Men’s mental health: why are we are trying to change masculinity rather than create male-friendly services?

Martin Seager, Consultant clinical psychologist; adult psychotherapist

Published in JHH14.3 – Men’s Health

It wasn’t until I was in my mid 40s having worked as a clinical psychologist and psychotherapist in the NHS for nearly 20 years that I got struck by men’s issues and how invisible they are. I had been working with men and women for all this time but had only really thought about gender issues as applying to women.What triggered my awakening was a male clinical psychology trainee coming up to me in desperation after one of my lectures at UEL where he was the only male among the 30 or so doctoral students in the room. Suddenly I realised that psychology was not a man’s world and then I came to realise that in many areas of life men also can suffer for their gender. Once I started looking around at issues such as suicide, life expectancy, homelessness, addiction, parenthood, imprisonment, educational performance and deaths in the workplace, I began to see that men too have a gender that places particular burdens upon them. From that time I have become passionate in all my work, more recently in the voluntary sector, researching and shedding light on men’s gender issues and developing new ways of reaching and helping men.

The injunctions for men to open up and man up constitute a double-bind, which results in a state of affairs as bad for the women and children who share their lives, as for the men in our society. It is a mixture of bad science, political correctness and disregarded evolutionary gender differences. I argue that until we can separate the science and the humanity from the politics and the prejudice, we are unlikely to improve the wellbeing of men considerably and may even in some ways worsen it. I end by showing positive examples of how men and boys can be genuinely helped by those few services that do get it right by tailoring their approach to the needs of men rather than trying to tell men to change their masculinity.

Double-bind – message 1 (explicit): open up!

The notion that men should ‘open up’ about their problems, vulnerabilities and emotions is now a mainstream policy and an unquestioned piece of public health thinking. The call upon men to ‘open up’ is pervasive. Implicit in this idea is the assumption that masculinity is somehow emotionally illiterate, repressed or deficient. This message also carries with it the implicit assumption that, by not ‘opening up’, men are somehow to blame for their own troubles and distress. The help is out there if only they would seek it, but they don’t. They are too stubborn, ‘traditionally masculine’ and even ‘macho’ for their own good. This viewpoint is hard to challenge in public and to do so is often to invite ridicule and contempt. Of course, even if it were true that men and boys were emotionally deficient we would still have to ask two big scientific questions: (a) why should this be the case when most childcare is still carried out by adult females? And (b) why should we criticise men or any group for a deficiency? Shouldn’t we be trying to empathise with their problems and adapting our services to take account of any deficiency?

Double-bind – message 2 (implicit): man up!

In contrast to the first message, the second is much louder though perhaps less explicitly voiced. However, our true attitudes to the male gender must surely be evidenced primarily by the actions we take and the services we provide for vulnerable men. If we truly believed that male vulnerability was an important thing, then society would surely provide the services to meet this need. But when we take a look around we find:

  • 97% of deaths in the UK workplace are male and there is no policy that addresses this – men are doing the bulk of the dangerous and heavy manual jobs without gender recognition1
  • 99% of combat deaths are male and this is accepted as the norm
  • nearly 80% of suicides are male but there are almost no male-specific suicide or mental health services2
  • 85% of rough sleepers are male but street homelessness is not seen as a gender issue
  • male life expectancy is significantly less than female but there is no major initiative to address this as a gender inequality issue
  • funding in specifically male cancers and other health problems is significantly less3
  • 95% of prisoners are male and most have severe or significant mental health problems but their living conditions are neglectful of mental wellbeing and little thought is given to their rights and needs as fathers or the needs of their children to have fathering
  • there are almost no specific services for male victims of domestic abuse although, even allowing for underreporting, they still make up 30–40% of the total
  • male victims of atrocities are overlooked (eg the boys who were burned to death in Nigeria by Boko Haram when the girls were kidnapped got no press coverage5)
  • perinatal services, employment law and the family courts on the whole do not acknowledge that fathers have equal feelings for or value to their children
  • in the UK women are now over a third more likely than men to go to university – there is no national policy or strategy to close this gap.

In summary so far

There is a paradox or double-bind in that while we chide men for not ‘opening up’ and seeking help we have arranged our society in such a way that we deny male emotionality, vulnerability and victimhood. The reality is that men and boys will listen more to the actions of society than its words, rather as we all will judge politicians by their deeds more than their rhetoric. In terms of our actions as a society we clearly have less empathy for the male of the species. We might be saying we care but our actions show we don’t mean it. This gender differential in compassion has been called the gender empathy gap6, male gender blindness or the elephant in the room of gender.

How do we explain the male gender empathy gap?

Once we remove our blinkers enough to ask this question it is not too hard to answer. Starting from an evolutionary perspective there is clearly a male archetype which myself and colleagues7 have distilled into what we have called the three ancient rules of masculinity:

  1. Be a fighter and a winner.
  2. Be a provider and a protector.
  3. Retain mastery and self-control

Much of male behaviour can be explained and predicted using these three simple rules, most notably male risk-taking and the male reluctance to seek help. These behaviours make sense once we recognise that the male archetype is to protect and provide for others, not to seek protection for the protector. The theory that male behaviour is merely a social stereotype, on the other hand, does not fit the evidence of universal differences across all cultures in these respects. If male behaviour was a stereotype then it would be hard to explain scientifically why the same universal pattern of risk-taking in men is found across all cultures and at all points in history. This is in essence an evolutionary ‘women and children first’ pattern which persists to this very day.

In addition to evolutionary factors, we have a mainstream socio-political narrative that assumes a picture of female inequality and disadvantage coupled with male privilege and power. This means that the very idea of male inequalities and disadvantages becomes almost unthinkable and certainly unsayable. This applies even to our history where, for example, we somehow forget (even in 2017 at the centenary of World War 1, 1914–18) the thousands of young working class men who also had no suffrage but were compelled by virtue of their gender to sacrifice their very lives for our freedom and protection. In the same period of history (1912) the chances of survival as a man travelling first class on the Titanic were lower than those of a woman travelling third class. This is because the role of the male has always been to protect and rescue. On the Titanic 97% of women travelling first class were saved and all the children who were travelling first or second class (100%). On the other hand, less than 10% of men travelling second class survived. Our very survival as adults has always been intimately connected with our gender. This is rarely factored in to gender equality discussions or policies.

Is masculinity toxic or just our attitudes to it?

Beyond even a lack of empathy, there is now a prevalent view that masculinity is a bad thing and should be somehow reformed, redefined or fixed. In terms of modern socio-political attitudes in the western world, masculinity has become stigmatised at least in the liberal middle class as something dangerous and toxic even though the science (facts and statistics) tells a very different story, that humanity continues to rely on working class masculinity to provide infrastructure, protection and security. In May 2016 I took part in the first debate on masculinity ever held at the Cambridge Union8. However, the very title of the motion being debated (‘This house believes that masculinity is damaging for everyone!’) evidenced that UK society has reached a sad point where masculinity, far from being celebrated or even appreciated, is now firmly ‘in the dock’. It seems that the worst abuses of physical, sexual or political power by some highly damaged or over-privileged men has been generalised to the whole of malekind. We have confused the extreme and the bad with the norm. The most damaging men (including sex offenders and crazy dictators), while being in a significant minority, have come to be seen as typifying the dangers of the whole male gender rather than as examples of what can go wrong when male human beings are damaged.

So what is the right approach to helping men?

If society is to authentically help men and therefore help itself, one thing for certain is that it needs to change not men, but its own attitudes to men and masculinity. How are we to help any client group without empathy for them? A better theory is that men are not emotionally deficient or illiterate but differently literate. It should hardly be surprising that there are some important sex and gender differences in the way human beings process and respond to emotions and distress. In all other spheres of life (ethnicity, age, culture, religion, disability) we celebrate difference and take account of differences when trying to help people. When it comes to gender, our society seems to be trying to deny any difference, while at the same time paradoxically stigmatising masculinity. However, where services have tried to adapt to men rather than trying to make men change, the results are very promising. In particular, services (for example CALM9, Men’s Sheds10) seem to work where they do the following:

  • are not constrained by a traditional feminised11 counselling model based on direct face to face emotional exploration
  • focus more on telling your story than directly exploring feelings
  • honour male banter and male vocabulary as attempts to make connections rather than seeing these as defensive and emotionally avoidant
  • allow more space for non-verbal communication and activities that can be a bridge to verbal communication
  • use male culture, camaraderie and male team spirit

In essence successful approaches to men honour male archetypes rather than undermining them – for example a service that encourages men to seek help as a way of taking action and taking control (going with the archetype) alongside other men will be more successful than one that encourages men to get in touch with their internal vulnerabilities (going against the archetype). Similarly, a service that went against the female archetype (‘beauty doesn’t matter’) would be much less successful than one that went with it (‘many different body shapes can be beautiful’).

One brief illustration

In 2014 at Central London Samaritans I helped deliver a project called Man Talk where rather than focusing on how men talk we simply addressed how volunteers were listening. We simply ran a series of workshops and training events that exposed our volunteers (80% female) to male culture and male issues, for example blues music and female actors trying male roles in Shakespeare’s Julius Caesar. After a year we took a simple quantitative measure of the length of phone calls with men and found that this had increased significantly (based on a large sample of 1,000 calls).


The simple message based on science and humanity is this: if we stop trying to change how men talk but change how we listen, and if we stop seeing male behaviour as a stereotype and start respecting the male archetype, we will all get a lot further. In other words, if we develop a male-friendly approach, men will actually respond.


  2. 20Psychology/public/Gender%20-%20Final.pdf