Describe the concept of men's mental health.

Introduction

Researchers who study the mental health of men will ultimately find themselves becoming conversant on various issues, most of which share the problem of gender identity politics as their root cause. Both academicians and clinicians study diverse aspects of men’s mental health, including male development and theories of masculinity. Contemporary perspectives of masculinity do not always focus solely on men who conform to the expectations associated with traditional masculinity; rather some of the later theories examine and describe the increasing number of men in modern Western societies who actively eschew traditional masculine values and choose not to engage in traditionally rigid male role behavior. Such studies not only examine the individuated behaviors and beliefs of the liberated man, but also question the extent of societal support and acceptance of the changes in gender identity. In short, men who identify with both masculine and feminine roles risk social sanctions because they either choose to disregard gender norms or are unable to fit the idealized male image as reflected in hegemonic culture.

Mental Health and Health Issues

Generally, some of the more often discussed issues in men’s mental health include normal childhood development and psychopathology, adolescent impulsivity (including neurodevelopment), male depression, workplace anxiety disorders, substance abuse, sexual health issues (erectile dysfunction, premature ejaculation, and male orgasmic disorder), emotional issues related to partner health, and aging—especially its relationship to depression and suicide. Other popular issues among theorists in the discipline include studies of antisocial personality, conduct, and post-traumatic stress disorders; fathering, as it is related to mental health; masculinity, gender identity, and the family unit (marriage and divorce included); propensities toward aggression, violence, and domestic abuse; issues stemming from culture, ethnicity, and race; homosexuality; and help-seeking behavior, which includes overcoming stigmas and barriers to mental health treatment. Also of note are the problems introduced by men’s body image concerns.

Help-Seeking

Generally speaking, most clinicians find that male clients who seek out therapy do so because their hand has been forced. For example, they may have been referred for treatment in response to excessive alcohol consumption or substance-related abuse, such as driving under the influence (DUI) citations or arrests for domestic violence. In some cases, the spouse has demanded that undesired behaviors must be stopped or curtailed. Similar to their avoidance of seeking medical help (the grin-and-bear-it syndrome associated with traditional masculinity), men typically eschew therapy because talking about their feelings is viewed as at best weak, and at worst completely nonmasculine, contrary to the male robust image. As a result, they place both their physical and mental health at risk. Men who exhibit self-destructive behavior may seek therapy as a result of a physician’s referral, but the irony is that the behaviors that lead to men being referred to therapy (for example, excessive anger, uncontrollable competitiveness, or sexual harassment in the workplace) are often seen as socially desirable, even essential, because these behaviors define masculinity. In fact, Morley D. Glicken found that “the involuntary nature of a man’s use of therapy is complicated by the fact that men often view therapy as feminizing and their resistance to the process can be considerable.” Gender issues can become problematic, because at a very early age, boys are constantly barraged with the message that they are essentially different from girls. They may receive these messages from their parents; however, even parents who attempt to encourage boys to be sensitive and to recognize the feminine traits that are part of their masculinity can find themselves facing the same negative influence of strict adherence to gender identity, for their sons receive messages of male expectations from peers, from older boys, from sports exposure (including from their coaches), and from various media outlets. In essence, boys, especially those involved in sport, make pain what Glicken calls “a pledge of manliness.” This stands in contrast to women, who as girls are taught to always express their emotions.

Masculinity and Gender Roles

It is particularly tragic that the masculine sense of independence stands in the way of counseling or therapy, for men generally have few other support systems—and a very limited number of friends. The problem is that male clients often feel uncomfortable revealing their emotional problems and insecurities to a therapist. Traditional maleness usually involves some embracing of self-sufficiency, which can lead to aloneness or loneliness, both part and parcel of the unwritten code of masculinity. Yet some theorists argue that issues of men and masculinity have rarely been considered in relation to the theory and practice of person-centered therapy, arguing that the trappings of modern society make this focus more essential.

Scholars and clinicians have expressed the need for a male-sensitive approach in the mental health and psychotherapeutic domains, especially given the ongoing research that indicates the need for a diverse range of seemingly competing theories pertaining to the nature and basis of male gender identity in the Western world. Some theories emphasize the biological aspects of masculinity, with lengthy discussions of the underlying sexual (physiological) differences between men and women, while others look at psychodynamics, sociological pressures (especially the role of relationships), and even power structure issues. Although the traditional idea of masculinity is basically hegemonic, consisting of varying beliefs, tropes, role definitions, and practices, at any given time, alternative constructs of maleness are recognized as valid, making it even more complex for clinicians involved in therapeutic work with men, thereby calling for an ongoing dialogue. What some academicians refer to as a crisis in masculinity also contributes to gender identity issues; these crises usually involve radical questioning of the meaning of masculinity, and they occur during periods of significant ideological, economic, and social tension, producing a culture wherein traditional masculinity is seen as less valid. However, because new definitions need to be firmly established, these periods may be more confusing than they are enlightening.

Another fundamental dialogue exists between theorists who argue that young men inherit what is called innate maleness at birth and that their masculinity is predetermined, and those who posit that men are born tabula rosa and are socialized into maleness. Gender role strain theory argues that masculinity and femininity are socially constructed and are relative, so that the contemporary understanding of gender roles tends to be contradictory, despite consistent themes. These contradictions inherent in modern masculinity ideology can have the negative impact of creating a sense of trauma in young men when it comes to issues of socialization. In some cases, male teens and young adults will over-conform, adopting extreme, perhaps even toxic versions of traditional male traits. Some theorists argue that ultimately this can lead to the male propensity toward violence and other unhealthy practices.

Academicians who focus on male gender-role development (with special emphasis on early developmental struggles) theorize that even though male children are masculine at conception, they possess the same innate feminine emotional and psychological traits. It is only through the deidentification with the mother that they begin the stages of repression, and if the father subscribes to traditional roles of masculinity, which would dictate that men are breadwinners, sacrificing familial interaction for professional advancement, the male child is left without a parental figure with whom to identify. Hence, boys learn about masculinity through negation, by inferring what it means to not be feminine. Daniel J. Levinson and associates have found that these restrictive notions of the male role are present throughout most of adulthood, tending to be modified in middle age, perhaps due to healthy relationships. Toward middle age, men begin to integrate both male and female definitions of their roles, becoming more nurturing. Men at this stage of life also seem to be more concerned about the quality of relationships.

Interpersonal Relationships

Relationships seem to be at the forefront of men’s mental health issues. Problems such as role in the family unit and sexual dysfunction are omnipresent in the literature. Of the latter, researchers and practitioners have found that there is a direct association between emotional health and sexual function in men. In addition to the physical reasons for erectile dysfunction (hypertension, for example), therapists have also identified psychological contributing factors, such as general fatigue, depression, and prolonged stress. Because male arousal disorder can also result from combined factors, it is possible that a man with a medical condition of insufficient severity to cause dysfunction could experience dysfunction after a slight emotional trauma—which by itself would not have caused difficulty. Because of this complexity, therapists and academicians use various methods to study the causes of male arousal disorder, such as determining organic, psychological, and relational etiologies, and have found that eclectic therapeutic approaches raise the success rate.

When studying the male role in the modern family unit and how it affects the mental health of men, researchers begin with the acknowledgement that the reliance on the standards of a hegemonic patriarchy serves as the primary source of difficulty in relationship adjustment. Despite the actual change over time of the male role in family function and structure, societal pressure continues to prioritize and aggrandize the idea of the traditional, heterosexual, two-parent family in which the man is the primary means of financial support. This, of course, inadequately reflects reality, where a broad spectrum of manifestations of the family unit are observed; this inconsistency between expectations and reality results in the majority of contemporary families first appearing to be dysfunctional and then perhaps becoming so as a self-fulfilling prophecy. The main problem with the gender-role expectations that promote male dominance is that patriarchal values often promote inequitable gender expectations, which by extension sanctions female subordination. As female partners in the family unit are perceived principally responsible for both the relationship itself, for the well-being of the family, and for domestic upkeep, familial conflict is likely to ensue. Theorists therefore must examine the basis for the continual adherence to patriarchal standards to determine methods to ameliorate resulting difficulties. On the individual level, therapists work with men who find themselves being torn between societal expectations and the realities of their family units by helping them understand the necessity and inevitability of shifting gender roles.

Aggression and Masculinity

Another prevalent issue in men’s mental health is the reliance on
aggression as a coping technique, which can lead to violence and possibly even domestic abuse. Because men, as young children, are taught, perhaps even in good faith (to protect themselves from bullies, for example) to fight, as they age, boys are faced with the decision to either eschew physical methods of settling differences or continue to use violence to cope. Unfortunately, many male young adults lack effective strategies to deal with anger and frustration; therefore, they will adopt behaviors such as throwing items, banging on materials that frustrate them, or punching inanimate objects. Sandra P. Thomas found that men, in general, were no more comfortable with the emotion of anger than were women. As a result, some men feel shame concerning their inability to cope without violence, so they withdraw altogether. In worst-case scenarios, they self-isolate, which endangers relationships.

Depression

Problems such as anger management issues and self-isolation, as well as other issues, make
depression one of the biggest mental health concerns for men. In England, for example, researchers have found that heart disease, sexual dysfunction, and other chronic conditions can lead to serious emotional problems such as depression, and that conversely, men who are depressed are three times more likely to develop long-term illnesses such as heart disease. The same study found that although an equal number of men and women are affected by mental health problems, twice as many women are diagnosed and treated. As Rosemary L. Hopcroft and Dana Burr Bradley noted in 2007, generally, in developed countries, the sex difference in depression and symptoms of depression is well documented. In the United States, women are more likely to report symptoms of depression than men at all ages, with a peak in the sex difference in late middle age. Psychiatric epidemiology has consistently shown that with the notable exception of substance abuse, women have higher rates of nonpsychotic disorders and report depression, as compared with men, at a 2:1 ratio. However, a growing body of scholarship in men’s studies has focused on sociological and artifact explanations, purporting that the traditional male role, associated with self-reliance and stoicism, actually results in men’s depression often being undetected and untreated. Psychiatrist Martin Kantor argues that the signs and symptoms of depression differ between men and women and that clinicians, looking for the classic signs of depression in women, may miss the diagnosis in men. He identifies the major inconsistency in diagnosis as being a result of the failure to recognize the male depressive equivalents—the indirect actions that men use to display depression. For example, depressed men do not appear tearful; rather, they have a tendency to become irritable or develop psychosomatic symptoms, or, as Kantor theorizes, deny their depression and shift into hypomania.

Suicide

Sam V. Cochran and Fredric E. Rabinowitz argued that far too many depressed men ultimately commit
suicide and that the number rises dramatically with age. In the United States, suicide rates for men in all age groups are higher than for women; in fact, men are four times as likely to kill themselves as women, according to the American Foundation for Suicide Prevention. When dealing with suicidal men, therapists often watch for suicide equivalents, since suicidality can be subtle, even sometimes symbolic. Suicide equivalent behaviors include actions such as inadequate care of one’s physical health, suffering from professional or occupational block, workaholism, hypomania, substance abuse (especially addiction to alcohol, cocaine, and oxycodone), and self-defeating neuroses. At-risk men will often express suicidal thoughts (which may or may not evolve into suicidal behavior), although some depressed men may hide their intentions. In cases in which suicidal thoughts become threats, clinicians are forced to determine the seriousness of the claim. Suicidal attempts will range from those that are symbolic or gestural (which are usually used to manipulate an individual or group) to those that signal a sincere desire to end one’s life.

Of particular concern to many researchers in the field is the fact that many men, responding to what they feel is a cultural imperative to be traditionally masculine, view help-seeking as showing weakness and therefore avoid therapy. This behavior is endemic among certain cultures. A 2007 study found that rural men not only lead a life that presents more challenges that statistically increase the risk of mental illness, but also are most likely to not seek professional help. Researchers have found that, generally speaking, one of the biggest dilemmas for psychotherapeutic practitioners is getting men (of all ethnicities, cultures, and ages) to actually attend counseling or psychotherapy. Statistics show that men are far less likely than women to seek help in the form of therapy; service statistics verify this, showing a preponderance of female clients. The reasons for this phenomenon are varied, but the overarching theme seems to be that male reticence to seek counseling is a reflection of the masculine emphasis on self-sufficiency, part of a wider refusal to ask for help until absolutely necessary. If one examines the act of help-seeking through the lens of traditional gender-role identity, the resulting portrayal of therapy would be that it d vulnerability and weakness, in other words, failure. Therefore many men, especially young men, avoid services offering help, working out psychological and emotional problems themselves, or using unhealthy coping mechanisms, such as substance abuse, resorting to violence, or ending their own lives. Therapy is not even viewed as an option by these types of men. To offset the negative help-seeking behavior of men, clinicians are developing a better model. Group discussions about health are one viable alternative, and men seem to respond positively. Also, responding to studies that indicate that men are less likely to report pain while in the presence of a female clinician, practitioners are steering male patients towards male therapists.

Bibliography

Berger, Joshua L., et al. "Men’s Reactions to Mental Health Labels, Forms of Help-Seeking, and Sources of Help-Seeking Advice." Psychology of Men and Masculinity 14.4 (2013): 433–43. PsycARTICLES. Web. 22 May 2014.

Cochran, Sam V., and Fredric E. Rabinowitz. Men and Depression: Clinical and Empirical Perspectives. San Diego: Elsevier, 2000. Print.

Edwards, Tim. Men in the Mirror: Men’s Fashion, Masculinity, and the Consumer Society. London: Cassell, 1997. Print.

Glicken, Morley D. Working with Troubled Men: A Contemporary Practitioner’s Guide. Mahwah: Erlbaum, 2005. Print.

Grant, Jon E., and Marc N. Potenza. Textbook of Men’s Mental Health. Washington, DC: American Psychiatric, 2007. Print.

Haddad, Mark. "Promoting Mental Health in Men." Nursing Standard 27.30 (2013): 48–57. Academic Search Complete. Web. 22 May 2014.

Hopcroft, Rosemary L., and Dana Burr Bradley. “The Sex Difference in Depression across Twenty-Nine Countries.” Social Forces 85.4 (2007): 1483–1507. Print.

Judd, Sandra J. Men's Health Concerns Sourcebook. Detroit: Omnigraphics, 2013. eBook Collection (EBSCOhost). Web. 22 May 2014.

Levinson, Daniel J., et al. The Seasons of a Man’s Life. New York: Ballantine, 1988. Print.

Rabinowitz, Fredric Eldon, and Aaron B. Rochlen. Breaking Barriers in Counseling Men: Insights and Innovations. New York: Routledge, 2014. eBook Collection (EBSCOhost). Web. 22 May 2014.

Thomas, Sandra P. “Anger: The Mismanaged Emotion.” Medical and Surgical Nursing 12.2 (2003): 103–110. Print.