An exploration of rejection and discrimination related to men's mental health.
Men’s mental health stigma remains overlooked and ignored, and still lurks silently in the shadows of society. Importantly, stigma is typically divided into two dimensions: internal stigma and external stigma. Internal stigma refers to private feelings of shame and worthlessness held by stigmatized individuals, often leading to social withdrawal and low self-esteem. External stigma refers to negative attitudes and prejudicial stereotypes held by people at large, often leading to rejection and subsequent discrimination.
Importantly, the discourse surrounding men’s mental health tends to focus on the internal stigma of affected men, who are often depicted as self-destructively stubborn and silent in the face of mental illness. This narrow focus can sometimes descend into a victim-blaming discourse. As such, it is important to broaden the focus to consider external stigma by examining negative attitudes and prejudicial stereotypes elsewhere in society.
This external stigma may be a key factor deterring men from discussing their mental health issues and seeking help from services, and is found in surprising places.
Men’s Mental Health Stigma in Health Services
The academic literature indicates that men are significantly less likely to use mental health services than women in the face of a mental illness. The reasons for such under-utilization are varied, but external stigma is a huge and under-acknowledged factor. Indeed, some research indicates that health care providers themselves can hold stigmatizing attitudes towards people with mental illness.
For example, one survey found that 44 percent of service users report major discrimination in their interactions with the mental health care system. In a study of low-income men living in rural New England, participants reported numerous negative encounters with clinicians, with one stating that "Whenever I would go in there [a local hospital], they treated me like a drunk, and I don’t drink!"
More recently, the American Psychological Association released "guidelines for psychological practice with boys and men" which states that "conforming to traditional masculinity ideology has been shown to… negatively influence mental health." The guidelines were severely criticized by a range of experts, who argued that the document stigmatized and pathologized masculinity, thereby missing an opportunity to reform and innovate approaches to men’s mental health.
Men’s Mental Health Stigma Within the Family
Research indicates that the immediate family can be an important source of support and solace for people with mental illness. That said, evidence suggests that some family members can perceive mental illness as a source of shame that is ruinous to familial reputation. This can lead to attempts to deny or conceal the mental illness, again deterring help-seeking.
Parents, children, and even spouses can be complicit in this silence, which may be particularly intense if the family member was a man. For example, my colleagues and I conducted a research study finding that husbands with mental illness frequently reported negative and unsympathetic comments from their wives. This was especially so if the mental illness interfered with the man’s bread-winning abilities, leading some wives to question his masculinity. This can worsen mental health issues, as evidenced by the quote below from a study participant:
"I lost the respect of my wife as I continue to fail in my duties. She lost trust in me. I am extremely sad when I hear the sentence 'Are you a man?' and 'Are you a husband?' from my wife. I want to die. I want to commit suicide."
Men’s Mental Health Stigma in the Media
It is well-known that media portrayals of socio-economic groups can shape wider public attitudes and beliefs. In a recent study, my colleagues and I examined media coverage of mental illness by gender, finding that articles about women with mental illness tended to be more positive and empathic, while articles about men with mental illness contained more stigmatizing content, and linked men’s mental illness to crime and violence.
This is an important finding, as these media portrayals can contribute to a wider climate of fear regarding men with mental illness, which can deter help-seeking. For example, men may legitimately fear being stereotyped by their family, friends, and colleagues as prone to crime and violence if they disclose mental health issues. Indeed, this is a common sentiment among men with mental illness, summarized by a research participant below:
"People, they have fear... They think, 'That man there, he is crazy. He could kill us!' They think, 'He is not like us!' They think you are lower than them. If I say to some, 'Yes, I am schizophrenic,' for sure they are going to have another idea of me. I am scared of saying that to people. I do not want them to judge me."
Discussions about men’s mental health typically adopt a narrow lens, focusing on the supposed silence and stubbornness of men with mental health issues. However, evidence suggests that it is vitally important to widen this lens to understand the broader social context in which men’s mental health issues occur.
Men may be silent in the face of mental illness due to external stigmas and social stereotypes purveyed by disparate groups including health care professionals, family members, the media and other elements of society. If we are serious about tackling men’s mental health issues, then this external stigma must be documented and addressed.
A narrow approach will solve little.
Rob Whitley, Ph.D. Nov 25, 2020