Sex, Shame, and Violence

A Revolutionary Practice of Public Storytelling in Poor Communities

Kathleen Cash

• Publisher: Vanderbilt University Press
• Year: 2016
• Print ISBN: 9780826520500
• eBook ISBN: 9780826520524
• Topic: Medicine
• Subtopic: Health Care Delivery

For more than three decades, Kathleen Cash has lived and worked with impoverished people, learning about their lives. Listening to them talk about their feelings of shame, Cash heard how people suffered from being unable to change what was happening to them--HIV infection, sexual and domestic violence, violence toward children, and environmental degradation. She saw that many interventions lacked emotional and cultural integrity and thus did little to alleviate these hardships. So Cash went outside the conventional approaches to health promotion and social justice and devised a community narrative practice, a strategy for engaging people through storytelling. From numerous ethnographic interviews, she pieced together cultural stories in a way that resonated with community people and revealed the paradoxes in their suffering. Cash recruited local artists to illustrate the stories in a form resembling a graphic novel and distributed these booklets for community discussion. (This book includes excerpts from these illustrated stories.)

In Thailand, Bangladesh, Haiti, Uganda, and the United States, people learned to talk about forbidden subjects and say what they could never say before. They stood up to each other, reconciled, and made health-seeking decisions. By helping others, they repaired themselves. In cathartic conversations they acknowledged shame, which led to acts of courage and generosity.

1

Lessons from Others

When you are poor, people will never appreciate you as a person. If they tried to know who you are that would mean that you are somebody.

—Haitian peasant farmer, 2002

Years ago I began using cultural narratives as an educational tool. This led me to narrative practice, the subject of this book. This path was not a direct one, but one that took me on a circuitous route of trial and error. I have had many experiences living and working in different cultural settings. Each in turn gave me deeper insights into ways in which cultural narratives could effect social change.

Early on, in two very different venues, I experienced life in poor communities and saw how people’s views in these communities could be reconfigured, ignored, or misunderstood. In the 1960s I experienced how culture and the material world intersected, in an American Indian Mission and in an Ethiopian village. First, I worked on a Winnebago Indian Mission in Black River Falls, Wisconsin. I grew up in a middle-class family, and though my relatives had stories of growing up poor, I had not been directly exposed to extreme poverty. On the mission I lived with Reverend Whiterabbit and his family, and over the summer, I worked with American Indian children to prepare them for their upcoming integration into local public schools. The mission had had a school for thirty-five years, and the teacher had stressed arts and crafts. Prior to their integration, the children were given a battery of tests, which diagnosed them as socially and intellectually backward. The test takers were supposed to match electrical objects, but these children had never seen most of the objects. The children lived in wooden shacks heated by pot-bellied stoves without electricity in one of the coldest areas of Wisconsin. I remember telling the sociologist who had performed the tests that it would be unlikely that any child from this mission would score well on this test because the questions did not reflect what the children knew or had been exposed to. As far as their social skills, I remember that we played many games and the children were polite, rule abiding, and lively and caring with their friends. I could see no evidence of poor social skills, though perhaps when in public school with non-Indians, the Indian children would feel shy, withdrawn, and ashamed of whom they were in the material scarcity of their world.

My second experience was in Ethiopia in 1966. I lived in a large thatched, windowless, round house with an open fire pit in the middle (there was no electricity) and a side section where cows and goats lived at night because hyenas roamed the area. I managed to get two windows built and after a time, I converted the area where cows lived (though a few goats remained) into a small kitchen with a wood stove. The dirt floor of my house was periodically washed with cow dung mixed with water, which left a hard, smooth cement-like finish. The washing removed dried cracks and unwanted insects that (if the floor was not washed regularly) laid eggs in these cracks and burrowed into your toes if you walked barefoot. As with most things, one can easily get used to living with grass-eating animals, even their bucolic emanations.

I wavered in those years from believing that we are really all the same under the surface to the opposite, that my life experiences and the material world from which I came were so different from my Ethiopian neighbors that we were viewing each other across a huge divide. I saw a child of four pick up small rocks and meticulously form them into an intricate pattern only to have an adult kick the rocks away and tell the child he was too old for that. I saw another child of five beaten for allowing a calf, which he was supposed to be herding, stray from the herd. However, I realized that a young child, by shepherding the village cows, was taking care of the family’s wealth, not a task a five year old could take lightly.

I witnessed absolute poverty: the suffering of lepers with half eaten faces; the hardships of emaciated, spindly-legged women who carried huge piles of wood up steep hills; donkeys, mules, and horses hobbled in grotesque ways that made them hop like rabbits; many people half-clothed in ragged remnants of barely recognizable shirts, pants, or dresses; and children regularly leaving school without having eaten anything the entire day. Occasionally a student or a man on a market or festival day had shoes, but no one else.

One night I was awakened by a frantic child who said his sister was giving birth and would die unless she was taken to Addis Ababa. They had no money to do this. There were no clinics within four hundred kilometers, and the village midwife could not perform a cesarean. Not surprisingly, a rural woman did not want a big baby for fear of being unable to deliver it. Health practitioners who tried to get pregnant women to gain weight were unaware of this fear and attempts to fatten up pregnant women often failed (though for many there was nothing to be fattened with). I heard funerals, regular occurrences, accompanied by intense wailing. Many children died but if one could make it to age five there was a good chance of reaching adulthood. My landlady had had fifteen pregnancies and of these, three of her children had survived to become adults.

Foreigners sometimes prefaced statements with “as Ethiopia leaps into the fourteenth century,” because the land system in Ethiopia at that time was feudal. Concepts born in Western policies about social equity regarding the just and impartial distribution of resources in some sense seemed irrelevant, if not ridiculous, in this context. Rather social equity related to personal, family, and community ties. Though the material world was sparse, if one ever had something, he or she would share it with friends. If I lent a sweater, later I would see my sweater walking on someone else I did not recognize. On foot, children traveled distances of up to fifteen kilometers from their homes to school and back every day. Few ate before or during school. If one had money to buy a roll, he or she would share it. To me it seemed like no one ever refused a request. There was an implicit understanding that what was mine was yours if you were a friend, or family, or from the same village.

Rural Ethiopians did not have a drive for private property (theirs was a subsistence economy) and the all-consuming attentiveness to ownership that this drive entails. I once asked two children from my village to deliver a book to an American woman living in the town. When I saw her next, she demanded that the children apologize. She accused them of stealing a banana from her house. In their minds, they had done her a favor and probably regarded her as a friend. I told her they were probably hungry (which was another likely explanation) to try to soften her. However, she was adamant, so they had to apologize, and I had to explain to them why. I could see by these children’s expressions that the experience was confusing at best and shaming at worst. The only plausible explanation to the children was that this woman was from the different planet of America. Property ownership, what one viewed as “mine” and/or “yours,” was complicated, and not easily resolved with an apology. The banana incident was, for me, the tip of a cultural iceberg, a small glimpse into a vast array of frozen, irreconcilable beliefs we share about each other.

When I started working in development projects, I felt these projects did not consider culture and its relevance except to ignore, disparage, or idealize it. People were identified as statistical measurements, graphs, and calculations. Culture was an abstraction, a curiosity or a political mechanism to facilitate an intervention, but not to be understood, accounted for, and seriously responded to. I never saw an intervention that incorporated the cultural values of recipients into its intent except in superficial ways.

The language of development research often consists of measuring behavior by molding it into abstractions. I saw this in the Theory of Reasoned Action (Fishbein, Middlestadt and Hitchcock 1991; Valdiserri 1989), in the Health Belief Model (Rosenstock 1974; Rosenstock, Stecher and Becker 1994; Abraham and Sheerun 2007), and in the self-efficiency approach of Albert Bandura (Bandura 1990)—all widely used to explain, develop, and evaluate HIV prevention programs. Without considering the significance of human relations and interactions, these types of theories and models assume behavior and psychological change happens due to personal mastery. Researchers’ academic attraction to abstractions generated many articles about how HIV prevention should be or was working (though statistics of transmission consistently proved otherwise). I saw myriad surveys with ideological underpinnings quite in contrast to the lives of the so-called beneficiaries. Surveys asked questions, used language, and assumed values unfamiliar to respondents as in the following example, the Sexual Relationship Power Scale, used with women in marginalized communities. Here are a few questions from this scale. Each was scored on a 4-point Likert scale, where 1 is Strongly Agree; 2, Agree; 3, Disagree; and 4, Strongly Disagree.

2. If I asked my partner to use a condom, he would get angry.

5. When my partner and I are together, I’m pretty quiet.

6. My partner has more say than I do about important decisions that affect us.

9. I feel trapped or stuck in our relationship.

11. I am more committed to our relationship than my partner is.

13. My partner gets more out of our relationship than I do.

15. My partner might be having sex with someone else.

24. Having a partner at all times is important to me.

25. There are lots of good men around to have a relationship with.

27. My partner tries to understand me—I try to understand my partner.

30. No other man could love me the way my partner does.

33. I have sex with no one else but my partner.

(Pulerwitz, Gortmaker, and Dejong 2000)

The goal of this survey is to assess degree of empowerment. What is apparent in this survey is that researchers have an ideological orientation regarding interactions between women and men. Not only would it be difficult to apply the data acquired from this survey to an actual intervention, worse still, this research has a hidden agenda indifferent to respondents’ lives. How will this type of questioning and analytical framework inform? The authors set up a criterion of relationship—evaluated in terms of how much or how little—assuming respondents can interpret or have ever thought of their relationships in this way. Words and phrases like “love,” “committed,” “more out of a relationship,” “trapped in a relationship,” “being quiet,” “good men,” “important decisions,” “to understand,” or being “pretty quiet” might have no meaning or might have complex cultural meanings. This instrument assumes a lot: that a man will become angry if a woman introduces a condom but not the other way; that a married woman would admit interest in other men; or that if the respondent’s husband is having sex with someone else or if the respondent suspects her husband is having sex with someone else, this is related to the respondent’s empowerment. The instrument assumes correlations as though there are universal ways a woman acts (regardless of culture) if she is empowered. What does this tool diagnose except how any respondent compares to an idealized bias outside that respondent’s experiences? The authors try to replicate a model of scientific validity, but validity here is internal to the instrument itself. Beyond this, it has little.

Does research ordinarily inform application and vice versa? Traditionally, project planners conduct a needs assessment, which is a misnomer for preprogram research. Also, needs assessment is often based on the perspectives of program planners rather than on those of the recipients. Interventionists do look to research to keep informed and to write proposals. However, like two ships passing in the night, researchers and interventionists miss opportunities to jointly design projects that integrate their purposes and activities. Commonly a study ends with a few grand, bland suggestions that give little insight or information on how a project could possibly apply the results to real conditions or circumstances. Research and intervention go about their separate journeys, independent but obliquely connected to each other in words rather than deeds.

The term intervention assumes the urgency of an involvement in the lives of those deemed in need. Many interventions are short lived—flash-in-the-pan experiences. Many interventionists appear to be inadvertently setting up real-life renditions of “The Emperor’s New Clothes.” Though not the subject of this book, this fairy tale in turn has captured the understanding of the so-called beneficiaries so well that they, too, now appreciate the emperor’s fineries and play along. Some interventions might have dramatic, immediate impact, but disregard possibilities for replication, expansion, and community initiative—except to hide the fact that not much is going on. Careers are made, money spent. So I asked myself, Who is better off? Do the so-called beneficiaries believe their lives are any better and do people behave any better toward each other because of this? Do they feel more hope about themselves and their communities? In many cases, I had to answer that the outsiders and the local people who run projects—who are often more comfortable with foreigners than rural people in their own country—were the ones who profited and became better off.

My first opportunity to create a cultural narrative and test out my ideas came between 1991 and 1995 when I worked in Chiang Mai, Thailand, developing an HIV prevention program for adolescent migratory factory workers. Though I was confined to certain terms of the grant, I knew from the outset that I would try out some ideas that I had been thinking about for a long time. I wanted an HIV prevention program to reflect the complexities of culture and in that context address the problems Thai youth faced in practicing safer sex.

“Thai women are virgins until they marry.” I heard this after I arrived in Chiang Mai while preparing to conduct sexual behavior interviews with unmarried youth. This subtle warning from a few university colleagues suggested that my impending interviews with Thai teenagers were misguided. One Thai colleague told me, “These factory girls are good girls. It’s unlikely that they’re having sex.” I matter-of-factly countered this with, “Even if they are virgins, don’t they still need to learn about AIDS?”

I met up with the complexities of Thai virginity after conducting a written sexual behavior survey with factory girls. I wrote a pre- and post-survey—a knowledge, attitude, and perception (KAP) survey, a commonplace type of instrument often used to evaluate HIV and AIDS programs. At the end of the anonymous KAP survey, I decided to include questions to find out whether the girls were having sex. I asked girls to check different yes or no boxes.

In retrospect maybe I wanted to disprove the admonition of Thai colleagues. My research assistants and I collected the survey and discovered that many of the girls checked the box “Yes, I have a boyfriend” or “Yes, I used to have a boyfriend.” However, out of 240 girls, all of them checked “No, I have never had sex.”

“I don’t believe it,” I told my research assistants. “There has to be at least one young woman out of 240 who is sexually active.”

Up to that point, I had met the factory managers to gain permission to conduct research, but I had not visited the girls in their own milieu. A research assistant, Wantana, conducted the surveys, but she, too, had had few private conversations with the girls. One night at 10:30 pm (the girls usually ended overtime work at 11 pm), we rode out to one of the garment factories on Wantana’s motorbike.

We approached the high-walled factory enclosure through a winding dark alley. An iron-grated gate demarcated the entrance. Parked outside the grounds were groups of young men, slouched over their motorbikes, patiently waiting. The night guard knew Wantana. He admitted us into the grounds, and I asked permission to walk around. The inner factory compound was completely walled and extended from the entrance gate through a wide expanse of vegetation to the concrete factory building. Outlines of trees, tables, and murky figures emerged from the shadows between two beaming neon lights that illuminated either side of the compound yard. One light highlighted the compound entrance, and the other the main door to the garment factory workroom. Girls briefly emerged one by one from the factory door and then disappeared into the darkness. Many girls had already left; some were still leaving.

As I walked around in the dim light, I began to see couples—some on chairs, others in bushes. This particular factory had both girls’ and boys’ dorms. A few girls were entering the boys’ dorm. Others were leaving to join the young men waiting outside the wall. Ambling around, I found myself avoiding the eyes of warmly embracing couples. In one corner a young boy was singing and strumming his guitar while groups of girls and boys encircled him, carrying on flirtatious banter oblivious to my presence. I passed what I thought was an empty phone booth, but I was surprised to see a couple necking inside, unaware of the prowling stranger. They giggled when they finally saw me.

Before leaving the factory, I talked to the guard, an older man firmly in charge of the entrance gate who probably knew more about the girls’ after-hour activities than anyone. The guard sat under an eave near the gate in a well-lit area. A small outdoor kitchen and his sleeping quarters bordered the guard’s station. Uniformed, straight backed, and carrying a night stick, he let me know that he took his job seriously. But in truth he was not really a no-nonsense kind of guy because his rotund, cheerful, and talkative demeanor revealed his friendship with his charges. He was protective of them but running scared.

He told me, “They are all good girls. . . . They are well-behaved and polite.”

So I said, “They are like young girls you knew when you were their age?”

“Oh, NO! They are nothing like girls before, when I was young. These girls have boyfriends.” Perhaps he had said too much. He backtracked . . .” but they are good girls.”

“Don’t worry,” I told him, “nothing you say to me will get back to the girls or the management here.” I briefly explained our research and intended program.

As though he had been waiting for the chance to talk openly about his unruly children, the guard confessed that a few weeks ago someone wrote graffiti on the fact...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Contents
• Acknowledgments
• Foreword
• Introduction
• 1. Lessons from Others
• 2. Storytelling and Shame
• 3. The Narrative
• 4. The Pedagogy
• 5. Evaluation
• 6. An Example of Narrative Practice
• 7. Reflections
• References
• Index