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Undoing gender? The case of complementary and alternative medicine Joslyn Brenton and Sinikka Elliott

Department of Sociology and Anthropology, North Carolina State University, USA

Abstract Despite a rich body of sociological research that examines the relationship between gender and health, scholars have paid little attention to the case of complementary and alternative medicine (CAM). One recent study (Sointu 2011) posits that men and women who use CAM challenge traditional ascriptions of femininity and masculinity through the exploration of self-care and emotions, respectively. Drawing on 25 in-depth interviews with middle-class Americans who use CAM, this article instead finds that men and women interpret their CAM use in ways that reproduce traditional gendered identities. Men frame their CAM use in terms of science and rationality, while simultaneously distancing themselves from feminine- coded components of CAM, such as emotions. Women seek CAM for problems such as abusive relationships, low self-esteem, and body image concerns, and frame their CAM use as a quest for self-reinvention that largely reflects and reproduces conventional femininity. Further, the reproduction of gendered identities is shaped by the participants’ embrace of neoliberal tenets, such as the cultivation of personal control. This article contributes to ongoing theoretical debates about the doing, redoing and undoing of gender, as well as the literature on health and gender.

Keywords: alternative medicine, gender, neoliberalism

Introduction

Once considered a rogue faction of therapies and medicines, complementary and alternative medicine – popularly dubbed ‘CAM’ – has gained a foothold in Americans’ health care prac- tices. Complementary medicine, like chiropractic and acupuncture, is generally used together with conventional medicine and may even be covered by insurance (National Center for Com- plementary and Alternative Medicine 2011). Alternative medicine, like reiki and homeopathy, is typically used in place of conventional medicine and is considered less amenable to the rigours of evidence-based testing (see Winnick 2005 for a review). The lines separating com- plementary from alternative medicine are not always clear-cut, however, and both generally share themes of holism and empowerment (Barrett et al. 2003, Pawluch et al. 2000) and enjoy widespread popularity. Since 1990 surveys have revealed that approximately 40 per cent of Americans report having used CAM in the past year and that people use CAM to manage chronic illness, because they distrust biomedicine or are unhappy with their lack of control in traditional medical settings, and as a form of preventative health care, among other reasons (Barnes and Bloom 2008, Eisenberg et al. 1998, Institute of Medicine 2005). CAM is © 2013 The Authors. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd. Published by John Wiley & Sons Ltd., 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Maiden, MA 02148, USA

Sociology of Health & Illness Vol. 36 No. 1 2014 ISSN 0141-9889, pp. 91–107 doi: 10.1111/1467-9566.12043

especially popular among middle-class white Americans with women (42.8%) using CAM somewhat more than men (32.5%) (Barnes and Bloom 2008).

Despite a rich body of sociological research that examines the relationship between gender and health, scholars have paid little attention to the case of CAM. Yet CAM is considered a socially feminised form of health care and does not enjoy the scientific legitimacy afforded to standard biomedical practices (Sointu 2011). Examining the use of CAM by men and women can thus offer insight into contemporary constructions of masculinity and femininity and their implications for health practices. In her study of middle-class CAM users, Eeva Sointu (2011) argues that CAM use reflects gender detraditionalisation because men and women who use CAM defy traditional enactments of masculinity and femininity. These findings are relevant to current theoretical debates about gender, especially the potential for ‘undoing gender’ (Deutsch 2007, Risman 2009). Drawing on 25 in-depth interviews with middle-class men and women, we found that CAM users are not undoing, but rather are doing and redoing gender in ways that reflect social class position and in response to current neoliberal gender-blind imperatives. To develop this analysis we first discuss current debates among gender scholars on the use of West and Zimmerman’s (1987) classic theory of ‘doing gender’ and situate our study in a sociopolitical context, reviewing the links between neoliberalism and CAM use. We then present our study methods and findings and conclude with a discussion of this article’s contributions to the sociology of gender and alternative medicine.

Doing health as doing gender

Our analyses are guided by West and Zimmerman’s (1987: 126) conceptualisation of gender as a ‘routine, methodological, and reoccurring interactional accomplishment’, whereby perfor- mances of femininity and masculinity simultaneously reflect and reinforce socially constructed ideas about inherent differences between men and women (e.g., women are nurturing; men are tough). Sociologists draw extensively on gender theory to understand how men and women experience health and illness. This literature is heavily influenced by Courtenay’s (2000) rela- tional theory of health. Building on the work of West and Zimmerman, Courtenay contends that health-related beliefs and behaviour are resources people use to perform masculinity and femininity. Men generally tend to avoid seeking help for mental and physical health issues (Addis and Mahalik 2003), for example, and men with strong masculinity beliefs are less likely than men with weak masculinity beliefs to engage in preventative health care (Springer and Mouzon 2011). Further, men’s gendered health behaviours often reinforce and reproduce gender inequality whereby ‘rejecting what is constructed as feminine is essential for demonstrating hegemonic masculinity’ (Courtenay 2000: 1389). A key feature of men’s health behaviour is the denial of weakness and emotional hand-holding (Courtenay 2000, Dolan 2011, Evans et al. 2007) – characteristics stereotypically associated with femininity – and Noone and Stephens (2008) find that during doctor’s visits, men affirmed a masculine identity by contrasting their use of health care as serious and women’s as ‘trivial’.

Research offers a complex understanding of the relationship between gender and health in traditional medical settings, yet we know far less about how gender plays out in unconven- tional health care settings (Flesch 2007). Heelas and Woodhead (2005) hypothesise that women are drawn to the holistic or wellbeing culture because they are more likely than men to develop the subjective self in relation to others, which is also a focus of many CAM thera- pies. And Flesch (2007) goes a step further to ask how women’s participation in CAM, as practitioners and users, may reinforce their status as a subordinate group. Some research finds that men with potentially terminal conditions, such as cancer and human immunodeficiency © 2013 The Authors Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd

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virus (HIV), more readily embraced the emotional and physical benefits of CAM (Foote-Ardah 2003, Pawluch et al. 2000). Yet Evans et al. (2007) observe that male cancer patients were sceptical of alternative therapies that emphasised emotions and Boudioni et al. (2001) find that men with cancer were less open to CAM than women cancer patients. These studies suggest that men’s and women’s involvement in CAM is influenced by social expectations surrounding masculinity and femininity, but do not systematically develop this argument.

More recently, in her study of 44 middle-class CAM users, Sointu (2011) suggests that holistic health settings may be spaces in which men can safely explore their emotions (Sointu 2011) and thus challenge socially proscribed feeling rules (Hochschild 1979) that expect men to be tough and stoic (Oransky and Marecek 2009, Sattel 1976). Sointu finds that while men sometimes described their CAM use in ways that reinforced an image of conventional mascu- linity, for example, emphasising physicality, competitiveness, and achievement, they also embraced emotional honesty and intimacy and used CAM to explore their emotions and weak- nesses. Similarly, although some women’s narratives of CAM use reflected and reproduced traditional aspects of femininity, such as using CAM to deal with the stress of caregiving, women also embraced a discourse of self-care that emphasised prioritising and defining the self apart from the needs and expectations of others. Thus Sointu asserts that CAM use under- scores a detraditionalisation of femininity and masculinity.

Sointu’s findings are timely considering recent debates over West and Zimmerman’s theory of doing gender. Scholars such as Deutsch (2007) and Risman (2009) question whether the rote application of West and Zimmerman’s theory leads researchers to overlook instances in which gender is being undone; for example, when people’s actions challenge gender binaries and hierarchies. Instead of focusing exclusively on how gender is done, these scholars urge researchers to also examine how social interactions may become less gendered or instances in which gender may be irrelevant (Deutsch 2007). In response, West and Zimmerman (2009) argue that people are continuously held accountable for their membership to a sex category. The tenacity of this phenomenon undergirds their position that gender is ‘not undone, so much as redone’ in ways that may reflect changes to gender accountability structures but do not fun- damentally undermine the gender order (West and Zimmerman 2009: 118).

By situating middle-class men’s and women’s CAM use within the context of a postmodern society, we argue that CAM users are doing and redoing, but not undoing, gender, and that their gender enactments are shaped by an embrace of neoliberal tenets, such as self-reinvention, health consumerism and the cultivation of personal control. To develop this argument, we briefly review the links between neoliberalism and CAM use.

CAM and neoliberalism

Several scholars argue that a rise in postmodern values has paved the way for CAM’s popularity (McQuaide 2005, O’Callaghan and Jordan 2003, Siahpush 1998, Winnick 2005). Postmodern societies are marked by drastic changes in economic and cultural arrangements. Manufacturing jobs, once considered ‘jobs for life’ (Ringrose and Walkerdine 2008: 228) are being rapidly replaced by low-paid and part-time service jobs that often have no benefits such as health insur- ance or pensions. A shift in cultural values parallels these economic changes, and entails a ‘deprivileging of rationality in general and science in particular’ and concomitant emphasis on relativism and pluralism (McQuaide 2005: 289). Contemporary Western societies are also char- acterised by a ‘massive subjective turn’ whereby subjective experiences become a ‘unique source of meaning and authority’ (Heelas and Woodhead 2005: 3). The response to economic instability coupled with a postmodern emphasis on difference, cultural diversity and the

Undoing gender with complementary and alternative medicine? 93

importance of subjective experience has been an emergent neoliberal rationality or discourse, emphasising individual choice, self-management, and personal responsibility for health (Cren- shaw 2007, Ringrose and Walkerdine 2008). Neoliberal discourses are inextricably tied to the capitalist agenda of consumption. The self is now developed through consumption. Through the purchase of clothing, education, homes and leisure experiences, as well as health practices, peo- ple ‘consume themselves into being’ (Ringrose and Walkerdine 2008: 230).

Within this sociopolitical context, CAM’s eclectic mix of science and spirituality give it what Kaptchuck and Eisenberg (1998: 1060) call ‘persuasive appeal’, helping health consum- ers expand the possibilities for behavioural options, identity, experience and meaning-making. Editors of eight British health and lifestyle magazines describe promoting CAM as a way to deal with the ‘existential dis-ease’ of the 21st century (Doel and Segrott 2003: 135). Congruent with a neoliberal emphasis on self-reinvention and personal responsibility, people report using CAM because they have an interest in spirituality and personal growth (Astin 1998) and feel empowered using holistic therapies that put them in the driver’s seat of their healthcare experi- ences (Barrett et al. 2003). Survey research finds that postmodern values, such as a belief in natural healing, rejection of authority, and a desire for control, predict positive attitudes about CAM (Rayner and Easthope 2001, Siahpush 1998) as well as actual CAM use (O’Callaghan and Jordan 2003).

A neoliberal emphasis on self-reinvention has important implications for the production of gendered identities. Neoliberal discourses emphasise individual choice and autonomy while explicitly ignoring persistent institutional inequalities that shape the amount and type of self- construction and reinventing people can do. Our analyses of the narratives of women and men who use CAM demonstrate that despite embracing several ostensibly genderless tenets of neoliberalism, such as personal responsibility and the importance of self-reinvention, gender continues to play a key role in CAM users’ decisions for and explanations of CAM use. We argue for caution in interpreting men’s and women’s CAM use as a sign of undoing gender and discuss the implications of our findings for contemporary debates about doing gender, and gender and health.

Methods

The data and analyses presented in this article come from 25 in-depth interviews with 14 women and 11 men who use CAM. The participants were recruited from two yoga studios (n = 17), an acupuncture clinic (n = 2), a tai chi studio (n = 4) and an advert placed in a local independent newspaper (n = 2), all located in three small cities in the south-eastern USA. Eligibility for the study required that participants had used three or more therapies or practices in the past 12 months – a time frame consistent with past studies of CAM use (Eisenberg et al. 1998). The participants had used an average of seven therapies in the past year, repre- senting a wide range of modalities. The National Center for Complementary and Alternative Medicine groups CAM into four modalities. In the previous year, 52 per cent (n = 13) of the participants in this study had used ‘natural products’ like herbs and vitamins; 100 per cent (n = 25) had used one or more ‘mind-body medicines’ such as acupuncture, yoga and tai chi; 80 per cent (n = 20) had used at least one ‘manipulative or body-based’ practice such as chi- ropractic, reiki and massage therapy; and 72 per cent (n = 18) had used one or more practices grouped as ‘other’, which include homeopathy, craniosacral therapy and Chinese medicine. Roughly equal numbers of men and women used practices from the first three categories listed above, however women were more likely to use ‘other’ therapies than men (women = 14; men = 4). Mirroring the findings of national surveys on CAM use (Eisenberg et al. 1998), © 2013 The Authors Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd

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most participants identified as white (n = 22). The average household income was $70,000. In all, 22 of the participants had a 4-year college degree or higher, while the remaining three reported completing some college. The average age of women was 40 years; for men, the average age was 52 (see Table 1).

The interviews averaged one and a half hours, took place in local libraries, business offices and participants’ homes, and were digitally recorded and transcribed verbatim. Each interview began with an open-ended question: ‘Tell me how your journey with CAM use began?’ allow- ing participants to frame their CAM use in ways that were meaningful to them. We developed our analyses following the main tenets of grounded theory (Charmaz 2006). The first author conducted all the interviews and coded the data, identifying key themes such as ‘transforma- tion’ or ‘science talk’. The initial focus of the project was to broadly explore the appeal of CAM for those who use it. By simultaneously conducting interviews and writing analytic memos, the first author noticed several themes in her early interviews clustering around the topic of gender. To explore these in more detail, she began asking questions around these themes and, following purposive sampling (Charmaz 2006), she recruited and interviewed more men to elaborate on gendered processes. Subsequent rounds of focused coding involved a synthesis and refinement of the role of gender in participants’ narratives using gender theory

Table 1 Interviewees’ characteristics

Pseudonym Age Race/ethnicity Highest degree

Occupation or industry of employment

Marital status

Household income (‘000$)

Angie 48 White/Native American

Bachelor Registered nurse/ yoga teacher

Married Over 150

Cameron 29 White Master’s Massage therapist Single 20–29 Erika 24 Black/White Bachelor Grant writer Single 30–39 Gloria 50 White Some college Administrator Married 80–89 Grace 57 White Some college Artist Married 100–149 Layla 36 White Bachelor Computer technologist Single 30–39 Margo 51 White DDS Dentist Married Over 150 Mickey 46 White Bachelor Business owner Partnered 60–69 Miriama 37 White Bachelor Engineer Single 70–79 Nancy 51 White Master’s Archival manager Married 30–39 Robyn 27 White Bachelor Business owner Divorced 30–39 Shree 41 White Master’s Massage therapist Married 100–149 Terri 35 White Master’s Physician’s assistant Divorced 80–89 Yolandra 30 Greek/Puerto

Rican Master’s Student Divorced 10–19

Bodhi 60 White PhD Martial arts teacher Married 50–59 Dustin 58 White Bachelor Peer support specialist Single 30–39 Edward 51 White Bachelor Business consultant Divorced Over 150 Gregory 53 White Master’s Museum archivist Divorced 30–39 Harry 55 White Master’s Consultant Divorced Over 150 Kenneth 56 White Master’s Optometrist Divorced 100–150 Kyle 36 White Master’s Administrative assistant Single 30–39 Liam 51 White Bachelor Information worker Married 100–149 Patrick 29 White Some college Technology consultant Single 100–149 Paul 63 White PhD Professor Married Over 150 Victor 49 White Bachelor Yoga teacher Married 60–69

Undoing gender with complementary and alternative medicine? 95

and research as a guide. Both authors wrote and discussed memos to develop the present analysis.

Women and men in our study described using CAM to deal with strikingly similar health issues. Equal numbers of men and women said they used CAM to deal with depression as well as chronic health conditions such as neck and back pain. More women reported using CAM for acute problems like pelvic or uterine pain or unpredictable issues like sudden numb- ness in the body. One male participant was using CAM to deal with a life-threatening illness (cancer). Overall, participants shared similar experiences with and a disdain for conventional medicine. Congruent with postmodern values, many expressed scepticism of mainstream science and medical authority, like Layla, who said, ‘America’s health-care system is commer- cial and money-driven’. The participants generally felt doctors were overeager to prescribe powerful medication and had ‘become nothing more than agents for pharmaceutical compa- nies’ (Dustin). Their narratives emphasised the importance of individuality – a hallmark of a neoliberal discourse – as exemplified by Robyn’s critique of conventional doctors: ‘I am not going to be treated like a symptom that is walking around. It’s like, see me for who I am!’ Although most participants felt there was a time and a place for conventional medicine, engag- ing in alternative health practices was central to their identities as individuals and as responsi- ble health consumers. Despite these commonalities, however, men and women described markedly different reasons for their CAM use, as well as the meanings they attached to it.

Men’s narratives of CAM use

Given the potential for CAM to undermine men’s performances of conventional masculinity (Sointu 2011), it is reasonable to wonder why men turned to CAM in the first place. Unlike working class men, who are often unwilling to seek medical help (Addis and Mahalik 2003, Noone and Stephens 2008), the narratives of middle-class men in this sample suggest that seeking help for health-related mental and physical issues is the norm. In fact, all but two men spoke of regularly visiting a therapist and referenced influential self-help literature, such as 8 Weeks to Optimum Health (Weil n.d.) (Victor), The Necessity of Mourning (Harris 2003) (Paul), and EnlightenNext (n.d.) (Dustin). Yet the men’s narratives also reveal a persistent ten- sion between being responsible health consumers and asserting masculine selves. Men employed several discursive strategies to resolve this tension.

Justifying CAM use Although work stress or health problems underlay most men’s participation in CAM, many men justified their CAM use saying they were cajoled by a female partner to try it. For instance, Gregory said, ‘The first time I took a class was because the woman that was living with me was taking yoga and she said, “You ought to take yoga”’. Similarly, Edward explained his entr�ee into CAM:

When I was in college I thought about taking tai chi and yoga ... then over that like 6 to 9 months my ex [wife] kind of said, ‘You should do this, you would like this’. And so at some point I took a [yoga] class.

By suggesting he was initially ambivalent, Edward positioned himself as a person who was not too eager to try yoga but instead eventually acquiesced to his wife’s insistence that he should try it (see Evans et al. 2007). Victor went to even greater lengths to explain his reluc- tance to try yoga: © 2013 The Authors Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd

96 Joslyn Brenton and Sinikka Elliott

My wife said, ‘You should come to yoga class with me’. And I was like, ‘Eh’. I never was one for group classes. I always liked physical activity and more solo stuff than group things. Team sports like softball [and] volleyball are one thing. But doing – just exercising and not competing never was a group thing for me. But I said, ‘OK, I’ll try it’. [This] was gym yoga. It wasn’t meditation-type yoga. It was like a power yoga class. I was moving all the time and building heat and trying to get flexibility and stuff.

Like Victor, other men’s narratives of entr�ee into CAM suggest a process of justification – a particular kind of accounting in which ‘one accepts responsibility for the act in question, but denies the pejorative quality associated with it’ (Scott and Lyman 1990: 220). Victor negoti- ated the pejorative nature of yoga as feminine and introspective by downplaying the meditative aspect and instead emphasising the masculine-coded location (gym), and physical nature of the class. Victor’s narrative is in keeping with the expectation that real men engage in competitive and sometimes aggressive group activities such as football (Messner 1990) or are stoically independent in their pursuits.

Men also justified their use of feminine-coded CAM practices by presenting themselves as responsible and informed consumers of health care. At the same time, they suggested that women are primarily concerned with superficial health issues, such as bodily appearance. For example, Kenneth, who professed a long term ‘interest in health care’ said he was drawn to CAM when he picked up Prevention magazine in the grocery store and read an article about using antioxidants to ward off macular degeneration:

Kenneth [Prevention’s] one of the first [magazines] that’s kind of ahead of the curve. It’s mostly for women, but they have men’s parts in it too and there’s some things that go for both sexes.

Interviewer What makes it mostly for women? Kenneth Well I mean that just seems to be its focus. When you look on the cover it’s

always a woman. It’s always about various diets and things. A lot of them [feature] women – so you have to – but Andrew Weil always writes for it too ... he’s a Harvard-trained physician.

Despite perceiving Prevention as ‘mostly for women,’ Kenneth positioned it as acceptable because men of science like Andrew Weil1 write for the magazine, thus nullifying the associa- tion with feminine health behaviour and establishing himself as a masculine and well-educated consumer of these products. Kenneth’s desire to be seen as a responsible health consumer – one who is ‘ahead of the curve’ – reflects the construction of a responsible healthy male citi- zen (see Crenshaw 2007) as well as a trend in medical consumerism among the middle-class (Cockerham et al. 1986, McQuaide 2005)

Downplaying emotions Men also generally distanced themselves from the emotional components of CAM. Liam, a devoted student of tai chi, explained that he does not use CAM for emotional issues: ‘I guess I feel like I’m pretty even-keeled. When I feel like I need some emotional healing I go for a long walk in the woods somewhere’. While Liam did not deny that he sometimes needs emo- tional healing, his statement nonetheless reveals a stoically independent, masculine-coded approach to dealing with emotions. Some men connected emotions to the body and saw emo- tional benefits in CAM but did so in ways that suggested this connection is straightforward and commonsensical, as illustrated by Edward’s response to the question: ‘So, does yoga do something for your emotional state or being?’:

Undoing gender with complementary and alternative medicine? 97

Well yeah. I think – well there’s the obvious ... being better connected with the body affects where I’m at, where you’re at emotionally, because if you’re overweight and sick and what- ever, well it’s gonna affect how you feel emotionally. That seems to me kind of self-evident.

Edward’s language suggests a demystification of the role of emotions. Like Edward, other men downplayed the role of emotions in CAM, even as they said CAM provided emotional benefits. When asked what role alternative therapies play in staying healthy, Harry replied:

Medium [role]. I mean I’m not into – my body is not my temple and I don’t live to be fit. But to the extent that it [yoga, tai chi and meditation] can allow me to experience – I haven’t thought about it this way, but ... as long as it can allow me to experience joy, some sense of serenity and contentment, if not happiness – I think happiness is overrated – but um, but all the other kind of – I mean, sounding corny, feel good emotions.

Harry would like to experience joy through his CAM practices, yet his counterstatement, that ‘happiness is overrated,’ and his pejorative description of ‘corny, feel good emotions’ suggests an effort to differentiate his own use of CAM from the stereotypical CAM user.

Other men were more equivocal in discussing the role emotions play in health and healing. Paul described the limits of expressing emotions through expressive writing therapy – a prac- tice he used to work through years of debilitating depression:

So it was a reality check for me, you know, writing about what was actually happening, making the journal not a place where you just dump all your emotions and let it be cathar- tic ... I mean I had been doing that for years. But as Pennebaker [a male expert on writing] warns, if you find yourself writing about the same thing, with the same intensity, using the same words, you’re in a rut and you need to move on, because you’re just re-traumatising yourself.

Here Paul differentiated between emotions and reality by suggesting that emotions are not ‘what was actually happening’. Paul also constructed his emotions as potentially dangerous. Later he described the importance of moving on to the next phase – writing your desires into existence – thereby suggesting that at some point emotional experiences need to be discarded and replaced with taking control. Similarly, in response to a question about what he hopes to get out of tai chi, Patrick replied:

My objective has been to maintain an equanimity, sort of a balance in life ... but more importantly, it’s learning a mental fortitude ... I’m able to speak to people from the heart; live rationally rather than by impulse or irrationality ... And I suppose I separate intuition from impulse. Intuition has a greater wisdom behind it, an inner wisdom, or a wisdom from outside, an external wisdom but nonetheless, it’s something that’s not whimsical or emo- tional.

Cultivating the self reflects a core feature of the neoliberal project of self-discovery and rein- vention. For Patrick, however, self-development is synonymous with masculine terms like ‘mental fortitude,’ which he juxtaposed with qualities commonly associated with femininity, such as living by impulse and irrationality (Connell 1995). Other research finds that men display masculinity in health contexts by rejecting therapies associated with emotional hand-holding (Evans et al. 2007). By downplaying the role of emotions and emphasising

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rationality, men thus engaged in a process of self-discovery and reinvention that affirmed con- ventional masculinity.

Emphasising science, logic, and scepticism The use of complementary and alternative therapies may pose a threat to men’s masculinity because these practices are deemed to be illogical (Sointu 2011) or, as Edward called aroma- therapy, ‘loosey goosey’. Perhaps in an effort to fend off pervasive stereotypes that CAM is nonsensical, men’s narratives involved a great deal of what we term ‘science and logic talk’. For example, some men stressed the ‘mechanics’ of CAM and employed the language of science to explain what these therapies do for them physically. Patrick said:

My first yoga class was a fantastic experience. It’s funny, I’d probably not enjoy that same yoga class nearly as much anymore because I found a yoga now that has, I think, a better approach to the biomechanics.

Similarly, Paul said:

I subscribe to the whole mind-body connection ... I think breathing involving the diaphragm really does help release some toxins in the body and it sends signals to the immune system to work.

Referring to chemicals such as ‘toxins’ and processes such ‘biomechanics’ not only emphasises the physical effects of CAM use, but reinforces the idea that men are logical, scientific, and mostly concerned with ‘practical’ bodily issues (Boudioni et al. 2001, Connell 1995). Dustin used the language of science to account for his belief in the tenets of homeopathy:

The AMA edged out the advocates of naturopathy/homeopathy – what has become now known as alternative medicine. But the research was just as ardent and empirically derived back then, in the 1800s – very solid research. It seems like it all makes sense to me.

Men also routinely emphasised their scepticism of CAM’s efficacy. Their narratives suggest a tension between subscribing to a masculine paradigm of scientific inquiry and acknowledging the potential efficacy of therapies often discredited by the advocates of biomedicine (Freedman 2011). Liam interpreted his positive experience with reiki, an alternative therapy premised on the manipulation of bodily energy, in the following way:

It [the ankle injury] was better within a week or so after that [reiki session]. I can’t say – I’ve got too much Western scientist in me. That’s not a statistically significant sample to say anything. On the other hand, it felt better. So I really don’t care.

In discussing his friend’s successful treatment via acupuncture, Harry literally put himself in the role of a scientist:

[My] friend had allergies ... nothing worked ... [She] went to the acupuncturist and would say, ‘I’m going to the witch doctor’. And it fixed her allergies. Now again, sometimes I think we look at those things and we go ‘Okay, a scientist would say, oh, it’s just [a] pla- cebo effect’.

Undoing gender with complementary and alternative medicine? 99

Whereas men’s narratives suggest preemptive accounts to explain away the effects of a ther- apy, most women readily accepted the interpretations of CAM practitioners and at times appeared to be looking for effects of healing.

Women’s narratives of CAM use

Women’s narratives of CAM use closely reflect the neoliberal project of self-reinvention and exploration and also underscore the role of gender in this project. For a start, many women sought CAM and its healing properties to deal with problems women in the USA dispropor- tionately bear, including low self-esteem, abusive and controlling heterosexual relationships, and eating disorders and body image concerns (Bordo 2003, Tjaden and Thoennes 2000). Our data suggest that CAM offers women an empowering rhetoric of individualism and agency via the self-as-project, but that this individualistic approach often reinforces traditional expecta- tions around femininity.

Discovering the gendered self The women’s narratives suggest that many not only embraced CAM from the beginning but that CAM use is tied to a gendered project of self-discovery and improvement. For example, Nancy framed her use of guided mediation as a search for her ‘inner goddess’ and Erika said that yoga was a remedy for feeling like a ‘bad woman’ because it helped her get in touch with her body. Other women described using CAM to rediscover the self outside intimate relation- ships with men. In fact, both men and women described using CAM in the context of break- ups or divorce. Gregory started taking classes when he and his ex-wife started talking about separating. For him, ‘taking yoga classes helped tremendously, just to kind of get out of my head’. However, whereas men often described using CAM to distract themselves from the stress of work, break-ups and divorce, women used CAM to explore the meaning of relation- ships gone bad and to discover the ‘true’ self. For instance, Margo said she took a yoga class:

[R]ight after I was single again, after many years [in a relationship] ... it was the time in my life when I needed something different ... it just sort of helped me get in touch.

Margo’s desire to ‘get in touch’ suggests that CAM use can help a person discover an osten- sibly authentic self. Some women described losing sight of their selves while in relationships with men. Leaving the relationship offered women an opportunity to reconnect with the self. Yet these women still referenced the importance of being in a relationship. For example, Shree took up yoga because:

I had just gotten out of a relationship and I wanted to do something for myself ... This relationship had ended and I realised that this relationship was very similar to the first relationship I ever had. And I was just kind of like, ‘Why am I repeating myself?’ and ‘Why did I choose this person?’ and ‘Will I ever meet anyone?’

As Connell (1987) notes, the dominant form of femininity in Western culture is organised around performing femininity to and for men. Shree’s focus on meeting someone, a theme repeated throughout her interview, suggests that meeting a man was, and is, central to her pur- pose in life. In turn, her project of self-discovery was centred on understanding and improving herself to attract a better male partner. Shree and other women talked at length about their

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struggles with low self-esteem and dating men who were not positive influences in their lives. These women said they used CAM post-relationship to not only discover the self but also to remedy the flawed self they identified as the cause of their suffering.

Cultivating ‘good’ emotions The role of emotions was another prominent theme in women’s narratives. Women frequently attributed their ability to achieve ‘positive’ and ‘thankful’ emotions to their use of therapies such as yoga, meditation and craniosacral therapy. For some women, emotions were literally embodied. For example, Cameron said that during one acupuncture session her ‘muscle grabbed every needle and was twitching. Like my whole right side was angry at me or some- thing. I mean it’s bad’. As Sointu and Woodhead (2008: 265) note, holistic therapies are typi- cally premised on the idea that ‘the body provides privileged access to the inner life of the emotions and the spirit’. The narratives of women in our study suggest they share this assumption. However, they also reveal women’s explicit use of CAM to transform bad feel- ings – embodied or otherwise – to good feelings. As Cameron implied, angry feelings are not appropriate for a woman to embody. Similarly, Layla described the process of rediscovering an authentic and ‘happy’ self:

[Yoga and meditation] are things that have gotten me back to the person I was before ... I feel so restored now ... I feel back in touch ... when I was really happy, really free ... I think that when people are going through hard times they identify with a lot of negative things in the world, the bad. You know, it’s like self-medicating though bad things, or whatever. So instead of being on a bad path, it’s like being on a good path.

For Layla the experience of happy and carefree emotions signified her authentic self – a youn- ger self that she sought to ‘get back to’. She explicitly identified happy emotions as ‘good’ emotions and ‘bad’ emotions as negative ones – and her experiences of the former signified that she had reconnected with her true self. Like Layla, women CAM users consistently asso- ciated positive emotions with successful self-transformation. Some described using CAM to get rid of negative feelings. Nancy said her experiences with guided meditation, which involved tapping into spiritual realms that correspond with directional points ‘would pretty much knock all this negativity away’. Similarly, Miriama described using CAM to temper neg- ative feelings:

If I go for a few days without practicing yoga, it’s not good, I get real bitchy ... all of the negative emotions that you feel about yourself, they are [on the] back burner whenever I am having a good practice. If I go a few days without practicing, those emotions start creeping back into my life.

Some women described cultivating ‘good’ emotions in the context of their struggles with low self-esteem. Robyn said ‘yoga helped me to move from an attitude of lack and unworthiness to the opposite, to thanks and gratitude’.

For women in this study, then, emotional experiences were not only signifiers of finding an authentic self – women framed the authentic self as one that embodies traditionally feminine characteristics such as happiness, caring, and forgiveness. One woman even policed her emo- tions during her interview. When asked if it was a turnoff when alternative therapists seemed inconsistent in their advice, Shree responded:

Undoing gender with complementary and alternative medicine? 101

Yeah, it is. I think people should be focused on – listen to me that sounds so judgmental – [but] I kind of wondered if I was spending a lot of money for nothing.

Women have historically been encouraged to police their internal states, subjecting themselves to a self-scrutiny that benefits the emotional needs of others (Hochschild 2003).

Finding control: being empowered Cultivating positive emotions was linked to another process women spoke of frequently: find- ing control. A centrepiece of neoliberal discourse is the idea that individuals have the ability to, and thus should, exercise control over their lives. Yet this expectation conveniently ignores the way in which structural arrangements shape people’s lives. Many women’s narratives reflected the tension found at the intersection of lived experience and cultural ideals. Nine of the 14 women recounted their experiences with abusive male partners and/or eating disorders, and body image concerns. The women’s narratives revealed how they used CAM to negotiate tensions resulting from feeling like a victim yet wanting to feel in control. For example, sev- eral women with histories of disordered eating described using CAM as a tool to gain control of their eating and their weight. Having battled with anorexia for over 8 years, Cameron noted wistfully that she hoped acupuncture treatments would help her deal with a ‘looming sort of self-hatred eating disorder thing’. Cameron was unsure how acupuncture would help resolve this issue, yet others were more explicit about this connection. Terri said:

Terri The biggest thing I got out of yoga was that I stopped caring so much about being skinny.

Interviewer What was it about yoga that made you stop worrying about being skinny? Terri I’ll never be somebody who can eat whatever they want ... but with yoga, I’m

less of an emotional eater. The more I am practising the more likely I am to stop eating because I’m no longer hungry rather than stop eating because my pants are about to bust.

While it could be argued that CAM offers women spaces to cultivate greater self-acceptance, Terri’s narrative suggests a relentless, and all too common, desire to be like ‘somebody who can eat whatever they want’ and still be thin. Her narrative reveals a theme of the self-as- continuous-project – a quest rooted in entrenched gender discourses that posit women as imperfect beings who must strive to change their physical appearance (Bordo 1993). Terri did not reject hegemonic expectations of thinness, but instead identified her own emotional state as the problem and the self-control she gains from yoga as the solution.

Similarly, six of the 14 women in our study reported being formerly, and in one case cur- rently, involved in abusive relationships and described using CAM to fix their own emotional states that resulted from this abuse. This number is higher than national statistics, which report that one in four women experiences domestic violence in her lifetime (Tjaden and Thoennes 2000). Gloria described a history of relationships with controlling men, including an ex-husband who she said would not let her attend college. Perhaps because she could not control the abusive men in her life, at the time of our interview Gloria was working at controlling herself:

I am working on ... my state of consciousness and energetically working on having those thoughts of forgiveness and love and that’s creating a greater healing. And I am also learn- ing about non-interference. Because karmically you can – you are not supposed to interfere. You can share and help and give or whatever, but not interfere in other people’s states of consciousness.

102 Joslyn Brenton and Sinikka Elliott

Using karma, a discursive resource found in many types of energy therapies (Kaptchuck and Eisenberg 1998), Gloria’s words reveal an embrace of behaviour traditionally linked to femi- ninity, such as helping and giving, but also suggest the healing process involves not interfering – or perhaps silencing herself. Mickey spoke of using yoga to intentionally reinterpret and transform her emotions in the context of a verbally abusive relationship with her current hus- band:

He is horrible to live with, but it’s still my choice to be miserable or not ... I think that’s what yoga taught me, is that there’s nothing that we ever need to be miserable about ... You need a little time sometimes to get to grateful. But yeah, I don’t live with any regret for anything because it just takes you to the next place.

Linking her ideas about suffering and choice to yogic philosophy, Mickey identified herself as both the source of suffering and the solution to the problem. Such philosophies may be resources that help middle-class women construct a sense of choice, and thus control, in response to issues that have social, not individual, origins. Some women described attracting their own problems – presumably through misdirected energy, as Robyn notes:

I used to get down – be down on myself, you know. And my marriage was certainly a product of that mentality. Because [my husband] was psychologically abusive to me. And I would take everything that he said, and really believe it, and take it to heart. He’d call me names and things. So, you know, it’s just what I was attracting in my life and the lessons that I had to learn.

Robyn’s statement implies that a certain law of energy was at work in her abusive relationship. Her narrative reveals the tension that exists between wanting to make sense of one’s problems and to feel agentic. Energy healing therapies may help women resolve this tension. Women using energy therapies said they were learning that individuals unknowingly create their own suffering, and how to control their energy to produce more positive life outcomes.

Conclusion

In this study we examine how gendered identities are produced in unconventional health set- tings that offer the potential to disrupt the gender order (Sointu 2011, Sointu and Woodhead 2008). Our analysis is guided by West and Zimmerman’s (1987) concept of doing gender and thus contributes to current debates about the usefulness of this theory in interpreting contempo- rary gender relations. Some scholars urge us to consider how people may be undoing gender (Deutsch 2007, Risman 2009), while others maintain that as long as people are accounting for their behaviour as men and women, gender is not being undone (West and Zimmerman 2009). In the context of this debate we can ask of our own findings: do the narratives of the men and women in our study who use CAM indicate a detraditionalisation (Sointu 2011) that is, the undoing of traditional masculinity and femininity, respectively?

Our data led us to turn a critical eye toward interpretations of CAM use as a sign of female empowerment or of men’s liberation from hegemonic gender norms. Men’s CAM use may appear to challenge conventional masculinity through its emphasis on self-care, yet our find- ings suggest a more nuanced process of gender performance at work. We argue that the men’s narratives reveal a process of doing, and at times redoing, rather than undoing, gender. In their

Undoing gender with complementary and alternative medicine? 103

narratives of CAM use, men were doing gender by emphasising a discourse of science and rationality, while simultaneously rejecting aspects of CAM associated with femininity, such as emotional experiences. Men were also redoing gender, which occurs when men and women adapt their behaviour in response to changes in the gender accountability structures (West and Zimmerman 2009). Our analyses demonstrate that the men used classed knowledge of health to present themselves as informed health consumers while simultaneously positioning their CAM practices in masculine-coded ways. In the context of a neoliberal emphasis on self-rein- vention, self-control and consumption, the way middle-class men are held accountable for doing gender through their health practices has shifted. Taking charge of health and gaining control over the body may be a new way to assert a middle-class masculine self. As others note (e.g., Pyke 1996), middle-class men can use socially valued resources, such as education, to perform conventional masculinity.

Similarly, the women’s narratives reveal they are doing and redoing, but not undoing, gen- der. In line with doing gender, women described an ongoing process of monitoring and scruti- nising the self for physical and emotional imperfections and cultivating feminine-coded emotions such as love, acceptance and forgiveness. Many women interpreted the legitimation, comfort and meaning they received through their CAM practices as feelings of control and strength, implying a challenge to the gender order. We argue, however, that women’s interpre- tations of strength and empowerment through CAM use reflect a process of redoing gender. The accountability structures around femininity have shifted somewhat. The rhetoric of female empowerment through transformation and consumption resounds within the context of neolib- eral societies that emphasise personal responsibility and self-reinvention. Yet women’s descrip- tions of their reasons for using CAM – abuse, low self-esteem, and so on – mirror wider trends in women’s experiences of living in patriarchal systems. Although some have suggested that CAM’s emphasis on putting the self first offers ‘subversive potential’ (Sointu and Wood- head 2008: 267), we find that through their CAM use, middle-class women identified their own selves, negative emotions and misdirected energy as the source of their problems, not per- sistent gender inequalities. Part of CAM’s persuasive appeal (Kaptchuck and Eisenberg 1998) to middle-class women thus lies in its treasure trove of discursive resources that help resolve the tension between neoliberal discourses of self-reinvention and personal responsibility and structural inequalities.

In sum, within the context of a neoliberal emphasis on self-reinvention and responsibility, CAM appeals to middle-class men and women – the largest group of CAM users – who are invested in creating and maintaining healthy bodies. Attempts to remedy chronic health issues or to boost strength and flexibility were common reasons that both men and women cited for their CAM use. However, our data reveal that women were also using CAM to make sense of gendered life experiences in ways that support a distinctly feminine identity and that men’s interpretations of their CAM practices were markedly gendered in ways that supported rather than undermined their claims to normative masculine selves. Our sample is limited by its race and class homogeneity, thus future research should explore the meanings of CAM for working-class men and women who use it as well as men and women across racial and ethnic categories. Only one participant in this study identified as gay and, given the linkages between gender and sexuality, another important future direction would be to examine how gay men and lesbians make sense of CAM. It is also important to explore why some men and women do not embrace CAM. Despite these limitations, our findings lend credence to critics of CAM who argue that holistic medicines ‘provide individualist solutions to problems of health by focusing on changing the individual rather than on altering the social structure that promotes an unhealthful environment’ (McKee 1988: 775). At the intersection of gender and class, and in the context of the neoliberal call for informed, empowered health consumers, we find that © 2013 The Authors Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd

104 Joslyn Brenton and Sinikka Elliott

men and women used CAM in ways that reflected gendered experiences and reproduced gendered selves, ultimately contributing to gender inequality.

Address for correspondence: Joslyn Brenton, North Carolina State University, Sociology & Anthropology, 10 Current Drive Campus Box 1807, Raleigh, NC 27695, USA e-mail: [email protected]

Acknowledgements

The first author would like to thank Michael Schwalbe for his valuable guidance throughout this project. Both authors thank Corinne Reczek, Sarah Rusche and Emily Cabaniss for their comments on earlier ver- sions of this article, as well as the anonymous reviewers for their helpful guidance.

Note

1 Andrew Weil is a physician, author, self-proclaimed health advisor and popular advocate of integra- tive medicine. His website includes information about supplements and herbs, balanced living, and his ‘optimal health plan’ Weil (n.d.).

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