An impact of male gender on the experience of illness
|CECIL R., McCAUGHAN E., and PARAHOO, K. (2010) ‘It’s hard to take because I am a man’s man’: an ethnographic exploration of cancer and masculinity European Journal of Cancer Care 19, 501–509
This paper reports on a study into male participation in cancer support groups, which elicited data on the impact of cancer on masculinities. This small qualitative pilot study, which took place in Belfast in Northern Ireland, involved semi-structured interviews with eight men with a history of cancer who were no longer being actively treated (i.e. they were not receiving chemotherapy or radiotherapy), and who were proficient in spoken
and written English. Whereas most studies into men with cancer that have looked at issues of masculinity have been on prostate and/or testicular cancer and have tended to focus upon sexual ability and activity, this study identified more sociological issues of concern that also present challenges to masculinity and to male identity.
Economic concerns were identified as being major issues for men, as were their changing role vis-à-vis their family, friends and colleagues, and changes to their body and to their body image.
The findings from this study indicate that cancer support services need to be gender sensitive in order to ensure that interventions do not undermine masculine values but address men’s concerns and foster their positive coping strategies.
Masculinities (and Femininities).
The above research indicates what being a man is and what values are held by men in Northern Ireland. Three issues seem pertinent for these men surviving cancer:
- Money worries, perhaps the role of ‘breadwinner’ is undermined.
- Their other roles in life and how cancer changes that.
- Body image – virility and strength might be challenged.
These are the subjective experiences of this group of men, so that we can see that cancer not only brings about physical changes but also challenges the very idea of what it is to be a man. Are these men feeling a loss of control and power over their jobs, their lives and their women? In the context of testicular and prostate cancer the idea may be that loss of sexual function or perceived loss diminishes them both in their own eyes and in the eyes of wives and girlfriends.
But, what do we think being masculine actually means for other men? Are these ideas fixed in society? Raewyn Connell discusses what being masculine means and considers that it is a dynamic concept, i.e. what it means to be a man is not fixed and can change over time and across a society. Masculinity is about where one sits in a power structure, and therefore there is more than one masculinity. So we must be careful to understand that a change in health status may be subjectively different for the metrosexual man, for example living in central London. Connell also refers to a ‘world gender order in which men continue to have power over women’. A cancer diagnosis for a man will of course impact on his family and partner and if they are feeling challenged in the most fundamental aspect of their identity this may well impact on their on-going relationships. We might ask whether we have a set of norms and patterns for the ‘correct’ social response to these challenging issues.
The research paper suggests that those working with men diagnosed and treated for cancer might want to think about the values men hold , and clarifying with them their coping strategies. It clearly illustrates the psycho-social nature of a condition like cancer. A question remains though around how well equipped nurses feel they are in relation to these issues, is it easier to stick to bio-medical issues around treatment modalities, prognosis and coordinating support services.
Rabin (2009) also reported a US study which suggested: “Men who strongly endorsed old-school notions of masculinity — believing the ideal man is the strong, silent type who does not complain about pain — were only half as likely as other men to seek preventive health care, like an annual physical”. This then suggest that how men see and feel about themselves in this manner are putting themselves at risk of for example a too late diagnosis of cancer or other serious conditions such as hypertension.
This anonymous post form the US raises the issue of obesity, ethnicity and class in the relationship between men and their doctors, arguing that condescension, arrogance and rudeness on behalf of some doctors may also be class and racially based:
“The problem is, a LOT of doctors are rude, condescending assholes who may be very good scientists and diagnosticians, but are HORRIBLE at customer service!
For a lot of men – including myself – going to a 12:15 appointment but not being seen until 2 and then being told a whole lot of stuff that I already know AND having to deal with medical arrogance is insufferable!
At this point he is illustrating issues around access to health services – this relates to wider social structures around employment patterns for both men and women who now make up > 50% of the UK workforce, so access issues may not be gender specific but might have socio-economic foundations. In other words people on low incomes with less freedom to leave work during the day might put off going to the doctor unless they really have to. Consider the man with prostate issues or testicular lumps which might not be painful who then does not go to the doctor because of losing a day’s pay. This applies to those who have been labelled the ‘precariat’.
Add to that that I’m fat, African American and working class and multiply the rudeness factor x 20. I know I’m going to be accused of being a fat pig and a glutton and will be branded as a liar if I comment on what I eat – I know the doctor won’t give a damn if I give him/her an accurate description of how I got fat in the first place – and I know that I will be blamed, guilt tripped, shamed and not listened to – why would I want to subject myself to that bullshit (AND have to pay a $ 20 co pay!)
If I want to be insulted for being fat, I can find some neighborhood elementary school kids who will do it for free!
Here he illustrates obesity as a ‘fatphobia’, or obesity as a personal moral failing which might be the default position of some healthcare professionals. The responsibility deal initiated by Andrew Lansley emphasises taking personal responsibility for health and seeking partners to do so. Being fat could be seen as not taking that responsibility. This view downplays or challenges the idea of an obesogenic environment. It buys into the cultural/behavioural explanation for health, i.e. that illness arises because of the your cultural habits and behaviours (eating junk food and smoking for example) and it also form part of the Moral Underclass discourse which focus on the failings of people themselves and locates the origins of illness in their ignorance and fecklessness.
Like a lot of men, I would NEVER tolerate that kind of rudeness in any other type of social setting, so why would I put up with it from some douchebag wearing a white lab coat?
I suspect women are socialized to tolerate much higher levels of disrespect and verbal abuse than men are – which might explain why they have a higher tolerance level for the verbal and psychological abuse that many doctors inflict on their patients.
They’d have to – because, from what women have told me, female medical exams are not only filled with insults and rudeness but procedures that are actually physically painful (like the mammogram and the speculum).
So, if doctors want male patients to come to get routine checkups, they need to learn how to talk to their patents with courtesy and respect – especially their fat patients, who need more medical monitoring than our skinny counterparts, but are more likely to avoid the doctor’s office because of all the bullshit that many doctors put their patients through.
The same goes with African Americans – we get a double dose of condescension and rudeness, get less pain management and in general get worse medical care than our White counterparts.
I actually had a White doctor at Columbia Presbyterian Hospital accuse me of “fraud” when i came to have a knee injury treated – and he also ordered me to “go to the clinic across the street, where the neighborhood people go” (that is, CPMC’s medicaid clinic, who’s patient load is almost entirely Black and Latino, as opposed to the clinics at CPMC, that treat affluent White patients from other neighborhoods).
In short, it’s not a “masculinity” problem – it’s a medical rudeness problem – and men are just more likely to avoid doctors to get away from the rudeness and verbal abuse!”
Here we have an illustration of intersectionality, i.e. how class, ethnicity and gender interact to position a person in the social hierarchy and how this then affects health.
So, being a man in a particular subculture can be dangerous: you take risks occupationally which you might not be able to avoid , for example in the construction industry, and you take risks with lifestyle choices because that upholds your idea of masculinity. Not going to the doctor because a) they are a different class and b) ‘that’s not what mend do’ and c) you cannot afford the time or money further places you into a place of risk of undetected health problems. However, gender is only one aspect of health seeking behaviour, morbidly and mortality patterns. Arguably low socio-economic status is more important in explaining health inequalities.
Stets, J., and Burke, P. Femininity/Masculinity in Edgar F. Borgatta and Rhonda J. V. Montgomery (Eds.), (2000) Encyclopedia of Sociology, Revised Edition. New York: Macmillan. pp. 997-1005