There's No Such Thing as a Man Cold: Men's Health Initiative (Part 1)
A popular colloquialism has grabbed my attention recently. Every time I hear it, my skin crawls, and so I decided to explore why it bothers me so much.
“First world problems”, as a response to statements or complaints about non-life-threatening concerns. For example “this coffee is cold “, “how do I look in these pants?”, and “hey, that’s my sandwich!”, woven into the tapestry of our commonplace dialogues.
“Wait, I ordered the ham on rye!”
“Yeah, first world problems, buddy,” as though nothing short of chaos and civil unrest is worth mentioning. To my mind, it’s a socially acceptable version of “shut-up”. As it happens, I do believe in resilience as an ethic. Don’t sweat the small stuff, as they say. How much unhappiness should you recruit into your exchange with the dry-cleaners, after all? But do we get to have our little heartbreaks? Am I permitted to experience an emotion that wasn’t inspired by, say, the bombing of my village?
So what has this got to do with men’s health? Well, in my opinion, everything.
It’s a real challenge to recruit men into my practice. I always open initial consultations with an invitation to share: Tell me your story, in your own words: what brings you here? And as often as not, my male patients respond “My wife asked me to come”. It appears that in a rare twist of humour, fate has supplied a clever reversed gendering of roles: society has constructed a space that men are not invited into, namely, healthcare.
It’s almost a running joke at our clinic, except that it’s not actually funny; when it’s really busy, when we’re barely keeping up, and starting to drop things, we see a male patient on the schedule and exhale with relief. “Oh, thank God. A dude. This should be quick .'' This is not because men’s health is simple, but because male patients are notorious for under-sharing.
“How’s your sleep?”
“What about digestion?”
“Tell me about your bowel movements?”
I recently asked my son to describe an ideal adult male. He portrayed someone with magnificent strength and skill, speed, limitless energy, impervious to injury, pain, and even death. He didn’t use the word “Superman”, but he depicted a non-human entity when asked to characterize the qualities he ultimately hopes to someday embody. He’s 11 years old.
Let’s acknowledge the experience of a man trying to get his needs met in a society where masculinity is defined by strength, independence, courage, and, of course, durability; where a chink in the armour of masculinity can be dangerous. What does it look like, then, to enact manhood in this place? When we consider that men in the states die four or five years younger than their female peers, and have higher death rates for all 15 leading causes of death, this question becomes all the more relevant.
There are clearly social practices that influence men’s health; practices that are ingrained in our culture and society, and thus not easily undone. For example, men are less likely to seek a physician’s help during an illness, and may mask or lie about symptoms to avoid asking for help. Simply adopting healthier habits can expose a man to scrutiny by his peer group. This is because poor health behaviours are linked to more traditional beliefs about masculinity, such as ignoring pain, thirst and the need for rest. (Self-care, on the other hand, is considered a decidedly feminine pastime). In short, real men don’t get sick. They don’t get hurt, they don’t feel pain, and they certainly don’t need help.
But this seems wrong, so we toss around ideas for men’s health initiatives, to encourage male engagement, such as special guys-only IV clinics, supplement packages for sperm health, community acupuncture men’s-only clinic, yet still the number of men coming to our clinic hovers around 10%. What, we ask ourselves, are we doing wrong?
I have a theory on that. On some level, (buried deep down in some of us, and closer to the surface for others), whether we admit it or not, there abides a real, tangible admiration for the ubermensch. He makes us all feel safe, after all. I assume this explains the concept of “the man cold”. I see this over and over: when a man feels sick, no one wants to hear it, not even their partners.
I have a close friend who is a nurse. And not just any kind of nurse, but a psych nurse, working one-on-one with involuntarily-committed patients in a locked psychiatric unit; a nurse who feeds and washes people in various states of illness; who helps them relearn basic life skills; who stabilizes them on new meds, and guides them, sometimes painfully, through a slow, spiraling journey back into society. My friend the caregiver, the nurturing guide, the strong, gentle healer. A few months ago, this friend was sexually groped by two patients in acute psychosis. Unable to restrain them, my friend called upon colleagues, who arrived quickly at the scene. Normally, this would trigger a cascade of actions such as immediate debriefing with a counselor, support for the assaulted staff, and ideally, to be sent home for the remainder of the shift. However, none of this happened, and my friend was simply told by the head nurse to “make sure you fill out an incident-report”. My friend was not even simply asked “Are you ok?” As I’m sure you’ve guessed, my friend is a man.
When I told this story to a friend we have in common, he shook his head and said “I wish I could say I’m surprised. I’m sorry, but we’re just not there yet”. And he’s right. We are not there yet; in a world where a man can feel hurt, scared, threatened, ashamed or humiliated, even in the moment that two psychotic women are grabbing his testicles, and his colleagues snigger and try not to laugh. “Hey, buddy, first world problems”.
So we can brainstorm creative incentives to coax men into the clinic all day long, but there is no quick fix. In a healthcare setting, men are not going to speak until they are sure to be heard, and that’s going to require deep, systemic social change.