Morning team (INTRO) – today I wish to talk to you about Men and Mental Health. Specifically, I wish to talk about men’s preferences when it comes to therapy and psychological treatment.
But first, some background information.
According to the Adult Psychiatric Morbidity Survey 2014, Common Mental Disorders have been on the increase since the study first started in 1993 and women suffer around 50% more often than men in all iterations of the study.
A Common Mental Disorder (CMD) is defined by APMS as having reached a score of 12 or more on the revised Clinical Interview Schedule (CIS-R) and is comprised of different types of depression and anxiety. To quote:
(A more expansive definition and explanation can be found in Section 2.2 of APMS 2014.)
I have compiled graphs detailing the gender differences and change over time for scores of 12 or more, scores from 12 to 17 and scores of 18 or above. Scores are given based upon past week prior to the study. To quote the significance of the scores:
This graph shows how, overall, the number of people reporting a CMD has been steadily increasing over the past 20 years.
This graph shows how the number of people reporting a CIS-R score of 12-17 has stayed in roughly the same amount, with a little fluctuation.
This shows the outright growth in numbers of people suffering from a CIS-R score of 18 or more.
This is all the data for 2014.
Several things can be ascertained from the data presented here:
- As prior mentioned, the female CMD rates are consistently higher than male rates.
- The problem is getting worse, not better, more people are reporting CMDs.
- The overall increase seen since 1993 is because of the extreme end, many more people are reporting CIS-R scores of 18+ (whilst scores of 12 – 17 are similar to what we saw 20 years ago).
- The percentage of people reporting a CIS-R score of 12 – 17 is only slightly larger than the percentage of people reporting a CIS-R score of 18 or more.
Whilst the female rates have been consistently higher, comparing the results of APMS 2014 to 1993, there was a larger growth in male rates (of 12 and above) than in female rates; 20.9% increase in female rates compared to 29.5% in male rates. However, in 2014, 1.57 times as many women (to men) reported CIS-R score of 12 or more, 1.60 times as many women reported CIS-R scores from 12 to 17 and 1.55 times as many women reported CIS-R scores of 18 and above. Even despite the growth in male rates, women still lead by at least 50%.
All the data for types of CMDs suffered in past week for 2014 can be found here (for all other years, please see table 2.4):
So, unsurprisingly then, women are 1.58 times as likely to be in receipt of mental health treatment.
Looking further, we can see a better breakdown:
We can see that, overwhelmingly, people who are receiving treatment are more likely to be on medication than receiving counselling or therapy. There also seems to be little gender difference save women are more likely to be receiving treatment. We also see across the ages some but, not much, correlation between mean CIS-R scores and the receiving of treatment.
There’s a plethora of research already available on the topic of therapy, detailing the differences between men and women regarding what they look for in Psychological Treatment.
Women, being naturally more empathic, see this study here, are better equipped at opening up and talking about their feelings.
Men, however, prefer more action based interventions that use action, rather than emotion, based terminology.
For example, presenting help-seeking as ‘rational’ and as a strength; using ‘regaining control’ rather than ‘help-seeking’; ‘coaching’ rather than ‘therapy’; “releasing emotion’ rather than ‘crying’; and, to use military terms that many veterans like: “un-fucking your shit” and “dropping your baggage”.
For further reading, please see this report:
And check out the Veterans’ Transition Program by Marv Westwood, links are in the script below.
However, despite the knowledge of different requirements for men and women in Psychological Treatment, they are not being met.
In fact, writing in The Psychologist, The British Psychological Society admits that so few men seek help because of, and I quote “the lack of men in service provision, combined with arguably feminised psychotherapeutic approaches”.
They even open the article with “A man entering mainstream NHS psychological services will correctly perceive this world to be predominantly populated by women. He might wonder if such services are meant for him – will he be misunderstood or judged, will he be forced to talk about his feelings?”
There is a noticeable problem here. Approaching services is daunting for men and is not helped by the fact that the services can’t even cater for them.
The American Psychological Association has also recognised how the dearth of male psychologists and male-friendly treatments is harming men, stating “Guys are built differently. They have different brains and different ways of being emotional”. Ignore all the Feminist Propaganda in the article (it blames the gender disparity on the pay gap – WHAT THE FUCK!?!?!?) but, ignore all that, and it nearly adequately argues how the lack of men in Psychology is having an impact on how the field operates.
Ultimately, men and women are different. And, by understanding these differences, we can create systems and treatments that can help them both and give them what they need.
But, what causes these differences?
For a start, as I have mentioned, women are naturally more empathic than men.
There’s also the behavioural and psychological impacts of our sex-hormones. Take this quote from Max Valerio, writing in “The Testosterone Files”:
“I’d believed that men could cry as much as women if they’d just let themselves go. Men were victims of a masculine ethos that forbade tears that made them into unfeeling seething septic tanks of repressed pain ready to lash out. I was wrong.”
After having undergone male-to-female transitioning and hormone therapy, Max understood the differences between men and women.
Notably, testosterone inhibits empathy, just one shot is enough to impair women’s performance on a “Reading the Mind in Eyes” test and testosterone reduces connectivity in brain regions responsible for feeling empathy towards others.
I must add though, this is not to mean men are defective women, as many seem prone to argue.
Evidently, there are biological differences between men and women regarding emotions and empathy that cannot be dealt with or caused by socialisation.
We must adapt ourselves to help men and the way to start that is by understanding men.
This is where I get to the crux of this video because just under two weeks ago we were treated to this study:
The study opens up by highlighting the disparities:
I volunteer for a fathers’ charity and many of the men who come forward are only looking for a solution to their problems but, especially if they are new members. Those who have been in the fight for a while start to recognise the value of preserving themselves as much as preserving (or attempting to regain) contact with their children. Those who are here for the first time, many of them, they just want to be told what to do, how to fix their problems and then move on.
This is echoed when the authors write “These (gender) differences can be summarized as ‘men seek a quick solution, whereas women want to talk about their feelings”. Yes. Completely, yes!
Previous research and evidence is cited, such as Tom Golden’s book ‘The Way Men Heal’, noting that “grieving men sometimes display a grieving ‘action’ (e.g., writing a book or song about a recently departed loved one) rather than crying and talking about feelings. In such cases, rather than encouraging emotional sharing and direct eye contact, therapy should move indirectly to the subject of feelings by talking first about the grieving action.”
Men express their pain through doing rather than saying. The example cited is of writing a book, in Tom Golden’s book he speaks of a father who lost his son. The way he dealt with the pain was to write a book about his son, interviewing his friends, teachers, past girlfriends, etc. This is how the father dealt with losing his son.
Continuing this trend, the authors note how men have different responses to stress, citing Shelley Taylor’s work (see Tend and Befriend). They also cite evidence that shows how “men and women differ in regard to the things that cause them to seek psychological help. For example, men were more likely to open up about personal issues when it was impacting their work or when prompted by a female family member or partner”. For me, this shows how men relate themselves to those around them – their work is their identity (so they can provide) and they care for the women in their lives.
The participants were invited to complete a cross-sectional online survey. The primary outcome variables were the degree of liking for various aspects of therapy, which was operationalised in four ways:
The first two operators are then succeeded by lists of options and for each option a six point Likert scale from 1 = strongly dislike to 6 = strongly like. The third operator has options but no scale and the final operator allows for free text.
There were 10 predictors in the final model (Gender, Age, Ethnicity, from a Westernized country, Educational status, Occupational status, Marital status, Income, Relied on by others, and Whether have had therapy before). There were originally 11, but one (‘History of mental health issues’) was removed from analysis because it was collinear with ‘Whether have had therapy before’.
From the table on display, we can see that “Sex” as a characteristic was a predictor for two of the therapies listed: Men liked Support Groups and Women liked Psychotherapy. I am, however, surprised that “Sex” was not a predictor for Life Coaching, speaking anecdotally, I know a lot of Men have been warming to it. Especially to the concept and term “Coaching”, it helps affirm the male identity (whereas “therapy” is a feminised term, as I discussed earlier in the video).
Table 4 is interesting because it shows differences in coping strategies. “Sex” as a predictor predicted 30% (7 / 23) of the coping strategies, and “Age” as a predictor predicted 35% (8 / 23).
For Sex the predictors were:
Talking to Friends – Women
Self-help book – Women
Take Prescription Medication – Women
Comfort Eating – Women
Have Sex or use Pornography – Men
Do arts or craft – Women
Play video/Internet Games – Men
What is interesting is what’s missing from this list: alcohol and drug use. There was no sex difference found in this study in the use of alcohol and drugs as a coping mechanism, despite previous research finding differences.
However, when it came to Prescription Medication, Women were more likely than Men to utilise this coping mechanism (52% vs 27%) and this difference is statistically significant. Yet, this can be because women are more likely to see a doctor and thus be prescribed the medication.
The Video Games element is fucking obvious – guys (and young people) love their video games.
Also, please note that for both men and women, “Talking with friends” was the most popular coping strategy, highlighting the need for strong support networks. Yes, there’s a ten percentage point difference between them but, 74% of men named it as a coping strategy, blowing out of the water the accusation that men don’t open up. I will also add that whilst women are more likely to talk to friends (84% vs 74% of respondents), the difference was not statistically significant after familywise correction.
What I also find interesting is Table 5, which denotes differences in male and female respondents for aspects of causes of help-seeking.
We can see that sex of the participant predicted 28% (five of 16) of the help-seeking themes identified. They are:
Impact on Daily Life – Women
Self-aware – Women
Fix Problems Myself – Men
Men don’t admit to problems – Men
No male-friendly options – Men
The last three on the list are obvious.
The self-awareness lends itself to the normative male alexithymia hypothesis, which argues that men are emotionally shut off. They are socialised into being emotionally repressed, rather than it being an inherent condition. I call bullshit on this, which is why I called it the normative male alexithymia hypothesis. There’s also contention over its existence.
Men are not emotionally shut-off, we feel emotions just as everybody else. We just don’t express our emotions as women do. We have our own language, our own mannerisms. And, because the world of psychology cannot speak said language, they, in their ignorance, have wrongly pathologised men with this idiotic and frankly slanderous label.
You cannot hear, what you do not listen to. Do not blame the speaker for your deafness.
The study concludes by stating male that help-seeking seems to be hampered by barriers at both the personal level (i.e., men struggle asking for help) and systematic level (i.e., lack of male-friendly services), and more attention is needed to address the issue of improving uptake of mental health services by men.
So, overall, we see notable gender differences in mental health. This is just a simplistic look at the peripheral layer of mental health. For further reading and understanding, please, check out the Adult Psychiatric Morbidity Survey …trail off, crumple up notes, Ad-lib.