‘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.     

Immediate breast reconstruction and psychological adjustment in women who have undergone surgery for breast cancer: a preliminary study

Current debate exists regarding the timing of reconstructive surgery following mastectomy for breast cancer, with research pointing in favour of immediate reconstruction. This cross-sectional study sought to compare the psychological outcome of breast cancer treatment in women who had either received mastectomy and immediate reconstruction using autogenous tissue (n?=?30), or mastectomy alone (n?=?34), and also determine adjustment factors in this population as a whole. Participants completed measures of depression, anxiety, body image, self-esteem, coping and perceived social support at a time point 3?-?15 months after initial surgery. No significant differences were revealed between the two groups on any of the outcome measures. Poor body image, low self-esteem, and a tendency to use coping strategies characterized by helpless/hopelessness and anxious preoccupation, rather than fighting spirit, were highly predictive of distress. Reasons for the lack of differences between the two groups are explored.     

Religion and Spirituality in Coping with Advanced Breast Cancer: Perspectives from Malaysian Muslim Women

This article is part of a larger study on the role of spirituality in coping with breast cancer among Malaysian Muslim women. The study seeks to reveal the meaning of the experience through the stories of three Muslim women surviving advanced breast cancer, to better understand the deep meanings that inform their experiences with spirituality and transformation as they cope with the challenges of breast cancer. Data were gathered using in-depth interview. Qualitative methods were used in identifying two themes—illness as an awakening and hope and freedom comes from surrendering to God. The themes were discussed in the context of two broad areas: (1) what are the new meanings these women discovered in their experiences with cancer; and (2) how did the new meanings change their lives? The study suggests that cancer survivors’ experiences with cancer and their learning processes must be understood within the appropriate cultural context. This is especially so for spirituality. The common emphasis of spirituality on relationship with God, self and others, may significantly influence how people learn to live with cancer.     

In search of the ‘Aha!’ experience: Elucidating the emotionality of insight problem‐solving

Although the experience of insight has long been noted, the essence of the ‘Aha!’ experience, reflecting a sudden change in the brain that accompanies an insight solution, remains largely unknown. This work aimed to uncover the mystery of the ‘Aha!’ experience through three studies. In Study 1, participants were required to solve a set of verbal insight problems and then subjectively report their affective experience when solving the problem. The participants were found to have experienced many types of emotions, with happiness the most frequently reported one. Multidimensional scaling was employed in Study 2 to simplify the dimensions of these reported emotions. The results showed that these different types of emotions could be clearly placed in two‐dimensional space and that components constituting the ‘Aha!’ experience mainly reflected positive emotion and approached cognition. To validate previous findings, in Study 3, participants were asked to select the most appropriate emotional item describing their feelings at the time the problem was solved. The results of this study replicated the multidimensional construct consisting of approached cognition and positive affect. These three studies provide the first direct evidence of the essence of the ‘Aha!’ experience. The potential significance of the findings was discussed.     

Anxiety and body satisfaction before and six months after mastectomy and breast reconstruction surgery

As breast reconstruction is an important adjunct after mastectomy to regain physical integrity and also to improve affect, the present aim was to evaluate patients' subjective perceptions of body image during the whole breast reconstruction period and to assess the importance of their psychological reaction in terms of negative affectivity. Participants were 62 women, 43 women (M age = 46.4, SD = 9.8) who had had mastectomies and 19 healthy women (M age = 39.9, SD = 13.99). Patients were admitted for surgery at the Hospital S. Orsola in Bologna. Healthy subjects were relatives of the women and students, all with no history of breast pathology. The Body Satisfaction Scale and the State Anxiety Inventory-Y were administered to the two groups before, post, and 6 mo. after surgery. Analysis of scores indicated that during the period of the study, the women with mastectomies reported higher anxiety and also greater dissatisfaction with their body image than the healthy group, even when the breast had been reconstructed. This unexpected finding suggests patients' unrealistic expectations of the breast reconstruction and the surgical outcome.     

The lived experience of psychotherapists working with older clients: an heuristic study

This paper presents the results of an heuristic study based on the research question: ‘How do psychotherapists experience working with older clients?’ The question came from the researchers’ experience and interest in working with older clients in general practice. It started from the researchers’ desire to examine more closely feelings and elements present in their own experience in dialogue with seven other practising therapists who had an interest and experience of working with this client group. Qualities and elements identified were: perceptions of old age and ageism; boundaries and settings; changes to practice; culture and experiences; awareness of time; loss; decline and mortality; and parents and children. These are illustrated by material from each of the participants, a composite depiction of the experience, a creative synthesis and examples from the researchers’ experiences.     

Men's experience of considering counselling: ‘Entering the unknown’

Agency statistics in the UK and North America reveal that fewer men than women attend counselling, at a ratio of about 1:2. This study investigated men's experience of considering counselling, with the aim of gaining further understanding of factors that might contribute to the existing gender discrepancy in utilisation of counselling. Following responses by 47 men to written questionnaires, 10 men who had considered and ultimately attended counselling were interviewed, and a grounded theory method of analysis was used to generate and analyse the participants' experiences. Three interconnected categories emerged: societal perceptions of counselling and gender roles; change of experience over time; and knowledge — ‘knowing’ and ‘not knowing’ the protocols of counselling. The implications of these findings are discussed. It is recommended that prospective male clients should be provided with information about the counselling process, and that there needs to be increased awareness by counsellors and referring agents of male gender issues.     

The stage-specific role of spirituality among African American Christian women throughout the breast cancer experience

This study presents the results of semistructured interviews conducted with 18 African American Christian women regarding the role of spirituality throughout their breast cancer experiences. The spiritual themes relevant for phases of the breast cancer experience are identified. Analysis resulted in the identification of 11 codes and 5 subcodes that corresponded to the diagnosis, treatment, and posttreatment phases of the breast cancer experience. Most of the survivors indicated that their spirituality and faith assisted them throughout the breast cancer experience. Discussion focuses on the spiritual resources used by the participants at the different stages in the breast cancer experience. Attention is given to implications for how professionals can use these resources to assist African American women coping with breast cancer.     

Short- and Long-Term Impact of Receiving Genetic Mutation Results in Women at Increased Risk for Hereditary Breast Cancer

Forty-seven unaffected women from high-risk breast cancer families who had received results for hereditary breast/ovarian predisposition genes between 1 month and 5 years ago were interviewed regarding their experiences. Women responded to open-ended questions. The initial emotional turmoil reported by most was generally short lived. However, the impact of genetic testing went beyond the individual to the extended family and social context, particularly in the short-term. A common theme was the difficulty associated with divulging a result to family members, who were also adjusting to their own result. The majority of carriers reported advantages that were both physical (options for surveillance programs and prophylactic surgery) and emotional (reduced uncertainty, increased awareness of options and knowledge about risk, preparation time). Most carriers reported no change in lifestyle although some reported discovering their mutation status as a positive life-changing experience. Implications for genetic counseling and further research are discussed.     

Seeing,mirroring, desiring: The impact of the analyst’s pregnant body on the patient’s body image

The paper explores the impact of the analyst’s pregnant body on the course of two analyses, a young man, and a young woman, specifically focusing on how each patient’s visual perception and affective experience of being with the analyst’s pregnant body affected their own body image and subjective experience of their body. The pre‐verbal or ‘subsymbolic’ material evoked in the analyses contributed to a greater understanding of the patients’ developmental experiences in infancy and adolescence, which had resulted in both carrying a profoundly distorted body image into adulthood. The analyst’s pregnancy offered a therapeutic window in which a shift in the patient’s body image could be initiated. Clinical material is presented in detail with reference to the psychoanalytic literature on the pregnant analyst, and that of the development of the body image, particularly focusing on the role of visual communication and the face. The author proposes a theory of psychic change, drawing on Bucci’s multiple code theory, in which the patients’ unconscious or ‘subsymbolic’ awareness of her pregnancy, which were manifest in their bodily responses, feeling states and dreams, as well as in the analyst s countertransference, could gradually be verbalized and understood within the transference. Thus visual perception, or ‘external seeing’, could gradually become ‘internal seeing’, or insight into unconscious phantasies, leading to a shift in the patients internal object world towards a less persecutory state and more realistic appraisal of their body image.     

Significance of nature in a clinical setting and its perceived therapeutic value from patients’ perspective

The effect that nature can have on the development of mental health and the implications for recovery is important for understanding the impact nature has on humans, as well as delineating possible alternative venues for treating psychological problems. The present qualitative study examined how individuals understand the significance of nature in relation to their mental health and treatment. A total of 12 participants in residential treatment for varying nonpsychotic mental health issues were interviewed about previous and present experiences with nature and the meaning these experiences have for them in recovery. Thematic analysis resulted in the creation of two main themes: «being human in nature», which included three sub-themes ‘experience of nature’, ‘effects on focus and attention’ and ‘change and the transformative in nature’, and «nature, the patient and treatment», with two sub-themes ‘nature as therapy’ and ‘nature and therapy’. Participants describe a feeling of coming closer to themselves, to their problems and existential meanings when in nature. In addition, they report being able to make new relational experiences with other patients, and that some experiences in nature can function as symbolic tools in therapy. The study underlines the complex interrelationships between nature and humans and points to new lines for future research.     

Making sense of male rape: constructions of gender,sexuality and experience of rape victims

This study reports a preliminary investigation into accounting practices for male rape in conversation. Thirty men and women, in dyads, were asked to discuss an incident of male rape presented to them in a vignette. The findings showed that two main issues were discussed: the experience of the rape act and societal responses to male victims. In addition, participants established a ‘hierarchy of suffering’, where rape was judged to be worse for ‘heterosexual’ men than it is for ‘women’ or ‘gay’ men. Hegemonic, phallocentric representations of heterosexuality were mobilized to argue that acts of rape and consensual intercourse are the same for ‘gay’ men and ‘women’ and therefore less traumatic than for ‘heterosexual’ men. This obscures the violence of rape for gay men and women and exonerates perpetrators by minimizing injury sustained. Participants also argued that heterosexual victims are likely to experience ridicule for having departed from hegemonic masculinity. Arguments were constructed to avoid charges of being dismissive towards women and gay men and of victim blaming in relation to heterosexual men. Copyright © 2004 John Wiley & Sons, Ltd.     

African American Women’s Limited Knowledge and Experiences with Genetic Counseling for Hereditary Breast Cancer

Genetic counseling and testing for hereditary breast cancer have the potential benefit of early detection and early interventions in African American women. However, African American women have low use of these services compared to White women. We conducted two focus groups with African American women diagnosed with breast cancer (affected group, n?=?13) and women with at least one first-degree relative with breast/ovarian cancer (unaffected group, n?=?8). A content analysis approach was employed to analyze interview data. Breast cancer survivors had more knowledge about genetic counseling and testing than participants who were unaffected with cancer. However, knowledge about genetic counseling was limited in both groups. Barriers to pursuing genetic counseling and testing included poor understanding of the genetic counseling and testing process, fear of carrying the mutation, concerns about discrimination, and cost. Motivators to participate in genetic counseling and testing included desire to help family members, insurance coverage, and potential of benefiting the larger African American community. Education efforts are needed to increase genetic counseling and testing awareness in the African American community.     

Men’s Lived Experiences with Breast Cancer: The Double Consciousness of Marginal Men

The present study investigated men’s experiences with their breast cancer diagnosis and post-mastectomy lives. It is based on the sociological tradition of investigating the “marginal man” who lives in two not merely different but incompatible cultures (e.g., the pink ribbon culture of breast cancer and the everyday ideals of masculinity and the male body). Seventeen mature and aging U.S. men who all lived with a breast cancer diagnosis and treatment, including a mastectomy, were interviewed. The principle finding reveals that they saw themselves as men and remain seen by others in terms of their gender, not their atypical illness. Two meta-themes underlying men’s breast cancer stories were identified: body talk and embodiment of their breast. Each of these themes had subthemes. Noticeable was how the historical era when diagnosed and men’s aging experiences influenced their illness journey and stories. For all, even the recently diagnosed, their journey was a lonely one. No man had known another man with breast cancer to consult. Only a few men felt their breast cancer was a stigma, and they too did not feel emasculated. Instead, in the process of embodying their breast cancer, they amended their identities and practiced softer, hybrid forms of masculinities.

     

The impact of assuming the primary caregiver role following traumatic spinal cord injury: An interpretative phenomenological analysis of the spouse's experience

This study aimed to explore the lived experience of assuming the primary caregiver role in a group of spouses of individuals living with a traumatic spinal cord injury (SCI) (injuries ranged from paraplegia to quadriplegia). Individual in-depth interviews were conducted with 11 participants who were both the spouse and primary caregiver of an individual with a SCI; of these, 10 were female and 1 was male. All interviews were transcribed verbatim and were subjected to interpretative phenomenological analysis (IPA). Here we present three inter-related master themes: ‘The emotional impact of SCI’; ‘Post-injury shift in relationship dynamics’ and ‘Impact of caregiving on identity’. Regarding the emotional impact of spinal injury, participants reported an almost instantaneous sense of loss, emptiness and grief during the injured person's rehabilitative period and feelings of anxiety were reported in anticipation of their return to the family home. A distinct change in role from spouse and lover to care provider was reported and this ultimately contributed to relationship change and a loss of former identity. The findings are discussed in relation to extant caregiver literature and recommendations for future caregiver support are highlighted.     

The experience of feeling fat for women with anorexia nervosa: An interpretative phenomenological analysis

Feeling fat has been implicated as a maintenance factor in anorexia nervosa (AN), despite limited research into the experience. This study expanded the literature by exploring the lived experience of feeling fat for women with a diagnosis of AN. Seven women participated in this study and data was collected through semi-structured interviews. Interpretive Phenomenological Analysis (IPA) was employed to explore the participants’ experience of ‘feeling fat’ and its relevance for clinical treatment. Four main themes emerged from the data: ‘negative sense of self’, ‘feeling out of control’, ‘coping with feeling fat’, and ‘making sense of feeling fat is complex’. These results highlight feeling fat as a significant experience and maintenance factor for women with a diagnosis of AN. Implications for addressing feeling fat within psychological therapy are explored.     

The experience of ‘healing stories’ in the life narrative: A grounded theory

‘healing stories' are part of an emergent narrative literature in psychology and counselling. This research explored the subjective experience of ‘healing stories’ within the context of individual's life narratives. A grounded theory (Strauss and Corbin, 1990) method of analysis was used to generate and analyse six participant's life narratives. Analysis of these accounts revealed three categories. The first is the context of struggle that preceded the healing process. participants told of struggle in their relationships with others as well as turmoil in their experience of themselves. The second category, the healing process reflected the participants' growing awareness of life's existential givens (Yalom, 1980). This represented a personal exploration that opened lparticipants to a ‘healing story’ that offered them an insight into choices and possibilities for liberation. The third category illustrated that in the ongoing struggle the ‘healing story’ has continued to provide inspiration in the participants' lived experience as an ‘evoked companion’ (Stern, 1985). This research posited a core dynamic whereby participants' experience of their ‘healing story’ provided not only an initial inspiration that was healing but also, in their ongoing struggle, the ‘healing story’ continued to inspire their lived experience.     

The role of positive thinking in social perceptions of cancer outcomes

Pressure for ‘positive thinking’ (PT; i.e. focusing on positive thoughts/suppressing negative thoughts to ‘fight’ cancer) burdens cancer patients facing health deterioration. It was determined whether PT exposure enhanced effort, control and responsibility attributions assigned to an individual for his/her cancer trajectory. Within an online blog a hypothetical same-gender person describes a personal cancer experience. 482 participants were assigned to one of six experimental conditions in which we manipulated PT exposure (blogger learns about ‘power of PT’ but does not try it, blogger tries PT, control/no PT) and cancer outcome (successful/unsuccessful treatment). A 3?×?2?×?2 multivariate analysis of covariance (with personal cancer experience covariates) tested PT exposure?×?cancer outcome?×?gender effects on attributions for the blogger's cancer outcome. Results indicate that PT exposure enhanced effort and responsibility attributions assigned to individuals for their cancer outcomes and that responsibility attributions differed as a function of gender. Findings suggest that exposure to the idea of PT may lead to cancer patients being perceived as culpable if they do not recover from the disease.     

An Interpretative Phenomenological Examination of Psychosocial Changes among Breast Cancer Survivors in their First Season of Dragon Boating

This study used an interpretative phenomenological perspective to qualitatively examine changes in body image and social support experienced by novice participants in breast cancer survivor dragon boating programs. Fourteen women were interviewed at the beginning and end of their first dragon boating season. The participants typically experienced increased perceptions of strength and fitness, and a shift towards discussing body image with respect to fitness, strength, and musculature rather than weight and appearance. Many women discussed an emerging athletic identity. Social benefits included connecting to women who understood the breast cancer experience and could share first-hand information. Some women also reported struggling with the constant reminder of being a survivor. Overall, breast cancer survivors experienced benefits, but further work should explore how they cope with challenges and how dragon boating could inform other physical activity contexts for this population.