I remember seeing my primary care physician a number of years ago for my annual physical. It had been years since my last exam. My doctor told me men see him for one of three reasons: One, a woman - a man's significant other, mom, or sister - made them. Two, they’re experiencing chronic and debilitating pain. Basically, they’re in a world of unrelenting hurt. Finally, they’re dealing with a condition that threatens their manhood (i.e. erectile dysfunction). I was in the first camp as my wife made me. In general, men resist seeing a doctor almost as much as they resist seeing a therapist. Therapy has less of a stigma for young men than earlier generations. According to this article, there appears to be about 2:1 female to male ratio of those who go to therapy. Why is it so difficult for men to seek therapy? Here are five possible reasons:
Men fear exhibiting weakness: Though less true today, going to therapy is viewed as weakness as men tend to experience shame when asking for help. Part of this is due to a masculine narrative that emphasizes strength and competence. Again, this masculine narrative does not have to explicitly denigrate vulnerability to induce shame. Rather, simply emphasizing the appearance of strength and competence is sufficient to trigger a man's disgust reflex in the face of weakness. Women certainly experience shame regarding weakness but masculine narratives create more barriers for men to feel comfortable with vulnerability.
Men see therapy as a threat to autonomy: I hate going to the doctor because he/she will tell me what to do and I don’t like being told what to do. In the same way, men tend to avoid therapy because they view the therapist as someone who will place demands that they’re unwilling to meet. It may actually be the demands (like a doctor’s prescription) are good for a man’s wellbeing. That is still insufficient to overcome a man’s aversion to being told what to do. Again, this is often due to a masculine narrative that emphasizes independence and self-sufficiency.
Men are conditioned to avoid talking about emotions: This is particularly evident for those who grew up in a culturally Asian household where emotional expression was discouraged and/or conversation about one’s emotional life was minimal or absent. This is also true for many who grew up in a baby boomer household, as that generation was renown for emotional restraint and “manning up.” As previously discussed and written about elsewhere, what’s more important is what is modeled rather than explicitly taught. Examples include the refusal to acknowledge anger, grief, and sadness or the dismissal of any positive feelings such as happiness, joy, or delight.
Men seek help when a problem is concretely defined: The stereotype of men being more goal-oriented than women has validity. Men appreciate a well-defined problem statement. It lends itself to concrete solutions and gives them something they can work with. It also has parameters. If a man decides to remodel a bathroom, the problem and solution are clearly defined and a man can seek help with tile or electrical work because those areas fall outside his expertise. In addition, the parameters can be set precisely so he knows exactly when he no longer needs help. The nature of mental illness and emotional health is that problems are rarely concretely defined. In fact, one goal of therapy is to define the problem. But it’s an area where subjectivity is the norm. By the same token, men want discernible progress. That’s also difficult to measure and often ambiguous when it comes to therapy. So in regards to seeking therapy, men may feel overwhelmed because it’s not clear what the problem is, how it’s going to be fixed, how long it’s going to take, and how to know when therapy is complete.
Men will pay when there’s a clear value proposition: Another male stereotype that has validity is that men love stuff. Men accumulate gear because it is tangible and the value proposition is precise and clear. When a man buys a car, he looks for specific features. He can make a spreadsheet of all the features and then do online research, test drive, and comparison shop, etc. He will enjoy every second of the search. And the point is, he understands exactly what he is purchasing - literally see, touch, feel, smell, taste what he is buying before putting down any money. You can’t do that with therapy. The value proposition is vague. It is defined as you go through therapy but not before you invest time and money. Men have trouble with that.
How do we address these obstacles?
Define a problem: It was very helpful to have a well-defined issue that I wanted to solve when I had my first appointment with Dr. Dean Smith over a decade ago: compulsive behavior was affecting my marriage. So when it came to therapy, I had something specific I wanted to tackle. It gave the session a focus and a forum to discuss deeper things. In the course of therapy, I realized my issues were much broader and deeper than my compulsive behavior and I continued to visit my therapist for far longer than I anticipated. There was deep work involved and I realized it was hugely beneficial to work on foundational aspects of my identity rather than obsess with managing symptoms.
Apply therapy as a customized classroom: There’s nothing wrong with wanting a clear value proposition. It’s beneficial to communicate what your expectations are and how you desire to benefit from therapy. Another helpful approach is to view therapy as a form of mentoring. You can create a process and define outcomes in collaboration with your therapist. It a classroom completely customized for you and yet it absolutely takes effort on your part. This class has homework and in a sense, you never graduate.
Question the masculine narrative and source of shame: It’s important to question why one has a disgust reflex around asking for help or displays of weakness. Find other men to talk about this with. On my first visit, my therapist read me well and challenged my desire for autonomy. I told him I was working on my issues, how I had people helping me, I had made these plans, etc. He calmly saw through my rationalizations and commented that despite my best efforts, it was likely my patterns would continue. He painted a picture of someday being divorced, jobless, and estranged from my kids. His tactic was effective and I decided to go see him. This wasn’t the first time I questioned the value of masculine narrative of autonomy but as I grew from working with my therapist, it reinforced my decision to devalue autonomy.
In retrospect, I learned to view therapy as meeting my desire for novelty, learning, and progress. This outweighed the stigma, cost, and effort required to keep seeing Dr. Dean. Of course, there were times of discouragement, fatigue, even boredom from circling around the same issues. But the discernible progress of experiencing freedom, of changing my view of God and of myself, of receiving my wife’s comments as constructive and acts of intimacy, rather than personal attack - that helped me to persist. In the end, I learned to leverage the aspects of my personality that might seek and benefit from therapy against the ones that chafe against it. My hope is more men might do the same and make the most of therapeutic relationships. It’s good and important to ask for help, and more so the older we get.