"Surviving discrimination by pulling together" : LGBTQI cancer patient and carer experiences of minority stress and social support

Background: Lesbian, gay, bisexual, transgender, queer and/or intersex (LGBTQI) people with cancer and their carers report poorer psychological outcomes than the general non-LGBTQI cancer population. There is growing acknowledgement that these health inequities can be explained by minority stress, which can be buffered by social support. Study Aim: To examine subjective experiences of minority stress and social support for LGBTQI people with cancer and their carers, drawing on qualitative findings from the Out with Cancer study. Method: An online survey including open ended items was completed by 430 LGBTQI cancer patients and 132 partners and other carers, representing a range of tumor types, sexual and gender identities, age and intersex status. A sub-sample of 104 patients and 31 carers completed an interview, with a follow-up photovoice activity and second interview completed by 45 patients and 10 carers. Data was thematically analysed using an intersectional theoretical framework. Results: Historical and present-day experiences of discrimination, violence, family rejection and exclusion created a legacy of distress and fear. This impacted on trust of healthcare professionals and contributed to distress and unmet needs in cancer survivorship and care. Social support, often provided by partners and other chosen family, including intimate partners and other LGBTQI people, buffered the negative impacts of minority stress, helping LGBTQI patients deal with cancer. However, some participants lacked support due to not having a partner, rejection from family of origin and lack of support within LGBTQI communities, increasing vulnerability to poor psychological wellbeing. Despite the chronic, cumulative impacts of minority stress, LGBTQI patients and carers were not passive recipients of discriminatory and exclusion in cancer care, demonstrating agency and resistance through collective action and advocacy. Conclusion: LGBTQI people have unique socio-political histories and present-day psycho-social experiences that contribute to distress during cancer. Social support serves to buffer and ameliorate this distress. There is a need for cancer healthcare professionals and support services to be aware of and responsive to these potential vulnerabilities, including the intersectional differences in experiences of minority stress and social support. There is also a need for recognition and facilitation of social support among LGBTQI people with cancer and their carers

LGBTQI inclusive cancer care : a discourse analytic study of health care professional, patient and carer perspectives

Background: Awareness of the specific needs of LGBTQI cancer patients has led to calls for inclusivity, cultural competence, cultural safety and cultural humility in cancer care. Examination of oncology healthcare professionals’ (HCP) perspectives is central to identifying barriers and facilitators to inclusive LGBTQI cancer care. Study Aim: This study examined oncology HCPs perspectives in relation to LGBTQI cancer care, and the implications of HCP perspectives and practices for LGBTQI patients and their caregivers. Method: 357 oncology HCPs in nursing (40%), medical (24%), allied health (19%) and leadership (11%) positions took part in a survey; 48 HCPs completed an interview. 430 LGBTQI patients, representing a range of tumor types, sexual and gender identities, age and intersex status, and 132 carers completed a survey, and 104 LGBTQI patients and 31 carers undertook an interview. Data were analysed using thematic discourse analysis. Results: Three HCP subject positions – ways of thinking and behaving in relation to the self and LGBTQI patients – were identified:’Inclusive and reflective’ practitioners characterized LGBTQI patients as potentially vulnerable and offered inclusive care, drawing on an affirmative construction of LGBTQI health. This resulted in LGBTQI patients and their carers feeling safe and respected, willing to disclose sexual orientation and gender identity (SOGI) status, and satisfied with cancer care. ‘Egalitarian practitioners’ drew on discourses of ethical responsibility, positioning themselves as treating all patients the same, not seeing the relevance of SOGI information. This was associated with absence of LGBTQI-specific information, patient and carer anxiety about disclosure of SOGI, feelings of invisibility, and dissatisfaction with healthcare. ‘Anti-inclusive’ practitioners’ expressed open hostility and prejudice towards LGBTQI patients, reflecting a cultural discourse of homophobia and transphobia. This was associated with patient and carer distress, feelings of negative judgement, and exclusion of same-gender partners. Conclusion: Derogatory views and descriptions of LGBTQI patients, and cis-normative practices need to be challenged, to ensure that HCPs offer inclusive and affirmative care. Building HCP’s communicative competence to work with LGBTQI patients needs to become an essential part of basic training and ongoing professional development. Visible indicators of LGBTQI inclusivity are essential, alongside targeted resources and information for LGBTQI people

Constructing ‘decency’ : government subsidized cultural production during the culture wars

This article examines the production of normative subjectivity and the construction of ‘appropriate’ and exportable knowledge through cultural policy during the culture wars of the 1980s_1990s in the USA. During this time, the performing and visual arts, and mass media were increasingly seen as the cause, rather than the reflection, of social instability, and quickly became subject to governmental regulation. Focusing on a 1998 US Supreme Court case, National Endowment for the Arts v. Finley, I examine the construction and application of decency offered in the oral transcripts, and attend more broadly to the relationship between cultural policy and law. Cultural policy is a technique of governmentality, and a means through which citizenship and national identity is constituted and regulated, and self-governance inculcated. Similarly, law is a key technology through which governance, and subjectivity is produced, constituted and regulated. Policies such as the ‘decency’ clause depend on a series of coercive technologies and practices, which ensure that only particular kinds of individuals are understood as embodying norms that are constitutive of citizen-subjects that the State desires. The introduction of the ‘decency’ clause may be understood, in part, as a response to a perceived failure in the arts community of individuals to effectively selfregulate and embody standard sociocultural norms

Affectively addressing cultural studies

A review of Melissa Gregg, Cultural Studies’ Affective Voices (Palgrave Macmillan, New York, 2006). Cultural Studies’ Affective Voices offers a nuanced genealogy of scholarly contributions from key voices that have influenced the formation and development of cultural studies as a discipline, while arguing for the vitality of an affective address that speaks to a wider audience so as to effect change. Gregg’s own scholarship enacts the ‘optimistic, inspiring and mobilising functions’ (159) she suggests are crucial for cultural studies to avoid complacency, remain relevant, and to intervene in wider socio-political regimes and structures. Gregg’s vision is complemented by Sydney-based artist Jane Simon’s photo on the cover, titled Ajar (2005). The open book, unhinged bookcase and play of light from the window’s reflection refer to Simon’s interest in domestic detail and small forgotten spaces. So, too, does Gregg provide for her reader the details, subtleties and nuances of an account that might otherwise be forgotten

Reviewed work : Performance in America: Contemporary U.S Culture and the Performing Arts by David Román

Book review: Performance in America: Contemporary U.S Culture and the Performing Arts. By David Román, Duke University Press, Durham and London, 2005

The poetics of hip hop : Elena Knox in dis miss!

Squinting in the dark at the viewfinder of Elena Knox’s digital camera, I capture an image of her moving body centre screen, and then gently rest the camera on my knees. While I ensure that my body remains static for the duration of her performance so as to keep a visual and sound “record” of her live performance, my eyes shift upward so that I too can view the event. Seated in the front row of Women and Theatre’s performance space at New York University, I share the heat of the stage lights with Knox, and we are both perspiring. I am trying to keep still, prioritising recording the live event over the affect of my body’s response to the performance. Surrounded by a largely American audience composed of academics, performers and theatre-makers, Knox temporarily shifts me elsewhere with her vernacular; how strange it is to hear a female Australian voice delivering smooth, fast rhyme to rap music in New York City

‘It’s not at all chic to be denied your civil rights’ : performing sexual citizenship in Holly Hughes’s Preaching to the Perverted

The following discussion examines processes of governmentality and regulation in the arts during the culture wars in the USA. Using performance artist, Holly Hughes's, Preaching to the Perverted, as a case study, I examine this performance as resistant to cultural policy that attempts to constitute heteronormative citizens. I engage with the question of how a queer critique can rethink the possibilities of citizenship by arguing that performance art is a queer time and space in which American citizenship is contested and reconceptualized. The moral panic that ensues from cases such as this solicits the participation of the general public, wherein some citizens demand regulation often bringing closure to any serious debate about alternative responses to controversial issues. Debates about the politics of representation in the arts, and of government-subsidized production of particular kinds of citizen subjects are critical because they significantly impact on the formation of cultural policy

Imagining otherwise : performance art as queer time and space

This chapter imagines performance art as queer time and space. Performance art not only contests normative structures of traditional theatrical performance, but also challenges understandings of normative subjects, and the relation of the arts to structures of power. Focusing on two performances: Australian performance artist Elena Knox.’s solo show, Lapdog, which fuses cabaret with poetry and physical performance, and Spiegeltent Productions.’ global theatrical phenomenon, La Clique, inspired by cabaret, new burlesque, circus and contemporary vaudeville, Davies explores narratives of resistance, counter discourses, and alternative imaginings of gender, sexuality and socio-cultural life. In her performance of Lapdog, Knox attends to gender, sexuality and class as these categories affect the position of women in the service industries. Her persona is a Barbie doll that breaks free from her box, but still perpetually imagines herself elsewhere while she undertakes the mundane tasks required by the various apparatus of her .‘outfit..’ Throughout her performance she develops subversive techniques resisting the politics of consumption, while drawing attention to the heteronormative framework in which she has been designed to excel. Performed on a larger scale, La Clique includes two pin-striped, pipe-smoking, acrobatic English gents in bowler hats, an erotically charged bathtub acrobat, and an American hula hoop act in which the performer subverts the notion of patriotism by playing.‘The Star-Spangled Banner.’ through vaginal contractions. In this tent of mirrors, performers queer normative boundaries through challenging bodily acts and practices to entertain, mesmerize and provide an audience with an alternative, seductive and chaotic imaginary world. Elizabeth Stephens responds to this chapter

Section introduction : working positively with sexual and gender diversity in schools

Both from the point of view of the experiences of different groups of students, and also with respect to the form that education about sexuality, sex, and relationships should take, education and sexuality raises complex questions and provokes heated-sometimes furious-debate

Rethinking inclusion : reading for success

Although the term 'inclusion' is used widely in the children's services sector, seldom has time been taken to explore what inclusion looks like in daily practice