The Paradox of Powerlessness: Gender, sex, and power in 12-step groups.
The growth of twelve-step groups, part of the larger self-help recovery movement, is a response to personal and social problems in which individuals seek empowerment and transformation. Originating with Alcoholics Anonymous in the 1930s and now international in scope, twelve-step groups address a wide range of problems, including drug addiction (Narcotics Anonymous), gambling (Gamblers Anonymous), food addiction (Overeaters Anonymous), sex and relationship problems (Sex and Love Addicts Anonymous), emotional problems (Emotions Anonymous), families of alcoholics (Al-Anon), children of alcoholics (Alateen, Adult Children of Alcoholics), and families of drug addicts (Nar-Anon). Recovery from these problems into a "normal, useful way of life" is a primary goal of all these groups (AFGH, 1988, p. 233).
All twelve-step groups typically rely on an adaptation of Step One of Alcoholics Anonymous (AAWS, 1976): "We admitted we were powerless over alcohol--that our lives had become unmanageable" (p. 59). What exactly is the paradox here? Webster's Unabridged Dictionary identifies a paradox as a statement that seems contradictory, unbelievable, or even absurd, but that may indeed be true. In an earlier work (Herndon & Eastland, 1999), 1 described this paradox as one which asks group members to admit powerlessness in a group whose purpose is empowerment--a seemingly contradictory, if not absurd, idea. The purpose of this paper is to explore the paradox of power and its obverse, powerlessness, in twelve-step groups, especially in relation to gender. To accomplish this goal I will 1) identify some of the fundamental issues in twelve-step groups relating to the idea of powerlessness, 2) discuss briefly the philosophical basis of the paradox of power and powerlessness, 3) explore the gender implications of this paradox , and 4) identify alternative ways of addressing these issues in the context of twelve-step groups.
The paradox of powerlessness inherent in twelve-step groups has generated controversy and critique in part because of the connotations of the term 'power.' Power is defined by Webster's Unabridged Dictionary as vigor, force, strength, influence, or ability to control others, while powerlessness is defined as weakness or impotence, without force or energy. Why and how are members expected to admit their powerlessness? To the Western mind such an act is untenable. For members of self-help groups seeking direction and guidance in solving difficult problems to be told, first and foremost, to admit powerlessness appears tantamount to being told to admit defeat. In addition, the relationship between gender and powerlessness is significant. Webster's defines masculine as strong (therefore powerful) and feminine as weak (therefore powerless). Hence the meaning of admitting powerlessness must inevitably differ, depending on one's gender and/or sex role.
The matter of gender or sex is rarely acknowledged in twelve-step literature and then principally as a role (e.g., the wife of the alcoholic). However, gender and sex-role issues underlie the groups' histories. Alcoholics Anonymous (AA), the earliest and perhaps most recognizable of these groups, began as a group of white upper-middle-class Protestant alcoholic men in the 1930s (see AFGH, 1989; Rudy & Greil, 1988; AFGH, 1976) although many women now participate in AA. Al-Anon, begun by the wives of AA founders for families and friends of alcoholics, continues to consist predominantly of women. This paper will use Al-Anon as its primary example of a twelve-step group because it evidences issues clearly related to gender and defined sex roles, but many of the issues are similar in all groups modeled on AA.
Power and Powerlessness in Twelve-Step Groups
This section will identify some fundamental tenets related to power and powerlessness in twelve-step groups which are based on a set of twelve steps and twelve traditions (see Appendix A for a list of Al-Anon's twelve steps). The steps provide a guide for personal change and growth based on personal responsibility and a belief in a spiritual force or Higher Power while the twelve traditions guide group process and structure (Herndon, 1992).
Much of the current literature about alcoholism describes family roles, based frequently on the model of the alcoholic husband, codependent or enabling wife, and children who enact a variety of roles. The nature of these interpersonal interactions, regardless of who occupies which role, is addressed in Al-Anon, a program for families and friends of alcoholics. According to Al-Anon's Twelve Steps and Twelve Traditions (AFGH, 1981), the twelve steps are the "heart of the program in which the family of an alcoholic can find a new way of life in the fellowship" of the group (p. ix). Several of these steps are related directly to issues of power/powerlessness:
"Step 1: We admitted we were powerless over alcohol--that our lives had become unmanageable." In this and related steps, group members are encouraged to understand that by admitting powerlessness over the "facts of our situation and the other people involved," they will discover that they "are not helpless" (AFGH, 1990, p. 31). Following this step, it is advised, provides a feeling "of release, of yielding or letting go" when it becomes clear that "no change in others can be forced" (AFGH, 1989, p. 8). An Al-Anon member writes, "Many meetings later, I grasped the idea that the only person I have any power over is myself" (AFGH, 1990, pp. 40-41).
"Step 3: We made a decision to turn our will and our lives over to the care of God as we understood Him." AlAnon guidance suggests a reliance on and relationship with a "benign Power" in which "our part . . . was to learn to recognize, reach out, accept--and act, with the inner awareness of the spiritual presence whose direction we decided to follow when we made a decision to turn over our will and our lives" (AFGH, 1981, p. 21). Commonly referred to as "turning it over," this step acknowledges reliance on a Higher Power, however it is defined. Kasl (1992) calls this the "let go and let god" step, referring to one of the frequently used slogans in twelve-step groups (p. 312).
However, the official language always refers to "God" as "Him," thus reaffirming a patriarchal view of spiritual guidance. While individuals or local groups may be flexible in their own language use, nowhere has the issue of sexist language or its power implications been addressed in conference-approved twelve-step publications (those materials officially sanctioned by Al-Anon Family Group Headquarters, Alcoholics Anonymous World Services, or their counterparts). The equation of God with a male 'Higher Power' reinforces an inherent gender inequality.
Step 8: "We made a list of all persons we had harmed, and became willing to make amends to them all, and Step 10: "We continued to take personal inventory and when we were wrong promptly admitted it." In these and related steps, members are encouraged to confess their mistakes and strive to be more aware of the consequences of their actions in relation to other people. Al-Anon guidance suggests, "Taking Step Ten gave us the opportunity to spare ourselves the consequences of being stubbornly opinionated. It reminded us that we were not all-wise, that the philosophy of our Steps is based on humility, on acknowledging a Power greater than ourselves" (AFGH, 1981, p. 64). Admitting one's failings and making amends can certainly be cleansing and renewing; it may also be a source of shame and reconfirmation of one's worthlessness. Kasl (1992) identifies this problem as a "cultural double bind" where the "victim" may be taking responsibility not only for her own behavior but also for what has been done to her (p. 322). A feminist critique would ask why she should focus on her shortcomings at the expense of her achievements.
How can admitting powerlessness empower someone? How can yielding or surrendering produce strength? Although these ideas may seem contradictory to those of us schooled in the Western tradition, they have a long history in Eastern philosophy. In this section I want to demonstrate very briefly the philosophical roots of this paradox.
A description of the "working principles" of Al-Anon identifies them as the "concepts on which all spiritual philosophies are based," in the "Bible as well as the sacred literature of the Orient" (AFGH, 1988, p. 229). The AlAnon book of daily meditations, Courage to Change (AFGH, 1992), is punctuated with quotations from a variety of sources, including Lao Tzu, Confucius, Kagawa, Helen Keller, Kahlil Gibran, Carl Jung, Soren Kierkegaard, Antoine de Saint-Exupery, Langston Hughes, Meister Eckhart, The Bhagavad Gita, The Bible, The Talmud, and Persian poems, as well as Ojibway, Zen, Turkish, and American proverbs and sayings. The debt to the thinking of many of the world's great writers and traditions is evident.
Writing in the sixth century B.C., Lao Tzu penned Tao Te Ching (1972), the basis of Taoism which remains a central part of Chinese culture. The paradox of power and powerlessness is a prominent theme, as evidenced in these excerpts:
Yield and overcome;
Bend and be straight;
Empty and be full;
Wear out and be new;
Have little and gain;
Have much and be confused. (Twenty-Two)
The softest thing in the universe
Overcomes the hardest thing in the universe. (Forty-Three)
A man (sic) is born gentle and weak.
At his death he is hard and stiff.
Green plants are tender and filled with sap.
At their death they are withered and dry.
Therefore the stiff and unbending is the disciple of death.
The gentle and yielding is the disciple of life.
Thus an army without flexibility never wins a battle.
A tree that is unbending is easily broken.
The hard and strong will fall.
The soft and weak will overcome. (Seventy-Six)
The truth is often paradoxical. (Seventy-Eight)
Hassett (1996) writes in an article unrelated to twelve-step programs, "The many paradoxes of the Tao now make sense. When Lao Tzu says 'yield and overcome,' I know what he means because I've pushed against life, trying to make it obey my desires, and have learned that it doesn't work that way." Here we can begin to see how, ironically, admitting powerlessness may result in a sense of power-flexibility may provide strength, yielding may "get" us what we cannot get through force.
The Buddhist tradition also illustrates the paradox of having and turning loose. Mark Epstein (1995), a Western-trained psychiatrist and a practicing Buddhist, explores our Western confusion about the nature of happiness which he describes as "the ability to receive the pleasant without grasping and the unpleasant without condemning." Ultimately, he says, happiness is "release from the attachment to pleasant feelings." Ron Leifer (1997), a Buddhist as well as a psychiatrist, says that from the Buddhist perspective suffering results from our selfish pursuit of happiness. In describing the "way of the Lotus" associated with Buddhism, Herman (1997) suggests that "the Lotus way invites us to engage in action.., but to do it with unattachment," comparing this principle with the teachings of the Upanishads, Jesus of Nazareth, Islam, the Bhagavad Gita, and Taoism. This paradox is reflected in the Al-Anon principle of detachment: "We let go of our obsession with another's behavior and begin to lead happier and more manageable lives, lives with dignity and rights, lives guided by a Power greater than ourselves" (AFGH, 1992, p. 43).
For many of us steeped in the Western tradition, the idea of being powerless suggests losing, being dominated or defeated. These ideas are based on the assumption of a dichotomy (one wins and one loses) rather than complementarity or mutuality (Berenson, 1991). The paradox is that one may become empowered by accepting one's powerlessness. The gender implications of this paradox will be explored in the next section.
I begin this section with a brief summary of the obvious. The dichotomous stereotypes of masculine as rational, objective, strong (and therefore powerful) and feminine as emotional, subjective, weak (and therefore less powerful or even powerless) continue with us. Being powerful connotes being successful, in control, in charge, in authority. Inevitably, in a patriarchy, power, being associated with masculinity, gets conflated with being male. Being powerless, however, suggests the opposite and therefore gets conflated with being female, a double-bind ("catch-22"), explicated by Kasl (1992), Jamieson (1995), and others.
It becomes evident that the twelve-step prescription to admit powerlessness carries an implicit challenge, albeit a paradoxical one, to normative expectations, especially of masculine behavior. While accepting powerlessness may be difficult for anyone in a culture which celebrates being in control, it is not surprising that females, having been socialized into expectations of femininity, may have less difficulty acknowledging powerlessness. According to Kasl (1992), AA founder Bill Wilson was "constantly concerned with the need to deflate a rigid, over-blown ego as a prerequisite to admitting one has a problem with alcohol" (p. 17) which worked well for the privileged white men with whom he worked. Kasl points out, however, that such an admission of powerlessness does not necessarily serve the same purpose for most women and many underprivileged people who may already be painfully aware of their powerlessness. Indeed, building up a healthy ego may need to be the goal for those who suffer from oppression as w ell as problems associated with addiction.
Furthermore, turning over one's will and life to a Higher Power, always referred to as masculine, is also paradoxical. On one hand, the process of letting go can be liberating, hence the slogan "Let Go and Let God" (AFGH, 1988, p. 248). On the other hand, it can increase one's sense of powerlessness. Kasl (1992) argues that the "last thing women and minorities need to do is hand their wills over to others to control. To do so is at the heart of oppression" (p. 313). A feminist critique would argue that people who have had their power and autonomy restricted or even stripped away (e.g., women, racial/ethnic minorities, gays and lesbians) are rightly wary of prescriptions to do anything that might further reduce their strength, power, dignity.
Another major gender implication inherent in Al-Anon practice is the reliance on stereotyped sex roles, perhaps best illustrated by a free pamphlet made available at meetings and identified as a helpful source of information especially for newcomers. using a theatrical metaphor, Alcoholism: A Merry-Go-Round Named Denial (Kellerman, 1969) identifies one of the major characters as the "provoker," a role described in other literature as codependent. This "key person" in the play is "usually the wife or mother," who is "hurt and upset by [the alcoholic's] repeated drinking episodes; but she holds the family together ... she feeds back . .. her bitterness, resentment, fear and hurt, and so becomes the source of provocation. She controls, she tries to force the changes she wants; she sacrifices, adjusts, never gives up, never gives in, but never forgets" (pp. 5-6). Kellerman explains that "the customs of our society train and condition the wife to play this role" (p. 6). While this pamphlet is sympathetic to the w oman's position and its difficulties, it reveals the classic double-bind, or paradox of powerlessness. If she actively tries to change him, she is denying his autonomy; if she passively accepts the situation, she reinforces her own sense of powerlessness. Either way, she loses.
One criticism of Al-Anon is that by privatizing the problems of living with an alcoholic, it implicitly reinforces societal expectations of female passivity in the name of acceptance. The story of one such group member is detailed under the title "I Learned to Love" in Al-Anon Faces Alcoholism (AFGH, 1988, 134-139). The "wife of an active alcoholic" recounts that since she learned not to "hand over the money" to him, her husband now "manages to pay the bills." She has allayed her anxiety about his irresponsibility by recognizing her own flaws and determining not to "blame" him for his drinking. No mention is made of the consequences of unpaid bills or any alternatives she might have to this dependency. In describing a similarly unhealthy relationship, Kasl (1992) stated that the woman in this situation needed "some feminist consciousness-raising" (p. 265). Repressing anger, Kasl argues, results in loss of power.
Krestan and Bepko (1991) describe codependency, such as the behavior described above, as the "process of 'losing' one's identity to an overfocus on another person or relationship" (p. 50). Such behavior becomes even more problematic when it is described as a disease. While Al-Anon literature refers to alcoholism as a "family disease" (AFGH, 1988, p. 47), its members often speak of their own "disease" of codependency in meetings. Medicalizing social or political conditions only serves to perpetuate them because the underlying causes are not examined, as Western medicine customarily proceeds from a mechanistic model of the body independent of circumstance. The traditional medical model casts the doctor as a knowledgeable and powerful (usually masculine) authority, the patient as supplicant (usually female) having less power or knowledge. Gender inequality, hardly a medical condition, is certainly a major source of what is described as dysfunctional, codependent behavior (see Berenson, 1991; Krestan & Bepko, 19 91). Kasl (1992) reframes the idea of disease by redefining codependency as "a disease of inequality--a predictable set of behavior patterns that people in a subordinate role typically adopt to survive in the dominant culture. Codependency is a euphemism for internalized oppression and includes traits of passivity, compliance, lack of initiative, abandonment of self, and fear of showing power openly" (p. 279). She argues that this behavior is taught and reinforced through our primary cultural institutions in order to maintain patriarchy and capitalism.
Concern over issues relating to gender and powerlessness has spawned some critique and spurred the development of alternatives which will be identified in the next section.
Several authors have revised the twelve steps to address many of the issues described in this paper (see Berenson, 1991; Kasl, 1992). These revisions fall outside the boundary of "conference-approved literature" (AFGH, 1988, p. 258), a limitation which has resulted in material that does not challenge or critique gender inequality. First published in Ms., Kasl's (1990) original revision of the steps (see Appendix B) offers a provocative alternative addressing the fundamental issues of power/powerlessness and gender inequality. Following is her revised version of the steps analyzed earlier in this paper: Steps 1, 3, and 8-10 (pp. 30-31):
"Step 1: We acknowledge we were out of control with -- but have the power to take charge of our lives and stop being dependent on others for our self-esteem and security." This formulation moves away from powerlessness as loss of control toward claiming power over one's own life.
"Step 3: I declared myself willing to tune into my inner wisdom, to listen and act based upon these truths." A radical departure from the original, this revision places the primary locus of spirituality inside the individual, rather than in a masculine deity.
"Step 8-9: We took steps to clear out all negative feelings between us and other people by sharing grievances in a respectful way and making amends when appropriate." This revision rights the imbalance of the original one-sided version by emphasizing respect and openness as opposed to an apologetic attitude.
"Step 10: Continued to trust my reality, and when I was right promptly admitted it and refused to back down; we do not take responsibility for, analyze, or cover up the shortcomings of others." A complete inversion of the original, this step now emphasizes the right to stand up for oneself and not to take responsibility for others, rather than focusing solely on one's mistakes.
Another interesting alternative is provided by "J" (1996) who has translated AA's primary text "from the gender-weighted English of the 1930s to an English that treats men and women equally" (p. vii). Arguing that the original version essentially ignored women except in the role of wife, "J," a self-identified sober alcoholic in AA, seeks to rectify this imbalance both by getting rid of the masculine pronouns and by changing the sex of the principals in several examples in the text. To date, this version has not been conference-approved.
In addition to alternatives focusing on changing language, Kasl (1992) identifies three twelve-step programs which have formed as alternatives to Alcoholics Anonymous: Women for Sobriety (WFS), Rational Recovery (RR), and Secular Organization for Sobriety or Save Our Selves (SOS), which were begun because of dissatisfaction with the treatment in AA of such issues as powerlessness, definition of God, and sexism.
At a fundamental level all these alternatives attempt to restore a balance of power. Berenson (1991) argues for a redefinition or "recovery" of power, to move from power as "technical will" or control toward power as "existential will" or willingness. He suggests that the "process of recovery from addiction is a process of recovering a different, more feminine, sense of power and will" (p. 74). Rather than power as domination over, we can think of power as autonomy, the ability to take responsibility for oneself and act in a caring and respectful way toward others, a conception of power that is mutual and balanced. The revised twelve steps reinforce this view. Autry and Mitchell (1998), in drawing lessons for business from the Tao, argue for just such a redefinition of power.
This paper has attempted to identify and explore a fundamental paradox at the heart of twelve-step programs-the paradox of powerlessness-and to explore its gender implications. It can be well argued that paradox is what makes the program work. However imperfectly, it reflects the wisdom of the ages. Yet equally valid is the need to rid twelve-step groups of destructive gender inequality. Perhaps the Serenity Prayer, written by theologian Reinhold Neibuhr and used in many twelve-step group meetings, reflects the balance needed to manage these paradoxical demands:
God grant me the serenity
To accept the things I cannot change,
Courage to change the things I can,
And the wisdom to know the difference.
(AFGH, 1988, p. 252)
Sandra L. Herndon is Professor and Chair of the Graduate Program in Communications at Ithaca College. She has published a volume on "Communication in Recovery: Perspectives on Twelve-Step Groups" and finds the intricacies of paradox to be intriguing.
(1.) An earlier version of this paper was presented at the annual conference of the Eastern Communication Association in Portland, ME, in April 2001.
(2.) Special thanks to Anita Taylor for helping me clarify the title of this paper.
Al-Anon Family Group Headquarters, Inc. (AFGH) (1988). Al-Anon faces alcoholism (2nd ed.). New York: Author.
Al-Anon Family Group Headquarters, Inc. (AFGH) (1981). Al-Anon's twelve steps and twelve traditions. New York: Author.
Al-Anon Family Group Headquarters, Inc. (AFGH) (1992). Courage to change: One day at a time in Al-Anon II. New York: Author.
Al-Anon Family Group Headquarters, Inc. (AFGH) (1990). In all our affairs: Making crises work for you. New York: Author.
Alcoholics Anonymous World Services, Inc. (AAWS) (1976). Alcoholics Anonymous. New York: Author.
Autry, J. A., & Mitchell, S. (1995). Real power: Business lessons from the Tai Te Ching. NY: Riverhead Books.
Berenson, D. (1991). Powerlessness--liberating or enslaving? Responding to the feminist critique of the twelve steps. In C. Bepko (Ed.), Feminism and addiction (pp. 67-84). New York: The Haworth Press.
Epstein, M. (1995). Opening up to happiness. Psychology today [Online], 28(4). Available: http://web.lexisnexis.com/univers...5=f99b6e9824f2f89420d63e47b3a7980 e
Hassett, B. (1996, Sept. 22). Finding wisdom in ancient philosophy means letting analysis go. Sacramento Bee [On-line]. D5. Available: http://web.lexisnexis.com/univers...5=acfd081cf283814e2450c883d214d86 a
Herman, A. L. (1997). The way of the lotus: Critical reflections on the ethics of the "Saddharmapundarika Sutra." Asian Philosophy [Online], 7(1). Available: http://web3.searchbank.com/infotra...on/411/306/20313689w3/7!xrn_11&b km
Herndon, S. L. (1992, May). The twelve traditions: A study in group process and organizational structure. A paper presented at the annual convention of the Eastern Communication Association, Portland, ME.
Herndon, S. L., & Eastland, L. S. (1999). Introduction. In L. S. Eastland, S. L. Herndon, & J. S. Barr (Eds.), Communication in recovery: Perspectives on twelve-step groups (pp. 1-10). Cresskill, NJ: Hampton Press.
"J" (1996). A simple program: A contemporary translation of the book "Alcoholics Anonymous. "New York: Hyperion.
Jamieson, K. H. (1995). Beyond the double bind: Women and leadership. NY: Oxford University Press.
Kasl, C. D. (1992). Many roads, one journey: Moving beyond the twelve steps. New York: Harper Perennial.
Kasl, C. D. (1990, Nov.-Dec.). The twelve-step controversy. Ms., 30-31.
Krestan, J. A., & Bepko, C. (1991). Codependency: The social reconstruction of female experience. In C. Bepko (Ed.), Feminism and addiction (pp. 49-66). New York: The Haworth Press, Inc.
Kellerman, J. L. (1969). A merry-go-round named denial. New York: Al-Anon Family Group Headquarters, Inc.
Lao, Tzu. (1972). Tao teaching [G. F. Feng & J. English, Trans.]. New York: Vintage Books.
Leifer, R. (1997). The happiness project. Ithaca, NY: Snow Lion Publications.
Rudy, D. R., & Greil, A. L. (1988). Is Alcoholics Anonymous a religious organization?: Meditations on marginality. Sociological Analysis, 50(1), 41-51.
Al-Anon's Twelve Steps (From Al-Anon Family Group Headquarters, Inc. . Al-Anon's twelve steps and twelve traditions. New York: Author.)
1. We admitted we were powerless over alcohol--that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him (emphasis in original).
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him (emphasis in original), praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to others, and to practice these principles in all our affairs.
Revised Twelve Steps (Kasi, C. D. [1990, Nov.-Dec]. The twelve-step controversy. Ms., pp. 30-31.)
1. We acknowledge we were out of control with but have the power to take charge of our lives and stop being dependent on others for our self-esteem and security.
2. I came to believe that the Universe/Goddess/Great Spirit would awaken the healing wisdom within me if I opened myself to that power.
3. I declared myself willing to tune into my inner wisdom, to listen and act based upon these truths.
4. We examined our behavior and beliefs in the context of living in a hierarchal, male-dominated culture.
5. We shared with others the ways we have been harmed, harmed ourselves and others, striving to forgive ourselves and to change our behavior.
6. We admitted to our talents, strengths, and accomplishments, agreeing not to hide these qualities to protect others' egos.
7. We became willing to let go of our shame, guilt, and other behavior that prevents us from taking control of our lives and loving ourselves.
8-9. We took steps to clear out all negative feelings between us and other people by sharing grievances in a respectful way and making amends when appropriate.
10. Continued to trust my reality, and when I was right promptly admitted it and refused to back down. We do not take responsibility for, analyze, or cover up the shortcomings of others.
11. Sought through meditation and inner awareness the ability to listen to our inward calling and gain the will and wisdom to follow it.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to others, and to practice these principles in all our affairs.
|Printer friendly Cite/link Email Feedback|
|Author:||Herndon, Sandra L.|
|Publication:||Women and Language|
|Date:||Sep 22, 2001|
|Previous Article:||Paradoxes: No simple matter.|
|Next Article:||Paradoxical Constructions of Self: Educating young women about Menstruation.|