Ilkka Pietilä

'Health is not a man's domain' : lay accounts of gender difference in life-expectancy in Russia

The substantial gender difference in life-expectancy is among the key characteristics of current health crisis in Russia. Despite a relatively large body of epidemiological literature on gender difference, there is little empirical research on the gendered meanings of health among Russian lay people. This study aims to enhance understanding of gendered meanings of health by analysing lay accounts of the gender gap in life-expectancy on the basis of 29 interviews with Russians aged 15-81. The analysis showed that gender difference was largely attributed to structural conditions and changes in Russian society and, to a lesser extent, to behavioural factors. Another important conclusion drawn from the analysis was that talk about gender included very few alternatives to conventional gender relations, or negotiation of their effects on health and illness. We interpret these findings to reflect, first, the culturally weak role of the individual in Russian discourses of health that are still largely focused on the role of government as primarily responsible for public health. Secondly, it seems that there are few alternatives to conventional discourses of gender in post-Soviet Russia; the gender relations in peoples understanding appear to be static and persistent despite recent profound social changes.

Immune to ageism? Men's perceptions of age-based discrimination in everyday contexts

Despite long-term, conceptually and theoretically refined discussions, the phenomenon of ageism still remains empirically under-developed. To better understand the diversity of ageism, its contextual variations and gender-specific dynamics in peoples daily lives, this study focuses on how different interactional contexts shape mens perceptions of ageism. Using data from 67 thematic personal interviews with 23 middle and working class men aged 50-70, this study contributes to the sorely lacking, empirically based and nuanced understanding of how ageism is experienced, and adds to the research on the internalization of ageism which to date has primarily focused on older womens experiences. Key findings are as follows: 1) men are not totally immune to ageism, but rather, 2) the experiences and interpretations of ageism are structured by the interactional context in question, 3) acts and expressions interpreted as discriminative in one context become defused in others, and that 4) in family contexts positive ageism represents a naturalized order of things within intergenerational relations. The study contributes to the existing body of work on age negotiations and on the ways in which chronological age as a cultural resource functions in interaction. It also underlines that adopting a gender and context sensitive approach into ageism opens up promising avenues for further conceptual development.

Natural(ly) men: masculinity and gendered anti-ageing practices in Finland and the USA

ABSTRACT The neo-liberal ideologies that point to individual responsibility for risks increasingly influence countries of the global North. The anti-ageing industry reflects this dictate and encourages middle-aged people to use their products and services to manage their ageing. However, given the negative connotations attached to the term ‘anti-ageing’, which is usually seen to focus on aesthetics and thus be a womans concern, men may be likely to disavow being involved in such activities. The article uses interview data collected from men aged 42–70 from Finland and the United States of America to explore whether and how men adhere to the call to manage their ageing when such anti-ageing activities are seen to be potentially feminising. We find that these men reflected neo-liberalism in the sense that they felt that, although ageing cannot be prevented, it can be controlled. Also while they generally rejected anti-ageing products and services that they judged to affect aesthetics, they reported that they use those that they define as promoting health and performance instead. For them, masculinity is the instrumental focus on performance to the exclusion of beauty or attractiveness. Masculine anti-ageing bodily strategies must also be ‘natural’, involving hard work rather than the use of products, which they regard as never having been scientifically proven to enhance performance. Thus, in talk of their anti-ageing, men distance themselves from women.

Active and non-active agents: residents’ agency in assisted living

ABSTRACT Culturally, institutional care has been seen to strip older people of their status as full adult members of society and turn them into ‘have-nots’ in terms of agency. The substantial emphasis in gerontology of measuring the activity and functional ability of the elderly has unintentionally fostered these stereotypes, as have traditional definitions of agency that emphasise individuals’ choices and capacities. The aim of this paper is to discover what kind of opportunities to feel agentic exist for people who have reduced functional abilities and therefore reside in assisted living. In this paper, agency is approached empirically from the viewpoint of Finnish sheltered housing residents. The data were gathered using participant observation and thematic interviews. This study suggests that even people with substantial declines in their functional abilities may feel more or less agentic depending on their functional and material surroundings and the support they receive from the staff, relatives and other residents. The perception that residents’ agency in assisted living cannot be reduced to measurable activity has methodological implications for gerontological research on agency. Care providers can utilise our findings in reasserting their residents’ quality of life.

Is Retirement a Crisis for Men? Class and Adjustment to Retirement

Because paid work is taken to be central to manhood, scholarly and popular discourse have characterized retirement as presenting a “crisis of masculinity.” However, such a crisis is not borne out by research, perhaps because scholars have not considered how class might shape masculinities and thus expectations and experiences of retirement. Using data obtained from interviews with Finnish metal workers and engineers who are either approaching retirement or recently retired, we ask whether (1) this crisis discourse is reflected in their retirement expectations, (2) it matches their actual experiences of retirement, and (3) retirement disrupts the masculinities of some class groups more than others. We find evidence of this retirement crisis discourse in our respondents’ views of retirement, but not in their actual experiences, belying the homogeneity of masculinity implied by it. Class shapes both the perceived content of crises and the actual retirement experiences.

Ruptures of affiliation: social isolation in assisted living for older people

ABSTRACT Transfer from a private home to an assisted living facility has been pictured as a major change in an older persons life. Older people themselves tend to perceive the change as something eventual that breaks the bonds and familiarities of previous life. The aim of this article is to shed light on residents’ chances to reach affiliation (as Nussbaum defines it) in their new living surroundings, and thus adjust to that social environment. Based on ethnographical data gathered in a Finnish sheltered home in 2013–14, we studied residents’ affiliations through ruptures, namely residents’ perceived social isolation. Social isolation was found to be connected with two separate social worlds: the one inside the facility and the one outside. Social isolation resulted from different factors connected to the quality of social interaction with co-residents and the staff, daily routines of the institution and residents’ personal life histories. Also, residents’ older friends seemed to avoid visiting care facilities which caused perceived social isolation. This article deepens the insights into the perceived social isolation of assisted living and thus helps care providers to create new strategies to enable due affiliation for their residents.

The Limits for Deinstitutionalization of Psychiatry in Russia: Perspectives of Professionals Working in Outpatient Mental Health Services

Abstract: The purpose of this study was to explore the views of mental health professionals on deinstitutionalization reforms in Russia. Qualitative interviews were conducted with 33 specialists from outpatient mental health clinics. The data were analyzed using thematic analysis. The results revealed that the professionals appeared very restrained in supporting the reforms. They argued for the preservation of the existing mental health care system rather than its transformation. Their lines of argumentation were organized around four key themes as follows: 1) critiques of state policies and a suspicion of reforms, 2) tradition instead of innovation: reclaiming the image of Soviet psychiatry, 3) hospitals as a means of social control, and 4) reform as a threat to the protection of people with mental health problems. The findings suggest that practitioner resistance to deinstitutionalization is a complex phenomenon, demonstrating how various political, economic, social, and cultural factors are intertwined in the construction of professional discourse on the reforms.

The views of family caregivers on the deinstitutionalisation of psyhiatric care in Russia

As with many other countries, the Russian Government has declared its intention to deinstitutionalise mental health care and provide people with mental disabilities with services that go beyond inpatient care, thus offering better prospects for integration into society. These policies have major effects not only on the lives of the people with mental disabilities but also on informal caregivers such as parents and spouses, who care for diagnosed children and partners. This study explores the views of family caregivers on the deinstitutionalisation of psychiatric care in Russia. The study is based on interpretive policy analysis. Qualitative interviews were conducted with twenty caregivers in a large Russian city. The results revealed that there was very limited support among caregivers for the reforms. They did not question the practice of institutionalised care or treatment in stand-alone psychiatric clinics, but rather took this for granted. Highlighting negative social attitudes towards the people with mental disabilities, carers claimed that stand-alone psychiatric services provide a protective environment away from the hostile outside world. Caregivers lacked knowledge about any particular social approach to mental disability or alternative ways of organising the mental healthcare system. Besides this, the caregivers were strongly disturbed by the prospect they may lose the support they receive from existing services. Although the carers criticised the current situation in psychiatric hospitals, they claimed that hospitalisation provided them with significant respite from care. All interviewees reported being overburdened, complaining of insufficient financial and social support. We suggest that caregivers in Russia have good reason to be suspicious of the reforms, which in many cases are not accompanied by proper funding, or by the development of alternative services or activities to prevent stigmatisation.