David Peters, Editor

Published in JHH14.3 – Men’s Health

A meltdown of old norms is stirring dark suspicions about maleness and men’s place in the world. Men commit most of the world’s murders and most often the victims are their partners or former partners. Are these men ‘naturally’ violent? If we over-biologise gender differences, men are testosterone-driven aliens and women hormonally compelled babymakers. Societies woven around these assumptions split humankind along gendered faultlines so men hold the power. The notion that men are wired for aggression and women are programmed for nurturing offspring only serves to keep this obsolete show on the road.

Men dominated labour markets and ruled over production and government when women were economically dependent and work was physical. But these bastions of maleness are crumbling in a post-industrial information age, and women are in the ascendant. Do men feel surplus to requirements now that women control their fertility, get pregnant independently and rear children alone? An enfeebled patriarchy is making waves and pushing back: could domestic violence, terrorism, sexual harassment and child abuse be the death throes of a sick and redundant masculinity?

We are not held hostage by our genes as much as we are by the stories we tell. Let’s dump stories that force a political wedge between the sexes; we are one humanity. Yet there are many differences in the ways we become ‘en-minded’ and embodied: each one of us is an all too brief expression of evolution, ancestry, mind and culture, emergent in a particular place and time. Sociologists play down biological factors, imagining human nature as painted on a blank canvas in childrearing and culture. But the canvas is not blank; humans are biological beings, who share their potential for violence with other primates. The human prefrontal cortex makes self-awareness possible, but evolution hung on to what had worked before – the limbic brain. Its mammalian emotion systems trigger fast, effective emergency action in the wild: we respond to threat when we feel anger and fear, seek food, shelter, or mates because of hunger or desire. Then, once we feel safe enough or full enough, the threat circuits are supposed to turn off. But now the things that threaten us are hard to pin down, and highly subjective. We see the world through how we feel, yet can we feel ‘safe enough or full enough’ in a world shot through with deprivation, where background ‘threats’ are unremitting and subliminal, and where the media keeps hitting our hate and desire buttons?

These imaginal impulses keep the limbic system churning. And when powerful emotions stir up, they get acted out unless consciously noticed and tolerated. The limits of tolerance are set early on in life: secure attachment lays the neural foundations for emotion-processing in the infant brain; insecure attachment and persistent stress enlarge the amygdala – the brain’s smoke alarm for threat – so that limbic rage and fear are on a hair trigger. Small wonder that men living in brutish conditions – especially if they have experienced childhood trauma or too little love and security – are likely to run amok. Yet men as well as women have nurturing instincts: we are wired for empathy, and for tending and befriending, not just for strife and striving. Yet under ‘threat’, when life is harsh and society austere, mercy will be in short supply in someone with no sense of the ‘remembered safety’ needed for tolerating extreme emotion. Danger, despair or desperation turn off our other limbic circuits for kindness, care and co-operation.

In his masterly exploration of the roots of contemporary male insecurity Anthony Clare (2000) calls for ‘the taboo on tenderness’ to be lifted from men, in the ways boys are reared and educated, but also in the way men can increasingly see their maleness reflected in their ability to be kind, to care and love.

We spend money on killing machines and wonder why our youngsters are so aggressive. We insist our children, from the earliest years, familiarise themselves with the intricacies of human biology, yet ensure they learn little or nothing of psychology until their own personalities are distorted beyond correction. And, rather than acknowledge the neglect we have shown towards structures such as marriage and family life, we resort to undermining their importance in the sum of human health and happiness.

The present time feels like a tipping point, and the biology of human nature won’t change in a hurry. So the culture will have to respond to our urgent need to tackle deprivation, condemn violence and live with respect for difference. Evolution, now impelled by a resonance between Earth’s crisis and masculinity’s precarious predicament, depends on social and political action. It’s a synchronicity that invites compassion for ancient wounds and a reconciliation with the suffering Earth. Many are waking up, sensing their vulnerability and interdependence as precious and significant. To these men and women we dedicate this issue of the JHH.

Clare A (2000) On men on men: masculinity in crisis. London: Chatto & Windus.

Two-day foundation course on integrated medicine

The College of Medicine is still taking bookings for its third two-day foundation course on integrated medicine, which will take place on 16/17 November 2017 at the iconic Dumfries House in Ayrshire. The course will be an introduction to integrated health and care including lifestyle approaches, social prescribing, mind/body therapies, and the mainstream complementary therapies. It is open to all clinicians but should be particularly helpful for GPs and nurses interested in looking beyond the conventional biomedical box. Spaces are limited and the previous courses in London and Bristol were fully booked.

https://collegeofmedicine.org.uk/events/#!event-list

A new UK Diploma in Integrated Medicine

Bristol’s Portland Centre for Integrative Medicine is developing a centre of excellence for IM. The centre offers a range of holistic healthcare therapies and services designed to support health and wellbeing. As part of its aim to transform healthcare the centre launched a new two-year diploma in IM at the Penny Brohn Centre in October. Nine doctors have already joined the course which is led by Dr Elizabeth Thompson and the education team at the Portland Centre. For more information see

http://portlandcentrehealthcare.co.uk/diploma-for-integrative-medicine

BHMA/SMN gathering of change-makers

Transformative Innovations for Health is a BHMA conference in collaboration with the Scientific and Medical Network. This gathering of change-makers will be on Saturday 18 November 2017 at the University of Westminster. The BHMA AGM will follow at 6pm. Please book online if possible at www.scimednet.org (and click on events), otherwise email info@scimednet.org or download the programme from BHMA website.

Medical teachers symposium

This second symposium for medical teachers brought together colleagues from many of the UK’s medical schools. The working conference, designed to address the challenges of 21st century medical education was opened by a panel of activist medical students. Updates followed on research into medics’ wellbeing, and the challenges of culture change. Posters, round-table discussions and presentations gave innovators in student support and education many opportunities to explore and share an exhilarating mix of new ideas and ways forward. A report on the event is expected in December. Look out for notifications on the Centre for Resilience.

Eden Project Eco-Psychology Conference

Transpersonal Narratives in Eco-Psychology proposes that caring for the natural world of which we are an integral part is critical for our survival and our emotional wellbeing. The programme rests on the premise that alongside the damage being done to the biosphere our psychological, social and spiritual health is being harmed. How then can we strengthen our capacity as practitioners and activists to counter these intertwining downward spirals? In this context, the three-day meeting will be looking at spiritual traditions as well as psychological insights that support such capacity, and asking how such insights can support and deepen psychotherapy.

Friday 24 to Sunday 26 November 2017, Eden Project, Cornwall www.confer.uk.com/eco-psychology.html

The NHS clinical commissioners recommending homeopathy prescribing ban

Homeopathic remedies cost the NHS just £92,412 in 2016. Though they are hardly prescribed in the NHS, they are among several treatments the commissioners will stop the NHS offering. Others include chondroitin and glucosamine (costing the NHS £444,535) herbal remedies (£100,009), and omega-3 fatty acids (£6.3 million). The latest (positive) evidence for chondroitin for knee osteoarthritis is flagged up on the research page of this issue of JHH. The commissioners claim homeopathy effects are mere placebo, but even so might they still be good value treatment for certain conditions? Ted Kaptchuk at Harvard recently found that despite having been explicitly informed they were getting a ‘sugar pill’ without active medication, patients with IBS symptoms given these ‘open-label’ placebos experienced a dramatic and significant improvement compared with those given nothing at all. Kaptchuk suggests placebos can work for conditions defined by subjective symptoms like pain, nausea, or fatigue but can’t do much to change objective tests (eg to reduce cholesterol) or cure a disease such as cancer. Kaptchuk says, ‘People can still get a placebo response, even though they know they are on a placebo’. ‘You don’t need deception or concealment for many conditions to get a significant and meaningful placebo effect.