Masculine Mental Health

I recently returned from a two week trip to Malta, small Mediterranean island off of the boot of Sicily, where my grandmother was born and raised, and I have relatives still living in the country. It struck me, as my oldest son and myself walked in the town Throughout the days was the cluster of men that start the day together, sitting in the plaza or looking out at the water, strolling, having lunch, perhaps enjoying a cappuccino at days end. It is a palpable feeling, the male friendships and the agent of it all. Old men, laughing on a bench, telling stories, that I can only assume have known each other for many decades, if not their entire lives. The warmth and joviality was something to behold. I witnessed the opposite of isolation.

Malta, as a small side note, has the third youngest median age in the EU - a suggestion that family life is thriving and communities are supported. 

The psychology and social work profession is virtually male-free. 

Current educational pipelines reveal male mental health providers at just 20% in psychology and 12% in social work. 

To my female clinician cohorts, I ask, how do you reach out to males in your community? 

How can we better understand masculine psychology and incorporate it into meaningful therapy outcomes?

Men have higher unemployment, daily marijuana usage, suicide and addiction rates, and with boys falling behind at twice the rate as girls in lower schools, it is incumbent upon clinicians to tap into a deeper understanding (authentically) and appreciation of the male perspective to be effective in a counseling environment.

We have done a superb job of increasing female college attendance in most areas including targeted STEM fields with direct messaging such as "The Future is Female," (a 1970's slogan, revived in the 2010's, by Sally Miller, who advocated that the males should be reduced to less than 10% of the population), "nevertheless, she persisted," and "Girlboss," resulting in female enrollment surpassing males in advanced degrees, including both law school and medical school. In 2020, the CDC rolled out the Hear Her awareness campaign to reduce maternal deaths by  educating women on serious health concerns but more importantly, teaching physicians on the artistry of hearing women. The campaign boasts of 400 million visitors to their website, bravo! Certainly, elevating female health should not, and does not detract from male needs and the nuance special language - or does it?

The only tagline that I’ve heard trend towards men in the last decade has been "toxic masculinity," not exactly favorable messaging.

In a field such as mine where women practitioners dominate, I encourage a special sensitivity and awareness around uniquely male vulnerabilities which often become problematic and drive men into therapy: pornography, sexual desire, anger management, gambling and criminal activity, lifestyle potholes that women seem to inherently bypass.

New areas of concern in recent years have been the loss of male role definitions in the dating game and the fear of false allegations on campuses that heavily tilt towards the female. Moreover, looming on the horizon is the AI model for romance, which will undoubtedly be more appealing to males than females, further maintaining the growing division between the sexes.

Men typically enter therapy with a fear of being characterized as the problem. The talk-therapy model is hyper-verbal, favoring the female brain, and the lingo is its own brand, often feminized. Men can become easily flooded, a counterproductive process unless both therapist and client establish a shared language. For therapists like myself working with couple's in conflict, re-interpreting the position of each party and pumping the emotion brakes at crucial moments will avoid male client's tuning out or feeling unheard.

Men may resist entering therapy out of concern that their political values will be dismissed by what they assume are left-leaning or liberal therapist types. Additionally, faithful or conservative males may assume they will not be understood for their core values. Research published in Behavioral and Brain Sciences found that mental health professionals are more politically liberal than the general population. In a survey of over 800 mental health professionals, 68% identified as liberal or very liberal, compared to 26% moderate and only 6% conservative.

It is critical that a therapist set his or her political leanings aside and center the patient’s world view as a baseline of respect.

A common complaint in my office, working with hundreds of couples over the past 30 years, is something like, "He is harsh with our kids," or "He is so angry." A simple psychoeducational explanation is useful for each spouse to grasp the sex evolutionary drivers. It actually helps to learn that men and women are different - Men Are From Mars, Women Are From Venus (1998) brought a lot of comfort to the sexes. Denying our differences does not bring comfort; "happy wife, happy life" is catchy but harrowing, and in fact creates a marital malaise. In our effort to champion equality, we have stifled the sweetest differences. 

We shouldn't be destined to swing from one extreme to the other. Yet, as the social currency of everyday men is devalued, the adoration of horrifically misogynistic men like Andrew Tate fill the void. 

Robert Bly, in Iron Man (1990), explored the Western "soft" male passivity that occurred in the 1970's, perhaps refreshing after the 1950's emotionally-isolated male. 

The 70's might be defined as a coming of age for psychology; a synthesis of feminist psychology, the women's movement, and transformative groups like EST that encouraged emotional release and breakdown. Bly's interpretation that mentorship, fatherly guidance and sexual energy had been muted as male initiations, rituals and social value were lost in the shuffle. Mature masculinity requires clean fighting, clear boundaries, and most importantly, the notion that women cannot replace the camaraderie provided by men. 

As journalist Sebastian Junger, embedded with U.S. troops in Afghanistan, outlines in his book, Tribe (2016), war time brotherhood proves to offer great psychological well-being, a sense of community and purpose. 

If the communal scaffolding is not in place to support the necessary mail, is therapy able to take its place? I believe the sense of camaraderie that is simulated so naturally can be seen and the Los Angeles Homeboy industries gang rehabilitation program. The remarkable program is to observe, male support and comfort at its best, it is modeled, permitted, and promoted. 

Oftentimes the best therapeutic direction I can give a man in my practice is to inquire about the men in his life that have been confidantes. With consistently positive feedback, I often suggest a client make contact with another male that has meant something to them in the past, even if now distant -  a pastor, brother, coach - is likely to offer an open-arms reception, furthering the drum circle of meaning and engagement. Reconciliations with men from their past are typically psychologically healing.

Familiarizing ourselves with the "lived experience" of one half of the world's sex will better inform our skill-set in the counseling environment. Three real-life examples used as a litmus test for the female counselor to equip herself with heroic masculinity are societal events with a heavy impact: every firefighter that went into the burning towers on 9/11 were male. And when a shooter went into the Aurora, Colorado theater and opened fire, killing 12 people, four of them were men who willingly, in a visceral split second, made the ultimate sacrifice by shielding their girlfriends with their own bodies. Finally, as Russia invaded Ukraine, I watched the news feed for several hours straight as Ukrainian men lined up to leave for frontline combat, with an imprecise current death toll estimated to be 46,000-80,000.  The women and children were on buses, tearfully looking through the windows as their men left for war.

A couple of years ago, I was sitting in a crowded airport terminal when a small child, about 4 years old, began crying. After a few minutes, several of us looked around and realized this child was walking unattended. As we all became alerted to a lost child, and simultaneously positive the parent would quickly present themselves, just then, the child wandered into the men's bathroom. I was aghast, but still hopeful that a parent would come around the corner frantically searching, but instead, again, in an instant, a man came out of the men's restroom holding the child, a stranger's child. Why should anything different happen? To everyone's relief, Mom ran up just at that moment, shaky and grateful. The sexism of low expectations, or worse, had those of us in the airport imagining the worst case scenario.

 

I advise new counselors entering the field to self-check for gender bias and navigate a deep dive into Michael Gurian as I have (attend a workshop) or catch up on the social project of George The Tinmen. 

Professions that course-correct are healthy and trustworthy; therapists are curious and compassionate by nature.

Robert A. Johnson, a Jungian analyst and author of He (1974), asserted that true masculinity involves integrating feeling, compassion, and integrity - the very aim of sound clinical efforts and the kind of work that counselors expertly midwife.

Perhaps the mental health field will create a campaign to attract males to a rewarding career in counseling, e.g., nursing experienced a 4-fold increase in the 80's with a successful targeted recruitment to increase the male nursing workforce. 

Until then, it is left to the front-line women to deepen their knowledge of masculine psychology. 

I hope they will come to delight in the masculine mind.