1. Introduction: This blog entry is my reflection on how we as occupational therapists undermine our own profession by failing to reflect deeply on and analyse the global repercussions of some of the mundane decisions we make. The example used for this reflection is conflict with social workers, but it could just as easily have been any one of several other situations that occur routinely during my working day. One of my seniors expressed to me on several occasions that she did not feel able to deal with global issues, and those are the responsibilities of managers and the College of Occupational Therapists. This argument could only stand if we were actually applying the standards set by the College of Occupational Therapists to our work. Some of us would like to think we are, but are we really? When was the last time you studied them with a view to scrutinising your own work? If we do not apply the standards set by the College of Occupational Therapists, how can we expect the British Association to protect us?

1. Introduction:
During my short career in health and social care, I have seen people rushed into hospital by ambulance, treated with major surgery and kept alive against great odds in intensive care. I have seen people rehabilitated by physiotherapists and speech and language therapists and cared for by nursing staff. I have seen social workers speaking to patients to ensure their care needs are met in the community. What is it all for? Why do we work so hard to keep people alive? The answer to this question must lie in the meaning of life. What is the meaning of life? This blog entry briefly explores the meaning of life and extrapolates from it reasons why occupational therapy is an essential component of quality care. It reflects on evidence that occupational therapy is currently undervalued and suggests a radically different professional image for the future.

1. Introduction:
I was recently told by a lady in her nineties (Mrs X) that it is not right for men to be occupational therapists because they have no knowledge of domestic activities. When I asked her if she had ever heard of Jamie Oliver or Gordon Ramsay she told me she did not watch television because it was rubbish. I thought it best not to mention Ainsley Harriott, as she may have been indicating to me a mistrust of people of colour on several occasions when she said “we English do not like people nosing into our private affairs”. I think she was trying to tell me I had no idea about her culture. I agree with her, not because of the country I was born in, but because British culture has evidently changed greatly with time. One big aspect of that change is gender-role blurring. This blog entry looks at some of the problems caused by gender-role blurring and briefly suggests some avenues for their resolution.

2. Innate gender differences:
Sexual dimorphism suggests that gender roles are biologically determined. Why do men not have breasts? In the post-feminist era it seems politically incorrect to suggest there is a variance in aptitudes and capabilities between males and females[1]. Politics cannot however change scientific fact. Physiological and psychological differences between the genders (such as gender-specific pain perception) differentially affect the way they interact with their environments. Cognitively, men generally have better spatial awareness than women and are therefore better at related tasks such as map-reading[2]. Boys are more impulsive, emotionally sensitive and vulnerable to social conditioning, but less expressive than girls [1]. Women generally have better empathy[1], listening, language and memory skills[2]. Physiologically, men have higher levels of testosterone which stimulates increased lean muscle mass[3] and an increased sex-drive for both genders[4].

The ways the genders communicate are very different. When I was a first year occupational therapy student, a female friend phoned me while I was in the middle of a run and said something like “Venth, will you come to Comet with me and help me choose a fridge, because it is raining and cold.” I wondered why the rain and cold weather would increase the need for a fridge, but agreed and ran to her accommodation. When I got there she asked me where my car was. When I told her I ran, she asked me what the point of me coming was. I told her I had no idea. Then she told me it was obvious she wanted a lift and that I had deliberately not brought my car just to wind her up. I believe there are very few men who will deduce that “will you come to Comet with me …………. because it is raining and cold.” really means “I want a lift.”.

Perhaps innate differences suggest that men and women are naturally suited to different occupational roles and when defying gender roles we are defying nature. It has been argued that during their pursuit of professional and social fulfilment, women are forgetting that they are biologically programmed to experience life differently from men[5]. If I am ever lucky enough to stay at home and rear children as a house-husband will I be defying nature? More importantly, will it be the healthiest option for anybody concerned?

3. Benefits of gender-role blurring:
I guess we have the feminist movement to thank for gender-role blurring. I am therefore grateful to feminists for my occupational therapy career. Where would I be now if my University tutors or clinical supervisors shared the opinion of Mrs X? Feminism has earned some great social gains for women such as the right to vote[6], sexual liberation and financial independence. Gender-slavery was a terrible occupational injustice that left unfortunate women defenceless against abuse[7] and feminism has effectively displaced it as a social norm. This can only be a good thing. There have however been high costs due to poor social engineering.

4. Problems with gender-role blurring:
4.1. Occupational imbalance:
The grass is always greener on the other side of the fence. Women have arguably gained financial independence from men by pursuing and excelling in education and career development, but as far as I am aware feminism put nothing in place to protect work-life balance, family-life or the cost of living. Women used to get their husband’s pensions when they were widowed. I do not believe this happens any more. Society has adapted to working women in an unhealthy way. The very changes that have given women financial independence have also stolen family-life and love from them[8]. When I was a first year occupational therapy student, one of my friends told me she wanted to be a housewife but could not concieve of any method for making it happen. Luckily for her, it appears that she may be marrying into a sub-strata of the aristocracy, and her dream may therefore come true after all. The cost of living has increased in a way that would have been inconcievable in the days of single-income households. Women have simply been shifted from gender-slavery to financial slavery; the same financial slavery that men have been subjected to for decades if not centuries.

Feminists fought a long, drawn out campaign to allow women access to occupational terriory formally thought of as male, only to find that the coveted territory is hostile and barren (as it always has been). Why has human female life expectancy always been higher than that for males? This may be purely physiological, but as an occupational therapist I am biased towards the belief the cause is occupational. As women move deeper and deeper into the traditional Western male occupational blue-print there is evidence that they are also adopting the unhealthy behaviours associated with it. According to the Tantric frame of reference[9] adequate balance is needed between occupations in the following domains: survival, pleasure-seeking, power-seeking, loving, creative and altruistic. People usually compensate for deprivation in one domain through over-activity in another. If we look at modern Western male behaviour for example, earning potential (power) is an established expectation of the male gender associated with sexual attraction[10]. Young males generally have had little or no opportunity to express power (other than by fighting in school playgrounds). They can therefore be trapped in the pleasure seeking-domain; sexually pre-occupied[11] and unable to progress to the development of compassion or altruism. This may explain why young business executives (who can never have enough power) have come to be associated with harmful hedonistic behaviour, such as excessive alcohol intoxication. It may be no coincidence that as social expectations of women have changed, young women have fallen prey to the same unhealthy patterns[12, 13]. Research in British Columbia has shown the risk of cancers of the reproductive system for professional women is double that of women in traditional roles such as waitress or domestic work[14]. Life would be healthier if couples consisted of two people each working part-time.

4.2. Occupational injustice:
Perhaps gender-role blurring has been based on the belief that traditionally female occupations were less rewarding or satisfying than male ones. Gender-role blurring as influenced by feminism has therefore been biased towards females wishing to undertake traditional male occupations. Women can now do almost everything men do, but the reverse does not apply. Little (if anything) has been done to increase the occupational freedoms of men. Do you know of any employers that grant men paternity leave? Even amongst those that do, is the timescale anywhere near that for maternity leave? Why is there no law to enforce this? Personally I would rather stay at home and raise my family while my wife goes to work. In cases of divorce, which gender is custody of the children more likely to go to? In some extreme cases the granting of custody to the mother has caused serious and avoidable harm to the children[15]. Common law in Scotland and UK divorce law have completely reversed gender-slavery. Heterosexual men currently have to work hard to achieve sufficient financial or social status to attract spouses, and if marriages break down they not only lose access to their children but also half, if not most of their life investments[16, 17]. Women by comparison are more likely to gain financially from marriage. In the short time I have been alive I have already known one woman who married just to have a child and then divorced so she could bring him up herself, one woman who married a friend of mine that she did not love, just because she wanted to get married and another who married for reasons she could not explain to me, and then got divorced shortly afterwards. Bearing these factors in mind, I would argue that men in the UK are taking much bigger risks than women by getting married. Has this situation been allowed to arise due to institutionalised sexism?

4.3. Occupational alienation:
Society is becoming increasingly feminised[1]. Modern technology is making male-biased skills obsolete[18] while female-biased skills are becoming increasingly valued[1]. Men are therefore losing relative-occupational-opportunity as women gain it. Women’s collective demands of men today are paradoxical and unrealistic to the point of being laughable[19]. Men are expected to be kind, commited, humorous, beautiful[20] and tough at the same time[21]. This type of hyperconformance is a known health risk-factor[22] and when faced with such abhorrent odds, some men just give up altogether. Apparently, it seems socially acceptable to say such men are ‘faulty’[23].

4.4. Diminished hetero-sexual attraction:
It is the differences between the genders that cause heterosexual attraction. The ironing out of these differences is causing dissatisfaction amongst heterosexual females and mass confusion amongst males. "Since the emergence of our species, it has been a brutally sexist feature of romance that women on the whole — and I stress on the whole — will want to mate/procreate with men who are either on a par with themselves, or their superior, in socio-economic and intellectual attainment. A recent study shows that if a man's IQ rises by 16 points, his chances of marrying increase by 35 per cent"[24]. Usually, this boils down to women fancying men who earn more than they do (subconscious gold-digging[25]). This phenomena is not compatible with feminist campaigns for equal pay. The success of the latter has made it much harder for women to find men that earn more than they do and therefore appeal to their primitive socio-sexual instincts[24]. Hugh Hefner is 81 years old and has 3 girlfriends. The youngest is 22 years old and the oldest is only 33[26]! Do you think any of them would be attracted to him if they were self-made millionaires? Would they be more satisfied that way? Do you think it is any coincidence that Elizabeth Taylor has been unable to find any man that can satisfy her? As the social differences between the sexes disappear the risks of sexual objectification will increase, because the only apparent differences between the genders will be physical. There is already evidence of girls starting to see boys as sex objects[27, 28].

4.5. Gender-role confusion:
To project sexuality one must first know what one’s potential partners find sexually attractive. This may once have been relatively simple. Men had to project wealth and strength or power[10], while women had to project beauty. Women may resent being desired mainly for their physical attributes just as men may resent being desired for their wealth[29, 30], but according to the theory of evolution through natural selection, sexual attraction will always be based on the survival of the fittest; not the nicest or friendliest. Gender-role blurring has altered our expectations of each other. Having grown up in the feminist/post-feminist era I find myself attracted to physically strong and socially powerful women. This is not the case for all men. Similarly, some women report seeking sensitive caring men, while others find this (new man) effeminate and unattractive[24]. How does anybody know what to project nowadays?

Most women expect to be treated as equals in Western society, yet some paradoxically demand gallantry[31]. The failure of men to meet these all-encompassing expectations has been a big source of disappointment for some women. “Men don’t want to be fixed….It’s like a surgical procedure for them”[32 page 4]. At the other end of the spectrum I have seen one woman confused as to why her displays of chivalry have not helped her court men[33]. The loss of defined gender-roles ultimately increases the risks of romance dying and sexual objectification becoming the norm as explained in section 4.4. There is already some evidence of a backlash against the dissolution of gender-roles[34]. Feminism has increased women’s expectations and therefore made them more likely to be dissatisfied. Exposure to feminist ideology has for example, been attributed to increased suicide rates amongst Afghan women[35]. Every war causes innocent casualties and the feminist campaign is no different. Disappointment due to raised expectations does not necessarily indicate that feminist principles are not worth fighting for. It does however provide a good argument for the regular evaluation of feminist objectives due to their unpredictable effects.

4.6. Confused hetero-sexual politics:
There is some evidence that even on an intra-personal level hetero-sexual women are confused about what they want from men. There is evidence that heterosexual women look for males with masculine characteristics for short-term relationships but more feminine characteristics for long-term relationships[36]. When I was at school I noticed that girls were generally most attracted to the boys that were least respectful and most likely to abuse them while gentlemen[37] were seen as weak and undesirable. I saw girls being hit by their boyfriends on a regular basis (several times a day) and wondered why they were so stupid. During my first year at University as a student physiotherapist a first year occupational therapy student advised me that I would be more likely to get a girlfriend if I tattooed the word ‘BASTARD’ across my forehead. I now understand that my major failing was not displaying alpha-male behavioural characteristics[38].

According to the theory of evolution through natural selection sexual attraction is based on survival instinct. Pheromones subconsciously tell us about potential mates’ immune function, while physical appearance provides an indication of fertility and behaviour or social status are determinants of survivability. If the theory of evolution holds true, these are the qualities that will attract us to a mate. A more romantic theory is that sexual desire is of spiritual origin and our particular preferences are pre-set in an attempt to guide us towards our individual destinies. In any case, it is believed our preferences are set as early as the age of 5[39]. If any of these theories are true, it is unlikely that genuine sexual attraction can be influenced by adult sexual politics.

That men are sexually attracted to women mainly by their physical attributes (objectification) has been a cause of resentment (by women) for some time[40] but despite social change, male sexual attraction has remained simple and predictable[41]; based largely on physical parameters of genetic make-up and health[10]. Applying the Tantric frame of reference[9], male sexual attraction can be said to come purely from survival and sexual, pleasure-seeking consciousness. It appears that some women are happy to pander to that simple desire[42] and some even make a living out of it [43]. A recent survey showed that 63% of 15-19 year old girls would rather be glamour models than doctors and 37% had posted pictures of themselves on the internet [44]. This type of female sexual expression has been frowned upon by some modern feminists[45]. A well reasoned argument for this is that women can become obsessed with their physical images and their mental health can suffer as a result[44]. Equally, one could argue that men are at risk of becoming wealth- or career-obsessed. It has been argued that such dysfunctions are “merley evidence of a normal spread of human (in)activity”[46].

Just as for men, female sexual attraction also comes purely form survival and sexual, pleasure-seeking consciousness, but due to social conditioning women have difficulty distinguishing between love and sexual attraction[47]. In the past, this was not such a great problem, because gender roles were clearly defined and alpha male behaviour (which appeals to sexual and survival consciousness) was admired (and therefore also appealed to egotistical consciousness). Today, alpha male behaviour is seen as politically incorrect and therefore unacceptable[38]. It has been argued therefore that women’s egotistical (power seeking) and compassionate (love) consciousness now cause inner-conflict between their egos and their sexual desires[48]. As the balance of consciousness varies between and within individual women, it is difficult for men to know whether to appeal to women sexually or compassionately for the purposes of courtship. Attempting to appeal to women at all is a risk because “in an age obsessed with sexual harassment and stalking, romance ain't as straightforward as it used to be. Sending a cute card to your secretary could be a nice gesture or a disciplinary offence; sending a florists' worth of flowers to your ex-lover is as likely to earn you a spell in jail as it is an invite to come up for coffee.”[49].

Women were once consistently sexually repressed by Western societies that expected them to remain chaste. This pressure came from women themselves; they sacrificed sexual pleasure for love[50]. The role of seduction was once clearly that of men[51]. Some women married despite not enjoying sex at all[52]. This is evidence of a total lack of awareness of sexual consciousness. Currently there is conflict on this issue between female authors; some advocating the use of men for female sexual pleasure while others advocate abstinence as a method for controlling men[53]. Advocates of the latter strategy have been compared to the Taliban[54]. Manipulation is unethical and by a process of elimination selects males of insufficient intelligence to understand the game that is being played.

4.7. Diminished inter-gender co-dependence:
Gender-role blurring has made the sexes independent of each other[55] for everything except procreation. Modern technology has developed in such a way that human contact is no longer essential for sexual pleasure[56] and post-feminist sexual politics are so complicated that for some men, the pleasure is no longer worth the effort[57]. Sexual independence may lead to the destruction of the human species. We will never be able to procreate independently of each other through natural means. Modern technology may soon allow uni-gender procreation, but I am fairly cynical about it; I suspect it will bring unforeseen problems. The end of the human species will be no major loss though. Nothing material lasts forever[58] and we have certainly had our day.

5. How will we ever get out of this?
We are in the middle of a great social upheaval. Whether the results of it are good or bad are a matter of opinion. Any attempt to resist it is likely to prolong the conflict. At this period in time, heterosexual-male occupational stresses are high due to the unrealistically high expectations of heterosexual-women in general. It is possible that this will decrease as women realise that men will never meet their current expectations in today’s society. There is some evidence that this is starting to happen. Having already been used by a couple of sexually aggressive women I can confirm that it is much easier and more relaxing than working for a relationship. One of them even took me out regularly and paid for everything! It is likely that heterosexual-female occupational stresses will increase as the career expectations placed on them by themselves and by heterosexual men increase. Perhaps as men adapt to the social change, physical attributes will no longer be enough to sexually attract them, and they will consider power and social status as many women currently do. If this happens, male sexuality may become as complicated as female sexuality, and then everybody will be equally confused. It is unlikely that there will ever be a social solution to sexual politics.

6. The role of occupational therapy?
Happiness cannot ultimately be found in material pursuits because their effects are always impermanent[58]. Feminism’s effects on material expectations might therefore ultimately not prove of benefit to many. The key to occupational freedom is fearless respect of intuition[59]. While well engineered social change can reduce injustice and occupational fear, fearlessness is arguably best learned on an intra-personal basis. Occupational therapists can help people increase their life-satisfaction by showing them techniques identify the social pressures that are making them unhappy, and then facilitating their detachment from those expectations. Frames of reference compatible with this approach include reverse therapy[60] and psycho-spiritual integration[61]. An ancient philosophy that could also be used to manage the occupational risk factors associated with gender-role blurring is Tantra.

Tantra is a branch of Hindu/Buddhist philosophy that has been praised by feminists for its ritual worship of feminine energy[62]. The three components of Tantra most relevant to occupational therapy are non-attachment, spiritually authentic behaviour and recognition of the human body as a temporary gift on loan from the divine. Without attachment there is no fear[58]. You would not fear for your life for example, if you were not attached to it. It is our psychological attachments that allow society to manipulate us and cause us stress. It is attachment to the opposite gender that drives heterosexual men to compete with each other for money, power and social status. Similarly, it is arguably a similar attachment that drives women to compete in terms of beauty. Without these attachments and the competition that goes with them, where could sexual manipulation or dissatisfaction come from? Spiritually authentic behaviour simply means living life the way you intrinsically want to regardless of social pressure or fear[59]. This is not possible as long as a person allows him or herself to be influenced by attachments.

If you recognise your body and mind are a vehicle on loan to you from the divine, how would you treat it? Perhaps you would treat it the same way you would an extremely precious item lent to you by a trusting friend; with great care. Divinity also implies that each individual’s body is perfect the way it is, and does not require any modifications. Social pressure cannot persuade a Tantric practitioner to have cosmetic surgery or place stress on his or her body with harmful diets or exercise. This self-belief neutralises the potential harmful effects of sexual objectification. Similarly, a Tantric practitioner is unlikely to over-work his or her body or mind in the pursuit of wealth or social status.

According to Tantric philosophy there is masculine and feminine energy in every person[59]. Mediations can be used to alter the balance of these energies, so people need not be restricted to either masculine or feminine roles by their physiological genders. Tantra is therefore suitable for all genders. A male practitioner can manifest himself as a female if he so wishes, and similarly a female can manifest herself as a male[58]. Perhaps in the future Tantra will have a role in reducing the need for surgery or hormone therapy for people who desire gender re-assignment. Finally, Tantric mediations can empower people by making them sexually independent[63]. People who practice these techniques successfully will be immune to sexual manipulation by potential mates.

7. Conclusion:
Gender-role blurring has increased stress for everybody concerned. Occupational therapists may be able to alleviate some of this stress by teaching people to detach from social pressure and act authentically. This blog entry is unashamedly journalistic. A thorough review of the relevant research is required to advance the occupational therapy profession’s understanding of the effects of gender politics on occupation. As a Band 5 occupational therapist who has been threatened with the lowest pay scale however, I feel it is fair to leave that to the more senior occupational therapists that are actually being paid for the responsibility.

Occupational therapists with an interest in Tantra may like to network with this link: http://www.facebook.com/group.php?gid=2352527880
Occupational therapists with an interest in reverse therapy can find more information with this link: http://www.reverse-therapy.com/
Male occupational therapists may like to network with this link: http://www.facebook.com/group.php?gid=2418780778

V

8. Acknowledgments: I would like to thank Katie Tunn (model) for her image-use permission.

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Well I'm not entirely sure what to make of the following - here are some musings and the the transcript for yourselves to ponder.

Last Friday I awoke to the Today programme on Radio 4 and hazily heard a fascinating interview with The National Clinical Director for Mental Health, Professor Louis Applepy. He spoke to the Today programme discussing the "Breaking down barriers - the clinical case for change" Document (although it was stated as "some ideas"). Above everything else what I find fascinating is the strong hinting of the word "occupational therapy" without actually saying it. Or, did I have my "wishful thinking" hat on and they are infact thinking of using doctors & nurses... hmmm. The document doesn't really state anything new in my opinion - its what OT's (and on occasion some other AHP's and to some extent nursing) have been saying for a while. I also agree that many Mental Health units - particularly those involved outreach work are doing what is outlined. So who is this for? I'm not entirely sure. What's nice is the strong undertones that we need to move towards a more social model of healthcare - but it will take more than a couple of documents from the mental health sector of healthcare to get us there.

For the record I am posting it here. You have until this Friday to listen again on the BBC's site.

Quite probably copyright the BBC, Radio 4, Today Programme.