Male Psychology Counselling
As the song goes, “He aint heavy, he’s my brother” and it seems that despite the length and difficulty of life’s journey, some men are willing and caring enough to help share the burden; some men are strong enough and able to help their fellow man. Fantastic!
Now, whether or not you agree with Scott & Russell, it seems that their main message is that it is a great thing to help our brethren; to step up when things get messed up for another. But hands up who’ll speak up and ask for help for himself? I reckon most of us find this difficult; to what extent though varies with each man.
Help Avoiding Behaviours
Men are often characterised as reluctant to seek help in many problematic situations; from refusing to ask for directions when lost to ignoring that oddly shaped lump on a delicate part of the body, we’ll stereotypically go it alone. We’ll deny, avoid, self-diagnose, self-medicate: we’ll mis-trust those who may have an answer and pretend we knew the answer all along when one is rudely thrust upon us. The audacity of some fellas who think they have all the answers. Really!
And even when we do go to a doctor, for example, we’ll stockpile a list of ongoing worsening issues the length of a badly infected arm; issues that, if dealt with sooner, may get resolved quicker and not lingeringly fester and kill or maim us. However, there are lots of reasons behind our delaying or avoiding tactics which, sadly, is often crudely simplified as indifference or thrifty: whilst it is more complicated than self-disregard or saving a few bob, it is simple that such behaviour is losing us a few Bobs and Robs and Terrys, you name them.
Although health care could be more male friendly environments, our help avoiding behaviour is harming us, especially when we avoid caring for our mental health.
Help Seeking Obstacles
Basically, we’re not great at seeking help as barriers like opening times, how we are received, poor education about health, fear, financial difficulties, and a lack of experience communicating about health, are difficult hurdles for us to overcome. Naturally, such obstacles exist for women too; however, it is different for men.
Consider work. For those who do work, it can be hard to be down money or to get time off if the boss is not compliant; it might even jeopardise keeping or progressing in the job. However, as many men are likely to work full-time and/or have to travel far to get to work, this means that they’ll be working when most healthcare settings are open.
And consider healthcare education/systems. In general, the health system has evolved to provide more routine and regular check-ups for women who themselves are more likely to talk about their health and to be accepted for doing so by practitioners and friends too. Indeed, if a man talks about feeling a little ill or under the weather a common response is to joke about “manflu” which minimises the fact that he is poorly, dismisses how he feels, and jeopardises his future help seeking behaviour. Perhaps it’s time to give “manflu” the old one-two.
Unfortunately, men continue to get the message that they must be strong, not talk about how they feel, and not to see their health as a priority—which they don’t! Often, they only ask for help when it’s too late to deal with issues effectively or when they accept the influence (nudging not nagging) of their spouse.
Overall, men are less likely to talk about their health and to have limited repertoires, outlets, and experiences talking about health. Furthermore, health carers expect men to emulate women’s emotional processes and are more receptive to the language of women as they miss many verbal and non-verbal cues from men who may not be as direct or articulate about their issues as women are. Such will close down men’s expressing themselves before they’ve even gotten started.
Yet it seems that the biggest obstacle for men seeking help is the perception that asking for help “undermines” masculinity. For many, denying the plainly obvious problem is the go-to response; for some, this can be extreme denial whereby help (and even reality) is refused despite deteriorating health and abilities. The result is that many men suffer in silence whilst exercising great restraint: they keep a stiff upper lip, they bite their lip, they button their lip; they remain po-faced, poker-faced, straight-faced, let's face it, asking for help is considered girlie.
Traditional masculine beliefs holds health care and asking for help with health as feminine and contradictory to what men are supposed to be: it can be a challenge to admit a weakness, to open up and share a vulnerability, to change our ways, to be sick, to relinquish control, to allow help, to be protected, and to accept and enter a “female world”.
Consider when you (eventually) go to the doctors; typically, there are more women than men waiting to see the doctor; even the reading materials are more likely to be aimed at women. Likewise when you go to hospital, nurses and patients are more likely to be women. However, although the statistics just barely support such arguments, naturally, health care will be seen as a female area.
Similar views are taken for counselling: counsellors and their clients are more likely to be women—despite the long-time non-changing world-wide fact that more men die by suicide every year. Regarding Ireland, since the year 2000, 4 times as many men as women died by suicide per year—400 Men: 95 Women on average. Clearly, something is wrong here; but with men? with society? with the systems?—or with the whole shebang?
Health Seeking Behaviour Promotion
Whilst it is clear that men need to change how they go about getting help, it is also important that healthcare systems get better at helping men, rather than addressing the issues in terms of fault with men solely. Specifically, whereas it seems women “have” problems, men “are” problems. Such opinions which focus on gender only are more shaming and blaming and are counter-productive to improving the health of men in our families and communities. Furthermore, they do not address the real cause of the issues that leave men vulnerable, e.g., joblessness, fatherlessness, homelessness, poor education, severe mental health problems, and male unfriendly care services. Surely we can all do better! Well, it seems we can.
Clearly, there are costs to men not receiving help, e.g., rates of premature death, addiction, violence, abuse, and behaviour problems, are higher among males than females. But there can be costs to asking or getting help too, e.g., exposed to ridicule or reduced self-esteem. However, whilst research will highlight some potential problems these can be negligible to the positives received if the care is handled sensitively and properly from a male perspective.
Consider the following sections which attempt to clarify or reframe common issues with men.
Men are deterred from seeking help if they see their problem as abnormal. The irony is though that many of the “abnormalities” are actually quite normal. It all depends on experiences. For instance, a counsellor who regularly sees men who’ve been flattened by the demands of society realises (1) how common the struggle is for many men in coming to terms with “failing” to become a male “success object” and (2) how frequent a safe, private space to talk about their beliefs and attitudes towards life will provide a clearer plan to bounce back.
Unfortunately, our culture has been structured so that men become the clichéd and “normal” strong, silent types who don’t talk or share their thoughts or feelings about their concerns about their mental health, physical health, family, work, etc. In effect then, we end up with a bunch of men all individually holding a normal commonly held concern alone—erroneously thinking they are weak, inferior, or abnormal.
Thankfully, things are changing as more and more hugely successful, powerful, influential and popular people are disclosing and openly discussing that which is often considered taboo. This helps to normalise an issue. Take depression, for example. Surely when the likes of Bruce Springsteen, and many others, share that they suffer depression it can help change perceptions of what kind of men get depression—the fact that even “The Boss” gets blue should help make it ok, right? But we also need more everyday men talking about their depression too. And sadness. And anxiety. And distress, despair, shame, frustration, boredom, meaninglessness, what ever it is that is ailing us. We need everyday men to encourage others to talk about their mental health, to challenge the stigmas and negativity about talking about such things, to fight and not let such things beat us, and to share what it is that helps us cope.
Central Part of Me
Research shows that men are less likely to ask for help when it reflects poorly on a major quality aspect of their manliness. So, for example, men who “just get on with it” would probably think that getting help with anxiety is a threat to their self-esteem or to their manliness. Some of these men however may see that a hitherto unsolvable problem ought not to be let beat them. Instead, getting help could be seen as successfully competing with one’s emotional self and reclaiming or maintaining control and mastery to continue in the role of provider and protector.
Payback and Pay-forward
When they deem it for a social good, men are heroes, rescuers, givers—often, you’ll see a man changing someone else’s car wheel on a roadside or freely training kids in a community sports club. Often though, men give because they believe in its worth, men give because it’s a part of who they are, men give because they are giving back. Others times, they are paying forward. It’s good karma.
Effectively, whilst an issue is more likely to be normalised when lots of men give to it or talk about it frequently, men are more likely to ask for or give help if others are doing or going to do likewise, i.e., payback or pay-forward. So, for example, when the floods or snow storms hit, the great human spirit of togetherness and rallying around to help increases, as do the chances of a man asking for help with keeping his property and family safe—the perception is that it’s normal, it’s widespread, and it’s possible to payback.
The same applies for social movements like the Ice Bucket Challenge and Movember. Respectively, these normalised what would otherwise have been seen as very peculiar behaviour indeed: throwing a bucket of ice cold water over your head became acceptable and moustaches returned to the everyman instead of just for the likes of Freddie Mercury or Tom Selleck. In effect, Ronnies and soakings became cool, conventional, and common and included the elements of payback and pay-forward.
However, the perception of being able to payback is less so for an issue like addiction or depression, for example, as many will view these issues as not normal thereby decreasing the likelihood of payback or even asking for help. Therefore, the challenge is to change this perception, e.g., through relevant groups and bodies.
For instance, whereas many volunteer groups recruit people who have not being personally affected, many volunteers get involved because they used the services themselves. Indeed, many men’s help groups incorporate payback into their systems to help keep their groups alive and to harness the sense of belonging and ownership but also to preserve their members’ masculine status, i.e., not in debt, still strong and competent.
Although it’s good to talk, it aint good to be an open book; we must choose wisely what we say, when we say it, and to whom. For those who belong to groups whereby “staying strong” and being a “man’s man” is key to belonging, sharing a vulnerability can risk a man’s status within the group; therefore, many choose not to express their true feelings when they are feeling down. Such groups might respond disparagingly and such responses will damage a man’s self-esteem if his peers’/family’s opinions are important to him. Overall, most men will conform to masculine norms if this is important to retain identity and belonging to the family, community, team, workforce, etc. However, the costs of not talking to someone could be detrimental for one’s mental health.
For the many men who do not share the fact that they suffer with depression, the likelihood is that their social group believes and states that depression, asking for help, tending to mental health are signs of weakness. Furthermore, although many of these men may have considered getting help their choices are minimised by the fact that their group doesn’t talk about it or “allow” it and will therefore bury the feelings and not seek professional help or support from family and friends.
However, some men belong to groups (e.g., Church, volunteer, work, training, sport, or help groups) whereby talking about feelings with family and/or peers is important and seeking help is encouraged. Indeed, if help seeking behaviour is encouraged and framed as part of who we need to be as men (to fulfil our role as protector, provider, etc.) it further normalises getting help. It’ll make it ok.
Losing Some Control
Clearly, getting help does require handing up a bit of control. For example, if a man goes to the doctor he might have to wait, deal with delays, deal with uncertainty, follow directions, come back again for results, undergo a medical procedure; indeed, he may be attending the doctor because his other half told him to. Similar applies for going to counselling whereby one needs to ask for support, clarity, acceptance, understanding, empathy, maybe guidance from another person. Either way highlights that something has gone out of control and it needs to be reclaimed with the help of another person.
Furthermore, a man may feel that if other people find out that he is getting help he might lose face or standing within his community as he will be considered weak (see above). Such relinquishing of control is why, some say, men will refuse to ask for or accept help. However, key to challenging that belief structure is highlighting that we often have to take one step back to take two steps forward: sometimes we need to re-learn how to gain control; sometimes we have to give up control to get control; sometimes we need help in fighting the good fight; sometimes we need a hand.
Whilst it’s hard to stop responding in ways we’re used to, it’s also hard to start responding in ways we’re not used to. Overall though, things can be improved for men if each of us tackle the problems within ourselves and within our families, communities, healthcare settings, etc. Keep the following in mind when “men and health” are (not) being discussed:
Although many of us are more inclined to give than take, eventually, we all need a bit of help. It’s worth remembering that whilst part of the traditional masculinity is to retain control and be a provider and protector, sometimes we need to re-learn or reclaim our abilities to do so. To be at the top of our game we need to see our health as a priority. To be our best we need to be able to recognise and admit when problems exist, to tackle them head-on, and to not let them beat us. We need to trust the opinions of others whilst not losing our own self-belief and our own ability in helping others. After all, whilst it’s good to share your brother’s burden, it’s good to let him help you likewise.
Ivan Kennedy Counselling Carlow & Kilkenny