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Being A Man About It: Researcher examines why males underuse mental health services


Being a “real” man can be tough. Real men allegedly don’t dance. They don’t cry. They don’t ask for directions when they’re lost. They don’t eat quiche. And they don’t get the blues. Allegedly.

As it turns out, “real” men, in addition to eating quiche and dancing, do suffer from the blues and experience sadness and depression. What they often do not do is use physical and mental services to make their lives better.

Aaron Rochlen
Dr. Aaron Rochlen

Dr. Aaron Rochlen, an assistant professor in the Department of Educational Psychology at The University of Texas at Austin and a licensed psychologist, devotes most of his research time to examining the special mental health needs of men and studying why men often are their own worst enemies.

“What we’ve found is that traditional notions of masculinity and traditional male gender roles can be quite harmful to men,” says Rochlen. “Gender studies, as they relate to physical and mental health, are increasingly showing that men and women handle mental and emotional distress very differently and certainly take different approaches to getting help.”

There also appears to be considerable differences among men. According to Rochlen, a man who strongly adheres to traditional, restrictive masculinity norms and values probably places great value on being independent. He also may have difficulty with intimacy and be very preoccupied with success, power and competition.

For many men, traditional male behaviors and attitudes are central to their identity, and they see the rituals and values as positive. Study results in recent literature on the psychology of men and masculinity, however, consistently document the negative consequences of being a stoic, stalwart, strong man.

“Although many more men than women commit suicide, for example,” says Rochlen, “we’re still seeing that most patients who are getting mental health services are women. With both physical and mental health services, men are just more resistant to getting care.”

Dr. Laura Ebady, a therapist at the campus Counseling and Mental Health Center, can attest to the fact that males often seek professional help with much reluctance and only as a last resort.

“Generally, men seem to talk about their emotional problems in terms of stress rather than sadness or anxiety,” says Ebady. “Men—Texas men in particular—are socialized to be strong, independent and ‘suck it up’ when the going gets rough.

Construction worker standing at the bottom of a ladder
Some men may feel that asking for outside help when they are depressed, stressed or anxious is unacceptable and not ‘masculine.’

“They feel they should take care of things themselves, and it’s quite difficult for them to accept that there’s something fundamentally wrong in their lives that they cannot fix. Men tend to come in seeking therapy only after matters have progressed much farther than is the case with many of my female clients.”

According to Ebady, the most common reason for a male student to seek outside help is declining grades and a severe lack of motivation, to the extent that it may become almost impossible even to get out of bed and go to class.

“A lot of these men do not realize they’re depressed,” says Ebady. “They’re feeling irritable, frustrated and stressed. They say that they’ve lost motivation and don’t care about the things, like sports or going out with friends, that they used to enjoy so much. They can’t concentrate on anything and even though they’re sleeping much too much, they’re still dead tired.

“It’s not uncommon for them to deal with all of this by working twice as hard or maybe engaging in substance abuse and just trying to numb the awareness of an underlying problem. They tend to feel very guilty that they cannot come up with a solution on their own and are self-critical—they don’t realize that depression, for example, is very real and very debilitating.”

Watch video testimonials from the National Institutes of Health “Real Men, Real Depression” Campaign.

To evaluate the contradictorily desirable and damaging effects of being a John Wayne type, Dr. James O’Neil, a psychology professor at the University of Connecticut, created a measurement tool that can be used to detect what O’Neil terms “male gender role conflict.” Researchers using this tool have found that men with gender role conflict tend to have higher rates of depression and anxiety, lower self-esteem, heightened stress levels, higher rates of substance and alcohol abuse, significant problems with intimacy and career difficulties.

To complicate matters, the more passionately a man embraces traditional male gender roles and the more “alpha” he is, the more likely he is to resist accepting professional help. Research has shown that these men tend to be extremely hesitant to engage in constructive help-seeking behaviors when they begin to suffer emotional distress and may not even realize that they are depressed or are having difficulty coping.

“Although more research is needed, male-based depression appears to manifest in a qualitatively different way from the way women exhibit depression,” says Rochlen. “Men may not be willing to acknowledge that what they’re feeling is sadness and they may tend to cope in destructive ways—what you’re seeing may not look like sadness, but that’s the root.”

Three climbers scaling an ice cliff
Men suffer higher mortality rates than women but get professional help less often than women for problems such as depression, cocaine use, alcohol abuse and fatal diseases.

Rochlen’s approach has been to focus on identifying the barriers that are keeping some men from getting professional help for their distress and locating new options that encourage them to access therapy and counseling.

Because traditional male values are heavily oriented against seeking help, the entire process of getting therapy contradicts some men’s basic beliefs. The man first must realize that he is suffering from depression, sadness or problems with intimacy, for example, and be willing to acknowledge his true mental and emotional state. It then is necessary to express this state of need to others and act on the need by seeking a therapist and attending counseling sessions.

“What we’re looking at are alternative ways for these men to get help,” says Rochlen. “Some include modifying the way counseling is conducted once they go in for therapy, modifying the way mental health is marketed to males, encouraging some of them to go to an executive coach rather than a therapist, using writing therapy to work out their problems on paper or even considering letting them access therapy online.”

Already in full swing, the National Institutes of Health multimedia marketing campaign “Real Men, Real Depression” was initiated with the goal of removing the pall of secrecy and stigma from men’s mental health issues. In addition, the National Football League is using a similar campaign titled “It’s What’s Under the Helmet That Counts” to reach males who may feel great reluctance to see a therapist.

Some Facts About Depression

  1. Depressive disorders affect about 19 million adult Americans in a given year.
  2. Four times as many men as women die by suicide in the United States, and research indicates that suicide is often associated with depression.
  3. Instead of asking for help, men may turn to alcohol or drugs, become irritable, frustrated or abusive when they are depressed.
  4. More than 80 percent of people with depressive disorders improve when they receive appropriate treatment.

“Enormous amounts of money have been spent on advertising for drugs like Levitra and Viagra,” says Rochlen, “and the nature of that advertising has removed much of the stigma surrounding erectile dysfunction. Pharmaceutical companies have even pulled in celebrities to be spokespersons for those drugs, with the message being, ‘You don’t have to be ashamed.’ These strategies could work with men for depression as well.”

Dr. Wayne Hoyer, a marketing professor in the McCombs School of Business who has worked with Rochlen on several articles, agrees that the solution to breaking down men’s barriers to mental health services may have a lot to do with the media images that are presented of the “typical” man who sees a therapist or takes Prozac, for example.

Is the “average” client quintessential man’s man Tony Soprano on the HBO hit “The Sopranos” or is it a man who weeps inconsolably at chick flicks, can’t hold a job for more than two months and, at 40, still lives with his mother? Or is depression an equal opportunity offender that can strike anyone?

“This dilemma of trying to get men to address their mental health needs is, as it turns out, largely a matter of marketing,” says Hoyer. “There are several stages at which men can run into barriers and not pursue the help they need, points at which they decide that seeing a doctor for depression or anxiety is not ‘masculine.’

Two firefighters walking down busy city street
Men who embrace traditional masculine ideologies may place great emphasis on self-reliance in the face of hardship, emotional control, aggression, power over others and competitiveness.

“It could be at the stage of awareness that there is a problem or at the stage of evaluating their values and determining if they’re comfortable with going to a therapist and talking about their problems and emotions. It can be at the point where they have to actually find a therapist, make time to go to the appointment and act on this decision. We hope to identify where these feelings of resistance are occurring and develop communication programs that help.”

As Rochlen points out, getting men who need therapy to a therapist not only alleviates their suffering but also makes life easier for those around them.

Although well over 100 studies have verified the negative effects of male gender roles on men, Rochlen discovered that surprisingly few studies have examined the effects on women. And the studies that do describe the effects of male gender role conflict on a relationship or job, for example, present the findings from the male participants’ perspectives.

Looking over the body of research on the subject, Rochlen became curious about how women experience the gender role conflict of a romantic partner and how it affects their psychological health, self-esteem and satisfaction with the relationship. Past research had shown, among other things, that men with higher levels of gender role conflict and difficulty expressing their emotions reported having more conflict-ridden and unsatisfying relationships and marriages. These men often adopted behaviors and attitudes that were harmful to relationships with women, in general. They exhibited a higher level of tolerance for sexual harassment behaviors and were less likely, when shown a sexual harassment scenario, to identify the harassing behavior as negative or wrong.

Some Symptoms of Depression

  1. Feeling sad or hopeless for an extended period of time.
  2. Feeling little interest or pleasure in doing things that once were pleasurable.
  3. Significant weight loss or gain.
  4. Disturbance in sleep pattern.
  5. Noticeable agitation or slowness.
  6. Fatigue or loss of energy.
  7. Inappropriate feelings of worthlessness or guilt.
  8. Diminished ability to concentrate or make decisions.
  9. Recurrent thoughts of death or suicide.

With the hypothesis that the negative consequences of being a female partner of a gender conflicted male would be significant, Rochlen initiated a survey of about 170 women to see if his theory was correct. As predicted, Rochlen discovered that women who had gender conflicted male partners reported being more depressed, anxious and less satisfied in the relationship.

“So-called ‘alpha’ males who experience higher levels of power, success and competition and lower levels of emotional sharing and intimacy with others don’t seem to be good for healthy, romantic relationships,” says Rochlen. “So what you have are men who are making themselves unhappy and isolated by being this way and women who are unhappy with them being this way—and the more ‘this way’ they are, the more resistant to getting help they become. It’s a real dilemma.”

Fortunately, it’s a dilemma that researchers like Rochlen are tackling and anecdotal evidence suggests that men slowly are changing their definition of “masculinity.” Broader definitions of what it means to be a man have resulted in an increase over the past several years in the number of men who are getting professional help for emotional problems and mental disorders.

According to Rochlen, men also have benefited from the relatively recent acknowledgement in the medical community that gender must be considered when diagnosing and treating many mental and physical health problems

In addition to studying men’s mental health, Rochlen also is researching the use of dream interpretation in therapy, career counseling, and the effectiveness of online counseling. In August Rochlen will be presenting a paper on men’s mental health at the annual American Psychological Association (APA) meeting and is participating in a program with the president of APA at a symposium entitled “Men and Depression—New Perspectives in Practice, Healthcare Promotion and Research.”

Kay Randall
Office of Public Affairs/College of Education

Photo of Dr. Rochlen: Marsha Miller

Facts and symptoms from “Real Men, Real Depression” Campaign


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  Updated 2014 October 13
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