Condemned as a ‘Typical’ Man?

By Robin Hadley

A few moths ago, I attended a seminar on infertility treatment. The audience included those involved in infertility treatment, academics, practitioners, and interested others. The complexities surrounding infertility treatment are vast and range from the very intimate and personal to legalities at national and international level. Conducting research in such a sensitive area is fraught with difficulties and the speakers were all very aware of the ethical implications of their research and practice. I was particularly interested in the researchers’ experience of accessing and interviewing men. The general view in infertility studies has been that men are not interested in participating in research, and many studies are heavily weighted with female respondents. As one researcher described her many efforts to interview the male partner of a couple, a ripple of sympathetic recognition of her struggle arose from the audience. ‘Typical man’ seemed to be the collective verdict, mine included. As I reflected back on the day I returned to that incident. The audience reaction was one of sympathy for the researcher and I wondered if that man did not also deserve some empathy. I know from my own research that many men assume that they will be fathers and that that knowledge is so embedded that it is not discussed. The assumption expressed has been that one would leave school, get a job/go to university/ get a job, find a partner, find accommodation, have children. That being the case I tried to put myself in that man’s position: the assumed ‘natural’ event had not happened. How would I feel? Shocked to the very core? I think so. Perhaps I had been brought up not to show feelings and instead, to show control – ‘mastery’ – through actions and/or rationality. In which case my reactions may include striving to balance things up by working and playing harder, or not becoming involved. Being raised in an environment where I am not expected to express emotions, I possibly, do not have the confidence or vocabulary to verbalise my emotional state. Here are my musings on what may have been ‘going on’ if I was that unwilling participant, “So, here I am, not fulfilling the role I expected to – and that others seem to achieve with ease – and I cannot make it right. There is only one person I can talk to and that is my partner but it is worse for her and the one thing I can be is strong for her. Then there is this University researcher who wants to have a talk. She’s talked to my partner, and wants to talk to us both. My partner thinks it will do me good. I don’t know how to express these feelings inside without bursting. I want to support my partner, part of me thinks it would be good to release the emotions but I can’t risk overwhelming her in the way I am sometimes overwhelmed. I’ll say I’ll do it and then see.”
If the participant’s thoughts and feelings were similar to the above then it is understandable why he was ambivalent about being interviewed.

Infertility has been seen as a form of complex bereavement consisting of multiple loses (Adler, 1991; Lechner et al., 2007) with levels of distress in women recorded as high as those suffering from serious medical conditions (Domar et al., 1992; Domar et al., 1993). However, recent research shows that, post infertility treatment, men who did not become fathers suffered poorer mental health than those who had become fathers (Fisher et al., 2010). In their conclusions Fisher et al (p.6) state ‘…that stereotypes that infertile men conflate fertility and masculinity, are less distressed than women about potential loss of parenthood, and adjust more readily to childlessness appear inaccurate.’ Men may or may not be ‘typical’ by choice but there are many social factors that influence their behavior and how their behavior is perceived. The belief that men are not interested in taking part in research, and their absence ‘condemned to be meaningful’ (Lloyd, 1996: p.451), reflects a lack of insight by the research community. I feel I must stress here these are my own reflections based on my research on involuntarily childless men and not a particular person or persons.

Useful websites
Infertility Network UK: http://www.infertilitynetworkuk.com
The Human Fertilisation & Embryology Authority: http://www.hfea.gov.uk/index.html
Mensfe: http://www.mensfe.net

References
Adler, N. E. (1991). Forward. In Stanton, A. L. & Dunkel-Schetter, C. (Eds.), Infertility: Perspectives from Stress and Coping Research (pp. vii-ix). Plenum Press: New York.
Domar, A., Broome, A., Zuttermeister, P. C., Seibel, M. & Friedman, R. (1992). The prevalence and predictability of depression in infertile women. Fertility and Sterility, 58, 1158-1163.
Domar, A. D., Zuttermeister, P. C. & Friedman, R. (1993). The psychological impact of infertility: a comparison with patients with other medical conditions. Journal of Psychosomatic Obstetrics and Gynaecology, 14(Special issue), 45-52.
Fisher, J. R. W., Baker, G. H. W. & Hammarberg, K. (2010). Long-term health, well-being, life satisfaction, and attitudes toward parenthood in men diagnosed as infertile: challenges to gender stereotypes and implications for practice. Fertility and Sterility, 94(2), 574-580.
Lechner, L., Bolman, C. & Van Dalen, A. (2007). Definite involuntary childlessness: associations between coping, social support and psychological distress. Hum. Reprod., 22(1), 288-294.
Lloyd, M. (1996). Condemned to be meaningful: Non-response in studies of men and infertility. Sociology of Health & Illness, 18(4), 433-454.

A Darker Side to Care..?

It’s been great to read the diverse blogs on this site and the definite slant given by commentaries on issues of identity and sexuality to the challenge of revaluing care. Some time ago I attended a meeting with some of the other members of this network where we raised the question of what is ‘queer care’. And more specifically, how could we go about finding out how it was practised and what it meant to people? We were interested in the lived realities of care for LGBT people but also whether queer theory could offer a framework for making sense of this experience.
Of the still very limited research on care in the context of LGBT ageing there is every indication that helping relationships are organised rather differently to traditional binary notions of the care-giver and care-receiver. For instance, Ann Cronin and Andy King’s work suggests interdependence over dependence in lesbian and gay relationships.  Research with the trans community by Sally Hines also points to support clusters and collective ways of helping people rather than dyadic carer/caree encounters. While Margrit Shildrick and Janet Price’s joint work on intercorporeality and their notion of ‘two bodies becoming together…’ sheds a very different light on how we think about the body itself and its potential in helping situations. However, the closeness and intimacy signalled by these accounts stand in contrast to findings regarding care for older LGBT people of the more formal/paid variety.
Here, care is an uneasy term, and comes with baggage. This is why it has been all but bracketed off in critical disability studies, with the intention that this may lead to more novel ways of thinking about the helping relationships that evolve between people. Perhaps then a queer approach could also usefully begin by treating care with caution –  after all there’s no saying that ‘revaluing care’ might not lead us to decide it is a less useful term for future understandings of helping relationships rather than necessarily investing it with new worth. Many LGBT people’s experiences invite such a possibility because so much of what is badged as care can be experienced as very negative and damaging. This can range from the wholesale neglect of the individual supposed to be ‘in care’ to a diverse range of sometimes more subtle indicators of disapproval, disgust or rejection communicated verbally, behaviourally, emotionally, viscerally etc. and all of which are enfolded within care practices. To date, these experiences are not well documented, partly because LGBT people in the ‘Fourth Age’ are largely invisible and ignored by mainstream gerontology, as Ann Cronin has pointed out, and often are too concerned for their safety to identify themselves in the context of relying upon care services. Do the assumptions that underpin how we currently think and talk about care serve to perpetuate the cultural silence about this darker side?
Taken collectively, research to date tells us that many LGBT people are afraid of a time when they might require care. Findings in the UK and US have uncovered significant numbers who would rather take their life than be admitted to a care home and many more who report a fear of care that involves body work and the prospect of being exposed to and handled by a care worker (although much of this research has been conducted with fit and independent people being asked to anticipate the need for care rather than describe the experience of it). Ironically, older LGBT people are more likely to require formal care by virtue of being less likely to have children and more likely to live alone, but evidence suggests many delay or refuse altogether the uptake of services due to anticipation of negative treatment and its impact upon their lives. At the very least then, formal care has a serious reputation problem in certain quarters. But research with older LGBT people also suggests it has a dark side – one that is perhaps most visible from certain (queer) standpoints. In our efforts to debate and revalue care maybe we should begin with the perspectives of those who have a close-up on the under-side of care and its darker recesses. And perhaps the place to start in ‘queering’ care is to dispense with the term altogether in an effort to find alternative ways of capturing helping relationships and reconfiguring the terrain of help and support in later life in ways that might feel more acceptable to minoritised groups…?

‘Gender Identity and Health Care Experiences in Australia’ by Dr Damien Riggs

In 2012 and 2013 Dr Clemence Due and I conducted two surveys, the first focusing on the health care experiences of Australian people who were female assigned at birth (FAAB) but who now identify with a different gender identity, and the second focusing on the healthcare experiences of Australian transgender women. Our analyses so far have adopted a comparative approach, primarily because most previous studies of transgender, transsexual or genderqueer people’s experiences of healthcare have not disaggregated findings by assigned sex. We thought that a comparative approach might thus be useful given that research suggests that transphobia is highly correlated with both homophobia and sexism amongst heterosexual, cisgender people (see Riggs, Webber & Fell 2009). These three forms of discrimination are related by the fact that the first two are about attitudes towards gender non-conformity, and the third measures how much an individual subscribes to social norms about (nominally cisgender) gender role conformity. Previous research suggests that transphobia (and cisgenderism more broadly) is gendered, not only in the sense that cisgender men are more likely to be transphobic than are cisgender women, but that people FAAB will experience transphobia or cisgenderism differently than will people male assigned at birth (MAAB). In undertaking a comparative approach, then, our hypothesis was that such differential discrimination would result in different experiences with healthcare providers between the two surveys.

In order to test if it was appropriate to group all responses from people MAAB together as one group, and to compare this with all responses from people FAAB, we first checked to see if there were any significant differences within each group in terms of current gender identity. In each study participants were asked to name their current gender identity. The three main categories used by participants within both of the studies were:

1. Affirmed gender (i.e., simply ‘male’ – used by people FAAB – or ‘female’ – used by people MAAB)
2. Transgender (this included terms such as trans woman, trans girl, trans boi, transgender man)
3. Genderqueer

Statistical testing indicated that both within the surveys, as well as when combining the two samples into a whole, there were no significant differences in between those people who identified themselves using either their affirmed gender, the term ‘transgender’, or the term ‘genderqueer’.

In order to further ensure that focusing on differences between people MAAB and people FAAB was a valid approach, we also looked at whether there were other notable differences across the two samples. We found that:

1. Participants who were older were more likely to have undertaken sex-affirming surgery than participants who were younger,
2. Participants who were older reported more positive levels of mental health than did participants who were younger, and
3. Participants who had undertaken sex-affirming surgery reported more positive levels of mental health than did participants who had not undertaken surgery (as we had already found when looking solely at the first study, see Riggs & Due, 2013).

These initial findings suggested to us that it was possible that the main issue at stake across the samples was age. What we did, then, was control for age in our subsequent statistical testing. This enabled us to examine whether assigned sex (MAAB or FAAB) was a significant predictor of experiences. The answer was yes:

• Participants who were MAAB were more satisfied overall with the support they received from counselors, psychologists and psychiatrists than were participants who were FAAB,
• Participants who were FAAB reported more positive levels of mental health than did participants who were MAAB,
• Participants who were MAAB reported more positive experiences of gender-affirming surgery than did participants who were FAAB,

In addition to differences between participants MAAB and participants FAAB, there were other interesting findings. Some of these highlight areas in need of improvement by (nominally, though not in all cases) cisgender mental and physical health care professionals:

• Participants who reported higher levels of discrimination from health care professionals reported less positive levels of mental health,
• Participants who reported feeling that they frequently had to educate health care professionals about issues related to their current gender identity reported higher levels of discrimination,
• Participants who reported feeling that they frequently had to educate health care professionals about issues related to their current gender identity reported that they felt less respected by the professionals.

So what do all of these findings suggest to us? We of course acknowledge that this was a modest sample (78 people FAAB and 100 people MAAB), though these numbers are similar to those of the pioneering TranZnation report (2007), and they include participants from all Australian states and territories. The findings suggest the importance of taking into account both age and natally assigned sex. These demographics may impact upon people’s experiences due to differing:

• Diagnosis rates of ‘gender dsyphoria’ between people MAAB (0.005% to 0.014% of the population) and people FAAB (0.002% to 0.003% of the population),
• Societal gender norms and expectations of people FAAB and people MAAB, such that experiences of discrimination from the general population, from transgender communities, and from health care professionals will likely differ according to cisgender (and transgender) people’s assumptions about gender norms,
• Degrees of availability and successful outcomes of surgery as perceived by people MAAB when compared to people FAAB (though this is slowly changing, see Cotten, 2012),
• Understandings of gender identity within non-gender normative communities.

The report documenting the full findings is available at: http://www.genderidentityaustralia.com/?p=262

References

Cotten, T.T. (Ed.). (2012). Hung jury: Testimonies of genital surgery by transsexual men. Transgress Press.
Couch, M., Pitts, M., Mulcare, H., Croy, S., Mitchell, A., & Patel, S. (2007). TranZnation: A report on the health and wellbeing of transgender people in Australia and New Zealand. Melbourne: Australian Research Centre in Sex Health and Society.
Riggs, D.W. & Due, C. (2013). Mapping the health experiences of Australians who were female assigned at birth but who now identify with a different gender identity. Lambda Nordica, 5.
Riggs, D.W., Webber, K., & Fell, G.R. (2012). Australian undergraduate psychology students’ attitudes towards trans people. Gay and Lesbian Issues and Psychology Review, 8, 52-62.

Dr Damien Riggs
Senior Lecturer
Flinders University
GPO Box 2100
Adelaide 5001
South Australia