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The Positive Mindset Index (PMI): a freely available validated measure of mental wellbeing.

by Dr John Barry

Should we measure mental illness, or mental health?

Measures of mental health can be difficult to get right. For example, if you want to measure suicidality, the most obvious thing to do is ask people questions about how much they have been thinking about suicide, have they ever attempted suicide etc. This can make for an uncomfortable time for many participants, and can result in people dropping out of studies.

But what about if you can tap into mental health by asking people about their mental wellbeing? This would make the participant’s experience a lot less awkward, but can it be done in practice? Well, the Positive Mindset Index (PMI) (Barry, Folkard & Ayliffe, 2014), which asks people to rate their level of happiness, confidence etc, has proved to be strongly negatively correlated with suicidality (r = -.539) and strongly positively correlated with the SF-12 measure of mental health quality of life (r = .678). So not only does the PMI give you a sense of a person’s mental positivity, but it also gives you a sense of their mental health.

The PMI has proved it’s worth in several published projects since 2014, with a variety of demographics (people with health problems, men and women of various ages and ethnicities etc). But the PMI also has an advantage for people who interested in men’s mental health: it just so happens to be very male-friendly.

 

A male-friendly measure

What makes the PMI so male-friendly? Well, it is a very short questionnaire, and easy to fill in. Men are notorious in the research world for being difficult to recruit and having little time for research, so brief measures are definitely the way to go. It is also useful for people with limited reading skills, because it uses very few words, and all of them are relatively simple. It also also uses a neutral midpoint, which means participants aren’t under pressure to give strong opinions if they don’t want to. If participants become frustrated or bored, they can drop out of studies.

Because of this male-friendly aspect, the PMI has been used on several of the Male Psychology Network research projects with a total of almost 10,000 participants:

 

So what does the PMI look like?

The Positive Mindset Index scale consists of six items (happiness, confidence, being in control, emotional stability, motivation and optimism) on a 5-point Likert scale.

Participants are asked:

Please select one of the options (e.g. “happy” or “unhappy”) for the words in each row, indicating how you are feeling at this moment.

The response options are selected in each row:

Item 1 Very unhappy Unhappy Moderately happy Happy Very happy
Item 2 Very unconfident Unconfident Moderately confident Confident Very confident
Item 3 Very out of control Out of control Moderately in control In control Very in control
Item 4 Very unstable Unstable Moderately stable Stable Very stable
Item 5 Very unmotivated Unmotivated Moderately motivated Motivated Very motivated
Item 6 Very pessimistic Pessimistic Moderately optimistic Optimistic Very optimistic

The PMI is scored from 1 to 5, with lower scores indicating a less positive mindset. The mean of the 6 scores is used. The average score is around 3.5, with slight variation for age and culture. The scale shows excellent psychometric properties, and further details for researchers can be found here.

 

Is positive mindset related to positive psychology, or positive masculinity?

Although not specifically derived from positive psychology, there is some common ground between positive psychology and the PMI. Up until the 1990s, men and masculinity were seen in fairly benign terms in the field of psychology. However the 1990s saw a new deficit model of masculinity, which defined masculinity in negative terms (including misogyny and homophobia) and explored the ways in which masculinity might be damaging to the mental health of men, boys, and everyone around them. It’s been a relief to many people that the past decade has seen the birth of ‘positive masculinity‘. Positive masculinity has it’s roots in positive psychology, so brings not just the return of masculinity as a benign construct, but sees masculinity as something which is potentially an asset. In tandem with positive psychology / positive masculinity (PPPM), we have seen the development of the Male Gender Script (Seager, Sullivan & Barry, 2014), which takes a realistic view of masculinity, rather than the excessively harsh view of the 1990s.

 

Using the PMI in your research

The PMI is free to use and is very handy because it is short and therefore easy to add to a study without adding a burden to the person filling in your study. It is also very easy to score, so is attractive to researchers at all levels of experience. It’s not simply a measure for men’s mental health either, and although it hasn’t been standardised for children or non-English speakers, is perfect for use with adults in general.

For a more detailed description of the scale and it’s properties, see here.

Reference

Barry, J. A., Folkard, A., & Ayliffe, W. (2014). Validation of a brief questionnaire measuring positive mindset in patients with uveitis. Psychology, Community & Health, 3(1), 1-10. Full text available here

About the author

Dr John A. Barry is a Chartered Psychologist and Associate Fellow of the British Psychological Society, Honorary Lecturer in Psychology at University College London, clinical hypnotherapist, and author of over 60 peer-reviewed publications on a variety of topics in psychology and medicine. John is a professional researcher and has taken an interest in improving the teaching of research methods and statistics. He has practiced clinical hypnosis for several years and is a member of the British Association of Clinical and Academic Hypnosis. His Ph.D. was awarded by City University London, on the topic of the Psychological Aspects of Polycystic Ovary Syndrome, which is also the topic of his forthcoming book (Palgrave Macmillan, 2019). He is co-founder of both the Male Psychology Network and the Male Psychology Section of the British Psychological Society (BPS), lead organiser of the Male Psychology Conference, and co-editor of the Palgrave Handbook of Male Psychology and Mental Health (2019).

 

 

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How do men deal with traumatic brain injury?

by Dr Ruth MacQueen & Dr Paul Fisher

Picture: famous brain injury patient, Phineas Gage.

contact: ruth.macqueen@nhs.net

 

Men are twice as likely to experience a traumatic brain injury (TBI) as women.  This suggests that aspects of masculinity, such as choosing risky jobs and sports, play an important role in how people acquire their brain injury. Research also suggests that masculine identity has an impact on how people manage the experience of illness.  Adjustment to traumatic brain injury can involve changes in cognitive, behavioural, emotional and physical functioning. Given the potential disruptive consequences of TBI, the day-to-day lived experience of being in the world can be, and often is, altered for the individual.

Our chapter in the Palgrave Handbook of Male Psychology and Mental Health summarises research which explores masculine identity in relation to how men experience these adjustments.  Individuals who have had a TBI can experience a changed sense of personal identity (Levack, Kayes, & Fadyl, 2010) and changes to the self tend to be viewed negatively in comparison to the pre-injury self (Carrol & Coetzer, 2011).  Identity as a man can be threatened by the changes in interactions and activity which can lead to a loss of traditional male roles such as being a provider, being strong, protecting others, having physical strength, and self-reliance (Addis & Mahalik, 2003;  Connell, 2005).  Roles which men have, for example within their occupation and relationships can therefore be lost or changed and men may face challenges in coping with this loss and adapting to the changing roles.  Masculine identity is therefore an important consideration for neuropsychological therapy and rehabilitation particularly because part of the process of rehabilitation concerns helping individuals with their sense of self.

Some evidence suggests that adherence to masculine ideals can be negatively associated with rehabilitation outcomes in TBI (Meyers, 2012).  Barriers to engaging in rehabilitation services may include that working with professionals is viewed as requiring help and therefore suggests that the individual lacks strength or self-sufficiency to be able to cope (MacQueen, Fisher and Williams 2018). Viewing the self as being reliant on others can lead to experiences of shame and the perception of the self as weak.  This can mean that developing therapeutic relationships may conflict with ideals of independence (Good et al., 2006; Sullivan, 2011).

However, aspects of masculine identity may also promote wellbeing in the context of adjustment to TBI for men. For example, there is evidence which suggests that adherence to dominant masculine ideals such as higher success, power and competition are associated with the perception of fewer barriers to community functioning (Good et al., 2006).  Similarly, Schopp et al. (2006) found that there was a positive effect on functional outcomes for men who adhered to ideals such as winning and seeking status and the authors suggest that therefore drawing on these values can promote positive outcomes after TBI.

It is important that gender identities are considered as part of rehabilitation and providing a gender-sensitive service can begin during initial discussions when men are referred to a service and should be considered throughout rehabilitation. In addition, given the higher prevalence of mental health problems in the TBI population (Seel et al., 2003) it seems particularly important to work with individuals in reducing the stigma of mental health problems after brain injury.   Within the context of masculine identity, the application of positive psychology constructs may be particularly beneficial.  Positive psychology has been applied within acquired brain injury (ABI) rehabilitation and these initial studies indicate that the application of positive psychotherapy may promote wellbeing following ABI (Andrewes, Walker, & O’Neill, 2014; Cullen et al., 2016).   The concepts of growth, strength and resilience within positive psychotherapy may particularly encourage flexibility in identity which may facilitate adjustment for men.

The implications arising from the research in relation to issues around engagement and outcomes in neuropsychological therapy and rehabilitation are further considered within my chapter in the Palgrave Handbook of Male Psychology and Mental Health.

Dr. Ruth MacQueen completed the Doctorate in Clinical Psychology at the University of East Anglia in 2016. Her doctoral thesis employed a

qualitative methodology to research men’s experiences of masculine identity following traumatic brain injury. She has presented her research as a poster

publication at the Neurological Rehabilitation Specialist Interest Group of the World Federation for Rehabilitation conference and published in

Neuropsychological Rehabilitation. Since qualifying, Ruth has continued to work within neurorehabilitation in Bath, UK.

 

Dr. Paul Fisher is a Clinical Psychologist and Senior Clinical Lecturer with significant experience working clinically with people with neurological

impairments across a range of settings and as an academic and researcher. Paul has worked in the UK and Singapore. He has a long-standing interest

in issues of identity and identity change and adjustment which he uses within his clinical work and has been a focus for his research using qualitative

research methods. Paul currently works at the University of East Anglia in the Department of Clinical Psychology and in Norfolk and Suffolk NHS

Foundation Trust.

 

References

Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help seeking. The American Psychologist, 58(1), 5–14. doi:10.1037/0003-066X.58.1.5

Andrewes, H. E., Walker, V., & O’Neill, B. (2014). Exploring the use of positive psychology interventions in brain injury survivors with challenging behaviour. Brain Injury28(7), 965-971.

Carroll, E., & Coetzer, R. (2011). Identity, grief and self-awareness after traumatic brain injury. Neuropsychological Rehabilitation, 21(3), 289-305. doi: 10.1080/09602011.2011.555972

Connell, R. W. (2005). Hegemonic Masculinity: Rethinking the Concept. Gender & Society, 19(6), 829–859. doi:10.1177/0891243205278639

Cullen, B., Pownall, J., Cummings, J., Baylan, S., Broomfield, N., Haig, C., … & Evans, J. J. (2016). Positive PsychoTherapy in ABI Rehab (PoPsTAR): A pilot randomised controlled trial. Neuropsychological Rehabilitation, 1-17.  doi:10.1080/09602011.2015.1131722

Good, G. E., Schopp, L. H., Thomson, D., Hathaway, S., Sanford-Martens, T., Mazurek, M. O., & Mintz, L. B. (2006). Masculine roles and rehabilitation outcomes among men recovering from serious injuries. Psychology of Men & Masculinity, 7(3), 165.

Levack, W. M., Kayes, N. M., & Fadyl, J. K. (2010). Experience of recovery and outcome following traumatic brain injury: a metasynthesis of qualitative research. Disability and Rehabilitation 32(12), 986–999. doi:10.3109/09638281003775394

MacQueen, R., Fisher P., & Williams, D., (2018) A qualitative investigation of masculine identity after traumatic brain injury. Neuropsychological Rehabilitation doi: 10.1080/09602011.2018.1466714

Meyers, N. M. (2012). The effect of traditional masculine gender role adherence on community reintegration following traumatic brain injury in military veterans. (Doctoral Thesis) American University, Washington, D.C

Schopp, H., Good, E., Barker, B., Mazurek, O., & Hathaway, L. (2006). Masculine role adherence and outcomes among men with traumatic brain injury. Brain Injury, 20(11), 1155.

Seel, R. T., Kreutzer, J. S., Rosenthal, M., Hammond, F. M., Corrigan, J. D., & Black, K. (2003). Depression after traumatic brain injury: a National Institute on Disability and Rehabilitation Research Model Systems multicenter investigation. Archives of Physical Medicine and Rehabilitation, 84(2), 177-184.

Sullivan, C., Gray, M., Williams, G., Green, D., & Hession, C. (2014). The use of real life activities in rehabilitation: The experience of young men with traumatic brain injuries from regional, rural and remote areas in Australia. Journal of Rehabilitation Medicine, 46(5), 424–429. https://doi.org/10.2340/16501977-1788

 

 

 

 

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Men are boxing their way back to mental fitness

An interview by Dr John Barry with boxing coach Paddy Benson of Birmingham’s Pat Benson Boxing Academy.

It’s a familiar story. A young rebellious man seems out of control, always getting into conflict and looking destined for prison. Somehow he finds out about the local boxing club. Maybe it’s his last chance, or maybe it’s just a challenge he won’t refuse. But one thing leads to another and he suddenly finds that he has got something that is more important in his life than getting into trouble. Somehow or other, boxing has saved him from wasting his life.

If the NHS clinical psychology or forensic psychology services could replicate this kind of success story they would quickly recognise it as a breakthrough treatment programme. In fact some people outside boxing are starting to recognise the mental health benefits of this activity, and it just so happens that an old-school boxing club in Birmingham is leading the way. When I found out a few months ago that something called the Mind-Fit programme had won a mental health prize, I tracked down Paddy Benson of the Pat Benson Boxing Academy as quick as I could to find out more:

Barry: Congratulations Paddy on getting a prize for your wellbeing programme. What are your thoughts on your programme, and on the impact of boxing on men’s mental health?

Benson: It started after we had a guy who was from a substance abuse background. He used to train a lot, but sometimes he would go missing. We knew when he went missing he was on a relapse. One day we started chatting with him, and he opened up and said he really valued the structure and routine of the boxing training, which is why he kept coming back. That’s what he was really looking for and that kept him on the right track, away from drugs. We realised that we hadn’t given him any special treatment, but the boxing environment and routine had helped him deal with drugs. In fact of course training is a natural high, a release of endorphins.

Within about 30 mins radius there are lots of charities where we are in Birmingham, so we talked to them and put together a basic mental health package. We think that men’s mental health is a taboo subject at present, but one that will explode soon.

We evolved this programme due to feedback. We try to get the best out of everyone. Our strategy is inclusive – it’s not just for the top half-percent of boxers to win national titles. The programme is one hour per week doing bags and pads in a traditional boxing club, and participants like being coached in this real environment.

We have some specialist mentor staff, we have a social group – basically getting men to talk – and the feedback has been fantastic. We’ve had a national sporting award, and started getting funding. This is social prescribing. These guys are going to their GP but don’t necessarily need a clinical psychologist. For some people who have been using drugs or homeless, just eating fresh fruit is a new thing. The routine is the main thing.

We have worked with Nottingham Trent for a case study, but more with Brunel. Street Games provided free mental health first aid. Some of the participants get back on the straight and narrow, become mentors themselves, and even go on to university.

Barry: Are other things like martial arts just as good, or is boxing special?

Benson: Getting fit and building trust is key. Anyone will feel better. And staying away from drugs. Maybe boxing is more old school so there is a special sort of traditional aura. Our trainers have been around. This does help build trust. It’s hard to explain, but over time participants start to talk. They even start to trust themselves more when they feel more confident and healthy.

Barry: Do you think gaining meaning in life is important?

Benson: Yes, if you have been homeless or on drugs you know you are on the wrong path. When they meet us they mostly right away want to get their lives back on track. Finding an identity and purpose in life is a real achievement. They also learn to help others and give something back.

[Interview ends].

Some of the findings of my research in male psychology are things that are fairly unsurprising to most people who haven’t been steeped in the ideology of gender studies. However in these strange days when traditional masculinity is misunderstood even by psychologists in the US and UK, finding ways to help men’s mental health can sometimes be best done outside of mainstream mental health services. Important understandings about gender aren’t yet part of the psychology syllabus, for example, that when distressed, women often want to talk about their feelings whereas men would rather fix their problems. With men more likely than women to kill themselves, but less likely to seek help from a therapist, it’s my prediction that rediscovering how men have, for generations, been taking care of their mental health might benefit modern psychology. Activities like boxing might not appeal to everyone, but a pilot study by Brunel found it worked for the 24 participants on Benson’s Mind-Fit programme. Without a doubt the merit of this approach is worth further investigation.

 

About Paddy Benson

Paddy Benson trains in the Pat Benson Boxing Academy, a club based Birmingham’s Irish Quarter – produced the likes of champion Matthew Macklin and is currently training future world class boxers. The Academy was created to honour legendary trainer from Mayo in Ireland, Pat Benson, after he was crowned BBC Unsung Hero 2010. Pat and his grandson Paddy, a University business graduate who has also boxed for England Youth, work together in the family run club. Paddy will be giving a short presentation at the Male Psychology Conference at University College London in June.

 

About John Barry

Dr John Barry is a Chartered Psychologist and Associate Fellow of the British Psychological Society, Honorary Lecturer in Psychology at University College London, clinical hypnotherapist, and author of over 60 peer-reviewed publications on a variety of topics in psychology and medicine. John is a professional researcher and has taken an interest in improving the teaching of research methods and statistics. He has practiced clinical hypnosis

for several years and is a member of the British Association of Clinical and Academic Hypnosis. His Ph.D. was awarded by City University London, on the topic of the Psychological Aspects of Polycystic Ovary Syndrome. He is co-founder of the Male Psychology Network, and co-founder of the Male Psychology Section of the British Psychological Society. He is one of the authors of the new Palgrave Handbook of Male Psychology and Mental Health  DOI: 10.1007/978-3-030-04384-1

John has blogged previously on the mental health benefits of boxing.

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Book review. Updating timeless advice for fathers: Owen Connolly’s ‘Standing on the Shoulders of Giants’

Review of Owen Connolly’s book ‘Standing on the Shoulders of Giants – from Father to Dad’.

by Dr John Barry

In his book The Boy Crisis, Warren Farrell warned us about the dangers of ‘dad deprivation’. This is the phenomenon of boys who drop out of highschool, become unemployed, prone to imprisonment. Almost every mass shooter since Columbine has been a boy who grew up with minimal or no father involvement. So what has happened to fatherhood? Masculinity is often devalued (e.g. the recent controversial APA guidelines) and dads are portrayed as bumbling fools in the media.

Against this backdrop of boys who desperately need dads, and men who feel disenfranchised from the fathering role, what is a man to do? Well, consultant psychologist Owen Connolly may have some answers in his book ‘Standing on the Shoulders of Giants – from Father to Dad’.

In a slim volume that avoids unecessary jargon, Connolly gives practical advice to men in a way that answers questions to the everyday problems of parenting. The giants on whose shoulders we stand are those generations of men who have lived before us, and through their struggles and survival have passed on instincts we can tune in to in order to sense that we are doing the right thing for our children. So a lot of the advice is about tuning into our own feelings and needs as well as those of our children and spouse. But it’s not all touchy – feely. For example, there is the Top 10 Discipline Tips which offers practical ways of dealing with your child when they are being unruly.

Connolly recognises that we all have strengths and weaknesses. He asks men to recognise this, and to play to their strengths. He understands that when men are distressed, they often want a practical step-by-step approach to solutions, so the simple Q&A format adopted in this book makes perfect sense, as is the practical advice.

An example of the Q&A format is the question: ‘Does a man’s childhood affect the way in which he will parent his own children?’ The advice given is: “When each of us reaches 16 or 17, we become our own person, and after that it’s important for all of us to have a look at our lives and value who we are and shed many of the labels that were put upon us. We have to start looking at the positive aspects of ourselves” (Connolly 2006, p. 14). This is based on the idea that if we don’t learn to love ourselves, our negativity will be a disadvantage to anyone around us. Such advice fits in very well with modern ideas around positive masculinity, and the book has many examples of timeless good advice.

The book has four sections: Men & Women, Parenting Small Children, The Teenager, and Parenting Today. There is also a workbook section at the back, with some questionnaires, as an aid to self-reflection and development. These add to the overall user-friendly feel of the book. Those who like an index at the back of the book and references supporting every single statement will feel a bit lost at times, but for those who simply want solid advice, such academic niceties are not needed.

One of the take-home messages of this book is ‘any man can be a father, but not everyone can be a dad’. The aim of this book is to help men to connect with parts of themselves that are beyond modern fads about masculinity, and understand how to be a dad.

 

Connolly, O. (2006). ‘Standing on the Shoulders of Giants – from Father to Dad’. Dundrum: Nurture Press.

To purchase this book please email info@counsellor.ie 

 

About Owen Connolly

Owen Connolly is a consultant psychologist and marriage and family therapist in private practice in Dublin. As well as “Standing on the Shoulders of Giants – From Father to Dad”, he is co-author of the book “Parenting for the Millennium”, a best-selling book on childcare. He completed his training in the UK, Ireland, and the USA. He lectures in childcare and parenting, and is Chairman of the Nurture Institute of Further Education for Parents, a not-for-profit organisation which runs parenting courses and day-long seminars on fatherhood throughout the greater Dublin area.

Owen is running a workshop on the subject of ‘fatherhood and being a good dad’ at the Male Psychology Conference at UCL in June 2019.

 

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When did Psychology start adopting a negative view of masculinity?

by Tom Golden.

The popular discourse on men and masculinity has become toxic in the past few decades, and it looks like the profession of psychology has not been immune.

There are many places where one can easily observe this, but none quite as blatant as in the ways that psychologists have labeled the “norms” for men and women.  I ran into the Conformity to Masculine Norms Inventory (CMNI; Mahalik, 2003) and was shocked to see this misandry starkly presented. I wrote an article criticizing this inventory and a part of the criticism was looking at the history of labels psychologists had used in describing men and their norms.  I was shocked to see that the CMNI labels used for men were things such as violence, power over women, disdain for homosexuality, and being a playboy.  As I noted in my article, these four “norms” seemed to pass harsh judgment on men and boys. Moreover, they seemed much more like cartoonish stereotypes than norms, and begged the question: do they even belong in a science of human behaviour?

My doubts about the validity of the description nudged me to pull together examples of terms that had been used as norms for men previously in psychology.  and the CMNI.  The chart below offers examples of the terms that have been used to describe masculine norms during the period of 1974 to 1986, and Mahalik’s (2003) CMNI for comparison:

Notice that the norms that were used prior to the 1990s seem to be neutral. Examples included competency, level headed, independence, aggressive, forceful, suppressing emotion, willing to take a stand, assertive, and self-contained.  All of these could be seen as being close to neutral with some like “level headed” or “self-confident” seeming even a bit complimentary.  Someone could have some of any of these qualities, like some aggressiveness, some forcefulness or some assertiveness and depending on the situation would be considered okay.  Now think of having some violence.  Nope, you can’t even have a little bit of that before you are judged harshly.  Same thing with power over women, playboy or disdain for homosexuals.  A little bit of any of those and you are sunk.  These four categories from the CMNI seem quite different from all of those from 1970-1986.

It seemed obvious to me that anti-male ideas were leaking into psychological journals.  Those four “norms” had no clear research showing that they were common among men.  They simply seemed to appear.  I contacted the researcher and asked about his reasons for including those four norms and he didn’t have much of an explanation. Very odd and what I thought at the time was this was simply a psychological version of male bashing.

Still I wondered if maybe I was a bit too critical.  I found that the same researcher had done an inventory for women, the CFNI or Conformity to Feminine Norms Inventory.  I thought that maybe the harsh treatment of men in the CMNI might be a shift in the times and that a similar harshness would be played out in the female version of the inventory. Would they talk about relational aggression?  Queen bee? Hypergamy? Gossip? I found the CFNI and the feminine norms.  The chart below will show you those norms and list the CMNI along with the CFNI.

Needless to say, that earlier wondering was put to rest.  The female norms were sweet and nice while the male norms were harsh and unforgiving.

At the time I was looking into this I was a member of the APA Division 51 (the study of men and masculinity) mailing list.  I brought this idea up to the list and it was immediately dismissed as ridiculous.  Among the hundreds on that list, not one would admit that the norms for men were anti-male and not one would admit that the female norms were very different from the males.  They either couldn’t see it or they couldn’t admit it.

The redefinition of masculinity is one small indication of the confused state of our psychological world today, but here is a novel idea for you to think about:

Men are good!

 

Further information on this topic

Read the full article which is part 5 in a five part series on bias against boys and men in psychological research. It goes into much greater detail. Or have a look at a short video on this topic.

 

About the author

Tom Golden is a counsellor and author of several acclaimed books. He gained note for his first book  Swallowed by a Snake: The Gift of the Masculine Side of Healing which is seminal in the psychology of men’s grief.  It was acclaimed by notable psychologists and psychotherapists such as Kubler-Ross, Hope Edelman, Robert Bly and others. Tom has also written The Way Men Heal and recently a book for mothers called Helping Mothers be Closer to Their Sons: Understanding the Unique World of Boys. Tom conducts workshops in the U.S., Canada, Europe and Australia, having been named the “1999 International Grief Educator” by the Australian Centre for Grief Education.  His work and his web site webhealing.com (which was the first interactive site (1995) on the internet to serve grieving people) have been featured in the NY Times, Washington Post, as well as on CNN, CBS Evening News, ESPN and the NFL Channel. He served as the Vice Chair of the Maryland Commission for Men’s Health and maintains a private practice in Gatihersburg Md.

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The psychological impact of androgen deprivation therapy (ADT) in prostate cancer

By Dr Kenneth Gannon and Dr John Barry

Prostate cancer is the most common type of cancer in men and has become the third most common cause of cancer death in the UK, with almost 12,000 men dying from it every year (Prostate Cancer UK, 2018), slightly more than the number of women who die from breast cancer. Compared to White men, African Caribbean men are three times more likely to develop the disease and tend to do so at a younger age and in a more aggressive form.

Similarly to estrogen in some types of breast cancer, testosterone is associated with the development and course of prostate cancer. Androgen Deprivation Therapy (ADT) is a commonly used treatment for advanced prostate cancer, although it may also be used to treat disease confined to the prostate. Up to 50% of men being treated for prostate cancer may receive ADT.  It reduces symptoms and increases survival times by stopping testosterone production (Connolly et al, 2012). However this causes a range of serious side effects, including erectile dysfunction, genital shrinkage, loss of libido, hot flashes, osteoporosis, loss of muscle mass, breast enlargement, anaemia, fatigue, risk of diabetes, risk of cardiovascular disease and of potentially fatal cardiac events (Holzbeierlein, Castle & Thrasherl, 2004; Thompson, Shanafelt, Loprinzi 2003). ADT has also been linked with an increased risk of developing some types of dementias, though findings are inconsistent and the increased risk appears to be small.

ADT can impact mental health too. For example, it may increase mood swings (Cary, Singla, Cowan, Carroll, Cooperberg, 2014) and tearfulness (Ng, Woo, Turner, Leong, Jackson and Spry, 2012).  Depression may also occur as a result of testosterone reduction and the associated problems (Lee, Jim, Fishman, et al., 2015).

Understandably, some of these physical and mental symptoms can impact a man’s sense of his masculinity (Oliffe, 2006). Compared to patients having what might sound like more radical treatments (e.g. prostatectomy or radiotherapy), patients on therapy with hormones have relatively low HRQoL scores (Bacon et al, 2001).

Not all studies are in agreement (perhaps due to differences in methodology), but there is evidence that ADT is also linked to impairment to executive cognitive functioning, causing problems in planning, initiating and sequencing goal-directed behaviours, and memory issues. Further research is required on this issue. There is also some evidence that because of the reduction in testosterone, men on ADT perform less well in spatial cognitive abilities (Cherrier, Aubin & Higano, 2009).

In conclusion, prostate cancer treatment with ADT has a range of psychological implications for men and their partners. Some of these implications are in need of further research, especially treatment-related decision making, survivorship and the experiences of men from ethnic and sexual minorities.

If you have concerns about prostate cancer, contact https://www.prostatecanceruk.org/

About the authors

Dr Kenneth Gannon is the Clinical Research Director and Research Degree Leader at the University of East London. His chapter ‘Men’s Health and Cancer—The Case of Prostate Cancer’ covers various topics, including sexuality and ethnicity, and appears in the new book The Palgrave Handbook of Male Psychology and Mental Health

Dr John Barry is a Chartered Psychologist and co-founder of the Male Psychology Network and Male Psychology Section of the British Psychological Society. He is one of the editors of, and contributors to, The Palgrave Handbook of Male Psychology and Mental Health. https://doi.org/10.1007/978-3-030-04384-1

From the back cover of the Handbook of Male Psychology:

“This handbook brings together experts from across the world to discuss men’s mental health, from prenatal development, through childhood, adolescence, and fatherhood. Men and masculinity are explored from multiple perspectives including evolutionary, cross-cultural, cognitive, biological, developmental, and existential viewpoints, with a focus on practical suggestions and demonstrations of successful clinical work with men”.

References
Bacon, C. G., Giovannucci, E., Testa, M., & Kawachi, I. (2001). The impact of cancer treatment on quality of life outcomes for patients with localized prostate cancer. The Journal of urology, 166(5), 1804-1810.

Cary, K.C., Singla, N., Cowan, J.E., Carroll, P.R., and Cooperberg, M.R. (2014). Impact of androgen deprivation therapy on mental and emotional well being in men with prostate cancer: analysis from the CaPSURE registry. Journal of Urology, 191, 964-970.

Cherrier, M. M., Aubin, S., & Higano, C. S. (2009). Cognitive and mood changes in men undergoing intermittent combined androgen blockade for non‐metastatic prostate cancer. Psycho‐Oncology, 18(3), 237-247.

Connolly, R.M, Carducci, M.A. & Antonarakis, E.S., (2012) Use of androgen deprivation therapy in prostate cancer: indications and prevalence. Asian Journal of Andrology 14:2, 177-186

Holzbeierlein, J.M., Castle, E. & Thrasher, J.B. (2004). Complications of androgen

Lee, M., Jim, H.S., Fishman, M., et al. (2015). Depressive symptomatology in
men receiving androgen deprivation therapy for prostate cancer: a controlled comparison. Psychooncology, 24, 472-477.

Ng, E., Woo, H.H., Turner, S., Leong, E., Jackson, M. and Spry N. (2012). The influence of testosterone suppression and recovery on sexual function in men with prostate cancer: observations from a prospective study in men undergoing intermittent androgen suppression. Journal of Urology, 187, 2162-2166.

Oliffe, J. (2006). Embodied masculinity and androgen deprivation therapy. Sociology of Health and Illness, 28, 410-432.

Prostate Cancer UK (2018). We call on UK to step up as new figures show prostate cancer now a bigger killer than breast cancer. Accessed online 7th May 2018 on the internet [here]

Soloway, C. T., Soloway, M. S., Kim, S. S., & Kava, B. R. (2005). Sexual, psychological and dyadic qualities of the prostate cancer ‘couple’. BJU international, 95(6), 780-785.

Thompson CA, Shanafelt TD, Loprinzi CL (2003) Andropause: symptom management for prostate cancer patients treated with hormonal ablation. Oncologist, 8, 474-487

 

Open post

The provider role indicates that masculinity is prosocial

by Belinda Brown

For decades now, masculinity has been under assault – largely by visionaries who anticipate a new gender-free social order. Creation of the new involves destruction of the old, so ‘new man’ can arise phoenix like from the patriarchal dust.

And masculinity is, after all, an easy target. Men appear to be more physically violent than women, they are more likely to kill themselves and they are much more likely to commit crime. All this has provided ballast for the concept of toxic masculinity, and has had potentially damaging consequences for male self-understanding by drawing attention to stereotypes of dysfunctional male behaviour and treating them as if they are the true nature of all men

My chapter From Hegemonic to Responsive Masculinity; the transformative power of the provider role  for The Palgrave Handbook of Male Psychology and Mental health takes a different approach.

In the chapter I ask why it is that since the beginning of recorded history men have, by and large, done the hardest most gruelling labour, given the proceeds of their labour to women and children, usually deriving little benefit for themselves. I also ask why it is that, despite earning less than men, women have extensive control over resources and, why even welfare is largely spent on women and children while the taxes to pay it are earned by men.

All this points to extraordinarily altruistic behaviour by men and this, I argue, is mystery which we should explore.

A clue to male motivations lies in men’s family role. A rich seam of data has shown that partnered men earn more than unpartnered men, married men earn more than those who are cohabiting and married men living with their own children trump the lot. And this is not simply a case of female selectivity. The data show that men appear to be responding to female preferences and need.

In order to understand why men should do this I turn to the vineyards of evolutionary psychology. This field explores how our psychological adaptations are rooted in genetic and neuroendocrine systems, which have evolved in ways that help to ensure that our descendants survive.

One of the mysteries for evolutionary psychologists is paternal investment – why do human males invest so much time and effort in women and children, when the majority of primate males do little for their own offspring. This has spawned a great deal of creative thinking about the benefits of paternal investment to evolutionary fitness, and theories have focussed on mechanisms which have brought this investment about.

My own explanation is that males have evolved to be responsive to human females. As human females choose mates who can provide for them, the corresponding desire to provide may have become biologically embedded in males. Males then become deeply attached to those infants, who they help to socialise and provide with food. The result is that men are in hock to potentially self-sacrificial behaviour because this is what ensures the survival of their genes.

If men are impelled to be responsive to females and possibly to provide for and even become attached to their children, we would expect some accompanying biological scaffolding to have evolved. My paper is only exploratory but some clues point us in directions to look.

Firstly, there is evidence to suggest that little boys start out in life more sensitive and responsive than little girls. Later, men and women experience emotion to the same depth and in similar ways. So why is it that when it comes to emotional literacy or emotional awareness women tend to assume men are second best?

The key difference is emotional expressiveness; this is the domain in which women have the upper hand. When we think of men as stoical this is only in contrast to female emotional expressivity – the other side of the coin. Female emotional expressiveness is ultimately evolutionarily adaptive. It involves the rapid translation of cognitive information into a form of behaviour which will spur others into a response.

It is not just that this female emotional expressiveness appears inbuilt. So does the male capacity to respond. Men have been found to have higher levels of empathy for women than they do for other men. If male empathic responsiveness is particularly honed to female need, then males are likely to be vulnerable to female emotional expressiveness in ways that elicit altruistic behaviour. Even where this incurs a cost.

If masculinity is essentially responsive, what underlies male providing is not the desire for status or dominance but rather to be desired by women themselves.

And this too is supported by the data. Some of the most extensive studies conducted in the social sciences are on mating preferences. And what these incontrovertibly show is that women are looking for men who will be a good financial prospect. Men respond to female cues by providing them with resources because this will further their own genetic fitness.

But what I suggest is that the value of male provisioning does not necessarily lie in its nutritional content. Male provisioning stimulates paternal attachment in the same way maternal attachment is stimulated; through the experience of having others dependent on you. Male provisioning is the cornerstone on which fathering work is built. It is linked with paternal care and having a father in the home.

That men are primed to develop paternal attachment is again suggested by the male physiological response. As men marry and have children their levels of testosterone drop which is thought to facilitate a nurturant behaviour. Research on couvade has shown that men experience many of the symptoms of pregnancy as well. Men are primed to respond to infants. Not only is there evidence they experience hormonal changes in response to the cries of their infant but they can also recognise their infant by touch.

Research from the animal kingdom has found links between provisioning behaviour and reductions in testosterone. If this was found in humans, it would provide a biological link between the act of provisioning and a nurturant response. Although such evidence may not yet exist,  there is evidence to show that when it comes to childcare it is those men who have more traditional attitudes, or those men who are actually engaged in providing for their families, who are more likely to be involved.

There are a number of hypotheses in my handbook chapter which need to be explored further and tested. They raise the possibililty that the male provider role is not simply a social construction belonging to a bygone age. Rather the provider role may be not only socially, but psychologically acting as a trigger for nurturing behaviour. It may even, as I suggest in my chapter, play a vital role in transforming a more immature and potentially ‘hegemonic’ dimension of masculinity into a more socially responsible, co-operative and nurturing form.

For these reasons, the provider role – as an important dimension of masculinity – deserves further investigation. If it emerges that it is not only socially but also psychologically salient, then perhaps we need to start encouraging provisioning in men.

 

About the author

Belinda Brown is a Social Anthropologist who writes about family and gender issues.

Belinda’s chapter, From Hegemonic to Responsive Masculinity; the transformative power of the provider role, appears in The Palgrave Handbook of Male Psychology and Mental health, is available here https://www.palgrave.com/gb/book/9783030043834#aboutBook

DOI 10.1007/978-3-030-04384-1

 

 

Open post

Negative attitudes towards men and masculinity in Spain

by Daniel Jiménez

In the second of our occasional blogs on the theme of Male Psychology and masculinity around the world, Daniel Jiménez describes the surprisingly high levels of prejudice against men in Spain in the past 20 years. The implications for men’s mental health are concerning.

 

In recent times the United States has been witness to a devaluation of masculinity in the public discourse. From academia to mass media and gradually pouring into popular culture, masculinity has been blamed for a range of social illness: mass shootings, intimate partner violence, sex crimes… to the point where some claim that there is no toxic masculinity, but rather masculinity itself is toxic. Male creativity, contributions and achievements are, on the other hand, attributed to individual traits or to a position of privilege. The so-called “masculinity crisis” has been a hotly debated topic, as the State gradually appropriates the role of provider and protector that men held, and modern economy facilitates women becoming financially independent.

From the Unites States it would be easy to perceive these developments as particular to the Anglo-Saxon world, and perhaps Nordic European countries such as Sweden. On the other hand Spain, like most of Southern Europe, tends to be regarded as a place where traditional notions of masculinity remain strong. This is the country the world associates with Don Juan Tenorio, brave bullfighters and the term machismo. Most Americans are surprised to find that a negative perception of masculinity not too dissimilar to that of the United States has developed in Spain, and that its devaluation has been taken even further.

The catalyst that triggered the change was the killing of Ana Orantes in 1997. Domestic violence was starting to be discussed openly in the Spanish media, and Orantes appeared on national television to tell her story. She was burned alive by her husband the next day, and this brutal killing shocked public opinion. This wasn’t the death of an unknown person, but a familiar face that people could recognize and a story they empathized with. Over the following years domestic violence killings (when committed by a man) became treated not as the isolated actions of evil or unstable individuals, but were rather understood according to gender theory postulates. Domestic violence was explained as a manifestation of male oppression, and the dismantling of structures and socio-cultural practices that made this oppression possible was said to be the only way to eradicate it, because domestic violence emanated from the imbalance of power.

In 2004 the view of domestic violence as a gendered phenomenon materialized into the Organic Act on Integrated Protection Measures against Gender Violence. The adoption of the term “gender violence”, instead of alternatives such as “domestic violence” or “intimate partner violence”, framed the conversation in terms of violence against women by their male romantic partner or ex-partner. The law would impose higher penalties to these men in a subset of domestic violence crimes, as shown in Title IV. The act would include, among other measures, special courts designed only for these crimes: the juzgados de violencia sobre la mujer, which presently number over a 100. To my knowledge Spain is the only country that has courts exclusively focused on male crimes (as gender violence is defined), making the U.S. Violence Against Women Act seem soft in comparison. The law has also been weaponized during divorce processes, as accusations often activate a protective order against the male and give automatic custody of the children to the accuser until the accusation is resolved. Depending on the circumstances and the region, making an accusation – regardless of the outcome – can confer other benefits such as a small stipend, free college tuition, job placement or the granting of permanent residency in the case of immigrants.

The complexity of the 2004 law would merit a separate article, but what needs to be pointed out is that it marked a turning point in Spain. Gradually, mass media, education at all levels and public policies came to be interpreted through the lense of gender theory, cementing a discourse that fuels a sex war where the male sex is widely portrayed as a problem in need of fixing.

While the United States has also fed on ideas about masculinity based on gender theory, having lived in both countries I would assert that the negative perception about masculinity is more pronounced in Spain. In fact, the Spanish media has not only created expressions such as “violencia machista” to replace the less explicit term “gender violence”, but has shown itself eager to adopt terms that originated in the United States as well. Aside from expressions like toxic masculinity (mascunilidad tóxica), neologisms such as manspreading, mansplaining and manterrupting have either been borrowed or translated by the Spanish media, with machoexplicación (the translation of mansplaining) becoming candidate for word of the year by Fundeu (Fundación del Español Urgente).

Masculinity, and men in general, have become an acceptable punching bag for the media and public officials. While there are many examples, I will only mention some of the most recent. On one occasion a journalist declared on national television that celebrating Men’s Day would be akin to celebrating “The day of the terrorist”. There is also the case of a judge specialized in gender violence that described males as “acorn-fed animals.” And not long ago, in a regional government-run campaign against gender violence, male bystanders were accused of sexist attitudes or even domestic abuse by an actor who introduced himself as “your (inner) machismo.” [1]  In the political arena, the 2017 State Pact Against Gender Violence included in its congressional discussion terms such as “patriarchal justice,” “patriarchal domination,” “male domination,” “structural machismo,” “patriarchal violence” or “privileged-oppressed relationship.”

While discontent (and disconnect) about men’s negative portrayal in the media and public institutions is growing among the Spanish population, the negativity doesn’t seem to be waning. And while it’s true that ideas from the United States have had an influence on the perception of masculinity in Spain, if the latter country were to be considered its student, it would no doubt have surpassed its master.

 

[1] Machismo in the Spanish sense of the word, which implies a sexist sense of superiority over women and even a sense of entitlement over them in more recent uses of the term.

 

About the author

Daniel Jiménez is a Spanish Language and Culture Instructor for the U.S. Defense Language Institute. Raised in Spain, he has been living in the United States since 2006. The views and opinions expressed in this article are those of the author and do not necessarily reflect the official views or opinions of any agency of the U.S. government

 

 

 

Open post

You can’t help men by attacking masculinity

by Dr John Barry

You might not have noticed it, but in many countries November 19th was International Men’s Day.  The UN has four international days for women, but for the UN November 19th is World Toilet Day.

It seems to be the fashion today to attribute many of the world’s ills to men. Although some people directly attack men, often the attack is presented as a way of helping men by rescuing them from masculinity.

The term ‘toxic masculinity’ is often seen in the media, but the evidence that toxic masculinity explains men’s bad behaviour is based on the circular argument that 1/ violence and sexism are part of the definition of masculinity, and 2/ violent and sexist men are proof that masculinity is toxic. However the reality is that 1/ masculinity does not need to be defined by violence or sexism and 2/ psychologists know that violence and sexism are usually rooted in trauma, not masculinity. In fact, some of the very worst examples of violent sex offending are caused by men having been sexually abuse in childhood, often by female caregivers.

It is surely difficult to empathise with violent and sexist men, but we know that there are evidence-based ways of dealing with them. Professional psychologists have an ethical obligation to use treatments that are evidence-based, not faddish programmes offering to help men overcome their burdonsome masculine traits.

The forerunner of such programmes is the Duluth Model, a psychoeducational perpetrator program based on the notion that all domestic violence is caused by patriarchy, which causes men to exert control over women through violence. A meta-analysis found that Duluth, and interventions using similar ideas, showed only about half the benefit of other programmes, such as relationship enhancement. This, and the failure of the Duluth model to even recognise that at least a third of victims of domestic violence are male, should persuade us against using models based on flawed ideas about men and masculinity. Unfortunately this lesson has not been learned, as demonstrated in pages 124-8 of the Power Threat Meaning Framework (PTMF). Attempts to change masculinity have been compared with conversion therapy to ‘cure’ gay people of their sexuality. Conversion therapy has recently been condemned by the BPS, yet attacks on masculinity go unquestioned.

Some people might say they want to change masculinity rather than change men, but this is based on the mistaken belief that masculinity is merely learned, and independent of biology. However there are obviously biological aspects to masculinity. Using Martin Seager’s dimensions of masculinity to demonstrate this, being a Fighter & Winner is supported by men’s physiology, such as greater muscle power and upper body strength. Having Mastery & Control of one’s feelings is supported by the tendency of testosterone to reduce fear and increase stress resilience, and being a Provider & Protector is seen in the fact that for men wellbeing is strongly linked to job satisfaction. The tremendous value of these attributes should not be forgotten, especially in 2018, the centenary of the end of World War I, a time when so many men were the protectors of civilisation.

There are undoubtedly many positive things about masculinity, and stigmatising masculinity is likely to make men feel ashamed and alienated. If negative views are internalised they could even become a self-fulfilling prophesy, putting boys on a mission to live up to the toxic label imposed on them.

Psychologists need to lead the way in offering evidence-based solutions to men’s mental health problems, and should not stand idle when 50% of the world’s population is being stigmatised in the media and elsewhere.

 

About the author

John is one of the founders of the Male Psychology Network and the Male Psychology Section of the British Psychological Society. After completing his PhD in psychological aspects of polycystic ovary syndrome, he joined University College London’s Institutefor Women’s Health at the UCL Medical School in 2011. Since then he has published over 60 papers in various peer-reviewed journals, including in international-standard journals in gynaecology, cardiology and ophthalmology. Prompted by the considerable suicide rates among men and the establishment’s inertia in dealing with men’s mental health problems, in 2011 John led an independent research programme investigating the mental health needs of men and boys. John specialises in research methods (especially surveys and questionnaire development) and statistical analysis (e.g. meta-analysis, meta-regression), currently practices clinical hypnosis on a part-time basis and is an honorary lecturer with the Dept of Psychology, University College London.  John is an advisor to the Royal Foundation for issues around men’s mental health.

 

 

 

 

 

Open post

The importance of fathers to mental health

A talk by Consultant Psychotherapist Andrew Briggs, followed by questions from the audience.

This lecture will consider the impact on child development and mental health when fathers are absent from their families. Positive and negative outcomes for the child will be the main focus of the talk. The role of the mother on child development, both positive and negative, will be discussed. Reasons for father absence will be explored.

This talk is part of the series of talks on Masculinities and Health organised in conjunction with UCL’s Centre for Global Health and Global Action on Men’s Health.

Further details: http://ighgc.org/newsevents/masculinities-and-mens-health-from-sex-to-structure

Tickets are free and open to all, but registration is needed by emailing igh.gendercentre@ucl.ac.uk

 

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