The Salience of Gender 73 4 Introduction Parkinson’s disease (PD) is the second most common neurodegenerative disorder and is the fastest growing in prevalence and disability.1,2 Retaining social role performance is an essential health outcome for people with PD and the clinicians who treat them.3 Social role functioning encompasses performance in specific social roles, or “expected ways of behaving,” which are established by both an individual’s personal goals and societal norms. Although the relevance of gender as a particular social role determinant in PD is increasingly recognized 4–7, much still needs to be understood about how genderrelated aspects impact PD outcomes and vice versa. Recent research demonstrated that distinct gender dimensions, such as gender identity and culturally shaped gender roles and relations, can impact health outcomes differently among people with PD.8 This study highlighted the importance of accurately conceptualizing socio-cultural dimensions of gender in PD research, in association with- and distinct from sex-linked characteristics. One of the few studies examining the impact of gender identity as a particular social identity and maintaining “masculine” or “feminine” social roles in living with PD found that while men and women face similar somatic symptoms, the experience of these impairments was gendered.9 For example, women emphasized on/off effects and “thinking problems” that affected their ability to organize and fortify social relationships, consistent with a stereotypical view of feminine social role as “communal organizers”. In contrast, men’s narratives were characterized by attention to appearance and strength, consistent with masculine norms emphasizing physical performance. Loss of physical performance can be an important challenge for aging men in later life and chronic illness can lead men to re-evaluate their place in the gendered social order. According to the authors, gender is a salient social category for people with PD through which the meaning of illness experiences is produced. Earlier social studies in medicine also emphasize the relevance of gender related aspects in illness experiences.10,11. However, the impact of gender on illness experiences is mediated by how strongly committed a person is towards their gender identity and related aspects and in which context this becomes salient in a person’s lived experience (“doing gender”). The more strongly committed a person is to their gender identity, the more likely they are to perform roles and cultivate relations that are consistent with socio-cultural role expectations associated with that gender identity.12 This approach to gender challenges the idea that just because every person has a gender identity, their perspectives, attitudes and behaviours can be directly interpreted as gendered representations. Rather, gender becomes relevant when either people themselves or their environment make it relevant through normative ideas, language or behaviours
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