Healthcare Work in Marriage: How Gay, Lesbian, and Heterosexual Spouses Encourage and Coerce Medical Care

Abstract

Marriage benefits health in part because spouses promote one another’s well-being, yet how spouses facilitate formal healthcare (e.g., doctor’s visits, emergency care) via what we call healthcare work is unknown. Moreover, like other aspects of the marital-health link, healthcare work dynamics likely vary by gender and couple type. To explore this possibility, we use in-depth interviews with 90 midlife gay, lesbian, and heterosexual spouses to examine how spouses perform healthcare work. Our results show that in heterosexual marriage, women perform the bulk of healthcare work and typically do so in coercive ways. A minority of heterosexual men provide instrumental healthcare work for their wives. Gay and lesbian spouses appear to commonly use both coercive and supportive healthcare work strategies to effectively promote healthcare use. Our findings demonstrate the ways spouses are central to supporting and coercing one another to obtain medical care and how these patterns are gendered.

“Go See Somebody”: How Spouses Promote Mental Health Care

“…This study makes significant contributions to the sociology of mental health and mental health care utilization. Our main finding shows that spouses play a significant role in facilitating, promoting, and encouraging engagement with professional mental health care in ways that fit within the broader theoretical construct of “health care work” (Reczek et al 2018); previous research has not articulated health care work dynamics regarding mental health care. Importantly, research on heterosexual men repeatedly shows that men resist seeking help for mental health conditions, yet these studies pay little attention to gender composition of couples and rarely develop theoretical models that include multiple masculinities, such as gay or lesbian masculinity (Addis and Mahalik 2003; Oliffe and Phillips 2008).…”

“…In this study, we contribute to research on mental health in marriage by considering how spouses encourage professional mental health care as part of the broader constellation of what is known as health care work (Reczek et al 2018), as well as how these dynamics vary by the gender composition of the couple. We draw on a unique qualitative dyadic data set that allows us to consider each spouse’s perspective on mental health care and relationship dynamics within the couple and provides a comparison of men and women across gay, lesbian, and heterosexual marriages.…”

“…Spouses are typically the first line of defense during the development, diagnosis, and progression of physical illness, wherein spouses notice and identify health symptoms, help each other decide whether physical symptoms warrant professional intervention, and facilitate formal and informal care in response (Chen, Waite, and Lauderdale 2015; Kiecolt-Glazer and Newton 2001; Reczek et al 2018; Umberson et al 2016)—a form of spousal interaction termed health care work (Reczek et al 2018). While previous work has largely focused on how spouses monitor and promote medical engagement in response to physical health conditions, similar spousal interventions likely also occur for mental health symptoms.…”

“…How spouses encourage one another to seek mental health care likely varies by gender due to long-standing and pervasive gendered social scripts, expectations, and roles regarding both marriage and mental health (Thomeer, Reczek, and Umberson 2015b; Schonbrun and Whisman 2010). These dynamics are further complicated by the gender composition of the couple as relationship dynamics depend on not only one’s own gender but also whether one is partnered with a man or woman (Reczek et al 2018; Umberson et al 2016). Research on heterosexual marriage has demonstrated that women and men have different expectations, skills, and experiences when one partner is physically ill (Calasanti and Bowen 2006; Pinquart and Sörensen 2006).…”

“…Additionally, how spouses encourage mental health care likely varies for men and women and by the gender composition of a couple (e.g., whether the couple is composed of two men, two women, or a man and a woman; Umberson, Thomeer, and Lodge 2015). Women typically take on the role of “health expert” and “emotion expert” within heterosexual marriage (Hochschild 1979; Risman and Johnson-Sumerford 1998), and thus women married to men may be especially likely to encourage their spouse to obtain mental health care (Reczek et al 2018). In turn, research shows that heterosexual men often ignore their own and their wives’ health problems in general and mental health problems in particular (Addis and Mahalik 2003; Wendt and Shafer 2016), partially due to the stigmatization of professional mental health care.…”