Get angry or get even: Finding balance in the discussion of masculinity and mental health

To the Editor

In August 2018, the American Psychological Association (APA) released the first set of guidelines for psychological practice with men and boys (American Psychological Association, Boys and Men Guidelines Group, 2018). Despite a quiet reception among those in the field, these went largely unnoticed until a tweet (January 2019) titled ‘Traditional masculinity is harmful’ went viral. Within this context, ‘traditional masculinity’ refers to a dominant, largely Western concept of masculinity, underpinned by norms of stoicism, strength and self-reliance (Addis and Cohane, 2005). In response to the debate, men across the globe took to social media sharing opinion pieces expressing their disgust with the APA’s blatant, ‘unscientific’ attack on masculinity. Importantly, however, these guidelines largely concur with the results of our own recently published international Delphi study (Seidler et al., 2019).

What is being drowned out by the men’s rights uproar is this; the APA guidelines for psychological practice with men and boys aim to provide practitioners with a better understanding of men and their multiple masculinities, not pathologise or get rid of maleness. These guidelines clarify traditional masculinity as only one of many ways of enacting masculinity, although traditional masculinity is the most historically privileged among them (Seidler et al., 2017). The APA guidelines clearly state the benefit of a flexible endorsement of traditional masculine norms according to the given situation, offering men a wider range of adaptive coping responses and behaviours. The guidelines also point to the possible harm associated with a rigid and inflexible adherence to these same norms, viewing behaviours like risk-taking or competitiveness, for instance, on a continuum from healthy to unhealthy. The disproportionate rates of male suicide, substance abuse, interpersonal violence and impeded help-seeking are all evidence of the broad negative health implications stemming from a rigid enactment of traditional masculinity (Affleck et al., 2018).

Mental healthcare practitioners can hold explicit and implicit biases, and can at times be complicit in either reinforcing stereotypical masculine responses in their male patients (e.g. overdiagnosing anger issues and underdiagnosing men with depression; Affleck et al., 2018). Armed with this knowledge, practitioners can challenge and overcome restrictive stereotypes infiltrating their treatment practice, instead offering tailored, engaging and useful treatment to their male patients (Seidler et al., 2019). Therefore, argument for change does not restrict or disempower men, as many commentators have suggested, but rather helps to find ways that practitioners can become aware of and promote positive, healthy and diverse gender norms that improve well-being in all men. In broadening the definition of masculinity, we can support men to choose to flexibly apply these useful traits to their advantage and not feel controlled by them.

It is time the field moves away from ‘gender blind’ mental health curricula, training and service delivery, towards a ‘gender inclusive’ model of care that incorporates, understands and responds to masculinities (Seidler et al., 2017). Without this development, we will struggle to keep men engaged in services and stop their deaths by suicide (Addis and Cohane, 2005). In focusing on drawing out men’s strengths and leveraging their masculinities to promote health and well-being, the mental health field has a unique opportunity to improve population health. This should not be stymied by critics who are now fighting against the very thing they have been asking for.