A Few Thoughts on Men’s Mental Health in the 21st Century
Feminism has made women’s problems extensively studied and their voices widely heard but a few are noticing that many men have been “drowning”. In this emancipated world where traditional masculine ideology has been challenged, men might need help more than ever. Empowering women is great but so is empowering men and that can be done by encouraging the healthy aspects of masculinity such as self-reliance, courage, their own way of caring, and many more. In this article, I have tried to summon some basic ideas about an issue that needs immediate attention, in my opinion. Recognizing the huge gap in psychotherapy resulting from the underutilization of services by men is essential for the overall well-being of society since having healthy men is as important as having healthy women.
The culture of masculinity in psychotherapy is a topic that has been undergoing intense study by both researchers and counselors lately. It is a well-known fact that men underutilize counseling services and are less likely to seek help when it comes to their mental health. According to the World Health Organization (WHO, 2018), global rates of severe mental illness such as schizophrenia and bipolar disorder are almost identical for men and women, however, there are significant gender differences in the prevalence rates of common mental disorders such as depression, anxiety, somatic complaints, and substance abuse. Although women get diagnosed with depression and anxiety twice as often as men do, the number of men committing suicide is four times higher than that of women (Kilmartin, 2005). Also, 86% of violent crimes are committed by men and approximately one in every five men develops substance dependence as opposed to one in every twelve women (Kilmartin, 2005). Yet, it is mostly women who seek counseling and engage in the counseling profession mostly due to the feminine-gendered pattern of psychotherapy. Research shows that there is a lack of “systematic or theory-driven guidance” on how counseling should be adapted to the culture of masculinity (Bedi & Richards, 2011). The American Psychological Association (2007) and the Canadian Psychological Association (2007) both have guidelines for working with women, but none of them has documents for practice with men (Bedi & Richards, 2011).
Many argue that masculinity is a socially constructed concept that varies across cultures (Berger, Wallis & Watson, 2012). Whether one lives in North America, Europe, or Asia, masculine gender role beliefs shape the behavior, partly or fully, of many men around the globe. Being a man means being strong, brave, and competitive. It also means being in control of your emotions, thinking rationally and analytically. Men are believed to be driven by logic, not feelings, and to be very capable of solving problems, so the idea of seeking help is foreign to them. They are known to be good at science, engineering, and math, and to have strong leadership skills due to their high levels of confidence and assertiveness. Men are often portrayed as aggressive, dominant, and highly sexual and they are expected to offer protection and support. In Latin cultures, for example, “machismo is equated with strength, male-dominance and being a successful provider and protector of the family” (Janey, 2003). Costa, Terracciano & McCrae (2001) studied 26 cultures using the Five-Factor Model and reported gender differences that were consistent with widely known gender stereotypes. For example, women scored high on neuroticism, agreeableness, warmth, and openness to feelings, whereas men scored higher on assertiveness and openness to ideas (Costa, Terracciano & McCrae, 2001). The authors argued that some countries like Austria and Japan have “masculine cultures” because the focus in these cultures is on “occupational advancement and earnings”, whereas countries like Sweden and Costa Rica, where “cooperation with coworkers and job security are valued” have “feminine cultures” (Costa, Terracciano & McCrae, 2001). A study conducted by Ng, Tan & Low (2008) that explored men’s perspectives on masculinity in five Asian countries (Malaysia, Japan, Taiwan, Korea, and China) showed that “career, honor, control, family and money” were considered to be the most important masculinity traits for men in these countries. While most of the above-mentioned characteristics are typical masculine gender stereotypes, they are also a product of masculine gender-role socialization. Addis & Mahalik (2003) point out that “Role socialization paradigms begin with the assumption that men and women learn gendered attitudes and behaviors from cultural values, norms, and ideologies about what it means to be men and women. For example, many of the tasks associated with seeking help from a health professional, such as relying on others, admitting a need for help, or recognizing and labeling an emotional problem, conflict with the messages men receive about the importance of self-reliance, physical toughness, and emotional control”.
On the other hand, one should not ignore the biological side of masculinity. Evidence-based studies show that male and female brains differ in structure, chemistry, and functioning (Cahill, 2005). In the past ten years, scientists from Harvard Medical School have been able to measure the sizes of different areas of the brain such as the cortical and subcortical areas, with the help of MRI, and have discovered that parts of the parietal cortex, which is responsible for space perception, is bigger in men than in women and so is the amygdala, which controls the response to “emotionally arousing information”, gets the heart pumping and the adrenaline flowing (Cahill, 2005). Researchers believe that these anatomical differences might be caused by the sex hormones, which are activated during the fetal phase and are responsible for the organization and wiring of the brain as well as the build-up of neurons in various areas during development. The parts of the brain that were found to have different sizes in men and women were the ones that contained the highest number of sex hormone receptors in animals in utero, which comes to show that not all gender differences associated with cognition are a product of culture (Cahill, 2005). A wide number of studies on the role of “nature versus nurture” in sex differences reveals that there are biological reasons for certain behaviors in men e.g. men are better equipped to tolerate acute stress but not chronic stress and they could remember the gist of emotional memory, but not the precise details (Cahill, 2005). When it comes to mental health, scientists have found out that serotonin production is 52% higher in men than in women, which can explain why women are more prone to depression than men. In other words, masculinity might be a socially constructed concept but it has its biological and evolutionary roots.
It is not clear whether the idea of seeking help and talking about emotional problems is foreign to the masculinity ideology and norms or the biology of men somehow dictates that, or both, however, evidence shows that counseling is underutilized by many men who experience a wide range of psychological problems. Some argue that the standard counseling practices as well as the diagnostic tools in psychotherapy are not tailored to men and there is even a statement that “psychotherapy is the antithesis of masculinity”, (Bedi & Richards, 2011). Kilmartin (2005) talks about a possible ‘‘masculine’’ form of depression that is under-diagnosed and under-treated. The author refers to the diagnostic criteria for major depression found in the DSM-IV (currently DSM-V) as being representative of a feminine-gendered pattern of the disorder. Kilmartin (2005) argues that since men are conditioned to avoid introspection and find the expression of feelings to be disempowering, many men fail to recognize that they have a mental health problem. However, that might not necessarily be true and those are some of the stereotypes that need to be overcome. Instead of suggesting that men “avoid introspection” and “they fail to recognize they have a mental health problem”, why not focus on the virtuous sides of masculinity such as self-reliance, for example? What if men are able to reflect and recognize they have a problem but they believe they can solve it themselves and they do not need outside help?
Kiselica & Englar-Carlson (2010), suggest a positive psychology/positive masculinity (PPPM) model that could serve as a practical guide to counseling men using a multicultural approach. Their model is based on the principles of positive psychology and puts a strong focus on the “noble aspects of masculinity”. They elaborate on male relational styles, male ways of caring, generative fatherhood, male self-reliance, the worker-provider tradition of men, male courage, daring and risk-taking, the group orientation of boys and men, fraternal humanitarian service, male forms of humor, and male heroism. Kiselica & Englar-Carlson (2010) demonstrate the practical application of their model by presenting a case study in which the client’s masculine characteristics rather than the counselor’s assumptions and beliefs guide the counseling process. As far as the therapeutic alliance is concerned, Bedi & Richards (2011) offer some insight into “what a man wants” when working with a counselor. They point out that the development of a therapeutic alliance with men requires a fine balance between standard relationship-building techniques, such as validation and empathy, and asking questions, providing suggestions, and listening to the client’s negative comments about the therapist (Bedi & Richards, 2011). According to the authors “receiving direct emotional support does not seem as pivotal as psychotherapist nonverbal behavior, formal respect, bringing out the issues, practical help, and client self-responsibility” (Bedi & Richards, 2011). Providing clear information is also key.
Beel (2016) gives some great recommendations for men-friendly counseling. For female therapists working with men, he recommends that counselors work to recognize their own gender socialization and how it is different from their client’s gender socialization and also the impact of these differences on the counseling relationship. He encourages them to watch for unresolved issues with men and be mindful of the relationship dynamic (sexual attraction or taking on a caretaker role). They also need to be mindful of power imbalances, recognize the role of shame, and provide insights into different female-oriented perspectives (Beel, 2016). Male counselors, on the other hand, could serve as a positive role-model for their male clients since this is something that most men look for. However, they should watch for and be mindful of countertransference issues, male power competitiveness, and “blind spots” due to shared assumptions (Beel, 2016). In order to make psychotherapy more appealing to men, some fundamental changes need to be introduced to the counseling field. These changes need to take into consideration the different aspects of the culture of masculinity and apply them to the counseling process in order to make it more balanced and less feminine-oriented. The outlined suggestions are geared towards adapting the standard counseling practices to the culture of masculinity in an attempt to enhance men’s use of mental health services. The existing body of empirical research shows that the need for a change is present, however, there is a lack of practical guidelines for counselors on how this new paradigm could be implemented into the existing counseling processes. More research is needed to identify ways of making both counseling and the counseling profession more attractive to men in the first place.
To learn more about Vanya Malixi, go to www.vanyamalixi.com
References:
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American Psychological Association. (2007). Guidelines for psychological practice with girls and women. American Psychologist, 62, 949–979. doi:10.1037/0003–066X.62.9.949
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Bedi, R. P., & Richards, M. (2011). What a man wants: The male perspective on therapeutic alliance formation. Psychotherapy, 48(4), 381.
Berger, M., Wallis, B., & Watson, S. (2012). Constructing masculinity. Routledge.
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