Dementia; the gendered experience.

In the United Kingdom there are currently 750,000 people diagnosed with dementia and that figure is expected to rise to 1.5 million by 2050. Despite the fact that over the years dementia awareness has increased, more research and improved health and care services are fundamental to eradicate the isolation, fear and despair many feel. The medical model of dementia views the condition as primarily a disease of the brain, this view has achieved paradigmatic status and is referred to as the standard paradigm. This paradigm conceptualizes dementia within an overwhelmingly negative framework with people going from normality through inevitable and tragic cognitive and physical degeneration to death. The main problem with this paradigm is that it appears to have little room for the lived reality of people diagnosed with dementia and gives intellectual credibility and authority to what is essentially a disaster view of cognitive loss. This has resulted in a depersonalization of the experience of dementia, voices of people with the condition and their carers have only until recently been conspicuously absent from mainstream narratives. The subjective experience is crucial in developing our understanding and explaining physical and behavioral manifestations of the condition. In this post I will focus on the experiences of women and dementia as their is a growing need to understand the sex-specific and gender dimensions of dementia as women continue to live longer than men. Women bear the brunt of dementia as sufferers as well as carers, and whilst carrying the stigma of the condition they are also faced with gender inequality and discrimination in the wider society. Dementia is a foreboding reality for women and it is the most disabling of all chronic diseases.  By approaching dementia through the prism of sex and gender I hope to explain the complexities of the interaction between biology and socially constructed roles.

The feminisation of ageing is explained in Sally-Marie Bamford and Trinley Walker’s article ‘Women and Dementia – Not Forgotten’ stating that women face a ‘triple jeopardy’ as a result of the associated stigma attached to their age, gender and decline in cognitive ability. Across the developed world people are living longer than before and in which women constitute the majority. However, Bamford and Walker argue that  just because women are living longer, it does not necessarily mean they are enjoying healthier lives. Old age and gender combine to create distinct challenges, especially when it comes to dementia. While they state that biological factors are significant in explaining the disability burden older women face, gender based discrimination and prolonged inequalities will also influence the incidence and prevalence of the condition.

The awareness and diagnosis of dementia is also a gendered experience and according to Banford and Walker deferentially contributes to health interventions and outcomes. Not only dementia itself but the wider social prejudice, discrimination and stigma surrounding ageing influence diagnosis rates. It is during this process where women may suffer greater disadvantage than their male counterparts. In their article Bamford and Walker argue that specific dementia symptoms are particularly powerfully stigmatizing both in the community and care settings. Disturbed behavior, poor self-care and incontinence are the main examples that can contribute to the stigma surrounding women and dementia. Not only are sufferers prone to stigmatization, care givers are also vulnerable to discrimination and prejudice. Bamford and Walker state that the majority of caregivers are women and they often find themselves blamed for the apparent state of neglect of their older relatives suffering from the condition. In terms of self-reported cases of dementia and contact with healthcare services, women are more likely than men to report poor health and access medical care. This is often due to gender stereotyping by doctors and psychiatrists. Bamford and Walker highlight how it is the institutional response in the treatment of mental health and they give the example that older women are more likely to be diagnosed as depressed despite presenting the same symptoms as men. It is impossible to ignore that women’s respective role and standing in society will influence the diagnosis of dementia. Without improving women’s overall position in society, dementia will remain to pose a significant challenge to old age.

The treatment and response to women diagnosed with dementia differ to that of men. Whilst there is no cure for dementia, there are treatments available which can help the cognitive, behavioral and psychological symptoms of the condition. Yet there is an absence of research on the sex-specific and gender dimensions of treatments and the differences in responses to medication. Bamford and Walker state that dementia clinical trials are weighted towards men, with very little participation from women despite the condition affecting more females. It is known that different types of Alzheimer affects males and females differently, for example vascular dementia affects more men than women. Also men and women with dementia experience different behaviors and symptoms. Men often demonstrate verbal incoherence, apathy and excessive sleeping and a propensity for aggressive behavior including sexual aggression. Women however show more reclusive behavior and intense mood changes, behaviors such as hoarding, refusing help and inappropriate laughter and crying are common. This stresses the importance of noticing and working on gender differences in dementia in order to improve medical treatments. Again the self-reported experience of women with dementia continues to be overlooked. Dementia is extremely subjective and the inclusion of women with early-stage dementia as an active participant in research can provide an in-depth understanding on the experience of dementia. What Mike Van Dijkhuizen states in his article, ‘Striving for Connection’, is that a helpful avenue for the understanding of subjective dementia experiences is provided by the literature on stress models for living with chronic illnesses. Dijkhuizen’s argument is that an individual’s social environment, life goals and values are important factors in understanding the impact of chronic disease. He found that older women tend to use more avoidant and emotion-focused coping styles and the extent to which women have had the opportunity to develop and maintain a variety of social roles may be relevant to their coping process. This leads on to what Dijkhuizen calls ‘connectedness’.  This is the connections a woman has with her past, family, friends and social roles as well as her environment. Dementia is a threat to women’s connectedness and produces feelings of distress, but in the face of possible disconnection supportive family relationships are central to the women’s ability to to maintain a sense of self. Social support therefore cushions the effects of memory problems and this reliance on family is a significant social strategy. Anxiety about the progressive degenerative nature and stigma of dementia may lead to avoidance strategies being employed by the woman herself as well as carers and professionals, the threats to connectedness may promote strategies whereby the embarrassment and potential humiliation of memory loss are dealt with by a way of minimization or covering up with humor. From Dijkhuizen’s article it is clear that women’s coping seems more crucially dependent on the interpersonal context and this reflects the gender differences in valued aspects of self-identity. Traditional male gender roles emphasize autonomy whereas women’s self identity tends to be based more on their ability to develop and maintain relationships. According to Dijkhuizen a loss or disruption of a relationship through cognitive impairment such as dementia, may thus be perceived as a loss of identity. All of this research suggests that support for women suffering from dementia should focus on the person’s history and values in the context of person-centered care and proposes that interventions should involve the woman’s wider network of family and friends.

When talking about dementia it is extremely important to talk about care and care-givers. Social care plays an important role in treating the condition and family members play an integral part in the process. Yet Bamford and Walker’s article interestingly states that often “family care is considered a euphemism for female care” and women form the cornerstone of care in many communities. The strong societal pressures cause women to conform to specified gender roles which is that of the nurturing caregiver. Women are recognized as the primary carers  and therefore have multiple caring responsibilities for other family members. The cost of caring is profound for many women, not only can it cause financial hardship but can result in social isolation and mental and physical health problems. According to Lisa Gallicchio’s article, ‘Gender Differences in burden and depression among informal caregivers’, more than 8.5 million Americans provide informal, unpaid care to those suffering from a variety of behaviorally, functionally ad cognitively impaired elderly individuals in the community. And an estimated five million care for a dementia patient at home. Because of the ageing of the world’s population and the fact that the prevalence of dementia doubles every five years after the age of sixty-five, it is expected that the number of informal, community-based caregivers for dementia patients will increase dramatically. This is why understanding the impact of care-giving is critical in maintaining the mental and physical health of the caregiver. According to Gallicchio, women compromise approximately seventy percent of the care-giving population in the United States and seventy-three percent provide care for an individual with dementia. It is important to recognize that there is a lack of knowledge on men as caregivers, this is partly because women have been thrust into the care-giving role as women’s life expectancy is longer and men have generally married younger women. But what the article points out is that the impact of care-giving on male well being cannot be ignored, the numbers of male carers will increase as more women live longer and are diagnosed with the condition. However as we turn are focus back to the present, numerous studies, including Gallicchio’s, show that the majority of caregivers are female, spouses or children of dementia patients, are living with the patient, are not employed, have no in-household help and perceive themselves as having good physical and mental health. Women have to deal with high levels of care burden, finding themselves thrust into this position reluctantly and often ill-equipped. As this article has shown, women have been found to have more frequent, intensive and effective involvement when in the care-giving role. Thus adequate assistance must be given to women caregivers to ensure that they are not strained beyond what is considered clinically healthy. The level of care for dementia patients is something that has only recently entered the public sphere with reports of serious abuse toward those in the later stages of dementia where they are most vulnerable. The mistreatment of dementia patients is arguably all the pernicious given their vulnerable status and has too often been under-reported. Insufficient attention and priority has left many women particularly susceptible to abuse given their increased numbers with the condition. It seems that women disproportionately bear the burden of dementia, with particular regard to either living with the condition and/or caring for family members.

Whilst we have recognized that dementia effects and impacts women differently than it does men, there needs now to be a focus on how we treat and help women affected by dementia. Creating awareness and reversing the stigma surrounding women with dementia is crucial. This year the National Health Service in the U.K embarked on a new campaign to raise awareness of such issues to help hospital staff and community carers. The campaign is a short film about Barbara and her experiences of dementia and aims to remind people how important everyone’s contribution is when it comes to creating a safe and positive environment for women with dementia.

The powerful video is seen from the dementia patients perspective and reveals her bewildering, confusing and sometimes frightening experiences of dealing with the healthcare system. Research by the Alzheimer’s Association shows that nearly two-thirds of people with dementia experience loneliness and almost half report a loss of friends following their diagnosis. This refers back to Dijkhuizen’s idea of connectedness and the need to provide female sufferers a network of support in order to maintain a sense of personal identity. That is why the Alzheimer’s Society in the U.K last year launched its largest social movement – ‘Dementia Friends’ which encouraged the public to sign up to learn more about the condition. By providing an understanding of dementia, the organisation hopes to tackle the stigma that see’s so many people face social exclusion. The movement uses face-to-face sessions with volunteer advisers in communities, schools and workplaces along with online videos to help explain dementia. The impact ordinary people have on reducing the stigma of dementia is immense and only through education can the care and support of dementia patients be improved. Yet cuts to healthcare budgets and a reliance on the voluntary sector does little to promote and help the cause. Without adequate funding for services and staff training it is clear that with an ageing population the dementia crisis is only going to escalate.

In terms of care for women with dementia, the nature of women’s role is largely hidden and forgotten. This discrimination and stigma is reflected in the persistent inequalities still face in society as a whole. Women are currently at the epicenter of the dementia crisis, not only are they more likely to develop the condition but they are also more likely to be caregivers of those with dementia. Women caregivers provide more intense care for longer periods of time and such care-giving responsibilities take a toll on women’s health and well being. It is society’s traditional social norms that force women who are often reluctant and ill-prepared into the care giving role. The medical model of dementia ignores the subjectivity of the condition and therefore ignores the experiences of women. There is a real need to start to view the condition through the prism of sex and gender which also allows for the experiences of gays and lesbians with dementia to be seen and heard. The medical model too often focuses on the negative consequences of dementia and whilst it is one of the most debilitating and heartbreaking conditions, a focus on support and education can help maintain someones personal identity as long as possible. There may be a long time until science can find a cure for dementia and with an ever ageing population resources and support funding needs to take top priority in order to prevent the crisis escalating any further.

Advertisements

Depression and the Silent Male. Discussing the relationship between masculine hegemony and depression.

According to the Diagnostic and Statistical Manual of Mental Disorders 5, symptoms of depression include the persistent sad, anxious or ’empty’ mood; feelings of hopelessness and pessimism; feelings of guilt; worthlessness or helplessness. Too often depression is referred to as the “common cold” of mental illness and is routinely positioned by healthcare providers and the media as a women’s mental disorder. But male depression has taken center stage recently with the suicide attempt of football player Clark Carlisle. Newspapers  showed the bruised and tearful footballer appearing raw and vulnerable as he left a psychiatric hospital, the front page provokes thoughts of a modern day version of Bedlam – treating the mentally fragile as entertainment. This idea of mental pain as entertainment is highly dangerous and possibly prevents others, men in particular, from seeking help. Men and depression is severely under researched and not on the public’s radar. Men are diagnosed at lower rates than women but suicide rates in the UK are currently three times higher for men than women. Yet despite this women are subjected to less mental illness stigma than men. According to author Matt Haig, depression is the deadliest disease on the planet, killing more people than any other form. Reasoning for this is that many men may find it difficult to seek help because of the hegemonic forms of masculinity, which is characterized by emotional control and lack of vulnerability whereas depression is associated powerlessness and uncontrolled expression of emotion. Numerous articles show that stereotypes about people with mental illness’ focus on violence and dependency and how they map onto sex role stereotypes. However the literature on this issue is steadily growing and in order to better understand men’s mental health, the relationship between social construction of ‘masculinity’ and health beliefs needs to be explored. It is important to acknowledge and not generalize all men as silent in their depression and ending in suicide. Suicide is a style of depression that is common in men, but it is not universal. Here I discuss the social construct of masculinity, how it is failing men with depression and what can be done to change this so depression is viewed as a common human experience and not a male weakness.

‘Hegemony’ refers to power and the insidious process of domination where the majority of people come to believe that particular ideas are not only natural but are there for the benefit of society. The concept of hegemonic masculinity has often been used in attempts to understand men’s experiences and expressions of depression. Connell’s concept of hegemonic masculinity is perhaps the most popular approach to gender in academia at present. It focuses on the social aspects of gender and according to Pete Branney and Alan White in their article, Big boy’s Don’t cry, enacting depression is to enact gender. According to Jukka Valkonen and Vilma Hanninen hegemony refers to practices and structures in society that define the norms and values according to which a man is expected to behave and experience. This is reinforced in an article by sociologists Carol Emslie et al who states that hegemony is the “winning and holding of power by white, middle class, heterosexual men who then set the standard for other men.” Fellow sociologist Warren furthers this idea and argued that depression is incompatible with masculinity in three ways; firstly expressing emotion and crying is linked to femininity, secondly masculinity equals competence and achievement and finally to be masculine is to be tough and self-reliant. Emotional control and denial of vulnerability are important parts of hegemonic masculinity, therefore denial of depression is one of the means men use to demonstrate masculinity and avoid assignment to a lower status position. In our society there is multiple insults to differences in masculinity, men are labelled as weak or sensitive if they do not conform. Famous sociologist Ken Plummer suggests that homophobic insults are used to delineate acceptable and unacceptable male identities amongst boys in their early years, crucially shaping masculinities for both gay and straight men. This creates a “circle of legitimacy” and any man who deviates from this is labelled as culturally subordinate. However as Carrie Paechter suggests, most of the time gender identity is taken for granted, yet worryingly there is some evidence that pressure of conformity to the standards of hegemonic masculinity plays a part in suicidal behavior. Ultimately in the industrialized Western world, strength, competence and rationality are appreciated as central masculine attributes. These ideals affect a man’s life, irrespective of whether he conforms to them or not.

As stated before, men are diagnosed with depression at lower rates than women are, yet men commit suicide four to fifteen times more often. This is due to the complexity of masculine attributes to suicide. Canetto interestingly puts forward the view that nonfatal suicidal behavior is associated with femininity, whereas suicide is associated with the masculine. Thus, surviving a suicide attempt is perceived as particularly inappropriate behavior for males, suggesting that suicide takes courage – another masculine attribute. Whilst suicide is not classified as a mental disorder, Emslie states that major depression underlies more than half of suicides. Studies routinely suggest that depression is part of an inner emotional world that is contained and constrained by gendered practices. Brownhill et al developed the ‘big build’ which is a descriptive model used to help explain how masculine practices in relation to depression result in a debilitating trajectory of destructive behavior and emotional distress.

There is a difference between how depression is enacted in terms of masculinities.

These behaviors then may escalate to violence and suicide. From this concept depression in men is not masked or hidden but may be visible through abusive and destructive practices. Branney and White make it important to note is that this is not exclusive to men, women can ‘do’ masculinity and may cope with depression in similar ways. According to the charity CALM (campaign against living miserably), men account for more than three-quarters of all suicides in England and Wales, yet three out of four had no contact with mental health professionals. In her book The Patient ParadoxDr. Margaret McCartney explains that the severely depressed are in too much pain to make plans to end their life. It is when a person is beginning to recover that suicide becomes an option, especially if they are male. If we understand masculine hegemony it becomes apparent that suicide isn’t biological but cultural. By observing how the suicide rates have changed, how they go up and down over the past fifty years, it becomes obvious that our culture and what we expect from it is to blame. For example, being unemployed at a young age has long term effects on ones mental health. Research by the Samaritans reveals that if you are male and in the poorest socioeconomic status, you are ten times more likely to commit suicide than those more affluent. Men have experienced “dislocation” as they have increasingly lost their role as breadwinners. According to Owen Jones, Britain’s rapid de-industrialisation played a huge factor in casuing depression amongst men. This is still being felt today as skilled apprenticeships are not awaiting many of the young men now leaving school and being unemployed at a young age leads to increased anxiety and depression.The uncomfortable truth is that the masculine hegemony is killing men.

Because depression is such a taboo subject in the masculine world of football, it is has been extremely significant that footballer Clark Carlisle has been open and honest about his eighteen month struggle with depression. He has explained that the end of his career, his struggle with alcohol and financial problems led him to feel a lack of “a sense of worth and value in life.” This January we saw him try and take his own life again by jumping in front of a truck.

The Sun is known for its shameless headlines, again provoking images of people in mental pain as entertainment.

In his many emotional interviews, Carlisle has explained that when his wife was diagnosed with postnatal depression, he advised her to “get a grip”, it wasn’t until he looked at the list of symptoms did he recognize his own feelings as depression. These symptoms included lack of energy, sadness, negativity and self-destructiveness. It seems that many men are reluctant to go to their GP and fail to identify their own symptoms as depression, as in the case of Carlisle feeling sad or low was a weakness and you simply just had to pull yourself together. Another survey by CALM revealed that sixty-nine percent of men said they preferred to deal with their problems themselves and fifty-six percent didn’t want to burden others. This makes it clear that the traditional masculine hegemony surrounding depression is increasingly failing to protect men from themselves. Carlisle’s realization and his emotional narratives of his suicide attempts has encouraged many other men, especially in the sporting world, to seek help and he is now an ambassador for the charity Mind. His documentary, Football’s Suicide Secret, is extremely powerful as he talks in depth about his crippling mental pain, encouraging education of depression in order to end the stigma and how talking about depression is extremely cathartic. He also interestingly points out that there is no logical trigger to depression, it is something that just happens to anyone and just like a physical illness, it needs diagnosing and treating.

Recovery narratives are also explored in Emslie’s study, where male accounts of depression are examined for connections between depression and social constructions of masculinity. The study revealed that as a part of recovery from depression, it was important for men to reconstruct a valued sense of themselves and their own masculinity. It highlighted a range of emotions the men felt with vivid imagery of isolation; “like being in a glass tube where you could see everybody but you couldn’t reach them.” Many of the men recounted their depression journey with many involving insults to their sense of masculinity. They described being labelled as ‘weak’ and ‘sensitive children’ by friends and families, this retorts back to Plummer’s idea of homophobic insults being used to shape masculinity. The ‘macho’ school environment was continuously mentioned throughout the narratives and how it did not encourage boys to express their emotions. One participant was quoted stating;

“At that age, 17, school kid, pretty macho, tough environment I think, not a place you could really talk about feeling bad and not really possessed of a vocabulary. yyou feel really alone, you feel weedy, you feel cack, you just think that you’re no good.”

Although the study was not about suicide, many of the respondents revealed they had experienced serious suicidal thoughts and some discussed their suicide attempts. Yet the men interviewed were all stable for an interview and the majority were on recovery. Emslie explains depression as simply a continuous construction, destruction and reconstruction of one’s self in the face of problems. Her research then goes on to portray how the respondents recovery narratives were used to maintain a valued sense of their selves as men.

The recovery narratives in Emslie’s study show an emphasis on an importance of moving from dependence to independence, especially in terms of gaining a degree of control over their healthcare and medication. This for many was an important part of recovery; reducing dependency on others. One participant stated that;

“Your whole autonomy is being taken away and gradually eroded, so everything’s conspiring against you to become effective again.”

The relationship between establishing control and medication is one that appears to be extremely common, whilst some resisted medication, others saw it has helping them regain control not causing them to be dependent. In the study others drew on traditional concepts of masculinity, conceptualizing depression as an entity that could be ‘fought’ and putting an emphasis on ‘strength’, ‘anger’ and ‘control’ to pull themselves out of depression. More interestingly, many other men put emphasis on their depression making them different and embracing their diagnosis as a positive feature of their identity. A mechanism that Emslie found consistently used was to compare themselves to real or fictional characters who had also suffered from depression, such as write Ernest Hemingway. Emslie concludes that by drawing these comparisons it is important to note that men with depression often have other qualities such as more intelligence or emotional sensitivity. Emphasis on difference allowed men to discuss changes in themselves that many other men might have found difficult within the constraints of traditional masculine discourse. This study shows how respondents used varied and creative strategies to try and rebuild their sense of masculinity, whilst many drew on values associated with hegemonic masculinity, others constructed a narrative based on difference.

Whilst Emslie encourages men’s recovery from depression by reconstructing one’s self image, there has been numerous other suggestions about how to promote awareness of depression and provoke men to seek help. This year CALM released a much needed four-point charter to encourage change and attitudes toward male depression. It includes a shift in thinking about the needs of males in schools, workplaces and public services but more crucially focuses on fuller range of expression of masculinity in the media and advertising. Challenging unreconstructed masculinity is a priority and campaigns have been launched encouraging men to challenge “anarchic male stereotypes” and “define themselves in their own terms”. As we have seen in the case of Clark Carlisle, men speaking out helps encourage others. Emslie’s article also goes on to suggest that healthcare professionals should teach men with depression about the importance of gender in order to help them resist masculine hegemony when it comes into conflict with life goals. Nevertheless, healthcare services currently lack the expertise required for providing solutions specifically targeted at men, ‘health’ is still viewed as a women’s issue. According to Jukka Valkonen and Vilma Hanninen, mental health diagnostic tools may ignore men’s depression because of men’s unique ways of expressing or concealing their mental distress. This year the UK has piloted a “zero suicide” policy that asks the community to look out for each other, teaching warning signs and offering help not exclusion. However according to Owen Jones’ article for the Guardian, UK mental health trusts have cut funding by twenty percent and beds by ten percent in the past three years, despite warnings from mental health charities that these cuts to services are risking people’s lives. Another huge problem with the British mental healthcare system is that it is aimed at treating illnesses as they happen, instead of preventing them in the first place, which is perfect for the drug companies. Jones finishes his article with the profound statement that the stigma of mental distress, especially toward men, makes such services easier to attack, which I find myself strongly agreeing with, as depression and suicide can be avoidable and not inevitable.

It is still the dominant paradigm that depression is caused by a chemical imbalance of the the brain, but depression is simply a human experience. It does not define you, it is something that happens to you and you are no less of a man or woman or a human for having depression than you would be for having cancer. There needs to be more emphasis on talking, listening and encouraging discussion in order to tackle the severe stigma attached to depression. Emslie’s study suggests that it is important for men with depression to reconstruct a valued sense of themselves and their own masculinity as a part of their recovery from depression. The study also highlights the importance not to generalize all men and depression, some men will talk about depression if they are given the right circumstances they will talk openly and honestly about their experiences. Speaking out and challenging the stigma of male depression is certainly courageous, especially because the masculine hegemony in our society is incredibly powerful. With the likes of Clark Carlisle, society is is starting to recognize and talk about mental health issues more frequently. However depression still remains a taboo subject for men and more needs to be done to recognize and prevent mental pain if the male suicide statistics are to be reduced. Male stereotypes, rising socioeconomic insecurity and healthcare cut backs are all detrimental factors that increase the risk of more lives becoming endangered as they simply do not feel comfortable seeking help for something so stigmatized by masculine hegemony.

Bibliography

http://pss.sagepub.com/content/20/2/169.full.pdf+html

http://ac.els-cdn.com/S0277953605005435/1-s2.0-S0277953605005435-main.pdf?_tid=d39102e2-b93e-11e4-9dcd-00000aab0f6b&acdnat=1424464201_dd0bf68f93bcdc598919c2147ceba774

http://www.cfp.ca/content/57/2/153.full.pdf

http://onlinelibrary.wiley.com/doi/10.1111/j.1468-2850.2008.00125.x/epdf

http://www.theguardian.com/commentisfree/2015/feb/08/depression-drives-many-men-to-commit-suicide

https://books.google.com/books?hl=en&lr=&id=t1oTjCzKPEsC&oi=fnd&pg=PA15&dq=stigma+of+male+depression&ots=MgAvTXdzPr&sig=cSXgXszGa_ir9niZ8xNE_E7C4zc#v=onepage&q=stigma%20of%20male%20depression&f=false

http://www.theguardian.com/commentisfree/2014/jul/02/young-men-mental-health-crisis-support-cuts

http://jmm.sagepub.com/content/16/2/160.full.pdf

https://books.google.com/books?id=_fCAAAAAQBAJ&pg=PT96&lpg=PT96&dq=depression+in+conflict+with+masculinity&source=bl&ots=TYHmm2x47j&sig=575ARfi1NC71JiQOxZJ8Yz6glok&hl=en&sa=X&ei=h3rrVO7yEMGhNpKzg-AJ&ved=0CCwQ6AEwAg#v=onepage&q=depression%20in%20conflict%20with%20masculinity&f=false

http://ac.els-cdn.com/S0277539503001225/1-s2.0-S0277539503001225-main.pdf?_tid=3989a59e-bb8e-11e4-95b2-00000aab0f6b&acdnat=1424718205_32a2c361908affc9340d4266bb9b7fe0

http://www.theguardian.com/commentisfree/2015/feb/05/clarke-carlisle-retiring-sport-professional-athletes-depression

http://apt.rcpsych.org/content/14/4/256.full

http://www.theguardian.com/society/2014/aug/15/suicide-silence-depressed-men

“But you don’t look gay!” The issue with camp within the gay community.

It was not until I read an article addressing homophobic backlash from the gay community aimed at a gay comedian did I realize that many gay men actually have a big problem with campness and effeminate gay men. The article was about a P.E.T.A campaign a British comedian took part in, in which he was portrayed as a fairy. Despite being openly camp and renowned for it, the image of the comedian, Alan Carr, sparked huge controversy and created a great amount of abuse. He then tweeted a message saying that “The most homophobia I get is from gays” and followed with the hash tag, ‘#selfloathing’. This is an extremely interesting statement and one that addresses something that is rarely talked about; homophobia within the the gay community in relation to campness. This seems partly due to the feeling that campness invites homophobia and the reasons behind this is the fact that society’s gender roles and norms have socialized all men into thinking that heterosexuality masculinity is the natural order. This then leads to ‘internalized homophobia‘ which is often the feeling of shame and denial and can lead to the hating of other gay people, especially camp gay men. The stereotype of a gay male as a ‘camp queen’ has led many gay men to present themselves as ‘straight-acting‘ on dating websites and to refrain from presenting themselves in anyway that may lead them to be portrayed as camp. It is now a compliment for a straight person to tell a gay male that they don’t look gay, but this highlights serious issues not only within in the gay community but in society as a whole. The statement portrays being gay as a lifestyle choice and these assumptions of gay people are based on stereotypes that view all gay men as effeminate. All of this refers back to the strict gender norms society produces, especially that of masculinity and for a man to challenge this discourse by acting camp society, including the gay community, will react by asserting traditional gender norms. It is important to recognize the wide spectrum of gay men and camp is just a form of gender expression but it seems that being camp is much harder to accept than being gay.

The image that ignited this debate was that of comedian Alan Carr dressed as a fairy. The pink wings, pink wand and the luminous pink text is extremely camp and I understand how the image can be seen as encompassing the gay stereotype that dominates society.

Controversial campaign that sparked backlash from the gay community.

One argument that is put forward by Owen Jones in his article for the Guardian is that many may view this as portraying all gay men as fairies, contributing to the stereotype that all gay men are simply court jesters and therefore this image is extremely offensive. Jones helps explain why this view is shared amongst the gay community, when gay people appear or are portrayed on television and in the media they are “one dimensional, caricatured camp clowns, a kind of gay minstrel show.” Despite this argument Jones points out that it is important to realize that Carr is not claiming to represent all gay men. Carr is known for his camp personality but his sexuality has never been a focal point in his comedy. His camp act with his shrill, giggly voice has faced countless criticism from the gay community with him being accused of being a throwback to the limp-wristed homosexual stereotypes of the 1970s.

Despite his obvious camp mannerism, he ever explicitly mentions his sexuality.

In an interview with the Guardian in 2008, Carr stated that “gays hate me” and the community views him as if he is “letting the side down.” He also goes on to say that he does’t talk about being gay and that is what he believes preaches gay equality. This is extremely interesting as he is not being judged by his sexuality but he is being judged for being outrageously camp. This is because, according to Jones, there is a sense in the gay community that “loud and proud campness” invites homophobia and therefore all gay men suffer as a result. This is complicity with oppression and can be linked to the way in which a woman is blamed for a sexual attack if she was wearing a short skirt. The issue of campness, according to Damian Barr, is where homophobia and misogyny meet and metastasize. Men who refuse to perform masculinity therefore deserve to be punished, just like women who refuse to be “corseted by femininity.” It is a way of policing within a community; it is sending the message that if you act camp then you deserve the homophobia.

The issue with camp is major. The argument is that campness is a much harder thing to accept than being gay, because it comes with judgement all round. This hostility towards campness comes from the desire to conform to society’s gender roles; which Jones accurately states that gay men have already subverted whether they like it or not. This all round judgement also includes homophobia from gay men. Whilst initially I found this surprising after further reading it started to make sense. Gay men grow up in the same society as straight men that teaches that settling down with a woman is the natural order. Masculinity is viewed with such prestige in society that anyone who goes against this paradigm is often punished with ridicule. Liam Murphy also suggests that it is society’s fear and hatred of the feminine and the rigid adherence to gender roles that underpins the intolerance of campness. Other factors such as hearing the word ‘gay’ being used as an insult, or seeing the horror on a straight man’s face when being accused of gay, not to mention the frequent violent verbal and physical attacks gay men receive can lead to internalized shame within gay men. This is explained in Alan Downs book, The Velvet Rage. He states that internalized shame is formed in gay men at a young age “during those tender and formative years” where it is taught that there is “something flawed” about them. As a result of developing and living in an environment of hostility towards homosexuality, gay men internalize anti-homosexual views in an effort to achieve society’s desired masculinity. In David J. Allen and Terry Oleson’s article they argue that the dissonance between an internal negative view of homosexuality and an emerging homosexual identity tends to create tremendous conflict. Allen and Oleson also point out the fear of being seen or exposed as an undesirable in the eyes of society can create shame and therefore many gay men will avoid the stereotypical traits that society attaches to homosexuality in favor of passing as a heterosexual.  Therefore a result of internalized homophobia is the discrimination of camp and effeminate gays as they fail to conform to societal gender norms and may attract ridicule for other gay men. But it is important to recognize that campness is a form of gender expression and something that happens in conjunction with sexuality; campness does not equal homosexuality.

Due to this attack on campness, ‘straight-acting’ is now the crowning achievement to many gay men, especially when it comes to dating sites. According to Andy West’s article in The Independent the most common phrases on gay dating websites are; ‘straight-acting’, ‘non-scene’, ‘no camp guys please’ and ‘real blokes only’. It seems that masculinity has become the benchmark for attractiveness and the stereotypical traits of campness such as; flamboyant mannerisms, ostentatious dress sense and fastidious grooming are at odd with heterosexual culture. Obviously every person has a different perception of what they find attractive but according to Cameron Lamont, that does not necessarily mean that inherently camp men are any more likely to reject their inner camp simply because they might be found more attractive. The desire for gay men to fit into the heterosexuality norm has resulted in the phrase “but you don’t look gay” being used as a compliment, as if reassuring them that their homosexuality is barely visible. This again refers back to the blaming the victim ideology, because if they do not look gay then they do not deserve homophobia. But if you are a ‘straight-acting’ gay surely this means that you find women attractive, this label is deeply ironic and perhaps it would be better to simply accept that humans have a diverse range of personalities, traits and behaviors. According to Dave Stalling, by applying the term camp or straight-acting to gay men, it simply contributes to the myths and misconceptions of what is feminine and masculine.

surely straight-acting means being heterosexual?

Despite the fact that, in Britain, there has never been a better time to be gay with the majority of anti gay laws being overturned and marriage equality, being gay still means you are an outsider and homophobia is extremely common. It seems that gay men are now under more pressure from the gay community to “tone down and reject” their camp, due to fear of exclusion or because it is not found attractive. Referring back to the example of Carr and the fairy campaign, camp is a form of gender expression that does not necessarily relate to sexuality. His routine and personality may be camp but his sexuality does not play a role. People’s difficulty in accepting campness comes from the strict gender roles that have dominated society and have caused many gay men to internalize the shame of being gay in order to fit in with the heterosexual masculinity norm and escape the label of camp. It seems that all men and women are oppressed by straight male masculinity, therefore it is important to challenge homophobia, especially within the gay community as this rise in campophobia may lead to victim blaming in cases of homophobic attacks. Instead the gay community needs to unite and celebrate its differences otherwise the camp gay will become a minority within a minority.

“There is no one way to be a woman.” (R. Claire Snyder.) How the emergence of third wave feminism is challenging dominant feminist discourse on transgenderism.

The meaning of Feminism is constantly changing, fluctuating between negative and positive connotations, radical and liberal demands with pop stars such as Beyonce are claiming to be feminists, but what is interesting to me is to assess its relationship with a group who I had believed had always been mutual allies – people of transgender. According to Cressida Heyes in her article, ‘Feminist Solidarity after Queer Theory: The Case of Transgender’ “feminists of all stripes share the same political goal of weakening the grip of oppressive sex and gender dimorphisms in Western culture.” There has been different waves of feminism which have brought new ideas and new approaches, this is simply because different demands need to be met to gain gender equality as our society changes and evolves. Feminism should fundamentally represent every woman no matter their colour, age or social status but it has often ignored and failed to engage with transgenderism. Despite the fact that many transgender women are the daily victims of the most intense and public attempts to discipline gender, ways feminists have long criticized, “trans-liberation” and “feminism” have often been cast as opposing movements. This is not to say that feminism has completely ignored transgenderism, but as Eleanor MacDonald points out in her article, ‘Critical Identities: Rethinking Feminism Through Transgender Politics’ it has responded to the topic in mainly disquieting ways. Too frequently feminism’s relationship with transgender women is expressed as direct hostility and exclusion. The main example used when assessing this relationship is radical feminist Janice Raymond’s book The Transexual Empire: The Making of the She-Male first published in 1979.  This book presented a dramatic opposition to transgenderism and controversially likened the transgender woman to a rapist. From this point onward there has been a deep ambivalence about the relationship of feminism to the question of gender fluidity. As MacDonald asserts, “gender is viewed as mutable and socially constructed while also contrarily presented as determined immutably by ones sex at birth.” Feminism holds the view that “gender is a patriarchal structure that women can and must defeat or transcend”, yet radical feminism refuses to view transgender women as women. To them transgenderism is a medical or psychiatric problem, a private concern and not one of feminism. ‘Transgender’ is an “umbrella term” which encompasses a whole range of people who do not seek medical alignment surgery but just do not associate with their assigned gender. Transgender people offer a unique perspective on what it is to be a woman and can help contribute an understanding of the gender experience that feminism must not ignore. The emergence of Post- Modern Feminist Theory in the 1990s, also called Third Wave Feminism, moved beyond radical and liberal feminist thought and began to embrace transgenderism and the expression of diversity amongst women. In her article, ‘What is Third Wave Feminism? A New Directions Essay’, R. Claire Snyder depicts how the movement broke down the binary dualism of western society and highlighted the intersectionality of feminism. As the concept of transgenderism is growing and achieving publicity in the media, especially within television series such as Laverne Cox in ‘Orange is the New Black‘ , the experiences of transgender women need to be taken seriously by feminism so they can move forward and represent the rights of all women.

The first concept to understand when discussing  transgendersim is what gender actually means. According to MacDonald, sex and gender are both complex terms, with external genitalia the primary factor in attributing either the male or female sex and gender is then expected to cohere with the sex. But gender is in fact made up of many rich and complex variables including; gender assignment at birth, social roles, social status, employment, social relations, behavior, language, clothing and mannerisms. Ultimately, ones gender is not one’s own decision it is assigned at birth, yet it is the right of the individual to express gender in whatever they want. Gender is fluid and a socially structured concept, yet many, including radical feminists, believe that one simply is essentially either male or female. As Deborah M. Withers suggests in her article, ‘Transgender and Feminist Alliances in Contemporary U.K Feminist Politics’, gender is always transitioning, what it means to be male or female is constantly changing and therefore it is not a fixed state. Just because one matches their biological sex with their subconscious sex does not make them any more ‘natural’ or ‘authentic’ than people who don’t. It is Heyes who states that gender should be understood as a “property of the individual” rather than their relations. It is the right of individuals to express their gender as they choose or to engage in gender free play. Also present in the article is the arguments of Post-Structuralist writers such as transgender Leslie Fienberg, who state that “people of all sexes have the right to explore femininity, masculinity and anything in between, the ideas of what a ‘real’ woman or man should be straightjacket the freedom of individual self-expression.” However, it is important to recognize the factors that disallow this expression and shape the way many people think about gender. In her article Heyes states the cultural intolerance and disgust directed at gender ‘deviance’ which supports the “privilege of white bourgeois male masculinity and the patriarchal social structures.” Gender expression is not a simple aesthetic choice, there are serious political issues that need to be answered before gender is viewed as fluid. Feminism has had trouble coming to terms with the fluidity of gender and what it takes to be a woman; as the boundaries of gender expand there is greater freedom for people to classify themselves as a woman, it is a lot easier for people to alter their appearance and change their lifestyles. For many feminists, feminism belongs to the female biological sex but in a contemporary society with transgender women facing serious backlash and inequality feminism can not afford to ignore these issues.

The second wave of feminism in the 1970s was the most controversial and influential form of feminism that still has a foothold in feminist agendas today. The radical feminists of this era demanded a cultural change that “rejected all male ideas and concepts” and according to Heyes this brand of feminism required only one subject; the woman identified woman. As stated in Michelle Goldberg’s article for the New Yorker, the conflict between feminism and transgenderism became apparent  nearly forty years ago at the height of the second wave movement at the West Coast Lesbian Conference, in Los Angeles in 1973. The keynote speaker, Robin Morgan, refused to call transsexual singer, Beth Elliot, a ‘she’ because after;

 “thirty-two years of suffering in this androcentric society, and of surviving, have earned me the title “woman”; one walk down the street by a male transvestite, five minutes of his being hassled, and then he dares, he dares to think he understands our pain? No, in our mothers’ names and in our own, we must not call him sister.”

Whilst this statement presented the hostility towards transgenderism by femininism, the most influential statement on transgenderism in this era was Janice Raymond’The Transsexual Empire in which she likens the transsexual women to a rapist – “all transsexuals rape women’s bodies by reducing the real feminine form to an artifact, appropriating this body for themselves.” In Heyes’ article she states that the book was fundamentally an attack on the patriarchal medical and psychiatric establishment, claiming that transsexuals had a mental disorder and were “artifacts of a patriarchal medical practices” that use women’s bodies. Therefore Raymond treats transgendered women not as choosing their transition, but as it having it inflicted upon them as patriarchy’s way of destroying women who challenge femininity. Heyes describes how Raymond believed that transgenderism was a plot by men to infiltrate the women’s movement. The book as a whole drew a “lurid picture of transsexual women as parodies of femininity” and male invaders of women’s space. Again in Heyes’ article she portrays how Raymond and other radical feminists of the time rejected the notion of a female brain and that membership to womanhood is determined by chromosomes with gender being a biological concept. The main argument held by these feminists was that anyone born a man retains male privilege in society, even if he chooses to live as a woman he has a choice and therefore can never fully understand what it is like to be a woman. This is a debate that remains in contemporary discussion about gender, in Wither’s article she writes that some feminists are still arguing that transgender women never lose male privilege at all, male socialization during childhood and adolescence is unavoidable and therefore would constitute as a significant difference between females assigned at birth. Whilst this argument completely ignores the complex issues faced by transgender women, the dramatic feminist opposition was widely followed by far more hostile opinions that transgender women should not exist at all. In Raewyn Connell’s article he states that in a post-patriarchal world, for these radical feminists, transgenderism could not be imagined.  In 1994, Raymond issued a new introduction to her book which she again states that membership to feminism and womanhood depends on those with a shared female history. Feminist writers such as Sheila Jeffery and Germaine Greer have continued to reinforce such transphobic views into the 2000s proving that this perspective still has strong influence over feminist agendas. In this view of radical feminism, as said by Goldberg in the New Yorker, “gender is less an identity than a caste system.” It seems that for many “re-conceptualizing how we think about who is a man and who  is a woman is in some ways a deeper challenge to people’s sense of the way the world works” therefore find it hard to accept gender fluidity and transgenderism.

The elasticity of the term transgender has forced contemporary society to rethink what sex and gender really mean. What is determinative is not people’s chromosomes or their genitals or their upbringing but how they see themselves. Until very recently Heyes states that the public transsexual has been manipulated as a talk show gimmick, a sexual fetish or a tell-all sensationalist. However Heyes interestingly points out that in a contemporary society it is not unusual for a person to change their appearance and dramatically change their bodies for reasons also connected to gender identity, for example body builders, dieters, cosmetic surgery candidates all alter their bodies to fit how they want to feel, therefore these people are hardly different to those who live a transgender life.  Despite the hostility many transgender women face they are actually growing in recognition, for example the recent Time cover featuring transgender actress Laverne Cox with the title ‘The Transgender Tipping Point’ has brought trans-liberation to the forefront of Western societies attention.

Laverne Cox on the cover of Time Magazine, May 2014

With the growing visibility of the transgender movement, it is baffling that it has not shared its platform with feminism as both have to build their lives in the face of gender inequalities and insecurities.

In 1990 post-modern feminist Judith Butler published her book Gender Trouble. She stated the assumption of a natural basis for women’s identity is non-existent. Connell states how her work was strikingly more positive than previous radical feminist writing on transgenderism and “helped launch a wave of post structuralist and queer feminist writing” about transsexuality.

Judith Butler taking about the fluidity of gender

The main change in this switch of feminist perspective was the book The Empire Strikes Back: A Post-Transsexual Manifesto by Sandy Stone in 1991. Stone is a transsexual woman who was specifically attacked by Raymond, her essay describes transgender women as a ‘genre’ and claims that they have the potential to disrupt and break down gender categories. Connell argues that from this point onward a huge “paradigmatic shift” occurred where transgender has become a widely used term within feminist literature stating the significance of gender plurality and in which transgender women are treated with respect. Snyder labels this shift ‘Third-Wave Feminism’ which is a response to the collapse of the category of ‘womanhood’ and the theoretical problems that came with the second-wave. This form of feminism focuses on personal narratives that illustrate an intersectional version of feminism; with Snyder stating that “feminism is something individual to each feminist.” Snyder highlights how the challenges women face have changed since the 1970s, today young women face a world colonized by the mass media therefore third-wave feminism focuses on; pop culture, interacting with men as equals, actively playing with femininity and reclaiming terms such as “bitch” “cunt” and “slut”. Bitch magazine is a great example of third-wave feminism as it critically questions messages the mass media sends surrounding issues of gender. Diversity is a central feature and third-wave feminism rightly rejects the universalist claim that all women share a set of common experiences, after all the core of feminism is the fact that “the personal is the political.” According to Snyder, when it comes to gender identity third-wave feminist ideas “embrace the notions of contradiction, multiplicity and ambiguity engaging with the fluid nature of gender and sexual identity.” There is no unified category of women and this non-essentialist approach explicitly questions the gender binary of male or female, therefore transgenderism fits much more fully into third-wave understandings of gender. Transgender women are severely oppressed, Connell’s article highlights how they find themselves having to deal with discrimination in social institutions ranging from the patriarchal state, the economy, the medical profession to the family. For many years transgenderism has been referred to as a disease or mental illness and therefore transgender women are viewed to lack agency and opinions are irrelevant. Connell argues that this is structured by the inequalities of the gender order and transgender women are subsequently punished for denying their patriarchal privilege. He states that these women have to “make their way through a gendered social landscape” in which they do not fit into the restrictive gender norms. Due to this they are too frequently victims of violence and many suffer from depression. This discrimination provides key evidence for third-wave feminism about how gender categories are sustained in everyday practices of social interactions and institutions. Connell  gives the example of how transgender women are often denied medical treatment by the establishment itself or simply can not afford treatment and have no personal support. Finding housing, dealing with workplace discrimination and gaining social recognition are also just some of the obstacles transgender women face in their lives. What I found most shocking is how in her article for Bitch magazine, Tina Vasquez states that in most states it is legal to fire someone for being transgender and that transgender people can not serve in the military. But as Connell argues, it is important to point out that the process is not the same for transgender women and transgender men. Transgender women are “shedding the patriarchal reward that accrues to men as a group in labor markets, finance markets, family status and professional authority.” By denying this privilege Connell shows that there is also an economic penalty as transgender women lose on average nearly a third of their income. It is also crucial to recognize the intersectionality within transgender women as in her article Vasquez states that “transphobia is lot more intense when it comes to transegender women of colour and low social status”, with them being twice as likely to to be victims of violence and suicide. The white privilege of second-wave feminism has allowed intersectionality to be ignored and the issues of minority women have been pushed aside.

Report by the National Gay and Lesbian Task Force and the National Center for Transgender Equality

Because transgender women’s lives are shaped by the resistance of gender, there is a common ground with feminism. Much of what transgender women need is already contained in feminist agendas; equality in education, equal employment conditions and wages, prevention of gender based violence and resistance to sexist culture. The best guarantor of justice for transgender women is a gender equal society.

With the queer community demanding that the silencing of transgender women be addressed and third-wave feminism challenging the previous dominant discourse held by the second-wave feminist movement that transgender women, society is finally changing its perceptions. With new legislation in the United States lifting previous exclusions and preventing discrimination in the workplace, the idea that transgender women are just as legitimate as a woman born of female sex is becoming the norm. Even more crucially the media is changing how it represents transgender women by not just focusing on transition stories but allowing transgender people to take center stage as themselves. Historically television has not been a welcoming place for transgenderism, with transgender women being portrayed as jokes in sitcoms. But with the breakthrough success of Laverne Cox and the new series Transparent about a father aligning her body with her female gender identity, are helping to improve the lives of a long misunderstood minority. It is crucial that feminism incorporates the ideas and issues of transgenderism. Transphobia fundamentally undermines the principles of feminism itself and by including transgender on their platform the feminist message is enriched. Feminism has a lot to make up to the transgender community for years of exclusion, there are still many issues to tackle. Perhaps the biggest obstacle is that transgender women still live in a world largely built on a fixed definition of gender. In many places transgender women are unwelcome in female bathrooms, which is a constant reminder that they don’t belong. Third-wave feminists have to deconstruct these gender-binaries and demand gender equality for all. By creating a diverse arena where personal experiences can be heard it becomes clear that there is more than one way to be a woman.

Bibliography

http://www.newyorker.com/magazine/2014/08/04/woman-2

http://www.newyorker.com/culture/culture-desk/loud-radical-feminism-vs-transgenderism

http://plato.stanford.edu/entries/feminism-trans/

http://bitchmagazine.org/post/the-long-history-of-transgender-exclusion-from-feminism

http://www.advocate.com/politics/transgender/2014/05/29/laverne-cox-and-transgender-tipping-point-cover-time

http://bitchmagazine.org/post/finally-a-tv-show-that-handles-transgender-issues-with-grace

http://www.jstor.org/stable/10.1086/588436

http://www.jstor.org/stable/10.1086/343132

http://www.jstor.org/stable/10.1086/664478

http://journals.msvu.ca/index.php/atlantis/article/view/1682

http://www.jstor.org/stable/27919129?origin=JSTOR-pdf

http://www.jstor.org/stable/20836903