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The other ‘hidden homeless’: autistic men

by Dr John Barry

Around 85% of rough sleepers are men (St. Mungos, 2016). The reasons for homelessness are many and complex, but the most frequently cited reasons for male homelessness are relationship breakdown, substance misuse, or leaving an institution (e.g. prison, care or hospital) (Brown et al, 2019).

At any one time in the UK there are around 5000 rough sleepers (Ministry of Housing, Communities & Local Government, 2017). This isn’t counting the group often called the ‘hidden homeless’, a much larger number of people – at least 250,000 – with no stable accommodation (Shelter 2016). We know that almost half of rough sleepers have mental health needs (Combined Homelessness and Information Network, 2017), but these figures don’t identify the other type of ‘hidden homeless’ – people with autism.

Autism effects 1% of the population (Brugha et al, 2016). Autism exists on a spectrum of severity (Autistic Spectrum Disorder, or ASD). There are some interesting gender differences that might lead to underestimates of ASD in females (van Wijngaarden-Cremers, 2019), but most estimates suggest that more severe cases are four times more common in males, and the less severe form (Asperger Syndrome) is nine times more common in males (Barry & Owens, 2019).

Given the fact that most homeless people are male, we would expect a larger proportion of homeless people to have autism. In the first study on this topic published in a peer-reviewed journal, Churchard et al (2019) found that autism is at least 12 times more common in homeless people than the general population (or probably more, if it was possible to identify the ‘hardest to reach’ homeless people). This figure far exceeds the rate you would expect if autism in homeless people was simply due to both autism and homelessness being more common in men. So if gender doesn’t fully explain the over-representation of autism in the homeless population, then why are so many autistic people homeless?

Well, substance abuse does not explain it, because people with autism are less likely to have problems with substance abuse than other people (Butwicka et al, 2017). However Churchard et al (2019) suggest that the greater levels of social isolation experienced by people with autism might be the key; autistic people often have fewer people to turn to if things go wrong in their lives, such as their housing being threatened. People with autism are also less likely to be employed, so might slip into the poverty trap more easily (Calsyn & Winter, 2002). Churchard et al also suggest that because people with autism are more likely to experience sensory difficulties (e.g. finding noise distressing), this makes living in shared accommodation or a hostel virtually impossible. Also for those with cognitive impairments to abilities such as planning, everyday independent living might become virtually impossible.

Although the current level of knowledge regarding homelessness and autism is very basic, there has been some progress by a group called Homeless Link (2015), who have created practical guidelines on how to identify autism in homeless people, and how to communicate in a way that best facilitates support for the homeless person.

This article only scratches the surface of mental health issues in homelessness. Other issues that impact the general population of homeless people include a history of childhood abuse and neglect, seen in 80% of homeless people (Torchalla et al. 2012). This type of history creates special problems for housing homeless people, because they may have learned to associate home with abuse and neglect (Duffy & Hutchison, 2019). Trauma prior to homelessness is also common (e.g. military-related PTSD), as is trauma as a result of life on the street (Buhrich et al. 2000).

More research is needed to identify the scale of the problem of autism in homelessness, and to develop evidence-based methods of helping these vulnerable people. There can be little doubt that homeless autistic people should be one of the key issues for anyone interested in Male Psychology.

 

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).

 

References

Barry JA and Owens B (2019). From fetuses to boys to men: the impact of testosterone on male lifespan development, in Barry JA, Kingerlee R, Seager MJ and Sullivan L (Eds.) (2019). The Palgrave Handbook of Male Psychology and Mental Health (pp. 3-24). London: Palgrave Macmillan. DOI 10.1007/978-3-030-04384-1

Brown, J. S., Sagar-Ouriaghli, I., & Sullivan, L. (2019). Help-Seeking Among Men for Mental Health Problems. In The Palgrave Handbook of Male Psychology and Mental Health (pp. 397-415). Palgrave Macmillan, Cham. DOI 10.1007/978-3-030-04384-1

Buhrich, N., Hodder, T., & Teesson, M. (2000). Lifetime prevalence of trauma among homeless people in Sydney. Australian and New Zealand Journal of Psychiatry, 34(6), 963–966.

Butwicka, A., Langstrom, N., Larsson, H., Lundstrom, S., Serlachius, E., Almqvist, C., … Lichtenstein, P. (2017). Increased risk for substance use-related problems in autism spectrum disorders: a population-based cohort study. Journal of autism and developmental disorders, 47(1), 80-89.

Churchard, A., Ryder, M., Greenhill, A., & Mandy, W. (2019). The prevalence of autistic traits in a homeless population. Autism, 23(3), 665-676.

Combined Homelessness and Information Network. (2017). CHAIN annual report: June 2015. The Greater London Authority.

Duffy, J., & Hutchison, A. (2019). Working with Homeless Men in London: A Mental Health Service Perspective. In The Palgrave Handbook of Male Psychology and Mental Health (pp. 533-556). Palgrave Macmillan, Cham. DOI 10.1007/978-3-030-04384-1

Homeless Link (2015). Autism and Homelessness: Briefing for frontline staff. https://www.homeless.org.uk/sites/default/files/site-attachments/Autism%20&%20HomelessnesOct%202015.pdf

Ministry of Housing, Communities & Local Government. (2017). Rough Sleeping Statistics, Autumn 2017, England. London: Author.

Shelter. (2016). Green book 50 years on: The reality of homelessness for families today. http://www.shelter.org.uk/__data/assets/pdf_file/0003/1307361/GreenBook_-_A_report_on_homelessness.pdf.

St. Mungos. (2016). Stop the scandal: An investigation into mental health and rough sleeping. http://www.mungos.org/documents/7021/7021.pdf.

Torchalla, I., Strehlau, V., Li, K., Schuetz, C., & Krausz, M. (2012). The association between childhood maltreatment subtypes and current suicide risk among homeless men and women. Child Maltreatment, 17, 132–143.

van Wijngaarden-Cremers, P. (2019). Autism in Boys and Girls, Women and Men Throughout the Lifespan. In The Palgrave Handbook of Male Psychology and Mental Health (pp. 309-330). Palgrave Macmillan, Cham. DOI 10.1007/978-3-030-04384-1

 

 

 

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Psychological treatments for erectile dysfunction

By Dr John Barry

About a third of men experience difficulty in getting or maintaining an erection, and this percentage increases in older men. Around 85% of men find that sildenifal (Viagra) improves their erections. This is a good success rate, but it doesn’t address any underlying psychological issues the man might have in relation to sex or relationships. In fact the success of Viagra has led researchers to focus almost entirely on organic factors in erectile dysfunction (ED) rather than psychological factors.

Research shows about 40% of cases of ED are caused by psychological (psychogenic) factors alone, though psychological and physiological (organic) causes can interact. If you can achieve an erection through masturbation but not with a partner, then the cause is probably psychogenic. If you can’t achieve an erection at all, the cause is probably organic.

The main causes of psychogenic ED are depressed mood, low self-esteem, anxiety, and stress. The causes can be grouped into three categories: performance anxiety, recent stressful life events, and vulnerabilities from childhood and adolescence.

The main organic causes of ED are: cardiovascular disease (blood pressure, cholesterol), diabetes, surgery to prostate (prostatectomy), loss of T (e.g. due to ADT androgen deprivation therapy in prostate Ca), drug & alcohol intoxication or side effects.

We know that Viagra has a good success rate, but how well does ED respond to psychological therapies? Well, hypnotherapy has been found to be successful in 70% of cases of ED. A meta-analysis of 11 randomised controlled trails (RCTs) of 398 men found that group therapy improves ED compared to no-treatment, and combining Viagra with group treatment caused a significant improvement in ED compared to those who received Viagra alone. Psychological interventions also compared well to local injection and vacuum devices for ED. The success of group interventions echos evidence that group therapy and educational (information-sharing) interventions a sometimes more successful in ED than more traditional one-to-one psychological approaches, and this would be in line with other research on gender differences in preferences for therapy.

So what should you do if you experience ED? First of all, try not to worry about it because effective therapies are available, and worry can become a vicious cycle. Try to establish the cause by asking yourself questions such as: can you achieve and erection by yourself but not with a partner? Do you have an undiagnosed medical condition such as heart disease or diabetes? Are you under a lot of stress at work? If in any doubt visit your GP. And remember that although most men don’t exactly brag about it, ED is a pretty common condition, and one that can be successfully treated.

 

About the author

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

 

The Palgrave Handbook of Male Psychology and Mental Health will be released in April 2019.

From the back cover:

“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”.

 

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Light at the end of a long dark tunnel for male victims of domestic violence?

by Dr John Barry

Picture: outside the European Union (EU) Parliament in Brussels. L-R Dr John Barry, Marta Iglesias Julios, Prof Joaquim Soares, Prof Nicola Graham-Kevan, Eduardo Zugasti.

Many of us will have found that when we try to discuss men’s mental health issues we are met with disinterest or even derision. It has even been suggested that men in general are so privileged that they don’t need any male-specific help.

It could be that there is especially little sympathy for male victims of domestic violence, even amongst male victims themselves. There are lots of reasons for this. In general, neither men nor women want to see men as victims. Also, the domestic violence industry is focused almost exclusively on female victims, and any sign that funding will be diverted to male victims is not welcomed with open arms. Campaigners such as Erin Pizzey and researchers such as Prof Murray Strauss have experienced threats and abuse, and it is true to say that the decades since the 1970s have been bleak times for people sympathetic to male victims of domestic violence.

But now in 2018, perhaps we are seeing the first green shoots of fresh thinking about domestic violence:

Since September 2018 we have seen Mark Brooks and the Mankind Initiative in the UK feature prominently in the mainstream media, including the Victoria Derbyshire show on BBC1  They – especially Mark himself – are to be congratulated for the determination and professionalism.

27th November 2018 saw Dr Liz Bates (University of Cumbria, UK) be honoured with an award for her research on male victims of domestic violence as one of the ‘UK’s Best Breakthroughs’ in academia this year.

4th December 2018 saw a meeting in the EU parliament in Brussels, focusing on research evidence of the extent of domestic violence against men worldwide, compiled by Professor Joaquim Soares (Mid Sweden University). In the same meeting, Professor Nicola Graham-Kevan (University of Central Lancashire, UK) discussed research into the sometimes devastating impact on children of witnessing domestic violence. Marta Iglesias Julios, a PhD candidate from Portugal, gave a very thought-provoking presentation on the potentially far-reaching harm caused by non-physical violence (e.g. spreading malicious rumours) of the type that women tend to engage in more than men do on average. The forum was organised by MEP Teresa Giménez Barbat and Euromind, and was very positively received. For me it was a very pleasant surprise that support for male victims of domestic violence is alive and healthy in Europe.

So it appears that this topic is moving from the hinterlands and breaking into mainstream consciousness. What we need to see is this progress continuing in a sustainable manner. To facilitate this process, it would be helpful if the following developments were to occur:

1/ We need for the mainstream media – especially the BBC who we pay a tax for –  to tell the people of the UK the truth about domestic violence, not distortions of the truth. Failure to devote proportionate time to male victims should be condemned as a breach of the BBC code of impartiality.

2/ Greater recognition of the lack of services for male victims is needed. For example, male-specific treatment programmes – not the widely discredited Duluth model –  and other types of male-friendly support are urgently needed.

3/ We need greater recognition of the huge sacrifices made by people working in the field of male victims of domestic violence. Many people are doing incredible work voluntarily, or survive on a shoestring, in their efforts to help male victims.

Although there is light at the end of the tunnel, this tunnel is filled with obstacles. Funding to help male victims is still almost unheard of. Even the excellent MankindInitiative charity recently almost had to shut down due to lack of funding. Ironically, because of the recent heightened awareness of male victims, the domestic violence industry – after years of focusing only on helping women – are apparently now keen to apply for funding so that they can extend their services to men. This isn’t a solution, mainly because the domestic violence industry has a reputation for treating men as perpetrators rather than victims, and because most women (and probably many men) will not be happy with having mixed-sex shelters and other facilities in this highly sensitive field.

So is there room for optimism when it comes to male victims of domestic violence? My answer is that we should be realistic and recognise the gains that are being made, strive to build upon them, and be prepared to have to work hard to finally reach the light.

 

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 Institute for Women’s Health at the UCL Medical School in 2011. Since then he has published some 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.

 

 

 

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Men Bereaved by Abortion

by author and journalist John Waters

One of the more commonplace arguments that crops up in relation to abortion is that it is a matter on which only women should have a voice. Even if we are to take this argument on its own reductive “gender” terms, an obvious question arises: may anyone speak on behalf of the male 50 per cent of those human creatures whose existences are snuffed out by abortion?

But there is another unspoken category of overlooked humans here also: the might-have-been fathers of those obliterated children. It is noticeable that, when this issue is referred to at all in these discussions, it usually gets disposed of in the conventionally censorious terms our society has contrived to dispose of fathers: “Oh, he won’t be seen for dust”, etc. etc. Just as self-styled “liberals” use hard cases to bludgeon problematic principles, they also like to advance worst-case caricatures to disallow the claims of inconvenient parties whose involvement might complicate things more than liberals like (a pretty low threshold, generally speaking).

But imagine a 19 year-old boy, perhaps your son, brother or nephew, who gets his 18-year-old girlfriend pregnant. The pregnancy is unplanned, i.e. in conventional terms “unwanted”. In the culture we have constructed of recent times, the question of the child’s survival is a matter primarily for the woman. Perhaps her parents will become involved, but nowadays this is unlikely to alter the dynamic significantly. The man or his family have no right to an opinion. The culturally-allocated role of the might-be father is to offer “unconditional support”.

But let’s imagine that the woman has not quite made up her mind.  She is taking her time with the decision. This, we insist, is her prerogative entirely. The man – the putative father of the child-in-the-balance has no entitlement to speak for himself or his would-be son or daughter. He waits to hear the fate of his child.

In that period of uncertainly, what is to be his disposition? He may be about to become a father or he may not.  Indeed, in his own mind he may already be a father, but this is something he will be well advised to keep to himself.

Western societies increasingly take the following view: If his child is allowed to live, this man must be available, for the rest of his life, to love and provide for his child – emotionally, materially, psychologically, and in manifold other ways. He will be expected – by the mother, her family and friends, and by society in general – to step up to the plate and become a loving, caring and responsible father. He will also be expected to live his life thenceforth as if these days or hours of indecision and mulling-over have never occurred –  as if the idea of obliterating his child had never been considered. From the moment his child is delivered from the threat of the abortionist’s knife, he must locate in himself the qualities of love, devotion, duty and protectiveness that society feels entitled to demand from a father while implacably refusing him the legal basis from which to protect his child.

If, on the other hand, it is decided that his child is to be destroyed, he should be able to go about his life as if nothing has happened, as if he never had a child, the prospect of a child, even the thought of a child.

You do not hear or read much in the media about male bereavement by abortion, but it is nonetheless a real syndrome, documented in numerous academic studies. This research tells us that abortion causes many men to become emotionally overwhelmed, to experience disturbing thoughts, feelings of grief and loss. They react either by silence or hostility.

Reviewing how abortion impacts intimate relationships, Coleman, Rue & Spence (2007) reported that men tend to exert greater control than women over the expression of painful emotions, and so tend to intellectualize grief, and cope alone. The study also found that men are inclined to identify their primary role as providing support for their partners, even after an abortion—even if they opposed the decision. The study also revealed that men are more likely than women to experience feelings of despair long after the abortion, and are accordingly more at risk of suffering chronic grief.  Another study, (Coyle, 2007) found that men whose children have been aborted experience feelings of grief, guilt, anger, depression, anxiety, helplessness, powerlessness, and other feelings akin to post-traumatic stress disorder (PTSD), and that they tend to repress these feelings rather than expressing them.  PTSD symptoms, which manifest in 40% of men implicated by abortion, can take an average of 15 years to manifest. Some studies (Coleman & Nelson, 1998; Kero & Lalos, 2000; and Lauzon et al., 2000; Mattinson, 1985) have found evidence that some men grieve more than the mother following the loss of an unborn child, giving the lie to conventional notions about the male as emotionally disconnected from his child. In fact, a great number of men experience abortion as the actual death of a child. Such feelings are frequently exacerbated by the man’s inability to understand what the woman expects of him, with many women experiencing ambivalent feelings which cause them to emit contradictory and confusing messages. Due to the relentless propaganda that attends such matters, many men assume that their role is to ‘support’ the woman even when he disagrees with the decision to abort, whereas in truth the woman may secretly wish for the father to talk her out of killing the child.

I wonder: in the event that his child is not permitted to live, at what precise moment is the father expected to extinguish in himself the love, duty, affection and devotion that would have been required to parent a living child – and demanded of the father by society, even though it simultaneously forbids him to have any say in the matter? Or, conversely, if the child is given the green light, does the father’s responsibility to ignite in himself the various qualities that are expected of a good-enough father begin from the moment of the announcement of the baby’s reprieve? Or is such a suddenly incorporated father entitled to a period of time to initiate the process of ignition in himself? If so, how long might he have to do this?

Of what do we imagine a man is made?

Does modern Western society imagine that its young males come equipped with some hidden mechanism for use when their children are annihilated – when, having been briefly invigorated with the possibility of fatherhood, they find that the emotions normally called upon in this context are not needed? Or, on the other hand, do we—collectively, I mean—believe that a man who has started in himself the process of grieving his child should be able to arrest this procedure and behave as though his child had merely had a miraculous recovery from a serious illness?

What kind of men might such a society expect to produce? Automatons with switches secreted in various regions of their bodies for turning on and off their human passions and emotions? Or – if flesh-and-blood males with real human desires, affections and capacities – what might we expect to happen to the hearts of men under such a regime? Would a society such as ours be entitled to be surprised if it ended up producing male humans who were incapable of loving, or grieving, or telling the difference between?

 

About the author

John Waters is a Permanent Research Fellow at the Center for Ethics and Culture, University of Notre Dame, Indiana, USA. Having started his career in 1981 with the Irish Music journal Hot Press, he later wrote in The Irish Times from 1990 to 2014. His first book, Jiving at the Crossroads (1991), about Irish politics around the 1980s, became a massive best-seller. He has written a number of books and plays for stage and radio and currently writes a fortnightly essay for the American magazine of religion in the public square, First Things. His latest book – Give us Back the Bad Roads – has just been published

 

 

 

 

 

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