APA issues first-ever guidelines for practice with men and boys
Men commit 90 percent of homicides in the United States and represent 77 percent of homicide victims. They’re the demographic group most at risk of being victimized by violent crime. They are 3.5 times more likely than women to die by suicide, and their life expectancy is 4.9 years shorter than women’s. Boys are far more likely to be diagnosed with attention-deficit hyperactivity disorder than girls, and they face harsher punishments in school—especially boys of color.
APA’s new Guidelines for Psychological Practice With Boys and Men strive to recognize and address these problems in boys and men. Thirteen years in the making, they draw on more than 40 years of research showing that traditional masculinity is psychologically harmful and that socializing boys to suppress their emotions causes damage that echoes both inwardly and outwardly.
Researchers assumed that masculinity and femininity were opposite ends of a spectrum, and “healthy” psychology entailed identifying strongly with the gender roles conferred by a person’s biological sex.
The main thrust of the subsequent research is that traditional masculinity—marked by stoicism, competitiveness, dominance and aggression—is, on the whole, harmful. Men socialized in this way are less likely to engage in healthy behaviors. For example, a 2011 study led by Kristen Springer, PhD, of Rutgers University, found that men with the strongest beliefs about masculinity were only half as likely as men with more moderate masculine beliefs to get preventive health care. And in 2007, researchers led by James Mahalik, PhD, of Boston College, found that the more men conformed to masculine norms, the more likely they were to consider as normal risky health behaviors such as heavy drinking, using tobacco and avoiding vegetables, and to engage in these risky behaviors themselves.
“Because of the way many men have been brought up—to be self-sufficient and able to take care of themselves—any sense that things aren’t OK needs to be kept secret,” Rabinowitz says. “Part of what happens is men who keep things to themselves look outward and see that no one else is sharing any of the conflicts that they feel inside. That makes them feel isolated. They think they’re alone. They think they’re weak. They think they’re not OK. They don’t realize that other men are also harboring private thoughts and private emotions and private conflicts.”
Some of this involves outreach. Efforts like the National Institute of Mental Health’s “Real Men. Real Depression” campaign can normalize help-seeking by showing tough guys struggling. When men do seek help, clinicians need to be aware that aggression and other externalizing symptoms can mask internalizing problems, Levant says. From early childhood on, boys are encouraged to push down any emotion other than anger, he says, which interrupts boys’ emotional development.
“I tell clients that oftentimes anger is a powerful emotion to cover for a more vulnerable emotion we might feel,” such as sadness or shame, Levant says.
It’s also important to encourage pro-social aspects of masculinity, says McDermott. In certain circumstances, traits like stoicism and self-sacrifice can be absolutely crucial, he says. But the same tough demeanor that might save a soldier’s life in a war zone can destroy it at home with a romantic partner or child.
“There are times when you need to be able to power through,” McDermott says. “But if you only do that, and you believe that if you don’t do that then you’re somehow less worthy as a person, that’s where you have a problem.”
The clinician’s role, McDermott says, can be to encourage men to discard the harmful ideologies of traditional masculinity (violence, sexism) and find flexibility in the potentially positive aspects (courage, leadership).
[The vast majority of males are not violent or sexist.]
Getting that message out to men—that they’re adaptable, emotional and capable of engaging fully outside of rigid norms—is what the new guidelines are designed to do. And if psychologists can focus on supporting men in breaking free of masculinity rules that don’t help them, the effects could spread beyond just mental health for men, McDermott says. “If we can change men,” he says, “we can change the world.”