Chapter 6 172 in their self-image, self-confidence, and self-reliance require care approaches that are sensitive towards these gender normative constrains regarding the expression of emotional experiences. Particularly those that are considered stereotypically feminine and gender role inconsistent for men (e.g. fear, sadness, embarrassment, shame or guilt).35 It is well known that maladaptive emotional regulation increases psychological stress, exacerbates motor symptoms and result in poorer health outcomes in PD.36 Especially for men who consider their masculinity a strong component of their overall identity and define their masculinity in traditional, hegemonic, terms, emotional disclosure can be challenging. These restrictive masculine norms and self-stereotyping behaviours are illustrative of a gendered pathways to health that can limit men’s access to and utilisation of psychosocial PD care. It is important to note that masculinities demonstrate a wide range in patterns of practice and a generalisation about emotionality and men would be misleading. Focusing on masculinity risks being overly focused on problems associated with ‘negative’ masculinity and may neglect to focus on adaptive traits and the normalisation of emotional experiences.37 Gender transformative approaches to improve emotional health and wellbeing of men with PD require not only changes in personal narratives but also in media representations, healthcare discourses and care services that normalise mental health, integrate role modelling and leverage adaptive gender norms and value systems.18,38 This is particularly relevant in a strong national gender equality discourse in which women’s emancipation promotes non-traditional role changes for women and dynamic feminine stereotypes, whereas the transgression of men into social roles that are generally considered communal or feminine progresses much slower and traditional masculine norms seem much more resistant to change.39–41 It is important for researchers, clinician and policy-makers in healthcare to recognise that cultivating dynamic and less restrictive masculinities, normalising mental health and acknowledging the diverse ways in which men may construct gender ideals, is psychosocial health promotion for men with, and without, PD.10,37,42,43 Gender norms related to ‘women as family carers’ were most strongly internalised among the women in our study. Norms related to ‘women should look friendly’ were largely experienced by women as ideological, descriptive norms. A recent study into emotional cues in expressive behaviours of men and women with PD found that, to conform to gendered social expectations, women with PD may experience more pressure to express sociable behaviours such as more smiling and laughing during conversations. This study suggested that these socially desired behaviours can be misunderstood by observers, even healthcare professionals, and mask negative emotional experiences of women with PD, particularly when smiling and laughing
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