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Submitted by Hvovi Bhagwagar on 22 April 2020
A man in grey shirt and jeans sitting on a couch and holding his head in despair

Psychotherapist H'vovi Bhagwagar points out that today an increasing number of Indian men are feeling the pressure of gender role strain and need to be motivated to seek help for mental health issues. These issues are likely to be accentuated during the covid19 pandemic, the lockdown and the economic downturn.

The stigma associated with therapy is a global phenomenon, and for a very long time it was believed that therapy was only for the very disturbed, poverty-ridden, drug addicts and the severely anxious and depressed. The reality is that according to World Health Organization prediction roughly 20 per cent of India will suffer from mental illnesses by the year 2020. However, there is a large-very large- section of the population, in our country, and across the world that find it difficult to seek help. The men among us.

Since time immemorial it has been a popular opinion, endorsed by both research and social experience that men find it difficult to talk about their feelings, or to reach out for psychological care. How true is this? Terrence Real, author of ‘How Can I Get Through to You? Reconnecting Men and Women’ writes "The average man is as likely to ask for help with a psychological problem as he is to ask for directions!" He adds that even though many men do agree to see a therapist, although primarily for marital issues, divorce rates are still on the rise, because men are still reluctant to share feelings even in therapy, leaving their spouses embittered and disillusioned.

To get some perspective closer to home, I spoke to some fellow therapists for their views, and to understand if reluctance in help-seeking among men is as evident as proclaimed. Most therapists aligned with the view that the gender ratio in their practice was skewed, with twice or thrice the number of women approaching a therapist, as compared to men.

  • Rimpa Sarkar a senior therapist who works with Sentier Mind, says “Yes, reluctance in male patients is very much evident. And those who are not reluctant don't share with their families that they are seeking help. She says that the ratio of male: female clients in her practice would be around 1:4.
  • Similar views are offered by Pritha Saha, a Life Coach. She says the male to female ratio is 2:8 in her experience. Also, “women tend to continue therapy for a longer while as compared to men and men have the tendency to stop intervention the moment the issue becomes manageable”.
  • KV Ganpathy who works as a Palliative Care Provider, brings up an interesting perspective, “I have experienced many men refusing to acknowledge their anxiety about looking vulnerable while discussing the prognosis of their child. Later we learn from our social workers who do home visits or from their spouses that their behaviour is extremely anxiety-ridden”.

Can You Talk Your Way To Mental Health?  

When experts also perceive that men are reluctant, and secretive about seeking help, it further reinforces the popular opinion that men dislike being “analayzed” and prefer to keep problems to themselves rather than seeking professional help. For a country that is already in a precarious mental health situation, such reluctance can only spell doom. However, the start to change is always a compassionate outlook. So the first question we need to ask ourselves is makes men reluctant to seek help?

Cultural conditioning

From childhood men have been taught to be tough, stoic and not show any vulnerability. Chimamanda Ngozi Adichie, the award-winning author says “By far the worst thing we do to males —by making them feel they have to be hard — is that we leave them with very fragile egos.”. Discourses on gender norms and help-seeking typically capture men in frames of traditional gender roles which have unspoken demands. From childhood men have been taught to be tough, stoic and not show any vulnerability.  Popular media further reinforces this stereotype. From Talaash, where Aamir Khan refuses to seek therapy- despite being traumatised by his child’s death- while his wife visits a psychiatrist, to Arjun Kapoor in 2 States seeking therapy from the invisible therapist, Bollywood portrays men seeking counselling, almost as an after-thought, to “spice-up” the dish. The main course, however, still is the macho soft-drink glugging, deodorant-splashed lady killer who swash buckles into the scene to rescue the damsel in distress. This image of the Indian male definitely doesn’t sync with the guy sitting in a therapist’s office pouring his heart out. 

  • Priyanka Bajaria, a psychotherapist practicing in Mumbai and Pune says that “Gender norms in our society tend to promote the following narratives: ‘Men don't cry/Ladkenahi rote’, ‘Mard ko dard nahin hota/Men are strong’, ‘Wash away your worries with some alcohol’ amongst others. These narratives trigger shame among the men who do want to seek help too”.
  • Rimpa shares a sad story to that effect. “One of my male patients once said ‘People expect me to have everything in life but no mental weakness, as men can never be weak’”.
  • “Mental health is a taboo, associated with weakness, while males in our society have always been taught to stay strong and hold that position. Therefore, seeking mental health help causes male to face stigma and societal embarrassment” sums up Sakshi Jain, a therapist who says she has seen men reluctant to seeking help, in her practice of two years.
  • A wider perspective is offered by Vinod Mudliar, a therapist from Mumbai who previously practiced abroad. “I find a stark contrast in my clients' approach to counselling as compared to my experience in the US. In my opinion, the lack of awareness about counselling and its benefits is in itself a huge barrier. I feel men I have counselled found it difficult to express emotions and were of the understanding that medicines were helping them deal with clinical symptoms immediately. And those who make it, often drop out after a session or two”.

Read this: Why Do Men Suffer Depression In Silence?

Research validates these views. A 2015 review paper by Yousaf, Grunfeld and Hunter examined several papers to understand what prevents men from seeking medical and psychological help. They found that certain common predictors that act as deterrents to seeking help: disinclination to express emotions, concerns about health, embarrassment, anxiety and fear, and poor communication with health-care professionals. Other research finds that for many men help seeking becomes a “double jeopardy” as it underlines their being “failures” in managing their own problems. Some studies indicate that suicide may be perceived by men as a way to regain control over their lives and to end their suffering on their own terms.

And thus follows the next question. How does such reluctance impact men’s mental health? The term “toxic masculinity” was first used by psychologist Shepherd Bliss in the 1980s and 1990s, to refer to a highly dangerous social norm which forces men and boys to conform to a very narrow view of the male archetype, which leads to harmful behaviour and attitudes commonly associated with some men, such as the need to repress emotions during stressful situations, and to act in an aggressively dominant way. The pressure to be "all-male", to “fit-in” by doing actions teetering on sexual harassment, to keep their sexual preferences a secret, and to adhere to the “silent and strong” prototype of the global male is actually a slow poison for most men.

Dangers of toxic masculinity

The statistics about men’s mental health is alarming. According to the American Foundation for Suicide Prevention, men died by suicide at a rate of 3.54 percent higher than women in 2017. Even more alarming is that depression and suicide are ranked as a leading cause of death among men, and yet men are far less likely to seek mental health treatment than women. In India, around 53% of sexual abuse incidents are crimes against boys, but boys are 89% less likely than girls to reach out for psychiatric support.

Men are thus obvious victims of gender role strain - a psychological situation in which gender role demands have negative consequences on the person, to the extent that they may not even realise they may be facing a mental illness. APA President Ronald F. Levant has coined the term "normative male alexithymia" to refer to the male phenomenon of being so unaware of their feelings that they are literally "without words for emotions", even when faced with obvious signs of depression.

Helping men help themselves

With the strong influence of gender norms and social stereotyping, reversing this deeply ingrained cultural conditioning may take several generations, at a conservative estimate. However, change should, and can, begin immediately.

Read: Tips for men looking for help 

According to Dr. Wizdom Powell, who was awarded by the American Psychological Association for her Study of Men and Masculinity, “We all have a role to play. The first thing we can do is to try to create a culture to disrupt the narrative around silent suffering and the expectations for men to be strong, stoic, and silent.”

It was heartening to hear the voices of several Indian men across Social media on World Mental Health Day 2019, raising objections to gender stereotypes. Men from various walks of life, including some public figures, described the social, emotional and health burdens that toxic masculinity was putting them at risk for. This is perhaps the start to a social change where men can freely talk about their feelings, where there are more such open conversations, and more spaces where men can express without the fear of being judged.

For most men, mental health and their conception of manhood are often closely linked. So we need to be mindful that apart from breaking silence on gender norms, we should concurrently be sensitive to social stereotyping so that men can seek psychological support in a safe way. The findings of several research studies continuously indicate that psychotherapy can and will be beneficial to male clients. However, the way psychotherapy is offered to them needs to be different. Men prefer “specific and achievable goals” for treatment and straightforward descriptions of the therapy process. More therapists need to be encouraged to be sensitive to the way they handle male clients, acknowledging their needs to discuss emotions gradually, while also avoiding the assumption that all men are emotionally illiterate.

Interestingly, how many male psychotherapists are around? The feminization of psychotherapy could further inhibit men from seeking help. Breaking gender stereotypes may be needed here as well. Would more men seek help if there were more male therapists, or if therapy were not thoughts of “such a female thing”? Let’s ponder on that.

Increasing men seeking help

Bringing in my own viewpoint as a therapist, over the last two decades there has been a significant growth in the number of men seeking psychological treatment. However, the attrition rate for male clients continues to remain alarmingly high. Men continue to express a high need for quick fixes and prefer to rely on medication and substances, rather than inner exploration. So, while more men may be seeking help, they are unaware that help also requires a willingness to be vulnerable and make emotional changes. Therefore, we need to not just motivate men to seek help, but also to be okay with vulnerability, let down their guards and learn to reflect on their thoughts and feelings. It is imperative in today’s times that men re-think what it means to be a “provider.” The world has changed, and men need to re-learn ways of being in the world in a more flexible and emotionally generous way.

Finally, we need to stand together as a society, encouraging and cheering the men among us to make their mental health a priority. Eradicating redundant gender norms should be our collective goal, as we are finally the beneficiaries. “When men suffer from mental health problems in silence and fall victim to substance abuse or suicide, it’s often women and girls who are left to pick up the pieces and take on caregiving burdens. So this is really about creating healthier families and communities and creating better mental health for everybody”, says Wizdom Powell.

H'vovi Bhagwagar is a Psychotherapist with her office “MANASHNI” at Powai, Mumbai and works with adults, children and teens diagnosed with mental health issues. H'vovi lives by the belief that being an effective therapist flows from being a good human being. She writes to spreads awareness about mental health through her blog and articles.