‘Mad and Bad’: Men’s Experiences of Psychological Therapy in a Forensic Mental Health Setting

by Shazia Hussain

Since boyhood many men are socialised to behave in accordance with approved gender role norms, internalising the several gendered messages still rampant in our postmodern society. Inadvertently setting contingencies around appropriate self-expression and a collective set of expectations of how men ‘should be’. This sets them up with a pervasive image of what it means to be a man – what it means to be masculine. This is an image that they carry with them into adulthood.

Masculinity has no set definition, rather it is dynamically constructed through interaction with the dominant socio-cultural ideas present at any given time, within a specific context (Connell & Messerschmidt, 2005), hence it is multifaceted. Nevertheless, the archetype of masculinity as in the minds of many men encapsulates a common set of attitudes, such as, emotional control, self-reliance, power, invulnerability, sexual prowess and success. Those who conform rigidly to these ideals experience what O’Neil (2008) referred to as ‘gender role strain’ and are at the greatest risk of psychological distress (Addis & Cohane, 2005) and engaging in maladaptive behaviours, such as aggression (Amato, 2012) . For they have set themselves the impossible task of achieving an ideal male image that is unsustainable.

Expectedly, when faced with circumstances that result in imprisonment, further affected by poor mental health, this ideal image threatens to collapse (Whitehead, 2005). To avoid complete disintegration of the self, a protective self or persona is erected in its place (Whitehead, 2005). In this new hypermasculine state emotional control becomes callousness, self-reliance and power become dominance, invulnerability becomes violence, and danger is seen as exciting (Beesley & McGuire, 2009). However, this state of manhood is fragile and can be easily lost or taken away (Vandello, Bosson, Cohen, Burnaford, & Weaver, 2008) resulting in increased hypervigilance towards the self and other men.

Where does this leave these men? Forensic mental health services face various challenges in engaging men in therapeutic interventions (McMurran & Ward, 2004). Rates for attrition and non-completion are variable, but reportedly range from 37 to 50% in extreme cases (McMurran & Ward, 2010). Those who do not complete treatment are at high risk of reoffending (McMurran & Theodosi, 2007). In the background, the men admitted to these services are faced with the reality of a loss of autonomy and control, alongside the double-stigma of being both ‘mad’ and ‘bad’ (Adshead, 2012).  For those working with these men and the men themselves, the journey of overcoming these internal obstacles is a gradual, non-linear and often lengthy process. It requires them to move from a position of defensive avoidance towards openness and vulnerability, which for the men in their current circumstances is often too threatening. This plays out in their time in psychological therapy as they attempt to redefine themselves as men.

About the author

Shazia Hussain is a ForenClinPsyD candidate at the University of Birmingham.


You can vote now (7th May 20th June) for a Male Psychology Section of the BPS.
Details are here http://www.malepsychology.org.uk/male-psychology-network/vote-for-a-male-psychology-section/



Addis, M. E., & Cohane, G. H. (2005). Social scientific paradigms of masculinity and their implications for research and practice in men’s mental health. Journal of Clinical Psychology, 61(6), 633–647.

Adshead, D. G. (2012). Their Dark Materials: Narratives and Recovery in Forensic Practice. Royal College of Psychiatrists, 1–11.

Amato, F. J. (2012). The Relationship of Violence to Gender Role Conflict and Conformity to Masculine Norms in a Forensic Sample. The Journal of Men’s Studies, 20(3), 187–208.

Beesley, F., & McGuire, J. (2009). Gender-role identity and hypermasculinity in violent offending. Psychology, Crime & Law, 15(2–3), 251–268.

Connell, R. W., & Messerschmidt, J. W. (2005). Hegemonic Masculinity: Rethinking the Concept. Gender & Society, 19(6), 829–859.

McMurran, M., & Theodosi, E. (2007). Is treatment non-completion associated with increased reconviction over no treatment? Psychology, Crime & Law, 13(4), 333–343.

McMurran, M., & Ward, T. (2010). Treatment readiness, treatment engagement and behaviour change. Criminal Behaviour and Mental Health, 20(2), 75–85.

McMurran, M., & Ward, T. (2004). Motivating offenders to change in therapy: An organizing framework. Legal and Criminological Psychology, 9(2), 295–311.

O’Neil, J. M. (2008). Summarizing 25 Years of Research on Men’s Gender Role Conflict Using the Gender Role Conflict Scale: New Research Paradigms and Clinical Implications. The Counseling Psychologist, 36(3), 358–445.

Vandello, J. A., Bosson, J. K., Cohen, D., Burnaford, R. M., & Weaver, J. R. (2008). Precarious manhood. Journal of Personality and Social Psychology, 95(6), 1325–1339.

Whitehead, A. (2005). Man to Man Violence: How Masculinity May Work as a Dynamic Risk Factor. The Howard Journal of Criminal Justice, 44(4), 411–422.




Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Scroll to top