Death, Gender and Ethnicity

David Field, Dr David Field, Jenny Hockey, Neil Small, David Field, Dr David Field, Jenny Hockey, Neil Small

• Publisher: Routledge
• Year: 2002
• ISBN:
  9781134756599
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

Death, Gender and Ethnicity examines the ways in which gender and ethnicity shape the experiences of dying and bereavement, taking as its focus the diversity of ways through which the universal event of death is encountered. It brings together accounts of how these experiences are actually managed with analyses of a range of representations of dying and grieving in order to provide a more theoretical approach to the relationship between death, gender and ethnicity.
Though death and dying have been an increasingly important focus for academics and clinicians over the last thirty years, much of this work provides little insight into the impact of gender and ethnicity on the experience. The result is often a universalising representation which fails to take account of the personally unique and culturally specific experiences associated with a death. Drawing on a range of detailed case studies, Death, Gender and Ethnicity develops a more sensitive theoretical approach which will be invaluable reading for students and practitioners in health studies, sociology, social work and medical anthropology.

Chapter 1

Making sense of difference

Death, gender and ethnicity in modern Britain

David Field, Jenny Hockey and Neil Small

INTRODUCTION

Death has often been represented as the ‘great leveller’ who returns both monarch and beggar to a common dust. As such this image has been used both to diminish the political zeal of those who would reform earthly inequalities (Illich 1977) as well as to undermine the power and status of those who assume positions of authority. This volume demonstrates that while the image of death as the great leveller may have powerful political and religious overtones, it is a far from accurate representation. Worldly inequalities are in no way levelled at the time of death but persist, permeating every aspect of death and dying. The timing, place, manner and social implications of an individual’s death are shaped by their social position in the society. Age, ethnicity, gender, social class and sexuality all profoundly affect the ways people experience death, dying and bereavement. Such forms of social differentiation should not be seen as fixed elements of a reified ‘society’ which bear down upon us in life and in death (West and Zimmerman 1991) for they are produced precisely through the ways in which we live our lives and encounter our deaths. Rather than being unaffected by them, differences and diversity in the manner and social implications of dying are both constituted by and constitutive of such social identities. This volume takes gender and ethnicity as its areas of interest but many of the chapters reveal the ways in which these are themselves cross-cut by other forms of social identity and social differentiation such as age and social class.

The ways in which a society deals with death reveal a great deal about that society, especially about the ways in which individuals are valued. In this introductory chapter we provide a selective overview of the place of gender and ethnicity in modern society in order to provide a context for the chapters which follow. We summarise the available material about mortality, gender and ethnicity, drawing particularly upon research in the sociology of health and illness. The relative absence of discussion and analysis of gender and ethnicity in the now extensive sociological literature about death, dying and bereavement in modern societies follows a similar pattern to the initial neglect and subsequent concern about these topics in sociology. We suggest that, with respect to gender, the insights of feminism have much to offer. We conclude our introduction with a brief consideration of the contribution of more general theoretical conceptualisations in sociology to the developing interest in the ways in which gender and ethnicity are related to death and dying in modern societies.

Table 1.1 Selected causes of death in the United Kingdom: by sex and age, 1992

DEATH, ILLNESS AND GENDER

There are a number of striking differences in mortality and illness between men and women in Britain and other industrial societies. In all such societies at all ages the death rates of females are lower than those for males. The patterning of death is also different (Table 1.1). Men are more likely to experience and die from cardiovascular conditions (though these are important among women), cancers (except breast and cervix) and bronchitis. These are the major causes of death in our society. Especially large differences appear where individual acts are the cause of death. Males, especially young men, are more likely to die from suicide, homicide and accidents. Men are also much more likely to die in war, whereas women stand a greater risk of injury and death from domestic violence (Dobash and Dobash 1992). In terms of illness, women report more acute illness, make more physician visits, are more likely to be hospitalised (even when excluding childbirth and reproductive admissions) and consume more medicines than men (Blaxter 1990). The picture for chronic illness and disability is less clear cut, but again in the UK women generally have higher rates than men.

A number of empirical and conceptual explanations of the gender differences outlined above have been advanced (Clarke 1983, Nathanson 1977, Verbrugge 1985). There may be some influence from artefactual and definitional factors. There is some evidence that gender influences diagnosis and treatment, with doctors and nurses responding differentially to clients along gender lines. Two examples are the greater likelihood of women being diagnosed as mentally disordered and men being more likely to be candidates for heart surgery. However, it seems that clear differences exist between males and females with respect to mortality and physical morbidity.

Another source of explanation relates to biological differences in the susceptibility to death and disease (Waldron 1983). For example, genetic factors have been linked to higher rates of miscarriage and infant mortality of male babies and to the greater likelihood of women developing breast cancer. This latter is also linked to the female reproductive system. Differing hormonal balances between the sexes are thought to be linked to a variety of conditions, although outside the realm of reproduction there do not appear to be significant consequences for overall gender differences in mortality and illness. Where biological effects have been established they have mainly referred to within-sex differences rather than to between-sex differences.

A number of writers have argued that gender differences in death and illness are the product of differing behaviour patterns and styles of life between males and females. That is, that they are linked to gender roles within the society. Such explanations refer to two aspects – differential risks of illness between males and females and differences in the health and illness behaviour between the genders. The greater levels of fatal diseases among men do seem to be related to behaviour and environment, especially at work. It is suggested that male gender roles both expose men to greater risks and restrain men from ‘giving in’ to illness by restricting their activity and use of health services. By contrast, it is argued that female gender roles both expose women to less risk and permit (and possibly encourage) them to be more responsive to illness and to seek medical help. Help-seeking and ‘emotionality’ are part of conventional ideas about female roles, whereas males are expected to restrain their expression of emotion, to deny illness, and to be more reluctant to seek help from others. Thus, help-seeking (and help-giving) are congruent with idealised female gender roles in our society. It has been suggested that as females come to behave as males (note the assumption!) in their work and leisure activities, then their patterns and rates of mortality (and morbidity) will approximate the male patterns and rates. For example, the convergence in the levels of smoking between males and females is expected to result in increased levels of lung cancer among women, even though women rather than men are subject to pressure not to endanger the health of their children – born and unborn – through smoking.

The main weakness of these explanations is that it they tend to address the effects of gender largely in isolation from other social variables. For example, social class is known to be an important determinant of the likelihood of death and the prevalence of disease. Although females, as a category, live longer than males, males from the upper social classes will live longer than women from the lower social classes and are likely to experience less ill health. Social class influences illness-related gender behaviour in important ways which are still to be unravelled. Age is another important influence. The detailed analysis of gender and health status by Macintyre et al. (1996) confirms earlier reservations that it is misleading to assert that at all ages women are sicker than men (Clarke 1983). They conclude that both age and disease condition exert important influences on gender-specific levels of chronic illness.

A final set of explanations for gender differences in health and illness draws upon feminist analyses of the oppressive role of patriarchy in shaping the experiences of women in our society. Within the sociology of health and illness literature such work has largely focused upon relationships between female patients and male practitioners, especially within ‘reproductive encounters’ (e.g. Martin 1987; Scully 1980) and so does not bear as directly upon the issues of death, dying and bereavement which are our focus here. However, the broader issues raised by feminism provide an appropriate and useful way to begin our consideration of relationships between death and gender.

GENDER DIFFERENCES, DEATH, DYING AND BEREAVEMENT

Writings about death and dying have either generalised about broad trends (e.g. Ariès 1981, Blauner 1966) and recurring experiences (e.g. Glaser and Strauss 1965) or assumed that there are no significant gender differences. Observations that, for example, adult men of working age receive greater attention from hospital staff and are more likely to be told their terminal diagnosis than women, especially old women, were seldom integrated into wider theoretical explanations about gender differences in modern society. In short male deaths set the agenda for discussion and research, albeit in an unaware and unreflective manner. For example, the concern with the supposed fear of death in modern societies (Gorer 1965, Kellehear 1984, Sontag 1979) has been dominated by consideration of cancer, heart disease and latterly AIDS (Sontag 1989). For each of these, the research agendas have been dominated by male concerns. Although cancer affects significant numbers of women it is only in recent years that sustained research focusing on breast and cervical cancers has been apparent, and despite the growing number of women who are victims of heart disease there is still little research into the experiences of women suffering heart attack and heart failure.

A more striking contrast can be found in the discrepancy between the extensive literature about the ‘fearful deaths’ from cancer and AIDS with the relative neglect of miscarriage and stillbirths – fearful and feared deaths which affect many women. It is suggested that in the UK around 7,000 babies a year are born dead or die in the first week after birth (Rajan and Oakley 1993). In our society it appears to be women who bear the brunt of dealing with such ‘tabooed deaths’ both as victims and as carers of the victims. The attitudes of health staff may contribute to the difficulties some parents may experience in handling their sense of guilt, especially as some of the medical explanations for early deaths may reinforce individualistic explanations and victimblaming tendencies (Lovell 1983 and in this volume).

Reactions to such early deaths are rooted in the ways in which societies value different categories of people. In pre-industrial societies there were high rates of death at the start of life, and such life was not highly valued. Entry to the social world was marked by survival until a ceremony of naming (e.g. baptism) took place, at which point the infant became socially recognised as a member of the community. Deaths prior to this time were scarcely recognised and infants and stillbirths did not receive full funeral rites (Hertz 1960). In modern society, where it can be presumed that infants will live and there are comparatively few births, early deaths are traumatic and potentially threatening; with most deaths occurring in old age it is now the deaths of the old which are undervalued. However, in modern society the ways in which the experiences of women with deaths at both the start and end of life are ignored and disregarded reflect the lower esteem placed upon women throughout the life course and in most areas of social life. The grief of women whose children have died either in utero or around the time of birth is made illegitimate through bureaucratic and ritual procedures which deny the social identity and meaning of the dead child or of ‘failed’ mothers.

The neglect of gender as an important substantive or explanatory category in the literature about modern death, dying and bereavement is similar to the general neglect of gender within academic circles prior to the 1960s. Second-wave feminism introduced the concept of gender into academic agendas. It highlighted and problematised gender issues, and particularly the subordinate social position of women, as reflected in research and writing within a whole range of academic disciplines. On the academic front feminism was a movement which called for more than just the inclusion of women in the academic community and in research studies. The political struggles of the late 1960s engendered not only activism oriented towards cultural and social change but also intellectual debate aimed at transforming the theoretical (masculinist) perspectives underpinning many academic disciplines. Thus the activists of the late 1960s fought around issues which, by the late 1970s, were being addressed by sociologists and a range of other social theorists and which demanded a reconceptualisation of the nature of knowledge itself. Core areas of attention were the documentation of genderbased social inequalities; the development of theories to explain women’s subordination (focusing on aspects of society such as capitalism, patriarchy, the family, language, and women’s ‘natural’ reproductive roles); the problematising of academic knowledge which rendered invisible the interests and experiences of women; and debates about the nature of gender itself.

Oakley (1972) defined gender as the social elaboration of biological sex differences. Thus sex referred to bodily difference and gender referred to social difference. This distinction underpinned research within anthropology and sociology which undermined naturalist arguments about women’s place within society, and indeed gave such work its political edge. For example, naturalist arguments saw women’s social position as wives and mothers and their ‘nurturant’ and emotionally expressive behaviour as based upon their distinctive biological capacity to bear children and to lactate. Once gender came to be clearly conceptualised as socially constructed rather than ‘naturally’ or ‘biologically given’, it was amenable to social change. Later theorists have problematised the straightforward distinction between the endowments of ‘nature’ and the constructions of ‘society’ (Grosz 1994). Instead, they argued, the body itself and the differences between women’s and men’s bodies, are ‘mapped’ and known through culturally specific gendered knowledges. This is a deeper critique of the accepted sexual order which claims that differences between ‘men’ and ‘women’ are produced within discourse, within the flow of daily thought and practice. An individual’s gender is no mere cultural overlay which encompasses innate sexual differences; instead it is constituted through unfolding performances of femininity and masculinity which are predicated upon everyday taken-for-granted naturalist assumptions about the individual’s ‘sex’. Such assumptions, however, are profoundly cultural. Thus, the ways in which the body itself is perceived and experienced are gendered (Butler 1993). This includes, of course, the dying body.

One manifestation of gender differentiation within death, dying and bereavement concerns the area of care. Walter (1993) points out that the medicalisation of death in the eighteenth century saw a ‘de-feminisation’ of what had previously been an area of female control – the dying and dead body. In subordinate roles of informal carers and nurses, women nonetheless continued to undertake the more menial tasks of care. For example, the care of the dead body, which had come to be seen as distasteful by the end of the nineteenth century, constituted the one area of work remaining to the ‘handywomen’ who had acted as both layers-out and midwives in Coventry up until the 1920s (Adams 1993). Nurses (predominantly female) are the main group performing such bodily care in modern society although funeral directors (predominantly male) may also be involved. Women have continued to meet the need for care in more mundane ways both as unpaid ‘lay’ carers of the chronically ill and dying (Ungerson 1987) and as the main ‘front-line’ carers in the health service. In both roles the practical and emotional labour of women is central to the care of dying people, although the latter may be undervalued and overlooked.

Women are also central to the process of making sense of death. Cline (1995) argues that ‘lifting the taboo’ on death, dying and bereavement is something which women in particular can and should achieve. Indeed she argues that women rather than men suffer as a result of the ‘taboo’ in that they are charged with the tasks of nurturing and nursing, both of which make them vulnerable to suffering. In this volume Neil Thompson maintains that the grieving of males is hindered by negative views of masculine responses such as anger, and argues for a more flexible expression of emotion. Gordon Riches and Pam Dawson in their chapter challenge the conventional wisdom about gendered responses to grief in their examination of the ways fathers and mothers try to make sense of the death of their child.

Within the literature on death women have often represented the unacknowledged empirical basis of theorisation. The most obvious example of this is in the area of grief and bereavement where married women’s grief following the death of a husband has been extensively documented. While women’s grief has constituted core interview data, the gendered nature of this material becomes invisible when used as a basis for theorisation. The influential work of Parkes (1972) and Bowlby (1981) drew on studies of widows in order to develop models of bereavement which were then used to frame bereavement as a universal rather than culturally variable experience. It is plausible to argue that, as a result, while positing a general model which is equally applicable to men and women, their theories simply reflect the experiences of married women. For example, the notion that bereavement can be seen as a loss of the self most closely corresponds to the experiences of widows whose self-identity derived from the man they married, whose name they took, whose domestic life they serviced and upon whose income they depended.

More recently the deaths of women have come to attract considerable attention, as Bronfen (1992) and Pickering, Littlewood and Walter (this volume) indicate. Here again, however, they are highlighted according to their positioning within a patriarchal society. I...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Illustrations
• Notes on contributors
• Introduction
• Chapter 1
• Chapter 2
• Chapter 3
• Chapter 4
• Chapter 5
• Chapter 6
• Chapter 7
• Chapter 8
• Chapter 9
• Chapter 10
• Chapter 11