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WEEK 1: GENDER, SEX, and the BODY Johannes Machinya  Part 2: Overview Socio-cultural and environmental factors that shape people’s ability to recognise and how they respond to disease and illness Identity and the “illness...

WEEK 1: GENDER, SEX, and the BODY Johannes Machinya  Part 2: Overview Socio-cultural and environmental factors that shape people’s ability to recognise and how they respond to disease and illness Identity and the “illness experience” Gender and sexuality Mental health and disability What is gender? What is sex? Gender, Sex: A set of biological attributes that are associated with physical and physiological features that sex, and distinguish females from males, such as chromosomes (XX for females, XY for males), reproductive organs, and other secondary sexual characteristics (like voice depth) (Heidari, et al. 2016) Common perception is that “sex is solid and rigid and fixed and binary and scientific” the body A biological construct? Gender: Refers to the socially constructed roles, behaviours, expressions and identities of females and males. Gender roles are socially constructed: change over time and vary between societies. This means that the expectations and behaviours associated with being male or female are not biologically determined but are shaped by the cultural, social, and historical contexts in which people live. Influences how people perceive themselves and each other, how they act and interact, and the distribution of power and resources in society. Gender identity is not confined to a binary (girl/woman, boy/man) nor is it static; it exists along a continuum and can change over time. Gender ideology prescribes (and circumscribes) the social behaviour of men and women, and of different age or ethnic groups of men and women. Social myths and stereotypes about appropriate or supposedly “natural” behaviour for women and men impact on their health and well-being, such as body image and weight control.  Gender and sex – cont’d Biological vs social construct A social construct is when we put artificial boundaries around groupings that are complex. The roles or characteristics are created by society through norms, traditions, and expectations rather than being innate or naturally fixed. Biological sex is certainly a social construct. Intersex variations: Some individuals are born with a combination of male and female biological characteristics, which challenges the binary notion of biological sex and suggests that biology itself is more diverse and complex than a simple male/female distinction. up to 1.7% of people are born intersex/born with diverse sex traits. These ‘exceptions’ show that the idea of two binary biological sexes is just that – an idea – something we humans have come up with to explain and simplify our world – a social construct. NB: Sex and gender are interconnected – (WHY) social understandings of gender shape how we perceive and categorise biological sex. While sex is grounded in biological differences (and gender in socially constructed roles), the ways in which those differences are understood and categorised are shaped by social and cultural factors, making it more than just a biological construct.  Significance of Gender for Health Gender is structural; it is not simply an individual characteristic – goes beyond individual choices. It is deeply embedded in the core institutions of society that influence people's opportunities, experiences: Economy (determines access to resources, types of employment, which shapes health disparities between men and women) Family (shapes caregiving and breadwinning roles, reproductive health expectations) Politics and policy (influences healthcare policies, access to reproductive rights, and medical research priorities) Medical and legal systems (impacts treatment protocols and legal rights related to health) Lorber (1997): Gender is important in shaping health outcomes across different groups, transforming biological experiences into socially defined realities, e.g., the illness experience. By recognising the influence of gender on health, we will be able to address inequalities in healthcare access, treatment, and outcomes.  Gender and health Impact of gender on health and illness The structural nature of gender means that it shapes health and illness outcomes for individuals at every life stage – from birth to death. Because of its embeddedness, it impacts not only how individuals experience health but also how they receive healthcare and navigate systems designed to address illness. Health disparities: Gender norms can lead to significant disparities in the diagnosis and treatment for men and women. Such disparities can manifest in different treatments for men and women, whereby men and women can receive different medical care for the same conditions due to entrenched gender biases in medical research and treatment protocols. e.g., heart disease in men and women Reproductive health: Gender influences access to reproductive healthcare and the regulation of women's bodies. Mental health: Gender roles and expectations may increase stress and mental health risks for both men and women, e.g., women are often expected to balance work, caregiving, and household responsibilities, which can lead to anxiety and depression Gender and health Social management of bodies This refers to how societal norms and expectations related to gender, shape not only how people think about their bodies but also how they behave, treat themselves, and are treated by others. Gender, in this sense, transforms biological bodies into “social bodies,” (Lorber, 1997) where cultural values and societal expectations influence everything from health to appearance to behaviour. This process of involves: Gendered expectations: Society assigns certain behaviours, appearances, and health risks to men and women based on gender norms (e.g., ideas of masculinity may discourage men from seeking healthcare). Medicalisation of gender: Gendered assumptions in medical practice can affect diagnoses and treatments, often reinforcing gender stereotypes. Medical practices often assume that men and women experience illnesses in inherently different ways, leading to gendered approaches to treatment, (e.g., mental health conditions – overdiagnosis in women, under-diagnosis in men). Intersectionality: Other forms of social stratification, such as race, class, and sexuality intersect with gender to create complex and unique experiences of health and illness. Gender and women’s health in medical sociology In the 1970s and 1980s, there was a notable evolution of perspectives on women’s health within medical sociology, particularly a shift from focusing on biological differences to incorporating a gender analysis, influenced by the women's health movement and feminist critiques of the medical establishment. Women’s health was understood through the lens of biological essentialism, i.e., women's primary health concerns were tied to their reproductive functions – “resulting in specialized services for childbirth, contraception, abortion, and infertility” (Arber and Thomas) While crucial in addressing women’s specific needs, these services reinforced the idea that women’s bodies were defined by their ability to reproduce. Women’s health concerns that fell outside the reproductive scope – e.g., cardiovascular disease, or mental health – were often under-researched or dismissed. Women’s health: Medicalisation of reproduction Medicalisation of reproduction refers to the process by which reproductive health processes like pregnancy, childbirth, and menstruation, are increasingly managed and controlled by medical professionals and institutions. This often shifts the focus from viewing these processes as natural life events to treating them as medical conditions that require close monitoring, intervention, and management. This positions medical practice as the dominant authority over women’s bodies e.g., Pregnancy and childbirth, once largely managed by traditional birth attendants and women themselves, became medicalised processes overseen by physicians, particularly male doctors. This shift placed women in a more passive role regarding their healthcare, with decisions often made by medical professionals rather than by the women themselves.  Critique of medicalisation of reproduction Prioritises “search[ing] for pathology rather than women's experience of birth and parenthood” (Arber and Thomas 2001), i.e., identifying risks, complications, and potential health issues over the personal, emotional, and social experiences of women. In maternity care, this results in treating “normal social events” of sexual and reproductive experiences – pregnancy and childbirth – as inherently problematic, requiring medical intervention in clinical settings even when the pregnancy is progressing normally (Thomas 1998). Women’s autonomy and preferences marginalised Medicalisation creates tension by contrasting with the idea of pregnancy and childbirth as normal, significant life events that many women want to experience with a sense of agency and emotional connection. NB: The critique is not that medical intervention is always negative, but that it should be more balanced with respect for women’s agency and personal experiences, ensuring that maternity care is both medically sound and responsive to women’s holistic needs.  Critique of medicalisation of reproduction – cont’d While much focus is “Women's postnatal placed on the dramatic health is the least recognized, least and medically intensive glamorous aspect of pregnancy and birth. aspects of labour and Once the drama of the birth is over, a woman's delivery, the mother's own health appears to take second health in the postpartum place in the eyes of health professional” period tends to receive (Thomas 1998 in Arber and Thomas 2001) far less attention. Gender, intersectionality and women’s health Research on women’s reproductive health neglected differences among women – in relation to factors like poverty, class, race, ethnicity, and sexual orientation, which can affect a woman's access to reproductive healthcare, her experiences during pregnancy, and the risks she faces during childbirth. Ignoring these differences can lead to an incomplete and skewed understanding of reproductive health. Gender and health: The male ‘standard’ in research and healthcare Medical standards and definitions of health have historically been based on male bodies, with men – particularly white, middle-class, working-age men – considered the norm against which women’s health is measured. This bias reflects a broader issue where women's bodies are viewed as deviations from the male standard, leading to a lack of adequate attention to their specific health needs in non-reproductive areas, such as heart disease or clinical trials. Women have often been excluded from clinical trials and epidemiological research, or included in insufficient numbers, as highlighted by research on conditions like coronary heart disease (CHD). CHDhas typically been based on male patients, which means that women’s symptoms and responses to treatment for CHD are less well understood. As a result, women with heart disease may not receive optimal care because treatments are designed based on male-centric data. This systemic bias toward male-centric medical standards and research contributes to misdiagnosis, inappropriate treatment, and poorer health outcomes for women in many areas of healthcare. There is a critical need for a more inclusive approach to medical research and healthcare, one that accounts for gender differences – the unique biological and physiological differences between men and women – rather than treating men as the "default" patient.  Social conditioning and gendered health-seeking Gender differences in illness behaviour – i.e., how individuals recognise, interpret, and respond to symptoms of illness, how they seek medical care – can lead to variations in how men and women experience, report, and seek treatment for illnesses (McKinlay 1996) Social and cultural norms surrounding gender influence how men and women engage with their health and medical care. These norms often shape behaviours that either encourage or discourage seeking medical help, based on gendered expectations about strength, vulnerability, and illness. Women vs men Health-seeking behaviour: Women are socialised to be more attuned to their bodies and to take on caregiving roles, which may make them more likely to monitor their own health and seek care for symptoms AND Men are socialised to avoid appearing vulnerable, which can lead to a reluctance to seek medical care for "minor" symptoms. For women, this may create the assumption that women are seeker than men (but Macintyre et al. 1996 challenge this) AND For men, it results in the social invisibility of men’s illness as revealed by Cameron and Bernardes (1998) who show how cultural constructions of masculinity contribute to men’s reluctance to seek help for prostate problems. The impact of gender differences in illness behaviour and health-seeking patterns is that they result in delayed care and missed diagnoses To improve health outcomes and address the disparities in illness behaviour between men and women, healthcare systems need to consider how gendered expectations influence both patients' and providers' behaviours.  The need for a gendered analysis of health A gendered analysis of health focuses on understanding how cultural values, gender roles, and social interactions influence the way illness is perceived, experienced, and treated differently by men and women. The perception of illness and the decision to seek medical care are deeply shaped by cultural values, gender roles, and social interactions. Different societies and cultures have unique beliefs about health, which influence how individuals interpret symptoms and determine what is considered an "illness" requiring attention. These cultural frameworks also dictate how men and women understand and respond to health concerns, leading to distinct patterns of illness behaviour. Gendered norms and assumptions and the role of health professionals in defining illness Intersectional analysis of health – how gender interacts with other social categories, e.g., race, ethnicity, class, and sexual orientation, to create differential health risks and protections (Lorber 1997) Differential responses from healthcare providers Hence, the need to broaden the analysis from a focus on women's health to a more holistic examination of how gendered expectations, roles, and norms affect both women’s and men’s health.  The body in sociological discourse Traditionally, the body was seen as a biological fact – ‘The “fact” that we are born, have a body, and then die is of course something that does seem to be beyond question” (Nettleton 2001) – birth, life, and death were certainties However, with advances in medical technologies, this “fact” has become increasingly blurred – “… technological developments have meant that boundaries between the physical (or natural) and social body have become less clear.” ❖ Technological advances like assisted conception challenge our assumptions about the body's natural processes. Life-extending technologies, e.g., ventilators, organ transplants, or artificial life support, can prolong physical life even when someone may be considered medically dead by traditional standards (such as brain death). QN: Is death the moment when biological functions stop, or is it when conscious experience ends? Advances in medicine blur this boundary, complicating the definition of death itself. The body in sociological discourse– cont’d What constitutes a 'pure' human?: Prosthetic limbs, or artificial organs help people lead more "normal" lives, but they also raise the question of what it means to be fully human. QN: Is a person with multiple artificial parts still a "pure" human, or does the integration of technology alter that status? The boundaries between human and machine are increasingly difficult to define. Technological advances and understanding of the Body For Nettleton, our understanding of the Body and Identity: In late modern body has become more uncertain, societies – “that appears to be ever which is reflected in modern more uncertain and risky” – the body is sociological debates. central to identity formation (Giddens 1991; Beck 1992). The regularised control and modification of the body become ways to maintain self-identity amidst societal risks and uncertainties. Technological advances and the changing body Cyborg Bodies: Advances in medical technologies – prosthetics, organ transplants, and genetic interventions – have blurred the line between human and machine: “the cyborg is neither a “natural body” nor simply a machine” The concept of the “cyborg” (a hybrid of human and technology) challenges traditional understandings of what it means to be human and how we understand the body. Historically, the human body was seen as a purely biological, self-contained system. However, with the introduction of technologies that can replace or enhance body parts, humans are increasingly integrated with machines. The result = the line between what is “natural” and what is “technological” becomes unclear. Example A person with a prosthetic leg is not just a human but also partially a machine. This hybrid state challenges the conventional notion of a purely biological body. Technological advances and the changing body Reproductive and Genetic Technologies: New reproductive technologies (NRTs) and the Human Genome Project have transformed how we think about bodies, identity, and kinship. With technologies like IVF and surrogacy, the biological and social aspects of parenthood can be separated. A child might have one genetic mother (egg donor), a different gestational mother (surrogate), and a third mother who raises the child. This disrupts the conventional idea that biological relationships define kinship and family, raising questions about the meaning of parenthood and family ties. Kinship and non-genetic parenthood: NRTs challenge the idea that genetic links define family. Surrogacy, egg/sperm donation, and IVF create family structures that are not always based on direct genetic relationships, shifting ideas of kinship and care away from pure biology. This allows for a more fluid and diverse understanding of what it means to be a parent or a family.  Sociological perspectives on the body There are three main sociological approaches: the social regulation of the body; the ontology of the body; the lived body or sociology of embodiment 1. Social regulation of bodies This refers to “the way in which social institutions regulate, control, monitor, and use bodies.” Bryan Turner’s concept of the “somatic society” highlights the regulation of bodies as a central concern in modern societies The body as a social and political site In a somatic society, the body is not merely a biological entity/organism but is heavily shaped by and involved in social, cultural, and political processes. Issues that were once personal – e.g., sexuality, aging, reproduction – are now subjects of public debate, policy-making, and social concern. For example: debates over body image and beauty standards, or public health campaigns about obesity and smoking all show how the body is a political and social matter, not just an individual concern. Institutions like law, medicine, and religion control and monitor bodies, especially at critical moments like birth and death.  Sociological perspectives on the body – cont’d Turner’s somatic society is also linked to Michel Foucault’s biopolitics. Biopolitics refers to how governments and institutions exert control over populations by regulating bodily practices – through healthcare policies, surveillance, reproductive laws, and public health initiatives. “Disciplinary power refers to the way in which bodies are regulated, trained, maintained, and understood and is most evident in social institutions such as schools, prisons, and hospitals. Disciplinary power works at two levels. First, individual bodies are trained and observed. Foucault refers to this as the anatomo-politics of the human body. Second, and concurrently, populations are monitored. He refers to this process as “regulatory controls: a bio-politics of the population”” (Foucault 1981: 139). The body becomes a site of political control, with governments increasingly interested in managing health, reproduction, and life expectancy for economic and political reasons. Mary Douglas (1970), an anthropologist: the perception of the physical body is mediated by the social body, i.e., “The social body constrains the way the physical body is perceived.” Drawing from Durkheim, she argues that all societies contain elements of both the sacred and the profane, and the distinction between these two realms is essential for maintaining social order. To manage disorder or ambiguity, societies create classificatory systems that define what belongs where, often labelling things that disrupt these boundaries as “matter out of place.” Sociological perspectives on the body – cont’d 2. Medicalisation of everyday life In a somatic society, many aspects of life that were once considered personal or natural – such as childbirth, aging – become medicalised. Medical and scientific institutions increasingly define what is considered normal or healthy, and these norms shape how individuals view and manage their bodies. NB: Reproductive technologies and anti-aging treatments all illustrate how society has become more focused on regulating and controlling the body through science and medicine. The body and social identity Sociologists argue that the body has become an important way for people to express and shape their social identities. In modern societies, where many things feel “out of control” (Giddens 1991) – like the environment or political events - the body becomes something we can focus on and control. For many people, their body becomes a foundation for building their sense of self. Giddens: our “self” or identity is tied to our bodies. The way we manage and control our bodies is key to how we maintain our personal identity over time. In the past, our bodies were often seen as a part of nature that we could not control much. For example, aging, illness, or physical features were simply “given,” and people had to accept them as they were. However, today, with advancements in medicine and technology, things have changed; bodies are no longer just natural but are now projects people work on to create their sense of self identity. The body as a project: Imagine someone undergoing cosmetic surgery. This is an example of how the body becomes a project. People see their bodies as something they can improve to feel better about themselves or to fit into social expectations.  The body as a constantly changing project Sociologist Chris Shilling (1993) says the body is always a work in progress, it is never "finished" because people are always changing it based on their social environment However, the more people learn about the body and how to change it, the less certain they become about what the body actually is. Example: Medical imaging and the body Medical technology has changed how we think about the body. For instance, when people visit a doctor, tests like X- rays or MRI scans often take precedence over what the patient says about their own pain. This suggests that the image of the body becomes more important than the body itself. A person with chronic pain might be told that there’s “nothing wrong” because the tests don’t show anything, even though they are in pain.  The lived body vs. The observed body There’s a difference Medical technology often This creates a tension between how we live in focuses on the observed between the two, and our bodies (what it feels body – images and tests – sometimes it can lead to like to be in them) and how while people experience feelings of alienation or experts (like doctors) their bodies through disconnection from one's observe our bodies. everyday life. own body.  Sociology of embodiment The sociology of embodiment emerged out of a critique of the literature on the body which neglected to incorporate the voices of bodies as they are experienced or lived (Nettleton and Watson 1998). This approach draws on phenomenology, which is a way of studying human experience from the perspective of the person living it. Nettleton and Watson argue that many earlier studies separated the body from the mind, treating them as two different things. This way of thinking, known as dualism, separates not only the mind and body but also things like culture and nature, or reason and emotion. The problem with these dualisms is that they create hierarchies in society and reinforce stereotypes. For example, historically, men have been associated with the mind and the public sphere (like work), while women have been associated with the body, nature, and the private sphere (like home life). This division has led to unequal treatment of men and women in many societies. ❖ The sociology of embodiment challenges these dualisms by showing that the mind and body are deeply connected.  Illness, injury, and embodiment Chronic illness and embodiment: Chronic illness disrupts the relationship between the body and self. For the chronically ill, the body becomes alien, a source of constant awareness, and a barrier to everyday life. Typically, we don’t think much about our bodies when they function normally – we take them for granted. Ordinarily, our bodies are “absent” from our minds, meaning we don’t actively think about them as we go about our day. But when we become ill or injured, we start to notice our bodies in new ways; illness, as Leder (1992) argues, transforms the body from an “absent” to a “present” object of focus ❖ Sociologist Simon Williams explains how people with chronic illness move between feeling like their bodies are dysfunctional (dys-embodiment) and trying to return to a more normal state (re-embodiment). This process of adjusting to illness involves a lot of work to rebuild a sense of self and life narrative. However, one limitation of this argument is the assumption that people always have a “competent mind” – th mental ability to reflect on their bodies and experiences. David Webb points out that people who suffer from traumatic brain injuries (TBI) often cannot engage in this process. For people with TBI, the mind itself is damaged, making it difficult or impossible to reflect on their bodies in the same way healthy people can.  Conclusion: Centrality of the body in social life: As medical sociology increasingly focuses on the body, understanding the body’s role in health, illness, and identity becomes crucial. The sociology of the body and embodiment has added new dimensions to the study of health and illness. However, the more knowledge we acquire about the body, the less certain we are about what the body truly is. As we gain more knowledge about the body, we also become more uncertain about what it actually is and how it functions. Understanding the body as both a physical and lived experience is crucial to fully analysing health, illness, and health care in modern society.