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Lesbian identities, daily occupations, and health care experiences
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Lesbian identities, daily occupations, and health care experiences
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A Bell & Howell Information Company
300 North Zeeb Road. Ann Arbor, M l 48106*1346 USA
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LESBIAN IDENTITIES, DAILY OCCUPATIONS,
AND HEALTH CARE EXPERIENCES
by
Jeanne Marie Jackson
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(Occupational Science)
August 1995
Copyright 1995 Jeanne Marie Jackson
UMI N um bert 9614030
Copyright 1995 by
Jackson, Jeanne Marie
AU rights reserved.
UMI Microform 9614030
Copyright 1996, by UMI Company. All rights reserved.
This microform edition Is protected against unauthorized
copying under Title 17, United States Code.
UMI
300 North Zed) Road
Ann Arbor, MI 48103
UNIVERSITY OP SOUTHERN CALIFORNIA
THE GRADUATE SCHOOL
UNIVERSITY PARK
LOS ANOBLES, CALIFORNIA 90007
This dissertation, written by
under the direction of Hr.C Dissertation
Committee, and approved by all its members,
has been presented to and accepted by The
Graduate School, in partial fulfillment of re
quirements for the degree of
DOCTOR OF PHILOSOPHY
Dean of Graduate Studies
Date . . . 2B,...1995 .....
DISSERTATION COMMITTEE
/?* ( jjl& M f y
Chairperson
DEDICATION
to
Jerry Sharrott
who courageously strove for authenticity in his life
Tom Clark
for his gentle wisdom
and
all my nieces and nephews
— Jami, Jake, Jennifer, Jenna and those to come--
whose innocence and wonder
give me immense hope that
the world will continue to evolve in a tolerant manner.
May they live their lives surrounded by acceptance and love,
regardless of their sexual orientation.
ACKNOWLEDGMENTS
I have been blessed with many friends, colleagues, and teachers over my life
time. I wish to acknowledge the numerous people who have supported me during
my academic endeavors, in particular throughout the course of this dissertation.
First and foremost, I would like to express sincere gratitude to the twenty
women who spent many hours sharing their lesbian stories with me. I was
privileged to meet a group of wonderful women who gave me their time and
personal reflections about being lesbian. Their insights have enriched my life and,
I hope, will make occupational therapy a wiser and more tolerant profession.
I would like to express my hcart-felt appreciation to the members of my
committee. Over the last decade, Florence Clark, the chair of my committee, and
I have embarked on a number of intellectual journeys, each one inspirational in and
of itself. She is much appreciated for her readiness to forge into territories once
hushed within our profession and bring them to the center of a new discipline.
Her willingness to turn every stone and enter into delicate yet exciting intellectual
critiques of this study has enhanced the flnal product. Florence is a remarkable
scholar and I am thankful for the opportunity to have worked with her.
I had the pleasure of being introduced to the occupational therapy program at
the University of Southern California by Ruth Zemke and she has remained
instrumental to my stay here. Ruth is one of those rare but much appreciated
graduate program coordinators who can balance genuine concern for each student's
specific situation with generalized bureaucratic regulations. Ruth has provided
sound ethical advice that has helped my graduate studies, this dissertation, and will
serve me well in my future academic career.
iii
Diane Parham has been a mentor since my earliest days at USC. Diane’ s
ability to respect and appreciate differences in students, patients, and friends has
been a source of courage for me, especially with respect to this dissertation topic.
On a more practical level, my participation in her research trained me for various
aspects of this dissertation, in particular, moving out of state to collect data.
Donald Folkinghome offered valuable assistance, especially with the
methodology. Our conversation about the contribution that occupational science
can make to rehabilitation was very enlightening. I look forward to more
discussions.
Crossing paths with Barrie Thome has had a profound effect on my academic
pursuits. I cherish the liberating discussions she encouraged in her Feminist
Theory course and am deeply appreciative of her emotional support and most
valuable input into this dissertation. Above all, Barrie’s feminist perspective and
practices have been a true source of inspiration to me. She has taught me how to
think about issues of diversity in the most respectful ways.
Beyond the members of my committee, I am immensely grateful for the
contact I have with Elizabeth J. Yerxa. Her wisdom and ethics have been a
guiding force in my life. I especially appreciate my annual pilgrimage to
Aspendell, a peaceful place to rejuvenate one's soul. Her gift. The Gift of
Courage, gave birth to my interests in themes of meaning and occupation.
I would also like to thank the numerous people who have supported me,
particularly during the early years of my doctoral studies. Edith Gillespie, Jason,
and Annie provided me a safe haven at the beach to collect my thoughts and begin
to explore new ideas. John White collaborated with me in many enlightening
classroom experiences. He also provided me valuable contacts for this project.
Wendy Wood and I spent countless hours on the telephone and in person dreaming,
intensely hammering out issues, and laughing. I hope never to foiget these fond
memories.
While in the throes of writing this dissertation, Jo Wright became the
colleague down the hall who would brighten my day with words of encouragement,
humorous cards, or an afternoon visit in which she shared life philosophies. She is
a treasured friend with whom I hope never to lose contact. Marian Karsjens’s
assistance throughout my doctoral studies is appreciated beyond words. She
transcribed tapes and offered editorial advice with utmost professionalism, an
extremely important attribute, given the confidential nature of this study. Sara
Karsjens must be commended for filling in and churning out tape transcriptions
when her mother was on vacation. Jim Karsjens is acknowledged for his behind-
the-scenes technical assistance. Marcia Knous has been a friend throughout the
project and extended her friendship to tape transcription when my time was
shrinking rapidly. I participated in wonderful conversations and received warm
encouragement from Susie Wendorf and Tom Clark, members of the feminist
reading group. Many kudos to Linda Florey and Bonnie Kennedy for their
technical assistance, overall concern, and encouragement.
Thanks is extended to the California Foundation of Occupational Therapy for
the Wilma West Scholarship and to the Department of Occupational Therapy at the
University of Southern California for the Penny Richardson Award.
Permission was granted by the American Occupational Therapy Association
to reprint portions of Jackson, Jeanne (1995) Sexual Orientation: Its Relevance to
Occupational Science and the Practice of Occupational Therapy from the American
Journal o f Occupational Therapy, 49(7), 669-679. Permission was granted by
v
F.A. Davis to reprint a portion of Jackson, Jeanne (in press) Living a Meaningful
Existence in Old Age, in R. Zemke and F. Clark (Eds.), Occupational Science:
The Evolving Science.
My family also deserves recognition. My sister Jackie, her partner Frank,
and their daughter Jennifer lightened the process of collecting data by providing me
a peaceful place to stay and by diverting my attention with gorgeous sightseeing
and a camping trip. Jackie, Juli, Joni, Jill, my sisters; Jon my brother; Frank,
Jay, Rick, Jim, and Julia, their partners; Gene my mother's partner; and Father
Ibm and Nan have all provided support in their own individual ways. Many
thanks. Early in life, my mother taught me to follow my convictions, a lesson
which has carried me through the arduous and joyful moments in life. I think her
for that lesson and many others.
There is no way to express the amount of admiration and respect that I have
for Jerry Sharrott. His spirit is infused throughout my life and thus, throughout
this dissertation. Jerry's words, thoughts, and smile will remain in my heart
forever.
Finally, and of utmost importance. Nina Treadwell deserves my warmest
affection. She alone has brightened my life on a daily basis and eased the
pressures of writing a dissertation. Her insights and experiences helped me frame
the initial research question and clarify some of the analysis. Most of all, she
provided enduring emotional support, continually opening windows to let in fresh
air.
vi
TABLE OF CONTENTS
DEDICATION
ACKNOWLEDGMENTS.............................................................................. iii
ABSTRACT.................................................................................................... xi
CHAPTER
1. INTRODUCTION .............................................................................. I
Background to the Problem ................................................................ I
Factors Contributing to the Invisibility of Sexual
Orientation in Occupational Therapy ............................ 3
Evidence to Support This Proposed Study............................... 8
C onclusion................................................................................. 10
Purpose of the S tu d y .................. ....................................................... 10
Significance of the Study ............................................ 11
Relevance to Occupational S c ien c e......................................... 12
Relevance to Occupational T herapy.......................................... 14
Relevance to the Occupational Therapy
Professional O rganization................................................ 16
The Researcher's Experience and Underlying Assum ptions 17
2. LITERATURE REVIEW ................................................................... 21
A Historical Glimpse of the Construction of
Lesbians in M edicine................................................................ 22
Lesbians: From Religion to M edicine.................................... 22
Lesbian Images in Contemporary Health Care Arenas 32
Health Care Experiences Among Lesbians ............................ 39
Summary: Implications for Occupational Therapy .............. 44
Lesbianism and Id en tity .................................................... 45
Identity as a Narrative .............................................................. 47
Identity Constituents................................................................... 50
Conclusion: Lesbian Id en tities................................................ 54
3. RESEARCH METHODOLOGIES..................................................... 59
Methodological A pproach................................................................... 59
Feminism ...................................... 59
Qualitative M ethods................................................................... 61
Selection Strategies.............................................................................. 63
vii
Participant Description.......................................................................... 66
Lesbians Who Are Occupational Therapists . . ....................... 67
Lesbians Who Are D isabled...................................................... 70
Data C ollection..................................................................................... 74
Interviews-Description............................... 74
Interviews-Procedures ............................................................... 76
Data A n aly sis........................................................................................ 83
Thpe Transcription ............................................................... 84
C oding................................................................... 85
M em os.......................................... 88
Ethical Responsibilities.......................................................................... 88
The Researcher’s Experience............................................................... 89
4. THE STRUGGLE FOR AUTHENTICITY
THROUGH OCCUPATION.................................................................. 95
Authenticity ........................................................................................... 95
Authentic Lives: Lesbian Identities Embedded in Occupation . . . 99
Lesbian Occupations: Coming H o m e ................... 101
Lesbian identities embedded in leisure occupations . . . 105
Lesbian identities embedded in political occupations . . 106
Lesbian identities embedded in spiritual occupations . . 109
Occupational P atterns.................................................................. 112
Lesbian identities in subtext.............................................. 113
Split lives .......................................................................... 114
Continual im m ersion......................................................... 115
Authentic Lives:
Occupations that Validate, Integrate, and B rid g e .................... 117
Inauthenticity in Relationships and Occupations .................... 118
Occupations that Validate ................................................. 123
Occupations that Integrate ......................................................... 130
Bridging Occupations............................................. 134
Family bonds .................................................................... 134
Inventing rituals: The mom’s p a r ty ................................ 139
Recasting heterosexual rituals:
The lesbian baby show er........................................ 142
Friendship b o n d s ............................................................... 144
Conclusion............................ 147
5. HETEROSEXISM IN THE OCCUPATIONAL THERAPY
WORK PLACE .................................................................................. 149
The Worker "Role": Appropriate Behaviors or C ensorship 150
Heterosexism in Occupational Therapy Clinics: Destructive or
Constructive C lim ates...................... 163
Heterosexual Climates: The Background N o is e .................... 164
Heterosexual discourse...................................................... 164
Homophobic comments ................................................... 171
Assumed heterosexuality................................................... 174
Perceived stereotypes......................................................... 176
viii
H arassm ent.................................................................................... 179
R um ors................................................. 179
S a b o tag e .............................................................................. 181
Threat of term ination.......................................................... 183
The glass ceiling ................................................................ 185
Nurturing Environments ............................................................. 189
Managing One’s Lesbian Identity in the
Occupational Therapy C lin ic....................................................... 193
Disclosure at Work ...................................................................... 194
Remaining closeted............................................................. 195
Coming out ........................................................................ 200
Maneuvering around Heterosexist C lin ic s ................................ 201
S ep aratio n ........................................................................... 202
Clamming ........................................................................... 208
Surveillance........................................................................ 208
Censoring ........................................................................... 210
P a ssin g ................................................................................. 212
Using anger to emplot palatable acts ............................. 213
Authentic representation.................................................... 214
C onclusion............................................................... 216
6. OCCUPATIONAL THERAPY CUNICS:
AUTHENTIC PATIENT CARE .......................................................... 219
Health Care: Problems and Joys, in General ................................... 220
Western Medicine: A Rude A w akening................................... 221
Conflicting M e ssag e s.................................. 225
Inadequate Care ........................................................................... 227
Rehabilitation: The Positive S id e ............................................... 228
Sexual Orientation: Its Influence on Health C a r e ............................. 230
Finding a Sensitive Medical Professional ................................ 231
Assessments: Censorship or D isclosure................................... 235
Individualized T reatm ent............................................................. 239
Denied care and less than adequate se rv ic e s.................. 239
Heterosexual c o n te n t.......................................................... 243
Gender b ia s e s ...................................................................... 246
Therapeutic interactions.............................................. 253
Occupational Therapy in the Context of
Acknowledged Lesbian Id e n tity .................................................. 260
Sandy's Rehabilitation Experience ............................................ 261
Therapeutic Interactions .............................................. 263
Treatment .................................................................................... 264
Does Being Lesbian Matter to Treatm ent?................................ 269
C onclusion............................................................................................... 273
7. IMPLICATIONS FOR OCCUPATIONAL SCIENCE
AND OCCUPATIONAL T H E R A P Y ................................................. 275
Implications for Occupational Science.................................................. 276
Implications for Occupational Therapy .............................................. 283
ix
REFERENCES............................................................................................... 290
APPENDIX
A. Definition ..................................... 301
B. Research Studies .................................................................................. 304
C. Stereotypes............................................................................................. 308
D. Recruitment Ads .................................................................................. 310
E. Recruitment L etters............................................................................... 313
F. Interview G uidelines............................................................................ 316
G. Consent Forms ..................................................................................... 321
x
ABSTRACT
At the heart of occupational science and the occupational therapy profession
ties the belief that people can create meaningful lives by engaging in occupations
(i.e., activities, practices, rituals) that arc symbolically significant on a personal
and cultural level. Related to this notion is the assumption in occupational therapy
practice that treatment must take into account the multidimensional aspects of a
person. This study explored these two themes in the lives of lesbians. First, I
described how lesbians created and nurtured their lives by weaving together their
lesbian identities and occupations. Second, I gathered descriptions of the kinds of
therapeutic environments that were constructive to versus those that hindered the
provision of authentic occupational therapy to lesbians. Qualitative research
methods embracing a feminist perspective were used to analyze multiple, in-depth,
open-ended interviews of twenty lesbians, ten were occupational therapists and ten
had disabilities.
Several key findings emerged. First, being lesbian influenced the
respondents' lives in leisure, political, and spiritual spheres. Second, occupations
that possessed particular qualities-homosexual social context, homosexual content,
homosexual symbolism, or a tenor that encourages emotional peace about one's
homosexuality— constituted expressions of lesbian identities. Third, occupations
often embodied and reified heterosexual ideologies and social convention, creating
discomfort for lesbians. Fourth, lesbians longed to be authentic with respect to
their lesbian identities. They described rituals that they created to honor their
lesbian identities, promote feelings of integration, or bridge the heterosexual and
homosexual world views of friends and family. Fifth, heterosexual climates
pervaded occupational therapy clinics and were maintained through heterosexual
discourse, homophobic comments, assumed heterosexuality, stereotyping, and
harassment. Therapists dealt with heterosexual environments by separating,
passing, surveying, censoring, and strategically using anger. Despite the
prevalence of heteroscxism, genuine humanistic approaches toward patients and co-
workers contributed to positive occupational therapy work environments. Sixth,
heterosexist attitudes and practices invaded most areas of rehabilitation and, at
times, compromised treatment in ways that were not immediately evident to
patients. Finally, occupation-centered occupational therapy is one way that
occupational therapy clinics can become more lesbian-sensitive.
CHAPTER 1
IN TR O D U C TIO N
We define occupation, simply, as chtmks o f culturally and personalty meaningfitl
activity in which humans engage tlmt can be named in the lexicon o f our culture.
Activities such as dressing, attending a party, gardening, watching television, making
love and preparing a meal are occupations. Our use o f the term occupation is tluts
conceived generally and not in the conventional sense o f a career or job, nor does it
only include activities that meet productivity needs. . . .When we attempt to explain
occupation simply as an activity unsalurated with meaning, we miss its essence.
(Clark ct al., 1991, pp. 301-302).
B ackground to the Problem
At the core of occupational therapy lies the belief that people have the potential
to create meaningful lives by engaging in a configuration of occupations that both
carries symbolic significance for the individual and serves as a connecting link
between the individual and society (Clark, cl al., 1991; Reilly, 1962, 1966a, 1966b;
Yerxa, 1983). This belief undcrgirds practice agendas that aim to assist persons with
disabilities to dcvctop the skills needed to adapt to their environmental surroundings,
specifically through what they do on a daily basis. In this sense, adaptation through
engagement in occupations that ore individually and socially meaningful is a central
theme for occupational therapy. It is important to note that, through the overriding
concept of adaptation, occupational therapists have not only been concerned with what
people do throughout their day and life but also with how they experience, or the
meaning underlying, these actions. Yerxa accentuates this notion in her statement,
"Authentic occupational therapy is based upon a commitment to the client's realization
of his own particular meaning" and "his potential in accordance with that meaning"
(1985, p. 170). Building on this idea, Yerxa later stated, "understanding patients'
views of themselves, their worlds and their sources of satisfaction is central to the
I
therapeutic process" (p. 152). If occupational therapists arc to be true to Ycrxa1 s call
and provide authentic occupational therapy, then they must begin to enter the worlds of
meaning in which their patients have carved out an existence.
Although responsiveness to the personal meaning systems or persons with
disabilities has been a cited concern in occupational therapy literature, this mandate
becomes considerably difficult to enact when the full realm of culturally specific
experiences of certain groups of individuals arc relatively invisible to the profession.
Of particular concern for this study is the pervasive absence of references to sexual
orientation, specifically lesbianism, within the occupational therapy literature, even
though this aspect of the person may have a profound effect on her life style, her
orchestration of occupations, and her sense of meaning. In fact, sexual orientation has
been noted by some lesbians to be a central theme contributing to their sense of self
and influencing many aspects of their occupations, such as work choices, friends, and
living situations (Bennett, 1992; Fadcrman, 1991; Stevens & Hall, 1988; Weston,
1991; Wood, 1990). It seems reasonable to conclude that, for women who arc
lesbian, their lesbian identity may be on empowering theme of meaning that inspires
their choices for action. For others it may be a source of tension infusing a sense of
duplicity in the everyday world of activity. In either ease, occupational therapists have
a commitment to create accepting environments that encourage these women to realize
their own potential including identities central to their lesbian experiences, whether
expressed overtly or operating at a private level. This commitment is unattainable
when the occupational therapy profession is unaware of the relationship between
sexual orientation and occupation.
Factors Contributing to thc.Invisibilitv or Sexual Orientation in Occupational Therapy
Why is sexual orientation so hidden in the literature and practice of
occupational therapy? This question can be addressed by examining both frames of
references within the profession and the attitudes of therapists toward issues of sexual
orientation. Although the occupational behavior frame of reference (Matsutsuyu 1969;
Reilly 1966a, 1966b, 1969) and the Model of Human Occupation (Kiclhofncr &
Burke, 1985) ore not the only two theoretical perspectives in the occupational therapy
profession, they are probably among the most influential at the present time. For this
reason, and the fact that occupational science has emerged from the philosophical
traditions set forth by Mary Reilly, the above two perspectives will be the focus of the
ensuing discussion. The contributors to these two schools of thought inadvertently
promote the silencing of sexual orientation through the omission or this content in their
work (Heard, 1977; Kiclhofncr & Burke, 1985; Reilly 1966a, 1966b, 1969). For
example, Reilly's reliance on role theory as she developed the occupational behavior
frame of reference defined the domain of activity which she designated as the specialty
of occupational therapy theory and practice. In this process, she (1969) claimed the
category of occupational roles as belonging to occupational therapy, while rejecting
sexual and familial roles. Reilly's exclusion of sexual roles, 1 suspect, stemmed in
part from her objection to the, then popular, psychoanalytic notion that sexual energy
was the basis for human action (Reilly, 1962). Although this choice appears related to
Reilly's rejection of this aspect of Freud's theory, the exclusion of sexuality from the
discourse in occupational therapy may have contributed to a continuing eclipse of
sexual orientation within the profession.
Consigning "sex roles" to a position outside the professional concerns of
occupational therapy, in and of itself, does not imply an exclusion of lesbian and gay
concerns from its corpus of knowledge. The latter follows only if lesbianism and
gayness arc construed purely in sexual terms. However, given the prevailing notions
of homosexuality in society that simply relate it to physical intimacy with a person of
the same gender, it is understandable that this occurred within the occupational therapy
profession. These beliefs about lesbian and gay existence were especially prevalent in
the time of Reilly's writings, and thus it can be expected that they were, for the most
port, embedded in the common stock of knowledge that informed occupational therapy
theory and practice. Thus, two issues, the view of lesbian and gay identity exclusively
in terms of sexuality and the exclusion of "sex roles” laid the foundation for
overlooking sexual orientation in the development of the occupational behavior frame
of reference and, ultimately, contributed to the invisibility of sexual orientation
throughout the profession.
Kiclhofncr, one of Reilly's students who both furthered her notions
(Kielhofncr, 1993) and through his work with Janice Burke on the Model of Human
Occupation moved them into new directions (Kiclhofncr & Burke, 1985), exemplifies
how Reilly's exclusion of sexual orientation eventually became embedded in the
models that emanated from her frame of reference. Following in Reilly's footsteps,
Kiclhofner (1993) defines occupation as the "dominant activity of human beings that
includes serious, productive pursuits and playful, creative, and festive behaviors" (p.
84). He explicitly notes that sexual, social, and spiritual activities remain outside the
domain of occupational therapy, although he begins to acknowledge an
interrelationship between these four types of activities. In this sense, Kiclhofncr's
inattention to issues of sexual orientation appears to be consistent with his dismissal of
sexual activities from occupational therapy's concern. However, Kiclhofncr's
blindness to the notion that one's sexual orientation could become an important
symbolic theme that influences occupations seems to be particularly apparent in the
Model of Human Occupation. The Model of Human Occupation recognizes the
essential function that volition plays in motivating one's participation in occupations.
Volition is defined as
an interrelated set of energizing and symbolic components
which together determine conscious choices for
occupational behavior. The energizing component is a
generalized urge for exploration and mastery. The symbolic
components arc images (i.e. beliefs, recollections,
convictions, expectations) which include personal
causation, values, and interest. (Kiclhofncr & Burke, 1985,
p. 14)
As this definition illustrates, Kiclhofncr and Burke offer a framework for analyzing the
relationship between beliefs, convictions, and values, all of which could be influenced
by sexual orientation, to occupation. Despite the fact that these authors provide the
opportunity to discuss how one's sexual orientation may influence occupation, the
subject docs noL appear to surface in Kiclhofncr's discussions or any ease studies that
he employs. One may surmise that sexual orientation is not addressed by these
authors because of the interpretation that it is tied to sexual activity, instead of an
overarching perspective imbued with a set of values and beliefs.
As stated before, these two theoretical perspectives arc quite influential within
the occupational therapy profession, in that they provide an overriding lens that guides
the analysis or occupational performance, and to some extent treatment principles.
Thus, the omission of sexual orientation from their analysis ultimately affects how
therapists provide services to their patients and the types of treatment they offer.
However, it is not sufficient to merely state that sexual orientation must be included in
these models. The prevailing belief that the essence of a lesbian or gay existence is
encapsulated in sexual acts precludes an adequate exploration of how a lesbian or gay
identity may influence, for example, choices that are made with respect to doily
activities, how communities of families and friends are constituted, or how political
and spiritual convictions are lived out, among other things. Thus it is conceivable that
5
(he limited mind set which connects sexual orientation only to sex acts could be
preempted with a broader and more detailed understanding of how one's lesbian or
gay sensibility informs beliefs, values, and convictions, and thus influences
occupations. If this were the ease, treatment plans might be more potent and patient
care more authentic.
I recognize that it is misleading to slate that the occupational therapy literature is
completely devoid of references to sexual orientation. Prior to Reilly's work on the
occupational behavior frame of reference, two prominent members of the profession.
Mosey (1968) and Llorcns (1985), who uses Moscy's work, suggested that
heterosexual relations constitute an adaptive skill that occupational therapists may wish
their patients to achieve. Specifically, Mosey (1968) discussed what she termed a
"sexual identity interaction skill" (p. 428) which was defined as "the ability to accept
one's sexual nature and to participate in a heterosexual relationship which is oriented to
the mutual satisfaction of sexual needs” (p. 428). Llorcns (1985) incorporated
Mosey's work into her synthesis of the various sources of knowledge that support
occupational therapy practice and referred to "mutually satisfying heterosexual
relationships" (p.202) as an adaptive skill. In these eases, sexual orientation is not the
center of the theories or discussions but rather implied in the assumption that
heterosexual relationships are adaptive. Twenty years later, sexual orientation is
resurfacing in the occupational therapy literature, again not os a topic directly under
consideration, but rather through the back door, under the concern with AIDS. In
articles that focus on AIDS and occupational therapy services for persons with AIDS,
the sexual orientation of gay men is both mentioned and in a minor way incorporated
into the discussion of treatment For example, in a case study of a 35-ycar-old male
with AIDS, Pizzi ( 1990a) mentioned his involvement with Dignity, a Catholic
organization for lesbians and gays, and his relationship with his partner. Likewise,
6
other authors who have contributed to a book on occupational therapy, entitled Living
Strategics for People With AIDS (Johnson & Pizzi, 1990), begin to deal with sexual
orientation by touching on the subject of homosexuality and stigma (Williams, 1990),
gay culture as it relates to sexual and friendship networks (Scaffa & Davis, 1990), and
feelings of spiritual guilt associated with being gay (Prcsli, 1990).
Although these articles open the door for a dialogue of sexual orientation, none
of them explore in depth how one's experience of being gay may influence
participation in occupations; nor do they present knowledge about gay subcultures that
would support therapists in their attempt to "understand the person and his or her
source of satisfaction” as Yerxa (1985, p. 152) suggested. Furthermore, because
these references to sexual orientation are presented incidentally within the context of
AIDS, readers ore presented with considerations of homosexuality solely within the
context of disease and gay men. This particular focus does not provide a blueprint for
the multiple ways sexual orientations influence occupation, nor does it even mention
the experiences of lesbians. If the dialogue stops here, a very limited and fractured
image of homosexuality will remain in the occupational therapy literature, creating a
great disservice to those patients who arc lesbian or gay.
An important insight that emerged from the articles that presented philosophical
discussions of ethical responses to AIDS was the suggestion that homophobia exists in
the occupational therapy profession (Hansen, 1990; Pizzi, 1990a, 1990b).
Homophobia was reflected in terms of the therapist's fear of working with persons
who have AIDS. This disease, as well as the establishment of a Lesbian, Gay, and
Bisexual Networking Group in the profession, served as a catalyst for uncovering
negative attitudes that therapists may unknowingly carry about certain populations of
people. Comments in response to both have indicated that some occupational
therapists fear "association with an out-group such os homosexuals" (Pizzi, 1990b;
Vincent & Schkadc, 1990, p, 209); deny that sexual orientation needs to be addressed
in treatment protocols or curricula (Weaver, 1992); and believe that homosexuality is
morally wrong (Grimm, 1992). Such attitudes, whether they emerge from fear,
naivctd, or religious training, contribute to a pejorative atmosphere that ultimately
burdens the relationship between therapists and patients. In the end, on atmosphere
that exudes negative attitudes from health care providers toward patients who ore
lesbian, gay, or bisexual will not promote "authentic" occupational therapy.
(Fora broader definition of terms such as homophobia, hctcroscxism, authentic
occupational therapy and lesbian see Appendix A).
Evidence to Support This Proposed Study
I have put forth the argument that sexual orientation needs to be addressed in
occupational therapy practice. No studies have examined the impact of on individual's
sexual orientation on the treatment he or she receives in occupational therapy per sc;
however, strong evidence exists that deeply embedded hclcrosexisi altitudes permeate
medical institutions in general. Furthermore, there is ample evidence that hetcrosexist
attitudes affect the services provided by other health core professionals, predominantly
nurses, physicians, social workers, and psychiatric aids. Overwhelming evidence
exists that lesbians receive poorer health care services than heterosexuals; that health
care providers ore ill informed about relevant issues related to being lesbian; and that
prejudicial attitudes of health care providers create a hostile environment in which
lesbians are fearful to fully discuss health issues (Cochran & Mays, 1988; Dardick &
Grady 1980; Potter, 1985; Roberston, 1992; Stevens & Hall, 1988; Stevens, 1992b;
Zeidenstein, 1990).
These studies predominantly address adult experiences; however, adolescents
encounter similar situations. The U.S. Report of the Secretary's Task Force on Youth
Suicide claimed that lesbian and gay adolescents have a two to six times greater chance
of committing suicide than heterosexual adolescents (U.S. Department or Health &
Human Services [DHHS], 1989). This statistic, combined with the fact that biases of
mental health professionals have been deemed a risk factor contributing to adolescent
suicide, suggests that lesbian and gay adolescents are subjected to more tenuous health
care than heterosexual adolescents. It is highly unlikely that occupational therapists
would be impervious to this present trend in health core. In fact, the previously
acknowledged altitudes of some occupational therapists begin to support the
conclusion that lesbian, gay, and bisexual adolescents os well as adults, may receive
less than adequate occupational therapy.
Provision of adequate heath care services to people who arc lesbian, gay, or
bisexual requires another level of understanding of sexual orientation by occupational
therapists. Specifically, how one's experience of being lesbian, gay, or bisexual
affects his or her daily activities needs to be addressed. As stated above, within
society at large, homosexual orientation, for the most part, is defined in terms of
physical intimacy, period. Given this definition, outside the realm of sexual activity,
one's sexual orientation appears to have little to no relevance. However, studies that
provide accounts of lesbian lives or that examine specific aspects of lesbianism indicate
that one's identity as a lesbian influences more that just the physical attraction one may
have for another woman. Lesbian identity has been cited as influential in work
choices, political alignments, family constellations, leisure activities, choice of
friends/confidantes, and spiritual affiliations (Bourne, 1990; Faderman, 1991;
Lockard, 1986; Weston, 1991; Wood, 1990). These findings begin to identify the
breadth of ways that one's sexual orientation may influence what one chooses to do
and also suggests that further analysis is warranted. For a full orbed understanding of
9
the meaning or and influences upon occupation, sexual identity, I have argued, must
be taken into account
Occlu sio n
On both a theoretical and practical level, occupational therapists have been
committed to assisting persons with disabilities to live in a manner that is both
personally and socially meaningful. For women who arc lesbian, this entails
providing a safe environment in which issues of sexual orientation can be discussed
with respect to the occupations that she may wish to reintroduce into her life following
disability. Presently, the occupational therapy profession offers little theoretical or
practical support for therapists who may wish to enhance their ability to provide
relevant treatment to lesbians. On the other hand, the profession seems to be on the
threshold of beginning dialogue about issues or diversity, including sexual orientation.
In order to begin this dialogue and ultimately enhance treatment, occupational
therapists must understand how an individual's identity as a lesbian may, first, affect
what she chooses to do and the meaning that she brings to those occupations, and
second, create a unique set of challenges within the occupational therapy clinic. This
study will contribute to that knowledge base by beginning to explore the experiences
of lesbian occupational therapists and patients and how their lesbianism affects their
occupations and the therapy they receive and provide.
Purpose of the Study
In this study, I gathered personal reflections about how lesbians created and
nurtured their lives by weaving together their lesbian identities and occupations. The
narrations I gathered begin to answer questions such as: How do people create their
lesbian identities through occupations? What are the narratives that they tell about how
10
their actions express their lesbian identities? How arc occupations central in women's
struggle to maintain authentic lesbian lives? and. How do occupations that embody
heterosexual ideologies create tension for lesbians?
The second purpose of this study was to gather descriptive information about
the types of therapeutic environments that arc constructive and those that hinder
authentic occupational therapy in relation to lesbians. I used interviews to tap the
experiences that two groups of women have encountered in occupational therapy.
These groups included women who arc disabled and lesbian, most of whom had been
the recipients of occupational therapy, and women who are occupational therapists and
lesbian and have thus been the providers of occupational therapy. The data gathered
show how hctcroscxist environments maintained in occupational therapy clinics and
hospitals and how lesbian-sensitive occupational therapy clinics con enhance the
quality of care for lesbian patients. They also illustrate how lesbian identities can
become part of occupational therapy that is informed by occupational science
principles.
Significance of the Study
This study has the potential to impact the occupational therapy profession in
three ways. First, the information gained advances the knowledge base of
occupational science. Second, support for providing "authentic" occupational therapy
for lesbians is offered. Third, information about the specific conditions of lesbians'
minority status both within the occupational therapy profession and the health core
system is described. 1 shall now discuss each of these expected benefits in more
detail.
II
Relevance to Occupational Science
"Individuals are most true to their humanity when engaged in occupation"
(Ycrxa ct al., 1990, p.7). In this quote, the authors aptly reflect the most fundamental
assumption of occupational science, that the nature of the human is to be engaged in
occupations. It is through participation in a personally constructed repertoire of daily
occupations that humans have the opportunity to experience pleasure in
accomplishment, develop a sense of competency, maintain health, foster a sense of
dignity, and, ultimately, create a meaningful existence. This is not to say that
occupations do not have the potential to be frustrating, humiliating, and painful (Ycrxa
ct al„ 1990). However, occupational science is ultimately concerned with the
human's ability to adapt to his or her specific social situation and maintain a sense of
personal worth through the organization and balance of daily occupations. The
findings of this study provide evidence of how some women's lesbian identities are
embedded in the occupations that arc part of their lives. Furthermore, evidence os to
how women who arc lesbian conceal, deal with, reconcile and/or reinforce their
lesbian identity through what they do is provided.
The second concept central to occupational science is the notion that people
engage in storied actions. Individuals impart symbolic significance to their everyday
actions and, in doing so, create a narrative of meaning about what they actually do
with their time. As each individual approaches his or her day, regardless of the
similarities in activity, the meaning attributed to actions that stem from his or her own
personal historicity shades the subjective construction of reality. The human's
capacity to interpret everyday experiences from multiple perspectives (Gergen, 1982)
underlies the individualism embedded in one's matrix of daily occupations. Yerxa
underscores the importance of attending to the interpretive nature of occupations,
stating that "humans live by and for symbolic causes" (1991, p. 202). People "do
occupations” for reasons and, whether their reasons are fueled by passionate
convictions or complacent justifications, these reasons are as much a part of their
actions as the physical doing of the activity. Thus. Lhc study of human occupation
must encompass not only its objective nature but also the personal symbolic meaning it
embodies. One purpose of this study was to document how a woman's lesbian sexual
orientation became a symbolic cause and/or a meaningful theme in her narrative, which
influenced how she perceived her occupations. By doing so, it was reasoned that this
study would further the understanding of the interpretive nature of occupations.
The third concept supporting occupational science is that human agency is to be
valued (Clark ct al., 1991; Ycrxa ct al., 1990). Individuals, according to occupational
science, create themselves through their choice of and participation in a particular
configuration of daily occupations. Although human agency is valued, occupational
science equally respects the social-historical condition under which individual choice is
expressed. People's choices of action arc impelled by personal passions and
convictions, yet these commitments arc always embedded within a particular social-
historical community of beliefs (Bruner, 1990). People do not act in isolation of
others, nor do they automatically assume the particular cultural traditions and beliefs in
which they are bom (MacIntyre, 1984). Rather, they engage in an ongoing
negotiation between their own personal vision for an acceptable life and the enabling
and constraining forces of their particular social traditions. The resolution of this
tension is expressed in the occupational configuration that emerges both on a daily
basis and throughout one's life. Likewise, through human action the environment,
including its physical form, political laws, social ideologies, and spiritual traditions,
can be transformed to create a habitable world. It was reasoned that the findings of
this study would provide greater insight into how physical, social, political, and
spiritual contexts enable or constrain the participants in their attempts to pursue daily
13
activities in the context or their lesbianism. By virtue of their sexual orientation, these
women find themselves immersed in a life that is at odds with mainstream notions,
creating a special tension in their lives. Of particular concern for this study was if and
how homophobia takes shape within their immediate environments and the dynamics
they employ to maintain a life that is personally acceptable yet fits within their
particular social traditions.
Relevance to Occupational Therapy
Following a 2-ycar extensive study that explored the process occupational
therapists used to make clinical judgments and carry out treatments, Mattingly ( 1991a;
1991b) and Fleming (1991) have articulated models of clinical reasoning that are often
present in the occupational therapy clinic but not well understood by the therapists
themselves. Mattingly (1991a) observed that a central concern in occupational therapy
is the illness experience which she defined as "the meaning that a disability takes on
for a particular patient, that is, how disease and disability enter the phenomenological
world of each person" (p. 983). To work with the illness experience of patients, the
therapists who participated in the study engaged in a narrative reasoning process which
entailed creating a shared image of what this particular disability meant to the specifics
of the individual's life. A truly effective therapeutic process required therapists to
enter the inner worlds of their patients, grasping the most essential elements of their
lives, including commitments, values, and beliefs. Pulling these threads together into
an "existential picture" (1991b, p. 1002) depicting an imagined future about the
patient's possibilities for living his or her particular life with a disability served to
guide choices for the present treatment. Mattingly ( 1991b) named this process a
"prospective treatment story" (p. 1001) in which the patient's past, present, and future
are brought together within the larger social context of family and community.
14
Occupational therapy, as depicted above, demands complex skills from the
occupational therapist Among those skills is the ability to move in a fluid manner
between different modes of reasoning while co-designing with the patient effective
treatment activities (Crcpcau, 1991; Fleming, 1991; Mattingly, 1991a). One mode of
reasoning requires therapists to be able to use a frame of reference effectively as a lens
for understanding possible problem areas and treatment procedures. In addition,
therapists must be able to assume a mode of reasoning that enables them to take the
perspective of the patient as a means for accessing his or her experience of disability.
In the same vein, the therapist must be able to understand the particular social and
cultural context which informs the patient's "life-world" (Crepeau, 1991; Fleming,
1991). It is the ability to take a reflective stance and grasp the patient's perspective that
is most challenging, os it requires both insight into the therapist's own unconscious set
of meanings that constitute reality, and the skill to achieve an inter-subjective
understanding^ the patient's life world (Crcpcau, 1991).
Effective clinical reasoning requires a shared world between the patient and
therapist (Crcpcau, 1991; Mattingly, 1991a). Trust and open communication lay part
of the foundation for achieving these shared visions. Yet, trust can only be achieved
within safe, respectful environments in which individuals feel comfortable sharing
their innermost selves. For people who are lesbian, gay, and bisexual, secrecy is one
response to the stigma that prevails throughout society at large (dc Monlcflorcs, 1993).
Without certainty that health care professionals will accept this aspect of one's life,
those who ore not heterosexual may be hesitant in sharing this aspect of their identity.
On the other hand, one's sexual orientation may be integral to the support networks or
life activities in which one engages. Thus, without an environment that supports
lesbian, gay, and bisexual orientation, the clinical reasoning process and ultimately
"authentic occupational therapy" cannot be fully realized. The findings from this study
15
provide information that could enhance the clinical reasoning process by (1)
broadening occupational therapists' understanding of a lesbian subculture, thus
fostering the inclusion of activities that are meaningful in relation to sexual orientation
into the therapy process; and (2) illuminating the factors present in the clinical situation
that constrain and facilitate both the paticnt-thcrapist relationship and the treatment
process with respect to lesbians. The practical information about the exigencies of a
lesbian life that arc described in this study has the potential to assist occupational
therapists in their attempts to achieve on inter-subjective understanding of the patient's
life world and, through that understanding, create shared visions or the patient's future
as an individual with a disability.
Relevance to the Occupational Therapy Professional Organization
In the 1991 American Journal o f Occupational Therapy issue dedicated to
Cross-Cultural Perspectives in Occupational Therapy, Julie Evans challenges the
occupational therapy profession to become aware of and rectify the racial
discrimination in health core. Specifically, she advocates conducting research studies
that document "how racial bias acts as a barrier to equal access" (1992, p. 681) as one
method occupational therapists can employ to identify the problems that contribute to
the disparity in health care access. This knowledge can be used to establish
professional policies and practice guidelines with the intent of eradicating
discrimination. The Minority Affairs Division or the American Occupational Therapy
Association has begun to address the challenge set forth by Evans through its goal to
educate the profession about the specific needs of students, practitioners, and patients
who may come from a minority background (Wells, 1993). Presently, the minority
groups named as part of this division include African-Americans, Hispanics, Asian
American/Pacific Islanders, Native Americans, individuals with disabilities, and men
(Wells, 1993). However, with the development of the Networking Group for
Lesbian, Gay, and Bisexual Concerns in Occupational Therapy, negotiations have
begun to include the concerns of this minority group as part of the educational and
mentoring systems set up by the Minority Affairs Division. It was reasoned that the
findings of this study would assist these actions in two ways. First, the knowledge
gained from the experiences or lesbians who ore therapists and patients further
supports the need to identify lesbian, gay, and bisexuals os a minority group. Second,
the information acquired in the interviews has provided real examples that con be
incorporated into material for use in educational and clinical programs.
The Researcher’s Experience and Underlying Assumptions
Rcinhortz (1992) states:
Feminist researchers start with an issue that bothers them
personally and then use everything they can get hold of to
study it. It defines our research questions, leads us to
sources of useful data, gains the trust of others in doing the
research, and enables us to partially test our findings. . . In
feminist research, then, the 'problem* is frequently a blend
of an intellectual question and a personal trouble (1992; p.
261).
This research project is certainly in line with Rcinharz's description of feminist
research in that it has grown out of intellectual inquiry and a personal passion. During
the 2 years I spent in doctoral coursework, a number of my papers centered around the
notion that many or our doily and lifetime occupations reflect certain symbolic themes
of meaning that emerge, recede, change, and are recycled at different times throughout
our lives. This previous work and my interest in the symbolic meaning of activities
definitely influenced both my desire to study this subject and my conceptualization of
lesbianism as a possible theme of meaning in a woman's life.
17
On a personal level, I approach this project as an occupational therapist who
spent 5 confusing years trying to sort out my own sexual orientation while
simultaneously passing as a heterosexual in the occupational therapy clinic. Not being
fully aware of my lesbian orientation during that period of my life, 1 only remember
moments, or was it days, of frustration, exhaustion, and a sense of inauihcnticiiy.
Which aspects of clinic life triggered these feelings still remain a mystery. One
particular moment of realization stands out in my mind. 1 acutely remember a feeling
or great relief when I moved from the occupational therapy clinic in which lunch table
conversations centered around marriage, baby showers, and weekend rendezvous with
whomever one was dating to the academic setting in which lunch table dialogue, when
it occurred, addressed the latest books reviewed in the New York Times Book
Review, great movies, and analyses of political situations around the world. Al that
time, I thought that my intense excitement at these new lunch experiences was due to
the immense intellectual stimulation and the presence of Elizabeth Ycrxa, who was at
the time chair of the department. To some extent it was, however, I now realize that in
this situation, I (It; al least I could participate without being on guard and engaging in
concealing behaviors.
I can remember only one patient whom 1 assumed to be a lesbian. She fit the
stereotypical image-short hair, mannish style dress, athletic, and a physical education
teacher. When her female friend and roommate came to the hospital for discharge
planning, the issue was confirmed os far as I was concerned. Yet there was no
discussion among therapists or in team meeting about the relationship or treatment of
her friend os family. Interestingly, at my patient's request, we accompanied her to her
place of employment for an evaluation rather than performing the usual home
evaluation. 1 always wondered if this shift in plans was intended to maintain her
secret.
18
Presently, I am a lesbian who has just begun to share this aspect of my identity
with others in my life. As 1 share, 1 have experienced Tear, joy, humor, trepidation,
loneliness, and an ample share of nightmares. Years or conditioning that heterosexual
marriage is the only normal life are not overcome easily, ir internalized hcicroscxism
is that tenacious, then it is highly probable that other people who are either homosexual
or heterosexual hold hctcrosexist/homophobic beliefs, however unwanted they may
be.
Oivcn these experiences in the clinic and my present feelings about being
lesbian, 1 entered this research with a number of observations. First, I do believe that
a strong heterosexual bias pervades many occupational therapy clinics and that most
therapists arc virtually unaware of its existence and/or its effect on fellow therapists
and patients. In this project, what I sought was to understand the dynamics of this
heterosexual bias. Second, I believe that the effects of homophobia ore detrimental in
differing degrees to all people, yet arc experienced by persons who arc not
heterosexual in a particularly harmful way. Third, I assumed dial because of their
standpoint as lesbian women in a predominately heterosexual society, lesbians would
be able to talk about situations inherent in the medical system that emanate from
heterosexual perspectives. Fourth, I believe that sharing my lesbian identity with the
participants in this study enabled them to feel safe enough to honestly share their
experiences with me.
As a lesbian carving out my own existence in today's world, I have no doubt
that sexual orientation is not limited to a sexual act but rather constitutes a theme of
meaning in some women's lives that, to some extent, influences what they choose to
do with their time, my fifth assumption. However, a variety of lesbian experiences
exist in the world and I do not pretend to know the full gamut of ways a lesbian
orientation may influence occupations. Nor do I assume that just because a woman is
19
lesbian, her sexual orientation will be an important symbolic theme in her life.
Furthermore, lesbian identities, us other identities, mature and grow with time and
thus, how lesbians interpret and live out their identities will differ. Along the same
train or thought, my sixth assumption is that many occupational therapists do not view
sexual orientation as influencing any activity beyond sexual acts and, thus, do not
identify sexual orientation, whether it is lesbian, gay, bisexual, or heterosexual, as an
important factor to consider when providing occupational therapy services.
Finally, my intention in this study is to proudly put the "L word" into the
occupational therapy literature. I firmly believe that occupational therapists arc not
living up to their professional and ethical responsibility to "nurture the human spirit for
action” (Reilly, 1962, p. 92) if, during a critical period in a patient's life, that is,
learning to live with a disabling condition, they contribute more pain in that
individual's life by inadvertently creating a homophobic environment or simply
denying that aspect of the patient's existence. From my perspective as a lesbian and an
occupational therapist, I believe that the occupational therapy profession needs to take
an active role in eradicating erroneous notions about sexual orientation. Oivcn this
strong conviction, 1 embarked on this project.
20
CHAPTER 2
LITERATURE REVIEW
In this chapter I am going to pul forth the idea that being lesbian influences
identity and consequently plays out in a variety of occupational settings, including the
health care setting. One could imagine, for example, that, assuming one embraced a
lesbian identity, problems that might arise in the health care setting could include
neglect, discrimination, fear of disclosure, and incomplete assessments of how life
style issues affect health. To build this ease, I reviewed the way in which lesbianism
has been socially constructed in medicine. 1 historically traced themes about
lesbianism from their foundation in religious beliefs to their expression in medical
ideology. I hope, in this section, to provide a historical framework for understanding
the tradition out of which current perceptions of lesbians among health care workers
emerged. Given that medicine has historically deemed lesbians to be pathological, it
would seem reasonable to assume that vestiges of that view may contaminate
contemporary health care. Next, I present evidence that, in fact, many negative
stereotypes pervade contemporary medical practice, although there is ample evidence
that health care workers arc not categorically hetcrosexist. The studies I reviewed
suggest substantial problems which allow us to conjecture that an individual's lesbian
identity could affect the quality of cote she receives. Following this discussion, I
provide evidence, albeit limited, that when they were interviewed, lesbian respondents
identified numerous problems with their health care, the origins of which they interpret
as being rooted in their lesbian identity.
Having argued that negative discourses about lesbians have historically
prevailed in medicine, lesbian stereotypes are pervasive in contemporary medicine, and
21
lesbians themselves have expressed their view that their lesbian identity impinges on
their ability to receive optimal health care, in the second section of the literature review,
I make the case that, for at least a portion of women who call themselves lesbian, their
lesbian identity is an essential symbolic theme of meaning that shapes their identity and
impacts not only their health care but also their everyday experience in the world. In
order to substantiate this claim, I draw from literature that addresses identity,
narratives, and action. In the (Inal analysis, the literature review provides an overall
framework for understanding why 1 chose to study the relationship of lesbianism to
occupation and lesbianism in health care, particularly occupational therapy.
A Historical Glimpse of the Construction of Lesbians in Medicine
Stevens and Hall (1991) provide an impressive summary of the historical
origins of derogatory stereotypes against lesbians and how these stigmas have been
both maintained through social structures and re-formed through the collective action
of lesbian and gay communities. The following discussion which presents a historical
perspective on the medical construction of lesbians is heavily influenced by and
elaborates upon the work of Stevens and Hall.
Lesbians: From Religion to Medicine
Sappho, an ancient Greek poet who resided on the island of Lesbos, is often
designated os the historical origin of lesbians (Stevens & Hall, 1991). She wus
revered for her lyric poetry which celebrated love between women. In this sense, she
provides a positive portrayal of lesbian love and is maintained within lesbian history as
a venerated icon (Stevens & Hall, 1991). However, this positive image or lesbian
existence is more of an anomaly than the norm when one explores the historical
construction of lesbianism. Although same-sex love has been documented as an
o*»
mm mm
acceptable form of relationships for men in prelitcratc societies (Gentry, 1992), lesbian
love has yet to be embraced as a respectable and worthy way of life in western
civilization.
Evidence that same-sex relationships have been subjected to severe penalties is
consistently recorded throughout history (Dubcrman, Vicinus & Chaunccy, 1989),
although the underlying arguments supporting such judgments have shifted from
moral to medically based justifications. Traditional Jewish, as well as early Christian,
ideology privileged heterosexuality as the natural form oT sexuality and denounced any
other type of sexual expression. In roman catholic theology heterosexual intercourse
served the sole purpose of procreation and the woman's part in that sexual act was to
bear children. This is dearly exemplified by S t Augustine, one of the revered fathers
in the Roman Catholic Church, who stated "I don't see what sort of help woman was
created to provide man with, if one excludes the purpose of procreation. If woman
was not given to man for help in child bearing, for what help could she be ?" (Rankc-
Hcincmann, p. 88). To ensure that procreation was the central function of sexual
intercourse, the absence of any pleasure associated with the act was to be upheld.
These prevailing attitudes about sexuality were later translated by Thomas Aquinas into
four categories of lustful sins against nature including "masturbation, bestiality, coitus
in on unnatural position, and 'copulation with an undue sex, male with male and
female with female'” (Brown, 1989, p. 68). Thus, early Christian dogma set definite
boundaries around what constituted moral sexual acts and ivhai did not.
Although it has been argued that female-female relationships were less
noticeable in the early church and thus less punishable as compared with male-male
relationships, acknowledgment of the existence of female-female love was apparent in
the detailed preventive measures taken in the convents (Brown, 1989). Even in the
time of St. Augustine, nuns were alerted to the evils of carnal love between women
23
and taught to avoid special friendships within the convent. Formal church laws
forbade nuns to enter each others cells and to lock their doors at night (Brown, 1989).
Strict surveillance by the abbey mistress was maintained to word off any chance that
two nuns meet in privacy. These behaviors were all grounded in the pervasive fear
that, given the opportunity, unacceptable sexual acts would occur.
Despite the fact that early Roman Catholicism endorsed a thread of tolerance,
arguing that church laws prohibiting certain forms of sexuality should not necessarily
be mandated as social laws, Christian dogmas were inappropriately used by people in
political positions to forbid same-sex relationships and impose severe punishments
upon women and men who were accused of such behaviors (Boswell, 1980).
Medieval laws designating female-female relationships os sins against God and nature
were enforced by retributions of mutilation, banishment, public humiliation, beatings,
and death by burning, drowning, or the guillotine (Brown, 1989; Stevens & Hall,
1991;Zcidcnstcin, 1990). Witchcraft and heresy were conceptually linked with
female-female relationships and classified as elements of demonic behavior (Saslow,
1989). During the time of the Inquisition, punishment of death was inflicted upon
women who were accused of these behaviors (Stevens & Hall, 1991). Although
drastic punishments were implemented for sexual crimes in general, there were
discrepancies in the degree of punishment bestowed on specific acts. As Brown
points out, women who assumed a male identity in dress and lifestyle were considered
one of the most dangerous types of criminals because their behavior directly
confronted the accepted gender relationships in Europe. Usurping power that was
designated for men was often met with harsher punishment than what was indicted
upon women who merely engaged in improper sexual activity. Thus, it may be
suggested that pronouncements against female-female relationships on the surface
carried the moral indictment of sinfulness, and underneath served to maintain the
existing gender and power structure that privileged men and heterosexuality over other
forms of sexuality.
The 18th and 19th centuries brought about an alternative discourse on non-
procreative sexuality, shifting from a religious interpretation of immorality to a medical
interpretation of pathology (Bullough, 1976a, 1976b; Stevens & Hall 1991; Weeks,
1989). Naming certain sexual behaviors as diseases became another form of
management (Stevens & Hall, 1991). Therapeutic remediation could be employed to
correct the defects rather than inflicting tortuous punishments which had proven to be
unsuccessful in eliminating homosexuality. As Stevens and Hall point out, the
accumulation of medical treatises on non-procrcativc sex as a disease slate did not
necessarily obliterate moral sanctions against same-sex love, but rather confidently
reinforced moral imperatives through scientific justifications. In this sense, medicine
os an institution assumed a position of social control through its ability to name those
behaviors which fall into a "normal" domain and those which arc relegated to a
"deviant" status (Stevens & Hall, 1991). It is important to note that the medical
labeling of deviance has greater power than merely determining who needs medical
intervention. "Deviance designations serve political purposes and arc created to
support and buttress specific status interests at the expense of others" (Stevens &
Hall, 1991, p. 294).
Tissol, an 18th century physician, was instrumental in the initial steps to
mcdicalize homosexuality. His well-received manuscript addressing the medical
hazards of masturbation, which was defined as all other non-procreativc sex, provided
"the ultimate argument about the dangers of sex" (Bullough, 1976b, p. 175). In a vein
similar to other physicians of his time, Tissol claimed that undue waste of semen
would ultimately lead to the decay of one's physical body and death, if not replaced.
Men were warned, under penalty of self-inflicted demise, to use their semen solely to
25
create offspring. Furthermore, Tissot detailed painful physical ailments, such as
blistering, itching, impotence, hemorrhoids, tumors, fevers and madness, that would
result from senseless masturbation (Bullough, 1976b). Regardless of the fact that
women did not lose semen during any sexual act and would thus, theoretically, avoid
the consequence of death, Tissot renders an equally perilous fate to females who might
have engaged in acts of masturbation. He states:
Females who engage in non-procreative sex were affected
in much the same ways as males but in addition suffered
from hysterical fits, incurable jaundice, violent cramps in
the stomach, pain in the nose, ulceration of the ccrvj, and to
the uterine tremors which deprived them of decency and
reason, lowered them to the level of the most lascivious
brutes, and caused them to love women more than men.
Onanism was far more pernicious than an excess in marital
or premarital fornication and if engaged in young people
would ultimately destroy the mental faculties by putting too
much strain upon the nervous system. (Bullough, 1976b
pp. 175-176)
Tissol’ s work, which was based on unsupported assumptions, was embraced by both
medicine and religion as sound scientific proof of the unnaturalncss of non-procreative
sex and thus provided a sense of confidence to religious sanctions against these
behaviors.
These false statements espoused by Tissot or other physicians of his time were
the foundation upon which 19lh and 20lh century sexologists began to develop their
theories about human sexuality. Richard von Krafting Ebb, one of the earliest
sexologists, was dedicated to accumulating case studies which detailed the
"psychopathological manifestations of sexual life in man" (Weeks, 1989, p. 64).
From these massive studies, extensive scientific classifications of sexual deviations
were created, such os homosexuality, fetishism, voyeurism, and zoophilia (Bullough
1976 a; Stephen & Hall, 1991; Week 1989). The result of these classification systems
was the designation of homosexual as identity rather than, or in addition to.
26
homosexual acts. In other words, medical interpretations of homosexuality centered
around the "homosexual individual" who, as a deviant from normal people in society,
possessed distinctive physical, emotional, and behavioral characteristics (D'Emilio &
Freedman, 1988; Weeks, 1989). Using this framework, a label of homosexuality
ultimately defined the type of person one was (Weeks, 1989). For example,
homosexuals were depicted as perverts, moral degenerates, primitive members on the
evolutionary scale, and congenitally abnormal and weak. Furthermore, the notion that
homosexuality could be acquired through "reading dirty books or keeping bad
company" (Bullough 1976a, p. 169) and passed on to offspring was accepted and
justified the medical prescriptions that homosexuals be secluded in asylums. This
view of the homosexual individual is considerably different from the religious
interpretations of masturbation os a discrete act or a temporary aberration (D'Emilio &
Freedman, 1988; Weeks, 1989).
Not all sexologists adopted a judgmental analysis of same sex relationships.
Some men, usually those who were not physicians, defined homosexuality as a natural
variation in sexual attraction that was due to a hereditary anomaly (Weeks, 1989).
However, in a medical world that was centered on pathology, their voices were
relatively unheard (Stevens & Hall, 1991). Weeks (1989) relates the silencing of
certain discourses about sex to the power of the medical profession, claiming that
theorists who "took the side or the deviant" (p. 78) were more vulnerable to
counterattacks of their work by physicians, (n the end, having a medical credential
and concurring with the accepted medical discourse provided credibility to one's
theories.
The discourse on homosexuality that emanated from the psychoanalytic
paradigm has sustained great influence on medical interpretations from the 1920s to the
present. Freud himself endorsed a liberal stance toward homosexuality, claming that
27
bisexuality was a normal experience for all individuals during certain stages of
development. However, he was adamant in noting that a woman who remained
attracted to another woman did so because her sexual development was arrested at an
immature stage. The implication in Freud's conclusions was that heterosexuality was
the most mature form of sexual attraction. Although one could correctly interpret
Freud's analysis as relegating lesbian attraction to an abnormal condition, he was quite
clear in his desire to reform the attitudes toward homosexuality as an innate
perversion. Freud's infamous "Letter to an American Mother" exemplifies this:
Homosexuality is assuredly no advantage; but it is nothing to
be ashamed of, no vice, no degradation; it cannot be classified
as an illness; we consider it to be a variation of the sexual
function produced by a certain arrest of the sexual
development. (Bayer 1987, p. 155)
The American psychoanalysts who followed Freud did not embrace the
somewhat softened and non-judgmental approach toward homosexuality that he put
forth. They negated the notion that bisexuality was a universal experience and, in
doing so, redesignated homosexuality as a pathological condition (Bayer, 1987;
Stevens & Hall, 1991). In their extensive review of the literature, Stevens and Hall
(1991) call attention to the numerous pathological characterizations of lesbianism that
ore cited by psychoanalysts, such os, "aggressive, hostile, and domineering" (p. 297),
obsessional, addictive, psychotic, schizophrenic, and paranoid. Lesbians were further
described as having violent hatred of men. mothers, and children, leading to
"homicidal rages" and "murderous revenge" (Stevens & Hall, 1991 p. 297). They
were seen as prone to seducing young girls into their evil lifestyle. Medical
sympomatology of lesbianism focused on short hair, a disregard of the "natural"
female adornments of make-up and jewelry, a career commitment, competitive spirit,
an affinity for the women's movement, and "'unwomanly* work such as skilled labor,
business, law, politics, theater, art, science, and writing" (Stevens & Hall 1991, p.
298). Morphological features such as wide shoulders, excessive hair growth, or well-
developed muscles were also designated as criteria for a lesbian diagnosis. In this
sense, the medical designation of a pathological lesbian character reified the very
stereotypes about lesbians that existed in society. These bizarre characterizations of
lesbians, and similar ones of gay men, fueled the irrational fear and hate which
underlies discriminative acts against the homosexual population.
One cannot discuss the medical construction of lesbianism in the early 1900s
without acknowledging its part in perpetuating patriarchal notions about "proper"
feminine behavior or traditional families (Stevens & Hall, 1991). The economic
changes that occurred with industrialism, as well as other factors, allowed for greater
freedom for women to move away from their homes and engage in lifestyles that were
inconsistent with the traditional family mode. Pathologizing lesbians was a convenient
mechanism of social control os it created fear in all women that behaviors, as simple os
moving to an apartment with a girlfriend to work in the city, could be interpreted as or
lead to a lesbian lifestyle (D'Emilio & Freedman, 1989). The power of medicine was
used to define normality, traditional dress, behaviors, and sexual activity of woman,
elevating them as moral and natural, and providing a stronger basis to coerce
conformity.
Within the religious and medical fury surrounding homosexuality, lesbian and
gay lifestyles nourished (Fodcrmon, 1991). Out of the 1950s and 1960s an organized
gay movement emerged that attempted to combat the prevailing negative images and
introduce an affirming gay or lesbian identity (Faderman, 1991; Stevens & Hall,
1991). Simultaneously, studies began to be undertaken comparing gay men who were
not in psychotherapy or prison to heterosexual controls. Findings from these studies
indicated no significant differences in psychological health between the two groups,
providing an element of "scientific" support to the political lobbying efforts of the gay
29
movements (Paulsen, 1988). Part of those efforts focused on intense lobbying to
remove homosexuality from the dogmatic classification of mental illnesses as listed in
the Diagnostic and Statistical Manual o f Mental Disorders II (DSMII). The fierce
tension that existed between the factions within the American Psychiatric Association
(APA)-ihosc who supported the removal and those who opposed it-ultimatcly led to
"an unprecedented referendum of the entire APA membership" (Bayer, 1987; Stevens
& Hall, 1991, p. 299), resulting in the removal of homosexuality as a category of
pathology.
Although this historic act has been declared symbolic of the dcmcdicolization of
homosexuality (Stevens & Hall, 1991), remnants of pathological interpretations of
lesbian and gay sexual identity remain in medicine. It can be surmised that these
remnants remain, in part, because the decision to remove homosexuality was not
unanimous among all the members and, in part, because medical labels appear to have
a tenacious hold on contemporary ideologies. In fact, lingering notions of pathology
were evident in the new category entitled, "Ego-Dys tonic Homosexuality" which was
part of the DSM-lII (Bayer, 1987; Suppc, 1984). This category was designated for
lesbians and gays who were distressed by their sexual orientation; it sanctioned
therapies that would revert them to heterosexuality (Stevens & Hall, 1991). A second
but more internal debate occurred within the American Psychiatric Association, with
some psychiatrists arguing that in specifying homosexuality and leaving out
heterosexuality, the category Ego-Dystonic Homosexuality implied pathology (Bayer,
1987). Presently, Sexual Disorder Not Otherwise Specified remains on the books,
denoting distress about sexual orientation, in general.
Bullough ( 1976b) suggests, and the above discussion concurs, that delabelling
homosexuality os a pathology is not a simple task. He argues:
30
it is not enough for the American Psychiatric Association to
say that their previous categories of sexual pathology arc
inoperative, but they also must take cognizance or the
damage they had done by their own erroneous assumptions,
assumptions which in light of other scientific findings
should have long ago been discarded (p. 176).
Bullough echoes the sentiments of many when he identifies the need for further efforts
to dcstigmatizc lesbian and gay life and suggests that the medical profession itself take
an active part in that campaign.
One could surmise that the medical profession is unable to support a campaign
that would eradicate the stigma of being lesbian or gay because of the absence of a
well-articulated discourse on the origin of lesbian and gay orientation that is well*
substantiated by traditional scientific studies. As Postman (1992) has stated, the spirit
behind traditional sciences, on which medical practice is based, inspires organized
searches for reliable and predictable answers that ore supported by rigorous empirical
methods. Objectivity, rationality, facts, and testable theories all constitute the mind
frame within which medicine is organized. When proven theories ore unavailable, in
this cose theories about the origins of lesbian and gay existence, old dogmas and
unsubstantiated claims seem to be maintained. In fact, contemporary medicine
continues to be of the mind-set that one can find the biological, psychological, or
developmental cause of homosexuality. It could be argued that this mind-set is still
grounded in what appears to be the impermeable notion that heterosexuality is
normative and homosexuality is due to some biological or developmental aberration.
Explanations about the origins of lesbians and gay sexualities fall primarily into
three comps, those who take on essentialist stance and believe that homosexuality is an
innate characteristic or at least developed at an early stage in life, those who call
themselves social constructionists, thus emphasizing cultural shaping of expressions
of sexuality, and those who believe in an interactionist approach which acknowledges
31
the various factors that contribute to sexual orientation (Boswell, 1980, 1989;
Faderman 1991; Halpcm 1989; Gonsiorek & Wcinrich 1991; Padgug, 1989; Wcinrich
& Williams, 1991). The medical model, with its focus on naming and eradicating
diseases, appears to be wedded to the cssenlialist stance in its avid search for the cause
of homosexuality. Current research efforts exist in the areas of genetics,
ncurocndocrinology, and neunoanatomy. Although no conclusive evidence can be
drawn from the ample studies in any of these medical specialties, some findings have
suggested that genetic factors may contribute to the presence of homosexuality in men
and, most recently, that certain brain structures (i.e., brain nuclei in the anterior
hypothalamus) may be smaller in gay men than heterosexual men (Cooper, 1992; Lc
Vay, 1992, 1993; Pillard, 1992). None of the studies to dale has sustained enough
evidence to be securely endorsed by the scientific community and thus, as Paulsen
(1988) states, medicine remains "enmeshed in almost eloquent but kaleidoscopic
confusion" (p. 4). However, this confusion is set within a changing social
atmosphere that has presently accentuated the question of gay rights and equal
treatment of all individuals, especially within the political arena. Thus, regardless of
which stance one may take in the debates about the origins of homosexuality, medical
professionals must be concerned with the perception and treatment of lesbians and
gays within medical institutions.
Lesbian Images in Contemporary Health Care Arenas
Given the historically negative interpretation of lesbianism in medicine, it is to
be expected that pejorative attitudes about homosexuality may remain among health
care professionals today. In fact, research within the medical and psychiatric
professions has documented a presence of negativity that pervades both the attitudes
these professionals hold and the services they provide. The following discussion will
32
present a review of 17 articles written over the previous 14 years that provide insight
into how nurses, physicians, social workers, psychologists, and psychiatric aides
view their lesbian patients. Fourteen or these articles report research findings, while
three entailed literature reviews and theoretical discussions. For the most part, the
research studies employed quantitative analyses using modified Likcrt-lypc
questionnaires, with the exception of four qualitative projects based on in-depth
interviews or case presentations, and three studies with both qualitative and
quantitative components. The authors studied people throughout the United Slates,
although the Midwest seemed to be particularly represented in research on nurses.
Because the purpose of this section of the literature review is to provide an
understanding of the altitudes about lesbians that pervade health care today, a detailed
outline of each study will not be provided, but rather contemporary images of lesbians
will be extracted and discussed (See Appendix B for a complete description of the
purpose, participants, and methodology of each study.)
Eliason, Donclan, and Randall (1992) offer a useful heuristic for discussing
the attitudes of health care professionals and students by identifying lesbian
stereotypes that arc most prevalent among nursing students. Although the framework
these authors use (i.e., naming lesbian stereotypes) provides a thorough discussion of
biases held by nursing students, it docs not enoompass the variety of opinions held by
health care professionals in general. Thus, an expanded version of Eliason ct ul.’ s
framework will be used to organize the following discussion. More specifically, the
first two stereotypes are limited to a summary of Eliason et al.'s findings referring to
nursing students. The lost six images represent a synthesis of information gleaned
from articles covering a number of different health care professions (See Appendix C
for a description of the stereotypes.)
33
One stereotype that emerged from Eliason ct al.'s research findings was that
"lesbians want to be men" (p. 139). When people assume that lesbians want to be
men, not women, they often have the view that lesbians take on stereotypical male
qualities (Eliason ct at., 1992). These nursing students felt that lesbians could be
easily recognized by their short haircuts, athletic interests, no make-up, and mannish
style of dress, such as boots, jeans, and outdated attire. Perhaps more important than
the particular ways in which they assume to be able to identify lesbians was the attitude
that some attach to this "lesbian look." One individual responded that lesbians are
"Ugly women who can't get dates with men" (p. 137). Another suited that a lesbian is
"a women who clings to other women and puts men down all the time" (p. 137).
These statements indicate the negative interpretation projected onto women who do not
portray themselves in a traditionally feminine way. The authors also noted that these
stereotyped images both surface from and reinforce the invisibility of lesbians who
may choose an outward appearance that is more reflective of traditional feminine attire.
The notion that lesbians arc too blatant about their lifestyle was another
consistent theme in Eliason el al.'s. research findings. Mentioning one's partner or
commenting on a lesbian event that one may have attended was interpreted as boasting
about one's exploits. This type of behavior on the part of lesbians was clearly
perceived as a form of flaunting, disrespectful of heterosexuals who should not be
subjected to such "proselytizing," especially within work settings (Eliason cl al.,
1992). In this sense, the everyday conversations about one's life that goes on within
the work place and contributes to a sense of community among personnel becomes
restrictive for lesbians. If women who are lesbian choose to remain silent about their
sexual orientation, they do so at a cost. The vigilance that it takes to modify stories
about life events to portray oneself in a heterosexual light requires excessive energy
and takes its toll on the individual's spirit.
Research conducted on nurse practitioners and students revealed that many of
t.
them held a belief that lesbians ultimately desire to seduce heterosexual women. This
constitutes the third stereotype held about lesbians (Eliason ct al.t 1992; Eliason &
Randall, 1991). Female nursing students feared that lesbians may sexually approach
them and, for that reason, they were wary of sustained eye gaze or close body contact,
assuming that these acts were messages of sexual desires (Eliason ct al., 1992). In
response, these students expressed a need to "protect*1 themselves and did so primarily
through distancing. Distancing was specifically manifested in the students'
unwillingness to sit by a lesbian in class or invite her home (Eliason & Randall, 1991).
Although female nursing educators did not express the same fear of sexual udvonccs,
social contact with lesbians was found to be equally anxiety-producing. Insecure
feelings about either conversing with a lesbian or attending a lesbian event were openly
expressed (Randall, 1989). Distancing has also been delected among physicians as a
technique to handle uncomfortable interactions pertaining to sexual orientation that
arise during treatment sessions. One lesbian woman revealed that following disclosure
of her lesbian sexual identity, her male physician left the room to "get equipment" and
returned with two nurses as if he needed protection (Stevens, 1992b). Although this
physician's response was not associated with a fear of being sexually approached, it
docs indicate some element of anxiety on his port
The image of lesbians as transmitters of sexual diseases, specifically AIDS,
was another prevalent stereotype grounded in the notion that lesbians and gays
comprise a homogeneous group (Eliason el al., 1992; Genliy, 1992; Randall, 1989;
Robertson, 1992). Students (Eliason & Randall. 1991) and nursing educators
(Randall, 1989) erroneously believed that lesbians were "responsible for the spread of
AIDS" (p. 136). Along the same line of thinking, they felt that the sexual acts engaged
in by lesbians, in general, spread other sexually transmitted diseases. These notions
35
display an unfavorable attitude on the part of health care professionals and educators
toward lesbian sexuality, and they indicate inaccurate knowledge that could be
detrimental to the health can; needs of lesbians.
The association of pathology with lesbianism was noted in statements such as
"They are not normal human beings" and "They arc sick" (Eliason ct al., 1992, p.
136). Despite the fact that, as discussed above, homosexuality is no longer deemed a
psychological or physical abnormality at least by the APA, perceptions that lesbianism
is an unnatural form of sexuality continues to prevail among psychology students;
physicians (Douglas, Kalman & Kalman, 1985), nursing students (Eliason cl al..
1992), educators (Randall, 1989), and practitioners (White, 1979). For example, in a
survey that examined the altitudes of psychiatric nurses toward lesbian clients, it was
found that pathological explanations were attributed to a scenario depicting a lesbian
relationship whereas no such explanation was given to the same scenario portraying a
heterosexual relationship (White, 1979). Similar findings were reported in studies
conducted with psychologists and psychology students when they were given ease
studies that differed only with respect to sexual orientation (Garfinklc & Morin, 1978).
Although it could be argued that these two studies arc somewhat outdated, they arc
consistent with the attitudes that arc reflected in recent research. For example, most
recently, Randall's (1989) study of nursing educators demonstrated that a small
percentage of these women not only felt that lesbianism was a curable pathology but
that psychotherapy should be mandatory. Along the same vein, some asserted that
laws should be maintained that punish lesbians for their acts.
The sixth apparent stereotype in the literature was the biased notion that
lesbians arc immoral people. Attributes of immorality and perversion were often
associated with lesbian clients, revealing both overt and covert messages of moral
judgment (Messing, Schoenberg & Stephens, 1984; Randall, 1989). Young (1988)
36
found that, for some nurses, negativity toward lesbians emanated directly from their
religious beliefs. Her study suggested that moral disapproval of lesbians has a
tenacious quality not attached to other religious mandates. This was exemplified by
the fact that, whereas the nursing students she studied could comfortably ignore other
situations that were in conflict with their religious teachings, their feelings toward
lesbians were not so easily overcome. A recent exacerbation of these religious
condemnations by some health care professionals are noted in the interpretation that
AIDS is “God's punishment" (Presti, 1990).
These stereotypical images represent emotional sentiments held by some health
professionals toward lesbians in general. However, specific groups, namely the
elderly and persons with chronic disabilities, who endure double and often triple
minority status arc subject to additional myths. Non-existence, or invisibility, is
strongly associated with older lesbians (Dcevy, 1990; Messing ct al., 1984). Health
core professionals os well as society at large simply deny the fact that they exist.
When recognized, they arc labeled os "unhappy childless spinsters or mannish-looking
female truck drivers" (Dcevy, 1990, p. 35). As one elderly lesbian suited, "I'm
perceived as a 'butch' but I'm a gentle shy soul" (Deevy, 1990, p. 36), indicating that
these stereotypes set up false assumptions that could restrain communication. Others
claim that their invisibility or butch image is related to society's view that they arc
burdens with little to offer a society built on female reproduction (Cooper, 1988).
Similarly to elderly lesbians, lesbians with chronic disabilities also encounter
messages of non-existence. These experiences stem from the pervasive attitude in
society that women with disabilities are inherently asexual (Fisher & Galler, 1988).
Medical institutions, schools, churches, families, and friends all participate in subtle
and overt ways to desexualize this population. Once desexualized, the notion of a
lesbian sexual orientation need never be considered. It is simply silenced along with
37
other subjects such os dating, marriage, and children. Just as problematic as ignoring
sexuality is the equation of a lesbian sexual orientation with immature sexual
development Yet, it has been implied in research studies that, by virtue of their
disability, some women will experience failure with heterosexual encounters and thus
assume a lesbian identity (Rousso, 1988). The myth that for persons with disabilities
a lesbian identity is assumed by default dclcgitimalcs their existence as mature adults
who may have primaty emotional and affectionate ties with other women rather than
men. In a sense, this myth is embedded in the notion that heterosexuality is the natural
and "proper" form of sexual identity.
As exemplified above, negative attitudes toward lesbians continue to pervade
health care arenas. However, it is important to note that in each of the articles
reviewed some respondents convey positive images of lesbians. For example, 37% of
the physicians surveyed by Mathews, Booth & Turner (1986) portrayed homophilic
attitudes toward lesbians and gays. Likewise, Randall (1989) found that 48% of the
nursing educators attributed a sense of normalncss (normality) to lesbian sexuality.
These statistics do not downplay the severity of negative biases against lesbians but
they do point to the fact that within the health care professions a potential for respectful
service provision exists. They also suggest that certain demographic factors may
influence the prevalence of homophobic attitudes. However, conflicting information
exists among the studies reviewed, with Randall (1989) finding no correlation between
homophobic responses and the demographic variables of age, education, years
leaching, sexual preference, and political and spiritual practices of nurses. Mathews et
al. (1986), on the other hand, found that homophobic responses of physicians were
correlated with gender, age, and medical specialty. Female physicians tended to be
more positive than male physicians about homosexuality. Likewise recent graduates
expressed more homophilic attitudes than older physicians. Practice areas also
38
influenced the degree to which the physicians felt homophobic. Altitudes or
psychiatrists, pediatricians, and those in internal medicine ranked the most homophilic
with physicians in family practice, gynecology, and surgery ranking the most
homophobic. While (1979) also found that among psychiatric nurses higher education
and minimal religious devotion or atheism correlated with more positive attitudes
toward lesbians. Finally, studies have shown that familiarity with individuals who arc
lesbian or gay appears to positively enhance one's opinions about homosexuality
(Eliason ct al., 1992; Eliason & Randall, 1991; Douglas ct al., 1985).
Health Care Experiences among Lesbians
Anti-lesbian notions among health professionals create a risky climate in which
this population must attempt to procure adequate health care. Research has indicated
that, although some health care professionals express feelings of caring, comfort, and
concern toward lesbinns and gays, negative attitudes of pity, disgust, discomfort,
distaste, embarrassment, fear, awkwardness, and repulsion arc rampant among
contemporary health care practitioners (Stevens, 1992b). The degree to which these
pejorative sentiments influence the actual practices of health care professionals has not
been fully researched. However, as Stevens pointed out, sufficient data exist to
illustrate that prejudicial attitudes about race, gender, and class directly impact
diagnostic judgments and the types of therapeutic interventions provided (Stevens,
1992b). One can hypothesize that the same experience may hold true when health care
professionals affirm negative biases about sexual orientation. In fact, studies that take
into account the point of view of lesbian clients begin to substantiate the dangers
inherent in contemporary health care by providing concrete examples of how
antagonistic ideologies influence actual service provision.
39
The most pervasive problem in health care that has been identified by lesbians
and gays is the assumption almost all health care professionals make that patients arc
heterosexual. Heterosexual biases nnc embedded in unsolicited and unncedcd lectures
on birth control, disrespect of same-gendered partners, inadequate diagnosis, poor
preventive health care, the absence of significant questions during an intake, and sexist
remarks (Cochran & Mays, 1988; Dardick & Grady 1980; Potter, 1985; Roberston,
1992; Stevens, 1992b; Stevens & Hall, 1988; Zcidcnslcin, 1990). Even if a health
care provider wishes to acknowledge differences in sexual orientation, the inclusion of
heterosexual notions within the initial forms one must complete or in the standard
questions one must answer often triggers cautious responses on the part of lesbians
and gays that, in many eases, silence important medical information. It is this
communication barrier that is most disturbing to women who arc lesbian. Numerous
research studies indicate that lesbians and gays feel more confident about their health
care when they are able to share their sexual orientation and it is received in a positive
light (Dardick & Grady, 1980; Robertson, 1992; Stevens & Hall, 1988; Stevens
1992b). However, heterosexual biases contribute to an ongoing dilemma of whether
or not it is safe to disclose. Fears surrounding disclosure arc often related to a concern
that adequate health care will be withdrawn. As one woman stated:
It would be very damaging if you got into interactions with
health care providers in which you are considered deviant.
Some people have very negative, violent reactions. I don't
think they can separate from their personal prejudices. It's
like pulling your life in someone's hand who really hates you.
(Stevens & Holt, 1988, p. 72)
Thus, assumed heterosexuality leaves few opportunities for lesbians to disclose
without great trepidation concerning the responses they may receive. It is important to
recognize that, although assumed heterosexuality is most often examined in terms of
its detrimental effects on lesbian or gay health core recipients, health professionals also
40
suffer consequences. The lack of honest communication contributes to a naivctd on
the part of health care professionals about the lifestyles of women who are lesbian.
This naivctd perpetuates inaccurate stereotypes, which in, turn support the
awkwardness of health professionals in their interactions with lesbians. Ultimately,
these communication barriers contribute to poor health care.
Not all lesbians choose to remain silent about their sexual orientation.
However, studies indicate that once out, their interactions with health care providers
often became strained. Women complained of being rough-housed, subjected to
derogatory comments, and confronted with nasty attitudes (Berger, 1983; Stevens &
Hall, 1988). Complaints that counseling visits became voyeuristic through
inappropriate sexual questions were recorded (Stevens & Hall, 1988). Women also
felt that once their sexual orientation was known, it became pathologizcd and was
viewed as the focus of their problems over and above the medical issue for which they
sought help (Messing ct al., 1984; Stevens & Hall, 1988). Stevens and Hall (1988)
noted that, in these eases, both sexual advances by male physicians and inappropriate
referrals for psychiatric counseling were used to "cure" the problem. A moralistic
approach to one's lesbian sexual orientation by physicians was also experienced as
exemplified in the following quote: "I identified myself us lesbian to one and the
reaction was very bad, really bad. Saying 'that is not natural, that's against God's law,
maybe you should think a little bit harder about what you're doing.' And he tried to
give me a moral lecture on the evils and sins of lesbianism and how wrong 1 was and
was young and there was lime to repent" (Robertson, 1992, p. 160). On the opposite
end of the continuum, some women were simply ignored. Call lights were left
unanswered and physicians became unavailable for discussions (Stevens & Hall,
1988), One woman stated, "1 was in the hospital and the nurses would never come
down to my room. I was told later that they had specifically talked about not wanting
41
to care for me because 1 was a lesbian. 1 was surprised. 1 am always surprised when
these things actually happen” (Stevens & Hall, 1988, p. 72).
Adolescents who are lesbian or gay experience even greater problems than
adults within the health care arena due to their status as minors. Parents who discover
their adolescents' lesbian or gay identities may respond in a violent manner, either
discarding them from their homes or forcing them into medical or religious
establishments for the sole purpose of curing their disease (Heron, 1983). Within
establishments that view a homosexual identity as a deficit, adolescents arc confronted
with the same negative messages of immorality and perversion that exist for adults.
These messages arc increasingly damaging for this population because there is little
opportunity to leave the situation or find a positive support group, given their
economic dependence on parents. Silence on the part of an adolescent docs not
necessarily guarantee safety os the negative attitudes that pervade high school
campuses, community groups, and families arc strongly felt and internalized by
closeted adolescents. Thus, the health care arena is filled with as many biased
reactions toward adolescents as it is for adults. The confounding factor for
adolescents is their relatively powerless position in the situation, at least compared to
adults.
Remafedi (1990) noted that attempted and successful suicides have become an
alarming response of adolescents who identify os lesbian or gay to the violence they
experience or the silence they maintain. In summarizing one study, he states that
”40% of the 5000 homosexual men and women (who were studied) seriously
considered or actually attempted suicide" (p. 1173). More specifically, the Report of
the Secretary's Task Force on Youth Suicide has estimated that 30% of adolescent
suicide is related to homosexuality (DHHS, 1989). Their extensive report further
addressed the issue of adolescent suicide by identifying risk factors that were
42
instrumental in contributing to the high rate or suicide among lesbian and gay
adolescents. These factors include social and religious discrimination against
homosexuals; society's belief that lesbians and gays arc self-destructive; family
rejection; abuse and ridicule by peers and teachers on the high school campuses;
substance abuse; and feelings of alienation and low self-esteem on the part of lesbian
and gay adolescents. Most problematic for health care providers is the finding that
their attitudes and behaviors at times can promote suicidal ideation within their
adolescent clients. Gonsiorck's (1988) discussion of the "pitfalls of clinical
management" (p. 120) examined three responses of health care professionals that can
be particularly damaging to the paticnt-clicnt relationship. These include minimizing
the tensions that adolescents feel about their lesbian or gay identity; avoiding
discussion of sexual orientation for fear that it is a form of recruitment; and
encouraging a premature decision about one's sexual orientation. It is important to
note that, whether or not reacting negatively to the disclosure of a client's homosexual
identity stands true for all health care professionals, adolescents arc knowledgeable
about the prevalence of hostile attitudes among health care providers and for that
reason avoid seeking help when needed (Uribe & Harbcck, 1992).
The incidents presented above, whether personally encountered or vicariously
experienced through friendship networks, place lesbians of all ages in a hesitant state
of mind when they contemplate procuring health care services. For lesbians, a
significant aspect of health is the stigmatization they receive from health care
professionals (Stevens & Hall, 1988). Thus, lesbians are in constant negotiations
about how to access quality health care within potentially hostile situations. Kenny
and Tash (1992) summarized this negotiation process: "After a lifetime of negative
derogatory responses from health care professionals and society, lesbians have
developed a sensitivity to those potential risks and, thus, seek ways to minimize their
43
exposure to thcm”(p. 211). Stevens ( 1992b) challenges health care professionals to
redefine the problems that lesbians encounter in contemporary health care arenas. She
suggests that, by virtue of the position of power that providers have in their
relationship with clients, the provider should assume responsibility for ensuring a
receptive environment in which lesbians can comfortably discuss all aspects of their
lives. In this sense, the burden on the part of the lesbian client to negotiate barriers
will be removed.
Summary: Implications for Occupational Therapy
Both Butlough ( 1976b) and Stevens ( 1992b) present compelling requests that
health care professionals take active responsibility for eradicating unjust medical
ideologies about homosexuality that have been recently debunked. The challenge that
these authors propose has important implications for occupational therapists.
Although studies have not been conducted that delve into the attitudes or behaviors of
occupational therapists toward their lesbian patients, the extensive documentation of
discriminative attitudes and behaviors that arc entrenched in medical institutions both
historically and currently suggest that it is highly unlikely that any one profession will
escape its influence. Thus, it is important that the occupational therapy profession
begin to examine barriers inherent in occupational therapy treatment environments that
prevent the provision or quality occupational therapy services to lesbian patients.
Of particular interest to occupational therapists is the congruency between
notions of health care espoused by some lesbians and those accepted by the
occupational therapy profession. Various studies that have explored how lesbians
perceive health care issues found that their subjects claimed a definition of health that is
much broader than that which is traditionally endorsed by medicine (Deevy, 1990;
Gentry, 1992; Stevens & Hall (1988; Zeidenstein, 1990). When asked about
44
wellness, (he women (hat Stevens and Hall (1988) interviewed accentuated
"independence and self-reliance as the primary components of wellness" (p. 71).
Personal health, to them, included qualities such as "a positive self-concept, an
affirming attitude toward life, purposeful work toward emotional health and an ability
to manage stress" (Stevens & Hall, 1988, p. 71). Social factors such as available
support networks, mutual relationships, and an ethical stance toward political issues
were highlighted in their statements on personal health. The most prevalent health
issues that were identified entailed aging with support for autonomy, childbearing and
parenting issues, loss of athletic abilities, substance abuse and battery (Dcevy, 1990;
Gentry, 1992; Zcidcnslcin, 1990). Finally, as Dcevy (1990) concluded in her study of
older lesbians, "The relevant health issue in sexual orientation is not the patient's
sexual behavior, but is instead the wcar-and-tcar of living in environments (including
health-care settings) that arc homophobic or hostile to lesbian and gay people" (p. 37).
The occupational therapy profession also endorsed a concept of health that accentuates
one's ability to adapt to various environmental situations by embracing meaningful
activity patterns into one's life on a daily basis. Respect for autonomy, independence,
and self-reliance white simultaneously valuing mutual relationships, social networks,
and collective political action can be noted in occupational therapy's belief system.
When examined in this light, occupational therapists have much to offer the lesbian
community. It would behoove them to explore in greater depth how a lesbian sexual
orientation may interface with the specific type of occupational therapy services
provided.
Lesbianism and Identity
In the second part of the literature review, I lay the foundation for
understanding lesbianism as one meaningful theme that affects personal identity. To
45
accomplish this task, 1 first introduce a narrative perspective on the formation and
maintenance of self-identity. Second, literature that addresses identity constituents or
the notion that multiple symbolic themes comprise identity is presented. On the basis
of these two discussions, I explore the notion that being lesbian for some women is a
symbolic theme of meaning that is central to their self-identity and doily experiences
and influences what they do.
Before discussing identity from a narrative perspective, it is important to point
out why this particular view is being endorsed. Many theories that address identity arc
concerned with specifying the lifetime developmental process in which a person's
sense of self changes and matures. These theories arc often classified as stage theories
in that they outline particular age-specific, ordered tasks that must be accomplished to
progress successfully to the next stage. Maturity or a positive identity, which appears
to be the culminating goal, depends on successful completion of each previous stage.
In this sense, the earlier developmental tasks set limits on one's future achievements
(Mishler, 1992). Although authors may suggest that these stages provide only broad
outlines describing a developmental process and ore thus useful as a general tool to
measure successful maturity, there is a tendency to label divergent behaviors as deviant
or to ignore the diversity in behaviors in order to ensure a good fit with the model
(Bourne, 1990). Furthermore, traditional developmental models are skewed toward
the experiences of one group, namely white, heterosexual, middle-class males, and
yet, they are used as normative benchmarks against which all people are measured.
Recently, research has explored positive identity development in lesbians to
counterbalance the distorted information that stems from a universal model approach to
development (Bourne, 1990). Although some of these studies offer relevant
information about the distinctive experiences of lesbians, they too arc encumbered by
the problems of stage theories. Furthermore, they focus on development rather than
how identity is expressed in human action. These inadequacies of stage theories,
i .
together with my intent to explore how identity is related to action in the present,
suggests that a narrative approach to personal identity is warranted.
Identity as a Narrative
Polkinghomc (1988) noted that the concept of personal identity has undergone
historical changes, shifting from theories that ground identity in the material substance
of the body to those that credit the unique memories or personal experiences as the
basis of identity. More recently, human disciplines have endorsed the notion that the
"self is a concept defined as the expressive process of human existence, whose form is
narrative" (Polkinghomc, 1988, p. 151). By defining the self as a process of human
existence, personal identity becomes embodied in human action, the specific
configuration of events that constitutes one's life, and the symbolic significance of
those actions, Giddens (1991) supports this notion, stating that, "Reflexive organized
life-planning. . . becomes a central feature of the structuring of self-identity" (p. 5).
He argued that the fact that pluralistic societies offer a greater variety or so-called
"authorities" than traditional societies accentuates the importance of life choices in
constituting identity. His notion of "reflexive" emphasizes the importance of
constructing self-narratives in the process of identity formation. The narrative
provides a unifying form for integrating often fragmented events into u contcxtualizcd
and coherent story (Polkinghome, 1988; Rosenwald & Ochberg, 1992). It is the
meanings that people attribute to various critical events in their lives that become the
cohering force unifying their personal narratives. In this sense, personal identity
becomes embedded in meaning and the enactment of that meaning through specific
actions.
47
Understanding identity in terms of personal narratives underscores the
"constructive and interpretive nature of the self" (Polkinghomc, 1988, p. 151).
Personal identity is an evolving process that unfolds throughout life and is continually
being refashioned against the background of new experiences and challenges. As
Polkinghome (1988) stated, it is a "process of actualizing what is potentially possible
in one's life" (p. 151). Through the narrative process, individuals can recollect past
notions of identity, project an evaluated vision of a future self, and, through ongoing
actions, attempt to bring the projected image into reality. Given that individuals do not
exert complete control over their life situations, future visions ore not always
actualized. MacIntyre (1984) noted that a unifying life story comes not so much from
direct authorship over one's actions but rather the narration or interpretation of life
circumstances into a sense of unity. Thus, revising story lines to provide new
understandings of how life events over which one has little control can be integrated
into a unifying whole becomes on ongoing process of identity development.
Identity, according to a narrative perspective, is not an individualistic concept,
something that is developed in the absence of one's community. On the contrary,
personal narratives embody meanings that ore public and shared by other members of
the community os well os personal meanings. Symbolic systems that arc embedded
within culture and language provide shared meanings and "modes of discourse"
(Bruner, 1990, p. 13) for negotiating meanings between community members. In
other words, a stock of knowledge, values, beliefs, and conventions are embedded
with one's particular social historical environment and from which narrative plots are
drawn to organize and interpret life events. When individuals assume these unedited
narrative plots os part of their stories, they incorporate prevailing discourses into their
self-representations (Rosenvvald & Ochbcrg, 1992). Thus, personal identities often
embody social traditions that arc expressed in dominant narrative discourses.
48
However, dominant discourses do not fit the experiences of all individuals. As many
feminist authors have pointed out, so-called universal world views arc more truly
reflective positions of white, middle-class heterosexual men than of other groups
(Harding, 1987: Smith, 1987, 1990). These prevailing discourses become personally
unrecognizable or distorted, though, applied to those who do not fit the above
category. Ocrgcn (1992) noted that linear, achievement-oriented narrative forms often
attributed to male heroes fall short of reflecting the complexity and multiplicity of
relationships and goals in which women's lives take shape. Similarly, Oresson
(1992) presented the conflicts encountered when African-American women move
beyond the prevailing discourses about racism and endorse personal stories about their
blackness that support their decisions to date and marry white men. Both of these
situations illustrate that, although culture provides a repertoire of narrative plot lines,
all individuals do not automatically endorse these specific story lines but rather adapt
the cultural stock to provide meaning to their specific situations.
Adaptation of dominant discourses docs not occur without ambivalence and
struggle. For some, the struggle is a deeply reflexive enterprise, in which a person
attempts to reinterpret life situations in a manner that is coherent and reasonable despite
the fact that it is at odds with dominant notions. For example. Walkover (1992)
described the dilemmas that couples experience when making decisions about having
children. These dilemmas emerged from their struggles with competing notions of
parenting-thc culturally prescribed images of the perfect family and their own personal
family experiences and concepts of parenting. In other cases, the tension that exists
when individuals become conscious of the embeddedness of unacceptable political
conditions in dominant narratives evokes actions which challenge, violate, and revise
these prevailing discourses (Rosenwald & Ochberg 1992). Narrative changes that
emerge from these actions have the potential to offer new narrative configurations to
the cultural stock and possibly result in concrete social changes as Roscnwald and
Ochbcrg (1992) acknowledge” If a critique of these conditions [meaning unacceptable
cultural-political conditions] occurs widely, it may alter not only how individuals
construe their own identities but also how they talk to one another and indirectly the
social order itself" (p. 2).
The narrative construction of identity offers a view that grounds personal
identity in the events of one's life and the meanings one attributes to those events.
Meaning emerges from the story plots that people employ to provide coherence to their
actions. Although contemporary plot lines arc readily available within one's culture or
subculture, identity more than likely is embedded in the ongoing refinement of one's
personal narrative that emerges from the struggle between the contemporary stock of
cultural ideas and the individual's unique experiences.
Identity Constituents
Numerous authors who address self-identity within the narrative tradition have
examined what Mishlcr (1992) called "part identities” (p. 36), or the various
components that may comprise one's total identity. Mishlcr warns that master
identities, which ore often consistent with stage theories, do not allow for an in-depth,
accurate analysis of the complexities of today's world. He claimed that identities are
not linear, but rather "involve detours, recursions, embedded cycles" (p. 36).
Furthermore, he stated that the vicissitudes of life stem from the fact that individuals
are embedded in a web of conflict over the value-laden tugs and pulls of the multiple
domains in which they exist, that is, work and family. He suggested that, whereas
integration throughout life may occur, it does so in a complex way requiring many
conflict resolutions. Chun (1983), who is particularly concerned with the absence of
adequate representation of "ethnic identities" from the prevailing studies grounded in
50
role theory, also endorsed the notion or identity constituents. However, his
framework moves beyond Mishler's in that he emphasized the influence of social
conditions on the emergence of certain identity constituents. For example, ethnic
differentiation or identity may occur within a social context of power inequality, ethnic
disparity, and social devaluation (Chun 1983). Thus, Chun suggests that, at least with
respect to ethnic identity, the social-political consequences of identifying with a
particular ethnicity need to be understood. Both Mishlcr and Chun suggested that
constructing identity in this way acknowledges the multiple influences that bear upon
one's life and may affect identity formation.
Kaufman's (1986) study on the sources of meaning in the lives of elderly
individuals is consistent with Mishler's notion of part identities in that she focuses on a
variety of themes that constitute one's sense of self. She begins to touch upon the
complexities of identity by focusing on the particular ways that cultural heritage and
idiosyncratic personal experiences, as well as the interpretation of those experiences,
interact to support an evolving sense of identity. Specifically, Kaufman provided
insight into the way in which people create a sense of continuity in their personal
identities through the subjective interpretation and rcframing of events throughout their
lives. Kaufman's (1986) findings suggest that creating a personal identity is a lifelong
process of interpreting one's actions in the world within the framework of one's
cultural background and personal historicity. Kaufman used the concept of "theme" to
describe the "cognitive areas of meaning with symbolic force-which explain, unify,
and give substance to their perceptions of who they are and how they see themselves
participating in social life" (p. 25). The stories of the elderly individuals in Kaufman's
study drew upon a number of themes which, tied together, created a life story that not
only integrated the diverse lifetime events they experienced but also informed their
present identities and actions. For example, Stella's life story entails the themes of
51
achievement, sense or aesthetic, need Tor perfection, and need for relationships and
selflessness. Some of these themes, such as achievement and sense of aesthetics, can
be traced from her childhood experiences of skipping two grades and ranking among
the top one-third in high school, to her early adulthood ability to secure and perform
extraordinarily as a secretary following a sudden divorce, to her present activities of
being a superb sculptor. Other themes, particularly the need for relationships, were
cultivated later in life after her 14-year-old daughter was suddenly killed. Stella's life
story, like those of the other participants, was filled with a number of themes that
"merged to define both who she is and the essence of life" (pg. 75).
Kaufman (1986) classified the themes that emerged from her informants'
stories into two categories, topics and interpretive labels. Topic themes, such as
marriage, education, or work reflect structural properties of the social world that carry
symbolic meaning. Interpretive themes, on the other hand, denote the individual's
sense of connectedness with cultural norms, expected goals that emanate from these
norms, and a personal appraisal of his or her behaviors with respect to these goals.
Self-determination, creativity, and selflessness ore examples of interpretive themes.
Kaufman (1986) furthered her discussion by unraveling the various sources of
meaning that inform the emergent themes. She claimed that these themes draw
meaning from both the shored symbols and experiences embedded in one's cultural
heritage and the subjective interpretation of one's personal experiences, although not
equally. All informants shared a common cultural heritage that included an ideational
component, defined as dominant values, and a structural component, defined os
socioeconomic status, education, geographical mobility, and familial ties. Historical
events specific to this group included World War I, II, and the Great Depression.
In analyzing the life stories, Kaufman (1986) found that a common cultural
heritage held meaning for her informants only insofar as it served os the backdrop that
52
provided opportunities and stipulated limitations for individuals' idiosyncratic personal
framework for interpreting their experiences. For example, the value of education was
expressed by most of the informants. However, the specific way that education
figured into their life stories and was perceived as memorable differed among the
informants. For Millie, education was a form of cnculturation, providing her the
opportunity to join the melting pot of America at a young age and to affiliate with
friends whom she cherished into adulthood. Family economic survival precluded any
education past 16 as she was forced to work. There she met her husband and married.
For Millie, education was enjoyable but possessed no specific meaning in her life. It
was merely a structural factor that provided the selling for themes that were more
meaningful, such as affitiaiivc ties, her family's survival, and her ethnicity. Ben, on
the other hand, pivoted his life story around the issue of education. "His self-image,
his fear of failure and notions of success, his worries about pleasing his parcnts-arc
all defined through his schooling" (p. 95). He attributes his sober identity and feeling
of social isolation to the all-male environment of a small Catholic school. College
served again os a pivotal point in his life when he decided to reject the call for
priesthood and follow his more intellectual propensities. For Ben, education was key
to his identity. These examples demonstrate that, although certain cultural structural
factors, c.g., education, stood out in the stories of these elderly individuals, indicating
their common cultural bond, no generalization as to how they influenced identity could
be made. The same phenomenon was seen with cultural ideational factors. Certain
values that were speciftc to this cohort, such as, achievement, productivity, work,
progress, serving others, and autonomy, were present in many informants' stories.
Once again, how these values were expressed within themes of personal identity
reflect the informants' subjective explanation of their life experiences in relation to
dominant values held by their culture.
53
What stands out most predominantly in Kaufman's (1986) study is the
idiosyncratic construction of personal identity that emerges from the subjective
interpretation of personal experiences against the backdrop of cultural heritage. Her
study highlights the creative process of self-formulation, the manner in which people
dynamically integrate certain experiences into themes which become the "building
blocks of personal identity" (p. 187). Most important, Kaufman broadens our
understanding of the constituents of personal identity by bringing to light the multiple
themes that may influence one's sense of self. In the same vein, Kaufman pointed out
the variety of sources that seed life themes. For example, she indicated that childhood
events may become prominent in adulthood because of the symbolic significance they
held for the individual earlier on. Beyond childhood experiences, themes also
emerged from cultural values, parental attitudes, environmental opportunities, and
religious experiences, among other things. In the end, Kaufman's findings provide a
model for examining how an individual's political-cultural situation and the narrative
that he or she creates to explain that situation interact to impact one's choice of actions
and the interpretation of those actions.
Conclusion: Lesbian Identities
A narrative perspective on personal identity encourages the notion that identity
comprises a variety of constituent themes that may be meaningful to varying degrees
throughout one's life. For the purposes of this study, sexual orientation, specifically
lesbianism, will be considered an identity constituent for some women and, thus, a
potential symbolic theme that affects their sense of self and to some extent what they
do. In fact, this view was supported by Bennett's study (1992) in which she asked
her participants if being a lesbian was an important aspect of their identity. Nine out
of ten of her participants responded positively and all ranked it as one of the top
54
themes that influenced a core sense of self. Similarly, Kricgcr (1983), who studied a
Midwestern community of lesbians, round that participants expressed their lesbian
identity in terms of the feelings and ideas that they held about themselves; feelings and
ideas that shifted and changed over time, yet maintained a sort of rough coherence in
their lives. She also demonstrated the struggle that these women experienced between
pride in their lesbian identity and rejection of that identity. These two studies imply
both the importance of a lesbian theme in some women's lives and the shifting nature
of that identity.
Other studies that attend to various aspects of lesbian life either demonstrate or
imply that being a lesbian affects politics, w ork, family configurations, and
communities, indicating that identifying as a lesbian will potentially shape one’ s
actions (Bennett, 1992; Kricgcr, 1983; Lockard, 1986; Weston, 1991; Wood, 1992).
For example, both Kriegcr (1983) and Lockard (1986), who delved into the dynamics
of lesbian communities, have illustrated the essential role that intense social networks
play in linking lesbians with one another to provide emotional support, friendships,
and information about community leisure activities and medical services. Women's
bookstores, music festivals, political activities, bars, or athletic events may become
central institutions or sites of occupations that offer a place to congregate and facilitate
information exchange. This is not to imply that all lesbians are intricately linked to
lesbian communities. In fact, Lynch (1987) illustrated a growing trend of gay couples
to feel more connected with their middle-class urban identity than their sexual
orientation per se. They may be less concerned with collective activities based on
sexual identities than their individualistic orientation with respect to career, home
ownership, and monogamous relationship. Of course, one could argue that gay men,
especially white middle-class gay men, may be significantly different in their
expression of sexual orientation than lesbians. However, studies that look at lesbian
55
experiences also comment that many lesbians are not formally tied to a lesbian
community, suggesting that different patterns of activities may exist, depending on the
degree to which one connects with a format lesbian community.
Furthermore, assuming a lesbian identity has been shown to affect the types of
opportunities that are available in one's community. Similar to ethnic identities
discussed by Chun (1983), an open lesbian identity takes shape within a context of
power inequalities and social devaluation and for this reason may evoke negative
social-political consequences. This is exemplified by the political laws that prohibit
certain expressions of sexuality, the types of jobs one can acquire, and the places one
can choose to live. Sexual prohibitions arc not only explicit in the sodomy laws that
exist in many states but, as 1 demonstrated in the lirst section of the literature review,
they exist in the notions shared by some heterosexuals that, when lesbians talk about
their partners or lesbian events, they are simply boasting about their exploits. These
notions convey the message that certain sexual lifestyles are inappropriate. Likewise,
employers may or may not explicitly discriminate against lesbians, however, there
appears to be a pervasive judgment as to whether or not lesbians should hold particular
jobs, educating young children being the most obvious example. Within work
settings, discrimination prevails and has been well documented. Wood (1990), in a
study of lesbian physical educators at various high schools, demonstrated the great
care that these educators look to hide their sexual orientation for fear of being found
out and fired. Jokes around the lunch tables, as well as the use of labels such as dyke
to denigrate students or teachers, served as clear messages that lesbianism was not an
acceptable identity.
It is also important to note that living a lesbian identity docs not occur in
isolation from other identity components, nor does it occur in an ahistoricol manner.
For example, Faderman's (1991) historical analysis of lesbianism in America from the
56
turn of the century to the present demonstrates, among other things, how class and
sexual orientation were woven together into very different behaviors in the 1920's.
Often women from working class families lived at home due to their financial
constraints. Meeting other lesbians required a relatively safe and known location
where these women could gather. Lesbian bars emerged as that central meeting place.
Given the consequences of police raids that were prevalent in the 1920s, strict codes of
behavior were maintained within the bars. These codes, embedded in the butch-
femme relationships, served to tip off insiders to any intruder and thus preclude
danger. Lesbian women from upper class backgrounds, on the other hand, maintained
different rituals and relationships. They enjoyed the luxury of private homes at which
they could entertain their female friends. Dinner parties became one core occupation
around which meetings occurred and relationships developed. Without the fear of
police raids, the strict behavior codes of butch-fcmmc relationships were not prevalent.
The notion of romantic friendships was more reflective of their experiences
(RuJemran, 1991). This is not to say that butch-femmc relationships or romantic
friendships ore solely class-based but only to acknowledge how factors such as class
may interact with sexual orientation and be expressed in what one docs. Furthermore,
the political climate of a particular historical period influences the expression of lesbian
identity. The fear associated with disclosing one's sexual orientation during the
McCarthy era was quite different from contemporary times in which women who arc
lesbian have greater latitude to disclose without severe repercussions (Fadcrman,
1991). However, even today, overt and subtle homophobia prevents disclosure equal
to that of their heterosexual counterparts.
In sum, the narrative literature on identity provides a rich foundation
supporting the notion that for some women, lesbianism may serve os a symbolic theme
that shapes personal identity and affects their everyday experiences in the world. For
57
occupational scientists, who arc ultimately concerned with how people express the
various themes of meaning they embody through their particular configuration of daily
occupations, understanding the nuances of how lesbianism as a meaningful theme in
one's life may enter into daily occupations becomes a central issue for study.
Furthermore, for occupational therapists who aim to create accepting environments that
encourage persons with disabilities to recreate their lives following a life disruption,
knowledge about weaving one's lesbian identity into daily occupations may be crucial
to the rehabilitative process. Additionally, an awareness of how particular health care
settings may foster or hinder a patient's expression of her lesbian identity will be
essential to the overall purpose of therapy. Drawing upon the literature I have
reviewed, I set out to discover how a lesbian identity influences both the occupations
in which one partakes and the meaning one ascribes to those occupations. I also
gathered gain information about the types of therapeutic environments that arc
constructive and those that hinder the provision of authentic occupational therapy in
relation to lesbians.
58
CHAPTER 3
RESEARCH PROCEDURES
Methodological Approach
The overall purpose of Chapter 3 is to lay out the specific research procedures
that were used in this project. I will open with the philosophical pcrspcctivc-thc
overall orientation toward knowledge development and view of human oction-that
underlies the project as a prelude to a more specific discussion of the methods 1 used.
This work is anchored in feminist philosophy and qualitative methodologies.
feminism
A single philosophical approach to feminist research docs not exist; however,
certain notions appear fundamental to and interwoven throughout much of the feminist
writings. Rcinhortz(1992) identified ten themes in feminist research, three of which
influenced the direction of this research project. These include (a) respecting women's
voices as an important source of reality; (b) representing the diversity of women's
voices in theory development; and (c) acknowledging the need to create social change
through the knowledge developed.
Feminists have pointed to the absence and distortion of women's lives and
experiences in mainstream bodies of knowledge. For that reason, those theories ore
creating difficulties for grasping women's worlds or providing an accurate account of
social phenomenon in general (Harding, 1987; Smith, 1987,1990). A genuine
respect for women's experiences and inteiprctations as a legitimate form of knowing
underlies feminist research. The eveiyday lived actualities of women becomes the
vantage point from which areas for study are identified and analysis begins (Smith,
59
1987,1990). Feminism asks questions that arc of importance to women's affairs and
poses solutions that grapple with how to change an oppressive, or at least a devaluing,
system (Harding, 1987). To accomplish this task, feminist scholars often focus on
both the process by which ideologies, social and political structures, and interpersonal
dynamics contribute to the devaluing of women's experiences, and how women resist
this devaluing and work to transform systems that arc unacceptable to them. The
experiences of lesbians as they live out their daily activities was the central focus of
this study and the vantage point from which an anatysis of the relationship of personal
ideologies and structural elements to daily occupations was made. By gathering and
presenting the experiences of lesbians within occupational therapy clinics I have
sought to bring their voices into the occupational therapy literature.
In the past, a universal women's perspective was endorsed to counter the male
bias in social theory and political agendas. While the notion of an essential woman
provided strength in the early women's liberation movement, the realization that
assumed homogeneity among women's voices tended to privilege white, middle-class,
able-bodied, heterosexuals is clearly present in current writings (Lordc, 1984;
Spclman, 1988). An appreciation for diversity in feminism has emerged, guiding
research and theories that aim to correct the previous blind spots and shed light on how
race, class, sexual orientation, and gender may, in on interwoven manner, influence
social oppression (Aplheker, 1989; Harrison, 198S; Lordc, 1984; Rcinhartz, 1992;
Spclman, 1988). Although a notable attempt to rectify the lack of diversity among
women's voices in the early feminist literature has been made, certain groups,
especially women with disabilities, claim that their presence is barely noticeable within
feminist academic and political agendas (Asch & Fine, 1988). These women argue
that their particular situation, that is, double oppression, could stimulate critical
insights into how sexism interacts with disable-ism. By having listened to lesbians
60
who are disabled speak about their interactions with the medical system, I have sought
to represent the voices of women who, at times, identify themselves as marginal to the
feminist movement
Feminist theories stand not only as an abstract explanation of social
phenomenon but as a force urging social change (Rcinhartz, 1992). The responsibility
of feminists to influence knowledge or social policy in a way that transforms gender
inequalities is a valued commitment consistent with a feminist ethic. Thus, research
assumes a practical, as well as scholarly, bent (Rcinhaiz, 1992). The findings of this
study can be used to modify educational curricula, to set more inclusive professional
policies, or to eradicate some of the homophobia in the occupational therapy clinic.
Often educators, clinicians, or political representatives in the occupational therapy
profession wish to address the concerns of lesbians, gays, and bisexuals, yet do not
fully understand those concerns or how to make positive changes with respect to those
concerns. The findings of this study provide knowledge-concrete examples or
discriminative practices in the medical system and of how sexual orientation can
influence daily occupalions-thai can be used in classroom discussions on hospital
ethics or woven into courses on occupation. Understanding the ways that lesbian
patients and occupational therapists are faced with discrimination within hospital
settings can assist occupational therapists to institute changes within their clinics with
respect to office artifacts, conversation topics, assessment forms, the content of
treatment, and the approach of therapists to patients.
flnnliifltive Methods
Qualitative methods that arc consistent with the philosophical premises of
feminism were used in this study. For the most part, qualitative techniques are
concerned with lapping the individual's or the collective experience of a certain
61
phenomenon. The belief that individuals do not engage in a preset itinerary of
activities but rather act out of an interpretive mode underlies the concern for accessing
both the meaning or subjective interpretations of experiences as well as the concrete
actions of humans (Bogdan & Biklen, 1982). In fact, qualitative methods are often
viewed as phenomenological in nature because they seek to define how ideologies or
meanings arc lived out in daily actualities. Such methods concentrate on actors
realities (Folit & Hunglcr, 1991). Because contexts affect action and interpretation,
observing behavior as it occurs in a particular setting and viewing that particular setting
within the larger social-historical realm is an important qualitative technique.
Qualitative methods arc many and can include, but are not limited to, life histories,
ethnographies, participant observation, interviews, analysis of videotapes, and focus
groups. In this study, I used audio-taped in-depth interviews.
Polkinghome (in press) describes two types of narratives os data: synchronic
and diachronic. Diachronic data arc temporal, relational, developmental, and
intentional information about events, whereas synchronic data represent information
about events in response to different categories of questions put forth by the
interviewer (Polkinghome, in press). The interview format used in this study was
designed not to elicit answers to specific questions but rather to gather stories about the
women's experiences with respect to being lesbian. Although questions to guide the
direction of the interview were used at limes, a large part of an interview revolved
around a singular topic, such os the person's rehabilitation experience in general, or
what she did last weekend. At other limes, the interviews yielded "chunked episodes"
from various moments in life that related to a particular question. Thus, the findings
could be described as diachronic data.
Polkinghome (in press) pointed out that two approaches can be used when
analyzing storied narratives. The first approach,--analysis of narrative-entoils
62
developing general concepts from several particular stories. The researcher
concentrates on finding common themes and relationships between thematic categories
as a way of analyzing the data. Narrative analysis, on the other hand, entails piecing
together various elements of data into an ”cmplottcd narrative" (Polkinghome, in
press, p. 13). The purpose of this type of analysis is to illuminate complex issues
concerning how and why events come about. Polkinghome cites various types or
stories that may result from narrative analysis including, "historical accounts, a ease
study, a life story, or a storied episode of a person's life" (in press, p. 13). In this
study, I primarily engaged in an analysis of narratives approach in which concepts
such os heterosexual work climates emerged from the various experiences that were
shared by the women.
Selection Strategies
Lesbians who are occupational therapists or who are disabled comprise a
somewhat invisible group, both within the lesbian community and the occupational
therapy community. 1 relied upon various strategics to find women who would be
willing to participate in this study. Initially, I contacted two occupational therapy
administrators at two major hospitals who had previously implied that they knew
lesbian occupational therapists. 1 requested that they share my research project with
the lesbians they knew. However, in both cases, the people they knew were
unreachable. Second, I placed ads (See Appendix D for Recruitment Ads) in the
Lesbian News and Lesbian Connection requesting participation by occupational
therapists or women with disabilities. One occupational.therapist and two women who
were disabled responded and subsequently participated in the study. Three other
women responded but were unable to participate. One was changing locations shortly,
one was a certified occupational therapy assistant, and one was deaf. The woman who
63
was deaf had not had occupational therapy and, at the time she called, participating in
occupational therapy was one of my criteria for including someone in this study.
My most comprehensive attempt to solicit participants entailed mailing 1,000
letters (See Appendix E for a copy of the letter) to occupational therapists who were
members of the Occupational Therapy Association of California and who lived in the
surrounding area. 1 chose names from the mailing labels I received based on their
proximity to Los Angeles and their female gender. As a publicity ploy to attract the
attention of my readers, I both addressed each letter with the individual's name and
personally signed it. Furthermore, I attempted to assuage any potential anxiety about
receiving a letter that even suggested that the recipient may be lesbian by stating up
front that 1 was writing all occupational therapists in the Southern California area and
that I would welcome talking to people who were heterosexual as well.
I received 4 positive responses from lesbians who were willing to participate
and 14 responses from heterosexuals who were willing to participate. One religious
newsletter with a mission to convert homosexuals arrived in an envelope in which the
sender scribbled out and pasted over the hand written return address, attempting, I
assume, to retain anonymity. Thirty-five letters were returned to sender due to address
changes. Three other lesbian occupational therapists who participated in this study
heard about this study either through people employed in the clinic in which they
worked who had received the letter requesting participation, through a previous
participant, or through a friend.
I later teamed that the letters I sent were not, in all situations, received as
neutral requests for participation in a research study. Two of the women who
participated in my study informed me that my name and the study had become the
focus of conversation during work. One participant claimed that one of her co-
workers wanted to know "who this Jeanne Jackson was anyway" and wlmt is she
64
doing studying lesbians. Her tone or voice, as well as her bewilderment as to why the
subject should even require study, is indicative of a prevailing attitude in occupational
therapy, that is, a mixture of naivctd and homophobia. In that situation, the participant
simply remained nervously silent, not acknowledging any connection with me, even
though I had taught her in the past, and my name had been brought up at previous
lunch tables within that context I'll discuss how her response becomes a form of
passing in the clinics later in the dissertation. The other participant related a more
troubling incident She stated that one of my previous students with whom I had
worked very closely and whom I knew very well, entered a work conversation quite
upset because, having received one of my letters, she assumed that 1 considered her to
be lesbian. Despite the fact that my initial sentence and the lost paragraph assured
people that I was writing to all occupational therapists in the area, the fact that it was
addressed directly to her, 1 suspect, led to her interpretation that I had singled her out
os a lesbian. Another woman in the group who had also received a letter successfully
assured this person that it was a general request. Again, one of the participants in this
study was part of the conversation and remained silent
To recruit lesbians who were disabled, I called the Los Angeles Gay and
Lesbian Community Service Center, the Lesbian Health Project, Lesbian Nurses, and
the Los Angeles and Van Nuys Centers for Independent Living to explore whether or
not they provided services for this population, or could offer assistance locating
lesbians who were disabled. No one could offer help. I became aware of Sister
Homelands on Earth (SHE) through a newsletter that Dorothy, one of the first women
I interviewed provided me. From the newsletter, it appeared that a group of lesbians
who hod various disabilities hod bought two acres of land with the intention of creating
a completely accessible place for disabled lesbians. Although I was unable to contact
that particular group, it led me to the Pacific Northwest area where I hod heard that
65
another such place existed and where my sister lived who could assist me in tracking
down people. I never found that particular Womyn's Land either, but I was
introduced to a home-busincss called "Ask Ellen." Etlcn, the sole owner and
participant in this business, researches any request put before her, such as, find the
lesbians with disabilities who may be willing to participate in this research project.
Through the immense help of Ellen's service, social service programs, the Lesbian
Community Project, and one month of phone calls, I was introduced to seven lesbians
who were disabled. Thus, I moved north and conducted interviews.
Participant Description
Twenty lesbians, 10 of whom were occupational therapists and 10 of whom
were disabled participated in this study. All were white. Given that extended practical
experience usually promotes a more advanced, expert style of clinical reasoning, I
initially reasoned that the occupational therapists should have worked for at least 2,
preferably 3 years, at a rehabilitation or psychiatric hospital setting in order to
participate in this study. A 2 to 3 year duration would afford the therapists time to
become familiar with the facility, learn specific occupational therapy procedures, and
treat a number of individuals. Nine of the occupational therapists had between 5 and
15 years of experience. One respondent had only 1 year of experience, but because
she was in the middle of coming out at work 1 felt her perspective and experience
would be valuable to include.
For the lesbians with disabilities, I initially set out to interview women who
had received rehabilitative services from on occupational therapist within a hospital
setting and who had sufficiently adequate speech and cognitive abilities to enable them
to participate in the interview process. However, because of the difficulty in locating
lesbians who were disabled, I decided to revise my plan and I interviewed all who
66
agreed to participate. Of the ten women who participated, seven had received
occupational therapy, one had been an occupational therapy assistant, and two had
never received occupational therapy. All the women had visible disabilities, meaning
that they used a cane, wheelchair, or scooter; walked in a slow and cautious manner;
or had obvious bone deformities. Initially, I did not perceive the type of disability that
the women had to be an important factor in this study. However, it became evident
during the analysis that, for some of the women, having a visible disability affected
how they were perceived by others and thus how they integrated their identity as a
person with a disability with other aspects of their identity.
Any attempt to provide a short introduction to the women who participated in
this study feels superficial and narrow. Nevertheless, the following scenarios arc
meant to give a few details about their lives that may be important for understanding
their responses. AH the names have been changed to maintain confidentiality. In some
instances the women have chosen their own pseudonym, and for those I did not
contact, I made a choice. In some instances, I have also changed the type of
occupational therapy practice they perform or masked the specific area of the country
in which they worked to protect their identities.
Lesbians Who Are Occupational Therapists
Arlene has worked as an occupational therapist for the past 10 years in a
variety of areas including adult physical disabilities and home health. She has never
been "out" (openly lesbian) in any occupational therapy clinic although she was out to
her lesbian bosses when she was a consultant for a social service agency. Three
interviews took place at a restaurant of her choice. She reported on work experiences
from various parts of the country. She considers herself lesbian and lives with her
partner in their shared apartment. She is 36 years old.
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Linda has approximately 15 years or experience at a small rehabilitation
hospital for people with physical disabilities. She is presently a manager and has been
openly lesbian since she began working at this hospital. She is 38 years old and
considers herself lesbian. Two interviews took place at her home where she lives with
her partner. During the second interview, her partner joined us.
Sant and Ami: Sara, an occupational therapist, and Ami, a physical therapist,
have been in a relationship with each other for the past 10 years. Both were equally
interested in the interviews. Thus, the four interview sessions occurred with both of
them at either Sara's or Ami's home. They both have approximately 15 years
experiences in adult rehabilitation and convalescent hospitals, and have never been out
in any work situation. Both consider themselves lesbian. Sara is 42 years old and
Ami is 38 years old.
Marie is 29 years old. She had 1 year of experience at an acute rehabilitation
hospital. She came out at work after a traumatic break-up with her partner. However,
since the interviews, she has changed jobs to a larger, more bureaucratic facility and
has chosen to remain silent thus far. She lives at her parent's home in an upstairs
three-room, mini-apartment. The four interviews that were conducted occurred at a
restaurant of her choice and at her home. She considers herself to be lesbian.
Monica had approximately 10 years of experience. She has worked at a
number of facilities throughout the country, primarily in the area of adult physical
disabilities. She has remained "closeted" (hid her lesbian identity) at all her work
settings, except in one situation in which she was unexpectedly outed to her
supervisors. She presently lives with three roommates, one of whom is her partner, in
a rented home. Three interviews took place at her residence. She is 37 years old and
considers herself lesbian.
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Jenna is 41 years old. She has worked as an occupational therapist for the past
18 ycats in psychiatric rehabilitation, physical disability rehabilitation, and vocational
rehabilitation. She has been employed in hospitals, as a consultant, and in private
practice. She has been closeted in all her jobs except one in which the majority of
employees were lesbian and gay and one in which she was outed by her partner during
a nasty breakup. One interview took place at her condominium. She considers herself
bisexual. She is presently married to a man and prior to that was in a long relationship
with a woman.
Connie has 5 years experience primarily in the area of adult and pediatric
rehabilitation. She has worked both per diem and Tull time at several rehabilitation
hospitals. Connie is 30 years old. She is selectively out to friends and lesbian-
friendly co-workers, although as time wears on she is more and more out. Three
interviews took place at the home she owns with her partner. Connie considers herself
bisexual. She has dated men in the past, but has recently made the decision to settle
with her female partner and have children. One interview was conducted with both her
and her partner. The other two were conducted with Connie alone, at their home.
Leah is 40 years old. She has been working as on occupational therapist for
the past IS years with adults who have physical disabilities. She is presently an
administrator for a private company that provides occupational and physical therapy
services for acute and convalescent hospitals. All three interviews with her and her
partner took place at the home they own. In general, she chooses not to be out at
work. However, a situation arose at work to which she responded by informing her
bosses that she was lesbian. She considers herself lesbian.
Cathv has about 10 years of experience with adults who have physical
disabilities. She is selectively out to her friends at work. Two interviews occurred at
the home which she owns. She is 37 and considers herself lesbian.
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Noel has approximately 5 years experience both as a staff therapist and a
supervisor at an acute rehabilitation hospital. She recently came out to her co-workers.
The one interview was conducted at a lesbian-friendly coffee house. She lives in a
rented home with her partner. She is 32 years old and considers herself lesbian.
Lesbians Who Are Disabled
Lisa is 41 years old. She lives in a rented apartment with her partner. She
docs not work due to chronic back pain as a result of an automobile accident IS years
ago and a progressive disease in which the fascia tears away from the bone. She has
hod two children from a previous heterosexual marriage, one of whom is in junior
college and one of whom is graduating from high school. She has been in and out of
hospitals since her cor accident and thus has had extensive interactions with health care
professionals. She has had no occupational therapy. She considers herself lesbian,
and is predominately silent about her lesbian identity to her friends. She changed her
last name to match her partner's last name so that they can pass os sisters in any health
core situation.
Dorothy recently retired from employment in the school systems as a speech
therapist Prior to that she worked as an occupational therapy assistant at a physical
rehabilitation hospital. As a child she had juvenile rheumatoid arthritis which
interfered with her bone growth. She is 46 years old and considers herself a lesbian.
The three interviews took place in her home. She is out in all spheres of her life.
Barbara recently retired from a productive career as a saleswoman with a cable
television company. She presently works as a consultant with a micro-computer
company that mokes environmental control units which, similar to a dental plate, fit
within one's mouth and are tongue-controlled. Simultaneously, she is developing her
own faux finishing company. Barbara incurred a spinal cord injury 4 years ago and
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was rehabilitated at a nationally known rehabilitation center. She considers herself
lesbian and was out during her hospitalization. In fact, her friends sought a hospital
that could both provide good rehabilitation and was, by reputation, lesbian-friendly.
She is 45 years old and lives in her townhousc with her partner. Our three interviews
took place at an outdoor beach front coffee shop, in the lobby of a hotel at a conference
she was attending, and at her townhousc.
Isabel works as a social worker in a community agency. She has multiple
sclerosis and has received occupational therapy both in the hospital and at home on
different occasions when her disease has flared up. The day of our initial interview
she was admitted to the hospital for intravenous drug regime to slow the progression
of the disease. All three interviews took place in the visiting room or the lobby on her
floor at the hospital. Upon discharge she has plans to move into her partner's home.
When in the hospital, she has not, up until this last hospitalization, been directly out.
Her philosophy is that most people don't want it thrown in their face and thus she is
much more discreet. On the other hand, she has told some of her health care
professionals and, during the lost hospitalization, she and her partner laid in the same
bed watching television. She is out in most other areas of her life. Isabel is in her
early 50s.
Emma is 44 years old. She hod a closed head trauma and multiple fractures
due to a cor accident that occurred 3 years ago. She participated in occupational
therapy at both a rehabilitation center and at the convalescent hospital where she
initially underwent therapy. She later received home therapy from an occupational
therapist She was selectively out during her rehabilitation. At the time of her
accident, she was self-employed as a housecleaner and was studying botanical
medicine. Emma continues to regain endurance and motor control and is thus
presently unemployed. Emma considers herself a lesbian and is out to her friends.
71
She lives in her own home with her dog. Both interviews took place at her home.
Emma belongs to a disabled lesbians group.
Natasha is a librarian and technical editor. She is 45 years old and has lived an
exclusively lesbian lire for the past twenty-three years. Although she doesn't always
say the words "I am a lesbian" when first meeting people, she looks and acts like her
natural self, making no attempt to "pass” straight She was not out to the medical
rehabilitation team twenty years ago, following a severe automobile accident in which
both her legs were broken, and one of her feet was crushed. While still recovering
from those injuries, she became involved in a romantic/sexual relationship with a bi
sexual woman whose jealous ex-boyfriend attempted to kill her. A .22 bullet from his
pistol passed through her arm and shoulder, causing permanent injury to the joint
Natasha received rehabilitation but not occupational therapy. Fortunately, her
education and training was in a profession that she was able to continue after these
disabling injuries, precluding the need for work re-training. However, due to the
debilitating effects of chronic pain and limited mobility (she walks with a cane), she
has chosen half-time employment to preserve both time and energy for other aspects of
her life. Both interviews took place at her home.
Tcri is 37 years old. She is retired from her job working for Cal Trans. She is
presently training to be in the Gay Olympics and a member of the city's Lesbian Choir.
Fourteen years ago she incurred a spinal cord injury for which she received
occupational therapy at a nationally known rehabilitation center. She considers herself
lesbian and was out to the hospital personnel. A rainbow flag hangs outside her home
and she displays lesbian stickers on her wheelchair. Both interviews took place in the
home she owns.
Roberta incurred a spinal cord injury approximately 15 years ago at the age of
15. At that time she was not fully aware that she was a lesbian. She participated in
72
occupational therapy during that rehabilitation and during subsequent hospitalizations.
She has been closeted during her hospital stays, although she has informed a few
health care professionals, from whom she has subsequently received care, that she is a
lesbian. Roberta works on and off (depending on grant money) for the department of
vocational rehabilitation. Her home has been adapted so that she can carry out some of
her work duties there. At the time of the second interview, she had recently undergone
surgery and thus, the interviews took place while she rested at her home. Roberta
owns her home and rents out another room to her attendant, who is also her partner.
Roberta belongs to the newly developing disabled lesbians group.
Sandv lives in her own home with her teenage son. At the time of the
interviews, she was considering moving in with her partner. Sandy retired from a
stressful job with an insurance company following a "double" stroke about 1 1/2 years
ago. She is in her early 40s. Sandy was not out as a lesbian at her work and
selectively shares this information with her present friends. During her
hospitalization, she was only out to her occupational therapist and a physical therapy
assistant who knew her sister. Both interviews took place at her home.
Marguerite refers to herself os "an incurable lesbian feminist." For years she
has been active in various social movements, specifically ones that have dealt with
lesbian and peace issues. Recently, as her Friedcrich's Ataxia has worsened, she has
been unable to participate in the activities that previously consumed most of her time.
Marguerite is 40 years old. She is out in every sphere of her life. She stated that she
tended to slay away from health care professionals because she docs not like the
medical field. However, she had occupational therapy for both a brachial plexus
injury and to adapt her home, and physical therapy to work on various mobility issues.
In these situations, she feels that it is obvious she is a lesbian by the objects she
displays in her home. Presently, she lives by herself and has attendant core on a daily
73
basis. The one interview that I hod with her took place in her apartment Although
she has a speech impairment, by repeating back her answers to my questions I was
able to communicate sufficiently and to gain confidence that 1 was understanding her.
Data Collection
As slated previously, I used multiple audio-taped, semi-structured interviews
to analyze the experiences of lesbians in their daily occupations and in health care
situations. The 20 women in this study participated in a total of 47 interviews.
Interviews lasted from 1 1/2 to 2 1/2 hours, depending on the flow of the
conversation, resulting in approximately 70 to 80 hours of interview time and 2,033
pages of transcription. For most of the women who lived near me, 1 conducted
interviews every other week until completed. Occasionally more time passed between
interviews because of a holiday, an illness, or scheduling difficulties. The women
who lived out of state participated in weekly interviews with me until completed.
Interviews--Description
Semi-structured interviews can provide a rich source of information about
human meaning and how it is lived out in one's everyday world (Van Mancn, 1991).
In-depth interviews culminating in approximately 4 to 8 hours per person had a
number of benefits for this study. An extended amount of time in conversation with
the women fostered a misting relationship that uncovered experiences not normally
shared. Lengthy interviews over a span of time allowed for in-depth probing of issues
that were not clearly recognizable in everyday notions or language (DeVault, 1990).
This was particularly important to this study os sexual orientation is not usually framed
with respect to activities outside of intimacy. Finally, multiple interviews of each
participant contributed to the accuracy of the analysis by providing an opportunity to
74
clarify ideas presented in previous interviews and to secure feedback from the
individual on the researcher's interpretation of the stories that the participant tells about
her life.
In keeping with feminist philosophy, an "egalitarian cooperative" approach to
the interview process was a primary concern (Reinhartz, 1992). For this reason, the
interview remained flexible and largely guided by the interactions between the
researcher and the participants. Maintaining an informal and free (lowing conversation
style is essential to encourage open, honest narrations of the women's lives and health
care situations. Relatively free interaction promotes the expression of feelings and
ideas in the women's own words, which is particularly important when studying a
group that is relatively invisible to mainstream literature (Rcinhorz, 1990). Caution
was taken to listen attentively to the women's stories, respecting what may have
appeared to be seemingly irrelevant pieces of information or digressions as these
sometimes became essential elements of the analysis (DcVault, 1990; Mishtcr, 1986;
Stevens, 1992a). DeVault (1990) points out that within the interview "halting,
hesitant, tentative talk" (p. 103) can be vitally significant to capturing those aspects of
women's experiences that ore often glossed over because existent vocabulary is
inadequate in naming them. Audio-taped interviews supported a close, accurate
analysis of women's realities by retaining the words, pauses, and tone of voice.
Furthermore, audio-taped interviews ensured that the integrity of the women's spoken
words were maintained by permitting the researcher to glean direct quotes from the
interview.
To further create an egalitarian relationship, I asked the women to choose the
place at which they would feel most comfortable participating in interviews of this
nature. Fifteen women chose their homes or apartments as the most comfortable place
to have on in-depth discussion. One women was unexpectedly admitted to a hospital
75
and requested the interview to be held there. Two women chose their favorite
restaurant or coffee house and two other women requested that each of their interviews
be held at a different place including their home, a restaurant, and the lobby of a hotel.
One's residence or favorite "hang out" provides a familiar environment conducive to
exploring personal issues. Within a relaxed familiar atmosphere, the expression of
emotions and attitudes toward the stories of one's life is more apt to occur. In
addition, by positioning the interview within familiar territory of the woman rather
than a site determined by the researcher, any power asymmetry that may be inherent in
the rcscarchcr-participant relationship could be lessened (Stevens, 1992a).
I ntcrvicws-Proccdures
Anxiety about how I was going to elicit the type of information that 1 needed
while maintaining a free-flowing convcrsation-style interview led me to pilot test this
project on a gay mole friend of mine, Tom Clark. Besides figuring out the perils of
voice-activated tape recorders, an appropriate volume at which to set the machine, and
how long Evcrcady batteries actually work, Tom's detailed stories in response to my
queries (See Appendix F for interview guidelines) confirmed that this particular format
could easily evoke the types of narrative I was seeking. Perhaps most important was
his optimistic good-bye at the door in which he cheerfully invited me back,
commenting that "lesbians and gays arc going to love to do these interviews because
where else would someone get to talk about his life os a gay person-it just doesn't
occur often" (paraphrased). His point, that lesbians and gays are often in positions
where many of the most important aspects of their lives remain hidden, was one of the
reasons why the women in this study were able to talk at length about their life, once
given a stage on which to do so. In addition, it was one of the reasons that many of
the women chose to participate in this study. The occupational therapists who
76
participated in this study were aware of the absence of lesbian and gay issues in the
occupational therapy profession and some chose to participate because they felt they
could help eradicate that omission. Participating in this study became a way that they
could contribute to changes in the profession, especially for those who felt closeted in
their work setting. As one woman commented, "We're political wannabe's."
Likewise, some of the women who were disabled participated in this study with the
hope that their information could contribute to changes in rehabilitation, with respect to
how medical personnel treated patients in general and lesbians in particular.
Additionally, the women I interviewed participated because they were willing to help a
good project.
One woman, however, deserves specific acknowledgment Marguerite's name
had been mentioned to me by two to three other participants os someone who would be
particularly articulate about the subject matter that I was studying. She had been
quoted in a recent lesbian newspaper arguing for accessible feminist bookstores. I
followed up on this lead, even though it was shortly before my departure date and I
was uncertain that we would be able to schedule on interview session, if she agreed to
participate. We did schedule a lime, and when 1 arrived at her home, I laughingly
commented, "Boy, have 1 heard about you." She retorted, "I've heard about you,
too." Of course, this perked up my cars and I immediately questioned how. She
explained that when 1 was in California looking for participants, a few people had
called her with my request and she chose not to participate. I asked her why and she
claimed that she was tired of being viewed and "needed" because she was disabled.
Being disabled was not the most important part of her identity and yet, more and more,
she was being called on to speak from that perspective. I responded that I was not
solely asking questions about her disability but also about her experiences as a lesbian.
It seemed apparent to me that being lesbian was on important identity that she
77
wholeheartedly embraced and that she wanted others to see and respect. She had
worked for years as an out lesbian in many women's and peace movements.
Disability, on the other hand, was a part or her life, but not something of which she
necessarily felt proud or embraced. As I will explain in Chapter 4, the fact that she
was being recruited into projects because of her disability was non-affirming,
especially because she was simultaneously being excluded from projects having to do
with her lesbian identity.
Now I will describe the specific process for carrying out the interviews. Upon
receiving a message from someone who had received a letter, seen an ad, or had been
told about my study, or the name and phone number of someone who might be willing
to participate, I contacted the person, explained the details of the study, and requested
some preliminary information to assure that they were occupational therapists or had a
disability and to ascertain their sexual orientation. For the women who were
heterosexual, I explained that I would primarily be interviewing lesbians and bisexuals
first and would gel back to them in about 9 months. (I decided later to interview only
lesbians and bisexuals). For the other women, I scheduled an appointment for the first
interview. Confidentiality was also addressed in this first phone call. In many
situations, the process of building rapport began within the first phone call when the
women would spontaneously offer a personal story about a work or health care
situation in which their lesbian identity had negative consequences. In three situations,
I hod previously known the occupational therapist and thus, in the first phone call, we
re-acquainted ourselves as "lesbian" occupational therapists. In one situation, I was
the person's friend.
The first interview began with the signing of the consent form (See Appendix
G for consent form). For purposes of confidentiality, two participants provided a
taped verbal consent rather than signing their name to any form. I initially conceived
78
the purpose of the first interview to be that of retrieving unccnsorcd narratives about
the participant's lesbian identity and how it is manifested in day-to-day activities.
However, because many of the women so readily shared work or health care
experiences on the initial phone call, I decided to begin the interviews by exploring
how being lesbian affected rehabilitation. Specifically, I asked the occupational
therapists to tell me about each of their work situations and what factors contribute to
the creation of supportive or non-supportivc situations with respect to being lesbian. I
asked the lesbians who were disabled to reflect back on and share their experiences in
the hospital setting, in particular with occupational therapists. Although I focused on
occupational therapy, I quickly learned that, when hospitalized, many of the women
did not distinguish between the different therapies. Furthermore, what was said or the
treatments provided by health care providers in one discipline often affected the
attitudes toward or interactions with other health core professionals in creating a
general climate of core. Thus, I talked about their health care experiences in general. I
ended the first interview by telling each participant that we would continue on the same
topic in the next session as well os begin to explore how being lesbian influenced their
daily occupations. By providing prior information about the following session's
topic, I hoped to sensitize each woman to what was to come, thus jogging her memory
or directing her awareness toward these topics.
The second interview differed for the lesbians who were occupational
therapists and for those who were disabled. For most of the women who were
occupational therapists, I began by asking them to recount their previous week at
work, including treatments and interactions with patients and co-workcrs. I then
moved into questions that began to address how being lesbian influences their day-to-
day activities. The second interview for the women who were disabled began directly
with a discussion about how being lesbian was played out in occupations. For both
79
groups I used each subsequent session to clarify any questions from the previous
session.
The intent of the third interview was to continue the discussion about how
being lesbian influenced their occupations. Thus, I asked all of the women to recount
the past week or two explaining what they did with their time. From that vantage
point, I explored how each activity was or was not influenced by their lesbian
identities. In all three interviews, I was an active participant. I was absorbed by the
conversation, nodding, agreeing, and many times laughing, or showing empathy as
they described painful experiences.
Although I have provided a general outline of the process used in the data
collection, each set of interviews differed depending on a number of factors. First, not
everyone participated in three interviews. For a few women, a fourth interview wus
required to share all the information they felt they had to provide. Some women
participated in two interviews because my time constraints permitted me to stay in the
Pacific Northwest for only about 3 weeks. The three women who participated in one
interview did so for different reasons. One was quite succinct and was able to provide
ample information in a single session. As I explained previously, I was put in contact
with Marguerite near the last day of my stay in the Pacific Northwest and thus had
limited time to see her. Finally, scheduling issues mandated that I interview the last
occupational therapist when I was well into the analysis process. I used her
information to add to the existing data.
The interviews also differed depending on where that person fell in the order of
the interviews. The interviews with the first few participants were influenced by both
my anxiety and the fact that I had no sense of the direction that the interviews would
take. Thus, at times, there were hesitant moments in the interviews when I tried, yet
was unsuccessful, at formulating a clarification question. In particular, this occurred
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during discussions about how lesbian identities were expressed in daily occupations.
Although the women often claimed that their lesbian identities affected virtually every
aspect of their lives, for the most part, specifying when, how, and why was difficult
for them to explain and me to understand. Later on in the interview process, themes
began to emerge, and although the interviews themselves remained spontaneous, I
became more skilled at probing into areas that people had not previously considered.
In addition, the degree to which each individual had refined the art of
storytelling was on influential factor in how the interviews unfolded. Although all the
interviews were driven by narrative recollections, some people used short narratives
with a single theme whereas others brought in multiple factors that had bearing on the
subject. Likewise, some women recalled incidents that related to each subtopic area 1
introduced, whereas other women did not rely to any great extent on my introduction
of topic areas but rather spent most of the interview using each narrative to spin off
into the next narrative. The following discussion will shed light on the difference in
interviews based on story telling mode,
Leah hod a gift for storytelling. I had known her in the past and thus, she
invited me over for dinner for our first interview session. That evening set the tone for
subsequent interviews in which Leah and her partner told me work and home stories.
The degree to which the sharing of particular events guided the interview process was
best exemplified when Leah and 1 decided 1 should return for another session because
she had not told me the story about her "transsexual bed and breakfast guest" or the
"Spaghetti Dc Lagado Event." She typed into her computer a reminder of which
stories she needed to recall the next session. Although the next session explored areas
for beyond these two incidents, I rarely followed my interview guide for those three
sessions.
81
In two other situations, the individuals were in the middle or what they
considered a life transition. Marie, whom I had known previously, was involved in a
traumatic break-up with her partner of over 7 years. During the interview, she flipped
back and forth between the break-up, work situations, and what she was doing in her
everyday activities. The conversations occurred over dinner which contributed to their
fluidity. Ami and Sara were in the middle of coming out to an important family
member and thus, much of the conversations revolved around family events that led up
to her telling her sister. As with Leah, all three of these women were quite adept at
sharing their experiences.
Besides these three women, many other women seemed to engage in
storytelling quite easily, although they relied on more guidance from me. One woman
was careful to try to answer the question while simultaneously going off in what she
seemed to interpret as tangents. Occasionally, she would stop and check, "Is this what
you want to hear?" and then launch into her story. Most people fell into this category
with some topics creating more ease for them than others.
In only three eases did I feel that the women stuck fairly closely to the
questions I proposed, and in this sense, relied upon me to guide the interview process.
In those situations, I tried to simply present broad topic areas, but found that probing
was essential. I often asked for details related to the narration, in order to encourage a
more in-depth description of the event. Finally, in only one situation, the person
repeated herself and become so tangential that I had difficulty following our
conversation. On both of her interviews, I listened for about the first 1 1/2 hours and
then became more directive in the lost hour. I chose this approach because her
particular disability and the drugs that she was taking could have contributed to what
appeared to be a wandering conversation.
Data Analysis
t.
Data analysis refers to a systematic process for interpreting interview material
through organization, synthesis, and analysis (Bogdan & Biklcn, 1982). Three
different procedures were used to analyze the data including tape transcription, coding,
and memo writing. It is important to note that these procedures were not independent
sequential steps but rather occurred in an ongoing, overlapping fashion that
strengthened each procedure. In the same vein, data collection and analysis occurred
simultaneously with the ongoing analysis, influencing the direction that subsequent
interviews took and the observations that were made. Further interviews seemed to
broaden the analysis (Charmatz, 1983).
The analysis occurred in two parts. On the suggestion of my committee I set
out to answer only one of the two proposed research questions. I initially chose to
answer the second question, how being lesbian influenced health care experiences.
My decision stemmed from the fact that many of the participants had burning issues
about their health care experiences and told them with great passion. Furthermore,
some of the women's decision to participate was for the purpose of sharing this
information in the hope that the findings could contribute to change in the health core
system. In the process of analyzing the data in relation to this question, I realized that
explicating how an individual's lesbian identity entered into daily occupations, the first
question or the study, was necessary to fully address the second question.
Furthermore, I tried to listen attentively to the stories that were told with great emotion
because I felt that these were most important to the individual. The notion of living an
authentic life came across loud and dear in many ways. Thus, after reading the
transcripts over and over again, I felt I could not do this dissertation justice without
analyzing the first question, how being lesbian is expressed in daily occupations, at
least to provide on introduction to the second question.
83
TapcTranscripiion
The tape transcription process for the interviews that took place in California
differed from those that took place outside of the southern California area. For the
local interviews, I recorded general observations including nonverbal attitudes of the
participants, descriptions of the setting, general impressions, and my subjective
responses to the process, or momentary insights directly following the interviews.
For the local women, I gave the option of having a typist or me transcribe the tapes.
In four cases, the individuals requested that 1 be the only person to hear the tapes due
to confidentiality. Thus, I personally transcribed approximately 20 hours of taped
interviews. This process required 9 to 10 hours of transcription time per 1 hour of
taped interview time. Confidentiality was not as important to the people who lived out
of state and thus, they all readily agreed to having the tapes transcribed by a
professional typist. All tapes were transcribed verbatim with on attempt to retain
pauses, exclamations and other nuances of language. Identifying names and places
were deleted. For those tapes that I did not personally transcribe, I re-listened to the
tapes, checking and making corrections on the typed transcriptions. This process
required approximately 3 to 4 hours per 1 hour of taped interview time and allowed me
to once again immerse myself in the interview. Because tone or voice, intensity, and
emotions such as anger and laughter ore retained on the tape, it was easy to transport
myself back into the setting. This process also afforded me the opportunity to reflect
upon the data and the research process. I recorded three types of insights: (a) personal
reflections, in particular my emotional responses to the stories; (b) clarification of
statements when they seemed to be ambiguous or I felt that I might misinterpret them
when reading the transcripts without the audio-tapes; and (c) my reflections about the
interactions during the interviews or any other part of the interviews. 1 either inserted
84
these insights directly into the interview itself (in bold print) or wrote a note at the end
of the interview.
When the tapes of the local interviews were transcribed by my typist, I was
able to re-read the transcripts before the individual's next session. Because of the
lengthy process involved in transcribing the tapes myself, I was not always able to
finish the transcription prior to the subsequent session. In those situations, I re-
listened to the tapes, in order to refresh my memory. This allowed me to relate the
present interview to past interviews. For the out-of-state women, I was not able to
have any of the tapes transcribed between the interviews. Thus, following each
interview, I made a concerted effort to record my impressions, the main points that
came up, and some guiding questions for the next session. Furthermore, 1 re-listened
to the tape prior to the subsequent interviews.
Coding
Coding is a process of synthesizing and categorizing discrete pieces of data
into abstract conceptual categories (Charmaz, 1983). To accomplish this task, three
levels of coding can be used. Open coding (Strauss, 1989), or initial coding
(Charmaz, 1983) as others have named it, refers to a search process during which the
researcher scrutinizes the data for emerging concepts or repeated themes, regardless of
how provisional they may seem. During this searching period, the researcher is
particularly interested in detecting general leads or ideas and a beginning sense of
connection between concepts. It serves as a springboard to facilitate new insights
about the data. This level of coding is a beginning attempt to create order in the
material (Charmaz. 1983).
Initial coding began as I re-listened to the tapes and wrote my insights within
the context of the interviews. As each interview was finished, I re-read the interview
85
and coded in the margins for content, emotions, or themes. 1 paid special attention to
the stories which were told with intense emotions or that the woman pointed out were
particularly important I also earmarked parts of the interview that stood out as "good
quotes," although I was not always sure why 1 designated them as such. I also used
this initial coding stage to pull together story parts that were woven throughout the
interview. For example, Monica's decision to remain closeted in the work setting
could only be understood within the context of her previous experiences with family
members and the hallway discussions between co-workers. Thus, for each individual,
as I re-read the interviews, I drew connections between each of her three interviews
and developed coherent stories, when needed. This stage was truly an exploration into
the data in an attempt to ascertain what was of most concern to the participants us well
os to identify common themes.
The next level of coding, axial coding, entails a concentrated effort to expand
the analysis of certain concepts identified in the initial, open coding phase. The intent
is to develop and refine categories by raising concepts to a more abstract, analytical
level (Charmaz, 1983). During this phase, concepts that the researcher deems most
significant ore pulled out and applied to the rest of the data for the purpose of creating a
dense understanding of the identified category (Charmaz, 1983; Strauss, 1989).
Specifically, axial coding involves dimcnsionalizing concepts, specifying the various
conditions associated with, contributing to, or resulting from the phenomenon, and
hypothesizing about the connections between concepts.
After approximately eight interviews were completed, certain broad themes,
such os heterosexism at work or homophobic interactions with health care personnel,
began to emerge. I re-read each interview scanning for more information to further
flesh out these categories. For example under coping with heterosexism at work,
subcategories such as remaining silent, censoring information, or editing stories began
86
to take shape. As these subcatcgorics took shape, I continued to read for new ideas.
As new ideas emerged, I again re-read the interviews, applying the new ideas to all the
interviews. This circular process continued. I ended up with approximately 100
codes.
Selective coding, the third type or coding, occurs when the central categories
have been identified and somewhat fleshed out. The purpose of selective coding is to
systematically link the axial codes, or subcatcgorics, to the core categories that have
emerged as central to the study (Charmaz, 1983). It entails an attempt to exhaustively
analyze the conditions of the Core categories and, in doing so, explain the phenomenon
studied. Thus, selective coding emphasizes a "proccssual analysis" (Charmaz, 1983,
p. 106) which illustrates the interwoven nature of subcatcgorics to the core categories.
Once I hod coded and rc-codcd, I began to develop an outline that related one theme to
another and I began to write the findings of the study. As I wrote, I continued to flesh
out concepts, collapse concepts, delete notions, and rearrange ideas. During this time,
I also relied on outside literature to provide comparisons.
The above procedure provided guidelines for analyzing the thematic content of
the narratives I collected in the interviews. However, at times I felt that in the process
of categorizing concepts and linking categories, I lost the complexity of situations. 1
struggled with my desire to illustrate the complexities of situations by analyzing one
narrative rather than thematic content across narratives. Thus, whereas 1 used the
above procedure in terms of describing concepts such as the various ways a
hctcrosexist environment was maintained, or the various ways that people managed
their lesbian identities at work, I did not try to develop categorical descriptions of
concepts such os the degree to which people were out at work. Rather I picked two
different styles and tried to explicate the various personal, social, or environmental
factors that contributed to why someone would choose to stay closeted versus come
87
out. f used a similar approach when I described situations in which individuals felt
harassed at work.
M e m o s
Memos arc a written representation of the researcher's ongoing analytical
thought process about the data. They serve to record the continual elaboration of ideas
that explicate the conditions of selected categories (Charmaz, 1983). I wrote memos
throughout the project using them to outline concepts os they began to emerge,
describe concepts or the links between concepts, remind me of new issues to explore,
and to record any struggle I was having in the data analysis. As the project proceeded,
memos were integrated into a final analysis.
Ethical Responsibilities
"Remaining hidden" is a strategy people who ore lesbian, gay, and bisexual
use in varying degrees to maintain their physical and emotional safety (Warren, 1977;
dc Montcflorcs, 1993). The decision to share one's sexual orientation with family, co-
workers, heterosexual friends, or even lesbian, gay, and bisexual friends is an
individual choice that must be made continually throughout one's life as one's social
and emotional situations change. The degree to which lesbians arc out in occupational
therapy spans the entire continuum from those who have commented, "I'm out in all
spheres of my life and have been for many years" to those who are closeted in all
professional and work arenas and express fear about having their names even
associated with the Network for Lesbian, Gay, and Bisexual Concerns in Occupational
Therapy.
Given the range of responses to being out in the occupational therapy
profession, utmost attention was given to confidentiality. Participants were warned
88
that the findings of this study may be published in an occupational therapy journal and.
thus, allying themselves to this particular study or myself as a researcher could be
revealing. The data were coded with pseudonyms that cither the women themselves
chose or 1 chose for them. The decoding list will be destroyed after the dissertation is
completed. Pseudonyms were used to identify the tapes and any other written or
verbal material associated with the individual. Tapes were transcribed using numbers
rather than names. Discussions with committee members maintained the
confidentiality of the participants. Furthermore, the names of the hospitals and any
defining characteristics about them have been disguised.
The Researcher's Experience
Shulomit Rcinharz (1992) suggests that feminist researchers often write about
the researcher's relationship to the research project. In this section, I will describe my
relationship to the project, some of the particular problems I encountered, and what 1
have learned.
Unlike many forms of mainstream research in which the researcher's personal
characteristics arc viewed as biasing objective data, in feminist research they arc often
viewed os on asset (Rcinharz, 1992). By explaining my standpoint as the researcher in
this project, I hope to provide the reader more information with which to interpret the
findings. I approached this project os a Euro-American, middle-class, able-bodied,
lesbian, occupational therapist From this standpoint, I came from a similar
background to many of women who participated in this study, in particular the
occupational therapists. The occupational therapy profession grew out of the efforts of
middle-class, Euro-Americons associated with moral treatment and the arts and craft
movement. Currently, the profession remains primarily influenced by women of the
same sociocultural background. Although there are always personal differences
89
among people within a group, I found many threads of similarity with the women I
interviewed which enabled me to establish rapport rather easily. One could say I was
an insider.
I also came from a similar background as the women who were disabled, in
terms of being Euro-Amcrican, middle-class, and lesbian. However, as both able-
bodied and an occupational therapist, I was distant from their experiences. Moreover,
I was requesting their critique of the medical system in which I had worked. For that
reason, I found myself, at times, being cautious in the ways I asked questions, trying
to assure them that I welcomed their criticisms of my own profession and medicine in
general. I listened intently to the problems they reported, trying to ferret out the
multiple issues underlying their complaints. Because I sincerely agreed with most of
their complaints and was aware that they occurred in hospitals, I feel I could honesty
relate to the women's stories. From the responses I received, it appeared that no one
seemed uneasy in sharing the negative aspects of their health care even though 1 was a
health care professional.
Perhaps what separated me most from the people I interviewed was the
historical periods in which they became involved in the lesbian movements and the
geographical areas in which they presently lived. Some women took me back into the
pages of Lillian Fadcrman's book Odd Girls and Twilight Lovers (1991) as they told
me about, for example, their adventures down dark alleys into unmarked bars in the
1960s, or their experience as a lesbian separatist living in a commune. Although the
histories of these women were not a central part of the analysis or the interviews, they
were delightful to hear and provided quite an education for me. The women who lived
in the Pacific Northwest were from cities that were smaller than Los Angeles and quite
liberal. Although many of them came from a state in which politicians had sponsored
propositions to silence their activities, they lived in a pocket of liberal support within
90
that city. This geographical situation supported networks that seem to be more
dinicutl to build in larger cities, at least from the accounts of the women in larger
cities.
Throughout the process of data collection, I was acutely aware that the voices
of single lesbians were relatively missing from my study. Only two lesbians who
participated were non-partncncd; both of them were disabled. Long before I
considered the potential of spending my life with a woman, I was certain that marrying
a man was not in the cards. For many years I saw myself as a single women, but,
throughout that time, 1 became painfully aware that this world was made for couples.
Now that I am in a relationship, the privilege I receive from being coupled is even
more obvious. The invisible walls that separated me from other family members,
friends, or co*workcrs were often constructed because I was excluded from the events
and rituals that were meant for or celebrated by heterosexually coupled people.
Because of that long drawn-out period of life, I realized that I have suffered from
internalized singlcphobia much more than I will ever suffer from internalized
homophobia. Although coming out as a lesbian has its disadvantages, being couptcd
definitely has its rewards.
Given my personal experiences, I feel a responsibility to single women. I am
perplexed as to why single lesbians did not respond to my interview request, but I do
believe that the Findings may have been different had more single lesbians responded.
For example, one of the women who was disabled and single explained that her family
did not lake her lesbian identity seriously because she did not have a female partner.
She was discounted because she did not have sexual proof that she was lesbian.
Second, a widely used approach in the workplace and at family gatherings is to share
one's lesbian identity by talking about one's partner. Third, even if discussing a
person's lesbian identity is taboo at work or home, that individual can receive support
through her co-worker's and family's acknowledgment of her partner. These findings
lead me to wonder if single lesbians, especially those who were not immersed in a
lesbian community would, feel more isolated.
The process or conducting this research put me in awkward positions on a few
occasions when I realized that, by stating my dissertation topic, I might be revealing
more about myself than I wished to at the time. One woman in my study claimed that
in her hospital my letter inviting people to participate was perceived as a "huge coming
out party." The most uncomfortable situation for me was when I attended a meeting of
the American Occupational Therapy Foundation, at which very influential people,
including potential future employers in the field, were in attendance. Doctoral
students, who had been invited to sit in on the meeting, were surprised when the
leader of the meeting spontaneously decided to go around the room giving each
doctoral student the opportunity to share his or her dissertation topic. I carefully
worded my topic so as not to mention the "L word" but rather spoke about sexual
orientation, in general. Although that choice was a spur of the moment decision, 1 was
told later by others, even the other lesbian in the room, it was a wise choice. I believe
that sharing one's lesbian identity requires political acumen. I do not endorse the
sometimes flippant attitude that lesbians and gays should be out as a way of educating
the world. 1 found that at times I had to moke quick judgments about how to handle
this topic in public.
On the other hand, sharing my dissertation was advantageous. For the most
part, social protocols for inquiry about an individual's sexual orientation are not
available. Even when people suspect that a person is homosexual, and would
welcome the knowledge, they arc, at limes, puzzled about how to approach the topic.
In this sense, the dissertation opened some doors, providing a comfortable entree for
some people to inquire about my orientation.
92
The process of conducting this research was at limes exhilarating and at times
exhausting. 1 was exhilarated to meet so many people who were wilting to share their
stories. Many of these people had experienced trauma in their lives as a consequence
or being lesbian. One had her children taken from her, one was shot at close range,
one lost the love or her mother, one nearly had a nervous breakdown. Yet they all
exuded a sense or hope as they embarked on quests in their everyday lives to make this
world a better place Tor lesbians. To this end, I made instant friends. Because or their
willingness to share, I have rclt the weight or faithrully recording the things that
mattered to them and accurately representing their stories throughout the entire
process. I only hope I did it justice.
The dissertation experience became emotionally exhausting when the women
shared painful stories of rejection and harassment. One story of harassment was
particularly disgusting. It occurred during my first interview and although the
individual who shared the story did not want it repeated, she certainly conveyed that
severe repercussions can occur when one comes out in the occupational therapy
profession. I remain angered because I know that her perpetrator still holds the power
to continue harassing other lesbians and that, because of her position of power, it was
and will continue to be difficult to confront her. This participant's story, as well as the
other incidents of harm, served as a cruel reminder that harassment often happens in
discrete ways, camouflaged by what appears to be legitimate complaints, or behind
closed doors where little proof of the act remains. The feelings of helplessness that
individuals experience when there appears to be no recourse ore overwhelming. In the
end, these stories illuminate the importance of understanding the intricate ways that
homophobic attitudes can play out in work settings so that people who care can attempt
to put an end to it Moreover, they reminded me that, although I may envision myself
in a somewhat safe environment with respect to being lesbian, I must remember that
93
safety is a privileged position among lesbians. To respect that privilege, 1 need to
work for the safety of all lesbians.
94
CHAPTER 4
THE STRUGGLE FOR AUTHENTICITY
THROUGH OCCUPATION
This chapter addresses the first purpose or this study, namely, to explore the
ways in which the women who were interviewed experience their lesbian identity in
their occupations. The most powerful message each woman conveyed was a genuine
longing to be authentic with respect to her lesbian identity, both in what she did and in
how she described her life to others. The various ways these women created authentic
lives and the feelings they had about what constituted an authentic life varied with
respect to personal philosophies and their social specificities. However, the desire to
be authentic was echoed by each woman. 1 will use Charles Guignon (1993), a
philosopher, and Stephen Kern (1994), a historian, interpretations of Heidegger's
notion on authenticity and human existence to provide a framework for this next
section. This introduction is meant to accent the narralivists ideas about identity
described in Chapter 2 and Yerxa's (1985) discussion of authentic occupational
therapy in Chapter 1.
Authenticity
Kern states, "Heidegger is careful to emphasize how human existence is
always poised between accepting life os governed by external circumstances over
which we have no control and the possibility of acting resolutely in the face of those
circumstances” (1994, p. 6). In this statement, Kem alludes to Heidegger's
distinction between authentic and inauthentic living. Living inauthentically entails a
mindless incorporation of traditional conventions into one's daily behaviors. On the
other hand, authentic living entails a self-reflective quality, a questioning of the
95
meaning of one's actions, and an appreciation Tor the multiple possibilities Tor human
participation in life.
Heidegger's notions or authenticity and inauLhcnlicity arc best understood as
they relate to his view or human existence (Guignon, 1993). According to Heidegger,
identity or seir is not grounded in a core set or personality traits or deep inner realities
to which one con eventually gain access and act upon. Rather than objectifying the seir
as a pie-determined and pure entity, he proposed that the self is a process or human
existence, embedded in the unfolding events which occur over a lifotimc (Guignon,
1993; Heidegger, 1927/1962). In this sense, identity has a temporal component in that
the self is always in the making, continually being refashioned in terms of past
challenges and future commitments. It is through daily and lifetime occupations and
their symbolic significance that identity is defined and realized. Identity and
occupation cannot be separated.
Heidegger's notions point to the social embeddedness of human activity
(Guignon, 1993; Heidegger, 1927/1962). Social norms or codes of public behavior
are incorporated in simple everyday community routines such as driving a cor, as well
as the more elaborate cultural rituals such as heterosexual marriage ceremonies.
Because the self is continually constituted in occupation, historical conventions and
traditional protocol that arc part of everyday routines and culturally endorsed rituals
have the potential to shape human existence. As Guignon (1993) states, "public
context provides the medium of intelligibility we draw on in making something of our
lives" (p. 226). Social conventions, then, olTer individuals potential for action and
interpretations of their actions. Heidegger warned, however, that beyond providing
guidelines for communal living, restrictive social conventions that regulate behaviors
according to rules that privilege some and not others can have a crippling effect on the
development of individuals and society as a whole (Kem, 1994).
Heidegger proposes that humans arc always poised somewhere between
authentic and inauthentic living (Kern, 1994). The routine nature of everyday
business encourages people to meander through their daily occupations without
pondering the meaning or consequences or their actions. Rtmiliar social scripts that
arc conveniently attainable and provide social respectability become easy to embrace,
offering the individual comfort in fitting in while simultaneously disburdening their
responsibility for their choice of action (Ouignon, 1993). They provide a false sense
of honesty. Inauthentic living oocurs when an individual becomes unrcflcctivcly
immersed in social protocols and historical conventions such that he or she becomes a
mere reflection of what Heidegger (1927/1962) would call "they," that is, publicncss.
Authentic living entails a "decisive dedication" to one's own commitments and
thus a richer participation in society (Ouignon, 1993, p. 229). According to
Heidegger, one is acting authentically when he or she engages in honest self-
disclosure, genuinely revealing to himself or herself what it means to be in a particular
life story. Sclf-rcflcxivity in the form of standing outside of social conventions,
pondering their meaning and potential consequences, allows individuals to begin the
continual challenge of disentangling truth from untruth. In the process of
disentangling the meanings underlying social conventions, individuals begin to
perceive choices and possibilities that range beyond traditions. It is this broadened
vision that enables an individual to take a stand on life and choose his or her actions in
a more genuine manner. Guignon (1993) summed up this aspect of Heidegger's
concept of authenticity slating, "authentic self-focusing, understood as a resolute
reaching forward into a finite range of possibilities, gives coherence, cohcsivcness and
integrity to a life story" (p. 229).
In this study, the concept of authenticity is not confined to a strict Heideggerian
interpretation. I was influenced by the statements and emotions of the women who
97
talked to me about their lives. Some of them alluded to, what I call inauthentic
feelings, when they expressed a need to carefully maneuver around hetcroscxist
environments, often hiding or lying about their lesbian identity. Feeling devalued or
less than genuine in their actions and narratives, at times, brought about an acute self-
reflexive awareness about how to express and be respected for their lesbianism in a
heterosexist world. Because social convention is enmeshed in heterosexual ideologies
and practices, lesbians are often forced to consciously create themselves rather than
move along with the status quo. These women alluded to authentic feelings when they
could express their lesbian identity in action. For some, this meant full integration of
their lesbian identity into many parts of their lives, for others, it meant a subtle
infusion into particular hctcrosexist situations. It is not my intention to suggest that
"an authentic lesbian life" exists. As Ycrxa (1985) has pointed out authenticity relates
to a realization of one's own particular meaning. How each woman authentically
realized her lesbian identity depended on personality, aesthetic tastes, social situation,
and development. Thus, although commonalties were present, authenticity with
respect to their lesbian identities was based on individual interpretations.
The following chapter, which is divided into two sections, will focus on how
the women in this study maintained a sense of authenticity with respect to their lesbian
identities. The central purpose of the first section, entitled Authentic Lives: Lesbian
Identities Embedded in Occupations, illustrates the ways in which the women in this
study defined and realized their lesbian identity through occupations. As Heidegger
and narrativists suggest, for the women in this study, their lesbian identity cannot be
explained as a pre-ordained trait but rather a course of action that they created and
through which they were created. Thus, I will describe the diverse ways that women
expressed their lesbian identity in their actions in the various areas of their lives.
Having laid the foundation for understanding how the women experienced their
98
lesbian identity in occupations, the second section entitled Authentic Lives:
Occupations that Validate, Integrate, and Bridge, I provide a more in-depth look at
how they struggled to maintain a sense of lesbian authenticity while immersed in a
hctcrosexist society. Social convention mandates that lesbians should conceal their
lesbian identity most specifically in public arenas but also within private spheres of
their lives. In this section, I describe how these women used occupations to fight this
notion and instead to affirm their lesbian identity, to integrate their lesbian identities
with other aspects of their lives, and to create a bridge connecting their lesbian culture
with the heterosexual cultures of their families and friends.
Authentic Lives:
Lesbian Identities E m bedded in O ccupation
The view that sexual orientation is related solely to physical intimacy,
specifically the mechanics of sex, was expressed in its most obvious form when
Marie's boss responded to her coming out by saying "1 don't expect to tell you about
my sex life and, you know, so 1 don't expect you to tell me about your sex life." With
whom and how one engages in acts of physical intimacy is, in some people's minds,
the defining factor which separates homosexuals from heterosexuals. Given this
perspective, people often feel justified in making the above request. Marie's response,
"And she thinks that's all it's about. That's not what it's about!" indicates that she
was quick to discount this strictly sexual interpretation of her lesbian identity. Marie,
and many of the other women, knew their lesbian identity permeated alt aspects of
their lives. To them it was a way of experiencing, or being in the world.
When asked directly if being lesbian or bisexual was important to their self-
identity, all the women indicated "Yes" although some clarified that it was not
necessarily the most salient aspect of their identity and no one indicated it was the only
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aspect of their identity. Their message was clearly that being lesbian was one of many
aspects of their identity that influenced the multiple ways they lived in this world.
Athlete, mother, friend, social activist, sister, and humanitarian were among the other
identity parts that were mentioned by the women. These identities were experienced in
various occupations os exemplified by the athlete who participated in a rigorous regime
of early morning swimming, evening runs, and weekend hikes. It was relatively easy
to describe the occupations in which this woman felt os if she were an athlete, while it
was difficult to apprehend how her lesbian identity was lived in occupations.
However, by centering the interview conversations around occupations-what the
woman did with her partner, friends, or when alone, and around the emotional and
pragmatic reasons for, or responses to, their participation in these occupations--the
specific ways that being lesbian was experienced in occupations emerged.
The following discussion expands upon the concepts that emerged when the
participants started talking about, and thus became consciously aware of, how they
experienced their lesbian identities in occupations. First, I will describe the parameters
of a "lesbian occupation." Although the women specified particular occupations
through which their lesbianism was manifested, they also talked about the qualities of
occupations which were expressions of their lesbian identities. This section is
introduced with a description of those qualities. Next, i will provide an overview of
leisure, spiritual, and political occupations that participants felt embodied their lesbian
identity. It is important to note that this will merely be an overview, as I will not
discuss the various ways that their lesbian identities arose in the crevices of daily life,
such as when one picks up the newspaper and happens upon an anti-gay statement by
a political leader, or when one engages the attendant of the local cleaner in daily
conversation while retrieving one's partner’ s clothing. Finally, the women in this
study appeared to have different thresholds for expressing their lesbian identities in
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occupations. In other words, some felt a need to engage in "lesbian occupations" on a
daily basis whereas others felt comfortable when this occurred on a weekly or even
monthly basis. In the final section, I will elaborate upon how lesbian identities were
expressed in the women's overall daily, weekly, or monthly patterns of occupation.
Lesbian Occupations: Coming Home
As the interviews evolved, the terms lesbian activities or lesbian occupations
seemed to surface in both my phrasing of questions and the participants' answers.
Although this term was not concretely definable, it came to represent certain
occupations during which the women felt particularly in synchrony with being lesbian.
No one type of occupation fell into this category; rather a lesbian occupation came to
mean on occupation in which (a) the social context was predominantly homosexual or
homosexual-friendly; (b) the content of the occupation was directly geared toward a
homosexual topic; (c) the occupation embodied homosexual symbolism in a personal
and sometimes secretive way for the individual; or (d) the occupation hod a strong
emotional component that was tied to their sense of self as a lesbian. Thus, for one
person a lesbian occupation came to mean the time in which she went out to dinner
with her lesbian friends. Even though the event took place at a predominantly
heterosexual restaurant, her immediate social context was lesbian-friendly. For
another person, attending the Gay Pride Parade or the Gay and Lesbian Film Festival
in which the content was directly about homosexuality constituted a lesbian
occupation. For a third individual, taking her partner on a family camping trip even
though her extended family hod no idea about their relationship allowed her to secretly
infuse lesbian meaning into this event. The final aspect of lesbian occupations, the
emotional component, will be elaborated upon below because it seemed to be the most
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difficult notion to explain, yet the most riveting aspect or occupations that truly "got at"
how being lesbian affected occupations.
In the statement, ”1 went to an event and I just felt like, oh, I'm home. Oh,
thank Ood I'm home,” Arlene uses the image of home to evoke the emotions which
she experienced during a past lesbian occupation. The power of that emotion was
demonstrated by the fact that the emotion itself was remembered even before the event
was recalled. ”1 can't remember what I did, I did something, that Christmas party!"
She went on to describe in more detail.
Home, um, what, it just felt like it, it everything happens in
my stomach, so my stomach just like, it relaxes yeah, and I
just get really calm and kind of feel like, ahh, like I can let my
head drop, or I con put my feet up and know that I don't have
to do anything else, I don't have to say anything else but I'm
just there. It's like a whole body experience starting in my
stomach and everything else kind of goes limp. But then
there's this like, this is weird, that it's like this energy thing
where you just, you just, everything is copaccttc, or
something. It's just like going in and going ouu It's like
everybody's in the same [in sync, connected].
Roberta echoed a similar sentiment when she described what the disabled lesbian
group provided her.
Just maybe a home, where we can discuss that part of being
disabled, that part of being lesbian, that part of being a
woman in society, and all those are very, you know, it's hard
to go to any one of those groups and not exclude yourself in
some way. Or not have to censor yourself, one part of
yourself to be part of the group.
The notion of home is a powerful emotion that encompasses many images.
Home can represent a place or safety and comfort, where one can go when the world
gets cold and the nights get dark. It can refer to peace of mind where people can just
relax, putting their frustrations aside. Home con also represent authenticity, in that
people can put aside airs and honestly "be themselves." Home, when used in the
sense of going home for a good meal, depicts a place to go to replenish oneself.
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Finally, home often refers to a place of common understanding, a sort of grounding
point, from which people can venture out into the unknown but to which they can
always return. Whether or not these images adequately depicted many people's
personal experiences of home life, the word when used in the above contexts was
meant to bring to mind these types of heart-warming positive images.
Engaging in lesbian occupations evoked this emotion because, as Arlene
explained, during such activities "the censor police [could] go to bed," allowing these
women the space to feel less guarded and more secure and honest in their expressions.
They were able to be more authentic os they shared more freely what they did and who
they were, rather than presenting only a skewed version of themselves that occludes
the most important parts of their pcrsonhood, yet fits in with social convention based
on heterosexual ideology. Lesbian occupations allowed them to feel more centered
and, as Donna claimed, cloak themselves from external hctcioscxism. Most of all,
lesbian occupations evoked the sentiments of home because they entailed people
sharing a common understanding of their experiences as lesbians, a commonality not
necessarily verbalized but felt and understood in a deep soulful way. This is not to
imply that a universal lesbian experience exists or that all lesbians like each other,
much less connect intimately. However, because of their membership as a covert
group that has historically been discriminated against and often thought of as
pathological, criminal, or sinful, an understanding of that social position is shared on a
very deep level. In this study, because lesbian occupations often occurred with
friends, this common understanding went beyond that of a shared social position and
included a deep personal concern for each other's well-being os a lesbian. Thus, the
final component of a lesbian occupation entailed this emotion described so well by
Arlene. "Oh I'm home."
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Ouignon (1993) stated, "Heidegger also speaks or the 'sober joy1 of an
authentic existence: when one seizes hold of one's life with decisiveness and clarity,
one lives with intensity, openness, and exuberance" (p. 233). The notion of lesbian
occupations came to represent authentic moments in these women's lives, moments
when they were able to seize hold of their experiences and infuse a lesbian theme into
the event. It was the ability to live with intensity, openness, and exuberance (p. 233)
with respect to their lesbian identity that fueled their feelings of coming home. It is
important to clarify that not all lesbian occupations embodied the same emotional
intensity. The situation in which Noel brought her partner on a camping trip with her
extended family, yet kept their relationship a secret, allowed her to feel more honest
than had she gone camping without her partner. This decision to even begin to break
through the boundaries of silence left her with a feeling of sober joy. Yet it can not
compare to the feelings of openness and exuberance described by Arlene at the
Christmas party. Thus, by definition, the notion of lesbian occupations refers to
occupations in which the women experienced their lesbian identity on some level, yet
not necessarily on the same level. Similarly, it provides moments of authenticity but
the intensity of their authentic feelings may differ.
In summary, the women in this study did not describe any one specific
category of activity, such as leisure or political activities, as being inherently lesbian.
Rather, they alluded to qualities of occupations that would potentially allow them to
express their lesbian identity which were described in the above section. In the
following section, I turn to a more concrete description about how lesbian identities
were experienced in three categories of occupations, leisure, political and spiritual. It
is important to note that these three categories did not necessarily emerge
spontaneously from my analysis of the interviews; rather they became an easy way to
bundle occupations and begin the discussion.
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Lesbian.idcntitics embedded in leisure occupations. Leisure occupations
offered participants a variety of ways to experience their lesbian identity or to connect
with other lesbians. The feelings associated with being lesbian were most potent when
they participated in occupations that were specific to their lesbian culture. For
example, Ami and Sara spent much of their recreational time attending events
sponsored by the Gay and Lesbian Center, GLAAD, or other lesbian, gay, and
bisexual organizations. Some of those events included the Lesbian Writer Series
where "local and not so local" writers read their stories; the Business Alliance, a group
whose purpose is to unify professional lesbians; the Highways Playhouse which often
sponsors plays having lesbian themes; or dinners sponsored by the Lambda Defense
Organization. Similarly, Barbara spoke about the women's bookstore in her town as
being a central place for lesbians to congregate or to keep informed about political or
social events, which, along with the Lesbian and Gay Center, were the mainstay of the
town's public lesbian, gay, or bisexual activities. Other leisure occupations that
participants felt most directly expressed their lesbian identity included concerts, ftlm
festivals. Pride Parades, vacation cruises, Paradise Week in Key West Florida, or
vacations in Provincctown, Massachusetts, support groups, choirs, magazines or
books, and softball games that were specifically for or about lesbians.
Besides the leisure occupations that were specific to lesbian cultures,
participants also talked about occupations that did not explicitly encompass a lesbian
theme but that were engaged in with their lesbian friends, and, therefore, allowed them
to express their lesbian identities. Planning get-togethers with lesbian friends at a
straight restaurant or going on hikes did not allow them to immerse themselves in a
lesbian culture in the ways an Olivia cruise (cruises that are specifically for lesbians)
would, but it did allow them to affirm their lesbian identities within that particular
group. In fact, many times participants found that they had to infuse lesbian meaning
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into a heterosexual event Movie goers were often presented with this challenge as
they watched a good mystery with heterosexual overtones. At times, the "post film
discussions” with lesbian friends bridged the gap. For some people, though, the gap
was too wide. As Barbara commented, "It's not satisfying for me even if it's a
happily-ever-aftcr movie. . . . I feel very isolated." In these eases, participants
found themselves yearning for occupations that were lesbian in nature.
Lesbian identities embedded in political occupations. Involvement in political
occupations was another way that the women experienced their lesbian identities and
remained connected with a lesbian culture. The level of political activism varied
widely. Two women considered themselves to be bona fide political activists.
Marguerite spent the last 10 years working primarily for the Women's International
League for Peace and Freedom and for the Lesbian Community Project Isabel, on the
other hand, "picked up on a particular cause and got real involved." Over the years,
these causes have included women's rights to choose pregnancy, disability awareness,
accessibility for people with disabilities, closing the Trojan (a nuclear plant), retaining
fishing rights for American Indians, changing bigotry, and providing safe havens and
education for battered lesbians. For these two women, lesbian issues were only a few
among the many political causes to which they dedicated their time and energy. Being
lesbian positioned them not only to be active in issues directly related to their
lesbianism but also to be aware of the plight of other minority groups, and thus,
become advocates for their causes.
Other women did not perceive themselves as particularly politically active with
respect to lesbian or other issues. However, their intolerance for homophobia became
a personal conviction that was acted upon in everyday interactions. The women spoke
about various situations that arose almost suddenly and to which they felt compelled to
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respond in a way that affirmed their lesbian identity. For example, Lisa surprised
herself when she almost spontaneously picked up the phone to respond to a radio
show that was debating a homosexual issue. She recalled her comments, stating,
I've been in this longterm lasting relationship, we've raised
children, we go to work, we come home, we wash our
dishes, we watch TV and we pay our bills. That's it. . . .
We are just a family. . . . We go to work, we pay our bills,
we buy furniture, you know, we arc just part of society. . . .
we're just people.
By couching her experience in terms of normal, everyday activities, she hoped that she
could contribute to the process of changing the listener's stereotype that lesbians were
somehow abnormal. Similarly, Ami and Sara suited, "It is important to be able to help
change stereotypes, and that's my internal conflict, is that I'm not doing all that I can
do to really help change that image." Many of the women felt compelled to combat
negative stereotypes about lesbians, gays, and bisexuals through being a good
example. Cathy explains, "the way that I deal with it is in my everyday life to just
show whomever I come in contact with that this is who I am and 1 just try to set a
good example, as a person and as a lesbian."
In addition to combating negative stereotypes about being lesbian, some of the
women spoke about other forms of everyday politics. For example, while dining in a
slate that had passed on anti-gay law, Leah commented that she made a point of writing
"purchased with gay and lesbian money" on her check. Likewise, when a hotel clerk
assigned her and her partner a room with two queen-size beds after she hod reserved a
room with one king-size bed, she marched right back down to the hotel desk and
demanded, in a polite way, that the mistake be corrected, even though she and her
partner sleep comfortably on a queen-size bed at home. Her personal conviction that
she had the right to experience her vacation as a visible lesbian, and that she could use
this opportunity to quietly challenge this hotel clerk's notion that two females
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vacationing together arc "just friends/ was expressed in her actions that afternoon.
Political actions also took the form of earmarking gifts and contributions to
organizations such os those that address gay and lesbian health issues or those that arc
dedicated to preserving gay and lesbian history; talking freely about one's partner to
the person occupying on adjacent airplane scat who, for the past 30 minutes, has just
managed to recount her entire heterosexual family story; wearing buttons and stickers
that support lesbian issues on one's wheelchair; flying the rainbow flag outside one’ s
home; requesting the "family" membership to the Holocaust Museum while pointing
out that the forms needed to include domestic partner in addition to spouse, husband,
or wife; attending the Gay Pride Parade as a disabled contingency for the purpose of
increasing disability awareness among the lesbian, gay, and bisexual population; and
making a concerted cfTort to use gay services whenever possible.
Finally, some participants in this study felt almost forced to become politically
involved when they were confronted with the strong possibility that an anti-gay
proposition (Proposition D) could pass in their state. Even if they wanted to remain
closeted and apolitical, they could not run from the political campaign ads and
speeches and the conversations among co-workers and friends that perpetuated the
false and degrading images of homosexuals. Many people dealt with these
circumstances by coming out to their co-workers and challenging their distorted
perceptions about what it means to be lesbian. One woman who was a librarian
developed an extensive list of gay and lesbian literature that she was able to get the
state library system to purchase and put "on line." Another woman joined a group
called People of Faith Against Bigotry (PFAB) and worked with women and men
from various faiths to provide a positive understanding of gays and lesbians based in
religious texts.
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For some women, experiencing the daily barrage of severe homophobic
comments and actions through the media and personal interactions changed their lives
significantly. Tcri explained that when the elections were over and the proposition
was defeated, she suffered from emotional exhaustion as the reality of what her life
might have been like if the measure had passed began to sink in. When she finally
overcame her depressed state, she decided that political activism would become a
greater part of her life. To this end she stated, "I probably wasn't political before
Measure D, I probably miked a lot, but I wasn't as active. And I kind of want to make
it a career to be an activist."
Lesbian identities embedded in spiritual occupations. Every woman in this
study perceived herself to be spiritual on some level. Some were able to express their
spirituality through organized religions, others tended to find it within themselves or
through friends. Sara stated that her conflicts with the hypocrisy that she witnessed
within her church prevented her from aligning herself with this form of organized
religion, although, as she slated, "I feel that I've gathered great values from the church
and, you know, ten commandments, the golden rule, I mean your basic things and I
feel I'm a good person." She relies upon an internal spiritual guidance. On the other
hand, when the participants did align themselves with organized religion, it seemed as
if they chose less mainstreamed religions or the more liberal sections of organized
religions, such as attending a gay and lesbian Jewish temple.
Whereas the need for spiritual enrichment seemed to be prevalent among the
women in this study, the need to relate as a lesbian to which ever form of religion they
endorsed was also imperative. Furthermore, some women argued that their feelings of
exclusion from patriarchal churches stemmed from not only their perspective as a
lesbian but their perspective as a woman, in general. Natasha stated,
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A lot of Jewish women arc reclaiming their Jewishness, and
rethinking it, and not just lesbians but the liberal wing or
Judaism is becoming very much more conscious of the
sexism that's very pervasive and reaching out to, um, women
and acknowledging women, it's very, very moving.
Given this need to be validated os lesbians and women, the concerns that the
participants took into consideration as they chose a spiritual community in which to
participate or a spiritual philosophy to guide them were threefold.
First, participants tended to gravitate toward religious philosophies which they
interpreted as promoting notions about being a positive force in the world rather than
those religious doctrines that were concerned with social control by dictating the
specific do's and don'ts of how to live their lives. For example, Donna, who
identities herself as a witch, stated, "Life is soup and we are all the ingredients in it
and as a conscious ingredient 1 know to what extent my ingredient aTfects the soup and
I can control and influence my contribution to the soup. That's my spirituality." In
explaining her spiritual beliefs, Monica stated,
There arc all these souls that are just trying to grow together.
. . . We arc all growing together, I mean, ah, that we all have
a purpose, a function on this earth. I, you know, I really
think that before we enter into a life time, um that we outline a
mission to Icam things. This is my belief. . . . and part of,
maybe, my mission is um, 1 don't really know but is to you
know be of service as the best way possible.
Finally, Marie described her religious affiliation stating.
It's kind of like a mixture of psychology and, and spirituality
with, you know, religion. . . . they talk about using the
power of your mind, to, 1 don't know, to, to make your life
positive. . . . This church really advocates, you know,
centering yourself, doing what's best for yourself. Like
telling yourself that you are good. And positive thinking and
centering yourself and getting the best out of life for you.
For these women, incorporating the above philosophies into their lives is possible
because they remained in concert rather than in conflict with their lesbian identities.
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They did not have to engage in a continual struggle to find a place for themselves as a
lesbian or as a woman within religious doctrines that gave spiritual privilege to
heterosexuals and in particular heterosexual men.
Second, the participants involved in organized religions looked for religions
that had official doctrine, policies, or beliefs that were inclusive of lesbians and gays.
For example, Linda attended and was married in a gay Jewish Temple that had a
lesbian rabbi. Isabel, who was also Jewish, participated on a committee which was,
in part, dedicated to providing religious doctrine that contradicted the assumption that
homosexuality is immoral. Although the Jewish faith has some conservative sectors
that disagree with homosexuality, both Linda and Isabel attended synagogues that
publicly stated their acceptance of lesbians and gays. The women were also quick to
observe the acceptance or lesbians and gays in the official literature published by their
church, such os a picture of a holy union between two lesbians on the front of their
monthly magazine; or in the sermons given by the ministers, such as a minister who
alluded to the many faces of Ood allowing for multiple interpretations including a
homosexual or heterosexual one.
Third, the women were concerned that some semblance of gay presence be
openly visible within their church. The presence of a gay pastor, lesbian rabbi, gay
choir director, or same-gendered partners openly holding hands in church were forms
of visibility. More important, though, was the visibility provided through lesbian
participation in spiritual rituals. Examples of such rituals were: Jewish naming
ceremonies for children of lesbian couples, holy unions for lesbians, prayer and candle
lighting rituals for people with AIDS and their families, "rewriting and incorporating
lesbian and feminist principles" into Passover and other seders, and the use of
inclusive language in hymns and scriptures. In addition, Natasha talked about "liberal
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Jewish women" resurrecting one of the more obscure Jewish traditions, Rosh Kodcsh
which celebrates the cycles, for example, of the moon. She explained,
It's a holiday that Jewish women have traditionally celebrated
to mark the new moon. . . . lesbians arc getting more
interested in acknowledging that, having groups like my
friends down in X have had, Jewish lesbians, have had a
Rosh Kodcsh group that meets monthly for almost 10 years
now. [In one celebration] you would bring a candle and light
a candle, something simple os that, because at the new moon,
it's when the moon is at its darkest and it's like to call back
the light. It's like join all of your light together.
When the above types of rituals were part of the mainstream religious ceremonies, the
women were more apt to feel included os lesbians and women.
In the end, the need Tor engaging in spiritual occupations was critical to many
of the participants. Yet, many had been brought up under religious doctrines that
discounted their existence os lesbians, and therefore, continuing to participate in these
forms of spirituality felt inauthentic to them. For these women, participating in
religious rituals, hearing inclusive doctrine, or being in the social context of other
lesbians or gays during religious ceremonies were ways that they affirmed and
expressed their lesbian identities within the context of spiritual occupations.
Occupational Patterns
In the above section I have described how being lesbian was experienced in
specific occupations. In the interviews, however, the women implied that, equally if
not more important than how it was experienced in specific occupations, was how it
was experienced in the doily, weekly, or monthly pattern of occupations that
individuals chose for their lives. In other words, the opportunity to simply experience
lesbian identities somewhere in their overall pattern of occupations, whether it be at
work, at church, or during leisure or political activities was essential if they were to
feel authentic as lesbians. Without this opportunity, people felt out or synchrony, os if
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something was missing in their lives. Furthermore, the women differed in terms of
the degree to which they needed to experience themselves as lesbian through what they
did. For some women, their lesbianism seemed to be a private affair, kept quiet,
except within the confines of their own home. For others, it was central to the
majority of their occupations. The following examples provide a more in-depth
understanding of how being lesbian was experienced in occupational patterns rather
than individual occupations.
Lesbian identities in subtext. Sandy's situation is representative of a few of the
women for whom being lesbian was an important identity, but one that remained in the
subtext of their stories. Following Sandy's cerebral vascular accident, she was unable
to return to her job and thus spent much of her time at home. She described one of her
weekly schedules as revolving around three particular occupations: Bunco (a card
game), bowling, and volunteering. That particular week, her Bunco group was
scheduled to play at her home on Tuesday evening, which necessitated both
preparatory house cleaning and food organization on the previous day. Wednesday
she volunteered at the local hospital and both Tuesday and Thursday she participated in
her weekly bowling tournaments. Friday she rested in order to restore her energy for
the weekend during which she ran errands, readied her house for her son's return
home, and went out to dinner with a group of lesbian friends and her partner.
Sandy's lesbian identity did not appear to influence the primary occupations
that made up her week or her days. 1 inferred from the data that all but one woman in
her bowling or Bunco group and at her volunteer job are heterosexual. Conversation
that arises in these contexts rarely revolves around issues that could potentially expose
her lesbian identity and she keeps this aspect of her identity relatively quiet. In
Sandy's life, being lesbian was most directly expressed when she went out to dinners
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or lunches with her lesbian friends or watched TV at home with her partner. This is
not to imply that being lesbian did not alTcct her life on a daily or weekly basis; it was
a bone of contention with her family, affected where her son lived, and, as mentioned
above, influenced her relationship with her partner and her lesbian friends. However,
the occupations (watching TV with partner, going to dinner and lunches with lesbian
friends) which were direct expressions of her lesbian identity occurred around a
weekly or monthly temporal rhythm rather than on a daily basis. The important point
is that Sandy feels satisfied with her degree of expression. She feels being lesbian is
so integral to her identity that she docs not need to express it directly in her
occupations any more often than she docs. Furthermore, because Sandy spends much
of her time at home, with her partner or with friends whom she has chosen, she is not
confronted with homophobia by co-workers or other semi-acquaintances. She claimed
that she felt fine with being lesbian and the degree to which she expressed it in
occupations. This is in stark contrast to Ami and Sara.
Split lives. Ami and Sara were equally closeted about their lesbian identities,
especially at work, the occupation that consumed most of their time. They described
this experience as one of leading a split life. Most recently in their lives, this split hod
begun to feel extremely uncomfortable. They were less able to feel authentic living
exclusively in a heterosexual world whenever they were beyond the confines of their
own home. Thus, they spoke about making very deliberate decisions to go out and
connect with a lesbian community. In particular. Ami and Sara stated, "We often just
go out for dinner, 1 mean, we'll drive to West Hollywood so that we can just have
dinner amongst gay men and lesbians." Furthermore, they commented,
I mean. I certainly like to kind of plan my events around, and
not that they solely have to be gay or lesbian thing but they
are much more, I think, enjoyable. . . . We need to do it
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because I really feet when, especially for us, being closeted in
so many areas of our lives,. . . that there has to be a time
when we can substantiate who we are. That we can really be
as dose as we can to who we are and be around people that
validate our feelings. Otherwise it, you know, otherwise I
can just start to feel a sense of you know, disintegration. And
I think by the end of a week, I feel I need to do something.
And it doesn't have to be a lot, it can just be something small,
but you know, it carries us through the week.
Lesbian occupations, such as dining, attending the Lesbian Business Alliance or
lesbian plays and concerts, serve to revitalize them as lesbians in this world. These
occupations were essential to their identities as lesbians. Yet their rhythm for
participating in such occupations was only weekly and, even then, perhaps only one
night of the weekend. Like Sandy, Ami and Sam remained hidden os lesbians during
the occupations that consumed most of their time. However, Ami and Sam have a
lower threshold for concealing this part of their lives. For them, the need to connect
with their lesbian identities through occupation was a very powerful force influencing
their decisions to drive long distances to restaurants that may not be as convenient or
as delicious as the ones closer home, just to renew themselves as lesbians. In fact,
during the 2-month time span over which our interviews occurred, their rhythms for
experiencing their lesbian identities changed and they began inserting more
occupations into their lives that allowed them to reconnect with their lesbian identities.
Continual immersion. On the other end of the continuum, Isabel felt that she
was continually immersed in occupations through which she experienced her lesbian
identity. She was employed as a social worker in an organization that was lesbian,
gay, and bisexual-friendly and advertised her services in the newspaper published by
the Center for Lesbians and Gays. Thus, on a doily basis she was often counseling
lesbians, gays, or bisexuals through the coming-out process or about how to deal with
issues of discrimination in their lives. From a political standpoint, she talked about the
115
need for social change as her overarching umbrella, delineating that which was
important for her to pursue in life. She stated "everything else that lights my lire fits
into that umbrella." Although she sees herself as an activist for many political issues,
lesbian issues have become particularly important since the emergence of Proposition
D which inspired her to be an active member on committees that addressed this
proposition. She is openly lesbian at her synagogue and headed a committee to hire a
rabbi, thereby assuring that the acceptance of lesbians would be maintained. In
addition, she works on the violence reporting line for the Lesbian Project. Isabel also
spoke about numerous leisure activities that connected her with other lesbians.
Isabel rarely needs to deliberately insert specific occupations that express her
lesbian identity into her schedule because lesbian issues arc embedded in every aspect
of her life. In fact, it was only after her multiple sclerosis worsened that she began to
feel distanced from the lesbian community with respect to leisure and some political
occupations. Inaccessibility to both activities and the buildings in which they were
held prevented her from attending them. For example, after she needed to rely on a
scooter to gel around, she was no longer able to go to lesbian Western donees, nor
was she able to go on hikes or nature outings put on by the Lesbian Center. She was
still able to participate in athletic occupations, which were a strong interest in her life,
but these were now carried out through programs for people with disabilities rather
than the Lesbian Project. Thus, in Isabel's cose, when lesbian leisure occupations
were no longer available, she was able to maintain her comfort level because of the
multiple ways that she could express her lesbian identity in other arenas of her life,
namely work and politics. Unlike Sandy, Ami, and Sara, Isabel had a more intense
desire for occupations that embodied her lesbian identity. Thus, if one looked at her
daily, weekly, or monthly pattern of occupations, one would see that her lesbian
identity surfaces throughout oil pockets of her life.
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In summary, Tor the women in this study, being authentic with respect to their
lesbian identity required a concerted effort to participate in what came to be known as
lesbian occupations. No individual listed specific activities that were, in every
situation, an expression of their lesbian identity. Rather, occupations that had
particular qualitics~a homosexual social context, homosexual content, homosexual
symbolism, or emotional peace about one's homosexuality--\verc seen as expressions
of lesbian identities. However, given the focus of the interviews, the women also
detailed the specific ways their lesbian identities were embedded in leisure, spiritual,
and political occupations. Finally, the women tended to talk about temporal patterns
with respect to feeling authentically lesbian that depended upon their personality and
social situations. These rhythms ranged from those who felt their lesbian identities
were infused into almost all aspects of their life to those who experienced their lesbian
identities as a subtext to their daily occupations. Irrespective of their particular
occupational patterns, these women's lesbian identities were continually being realized
and defined through their participation in lesbian occupations.
Authentic Lives:
Occupations that Validate, Integrate, and Bridge
Feeling authentic with respect to their lesbian identities was on ongoing
challenge even for those who were relatively comfortable os visible lesbians within
their particular social contexts. Many women expressed a desire to be respected for
this aspect of their identities, not necessarily os their only or core identity, but as an
important part of their identity part that needed to be recognized, validated, and
nurtured in the same way that other aspects of their identity were. The following
section discusses very deliberate ways that women created opportunities to ensure that
their lesbian identities were validated, and, in doing so, enhance their feelings of
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authenticity. I will introduce this section by describing situations in which the women
felt inauthentic because they were dishonest about their lesbian identities in their
relationships and conversations with others, and in their occupations. Following that
introduction, I will discuss how inserting occupations that validate their lesbian
identities into their lives, occupations that integrated their lesbian or disabled identity
with other identity parts, and occupations that bridged their relationship with family
and friends contributed to a sense of authenticity.
Inauthenticitv in Relationships and Occupations
Often, lesbians, gays, and bisexuals grow weary in the face of the ubiquitous
and unrelenting hctcroscxist forces of society. An enormous amount of personal
fortitude and patience is needed to weed through the negative attitudes against lesbians,
gays, and bisexuals while knowing that, although small successes may happen, every
day will bring more rejection and resistance. Whether or not they remain invisible, the
energy it takes to engage in the struggle and maintain a level of hope con take a loll on
their creativity and excitement for life. The struggle to achieve authenticity in the
dailincss of their lives was expressed in a number statements about invisibility and
dishonesty. For example, Leah stated,
Identity is again for me, how much am I willing to share and
why shouldn't I be who I am ,. . . I don't have to be in their
face. . . but I think it's important for us to be who we ore.
For us to just be out there very subtly, even if someone
walks past us holding hands, or arm-in-arm and kind of
notices, and gives us a look. . . I think that it is important
for us to be who we are. . . . I'm tired of being invisible.
In this statement, Leah talked about continually negotiating when and where she can be
true to herself by honestly portraying herself to her family, friends, and in the work
place. Furthermore, she gives insight into the emotional struggle and the exhaustion
she endures when she tries to remain invisible.
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For many of the women, the invisibility struggle was framed in terms of
honesty. Arlene stated that being lesbian meant that "you are something everybody
assumes you are not." They expressed frustration at wanting to be honest yet needing
to survive in a hctcroscxist world. They struggled with what constituted lying and
under which conditions it was justifiable. Some stated "I won't lie," indicating that
lying went beyond their personal standards for living authentically, and thus they
contributed to their invisibility by omitting parts of their lives from conversations.
Others justified changing stories and inventing boyfriends, claiming that they weren't
necessarily lying, just using on essential strategy that would ensure them the same
protection and benefits as heterosexuals. Although people had overall personal
philosophies that guided them in handling these situations, most incidents were
approached on an individual basis. For example, Leah talked about a situation in
which she and her partner shored a secretary who did not know about their relationship
but was very close to both of them. She stated.
About 9 months into it, I said, this is feeling like a lie. We
need to, this is not, I said, somebody somewhere, in one of
these facilities is going to tell Nellie that we live together and
that we live in the some house. No matter what she
extrapolates from that, Nellie will feel betrayed that we didn't
tell her.
Although Leah has a personal policy that her sexual orientation is not a work issue and
thus remains relatively closeted at work, in this ease, her usual technique of omitting
information was problematic. Her need to be honest and her concern that a co-worker
not be betrayed influenced her decision to tell Nellie.
In another situation. Ami talked about honesty when she relayed the story
about coming out to a sister whom she loved dearly. She recalled the discussion
which she had that day with her sister. "I said, you know, there's just something that
I've really been wanting to tell you. . . . It's something that I had really wanted to tell
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you just to really be honest, and I said, you know Sara and I have been coupled for 10
years now." She continued,
I Teel guilty when you're telling me, you're really
complimentary, and you say all these wonderful things [about
me], and I feel like I have this secret that I'm not telling you,
that you don't truly know me. I think the thing that prompts
me more than anything to tell you is that I want to be able to
genuinely say, I love you, and that you know everything
about that, everything about that, and it's one aspect of my
life, but it is my life.
As this conversation indicates, although Ami was very close to her sister and her
partner Sara was well accepted into Ami's family, until she was able to openly say the
word lesbian and honestly talk about her lire with Sara, something was missing in her
relationship with her sister. Ami would not have classified herself os particularly
dishonest with her sister in the past, yet at this point in her life she sought a different
level of honesty in her relationship with her sister. And obviously the feelings were
mutual os indicated in her sister's response. "I'm just so happy for this day that you
con feel the comfort to tell me. . . . I just wanted this day so badly that we could have
that relationship where we could just really talk." No matter what level of honesty was
tolerable, given the different constraints in each woman's life, many of the women in
this study implied that maintaining honesty was a struggle, yet a worthy struggle to
take on,
Inauthcnticily was experienced, not only when people were in a quandary
about which aspects or their lives they could honestly share and which they must keep
secret, but also when their occupations felt less than genuine. For example, Lisa
recounted that even though the conservative Jewish temple had been a "safe place in
my childhood," because of its negative position on homosexuality, "it doesn't feel like
a safe place anymore. Now I would have to go there and live a lie." Similarly, Jenna
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explained how her comfort level while attending professional meetings changed as she
was able to be more honest in her self-presentation.
On a professional level. . . I've gone to AOTA [American
Occupational Therapy Association] maybe twice, when
they've had the Gero SIG [Special Interest Group]. It's the
same social thing you know. Who arc you and arc you
married, do you have kids, that whole routine. . . . I don't
want to have to dodge questions or lie or be uncomfortable in
social situations, yeah. Now that I'm married [to a man], I'll
probably start going, just because life is easier. It's easier to
fit in.
Additionally, Leah talked about how she infused a sense of truth to her favorite
nephew's wedding in the following story.
After all the ceremony types of things that happened, the
cake-cutting and all that, they hod dancing and whatever, so
my brother wants to dance, his wife doesn't like to dance, so
he and I gel up and dance. And you know we're having a
good time. He wants to get his kids up and dance, you
know, I said, you know, that's great. So he brings a kid up,
I get a kid, you know, there's all sorts of nieces and
nephews, I got plenty of people I con dance with-Jossic [her
partner] isn't dancing! And I sat back down at some point
and I said "Let's dance". . . . I don't know that they knew
that we were dancing together. But I didn't want Terry to not
dance, because of not [wanting] to be visible when that is
really again a little bit of heresy, it's really not truth in reality.
Finally, Marie talked about bringing her partner to the Christmas Parly,
It was hard to be at the Christmas party because it was a
hctcro event So, with Diane going with me, it made it more
bearable like it was our own little lesbian piece to it I didn't
have to pretend like I was a heterosexual. You know, I could
still feel like there was some connection to being a lesbian
even when I was at the party. . . . I felt like I didn't have to
lose who I really was. Maybe that's the thing.
In each of these scenarios, the women talk about how they were able to make an event
a little more authentic by either avoiding the occasion, such as Lisa and Jenna have
done, or by infusing honesty into the situation us exemplified by Leah and Marie.
Perhaps the most important point is that they all fell less than genuine when their
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occupations reflected what they considered a lie or a pretense. And they actively
sought to modify the situation.
In summary, throughout the interviews, the women talked openly and at length
about the joys and troubles of being lesbian. Both the unintended and deliberate
pressures by family members, friends, and social institutions placed a tremendous
emotional toll on the participants. In a discussion with her sister, Leah stated.
Would you like to face this kind of, you know, you know,
abuse and whatever? I guarantee you that people who find
their love in the same sex partner are utmost fighting against
everything that they have been taught, etc. They're going
against the potential of abandonment, family hatred, family
cut off, family— you're not alive and whatever.
Yet despite these and other severe repercussions that these women experience
either personally or vicariously through friends, the joys of being lesbian had equal
representation in their stories. Ami attributed it to finding the person you can love.
She stated, "It [being lesbian] really was difficult, but despite all of that, it's worth it,
and when you find the right person and you find that person to love, there is just, that
[the discrimination] all becomes insignificant, fortunately speaking." Love is certainly
a powerful emotion and one that could easily outweigh the discrimination. Yet
achieving honesty and authenticity in one's life seemed to have the some affect. Lisa
summed up the privileges of her heterosexual marriage, stating that when she was in a
heterosexual relationship, she hod an incredible support system, approval from friends
and in-laws, and shared occupations which bonded her with family. However, she
reported, "[my husband] was a male that would make me fit into society. And it did
do that. It did do that". On the other hand, she stated "1 was different Everything
about me felt different. It never worked. . . For me there was the terrible pretense. I
never knew what to do with that." Finally, she stated, "Yeah, when I finally came
out, I thought it was the greatest thing in the world, I finally felt good about myself, I
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could be honest" In the end, il was when these women were able to authentically
express their lesbian identity in their actions, occupations, and narratives, at the level
of honesty with which they felt comfortable, that they found a soul-deep sense of
peace and joy.
Occupations that Validate
In everyday public life, lesbians, gays, and bisexuals are exposed to an
overpowering heterosexual presence. Against this strong background of heterosexual
meanings and behavioral codes, they must etch out ways to validate their own inner
realities, which arc often in conflict with the status quo. The most powerful forms of
validation for the women in this study occurred in public arenas when lesbians, gays,
or bisexuals were appropriated respect equal to that given naturally to heterosexuals.
These moments, although exhilarating, were fleeting, and the women had little control
over them. Thus, the women also engaged in a very thoughtful and deliberate form of
validation in which they created cclcbrativc events within their own lesbian
community, that paid homage to their lesbian identities. The following provides
examples of both forms of validation.
"Philadelphia," a movie that not only depicted the life of a gay man but was
publicly honored by winning an Academy Award, caught the attention of one woman,
Arlene, in an affirmative way. She staled,
. . . [I was] feeling like first of all excited that, that, that, this
sort of gay movie was lop movie of the weekend and um, [I
was] really connecting with the issues and feeling like, that in
some way [it] really influences my life and also validates my
sense of self. . . . it was very validating to be at that movie.
A similar incident happened when Ami and Sara attended a public showing of "the
lesbian kiss" on the "Roseanne" show with about 400 other people. Even though the
"Roseonne" show was not recognized for its excellence in the same way that
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"Philadelphia" was, the fact that ABC had chosen to air the show in spite of all the
opposition provided Ami and Sara with a sense of public recognition and validation.
Finally, attending clubs where "female singers," "feminist lyrics," or "powerful
women singing political songs” were featured also evoked feelings of validation both
os women and as lesbian. Linda's partner, whose side profession was os a musician,
explained that she performs in clubs that primarily attract heterosexuals. However,
she is careful to write lyrics that could be interpreted with a lesbian, gay, bisexual, or
heterosexual perspective, again to provide a source of validation for the lesbian and
gays in the audience.
The absence of accurate homosexual representation in everyday public arenas
is a nagging reminder to lesbians, gays, and bisexuals that they arc "the other" in
contemporary society. To survive, they often acclimate to pervasive heterosexuality
by dulling their senses when in the public. The above situations served to awaken
their senses. These occasions often take homosexuals by surprise and allow them to
momentarily relish their hopeful images about what the world would be like if their
realities were reflected in everyday public images, narratives, and behaviors.
In a less public way than movies or songs, Roberta described an experience in
which she felt validated when she went to her local used bookstore to pick up some
reading materials. At this time, Proposition D had not been voted on and tension
seemed to permeate everything. She suited, "It was so intense. . . what I was hearing
was 50% of the people in this area hate me and they don't even know who I am."
After browsing through the store, she bought some books. When the saleswoman
placed the books in the backpack hanging on Roberta's wheelchair she noticed her
"Stop Proposition D" button. In reference to the campaign to support Proposition D,
the saleswomen commented, "You know, my husband barely escaped from Auschwitz
and both of his parents were killed there. . . . You know, it's the same voice we heard
124
heard there." For Roberta, this passing reflection on the port or the saleswoman felt
very validating because it confirmed her feeling that "It was hate I was hearing" by the
pro-campaigners and it provided her support from someone from another targeted
group.
Unlike the above situations in which lesbian and gay-themed movies, songs,
or events were brought into mainstream society. Ami and Sam validated their existence
as lesbians by bringing a few of their "mainstreamed friends" into a lesbian and gay
culture. Ami and Sara had scheduled to go out to dinner with a couple of friends who
did not officially know about their sexual orientation. Because Ami and Sara were
known for their "dining sense," they were given the task of choosing the appropriate
restaurant. They decided upon a heavily gay-populated restaurant os a way of
exposing their friends, who rarely ventured beyond the boundaries of their own
worlds, to a different culture. Although it was a bit risky, the evening was a success.
One friend shored, "I've never been here before. This was really nice. I'm really
having a good time." After that evening. Ami and Sara stilt remained closeted to these
friends, but by taking the initiative to venture into West Hollywood and introduce their
friends to one type of gay culture in a positive way, they covertly received validation
for their life style.
In summary, in some respects the fact that Arlene, Ami, Sara, and Linda could
feel such an empowering sense of validation from a couple of evening occupations is a
pathetic statement about how intensely heterosexual contemporary society remains. It
could be argued that, compared to the Freudian era when lesbians and gays were
medically pathologizcd, or to the McCarthy era when they were witch-hunted,
contemporary society is more liberal in its acceptance of homosexuals. Yet the fact
remains that homosexuals are under strong public pressure to be invisible in most
social arenas. When they become visible, all too often it is not under their control and
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in a stereotypical way that, at times, perpetuates negative images. The fact that the
lesbian kiss of the "Roseanne" show received so much attention, given the numerous
heterosexual romantic interludes that are part of weekly television love stories, attests
to the discrimination that remains in society against homosexuals. On the other hand,
the fact that ABC overrode public pressure and aired the show was interpreted as
hope-that such discrimination is continually being chipped away. For these women,
movies such as "Philadelphia" and the "Roseanne” show, lesbian-friendly concerts, or
bringing their friends to a lesbian restaurant, were not only validating because, for the
duration of the movie, concert, or dinner, lesbians and gays were the subject rather
than the invisible other, but also because their presence in the mainstream ultimately
exudes hope that eventually attitudes may be changed. Similar to other situations
throughout history, such as the acceptance of heterosexual couples living together out
of wedlock, lesbians arc looking forward to the time in which what presently appears
to be shocking immorality becomes viewed as a natural everyday occurrence.
Although public recognition was validating, it was less under the women's
control, both in terms of its frequency and its intensity, than creating rituals or
celebrations within their own community. Many of the women relied upon shared
occupations either with their friends (lesbian or lesbian-friendly) or with the lesbian
community to express their lesbian identity in the most genuine way. The following
three scenarios exemplify this phenomenon.
Holiday or birthday celebrations often served the puiposc of celebrating the life
of each person and nurturing the relationship between lesbian friends. More than one
participant explained that their community of friends marked every member's birthday
with some sort of celebration. Holiday celebrations, though, took on a special
meaning, especially for those who chose to spend it with their lesbian families. For
example, Kathy described a Christmas party that she attended with her partner and
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several other lesbian couples. On the surface, the party resembled many "straight"
Christmas dinners that she had attended in the pasL A turkey dinner, complete with
stuffing and homemade gravy, was prepared. An old fashioned piano player
accompanied the group as they sang the traditional Christmas carols. And the evening
was completed with a Christmas gift exchange. But the most important part of the
evening was the pre-dinner grace ritual. Instead of reciting a prefabricated prayer,
each individual was invited to give her personal thanks for whatever she deemed
important in her life. As they went around the room, appreciation for one's lover was
most often recited. It was these moments of thanks that differentiated this party from
straight Christmas parties because, here, the women could reveal those parts of their
lives that ore usually kept in the shadowy background in most heterosexual contexts.
Furthermore, a shared understanding of the trials and joys of being lesbian gave these
women a deeper appreciation for even having the opportunity to publicly express their
love for another women, or to publicly express their lesbian identity. The community
support for each other as lesbian women further validated each individual's lesbian
existence.
For Ami and Sara, Valentine's day became an important holiday for which they
created a celebration that would validate both their lesbian existence and their
relationship. They described it in the following way.
There's a new little restaurant that opened up in West
Hollywood called Checkup. . . and we decided that we were
going there for Valentine's Day. Well we went there, the
food was OK, but you look around and there ore all these
men together, and there are oil these women together. And at
the vciy end [of the meal] they bring us out this chocolate
cake. And it's heart shaped and it says Ami and Sara on it.
And 1 thought, you know, this just really made my dayl So
we get ready to leave and there's this man who is silting there
by himself. . . and he says, you know, I just wanted to say,
you two make a really nice couple. . . . You know, he will
never know how much that meant,. . . we left thinking, you
know. I'll remember this Valentine's Day, something as
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simple as that. The acknowledgment. Now had we been any
place else, believe me, no one would have said [this], you
wouldn't have gotten a chocolate cake with our names on it
[But at Chockups] it's Valentine's Day and you're there and
you arc a couple, and they come over and they talk to you as a
couple, kind of equally acknowledging each person, and, um,
it was just so nice. And, you look at what makes us happy,
you know, we're simple people and what we go through,
drive 25 miles to just have this. You know, it [having to
drive that Tar to find an accepting restaurant] is pathetic,
actually.
The oppressiveness or pervasive heterosexuality is magnified for coupled
lesbians on Valentine's Day, as they are brutally reminded that their love is not worth
recognizing as is heterosexual love. Even if occasional references to alternate types of
relationships arc made, the commercialism surrounding Valentine's Day is basically a
reminder that it is a tradition designed to celebrate normal heterosexual love. Having
to silence their love for each other, on this particular day, was doubly deceptive. As
Ami and Sara have clearly indicated, their willingness to drive long distances just to
experience simple acknowledgments, such as a comment from a stranger, being treated
as a couple by the waiter, receiving a chocolate cake with both of their names on it, or
sitting among other same-gendered lovers, indicates how important being validated as
a lesbian and as a lesbian couple, especially on Valentine's Day, was to their lives.
The third example relates to gay and lesbian vacations. Leah and her partner
operate a bed-and-breakfast inn out of their home. Although they accept all people,
they specifically advertise in a newspaper with a lesbian and gay readership so that
they can attract this population. When talking about one of their patrons, Leah
explained a ritual that she claimed was specific to her lesbian, gay, bisexual, or
transsexual population. She stated,
[soon after they arrive] we sit up at the table and we sit there,
we proceed over the next hours to do what gay and lesbians
do when they come here. Invariably people go to a bed and
breakfast in order to be in a, in a safe and friendly
environment that feels different than the Holiday Inn. No
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offense to the Holiday Inn but it's definitely a different thing.
And in a home slay you have an opportunity to meet with the
host and find out what there is to do, and you know, just
genuine you know, cup of coffee, glass of tea, or whatever.
So, that's what they were doing. Well, gays and lesbians
who come to stay in bed-and-breakfast invariably knowing
that we're a couple, we do coming out stories, so it's like a
regular ritual being able to do your coming out stories. . . .
Gay and lesbian couples arc so connected to other couples via
their stories that it's a very powerful, you know, vehicle for
them to come here where they can feel safe, they con tell their
stories and whatever.
Again this ritual of telling coming-out stories performs the function of validating
themselves os homosexuals and their homosexual relationship. In addition to their
patrons feeling respected, os Leah indicated in her statement, "So we get to rc-tell ours
and re-bond," this ritual allows Leah and her partner to be continually validated within
the lesbian community, almost in the same way that renewing wedding vows at
weddings would for heterosexuals. For Leah, this is particularly important because
she received little direct validation at work or from her family.
In summary, some of the women in this study encountered a barrage of
hcterosexism os they went about their everyday occupations. For them, the challenge
to live authentic lesbian lives, amid the public pressure for them to remain invisible,
led to conscious decisions to create occupations that would celebrate their lesbian
identity among caring friends and acquaintances. The Christmas Party, the Valentine's
Day Celebration, the nightly coffee ritual at a bed-and-breakfast, and other similar
occupations were times in which lesbians were able to replenish their sense of honesty
about themselves as lesbians and often as partners. Occupations that validated lesbian
identities which occurred within the lesbian community were especially cherished
because, within their own communities, the trials of being lesbian and the importance
of such validation in the lives of lesbians was well understood. On the other hand, a
glimpse of their lesbian selves in the occupations of mainstream society energized
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these women with hope because they indicated the possibility of social change and of
being incorporated into the social conventions that define normality.
Occupations that Integrate
Beyond their desire to engage in occupations that validate their lesbian identity,
the women in this study spoke about feeling more whole or authentic when they had
the opportunity to pull together various themes that were important to them into one
occupation. As Isabel stated, "Oh yes, 1 really like it when different passions in my
life all come together and I con put all my energy [into one activity]." When talking
about occupations that integrate, for the most part, the women were referring to
occupations that integrated their lesbian identity or disabled identity with other identity
parts. Being lesbian involves a degree of invisibility. Unlike heterosexuality which is
assumed and rarely has to be outwardly stated, lesbian women must inform people
about their lesbian identity. To some extent, this gives lesbians a choice about
disclosure. On the other hand, lesbians ore forced to disclose over and over to
different people in just about every area of their lives if they want to be accurately
perceived as who (hey are with respect to their sexual orientation. Furthermore, once
they disclose their lesbian identity they often need to engage in expanded dialogue to
correct people's faulty assumptions about what it means to be lesbian. Because of this
process, some women talked about integration in terms of being recognized os a
lesbian in the same way that they were recognized as on occupational therapist, an
athlete, or a humanitarian. They balked against having their lesbian identity be
perceived as their sole identity. Lisa depicted this in her statement.
When I was considered a straight woman, 1 had a name, a
job, hobbies. I was seen os a whole huge spectrum of a
human. Once you say you are a lesbian, that's it. You are a
sexual deviant. You no longer have a name, a job, hobbies.
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You arc not a person with any other dimensions, you ate only
seen os a sexual deviant That is it You are defined os a
lesbian. That is your whole identity. It's bizarre.
Equally important, the participants balked at having to separate themselves from
mainstream society and to immerse themselves in a lesbian culture as the only way to
get in touch with their lesbian identities. Ultimately, for them integration meant being
seen as a person with multiple threads of meaning in their lives, lesbianism being one,
and having on opportunity to simultaneously express those threads of meaning in a
single occupation.
For women who were disabled and lesbian, the notion of feeling integrated
took on a different slant. When discussing whether being lesbian was on important
part of her identity, Roberta suited,
Sometimes, being a person seems much more important
because sometimes I feel like I'm just a disability and
discounted. . . . I want to be recognized os somebody that has
authority . . . or just acknowledged os, os a person, who,
whose, who is saying valid things, whether, you know,
whether I'm in a chair [wheelchair] or not.
Because their disability was so visibly prominent, they had to work extra hard at
showing people the "whole spectrum of their humanness." This process is almost a
mirror image of the process used by lesbians where they must work extra hard at
showing people their lesbian identity, rather than letting others simply assume they ore
heterosexual. As was discussed in Chapter 3, Marguerite's situation exemplified the
problems that women who arc disabled face when disability is perceived by others os
the most prominent aspect of their personality. Marguerite, who for years put her
energy into lesbian and peace politics, has now been slotted into the position of
disability advocate by virtue of a deteriorating physical condition. It is assumed that
this is where her politics belong because her identity as disabled seems to preempt all
others. The people she encounters do not seem able to move beyond her electric
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wheelchair and slow speech. Although her past political experience positions her as a
perfect advocate for disability issues, and she views them as important, her heart still
lies with the peace movement and with lesbian issues. Opportunities for political work
in these areas arc basically dosed, whereas she has most recently been called upon
twice to participate in projects that have to do with her disability.
In the end, Barbara summed up the desires of many women in this study when
she stated, ”1 think what's important is to be perceived as w hole. . . without the
trappings of labels. They arc a person. There's a woman, there's a lesbian, there's a
handicapped person, there's a Southerner, there's a salesperson." In other words, the
women in this study desired to be perceived os the complex human beings that they arc
with no one identity part taking ultimate precedence over another and no one identity
part being forced underground because of societal ignorance.
As stated above, the women expressed a desire not only to be viewed as
multidimensional people but to have opportunities for the "different passions in their
lives to come together" in occupations. The following stories exemplify three ways
that participants talked about occupations that allowed for identity integration. Arlene
commented, "I miss connecting in that way with women on a professional level and
also an interest level." Since she has moved from the city where she had spent the last
10 years of her life, Arlene has yet to find a group of friends who could replace her
previous Women's Outdoor Group.
We'd get together and do hikes and get together and have pot
lucks or watch slides of where people had just gone,. . . the
common event would be something that we were all interested
in like hiking or cross country skiing, urn something like that.
In her home town, this group, which was made up of professional lesbian women,
brought together Arlene's athletic, lesbian, and professional interests all in one hike,
snow trip, or potluck. Presently, she hikes with her partner and occasionally
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socializes with other lesbians over dinner. But this Teels split to her. It doesn't satisfy
her need to subsume the many facets of her life together under one occupation.
Isabel's involvement in PFAB (People of Faith Against Bigotry), a religious
group dedicated to helping eradicate bigotry using religious doctrine, accomplished the
same goal os Arlene's Outdoor Women's Group by giving her an opportunity to bring
her lesbian identity into different realms of her life. Isabel stated, "I politically became
more visible. I've been always Jcwishly visible. But I haven't been Jcwishly lesbian
visible [until Proposition 9]." In this group, Isabel was able to combine her
Jewishness and lesbianism under the umbrella of social activism, one of the most
compelling themes of meaning in her life. Thus, when participating in conferences
and committee work associated with PFAB, Isabel talked positively about feeling
centered and integrated. These occupations seemed to provide a feeling of wholeness
that others did not
Finally, Monica recalled a feeling of freedom and wholeness that she
experienced while attending a dinner party. She attributed these feelings to the fact that
at that event she could talk about the many things that really mattered in her life. For
her it was disconcerting to have to partition the various aspects of her life, when in
actuality, she perceives them in on integrated way. In one part of our conversations,
she commented, "everything's kind of a lesbian, spiritual activity." Later she suited.
So those things [being lesbian and being an occupational
therapist] are really intcrmeshed. Well who I am is really a
person, who happens to be a lesbian and an occupational
therapist, a professional occupational therapist. So um, you
know, at the lesbian dinner party, I could express those
concepts or those parts of me more readily and freely.
The lesbians in this study who felt that their lives were particularly fragmented
due to the secret nature of their lesbian identities experienced feelings of self-harmony
when what seemed to be disparate parts of their personality were merged together in
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one occupation. The feeling that their lives were more authentic when occupations
embodied various identity parts, though, was not exclusive to those lesbians who
represented their lives as a split entity. Even women such as Isabel, who did not hide
behind a shroud of secrecy, felt more authentic when they could partake in occupations
through which they felt unified. Heidegger's notion of authentic temporality implies
that lives arc more authentic when they are lived and recounted as a unified whole, or
coherent, story with a future perspective. For these women, the need to feel integrated
was not only in terms of their overall life stories, but also in terms of their present sclf-
conccpt. And because identity is lived in action, they longed for occupations through
which they could physically and emotionally apprehend the complexity of their human
existence.
Bridging Occupations
In the following section I will describe how the women used occupations
creatively to establish and nurture relationships between themselves and family
members or friends while at the same time bridging the gap between heterosexual and
homosexual orientations. First, I will explore mother-daughter relationships and how
they change when grandchildren, or the typical occupations relating to grandchildren
were not present. Second, I will provide on example or how one couple used a typical
occupation ( a baby shower) to invite their predominantly heterosexual family into their
lesbian world. Finally, I will explore how the bonds between some of the women
with disabilities and their friends were disrupted when inaccessibility prevented them
from gaining access to occupations such os political meetings or leisure events.
Family bonds. Occupations were described by some women as a medium that
created an opportunity for them to bond with family and friends, an opportunity which
134
may otherwise have occurred through culturally sanctioned rituals not as readily
available to the lesbians in this study as they arc to coupled heterosexuals. The bond
between family members, in particular mother and child, was the most prominent and
emotionally laden bond that was discussed in the interviews. Jenna's statement. "Her
[mother's] biggest disappointment was that I wasn't going to have children" resonates
with the experience of other women in this study. It seemed that mother-daughter
connections were pushed out of kilter as mothers learned that their dreams for having
grandchildren were not to be realized. If the women happened to be only daughters,
the significance of this disappointment amplified greatly.
The presence of grandchildren was not the only thing that mothers and lesbian
daughters abdicated. Grandchildren, with the abundance of shared occupations that
surround them, offered an opportunity for a renewed relationship between the mother
and daughters. Leah described how important having a child became for the
relationship between her sister and her mother in the following story.
My sister and my mom were like oil and vinegar, in fact, like
night and day. My sister, she's older than I am, I’ ll tell you..
.. my mother cut her mothering teeth on that child. And my
mother's very, very, very, conservative and my sister went,
you know, boy crazy at about 11.2 and the Beatles were
coming up and my mother was fairly certain they were a
communist plot, you know to overtake America. But I'll tell
you the two of them hated each other until the moment that my
sister ended up getting married and having a baby at 19. She
was 20 when she had her baby. She had this youngster she
was 20 years, it was the first youngster [grandchild]. . . . And
I'll tell you, no matter what had gone on before, that bond was
different. That [the new bond] was totally unutterably not to
be changed.
In this situation, the presence of a grandchild enabled Leah's sister and mother to
override their past wars and find a reason to nurture the relationship between them.
No other issue except the birth of a grandchild had ever enabled them to do this.
135
Beyond providing a reason for a mother and daughter or mother and daughter*
i.
in-law to further their relationship, after children were bom, the occupations
surrounding that child (that is, baby showers, birthdays, baseball games, school,
Disneyland trips, school plays, girl or boy scouts) brought people together, to invest
in a common interest that had not been present previously and, at other limes, to
provide them with an opportunity to congregate. For example, referring to a
discussion she had had with her brother-in-law, Sara recounted,
And David doesn't have a wonderful relationship with his
xuents but he said, you know, it's wonderful to have a child
>ccausc it's a good distraction. He said, you know if 1 didn't
have this baby 1 wouldn't have anything in common.
Likewise, Leah stated,
See my siblings who have children can create those family
gatherings because of things that happen to their children.
Each child has a birthday, you know, you get invited to a
barbecue or a this or a that, or you know, you graduate from
kindergarten and then you go on to this. They have, they have
markers on which they can bring the family together to, to very
easily connect to those markers. I don't have those markers.
So when I want to create a family gathering, we have to create
it around something totally different.
Although the shared family occupations that marie various events in a
grandchild's life serve to fortify family relationships, they also serve a less obvious
purpose. These events arc rituals that communicate and reinforce notions about the
importance of traditional heterosexual families and the proper conduct of women
within these families in contemporary society. Affirming heterosexual love and
childbearing is perhaps not the central meaning of these occupations, but definitely a
potent underlying message of such celebrations. There is on element of normality
attributed to childbearing and child raising for women. Grandchildren become the
ultimate prize for a grandparent that indicates she has successfully raised her child.
136
Thus, a grandchild, and ihc celebrations of that child, become an outward
manifestation of normality for not only the mother but also the grandmother.
Equally important os what these celebrations honor, though, is that which they
leave out. For example, although Leah was a central figure in the family-baby-sitting,
bringing gifts, and caring for her nieces and nephews, and for those reasons, a greatly
appreciated and loved aunt-she was never the focus of the celebration either herself or
through her children. In essence, she is only an aunt, not a mother or grandmother,
and thus excluded from full participation in these celebrations. She remains on the
periphery. In her in-depth study of women preparing family meals, DcVault (1991)
uncovered how this everyday activity embodies notions of gender relations, class, and
race that are at times contested and at other times reproduced by the very women who
arc immersed in the process. The women in my study who were drawn into family
celebrations of grandchildren talked about how these occupations reinforced cultural
ideologies about a particular type of heterosexuality (that is, married with children) by
celebrating three generations of family: grandmother, mother, and child. If these
celebrations do embody messages os to what is culturally accepted os normal, then the
fact that fewer, if any, publicly recognized celebrations are named for lesbian couples
or single people of any sexual orientation may imply that these lifestyles are not as
respectable in the public's eyes os those of heterosexual married couples.
It would be misleading to imply that the presence of grandchildren
automatically cures all previous ills between children and parents. A grandchild docs
not necessarily ensure that a positive relationship will be developed between the
mother and her own mother or mothers in-law. At times, the presence of
grandchildren can escalate poor family dynamics that previously existed. However, in
this study, if the desire was present, a grandchild contributed strongly to the
preservation of the mother-child bond. Second, it is important to clarify that, because
137
of the design of this study (that is, women were the informants), I have couched the
discussion in terms of mothers and daughters. However, as Sara's comment about
her brother-in-law implies, the findings could relate to mothcr-son relationships.
Furthermore, the vacuity that childless lesbians feel from mothers may be similarly
experienced by childless heterosexual single women.
Given that only two of the participants in this study had children through
previous heterosexual marriages and that only two others were considering having
children in the future, connections with family had to be maintained in other ways.
For some individuals. Mother's Day, Father's Day, and birthdays among other
holidays serve to ensure connections. For Cathy and Connie, two relatively new
homeowners, home decorating events provided a connecting bond with parents. For
example, Cathy talked about spending one weekend on a shopping spree with her
mother looking for a refrigerator, a birthday present that her mother had decided to buy
her. This was only one of many home decorating activities that she and her mother
and father had shared. Connie also commented that the home which she and her
partner, Fatty, had just bought became a common ground for communication between
her partner's mother and her. Patty's mother was quick to offer advice on what color
they should paint the various rooms and, when Connie and Patty found a bird's nest in
the chimney, Connie immediately said to Patty "Call your mom because she knows
about these things." Advice about the bird's nest was only the superficial purpose of
the phone call. Ultimately, it gave them a reason to connect with their mothers.
Although the above two stories demonstrate that remaining in touch with mothers and
family members did not necessitate having children, these other forms of connecting
were not as regular in their occurrence and not as easy to create as those that
surrounded childbearing. Furthermore, they did not seem to carry the same emotional
138
valence with respect to nurturing relationships than occupations centering on
grandchildren did.
Inventing rituals: The mom's party. Intentionally inventing a ritual to celebrate
mothers and daughters, or the family in general, became one way that Leah dealt with
the absence she fell by not having had her own children. Leah is the second oldest of
a family of five; she is the only female sibling married to a woman and has no
intentions of having children other than her "trusty dog Dusty." The idea for the
following event, which became known as "the Mom's Party," came to Leah as she
was sitting around a dinner table with her core group of lesbian friends during one
Christmas holiday party. The intent was to create a memorable occasion celebrating
not only their mothers but also their lives as lesbians and their lesbian friends. Leah
explained,
I was a little afraid to ask my mom because even though she
knows, she's been very much reluctant to deal with it as an
issue. . . . And so, I said to myself you know my mother
goes to live with my sister for 2 to 3 months at a lime, [to see
Die grandchildren]. My mother goes to live with my brother
for a weekend, he's closer so she doesn't have to stay that
long lime. My mom docs whatever my sister or my brother,
my other siblings ask her to do. She cfocs [it] you know, if
it's [a grandchild's] baseball games or it's, whatever it is, she
does that for them and, by jingo, she con do this for me. So I
said, Mom, save February 8. She says Oh what for. I said
Oh, I'll give you the details later, I said, we're going to get
together with a group of out friends, etc. So os lime got a little
closer, I said, Well this is the kind of attire and, and um, we're
going to be going to, you know, one of our friend's house and
the, three other of our friends will have their moms there. So
you won't be the only mom. you know, it's kind of a mother-
daughter thing, and we just really wont you to come, blah,
blah. She was like, was excited. She was excited to come.
She was, she was dressed up, she looked really nice. . . . So,
we escorted her, and drove over there, . . . They all come in.
They see that all of these lesbians are highly educated, we're
talking from doctors to Ph.D.'s to, there wasn't a slouch
139
among us, MBA's, blah, blah, blah. . . . Gorgeous home,
you know, beautiful, they meet other moms, they like other
moms. They said "Oh other mothers". And I'm normal, and
we produce these normal children.
The highlight of the evening, though, centered around a ceremony in which
each daughter presented her mother with a rose. Leah explained,
One of our friends had said, Why don't we get our moms
long-stemmed red roses. . . . So, we're all sitting around, we
have dinner, we present our moms with our roses, it was such
a touching moment because our mothers just sat there. We
went around the room and each mother and each daughter told
a story about the other. And I'll tell you. It was just, you
know, one mother saying, you know, Julie was always my
beautiful little girl. . . . I mean daughters getting acclamation
from mothers that they had never gotten before. . . . It was
probably one of our finer moments.
Leah savors this event and the symbolic significance that it held for her and her
mother. Two years later she continues to tell, and in the re-telling, experiences over
and over again, the emotional bond connecting her with her mother in the context of
her lesbian life. These types of occupations arc few and far between but perhaps
because of their infrequency they arc especially potent. For one evening, Leah's
mother was able to enter into her daughter's lesbian world and experience it os a
normal and respectful place.
Interestingly, in Leah's ease, the desire to nurture the mother-daughter bond
was not one-sided. Leah found out through her older sister that her mom always kept
some frozen food in her freezer so that she could quickly whip up a lunch or dinner if
Leah happened to come over. Leah is the only child for whom her mother keeps this
food. This scenario suggests that, like Leah, her mother felt a vacant space between
them that she wanted to fill; but unlike Leah, although she may have desperately
wanted to, she didn't have the knowledge, skills, or whatever it took to break beyond
traditional convention and create situations that would bring the two together.
140
On the other hand, Leah is especially creative and uses her creative abilities to
continually fabricate occupations that link her with not only her mother but with each
member of her family and friends. In her book Feeding the Family, DcVault (1991)
observes that the skills required for women to plan and execute family meals arc often
taken for granted as if they were natural endowments encoded on the XX chromosome
of every female. With this mindset, women arc expected to engage naturally in this
occupation with simplistic ease. Her warning, although it refers to the relationship of
gender and occupation, could apply in Leah's ease. Even though Leah appears
innately talented in organizing family theme parties, it is important to remember that
conceiving the idea, planning for the event, and hostessing such occasions requires
extra effort and energy because they arc not embedded in the cultural slock of activities
in the way that a grandchild's birthday or first ballet performance is. What may appear
to be an innate talent is in actuality a difficult task which she docs to maintain a sense
of family with her biological kin.
In the book The Culture of Love, Kem (1994) warns the readers about the
potentially inauthentic nature of rituals. He claimed that rituals, especially those with
past historical significance, embody social conventions that dictate not only prescribed
ways in which people ore to behave but also the appropriate emotions that people arc to
experience. These rituals, when they are carried out in a mindless manner without
sufficient self-reflection, simply pcipetuate the status quo. Although a common stock
of rituals to bond heterosexual family relationships exists in contemporary society, it
docs not necessarily mean that they are carried out in a thoughtful authentic way.
According to Kem, many times they ore not On the other hand, the fact that childless
lesbians do not have the array of traditional rituals that will fortify family relationships
as do heterosexuals not only gives them the opportunity to, but also forces them to,
invent their own rituals. The very nature of inventing rituals without a prefabricated
141
template requires some level of sclf-rcflcction, thereby enhancing authenticity. The
i .
mom's patty became an authentic ritual because it was deliberately designed to
communicate specific meanings about the normality of lesbians and the love between
mother's and daughters,
Recasting heterosexual rituals: The lesbian babv shower. In the second
situation, a lesbian baby shower for Sara's cousin, Linda, and her partner, Libby,
became a crucial occupation that on one level celebrated the approaching birth of a
child, and on another level gave Ami and Sara's heterosexual family members both a
glimpse of what Ami and Sara's lesbian lives were like and an opportunity to
demonstrate their affection for Ami and Sara as lesbians. In planning the event. Ami
and Sara very carefully constructed an opportunity for two lesbian women to be
celebrated within the context of on occupation that seems to fit naturally with a
heterosexual world view, mainly because in the past, baby showers have been more
associated with heterosexuals than homosexuals. Thus, this occupation was
comfortable for all of the attendees. The shower itself resembled many "typical" baby
showers: food was served including a cake saying "Congratulations, Linda and
Libby”; the noise level was heightened with conversations and people meeting new
acquaintances; advice on mothering was flowing; and the audience was filled with
"oohs" and "ohhs" os gifts of tiny baby clothes were opened. By the end of the day,
everyone was exhausted with excitement. As Ami stated, "Ah, it ended up being such
a nice day, and on my end to have my mother here, to have my sisters here, and to
have my nieces here. So, it was just a group of women getting together, and you
know, having this nice baby shower."
Yet, the shower went beyond "just a group of women getting together having
this nice baby shower." It hod different meanings than the typical baby shower; the
142
child was to be bom to two women and, in this sense, it became an educational
experience for heterosexual family members. For example, it necessitated that Betty,
Ami's sister, carefully explain to Jane, her 13-ycar*oId daughter,
Well, we're going to a baby shower at Sara's house. And it
will be Linda's [shower], her cousin, and she's pregnant,
she's going to have a baby and you know, Linda is gay. And
her partner Libby will be here so, anyway that's where we're
going.
A simple explanation in passing allowed this 13-year-old to experience the shower,
and the birth of a child to two women, as an acceptable event For the adults, many of
whom had little to no association with lesbians or understanding of the lesbian culture,
just being in a room with an equal number of lesbians as heterosexuals, hearing the
conversations, watching women relate to their partners, and participating in an event
that challenged the traditional notions of relationships, parenting, and families was an
eye opener. Ami related,
So, Betty left, she called me up the next day, and she says,
you know, I had such a good time, she goes. I feel like a
woman of the 90s. I feel like for one time she says, I'm not
sheltered in my life. She goes. I've kind of opened up to
really accepting a different lifestyle. Sara told her you know
our commonalities arc far greater than our differences. . . .
and Betty couldn't get over it, she says, they just were so nice
and it just doesn't matter.
In addition, the shower deepened family relationships. Prior to the shower.
Ami and Sara were out to only a few members of their Tamily, but regardless of
whether or not they had officially disclosed their sexual orientation, the fact that Ami
and Sara had been together as a couple attending family events for about 10 years was
revealing. Irrespective of this, their life as a lesbian couple had rarely been broached
in family conversations. Because their sexual orientation become an "untouchable"
subject that everyone knew about but no one addressed, the grounds for mutual
understanding began to slip out of reach. There was never a doubt that all parties
143
genuinely desired truthfulness, but until this point they had not been able to bridge the
distance that had developed between them. This baby shower, however, transformed
their relationship to some family members in that it opened the door for genuine
heartfelt conversations about their lesbian life. Whereas in the past, they walked past
each other in conversations about Ami and Sara's life, now space existed in which
they could shore a more authentic relationship. For example, it enabled Ami and Sara
to finally have an honest talk with Sara's sister-in-law that they had longed for ever
since they had told her about their relationship, but that never seemed to materialize.
Finally, the shower offered parents and family members a public place to
demonstrate acceptance of Linda and Libby, and in acknowledging them, also show
their acceptance of Ami and Sara. In the end, for Linda it was a "day of all days."
Ami related, "Linda just cried all night because the emotions were so high and she
said, you know, I had such a headache just trying to fight off that acceptance that's so
often, you're not realty sure that you'll be met with, and it just turned out to be a really
nice day." Most mothers-to-be never think about whether they will be accepted for
their sexual orientation at their own baby shower. However, for Linda, like many
lesbians, wondering if you will be accepted as a lesbian in any public arena, is a
nagging concern. When they arc not only accepted but celebrated for it, that
acceptance is experienced with overwhelming warmth. And, similar to the mother
who experiences validation in her child's accomplishments, in this ease, the warmth of
acceptance was vicariously felt by Ami and Sara as well.
Friendship bonds. The way in which occupations serve as a forum for linking
friends and acquaintances became obvious for some of the women with disabilities
when the inaccessibility of buildings prevented them from participating in such
occupations. As stated above, Isabel had difficulty connecting with the local lesbian
144
community through leisure occupations, once she began to rely on her scooter Tor
mobility. For Marguerite, however, the loss or friends that she experienced due to her
inability to participate in political occupations was mote severe. For years she was the
editor of a newsletter for the Women's International League for Peace and Justice,
bringing a lesbian perspective to the articles that she wrote. She attended meetings and
was quite vocal on many issues. More recently she became the treasurer of a Political
Action Pact for the No on Proposition D campaign. After the intense work she did
fighting against Proposition D, her multiple sclerosis worsened such that she is
presently unable to write, needs assistance with her mobility, and has difficulty
speaking. It is important to note, however, that it was the discrimination against
persons with disability in the form of physical inaccessibility to meetings and of
limiting social attitudes (that is, fear of disability) that prevented Marguerite from
remaining part of political causes that she loved. Although her writing skills and
speech may have deteriorated somewhat, she was still able to perform tasks that were
important to those committees. Most of all, she had had a history of involvement and
remained dedicated to the causes with fresh ideas. Marguerite, though, spends most
of her time in her apartment. She stated that her friends have drifted away from her
because "they arc seared to see their friend get worse.” And, as she pointed out,
"people I enjoy arc involved in political things." In Marguerite's situation, political
occupations embodied the issues that raged in her soul. Through those activities,
Marguerite met the type of people who inspired her and whom she could inspire. In
this sense, political occupations held dual purposes. The absence of such occupations
from her life not only revoked the opportunity for her to act on some very deep
convictions but it also took away her opportunity to socialize with friends and meet
new peopte.
145
In summary, drawing upon Heidegger's notions about human relationships,
Kem (1994) stated, "People do not actually meet at some point; rather they clear away
space and make room for one another” (p. 31). Kem continued by analyzing a scene
in the novel The Thibaults, where two people who later become lovers meet while both
arc involved in saving the life or a young women who hod been hit by a truck. He
pointed out that both characters "made room for one another in a place that was
invested with meaning of their shared project of saving a life" (p. 33). People often
make room for one another while engaging in shared occupations. On the other hand,
by virtue of the social conventions that arc deeply entrenched in some occupations,
occupations can mask as opportunities for bringing people together, while in reality
exclude some and accept others. The above three stories exemplify both how people
made room for one another and excluded one another through shared occupations.
In Leah's cose, the space created by the shared activities of celebrating
grandchildren was, on the surface, a welcomed invitation for her and her partner to
participate in family relationships. The fact that she was a cherished aunt granted her
ample accolade from other family members. Yet that accolade for being a good aunt
could also be heard os a hounding reminder that, because she had no intention of
having children, she was to remain as a peripheral member of the group. Unless Leah
creates space in her life for her heterosexual family to celebrate her, she will continue
to feel a void.
On the other hand, in the "shared project" of the baby shower. Ami and Sara
were able to create a safe and more authentic place for heterosexual and lesbian family
members and friends to meet Unlike the heterosexual family celebrations that Ami
and Sara usually attend, this baby shower was a lesbian event, a time in which they
could openly experience their lesbian identities. In fact, their lesbian identities made
them central players in this celebration rather than peripheral onlookers who were
146
appreciated, but nonetheless onlookers. Whereas most public and even private family
spaces arc controlled by heterosexual ideologies, that afternoon lesbian ideologies, as
defined by Ami and Sara and the other lesbians who were attending the shower,
prevailed.
For Marguerite, political activism both opened and slammed the doors on
opportunities to be part of her community. Prior to her most recent physical
exacerbation, political occupations not only provided space for people with common
commitments to converge in action, but they also provided a space for people who arc
disabled to unite with people who ate not disabled. However, once her health
worsened, the fact that these occupations took place in inaccessible buildings and that
the public was afraid to watch her deteriorate, excluded her from participation.
Without access to these shored projects she was isolated from the community that she
loved so dearly.
Conclusion
At the beginning of each year, the editors of the "Occupational Therapy Week"
index the previous year's articles under what they consider appropriate subject
headings. Curious about how they would classify an article that discussed the
National Annual Meeting of the Network for Lesbian, Gay, and Bisexual issues in
Occupational Therapy, I flipped through the various pages looking under subjects such
as professional affairs, diversity issues, and even homosexuality. Having had no luck
with theses areas I regretfully moved to the S's only to discover that this article was
the sole article classified under "sex behaviors." It is my hope that the findings in this
dissertation begin to dispel the detrimental notions in occupational therapy that
homosexuality is simply a sexual issue.
147
The 20 women who participated in this study spoke for hours about how their
ik
lesbian identity became embedded in daily occupations, far beyond the sexual
encounters they may or may not have had with other women. Participating in
occupations that occurred within a homosexual social context, addresses homosexual
content, embodied homosexual symbolism, or provided on emotional comfort with
respect to one's homosexual identity became ways that these women defined and
realized their lesbian identity. Irrespective of the specific patterns of leisure, political,
and spiritual occupations in which they engaged or the temporal rhythm with which
they expressed their lesbian identities, it was clear that engaging in such activities was
important to these women's needs to express themselves as lesbians in the world.
Given the present social and political climate, which is less than completely
tolerant of homosexuality, living as a visible lesbian was a challenge even for the
women who were most skilled in this area. Thus, women spoke about the struggles
that they had with remaining honest in what they did and said, yet protecting
themselves from hctcroscxism. Occupations became crucial in the women's attempts
to create authentic lesbian lives. In particular, these women discussed ways in which
participating in occupations that validated their lesbian identity integrated their lesbian
identity with other identity parts or bridged their relationships with family and friends
contributed to a sense of authenticity.
148
CHAPTER 5
HETEROSEXISM IN THE
OCCUPATIONAL THERAPY W ORK PLACE
In order to address the second purpose or this study (that is, to gather
descriptive information about the types of therapeutic environments that foster and
those that hinder authentic occupational therapy with respect to lesbians, gays, and
bisexuals), this chapter focuses on how being lesbian weaves itself through one
occupational context: hospital work. Literature that addresses work cultures, work
climates, and "proper" work etiquette is used to frame the experiences of lesbian
occupational therapists in their hospital work settings. Often, lesbians, gays, and
heterosexuals proclaim that sexual orientation is not a work issue. In fact, this notion
has been codified in legal terms under the U.S. Army mandate that military personnel
must remain silent about their sexual orientation. I wilt explore this stance by first
describing how notions about the split between work life and home life arc used to
ascertain, in a supposedly fair manner, which topics of discussion ore appropriate for
work environments. On the surface, when one conceptualizes work and home as two
distinct life spaces, it may seem obvious that disclosure of one's homosexual
orientation is irrelevant in work environments. However, I will show that, in fact, the
so-called universal notions about "proper work etiquette” not only allows
heterosexuals to cross the home-work boundary but expects them to do so.
Furthermore, I will use Woods's (1994) argument that the discrepancy between how
the philosophy about the separation of work and home is applied to heterosexuals
versus homosexuals is grounded in a view of sexual orientation that frames
*
heterosexuality in terms of relationships, and homosexuality in terms of bedroom sex
acts.
149
Following this introduction, t will describe the climate, with respect to lesbian,
gay, and bisexual issues, within the occupational therapy clinics where the therapists
who were interviewed were employed either presently or in the past. In describing
their work settings, I will demonstrate how heterosexual climates are maintained
through heterosexual discourse, homophobic comments, assumed heterosexuality, and
perceived stereotypes. These heterosexual environments, sustained under the pretense
or neutrality, create negative sanctions or harassment of occupational therapists. I will
discuss four types of harassment ranging from very subtle back stabbing among co-
workers to the more explicit glass ceiling which prevented some lesbians from well-
deserved promotions. However, despite the negative sanctions that some lesbian
occupational therapists experienced in their work settings, not all settings were
characterized as destructive. In fact, many of the women spoke positively when
recounting their work experiences. Thus, I will move on to present the therapists'
perceptions about the ways in which their work settings were "lesbian-sensitive.'1 I
end this second section, by discussing how the women I interviewed managed their
lesbian identity in both lesbian sensitive and non-lesbian sensitive environments.
The Worker "Role":
Appropriate Behaviors or Censorship
James Woods (1994) opens his book The Corporate Closet by recounting his
first day on the job in an. advertising company. His stoiy goes like this:
On July 8,1985, a few minutes before nine, I met my new
boss in the upstairs lobby. She whisked me into an office, and
we ran through the preliminaries: identification card, benefits,
vacations, how to find the men's room. Then she explained,
with a smile, that I would be working on the men's razor
aocount, an assignment she thought "would be perfect for a
young man like you."
Over the next few hours, 1 was escorted around the agency
and introduced to some of the key people I needed to know.
First I met Sharon, who had joined the company the week
150
before. She worked on the fast food account and seemed as
nervous as I was. I liked her at once. . . . "Let's have lunch",
she suggested "so I can share my vast experience with you." I
agreed and continued my tour of the agency. (Later that week,
my boss warned me that Sharon was off limits. "I know what
you're thinking," she said quite spontaneously, "but
tntrafucking is strictly against the rules.")
We moved on through the various offices and meeting
rooms, where I met the writers, producers, media planners,
and brand managers I'd be working with. After each ritual
introduction, we exchanged a few vital statistics. I asked how
long they had been with the agency, what accounts they
worked on, how they liked New York. They wanted to know
where I'd gone to college, where I lived, and if I was married.
When I assured them I was neither married nor "otherwise
involved" one of the men told me about the weekly singles
night in the cocktail lounge on the second floor. "I'll be
there," I said.
After lunch I was taken to a tiny screening room, where my
boss had arranged for me to sec a reel of television
commercials for competing brands of men's razors. She also
wanted me to sec the currant campaign for our brand, which
featured clcan>shavcn young men laughing and playing,
having a great time in cars, on beaches, and at basketball
gomes. The new campaign, which was scheduled to air in a
few weeks, featured rock music and a college dormitory
setting. The old stuff, she told me, was "really faggy."
As five o'clock approached, I was introduced to one of the
head writers, on older man named Don. He reminded me of
my grandfather, with his wispy white hair and gentle, amused
eyes. His office was littered with toys and old movie
paraphernalia. Though I didn't notice it at the time, Don was
the first person who didn't ask the usual questions about my
personal background. Instead he showed me a script he was
working on and insisted that I visit a certain restaurant, on old
favorite of his, in on obscure comer of my new neighborhood.
"How do you like New York?" he wanted to know. "Do you
enjoy the theater?" "Have you been to Chinatown?" Leaving
Don's office, I remarked, "He seems like a nice guy." My
boss was amused. "I'm sure he thinks you're nice, too."
Don hod been with the company a long time, she told me, and
was an important person to know, "especially if you want to
have a homosexual fling." She caught my eye, and we shared
a chuckle.
Walking home, I felt the curious mix of exhaustion and
exhilaration that follows an extended dose of adrenaline, the
relief an actor must feel when he steps offstage after a
performance. Nothing disastrous hod happened, and it seemed
to me that I hod performed quite well dunng the introductory
small talk. My boss had impressed me as someone who
would make a stem but effective teacher, someone who hod
my best interest at heart, concerned as she was with the
subtleties of my public image. To make sure 1 was sending the
tight signals, she had even persuaded me to run with her and
several others in the annual Corporate Challenge, a five-mile
road race in Central Park. "You want people to see you as a
team player," she had explained. I agreed at once, grateful that
she would want me on her team.
Joining a college friend at a gay bar later that evening, I
spoke glowingly about my first day. . . . It didn't occur to
me, not even Tor a moment, that my initiation into the working
world had been hostile or demeaning. On the contrary,
Monday struck me as a typical day at the office. My first day
of work felt like countless other experiences I had been
through over the years: beginning the school year, moving to a
new town, entering a room full of strangers, (p. xi to xiv)
Woods's story is telling not onty in terms of how heterosexuality permeated
the work environment but also in terms of how oblivious he was to the constant
heterosexual badgering he encountered that day. Perhaps his obliviousncss attests to
the depth of heterosexual privilege in many areas of his life. Woods's story also
suggests that heterosexuality in the workplace may be so common that it is scarcely
recognizable to any individual who is not predisposed to seeing it. In the following
section, I will explore the ways in which one's notions about proper work etiquette,
that is, keeping one's personal life separate form the workplace, reinforce the
simultaneous pervasiveness and invisibility of heterosexuality.
The first massive splitting of home life from work life has been linked by some
to the industrial revolution (Bernard, 1992). Bernard claimed that it was at this time in
American history that both types of work and separate work sites become gender-
identified, with women maintaining responsibility for activities within the home and
men working at businesses in public arenas. The psychological ramifications were
such that women supposedly became the purveyors of emotional expressiveness and.
caring, and men the economic breadwinners. An unstated assumption, of course, was
that both the emotional and economic needs of men and women were satisfied through
heterosexual marriage. Putting this issue aside, one can focus on the fact that the
152
division of work spaces imposed upon each sex their "own turf" (Bernard, 1992, p.
205), meaning that women supposedly controlled the home domain and men the public
domain (Bernard, 1992). Studies have shown that not all women stayed at home and
not all men became breadwinners (Fadcrman, 1991; Collins, 1990). But, as Bernard
stated, ideologically this gendered spilt "was a seemingly rock-like feature of the
national landscape" (p. 205). In other words, even when women worked outside the
home, they felt the pressure to live up to the ideologies about what constituted the
"good housewife role." Likewise, men felt their masculinity was measured by the
degree to which they could live up to the "good provider role."
In the workplace, this gendered division of life spaces took on a specific
meaning that is expressed primarily through codes of work etiquette which state that
workers should leave their private affairs at home. In 1974, Amy Vanderbilt, a
preserver of such behavioral codes, expressed this in various ways throughout her
etiquette book, most specifically through her strict cautioning about even letting family
members or visiting relatives tour work spaces or meet co-workers during the work
day. The vagueness of what constitutes private affairs has led to confusion about
appropriate behavior in the workplace. This is discussed later, but it seems safe to
conclude that the work-home split docs imply that work places were considered to be
non-scxualizcd environments. In fact, Schneider (1981) claimed that, prior to public
awareness about sexual harassment in the workplace, the lack of studies about
sexuality in the work environment could be attributed to the strongly held contention
that intimacy and trust were elements of home life and not of the depersonalized
bureaucratic work world. In the end, those who ascribe to the work-home split might
begin to argue that a clear distinction exists between what an employee should or
should not disclose about his or her personal life at work. For them, the imperative to
keep persona] life, particularly issues of sexuality, outside the office is simply an issue
153
of "proper" work behavior. These attitudes arc not held exclusively by heterosexuals.
Woods (1994) found that this work ideology was in fact internalized by many of the
gay men that he interviewed who also strongly professed the opinion that their sexual
orientation was a personal and not a work issue.
Connell (I9S3) argued that one of the problems with role theory is that it neatly
packages certain ideas about proper behavior as if they were somehow universal or
morally superior than other ways of behaving. Notions of proper work etiquette fall
prey to the same illusion, namely, that at times, they reflect an ideology that is often far
from the daily experiences of the majority of people and an ideology that privileges
certain people's experiences over others. The supposedly neutral notions about
keeping one's personal life separate from the work arena or that sexuality has no place
in the work environment is, to some degree, a cultural narrative that masks reality and
privileges some heterosexuals. For example, the presence of (hetcro)sexuolity in the
work arena is not only existent, but has had a substantial history. Some people claim
that anytime men and women arc in close proximity for prolonged amounts of time,
(hetero)sexual energy is present and thus sexuality has always been embedded in co-
gendered work places (Schneider, 1981). The notion that (hctero)sexuality has a
potentially strong presence in the workplace has certainly been understood by people
such as Amy Vanderbilt. In 1970, she dedicated at least one-third of her treatises on
work etiquette to ways to manage potential sexual energy at work. At one point she
states,
It is only human for a man to wont his secretary to be neat,
attractive, and, if possible, pretty. He has to look at her all day
long. But the more attractive she is, the more, for his own and
her protection, he must treat her with careful, polite objectivity
(p. 116).
She clearly outlined how women should dress so they looked presentable and yet not
enticing; how men should address their secretaries in a way that walks the line between
154
professionalism and friendliness; and where and when men and women w ho arc
(raveling together for business purposes should dine or reside, among other things. If
sexuality were not a work issue, it would appear that less emphasis would be placed
on specifying how to control it
In contemporary businesses, the prevalence of (hclcro)scxual encounters in the
work place is more publicly recognized than in the 1970s when Vanderbilt wrote. As
more women enter the work force, the potential for (hctcro)sexuality to energize
everyday interactions snowballs (Schneider, 1981). That, together with the fact that
sexual harassment in the work place has began to teach the public eye and business
policies, has led some authors to rcframc the work-home split even to the point of
recognizing that workplaces often double os heterosexual matchmaking arenas (Hall,
1986). Again, we can look to wcll-rcccivcd etiquette books as a way of defining at
least one social stance on appropriate work behaviors. In her book Ttie New
Complete Guide to Executive Maimers, Lctitia Baldridge (1993) entitled one chapter,
"A Good Manager Faces Up to Sex in the Office Today." The title alone conveys the
shift in attitudes toward the private life versus the work life dichotomy. It serves as a
wake-up colt, suggesting that it is no longer to anyone's advantage to mask the issue,
but rather it is to everyone's advantage to address the issues. By acknowledging that
any arena has the potential to be scxualizcd, work managers and employees can
explore, in a more realistic manner, what the boundaries between home life and public
life should be while paying attention to how this philosophy is presently being played
out in the workplace today.
Overt sexual relationships with co-workers are the most obvious example of
how private lives permeate work situations. But even more important to this study arc
the more subtle ways that the private lives of heterosexuals seep into the workplace, in
a seemingly unnoticed and innocent manner. Hall (1986) wrote about the "new
155
corporate culture which extends beyond the bounds of 9 to 5" (p. 63). She claimed,
"As extended family, spa, health center, the corporation has taken over functions
previously assumed by relatives, neighborhoods, and communities. The line between
work and leisure is blurred" (p. 63). Woods (1994) supports this claim stating that
most corporate office work entails beneath the surface obligatory socializing. In this
sense, the blurring of work and leisure is present in the countless invitations that
employees receive for socializing, from a quick afternoon lunch, an after-work visit to
the local bar, or a wedding invitation, to the more formal business cocktail and dinner
parties. Beyond blurring the home-work distinction, these events become
(helcro)scxualizcd by either the place at which they are held (that is, heterosexual bars)
or the expectation that one bring a date (Woods, 1994). One could easily argue that
such invitations should simply be rejected if the individual feels uncomfortable about
attending. Yet such rejections have ramifications as these events many times become
central places in which unofficial information is relayed or organizational decision
making occurs.
In fact, some authors (Woods, 1994) argue that the chemistry between people
plays a significant part in decisions concerning hiring or promotions. Likewise, trust
between co-workers, or co-workers and their bosses, is nurtured not only over work
tasks but as people begin to shore out-of-work time together and slowly disclose bits
of their life to each other. Conversations within and outside the workplace in which
co-workers bond around similar world views, jokes, references to their weekend
escapades, or life transitions (all of which con have heterosexual overtones) are
common occurrences and contribute to the overall impression that this individual fits
this company. To Woods, a sexual subtext is present in many of the shared
conversations and socializing that occurs at work. He stated "A sexual subtext is
156
often the basis for such intangibles as rapport, familiarity, and chemistry. It can
generate intense feelings of loyalty and personal commitment” (p. 28).
Although, as t have demonstrated above, there is a (hctero)scxual subtext to
many work interactions, for the most port these are not interpreted as sexual in nature.
We can return to the story of Woods's first day at work as evidence. It wasn't until
years later that he even reflected on the degree that heterosexual subtexts were woven
through that introductory day to his new job. Re-analyzing the situation, he suited,
I now recognized the countless ways I was told-formally and
informally, in word and in deed-that 1 was unwelcome in this
organization. Like the company's other lesbian and gay
employees, I sensed the moral judgment implicit in social
invitations for ”you and a girlfriend,” in the occasional joke
about who was or wasn't a queer, and in the seductive
advertisements, depicting heterosexual romance and love, that
I would be helping to create. I filled out personnel forms that
recognized only one kind of domestic relationship and that
promised health insurance and other benefits to the families of
those checking the "married” box. I learned the rules about
dating: "Homosexual flings" and heterosexual "intrafucking”
were forbidden, even as it was taken for granted that 1 would
desire the latter. I discovered that there were other people tike
me in the company, single people who gathered on Fridays in
the hope of solving that particular problem. Finally, I had
been told that "faggincss” was undesirable in any form: in
nicknames, in product advertising, and in people. (Wood,
1994, p. xiv).
Woods, like many heterosexuals, gays, and lesbians, lived in a (hctcro)scxualizcd
work world without even noticing it. Conversations that day which carried strong
sanctions against homosexuals were perceived as natural, to be expected,
"introductory small talk.” It is the invisibility that ultimately shows how ingrained
(hetero)sexuality is in the work world. But this story also points to the fact that not all
sexualities were treated equally (Wood, 1994). Although both "homosexual flings"
and "heterosexual intrafucking" were equally forbidden, the acceptance of other forms
of gay bashing (that is, negative references to fags and jokes), the assumption that
anyone who is single would enjoy a heterosexual singles' club and the provision of
157
fringe benefits to heterosexual couples only gave the message that some forms of
sexualities arc quite accepted whereas other sexualities (that is, "fogginess") arc not.
Interpreted another way, some people’ s private lives ore acceptable at work whereas
other people need to remain silenL
The double standards for heterosexuals and homosexuals flourish in
professional cultures because, first, heterosexuality is ubiquitous to public behavior
and, second, the meaning that heterosexuality assumes is vastly different from the
meaning attributed to homosexuality. Woods speaks to the first issue, claiming that
heterosexuality becomes a habit of perception; in other words, people "fail to notice
that which becomes most familiar" (Wood, 1994, p. 57). Thus, the fact that typical
office activities, conversations, symbolic objects, and corporate images arc highly
hctcroscxualizcd fades into oblivion simply because they arc perceived os normal
reality. In being stripped of their sexual symbolism, they become classified in
people's minds as typical asexual office behaviors. (Woods, 1994).
The second issue that supports a double standard for heterosexual and
homosexual individuals is the differing meanings attributed to heterosexuality and
homosexuality. In the past and presently, the corporate image of a male executive has
been synonymous with a family man. The wife and children who were definitely
behind the scenes were also proudly displayed upon the men's desks in the form of
family pictures. Furthermore, wives were responsible for attending, and often putting
on, social events for co-workers. In this sense, his (helero)sexuality is part of the
qualifications for his job, yet his marriage or his family in these specific instances is
not necessarily inleiprclcd as a merging of home life and work life or sexualization of
the work place. In the proper context, knowing that an employee has a wife and
children is a sign of his good character. Woods (1994) points out that the monolithic
family institution encompasses deep heterosexual values which ore not only on display
158
but given status in the corporate world in countless ways. Yet they arc rarely
classified under the rubric of sexuality. Rather they arc seen as statements about
family, love, relationships, or a man's identity as a father, husband, (sometimes)
religious man, and, most importantly, a good corporate employee.
As Woods (1994) claims, the same type of disclosure by a homosexual man is
often received with an indignant retort about his need to "flaunt it" or that he is
"making an issue of his sexuality." The difference in responses is due to the
perception of the disclosure. In the eyes of society, homosexuality is equated with sex
alone. With this interpretation, the disclosure of one's homosexuality or homosexual
partner-family would be no more appropriate than it would be for a heterosexual to
brag about his or her sexual intercourse with a dale he or she picked up from a bar on
Friday night, or for a co-worker to announce his or her extramarital affair with the
secretary. The common theme to these situations is their categorization as forbidden
sexual encounters. Common sense office etiquette is that these subjects should be
dealt with discreetly. It is during these incidents that the mandate to keep one's
personal life out of the work place is invoked. Thus, in reality, the discourse
surrounding the dcscxualization of work places or work-home split is reserved to
sanction those sexual behaviors deemed as repugnant (Woods, 1994).
Regardless of the general public's opinion about the meaning of being
homosexual, in the first section of this dissertation, I demonstrated how being lesbian
for my respondents was an integral part of their identity that influenced occupations in
all realms of their lives. I also showed that the silence about their lesbian orientations,
enforced by societal norms, placed them in the untenable position of having to struggle
to maintain an authentic existence against tremendous pressures to stay closeted.
Because sexual orientation is so integral to one's life, in the case of homosexuality,
which is interpreted by others as simply sexual acts, people who are lesbian, gay, or
159
bisexual arc ai a severe disadvantage when the mandate to keep their private lives out
r.
of business is placed upon them.
The previous discussion has drawn from research primarily about the corporate
world. I used this information because first, I was unable to find material that
analyzed with equal depth hospital cultures alone, but more importantly, because
hospitals and private practices are being purchased by corporate businesses. Thus,
occupational therapists ore already carving out their place within corporate cultures. In
fact, in Woods's book Tfte Corporate Closet the experiences of physicians were
included, indicating that hospitals arc categorized os corporations. Yet all work
situations, even within the realm of corporate world, do not exhibit identical work
philosophies or communication patterns among work personnel. Thus, the degree to
which private lives seep into the work setting varies, in part, according to the culture
and climate of that specific work setting.
Work cultures have been defined by Schneider, Gunnarson, and Niles-Jolly
(1994) as "broader patterns of an organization's mores, values and belief" (p. 18). In
this sense, the work culture serves as an overall philosophical umbrella which is
endorsed and transmitted primarily through the manager of the institution or the formal
policies. Grolnick (1988) proposed that, within psychiatric hospitals, the culture is
also determined by the attitude taken toward the cause or mental illness. Those who
view it as a biological-physical problem tend to be more focused on curing each patient
with medications. Their concern with the hospital community or environment will be
considerably less than health care providers who view mental illness os a social issue.
When viewed as a social issue, the camaraderie between staff members becomes an
integral part of creating a social environment in which patients are expected to get well.
The hospital becomes a microcosm of the larger society in which patients work out
their problems in preparation for their discharge back into their community. The
160
important point is that the degree to which work becomes either a depersonalized 8 to 5
job or an extended family experience depends upon factors such as the philosophical
approach toward the actual work being conducted, the manager's personal style, and
the formal policies that incorporate legal or economic mandates into the workplace.
The work culture is not the only factor that influences the work setting.
Schneiderct ol. (1994) also state that multiple work climates may exist within the
overall work culture. Work climate is defined os,
"the feeling in the air" one gets from walking around the
company. . . the atmosphere that employers perceive is
created in their organization by practices, procedures and
rewards. . . . [Work climates] arc not based on what
management, the company newsletter or the annual report
proclaim, (p. 18)
Employee perception is perhaps the most important concept in the above definition
because it is employees' perception about the organization's vision, practices, and
procedures that feeds into the work climate. Schneider ct ol. suggest that most of the
employees' interpretations happen through the "storytelling" that goes back and forth
between employees os they draw conclusions about office decisions, policies,
business events, and interactions. This storytelling is not simply an interpretation on
the part of the employees. Schneider cL ol. claim "the more employees talk about
management qualities, the more the qualities become the organization's characteristics"
(1994, p. 19). In this sense, the everyday chit-chat that goes on among employees
plays a vital part in developing the companies' unofficial policies, irrespective of what
may be outlined in detailed manuals.
Everyday chit-chat among employees is essential to the daily workings in many
ways beyond interpreting work philosophies and policies. Newcomers are often
integrated into the subtle workings of an organization through the conversations they
have with their peers as well os the more formal orientation given by supervisors
161
(Ostroff & Kazlovvski, 1992). Engaging in discussions with co-workcrs about non-
work-related issues or the positive aspects of one's job has been found to have a
stress-reducing effect on workers who were undergoing occupational strain. These
conversations serve as a buffer, providing social support, as employees work through
their problems or ease into the work place (Fcnlason & Beehr, 1994). Co-worker
support against sexual harassment is, at times, evoked when women feel powerless to
Fcspond in more effective ways (Bingham & Scherer, 1993), and gossip among co-
workers is one way that some disgruntled employees handle grievances (Tucker,
1993). The importance of this research is to demonstrate that co-workers' comments,
jokes, and interactions play a significant part in conveying subtle work policies,
offering support to newcomers, giving guidance to those who may feel harassed by
the work environment, and even a way for disgruntled workers to retaliate. These
types of interactions require that employees develop trust in each other by getting to
know each other on a semi-personal level. Employee relationships that do develop
contribute to the work climate.
In the end, notions of work culture and work climate further supports the fact
that interactions between co-workcrs arc integral to the work place. Often these
interactions move beyond work subjects and into private lives or personal
philosophies. Again, as I demonstrated in Chapter 1, a person's lesbian orientation
can influence what she docs with her time os well as her outlook on life and thus what
she might share with co-workers, if it were not prohibited. Hesitancy to share may
preclude the ability to build the needed trust with co-workers, trust that becomes vital
in easing one's way into a company, understanding the subtle messages behind the
formal press releases, or dealing with job uncertainties before they escalate into
unmanageable situations. Thus, being silent at work under the pretense of keeping
one's private affairs at home may ultimately be disadvantageous for that individual.
162
Heterosexism in Occupational Therapy Clinics:
Destructive or Constructive Climates
Like corporate Americans, the occupational therapists interviewed found their
work environments to be overwhelmingly hctcroscxisL The hctcroscxisl attitudes
toward lesbians, gays, and bisexuals expressed by medical professionals and patients
became a type of background noise or static to the everyday workings of the
occupational therapy clinics. Sometimes that noise was overbearing in its presence,
grating on the therapists' nerves like the constant scratching of a chalkboard with sharp
fingernails. Other times, the noise was hardly recognizable os a low level hum of
which one is aware but which requires deliberate concentration to actually identify. It
remains unnoticed for the most part, and when it consciously surfaces it is perceived
simply os a gentle annoyance.
In the following section, I will take a detailed look at how hctcroscxism
influences the work experiences of lesbian occupational therapists. I will do this, first,
by specifying the various ways in which this background noise, or hctcroscxisl work
climate as it will be referred to it in the future, was maintained within occupational
therapy clinics and hospitals. My discussion will extend beyond the occupational
therapy clinic because occupational therapists work as members ol* teams, and thus arc
affected by the attitudes and interactions of other hospital personnel. Although
heterosexism is pervasive in hospitals, how it actually affects the day-to-day
experiences of the therapists os well as their lifelong careers differs. Thus, in the
second part of this section, I will discuss the situations in which therapists suffered
severe consequences due to the overbearing presence or heterosexism. Specifically 1
will outline four forms of harassment that therapists encountered. It would be
misleading, though, to present only the harassment that therapists felt about being
lesbian. Many therapists were comfortable in their work settings. Thus, in the final
163
section I will discuss how work climates can be nurturing to lesbian therapists despite
the unrelenting hum or hctcrosexism.
Heterosexual Climates: The Background Noise
Conversations, debates, anecdotal stories, jokes, and greetings take place
between therapists, staff, and patients throughout the work day. The content of this
everyday work chit-chat or informal talk to some degree reflects the protocols and
policies of the institution os well os the altitudes, values, and interests of the
individuals. In other words, people disclose information about their lives and shore
their opinions with one another even in the minor conversations that they may make
prior to a meeting or waiting in line at the cafeteria. For the most part, this sharing
docs not occur in a calculated, conscious way but rather an individual's world view is
expressed in an unccnsorcd manner through the content of, and the emotion
underlying, their comments or stories. The lesbians in this study, both those who
were therapists and those who were patients, were especially adept at figuring out the
attitudes and agendas of the various hospital personnel and the policies of the
institution with respect to homosexuality through the nuances of everyday hospital
discourse. For the most part, the respondents in this study claimed that heterosexual
climates pervaded medical arenas. Furthermore, the environments were maintained
and nurtured through everyday work chit-chat. Heterosexual climates were maintained
through heterosexual discourse; homophobic comments; assumed heterosexuality; and
perceived stereotypes.
Heterosexual discourse. Heterosexual discourse primarily refers to the types
of verbal interactions that either state overtly, or imply subtly, one's heterosexuality,
or that imply one's acceptance of heterosexuality as the natural way of being. The
164
prevalence of heterosexual discourse in occupational therapy departments is, in part,
due to the fact that everyday hospital or clinic talk occurs within a larger social context
or pervasive heterosexuality. For the most part, people arc not consciously aware of
how a heterosexual world view influences their interpretation of everyday situations.
For example, when a woman announces her engagement, the question "Who's the
lucky man?" comes to mind far quicker than "Who's the lucky woman?" unless she
has prefaced this announcement with the fact that she's lesbian or bisexual. Similarly,
a likely interpretation of two unmarried female co-workcrs vacationing together is that
they ore friends with similar interests, and that they would probably be with
boyfriends or husbands if they were available. In both of these examples, the
common cultural understanding of marriage and family emerges from a heterosexual
consciousness. Jerome Bruner (1990) claims that the "ordinary" nature of such
interpretations and conversation can be explained by the fact that they ate part of the
"canonical world of culture" (p. 52). As individuals go about their day interacting
with others in the public and home spheres, their behaviors and conversations, for the
most part, appear to be typical, takcn-for-grantcd ways of relating and carrying out
business. Such events and interactions do not provoke questions os to why they
occur, because they fit into the individual's canonical scheme about human existence
(Bruner, 1990).
Monique Wittig (1992) analyzes heterosexual consciousness in her essay The
Straight Mind. She points out that the "obligatory social relationship between 'man'
and 'woman'" (p. 27) is an inescapable concept that infuses both scientific research
and theorizing, therapeutic practices, and the categories of language used in everyday
communication. She states that
the straight mind develops a totalizing interpretation of history,
social reality, culture, language, and all the subjective
phenomenon at the same time. I can only underline the
165
oppressive character that the straight mind is clothed in in its
tendency to immediately universalize its production of concepts
into general laws which claim to hold true for all societies, all
epochs, alt individuals, (p. 27)
She further states,
The consequence of this tendency toward universality is that
the straight mind cannot conceive of a culture, a society where
heterosexuality would not order not only all human
relationships but also its very production of concepts and all
the processes which escape consciousness as well. (p. 28)
In this sense, Wittig claims that heterosexual discourse frames the way people think
and interpret their world. To this end, such discourses become oppressive to
homosexuals "in the sense that they prevent us from speaking unless we speak in their
terms" (Wittig, 1992, p. 25). The following discussion illustrates three ways that
heterosexual discourse frames the interpersonal interaction in occupational therapy
clinics and thus promotes a climate that marginalizes lesbians, gay men and bisexuals.
First, the topics that arise within clinics often express heterosexual world
views. Discussions of topics pertaining to boyfriends or girlfriends, marriages, and
children constitute a kind of press release about one's heterosexuality, while those
addressing family vacations, vacationing in-laws, home decoration, division of
household labor, and/or gardening embody less obvious heterosexual themes. For
example, in some occupational clinics, announcements about approaching marriages
were usually greeted with excitement and discussions about caterers, ceremony rituals,
wedding attire, and family opinions served as one focus of lunches and breaks in the
months preceding the event Likewise, pregnancy and birth often evoked at least 6
months of questions from concerned co-workers about the woman's health, the baby's
room, or maternity or paternity leaves. Discussions about where and with whom to
spend vacations or about the perils and joys of visiting in-laws also evoke concerned
responses.
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Weston (1991) refers to this kind of discourse when she explains that, "while
sex may not be an cvciyday topic of discussion in settings like the workplace, schools,
churches and synagogues, references to kinship arc omnipresent" (p. 67). As she
pointed out, it is in reference to kinship or relationships that heterosexual identity is
most often disclosed. Sexual orientation is quite naturally implied in conversations
regarding the above or similar topics because these subjects ultimately address issues
of relationships. In fact, most of the participants admitted that few heterosexual co-
workers spoke in ways that did not readily and almost subconsciously disclose their
sexual orientation through heterosexual discourse. Although heterosexual discourse
served to reveal heterosexual orientation, it also was a signal that heterosexuality was
the normal and expected framework from which people would interpret the clinic
conversations.
One could accurately argue that topics such as children, marriage, in-laws, and
vacations arc not exclusively heterosexual. More and more lesbian couples and gay
couples arc having or adopting children. Formal commitment ceremonies and, in this
sense, marriages arc being conducted by some synagogues and churches, although
they arc not legally binding. Consequently, family vacations or in-law visits can be
with same-scxcd partners. Although this is true, the typical clinic dialogue around
these issues stemmed from a heterosexual perspective, contributing to what is called
the heterosexual climate. For example, during the interviews, Marie talked at length
about the difficulty her aunts and uncles had had with her announcement that she was
now engaged to her partner. Her relatives claimed that attending a wedding ceremony
would indicate they approved of homosexuality. They made it quite clear that
homosexuality was not endorsed by the Bible and that such a ceremony was a betrayal
of God's plan. For Marie, the acceptance of her and her partner as a lesbian couple by
family and friends became one of the most important issues in the early planning of the
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wedding. Similarly, Linda said that an important decision in her wedding plans was to
exclude family and co-workcrs from the ceremony but to include them in the reception.
In doing so, she could feel comfortable touching and kissing her partner during the
ceremony without offending anybody and still have the people she eared about
celebrate with her. In both of these situations, if Marie and Linda had talked about
their wedding plans, the conversations would have entailed issues that would have
departed from the typical heterosexual wedding discussions in the clinic, at least not
the ones that the participants of this study overheard. Thus, although weddings arc
not exclusively heterosexual, the clinic discourse surrounding the topic is restricted to
a heterosexual perspective.
Lesbian childbearing would also challenge the heterosexual discourse on
childbearing. For example, in the process of having children, lesbian couples decide
whether to use sperm from sperm banks, a relative of one's partner, or a gay mole
friend. Additionally, who will give birth to the child, or how to arrange adoption by
the second mother become important considerations. Connie and her partner, Pat,
talked readily about these questions when discussing their plans for having children
during the interview; yet Connie claimed that she refrained from discussing these
issues with co-workers because they did not fit the discourse surrounding heterosexual
childbearing. These examples ore not meant to imply that topics in common, which
would bring the marriage or childbearing experiences of lesbians and heterosexuals
together, do not exist. On the contrary, there are an abundance of shared concerns.
These examples suggest that important aspects of marriage and childbearing that relate
specifically to lesbians are not found in the "ordinary" stories of marriage and
childbearing that emerge around the lunch table or during other informal conversation
in occupational therapy clinics. This absence contributes to the sense that a
heterosexual perspective is the norm and the only respectable option.
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The second parameter or heterosexual discourse is its emotional tone. June
expressed this in the statement, "It relates to the ease with which heterosexual people
talk about their daily lives and how homosexual people have to kind of wonder how
docs this fit and whatever." Dates, marriages, births, vacations, and home decorations
arc often discussed by heterosexuals with the assumption that all people in the clinic
view heterosexuality as normal, acceptable, and worth celebrating through sharing.
As June stated, there was a certain ease which came from an expected appreciation and
understanding of the topic.
The following story speaks to the notion of shared understanding and how
hesitancy on the part of lesbians can be reinforced by the responses they receive when
they risk sharing. Marie related that one day, in between patients, two of her co-
workers (Peg and Sharon) were complaining that their husbands were not even
remotely cognizant about how much work it takes them to keep the house running.
Relating to their experiences, Marie chimed in, recalling that Diane, her previous
partner, was also clueless about the time it took to do the laundry and go to the market,
etc. However, instead of receiving approving nods from Peg and Sharon, Marie
stated, "They kind of both looked at me. I don't know, they looked a bit bewildered
like, oh how docs that apply. You know what I mean, they couldn't like figure it out."
In this story it was obvious that Marie's co-workers did not grasp how her life
experience fit theirs. This incongrucncy, I suspect, stemmed from the fact that Sharon
and Peg were talking about stereotypical behaviors that they assumed were inherently
mole. Marie's comment pointed to the fact that these behaviors could be and were also
female. Sharon's and Peg's bewilderment emerged from a collision of heterosexual
and homosexual world views. But the story also points to the fact that Sharon and
Peg could easily commiserate with each other about similar household problems.
They expected a certain degree of mutual understanding between them and the fact that
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they received it again reaffirmed that the anecdotes they were discussing were normal,
experienced by everybody, kinds of things. Although, in this instance, Marie readily
jumped into the conversation offering her support through a similar incident; she was
confronted with the reality that shared understanding did not exist and was left with a
reminder that lesbian experiences can be intciprctcd as not fitting within heterosexual
discourse. It was interesting that later in the interview, Marie commented that when
Sharon talked about the fact that her husband helped her through school by
proofreading all her papers, she declined to share that Diane had done the same for
her.
Finally, the constraints of heterosexual discourse were also defined by what
was omitted from the clinic conversations, that is, topics that were not readily talked
about in the clinic because heterosexual co-workcrs did not possess the background
knowledge to discuss them. For example, one day Marie was expressing to Sharon, a
co-worker, her relief that the technology workshop to be held at their facility had been
scheduled in early June. She stated, "Oh, good, because I may be going to New York
in June for the National Gay and Lesbian Health Conference and you know they arc
having the gay gomes and stuff." Sharon's response was simply, "I didn't know they
had all that." When reflecting on the situation, Marie commented, "Well, people can't
even fathom it, I don't think. National Gay and Lesbian Health Conference. That
would be like, what's that What could that possibly be about?"
If Marie's co-workcrs were lesbians, gay, or bisexual occupational therapists,
the Gay Games, the 1994 Commemorative Celebration of Stonewall, and the National
Health Conference would, more than likely, be recognized as exciting events with
historical significance. The conversation would probably flourish around questions
about where she was going to stay or which sessions she was going to attend at the
Conference. Co-workers might have reciprocated, talking about their own experiences
170
when they went to local gay pride parades or the National March on Washington. In
Marie's situation, none of this occurred. Marie felt comfortable to be out around this
co-worker, experienced a lot of support from her, and considered her to be a good
friend. Regardless of how well meaning Sharon may have been, it appeared that she
simply did not have the background knowledge to engage Marie in a conversation
about the National Qay and Lesbian Health Conference or even to show her support
by asking a question, thereby prompting Marie to further the conversation. It is also
possible that she did not understand the symbolic significance of this event in Marie's
life, and thus did not see it as a particularly important issue to pursue. Regardless of
the reason, the discussion around this event, which was imbued with lesbian
significance, came to a screeching halt There wasn't a place for it in the
predominantly heterosexual discourse of this clinic.
Homophobic comments. The second way in which a heterosexual climate was
maintained within the hospital was through homophobic comments. Jokes or
derogatory comments about gays, lesbians, and bisexuals were often heard on the
wards of the hospitals, in charting rooms, around the nurses stations, or during team
meetings. The participants in this study indicated that they were less likely to occur
between occupational therapists themselves, although a few incidents during treatment
sessions were noted. This is not to say that the participants felt that the occupational
therapy profession was any less heterosexist than other health care professions. One
participant commented that she was outraged at the negative attitudes about gays,
lesbians, and bisexuals that were expressed in the editorial responses to the formation
of the Network for Lesbian, Gay, and Bisexual Concerns in Occupational Therapy
(Grimm, 1992; Weaver, 1992). Two other participants related that occupational
therapists in their clinics were either offended or insulted by my letter requesting
participants for this study. Thus, hclcroscxism exists within the profession, but in the
i.
clinics it was usually manifested as heterosexual discourse, assumed heterosexuality,
and perceived stereotypes.
Degrading jokes or comments were perceived by the respondents as quite
damaging and often a strong indicator of homophobia. Jenna talked about the
difficulty lesbian patients had in building rapport with the nursing staff in one
psychiatric hospital at which she was employed. She stated,
Most of the time it was a situation where they [patients]
couldn't build rapport with the nursing staff because most of
the staff were homophobic, they would joke about, you know,
that fag there, and this dyke there, you know, and 1 knew that
they [patients] were probably hitting a brick wall when it came
to finding staff that they could open up to.
Homophobic comments were not only detrimental to patients' relationships with health
care personnel but, when openly stated around the nurses' station, they also influenced
patients' relationships with one another. Jenna recalled that the patients' responses to
other patients who were lesbian, gay, or bisexual mimicked the staffs responses.
They would tend to follow the staffs lead; if the staff projected
that they felt uncomfortable, then they would too. . . Yes, it's
very damaging. In fact, this one person [referring to a patient
who was lesbian] that attempted suicide I remember, people
didn't want to share a room with her because they overheard
rumors by the nurses that she was lesbian.
Derogatory comments that were heard directly by patients or directly disrupted
the patients' core were the most harmful incidences reported in this study. On the
other hand, therapists also noted that jokes and comments about gay and lesbian
patients occasionally occurred in team meetings. On the surface, it appeared that these
snickers and side comments were simply to relieve uncomfortable tension among team
members; however, they also provided a clear message that making fun of gays and
lesbians was tolerated in that group. Monica pointed out that, in the private hospital
where she works, homophobic comments at team meetings were not equally projected
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onto all groups of gays, lesbians, or bisexuals. Which homosexuals were targeted for
backhanded comments reflected a classist attitude on the part of hospital personnel.
She stated,
we had a very, sort of prominent fellow, who was here and
was gay. And you know, he was a big muckity muck. So
then it was kind of elegant. . . then it was, oh and his partner
is doing this and we're going here and he's going to drive the
BMW. . . . And then it was just kind of cool. You know, it
was sort of like having a gay hairdresser or ballet dancer, you
know, then it's kind of cool but, and he's a VIP. But other
than that, the everyday, gay-schmoe,. . . It's not as
understood, or there's not as many accommodations made or
people aren't as eager to find out those dynamics of families.
In Monica's hospital, the behaviors of upper and middle-class gay men were
considered chic and were accommodated, yet homophobic attitudes were still present
with reference to working class or poor guy moles. It is important to mention that it is
not uncommon in some private hospitals for classist altitudes to prevail.
Heterosexuals, as well as lesbians, gays, and bisexuals can be treated differently
depending on their job status. A judge, senator, or physician may receive preferential
treatment when compared to a truck driver or waiter. However, the homosexuality of
lesbians and gays could potentially distort any respect they may otherwise receive from
their association with a particular job status. When health core providers treat upper to
middle-class gay men with greater Fcspect than they afford the working class or poor
gay man, it is dangerous to assume that (he hospital environment is gay-friendly.
Such behavior merely demonstrates that, like the heterosexual population, people from
certain classes are afforded more privilege than people from other classes.
Beyond issues dealing with patient care, the heterosexist attitudes of health care
professionals toward their lesbian co-workers were often delivered in derogatory
conversations that were conveniently overheard by others. For example, a lesbian
nurse, Nancy, decided to take a personal holiday to celebrate her anniversary with her
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partner. Cathy, the occupational therapist, stated that, during a break, two other
nurses began lo treat Nancy's anniversary celebration as a joke, making comments
like, "Give me a break" and "Can you believe that she had to leave and do that?” The
attitude that a lesbian relationships ane not deserving of the same celebration as
heterosexual relationships was dearly transmitted. Likewise, Jenna, who is bisexual,
shared that although her staff stuck by her during a particularly difficult break-up with
her lesbian partner, "They were very relieved when I got marricd [lo a man]. Like oh,
she's normal again.” In a world that privileges couples over single individuals,
marriage may be seen os normalizing, but even Jenna agreed that the fact that she was
marrying a man contributed to her co-workers' notions of normal. Furthermore,
norma] clinic scripts about marriage relieve co-worker's uneasiness because they arc
the canonical. Co-workers'can go about their day unchallenged in their discourse
around comfortable stereotypes about human relationships. Once again, heterosexual
discourse prevails, allowing some people to feel at ease yet thwarting valuable
education.
Assumed heterosexuality Monica summed up the feelings of most therapists,
especially those who were closeted, about the prevalence of assumed heterosexuality
in the hospital when she stated, "Yeah, that's a daily thing. It is just accepted os part
of life. 1 mean that's really daily." In this sense, the occupational therapy work place
is merely a microcosm of socicty-at-Iarge where people are assumed to be heterosexual
unless otherwise stated. The following comments exemplify three ways that assumed
heterosexuality was expressed in the statements of hospital personnel.
In discussing her co-worker's perceptions of her, Monica commented, "They
think my lost relationship was with a male. I never denied it, said it was a female, so
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they think it was a male. You know, people arc always trying to fix me up." Sara
also shared.
Like this week, one of the dietary supervisors comes up and he
goes urn, and t guess 1 didn't have the ring on then, and he
said, "Well, so you're married" and rather he said, "So you're
not married". And the activities person that is right there just
kind or hones in and she said, "Con you believe it, she's
single, I can't believe she's single”. And I said, Welt if you're
not outwardly married, it doesn't mean you're not with
someone, you're not committed.
Finally, Marie recalled,
But I went to have my picture taken [for a hospital
identification card) and that's right he said, "Now smile".
That's right, he said "Pretend like you're smiling Tor your
boyfriend,” and then he said, I can't remember, "See how that
picture came out better when I told you to smile for your
boy friend."
The statements above demonstrate, first, how being coupled is falsely assumed to be
universally desired, and, second, how being coupled is expected to be heterosexual.
Furthermore, os some therapists pointed out, although assumed heterosexuality is
most potent when a question is pointed directly at their personal lives (the first two
examples), it is just os annoying when presented by a stranger in the form of a joke
(the third example).
When assumed heterosexuality occurs within the work place, it puts therapists
who arc lesbian, gay, or bisexual in an uncomfortable position. Therapists who ate
not out and feel they cannot respond to such comments are at particular nsk for feeling
ill at ease. In two situations, participants in this study talked about times in which their
co-workers confided in them about their troubles with lesbian and gay lifestyles. One
woman quite nonchalantly suited to Monica, "You know, I don't mind gay men but
that lesbian stuff, I just couldn't handle it." Likewise, an employee told Jenna that a
good friend of hers was lesbian, and that quite frankly, she hod "trouble understanding
that whole life style. . . . I don't see how she can do it, what's in it for her." Both
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Jenna and Monica were able to manage these situations. They understood the
intentions underlying these comments. Jenna even took the opportunity this
interchange offered to educate her friend, staling, "Well, you know, some people get it
from being with a guy, other people get it from being with a woman. There's no right
or wrong." These two events happened because co-workcrs assumed that Jenna and
Monica were heterosexual. It appears that their heterosexual world view did not
permit them lo question the sexual orientation of Jenna or Monica. Similar situations
also happen to and create tension for patients. For example, Marie was working with
a man, James, who, according to her, had no outward signs of being gay or
heterosexual. One day another patient, Ken, who was particularly talkative, quite
intrusively quizzed James as lo his marital status. When Ken left, James slated,
"Don't you just have friends like that, that open their mouth and slick their foot right
in." In this situation, James expressed his annoyance at the inappropriatcncss of
Ken's queries, queries that more than likely came from Ken's assumptions of the
normality or heterosexual couples.
Perceived stereotypes. Stereotyping or negative symbolism, as Warren
Blumcnfcld (1992) defined it, was the fourth factor that contributed to u heterosexual
environment in the hospitals. Patients and other therapists were most often
stereotyped as gay or dykes by their dress, mannerism, single status, silence about
dates, or the friends who came to visit them. Jenna stated, "The nursing staff would
pretty quickly stereotype somebody just by their mannerisms and their dress and by
what little they learned from their own interviews. Or you know, watch for the
visitors that came to see that person and tag them." Cathy also spoke about quickly
slipping into the back charting area when she noticed two lesbians, whom she had
briefly met before, visit a patient. Realizing that nurses and therapists do notice and
176
stereotype visitors, and that these two particular visitors might easily approach her to
say Hi, Cathy's immediate escape avoided what might have been an unwanted outing.
In addition to stereotyping an individual as gay or lesbian, therapists and health
care personnel stereotyped behaviors os to whether or not they were appropriate. The
example given above about two nurses condemning their co-worker's request for time
off to celebrate her anniversary is one situation in which behavior was stereotyped.
Another example pertained to a gay man who kept the flowers he received from his
partner on his desk at work. When Connie relayed this story she stated that, "Some of
the women there were very appalled that he was showing off that he got flowers. . .
one lady started saying why is he flaunting," even though, when heterosexuals receive
flowers at work, the response is usually, "Ooh, who received (lowers at work." As
was described in the introduction, similar behavior is interpreted differently for
heterosexuals and homosexuals. The heterosexual who receives (lowers at work is
teased in an envious manner indicating that he or she is perceived as special. The gay
man is stereotypically labeled as flaunting indicating that he is inappropriate.
Therapists' concerns about being stereotyped went beyond their fears that they
would be found out or that people might talk behind their backs. Perhaps this is
because most of the participants who remained closeted felt that their co-workcrs
assumed they were heterosexual. On the other hand, they were concerned with how it
might influence patient treatments. One woman stated that she is always careful to
moke sure that her female patients are physically covered during dressing training.
Likewise, when treating a child, she informs parents if she needs to undress the child.
A physical therapist commented that it was important that she not disclose her lesbian
identity because massages are one form of treatment that occurs in acute physical
therapy. These therapists ore well aware of the stereotypes about lesbians, that is, that
they are child molesters, crave sex, and try to seduce some heterosexual women.
177
Their actions become self-protecting. As one therapist stated, she self-protects
«,
"Because 1 don't want the therapist who doesn't know about me to come back to me
and say 'Well no wonder why this woman had this, her clothes olT this certain period
of time.'"
In summary, it is obvious from the reports of the women in this study that the
private lives, including heterosexual orientation, of health care professionals enter into
many aspects of their hospital work. Lunch table conversations, comments at
business meetings, and even the small talk that accompanies the process of acquiring
on identification photograph are (hctcro)scxualizcd. The lesbian therapists who
participated in this study were continually bombarded with messages that, in their
particular institution, heterosexuality was the normative framework from which people
thought and acted. These messages about heterosexual privilege, whether they came
in the form of hctcroscxist discourse, homophobic comments, assumed
heterosexuality, or perceived stereotypes, were integral to the women's work culture
and climate. They were also present in more formal and complex ways at team
meetings where the physicians who represent leadership presided. And they were
present in the informal chats around the nursing stations, or the one-line comments
about flowers that sit on a co-worker's desk. To many therapists, the messages went
unnoticed and at times were meant as humorous jokes to bridge communication
between two people. But in the end, they provided strong indications that
helcrosexism prevailed in those environments. Perhaps most damaging were the
severe repercussions they had on patients who were confronted with hcterosexist
attitudes of those health care providers who were presumed to be helping them. (This
will be referred to in greater depth later in this chapter.)
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Harassment
Heterosexual climates provide daily confirmation lo all people involved that
homosexuality is marginal, something to be tolerated when it feels palatable to do so,
but certainly not part of the canonical narratives. For some lesbian therapists, these
hcteroscxist environments had a tenable quality. Although the messages about the
marginalily of homosexuality were reasonably controlled and allowed the therapists to
carry out their daily job responsibilities, the environment also had an explosive side,
moving beyond controlled boundaries into what some therapists labeled as outright
harassment Five of the ten of the occupational therapists in this study either
experienced or watched another lesbian endure some type of overt attack on their
pcrsonhood stemming from their lesbian identity. For them, harassing situations
differed in intensity from the spreading of rumors, lo projects being sabotaged, to
threats of termination, and finally, to being denied job advancements. In the following
section, I will present four situations that portray different types of harassment. In this
sense, harassment refers to being pestered or bothered by a person in authority
because of one's sexual orientation.
Rumors. Sara, an occupational therapist, and Amic, a psychiatric nurse, met at
their first job when they worked together as a team with adults who had schizophrenia.
Initially, neither of them realized that she or that the other was lesbian, and thus it took
a few years for their close friendship to develop into a partner relationship. For the
entire time that they worked at this facility, they were very dedicated therapists, often
spending time together planning patient programs or writing notes. Neither of them
thought twice about taking work home on the weekends or using their lunch time
break os an escape to a nearby restaurant to discuss their treatments. They prided
themselves on the fact that their patients received very thoughtful, interdisciplinary
179
care. Yet, it was the time they spent together preparing good co-treatments for their
patients that ultimately created the problem. In a sense, their approach to patient care
went beyond the boundaries of that particular hospital, in which team work was
encouraged but not to the degree that they hod perfected it. The fact that they spent
more time together than any other teams sparked the initial rumor about their
relationship. At first they were simply met with comments such as "Oh you're
together again." But soon they were approached by a psychiatric technician, who, in a
supposedly friendly manner, stated, "I just want you to know that some people in the
area are questioning your sexuality. . . Well, 1 just wonted you to know there arc a
couple of therapists, you know, that I overheard talking about that." The rumors were
devastating. As they both stated, "And it was real upsetting, I mean we left and I just
fell like, my God, you know, it's the reality sets in that there is that kind of, in a
hurtful way, where people just have nothing belter to do. . . . We just wanted to
cry."
The hospital culture in which this incident took place subscribes to ideologies
that are deeply embedded in a hierarchical bureaucracy. During a casual conversation
with a supervisor at that facility, who was not privy to the fact that 1 was interviewing
a past therapist, I was informed that homosexuality was never on issue at their
hospital, discrimination did not occur, and there would be no reason for one to ever
state that she was lesbian because one never knows what will happen with
promotions. Her statement indicates that strict silence is the "appropriate" way to
handle one's sexual orientation. To this extent Sara and Ami adhered to the unstated,
yet strongly endorsed, rules of that institution. On the other hand, their behaviors,
primarily spending so much time together, begun to fall slightly lo the edge of what
some people deem appropriate, and thus revealed their secret. This alone would not
have created enough tension to instigate such a cruel response on the part of the
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technician. In hierarchical business such as this particular hospital, the lower an
individual is on the administrative chart, the less perceived and actual control that
individual possesses. The hierarchy of bosses one would have to wade through to get
to the top supervisor with a request or complaint is foreboding. Tucker (1993) claims
that rumors can serve as a form of retaliation against hardships at work when
employees perceive no other outlet. Along the same lines, Sara and Ami suggested
that hospital rumors were one area over which the technicians claimed control when
they felt hardship, in general, due to their job condition or their low position in a
hierarchical work environment. Given that the hcteroscxist environment at that
hospital is strongly embedded in the status quo, Sara and Ami were ripe victims for the
rumor mill when the technician fell a need to do so. On the other hand, because they
had conscientiously adhered to what they considered were strict professional
guidelines and only acted in the best interests of their patients, they were horrified that
such rumors spread.
Sabotage. Arlene told a story about one of her first jobs where she was
working with adults who had brain injuries. Even though she was a relatively new
therapist, Arlene was quick-minded and cosily integrated new information into her
repertoire of therapeutic skills. Her supervisor acknowledged the fact that Arlene was
superior to many new graduates and when an opportunity to deliver a paper at a
conference arose, she chose Arlene to represent occupational therapy. After much
thought, Arlene decided that behavior management of patients who ore in a suite of
agitated confusion following a head trauma would be a topic that was not only
appealing to her but also one of the more challenging aspects of her present clinical
work. Realizing that this topic overlapped with what the social worker, Rene, might
181
have to offer the conference, she conscientiously checked it out with her and was met
with both emotional and practical support in the form of articles and wcll-wishes.
Arlene spent the next 4 months developing the presentation while she was
carrying out her duties of treating patients and supervising a student Shortly before
the conference, on two separate occasions, the student whom she was supervising and
the physician who was the head of the head trauma department warned her that the
social worker was talking angrily behind her back, claiming that she was ill-prepared
to speak at this conference in general, and specifically about this topic. These rumors,
which were flourishing around the occupational therapy and the head trauma ‘
department, unbeknownst to Arlene, began to sabotage the project and undermine her
relationship with her boss and co-workcrs. To some extent the warning was no
surprise to Arlene; she had begun to feel that the social worker as well os other team
members were distancing themselves from her. Even though she was upset by this
information, Arlene was somewhat relieved that her feelings of paranoia had a concrete
basis.
An interesting piece of background information to this story was that a physical
therapist had had a similar problem with that social worker and like Arlene, the
physical therapist did not dress or wear her hair in what would be considered a
traditionally feminine style. Arlene found out later that the social worker had often
been "troubled” by both of them. To this end, Arlene slated,
And 1 can't say that all of that happened because I'm gay. I
think the only way that 1 could define why I may have been
scapegoated in that situation is that I may have been an easy
target because I have always been different than the other
females who work there. And that [when] people arc dealing
with stress and they don't feel like they ore getting recognized
enough and there's this wall and there's me as part of that
wall, but that, that stone looks a little weaker or different. So
you're going to go right in there with a punch and I feel like
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that's exactly what happened and I can't couch it as lesbianism
or whatever but I can couch it as someone who presents as
being different, who doesn't obey all the norms as in dress and
hair.
As Arlene began to piece together the story, the fact that she stood out as
different became a significant theme that influenced her interpretation of the situation.
Her dress, her mannerisms, and her inability to engage in the lunch table talk of
boyfriends and weddings that ultimately bonded co-workcrs, placed her on the fringe,
but not by any means outside, of the occupational therapy clinic. She was important to
the inner workings of the clinic and as long as the clinic was running smoothly, her
difference did not evolve into a noticeable community problem, although internally she
hod always been troubled by feelings of being different. Yet, as Arlene stated, it is
highly likely that her vulnerability to scapegoating when the system was shoved out of
kilter was grounded in her difference. Being lesbian was not the reason that Arlene's
project was being sabotaged, but it was one reason, and perhaps the factor that tipped
the scale of anger on the part of the social worker and drove her to begin backstabbing.
Not having a strong support system within her clinic, again, because she was
perceived as different, contributed to the process by allowing the rumors to flourish
without interception from friends or even a reasonable confrontation.
Threat of termination. Linda was a young, and in her words, "radical" lesbian
occupational therapist. She used the term radical to denote that, at that time in her life,
she openly talked about being lesbian whenever the chance arose. Linda related the
following story of how she was targeted for termination. She recalled.
And then there was a situation where I had, I mean it took me a
long lime to figure out how it all cume about, but I ended up
getting called into John's, my director's office. I was given a
letter which outlined different complaints. . . this complaint,
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lhai complaint, then; were general complaints and the last thing
was about the Tact that, my lifestyle, I wasn't to discuss my
lifestyle.
Linda continued, staling that the letter required her to participate in monthly behavioral
counseling sessions with her boss to rectify the problems. Although Linda
acknowledged that during those meetings, she did indirectly gain skills about self-
presentation, for the most part, the accusations and meetings were "pure bunk." Linda
was never fired. In fact, as she stated.
What ended up happening is that the president at that hospital
left, I ended up with a whole new administration, t ended up
with a new boss. . . they weren't happy with John's
performance. . . he ended up being moved inside, offered a
position as a staff therapist, and I was moved up. So I've
always fell vindicated in that 1 outlasted the people that tried lo
terminate me.
Outlasting the people who attempted to terminate her was not the only way she was
vindicated. Upon learning about the situation, her new boss removed the original
complaint letter from her flics, handed it to her, and apologized profusely that the
incident had ever occurred. His action reconfirmed that this incident was pure bunk,
and more than likely, related predominantly to her being lesbian.
Linda's story clearly portrays the a fear of many lesbians, namely that being
out at work eventually could lead to their termination. More importantly though,
Linda's story points to the underhanded way that terminations can be handled. As one
therapist participant who is in management conveyed, the management can always find
a reason for terminating someone if it is their intention to do so. People make mistakes
at work and, whether these mistakes arc overlooked, addressed gently, or interpreted
as major infractions con, in some situations, depend upon intangible issues such os
how well the person fits in with their co-workers or bosses, their personality style, or
the moral judgments imposed by co-workers and bosses upon the action. Linda
admitted that some of the accusations probably fit. She was young and her style of
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communication was a bit brash. However, it could easily be argued that what
appeared as number ten on the list of concerns, that is, she was openly lesbian, was
the underlying reason that issues such as communication style were constructed as
grounds for termination.
The class ceiling. Leah has reached a prestigious position in the company for
which she works, in fact the highest management position a women has ever attained
in that company's history. Although she is out to her immediate bosses and one or
two other employees, she has maintained the position that being lesbian is not a work
issue. Thus, even around those who know, conversations rarely addressed this aspect
of her life. As part of her job responsibilities, Leah supervises a number of
occupational therapy and physical therapy supervisors, who, in turn, manage different
treatment sites. Naomi, a lesbian, is one of the physical therapists whom Leah
oversees. Naomi takes a different approach to being lesbian in the work place. As
Leah explained T his particular person promised herself that she would not, promised
herself that she would be who she was and she'd live with all those consequences.
She would not be a fake. She would be true to who she was." To this end, Naomi
talks about typical conversation topics engaged in by many heterosexuals: her partner,
their home together, and shared vacations. She occasionally makes comments
reflecting a lesbian perspective. Naomi doesn't wear make-up, shave her legs, or
wear nylons, all choices that she relates to her lesbian identity. According to Leah,
Naomi's expression of her lesbian identity always occurs in a very appropriate and
professional manner.
Naomi's job performance is excellent. As Leah stated," [she is] doing a
wonderful, doing an awesome job in facilities." She has demonstrated constant
loyalty to the company. When one of the company's facilities outside her territory was
185
failing, she moved 300 miles away from her partner and lived in a hotel room for
seven months while successfully redesigning the therapy department and saving the
company from a large financial toss. Furthermore, Naomi has become an expert in
giving conferences. Course evaluations indicate that she is organized, informative,
and quite endearing to the audience.
Her performance notwithstanding, Naomi has been overlooked when job
advancement opportunities arose. To exemplify this, Leah described a specific
situation in which the company needed a consultant, Naomi had all the skills to
perform the job and, as mentioned above, had demonstrated these skills both when she
saved a physical therapy department from financial demise, and through the many
educational conferences which she has given. Moreover, the facilities she oversees
were well staffed and running smoothly, which would allow Naomi the freedom to be
away while she consulted with other facility administrators. Although Leah informed
her boss that Naomi would be an excellent candidate for the position, no decision was
ever made. The position remained open until one evening at an all-company meeting,
Linda, an occupational therapist whom Leah also supervises, approached the boss
and, during a conversation about their families and vocations, nonchalantly stated that
she would love to do consulting for the new facilities. The bosses decided to give her
the position.
As the supervisor of Naomi and Linda, Leah knew the strengths and work
loads of both. Linda was also a good therapist, able to perform the task but she was
no belter than Naomi. In addition, for Linda, traveling would be an extra burden to
her work load which was already stressed by the staff changes that were occurring at
the facilities for which she was responsible. There was no doubt in Leah's mind that
Linda was chosen because she fit the port. She presented herself os a heterosexual,
married woman, an image that signified normality for this very conservative company.
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This situation is particularly interesting because it is portrayed from the
perspective of a third parly, a person who is well aware of how helcroscxism is played
out in the work place. Leah is able to assess the skills and work loads of both
individuals. She also has insight into the expectations of the bosses, the subtle ways
that heterosexuality and a particular form of heterosexuality for women (make-up,
nylons, dresses, comments about boyfriends, or marriage) is preferred, although
homosexuality is tolerated. From her perspective, it is clear that, in this situation,
sexual orientation played a key factor in who was given the consulting position. As
Leah stated, "Because she's [Naomi's] very out, she's dearly out, she's got a glass
ceiling that's about a foot tall."
By comparing the situation of Leah and Naomi, both of whom arc lesbian and
work for the same company, the parameters of homosexual tolerance in this company
can be fleshed o u l Leah made it to the lop of her company os a lesbian who is not
entirely closeted. However, Leah was very cautious in that she did not share her
sexual orientation until she was already highly respected by her company for
excellence in job performance. Even then, it was under a very specific work-related
situation that she mentioned it, and she has never brought it up again. More
importantly, as Leah states, "I'm able, I choose to pass in a straight world, I choose to
do th at. . . I choose to shave my legs, I choose to not necessarily be self-disclosing to
everybody." Leah's choice to manage being lesbian by passing and remaining
relatively silent, along with her excellent skills, has resulted in numerous job
opportunities and advancements. The bottom line is that homosexuality is tolerated at
this facility when it is tucked into the background of one's personhood like u well-kept
secret. In this sense, administrative support is contingently provided only if the
lesbian remains respectable within the eyes of the company. Company respectability is
rigidly defined as being able to fit in with the heterosexual environment by both
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dressing as a traditional business women and actively engaging in heterosexual
discourse.
Lesbians who pass in order to make it to the top do so by paying a price. As
Leah stated, "The sadness for me is that they all ask Naomi, 'How's Mama* [her
partner]. See, they validate her." In this work setting, no one validates this aspect or
Leah's life by asking about her partner. Naomi, on the other hand, receives a "ton
more validation," yet she struggles with a lower ceiling. In the end, it's a tradeoff-job
advancement or validalion-an unfair decision both lesbians have to make. Linda, on
the other hand, enjoyed the privilege of both job advancement and personal validation,
she engaged in a delightful conversation about her child and husband with the same
boss who ultimately chose to give the position to her. Furthermore, when the final
decision is made, Linda, os well os everyone else, will be led to believe that this is a
simple ease of choosing the most qualified candidate. The fact that she 1 1 1 the
administrator's vision of the ideal consultant, a vision steeped in traditional
heterosexual feminine qualities, will remain unspoken. While Linda will likely feel
proud of her accomplishment, Naomi once again will be humiliated by the facade that
fairness prevailed.
Leah's and Naomi's story depicts the hypocrisy that is part of work etiquette
mandates that imply that personal issues should not be discussed at work. Not only
did Linda bring her personal life into u work party, it became the bridge that warmly
connected her with the administrators and ultimately landed her the job. For Naomi,
bringing her personal life into work has disadvantaged her. The fact that she
represented herself in an authentic way by talkingoibout her lesbian family life actually
contributed to existing communication barriers between herself and the bosses. Leah's
story supports Woods's (1994) suggestion that when the private lives of heterosexuals
ore brought into the work arena, it is often perceived as normal and thus goes
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unnoticed, while the private lives of homosexuals remain classified as non-work
issues.
In summary, harassing situations were the most severe forms of sanctions
against being lesbian experienced in the hospitals by the interviewed therapists. These
events were interpreted as overt attacks on their pcrsonhood. It was not only the actual
situations that troubled the therapists but the ambiguity that each situation presented.
Even though they knew that being lesbian was a central factor in each situation, it was
easy for the perpetrator to couch the situation in terms other than being lesbian. Being
a victim of hctcroscxism and having it represented as something other than
hctcroscxism was a cruel reminder that being out in the work place could have grave
consequences against which they may have little recourse.
Nurturing Environments
Most of the lesbian occupational therapists whom I interviewed were readily
able to shore incidents in which they hod a head-on collision with hctcroscxism at their
work places. One might question why occupational therapists would slay at any place
of employment that provided so much torment In actuality, some left and entered into
practice arenas in which they perceived more openness in their co-workers attitudes.
But, like Woods's experience with his first day of work at the advertising company,
some of the therapists were not consciously aware of the hovering presence of
heterosexism on a doily basis. They downplayed its significance in their lives, or
perhaps were blinded by its pervasiveness simply because it was not unlike most
settings in their lives where heterosexism prevailed. Other therapists acknowledged it,
but, given that they live in a heterosexist world, work, like any life space, was a
negotiated place in which they carefully weighed the many factors that contribute to its
climate. Thus, it would be misleading to present only the situations in which
therapists felt personally confronted by hcterosexism. Throughout the interviews,
some therapists asserted that they were relatively satisfied with their place of
employment despite a hetcroscxist atmosphere. In this next section, I will explore
three factors that fostered a nurturing environment for the therapists.
First, work places that were nurturing in general were viewed in a positive
light Two therapists in particular spoke highly about their places of employment,
praising it for its family-like quality. Linda commented.
It is a small hospital, it has a very rural feel, it is a very close-
knit group of people, it is a family. It is not a machine.. .the
feeling is humanistic, we're all here for the same reason.
Likewise, Marie stated,
.. .When I was looking for a place to work, I was looking for
a small place. X was too big. You can't feel like a family
there. You could have people whispering behind your back. I
just don't feel like they do that here.
In using the term "family," these therapists were in direct conflict with notions about
the separation of work and home. They desired contained environments where people
knew each other on a personal level and genuinely cored about their well-being.
Although Cathy did not refer to her place of employment as family, she also stated,
I can tell you that probably one of the reasons I'm still where I
am working--the people I work with are very, very nice and
non-judgmcntal just about anything. . . They bring out your
strong points and kind of you know, address, you know,
there's problem areas as like ways to improve, not like you
really stink. . . it's a nurturing environment.
The qualities mentioned in the above stories, that is, non-judgmcntal,
humanitarian, caring, well-meaning, close knit, and nurturing, created an inviting
work environment about which the participants in this study spoke positively. In this
sense, therapists acknowledged that a general sense of caring and support for one
another could override the daily heterosexism. In Linda's statement, "We're all here _
for the same reason," she is highlighting the fact that patient care was of central
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concern to the therapists and that these qualities contributed to what therapists
considered good patient cate. Thus, believing that their co-workers were very
dedicated people who truly eared about helping patients reassemble their lives in a
meaningful manner was a positive factor in creating happiness in the work place.
Therapists often used that point to argue sincerely that their occupational therapy clinic
was an honorable place to work despite the fact that it was predominantly hcierosexisL
A second aspect of nurturing work environments was the cmpathic responses
of co-workers to personal tragedies. A couple of therapists reported that when "push
comes to shove" many co-workers were very supportive. Jerina, who was closeted at
work and had every intention of remaining that way, stated
When I broke up with my lover of 10 years, she mode quite a
big fuss and ended up outing me, essentially to my employees,
which was pretty devastating. I mean they were very
supportive of me and basically said, "You know she's trying
to rip you off," but I really was unhappy with the whole thing,
I did not want people to know my private life.
Similarly, Marie experienced a very tragic break-up with her partner of 8 years in
which she felt betrayed and humiliated. She described her break-up much like a
divorce in that it entailed dividing up household items, and dealing with the emotions
of not seeing the other partner's family or friends. Finally, Marie confided in her co
workers because, when asked "Hi, how are you?" she was no longer able to pretend
that her home life was problem-free. The co-workers' responses in both of these
situations were tremendously supportive. As Jenna slated, "But they were great. They
stuck with me and it didn't seem to affect our working relationship." Death evoked a
similar response from co-workers. Sara recalled that when a lesbian therapist at their
place of employment received news of a sudden death in her family, her partner came
to work to console her. It was this event that partially outed her; as Sara recalled.
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"Everyone in our, at least in our department was very respectful, no one made any
comment, at least none that I heard."
"When you're in pain or whatever, when you are really hurting then they
listen.” The above stories demonstrate the cmpaihic quality of many occupational
therapists. In all three situations, co-workers were able to respond to the pain of the
individual therapist. Empalhic understanding could also explain the response of the
lesbian occupational therapists to the homophobic comments of their co-workers. As
demonstrated above, both Monica and Jenna were able to overlook their co-workers'
comments about feeling uncomfortable with lesbians and use it as a moment to educate
or just listen because they were cmpaihic. Again, therapists seemed to cosily forgive
or overlook hctcroscxism when they perceived their co-workers to be caring and
cmpaihic.
Finally, for therapists who chose to come out, work places were perceived os
positive when they could share experiences with their co-workers that hod to do with
being lesbian. Two therapists found room within the prevalent heterosexual
environments to talk openly about life events fairly regularly, while at least four others
did so when a major event arose. In one situation, a lesbian couple decided to have a
child and the partner who wasn't pregnant celebrated by bringing in a coke and
announcing the pregnancy at a staff meeting. She was met with the typical questions
and, at least on the surface, acceptance. In another situation, a therapist had a formal
marriage ceremony and invited her co-workers to the reception. Two other therapists
were out to the point that they could begin to discuss personal life situations at lunch.
Although room did exist for some lesbian therapists to participate openly in
conversations and celebrations at their work settings, it required both initiative on the
part of the lesbian therapists and negotiations as to when and where they could safely
disclose. All but one therapist indicated that lesbians did not talk about their lives with
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the same ease that heterosexuals did. Even with this uneasiness though, if the freedom
and sense of safely existed to disclose information about their lives, work became
more pleasant.
In summary, many of the therapists struggled as they attempted to create an
image of their work settings during the interviews. Without a doubt, hctcroscxist
environments existed. Regardless of whether the therapists felt swallowed by the
destructiveness of such environments or found they were able to maneuver around the
settings quite effectively, they spoke in depth about the destructive nature of
hctcroscxism. However, in all but one ease, therapists qualified their descriptions,
inserting statements about the nurturing aspects of their work places. They felt
compelled not to let the negative incidents override what they perceived as good
therapy. It was obvious that genuine humanistic approaches toward patients and co-
workers were a significant factor that may have had little to do with sexual orientation,
yet influenced their overall perception of the workplace. The ideal situation, of course,
was when therapists felt that humanistic sentiments were strong enough that they could
share their lesbian lives with the same equality that heterosexuals could. In the end,
therapists found themselves somewhere between a purely destructive and purely
supportive environment.
Managing One's Lesbian Identity
In the Occupational Therapy Clinic
When immersed in a hctcroscxist environment, no matter how destructive or
how friendly that environment might be, therapists must leam to manage their lesbian
identities in order to survive potentially harassing situations. In the following section,
I will describe the survival strategies employed by the lesbian women who participated
in this study. First, therapists must struggle with the overarching decision as to
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whether or not they wish to come out, and ir they do, under what circumstances and to
whom they will do so. Coming out is a complex phenomenon which, for these
women, depended upon personality, their previous experiences with disclosing their
sexual orientation at work, and the attitudinal climate of their particular hospitals or
clinics. I will explore how these factors come together in the individual's life.
Regardless of one's choice to be predominantly open or remain closeted, though, daily
confrontations occur, to which therapists must respond. Thus, in the second half of
this section, 1 will describe five different ways that therapists managed their identity on
a doily basis.
Disclosure at Work
Some may argue that there is a certain social etiquette as to how much people
would disclose about their personal lives, especially within a work situation.
However, as discussed in the introduction, sexual orientation is an expected part of
work disclosure, if one follows a traditional heterosexual trajectory of marriage (or
even desiring marriage) and children. A lesbian sexual orientation is classified os
one's "private personal life" only because of the interpretation placed upon it For the
most part, therapists in this study wanted to be respected equally for their lesbian
identity just os their heterosexual counterparts ore respected for their heterosexual
identity. A therapist's choice to be out at work stemmed primarily from her desire to
be authentic with her co-workers in order to build bridges of communication that could
assist with patient care as well as provide personal comfort at work. Although equal
respect for lesbian and heterosexual orientations may be the.ideal situation, lesbians are
acutely aware that they live in a world in which equality is not a reality. Thus, many
choose to remain closeted. When they made this choice, it was primarily because they
understood the danger that could arise if they disclosed to the wrong person and
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believed that they did not deserve, or just did not want, to experience the consequences
that may befall them if they did.
Even though some of the therapists claimed that their lesbian sexual orientation
was not necessarily a work issue, or that they did not discuss this part of their life with
just anyone, it was not out or social etiquette that they made this decision. Their
decisions were a survival strategy that allowed them to work with as few
repercussions as possible while remaining as honest as they could. In the following
section, I will delve deeper into the many factors that fed into these women's decisions
about disclosing. I will specifically focus on why people made the choices they did
and in which environments these choices occurred. Although varying degrees of
openness about sexual orientation in the work place existed, 1 will primarily present
stories about the two ends of the continuum, that is, those who remained closeted and
those who were out.
Remaining closeted. Three of the women decided to remain strictly closeted at
work, although their justifications for doing so differed. The following two stories
illustrate the multiple factors contributing to one's choice to remain closeted and the
ongoing personal struggles that accompany their silence.
From the outset of the interviews, Monica clearly staled, "I've never been out"
in any work setting. She went on to explain, "I mean why does someone not talk
about who they ore. In part, it's how you ore raised and, you know, how much you
are invested in other people's views of you and what you think the appropriate thing is
to do." Monica was raised in what she called, "a middle-class house of parents who
were daughters and sons of immigrants. . . they were religious people, traditionally
religious." Fitting into middle-class America was an ideological notion that Monica
inherited from parents and grandparents who believed in the melting pot of America.
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The specifics of how one must fit were dearly outlined by the doctrine of the Catholic
L.
church which was strongly endorsed by her mother. To Monica's mother, fitting in
meant, among other things, heterosexual marriage, children, and raising them close to
home. Thus, although Monica commented that marrying later in life had become
acceptable in her mother's eyes, being in a lesbian relationship and committed to a
woman, not a man, was sinful. Her mother so vehemently embodied these values that
when she found out Monica was lesbian, as Monica stated, she "annexed me,
ostracized me from the family,” even to the point of not visiting her daughter when
Monica was hospitalized in critical condition following a near fatal car accident. In the
end, the family values under which Monica was raised provided the background for
her present desire to fit in, and substantiated any fear she may have that doing
otherwise could mean separation from people she loved dearly.
As Monica stated above, it was not only her upbringing that contributed to her
choice to remain silent in the occupational therapy clinics. Yearning for approval or,
as she put it, "Being invested in other people's views about you" also contributed.
More specifically, she commented that she was, "always, like, wanting to look for
approval. . . you know it was always true of my mother, always wanted to look for
her approval of being OK." Likewise she sought the approval of her bosses and co-
workers. At her first job, Monica perceived approval and silence to be intertwined.
For example, after 3 years of employment at a large rehabilitation hospital, Monica
was outcd os a lesbian to her boss due to an unexpected turn of events. Although her
bosses were very caring people and in no way indicated their disapproval of her sexual
orientation, they did imply that when she left that setting, her secret would be kept
with them, indicating that silence about this aspect of her life was the appropriate
approach within the work setting. At her second job, Monica commented that
remaining closeted was encouraged by the pervasive assumed heterosexuality, which
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occurred on a daily basis. She stated, "I don't know where they [co*\vorkcrs] get their
concepts. 1 think they just have this image of who 1 am . . . they don't see me as
gay."
Although Monica appeared committed to remaining closeted at work, her
decision was often enveloped in conflict At one time she explained, "I mean, I'm
sure it's still self-serving. I'm protecting myself but it's just who I am." At other
times she commented, "I feel like I've been deceiving all this time." Perhaps this
conflict is best explained in an interaction she had with her boss, Jackie, a woman she
held in high esteem and who likewise held Monica in high esteem. At the time,
Monica was emotionally exhausted due to a break-up with a partner who was leaving
for a job oversees. She stated,
I remember being in Jackie's office and even contemplating it
[disclosing her sexual orientation]. I might have related that to
her but immediately she [Jackie] thought, she made the
assumption that it was a heterosexual relationship. You know,
so I just never said anything. And from there, it s just like you
are building a lie. You know, and now I feel like I'm in so
deep what would be the point.
Later she stated,
I mean, I don't think that she would probably make a judgment
but just because she's assumed it all this time and I haven't
been, I haven't bothered to let her know that that's not the
cose, I just feel like she would think, wow, why couldn't you
tell me? And I just, I wouldn't wont to disappoint her.
Here, one can see how Monica's desire to break through the silence is thwarted by
assumed heterosexuality on the part of her boss and Monica's internalized need to
receive approval from those whom she respects.
In summary, the above story exemplifies the complex nature of choosing to
disclose. Monica brings to the occupational therapy clinic her emotional conflicts
about being accepted by her boss and co-workers, conflicts that were well
substantiated by the painful rejection she continues to experience from her mother and
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extended family. The occupational therapy work environment further supports the
notion of silence through both her previous supervisors implied message that she
might want to keep her sexual orientation a secret and the daily assumed
heterosexuality at her present employment. The emotional discomfort Monica feels
while grappling with her desire to freely express her lifestyle and simultaneously her
need to receive approval occurs against the background of continued messages that
silence is the most appropriate, the most elegant, approach to being lesbian.
Fear of losing their jobs was the primary reason that the other two who remain
closeted did so. Because their stories arc so similar I will describe one story to
exemplify their situation. Presently, Arlene contracts with a school system in
Northern California to provide independent living skill training for children who arc
developmental^ delayed. She attributes her present decision to remain closeted to the
discrimination she received in two previous jobs.
From her first day of employment at the gerontology center, Arlene fell labeled
os different. A buzz-cut hair style, neutral colored baggy pants, and a propensity for
reading novels during lunch break were interpreted by her co-workers as a break from
the usual way the occupational clinic ran, in which most women wore make-up and
stylish slenderizing pants and spent their lunch breaks discussing weekend adventures
with their heterosexual families and friends. Although Arlene was never told overtly
that she was perceived as different, comments and jokes about her attire or eating
habits made her uncomfortably aware that her difference was being noticed. For
example, she stated, "One day, my supervisor said~I had a pair of tight pants on,
what 1 consider tight-- she's wearing clothes that fit her today." Initially these types of
sarcastic remarks were infrequent and often couched in humorous terms. However,
the emotions underlying these comments soon escalated to the point that Arlene was
informed by her boss that people were beginning to be "bothered" and "troubled" by
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her, although they couldn't really articulate why. Arlene soon quit and moved into a
position in which she spends more time on the road doing home health than in a clinic
interacting with other health care professionals. She still wears baggy clothes but has
let her hair grow longer, a survival strategy to enable her to pass as a heterosexual.
She is committed to remaining silent because she understands how being different can
create conflicts that affect the work environment As Arlene explained, in an acute
setting, trust among team members is essential if good care is to be provided. She was
not able to develop that trust with people who were bothered by her dress and habits.
Unlike Monica in the previous stoiy, Arlene approached her first job in
occupational therapy cautiously but with the attitude that there would be latitude in the
way occupational therapists dressed and spent their lunch time. She never expected
that she would not fit in. In Arlene's situation, the consequences of her dress and
actions, meaning her co-workers remarks and attitudes, strongly affected the way she
viewed the occupational therapy profession. She pondered her recent discovery when
she looked for a new job. Her decision to do home health was a conscious choice,
purposely made to avoid being subjected to the discriminative altitudes she had
experienced in the past. Although the reactions she received on her first two jobs in
occupational therapy influenced Arlene's decision to remain closeted, she was also
driven by a need for self-preservation. Arlene knew she had valuable skills to offer
children with disabilities, given a non-homophobic environment. Equally important,
she believed that she did not deserve to be harassed or fired for being lesbian. Thus,
her job change and decision to remain silent enable her to stay employed, cam respect,
and experience job advancements.
These two stories portray the multiple considerations that go into remuining
silent within an occupational therapy work place. Other reasons the women gave for
remaining silent in general or selectively coming out included: (a) "I wasn't there long
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enough to Teel comfortable with people"; (b) "the bottom line was the reality of
conducting a business in XX a conservative business atmosphere . . . because it's a
close knit group”; (c) "I don't feel like dealing with other people's baggage. . . 1 don't
. . . [like] them spreading rumors; (d) "1 hate to put my practice at risk”; (c) "I don't
think it needs to be thrown in their face if they're uncomfortable with it”; (0 "I do not
feel comfortable with her as a person and I don't feel like 1 would want to reveal that
part of me because I don't feel that dose to her”; (g) "I mean if ... she was a little
more liberal [referring to her religious background] then I would have just told her
already”; and (h) "It's not a work issue." In addition to these reasons, the option to
remain silent ortcn related to the therapist's ability to pass as a heterosexual. One
woman commented that she looked very straight and by remaining silent she could
have the best of both worlds, while not rocking the boat.
Coming out. Linda was the only occupational therapist who related that she
was out in almost all areas of work, with the exception of a few middle managers.
Four other therapists were selectively out to friends or people they trusted. Two other
therapists who arc presently closeted had previously worked in openly lesbian and gay
environments. Linda claimed that her decision to be completely out emerged in part
from the fact that she was hired at her place of employment 8 years ago as a very
young and out lesbian therapist As I've discussed before, this choice did have some
repercussions. The threat of being fired along with getting older encouraged Linda to
modify the way she talked about being lesbian. Linda was quick to point out that
being from a small rehabilitation hospital in which employees were treated like family
contributed to her decision to remain o u t Equally important, though, was Linda's
belief that she could not compromise her conversations about her home life, and so
Linda talks about her partner with the some freedom that any heterosexual has in
200
doing so. Finally, Linda states that "In the sense of my job security, I don't Teel
threatened at alt. I feel like I'm an extremely valued manager, and, you know, so to
m e... it's not an issue.” In the end, Linda's initial impulsive disclosure, her
perceived low risk, and her commitment to talk about her lire contributed to her choice
to be out.
For the other therapists who were selectively out, it appears that the need to
comfortably express themselves in their work place in general or following a life
tragedy, such as the break-ups or deaths that were discussed before compelled them to
make the decision to come out The two therapists who hod previously worked in
openly lesbian and gay facilities unequivocally staled that these work situations were
the ones in which they felt the greatest sense of comfort, demonstrating that the
freedom to talk about their lives did enhance their overall satisfaction in the work
place. Arlene stated, "Actually it was much more casual. It was much more personal
and I felt freer to disclose what I did over the weekend and actually hod more of a
camaraderie there with them . . . I could be who I was.” Similarly, when talking
about ideal occupational therapy work settings, Leah, who hod worked in a lesbian
and gay environment, stated,
Ideally it would be great to be out, and if I was in a hospital
environment just to be part of the staff. And to be out and to
be free to talk about what goes on. And to have that be as
normal as someone clse's story of what goes on.
For therapists who chose to be out in their clinics, the desire to have their experiences
affirmed, that their story be as acceptable as anyone clse's, drove their decision.
Maneuvering around Heterosexist Clinics
Irrespective of the therapist's decision to be out or to remain closeted, each day
brought new situations requiring on-the-spot responses from therapists. In the
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following section, 1 will describe the various management strategies that therapists
i.
used to maneuver around hctcroscxist clinics in particular lunch table conversations,
clinic chit-chat, meetings and the other interactions that occurred among health care
professionals. Five management strategies will be described including separation,
silence, guarding, omitting, passing, or cmplotting anger to palatable acts.
Separation. Physically removing herself from conversations that were
potentially threatening was one strategy that many of the respondents hod used
somewhere in their careers. Most often, it was employed to deal with the dilemmas of
lunch table talk. Thus, although this strategy has been used in other contexts, I will
describe its use with respect to lunch table conversations.
Shared lunches often occurred around a big table in the clinic, or in the
cafeteria. Although lunches were somewhat fluid events, that is, at times, a couple of
people would go out to a restaurant, at other times someone would work through his
or her lunch break, and on occasion, on educational lecture took precedence, there
seemed to be on unspoken expectation that people did cat with the other therapists on a
somewhat regular basis. One purpose of lunch was to share their personal lives, even
if on a relatively superficial basis. Health care professionals were surprised when they
didn't know at least a minimal amount about their co-workers lives. For example, one
charge nurse expressed this when talking about another nurse with whom she hod
worked for 6 or 7 years;" I've never worked so long with a person und known so
little about them."
Lunch table talk varied from day to day. Heterosexual discourse (described
above) frequently occurred in the form of "Make-up, boys, and dating"; "Baby talk,
and baby showers, wedding showers"; "kids and kids getting married." However,
these were not the only subjects that arose. "Retirement plans," "food preparation,"
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"vegetable gardens," "movies," "shitty treatments," and "work issues" were more
neutral subjects with respect to sexual orientation. Although sexual orientation could
influence a discussion of these subjects, it is less central to topics such as vegetable
gardens and food preparation than it is to marriage, dating, and children. Subjects that
were more neutral with respect to sexual orientation were important to lunch table
conversations because they allowed a greater degree of comfortable participation by the
lesbian therapists.
When glanced at superficially, the lunch table talk can be interpreted as
frivolous discussions about therapists' personal lives that provide moments of relief
from the more serious task of caring for patients. However, when couched in terms of
a bonding ritual, sharing lunch times becomes a vital event that socializes new
therapists into the occupational therapy clinic culture and continually revitalizes the
existing relationships among therapists. These relationships ultimately bear on patient
care. In her book, CUnical Reasoning, Mattingly suites, "We took seriously a part of
practice that therapists generally did not noticc-thcir own everyday storytelling.
Therapists we studied often traded stories about patients in the lunch room. This was
not gossip. Rather, it turned out to serve two very important functions. It was a
method of puzzling out problems. .. .[it also served] to enlarge each therapist's fund
of practical knowledge through vicariously sharing other therapists' experience" (p.
18-19). In this study, patient problem solving was intermeshed with personal life
stories during lunch lime discussions. New or experienced therapists had to be willing
to place themselves in the vulnerable position of publicly managing their persona)
stories to benefit from this clinical sharing. As the following incidents will
demonstrate, the need to manage disclosure about their sexual orientation was most
discomforting for the women interviewed. Yet their decisions to separate themselves
203
from this event ultimately disadvantaged them, denying them valuable information
about patient care.
For many of the women in this study, the process of bonding with other
therapists through shared lunches was highly unsuccessful. Therapists talked about
feeling uncomfortable, threatened, and isolated. One woman stated, "I always fell
very alone. Like I wasn't with anybody that I could identify with. . . . 1 didn't feel
tike I had much to say to them because my life was hidden." Another woman
commented that at the lunch table "My contribution about my life is very skewed and
oftentimes a lie." As these quotes indicate, isolation or feeling alone often resulted
from the fact that what was spoken about during lunch was unrelated to these
women's lives. Sara expressed this concern more completely in her discussion about
lunch time events. At first she commented that the conversations were just "silly talk"
and it was not her thing to sit around a big table and have lunch. On further reflection,
though, she clarified her thoughts, stating,
Oh, well, actually it wasn't silly talk when I think about it. It
was really people sharing their experiences with their loved
ones [and] with their family, or things like that. So, really it's
not silly talk. But, sometimes it was, sometimes it was just,
you know, not very interesting, but probably because 1 felt so
isolated and I felt that I needed to keep my distance. I wasn't
sharing my, you know, the wonderful play we went to see, the
wonderful lecture we went to see, you know things that were
really interesting and wonderful.
Here Sara acknowledged that the lunch table talk was important and personal to those
who could share. Perhaps the realization that her colleagues were able to share these
important things in their lives and that she could not share similar things of importance
further deepened her feelings of isolation contributing to a separation between her and
the rest of the staff. In her case, her isolation from her co-workers led to vicious
rumors about her being lesbian.
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In response to these feelings of discomfort, some therapists chose not to join
the lunch table. In some respects, not eating with others during lunch, under the guise
of too much paper work, can be easily excused in contemporary medical care where
one must treat patients about 6 to 7 hours out of an 8-hour day. Jogging, going out to
lunch with a few sarc friends, or attending a lunch time seminar were equally
excusable.
In the following two stories, Marie and Leah explained in more depth the
feelings they had about managing the lunch table ritual and how their co-workers
interpreted their actions. Marie recounted a conversation that occurred about 6 months
after she was hired.
Tone of her colleagues] goes "gosh you know, when you were
first here you never used to go out to lunch with us, did you?"
And I said "no". And she said, "yeah why was it, you didn't
tike us or you just didn't know us or what?"... I said
"probably because I didn't know you guys."
Marie then disclosed the real reason she chose to stay at her desk during lunch.
I mean it was really, just not wanting to be in that close
situation with people where I'd be forced to answer questions
like, so do you have a boyfriend?. . . I used to cat lunch by
myself, because. . . I didn't even want to cat lunch with these
people.
For Marie, separation was necessary because she felt threatened by the questions that
may potentially expose her as a lesbian. She had to manage carefully how much and
what she would shore about herself so to avoid evoking questions that would
ultimately point to her sexual orientation. She was constantly alert to picking up clues
os to whether or not her colleagues would be accepting of her disclosure. Separation
from the lunch table seemed to be the easiest way to manage this discomfort.
Months later, Marie came out to many of her colleagues and started to share
lunch with them. In contrast to her initial attitude toward the lunch ritual, she now
suited, "See, conversation is always so good at lunch. It's never threatening. It's not
205
usually threatening or negative. It's not threatening to me because t know that I'm OK
being a lesbian around them." When talking about a lunch time baby shower she
staled "It was just nice being at the shower. It is so much nicer to work in a
department where people know what is going on in your personal lire. I feel so much
more comfortable. I feel so much more competent." What is important in this lost
statement is that after she began to feel accepted in her work setting and could
authentically share about her life, she became excited to participate in the lunch lime
events. This feeling of security seemed to spill over into patient care as indicated by
her statement that she felt more competent. For relatively new therapists, competency
can be related to overall feelings of self-esteem and the informal feedback about
performance that one receives from co-workers. Marie's comments appear to confirm
the importance of the lunch lime rituals in cncutturaling new therapists. The rather
drastic shift in the way Marie experienced her interactions with her co-workers before
and after she was out reflects the importance of the bonding that occurs at lunch and
the wide ranging effects that being separated may have on the self-confidence she
needs to develop as a therapist. By separating from the other therapists, new
therapists miss the opportunities for consulting about patients and the positive
feedback from other co-workers about their treatments may be lost.
During her employment at one facility, Jenna, who is bisexual, separated from
u woman and later married a man. When asked how the difference between being
married to a man and being in a relationship with a woman affected her work, she
stated,
Well, in my work environment I am now eating lunch more
often with my staff. I use to not eat lunch with them too
much. And again it was that same thing, talk about kids,
talking about stuff that 1 just had no interest in. Plus I lend to
work too much, which isn't good. But now I find myself
taking the lime to go have lunch and you know,... we huve
the kids every other weekend. So, I have things to talk about
206
that kind or fit the rest of the people. And even with my
colleagues, you know, they'll say "How is your husband
doing7N Or "How arc you getting along with the kids?” You
know that kind of leaves them more things to ask me about.
So I find it easier to have social relationships with them.
She.also pointed out that in private practice it is important to be able to relate to other
business people in order to get referrals. She staled.
Cause in my industry, people that use me, they respect me as
an OT but they also like me as a person. And part of that is
getting to know me and me getting to know them. You know,
so that, there's not strictly professional in that sense.
Jenna again demonstrates the importance of being able to connect with fellow
workers and with other potential business associates on a personal level. Without
those contacts her private practice could not be maintained. Because she is bisexual,
Jenna is in a unique position of experiencing the same work environment while being
partnered with a man and a woman. Her experiences strongly indicate that her work
and business connections were easier to moke and maintain when she was in a
relationship with a man primarily because she hod on authentic access to the
heterosexual discourse that allowed her to relate to others and them to more easily
relate to her.
Jenna's experience brings up another point about the process of lunch lime
distancing. Initially, she mentioned that her decision to cat alone was due to the fact
that she was busy, she wotked too much, and that she had little in common with her
staff. Yet after she started to shore common conversations, she found herself taking
the time to have lunch with her staff. Throughout this study, the informants rarely
claimed that being lesbian was the sole reason that they chose not to have lunch with
the others or even that they chose to leave a job. They often saw it as a thread, and
many times a minor thread, in the complex web of reasons that led to a decision.
Jenna's story however, suggests that what is sometimes perceived as a minor thread
207
is, in actuality, a strong influence in the decisions lesbians or bisexuals make. When
Jenna was no longer with a woman and could relate to others in a female-male
relationship, the fact that she was busy did not influence her choice to participate in
departmental lunches. This is not to discount the fact that she is still overworked, but
merely to suggest that being in a relationship with a woman hod a much stronger
influence over her separation from lunches than being overworked. Yet it was not
perceived that way.
Clamming. In a manner similar to removing oneself physically from a group,
some therapists removed themselves emotionally by remaining silent when certain
topics arose in conversation. One woman described herself as remaining "mute"
during a planning meeting for a work event that was to include spouses. For at least
four other participants, remaining silent meant not "telling a soul” at work about their
lesbian identity. As one woman stated, "For about the first 3 years we were it. I mean
we just really did not come out of the closet." Other therapists, especially those who
were selectively out, managed their silence by talking freely around people who knew
about their sexual orientation yet closed up like a clam when around those who did not
know or those whom they did not yet trust. Although most therapists who remained
silent did so because they feared possible retribution if they were out, Leah stated that
as a supervisor she did not want to put her employees in an uncomfortable situation.
Surveillance. A third way the therapists managed sexual orientation in the
work place was by maintaining a continual surveillance of their surroundings. For
some, surveillance meant having their antennas up to detect clues about co-worker's
attitudes toward homosexuality. Homophobic jokes or comments were considered a
confirmation that potential negativity was present. Cathy explained that comments
208
like, "Con you believe it?" or "I just think that's disgusting" arc purple Dags for her to
remain silent. in addition to keeping a constant vigilance about potential homophobia,
therapists were alert to co-workers who might be lesbian-friendly. Monica talked
about detecting a shift in language from "spouses" to "partners" by her boss.
Although this was not enough to encourage her to come out, it was notiocablc and
pleasant to hear. Similarly, Connie commented that she often had lunch with Martha,
one of her co-workers, whom she really enjoyed but with whom she was still
somewhat hesitant to share her lesbian identity. Although Connie thought Martha
would be accepting, the fact that Martha was strongly religious contributed to Connie's
hesitancy. During one Monday lunch, Martha launched into a discussion about the
lesbian movie "Fish" that she had seen the past weekend. Besides talking about how
interesting she and her husband found the movie, she personalized the discussion by
disclosing that her two cousins were lesbians. This conversation about the movie
"Fish" was the clue for which Connie had been patiently waiting. It confirmed
Connie's conjecture that Martha was lesbian-rricndly and enabled her to come out to
her friend.
Surveillance was also described with respect to what and with whom the
women shared personal information. For example, Cathy recounted how she
constructed "press releases" about her birthday celebration and put different spins on
the account, depending on with whom she was talking. She suited,
I mean I even found myself today, my girlfriend and 1 were
like okay, Usaid where am I going to tell them I went to dinner
because everyone's gonna want to know, we went to a gay
restaurant. . . . We're like trying to dream up a name and I
told some people one place and then other people, even straight
people, the gay plaoe that 1 went to. But the other ones that 1
didn't feel comfortable with I told them a different place.
Here Cathy guards her conversations by planning ahead which press release will be
shared with which people.
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Surveillance allowed Marie to foresee a potential problem and quickly intercede
to solve it by creating a palatable press release. After much contemplation, Marie, who
was out to some of her co-workers brought her partner, Diane, to an office Christmas
party. They unexpectedly sat with Michelle, the head of the rehabilitation department
who did not know about their relationship. Diane worked at a lesbian organization for
homeless lesbian youth. Realizing that this piece of information would be quite
revealing, Marie become concerned that Michelle might engage Diane in a conversation
about her work. To avoid this situation, Marie casually mentioned the fact that Diane
worked in a resident youth shelter, deleting the part about the youths' homosexual
identities. Her plan worked, and although homclcssncss was discussed extensively,
the sexual orientation of the youths was never addressed. Marie is accepted in her
department and felt comfortable bringing Diane to a Christmas party. However, even
in these supposedly safe work environments, unexpected situations arise where one
must be quick to manage the conversation while simultaneously assessing whether or
not this particular lime is appropriate or safe for disclosure.
Censoring. The fourth and most flexible technique for managing one's sexual
orientation is censoring revealing information.' To be proficient at censorship,
therapists must be adept at both interpreting the environment and knowing how to
redirect personal stories to communicate the main points while not divulging any
information that may imply their sexual orientation. When therapists censor revealing
information, they arc in a constant process of editing their explanations, a process that
requires great amounts of psychic energy. Some therapists talked about it as "not
being as forthcoming" with some people as you might be with others. For example,
when Connie told the story about Martha, she introduced the story by saying that they,
were talking about what they had done on the weekend. Connie had gone to the movie
210
"Fish” with her partner. Yet in her response to Martha's question about how she spent
her weekend, she simply stated that she went to the movies with some friends.
Connie was not as forthcoming with her weekend story as Martha was. Her guard
was up and she censored the name of the movie, one piece of information that could
imply her lesbian sexual orientation.
In addition to censoring parts of conversations, some therapists edited out
entire chunks. Sara stated that she and her partner would often escape the city to take
weekend rendezvous at bed-and-brcakfasts inns along the coast where they could
celebrate and not hide their relationship. Sara described her experience.
We'd go to bed and breakfast here and there, just different
places you know along the coast or wine country and things
like that and then you'd come back and you really wouldn't
share. . . whereby anyone else would want to share that sort
of thing.
Sara relumed to work and plunged into patient care, not letting on that she had just
relumed from another wonderful and significant weekend in her life. By censoring the
entire weekend story from the conversations she had with her co-workers, she
remained superficial in her interactions, at least with respect to her leisure activities and
relationships.
Finally, one therapist who was relatively out commented that, when telling a
story about her life, she will freely talk about Samantha, her partner, although she
doesn't always identify her as such. She states, "I mean 1 refuse to not talk about my
life and they can conjure up whatever they want in their head that works for them, you
know, if they want to think she's a roommate, great, she's a roommate. If they want
to think that she's my lover, she is. And whatever in the spectrum Ills into their reality
is fine with me.” Here Linda is censoring information but not trying to conceal her
sexual orientation. Because she feels free to be out in her environment, she simply
leaves the interpretation up to her co-workers. Linda, os well as others, has
211
commented that pervasive heterosexuality often supports their co-workers'
interpretation that women are roommates and friends. On the other hand, by leaving
her relationship with Samantha open, she is providing a clue to those co-workers who
arc enlightened enough to pick it up.
Passing. Passing as a heterosexual can be in the form of physical presentation
and/or engaging in heterosexual discourse. Both arc explained. Stereotypical images
of lesbians include the "mannish look," for example, short hair, unshaved legs, old
fashioned clothing, men's pants, and a lock of adornments such os jewelry and make
up (Elioson ct ol., 1992).) Passing as straight requires the reverse. All therapists felt
that they naturally passed as straight because their desired way of dressing included
wearing nylons, dresses, make-up or jewelry, having long hair, or engaging in any
combination of the these requirements. Passing as straight was easy for the
participants simply because their appearance fell within the boundaries of the "a
traditional feminine look."
Engaging in heterosexual discourse at lunch table conversations or during other
informal work conversations also enabled the therapists to pass. Arlene stated that she
used the "pronoun switch." She was dating a woman, yet talked about that person as
a he. Changing she to he was particularly easy for Arlene because her girlfriend's
name was Chris and if she slipped and colled her by name, Chris could easily be
interpreted as male. A second, less direct, approach to discussing partners in
heterosexual terms was to refer to their partners as roommates. Jenna sated,
I would talk about a roommate. She and I would go places, go
on vocation and I just talked about my roommate. But it never
got more into, you know, I could never share the goods and
the bads and other frustrations and alt of that, that you
experience in a long term relationship.
212
Using the term roommate rather than converting pronouns felt a bit more honest, but it
did have consequences, mainly squelching the opportunity to discuss the relationship
in depth.
The uvo women who considered themselves bisexual had an easier lime
passing as straight because their co-workers had seen them authentically dating or
married to a man. A bisexual identity is even less thought about or understood in
contemporary society than a lesbian or gay identity. After being seen with men, the
assumption that one is heterosexual is practically cast in concrete. Jenna explained,
"Well, see. I'd been married before, so people that would ask, 'Arc you married?' I
could say, 'No, I'm divorced.' It's real easy and it's honest."
Using ancer to cmplot palatable acts. Two stories in particular represented the
way therapists managed their sexual orientation by becoming angry, or defensive as
one participant colled it. When talking about her earliest days of employment, Linda
stated, "I used to get realty defensive when people asked me about my personal life. I
would get mad. . . . Because people wanted an answer. . . . 'Oh are you married?'
No. And 1 felt mad that 1 didn't feel like I could share." Marie shared similar feelings
of anger when people would ask her about the ring that she wore. On the one hand,
she wanted to share about her relationship with Diane. On the other hand, she was
unable to assess if it was safe to do so. A sequel to these stories is that presently both
Linda and Marie are relatively out in their facilities and happy with their interactions,
Linda more so than Marie because she has approximately IS years of experience and
Marie has 1 year of experience. In analyzing these stories it seems as if the anger that
these two individuals felt had multiple sources stemming from their position os new
therapists. They were faced for the first time with a double standard in the
occupational therapy work settings, namely, that it was easier for heterosexuals than
213
lesbians, gays, or bisexuals to share about their lives. They had not yet become adept
with the management skills needed to deal with the type or seemingly mundane
questions that arc perceived as quite intrusive Tor closeted lesbians. Finally, they
experienced the anxiety that naturally comes with wanting to fit into a new
environment by making friends and performing well. This anxiety exacerbated their
fears and anger.
Sarbin (1989) proposed that anger, fear, jealousy, and guilt, as well os other
emotions serve to cmplot actions. Marie's anger enabled her to be more aware of the
particular ways that hctcrosexism worked within the clinic and created tension for her.
Awareness is often the first step in making changes. She responded by disclosing her
sexual orientation, thus decreasing, but not alleviating, the number of limes she was
directly confronted with hctcroscxist comments by her co-workcrs. Because of her
disclosure to some co-workers, she felt more comfortable dealing with unexpected
confrontations.
Anger can also be precarious because actions that emerge from anger occur
within a social context; thus the individual is confronted with the recipient's
interpretation of his or her actions. Linda's story illustrated this risk. Linda was
harassed and nearly fired because she chose to assertively confronted her co-worker's
stereotypes and derogatory comments. Although getting angiy at the discrimination in
her work place was not the only way she managed her lesbian identity, Linda implied
that it could have contributed to the administration's harassing response. Being able to
convert anger into actions that are palatable in the social world and that allow an end
goal to be achieved is a skill that certain participants employed.
Authentic representation. Although the therapists who participated in this
study were fairly adept at management skills, they were most happy when
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management was not needed. Being completely at case with respect to one's lesbian
identity occurred in only two situations when the therapists had worked in a
predominately lesbian or gay business. Jenna shared,
It was a small newly started company. . . And there was
another gay therapist, and then a gay nurse and his gay lover.
He was a video technician. And all or us were out to each
other. And so it was a lot more Tun to, and you know we
would laugh and we would have, you know, it was more like
family. I would say that was probably the most comfortable
working relationship I've ever had... We could talk about
our lives. We could talk about what happened at home or our
vacation plans or the bar that we went to, the movie that we
saw, you know, gay movies, things like that and share
experiences together.
Other situations in which management was minimally needed occurred in
places where an individual had been working relatively open as a lesbian for quite a
few years. Undo, who has worked Tor about 10 years in one place, talked about the
fact that she rarely needed to manage.
You have to understand, because I came up through the ranks
of the therapists, a lot of my employees were one-time co-
workcrs, on the same level with them. So they know I'm gay.
The people that were hired after that, it doesn't take a rocket
scientist to figure out, I mean I talk about Samantha, I talk
about my life, I talk about what I do..
Around her staff, Linda rarely manages her identity, although it is still minimally
needed around a few of the other managers.
In summary, various management techniques were employed by the therapists
in this study. No one individual used only one technique. Rather, managing one's
lesbian identity required well-honed skills to quickly assess environments, pick up
cues about co-worker's attitudes, remain silent and detached in the face of humiliating
jokes or comments, perform on-the-spot realistic editing of one's life, and using anger
to emplot palatable acts. Even though therapists may become quite adept at managing
and comfortable in their work situation, identity management was a never-ending
215
process. Co-workcrs leave and new ones arc hired requiring the coming-out process
to begin all over. The political climate changes. For example, sometimes the tension
is eased through, for example, the passage of domestic partnership bills; and other
times, fears arc intensified through, for example, statewide ballot propositions that
could result in the silencing and firing of lesbians, gays, and bisexuals. On a more
particular or local level, political changes within the occupational therapy profession or
within the hospital or school administration can also require a readjustment in the way
lesbians manages their lesbian identities.
Juggling management techniques to employ the most useful technique at the
most appropriate time is related not only to the changes that occur within the work
setting and the broader political climate. Therapists engaged in an ongoing struggle to
maintain an authentic expression of their identities while working in not entirely
accepting environments. As was discussed in the first section, maintaining
authenticity to the degree that they felt it was possible in their particular facility
motivated which management technique they used. The ways the women maintain
authenticity differed given their experience in the profession in general and in each
particular work setting. But regardless of why or how the therapists managed their
lesbian identities, the process was an enormous burden requiring energy that would be
more useful if put into patient care or professional concerns.
Conclusion
Under the guise of neutrality, people who are homosexual have been told and
tell others that their homosexual identity is a private aspect of their lives that has no
relevance to the work setting. This discourse, which has its basis in the notion that
work and home ore separate spheres, in fact docs a disservice to homosexuals who
often need to remain aloof and secretive about their lives at the same time that their
216
heterosexual counterparts appear to blend in with the office culture simply because
office culture is a heterosexual climate. The occupational therapists who were
interviewed described multiple ways that a heterosexual climate permeated the
hospitals at which they were either previously or presently employed. Therapists were
bombarded with heterosexual discourse, homophobic comments, assumed
heterosexuality, and perceived stereotypes in both informal work interactions around
the lunch table and the more formal business interaction at team meetings. Although
therapists could lightly discount hctcrosexism as ignorance, it became particularly
difTicutt to overlook when it escalated into what therapists interpreted as personal
harassment. These environments challenged therapists who were thwarted in their
attempts to build honest relationships with at least some of their co*workcrs or, for
few individuals, achieve their potential to be maximally effective.
An important point is that very few environments were so oppressive that
therapists sought to leave. In fact some therapists considered their clinic environments
to be positive, nurturing work places. It could be argued that, because hctcrosexism is
so prevalent in society, these women simply acclimated to the heterosexual work
climates and thus failed to perceive its presence. The women themselves explained
that what they perceived as genuine humanistic attitudes toward patients and the
general friendliness of therapists counterbalanced any negative hctcrosexism.
No mutter how they described their work places, each therapist engaged in on
ongoing process of managing their lesbian identities which occurred on two levels.
First, the therapists were confronted with whether or not to come out as a lesbian.
Some people, both lesbian and heterosexual, suggest that coming out is a positive
political move through which other people will Icom about and thus be less fearful of
lesbians. But the lives of some of the women in this study clearly indicate that this
decision was neither simple nor something that could be easily dismissed. Some
217
endured severe family and co-worker rejections. Others met with nonchalant
acceptance. For each individual it was a risk that needed to be assessed.
On a daily basis, therapists managed their identities as necessary using a
number of techniques including separating from the group, passing as heterosexual,
surveilling the environment, censoring their discussions, clamming up, and/or turning
anger into action. From the findings in this study, one could not identify a typical way
that hctcrosexism manifests within the hospital environment, nor suggest the most
effective way for lesbian occupational therapists to manage their identities, The lives
of these women indicate that they are subjected to and forced to deal with hctcrosexism
in various ways in every work environment described. The energy required to address
this issue, whether it was perceived as overwhelming or merely a nuisance, is energy
that would best be used enhancing patient care.
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CHAPTER6
OCCUPATIONAL THERAPY CLINICS:
AUTHENTIC PATIENT CARE
In this chapter, I shift mostly to the perspectives of the lesbians who arc
disabled and begin to construct a sense of what is needed so that occupational therapy
can be more authentic. For the most part, patients wake up one day to find themselves
immersed in a hospital culture, a setting where they would rarely opt to spend their
lime, if given a choice. The lack of (It that patients feel in their hospital settings stems
from the suddenness of their disability and the general sterility of medical settings.
But, for the lesbian patients in this study, superimposed upon this general feeling was
the heteroscxist character of hospital environments. Because this dissertation is
concerned with how sexual orientation influences health care experiences, the
overarching question, How important is it that hospitals be lesbian-sensitive in order to
provide quality medical core? will guide this section of the dissertation.
First, I will provide an overview of the women's account of their general
hospital experience accentuating both the problems and the joys of the rehabilitation
process. In this initial part, I hope to demonstrate that the women whom I interviewed
did not always perceive their lesbian identities to be the most problematic factor
interfering with good rehabilitative core. Instead they articulated a number of other
general hospital issues that quite simply baffled and frustrated them. I will describe
how these frustrations played out in the therapies and interactions during rehabilitation.
Although one's lesbian identity may not be perceived os the most important issue
throughout her entire hospitalization, many of the recipients of core who participated in
this study reported that it emerged as problematic at various time with various health
219
care professionals. In particular, problems were identified with respect to finding
lesbian-sensitive health care providers, giving honest responses to assessment
procedures, receiving adequate unbiased care, and engaging in genuine interaction
with health care professionals. I will address each of these issues, in the hope of
demonstrating how a lesbian-sensitive environment is necessary for quality medical
care. Although I wilt focus on how lesbian issues affect occupational therapy services
with respect to each of the above categories, 1 will also address how they affect the
other medical services os issues arise. I do this because patients often talk about their
rehabilitation os a total experience, not as individualized therapies.
Health C aret Problem s and Joys, In G eneral
Discussion of the problems and successes that patients experienced with health
care in general demonstrates that being lesbian was not always the most visible
problem that these patients experienced within the hospital setting, although it was
present. For example, sexual orientation didn't seem to matter at all os they began to
deal with a life threatening emergency. Terri expressed this in her statement
At the initial time of the injury, I think I was given, like you
know, heroic treatment because, you know, they like, saved
my life. I had surgery and all of that, and it was like no
question about my sexuality or anything. There was just a
person in need, and that was really tremendous.
As time passed and patients became involved in reinventing their lives, being lesbian
was of greater concern. But until then, other salient issues emerged that, depending
on where on individual was in the rehabilitation process and how they handled being
lesbian in general, overshadowed any problem related to being lesbian. Three of these
issues are discussed; (a) philosophical conflicts with Western medicine; (b) conflicting
messages by health care providers; and (c) inadequate core. Finally, 1 will briefly
220
comment on what contributed to positive experiences in health cane, in order to avoid
any notion that all of rehabilitation was negative.
Western Medicine: A Rude Awakening
Western medicine is grounded in certain ideologies about the relationship
between patients and health core providers, the expected altitudes of patients and heath
care providers, and the expected behaviors of patients and health care providers (Starr,
1982; Ycrxa, 1983). Such notions, which arc often so ingrained in health core
providers that they arc unable to articulate them, become the basis of conflict for
patients who do not conform automatically to the expectations of the health care
providers. To understand the feelings of the women in this study, a brief review of
two values that underlie medical practice arc described by Elizabeth Ycrxa (1983).
First, traditional Western medicine is built upon the premise that the physician
is the expert who is responsible for eradicating disease while the patient is expected to
comply passively with the physician's wishes (Ycrxa, 1983). In this sense, a paternal
relationship exists in which the physician holds the authority about the "proper course
or action" to take with respect to the patient's body. The patient, in turn accepts the
physician's expertise. Paul Starr (1982) suggests that the roots of medical authority tic
in the legitimacy physicians receive through their education and status, and the
dependency of patients who will incur "foul consequences" if they choose not to obey.
This hierarchical, patriarchal relationship which is, in part, supported through the
potential of severe consequences may disadvantage patients who do not comply with
physicians, or any other health care professional's orders.
Second, Western medicine, which is grounded in the physical sciences, values
"objectivity, analysis, observation, and diagnosis" (Yerxa, 1983, p. 155). Disease,
according to Western medicine, lies in some physical malfunction of the body.
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Humans arc often viewed as "body machines” which can be repaired through
medication or surgery to correct the defunct mechanism (Ycrxa, 1983). Physicians
who are trained in Western medicine pay less attention to subjective factors such os the
individual's emotional system or the environment's influence on health than they do to
the physical systems. Rather than a holistic approach, quality health care depends
upon specialists who have thorough knowledge about the workings of one particular
body part. One could argue that viewing the human as a physical entity white ignoring
his or her emotions seems to influence not only the technical diagnostic and treatment
procedures of Western medicine but also the interactions and respect of patients as
people with experiences, fears, hopes and emotions. As Reynolds Price (1994) points
out in his book about his life with cancer.
The vastly improved technology of modem medicine
obviously requires that the seriously threatened patient come to
the cumbersome machinery; most of it cannot come to him.
But surely it's more than incumbent on the doctor to know the
nature of the toll he or she has exacted from a fellow creaturc-
somcone in pain or fcar-in forcing that move from the safely
of home to the faceless threat of hospital hallways. And surely
a doctor should be expected to share— and to offer at all
appropriate hours--the skills we expect of a teacher, a fireman,
a priest, a cop, the neighborhood milkman or the dog manager.
Those ore merely the skills of human sympathy, the skills
for letting another creature know that his or her concern is
honored and valued and that, whether a cure is likely or not, all
possible efforts will be expended to achieve that aim or to ease
incurable agony toward its welcome end. (pp. 145-146)
At the end of his discussion detailing what many physicians lock in their treatment of
human patients, he comments that some practitioners might do well to hand the sign
Expect technician. Expect no more. The quality ojyour life and death are your
concern" (p. 146) on their door or lab coat. The point that he, like many of the
patients in this study, is making is that, in Western medicine, a specialist's attention to
the physical body is experienced as a depersonalized technical fixing to a patient.
Given these philosophical underpinnings or Western medicine, one can begin
to understand the problems that some women had in feeling comfortable in the hospital
environment in general, notwithstanding their sexual orientation. During the
interviews, these women told stories of their hospitalizations which were filled with
frustration and pure bewilderment as to why treatment occurred the way it did. Emma
was probably the most out of synchrony with the philosophies guiding Western
medicine. Prior to her head trauma injury, Emma's infrequent medical needs had been
eared for by osteopaths, naturopaths, and acupuncturists, many of whom had a
feminist perspective on health care. The degree to which the hospital environment was
alien territory was exemplified in the statement, "I didn't even know what a fucking
neurosurgeon was." She came from a more holistic approach to medical care and was
accustomed to coequal participation in her health care. Because she was studying to be
a naturopath at the time of her injuty, she fell entitled to have a say in the type of
medical care she received. This did not readily occur and it took time for her to begin
to figure out how to refuse certain treatments, much less have a say in them before
they were ordered. Thus, she perceived herself in constant power struggles with the
physicians and nurses over who controlled her body.
Emma stated, "The extent to which MD's [are] fragmented shocked me. It
really did. That Doctor Moc could know about this 3 inches of my neck and not know
how to examine my leg was to me... I couldn't figure out how you could be quite
that specialized." It was no wonder that Emma felt more at ease when she received
treatments from her osteopath who helped her release negative emotions that were
interfering with her mobility. Emma believed that the body systems interacted in
overall health and therefore, her osteopath's approach was more understandable to her
than that of her MD. Furthermore, subscribing to a lesbian separatist philosophy,
Emma had previously surrounded herself with female healers. During her present
223
hospitalization, she felt overwhelmed by the number of men who could touch, prod,
and move her body at their will, not hers. Because her view of health care dashes so
dramatically with Western medicine, Emma's major obstacles in the hospital setting
arose from trying to figure out her place in the medical system as well as dealing with a
new injury.
Although Emma's frustration with her initial hospitalization occurred in part
from her unfamiliarity with Western medicine, other patients who had experienced
only Western medicine, although infrequently, expressed similar complaints. Terri,
who described herself as a jock indicating that she was very healthy prior to her spinal
cord injury, found the hospital to be foreign territory. She stated.
It was like shock. This was my first, my, um, my first
interaction with the medical field and just, you know, the
impersonal,. . . yeah, detached treatment. It was really like
who arc these people? you know. What arc people doing to
my body or, you know, they're just talking about me like I
was a piece of meat.
She acknowledges that even for those individuals who arc aware of Western Medicine,
being totally immersed in a hospital situation where health care professionals suddenly
claim control over your body parts, is disturbing. Like Emma, Terri initially felt
bewildered and had to struggle with understanding the parameters of this new system
in which she felt she no longer had a say over what would happen to her body, and in
which her body was treated os distinct from her emotional self, like a machine that
needed to be fixed. Terri was forced to assimilate the seemingly prevailing mindset,
that the professionals were the experts and decision makers and that the patient should
passively trust their decisions, in a very short time, in order for her to survive
*
emotionally in this system.
The frustration with having no control over medical decisions materialized in
specific treatment sessions. Both Terri and Barbara, who had been treated at the same
224
hospital although approximately 10 years apart, were frustrated that they were not
allowed to have indwelling catheters and leg bags but rather told that they needed to
wear Depends, a diaper to cate for adults' urinary incontinence. The physicians
argued that catheters would cause a continual bladder infection requiring ongoing
antibiotic cote; the patients argued that emptying a leg bag rather than toilet transfers
and diaper changes allowed flexibility for reluming to work and travel. It gave them
"total freedom.” These competing arguments exemplify the conflicts the patients felt
when their desire to participate in everyday occupations collided with the medical
professional's desires to cure the disease or fix a body part Both Terri and Barbara
were clever and assertive enough to eventually manipulate the system and get what
they wanted. They talked at length about how a catheter enhanced their quality of life
by giving them more freedom to participate in a variety of occupations in the realm of
work and leisure.
Conflicting Messages
The second issue that became problematic was the conflicting expectations of
medical personnel toward patients' rehabilitation. Medical personnel seemed to
encourage patients to "gel better" and "regain function" while simultaneously
suggesting that they should respond passively and accept their eventual disability.
Sandy was taken out of physical therapy where she was working very hard to regain
her ability to walk, in order to sign Social Security documents that would "admit that 1
was going to be a vegetable. . . admit my shortcomings." She was bewildered and
angry that she was being asked to replace the vision she had of being able to return to
the occupations that constituted her previous life with a vision that emphasized
shortcomings and passivity. She was equally shocked that the hospital which was
assumed was concerned with her "getting belter" interrupted the process of "getting
225
better" (therapy) to make a final pronouncement or permanent disability (signing
documents). Sandy's hope, encouraged by the therapists who assured her that
physical improvement can continue until 1 year after a cerebral vascular accident, was
simultaneously being destroyed by the social worker who demanded that she agree to a
permanent disability status. It is quite possible that the social worker was attempting
to work within the system by setting Sandy up with the social services that she would
need os she worked toward independence and was not intentionally squelching
Sandy's hopes. But the fact that she was taken out of therapy, against her will,
contributed to her frustration.
Other patients such os Lee reported being incensed over the way that certain
therapies look precedence over others in the eyes of the medical doctors, regardless of
what they meant to the patient She recalled that only physical therapy was
competently addressing issues she deemed relevant to her life. On numerous
occasions, though, she would be removed from physical therapy for a variety of, in
her eyes, irrelevant medical appointments. She stated.
Every person who treated me felt they hod the right to moke
appointments for me without my permission. And I would be
working out in the PT [gym] and some technician from x-ray
would come and say "You have to go to x-ray." "What for?"
"We're having a KUB today." "We, who, pale face. I'm not
leaving." "Well, you have on appointment." "Nobody asked
me." And the FT person then had to assist the technician to
take me over to keep the appointment. And I told my social
worker and the head of nursing, "Don't do that. I'm paying
you people. Stop treating, you know," They pin this yellow
tag on you to say, with your name and number. I said "Why
don't you put it on my toe. You already treat me like a dead
person anyway.
Patients construct personal agendas os they move through therapy. Many of
them are just beginning to imagine a future outside the hospital walls. Although this
vision may shift and change throughout their therapy, they often have a singular
purpose, that of getting well. They rely upon medical personnel to support this goal.
But the medical institution can be, in the w ont eases, driven by bureaucratic rules and
medical paternalism. It is common practice for personnel who are attempting to work
within that bureaucracy to assert their authority over patients. When this authority is in
direct conflict with what the patients perceive to be the purpose of their hospitalization
patients gel angry in an attempt to defend their chance to get healthy. 1 1 was simply
incomprehensible to Sandy and Barbara that the medical personnel would thwart their
attempts at rehabilitating their lives.
Inadequate Care
Patients appeared most angry when they perceived their care to be less than
adequate. Terri claimed that she first realized how poor her physical therapy had been
when she relumed to another hospital for outpatient follow-up care and learned that
she hod not been taught the proper mechanisms for transfers. She reflected that in
actuality, she, not her therapist, had taught herself to transfer into a car when she
desperately wanted a weekend pass. She found it most distressing because her
rehabilitation occurred at a world-renowned hospital which was known for employing
excellent physical therapists. She just happened to be assigned a physical therapist
who was also a model for a jewelry company and, who Terri felt, was more concerned
with this second vocation than her present job.
Other incidents of inadequate core included Isabel, who was extremely upset
when she realized that the intravenous medication for her multiple sclerosis was not
working and that she may soon be sent home, unable to perform a transfer
independently. Emma was irate when she attempted on numerous occasions to
convince the nursing staff that she was allergic to the milk that they were giving her.
Finally, Linda appeared to be disillusioned with occupational therapy that she felt was
"designed for quads" not people with paraplegia. As she stated, the only reason she
227
was being treated by occupational therapists was because "What else were they going
to do with me? I had 2 hours a day that were unscheduled, if t didn't do that" These
and similar complaints that inadequate care had been provided were not confined to a
few disciplines. They spanned all health care professions including physical medicine,
nursing care, physical and occupational therapy, social work, and vocational, religious
and psychological counseling. Moreover, they usually occurred when treatments were
determined to be ineffective, without purpose, or when the women felt they were
treated with disrespect
Again, one can sense that these patients experience an urgency to get better.
They, perhaps more than the health care professionals who worked with them,
appreciated the importance of gaining all they could from their time in rehabilitation.
On some intuitive level they sensed that poor medical core can severely impact their
chances for success. Most of all, these women seemed to be expressing the frustration
that comes from suspecting that one's personal choice for success was being thwarted
by the policies and altitudes embraced by the institution that they supposed is designed
to assist in the rehabilitation process.
Rehabilitation: The Fbsitivc Side
To provide an accurate view of the health core experiences of the women who
were interviewed, it must be emphasized that not all rehabilitation or other medical
experiences were perceived os negative. To the contrary, Sandy felt that her
rehabilitation program was excellent and, except for a few disconcerting events, she
was happy with her care. Others reported similar positive attitudes for at least parts of
their medical care. Whether or not the hospitalization was perceived os positive was
usually related to (a) the patient perceiving therapies and medical core as relevant to
228
their lives and provided by a competent health cane provider, and (b) their health cane
providers demonstrating a general and respectful concern for their well-being.
Positive rehabilitation, therefore, is the flip side of what is considered
inadequate care. For example, Roberta was delighted when she was transferred to a
hospital where she was taught how to avoid pressure sores in a regular rather than a
hospital bed, because it related to her life outside the hospital "where you don't
necessarily have beds that accommodate you." Terri spoke about being excited that
she is now connected with a physical therapist who had expertise to teach her the
transfers and other mobility skills that she will need in order to be the "elite athlete" she
desires. Finally, almost all stated that they needed health care professionals who
would respect them as participants in their health care by brainstorming ways to solve
problems or by talking about their life satisfaction in general. These qualitics-
ossisting people to adapt to obstacles that ore part of their lives outside hospitals,
helping people enact new identities and respecting people os participants in their carc-
are all central to the beliefs of occupational therapy, although not always held by
occupational therapist.
In summary, some of the women in this study who underwent rehabilitation
seemed to have been overwhelmed by their initial induction into the rehabilitation
process. They felt estranged in the hospital setting, confused by the conflicting
expectations of health care professionals, and angered by the inadequate care they
received. Simultaneously, they marveled at their successes and were satisfied when
they encountered competent health care professionals who provided meaningful and
respectful services. At limes, these issues loomed in the forefront of their
hospitalizations, pushing anything to do with sexual orientation into the background.
As Clark (1993) has suggested, the hospital is a place of liminalily, suspended in time.
Thus, some patients suspend their full identities as they attempt to rebuild their lives.
229
When sexual orientation is perceived as a problem, these patients may decide to keep
quiet or ignore the problem in order to survive in this foreign medical arena, realizing
that their hospital stay is only a "moment" suspended in time and they can get back to
living their lives, after discharge.
Being lesbian was not always perceived as an important issue during the early
stages of rehabilitation because people were dealing with a life-threatening emergency.
When people are newly injured they are often most concerned with getting their bodies
back in working order. Terri, like other women with whom I spoke, perceived the
medical hospital to be a place where getting well meant she would receive physical care
and might even be physically cured. It takes time to realize that one may never regain
prior physical ability and to begin to envision life with a different kind of body. This
shift in a person's consciousness may only begin to develop during the rehabilitation
process coming into sharper focus after discharge from the hospital setting. It is
reasonable, then, that patients may bring an understanding of acute medicine into the
rehabilitative process. If this occurs, the rehabilitation process could be interpreted
initially as a process of being physically cured in order to return to one's previous life.
In fact, walking, talking, moving a body part, or going to the bathroom were often
recounted as primary concerns during the rehabilitation phase of recovery. From a
stance in which the physical aspect of care is emphasized, sexual orientation did not
appear to be important. However, as I will demonstrate in the next section, whether or
not it appeared to be important on the surface, it had negative consequences in almost
all aspects of occupational therapy and medical treatments, in general.
Sexual Orientation: Its Influence on Health Care
In the previous section I painted a broad picture of the types issues that arise in
rehabilitation. Although rehabilitation was emphasized, these types of experiences
230
were not confined to the hospital setting but also occurred in a myriad or other medical
arenas in which the patients found themselves. I have also suggested that for some
patients it appeared as though on the surface being lesbian was not a salient issue in
their rehabilitation process or subsequent medical interventions. In this next section, 1
will begin to unpack how being lesbian, gay, and bisexual influences occupational
therapy and other medical interventions. Four areas in which being lesbian seemed to
create the most problems for the patients will be discussed: finding a sensitive medical
professional, assessments, treatment approaches and therapeutic interactions.
Finding a Sensitive Medical Professional
In general, the participants talked about being more secure with medical
professionals who were sensitive to lesbian issues. The implication is not that they
preferred only lesbian medical professionals, although most would certainly go to
someone whom they knew was lesbian in preference to someone who was straight, if
both were equally competent What was most important was that they could feel free
to talk about being lesbian without fear of, os Roberta stated, "getting that one
psychotic [health care professional]." As Stevens (1992b) pointed out, either through
personal or vicarious experiences, lesbians become astutely aware of the consequences
of hetcrosexism among health care providers. This knowledge results in constant
negotiations between sharing information about their lesbian identity that they perceive
as possibly affecting their health care and realizing that sharing anything at all could
prevent them from receiving good health care. The women with whom I spoke
therefore sought health care professionals who were lesbian-sensitive.
Health care professionals who were considered sensitive to lesbian issues were
usually described in terms such as "she was always there for me, she listened and she
acted, and she was a real life-saver." A significant part of "being there for someone
231
and listening" is the ability to pick up on life issues that may, on the surface, be
presented as one problem and underneath be lesbian-related. Roberta expressed strong
appreciation that her social worker was able to move beyond the "quad attendant
problems" she was having with her attendant and lover and see them as "a troubled
lesbian relationship." People also felt secure when health care professionals
acknowledged that they were aware of issues that were of concern to lesbians.
Roberta stated, "He was very, very concerned about... breast stuff, knowing that
lesbians who haven't had children run a great [risk]."
Although receiving services from a sensitive health care professional was
important, the majority of participants in this study who hod occupational therapy were
not afforded the opportunity to choose particular occupational therapist or seek
referrals for them. Typically, they were admitted to a hospital near their homes, one
that their insurance policies would cover, or one with a good reputation. It usually
happened quite suddenly. Even though this was the status quo, one woman, Barbara
did have an opportunity to shop around (via advocates) for an appropriate hospital.
Her partner and a friend who was a vocational counselor interviewed hospital
administrators at a number of facilities to determine where she would receive the best
core, with respect to her spinal cord injury and to being lesbian. As Barbara
explained, the hospital she chose "hod the largest facility and the greatest number of
people in wheelchairs getting treatment at any time, alt the time "and supposedly had
lesbian therapists. Unfortunately, Barbara's attempts backfired. She received good
physical therapy and vocational rehabilitation services but was critical of the care
received from physicians, nurses, occupational therapists, psychologists, and social
workers. She was also confronted with constant hctcrosexism. Unlike referrals to
private health care professionals, rehabilitation professionals come in a team. Even
though one team member may be receptive to lesbianism, others may find it repulsive.
Barbara found herself in this situation. Although she identified at least three sensitive
people at the rehabilitation center, she believed her lesbianism became an issue of
which everyone was aware but not accepting.
The therapists I interviewed also spoke about feeling especially excited when
they could provide services to clients or families who were lesbian or gay. They too
understood the advantages of having therapists who could be sensitive to homosexual
issues. Yet they acknowledged the difficulty they had in connecting with patients on
the level of sexual orientation because of the hesitancy on both the therapists' and the
patients' part to share this aspect of themselves. Behind this shroud of hesitancy,
therapists tried to demonstrate their desire to work with lesbian, gay, or bisexual
patients without disclosing their own sexual orientations. They hoped that, if they
publicly displayed their acceptance, these patients would be assigned to them. One
woman who remains closeted in all work situations stated that she was careful to
respond positively when her case manager gave her a referral to the home of a lesbian
couple to visit their child who was dcvclopmcntally delayed. Telling the ease manager
that her brother was gay and that she was happy to work with this family opened the
door to future referrals. This therapist believes that her case with the couple's sexual
orientation relaxed the parents, enhancing the therapeutic interactions. In fact, one of
her gay clients commented to her "God, you know I could tell that you were really
comfortable.”
In summary, when people seek the services of health care providers, they
desperately wont good care. "Getting well" is first and foremost on their minds. Like
most people, the women who participated in this study were aware that some health
core providers were more competent than others. Finding a "good" health care
provider, then, may appear to be a universal concern. But the notion of competency
took on an additional consideration for these women. Because of their lesbian
233
identities, they sought health care professionals who could, first, handle their lesbian
identity and, second, be cognizant of how one's lesbian identity may influence health
care issues.
Health care issues arc complex. Typically, people go to health care providers
to get assistance from experts in ascertaining what's wrong. The problem solving
required to diagnose a medical problem is dependent upon the patients' ability to share
with their health carc providers all the facts that may or may not contribute to the
medical problem. If patients censor issues relating to being lesbian, it is quite possible
that they may omit something that is critical to diagnosis. Silence about one's lesbian
identity and all the behaviors that come with it can thwart the medical process.
Knowledge that one is keeping some things secret can make lesbians uneasy,
constantly wondering if their medical core would be different, if they hod shored that
fact about their life. This may seem more obvious when applied to medical diagnosis,
such os the relationship of heterosexual intercourse to women's urinary tract
infections. But, as Roberta's situation demonstrated, the importance of sharing one's
lesbian identity enters into health carc issues that ore not physical in nature but are
similar to those addressed by occupational therapists. She pointed out that what may
superficially appear os an "attendant carc problem” is, in actuality, related to her
lesbian identity.
Lesbians, like most people who seek health care services, prefer health care
professionals who will provide them with the best medical core available. The best
medical core available, for them, entails having lesbian-sensitive health core providers
so that they feel secure in honestly talking about their lives. This does not necessarily
mean that the health carc provider needs to be lesbian herself. On the contrary,
heterosexual health care providers who were sensitive were much preferred over
lesbian or gay health carc providers who were not.
234
Assessments: Censorship or Disclosure
Formal assessments arc performed in occupational therapy to help determine be
the focus of therapeutic intervention. Occupational therapists use a myriad of
evaluations, some that have been developed within the profession and others that arc
imported from other professions. No therapists in this study asked directly about
sexual orientation, nor was it part of any formal assessment In fact, therapists
complained that the content of some formal assessments could not elicit information
about sexual orientation. For example, Marie suited that, for many of the people she
sees who have hip or hand injuries, the evaluations and treatments either include
standard biomcchanical procedures or teaching simple skills such as using a dressing
slick in a general routinized manner, neither of which tended to elicit conversations that
could imply one's sexual orientation. Jenna, who is an experienced therapist, also
confirmed this situation, suiting that when she performs vocational assessments for
people who have been injured on the job, sexual orientation never seems to surface.
On the other hand, when she worked with people who had psychiatric problems, she
was able to get at sexual orientation more easily. When the focus of occupational
therapy is solely on the physical aspects of the person, sexual orientation may appear
to have less relevance and is less likely to surface. Yet when evaluations address
occupations, home situations, relationships, or attendant core, there is more
opportunity for sexual orientation to arise os part of the conversation.
Sara further clarified that the format of some evaluations precluded deep
discussions even when the content could potentially elicit the subject. In fact, as the
following story about Sara demonstrates, sticking to the assessments actually deterred
the therapist from getting at one of the most important aspects of the patient's life,
being lesbian. Sara was a student finishing up her psych affiliation at a rehabilitation
hospital when she was asked to treat Pat, a woman who was diagnosed as having an
235
anxiety disorder. Adhering to Sara's request that she bring a family member to the
occupational therapy session. Pal arrived with her lesbian partner to whom she had
been married for 5 years. The two women freely disclosed their lesbian identity and
started talking about their relationship. Although Sara was not particularly phased by
their disclosure, she stated "1 certainly wasn't prepared to deal with that" Instead,
Sant dutifully handed Pat the standard occupational behavior evaluations and checklists
to fill out Reflecting back, Sara talked about how ineffective she felt, particularly
because the "forms and checklists" didn't seem to get at the heart of this couples
situation. Although they addressed relevant issues such as how Pat spends her time,
or Pat's occupational interests, the "form and checklist" format encourages
supcrflciality in discussing these issues.
It is evident that Sara's need to have the patient complete the specific evaluation
forms stemmed, in part, from being a new therapist. An experienced therapist, who
relies on tacit information to a greater degree than a strict problem idcntification-
treatmcnt model may have been more flexible and able to shift from the concrete formal
evaluation to an informal evaluation in which he or she simply would have elicited the
couple's story about their occupations (Mattingly & Fleming, 1994). On the other
hand, if therapists feel uncomfortable working with lesbians, gays, or bisexuals,
irrespective of their level of expertise, they could easily hide behind the assessment
and touch only the surface of pertinent areas. As it turned out, when Sara moved into
treatment where she did not rely on standard assessments, she was able to incorporate
issues relating to Pat's lesbian identity into the sessions. She stated,
I treated them os I would any other family. And that was her
family and so we had to work on strategies for handling stress
and decreasing anxiety, and what each could do, and you
know, there were a lot of things with managing the household,
and things like that.
236
Beyond a formal assessment phase of occupational therapy, therapists engage
in an ongoing evaluation process that often becomes embedded within treatment
sessions. Therapists listen carefully to their patients, searching for what makes their
lives unique and interesting and using this information to design treatment sessions
that arc relevant and appealing to each person. The therapists and patients looked for
signs during these informal assessments about someone's sexual orientation and how
it could play a part in the rehabilitation process. As many therapists pointed out, these
signs did not come easily and when they did they were not always readily detectable.
One of the reasons that sexual orientation is so difficult to assess is, in part, because of
the fear that therapists and patients have about being out in the medical institutions.
Many of the lesbians who received occupational therapy, shared that they rarely
noticed or remembered formal evaluations. During their first few sessions, they were
hoping to build positive rapport and looked for openings that would allow them to
share relevant parts of their lives. They preferred that therapists open the door for
discussions about sexual orientation by showing their acceptance. Isabel stated that a
direct question would be too confronting; she wanted to retain the choice and the
responsibility for sharing this information. Others wished that a lesbian, gay, or
bisexual identity could be addressed in the same manner that heterosexuality is.
Although a definitive answer as to how occupational therapists should address sexual
orientation in evaluations is not apparent from the interviewees, the recipients and
providers of occupational therapy in this study acknowledged that it is relevant to the
occupations that make up their lives and to the therapy that on individual receives.
In summary, therapists and patients seemed to be dancing around an issue that
they both knew was important to therapy and wanted to discuss but the prevalence of
assumed heterosexuality and hctcroscxism put both therapists and patients on guard.
Therapists were afraid that if their hunches about the patient's sexual orientation were
237
wrong and the person was insulted by a question about his or her sexual orientation or
wished to have their sexual orientation remain private, it may set up a non*thcrapcutic
relationship with that person. Patients arc afraid that disclosure to a health care
professional who is hctcroscxist may prevent them from getting quality care. Thus,
they seem locked in a stalemate, neither able to move forward.
Yet, as Crcpcau (1991) pointed out, because of the power differential
embedded in the palicnl-thcrapist relationship, it is the therapists who have the
responsibility for creating a trusting environment in which honest communication can
occur. Thus, it seems reasonable that occupational therapists might want to develop
strategies for respectfully eliciting information about sexual orientation during informal
assessments.
Specifically, this study points to the need for theorists and practitioners to
develop assessments whose content addresses this issue directly. In the first section
of this dissertation, I have shown that one's lesbian identity influences the occupations
in which she engages, with whom she carries out those occupations, the environment
in which those occupations occur, and the way people use occupations to adapt to
hctcroscxist environments. Based on that information, assessments that allow for
disclosure in the context of occupations may be important Therapists may also need
to slratcgizc ways to provide openings for informal discussions to occur.
Clark, Larsen, and Richardson (in press) provide guidelines as to how the
above may be accomplished as part of occupational therapy storytelling and story
making. These authors propose that during therapy, therapists and patients may need
to build a communal horizon of understanding, in which each begins to grasp the
other's standpoint The authors identify five techniques important to this process
including collaborating with the survivor, development of empathy, inclusion of the
ordinary, listening, and reflection. They specifically point out that discussing the
238
ordinary daily happenings can lead to critical insights about the patient's lire. For
patient's who are lesbian, gay, or bisexual, Clark ct al.'s approach may clear the way
for communication between therapists and patients to occur.
But in the final analysis, in order for the occupational therapy setting to be truly
safe, hctcroscxism must be eliminated from the clinics and medical arenas. It is overly
idealistic to suggest that occupational therapists could accomplish this task. However,
they could begin to chip away at the physical and verba] signs within their own clinics
that signify the acceptance of hctcroscxism.
Individualized Treatment
The following section examines four ways that sexual orientation influenced
occupational therapy service provision: (a) denying or providing less than adequate
services; (b) providing inaccurate information based on heterosexual content; (c)
providing gender-biased treatment; and (d) engaging in negative therapeutic
interactions.
Denied care and less than adequate services. The most bothersome incidents
that therapists reported about their particular clinics revolved around the hctcroscxist
comments and actions of their co-workers that resulted in patients being denied core or
receiving less than adequate care. Connie illustrated the first situation in her story
about the "AIDS unit." She described the system of patient assignment at her hospital
to be one based on fairness. Quite simply, orders come in and they are assigned to the
next therapist in line. In other words, "what ever comes up next, you have it." What
appears to be fair for the therapists does not necessarily turn out to be lair for the
patients. Connie claimed,
239
[some] people don't want to go to work on that unit [referring
to the AIDS unit]. . . . There's no one that has actually come
out and said I don't want to work on that unit. . . . It's the
patients that have been missed all week. You know so that
kind of a thing. Or the patient who's not a priority.
She continues to describe,
It depends who does the evaluation on the patient, on what we
think their needs are. Someone who thinks this patient is not
going to do well, this patient, you know, he doesn't really
need anything because of the disease process, he doesn't need
whatever, he's not going to be seen. But on the other hand, I
might see this patient and say that he docs need to be seen
because he needs this and this and this.
Occupational therapists often work with people who have progressive diseases
or terminal illnesses. Treatment stories about how they helped a dying mother make
time capsules filled with memories for her children or assisted a patient to prepare the
lost family meal together (Karcll-Pcrson, 1987) arc told with pride, indicating that
some therapists attach high value to helping patients find meaning in occupations, no
matter how disabled they may be or how long they have to live. Connie relates the
opposite response of therapists. Many of the patients on the AIDS unit were gay men
and AIDS remains a highly stigmatized disease. Some therapists were quick to avoid
these people, possibly because the therapists sincerely could not envision a valuable
treatment session for them. It is also possible that when therapists arc stressed by
patients' short hospital stays and down-sizing of departments, prioritizing patients, or
claiming some treatments ore more important than others may seem like a reasonable
strategy to some therapists. Likewise for the therapist who, because of fear or dislike,
doesn't want to work on that unit, a patient refusal to come to therapy might
subconsciously be welcomed. However, as Connie pointed out, for a period of time a
gay therapist offered to work with patients on that unit which resulted in many positive
treatments. Other therapists, who are lesbian and gay sensitive, have similar positive
responses.
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Occupational therapy's ethical codes, described by Bailey and Schwartzbcrg
(1995) require occupational therapists to "demonstrate concern for the well-being of
those receiving the therapist's services, by providing services equitably" (Principle of
Beneficence, p. 4); "take reasonable precautions to avoid harm to the service recipient"
(Principle of Nonmalcficcnce, p .6 ); and, respect the dignity of the people they serve
by informing them of potential outcomes, respecting patients' rights to refuse
treatment, gaining informed consent for research, and including patients in the
treatment planning proccss"(Principle of Autonomy, p. 9). Regardless of these broad
guidelines, those who have struggled with ethical issues both within and outside the
occupational therapy clinics (Bailey & Schwartzbcrg, 1995) claim that clear-cut
justifications about how to ration treatments, given ease overloads or the rising costs in
health care, arc difficult to moke. An important consideration in making these
decisions, though, is to focus on each specific patient's situation, paying attention to
the gains that can be mode for his or her particular life (Bailey & Schwartzbcrg, 1995).
Thus, therapists' decisions to deny treatment to patients from one diagnostic category
more often than other patients may be suspect. This is especially true, given that
ample guidelines for reasonable treatment for persons with AIDS exist within the
occupational therapy literature (Johnson & Pizzi, 1990; Pizzi, 1990a, b). Although the
intentions of each particular therapist in the above situation cannot be suited with
certainly, Connie suggested that the negative attitudes of some therapists toward
homosexuality color their interpretations about who should receive treatment priority
should be given or the ease with which they tolerate missed treatments.
Connie's story suggests that hctcroscxist attitudes shade therapists'
interpretation of patients' needs. These therapists, though, did not refuse openly to
treat a particular patient because of his or her sexual orientation. Connie explained that
because of the number of gay therapists in her facility, it was not politically correct to
241
admit to those biases and, thus, very few therapists talk about not wanting to treat
someone. In other hospital settings, negative altitudes toward lesbians and gays were
not as guarded. Jenna retold a story in which her co-workers' homophobia was much
more blatant. She was working in the vocational program of a rehabilitation hospital
when a woman who was open about being lesbian was referred for services. She
recalled that one day, when she was talking with the other two occupational therapists
and assistants at that facility, "they. . . voiced their opinion that they were
uncomfortable around her, they didn't understand her life style, they wouldn't work
with her, it was more like that global, '1 can't work with her.'" Jenna confessed that
she was troubled not only by their remarks but also by the poor treatment she
observed. She stated.
And when I saw that going on, I thought this isn't right to treat
somebody like this. The quality of treatment is different for
her than it is for everybody else. And at that point, I said. . .
Why don't you let me take over evaluating her?, 1 don't have a
problem interacting with her and I find her kind of fascinating.
And I was still passing so I didn't have to worry about it.
In this setting the tics between hclcrosexisl attitudes and inadequate treatment
was obvious to Jenna and supported by the therapists' own admission that they felt
uncomfortable. When hctcroscxist altitudes leading to unethical treatment are this
blatant, lesbian therapists often find themselves in a dilemma. Most of the therapists in
this study talked about feeling uneasy and needing to respond when heterosexism was
present, especially if it interfered with treatment. Yet responding was risky; it could
possibly out them. Because Jenna was still passing, she knew that offering to take
over treatment could evoke a question in her co-workers' minds about why she was so
willing to work with this patient, but she felt secure enough in her ability to pass to
take that risk. In addition, she confused this issue by explaining that she found this
patient fascinating. This comment is left open for interpretation. Whereas Jenna saw
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it in a positive light, that is, working with another lesbian could be fascinating, her co-
workers may interpret it mote negatively, that is that she was intrigued by the different
life style.
In summary, homosexuals receive less than adequate care by occupational
therapists, at times, because of the therapists' hclerosexist attitudes. Although in
Jenna's situation it was obvious to her that the quality of care was compromised by
therapist's attitudes, in Connie's situation we begin to see how homophobia can seep
into therapists' decisions, yet appear os if the decision making process is based solely
on legitimate concerns, such as justifiably rationing care. One reason hcterosexism
may be disguised is, as Connie suggested, because people arc beginning to realize that
verbalizing their hctcrosexist altitudes is "politically incorrect." Yet this story also
suggests that although therapists may remain silent, their decisions may still be colored
by their emotional responses. It seems that an accepting attitude toward lesbianism is
critical to providing quality care to homosexuals. Being sensitive to the needs of
lesbian, gays, and bisexuals, as welt as being attuned to the possibility that
homosexuals may be the victims of hctcrosexist altitudes is an important factor in
providing quality care that therapists who arc lesbian-sensitive can provide.
Heterosexual content The most overt heterosexual content was found in any
treatment that related to sexual activities. Both lesbian therapists and patients
immediately recognized their exclusion from the written materials or discussions
surrounding this subject matter. Marie commented that a women she was working
with confided to her that her back pain prevented her from engaging in sex with her
boyfriend. Curiously, she also commented that the foci that sex was missing from her
life was of no great concern to her. Marie, however, offered her a standard
department pamphlet that both described in derail and sketched out various pain-
243
reducing positions for heterosexual intercourse, stating that it may come in handy for
future reference. Although this patient indicated that she was heterosexual, the
interaction was a reminder to Marie that similar information would not be available for
lesbians or gays.
Not only was information for lesbians, gays, or bisexuals not available but no
one in the department seemed to recognize or be concerned with this omission. Marie
did not describe her co-workers as particularly homophobic but they were
heterosexuals who were immersed in a heterosexual world with no reason to question
what seemed to them to be the natural, normal way that sexual activities were carried
out. Pervasive hctcroscxism often creates blinders to the experiences of lesbian, gay,
or bisexuals. Thus, even when therapists wish to be sensitive to homosexual issues,
the degree to which heterosexual assumptions influence treatment is not apparent to
them. They are simply unable to correct faulty treatment because the problem is
invisible.
A situation that was even more dangerous, though, arose when Connie was
working with two gay men, one of whom was hospitalized for a cardiac problem. In
the course of their treatment, Bob brought up the issue of sex by reconfirming that he
had learned that men were not supposed to have sex until they could walk up a flight
of stairs without any cardiac symptoms. In the same breath, though, he quickly
dismissed this fact saying, "but that only counts for heterosexual people." Bob knew
that he was given information about heterosexual intercourse and that it was his
responsibility to interpret that piece of information for his own life as a gay man. He
cautiously approached the subject by making an off-the-cuff statement to test the
waters and see if Connie was receptive to discussing this subject matter. Connie was
receptive and adamantly clarified his misconception. Information that pertained to
heterosexuals was less than adequate for Bob. In fact, without the right circumstance,
244
that is, a gay man who was assertive enough to ask the question and a therapist who
had the knowledge and was open enough to answer the question, the consequences of
communicating inaccurate information could have led to some very serious bodily
damage.
As Bob's story demonstrates, lesbians, gays, and bisexuals ore responsible for
either reinterpreting heterosexual information or informing health care professionals
that heterosexual information is not relevant to their lives. Some of the women in this
study, though, stated that taking the responsibility for discussing sexual issues was
not easy. For example, Isabel indicated that, she had questions about the mechanics of
lovcmoking that she felt would be appropriate for occupational therapists. She had
worked with a number of occupational therapists who had helped her devise adaptive
equipment for her kitchen, bathroom, and bedroom. She herself had developed a very
elaborate method of getting herself out of bed with the use of ropes attached to the wall
opposite her bed. She had wonted an occupational therapist to help adapt this system
so that she would be able to roll over on top of her partner while making love without
asking her partner for assistance. She stated, "And the one area that I have never
talked with h e r. . . about. I haven't gotten together to say I want to know how to do.
how to have equipment available to engage in lovemaking." Arguably, discussing that
issue would be difficult for anyone regardless of their sexual orientation because sex is
an uncomfortable subject to bring up in the first place. However, for lesbians,
discussing sexual issues has the added dimension of outing oneself. Isabel's needs
will remain unmet until she can feel safe that she is working with an occupational
therapist who is receptive to lesbians.
In summary, occupational therapy services become inadequate for lesbians,
gays, and bisexuals when heterosexual bias exists in the information therapists provide
about the occupation of lovemaking. Inaccurate information becomes most dangerous
245
in Bob's situation where his heart could have been damaged had he left the hospital
with misperceptions regarding guidelines about sexual activity. The lack of sensitivity
on the part of the therapist, in Isabel's situation, did not endanger her life but did
prevent her from getting thorough treatment. The problem lies not only in the
provision of inaccurate treatment but also with the inability of therapists who arc not
sensitive to homosexual issues to change hctcroscxist treatment protocols. Thus,
lesbian-friendly therapists is important to the elimination of heterosexual biases in
occupational therapy.
Gender biases. In describing the hospital personnel, Natasha, a woman who
had orthopedic injuries, slated, "they were w eird. . . a mixture of sexism und
homophobia." Natasha suggests that lesbian invisibility in the rehabilitation process
is, in part, due to a broader gender bios in therapy. At least four of the women who
had undergone therapy discussed gender bias with respect to the expectations
therapists and other medical personnel had for patients' behaviors and goals. For
example, Natasha stated that the medical professionals wanted her to wear a "certain
hospital attire" meaning dresses, not shorts, and act in a "ladylike manner" meaning
smile not scream when being subjected to painful medical treatments. She further
reported, "I went to this orthopedic surgeon, he was. My leg was all munglcd to hell,
and he tells me. Well, you know, it won't look so bad if you'd shave your legs."
Natasha was a rugged woman; a good pair of jeans and the natural look suited her
fine. But her "look" was more representative of what medical personnel considered
mole.
More specifically, the purpose of rehabilitation is to both heal patients
physically to the extent possible and retrain them so they cun re-integrate into life's
activities. Patients' routines, in rehabilitation hospitals, are to some extent expected to
246
simulate "real lire." Getting out of bed and dressed everyday is one way that real life
is supposedly reproduced. The medical professionals are doing their job, attempting
to heat Natasha's "mangled teg,” and when they arc unable to do that, helping her
figure out ways to re-enter life looking os "normal” as possible. Therefore, they
encouraged her to dress and act like a lady in the hospital. The surgeon was sincere in
giving her extra hints on how to re-integrate into society after she was discharged.
Yet, underlying their therapeutic interventions was the gender bias that women should
look and behave according to traditional feminine standards. These images may have
fit for some women, including lesbians, they did not do so for Natasha.
One caveat is that this particular story occurred 15 years ago. One could argue
that with the influence of feminism and general societal awareness about gender
biases, hospital practices have probably changed. To some extent they have. No
other interviewee talked about having difficulty fitting into a hospital dress code for
women. Wearing pants or shorts is readily accepted and is part of dressing training in
occupational therapy. However, two women, both of whom had spinal cord injuries,
reported similar stories that they felt their rehabilitation was geared toward men.
These two women underwent rehabilitation at the same hospital, although Terri
completed her rehabilitation 14 years ago and Barbara 4 years ago. It was not os easy
for Barbara and Terri to specify how gender biases influenced treatment. They talked
about certain expectations being held for men and certain expectations being held for
women, expectations that were never verbalized but seemed to ooze their way into the
therapy via the type of treatments that were provided and the attitudes of therapists.
For example, Terri commented, "I think in general they, the general population thinks
of women being dependent on men and that, you know, they just send you out into the
world, you know, with the idea that somebody's going to come along and take core of
you." Prior to her accident, she was the first journey woman tree cutter Cal Trans hod
247
hired in her district. In her words, she was a daredevil and enjoyed the notion of
going out to do dangerous things. She admitted cmborrassedly that her rehabilitation
had occurred prior to her becoming a feminist and, thus, she was in a somewhat
unequal relationship with her partner. Her partner was responsible for performing
household chores and caring emotionally for Terri, she was responsible for working
outside the home and bringing in the money. Therapy became confusing because after
adaptive strategies for dressing, grooming, and dining had been learned, there seemed
to be a stalemate. The traditional tasks of homccarc that were part of standard training
for female patients were not appropriate in this situation.
Terri talked positively about her occupational therapist, stating that she
adequately performed her job during a home visit in which she made sure that
someone would attend to home tasks, even if it wasn't Terri. Yet something was
missing from her therapy. Terri would have benefited from a more physically
challenging therapy in which she learned to do heavy sports. She staled that she
wasn't even taught proper transfers. It took her many years to find a physical therapist
who would assist her as she trained for the Quy Olympics, a vision that could have
been prepared for in her early years of therapy had she not been slotted into what
seemed to be a traditional program for women with disabilities.
In addition to the type of treatment Terri received, she implied that male
patients were given more attention. There seemed to be more concern that they would
succeed and make it in the world. It was almost as if the expectation that men would
need to do more because women would eventually be token care of by someone else
was translated into the visions that therapists had for their patients' futures and the
specific treatments they designed to meet these visions. (I will discuss this further
under interactions).
248
Gender biases also appear to influence the way the women were taught to deal
with bladder incontinence. Both Terri and Barbara were angered that women learned
to cathctcrizc themselves only in bed and were expected to wear Depends (diapers)
rather than have indwelling catheters and leg bags, which was the standard procedure
used by men. These methods were reasonable for a woman who worked at home.
She could wheel herself to her bedroom, transfer to the bed, change her Depends, and
sclf-cathclcrizc as needed. However, for women who worked outside the home,
knowing how to cathctcrizc themselves while sitting in a wheelchair during a lunch
break was essential. Furthermore, needing to take frequent breaks to change Depends,
often in inaccessible bathrooms, was inconvenient and interfered with job
performance. A leg bag needs emptying less frequently than changing Depends and it
is easier to swing one's leg over a toilet than perform a transfer in an inaccessible
bathroom.
Of course, one could argue that medical reasons worn against indwelling
catheters for women, claiming that they will create life-long infections. Even if one
accepts this argument, how to manage bladder incontinence at the work site would be
given more attention, if therapy for women were geared toward returning to the public
work arena. It would at least have been a topic for discussion in therapy. Barbara's
and Terri's concerns would have been met with compassion and attempts to devise
alternative ways to deal with incontinence. However, Barbara and Terri felt that the
medical professionals expected them to accept the standard female approach to bladder
continence, an approach that assumes women will stay at home. On a broader scale,
research addressing ways to curb continual bladder infections may receive more
attention if this problem were acknowledged as important. As feminist authors are
beginning to point out, women's issues or women themselves have been noticeably
absent from medical research agendas (Epstein, 1988; Tavris. 1992). Tavris (1992)
cites many examples that research on heart disease, drugs, alcohol, rheumatoid
arthritis, cholesterol, and hyperglycemia in women has been lagging, to name a few.
The pervasive male perspective in medical research has allowed male bodies to become
the medical standard against which women arc mismcasurcd, and male concerns arc
the concerns that reach the level of research (Tavris, 1992).
Finally, the most explicit example of how sexism and hctcroscxism influenced
therapy occurred in sexual counseling. Terri stated, "Well, you know, we all get sent
to Dr. X's (a male urologist), you know, little classes on sexual activities which arc
totally geared towards men. Absolutely totally geared toward men." The classes that
were provided stemmed from a rather limited and traditional view or heterosexual sex,
the purpose of which is to have children. Women were seen os the bearers and men
provided the sperm. Thus, the predominant message of this class seemed to be
assuring men that they could still father a child and assuring women that they could
still have one. From this perspective, it would seem reasonable that the majority of the
instruction would be geared toward men, many of whom needed to learn new
techniques for ejaculating because women could be impregnated despite the fact that
they couldn't feet or move anything below their chest. It was reasonable, given that
the relationship between urology and sexual function is more pertinent for men than
women, to have a male urologist conduct the course on sexual functioning that is
geared toward men. Barbara summarized the classes slating, "The [male] quad rolled
in who had a child, stud! . . . that's their equivalent to the toss of ejaculation, [the
message was] I can do it, so can you."
Female reproduction was not given the same emphasis. The classes did not
begin to address issues that lesbians may face in having and rearing a child. As
Barbara stated, T hat has nothing to do with my life. However, I had wanted a child
at that time but I was not concerned with reproduction." Issues around sperm banks
250
or adoptions when people carry a double stigma of being lesbian and disabled, or
around parenting with a disability that may have been important to lesbians and some
heterosexual women and men were not addressed. Sex as an intimate occupation, for
its pure physical pleasure, was ignored. Most would agree that heterosexual sex is not
solely for reproductive purposes but lesbian sex is never for reproductive purposes.
By focusing on reproduction, the medical professionals were completely ignoring
lesbian sexuality. Barbara stated that "They couldn't even begin to fathom the loss 1
felt as a woman, with my body and with my sexuality." She recalled that they told her
in a rather patronizing voice, "Well, it's not that different. After all, the mind is the
primary sex organ and there's nothing wrong with your mind." It was obvious that
the physical lust and tender touch that is all part of sex was pushed into the
background, if it was addressed at all. Terri concluded by stating that everything she
learned about her sexuality, she learned by reading in books about women with
disabilities.
To understand fully why gender issues became so central to women who were
rehabilitated in orthopedic departments of hospitals, one must examine both the
"vocational concept of disability" (Bickcnbach, 1993, p. 94) and the prevalence of
male patients with orthopedic injuries. Bickcnbach states,
And in the United States in particular, disability as a category
for entitlement to both private and public insurance schemes at
the turn of this century was assessed in terms of the ability of
the upplicanl to pursue 'gainful occupation.' American social
security legislation, when it come on the scene in the 1930's
and 1940's, retained this vocational concept of disability.
(1993, p. 94)
Bickenbach illustrates how a national philosophy toward disability was embedded in
many of the laws that regulated federal funding for rehabilitation programs such as the
Rehabilitation Act of 1973. This act, for example, provided vocational funding for
only those individuals who hod a retum-to-work goal. Because work was defined as
251
paid work outside the home, women who chose to work within the home did not
qualify for funds and thus rehabilitation was truncated for them. Additionally, the
opportunities for people with disabilities to re-enter the work force was slim, and those
that existed were primarily for men. Thus, rehabilitation programs had more to offer
men in general and for those with the goal of returning to paid work specifically.
Furthermore, the fact that orthopedic injuries mostly happen to men meant that
rehabilitation centers were often filled with male patients. Therapists were thus
encouraged to continue their focus on men, to the detriment of the female patients (hey
did have.
In summary, sexism and homophobia have been closely entwined through
history (Blumcnfcld, 1992; Dubcrman cl al., 1989; Pharr, 1988;). In fact, throughout
history, lesbian women were more often punished for usurping mole privilege through
their dress, language, and work, than for the actual love relationships they had with
another women (San Francisco Lesbian and Oay History Project, 1989). Numerous
authors have shown that political discrimination against lesbians and gays often goes
hand-in-hand with strong social efforts to force upon women the traditional gender
expectations that women's primary purpose is procreation and maintaining the
emotional well-being of the family. Lesbians seems to be threatening because they
challenge the heterosexual status quo by engaging in activities and behaviors that arc
reserved for men through systems of patriarchy. The threat becomes viable only when
ideologies that specify certain behaviors for men and women are upheld as the natural
and morally correct way of being. Thus, as Suzanne Pharr (1988) stated, "Without
the existence of sexism, there would be no homophobia" (p. 26).
Not all lesbians desire to engage in those activities that have been associated
with men. However, in this study, two women fully expected to work outside the
home, and one desired to participate in heavy sports. Sexist notions about what
252
women should and should not do, combined with homophobic attitudes, strongly
influenced the rehabilitation of these women. They felt that gender biases precluded
them from receiving thorough treatment that addressed their particular lives. Although
the specific ways these gender biases manifest in therapeutic treatment may have
shifted over lime, they arc still present. What is most telling about the tenacity of
hctcroscxism in occupational therapy clinics is that Barbara and Terri, who underwent
rehabilitation 10 years apart at the same facility, had the identical complaint that males
were given more attention and better treatment than females. Despite the changes in
attitudes toward women, rehabilitation seems to be lagging behind. The quality of care
for these two was compromised because of the gender biases that were held by their
therapists and were embedded in the treatment protocols.
Therapeutic interactions. Occupational therapists believe strongly in the
importance of patients' active involvement for therapy to be truly successful. This
belief, a hallmark of the occupational therapy profession, materializes in clinical
practice os patients become absorbed in performing occupations that arc relevant to
their future lives. Expectations for active involvement also apply to the therapeutic
relationship between occupational therapists and patients. Occupational therapists
continually develop and nurture their relationships with patients by engaging them in
conversations that may range from relatively neutral subjects such as how they slept
the previous night, to more in-depth subjects, such as how they feel about returning to
work. Both therapists and patients must be willing to actively participate for these
relationships to flourish.
Clinical reasoning studies have begun to illuminate the importance of patient-
therapist interactions in building rapport, trust, and, most of all, enabling the therapist
and patient to design a therapeutic program that is relevant to the specifics of that
253
patient's life. (Clark ct al., in press; Crcpcau, 1991; Mattingly & Fleming, 1994).
Although the specific ways that palicnt-thcrapist interactions enhance the occupational
therapy process have most recently been discussed in the context of clinical reasoning
studies, this issue has been recognized as important from the inception of the
occupational therapy profession, and has been emphasized in curricula under the rubric
of therapeutic use of self. Given that these interactions arc perceived as vital to the
therapeutic process, I will now discuss two ways in which the interactions between
health care professionals and patients were less than adequate, including general
interactions and specific references to partners.
Mattingly and Fleming (1994) pointed out that in order for occupational
therapy to work, therapists need to "gel under the skin of their patients." The need to
become involved with their patients' lives is at odds with the philosophy of the
traditional medical model that being unbiased and detached can be an ussct to
treatment. Rather than interpreting detachment as an asset, patients often describe such
interactions as dehumanizing. Price (1994) depicts the relationship he had with his
physician in the following statement:" ... my presiding oncologist saw me as seldom
as he could manage. He plainly turned aside when I attempted casual conversation in
the halls; and he seemed to know literally no word or look of mild encouragement" (p.
56). He adds, "what [I] needed badly from that man then, was the frank exchange of
decent concern" (p. 56), unattainable through the wall of detached professionalism that
the physician had constructed between them. By contrast, Price described the nurses
as "those women were able to blend their professional code with the oldest natural
code of all-mere human connection, the simple looks and words that award a
suffering creature his or her dignity" (p. 132). Similarly he stated,
My first therapist was Diana Betz, a woman who proved her
loyalty in numerous professional and friendly acts of
generosity and who played a tangible part in my survival.
254
z ?
With never a trace or complacency, she quietly proved that a
thoroughly skilled medical practitioner can give a patient
constant human sympathy, frequent warm laughter and
realistic caution without surrendering her own perspective and
self-possession. (pp. 38*39)
He demonstrates how the ideologies of Western medicine may infiltrate some health
care professional behaviors and not others.
The lesbians I interviewed were just as appalled as Price at the detached
auiludcs of some health care professionals, physicians in particular. For example,
Terri recounted the "weekly rounds ritual” in which ten or so medical personnel filed
into the room, flung open the curtain surrounding her bed, and proceeded to talk to
each other about her, making minimal eye contact and only occasionally asking a
question. Although detached health care providers were not appreciated by the
lesbians I interviewed, these women were clearly aware that some therapists and
nurses did relate to other patients, as Price suggested, with care, yet were reserved
when interacting with them. These patients inferred that their lesbian identities, not
just that they were patients, was affecting their relationship with their caregivers. Terri
described the differences she perceived between the treatment she was provided and
the treatment that she had observed other patients receive. She stated,
1 was 23 years old and very naive, very young and very proud
of being a lesbian. . . I told them in rehab that I was a lesbian,
you know, because my partner was there with me and she was
there, you know, cvciy day, helping to take core of me and
what-not. And it just seemed like from then on the nurses, all
kind of like, you know, were a little bit standoffish and just,
you know, there wasn't that some kind of loving, you know,
sweet care that generally, you know, that people gel when
you're in that kind of situation. . . . There was just always
that kind of, you know, feeling that they were like, you know,
not, I don't know if it's amused or just, you know, bewildered
by me or something. It was like, they just, it was like all of a
sudden I was this, you know, strange, enigma-type person.
255
Although Terri referred to the nursing staff, she identified similar responses by her
physical therapist, indicating that these interactions were not confined to one
discipline.
Barbara specified the particular ways that interactions with the nursing staff
and occupational and physical therapists ostracized patients from health core
professionals. With reference to the nursing staff she stated.
People usually warm to me. And I lake a lot of pride in being
able to move people into my sphere. And at first, there was a
distance. I believe it was because lesbian was there in 6-inch
tall letters somewhere in the chart And the, the uh attendant
staff and the nursing staff treated me with some distance. . . .
No smiles, no How arc you? . . . And uh, that was, I felt very
lonely then. I was 100 miles away from my buddies so they
couldn't come in everyday, and these people coming in (health
care professionals] weren't friendly, they just were not
friendly and 1 attributed it to that I think the people who did
come to see me were also looked at with suspicion.
With reference to therapists she commented,
But the women that I would perceive to be lesbians in PT and
OT mode huge demonstrations of their heterosexuality.
Talking about guys, dating, their desire to have children,
partying at known places. . . . Yeah, because I would see one
and sense that they were, and I would try to engage them in
conversations and they'd just, you know, one word
responses. And they felt very, very threatened by me.
Barbara indicated that the loneliness any patient may Iccl being 100 mites away from
home and having to struggle with a new disability was exacerbated by the hctcroscxist
reactions of medical professionals, in particular the lack of common courtesy to smile
and ask how she was. Even when Barbara attempted to reach out and engage them in
conversation, she was subtly distanced by their one word answers.
Although distancing interactions are well documented in the literature (see
Chapter 2), for the most part they are discussed solely from the perspective of the
patient. Skeptical people could dismiss these findings os misinterpreting the responses
of the health care professionals. Many of the occupational therapists in this study,
256
though, confirmed that they observe therapists and other health care professionals
purposefully engaging in distancing behaviors. Jenna talked about the time when her
co-workers overtly stated that they felt uncomfodablc working with a particular patient
because she was lesbian. She observed that when they did perform an evaluation with
her, they engaged in
very minimal interaction, they would just tell her what to do
and then they'd step back and observe her and then write down
her score and that was it, you know, they made no effort to try
to gel to know her and understand her.
In summary, the beliefs about the relationships between physicians and
patients underlying the traditional medical model encourage detachment in the name of
rational scientific procedures. Weekly rounds in which physicians talk among
themselves about not the person but the body that lies before them is a manifestation of
this belief system. Many patients, regardless of their particular sexual orientation,
seem to experience this type of alienation. However, both therapists and patients
identified another type of detachment that come from health cate professionals who
were not necessarily wed to the traditional medical model. This detachment occurred
selectively and was related to sexual orientation. Ultimately it interfered with the
patients' care.
The second way that interactions were influenced by the patients' lesbian
identities had to do with how partners were treated and discussed. Medical personnel,
at times, evaded any reference to partners. They seemed, at other times, to be all right
with the notion that partners were to be included as family and invited them into
treatments. Although the gesture of inviting partners into treatments was certainly a
confirming statement, Isabel pointed out that there was still a subtle difference in the
way some medical professionals included partners in conversations they had with the
patients. Her specific example was about her neurosurgeon who hod met her partner.
257
Ruth, and would talk to Ruth when they were both present, yet would never mention
Ruth’ s name when he was alone with Isabel. This could be seen as inconsequential
except for the fact that he would be sure to ask about her son, who was grown and not
very present in her life or relevant to her care. These small inquiries become a central
way of acknowledging family members. The fact that her neurosurgeon recognized
her son in this manner and not her partner suggested that Ruth was not perceived to be
integral part of Isabel's life.
The assumption by health care professionals that partners arc not real family
members was best described by Roberta. She recalled that during one hospitalization,
her mother came quite frequently to visit. Her partner Beth, on the other hand, was
there daily performing most of her personal care, which was essential because the
hospital had just cut back on nursing staff. Roberta was not out overtly as a lesbian,
nor did she introduce her partner as such. But Roberta commented that it didn't matter
because her mother was naturally assumed to be family and Beth was assumed to be
her aide. This assumption was most obvious in the interactions between the nursing
staff and Beth. Roberta commented that Beth was treated with "this real low status."
They expected that she would perform Roberta's personal care for which they would
otherwise be responsible and she was never afforded the cordial interactions that
family members expect and that her mother received.
From a therapist's standpoint, Monica also acknowledged that some health care
professionals, although unintentionally, nonetheless overlooked partners in
conversations where they may not have overlooked spouses, mothers, or children. To
combat this tendency, Monica talked about the ways that she attempts to include a
patient's partner in the conversations that surround and are vital to treatment.
Reflecting on one patient she stated that she
258
Asked how they were doing, much the way I would ask how
Mr. and Mrs. Jones were doing. And I really tried to, and did
it very intentionally, very deliberately, to try to let them know
that 1 was incorporating him into his lire. .. .What did they do
together? or Was that OK for so-and-so to do that Tor you, Mr.
so-and-so.
Acknowledging a patient's partner as a central person in the patient's life is a dear way
to validate that person's lesbian, gay, or bisexual identity. Forgetting to do so when
the patient has made it clear that this individual is his or her partner could possibly
thwart future communication.
In summary, one may ask. What happens to the therapeutic process when
therapists allow their discomfort and fears to interfere with "getting to know and
understand the patient?” or they invalidate their patient's lesbian identity by
overlooking their partners in conversation? In their book on clinical reasoning
studies, Mattingly and Fleming (1994) provided examples of how therapists shaped
conversations very deliberately to "unearth that which impassioned" their patients.
This information is transformed into relevant treatment ideas or used to build images of
future possibilities for the patient's involvement in life. In addition, the process of
getting at and sharing this information nurtures a trusting relationship between
therapists and patients, enabling patients to believe that the therapists have his or her
best interests at heart and enabling therapists to continue to learn about what is
important to the patient. One therapist in the clinical reasoning stories, whom Fleming
(1994) quoted, sums up this process stating, "I have found that the most successful
gains with Dan have been when I carefully listened to what he saw as important and
brought this together with what 1 saw as valuable for him" (p. 217).
Listening carefully to patients and understanding what is important in their
lives is essential to good occupational therapy. The above stories from the participants
in this study indicate that careful listening and understanding were missing from their
259
interactions with the health care professionals. Certainly this interfered with building
trust and rapport between the therapists and patients, which is particularly troublesome
to lesbians who understand the pervasiveness of hctcroscxism and keep a vigilant
watch to determine how open people will be to this aspect of their life. Once they
experience any sign of hctcroscxism, the chances of them taking a risk to open up
again are slim. Treatment programs and commitment to treatment arc less than
adequate if patients or therapists have closed the communication lines. Realistically,
occupational therapy, albeit not good occupational therapy, can still proceed. There
are many themes of meaning in an individual's life and therapists can tap into one of
the other themes, particularly those that arc more neutral, without ever acknowledging
that the individual is lesbian. Barbara's treatment, to some extent, followed this
format us the therapist worked with her on computer skills that would be needed when
she relumed to work. An individual's lesbian identity can also be ignored when
therapists revert to a non-individualized biomedical treatment program that progresses,
in a rote manner, through various levels of skill building from muscle strengthening to
dressing training, without ever relating those activities to the bigger picture of the
patient's life. Sensitivity to the ways in which lesbian patients may be ignored or
invalidated is important in providing quality occupational therapy.
Occupational Therapy In the Context of
Acknowledged Lesbian Identity
In the preceding chapter 1 have explored the various ways that insensitivity to a
patient's lesbian identity can contribute to ineffective assessments, interactions, and
treatment. Although the negative experiences of some lesbian patients and therapists
can point in the direction of what impedes optimal occupational therapy, the question
may remain of how to provide good occupational therapy, in which, as Yerxa (1985)
has proposed, patients realize their own particular meanings in occupation. To begin
260
lo address (his question, I wilt present one example of what occupational therapy can
look like when a patient's lesbian identity is both acknowledged and addressed. One
must acknowledge, from the beginning, that the story docs not exemplify perfect
occupational therapy nor docs it outline what therapists should do. Rather it provides
one positive example of how a patient's lesbian identity did enter into the therapeutic
process, and from there, ideas about future possibilities can be generated. First, I will
provide a brief overview of the occupational therapy experience from the perspective
of the patient and the therapist, both of whom arc lesbian. Then I will analyze three
aspects of the therapy: (a) how being lesbian entered into therapeutic interactions; (b)
how Sandy's lesbian identity permeated treatment; and (c) why both the therapist and
patient perceived that being lesbian "didn't really matter.”
Sandy's Rehabilitation Experience
Sandy was admitted to Lang Rehabilitation Hospital after a short slay ut a
convalescent hospital following what she termed a double stroke. She had been living
with her son in a home she owned. Her time was consumed by working long hours at
a stressful job for X company and her career as an amateur bowler. Three months
prior to the CVA, Sandy had ended a stagnated relationship with one woman and was
beginning to settle into a nurturing relationship with Missic. Sandy summed up her
disability experience stating,
There arc many times I wish I had died. Yeah, because you,
one day you're up, olive, walking and talking and working and
living a very normal life and then the next thing that you are
aware of, you're laying in bed, you can't move, you can't gel
up [you can't talk] you don't know where you arc, who you
are. It's terrible.
261
Sandy remembered her rehabilitation therapy as a positive experience. She commented
that she had a special connection with her occupational therapist, to whom she was
o u t Although she couldn't definitely slate why, she speculated.
Part of it was her smile and her laugh. And she kind of
communicated to me like I was a normal person, you know, I
was just, you know, rather than oh this poor girl, she had a
stroke, she's only 40 years old and you know. She just
communicated to me like I was normal and it made me feel um,
normal.
When asked what she did in therapy, she recalled that it was mainly exercise,
dressing, cooking, and a trip to Lloyd's Center. Sandy didn't really think that being
lesbian affected her rehabilitation, nor was she sure that it was important for people to
know that she was lesbian. Even though she didn't feel that being lesbian was
important to her therapy, she did chuckle about the fact that after her stroke she
couldn't remember her present lover and thought she was still together with her past
lover.
Cathy, the occupational therapist, was initially uneasy with disclosing to Sandy
the fact that she was lesbian. But Sandy insisted that she knew her and, within the
first week or therapy, the subject of bowling came up which led to the fact that they
hod mutual lesbian friends. Cathy claimed, from then on, that dressing training look
on a whole new meaning. Every morning Cathy would come in, shut the door, and
engage in "girl talk," as she taught Sandy multiple adaptive ways to put on clothing
and carry out grooming. Cathy really began to grasp what type of life Sandy had
constructed prior to her injury during these sessions while at the same time she began
to share her life with Sandy. She did comment that Sandy's inability to remember her
present partner was troublesome, but they were able to talk about it and Sandy reached
some resolution. Cathy couldn't remember the specifics of all her treatment sessions
with Sandy but she also recalled that they consisted of exercise, dressing training.
262
cooking, and a trip to Lloyds' Center where they happened to pick up a present for
Cathy's partner.
Therapeutic Interactions
Sandy was both shocked and devastated by the way that this unwanted brain
hemorrhage intruded into her stable lifestyle. Her initial inability to perceive a viable
future was indicated by her wish for death. In part, Cathy's responsibility as her
occupational therapist was to continue nurturing hope within Sandy that a future filled
with stimulating occupations would be achievable. The almost instant rapport that was
established between Cathy and Sandy contributed to the way in which therapy became
meaningful to Sandy. The issue of being lesbian was central to rapport building. In a
foreign and frightening hospital atmosphere, Sandy was able to feel a sense or home, a
familiarity in knowing that she recognized someone from the outside. As this simple
recognition evolved into the realization that there was a lesbian link between the two,
trust grew even stronger. Cathy expressed her belief that this lesbian bond was
important to Sandy's recovery when she stated
If we could have this common bond, how it would help her
because I would feel so lonely if I was in this setting and if
there was another lesbian around who could identify with me it
would help. Granted, I mean you don't tike every lesbian you
meet.
Cathy understands the importance that a common bond can have in assisting Sandy to
feel comfortable so that a trusting relationship can develop. She appears to understand
that, os Mattingly and Fleming pointed out, some level of trust is essential if patients
are going to be willing to hand over their bodies and share their emotions with the
therapists, on essential part of therapy.
It is noteworthy that rapport and trust did not occur automatically simply
because Cathy and Sandy were both lesbians. Being lesbian was a common bond that
263
provided the groundwork for further discussion, tn fact, dressing training, which
Cathy described os happening behind closed doors surrounded by "girl talk," became a
time in which Cathy could explore how to make therapy meaningful and eventually
prepare Sandy for her discharge home. Cathy commented that they often just chatted
about what they did over the weekend, who came to visit Sandy, or what Sandy's
home and work was like. Cathy would talk about how her dog had managed to jump
over the fence, or what restaurant she and her girlfriend had frequented that weekend.
Sandy would discuss her cat, that her girlfriend hod come to visit, and how her son
was doing in school. Although being lesbian may not have been central to each of
these conversations, it was easily woven in when it was pertinent. Within these
sessions a sense of camaraderie developed os both Cathy and Sandy shared about their
lives. Mattingly and Fleming (1994) pointed out that therapists need to become human
to their patients for trust to build. Therapists often Find some commonalty that they
can talk about as they cross paths in the hall or arc engaged in some therapeutic
activity. Sharing recipes, discussing a favorite TV show, or talking about vacations
arc among the many topics that can enable patients and therapists to relate to each other
us people. A lesbian link was among the commonalties that provided a sense of
camaraderie for Cathy and Sandy. These sessions prepared both Cathy and Sandy for
delving into deeper subjects about how disability had interrupted all aspects of Sandy's
life.
Treatment
The first way that Sandy's lesbian identity permeated treatment was in the
discussions surrounding significant occupations and relationships in Sandy's life. For
example, the conversation about being lesbian was broached initially in port because,
os Cathy recalled, she and Sandy realized they hod a common friend who bowled.
264
Sandy longed 10 return to bowling which provided her with a sense of achievement
and connected her with a community of close friends. Although her bowling
community was primarily straight, at least one person was lesbian, and in order to
conlcxtualizc her story about the occupation of bowling, this fact became important to
the conversation. Being lesbian was not central to this occupation but it was a subtle
and important aspect that was embedded in the story that was told about bowling. Yet,
occupational science literature emphasizes that the environmental context and the
cultural and symbolic meanings associated with occupations becomes important if one
is to grasp how occupations play out in an individual's life (Clark ct al., 1991).
Cathy's cose with the lesbian issue allowed Sandy to talk freely about all aspects of
bowling and perhaps begin to open up more to the importance of this occupation to her
life. Although bowling did not become a focus or therapy, the discussions led to other
occupations of interest and began to plant the seeds for her future return to bowling.
Unlike the stories in which therapists' fears precluded their ability to understand their
patients' lives, and patients' fears about the homophobia in the hospitals stop them
from sharing their full stories, Cathy and Sandy were able to share information more
openly os they construct meaningful therapeutic sessions.
Being lesbian was a subtext to the story about bowling, but it was in the
forefront of Sandy's issue about forgetting her present partner. This subject could not
have been broached without both the therapist and patient feeling comfortable talking
about Sandy's lesbian identity. Because they were comfortable, the subject not only
arose but was handled in a very calm, delicate way. Somewhere behind the closed
door "girl talk" sessions during dressing training, Sandy was able to share the letters
that one woman w a s writing her and to talk about her weekend visits from yet another
woman. Cathy, knowing that Sandy would probably regain much of her memory as
time went on, convinced Sandy to "just let it go and concentrate on getting belter."
265
Simultaneously she was able to work with Sandy in reconstructing her friendship
network as they talked about who came to visit her over the weekend. Cathy was one
of only two people with whom Sandy was able to discuss this rather significant issue
in her life, because, even if others knew that she was lesbian, her lesbian identity
wasn't discussed as a natural part of everyday conversation between patient and health
care professionals and therefore, not likely to emerge in the context of a serious
problem.
The second way that the issue of being lesbian permeated treatment was when
it became a theme in a community outing. Occupational therapists, typically, will
organize at least one community outing for patients who have had a stroke to assess if
the individual has problems with transferring in and out of cars, physically
maneuvering around public places, communicating with store clerks given speech
limitations, or dealing with social stigma, for example. Community outings arc
carefully planned around on occupation of interest to the patient, although occasionally
lime constraints encourage therapists to choose a public place of convenience that
offers generic challenges inherent in most community excursions. Patients who often
cat out may go to a restaurant and patients who like to read may go to a book store.
Cathy and Sandy went to Lloyd's Center, a major shopping moll in their city offering a
variety of stores that Sandy frequented prior to her accident. However, once there
Sandy really couldn't think of anything she wanted to buy. To inject a purpose into
their mission, Cathy shared that she was preparing dinner for her girlfriend that
evening in celebration of their third anniversary and needed a tablecloth. For the rest
of the afternoon, the community outing revolved around this theme os they traveled in
and out of stores in search for the perfect tablecloth.
One might argue that shifting the therapeutic outing to accomplish Cathy's
errands that afternoon was a questionable use of Sandy's time. Other options would
266
have been to simply window shop or just stop by a restaurant Tor a cup or coffee.
Sandy could have met one of the primary goals of community outing, namely to
maneuver architectural barriers. But I propose that, although choosing one of these
last two options would have superficially appeared more acceptable, in actuality it
would have compromised the patient's potential for improvement As Clark (1994)
pointed out in her Eleanor Clarke Slagle address, Penny Richardson, a 40-year-old
woman who hod an aneurysm lamented that, although the therapists may have been
nice, she wished that they had presented more challenging situations in her therapy.
Although Penny was referring to physical challenges, because she perceived herself to
be an adventurous outdoors person, the point is that therapists have a responsibility to
provide the most challenging therapy possible for each particular patient
I believe that the success of that afternoon's excursion was due, in part, to
Cathy's ability to spontaneously create a situation so relevant to Sandy's life that she
became absorbed in the task as if she were simply out for an afternoon shopping spree
with a friend. Buying the perfect tablecloth for a party celebrating one's anniversary
fits within the scheme of Sandy's life because it embodied many themes that were part
of her previous and future life experience. Sandy is a lesbian who had celebrated
many anniversaries in her life and hoped for more in the future. She was also
enmeshed in a confusing situation with her past and present girlfriends. She knows
about household objects because she owns a home which she continues to decorate.
Sandy feels comfortable about planning parties because she had done this before with
friends and would have opportunities to do so in the future. This shopping spree
made sense because it was part of her life world.
According to occupational science literature (Clark clal., 1991; Yerxa et al.,
1990) occupations typically do not happen in a random fashion; people continue to
create and express themselves through what they do. Being lesbian is an integral part
267
or Sandy's identity which was infused into the shopping excursion of that afternoon.
Although Sandy may not have been consciously aware of her lesbianism on a
continual basis, she physically and symbolically lived identity as a lesbian that
afternoon. Phenomcnologists note that on one level, meaning becomes embodied in
habitual structures. Meaning is not necessarily talked about but rather "fell" in the
actions one carries out (Fleming, 1994). Although shopping is not an everyday
occupation, it is carried out on a somewhat habitual level. People tend to use familiar
molls, park in familiar places, ask clerks for help, and pay for items on a semi*
automatic basis. However, the occupation encompasses different meanings depending
on where one chooses to shop, for whom one is shopping, and which items arc being
purchased. By engaging in what had been a semi-automatic task of shopping, Sandy
was able to rekindle the physical, cognitive, and emotional sensibilities that were
associated with her identity os a lesbian. Being lesbian was not the only aspect of self
that this occupation rekindled; at the shopping moll Sandy could rc-cxpcricncc the
enjoyment she previously had when she spent the afternoon with friends or planned
her own parties. In fact, it was the pulling together of multiple themes of meaning in
her life in this one occupation that mode it seems to relevant, so natural to her life. As
was pointed out in Chapter 4, the women who participated in this study described
feelings of harmony and wholeness when they engaged in occupations that
synthesized the multiple parts of their lives.
The "tablecloth shopping spree1 was also therapeutic because by participating
in an occupation that was representative of her life, Sandy was also constructing future
possibilities. The process of shopping offered her not only the opportunity to develop
adaptive skills on the physical and cognitive levels, but also to develop images of
herself in future time. Occupational therapists ore often involved in co-constructing
with their patients images of how their patient's will lives their life following disability
268
(Mattingly & Fleming, 1994), in particular, images or themselves participating in new
or old occupations with a new disability (Clark, 1993). These images provide "hopeful
endings” (Mattingly, 1994) suggesting what their futures could entail and serve to
guide treatments (Clark 1993; Mattingly, 1994). In order for patients to be committed
to the process of image building os Mattingly, Fleming, and Clark have described,
therapists need to create situations that arc relevant to the patients' life world and
recognizable to the patient. Cathy created such a situation when she used her
knowledge about what was important in Sandy's life to make this shopping excursion
recognizable to her on a deep emotional level. Cathy opened a window for Sandy's
future by offering her a non-threatening opportunity to enter into someone elsc's
lesbian story and perhaps begin to rewrite her own lesbian story, a process Clark calls
occupational story making, through creating images of herself performing
occupations. In this sense, she individualized this outing, enabling Sandy to move,
through images, from inside the hospital walls in which she was just a stroke patient to
the outside world where she is a particular person with a particular history who had a
stroke and who is exploring how she could regain access to her life. In this instance,
lesbianism as a theme of meaning was an essential part of creating Sandy's future
images.
Poes Being Lesbian Matter toTreotment?
It would appear that knowing Sandy's lesbian identity was important for
occupational therapy to be meaningful and successful. Certainly a lesbian theme was
incorporated into Sandy's and Cathy's interactions and treatment sessions. However,
Sandy fell that she was not discriminated against for being lesbian in the hospital and
that she wasn't really sure that it mattered if people knew. Cathy seemed to be pulled
in both directions, acknowledging that it would be important for Sandy to have on
269
advocate who knew that she was lesbian and yet also staling that she wasn't sure how
much it influenced treatment. Their responses were particularly interesting given that
two of the four areas of therapy that both Sandy and Cathy remembered off the top of
their heads, that is, dressing training and visiting Lloyd's Center, were influenced by
the fact that Sandy was lesbian. I propose that Sandy did not see being lesbian as
important to her therapy precisely because of its presence throughout her occupational
therapy in on incidental rather than a contrived manner. This was suggested by the
way that Sandy repealed the word "normal" throughout her interview. She talked
about things being normal when she was able to return to her typical home routines of
"being able to take a shower, get dressed for a day, and fix something to cat." Normal
was also used to describe Saturday evening dinners with her lesbian friends. In
particular, she mentioned that she didn't realty interpret these occupations os lesbian in
nature because "it's normal for me." Sandy's claim that one of Cathy's outstanding
features was that she "communicated to me like was I normal and it made me feel, um,
normal" may indicate that the importance of including a lesbian theme into occupational
therapy was not recognized because it was interwoven into therapeutic interactions and
treatment with an everyday taken-for-grantcd familiarity.
When Sandy's situation is juxtaposed to one like Barbara's, the difference
between a natural and contrived approach to addressing a person's lesbian identity
becomes more apparent. Barbara was admitted to X hospital only after her friend had
searched for a rehabilitation program that claimed to be lesbian-friendly. She was met
by a social worker who commented, "You know your friend told us about your
lifestyle. We will do everything possible to meet your needs." Later, when she
wanted her partner to stay at a hospital-owned housing fucility that was usually offered
to family members with financial problems, she was obliged but, os she suited,
"instead of doing what was naturally, [it was] a really big thing." Barbara summarized
270
her interactions as "it tvas a bunch of heterosexual people acting as if it was special
needs to satisfy. Instead or I'm just a person.” The lesbian issue became part of
Barbara's rehabilitation in a contrived manner, as if it was a separate issue "to be
handled”; for Sandy it was addressed as one aspect among multiple aspects of her
identity that was interwoven into therapy and conversations when appropriate.
A second reason that Sandy may not have felt that being lesbian was significant
in her rehabilitation may have been because she was hospitalized in a facility where
there was some sign of a gay or lesbian life among the hospital personnel. Cathy
provided this on a direct and daily basis for Sandy, even if being lesbian wasn't part of
the conversation. Other women who participated in this study alluded to the fact that
they felt more comfortable in hospital environments where they recognized other
lesbian or gay- friendly patients or personnel. For example, Roberta commented that
she enjoyed the transporters at the convalescent hospital where she stayed, many of
whom were "screaming queens," because of the comments and jokes made back and
forth between them, and "I guess maybe because I feel some of my culture is there."
Emma pointed out that she felt "way more relaxed” at X hospital than Y hospital in part
because of the gay nurses. Although gay issues were never mentioned, the presence
and interactions among gay men on a daily basis were noticeable and pleasant. In both
these situations, the patients felt at home because elements of what may be termed a
gay culture were present, not in a contrived way but just os part of the background
noise.
Finally, and probably most problematic, is the fact that one's lesbian identity
can appear insignificant because occupational therapy cun, and is often provided
without acknowledging sexual orientation. This occurs when therapists focus solely
on the biomedical aspects of occupations. Diagnostic categories are used to outline the
patients' problem areas and in a check like fashion patients arc taught skills such as
271
bed mobility, dressing training, or how to use adaptive kitchen equipment to enable
them to overcome the problems that have been identified. In addition, occupational
therapy that docs not rely solely on the biomedical model can also be provided without
acknowledging someone's lesbian identity. As Mattingly and Fleming pointed out,
therapists have multiple reasons for performing each treatment session. The trip to
Lloyd's Center could have been justified by Cathy as necessary because (a) Sandy
needed to problem solve and practice how to overcome the architectural barriers that
arc inevitable when one uses a wheelchair; (b) Sandy needed to practice wheeling her
chair over a variety of terrains; (c) Sandy needed to practice maneuvering around store
aisles so that she might shop in the future; (d) Sandy needed to problem solve how to
handle the discrimination to which people who have disabilities arc subjected; and (c)
Sandy needed to engage in an occupation in which she previously participated in order
to give her hope that she con do so in the future. If a therapist used one or all of the
above justifications for going to Lloyd's Center, the outing could be deemed a success
without the patient's lesbian identity being addressed. Treatment of this kind may be
successful in terms of leaching the cognitive and physical skills needed to cany out
some occupations, but because it docs not assist individuals in building images and
skills to support their new selves, combining past identities with new identities, this
type of therapy falls short of "authentic occupational therapy" as suggested by Ycrxa,
or the occupational therapy suggested by occupational scientists.
In summary, Sandy's rehabilitation experience exemplifies one person's
situation in which her lesbian identity was neither on all-consuming nor invisible factor
in her occupational therapy. Sandy's lesbian identity became woven into the therapy
process when appropriate because Cathy was sensitive to the various ways it may
impact her relationships and occupations. In particular, their shared lesbian identity
become one of a few commonalties that contributed to the trusting relationship that
272
grew throughout Sandy's hospital stay and was essential to the therapeutic process.
Having some understanding of what it meant to be lesbian, Cathy was able to support
Sandy when she was confused about the two women who were suddenly appearing in
her life. In addition, Sandy's lesbian identity became a subtext to the morning
conversations about what had transpired over the weekend between Sandy and her
visitors. Most important, Sandy's lesbian identity was woven into a community
outing where, on the surface, it appeared as if Cathy were assisting Sandy in what is
often considered traditional occupational therapy, that is, learning how to maneuver
her wheelchair in public environments, interact with salespersons when she had both
speech and cognitive deficits, and problem solve tasks such as buying objects from the
store. Perhaps more importantly, Cathy carefully molded an experience for Sandy in
which she could begin to bridge the gap between the hospital environment and her
community by both envisioning and experiencing herself with this new disability
engaging in old activities. Through actual participation in an occupation that embodied
the content and emotions associated with being a lesbian, a friend, a shopper, and
disabled, Sandy was able to experience herself in an integrated fashion. The final
puzzling piece to Sandy and Cathy's story was that, although Sandy's lesbian identity
appeared to be a recurring theme in her therapy, it was not identified by Sandy, in
particular, as that important to her process of healing. It is possible that her lesbian
identity did not loom as important simply because, os in her life situation before her
CVA, Cathy responded in therapy to Sandy's lesbian identity as a natural subtext to
the many facets of her life.
Conclusion
Rehabilitation is a confusing moment in patients' lives, a moment in which
they are confronted with one of the greatest challenges of their lives. To this end, one
273
may argue that a patient's lesbian identity is or little concern when compared to the
many facets of disability that the individual must face. Not only docs this seem
reasonable but to some extent this was condoned by the women who participated in
this study. When they were confronted with a hierarchical, patriarchal medical system
in which they fell discounted and disrespected, or when they felt that their therapy or
interactions with health cate professionals were less than adequate, many became
enraged at the system that appeared to be holding them back on their road to recovery.
This anger and frustration, at times, overrode any problems they may have had due to
their lesbian identities, in part because, physical recovery was a primary goal. At other
times, the women perceived that their lesbian identity and the gender biases underlying
therapeutic practices contributed to the poor therapy that they received. Despite the foci
that insensitivity to a patient's lesbian identity was not necessarily the most prominent
problem reported by these women, they did claim that hctcroscxist attitudes and
practices infiltrated and created problems in many aspects of rehabilitation, including
finding a sensitive therapist, the assessments, the therapeutic interaction, and the
therapeutic practices. Similarly, therapists confirmed that the hetcroscxist attitudes of
their co-workers compromised treatment in ways that were unknown to patients. The
experiences of both the therapists and patients strongly imply that lesbian-sensitivity
on the part of health care professionals enhances the therapeutic process. Sandy's
rehabilitation experience, in which Cathy used her sensitivity to lesbian issues to guide
her practice, demonstrates one way that a patient's lesbian identity can become part of
therapy in an affirming manner.
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CHAPTER 7
IMPLICATIONS FOR OCCUPATIONAL SCIENCE
AND OCCUPATIONAL THERAPY
At the 1993 American Occupational Therapy conference in her plenary address,
Helene Polatajko, the president of the Canadian Occupational Therapy Association
shared the following story.
In Canada, a 25 -year-old woman caught national media attention when
she fought the legal system for the right to refuse life-sustaining
treatments. Having spent 2 1/2 years in a hospital bed because of a
disease that resulted in the permanent loss of all her independent
function, including respiration, Nancy B. pleaded for the right to die.
She told the judge that a life without the ability to do is not worth living
("Woman makes plea," 1991). She won her ease. On February 13,
1992, Nancy B. died. (p. 591)
In this story, Polatajko stressed that the primary argument supporting this woman's
request for euthanasia was not pain or the high cost of medical care but simply that she
was no longer able to "do anything," meaning she could no longer engage in
occupations. The fact that engagement in occupations became her criteria for living is
a powerful statement about the potency that occupations have for human existence.
This respect for occupation has long been recognized by the occupational therapy
profession and was most recently acknowledged when occupation was identified as
the major focus of study for the discipline of occupational science. One of the
founders' concerns when designating occupational science as a new discipline was to
provide academic support for the occupational therapy profession by creating a more
solid understanding of occupation. Thus, one primary purpose of occupational
science is to support the practice of occupational therapy.
In the final chapter of this dissertation, I will discuss how the experiences of
lesbians who ore either occupational therapists or disabled might contribute to a science
275
that attempts to understand the occupational nature or humans and to a practice
profession that is dedicated toward enabling people with disabilities to return to a life
fitted with satisfying occupations. Specifically, I wilt address four implications of this
study for the theoretical content of occupational science. Next, I will explore how the
findings of this study may guide occupational therapy practice that is informed by
occupational science.
Im plications for O ccupational Science
Heidegger claims that it is in human action that individuals reveal to themselves
and to others their identities. Occupational science, loo, celebrates the power of
occupations as the medium by which people express their beliefs, dreams, and hopes,
and in doing so, continually create and mold their existence. For the women who
participated in this study, their lesbian identity became a course of action that they
created and that created them throughout their lives. Taken individually, there was
tremendous variation in both how they experienced their lesbian identities through
occupations and the intensity with which they felt a need to express this part of their
lives. Variation, also, occurred in the degree to which these women wove their lesbian
identities into the narration of their occupational stories. For example, Sandy who
discusses her lesbian identity as a subtext in her occupational story, stands in stark
contrast to Isabel who rarely narrates any part of her occupational story without
drawing a link to her lesbian identity. She is immersed in occupations that, she
perceives, are expressions of her lesbian os well as other identity parts.
Beyond the variation between individuals in their expression of their lesbian
identity, most of the women also talked about its shifting nature os they moved
throughout life. For some, being lesbian shifted from an all-encompassing community
involvement in the lesbian culture to a more sporadic and private experience with select
276
friends. For others, the specific way one expressed her lesbian identity shifted from,
for example, a few leisure occupations to political involvement. The important point is
that there is no singular way of being lesbian. From the experiences of these women,
it appears as if individuals do not simply come to realize some deep inner reality that
they arc lesbian and then take on and live out what is referred to in some lesbian and
gay literature as "the homosexual role" (Troidcn, 1993). Rather, as the women in this
study indicated, they were immersed in an ongoing process of being and becoming
lesbian; a process that entailed a continual refashioning of their occupational patterns
depending upon factors such as their personalities, the social sanctions they
experienced, maturity, the acceptance or rejection of friends, family, and co-workers,
changes in geographical locations, and feelings of safety about risking disclosure
through their actions. In this sense, the experiences of these women arc a grounded
example of what Giddens refers to as the reflexive project of the self; that of
rcflcxivcly creating a coherent life narrative. Occupations become central to this
process as they arc the material form of one's narrative (Giddens, 1991).
Furthermore, through sclf-rcflcxivity in the present, individuals construct how they
wish to exist in the world and plan their life trajectories based on these constructions.
Occupations, again become central to how they manage, shift, and change their
identities over a life span.
Second, the findings of this study also support the notion that sexual
orientation influences more that just the gender of one's sexual partner or the
mechanics of sex. For the women in this study, their sexual orientation was expressed
in many spheres of their lives, including leisure, political, and spiritual occupations.
More important, though, was the symbolic or emotional component of an activity. For
these women, the symbolism or emotions that they as individuals or their communities
of friends attributed to occupations was essential in their interpretation of how those
277
occupations became expressions or their lesbian identity. Furthermore, for some
lesbians it seems that the symbolic element of occupations was particularly important
as many times the lesbian meaning was secretly infused into an activity, such as in the
ease when someone's partner attends an event but is introduced as a friend. Thus, the
findings of this study support the strongly held contention by occupational scientists
(Clark ct al., 1990; Clark & Jackson; 1990; and Ycrxa et a!., 1990) that occupations
cannot be studied without attending to the symbolic significance they hold for the
individual.
Focusing on the symbolic component of occupations also allows a more
thorough understanding of the various ways that individuals express themselves as
lesbians through what they do. Because humans have the capacity to interpret
everyday experiences from multiple perspectives (Gcrgcn, 1982), various occupations
can embody lesbian meaning depending on the people involved and the context of the
activity. By attending to the symbolic level of occupations, one may be able to
contribute to the mission of some lesbian and gay writers, that is, examine the
variations in lesbian and gay lives, rather than portraying "the homosexual" os a
singular entity. Although the women in this study all identified as lesbian or bisexual
how they construed their lives through their occupations and the meaning of those
occupations differed.
Third, Clark ct al. (p. 301) claim that occupational science "honors the power
of ordinary experience..." The findings of this study suggest that if occupational
scientists ore to thoroughly understand the power of ordinary experiences, then they
must begin to analyze how certain social ideologies are embedded in everyday
activities. In her book, Feeding the Family, DeVault (1990) provides an excellent
account of how middle-class ideologies about food and meals are reproduced by the
women and men she interviewed through the process of creating family meals. In this
278
study, through their participation in celebrations of grandchildren, weddings,
restaurant dining, work-related lunch sessions, or various other ordinary experiences
the women in this study began to experience the various ways that heterosexual
ideologies were represented in the form or the activity (that is, who is celebrated) and
the discourse surrounding the occupations (that is, topics that are considered
appropriate and those that arc taboo, or comments by, Tor example, waiters or
waitresses). Such occupations create a nagging tension Tor those who participate
because they Teel pulled both into a set of relationships with family and friends that
they greatly desire and into an occupation that reifies social ideologies with which they
disagree. Although my analysis only skimmed the surface of the ways that
heterosexual ideologies ground many family and public occupations, it illuminates the
need for occupational scientists to seriously continue this line of research when
looking at social contexts.
To do this, occupational scientists may need to shift the way they perceive the
relationship of occupations to their environmental contexts. From the outset,
occupational scientists have acknowledged that humans act upon and respond to their
environments, including its physical form, political laws, social ideologies, and
spiritual traditions (Clark ctal., 1991; Ycrxa, 1990, 1991). How those environments
influence the availability of the occupations, for example, the effects of particular
physical environments on the availability of leisure activities, or the effects of political
laws that restrict rather than encourage people with disabilities to work, becomes a
focus of inquiry. Likewise, occupational scientists acknowledge the changing nature
of environments and the effects of human action on potential changes in the
environment, such as, the effects of pollution on the lakes and rivers, or the effects of
constructing accessible buildings on the ability of people with disabilities to participate
in occupations that occur within those structures. This present perspective, however.
presents a particular relationship of occupations to the environments in which they
occur that has not yet lent itself to an in-depth analysis of how everyday occupations
actually embody and reify social conventions and cultural ideologies. The findings of
this study suggest that occupational scientists may wish to take a look at occupations
as a way to understand how social ideologies become reinforced in the typical doily
practices of humans, in addition to how social ideologies influence choices for
occupations.
Fourth, the findings of this study offer occupational scientists insights os to the
need for and ways that people create authentic lives through their day-to-day
occupations. The vignettes shared by the women in this study emphasized the extent
to which they found themselves immersed in lives that were at odds with mainstream
traditions. Simply slated, being lesbian is not afforded the some ideological respect,
political protection, religious promise, or emotional and material support that being
heterosexual is. By the mere fact that lesbians are living in a pervasive hetcrosexist
society and their identity is contested in most public arenas, their existence becomes a
comprehensive lie unless they engage in the grueling struggle for authenticity. The
degree to which the women in this study found it necessary to engage in that struggle
differed, yet for everyone it was present somewhere in her life. Because the need to
struggle for honesty in one's life may be more noticeable to those who stand outside
social convention to the degree that lesbians do, by placing lesbians at the center of this
study, occupational scientists are provided a particular perspective on the occupational
nature of human and encouraged to begin a more thorough investigation of how
occupations become central to the quest for an authentic life.
This is not to claim that people who are satisfied conducting their lives in a
manner that is consistent with the more accepted forms of social convention, do not
struggle with living on authentic life. On the contrary, as Giddens (1991) points out,
280
"The more tradition loses its hold. . . the more individuals arc forced to negotiate
lifestyle choices among a diversity of options" (p. 5). If Giddens is correct, then one
can assume that rarely docs an individual not struggle with authentic living at sometime
in his or her life. Thus, the findings of this study move beyond the lives of lesbians
and support the notion that occupational scientists may wish to take considerable notice
or how all humans struggle to create authentic occupational lives.
The women in this study provide specific examples of how some lesbians
engage in ongoing negotiations to adapt to their specific social situations while
maintaining personal dignity and self-worth. For some women, this meant attempting
to make changes at an institutional level by working for organized political campaigns
to defeat propositions that were potentially harmful to gays and lesbians, or educating
religious organizations to help broaden their dogma. Other women mode it their policy
to respond to any aspect of hclcroscxism with which they were personally confronted
or personally observed. Lisa's telephone coll to the radio station to present a positive
view of lesbians; Linda's response to homophobic comments at the hospital at which
she works; and, Leah's request that the hotel management provide her and her partner
with a king size bed all exemplify these personal statements. At times, occupations
were creatively employed in these negotiation process. The Valentine's Dinner, the
Christmas party, or the nightly coffee ritual at a bed-and-breakfast served to link
lesbians with other lesbians and allow them to affirm their lesbian identity. Similarly,
engaging in occupations through which these women apprehended the complexity of
their existence supported feelings of integration and self-harmony.
The use of occupations to bridge the heterosexual and homosexual life worlds
become more complex when the women either invented or reshaped occupations in a
way that they could redress the hcteroscxism in their families. For example, in the
situation of the Mom's Parly, Leah invented a new ritual to celebrate her relationship
281
with her mother because the traditional rituals that rortillcs the mother-daughter
relationships for her siblings were not readily avaitablc for her. A similar situation
occurred with the lesbian baby shower; however in this ease, Ami and Sara did not
create an entirely new occupation but rather infused new meaning into a typical
heterosexual occupation as a means for bridging the heterosexual-homosexual gap
between family members. In other words, by manipulating the meanings underlying
this occupation they could challenge and potentially change the straight consciousness
of friends and families, ir, os suggested above, some occupations embody social
conventions, then infusing new meaning into a typical heterosexual occupation by
shifting the context, in a sense contributes to social change. Furthermore, Ami and
Sara recruited heterosexuals into the task of broadening social ideologies about
lesbians and gays by inviting them to participate in creating the event Their
heterosexual family members and friends were not simply passive attendees but rather,
through their presence and interactions, they, loo, became part of the process of
recosting a heterosexual occupation which at least challenged, if not changed their
understanding of lesbianism.
In summary, the lesbians who participated in this study offer valuable
information for occupational scientists about the power of ordinary occupations.
Through careful attention to their occupational patterns, they were able to respond to
the hctcrosexism in their lives and fortify their lesbian identities. Their experiences
illustrated how heterosexual ideologies arc embedded in occupations and the
possibilities for bridging ideological worlds through recasting typical occupations and
inventing new rituals.
282
Im plications Tor O ccupational Therapy
Ycrxa (1989) claims that "Occupational therapy is a therapeutic intervention
that promotes health by enhancing the individual's skills, competence, and satisfaction
in daily occupation” (p. 6). One purpose of occupational science is to provide a
foundation for current and innovative models of occupational therapy practice. In the
following section, I will illuminate some of the ways that the findings of this study
contribute to the ongoing dialogue about how occupational science con inform
occupational therapy practice.
Ultimately, occupational science re-emphasized the placement of occupations al
the center of practice, both in terms of the outcome of therapy and the means by which
therapy is carried out. According to the literature in occupational science, how people
organize their round of occupations, in which occupations they partake, and with
whom they shore occupations all contribute to their state of health, ability to adapt to a
changing lifestyle, and overall feelings of self respect and dignity (Clark ct al., 1991).
Thus, occupational therapy, as a practice profession, is dedicated to enhancing
patients' quality of life by increasing their opportunities to participate in occupations
that they deem personally and culturally satisfying. In some occupational therapy
clinics, stacking cones arc used to promote normal motor control, or parquetry blocks
ore used to provide perceptual challenges. Occupational therapists have participated in
on ongoing debate about the appropriate medium for treatments. Some people have
dcrogatorily labeled the above occupational therapy practices os rcductionistic. The
findings of this study support the notion that occupational therapy practice as informed
by occupational science is particularly beneficial when it occurs at the level of
occupations rather than in a more rcductionistic form. Occupations ore on appropriate
medium for occupational therapy practice, not only because successful participation in
occupation is a valued outcome, but because engagement in occupations is a complex
enterprise that places simultaneous demands on the individual's physical, biological,
cognitive, sociocultural, symbolic and transcendental subsystems.
Practice at the level of occupations is valuable, first, because occupations can
provide an opportunity for patients to experience an integrated sense or self. As the
women in this study pointed out, being disabled, at times, led to feelings of
fragmentation. Fragmentation stems from both the suddenness with which a disabled
identity is thrust upon a person and the fact that a disability disrupts other past
identities that the individual may hold of him or herself. Oiddens (1991) suggests that
people develop a "protective cocoon" that enables them to fend off potential threats to
their self-integrity. Initially, disability may not only disrupt the feeling of self-
wholeness but also one's protective strategies for maintaining integrity. As Clark
(1993) pointed out in her Slagle’ lecture, part of the purpose of occupational therapy in
rehabilitation is to enable patients to bridge the connection between their past and
future occupations and, in doing so, create new self-images. This study supports the
use of occupations in therapy because occupations can provide opportunities for
people who arc disabled to begin to integrate various meaningful parts of their lives
together and thus experience a sense of wholeness as they begin to reconstruct their
lives.
The issue of fragmented identities arose not only in reference to disability but
also with respect to being lesbian. Perhaps because both disability and lesbianism arc
socially stigmatized, the women did not feel centered when either of these identities
were pushed to the forefront or kept in the background of their image. Quite simply,
they were unsettled when they were not recognized for their multidimensional lives. If
one goal of occupational therapy is to assist patients in rebuilding their identities
through occupations, then it seems reasonable that occupational therapists would need
to pay attention in therapy to the many factors that contribute to a patient's selfhood in
284
therapy. Conversely, therapy would become less than adequate if therapists chose to
ignore one aspect of the individual simply because the therapists did not find it
pertinent to address. The tablecloth shopping spree became essential to Sandy's
rehabilitation because, through that occupation, Sandy could experience herself as a
multidimensional person. Disability os one dimension of her life and lesbianism as
another dimension became integrated with other important identity parts. The
occupational outing worked because it tapped the important themes in her life enabling
her to experience a new self in the occupation.
The second reason, practice at the level of occupations, is valuable is because
occupations challenge the physical, cognitive, psychological, symbolic, and
transcendental aspects of the person. In this sense, working on occupations becomes
an efficient approach toward treatment, yet more comprehensively challenging than
merely going on a community outing in order to simply practice transfers or to check
out architectural barriers. Occupations become more efficient because therapists can
work on more than one problem at a time, a feat insurance companies should
appreciate. They become more appropriately challenging because, once out of the
hospital, people generally approach life in terms of complex occupations, not isolated
tasks. A patient may be able to conquer the challenges of maneuvering around a safe
hospital gift shop to select a magazine. Yet, when this same occupation is carried out
at his or her favorite moll, with the added tension of having to interact with
salespersons, problem solve solutions to unexpected barriers, and confront new
realizations about being disabled, the challenge more accurately reflects that which the
individual will return to following disability. Clark suggested that occupational
therapists may need to think of themselves as coaches who can teach occupational
strategies to patients (Clark et al., in press). In the tablecloth shopping spree, Cathy
coached Sandy, providing her strategies as they moved through the steps of the
285
activity. As Clark suggests, this type of coaching reaches the more complex issues of
how occupations can enrich one's life and which techniques one can employ to
become involved in occupation. This level or complexity is more difficult to address
when occupational therapists use modalities that focus on body parts or task training.
Beyond providing support for occupation-centered practice, the findings of this
study speak to the importance of lesbian-sensitive occupational therapy clinics in
providing adequate health care for lesbian patients. Medicine, os a profession and an
institution, is overwhelmingly hclcroscxist. Occupational therapy, when housed in
hospitals and medical clinics, becomes part of that institution and cannot escape the
hclcroscxist influence. Even if therapists themselves are sensitive to issues that pertain
to their patient's sexual orientation or wish to create a safe space within occupational
therapy clinics, it may be difficult to do so. As the findings of this study
demonstrated, some patients recalled their rehabilitation as a total experience, not
separate therapies, and thus the attitudes and behaviors of personnel anywhere within
the hospital environment can potentially influence the patient's occupational therapy.
The women's experiences also illuminated how heterosexual environments arc
maintained within occupational therapy clinics themselves, through heterosexual
discourse, homophobic comments, assumed heterosexuality, and perceived
stereotypes. Furthermore, the experiences that were recorded provide therapists a
beginning idea about how helcrosexist attitudes on the part of health care providers con
infiltrate assessments, treatment sessions, interactions with patients, and treatment of
family members. Heterosexist environments in general disadvantaged these patients in
receiving quality care.
It is my hope that the experiences described by both the occupational therapists
and participants can provide the knowledge needed by occupational therapist to make
appropriate changes within their clinics so that they become nurturing spaces for
286
patients and co-workers. Such changes require, first, that therapists shift their
mindsets so that they begin to (a) view their patients without imposing a heterosexual
label upon them, (b) understand the potential relevance a patient's sexual orientation
may have for his or her occupations, and (c) be aware that the medical arena may be an
unsafe place for homosexuals. Additionally, therapists may need to recognize the loll
that hctcroscxism takes on lesbian occupational therapists who put excess energy into
managing their sexual orientation which could be belter used caring for patients, or
how hctcroscxism may turn into harassment again overshadowing therapist's
competence in patient care.
Knowledge empowers people to make change. The concrete examples .
described in this study provide therapists with specific ideas on how to change their
clinics. Therapists who wish to create safe environments may consider erasing
hclcroscxist and gender biases from assessments and treatments. Additionally,
therapists may need to be cautious with respect to the homophobic jokes made in
clinics, the homophobic references made about patients under the pretense of comic
relief, the negative stereotyping about certain patients' sexual orientation, or the
assumption that patients ore heterosexual. These cautions need not only be taken with
respect to patients. As the therapists' demonstrated, the hospital climate is steeped in
heterosexual ideologies and actions; thus these cautions need to be taken for
interactions with other health core professionals. The ultimate goal, though, is not
only to provide therapists a list of things they may change within their clinics, but to
give them a new lens with which to view their clinics, so that they are able to take the
responsibility to wonder if and how their clinic may impede the quality of cure for
lesbian patients.
I end this section with two questions that need to be raised in light of the
argument put forth that a patient's lesbian identity may need to be addressed in
287
occupational therapy practice in order for authentic occupational therapy to occur. The
questions ate: Must alt patients' disclose their sexual orientation in order to receive
authentic occupational therapy? and Can occupational therapists provide authentic
occupational therapy without knowing or simultaneously addressing all identity parts?
Occupational science claims that humans arc authors of their lives (Ycrxo, 1990).
Although it is acknowledged that people arc, in actuality, co-authors of their lives, the
underlying intention of this comment is to pay homage to human agency. A strong
theme throughout occupational science and occupational therapy is the belief that
patients should have the ultimate say in their care. Thus, to some extent, the decision
remains with the patient as to if and how his or her homosexual identity affects his or
her future life with a disability. As demonstrated in Chapter 4 vast variability exists
among the women with respect to how and with what intensity their lesbian identity
was expressed in occupations. Thus, a single way of relating to all lesbians is no
more appropriate than it would be to treat all mothers the same or all patients with
spinal cord injuries the some. Moreover, some people arc more private by nature and,
regardless of their sexual orientation, may share little about their lives to health care
professionals. Their choice, which according to the tenets of occupational science
needs to be respected, may be to remain silent about any number of life's facets.
On the other hand, choice docs not occur in absence of one's environment,
which, for the most part, is a hospital or clinic situation. As I mentioned in Chapter 1,
Crepcau (1991) points out that the power differential between patients and therapists
often disadvantages patients with respect to communication. The women in this study
certainly supported this notion with their example of how the professional distancing
of many physicians with all patients precluded genuine conversations about their
conditions. However, they also provided copious examples describing how the
homophobic distancing of health care professionals added an extra barrier to
288
communication. Thus, it is not enough for therapists to sit back and wait for patients
to disclose. Instead, occupational therapy that is informed by occupational science
needs to respect the environments in which therapy takes place and make a concerted
effort to change them in a manner that alleviates hctcroscxism.
In summary, the findings or this study suggest that if occupational therapists
arc to provide "authentic occupational therapy" as described by Ycrxa (1985), then
how sexual orientation is expressed in the patient's occupations may need to be
addressed within the therapeutic context Furthermore, the degree to which
occupational therapy clinics are lesbian-sensitive will play a targe part in the ease with
which patients will shore this information.
289
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Appendix A
Definitions
301
DEFINITION OF TERMS
Authentic Occupational Therapy: Authentic occupational therapy as defined by
Elizabeth Yerxa encompasses three dimensions including a) sensitivity to and
respect for the patient's sense of meaning; b) focus on patient's potential to
realize his or her meaning through action; and, c) belief in the mutuality of
patient relationship in which the therapist actively engages in and is affected by
the therapeutic process (Yerxa, 1985).
Heterosexism: Hctcroscxism "privileges heterosexuals to view personal
relationships and sexuality os legitimate subjects for public discourse. When
such issues arc discussed from a lesbian, gay, or bisexual view they ore seen
os inappropriate or obsessive." (Hamlin & Tarala). Inherent in a hcterosexist
viewpoint is the assumption of the superiority of heterosexuality.
Homophobia: in general, homophobia refers to an irrational fear or hatred of,
generalized discomfort with, or negative predisposition toward persons who
arc of any sexual minority including lesbians, gays, bisexuals and
transgcndcrcd individuals. The spectrum or attitudes and intensity of feelings
widely varies among people. (Blumcnfcld, 1992; Gonsiorck, 1988;
Zcidcnstcin, 1990). Blumcnfcld identifies four manifestations of homophobia
including personal homophobia, interpersonal homophobia, institutionalized
homophobia and cultural homophobia.
Personal homophobia: Personal homophobia "refers to a personal belief system
(a prejudice) that sexual minorities cither deserve to be pitied as unfortunate
beings that arc powerless to control their desires or should hated, that they ore
psychologically disturbed, genetically defective, unfortunate misfits, that their
existence contradicts the "laws" of nature, that they arc spiritually immoral,
infected pariahs, disgusting -to put it quite simply, that they are generally
inferior to heterosexuals." (Blumcnfeld, 1992, pg. 4)
Interpersonal homophobia: Interpersonal homophobia refers to the act of
discrimination, when personal homophobia affects other individuals.
Examples include, telling jokes or insults; verbal, physical or emotional
harassment for the intent of intimidating; withdrawal of support or ejection by
friends, co-worker, family; and refusal to hire or rent. (Blumcnfcld, 1992).
Institutional homophobia: Institutional homophobia refers to formal or
informal codes within political, educational or religious institutions that
discriminate against persons from sexual minorities. (Blumcnfeld, 1992).
Cultural homophobia: Cultural homophobia refers to "social norms or codes of
behavior that, although not expressively written into law or policy, nonetheless
work within society to legitimize oppression^ pg. 6). Some examples include
negative stereotypical images that are displayed in media, denial of
representation of lesbians, gays or bisexuals in history, denial of self-labeling,
accusations of being blatant if publicly affectionate and tolerance when it masks
an underlying fear or hatred and a desire that the person will go away
(Blumenfeld, 1992).
Lesbian: Women whose primarily physical and emotional attraction is to other
women. "Lesbian identity is not limited to sexual activity but is a totality that
encompasses a primary orientation toward women and a way of being ihat is
302
womcn*rclation" (Slcvens & Hall, 1988, p. 69). Participants in this study will
be considered lesbian if they self identify as such. ' * -
Lesbian Identity: For the purposes or this study lesbian identity is grounded in a
narrative concept of personal identity, in which identity becomes embodied in
human action and the meaning one attributes to one's actions. Lesbian identity
refers to one theme that contributes to one's total identity which may affect
various dimensions of one's life including but not limited to occupational,
social, emotional, political, sexual or spiritual (Mishler, 1992; Polkinghomc,
1988; Zcidcnstcin, 1990).
303
Appendix B
Research Studies
304
Authors Purpose Rmicipants Methodology
Cochran,
Mays
1988
Elicit information about die
disclosure rates of black lesbians
& bisexuals about their sexual
orientation to physicians
607 women; 529 were lesbian, 65
were bisexuals; all were self*
identified
•Questionnaire eliciting information about disclosures,
women’s relationship with women & men, family, friends, &
social rituals
Dardick,
Grady
1980
Ascertain the factors that
contributed to being open with
one's sexual orientation with
health care professionals. To
ascertain haw identifying oneself
as lesbian or gay affects quality of
care
622 lesbians & g ays; 73% male;
91% white; 6% urban; between 22 it
41 yrs. old
•Mailed questionnaire predominantly multiple choice with a
few open-ended questions. Subjects addressed included:
demographics, health care experience, sexual experience,
openness of health care, attitudes to lesbian or gay identity,
preference for health care profession with respect to sexual
orientation
D em y
1990
Discover the health care behaviors
it life experiences of older
lesbians
79 lesbians over 50 years old; who
resided throughout the nation
•Mailed survey including questionnaire (a) life experiences
pertaining to lesbianism; (b) personal life style questionnaire
addressing health behaviors
Douglas,
Kalman, &
Kalman
1985
Identify auhudes about
homosexuals from nurses & ■
physicians who were working with
people with AIDS
91 nurses & 37 medical house officers •Questionnaire measuring anitudes about homosexuality
Eliason &
Randall
1991
Explicate attitudes toward lesbians
it the relationship of altitudes to
age; own sexual identity it
familiarity with lesbians
120 heterosexual females enrolled in
undergraduate nursing program at a
Midwestern university
•Demographic questionnaire
•Sex role inventoty
•Attractiveness ratings of photographs of women in feminine
vs. nonfeminine attire; both labeled lesbian
•Likert-type scale rating on familiarity with lesbians; anitude
inward acceptability of lesbian lifestyle
306
Authors Purpose Participants
-------------------------------------------------------------------------
Methodology
Eliason,
I Donelan,
Randall
1992
Identify stereotypical images held
by nursing students and relate
demographic variables including
age, class, St level of education
189 nursing students from 3 settings:
community colleges, private college
& university. Students ranged from
pre-nursing program to graduate
nursing programs
•Content analysts of 3 open-ended questions including
•How would you know if a co-worker was a lesbian?
•How would you feel about working with a woman you know
to be lesbian?
-Are lesbians a threat to society?
95% reliabDity on major themes
Garfinkle St
Morin
1978
Assess whether sexual orientation
would impact diagnosis of
psychological health
80 psychotherapists; 40 female. 40
male residing in California
Hypothetical case studies that differed only with respect to
sexual orienation (lesbian, gay, heterosexual) St gender
(male, female) were analyzed. Diagnosis, problem, treatment
plan S t treatment strategy were requested
Mathews,
Booth,
Turner,
Kessler
1986
Identify the attitudes of physicians
toward lesbians St gays
1,009 physicians: 93% males; 86.4%
private practice; 43% primary care
specialists
•Mailed questionnaires including information about
demographics S t 4 attitudmal questions about treating lesbians
S t gays or allowing lesbians S t gays to practice medicine.
Likert scale responses required.
•Heterosexual anhudes toward homosexuality scale (HATH)
Randall
1989
Attitudes of nursing educators
toward lesbians
95 females, 7 of whom were lesbian.
Participants lived in Midwestern sate
-Mailed survey requesting responses to satement about
lesbians using a modified Likert scale. Information included
demographics; social comact with lesbians; anitudes toward
ethical, moral, St pathological aspects of lesbianism;
knowledge about sexual orientation
Robertson
1992
Elicit health care experiences of
lesbians
10 women who self-identified as
lesbians: white; employed at least part
lime
Qualitative research using a grounded theory approach; semi
structured interview based on 5 questions
1. Tell me about your experiences as a lesbian seeking health
care?
2. Did lesbian identity affect your care?
3. Preference in regard to health care provider?
4. Experiences with a partner?
5. Have you ever not sought health care because of sexual
orienation? H
| Authors Purpose Participants Methodology
Stevens &
Hall
19S8
Elicit information about the health
care experiences of lesbians
25 lesbians predominantly white,
middle < f c working class & living in
the Midwest
Qualitative research using semi-structured interviews that
addressed ‘lesbian idcntifiability, health strengths and
vulnerabilities, & interactions with health care providers* (p.
7°) 1
Rousso
1988
Identify the heterosexual interest
and relationship of adolescent
females with disabilities and relate
these to the expectations of
parents
45 women with physical disabilities,
31 of whom were disabled prior to
adolescence & 11 of whom were
diabted following adolescence
-Questionnaire entitled ‘Social & Sexual Experiences of 1
Disabled Women During Adolescence* I
-In-depth interview of 8 women
White
1979
Identify attitudes held by
psychiatric nurses toward lesbians
67 nurses employed at a Midwestern
psychiatric hospital; nursing students
attending a master's program
-Questionnaires including
(a) MacDonald’s Attitudes toward Homosexuality Scale;
(b) TAW Altitudes toward Lesbian Scenario
Young
1988
Attitudes of nurses toward
homosexuality
22 registered nurses providing health
care to persons with AIDS
Pre and posl-test following a workshop on AIDS. Test
included 20 cognitive questions about immune system and 3
open-ended questions about feelings associated with the word
homosexuality and one’s desire to change those feelings
Appendix C
Stereotypes
Stereotypes Description Sources
Lesbians want to be
men.
Equates lesbian existence
with male qualities.
Eliason. Donelan &
Randall. 1992
Lesbians boast about
their conquests.
Equates discussion o f
lesbian relationships or
events with boasting and
proselytizing.
Eliason, Donelan &
Randall. 1992
Lesbians desire to
seduce heterosexual
women.
Depicts lesbian women os
attracted to all women and
overzealous in their desire
to seduce others.
Eliason, Donelan &
Randall, 1992;
Eliason & Randall. 1991;
Randall, 1989;
Stevens, 1992b
Lesbians transmit
AIDS.
Depicts lesbians as
transmitter of all sexual
diseases, especially AIDS.
Eliason. Donelan &
Randall, 1992;
Eliason & Randall. 1991;
Randall, 1989;
Robertson, 1992:
Gentry, 1992
Lesbians are
pathological.
Depicts lesbianism as a
physical or psychological
abnormality.
Eliason, Donelan &
Randall, 1992;
Douglas, Kalman &
Kalman, 1985;
Randall, 1989;
White, 1979;
Garfinkle & Morin. 1978
Lesbianism is
immoral.
Equates lesbianism with a
chosen immoral act.
Messing, Schoenberg &
Stevens, 1984;
Presti, 1990;
Randall. 1989:
Young, 1988
Older lesbians don’t
exist.
Older lesbians are unhappy
spinsters or female truck
drivers.
Cooper, 1988;
Dcevey, 1990:
Messing, Schoenberg &
Stevens, 1984
Women with
disability ore
asexual.
W unen with disabilities
are not sexually attractive;
if lesbian, it is by default.
Fisher & Galler, 1988;
Rousso, 1988
309
Appendix D
Recruitment Ads
LESBIAN RESEARCH PROJECT
YOUR HELP IS NEEDED .
I am a Lesbian Ph.D. Candidate looking for lesbians with disabilities and
lesbian occupational therapists to participate in my dissertation research, t am
interested in how being lesbian has affected your health core experiences and is
expressed in your daily activities, ir you arc willing to share some of your experiences
with me, or want more information please give Jeanne Jackson a call at (213) 892-
0908.
311
LESBIAN RESEARCH PROJECT: Need lesbian occupational therapists and
lesbians with disabilities to participate in an interview study that looks at how
being lesbian has affected your health care experiences and is expressed in your daily
activities. Volunteers should be located in the So. Calif, area. Please call Jeanne
Jackson at (213) 892*0908.
312
Appendix E
Recruitment Letters
313
Dec. 8, 1993
Dear JoAnnc,
I am writing to occupational therapists in the southern California area with a
call for help. I am presently involved in collecting data for my dissertation entitled
Lesbian Themes o f Meaning: Daily Occupations and Health Care Experiences.
Basically I'm trying to document ways that being lesbian influences a woman's life on
a daily basis through what she docs. I also want to collect stories from lesbian
occupational therapists about their experiences in the hospital or clinic. More
specifically, 1 wont to hear how the sexual orientation of our patients is being
addressed or not being addressed as we provide them services. It is my hope that
these findings will provide more concrete and compelling examples of why and how
occupational therapists need to consider sexual orientation in their treatment.
I am looking for lesbian occupational therapists who would be
willing to talk to me and tell me their experiences. As you arc probably aware, being
lesbian is often kept quiet in the occupational therapy profession, and thus, it is
difficult for me to access people who may be willing to shore their stories. If you arc a
lesbian occupational therapist, I hope you will be able to help me out by participating.
If you choose to join me in this project, be assured that maintaining confidentiality is
of utmost concern to me. I will not use your name or place of employment in uny part
of the dissertation. I have additional methods of ensuring confidentiality that we can
discuss.
I realize th a t you m ay not be lesbian. However, 1 am also planning on
talking with occupational therapists who are not lesbian, to get an idea about if and
how they think sexual orientation is being addressed in the clinics. Thus, if you ore
314
not lesbian and would stilt be willing to share some of your time with me, I would
Ju
appreciate it.
So, if you arc willing (o participate or would just like to hear more about the
project give me a call at (213) 892*0908. If you are interested but feel that you don't
have time because of the upcoming holidays, coll anyway. I will conduct interviews
over the next nine months and I'm sure we can find a time that is convenient for you.
Think about it. I do believe that together we con make a difference in the care received
by lesbian and gay patients, so please consider this request carefully. Hope to hear
from you soon.
Sincerely,
Jeanne Jackson MA, OTR
315
Appendix F
Interview Guidelines
Interview Guidelines:
Interview with all women regarding occupations
•What docs it mean to be a lesbian to you?
•What is a lesbian lifestyle to you?
•What areas of life ore influenced by your sexual identity? (for each area go in depth
with examples of specific situations describing the events, social contexts, other people
participating).
•Con you identify times in which you feel especially proud or humiliated about being
lesbian. (Describe the situation; what is the social and temporal context; who was present
and of what relationship were they to you; what was said; how did your interpret the actions
and statements; what was your response.)
•In what situations arc you out as a lesbian? How long have you been out? How
long have you known that you were lesbian?
•Arc there limes when you purposely hide your lesbian identity. Describe what you
are doing, with whom, why you have chosen to conceal your identity.
•How important is being lesbian to your overall sense of identity ? What other
factors are important? In what way ore they played out in your doily life?
•In your home environment what are the objects that remind you of your lesbian
identity?
317
Interview G uidelines:
Interview with women who are disabled and lesbian regarding health care
e x p e rie n c e s.
•What were your experiences with occupational therapy ?
•Can you recall positive interactions with your occupational therapist or other health
care providers. Do any of these situations relate to being lesbian? ( If so, what was the
content of the encounter?; What was the social and temporal context?; Who was involved?;
What was your expectations of the situation?; What was the outcome?; What was your
interpretation?; How did you feci about the encounter?; How did the experience relate to
your lesbian identity?; What ate your opinions about why this encounter occurred.)
•Can you recall negative interactions with your occupational therapist or other health
carc providers ? Do any of these situations relate to being lesbian? ( If so. What was the
content of the encounter?; What was the social and temporal context?; Who was involved?;
What was your expectations of the situation?; What was the outcome?; What was your
interpretation?; How did you feel about the encounter?; How did the experience relate to
your lesbian identity?; What are your opinions about why this encounter occurred.)
•How do you think lesbians experience health care/occupational therapy differently
than women who are not lesbian?
•How could the occupational therapist have provided belter services to you? How
could he or she have related to your lesbianism in a more productive manner?
•How could the hospital environment support you as a lesbian in a more productive
manner?
318
Interview Guidelines:
Interview with occupational therapists who are lesbian regarding work
experiences.
•Can you recall any instances with patients or other health care providers that directly
related to your being lesbian or your patients being lesbian? ( If so, what was the content of
the encounter; what was the social and temporal context; who was involved; what were your
expectations of the situation; what was the outcome; what was your interpretation; how did
you feel about the encounter, how did the experience relate to your lesbian identity; what arc
your opinions about why this encounter occurred.)
•Did you encounter assumptions of heterosexuality in the past week or in general ?
(Describe the content of the situation; what was said; who was there; how did you respond).
•How do you manage your lesbian identity differently at work that during non-work
hours ?
•Docs being open as a lesbian matter to you, at work? Explain
•If being open as a lesbian matters to you at work, describe an ideal occupational
therapy department and medical setting as it relates to lesbian sexual orientation.
•What are your ideas on why lesbians remain closeted at your place of employment.
•What arc your ideas on why lesbians are out at your place of employment.
•Does a difference exist in how female health care professionals and male health care
professional relate to you or display homophobia?
319
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Asset Metadata
Creator
Jackson, Jeanne Marie
(author)
Core Title
Lesbian identities, daily occupations, and health care experiences
Degree
Doctor of Philosophy
Degree Program
Occupational Science
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
Education, Social Sciences,health sciences, rehabilitation and therapy,OAI-PMH Harvest,women's studies
Language
English
Contributor
Digitized by ProQuest
(provenance)
Advisor
Clark, Florence A. (
committee chair
), Parham, Linda Diane (
committee member
), Polkinghorne, Donald E. (
committee member
), Thorne, Barrie (
committee member
), Zemke, Ruth (
committee member
)
Permanent Link (DOI)
https://doi.org/10.25549/usctheses-c20-590213
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UC11226758
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590213
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Jackson, Jeanne Marie
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Tags
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women's studies