Abstract/Acknowledgements/Table of Contents -

Introduction - Chapters 1 |  2 |  3  |  4 |  5  |  6  - Conclusion – Appendices – Bibliography

________________________________________________________________________

Ruben, a 42 year-old immigrant from Guatemala City, wanted to tell me a story. We sat together in a fast food restaurant in Northwest Toronto and chatted about his life in Canada. Ruben fled Guatemala as an undocumented refugee in 1972 because of the poor economic situation and increasing political violence. He lived in the United States for ten years and then migrated to Canada in the early-eighties. Ruben now lives in Toronto with his wife and daughter. I asked him about his health since moving to Canada, and in broken English he responded:

I’m gonna tell you this story of mine. When I got an operation for my gall bladder, I had kept a pain for almost seven weeks.

And the funny part is that when I went to play soccer, I got the pain. Right before the game I had that pain. But I never complained about that pain to anybody else. When I got home I was cold, so I took a hot shower. I took Aspirin. I remember I took about four Aspirin that particular moment. I got the pain at least diminished a lot. And I lay down for almost seven hours.

And then, a week after, I got the pain again. I was gonna take my daughter to the playground, but I got the pain. I couldn’t move from the door. My daughter was seven years old I think. And I called the hospital. I couldn’t move from the door. I couldn’t even straighten myself. So the people came and took me to the hospital. And the hospital gave me a needle for the pain, and it was gone.

Ruben: Because you feel that you don’t have to show your pain. That’s a really macho thing, not to show that you are weak. That’s the meaning of being macho: not to show that you are weak. Even though you might be the kind of person that cries the most, you don’t have to show the rest of the people that you cry.

You see, it’s my problem. Why should I make everybody else suffer for that particular problem?

Ruben’s story is not only about his gall bladder problem. It is also about what it means to be "macho." "Machos," according to Ruben, must be strong and self-reliant, and able to "keep the pain." "Machos" must not worry others by crying or showing their emotions and instead should take responsibility for their own problems. However, as Ruben explained to me later in the interview, macho can have many meanings. "Macho does not mean the same thing to everybody," he claimed. But soon after Ruben emphasized that "being macho" has different meanings for different people, he reiterated that certain ways of being macho can be bad for one’s health. Being macho, in Ruben’s view, can lead to all sorts of problems: unnecessary pain, reluctance to talk to people about health, refusal to visit doctors, and family conflict. Although Ruben could not pin-down the precise meaning of macho, he argued that certain ways of being macho can cause (or exacerbate) health problems.

What, then, does being macho have to do with health? What is the relationship between gender and health? What does it mean to be a man, a woman? How does being a man or a woman affect one’s health? Moreover, what happens to one’s gender identity when one is forced¾ due to political persecution, widespread political violence and worsening economic conditions¾ to migrate far away from home? Does gender identity change as a result of migration and, if so, how might this change influence emotional and physical health?

This thesis is about the relationship between gender and health among Guatemalan immigrant men in Toronto, Canada. Broadly, it is about how the beliefs, practices and expectations associated with gender identity (in particular, "being a man" or "being macho") influence¾ and are influenced by¾ physical and emotional well-being. I argue that there are diverse ways to ser hombre ("be a man") for Guatemalan immigrant men¾ there is constant contest, debate and confusion over gender identity. But I also argue that particular constructions and practices of ser hombre ("being a man") affect health and help seeking behavior in different ways. Immigrant men, like Ruben, who neglect to deal with pain and illness are putting a certain gender identity into practice which exacerbates ill-health. Those who renegotiate their sense of responsibility and manhood¾ such as Carlos, whose story about unlearning domestic violence is discussed in Chapter 3¾ potentially improve individual emotional and physical health as well as promote meaningful social and family relations. Thus, this thesis not only discusses the emotional and physical health problems faced by Guatemalan immigrant men, but also describes the ways in which they have maintained health and well-being despite experiences of political persecution, displacement and resettlement. Without overlooking the potentially serious health impacts of migration, I also explore the resilience strategies among these men. In doing so, I write against the tendency for social and health scientists to pathologize immigrants and refugees (Jenkins 1997).

This thesis is also about migration. It explores how political persecution, displacement and resettlement affect the health of Guatemalan immigrant men. I argue that the lived experiences of war, violence, un(der)employment, and other adjustment difficulties affect emotional and physical well-being in the country of resettlement. For the Guatemalan immigrant men that I interviewed, many struggle with health problems such as stress (estrés), loneliness (soledad), alcoholism (tomar), and bodily aches and pains (including arthritis, back problems, weight gain, and work-related injuries). I suggest that these sorts of health problems can be linked to the experience of forced migration. But I also assert that without attention to gender as a key factor influencing everyday decisions and actions, we cannot properly understand the health issues¾ nor the health strategies¾ of immigrants and refugees. For, as I will argue in Chapter 3 ("Ser Hombre"), migration can cause shifts in gender identity; shifts that in turn influence health and help-seeking practices.

This thesis is about belonging. It is about how people’s sense of belonging may shift as a result of displacement. I argue that belonging (pertenecer; parte de) is a key idiom through which Guatemalan immigrant men attempt to make sense of¾ and act upon¾ changes that are largely beyond their individual control (such as forced removal from their homes and communities in Guatemala, lack of recognition of professional and other credentials in Canada, and so on). But I am less concerned with where these men belong (in Canada, in Guatemala) than how they belong. I treat belonging as a process to account for the diverse ways in which Guatemalan immigrant men adopt new attitudes and practices in Canada. Belonging, as I argue more fully in Chapter 5 ("On Bodies and Belonging"), cannot be reduced to where one considers "home" ("here," "there"). How individuals attempt to make themselves feel at home (through language, work, relationships, and sport), rather than simply where they belong, is perhaps a more productive way to understand the process of belonging for displaced peoples. For belonging is not an attribute or category in these men’s lives but a process that involves ongoing negotiation of identities in order to resettle healthily.

Further, I contend that not belonging (no pertenecer; no parte de) can have health consequences for Guatemalan immigrant men. Forms of emotional distress such as loneliness, depression, and worries (preocupaciones) stem primarily from lack of work, difficulties learning English, and the interruption of life-long goals and aspirations. But these forms of distress are not only health problems. They are also embodied commentaries on the social and economic struggles that Guatemalan immigrant men face. By theorizing the body as a site of disruption and resistance¾ and not simply as a natural, passive object¾ I suggest that, through health and illness, men’s bodies speak to the challenges in their lives. The body, therefore, is a valuable locus from which to analyze the political and collective nature of health and illness (Scheper-Hughes and Lock 1987). I argue that Guatemalan immigrant men’s bodies are social in order to demonstrate that emotional and physical distress do not simply result from easily identifiable, individually-based contagions or stressors. Distress also stems from social tensions, and should be understood as a commentary on the social circumstances of people’s lives.

This thesis is also about narrative. It focuses on what Guatemalan immigrant men say (and do not say) about their health. I pay close attention to narrative and the ways in which men talk about their bodies, their identities, their histories. Narrative¾ defined broadly as "stories that relate to the unfolding of events, human action, or human suffering from the perspective of an individual’s life" (Muller 1999:221)¾ is one way in which Guatemalan immigrant men attempt to come to terms with experiences of violence, kidnapping, "disappearances," displacement, un(der)employment, family separation, and unfulfilled dreams and aspirations. The shape and content of these stories (what they say or don’t say about their health, for example) provide clues to what is important in these men’s lives and how they cope with change on a day-to-day basis. But since the Guatemalan immigrant men in my study were not always willing to talk about their health, I argue that gender influences whether or not people narrate about certain issues. Although Ruben talked openly about his gall bladder problem, for example, not all Guatemalan immigrant men I interviewed were willing to share this sort of information. My questions about health did not always elicit stories about health but rather prompted stories about jobs, housework, and political activism. Conversely, my questions about work, community, family, and sport would sometimes lead to discussions about back problems, loneliness, weight gain, stress, and other health problems. What I initially viewed as a methodological predicament became an indicator of the influence of gender on health talk. As both a methodological and theoretical tool, therefore, narrative provides an opportunity to analyze the entanglements between health and other aspects of people’s lives.

Finally, and importantly, this thesis is not only about men. It is about gender and how gender identities and roles are (trans)formed in relation to each other as a result of migration. Thus, I attend to Guatemalan immigrant women’s gender constructions and practices with a view to gaining a broader understanding of Guatemalan immigrant men’s health and illness. Building on the work of Matthew Gutmann (1996; 1997a; 1997b; 1999) and other anthropologists of masculinity, I argue that you can never truly study one gender. As Chapter 4 ("Caprichosos, Celosos, Trabajadores") demonstrates, an analysis of women’s beliefs about their own (and men’s) gender identities is critical to delineating the relationship between gender, migration and health. Although an ongoing argument of this thesis is that there are no stable, fixed gender identities, men and women do draw on stereotypes in the process of fashioning their identities. That Guatemalan immigrant women complain about men for their excessive drinking habits, lack of long term goals, and inability to salir adelante ("move on")¾ as well as praise them for their hard work and commitment to family¾ speaks to the diversity of men’s experiences and women’s expectations in migrating to Canada. Again, this illustrates that masculinities and femininities are co-constructed and therefore have little meaning except in relation to each other.

This thesis is organized into six chapters, followed by a brief conclusion and appendices. In Chapter 1 ("Doing the Research") I do two things. First, I discuss the important theories and concepts that have guided my research project on health and gender identity among Guatemalan immigrant men. Although I have reviewed a wide range of literature in medical anthropology, gender studies and the social sciences more broadly, in this chapter I define and discuss those concepts most pertinent to my study: diaspora, identity, health, gender, embodiment, belonging, disruption and narrative. Second, in a discussion of my methodology, I share the pleasures, benefits, challenges, expectations, mistakes and discomforts of doing medical anthropological research with immigrant men. I critically reflect on my positionality as a white, male, middle-class graduate student and offer a critique of recent literature on methodological approaches to studying immigrant (and men’s) health.

Chapter 2 ("La Violencia and Guatemalan Community Formation") is divided into two parts. The first provides a brief discussion of Guatemala’s recent history (1960-2000)¾ with particular attention to the impacts of Guatemala’s 36 year civil war (1960-1996) on its civilian population. I also highlight the political and economic processes that forced over 300,000 Guatemalans to flee their country during the 1970s and 1980s, and illustrate these processes through the narratives of Guatemalan immigrant men. Secondly, I focus on community formation and identity among Guatemalans in Toronto. I analyze the meanings that Guatemalans in Toronto attach to Guatemala and its history in order to build a "Guatemalan community." Issues of diaspora, community and belonging are foregrounded not only to understand community (trans)formation as a process, but also to suggest that belonging in particular is a key influence on the individual and social well-being of Guatemalan immigrant men.

In Chapter 3 ("Ser Hombre"), I connect the experiences of displacement, community and belonging to gender identity and gender roles. The purpose of this chapter is to foreground the various ways in which Guatemalan immigrant men in Toronto construct and act on their identities as men. I argue that displacement and resettlement influence how men view themselves and how they engage in social relationships. The ways to ser hombre ("be a man"), I suggest, are diverse, contested and never fixed. But I also point out how certain constructions of ser hombre can have serious health implications. I conclude by arguing that closer attention to the nexus between gender, displacement and health can improve researchers’ and practitioners’ understanding of the health and resettlement needs of immigrants and refugees.

Guatemalan immigrant women’s narratives on the relationship between ser hombre and health are the focus of Chapter 4 ("Caprichosos, Celosos, Trabajadores"). Broadly, it focuses on how women influence and talk about men and their health. I discuss how my sample of Guatemalan immigrant women construct men’s and women’s identities and suggest that these constructions influence health behavior. My goal is not to provide a comparable set of data on Guatemalan immigrant women’s health experiences, but to demonstrate that these women’s narratives provide clues as to why Guatemalan immigrant men act in healthy and unhealthy ways. By talking with women about men, for example, I was able to gain a broader and more informed perspective on why Guatemalan immigrant men seem to be more reluctant than women to discuss and deal with both emotional and physical health problems. My conversations with these women also helped to illustrate how Guatemalan immigrant men persevere and continue to live fruitful lives despite experiences of political persecution, migration and adjustment to a new society.

Belonging (pertenecer; parte de) is a key idiom through which the Guatemalan immigrant men in my sample strove to make sense of displacement, and Chapter 5 ("On Bodies and Belonging") focuses on the meanings and health implications of (not) belonging. Not belonging for Guatemalan immigrant men can result from a wide range of challenges in Canada: finding work, learning English, and attempting to fulfil goals and aspirations. I point to how a sense of not belonging for Guatemalan immigrant men can cause bodily and emotional disruption, manifested as loneliness, drinking, stress and injury. By conceptualizing belonging as a process, rather than as a category attached to a particular place (Canada, Guatemala etc.), I argue that we can gain better understanding of how displaced peoples become healthy or ill in the country of resettlement.

Chapter 6 ("Keeping It Inside") outlines the kinds of health problems that Guatemalan immigrant men face (particularly stress, loneliness, alcoholism, and bodily aches and pains), and discusses the influence of gender identity on the attitudes and behaviors toward emotional and physical distress. I show that although both Guatemalan immigrant men and women experience health problems in Canada, men more frequently refuse to deal with distress in a positive or constructive manner. Beliefs about responsibility, pain management, pride and self-reliance shape health experience. Although ways to ser hombre are diverse and debated, certain gendered practices ("keeping it inside," appearing strong [hacerse muy macho], not worrying others) can negatively affect health and social well-being.

In the Conclusion, I attempt to contribute to an anthropology of health and resilience¾ not only illness and pathology¾ by illustrating the health maintaining strategies of the men in my sample. The fact that these men have survived political persecution and economic decline, migrated to Canada, and learned to live in a new society is evidence of their perseverance in the face of adverse circumstances. Keeping busy, forgetting or learning about the past, seeking support services¾ Guatemalan immigrant men have responded to resettlement in different and sometimes healthy ways. Although the majority of these men are reluctant to seek care from biomedical professionals, many have practiced alternative sources of healing.

The Conclusion also summarizes the contributions, implications and limitations of my study. As one of the few medical anthropological studies on immigrant men’s health, I demonstrate that although both immigrant men and women may face a range of health problems during the processes of displacement and resettlement, men in particular seem reluctant to talk about health problems or visit health professionals. I conclude that gender constructions and practices are key factors that influence these health beliefs and behaviors. But I also recognize that my study is limited in scope. It is not a quantitative or clinical study that provides data on the epidemiology or levels of illness within a particular population. Nor is it a comparative study of men’s and women’s health. Rather, it is a qualitative description of the kinds of health and gender transformations experienced by immigrant men. It is a study of how gendered constructions and practices influence health beliefs and behaviors, and thus provides important data for both health researchers and practitioners working with displaced populations in Canada.

Abstract/Acknowledgements/Table of Contents -

Introduction - Chapters 1 |  2 |  3  |  4 |  5  |  6  - Conclusion – Appendices –

 Bibliography