Journal of Research in Peace, Gender and Development (ISSN: 2251-0036) Vol. 2(13) pp. 268-274, December 2012, Special Review Available online@ http://www.interesjournals.org/JRPGD Copyright ©2012 International Research Journals Review The toll of traditional masculinity: A critical literature review Leehu Zysberg Betty Irene Moore School of Nursing, University of California, Davis, CA. Department of Psychology, Tel Hai College, Upper Galilee, Israel. E-mail: leehuzysberg@yahoo.com Abstract Traditional academic and social discourse around gender and gender- roles have emphasized an approach viewing traditional roles as serving the male gender, putting it in power position with access to social, psychological and physical resources. This paper presents a critical view of the literature on gender roles and their implications in diverse fields of everyday life, suggesting that traditional gender roles put men more at disadvantage than commonly thought. Evidence borrowed from the fields of health, criminology, economics and psychology are presented to undermine popular notions of traditional gender roles. The paper concludes with a few trends and suggestions for future discussion and research. Keywords: Gender, gender roles, traditional masculinity, review. INTRODUCTION A contemporary look at masculinity in an age of complexity requires that we reexamine basic assumptions concerning masculinity and femininity in various contexts. This paper offers a review of empirical research and theoretical models in order to develop discussion around several basic assumptions that have shaped the discourse regarding masculinity and femininity in recent decades. Such discourse put a mirror in the face of society in which, for the first time, masculinity versus femininity was reexamined. The word "versus" was not chosen at random. Despite the proliferation of approaches and definitions of feminism (Currie and Kazi, 1987), most of the authors in the field share the following basic assumptions: the first holds that due to a variety of political and historical factors, human society organized around a masculine system of norms, which imposed male dominance serving male interests, and thus directly or indirectly deprives women, at every possible level, of rights, freedom of choice, and welfare (Currie and Kazi, 1987). The second fundamental assumption is that a variety of social structures and mechanisms represent tactics of power and control that perpetuate male advantage and privilege, while women are excluded from access to these resources (Currie and Kazi, 1987; Shulman, 1980). These basic assumptions have typically transcended the boundaries of the feminist discourse and penetrated deep into popular culture, organizational and social systems, academia, the justice system, and more e.g (Bendl, 2008; Teigen and Wangnerud, 2009). Here I will propose that the stereotypical gender roles, as well as the social and psychological centers of power that are perceived as serving the male gender and as excluding women and inflicting injustice upon them – may not be what they seem. I will argue that the prices that men pay for traditional masculinity in a traditional world are no less heavy than those paid by women, and that traditional gender inequality does not necessarily work in favor of men. Though this is hardly a novel claim, previous reviews and research focused on single aspects (e.g.: health promotion, aggression, etc.) while this review will attempt to provide the reader with a more general picture and re-interpretation of data and study outcomes. The following review does not intend to be exhaustive. It focuses on several selected aspects of psycho-biosocial research in order to present various aspects of the toll of masculinity in the context of a traditional masculine worldview as well as, and perhaps even more so, in a post-chauvinistic world; a world in which women have made impressive strides towards legitimate and socially acceptable gender role flexibility, while men are yet to make such headway and therefore find themselves in a double bind of greater social and psychological pressures than in the past (Moss, 2011). The following will review evidence and findings from several representative psychological and sociological fields of research Zysberg 269 concerning sex and gender, in order to elicit reevaluation of the basic assumptions detailed above. Coping with illness and health The issue of gender bias in of health management, health systems, diagnosis, and coping with illness constitutes the focus of long standing debate. The main argument derived from basic current assumptions is that the medical and health establishments are an example of a social function controlled by men, which promotes and perpetuates masculine dominance (Ruiz and Verbrugge, 1997). Thus for instance, the literature mentions gender biases that create discrimination in medical diagnoses of women and thus prevent proper treatment, especially in the fields of mental health and heart disease. "Gender blindness" – is a concept referring to the tendency to judge men and women according to social stereotypes related to their gender and the difficulty in adopting a more holistic and accurate picture of the individual (Hamberg, 2008; Ruiz and Verbrugge, 1997). This concept may account for such biases in health care delivery described above. For example-heart problems in women are often attributed to anxiety disorders, thus preventing proper treatment of women's heart disease for decades, in the Western world (Remes et al., 1991). When such one-sided discrimination is highlighted, less attention is given to the social forces and masculine characteristics of patients and caregivers, which lead men to have a lower quality of life in terms of health, to apply for medical, social and psychological assistance at a frequency and effectiveness markedly lower than that of women, and to a significantly shorter life expectancy in the Western world as a whole (Springer and Mouzon, 2011). Research findings on men’s health reveal and interesting trend with regard to health habits, ways of coping with sickness and most importantly: patterns of help seeking behavior, requesting and accepting counseling, information, assistance, and treatment among men. The findings are horrifyingly consistent: the masculine gender role does not permit men to admit to weakness, and since sickness and need of assistance can be perceived as weakness, men tend to avoid them as much as possible (Tudiver and Talbot, 1999). Furthermore, the traditional male sex role has been found in the literature to be related to the adoption of risk taking while disregarding the potential dangers and implications involved in them (Courtenay, 1999). In other words, male stereotypes encourage those holding them to put their health at risk (in any number of ways: from hard work, to smoking, eating unhealthy foods, to "extreme" sports), while preemptively denying any need of assistance or help. A field that has been the subject of much research in the past decade concerns the components of masculinity and femininity that increase the risk of contracting HIV: for instance, a study conducted among African Americans showed that having sex with a condom is considered a non-masculine act (Bowleg et al., 2011). The result: greater risk of contracting AIDS first of all - for men. These findings are often presented as a phenomenon harming women, but somehow there is a tendency to ignore the fact that this behavior pattern primarily causes men to contract the disease. Another relatively rich body of research reflects the problems surrounding seeking medical assistance among men. Although men are traditionally at a higher risk than women for heart disease, diabetes, and other severe illnesses, the rates of seeking medical counseling, tests and diagnosis, treatment, and assistance is lower among men compared to women (Courtenay, 1999; Umberson, 1992). Another interesting finding is that married men tend to adhere to these patterns of behavior to a lesser degree, a tendency which is attributed to the existence of "female supervision" that encourages seeking help, which in turn allows the male to attribute the need for help to his wife (Parent, Moradi, Rummel and Tokar, 2011; Umberson, 1992). Findings focused on men suffering chronic, life-threatening disease show that they tend to take their illness less seriously and adhere to the necessary treatment regime to a lesser degree than women (Galdas, Cheater and Marshall, 2005; Tudiver and Talbot, 1999). It is no wonder, then, that life expectancy among men is lower than that of women in in most western countries: the life expectancy of men in the United States is 76 years compared with 81 for women (Central Intelligence Agency, 2012). Although there is a tendency to attribute a significant portion of these differences to genetic and physiological factors, there is evidence that points to a different interpretation and which attributes these differences to life style and social roles. In a fascinating social study called The Blue Zones Project (Buettner, 2009), the author presents five regions in the world in which people live the longest and enjoy the best quality of life at older age. In four of the five regions, women make up the largest percentage of centenarians. This trend is reversed in only one such zone: Sardinia. Analysis of the living conditions in this location shows that in Sardinia, the traditional division of labor among the sexes is reversed. Women are the primary bread winners, organizers, doers, producers, and even fighters (historically speaking). Men function mainly as housekeepers and shepherds. In this social environment, men live many years longer than women. Such findings suggest that the short life expectancy of men in most of the world represents the effects of life style more than biology. Aggression Popular conceptions of gender roles attribute to men a 270 J. Res. Peace Gend. Dev. tendency for overt, usually physical aggression and assign to the feminine gender role communicativeness, avoidance of conflict, and what would be called "agreeableness", in terms of the five dimensions of personality model (Levy, 1972). A closer look at the literature in the field of aggression research reveals differences between men and women that are much more subtle and inconsistent. Apparently, the general level of aggression does not vary significantly among the sexes but rather its expression does – while men tend toward direct, physical expression aimed at others or themselves, women tend to express violence and aggression in an indirect, more social and sublimated manner e.g. (Eagly, 1996). Another popular trend in the literature regarding gender and aggression is the tendency to describe women as living in a world in which violence is almost solely emanating from men, directed towards women (Graham and Wells, 2002). There is insufficient research examining violence of women towards men and of men towards other men, emphasizing a gender perspective. Research concerning aggression that does not emphasize the element of gender is of course abundant and will provide some of the evidence below. Findings consistently reflect the fact men are more involved in incidents of aggression and physical violence as aggressors and victims alike. In other words men, more than women, live in a world which is physically violent (as opposed to verbal and psychological violence, which we will attend to forthwith) not only as perpetrators of acts of violence but also as individuals required to survive and cope with direct physical violence as victims or bystanders. One of the prominent examples of the reverse gender bias in the research and treatment of violence from a genderal point of view is the "National Survey of Violence against Women" (Tjaden and Thoennes, 2000) conducted for the United States Department of Justice about a decade ago, which thoroughly mapped the different types of violence and put the issue of violence against women, especially in the family, on the public agenda in the United States. Yet, generally speaking, the survey showed that men are more frequent victims of violence than women. While 55% of the 8000 women participants reported being exposed to violence (of all types) almost 67% of the men (also 8000 participants) did so. A later analysis of the data of these surveys revealed that men, no less than women, suffer from psychological and health syndromes of stress, post trauma and more, due to exposure to violence (Coker, et al, 2002). Contrary to the norms regarding women, for men, public discussion of being victims of violence and coping with exposure to aggression and its results are not part of the popular discourse and do not grant men legitimacy to seek assistance and cope more effectively with these situations (Durfee, 2011). Sexual harassment and rape are aspects of violence traditionally receiving somewhat biased treatment in the literature and even more so-in public discourse (although officially and legally –the phenomenon is treated in equal fashion). Indeed, numerically and relatively, women are the main victims of rape (a ratio of 1:5 according to the incidence tables the United States and in other western European countries; e.g. Cybulska, 2007). Numerous sources treat sexual assault of varying types and rape (the act of coercive vaginal, oral, or anal sexual intercourse) under the same umbrella. When summing up the incidents (according to sources in the United States and other coutries) the ratio changes to 1:3 and even less (for examples see data tables in Tajden and Thoennes, 2000). In other words- men, admittedly less than women, also are victims of sexual harassment and different types of sexual assault. The discussion of this phenomenon, the legitimacy for exposing it or understanding it, have not yet become part of the public discourse: While women have more access to help resources, and receive at least certain levels of legitimacy as victims of sexual assault, Male sexual assault victims receive much less attention, scientific or public acknowledgement (and thus legitimacy) to report abuse or assault and to seek (and receive) help (Peterson, Voller, Polusny and Murdoch, 2011). Adding insult to injury, the few existing testimonials regarding the experience of men who became victims of abuse or violence suggest that such men are more hesitant than women to file complaints, tend to avoid coping with their situation fearing stigma, and ridicule (e.g.: Sorenson and Siegel, 2010). In general the literature conveys a picture of a violent life-experience for men, and little room for showing weakness, fear, distress, or addressing the physical, emotional and social consequences of such experiences for men. Coping, stress and anxiety Stress and anxiety are defined by the CDC as the plague st of the 21 century. It is estimated that stress and tension factors may became the number one factor in the deterioration of the quality of life of the individual and the leading cause of death (Middlebrooks and Audage, 2008). The traditional male gender role greatly limits the variety of techniques available for men to cope with stress and anxiety and actually leads them to one of two possibilities defined by the basic response pattern of "flight (not recommended for the male self-image) or fight". On the other hand, the female gender role permits a wider range of coping mechanisms such as sharing, requesting assistance, self-assertion, and more. As a result, evidence is accumulating relating the adoption of a rigid male gender role to distress and illness in a variety of populations (e.g. Courteney, 2000). Here are several examples demonstrating this principle: A study focused on men serving or having served in the Zysberg 271 Iraq War and the Gulf War found that the adoption of male norms (claimed a prominent characteristic of military men in general) constituted a significant risk factor for suicidal thoughts and attempts following exposure to the stress and traumas of warfare (Burns and Mahalik, 2011). Bowleg and others (2011) found that male behavioral norms were linked to a tendency to contract AIDS (due to carelessness and taking health risks, which were both related to adoption of traditional male norms) and also to greater difficulty in seeking and receiving assistance in coping with the disease and its implications. Sanders (2011) argue that adolescents adopting stereotypical male norms, tend to replace psychological and social coping strategies with destructive behaviors such as drug abuse, violence, and delinquency. In other words, the male stereotype limits the scope of coping strategies available to young men to such a degree that they are forced into destructive behaviors in order to express emotional difficulties, confusion, and turmoil. Another series of studies looking at caregivers' coping with family members' chronic illness showed that men caring for others suffer much more (in some cases up to 6 times more than women) adverse effects, as a result of stress, and ineffective coping, compared to women (Vitaliano, Zhang and Scanlan, 2003). An interesting qualitative study conducted in Russia examined how women and men are coping with stress related to the social, economic, and political changes characterizing the country in the past two decades: the study participants (male and female) tended to describe men as experiencing higher levels of stress and attributed this to their gender role as breadwinners and as being socially responsible for the financial-economic integrity of their family unit (Petila and Rytkonen, 2008). The above are merely examples of the cumulative evidence suggesting men might be disadvantaged in their coping with anxiety, stress and trauma. Men and women cope differently with stress. There is enough evidence to posit that the coping tactics of men are more limited than those at the disposal of women due to their gender role (Ptacek, Smith and Dodge, 1994). Sexuality, romantic and intimate relationships Norms related to the formation of intimate relations are often defined according to traditional gender – division- of - labor. A frequently raised argument posits that this very division of labor is designed to preserve the social power relations in which men are dominant and women are subordinate, subservient (for example: Garber, 2009). A popular example for this is the concept of "the double standard", which has been mentioned many times in the literature as a primary factor in the suppression of female sexuality on one hand and maintaining male dominance on the other: the traditional division of labor created an expectation that women be sexually selective and loyal while men are expected to be competitive and oriented towards "sexual conquest" as a modern expression of their hunter or Alpha-male roles (Milhausen and Herold, 1999). Fundamentally, the double standard means that men are socially rewarded for having multiple sexual partners while women are socially "penalized" for permissive sexual behavior. Conflicting contemporary evidence has given rise to a turbulent debate regarding the question "does the double standard still exist in modern Western societies?" Although the debate continues (and apparently will continue for a while), it is clear that at the very least one can say that men and women differ in how they judge their sexuality and sexual behavior (Parker, Barbosa and Aggleton, 2000). The typical pattern arising from the research is that while men express more positive attitudes than women towards descriptions of a sexually permissive male figure, the pattern is reversed when the figure is a woman: men will express less positive attitudes than women towards a permissive woman. In other words, it is definitely possible that the double standard has changed its nature but it probably hasn't disappeared. Going beyond the double standard, there is a body of research suggesting that in terms of social perception, traditional male sexuality is more elusive than female sexuality. Male sexuality is perceived as something that must be earned: there is an expectation to be a sexual conqueror, to display certain behavioral patterns traditionally linked to aggressiveness, seizure and preservation of territory, and the persistent conquest of additional territory (Bosson and Vandello, 2011). Furthermore, traditional masculinity requires on-going confirmation as the danger of ‘losing it’ is constantly present. A popular example is the perception of male responsibility for the sexual satisfaction of his partner as part of the affirmation of his masculinity (Bosson and Vandello, 2011; Land, L.N. et al., 2011). Traditional masculinity (or its lack thereof) is associated with the man’s capability of pleasuring his partner and is less associated with the nature of the relationship, support and intimacy. Feminist writers interpret this phenomenon as male de-legitimation of female sexuality and women's right to take charge of sexual relations. A counter argument may claim that such an attribution places the entire burden of the quality of the sex act on the male (in the eyes of traditional men and women), shouldering him with a responsibility that physiologically and psychologically does not necessarily his (Gerber, 2009). These patterns exact a toll: intimacy is perceived as weakness; avoidance of direct interpersonal communication creates conflict and makes it difficult to preserve satisfaction in long term relations. Actually, most of the characteristics that are considered critical to preserving a quality intimate relationship, such as caring, intimacy, openness and communication, are not included in the stereotypical male sex role. 272 J. Res. Peace Gend. Dev. The traditional male sex role defines clear limits to what is allowed and what is forbidden within intimate relations. A characteristic example came up in a series of interviews conducted with women and men in contemporary Russia, a country that has undergone social, economic and political changes and crises. In this study, men and women alike identified the role of the male in the family as organizer, breadwinner, and supporter (primarily physically and economically). All of these greatly limit the degree to which men are allowed to need help, support, to be dependent or fragile (Hoover and Coats, 2011; Pietila and Rytkonen, 2008). As a result of these processes and patterns, men who adhere to the traditional-stereotypical gender role are denied the legitimacy and the ability to invest in intimacy and enjoy it and to derive strength and support from an intimate relationship compared to the extent to which this is possible for women (with regards to social expectations and permission). Professional identity and career The field of employment and career is a traditional battleground in which feminist and chauvinist opinions, and discrimination against women seems especially prominent: The world of employment is seen as a male arena, a modern embodiment of the primordial hunting fields, in which the exclusion of women or the restriction of their advancement and the legitimization of their abilities as workers and managers is described as common practice (e.g.: Levy, 1972; Weisgrau, Dinella and Fulcher, 2011). As a result, biases against women in the labor market are perpetuated, such as the "glass ceiling" – the invisible barrier that prevents women from getting promoted to senior positions – and the division of professions into feminine and masculine categories, with implications for prestige, pay etc. (Lips, 2003). The current world of employment is demanding and more complex than ever before. It requires personal resources, professionalization and life-long updating and learning. This leads research to focus on career choice and especially home-work conflict among female populations (e.g.: Emslie, Hunt and Macintyre, 2004). The assumption is that this brave new world constitutes a challenge especially for women and puts them in a double-bind, since on one hand they are still socially committed to traditional roles (such as motherhood, housekeeping) while on the other they are subject to increasing pressures in terms of career and involvement in a world of employment that is more complex and demanding than ever (for an example of such writing based on Israeli samples see: Cinamon and Rich, 2002) Research findings dealing with employment values, priorities, and career choices of men and women are frequently biased: many studies compare men and women in different occupations, for instance: nurses and engineers, and in this way create a whole complex of intervening variables that blur the findings regarding gender and psychological responses to work. Studies that isolate these aspects do not find significant differences between the genders regarding conflicts between family demands and employment demands, contrary to what may have been expected (for typical examples see: Emslie, Hunt and Macintyre, 2004; Frone and Rice, 2012; Wiesgram, Dinella and Fulcher, 2011). Actually, recent meta-analyses have found that gender plays almost no role in work-related stress and the intensity of the home-work conflict, after controlling for intervening factors (for example: Ford, Heinen and Langkamer, 2007). Going beyond the above, I suggest that the changes in the world of work posit unique pressures on men who adhere to the traditional gender role, that do not necessarily serve them or put them in an advantageous position. Studies describe the role of "breadwinner" or "economic axis" as a significant career consideration creating psychological pressure regarding competitiveness, sacrificing quality time with the family, and choosing jobs with higher salary expectancy and status, not necessarily those which suit one's preferences and areas of interest (for a recent comparative study of boys and girls vocational interests and aspirations see e.g: Melamed, 20122). These pressures to achieve, earn and provide through work exact a significant psychological toll: in a study conducted in Hong-Kong, a patriarchal society embracing a western way of life, employed men reported sources of work-related stress. The main sources of stress for men were advancement and pay, both directly related to the traditional breadwinner role (Leung and Chan, 2012). Another recent study suggests a link between the degree of masculinity-femininity and the considerations applied when choosing a career: those adhering to traditional gender roles tended to choose a career according to the chances of gaining income and employment security, meaning that they emphasized their responsibility as breadwinners at the expense of satisfaction, interest or personal inclinations (Weisgram, Dinella and Fulcher, 2011). The psychological toll increases in situations of moving between jobs, unemployment, or imbalance between income levels in the family household. The manner in which men cope with unemployment, lack of income, and so on is problematic and inefficient often limited by the male gender role generating a vicious cycle of roleinduced stress and roles induced limitations on coping (see for example: Artazcoz, et al., 2004). An example of such dynamics can be found in a study that reviewed data from a survey held between 1964–1986 in a large sample representing populations of various western countries. The study found that men tend to react with greater emotional distress than women to unemployment; they deal with work-related stress less efficiently, and are Zysberg 273 at a higher risk of suicidal behavior as a result. An interesting finding shows that with the emergence of modern work values in the labor market, the share of suicidal ideation among unemployed women has also risen. Actually this suggests that the psychological toll is apparently a product of gender roles and not biologicalphysiological factors related to the sex of the individual (Pritchard, 1990). Summary and conclusions) some suggestions (in lieu of One of the ‘traditional’ arguments in both academic and political gender discourse maintains that stereotypical gender roles reflect a society that favors men over women. The review presented here wishes to shake this basic assumption. The physical, social, and psychological prices men pay for being ‘stereotypically male’ are perhaps different than those that women pay, but are not lower. Taking into account evidence showing that modern society has allowed some changes in traditional gender role regarding women (such as: entering the world of career, sexual freedom, and so on) it is surprising to see that the very same societies have not changed their traditional perception of masculinity to the same extent (Archer, 1985; Norman, 2011). Therefore, it cannot be claimed that traditional gender roles serve men, or benefit them more than women. A closer look at empirical evidence suggests the opposite. Men actually fare worse than women in life expectancy and longevity, effective coping and utilization of coping resources, and quality of social networks and interpersonal relationships. Facts suggest a traditional world which is anything but beneficial to men: Men live in a more violent world, not only as aggressors but also as victims. Their world is lonelier that that of women: Men report less friendships and less reliance on social support in times of hardship and challenge (Barbee et al., 1993; Holahan and Moos, 2011). The pendulum movement typical of every social and scientific development (as in: thesis, antithesis, and synthesis), is apparent in the relatively brief history of the discussion of gender roles. Originally, the issue had no legitimacy or recognition: from a clearly defined, rarely challenged traditional division of sex roles, the pendulum swung to the opposite direction, whereby traditional basic assumptions were shattered and their veracity cast in doubt. What, then, is the synthesis? Where would the pendulum stabilize with the maturation of the discussion of gender in Western society? Gender discourse in its current form generally encourages a "contest of misery" on the part of both genders: who suffers more, who faces more inequities, obstacles, and other malaises due to being a man or a woman. To a certain extent the current paper fell into the very same trap. This discourse, naturally, is counterproductive. The purpose of this review was to slightly unsettle the prevailing basic assumptions regarding the stereotypical order of things and to help the reader reconsider the matter from a less conventional point of view. It is possible that as the field matures we will see at least two trends take place: the public, social discourse may continue, but in a slightly different manner: there does not have to be a worldwide male conspiracy aiming to subjugate women and remove them from positions of power. The feminist movement on the other hand is not a collection of men-hating misanthropes. As we discuss social changes we may want to bear in mind that social order is a necessity without which no society can exist or maintain necessary basic social institutions and functions. In a different social and personal order, individuals will adopt different roles and areas of responsibility. The discussion of literal equality versus the ‘different but equal’ approaches can have serious repercussions as social structures change and social revolutions unfold. On the empirical, more academic front It would be interesting to study and examine the implications of adopting different personal and social roles regardless of biological sex. Some of the evidence presented in this chapter suggests that lifestyle and the burden of duties and responsibilities placed on the individual have a crucial effect on a person's welfare and symptomatology, and not necessarily as a function of one's gender and sex. Can the future focus more on these aspects and less on gender labels? 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