Four points that everyone concerned about men’s mental health should be aware of.

Nov 19

Since I started working in the field of male psychology nearly 15 years ago, there has been a huge surge in the number of people and organisations wanting to help men. This is fantastic… or is it? To understand why I have my reservations, let’s look at an interesting episode from marine biology:

“In the 1970s conservation biologists became concerned about the turtle population size because of the huge numbers of newly hatched turtles that were eaten by predators in the rush to the sea. The biologists […] would pre-empt the rush by digging up the eggs before they hatched, incubating them under laboratory conditions […] then releasing them directly into the sea. This seemed like a good solution, but the biologists did not realise that the temperature at which the eggs are incubated influences the sex of the turtle, […] It takes about 20 years for the sex of turtles to become apparent, and in this time the conservationists realised that their incubators were slightly too cool, so they had flooded the turtle ecosystem with males. This reduced breeding opportunities, and negatively impacted the size of the turtle population.” (Liddon & Barry 2021, pp. 272-3).

Despite undoubtedly good intentions, efforts to help can sometimes completely backfire. There are so many very talented psychologists and others in the field of men’s mental health, and in the past few decades, a growing abundance of research. The reason I wrote this article is to highlight four points that everyone concerned about men’s mental health should be aware of. Once seen, it will be clear these points have the potential to add signficantly to the quality of the work we are all doing, benefitting the men who are struggling to cope, and the families, neighbours and colleagues of the men who want them to be well again.

Here are the four points:

1/ Masculinity is not a key cause of men’s mental health problems
It has become a cliché that masculinity is bad for men’s mental health, for example, the idea that masculinity prevents men from talking about their problems. But what is the evidence for these ideas? Let’s look at one of the most commonly cited papers on this topic, called Masculinity and Suicidal Thinking. However the analysis in this paper reveals that masculinity is not the strongest predictor of suicidal thinking; suicidality was more strongly predicted by four other factors: depression, life events, not being in relationship, and substance use. Of the 11 aspects of masculinity assessed in this study, only one aspect (refusal to seek help aka ‘self-reliance’) was found to be statistically significantly related to suicidality, and then only barely so. Why was masculinity the main finding of the paper when it was such a weak correlation and wasn’t a unexpected finding in this field? Nonetheless this study is widely cited as evidence that masculinity may place men at risk of suicidal thinking. This means people interested in helping men are focusing on masculinity rather than more significant issues such as depression.

“The idea that science proceeds on the shoulders of giants is a good one, but this only works properly when we are referring to a giant accumulation of good science.”

2/ Men’s mental health research needs to try a new direction
In the 1980s research into men’s mental health began to focus on masculinity, and has suffered ever since from ‘paradigm fixation’. In other words, it has been fixated on conducting the same type of research over and over, without learning from important errors along the way. Studies like the one are the norm and are produced in abundance, but the errors go beyond elevating relatively minor issues to the headline. Here are the three key recurring problems:

The definition of masculinity used in research is unrealistically negative (sometimes called the ‘deficit model’) is usually based on negative stereotypes about men e.g. being homophobic, and wanting power over women. No surprise then that the findings typically paint an unrealistically negative picture of the average man in modern Western countries.
Findings based on young men’s opinions are taken as representative of all men, ignoring that fact that most men develop more mature views as they grow older;
Studies based on correlation are talked about as if they prove causation, although it’s a truism that ‘correlation does not prove causation’.

The idea that science proceeds on the shoulders of giants is a good one, but this only works properly when we are referring to a giant accumulation of good science. If it’s a giant pile of defective papers, then even a meta-analysis of these – which would usually produce high-level information – will merely raise the defective work to a position of credibility it doesn’t deserve. Universities and the talented people who work they have the potential to help men’s mental health, but for this potential to be realised a new approach is needed.

“This may surprise some people, but there is evidence that traditional masculinity is linked to better mental health”.

3/ Masculinity can benefit men’s mental health
This may surprise some people, but there is evidence that traditional masculinity is linked to better mental health e.g. one study found that higher self-esteem and mental positivity were predicted by more acceptance of traditional masculinity. What should surprise you even more is that even when benefits of masculinity are found, instead of being discussed enthusiastically for their potential as an interesting new therapeutic approach, the findings are ignored or dismissed. For example, one systematic review found that in studies of men in their 40s, masculinity was used in various ways (e.g. chopping wood, motor biking) to help men cope with depression. However the paper dismissed these approaches saying they might put “pressure on men to meet hegemonic ideals [and] reproduce traditional gender relations and power imbalances”. Because of the prevailing paradigm fixation, few people do research investigating the benefits of masculinity, and when benefits happen to be found, they are often ignored or downplayed.

We should have a more realistic and positive view of masculinity, but note that the term ‘positive masculinity’ is sometimes used to mean ‘less masculinity’, without the recognition that traditional masculinity is in itself positive. Lots of people are starting to agree that ‘toxic masculinity is toxic terminology’, but in some cases they still use terms that are just as toxic (e.g. ‘hegemonic masculinity’), or continue to blame ‘masculine norms’ or ‘traditional masculinity’ or ‘traditional masculinity ideology’ or patriarchy for men’s problems. It seems unlikely you can do genuinely male-friendly therapy while stereotyping masculinity and making this the focus of men’s problems. My own research published last year found that one of the strongest predictors of men having lower mental wellbeing was how much they blame masculinity for negative behaviours, such as not talking about how they feel about their problems, or making them feel inclined to be violent towards women. This finding implies that making men think masculinity is their problem is not a credible way to help their mental health.

4/ We need a male-centred approach
Empathy is, arguably, the key factor in the success of therapy, and might be the key factor missing for male clients. Interventions based on a negative view of men and masculinity tend to perform relatively poorly. Interestingly, Men’s Sheds - an intervention that isn’t burdened by theoretical clutter and just lets men get on with being themselves – can improve wellbeing and health outcomes. Building from these facts, it seems the best next step would be to ensure that we use therapies that are unambiguously male-centred. I am using the term ‘male-centred’ rather than ‘male-friendly’ because although the latter has been used in relation to some of the structural aspects of therapy (the language used, the location etc), the opinions and theoretical viewpoint of the therapist have largely been left out. I think it’s useful to apply Carl Rogers’ idea of person-centred therapy to men, so that in relation to male clients the therapist should show:

Unconditional positive regard: be accepting and non-judgemental even if they are male-typical things you don’t really like or understand e.g. banter, competitiveness etc.
Congruence: be open with the client about their view of men and masculinity
Empathy: seeing the world from the man’s perspective e.g., if he doesn’t think patriarchy caused his marriage breakdown, work with him on that basis

These three concepts are more nuanced than briefly outlined here, but I am emphasising the distinction between ‘male-centred’ and ‘male-friendly’ especially because sometimes ‘male-friendly therapy’ (e.g. male-typical communication in a setting men feel comfortable in), is sometimes done – incongruously - in parallel with the assumption that men’s problems are caused, at least in part, by patriarchy or masculinity norms. Signs that an approach is not male-centred is citing certain types of material (such as the APA guidelines, or the Masculinity and Suicidal Thinking paper outlined above), or using certain terms (such as ‘hegemonic masculinity’, ‘masculinity norms’ or patriarchy) as an explanation for men’s problems. The incongruity of this is apparent when you think that relationship problems are a key issue for many men: if a man is suicidal because of his divorce, is now homeless, and only allowed to see his children for a few hours per month, he might feel somewhat misunderstood if you said his problems were caused by patriarchy and masculinity norms. However if that’s how a therapist sees men, they should make this clear at the outset so that potential male clients can decide in advance if that’s good fit for them or not.

“Not only are more and more people are becoming interested in men’s mental health, they are also realising that the current masculinity theories don’t fit. This is driving many grass roots organisations and individuals to go their own way, and in some cases grow bigger than established therapy organisations.”

Concluding comments
Some people will immediately see the sense in the four points above, others will struggle with some or all of them. Most people reading this article have been raised from childhood in a culture telling you that many problems are due to patriarchy and masculinity. These ideas usually stick, and this impacts everyone, including psychologists and researchers. To extract your mind from these ideas is not easy. You might read this article and see the sense in it, but in the next moment read another article, or have another conversation, or read an op-ed, or see something on TikTok, that lulls you back into the prevailing cultural fixation. However, our culture is showing the first small signs of change. Not only are more and more people are becoming interested in men’s mental health, they are also realising that the current masculinity theories don’t fit. This is driving many grass roots organisations and individuals to go their own way, and in some cases grow bigger than established therapy organisations. Furthermore, some of the larger organisations have started challenging the deficit model of masculinity, including the British Psychological Society (BPS), and even the global giant in psychology, the APA, is showing signs of moving away from their notorious guidelines and towards a more rounded view of men and masculinity. However whether these changes will continue and influence others is an open question, and in some ways the quality of support for men’s mental health today is as uncertain as the future of those turtles in the 1970s.

You can find out more about these themes in our magazine, our textbook (Perspectives in Male Psychology), and our online course.

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Selected references / recommended reading

Seager, M., Barry, J.A. (2019). Positive Masculinity: Including Masculinity as a Valued Aspect of Humanity. In: Barry, J.A., Kingerlee, R., Seager, M., Sullivan, L. (eds) The Palgrave Handbook of Male Psychology and Mental Health. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-04384-1_6

Barry, John; Walker, Rob; Liddon, Louise; & Seager, Martin. (2020). Reactions to contemporary narratives about masculinity: A pilot study. Psychreg Journal of Psychology, 4(2), 8–21. https://doi.org/10.5281/zenodo.3871217

Barry J. (2023). The belief that masculinity has a negative influence on one's behavior is related to reduced mental well-being. Int J Health Sci (Qassim). PMID: 37416841

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