Speaking of Psychology - How masculinity can hurt mental health (SOP38)

Episode Date: June 10, 2016

The availability and quality of health care is often substandard when it comes to serving low-income boys and men in ethnic/minority communities. As a result, they have some of the worst health outcomes in the country. In this episode, psychologist Wizdom Powell, PhD, MPH, talks about how racism, discrimination and gender stereotyping can contribute to a decline in men’s health over time. APA is currently seeking proposals for APA 2020, click here to learn more https://convention.apa.org/proposals Learn more about your ad choices. Visit megaphone.fm/adchoices

Men are more likely than women to die prematurely, regardless of background. But when you look at men from lower income and minority groups, their chances of living a long and healthy life are greatly reduced. That's according to numerous studies. But what's behind the statistics? In this episode, we speak with one psychologist about depression, substance use, and how issues like gender roles are affecting men and boys in these vulnerable groups. I'm Audrey Hamilton, and this is Speaking of Psychology.

Wisdom Powell is an associate professor of health behavior at the University of North Carolina at Chapel Hills Gilling School of Global Public Health. Dr. Powell is also a faculty member at UNC's Limeberger Comprehensive Cancer Center and director of the UNC's Men's Health Research Lab. She is a nationally recognized psychological expert on the health disparities faced by minority boys and men. The term health disparities refers to differences in the availability and quality of care that are often experienced by members of minorities. groups. Powell's research focuses on the intersection of race, masculinity, health beliefs, and behavior, and she has been recognized by the American Psychological Association and the White House for her work. Welcome, Dr. Powell. Thank you for having me. How and why are lower-income black men and boys at a significant disadvantage in this country when it comes to health outcomes

and mental health outcomes? Well, I think it's important to keep in mind that the correlation does exist between low-income status and poor mental health. That's a consistent correlation across a number of longitudinal cross-sectional studies. But that's a simple, single story. I think it's important to sort of unpack that and contextualize it because low-income black men and men of color and boys of color are not predisposed to engaging in riskier behaviors or having poor health outcomes. There are a lot of sort of contextual issues and factors that drive those associated.

We know that when people have lower income, they have lower access to resources, they have lower access to opportunities for upward social mobility, they have lower access to health care and mental health care. And because of those sort of essential factors, you see this relationship that manifests as one that suggests that being lower income means that you will automatically have poor health status. I think that in order to get beneath that correlation, you have to look at it. at some of the mechanisms driving it, including poor access to care and also poor access to jobs and other forms of socioeconomic opportunity. Mascular norms, as they're called in psychological research, are sometimes described as the rules of masculinity.

They include specific ways men are told they should act, be tough, stay in control, be a provider, etc. What effect do these norms have on men's mental health over time, particularly when men encounter or difficult times or maybe they don't fit these norms? Yeah, so masculinity norms, for example, can govern the way men seek help. They can govern the kinds of disclosures men make when they are feeling distressed or they are exposed to stressful events. But those norms don't operate in a single way all the time.

They vary from moment to moment situation to situation, such that, you know, a man who enact a particular masculinity in the boardroom may enact a very different kind of masculinity on the street corner. It's just, it is more complex than that. But in general, when men adhere rigidly to the kinds of norms that encourage them to not share their emotions to be sort of relentlessly self-reliant without, you know, seeking the help or support of others, they can have poor mental health outcomes, particularly more depressive symptomatology, because doing so cuts them off, I think, from the social networks and the social supports that might help them get through a difficult time. The norms around masculinity also vary by race and social location. So it depends on where you sit

on the social ladder, how you enact the particular brand of masculinity. Lower income men and men who have been etched out of the opportunity structure may feel a particular pressure to man up in different kinds of ways because they don't have access to all of the ways that a man who's a breadwinner and a provider may be able to enact a masculinity. So you may in those cases see different displays of masculinity. I think it's also important to keep in mind that, you know, among men who are marginalized and oppressed, that often the masculinity that they enact is a response to those threats to their humanity. When people are feeling put upon by social, pressures by

exposures like everyday racism, they may act in a particular way because doing so allows them to recoup that part of themselves that gets chipped away at by those social exposures. So it's a very sort of complicated story. I think we're still learning more about

the physiologic effects of masculinity norms, particularly as it relates to emotion regulation. Okay. And so what do you mean by emotion regulation? Yeah, so when I'm talking about emotion regulation, I'm talking about the strategies individuals use to manage, cope with, sort through the various emotions that come with daily living.

So those strategies can include expressing yourself, something happens to you, then you talk about it, or they can include suppressing those experiences. And what we found from the data is that suppressing emotion in of itself isn't necessarily harmful. It's when you do it habitually. Like if it's your go-to response to all the stress that you experience, that eventually that suppression will cause a rebound in some other areas, like whack-a-mole. You know, you hit it down in one place and it kind of pops up in another.

And you can see that over time among men who use that as a strategy to cope consistently and habitually. What are some other strategies that men use to cope? I mean, what about anger or withdrawal or just some examples of how. how some of these difficulties can create more difficulties down the road. I think that we are learning more about the variation in emotional responses among men, because quite frankly, we focused a lot of our attention on men's anger. And anger is a legitimate emotion.

It's legitimate, especially in the face of social injustice, so I think it's getting a bad rap. But I also think it gets an overwhelming amount. a focus, and despite the fact that men have a range of other kinds of emotions that they experience, including those we call the self-conscious emotions like shame. So I think that when men experience stressful experiences, they respond with the emotion that is closest and most available to them. I think that what we can see in terms of emotions that are associated with more harmful

behaviors is that when men experience heightened anger or other negative emotions, they can transfer those emotions into behaviors. So as you were, I think, alluding to, like there are other kinds of things men do in response to stress and negative emotion that can put them on the pathway to poor health outcomes. Like the data suggests that men tend to use more alcohol as opposed to, you know, women when they are stressed. so we can see higher rates of substance abuse in males because of that anger and emotion response. One of the studies that you conducted talks about how men, black men in particular,

are very distrustful of the health care system, which I assume can only, like you said, keep them going through this cycle of lack of coping, lack of seeking out resources to help them. You know, why do you think this is and how does this behavior play a role in their health and well-being? I think it's really important. I'm always careful to contextualize these kinds of findings because I think one could look at this and think black men are mistrustful, and that's in some inherent personality flaw or dispositional defect. And actually, mistrust among black men is rooted in experiences in here and now. We know that there's a long, long, dark history of medical malice and apartheid in certain marginalized communities.

And certainly those experiences are top of mind. for some black men, as they should be. But I think what we're finding more is that even with those experiences in the background, when black men have more patient-centered, empathic experiences with physicians, they report lower medical mistrust. So in other words, mistrust is not immutable. It can be fixed. It can be intervened upon.

And in fact, we know that mistrust really thickens and thins as a function of cumulative interactions with systems and individuals. And so in the studies that we've conducted, what we've learned is that men who report more frequent everyday racism in their lived experience from day to day have more mistrust of medical organizations. And you can imagine how that might be rational, right? I mean, if you experience discrimination when you're trying to get a cab,

how likely might it be that you would experience discrimination in a situation when you're wearing a backless gown? you're at the most vulnerable position that one can be. So I think that those are rational thoughts, but that to intervene upon them, we have to change the systems and structures that black men interface with so that mistrust will become the natural response. And how do we go about doing that? As psychologists as health care providers, what can the system do to improve on that trust?

Well, I think that what we, the first thing that we learned in the work that we've conducted it so far is that when men report having a more patient-centered experience that they report lower levels of mistrust. So I think that one clear implication of that finding is that we need to address implicit bias on the parts of physicians, providers, nurses, frontline staff, when they face with black men, when they do come to secure health care. I think the other part of that puzzle is to create more equitable health care. systems that actually focus in on some of the gender role norms that can also push back on mistrust. So if you feel more vulnerable, as we all do in health care transactions, and you

have these norms that encourage you not to be closer or tell your doctor if you're feeling a particular symptom, then you're going to have more mistrust. But it's all about the context of those exposures and that access to care. We also have a question. I mean, men don't have the kind of socialization experiences with health care systems that women and girls do. I mean, women and girls start interfacing with health care providers in their preteens because of biological changes. Unless a male is playing organized sports, in most cases, he doesn't have a well-boy visit in the same way that girls do. And that interface early in the life course has implications for how comfortable people feel with securing health care or interacting with physicians and doctors and nurses. And so we have to create those opportunities for boys early on.

And that speaks to a need for more policy-level systems change that would encourage and facilitate that early contact with health care systems among boys and men. Another study you conducted looked at the association between everyday racial discrimination and depression among a black man. Based on that study and other research, how do you think racism plays a role in men's health and mental health? And why do some men fare better than others? So there's a long sort of now documented evidentiary base that establishes a link between exposure to racism and poor mental health.

It took us a long way to get there to be able to say definitively because now we have longitudinal data to support this causal association that when you experience more discrimination, you're more likely to have depressive symptomatology. And that's perhaps because experiencing discrimination chips away or exact some sort of wear and tear on the spirit that can lead to the experience of more depressive symptomatology. I think it's the frequency of it. It's the chronicity of it. It's also the fact that it's subtle and hidden and difficult to document and therefore verify and get support around. You know, you might experience something very similar and not see that as a racial or racial. racialized experience. And because of that lack of validation, that can also mean that people become more silent about what they experience. They just take it, you know, take it like a man, and they just keep moving forward. I think that the reason we see the differences in men who experience depression as a consequence of racism has to do with a lot of the mechanisms and those things that can

either exacerbate or mitigate those exposures. So I'll tell you a little bit about what we're learning thus far. The data are still unfolding. I mean, this is fairly new work, I think. So what we've learned is that when men are exposed to more frequent racism and they believe that they should shut down their emotions or suppress them as a normative response to stress, they have a more pronounced depressive symptom-symptomatology sort of cascade. So in other words, you know, experiencing discrimination is bad for your mental health, but if you do that and you believe you should take it like a man, take, you know, take discrimination like a man, then you're more likely to have more pronounced depression. And I think that speaks volumes to the need to develop interventions

that help men to, one, process, addressed, acknowledge the discrimination in their experiences and to give them a broader repertoire of coping possibilities. But, even while we do that, we still need to focus on the structural change. I think all of our interventions for black men who are exposed to discrimination cannot be around helping them to cope better with the discrimination they face. We have to shift the systems, the structures, the places where they live, work, play, pray, and get health care so that those spaces feel humane, warm, and open for them. Well, this has been very interesting, Dr. Powell.

Thank you so much for joining us. It's my pleasure to be here. I think this is really critical work, and I think we're at a really interesting time in the national discourse around issues that affect boys and men of color in particular, but especially those that affect male health disparities. I think that as we move forward with this work, what's really important for us to keep in mind, that this work is about creating healthier families, communities, and really ultimately a healthier nation. Thanks for listening. To hear more episodes, please go to our website at speakingofpsychology.org. With the American Psychological Association, Speaking of Psychology, I'm Audrey Hamilton.