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Gender and identity
According to feminist writers, historically, women’s selves, identities and positions in society “have been undermined by attempts to define their ‘unstable’ bodies as both dominating and threatening their ‘fragile’ minds” (Shilling, 2003, p. 40). This view of women originated in the 18th Century and can be seen even in the history of psychology. According to Shildrick (1997): …in being somehow more fully embodied than men, women have been characterized simply as less able to rise above uncontrollable natural processes and passions and therefore disqualified from mature personhood…it is as though bodies could somehow interfere with moral thought, instructing the mind, rather than the other way round as is the case with men (p. 26). A woman’s body seems to have become the battlefield where women fight for liberation: “It is through her body that oppression works, reifying her, sexualizing her, victimizing her, disabling her” (Greer, 1999, p. 114). For decades, feminists have been fighting to reclaim women’s bodies and minds from these stereotypes (Fernandes, Papaikonomou & Nieuwoudt, 2006), seeing embodiment as a process and not a split between body and mind (Shildrick, 1997) and showing that experiences of embodiment are essential for a healthy functioning of the self (Castle & Phillips, 2002). According to Macdonald (1995) the body is considered an integral part of a woman’s identity formation and the perceptions she holds regarding her physical appearance are usually complex and influenced by genetics, societal discourses regarding ‘ideal appearance’ and the woman’s particular personality style. According to Freedman (in Fernandes et al., 2006) “It is a woman’s body image that ultimately determines how she sees and experiences herself and others” (p. 852). According to Cromby and Nightingale (in Fernandes et al., 2006) a woman’s body is particularly associated to her identity due to the facts that it is a “site of birth, growth, aging, and death, of pleasure, pain and many things an object of desires…a bearer of features…a biological machine that provides the material preconditions for subjectivity, thought, emotion and language…” (p. 853). Hence the distortions of shape and bodily functioning that are characteristic of illnesses, such as AIDS, tend to be a crisis in terms of threatening a woman’s very identity and sense of self. As well as being a threat to life itself, AIDS can threaten physical appearance and the ability and/or practicality of bearing children, which brings a number of social stigmas to bear. According to Shildrick (1997) women who view themselves as being ‘disabled’ may experience a threat to their self-identity and then find their bodily experience invalidated. According to Fernandes et al. (2006) “A search for psychological and spiritual wholeness will emerge from these particular life crises. These turning points almost always raise fundamental questions about oneself and are instrumental in redefining a woman’s selfidentity in relation to the way in which she perceives her purpose and value in life” (p. 853). Hence, it can be seen that HIV/AIDS may necessitate a redefinition of identity for many women.
Culture, religion, stigma and HIV/AIDS
According to Manganyi (1981): “…culture is symbolization, ritual, intersubjectivity, in terms of which shared meanings and significances are attributed to a shared universe…culture is a medium for human self-extension and transcendence – a kind of symbolization which has a lot to do with the notions of individual and group identity” (p.65). According to Fife and Wright (2000) stigma is a ‘central force’ in the lives of HIV-positive individuals. Stigma can be defined as having an attribute that is considered deviant or different by society and that is experienced as deeply discrediting and spoiling one’s identity (Goffman, 1963). Stigma has also been described as a means by which society wields its power in terms of defining what is and what is not acceptable or desirable. By defining something as deviant or undesirable and excluding those decided to be deviant or undesirable, society is able to exercise its power (Gilmore & Somerville, 1994). A definition of AIDS related stigma is “prejudice, discounting, discrediting and discrimination directed at people perceived to have AIDS or HIV and individuals, groups and communities with whom they are associated” (Herek, 1999, p. 1102). In a national household survey it was found that 26% of those surveyed would be unwilling to share a meal with an HIV-positive person, 18% would be unwilling to sleep in the same room with someone with AIDS and 6% would not talk to someone with AIDS (Shisana & Simbayi, 2002). Although these percentages seem low, Stein (2003) criticized the study, stating that the quantitative, questionnaire method measures selfreport and not actual incidence of HIV/AIDS discrimination and stigmatization, and that therefore it cannot be considered an accurate measure of stigma. According to Visser, Makin and Lehobye (2006): HIV/AIDS stigma is a complicated issue with deep roots in the domains of gender, race, class, sexuality and culture. Although it is difficult to understand the process by which stigma is developed or changed on a community level, the clear need for establishing stigma-curbing interventions in the South African community cannot be denied. In addition to the counseling and education of HIV positive individuals to reduce their own fear of discrimination, interventions are needed on the community level, such as the implementation of Human Rights laws, the provision of social and healthcare services and social action campaigns to address the public’s negative attitudes towards and perceptions of HIV/AIDS. This would contribute towards changing the context within which individuals and communities respond to HIV/AIDS (p. 55). AIDS-related stigmas that permeate certain sectors of the South African population have been reported to be the greatest obstacle to HIV prevention and care (UNAIDS, 2003)due to the fact that the fear associated with HIV/AIDS stigma prevents many people fromtesting, disclosing their status or attending clinics for treatment and support (Kalichman & Simbayi, 2004). “Stigmas are linked to discrimination and therefore pose a realistic barrier toengaging in HIV-testing and prevention” (Parker & Aggleton, 2004, p. 14). According to Kilewo, Massawe, Lyamuya, Semali, Kalokola, Urassa, Giattas, Temu, Karlsson, Mhalu and Biberfeld (2001) the primary reason for not disclosing HIV/AIDS status and seeking treatment, amongst HIV positive sub-Saharan women, is fear of AIDS stigma. Sontag (1991) states that HIV carries the greatest stigma and “capacity to create a spoiled identity” (p. 101) than any other illness or disease. Underlying this stigma, in many cases, are beliefs associated with Western religious ideas of immorality and punishment or traditional African belief systems. While some conflict exists between traditional African beliefs and Western religions brought to Africa during colonialism, for the most part, these religions appear to have been integrated into current African culture (Eskell-Blokland, 2005). According to Masolo (in Eskell-Blokland, 2005) this ‘accommodation’ of the newer religions most likely occurred as adaptation to the pressures of Westernization. Eskell-Blokland (2005) writes that in the traditional African worldview, daily life intertwines with the spiritual and according to Masolo (in Eskell-Blokland, 2005) traditional African thought process remains for the most part undisturbed by new scientific explanations and has been referred to as a “world of magical beliefs” (p. 129). Eskell-Blokland (2005) states: For the traditional African the identification of words with reality opens a window to the magical, the spirit world and personal spiritual explanations…this is typical of the dynamic at play in some African traditional ceremonies…and in the significance of the role of spirituality in the African traditional way of life (p. 107). Hence, according to Goba (in Eskell Blokland, 2005) the present day African Independent Churches tend to be a combination of both Christian and African spiritual traditions, offering physical and mental healing and connection with the ancestors. According to Eskell-Blokland (2005) “The social power and authority held by the churches of Africa testify to the important place spiritual life plays in traditional and modern African culture beyond the narrow delineation of religion” (p. 108).
CHAPTER ONE INTRODUCTION
1.1. INTRODUCTION
1.2. RESEARCH AIMS AND OBJECTIVES
1.3. USE OF TERMINOLOGY IN THE STUDY
1.4. MOTIVATION FOR THE STUDY
1.5. RESEARCH DESIGN
1.6. THEORETICAL FRAMEWORK
1.7. BRIEF DISCUSSION OF THE FOLLOWING CHAPTERS
CHAPTER TWO LITERATURE STUDY
2.1. INTRODUCTION
2.2. HIV/AIDS AND MENTAL HEALTH IN CONTEXT
2.3. HIV/AIDS, IDENTITY, CULTURE AND STIGMA
2.4. HIV/AIDS, DEATH AND DYING
2.5. HIV/AIDS, SHAME AND STIGMA
2.6. CONCLUSION
CHAPTER THREE DISCUSSION OF THEORY
3.1. INTRODUCTION
3.2. POSITIVE PSYCHOLOGY
3.3. OBJECT RELATIONS THEORY
3.4. ANALYTICAL PSYCHOLOGY – THE WORK OF CARL JUNG
3.5. CRITICAL DISCUSSION AND INTEGRATION OF THEORETICAL APPROACHES
3.6. CONCLUSION
CHAPTER FOUR RESEARCH METHODOLOGY
4.1. INTRODUCTION
4.2. THE AIMS AND OBJECTIVES OF THE STUDY
4.3. RATIONALE FOR THE STUDY
4.4. THE THEORY BEHIND QUALITATIVE RESEARCH
4.5. MOTIVATION FOR USING A QUALITATIVE RESEARCH APPROACH
4.6. RECRUITING OF PARTICIPANTS
4.7. THE DATA COLLECTION PROCESS
4.8. DATA ANALYSIS AND ESTABLISHING STABILITY AND CREDIBILITY
4.9. REFLEXIVITY
4.10. ETHICAL CONSIDERATIONS
4.11. CONCLUSION
CHAPTER FIVE THE PARTICIPANTS
5.1. INTRODUCTION
5.2. BACKGROUND TO THE PARTICIPANTS
5.3. PATTERNS EMERGING FROM THE PARTICIPANTS’ LIFE STORIES
5.4. CONCLUSION
CHAPTER SIX RESULTS OF THE STUDY
6.1. INTRODUCTION
6.2. THEMES AND SUBTHEMES EMERGING FROM THE DATA: COPING ACCORDING TO THE PARTICIPANTS
6.3. INTEGRATION OF THEMES: COPING AS A PROCESS OF DISCONNECTION AND RECONNECTION
6.4. CONCLUSION
CHAPTER SEVEN DISCUSSION OF RESULTS
7.1. INTRODUCTION
7.2. THRIVING IS SURVIVING THE HERO’S JOURNEY: HIV/AIDS AS A CATALYST TO FURTHER INDIVIDUATION
7.3. CONCLUSION
CHAPTER EIGHT CONCLUSIONS AND RECOMMENDATIONS
8.1. INTRODUCTION
8.2. CONCLUSIONS DRAWN FROM THIS STUDY
8.3. LIMITATIONS OF THE STUDY
8.4. RECOMMENDATIONS
8.5. CONCLUSION
REFERENCE LIST
