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.