Men in distress

2008-11-27 00:00

Have you heard the joke about what would have happened if God had chosen a woman to lead the Israelites out of Egypt instead of Moses? They would not have wandered in the desert for 40 years because she would have stopped to ask for directions. Although a bit corny and not entirely accurate, where this joke and others like it are accurate is in the profound truth they carry about what it means to be a man.

That is that it is very difficult for men to ask for help, which is not another joke, but a psychological and emotional reality. In case women are tempted to stop reading because this is a story about men, don’t, because we are partly responsible for making it difficult.

The fact that men try to avoid asking for help is particularly relevant as the nation observes the 16 Days of Activism against Violence against Women. Dylan Evans, a clinical psychologist and lecturer at Town Hill Hospital and Nelson R. Mandela School of Medicine at the University of KwaZulu-Natal in Durban, said: “It’s difficult for men to ask for help because of cultural beliefs about masculinity. The more patriarchal a culture, the harder it is for men to seek help and the stronger the sanction against it. These kinds of cultures expect men to be dominant, strong and resourceful, the provider and the protector. Men, therefore, tend to value success and power, and are expected to be self-reliant.

“They are expected to avoid expressing and experiencing emotions that make them feel vulnerable because ‘boys don’t cry’. Being emotional and vulnerable is often experienced as shameful and as evidence that you are not a real man, which can lead men to cut off their emotions. Men’s interactions with each other tend to be characterised by competition, dominance and the fear of being shamed if you do not conform to traditional masculine ideals.”

Evans said that this kind of traditional understanding of masculinity is common to most cultural groups in South Africa and both men and women play a role in constructing the expectations of what it means to be a man. The traditional stereotype of masculinity can be harmful for both men and women. It is harmful for men because it cuts them off from their emotional life and makes intimacy difficult, and for women and children because they can suffer the consequences when men avoid intimacy and act out aggressively.

“Men are also human beings who want the same as women: loving and fulfilling relationships. However, they often find intimacy very difficult because they struggle to be aware of and express more vulnerable emotions. This emotional restrictiveness also handicaps men when they face emotional and psychological problems. They find it difficult to experience and express their emotional distress, as this makes them vulnerable. They may then avoid the difficult emotions through abusing alcohol, or keep them in check until they explode in uncontrollable anger. Anger is often one of the only emotions that men will allow themselves to express and feel because it is active and powerful.

“Men are also often more comfortable ‘doing’ rather than ‘being’. They want to take an active, problem-solving approach to emotional difficulties and struggle to experience and tolerate vulnerable emotions. This can create problems as there is often not an easy, quick solution to emotional difficulties. We often have to learn to accept and fully experience difficult feelings, to ‘be’ with them, before we can work through them and resolve them. Men often struggle with this, which can cause a build-up of unresolved problems which they then act out in destructive ways.”

To understand why it is so difficult for men to ask for help, we also need to understand how shame is central to the way they function, especially the way they relate to one another. “First, there is shame in admitting that something is wrong. That can make them feel inadequate and unable to live up to the stereotype. Then, it is shameful to put themselves in a less dominant position and be vulnerable without feeling less of a man. They often feel ashamed in case other men hear that they have needed help and worry about what others will think.

“To act in loving ways towards another, you have to have experienced being loved yourself. Many fathers are absent from families which means that many men grow up without positive male role models. This perpetuates a vicious cycle of men not knowing what it means to be a man who has healthy, loving relationships in a family. Because they have never experienced it, they struggle to provide this for their own families. The absence of loving father figures can leave men with many unmet needs that can lead to high levels of rage and aggressive behaviour.”

Evans says that our current social climate often paints men as perpetrators and women as victims. “It labels men as ‘bad’ and women as innocent. To label all men like that does not help to change the situation and might even have negative consequences. It can make men more defensive and even less likely to look for help, rather than encouraging them to get help.

“I feel we should rather try to understand why men behave in often aggressive ways so that we can help them. However, I am not suggesting that understanding men’s behaviour means that they aren’t responsible for what they do. Men need to take responsibility and be held accountable for their actions. It is only by taking responsibility that people can change.”

He offers several suggestions to combat the traditional stereotype of masculinity and its negative consequences. “We need to create opportunities for men to reflect on their implicit assumptions about what it means to be a man. They need to be able to evaluate these and reconstruct a healthier concept of masculinity that enables them to be more vulnerable and have more healthy fulfilling relationships. This could be achieved through educational programmes in schools which encourage young people, both boys and girls, to question the traditional understandings of masculinity and femininity. Public programmes such as the HSRC (Human Sciences Research Council) Fatherhood Project ( /RPP-Fatherhood-1.phtml) can also play an important role. This project aims to emphasise the nurturing aspect of masculinity by recognising, encouraging and supporting men’s care and protection of children. It is about ‘the love that children need, but also about the need that fathers have to love’.

“I also want to encourage us all to help ‘normalise’ emotional and psychological difficulties. Life is hard and we all, including men, struggle sometimes. This is nothing to be ashamed of and instead of condemning ourselves, we need to be gentle and take care of ourselves by asking for help.”

are the men in your life depressed?

If you sometimes wonder why some of the men you know are irritable, given to angry outbursts and drinking too much, you may be surprised to know that they could be depressed.

“From research and clinical experience, we know that gender plays an important role in the ways people experience and express psychological distress. If women are depressed, they usually talk about having feelings of sadness or worthlessness and being unable to be interested in or enjoy anything. However, depression in men is often associated with substance abuse, difficulty meeting expectations about their role as men and suicidal feelings. This is because men have a tendency to externalise psychological distress through action, distraction and compulsive acting out,” says Dylan Evans (see main feature).

If you feel you or someone else needs help, call one of the following hospitals or clinics and ask to see a psychologist:

• Pietermaritzburg Assessment Centre, Northdale, at 033 397 0382.

• Imbalenhle Primary Healthcare Clinic (PHC), Imbali, at 033 398 5013.

• Scottsville Clinic, Oribi Road, at 033 386 7311.

• East Boom PHC, city centre, at 033 342 6022.

• Woodlands Clinic, Woodlands, at 033 387 6667.

• Fort Napier Child & Adolescent Outpatients Department (OPD), Napierville, at 033 345 4221.

• Northdale Hospital, Chota Motala Road, Northdale, at 033 387 2512.

• Edendale Hospital at 033 395 4911.

• Town Hill OPD, Hyslop Road, at 033 341 5653.

You could also ask your general practitioner to refer you to someone suitable, go to a private psychologist or phone Lifeline at 033 394 4444.


DYLAN Evans and Professor Anthony Pillay, principal clinical psychologist at Nelson R. Mandela School of Medicine and Fort Napier Hospital, conducted research into men who attended district level clinical psychology services in Msunduzi Municipality in 2006. The total population of the area is 553 212 people of whom 142 471 (25,8%) are men over the age of 21 years (Statistics South Africa, 2008). Only one man attended for every six women. That is 70 men compared with 422 women. More than half of the men had children, but less than half were married.

The most common reason for referral was suicidal feelings, while most were subsequently diagnosed with a mood disorder, especially depression. Only two-thirds attended voluntarily. The rest attended under pressure, mostly from families. Their average age was 35, 80% had secondary level education and just over half were unemployed. Over 70% had financial problems and 44,3% admitted to substance abuse. Almost three-quarters reported relationship problems and 14,3% admitted to being violent to their partners. Clinical assessment revealed that three-quarters of the men had low self-esteem and almost three-quarters (73%) were judged to be emotionally restrictive.

Among the implications of these finds, says Evans, is the need to train mental health workers to be aware of the way men express mental health problems and how to understand and deal with their resistance to asking for help.

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