Australia’s peak body for psychologists says it will consider developing new practice guidelines for psychologists working with boys and men after the American Psychological Association announced its own set of guidelines for the group last month.

The APA guidelines, which say that “traditional masculine ideology has been shown to limit males’ psychological development … and negatively influence mental health”, were designed to provide psychologists with an “evidence-based approach” for responding to the particular needs of boys and men.

“The guidelines support encouraging positive aspects of ‘traditional masculinity’, such as courage and leadership, and discarding traits such as violence and sexism, while noting that the vast majority of men are not violent,” the APA wrote on Twitter.

“Traits of so-called ‘traditional masculinity’, like suppressing emotions and masking distress, often start early in life and have been linked to less willingness by boys and men to seek help, more risk-taking and aggression — possibly harming themselves and those with whom they interact.”

Ros Knight, president of the Australian Psychological Society, said the APS had been highlighting the “quiet crisis around men’s mental health” since 2012.

“What we’ve done is address it through ethical guidelines — so things [psychologists] need to think about when treating men,” Ms Knight said.

“But there is an opportunity for us to consider whether making specific practice guidelines for boys and men would be a sensible thing to do.

“I think as a result of the APA really bringing this much more to the fore, it’s something that we’re going to think about doing in 2019.”

Taking a ‘gendered’ approach

While the APA guidelines were released in August last year, they captured widespread attention in January when the APA published an article (and subsequent tweet) about the guidelines.

It sparked controversy on social media, and attracted negative comments from conservative US media.

The health body has released several guidelines in the past for psychologists working with people belonging to certain groups, including members of racial and ethnic minorities, the LGBTI community, and women and girls.

But for boys and men, who have historically been considered the norm in psychological practice, no such guidelines existed.

Lead author Fredric Rabinowitz, a psychologist at the University of Redlands, said the purpose of the guidelines was to help boys and men lead happy, healthy lives.

“We see that men have higher suicide rates, men have more cardiovascular disease and men are lonelier as they get older,” he told The New York Times.

“We’re trying to help men by expanding their emotional repertoire, not trying to take away the strengths that men have.”

Michael Flood, a researcher from Queensland University of Technology who specialises in gender, masculinities and violence prevention, said the guidelines were “long overdue”.

“We’ve known for a long time, probably 40 years, that norms of masculinity shape boys’ and men’s behaviour, including in unhealthy and negative ways,” Associate Professor Flood said.

“There’s literally decades of research pointing to the fact that conformity to traditional masculinity is associated with poor health among men, high levels of suicidal thoughts and behaviour, poor relationships and parenting, and involvements in violence against women and other men.”

Associate Professor Flood said there had been growing recognition in the fields of psychology and social work, since the mid-1990s, that a “gender-sensitive approach” to men’s health was needed.

“That began with a recognition that women’s lives are gendered — women’s health and wellbeing are shaped by stereotypes and norms regarding what it means to be a woman,” he said.

“But it took some time before that same insight was applied to men, with the recognition that men’s lives too are gendered.”

Men less willing to seek help

According to the guidelines, several factors influence the way men construct ideas of masculinity, including race, ethnicity, age and socio-economic status.

“Although there are differences in masculinity ideologies, there is a particular constellation of standards that have held sway over large segments of the population, including: anti-femininity, achievement, eschewal of the appearance of weakness, and adventure, risk and violence,” the guidelines state.

It is these cultural lessons, according to the APA, that have led to boys and men being overrepresented in a variety of psychological and social problems, in part because they’re less willing to seek help.

“Research shows that boys and men are at a disproportionate risk for school discipline, academic challenges, health disparities, and other quality of life issues,” the APA wrote.

In Australia, men have more accidents, are more likely to take their own life and are more prone to lifestyle-related chronic health conditions than women and girls at the same age.

Andrea Fogarty, a research fellow at the Black Dog Institute, said the cultural expectations placed on men to be “tough” and emotionally stoic meant that many men avoid seeking help.

“We know that for pretty much any mental health problem, men are not accessing health services at the same rate as women,” Dr Fogarty said.

A 2014 Black Dog Institute report found “unhelpful conceptions of masculinity” were among four factors — alongside acute stress, depressed mood and ineffective coping strategies — that increased men’s risk of suicidal behaviour.

“What we found in our research was that for some men, particularly those who adhered to a conception of masculinity that was quite traditional, they were less likely to seek help earlier in the course of illness,” Dr Fogarty said.

Similarly, a 2016 study from the University of Melbourne found men who strongly identified with being self-reliant were significantly more likely to have experienced suicidal thoughts.

“In addition to self-reliance, the men in our study didn’t want to be seen as a burden to their families and support networks … which often drove them further away,” Dr Fogarty said.

“That might be a way of temporarily managing distress … but in the long term, it’s not helpful.

“It comes through in alcohol use, substance use, withdrawal and isolation, and sometimes aggression.”

This is part of the reason there is a lower incidence of mood disorders yet a higher rate of suicide among young men — they are being misdiagnosed, according to a report from Orygen, the National Centre of Excellence in Youth Mental Health.

Impact of masculinity on relationships

In addition to looking at the impacts of traditional masculinity on men’s mental health, the APA guidelines also encourage psychologists to focus on how ideas about masculinity can influence men’s interpersonal relationships.

“If we socialise boys and men to avoid vulnerability, to be stoic, strong and avoid showing weakness or dependency … that plays itself out in a whole series of ways in men’s friendships, in their intimate and sexual relationships, and in their parenting,” Associate Professor Flood said.

He said while it was important to acknowledge how traditional masculinity can be “limiting for men”, it was also important to talk about how it can be harmful, or indeed lethal, for women.

“There is a very well-established link between agreement with traditional masculinity and men’s use of violence, whether that’s domestic violence, sexual violence, or violence against other men.

“It’s not the only factor that shapes men’s use of violence … and it’s not just any kind of traditional masculine norm. So, we need to look at what bits of traditional masculinity are at stake.”

He added that there were times and places where some traditional masculine qualities were “highly desirable”.

“The problem is, in part, that we tell boys and men to show these traditional masculine qualities all the time — to always be stoic, to always be tough, to always be in control,” he said.

“That can sometimes leave men emotionally stunted, even crippled, in contexts where showing weakness, asking for help, or being nurturers would be much better for them.”

Guidelines not an ‘attack’ on men

Some of the negative responses to the guidelines, including that they conflate traditional masculinity with “being a pig, or a creep or a Harvey Weinstein kind of person”, misunderstand what they’re about, Associate Professor Flood said.

“This is not an attack of men. It’s an attack on one particular set of ideals about how to be a man — a set of ideals which are actually pretty harmful to men themselves,” he said.

“What’s been criticised is a particular version of masculinity, based on sexism, rigid homophobia, and narrow emotional stoicism.”

Zac Seidler, a psychologist who specialises in the treatment of boys and men, said the idea that traditional masculinity is “fundamentally dangerous” was not the case, and not what the guidelines were suggesting.

“What the literature has shown is that if you are to enact traditional masculine norms — like stoicism, aggression and competitiveness — to an extreme, in a way that is extremely restrictive and rigid, that you are more likely to be depressed, and less likely to seek help,” said Mr Seidler, who is undertaking a PhD at the University of Sydney.

He said that when it came to men’s mental health, pretending that boys and men were not “socialised in certain ways” was “a dangerous way forward”.

“I think people have their eyes shut when they think this stuff isn’t happening anymore,” he said.

“We know these traditional norms are slowly dying off, but everyone has a bit of it — myself included.”

Both experts agreed that the guidelines were driven by a “profound compassion and concern” for men.

“It’s a shame that [the guidelines] have been misconstrued, but if anything, the fact that this is out in the public domain means that we’re heading in the right direction, in understanding that masculinity, and gender on the whole, is a cultural competency that all psychologists need to understand,” Mr Seidler said.

This piece by Olivia Willis was first seen on ‘ABC News‘, 5 February 2019.