After several years of psychiatry residency I felt pretty comfortable doing group therapy sessions. Whether depressed, manic, or psychotic -- most patients could benefit from "Dr Phil's" budding expertise. Some colleagues caught wind of this and asked me to facilitate a group discussion with people outside of the mental health system. Leading a group didn't throw me, but the setting was a bit outside of my comfort zone.
The group would consist of men of color at risk for cardiovascular diseases and diabetes who were enrolled in a 12-week health program to promote fitness, nutrition and life style changes. This brought images to my mind of a locker room or barbershop, which weren't exactly the best places to conduct therapy sessions. And my chromosomal kinship reminded me how painful the idea of a group of men sitting around "talking about feelings," could be. With these thoughts fresh in mind, my job seemed impossible: In one session, I was supposed to talk to a bunch of regular guys about the importance of mental and emotional health.
The topic of men's physical and mental health has been steadily gaining attention. From stalled men's health legislation in 2001 to the "Movember" movement, awareness of the health challenges men face now seems to be reaching a fever pitch. National studies and anecdotal evidence show men bringing up the rear in outcomes for chronic medical conditions, and leading the pack in deaths from suicides and homicides. When pundits try to explain why, they often use social narratives about how men have lower rates of health care seeking behaviors and poorer coping mechanisms. The idea of the stoic loner has been ingrained and reinforced through contemporary culture and the media. For men the message has been, "Be in charge, be strong, resourceful and unfazed in every situation." This may work in movies and books, but is quite a tall order to fill in everyday life. Men are crumbling under the heavy weight of trying to "take it like a man."
I was told the first group would consist of up to seven working class men on a weeknight at a local primary care center. I agonized about goals, objectives and content during the weeks leading up to the first group. After exhausting all possibilities I told myself, "man up." At the first session, my anxiety was visible as I walked into the room. Slowly the men trickled in. Some had just come from work and others were more casual in appearance. They each took their seats in the room as I stood before the blank dry-erase board. Jokes and pleasantries were exchanged as the men spoke about the some of their challenges implementing the program's recommended diet and exercises.
I broke the ice by talking about the importance of physical health and how it took patience to break bad nutrition habits. Finally, the moment of truth arrived: I introduced the topic of men's mental and emotional wellness. Where I expected to hear crickets chirping, the men in the room instantly attached to the subject matter. An older man appearing 60 years old raised his hand to speak. He was clean cut, wearing a sweater to protect him from the New England winter. His dark skin and soft-spoken nature reminded me of my father, which added to the weight of his words. He said, "When I was growing up all you had to do was hold your liquor, win fights, and take care of your woman. Boys today have it a little different, but I'm not saying that's a bad thing."
Without missing a beat a man likely 30 years his junior wearing a sweatshirt, fitted cap and sneakers agreed saying, "Yea, That's what I've been taught since I was a kid, and it's been killing me." The conversation continued to flow with all of the men in this small group participating. They spoke about personal and social pressures to lead, and the imperative to not disclose any visible vulnerabilities. They were well aware of how this stylized caricature of men interfered with a full life - and their difficulties escaping it. These men also shared concerns about male friends and family members. Each group member had questions about the best ways to seek help, or speak with other men who were having difficulties. They also spoke about how broaching problems with other men could be seen as violating the rules that governed how men relate to each other. The group soon came to the conclusion that the best approach is to check in with a man when you feel something about him is "off." This approach would be low pressure, while allowing the other person to respond at his own pace.
The men in this group taught me an important lesson, namely that I had to examine some of the ways I was biased about men. I learned that talking about problems need not be off limits for men. I am not suggesting pressing every man you meet with questions about problems or urging them to cry and let it out, but that's not something I'd recommend for anyone.
When it comes to talking about the topic of mental and emotional health, what's important is knowing that often just opening the door for the conversation can be effective and helpful. Men are ready for the challenge, I think. After all, facing the unknown, being strong and mastering problems are what men are supposed to do!
If you -- or someone you know -- need help, please call 1-800-273-8255 for the National Suicide Prevention Lifeline. If you are outside of the U.S., please visit the International Association for Suicide Prevention for a database of international resources.
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