Masculinity: The Key to Understanding Men`s Experience of Disease

Masculinity: The Key to Understanding Men’s Experience of Disease While it has long been known that men die of chronic disease at much higher frequency than women, it hasn’t generated much interest, until recently. In 2009, the 6th Men’s Health World Congress selected as its theme, “Why Men Die Earlier and Suffer More”, which attracted nearly 1000 participant from 69 countries. This year’s Men’s Health World Congress, which will be held in Vienna, Austria, is titled, “Men and Ageing: A Life-Long Process! Improving Health by Ensuring Interdisciplinary Care”1. And the Men’s Health Network, a national non-profit organization with a mission to reach men for health improvement, and the sponsor of National Men’s Health Week, has as one of its stated goals, “Save men's lives by reducing premature mortality of men and boys”2. In fact, Randolph Nesse, MD, professor of psychiatry and psychology at the University of Michigan, and author of several books on evolutionary medicine, say in a BBC news article, “Being male is now the single largest demographic factor for early death. If you could make male mortality rates the same as female rates, you would do more good than curing cancer.”3
 This statement confirms the importance of a growing momentum for the idea that men’s health issues are preventable. Men can evolve into a different mindset about how to author their lives, a concept well-rooted in naturopathic medicine principles. There seems to have been some complacency around the idea that men suffer from higher rates of chronic disease than women and the reason for this had been centered on the idea that men simply don’t want to care for themselves. However, recent studies demonstrate that the key to understanding why men historically don’t take care of themselves, lies in the understanding of the social construct of masculinity. New research on how men experience chronic illness such as osteoporosis, diabetes and heart disease, is leading the way toward changes in health care delivery methods such that men are encouraged and supported for taking care of themselves. A 2010 study by Nielsen, at the University of Southern Denmark, published in the American Journal of Men’s Health, provides important insight into the experience of men diagnosed with osteoporosis, which is similar to the experience of men with breast cancer and other chronic diseases.4 Osteoporosis is predominantly known as a women’s disease, and therefore several issues arise which are unique to men with the diagnosis. First of all, because of the image of frailty (men are “supposed to be strong”) associated with osteoporosis and other chronic illnesses, men stay away from doctors to avoid being diagnosed. Often when they do finally go see a doctor, it is too late and bone fractures occur. Men kept up their normal level of physical activity despite bone fractures, because it supported their self-image as men, and, to negate their self-identification as “sissy” and “whiner”. Also, because osteoporosis is thought of as a woman’s disease, men, and their doctors, aren’t educated on recognizing risk factors. In her post-graduate research project, H.M. Raphael authored a qualitative study to explore men’s perceptions of

osteoporosis.5 She found that men often reported that information given to them on osteoporosis was biased toward informing women and not applicable to men. In consideration of the holistic perspective of men, it is important to note that Nielsen’s study discussed the isolation that men with osteoporosis felt. Men were reluctant to be open about the disease because the diagnosis was not taken seriously, even joked about, and they were often told by partners and colleagues to simply “get over it”, even with bone fractures that limit physical ability. Similar results were found in a male breast cancer study6 and in a diabetes study, where “it was concluded that masculinity is rarely explored, and there is an absence of masculine perspectives in diabetes education and management research”7. Men are strongly bound to their sense of honor and physicians need to understand this when creating a treatment plan. In the osteoporosis study, it was noted that advice in the form of restricted activity or other demasculinizing suggestions would likely be met with resistance. Substitution of advice that preserves that sense of honor as a man, such as physical therapy, will earn greater patient compliance. From early childhood, boys and young men get contradictory messages about taking care of themselves. Research shows parents (both moms and dads), other adults such as teachers and coaches, and peers all discourage boys from asking for help.8 Considerable media attention is given to the aggressive dad who pushes his kid to be tough out there on the soccer field. But women too, are guilty of withholding physical touch with their sons to keep them from being too “soft” and encouraging them to be “mommy’s little soldier”. Indeed boys are even ridiculed and punished for seeking help- part of what Dr. William Pollack, clinical professor of psychiatry at Harvard Medical School, defined as the “boy code” in his ground-breaking research in 1998.9 Boys are encouraged by health professionals to seek help for their physical, psychological, emotional and even spiritual struggles, but are pressured to become stoic and independent, avoiding the expression of feelings, which is thought to be “feminine”. And so many boys, despite their natural desire for nurturance, learn to abandon their needs and take on the behavior of traditional masculine roles. These masculine stereotypes get adopted by so many young men, under necessity to be accepted. Spend much time on college campuses, at the gym, or at a sports event and it becomes painfully evident. Too often, men deny their individuality and put on the mask of traditional masculine role behavior in which men deny their needs, even medical needs10. Those who buck the tendency to conform and maintain their sensitivity, pay the price of marginalization, which is social isolation. In the July/August 2010 Atlantic Monthly, Hanna Rosin wrote a provocative article entitled, “End of Men” in which she suggests that in a postindustrial economy, men are less suited for being in position of leadership because they lag in areas of social intelligence, communication and ability to focus11. But even more relevant is the response by Ann Friedman written in the June 2010, The American Prospect, in which she writes, “She thinks the problem is men; really, it’s traditional gender stereotypes. The narrow, toxic definition of masculinity perpetuated by Rosin and

others—that men are brawn not brains, doers not feelers, earners not nurturers—is actually to blame for the crisis.”12 Indeed, traditional masculine ideologies have a price. In his work looking at the health behaviors of college men, Dr. William Courtenay, internationally recognized social scientist and researcher on men and boys, has found that traditional attitudes about masculinity have been linked with poor health behavior, including smoking; alcohol and drug use; and behaviors related to safety, diet, sleep, and sexual practices13. College men who rigidly adhere to traditional notions of manhood have: •more anxiety •poorer health habits •greater cardiovascular reactivity in situations of stress (leading to heart attacks) •higher levels of depression •more vulnerable to psychological stress and maladaptive coping patterns •tend not to seek help from others and underutilize professional services on campus Concerns about men’s academic success have also been linked to masculinity. In a study of college men looking at how the meaning of masculinity impacts motivation in higher education, it was found that men who have a “player” mentality regarding sexuality, have a belief that violence is acceptable, and have a lower primacy to work showed statistically lower scores for intrinsic stimulation (self-motivation), accomplishment and desire to learn.14 Conversely, men who put less emphasis on winning, displayed less rigorous emotional control (rather than the old idea that only girls cry) and had decreased self-reliance (such that they could ask for help from others) are more apt to engage in self-investigation and development through intrinsic motivation. These men who have broader definitions of manhood and masculinities had increased academic motivation. One could extrapolate that men with greater self-investigation (who am I, how do I feel, what are my beliefs and what do I value, etc.) would be more likely to seek better methods of creating health. Perhaps this is the moment in time for men to finally say no to traditional ideologies of masculinity, which seem to be based on false notions anyway. In the findings of Beatty, Syzdek and Bakkum15, college men view their peers as “more stereotypically masculine than their peers self-report. This misperception may lead them to behave in more stereotypically masculine ways and construct their gender schema with more stereotypical masculine beliefs, potentially resulting in negative health outcomes.” So guys tend to act more “manly” simply because they think that other guys feel more masculine, when in fact, they don’t. Masculine ideologies that don’t represent individual men’s experiences are what get perpetuated. The stress that accompanies adherence to traditional ideologies of manhood has lead to what is known as the Gender Role Conflict Theory, defined as a psychological state in which socialized gender roles have negative consequences on the person or others, which occurs when rigid, sexist, or restrictive gender roles result in personal restrictions, devaluation, or violation of others.16 In other words, when there is a gap between a guy’s natural state of masculinity and a socialized “mask” of masculinity, he will likely suffer a level of stress, decreasing his overall level of

health. Gender role conflict has been associated with decreased male college students’ psychological well-being, increased levels of shame and alexithymia (inability to express feelings), low ego identity and lower ability to create intimacy. Additionally, there is also a drive for muscularity & high risk health behavior, as well as increased levels of anger, helplessness, self-destructiveness, suicide probability and dysfunctional patterns in interpersonal relations, including marital dissatisfaction and negative attitudes toward women and minorities. In his book, “Under Saturn’s Shadow: The Wounding and Healing of Men”, James Hollis writes: “We are born free, bearing the germ of wholeness and health, and then life happens. Where did it go? Why the heaviness, the body ache, the soul fatigue, the ennui of brain and bone? What happened to that child, afraid but full of itself?”17 For too long, men have been enduring the burden of living without any connection to meaning, which gets translated into poor health behaviors. But in response to rapid changes in the world- globalization, economic crisis, environmental crises, men are slowing opening the door to a new way of life. More men than ever are staying at home as the primary caretaker of their children, fulfilling a need to nurture that was robbed so long ago. More men are finding their way into therapy and groups to address their challenges. Hospitals and clinics are finding new and creative ways to bring healthcare to men at sporting events and other venues frequented by men. And new studies, such as the study on men with osteoporosis, are paving the way for understanding men’s experience of disease. Perhaps the gift of all the focus on men’s health is the push over the edge that men have long needed to shed to the burden of constraint of traditional male roles. The great Dr. Bill Mitchell, co-founders of Bastyr University, once said, “Intention is the mother of actualization” There may be an opportunity now, to set the intention of embracing new ideologies of masculinity where men are free to reacquaint with that wholeness, which Hollis writes about, to take care of themselves, to be supported for doing so, especially when faced with chronic disease. References 1. International Society for Men’s Health Web site. Available at: http://www.ismh.org/en/ismh-news/mens-health-world-congress/. Accessed July 8, 2011. 2. Men’s Health Network Web site. Available at: http://www.menshealthnetwork.org/. Accessed July 8, 2011. 3. Being a Man is ‘bad for health’. BBC Web site. Available at: http://news.bbc.co.uk/2/hi/health/2148573.stm. Accessed July 17th, 2011. 4. Nielsen, D. Men's experiences of living with osteoporosis: Focus group interviews. American Journal of Men's Health. March 2011; 5(2):166. 5. Raphael, H M. A grounded theory study of men's perceptions and experience of osteoporosis. Bone 2009;44(2):200. 6. France, L., Michie, S., Barrett-Lee, P., Brain, K., Harper, P., & Gray, J. Male cancer: A qualitative study of male breast cancer. Breast. 2000; 9:343-348.

7. Jack, L., Jr., Toston, T., Jack, N. H., & Sims, M. A gender-centered ecological framework targeting Black men living with diabetes: Integrating a “masculinity” perspective in diabetes management and education research. American Journal of Men’s Health. 2010;4:7-15. 8. Courtenay WH. Constructions of masculinity and their influence on men's well-being: A theory of gender and health. Presented in partial fulfillment of the doctoral degree, University of California; June 26, 1996; Berkeley, CA. 9. Pollack, William, Ph.D. “Real Boys: Rescuing Our Sons from the Myths of Boyhood”, Random House, New York, 1998. 10. Verdonk, P., Seesing, H., deRijk, A., Doing Masculinity, not doing health? A qualitative study among Dutch male employees about health beliefs and workplace physical activity. BMC Public Health. 2010;10:712 11. Rosin, H. The End of Men: Women are dominating society as never before. The Atlantic monthly July/Aug 2010;306(1):56. 12. The American Prospect Web site. Available at: http://prospect.org/cs/articles?article=its_not_the_end_of_men Accessed July 10, 2011. 13. Courtenay, W.H. Engendering health: A social constructionist examination of men’s health beliefs and behaviors. Psychology of Men and Masculinity. June 2000;1(1):4-15. 14. Kahn, J., Holmes, J., & Brett, B. Concerns with Men’s Academic Motivation in Higher Education: An Exploratory Investigation of the Role of Masculinity. Journal of Men’s Studies. 2011;19:65-82. 15. Beatty, A., Syzdek, M., Bakkum, A., The Saint John's Experience Project: Challenging Men's Perceptions of Normative Gender Role Conflict. Journal of Men's Studies. Fall 2006; 14(3):322 16. O'Neil, J.M., Good, G.E., Holmes, S. Fifteen years of theory and research on men's gender role conflict: New paradigms for empirical research. In: R. Levant & W. Pollack (Eds.) The New Psychology of Men. New York: Basic Books; 1995. 17. Hollis, J., Ch. 1, Under Saturn’s Shadow: The Wounding and Healing of Men. Toronto, Canada. Inner City Books; 1994.