‘Everyone assumes a man to be quite strong’: Men, masculinity and rheumatoid arthritis: A case‐study approach

Abstract

Current literature has overlooked the impact of chronic illness on masculine identity. We therefore aimed to investigate the impact of rheumatoid arthritis (a long term condition, affecting more women than men) on masculine identity. Six focus groups with 22 men with rheumatoid arthritis (RA) (data reported elsewhere) followed by five one‐to‐one interviews with men (English, mean age: 59 years) sampled to reflect a heterogeneous experience of life with RA based on knowledge gained from the focus groups. Transcripts were analysed using thematic analysis and are presented as individual case studies. Whilst the case studies provide five distinct experiences, common themes can be drawn across them, such as the importance of paid work. The men needed to renegotiate their masculine identity to deal with their RA. Two dealt with this by pushing through pain to retain masculine activities, two replaced masculine roles they could no longer do with other roles, and one rejected masculinity completely. Men with long term conditions may need to re‐write their masculinity scripts to enable them to accept and adapt to their condition. However, some men struggle with this, which should be taken into consideration when designing self‐management services for men with long term conditions.

“I can’t have it; I am a man. A young man!” – men, fibromyalgia and masculinity in a Nordic context

“…The onset and development of chronic widespread pain can be a threatening experience to one's gender identity. Research shows that gender has a significant impact on health behaviour such as help seeking or on expression of physical symptoms (Boerner et al, 2018;Ek, 2013;Flurey et al, 2017;O'Brien, Hart, & Hunt, 2007;O'Brien, Hunt, & Hart, 2005;O'Loughlin et al, 2011). Concerning chronic pain, research shows that men tend to adopt a "wait and see" approach more often than women, especially if the symptoms are perceived as minor and not life threatening (Keogh, 2015;Paulson, Danielsson, & Söderberg, 2002;Paulson, Norberg, & Danielson, 2002).…”

“…However, the constitution of masculinity through bodily performances, such as sports or manual labour, means that gender is vulnerable if the performance cannot be sustained due to illness or physical disability (Connell & Messerschmidt, 2005). For example, Flurey et al (2017) noticed that men with rheumatoid arthritis renegotiated their masculinity in different ways and had to re-write their masculinity scripts to enable them to accept and adapt to their condition. Some of them seemed to push through the pain to retain their masculine activities (such as sports), whereas some others replaced them with other activities (Flurey et al, 2017).…”

“…For example, Flurey et al (2017) noticed that men with rheumatoid arthritis renegotiated their masculinity in different ways and had to re-write their masculinity scripts to enable them to accept and adapt to their condition. Some of them seemed to push through the pain to retain their masculine activities (such as sports), whereas some others replaced them with other activities (Flurey et al, 2017). O'Brien et al (2007) remarked that many studies exploring the relation between masculinity and chronic illnesses, have examined experiences of men with gender-specific diseases such as prostate cancer, or diseases that are more common in male than in female population (e.g., coronary heart disease).…”

Coping Strategies, Psychological Impact, and Support Preferences of Men With Rheumatoid Arthritis: A Multicenter Survey

“…Very little research has focused solely on men, and there is no consensus on whether gender affects a person's ability to cope with RA. Qualitative research has begun to address the experiences and coping styles of men with RA and its impact on their masculine identity (6)(7)(8)(9), suggesting a need to renegotiate masculine identity and rewrite scripts on masculinity (10) to adapt to life with RA.…”

“…The second questionnaire concerned patient preferences for self-management support, including mode of delivery and practical issues (e.g., time of day). Options for self-management support came from previous qualitative work (8,9) and a systematic review of effectiveness and acceptability of self-management support for men with long-term conditions (16,17). To assess whether men and women have different preferences for support, the questionnaire for female participants contained the sections on demographic and clinical information, and self-management support preferences.…”