoms of depression, post-traumatic stress, somatisation and burnout at the time of the survey. Data were analysed for associations between duration of each reaction and present symptoms. Using cut-off scores for the outcomes, we tested the RR of high scores in each of three situations: occurrence of the reaction, persistence of reaction beyond one night and persistence beyond 1 week. Results Prolonged duration of all five acute stress reaction components was associated with all four outcomes, with the strongest associations being with post-traumatic stress and depression symptoms. The occurrence of physical symptoms of arousal is an immediate predictor of long-term sequelae. Three other components—disturbed sleep, irritability and social withdrawal—provide potential indicators of long-term emotional sequelae as early as 2 days post-incident. Conclusion Four easily identifiable responses to a critical incident can potentially be used for early self-identification of risk of later emotional difficulties. These findings should be submitted to prospective testing.

Attachment Insecurity, Responses to Critical Incident Distress, and Current Emotional Symptoms in Ambulance Workers

Ambulance workers are exposed to critical incidents that may evoke intense distress and can result in long-term impairment. Individuals who can regulate distress may experience briefer post-incident distress and fewer long-term emotional difficulties. Attachment research has contributed to our understanding of individual differences in stress regulation, suggesting that secure attachment is associated with effective support-seeking and coping strategies, and fewer long-term difficulties. We tested the effect of attachment insecurity on emotional distress in ambulance workers, hypothesizing that (1) insecure attachment is associated with symptoms of current distress and (2) prolonged recovery from acute post-critical incident distress, coping strategies and supportive contact mediate this relationship. We measured (1) attachment insecurity, (2) acute distress, coping and social contact following an index critical incident and (3) current symptoms of post-traumatic stress, depression, somatization and burnout and tested the hypothesized associations. Fearful-avoidant insecure attachment was associated with all current symptoms, most strongly with depression (R=0.38, p<0.001). Fearful-avoidant attachment insecurity was also associated with maladaptive coping, reduced social support and slower recovery from social withdrawal and physical arousal following the critical incident, but these processes did not mediate the relationship between attachment insecurity and current symptoms. These findings are relevant for optimizing post-incident support for ambulance workers.

Managed Not Missing Young Women’s Discourses of Sexual Desire Within a Postfeminist Heterosexual Marketplace

Our article describes findings from a project exploring sexual agency and desire among young women, focusing on the negotiation of sexuality within relationship contexts. Adopting a social constructionist framework, we used discourse analysis to examine semi-structured, audio-taped interviews with 39 Canadian young women (aged 18–26). Three related interpretive repertoires were identified, namely, (a) Sex as Relationship Hygiene (i.e., beneficial to the health of one’s relationship), (b) Sex as Exercise-esque (i.e., part of a wellness regime), and (c) Sex as Economy Exchange (i.e., a commodifiable practice within the heterosexual marketplace). Desire was not absent from participants’ accounts, however, it was channeled into specific forms of sexual expression and mediated by multiple and competing cultural imperatives. The interpretive repertoires provided spaces for agentic sex within which subjective sexual desire was not the primary motive but rather was subordinate to a rhetoric of self- and relationship improvement as a key register of sexuality. We discuss these findings in the context of postfeminist directives about sexual desirability and proficiency that young women must traverse as they develop ideas about successful female sexuality within heterosexual relationships.

Identifying, describing, and expressing emotions after critical incidents in paramedics.

For paramedics, critical incidents evoke intense emotions and may result in later psychological difficulties. We examined 2 ways to deal with emotions after critical incidents: (a) identifying emotions, and (b) describing and expressing emotions, and their association with recovery from acute stress and psychological symptoms. We surveyed 190 paramedics, examining how impaired capacity to identify and describe emotions (alexithymia) and voluntary expression of emotions during contacts with others in the first 24 hours after the incident were associated with recovery from acute stress and current symptoms of PTSD, depression, burnout, and somatization. Overall alexithymia was not associated with recovery, but the component of difficulty identifying feelings was associated with prolonged physical arousal (χ(2) = 10.1, p = .007). Overall alexithymia and all its components were associated with virtually all current symptoms (correlation coefficients .23-.38, p < .05). Voluntary emotional expression was unrelated to current symptoms. Greater emotional expression was related to greater perceived helpfulness of contacts (χ(2) = 56.8, p < .001). This suggests that identifying emotions may be important in managing occupational stress in paramedics. In contrast, voluntary emotional expression, although perceived as helpful, may not prevent symptoms. These findings may inform education for paramedics in dealing with stress.

Querying Theory and Politics: The Epistemic (Dis)Location of Bisexuality within Queer Theory

Bisexualitys capacity to reveal and disassemble existing regimes of power and knowledge that shape gendered and sexed discourses, identities and politics would appear to make it an obvious ally to queer theory and politics. Yet queer theory has variously sidestepped, marginalized and even arguably erased bisexuality. This article focuses on the epistemic dilemmas presented by bisexuality. The theoretical (not to mention psychic) machinations required to keep bisexuality outside the queer parade incite us to consider what function bisexuality serves discursively, epistemologically and politically. We join a number of scholars in an exhortation to consider bisexuality not merely as an identity or a practice, but as a key epistemological register from which to disassemble the polarized axes of gender and sexuality. In this way, we consider bisexuality in the context of its interdependent relationship with other sexualities and identities, rather than treating it as a distinct identity signifier. This approach permits us to see how bisexuality functions in the construction and maintenance of all sexual categories and asserts that its elision from sexuality discourses in general leaves a gap in all such discourses. For bisexuality to achieve its subversive potential, we need to extend theory and politics beyond quests for visibility and inclusivity, and to explore bisexualitys capacity to expose the inevitable contradictions, ambiguities and conflicts of all adopted identities.

Postpartum depression in refugee and asylum-seeking women in Canada: A critical health psychology perspective

Canada has one of the world’s largest refugee resettlement programs in the world. Just over 48 percent of Canadian refugees are women, with many of them of childbearing age and pregnant. Refugee and asylum-seeking women in Canada face a five times greater risk of developing postpartum depression than Canadian-born women. Mainstream psychological approaches to postpartum depression emphasize individual-level risk factors (e.g. hormones, thoughts, emotions) and individualized treatments (e.g. psychotherapy, medication). This conceptualization is problematic when applied to refugee and asylum-seeking women because it fails to acknowledge the migrant experience and the unique set of circumstances from which these women have come. The present theoretical article explores some of the consequences of applying this psychiatric label to the distress experienced by refugee and asylum-seeking women and presents an alternative way of conceptualizing and alleviating this distress.