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RESEARCH ARTICLE |
Department of Sociology, Virginia Tech, Blacksburg, VA.
Address correspondence to Toni Calasanti, Department of Sociology, Virginia Tech, Blacksburg, VA 24061. E-mail: toni{at}vt.edu
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Abstract |
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 TOP Abstract What Is Feminist Gerontology?"Bringing Men in": Examining...Men's Health: A Feminist...Manhood and Health over...Manhood, Health, and Old...DiscussionReferences |
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The purpose of this article is to clarify feminist gerontology and its approach to men. This involves, first, briefly describing a feminist framework and its application to the study of women and gender inequality. I then discuss doing research on the advantaged, that is, men, examining both the positives that accrue to a privileged position as well as the negatives, without equating the latter with oppression.
Misperceptions about feminist gerontology persist, despite research conducted from this vantage or attempts to explain it. These misunderstandings include the idea that feminist gerontology deals only with "special" populations, such as women, and excludes old men. This is incorrect because feminists understand gender as relational. Even if women are the focus of research, their positions are intrinsically tied to those of men, and vice versa. Thus, feminist gerontology is not "only about ‘special groups.’" At the same time, most work in feminist gerontology has focused on women in order to build upon and reconceptualize the conclusions drawn from research based on men.
Frequently, justifications for using a feminist framework to examine aging rest upon the fact that most old people are women. This reasoning does justice neither to old women nor to the theoretical approach. On the one hand, it fails to explain why examining old women demands this particular approach; at the same time, it implies that feminist gerontology is useful only for looking at women and that if life expectancy were to change and old women constituted < 50% of the old population, the theoretical perspective would no longer be worthwhile.
Feminist gerontology does more than include women as topics of research. It also challenges mainstream scholarship for not naming men as men (Collinson & Hearn, 1994
) and thus enables us to theorize gender relations: the power relations that construct the interdependent categories man and woman. A feminist perspective sensitizes us to other power relations such as age relations, and I use the term "old" rather than "older" for political reasons (see Calasanti & Slevin, 2001). Whereas "old" is socially constructed, reified, and stigmatized, using the term "older" conveys that old people are more acceptable if we think of them as like the middle-aged. Just as many would object to referring to Blacks as "darker" and instead recognize the efforts to reclaim the word "Black" and imbue it with dignity, so, too, I use "old" to recover and instill the term with positive valuation.
Thus, this article advocates that men be included, as men, in theory and research while also considering how both gender and age relations shape experiences in later life.
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WHAT IS FEMINIST GERONTOLOGY? |
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TOPAbstractWhat Is Feminist Gerontology?"Bringing Men in": Examining...Men's Health: A Feminist...Manhood and Health over...Manhood, Health, and Old...DiscussionReferences |
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). Indeed, we can point to at least two different—and not mutually exclusive—nonfeminist ways of including women and gender in aging studies. The initial response to women's call for greater inclusion in scholarship simply adds women into existing research models that use men as the implicit or explicit reference group. Even studies that focus only on women can be guided by a conceptual strategy derived from research on men, such as research on sexuality in later life that focuses on frequency of penile–vaginal intercourse and orgasm. A second common strategy for including women treats gender as a fixed, demographic or descriptive variable that can be "accounted" for by factors and processes that are of more central interest. The goal of such research is to control and "eliminate" gender's influence relative to other variables such as levels of education, income, or occupation.
Both of these approaches can lead to findings of gender differences that "ought to be considered," but they offer little theoretical examination of gender itself or guidance for intervention. If, as in the first case, research questions derive from assumptions or models formed from men's experiences, findings can illuminate only how women do or do not fit this preconceived model. Gibson (1996, p. 444) provides an example of how research conducted in this vein constructs women as "other" and also obscures the relational nature of findings of gender differences:
[W]e tend to refer to gender differences most often in terms of women's difference—women live longer, are higher users of prescription drugs, have higher rates of institutional care, and so on. We do not generally refer to men living shorter lives, being lower users of prescription drugs, having lower rates of institutional care, and so on.When we proceed in this manner, we gain little understanding of either women's experiences or gender relations; consequently, we really know less than we should about the lives of women and men.This in and of itself is not important. The comparisons are valid in either direction. It becomes an issue ... when the orientation of the research—the questions asked and the research strategies employed—reflect the presumption of men as the dominant group.
Similarly, research that treats gender as a demographic variable often implicitly posits it as a characteristic of individuals rather than as a relationship between groups of women and men. As a result, variations between women and men can be documented but not explained. We end up with a listing of differences as separate entities and have even greater difficulty understanding how men and women could be similar.
Often underlying these two approaches (and our inability to explain similarities and differences between men and women) is the (usually implicit) assumption that gender is relevant only for women: Only women "have" gender or have lives shaped by it. Ultimately, they mystify rather than reveal gender relations. Even when they focus on differences between groups of unequal power, they ignore the power dynamics that produce these variations.
Feminist Gerontology
By contrast, feminist gerontologists theorize gender relations as forces that shape both social organizations and identities that emerge as men and women interact with one another. Gender relations are dynamic, constructed power relations embedded in social processes and institutionalized in social arenas with important consequences for life chances (Calasanti & Zajicek, 1993; Glenn, 1999). These power relations privilege men—give them an unearned advantage—while they disadvantage women, even as people resist and reformulate seemingly "natural" gender differences and gender meanings. This approach makes visible gendered bases of social structures that result in, for example, the different educations that men and women receive or their varied experiences within similar occupations. This focus on the relational character of gender and the power differentials that shape it and the commitment to reveal and eradicate sources of inequality make research on aging "feminist," rather than simply "research on women." Indeed, as I will demonstrate, gerontological research can be feminist even with all-male samples. The approach, which views men and women in relation to one another, is what matters.
Because gender is relational, feminist gerontology is not "narrow." It encompasses men and women alike, exploring their linked experiences. For example, we see that domestic labor is part of the retirement experiences of both women and men. To be sure, a woman's retirement is often characterized by a continuation of domestic labor. By the same token, White, middle-class, heterosexual, married men's "freedom" to enjoy "leisure" time in retirement or "choose" to "help" with domestic labor is tied to wives' responsibility for same. Her experiences are defined by the burden of domestic labor, while his—"free time"—is defined by the freedom from this obligation (Calasanti & Slevin, 2001). Similarly, feminist gerontology urges us to consider how gender is embedded in social relationships at all levels, from individual interactions to structural or institutional processes, and how gender relations shape, for example, how people conceive and implement government and other public policies such as care-related policies that often assume that a family member, that is, a woman, will be available and willing to provide it.
Finally, many feminist gerontologists (e.g., Calasanti & Slevin, 2001; Estes, 2001; McMullin, 2000) acknowledge that gender is inextricably linked with other social inequalities such as race, ethnicity, sexual preference, and class. Each of these hierarchies comprises power relations in which the privilege of one group is tied, intentionally or not, to the oppression of another. These inequalities are interlocking and not "additive"; we experience our gender, race, ethnicity, class, and sexuality all together, not one at a time. Even if they share the same class and sexual preference, old African American women and old Asian American women experience different sorts of womanhood in old age. Understanding systems of inequality as intersecting allows feminist gerontology to focus on gender in a way that incorporates diversity and to comprehend more easily the simultaneity of hierarchies in people's lives. And although my current discussion emphasizes gender, it is always with an eye to this diversity.
Because gender relations are so deeply rooted in everyday practices, they are often invisible, particularly to those privileged by them. At the same time, the norms embedded in institutions are often more apparent to those disadvantaged by them. Thus, to expose power relations and understand how they are connected, feminist gerontology advocates examining disadvantaged groups from their perspective, privileging their knowledge. Using the knowledge of oppressed groups that we obtain in this manner then provides the basis for comparison with more privileged groups. In this way, we broaden our knowledge of both groups as their similarities and differences are situated in relation to one another.
In this sense, feminist knowledge transforms scholarship. It does not entail simply throwing out previous knowledge but takes knowledge and theories gleaned from research on women to transform previously male-based theories, concepts, and the like, to be more inclusive. Having revised theories in this manner, one can then examine men's experiences from the standpoint of gender privilege, allowing that men are quite diverse—simultaneously disadvantaged on a number of dimensions. Most important to this discussion is the way in which gender relations interact with age relations to lift men up while bringing some of them down.
Old age intersects with other systems of privilege and oppression. For instance, policies targeted to old people serve to differentiate their experiences from those of younger people in ways that can, in certain situations, promote ageism. Thus, the existence of Social Security and Medicare contributes to the belief that old people are dependent and, in a context of high federal deficits, a burden. At the same time, cumulative processes over the life course lead to diverse experiences of ageism and old age (Estes, Linkins, & Binney, 1996; O'Rand, 1996). The onset, meaning, and impact of ageism are not universal but mediated by other social locations. In terms of gender, then, we need to recognize and investigate how masculinities and femininities vary as these intersect with age relations.
In sum, feminist gerontology provides a theoretical framework and knowledge built upon the experiences of groups situated in a web of interlocking power relations. We begin by studying the experiences of particular groups on their own terms, rather than through the lens of unquestioned standards. Then, by comparing across groups, we explore variations and similarities in terms of the power relations in which they are embedded. We understand how groups are positioned in relation to one another, including how the privileges enjoyed by some groups may be rooted in the disadvantages that plague others. Still, feminist gerontologists have not turned their gaze to men in great numbers as yet (but see Arber, Davidson, & Ginn, 2003), despite Thompson's (1994) earlier work on old men. Feminists in other fields have incorporated concerns with masculinity more thoroughly, however, and I will use these to inform my discussion of how gerontologists would look at old men critically and as subjects of inquiry.
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"BRINGING MEN IN": EXAMINING OLD MEN AND MASCULINITY |
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TOPAbstractWhat Is Feminist Gerontology?"Bringing Men in": Examining...Men's Health: A Feminist...Manhood and Health over...Manhood, Health, and Old...DiscussionReferences |
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What does it mean to problematize men and masculinity? First and foremost, men's experiences no longer serve as unexamined standards, and research on men is not equated with the study of "everyone." Instead, a feminist perspective views men and masculinity critically, as integral parts of a system of inequality. It considers how manhood relates to and emerges from gender relations. It makes male privilege problematic and explores the socially constructed aspects of men's dominance over women.
A variety of competing masculinities, shaped by intersecting social locations, co-exist, only one of which achieves dominance in a particular time and place and serves the interests of elite men. In the United States, this idealized "hegemonic masculinity" (Connell, 1995) might include such traits as physical strength, aggression, virility, professional success, wealth, heterosexual prowess, and self-control over such emotions as hurt, grief, or shame. Although most men aspire to and measure themselves against this dominant masculinity, the majority do not achieve it, leading to "contradictory meanings and experiences of manhood" (Coltrane, 1994, p. 42). Only so many men can be successful and wealthy, for example, or be heterosexually dominant; and the disempowerment of the majority of men often results from discrimination on the basis of their positions in other systems of inequality. Further, hegemonic masculinity "allows elite males to extend their influence and control over lesser-status males" (Sabo & Gordon, 1995, p. 8), subordinating not only femininities but other masculinities as well (Courtenay, 2000a). Thus, it is not surprising that many men feel powerless. Many are relatively powerless—not in relation to women, but in their relationships with other men. These two hierarchical systems—domination over women and over most men—express and reproduce one another. Thus, for example, the single-sex organization and violence advocated in many competitive sports allow men to dominate other men, on the sporting field and in social settings, and also encourage the use of violence in relationships with women (Messner, 1990; Pappas, McKenry, & Catlett, 2004).
Bringing men and masculinities into research on aging means recognizing that manhood is constructed "through and by reference to ‘age’" (Hearn, 1995, p. 97). Manhood in old age becomes a subject of investigation, revealing, for instance, how the different ways that men or particular masculinities interact with age relations to exclude some men while giving power to others are linked to later life experiences. Age relations shape manhood such that old men are often depicted as "other," even those who may be able to approach hegemonic masculinity. Thus, feminist gerontology examines how age relations shape masculinities, resulting in lower status (and even invisibility) for old men, and how masculinities shape old men in relation to old women, maintaining gender inequality. I briefly illustrate this approach to manhood and old age by examining the area of health.
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MEN'S HEALTH: A FEMINIST VIEW |
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TOPAbstractWhat Is Feminist Gerontology?"Bringing Men in": Examining...Men's Health: A Feminist...Manhood and Health over...Manhood, Health, and Old...DiscussionReferences |
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; Federal Interagency Forum on Aging-Related Statistics, 2000). To explain these differences, researchers point to men's risky behaviors and lack of self-care (Watson, 1998). For instance, Courtenay (2000b) finds that men are more likely than women to engage in > 30 health-damaging behaviors, including smoking, drinking, and taking physical risks such as driving recklessly. Men are less likely to see doctors regularly or when needed. For instance, one-fourth of middle-aged men between ages 45 and 64 do not have a regular doctor compared with 13% of like-aged women. Even among those people who have health problems, men are significantly less likely than women to see doctors (Courtenay, 2000b).
Although these actions are certainly linked to health, their enumeration does not explain why men do these things. By contrast, feminist gerontology asks how men's mortality and morbidity result from gender relations. How does "doing masculinity" lead men to hurt their health, risk their physical safety, and neglect social relations by engaging in actions that reproduce their privilege over women? Health behaviors provide a means by which people construct gender, and the ways in which men signify their manhood or negotiate power are often those that undermine their health (Courtenay, 2000a, p. 1385). One obvious example is the physical combat between underclass men to demonstrate physical superiority and courage—markers of status for a disenfranchised group (Anderson, 1999; Staples, 1995). Thus, men's health is related to social practices by which their positions of privilege are produced and maintained vis-à-vis women as well as in relation to and in competition with other men. That is, "men learn to function psychologically in ways that maintain their authority and psychosocial priorities rather than women's" (Sabo & Gordon, 1995, p. 9).
Courtenay (2000a) suggests that men have a vested interest in perpetuating a notion of male superiority in terms of physical or mental health. Men are "tough" and therefore naturally dominant. This stance leads to individual practices whereby men will deny pain or any perceived sign of physical weakness and also results in medical researchers (be they men or women) constructing men as "stronger" even in the face of contradictory evidence.
For example, we have tended to depict women as more likely to be depressed than men throughout the life course. But this is based, first of all, on self-reports; and we know that women are both more open with health care professionals and more likely to discuss a range of problems. By contrast, many masculinities require that men not express such feelings, that they suffer in silence and deal with their problems alone (Courtenay, 2000a). For instance, one study of men and women divorced a second time found that even though men cited being depressed twice as often as women, fewer men sought help than women did (Helgeson, 1995). Similarly, "decades of research ... have consistently found a lack of significant differences in diagnosable depression among college students," and men are more likely to commit suicide than are women (Courtenay, 2000a, p. 1396). Men may refuse to seek help because of their beliefs about what is appropriate/consistent with masculinity. To the extent that we accept hegemonic masculinity, its restricted emotions, and its denial of need for help, those who come into contact with depressed men may ignore it or view them negatively. Male counselors may themselves have a stake in maintaining hegemonic masculinity; counselors with traditional masculine attitudes approach male clients more in terms of vocational than emotional or psychological concerns (Helgeson, 1995, p. 81).
The male-based standards upon which we evaluate health need not be conscious or intentional; they are embedded in our very notions of health.
The assumption underlying ... indices of health is that male behaviour is the normative or hidden referent; consequently, researchers and theorists alike presume that women are in poorer health because women get more bed rest than men do and see physicians more often. ...Unexamined gender referents—be they based on men or women—shape our views of health and can unintentionally turn positives into negatives and vice versa. For instance, masculine norms are so entrenched in our beliefs concerning physicality that we measure this in terms of muscles rather than longevity. Even men who maintain that muscularity does not prove that one is healthy still predominantly envision a "healthy person" as masculine (Watson, 1998Given that women are unquestionably less susceptible to serious illness and live longer than men, it would seem that women should provide the standard against which men's health and men's health behaviour are measured. If this were the case, we would be compelled instead to confront men's inadequate bed rest and men's underulitisation of health care. (Courtenay, 2000a
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MANHOOD AND HEALTH OVER THE LIFE COURSE |
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TOPAbstractWhat Is Feminist Gerontology?"Bringing Men in": Examining...Men's Health: A Feminist...Manhood and Health over...Manhood, Health, and Old...DiscussionReferences |
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). Men must constantly "prove themselves by achieving success in the society's dominant institutions, or at the very least through the ideologies and icons that suggest this power (dangerous professions, sports, military)" (Klein, 1995, p. 116). Among other characteristics of hegemonic masculinity, these arenas involve demonstrations of strength and physical prowess as well as particular types of health risks. Although muscularity is less and less necessary in the contemporary workplace, strength and force have taken on more symbolic meaning for masculinity (Klein, 1995; White, Young, & McTeer, 1995). Male bodybuilders, who perhaps provide the most extreme example of the symbolic importance of masculinity, maintain that "all I'm out to impress is males ... and you can see that other males are impressed" (Drummond, 2002, p. 138).
Historically, demonstrations of men's strength have been tied to changes in gender relations. For example, the nineteenth century ascendance of organized sports served in part to reinforce men's superiority over women (Dworkin & Messner, 1999), and some scholars characterize the association of manhood with violent sports such as rugby as a response to the women's suffrage movement (White et al., 1995). Similarly, twentieth century changes in gender roles have been related to the increased connection of masculinity with the strength and aggression embodied in contact sports. This dual aspect of sports is critical in the production of masculinity; men are able "to develop and exhibit traditional masculine qualities including power, strength, and violence while rejecting traditionally ascribed feminine values" (Pappas et al., 2004, p. 293). Competing aggressively and successfully against other men rehearses attempts to dominate these men and serves as a way to distance men from anything weak or "feminine" (White et al., 1995). At the same time, organized sports were also born in a class and racial/ethnic context that bolstered the dominance of White middle-class men and their claims on masculinity (Dworkin & Messner, 1999).
As a critical realm for the cultural production of masculinity (Dworkin & Messner, 1999), sports teach both participants and spectators important lessons about manhood, lessons that have direct and indirect effects on health throughout the life course. At the individual participant level, men's involvement with sports is contradictory, leading to injuries and misusing bodies. The accepted (and often expected) use of steroids among competitive bodybuilders, even though they may cause tumors or other bodily damage, is but one example (Klein, 1995; Monaghan, 2002). Masculine ideologies require that male athletes deny whatever pain their bodies might feel while training or competing and accept that they will sacrifice their health and risk injury in order to succeed (White et al., 1995). This process by which athletics "separates the men from the boys"—that is, teaches manhood—creates a paradox wherein "the systematic destruction of the male body in sport is framed as empowering for masculinity. Ironically, the battle-worn athlete is subjectively hypermasculine when objectively he may be physically disabled" (White et al., 1995, p. 177). Distancing oneself from one's body, treating it like a machine, is a way to affirm manhood taught to athletes and nonathletes alike. By contrast, "sensitization to bodily well-being and matters of preventive health in general become viewed as the jurisdiction of women and ‘ambiguous’ men" (White et al., 1995, p. 180). Not coincidentally, pursing athletic careers also constrains the development of emotional and interpersonal skills (Dworkin & Messner, 1999), areas that also have important ramifications for health, as we shall see.
Not only permanent injury but also lower life expectancies result from male athletes' alienation from their bodies. At the extreme, professional football players are estimated to die 15 years sooner than men in general (Messner, 1990). Such adverse physical effects are especially high for young men from economically, racially, or ethnically disadvantaged backgrounds, who "seek status, respect, empowerment, and upward mobility through athletic careers" (Dworkin & Messner, 1999, p. 343). Few such men "make it," of course; and those who do tend to play the most violent sports, such as football or boxing, which also have the most severe impact on their physical well-being. It is also worth noting that those relatively few Black men who have reached stardom continue to be differentiated from White men; attached to them is an imagery of dangerous muscularity and sexuality (Dworkin & Messner, 1999).
Whereas career athletes or steroid-abusing bodybuilders may represent an "exaggerated form of a societal masculine malaise" (Klein, 1995, p. 119), they illustrate the link between manhood and adverse health behaviors. Klein (1995, p. 119) asks us to "consider the lengths to which men go to appear manly to others: for example, suppressing emotion in public, affecting denial or bravado in the face of physical or mental health problems, reckless driving, binge drinking, or displaying aggression in normal workaday lives." Indeed, high masculinity scores are related to elevated rates of smoking and drinking (Emslie, Hunt, & Macintyre, 2002).
Stoicism, an emotional form of "strength," is closely related to the emphasis on physical might. Men should not only learn to "take it" physically but also to repress certain emotions; they should see themselves as invincible on all levels. Such stoicism, and resultant lack of communication about problems and sources of stress, may account for men's reluctance to admit to or seek help for mental health problems as well as for the fact that they tend to suffer worse health effects after stressful events than do women (Consumer Reports on Health, 2002, p. 5).
To the extent that stoicism involves denial, it also likely influences men's poor self-care, which includes decisions about taking prescription and over-the-counter medications and changing daily diets and routines. Both preventative care and self-care after problems arise involve the realization that one could become sick or injured. Refusal to admit potential vulnerability bolsters men's resistance to visiting doctors or following their advice (Courtenay, 2000a). As reported by Helgeson (1995, p. 82),
The man who had the heart attack said he had felt symptoms but refused to admit or report them because symptoms signified weakness that contradicted the masculine role. He also refused to seek help for symptoms because it would have interfered with his business, which was his primary route to affirming his masculine identity. Ironically, his failure to adhere to good health behavior after the first MI [myocardial infarction] led to a second, more debilitating, MI that resulted in the loss of the business he was striving to maintain.
Women's increased participation in sports has not significantly altered the importance of this arena for the production of masculinity (Drummond, 2002). Indeed, in some ways, it may be reinforcing sports as a purveyor of hegemonic masculinity as men seek to sharpen the distinctions between themselves and women. In those relatively few instances where women and men participate in the same events together, the men display a strong desire to beat women in both training and competitions. Male athletes view with contempt any man who has lost to a woman, even if early in one's career (Drummond, 2002). The prospect of parity with women defeats a major point of sports for men—the demonstration of their superiority.
Intersections with Social Inequalities
Differences in health across groups of men reflect hierarchies as well; social inequities intersect with manhood to influence types of health behaviors, illnesses, access to health care, and the like, leading to varying risks of early death, poor health, and unique health situations in old age. For instance, social class has long been associated with health (Quadagno, 1999) and thus differentiates among groups of men. But how does this relate to manhood? Link and Phelan (1995) draw a distinction between proximate and distal causes of disease. The former, which have been the focus of most epidemiologic research, includes such individual risk factors as diet and exercise. The latter has received much less attention. It refers to "what puts people at risk of risks" (p. 80): the social locations, such as social class, that comprise distal, or fundamental, causes of disease. They influence access to important resources—"money, knowledge, power, prestige, and the kinds of interpersonal resources embodied in the concepts of social support and social network"—that mediate individuals' abilities to deal with risk factors as well as the consequences of disease (Link & Phelan, 1995, p. 87). Because social class is a distal cause, the relationship between it and health persists even as risk factors, knowledge, and treatments change over time. Those who have the most resources are best able to adapt to the changing context of health (Link & Phelan, 1995).
The close relationship between social class and racial and ethnic group membership complicates our understanding of the impacts of each (Whitfield & Hayward, 2003), and so these two forms of inequality will sometimes be discussed together. At the same time, they are different; for example, whereas education influences the prevalence of hypertension, stroke, and diabetes, Blacks who complete 16 years of education have roughly the same rates as Whites with only 8 years of education (Whitfield & Hayward, 2003). Similarly, the influence of poverty-level income on such diagnoses as hypertension, heart attack, diabetes, and arthritis differs by race and ethnicity, and by genders within these categories (Miles, 1999), suggesting that race and ethnicity intersect differently with masculinity as well. Finally, because high-quality health data for Hispanics, Asian Americans, and American Indians tend to be rather limited (Whitfield & Hayward, 2003) and scholarship on masculinities among these groups even more so, much of the focus of the discussion of race and ethnicity will be on Blacks.
For instance, in 1996, Black men had lower life expectancies at birth (66.1 years) than both White men (73.9 years) and Black women (74.2 years), and the gender gap is larger among Blacks (8.1 years) than among Whites (5.8 years). Although these within-race gender differences level out in later life, Whites still live more years overall (Miringoff & Miringoff, 1999, p. 69).
Racism and resultant marginalization combine with masculinities to render Black men's health poorer than that of Whites and to make it less likely that they will live to old age (Staples, 1995). Within the economic sphere, White men's economic privilege relegates many Blacks to secondary labor market jobs whose instability, low pay, poor working conditions, and lack of benefits have numerous impacts on their health through life (Gibson, 1987; Hayward, Friedman, & Chen, 1996). Not only are Black men more likely to be employed in jobs that present risks of occupationally induced injuries and diseases, but the unique concentration of Black poverty forces many to live in neighborhoods that are environmentally dangerous (near toxic waste, pollution, and so on), resulting in a cancer rate double that of Whites. Because of limited access to and poor quality of health care, they have lower survival rates as well (Staples, 1995).
Members of racial and ethnic minority groups must struggle to find health care throughout their lives, owing in part to a lack of job-based health insurance coverage. Brown, Ojeda, Wyn, and Levan (2000) find that Latinos and Asian American/Pacific Islanders in particular are far less likely to visit health care professionals than Whites, even when in poor health. Racial and ethnic minority group members are also more likely to report not having a place where they regularly go for health care, a fact that also limits the quality of care received because medical providers do not get to know their patients. And although these health care limitations occur among minority men and women both, Brown and colleagues find gender differences as well. For instance, Black women in fair to poor health are less likely than their White counterparts to report a recent doctor visit, but more likely than Black men are (Brown et al., 2000). How these variations might relate to divergent masculinities among these groups is an open question, but they likely emanate from the desire to deny "weakness."
Men of different social classes will vary in the types of risky actions that become a part of their masculine repertoire: "skydiving for an upper class man, mountain-climbing for a middle-class man, racing hot rods for a poor urban man" (Courtenay, 2000a, p. 1390). Further, when denied access to legitimate avenues for advancement, working-class or poor men construct alternative cultures based on a repudiation of these respectable ideals. This sort of street culture (Anderson, 1999) or culture of reputation (Sampath, 2001) provides an alternative masculinity at the cost of physical safety. It features hard drinking, drug use, physical combat, demonstrations of daring, and risky sexual behavior, among other dangerous practices (Anderson, 1999; Sabo, 1997; Staples, 1995). A similar observation has been made in relation to poor Black men who confront exclusion from legitimate employment and pathways to success, making it even more difficult for them to achieve hegemonic masculine ideals, at least in socially approved ways. As a result, they may form alternative masculinities that include engaging in illicit behaviors that provide some measure of success, such as drug dealing—an activity that also increases risk of violent death. Their drug and alcohol use rates, which outpace those of Whites fourfold, reflect their alienation and perception that they are "powerless and without any kind of future" (Staples, 1995, p. 132). Together, these factors help explain why Black men's life expectancy in some central cities is only 57.9 years (Miringoff & Miringoff, 1999, p. 69).
Overall, we know little about how masculinities among other marginalized groups of men influence their health behavior (Courtenay, 2002), though, as with working-class and Black men, it appears that their exclusion from avenues of achieving hegemonic masculinity can lead to forms of asserting masculinity that are detrimental to their health. Baca Zinn (2001, p. 31) notes that the more that social inequities based on race and ethnicity present barriers to men, the more "they also contribute to sexual stratification." Thus, she argues that the Chicano emphasis on machismo, a traditional form of dominant masculinity, is not so much a cultural phenomenon as a result of their structural location and exclusion from valued roles. Notions of manhood have cultural underpinnings, but these take on significance in certain contexts. Similarly, Espiritu's (2001) overview of Asian men points to the role of economic inequality in their constructions of masculinity. She notes that the loss of economic status that accompanied the immigration of Asian men has made some groups, such as the Hmong, more vulnerable to depression and anxiety. Wives sometimes contribute in equal or greater amount to family income, challenging Asian men's authority in the family and calling their masculinity into question. In some instances, this has resulted in spousal abuse and divorce (Espiritu, 2001).
Working-class men, whose jobs are often more physical, are also more likely to see a direct link between physical strength and manhood (Connell, 1995). Resultant expressions of masculinity tied to their work often demand physical strength, endurance, and a denial of fear, factors that increase the likelihood of injury (Courtenay, 2000a, p. 1390). Even without injuries, their occupations are those that result in the greatest physical wear and tear over time, a fact that influences both their health in old age and masculine identity. This reality is exacerbated by the health care inequalities experienced by members of racial and ethnic minority groups. As Staples (1995, p. 123) explains, "Whereas black men suffer higher rates of diabetes, strokes, and a variety of chronic illnesses, they are also at the mercy of public hospitals, and, therefore, are the first victims of government cutbacks. When they do go to a hospital, they are more likely to receive inadequate treatment."
The financial aspects of social class also shape how men negotiate physical decline. Research on a small sample of men with disabilities documents a variety of ways that they sought to reconcile their physical state with hegemonic masculinity's emphasis on independence. One response involved exercising self-reliance and autonomy by controlling their care, a redefinition that was tied to adequate financial means. Because they could pay for help, rather than having to rely on friends or family, they felt they could better influence the ways tasks were done (Gershick & Miller, 1994). Research on care receipt among old people echoes this finding: Those with great need but little control over the conditions of care receipt are most vulnerable to feeling powerless and dependent (Gibson, 1998). Given the emphasis of hegemonic masculinity on both strength and power, declines in the former must be offset by retaining some degree of the latter. The intersections of class and race on decreasing power are therefore especially crucial to manhood in old age.
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MANHOOD, HEALTH, AND OLD AGE |
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TOPAbstractWhat Is Feminist Gerontology?"Bringing Men in": Examining...Men's Health: A Feminist...Manhood and Health over...Manhood, Health, and Old...DiscussionReferences |
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). Conversely, doctors may rob old people of their ability to make decisions about medical care and their bodies through drug use. Similarly, depression among old people often goes undiagnosed or is treated with drugs alone, whereas the same symptoms among younger clientele are addressed with additional psychotherapeutic measures (Hooyman & Kiyak, 2002; Ray, McKinney, & Ford, 1987).
Self-care is the most predominant form of health care among old people (Stoller & Gibson, 2000), and the strongest predictor of self-care is gender: Old women both utilize and display a wider repertoire of self-care than do men (George, 2001). Further, old women are more likely to serve as lay health care consultants than are men (Stoller, 1993). How alternative masculinities influence self-care is unknown but possibly critical, given the limited access to formal health care of many minority groups.
As men's strength, mobility, and the like decline with age, how do hegemonic masculine ideals influence their adjustment? How does this vary by race, ethnicity, class, and sexual preference? Although these issues remain largely unstudied, available literature provides some clues. For instance, preliminary research suggests that when older individuals experience stress in roles highly salient to identity, they increase, rather than decrease, their commitments to these roles (George, 2001). Given the importance of gender identity to sense of self, individuals might work to preserve gender identities threatened by health conditions and might feel more stress if unable to do so. This could help explain why old women with osteoporosis express more difficulty coping with changes in their ability to fulfill family-based gender roles, such as housekeeping, than in appearance (Roberto & Reynolds, 2001). Similarly, one would expect men's responses to be based on how they perceive their masculinities to be influenced by health concerns.
Chronic illness, for instance, poses a serious threat to men's gendered sense of self. It can constrain men's participation in various arenas, such as work and sexual realms, in which they might exert power or control. As a result, chronic illness can shift a man's status in relation to other men and women "and raise his self-doubts about masculinity" (Charmaz, 1995, p. 268). Given the decreased status that accrues to aging, chronic illness in an old man may pose a special problem for masculine identity. Hegemonic masculine ideals are paradoxical: They can encourage men to strive and hasten their recovery; but they also limit "credible" responses to illness, setting conditions for depression. Depression becomes more likely for men who perceive that they have limited future possibilities (Charmaz, 1995). Having chronic illness in old age exacerbates the likelihood that old men will not envision future possibilities and thus sink into depression.
Chronically ill men may resist devaluation by trying to exert greater power in the home or taking additional health risks (Charmaz, 1995), a finding that sheds light on old men's behaviors. In Davidson, Arber, and Ginn's (2000) study of spousal care work among old people, male care receivers exhibited more difficult and demanding behaviors than did women. The researchers attribute part of this difference to the gender division of household labor. Men did not comprehend the work involved in care because they had not been previously responsible for such labor. By contrast, chronically ill wives knew the work involved and were thus more reticent to make demands and be more grateful for the care they received. The authors also found that men were still trying to assert their position as "family head"; they sought to maintain as much control as possible over the household. Charmaz's observations on masculinity and health dovetail with this insightful analysis: These men in poor health were affirming their masculinity by exerting control in the one realm left to them and over those typically subordinate to them—their wives.
Demonstrating strength may be even more important to some masculinities as men age and move into a devalued status and social location. Indeed, the most privileged men may be least equipped to cope with age-based disadvantage, especially if other resources, such as wealth, decline as well. This, combined with stoicism, may help us understand old White men's higher suicide rates, at the extreme. And the picture shifts and worsens when we look at disadvantaged men. Assuming they have survived the risks of accident and homicide in earlier life, Black men still face a variety of barriers to health in old age beyond physical conditions themselves, such as racism by practitioners and within the health care system itself. Given that Blacks receive less aggressive cardiac treatment than do comparable Whites (Wallace, 1991), we can guess that ageism only further compounds this situation.
Social Support and Health
Research consistently finds that people embedded in strong support networks experience better physical and mental health (Krause, 2001). Exactly how and why this is so are still debated, given the multifaceted nature of support and the myriad factors to be considered. Research must assess both social networks and social support. Simply assessing the size or quantity of support networks does not tell us how much support an individual actually receives. Further, support can be instrumental or emotional; we can also talk about objective and subjective dimensions (George, 1996). Despite the complexity of this research area, the link between support and health is robust, and subjective dimensions, such as perceived support and anticipated support, appear to be critical (George, 1996; Krause, 2001).
Men have smaller support networks than do women, a factor associated with less longevity (Courtenay, 2000b), perhaps because social support helps attenuate stress and aid recovery. Many aspects of hegemonic masculinity, gender relations, racial and ethnic relations, as well as class can account for differences in support in old age. Men's dominance in the household means that women are delegated most reproductive activities, including kin (and friend) keeping. This division of domestic labor privileges men in the workplace as well, allowing them to focus their energy on the productive sphere, making them more financially secure in old age. However, it also means that women develop more extensive social support networks. Men's relative lack in this regard can be critical to maintaining both health and masculinity itself in old age. For instance, White widowers' inabilities to perform daily life work lead to a greater likelihood of dependence upon others and a greater vulnerability to institutionalization unless they have very strong support networks (Blieszner, 1993).
Race, ethnicity, class, and sexual orientation further shape social support in later life. For example, Blacks tend to have more extensive social support networks in comparison with Whites, a reality reflected in their greater likelihood of receiving care from those who are neither spouses, children, nor grandchildren (Shirey & Summer, 2000). At the same time, gender differences among Blacks point to the intersections of masculinity with other hierarchies. In their research on old, poorer Black men and women, Barker, Morrow, and Mitteness (1998, p. 199) found that Black men's economic marginalization significantly shaped their access to informal social support in old age. Consistent with some masculinities and gender relations that both give women the nurturing role and mandate men be breadwinners, Black men tend to rely on wives for their link to the wider community. However, labor-market barriers have kept them from fully enacting their masculine ideals as "providers." As a result, they often experienced marital instability and estrangement from their children, thereby attenuating networks that would have sustained them in old age. Historical factors such as migration patterns severed family ties and frayed men's networks over their life courses. Remarriage left these men dependent upon their wives for informal support; they had few others upon whom they could rely in old age.
People build their networks by "sharing" with others, in part through self-disclosure. Given the repression of emotions central to hegemonic masculinity and that self-disclosure leaves one vulnerable and cedes power to another, many men cannot or will not share (Helgeson, 1995). The cultivation of social skills that would enhance support networks works against the training of male athletes; stoicism does not enhance communication. Neither do objectification and repudiation of women promoted within sports facilitate heterosexual stability (Pappas et al., 2004), and preliminary research among elite male athletes finds hegemonic masculine ideals interfere with their ability to develop relationships with women over the life course (Drummond, 2002), indicating that the more one learns to be "a man," the less one develops social supports. As a result, men tend both to receive and to give less emotional support than women (Helgeson, 1995).
Overall, then, men's privilege in work and family spheres can cripple them in later life—taking a toll on bodies and ultimately depriving them of hegemonic masculinity through a loss of power, autonomy, and the like. However, against this image of men hobbled by old age, many current consumer-goods advertisements offer a different picture: of men remaining healthy by having the times of their lives.
Popular Images of Aging and Health
Recent images of "positive ageing" in advertising (Katz, 2001/2002) continue to emphasize physical activity and competition for old men. Such ads present a paradox to old men, however. Although they entice old men with promises of manhood retained or regained, hegemonic masculinity remains out of reach, as it is based on the lives and bodies of younger men.
These images show old men engaging in activities modeled after the experiences of middle-aged, White, middle-class men. They aim for ideals of masculine achievement during their paid-work years but have exchanged productive work for activity-based consumption. Such leisure pursuit appears, for instance, in Aetna advertisements for retirement financial planning. Retired men visit exotic places to surf or commune with penguins. Captions under such pictures say, "We know people whose lust for life has not and will not diminish because it's the morning after their 65th birthday. They're too busy ... [R]etirement isn't viewed as merely an end. But rather the way you've been living all along: passionately" (Newsweek, October 27, 1997).
This (hetero)sexual innuendo appears in many advertisements, some in ads for products directly related to sexual intercourse: Viagra ads promise to help men "love life again." This double entendre conveys both the idea that aging is akin to dying and that an important aspect of living as a "man" is erectile potency. As Marshall and Katz (2002, p. 63) observe, "Masculinity remains anchored in the erect penis across the lifecourse." Hence, aging men can approach hegemonic masculinity and fight aging by making their sex abilities more like those of younger men. But such images also sell a variety of other products to the senior market, implying that with these goods comes virility. In an ad for Martex towels, three old men stand together, towels around their waists, with their surfboards stuck erect in the sands behind them.
Whereas these depictions of manhood in old age may be touted as more positive than those of the sickly or frail, they reproduce age and other inequalities. The emphasis on performance—sexual or otherwise—is still rooted in the lives of middle-aged or younger men. A sexual life based on something other than hard penises and heterosexual intercourse is not depicted; old men retain status only to the extent that they appear to be like younger, heterosexual men. In addition, old men engaged in expensive forms of leisure appear not to need or deserve either money or paid work, thus freeing younger men from competition from older men for good jobs or government benefits. At the same time, only those most privileged on many dimensions—primarily White, middle-class men who are most similar to middle-aged men—will be able to engage in these activities. Finally, the health impact of many anti-aging products that tout continued virility and performance for older men remains unknown.
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DISCUSSION |
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TOPAbstractWhat Is Feminist Gerontology?"Bringing Men in": Examining...Men's Health: A Feminist...Manhood and Health over...Manhood, Health, and Old...DiscussionReferences |
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When we examine men and masculinities in old age, we see how men's positions of privilege, divided by inequalities, shape old-age experiences. This lens gives us a very different vantage from which to view men's health in old age. In a society that increasingly emphasizes personal control of, and responsibility for, health, people often ignore structural determinants. Critical perspectives such as feminist gerontology warn us not to neglect the power relations that shape access to and quality of health care as well as the identities that influence health behaviors. Neither advocating health behaviors beyond the means of many nor rewarding health behaviors that run contrary to men's senses of self will have much impact. As Monaghan (2002, p. 707) concluded in his insightful study of steroid-abusing bodybuilders: "Health promotion will be more adequate if it is connected to the meanings shaping people's identities and lifestyles." In terms of men's health over the life course in old age, effective programs must emerge from an understanding of masculinities and not be based solely on ideas about danger, death, or future illness. This lesson informs recent anti-smoking campaigns undertaken by Health Canada, which use the threat of impotence—and not illness or death—to try to curb men's smoking (Katz & Marshall, 2003). As Katz and Marshall (2003) note, this health agency recognizes that not being a "man" seems worse than death to many.
When we point to the many contradictions that characterize masculinity and hurt old men, we are not talking about gender oppression. To be sure, old masculinities are not dominant; so, old men are certainly disadvantaged in relation to younger men. We can see this in relation to care work, for instance. Do people value old men's care work as much as younger men's? Do they value care differently based on the recipient? People celebrate the younger men who provide care—for children or for parents—in part because they presume that such men do "other important things" (i.e., paid work) in addition to providing care. The "new man" or "sensitive man" image is more firmly attached to younger than to older men, and the former receive more accolades for it. Nevertheless, similar value does not accrue to younger women's care work. Patriarchy is governed by relationships among men who, while hierarchically arranged, are all privileged in relation to women. Men are not oppressed as men.
My aim in this work has been to demonstrate that feminist gerontology provides an important framework for exploring the lives of all old people, including those who are privileged on one or more dimensions. In so doing, I have focused on old men and masculinities in relation to only one aspect of later life: health. This discussion represents a first step, not only in the area of health but in other aspects of later life as well. For example, we might ask how social and bodily changes intersect with the pursuit of hegemonic masculinity in shaping the family lives of old men. Do they seek different expressions of masculinity, and do these influence their relationships in later life? With the relinquishing of roles related to paid production, does consumption become a more important avenue for competition and status among old men? Similarly, investigations of male caregivers would focus less on whether their care is better or worse than women's and instead would ask such questions as how different masculinities (and femininities) shape rewards and stresses associated with care work.
As we explore these and other areas, we must be mindful of the dynamic nature of gender. As generations age, they bring with them nuanced and historically specific gender identities shaped by changes in men's and women's relationships to and within such realms as work and family. In addition, focusing on men's privilege—its construction and consequences—is only the beginning of understanding diversity, as we begin to recognize the intersections with other inequalities that result in multiple masculinities and femininities. The relational understanding of privilege and oppression provides a basis from which we can build a more inclusive and effective understanding of old age.
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Acknowledgments |
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Footnotes |
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Received for publication April 30, 2003. Accepted for publication April 14, 2004.
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TOPAbstractWhat Is Feminist Gerontology?"Bringing Men in": Examining...Men's Health: A Feminist...Manhood and Health over...Manhood, Health, and Old...DiscussionReferences |
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