MEANINGS OF HEALTH AND WELL-BEING FOR RURAL LESBIANS IN NORTHERN BC by Amber Perry B.A., University of Victoria, 1996 THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in GENDER STUDIES © Amber Perry, 2002 THE UNIVERSITY OF NORTHERN BRITISH COLUMBIA April 2002 All rights reserved. This work may not be reproduced in whole or in part, by photocopy or other means, without the permission of the author. 1^1 National Library o( C an ad a Bibliothèque nationale du Canada Acquisitions and Bibliographie Services Acquisitions et senrices bibliographiques 385 WeWnglon Sum( 395, ru* WaSinfltoo Orna*#ON K1A0N4 Canada O em w eON K1A0N4 Canada The author has granted a non­ exclusive licence allowing the National Library of Canada to reproduce, loan, distribute or sell copies o f this thesis in microfonn, paper or electrcmic formats. 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Ni la thèse ni des extraits substantiels de cdle-d ne doivait être inq>rimés ou autrement rqnroduits sans son autorisaticm. 0-612-80684-7 Canada APPROVAL Name: Amber Perry Degree: Master of Arts Thesis Title: MEANINGS OF HEALTH AND WELL-BEING FOR RURAL LESBIANS IN NORTHERN BC Examining Committee: Chair: Dr. Dee Home Associate Professor, English Program UNBC rvisor: Dr. Jo Anne Fiske Associate Professor, First Nations Studies Program UNBC Committee Member: Dr. Ellen Associate Professor, Regional ChmrTSouth Central Region UNBC Committee Member: Dr. Theresa Heal y Adjunct Professor, Women’s Studies Program UNBC External Examiner: Dr. Kenneth M. Prkachin Professor, Psychology Program UNBC Date Approved: /^uuU 11 ABSTRACT Knowledge of meanings of health and well-being is an important component of sensitive and culturally appropriate health care. Knowledge of health beliefs contributes to a greater understanding of health-related behaviour and can benefit the design and effectiveness of services, policy and educational materials. This thesis explores meanings of health and well-being of four lesbians living in northern, rural communities of British Columbia. Phenomenological interviewing elicited rich descriptions of meanings of health. These taped interviews were subsequently transcribed and analyzed by the researcher, resulting in a composite statement of the underlying structure of participants’ meanings of health and well-being. The analysis also yielded three major themes—Control of Space, Integration, and Means— underlying participants’ essentially holistic paradigm of health and well-being. Acts of acceptance by the heterosexual community and desire for an organized lesbian community were also significant to participants’ experience of well-being. Building on the research relationship between community/academic researchers and rural lesbians in this region, and focusing on positive experiences of living rurally (as opposed to negative experiences with formal health care) are two important contributions of this research towards strengthening and diversifying knowledge in this field. Ill TABLE OF CONTENTS PAGE ABSTRACT......................................................................................................................... ii TABLE OF CONTENTS...................................................................................................iii ACKNOWLEDGEMENT.................................................................................................vii DEDICATION..................................................................................................................viii CHAPTER ONE: INTRODUCTION................................................................................. 1 Overview................................................................................................................................1 Foundation for Topie........................................................................................................... 5 Structure.................................................................................................................................8 Definition of Terms used in this Study..................................................................9 Participants’ Confidentiality.............................................................................................. 12 CHAPTER TWO: LITERATURE REVIEW.................................................................. 13 Part One - Health Meaning Literature.............................................................................. 13 Health M eanings.................................................................................................................16 General Health Domains....................................................................................... 16 Qualitative Methods............................................................................................................19 Rural Meanings of Health and Well-being.......................................................................23 Conclusion............................................................................................................. 24 Part Two - Canadian Women’s Health............................................................................26 Northern/Rural B.C. Women’s Health Literature.............................................. 27 Conclusion............................................................................................................. 43 CHAPTER THREE: RESEARCH DESIGN...................................................................46 Research Goals................................................................................................................... 46 Complimenting methodology, method, research topic and researcher.............47 Choosing a Qualitative Methodology...............................................................................48 Defining Qualitative Research..............................................................................48 Flexibility and Refiexivity....................................................................................48 Heterosexism within Methodology......................................................................50 Phenomenology as Qualitative Research.............................................................51 Feminist Research.............................................................................................................. 55 The Significance of Feminist Research................................................................56 Feminist Research and Phenomenology..............................................................58 IV Lesbian Research Ethics and Practices.............................................................................62 Confidentiality....................................................................................................... 64 Respecting Identity................................................................................................ 65 Language................................................................................................................ 66 Stigma..................................................................................................................... 67 Giving Back to Community..................................................................................68 What I Learned Doing Feminist Lesbian Research.........................................................69 Study D esign...................................................................................................................... 71 The Researcher...................................................................................................... 71 Research Settings................................................................................................... 74 Selecting Participants............................................................................................ 75 Group Profile......................................................................................................... 78 Ethics....................................................................................................................................79 Confidentiality....................................................................................................... 79 Informed Consent.................................................................................................. 80 Interview M eetings............................................................................................................ 81 In-depth Interviewing............................................................................................ 81 Data Collection................................................................................................................... 83 Audio Tapes........................................................................................................... 83 Field N otes............................................................................................................. 84 The Role and Contribution of the Northern Secretariat Lesbian Health Group............ 85 CHAPTER FOUR; DATA ANALYSIS..........................................................................88 Approach to the Topic....................................................................................................... 88 Bracketing........................................................................................................................... 90 Evaluating Transcripts....................................................................................................... 91 Analyzing the Data............................................................................................................. 92 On-Going Analysis................................................................................................ 92 Transcribing Interviews......................................................................................... 95 Analytical Table..................................................................................................... 95 Analysis.................................................................................................................. 95 Participants’ Code Names.................................................................... Confidence in the Data........................................................................................ 101 Interviews..........................................................................................................................103 First Round........................................................................................................... 103 Second Round...................................................................................................... 104 CHAPTER FIVE: FINDINGS........................................................................................ 107 Introduction to Findings.................................................................................................. 107 Participants............................................................................................................107 Positiveness.......................................................................................................... 109 Rural Lesbians’ Meanings of Health Inside Holistic Frameworks..............................110 100 Theme One: Control of Space.........................................................................................113 autonomy..............................................................................................................114 privacy.................................................................................................................. 115 Theme Two: Integration ................................................................................................. 117 being inside/being outside...................................................................................120 self-knowledge/self-work....................................................................................121 Theme Three: M eans........................................................................................................123 Validation by Town Community.....................................................................................126 support.................................................................................................................. 128 acceptance.............................................................................................................128 Significance of Rural Lesbian Communities..................................................................129 CHAPTER SIX: DISCUSSION - PART O N E ............................................................ 132 Lesbians Living Within Rural Contexts......................................................................... 132 Rural Contexts......................................................................................................133 Rural Contexts and Lesbians’ Meanings of Health and Well-being............................138 Control of Space.................................................................................................. 139 i. autonomy............................................................................................. 140 ii. safety.................................................................................................... 141 Integration.............................................................................................................143 Means.................................................................................................................... 144 CHAPTER SEVEN: DISCUSSION - PARTTW O...................................................... 145 Rural Lesbian Communities and Meanings of Health and Well-being....................... 145 Queer Communities..........................................................................................................145 Value o f Queer Communities............................................................................. 145 (Lack of) Queer Communities in Rural Contexts..............................................146 Rural Barriers to Lesbian Communities......................................................................... 148 Social Climate.......................................................................................................148 Distance and Farming Commitments.................................................................150 Lack of Diversity................................................................................................. 151 Transient Populations.......................................................................................... 152 Closed Networks.................................................................................................. 153 Lifestyle Differences........................................................................................... 154 Lesbian Community and Meanings of Healthand Well-being..................................... 156 Strategizing Wellness..........................................................................................157 Impeding Behaviours........................................................................................... 158 Commuting for Community............................................................................... 159 Independence-based Well-being......................................................................... 159 Conclusion............................................................................................................160 VI CHAPTER EIGHT: CONCLUSION............................................................................. 164 Summary of Findings...................................................................................................... 164 Meanings of Health and Well-being...................................................................164 Lesbian Community and Well-being..................................................................166 Methodology..................................................................................................................... 167 Purpose of Qualitative Researeh......................................................................... 167 Lesbian Research Issues......................................................................................168 My Learning..................................................................................................................... 168 Power in the Researeh Act...................................................................................168 Future Research Recommendations............................................................................... 172 Contribution to Existing Knowledge.............................................................................. 173 References..........................................................................................................................174 Appendix 1........................................................................................................................ 184 Appendix 2.........................................................................................................................186 Appendix 3........................................................................................................................ 187 Appendix 4.........................................................................................................................188 vil ACKNOWLEDGEMENTS My honest appreciation and respect to Dr. Jo Anne Fiske. Your commitment to my completing this research rekindled my own responsibility and confidence to finish. Thank you Jo. To Dr. Barbara Herringer and Dr. Theresa Healy, my original inspirations and role models for teaching and for community research. You both contributed to this research in tangible and intangible ways. I hold you, your work, and your process very highly. My gratitude to Dr. Beverly Leipert for your careful review of my work and your suggestions and criticisms which significantly improved its quality. My appreciation to Dr. Ellen Facey and Dr. Kenneth M. Prkachin for your time and support of my research. Many thanks to my father Russ Perry - 1 would not have been able to complete this degree without your generosity. My fond appreciation to Jenny Fry. Thank you for your unwavering support and administrative help. Most of all I thank Sue Sorrell. You travelled closely with my heart and mind through this time. Your editorial finesse is incomparable. Your belief in the value of my work treasured. Light and Love to you. vin DEDICATION This work is dedicated to the resilient and courageous rural lesbians who shared their time and knowledge with me, especially Silverweed, Hemlock, Bluegrass and Fireweed. Documenting your lives and meanings has made me aware of the purpose and value of doing qualitative research. vni Chapter One Introduction Chapter One is composed of five sections which overview and situate the research topic These sections are: (1) overview; (2) foundation for topic; (3) structure; (4) definitions of terms used in this study; and (5) participants’ confidentiality. M ost research on gays and lesbians conceptualizes g a y life as urban, and research on rural fam ilies and communities does not typically include lesbians and g a y men. A s a result, w hat w e know about rural g a ys and lesbians is based m ore on clinical and advocacy work than em pirical research. (Oswald, 2000, Rural gays and lesbians book review, para. 5) Overview This research explores rural lesbians’ meanings of health and wellness based on their everyday experiences in rural contexts. Stevens and Hall (1988), McCormack and Gooding (1993), and Rosenbaum (1991) state that knowledge of marginalized populations’ health meanings is particularly important because marginalized people usually have greater health risks in the first place. However, the purpose of this study is more about recognizing and understanding lesbians’ wellness in relation to their unique contexts than it is about simply itemizing health beliefs. In fact, in this research, participants’ health meanings take on their deepest meaning when they are considered in relation to participants’ everyday contexts. Meanings of health, if they are studied through the lens of everyday experience, also contribute to health knowledge on marginal populations because the social barriers to wellness are construed in the particular ways an individual defines and manages her well-being. Ideally, rural lesbians’ meanings of health and well-being will inform and complement policy recommendations and needs assessments aimed at this population. “Studies of rural life and lifestyles have yet to seriously address issues of sexuality” (Bell & Valentine, 1995, p. 113). On the other hand, within gay and lesbian studies there is a related and increasingly noted absence of research about rural queers: “The Urban biases of empirical research on gay men, women, and families have resulted in minimal knowledge about gay people in rural settings (D’Augelli & Hart, 1987, p. 79). Gay and lesbian health researchers note the dearth of knowledge about lesbian experiences of health, in particular rural lesbian experiences of—and strategies to achieve—health and well-being (see D’Augelli, Collins & Hart, 1987; D’Augelli & Hart, 1987; and Stevens & Hall, 1988). Within rural studies, queer studies, nursing and social work, some researchers have suggested that both a heterosexist bias and an urban bias have omitted and underestimated the unique experiences and knowledge of queer folk residing within marginal contexts. These gaps in the awareness of rural queers’ experiences have shaped the borders of this study, including the broad interview questions and the exploratory, empirical focus of the research. Studying rural lesbians’ meanings of health and wellness is a step towards addressing the limitations in existing knowledge about the well-being of marginal people living within marginal locations. Understanding the intricate and diverse intersections of different kinds of marginalization (e.g., location/geography-sexuality-gender), and the relevance of health and well-being to these intersections, is an ambitious project. One of the meanings of this research is that it is partial, incomplete, modest. My desire for this project is that it would largely be about actual people living the research topic. Their experiences and my interpretations o f them—and not the academic, elite discussions taking place outside of their circumstances—form the bulk of this project. I intentionally focused my research question on the everyday, lived quality of well-being, as opposed to a focus on or inclusion of experiences with formal services. I chose this path in order to complement and diversify the existing body of literature that documents lesbians’ formal health eare experiences. ’ This research also rests upon the artificial separation of rural lesbians from other queer folk such as rural gay men, bisexuals, and transgender people. In other words, my envisioning this research assumed that meanings of health and wellness as understood and described through lived experience are meaningfully differentiated by gender and sexual orientation. Although there are differences between rural lesbians’ and gay men’s experiences of life, rural gay men, lesbians, bisexual and queer-identified folk are often considered as one population in research (for example, Healy & Herringer, 1997) perhaps due to small sample size, and/or the fact that very little research in this area exists: researchers may be more focused on documenting queer experience than on the ways those experiences differ between sub-populations. While recognizing potential shared experiences as well as the need to broadly document in little-researched areas, I feel it is still necessary to consider lesbians’ experiences separately in this research. I considered this separation necessary for three reasons: although gays, lesbians and bisexual people ’ See, for example, Barnett, 1985; Buenting, 1992; Dennenberg, 1992; Eliason, 1991; Geddes, 1994; Gentry, 1992; Lucas, 1992; Peterson & Bricker-Jenkins, 1996; Roberts & Sorensen, 1995; Robertson, 1992; Rothblum, 1994; Simkin, 1991; Stevens, 1992, 1993, 1994, 1996; Stevens & Hall, 1988, 1991; Trippet & Bain, 1992; White & Matinez, 1997; W innow, 1992;). (and to a lesser degree transgendered people) in rural communities together compose rural queer communities, there are significant differences in their experiences that I do not wish to gloss over or homogenize in this research. For example, in the same way as research on urban lesbians cannot represent rural lesbians’ experiences, the experiences of gay men and bisexual people, for example, can only represent gays and bisexuals. I think this is especially significant when research is geared towards an intensive inquiry constrained by space and financial limits. It would be more appropriate to consider the experiences o f all queer identified people together, for example, if the research question is about documenting a group experience or history, such as a history of rural queer people, where many perspectives are desired for both their individuality and in their relationships to each other. Another reason to separate lesbians from gay men and bisexual people is because the majority of my experience as a queer person has been played out within lesbian community and friendships. It made sense at the time to undertake research with a population with whom I shared a sexual identity and with whom I could therefore relate in important ways. For example, I did not need to be convinced of the realness and ubiquitousness of homophobia and sexism (and sexism within queer communities), and how they become amplified in rural communities. Sharing the sexual identity of my participants (and hence being an insider) also made it easier to be trusted as someone from a different community. The third reason to support considering the experiences of rural lesbians separately from other queer people is that while research on queers exists, most of this research is both quantitative and takes gay men as its subject. However, qualitative research on women and lesbians is growing. making it possible to solely focus on lesbians without having to cite studies that are predominantly about gay men, or without having to narrow the experiences of female bisexuals to their relationships with other women. Foundation for Topic My interest in rural lesbians’ meanings and experiences of health and wellness developed after moving to Prince George in 1996 from Victoria. Being queer in a mid­ size West Coast Canadian city is a fundamentally different experience than being queer in a small(er) northern/interior city. For example, outwardly acts of affection and bonding that I was used to expressing with my girlfriend in Victoria seemed out of place and unwelcome in Prince George. The habit and luxury of associating with queer-only folk for friendship and support in Victoria was irrelevant in Prince George where other lesbians were not easily identifiable or easily approached. Outside of the university, the lesbian community was hushed, subdued and, for the most part, underground. At least that was my impression as a new import from the south. I describe the community as ‘underground’ because I believe that Prince George society in general remains unaware of the extent of its queer community and of how many queer individuals reside and work there but remain closeted to co-workers, acquaintances or even family. Over the course of three years, and starting with my first month in Prince George, I noticed a change in my attitude and way of being in the world. I felt I was backing into the closet, a behaviour I would have deemed unthinkable had I remained in Victoria. But it was impossible to point my finger at any one source to explain my reluctance to express my sexual identity outside of small queer circles. No one in particular had done anything to me, but I sensed strong discomfort and hostility just below the surface. My reticence was an invisible yet ever present filter that restricted outwardly acts of lesbianism whether that be public affection to my partner, or choosing clothing/accessories that would advertise my queemess. My first awareness of the need to be covert occurred when I registered for women’s hockey. I called up a representative who also happened to be a player on the strongest team in the women’s league and inquired about vacancies on her team. I also told this person that I was gay and hoped that would not be an issue. I never heard back from her again. However, 1 discovered later that she did refer my number to another representative of a weaker team—a team that was sometimes referred to by other teams as the ‘dyke team’. At the same time as I was experiencing an ineffable alienation and subduing of my queer expression, 1 became interested in lesbians’ formal health care experiences through some course research for a final paper. That research taught me that to the extent that lesbians are included in health studies, they are overwhelmingly lesbians living in large, metropolitan cities, and that their experiences had come to define the limited knowledge on lesbian health issues everywhere. Furthermore, it was obvious that lesbian health researeh typically investigates lesbians’ relationship to formal health care and not informal health experiences. I thought about the changes I felt inside myself about publicly expressing my queemess and how these experiences had dramatically altered my conceptions of being healthy and the process of achieving and maintaining my wellness. To a certain degree, what I read in the literature as lesbian health concerns resonated with my own experience: issues of confidentiality and respect, the concern for knowing which physicians and other health care providers were lesbian-friendly, and lesbian specific health issues such as breast cancer and STDs. However, there was a significant absence in the literature of the connection between health/wellness and geographical location. For example, access to resources, support, and the effect of stigma on rural lesbians’ well-being are a few health issues that are uniquely experienced in rural communities. I started to wonder about the invisibility of non-urban lesbians’ health/wellness experiences and whether or not the experience of living outside of an urban context was influencing others’ experiences and meanings of health/wellness as much as they had mine. During my stay in Prince George, I realized very soon that many people do not consider Prince George as either a ‘northern’ or ‘small’ city. Folk living in small communities of 5000 or less outside of Prince George in particular hold this view. Even though my own sense of wellness had shifted dramatically after moving from Victoria to Prince George, it was also obvious that Prince George was not limited in the same ways or to the same extent as the outlying rural communities. Around the same time I was thinking about these issues, I became aware of a research project designed to explore support services for lesbian and bisexual women in rural communities. The publication of that report—And They Lived Happily Ever After: support systems created by lesbian and bisexual women in the central interior^ (Sorrell & Watson, 1997)— further provoked and supported my interest in the health/wellness experiences of lesbians in small rural communities. A couple of years later, another project began— Out in the Cold: the ^ This research project is also com m only referred to as the “LA BIA ” project {LABIA meaning Lesbian And Bisexual women In Action). contradictory context o f health and wellness fo r lesbians in northern communities (Anderson, Healy, Herringer, Isaae & Perry, 2001)—whieh also proposed exploring rural lesbians’ experiences with both formal health care services and their communities in general. I felt that building on the existing researeh and working in collaboration with the Out in the Cold project would demonstrate a commitment to queer rural women and their issues and in that way address both the alienation so prominently expressed in the “LABIA” report as well as the under-representation of queer rural women’s experience and health knowledge in academic literature. Structure This thesis is composed of eight chapters. Chapter 1, Introduction, introduces the topic and defines terms used in this study, as well as situates the choice of topic to my experience in a northern city. Chapter 2, Literature Review, overviews the related literature and how this thesis contributes to the existing body of researeh. Chapter 3, Research Design, outlines my research goals, explains my choice of methodology and how feminist and lesbian research practices complement the methodology. Chapter 3 also describes the relationship between myself and the researeh process, how participants became involved in the study, participants’ demographics, choice of method (in-depth interviewing), data collection, and the role of the Northern Secretariat in this research process. Chapter 4, Data Analysis, details the process of how I approached and became intimately involved with the data, including the analytical steps that led to the condensed and formulated meanings of participants’ everyday experiences of health and well-being. Chapter 5, Findings, presents the major and minor themes from the data analysis. Chapter 6, Discussion - Part One, discusses how the experience of living in rural communities bears on the findings of the previous chapter. Chapter 7, Discussion - Part Two, discusses the significance o f (rural) lesbian community, and how (lack of) rural lesbian community bears on meanings of health and well-being. Chapter 8, Conclusion, summarizes the main points of this research, including personally valuable aspects of the research process to the researcher, and how this research contributes to knowledge of lesbian lives. Definitions of Terms Used in this Studv The following definitions reflect how these terms are used both by participants in this study and/or in related literature. Closeted: Fearing public/familial exposure of one’s sexual and/or gender identity which may result in selective coming out, or not coming out at all. For example, being out to a partner and close friends but closeted to family or workplace. Coming Out: A lifelong, (and initially an often profound) process of sharing one’s sexual and/or gender identity with other people after first acknowledging and accepting it within oneself. Feminist Research: Refers to a research approach that is informed/guided by feminist research principles/features and/or ethics, and not a unified, specific methodology per se. Feminist research principles used in this thesis include privileging women’s experiences, use of a research method (in-depth interviewing) that privileges women’s voices and expressions, documentation and analysis of the researcher’s role in the research process (including an analysis of power-over), and member validation of the findings. 10 Gay: A male or female homosexual. In this research, “gay” only refers to homosexual males when specified (for example, gay males/gay men), or when used with lesbian (for example, gay and lesbian communities). Otherwise, it can mean a homosexual woman or man (e.g., gay men and women; I am a gay woman). It is a term many rural lesbians comfortably use to self-identify. Health: In this study, “health” more often than not refers to a physical health/state o f being, though it also means overall health or general health. The term ‘health’ is often used in combination with well-being or wellness to represent a complete health continuum.^ Heterosexism: “A world view in which non-heterosexual people, their history and culture, are ignored and omitted” (Roberts, 1992^ p. 13). Homophobia: Fear and hatred of homosexual people, which manifest in attitudes, policy, and/or violence. Internalized Homophobia: Shame, fear and guilt of one’s homosexuality caused by internalizing social stigma of queers (gays, lesbians, bisexuals, and transgender people). In-Town Lesbians/Queers: Lesbians/queers who live within the rural township in residential neighbourhoods. ^ Across a broad context, “health” refers to more than just a physical state o f being. The World Health Organization (W HO) defines health as “a state o f complete physical, mental, and social w ell-being and not merely the absence o f disease or infirmity” (Larson, 1999, p. 126). Within Canada, the definition o f health also includes gender, social, econom ic and environmental factors as significant health determinants (Leipert, 2000). Lesbians’ predilection towards self-care, and alternative and non-Western health care practices (Hudspith, 1999), in a broad sense further outlines a working definition o f health specific to queer women. 11 Power Plays: What exists in human research “because of tensions between the researchers’ subjectivities and the demands of social relations encountered in the research process. They are made visible through adherence to the principle of refiexivity in writing accounts of the research process” (Ristock & Pennell, 1996, p. 66). Queer: Not identifying as ‘straight’ or heterosexual. Rurality: Term used in (political) geography and rural studies that refers to the idea and meanings of rural-ness and country-ness. Rural Community: Terms used in place of the actual names of participants’ townships. Also refers to a psychological sense of belonging to a particular tradition, value system and way of life (e.g., rural communities are typically conservative). Town Community: In this research, refers to the predominantly heterosexual community that composes the residential/commercial neighbourhoods in rural communities. Transgender: A self-referent used by people who feel their gender identity does not correspond to their chromosomal sex. Transgendered identities exist on a continuum, for example, MTF (male-to-female), FTM (female-to-male), and gender-queer (neither exclusively male nor exclusively female). Well-being/Wellness: More often than not means a holistic concept of health representing an overall totality of health. Any aspect of one’s life that has to do with inner and outer health is relevant (e.g., spiritual, psychological, mental, sexual, physical, social and emotional). 12 Participants’ Confidentiality Confidentiality of information was guaranteed at the beginning of this project. However, participants varied in their desire to remain anonymous throughout the research. For my own peace of mind and for the present and ongoing protection of participants, I decided to remove any evidence that could identify participants such as names, detailed job descriptions, names of participants’ friends that were mentioned in the research, and names of participants’ rural communities. 1 also asked participants to read over their transcripts and the Findings chapter and indicate passages they thought could identify them. I feel taking these measures is one of the responsibilities of working with marginal, stigmatised groups in small communities. In such contexts, seemingly small details about an individual can easily lead to their identification. 13 Chapter Two Literature Review Chapter Two is divided into two groups of literature that have either shaped or influenced my research: (A) health meaning literature; and (B) northern and/or rural BC women’s and lesbians’ health literature. Part one (A), health meaning literature, includes the following sections: (1) health meanings; (2) qualitative methods; (3) rural meanings of health and well-being; and (4) conclusion. Part two (B) discusses (1) northern/rural B.C. women’s health literature; (2) conclusion. Documents from these two groups have little in common in content and style and eonsequently I consider them separately. However, what is similar between these two groups is that they each deal with marginalized populations. Both groups also claim as one of their research goals to improve the experience and delivery of health care. Part One - Health Meaning Literature The meanings given to o n e ’s physical, mental, and so cia l health p ro vid e a measure o f how the individual view s living and quality o f life. (Lee, 1993, p . 20) Since the early ‘80s, it has been the increasing interest of nursing and sociology to study different populations’ health conceptions. A significant portion of the research in this area surged between the mid 1980s and early 1990s. It consists of primary and secondary, and qualitative and quantitative research in health meanings/concepts/models and beliefs. There exists a significant amount of health meaning literature from which to choose. Not all health meaning studies are relevant to my research: I selected health meaning research on the basis of two criteria: (1) research dealing with a marginal population and (2) studies that use a qualitative methodology (ideally phenomenology). 14 The health belief literature I located dates from 1974 - 2000, although the studies I review here date between 1987 - 2000. Increasingly, health research is acknowledging and documenting the important influence of social and cultural factors upon health beliefs and experiences of well-being. Furthermore, recognition of this influence is valuable to the delivery of more effective formal health services (Emami, Benner, Lipson, & Ekman, 2000). Health meaning research suggests that health meanings are relevant to culture and social identity, and that individual differences within groups are also significant (Claire, Watkins & Billinghurst, 1996; Burkhart, 1993; Hopper, 1993; Rosenbaum, 1991; Morse, 1987). Health meaning research also confirms that health meanings are varied, pluralistic and subjective; “Health can only by defined by the individual experiencing it,” (Burkhart, 1993, p. 123); “Because health is an integral aspect of culture, it must be studied and defined within the context of specific cultures” (Rosenbaum, 1991, p. 1321); “Health is ... a relative state, culturally defined and varying according to the belief systems between cultures” (Morse, 1987, p. 29); “Lay beliefs about health differ according to the social group to which respondents belong and that further diversity between individuals exists” (Claire, Watkins and Billinghurst, 1996, p. 511). Morse (1987) states that the method by which health is attained is reflected in the meaning ascribed to it. Keller (in Burkhart, 1993) also notes that health beliefs also reflect vested disciplinary interests, and that each discipline “offer[s] its own view of health from its own particular vantage point” (p. 122). Only two o f these studies (Butler & Hope, 1999; Stevens & Hall, 1988) explore the health beliefs o f lesbians. However, the studies on health meanings o f other marginal populations have been valuable to my research because they also suggest that the conditions which marginalize a population are relevant to that populations’ health meanings. 15 I conceived my thesis topic out of the recognition that rural lesbians’ health experiences in general are invisible in lesbian health research, and that often the findings from lesbian health researchers are generalized to all lesbians, even though the findings often represent the exclusive experiences of (younger) lesbians living in urban contexts. Often a geographical context is specified but not considered a factor in the analysis of health meanings and experiences, overlooking the fact that geographical contexts impact health experiences and expressions. It is unlikely that the significance of differences in health beliefs between participants from one culture/social group will be perceptible and appreciated unless more is known about the interplay between health/wellness and partieipants’ specific contexts. Another way existing research on rural lesbians obscures rural lesbians’ everyday health experiences is that it only documents lesbians’ experiences and/or needs with formal services (e.g., how can experiences with formal health care workers be improved? What are the barriers in rural communities to aecessing formal health care?). Focusing on rural lesbians’ health experiences based on their everyday lives creates space in which to learn about another little-known aspect of lesbian health experiences. Not only is such research valuable in its own right, but it also contributes to a more thorough understanding of rural lesbians’ relationship to formal health services. The studies I look at in depth explore the health meanings of mature, rural lesbians; urban lesbians; the homeless, the elderly; transient, inner city residents; and Greek-Canadian widows—groups which by definition are all marginal to mainstream healthcare. 1 consider these studies in the following ways: I summarize the health 16 domains of each study; discuss the relevance of health domains to the stated population; and assess the significance and effectiveness of the qualitative research methods used in these studies to explore health meanings. Health Meanings Health meaning research recognizes the significance of understanding health meanings in relation to their context in order for their successful integration into health care policy and settings. Simply listing health beliefs without their wider contexts undermines their greater value for health research. Understanding that health beliefs are integral to a specific cultural/social role/context (and not simply an end product of those roles/contexts) leads to an appreciation of the meaningful differences within a subpopulation (Congress & Lyons, 1992). An overview of these studies reveals that variation in health meanings is relevant to participants’ contexts, suggesting the need for more research into context-based assessment of marginal populations’ health needs, barriers, and behaviours. General Health Domains As can be presumed, most studies found that meanings of health were construed through the following general domains: physical, mental/emotional (including psychological), holistic, and social, although emphasis on these domains differs. Sometimes health meanings are expressed independently through one of these domains (for example, physical or emotional); often they are expressed in combination and/or in relationship to two or more domains (for example, physical health resulting from positive well-being), sometimes they included the totality and interplay of all domains (well-being 17 derived from equilibrium amongst physical, mental, psychological, and social domains). Holistic hcalth/wcllncss encompasses descriptions of integration and balance in all aspects of physical and non-physical health, and sometimes includes an intangible, spiritual, life-positive energy force that comes from within and also from one’s environment. Though Butler and Hope (1999) did not explore meanings of health per se, participants from their study on older rural lesbians described the contribution of their beautiful natural environments to their experience of well-being. In Stevens and Hall’s study (1988), lesbians primarily conceived of their health holistically, which included combined emotional, physical and social elements. McCormack and Gooding (1993) found that homeless people express their health meanings in four distinct perceptions based on the unique combination of “physical, mental, emotional, spiritual, social, and environmental health dimensions” (p. 47). Elderly people in a phenomenological study by Wondolowski and Davis (1991) contributed profoundly unique meanings of health based on a psychological and metaphysical sense of being in the world (and not on health dimensions per se), including energetic self-affirmation, creating fulfillment, and the reverie associated with reminiscing and future projection.^ The inner city residents in Morse’s study (1987) expressed their health meanings through different combinations of physical and mental (e.g. psychological and emotional) dimensions. Rosenbaum’s study (1991) found that Greek widows predominantly express their health meanings as a sense of well-being, an ability to meet role expectations within their culture, and as the ^ Research conducted by W ondolowski and Davis (1991) with elderly people is unique in that health domains were neither identified nor incorporated by the researchers in their findings. 18 avoidance of pain and illness. The definition of health domains (e.g., what sort of descriptions are grouped under a domain heading) suggests that despite the use of similar language across studies (e.g., physical domain, psychological domain), what constitutes each health domain is unique to the population under study, further emphasizing the value of learning different populations’ health meanings. For example, lesbians cite athleticism and involvement in physical exercise as characteristic o f a physical domain (Stevens & Hall, 1988), whereas inner city residents in Morse’s study (1987) (including alcoholics, frail individuals, and the elderly) characterize a physical domain as including “a warm, clean place to live,” “the ability to eat,” “the ability to sleep,” and the “ability to move around” (pp. 34-35). In McCormack and Gooding’s study (1993), homeless people’s conceptualization of a physical domain includes physical fitness, strength, regular exercise, a balanced diet and plenty of sleep— all qualities that are relevant to their challenges of meeting basic physical needs such as nutrition, rest, and exercise. Qualities that relate to the meaning of health in a general sense are also meaningful when the context of the population is considered. For example, Greek widows in Rosenbaum’s study (1991) characterize health as the ability to meet various role expectations in their daily agendas. This meaning of health is relevant to the salience of family in Greek culture, such as the responsibility to one’s family in terms of cultural role expectations, the role of family to care for a parent, and the prevalence of folk health meanings/expressions that had been passed down through generations. However, for homeless people (McCormack & Gooding, 1993), significant meanings of health include the goals of simply having a daily agenda, or simply the process of planning daily 19 activities. In lesbian health literature, the predilection of lesbians towards self-care and independence from formal health services (Barnett, 1985) is consistent with research conducted with lesbians by Stevens and Hall (1988) and Butler and Hope (1999), where self-relianee and a predilection towards alternative health care lie at the core of lesbians’ conceptions and expressions of wellness. Qualitative Methods Several of the above researchers also advocate qualitative methods/methodologies as the most appropriate approach to health meaning research,*^ especially when little is known about a field of study (Burkhart, 1993; Morse, 1987; Rosenbaum, 1991). All of the studies reviewed here employed qualitative research techniques to obtain knowledge about health meanings. Qualitative research centres on the subjective experience of partieipants. In health meaning research, participants’ experiences are considered the most effective means to understanding health meanings, which are intricately woven into one’s value system, culture and identity. Stevens and Hall (1988) state that, “qualitative research seeks the insider’s view and is more reflective of the complexities of the natural world” (p. 70). Most importantly, qualitative methods arrive at knowledge inductively and often utilize the participants’ own words to express major points of the analysis. Because the nature o f health meanings is specific to a culture, a social group or an individual, an inductive analysis expressed as much as possible in participants’ own language is critical to a meaningful and context-relevant understanding of health beliefs. ^ These studies also acknowledge that health meanings are affected by choice o f m ethodology, raising the issue o f the role(s) o f methodology/methods in the pursuit o f knowledge. 20 All studies reviewed here employ qualitative methods, ineluding unstructured or semistruetured interviews (including repeat interviews) which in some cases lasted as long as four hours. Butler and Hope (1999) conducted face-to-face interviews of one to two hours with a snowball sample of 21 informants. They identified five major themes which were subsequently presented in participants’ words. The researchers note that although flyers advertising the project were left in rural community buildings (health care and social service centres), no participants were solicited by this means. McCormack and Gooding’s phenomenological study (1993) employed open-ended questions in guided interviews to leam about the health meanings of twenty-nine homeless persons. Guided interviews ensured the appropriateness and relevance of information to the research questions. McCormack and Gooding also kept verbal diaries of their own observations and inferences that they transcribed and considered as part of the database. Rosenbaum’s (1991) ethnographic techniques, including in-depth interviews lasting 1 . 5 - 4 hours and observation-participation, elicited rich data and facilitated an understanding of context­ relevant health meanings. Wondolowski and Davis (1991) employed van Kaam’s modified phenomenology to explore the lived meaning of health of one-hundred and eight men and women over the age of eighty.^ In this study, three common elements surfaced from 411 descriptive expressions through a process of “intuiting and analyzing” (p. 115). Stevens and Hall (1988) chose open-ended questions and encouraged participants to speak o f the experiences of “lesbians in general” to generate data in ^ van Kaam’s phenom enology enabled such a large sample in part because “there is no provision for returning to the subject for an elaborated description” (1991, p. 115). 21 individual interviews lasting up to two hours (p. 70). This approach resulted in freely given data determined by participants. Non-verbal responses such as body language were also recorded and considered in the data analysis. Morse (1987), in her study dealing with health meanings of an inner city community, used open-ended, unstructured interviews, second interviews, and recorded the personal impressions of the interviewers^ to leam about health perceptions and health care use with 93 individuals. All of the studies reviewed here inductively derived general health meaning categories from transcribed interviews. After establishing general categories, researchers then more thoroughly pemsed the words and expressions to validate the categories and to understand the significance of variant data. The confirmation of health meaning categories was followed by an analysis of the relationships between categories. These procedures, which are more or less similar between studies, enabled health meanings/perceptions based on participants’ subjective knowledge to be identified and valued. Another commonality to the studies (and another goal of qualitative research) is the role of trust between researcher and participant. Initial interviews (in which researchers and participants could talk about themselves) and snowball sampling techniques (in which tmst already exists—or is extended—due to a prior friendship) are two ways in which tmst and comfortableness were achieved with participants.^ For example, Butler and Hope (1999) state that “all informants were known either to the * Morse recruited three lay community members to collect data for this study. These individuals were oriented in a tw o-w eek period to interviewing and observational techniques, health and illness theories, and the ethics and challenges presented by fieldwork. ^ One study (W ondolowski & D avis, 1991) did not clarify how trust was achieved with participants. 22 authors, to acquaintances of the authors, or to informants in the study” (p. 31). As Stevens and Hall (1988) note, a rapport between the participants and the researcher to a certain degree will enhance the accuracy of the volunteered information. All six qualitative studies encouraged this rapport by either spending time in the participants’ environment, condueting first and second interviews (in whieh the first interview developed trust and familiarity), and/or by enlisting individuals who already shared a relationship with the research population (who act as a liaison between potential participants, the project and the researcher). In studies using the snowball technique, potential participants’ trust of the researcher/project is based on the recommendation of personal contacts who support the researcher/project. The literature reviewed here suggests that health beliefs meaningfully vary between groups of people, and within subgroups of a particular population. The identity of participant groups invariably situates and brings greater meaning to their health meanings. Changing social identities and social status are two factors that may also significantly influence health behaviours and associated meanings. For example, the stigmatized social status of lesbians compared to the normalized social status of heterosexual women implicates the health behaviour and beliefs of lesbians (Stevens & Hall, 1988). Differing social identities, social status, age, location and so on are also qualities that may further demarcate a specific population within a larger population (e.g., rural lesbians from urban lesbians) with accompanying variation in health beliefs. For these reasons, all of the studies reviewed here support the continued exploration into the particular health meanings o f diverse populations 23 Rural Meanings of Health and Well-being “People’s values and beliefs are in many ways a function of their cultural and physical environments as well as the information they receive and to which they attend” (Keller & Murray, 1982, p. 8). Self-reliance, hardiness, independence, industriousness, and productivity are all qualities that characterize rural people’s meanings of health (Foster, 1997; Lee, 1993 & 1991; Leipert & Reutter, 1998; Smith, 1997). Lee (1993) states that, “For many rural persons, health is equated with the ability to work” (p. 19), and that farmers and ranchers rejected the sick role more than non-rural populations. Leipert and Reutter (1998) link these deep, core rural values back to early immigrant populations settling in Canada’s northern frontier environments; Early immigrants to Canada’s rural areas in harsh northern frontier environments developed values such as right-wing politics, support for the nuclear family, hard-working individualism yet interdependence with others, and self-determination and self-reliance, (p. 577) The ruggedness associated with rural folk, however, means that seeking out health services is difficult and even stigmatized in rural communities, even though rural environments have unique stressors that can produce feelings of isolation and depression. Consequently, although rural folk may need varied health services, stigmatization of help-seekers may prevent or undermine rural people’s use of helping services (Keller & Murray, 1982; Quevillon & Trenerry, 1983). Foster (1997) further clarifies the embeddedness of rural values within health perceptions and expectations, and how such values persist despite being disadvantageous to community well-being: 24 Rural values emphasize self-reliance. As a result, there is a strong stigma attached to those who are not mentally able to care for themselves. This is so much so that many rural residents do not perceive a need for greater availability o f mental health services, even when mental health resources are inadequate in their community, (p. 26) The significance of these values to the conception of health ultimately affects the availability of accessible health care for gays and lesbians, whose stigmatized gay identity contradicts right-wing family values. “A community that does not see the need for services for residents who conform to community values is much less likely to appreciate the service needs of gays and lesbians who go against the community grain” (Foster, 1997, pp. 26-7). Interestingly, although rural communities (and file populations residing within them) have changed dramatically fi-om earlier times, a rural meaning of health associated with fi-ontier values still persists in contemporary meanings underlying rural health and wellness. Conclusion One of the premises underlying health belief research with marginal populations is that such research can contribute to more respectful and effective healthcare interactions and policy. Health meaning research is thought to achieve this goal because it emphasizes the social context of the patient—including cultural values about health—and in doing so permits a more thorough understanding of health needs, expectations and behaviour (Todd, 1989). In a sense, health belief research is a critical part of the process of redistributing power between health professionals and clients because health belief research recognizes the salient role of lay health values and meanings to an individual’s overall wellness. For example, Stevens and Hall (1988) state that 25 To offer culturally sensitive care to lesbians in a way that allows them to feel respected and regarded, nurses need an understanding of the cultural experience of being lesbian, a knowledge of what illness and wellness mean for them and a comprehension of their experience in health care interactions, (p. 69) This is in opposition to traditional healthcare, which has typically been administered out of the impersonal and illness-focused medical model. Embracing a rural identity may also affect the health and wellness meanings and behaviours of rural gays and lesbians. Emphasis on self-reliance, privacy, independence, and use of informal networks made up of family and friends may all influence rural queers’ health meanings (and behaviours) and their experiences of health and wellness may reflect these values. For example, one study suggests that fitting into a rural community by developing a rural identity may be more important to rural gays and lesbians than maintaining a queer identity (McCarthy, 2000). Qualitative health research may contribute to a greater sense of health/wellness for participants through its regard for cultural and social differences in meanings and experiences of health. It is my belief that qualitative research on rural lesbians’ health meanings will encourage a greater sense of personal wellness for rural lesbians, will help distinguish and clarify the differences in health beliefs between groups of lesbians, and will contribute in the long run towards rural lesbians feeling more comfortable, respected and recognized in their formal health care interactions. 26 Part Two - Canadian W omen’s Health Women’s health care research in Canada has surged since 1995, when national recognition of women’s unique health status resulted in a federal government commitment to fund women-centred r e s e a r c h . " Major themes underpinning this health research are as follows: gender is the single most important health determinant for women (Leipert, 2000); women’s subjective beliefs and experiences around health and wellness are fundamental to understanding their health beliefs, needs and concerns (hence the mandate for feminist, qualitative, and multidisciplinary research); and women’s health is multifaceted, involving “emotional, social, cultural, spiritual and physical well­ being, and it is determined by the social, political and economic context of women’s lives as well as by biology” (Maritime Centre of Excellence for Women’s Health, 2001, “What is Women’s Health?”, para 2). Furthermore, feminist values and ethics reflected within a women’s health model ground this contemporary interest in women’s health: “The philosophy of women’s health involves having women at the centre, rather than at the margins, or planning for and participating in health services,” and that, “women’s health practice involves listening and responding to women’s lived experiences” (Lauver, 2000, p. 81). In BC, Canada’s W om en’s Health Strategy has resulted in the establishment o f the BC W om en’s Hospital and Health Centre and the BC Centre o f Excellence for W om en’s Health Program (BCCEW HP). These tw o organizations have significantly promoted and facilitated multifaceted research on w om en’s health issues specific to BC. " To view research documents to date supported by BCCEWH, visit http://www.hcsc.gc.ca/wom en/engli sh/facts_centres. htm. 27 Northem/Rural B.C. Women’s Health Literature Geography is also regarded as an important health determinant for women, as evideneed by government policy and research recommendations that consider location as a significant determinant of women’s health (Leipert, 2000). The experience of living in either urban or rural communities is a factor that shapes health conceptions, health/care expectations, and use of formal and informal support (Mitchell, 1999). However, very little research exists documenting women’s health experiences in rural and northern communities, despite evidence that rural women face unique barriers to health care and have unique health/wellness experiences (Bodycoat & Henderson, 1993; Castaneda, 2000; Geissinger, Lazzari, Porter & Tungate, 1993; Leipert & Reutter, 1998; Tiemann, Kennedy, & Haga, 1998;). Some classic characteristics of rural communities that affect rural populations in general include lack of confidentiality, right-wing politics,'^ gendered role expectations, and emphasis on societal ‘norms’. “Long, cold winters, low population base, geographic isolation and limited accessibility to the resources of the larger urban centers” are also consistent rural qualities which contribute to health challenges faced by rural women (Anderson et ah, 2001, p. 6). Furthermore, Smith (1997) lists the significance of religious communities and values, traditional values, and resistance to diversity and change as common rural qualities. Although these qualities may affect everyone in a rural community, they also uniquely affect women. “The resource-based industries that dominate northern B.C.’s economy have a masculine and transient nature, which is disadvantageous for women in “Right-wing politics” refers to the conservative, traditional, family and church oriented values o f these regions, and the right-wing representatives that are elected in these regions. 28 general because the focal point of such communities is men’s work, hence men’s experience,” (Anderson et al, 2001, p. 6). Little and Austin (1996) state that “traditional images of rurality also reflect another form of power relations that is the power of patriarchy,” because “patriarchal gender relations are still more fundamentally embedded in the creation of the rural idyll [than in the suburbs]” (p. 103). For example, traditional roles for women are generally ones of support to men and children (Leipert & Reutter, 1998). There are also specific qualities of rural environments that increase the likelihood of violence towards women, thereby increasing women’s need for appropriate and accessible health care: Factors in rural and northern areas that contribute to increased violence and that complicate women’s safe and appropriate resolution of violent situations include isolation, seasonal employment of men that may result in increased alcohol consumption and more abuse, the presence of hunting weapons, lack of privacy and anonymity, the belief that leaving one’s partner necessitates leaving the town, fewer social and health supports, and harsher climates and geography. (Leipert & Reutter, 1998, p. 577) Leipert (1999) also found that “self-interested and discriminative” attitudes among health professionals discouraged women from seeking health care (p. 285). Lauver (2000) suggests that relationships are integral to women’s psychological development, integration, self-empowerment and social role. Bushy (1994) states that “it is impossible to discuss the health of a woman without considering her life style in the context of family and community networks” (p. 67). Leipert and Reutter (1998) suggest that a woman’s network of relationships in rural communities is especially important to combat the isolation commonly faced by rural women: “In rural and northern settings in 29 Canada, social support is particularly important for women’s health because of geographical and other forms of isolation,” (p. 579). However, Castaneda (2000) notes that the primacy of relationships to rural women’s social identities may also limit women’s choices since challenging traditional role expectations carries the risk of jeopardizing one’s social support network: In a small community where many people know each other, or at least know of each other, a woman comes to be known, and often to identify herself, as a sister, mother, wife, friend, neighbour, daughter, etc. of someone else. What she does reflects not only her identity, but that of others in her social network. Women, to a greater extent than men, may therefore be constrained and limited in their behaviour by their relationships to others. In rural and small town communities women’s actions are not necessarily determined solely by their own needs and desires, but also by the perceived social costs to others in their perceived social networks, particularly male partners. (Castaneda, 2000, Confidentiality regarding HIV/AIDS in rural communities, para.2) This finding is supported (somewhat dramatically) by Cheitman (1981) who states that “kinship ties can support woman-oppressive behaviour with an effectiveness that surpasses that which made the trains run in Mussollini’s Italy” (p. 26). The multitude of characteristics discussed above inherent to rural and/or northern communities may significantly undermine women’s abilities to be well, especially those women who challenge the status quo in their communities. The privileging of men’s experiences and diminishing of women’s experiences, the isolation caused by factors such as climate and geography, the entrenching and perpetuating of gender ‘norms’ through religious propaganda and traditional values, the active resistance to new ideas and alternative lifestyles (Anderson et al., 2001), and poor public transportation 30 (Castaneda, 2000) are some rural factors that contribute to the unique health challenges faced by rural women. Research suggests that not only do rural and/or northern settings present unique barriers to health, but that women in particular are uniquely affected by general characteristics of such communities and by qualities specific to their being female.’^ Although lesbians share health issues with heterosexual women, they also have different health needs and health risks that can remain misdiagnosed or undetected if they do not reveal their sexual identity (Horsley & Tremellen, 1995; Rankow, 1995; Rosser, 1992). For example, some research suggests that incidences of breast and cervical cancers and sexually transmitted diseases are different for heterosexual and lesbian women (Hudspith, 2001).’"* Lesbians also deal with social stigma, which may compromise their overall health and well-being (Stevens & Hall, 1988). In rural communities especially, lesbians face unique barriers to their health and well-being. Smith (1997) states that. Gay people often are socially isolated in their rural communities.... Many gay people ... are afraid they will be discovered [to be gay]. Energy is spent hiding. Intense social isolation, lack of communication with other gays, feelings of hopelessness and of having no options combine with other social limitations to create difficult situations, (p. 17) I do not distinguish “wom en” here according to race, ethnicity and culture, age or ability, etc. although it can be assumed that each unique population experiences these identified barriers in similar and unique ways, in addition to issues directly related to other aspects o f their identity. Leipert and Reutter (1998) discuss som e specific health issues for rural wom en disadvantaged by immigrant status, race, age, poverty and ability. There is concern over the accuracy o f research considering differences in cancer and STD rates for straight and gay w om en due to problems with sampling stigmatised, marginalized populations and from using labels (“lesbian,” “gay,” “queer”) that are not standardized (Donovan, 1992; Sell, 1996). 31 In rural communities, where deviation from the norm is especially discouraged, lesbians can also expect to face homophobia from health professionals. Leipert (1998) states that. Traditional attitudes about women’s roles and threats to confidentiality in small communities contribute to poor health care for lesbian women. The health of lesbian women in small rural communities in Canada may also be eompromised because most of the physicians in these communities are male. Male physicians have been identified as having the most negative responses to women’s declaration of lesbianism, (p. 579) Foster (1997) explains the efleet of the conditions of rural communities on helping professionals, which in part accounts for homophobia in health service delivery: It has been documented that helping professionals, as do members of any profession, often carry their racial and ethnic biases into their professional relationships. Therefore, it is unrealistic to expect that they would not carry their sexual orientation biases too. One reason is that the isolation and population sparseness of rural areas places professional helpers in a fishbowl setting, they must fit what they say or do into the social values. If the values promote a bias against gays or lesbians, this makes it even more difficult for them to keep their biases out of practice. Unlike their urban counterparts, rural helpers cannot blend into the crowd. They come into contact with their consumers, agency staff, and community leaders on a regular basis. News that they are not upholding community values spreads fast. And their reputation may be questioned [as a result].... They have few opportunities to consult with their colleagues regarding gay and lesbian issues. When they do, they have to be careful how they approach the subject. There is a strong chance that they may be misinterpreted and stigmatized along with the gay and lesbian consumers they are trying to serve, (pp. 26-27) Consequently, lesbians and heterosexual women share the challenges of rural and northern conditions, although lesbians also experience these conditions in unique ways, and deal with unique circumstances, due to the social context of rural and northern landscapes that privilege male values and heterosexuality. Following is a review of three 32 valuable publications that document the social context of rural and northern BC from the point of view of the lesbians living in these small communities. (1) Out in the Cold: the contradictory context o f health and wellness for lesbians in northern communities (Anderson et ah, 2001). This is the most recent document detailing the special lives of forty B.C. rural and/or northern lesbians. Research sites included small communities situated up to six hours outside of Prince George, as well as participants living in the greater Prince George area. This qualitative project received funding from the B.C. Centre of Excellence for Women’s Health. It used a collaborative approach between researchers and participants. One of its priorities was to be accessible as both an academic and community document encouraging future research in this area. An important aspect of this research is that some of the participants worked as health professionals and witnessed homophobic/heterosexist behaviour in their co-workers towards patients known or rumoured to be homosexual. Two essential points of this research are that (1) northern and rural contexts produce complex, often contradictory experiences of health and wellness for lesbians, and (2) that this complexity is not always apparent at the surface level (such as simply itemizing barriers to formal health care services). For example, although this report documents multiple barriers that rural northern lesbians experience when they attempt to access formal health care, including the experience of pervasive homophobia, there is also recognition of the other aspects of rural living which foster a strong sense of well­ being: 33 Health as a state of “physical, emotional and social well-being” may be difficult to achieve for lesbians who live in northern communities where homosexuality is reviled and personal safety may be at risk as a result.... [But] this reality is more complex and contradictory than it would initially seem. Although many participants ... expressed anger against the oppressiveness of their communities, those who lived in rural or isolated settings also described the positive impact of proximity to the northern wilderness and the privacy it afforded them. (p. 5) Independence from the formal health care system and ingenuity around self-care are also described as positive experiences for rural northern lesbians’ health and well-being. Recognizing and understanding the meanings of this complex experience may depend on choice of research approach, specifically an approach that is qualitative, collaborative, women-centred, and based on (and builds on) rapport and trust between researcher and participant.'^ In Out in the Cold, the researchers themselves experienced first-hand many of the same issues participants spoke of, which both facilitated trust between researchers and participants, and made it easier for researchers to understand participants’ experiences: Our unique position as researchers living with the research context reflects the circumstance of small northern communities in which researcher and researched are often known to each other and where researchers have “insider” knowledge and experience on the subject. Our position provided an advantage to understanding the meaning and significance of the experiences non-team participants shared with us. (p. 10) Another essential point of this document is that although this research was guided by the project goals o f “identify[ing] barriers to health care for lesbians in northern BC For example, this researeh process involved allotting time to soeialize with participants and the use o f humorous and informative skits at group m eetings to ‘break the ie e ’ and encourage participation. 34 and ... mak[ing] recommendations for health policy and practice” (p. 10), researchers also learned that a significant and valuable dimension of rural northern lesbians’ health and wellness experiences resides outside of formal health care interaetions. For example, one of the “critical understandings” of this research is that “many [rural northern] lesbians associate health and healthiness with their northern, rural lifestyle” (p. 11), and that “to focus exclusively on interactions with formal health eare would diminish the significance of this relationship between health/wellness and the northern social context” (p. 12). Another significant finding of this research is that participants developed strategies to achieve personal health and well-being, but that sometimes these strategies, which centre upon self-education, self-care, and self-protection, in fact undermine potential formal and informal support for health and wellness. For example, self­ censorship and avoidance o f other known lesbians may lessen the chance of harassment and threats by helping to proteet the confidentiality of lesbians/lesbian community/family and lovers. However, another end result of these strategies is increased soeial isolation. Similarly, by looking after their own health needs and eoneems out of a rural ethic of self-reliance and self-determination, lesbians lose the opportunity to build long-standing relationships with medieal professionals that could benefit them in times of emergency. A key point is that some participants expressed doubt about whether their strategies for well-being could be entirely attributed to a belief in the superiority of altemative/self-eare or if they were a reaction to negative experiences with the formal health care system. 35 Out in the Cold is a document that covers a broad range of experience, providing a rich springboard of research areas for future work, including my own research. I make the following criticisms in the spirit of supporting the role of my research choices, and not because I am unaware of the limitations placed on this document due to its vast agenda and commitment to the funder’s research objectives. One limitation of this report is lack of clarity about the distinctions between lesbians living in northern cities and lesbians living in smaller, rural northern communities. While there is evidence of this difference in the research, it is not an analysis consistently carried out for each finding,’^ which obscures a more detailed understanding of what the important differences are between these two groups’ experiences and expectations of wellness and health care services. For example, while it is true that lesbians from Prince George and lesbians from outlying areas may agree on the pervasiveness of homophobia in their communities, it does not follow that their experiences of homophobia in relation to their well-being are shared.’^ Throughout this report, it is not always clear what these differences are, or if they are relevant to each finding. Another limitation to this study is that participants’ meanings of health are not explicitly solicited, but rather are described through health needs and barriers to care. The focus on formal health care experiences in the interview sets a tone about what health experiences are valued and expected in this project. In spite of this framework. In m y own research, I also found significant differences between lesbians living in the village or centre o f small towns to be different from lesbians living outside the village or town centre. For example, w hile lesbian participants from outlying communities travelled elsewhere to partake in lesbian community, not one participant from Prince George cited commuting outside o f the city for lesbian community. 36 participants nevertheless also communicated a meaning of health situated in their rural lifestyles and contact with Nature, although there is an inadequate emphasis and analysis on this finding. In other words, it was not the priority of the Out in the Cold team to investigate meanings of health per se, even though meanings of health provide an intriguing pathway into understanding patients’ health behaviour, expectations, and values (Stevens & Hall, 1988), and in this sense could inform health policy and service in these regions. My research addresses this report’s limitations by its exclusive focus on lesbians in small rural northern communities, and by exploring meanings of health and wellness outside of the formal health care framework. (2) And They Lived Happily Ever After...: support systems created by lesbian and bisexual women in the central interior. (Sorrell & Watson, 1997).’* Sorrell and Watson (1997) contacted rural northern lesbians to leam about their experiences with formal support services in the central interior of B.C., and their recommendations for actions that could improve the use and delivery of these services for lesbians. This project, often referred to colloquially as the “LABIA” report, received funding from the Status of Women, B.C./Yukon Region, and worked in alliance with the Northern Women’s Centre at the University of Northern British Columbia, which organized a community advisory group to oversee the project. This project preceded the work of Anderson et al. (2001) by four years, although the findings of LABIA For ten years under the Progressive Conservatives, there w as a moratorium on funding for research on homosexuals. The LABIA report research was the first research to receive funding under new Secretary o f State funding guidelines allowing for research into gay, lesbian and bisexual issues. Minister Responsible for the Status o f W omen, honourable Hedy Fry, initiated the change in this guideline. 37 foreshadow some o f the findings in Out in the Cold}"^ For example, findings from LABIA concerning the pervasiveness and effect of homophobia in small rural communities on health and well-being, and the emphasis on autonomy from formal support, are consistent with the findings of Out in the Cold. Like Out in the Cold, LABIA documents a vast range o f experience, although time and budget limitations significantly restricted the depth to which major threads were explored (S. Sorrell, personal communication, Summer 2001). However, because formal documentation on rural lesbians is so lacking, research that covers a broad scope of experience is appropriate as it provides a rich descriptive landscape for future research. Two researchers gathered information from sixty participants through one-on-one interviews, focus groups, and written responses. In addition, researchers delivered surveys to service providers in participants’ communities, although this data is only addressed in a quantitative format and lacks a discussion.^® Important differences arose between groups of lesbians, such as lesbians who were bom and raised in rural communities (or who had resided there for a significant amount of time), and lesbians who had moved to raral communities from larger centres. For example, long-term or ‘bom and bred’ lesbians placed less emphasis on the use and availability of formal support services, and had fewer expectations around service quality than lesbians who had moved to rural communities from larger cities. Another difference is that lesbians Differences in the findings o f these tw o projeets can be mostly attributed to differing research focuses. One interesting eonclusion drawn from the analytieal tables in this report is that more serviee providers than not did not think lesbians and bisexual women required different service needs than heterosexual women. At the same time, m ost service providers who took part in this researeh were open to being educated on lesbian and bisexual health/support needs. It should be noted, however, that the majority (70%) o f service providers w ho received this three page survey did not take the time to respond. 38 from larger cities were more likely than long-term lesbians to advocate political action as a strategy to address and influence the quality and delivery of formal support services in rural northern communities. Two major contributions of this project were to initiate contact with various rural northern lesbians and to set a research precedent in this community. Both the Out in the Cold research and my own research for this thesis depended on the involvement and trust of lesbians who were first involved with the LABIA report. LABIA may have familiarized lesbians with the researeh process so that they were willing to trust future projects, in addition to encouraging friends to participate (S. Sorrell, personal communication. Summer, 2001).^^ I believe participants’ trust in the confidentiality, commitment and thoroughness of the researchers and research process is key to rural lesbians agreeing to become involved in this kind of research. Rural lesbians are not a population that just any researcher can access without someone familiar to the community first priming the way (and this could hold especially true for older lesbians who have lived in small communities for a long time). Participants’ trust of the project and the researcher can also determine how committed they may be to the project and what they are willing to share: Justifiable fears prevent many lesbians, gays and bisexuals from self-identifying in any way, and accessing this “closeted” population presents a serious obstacle to social research. Further, other lesbians, gays and bisexuals resist research efforts unless the researchers are clearly “of the community” (i.e. researchers who are themselves lesbian, gay or bisexual) or who are personally known to It is also significant that one o f the researchers from the LABIA report grew up in a northern rural (B.C.) community and provided all o f the initial contacts from outside o f Prince George for that project. Furthermore, the majority o f these contacts were established through involvem ent in w om en reereational sports. 39 them. The fear is that researchers who do not have a grounding in the community and the issues it faces are liable to misinterpret or misuse gathered data. (Healy & Herringer, 1997, p. 189) An important point about this research is that although it was originally conceived to leam more about lesbians’ experiences with formal support services in different communities, it was quickly evident that “participants see their support systems as being made up of two very different kinds of support—formal or service based, and informal or personal-based” (p. 4). Furthermore, “most [participants] rely much more heavily on personal or informal support than they do on professionals or formal services (p. 4). This finding is particularly true for lesbians who have lived most of their lives in rural communities. A mral identity, which emphasizes qualities such as self-reliance, pride and independence, may also contribute to the meaning and role of informal support in rural communities. In other words, rural lesbians themselves provide their own support, and needs they cannot meet on their own or with a partner are met through informal support networks: “They see themselves as strong, independent and capable of taking care of most of their needs without the help of paid professionals. What they can’t provide for themselves, they can usually get from partners, children, friends, peers, neighbors and co­ workers” (p. 5). The emphasis on meeting one’s own health and support needs whenever possible in both Out in the Cold and LABIA suggests that lesbians’ rural identities are significant to their behaviours around maintaining health and wellness. However, both reports also question to what degree social stigma and negative experiences with formal health care have contributed to rural lesbians’ ethic of self-care, self-dependence, resilience, and 40 reliance on informal support. For example, the Out in the Cold report concludes that the dilemma of whether to come out or not is a determinant of lesbian health and wellness because it underlies all of the findings around participants’ experiences of health and wellness. The significance of the dilemma over whether to come out or not is foreshadowed by the participants in LABIA who experienced powerful feelings of well­ being and wholeness within social contexts (such as recreation and social activities organized by the queer community) that did not require the diminishing of their sexual identities. In fact, LABIA participants rated these activities above formal services in terms of their supportive value. One of the limitations in this researeh is that it claims to address the experiences of bisexual women and lesbian, although it does not document how those experiences are different. For example, do bisexual women have more options for support from the heterosexual community? Can bisexual women ‘pass’ more easily than lesbians and does this affect their use of support services? Do bisexual women have specific health issues that require them to be explicit about their sexual identity to health professionals, or that may necessitate specific kinds of support? Do bisexual women access a separate community, and/or are they welcome as equal members to existing lesbian functions? Did the bisexual women in this report hold primarily lesbian identities, or were they in relationships with men at the time of interview? In other words, on what basis are the experiences of lesbian and bisexual women grouped together, and how did this grouping affect the research process and findings? Lack of distinction of these differences will make it unclear how other research on rural lesbians can relate to the findings here. 41 Although LABIA did not specifically address meanings of health in an interview question (although definitions of support were elicited), knowledge of lesbians’ health beliefs will complement this research. For example, awareness of the health meanings of rural lesbians will further an understanding of their behaviours towards formal and informal support (services), in what capacity services and informal support are valued (or not valued), and what sort of recommendations for informal and formal support are most realistic to improving rural northern lesbians’ experience of support. In addition, knowledge of this populations’ health meanings could provide a better analysis of the relationship between participants’ rural identities and their experience of health and wellness, as well as further the analysis of the effects of homophobia and heterosexism on health-related behaviours, such as accessing formal and informal support. LABIA and Out in the Cold are similar in that their inquiry of rural northern lesbians’ experiences of health and wellness is framed by the relationship of these experiences to formal services. Whereas Out in the Cold looked at experiences related to formal health care services, LABIA considered formal health care services (physicians and mental health workers) and community services (police, lawyers, clergy, transition houses, and queer political and social organizations). A shared finding of these two documents is that a significant aspect of rural northern lesbians’ health and wellness related experiences are located outside of a formal framework. Furthermore, although both projects sense a relationship between the (lack of) use of formal services and reliance on informal support (including self-reliance), this relationship remains unclear. Research on this population’s health meanings may contribute to a better understanding 42 of this relationship by exploring the influence of (rural) identity and negative formal health care experiences upon rural northern lesbians’ health and wellness beliefs/practices. (3) “Lesbians, Gays and Bisexuals”. In Quality of Life: Report on the quality of life in Prince George. (Healy and Herringer, 1997)?^ In 1996, the City o f Prince George Healthy Communities Committee conducted a research project examining quality of life for Prince George residents. Researchers were drawn from the Prince George community and from the University of Northern B.C. This research included a chapter on the quality of life for lesbians, gays and bisexuals. The experiences of queers living in Prince George cannot represent the experiences of queers living in small communities outside of Prince George (where smaller populations, less opportunity for services of all kinds, and smaller and less visible queer communities are some factors constituting a unique context). However, the anti­ queer tone that exists in Prince George, and that this chapter of the Quality of Life report documents, is also a tone that reverberates throughout smaller outlying communities to the same degree if not in exactly the same ways.^^ In this way. Quality o f Life contributes importantly towards formal public recognition and validation of the existence of strong ^ The fact that this research considers lesbians, gays, bisexuals and queer-identified and transsexual people as a unified population limits its relevance to m y research on lesbians’ experiences. For many participants. Prince George is the large city that offers anonymity, social events and informal and formal support (e.g., many lesbians travel to Prince George to see medical professionals). Some participants in m y research who had previously lived in Prince George before m oving to smaller communities found the experience o f living in their smaller communities much more challenging. Furthermore, other long-term rural lesbians in small communities visit Prince George for the support o f lesbian community; the larger population o f Prince George also allowed these participants som e degree o f anonymity, enabling them to express affection in public places. 43 anti-gay sentiments and their negative influence on gays’, lesbians’ and bisexuals’ quality of life in B.C.’s northern, rural communities. According to this research. Prince George’s lesbians, gays and bisexuals are aware of both the homophobic attitudes and the community support for these attitudes in their city. Many queers believe homophobia to have been the motivation for a crime against them.^"^ The existence of violence towards sexual minorities also creates an atmosphere of fear that limits the lives of those who have not experienced direct crime. Living safely within the everyday anti-gay tone requires changes in lifestyle and behaviour that ultimately constrain the activities and self-expressions of Prince George’s queer citizens. Everyday acts of affection, forms of social behaviour, and personal appearance, for example, are tailored in response to the fear of threat, assault and bias of other people. Almost 70% of participants remained closeted at work because they believed work-place knowledge of their sexual identity would significantly diminish their chances of career advancement. Conclusion The three documents— Out in the Cold, LABIA, and the chapter on gays, lesbians and bisexuals in the Quality o f Life report—emphasize the issue of coming out as integral to the experience of well-being for rural lesbians. Although many qualities of small town rural life would have to change drastically in order for the effects of coming out to be entirely positive (or without significant threat to safety), the issue of coming out is viewed as one of the most critical factors that can have a positive influence on access For example, o f the 42% o f participants w ho experienced crime, 13% attributed this crime to their sexual orientation. 44 to informal and formal support. Some LABIA participants, for example, “feel that coming out is essential to their overall satisfaction with their lives” (p. 50).^^ The significance of coming out (or not coming out) to Out in the Cold participants resulted in researchers flagging this dilemma as a specific lesbian health determinant. Quality o f Life explores coming out in a wider context, simply because the report is not limited to formal/informal health care/support services; this broader consideration complements the findings of the other two studies by documenting the different understandings and ways of coming out. For example, twenty percent of participants in the Quality of Life research did not feel they had the option to be out or not: they considered their physical appearance to distinguish them in all contexts as queer.^^ Furthermore, this broader examination of to whom and in what context gays, lesbians and bisexuals come out “highlights a significant factor in the lives of gays, lesbians and bisexuals. The cleavage between coming out, an act that has to be considered and revisited time and again, and being out, living as a gay, lesbian or bisexual person without paying undue attention to the fact of sexual identity (p. 193). This richer perspective on coming out issues helps to distinguish rural northern lesbians’ experiences from their southern counterparts, as well as provides a framework within which to understand their unique experiences. Limitations in the literature on lesbian health include lack of recognition of health and wellness experiences— including meanings, beliefs and behaviours— situated in everyday lived experience as opposed to the dominant framework of formal health care. LABIA participants distinguish different versions o f com ing out to achieve different ends: “Those who advocate com ing out as a political act suggest a need to com e out generally, to everyone. Those who advocate it as a means to enhance your personal life, suggest com ing out on a more selective basis,” (p. 50). For these individuals, m odifying on e’s appearance in order to ‘straighten up’ w as not an option. 45 In addition, there is very little research that considers the unique experiences of different lesbian sub-populations such as aboriginal lesbians, immigrant lesbians, and lesbian youth. Building on former research, my research addresses the gaps in knowledge concerned with rural lesbians’ health and wellness. In doing so, my research complements and enriches the limited existing documentation of rural lesbian lives in general, and specifically on rural lesbians’ health informal and formal health experiences and behaviours. 46 Chapter Three Research Design Chapter Three is composed of ten discussions as follows: (1) research goals; (2) choosing a qualitative methodology; (3) feminist research; (4) lesbian research ethics and practices; (5) what 1 learned doing feminist/lesbian research; (6) study design; (7) ethics; (8) interview meetings; (9) data collection; and (10) the role and contribution of the Northern Secretariat Lesbian Health Group. The hallmark o f in-depth qualitative interviewing is learning about what is im portant in the minds o f informants: their meanings, perspectives, and definitions; how they view, categorize, and experience the world. (Taylor & Bogdan, 1984, p. 88) "M ethodology” refers to the ph ilosoph ic fram ew ork, the fundam ental assumptions and characteristics o f a human science perspective. It includes the gen eral orientation to life, the view o f knowledge, and the sense o f what it means to he human which is associated with or im plied by a certain research method. We might say that the m ethodology is the theory behind the method, including what m ethod one should fo llo w and why. (van Manen, 1990, p. 25-26) Research Goals One of my goals as a researcher was to locate participants’ experiences at the centre of this project. I accomplished this by using a qualitative framework (phenomenology) and feminist research values. Lived experiences are both critical and fundamental to phenomenology and feminist research (Garko, 1999). With a phenomenological, feminist research approach, women’s experiences (elicited through in-depth interviewing) constitute expert knowledge and their expressions and meanings are the basis for the analysis and are incorporated as much as possible into the actual written text. Other personal research goals were to describe as much as possible participants’ exceptional contexts of small rural communities, and to show how the 47 experience of living in these contexts relates to what it means to be well (and how wellness is maintained). It was also important to me that the methodologieal framework for this research could accommodate and value a critical awareness of the relationship between the researcher and the research project/participants. Finally, it is a personal goal that this research be meaningful, accessible, and above all interesting to rural queers now and in the future. Complementing methodologv. method, research topic and researcher I feel that all of these goals were accomplished to varying degrees due to my choice o f methodology and method. For example, I chose a methodology that emphasizes and values the subjective nature of human experience. My method choice of semi­ structured, open-ended, repeat interviews made it possible to centre this research on the participants’ lived experience because the nature of the in-depth interviews facilitates and encourages thick description of everyday life (which may ultimately make it more appealing to a broader audience). Furthermore, both phenomenology and feminist research practices value the exposition of the ways in which the researcher is necessarily entwined in the research act and research content. Feminist/lesbian research principles also enabled me to meet my goals of centring on lesbians’ experiences in an ethical and accountable manner, in addition to situating those experiences in participants’ contexts. It is important to emphasize that my particular choices around methodology/method constitute one way of exploring this research topic. 48 Choosing a Qualitative Methodology Defining Qualitative Research A major emphasis of qualitative research that resonates most strongly with my own values and purpose as a researcher is that a greater awareness and comprehension of any human experience is possible through both the participants’ telling of their experience and the centring of these narratives in the research process and product. Taylor and Bogdan (1984) state that, “The phrase qualitative methodology refers in the broadest sense to research that produces descriptive data: people’s own written or spoken words and observable behaviour” (p. 5). In other words, qualitative research holds at its core the idea that knowledge is possible through direct experience with the physical world (Rossman & Rallis, 1998). I believe that the significance of participants’ experiences in their own words in much qualitative research—indeed the scrutiny of participants’ language and expressions as a way to understanding meaning— conveys the respect and passionate inquiry back to participants and, indirectly, back to the research topic. Flexibilitv and Reflexivitv Qualitative research is also defined by the closely linked values of flexibility and reflexivity. Ristock and Pennell (1996) define flexibility as follows: “ .. .Being prepared to reshape the research design and adjust the research methods to reflect what we learn in the course of doing the research” (p. 48). It is important for qualitative researchers to remain flexible in their research question and choice of methods over the course of the research process in order to respond to the spontaneous and dynamic nature of their 49 subject. This ongoing adaptability of research methods strengthens the integrity of the study (Miles & Huberman, 1993). Another aspect of qualitative research which can determine the quality of the research process is reflexivity. Reflexivity refers to the intrinsic relationship between researcher and research process, or more simply put, “self-awareness” (Ristock & Pennell, 1996, p. 48). Reflexivity includes the documentation and discussion of interpersonal issues and dilemmas between the researcher and the research process and constitutes a significant ethical component of qualitative research (Marshall & Rossman, 1995). Reflexivity leads to the awareness that knowledge is political (Peter, 2000) because it demands the researcher to both acknowledge her power in the research process and to justify or transform any inequity. One purpose of reflexivity is to “enabl[e] the researcher to recognize alternative ways of viewing reality and thereby avoid perpetuating the status quo” (Peter, 2000, p. 109). The researcher is essentially in an intimate relationship to those being researched; her role is that of a learner (and not an expert) knowingly shaping and being shaped by the process of gathering, describing and interpreting data into knowledge: In qualitative studies, the researcher is the “instrument”: Her presence in the lives of the participants invited to be part of the study is fundamental to the paradigm. Whether that presence is sustained and intensive, as in long-term ethnographies, or whether relatively brief but personal, as in indepth interview studies, the researcher enters into the lives of the participants. This brings a range of strategic, ethical, and personal issues that do not attend quantitative approaches. (Marshall & Rossman, 1995, p. 59^ 50 The researcher makes meaning (interprets) what he [sic] learns as he goes along. Data are filtered through the researcher’s own unique ways of seeing the world—his lens or worldview. Given this interpretive nature of qualitative research, the researcher’s personal biography shapes the project in important ways. It is crucial, therefore, that researchers develop an acute sensitivity to who they are in their work. (Rossman & Rallis, 1998, p. 26) Heterosexism within Methodologv Binnie (1997) states that “another reason to advocate for qualitative methodologies/methods when working with marginal populations such as gays and lesbians is because quantitative science is inherently heterosexist: “The notion that there is a single observable truth has of course been used to silence and marginalize lesbian and gay lives and experiences” (Binnie, 1997, p. 229). Qualitative research, on the other hand, does not seek to exclude marginal points of view or underestimate the diverse ways the researcher shapes the research process. Ristock and Pennell (1996) discuss the ways in which traditional, positivistic research sustains and perpetuates the marginalization of participants, and propose the appropriateness of a qualitative, feminist research approach to conducting sensitive and accountable research with marginalized populations. For example, Ristock and Pennell (1996) suggest that the emphases on flexibility, reflexivity, and transparency^’ in qualitative and feminist research produces a research approach that recognises, and remains critical of, the ways the research process can further disempower marginal groups. 27 A more detailed discussion o f transparency exists in the feminist section o f this chapter. 51 Phenomenology as Qualitative Research Phenomenology is both a qualitative methodology and a research method, although there is no one phenomenological methodology or method per se (Baker, Wuest & Stem, 1992; Osborne, 1990). Phenomenology is the “sense of understanding social phenomena from the actors’ own perspectives, describing the world as experienced by the subjects, and with the assumption that the important reality is what people perceive it to be” (Kvale, 1996, p. 52). Beck (1992) states that, “Phenomenology is both a philosophical movement and a research method in which the main objective is to examine and describe phenomena as they are consciously experienced” (p. 318). The phenomenological goal of knowing the life-world depends upon participants’ rich, subjective descriptions, which are elicited through in-depth, un-stractured or semistmctured interviewing, and by making explicit the researcher’s assumptions, theories, and prior knowledge of the research topic (the phenomenological reduction or bracketing). Phenomenology was originally concerned with “undo[ing] the effect of habitual patterns of thought and ... retum[ing] to the pristine innocence of first seeing” (Spiegelberg, 1982, p. 60). One significant challenge of phenomenology as distinet from other qualitative method(ologies), though, is understanding and then incorporating this philosophical underpinning into a method guiding a research practice investigating concrete experience (Caelli, 2001; Lawler, 1998). What makes this task especially Bracketing is discussed more in Chapter 4: Data Analysis. 52 difficult for the novice researcher is the lack of a clearly articulated consensus and approaeh within the research community on how to accomplish this integration: The lack of articulated methods for achieving phenomenological research, together with the even greater challenge of understanding the philosophical underpinnings of such research, represent perhaps the two greatest challenges faced by the researcher wishing to follow the phenomenological path. (Caelli, 2001, p. 276). Because of these difficulties, I do not engage with the philosophical goals of phenomenology that are undisputedly more appropriately addressed by philosophers, or at least seasoned phenomenological researchers. My use of phenomenology in this research is limited to its implementation as a reflective and descriptive method resulting in greater awareness and insight about participants’ concrete lived experiences. This particular use of phenomenology is consistent with a North American style of phenomenology. I chose this implementation of phenomenology because it is more accessible to me as a novice researcher, and because it is appropriate for my research topic. Caelli (2000) summarizes the major distinctions between the American and Traditional (or European) development and use of phenomenology as follows: Major differences exist between the American and Traditional European approaches to phenomenology. First, there is a different emphasis on experience within each approach, with traditional phenomenology insisting on pre-reflective experience and American phenomenology allowing for the exploration of experience per se. (Caelli, 2000, p. 375). 53 In other words, the American application of phenomenology has led to the validation of human experience in its own right “regardless of whether they are about immediate experience or about experience that has already been reflected upon and interpreted by the person who does the describing” (Caelli, 2000, p. 369). This shift in the interpretation and application of phenomenology rests on the distinction between the European preoccupation with “objectively examin[ing] the subjective reality of phenomena in our experience” and American phenomenology, which focuses on the “exploration and description of everyday experience itself’ (Caelli, 2000, p. 369). “Analysis in the American phenomenological mode focus[es] on describing the participants’ lived experiences of the phenomenon within the context of culture rather than searching for its universal or unchanging meaning outside the cultural context” (Caelli, 2001, p. 274). In this sense, American phenomenology values the exploration of phenomena through lived human experience and is less concerned with seeking the universal, objective essence of reality as perceived through pre-reflective human thought (Caelli, 2000). Despite the break with traditional conceptions of phenomenology, Caelli (2000) suggests that American phenomenology may be more productive as a research method than as a philosophical movement, and that the differences that characterize American phenomenology “may well have resulted from the fact that the [American] approach is being used for research rather than for the solitary philosophical reflection of Husserl and Heidegger” (p. 373). Another difference between American and European phenomenology has to do with the role of, and regard for, culture. The contemporary regard for situated meaning 54 (that is, knowledge that is located in the identity and context of the knower(s)) challenges both the idea that humans can transcend their cultural and habitual modes of thought, and that doing so produces a superior knowledge. Whereas traditional phenomenology seeks to transcend culture, habitual thought, and context in order to apprehend the original, unchanging nature of reality, American phenomenology is defined by a postmodernist regard for the inescapable and ongoing constitution of experience: In its American for[m] ... participants are rarely asked to make a determined effort to undo their habitual patterns of thought and objectively examine their experiences to see whether they have been colored by culture and tradition. This position results from more recent philosophical thinking about the role of culture and the recognition that it is impossible for humans to think aculturally because our understandings of the world are constructed by the language and traditions of our heritage. (Caelli, 2000, p. 371). The American implementation of a phenomenological research approach, with its emphasis on everyday lived reality (as opposed to original or primordial everyday experience) and cultural contexts, has complemented health and nursing science, where subjective meanings o f health, and the contexts they are situated within, are viewed as significant to the goal of culturally sensitive care. [The] reorientation of phenomenology toward human science rather than the more critical approach of traditional phenomenology ... clearly addresses the needs of a discipline such as nursing, given that a requirement o f nursing is to understand the human condition rather than phenomena as such. (Caelli, 2000, p. 374) 55 Feminist Research Fem inist theory ... recognizes the centrality o f gen der in the research act. O bservers can no longer be regarded as passive, neutral agents through which knowledge flow s. O bservers are gen dered beings, an d the research a ct is a gen dered product. Feminism lays positivism to rest in the human disciplines. (Denzin, 1989, p. 67). Feminist research originates in the belief that what we know about women’s lives is distorted and hidden and above all impoverished by traditional research methodologies and methods. Addressing these distortions through the use of qualitative research and mixed quantitative/qualitative studies guided by feminist principles is one goal of feminist research. “While studying women is not new, studying them from the perspective of their own experiences so that women can understand themselves and the world can claim virtually no history at all” (Harding, 1987, p.8). Feminist research honours and deems women’s lives as significant and worthy of study as individuals and within social contexts. Although there is no one feminist research approach (O’Neill, 1995), nevertheless multiple feminist research approaches (for example Marxist feminism, eeofeminism, and post-modern feminism) have in common “a focus on the everyday world of women, work with methods appropriate for understanding the very lives and situations of women, and [consider] understanding [as] a means for changing the conditions studied,” (Kvale, 1996, p. 72). Futhermore, “feminist research, in general, is distinguished by certain features, even though it may utilize a variety of methods,” (Hall & Stevens, 1991, p. 17). These features include research that: organizes around and prioritizes women’s experiences; considers these experiences as constituting a version of reality; recognizes women as 56 expert knowers about their own lives; contributes to greater awareness and changes in the interests of the women studied; is self-reflexive and accountable; and is critical of dominant intellectual, ideological and socio-political conditions and traditions oppressive to women. Feminist research may employ methods that are also used in other non­ feminist research (such as interviewing, participant observation, and triangulation), as well as original methods created by feminist researchers to address the particular nature of their topic such as consciousness-raising, group diaries, intuition, and conversational analysis (Reinharz, 1992). However, although feminist research may resemble other traditional inquiries in its choice of method(s), it is always distinguished by “the questions asked, the behaviors observed, the patterns identified, and the conclusions reached ... beeause women’s perspectives are afforded primacy,” (Stevens, 1992, p. 17). The Significance of Feminist Research In addition to creating lively debate over possibly every aspect of the research process, feminist research principles are important because they provide a means of doing research with women that is more adequate and accurate than the results produced by traditional research on women’s lives. In particular, both the grounding of feminist research in women’s experience, and the self-critical stance towards the power relations inherent within any research process, are fundamental to the concept of feminist research. These two traits indelibly distinguish feminist research from traditional, positivistic Western science. 57 Research that begins in women’s experiences, as told by women, is fundamental to feminist research: Women have recognized the alienating effects of our participation in language that does not express our experience. The issue goes beyond that of entering women’s experience into language. When we begin from women’s standpoint in the actualities of our everyday/everynight world, we confront a sociology that is written from, and writes, a standpoint outside of experience. This alienation is more than in the relation between women’s experience and sociological utterance; it is also in how that speaking and writing transposes and displaces a speaking and writing grounded in experience. (Smith, 1990, p. 31) Beginning in women’s experience extends a stature and legitimacy to knowledge derived from bodily experience that the traditional scientific paradigm (based on a mind/body dualism) has historically denied and invalidated (Alcoff, 1996). Furthermore, situating women’s experience within specific contexts is critical to understanding and clarifying that experience. Whereas traditional science assumes that “clear, unequivocal knowledge can only be produced by abstracting the subject/object of study from the confusion of its context ...” (Code, 1995, p. 18), “a feminist perspective recognizes women’s everyday experiences as inextricably connected to the larger political, social, and economic environment,” consideration of which constitutes “a necessary condition for an adequate science of women’s lives” (Hall & Stevens, 1991, p. 18). Feminist research is also characterized by its revelation of the power relations inherent within traditional science, and the ways in which these power relations are specifically disadvantageous to women and other marginalized groups. These power relations—entrenched in the form of research premises—include the belief that 58 knowledge is value-neutral, the product of a ‘“ view from nowhere’” (Duncan, 1996, p. 4); that controlled, de-contextualized, replicable settings ensure the validity of research; and that white, male subjects represent the norm from which female subjects (and non­ white males) deviate. Thome & Varcoe (1998) list the ways in which feminist research has challenged traditional science, and how this challenge has resulted in stronger research: By uncovering the extent to which power inequities are embedded in our research traditions, including such issues as who conducts research, which questions are studied, and how they are studied, feminist critique can be a powerful tool toward stronger research with more socially relevant findings. (Thome & Varcoe, 1998, p. 481). Eschewing positivism, however, does not safeguard feminist research from the biases of its own researchers: “The cultural beliefs and behaviours of feminist researchers shape the results of their analyses no less than do those of sexist and androcentric researchers” (Harding, 1987, p. 9). In feminist research these biases are addressed by the processes of reflexivity, transparency and accountability, whereby a critical, selfreflective account of researchers’ biases and power within the gathering, interpretation and presentation of knowledge is documented in the text. Feminist Research and Phenomenoloev Stanley and Wise (1990) refer to the “useful tools” offered by phenomenological approaches to feminist research, due to phenomenology’s “coneem with methodologieal issues as well as those of theory” (p. 23). In other words, values underpinning feminist theory must also be visible in the methodological approach, and phenomenology is a 59 methodology that embraces feminist values and theory. Specifically, Garko (1999) argues that feminist research values and theory are visible within (existential) phenomenology, which he characterizes as “axiologically in tune with” feminist theory and research values (p. 174). According to Garko (1999), the harmonic relationship between a feminist research perspective and phenomenology originates in their shared acknowledgement of the primacy of lived human experience to the research question and theoretical framework. Harding (1987) states that, “One distinctive feature of feminist research is that it generates its problematics from the perspective of women’s experiences. It also uses these experiences as a significant indicator of the ‘reality’ against which hypotheses are tested” (p. 7). This research feature is methodologically enabled by phenomenology, which begins in the subject’s lived experience: “the realm of day-to-day lived experiences pre-reflectively encountered in consciousness” (Garko, 1999, p. 168). A feminist research approach and phenomenology also share other qualities which, when fused, constitute an effective research design to investigate women’s experiences. Garko (1999) outlines four more complementary relationships between phenomenology and a feminist research approach. One of these is the shared goal of uncovering and exploring previously hidden or distorted experiences through the use of descriptive methods which privilege the vantage point of the experiencing subject. “What makes phenomenology useful in studying the misinterpreted and concealed experiences of women is its devotion to description and understanding, its openness to the life-world; and its celebration of experience and the experiencing person” (Garko, 1999, p. 169). 60 A feminist research approach and phenomenology also value consciousness. Consciousness-raising is integral to feminist research because it is considered a precursor to conducting feminist research in the first place: “Consciousness is foundational to the feminist movement in that it is deeply implicated in feminist thinking about women’s experiences and lives, how women perceive and make sense of the world, and research methods unique to the study of women” (Garko, 1999, p. 169). Consciousness-raising is also considered a feminist research approach because it replaces the artificial separation o f subject and object (upon which positivism is founded) with the idea of inter­ subjectivity. Phenomenology is also located in the experience of consciousness, specifically because consciousness “ ... connects humans to existence. It is how they [humans] relate to and intentionally give meaning to phenomena” (Garko, 1999, p. 170). Phenomenology’s view of consciousness as intentional (that is, it is always directed towards something) complements and facilitates the feminist research value of intersubjeetivity. van Manen states that phenomenology is “intersubjective in that the human science researcher needs the other ... in order to develop a dialogic relation with the phenomenon” (p. 11). Intentional consciousness implies an “indissoluble link between subject and object” (Garko, 1999, p. 170), which also challenges the dualism of subject/object in the same way as does a feminist research approach. Another relationship between a feminist research approach and phenomenology is the recognition of the relationship between researeher and co-researcher, how this relationship is constituted, and how it contributes to the course of research (and to the 61 research itself), including the findings of a study. Both phenomenology and a feminist research approach assume the researcher and researched are interdependently and humanly linked and not individualistically and mechanically separated, that existential truth and meaning are gained through the intersubjectivity of the subject and object and that the relationship between subject and abject is a dialectical and dialogical relationship. (Garko, 1999, p. 171) Garko’s (1999) last comparison between a feminist research perspective and phenomenology is that both approaches acknowledge the methodological significance of the researchers’ held personal values and theories (which may obscure or influence the research). Garko (1999) suggests the feminist motivation for “suspending the taken for granted” (p. 171) is to transform society’s values so that women’s experiences (and not solely men’s) can be reflected and valued. Suspending the taken for granted permits feminist researchers to “see what is there and not what they have been taught is there or what they might desire to be there so they can discover and uncover the facts of women’s lived experiences” (Garko, 1999, p. 172). Garko (1999) compares this process to the phenomenological act of bracketing the natural attitude. Bracketing requires the intentional suspension of natural attitudes, beliefs, knowledge and preconceptions of the phenomena. The result of bracketing produces an “open, receptive, and naïve” ambience to the interview, permitting full acknowledgement of participants’ experiences. (Garko, 1999) The suspension of one’s beliefs and theories of the topic benefits the research process by “allow[ing] for new understandings and possibilities” which can bring one closer to the “depth of the phenomenon” (Bergum, 1991, p. 62). 62 One way to ensure the production of feminist research in the absence of a specifically feminist methodology is to choose a methodology (and method) that is both in accord with, and can facilitate, prominent feminist research values and theory. The complementary relationships outlined by Garko (1999) constitute five significant convergences between a feminist research approach and phenomenology. According to Garko (1999), phenomenology is one research methodology that both reflects and (can) incorporate important feminist research principles. Lesbian Research Ethics and Practices Research methods and ethics that are specific to lesbian research are under­ developed, even though research with lesbians (and conducted by lesbians) requires unique methodological and ethical principles. Ristock and Pennell (1996) document methodologieal and ethical issues unique to doing research with lesbians at virtually every stage of the research process (funding, selecting participants, interviewing, data analysis, conclusions).^^ These issues centre upon the heterosexist frameworks of both funding agencies and academic communities, and even within feminist methodological and ethical guidelines, such as the heterosexist underpinnings to the feminist research tenets of reflexivity and transparency; Starting from the personal, common to current guidelines for feminist research, can in fact be experienced by lesbian researchers as heterosexist. Feminist principles require that we be honest in the research process without recognizing the privilege inherent in this demand. Frank se lf Appendix III o f Community Research as Em powerm ent (Ristock & Pennell, 1996) outlines some suggested methodological and ethical guidelines for work with lesbians; som e o f these guidelines may also be appropriate to research with other marginalized populations. 63 identification is perhaps merely good, accountable practice for white, heterosexual women; but for other, marginalized identities it often poses a risk o f grave professional damage, and to make it a research requirement for lesbians is tantamount to ‘outing’. To be able to acknowledge fully the ways in which ‘fragmented identities’ shape our work is a rare privilege when one of those identities is lesbian, (p. 72) Consequently, the principles underlying a feminist research approach are relevant to research with lesbians but they are nevertheless incomplete. Whereas a feminist research perspective privileges women’s lives and seeks to develop research practices that are sensitive to and consistent with women’s experiences, a lesbian research perspective privileges lesbians’ experiences and addresses the unique research issues related to their marginalized identities. Although the concept of a definitive lesbian experience is untenable, the idea of ‘lesbian experience’ is valid in a broad sense, and meaningful in a research context. A lesbian research perspective assumes that being lesbian constitutes a fundamentally unique experience. Consequently, locating, exploring and understanding the ways in which this experience is unique requires a research approach that privileges and centres upon lesbian experience. Through my own experiences as a lesbian in academia conducting research with other lesbians, discussing research with lesbians and lesbian faculty, and from reading about the challenges of other lesbian researchers undertaking studies with lesbians, I became aware of some important research issues. I incorporated this awareness into my own research in the form of principles and/or ethics that I believed could benefit my interactions with lesbian research participants. These principles/ethics include providing a guarantee of confidentiality, being non-judgemental and non-restrictive of lesbian self­ 64 identification, remaining positive and uncritical of participants’ self-referents and reflecting these identities throughout the research (e.g., dyke, lesbian, gay, queer), being sensitive to the ways in which participants experience stigma, and promoting a sense of community, support and inclusiveness through the project.^'’ Confidentialitv Lesbian communities are small by definition. Lesbian communities in rural contexts are even smaller than their urban counterparts. Providing a guarantee of confidentiality is exceptionally important to lesbian participants who may need to feel anonymous in order to share their thoughts and experiences. While assuring confidentiality is relevant to any human research work, it is especially significant for a stigmatized population. For example, a lesbian living in small rural community can be identified through a small and seemingly mundane characteristic of her life, such as her job description. While researchers can assure a level of confidentiality, the level of confidentiality should also be determined by individual lesbian participants in order to address personal situations that may not be disclosed to the researcher but may yet be relevant to the topic. Participants also vary in their need for and purpose of invisibility/visibility. For example, some lesbians make a point of being recognizable in research projects as a political act that expresses their refusal to be intimidated and pushed into concealment. From this perspective, understanding the motivations behind a participant’s choice over Many o f the issues I experienced as unique to researching lesbians are also cited by Ristock and Pennell (1996). 65 identity will contribute to a greater understanding of her context and a greater ability to effectively address confidentiality issues. Respecting Identity Accepting lesbians’ personal definitions of their lesbian identity is important to a successful rapport between researcher and participant. Too often in the lesbian community, a misguided attempt to strengthen our communities results in a debate over who is and is not a ‘real’ lesbian (in other words, who can and cannot be trusted). For example, some lesbians have never been sexually involved with other women; some lesbians are uncomfortable looking like a lesbian in a stereotypical sense (short/shaved hair for example) or being seen in the company of such women; some lesbians remain married with no intention of leaving their marriages; some lesbians occasionally have sex with men; some lesbians want nothing to do with gay and lesbian rights; and some lesbians oppose education around homosexuality in the school curriculum. The special conditions of rural contexts, such as conservative attitudes, lack of social awareness and change, lack of educational and media resources promoting positive gay images, and the development of survival techniques in response to these conditions, may contribute to how and under what circumstances participants articulate their identity. Smith (1997) states that: The local rural values and beliefs of any given rural community hold together the boundaries that often are not open to diversity or social differences. In rural communities, many lesbians and gay persons choose or are forced not to be known as gay in their communities as a means of coping with everyday life. (p. 14) 66 Even if participants’ meanings of lesbianism contradict popular or academic notions of lesbian identity (or even just the personal concept of lesbianism held by the researcher), it is not the role of the researcher to judge participants’ eligibility for the research based on those comparisons. In fact, the ways in which gay rural women articulate and/or act out their lesbian identity are significant pieces of knowledge that contribute to a greater understanding of lesbian experience in these contexts. Invalidating the multiple and perhaps strategic meanings of rural female queemess only results in obscuring or denying this knowledge. Furthermore, challenging participants’ identities either explicitly or implicitly does not serve the goal of friendly rapport between research and participant. In rural contexts already characterized by lack of confidentiality and mistrust, it is especially important that lesbian participants do not feel judged by the researcher. Language Lesbian participants also need to be represented as much as possible in their own language, even though there is little scholarly work that represents lesbians as anything other than ‘lesbians.’ Very infrequently do I read about research on lesbians that uses language such as ‘dyke’ and ‘queer.’ I think this is because there is an uncomfortableness in academia around using politically incorrect words, street/colloquial terms and/or dated terms, which ultimately affects what language researehers feel least at risk using in their projects. There may also exist an uncomfortableness on the part of the researcher to interchange language that some participants use but make other participants uncomfortable. For example, self-referents in the current study included not only 67 ‘lesbian’ and ‘gay,’ but ‘dyke,’ and ‘queer.’ Ristoek (Ristoek & Pennell, 1996) navigated similar issues in her work with lesbians: On the posters and in the survey and interview questions I used the word ‘lesbian’ exclusively. Yet the first woman I interviewed revealed that she was not sure if she qualified for the researeh because she was married to a man, involved with a woman, and considered herself to be ‘gay’, an identity she saw as preferable to the more stigmatized one of ‘lesbian’. This encounter pointed to the danger of using rigid categories, as well as the effects of language, (p. 74) In keeping with the commitment of feminist researeh to ground researeh in the experience of participants, including their language and expressions, researehers working with people with stigmatized identities may be challenged by the expectations of both participants and academic institutions to represent these identities accurately and appropriately. Lack of precedent within scholarly work of representing queer folk as anything other than lesbian, gay, bisexual or homosexual further undermines the goal of representing participants in their own language. One way of navigating this dilemma is by gaining participants’ support for the language used to represent them, even if this language is not thoroughly accurate for all participants. Stigma Being exceptionally aware and sensitive to participants’ experiences of stigma is extremely important when doing research with (rural) lesbians. Most lesbians do not have untainted experiences of being gay, and I found this is especially true for lesbians living in rural communities in which conservative morals and lack of diversity bear on their lives in profound ways. Rural communities are not equal counterparts to cities in their 68 degree of tolerance and/or acceptance of deviation, including sexual deviation (McCarthy, 2000; Foster, 1997). Rural lesbians experiences’ of stigma, for example, include alienation and shunning, isolation, fear, threats, branding and suspicion. Unless the researcher is herself a resident of a small community, it is a challenge to accurately comprehend the significance and consequences of what can seem like small and sometimes trivial acts o f homophobia. Smith (1997) states that. While many gays and lesbians confront non-acceptance from the general population regardless of locality, they are perhaps nowhere more subject to hostility or more reminded of their differences than in rural communities. In rural areas, more than any other geographic setting, conformity is strongly urged, if not demanded, (p. 24) For these reasons it is important for the researcher to challenge her own beliefs about what counts and does not count as ‘stigma’ and by what criteria she uses when evaluating the seriousness of experiences of stigma. Rural lesbians’ experiences of stigma are unique and subtle, and their greater meanings can be lost or misunderstood if they are not considered in relation to rural qualities and values. Giving Back to Communitv A shared feminist and lesbian researeh goal is that something relevant will be contributed back to the community from which participants are drawn. Due to the geographic barriers between lesbians, in addition to issues of cost and availability, and even political differences, it is not always possible to create community in a tangible sense when doing researeh with lesbians from multiple rural communities. One way of contributing to a dispersed community, though, is to build on former researeh in the area 69 with which participants’ may also have been involved. Building on former researeh (if it exists), is one way to promote a sense of visibility and validation in rural lesbian communities. For example, my choice of topic, and my use of earlier and concurrent research and research communities (for example, Anderson et al., 2001; Sorrell & Watson, 1997) were ways in which I could realistically contribute to rural lesbian communities. As an outsider to these communities, I knew that my project in and of itself would not bring rural lesbians together into lasting soeial groups, but it could contribute to a sense of shared community and a feeling of recognition that could benefit community development. What I Learned Doing Feminist, Lesbian Research I learned a great deal about rural lesbians lives through the course of this research, in addition to the research process itself. My goals of eomplementing the topic with my choice of research methodology, method, and ethics produced expectations that I could not always fulfill to the degree I wanted. For example, expeetations around interviewing, in partieular that they be informal and conversational, clarified some of the weaknesses in my interviewing skills. Challenging the concern for equity between researcher and partieipant was the unequal interest in and dedication to the researeh (that is, while the research constituted a major foeus in my life, it was not the major focus in participants’ lives). Living outside of participants’ communities may have also contributed to the limited connection between myself and participants, and between participants and the research topic. Although participants contributed in substantial ways to this project, I never felt the projeet achieved a level of eonnectedness and intimacy that is held as an 70 ideal in the feminist research community (Reinharz, 1992). Lack of experience as a researcher of human experience also contributed to limitations in my interviewing skills. Reinharz (1992) states, “Feminist phenomenological interviewing requires interviewer skills of restraint and listening” (p. 21). Although 1 remained aware of power differentials in my relationship with participants, this awareness did not necessarily prevent behaviours and decisions that could be described as controlling or oppressive, such as interrupting, and offering interpretations of rural life based on my experience before participants initiated those topics themselves. Although 1 began this project with eight participants, I focused on only four of them in my data analysis. 1 felt the decision to only focus on four participants was necessary, and that the criteria I used to select key participants were appropriate.^' Nevertheless, this decision was based on my interpretation that there were qualitative differences between participants’ contributions. I also wanted my findings and ways of expressing them accepted and supported by the participants before finalizing them, although this has proven to be a challenge due to one participant moving without leaving a forwarding address. Being aware of the stigma associated with queers in rural settings, I was especially concerned about confidentiality. It was a priority to protect the confidentiality of the participants as much as possible even though not all participants were coneemed at the time about being identified. 1 could not pre-select participants on the basis o f their ability to be self-reflective and verbal (criteria Reinharz (1992) proposes for selecting participants for a phenomenological study). Subsequently, 1 chose to focus m y analysis on the participants who m et this criteria based on their interviews. 71 Study Design The Researcher This research project is my first engagement with qualitative research. Who I was/am has significantly influenced (and continues to influence) the research process. Reflexivity is the critical consideration of the researcher’s relationship to the participants and research process, including the sharing, gathering, organization, analysis and representation of knowledge. Contemplating one’s role at all levels of the research project is one way to value the subjectivity of qualitative research. For example, the choice of topic and methodology, who is involved with the project, what and how participants share with the researcher, the researcher’s understanding of what the participants share, and the challenge to remain passionately involved with the project are all aspects of the research process that are related to the researcher. In this section, I situate my research by discussing the relationship between the significant qualities of my identity/experience and the research process. At the time of conceiving and initiating research I was twenty-seven years old, and had been comfortably “out” as queer for three years. I identified as a “feminist” although looking back 1 had very little formal knowledge and sophisticated understanding about what this meant. My educational background is in English literature and British history. All of my research experience before this project focused on text as the primary and secondary research source. This thesis is my first experience formally interviewing other people, including people from economical and racial backgrounds, ages, and geographical settings that were different from my own. 1 chose a phenomenological 72 approach, with in-depth interviewing as my data-gathering method, even though I realize that phenomenological research and in-depth interviewing are probably best accomplished by a seasoned researcher. To complicate matters, halfway through this project I began to acknowledge my denial about my gender identity. This resulted in the reeonsideration of my gender and changing my name. Transgender people typically do not feel a psychological sense of gender that “matches” their chromosomal sex. For me this meant no longer denying the fact that I was uncomfortable identifying as female/woman. This shift in my identity had implications for my research project because I no longer identified with my partieipants. I felt unease as a researcher in not “eoming out” as transgender to my partieipants, and wondered retrospectively if they would have agreed to be part of the research project and shared as much as they did if they knew I would not be identifying comfortably as a woman/lesbian for much longer. One of the benefits of identifying as lesbian when doing research with other lesbians is that the researcher is also an insider. Having an insider status is a privilege because it means entry into the field is easier than it would be otherwise: as part of a subeulture, I knew where to find contacts, and I knew the participants would trust me in a way they might not trust an outsider. Stevens (1992) suggests that the level o f rapport she achieved with her lesbian participants “would have been very difficult or perhaps impossible had [she] not been a lesbian,” (p. 96). Riessman (1987) suggests that being outside of the eultural group one is studying— even if participant and interviewer are of the same gender—can lead to misinterpretation and limitations on what the participant feels comfortable sharing. Establishing trust with 73 lesbian participants is especially critical when doing research because of pre-existing societal stigma towards lesbians. This trust was evident in the degree of ease in our interviews, as well as in key participants’ willingness to share information and the nature of that information. Stevens (1992) states that, “Given the prevalence of societal prejudice against lesbians and the history of pathologization of lesbians in health-related research, lesbians do not come easily to research efforts unless they trust the circumstances explicitly” (p. 96). In the end, I mediated the tension I felt in my research by remembering and emphasizing the outsider status all sexual minorities share in small communities. Furthermore, what I knew and had experienced under the label ‘lesbian’ did not change even if my identity had. There are also other ways in which I am an outsider to this research project that may have produced limitations in the study. For example, I had not lived in small communities to a length of time comparable to that of my participants. Consequently, participants may not have entirely perceived me as someone who could relate to their experience. There is also a significant age difference between myself and participants, in that some participants are much older than I, and some are more than five years younger. This age difference may have limited the extent to which interviews could resemble conversations, and thus affected what participants felt like sharing at the time of the interview. Another way that I was an outsider to the participants’ realm of experience was that as the researcher I had a status and power that is formally recognized in the identity o f a university graduate student—I am located outside of the participants’ communities 74 and I represented UNBC as well as the Northern Secretariat of the Centre of Excellence for Women’s Health/^ Participants’ power and authority are not formally recognized as such: even though participants were the ‘experts’ in the research process, they would not be granted the same formal credentials I would be by virtue of contributing to academic knowledge. I tried to mitigate any hesitancy some participants may have felt towards being part o f a university project by emphasizing that my study would be of a qualitative nature; that the interviews would be organized around the participants’ lives and needs; that my thesis was building on former research that was community-initiated and driven; that the participants would have an opportunity to qualify anything they shared with me; and that the participants would have the right to support or challenge my preliminary analysis of the data. I feel that the age difference between myself and the majority of my participants, combined with my lack of experience in rural communities resulted in some limitations in what participants shared with me. Working with other lesbians, grappling with qualitative methodology, trying to accomplish a feminist agenda, trying to represent the meaningful experiences of others, and above all, remaining reflective about, centred in, and critical of my work was/is an incredible challenge. Research Settings Eight lesbians from rural communities in the BC Central Interior agreed to be interviewed for this project. There is no academic agreement on what ‘rural’ means: “The concept of ‘ruralness,’ while seemingly simple to characterize, has not been clearly or As a member o f the Northern Secretariat Lesbian Health Group (NS Group), I agreed to share my interviews in exchange for access to the interviews o f lesbians in Prince George and smaller rural communities undertaken by the Northern Secretariat Lesbian Health Group. 75 consistently defined in the literature” (McCarthy, 2000). Keller and Murray (1982) suggest that strict definitions of rural are arbitrary, while Quevillon and Trenerry (1983) note that rural areas “differ greatly from region to region” (p. 47). Research communities ranged in population from less than 700 up to 5000. Travelling times from these communities to the nearest city ranges from forty-five minutes to five hours. Although the communities included here are geographically situated in the central interior of British Columbia, many participants considered themselves to be living in rural northern communities. Part of the meaning of living ‘north’ may derive from living significantly north of Vancouver. In research on women in BC, Vancouver is generally considered to represent B.C.’s ‘south,’ while B.C.’s interior is generally referred to as the ‘north.’ Hamelin (1989) states that residents’ perceptions of “north” are meaningful and important even though they may not be geographically accurate. In the same way, participants’ perceptions of living ‘rurally,’ or of having a ‘rural’ identity are meaningful though they might not fit technical criteria for what constitutes ‘rural.’ This study does not intend to generalize or represent all northern and rural communities in BC; smaller, more remote and even isolated communities exist in BC that might present unique issues. At the very least, however, the findings from this study are relevant to similarly sized B.C. communities in the interior, and are perhaps of interest to remote communities. Selecting Participants Stigmatized populations such as gays and lesbians are uniquely challenging groups to solicit for research. Soliciting stigmatized populations from areas characterized Interestingly, when I first m oved from Victoria to Prince George, I considered m yself to be living in a northern, rural setting. 76 by traditional and conservative values makes it even more difficult (Kramer, 1995; McCarthy, 2000). Other problems that arise with researching queer folk in partieular is that no standard, universal definition of gay or lesbian exists (Sell & Petrulio, 1996; Donovan, 1992). “To study gays and lesbians is to study whom? ... Inconsistent responses ... make it unsurprising for workers to reaeh contradictory conclusions if, upon examination, they are dealing with different populations albeit labelled by the same terms” (Donovan, 1992, p. 7). Snowball sampling addresses both the issue of access to stigmatized populations and assuranee of a shared identity among participants. Snowball sampling relies on initial contacts who solicit other partieipants through their personal networks, thus providing the researeher with access to a hidden population, as well as an assurance that participants’ identity are stable and consistent within that network. The snowball method for the eurrent study involved using word of mouth among lesbian friends and aequaintanees in Prinee George who knew of lesbians in outlying communities who might be interested in my project. I did not advertise in loeal community newspapers or newsletters. My involvement with the Northern Secretariat Lesbian Health Group provided an opportunity to interview willing lesbians contacted through that project. Significantly, most of my contacts were established through pre­ existing connections between rural lesbians and a rural support services assessment project conducted one year prior to my research (Sorrell & Watson, 1997). One of the researchers for this project agreed to contact participants and ask them if they would be interested in participating in my study. The participants that were willing agreed for their phone numbers to be passed along to myself. Partieipants also solicited other contacts 77 through word of mouth to their friends and acquaintances. Prior to my research, I was familiar with two of the partieipants. I believe my credibility with them helped gain the interest and trust of subsequent volunteers. Inclusion criteria for my project were that partieipants must identify as lesbian (or as a queer woman), and be living in a mral community accessible to me by vehicle. Ideally I would have involved only lesbians that were comfortable with self-reflection, who were articulate, who were from diverse racial/ethnic and economic backgrounds, and who had spent at least five adult years in a rural community. However, there are many reasons why lesbians in rural communities are unwilling to participate in a project focusing on their lesbianism, and I could not specify who my participants would be. Furthermore, positivist criteria for determining number of partieipants are not relevant to phenomenological studies, because there is no expectation that findings should be generalizable to a larger population: The starting point for an existential-phenomenological study is ... not the adequate number of randomly chosen subjects to conduct statistical tests of significance to confirm or disconfirm hypotheses and make generalizations. (Garko, 1999, p. 172) Criteria for involvement in a phenomenological study, however, require that participants have direct experience with the phenomena (Osborne, 1990), as well as an ability to illuminate the phenomenon verbally (Baker et al., 1992). Good rapport and trust are also critical to “authentic descriptions of a co-researcher’s experience” (Osborne, 1990, p. 84). The priority and regard for exploring the richness of individual experience also means that sample sizes are deliberately small (Baker et al., 1992). 78 Together, the above-listed criteria constitute the selection process for my original eight participants, as well as the subsequent in-depth foeus on only four of those participants’ transcripts. Although I held two interviews with seven of the eight participants (one partieipant declined a second interview without explanation), I performed a phenomenological analysis with only four partieipants. Age differences among participants and perhaps researcher, degrees of experience with the community, and time spent in a rural community raised issues that might otherwise have been absent. The interviews contain rich information that cannot be adequately analysed within the borders of my thesis. Perhaps a future project can go beyond my own partial analysis to do justice to this resource. Group Profile The following demographic information was compiled from a demographic information sheet (see Appendix 1) filled out with each participant at the time of the first interview. The initial eight lesbians ranged in age from 17 to over 50. All of the participants identified as white or European. Lived time in rural communities ranged from 6 months to over 25 years. Six of eight participants lived in small rural communities at some time in their lives prior to their community at the time of the interview. Four participants had moved from Prince George to their community. Five of the eight participants lived outside of their small eommunities ranging from a 15 to 90 minute drive. Seven participants worked in their communities while one partieipant commuted forty-five minutes to a larger city for work. At the time of interviews, all of the participants were involved with other women ranging from committed relationships (short and long term) to dating. Three of the participants had children ranging from young children (4 yrs) to grown adult 79 children. Four of the eight participants lived with their partners; one participant lived part-time with her partner. At the time of interviews, all participants were engaged in either full or part-time work (including contract work); none of them earned more than $40,000 per year and some earned as little as $5,000 - $10,000 per year. None of the participants identified her class background as other than poverty class, working class (including rural working class), and lower middle class. Employment descriptions are as follows: researcher, park facilitator, operator and project coordinator; mental health worker, entrepreneur and landlord; gas attendant; drug and alcohol counsellor; and book-keeper. Two of the participants combined work with university at the time of the interviews. One participant withdrew from the study after the first interview with no explanation. I did not include direct quotes from this participant’s transcript in my thesis, though I did consider her experiences in a rural community as a legitimate resource in my understanding of rural contexts. Ethics Confidentialitv Confidentiality was guaranteed to the participants as outlined in the Agreement of Participation Form (Appendix 2) each participant received and signed prior to the initial interview. This form outlines the confidential storage of transcripts and audio tapes, the steps the researcher would take to ensure anonymity in the thesis, the potential uses of participants’ shared information (e.g., publications, educational conferences and teaching materials), who could have access to participants’ transcripts, and the knowledge that participants could withdraw from the study at any time. Another step I undertook to ensure confidentiality was to submit copies of the 80 transcripts to participants to provide the opportunity to delete, qualify or change anything with whieh they were uncomfortable. By safe guarding the transeripts against unwanted identification I am confident that any quotes I use throughout my thesis, and especially in my data analysis chapter, are derived from a souree approved by the participants. I think it is interesting to note that the degree to which participants desired anonymity ranged from slightly earing (in eertain contexts) to unconcerned. Although two participants made grammatical changes to their transcripts, no changes were made to their quotations in the Findings chapter. Informed Consent Participants were verbally introdueed to the project, its purpose and parameters in initial phone calls. They were also mailed information sheets (see Appendix 3) to review before our first interview. The involvement of the participants was voluntary, and they could withdraw from the study at any time. Or alternately, participants could also challenge/change the parts of the interview process with whieh they were uncomfortable. I emphasized the flexibility and exploratory nature of the study and stated clearly that there were no right or wrong responses or ways of articulating. Partieipants were asked to sign a formal consent form before we proceeded with the interviews (Appendix 2). Agreement to the second round of interviews was verbal; the initial consent form served for both interviews. Both the Agreement of Participation form and the Letter of Information to the project were approved by my initial thesis committee; the Agreement of Participation form was also approved by U.N.B.C.’s Ethics Review Committee. 81 Interview Meetings In-depth interviewing Taylor and Bogdan (1984) state that “The choice of researeh method should be determined by the researeh interests, the circumstances of the setting or people to be studied, and practical constraints faced by the researcher” (p. 80). The method for this research is in-depth, semi-structured, open-ended, repeat interviews. The fact that there is little published research about the health experiences and meanings of lesbians in rural communities directed me to in-depth interviewing as the method for this thesis. In-depth interviewing would allow participants to talk at length about their experiences and meanings. Participants’ language, meanings and emphases would therefore be the essence of what could be known about this topic. I felt that in-depth interviewing would be best accomplished in a face-to-face scenario as opposed to a telephone interview. Telephone interviews also carried the risk of being overheard by others due to the reality of partylines in these areas. 1 think making this sort of in-person commitment to the interviews also added to the integrity of the interviews because participants knew I had made an effort to come to their communities. Ideally, 1 would have liked to conduct at least one more set of interviews but was faced with time and financial constraints. In addition to being a popular method for much qualitative research, and in keeping with feminist research ethics, interviewing is also the method most consistent with my own values and interests as a researcher. The following questions acted as guides for the interview: ■ What do you think health means? ■ What do you think lesbians living this area need most in order to be well? 82 ■ Can you tell me about how living rurally (or in a small community) has contributed to your overall well-being? ■ In what ways is your overall feeling of well-being connected to your day-to-day life? ■ What are the day-to-day things that contribute to the different parts of your overall well-being? ■ How do you think your definition of health would change if you lived in an urban centre? While participants’ contributions were prompted by these questions, they were not limited to them. My understanding of and interest in qualitative research is that it is fundamentally a methodology that brings researcher and participant(s) together with as little hierarchy as possible, and that interviews can be informal, conversational, and place an emphasis on shared learning and contribution. For example, Kvale (1996) states that, “The qualitative interview is a construction site for knowledge. An interview is literally an inter view, an inter-change of views between two persons conversing through the concrete about a theme of mutual interest” (author’s emphasis, p. 14), further it is a “specific form of conversation” (p. 19). The cooperative nature of interviewing also allows for joint meaning through expressed the participants’ own words and immediate validation/clarification of participants’ meanings. In these ways, interviewing is a method that respects and incorporates participants’ uniqueness rather than producing standardized information (Reinharz, 1992). The nature of the qualitative interview also allows for thick description and rich detail so desired by qualitative researchers. This is accomplished by 83 the use of open-ended questions (or guides), which encourage participants to speak at length about their ideas. The highlights of implementing interviewing as the research method in this study were twofold: undoubtedly, one highlight was meeting the participants personally and learning more about who they are and their ways of managing their unique positions as lesbians in small rural communities. Secondly, reflecting on my role in these conversations (e.g., how being who I am limits and/or enhances what is shared) was challenging and at times profound in the degree of self-honesty it required. This specific character of the relationship to my research was possible because of my choice of interviews as the method for this research. I discuss more about my role in the interviews in Chapter 5: Data Analysis. Data Collection Audio Tapes All interviews were audio taped on a portable recorder. The quality of the tapes varied according to setting, but generally voices were clear on play-back. It is difficult to determine the impact of the recorder on participants’ degree of comfort: certainly the tone of the conversation changed once the recorder was turned on, but soon afterwards several of the participants seemed relaxed and casual. Perhaps two participants displayed nervousness during the length of the interview and were visibly pleased and talked more extensively once the recorder was turned off. I audio-taped the interviews and informed each participant that she could stop the recorder at any time (or signal me to do so). Some participants chose to stop the recorder. The reasons for this varied: participants realized 84 they were not ready to have their voices recorded; they wanted to impart criticism about other lesbians in their communities, or about their communities in general; they were interrupted by children or clients; they felt embarrassed or conscious of not expressing their ideas clearly. Sometimes I turned the recorder off when I sensed participants were intimidated by its presence and when I felt I needed to ask them to clarify their meanings in a way that might first require their consent. I transcribed the interviews as soon as possible after meeting with the participants to ensure accuracy. Parts of the interview that were unclear on the tape are indicated as such in the transcriptions. Field Notes I made notes during and after each interview. These notes generally focused on the topics to revisit, any particular unease a participant may have felt in response to one of my questions or in expressing an experience, my perception of the rapport between myself and the participant, and body language during the interview, as well as interview setting such as location, time of day, and how the setting may or may not have contributed to what participants shared with me. For example, one interview involved two participants (friends) and took place in a local café. I made notes afterwards about how each participant seemed to hold back information that may have contradicted the testimony of her friend, or that was too private. The location (a public café) may have also influenced the quality of the information being shared; whether or not this was true remains indeterminate. However, subsequent interviews with each participant separately and at a later date were more open and detailed than the initial interview, leading me to 85 believe that the setting may have influenced the first interview in the ways I had suspected. Taking such notes, and reflecting on their meaning was an exhausting process in the context of organizing and accomplishing the actual interviews. For example, I underestimated what would be required of myself in terms of energy and concentration to consistently make detailed and thoughtful notes on days when I conducted three interviews. However, the notes I made were invaluable as aides to my memory in remembering the interview and in understanding the fuller meaning of a participant’s words and context. I learned in a methodology course prior to the research that often participants share important pieces of information in the follow-up conversation to the interview (once the recorder is turned off) and that researchers should be prepared for this to occur and to attempt to jot down these thoughts as soon as possible. This advice was well served because several of the participants articulated valuable thoughts and feelings once we had completed the ‘formal’ interview. The Role and Contribution of the Northern Secretariat Lesbian Health Group The Northern Secretariat of the BC Centre of Excellence for Women’s Health lesbian health research team formed in November 1997. Many of the goals, assumptions and curiosity of this project were similar to, or overlapped with, my graduate thesis topic and research goals. My involvement with this project was therefore appropriate and benefited both my own research and the Northern Secretariat’s (NS) research.^"* My role The Northern Secretariat (N S) is now called Northern FIRE (Feminist Institute o f Research and Evaluation (NF)). 86 was that of researcher (including contact person, interviewer, transcriber and data analyser) and as a contributing author to the research report. One of the goals of the NS Lesbian Health Research Group was to assist and support graduate students pursuing lesbian health issues in the north. One of the ways the NS Group demonstrated its support was to allow me to utilize participants’ transcripts from the NS project in my own analysis of lesbian health experiences. The NS Group also agreed to ask my thesis research questions in interviews. In return, my interviews with participants also included the NS Group’s questions. Therefore, interviews initiated by both the NS Group as well as my own thesis interviews are organized around including both my questions and the NS Group’s questions. Questions for my interview were in part devised from brainstorming sessions with this group about what sorts of questions we felt would be appropriate if we were to be asked about our experiences and meanings of health as lesbians living in a rural community. My interview questions were subsequently approved by my thesis committee, which included one member who was familiar with phenomenology. In the actual interviews, I experienced the contradictory feelings of wanting to let participants determine the direction of the interview and anxiety that participants all be asked the same guide questions. This means that if participants talked about subject areas that were identified in the interview guides, they were not asked to comment on those questions as part of a standardized process. However, if participants did not voluntarily discuss these subjects, I made a point of asking these questions before the interview ended. My experience from the first interviews also bore on the quality of the second interviews. For example, I was more comfortable in the second interview due 87 to the rapport that was established by the first interview. I also had experience from the first interview that participants would contribute the rich detail I needed, which made me less concerned with making sure all participants commented on the same general areas. In this sense, my own comfortableness and trust in the participants’ ability to contribute benefited the content and flow of the second interview. As part of our commitment to collaborative research, and also in response to the dearth of research resources on lesbians in the rural north, the NS Group and I agreed for there to be open access for both parties to our respective research information. Participants were informed of this open access in the Letter of Information and Participant Consent sheets. In exchange for conducting interviews on behalf of the NS Group, funding for my travel expenses for my first round of interviews was generously provided by the NS. This funding made possible two sets of interviews for my own research. I also benefited from several discussions and analysis sessions on lesbian health experiences in the rural north from my involvement with the Lesbian Health Group. These conversations and brainstorming sessions contributed to my understanding and interpretation of lesbians in rural contexts in BC, and to my research process. 88 Chapter Four Data Analysis Chapter Four contains five sections; (1) approach to the topic, (2) bracketing, (3) evaluating transcripts, (4) analyzing the data, and (5) interviews. Section four (data analysis) is comprised of the following important subsections: (a) on-going analysis, (b) transcribing interviews, (c) analytical table, (d) analysis, (e) participants’ code names, and (f) confidence in the data. Approach to the Topic Primary and secondary literature, as well as my personal experience in northern and rural communities inspired my topic and constructed a particular way of approaching it. Primary research consists of in-depth interviews undertaken by myself with eight participants, as well as a large body of interview transcripts from two separate but related projects (Anderson et ah, 2001; Sorrell & Watson, 1997). Journal articles, books, community reports and government documents comprise the secondary research, all of which discuss rural contexts, and/or rural gays and lesbians, and/or rural women’s health. My personal experience comes from living in a conservative, northern city. I also lived for six months in a small rural town of less than seven hundred people. Mirroring much of the focus in research on women’s health in general, contemporary research on lesbians’ and bisexual women’s health is almost exclusively defined by their formal health care experiences. My focus on lesbians’ experiences of health and wellness outside of their formal health care interactions addresses this bias. I 89 consider lesbian health as they experience it outside of formal health care a distinct topic warranting its own research. This privileging of alternative health experiences is consistent with the women’s and lesbian health movements, which are both grounded in the body of health experiences shared by women in feminist consciousness-raising groups (Denenberg, 1997). For example, feminist values of self-empowerment and independence from formal institutions (which were thought to be andocentric and oppressive to women) emphasized self-knowledge, self-care, and equal participation in formal health care settings (Denenberg, 1997). Women and lesbians have also been shown to value alternative health care services, such as a woman-centred holistic approach, which respect and integrate women’s lived experiences, spirituality and knowledge of their bodies (Lauver, 2000). For these reasons, research focusing on women’s/lesbians ’ experience of wellness outside of formal health care is important to understanding a broader picture of their health and wellness. One of the purposes of health meaning research is to understand the relationship between populations’ health meanings and their health needs/behaviours and issues. This health meaning research suggests that participants’ contexts and cultural/social identities influence health beliefs and behaviours. In the current study, asking lesbians’ to describe their health meanings through everyday experiences elicited rich material concerning the nature of their rural communities and provided a framework for understanding the relationship between these factors and well-being. However, my personal experience and 90 my review of the literature also led to a strong bias in my orientation to the research topic, to which I became accountable through the process of bracketing. Bracketing Bracketing is one hallmark of phenomenological research. Bracketing involves being self-aware of the experiences, assumptions, hunches, theories and frameworks one brings to the research act, and then making these perspectives explicit in the research process and written product (Parse, Coyne, & Smith, 1985). Bracketing at the start of a phenomenological study is important in order to be conscious of, and to minimize, the effect of the researcher’s prior perspectives and opinions on the research act (Colaizzi, 1978). Bracketing in the current study resulted in my awareness of one particularly strong theme characterizing my perspectives on rural communities and the health and well-being of gays living within them.^^ This theme presents rural communities as negative— even damaging—contexts for queers. For example, I assumed that any gay person living in a rural community was confronted daily by pervasive and hostile homophobic discrimination. Furthermore, I assumed that this negative experience would characterize gay people’s experience in small rural communities, inevitably affecting their quality o f life. I was also concerned about letting my biases of rural communities define or influence my interactions with participants. I worried that my biases might limit what participants felt comfortable sharing with me, and also what I would be open to This theme is also prevalent in the literature on rural queers, which raises the issue o f the value o f doing a literature review before interviewing participants and analysing the data in a phenomenological study, since reviewing the literature also constructs a partieular perspective about the researeh topic. 91 hearing, thus limiting a deeper understanding of the relationship between living rurally and well-being. 1 attempted to counteract this bias through the process of bracketing. In this study, bracketing involved several strategies: establishing rapport, directly learning about participants’ contexts by travelling to their communities for interviews (which conveyed a sense of commitment and interest in their communities), examining how my biases could be both limiting and productive before each interview and textual analysis, explicitly asking participants to discuss the positive things about their environments in terms of their well-being, and formally acknowledging my biases in the written text (accountability). Although participants themselves expressed many of the negative stereotypes I harboured, emphasis on the positive qualities of health and well-being enabled a broader description of health experiences and meanings that ultimately challenges the perception of rural communities as simply negative contexts for rural queers’ well-being. Being mindful of my biases, including writing them down and reflecting upon them during the research process, enabled a more open and sensitive understanding of participants’ experiences. Ultimately, bracketing led to a broader description and understanding of the relationship between rural contexts and well-being because 1 was more open to (and encouraging of) different perspectives. Evaluating Transcripts After reviewing the fifteen transcripts, I decided to do a core analysis of health meanings from four key participants’ transcripts (eight transcripts total), as opposed to all 92 eight participants (fifteen transcripts).^^ I characterize these four participants as ‘key participants’ due to their ability to be articulate and self-reflective, and by how well they could illuminate the phenomenon. Qualitative research in particular depends on participants who can talk extensively and reflectively about their personal experiences (Colaizzi, 1978). In addition to being exceptionally articulate and comfortable with talking about themselves, key participants’ reflections also contain contradictions and discrepancies that serve to deepen and enrich the content. I believe these differences (such as differing positions within their communities, length of time of residency, past experience with rural communities, age, and length of time being an ‘out’ lesbian) also serve to enrich the research content by offering different angles on the topic. I treated the remaining transcripts as a primary resource to further situate and interpret the findings from the key participants.^^ Analysing the Data On-Going Analvsis The data analysis was an on-going process beginning with my consideration of the topic. My personal experience and knowledge of the subject through related literature were factors that influenced which part of the subject area (rural lesbians) I would pursue. In other words, before my first interviews I was already processing related experiences and knowledge of my topic that would influence the specific focus of my topic, my choice of method for gathering data (in-depth interviews), and what sorts of questions I ^ One participant declined a seeond interview. All quotes from primary data in this study are from key participants’ transcripts. 93 would ask in the interviews. Though some of these thoughts and decisions were recorded informally, the hulk of this analysis was immaterial. The beginning of the material analysis of primary data began in the first interview. Analysis of primary data in the first interview is consistent with a phenomenological approach (Leipert, 1996). Analysis of primary data from the field involved active listening to and probing of participants’ recollections, including changing and rearranging interview questions, spontaneously inventing new questions, and determining the significance of tangential pathways leading off from the general topic. For example, I abandoned questions when it became clear they were not relevant or had already been adequately discussed as part of a different response. Also, when a participant discussed qualities of rural living that did not obviously relate to my topic, 1 had to decide whether or not to pursue these pathways further through probing (because they could be relevant in a way not apparent to me) or to let the participant finish talking and then guide the discussion back to areas that seemed—at least on the surface—more relevant. Making these sorts of decisions required an almost intuitive feel for what participants’ shared. For example, should I pursue issues that participants commented on but were uncomfortable talking about (even though I considered them important to the research); when was seemingly unrelated information meaningful to the topic (and hence requiring more probing); and when was it merely part of the informal nature of a conversation; and, when was emphasis always relevant to the significance of the information to my topic, and when was it significant just to the participant? As a novice researcher doing human research, 1 found these sorts of decisions challenging. However, 94 this experience provided me with an insight into the inevitability of power in the research act, and how this power is dynamically construed. 1 found that each interview acted as a building block to my understanding of the topic as well as to my understanding of the interview process. This knowledge increased incrementally with each interview and ultimately resulted in greater confidence around decision-making and more comfortable subsequent interviews. In these ways data analysis occurred from the very beginning of my first interview. The spontaneous and constant weighing and judging of different parts of knowledge seemed a necessary process to providing some loose structure to the exploratory nature of my interviews. In essence, the analysis was both step-like and cireular: there was a clear process to follow but each step forward depended upon a retrospective analysis to account for where the analysis had taken me, and what it meant in terms of the larger picture. One important result of this on-going analysis is that interviews are richly varied; each participant contributes unique knowledge and an emphasis particular to her interpretation of the meanings of her experiences of well-being. I am excited by this nature of the interviews. It not only contradicts idyllic notions of ‘rural’ (Little & Austin, 1996; Keller & Murray, 1982), but also idyllic characterizations of rural queers in popular gay and lesbian images and myths of the countryside as a safe and erotic setting (Bell & Valentine, 1995; Lindhorst, 1997; Valentine, 1997). In addition, the richness of the data provides a base for future research, such as exploring the value and viability of rural ‘virtual’ communities, experiences of rural queer youth, the roles of passing 95 w o m e n , a n d the meaning and purpose of the buteh-femme aesthetic in rural lesbian relationships. Transcribing Interviews The next formal step to the data analysis was transcribing the interviews, which required a particular format for the verbal records to be displayed as text. I chose this format based on former experience with it from a previous research project. This format presents the text as both a document and a worksheet by situating the interview text along the left hand side of the paper with a wide margin on the right side for notes and comments on lines and passages. The lines of text are numbered (in this case by increments of five) for ease of reference during the analysis. Analvtical Table Once interviews were transcribed in this format, an analytical table was required upon which to conduct the analysis (see Appendix 4). Again, I developed this table from previous experience with data analysis, my practical needs as a researcher, the specific requirements of the data for this project, as well as ensuring that this table could facilitate Colaizzi’s (1978) recommendations for data analysis. Analvsis An important point regarding the transcription and analysis of interviews is that first-round interviews were transcribed, reviewed, and mailed back to the participants for verification before I undertook second-round interviews. I mailed back participants’ transcribed interviews, along with my comments about central themes and issues that 38 Passing w om en are known in lesbian culture as w om en who strategically and deliberately pass as men. 96 needed more elarification, in addition to new issues I suggested we explore in the second interview. At this time, participants had the opportunity to add or omit information from their first transcript, and to comment on my suggestions and insights, and to raise issues for the seeond interview. The purposes of returning the transcripts to participants were to situate the second interview, to receive participants’ validation of my interpretation of their experiences, and to keep in contact with participants via the project. My comments and insights on participants’ first-round interviews do not constitute a formal analysis. I was not comfortable doing an in-depth analysis of these interviews until I had conducted and transcribed the second interviews. I felt I needed to be familiar with all of the information from both first and second interviews before beginning an in-depth analysis of them. Furthermore, conducting first-round interviews had required substantial travel time and the coordination of work schedules; once I began an in-depth analysis, I did not want to interrupt the process with the ordeal of organizing and accomplishing secondround interviews. Therefore, I performed a formal analysis (as outlined below) on all eight transcripts once second interviews were completed and transcribed. Data analysis is based on the method developed by Colaizzi (1978). One of the reasons I chose this method was because I had two examples from other health studies that had based their analysis on Colaizzi’s phenomenological approach to data in a way I found accessible (Beck, 1992; Leipert, 1996). These two studies provided me with models to refer to for both my data interpretation and my application of Colaizzi’s method (which proved invaluable to this novice researcher!). Beck (1992) summarizes Colaizzi’s analytical steps as follows; 97 1. All the subjects’ oral or written descriptions are read in order to obtain a feel for them. 2. From each transcript significant statements and phrases that directly pertain [to the research topic] are extracted. 3. Meanings are formulated from these significant statements and phrases. 4. The formulated meanings are organized into clusters of themes. 5. The results of the data analysis so far are integrated into an exhaustive description [of the phenomenon]. 6. To achieve final validation, the researcher returns to the participants with the exhaustive description. Any new or relevant data obtained from the participants are incorporated into the fundamental structure of the experience, (p. 167) Once all sixteen interviews were transcribed, I read through them twice as an entire collection. The first reading was for coherency and to re-familiarize myself with the participants’ contexts and personal issues. During the second reading, I underlined passages explicitly related to my topic (such as definitions of health and wellness), although this reading was not intended as an exhaustive review. I chose to conduct these two readings as a way to mentally enter participants’ worlds and experiences, and to familiarize myself with the data in this form (text), which was a very different experience from listening to the data on tape. After these two readings, I decided to do an in-depth focus on only eight of the transcripts (involving the first and second interview transcripts from the four key participants) based on the quality of the participants’ contributions to my topic. After familiarizing myself with the data from the first two readings, I began an indepth analysis of individual transcripts. The first step of the in-depth analysis was to read through a transcript and identify and highlight significant statements and phrases about health and well-being. However, statements that were not explicitly related to health and wellness, but which carried a great deal of emphasis, were also highlighted. I identified 98 these passages because my topic takes into consideration participants’ contexts, and how their contexts relate to and situate their meanings and experiences of health and well­ being. After meaningful and significant statements were indicated, I returned to the beginning of each transcript and reviewed highlighted passages to determine their formulated meanings (which were recorded in the wide right-hand margin). Next, I formally recorded this information onto the analytical table, which made the analysis more efficient because it was more visually accessible. Reading from left to right across the table, data were presented in six columns as follows: column one: quote; column two: source, participant’s identity, transcript number, and page number; column three: theme; column four: sub-theme(s); column five: formulated meaning; and column six: relevance to health and wellness. Each of the eight key transcripts was analysed in this manner. The analysis resulted in the identification of thirty-three themes (a figure later reduced to thirty-one themes as two themes were collapsed into other categories). These thirty-one themes were colour-coded and also recorded onto the analytical table, along with sub­ themes. Some data were cross-relative in that their meanings were relevant to more than one theme. From here, I edited the table so that all of the data concerning one theme was available on one (or more) sheets of paper. This entailed building separate computer files for each theme and cutting/pasting rows of data into each file. After this, each row of information on a sheet of paper was cut and pasted onto an index card. Each index card, therefore, bore the information as follows: quotation, source of quotation, sub-themes, formulated meaning, and relation to health. The theme of the formulated meaning was 99 written at the top of the card but it was not considered as a restrictive factor to the potential groupings of the data. The use of index cards to further analyze the data in this way proved invaluable. Transferring the data from the analytical table to index cards enabled me to more easily group and experiment with the data, in order to view it from different perspectives. Through this process, I grouped data into clusters of similar themes and sub-themes, as well as other factors. Data coded as well-being was further grouped according to which aspect of well-being it represented (for example, value of space, need for control). The use of index cards also allowed me to determine emphasis. For example, individual emphasis was determined by number of contributions overall, and number of contributions to each issue, as each contribution was isolated as a unit of data upon its own index card. With this system, I gained insight into which areas participants were most concerned about, the nature of their concern, and how participants’ concerns were similar and different. Further analysis on the concept of health and well-being revealed three central themes (including accompanying sub-themes): Control of Space (sub-theme autonomy); Integration (sub-themes being inside/being outside, self-knowledge and self-work); and Means. These themes are discussed in ensuing chapters. At the end of this process, 1 wrote a composite definition of the meaning of health and well-being based on the data analysis and then compared it to the individual definitions to make sure all aspects were Qualitative analyses can also be performed through computer programs (e.g., Nudist). I was cautious about using any such program as I wanted to have as much contact with the data as possible. Entering my data into a computer program seem ed like an unnecessary process that would remove m e from the data. 1 found the use o f index cards suitable and efficient for m y purposes (my study is not large and the quantity o f data was manageable without the help o f a program). 100 represented and integrated. The composite definition is as follows: Health and well-being is fundamentally an holistic phenomenon characterized by a pervading sense o f selfreliance, self-determination, resiliency, purposefulness, integrity and inner peace as experienced through and grounded within the day-to-day lived experience o f a rural lifestyle and natural environment. However, because I wanted to learn the significance of context to meanings of health and well-being, I included data in the analysis that was not explicitly related to health and well-being. Consequently, the analysis also produced two themes that reflected this data. These themes are: (1) the nature of rural communities, and (2) the role of rural lesbian communities. I did not perform a further analysis on these themes in order to determine their underlying structure; however, I used this data to situate the main finding, and these relationships are discussed in chapters six and seven. Participants’ Code Names At the end of this laborious process, I decided that none of the participants’ should be recognizable in the research because some of the data contained criticisms about townspeople and other lesbians. I developed a new coding process to ensure participants’ anonymity: rural communities would not be named in the study, and participants would go by names of plants common to EC ’s interior. Using random names as pseudonyms in place of participants’ names carries the risk of identifying a lesbian in a rural community who had had nothing to do with my project. The new code names I developed to represent key participants are Silverweed, Bluegrass, Fireweed and Hemlock. 101 Confidence in the Data Criteria for examining credibility of qualitative and feminist research are different from those used for quantitative studies (Osborne, 1990). Validation of descriptive methodologies does not rely upon the success with which the study can be reproduced. Generalizability, which depends on the idea of one true reality against which phenomena can be measured, is not a goal of qualitative research: “Phenomenological research is not intended to test an hypothesis. The aim is to understand a phenomenon by allowing the data to speak for themselves” (Osborne, 1990, p. 81). Similarly, rigor in feminist research, which emphasizes the unique contextualized nature of women’s experiences, cannot be measured by a process which values standardization and repeatability: “Human experiences are unique, particularized, and not always amenable to verification” (Hall & Stevens, 1991, p. 19). The value of feminist and phenomenological research, however, can be determined through procedures advocated from within the feminist and phenomenological research communities. For example, the call for reflexivity in feminist research resonates with the phenomenological task of bracketing. Reflexivity is described as the researcher’s critical self-awareness of her own values, beliefs, assumptions and motivations, and how these attributes bear on the research process (Hall & Stevens, 1991). Similarly, bracketing in phenomenological research refers to suspending the researcher’s biases towards the phenomenon: “The phenomenological researcher attempts to articulate predispositions and biases through a process of rigorous self-reflection” (Osborne, 1990, p. 81). The significance of credibility in feminist 102 research also eoincides with the phenomenological goal of having participants’ support of the researcher’s interpretations of their experiences. Credibility is assessed by member validation—whether or not participants can identify with the researcher’s interpretation o f their experiences (Hall & Stevens, 1991, p. 22). In phenomenological research, the steps of data collection and interpretation are usually referred back to participants for verification and accuracy, giving them the opportunity to affect the research process. Dialogue between the co-researchers and researcher is a good way of cheeking the congruence of the researcher’s interpretations with participants’ accounts of their experience. Both a feminist research approach and phenomenology also advocate the careful description of every step o f the research approach and analysis. The feminist concept of ‘dependability’ provides a rationale for the research procedure, enabling outsiders to retrace the steps of the researcher to better understand the researcher’s interpretation and representation of the data (Hall & Stevens, 1991). Also called ‘audit trails’ in qualitative research, this process allows for retrospective verification, as well as makes the study more valuable to outsiders (Osborne, 1990, p. 87). Reflexivity, bracketing, careful description of the data analysis, and member validation are all steps that are crucial to the value of feminist and phenomenological research. 1 undertook these steps in the course of my research to ensure the rigor of this study. 1 consider member validation and audit trails to be the most important test of the validity of my analysis of participants’ lived meanings of health and well-being. Gaining 103 the support of participants for this work was critical to my sense of it being worthwhile and valuable to both the rural lesbian community and the academic community. Furthermore, providing careful detail about my decisions affecting participant selection, data gathering and analysis was also significant to my sense of the validity of this project; this process created an audit trail whereby my steps could be retraced and my findings situated. This process also increased my awareness of the ways I affected the research, thus deepening my connection to the research. The following section details the ways in which participants were involved in the analytical process, and what opportunities they had to verify or contradict my interpretations. It is also an example of the careful detail I undertook to make the research process transparent. Interviews First Round The first round of interviews occurred over the Summer and Fall of 1998. It was a challenge to organize interviews around my own work schedule and participants’ work schedules because meeting the participants entailed blocks of two or three days for a road trip. I tried to coordinate the interviews to avoid unnecessary travel. Some of the participants were only in town certain days of the week; it was unthinkable that they would travel the long distances to town for the sole purpose of my interview. Often this meant interviewing two or three women in one day. The nature of the interviews, combined with travel, made this step of the research process exhausting. I found there was really no way for a novice researcher to prepare for conducting in-depth interviews 104 other than doing them and learning from the inevitable mistakes. Without question, my interviewing technique improved with each session. Interviews lasted between forty-five minutes to 1 16 hours. They usually occurred at participants’ work places or in their homes. One interview took place in a forest setting at the request of the participant. Another interview took place in a local café, which 1 thought was significant because it reflected a degree of comfort around discussing lesbian issues in public. However, the public setting also limited the explicitness with which we could discuss the topic. I conducted one interview with two participants present; that is, each participant took turns responding to my general questions. 1 found this unsatisfactory, especially because one participant was more talkative than the other. Some of my questions elicited rich data that took several minutes to express; 1 noticed unrest in the other participant and my own anxiety that 1 was losing her. 1 also found that some of the responses were personal and even in the context of friendship 1 sensed a degree of uncomfortableness in expressing personal thoughts. I made notes about this interview and decided to conduct separate second interviews with these two participants, even though it would mean an extended visit. I transcribed all tapes as soon as possible after the interview, and transcripts and the informal preliminary analyses were then mailed back to the participants who could qualify, omit or add to them. Seeond round The second round of interviews took place over December 1998 and January 1999. Transcripts from the first round of interviews were mailed to participants, along with my comments, a summary analysis, and topics I wished to return to in the second 105 interviews. This step allowed participants to revisit their words, consider my analyses, perhaps clarify their meanings, and inspire more thoughts in preparation for the second interview. Like the first round, second interviews lasted from 45 minutes to 1 Vi hours. The amount of time between the two interviews was significant: organizing participants’ schedules remained difficult, and financing a second road trip was an impediment. I remained determined to interview participants face-to-face but I tried to avoid winter travel as much as possible. Fortunately, several of my participants were planning on travelling to Prince George, and I was able to interview five of the remaining seven participants in Prince George. With participants’ consent, interviews took place in my home. I made a road trip to complete the remaining two interviews at the worksites of the last two participants. Completed interviews were transcribed and returned to the participants for final clarification, qualifying and validation. 1 found the space of time between first and second interviews insignificant in terms of participants’ willingness and interest to participate. However, in the space of time between interviews, some participants’ lives had changed. These changes were relevant to what they felt health and wellness means and how these meanings relate to context. For example, two of the participants were offered jobs in Prince George. For one participant, anticipating her move to a larger, more central community allowed her to think about her experiences and meanings of health in a new way, and these changes were related to her anticipation of being in a larger lesbian community with an active social network. I think her anticipation allowed her to be more critical of her experiences in a small community because she no longer had to defend them. 106 Member validation was elieited cnee I had eompleted a formal, in-depth analysis of participants’ transcripts from both sets of interviews. The Findings chapter, including the composite summary of what health means, was mailed to participants, who were invited to edit, clarify, omit or challenge any of my interpretations and conclusions. Unfortunately, one of the key participants was unreachable, and therefore could not support or deny my findings. The remaining three participants expressed their support of this research verbally, by mail, and in the implicit act of not submitting any changes."*® ^ I gave participants the option o f contacting me by email, mail, and phone if they had comments on my conclusions. I stated in this letter that no response would also be interpreted as validation. 107 Chapter Five Findings Chapter Five ineludes seven sections as follows: (1) introduction to findings; (2) rural lesbians’ meanings of health inside holistic frameworks; (3) theme one: control of space; (4) theme two: integration; (5) theme three: means; (6) validation by town community; and (7) significance of rural lesbian communities. Introduction to Findings Participants Participants contributed unevenly in both discussions and their emphases, although this chapter presents them as a somewhat unified group. In other words, not all participants strongly identified all of the categories that were revealed. I performed an indepth analysis of experiences that were strongly identified by all key participants, and also considered the discrepancies between participants’ experiences in order to gain a richer understanding of their unique positions. I attempted to relate these discrepancies to factors behind these differences such as role(s) in the town community, lifestyles, age, and length of time living in the community, although this should not be considered a definitive analysis. During the process o f data analysis, I devoted a lot of thought to listening beneath participants’ voices in order to understand the deeper meaning of what was shared. This was by far the most challenging and interpretive act in the analytical process. Understanding and valuing participants’ different contributions was difficult and time­ 108 consuming, but it was also the most rewarding aspect of the data analysis. In the end, I felt my attention to partieipants’ different relationships to shared experienees had resulted in a deeper understanding of the phenomena in question. The ways that participants differ in their responses and reflections are key to clarifying both a broader context within which all experiences can be evaluated, and the eomplex positions and roles queer folk occupy in rural communities. For example, the participant who reflected the least about a rural lifestyle as a core resouree for well-being is also the participant most accepted and integrated into her town community. Understanding this brought me closer to understanding why other partieipants greatly value their rural lifestyles: rural lifestyles in many ways provide the core to self-esteem and self-confidence so necessary to surviving as an outsider in a rural community. The participant most accepted and integrated into her town community also weakened the stability I had begun to associate with certain identities (and had initially “brought to the table”) such as queer = outsider, and rural = homophobic. In keeping with this, the findings presented here are very much the sum of the similarities and differences between four key participants of varying age and experience in rural communities. Research on queers in rural communities is so lacking that documentation of their experienees needs to happen before real challenges to the status quo in these environments (which require support structures and unity) can take place. But, in stereotypically hostile environments it is easy to forget or dismiss the ways in which minorities do fit into dominant structures (and choose to do so), often as part of a strategy to meet their own needs. Smith and Mancoske (1997), for example, note the lack of 109 research on the positive experiences of rural gays and lesbians, such as successful integration into rural communities. Some participants articulated a much greater sense of integration and acceptance of the terms upon which their community involvement was based. In conversations with participants about rural well-being in the current study, often the focus turned to ways in which participants fit into their communities, what personal compromises they made in order to do so, and how queer folk’s expectations of straight rural communities are scaled back from what they might have been in larger centres. For example, tolerance of sexual diversity (as long as sexual behaviour was modest or kept in the privacy of one’s home) was considered acceptable in place of full acceptance and concrete change of attitudes. Positiveness In the overall organisation of the findings chapter, priority is given to the presentation of participants’ health meanings without going into great detail about the complex circumstanees of being a rural lesbian. Because of this, the data presented are generally more affirming of rural communities than stereotypes and other research on rural gays and lesbians might suggest. However, to a large extent, the research topic also determined the positive quality of the findings. There is, nevertheless, value in contributing research on rural lesbians that is in some ways an alternative to existing research, which often focuses on the hardships and damning attitudes that rural queers may experience in their communities. In the current study, negative meanings/experiences are included only as a strategy to better understand the positive meanings/wellness that do exist. Abstracting on well-being 110 is often tiresome and tedious; it is not an easy task to represent deep inner feelings, nuance and complex relationships in language and metaphor that is both original and personal. Exploring negative factors helped to strip away cliché and redundancy in descriptions of well-being. Finally, it is often easier to identify experiences that undermine well-being than it is to accurately describe what well-being means. My sense is that participants offered criticisms of their contexts when they did because they felt comfortable (enough) to do so: criticizing their environments as one queer to another was perhaps an act of trust and solidarity. O f greater significance than these criticisms, though, is the sense of participants’ inner confidence, their resiliency and strength, and their joy in surviving as lesbians in (often) alienating contexts. My intention is not to criticize rural communities from the perspective of an outsider. Rather, every attempt was made to listen to the positive qualities and understand how they intersect with negative ones. I feel this characteristic of the interviewing process facilitated a more open discussion because it seemed that once participants expressed how rural living fuelled their core wellness, they could move on to criticisms of it without feeling they were betraying their communities. Rural Lesbians’ Meanings of Health and Well-being inside Holistic Frameworks Take advantage o f the outdoors, like spend as much time as p o ssib le outside, notice yo u r p la n t surroundings and you r animal surroundings and notice the w ater and look a t the stones and listen to the creek go by and watch yo u r trees grow, watch yo u r flo w ers change. (Hemlock) The participants in this study defined personal meanings of health and wellness as essentially holistic. What distinguishes participants’ health meanings from other health- Ill meaning research is that they are firmly situated within a holistic paradigm: “I think health or wellness includes every aspect of your life, like your spiritual, your emotional, physical. It certainly includes your ability to be who you are in the world, whether that be your sexuality or anything else” (Silverweed); “Health for me means a whole lot of things whether it’s physical or emotional or an ability to create a sense of well-being” (Fireweed); “For me it means all four well-beings ... emotional, spiritual, mental, physical ... it’s a whole picture” (Bluegrass). In other words, participants do not identify holistic meanings of health and wellness in addition to other meanings (like other health meaning studies reviewed earlier); rather, partieipants articulate a general holistic approach to health through which specific qualities or elements of health meanings are expressed (qualities and elements which do resemble the findings in other studies). Well-being is the product of many different and essential core strands that are related, supported, and integrated. Well-being as a holistic experience is also very much an actual process: living a lifestyle that supports access to core dimensions (mental, spiritual, emotional, and physical); the communication and relating of these dimensions with each other; and a sense of safety and integrity in the expression of these dimensions: What I’ve noticed about living out here is, I knew in theory that living closer to the land and having more privacy and being more in my body and doing more work that required my body, I knew in theory that all of that was important, but it was a part of me that was, that was the part that was being left out ... 1 think that the part of my spirituality that I get to realize in nature I don’t think I was enjoying as much of that before as I have been since I came out here. (Hemlock) 112 Importantly, participants identify living rurally as an experience (in and of itself) that leads to an awareness and appreciation of an holistic orientation towards wellness. At the core of everyday wellness, then, is a sense of integration and relation resulting from rural lifestyles; Yeah, it’s all right here for me. And that everything that 1 do has some eomponent of all of it in it. Even just going for a walk here 1 can just feel the Goddess emanating from everywhere! It feels great! And getting physical ... yeah it feels very integrated here. (Silverweed) Partieipants who had formerly lived in the city (or moved to larger centres after the first interview) deseribed pursuing and experiencing wellness in the country as a significantly different experience than it was in urban settings. “When I have lived in urban centres in the past, my life exists at the very outside barrier of who I am ... 1 don’t live right in m yself’ (Silverweed); “The privacy’s really important for me. And that’s forced me to get way more in touch with myself that 1 have to in the city’’ (Hemlock). In this sense, the experience of living rurally is deeply connected to the value and meaning of participants’ holistic orientation to health and wellness. Both the lifestyle and environment of living rurally are deeply valued core experiences because they facilitate a personal awareness and appreciation of a holistic orientation to health and well-being. I identified three significant shared themes within participants’ holistic paradigms. They are, in order of emphasis: Control of Space, Integration, and Means. 113 Theme One: Control of Space (a. autonomy, b. privacy) P articularly in this community I ’ve experienced a "just not in their f a c e ” attitude. And out here I ’m ju s t not in their face. (Silverweed) Control o f space largely refers to the autonomy (and the positive emotional/psychological influenees of autonomy) partieipants feel in their home spaces precisely because they are separate from work, public and social settings. Being ‘out’ is important to all participants, and home spaces are the only cited spaces in their communities where they could be themselves with ease: 1 think that in a rural space ... almost every place is heterosexually informed as well, there are very few spaees where it’s OK to be completely out and to be completely who I am. Very very few. Even at very very few dyke houses because most of us, all of us to a degree, are still incredibly homophobic and heterosexist and misogynist and just generally terrified people, and so even in those plaees there’s always this undercurrent of apology, you know, or of rationalization, of justification, whereas in my own space I don’t, just beeause I don’t have to see it 1 don’t have to think about it, there is nothing, there was nothing in my space in ***** when 1 was at home that said there was anything about my dykeness, or any aspect about my dykeness that wasn’t totally OK. 1 was absolutely unselfconscious about it, I could be totally with i t ... 1 never sat around thinking some part of me [was] going to be met with disdain, or some part of me wouldn’t be recognized. It was the safest place to be all of who 1 was as a dyke too. (Hemlock) I can really understand other women saying, “People can’t tell me what to do.” People can’t peek over my fence and say whatever. Yeah well gosh, I guess if 1 just try to think of living in town, 1 mean my neighbours would know that my partner’s ear was parked there all the time.... It’s just privacy. And it affects all kinds of my life and sexuality, it’s a big part of that. (Silverweed) 114 All key participants distinguish between living out o f town and living within town. That is, even in rural communities there is a significant difference in terms o f lifestyle between those who live right in the town community and those who live out of town, generally on acreage. Living outside o f the town community is important to these participants’ well-being because the daily stresses and limitations on their lives due to their sexual identity are mediated by the time participants spend on their own land, away from the pressures and expectations of, and exposure within, the town community. In this sense, living out of town and the accompanying rural lifestyle are very much a health/wellness resource for key participants. Significantly, non-key participants living in town did not have a comparable resource to draw on for their well-being. Nor did they emphasize the role of land-based living and self-reliance as did key participants.'^' Autonomv The value o f living out o f town lies in both the practical and mental/spiritual aspects o f autonomy. Participants value immensely being able to do exactly what they like as independent lesbian woman on their own land without interference from neighbours/passers-by. This independence, along with other factors, is also part of a rural identity with which the research participants identify. This phenomenon leads me to suspect that there are two distinct social groups o f rural lesbians with very different experiences: those living within rural town communities and those living outside o f town. 115 1 can do anything that I want here that feels what I need to do. Whereas in town, around people, I feel the pressures to be what is expected of me. (Silverweed). I like the natural sounds, 1 like just being out there and being able to do what I want. (Bluegrass) Participants also express a deep satisfaction/contentment towards living a lifestyle that reflects a rural identity. Rural people have different needs. They need more space ... I think crowds in the cities, rushes and all that stuff bother them and they like to be out in the country where there’s a place to grow animals and food and not be in somebody’s fishbowl all the time. There’s some place where you can be where nobody ean see in and you can just be yourself. And I think that’s a rural thing. And I think also lots of rural lesbians like some kind of physical aspect to their life where they work hard, or challenge themselves that way, but in the city you’re too confined, you ean’t do that.... I think the rural lesbians would be more physical, probably try to grow more of their own food. (Fireweed) Privacv The sense o f privacy in particular is key to the value lesbians place on their autonomy: “And I like to go sit in my yard and hold hands if I want to. And I don’t think you can do that in a city necessarily” (Fireweed). Personal space includes both external spaces such as homes, gardens, livestock areas, workshops, and surrounding acreage; and interior spaces such as participants’ mental, emotional, and spiritual lives (being in control of how you feel). The significant finding is the relationship between exterior and interior spaces: participants’ control over external environments results in 116 greater well-being within interior spaces. Control over interior spaces means feeling grounded and in control of one’s mood. Control of exterior space, in this sense, means being able to ensure a quality environment that both creates and enables participants’ well-being. Control is demonstrated by initially claiming and creating personal space that is untouched by the pressures and stresses participants experience in public and work spaces. Some participants think that their way of being inside these spaces is more true to themselves: This place is so much, living out of town is so much the total of what I am.... My spiritual health is very accessible here.... That your creation of space, your space to be yourself, that buffer zone of, creation of space where I am alone in that, where I’m whatever I need to be in that space. Fills me up to my outer, fills me up totally right down to the tips of my toes with my self. So 1 can bring that whole self to community, and both of those things feed into my wellness. That if I can be my full whole self then I can experience community ... whatever kind of community, I can experience interaction with other people and value it so much more and that is wellness. (Silverweed) One participant describes the difference she felt in her overall well-being after she moved from a rural community to a city: 1 don’t feel as sure of myself, I don’t feel like I know myself as well. I’m not as connected as I got used to being when 1 was living in the country ... I feel like my spirituality has been definitely minimized. (Hemlock) Control over personal spaces leads to a confidence and assurance in these spaces that distinguish them from the spaces participants try to claim (make safe) at work 117 and public settings. Claiming space in these latter settings is diffieult, on-going and generally forfeited due to the energy it takes to maintain them as safe spaces: So that sort of openness that happened [at work], because I’m not standing there with my arms pushing the side of it open, holding it saying, “Hey!” It sort of sealed over. And then I walk into that thing thinking, “It’s got to be here! Where did that go? It was just here, I just felt OK here and now suddenly 1 don’t.” So it doesn’t feel fluid to me, it feels very truneated. (Silverweed) Feeling at ease as a lesbian is a quality of personal spaee that participants identify as eritical to the meaning of and value of well-being. In other words, participants experience a great deal of assurance and eonfidence in their living spaces and these spaces come to act as retreats and/or enclaves from other public parts of their lives where they cannot live outwardly as lesbians with consistency and comfortableness. Theme Two: Integration (a. being inside/being outside, b. self-knowledge/self-work) One common element in partieipants’ descriptions of well-being is the sense of integration in their everyday lifestyles. This sense of integration is tremendously valued and lies at the core of rural lesbians’ well-being. More clearly, a sense of integration means feeling grounded and eonnected inside oneself, as well as having the ability to bring this heightened self-awareness and self-confidence into one’s everyday social and work interactions. Participants described integration by contrasting the different experienees of well­ being in rural and urban settings. Participants were asked if and how their experience of 118 wellness changed when they moved to a rural community. All of the key participants have lived in other, larger communities (including large cities) and noted important differences in their health paradigms that came with living in the country. Sometimes the differences were profound: My sense of wellness just seems much more integrated into who I am, like in through all of myself. Whereas in other places, because I feel like in an urban place I’m going very quickly, and everything is very stimulating, and this includes in terms of the gay culture that I have access to there, is all very stimulating and interesting, and when I come here I seek my validity for all of myself through m yself... yeah the framework definitely changes because I guess in the city I feel like I’m just taking stuff in and if I’m giving out it’s just gone. It’s not coming back to me, it doesn’t follow the natural sort of cyelical flow of “I’m learning something and teaching something and learning and giving and taking.” And here it feels like it does.... So yeah that definitely changes the framework, that would have to I think compartmentalize what I do for my wellness in a rural area in an urban centre because it would be like, “OK I need to get out of the city ... and I ’m going to get fresh air and think ... and then I need to get some physical activity.” So I have to go to do that whereas I feel like all of that is very very accessible to me here. Like my spiritual health is very accessible to me here. (Silverweed) When asked if she noticed a change in her overall wellness since she moved back to an urban centre, one participant said: Yeah. It’s not easy to talk about, because I think in some ways it’s improved and some ways it’s definitely gotten worse. The parts that are worse is that I don’t feel as confident as I normally felt this summer just on a day to day basis. I don’t feel, I guess this is something, I don’t feel as sure of myself, I don’t feel like I know myself as well. I’m not as connected as I got used to being when I was living in the country, especially in the summer.... I feel like my spirituality has been definitely minimized.... And then when I was at home [in the country] I would spend three or four or five hours on one task because there wasn’t anything to distract me like going up town, or going to a video store or going out for coffee or I didn’t really talk on the phone very much to 119 people.... 1 feel lonelier since I moved in to town. 1 have much more of a social life, I’m much more social, I’m around people a lot more than I was when I was out there, and there was a kind of loneliness I felt, but this loneliness seems to be more wanting to connect deeply with a lot more people because I’m not connecting as deeply with myself, and when I’m really connecting deeply with myself it’s less important, it still matters but it’s less important. Whether or not 1 have really deep connections with other people, but when I’m living in the city I just feel like I’m starving for it. Because I’m not getting that from me, and I’m not getting that from my connections to nature, and the only thing I have to get it from is people but it’s a bunch of busy people who are also living in a city who are more fragmented than usual. (Hemlock) Some participants emphasize the feeling of flow and connection—that is, moving easily inside oneself and feeling that all sides of oneself are accessible and related—that results from their rural lifestyles. Participants believe that their experiences of self­ connection and self-awareness within their rural lifestyle and environment not only enrich their personal lives but also fortify them in their dealings within public and work spheres (where restricting one’s behaviour and dress are strategies to circumvent homophobia). The outcome for participants’ core well-being as a sense of integration is increased confidence and mental/emotional strength. Participants carry these qualities with them in their public lives and this inevitably makes them more resilient to the challenges in their environments related to their being gay. Participants explicitly and implicitly describe two important qualities of the sense of integration that are particular to living rurally: being inside/being outside, and selfknowledge/ self-work. 120 Being Inside/ Being Outside Participants experience the sense of integration most strongly when they feel connected on the ‘inside’. ‘Being on the inside’ is characterized by an inner wellness that takes place as a result of feeling fully involved in day-to-day tasks, paid work, and other responsibilities. ‘Being on the inside’ was most closely related to living away from urban settings: “[In town] I’m on the outside and very much on my periphery in experiencing things, whereas here [in the country] I feel like I can sort of flow back and forth in myself, I don’t have to be on the outside” (Silverweed). Participants do not consciously pursue inner well-being; it is something that happens to them as a result of the way they live their lives. At the core of wellness stemming from ‘being on the inside’ is a valuing of the process o f being/becoming well, rather than focusing on whether or not specific health needs/components are being met. From this point of view, it is possible for participants to describe a deep feeling of well-being while enduring constant stresses in social and work settings associated with their sexual identity."*^ Well-being stemming from ‘being on the inside’ results in deep contentment, increased confidence and feeling centred/grounded. This is an experience that one participant described as spiritual: I don’t have such a good sense that I spend a good day here [in town] whereas at the end of the day there [in the country] I knew I ’d spent a good day, and even that was kind of spiritually rewarding in that all of me was involved in the things that I was doing there, and here it’s mostly just my head that’s involved in the things that I’m doing. (Hemlock) 42 This is not to undervalue or underestimate the stress o f living with homophobia, but rather a testament to the experience o f w ellness stemming from rural lifestyle. 121 On the other hand, health and wellness stemming from ‘being on the outside’ was a divided experience characterized by a conscious, practical sense of what one needs to do to maintain health. This experience was always related to living in larger communities and cities: I kind of have to entertain myself out here [in the country], I have to be more self-stimulated. In the city, it’s like I don’t even get a chance to entertain myself, as soon as I go outside of my home I’m immediately bombarded by all this stimuli, and I don’t even get a chance to be alone with myself or self-reflect very much. I’m just constantly interacting. (Hemlock) My sense of wellness would shift more from my deep inner self, to caring for that part of myself, to keeping that on a sort of maintenance program, whereas when I’m here [in the country] I feel like I’m about to sort of really do inner work and play with what’s going on inside of me. I think that would really shift to an exterior. (Silverweed) I found like I would start something and spend a long time on it, and that was much more relaxing and more fulfilling. Here [in the city] I feel like my life is really choppy, like I’m always sort of running here, getting something happening, spending a few minutes, never getting to something when I think I ’m going to get to it ... so I don’t feel as productive, and I don’t feel as calm about my productivity about what I’m doing. (Hemlock) Health and wellness from this point of view had been experienced (or imagined) as separate components that require separate attention, much like a list of needs that must be met: a funetional relationship that was spiritually lacking. Self-knowledge and Self-work The experiences of self-knowledge and self-work share a relationship to living rurally. Self-knowledge and self-work are both facilitated and promoted by time alone (e.g., living alone); time being still (meditation/self-reflection); pursuing spirituality 122 (chanting, drumming, alternative healing); pursuing sustenanee aetivities (gardening, stocking wood, clearing land, harvesting, and raising animals); pursuing hobbies and crafts (woodworking, spinning/weaving); self-education; and, perhaps above all else, access to the physical space to provide the privaey and safety in whieh to pursue these activities/^ These activities are all definitive of participants’ rural lifestyles—activities that all said would occur less or not at all, and would be pursued in a different way, in an urban context. Some participants identify self-knowledge and self-work (self­ development) as faetors essential to aehieving a deep connection/integration of self. One participant described it as follows: Part of it is to do with having your own space so that you ean develop yourself as an individual. When I moved out to this place I had intended to live alone. And ***** moved in after and she is moving out, and I’m really looking forward to living alone beeause it, again it’s a further step into having that aloneness with myself to be able to ... come home and not have any other distractions, but just be alone within myself and have that spaee to discover and explore. I really think that each one of us has such a wonderful garden in ourselves to explore that it’s a shame not to see that, not to spend a lot of time with that. So living rurally gives me the space to do that. (Silverweed) One participant included a commitment to self-work (sometimes referred to as self-improvement by other participants) at the mental/emotional/spiritual level as significant to her meaning of wellness. S elf improvement was described as confronting personal abuse issues (e.g., drug/aleohol abuse, sexual abuse, violence in relationships) to The emphasis on ‘safe’ environments is one distinguishing aspect o f these findings. For example, individuals who feel confident in public and social settings have the option o f pursuing self­ work/knowledge in a variety o f contexts. 123 improve one’s quality of life. For her, this commitment seems more possible and important within a rural eontext/lifestyle than it did in an urban context/lifestyle: In the city I was a political activist, there was not much time for health. I was busy saving the world or something. I didn’t know that many healthy people either, it was not the focus of that many people. Here I think I know a lot o f people who are dealing with their issues, or who are trying to grow, exploring themselves, working with maintaining sobriety or whatever, very different from the people I knew in the city who were meeting junkies and who were like go-go-go all the time, and social things always had to have alcohol at them, and you went to the big dances and things weren’t addressed. Like the battering wasn’t addressed, those things we could all see we didn’t talk about. Out in a rural community, you talk about it. I mean you see it, you talk about it. Nobody pretends they don’t see. So I guess that’s the difference. (Bluegrass) Self-knowledge and self-work are related qualities significant to the experience of well-being as integration. A challenging concept to describe, self-knowledge is the deliberate process of becoming more in touch and cognizant of one’s identity and/or being in the world: “So I think that’s been really really important to my overall well­ being, being basically more self interactive, getting connected” (Hemlock). Self-work stems from greater self-awareness combined with a commitment to confronting personal issues that were preventing an individual from growing. The natural settings of participants’ rural environments, combined with the stability and inner peace resulting from their rural lifestyles, both facilitate and foster self-knowledge and self-work. Theme Three: Means Means includes both the material (physical) and psychological (mental) access to wellness. Partieipants referred to material means as the quality of their environment 124 (unpolluted resources), and access to year-round recreational and provisional activities (skiing, biking, hiking, water-sports, gardening, raising livestock). Physical means also includes access to a natural environment including wildlife: I think we have the freedom to do a whole lot of those things more than people in the cities. It’s easy for us to go from our door step and go and do those things. It’s not so easy if you live in the eity, for any one for that matter. (Fireweed) So it’s spending time just watching the plants grow and watching how they look at different seasons, and watching which plants are where, and watching the animals and watching what they do outside and with each other and getting to know them. I’ve never taken plants seriously before. I’ve never spent hours and hours just sort of sitting by a creek and watching it and appreciating that and collecting rocks.... Those kinds of things I think are really really important. (Hemlock) 1 just love the physical space around me, 1 just really love having the animals around and the trees, the lack of noise, and just for physical health too. I think it’s less healthy to live in ***** or in ***** because of the pollution. (Silverweed) I feel like ... I’m free to grow a lot of what I eat, I can get exercise, just being able to stand out in my yard and watch an eagle go by or a beaver breath in some fresh air that doesn’t have a bunch of exhaust in it. 1 don’t have noise pollution. (Fireweed) I don’t function in cities very well, so living on the land is what keeps me sane. 1 was living quite isolated when we moved to this land which is on the main road. This made a huge change since in the winter the logging trucks go by a lot so I find it very noisy, which probably city folks would think is funny, right? But I like the natural sounds, I like just being out there and being able to do what 1 want. (Bluegrass) Because I have like thirty-three acres like right around me plus thousands of acres behind me that have nobody else on them, and people who are on them are there temporarily, sort of moving through. I’m not crowded in by people. I can walk around naked.... I think when you live out of town, the pressures aren’t constant so you can build up your ability to just be who you are and carry that into, when 1 go into town for work. 1 just love the 125 physical space around me, I just really love having the animals around and the trees, the lack of noise, and just for physical health too. (Silverweed) We live in a pristine setting, right on the lake, access to all the water sports and in the winter time we have access to all the outdoor skiing type things and ice skating, hiking, mountain biking, it happens right from our door.... (Fireweed) One participant described feeling most mentally/spiritually complete when her lifestyle regularly included—and to a certain extent demanded—physical activities (a relationship other participants also alluded to though not as explicitly): Planting a garden, doing really really hard physical labour, like we’re busting our ass out here and we’re not playing very much these days, but I feel really good at the end of the day. I can spend five hours cleaning up my soil and come in and not feel at all mentally exhausted, actually I felt mentally refreshed. I came in after five hours yesterday of just sorting through stones and just sort of thinking and being with myself and I was physically exhausted but mentally I was like really really alert. And I felt really cleansed and really at peace, and that was nice and I had my dogs around me and there was just no shit. (Hemlock). Broadly speaking, ‘psychological means’ refers to the contentment, peacefulness, and spirituality that result from having access to all of the above— to the raw materials and natural resources that provide for a particular lifestyle. This is not to say that the core significance of ‘means’ lies in its division into tangible components, but rather within the integration of these components. One participant in the current study describes living rurally as, “the total of what I am ...,’’ that wellness from living rurally means “your ability to be truthful’’ (Silverweed). In other words, the means to wellness expressed in terms of a rural environment both enables and provides the foundation for mental/emotional well-being. The emphases on context and a particular way of living 126 suited to one’s environment in these participants’ meanings of health are interesting points that have been found elsewhere (Morse, 1987). Validation by Town Community (a. support, b. acceptance) Lack of lesbian peer support—both formal and informal—means that rural lesbians are dependent on and vulnerable to the straight community’s values, attitudes, and acts of inclusion and exclusion more than their urban counterparts. Gestures of acceptance range from small outreaches such as public acknowledgement to more significant gestures such as invitations to weddings and dinner parties."*"^ Explicit, significant acts of support and acceptance from the straight community (such as seeking advice and information from participants, attending gatherings in participants’ homes, and challenging homophobia in the town community) were referenced less but carry substantial meaning for participants. In their rural conservative communities, any act of support was significant to participants feeling accepted as equal members in their communities, even though they did not depend on these behaviours for their overall well­ being. All key participants describe themselves as well and/or healthy despite the challenges of living in small rural communities as gay women. Participants did not explicitly identify acceptance by the town community as a core component to well-being; however, participants who had experienced instances of support were moved and felt ^A cceptance here refers more to acts o f acceptance than an inclusive, stable and integrated experience. Some participants also talked about ‘tolerance’ o f their sexuality as a form o f acceptance that they respected. 127 validated by them. Participants also remark about the positive long term influence such gestures carry; In a sense, we’ve never said those words [lesbian couple] out loud in town but everybody knows ... they’ve had their little buzz a long time ago, and they accept us and they invite us as a couple to things. (Fireweed) It was the day after Christmas and I didn’t really want to go. I couldn’t handle the rest of the local heterosexual community. But the fact that we were invited meant a lot. W e’re not being excluded. And they invited us as a family, all three of us, so again, in their way they are acknowledging that we’re a family.... But, the group of men that goes to the local coffee spot one or two of them has started waving as they go by and that’s significant that they’re willing to sort of accept their discomfort, because they’re uncomfortable, I mean there’s no way around it. But they’re willing to wave and with one I talk about onions and gardening. This is like a little pebble thrown in a pond, it’s just such a little ripple, but 1 think it has a long term huge effect. (Bluegrass) Validation for one participant is not about being accepted as a lesbian but being accepted as an individual: she tremendously valued these acts of acceptance because it proved to her that straight folk are willing to see past a quality about her that made them uncomfortable, in order to see all of who she is: If 1 wear lesbian as a label then that’s what they think of first. And so, it’s healthier for me to be thought of as a whole person. Like when somebody says my name I hope that they think of lots of other things I know. I hope it brings to mind some other neat things, not that I’m a lesbian.... I’m well respected and supported and validated as an individual. In terms of my lesbian lifestyle they just seem to set that aside. I don’t know how much that matters to me to speak that out loud, I need to be a whole person. (Fireweed) 128 Support Participants’ descriptions of lesbian communities in rural towns ranged from under-developed to non-existent. Generally, in the absenee of lesbian community in rural townships, participants develop support (to different degrees) within the straight community. Although participants stated that support from heterosexuals is qualitatively inferior to support from other lesbians, they recognise its value in their particular contexts: Yeah, that’s essentially where it all comes from out here [support from the straight community]. So in that sense they’re very supportive but they aren’t gay people so they don’t know. (Fireweed) Acceptance Participants’ overall well-being inereased when they felt respected and accepted as lesbians. In fact, some participants expressed concern about continuing to live in a rural community if they thought they might not eventually be accepted as lesbian: I don’t think I could survive out here if it was just me, or just me and my partner, no-way. So that is important. I think if I was gonna stay here I would start to find people I could be out to, like you know, not out in a screaming kind of way the way I can in a big city, but at least out to in a kind of quiet way, who would like know about my relationship, who would come to know and I wouldn’t be afraid to let them see what’s on my walls and on my bookshelf, and listen to my music and tell my stories to, so I would need to have some community out here, I wouldn’t always want to feel like a stranger. (Hemlock) To varying degrees, participants’ commitment to rural living depends upon the potential for positive change in rural attitudes. However, more important than this hope for change 129 was participants’ resilience and confidence in their ability to provide their own contentment, and to strategically—and over time— challenge homophobia in their communities. Significance of Rural Lesbian Communities Strictly speaking, the underlying structure of participants’ meanings of health and well-being did not include a sense of community or connection with other lesbians, although it is clear that lesbian community, for most participants, is significant to w e ll- b e in g .S p iritu a l and emotional well-being, when it was explicitly discussed, is most often a state of inner being related to time alone, meditation (including drumming and chanting), self-reflection, a connection to nature and animals, and alternative spiritual circles. In other words, participants describe well-being as an experience they largely provide for themselves. However, most participants stress lesbian community as an experience that would enhance their overall w e ll-b e in g .F o llo w in g are some responses to the question “What do you think lesbians living in this area need most in order to be well?” More lesbians! A bigger pool. Yeah, 1 think that in a big way for sure. Yeah, a bigger community, and whether that’s more people here or simply knowing of more, I mean, there’s probably thirty lesbians around and 1 just don’t know them at all. (Silverweed). More lesbians! (Bluegrass) Perhaps local lesbian community did not figure in lesbians’ health meanings beeause it did not exist in a w ay (for these participants) that could be experienced consistently. ^ It is possible that a different w ay o f exploring this topic may have elicited lesbian community— or a sense o f connection and mutual support with other lesbians— as a meaning o f w ell-being. 1 say this because lesbian community (or lack o f it) is clearly very significant to m ost participants, even though it was not identified as a meaning o f well-being. 130 I know that if I didn’t have a car and I couldn’t go into ***** on a whim, I mean I really can go into ***** on a whim, I don’t have to plan for it, I don’t have children, I always have gas money and I have a vehicle, I know that no matter how isolated I feel, ***** is really just an hour away if I want to go in. And that’s important to me. I wouldn’t be so cocky about living out here if I didn’t have immediate access to other gay people, to other lesbians when I needed it or when I wanted it. (Silverweed) Interestingly, the participant most integrated into her larger (heterosexual) town community did not identify lesbian community as significant to her overall w ell­ being. This participant also has the most lived experience in rural communities. For her, knowing where to find emotional support in the straight community is key to well-being, and something that needs to be strengthened: I think that the emotional support is the biggest thing and I think the lack of it causes stress which I think is the biggest health problem. And I think the support is even there, and sometimes they don’t know it’s there and don’t ask for it and they’re a little afraid of the rest of the community [at large], sometimes justified but sometimes not. (Fireweed) While other lesbians spoke about friendship, support and feelings o f belonging with like-minded folk, this participant shared these experiences with straight folk in her town. In addition, she perceived the limited number of self-identified gays as a factor which impeded community building per se; “There’s probably only four o f us in town so being supportive o f each other is a little lim ited” (Fireweed). For this participant, the friendship, support and feeling of belonging with like-minded folk talked about by other lesbians were experienced with straight folk in her community. Her experience is valuable in part because it suggests that in relation 131 to a sense o f belonging and identity within the larger town community, alliance building between straights and gays in rural communities may be more important than— or as important as—building solely queer communities. Given the barriers to developing and participating in rural lesbian communities, alliance building with the straight community may be more realistic and also an on-going strategy to change negative perceptions of homosexuality. 132 Chapter Six Discussion - Part One Chapter Six is the first part of a two-part discussion based on the findings of this research. There are two sections to this chapter: (1) lesbians living within rural contexts; (2) rural contexts and lesbians’ meanings of health and well-being. Lesbians Living within Rural Contexts The academ ic literature on ga y men and lesbians, while ever expanding, remains essentially incom plete concerning the special circumstances o f homosexuals in rural or nonmetropolitan areas, despite the f a c t that a considerable number o f sexual outsiders are born and raised in rural locations (and, o f course, there are lesbians and g a y men who choose to m ove to the country, or who visit it f o r recreational use). Correspondingly, the available research on rural geography and sociology, community p sych ology and related field s has alm ost totally ignored the existence o f g a y and lesbian rural residents. (Kramer, 1995, p. 200) In order to provide a framework for their unique experienees, research on rural lesbians necessarily includes a description of their special contexts (Anderson et ah, 2001; Bell & Valentine, 1995; Bostock, 1984; Cody & Welch, 1997; D ’Augelli, Collins & Hart, 1987; D’Augelli & Hart, 1987; Kramer, 1995; Moses & Buckner, 1980; Roberts, 1992; Sorrell & Watson, 1997). Rural lesbians’ meanings of health and wellness are framed in significant ways by the rural contexts in which they are experienced. This section discusses the ways in which rural contexts influence the findings from the previous chapter. First, though, it is important to summarize rural contexts from the point of view of gays and lesbians as expressed both in the existing literature, and from participants in this research. 133 Rural Contexts Though every rural town is unique, rural gays’ and lesbians’ existing testimonies of homophobia are consistent across rural communities and therefore permit, in the context of this research, a broad discussion.'*^ Breeze (1985) characterizes rural towns as predominantly conservative, traditional and fundamentalist; Keller & Murray (1982) suggest rural towns are “more likely to be dominated by certain proscribed regional norms, values, and expectations” (p. 16). Kramer (1995) likens rural communities to the idea of a time capsule because he believes lesbians’ and gays’ descriptions of homophobia in rural communities resemble American gay life in the 1950’s. This metaphor is not extreme. Social change is particularly slow-coming and even resisted by small-town residents. Rural dwellers are characteristically “less tolerant of diversity and ... conservers of the status quo” (Roberts, 1992) and demonstrate less motivation to change their values and beliefs (Keller & Murray, 1982). Homophobia shares, in the same way as racism and sexism do, an inverse relationship to the size of place of residence (Roberts, 1992). Another study (Sorrell & Watson, 1997) found that rural lesbians and bisexual women perceive size of community as more of a limiting factor to queer friendly service options than being gay. This is not to suggest lesbians living in rural communities are an undifferentiated group; one significant difference is the experiences o f lesbians living right within the village/town community, and those who live out o f the town/village on acreages or who are otherwise partially to fully isolated. A more thorough understanding o f rural queers’ experiences should also include an analysis o f rural gay men and rural lesbians as separate groups due to the salient differences in their experiences o f rural communities (Bonfito, 1997). A more thorough understanding o f rural queers’ experiences should also include an analysis o f rural gay men and rural lesbians as separate groups due to the salient differences in their experiences o f rural communities (Bonfitto, 1997). 134 Persistent barriers to change in rural communities also include lack of easily obtainable and reliable information on gays and lesbians, lack of easily identifiable and accessible queer communities and information networks, and deliberate alienation of people who are different from the norm (Buckner & Moses, 1980; Roberts, 1982)/^ D’Augelli & Hart (1987) state that “negative attitudes, minimal exposure to gay people, misconceptions about gay lives, and lack of positive cultural symbols and role models’’ make gays seem even more urmatural in rural contexts (pp. 82-83). Homophobic attitudes and behaviours are varied and ubiquitous: they occur on the street, in professional situations, within families, as part of the education system, in restaurants and other businesses, in local media, at places of employment, on notice boards and within different religious societies’ propaganda. Participants in my study cited various situations in which they experienced homophobia; several discussed the general anti-queer tone of their communities. Below are some participants’ descriptions of their experiences of homophobia in their communities: We’re school district **** and we’ve got a huge right wing political group, fundamental religious group that’s similar to what happens in the Fraser Valley, where they don’t want any school teaching your children any morals. So, getting condom machines in the schools or any kind of safe sex education, or any kind of mention of any gay stuff, that wouldn’t happen but the parents would know about it. (Fireweed) There’s a lot of right wing Christians and some of them put up notices on the bulletin board against gays and lesbians.... (Bluegrass) 48 Interestingly, lack o f formal support services does not figure strongly as a contributing factor to lesbians’ and gays’ negative experiences because rural queers tend not to access formal support in the first place (D ’Augelli & Hart 1987; Sorrell & Watson 1997). 135 In terms of the community, I mean I ’ve talked before about the very Christian aspect to the community, that’s definitely a barrier. You couldn’t have things in the newspaper.... (Silverweed) Homophobic acts are diverse, including violence, threats of violence, cruel practical jokes, harassment, shunning, exposure, and ridiculing: There is a lesbian up there and she was harassed, and they make fun, and they’re cruel, and very weird practical jokes, like they gave her a moose tongue and made sexual remarks to her about this tongue. (Bluegrass) The pressures of traditional gender images and role responsibilities are intense in rural communities and further contribute to the discrimination lesbians face (Little, 1986; Cody & Welch, 1997). Individuals who are gender role atypical are more likely to be targeted for harassment or violence based on perceived sexual orientation (Waldo, Hesson-Mclnnis, & D’Augelli, 1998). Gender roles also carry implications for successful political organizing: “The power of women in rural communities is particularly constrained by a very strong conservative ideology which as well as perpetuating the domestic role maintains the status quo and works against any united political action by women” (Little, 1986, p.7). Furthermore, the conservative nature of rural communities often limits the potential positive contributions of groups/businesses such as women’s centres and adult bookstores. Women’s centres in rural communities do not typically prioritize lesbian issues (if they are accommodated at all). Gay literature is often stored on reserve in local libraries and/or adult bookstores, and many individuals will not risk exposure by requesting it (Breeze, 1985; Kramer, 1995). 136 Anti-gay sentiment in rural communities is normalized through structural support and the political might these structures represent. Rural queers cite an almost complete absence of support for being gay from various sources: the local media, the education system, and religious societies. On the contrary, negative media, the banning of literature with homosexual content (including educational literature) by schools, and the circulation of religious propaganda that promotes religious arguments against homosexuality all work to perpetuate homophobia (Anderson et ah, 2001). Kramer (1995) states that “non­ metropolitan media sources function more as social executors than educators by sustaining traditional images of reality rather than validating or explaining new information to the public (p. 209). Rural lesbians and gays themselves express very little confidence in the potential for positive changes in these institutions’ anti-gay philosophies (Sorrell & Watson, 1997). This systemic resistance to change is significant considering that positive change in public attitudes and acceptance of queers in urban settings has been achieved in part through changes in educational policy, positive media representations, and religious tolerance/acceptance. Anderson et ah, (2001) characterize the on-going process of navigating and strategizing survival and quality of life in rural contexts as the “work” of being a lesbian. This “work” is manifold, ambitious, and for the most part underestimated and often invisible to the straight community: This “work” of just being a lesbian includes creating and sustaining alternative families and relationships in the face of a traditional heterosexual “family values” discourse. It entails seeking out other lesbians where there are few, or deciding to avoid other lesbians and face 137 isolation as a result. Unlike cities in southern Canada, in the north there are few on-going lesbian-positive organizations to turn to. (pp. 14-15) Fear of anti-queer attitudes and behaviour significantly affects many lesbians and gays, their relationships, and, importantly, their children. One participant from the current study thought that the poor quality of some lesbian relationships was a result of the stresses experienced by couples within small communities: “What’s really going on is that when you put that much pressure on a segment of society, it destroys relationships’’ (Fireweed). Some participants talked about the limitations they placed on their actions, their visibility, and their political stances out of concern for their children’s and partners’ well-being. Sometimes the exhaustion of having struggled in the past to educate an indifferent public on gay and lesbian issues left participants with little commitment to doing political work in their communities in the present. The demands of living rurally, and the stronger need to build support within the straight community worked against the desire to create local community through time-consuming activism: It’s not a fight that’s worth it. We’ve got our issues, like trees, right, and the water quality. So, I think whoever sets that up will have to have a lot of energy, and most of us don’t have that. (Bluegrass) It doesn’t interest me to bother to educate people very much anymore. I’m kind of tired of that. So I go to get what I need where I can get it. (Fireweed) Getting open lesbian and gay books in the library or in the school system would be mind blowing. Whoever finally challenges that school thing is going to have to want to have their name tarnished, like really be scapegoated, and most of us don’t have the energy. (Bluegrass) 138 Differences in homophobic experienees are significantly influenced by factors such as length of time in community, owning property versus renting property, and whether or not an individual is bom and raised in a community versus moving to that community as an adult (Anderson et ah, 2001). At one end of the scale are queers who experience increased isolation and alienation and, as a result, may leave the community for a larger centre. On the other end are gays and lesbians who perceive themselves as accepted and even socially integrated, as validated as whole individuals (as opposed to being stereotyped as homosexual), as making a significant contribution to their communities, and as having support from the straight community. It is important to note, though, that even the most integrated and accepted lesbian in this study felt restricted in significant ways by the straight community toward which she felt so close; “We couldn’t do a public display of affection, and it’s also very conditional on how we treat other people, and particularly other people’s kids’’ (Fireweed). Rural Contexts and Lesbians’ Meanings of Health and Well-being In this research, rural contexts are discussed in two ways: as the quality of living closer to nature (that is, living a particular lifestyle requiring self-sufficiency and physical hardiness); and as a particular social climate characterized in the existing literature as conservative and fundamentalist and, according to gay and lesbian testimony, homophobic. This section discusses the relationship between participants’ holistic orientation of well-being and living rurally. Rural lifestyles per sc lend themselves positively to a greater awareness and appreciation of a holistic conception and experience of health and well-being. In this 139 sense, rural lifestyles contribute positively to the experience of health and well-being for rural lesbians. No correlation was found between rural social contexts and participants’ holistic orientation of well-being, except that a holistic orientation towards well-being could be a more valuable framework within which to deal with the stresses of a conservative environment. For example, possessing a deep-seated inner connection and spiritual health, and learning how to provide one’s own well-being are particularly valuable resources to bring to contexts that overtly and covertly undermine and alienate homosexual persons. Rural contexts also contribute to the understanding of the theme-experiences of Control of Space, Integration, and Means. Following is a brief discussion on the relationship between rural contexts and these themes. Control of Space I t ’s a result o f this abuse which is not living in a community where you can be yourself, not being able to be yo u rse lf varies and i t ’s abusive. (Silverweed) Participants’ control of space contributes deeply to their overall well-being. They describe personal ease, increased self-confidence and self-esteem, increased spiritual awareness, inner relatedness, and increased appreciation and respect for their bodies as the positive experiences resulting from their autonomous living situations."^^ In these ways, control over personal spaces/territories is a very necessary and key resource for participants’ well-being. I refer to participants’ personal spaces as spaces, environments and territories to convey the ways participants value and relate to their contexts (specifically as a physical space, as a natural environment, and as a precious territory that they have claimed outside o f heterosexual space). 140 i. autonomy For most participants, control over space is also extremely significant in the context of the lack of control they experience in public and work settings. Home spaces/territories stand in sharp contrast to the larger town community where participants feel restricted in their speech, dress and behaviour and guarded around co-workers, in social settings, in professional settings such as health care, as well as among acquaintances. Queers who may not experience (or rarely experience) overt acts of discrimination nevertheless live in a particular homophobic climate that undermines well­ being: Just living with that constant sort of discomfort and just not being able to relax in a situation, coz who knows? Who doesn’t? What do they feel about it? Yeah just not sort of being able to let down and be relaxed there. You don’t know what people’s levels of acceptance are, you don’t know if they do or don’t know....“This person has a strange attitude here, am 1 reading into it too much, is this person uncomfortable with suddenly knowing that ... that my partner is a woman?” Just all of that takes so much of your energy just to, you know, to always he second-guessing yourself. (Silverweed) In fact, the ways in which most participants’ value their autonomy in personal environments seems to be very much related to the ways they experience a lack of control in other spaces. For example, all participants talk about not being ‘out’ in the community, and how a public display of affection would not be tolerated by their communities: “I think I feel free to go anywhere 1 want to go here. Yeah, there’s no place that I wouldn’t go, but 1 also wouldn’t be demonstrative in any of them, except in my own home” (Fireweed). If participants were demonstrative outside of home, it was in select spaces. 141 Interestingly, the two participants who said they would be demonstrative in select public places had also spent the least amount of time in their communities. The two participants who owned property and had been living in their communities for years and years stated that being openly gay could sabotage employment opportunities and alliances/friendships within the straight community. One participant confessed she and her partner often posed as sisters to avoid suspicion about their relationship. In contrast, participants felt comfortable and justified being lesbian in their own homes and on their own land; the privacy that came with living out of town made these spaces untouchable and even sacred. ii. safetv Safety is another quality participants value and that they feel their personal environments provide more than any other p la c e .M o s t participants identified personal territories as environments in which they feel most safe from threats to their emotional/psychological and physical well-being; in contrast, they described lack of safety as a quality they could sense in workplaces, public spaces and in the general town mood: I don’t think it’s a really safe community to be really out in.... [There’s] not enough exposure I think to have real acceptance, and real understanding. You know when you feel it isn’t quite safe? (Silverweed) I think there’s a lot of people here with nothing to do and it could be very threatening. [In response to the idea of having advertised lesbian social gatherings]. (Bluegrass) [T]here’s pockets of pretty terrifying people.... I always have to think about my partner and my kids in the choices that I make, in the statements 50 I refer here to the way rural lesbians feel safe and unsafe specifically as lesbians. 142 I make in the community, because whatever I do is gonna reflect on them .... So that makes you a little more cautious. (Fireweed) Participants value control over personal spaces as protected, safe environments where they feel autonomous, able to safely express their lesbianism, and to pursue personal development through physical and mental/spiritual work. For some, this feeling of safety comes from the protection offered by the distance between themselves and the town, and/or also the amount of land participants live on. One participant perceives the distance between herself and the town as both isolating and insulating; and although she admitted to feeling vulnerable as a woman living alone in the bush, her overall feeling is of being protected by the distance between herself and the town community. The control participants experience in their personal territories effectively counters the day-to-day oppression in most other spaces of being a sexual minority in a conservative, fundamentalist environment.^' In this sense, the negative contribution that rural social climates make to lesbians’ well-being seems significantly—and perhaps directly—related to their need for, and valuing of, control over their personal territories. Participants who experience an on-going lack o f control and lack o f safety in public spaces value controlling—and as much as possible guaranteeing—their safe home spaces. That is, unlike public or work spaces that have to be defended over and over again, participants can leave and Ownership is also one form o f control o f space; because m ost rural lesbians do not own land their control is mainly expressed through occupation. In this sense, control o f space is not about (necessarily) owning real estate but (also) a personal, psychological experience o f having a separate space to o n eself outside o f the larger world. 143 return to their personal territories knowing these spaces remained exactly as they had left them. Having control over this part of their lives in these ways is essential to most participants’ core well-being. However, this need appears to be somewhat lessened when participants experience acceptance and a sense of alliance with the straight community. Integration Rural contexts also contribute positively to participants’ experiences of integration. Both a rural lifestyle and closeness to nature produce and facilitate the sense of deep inner connection that comes from time spent alone, introspection, and commitment to self-work and self-knowledge. The practical aspects of a rural lifestyle that have to do with meeting basic needs such as gathering wood and growing food require or engender self-sufficiency and resiliency, which in turn enhances self-esteem and self-eonfidenee. In other words, the physical demands of living rurally produce inner contentment and peace for participants. The self-conscious experience of meeting isolated health needs in urban contexts is replaced by a natural process of well-being stemming from an integrated lifestyle. Proximity to nature leads to relatedness to one’s environment that contributes to a sense of integration and feeling grounded. Most participants experience the height of their well-being when they are connected/related to self and to natural environments. Rural contexts facilitate this and, as such, are highly valuable to rural lesbians’ well-being. 144 Means To a certain extent, rural contexts require and produce a particular lifestyle, one that entails living closer to the land to meet basic needs. Living closer to the land is not just a practical relationship but also includes an awareness of and participation in nature, such as regard for seasons, growing and harvesting food, raising animals, and relating to the natural world in spiritual ways. Participants living a rural lifestyle also revere it. The physical rural environment is essentially the raw material— or Means— out of which evolves a particular lifestyle and land-based relatedness. In this way, rural contexts contribute positively to rural lesbians’ health and well-being. 145 Chapter Seven Discussion - Part Two Chapter Seven—the second half a two-part discussion—contains four sections; (1) queer communities; (2) rural barriers to lesbian communities; (3) lesbian community and meanings of health and well-being; and (4) conclusion. Rural Lesbian Communities and Meanings of Health and Well-being A nd th e re ’s also a p o w e r i f you ’ve ever gone on a march or been a p a rt o f any kind o f a group p ro te st or organization, th e re ’s a huge, like even a w om en ’s conference, th e re ’s a huge high you g et from the p o w e r o f so many like-m inded p eo p le being together. Those are the things that happen in the cities and w e don 't have them in the rural settings. (Fireweed) Queer Communities Value of Queer Communities Queer communities are typically characterized as sanctuaries and/or reprieves for gays and lesbians seeking their own kind. Within these communities, queer folk can openly pursue friendships, formal and informal support, recreational activities, sex and relationships. For newly out queers, such communities can be of vital importance to the development of a positive self-image and self-acceptance. For example, Kramer (1995) found that the presence of openly gay women and men plays a key role in helping others come to terms with their sexual identity. Partieipation in queer communities and access to positive literature on homosexuality is also particularly important in the formation of a positive sexual identity (Bontitto, 1997; Schuyf, 1992). The experience and popular meaning of queer communities, however, are urban phenomena. On the one hand, unlike 146 rural towns and villages, cities attract and host large gay populations that can support active, diverse communities where gays can associate freely and anonymously. Rural queer communities, on the other hand, are unique phenomena that are strongly desired but generally remain under-developed.^^ (Lack of) Queer Communities in Rural Contexts Rural lesbian and gay communities are fundamentally different from urban queer communities because rural gays and lesbians live in “exceptional circumstances” (D’Augelli, Collins & Hart, 1987, p. 13). Rural lesbians face many of the same stresses as urban lesbians in addition to the stresses of northern rural contexts that all people living rurally endure such as severe weather conditions, fewer support services, and isolation. In addition to the “unique pressures and unique stressors” of rural environments that all rural populations undergo (Keller, & Murray, 1982, p. 3; Richardson, 1988), rural lesbians also “face additional challenges because of both their non-married status and affectional status ... [such as] ... fear of rejection, worry about loss of jobs, and social isolation” (D’Augelli, Collins & Hart, 1987, p .13). Unlike urban lesbians, rural lesbians manage these stresses “without the buffer of an urban lesbian community” (Bostock, 1984, p. 20). Lack of opportunities for developing rural lesbian communities also distinguish rural communities from urban ones; typical urban gay meeting places such as bars. When I refer to rural lesbian and gay communities, I mean the idea o f community and actual communities. The experience o f community shifts back and forth in participants’ interviews as something that exists and something that is lacking. In this sense, actual communities are very much defined by the local gays and lesbians and as such are distinct from a traditional notion o f queer community in urban settings. Actual rural queer communities could refer to a small group o f friends, invisible networks, a psychological sense (D ’A ugelli, Collins & Hart 1987), or a group o f dykes that met together for film s two years ago. 147 churches,theatres, bookstores and eommunity eentres (Weightman, 1981) have no rural equivalent. Furthermore, the opportunities that do exist in rural towns for queer socializing, and in particular for sexual expression, are gendered, making it even more difficult for lesbians to meet others. D ’Augelli and Hart (1987) found that rural lesbians lack the equivalent of the rural adult bookstore (traditionally a gay male resource) and have access to very few rural women’s bars, if any at all (men’s bars being slightly more common). Breeze (1985) specifically decries the lack of organized social activities, gathering plaees, bars and special counselling services because it translates into a lack of means to communicate. Thus, the potential for developing friendships, relationships and helping networks is significantly more limited than in urban centres (D’Augelli, Collins & Hart, 1987). More researeh is needed to document successful rural lesbian communities and how they get that way to provide a better understanding of their uniqueness. Not only do rural communities lack the larger gay and lesbian populations of larger towns and cities necessary to support queer venues, but the expectations of and needs for rural queer communities may also be different from their urban counterparts. Even if women’s bars and the support of community centres were established, there is no reason to assume community would follow. Pervasive homophobia that includes hostility and threat, loss of existing support networks, fear of loss of employment, dispersed populations. Churches in urban centres differ significantly from their rural counterparts in that many urban ehurches accept homosexuals. Urban churches can also be meeting places for gays and lesbians for non-religious events. Northern, rural churches protect and propagate homophobic attitudes and hold considerably more power in their communities. 148 internalized homophobia, and time and energy-consuming rural lifestyles are just some of the ways that may also undermine the success of rural lesbian communities Rural Barriers to Lesbian Communities Social Climate Rural populations in general are more likely to depend on personal support through natural networks than formal services. “A natural network is that system of interpersonal linkages that exits for an individual because of family ties or friendships, personal accessibility (e.g., neighbours, co-workers), or community role (e.g., minister, police, teacher)” (Young, Giles, & Plantz, 1982, p. 457). Rural lesbians and gays often lose this source of support from the straight community once they reveal their homosexuality. In particular, queers often lose the support from immediate family. As a result, they tend to build chosen families from queer friendships making contact with other lesbians and gays exceptionally important. Rural lesbians depend even more on personal support than do other rural women because rural support services, including women’s centres and women’s shelters, are often tinged with homophobic attitudes and ignorance. But developing informal support within rural communities is difficult for lesbians who bear a stigmatized identity and who may find pre-existing ties and alliances threatened once they come out. This is especially pertinent for lesbians with children who have left a marriage; coming out as a lesbian for them could mean losing their extended family support network (D’Augelli, Collins & Hart, 1987). 149 For newly-cut lesbians, or lesbians new to the community, opportunities to meet other local lesbians are considerably diminished by a reluctance on the part of longer standing members of the lesbian eommunity to advertise social gatherings (if a community exists at all). Rural lesbians may face a greater challenge than urban lesbians when trying to locate and gain acceptance into a pre-existing lesbian network: Lesbian women’s organizations, informal networks, and communities traditionally choose to be less visible than gay men’s groups and networks, even in urban areas. In rural areas, women’s social networks are unusually invisible, taking the form of small, highly interdependent social groups. The invisibility, which provides an atmosphere of protection and safety, also poses problems, particularly for women new to an area. (D’Augelli, Collins & Hart, 1987, p. 14) One participant in the current study even suggested that staying disconnected is one way to create support: “Rather than uniting to create support for each other it’s almost like keeping ourselves separate creates support in that there’s not too many of us at one place” (Silverweed). Despite the expressed need for support and validation within the special circumstances of rural communities, most lesbians will travel outside of the town community to meet these needs or manage without meeting them. Barriers to networking and building communities create an ironic situation where networking is extremely difficult in a context where “networking is of vital importance” (Breeze, 1985, p. 47). 150 Distance and Farming Commitments I guess I would like m ore o f a social life, / w ould like peo p le to com e visit more, and because w e are so f a r out, they d o n ’t. (Hemlock) Other unique barriers to developing rural lesbian communities are challenges presented by geography and commitments to seasonal sustenance activities such as harvesting and winter preparations. In terms of geographical distance, the division between lesbians who live outside of town and those who live in town is sometimes great (sometimes more than 45 minutes), resulting in a lack of motivation to commute in or out of town after a full day of work and in light of fuel costs: “The only other thing would be distance. Like if it was hard to travel to [a community event]. I just don’t have the resources to do a lot of traveling” (Bluegrass). Participants also cited the responsibilities of growing food (planting and harvesting) and tending livestock as realities that make it exceptionally difficult for some lesbians to be away from home for any length of time: So you know if there were younger [lesbians] that wanted to set up some sort of social club and deal with the hostility and all of that stuff, that would be great. But I mean busy with her horses, got her homestead, I have a huge garden in the summer. *****, I don’t think she’ll stay here, so she’ll be gone and then what? There’s just all of us and we’re scattered all over the place. (Bluegrass) Ironically, although winter provides the most leisure time, road conditions often keep lesbians from commuting for anything other than work and/or provisioning. Barriers such as these mean that rural lesbians are generally more likely to form personal friendships rather than commit time and energy to community building, per se: 151 It’s probably going to be less of a community and more individual friendships, I mean lesbians spend time at each other’s houses which is in part, is partly community but it depends on the nature of people too, it depends on how far they live apart. (Silverweed) Lack of Diversitv Rural lesbians’ differing politics and a lack of common ground with others also results in deliberate non-participation and/or disinterest. Laek of diversity makes avoiding personality, value, and/or political conflicts at potential gatherings difficult because groups tend to be small and repetitive. I don’t like going to places where there’s aleohol ... I’ve been quite a political activist in my time so the only thing I’m really not too interested in is S/M [sadomasochism]. I just have no interest. So yeah if it was the politics of that 1 wouldn’t attend, and like I said I don’t like being around alcohol.... (Bluegrass). Although lesbian community was highly anticipated by most participants, they were not willing to mingle at all costs: I think the other lesbians in the community who I know who would be involved that way [in community events] are those people that I don’t really feel comfortable with.... (Silverweed) And really all we would have in common probably is our sexual orientation and that we lived rurally. And that would be better than nothing, but it would still be really really sad and I would have to get so mueh out of the living rurally experience that would have to be so rich ... in order to aecept this abysmal potpourri of dykes. (Hemlock) 1 don’t particularly like them as people [other lesbians in her rural community], I don’t like their personal values and how they treat other people and so they wouldn’t be my friends. (Fireweed) 152 We may have very deep disagreeing over things and if we had more choice we may not have a lot to do with each other. The one thing about being in a rural area is you have to become more tolerant, whereas in an urban area you do not. (Bluegrass) All in all I find it difficult here. There’s no, there’s very little support, there’s very little kinship, there’s really nobody else that I know and the only women that I do know are very different from me socially. (Silverweed) Transient Populations Professional lesbians working their way through small communities for the purpose of gaining work experience and earning cash also pose a barrier to the formation of lesbian communities. Although they may participate in the short-term development of community, resident lesbians recognize that lesbian communities need to be developed around long-term lesbian residents who have a more crucial investment in its success. One participant with the experience of being a transient in small communities testified to this relationship when she stated that, “I mean the first time you open your mouth and say, T’m only here for a year,’ it’s people like turn around and never talk to you again” (Hemlock). Another participant characterized short-term lesbians as “professional women ... here for a short time, they’re on a money track, they have no ties or commitment to the general community, they’re here to take money and split” (Bluegrass). Generally, short­ term lesbians are viewed as a bad investment that ultimately produces resignation and disappointment in the remaining community after they move away: “Just when you get something maybe happening, a critical player leaves, and that’s like starting over again, you can only start over again so many times before you don’t start over again” (Hemlock). 153 Closed Networks Some participants sensed the existence of a much older, established lesbian group that they did not know how to access: “I’ve always had a sense th a t... there was an old, a group of lesbian women somewhere in the area of the valley ... I have some sense that they’re there but [I] haven’t found them at all” (Silverweed). The potential for such a group to contribute to the development of local communities is exciting: these women in particular are long-term residents who may have strong ties and credibility with heterosexual networks and businesses upon which a lesbian community could be built. At the very least, this group could act as liaisons or mentors for other lesbians just coming out, including lesbian youth who are isolated in rural communities across the north and interior of BC. However, one participant who may have ties with this group suggests otherwise: “They [other lesbians] wouldn’t be able to tap into that older one, I think it’s pretty shut” (Fireweed). The picture she draws of this closeted community is testimony to the pressures and effects of homophobia in rural northern communities even after forty years of residency: And they’re as paranoid and as closeted as they ever were. There’s women who are sixty years old who still move out of their bedroom when their parents come to visit.... Nope, it’s still too ... threatening for them, they don’t feel comfortable. And I know who a bunch of them are, and I know what their network was and it was all over Northern BC and they tied it to sports, they played ball. And that group of people, it was a huge network I think, and they were all over the place, and they are all still tied together. And they don’t come to anything, they don’t mix with other people. I knew who some of them were and tried to really get them to mix, but they’d hold back and were quite afraid, and I don’t know if they were afraid that they might lose their partners because they didn’t feel like there were many out there and especially in old age that’s worse, it feels worse.... [A]nd I suppose the sexual revolution also hit the gay 154 community ... and I think that the older people felt threatened by that. But at the same time they didn’t recognize that might not be what’s really going on.... The pressure’s too great. And so I don’t think they understood that they pulled back maybe for the wrong reasons. Yeah, I know they’re there. (Fireweed) Another closed/closeted group in rural communities is queer professionals who fear that the development of lesbian communities could spell disaster for them. One participant in the current study rationalized this fear: “Anybody in the professions would feel very threatened by that kind of a thing. If they were not open or out already, that would be quite a scary thing” (Fireweed). At least one author, however, states otherwise. Gunter (1986) believes that closeted professionals are doing their communities a disservice that she describes as “professional neglect” (p. 95). Gunter’s (1986) commitment to practising openly in rural environments as a lesbian-feminist practitioner stems from her conviction that doing so is the best way to influence policies and attitudes towards homosexuals in small communities. Lifestvle Differences Lifestyle differences between lesbians who live in the town community and those who live outside of town can also discourage long-term community building. As one participant notes, just having sexuality in common is not enough to form community in rural contexts: Being a lesbian is not a tight enough, you know that’s not enough to spend three nights a week in a bar with someone you’re really really not enjoying. It sounds like this other community that I sense is there and closed. So I mean what are my options? Recruiting some people ...“Hey move up to *****! I’m really alone here!” Yeah I just don’t feel like 155 there’s any options, it feels like, “OK this is the way it is here.” (Silverweed). While lesbians outside of town may appreciate purely social activities such as dances or coffee houses, their vision of a long-term community is generally more lifestyle/value-based, that is, forming community around activities that could contribute to their knowledge of farming and erafts-making, alternative health, and even work activities. In other words, they value community building that emphasizes rural lifestyle activities and values: Well [rural] community is a much more functional aspect of people’s lives— functional’s not the right word—things done by community in urban places are a lot more tangible than things done—in my experience—than things done in rural [contexts]. There’s a lot more talking, it’s not quite as active, whereas I think when you live rurally, in my experience anyways, 1 have a lot more responsibilities, especially in my home, you know getting to and from work, and getting wood, and all the things that come with being rural, where the community of my friends, we go and get wood together and we go, my eommunity is made up of people who share my lifestyle and it has to be that way, otherwise 1 wouldn’t have time to spend with them. (Silverweed) We had a really neat community that built up around ourselves anyway. We did work things, if you went somewhere you were doing it because it was a part of your life, you were going to get firewood or something like that, you weren’t going there for just socially. So yeah, building, work bees, fixing ear bees, whatever you have to do to survive. (Fireweed) [Talking about her experience of rural lesbian commimities in the past and what made them successful] Like every once in awhile I wouldn’t mind going to a dance or something, that would be neat.... 1 like the idea of picnics or I don’t know ... even sharing skills, making baskets together, 1 don’t know, something that would be useful. (Bluegrass) 156 In response to a question about the sorts of things she thought rural lesbians would he doing as a community, one participant responded: “Oh, talking about fixing their tractors and their trucks and their horses. Growing food and how you do that. There would he more of those kinds of conversations” (Fireweed). Socializing around a work-purpose carries the double benefit of meeting like-minded people and accomplishing something useful that can be taken away—a skill, knowledge, a pick-up truck full of wood, or food. But, relying on in-town lesbians to commit time and energy to helping out-of-town lesbians may be too idealistic. Barriers to forming community due to such lifestyle differences are perhaps best reflected in the following quote. Here, a participant who had travelled to town in support of queer social gatherings felt support from in-town lesbians was not reciprocated when she needed help insulating her cabin: 1 sound quite bitter, and I’m feeling bitter about the community in some ways, because I’m upset at the lack of support in a lot of ways. You know the community talks but no one, ... when 1 was desperate to get somebody to help me insulate my windows, whatever, there was no community there. So I’m kind of. I’m feeling a bit bitter about it and wondering what’s the premise of this community.... (Silverweed) Lesbian Community and Meanings of Health and Well-being Rural lesbians’ meanings of health essentially reflect a core self-sufficiency and resilience. While hardiness is a stereotypical characteristic of rural dwellers in general (Lee, 1991), it is more often associated with people surviving adverse climate, isolation, and fewer resources and services than it is with facing “pervasive societal bias”, which is the case for queers in rural communities (D’Augelli, Collins & Hart 1987, p. 13). As such, rural lesbians face both unique hardships presented by homophobia and ‘normal’ 157 hardships which homophobia amplifies. For example, though isolation may be a barrier faced by straight women in small industrial towns, rural lesbians face increased isolation because of their sexuality and non-married status. Though rural lesbian communities (where they exist) can provide a vital means of support,^"* rural lesbians lack the support of a lesbian community to offset the unique and compound hardships of their contexts. Ideally, the sort of lesbian communities from which rural lesbians would most benefit would be land-based communities, dominated by lifestyle activities which combine participants’ rural identities, lifestyles and needs, with infrequent, casual, social events. Strategizing Wellness The self-sufficiency, strategizing, and resiliency reflected in lesbians’ meanings of health are typical of and tailored to their realities. This is evident in the fact that although all participants to some degree thought the existence of lesbian community would enhance their wellness, they define their existing wellness as essentially something they can provide for themselves. In other words, participants’ meanings of wellness are more about an inner state of being resulting from their control of space, integration, and deep connections to their natural environments (qualities they can provide themselves) than they are about relationships with other people in the community. According to this research, strategizing wellness in the absence of community resources is part of what it means to be well as a rural lesbian, to the point where the lack of resources is negligible. As one participant states, “Well because of its [lesbian community’s] absence we get used to not having it. We have to survive, and so you have D ’Augelli, Hart & Collins (1987) found that “involvem ent with social groups and with lesbian social activities was significantly correlated with fewer personal problems” (p. 16). 158 to survive with what is. And so after awhile it’s not even an issue anymore” (Bluegrass). Learning to live without, and in the meantime creating alternate ways of fulfillment, is a significant part of what it means to be well as a rural lesbian. Impeding Behaviours Ironically, what it means to be well as a rural lesbian can also include cultivating behaviours that fundamentally impede community building and/or produce isolation and alienation (Anderson et al., 2001). For example, some gays and lesbians who fear the repercussions of a stigmatized identity deny their sexual orientation by pretending to be straight and avoiding visible contact with other known or suspected queers. One participant spoke of friends who would not walk with her in town so they could avoid being identified as lesbian by being seen with her (B luegrass).A nother participant in the current study stated she would not be a visible part of a local lesbian community because doing so would threaten her business ties with the straight community (Fireweed). D’Augelli, Hart & Collins (1987) found that cloaking one’s sexual orientation is perceived as necessary for survival by some queers, although it adversely affects an individual’s ability to be recognized by others gays, and thus impedes individuals’ chances to be part of a lesbian/gay community. To some degree, such individuals also undermine the success of rural queer community formation by their lack of participation. N one o f the participants in this study cultivated invisibility as a means to survive in their environments, although m ost talked about other rural lesbians who did so. However, all participants spoke o f diminishing their lesbian identities to som e extent in public and workspaces as a means o f self-protection. 159 Commuting for Community Testimony to participants’ resilience and self-sufficiency is that all participants leave their communities periodically (and some more than others depending on economic wealth and other responsibilities) to participate in lesbian community elsewhere, typically in larger cities. One participant states that, “It’s a lot easier to drive to ***** and be in that community than it would be to try and make a space here’’ (Fireweed). Accessing other communities is perceived as easier than developing local communities because ties in other communities may already exist through old ffiendships/ex-lovers, communities are already in place and organized (less effort from participants), and participants can be demonstrative in public without fear of being recognized on the street. Kramer (1995) also found that besides commuting to larger cities for queer social opportunities, many rural gays and lesbians travel in search of queer literature that is unavailable in their own communities (or is available but accessing it carries a risk of the participant being identified as queer at time o f purchase). Independence-Based Well-being The significance of rural lesbians’ self-sufficiency to their meaning and experience of well-being also means that to some degree participants are wary of committing time and energy towards developing another resource (lesbian community) if that commitment results in taking time and energy away from routines/lifestyles that already meet their core well-being needs. In other words, participants recognize that developing local lesbian communities would require a tremendous amount of energy, courage, and time—a huge effort with no guarantees of success. It was hard to imagine 160 being involved significantly in these new developments because doing so would undoubtedly reduce the time and energy they had left for cultivating wellness in the ways they knew and trusted. As one participant stated, When I think about what it would have been like to try and get a community going in ***** I just think it would have been full-time work in the sense of constantly thinking about it and imaging it and putting energy into trying to make it happen, probably wouldn’t have been that much time actually spent with other people, but there would have been lots of time spent trying to negotiate it. And other things that I really really value would have gotten sacrificed. And I don’t know in the end if I would have thought it was worthwhile ... I think it’s just hard, it takes a lot of work, and so you just want to stay at home where you don’t have to deal with that bullshit, what you get out of that community really doesn’t make it worth all the work you have to do. (Hemlock) Conclusion Yeah I f e e l like I ’m healthy. A n d I think, “Oh life can only g e t better. We w ill create a community somehow. (Bluegrass) In this study, the underlying structure of participants’ meanings of health and well-being do not include participating in lesbian communities locally or elsewhere, although most participants believe that rural lesbian communities would benefit their well-being. But, lesbian communities face a myriad of barriers stemming from at least two sources: homophobia from the town community and personal barriers to community formation developed out of the experience of—and identification with—a rural lifestyle of self-sufficiency. Homophobic contexts which demand resourcefulness and resiliency further reinforce this self-sufficiency, creating a catch 22 situation to some degree for queer women. Although mutual lesbian support is valued and desired, strategizing well­ being in rural northern contexts to some degree undermines the potential for lesbian 161 community in the first place. And due to the harsh physical and social context, lesbians take fewer risks and have less time to commit to alternate ways of being well that have not yet been proven. Practical considerations generally result in rural lesbians eomposing small, independent groups of personal lesbian/gay friendships that exist in place of a wideranging, integrated lesbian community. Limited support through personal friendships is in keeping with participants’ experience and valuing of being self-sufficient. Participants meet their own social needs, whether this calls for travelling to larger centres for queer events, relying on personal local friendships, or defining their well-being in ways that can be met by their rural lifestyles. Realistically, the integrated and extensive lesbian community that most participants idealize would require a blueprint that addresses the mutually reinforeing barriers to rural lesbian communities that stem from hostile environments and aequired strategies for well-being. Developing such a blueprint would require a sizeable commitment that many rural lesbians simply don’t have the time and energy to make, especially if they doubt the success and benefit of the endeavour in the first place. Nevertheless, some participants offered vague strategies for developing rural lesbian communities. These plans hinge on their understanding of power differenees between renting and owning property, whereby political and social power accrue with landowner status: In the country, when you rent, people ignore you. You’re there but they don’t see you as permanent. You’re a transient, even if you’re there for twenty years you’re still a transient. Once we bought, everybody in the 162 neighbourhood dropped by to say, ‘Hi I’m so-and-so’, which was my first experience with that, of OH! And it’s true, we were there and they see us as part of the community. (Bluegrass) Not surprisingly, participants’ suggestions for developing lesbian community include land-based, community-building activities based on lifestyle routines. Land-based communities included a distinctive rural lesbian base (lesbians living out of town but not closed to in-town lesbians) whereby key organizers would also own their own property. The status and political power wielded by land-owning groups in rural communities are resources through which attitudes towards homosexuals could be challenged in the town community by way of positive recognition and sheer power: So maybe that’s why I see the power more in the real estate that they own, and that that can become an influence, because as land owners you have a different voice in the community than a renter. So, I think if the community was going to express power or a sense of permanence that was going to make change, if I was planning to do that I’d say buy the land. Control it. (Fireweed) To a certain extent, the success of rural queer communities depends on a positive change of attitudes in rural communities and a design that can incorporate and benefit lesbians’ rural lifestyles. Because of these tremendous challenges, lasting rural lesbian eommunities should be envisioned as a long-term goal. A land-based lesbian community may signify a permanence and participation in/contribution to the town that may be positively recognized by heterosexuals, possibly in addition to inspiring rural lesbians to participate. Even if attitudes towards gays and lesbians did not change tremendously, a land-based lesbian community would represent stability and visibility to other rural 163 lesbians, as well as provide physical spaces where useful community-huilding activities could occur with which rural lesbians could identify. 164 Chapter Eight Conclusion Chapter Eight contains five sections: (1) summary of findings; (2) methodology; (3) my learning; (4) future research recommendations; and (5) contribution to existing knowledge. Summary of Findings Meanings o f Heath and Well-being The core shared themes in participants’ meanings of health and well-being, and the framework through which they are construed, are similar to the findings in Steven and Hall’s research (1988) which, as part of a larger study, explored health beliefs of (urban) lesbians. In their study, “Participants conceptualized health in a holistic fashion,” and significant themes included “independence and self-reliance as the primary components of wellness” (p. 7).^^ Similarly, a significant finding of Anderson et. ah, (2001), is the positive relationship between rural lesbians’ experience of health and the rural lifestyle values of “self-reliance, self-determination and privacy” and a closeness to the natural world (p. 15). Sorrel and Watson (1997) also found that “independence and selfsufficiency were also highly valued by rural [lesbians]” (p. 31). Hope and Butler’s study (1999) on older, rural lesbians found that informal support networks and personal initiative were important characteristics of participants’ positive health experiences Because Stevens and Hall (1988) do not query the relationship between their participants’ health meanings and their location, it is not possible to see how the urban contexts o f their participants contributed to their health beliefs and/or how they relate to my research in these ways. 165 because they permitted “independence and authentic self-identity” (p. 42). Independence and self-reliance, and related qualities such as autonomy and resiliency, are also major themes of participants’ health meanings in my research. While these qualities to some degree reflect rural cultural values, they are also significant as a strategic response to well-being in the face o f the pervasive homophobia and heterosexism which also characterizes rural culture. In this sense, rural lesbians’ meanings of health and well­ being in the current study reflect the core values and qualities of rural life, as well as the key ways and resources participants rely upon for their health and well-being. In my research, participants’ meanings of health and wellness are very much shaped by—and find their deepest relevance within—their rural communities, lifestyles and natural environments. All of the participants 1 interviewed also have the experience of living in urban contexts; this experience was very significant to participants’ understanding of differences in their health meanings related to living rurally. One of the findings of my research corroborated by other research on marginal populations’ health meanings is that people will define their health/wellness in ways that can be met through their particular lifestyles. This phenomenon turns out to be a valuable strategy for marginal populations for whom formal support services are lacking or otherwise inadequate. It is an especially valuable strategy for marginalized populations bearing a stigmatized social identity, such as lesbians, for whom even informal helping networks are threatened once one’s sexual identity is revealed. 166 Lesbian Community and Well-being Most participants’ lamented the absence of an organized, casual lesbian community in their rural lives. Most felt such a community would enhance their overall well-being although lesbian community per se did not figure into the underlying structure of participants’ meanings of health/well-being. Importantly, even the experiences associated with lesbian community (support, social events, a sense of unity) did not figure into participants’ health meanings. Personal friendships with other lesbians, and/or small groups of lesbian friends, stand in place of an organized lesbian community in participants’ lives. When it is possible, participants travel outside of their rural communities to larger centres to access lesbian community, because it is easier than developing lesbian communities in their own rural contexts. Myriad barriers to forming lesbian community in rural towns generally stem from homophobia and heterosexism. However, the commitment to living rurally is also a barrier to building lesbian community. Participants’ experience their rural lifestyles as a core resource for their well-being. The time, energy, and risk to their existing straight alliances associated with developing lesbian communities, combined with serious doubts about their long term success, are some explanations for why participants feel it is easier to live without an organized rural lesbian community, or travel to other centres for it, than develop community locally (although all participants would access community to some degree if it was already in place). Rural contexts are exceptional and community building within them cannot be based on community building strategies in urban centres. Some participants’ vision of a 167 land-based rural lesbian community begins to clarify uniquely rural strategies for building rural lesbian communities that could form the basis for future research in this area. One participant did not assign the same significance to lesbian community and a rural lifestyle to the meaning and experience of well-being as other participants. Her experience is especially valuable because it points to the significance of other sorts of experiences that contribute to well-being in rural societies such as straight-gay alliance building, and acceptance and integration into the straight community. Methodology Purpose of Qualitative Research One goal of this research was to put rural lesbians’ voices at the centre of the analysis, findings and discussion through the choice of a particular research methodology. Qualitative methodology enabled an exploratory, participant-centred journey not only into the unknown terrain of rural lesbians’ health meanings, but also into related aspects of the topic such as rural homophobia and challenges to rural lesbian communities. The American style of phenomenology, in its privileging of the every day world and every day experience as a means to knowledge, is a complementary methodology to this topic in which participants’ contexts and experiences are the essential filter through which the underlying structure of their health meanings can be made explicit. A phenomenological inquiry in this research permits an exploration into the experience of what it means to be well from the perspectives of rural lesbians. Such an approach, which focuses on, privileges, and is located within concrete experiences and contexts, provides a valuable incremental contribution to academic and community-based 168 knowledge of lesbian lives and culture, and to the lesbian community. A phenomenological inquiry also permits a productive contribution to formal health care because knowledge of the meanings of being-well (and being-ill) faeilitates superior care (Lawler, 1998). Lesbian Research Issues 1 loeated very little formal documentation discussing specific lesbian research principles and ethics. Feminist research principles do not adequately address the sensitive issues that arise when working with a stigmatized population. Researching marginal populations within marginal contexts, whose stigmatized identity is further amplified by these contexts, present unique challenges to researcher(s) and participant(s) alike. Many of my insights into some of these challenges (and how to deal with them) came to me during the interview process and afterwards when 1 considered how this study could be improved. A general ‘queer’ methodology or a ‘gay and lesbian’ research approach is also inadequate. Literature on gendered roles in rural communities, for example, as well as participants’ own testimony concerning the intersections between sexuality and gender, support the need for a lesbian-speeifie approach in qualitative methodology. I hope my discussion of a lesbian research approach will help clarify some of the ways this approach is productive. My Learning Power in the Research Act The most profound knowledge I gained through the course of this research has to do with power in the research act, in particular accountability/transparency. From a 169 feminist research point of view, researcher accountability/transparency are particularly important when working with marginal populations, where the opportunities for ‘powerover’ are especially stark. The call for accountability/transparency in feminist research, however, does not adequately address or mediate the different ways researchers and participants are both empowered and disempowered in the act of research if locations (identities) are simply listed and not problematized. In other words, listing our positions in terms of identity without analyzing how the research act is transformed by them is only a partial accounting, and perhaps it is never complete. In the course of this research, one of the most honest discussions I encountered on the researcher/participant relationship by Ristock and Pennell (1996): As feminists we have been aware of the unequal power and the exploitative potential inherent in this relationship. We struggle to develop new methodologies and meta-theories to circumvent the ‘power-over’ kind of research relationship: we state our goals in terms of empowerment; we treat our research participants with respect and equality; we locate ourselves within the questions we ask; we seek to make our research socially useful; we adhere to ethical guidelines that require reflexive feedback, informed consent, and no use of deception. But the issue of power remains, regardless of our attempts at sisterhood, thoughtfulness, and sensitivity. Power is always present in the complex reciprocal relationship between the researcher and the research participant. We cannot deny this power, nor can we deny the contradictions we experience between our roles as researchers and as women. (Ristock & Pennell, 1996, p. 68) Furthermore, Both the power and responsibility are inherent in the role of a researcher who comes into a situation and stirs up issues by asking questions; who demands reflection and analysis from research participants; and who terminates the project when she has her data regardless of the far-reaching 170 implications that the project may have for the participants. At the same time, the research participants may exercise their power and either refuse to continue with the research or insist on exploring only certain kinds of questions and issues. In this ‘knowledge/power couplet’, the relationship between researcher and participants is complex and reciprocal. To deny these power relations and their effect on the research is to obscure further the already complex and often contradictory research process.... Not acknowledging the researcher’s power as ‘discoverer’ can be as disabling and patronizing for research participants as overestimating that power. (Ristock & Pennell, 1996, pp. 70-71) There are many situations in which I as the researcher experienced ‘power-over’ in the course of this study. Without question, I made all the decisions regarding topie, initial interview questions, the space of time over which interviews were conducted, which interviews were chosen for an in-depth analysis, which quotes were used, and everything I brought into the project including the choice of secondary research, theories and frameworks. These are just the obvious ways I experienced control over this research. Another way that 1 was in a position of power in this research is the decision to withhold my transgender identity from participants. My transgender identity provides an opportunity to describe how both researchers and participants can be empowered and disempowered in the research act. For example, I made a deliberate decision to withhold from participants my changing identity halfway through the research process. Though my changing identity is not relevant to my topic, it is relevant to participants because I had serious doubts whether two of my key participants would wish to remain involved in this project if they knew I no longer comfortably identified as female and lesbian. In this sense, my withholding this information can be construed as a deliberate act of ‘power 171 over’ by the researcher. On the other hand, my fears about participants withdrawing are situated in the real experience of being marginalized by leshian-feminist community groups/individuals who are critical of transgendered people and who perceive transgenders as a threat to the meaning and stability of feminism. Thus, my experience of remaining silent about my identity during the research process is also based in the lack of power I experience in lesbian/feminist circles. I have come to view this experience as an example of the nature of power in the research setting and how difficult it is to know where to draw the line—when do participants’ rights to information supersede researchers’ privacy? Does the power intrinsic to the role of researcher require the researcher’s transparency even if the researcher experiences marginalization as a result? I have come to the conclusion that both researcher(s) and participant(s) can emphasize and de-emphasize pieces of their identity in order to negotiate power within the project such as ensuring access to a project and maintaining a role in the project. Describing and understanding the different ‘power plays’ in the research act is draining and tedious work, but it brings with it meaning to why situated-ness is important in the first place. Providing these partial analyses when possible represents the integrity and uniqueness of feminist research. A feminist research process enabled an awareness and accounting of some of the relations of power between myself and the participants, and I found this process in particular integral to the personal value of doing this research. 172 Future Research Recommendations This research raised some important issues for future research. One of the most ohvious of these issues is how the findings of this research are very much dependent on adult experiences and security. Participants derived well-heing from their home environments and rural lifestyles. Importantly, participants define and manage these spaces. Youth typically do not define and manage their own spaces, and so would not necessarily experience their residences and rural lifestyles as resources to their well-being (or experience them as a resource for health/wellness in the same way as participants in this study do). In any case, because this research and related research suggests that cultural groups and sub-groups have unique health meanings, separate research on the health meanings of gay and lesbian youth will likely yield health meanings specific to their experiences. In much the same way, in future research the experiences and health meanings of rural lesbians living within the residential rural community should be considered separately from land-hased lesbians living outside the town borders. My sense from my research is that the differences in experiences between rural lesbians living in residential neighbourhoods and rural lesbians living outside of the town community are different in significant ways directly related to location. The significance of lesbian community to participants, if not to their meanings of health and experience of well-being, prompts me to include another future research recommendation. The idea of virtual communities was raised by some participants. A website designed by and for rural lesbians (which could be sub-divided into groups such 173 as youth, lesbians over 50, lesbians from outlying communities, and so on) could be a feasible means to develop community in contexts where the need for confidentiality and anonymity, and the reality of distance and farming commitments (among other factors), make it difficult for lesbians to meet each other for friendship, relationships and/or sexual expression. A virtual community would also protect the identity of those who undertake the project. Such a website could also have a straight-gay alliance component that would inform lesbians (and gay men) which individuals/businesses/groups are gay-friendly—in other words, where support from the straight community lies. Contribution to Existing Knowledge The purpose of this research has been primarily to build on existing research on rural lesbians’ experiences in B.C.’s North/Interior, and by doing so further recognize and validate their experiences of well-being in relation to their unique environments. This research also carries the potential to inform future work with lesbians because it documents some important queer research issues/experiences/ideas. Although it was not a major goal of this research to do so, the findings presented here may also address/inform formal health care policy and/or educational materials. Most significantly, while there has been limited research concerning rural support services and networks on rural lesbians, there is no research specifically exploring their meanings of health and wellness. 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American Journal o f Community Psychology, 10(4), 457-469. 184 Appendix 1 Background Information All information on this sheet will be kept confidential Code: D ate:_________________ Community: Do you live in town? yes or no How long have you lived in this com m unity?__________ years Where did you live before?_____________________________ Racial/Ethnic Identity:_________________________________ Age group 18-24 25-35 35-44 45-54 55-64 65+ Household Make-up alone with partner with friend(s) (how many?) 185 with children (how many?) with parents Edcuation public school high school college __ program university _ _ program other Are you employed? y e s program part time full time no If yes, what is your occupation? What is your income level? less than $5,000 $5,000 to $10,000 $10,000 to $15,000 $15,000 to 20,000 $20,000 to $25,000 $25,000 to $30,000 $30,000 to $40,000 $40,000 to $50,000 over $50,000 contract 186 Appendix 2 LESBIAN RURAL HEALTH THESIS PROJECT: Amber Perry, Gender Studies, University of Northern BC. LETTER OF INFORMATION I am a lesbian graduate student in the Gender Studies Program at the University of Northern BC. I am interested in learning about lesbians’ meanings of health and well­ being. What is the purpose of this study? The purpose of this study is to learn about the meanings of health and well-being of lesbians living in rural environments in the Central Interior and Northern BC. Why is this study important? I am doing my projeet to try and point out and fill in some of the gaps in the research on lesbian health experience. I want to show how rural environments influence meanings of health and well-being. How will this study be conducted? I would like to talk to lesbians who have either lived or are living in small communities. Individual interviews will be arranged for lesbians who prefer them. I will be doing the interviews on my own or with a work partner. Small discussion groups lasting approximately 60 to 90 minutes will be arranged if they are desired by and convenient for participants. All of the interviews will be tape recorded. Typed copies of the taped conversations will be delivered to the participants for their approval. All such information will be kept confidential. IF YOU WOULD LIKE TO PARTICIPATE PLEASE CALL 250 998 4342. Discretion and confidentiality assured. 187 Appendix 3 RURAL LESBIAN HEALTH PROJECT Agreement of Participation: Individual/Group Interview Participants I, .......................... , volunteer to be interviewed by Amber Perry, Gender Studies graduate student, for her thesis project “Meanings of Health and Well-being for Rural Lesbians: A Phenomenological Study.” I have read the project information letter provided with this letter of consent and agree to contribute my knowledge on this topic. I understand the following: 1. The interview(s) will take place in the setting(s) of my choice, at my convenience. 2. The interview(s) will be tape recorded (audio only), and last between 60 - 90 minutes. 3. The audio tape will be kept in a locked drawer or filing cabinet until such time as it is destroyed. 4. Word for word transcripts will not include my name , and will be shared with myself, thesis candidate Amber Perry and (possibly) other co-researchers and/or thesis committee members. These transcripts will be secured in a locked drawer or filing cabinet and destroyed at the end of this project. 5. All information that could be used to identify me (name etc.) will be deleted from the manuscripts and will not be used in the reporting of this study. 6. My signature indicates that I give my permission for the information I provide in the interviews to be used for publication in research projects, articles and/or teaching materials, as well as for presentation at research symposia and/or education workshops. 7. My signature also indicates that I give my permission for the researcher to re­ contact me if there are any questions about things I have said in the interview. In addition, I may contact the researcher if I have any questions about the project or the interview. 8. I am free to withdraw from the study at any time. 9. My signature indicates that I have received a copy of this consent form and letter of information about the research project. DATE................................................................................................................... SIGNATURE OF PARTICIPANT........................................................................ PLEASE PRINT YOUR NAME........................................................................... Signature of research project leader...................................................................... Research Project Contact Number 250 998 4342. Participants please note: If you have concerns about this research, please contact Dr. Max Blouw, Dean o f Research & Graduate Studies, UN BC - 250 960 5821, or Dr. Barbara Herringer at 250 960 6643. Appendix 4 - Analytical Table Analysis 1 - horizontalization - health meanings quote source theme subthemes formulated meaning relevance to health and WB OO 00