Work, Leisure, and Support Groups: An Examination of the Ways Women with Infertility Respond to Pronatalist Ideology

Pronatalism embodies the belief that a woman's social value is linked to her production of biological children (C. Morell, 2000). Conceiving and bearing children is literally impossible, however, for some of the 5 million women in the United States who struggle with infertility. Women negotiate their experiences with infertility within a pronatalist society, yet their experiences therein have been given little attention. Thus, the purpose of this research was to explore women's lived experiences with infertility in a pronatalist ideology. Active interviews with 32 participants who had experienced infertility revealed that the women were aware of a pronatalist ideology, which was manifested through insensitive comments or questions and unsolicited advice. The women responded by immersing themselves in their work, leisure activities/experiences, or support groups. The findings illustrate how pronatalist ideology is manifest in social interactions, but they also suggest how it may be resisted.     

An Infertility Primer for Family Therapists: II. Working with Couples Who Struggle with Infertility

The distress of infertility and its medical treatments are profound, and the effects reverberate in each partner, the couple dyad, and the couple's relationships with family, friends, and medical systems. Yet family therapists, like others in our society, are often uninformed or misinformed about the experience of infertility. While the legacies of infertility may be painful and enduring, they often remain unspoken, and hence may be overlooked in standard interviews. This article describes the experiences of couples struggling with infertility, most of whom have sought medical intervention, and it provides treatment interventions for guiding couples through this difficult and often uncharted terrain. Case vignettes derived from 2 years of this clinical research study are included.     

Ethics,AIDS, and community responsibility

In the discussion of the responsibilities of society to the HIV infected and uninfected, a serious question seems to have been left out of the picture: To what extent are people who are not infected, have no special relationship to the infected and have no professional responsibilities for the care of AIDS patients under an obligation to come to the aid of people with the HIV? In this paper, I shall examine our responsibilities, as members of society, for the welfare of others to whom we may or may not have a special relationship. I shall argue that those responsibilities flow from the conditions that structure our transactions with others; conditions that make such transactions possible.     

A Back-Turning Harmony: Conflict as a Source of Political Community

It is widely assumed that community presupposes consensus on the good. As a result, liberals who acknowledge the permanence of pluralism have struggled to explain how a liberal society could realise the good of community. Here it is argued that our initial assumption is wrong. Conflict can serve as a source of political community. Our devotion to the things we care about provides us with reason to embark on a quest aimed at the elimination of conflict. The quest will require us to engage in the cooperative activity of dialogue with our moral adversaries. It is in this activity of dialogue, and not at the quests end, that political community can be located.     

Loving, discernment, and distance: pastoral care in schizophrenia

Schizophrenia is very common in our society, yet many people, both clergy and lay, are afraid of it and do not know what to do when confronted with someone who suffers from the disorder. Strange ideas and behavior can be frightening for those who don't understand and often result in further marginalization, even within the church community. This article seeks to outline the main features of schizophrenia and considers how to deal with particular situations which may arise in pastoral care. It suggests ways of dealing with people who express religious delusions and also argues that the "staples" of pastoral care--relationship building, empathy and inclusion--may not always be appropriate in the care of people with schizophrenia, who often need a "safe distance" between themselves and others. Some practical advice for families is also offered.     

On Creating a Theory of Feminist Therapy

Feminism implies, and comes out of, a phenomenological philosophy. This means that we know what is true not by the "givens" of society, but by listening to our inner experience and that of others. The fundamental political act is the same as the fundamental therapeutic act: it is the process of joining another person's experience in a way which enables that person to make explicit her internal knowledge of what is real. The therapeutic stance, which implies a belief in the basic rightness of a person's way of being in the world, is what makes this kind of experimental knowing possible. To carry our thinking and practice of feminist theory forward in an authentic way, we must approach ourselves and one another from a therapeutic stance. From this we can begin to formulate a reality which encompasses the experience of those who have thus far been invisible and silenced. This article uses the problem of boundary violations as an example of a current issue in feminist therapy that can be explored from an experiential perspective. The questions that come out of this perspective can inform our creation of a therapy and society that is truly pluralistic.     

Psychoneuroimmunology and male infertility: A possible link between stress,coping and male immunological infertility

Abstract

This current study investigated a link between stress and coping with some male infertility problems via psychoneuroimmunological theories. The study was carried out on 77 males who came to a fertility clinic for sperm diagnosis. Appraisal and coping with stress reaction to negative life events and to infertility were related to non-sperm cells within the seminal plasma. Those men who had felt strained from external events and from problems of infertility, and had used emotional escape coping strategies, were more prone to have an immunosuppressed reaction, indicated by bacteria within their plasma. Those using task focused control strategies were more prone to have an immunostimulatory reaction, indicated by white blood cells, including in some cases, sperm destroying phagocytes suggesting a possible auto-immunity reaction. When the analyses were done separately on patients with known male fertility problems in comparison with those with unexplained infertility, the two opposing psychoneuroimmunological processes became more pronounced.     

“Where Did I Come From?” The Impact of ART on Families and Psychotherapists

ABSTRACT

This article focuses on the field of assisted reproductive technology (ART) and psychoanalysis as it relates to people who’ve struggled emotionally in pursuit of their wish to create a family. Recent medical advances have changed baby-making to the extent that infertility is no longer a terminal diagnosis (Ehrensaft, 2012). New opportunities exist to create a family through introduction of a third party in the process of conception via in vitro fertilization, the use of donor egg and/or sperm, intracytoplasmic sperm injection, and surrogacy. The realities raised by these new methods have challenged usual cultural ideas of what constitutes a family, as well as what it means to become a parent or give birth to a child (Ehrensaft, 2000; Notman, 2011; Samish, 2006). The subject of reproductive medicine has stimulated a wide range of emotions within the community of people who suffer infertility and among psychotherapists who become involved with them in analytic and psychotherapeutic relationships.     

Liberalism, legal moralism and moral disagreement

According to "legal moralism" it is part of law's proper role to "enforce morality as such". I explore the idea that legal moralism runs afoul of morality itself: there are good moral reasons not to require by law all that there is nevertheless good moral reason to do. I suggest that many such reasons have broad common-sense appeal and could be appreciated even in a society in which everyone completely agreed about what morality requires. But I also critique legal moralism from the special perspective of liberal political justice. Liberalism requires that citizens who disagree with one another on a number of morally significant matters nevertheless coexist and cooperate within a political framework of basic rights protections. When it comes to working out the most basic terms of their political association, citizens are expected to address one another within the limits of what Rawls has called "public reason". Critics of liberalism claim that this is an essentially a-moral (or expedient) attempt to evade substantive moral issues--such as the moral status of the fetus. I argue, on the contrary, that liberalism's emphasis on public reason is itself grounded in very deep--though (suitably) "non-comprehensive"--moral considerations.     

‘A philosophy of change’: Emotions,civil society and global development

Dominant paradigms of global development have historically been devoid of emotions, connected with racialized and gendered ideas of rationality and civility. Within contemporary scholarship there is however increasing recognition of the importance of emotions for understanding development processes. This paper adds to this body of work by exploring the ways that emotions shape how people who are trying to ‘do’ development actually do it. Drawing on empirical material from conversations with civil society activists based on the Caribbean islands of Grenada and Barbados, this article explores some of the emotions that are present within civil society organizing and makes the case that in this context emotions are not just felt, they are generative of civil society organizing and wider development processes. Focusing on shame, the article demonstrates how emotions are produced relationally within civil society organizing, how emotions are generative and can co-construct spaces for civil society and how civic organizing can act as counter-expressions to these feelings. Emotions are then constitutive of global development, yet often neglected in dominant discourses of civil society within the development sphere, with professional subjectivities dominant.     

To Tell or Not to Tell: Breaching Confidentiality With Clients With HIV and AIDS

This article reviews some historical stereotypes and notes that society in general, and organized psychology in particular, have difficulty accepting and appreciating people who are different from traditional cultural and social norms. The history of Western civilization is written by the "winners" and usually does not capture the life and contributions of minority populations. This article suggests that psychology will be better served ethically when we recognize the biases of our discipline and give credence to the values of cultures other than our own.     

The Infertility Resilience Model: Assessing Individual,Couple, and External Predictive Factors

Resilience in couples experiencing infertility is critical to decrease the impact of infertility-related stress and sustain positive interactions and collective perceptions in couples. The Infertility Resilience Model (IRM) presented in this article provides a framework within which various individual, couple, and external factors that influence resilience can be understood. Although numerous approaches have been applied to infertility, few of them have examined resilience and the interconnections between individual, couple, and external influences. The concepts and connections within the model can be used by clinicians for assessment and interventions when working with couples facing infertility.     

LOSING SAMMY: A CATALYST FOR EXITING AN ABUSIVE RELATIONSHIP

Abstract

Miscarriage is a relatively prevalent occurrence in our society. The reported incidence of this event indicates that 20% of all women experience a miscarriage. Women who have miscarried report friends and family responding in ways that seem to try to reduce the impact and importance of the event. This leaves the grieving woman with a sense of little support or understanding of what she had just experienced. Furthermore, the experiences reported by women who have had a miscarriage are quite different from those reported by other individuals who have experienced other types of loss such as a spouse, partner, parent, or friend. Women who have miscarried report a lack of recognition that they have experienced a loss. Little is known about how society views miscarriage or why individuals respond in such an apparently unsupportive manner to a woman who has had a miscarriage. The present work sought to determine whether miscarriage is an unrecognized loss and to assess the meaning of miscarriage to others. Although the results indicate miscarriage is viewed as a loss, it is a loss with minimal grounded or valuative meaning for others, which suggests that the cultural norm of silence surrounding early pregnancy and miscarriage should be lifted     

Evolution,Altruism, and the Collective Superego

ABSTRACT

Our psychoanalytic understanding of human nature is that humans are self-interested. However, this view differs with those of evolution, ethology, and neuroscience, which show evidence of a natural altruistic capacity. A theoretical foundation for this capacity can be found in psychoanalytic works, particularly those of Melanie Klein. An emerging understanding is that of an altruistic capacity that is induced and shaped by early experience and either fortified or corrupted by social pressures and mental processes. In individuals and in collective society, superego dictates can conflict with natural altruistic impulses. Recognition within psychoanalytic theory of a primary altruistic capacity is important, because we as psychoanalysts have an impact on individual and cultural self-perceptions through our treatment of patients and through our writings and therefore contribute to the shaping of values in our society.     

Infertility as boundary ambiguity: one theoretical perspective

Infertility as a life event can be understood from a number of conceptual perspectives: a developmental crisis, a grief reaction, a disruption of marital contracts and roles, a crisis of identity, sexuality, and/or values, or a challenge of decision-making processes. Stress theory and the construct of boundary ambiguity can augment the understanding of the crisis of infertility by providing a different approach and unique perspective. It is the hypothesis of this article that the involuntarily childless couple may experience infertility as a stress of boundary ambiguity, that is, not knowing who is in and who is out of the family system. As infertile couples attempt to make the transition to parenthood they may experience the child they wish to have as a family member who is psychologically present but physically absent.     

Towards a new philosophy of education: Extending the conversational metaphor for thinking

Recently, feminists like Jane Roland-Martin, Elizabeth Young-Bruehl, and others have advocated a conversational metaphor for thinking and rationality, and our image of the rational person. Elizabeth Young-Bruehl refers to thinking as a constant interconnecting of representations of experiences and an extension of how we hear ourselves and others. There are numerous disadvantages to thinking about thinking as a conversation.We think there are difficulties in accepting the current formulation of the conversational metaphor without question. First, there is danger that we will lose important dialectical connections like that between the self and society. Second, the conversational metaphor alone cannot fully express the way conversations are constructed. We will want to take up the notion of narrative as a metaphor for thinking advocated by Susan Bordo, Alasdair MacIntyre, Jerome Bruner, and others, including Mary Belenky and her colleagues.Eventually, we want to champion narrative and the dramatic narrative of culture as a metaphor for thinking that involves such expressions as sights, insights, silences, as well as sounds, moments of mood and poetic moments. The dramatic narrative provides the structural possibilities needed to criticize certain kinds of conversations, in order to talk about the relations of public and private, self and society and most importantly, about the drama of our lives within and without.The dramatic narrative for thinking helps dispel the dangerous dualisms of mind and body that not even conversation or narration alone can banish, and allows us to frame questions about education that do not require us to separate mind from body. The dramatic narrative metaphor for thinking lets us show who we are, act out what we think, and reconstruct rationality to reflect what many women, and some men, do.     

Infertility,epistemic risk,and disease definitions

I explore the role that values and interests, especially ideological interests, play in managing and balancing epistemic risks in medicine. I will focus in particular on how diseases are identified and operationalized. Before we can do biomedical research on a condition, it needs to be identified as a medical condition, and it needs to be operationalized in a way that lets us identify sufferers, measure progress, and so forth. I will argue that each time we do this, we engage in epistemic risk balancing that inevitably draws upon values and interests, often including social and ideological values. My main interest here is in the conceptualization of infertility as a disease. Infertility is a rich test case for exploring the interplay between interests and epistemic risk management. There is no uncontested or standardized definition of infertility. The various definitions of it are internally ambiguous and tension-ridden, and in spectacular contradiction with one another. Many interest groups who are invested in framing infertility as a pressing problem deserving of social and medical redress are quick to insist that it is a legitimate ‘disease,’ but they cannot agree on which disease it is, what its symptoms or diagnostic markers are, or even what its basic ontology is. I suggest that there are political explanations for this epistemic mess. Indeed, I contend that there are good scientific and ethical reasons to reduce away the category of ‘infertility,’ especially understood as a scientific or medical category; I argue that we should excise the concept from our research and clinical practices.

     

Moral Philosophers as Ethical Engineers: Limits of Moral Philosophy and a Pragmatist Alternative

Ever since Kant, moral philosophers have been more or less animated by the mission of discovering inescapable law‐like rules that would provide a binding justification for morality. Recently, however, many have started to question (a) whether this is possible and (b) what, after all, this project could achieve. An alternative vision of the task of moral philosophy starts from the pragmatist idea that philosophizing begins and ends in human experiencing. It leads to a view where morality is seen as a “social technology” that aims to make living together possible, and strengthens people's capability to live a good life within a society. The role of moral philosophy is, accordingly, to develop our moral tools further. Moral philosophers become ethical engineers who use their expertise in ethical topics to criticize existing “moral technology” and construct new concepts, tools, and theories that better answer the current challenges for living a good life.     

The Infertility Experience: Biopsychosocial Effects and Suggestions for Counselors

Infertility affects many individuals and couples. This article begins with a case study of a couple who have experienced infertility yet do not identify infer tility as their presenting problem. Clients and counselors alike often overlook infertility. This article offers an overview of the biology of infertility and its psychological and sociological effects. Counseling issues are presented to assist counselors to identify infertility as a concern and provide interventions.     

Constructing a story to live by: Ethics,emotions and academic practice in the context of climate change

Starting from the concept of the narrative-self, this paper explores the everyday ethics of research and academic practice as seen through the storied-experiences of two women who have chosen their careers through their desire to contribute meaningfully to the resolution of environmental issues. Selves are embedded in language, in relationships, in societies, in places and in ecologies. However, selves are also co-constructed in dialogue between teller and listener or writer and reader. In the intersubjective space opened up through dialogue lies the potential for change at both personal and societal levels. Enacting a narrative ethics of reading and writing that draws on counselling practices, this paper brings my own affective, embodied story into dialogue with the published memoir of Alison Watt. As we both struggle to find stories we can live by within the contexts of specific academic and research communities we begin to challenge the narratives and discourses that dominate our respective fields of field biology and human geography. The emotional and embodied practice of narrative ethics is offered as one possible response to the overemphasis on technical rationality within our society and its institutions. I argue that the development of practical wisdom (phronesis) is essential to addressing issues such as climate change, which are not simply technical problems but are fundamentally rooted in the human condition.