Binary blues: Exploring beyond dichotomized gender comparisons with a theory-driven approach

Introduction

Gender identities develop within gendered societies, where social constructions of gender shape the body and define how the body is perceived (Johnson and Repta, 2012; Krais, 2006; Thorpe, 2009). In Western contexts, conceptualizations of gender are still largely organized around binaries of woman and man, assigned according to sex categories of female and male and marked by assumptions of inherent difference (Fausto-Sterling, 2003; Geary, 2006; Lorber, 1994). We often act in accordance with gender norms in ways that produce and maintain the social order (Lorber, 1994; Ridley, 2003). For instance, gender norms position women as more nurturing than men, often naturalizing and cementing their role as primary caregiver within the home. Men, on the other hand, are seen to be more stoic, tough and self-reliant (Blackstone, 2003). The dominant conflation of physical characteristics, identity, expression and social roles and norms ensures that people remain deeply circumscribed and determined by these binary and stereotypical gender assignments (Butler, 1990; Lorber, 1994).

Since the mid-1990’s authors such as Lorber (1996, 2011) have suggested reconsiderations of traditional gender categories, criticizing the tendency of research and researchers to assume that men and women necessarily enact patterns of femininity and masculinity or stereotypical role functions. This work has helped to illuminate the complex relationships and potential tensions between gender assignment, gender identity and gender expression. However, categorical and contrastive approaches to gender in research remain common, particularly in the health sciences. Johnson and Repta (2012) suggest that the problem of gender dualism is partially fuelled by the minimal interplay between theory and method, along with a lack of methodological innovation and instruction in the study of gender. Drawing on our experiences during a qualitative study of men’s and women’s involvement in cardiac rehabilitation (CR) (see Angus et al., 2018 for empirical findings), this article provides an account of the analytic and reflexive challenges of conducting research on gender and health and explores how the careful use of Bourdieu’s theory of practice (1980) can facilitate a departure from narrow gender binaries.

The article begins with a description of the methodological and analytic context of the study. Grounded in this context, we move on to tease out study-specific examples of key challenges that we experienced in conducting the research and aiming to see beyond gender binaries. Drawing on these examples, we highlight the problems we confronted in our analysis and discuss our confrontations with what we have come to know as ‘binary blues’ – a seemingly endless struggle to resist categorical and essentializing comparisons of men and women. We describe our reflexive efforts to break apart binaries that are tightly bound to the methods and logics of health science, but also to our own perceptions of gender and to participants’ representations of their social worlds. Informed by our own research experiences and rooted in Bourdieusian theory (Bourdieu, 1980, 1986, 2000; Bourdieu and Wacquant, 1992) and related feminist writings (Krais, 2006; Lovell, 2000; McNay, 1999; Skeggs, 2004; Thorpe, 2009), we then propose some theoretically informed analytic strategies (including theoretical constructs such as reflexivity (Bourdieu and Wacquant, 1992), dispositions (Bourdieu, 1980) and capital flows (Bourdieu, 1986; Scambler, 2001), that we as a research team found helpful in moving beyond the deeply inculcated disposition to reproduce binary and stereotypical ways of thinking about gender. We argue that the application of Bourdieusian theory can provide enhanced opportunities to explore the complexity and nuance of gender as it intersects with social, economic and cultural capital (Bourdieu, 1986) and in doing so, permit opportunities to venture beyond the limitations of binary logics.

The methodological and analytic context

The broader study from which this paper emerges, took a realist approach to the analysis of interview data from 16 women and 16 men who were in their first 3 months of a CR program, had a diagnosis of cardiovascular heart disease (CHD) and were receiving active medical treatment for type 2 diabetes mellitus (T2DM). Each participant completed two semi-structured interviews that were designed to elicit biographical information and descriptions of illness experiences, as well as detailed descriptions of daily health-related activities. To help us understand how gender relations patterned health behaviours, participants were asked to reflect upon changes in everyday activities (such as domestic chores, employment responsibilities and leisure pursuits).

Interviews were iteratively reviewed and discussed by the research team during bi-weekly meetings, which were concurrent with data collection. During these meetings, we discussed conditions of living as well as similarities and differences among the participants in order to produce a descriptive account of their illness experiences and efforts to change their health-related behaviours. Transcripts were coded, relying predominantly on first order concepts using participants own words along with terms reflective of the research purpose (Hammersley and Atkinson, 2007). We used a process of consensus to code participants’ accounts and refine emerging interpretations. In this way, we began to group the data into typologies of experience (Hammersley and Atkinson, 2007), which meant that we identified within the data set different patterns or types of health behaviour change and classified participants according to these typologies. At this stage, we employed abductive reasoning (Danermark et al., 1997), moving between individual descriptions and Bourdieusian theory to explore how change-related tactics were supported or constrained by access to capital and positioning within social fields (Bourdieu, 1980).

Analytic and reflexive challenges of ‘seeing’ beyond the binary

Our study set out to understand the central problem of changing deeply ingrained habits and health-related practices in response to CR recommendations (e.g. dietary and exercise prescriptions), with particular emphasis on how gender relations pattern health-related practices. In our interview approach, we were mindful of Bourdieu’s (2000) insistence on moving beyond participants’ preconstructions, or socially acceptable accounts of their experiences, to develop a deeper understanding of participants’ life circumstances (see also Yanos and Hopper, 2008). This was no simple task. People interpret their own and each other’s positions within social space according to gendered distinctions of practice – not simply identifying others as men or women but as moral and competent practitioners of situated repertoires of gendered behaviour (Davies and Harré, 1990).

There were various ways that participants represented gender in their interviews; typifications of ‘appropriate’ gender practices were among them. For instance, they would attribute certain characteristics (often bound up in stereotypical gendered domestic work) to what was portrayed as the ‘opposite’ gender, situating such characteristics as recognizably masculine or feminine comportment. In addition to the gendered nature of participant’s self-representation during interviews, we as a research team also held our own deeply anchored understandings of gender, as gendered subjects. Together, these informed our initial struggles with binary conceptualizations of gender during data analysis, despite seeing some important similarities in the narratives of women and men. As we wrestled with this tension, several analytic and reflexive challenges of seeing beyond the binary emerged. In the two proceeding sections, we highlight some key examples from the study to illustrate and expand upon these challenges, later visiting the theory-informed assists we used to help navigate through them.

Participant representations of gendered practice

Participants spoke about men’s and women’s practices as being different and we as interviewers were invited to collude with that perspective. In these discussions, men and women emphasized their (gendered) cultural capital. We perceived these discussions to be partially informed by broader social discourses of gender and, in some cases, a purposeful effort to reposition favourably in an interview otherwise focused on their experiences with illness (see Angus et al., 2018; Dale et al., 2015). Participants’ understandings of gendered practice were most evident in their frequent typifications of gender, often beginning or ending with statements such as ‘you know how men/women are’. Given the study’s focus on experiences of cardiac rehabilitation, these typifications tended to revolve around discussions of their cardiac event, dietary and exercise practices. For instance, a woman participant discussed her husband’s disinterest in joining her in learning healthier eating patterns, explaining it as a masculine trait rather than a lack of support.

You know men, they’re not very adventurous…my husband is not adventurous when it comes to food. He tends to like what he likes. I brought in a blue menu, Sheppard’s Pie, that has cauliflower on top instead of potatoes, because it’s less starch, right…and I thought he might like that, so I made it for him too…no.

Another woman, in recounting the evening of her heart attack, described her husband’s lack of concern about her symptoms, but dismissed it as typical of men.

I told my husband, this is not fibromyalgia. I never wake up from sleep like this, so I think I should go to the hospital. So then my husband said, “oh, you know, it’s probably nothing, it must be gas, so you know, take it easy.” You know how men are.

The men in our study also engaged in typifications of women (often bound up in stereotypical gendered domestic work). In their anecdotes, they alluded to what they understood as typical comportment for men and women and how this interacted with their own efforts to maintain masculine identity after cardiac illness. For example, men frequently referred to women’s embodied understanding of food preparation as their specialty in the domestic division of labour. This was particularly evident in men’s accounts of their wives who could not, or would not cook. Specifically, women who did not cook tended to be positioned by their husbands’ accounts as unusual or deficient in this form of cultural capital that is a central facet of gendered domesticity.

For instance, one man recounted his experiences with a nutritionist prior to being discharged from the hospital following bypass surgery:

They wanted to concentrate on my wife. Now my – okay, no sense giving books to my wife. You know, she’s [from a non-English speaking country]. But guess what they did? They went out and found some literature in [her native language]. Okay, but it didn’t matter because my wife doesn’t know where the kitchen is. Okay?

By emphasizing the ways in which his wife was singled out for nutrition education, this participant critiques the implicit gender assumptions held by health care providers, as they did not align with the actualities of domestic life in his home. Yet, he also describes taking on cooking responsibilities as a result of his wife’s inability, thus re-establishing dominant gender norms which naturalize women’s culinary expertise and men’s capacity for problem solving. We saw a similar trope with another man participant who positioned his wife as ‘spoiled’ because she did not learn to cook growing up – her family employed a cook, so a classed as well as gendered division of labour informed her dispositions and skills. He, however, describes growing up in a larger, poorer family, that required all ‘hands on deck’, demanding that even the boys ‘pitch in’ with daily household chores, including meal preparation. This afforded him a certain level of culinary knowledge which he employs later in life in response to his wife’s inability to cook:

We eat all our meals together, but I do the cooking. She is spoiled. She was brought [up] in a family of two girls and the mother had help, so the girls never learned to cook. I mean, she can make a cup of tea or boil water to make Jello, but she hates it anyway. She doesn’t like [to cook], and I’m from a big family…French family that was integrated and we [boys] had to pitch in. So, we more or less learned by osmosis.

In short, participants’ spoke in gendered ways, describing clear distinctions between men’s and women’s roles and behaviours, even when individual practices failed to align with such understandings. The gendered nature of representation in the sample primed us to see gender in binary ways. This pull toward the binary was further reinforced by our own positionalities, of which we discuss in greater detail below.

Positionalities of the research team

In addition to the profoundly gendered nature of representation among participants, were our own deeply anchored understandings of gender, as gendered subjects. Our core research team was composed of four women and one man. We have been socialized into these gender categories from an early age and live in a Western culture that is organized according to binary gendered distinction. The core members of the research team were also housed in Health Science Faculties (four in Nursing and one in Kinesiology and Health Science), where categorical and contrastive approaches to gender analysis remains common (Johnson and Repta, 2012). As critical qualitative health researchers, we were all conversant with research literature and methods that emphasized intersectionality (Collins, 1993; Crenshaw, 1991, 2017) and constant comparison (Boeije, 2002) among interviews; however, we were also immersed in the CR research, much of which was quantitatively based and tended to pool and compare data for men and women in a binary fashion, ascribing the differences to gender. Some qualitatively based articles studied women or men only, often (but not always) without guiding definitions or theories of gender to inform analysis (Angus et al., 2015). Implicitly, our social and institutional positioning primed us to view contrastively the characteristics of men and women’s lives or experiences. We were less predisposed to seek similarity or to find social structures that conditioned even the most subtle differences or similarities. Participants’ binary representations thus often provided confirming accounts to our own pre-reflexive understandings of gender, facilitating the pull toward categorical and contrastive views.

Ultimately, our respective positionalities informed our interactions with participants, the ways in which we ‘colluded’ with representations of gender during the interview, the deep pull we felt toward binary gender logics during data analysis, and our simultaneous unease with such logics. Similarly to the typifications and gendered representations of participants, our own positionalities are central to the contextual circumstances that fostered the emergence of our binary blues and the challenges we confronted in seeing beyond the binary.

The challenge: the emergence of binary blues

Informed by participants’ representation of gender along with our own understandings and experiences, we often found ourselves drawn to distinctions rather than similarities between men and women’s behaviour, despite seeing some similarities in the narratives. This informed our searches for circumstances that confirmed difference between men and women when indeed there were more remarkable within-gender differences to be studied. While we did observe some marked differences in men’s and women’s accounts of their early months in CR, we also noticed similarities in their stories and were challenged by the evasive nature of gender itself. As critical scholars, we felt a great deal of discomfort with categorical applications of gender, yet we often found ourselves drawn to this contrastive mode of analysis. At the nexus of this analytic conflict lied our ‘binary blues’.

While most participants represented gender in a dichotomized way, a few (knowingly or not) went against the grain of convention. However, even when men and women described activities that challenged gender typifications, we continued to find ourselves drawn to and relying on binary logics and talk, re-categorizing participants within a woman/man dichotomy. For instance, one woman challenged the interviewer about the ‘unscientific’ character of the open-ended interview, she described herself as content with her social isolation, and offered detailed accounts of disappointing encounters with providers. Several of us immediately commented that this narrative pattern seemed more like something we had heard from some of the men we had interviewed. This initial stance unintentionally reinforced binary assumptions about gendered practice. Indeed, we often found ourselves (albeit, unintentionally) engaged in false collusion (see Yanos and Hopper, 2008), looking for cases that confirmed participants representation as well as our own pre-reflexive assumptions. And while we were often aware of and uncomfortable with the reification of this dichotomy – which did not seem to fully account for participants’ struggles and successes with health work and changing habitual patterns of behaviour – we were unsure of how to overcome our own attraction to binary characterizations of gender, particularly when confronted with accounts where gender was practiced in unexpected ways. This often led us to crossroads in our analysis and fostered an uncertainty about the actualities and impacts of gender in the day-to-day lives of people as they attempt to reposition and change habits following a serious health event.

In consideration of participant dialogues and engagement with the messiness of our own discomforts, some important questions came to the surface. Firstly, we wondered, to what extent do participants’ gendered typifications map onto their real-world experiences of illness and rehabilitation? In illness, are men and women differently active in social situations, thus inhabiting their life worlds in different ways? And, if the social world is so sharply divided along binary gender lines, then what are we to make of the many similarities in men’s and women’s experiences? In unpacking these and other similar questions, we drew on Bourdieusian theory, adopting several theoretical concepts to assist us in rethinking the ‘fields’ that drew us to this comparative mode of analysis. Specifically, we drew upon constructs such as reflexivity (Bourdieu and Wacquant, 1992), dispositions (Bourdieu, 1980), and capital flows (Bourdieu, 1986; Scambler, 2001). Doing so helped to foster a flash of reflexive awareness that we describe more fully in the section below.

Locating solutions: theory as a tool to navigate binary blues

The theoretical and conceptual works of French sociologist, Pierre Bourdieu (see Bourdieu and Wacquant, 1992; Bourdieu, 1980, 1986, 2000) along with related feminist writings (see Krais, 2006; Lovell, 2000; McNay, 1999; Skeggs, 2004; Thorpe, 2009), provided us with valuable tools that fostered a departure from pre-reflexive understandings and representations of gender to tease out the larger social and contextual circumstances of participants. Bourdieu (1980) probed the links between the structures of the social world and individual dispositions to act in consistent, if not predictable, ways – thus making it a useful framework in the understanding of people’s struggles to change health-related habits. His work emphasizes the dynamic and co-constitutive relationship between social context – or specific positions in social space – the human body and the persistence of certain practices. This captures the generative interplay of situated logics and social embodiment, offering a fulcrum to explore the durability (but not inevitability) of gendered patterns of behaviour (Lovell, 2000; McNay, 1999; Thorpe, 2009). Furthermore, his work provides a useful point of departure to study the potential for and challenges to human agency when circumstances (such as lifestyle-related chronic illness) challenge habitual patterns of behaviour (Adams, 2006; McNay, 1999). We used Bourdieusian concepts of reflexivity (Bourdieu and Wacquant, 1992), dispositions (Bourdieu, 1980), and capital flows (Bourdieu, 1986; Scambler, 2001) as investigational tools to more accurately understand gender binaries, and why we are so drawn to them, as well as participant typifications and representations of gender behaviours. In unpacking the complexity and nuance of gender, these concepts were also invaluable in our efforts to explore beyond binary gender norms, rendering us better able to resist categorical and essentializing comparisons of men and women. In what follows, we describe these concepts in greater detail, highlight their application in the context of our research and examine the ways they helped us move beyond binary approaches to gender.

Researcher reflexivity: fighting binaries through reflexive thought

The social, cultural and political location of the researcher informs their orientation in the research process, influencing the questions they ask, the data they collect as well as the interpretation of that data (Holmes, 2020). Reflexivity provides a valuable tool with which to explore the role of one’s positionality in framing the production of knowledge (Leibing and McLean, 2007) and heightens capacity for creative analysis (Jacobson and Mustafa, 2019). Indeed, Bourdieu and Wacquant (1992) contend that as investigators, we ought to conduct our research with one eye repeatedly reflecting back on our own habitus, of which the dispositions learned through long social and institutional training are a large part. They suggest that this will assist the researcher to recognize when personal dispositions are imported into the inquiry – in this case our own deeply and firmly anchored understandings of gender.

The positionality of the researcher affects how they see, understand and interact with the research and research participants, but it also informs the ways in which research participants interact with them (Jacobson and Mustafa, 2019). Reflecting on our positions in relation to that of the research participants, we were better able to understand the nuances of these social interactions, including what participants told us and why, as well as the ways in which they communicated their experiences and how we as researchers responded to these accounts. For instance, as we discussed earlier, participants tended to draw on gendered discourse as they described clear distinctions of practice, even when those practices failed to align with the actualities of their lives. This was a tension that we discussed frequently in our research meetings, one that sparked our own discomfort with binary and stereotypical representations of gender. We drew on Bourdieu’s concepts of habitus, capital and field (Bourdieu, 1980) as we attempted to reflexively unpack this tension. In doing so, we realized that the ability to enact gender operates as a form of cultural capital (Skeggs, 1997), and we felt that this process of capital accumulation and display may be particularly salient in cases of perceived ‘lack’. In other words, we discussed the possibility that participants’ ‘doing of gender’ and use of gendered discourse during the interview may be partially explained by their efforts to reposition favourably in the context of a research study/research interview that was otherwise focused on their experiences of illness (CHD and T2DM) and rehabilitation. Our consideration of capital accumulation and positioning within the field provided additional insight into why the men and women in our study tended to articulate their narratives rather differently (and in stereotypically gendered ways) despite, at times, telling very similar stories and sharing very similar experiences.

Through individual and group reflexivity, we were better able to acknowledge, yet venture beyond our personal understandings and experiences of gender as well as participants own representations of gender to better observe the contextual factors that complicate gender dichotomies (Risman, 2009). This helped to illuminate the many, yet often backgrounded, factors that intersected with gender to frame participants’ lived experiences – such as those that inform divisions of labour within the home. For instance, as we reflexively called each other to account for binary thinking, we came to realize that cooking was not just a domestic duty that was relegated as ‘women’s work’ (despite being described as such), but that it was dependent on the individual’s circumstance, resources, and context. Foregrounding this view encouraged opportunities to broaden the focus of our explorations (e.g. social supports, opportunities and encouragement to acquire capital, and available time and resources) which ultimately led to enhanced understanding of the shared experiences and circumstances of men and women as they simultaneously repositioned within fields of practice that were new (e.g. CR) and some that were more familiar (gender domesticity and workplace).

Practicing reflexivity allowed us to recognize when personal dispositions (i.e. our own deeply and firmly anchored understandings of gender) were being imported into the inquiry and that reflexive discussions helped us to better consider the social, political and relational gender frameworks through which knowledge is embodied, practiced, and performed. Working within a core group forced us to confront difficult questions head-on, such as whether we should actually be using gender as a starting point in analysis, or if starting from this position renders analysis vulnerable to pre-conceived understandings of gender? This is especially important in a study where activities in the domestic field figure prominently in participants’ accounts, making the gendered division of labour a focus of analysis. While we do not purport to have all the answers to such questions, grappling with them as a team during regular analytic meetings prompted us to confront some of our previously held assumptions about gender. It also opened opportunities for us to ‘see’ the complexity and fluidity within and between binary categories of men and women and to parse out the unity in their struggles to rehabilitate and change habituated practices. In turn, we argue that the reflexive willingness to suspend gender stereotypes will assist researchers to move beyond personal understandings and experiences of gender to more clearly observe when gender identity is being ‘undone’ or undermined. It also encourages researchers to look beyond gender to consider the social circumstances that create persistent dispositions, which can counteract efforts to change health-related practices. As we discussed previously, patients have similar tendencies to hold assumptions of gender and articulate their narratives according to these understandings. If we take these accounts at face value, we risk reproducing binaries that, while potentially illustrative of narrative discourse, may not necessarily represent the complexity of social experience.

Our engagement with Bourdieu (Bourdieu, 1980, 1986; Bourdieu and Wacquant, 1992) and related feminist writings (Krais, 2006; Lovell, 2000; McNay 1999; Skeggs, 2004; Thorpe, 2009) often challenged our habitual positioning; promoting reflexive awareness that ultimately illuminated and problematized our collusion with participants’ binary representations of gender as well as our own categorical and contrastive approaches to analysis. As we engaged in reflexive practices, we found further assistance by drawing on the theoretical concepts of dispositions and flows of capital. Working with these concepts encouraged us to move beyond categorical understandings of gender to address the questions that emerged as a result of our reflexive struggles. More specifically, we worked to identify dispositions or tendencies among women and men, rather than seeking a universal trend in each case (Danermark et al., 1997). We also considered unique flows of capital (Bourdieu, 1986; Scambler, 2001) that may have shaped opportunities and experiences across the entire sample. These helped us work towards more fluid accounts of men’s and women’s experiences with illness and rehabilitation. Below, we describe these theoretical concepts in greater detail and draw on examples from our study to illustrate how we employed them to tease out more nuanced accounts of gender.

Dispositions

For Bourdieu (1980), habitus operates at every moment as durable dispositions which are deeply engrained and reflect the social position (i.e. class, ethnicity, race, sexuality, gender, generation and nationality) of the individual, or the circumstances of existence to which that individual is accustomed. Dispositions are converted in practice as postures, gestures and movements – and as aesthetic preferences or tastes (Bourdieu, 1980). Gender identities, for instance, develop within gendered societies, where social constructions of masculinity and femininity shape the body and define how the body is perceived. Thus, the gender specificity of habitus, instilled from an early age, becomes one of the most fundamental aspects of a person’s identity, forming the body’s habits as well as framing possibilities for expression (Thorpe, 2009). It is here that the connection between habitus and embodied practices of gender are made readily visible – situating gender as a major locus of social stratification (Krais, 2006; McNay, 1999; Skeggs, 2004; Thorpe, 2009). However, practices are not simply the direct and independent expression of habitus; individuals act with reference to particular social settings, and the logics governing actions may vary according to contexts or fields.

This perspective was useful in our evaluation of gender – explaining the tenacity of deep-rooted gender identities and practices without discounting the possibility of change (McNay, 1999). As previously noted, many aspects of our participants’ stories fit within stereotypical patterns of masculine and feminine comportment, yet several instances defied these binary categorizations. Indeed, binary and stereotypical understandings of gendered practices inadequately represented the various contexts and contingencies found in our participants’ accounts of illness and rehabilitation. For instance, while many women emphasized their responsibilities as family caregivers and stressed the tendency to put others first (perhaps as a strategy in ‘gender repair’ and/or as a rationale for their current morbidities), a few others repositioned their practices. For example, a woman participant suggested that the family presence was an unwanted distraction from her ‘routine’ health work – and while acknowledging the gender order of care work in the home as well as the potential loss of social capital accompanying her divergence from this position, she stated ‘I’m stepping back and I’m thinking, I am taking time for me. I’m saying, I don’t know if it’s selfish or whatever, but I am now me, me, me’. Her linguistic usage of ‘now’ suggests a conscious effort to change from her previous disposition.

While we agree that people may reflect dispositions that are characteristic of membership in particular social groups (like gender), we found that the concept of dispositions allowed us to see the ways in which practices, experiences and representations are variable within this category, because people also occupy positions across multiple fields and change throughout the life course as new fields and situations are encountered. Acknowledging that differences between men and women are not fixed or consistently replicated across all contexts allows us to consider the textured nature of gender within peoples’ lives. The textured nature of gender may be even more pronounced during the upheavals of illness when dispositions and habituated practices are called into question. An alternative approach is to regard gender behaviour as a situated accomplishment. In other words, that men and women can and do behave in ways that are both consistent with and contradict gender discourses and normative gender behaviour as they attempt to reposition themselves favourably during and following times of illness (Fenstermaker and West, 2002; Galdas et al., 2010; Lorber, 1996).

Accounting for differences within groups of men and groups of women as well as similarities between these groups may allow us to more accurately attend to their care and rehabilitation needs, as for some of our participants, binary and stereotypical understandings of gendered performance positioned them as ‘lacking’ and in some cases left them without the required resources to adhere to CR prescriptions (Angus et al., 2018; Dale et al., 2015). For instance, as previously discussed, binary gender logics assume that women embody dietary and culinary expertise. While there was a tendency among the women we interviewed to perform most meal preparation in the home, this was not always the case. Indeed, there were 3 examples of women (partnered and unpartnered) who were not involved in food preparation and 3 men who did most of the cooking, as well as numerous participants who described various degrees of shared responsibility. Despite varied approaches to meal preparation, these men and women still tended to talk of meal preparation as primarily a woman’s domain of practice and told similar accounts of binary approaches to the delivery of CR-provided nutritional education that focused outreach to women (e.g. women who were themselves enrolled in a CR program and wives of men enrolled in a CR program), thus leaving some patients and their partners without necessary information, services, and supports.

Lawson (1997) argues that while we may begin to detect patterns or identify what appear to be consistent realities in the data, underlying patterns may be detected in exceptions to or modifications of the patterns. We found that identifying typologies of experience among women and men, rather than seeking a universal trend helped us to move beyond participants’ gendered discourse to identify the otherwise backgrounded conversations that highlighted similarity in men’s and women’s everyday struggles to manage and recover from illness. This helped us to move beyond experiential knowledge to identify, unpack, and better understand the structural aspects of the habitus that influence participants in ways that they are not consciously aware. This approach to analysis is more consistent with intentions to explore beyond categorical distinctions and encourages a more open and less binary analysis. In the case of our study, cooking had far more to do with possession of capital, particularly cultural capital (i.e. knowledge of meal preparation), than it did with gender. And while women may tend to have more opportunity and encouragement to acquire this capital in their youth, this was not always the case in our sample. Indeed, gendered assumptions about culinary ability were as problematic for the women who could not cook as for the men who could but had not been targets of CR nutrition education.

Flows of capital

Fields are “structured spaces of dominant and subordinate positions based on types and amounts of capital” (Swartz 1997, 123). Capital and field, then, connect the agency of habitus to the stratifying structures of power in the social world. According to Bourdieu (1986), people accumulate, embody and are positioned by economic (wealth, income, property and time), social (supportive networks and personal connections) and cultural capital (knowledge, embodied skills, culture and educational credentials). In addition, some feminist scholars posit that gender is a learned competency and may in turn also operate as a partially embodied form of [cultural] capital that can combine with other valued capitals to contribute to social positioning within a given field (Skeggs, 1997; Thorpe, 2009). Further, the value of certain forms of capital change as people move across fields, which partially explains why gender is expressed differently by the same person depending on the social space in which they are located (i.e. home vs. workplace). Recurrent social interactions within fields inculcate and elicit certain responses, creating dispositions to act in specific ways, which become habitual within the particularities of a given field and may also inform responses within new and unfamiliar fields. Bourdieu maintains that the degree of agency to renegotiate social position within a field will likely depend on available material and symbolic resources that may contribute to desired changes in practice and habitus (Bourdieu, 1986).

In our analysis, we found that gender, as a form of embodied cultural capital, was intertwined with other forms of capital that were variable, and held different levels of importance throughout the life course. In our study, it seemed that while gender mattered, people’s biographies were marked by their varying access to social, cultural and economic capital and that success in CR depended more on the individual’s positioning at the time of illness than their participation in a gender role alone. Understanding this point allowed us to better explain the fluidity of gender, particularly during a time of crisis and repositioning. Furthermore, we found that disrupted or abundant access to social, cultural, and economic capital conditioned the enactment of newly acquired information about cardiac risk modification. Indeed, those participants who had difficulty mobilizing resources to follow CR program recommendations became frustrated with what they defined as ‘unreasonable’ expectations that did not take their unique needs or concerns into account. This trend was similarly found between men and women and led to some very significant differences in the way groups of women and groups of men experienced and were able to cope with/adhere to CR.

For example, our comparative analysis of interviews with two employed women revealed important differences between them, despite a number of surface-level demographic similarities (e.g. both were women, married, had children and were employed full time). One woman experienced considerable difficulty negotiating enough time to satisfy physical activity requirements. She explained that she had problems exercising during work hours because she wanted to hide any reminders of her illness, as this might decrease her chances for a promotion:

You don’t want to get a reputation of someone that is gone a lot of time because they’re ill. It’s harder for you to put yourself forward for anything, and opportunities that come up in the future, you know? She’s gone three days a week for this, or she’s at doctors’ appointments or she’s doing – employers look at that. They look at everything.

Instead of exercising during work hours, she tried to include physical activity in her already time-constrained home life. She struggled with this decision because it threatened the valued evening ritual of eating dinner with her husband, who arrived home later than she did. She had been advised that, as a diabetic, she should eat dinner before doing her prescribed exercise of walking, but she also wanted to walk before nightfall for safety reasons. Thus, she was torn between the loss of an important daily ritual with her husband and the risks of exercising at work or at home after dark. In contrast, another woman described being content with her current employment and felt comfortable exercising at work because she was secure in the open acceptance and support she received from colleagues and managerial staff. Health policies in her workplace supported her engagement in a daily walk while she transitioned back into her work activities. Supportive policies and acceptance from co-workers provided her with a sense of job security that was apparently unavailable to the other woman participant. In discussion of her workplace, she says:

The rest of the management team, they were always there in case I needed help to pick up something…because in the beginning there was a limitation of how much I could lift and you know those coin boxes are kind of heavy in the beginning. But they were all very wonderful and very, very supportive and they still are. Every time I have to go for an appointment, they are always pushing with me to do the right thing and make myself number one and everything else.

This participant described consolidating her social capital at work by practicing an ingratiating and friendly approach to co-workers and managerial staff. One additional benefit was that exercising at work meant she still had the usual amount of time for her family after work. This possession of time and social capital meant that she did not have the same struggles that the other woman participant experienced in repositioning after the crisis of illness. This comparison demonstrates how ostensibly similar people may differently reconfigure everyday practices in response to CR prescriptions of physical activity, confront different challenges to adherence, and experience different levels of ‘risk’ for attrition from CR programs, thus illuminating the role of capital in (differently) framing experiences within a gender category.

Analyzing the data according to the principles of capital flows helped to illuminate the ways in which gender and gender identity are situated in and influenced by the contextual realities of individual lives. The above accounts serve to illustrate that participants’ encounters and experiences with illness and rehabilitation were not simply a reflection of assigned gender and gendered expectations, despite participant’s tendency to represent them as such. Indeed, our data showed that behind very gendered accounts of experience, are the contextual factors (most notably, access to social, cultural and economic capital) that often influenced participants’ capacity, and/or willingness, to cohere with CR prescriptions and teachings. We found that examining relational flows of capital as a subsequent strategy in analysis helped to tease out this backgrounded talk and in turn, provided more nuanced accounts of the relationships that are forged between gender and experiences of illness and efforts toward rehabilitation. In short, through consideration of flows of capital, we see that men and women can and do behave in ways that both cohere with and contradict stereotypical expectations of their respective gender as they attempt to reposition following the crisis of illness.

Conclusion

There is a well-established relationship between gender and health status; the theoretically informed strategies that we offer in this paper may prove beneficial in exploring this relationship more fully. The analysis presented in this article adds to methodological writings on gender and health by drawing on Bourdieusian concepts of reflexivity, dispositions, and capital flows as tools to address the fluidity and complexity of gender as lived and negotiated in the everyday circumstances of men and women who engage in self-care during and after the upheavals of serious illness. The use of these concepts in our analysis helped provide meaning to participants’ typifications and representations of gender, and illuminated our own tendency toward binary thinking and why we are so drawn to this contrastive mode of analysis in investigations of gender. In doing so, these concepts proved invaluable in our efforts to explore beyond the binary, unveiling and enlivening the many contextual factors that intersect with gender to frame an individual’s experiences.

While our research confirms different tendencies in men’s and women’s behaviours, we argue that uni-dimensional analyses focusing on binary (and stereotypical) understandings of gender do not adequately capture the nuanced experiences and struggles of men and women to reposition as they attempt to blend and practice multiple self-care regimens and ‘rehabilitate’ their social selves in addition to their health. Seeing beyond the binary to capture the complex and fluid nature of gender when we as researchers and participants often think, speak and perform in deeply rooted gendered ways is challenging. However, our findings suggest that participants’ biographies are very textured and that opportunities for health during times of illness depend on the individual’s positioning (including access to capital) at the time of illness rather than their participation in a gender role alone. We also found that binary ways of thinking may lead us to miss important health practices, experiences, and struggles that are shared by both men and women (and can be experienced differently within groups of men and women).

The complex and fluid nature of gender seen in the narratives of our participants does not undermine the importance of gender in the investigation of health, illness, and rehabilitation. Rather, what we have argued here is that the way in which gender ties in with men’s and women’s day-to-day lived experiences, including their ability to reposition or rehabilitate following the crisis of illness, is highly complex. Yet, current empirical approaches to gender in this context have often lacked the theoretical drive needed to gain a nuanced understanding of men’s and women’s illness experiences as lived within highly influential social contexts. We argue that a reliance on gender binaries and norms may limit the scope and relevance of research results. By illuminating and enlivening some theoretically informed analytic manoeuvres and concepts – such as reflexivity, dispositions and capital flows – that can be usefully employed to provide more nuanced accounts of gender, the analysis presented in this article can be seen to have important implications for qualitative research. We argue that researchers need to move beyond gender stereotypes and comparisons to consider the more complex ways that gender relations are a part of, but not necessarily the only determinant of, health-related practices, experiences and opportunities. Indeed, a range of messages may be required that are sensitive to the complex and fluid nature of gender. We argue that the application of critical social and/or gender theory help to unearth the complexity of people’s experiences of illness and rehabilitation, and can illuminate meaningful ways forward.

While this article draws on examples from a study about men’s and women’s experiences with and understandings of CR, we argue that the theoretically informed strategies discussed transcend this specific area of focus, offering important and far reaching insights regarding studies of gender in various contexts, including those of health and illness management. However, we also acknowledge that our suggested strategies are not without limitations. For instance, our understanding of gender was informed by a Western Feminist lens, so we applied theoretical assists that were suited to helping us unpack the complexity of gender through that one particular way of ‘seeing’. Other conceptual lenses were not discussed. Further, our sample was composed of cisgender participants who identified as heterosexual. The perspectives and experiences of those who identify as non-heterosexual, transgender, and/or gender nonconforming are not represented. In short, we warn that the strategies we found helpful do not necessarily represent a ‘one-size fits all’ approach to gender research and analysis. To the contrary, it is a call for researchers to engage with the ‘messiness’ and complexity of gender, to discover or unearth their sociological imagination, and be more (theoretically) playful in their analyses of gender.