Aging Men, Masculinities and Modern Medicine

Antje Kampf, Barbara L. Marshall, Alan Petersen, Antje Kampf, Barbara L. Marshall, Alan Petersen

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136173332
• Edition: 1
• Topic: Medicina
• Subtopic: Teoría, práctica y referencia médicas

Aging Men, Masculinities and Modern Medicine explores the multiple socio-historical contexts surrounding men's aging bodies in modern medicine from a global perspective. The first of its kind, it investigates the interrelated aspects of aging, masculinities and biomedicine, allowing for a timely reconsideration of the conceptualisation of aging men within the recent explosion of social science studies on men's health and biotechnologies including anti-aging perspectives.

This book discusses both healthy and diseased states of aging men in medical practices, bringing together theoretical and empirical conceptualisations. Divided into four parts it covers:

• Historical epistemology of aging, bodies and masculinity and the way in which the social sciences have theorised the aging body and gender.
• Material practices and processes by which biotechnology, medical assemblages and men's aging bodies relate to concepts of health and illness.
• Aging experience and its impact upon male sexuality and identity.
• The importance of men's roles and identities in care-giving situations and medical practices.

Highlighting how aging men's bodies serve as trajectories for understanding wider issues of masculinity, and the way in which men's social status and men's roles are made in medical cultures, this innovative volume offers a multidisciplinary dialogue between sociology of health and illness, anthropology of the body and gender studies.

Part I
Rethinking concepts

Historical perspectives

1
Aging, embodiment and the negotiation of the Third and Fourth Ages

Paul Higgs and Fiona McGowan

It has been widely noted that concerns about the body and embodiment have moved from being primarily focused around women’s corporeality to becoming one of the contemporary arenas where masculinity is constructed and performed. This is ever more evident in a society focused around youth and vitality where men are increasingly expected to demonstrate certain levels of health and fitness in the context of narratives of idealized masculine physicality. The issues surrounding age and aging therefore need to be included in any discussion of how masculinity and embodiment interact, and how this relates to medicine and medicalization. Consequently, while biographical and social factors have been found to be significant in shaping and constraining the ways in which men experience the aging process, these factors are not static. Different issues concerning the body, health and the self emerge for men at different points in their lives and these in turn need to be related to the emergence of concepts such as the Third and Fourth Ages. They also need to be related to the role that biomedicine plays in changing the context in which ‘aspirational medicine’ (Gilleard and Higgs 2000: 187) operates to provide a narrative of enhancement in relation to the aging process. Such enhancements change the nature of ‘normative’ expectations about later life and as we shall see have a key significance in the negotiation of current forms of masculinity. To date most published work on the significance of aging in constructing the discourses of masculinity and embodiment has underplayed these critical concepts and the way in which they reflect profound changes to what constitutes aging and later life.

This chapter seeks to rectify this omission by drawing attention to changes in the experience of aging by challenging some of the assumptions about the ‘natural’ nature of the life course and how it refracts male embodiment and ideas of masculinity. In particular, the transformation of the notion of the ‘standardized’ life course into one that is now more ‘de-standardized’ (Gilleard and Higgs 2005) is one that has accompanied the transformation of classical modernity into what has been termed ‘reflexive modernization’ or, in Ulrich Beck’s formulation, second modernity (Beck et al. 2003). This transformation is particularly noticeable at older ages where the conventional construction of retirement as old age and dependency has been rearticulated through the cultural field of the Third Age (Gilleard and Higgs 2011a). Within the culture of the Third Age, discourses of individuals being older but not old have emerged out of the narratives of a maturing youth culture operating within a burgeoning domain of lifestyle consumption. This cultural domain also resonates with the changing nature of biomedicine which increasingly sees opportunities for enhancement and not just the amelioration of decline. The processes of an aging youth culture and lifestyle consumption therefore make up two vectors of a new ‘generational field’ of aging in which choice, agency, autonomy and freedom are valorized. In this a gendered bodily dimension becomes apparent with men facing issues of capacity, fitness and virility as challenges as well as the more conventional threats associated with being identified with an older status. These threats exist in direct proportion to individuals’ capacity to maintain themselves as active participants in the culture of the Third Age. Consequently, it is not at all surprising that it also leads to an engagement with a range of differentiated anti-aging and self-enhancement technologies which all relate to each individual having to deal with what Higgs and Jones (2009) have termed the ‘arc of acquiescence’ as they attempt to negotiate the signs and effects of their own bodily aging. For both women and men this engagement may range variously from hair dye to cosmetic surgery as well as extending from vitamin supplements to performance-enhancing pharmaceutical products (Leontowitsch et al. 2010). For men while there may be more scope for negotiating a ‘mature’ image, issues of potency and virility add to the mix (Loe 2006).

Dealing with the pressures created by the agentic culture of the Third Age also means having to face up to its shadow: the Fourth Age. Many writers are reluctant to grapple with this ‘dark’ side of contemporary aging because it seems to describe later life as one defined by ‘lack’ and frailty (Grenier 2007). However as Gilleard and Higgs (2010) point out the Fourth Age serves as a powerful ‘social imaginary’ containing many of the notions of frailty, physical dependency and mental infirmity that most undermine the capacities of adult human actors particularly around agency and identity. Not only is it a position that most would wish to avoid given its unpleasant underpinnings, it is also one from which there seems to be no possibility of escape (Gilleard and Higgs 2011b). In this the Fourth Age throws up specific issues for men and for masculinity as the implicit dependency reverses previously existing power relationships and social boundaries around the body and the care of the body. Given the importance of these two critical dimensions to aging, how men negotiate the Third and Fourth Ages is crucial for the understanding of male embodiment and masculinity in contemporary societies.

Masculinity, youthfulness and the body

Men as much as women are now subject to social expectations in respect of their physical appearance, influenced by the growth of consumer culture where idealized male bodies have become more visible in representing an increasingly dominant and desirable masculinity. A masculine physique has become a symbol of masculinity and as such is valued not so much because of what it can do but because of how it looks. Therefore men with bodies that epitomize hegemonic masculinity and match the cultural ideal – lean, muscular and youthful – have the physical capital most valued in the field of masculinity (Coles 2009). If these embodied qualities of youth are viewed as ‘essentially masculine’ then aging and old age are the negation of that ideal, threatening men as they age with the obvious failure of matching up to such representations of maleness. Men who were once secure in their body image are now subject to fears of personal devaluation (Whitehead 2002). That this is an ever-present issue can be seen in what Watson (2000: 96) terms ‘backward glancing’, where middle-aged men look back to their own younger selves in order to sustain their present self-identities. It is this ‘idealized image’ of the young fit body which is retained by the older man and it continues to contribute to the masculine sense of self as men grow older and age. This active yet ‘dated’ image is ‘attached to current masculine identity’ and helps explain men’s reluctance to acknowledge bodily changes regarded as intrinsically negative. Growing older therefore requires men to renegotiate masculine identities and just as the body is transformed through aging, notions of manhood are similarly influenced by age, but crucially also shaped and constrained by wider biographical and social factors.

So how do men negotiate their way through age in terms of expressing and retaining the hegemonic ideal? Though there is an increasing literature relating masculinities and health, there is relatively little that addresses the experiences of men as they age. Indeed, literature on men’s health remains dominated by epidemiological data and related research on risk. Such narratives serve to highlight male disadvantage as shown by mortality statistics and in risk factors such as being overweight, smoking and excessive alcohol consumption. Male lifestyles have become recognized as being dangerous to health and have prompted increasing reference to a contemporary ‘crisis’ afflicting men and masculinity. This overstated crisis, whilst referred in generic terms to men of all ages and stages, is seen to become more applicable to men as they become older and as masculine identity can no longer be portrayed or performed through a visually youthful male body. As Whitehead (2002: 200) states, ‘masculinity is not static and unchanging – it changes and masculine identity which was once “inscribed” on the youthful male body becomes transformed just as the body is transformed through aging’. However, in the context of the destandardization or deinstitutionalization of the life course, many of the assumptions of body and age are radically disturbed.

The idea of the standardized life course has its origins in the emergence and bedding down of a classical modernity that was formed in the advanced industrial economies of Europe and North America in the first half of the twentieth century (Kohli 2007). The processes of industrialization and urbanization demanded that stable social structures were developed that organized the life courses of the vast majority of the population. These included education, work and retirement in addition to the domestic division of labour and the heterosexual male-headed household. As a result, a hegemonic masculinity could develop as an expression of these stable or as Bauman would call them ‘solid’ institutions (Bauman 2000). In part this reification of modernist social norms valorized a male embodiment that was both fit and functional for productive manual labour. Mandatory retirement represented a recognition that the productivity of older male labour was now a drag on productivity and it would be better if these men were taken out of the workforce so that labour efficiency could be maintained. Retired men therefore had to face the implication that they were both economically and socially redundant. Their masculinity was regarded as so vulnerable that in the UK women’s state retirement ages were set at 60 instead of 65 so that wives would not potentially still be at work while their husbands were now drawing an old age pension.

However this was all to change. The classical modernist project started to fragment in the latter half of the twentieth century as both industrial labour and social norms started to be challenged by the advent of a more diverse economy and the rise of women’s educational and employment opportunities. What Beck and his colleagues (2003) have called ‘a revolution of side effects’ saw, in the closing decades of the twentieth century, a profound transformation of social life where relative stability has been replaced by increased contingency in both employment and household relationships. The standardized life course was disrupted by repeated changes in working skills and organizations and the growth of ‘precarious work’ (Kalleberg 2009). In the domestic sphere assumptions about household forms and age-stratified activities such as motherhood have become much more varied, to the point that Beck (2007) has talked about the emergence of a new ‘normativity of diversity’. In all of this the position of masculinity has been changed in two ways; first the need for a hegemonic masculinity becomes less as manual labour declines, and secondly the destandardization of the life course opens up opportunities for the Third Age to carve out a niche outside of employment and the labour process. Masculinity at older ages becomes more connected to a consumer lifestyle, as it does at earlier points in the lifespan, and is consequently as connected to narratives of fitness and vigour in later as it had been in earlier adult life. The one big difference is that retirement is no longer the cut-off point for maintaining a masculine identity; now it can continue as long as the individual can participate in Third Age cultures. Central to this change is consumer society and the way that it is oriented towards the body.

Consumer society, generation and the older body

Calasanti (2007: 358) argues that, as ‘bodies serve as markers of age’; in Western culture consumer citizens are motivated to maintain the body in a perpetually youthful state. Indeed, according to some writers, ‘western culture is predicated on the nexus of gendered youthfulness and consumption’ (Schwaiger 2009: 275). As men enter into ‘mid life’ and encounter signs of bodily change and the beginnings of physical decline, masculine identity must then be expressed in other social and behaviour domains while still retaining an association with and remaining representative of the youthful, healthy ideal.

Calasanti (2007) draws attention to the role of the post-war ‘baby boomer’ generation in challenging the entrenched views and traditional notions and expectations of aging. As she sees it, this demographic cohort represents a cultural grouping who are seen to embody the postmodern ideal that individuals can control their bodies through lifestyle and consumer choices, where they can ‘appear to age successfully and thus defend themselves against ageism’ (Calasanti 2007: 359). This approach represents what could be represented as the mainstream approach to the intersecting issues of aging embodiment and masculinity in that it accepts that aging is a ‘natural’ process and that men along with women would accept it if it wasn’t for the interventions of a youth orientated consumerism (Vincent 2006, 2009). Jones and Higgs (2010: 1514) on the other hand argue that the ‘natural’ life course has become destabilized along with traditional ideas of ‘normal’ and ‘normative’ aging and that ‘the new reality of ageing intersects with the somatic aspects of consumer society based on difference and choice’. Rather than this being a form of ‘false consciousness’ or ‘bad faith’ on the part of the individual who does not want to grow old, it is part of a new reflexivity about aging, oriented towards the culture of fitness.

Zygmunt Bauman sees fitness not so much as a form of individual health but rather as a defining feature of a somaticized consumer culture in which the anxieties of a more contingent ‘liquid modernity’ are acted upon (Bauman 2000). Bauman argues that modern society has been transformed from a ‘society of producers’ to a ‘society of consumers’. This is not just an economic transformation; it is also an ontological transformation whereby the body becomes the focus of individual action rather than being a factor of production, reproduction or military might. Bauman writes:

The postmodern body is first and foremost a receiver of sensations, it imbibes and digests experiences; the capacity of being stimulated renders it an instrument of pleasure. That capacity is called fitness; obversely the ‘state of unfitness’ stands for languor, apathy, listlessness, dejection, a lackadaisical response to stimuli; for a shrinking or just ‘below average’ capacity for, and an interest in, new sensations and experiences.

(Bauman 1995: 116)

The ‘fitness’ of the postmodern body is central to the practices of contemporary consumerism creating both discourses of ‘ratio...