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Masculinity, meditation, and mental health

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Abstract

There is a prominent discourse in academic literature, and society at large, that presents men as ‘damaged and damage doing’ (Mac an Ghaill and Haywood, 2012: 483). Incorporated within this idea is the notion that ‘masculinity’ itself is problematic and represents a ‘risk factor’ for health (Gough, 2006). For example, traditional masculine norms, like ‘toughness,’ have been linked to poor emotional management skills in men, which in turn are implicated in mental health problems (Aldao et al., 2010). However, it is increasingly acknowledged that there is diversity within and across men and masculinities, and that men are capable of positively managing their well-being, although little research exists exploring how they do so. To address this deficit, this study sought to find men – meditators – who were likely to have found ways to positively manage well-being to examine factors relating to this engagement. Meditation was selected as it is associated with positive outcomes on a range of mental health indicators (Mars and Abbey, 2010). Thirty male meditators, mainly from one organisation in London, were selected using principles of maximum variation sampling. The study employed a longitudinal mixed methods design, including in-depth narrative interviews analysed using a modified constant comparison approach (Strauss and Corbin, 1998), and also a cognitive-neuroscience component, involving EEG measurement across a battery of cognitive tasks and a meditation sitting. All participants were interviewed and tested twice, a year apart, between 2009 and 2010. Drawing on various theories, including Connell's (1995) notion of hegemonic (i.e. dominant) masculinity, and Mayer and Salovey's (1997) model of emotional intelligence, the analysis explored themes relating to men’s involvement with meditation, including how engagement came about, and its impact upon well-being. The findings suggested that men negotiated difficult journeys towards meditation: for example, they came up against traditional and other hegemonic forms of masculinity, and most described subsequent strategies to be emotionally tough and/or disconnect from difficult emotions. Meditation itself was linked to well-being in various ways, notably through the cultivation of emotional intelligence via the development of attention – this was indicated by emergent themes in the qualitative analysis, and results from the cognitive neuroscience component. Overall, the analysis was unusual in exploring masculinities and meditation, as well as the wider social context of practice, and how the social dimensions of meditation also impacted upon well-being. For example, many men meditated within a ‘community of practice’ (Lave and Wenger, 1991), which influenced their behaviour, e.g. reducing alcohol use. The findings also highlighted various problems linked to meditation that have received less attention in the literature, including mental health disorders, and ostracism from peers. In summary, the study discusses implications for helping men to better manage their well-being.
JOURNEYS TOWARDS WELL-BEING:
MEN, MEDITATION AND MENTAL HEALTH
TIM LOMAS
A thesis submitted in partial fulfilment of the
requirements of the University of Westminster
for the degree of Doctor of Philosophy
April 2012
i
ABSTRACT
There is a prominent discourse in academic literature, and society at large, that presents men
as ‘damaged and damage doing’ (Mac an Ghaill and Haywood, 2012: 483). Incorporated within
this idea is the notion that ‘masculinity’ itself is problematic and represents a ‘risk factor’ for
health (Gough, 2006). For example, traditional masculine norms, like ‘toughness,’ have been
linked to poor emotional management skills in men, which in turn are implicated in mental
health problems (Aldao et al., 2010). However, it is increasingly acknowledged that there is
diversity within and across men and masculinities, and that men are capable of positively
managing their well-being, although little research exists exploring how they do so.
To address this deficit, this study sought to find men meditators who were likely to have
found ways to positively manage well-being to examine factors relating to this engagement.
Meditation was selected as it is associated with positive outcomes on a range of mental health
indicators (Mars and Abbey, 2010). Thirty male meditators, mainly from one organisation in
London, were selected using principles of maximum variation sampling. The study employed
a longitudinal mixed methods design, including in-depth narrative interviews analysed using a
modified constant comparison approach (Strauss and Corbin, 1998), and also a cognitive-
neuroscience component, involving EEG measurement across a battery of cognitive tasks and
a meditation sitting. All participants were interviewed and tested twice,
1
a year apart, between
2009 and 2010.
Drawing on various theories, including Connell's (1995) notion of hegemonic (i.e. dominant)
masculinity, and Mayer and Salovey's (1997) model of emotional intelligence, the analysis
explored themes relating to men’s involvement with meditation, including how engagement
came about, and its impact upon well-being.
2
The findings suggested that men negotiated
difficult journeys towards meditation: for example, they came up against traditional and other
hegemonic forms of masculinity, and most described subsequent strategies to be emotionally
1
One participant did not complete the cognitive neuroscience component.
2
Pollard and Davidson (2001: 10) define well-being as ‘a state of successful performance across the
life course integrating physical, cognitive and social-emotional function.’ However, well-being is a
contested concept, used in diverse ways according to different theoretical frameworks (De Chavez et
al., 2005). The range of meanings attached to the concept is discussed in the theoretical review.
ii
tough and/or disconnect from difficult emotions. Meditation itself was linked to well-being in
various ways, notably through the cultivation of emotional intelligence via the development of
attention this was indicated by emergent themes in the qualitative analysis, and results from
the cognitive neuroscience component.
Overall, the analysis was unusual in exploring masculinities and meditation, as well as the
wider social context of practice, and how the social dimensions of meditation also impacted
upon well-being. For example, many men meditated within a ‘community of practice’ (Lave
and Wenger, 1991), which influenced their behaviour, e.g. reducing alcohol use. The findings
also highlighted various problems linked to meditation that have received less attention in the
literature, including mental health disorders, and ostracism from peers. In summary, the study
discusses implications for helping men to better manage their well-being.
iii
TABLE OF CONTENTS
Chapter Page
Abstract i
Table of contents iii
List of tables x
List of figures xi
Dissemination of findings xii
Acknowledgements xiii
Author’s declaration xiv
1. INTRODUCTION 1
1.1. Background 1
1.2. Outline of the study 4
1.3 Reflexivity and the researcher 7
2. THEORETICAL REVIEW 11
2.1. Overarching theoretical perspective 11
2.1.1. Social constructionism 11
2.1.2. Narrative 14
2.2. Masculinity 15
2.2.1. Conventional approaches 15
2.2.2. Social constructionist approaches 19
2.3. Well-being 24
2.3.1. Biological approaches 25
2.3.2. Psychological approaches 25
2.3.3. Social approaches 28
2.3.4. Critical approaches 30
2.4. Masculinity and mental health 31
2.4.1. Disorder, distress and coping 31
2.4.2. Masculinity, disorder and distress 35
iv
2.5. Positioning the current study 40
2.6. Summary 41
3. EMPIRICAL REVIEW 42
3.1. Resisting or redefining hegemonic masculinity 42
3.2. What is meditation? 46
3.3. Developing attention 50
3.3.1. Cognitive aspects 50
3.3.2. Neurophysiological aspects 52
3.4. Meditation and mental health 56
3.5. Religious participation and well-being 65
3.5.1. Meditation/Buddhism as a form of religious participation 65
3.5.2. Religion/spirituality and well-being 69
3.6. Summary 72
4. METHODS 74
4.1. Issues around mixed methods 74
4.1.1. Justifying mixed methods 74
4.1.2. A sensitising device: The Integral Framework 76
4.1.3. Different perspectives: A multidimensional approach 79
4.1.4. Epistemology: Critical realism 80
4.2. Participant selection and recruitment 82
4.2.1. Number of participants 82
4.2.2. Sampling 82
4.2.3 The London Buddhist Centre 85
4.2.4 Recruitment 88
4.2.5 Longitudinal participation 89
4.2.6 Ethical issues 90
4.3. Data collection 92
4.3.1. The interview 92
4.3.2. The experimental session 94
4.4. Data analysis 99
v
4.4.1. Qualitative data analysis 99
4.4.2. Quantitative data analysis 106
5. QUALITATIVE ANALYSIS AND RESULTS (1): 109
JOURNEYS TOWARDS MEDITATION
5.1. Before meditation 109
5.1.1. Becoming emotionally tough 109
5.1.2. Distressed subjectivities 113
5.1.3. Ineffectual remedies 116
5.2. Turning to meditation 121
5.2.1. Explorations around meaning 121
5.2.2. Responding to stress 123
5.2.3. Existential questioning 126
5.2.4. Crisis/breakdown 128
5.3. Summary 133
6. QUALITATIVE ANALYSIS AND RESULTS (2): 135
EXPERIENCES OF MEDITATION
6.1. Awareness of internal experience 135
6.1.1. Developing awareness 135
6.1.2. The contents of awareness 137
6.2. The right spirit 139
6.2.1. Acceptance 139
6.2.2. Metta 141
6.3. Working with the mind 143
6.3.1. Objectifying experience 143
6.3.2. Moving attention to the body 145
6.4. Stronger experiences 146
6.4.1. Feelings of well-being 146
6.4.2. ‘Mystical’ experiences 148
6.4.3. More advanced practices 149
6.5. Problems with meditation 152
vi
6.5.1. Adverse effects of strong experiences 152
6.5.2. Meditation as inappropriate 155
6.5.3. Difficulties with practising 157
6.6. Mindfulness out in the world 158
6.6.1. Living mindfully 158
6.6.2. Coping with difficulties 160
6.7. Summary 164
7. QUALITATIVE ANALYSIS AND RESULTS (3): 165
A NEW WAY OF BEING
7.1. A new way of being a man 166
7.1.1. A new world 166
7.1.2. A new path 169
7.1.3. Relating to others 172
7.1.4. Abstinence 175
7.1.5. Spirituality 178
7.2. Conflicts and issues 181
7.2.1. Conflicts 181
7.2.2. Issues 188
7.3. Changing narratives 192
7.3.1. Disruption 193
7.3.2. Relegation 194
7.3.3. Deepening engagement 196
7.3.4. Frustration/disappointment 197
7.3.5. Springboard 199
7.3.6. Existential concerns 200
7.4. Summary 202
8. QUANTITATIVE ANALYSIS AND RESULTS 203
8.1. Participant descriptive statistics 204
8.2. Cognitive analysis 205
8.2.1. Verbal fluency task 205
vii
8.2.2. Reading the Mind in the Eyes Task (RMET) 207
8.2.3. Defined Intensity Stressor Simulation task (DISS) 208
8.2.4. Emotional Stroop 211
8.3. EEG analysis 215
8.3.1. Theta amplitude 215
8.3.2. Theta coherence 219
8.3.3. Alpha amplitude 223
8.3.4. Alpha coherence 227
8.4. Discussion of quantitative analysis and results 231
8.4.1. Cognitive findings 232
8.4.2. EEG findings 235
8.4.3. Limitations 238
8.4.4. Summary 241
9 DISCUSSION 242
9.1. Overview 242
9.2. The struggle towards constructive engagement with well-being 244
9.2.1. Difficulties managing emotions 245
9.2.2. Internal conflict 246
9.2.3. Concealing distress, and alternative coping strategies 247
9.2.4. Turning to meditation 248
9.3. Working with the mind: Managing emotions through meditation 250
9.3.1. Attention 250
9.3.2. Emotional intelligence 251
9.3.3. Well-being 252
9.4. Problems with meditation 254
9.4.1. Mental health issues 255
9.4.2. Difficulties in meditation 256
9.4.3. Practical and motivational issues 257
9.5. Communities of Practice (CoP)/positive hegemonic masculinity 258
9.5.1. Communities of practice 259
9.5.2. Positive hegemonic masculinity 260
9.5.3. Connecting with others 261
viii
9.5.4. Working towards abstinence 262
9.5.5. A sense of spirituality 264
9.6. Trouble with communities of practice, and with taking on new
ways of being 266
9.6.1. Problems within CoP 267
9.6.2. External issues: Negotiating multiple contexts 270
9.7. Critical reflections on the thesis 271
9.7.1. Sampling issues 272
9.7.2. The interview process 273
9.7.3. Data analysis 276
9.8. Implications and recommendations 279
9.9. Conclusion 283
APPENDICES 261
Appendix A: Ethics approval 285
Appendix B: Information sheet for volunteers 286
Appendix C: Informed consent form 289
Appendix D: Demographic questionnaire 291
Appendix E: Interview schedule 293
Appendix F: EEG technical specification 296
Appendix G: Test schedule 297
Appendix H: Neutral stroop test card 300
Appendix I: Negative stroop test card 301
Appendix J: Positive stroop test card 302
Appendix K: RMET sample card 303
Appendix L: National Adult Reading Test (NART) 304
Appendix M: NART conversion table 305
Appendix N: Coding framework 306
Appendix O: Treatment of Rapid Visual Information Processing (RVIP)
task data 308
Appendix P: Discarded RVIP results 309
Appendix Q: EEG differential hemispheric activation 311
Appendix R: EEG change within meditation 313
ix
REFERENCES 316
GLOSSARY 375
x
LIST OF TABLES
Table Page
1 Socio-demographic characteristics of the sample of men 84
2 Meditation experience of the sample of men 84
3 Demographic descriptive statistics 204
4 FAS letter composite scores 205
5 Category scores 206
6 RMET scores 207
7 DISS scores (overall) 208
8 DISS scores (responsiveness 209
9 DISS scores (accuracy) 210
10 Time 1 (T1) Stroop times 211
11 Time 2 (T2) Stroop times 212
12 Stroop negative differential 213
13 Stroop positive differential 214
14 Theta amplitude 215
15 Theta coherence 219
16 Alpha amplitude 223
17 Alpha coherence 227
18 Coding framework 306
19 RVIP scores 309
20 RVIP scores (one-minute segments) 310
21 Hemispheric amplitude (descriptive statistics) 311
22 Hemispheric amplitude (ANOVA results) 311
23 Hemispheric amplitude (paired T-tests) 312
xi
LIST OF FIGURES
Figure Page
1 Schematic diagram of the four quadrants 77
2 Screen-print of the tasks in the DISS task 96
3 FAS letter composite scores 205
4 Category scores 206
5 RMET scores 207
6 DISS scores (overall) 208
7 DISS scores (responsiveness) 209
8 DISS scores (accuracy) 210
9 T1 Stroop times 211
10 T2 Stroop times 212
11 Stroop negative differential 213
12 Stroop positive differential 214
13 Theta amplitude (meditation vs. baseline) 216
14 Theta amplitude (meditation vs. RVIP) 217
15 Theta amplitude (meditation vs. DISS) 218
16 Theta coherence (meditation vs. baseline) 220
17 Theta coherence (meditation vs. RVIP) 221
18 Theta coherence (meditation vs. DISS) 222
19 Alpha amplitude (meditation vs. baseline) 224
20 Alpha amplitude (meditation vs. RVIP) 225
21 Alpha amplitude (meditation vs. DISS) 226
22 Alpha coherence (meditation vs. baseline) 228
23 Alpha coherence (meditation vs. RVIP) 229
24 Alpha coherence (meditation vs. DISS) 230
25 Schematic diagram of the 10-20 system of electrode placement 297
26 RVIP scores 309
27 RVIP scores (one-minute segments) 310
xii
DISSEMINATION OF FINDINGS
Journal publications
Lomas T, Cartwright T, Edginton T and Ridge D (2012) ‘I was so done in that I just
recognised it very clearly, “You need to do something.”’ Health, Epub ahead of print
5 July 2012, DOI: 10.1177/1363459312451178.
Lomas T, Edginton T, Cartwright T and Ridge D (2013) Complex constructions of
emotional intelligence and masculinity through meditation: A mixed methods enquiry.
Forthcoming.
Conference presentations
Lomas T, Cartwright T, Edginton T and Ridge D (2011) Men behaving well?:
Journeys towards constructive engagement with well-being through meditation. In:
BSA Medical Sociology 2011 Annual Conference, Chester, UK, September 2011.
Lomas T, Cartwright T, Edginton T and Ridge D (2011) Men behaving well?:
Journeys towards constructive engagement with well-being through meditation. In:
7th Biennial Conference of the International Society of Critical Health Psychology
(ISCHP), Adelaide, Australia, April 2011.
Conference posters
Lomas T, Cartwright T, Edginton T and Ridge D (2010) Men behaving well?:
Journeys towards constructive engagement with well-being through meditation. In:
24th European Health Psychology Conference, Translyvania, Romania, September
2010.
Lomas T, Cartwright T, Edginton T and Ridge D (2010). Men behaving well?:
Journeys towards constructive engagement with well-being through meditation. In:
Seminar Day on Men’s Health Behaviour, Sussex, UK, June 2010.
xiii
ACKNOWLEDGEMENTS
To my wife Kate, love of my life, best friend and soul mate. Thankyou for taking care of me
through this, for supporting and believing in me, for tolerating my crazy hours, for putting up
with your nemesis and its constant clicking (my laptop), for keeping me well-fed with lovely
food, and for just making me the happiest I have ever been. You are just the most incredible,
caring, beautiful, and wonderful person, and I feel so exceptionally lucky to have found you.
To mum and dad, thankyou for everything, for being the best parents anyone could ask for, for
guiding and encouraging me, supporting and loving me, and for putting up with my messy
books. To Peter and Lauren, thankyou for being the most amazing brother and sister, for all the
love and support through all this, for all the good times that have made the work easier to bear,
and just for being there for me. I love you all more than I can possibly express.
To Damien, Tina and Trudi, I honestly could not have asked for better supervisors, thankyou
so much for all your help and support, your patience (with my made-up words and spidery
sentences hopefully I have learnt the errors of my ways!), and for taking a chance on me in
the first place. Thankyou to the University of Westminster for the opportunity to undertake this
PhD, and all the support throughout. To Ken Wilber and Robert M. Pirsig, thankyou for
inspiring me through your work. A huge thankyou to my participants, who shared their lives
and their stories with such open-hearted generosity. It was an honour to have met you all, and
I hope you feel I have done justice to your incredible lives. Finally, thankyou to the reader for
taking your time to read what has been my life for the past few years. I hope you find it
interesting!
xiv
AUTHOR’S DECLARATION
I declare that all the information contained in this thesis is my own work.
1
CHAPTER 1
INTRODUCTION
1.1. Background
In recent times, men have become a problem. That is, in academic literature, and society at
large, men are seen as damaged and damage doing (Mac an Ghaill and Haywood, 2012: 483).
In terms of physical health, the current life expectancy of men is 4.2 years lower than women
(Office for National Statistics [ONS], 2010), and men have higher mortality and morbidity
rates on a range of heath indices (Courtenay, 2000a). Although it is suggested that men have
greater biological susceptibility to some health problems (Jones, 2005), many argue that such
health differentials are due to men enacting masculinity. For instance, men are more likely to
engage in risk-taking behaviour, like dangerous driving (Doherty et al., 1998) or alcohol abuse
(De Visser and Smith, 2007). Risk-taking accounts for much of the so-called ‘male mortality
excess’ (e.g. among 1529 year-olds, male deaths outweigh female ones by 2.6 to 1) (Phillips,
2006: 43). Masculinity is also linked to mortality/morbidity through poorer health behaviours,
e.g. reluctance to use health services (Pinkhasov et al., 2009). Masculinity is thus widely
viewed as a ‘risk factor’ and ‘bad for your health (Gough, 2006: 2477).
Moreover, masculinity is seen as having a detrimental impact on mental health. On the surface,
the mental health of women appears worse, e.g. women are nearly twice as likely to be
diagnosed with depression (Kessler, 2003). However, there is a concern that men express
distress in specific ways, such as alcohol abuse, where men account for two out of every three
alcohol-related deaths (ONS, 2011b), or suicide, with men over three times more likely to
commit suicide (ONS, 2011c). It is thought that such behaviours may be related to the way
men experience and express distress
1
(Addis, 2008). One suggestion is that women are more
prone to ‘internalise’ distress,, generating symptoms commonly associated with depression,
like low mood or feelings of worthlessness (Peveler et al., 2002). In contrast, men are seen as
1
Distress refers to an unpleasant emotional state (Gadalla, 2009). In contrast to identified disorders,
distress is more general in its definition and measurement, involving psychophysical and behavioural
symptoms not specific to a given disorder, including anxious and depressive reactions (Marchand et al.,
2005).
2
more likely to ‘externalise’ it, through risk-taking, substance use, self-isolation, over-work,
anger and suicide (Pollack, 1998).
Moreover, such ‘externalisation’ has been linked to the way socialisation pressures encourage
certain ‘emotional stylesin men (Addis, 2008). In particular, traditional masculine norms
around emotional toughness are implicated in tendencies among men to take on an affective
style referred to as ‘restrictive emotionality,’ i.e. denial, suppression or disconnection from
emotions (Nolen-Hoeksema, 1991). It is argued that restrictive emotionality can lead to poor
emotional management skills, which mean people are more likely to have difficulties dealing
constructively with negative emotions (Addis, 2008). Poor emotional management skills are
thought to be a transdiagnostic factor underlying distress and other mental disorders (Aldao et
al., 2010). In this way, traditional masculine norms are implicated in mental health problems
in men.
The observations above, together with other trends which reflect poorly on males such as the
relatively poor educational performance of boys, outperformed by girls at all ages from five
upwards (EHRC, 2010) have led to the notion of a ‘crisis’ of masculinity, i.e. the widespread
popular and academic agreement that something is troubling men (McDowell, 2000: 201).
However, this discourse of a ‘crisis’ has been criticised by scholars, who have questioned its
simplistic construction of men in negative, homogenous terms (Gough, 2006). For instance,
more recent theories of gender suggest that men are diverse (Connell, 1995), and that some
men can act in ways more conducive to well-being (O'Brien et al., 2005). For example, in terms
of mental health, some men are able to respond to depression in relatively constructive ways,
e.g. seeking help (Chuick et al., 2009).
However, despite these positive findings, men have long been overlooked and undertheorised
in mental health research, and little research exists examining specifically how some men are
able to negotiate their well-being more successfully (Riska, 2009). There is need for greater
understanding of men’s experiences of mental health (Ridge et al., 2011), particularly around
the heterogeneity of men’s approaches to managing well-being (Addis, 2008). In the light of
promising studies suggesting some men can cope adaptively with difficult emotions, more
research is needed to explore how men do so (Chuik et al., 2009). Moreover, research into
men’s engagement with mental health is often limited to depression, with assessment of their
engagement usually limited to help-seeking. There is no research examining men’s strategies
3
for engaging positively with mental health and broader well-being. Thus, the current study
explores the possibility that practicing meditation may be one such strategy.
There are good empirical and theoretical reasons to support the contention that meditation is a
means of positive engagement with well-being. Meditation is linked to positive outcomes on a
wide range of mental health indicators, including depression and distress (Mars and Abbey,
2010). It is possible that meditation may be particularly helpful in terms of enabling men to
cope with distress, given their tendencies towards ‘restrictive’ emotional styles. As a method
of attention development, meditation is thought to promote emotional awareness, and to help
ameliorate patterns of restrictive emotionality linked to distress and disorders (Bishop et al.,
2004). However, this possibility is as yet untested in men: only a few studies have explored the
intersection of meditation and masculinity (and only in passing); none have specifically
examined the impact of meditation on men’s well-being. The present study aims to further our
understanding in this area.
In addition, from a wider psychosocial perspective, meditation may also engender well-being
in other ways. The kind of social support provided by a community of meditators has been
linked to mental health, where it offers a ‘buffer’ against stress, leading to lower depression
and anxiety (McCullough and Larson, 1999). It is suggested that men often have smaller
support networks than women, which can be detrimental to well-being (Courtenay, 2000a).
However, most previous research on meditation has been from a narrow psychological or
physiological perspective, with less attention on its structural and social dimensions (Dobkin
and Zhao 2011). The current study is thus also unusual in exploring the social context of
practice, and how this might impact upon well-being.
In addition to being the first study to explore meditation in relation to masculinity and men’s
well-being, this study is unique in examining these issues using a mixed methods approach.
This answers calls in the literature for interdisciplinary collaboration to ‘investigate men’s
health using both qualitative and quantitative research methods (Smith et al., 2006: 81). In
qualitative terms, men’s experiences of meditation and well-being were explored by eliciting
narratives, analysed using a modified constant comparison approach. This approach enabled
analysis of not only meditation, but wider psychosocial factors, and how men’s engagement
unfolded over time. This qualitative investigation was augmented by quantitative cognitive
neuroscience analysis. One way meditation is thought to impact upon well-being is through
4
attention development, which then enhances emotional management capacities (Bishop et al.,
2004). The impact of meditation on cognitive and neurophysiological measures of attention
was thus explored here. Examining how the different methodological approaches interacted
was also a point of interest.
1.2. Outline of the study
Following this introduction, the dissertation unfolds over eight chapters. Chapter 2 outlines the
theoretical background to the study. First, it explains that issues around masculinity and well-
being will be explored from a social constructionist perspective, mainly through analysis of
narratives. The second part discusses theories of gender, including social constructionist
models particularly Connell’s (1995) theory of masculinities which argue that different
enactments of masculinity are possible. The third part considers different aspects of well-being,
before focusing on mental health. The last part looks at frameworks outlined by Addis (2008)
which connect traditional masculinity to mental health issues, suggesting that norms around
toughness can mean men have difficulty managing emotions. However, the chapter argues that
the implications of Connell’s theory have not yet been brought to bear on these frameworks,
and that some men may be able to engage constructively with mental health.
Chapter 3 is the empirical review. It begins by examining research suggesting that some men
engage with mental health in more constructive ways, but argues that more research is needed
to explore men’s strategies for positively managing well-being. The chapter then introduces
meditation, focusing on attention development as its key feature, with particular reference to
the cognitive neuroscience literature. The following part explores how attention development
is connected to well-being through the idea of emotional intelligence (EI, Mayer and Salovey,
1997). The chapter also discusses sociological literature which views meditation as a form of
religious participation, and suggests that such participation could also facilitate well-being.
Chapter 4 sets out the methodological details of the study. It first examines issues relating to
mixed methods, including: justifying this approach; introducing the ‘Integral Framework’ as a
sensitising device (Wilber, 2006) and the ‘multi-dimensional’ model as an analytic guide
(Mason, 2006); and expressing a preference for an epistemological stance of critical realism
(Layder, 1998). The second part describes participant selection/recruitment using principles of
maximum variation sampling. The third part outlines data gathering procedures, including the
5
interview and the cognitive neuroscience session. The fourth part discusses data analysis,
including analysis of interview data using a modified constant comparison approach (Strauss
and Corbin, 1998), and the treatment of the cognitive neuroscience data.
Chapter 5 the first of three presenting the qualitative results focuses on men’s narratives
leading up to engagement with meditation. Taking a psychosocial approach, used throughout
the analysis, it explores connections between men’s subjectivities and wider social factors. In
keeping with the source data, the chapter retains a sense of narrative, e.g. a temporal structure
(Bell, 2002). It begins with men’s experiences of childhood/youth, and charts their ‘journeys’
towards meditation. It suggests men were influenced by toughness norms, which were linked
to subsequent tendencies to dissociate from negative emotions, and difficulties managing
distress. Coping strategies, including turning to drink/drugs and relationships, are discussed.
Finally, the reasons men eventually turned to meditation are outlined, including exploration of
alternate ways of living, coping with stress, existential questioning, and crisis/breakdown.
Chapter 6 examines men’s narratives around learning meditation. The focus is less on social
themes, and more on men’s subjective experiences. Six key themes are explored. First, men
learned to turn their attention inwards in meditation. Second, this process could be painful, as
men encountered difficult thoughts/feelings they had previously disconnected from; men thus
needed to cultivate attitudes like self-compassion. Third, men acquired skills to work actively
with their inner experiences, e.g. detachment. Fourth, stronger positive effects of meditation
were reported. The fifth theme is a cautionary one, concerning mental health problems linked
to meditation. The final section examines the application of meditation skills in the ‘outside’
world, e.g. staying calm in difficult situations.
Chapter 7 steps back for a wider psychosocial view of men’s practice, exploring how many
men meditated in a social context identified as a Community of Practice (Lave and Wenger,
1991) which promoted ‘positive’ forms of hegemonic masculinity. Men were encouraged to
take on behaviours which were conducive to well-being, including connecting with others,
abstinence, and spirituality. However, the chapter also discusses issues with the community,
including some related to hegemony, e.g. marginalization. Men also had difficulties enacting
new ways of being in the context of the rest of their lives. The chapter ends by focusing on
narratives from the second interview, which offer an ‘update’ on the previous material.
6
Chapter 8 presents the cognitive neuroscience results. It was theorised that meditation may
facilitate well-being by helping men pay attention to their ‘inner world,’ in turn enhancing EI.
This idea was explored by examining cognitive neuroscience measures of attention. Men took
part in a session featuring cognitive tasks assessing attention, and also emotional reactivity and
empathy. EEG recordings were made of men’s brain activity as they completed the tasks, as
well as during meditation, to assess the neurophysiological correlates of these activities. Men
showed longitudinal improvement on the cognitive tasks. Moreover, the EEG analysis
suggested that men had higher attention levels during meditation than during the tasks, as
indicated by elevated alpha and theta activity, which reflects a mental state of attention
(Josipovic, 2010). The chapter ends with a brief discussion of the quantitative results.
Chapter 9, the discussion, concentrates on five key findings. First, it was possible to find men
constructively engaged with their well-being, highlighting the limitations of the homogenized
‘masculinity-as-risk-factor’ discourse. However, journeys towards this engagement featured
struggle and distress, often connected to traditional masculinity, and taking on more helpful
masculinities was a complex and challenging process. Second, men appeared to develop EI
skills through meditation which helped them manage well-being more constructively, which is
an addition to the masculinity literature. Third, tempering the second finding, meditation was
also implicated in various psychological problems, including psychosis; such issues have
received little research attention, particularly in non-clinical samples (Dobkin et al., 2012).
Fourth, the social context of meditation was a Community of Practice’ which promoted a
‘positive’ hegemonic masculinity. This finding augments our understanding of masculinities,
providing support for the argument that hegemonic norms are not necessarily detrimental to
well-being (Golding et al., 2008). This finding also extends our understanding of meditation,
as its social dimensions have rarely been explored (Dobkin and Zhao, 2011). However, fifth,
even ‘positive’ hegemony can be problematic, as the community was still troubled by issues of
power and marginalization. A feeling of conflict also emerged from men trying to enact new
forms of behaviour in other social contexts dominated by traditional hegemonic norms.
Implications are discussed, like the need to encourage emotional engagement in men, but also
the importance of helping men resist restrictive norms which can hinder such engagement.
7
1.3 Reflexivity and the researcher
The starting point of critical elaboration is the consciousness of what one really is...
‘knowing thyself’ as a product of the historical processes to date, which has deposited
in you an infinity of traces, without leaving an inventory... Therefore it is imperative to
compile such an inventory’ (Gramsci, 1971: 4).
Before commencing with the main body of the thesis, it feels appropriate here to offer a brief
introduction to the person who has written the work before you. There is a commitment in
qualitative enquiry to reflexivity: exploring the way the researcher’s own situated perspective
influences the design, implementation and outcomes of the research (Cutcliffe, 2003). Such
reflexivity is discussed in various places in the present study. In chapter 4, I outline my own
ontological and epistemological position with respect to the research. In chapter 9, in a critical
reflection on the thesis, I analyse some of the methodological and theoretical choices I made
in conducting the study which contributed to the findings obtained and the conclusions drawn.
However, reflexivity does not simply involve reflecting on one’s methodological and
theoretical position after the event, but also refers to an ‘immediate, dynamic and continuing
self-awareness’ (Finlay and Gough, 2003: ix). Thus the task here is to turn the reflective gaze
inward upon myself, as a person inextricably bound up with the research, rather than set apart
from it.
As such, in this section, I attempt to offer an outline of who I am as a person my historical,
cultural and social location, my experiences, my connections and relationships, my goals and
wishes, my commitments and values so that the reader might better evaluate this research.
Reflexivity is particularly important, as Schreiber (2001: 60) suggests, when using grounded
theory (upon which the analysis in the present study is based), as the ‘personal background of
the researcher is the filter of salience through which data are sieved.’ That said, I am minded
by Cutcliffe's (2003) caution against excessive reflexivity, which can potentially carry the
danger of epistemological narcissism, where researchers are more concerned with accounting
for themselves than their data. Thus, rather than ‘write myself’ into this thesis throughout its
presentation, I will limit the focus upon myself to the current section, which offers a brief
reflective biographical account.
8
I grew up in a very loving family in West London. It was a secure middle-class upbringing,
though my parents, teachers in further education, still continue to identify with their working
class backgrounds. I attended a local comprehensive high school, whose intake was ethnically
diverse, with a high proportion of students from disadvantaged backgrounds. While there was
significant peer pressure not to study, or exceed academically in the school, I loved reading,
and my parents were always very encouraging and attentive to my education. The house was
full of books, and we would often talk about all kinds of interesting ideas, around philosophy,
politics, literature. I was drawn towards Psychology, which I took at A level, and fell in love
with the subject. At the same time, I encountered Robert M. Pirsig’s (1974) classic Zen and the
Art of Motorcycle Maintenance. I was thrilled, confused, and intrigued by it, and read it
repeatedly. Through this book, and through conversations with my parents, I became drawn to
Buddhism and Eastern philosophy.
My interest in Buddhism grew when I had the chance to spend six months teaching English in
China at 19 (though I didn’t choose China because of its Buddhist links my mum suggested
it because she wanted an excuse to visit it!). While there, I didn’t do much reading, strangely
enough, but travelled extensively, particularly to ‘sacred’ places, like ‘Holy Mountains’ in the
North, adorned with Buddhist scriptures on rocks, and Taoist monasteries in the cities. The
next summer, after my first year of university, I spent time in Tibet. In Lhasa I visited the
former palace of the Dalai Lama and other monasteries. In the Himalayan foothills I camped
in the mountains where a monastery was holding its summer festival, and met the young holy
Karmapa a few months before his escape to India (TIME, 2000). Such experiences and places
were strange and otherworldly, and it was a heady, memorable, influential time. At university
I studied psychology, but was more drawn to reading philosophy and religion. I made some
(unsuccessful) attempts to meditate, and read all the books on Eastern philosophy I could lay
my hands on (and vaguely understand!).
After university I began working in mental health (while trying with limited success to forge a
music career!). I spent five years as a nursing assistant on various psychiatric wards, most often
on a neurobehavioural unit with patients with acquired brain injuries. While the work was
challenging and distressing especially having to restrain violent patients, or guard those on
suicide observations I found it meaningful. I appreciated dwelling on ideas I was reading
about (such as Buddhist ideas around suffering and compassion) in the hospital environment,
and trying to make them real by exploring them in a practical sense. In caring for patients, my
9
actions had some purpose, and in an odd way, despite the unsettling environment and difficult
duties I had to perform, I felt a level of peace there. At this time I also volunteered for the
Samaritans, and felt the same mix of complex feelings. I then resolved that I wanted to work
in mental health, and eventually train as a psychotherapist.
Coincidently, I was formulating my own proposals for a PhD relating to mental health and
meditation when I saw a scholarship offered by the University of Westminster in just this area.
I applied and was fortunately accepted. The PhD has been a real journey in itself, a hard road
both personally, involving tough but necessary changes in personal circumstances and
relationships, and academically, with considerable strain required to sustain one’s motivation
over a four year period and bring the project to fruition. At the same time though, it has been a
wonderful exploration of people and ideas. Through undertaking this study, my interest in
meditation/Buddhism has further deepened and yet also seasoned. While I remain drawn to
intellectual appreciation of these topics, my own practice has been inconsistent (against the
advice on most meditation books, which urge one not to read about it, but just to practise!). In
the past, I attributed my inability to construct a regular practice as due to an itinerant lifestyle,
irregular schedules, and lack of interaction with other meditators. In conducting the PhD, in
addition to intellectual exploration of meditation from a critical academic perspective, I had
hoped that immersing myself in the subject might help me to build up and sustain a personal
engagement with meditation. However, this has not proved to be the case.
Through the PhD, I involved myself with a particular meditation centre, the London Buddhist
Centre (LBC; see chapter 4). Although the primary initial purpose of this involvement was to
facilitate recruitment, it had a secondary function of allowing me to be a participant-observer.
That is, like other scholars studying meditation and/or Buddhist centres (e.g. Obadia, 2008), I
participated in meditation-related activities of my interviewees. This participation had a dual
function: scholarly, and personal. In scholarly terms, there are advantages, in terms of insight
and understanding, from trying to conduct research from an emic and etic perspective, or as
Kanuha (2000: 443) put it, exploring the ambiguous space at ‘the hyphen of insider-outsider.
That is, while keeping a critical reflexive distance, greater analytic understanding may be
facilitated by also trying to step inside the participants’ world to some extent. For example, by
joining in activities, such as rituals, I felt I gained a greater degree of appreciation of the
meaning and psychosocial dynamics of such occasions than had I just heard descriptions of
10
these second hand. Supervision was important for me here to be able to place one foot in the
‘whirlpool’ of a meditation centre, while keeping the other foot in academia.
The second purpose for such participation was more personal I had hoped it would help me
deepen my own meditation practice in the sustainable way that hitherto eluded me. Through
engagement with the centre, I joined in meditation sessions, retreats and rituals, and enjoyed
some memorable and fulfilling experiences. However, mid-way through the PhD, my living
circumstances altered and I left London. Though there are meditation groups in my new city
of residence, I have not explored them, nor kept up a diligent practice at home. I find myself in
the odd position of believing that I should meditate, yet being curiously reluctant to take steps
that I know would help me do so. In justifying my ambivalence to myself, I find myself
rehearsing arguments participants made regarding their own faltering practices (see chapters 6
and 7) that I am too busy, that circumstances are not right.
However, the truth is I do not know why I am reluctant to undertake an activity that I profess
to be interested in. Perhaps here we come to the limits of reflexivity. Cutcliffe (2003) argues
that although the methodological ideal of reflexivity is founded upon the Socratic injunction to
‘know thyself,’ this is always difficult: from the perspective of post-structuralist identity
theory, the self is a fleeting, multiple, fragmented phenomenon, with no singular, coherent ‘I’
to be known; from a psychoanalytic viewpoint, part of the self always remains hidden and
elusive, even to myself, exercising influence from behind a shadowy veil at the limits of my
conscious awareness. Thus, it is hard to state where my interest in meditation and Buddhism
stands; for questions of whether I meditate, both yes and no feel inadequate. It is tempting to
conclude this account by saying that this liminal zone beyond yes and no is actually very
Buddhist, that my ambivalence was a mark of having gone ‘beyond judgements’ (as the Zen
master Seng-ts’an advised for attaining peace, ‘Do not seek after truth, only cease to cherish
opinions;’ in Jones, 2003: 62). However, this conclusion would be disingenuous, as I feel no
such completion or finality. Perhaps it is just that while it is possible to render our past into
narrative form, as I have above, the present is rather more elusive.
11
CHAPTER 2
THEORETICAL REVIEW
This chapter reviews the theoretical background to the study. As this study is located at the
intersection of masculinity and well-being, it is necessary to explore theories in three areas:
masculinity, well-being, and the interaction between the two. It is also important to have a
theoretical appreciation for how these topics will be approached, which in the present study is
from a social constructionist perspective, partly through analysis of narratives. This chapter is
in four parts. The first part introduces social constructionism and narratives. The second part
discusses masculinity, focusing on Connell’s (1995) theory of masculinities. The third part
considers theories of well-being, especially of coping and emotional management. The fourth
part introduces theoretical frameworks at the intersection of masculinity and well-being which
explore how masculine norms are implicated in mental health problems in men.
2.1. Overarching theoretical perspective
This study approaches masculinity and well-being from a social constructionist perspective.
Within this approach, there is a particular focus on narratives. These are discussed in turn.
2.1.1. Social constructionism
Providing a concise summary of social constructionism is difficult, as it is a ‘broad church,’
incorporating diverse ideas and perspectives (Lock and Strong, 2010). Nevertheless, in this
diversity, theorists recognise commonalities. Butt (2004: viii) views social constructionism as
‘a family of approaches that emphasise the role of social forces, particularly language, in the
production of individual action.’ Burr (1995) argues that various approaches share ‘family
resemblances,’ including preferences for anti-essentialism and anti-realism, recognition of the
centrality of language in the production of knowledge, and awareness that our understanding
of the world is historically and culturally situated. Before discussing these ideas, it may help to
situate social constructionism in a wider perspective, as it is considered part of a broader current
of poststructuralist thought (Brickell, 2006).
Brickell argues that although social constructionism and poststructuralism are often treated as
coterminous and interchangeable, the former is a form of sociology, the latter a form of social
12
theory (social theory has a broader remit, encompassing sociology and ‘all the disciplines
concerned with the behaviour of human beings;Giddens and Dallmayr, 1982: 5). As with
social constructionism, defining poststructuralism is difficult. Not only is the term used in
diverse ways by theorists, poststructuralism denies the possibility of articulating essential
definitions per se (Brickell, 2006). However, poststructuralism can be usefully apprehended by
considering its intellectual precursor, structuralism, from which it emerged as a critique
(Marshall, 2010).
Structuralism, which originated in linguistics with De Saussure (1916), held that phenomena
derive meaning from their position within a network of other linguistic signs (Jenning, 1999).
As Lvi-Strauss (1981: 786) expressed it, ‘looking beyond the empirical facts to the meaning
between them,’ is ‘more intelligible’ than analysing phenomena in isolation. The concept of
‘man,’ for example, only makes sense in relation to signifiers like ‘woman.’ However, while
structuralism saw language structures as largely fixed and static, poststructuralism recognised
the shifting, dynamic nature of these structures (Marshall, 2010). Theorists such as Derrida
(1982) argued that meaning is not unitary or fixed, but ‘slippery and elusive’ (Rail, 1998: xii),
with multiple interpretations possible. Objects and categories of knowledge are not given by
the world around us, but are instead produced by the symbolising systems we learn’ (Tyner,
2008: 4). Poststructuralism endeavours to challenge terms that are assumed to be natural and
unchanging, and to ‘disrupt meanings and labels, categories and classification schemes.’
As a form of poststructuralism, social constructionism thus emphasises that distinctions used
to represent and explain the world e.g. man and woman are socio-cultural products (Lock
and Strong, 2010), reflecting ‘particular historical and cultural understandings,’ rather than
‘universal and immutable categories of human experience’ (Bohan, 1996: xvi). So, to some
extent, all phenomena are viewed as ‘constructed.’ However, this perspective has different
strengths. At one end, ‘hard constructionists’ veer towards radical relativism: knowledge is
‘whatever human beings come to socially certify as such’ (Potter and Lpez, 2001: 7). In
contrast, softer forms of construction may embrace realism to some extent, such as ‘critical
realism,’ which recognises that although knowledge is culturally situated, it can approximate
some degree of understanding of ‘reality’ (Layder, 1998).
In explaining people, constructionism departs from the presuppositions of ‘natural science’
psychology in important ways (Burr, 1995). First, constructionism has a tendency towards anti-
13
essentialism, denying that people possess an inherent ‘fixed’ nature. Instead, qualities
manifested by people like gender are shaped in a fluid, dynamic way by social structures
and processes (Weedon, 1997). There is a particular focus on ‘discourses,’ i.e. language and
communicative practices by which inter-subjective meanings are represented, apprehended or
established (Dean, 2003: 3). People exist within discursive fields, where institutions, power
relations and language intersect to construct the person, and our understanding of them (Hall,
1992). For example, a discourse of ‘gender’ creates gendered people humans understanding
themselves in terms of male and female, masculinity and femininity and influences how
people are approached as a focus of knowledge, e.g. ‘men’s studies’ (Brickell, 2006).
The way the world is constructed in discourse has implications for social practices, provoking
particular forms of action. For example, constructing substance abuse as a crime or a sickness
invites punishment or medical treatment respectively (Burr, 1995). Discursive practices are
bound up with issues of power, as the particular understandings which come to be accepted as
true tend to be determined by those with more power (Muehlenhard and Kimes, 1999). There
is a focus on the social and political processes that influence how explanations of phenomena
are arrived at, and who is advantaged/disadvantaged by such explanations (Maddux, 2008).
Social constructionism thus explores how competing constructions compete for legitimacy as
people seek to ‘normalise or trouble’ particular phenomena (Dean, 2003: 3).
As well as construing the focus of its enquiry e.g. gender as constructed, constructionism
has implications for how this enquiry should be conducted. In contrast to a ‘natural science’
approach which seeks to identify causal mechanisms and universal ‘laws,’ a constructionist
approach explores meaning and context (Potter and Lpez, 2001). There are variations within
this approach: some researchers aim at local description, others seek explanatory theoretical
frameworks (Layder, 1998). Nevertheless, among these variations, there is an emphasis on
exploring the construction of meaning in local historical contexts, with a preference for the
particular over the general, and for highlighting diversity rather than similarity (Burr, 1995). In
the present study, this means exploring configurations of masculinity as the product of local
contexts, rather than the essentialist notion of ‘how men are.’ Before looking in detail at the
construction of masculinity, the next part outlines the approach used here to explore these
constructions: narrative.
14
2.1.2. Narrative
Interviews were conducted to elicit men’s narratives relating to masculinity, meditation and
well-being. Although narrative is an increasingly prominent concept in qualitative research,
and societal discourse generally, e.g. as a journalistic trope, there is no clear agreement on what
a narrative is (Squire et al., 2008). Georgakopoulou (2006: 122) argues that narrative is a
‘contested, elusive and indeterminate concept,’ used as an ‘epistemology, a methodological
perspective, an antidote to positivist research, a communication mode, a supra-genre, a text-
type... a specific kind of discourse’ and a ‘way of making sense of the world.’ Despite such
conceptual indeterminacy, Savin-Baden and Van Niekerk (2007) suggest there is a degree of
consensus that, in an elemental sense, narratives are stories about experiences. Taking this
definition as a starting point, this section considers three questions: What is a story? Why are
they important? and, What type of data do they produce?
There are different ideas as to what constitutes a story. Ochs and Capps (2001) argue that
narrative research has been influenced by Labov's (1972) pioneering approach focusing on the
presence of canonical story-telling features which contribute to the ‘narrativity’ of a story, like
a coherent temporal sequence of events (Labov and Waletsky, 1997). However, Ochs and
Capps suggest recent research has embraced a post-modern turn which allows for partial,
fragmented and conflicting narratives. This approach embraces a poststructuralist view of
identity, rejecting the idea of a ‘unified, coherent, autonomous, reflected-upon and rehearsed
self,’ instead seeing people as comprised of ‘fleeting, contingent, fragmented and multiple
selves’ (p.128). From this perspective, storytelling is a dynamic complex process, involving
multiple ‘small narratives’ vying with each other, withheld, expressed, or altered depending on
the circumstances of the telling (Georgakopoulou, 2006). However, while a poststructural
perspective refuses to prescribe a specific form to stories, they are still usually recognised as
possessing certain features, including temporality and causality (Bell, 2002).
As to why narratives are worth studying, Savin-Baden and Van Niekerk (2007: 259) suggest
they are a ‘means of understanding experience as lived and told.’ This quote contains two key
ideas: the experience itself (lived), and the way the person represents this to themselves and
others (told). These two ideas relate to a similar distinction between narrative as method, and
as phenomenon (Xu and Connelly, 2009). As method, narratives are a source of information
about past experiences, and in this sense share conceptual overlap with approaches like life-
15
history and case-study research. Such approaches have been criticised for the questionable
historical veracity of their data, with issues around memory, and the tendency of people to
construct stories which uphold positive self-interpretations (Bell, 2002).
However, from the perspective of narrative-as-phenomenon, concerns around veracity are
irrelevant, since regardless of historical accuracy, narratives are an overarching code for the
way people construct, understand and transmit meanings about their identity, past, and life
(White, 1987). Frank (1997: 22): The stories we tell about our lives are not necessarily those
lives as they were lived, but those stories become our experience of those lives.’ So, without
denying the potential for narratives to reflect lived experience, as this would do injustice to
participants’ efforts to truthfully share their lives (Connell, 1995), narratives reveal current
constructions and meanings, which are valuable in their own right.
2.2. Masculinity
Many different theoretical approaches to gender and masculinity have been articulated over the
years. Before exploring social constructionist approaches, these will be contextualised by
outlining more conventional ways of understanding gender. This section is thus in two parts.
The first part explores conventional approaches, including ideas around ‘sex differences,’ and
gender roles and stereotypes. The second part considers social constructionist theories, which
highlight the way gender is constructed relationally through interaction. There is a particular
focus on Connell’s (1995) theory of masculinities, which argues that there are multiple forms
of masculinity, not only among men, but within them, as individuals negotiate different ways
of being a man according to the context. However, the theory also recognises that in a given
context, a particular masculinity becomes dominant, or ‘hegemonic.’
2.2.1. Conventional approaches to masculinity
Conventional approaches to masculinity have often understood gender in either biological,
social/cultural, or psychological terms (Cohen, 2009).
Biologically-oriented approaches tend to account for gender, i.e. masculinity and femininity,
primarily in terms of sex, i.e. ‘socially agreed upon biological criteria for classifying persons
as male or female’ (West and Zimmerman, 1987: 127). Gender is regarded as the behavioural
16
expression of biological attributes: masculinity is how men behave due to their ‘maleness’
(Eagly and Wood, 1999). Poststructuralists have critiqued the reductive simplicity of the binary
distinctions underpinning this approach, arguing that even physiological classification as male
or female is a social construction, bound up with issues of power and control (Lorber, 1996;
Peterson, 2009). Nevertheless, Brickell (2006: 100) argues that such constructions have a
powerful normative force, being ‘highly salient for those who live within them,with power to
structure lives ‘in profound ways.’ Thus despite the force of the poststructuralist argument
questioning the legitimacy of foundational distinctions, sex and gender binaries are powerful
frames for viewing the world for people ‘in general,’ and researchers and have influenced
how gender has been conceptualised and studied.
Biological approaches to gender view physical factors related to sex, like hormone levels, as
exerting a strong deterministic effect upon gender, i.e. on how men and women act (Cohen,
2009). Research in this area is labelled the ‘sex-differences’ paradigm, involving the analysis
of differential psychological and social outcomes on the basis of biological sex differences
(Maccoby and Jacklin, 1974). This type of approach is evident in studies linking testosterone
to aggression (Campbell et al., 1997) or risk-taking (Apicella et al., 2008). Such research is
often explained theoretically using evolutionary psychology ‘origin theories,’ which connect
behavioural traits to historical selection pressures (Eagly and Wood, 1999). This view of gender
has considerable currency in society. For example, an emergent genre of discourse, labelled as
‘neurosexism’ (Fine, 2008), has latched selectively onto neuroscience research to portray men
and women’s brains as ‘hardwired’ differently.
The biological determinism of the sex-differences approach has been challenged by theories
suggesting gender is socially acquired. Conventional approaches in this area have focused on
gender stereotypes and roles (Cohen, 2009). Stereotypes are ‘beliefs about what it means to be
male or female in terms of physical appearance, attitudes, interests, psychological traits, social
relationships and occupations’ (Granié, 2010: 727). Roles describe the way particular
behaviours and activities are not only encouraged as gender-appropriate (Maccoby, 1988), but
institutionalised in the ‘structural arrangements of society’ (West and Zimmerman, 1987: 128).
Theories have explored how gendered behaviour emerges as stereotypes and roles are
impressed upon people as they develop, from as early as 18 months (Eichstedt et al., 2002).
17
One model for the social acquisition of gender is social learning theory, which suggests that
children observe and learn from the actions of models around them; behaviours and qualities
are also reinforced or discouraged by significant others (Mischel, 1975; Bussey and Bandura,
1999). Social learning theorists have explored how gender is shaped through various social
influences, including parents (Morrongiello and Dawber, 2000), peers (Hay et al., 1998) and
the media (Witt, 2000). It is thought that one driver of social learning is that self-esteem is
linked to acceptance by others, which can be contingent on acquiescence to gendered norms
(Smith and Leaper, 2006). While social-learning is operative through childhood, and beyond,
many theorists identify adolescence as a period when gender comes to the fore as a ‘salient
factor shaping orientations towards oneself and one’s place in the social world’ (Barratt and
White, 2002: 451).
In terms of masculine stereotypes, Brannon (1976) identified four in Western culture that
contemporary research has found are still influential. First is ‘The big wheel,’ a concern with
success and status, reflected in studies associating masculinity with dominance (De Pillis and
De Pillis, 2008) or achievement (Jackson and Dempster, 2009). Second is ‘Give ‘em hell,
shown in work connecting masculinity to risk-taking behaviours, like alcohol use (De Visser
and Smith, 2007), unsafe sex (Campbell, 1995) or dangerous driving (Mast et al., 2008), and
to anti-social behaviour, from ‘laddishness’ (Francis, 1999) to violence (Moore and Stuart,
2005). Third is ‘No sissy stuff;stigmatisation of ‘feminine’ qualities, such as emotionality
(Mejía, 2005). Lastly, ‘The sturdy oak’ valorises strength and toughness, as in studies linking
masculinity to self-reliance (Courtenay, 2000b) and independence (Smith et al., 2007). An
important aspect of the latter two stereotypes is emotional toughness: emotional suppression
and avoidance (Pollack, 1998), and reluctance or inability to express emotion (Cramer et al.,
2005). Emotional toughness will be relevant below, as it connects to distress in men.
While stereotypes refer to beliefs, roles reflect the way these ideas create expectations and
promote certain activities as gender-appropriate (Maccoby, 1988). For example, endorsement
of risk-taking stereotypes means parents are less likely to intervene to prevent dangerous play
by boys (Morrongiello and Dawber, 2000). In this way, diverse spheres of activity from
sporting participation (Tagg, 2008) to food consumption (Gough, 2007) become regulated
according to stereotypes which encourage/discourage participation on the basis of gender.
Behaviours are not only encouraged, but institutionalised in societal structures, from implicit
biases to explicit rules (Thurnell-Read and Parker, 2008). Institutionalisation can be operative
18
early in life. For instance, Anderson (2009: 3) argues that sport is a ‘microcosm of societies’
gendered values, myths and prejudices, with competitive sports ‘compulsory’ for boys.
In adulthood, gender roles are evident in the structuring of occupations along gendered lines.
While occupations do not usually forbid participation by those of the ‘wrong’ gender (though
some jobs remain sex-specific, e.g. in the military), the culture of certain jobs can be heavily
gendered. For example, Thurnell-Read and Parker (2008: 127) describe the ‘organisational
structures, workplace practices and daily routines’ of firefighting as ‘steeped in maleness.’
While the gendered composition of work is changing as women challenge prohibitive cultural
and structural barriers (Kilminster et al., 2007), gender roles may still be reinforced via social
pressure, including harassment of those who challenge convention, as witnessed with the first
female beefeater (BBC, 2009).
Lastly, some conventional theories understand gender from a psychological perspective, with
a focus on ‘gender-identity, i.e. ‘one’s subjective sense of one’s own maleness/femaleness’
(Kulis et al., 2008: 259). Theories of gender identity are often conceptualised with reference to
the stereotypes identified above, where a person’s gender-identity refers to the extent to which
they feel they adhere to conventional gender stereotypes (Bem, 1974). This perspective moves
away from a strict male/female dichotomy. Masculinity and femininity are separate concepts
rather than poles on a continuum, and people may feel they embody both masculine and
feminine norms (Kulis et al., 2008). There is also the issue of the extent to which people feel
they should adhere to stereotypes. Pleck's (1995) gender role strain concept refers to the distress
felt by a person as they struggle to meet unattainable and contradictory standards of
masculinity or femininity (Addis, 2008: 159). A related idea is gender role conflict, which
suggests that people may be harmed in various ways by attempts to conform to rigid gender
norms, resulting in ‘devaluation or violation of others or self’ (O'Neil et al., 1995: 167).
Although research from these conventional perspectives is ongoing, scholars working from a
social constructionist standpoint have begun to articulate a more dynamic, nuanced reading of
gender. Such theorists critique the inherent essentialism of conventional approaches, which
tend to invoke ‘singular categories of male and female’ (Mac an Ghaill and Haywood, 2012:
483), presenting them as two fixed ‘containers’ (Courtenay, 2000b). This is reflected in the
homogenizing tendency towards making categorical generalisations about ‘men’ or ‘women’
as monolithic groups, ascribing definitive characteristics to the masculine personality (Addis,
19
2008). To take an example relevant to the discussion below, Nolen-Hoeksema's (1987: 276)
‘sex-differences’ theory of depression suggested that apparently higher rates of depression in
women were due to their different emotional responses: ‘women’s ruminative response styles
amplify and prolong their depressives episodes... while men’s active response styles dampen
their depressive episodes.’
Even theories that recognise the influence of culture/society are susceptible to essentialism,
often viewing gender as ‘fixed, unvarying and static much like sex’ (West and Zimmerman,
1987: 126). For example, although Nolen-Hoeksema’s titles evolved from ‘Sex-differences in
unipolar depression’ (1987) to ‘Gender differences in depression’ (2001), the latter still made
categorical generalisations: ‘gender differences in rumination at least partly account for the
gender differences in depression’ (p.175). Thus although the discourse had shifted to socially-
produced gender patterns, tendencies to essentialise the differences between men and women
remained. However, while some conventional approaches acknowledge a social influence on
gender, constructionist theories emphasise agentic construction: people are not regarded as
‘passive victims of a socially prescribed role,’ nor ‘simply conditioned or socialised by their
cultures,’ but as ‘active agents,’ continually engaged in constructing gender through social
interaction (Courtenay, 2000b: 1387-1388). The next part looks in detail at these ideas.
2.2.2. Constructionist approaches to masculinity
Viewing people as actively engaged in an ongoing project of gender construction introduces
two key ideas: the concept of ‘doing’ gender (West and Zimmerman, 1987), and the diversity
of gender constructions, i.e. multiple masculinities (Connell, 1995). For both ideas, the point
will be made that although traditional gendered behaviours are not inevitable or necessary, they
remain compelling and common.
First, in terms of ‘doing’ gender, poststructuralist theories of identity move away from the
essentialist idea of gender as a static psychological property or trait even if learned through
socialisation towards a ‘process’ orientated view (Lorber, 1994). Gender is not seen as a fixed
attribute, located ‘within’ the individual, but a fluid process, generated by the dynamics of
social interaction (Jackson, 2004). West and Zimmerman (1987: 140) captured this shift in
perspective from attribute to process by suggesting that gender should be seen more as a verb
than a noun; rather than something one ‘has’ or ‘is,’ gender is ‘something one does, and does
20
recurrently, in interaction with others. This notion of ‘doing gender’ incorporates two inter-
related ideas: gender as relationally-produced, and gender as a process.
The first idea is that gender is seen in relational terms as a product of social interaction, rather
than in individual terms as a personal attribute: i.e. gender is ‘a set of socially constructed
relationships which are produced and reproduced through people’s actions’ (Gerson and Peiss,
1985: 327). Second, gender is an ongoing, dynamically evolving process, rather than a static,
stable configuration people are continually engaged in constructing/re-constructing their
gendered identity as they negotiate their social world (McKinlay, 2010). The importance of
understanding gender in relational terms can be seen as deriving from structuralism (Levi-
Strauss, 1981). However, the emphasis on the fluid nature of these social productions that
gender is ‘not static but rather is constantly (re-defined) and contested in the contexts within
which it is invoked’ – marks these theories as poststructuralist (Nightingale, 2006:171).
This process-oriented view of gender was captured persuasively by Butler (1990) with her
influential notion of performativity. Butler argued that people do not have a foundational
gendered identity generating their actions in a causal way, e.g. risk-taking because they are
masculine. As Nayak and Kehily (2006: 460) put it, there is no ‘ontological subject which
prefigures action.’ Instead, gender is produced through repetitive actions in social interaction:
one becomes masculine by taking risks. Rejecting essentialist notions of self, Butler draws on
Nietzsche’s idea of there being ‘no doer behind the deed’ (Digeser, 1994). Gendered identity
is thus seen as the effect, not the cause, of an individual’s repeated behaviours: Repetition is
not performed by a subject: this repetition is what enables a subject’ (Butler, 1993: 95).
This lack of a ‘doer’ raises the question of who or what is the cause of gendered behaviour, if
not the person themselves. Butler (1990: 25) locates responsibility in the ‘compulsory frames
set by the various forces that police the social appearance of gender.’ People are situated in
discursive fields, in which ‘regulatory regimes’ encourage repetition of particular behaviours
that come to be viewed as ‘normal’ (Weedon, 1997). Gendered identity is thus produced by a
‘forced reiteration of norms’ (McKinlay, 2010: 235). This theory emphasises the constraining
role of social pressures in channelling enactments of gender towards conventional patterns. So,
even though there is no essential masculinity, regulatory regimes enforce the persistence of
traditional gender behaviours, e.g. the roles and stereotypes discussed above.
21
The idea of performativity has its critics, especially in terms of its implication for subjectivity
and agency. One of the central features of Butler’s theory was that conventional patterns of
behaviour could be resisted, and alternatives embraced. If gender was not foundational, but
produced through performance, this offered one the opportunity to ‘disrupt’ gender norms by
subverting expected patterns of behaviour (Nayak and Kehily, 2006). For example, Butler
(1990: 137) saw drag-dressing as an act which ‘mocks both the expressive model of gender
and the notion of a true gender identity.’ However, scholars have queried where the denial of
a foundational subject leaves the notion of agency: if the subject is produced through forced
repetition of norms, this seems to deny the volitional agent who would be capable of resisting
these patterns of behaviour (Brickell, 2005).
A related criticism of Butler is the neglect of the subject who is ‘produced by these discursive
processes’ (Brickell, 2005: 28). Social constructionist accounts in general are often seen as
articulating ‘overly-sociological’ views of identity (Jefferson, 2002), concentrating on social
aspects of gender production to the exclusion of men’s subjectivity (Whitehead, 2002). Roper
(2005: 58) suggests such theories often have an ‘abstract quality,’ which fails to address ‘real
human relationships and emotional states.’ Thus there have been calls for a ‘more adequate,
psychosocial account of masculinity, doing justice to men’s ‘inner world’ (Jefferson, 2002:
63). Recent efforts have been made to explore men’s inner experience, while acknowledging
the impact of cultural factors Gough (2004, 2009) pioneered a ‘psychodiscursive’ approach
drawing on psychoanalysis and discourse analysis, for example. Examining subjectivities in
the context of socio-cultural factors is also a concern of the present study.
A second key idea introduced by constructionist theories is the notion of diversity. Connell's
(1995) theory shifted the focus from singular masculinity to masculinities, drawing attention
to the variety of forms of masculinity enacted locally through everyday practices. However, a
key feature of the theory was that in a given context, a particular form of masculinity the
‘most honoured way of being a man (Connell and Messerschmidt, 2005: 832) dominates and
become normative. This dominant form was termed ‘hegemonic masculinity.’
The concept of hegemony was adapted from the political philosopher Gramsci (1971), who
argued that societal inequalities were entrenched because those in power maintained control
not only via political and economic dominance, but more assiduously through ideological
influence which legitimises the status quo as normal. Connell argued that masculinities exist
22
in hierarchical relationships, with a particular form of behaviour culturally authoritative in a
given setting. Hegemonic masculinity dominates subordinate and marginalized masculinities
through a normalising ability to frame behaviours as natural (Donaldson, 1993), and ability to
levy social and economic penalties on those who deviate from expectations (Moss-Racusin et
al., 2010). An example is how homosexuality, usually viewed as a marginalized masculinity,
is ‘censured(Roberts, 1993), from bullying to anti-gay violence (Mills et al., 2004).
While Connell recognised that among the many ways of being a man, particular forms of
masculinity were dominant, he also emphasised that the dominant forms varied according to
context. Moving away from static ideas around ‘the’ masculine stereotype associated with
conventional approaches, Connell argued that local milieus valorised particular masculinities
as hegemonic. Different forms of gendered behaviour, or ‘configurations of practice that are
accomplished in social action’ (Connell and Messerschmidt, 2005: 836), emerge in different
contexts. As such, recent research has explored variation in local forms of hegemony.
Studying Norwegian lumberjack workers, Brandth and Haugen (2005) found that hegemonic
norms included the possession of a ‘weathered’ countenance, reflecting years of outdoor toil.
Moreover, their analysis showed that hegemonic norms can shift over time, even in a narrow
context: changes to working practices meant that the ability to wield heavy machinery had
since become valorised. Diversity in forms of hegemony has been examined at various levels
of scale, from cross-cultural analyses at national levels, e.g. Argentinean machismo (Stobbe,
2005), or a post-conflict nationalistic Kosovan masculinity (Munn, 2008), to more specific
groups or locales, including the US Navy (Barrett, 1996), working-class youth in post-
industrial Northern England (Nayak, 2006), ‘transnational’ business executives (Connell and
Wood, 2005) and netball players in New Zealand (Tagg, 2008).
To understand how contexts can promote particular configurations of practice, some theorists
have used Lave and Wenger's (1991) idea of communities of practice (CoP) as a framework
for analysing how identities are ‘learned and reproduced within various groups and locales’
(Creighton, 2011: 37). Although CoP is an evolving and contested concept (Lindkvist, 2005),
CoP can be defined as ‘groups or networks of people with shared understandings of identity’
(Creighton and Oliffe, 2010: 414); or, ‘people who come together around mutual engagement
in an endeavour,and practices which ‘emerge in the course of this’ (Ekert and McConnell-
Ginet, 1992: 464).
23
Paechter (2003: 72) argues that CoP enable the ‘production, reproduction and negotiation’ of
particular forms of gendered behaviour through the way they encourage such behaviour as a
condition of participation, and eventually ‘full membership,’ in the group. Most studies have
emphasised the role of CoP in the maintenance of traditional masculine norms (Parker, 2006).
However, a study of the Australian ‘shed’ movement suggested these informal ‘workshop-
based spaces’ functioned as CoP which offered a ‘safe space’ that allowed the emergence of
‘non-traditional qualities in men,’ like emotional expression (Golding et al., 2008: 254). The
possibility that CoP can promote alternative ‘positive hegemonic masculinities is of interest
in the present study.
Connell’s theory has evolved in response to criticisms of the original formulation (Connell and
Messerschmidt, 2005). Among the issues raised was the accusation that it offered a fixed
typology of men which overlooked how men engaged in ongoing negotiations of masculinity
(Wetherell and Edley, 1999), and paid insufficient attention to men’s subjectivities (Jefferson,
2002). Connell and Messerschmidt (2005: 847) admitted the initial theory, which focused on
men’s ‘global dominance’ over women, was too simplistic to account for the ‘complexity of
the relationships among different constructions of masculinity.’ However, they rejected the
charge that the theory neglected subjectivities, highlighting how it drew upon psychoanalytic
ideas to reveal ‘tension and contradiction within conventional masculinities’ (p.832). Lusher
and Robins (2009: 390) argue that rather than ‘undermining the central tenets’ of the theory,
the critiques helped ‘expand the details.’ As such, recent formulations have emphasised the
dynamic nature of local hegemonic configurations (Connell and Messerschmidt, 2005).
Connell and Messerschmidt (2005: 841) proposed that diversity is not just between men, but
within them. Rejecting essentialist ideas of gender, they suggested that men take up different
subject positions according to need. Various enactments of masculinity represent not different
types of men, but reflect the way men strategically ‘position themselves through discursive
practices’ according to the dynamics of the social situation. As Paechter (2003: 69) put it, the
theory implies a ‘multiplicity of masculinities, inhabited and enacted by different people and
by the same people at different times.’
This view of identity as a ‘multiplicity’ has implications for the reflexive self, which is seen as
a site of confluence for competing discourses of masculinity. However, while there is no
unitary self in this view, Connell and Messerschmidt (2005: 843) suggest this does not erase
24
the subject.’ There is still a place for agency and subjectivity, a volitional self who acts and
experiences. Thus they reject ‘structural determinism’ (p.832) men have some freedom in
terms of the type of gendered performance they enact. However, this freedom is ‘constrained
massively... by embodiment, by institutional histories, by economic forces, and by social and
family relationships’ (p.843). In particular, men are constrained by hegemonic masculinity.
Thus, although masculinity is viewed as socially constructed, and multiple masculinities are
acknowledged, as with Butler’s (1990) regulatory regimes, hegemony explains why certain
forms of masculinity nevertheless become dominant within a given milieu. While hegemonic
masculinity may not be a statistical norm only a minority may successfully enact it it is
seen as normative (Connell and Messerschmidt, 2005). From this perspective, the stereotypes
outlined above can be understood as ‘traditional’ hegemonic norms which men feel pressured
to enact, or resist at the risk of censure.
1
Such pressures may be detrimental to well-being, as
explored in the last section of this chapter. Before that, it is necessary to introduce the various
ways in which well-being has been understood in the literature.
2.3. Well-being
Although well-being is of increasing interest to researchers in a range of disciplines, it is a
contested term, used in diverse ways by different theoretical frameworks (De Chavez et al.,
2005). For example, some psychological models focus on positive mood, while biomedical
conceptualisations tend to equate well-being with physical health. De Chavez et al. note that
while much of the work on well-being has been undertaken within single disciplines, there is
an increasing preference for a multidimensional ‘biopsychosocial’
2
approach to well-being,
incorporating physical, psychological, and social dimensions. The present study also seeks to
1
The qualifier ‘traditional’ is used to emphasise that there can be other forms of hegemony not based
on these stereotypes; e.g. sensitivity could be valorised as a local norm (McNeill and Douglas, 2011).
In the present study, ‘traditional hegemonic masculinity’ is used to refer to forms of hegemony which
correspond to the stereotypes identified by Brannon (1976).
2
The biopsychosocial model emerged in medicine as a holistic approach to health, accounting for ‘the
patient, the social context in which he lives, and the complementary system devised by society to deal
with the disruptive effects of illness (Engel, 1977: 132). The model is gradually gaining acceptance,
being incorporated into research, medical training and the application of medicine (Adler, 2009).
25
take this approach. However, it will help to first outline the ways different disciplines have
constructed well-being, including biomedical, psychological, social and critical theories.
2.3.1. Biomedical approaches
From a biomedical perspective, well-being is usually used ‘in an uncontested way to mean
physical health’ (De Chavez et al., 2005: 74). Like well-being though, health is a contested
concept, used in diverse ways (Larson, 1999). The conceptual links between health and well-
being are complicated. Although multidimensional definitions of well-being position physical
health as a component of the broader idea of well-being (Pollard and Davidson, 2001), some
models of health incorporate well-being as a component, while other models use the terms
synonymously. Larson outlines four health models: the ‘World Health Organization [WHO]
model;’ the ‘wellness model;’ the ‘medical model;’ and the ‘environmental model.’
The WHO’s definition of health – a state of complete physical, mental and social well-being,
and not merely the absence of disease and infirmity’ – unchanged since 1948, has health as a
polarity, with well-being its positive pole, illness its negative. In contrast, the wellness model
uses health and well-being synonymously. This approach is less concerned with alleviating
illness, focusing more on attaining ‘higher levels of health and wellness’ (Larson, 1999: 128-
129). In the reductive ‘medical model’ the individual is seen in mechanical terms as a system
of parts: disease is a ‘dysfunction of the body, and health is the absence of dysfunction (Patel
et al., 2002: 8). This model is criticised as dehumanising, reducing people to component parts
and ceding control over the body to health professionals (Frank, 1997). The environmental
model concerns adaptation to one’s environment. In contrast to the medical model, here the
individual is seen as a volitional agent, sharing responsibility for health through behaviour, as
evident in health promotion literature (Simon et al., 2009).
2.3.2. Psychological approaches
From a psychological perspective, Hatch et al. (2010) suggest that well-being refers to mental
health, conceptualised either negatively as the absence of mental illness, or positively as the
presence of desiderata, such as pleasure. Ryff and Singer (1998) argue that psychology has
often sought to emulate the medical model of health, pursuing a mainly ‘negative’ approach,
constructing well-being as the absence of mental illness diagnoses including discrete illness
categories defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV;
26
American Psychiatric Association [APA], 1994), and less-clearly defined phenomena such as
distress (Gadalla, 2009). The most common disorders are depression and anxiety (Kessler et
al., 2005), together referred to as common mental disorders (CMDs), a term introduced by
Goldberg and Huxley (1992). CMDs involve a mix of anxiety and depressive symptoms, and
are mental conditions that cause ‘appreciable emotional distress and interfere with daily
function (McManus et al., 2009: 11).
Depression refers to a spectrum of mood disturbance (mild to severe, transient to persistent);
its two cardinal symptoms are low mood and diminished interest in pleasure; other symptoms
include feelings of worthlessness (APA, 1994). Major depressive disorder is diagnosed if five
or more symptoms persist over a two week period. Subtypes include bipolar (alternating with
mania) and adjustment disorders (resulting from stressful events) (Elliott, 1998). Although
anxiety is sometimes seen as on a continuum with depression, they are separate constructs, and
can co-occur (Endler et al., 1998). Anxiety itself is on a continuum, from mild (can be adaptive,
e.g. a warning signal), to severe (maladaptive, interferes with functioning) (Endler and
Kocovski, 2001). Anxiety has various subtypes, including generalised anxiety disorder
(unfocused worry), social anxiety disorder (fear of social situations), obsessive-compulsive
disorder (intrusive thoughts/images; repetitive actions), panic disorder, post-traumatic stress
disorder (trauma-related persistent memories), and phobias (APA, 1994).
While distress is often ill-defined (Ridner, 2004), it involves mental suffering, and is an ‘an
unpleasant emotional state’ (Gadalla, 2009: 2200). In contrast to identified disorders, distress
is more general in definition and measurement, with psychological/behavioural symptoms not
specific to particular disorders, including anxious and depressive reactions (Marchand et al.,
2005). Distress is used to denote negative experiences that fall short of clinical diagnoses for
disorders, though there may be overlap (Green et al., 2010). Distress can range from ‘normal’
levels of negativity, to levels approaching clinical significance that fulfil diagnostic criteria for
depression and anxiety (Ziegler et al., 2011). Distress also connects to depression in other ways:
distress can precipitate its onset (Wang, 2005), be caused by it (Herman and Sadovsky, 2010),
and they can co-occur (Pandey et al., 2007). Theories of distress and depression are explored
further in the next section of this chapter.
In contrast to this ‘negative’ approach, a recent ‘positive psychology’ countermovement has
attempted to articulate well-being in positive terms (Seligman, 2002b). Positive psychology
27
sells itself as a ‘science that strives to promote flourishing and fulfilment... that studies what
makes life living’ (Linley and Joseph, 2004: xv). Positive psychologists usually distinguish
between subjective well-being (SWB) and psychological well-being (PWB).
The idea of SWB is rooted in utilitarian notions of happiness (Diener, 2009). SWB is viewed
as comprising an affective component, involving the ‘ratio’ between negative and positive
affect, and a cognitive component pertaining to judgements around life satisfaction (Myers and
Diener, 1995). The former reflects short-term situation-dependent feelings of mood; the latter
involves longer-term evaluations (Pittau et al., 2010). Theories of SWB often construct it as
relatively stable over time and circumstance. ‘Set-point’ theory (Lykken and Tellegen, 1996)
proposes that SWB levels fluctuate around a stable set point, determined largely by genetic
factors (accounting for about 50% of SWB variance). A related theory is the hedonic treadmill
(Brickman and Campbell, 1971), which suggests that losses or gains in SWB due to
circumstantial changes are temporary, as people adapt to new situations, usually within three
months (Suh et al., 1996).
These theories were prompted by studies which suggested that positive events like winning the
lottery did not raise SWB long-term (Brickman et al., 1978), while negative events like spinal
injury did not appear to significantly lower it (Chwalisz et al., 1988). However, recent
refinements to hedonic theory suggest set-levels can be altered. Some events appear to leave
such scarring as to permanently lower SWB, e.g. a child’s death (Wortman and Silver, 1989),
and longitudinal studies have also found permanent increases in SWB (Headey et al., 2010).
To account for the possibility of altering SWB, Lyubomirsky et al.'s (2005) dynamic theory
proposed three determinants: genetic set-point; circumstances; and activities. Empirical work
suggested that while circumstantial changes were subject to habituation, activities were not,
i.e. incremental efforts lead to durable increases in SWB (Sheldon and Lyubomirsky, 2006).
PWB or ‘eudaimonicwell-being (Greek for ‘good spirit’) concerns human ‘flourishing’
(Ryan and Deci, 2001). The concept of PWB centres on two key ideas: the importance of ‘a
purposeful and meaningful life,’ and psychological growth across the lifespan (Keyes et al.,
2002). The emphasis on meaning reflects the roots of PWB in Existentialism, a disparate body
of thought whose common reference point is analysis of the ‘human condition’ (Yalom, 1980).
Existentialists argue that it is incumbent upon people to find meaning in life, or suffer despair
(Tillich, 1952). In finding meaning, existentialists emphasise the ‘burden’ of freedom the
28
need to take responsibility for choices, even as they are constrained by contingencies; and the
importance of authenticity not renouncing this burden and allowing one’s goals to be
determined by others (Heidegger, 1962).
The idea of growth reflects the roots of the PWB paradigm in humanist philosophies (Keyes et
al., 2002). However, theorists have recast the idea of ‘flourishing’ as ‘optimal functioning,’ i.e.
striving to realise one’s potential and ‘use and develop the best of oneself’ (Huta and Ryan,
2010: 735). The PWB paradigm is avowedly about development of ‘good character’ (Seligman,
2002a). This is an acknowledged value position with an intrinsically hierarchical perspective,
in which people are at different developmental stages (Linley and Jospeh, 2004). This
perspective draws on theorists who have articulated structural developmental schemas for
various capacities, e.g. cognition (Piaget, 1971), morals (Kohlberg, 1969), values (Graves,
1970), needs (Maslow, 1943), and worldviews (Gebser, 1991). PWB is viewed as reflecting
the attainment of higher ‘stages’ of development in these capacities (Seligman, 2002a).
Drawing on these schools of thought, theorists have proposed various models of PWB. The
Psychological well-being’ theory identifies six key components: autonomy, purpose in life,
personal growth, positive relations, environmental mastery and self-acceptance (Ryff, 1989;
Ryff and Singer, 1998). Similarly, ‘Self-determination theory’ suggests that PWB depends on
satisfaction of three psychological needs of autonomy, relatedness and competence (Ryan and
Deci, 2000). Satisfaction of these needs is set within a larger motivational framework, which
highlights the importance of ‘inherently’ rewarding intrinsic goals, rather than extrinsic ones
(external inducements like material rewards).
2.3.3. Social approaches
Social dimensions of well-being have been explored by theorists in various fields, including
sociologists, economists and political theorists (and are also central to psychological theories
discussed above). Various factors that impact upon well-being have been conceptualised.
A prominent theoretical notion is that of ‘social capital,’ defined as ‘features of social life
networks, norms and trust that enable participants to act together more effectively to pursue
shared objectives(Putnam, 1995: 664-665). Theorists separate social capital into cognitive
(attitudinal beliefs, e.g. trust in people) and structural components (network connections, e.g.
29
membership of organisations) (Yip et al., 2007). Social capital can further be conceptualised
either on a micro level as a resource individuals call upon, e.g. social support in dealing with
stress (Berkman et al., 2000), or a macro level as a communal resource enabling achievement
of goals that individuals could not manage alone (Putnam, 1993). Various relational bonds have
been understood as forms of social capital, including family relationships (Nakhaie and Arnold,
2010). Numerous studies link social capital to lower levels of distress and disorders (e.g.
Borgonovi, 2010) and higher SWB (e.g. Hurtado et al., 2011).
Theorists have identified other social factors, unrelated to people per se, that impinge upon
well-being. Socio-economic factors are an important determinant of mental health. Men in the
lowest socio-economic class in England are almost three times more likely to have CMDs than
those in the highest (EHRC, 2010). Such socio-economic effects are observed cross-culturally.
In a systematic review of 131 papers covering 33 countries, 79% of these reported positive
associations between poverty and CMD measures (Lund et al., 2010). Theorists have sought to
elucidate elements of socio-economic deprivation linked to mental health. Reduced social
capital in deprived areas, reflected in social ‘disorder’ and higher crime rates, impacts upon
CMDs (Ross, 2000). Such areas may also have more ‘environmental stressors,’ e.g. air or noise
pollution (Rehdanz and Maddison, 2008). Interestingly, income per se may not be linked to
mental health so much as relative income, where societal inequality leads people to make
invidious social comparisons with affluent others (Solnick and Hemenway, 2005).
Political factors have also been explored. Cross-cultural research suggests that freedom,
equality and human rights are important for well-being (Diener et al., 1995). Kaufmann et al.
(1999) identify three types of freedom personal, political and economic that impact upon
well-being. These freedoms are determined structurally by governments, and depend on six
criteria: voice and accountability, stability and lack of violence, government effectiveness, the
regulatory framework, rule of law, and non-corruption. Scholars emphasise the need for action,
particularly in the developing world, to ensure more citizens enjoy social, political and
economic freedom (Sen, 1999). The potential role of government in facilitating well-being has
prompted calls for a ‘new utilitariarism’ to be the ‘goal’ of government, rather than GDP,
promoting well-being through public policies (Duncan, 2010). However, others argue against
such a centrist prescriptive political stance (Rhodes, 1996).
30
In theoretical terms, social factors are often conceptualised in terms of telic (goal satisfaction)
theories of well-being. Individuals are seen as existing in a transactional relationship with the
environment; SWB is the result of the environment satisfying basic biopsychological needs
(Diener et al., 1999). SWB thus depends on ‘livability’ (a congenial environment), and ‘life-
ability (the ability of a person to take advantage of this) (Veenhoven and Ehrhardt, 1995).
There are various theories of needs. Doyle and Gough (1991) outline 11 universal needs, the
deprivation of which affects SWB, including nutrition, healthcare and relationships. Some
theories are hierarchical: as basic physiological needs are met, more abstract ones assume
importance, like self-esteem (Maslow, 1943). Others argue that there are trade-offs between
different needs, that supportive relationships can minimise the impact of material deprivation,
for example (Biswas-Diener and Diener, 2009).
2.3.4. Critical approaches
Critical theorists suggest that conceptualisations of well-being reflect the cultural systems
from which they originate’ (Izquierdo, 2005: 768). Anthropological research highlights cross-
cultural variation in how well-being is constructed. For example, some societies place greater
value on communal well-being, or obligation to the environment (Adelson, 2000; Calestani,
2009). It is argued that contemporary theories of well-being are blind to their contextuality,
with ‘a fastidiously modern and ahistorical presumption about how individuals ought to fare in
life’ (James, 2007: 20-21). Theorists often critique the positive psychology paradigm, even
though this itself arose out of concern with the reductive discursive practices of traditional
schools of psychology, e.g. behaviourism (Strawbridge, 2003). Wierzbicka (2004) argues that
positive psychology presents a 20th Century Western notion of ‘expressive individualism’ as a
universal model of happiness, for example.
Beyond presumptions of universality, pernicious aspects of positive psychology discourses
have been identified. Ahmed (2007: 9) suggests its definitions of happiness e.g. ‘In matters
of politics, the happy tend to the conservative side of middle’ (Veenhoven, 1991: 16) are the
‘face of privilege,’ and carry normative force that ascribes value to qualities which are closer
to social norms. This normativity carries implicit blame and stigmatisation for those who fail
to achieve such norms, with admission of unhappiness portrayed as a moral failure (Ehrenreich,
2009). Making happiness normative may also hinder well-being, as unrealistic expectations
can lead to self-blame when not achieved (Schwartz, 2000). Going further, from a Buddhist
31
perspective, preoccupation with happiness may even cause unhappiness, as the very desire for
life to be different is held responsible for dissatisfaction (Gyatso, 2007).
Finally, by constructing happiness as an individual concern, positive psychology is accused of
precluding critical social thinking, fostering a culture of passivity which not only denies, but is
complicit in, the structural causes of unhappiness (Ehrenreich, 2009). That is, well-being is
presented as a private matter, rather than something to tackle politically by creating a better
society. For example, Harris (2012) argues that positive psychology has been used by the UK
government to suggest that inability to find employment is due to the failure of job-seekers to
‘think positive,’ rather than an inhospitable economic climate.
Having given an overview of approaches to well-being, this review now focuses on theories of
mental health, i.e. disorders and distress, and the way these intersect with masculinity.
2.4. Masculinity and mental health
In psychological terms, well-being is viewed negatively as the absence of disorder/distress, or
positively as the presence of desiderata like SWB (Hatch et al., 2010). This section focuses on
disorder/distress, referred to as mental health ‘issues’ or ‘problems’ (Seal et al., 2007). This
section is in two parts. The first part considers theories of disorder/distress, with a focus on
how mental health issues are linked to dysfunctional coping responses and poor emotional
management skills. Building on these theories, the second part outlines various theoretical
frameworks which connect disorder/distress to masculinity (Addis, 2008). For example, the
‘gendered responding framework’ suggests that emotional toughness norms are associated with
emotional management deficits in men.
2.4.1. Disorder, distress and coping
There are different frameworks for exploring mental health issues. This part briefly considers
biological and cognitive theories, before focusing on coping and emotional management.
One approach to mental illness adheres to the medical model of health highlighted above, and
accounts for illness in terms of brain dysfunction. For example, neurochemical theories of
depression have been proposed, like the monoamine deficiency model (Schildkraut, 1965),
which explains depression in terms of reduced activity of neurotransmitters such as serotonin
32
(Berton and Nestler, 2006), and is the basis for pharmacological treatments for depression
(Ferguson, 2001). Neurochemical ‘imbalances’ may be genetically acquired, but psychosocial
stressors are usually required to provoke disorder onset (Hayley et al., 2005). Other biological
approaches include linking depression to structural brain factors, including dysfunction of the
prefrontal cortex (George et al., 1994) or the limbic system (Mayberg, 2003).
Cognitive theories explain mental health in terms of dysfunctional mental processes. Some
theories implicate attentional information-processing biases, including selective preferences
for negative stimuli in depression (Strunk and Adler, 2009), or threatening information with
anxiety (Hunt et al., 2006). Other theories focus on maladaptive thought patterns (Beck et al.,
1979). Depression is linked to a ‘dysfunctional’ attribution style which interprets negative
events as internal (self-caused), stable (connected to enduring factors) and global (universally
applicable), e.g. ‘I’m always bad at everything’ (Abramson et al., 1978). Depression is also
associated with rumination, i.e. repetitively thinking about the causes, consequences and
symptoms of one’s negative affect’ (Smith and Alloy, 2009: 117). Cognitive therapy aims to
challenge and reconfigure these ‘depressogenic’ thought patterns (Beck et al., 1979).
A third framework for disorder/distress is the ‘psychosocial stressors’ perspective. This takes
a broader view, encompassing psychological and social factors, emphasising that stressful life
events can precipitate mental health issues (APA, 1994; Tennant, 2002), including depression
(Pace et al., 2010) and anxiety (Doron-LaMarca et al., 2010). As such, adversity is ‘causally
implicated in the onset of depressive and anxiety disorders (Turner and Lloyd, 2004: 481).
There are indications that overall exposure to traumatic events is greater for men than women
in the US (Hatch and Dohrenwend, 2007). However, the issue is not simply one of ‘exposure’
to stressors although particular events are seen as inherently stressful, people differ in their
ability to cope (Chokkanathan, 2009).
Coping theories view the individual as in a transactional relationship with their environment:
the environment imposes demands; the individual draws on internal and external resources to
meet these; if demands exceed resources, stress occurs (Lazarus and Folkman, 1984, 1987).
Theories of stress involve three factors (Chokkanathan, 2009): stressors (the source of stress);
resources (coping ability); and distress (emotional consequences). Coping is not just about
dealing with stressors, but with any subsequent distress, including distress unconnected to a
stressor, as in some types of depression. If distress is sufficiently severe and/or prolonged, it
33
can precipitate CMDs (Turner and Lloyd, 2004). Theorists identify various coping strategies,
or ‘response styles’ (Carver et al., 1989). These are classified as ‘problem-focused (targeting
the stressor), ‘emotion-focused(managing reaction to the stressor), or avoidance-focused’
(escaping the problem). These strategies can also be either cognitive or behavioural.
A cognitive problem-focused response could be rumination (Nolen-Hoeksema, 1991), while a
behavioural response could be ‘confronting’ the problem (Kaiseler et al., 2009). An emotion-
focused cognitive response could be cultivating positive thoughts, or trying to ‘accept’ the
problem (Luginaah et al., 2002), while a behavioural response could involve expressing one’s
feelings (Kaiseler et al., 2009). In terms of avoidance responses, a cognitive response could be
denying or distracting oneself from the issue (Appelhans et al., 2011), while behavioural
responses include suppressing negative thoughts/emotions through psychoactive substances
(Benson, 2010), or self isolation and avoidance of stressful situations (Plexico et al., 2009),
In terms of mental health, different strategies are seen as either adaptive (alleviating distress,
protective against disorders) or maladaptive (exacerbating distress, implicated in disorders)
(Aldao et al., 2010). The most maladaptive strategies are avoidance and rumination. Aldao et
al. suggest that there are gender differences here, with avoidance more common in men, and
rumination in women. Avoidance is causally linked to psychopathologies, including anxiety
(Roemer and Borkovec, 1994), depression (Borton et al., 2005), panic (Spira et al., 2004), self-
harm (Chapman et al., 2005), and eating disorders (Polivy and Herman, 2002). Not only is
suppression often ineffectual, it may even increase the salience of the suppressed qualia,
exacerbating distress (Wegner and Gold, 1995). The dysfunctional nature of avoidance as a
coping response is taken up in the next section, which explores how traditional masculine
norms around toughness encourage men to adopt this strategy, with negative consequences.
Recently, coping theory has embraced a more dynamic paradigm of emotional management
(Drach-Zahavy and Erez, 2002). Particular responses are still recognised as maladaptive, but
the selection of these responses is seen as indicative of poor management skills. For example,
avoidance is still seen as unhelpful, but a tendency to respond with this is conceptualised as
reflecting difficulties men have managing emotions generally (Addis, 2008). The concept of
emotional management has been developed across various models, including emotion work
(Hochschild, 1979), emotional regulation (Gross, 1999), emotional intelligence (Mayer and
Salovey, 1997) and self-regulatory coping (Carver and Scheier, 1998).
34
These models are located within a wider framework of self-regulation theory, encompassing
regulation of motivation, cognition, social interactions, and behaviour (Karoly, 1993). In self-
regulation theory, individuals are seen as volitional agents, capable of conscious, wilful and
motivated goal selection, decision making, planning and goal-directed determination (Drach-
Zahavy and Erez, 2002). In this context, emotional management concerns the self regulation
of emotion, using cognitive and/or behavioural strategies to evoke, suppress or alter feelings
and emotions (Schrock et al., 2009). The goal of these strategies is to reduce negative affect
through the selection and implementation of specific coping strategies (Baumeister and Vohs,
2003). This is a meta-coping’ model, in which the success of coping responses is monitored
from a higher perspective: the individual is reflexively aware of ongoing progress towards
the goal through feedback processes which indicate: the effectiveness of enacted strategies;
how experiential and circumstantial factors are changing; and whether it is necessary to alter
the strategy (Carver and Scheier, 1998, 2002).
One of the most prominent emotion management models is emotional intelligence (EI, Mayer
and Salovey, 1997). EI is constructed as hierarchical, involving awareness of emotions, and
ability to manage them (Goleman, 1995). While various models of EI have been proposed,
Mayer and Salovey's (1997) hierarchical four-branch model, developed over various papers
(Salovey and Meyer, 1990; Meyer et al., 1999, 2000, 2001, 2003, 2008a, 2008b), is the most
‘commonly accepted’ (MacCann et al., 2011). The ‘lowest’ branch is emotional awareness and
expression. The second branch is the ‘emotional facilitation of thought:’ the ability to generate
emotions in order to use them in other mental processes’ (Day and Carroll, 2004: 1444). The
third branch concerns ‘understanding emotional patterns.’ The ‘highest’ branch is the strategic
management of emotions.
The lower two branches, labelled collectively as ‘experiential EI,’ i.e. information processing
of emotional stimuli, are conceptualised as precursors for the higher two branches, known as
‘strategic EI,’ i.e. the strategic management of this information. Rather than rigidly adopting
coping strategies, those with high EI are conceptualised as selecting responses appropriate to
their situational demands (Brown et al., 2007). Moreover, strategic EI goes beyond ‘reactive
coping,’ i.e. dealing with stressful events. It also includes positive notions such as pro-active
coping (anticipating future stressful events and modifying their impact before they occur)
(Aspinwall, 2005), and the generation of positive emotions (Seligman and Csikszentmihalyi,
35
2000). Some regard EI as a dispositional trait (Petrides and Furnham, 2003), However, Mayer
et al. (2008b) conceptualise it as an ability amenable to development, a view supported by
control-group interventions which have increased EI (Crombie et al., 2011).
High levels of EI are conceived as protective against disorders and distress, helping moderate
negative emotions, and are linked to positive mental health outcomes (Berking et al., 2008).
Conversely, poor emotional management skills, also labelled ‘affect dysregulation,’ are seen
as a critical ‘transdiagnostic factor’ for mental illness (Aldao et al., 2010). Dysregulation is
‘integral to the development and maintenance of a wide range of mental disorders’ (Berking et
al., 2008: 1230), including depression (Borton et al., 2005), anxiety (Mennin et al., 2007), and
substance abuse (Sher and Grekin, 2007). This link between emotional management deficits
and mental health issues is important, as men are seen as more likely to have such deficits,
partly due to the influence of masculinity norms (Addis, 2008). Connections between
masculinity and mental health are explored in the next section.
2.4.2. Masculinity, disorder and distress
A number of theoretical frameworks have been identified and articulated by Addis (2008),
which seek to understand the links between masculinity and mental health. In various ways,
these frameworks explore how ‘restrictive norms defining how men should think, feel and
behave’ particularly the prescription that men should be emotionally tough and stoical
influence how men experience, express and respond to distress and depression
1
(Addis, 2008:
157). Addis’ own ‘gendered responding framework’ proposes that traditional gender norms
influence the way men respond to negative emotions. The ‘masked depression framework’
(Cochran and Rabinowitz, 2000) contends that men experience depression, as conventionally
understood, but that it is concealed from themselves and others. The ‘masculine depression
1
Addis’ (2008) paper is presented as an exploration of men and depression. However, he critiques
conventional understandings of depression, arguing that men experience depression in ways that fall
outside traditional diagnostic criteria. Moreover, he addresses a range of ‘distressing emotions,’ from
‘basic negative affect to an episode of major depression’ (p.154). He suggests that ‘masculinity can play
a role not only in how men respond to depression as a disorder (“depression with a big D”), but also in
how they respond to negative affect in general, including depressed mood, grief, sadness, and so on’
(p.160). Given this conceptual indeterminacy around the term ‘depression,’ and the range of negative
emotional states covered in the paper, the present study uses the less specific term ‘distress’ alongside
depression when discussing Addis’ frameworks.
36
framework’ states that men are liable to a ‘phenotypic variant’ of depression, characterised by
‘externalising behaviours,like anger. The frameworks are explored below. First, it is worth
articulating why the issue of masculinity and mental health is important.
On the surface, the mental health of women appears worse than men. Gender differences are
often noted in rates of CMDs, with women nearly twice as likely to experience these as men
(McManus et al., 2009). This trend is complicated with variations by ethnicity (Weich et al.,
2004), age (Bebbington et al., 1998), and socio-economic status (SES) (McManus et al., 2009).
For example, men appear more affected by poverty than women: men in the poorest 5th of the
population are almost three times more likely to have CMD than men in the richest 5th, while
for women the ratio is only two to one (EHRC, 2010). Thus the ‘intersectionality’
1
paradigm
cautions against generalising by gender alone, as variation among men is produced by the way
gender ‘intersects’ with other identity categories, like ethnicity or SES. However,
intersectionality notwithstanding, higher rates of CMDs in women, particularly depression, is
‘one of the most widely documented findings in psychiatric epidemiology’ (Kessler, 2003: 6).
However, there is concern that men experience and express distress and depression in other
ways. Men account for two out of every three deaths from alcohol (ONS, 2011b), and are three
times more likely to commit suicide than women (ONS, 2011c). In accounting for these trends,
theorists have argued that rather than ‘internalising’ distress as sadness, men are more likely to
‘externalise’ it in various ways, including anger, aggression, risk-taking, substance/ alcohol
use, over-work and suicide (Pollack, 1998; Cochran and Rabinowitz, 2000; Brownhill et al.,
2005). Theorists argue that this pattern of distress is overlooked by generic depression
diagnostic criteria, which reflect ‘internalising’ responses seemingly favoured by women, e.g.
rumination, and that this diagnostic bias explains the apparently lower rates of depression in
men (Kilmartin, 2005).
Various theoretical frameworks have been outlined by Addis (2008) to understand the links
between masculinity, depression and distress. First, Addis’ ‘gendered response framework’
1
Intersectionality highlights the limitations of considering individual categories of identity (e.g. race,
gender) in isolation (Hankivsky and Christoffersen, 2008). The paradigm focuses on the ‘interactions
between social hierarchies,’ and how an individual’s ‘location in multiple shifting categories shapes
experience in ways that are more than simply additive’ (Bates et al., 2009: 1002).
37
suggests masculine norms influence how men respond to emotions. This framework emerged
from Nolen-Hoeksema's (1991) ‘response-styles’ theory, which outlined gendered differences
in emotional behaviour, with males tending towards an affective style known as ‘restrictive
emotionality’ denial, suppression or disconnection from emotions. Response styles theory
sought to account for the differential levels of depression in men and women. Understanding
depression in a conventional diagnostic way, it argued that a tendency towards rumination
among women led to higher levels of depression.
The gendered responding framework adapted response styles theory in various ways. First, it
widened the focus from depression to highlight patterns of emotional responses to negative
emotions in general. Second, drawing on social learning theory, the framework highlighted the
way socialisation pressures encouraged particular forms of gendered responding. Thus
‘restrictive emotionality’ is linked to traditional masculine norms, e.g. toughness, which ‘lead
men to distract, avoid or get angry in the presence of negative affect’ (p.161). For example, a
study by Chaplin et al. (2005) found boys’ expressions of sadness decreased 50% from pre- to
early school, influenced by parental discouragement of emotional expression. Addis argues
that restrictive emotionality in men leads to maladaptive coping responses, such as emotional
suppression, and poor emotional management capacities, including alexithymia (the ‘inability
to recognise or verbalise emotions;Honkalampi et al., 2000: 99). As discussed, suppression
and emotional management deficits are implicated in the exacerbation of distress and the
development of disorders (Gross and Levenson, 1997), and in externalising behaviours like
aggression (Cohn et al., 2010).
A second approach to masculinity and depression/distress identified by Addis (2008) is the
‘masked depression framework’ (Cochran and Rabinowitz, 2000). This framework suggests
that men do experience ‘prototypic’ depression, corresponding to conventional diagnostic
criteria, but that this is ‘masked’ from men themselves, and from others. Addis (2008: 157):
[T]he disorder is definitively present but hidden in some fashion.’ First, men may experience
symptoms like low mood, but are unable to recognise it as such. This inability connects to the
idea of alexithymia introduced above. Moreover, even if depression/distress is recognised by
men, they may be reluctant to reveal this. Such ‘external’ masking connects to a larger body of
work which suggests men are reluctant to admit to or seek help for problems in general, not
just mental health issues (Addis and Mahalik, 2003).
38
It is suggested that traditional masculine norms discourage men from admitting vulnerability
(Chapple and Ziebland, 2002). Similarly, refraining from showing weakness can be a way of
performing masculinity (Saltonstall, 1993). Such norms are often cited in explaining men’s
reluctance to seek help and/or engage with health-care services (Addis and Mahalik, 2003: 5).
Other factors may contribute to such reluctance, including a systemic bias against recognising
distress in men (Peveler et al., 2002). Moreover, recent work has highlighted variation among
men, in that some are willing to seek help (Galdas et al., 2007) this point is explored in the
empirical review, which looks at men resisting or redefining hegemony in constructive ways.
Nevertheless, Addis and Mahalik conclude that ‘a large body of empirical research supports
the popular belief that men are reluctant to seek help.’
There are suggestions that men are particularly reluctant to seek help for mental health issues.
Disclosure for depression may be particularly taboo among men in comparison to physical
ailments (O'Brien et al., 2007). It is suggested that the lack of emotional control involved in
depression means it is often constructed as a feminised illness (Doyal et al., 2009). If men do
acknowledge that they are suffering, they may be reluctant to admit that emotional distress is
the problem. For example, men diagnosed with depression may find it easier to construct it as
stress (O'Brien et al., 2005), or to highlight physical aspects of their suffering, e.g. lack of
energy, rather than emotional issues, like feeling sad (Danielsson and Johansson, 2005). Also,
in discussing the aetiology of depression, men are found to be more likely to emphasise being
‘struck down’ by external causes, like work pressure, than by an inner ‘flaw’ (Danielsson et
al., 2009). The masked depression framework suggests that these issues can render men’s
depression invisible, preventing them from seeking and/or receiving help.
The healthcare system itself may contribute to men’s distress being overlooked. Reluctance to
seek help may be exacerbated by the way healthcare settings are seen by men as ‘feminised
spaces’ (Robinson and Robertson, 2010). Even if men do seek help, their distress may be
missed. Clinicians too may be influenced by gender stereotypes that men are less vulnerable to
emotional problems, and be less sensitive to detecting depression in men (Peveler et al., 2002).
Furthermore, aspects of the way some men express depression, like anger, can be less likely to
emerge in clinical interviews (Winkler et al., 2006). If such responses do emerge, clinicians
may focus on the presenting symptom and miss the underlying distress (Rabinowitz and
Cochran, 2008). Thus there are calls for greater sensitivity in dealing with depression in men
(Oliffe and Phillips, 2008). The WHO has recognised the importance of adapting health-care
39
to men’s needs (CSDH, 2008). Efforts have been made to reach to men in targeted ways,
including refashioning health engagement in ‘male-friendly’ terms, e.g. using metaphors of
vehicle maintenance to resonate with men’s ‘functional and mechanistic attitudes’ to health
(Burton et al., 2009).
A third approach to masculinity and depression is the ‘masculine depression framework.’ This
focuses on the externalising behaviours presented above, and argues that these constitute a
‘phenotypic variant of prototypic depression (Addis, 2008: 159). That is, in contrast to the
masked depression framework (involving ‘conventional’ depression, as defined by standard
diagnostic criteria, being hidden), in this masculine depression framework, the externalising
behaviours are conceptualised as a distinct ‘male-specific’ form of depression (Pollack, 1998;
Cochran and Rabinowitz, 2000; Brownhill et al., 2005; Winkler et al., 2006; Chuick et al.,
2009). These behaviours are linked to traditional masculine norms which ‘encourage action
and discourage introspection’ (Addis, 2008: 159), which again connects to ideas of restrictive
emotionality and alexithymia.
In addition to these frameworks, other conceptual models linking masculinity to distress have
been articulated. Pleck's (1995) ‘gender role strain’ model suggests that masculine norms can
cause stress as men ‘struggle to meet unattainable and contradictory standards of masculinity’
(Addis, 2008: 159). This inner conflict, or ‘intrapsychic strain’ in Pleck’s terminology, may be
generated by various norms, e.g. failure to achieve expectations of success. The concept of
gender role strain also intersects with the idea of ‘masked depression’ if men are depressed,
distress may be compounded by ‘strain’ around the idea that they should ‘suffer in silence.’
A final link between traditional masculine norms and mental health was not identified by
Addis, but is suggested by Connell’s (1995) theory of masculinities. Hegemonic masculinity
has been implicated in mental health issues through the marginalization of those who do not
conform, as the censuring process by which norms are enforced can be distressing. A notable
example is homosexuality. Many gay men suffer homophobic harassment (Mills et al., 2004).
Links have been made between such censure and distress. Warner et al. (2004) found 31% of
a sample of 2430 lesbian, gay, bisexual and/or transgendered (LGBT) people in Britain had
attempted suicide; such attempts were associated with recent physical attacks or bullying, but
not with higher scores on mental disorder. Such marginalization may also explain why men
persist with traditional forms of masculinity, even to the detriment of well-being, as
40
marginalization resulting from deviance may be even more detrimental than the behaviour
itself (Saewyc et al., 2008).
2.5. Positioning the current study
In theoretical terms, the present study is located at the intersection of Addis’ frameworks and
Connell’s theory of masculinities. This is largely unexplored terrain. As Addis (2008:159)
acknowledged in critiquing his own presentation of the frameworks, while there is ‘a growing
body of literature on variations in the social construction of masculinities... this work has not
been integrated into the literature on men and depression.’ He suggested that Connell’s theory
might reveal variation among men in terms of the extent to which these frameworks apply to
them. As it stands though, masculinity is often used in a singular way as a ‘catch-all’ term to
explain problems experienced by males (Mac an Ghaill and Haywood, 2012: 483). This view
presents men along a continuum, from too much masculinity, producing aggression, to too
little, causing vulnerability/risk.
However, constructionist theories argue that gender constructions are not set in stone, and are
capable of being dynamically refashioned in more adaptive ways. The theory of masculinities
opened up conceptual space for acknowledging variation in men. Recognition that hegemonic
ideals can shift according to local configurations allows for a more nuanced conception of the
relationship between masculinity and mental health. This more nuanced view has begun to be
examined in relation to physical health, where more constructive approaches to health in men
have begun to be explored (Sloan et al., 2010). However, men have long been overlooked and
undertheorised in mental health (Riska, 2009). Despite increasing theoretical and empirical
interest in the links between masculinity and mental health, as Addis admitted, there has been
minimal exploration of heterogeneity in men when it comes to mental health.
There is need for greater understanding of men’s experiences of distress and mental health,
particularly around the heterogeneity of men’s approaches to managing well-being (Ridge et
al., 2011). The empirical review chapter highlights promising studies which suggest that men
can cope adaptively with negative emotions, and negotiate more constructive approaches to
mental health. However, more research is needed to explore how men are able to adopt such
approaches (Chuik et al., 2009). Moreover, work on men’s engagement with mental health is
generally limited to coping with depression, with assessment of engagement often confined to
41
help-seeking. There is no research examining men’s strategies for engaging pro-actively with
mental health and broader well-being. The present study seeks to address this lack.
2.6. Summary
The chapter began by discussing social constructionism, and introducing narratives. It then
highlighted conventional approaches to masculinity, e.g. roles and stereotypes, observing that
traditional norms valorise toughness, and denigrate ‘feminine’ qualities like emotionality. A
constructionist perspective was then explored, with gender constructed relationally through
interaction. Connell’s (1995) theory was introduced: while there are multiple masculinities, in
any setting, a particular form will be ‘hegemonic,’ constraining behaviours and marginalizing
men and masculinities that do not attain to the hegemonic standard.
The chapter then explored perspectives on well-being. From a biological perspective, well-
being was linked to health. From a psychological standpoint, well-being was characterised as
the absence of distress and disorders, and the presence of positive qualities, like SWB. From a
social perspective, contextual factors which influenced well-being were considered, such as
‘social capital.’ Various critiques of well-being were also noted. The focus moved to theories
of distress and disorders. In particular, the idea was introduced that mental health problems are
linked to maladaptive coping responses and poor emotional management skills.
Finally, frameworks linking masculinity to depression/distress were discussed. The gendered
responding framework suggested that norms around emotional toughness link to restrictive
emotionality in men, where men are liable to avoid/suppress negative emotional states, with
deleterious consequences. The masked depression framework proposed that men experience
depression, but that this can often be concealed from themselves and others. The masculine
depression framework argued for a ‘male-specific’ depression, where distress is externalised
in various ways. Lastly, it was suggested that social constructionist theories of masculinity had
not yet been brought to bear on the connections between masculinity and mental health, hence
the value of the current study.
42
CHAPTER 3
EMPIRICAL REVIEW
The theoretical review introduced a number of frameworks connecting masculinity to mental
health issues. The frameworks suggested that traditional masculine norms (e.g. toughness)
were implicated in how men experienced and expressed depression/distress. However, Addis
(2008) recognised that the frameworks had not yet incorporated recent social constructionist
perspectives, like Connell’s (1995) theory of masculinities. This acknowledgment provides the
conceptual space and theoretical justification for the current study. Connell’s theory recognises
men and masculinities as diverse. It is thus possible that some men may engage with mental
health and well-being in more constructive ways than those suggested by Addis’ frameworks.
However, research here is sparse, hence the relevance of the present study.
Only a handful of studies have explored whether men can engage with their mental health in
constructive ways. However, other empirical work relates to the topic in various ways, as this
chapter explores, in five sections. The first section details recent studies which challenge the
idea that men are poor at engaging with emotions and mental health, and which indicate that
some men are able to resist or redefine hegemony in adaptive ways. However, no studies have
examined men’s strategies for engaging proactively with mental health. It is proposed that
meditation may be one such strategy.
The remaining sections focus on meditation. The second section introduces its historical roots
and various forms. The third section suggests that, from a cognitive neuroscience perspective,
meditation is conceptualised and studied in terms of attention development. The fourth section
explores the idea that meditation may facilitate well-being, partly because attention
development engenders EI. The fifth section considers how the social context of meditation,
e.g. involvement with Buddhist groups, may also impact upon well-being.
3.1. Resisting or redefining traditional hegemonic masculinity
43
Influenced by Connell’s (1995) theory of masculinities, scholars have begun to take a more
nuanced view of gender, and explore how some men have negotiated masculinities that are
potentially more conducive to well-being. This nascent body of work includes a number of
ideas, which are considered below. First, studies have challenged the idea that men are poor at
engaging with or expressing emotions. Second, men are capable of expressing care and
fashioning a ‘loving’ masculinity. Third, not all men are unwilling to seek help. Fourth, men
are capable of taking on other health behaviours, like reducing alcohol use. Fifth, in relation to
mental health, some men are found to deal with depression in constructive ways. However, in
outlining these studies here, the point will be made that men are still often influenced by
traditional hegemonic norms, and are redefining rather than resisting these. Finally, it will be
suggested that male meditators may be a case of men engaging pro-actively with well-being,
although no studies have hitherto explored this.
First, restrictive emotionality is not inevitable in men. When men are given ‘permission and
safety to talk’ they have ‘much to offer’ about their emotional experiences, and are capable of
insightfully analysing and sharing their emotions, even around sensitive personal issues such
as impotence following prostatectomies (Oliffe, 2005: 2257), or cancer (Hilton et al., 2009).
Other studies have shown emotional engagement in men caring for others, such as children
(Anderson et al., 2002), elderly parents (Campbell and Carroll, 2007), or ill spouses (Emslie et
al., 2009). Moreover, even if for some men, doing masculinity involves being emotionally
inexpressive, this does not mean such men are not or cannot be emotionally sensitive. Allen
(2005) observed that young men in focus groups engaged in identity management, wielding
traditional hegemonic discourses, e.g. of emotional detachment. However, underneath their
‘bravado,’ a ‘softer’ masculinity emerged as men discussed vulnerability, and desire for love
and intimacy. This finding highlights gender as a complex performance, and cautions against
making generalisations about men’s emotional capabilities.
Beyond simply expressing emotions, men are capable of showing care. Fatherhood appears to
be particularly liberating in enabling men to embrace a more loving masculinity (Williams,
2007). However, caring does not necessarily mean resisting traditional hegemonic norms, but
can often involve interpretative flexibility, incorporating caring within more conventional
masculine constructions. For example, older men caring for spouses pragmatically reframed
masculinity to incorporate caring as a necessary capacity as husbands (Ribeiro et al., 2007). In
a similar study, Bennett (2007) found that while older male carers endorsed emotionality, it
44
was still encompassed within a ‘masculine’ frame which stressed the importance of control,
responsibility and rationality.
In this way, men may both endorse and challenge traditional norms around emotionality.
Interviews with ex-servicemen revealed that although the military valorised a tough hyper-
masculinity prohibiting emotionality, a non-traditional masculinity based on interdependence
and caring was embedded within it (Green et al., 2010). Likewise, men in professions seen as
feminine, e.g. nursing, may enact traditional masculinity and adopt ‘feminine’ qualities, with
masculinity thus partly subverted and partly maintained (Pullen and Simpson, 2009). While
masculinity is expanded to include caring, male nurses assert their difference from women by
reframing discourses of care to privilege masculine attributes, e.g. describing their emotion
work as more rational.’ Pilgeram (2007) describes this appropriation of emotions within a
rational frame as the ‘masculinisation’ of emotion.
More nuanced gender enactments have also been examined around help-seeking for physical
health, where scholars have questioned simple generalisations of men as ‘reluctant’ to seek
help. Some studies have found commonalities between the sexes: a qualitative study of men
and women with acute coronary syndrome found that their help-seeking behaviours was ‘not
easily parsed into distinct binary gender patterns’ (Galdas et al., 2010: 18). Patients of both
sexes described behaviours typically viewed as ‘masculine,’ e.g. reluctance to seek help, and
‘feminine,’ e.g. worrying about health. Others studies have revealed diversity within men in
the UK. Galdas et al. (2007) found that while white men emphasised stoicism, men of South
Asian ancestry valued family responsibility and help-seeking as masculine attributes. These
differences were reflected in greater help-seeking among the latter.
Rather than viewing men as either ‘willing’ or ‘reluctant’ to seek help, the picture may be more
complicated. Robertson (2006) suggested that men endeavour to maintain hegemonic
‘citizenship’ by negotiating a complex balance between competing health-related narratives:
responsibility (‘should care’) vs. risk (‘don’t care’), and control (health vigilance) vs. release
(indulgence). Moreover, the way men negotiate these tensions may evolve. Studying smoking
behaviour in fathers, Bottorff et al. (2006) found that while risk-taking ideals had initially led
men to smoke, fatherhood prompted a re-evaluation of priorities, with greater emphasis on
control. Delays in help-seeking may thus be less about adherence to hegemonic norms, and
45
more that it takes men time to negotiate an alternative masculine identity taking health-status
changes into account (McVittie and Willock, 2006).
It is argued that men who seek help may not be resisting traditional hegemonic norms, but are
re-interpreting norms to accommodate help-seeking. In focus groups, O'Brien et al. (2005)
found that most men constructed help-seeking as ‘unmasculine.’ However, some were willing
to seek help if it helped to support more valued aspects of masculinity, such as work identity.
Similarly, Noone and Stephens (2008) report that New Zealand men only spoke positively
about help-seeking by positioning it in a hegemonic frame as a knowledgeable use of health-
care services, contrasting this with less-informed behaviour of ‘weaker’ men. These studies
highlight the complexities of the intersection between health behaviours and masculinity
while some men may re-define masculinity in ways that facilitate well-being, these men often
still appear to need to engage with hegemonic norms at some level.
Similar ‘reinterpretations’ of traditional norms are noted around other health behaviours, like
abstinence. Alcohol use is recognised as a ‘resource in the construction of masculinity’ (De
Visser and Smith, 2007: 609), a way for men to ‘embody the ideal, dominant and expected
form of masculinity’ (Peralta, 2007: 751). However, studies have observed that some men are
able to avoid alcohol. Such men may not necessarily be resisting traditional hegemonic norms
though. De Visser et al. (2009) found that men who forewent alcohol often upheld traditional
norms of independence and strength, but just attached these values to alcohol abstinence.
Reconstructing masculinity in more adaptive ways aligning with or challenging traditional
hegemony has been examined in the context of mental health, mainly depression. Recent
studies have explored how some men have responded to depression in relatively constructive
ways. Emslie et al. (2006) found certain men were able to frame their illness experiences in a
positive light and challenge ‘macho’ norms, creating a valued alternative masculinity based on
sensitivity. In contrast, others also constructed their plight in positive terms, but in ways
aligning with traditional hegemony, e.g. as a ‘heroic struggle.’
Similarly, Oliffe et al. (2010) observed that some men responded positively to depression by
seeking help; however, it was constructed as a rational way of regaining self-control. Chuick
et al. (2009) noted that some men with depression escaped a counterproductive cycle of
dysfunctional coping, seeking help through therapy. However, this positive response was
46
usually only through the intervention of a loved one who ‘destigmatised’ help-seeking. Such
studies confirm that engagement with well-being often depends on men re-constructing it as an
affirmation of traditional hegemonic norms, and less often as resisting these.
There is need for more research on men’s mental health (Riska, 2009). The few studies on
men’s experience of such issues have focused on depression, with assessment of engagement
usually limited to help-seeking. There is no research examining men’s strategies for engaging
pro-actively with their mental health and well-being. In the current study, men were sought
who were likely to positively self-manage their well-being. It was envisaged that men who
meditate might represent such a group, as meditation is linked to positive outcomes on many
mental health indicators (Mars and Abbey, 2010), as outlined below. However, despite
increasing interest in meditation in diverse academic and practical fields (Brown et al., 2007),
there are no studies exploring meditation in relation to masculinity and men’s mental health.
A few articles have touched on links between meditation and masculinity tangentially. Barker
(2008) explored emotional life stories of men who had found meaning through Buddhism.
Interviews with members of an Australian men’s group reported that a meditation at the start
of meetings served as a ‘ritual’ to strengthen interpersonal bonds (Reddin and Sonn, 2003).
Forbes (2005: 154) wrote a reflective account of using meditation with football players to help
them ‘challenge and reflect on the problematic aspects of masculinity.’ In a theoretical essay,
Hwang (2002: 98) argues that in Asian cultures, Buddhist influences have encouraged
‘feminine’ communication styles in men ‘harmonious, non-argumentative, mild, humble.’
Orr (2002) speculates that meditation could help challenge patriarchal practices in education.
Although such research is encouraging, no studies have explicitly examined the intersection
between masculinity, meditation and well-being. The work that comes closest is a theoretical
piece on male distress by Kingerlee (2012), featuring a speculative sentence in the discussion,
hypothesising that by promoting awareness, meditation may ameliorate tendencies towards
emotional disconnection, which contributes to men’s distress. Thus, as Kingerlee identifies,
and as the following sections explore, there are reasons to think meditation may be conducive
to men’s well-being. While none of the studies below examined men specifically, the mixed-
sex samples in these suggest that their findings may be applicable to men.
3.2. What is meditation?
47
This section introduces meditation. It explores the range of meanings attached to the term, and
locates it historically as a practice associated with Buddhism. It ends by highlighting how
meditation has become a focus of research, particularly in terms of attention development.
The term ‘meditation’ has evolved historically (Fisher, 2006). Its etymological roots lie in the
Latin term meditatio, to engage in reflection, and originally referred to all types of intellectual
exercise in the West. Later meditation functioned as a synonym of ‘contemplation,’ e.g. on the
sufferings of Christ. In the 19th century it came to refer to spiritual practices associated with
Eastern religions. Most religious traditions incorporate some form of meditation, e.g. Christian
contemplative prayer (Cunningham and Egan, 1996). Even within traditions, there are different
forms (Murphy et al., 1997). Meditative practices are also identified in areas as diverse as tribal
dancing (West, 1987) and artistic performance (Csikszentmihalyi, 1990).
Forms of meditation explored in the current study derive mainly from Buddhism, a tradition
built upon the teachings of Siddhartha Gautama. Gautama, usually known by the honorific
‘Buddha,’ meaning ‘Enlightened one,’ lived between around 480 and 400 BC in present-day
Nepal, according to most scholars, (Harvey, 1990). The cultural context of this time was one
in which the Hindu Bhramanic religion dominated, which promoted yoga practices dating back
to around 1500 BC, from which meditation emerged (Dumoulin, 1979).
Reliable accounts of the development of Buddhism are hampered by the lack of historicity of
the early source documents (Harvey, 1990). Nevertheless, Buddhism generally mythologizes
Gautama’s life with the following narrative (Gyatso, 2007). Living a sheltered life until 29, a
series of encounters with people who were ill or dying prompted an existential crisis, leading
him to pursue a religious existence exploring the ‘human condition’ (Kumar, 2002). After five
years of austere yogic practices, he rejected asceticism and meditated for 49 days until he
gained enlightenment. He spent the next 45 years formulating and propagating his insights,
referred to as the ‘Dharma,’ a Sanskrit term meaning ‘laws’ (Kabat-Zinn, 2003).
Central to the teachings are the ‘Four Noble Truths,’ a remedy in the form of a ‘medical
diagnosis’ for the alleviation of suffering: suffering is universal; it has a cause; cessation is
possible; achieved by following the ‘Noble Eightfold Path,’ a path of ‘right living,’ which
includes meditation and other moral recommendations (Thrangu, 1993). After the Buddha’s
death, various traditions evolved (Harvey, 1990). The Therevadan school adhered closely to
original scripture. The later Mahayana tradition (circa 0 AD) extended the original teachings,
48
developing elaborate philosophies. Exported into China in the 6th century, Buddhism mixed
with indigenous Taoism to produce the less mythological Zen Buddhism (Dumoulin, 1979).
With so many meanings and forms attached to the notion of meditation, despite increasing
academic interest, much of the research undertaken has been criticised for lacking adequate
operational definitions (Cardoso et al., 2004). That ‘meditation’ is conceptually ‘slippery’ is
expected from a poststructuralist perspective (Rail, 1998). Rather than advance a particular
definition of meditation, the current study is interested in exploring the different meanings men
themselves give to the term. Nevertheless, elsewhere in the literature, in an attempt to bring
classificatory rigour to the proliferation of practices, Mikulas (1990) suggested these be
differentiated along four parameters: form; object; attitude; and behaviours of mind.
Firstly, meditation can take different physical forms, including: rhythmic movements, like tai
chi (Field, 2011a); Yoga, i.e. physical postures held for varying durations, accompanied by
breathing techniques (Field, 2011b); walking (Jin, 1992); lying down (Ditto et al., 2006); and
even dancing (Palmer, 1980). The most common form is sitting, which has various forms,
including full-lotus (cross-legged, feet on opposing thighs), half-lotus (one foot on opposing
thigh), or upright on a chair (Adiswaranda, 2007). A recommendation is that the back is kept
straight (see Ong, 2007, for the anatomical significance of this posture). Eyes are generally
closed, although certain traditions recommend partially-open eyes (Austin, 1998).
Secondly, in terms of object, meditation can involve an intentional mental focus on a range of
phenomena. The Dalai Lama defines meditation broadly as a deliberate mental activity that
involves cultivating familiarity, be it with a chosen object, a fact, a theme, a habit, an outlook
or a way of being (Gyatso, 2006: 98). The focus can be directed internally, towards bodily
sensations, cognitions and feelings (Zindel et al., 2002), or outwardly. This inward focus may
involve concentrating on particular cognitions, e.g.: mantras (repeated words/phrases, used in
Transcendental Meditation, Travis, et al., 2009); koans (paradoxical statements/questions that
‘cut through’ thought, used in Zen, Braverman et al., 1994); ideas (e.g. of death, Perreira,
2010); and imaginative images (Vessantara, 2002). Focus can also be directly outwardly to
visual stimuli, like religious icons or mandalas (meaningful geometric patterns, as in Tibetan
Buddhism, Saso, 1990), and auditory or olfactory stimuli (e.g. bells, incense). Combinations
of stimuli can be assembled to create a shrine (Reynolds and Carbine, 2000).
49
Thirdly, focus on the objects of meditation is often accompanied by the cultivation of certain
attitudes, from relatively neutral, e.g. acceptance, to more positive, e.g. kindness (Siegel et al.,
2009). For example, Kabat-Zinn (2003: 145) argues that meditation should be conducted with
an ‘open-hearted, friendly... affectionate, compassionate quality.Stronger still, some practices
involve devotional stances of reverence. Although Buddhism is generally not seen as theistic,
some traditions revere the Buddha and other figures as deities (Harvey, 1990). The importance
of positive attitudinal qualities is discussed in the fourth section of the chapter.
The last component, behaviours of mind, refers to types of attention. Meditation practices are
classified as involving one of two types (Lutz et al., 2008a). Focussed attention (FA) refers to
concentrative, sustained attention on an object. Open-monitoring attention (OM) is receptive
monitoring of the wider moment-to-moment content of experience. Buddhism uses Pali,’ the
Indian language of early Buddhist texts, to refer to practices involving these types of attention
as ‘samathaand ‘vipassana’ respectively. However, it is difficult to differentiate in practice
between FA and OM, as most meditations incorporate both, or fall on a continuum between
them (Wallace, 1999).
Meditation has become a focus of increasing scientific interest in the last 50 years (Ospina et
al., 2007). For many researchers, attention is the defining feature of meditation: The need for
the meditator to retrain his attention, whether through concentration or mindfulness, is the
single invariant ingredient... in every meditation system (Goleman, 1988: 107). Prominent
definitions of meditation in the literature centre on attention. Walsh and Shapiro (2006: 228-
229) define meditation as a family of self-regulation practices that focus on training attention
and awareness in order to bring mental processes under greater voluntary control and thereby
foster general mental well-being and development and/or specific capacities such as calm,
clarity, and concentration.’ Similarly, Cahn and Polich (2006: 180) suggest that ‘regulation of
attention is the central commonality across the many divergent methods.’
This emphasis on attention partly reflects the process of translating a phenomenon usually
associated with religious or anthropological studies into an activity amenable to experimental
investigation (Chiesa et al., 2011). Classical descriptions of meditation are not conducive to
operationalization, and so researchers have articulated psychologically-orientated definitions
centred on cognitive processes, and attention in particular. The preference for such definitions
is evident in the theoretical and empirical interest in mindfulness meditation, which in recent
50
years has emerged as the pre-eminent focus of research (Chiesa and Serretti, 2009). Kabat-
Zinn's (2003: 145) widely-cited ‘operational working definition’ of mindfulness defines it as
awareness that arises through paying attention on purpose, in the present moment, and non-
judgementally to the unfolding of experience moment by moment.’ From this perspective,
meditation can be conceptualised as the training of attention, as the next section explores.
3.3. Developing attention
Grossman (2010) argues that meditation is so closely linked with attention/awareness that it
should be studied as a consciousness discipline,’ i.e. analysed from a cognitive neuroscience
perspective. This means exploring the cognitive processes involved, and neurophysiological
correlates of these processes. This section focuses on these in turn.
3.3.1. Cognitive aspects
Before exploring how meditation impacts upon attention, a brief overview of attention will be
helpful. Firstly, it is useful to distinguish between attention and awareness. While these terms
are often used synonymously, they are distinct, though related, concepts (Koch and Tsuchiya,
2007). Awareness refers to conscious experience: conscious registration of stimuli, including
the five senses, the kinaesthetic senses, and the activities of the mind (Brown et al., 2007:
212). There are different types of awareness. Phenomenal awareness refers to the subjectivity
of experience, a catch-all term for the experience of qualia (Fell, 2004). Access awareness
refers to aspects of conscious experience being available for use in reasoning and rationally
guiding speech and action (Block, 1995: 227).
Phenomenal awareness itself comprises subtypes pertaining to different sensory modalities,
e.g. visual, or proprioceptive (Sarrazin et al., 2008). There are also higher forms of reflexive
meta-awareness of one’s mental processes (Siegel, 2007). Awareness without content may
even be possible: this ‘non-dual’ awareness is described as a form of self-transcendence’
(Travis and Shear, 2010), involving the dissipation of the dualistic ‘subject-object construct’
(a subject who is aware of an object), leaving a bare ‘field’ of awareness (Josipovic, 2010).
While non-dual awareness is a disputed phenomenon, and may be rarely achieved in practice,
it is linked by scholars to advanced meditation skills (Wilber, 1997).
51
In contrast, attention refers to mechanisms which control what enters awareness (Fell, 2004).
This involves enhancement of the way information is processed from a particular area of the
sensory field (Rafal and Posner, 1987), where attention modulates cognitive and perceptual
processing by directing resources to relevant internal or external stimuli (Wiech et al., 2008).
As Austin (1998: 69) articulates the distinction, awareness implies sensate ‘reactivity, while
attention is a ‘searchlight: Attention reaches. It is awareness stretched toward something. It
has executive, motoric implications. We attend to things.’
Attention is theorised as modular, comprising interrelated subcomponents that are controlled
by executive processes within a Supervisory Attention System (Norman and Shallice, 1986).
This model proposes that inhibitory and excitatory cognitive processes work together to direct
and switch attentional processes to facilitate selective, divided and sustained attention. A
prominent framework proposes three functionally distinct but overlapping neural networks:
alerting; orienting; and executive attention (Posner and Petersen, 1990); these networks are
anatomically distinct with identified anterior and posterior attentional systems. Additionally,
Mirsky et al. (1991) added the faculty of attention switching.
Alerting (also called sustained attention or vigilance) refers to ongoing ‘task readiness’ for
processing non-specific stimuli (Pardo et al., 2006), involving extended performance over time,
conscious volitional control, and mental ‘effort’ (Hilti et al., 2010). There are two forms of
alerting, tonic and phasing (Cao et al., 2008). Tonic refers to internal control of arousal in the
absence of external cues. Phasic concerns the ability to increase response readiness after
receiving external cues. While alerting refers to attention intensity, the other networks pertain
to attentional selectivity, i.e. attention control.
Orienting (or selective attention or concentration) regulates and allocates resources to
certain stimuli (Pardo et al., 2006). There are two types of orienting, automatic and controlled
(Müller and Rabbitt, 1989). Automatic is the ‘capture’ of attention, e.g. by sudden sounds.
Controlled concerns the active top-down guidance of attention. Executive attention (or
divided attentionor ‘conflict monitoring’) involves monitoring and selection of competing
stimuli. Executive attention requires ‘effortful’ top-down processing using a range of higher
order cognitive process, e.g. inhibition of responses, self-monitoring and planning (Happé et
al., 2006), and is implicated in the self-regulation and control of behaviour (Simonds et al.,
52
2007). Lastly, attention switching is the ability to change focus in an adaptable and flexible
manner (Mirsky et al., 1991: 112).
Researchers have sought to understand meditation using this modular conceptualisation of
attention. Lutz et al. (2008a) suggest that FA-type practices involve the development of all four
networks: sustained attention (towards a target like the breath), monitoring (to prevent the mind
‘wandering’), switching (disengaging from distractions), and selective (redirecting attention
back to the meditative object). In contrast, OM does not involve biases focusing attention on
particular stimuli, but is a broad receptive awareness: an open field capacity to detect arising
sensory, feeling and thought events within an unrestricted ‘background’ of awareness, without
a grasping of these events in an explicitly selected foreground or focus (Raffone and
Srinivasan, 2010: 2). Passing thoughts, feelings and sensations are registered as they arise, but
not held on to (Grossman et al., 2004: 36). OM is characterised by qualities including
receptivity, clarity, stability/continuity, flexibility and non-conceptual awareness, i.e. without
discursive elaboration (Brown et al., 2007). FA development is a precursor to OM accounts
of meditation emphasise the sequential training of these faculties, i.e. FA must first be
developed to prevent the mind ‘wandering’ during OM (Chiesa et al., 2011).
Empirical studies have examined the effects of meditation on the various attention subsets
(Chiesa et al., 2011). Experienced meditators generally score higher than novices on most
attention measures, including selective (Hodgins and Adair, 2010), executive (Moore and
Malinowski, 2009) and sustained attention (Jha et al., 2007). Moreover, longitudinal studies of
novices learning meditation have found increases in most attention capacities, including
selective (Jha et al., 2007), executive (Wenk-Sormaz, 2005), sustained (Zeidan et al., 2010)
and switching attention (Heeren et al., 2009), although Chambers et al. (2008) and Anderson
et al. (2007) found no such changes. Early stages of training, involving development of FA,
are associated with improvements in selective and executive attention, while later phases,
characterised by development of OM, involve improvements in unfocused sustained attention
(Chiesa et al., 2011). Together, the training of these different attention faculties means that
mindfulness is viewed as a meta-cognitive skill, facilitating the self-regulation of attention
(Bishop et al., 2004: 233). The notion that meditation develops self-regulatory capacities will
be relevant in the fourth section of this chapter.
3.3.2. Neurophysiological correlates of attention
53
In the cognitive neuroscience paradigm, as well as analysing attention directly through top-
down measurement of cognitive performance, another strategy involves ‘bottom-up’ analysis
of ‘Neural Correlates of Consciousness’ (NCC; Cahn and Polich, 2006). The NCC paradigm
is based on the premise of ‘psychophysical isomorphism,’ i.e. states of consciousness are
accompanied by analogous neurophysical states (Fell, 2004). The paradigm involves analysis
of the neurophysiological correlates of cognitive functions and mental states. However, this
approach does not imply directional causality, or resolve the ontological mind-body problem,
i.e. how NCCs are connected to conscious states.
Although there is not a neurophysiological correlate of meditation, common characteristics
have been observed (Fell et al., 2010). These observations have led some to argue that the
difficulty in reaching an operational definition of meditation can be resolved through NCC
analysis. For example, Jaseja (2009: 483) defines meditation as a complex neural practice that
induces changes in neurophysiology and neurochemistry of the brain resulting in altered
neurocognition and behaviour in the practitioner.’ However, NCC is an emergent paradigm,
and the precise changes involved are only just being elucidated (Fell et al., 2010).
One way of approaching meditation from an NCC perspective is to explore the brain areas
involved. The NCC paradigm posits that activities of the mind are produced by interaction of
areas ‘distributed’ throughout the brain (Fell et al., 2010). Two key areas in a model proposed
by Newberg and Iversen (2003) are the anterior cingulate cortex (ACC) and the prefrontal
cortex (PFC), both of which are implicated in attention (Newberg et al., 2001). The ACC, in
the medial wall, is prominent in executive control of attention and cognition, and regulation of
cognitive and emotional processing (Posner and Dehaene, 1994). The PFC, in the frontal lobe,
is implicated in higher level activities such as attention, volition, planning and decision making,
and is central to the control of complex goal-directed behaviour (Fuster, 2008).
Analysis of brain changes during meditation, using functional magnetic resonance imaging to
measure cerebral blood flow, shows increased ACC and PFC activation, indicating enhanced
attentional processing (Hölzel et al., 2007). Moreover, practice may have a cumulative impact
on these areas. Kozasa et al. (2008) found greater activation in these areas after an intensive
retreat relative to before. Long-term meditation is even linked to structural changes in these
areas compared to matched controls, meditators had greater cortical thickness in areas like
54
the PFC, suggesting meditation may have neuroprotective effects, and ameliorate age-related
cortical thinning (Pagnoni and Cekic, 2007). These areas are not only indicative of attention.
For example, the ACC is involved in affective processing, and its enhanced activation in
meditators has been interpreted as reflecting higher levels of empathy (Lutz et al., 2008b).
Another NCC approach involves analysis of electroencephalograph (EEG) oscillations. EEGs
are ‘emergent phenomena,’ reflecting synchronisation of distributed neural networks (Basar et
al., 2001), capturing macro-scale spatio-temporal dynamics of brain activity (Stam, 2005).
Neural activity generates electrical potentials as neurotransmitter release alters the electric
potential of the post-synaptic cell membrane; as neighbouring cells synchronise, current loops
combine additively to create larger regional currents, detectable by voltage changes on the
scalp (Rampil, 1998). Voltage changes produce sinusoidal waveforms which can be analysed
in terms of amplitude, frequency, coherence and synchrony (Cacioppo et al., 2007).
Amplitude (or ‘power, the square of the amplitude), reflects the magnitude of the electrical
signal. Amplitude represents the level of synchronised activity in the underlying tissue, i.e.
neurons discharging simultaneously (Von Stein and Sarnthein, 2000). Frequency refers to the
number of oscillatory cycles per second, and is divided into bands: Delta (1-4 Hz); Theta (4-8
Hz); Alpha (8-13 Hz); Beta (1330 Hz); and Gamma (36-44 Hz) (Cacioppo et al., 2007). EEG
connectivity the functional integration of spatially distributed neural populations can be
measured by analysing the relationships between electrodes in terms of synchrony and
coherence. Synchrony is the degree of leading or lagging in the relationship between signals
from electrode pairs. Coherence is the stability of that phase relationship (Hebert et al., 2005).
In the NCC paradigm, efforts are made to connect patterns of neurophysiological activity to
particular brain states. Reduced amplitude in response to internally/externally ‘paced’ events
is referred to as event-related-desynchronisation (ERD), and increased amplitude as event-
related-synchronisation (ERS) (Pfurtscheller, 1992). The ‘signatures’ of meditation are theta
and alpha ERS (Josipovic, 2010), consistently found across different practices, relatively
independent of both technique and degree of practice (Fell et al., 2010). While the functional
significance of band activity can be hard to interpret, theta and alpha are both regarded as
markers of attention (Shaw, 1996).
55
Alpha appears during relaxed eyes-closed wakefulness, and was seen as signifying the brain
‘idling,’ a correlate of de-activated cortical areas (Pfurtscheller et al., 1996). However, Shaw
(1996) argued that although outer-directed attention results in alpha ERD, inner-directed
attention, also called ‘intention, results in alpha ERS. Alpha ERS is seen in tasks requiring
memory (Jensen et al., 2002), or imagination (Cooper et al., 2006). Theta ERS is also linked to
cognition, including switching and orienting attention (Dietl et al., 1999), and processing novel
information, increasing with greater task demand (Grunwald et al., 1999).
Not all studies have found alpha ERS in meditation (Travis and Wallace, 1999). However,
Cahn et al. (2010) argued that results showing alpha ERS may be attributed to use of novices
as participants. Cahn et al. found that although novices showed alpha ERS during meditation,
experienced participants exhibited greater alpha consistency across different states, in and out
of meditation. Thus although meditation may enhance alpha in early stages of learning, with
expertise, people may develop elevated trait alpha, being able to rest in mindfulness states
outside of meditation, thus rendering the control condition meaningless, and accounting for the
null results (Manna et al., 2010). Indeed, Aftanas and Golocheikine (2001) found a trait alpha
difference of 0.8Hz between experienced meditators and matched controls.
Travis and Wallace (1999) suggest coherence is a better marker of meditation than amplitude.
Coherence reflects information flow between distant cortical regions, signifying connectivity
(Aftanas and Golocheikine, 2001). Increases reflect top-down cognitive processing (Sauseng,
et al., 2005), while lower levels are found in those with neuro-psychiatric disorders, reflecting
cognitive impairment (Güntekin et al., 2008). Travis and Wallace observed elevated alpha and
theta coherence during meditation, interpreted as indicating increased ‘alertness.
Researchers have also tried to differentiate between different practices. Dunn et al. (1999)
compared OM and FA practices with a relaxation control: each produced ‘unique frequency
patterns,’ suggesting that they represent different forms of consciousness, not simply degrees
of relaxation. While OM and FA both produced more alpha amplitude than relaxation, they
differed in terms of the specific brain regions that were most active. Moreover, OM produced
more theta and alpha activity than FA.
Some studies have utilised an emergent neurophenomenology paradigm, where subjective
reports are gathered to correlate internal experience with brain activity to dynamically index
56
changing inner experience (Cahn and Polich, 2006: 182). In a three-phase meditation, self-
rated scores of attention across the phases correlated with theta and alpha ERS (Aftanas and
Golocheikine, 2002). Lehmann et al. (2001) examined a meditator across various practices.
Different areas were active depending on the subjective experience of the specific practice,
reflecting known functional neuroanatomy; e.g. the right superior frontal gyrus, connected to
self-detachment in lesion patients, was active in practices aimed at the dissolution of the self.
This section has connected meditation to the development of attention skills. The next section
explores the possibility that these skills may facilitate more constructive ways of relating to
emotions and well-being.
3.4. Meditation and mental health
This section explores a number of interrelated ideas. First, by helping people pay attention to
their ‘inner world,’ meditation can promote emotional intelligence (EI) (Bishop et al., 2004).
Second, EI skills may enable people to better manage disorder and distress (Chambers et al.,
2009). Third, such skills facilitate engagement with well-being generally through enhanced
self-regulatory competence (Brown et al., 2007). Fourth, meditation can engender positive
emotions. Fifth, meditation is linked to positive mental health outcomes. Lastly, a cautionary
note is raised, in that meditation has also been linked to mental health problems, although this
has received minimal attention (Dobkin and Zhao, 2011). The section ends by suggesting that
the social dimension of meditation practice also contributes to well-being, but that this has
rarely been explored as a research topic.
Although none of the studies here focused specifically on men or masculinity, their findings
have implications for men’s mental health. The theoretical review suggested that traditional
forms of hegemonic masculinity were linked to distress in men. For example, the ‘gendered
responding framework’ proposed that toughness norms could lead to restrictive emotionality,
which in turn connects to maladaptive coping responses (e.g. suppression) and mental health
issues (Addis, 2008). In this context, the possibility that meditation may help men resist such
norms and become more engaged with their emotions is intriguing. As this possibility has not
previously been explored, it is a point of interest in the current study.
57
First, an extensive and growing body of work has linked meditation to mental health (Brown
et al., 2007). Much of this work has focused on a range of programmes based around the idea
of ‘mindfulness.’ Various mindfulness-based interventions have emerged following Kabat-
Zinn’s (1982) pioneering Mindfulness-Based Stress Reduction (MBSR) program, which had
success treating chronic pain. These interventions, while rooted in Buddhist ideas/practices,
present meditation in a secular format (Shapiro, 1994). These have successfully alleviated a
wide range of mental health problems in diverse clinical and non-clinical groups (see Mars and
Abbey, 2010, Hofmann et al., 2010, and Fortney and Taylor, 2010, for positive reviews
1
).
Mindfulness courses are usually 8-10 weeks long, for groups of up to 40, either homogeneous
or heterogeneous with respect to disorder, involving weekly 2½-hour sessions, plus an all-day
session. The