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Abstract

Although the literature on men’s help seeking offers important insights into health service engagement patterns within this population, there remain gaps in our understanding. In addition to insufficient attention to a range of male experiences and a restricted focus on sex-specific or associated diseases, much of the extant work is limited by insufficient attention to how men navigate needs and supports across illness and a narrow conceptualization of the core concept of help seeking. Specifically, as research focuses on masculinity as a determinant of the decision to seek medical help (emphasis on prediction), less is known about how men, as gendered beings, are experiencing help seeking over the course of illness (emphasis on understanding). In this article, it is argued that research on men’s help seeking can benefit from the integration of a dynamic conceptualization of help seeking that is considerate of shifting needs and a diversity of supports and which emphasizes the subjective, interactive, and ongoing patterns in how men are perceiving, interpreting, and responding to the challenges of illness.

Keywords

men’s health help seeking gender theory illness behavior illness career

Introduction

Within the field of men’s health studies, a growing body of literature has focused on the study of barriers to men’s use of medical supports in the face of signs and symptoms of illness. Emphasizing a need to consider men’s help seeking through a gender lens, researchers argue for the need to ask “why” and “how” men’s help seeking appears to be problematic at a broad level (Smith, Braunack-Mayer, & Wittert, 2006) and why service use patterns vary among groups of men and across settings (Addis & Mahalik, 2003; Galdas, 2009). In accepting illness behavior as gendered, research often prioritizes the influence of masculinity norms (Galdas, 2009). This body of literature offers valuable insights into why some men delay or avoid engaging some health services, but critical gaps remain, including insufficient attention to a diversity of male experiences (Galdas, 2009) and a restricted focus on help seeking for sex-specific or associated diseases (O’Brien, Hunt, & Hart, 2005). Even more, there has been inadequate attention to how men navigate help seeking over time and an associated narrow conceptualization of help seeking. This article addresses the latter two limitations.

Following a critical review of the theoretical and empirical literature on men’s health-related help seeking, it is argued that although understanding has been significantly influenced by evolutions in gender theory, the study of how men respond to the challenges of illness can also benefit from theoretical developments found within the field of illness behavior. In particular, this article encourages a dynamic approach to help seeking by focusing on the interactive and subjective processes that continue across the course of illness and engage a diversity of informal and formal supports. By emphasizing help seeking as a trajectory or pathway, rather than an isolated, single decision point leading toward or away from medical services, the nature and qualities of the concept itself are problematized. The argument is made that theoretical and empirical work on men’s help seeking can be enhanced by a consideration of help seeking as a subjective, interactive process defined and guided by a variety of approaches and strategies that lead to a range of short- and long-term outcomes over the course of an illness experience.

As research focuses on masculinity as a determinant of why men may or may not engage medical help, there is limited understanding of how men experience needs and supports over the course of illness. Linguistically, the distinction is small, but conceptually and empirically, it is the difference between efforts to predict or explain help-seeking behaviors and those to understand the subjective experience of this process. If researchers accept the powerful influence of gender (and its many intersections) on how men make sense of illness-related needs and supports, there is value in examining help-seeking patterns beyond the initial medical visit. This expanded view is key to developing the knowledge important to enabling relevant and appropriate supports for men living with illness.

Summary of the Current Theoretical and Empirical Literature

Accepting health outcomes as partially influenced by modifiable behaviors (Robertson, Galdas, McCreary, Oliffe, & Tremblay, 2009), researchers over the past 30 years have focused attention on research suggesting that despite their elevated health risks, men in Western countries (particularly those aged between 18 and 64 years) tend to visit health providers at a lower rate than do women, even when accounting for obstetrical visits (Bertakis, Azari, Helms, Callahan, & Robbins, 1999; Blackwell, Martinez, Gentleman, Sanmartin, & Berthelot, 2009; Lee & Owens, 2002; Nabalamba & Millar, 2007; Pinkhasov et al., 2010). As detailed by Addis and Mahalik (2003), research on men’s help seeking has adopted three main approaches: comparisons of male and female rates of health service use, considerations of how gender role socialization influences men’s behaviors, and a social constructionist approach that recognizes health behaviors as gender performances.

Turning first to the sex-comparative research, although this body of primarily quantitative work provides some conflicting information about men’s help seeking amidst the inconsistent use of data collection tools and measures (Galdas, Cheater, & Marshall, 2005), it has had significant influence, indicating that men are less likely than women to seek medical help, tend to ask fewer questions and receive more limited information when meeting with practitioners, and are less likely to be compliant with medical directives (Addis & Mahalik, 2003; Courtenay, 2000a; Lee & Owens, 2002; D. Williams, 2003). Although this approach has garnered attention to men’s help seeking, it obfuscates diversities among men and similarities between men and women, is unable to explain processes linked to variations, and can fuel practiced stereotypes about men (Addis & Mahalik, 2003; Galdas, 2009; Schofield, Connell, Walker, Wood, & Butland, 2000).

The second approach, the study of how gender role socialization guides health behaviors (Addis & Mahalik, 2003; Good, Sherrod, & Dillon, 2000), is consistent with assumptions of sex role theory. In quantitative research, this lens guides the use of ideology and conflict scales, and it can serve as an assumptive base in qualitative work on how men perceive and react to symptoms. In both realms, as research accepts gender as a relatively stable, individual-level trait, questions focus on intrapsychic factors (i.e., adherence to gender norms discouraging help seeking) to predict or explain acts of help seeking. In accepting variability among men, research through this lens fills a gap left by gender-comparative work (Addis & Mahalik, 2003). However, in treating gender as a trait, it cannot handle the influence of context, leaving unanswered: “Why are some men, under some circumstances, able and willing to seek help for some problems but not for others?” (Addis & Mahalik, 2003, p. 7; see also Galdas et al., 2005). Even more, although sex role theory remains influential, it is criticized for assuming that a culturally dominant ideology is the norm, for treating gender as passively acquired, and as insufficiently attuned to power issues between and among men and women (Connell, 2009; Kimmel, 2007).

Social constructionists offer a third approach to theorizing men’s help seeking. Accepting that men learn sociocultural norms outlining behavior expectations, constructionists conceptualize gender as a verb, not a noun (Connell, 2005; West & Zimmerman, 1987). In other words, men manage their acts according to the situation to make their gender accountable to others present. In any given situation, a man might follow a range of gender norms, challenge them, or step around them, but he acts knowing that others are evaluating whether his act is appropriate for a man (West & Zimmerman, 1987). Masculinities (Connell, 1995) are socially built, multiple, and dynamic.

Within this orientation, health behaviors are viewed as performances of masculinity (Galdas, 2009; Moynihan, 1998), or as Noone and Stephens (2008) detailed, “‘doing’ health reflects ‘doing’ gender’” (p. 712). Research exploring help seeking through this lens accepts that a man’s acts can vary not only by intersections of age, race, class, sexual orientation (and more) but also according to situational context, the type of help required, expectations of others (including institutional forces), and perceived risks of not accessing support (Addis & Mahalik, 2003). There is recognition of the health implications of men’s efforts to match their acts to the prioritized way of being a man (Courtenay, 2000b) and awareness that help seeking is influenced by shifting constructions of masculinities as men build meanings of masculinity with others and in relation to femininity norms (Noone & Stephens, 2008; O’Brien et al., 2005).

As Oliffe (2007) argued, the study of men’s health has been limited by a lack of attention to the context of men’s lives, and a social constructionist lens offers an important opportunity to access “commonality as well as diversity” (p. 6) in how masculinity intersects with behaviors across the complexity of individual lives. Even more, a constructionist approach can better position researchers to respond to the important criticism that the field of gender and health must more fully engage with the complexity of the social determinants of health and a richer spectrum of health experiences as influenced by an array of social locations, or identity “axes” (Hankivsky & Christoffersen, 2008). Directly, gender cannot stand alone in studies of health but must be recognized as inextricably connected with other social identities including race, class, sexual orientation, ability, and more. As space is made for variability among men and within one man’s experience, research can actively oppose essentializing assumptions while also avoiding attributions of deficiency associated with masculinity.

Whether conceptualizing gender as a trait or as a process, empirical work examining men’s health-related help-seeking beliefs and acts tends to gather into two main areas: recognizing concerns and acting on them. In detailing the first domain, research offers a list of factors, including inaccurate symptom identification or normalization of signs (Chapple, Ziebland, & McPherson, 2004; Gascoigne & Whitear, 1999; Richards, Reid, & Watt, 2002; Sanden, Larrson, & Eriksson, 2000; White & Johnson, 2000), beliefs that scrutinizing one’s body is a feminine practice (O’Brien et al., 2005), and a sense of invincibility (White & Johnson, 2000). With regard to acting on concerns, findings describe men’s fears of wasting a physician’s time or appearing as a hypochondriac (Chapple et al., 2004; Galdas, Cheater, & Marshall, 2007; O’Brien et al., 2005), feelings of embarrassment around procedures (Chapple et al., 2004; Evans et al., 2005; Gascoigne & Whitear, 1999), beliefs that help seeking must be a last resort (Chapple et al., 2004; O’Brien et al., 2005; Rose, Kim, Dennison, & Hill, 2000; Tudiver & Talbot, 1999), and structural barriers related to clinic design or operation and practitioner performance (Banks, 2001; Seymour-Smith, Wetherell & Phoenix, 2002; Smith et al., 2006). In contrast, pain, sudden changes, constraints to functioning (Gascoigne & Whitear, 1999; Sanden et al., 2000; White & Johnson, 2000), and female partners (Chapple et al., 2002; Gascoigne & Whitear, 1999; Tudiver & Talbot, 1999) have been positioned as forces directing men to medical supports.

In linking correlates together, authors often interpret patterns through the lens of male socialization, with emphasis on a dominant image of masculinity in Western culture prioritizing stoicism, independence, denial of vulnerability, and self-reliance. However, variability has also been noted, particularly as researchers have begun to examine a diversity of male experiences, including those of immigrant, Black, gay, and low-income men (e.g., Galdas & Cheater, 2010; Malebranche, Peterson, Fulliove, & Stackhouse, 2004; O’Brien et al., 2005; Robertson, 2003; Rose et al., 2000; Wade, 2009; Winterich et al., 2009). As research struggles to engage with the fluid complexities of masculinities, detailing how “masculinities and health behaviours connect in unique and contradictory ways” (Oliffe, 2007, p. 17) across place and over time, it is increasingly apparent that men’s lived experiences frustrate efforts to offer simple summaries of who men are and how they respond to signs and symptoms of disease. Rather, both the process and production of understandings must be contextualized and nuanced.

Expanding the Conceptualization of Men’s Help Seeking

Adoption of a social constructionist lens and the associated recognition of variability in male experiences is an important step forward in the effort to understand the phenomenon of men’s health-related help seeking, but additional steps are required. For even amidst this more complex picture of how men perceive and respond to the signs and challenges of illness, heavy focus on masculinity as a determinant of whether men see help seeking as a viable choice directs research attention to a single medical decision at the onset of signs and symptoms (“why” men might resist help seeking) and limits consideration of how men are making sense of a diversity of needs and supports across illness (“how” men experience it). Theory approaches that focus on gender as deterministic are important but are too limited in the effort to study men’s help seeking more fully. Additional theoretical lenses must be applied to this phenomenon.

One approach to extending research on men’s help seeking is to draw on theoretical developments offered within the field of illness behavior, a domain of study positioning help seeking as one of a variety of concurrent responses to illness. Following a brief introduction to this research field, two broad orientations to conceptualizing help seeking are described, with emphasis given to how a dynamic approach can complement current work on men’s help-seeking experiences. In arguing for a shift in how help seeking is framed, attention is then given to six qualities of the core concept relevant to informing theoretical and empirical research on how men respond to needs across illness.

Examining the Dynamics of Men’s Health-Related Help Seeking

Medical sociologists, building much of the theory on illness behavior over the past 50 years (Young, 2004), define it as the many ways “individuals respond to bodily indications, how they monitor internal states, define and interpret symptoms, make attributions, take remedial actions and utilize various sources of formal and informal care” (Mechanic, 1995, p. 1208). This orientation positions a biomedical focus on disease as inadequate as it introduces a focus on the socially constructed nature of the illness. As Cassel (1976) explained, disease “is something an organ has; illness is something a [person] has” (p. 27). If research is to understand the complexity in how individuals respond to illness, work must consider subjective perceptions and evaluations as well as biological and environmental factors (Mechanic, 1995; Young, 2004).

As part of a broader complex of illness behaviors, help seeking has been conceptualized in two main ways: the rational choice (or “dominant”) approach exploring who seeks help and the dynamic approach exploring when and how one seeks help (Pescosolido & Boyer, 1999). As Pescosolido and Boyer (1999) detail, the rational choice approach focuses on a single decision (did one seek medical help or not), and help seeking is accepted as a voluntary, logical decision made by informed individuals weighing benefits and costs. This orientation has been described as a “ballistic approach;” individuals are viewed as missiles to be launched into the health system as researchers identify factors (i.e., age, class, gender) influencing successful deployment (Calnan, 1987). Focused on profiling users, tallying service outcomes (e.g., frequency), and predicting help seeking by measuring psychological, structural, or demographic factors, this approach is evident in empirical efforts drawing on health behavior theories including Andersen’s sociobehavioral model, Azjen’s theory of planned behavior, and Rosenstock’s health belief model (Armstrong, 1999; Pescosolido & Boyer, 1999).

In contrast, the dynamic approach accepts help seeking as part of an ongoing, interactive process of decision making (Pescosolido, 1992; Uehera, 2001). Informed by sociological inquiry into chronic illness, social networks, medical pluralism (i.e., many modes of healing), and recognition that individuals interpret symptoms within a powerful sociocultural context, the dynamic approach is argued to address three key limitations of the rational choice approach: (a) a conceptualization of help seeking as an either/or decision, (b) limited integration of deep understandings (meanings, processes, and practices), and (c) a lack of awareness of how health problems pervade one’s life (Pescosolido, 1992, 2000). Rather than limiting focus to the initial doctor visit, the dynamic approach examines the illness career, or “pathways” of care guided by lay networks (e.g., friends, clergy), a range of “healers” (e.g., physicians, homeopaths), and remedies (Pescosolido, 1992) as individuals move toward recovery or, if a cure is not possible, enhanced quality of life (Aneshensel, 1999). Emphasizing descriptions rather than explanation, consideration is given to how individuals work with others to recognize and define needs, decide to seek help (or not), evaluate choices, and seek informal and formal support during illness (Biddle, Donovan, Sharp, & Gunnell, 2007; Broadhurst, 2003; Pescosolido, 1992). Integration of subjectivity allows that definitions can evolve over the course of illness and in response to shifting physical and psychological conditions, priorities and expectations (Price, 1996), interpretations, and other labels (Coreil, Bryant, & Henderson, 2001; Liang, Goodman, Tummala-Narra, & Weintraub, 2005).

Pescosolido (2000) has argued that the question of “how individuals come to recognize, understand, and cope with health problems” is a “deceptively simple” one (p. 175), an observation holding true for the study of men’s experiences. As research on men’s help seeking has been dominated by psychology and health studies (Galdas et al., 2005) and aligned with men’s health studies (and, thus, men’s studies, more broadly; Crawshaw & Smith, 2009), there is little evidence that research is attuned to the sociological discussions of illness behavior, including theoretical developments specific to help seeking. In this absence of attention, research on men’s experiences has remained largely consistent with a rational choice approach, focusing on profiling users and failing to seize opportunities afforded by the explicit integration of a dynamic approach considerate of the ongoing, subjective process of help seeking.

Although efforts to predict help-seeking have merit, they are not sufficient. Focus on a single medical decision point or experience threatens to oversimplify theoretical and empirical understandings of how men experience and respond to illness, particularly nonacute conditions. Illness is not confined to the initial signs and symptoms of disease but is marked by a complexity of diverse and shifting needs and support opportunities in a variety of contexts. To develop a richer understanding of the phenomenon of men’s help seeking, questions of why men do or do not seek support must be complemented by those asking how men experience these.

In emphasizing the subjective, interactive, and dynamic process of help seeking, there are, at minimum, six intersecting aspects of this core concept important to orienting theoretical and empirical research to the study of how men respond to illness-related needs. These include awareness that (a) help seeking is initiated by a recognized need, (b) help seeking is interactive, (c) help seeking can take on a variety of appearances, (d) help seeking is learned, (e) help seeking can be directed by a variety of strategies, and (f) help seeking does not always lead to the resolution of a problem. Critically, these are offered as sensitizing concepts. In contrast to definitive concepts that “prescribe” the focus of analysis, sensitizing concepts “suggest directions” of research consideration (Blumer, 1954, p. 7). Or as Charmaz (2003) detailed, they are “starting points” in the analytic process (p. 259). In this spirit, the six elements are discussed with reference to how these dynamics are touched on in the existing literature on men’s help seeking and with consideration to how work can expand to engage with them more fully, thus fostering a more dynamic approach to the examination and understanding of men’s help seeking.

Help seeking is initiated by a recognized need

The presence of a pathogen is not sufficient for help seeking. The process can proceed only after an individual defines a situation as problematic and believes intervention is required (Kessler, Brown, & Broman, 1981). Recognition that subjective interpretations guide illness trajectories (Dingwall, 1976; Mechanic, 1989) encourages attention to how men perceive concerns and apply meaning to them. Signs and symptoms are interpreted according to situation, presentation, socialization, experience, and knowledge (see Brown, 1995; Coreil et al., 2001; Mechanic, 1989). Individuals who are more tolerant of symptoms, able to ascribe them to other sources, or drawn to deny illness are less likely to seek help (Mechanic, 1978). Accordingly, a man might view himself as ill in the absence of a pathogen or, alternately, not consider himself ill even when faced with disease (Mechanic, 1995). This pattern can also hold true for nonphysiological needs experienced across an illness career, whether they be information gaps, emotional struggles, financial needs, strained relationships, and so on.

As noted, the literature on men’s help seeking is attuned to this dynamic with regard to the initial physiological signs of illness, as researchers examine how some men might normalize or misinterpret symptoms, thus delaying medical visits. Particularly interesting is the work examining the influence of social norms that discourage men from taking too close of an interest in their bodies, positioning this as a practice reserved for women (Lee & Owens, 2002; Noone & Stephens, 2008; O’Brien et al., 2005; Robertson, 2003). White and Johnson (2000) have described this challenge in recognizing illness as a process of denial and rationalization, arguing that men in Western society can find it difficult to see themselves at risk, viewing acceptance of bodily dysfunction as a challenge to male strength and power. This notion resonates with Oliffe’s (2007) description of how men in his study felt pressured to deny or conceal illness amidst the social expectation of “a functional, resilient, ‘hard’ masculine body” (p. 9).

Attention to this process of identification and interpretation is central to understanding when, why, and how men reach out for supports, but research can also consider this gendered process across the course of illness, including how men make sense of ongoing physiological shifts as well as the emotional and social concerns across an illness experience. Research has detailed men’s efforts to develop knowledge around potential as well as diagnosed conditions (Oliffe & Thorne, 2007; Smith, Braunack-Mayer, Wittert, & Warin, 2008). This practice of learning can influence how men define and redefine needs. Recognizing this interpretive process as influenced by the perceived definitions of others, there is value is considering how men work with others in their lives to make sense of concerns. Apart from some attention to how wives might encourage men to see a doctor or engage in treatment (Chapple et al., 2002; Gascoigne & Whitear, 1999; Norcross, Ramirez, & Palinkas, 1996; Parslow, Jorm, Christensen, Jacomb, & Rodgers, 2004; Tudiver & Talbot, 1999), there has been limited information on how others in a man’s life influence this interpretive process. Research can benefit from a more nuanced study of the role of female partners, including that men may draw on partners to validate existing concerns (O’Brien et al., 2005; White & Johnson, 2000), offering them a way to legitimize a decision to seek help while maintaining their male identity (Robertson, 2003). Even more, there is a need to consider the influence of others in a man’s social network, particularly given that not all men have female partners (i.e., gay or single men) or have partners attuned to their needs.

Help seeking is interactive

Help seeking is a process of engaging with another person (or multiple others) to obtain support. This relational nature attunes research to interactive processes as men engage others in an “intensely personal” pursuit (Rickwood, Deane, Wilson, & Ciarrochi, 2005, p. 8). In accepting health behaviors as performances of masculinity, it is recognized that men construct this performance with others, whether they be health professionals, partners, friends, coworkers, or others. In addressing this dynamic, research on men’s help seeking has primarily focused on the patient–physician relationship. Studies indicate that men value communications with practitioners characterized by humor, empathy, frankness, competence, and promptness (Smith et al., 2008), qualities associated with an idealized masculinity image (direct, skilled) or which enable men to step away, even briefly, from the emotional intensity of the exchange (humor; Oliffe & Thorne, 2007). Although these patterns suggest efforts to present a more dominant masculinity, analysis by Oliffe and Thorne (2007) on the experiences of men with prostate cancer interacting with a male physician offers a more complex image, indicating a range masculinity performances in response to the inherent hierarchy in this dyad and demonstrating that the realities of disease can “disrupt” the dominant performance. Considering the role of health providers in this process, Seymour-Smith et al. (2002) found that the practitioners they interviewed were well versed in “what men are like,” endorsing dominant masculine ideals as they affectionately chided men as “hapless and helpless” in health matters and women as responsible, if a bit neurotic (p. 265). Notably, men who stood outside of this hegemonic form—including men without female partners (single and gay men) or who were perceived as “more feminine”—were invisible or positioned as trivial users, akin to women (Seymour-Smith et al., 2002).

Bringing the lens of intersectionality to this discussion, Malebranche et al. (2004) illustrated how barriers of distrust and stigma faced by some subpopulations of men can complicate help-seeking interactions. In particular, they found that the Black men who have sex with men in their study did not see their experiences reflected as they met with primarily White service providers. As one man noted, “I think a lot of times it’s just a culture. And a lot of these people [doctors] might be knowledgeable, but they’re not knowledgeable of the people they’re dealing with” (p. 102). Research with African Nova Scotians has also evidenced challenges of racism, as men expressed feelings of being unwelcomed by practitioners (Evans et al., 2005).

Consideration of the complexity of interpersonal dynamics across the experience of illness is critical, and the important work on engagement with medical professionals can be complemented by the examination of interactions more broadly and over time, including how men engage with informal supports (i.e., family, friends), illness support group, and even online social networking groups. In particular, the rapid proliferation of web-based health information and interactive sites (i.e., web 2.0) may deserve special attention as this medium has been shown to introduce important shifts in how health information is exchanged and integrated, including how information gathered online is used to support face-to-face modes of help seeking (Ybarra & Suman, 2006).

Help seeking can take on a variety of appearances

Help seeking can take the form of a discussion about a problem or a specific request for assistance or advice in a variety of settings (Gourash, 1978). In particular, research suggests that stigmas (Goffman, 1963) associated with a condition as well as sociocultural norms around help seeking influence not only whether an individual asks for help but also how they engage, including the use of indirect approaches to soliciting support (Kim, Sherman, & Taylor, 2008; S. Williams & Mickelson, 2008). Notably, indirect methods can be associated with unsupportive responses from potential help providers (S. Williams & Mickelson, 2008). In one of the few reflections on how men approach supports, Tudiver and Talbot (1999) reported that the physicians in their study perceived men as more likely than women to use indirect methods of sharing around health concerns, providing only general information and relying on health providers to ask specific questions. This finding is congruent with patterns of more limited clinical exchanges, detailed earlier.

Although devoting limited attention to how men approach support solicitation, existing research on men’s help seeking is exploring the foundational matters of stigma and sociocultural variability. At a broad level, it is recognized that conditions perceived as severe (e.g., cancer) or preventable (e.g., AIDS) tend to be more stigmatizing (Crandall & Moriarty, 1995), and research on the experiences of men with prostate cancer indicates that this disease can present a double stigma in association with the potential for a loss in sexual potency, leading men to avoid disclosure around their illness (Gray, Fitch, Phillips, Labrecque, & Fergus, 2000). Furthermore, depression and mental health concerns, including those associated with physical illness, are frequently cited as particularly threatening to a masculine presentation of stoicism and emotional restraint (Addis & Mahalik, 2003; Moller-Leimkuhler, 2002; Moynihan, 1998; O’Brien et al., 2005).

Stepping into the complex intersections of gender, conditions, and context, theoretical work by Addis and Mahalik (2003) suggests that a man is more likely to ask for help for a problem perceived as common or “normal” and which is not central to his identity, particularly if his social group is supportive and he believes the benefits of asking for help exceed the costs. These patterns bear out in empirical work exploring gendered patterns in association with other elements of identity, including age, occupation, race, and ethnicity. O’Brien et al. (2005) found resistance to seek help most pronounced among young and/or healthy men in their study, whereas men facing severe illness (e.g., prostate cancer), lost sexual functioning, or had a job requiring fitness (firefighters) were less likely to express a desire to “push it further” (p. 512). Explaining these patterns, the authors described young men as keen to follow peer norms characterized by a reluctance to seek help, whereas men with cancer or sexual dysfunction were willing to risk the threats associated with asking for help in exchange for a prioritized benefit of survival or preserved sexual performance. Alternately, positive group norms around health and fitness were understood to facilitate help seeking among firefighters, because of the importance of health for preserving their status as members of an “archetypically masculine occupation” (p. 514).

Integrating racial and ethnic identities into this discussion, Evans et al. (2005) argued that relative to White men, Black men in North America might perceive greater stigmas associated with prostate cancer screening (i.e., digital rectal exams) given their more limited opportunity to demonstrate a valid masculinity in a society marred by racism and marginalization (see Winterich et al., 2009). In addition, Galdas et al. (2007) found that U.K.-based men of Indian and Pakistani origin did not consider disclosing illness to family or formal help seeking as “unmanly,” focusing instead on wisdom, learning, and caring for health and family as core to masculinity. As one man noted, “Not to tell anybody, that’s not Asian that’s English” (p. 227).

Whether or not men adhere to social expectations around the resiliency of men’s bodies or the valuation of self-reliance and stoicism, these scripts are part of the discourse around men’s health in Western society (Oliffe, 2007). This story line can influence how comfortable men are soliciting support, which supports they engage, and how ready others are to offer assistance (Moynihan, 1998), an important bidirectional reality Kim et al. (2008) recognize in their assertion that a request for help is partially influenced by the “mutual understanding about the propriety and efficacy of seeking such support” (p. 519). Existing work has taken the critical step of drawing attention to variability in how threatening medical help seeking can be for men in relation to their condition and the context of their social and cultural communities, but there is a need to challenge research toward a consideration of the influence of these patterns on how men engage with others to address an array of challenges. Although men may delay or even avoid formal requests for help in the face of certain conditions, this does not mean they are inactive (see Smith et al., 2008). In the face of stigmas and prohibitive norms, men may adopt a variety of approaches (including coping, self-care, etc.) by which they respond to needs over an illness career. Some of these will be more effective than others. To enhance a full range of supports, research must be alert to indirect approaches, such as chats with a friend, as well as acts conforming to the more obvious, ask–receive exchange that may occur in a clinical setting (though this is, as noted, rarely simple).

Help seeking is learned

Whether engaging informal or formal supports, individuals must learn how to effectively obtain help from a diversity of others for a variety of needs in a range of contexts. This matter can become more complex in the face of novel or ambiguous experiences and within rigid systems such as formal medical services where procedures for soliciting help are more prescribed. In all cases, though, individuals are neither innately prepared nor naturally competent (or incompetent) at this endeavor. Accordingly, research must consider not just attitudes toward help seeking but also opportunities for skill development.

This matter has received limited attention in men’s help-seeking research, where focus on individual-level actions has limited the integration of detailed consideration of how men learn to care for their health. Researchers have found that relative to women, men in their studies position themselves as not as comfortable or interested in matters of health, arguing that it is easier for women to discuss personal or “embarrassing” issues and practice healthy behaviors (Chapple et al., 2004; Gascoigne & Whitear, 1999; Noone & Stephens, 2008). Battling against a stereotype that men simply care less about their health (a criticism leveled against studies of men’s help seeking by Smith et al., 2008), these patterns are appreciated by some as products of a broader social system positioning health as a woman’s issue (and the positioning of women as “naggers” or “nurturers”; Robertson, 2007; Seymour-Smith et al., 2002). With the exception of sports-related training, it is argued that boys and men tend to receive more limited formal and informal guidance on how to care for their health, including the provision of informational materials/programs and practice of regular medical visits (Banks, 2001; Courtenay, 2000b). The positioning of health as a female responsibility not only levels an unequal burden on girls and women but can also leave boys and men with more limited exposure to, and experience within, the health care system. This dynamic emphasizes the need to consider men’s prior experiences with the health system and help seeking and how their ability to effectively engage supports develops with practice.

Help seeking can be directed by a variety of strategies

As detailed, existing work oriented around questions of why men delay or avoid help seeking prioritizes the study of why some men are reluctant to seek medical help in the face of problematic signs and symptoms. Although framed as a barrier to help seeking, this is a process some in the field of education refer to as a form of nonadaptive help seeking (Karabenick & Newman, 2006). Less often considered in research specific to men and illness are other strategies of help seeking, as presented by Karabenick and Newman (2006), including the act of relying on others to do what one does not want to do himself (a second form of nonadaptive help seeking) and the practice of requesting information and support that effectively allows the individual to mitigate or eliminate a challenge (adaptive help seeking). Notably, the process of adaptive help seeking is understood to facilitate short-term, situation-specific problem solving as well as enable learning that increases an individual’s capacity to address future challenges (Newman, 2008).

Although those concerned with the individual and social costs of not seeking timely medical care are justified in focusing on why some men avoid or delay care, there is value in adopting the framework of nonadaptive help seeking. As Biddle et al. (2007) noted, research can benefit from explicitly examining the perceptions and interpretations (“drivers of action”) that move individuals away from supports rather than viewing these as barriers to the process. Awareness that perceptions of need and meanings of help can pull men from supports is implicit in existing research on men’s help seeking, particularly in research adopting a social constructionist approach accepting health behaviors as performances of masculinity. However, by adopting the framework of nonadaptive help seeking, there is opportunity to consider how avoidant help seeking (and dependent help seeking) practices can limit men’s ability to address concerns in the short term and can contribute to longer term vulnerabilities (see Newman, 2008).

At a broader level, whether research emphasizes barriers or nonadaptive processes, there are risks associated with prioritizing how men do not seek support. First, in emphasizing this dynamic, to the exclusion of others, work can perpetuate an inaccurate perception that all men resist help seeking (Galdas, 2009; Pietila, 2008) and that all men are resistant in the same way, a conclusion that stereotypes men and marginalizes healthy performances of masculinity. Second, in neglecting how men engage in adaptive forms of help seeking for a variety of needs (not just medical), work is not attuned to how men are developing their capacity (including help-seeking skills) to address illness-related challenges across the course of a single illness career as well as over a lifetime. For example, researchers can anticipate that men who have experience working through health challenges, both physiological and mental, may be differently attuned to these needs and the available supports relative to men lacking this experience. As Price (1996) noted, “As the case notes get fatter, so does the catalogue of experiences” (p. 276).

Help seeking does not always lead to the resolution of a problem

Finally, the solicitation of support does not automatically result in receipt of beneficial assistance (Gourash, 1978). Given the complexity inherent in the process of help seeking, as indicated across this discussion, this sixth sensitizing element is of little surprise but of critical importance. In arguing for the medical and social value of engaging with others to address a variety of illness-related challenges, it is not sufficient to examine whether a man sought help, research must also consider whether the need is addressed. Research considerate of this dynamic recognizes the role of patient–provider communication in health outcomes (e.g., Oliffe & Thorne, 2007) and has emphasized service gaps, noting that men’s interactions with practitioners tend to be briefer and result in more limited transmission of information and advice (Courtenay, 2000b) and arguing that health providers can fail to deliver health messages in a manner sensitive to how men are socialized in Western society (Smith et al., 2006).

Although current work centers on episodic clinical visits, this consideration increases in significance as help seeking is recognized as an ongoing, interactive process fuelled by medical and nonmedical challenges. Specifically, it can be theorized that unsuccessful engagement with a medical provider, family member, friend, or other support can influence a man to seek alternate avenues or experience unmet needs (and limited capacity or skill development) that can continue to have impacts throughout his illness and beyond. In particular, the challenge of addressing mental health challenges associated with illness and the enduring individual, relational, and social costs of untreated depression among men (Moller-Leimkuhler, 2002) emphasize the need to evaluate the impact of psychological as well as physiologically focused interventions.

In developing methodologies that support an examination of the impacts of a diversity of men’s help-seeking processes, awareness of the interactional nature of help seeking (as detailed) emphasizes the importance of viewing outcomes as a product of the relationship between the one seeking help and the one providing it. For example, frameworks offered by attachment theorists support a study of support seeking as a dyadic process bringing together attachment and care-giving systems, recognizing the contribution of this process to a sense of security within an intimate relationship (Collins & Feeney, 2000) and the efficacy of clinical interventions (Hunter & Maunder, 2001). As Collins and Feeney (2000) explained, “A capacity for intimacy and sense of confidence that one is valued by others appear to be vital both for recruiting social support and for providing sensitive care to others” (p. 1071). Other theoretical lenses may also apply, but acceptance of the interactive nature of help seeking requires consideration of the impact of this bidirectional process over the course of the illness career. Not all seekers are adept at soliciting support, not all carers skilled at providing it, and not all challenges amenable to solution.

Conclusion

An evolving conceptualization of gender has challenged research on men’s help seeking to move beyond essentialist portrayals of problematic men and encourages consideration of how men work with others to perform masculinity through health behaviors, including requests for support. These developments are emphasizing the importance of attending to intersectional dynamics, including research that incorporates the experiences of a diversity of men and recognizing variability in behaviors across conditions, context, and time. However, in focusing research on the question of whether (and which) men do or do not go to the doctor, emphasis has been placed on how masculinity acts as a determinant of behavior, limiting attention to how men, as gendered beings, experience help seeking over the course of a single illness career or across multiple illnesses.

Sociological advancements in the field of illness behavior can help push the conceptualization of help seeking beyond the “tyranny of use/no use” (Pescosolido, 2000). The dynamic approach accepts help seeking as an interactive, ongoing process of formal and informal support seeking, not as a single, individual, rational decision to seek medical care. In this expanded framing, research can be sensitive to a more nuanced consideration of the core concept of help seeking, acknowledging the process as influenced by perceptions, interactions, skills, and strategies and varying in methods and outcomes. These sensitizing elements are positioned as particularly relevant given the current focus of research on men’s help seeking, but there are, undoubtedly, many more to consider. The field of illness behavior is vast (see Young, 2004), offering a diversity of theoretical orientations and tremendous array of empirical understanding that may prove beneficial to scholars exploring how men experience and respond to illness. Even more, there may be value in expanding this lens to consider men’s help seeking processes in the context of health promotion, not just illness behavior. As Robertson (2007) argued, men who “legitimize” formal help seeking in response to actual or feared illness may feel less comfortable doing so with regard to health promotion or screening activities. This awareness invites a revisiting to these and other sensitizing concepts to consider their applicability and limitations in understanding how men experience help seeking in the absence of illness.

This review has additional limitations, including that this expanded conceptualization of men’s help seeking is marked by significant challenges that must be worked out in practice. Notably, as dominant models continue to be emphasized, the empirical development of dynamic models of help seeking has been limited (Pescosolido & Boyer, 1999), though important examples do exist (e.g., Biddle et al., 2007). Furthermore, in accepting interactive subjectivities over time, this approach is complicated by the significant diversity and concurrency of illness-related needs, supports, and related processes shifting over the context of an illness experience, as well as the complexity of experiences and identities men bring into the process. This theoretical integration prioritizes research questions focused on chronic conditions (over acute) and the use of qualitative methodologies that enable researchers to hear men’s voices (Watson, 2000), approaches that access subjective meanings of symptoms and supports and are attentive to dynamics over time. Specific to understanding men’s experiences as gendered, this approach encourages thoughtful attention to how expectations of masculinity are engaged at the level of individual perceptions and interactions as well as through institutional practices.

Although the challenges are notable, this approach critically expands the terrain of research on men’s health-related help seeking, allowing researchers to more fully engage with the complexity of the help-seeking trajectory, or as Pescosolido, Gardner, and Lubell (1998) have described, how individuals “muddle” through illness. There is value in examining whether men seek help when first faced with signs and symptoms, but the study of men’s help seeking must not be limited to questions of which men under what conditions are successfully “deployed” into the medical system. In this more expansive gaze, the research community can pursue a more inclusive understanding, explanation, and response to men’s help-seeking patterns.

Footnotes

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Beyond Ballistics

Abstract

Keywords

Introduction

Summary of the Current Theoretical and Empirical Literature

Expanding the Conceptualization of Men’s Help Seeking

Examining the Dynamics of Men’s Health-Related Help Seeking

Help seeking is initiated by a recognized need

Help seeking is interactive

Help seeking can take on a variety of appearances

Help seeking is learned

Help seeking can be directed by a variety of strategies

Help seeking does not always lead to the resolution of a problem

Conclusion

Footnotes

References