Home > Uncategorized > Austin S. Babrow & Kimberly N. Kline “Frome “reducing” to “coping with” uncertainty”

Austin S. Babrow & Kimberly N. Kline “Frome “reducing” to “coping with” uncertainty”

Babrow, Austin S.; Kline, Kimberly N. 2000. From “reducing” to “coping with” uncertainty: reconceptualizing the central challenge in breast self-exams. Social Science & Medicine 51: 1805-1816.

[…] BSE promotion commonly suggests that women can use the procedure to detect cancer, that such exams can detect cancer in its early stages, and that detecting it in early stages reduces the threat of breast cancer, and hence that BSE reduces uncertainties associated with breast cancer. (1805-1806)

[…] social scientifc researchers have typically overlooked the possibility that both the likelihood and benefits of BSE (both for early detection and for selfawareness) depend upon complex interactions among a number of factors. For example, BSE practices appear to be shaped by embarrassment, which itself is a function of uncertainties related to sexuality (Salazar & Carter, 1994), uncertainty about a health practitioner’s response if it is a false alarm (Salazar & Carter, 1994), more general self-confidence, etc. Self-confidence is likely related to personal experience with women who have/have not detected breast cancer through BSE, training, age or stage-of-life – or embarrassment. And exam proficiency, which may or may not improve breast cancer outcomes, is likely shaped by factors such as embarrassment and/or self-confidence (Champion, 1992). (1808)

But, reliance on the ideology of uncertainty reduction as the principal means of understanding motives for and barriers to BSE inhibits attention to the complexities that are likely to be present, particularly as they may reflect cultural variations, just as this insensitivity reinforces the ideology. For instance, we know of no empirical BSE research that recognizes that the meanings and significance of uncertainty varies across cultures (but see Basso, 1979; Fox, 1980). By contrast, the recent French consensus statement on clinical recommendations for women at increased risk of breast cancer (see Eisinger et al., 1999) underscores the potential significance of such cultural variations. (1808)

[…] it is not surprising to learn in a recent Washington Postarticle that “even Joanne Schellenback, director of public relations at the American Cancer Society (ACS), has trouble bringing herself to do the whole (procedure)” (Kastor, 1997). Even for this representative of the primary BSE advocatory organization, the ACS, there is concern that, “unless you really know what you’re doing, everything feels like cancer” (quoted in Kastor). (1808)

Notably, Kline’s (1999b) analysis of BSE mass media articles revealed that, “according to this discourse, women did not choose against BSE, they `resist[ed]’ doing or `fail[ed]’ at monthly self- examinations and then offered `excuses’ and `ignore[ed]’ symptoms because they were in a state of `denial’ ” (p. 128). (1809)

First, women who expressed positive feelings with regard to BSE had invariably detected cancer during self-examination (though the articles gave no speci®c information about the cancer stage, leaving the open question of whether they had detected cancer in its early stages). These witnesses maintained that all women should practice BSE. On the other hand, women who had not detected any cancer found it to be embarrassing, guilt-laden, and fearful – and then affirrmed that these were barriers that needed to be overcome. For example, one woman lamented that “In my mind, the `routine’ breast exam is not routine at all: It’s a grim, lonely ritual in which we probe our bodies, our womanliness, for death” (Schneider, 1986, p. 90). This same woman went on to say that “we all know what weshoulddo Ð what’s absolutely sensible and necessary for us to do. But sometimes we are too scared to be sensible.” (1809)

[…] the ideology assumes that certainty should increase with knowledge and understanding, but gains in knowledge and understanding are often accompanied by a realization of the complex and dynamic interplay of factors (e.g. those influencing our health). That is, learning often produces greater uncertainty. (1811)

A related limitation of the ideology is that it glosses the important fact that reducing uncertainty on a particular issue, such as getting a de®nitive diagnosis or finding a treatment, gives rise to a cascading sequence of consequent uncertainties. For example, a woman may resolve her uncertainty about whether BSE is in general an e€ective method of early detection only to become concerned about her own ability to perform the exam, how she would react if she found a suspicious lump, and ultimately about the outcome of a cancer diagnosis. The ideology of uncertainty reduction artificially punctuates experience at the point at which a given concern has been resolved. Clearly, this ignores the extended meanings of BSE that thread their way through so many aspects of women’s experience. (1811)

A fourth limitation of the ideology is that people often seek to sustain or create uncertainty (Babrow, 1995; Lazarus, 1983; Ford et al., 1996). Again, it is commonly assumed, particularly in England and the United States, that uncertainty is bad, that it must be reduced (for the sake of mental health, for the sake of rational action). However, a woman who has been diagnosed with breast cancer may want to increase uncertainty about possible outcomes because doing so will presuppose that survival and non-disfiguring surgery are all within the realm of possibility. (1811)

As a fundamental feature of illness experience, uncertainty is not so much a state that is Ð and must necessarily be – reduced. Rather, we mustcope with uncertainty. (1812)

In short, one must necessarily cope with uncertainty, which may or may not mean reducing it, in the process of coping with illness. Appraisal determines whether one will move to reduce, seek, or sustain uncertainty. (1812)

A second signi®cant characteristic of coping with uncertainty is the necessity of understanding clearly and adapting responses to the particular type of uncertainty a person is experiencing. One of the unfortunate inclinations fostered by the uncertainty reduction ideology is to see these experiences as homogenous. (1812)

We believe that the ideology of uncertainty reduction inclines medical experts, social scientists, journalists, and women considering BSE and those with whom they interact to homogenize and thereby erase these significant distinctions. In contrast, the coping framework naturally inclines one toward the idea that there is no single way to live with uncertainty because it can take on so many forms. (1813)

For example, the person who says that she is confused by what she has been told about BSE might be expressing (a) diculty understanding one or more technical aspects of the information, (b) information overload, (c) concern about the inconsistency of available information, (d) doubts about what sources to trust, and/or something else. Hence, a basic practical implication of the current analysis is that the hearer must clearly understand the form of the speaker’s uncertainty. (1813)

Women’s uncertainty should not be denied or discounted as a simple and simply eradicated nuisance. Rather, doctors and others who interact with a woman dealing with BSE (or any other health concern) should first and always be prepared to recognize, understand, and validate her uncertainty. Moreover, pamphlets and other BSE promotional discourse must not ignore or discount uncertainties as “excuses” with simple solutions. Rather, it should encourage women to identify, re¯ect on, and discuss their uncertainties with health care providers and other sources of information and support. These steps are ethically as well as pragmatically important. Only when uncertainties are seen, understood, and appreciated can communication be used to foster (re)appraisal of both the uncertainty and alternative coping strategies. (1814)

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