Why the APA Guidelines for Men's Mental Health Are Misguided

New practice guidelines fail miserably by framing masculinity as a pathology.

Posted Feb 25, 2019

The American Psychological Association (APA) recently released its ‘Guidelines for Psychological Practice with Boys and Men’ in a 31-page document. Any new initiatives on this topic should be welcome, as there is a desperate need for action and innovation to address the men's mental health crisis.

This crisis takes various forms. First, men make up around 75% of completed suicides, with around 100 American men dying by suicide everyday. Second, men make up the vast majority of Substance Use Disorder cases, with high rates of drug and alcohol addiction. Third, men tend to under-utilize mental health services during periods of psychological distress, and are much more likely to suffer in silence.

All this is very worrying, and men’s mental health activists are demanding concerted action to address these issues. The APA guidelines are part of ongoing efforts to equip psychologists to better engage men in mental health treatment and foster their recovery.

Sadly, the document fails miserably, and is a wasted opportunity to improve the mental health of men and boys. In fact, it may even make things worse.

What do the guidelines say?

First off, the document is written in pedantic and pretentious prose. The 31-pages starts with a long-winded jargon-laden introduction, followed by 10 dense and nebulous ‘guidelines’ that do not provide clear and concise advice for practicing psychologists.

Instead, the guidelines include rambling tongue-twisters such as ‘psychologists strive to recognize that masculinities are constructed based on social, cultural, and contextual norms’ and ‘psychologists strive to recognize that boys and men integrate multiple aspects to their social identities across the lifespan’.

Indeed, the whole document is wordy and verbose, impenetrable to the average psychologist who is interested in learning new techniques and approaches to help male clients.

Clinical guidelines should be clear statements that can be easily digested and implemented by busy clinicians. For example, the Canadian Network for Mood and Anxiety Treatments (CANMAT) have produced clinical guidelines for psychiatrists. These include simple yet valuable bullet-points such as ‘support education and self-management’, ‘establish a therapeutic alliance’ and ‘engage the patient as a partner to determine treatment goals’.

These CANMAT guidelines are now considered a gold standard with good reason. They are clear, concise and practical, a far cry from the APA’s cumbersome and unwieldy approach.

An ideological document

Relatedly, clinical guidelines should be driven by the best available scientific evidence rather than social ideologies. This is especially so in fields such as psychiatry, which have been historically tainted by political abuse. For example, Soviet psychiatrists invented a fake category of mental illness named ‘sluggish schizophrenia’ which was used to label and confine anti-communist political dissidents.

Sadly, the APA document appears to be driven by a similarly ideological approach in its continuous pathologization of ‘traditional masculinity’, while ignoring considerable evidence that aspects of traditional masculinity can be beneficial for men’s mental health.

For example, the document states early on that ‘conforming to traditional masculinity ideology (sic) has been shown to limit males’ psychological development…and negatively influence mental health’. Listed among the traits of such ‘traditional masculinity’ are factors including ‘achievement’, ‘adventure’, ‘risk’, and ‘success, power and competition’.

Such statements are bizarre given that achievement, success, adventure and risk have been associated with positive mental health in various studies. For example, much epidemiological evidence suggests that people who are graduates, employed and happily married tend to have better mental health than people who are school drop-outs, unemployed and single.

Cognitive Behavioural Therapy

Indeed, such knowledge is the basis for much cognitive-behavioral therapy. In CBT, clinicians often encourage clients to be adventurous and take risks. This can involve controlled exposure to anxiety-provoking situations to conquer incapacitating phobias such as fear of public speaking.

CBT can also facilitate goal-setting and skill-acquisition, for example progressively learning new skills to obtain a better job. This can result in achievement and success when done correctly, which has consistently been shown to benefit psychological resiliency.

The APA puzzlingly chose to ignore this well-known evidence, which is instinctively recognized by the general public as important for mental health, as illustrated in the short vox-pop video below.

An alternative approach

Some years ago, I wrote an academic article arguing that any critique should be counter-balanced by the detailing of solutions and proposals for change- what I call ‘no opposition without proposition’.

Thus, I propose 10 alternative ‘guidelines’ for psychological practice with men and boys below. It is important to say that these proposed alternatives have not been scientifically validated and are simply the product of my individual reflections on the scientific literature. But they can at least provoke thought and prompt further discussion. These are:

1. Do not jump to conclusions based on appearance, mannerisms or attire.

2. Every man has his own story to tell. Listen and learn.

3. Remember there is no ‘one-size-fits-all’ solution in men’s mental health.

4. Note that there are different modalities of healing; talk therapy is just one.

5. Men often prefer action-based healing over talk-based therapies. Work with this.

6. Do offer a choice of interventions tailored to individual circumstance.

7. Such choices could include exercise, peer-support groups and self-help.

8. Encourage goal-planning and skill-acquisition to foster a sense of achievement and success.

9. Offer specific supports during difficult life transitions such as divorce.

10. Help men access social or community supports that can foster resilience.

Conclusion

One of the few upsides of the rambling academese of the APA’s guidelines is that few men with mental health issues will actually get past page 1. Neither will many busy practicing psychologists.

Perhaps the only other upside of this document is that it has galvanized an intense response from a whole swathe of society including academics, journalists, political commentators, and the public as a whole.

The general consensus is that this document completely misses the mark, and that radical reform and innovation is necessary to help solve the men’s mental health crisis.

APA, take note.