The workings of our minds has always fascinated me, why do we do the things we do? How does the biological and the psychological interact?
Naturally, I have a particular interest in male psychology, especially around mental health and therapy but I have been very dissatisfied with the assumptions and approaches that have become predominant in the field for some time. Too much of the messaging is ideologically driven rather than evidence based.
If men are depressed, that must be something to do with “the patriarchy” or “toxic masculinity”. If only men cried a little more, and talked about their feelings, all the problems would magically disappear and they’d stop killing themselves. The fact that the less stoic society has become, and the freer men have been to express their emotions, the higher the suicide rate has gone just seems like an inconvenient fly in the ointment for this kind of world view.
In this murky sea of anti-masculine sentiment there has been a few beacons of hope that some psychologists are actually approaching the problem without the usual gaslighting and victim blaming of men. For example, reading “The way men heal” by Tom Golden was a real eye opener for me. As was Warren Farrell’s seminal work, “The myth of male power“. Closer to home in the UK, I’ve been keeping an eye out on the excellent work by John Barry and Martin Seager at the Centre for Male Psychology.
They have recently published a new set of guidelines for practitioners for helping men in terms of psychological intervention and it is everything I hoped it would be. You can read the full guide (it’s not actually a long read at just 6 pages) here.
I would like to highlight a few key parts
“Most counselling and therapy approaches are designed around the traditional assumption that direct emotional exploration and verbal expression within a personal face to face therapeutic space are essential conditions for psychological change and improvement. This general assumption within the culture of ‘talking therapies’ is, arguably, more suited to how women in general deal with their problems than how men in general do (Morison et al., 2014).”
This ties in very well with my experience of therapy. I’m not saying that this is not useful, for some people this works well, but for others, the face to face, eyeball to eyeball experience can feel uncomfortable.
I could never quite put my finger on why that was until I read Tom Golden’s book. If you think about how men bond, it tends to be shoulder to shoulder, not face to face. What does it mean when another man squares up to you and looks you directly into the eye? It means conflict.
I’ve spoken recently about how I’ve found Andy’s Man Club, a peer to peer support group far more useful than traditional therapy and guess what, the groups are arranged in a circle, it’s not eye to eye, it’s shoulder to shoulder.
“Men seek therapeutic help significantly less often than women do (Addis & Mahalik, 2003), but this has been attributed primarily to characteristics or deficits in men (e.g. stubbornness, stoicism) themselves rather than to characteristics or limitations of the therapy models and services.”
“Talking therapies should not be the only option, although men can and do talk in the right
setting. Action-oriented and community approaches should also be considered, including
due consideration of culturally appropriate settings.”
“Group and community approaches where men can identify with others like themselves may
encourage rather than deter help-seeking.”
“Problem-solving and action-oriented approaches will have, on average, greater
appeal for men.”
Again, I couldn’t agree more. We always here people talking about why men engage less with help and always come to the conclusion that the problem is men. We never ask whether it is the environment we provide for therapeutic intervention that could be part of the problem.
It’s not realistic to expect male nature to bend towards the kind of environments that we are used to providing, it’s much more positive to consider how we could provide additional services that work for men on men’s own terms. This could be peer to peer support groups like AMC where men feel more at ease talking, or it could be men’s sheds or team sports, writing clubs, music clubs etc etc.
The focus on an activity can be very therapeutic, it doesn’t have to be about talking about feelings. Men will open up when they’re ready and when they’re in an environment that makes them feel comfortable.
I remember attending the Conferences on Male Psychology in 2017 and one of the speakers was Kevin Wright, a psychologist that dealt with patients with post traumatic stress disorder, often ex-servicemen. His trick was that instead of asking the men about how they felt, he asked them to tell him their stories.
When he asked about their feelings, often he would get blank responses but by telling their stories they found it much easier to verbalise, and the feelings flowed with the stories. Another trick in his arsenal was to get men to write a letter, maybe to a colleague who had died or to a partner. The purpose was not for the letter to ever be sent but for many men (and women), it’s easier to write about these things rather than talk about them. I’ve always been in that camp and I use this blog as a form of self help therapy for exactly this reason.
“Therapy for men and boys, as for any demographic, should be based on empathy and
respect for the identity of the client within the human spectrum. Therapy models that
take a positive and empathic view of masculinity are likely to be more attractive and more
effective for male clients than therapy models that take the critical stance that masculinity
itself requires reform and change. Of course, ‘masculinity’ in this context should not be
defined narrowly or rigidly, and the client’s own experience must be paramount, as with
all therapy.”
This is the really worrying issue for me about the state of modern therapeutic interventions. The industry has been completely hijacked by an extremely narrow perspective of male psychology that sees useful characteristics like stoicism and competitiveness (they call it aggression) as “the problem”. Someone starting from that perspective is never going to be able to offer genuine empathy to a male client. Worse than just not helping, they may actually make men feel even more lost and misunderstood.
Don’t believe me that this is the case? Take a look at the American Psychological Associations Guidelines for Psychological Practice with Men and Boys. It completely denies that any biological differences exist between men and women, therefore coming to the conclusion that masculinity itself is a social construct. In reality this is not a guide for treating men and boys, it’s a guide to intersectional feminism and is completely inadequate to support the adoption of therapeutic support for men.
“There are gender differences in the presentation of mental health problems. Taking depression, perhaps the most common diagnosis, as the primary example, there is strong evidence that men are more likely than women to express depressed mood indirectly through ‘acting out’ (e.g. aggression, risk-taking, alcohol or substance abuse) than through direct verbal means (Whitley, 2021). Using traditional clinical measures, men appear to have lower rates of depression, but this could be because they do not self-report their feelings in the same way.”
On occasions when I’ve brought up the issue of suicide, and particularly the number of men committing suicide, it often triggers a defensive reflex argument of “yes, but women try to kill themselves more” or “women self harm more” or “more women get depression”.
That argument really annoys me because it sees mental health issues as a competition or zero sum game where if we acknowledge men’s suffering, we’re taking something away from the recognition of women’s suffering.
It doesn’t have to be like that. I am always very careful to talk about “suicide” rather than “male suicide” because to me it does not matter, what chromosomes the person taking their own life has, every life is precious and suicide ripples right through the pond. One of the biggest indicators for suicide is having experience of suicide in your social circles.
One of my uncles committed suicide and I also lost a female friend to suicide in 2018 and both these events have had an impact on my life. It is important to understand some of the psychological differences between men and women on aggregate because the events that are more likely to trigger suicide and the best course of action for prevention can be different. Having said that, I think women too are also let down by the one size fits all approach for clinical intervention. I would love to see more peer to peer support groups for ladies too.
That’s a slight side rant, but in terms of the “more women have depression” or “more women self harm” or “more women attempt suicide” arguments, I think there is a flaw in that reasoning. How do we know when someone has self harmed, attempted suicide or has depression? We know when they present to a clinician. We also know that men are less likely to do that so in reality we have no idea how many men and women out there are struggling with depression and not presenting and when men present with anger or addiction, it can often mask the underlying cause so we treat it as an addiction instead of depression.
This is similar to the way that autism in women is under-diagnosed because women tend to be better at masking the symptoms. We need to get better at recognising that men and women will often present differently with the same underlying conditions so we can better treat the hidden problems behind the facades presented.
“Suicide risk is on average significantly higher in men. This means that psychological practitioners when assessing and formulating, need to be mindful of the potential and archetypal gender specific issues underlying these differences which may include: (a) relationship break-up (b) family breakdown and loss of access to children (c) loss of employment or the financial capacity to provide for/protect the family (d) shame about failures and loss of capacity to control events or provide for loved ones. In assessing suicide risk in men, it is important for psychological practitioners to look beyond the talk and verbal expression of the male client where shame might prevent a full disclosure of the extent of despair.”
I think this paragraph is the most crucial piece of advise for any mental health professional or doctor. If we want to prevent suicide, we need to recognise that relationship break-up, separation from children, loss of employment, debt or a sense of a loss of purpose are major risk factors for suicide with men and we need to make sure we sign post men to the right kind of services and support groups whenever these risk factors are identified.
Maybe we should be giving divorce solicitors cards for groups like Andy’s Mans Club? Maybe we should be reaching out to employers and stressing the importance of these factors and train mentors on how to provide mental health first aid? It shouldn’t be left down to occupational health, HR departments, or token employee assistance hotlines. We need to treat it the same way we do with first aiders and fire wardens.
“Some research suggests that in coping with distress, although women on average want to talk about their feelings, men on average would prefer to ‘fix the problem’ (Holloway et al., 2018). Men may prefer an active problem-focused approach where they are given specific information about strategies to improve mental health (Sagar-Ouriaghli et al., 2019). Men are more likely to be on the autistic spectrum and more likely to have attention deficit issues, both of which will impact communication (Chheda-Varma, 2019; van Wijngaarden-Cremers, 2019) This means that psychologists and psychological practitioners must be prepared to step outside the box in finding ways of attracting men into settings and approaches that might be good for their mental health. If talking therapies are ‘not the only fruit’, then traditional clinical interviews are not the only way of assessing mental health needs. Practitioner psychologists can help lead the way in using community approaches rather than traditional clinical settings to reach out to men who may be vulnerable, rather than waiting for them to seek help. This could involve connecting with men in places where they might feel less exposed, safer, more at home and more willing to talk.
Examples of such community settings where less formal assessments and gateways to help can be achieved are: Men’s Sheds, barbers/hairdressers, sports clubs, men’s support groups, fathers’ support groups, employment support groups, male-friendly helplines. There is some evidence that although most clients prefer one-to-one therapy, men like working in groups more than women do (Kiselica & Englar-Carlson, 2010; Liddon et al., 2019) and that male-only groups might work better for men than mixed-sex groups (Seager & Thümmel, 2009). These community approaches will often take an action-orientated approach, where men will engage in sports (Abotsie et al., 2020) or work together on a project (Morgan et al., 2007).”
You can’t always fix people’s problems but you can help equip people with finding practical steps they can take so that they don’t feel hopeless and helpless and that there is a path out of the current situation. It’s very important for men and women to feel useful and that they have a purpose in life and it can be very disorientating when something happens that makes them feel inadequate.
Talking therapies are one tool we have in the toolkit and for some men and women, they will help, but we need other tools too.
Men, on average, are less comfortable in clinical settings and we need to find ways to take the support out into the community. Andy’s Man Club does an excellent job with this using facilities like football stadiums that are already familiar and comfortable for men.
There’s nothing complicated in this set of guidelines and there are no magic bullets when it comes to mental health issues. The current environment makes for challenging times in terms of keeping up with demand and I think community led groups following these guidelines can play a critical role.
There will always be men and women that decide that life is not worth living and I think those numbers will always be higher amongst men because of the sex differences in terms of testosterone and it’s role in risk taking behaviour, but I would like to see less ripples in that pond, more lives saved and better services to support people suffering from mental health problems.
We can start by listening to men, even if the way they are communicating is not the way we would expect them to communicate. Empathy and compassion is key.
If you are interested in Male Psychology, I would also highly recommend the The Palgrave Handbook of Male Psychology and Mental Health. You can find the details here. It is expensive but Palgrave often have it on sale if you look out for offers.
Rant Over 