Hello and welcome to today’s episode of The Nice-ish Ramblings Podcast with me The Nice-ish Psychologist. Today’s episode is the fist in a two part discussion that centres on men’s mental health, and specifically the barriers to men accessing mental health support. However, both episodes have a central aim of thinking about the question of whether anyone cares about men’s mental health, the answer of which will hopefully be concluded at the end of episode two.
Before I go ahead, I just want to say that this episode discusses the topic of men’s mental health and touches on some discussion about suicide and other leading causes of men’s ill health and death. I am aware that I have no lived experience of poor physical health, mental illness, or suicide attempts, ideation or self-harm. I do try talk about this subject sensitively, but at times I do tend to some irreverence here and there. Mostly when I think things don’t add up. No disrespect is intended; but I am also trying to be quite factual about things. So, if if parts of this discussion are hard to hear, or you just don’t want to listen anymore, I don’t blame you.
The topic of this larger discussion developed from some very in-depth, behind the scenes conversations I had on my Instagram page following a powerful video posted by UFC fighter, Paddy “The Baddy” Pimblett. In the video, just after a fight, an emotional Paddy makes a very moving and public statement about the loss of a friend who took his own life. Paddy Pimblett makes a plea for men to reach out and to seek support. He states this: “There’s a stigma in this world that men can’t talk. Listen, if you’re a man and you’ve got weight on your shoulders and you think the only way you can solve it is by killing yourself, please speak to someone. Speak to anyone. People would rather - I know I’d rather me mate cry on me shoulder than go to his funeral next week. So please let’s get rid of this stigma, and men start talking”. This video went viral and was shared multiple times on my feed from high profile mental health advocates like Dr Alex George to perhaps slightly lesser known accounts and organisations like Andy’s Man Club.
Interestingly though, in another video where Paddy is at a news conference (I am assuming sometime after the fight) he goes on to say this: “Men just kill themselves and no one cares. We need to change it. There’s no funding for men’s mental health and it’s the biggest killer for men between, like, 21 and 45. And no one talks about it. No one even mentions it”.
Which, I am not going to lie, took me by surprise as I thought it was a really interesting take on the state of men’s mental health. I will admit, this isn’t the first time I had heard this kind of sentiment, but it was certainly the first time I had heard it outside of what is known as the “manosphere”. I will get into this in the second episode of this two part series.
I guess the thing that strikes me is this idea that men are almost left to suffer with their mental health because no one cares. And because no one cares there is no funding and therefore no access to mental health services for men, which means men’s mental health suffers and one of the consequences can be that they end up taking their life. These are obviously not the exact words that Paddy Pimblett said in that later news conference, but I feel like this was the inference. Perhaps an unintended inference, but an inference nonetheless. Which, again, struck me as curious as I had always understood that mental health services, specifically here in the UK where Paddy Pimblett is based, were un-gendered and that any and all mental health services that were available were available for all, including men.
So, I posted these sound bites and video clips onto my stories and asked for the views of my followers along with my own thoughts. And the massive discussion ensued. Honestly, I have never had so much engagement on a story before, which leads me to suspect there is a lot of interest on this particular viewpoint. As a consequence, my response to that discussion has been formatted into a more in-depth exploration of what Paddy Pimblett said. So, if any of my followers are listening know that this is all your fault, the fact that I’ve had to make this a podcast episode. Just so you know!
But before we continue, I just want to highlight that I have nothing against Paddy Pimblett for saying what he said. I hardly knew about the man before that video of him went viral. He is entitled to his views, and I am not having a go at him. In fact, I think it is fantastic that a role model like him spoke about men reaching out if they are in trouble. Cynics might say that the only reason he said anything was because a friend of his had died, and it may likely not have registered with Paddy Pimblett to say anything if that hadn’t happened. Which is a fair point, and is something to perhaps be considered later in the this overall discussion. But I guess the fact is that Paddy Pimblett said what he said, from what looked like a very emotionally vulnerable position, and it generated discussion and further awareness. That in itself is helpful. So, as I said, I am not having a go at Paddy Pimblett.
But what I am interested in, though, and what these episode are about, is the narrative around men’s mental healthcare, which is also ground within the context of men’s healthcare in general.
Now that we have cleared that up, let’s get into it. Let’s have a think about men’s mental health, what the barriers are to men accessing it, and look at the question of whether men’s mental health is cared about or not.
So, as with most things in the world that are complex and multifaceted, there is no one clear cut answer to the question I asked in my stories. Being a DBT therapist, I sometimes think in terms of dialects, that being that two opposing truths (or viewpoints, positions, arguments, etc.) can exist at once. A basic example of this being that some people see a glass as half empty while others might see a glass as half full. These are known as “either/or” positions in that the glass is either half empty or it is half full. Part of recognising or thinking about opposing views is to try and find the balance, or a synthesis of the two positions. This is also known as finding the middle path. A way of viewing things that honours the truth in both positions, known as a “both/and” position. So, with the glass example a dialectical synthesis would be that the glass is both half empty and half full. However, in life opposing views are never that neatly synthesised.
What does this have to do with men accessing mental health services? Well, it seems that with this topic there are the two opposing views. One being that due to social norms and ideas of masculinity, which create internal barriers for men in terms of help-seeking, men do not access mental health service. I will be honest, this is generally the view that I subscribe to, and I mentioned as much in my Instagram stories. And the other view being that there are more prevalent external barriers to men’s help-seeking behaviour and that mental health services can do more to help get men access services.
So, because I don’t have a full time job or a family to help look after, I thought we could explore both of these opposing views of the dialectic and see what they bring up. This first episode will look at men’s internal barrier to help-seeking. While the next episode will focus on the external barriers.
So, in my view, and that shared by some others who I discussed this with on my Instagram page, internal barriers to help-seeking for men relate to ideas of masculinity or what it means to be a man. In previous podcast episodes I have discussed these issues of masculinity: in episodes two and three of this podcast I explore the concepts of toxic masculinity (if you are comfortable with that phrase) and Man Box culture in more detail; so if you want further context to this please check out those episodes. But for the purposes of this specific aspect of today’s discussion I will refresh some of that here and will expand on how help-seeking is hindered by toxic masculinity/Man Box culture.
So, just to clarify, my understanding of toxic masculinity (or Man Box culture) is not that masculinity is toxic – no one is saying that. Except for maybe the people who are upset about the term because that’s what they think it says (Jordan Peterson I am looking at you, pal!). They are the only ones who are saying that. The conceptualisation of toxic masculinity is that there are certain “rules” of how to “be a man” that have evolved over time and have been passed down through generations and within cultures (and here, because it is the culture in which I exist and have more knowledge of, I refer specifically to the Western concept of manhood – although it is possible that some of these rules are present cross-culturally).
These “rules” outline what those who are socialised as men should and should not do. Masculinity is largely a social construct (built around some biological differences between men and women), therefore these “rules” are based on the idea of what a man should or should not be, and they can change (and have changed) at particular points in time and within a particular contexts. However, while these rules have changed, when they are at their most accepted by society and have become understood as societal norms (which is also known as hegemonic masculinity), these rules are pretty fixed and rigid.
When writing the episodes on toxic masculinity, I read a book called “Is Masculinity Toxic?” by Andrew Smiler in which he talked about the fact that there have been three predominant models of masculinity, as it were, and that we are currently in the third model, known as industrialised masculinity. This form of masculinity arose in the 20th century as a consequence of the capitalism, which sought to ensure that men focused on their job and very little else and is primarily how we as men (and literally every other person who lives in the West) are expected to function today. In his book, Smiler notes that we are entering into a fourth model of masculinity, which is why the current model of masculinity and what it means to be a man is being questioned and challenged.
In largely Western cultures these “rules” of manhood are things like: “men have control over women”, “men are heterosexual, hypsersexual, and sexually dominant”, “men are providers”, and “men are financially secure”. These rules have far reaching harmful societal consequences. For example, the rules of men having control over women and being hypersexual and sexually dominant result in the normalisation of sexist and misogynistic behaviour. Which, at it’s least consequential (which is still quite serious) can create uncomfortable situations for women at work, on the streets, or nights out where men can engage in persistent sexually harassing behaviour. And at it’s worst, can result in significant instances of physical and sexual violence, such as domestic abuse and rape. While rules such as men needing to be emotionally and physically tough, and to not show emotions, cuts us off from learning how to develop empathy, which increase our likelihood to engage in aggression and violence. Not only towards women and other gender groups and marginalised folk, but towards each other. This also takes various forms: from the common and everyday low level bullying that we like to call “banter”, to the fact that in 2021 in the UK 70% of homicide victims were male with 94% of those convicted of murder being male. I explore all of this in a bit more detail in episode three of my podcast, so go check that out there.
However, rules of the toxic masculinity and the Man Box that relate to the issue of help-seeking are things like: (again) “real men are physically and emotionally tough”, “real men don’t show emotions”, and “real men never ask for help.” These stringent rules, and the threat of being seen as less of a man, and - in the eyes of some - being seen as feminine or doing things what women do, ensure that we stick to these rules to our very detriment. It is these rules, and variations of it - “man up”, “boys don’t cry”, “don’ be a pussy” - is what results in men seeking less help in general. Not just for mental health support, but for all forms of health concerns.
At this point you might be wondering if men’s health is that poor, anyway? Like, are men dying younger or more ill? I guess one way to answer that is to highlight that in July 2022, the World Health Organisation published an overview of men’s health and well-being in Europe, stating in the opening lines of the report’s introduction: “In recent years, the health and well-being of men has received increasing attention in the WHO European Region. A key trigger for this attention is the high level of premature mortality among men, particularly in the eastern part of the Region. Life expectancy at birth in males in countries of the Region ranged from 64.7 to 81.2 years in 2016, while healthy life expectancy ranged from 58.7 to 72.4 years.”
The report highlights that that main causes of death for men in the European Region of the WHO were what’s known as non-communicable diseases, such as cardiovascular disease, cancers, diabetes, and respiratory diseases. The other highest cause of death was linked to mental ill health, including substance use and self-harm and suicide, noting that: “self-harm and suicide comprise a significant cause of death and disease burden among men in the Region (WHO, 2018a): 127,882 deaths were attributed to self-harm and suicide in 2015, equivalent to a crude rate of 14.1 deaths per 100,000 population, which is the highest rate among all WHO regions.” So, yeah, while the report states that men’s morality rates in the Europe are improving, there is still al lot of variation between countries, and that overall that state of men’s health is pretty dire.
Within the report’s introduction it also goes on to say: “The focus on men’s health has also been driven by a growing body of evidence that provides a better understanding of how gender intersects with social, economic, environmental, political and cultural determinants of health, influencing exposure to risk factors and interactions with health systems.”
Some risk factors related to men’s higher risk of ill health that I had not thought about too much are men’s general increased risk taking behaviour and the breadwinner role. In terms of risk taking, it was noted in the report that men are likely to demonstrate higher risk taking in terms of smoking, choosing poorer diets, and drinking. For example, one study from within the Russian Federation suggested that heavy drinking of strong spirits “elevates or maintains a man’s status in working-class social groups by facilitating access to power associated with the hegemonic ideal of the real working man”. Alongside this, there is also noted research which has shown that in most societies, “males are less abstemious (I had to look this up - it means to indulge moderately), and that men tend to be greater so-called big drinkers and cause more problems as a result of these intensive consumption patterns, factors that are considered a measure of masculinity.” So, basically, men see it as a badge of honour, or see it as a measure of “doing masculinity right” to consume excessive amount of alcohol.
In terms of breadwinning, a systematic review highlighted how being a male breadwinner can be a factor for myocardial infarction and chronic back pain, while another study found that men who adhered to the breadwinner model felt compelled to earn money and return to work soon after a heart attack. So, even the idea of being the primary income provider can bring with it a lot of stress - to the point where you can have a heart attack (which is what a myocardial infarction is), and that once you have had said heart attack you would want to get back to work as quickly as possible. Now, I am aware of how this ties into capitalism, and the link between capitalism and masculinity is beyond the scope of this episode, but can you see how this links back to the industrialised, stoic, competitive, dog-eat-dog version of masculinity that we are currently existing in.
What am I trying to say? I guess what I am trying to say is that men clearly have some health issues that are impacting on them, causing them to basically die earlier than women. And there seems to be growing body of evidence (I’ve only named a couple of things here, please do check out the full WHO overview if you are interested) to suggest that the way in which men choose to adhere to the rules of masculinity is impacting on their health outcomes. Basically the way in which men think, or rather have been told they need to live their lives is having a direct negative impact on the length of their lives.
Therefore, it’s not too much of a stretch to think that adherence to these rules of masculinity would also impact on men’s decisions to seek help, specifically around mental health difficulties. As mentioned earlier, these specific rules would be things like appearing physically and emotionally strong, not showing emotions, and not asking for help. The WHO overview goes on to note that an analysis of coping mechanisms show that men, more so than women, would tend to cope with their problems and dilemmas through addictions and ignoring the need for treatment, and that men would avoid asking for help or deny any state of discomfort as doing so would be considered as being weak or vulnerable.
Closer to home, in an article by The Guardian written in 2102 it was reported that men were only likely to visit the GP, which is a fist line contact point for mental health support, four times a year, while women would visit their GP on average six times a year. Similarly, men were likely to visit a pharmacy four times a year compared to women’s average of 18 times a year. The same article highlighted that nine in ten men did not want to trouble a doctor or pharmacist unless they had a serious problem, leading the article to conclude that “men aren’t taking full advantage of the support to maintain good health which is available free of charge on their doorstep.”
In terms of mental health care, it has been noted by the Mental Health Foundation website that only 36% of referrals to talking therapies are men. However, according to the Adult Substance Misuse Treatment Statistics report for 2019 to 2020, published by Public Health England, men made up over two-thirds of those accessing treatment for substances (including alcohol, opiates and non-opiates), which fits as we have just heard that men are more likely to use substances as a means of coping with their difficulties. So, they may be accessing a service of some kind, but it’s not necessarily guaranteed that the substance use treatment will focus on the mental health difficulties that precipitate or perpetuate the use of substances in the first instance. All of this, everything I have said up till this point, in a nutshell could be considered internal barriers to help-seeking, which develop as a consequence of these ideas of masculinity and what it means to be a man.
Now, I am aware that some who oppose the view that masculinity can have some bad or unhelpful parts to it view these internal barriers to help-seeking as victim-blaming. That is, they think that by saying that elements of masculinity create internal barriers for men this is somehow men’s fault. And the answer to this is a bit yes and no, too. Do men have some agency over whether they adhere to and subscribe to the rule of manhood that limit their opportunities to accessing health care? Well, yes. I mean, if a man is ill it just makes sense that he goes to the GP to get himself checked out. That is not really anyone else’s responsibility. At the same time, the messages that men have been fed from society and internalised (like those previously mentioned) they didn’t ask to be told, to be received. We are all products of our environment and the cultures in which we grow up – and if the rules of that society and culture are that you do x, y, and z, well, then generally you end up doing x, y, and z. So, if a man has received multiple messages from multiple sources that men should always be strong and that to show weakness is unmanly, then it’s not really a man’s fault that he does not want to show any signs of weakness because he may then be viewed as being less of a man. And ultimately, this entire conversation is not about assigning blame – it’s about looking at what some of the barriers to help-seeking might be, where they come from, and if we can understand the societal messages and see how damaging they can be for men and men’s physical and mental health, then perhaps we can start to challenge and change those messages.
There we go, that it. That’s a bit of a whistle stop tour on this part of the dialectic. On this part of the views around men’s mental health. It might feel short, but as I have said, I have discussed some of these points in further detail in other podcast episodes. So, if you want you can always go and listen to those when you are finished here. Some cynics might think I am plugging my own work.. and you would not be wrong, my friend! In the next episode, I will look a bit more external, to the other side of the dialect and explore the external barriers to men’s help-seeking, and also to answering the question of whether men’s mental health is cared about.
If you have enjoyed this episode, please rate it and leave a comment wherever you’re listening. And, if you think that someone else might benefit from hearing my bullshit, please recommend it or share it on social media. As always, I am happy to hear from any of you, so please come find me on Instagram and say hi. As always, have a great day. Or not. No pressure. Bye for now.
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Watch:
14: Men's Mental Health - Who Cares? Part 1