Acceptance of a mental health problem is one of the most critical and difficult stages of recovery. In my book, Acceptance of Mental Illness: Promoting Recovery Across Cultural Groups, I use acceptance to refer to the process of recognizing and actively managing a mental health problem. One of my research findings is that the process of acceptance is particularly affected by gender. In my last post, I described the unique experiences of women in the acceptance process. In this post, I describe the obstacles men overcome to accept a mental health problem.
1. Hegemonic masculinity. One of the central obstacles men overcome in order to accept a mental health problem is hegemonic masculinity. This refers to the pressure men feel to conform to traditional gender norms such as toughness, fearlessness, and invulnerability to pain. Men I interviewed described suffering in silence because a mental health problem might be a sign of weakness or vulnerability. One of the women I interviewed spoke to this gender difference: “Sometimes I think it’s easier for women to have mental illness than men ‘cause at least we’re used to being told we can cry and we can be emotional… I can’t imagine being a man and having so much bottled up. I don’t know how they’re living and walking.”
Men navigated these rigid notions of masculinity by working within the confines of traditional gender socialization. One man I interviewed described his version of acceptance: “I have a symptom, and I'm going to go through life with this symptom. I’m going to make the best out of it, and I'm just going to roll with it.” Like this participant, men worked within pressures of traditional masculinity by constructing acceptance as a sign of courage, strength, and flexibility.
2. Help-seeking avoidance. Another key mental health challenge to acceptance involves men’s socialization to avoid help. Seeking help through professional means or peer support can foster acknowledgement and understanding of a mental health problem. I read stories describing the physical pressures of hegemonic masculinity (Charmaz, 1995; Courtenay, 2000), including prisoners who belittled inmates who sought medical treatment for pain. Or a man with diabetes in a wheelchair who skipped lunch rather than get help with a cafeteria tray, risking coma. Or, an executive who took great efforts to conceal his dialysis appointments to employees to avoid being seen as weak.
On the other hand, many men overcame help-seeking avoidance by resisting rigid notions of masculinity and engaging in treatment. At times this involved the recruitment of women into their care. Women sometimes act as health mediators to men in managing their mental and physical wellbeing, helping them to detect and respond to the symptoms they may ignore. Women can give permission to accept professional help when needed in the face of these rigid gender norms.
3. Emotional suppression. In my research, I found that men may be conditioned to dismiss and repress emotions that are integral to recognizing and responding to a mental health problem. I’ll never forget running an anger management group at a veteran’s hospital and my initial fear about whether people would come. I was shocked when I saw a room packed to the brim - all the men in the unit had come to the group. I learned that anger was one of the few difficult emotions that was socially appropriate for men to express. Painful feelings might be funneled through anger, rather than manifesting as sadness or loss. Alternatively, the conditioning to repress emotions can be surmounted through accepting and expressing feelings, supporting acceptance of the mental health problem through which these emotions may take shape.
4. Substance abuse. What happens when emotional expression is constrained by gender? Substance abuse can become a way to numb the pain. One man I interviewed spoke to converting his pain into substance abuse: “I was just feeling like crap, so I picked up the bottle and started drinking.” After drinking 40 or 50 beers, he was rushed to the hospital, where the mental illness he had tried to drown out was acknowledged and attended to. Many men overcome this obstacle to acceptance through addiction recovery, where they may find valuable sources of social support and a space where denial is actively overcome.
5. Destructive health behaviors. In my research on men and mental illness, I was shocked to learn about the ways in which we have taken for granted something as major as the difference in average age of death between men and women. Courtenay (2000) attributed this to issues as dramatic as the aforementioned addiction or homicide, to health behaviors as seemingly trivial as seat belt use. “Left unquestioned,” he argued, “men's shorter life span is often presumed to be natural and inevitable” (p. 1387).
One of the men I interviewed spoke to mental health nature of this problem: “"If I believe I don't have an issue, then I won't take my medicine... I think if I don't accept it, then I won't do what I need to do for my health." Self-care and healthy intervention can serve as alternatives to these barriers to the acceptance of a mental health problem.
Overall, it is incredible that men facing these obstacles to acceptance are able to overcome them. It is important to remember in these discussions of gender, that differences can abound across men with different racial-ethnic, sexual, and gender diverse identities. Discussions of gender differences between men and women risk essentialist and binary categorizations of gender. We can understand the social construction of gender as a category that privileges those identified as men but also comes with a number of challenges and losses. To put it plainly, traditional gender categories can be toxic to everyone. Developing more fluid notions of gender categories, like masculinity, can be a healthy direction for the mental health and acceptance process of all.
Charmaz, K., 1995. Identity dilemmas of chronically ill men. In: Sabo, D., Gordon, D.F. (Eds.), Men's Health and Illness: Gender, Power and the Body. Sage Publications,
Thousand Oaks, CA, pp. 266-291.
Courtenay, W. J. (2000). Constructions of masculinity and their influence on men's well-being: A theory of gender and health. Social Science & Medicine, 50, 1385-1401.
Mizock, L., & Russinova, Z. (2016). Acceptance of mental illness: Promoting recovery among culturally diverse groups. Oxford University Press. (Save 30% with promo code ASPROMP8)