Introduction

In this chapter we consider how language and discourses around anxiety relate to gender and sex, two terms which are sometimes used interchangeably. We make a distinction between the two, using sex to refer to biological and physiological characteristics and gender as relating to socially constructed characteristics. Sex is thus concerned with reproductive organs and hormones whereas gender would relate to social expectations about the kinds of roles, qualities and behaviours that are seen as appropriate (or not) for men and women. Such expectations can differ between societies and change over time, although they are often linked to sex. Gender is a crucial aspect in how people understand their own identities and their role in society as well as how they relate to others. We are thus interested in the part that gender plays in terms of helping people understand their experience of anxiety and, subsequently, the extent to which gendered discourses (in other words, what is viewed as common-sense knowledge relating to gender) are potentially helpful or problematic for individuals with anxiety. Our analysis involves two related strands. First, we compare distinct uses of language that men and women use in their postings, through the keywords technique. Second, we examine the ways that posters represent men and women in terms of expectations about them or the generalisations about their perceived qualities, particularly in reference to how this relates to the experience of anxiety.

Sex, Gender and Anxiety Disorders

The World Health Organization estimates that there are 264 million people living with anxiety, with females being almost twice as likely to be diagnosed as having anxiety than males (4.6% compared to 2.6% at the global level) (World Health Organization, 2017). Reference McLean and AndersonMcLean and Anderson (2009) review a range of studies relating gender to fear and anxiety, noting that even at age six, girls are twice as likely as boys to have experienced an anxiety disorder (Reference Lewinsohn, Gotlib, Lewinsohn, Seeley and AllenLewinsohn et al., 1998), and generalised anxiety disorder is six times as likely to occur with adolescent girls than boys (Reference Bowen, Offord and BoyleBowen et al., 1990). Research on the antecedents of anxiety indicates a wide range of possible explanations for these apparent sex differences. For example, Reference BarlowBarlow (2000) points to a non-specific genetic contribution towards anxiety disorders while anxiety in women seems to be exacerbated during the premenstrual phase (Reference McLeod, Hoehn-Saric, Foster and HipsleyMcLeod et al., 1993). Meanwhile, Reference Taylor, Klein, Lewis, Gruenewald, Gurung and UpdegraffTaylor et al. (2000) have argued that evolutionary factors have resulted in women not developing the ‘fight-or-flight’ response in the same way as men (as that would compromise pregnancy), and instead women have developed a response to fear that they call ‘tend-and-befriend’. Other factors could include different coping strategies, gender-specific trauma (Reference Kessler and McLeodKessler and McLeod, 1984), a sense of uncontrollability (Reference Nolen-HoeksemaNolen-Hoeksema, 1990), tendency to ruminate (Reference Nolen-Hoeksema and JacksonNolen-Hoeksema and Jackson, 2001) or heightened sensitivity to social cues (Reference CraskeCraske, 2003), all of which have been suggested as reasons for higher rates of female anxiety. Additionally, it has been argued that caregivers encourage gender-conforming behaviours; for example, parents consider withdrawal and inhibition to be less acceptable for boys compared with girls (Reference Stevenson-Hinde, Shouldice, Rubin and AsendorpfStevenson-Hinde and Shouldice, 1993). Socialisation may also contribute towards the higher numbers of women being diagnosed with anxiety.

The higher prevalence of female diagnoses suggests that anxiety is more likely to be seen as an issue affecting women. However, these rates of diagnosis of anxiety disorders should not automatically lead us to assume that women are more likely to be anxious than men – it could be the case that men are less likely to acknowledge they have anxiety to others and subsequently seek medical help. One argument is that the social patterning of hegemonic masculinities – privileging practices such as self-reliance and restrictive emotionality – limits the expression of symptoms of anxiety in men, leading to under-diagnosis (Reference Gough, Robertson and LuckGough et al., 2021), a point which we will explore further in the data analysis of this forum.

Reference CourtenayCourtenay (2000, p. 1388) notes that health-related beliefs can be understood ‘as a means of constructing or demonstrating gender’ and, subsequently, health behaviours ‘simultaneously define and enact representations of gender’. In particular, understandings of masculinities are based on the denial of vulnerability, with displays of self-reliance and strength being expected (Reference Clark, Hudson, Dunstan and ClarkClark et al., 2018). Such characteristics can all be undermined by (mental) illness, including anxiety disorders, resulting in the view that ‘masculinities are defined against positive health behaviours and beliefs’ (Reference CourtenayCourtenay, 2000, p. 1389). As a result, numbing or escapist behaviours might be found in men who experience chronic low mood, as opposed to discussing distress with health professionals or support networks (Reference Brownhill, Wilhelm, Barclay and SchmeidBrownhill et al., 2005). With men primed to exhibit externalising symptoms and cover up internalising symptoms for fear of stigma (Reference Smith, Mouzon and ElliottSmith et al., 2018), diagnosing anxiety in men is especially difficult. Furthermore, characteristics associated with stereotypical masculinity can exacerbate mental health problems. For example, Reference Martin, Kliber, Hodges Kulinna and FahlmanMartin et al. (2006) note that participants who viewed muscularity as having many benefits reported greater levels of social physique anxiety than did men who viewed muscularity less positively. Similarly, Reference HammondHammond (2012) found that higher restrictive emotionality was associated with more depressive symptoms among African American men aged 18 to 39 years and in relation to body image. It is with these findings in mind that we now turn to consider gender in the posts on the Anxiety Support forum.

When posters created an account with HealthUnlocked, they were asked to provide information about themselves relating to their sex, age, ethnicity and country of residence. For sex, posters had a choice of identifying as Male, Female or Other, or they could choose not to provide an answer. Table 5.1 shows that almost half the people who created a profile (46.70%) did not provide information about their sex. Over half (52.55%) of all posts were made by people who identified as female and 15.86% were made by male posters. A search across the forum for terms such as trans, transgender, transwoman, transman, non-binary or genderqueer indicated one person who had selected the option Male when creating a profile and subsequently self-describes as a transgender male when posting messages.

• I am a 17 year-old transgender male, and I have suffered from anxiety for as long as I can remember. (Male)

While this was a single case, it serves to remind that people can interpret categories such as male and female as relating to the sex they identify with as opposed to the sex they were assigned at birth.

It is important that gender-based research does not overlook cases where people explicitly do not identify as male or female and in this corpus 143 (0.05%) posts were made by those identifying as “Other”, contributing 7,617 words of posts.

The amount of text in the corpus written by people who chose ‘Other’ is relatively small, meaning that it is difficult to identify patterns based on frequency of usage. Comparing these 143 posts against the rest of the corpus produced only five keywords in the top 100 which occurred at least 10 times: checked (10 occurrences), real (11), physical (12), depression (14) and sleep (24). Concordance analysis of these words indicates that these posters discussed concerns about lack of sleep or dying in their sleep, being diagnosed with both anxiety and depression, checking physical symptoms and considering whether their physical symptoms were real. We also read these 143 messages to see if there were cases where posters referred to sex or gender explicitly. However, no incidences of this were found. We could tentatively conclude that on this forum, people who chose the ‘Other’ option for sex do not discuss their anxiety in relation to gender or sex, although a more confident conclusion would be that there is not enough data to make generalisations. With just 18 people on the forum identifying their sex as ‘Other’ (0.1%), we would note that this group is likely to be under-represented, particularly when we consider a study by Reference Bouman, Claes, Brewin, Crawford, Millet, Fernandez-Aranda and ArcelusBouman et al. (2017) which found that trans people had higher levels of anxiety symptoms compared with other people. There may be a range of reasons for this – perhaps people who do not identify as either male or female might be unwilling to go on-record about this aspect of their identity, even on an anonymous forum, or they may decide to seek support in contexts where they feel safer disclosing that information.

Male and Female Keywords

Our analysis thus moves on to the ways that self-identified male and female posters use language in the Anxiety Support forum. In order to identify linguistic features that are particularly typical of men and women, we have employed the keywords technique, which produces lists of words that are statistically significantly more frequent in one (sub-)corpus when compared against another (see Chapter 3 for a more detailed description of this process).

As in Chapter 3, we initially used a third reference corpus, the English Web 2020 corpus, comparing the male and female posts separately against it. This resulted in two keyword lists, although an analysis of the top 500 keywords in each list found that the vast majority occurred in both lists. This is an important finding, indicating that for much of the time, men and women use broadly similar language when posting to the forum. This is, overwhelmingly, the ‘big picture’ when it comes to sex differences in the corpus. The words we focus on in this chapter should therefore be seen as the exceptions to the rule.

In order to focus on differences, we decided to carry out a direct keywords comparison of male and female posts, that is, using each one as the reference corpus to the other. We thus obtained the top 100 keywords for these two sub-corpora along with the top 100 key multi-word terms (fixed sequences of words of at least two words in length such as panic attack). Table 5.2 shows the top 100 keywords and terms, with relevant frequencies shown in brackets.

Although the forum consists of 17,770 different contributors, there is variation in the number of posts that people made. Between them, just over 400 people made half of the posts to the forum, while the top 10 posters contributed 9.78% of posts. To ensure that the keywords we identify are not the result of the writing style of a frequently posting individual, we have removed key items which were used 50% of the time by only one person. We have also removed key items which refer to poster’s usernames (most of these had been anonymised as x prior to receiving the forum data but a few had been left in).

It should be noted that the keywords and terms in the table do not indicate words that are exclusively used by men or women only. For example, the male keyword, wife is used 767 times by men and 341 by women. As Table 5.1 indicates, female posts contain about three times as many words as male posts so, relatively speaking, the frequencies for wife come to 195.65 times per million words for male posters and 29.16 per million for female posters. In other words, men use wife 6.70 times more often than women. This is the male keyword with the largest relative difference. At the other end of the scale is the male keyword thoughts: 3,836 male uses and 8,277 female uses, which translates to 948.48 occurrences per million words for men and 707.80 times per million for women. Here, men only use the word 1.38 times more often than women. Keyness, therefore, is not an absolute measure but rather it shows trends.

An initial stage in our analysis involved categorising the keywords into groups, a process which was carried out by hand and involved obtaining concordances of the words so we could identify how they were being used in the context of the original posts. This kind of categorisation is admittedly subjective as some words have multiple uses and could be put into more than one category. Additionally, the types of categories themselves could be made more specific or general. We have used the same categories that emerged from the analysis in Chapter 3 (see Tables 3.1–3.10), although we have included three additional categories (abstract nouns, adjectives and grammatical bin) to account for items which would have been difficult to classify otherwise.

As we examined the keywords, we gradually began to consider them in terms of how they relate to a range of different aspects of anxiety. This has helped to provide an overall structure to the analysis in this chapter. Rather than simply starting at the top of each keyword list and working our way down, we discuss the keywords in groups, providing contrasts between male and female words in order to draw out a more interesting narrative. We found that analysing the keywords helped to address four questions:

• How do men and women understand their anxiety?

• How do they try to resolve it?

• How do they relate to the forum?

• How does anxiety relate to other aspects of their life?

We begin by addressing the first question.

Discussion

It ought to be emphasised again that the differences in language use found here are not absolute but a matter of scale. While men, collectively speaking, are more likely to refer to their anxiety as an illness, not all men do this, and some women call their anxiety an illness. The keywords thus examine what happens if we look at language use that is most typically male and most typically female, but it should be borne in mind that this is in reality a small amount of language and most of the words and phrases in the forum are used with similar relative frequencies by men and women. Additionally, hardly any men frequently use all the male keywords mentioned in this chapter, with the same point applying to women with the female keywords. As such, the preceding descriptions cite a kind of amalgamation of several typical male and female linguistic features across hundreds of posters, rather than claiming that all (or even most) men combine these features together to create a distinct gender identity. Bearing those caveats in mind, what do the keywords tell us potentially about gendered differences?

First, there are differences in the ways that men and women understand anxiety as it relates to themselves. Men are more likely to view it as a disorder or illness while women describe anxiety as a personal quality and identify as an anxious person. Subsequently, men view anxiety more in terms of curing or fighting it, and provide other posters with information and advice regarding the right way to do this. As Reference Lindinger-SternartLindinger-Sternart (2015) notes, men value self-sufficiency when it comes to health-seeking behaviours.

Female posters are more likely to offer suggestions for (non-medical) techniques to alleviate anxiety, like taking a hot bath. They also consider the impact of anxiety on those around them, as well as considering other people as a potential source of support. For them the forum is a place where they can describe how anxiety makes them feel and where they can provide support to others in the form of encouragement and empathy, noting that they have had similar experiences. The differences noted here have been found with respect to other mental health forums. For example, when looking at a forum concerned with depression, Reference NimrodNimrod (2013, p. 432) found that ‘men are more likely to cope by seeking information, while women are more interested in discussing daily living with depression’. Other studies (e.g., Reference Hausner, Hajak and SpiesslHausner et al., 2008; Reference Mo, Malik and CoulsonMo et al., 2009) looking at gender differences in online support groups have found similar patterns.

It is not our intention to judge whether the male or female discourses on anxiety are most productive in terms of helping people to resolve or live with their situation. It could be argued that there are pros and cons associated with each. Men might feel hopeful that their anxiety can be resolved (although this may result in disappointment if it is not the case), and their focus on obtaining knowledge about the processes around anxiety suggests they do not feel as much need to rely on the support of others. On the other hand, women appear more concerned with social structures, meaning they are more likely to turn to others for help rather than bottling up problems. Someone who views anxiety as a personal trait might believe that it will never go away, although this may also result in a more realistic appraisal involving learning to manage or live with anxiety. An important point to make is that all these discourses around anxiety appear in the forum. Those who join the forum for information on coping strategies can find them, while those who want kindness and empathy are catered for too. Different strategies were identified broadly in relation to sex in these data. However, this raises another question: if men and women understand anxiety differently, what happens if your perception of anxiety is not typical of your sex? In the next section, we take a different perspective, focusing not on language used by men and women but language used about them.

Discourses of Gender

In this analysis section we consider the whole corpus to look at the ways that posters refer to concepts relating to gender in order to identify gendered discourses (Reference SunderlandSunderland, 2004) or ways of understanding gender that are viewed as common-sense. To do this we first identified a set of words which were likely to be used when such discourses are referenced. This involved a three-stage process. First, we used introspection to think of a set of gender-related words. We then consulted a thesaurus to identify further words and, finally, we added new words which were identified as a result of engaging with the corpus data. This produced the following set of words (frequencies are shown in brackets):

• bloke (100), blokes (17), blokey (0), boy (1,039), boys (504), chap (46), chaps (3), guy (1,337), guys (3,594), lad (106), laddish (0), lads (48), macho (10), machismo (0), male (602), males (29), man (2,464), man(-)like (0), manly (7), masculinities (0), masculinity (0), men (785)

• effeminate (0), female (623), females (42), feminine (16), femininities (0), femininity (1), girl (1,794), girls (727), girly (53), lady (960), lady(-)like (0), ladies (272), lass (17), lasses (3), woman (1,248), womanly (2), women (941)

By reading expanded concordance lines of posts containing words in these lists, we identified the cases which referenced gender (references to masculinity or femininity or behaviours and expectations associated with identifying as a man or woman) as opposed to sex (references to being male or female). We then developed a categorisation system which grouped similar gendered representations together. The identification of representations involved examining adjectives used as descriptors of men or women, nouns that were used to label them and verbs that involved men or women as either carrying out actions or having actions carried out on them. Additionally, we considered other forms of language use including metaphors, implicatures and tautologies. Representations could, for example, involve assertions that men either do or do not possess certain qualities or should or should not possess them.

The analysis in this section of the chapter involves more qualitative evaluation, compared with the earlier keyness analysis. Despite words such as man and woman being reasonably frequent, the majority of occurrences are not used in ways where expectations about gender can be ascertained. The data for this section comprises 138 expanded concordance lines, meaning it is too small to be able to make strong claims about which views of gender are popular and which are not. We have focused on cases where there is evidence of repetition, involving different people making a similar claim about some aspect of gender, as opposed to single cases.

To begin the analysis in this section, we consider the variety of factors that are used to explain women’s experiences of anxiety. Unlike men, we found that women regularly categorised mental health issues, particularly anxiety, as at least partly influenced by biological sex, relating to hormones, monthly cycles and the menopause. Anxiety is therefore viewed as something that has the potential, at least, to constitute a part of what it is to be female.

• Another cause of anxiety can be hormonal – female hormones for instance – some women become anxious around the menopause. (Female)

• any women, myself included, experience an increase in anxiety around “that time”. (Female)

Another understanding of anxiety, however, is based more on social factors, with some women writing of their experiences of sexism and misogyny. This is sometimes viewed as contributing towards women’s anxiety and seen as something which makes women’s lives more difficult than they should be.

• it’s very sad how women get treated online and no woman should have put up with immature people like the ones you described. (Female)

• In my 30s, I am still getting over my childhood – I’m female so his mysogeny hurt me deeply. (Female)

• I know some will disagree with the reality of Patriarchy and female subjugation (including in the USA), but I am not here to debate reality: all I will say to those people who still deny women’s oppression … ignorance is bliss. (Female)

The following post views anxiety as hormonal and criticises the British medical system for not acknowledging this, implying that women’s specific experiences of anxiety are overlooked and that they are simply treated the same as men. Posters also note how male doctors are dismissive of mental health issues and advise one another to see a female doctor.

• The tendency in the UK is to treat women as men disregarding how fluctuations of oestrogen and progesterone can affect your moods, and your health (Female)

• I do find female doctors generally better on mental health issues. (Female)

However, another set of posts appear to represent women as possessing various personality qualities (indecisiveness, vanity, jealousy, empathy) which make them more likely to experience anxiety. Such qualities do not seem to be viewed as biologically inherent in the same way as hormones, but they also do not seem to be attributed to societal structures either.

• i know it’s such a girly thing to be obsessed with our looks, glad i’m not alone. (Female)

• That is a big part of my anxiety, wether the decisions are big or small, I know a lot of women do this but I can’t even decide what to wear (Female)

• I also get very jealous when there are beautiful women on tv. Maybe my boyfriend would rather look at them than my flabby chubby self. I don’t know if this is a female thing. (Female)

• Its very common for us women to take on others pain and emotions and blame ourselves for it. (Female)

Most of these perceived traits, apart from empathy, are negative and while they represent women as more likely to experience anxiety, other characteristics associated with being a woman are viewed as being likely to impact on women in terms of their management of anxiety. Women are seen as good communicators and able to be honest about how they are feeling.

• I think women, find it easier than men, to admit they are suffering, sometimes men can see it as a weakness, which it certainly isnt … maybe he feels that way (Female)

As a result, women are seen to value communication more than men, to the point where they are sometimes viewed as loquacious.

• i do believe that women need other women to talk with (Female)

• I do no women never stop talking & we are very good at saying how we feel & what we want (Female)

Perhaps contrary to the stereotype, some posters represent women as tough, as expressed in various metaphorical expressions (soldier on, machines, their rock).

• as woman we soldier on, but she may be worrying deep down (Female)

• All that hard work ur body is doing! We are machines us women! (Female)

• It is very hard on kids to see their mom unwell … they think of you as their rock. Sometimes we just cant be that for them. Your boyfriend may just feel helpless and not know what to do. We, as women, are always suppose to be strong and nurturing.. (Female)

However, other posters note concerns that their anxiety will be seen as a gendered example of a ‘helpless female’ and thus a sign of weakness and instability.

• I was angry that my husband was instructed to come, like I was the helpless female who couldn’t do it myself. (Female)

• he obviously thinks i’m being a bit of a wimp (I’m the only female engineer in the company) (Female)

The following poster identifies as male but worries how disclosing anxiety would result in him being seen as like a woman.

• I don’t have a fear of doctors, doctor offices or hospitals. I just fear talking about my mental state. I was worried I would be deemed weak, girly, feminine. That they would send me off, deem me mentally unstable, a danger to my self. (Male)

Men are generally viewed as less emotionally expressive than women. For example, one male poster advises a female poster who has been having problems with her husband, suggesting that she writes him a letter. He ends his post with the following sentence:

• I hope this helps in some way, i am a man and not good at touchy feely, good luck (Male)

Here the use of and can be interpreted not as a co-ordinating conjunction but as a subordinating conjunction, whereby the quality of not being ‘good at touchy feely’ is implied to be due to the fact that the poster is a man. Men also cite a pressure to be strong, and therefore silent.

• i cant talk to anyone close because i have to be the strong male type in the family and i dont want it to reflect on my son (Male)

With other posts, the connection between being male and emotionally inexperienced is made more explicit.

• Being a man the hardest is to allow yourself to have feelings …. .crying especially, followed closely by talking about your feelings to other people-it’s unnatural to me as I always used to keep things inside. (Male)

A female poster describes her male partner as a ‘typical cave man’, the result of which is that he is not able to provide support to her.

• last month he actually admited he cant be there for me emotionally, he is a typical cave man cant talk about his feelings, he said he got no one to help him, give him advice on how to cope with me (Female)

Other posters note how men differ from women in terms of not acknowledging problems, with the following poster being somewhat critical of what they see as a male response.

• i think quite often women tend to be the doer’s and organisers and often cope better, where men just put their heads down and hope it will just go away eventuallly or things will improve and the pressure will decrease (Sex unknown)

A view that men should be ‘strong and silent’ is seen as a barrier to men overcoming their problems.

• I know many men turn to drinking to hide their fears, problems and issues. (Female)

Other studies have found cases of boys and men ‘externalizing’ troubles, employing increasingly risky, dangerous or life-threatening behaviours such as excessive drinking, along with an externally directed physical release of emotional distress in the form of aggression, violence and suicide that conforms with masculine ideals of a strong outer physical appearance (Reference Brownhill, Wilhelm, Barclay and SchmeidBrownhill et al., 2005; Reference Smith, Mouzon and ElliottSmith et al., 2018). However, while some posters urge men to overcome concerns about not appearing masculine to talk about their fears and problems with others, others take a different perspective.

• Trust me heart is not as weak or vulnerable As we think about it. You are a man and be a man. Start workout, sweat yourself, say these stupid feelings to give you their best shot. Don’t surrender or yield before them. (Male)

On the surface, this poster appears to employ a tautological assertion ‘you are a man and be a man’, although this can be resolved if we interpret the two uses of man to have different meanings; for example, the first use referring to the biological status of being male, the second one referring to a gendered understanding of being a man (linked to notions of strength). The poster also uses metaphorical language which frames the experience of anxiety as a battle, urging the man not to surrender or yield before his feelings. He also is advised to confront the feelings, being told to give it ‘their best shot’.

Similar sentiments are put forward in the following post which also takes the form of a ‘pep talk’ from one man to another, who has been experiencing symptoms of anxiety.

• I have faith in you mate deep down your a strong ass man who can work threw anything fight my friend fight with everything you have and always remember im here for you (Male)

For this poster, anxiety is seen as a battle which can be overcome if the person experiencing responds in a way that is associated with notions of hegemonic masculinity – subordinating a foe through physical strength and violent action. A salient use of this discourse of male strength is in the phrase man up.

• I’m on meds now and gettin reay bad side effects but I no I need to man up if I want my life back (Male)

• I accept the fact that I’m lightheaded and I just man up and not worry. If I get anxious I embrace the anxiety and show it im not scared. (Male)

However, an alternative discourse views anxiety as affecting both men and women, and that it is acceptable for men to acknowledge this.

• Me being well me i’ve injured myself a lot, bruised 1 rib and fractured another, had a rugby pole pierce my kneecap and so on and I don’t care how less of a ‘man’ this makes me to the world, anxiety is the toughest thing I have ever faced. (Male)

This poster begins by positioning himself as a man who has experienced numerous physical injuries. He also implies that he plays rugby: a sport which involves players tackling one another for possession of the ball, thus requiring considerable physical strength and favouring players with large bodies. The poster thus establishes a set of masculine ‘credentials’, which help to off-set his subsequent description of how anxiety is the toughest thing he has ever faced and he does not care if that makes him less of a ‘man’ to the world. To an extent, by describing anxiety as tough, it is framed as a foe in a similar way to earlier posters who used the battle metaphor. However, the verb face suggests a different orientation to fight, and the poster’s use of quotes around the word man suggests a more critical perspective, one which challenges stereotypical notions of masculinity. At the same time though, not caring how much less of a ‘man’ his assertion makes him could be viewed as part of a more traditional masculine identity, one where other people’s opinions are seen as not relevant because men are self-assured enough not to require validation from others.

A similar report involves one poster reporting something he had heard.

• Also I have been to the ER multiple times for panic attacks. I have had cat scans and mri’s all because of anxiety. The doctors told me that a panic attack can bring a grown man to his knees. (Male)

The fact that this piece of information is from not one but multiple doctors, helps to function as a legitimation strategy (an expert opinion), which helps to counter any criticisms that the assertion seems to be outlandish. The poster uses the pleonasm ‘grown man’ rather than simply ‘man’, a choice which emphasises the power of a panic attack as a symptom of anxiety. While this poster also stresses how anxiety can affect men, he focuses on a specific type of men: ‘grown’ men, which both counters the idea that men do not experience anxiety but also helps bring to mind the idea that, usually, men are tough.

Other posters blame a ‘macho culture’ for making men’s experience of anxiety more difficult due to the fact that they feel unable to talk about it for fear of being perceived as weak and feminine.

• I struggle doing the most normal of things and I get the whole “man up” comments when I’m holding on to a wall struggling to breath it’s horrific. (Male)

• Having a breakdown in my early twenties was bad really rough because there was a macho culture and having bad nervres is a sign of weakness. I know now trying to hide the fact made me feel much much worse I treid hiding in the bottle taking all kinds of drugs which just drove me more crackers. (Male)

In addition, a small number of posters try to challenge the ‘man up’ discourse, positively representing men who talk about their feelings or acknowledge their problems and characterising such men as ‘more of a man’, ‘a bigger man’ or ‘a real man’. The words bigger and more function as comparators, thus implying a scale of masculinity where men can be ranked, while real implies that some men are ‘fake’. What makes such a man ‘bigger’ is the capacity to admit to having qualities that are otherwise purported to be unexpected or undesirable in men, despite their universal occurrence.

• yet it takes a bigger man to admit they are struggling & I believe every man will at some stage in his life struggle even though they may not admit it (Sex Unknown)

The following poster says she is a woman and prefers a man with qualities that make him appear sensitive.

• Well I am not a man, but as a woman, I do understand that, is the job description been tough in that industry, but personally, I prefer a man that is sensitive & has feelings & a heart & it makes them more of a man, not I suppose that helps any (Female)

Another poster contrasts the kind of man who can open up about how he feels (‘a real man’) with those who cannot (‘a coward’).

• keep an open mind and allow it to rather than pushing it away which we tend to do because we feel so bad about ourselves It takes a real man to be able to post like you have & open up about how you feel not a coward a coward cannot admit to how they are feeling so I hope you will eventually realize that :-) (Sex Unknown)

Such posts recontextualise masculinity as not being about silently suffering or refusing to acknowledge problems but as being brave enough to talk about them. While this representation offers an alternative perspective of masculinity to those which urge men to ‘man up’ or that ‘strong is silent’, it also has some elements in common with them. First, having masculine qualities is still viewed as a good thing and central to a man’s identity. Second, masculinity is still defined in terms of traditional concepts such as strength and bravery, as well as being demonstrated via comparisons with other kinds of men. While such qualities are seen as being demonstrated in different ways (e.g., by talking about problems), the overall discourse, that men should be strong, is still maintained.

Conclusion

While overall, the vocabulary used by men and women in the Anxiety Support forum is quite similar, the analysis of keywords and terms identified notable differences in the ways that they understand their experience of anxiety. Men appear more likely to view anxiety as a potentially temporary state and seek knowledge about it so they can find the right ‘cure’. To an extent, the findings from the earlier keywords part of the chapter illustrate and explain the gendered discourses found in the second part of the chapter. Despite the fact that it is acknowledged that men’s experience of anxiety can be hampered by their reluctance to be seen as breaking gender norms, male understandings of anxiety are framed in language around fighting and terms such as ‘man up’. Even the counter-discourses which encourage men to seek help still maintain traditional views of masculinity by positioning such activities as even more masculine because they require bravery to go against the norm. Perhaps this strategy is understandable; it does not seek to threaten a man’s self-image but uses the logic of masculinity-equals-strength to encourage men to be strong enough to do something that is seen as weak. Advice which tells men to be more like women and seek help is unlikely to be effective, given that we have observed concerns from men about appearing feminine or ‘like a woman’. More broadly, even though posters discussed critically gender-based norms relating to responses to anxiety, alternatives nevertheless referred to aspects of traditional gendered discourses, showing how difficult they are to counter.

We found fewer cases where women were concerned about not conforming to gendered expectations, although a small number of women felt that by talking about anxiety they would be dismissed by men as weak. Women are more likely to view their anxiety as a trait as opposed to an illness and they also discuss it more often as being influenced by hormones. Women are also seen as having personality characteristics which are likely to result in anxiety. Rather than primarily trying to seek understanding around the processes of anxiety, women tend to use the forum as a means of support and providing affiliation with other posters, as well as identifying cases of shared experience or activities that will alleviate anxiety. However, women’s perceived ability to communicate is also seen as a positive way that they can deal with anxiety, through use of different kinds of support networks, comprising either medical professionals, family and friends or online communities. Indeed, women’s postings position their experience of anxiety in terms of how it impacts on those around them, whereas male posters tend to be more focused on how anxiety relates to them.

We do not believe that there is a perfect, one-size-fits-all method of addressing anxiety but rather that there are a range of possible ways of understanding it, along with associated coping strategies, and individuals would be best advised to be made aware of them and given support (if required) so they can make an informed choice regarding which combination is most likely to benefit them. As this chapter has indicated, some understandings and coping strategies around anxiety are gendered, meaning that certain avenues might be more or less likely to be pursued than others, depending on how strongly aligned people feel towards notions of what is appropriate for their sex. This means that for some people, certain approaches or perspectives may feel off-limits.

Perhaps the point that emerges most clearly from the latter half of the analysis is the difficulty that men feel in terms of opening up about anxiety and seeking help. On the other hand, perhaps some women could benefit from the more typically male strategies around information-seeking and viewing anxiety as something that does not have to be an essential or inevitable part of your personality. Some men might do better to think about how their anxiety impacts on those around them, whereas some women could perhaps be advised not to exacerbate their anxiety by becoming too concerned about its effect on friends and family. Balance is key.

In terms of going forward, this chapter has identified different ways that anxiety is gendered and this could be helpful for both therapists and doctors, as well as for individuals with anxiety. It might be the case that programmes can be tailored in terms of what is likely to be seen as an appropriate strategy for the sex of the patient, or that individuals can be made aware of cases where their internalised gendered discourses might be influencing their understanding of anxiety in an unhelpful way or restricting their options for management. Ultimately, it is important to acknowledge the fact that anxiety is understood through a gendered lens and to consider the consequences this might have for treatment.