- Abstract/Acknowledgements/Table of Contents -

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

- Appendices - Bibliography -

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Can you imagine how much we’ve suffered?

Manuel

On October 2, 1999, Matias, a prominent Guatemalan activist and one of the key informants for my study, died of tuberculosis in a Toronto hospital. Matias’ health condition was complex. According to friends and family, he had an epileptic condition and, upon suffering a Grand Mal seizure, was admitted to hospital. Matias also had liver problems due to a long history of drinking and often caught terrible colds during the winter. In hospital, Matias learned that he had tuberculosis, but because of his liver problems his body was too weak to handle the necessary medication. Consequently, the tuberculosis spread and, after one month in hospital, he died of "sudden unexpected death and epilepsy".

Since migrating to Canada in 1984, Matias struggled to cope with life away from Guatemala and sorely wanted to return to his home country. My interview with Matias in July 1999 was particularly memorable. He was feeling distressed after seeing photographs of former "disappeared" classmates at San Carlos University in Guatemala City. These photographs had recently been released on the internet by the CIA in Washington, DC, and Matias was finding it difficult to cope with the memories of his friends. Soon after I asked Matias how seeing these photos made him feel, tears welled up in his eyes and he began to cry. After fifteen years in Canada, he was still haunted by the images of his friends and the memories of violence and political struggle in Guatemala.

To commemorate Matias’ life and his accomplishments, a small committee was formed to help organize a memorial service. Since I had Matias’ last recorded words on cassette tape, I suggested that we play a portion of the interview at the service. I ensured that his wife and close friends consented to the use of the cassette and asked them to help select the appropriate passage for the occasion. We agreed that the portion of the interview when Matias talks about his political activities in Guatemala and his commitment to human rights issues was the most "representative" of his personhood and character. At the memorial, the interview was just one of several testimonios to Matias: friends and family talked about Matias’ tireless social activism, his vibrant intellect, and his devotion to his family. As well, marimba music and tamales were enjoyed in his honor.

I share this account of the events surrounding Matias’ death not to discuss methodological or ethical issues, but to call attention to the salience of immigrant men’s health as a topic for medical anthropological research. Matias’ passing saddened many Guatemalans and non-Guatemalans in Toronto. His death was premature and it represents the loss of a tremendous activist, friend and father. But, curiously, his death also seemed to illustrate a major argument I was developing for this thesis: That refugee and immigrant men may be at risk for developing emotional and physical health problems due to experiences of political persecution, family separation, un(der)employment, and language difficulties. Moreover, since Matias was reluctant to seek formal or informal care for his emotional and drinking problems, his death was also an example of the gendered dimensions of health and help-seeking.

This chapter focuses on the health experiences of Guatemalan immigrant men in Toronto. As a way to bridge the topics discussed in other chapters¾ political persecution, diaspora and community, gender identity, and belonging¾ this chapter concentrates on how gendered expectations and practices influence individual health, and how health and distress inform processes of gender identity (trans)formation. I argue that compared to women’s health, men’s health has received scant attention in medical anthropology. First, I provide a glimpse into the various ways in which Guatemalan immigrant men define health and illness. Second, I discuss the idioms of distress through which Guatemalan immigrant men embody the struggles in their lives, particularly stress, loneliness, drinking, and bodily aches and pains. Finally, I highlight the ways in which gendered norms and expectations influence attitudes toward health and help-seeking.

Rolando

My approach to studying the health beliefs among Guatemalan immigrant men is guided primarily by the work of Robin Saltonstall (1993) and the few scholars who have researched the health and health beliefs of Guatemalan immigrants (Meredith 1992; Miralles 1989). In a study of white middle class men and women in the United States, Saltonstall emphasizes the importance of understanding individual "lay" constructions of health. In general, the men and women Saltonstall’s study had similar ideas of what constitutes health (1993:8). The idea of health was closely associated with a sense of mental, spiritual, and bodily well-being and was in some cases seen as synonymous with "life" itself (Saltonstall 1993:8; see also Adelson 2000). Compared with women, though, men emphasized the importance of work and outdoor activity to individual well-being (1993:10-11). "Doing health," Saltonstall concludes, "is a form of doing gender" (1993:12). Saltonstall’s analysis guides my study insofar as it outlines a gender-sensitive approach to understanding the relationship between health and gender identity.

I also aim to build on the small area of research that has specifically addressed health and illness among Guatemalan immigrants in North America. In her thesis on adaptation among Guatemalans in Toronto, Diane Meredith (1992) draws attention to the stigma that is attached to emotional problems for this population. She argues for a "cultural basis for the stigma attached to mental disorders and this commonly prevents some people from directly reporting the presence of depression or other mental health concerns" (1992:32). While Meredith’s analysis of the relationship between culture and health fills an important gap in research on immigrant and refugee health, her lack of attention to gender as an important influence on the perception of health problems and, consequently, the seeking of health care, is addressed in this chapter. As the narratives of men and women in this chapter illustrate, the stigma associated with "emotional" or "mental" health problems is more common among Guatemalan immigrant men than women. Gender, then, is a critical factor in the study of health beliefs among immigrants and refugees.

In the only other study known to me that addresses health and illness for Guatemalans living outside of Guatemala, Maria Andrea Miralles (1989) discusses the health beliefs of Maya Guatemalans in a small town in Florida. She states that humoral balance (establishing an equilibrium between hot and cold elements in the body, primarily by eating the appropriate foods) is widely held (1989:62). Miralles also observes the importance attached to strength and weakness among both men and women in the town. According to Miralles, "Being ill carries a stigma of weakness and an inability to carry out responsibilities" (1989:89). Miralles findings resonate with the narratives of participants in my study¾ particularly men¾ who link health and illness with work, strength, and responsibility. I aim to show that these factors have particular salience in the lives of men, because they are strongly associated with the meanings attached to being men.

I asked the men in my study about how they would define "health." I asked this question to understand how Guatemalan immigrant men talk about their minds and bodies. The nuances of the responses were diverse, but all the men in my sample agreed that mental, physical and spiritual health interact to produce an overall sense of well-being:

Carlos: Well, I think it’s a combination of physical and mental health and emotional. I think combination of these and spiritual health.

In almost identical fashion, Pablo replied:

It has to do with my body and mind. It is hard to give a definition like a book, but it’s to have my body and mind working in a good way. Taking care of all my organs, my weight, and things like that. My definition of health is that the mind and body are working together. Also the spirit is important, too.

Elaborating on the relationship between mental and physical health, Víctor discussed the importance of maintaining a good diet and avoiding drugs and alcohol:

Victor: Being physically and mentally healthy. Eating nutritiously. Not consuming alcohol or non-prescription drugs. Not smoking and getting exercise. And sleeping at least eight hours a day.

Manuel hints at the relationship between health and work. This became a major theme in my discussions with men about the meaning of health:

Sam: What does health mean to you?

Manuel: It’s a combination of factors: emotional, physical, environmental. There are many factors. How your body and brain responds to the environment. If you are not responding well to the environment, you get stress or something physical that doesn’t allow you to do or perform something. I think that is health.

For Manuel, to be healthy is to be able to work and perform at the level you are capable of. Pedro, too, spoke of health in functional terms. Health is a source of being able to perform tasks and live a culturally, socially and economically sound lifestyle.

Pedro: To me health is to function very well in all areas of your daily routine. If you are in good condition you will perform and succeed socially, culturally and economically. I think you have to keep a balance in your life to have a good life. I suffered a crisis in the past due to all the changes I went through, and I think I am a stronger man now, more mature and stronger.

Part of my aim in asking men about their definitions of health was to understand the relationship between mental and physical well-being for survivors of war and political persecution. Building on research that suggests that Guatemalan immigrants view the body and mind as part of an integrated whole (Miralles 1989; see also Green 1994)¾ as well as recent medical anthropological research that critiques biomedical constructions of bodies as pre-cultural and objectified (Becker et al. 2000; Csordas 1990, 1994; Kleinman and Kleinman 1994; Lock 1993; Nelson 1999; Scheper-Hughes and Lock 1987)¾ I tried to initiate my conversations with men on health by talking about their beliefs on the relationship between mental and physical health. I quickly learned that some men prioritize mental over physical well-being:

Sam: How do you define health?

Augusto: Maybe mental health is more important than physical health for me. When I get stressed my whole body goes through the brain as well. When I get stressed or I have a psychological problem or I cannot do something. Even in school, when I get a low mark I cannot sleep.

I remember once when a Guatemalan guy went back to Guatemala, his wife and his children stayed here. He had an alcohol problem because he wasn’t able to communicate. So part of physical health is related to the brain.

Similarly, Orlando emphasized the importance of being mentally well. He links mental health to the ability to be independent and make decisions for himself:

Sam: What does health mean to you? What is your definition of health?

Orlando: To be in good health I would say that you have to be good mentally and physically. That is short, but it says it all, you know. Not only physically but mentally too. Both are important. But if you asked me which one was more important, I would probably go with the mental. Because I would rather be fine up here (pointing to head) even if I am not physically fit. I would be able to think, to decide by yourself.

Sam: Why is that more important?

Orlando: Because if you are not able to work mentally then you have to depend on others. That would be tough.

With an emphasis on achieving goals and aspirations, Cesar makes a critical distinction between mental and physical health:

Sam: How do you define mental health? Are there any differences between mental illness and physical illness?

Cesar: Yes I think there are some. Mental health is connected to what you are doing and what you really want to do. Physical health is connected to physical condition and you have to take something to get better. The more important thing to me is to get mentally healthier to confront all the new situations in your life.

Each of these narratives point our attention to the ways in which mind and body interact to produce an overall sense of well-being or illness. Although these men do reproduce hegemonic biomedical (Cartesian) constructions of individuals as separated between mind, body and spirit, they also force us to reconsider how these dominant discourses are manipulated and negotiated in people’s everyday lives. These definitions of health provide clues to what matters to these men. Poor mental health, for example, may be a result of not realizing or accomplishing life-long goals. Further, given the importance of work and "performance" for these men, we may also gain insight into the ways in which gender influences the lived experience of distress and its expression.

For instance, notions of bodily and emotional well-being may be linked to having a good job and a harmonious family life.

Víctor: It is good to have a job that gives me economic stability and keeps me happy. I think if you have a job that you don’t like, it is only because you are getting paid more than you would with a job that you do like. But the chances of getting sick, depressed and frustrated are bigger, and will have an impact on you and on your family.

Here, Victor discusses the importance of maintaining "stability" in order to maintain good health. This stability can be achieved in part by having a meaningful job. Conversely, poor health is also viewed as a barrier to working hard and getting things accomplished. According to Alfonso below, sickness affects both the body and mind and prevents an individual from being a good worker:

Sam: What does health mean to you?

Alfonso: The state of health is when you are able to do things in a very good way. If you are sick, you cannot think. You cannot do manual things and cannot work; physically but also mentally. If you are tired, nervous, hungry¾ you cannot think. Your body and your mind are affected by these things.

Emphasizing the importance of physical fitness, Rolando talks about how he treats his body in order to live a productive lifestyle. Rolando believes it is important to be useful to the people in his life¾ colleagues, family, friends¾ and so he does his best to stay fit:

Rolando: My body is a temple. I have to respect myself. I owe it to myself to treat myself well, so I can be a service to my fellow human beings, especially my family. A temple that is treated well and well-maintained will always give you something good. I treat myself well; I work hard. But also I take vitamins, good meals; I rest. I do probably all the things that people do to keep my body in shape; to keep it functioning and healthy. I am a little fat (chuckling) because I eat a little bit more than normal but at 40 years it’s probably not too bad.

I foreground these narratives on the relationship between work, family and health to stress the gendered nature of health and illness. Both men and women tended to agree that men’s health was at greater risk due to long work hours, strenuous labor, and a reluctance to seek help for or talk about the problems in their lives. Men se gasta más ("wear themselves out more") than women, and this has consequences for individual health as well as family and other social relations.

Pablo

Pablo had cautious words to share about how my work would be viewed by Guatemalans in Toronto. Because I was asking about health issues, Pablo warned me, people may not be completely honest. Of course, this is a concern that all ethnographers face. But as researchers have mentioned in previous studies on refugee health (Aron 1992; Warner 1998; Zaharlick 1998), medical anthropologists in particular have to be sensitive to the meanings and stigmas that displaced peoples attach to specific health problems.

My questions about the definitions of health among Guatemalan immigrant men elicited opinions, ideas and perspectives on how people with mental or emotional health problems are viewed in the community. Manuel shared his view on the topic of "stigma" and drew attention to the historical context in which Guatemalans continue to suffer from memories¾ and the bodily and emotional impact¾ of war and political persecution.

In our country, if somebody is suffering from schizophrenia, the family will try to hide this problem because it is not socially accepted. And this is really bad for the family. In general, nobody talks about mental health. But it’s a huge issue, especially when a society is going through 36 years of war. Can you imagine how much we’ve suffered? A couple of generations have watched people dying: families and friends. Even though some people don’t want to accept it, we have many, many mental health problems in Guatemala. And how are we dealing with that? Not with much. We need more work. In Guatemala, we don’t want to accept that we have a relative or a friend who is mentally sick. So here in Canada it is different. People are more free to talk about it over here. A least it is more open here than in my country. As a Guatemalan, I feel that we should talk about it.

Manuel suggests that place and time have an influence on whether people are willing to talk about mental health problems. He argues that in countries that have not endured widespread political violence¾ like Canada¾ people are "more free" to talk openly about mental illness. In this straightforward explanation, Manuel maintains that the collective and widespread impact of violence in Guatemala is still a difficult topic for Guatemalans to discuss, both inside and outside of their home country.

In a similar vein, Ana called for attention to the lack of dialogue among Guatemalans on the prevalence of mental health problems in the community. I asked her if she knew anyone who suffers from problems such as depression, nervousness or anxiety. She replied:

That doesn’t exist in our culture though. They don’t believe that those are illnesses, or something that they are challenged with. They think that it is nonsense. That’s why they say, "Está loca" ("You’re crazy"). They’re not realizing that this person really does have an illness that they are trying to cope with. You just don’t hear about it.

Ana seems to suggest that mental illness has a way of "not existing" among Guatemalans. It is ignored or stigmatized instead of dealt with as a serious issue. There were other ways of viewing problems with mental health, though. In comparing her life in Guatemala and Canada, Carmen suggested that there is less mental illness in Guatemala not because it is stigmatized and ignored, but rather because life in Guatemala is slower, more calm (más tranquilo; menos agitado). She also suggested that the lack of talk about mental health problems among Guatemalan immigrants in Canada is due to the economic climate in Guatemala. That is, according to Carmen, there are not enough services or resources in Guatemala to deal with mental health problems seriously, and therefore there is little institutional support for health problems of this kind.

Carmen: My country is very poor, it is not developed like Canada. So it makes sense that mental health doesn’t exist in Guatemala. We don’t have the same opportunities there as we do here.

Regardless of the source of the stigma attached to¾ or "lack of talk" about¾ mental health problems among Guatemalan immigrants in Toronto, it is a pressing issue for both men and women. My findings also indicate that the "lack of talk" about health issues is a gendered problem. As I will explore in more detail later in this chapter, the difficulty that many men have in talking about their health is part of what it means to be a machista.

A primary aim of my project is to understand the relationship between displacement and health. What health complaints, I ask, could be attributed to the lived experiences of displacement and resettlement among Guatemalan immigrant men? What might particular health problems reveal about meanings attached to gender and identity? Also, how might gendered expectations and practices influence health and attitudes toward health problems? Not surprisingly, my questions about health did not simply elicit stories about particular illnesses or emotional struggles, but also prompted narratives on work, language, family and social interaction. These responses demonstrate the interconnectedness between health and social life.

Mark Nichter’s (1981) pioneering article on the expression of psychological distress among South Kanarese Havik Brahmin women in South India has provided a valuable framework for my analysis of emotional and physical distress among Guatemalan immigrant men in Toronto. Nichter argues a point that is now largely taken for granted in medical anthropological theory: that distress may be communicated in different ways¾ embodied, psychologized, or otherwise¾ and that particular manifestations of distress must be understood in relation to social and cultural contexts (1981:379). In Nichter’s study, "alternative" means of expressing psychological distress resorted to by Havik women are discussed in relation to Brahminic values, norms and stereotypes. Although Nichter doesn’t adequately problematize the concept of "alternative" (alternative to what?) and therefore fails to consider the role of power relations in modes of expressing distress, his article provides important groundwork in the study of distress and medical anthropology more broadly. I use Nichter’s work as a guide to analyzing Guatemalan immigrant men’s health and distress, and understanding how the expression of different forms of distress speak to¾ and are reflective of¾ gender identities and the power relations that influence the production of these identities.

The Guatemalan immigrant men I interviewed all shared stories on the health problems they had experienced throughout their lives. Among these, I paid particular attention to those maladies that developed, worsened, or improved upon migrating to Canada. What I found, in short, was that problems with stress, loneliness, drinking, and bodily aches and pains were health problems that seemed to be particularly influenced by displacement and resettlement. Jaime, for example, talked about the stress of migrating to and learning to live in Canada:

Sam: Have you had problems with stress or nerves or anything like that?

Jaime: Yeah, with stress. First of all because of the language. I had to go to the welfare centre. They charged me $40 to translate. And I said, "Wait a minute, I’ve never spoke English before." I didn’t have a job; I had a family. It was a new country, new life, and you have to know the city and everything. And so I really was upset and confused about the situation.

Sam: How would you describe your stress?

Jaime: If you have nothing to do, the stress comes. When you have stress you can’t think about anything. You need something to do. And when people come over here they don’t speak English. So they aren’t able to be with people very much.

Similarly, Jose talked about the stress of living in Canada. He linked this health problem to not knowing people in Canada and memories of violence in Guatemala:

Sam: Have you had any mental health problems?

Jose: Yeah, at the beginning because I didn’t have friends and I felt alone. But I think sometimes I also have stress problems. But I’ve tried to overcome that. But I try not to think about it because now I have two kids and I have to help them and raise them. But I do have problems because of the memories we have. I knew a lot of people who died. I will carry all these memories for the rest of my life.

Sam: How does this stress make you feel?

Jose: Angry. Sometimes I am driving and I want to pass everyone. But I try to control myself because it is no good. If you behave like that, what are you teaching your kids? Sometimes I want to beat them but I control myself and say, "This is my problem, not my kids’ problem." I feel like I want to cry and tell everybody, but it is difficult to tell them what is happening in my head.

Like Jose, Carlos also told me about his feelings of anger resulting from stress. For Carlos, his struggles with stress in Canada has lead to problems with abusive behavior towards his wife and a suicide attempt:

Sam: What have been your experiences with your health here?

Carlos: Well my physical health was okay, but my mental health was at risk because I was separating from my wife. I was kind of under stress with depression, but I didn’t understand these kind of words. In Guatemala I didn’t have this kind of situation. But here I was under stress and I tried to kill myself. I couldn’t deal with my family problems like the way I did in Guatemala. So I said everybody is against me, everybody wants me to be nothing, everyone wants me to be quiet and not say anything.

Carlos’ description points our attention to how individual problems with stress¾ an idiom of distress communicated by all sorts of people in different socioeconomic contexts¾ can "outfold" (Kleinman and Kleinman 1994) into the social world. Carlos’ struggles to understand that he cannot deal with his anger in violent ways¾ by beating his wife or children. His narrative on dealing with problems with stress, therefore, illustrates the difficulties that most Guatemalan immigrant men in my study have in dealing with their emotional problems. It also suggests the importance of delineating the relationship between gender, violence and the state.

Complaints of loneliness were also common among the participants in my study. While some viewed loneliness as an inevitable or natural part of the process of living in a new society, others felt that being alone had led to more serious health problems or had affected their family or social life in negative ways. Enrique didn’t believe his health was any worse since he had migrated to Canada from Mexico in 1988, but his sense of loneliness led him to decide to return to Mexico in December 1999.

Sam: Is your health better or worse since you moved to Canada? Or is it the same?

Enrique: It has been the same. The only difference is that here I am alone. My family is in Mexico. That is the only difference. Psychologically, there is a difference. I am more affected here. Because I am not married; I do not have children.

Sam: How does that make you feel?

Enrique: I feel very alone. Always I try to talk with somebody, friends, my family. But it is expensive on the telephone. Those are the things that keep me alive. But I am gonna go to Mexico for good this December. I feel happy about this because my family is there and it is closer to Guatemala. I decided to go after living for eleven years here. If I had a family here I would have stayed. For me, it’s better to go to Mexico. My objective was to stay here maybe five, eight years¾ but no more.

Cesar also complained of loneliness. For him, loneliness is a difficult problem to surmount. His sense of being alone continues to trouble him after seven years in Canada. As mentioned in the previous chapter, Cesar does not feel like he belongs due largely to an inability to communicate himself clearly in English and a nostalgia for Guatemala:

Cesar: Most of the time I think people are very angry and ready to attack me at anytime. I fear for my life at times and then I feel very isolated and lonely because I can’t express myself and communicate with them. These are the reasons for why I dream constantly of the beautiful beaches of my country; it is a way of dealing with my reality. I love the ocean and the warm water of the beaches, but Toronto doesn’t have an ocean.

In an attempt to elicit opinions on the broader beliefs about men’s health among Guatemalan immigrant men, I asked Cesar what sorts of health problems these men face:

Cesar: Yes, they feel very lonely and this is the biggest problem in the psychological disease because your capability of communication decreases by eighty or ninety per cent, you become melancholic, depressed, and then you feel that you have to do something crazy.

He then elaborated on how being lonely makes him feel:

You can feel and express loneliness in many different ways, but the most common is being alone all the time. Your biggest problem is your inability to communicate with the rest of the people and to participate in activities with the rest of the community. I understand there are a lot of things I need to do like: learning the rules, regulations, and the laws of this city, and getting to know the different cultures around me. You fall in a big depression because you can’t find the right way to adjust to this new society.

Feeling alone for both Enrique and Cesar has prevented them from belonging in Canadian society. In Enrique’s case, this has led to return migration to Mexico in order to be closer to friends and relatives. For Cesar, feeling alone continues to affect his everyday sense of well-being in Canada.

Anthropologist Matthew Gutmann has suggested that loneliness (soledad) positively resonates with meanings of being a man among working class men in Mexico City. He argues that manliness and loneliness are connected; it may be macho to be alone, independent, solitary, individual (1996:229). While the men in my study often emphasized the importance of being able to do things for oneself, loneliness was not considered positive or empowering. Though loneliness was not necessarily pathological, it was considered to affect one’s ability to live in a new society and have meaningful relationships with friends and family. None of the men in my study considered loneliness to be a positive expression of their masculinity. Instead, loneliness seemed to be an expression of the lived experience of displacement and attempts to belong.

However, following the work of medical anthropologist Theresa O’Nell (1996), I do not wish to pathologize loneliness. O’Nell points out that for Flathead Indians in the American Midwest, "Claims of loneliness can be positive expressions of belonging. Yet they can also be the expressions of profound distress" (1996:201). For the Guatemalan immigrant men in my sample, claims of loneliness varied in degrees of perceived severity. Loneliness can contribute to a profound sense of lack of direction, as Cesar explained above. But for Pedro, for example, a sense of loneliness is a part of everyday life, and thus it is an idiom of distress full of contradictions. For him, being busy can be both a source of stress and a way to cope with family and work challenges. Loneliness may stem from having "nothing to do" (Jaime), from lacking female companionship (Orlando), from lacking friends (Enrique), or from not being able to communicate in English (Cesar); but these experiences do not necessarily lead to severe distress or

pathology. As such, future analyses of "loneliness" need to pay close attention to the meanings attached to this idiom of distress in order to tease out the potential health impacts of migration for immigrants and refugees.

In both popular and academic discourses, stereotypes about Latino men as drinkers and drunks abound (see Gutmann 1996, 1999; Lancaster 1992; Singer et al. 1992). "Researchers and practitioners", notes Gutmann, "may have unwittingly influenced the perceptions and understandings of Latinos with respect to the relationship between ethnic identity and alcohol consumption" (1999:173). As such, drinking and alcoholism may become routinely associated with national culture traits. Building on these caveats¾ as well as recent research in medical anthropology that draws attention to the relationship between global political-economic processes and drinking patterns among migrant groups (Singer et al. 1992)¾ I analyze the health and illness narratives of Guatemalan immigrant men with a view to understanding why or why not these men drink. While Singer and his colleagues aptly point out that drinking can become a symbol of manhood itself for Latino men (1992), they fail to provide a nuanced discussion of how embarrassment, respect, pride and isolation are connected to the social practice of drinking.

My questions about health prompted stories on struggles with alcoholism in Canada. A few men in particular had had serious drinking problems since migrating to Canada. My conversation with Rolando was particularly memorable. He connected his bout with alcoholism not only to struggles to "fit-in" in Canada but also to memories of violence and persecution in Guatemala:

Sam: How have your experiences in Guatemala affected your life here in Canada?

Rolando: Once I witnessed somebody killing a guy who worked in the municipality in Guatemala and who opposed the ideas of the government. This motorcycle showed up with two guys and they stopped and shot this guy who was sitting next to me. When I saw the guy pulling out this gun, my instincts told me to run away. So they shot the guy and left on the motorcycle. It was awful.

How those things have affected me (not only this incident but many others that I also saw in Guatemala) is that I became a very depressed and melancholic person, and I didn’t care too much about things anymore.

When I came here I had many memories about those things. I met many people like myself who had come to Canada before. One friend was very involved. His family got beat up because he left the country: they killed his mother, tortured his brother, and beat up the whole family two or three times. So that he would feel remorse and then come to Guatemala and then they would kill him. But he didn’t.

And we used to gather together with other guys from Guatemala, and remember together. The trauma was so big that we got ourselves drunk remembering. Of course, that is not very healthy because a bunch of men drinking to forget every week will give you a problem. Not only for your emotional or body health but also with your wife and kids socially. You are not capable to do anything because you are a drunk. So that’s how it affected me. I was helpless in many situations.

Rolando went on to explain that although he had drank socially with friends and colleagues in Guatemala, his drinking increased during his early years in Canada.

Rolando: I couldn’t achieve my dreams or my goals as fast as I wanted to. First of all because I didn’t want to learn English. My type of personality is I want things now. I don’t want to work for them, I want it now. But over the years I’ve learned that you have to work for the things you need. In any place. It doesn’t matter if it is Canada, Russia or Guatemala. If you want something you work for it. Nobody’s gonna serve you something on a silver plate. I came here feeling very proud of myself. I was almost a engineering graduate. So I thought that everyone had to respect me.

But then things didn’t happen the way I wanted them to. And the only friend I could find was the booze. It made the problems a little bit easier. I expected too many things from myself at that point that I couldn’t fulfil. I blew it. People who drink can get addicted to alcohol, and that’s what happened to me. I got addicted to alcohol. I couldn’t live without it. I couldn’t live a weekend without a drink. I got sick. I was emotionally sick. I wasted a lot of time. Time that a healthy person can enjoy with his wife or her husband or kids.

Rolando’s drinking was an embodiment of his struggle to learn to live in a new society. In our interview, Rolando attempted to come to terms with his problem by highlighting pride, respect and unfulfilled aspirations as key factors that drove him to drink. He anticipated that he would be able to pursue his professional career in Canada. Since his credentials were not recognized and he had to accept more menial, labour-oriented work, he felt disrespected. Unable to express his concerns in a more healthy manner, Rolando began drinking because it provided a social arena in which to give voice to his personal struggle. Drinking, then, is an idiom through which Rolando embodies a set of social and economic concerns.

In opposition to stereotypes about Latino men as drinkers, few men in my study actually shared stories about problems with alcohol. Most considered themselves to be "social drinkers" and were aware of¾ and sometimes contributed to¾ stereotypes about Guatemalan men as alcoholics. This is why I raise Gutmann’s concern about researchers’ role in perpetuating stereotypes about Latino men. In the process of forging and transforming their own identities, social actors may reproduce these stereotypes in their everyday lives.

Lucas, for example, responded to my question about the health of men that he knew by emphasizing the pervasiveness of drinking among his male Guatemalan friends:

Lucas: Yes. The majority are from Guatemala and our biggest problem is alcoholism. I drink sometimes but not very much. I also have friends that drink and smoke a lot.

In another mode, I asked Manuel if Guatemalan men do things together and he replied:

It’s painful to say this but I am going to tell you anyway: the most powerful group of men I have seen here in Toronto is when we are drinking. At these moments, everyone is willing to do anything: they have money, time, everything. But to deal with Guatemalan issues or issues in the Latin American community, nobody has time, nobody has money. Unfortunately, that’s the truth. Everyone has time when it’s time to drink at a party or whatever.

Lucas and Manuel’s responses are interesting for two particular reasons. First, they suggest that drinking is part of being a man. This probably suggests that stereotypes about Latino men as drinkers continue to permeate the everyday consciousness of the participants in my study. But this belief may actually lag behind actual practice as Guatemalan men attempt to unlearn particular behaviors¾ such as drinking¾ that may damage social and familial relations. Second, these responses are part of a set of shadow data. As mentioned in Chapter 1, shadow data is when respondents discuss the experiences of other people and reflect on how and why these experiences resemble or differ from their own (Morse 2000:4). Interestingly, most of the men in my study denied having or did not mention personal problems with alcohol but readily discussed the experiences of men they knew who had. "I’ve never had a drinking problem, but I know so-and-so who has," was a common refrain. This sort of statement is at once an attempt to distance oneself from this stigmatized practice, while on the other to demonstrate concern for the health of the community as a whole.

There is one more response to my question about health that is particularly relevant to my discussion about gender and drinking. While talking about the meanings of being a man, Pablo mentioned:

Pablo here suggests that the difficulty that men have talking about emotional problems is one way of putting machismo into practice. Drinking provides both a social context and a physiological state in which men can talk about the struggles in their lives, particularly those which threaten their individual health. However, while drinking may "take away the mask that you are macho" by enabling men to talk about their feelings, the act of drinking itself is considered to be an enactment of a particular form of machismo. Drinking then becomes a social practice (and a potential health risk) that provides a context for men to enact manhood in all sorts of contradictory and ambiguous ways. As Pablo’s comment suggests, the meanings¾ and consequences¾ of drinking are not unitary or monolithic, but rather diverse and contested in everyday life.

Bodily Damage

In addition to drinking and other emotional problems such as stress and loneliness, participants also complained of bodily aches and pains. These problems¾ including arthritis, back problems, weight gain and injuries¾ were the result of climate change, stress, or work-related accidents. When I asked Eduardo if he had had any health problems since migrating to Canada, he complained of a sore throat due to the cold weather in Toronto. Although Eduardo grew up in a small highland village where night temperatures approach freezing during the cooler months, Toronto’s cold winter climate was a shock (un choque) to his body

When I came to Canada my throat was in poor condition, and the colder climate here made it worse. It was a shock, I was constantly losing my voice.

When I asked Manuel how is health was different from when he lived in Guatemala, he immediately replied:

The first three or four years here I was feeling sick every month or so: nerves, my liver, problems with my hands because of the cold weather. And the weather conditions, in one way or another, are still affecting my wife. We never suffered allergies. But here we have allergies. In Guatemala my wife would eat shrimp, but here, not anymore. She ended up in the hospital here.

I think that viruses here are more strong than in Guatemala. I’m just guessing but, for example, I never got really sick from the flu in my country. Here I am sometimes in bed for days, not being able to do anything. I never got that sick from a virus in my country.

Work-related health problems included back pain, weight gain and severe injuries. For Augusto, a doctor told him that he had a slipped disc due to stress. Augusto believes this stress was primarily caused by inadequate English skills:

Augusto: When I moved to Quebec the first three months were so stressful that the muscles in my back stretched my spine, and I had to go to the hospital and the doctor said that one of the discs slid. It was very painful. The doctor said it was stress. My mother thought so too.

As well, Augusto has gained considerable weight since moving to Canada in 1992. He attributes his weight gain to an inability to maintain an active lifestyle. Large work and study loads together prevent him from getting the kind of exercise he would like:

Sam: Is your health better or worse than when you lived in Guatemala?

Augusto: It’s worse. Before I came I used to run 10 KM a day. I used to do push-ups, sit-ups. I used to train because I liked to go to mountains and volcanoes. I used to swim; I used to play basketball. And right now I don’t do anything. I sometimes go for a bicycle ride or walk, but I don’t run anymore or play basketball for four hours. I’ve gained a lot of weight too. I used to weigh 140 lbs. and now I weigh 170 lbs.

Similarly, Lucas attributes his weight gain to reduced exercise time due to long work hours and a large appetite. When I asked him if his health was different from when he lived in Guatemala, he answered:

Yes. I have gained a lot of weight since I came here. My body shape has suffered a transformation, and I am worried about it not only because of the aesthetic reason, but because of medical reasons too. My problem here is that I eat too much all the time.

Several men linked work-related demands to poor bodily health. While these sorts of health problems are undoubtedly found among other populations¾ both male and female, immigrant and non-immigrant¾ my data suggests that particularly strenuous or unfamiliar work environments have caused bodily damage for many Guatemalan immigrant men in Toronto. Alfonso, who used to work in a municipal office in Guatemala City, was forced to seek manual labour positions in Canada in order to make ends meet. Alfonso argues that life is "slower"/"more calm" (tranquilo) in Guatemala and that a busier lifestyle (más agitado) in Canada has caused him health problems, including diabetes and injury.

Sam: How has your health been in Canada?

Alfonso: Well, first of all, when you say "in Canada" you make a distinction between here and my country. And there is a difference. Life in Guatemala is more calm, tranquilo. Especially if you work for the government. But even if you work for a factory. You don’t have the pressure that you are making money by the hour. You get money for the day and you work eight hours, it doesn’t matter how much you do.

Here it is different. In my experience in the factory, I worked in a place where they make furniture. I had to paint 300 tables a day. From 7AM until I finished. It was an assembly line job, so I had to paint the table in a couple of minutes. We didn’t even have time to go to the washroom. We had two breaks: one in the morning and one in the afternoon. And lunch for half an hour, and that’s it. If you wanted to go to the washroom you had to find somebody to replace you.

In some ways this affects your health because you don’t sleep very well, you are tired all the time. Plus you also have your political and solidarity meetings, you volunteer work after hours. It’s a whole new world. After five years of this kind of work, I ended up in the hospital. My sugar was up, and so was my cholesterol. So I had to stop smoking, drinking and eating fat.

Alfonso’s decrease in employment status also resulted in a work-related injury:

I’ve been in the hospital a couple of times. The second time was an accident at my work. I broke my leg very badly when I was painting. The guy I was working with couldn’t handle the crane that we used to move heavy things. The crane fell down and hit my leg. I was without work for six months.

This injury, I would suggest, is not only a health problem that caused significant financial and emotional distress for Alfonso, but also an embodiment of the process of displacement, migration and resettlement. Like many other men in my study, Alfonso left Guatemala as a refugee after being threatened for his activist activities. He was studying towards a law degree and had hopes of obtaining meaningful employment in his study area. Instead, Alfonso has been forced to work at several mundane, unrewarding labour jobs because his course credits are not recognized in Canada. Alfonso’s body, then, is a commentary on the socioeconomic conditions in which he has lived in the country of resettlement. His body is not passive but rather "speaks" to the lived experience of occupational decline and loss of status in Canada (Lock 1993).

Ruben

There was general agreement among the participants in my study that both Guatemalan immigrant men and women face emotional and physical distress as a result of fleeing Guatemala and resettling in Canada. Interviewees argued that a range of emotional problems are experienced by both immigrant men and women. Here, though, I want to concentrate on one critical difference between men’s and women’s health that was frequently reported by participants: the difficulty that men have talking about and seeking help for emotional problems as compared to women.

The anthropological literature on culture and emotions has surprisingly little to say about how gender shapes emotions and how emotional difficulties influence gender identities and roles. In a pivotal work on the nexus of politics, culture and emotions, Lila Abu-Lughod and Catherine Lutz (1990) argue that emotions are not simply a natural, universal phenomena determined by human biology but rather are sociocultural constructs with particular meanings and forms developed in particular contexts. They call for the analysis of "discourses on emotions and emotional discourses as social practices within diverse ethnographic settings" (1990:1). Although their introductory piece has nothing to say about gender specifically, I aim to build on their suggestion that emotion talk is situated in¾ and a commentary on¾ social life.

In the narrative at the beginning of this section, Ruben implies that men have a hard time taking care of themselves. Carelessness, it seems, is part of being a man according to Ruben. He attributes this behavior to cultural influence and suggests that men are prone to ignore health problems because they are raised that way. Similarly, in response to my effort to identify the relationship (if any) between machismo and health, Ernesto argues that being macho in itself may be pathological:

Sam: Does machismo affect men’s health?

Ernesto: Yes and no. In terms of emotional health, yes. Of course it has. People have to understand that being forceful or imposing things is not a positive social behavior. It is for sure an emotional problem. It is a way to pretend to be strong. And to try to dominate.

Edwin, too, made sweeping generalizations about men and women in his description of the health differences between men and women. Taking the examples of smoking and drinking, Edwin suggests that men’s health is generally (if not naturally) worse than women’s health:

Edwin clearly argues that men smoke and drink not because they suffer from stress, but rather because part of being macho is being able to appear important (hacerse muy macho). Edwin speaks against a biomedical explanation for high rates of smoking and drinking among men, and instead argues that gender is a key contributing factor to bodily abuse among Guatemalan men.

A linkage between gender and health may also be made in relation to men’s reluctance to talk about the problems in their lives. An intrinsic part of "being a man" according to most men in this study was an inability to deal with health problems in a positive way. Crying or expressing emotions by talking, for example, is contrary to a particular¾ and perhaps hegemonic¾ construction of being a Guatemalan man:

Manuel: This is another thing that is very common in Latin America. Because of the kind of education we have in our countries we were taught that we have to know everything about many things. This does affect me in many ways. At work, we don’t like to hear anything from a co-worker because we think we know more than him. Stuff like that. That’s because of our education in Guatemala. That’s what we were told since we were a child. "Men never cry!" If I fell down and something happened to my leg, my own mother would say, "Hey, men never cry! You’re a macho!"

Orlando, too, emphasized men’s inability to seek help for problems, but he had difficulty explaining why this is so:

Lastly, although Alfonso is aware of the difficulties many men have in discussing their personal problems, he distanced himself from this particular practice of ser hombre and instead emphasized his ability to talk openly about individual and familial issues:

Alfonso alludes to a particular way to be a man: violent, proud and silent on personal issues. In doing so he self-fashions an(other) enactment of masculinity, one that involves open discussion of personal matters between men. In reading Alfonso’s response¾ as well as the other responses of the men in this section¾ I am reminded of Matthew Gutmann’s suggestion that

There is continuous contest and confusion over what constitutes male identity; it means different things to different people at different times. And sometimes different things to the same person at the same time (1996:27).

Yet, despite this contest and confusion, social actors are aware of¾ and may actively reproduce or resist¾ hegemonic notions of gender identity. Thus, although I am hesitant to suggest that there is a single, dominant way to be a Guatemalan man, there are certain imagined and popular constructions of gender identity that people draw upon to construct and enact their own individual identities. Identities, as I have tried to emphasize throughout this thesis, are always produced "in relation." Alfonso, therefore, self-fashions his "non-macho" stance towards emotion talk in part by comparing himself to stereotypical constructions of Latino men and their health problems.

The narratives and analysis in this chapter resonate with Ruben’s story presented in the Introduction to this thesis. Ruben was reluctant to seek care for his serious gall bladder problem because of certain beliefs and expectations about how men deal with health problems. His story¾ along with the stories in this chapter¾ are intended to illustrate the influence that gender identity can have on the attitudes and behaviors toward health concerns among Guatemalan immigrant men in Toronto. Rather than argue for a particular "ethnic" or "cultural" explanation for why these men tend to ignore health problems, I have found that a more productive direction has been to concentrate on what "being a man" means, especially when men are faced with health problems. Pride, responsibility, taking care of oneself, not worrying others¾ these were all reasons why many of the men in my sample ignore or refuse to deal with illness.

With reference to gender identity, another aim of this chapter has been to show that although gender identities are never fixed or monolithic¾ there are diverse ways of being a man, as Chapter 3 has aimed to illustrate¾ certain ways to ser hombre do create health risks. By not talking about emotional issues or refusing to visit health professionals, an individual risks exacerbating his or her condition. My data indicate that these sorts of behaviors are more common among Guatemalan immigrant men than women. So, while it is important both theoretically and practically to write against static constructions of gender, it is equally important to pay close attention to those enactments of gender identity that lead to pathology and well-being. Men who emphasized the importance of talking about emotional issues with family and friends and identified family and social relations as important reasons for staying healthy, were behaviors that led to overall well-being. Men, like Ruben, who don’t want to ask for help because they don’t want to worry others, put their own health at risk as well as jeopardize social and familial relations. Future studies of immigrant and refugee health, therefore, should not only focus on the health effects of displacement and migration alone, but also on the transformations to gender identity that may affect individual well-being during the process of resettlement.

Finally, it is important to point out that several men in my sample (despite an overall reluctance to talk with friends and family about health issues, or to seek help from biomedical professionals) did develop alternative strategies for maintaining or improving health. Professional health care does not represent the only source of healing for Guatemalan immigrant men. Rather, some of these men employed personal (and sometimes relatively "private") resilience strategies such as "keeping busy." Others found help through support services including parenting groups and Alcoholics Anonymous. Thus, while the general thrust of my thesis is that many Guatemalan immigrant men in Toronto have difficulty salir adelante because of a reluctance to deal with health problems in a constructive manner (which in turn have positive implications for family and social relations as well), I am also sensitive to¾ and attempt to account for¾ modes of healing that allow these men to live their everyday lives. These issues are discussed more thoroughly in the Conclusion.

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- Abstract/Acknowledgements/Table of Contents -

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

- Appendices - Bibliography -