Constraints in men’s health

Similar assumptions about social and health expectations of gender impact men’s health. Unfortunately, many of these expectations privilege stereotypical depictions of masculine identity and therefore aid in poor health decision making. Men are half as likely to seek medical attention as women’2 and are considerably more likely to delay help-seeking for concerns related to reproductive health.” This framework is particularly challenging when coupled with factors that impact the outcomes of illness experiences such as race, ethnicity, socioeconomic class,34 and the performance of masculinity.35

Though men define health differently, there are significant commonalities in terms of what constitutes a “healthy man.” For instance, Black men may define health and masculinity in terms of social roles. ’6 Hooker et al. found that Black men, considered the following attributes as “manly”: leading a family/household, being a provider, having a strong work ethic, and having a masculine physique. The men also identified a “typical man” as being responsible, principled, and of good character.3 Therefore, an unhealthy or an unwell man is perceived as one who cannot perform these roles. As a result, Black men are reluctant to admit that they are unwell or seek medical assistance because this would indicate that they have failed at fulfilling the role of the “manly man.”

Relatedly, while the experiences of male-identifying patients are varied, a cross-cultural analysis of experiences reveals several common themes, such as a delay in seeking medical help, fear of the loss of the masculine identity, and loss of control. In Australia, patients revealed that their idealized constructions of masculinity were challenged as they moved through the diagnosis and treatment stages for prostate cancer.38 In other studies, male patients stated that they were often reluctant to disclose illnesses for fear of being viewed differently by their peers39 and when they had to, used humor to dispel tension and elicit sympathy.4" For research participants in the United Kingdom, cancer also caused an uncomfortable sense of vulnerability41 and embarrassment that threatened the cultural characteristic of strength associated with men.42 The threat of being perceived as weak, inadequate, out of control, incapable of providing for one’s family, and lacking in resilience or self-reliance are prominent causes for the delay in seeking and accessing health care. As was observed in Malawi,43 South Africa,44 and Zimbabwe,4’ the delay in seeking help is compounded by a fear of being associated with stigmatized illnesses, such as HIV/AIDS and tuberculosis.46

Men and mental health

Mental health is another gendered health experience that profoundly impacts personal identities, relationships, and performance in society. The social implications are acute, and in some instances fatal, when stigmatized mental illness is revealed. While heterosexual cisgender women and members of the LGBTQ community also encounter challenges with mental health, heterosexual cisgender men in particular face social obstacles in identifying, acknowledging, and treating mental illness. More significant for men is the overwhelming silence and shame that surround men’s struggles with mental health. In India, men with schizophrenia endure ridicule and shame and live in fear of losing their job if their diagnosis is revealed. These men engage in self-silencing because once the diagnosis is public, they also risk losing both their immediate and extended family.4' Black men in the United States with depression exemplify the compounding relationship that race, gender, and sociocultural background has with health. Daily, insidious, personal and institutional racism, and prejudice are cultural experiences in the United States that heavily affect the social performance of Black men,48 the roles they play in the family as mentioned earlier,49 and ultimately, their health.

Masculine expressions of underlying emotional distress and mental illness come in various forms and include “acting out” behaviors’0 such as, substance abuse, gambling, physical violence, sexual risk, anger, emotional stoicism, workaholism, and social isolation.’1 Many men mask their psychological distress and go under the radar especially if they work in a highly masculine environment, as a study on farmers in Australia revealed.’2 In fact, for Muslim American men, cultural distrust, cultural beliefs about mental health, the threat of imposed isolation from their cultural and religious community, and a distrust of the medical system prevent them from reaching out for medical help.”

Emotional containment and reticence are common coping choices among men struggling with mental illness. High-profile news stories, such as the suicides of actor Robin Williams,’4 television host Chef Anthony Bourdain,” and grunge musician Chris Cornell,’6 have highlighted that men struggle silently and unsuccessfully with mental illness. In writing about his anxiety and panic attacks, Kevin Love, a Cleveland Cavaliers player in the National Basketball Association League in the United States, stated that when he was younger, he learned the appropriate behavior norms for a boy: “You learn what it takes to ‘be a man.’ Its like a playbook: Be strong. Don’t talk about your feelings. Get through it on your oum’'”' His remarks echo research that has found that men are not used to talking about personal or family health on a day-to-day basis.’8 Nevertheless, Love’s story demonstrates that there is a slow, but increasingly open, conversation about mental illness and men. For example, Olympic swimmer Michael Phelps has publicly disclosed his battle with depression and suicide at a mental health conference.’9 Also, in the United Kingdom, Prince William and Prince Harry have thrown attention on mental health challenges faced by men by discussing their own personal struggles with depression, especially after the tragic death of their mother.60 As these stories about men’s mental illness experiences indicate, men’s health is complex and multilayered.

However, as the previous news stories and research also reveal, men can add more positive health behaviors to their perception of manhood by accepting more inclusive definitions of masculinity and being more health conscious.61 In fact, there are instances when male-identifying patients have resisted traditional gendered constructs. Rather than exhibit emotional or verbal reticence or distance,62 some seek emotional support from and connection with others experiencing a similar illness.6’ Additionally, as more men become involved in single parenting, same-sex relationships, and cohabiting stepfamilies, they are adopting traditional health responsibilities usually ascribed to women. Men are taking on more health monitoring, providing more social support, and are becoming primary caregivers.64 In essence, the sociocultural environment in which men exist cannot be ignored because it impacts the complete lived illness experience. Discourses of masculinity do not work in isolation. They often work with other notions of personal identity connected to culture, race, ethnicity, sexual identity, sexual orientation, disability status, and geography.'”

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