THE FORTNIGHTLY CLUB
Of
REDLANDS, CALIFORNIA

November 19, 2009
Men’s Health: A Psychological Perspective
Fredric E. Rabinowitz , Ph.D.
(Presented as a part of a special discussion on Men’s Health with David Baylink, M.D. and Stan Korfmacher, M.D.)

Assembly Room, A. K. Smiley Public Library

Men’s Health: A Psychological Perspective

Self-sufficiency, strength, and control are powerful forces in most men’s lives.  Reinforced by our media and culture, these principles often have their origins in childhood.  Many young boys are brought up in well meaning families to not cry, to not express tender or sad emotion, and to be tough.  As adults, these values are at the core of traditional masculine norms, such as not showing too much emotional vulnerability; keeping a rational attitude in the face of chaos; being competitive in life pursuits, including work and relationships; and being a good provider for family (Rabinowitz & Cochran, 1994).  One of the side effects of maintaining the masculine code of self-sufficiency, strength, and control, is the ignoring of physical and emotional pain (Harrison, 1978).  Many men posture strength when they are feeling weak, sick, or confused, in order to avoid exposing their vulnerability.  The impact of following this proscription is that men as a group are less likely to seek help for what might be troubling them (Addis & Mahalik, 2003).
Although there have been some strides made in the past 10 years, men’s life expectancy is still five years less than women (Centers for Disease Control and Prevention, 2007).   The ratio of male death from heart disease, lung cancer, colon cancer, respiratory illness, liver disease, and diabetes is close to double that of women.  Unintentional accidents and motor vehicle fatalities are more than double that of women.  Suicide and homicide deaths for men are four times that of women (Centers for Disease Control and Prevention, 2008).
One of the largest reasons identified for the discrepancy in death rates has to do with the extended time it takes for men to consult with the healthcare system.  The denial of pain, the ability to tough out discomfort, and the belief that one should be able to handle setbacks on one’s own often contributes to men’ avoidance of health services (Addis & Mahalik, 2003).  Instead of catching physical diseases and emotional conditions early, men seek professional help only when their health has severely deteriorated, leading to disastrous consequences (Courtney, 2000).  This is born out by statistics that show that for all types of non-pregnancy-related doctor visits, women attend 56 percent more than men.  For all annual check ups and preventative services the rates by women are 100 percent higher than among men (Centers for Disease Control and Prevention, 2001).  Traditionally women have been responsible for the family’s health care and even though many also work, women tend to make time for health related visits.  Men have are more likely to say they don’t have the time for doctor visits because of work obligations and other commitments.  It has also been suggested that men are extremely uncomfortable having to wait in health care settings for treatment because of feeling of vulnerability and discomfort with the sick role (Xu & Borders, 2003).
Men also seem to not get as much time or health related counseling even when they do attend medical appointments (Men’s Health Network, 2009) While this may be partially due to men not appearing receptive to advice from doctors, it also represents a possible bias in the medical profession to not fully explain procedures and health instructions to men.  Men are more likely to downplay their symptoms and thus, physicians have a tendency to not probe further about potential problems (Courtney, 2000).  With health maintenance organizations trying to cut costs, physicians are not always encouraged to seek further diagnostic testing or make referrals to specialists.  Even when primary care doctors do make referrals, appointments often take weeks or months to get scheduled, leading to less compliance in the face of a man’s tendency to already avoid healthcare. 
Mental healthcare has even more stigma attached to it than physical healthcare for men.  Men suffering from depression and anxiety disorders often self-medicate with alcohol or other addictive substances (Cochran & Rabinowitz, 2000).  Co-morbid physical problems can exacerbate the mental health condition, leading to avoidance of potential medical and psychological help.  Often it is left to a family member to encourage a man to seek treatment.  Health outcomes are better for those men who have insistent family members versus those that live alone (Kandler, Meisinger, Baumert, & Lowel, 2007). 
For those men who keep their psychological and physical pain to themselves, there are elevated risks for suicide.  Suicide rates of men between age 15-24 and for men over 80 are seven to fifteen times the rate of women of the same age.  Across ages, men kill themselves at four times the rate of women (Buda & Tsuang, 1990).  Because fewer men seek treatment for underlying emotional disorders, they are at a higher risk for their mental condition worsening, resulting in self-inflicted death (Cochran, 2001).  In contrast, men who maintain strong social networks throughout their lives are less likely to experience severe episodes of depression in their lifetime, even when facing loss (Cochran & Rabinowitz, 2000).
What are the solutions for men?  What will it take for men to attend to their physical and psychological concerns?  How can men live long and prosperous lives, even with physical and emotional concerns?  Most recently, campaigns to educate men to be more attentive to their health have been initiated.  There have been bills introduced in Congress to support an office of men’s health (Men’s Health Network, 2009).   Current initiatives enacted by the National Institute of Health are encouraging men to seek regular physicals and to be checked for early signs of colon and prostate cancer.  The National Institute of Mental Health, as well as a group of psychologists and psychiatrists, has collaborated on a campaign called, “Real Men, Real Depression” that has targeted men suffering silently from depression.  By using brochures and commercials featuring robust-looking men who have sought treatment, they are hoping that increasing social norms around help seeking will lead to men being more proactive in this area. (Rochlen, McKelly, & Pituch, 2006).  
Ultimately it will take men breaking the stigma of traditional masculinity that prevents help-seeking and acknowledging physical and psychological vulnerability.  Publicity about men taking care of themselves in the media can help change attitudes.  On a more personal level, men sharing their health concerns with each other will also shatter barriers toward getting help.  Male friendship needs a component that encourages men to support and assist each other with health concerns. By facing mortality together, men can gain emotional support, make more timely decisions to seek treatment, and learn from each other’s struggles.

References

Addis, M.E. & Mahalik, J.R. (2003).  Men, masculinity, and the contexts of help seeking.         American Psychologist, 58(1), 5-14.
Buda, M. & Tsuang, M. (1990). The epidemiology of suicide: Implications for clinical    practice.  In S. Blumenthal & D. Kupfer (Eds.), Suicide over the life cycle: Risk           factors, assessment, and treatment of suicidal patients. (pp. 17-38).  Washington,         D.C.: American Psychiatric Press.
Centers for Disease Control and Prevention (2008), National Center for Health         Statistics; Vital and Health Statistics.
Centers for Disease Control and Prevention (2007), National Center for Health         Statistics; Vital and Health Statistics.
Centers for Disease Control and Prevention (2001), National Center for Health         Statistics: Vital and Health Statistics.
Cochran, S.V. (2001).  Assessing and treating depression in men.  In G.R. Brooks & G.E.        Good (Eds.). The new handbook of psychotherapy and counseling with men.  (pp.  229-245) San Francisco: Jossey-Bass.
Cochran, S. V. & Rabinowitz, F.E. (2000). Men and depression: Clinical and empirical        perspectives.  San Diego: Academic Press.
Courtney, W.H. (2000). Construction of masculinity and their influence on men’s well    being: A theory of gender and health.  Social Science and Medicine, 50, 1385           1401.
Harrison, J. (1978).  Warning: The male sex role may be dangerous to your health.  Journal of Social Issues, 34, 65-86.
Men’s Health Network (2009).  http://www.menshealthnetwork.org/facts.htm         Retrieved November 2, 2009.
Kandler, U., Meisinger, C., Baumert, J., & Lowel, H. (2007).  Living alone is a risk factor        for mortality in men but not women from the general population: a prospective         cohort study. BMC Public Health, 7, 335.
Rabinowitz, F.E. & Cochran, S.V. (1994).  Man alive: A primer of men’s issues.       Belmont, CA: Brooks/Cole, Wadsworth.
Rochlen, A.B., McKelley, R.A., & Pituch, K.A. (2006).  A preliminary examination of  the “Real men. Real depression” campaign.  Psychology of Men and Masculinity,         7 (1), 1-13.
Xu, K.T. & Borders, T.F. (2003) Gender, health, and physician visits among adults in the          United States, American Journal of Public Health, 93, 7, 1076-1079.

Biography of the Author

Fredric E. Rabinowitz, Ph.D. was born and raised in Philadelphia, Pennsylvania.  He earned his B.A. at Ithaca College, his M.A. at Loyola College, and his Ph.D. in Counseling Psychology at the University of Missouri.  Since 1984, he has been a Professor of Psychology at the University of Redlands and a private practice psychologist in Redlands, CA specializing in individual and group psychotherapy with men.  Dr. Rabinowitz has been the Psychology Department Chair; Salzburg, Austria Program Director; Interim Johnston College Director, and is currently the Associate Dean of the College of Arts and Sciences, in addition to his faculty role.  He was the Clinical Director of the Redlands-Yucaipa Guidance Clinic from 1994-1997 and has been co-leading  therapeutic men’s groups in Redlands since 1987.  Dr. Rabinowitz has authored and co-authored numerous articles and three books: Deepening Psychotherapy with Men (2002); Men and Depression: Clinical and Empirical Perspectives (2000); and Man Alive: A Primer of Men’s Issues (1994).  Dr. Rabinowitz has earned Outstanding Faculty Teaching and Research awards in 1995, 1996, 2001, and 2002.  He was elected as a Fellow to the American Psychological Association in 2004 and is the past President of the Society for the Psychological Study of Men and Masculinity, a division of the American Psychological Association.  Dr. Rabinowitz is a father of two children, Jared and Karina and a husband to Janet Rabinowitz since 1989.  He is an avid reader, writer, skier, golfer, and poker player.