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Infertility: Interventions for Shame, Mourning, and Feelings of Inferiority
The physical and social realities of infertility are unique because individuals do not know whether their infertile status is permanent or merely temporary. As a result of the ambiguities surrounding infertility, both the fear and the reality of permanent infertility constitute a "turning point" (Charmaz, 1994) for many men and women as they struggle to make sense of their embodied selves.
Particularly among those men and women who attend an infertility clinic, their investment in and internalization of pro-natal values, as evidenced by their attendance, results in self-concepts that are strongly affected by their bodies' reproductive capabilities and limitations. The inability to control the body by becoming pregnant at will often results in an identity shock (Matthews and Martin-Matthews, 1986), particularly to many of the women in this study, who had anticipated becoming mothers following marriage. Many of these women are well-educated, upper middle-class individuals who have been socialized with the assumptions that they are in control of their lives, that their successes and failures are the result of their abilities, rather than the social context, and that success is defined as having both careers and families. As "self-made women," this group of individuals has been confronted with the painful realization that their selves cannot exist socially except in concert with their bodies. Thus, the loss of control of the embodied self that they experience through infertility is often devastating and difficult to reconcile with their socialization and the dominant social constructions of femininity and womanhood.
Similarly, men's masculine self-concepts as sexually potent and whole men are threatened by their inability to impregnate their wives. For men, infertility is experienced as a potential social marker that they are sexually dysfunctional, as well as lacking in socially privileged and normative understandings of masculinity. Rather than embracing a range of masculinities (Connell, 1987; 1995), many of the men have internalized the dominant conceptualization of masculinity that is defined in terms of sexuality, dominance of the self over the body, and social power. Consequently, a man's inability to procreate is thought to be emasculating and, thereby, to deprive him of sexual and social currency. Infertility challenges central aspects of identity and self and points to the fact that both masculinity and femininity are based on more than such symbols as physical appearance.
Infertility illuminates the centrality of the body or "biologic" individual (Mead, 1934) to the individual's sense of self. Rather than being a peripheral aspect of the individual's lived reality, the body is both subject and object, and exists in a mutually influential relationship with the self. In infertility, the body becomes the source of continuity and discontinuity for the self. While, in any circumstances, the body is always a strong influence on the self, in infertility it is the physical inabilities and failings of the body that shape the meanings of femininity, masculinity, parenthood and adulthood. For many infertile individuals, this is the first time that the body-self connection has been brought under scrutiny. The anger and frustration that results from the realization that what was once taken for granted cannot be controlled and bent to the wishes of the self, is augmented by the shock of newfound comprehension of the power of the body--a power to define the reality of who they are, and to give definition of what they can or cannot become. Infertility shatters previously held perceptions of the body and the self as healthy, whole, and normal. Infertile men and women may perceive, often for the first time, that the self is controlled and "captured" by the body, rather than exerts authority over it. At the mercy of their bodies, these men and women experience a profound sense of helplessness and the unsettling discovery that the body can limit the self.
However, many infertile men and women retain a strong belief that the self can dominate the body. This is evidenced in the language that they use to describe the body, especially the female body. The repeatedly expressed metaphor of the female body as a defective machine implies both the superiority of the self and that "self-will" has the power to "repair" the malfunctioning body parts and restore the reproductive equilibrium. The use of such language also attests to the strong adherence of the respondents to the medical model of health and its accompanying depiction of the body as a machine composed of discrete parts that are distinct from the self. Nevertheless, the control of the body, either through the will of the self or through medical intervention, is juxtaposed for some women against the fear that past attempts to control the body through contraception have led to the current reproductive difficulties. The body seems to take on an active reality and force of its own, independent from the self. Thus, the body is seen as defiant when it fails to respond to medical treatment, and punitive when it is assumed to be reacting to the previous suppression of female reproductive capabilities. This suggests that infertile men and women tend to see the body and the self as engaged in a dynamic tension in which the body exercises moral authority over the self for transgressions it has suffered in the past--a view somewhat contrary to the idea that it is supra-reflexive aspects of the social self (either as generalized other or superego) that fulfills this role of social conscience.
The impact of the failings of the body on the self are gendered and situated in gender roles and norms. Infertility highlights the differing definitions and aspects of masculinity and femininity that relate to the relationship between the body and the self. While there are strong cultural expectations that women will become mothers (Ireland, 1993; Letherby, 2002; Ulrich and Weatherall, 2000), a man's sense of self is potentially more closely linked to his roles as worker, provider and lover (Berg, Wilson and Weingartner, 1991; Mahlstedt, 1985; Nelson and Robinson, 2002). Therefore, a woman's sense of incompleteness as a result of her infertility is all the more poignant and threatening to her sense of self and self-esteem. It is notable that infertility does not cast any doubts on a woman's sexual desirability or sexual potency. However, because of the sexual connotations of infertility, men strive to distance themselves from the stigma of impotence and seem to be invested in situating the cause of infertility in the woman's body. The medical emphasis on the treatment of the female body both augments a woman's sense of shame, guilt and inadequacy, even as it gives her a measure of power within the couple relationship over treatment decisions. However, one consequence of focusing on the woman's body as the site of treatment is that it actually further accentuates her investment in reproduction and the impact of the possibility or reality of permanent infertility on her sense of embodied selfhood.
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