Rethinking Masculinity

By Lisa R. Rhodes

September 2024

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Men who experience psychological challenges are more likely to try to endure their symptoms — without seeking treatment. Nearly 1 in 10 men have depression or anxiety, but less than half will receive professional help, according to the Anxiety and Depression Association of America.

Data from the Centers for Disease Control and Prevention also found that nearly 80% of deaths by suicide were men in 2021, despite them making up only half of the U.S. population.

In addition to experiencing depression, anxiety and suicidal ideation, men may also have substance use disorders, says Suzy Wise, PhD, LPC, associate professor in the psychology department at Valparaiso University in Indiana. Men’s mental health symptoms can include gastrointestinal pain or discomfort, irritability, trouble concentrating and panic attacks masked as heart issues.

Public awareness and outreach campaigns — which have included Olympic gold-medalist swimmer Michael Phelps and actor Dwayne “The Rock” Johnson sharing their experiences — have aimed to educate men about the need to recognize mental health issues and the value of seeking treatment. But many men continue to suffer and not seek help because of stigma, Wise says.

“Stigma is still very much a thing, and its influence on men may be greater than on women,” says Wise, whose research areas include men and masculinities. “Social norms still discourage men from actively and verbally seeking help or talking about mental health issues as common everyday topics.”

Counselors who treat men for mental health disorders say these social norms are based on patriarchy and gender-specific expectations. “The ultimate betrayal for many men is that the pursuit of the things that patriarchal society says they’re supposed to pursue to be happy and successful are the exact things that cause them harm,” says Matt Englar-Carlson, PhD, professor of counseling at California State University at Fullerton.

The traditional masculine ideal for men to chase careers that offer status so they can attain expensive clothes and cars and attractive female partners leaves many men disappointed and empty, Englar-Carlson adds. “When you reach the pinnacle, you realize you’re all alone and you’re unhappy,” he says.

Masculine Norms

Men’s reluctance to acknowledge and seek treatment for mental health disorders can be traced back to how they are socialized to fulfill gender-specific expectations and masculine norms that discourage emotional sensitivity, regardless of the cost.

Wise says Western societies prize traits such as ambition, independence, individualism, stoicism, leadership, competition, assertiveness, achievement, confidence, problem-solving, material success, strength and direct communication. Although these traits are not specific to any gender, men have traditionally been expected “to embody them to a consistent and persistent degree,” Wise explains, noting that men are “often placed on a dichotomous scale” that measures the degree of their success or failure in living out these expectations.

Jimmy Hill, LPC, founder and co-owner of the Trailhead Treatment Center PLLC, in Knoxville, Tennessee, points to research on masculine norms, specifically the “Development of the Conformity to Masculine Norms Inventory,” published in Psychology of Men & Masculinity in 2003. In this article, the authors named 11 distinct masculine norms — winning, emotional control, risk-taking, violence, playboy, self-reliance, dominance, primacy of work, heterosexual self-presentation, power over women and pursuit of status — and discussed how to assess men’s conformity to these norms.

The practice of being measured and judged for how well one adheres to gender-specific roles and masculine norms can be harmful to men’s mental, physical and spiritual health. Wise says men who fall short of these ideals might struggle with workaholism, suppression, internalization, recklessness, avoidance and chronic stress. Wise also notes that restrictions on expressing vulnerability and the power of stigma can cause these struggles to manifest into serious mental and physical outcomes.

Yet, despite the painful consequences, men and women — who have also been wounded and oppressed by masculine norms — uphold the system of gender-specific expectations. “Gender role-specific expectations are socially learned and replicated from generation to generation,” says Wise, co-author of the article “The Effects of Gender Socialization on Boys and Men,” published in Counseling Today in June 2022. “Despite notable progress in attempts to break down these patterns over the past few decades and some improvement in balancing opportunity, the persistence of these patterns is strong.”

Rene Garcia, owner of Garcia Mental Health LLC in Plano, Texas, says in Latino cultures, the patriarchal ideal of machismo “is still a driving force in the emotional development of Latino men.” Machismo is “a set of rules and expectations placed onto Latino men from established and trusted social norms in their community,” Garcia explains. This set of gender rules encourages men to “go to work, make money and come home to be cared for by their wives, female family members or partners.”

The ideal “allows men to remain in positions of power,” primarily over their families and households, says Garcia, who specializes in men’s mental health. But he notes the effort men make to maintain their status strains their most intimate relationships with women and their children.

Solitude and Suicide

Male adolescents and young male adults are often negatively affected by gender-specific expectations in their inability to connect to others and the difficulty they have coping with stressors that can lead them to suicide.

Hill, whose practice specializes in men’s mental health, says masculine norms can prevent boys as young as three or four from voicing feelings of sadness or fear. These youngsters often become “stunted emotionally,” he notes. Boys quickly learn that society expects men to show only toughness.

A 2018 study of U.S. adolescents and gender equity, published by Plan International, found that 41% of boys say society expects them to be aggressive or violent when they feel angry, while 35% say they are expected to do nothing, keep quiet and “suck it up and be a man.”

Male teens learn to “fear judgment and ridicule from peers if they show vulnerability,” adds Englar-Carlson, co-director of the Center for Boys and Men at California State University at Fullerton.

Boys are also taught to be competitive with each other from an early age. This stifles young men from developing equitable, close relationships and puts men and boys in a “one up” and “one down” position where they often feel either superior or inferior to others, Hill says.

Garcia agrees. “Culturally, we are in an ‘Alphaverse,’ where men are fighting amongst each other to be the ‘top dog,’” he says. “I tend to see the aftermath in my therapy room when I meet men who are broken and are trying to survive, while at the same time trying to find themselves.”

Young adults in the armed forces are trained to exemplify positive core values, but they also are expected to follow an ethos that reinforces patriarchal ideals. Duane France, LPC, co-director of the U.S. Substance Abuse and Mental Health Services Administration’s Service Members, Veterans and their Families Technical Assistance Center, says recruits are taught in basic training to transition from an individualistic society to an interconnected collective that cherishes duty, integrity, ethics, courage, honor and loyalty. Recruits are taught that they must not let the team down or leave a comrade behind on the battlefield.

But military culture also requires that no one be a “weak link” in the chain of command. Service members are taught that “the chain is only as strong as the weakest link,” says France, a retired Army noncommissioned officer.

The military is “an inherently dangerous occupation,” he adds, where people are expected to perform at their best. The stigma of showing weakness is reflected in the military’s concern about the suicide rate among young male service members. According to the Department of Defense, the majority of service members who died by suicide in 2022 were enlisted (91%), male (93%), white (72%) and under the age of 30 (68%).

The Mental Health of Black Men and Boys

Statistics show that suicide rates among Black youth have risen faster than in any other racial/ethnic group in the past two decades, with suicide rates for Black males ages 10 to 19 increasing by 60%, according to the American Academy of Child and Adolescent Psychiatry.

Social and economic inequalities, stigma and lack of access to mental health treatment contribute to the rise in suicide among Black male youth, says Tasnim Sulaiman, LPC, founder and CEO of Black Men Heal, a grassroots nonprofit that provides free mental health services for men of color.

Too often, Black men strive to meet society’s ideals for success and social and economic status, but it is not without “psychological and emotional consequences,” says James L. Moore III, PhD, Education and Human Ecology Distinguished Professor of Urban Education and executive director of the Todd Anthony Bell National Resource Center on the African American Male at Ohio State University.

Popular images frequently depict Black men and boys in a negative light, which impedes their progress and causes them to “experience psychological and emotional turmoil in ways that other men do not,” explains Moore, a longtime counselor educator and ACA Fellow.

Black males are more likely than other males to be the victim of police brutality. And when they are not able to find the right coping mechanisms to deal with societal pressures, they may sometimes “self-destruct,” he notes.

Mark Raspberry, LCPC, a counselor at the Sheppard Pratt outpatient mental health center in Frederick, Maryland, says systemic racism is at the root of many of the mental health issues that affect Black men and boys, as well as Black and Indigenous people as a whole. The impact of intergenerational trauma cannot be ignored, he adds.

“We need to understand the impact of racism in America and how it stigmatizes and traumatizes,” Raspberry explains. One step forward is to consider efforts to reconcile with communities that have been marginalized by racism and scarred by trauma.

Men-Centered Therapy

When men do seek counseling, Hill says it is usually because their partners or family have urged them to do so — or because they are in crisis.

Englar-Carlson, co-editor of the ACA book A Counselor’s Guide to Working with Men, says when men seek treatment, the professionals they meet may be hindered by their own acceptance of traditional masculine ideals and their lack of exposure to gender-sensitive therapeutic approaches to treat male clients.

The article “Men and Mental Health: What Are We Missing,” published by the American Association of Medical Colleges in April, restates this concern, reporting that research has found that “mental health providers may miss or misdiagnose psychological problems in men because of their own gender biases.”

Here is some advice on ways counseling programs and clinicians can help reduce counselor bias and ensure they are using therapeutic interventions that are effective for men: 

• Biases are an important concern for mental health clinicians “simply because we are human,” Garcia says. And the possibility of countertransference is why the counseling profession needs to train new clinicians about natural biases, he adds.  
• Increased research and funding to study male-specific mental health issues and to develop evidence-based practices are essential in counseling, Englar-Carlson says. He suggests counseling programs revise curricula to include comprehensive training on men’s mental health. 
• France says counselors who have an interest in treating male military personnel and veterans should examine ACA’s Exemplary Practices for Military Populations to develop the cultural humility to understand the uniqueness of the military as an institution. 
• Hill and Wise recommend therapeutic interventions such as internal family systems, Gestalt therapy and narrative therapy for approaches that work well for male clients.

Proper Preparation

Counselors can play a critical role in helping male clients understand that if they stop adhering to the traditional notions of “what a man is supposed to be” they can focus more on who they actually are, Wise says. And they can “develop a greater range of emotional expression, a willingness to be vulnerable and a willingness to ask for help when necessary.”

The proper preparation of clinicians is central to ensuring that men receive the quality care they need and deserve. “Training counselors to see through societal stereotypes and take a closer look at the client in front of them will help to accurately assess their client’s concerns, select appropriate diagnoses and employ strengths-based strategies and treatment options,” Wise says.

DISCLAIMER

Opinions expressed and statements made in this magazine by the article authors or those quoted within articles do not necessarily represent the opinions of the editors or policies of the American Counseling Association.