2. Lifecourse Analysis

Question 1

Lifecourse Ruptures

Answer 1

• Narrative arc of someones life from birth to death
  
  • Through this is a lifecourse
  • Divergent trajectories- something happens (lifecourse transition) can be positive or negative (lifecourse rupture) which changes their lifecourse- transitional points with options for us to choose from. Point where the lifecourse drops- choice that you make to change or not
    Lifecourse analysis- look at those transitional points where you can change or stay on one trajectory

Question 2

Lifecourse analysis- origin

Answer 2

• William I. Thomas and Florian Znaniecki (1918/1996):
  
  • Sociology – Social History – Social Policy
  • Adopt a ‘bottom-up’ approach to documenting life history.
  • Attempting to understand the relationship between social class and how these relationships shaped history.
  • Concerned with detailed analysis of data from multiple sources, but especially personal correspondence and the experiential narrative of individuals.
  • (Dis)organisation of society and social interaction results from analysis.
• This book tracked the polish migration from mainland Europe across to America
• Shows how polish immigrants came to America
• Seen as the classic in starting lifecourse analysis as a methodology- causes and reasons why people would leave their homeland in pursuit of a new life
• This text pieces together the rationales of people- Started to look forensically specifically at how organised the societies were (when you take populations out of natural society to an artificial one, how is their society reorganised and assimilated)
• More modern Interpretation: talks about the disorganisation of societies- when you transplant people from one place to another there is an opportunity for new organisational structures to form e.g. the American Dream
  Because you are disturbing the natural environment, this displacement allows for structures to form e.g. the polish people became rich in America

Question 3

Lifecourse analysis- formalisation

Answer 3

• Kurt W. Back (1980)
• Human Development (Sociology, Anthropology, Psychology) – Demography – Gerontology
• An approach to research from multiple social science disciplines.
• Concerned with turning the autobiographical into the biographical.
• Focused on the sequencing of events in one’s life, and the consequences of sequences.
• Chronology and relationship between life events are important factors to consider.
• Acceptance that difficult periods in the life cycle can influence future events and experiences.
• Enables the synthesis of large datasets into cohesive and coherent explanation of a social history.
• Attempts to frame the psycho-social experience in a historical context and likewise frame a social history through a psycho-social lens.
• Formalised epidemiology
• We see that where the previous had looked at the autobiographies, the formalisation was concerned with turning the autobiographical to the biographical
• Interested in sequencing events- less so of the journey but what happened along this
• Tine became important e.g. how long people stay in places before moving
• Obsessive with large data sets e.g. full populations
  Tried to push away from social history narrative

Question 4

lifecourse analysis- theorisation

Answer 4

• Glen H. Elder Jr. and Janet Z. Giele (2009):
• Sociology
• Understands the period between birth and death as a period of human development and ageing – which are both lifelong processes.
• Largely splits life into Dependency, Middle Age, and Later Life.
• Concerned with the timing of events, human agency, linked lives, and the historical time and place.
• Incorporates the idea of ‘divergent trajectories’ across the lifecourse paradigm allowing for different outcomes and experiences – not better or worse, but different.
• Look at the health and wellbeing of people at specific times e.g. later life
• Not concerned with the transitions but what is happening within those periods
  By the early 2000s it started to look at why outcomes are different in different societies

Question 5

lifecourse analysis- interpretation

Answer 5

• Stephen J. Hunt (2005/2017):
• Sociology
• Taking the idea of the life-cycle from Anthropology and Psychology whereby certain rites of passage must be fulfilled for persons to conform to the ‘normative’ lifecourse.
• Concerned with the transitional nature of the lifecourse and trajectory changes in accordance with life events.
• Focus on transitions as point where one phase of life ends and another begins, and thus a point of enquiry by those around the person of interest and researchers.
• Lorraine Green (2010/2017):
• Sociology – Psychology
• Emphasis on the fact there is rarely linearity during the lifecourse.
• Concerned with the circular manner of lifecourse repetition between generations and cascade effect of generational lifecourse choices.
• Focus on social divisions, inequalities, and explaining the biological outcomes (i.e. what are the experiences of someone who is frail).
• Intersectionality of upmost importance for understanding the consequence of the lifecourse.
• Psychologists have picked up a different aspect
• They argue that the lifecourse is very rarely linear
  We are also picking up on the generational change- they say is is like cascades: we are influenced by people who have a big influence on our life e.g. teacher /family member. Cascade effects can change the way we project our lives- we ae influenced on how we recat to situations based on influential people in our life

Question 6

lifecourse analysis as applied to health

Answer 6

• Mary Larkin (2013):
• Healthcare – Social Policy
• Stages of life are not chronologically or biologically fixed.
• Greater focus on the fluidity of the lifecourse due to pursuance of ‘non-normative’ lifecourses.
• Concerned with the emergence of identity in post-transitional phases of the lifecourse.
• Theory that is used currently in how we shape healthcare policy
• Rooted fundamentally our entire system by lifecourse
• Stages are not chronologically or biologically fixed- there should be a greater focus on fluidity of lifecourse (some will die earlier or age faster than others)
  Larkin argues that the normative lifecourse is interesting but probably accepted and followed by the minority of people

Question 7

lifecourse analysis- classical application

Answer 7

• Barney G. Glaser & Anselm L. Strauss (1967):
• Medical Sociology
• Life is demarcated by transitions, each of which have a trajectory.
• Social roles aid the development of one’s own life path.
• Transitions have the potential to move someone from the trajectory and this shift and outcomes can be explored by researchers
• There are social roles that aid our development e.g. assumptions or having a position of responsibility- these social identitiy transitions where you assume a new identitiy can change the lifecourse positively or negatively
• Glynis M. Breakwell (1986):
• Psychology
• The idea of ‘threatened identities’.
• Identities are structured according to time, operation, and social context
• Barbara Rubin Wainrib (1992):
• Clinical Psychology
• Life-cycle is gender dependent.
• Cannot extricate lifecourse from social change.
• How gender development can affect the lifecycle
• Cannot extricate gender from the lifestyle- e.g. thinking about threatened identities
• Appreciation of social change- lifecycles are temporally dependent and change with time. Have to accept that social change changes them
  Across all of the social changes in the lifecourse we need to think of people with respect to their gender identity

Question 8

lifecourse analysis- modern application

Answer 8

• Bren Neale (2015):
  
  • Family Research
  • Focus on the specific phases of the lifecourse and the transitions between these phases.
  • Concerned with mechanisms which trigger these transitions (or trigger points).
• Susan Pickard (2018):
  
  • Sociology – Gerontology
  • Women are subjected to different expectations over the lifecourse than men- groundbreaking I terms of how we research society and people within it
  • Each lifecourse is fated by gender (‘normativity’)- the expectation that if you identify as a particular gender then society itself ahs an expectation of that gender to perform
• Robin Hadley (2022):
  
  • Gerontology
  • Idea that non-normative lifecourses are lifecourses ‘disrupted’.
• Cradle to grave approach- need to look at how each stage of the lifecourse affects you
  This is of its time even though the concept of cradle to grave is still used (the lifecourse just does not look like this)

Question 9

mental health in context

Answer 9

• Mental health is: “predicted to be the second leading cause of global burden of disease by 2020”. (WHO, 2002).
• Factors such as inequality, urbanisation, abuse (physical, sexual, verbal, & other forms including financial, psychological, & emotional) are known drivers of mental health issues and increased psychological distress.
• At any one time, in the UK:
• Almost 45% of people believe they could have a diagnosable mental health condition
• Just over 36% of people self-identifying with one
• Approximately 20% of men and 35% of women, have a diagnosed mental illness
  (Mental Health Foundation, 2016)

Question 10

mental health and context of gender

Answer 10

• The prevalence of depression is almost guaranteed to be twice as high in women as compared to men no matter which country you study.
• Drug an alcohol dependencies are almost always higher in men than they are in women, across the globe. (WHO, 2002). Seeing maladaptive coping in play- drinking to cope with depression which is more prominent in men (women ask for help)
• Women are known to present more frequently to psychological services and health care professionals with complaints of mental distress, be it mild, moderate, or severe.
• Suicide is the world’s 17th leading cause of death with close to 800,000 persons completing suicide each year (though many more attempt it). In the UK, it continues to be the leading cause of death for men aged between 5 & 50 years old. (Mental Health Foundation, 2016; ONS, 2016; Public Health England, 2017)- not that less women are suicidal but men use it to cope
• We know depression is more likely to be reported by women
• Also higher incidence of alcohol and drug abuse in men
  Is there a genuine distinction between men and women experiencing depression? Probably likely that there are the same rates of depression but men do not report it as much

Question 11

gender and mental health

Answer 11

• Mental health and mental health practices are inherently gendered.
• The images of the “neurotic” woman, and the “psychotic” man
• The stories of “hysterical” women, and “shell-shocked” men
• The way mental health disorders are characterised – even in this modern day – means that the expectations of with which disorder people will present, is somewhat dependent on their gender.
• Examples of gender-salient mental health conditions are as follows:
• Female:
• Depression
• Anxiety
• Eating Disorders
• Male:
• Post-Traumatic Stress Disorder
• The Autism Spectrum
  Obsessive Compulsive Disorder

Question 12

how we perceive women: the male gaze

Answer 12

① The woman looks in the mirror to view herself.
② The image of herself is viewed by the heterosexual male/heteronormative society.
③ The heterosexual male or heteronormative society projects an image of the “desirable female”.
④ The woman (and other women, and society) views her image through “The Male Gaze” and not as herself.

Question 13

the history is so bad, so what of the future?

Answer 13

• Women’s mental health has been pathologized and medicalised as a “problem to be dealt with” rather than a serious psychological epidemic to be understood.
• There has been little change in the way we, as a society, continue to view women’s mental health.
• Activist approaches have been largely disregarded as exaggerated, whilst gendered attitudes have been dismissed as insignificant.
  If women’s mental health is not about gender, and nor can it be approached through activist methods, then does women’s mental health then actually have anything to do with women?

Question 14

female psychology: a cradle to grave approach

Answer 14

• It frames psychological wellbeing in relation to the lifecourse, thus framing mental health positively, by looking at periods of strength and periods of distress so as to learn on what helps and hinders a person’s mental health.
• It incorporates social factors which may affect mental health, and also biological factors such as sexual activity & pregnancy, ageing, or the menopause
• It looks for patterns in mental health over the lifecourse, enabling the participant or patient & the researcher or clinician to see mental health as a dynamic, and continuous factor, rather than discreet event.
  It allows women to voice their own mental health narratives.

Question 15

importance of women’s health

Answer 15

• For too long women’s mental health has been disregarded, seen to be an exaggerated truth, and so unimportant and of little interest to policy makers.
• Women have rarely had a say in narrating their own discourses of mental health, but with some resistance movements, narratives are beginning to change.
• Women make-up 50% of the population, present to primary care more often with psychological distress, and are incessantly and often unnecessarily medicated rather than having the cause of the distress dealt with in an effective manner.
  ‘Female Psychology’ allows us to be sensitive to the everyday struggles and burdens which women are just expected to put up with (i.e. being a ‘sole partner’, childcare, harassment, glass ceiling effects, access to education, politics which favours men, and stereotypes about the jobs they can do).

Question 16

how to use female psychology to effect change?

Answer 16

• Make women’s mental health a public health priority by realising it is distinct from male mental health and is more readily effected by social pressures and familial support.
• Move away from the medicated seemingly benign complaints of psychological distress, and investigate the root causes of why the otherwise health woman is presenting at primary care settings.
• Engage women in lifecourse research, asking about their experiences in order to map differences across cultural populations and between ‘normative’ and ‘non-normative’ lifecourses.
  Those in positions of privilege (researchers, clinicians, educators, policy makers, etc.), use your standing to offer a platform for women to voice their experiences and change the damaging discourses around women’s mental health so that stories of women’s mental health are narrated by women.

Question 17

what is endometriosis?

Answer 17

• Endometriosis is a chronic condition characterized by the growth of endometrial-like tissue (the tissue lining the uterus) outside of the uterus
• Clinical presentations include (but are not limited to):
  
  • Chronic pelvic pain
  • Painful periods
  • Painful sex
  • Issues surrounding fertility
• According to WHO, endometriosis effects:
  
  • 10% of reproductive age women globally (World Health Organisation, 2023)
  • And of this population, 30-50% of women experience infertility (Meuleman et al., 2009)
    In the UK, it takes an average of 8 years and 10 months to receive a diagnosis (Endometriosis UK, 2024)

Question 18

endometriosis and infertility (Massachusetts General Hospital, 2023)

Answer 18

• While the relationship between the two is not fully understood, several factors can play a role…
• Chronic inflammation: Endometriosis can cause chronic inflammation, leading to damage of reproductive organs like the ovaries and fallopian tubes
• Blocking of the fallopian tubes: Endometrial-like tissue can implant around and block the fallopian tubes, preventing the egg from traveling
  Impact on egg quality and hormones: Endometriosis can also impair egg quality (likely due to associated inflammation) and negatively affect the hormonal environment

Question 19

treatment options (national library o medicine, 2011)

Answer 19

• Pain relievers, such as ibuprofen, aspirin
• Hormonal therapy, including contraceptives
• Surgical interventions:
  
  • To remove the endometriosis tissue (often done laparoscopically)
    Hysterectomy (removal of the uterus)

Question 20

Johanna Mitchell: the struggle for diagnosis with endometriosis

Answer 20

• While much endometriosis research has focused on symptoms, treatment options, and the broad impact on quality of life, we felt that there was a gap in the literature focused on the psychological & emotional impact of this condition

Methods:
- We wanted to understand this relationship through a qualitative lens. We decided that the best way to do this would be through one-to-one interviews with women diagnosed with endometriosis.
- Interviewed 18 women; the majority of these interviews took place over Microsoft Teams
- Each interview spanned 1-2 hours, during which handwritten ‘field’ notes were taken
- All interviews were recorded and professionally transcribed
Analysed using Grounded Theory Analysis

Question 21

Johannah Mitchells Theory- embattled empowerment

Answer 21

• Theme 1: Fighting a battle in isolation
  
  • This theme speaks to the feelings of isolation and loneliness that women voiced throughout interviews
  • Many women recounted these feelings prior to diagnosis, given a lack of validation and/or support
  • Underlying issue: health care professionals (HCPs) would sometime attribute symptoms to “normal” menstrual cycle discomfort
  • In the period following diagnosis, this dismissiveness often carried over to treatments - ones that seemed drastic or radical:
  • “I saw the consultant who pretty much tried to say that the MRI would probably be over-exaggerating, did an internal ultrasound, said, ‘Well it all looks fine to me. Look at your age, you are not going to have kids, just have a hysterectomy’, and I was just like so taken aback.” – Maria
  • Partner relationships:
  • For some women, there was a lack of support, empathy, or understanding from partners
  • Painful sex also led to a lack of intimacy
  • For others, partners were supportive and assisted with pain management
  • Fertility issues & social withdrawal:
  • Envy towards friends who were able to conceive easily
  • Many women described an overall sense of isolation and loneliness undermined by maze-like healthcare systems and lack of support from HCPs and those in their circle
• Theme 2: Shadows of Fear, Glimmers of Hope
  
  • Many women expressed feelings of fear and anxiety, often due to the unpredictable nature of endometriosis:
  • “It just meant that every time I had a flare-up, I felt that confusion again and that anxiety around what that meant.” – Madeline
  • This anxiety also carried over to concerns around fertility, often due in part to:
  • Whether conceiving would be possible
  • The chances of having a miscarriage
  • Feelings of inadequacy for not fulfilling “societal expectations”
  • A sense of losing control over one’s body:
  • “But when I had my first laparoscopy and they told me that doing this kind of surgery can affect your fertility, for that one moment, I felt that was my choice that I didn’t want to have babies but, what if it’s taken away from me?” – Gabriella
  • Small glimmers of hope occurred throughout the journey as well. For one woman, it was her gynecologist who provided this:
  • “I met this really lovely gynaecologist who said, ‘It’s a weird thing, endometriosis’, she said, ‘sometimes I see patients with only a little bit who just can’t get pregnant and other times I see people with endometriosis who do have children naturally’. And that was quite comforting to me because I had been told, ‘Oh God, you’ve got a really bad case’. -Scarlett
• Theme 3: Copelled into being my own advicate
  
  • Relief of Diagnosis → Grief → Acceptance → Empowerment
  • This theme gets at the range of emotions women experienced before reaching this state of empowerment:
  • For many women, the diagnosis brought relief, and it was a turning point - the point at which they felt compelled to keep fighting
  • But for some, this relief quickly turned into grief - especially for those struggling with infertility or loss (loss of control, of a life they envisioned…)
  • “I’m now in my mid-40s, and I’m never going to be a parent. Not the way that I wanted to be. Not to babies, and having a family, and all that sort of stuff. That’s not going to happen. And I still haven’t fully come to terms with that.” -Tessa
  • This sense of empowerment came through in interviews. We wanted to emphasize the ‘embattled’ to recognize all of the challenges women faced to reach this state of confidence
  • “I’ve become more unapologetic. I don’t care about anyone’s opinions… and I think I know my body more now…As a partner, I’ve been more vocal… I’ve communicated more. And it has given me the freedom to talk about my body without shame.”-Gabriella
  • “So, I think I’ve just become a little bit of a toughened endo warrior now that will shout it to the hills and when people go, ‘Oh I’ve got really bad periods’, I go, ‘Don’t get complacent.”-Maria
• Theme 4: Caution, Candour, but Not Conflation
  
  • The final theme speaks to the interplay between mental and physical health
  • It became clear through interviews that endometriosis and its impact on physical health affects psychological well-being (feelings of fear, panic, anxiety, isolation)
  • There is a nuance to this:
  • Too quickly labeling a valid emotional response as ‘anxiety’, ‘depression’, or otherwise, not only fails to address the underlying issue and the physical health concern(s), but it also invalidates the individual and increases the risk of mental ill health
  • The emotional support and validation (from partners, HCPs, family, friends) is crucial
    “I was feeling very nauseous, I was very bloated. I was getting asked, was I pregnant? I was in a lot of pain. I went to the GP… a very good GP surgery…And I was dismissed thirteen times for just being stressed. So that was very stressful!” – Serena

Question 22

what is early menopause?

Answer 22

• Accelerated reproductive ageing, whereby menstrual cycles cease before the age of 45
• Clinical presentations include (but are not limited to):
  
  • Sleeping issues
  • Hot flushes
  • Changes in cognitive abilities
  • Ceasing of reproductive potential
• According to research: early menopause affects:
  
  • 5% of women globally (Glen & Kallen, 2022)
  • And of this population, many experience ‘medical gaslighting’ (Fielding-Singh & Dmowska, 2022)
    Doctors are often unaware of the possibility of the menopause starting early (Singer & Hunter, 1999)

Question 23

early menopause and infertility (Chan et al., 2020)

Answer 23

• The relationship is directly linked…
  Menopause represents a change from youth and fertility to age-associated declines in physical functioning, whereby this transition from reproductive to post-reproductive life is unique for each individual

Question 24

early menopause treatment options

Answer 24

• Hormone replacement therapies (HRTs)
• However, pro menopause movements have been criticised as being led by: predominantly white, wealthy, non-disabled and normatively attractive women (Jermyn, 2023)

Question 25

Rebecca E. Fellows- the struggle for diagnosis with early menopause

Answer 25

• To explore how interactions with healthcare providers during an early menopause impact a woman’s health seeking behaviour and psychological wellbeing going forwards through the rest of her health journey.
• We wanted to understand this relationship through a qualitative lens. We decided that the best way to do this would be through one-to-one interviews with women diagnosed with early menopause.
• Interviewed 9 women; the majority of these interviews took place over Microsoft Teams
• Each interview spanned 1-2 hours, during which handwritten ‘field’ notes were taken
• All interviews were recorded and automatically transcribed
  Analysed using Grounded Theory Analysis

Question 26

Rebecca E. Fellows theory- between embattled empowerment and embattled resignation

Answer 26

• Theme 1: Fighting a battle in isolation
  
  • This theme represented the fight which women endured in order to make their voices heard and their concerns listened to
  • Many women were unable to get the practitioners to take into account the variety of symptoms they had due the practitioner’s refusal to talk about more than one symptom per consultation
  • “I went again at fifteen and me and my mum kind of just was like well we’re staying until you find out what’s wrong with me. ‘Cause I know something’s wrong with me.” – Sage
  • This reveals the sheer expectation of the consultation, formed from the women’s previous encounters, can impact the way in which the women communicate their care needs to the healthcare professionals going forth:
  • The participant’s lexical choices allude to the need for an individual to prepare for consultations, as they would in a battle, requiring an unwavering determination to ‘win’ the practitioner’s acknowledgement
• Theme 2: moments of fear vs moments of hope
  
  • Many women expressed momentary glimmers of hope which women encountered during their journey, however these were often over-shadowed by moments of fear
  • Women often felt disbelieved despite explaining they had family histories of early menopause
  • “They said to me, oh, well, you haven’t got cancer. And I said well I didn’t even know I was being tested for that ……… so I went through all of this. I went through a worrying like, months or so thinking, what the hell is wrong with me?”– Summer
  • Women were often left feeling once again alone, fighting for their concerns to be explored. Contrasting to this, some explained the ‘luck’ they felt when her doctor agreed to hormone tests
  • “So that’s when I went straight to a doctor and I was quite lucky in this sense that the doctor actually just straight away said we’ll get you some hormone tests” – Hope
• Theme 3: doubt and dismissal
  
  • Struggle for Diagnosis → Grief → Acceptance → Resignation
  • This theme gets at the doubt women received from practitioners when they shared their symptoms and concerns, as well as the dismissal and downplaying of such when the existence of them were acknowledged
  • “I saw a couple of GPs, had some bloods done and the first one just said you’ve moved, you’ve had a baby. It’s a big life change, it was, you’re stressed and just sort of parked it. Said there’s nothing wrong with you” – Maya
• Theme 4: rolling the dice for advice
  
  • Women often described the caution she felt necessary to demonstrate when interacting with her consultant, to save face on behalf of them so that she felt comfortable to question his care at a later point.
  • “I’ve kind of built my own support network. I’ve been very vocal about it. And when your vocal about it, other women kind of reach out and tell you I’m going through this or that, etcetera” - Maya
• Theme 5: compelled into being my own advocate
  
  • Relief of Diagnosis → Grief → Acceptance → Empowerment
  • Women described how their ‘navigation’ of the system was essential and this was often described to be done through a number of methods, such as researching, community-seeking and at times, demanding professionals’ attention
    “I think it is just the fear of being unwell is so much stronger than my fear of saying the wrong thing and especially being diagnosed so young, like the risks of it if I don’t get treatment like enough treatment early on, like my risk for like bone problems and heart problems is like so much more” – Etta

Question 27

the theory ‘embattled empowerment’ brings together these 4 themes:

Answer 27

• Interviews revealed that self-advocacy was not just important, but necessary for women navigating this condition and the emotional toll it carried
• Women were ‘compelled’ into being their own advocate - (for physical health, but also emotional & mental health) - because of a lack of understanding or inconsistent support from HCPs or those in their personal networks
• Interviews in both studies revealed that self-advocacy was not just important, but necessary for women navigating their conditions and the emotional toll it carried
  Women were ‘compelled’ into being their own advocate - (for physical health, but also emotional & mental health) - because of a lack of understanding or inconsistent support from HCPs or those in their personal networks