by Liz Plank
3. MEN AND DOCTORS: IT’S COMPLICATED
In addition to being encouraged to take more risks with less protection, prototypical “masculine men” are also expected not to seek help when that whole being-a-manly-man thing backfires. And research shows that the more a man subscribes to toxic tenacts of stereotypical masculinity, the less likely he is to seek protection in the form of preventative care such as regular checkups or routine prostate exams. And the effect is not small. Research from Rutgers University shows that men who glamorize rigid unhelpful beliefs about masculinity are 50 percent less likely to seek preventative care. The researchers say their findings “strongly suggest that deep-seated masculinity beliefs are one core cause of men’s poor health, in as much as they reduce compliance with recommended preventative health services.”
Our ingrained belief that men shouldn’t ask for help shapes our entire world. We see its effects in one of the worst epidemics on earth, HIV/AIDS. Experts at the World Health Organization argue the crisis is worsened by the often-ignored power of norms surrounding masculinity for men. Although more women are affected, Michel Sidibé, the executive director of UNAIDS, says in a 2017 report that “there is a blind spot for men—men are not using services to prevent HIV or to test for HIV and are not accessing treatment on the scale that women are.” Men who have sex with other men are twenty-four times more likely to contract the disease and yet men are less likely to get tested, visit clinics or get treatment. This is especially lethal in Sub-Saharan Africa, where the epidemic takes too many innocent human lives every year. In South Africa, for instance, 70 percent of the men who end up dying from HIV/AIDS never even sought treatment. In many regions, HIV status is still associated with being an effeminate man, which in a society riddled with toxic masculinity is the worst thing a man can be. Sidibé says that norms surrounding toxic masculinity are largely responsible. “The concept of harmful masculinity and male stereotypes create conditions that make having safer sex, taking an HIV test, accessing and adhering to treatment—or even having conversations about sexuality—a challenge for men,” he explained. “But men need to take responsibility. This bravado is costing lives.”
This is not to understate the plight of women with HIV/AIDS. In fact, the disease impacts far more women in the developing world, where young women can be more than twice as likely to contract the disease, depending on the region. And yet straight men are the number-one source of transmission of HIV/AIDS for women across the world. Targeting men’s reluctance to practice prevention or get treatment could be one of the most cost-effective strategies to help women. The AIDS epidemic in women is worsened by the fact that men aren’t getting the right treatment, so when we include them, that investment goes back to women. The women who get AIDS through sexual contact, except for those who exclusively have sex with women, are primarily being infected by the men in their lives. To ignore the way to control the epidemic in men is neglecting the whole spectrum of solutions to the problem. A man who is being treated for HIV has a much smaller chance of transmitting the disease to a woman than a man who isn’t. And of course, a man who doesn’t get tested or treated is a triple threat: to himself, to his partner and to his community. Ensuring that men feel comfortable seeking treatment and care has benefits to societies at large, including women. Ignoring men’s gendered constraints in the fight against HIV/AIDS puts women (and the men they love) at risk.
Sexual orientation and poverty also complicate how men handle HIV/AIDS. Here in the United States, for instance, a staggering 50 percent of black queer men and one-quarter of gay Latino men will be diagnosed with HIV at some point in their life. This isn’t because gay men of color engage in riskier behavior, but rather because they don’t have access to testing and therefore don’t know they’re infected. The shame associated with the disease is real and uniquely tied to a threat to performative masculinity. Nothing made that clearer than when Magic Johnson contracted HIV. As Phillip Brian Harper recounts in Are We Not Men?: Masculine Anxiety and the Problem of African-American Identity, after the public disclosure of his positive status in 1991, Johnson went on an impressive (and sadly rewarded) masculinity-reaffirming tour. In a late-night show appearance with Arsenio Hall, his utterance of the words “I’m far from being homosexual” were lamentably welcomed with applause. “At the same time,” writes Harper, “the fact that Johnson perceived a need to continue asserting his masculinity—specifically by publicizing his heterosexual exploits—even after he had supposedly set the record ‘straight’ on national television indicates that masculinity, as generally conceived, is a condition whose very validity in any individual instance consists in its being experienced as under constant threat.” So even when a man isn’t gay he has to deal with the stigma and internalized homophobia that accompanies the diagnosis and treatment. If we were to give men more freedom to be or love who they wanted, could it make a dent in one of the deadliest epidemics of our time?
Whatever pressure discourages men to ask for help for physical pain is exponentially worse when it comes to psychological pain. And again, the more you cling to unrealistic definitions of masculinity, the less likely you are to seek the support you need. Patriarchy demands that men conform, and according to the data, obeying its definition of manhood doesn’t always lead to positive outcomes. According to research published by the Journal of Counseling Psychology, whether a man subscribes to macho ideals about what it means to be a man has direct impacts on his health. Lead researcher Y. Joel Wong, of Indiana University Bloomington, did a meta-analysis of seventy-eight research samples that included almost twenty thousand male participants and measured their association with eleven masculinity characteristics. The researchers chose eleven norms traditionally associated with ideal masculinity and found that men who subscribed to them showed more overall reluctance to seek medical help and had overall lower health outcomes:
Desire to win
Need for emotional control
Risk-taking
Violence
Dominance
Playboy (sexual promiscuity)
Self-reliance
Primacy of work (importance placed on one’s job)
Power over women
Disdain for homosexuality
Pursuit of status
The most dramatic effects on health came from male subjects’ association with “self-reliance, pursuit of playboy behavior and power over women.” This led researchers to conclude that “sexism is not merely a social injustice, but may also have a detrimental effect on the mental health of those who embrace such attitudes.” Researchers also found that the association with these attitudes lowered men’s well-being and, worse, made them less likely to seek mental health help. So masculinity norms make men doubly vulnerable, by first enticing them to conform to ideals that make them unhappy and then making them reluctant to seek help when they need it. Interestingly, though, not all identification with all masculinity traits had negative impacts on men. Primacy of work and desire to win, for instance, were not associated with lower well-being, suggesting that work and seeking success provide men with positive identity-creating ideals that don’t encourage them to suppress their needs.
At this point you may feel deflated by this data. But there’s a silver lining! There’s a simple way to counter these misleading masculinity ideals and their negative impact on health: kindness.
Empathy toward oneself appears to lessen the effects of harmful masculinity on men. Although more than two in three college men who experience mental health issues never seek help, when researchers looked at a sample of 284 undergraduate males, they found that self-compassion and kindness toward one self helped buffer the link between the adherence to masculine ideals (like self-control and self-reliance) and the stigma around seeking help. In other words, empathy appears to have a protective effect on men.
But compassion is still viewed as a transgression of the male code. It was best explained to me by my friend John Haltiwanger. “I still know a lot of men who
think depression is basically a choice or a sign of weakness. I think too many men view seeking help as surrender, which is literally killing us,” he told me. “You don’t have to be in a deep depression to go to therapy. You can be perfectly content with life and still benefit, but in my experience most men don’t grasp that concept. Do physically fit people stop going to the gym? No. It takes constant work. So does mental health. I wish more men understood that.”
But it’s hard to know you need help when you’ve disconnected from yourself. Subscribing to idealized masculinity also makes a man less likely to be able to understand his own emotions. In fact, researchers have found that identifying with macho and traditional masculinity was correlated with more pronounced alexithymia, an inability to properly describe emotions, across different demographic groups of men. The paradox is that across the board, men are less likely to seek therapy, but they benefit just as much as women from therapy, and some research shows they may even benefit more. It’s not that men objectively experience less stress; women and men have different interpretations of whether they are coping with it correctly. For instance, one particularly interesting study that looked at African-American men and women showed that the same behavior can be interpreted very differently. While men believed they were coping with stress by “resting,” the women described how they were dealing with stress as “avoidance.” In the same study, African-American men described an emotional, social and physical toll of stress in their lives. But the good news is that researchers in the UK found that “alexithymia fully mediated the effect of intimacy on men’s attitudes towards psychological help-seeking,” which in plain English means that increasing help-seeking for men could be the key to unlocking a greater sense of emotional well-being for them.
HEALTH CARE PROVIDERS—THEY’RE ONLY LIKE SOME OF US
Of course, health care providers have been raised in this same culture—so it’s not just male patients who have internalized toxic masculinity but their doctors, too. They aren’t created in a vacuum; they’re born and raised in the same culture as we all are. Men aren’t the only ones who feel like men need to be self-reliant; health care providers (many of whom are, you guessed it, men!) have absorbed that message, too. This makes men less likely to get tested for HIV/AIDS but also less likely to be targeted by providers. The authors of the previously mentioned WHO report saw this with health care workers: “Health programs often view men mainly as oppressors—self-centered, disinterested, or violent—instead of as complex subjects whose behaviors are influenced by gender and sexual norms.” It’s one big, vicious cycle, where men’s individual actions confirm the beliefs of health care workers and then health care workers continue to treat them in a gendered way that doesn’t respond to their full set of needs.
And the relationship between masculinity and one’s experience of the health care system is complicated further by race. Given the dearth of doctors of color (only about 5 percent are black), the health care system is often treacherous when you’re not white, and this problem isn’t even getting better with time. According to data from the Association of American Medical Colleges, there were fewer black men enrolled in medical school in 2014 than there were in 1978, while there’s been an increase in every other demographic, including black women and Hispanics and Asians of all genders. This is most likely the result of a well-studied hostility toward affirmative-action programs.
Research by Liliana M. Garces and David Mickey-Pabello, who examined the impact of affirmative-action bans in six states, showed a 17 percent decrease in medical students of color receiving matriculations. The absence of men of color as health care providers is worrying because black men have the lowest life expectancy of any demographic group in America. The fact that they are far less likely to be treated by someone who looks like them compounds the problem. Research actually proves there’s a tangible black male doctor effect: black men were more responsive and more likely to agree to preventative treatments when they were treated by doctors who were black. The effect was so significant it even surprised researchers tasked with studying it. For instance, the results showed that black men were 50 percent more likely to agree to preventative diabetes screening when it came recommended by a black doctor rather than a white or Asian doctor. The researchers conclude that increasing the number of black doctors alone could reduce the oversized racial gap for death from cardiovascular disease by 19 percent, which is enormous. Black doctors literally save lives and could help restore trust in a health care system that African-Americans have every right to be suspicious of. Although very few studies look at the intersection of masculinity, blackness and health care services, one study showed that black men were more likely to trust information regarding their health that came from their family members than from doctors or nurses. This distrust of the health care system is rational, as there is mounting evidence that doctors respond to and treat patients differently based on their race. One study that came out of the University of Virginia showed half of white medical students believe false racialized myths like that black people’s bodies are stronger, black people’s skin is thicker, their nerve endings are less sensitive than whites’ and black people’s blood coagulates more quickly (none of which are true). No wonder communities of color don’t want anything to do with a health care system that so overtly and dangerously discriminates against them. Increasing the number of black doctors would fundamentally shift the size of the racial life expectancy gap in the United States, across gender.
And then even when communities of color want to trust the health care system, they’re much less likely to have access to it because of the way the system works. If you are Hispanic and nonelderly, you are more than three times more likely to be uninsured. Sure, the Affordable Care Act helped slightly narrow the uninsured racial gap, but it’s still abysmal. Black Americans are still more likely than white Americans to skip doctor visits because of financial reasons. So the cultural pressures in the black community to stay away from health care are compounded by a lack of access to those services in the first place.
So if men’s rights activists are truly committed to solving the problem of shorter male life expectancy, they would be far more effective if they invested all the energy they currently spend on blaming feminism into dismantling institutionalized racism, which is literally killing men of color at far greater rates than any other group. If only these so-called male interest groups were as committed to ending racism as they were to blaming women, perhaps they’d be more successful at actually helping the demographic they purport to be advocating on behalf of.
Another way for men’s rights activists to spend their time could be to contest the male code because so long as it’s the law of the land, men who don’t conform to it suffer. Even when men resist the forces instructing them to partake in risky behavior or eschew protection, the mere transgression of prototypical masculinity norms sets them back, health-wise. For instance, when researchers controlled for unhealthy behaviors such as smoking or drinking, they still found that the men who earned less than their wives for an extended period of time experienced poorer health outcomes, shorter life expectancies and more risk of cardiovascular problems like diabetes, heart disease, high cholesterol, hypertension and stroke. This led researchers to conclude that violating the toxic code of masculinity can be such a point of stress for men that it negatively impacts their overall health. Given how taxing going against the grain of mainstream male culture can be in a world where it is considered the norm, a lot of men self-correct to protect themselves.
In addition to paying a price when they don’t conform to idealized masculinity, men can pay a price when they do conform. For far too many men in America who are suffering from mental health issues, it’s easier to get a gun than get a therapist. Although more Americans die from guns than from car crashes and AIDS, the CDC cannot call gun violence a health epidemic because of a 1996 law that bars the organization from doing anything that would “advocate or promote gun control.” How
tied guns are to the male code became clear to me when I was speaking to Tomi Lahren and her friends John and Laura in Dallas. In the middle of our conversation about modern masculinity, John said, unprompted, “God didn’t make man equal. Colt did. Any gun-manufacturing companies have made men equal.” When I asked for more explanation, he indicated that because guns allowed men to attack and defend themselves against other men, it meant that any difference in status between them could be erased.
While for this white conservative young man, gun ownership represents an equalizer for men, a quick look at reality points to the contrary. Gun ownership is not available to all men in America. In fact, when they were first codified, gun laws only extended to white men, as they feared slaves would revolt if they had the right to possess weapons. However, after they joined the Union Army, black Civil War soldiers returned home with weapons, they were seized by the Black Codes and groups like the Ku Klux Klan. The Second Amendment, guaranteeing the right to bear arms, was consistently denied to people of color. Martin Luther King Jr., for instance, was famously denied a concealed-carry permit in the 1950s after his home was bombed. While white men have a history of casually walking into Starbucks with open-carry guns, black men have a history of casually being arrested in Starbucks without guns and for no reason. Half of what white men can brag about doing openly, black men are considered to be thugs for.
But this conservative position on guns is not original. Among gun rights supporters, the dominating narrative is that men own guns to protect their family. Research shows this is deeply rooted in their identity as men. After all, if they can no longer be the provider, guns ensure they can still be the protector.
Gun manufacturers’s marketing has been effective. The vast majority of gun owners are men, especially if they’re married. In fact, married male Southerners are more likely to own a gun than any other group. The link between guns and the search for new masculinity has often remained unexamined, but even the “good guys” (as the NRA refers to them) with permits to conceal and carry often seem to indulge in fantasies of alpha masculinity to justify owning a gun. One study conducted on gun owners across the country by Angela Stroud (a gun owner herself) at the University of Texas at Austin found that men who conceal and carry are often “motivated by a desire to protect their wives and children, to compensate for lost strength as they age, and to defend themselves against people and places they perceive as dangerous, especially those involving racial/ethnic minority men.” When I spoke to her about her research, she revealed that gun ownership has become one of the very few tools still available to the men who cling to a model of masculinity that is rapidly shifting. With fewer opportunities to provide and protect, guns remain a way for men to feel like they are successfully accomplishing these male responsibilities.
