Speaking of Psychology - Men, masculinity and mental health, with Ronald F. Levant, EdD

Episode Date: October 13, 2021

Stoic. Self-reliant. Unemotional. For many men, these watchwords of traditional masculinity still hold powerful sway. Men are less likely than women to seek help for mental health issues, they die by suicide more often, and they commit and are the victims of more homicides. Ronald F. Levant, EdD, discusses how cultural expectations of masculinity affect men’s mental and physical health, how our ideas of masculinity have changed over time and what psychologists have learned about how to reach out to men. Learn more about your ad choices. Visit megaphone.fm/adchoices

Stoic, tough, self-reliant, unemotional. Those are some of the watchwords of traditional masculinity, and for some men, they hold powerful sway. The idea that, quote, real men, unquote, exhibit these characteristics, is ingrained in our culture, even after decades of discussing evolving gender roles. Research has long shown that men are less likely than women to seek help or receive treatment for mental health issues.

They are less likely than women to say that they even have close friends, In the United States, men die on average five years earlier than women, and they die by suicide 3.6 times more often. Men commit 90% of all homicides in the U.S., and they make up 77% of homicide victims. What role does traditional masculine ideology play in these disparities, and what can be done to change them? How does traditional masculinity affect men's mental health and physical health? How does it affect women?

Have our ideas of masculinity changed over time, are younger men less tied to traditional masculine ideas than their fathers? And what have psychologists learned about the most effective ways to reach out to men? Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I'm Kim Mills. Our guest today is Dr. Ronald Levant, an emeritus professor of psychology at the University of Ohio in Akron.

Over his decades-long career, Dr. Levant helped establish the psychology of men and masculinities as a field of study, conducting research on how traditional masculinity ideology shapes men's lives and affects both men and women. He has authored, edited, or co-authored, more than 250 peer-reviewed journal articles, book chapters, and books, including his most recent book, The Tough Standard, The Hard Truths About Masculinity and Violence, published in 2020. He is a fellow of APA and was the 2005 president of the association. Thank you for joining us, Dr. Levant. Thank you, Kim. It's a pleasure to be with you today. Let's start by defining what you mean when you talk about masculinity. In the introduction, I use the term traditional masculine ideology,

which is a term that you coined. What is traditional masculine ideology? Well, let me back up for a second and just say a few words about how masculinity is understood in our society. In general, Among the public, masculinity is thought to be synonymous with being male. And, you know, it's a fact, if you look it up on various online dictionaries, it's, you know, the qualities of being male, a boy or a man. But psychologists view it in a much more fine-grained way. And we think of masculinity as we do a femininity as essentially gender role.

roles, roles that are defined by social norms. We're all familiar with social norms. We have norms in different countries for how close you can stand to a person about holding a door for somebody coming behind you. And we also have norms for gender roles. And these norms for boys are expectations for how boys and men should think, feel, and behave. So, when we think of masculinity, we think of it as something that is rather than inherent in the biology of being male, but rather something that is in the culture that's socially constructed, and that consists of a series of social norms.

And when we measure traditional masculinity ideology, we measure a set of norms that for boys and men's behavior. There are several scales for measuring traditional masculinity ideology, which I use the abbreviation TMI. The one that I've developed and revised over several decades is called the Male Norms Inventory, and it identifies seven norms, avoiding all things feminine. That's really the predominant norm because masculinity has to be defined as against something, so it's masculinity against femininity. the next norm is restricting the expression of emotions, particularly vulnerable emotions and a caring

emotions. Next is self-reliance through mechanical skills, toughness, dominance, having a great, placing a great importance on physical sex, and having disdain for sexual minority men, gay and bisexual men. So those are the norms of masculinity. You know, we have been, as I say, developing scales to measure TMI as well as other aspects of masculinity, such as a man's personal conformity to masculine norms, as well as the conflict and stress that a man would experience if he violates those norms. And this has been going on for over four decades. So your most recent book is about the intersection between masculinity and violence. and you argue that most violence, such as gun violence and sexual assault, is committed by men, even though most men are not violent. What role does traditional masculinity ideology play in violent behavior?

Well, thank you for that question, and it's really the crux of the matter. I think the paradox that males are responsible for the vast majority of violence, yet the vast majority of males aren't violent, points us to like, okay, can we identify who among the male population is likely to be violent? And you may be aware that some, I think, eight or ten years ago, APA published a report on gun violence. And basically it wound up concluding, I'm going to summarize a very long report briefly, but it said that there are many, many factors that go into it, and there's no one way to really identify it. but the best predictor of future violence is past violence. Exactly.

Well, to me, that begs the question. And I think we should be able to do much better than that. And so as a result of the book that I co-wrote with Shana Pryor, the Tough Standard, we've identified two groups of men who we think account for the linkages with violence. Now, let me just say at the beginning, in psychology, we cannot directly see. study violence. It would be unethical to create an experiment in which violence occurs. So we have to use indirect measures of violence. So we use self-reports of past violence, which, you know, aren't 100% reliable, but it's the best we can do. We use scales to measure aggression or hostility.

And then we use proxy variables, like inducing a man to punch a punching bag, after in an experiment. So that's as close as we can get. But based on 40 years of studies using, you know, those methods that I describe, and also there are other weaknesses with literature that are true of pretty much all fields of psychology. But based on that, there are really two groups of men that seem to be caused the linkages with hostility, aggression, et cetera, et cetera. One is men who check all the boxes, who score very high on measures of masculinity, whether it's TMI or hypermasculinity or conformity to masculine norms, the men in the upper tail of the distribution.

Because masculinity scores tend to be distributed in a rather skewed fashion. I should say that. That the scores are really pushed to the low end. And I'll come back to that point. But there is a thin upper tail of men who we would kind of describe as hypermasculine. And we believe that those, we have not yet found an experiment. There's only one study that supports that. So that finding is a little weak.

But we think that that is accounts of the linkage. But then there's another group of men, you know, who feel ashamed of themselves for violating masculine norms. Now, I want to back up for a second and say that, Most men, I essentially did a paper looking at three studies conducted over a 17-year period, looking at their scores on the male role norms inventory, my scale. And overall, I found that on average, most men do not endorse traditional masculine norms. But think about it. You know, an adult man likely has a vocational identity.

He likely has an intimate partnership. He may have children. He may have a mortgage or car payments. He's got far too much on his mind to worry about whether he's masculine or not. And most men don't. But there's a minority of men who do, who feel ashamed of themselves for violating masculine norms. I did some studies back in the 90s that showed this very clearly. I had a group of men, and I would pass out three by five index cards and pencils, and I asked them to write their top secret, the thing they've never told anybody and never would tell anybody, down on the paper.

And then I collected the cards, and I made an elaborate display of shuffling them, and then I started to turn them over and gasp would go up in the room. reason to read them. And what I found was so fascinating that many of the secrets, the shameful secrets that men would never tell anybody, were about violating masculine norms. I backed down from a fight in high school. I had a crush on another boy. I was too close to my mother. As a boy, I cried too often. It almost breaks your heart. These are 40 and 50-year-old men who feel ashamed of themselves for things that are just basically human. So the second thing I learned from that is that it's enormously, it provides enormous relief for men to hear that they are not the only one who have shameful secrets.

Because many men, because they never tell anybody, they never get corrective feedback to the effect that, oh yeah, I felt that way too. Or, oh, yeah, that's normal. And they come out of their inner caves where they think they're the only man in the world has ever violated masculine norms and all those other guys are doing fine. So they've experienced enormous relief from that. But there is this small group of men, like some of the men in this group, who feel ashamed of themselves. And this is called in our field discrepancy strain. It's basically strain the results from a discrepancy between your ideal self-image and your real

self-image. That is who you think you should be and who you feel you really. are. And this is very much akin to something well known in our field called cognitive dissidents, which is an unpleasant feeling that people get when they behave in contradiction to their beliefs that drives them to act in a manner consistent with their beliefs. Well, discrepancy strain does the same thing, that when you assess a man for discrepancy saying you will find correlations with measures, indicators of violence. If you experimentally induce discrepancy strain, such has been done in the precarious manhood studies,

where you essentially randomly assign men into either an experimental or a control group, and ask the experimental group to do a feminizing task, like braiding the hair on a mannequin and putting pink ribbons in it, versus a masculine. tasks, like tying ropes into knots, and then give both groups of men the choice of sitting quietly in a room or punching a punching bag.

Who do you guess chooses to punch the punching bag more often? The guys with the pink ribbons. Exactly. Because once you threaten their masculinity, they have to demonstrate it. So this particular phenomenon, threatened masculinity, discrepancy strain, precarious manhood, is called by very. various names, is actually found in a wide range of social science literatures, not only in social psychology and counseling psychology, but also in sociology, cultural anthropology, criminology,

and social work. So, you know, when you find that kind of finding across a range of disciplines, you have to have a lot of confidence in it, and we do. But it even gets better than that. There's a database of school shooters maintained by a psychologist, Peter Langham. And if you go into the database and search for the term masculinity, 18 cases come up. 18 school shooters in the portfolio that is established for them, which includes diaries and medical records and school records and all kinds of information, 18 men have masculinity mentioned.

And if you look at those 18 cases, Carefully, what you see in all 18 is threatened masculinity. Boys who are bullied for not being sufficiently masculine. Men who can't get a date with women. You know, just men who, in various ways, feel that they do not measure up, suffer discrepancy strain, feel their masculinity is threatened. I thought, you know, so this connects our, you know, experimental and survey research to anecdotal evidence out there.

in the real world concerning actual gun violence. It's also seen in another anecdotal set of data, which is homicide suicides, that is a person who kills his family and kills himself, or shoots up his workplace and then shoots himself. And also some of the school shooters like Columbine or murder suicides. And in a study of newspaper reports of murder, or suicides. And again, this is anecdotal, found that threatened masculinity played a role in all of the stories they looked at. So clearly, we're linking threatened masculinity, you know, in the experimental and survey research, to real-world evidence, as well as finding it across a range of dissimance. So I really think threatened masculinity is what we have to kind of look at if we are going to

solve the horrendous gun violence problem in our country. But how do you get to that before the shooting happens? What is the environment where you're able to test this and then predict a person who is likely to go down that path? Well, you know, I'm a academic psychologist, not a legislator or a public policy person. So I'm weak on the details of how you'd implement this. I mean, we do have scales that you could assess somebody for discrepancy strain. I don't know how you would actually use that information to prevent people from being violent. Do we start testing in schools maybe? I mean, can we identify people when they're young?

Well, I think it does go back to intervening when children are young. And what I think the answer is, is that we have to stop. making little boys feel that masculinity is obligatory. That is one of the biggest problems with masculinity is that boys are made to feel that masculinity is obligatory, that they have no choice but to be masculine. They get this primarily from their fathers and from their peers. Even recent research shows that fathers tend to believe that their job

is to make men out of their sons. But the peers, as you well know, are vicious in police. masculinity. Elementary school boys use various epithets, sissy and worse, to refer to these boys, as well as beat them up. So boys are made to feel masculinity is obligatory. Now, contrast that with a family that I saw when I was in practice who basically said, you know, we want to raise our son in a gender-neutral way. We'd like him to have full access to his emotions and not feel that he can't, you know, cry and all this kind of stuff, but we worry about how he's going to be treated out in the world. And I said, you know, that's a very real concern. I think what you need to

do is inoculate your son for that eventuality. You can have a conversation with him or several conversations with him along these lines. You know, Johnny, you know, in our house, we think it's okay for boys to cry. But not everybody agrees. And you have to know who, you have to know you're with because sometimes if you're with people who don't agree with you and you cry, they'll get mad at you. And so you have an age-appropriate conversation, but help your son know that there's a time in place. You teach the child display rules.

And this is a very valuable lesson not only about gender, but teaching a child to discriminate between different groups of people and how they're likely to respond to him. a very useful skill. So that's one way. But as to how we utilize the findings from psychological and social science research to immediately correct the problem, I think we'd have to have to have a panel with some policy experts and legislators to kind of present this information and have them think about what kinds of, you know, social interventions could be done. That's really beyond my level of expertise. Well, let me ask you then following onto what you were just saying, has the public understanding of masculinity changed at all over the decades since you started doing

this research? Do, for example, millennial men believe in these traditional masculine ideas to the same effect that their baby boomer fathers did? No. As a matter of fact, I just published a study in the Sage Journal of Men and Masculinities that actually showed that. What we did is we had a sample of men from young adults, 18 to 30, established adults 30 to 44, middle age, 45 to 60, and 60 plus. And we first did a very sophisticated psychometric analysis called measurement and variance to ensure that each group understood the scales in the same way. And because that's necessary,

because not every group will necessarily understand what the scale scores mean in the same way as the other group. So we first established that there was measurement and variance. And then we compared the mean scores on the measure of TMI. I think it was a mail-roll norms inventory short form and the male norms inventory very brief. And we found that the groups that scored the highest were the older groups. So basically, I think what happens is that males wind up living with the masculinity ideology they were raised with.

And as regards millennials, I think the big difference we've seen is actually goes way beyond measuring masculinity, which is that the norm of disdain for sexual minority men has disappeared. And this is following the over-gaphaffal decision that basically had an enormous impact on the social norms regarding the treatment of GLBTQ people that basically normalized those folks as just human variation rather than the way they were viewed in the 70s in the DSM, diagnostic manual as psychopathological. So I think millennials, along with the rest of society, does not view GLBTQ people as in some way abnormal. The other thing that has changed, and has actually been over the generations, is fathering. In the 1960s,

fathers paid did very little care for their children they played with them you know they would do the rough and tumble play but as far as feeding

diapering waking getting dressed getting fed none of that and when in response to the wife's employment

men increase their amount of child care a tenth of an hour a day Oh boy, could you spare it? Six measly minutes. Okay, by 1995, the latest time diary study that I know of, and these are very elaborate studies require a lot of funding, which isn't available anymore, found that in households where both parents worked, women did 62% of the family work, which includes child care and housework, and men did 30% of,000. So that's much better than one-tenth of a percent.

And men had 10 percent more leisure time. So, you know, men are doing more. We've gotten away from this idea called the essential father hypothesis, you know, that dads don't engage in care to the point now that I think we think of fathering as just parenting and parenting doesn't have a gender. and basically we have dads, you know, who provide full care to their children. So a couple of years ago, APA put out a guideline for the psychological treatment of men and boys. That's a project that you started during your APA presidency, and it took quite a long time for us to get that completed.

Can you talk about why that guideline was necessary and really can you summarize what it says? You're right. It took 13 years from 2005 to 2005 to 2000. As you're aware, Kim, the APA has multiple levels of review for approving guidelines for practice. APA, as you know, is composed of both academics like myself and practitioners. And so we utilize the science created by the academics to specify evidence-based practices for different groups. And we've had guidelines for girls and women, guidelines for older adults, guidelines for GOBTQ folks, guidelines for racial and ethnic minorities, and so on. And when I was president, I set up a commission, a task force to create guidelines for practice

in boys and men, just because there weren't any, but also because boys and men do not avail themselves of mental health treatment to the extent that girls and women do, largely because of adherence to masculine norms. It is not masculine to ask for help. It is not masculine to express vulnerability. It is not masculine, you know, to not think of themselves as, you know, a hundred percent strong. So men tend, and there's been a lot of studies showing correlations between various masculinity scales and either attitudes or intentions towards seeking help.

That is, the higher the score in the masculinity scale, the less favorable the attitudes. toward help-seeking or the less they intend to seek help if needed. So we felt, you know, this needed to be looked at. I mean, and we took the big picture. I mean, when you look at psychotherapy, it really began as an enterprise of men treating women with Freud and Breuer in his hysterical patients in Vienna. And it's pretty much continued in that modality until the 70s and after the second wave feminist movement and sort of the feminist scientific movement and Carol Gilligan and, you know, all of these folks in psychology who started revising the canon with regard to gender.

And some of us, I was a clinician and others who were clinicians, started experimenting with new methods to engage and treatment. One of the things that I ran up against is the fact that many of your listeners may be aware of is a lot of men have a lot of trouble identifying and describing how they're feeling. They cannot give a good account of their emotional life. Sometimes you've asked them how they're feeling, they'll tell you what they're thinking, or they'll tell you what they're going to do. And there's a word for this.

I hope it won't turn off your listeners. is it's a lexathymia, A-L-E-X-I-T-H-Y-A. It's a Greco-Roman roots, which means without words for emotions. And in my research, I found that there was evidence that as a result of gender role socialization, that boys between Neonese and 6 were socialized to restrict the expression of motions. It may be of interest to you that neonates, as neonates, boys are more emotionally expressive than girls. But what do neonates do? They cry or they sleep.

But this difference holds up until at least one year of age, boys, and they do a lot more one year of age than they do hours after birth. But the difference starts to reverse itself by two, where girls are more emotionally verbally, more verbally emotionally expressive than boys. and between four and six, little boys lose their facial expressivity. Now, what's happening to boys between four and six? They're in preschool or elementary school, and they're getting police by other boys. They're basically other boys are shaming them for expressing emotions.

They're reinforcing the masculine code. So I theorize that boys who are socialized to conform to masculine neurons, particularly the one of restrictive emotionality, grow up to be men who are mildly a lexathymic. And I've done a number of studies to provide support for that and actually developed a treatment intervention, a manualized treatment, six sessions for psychologists working with men. It can be incorporated into the regular treatment to help them recover their ability to talk about their emotional life, which is essential to doing psychotherapy, essential. Even the most behavioral methods of psychotherapy, like exposure therapy, expect that the patient

is able to discern within himself how he's feeling. So it's something that when you're treating an elixotamic patient, a man, can be very helpful in terms of helping him gain and benefit from the therapy. So I understand that over the past year, you and your colleagues have been doing research on men's behavior and health during the COVID-19 pandemic. What have you found so far? If I can just back up from that question and say a few things,

you did mention men's lower longevity than women in the beginning. In addition, men have higher morbidity in most major categories of illness than women, and men have poorer health behaviors than women. And so men smoke more, drink more, take more risks, do not go to the doctors often, do not take medications as it prescribed. There are 30 controlled behaviors identified by a colleague in which men have poorer health habits than women. And obviously, you can make the linkages between the health habits and the morbidities and mortality. Now, in the COVID epidemic at the time we started the study, which is in 2020, men were getting more severe infections, that is,

more ICU admissions, and more dying to a greater extent than women. And there have been some biological factors that have been connected to that, particularly something concerning immunity and so forth. But there are also prevalent behavioral factors, and that's what we focus on being psychologists. And we wanted to see to what extent masculinity played a role in men's unwillingness to engage in mitigation measures to prevent their infection with COVID-19. And we did find, indeed, that adherence to what's called the playboy norm, that is the belief in, you know, casual sex with many women, that it transmitted the effect of their endorsement of traditional masculinity ideology on their actual engagement in Centers for Disease Control and Prevention

recommended practices for mitigating COVID-19. So masculinity is the culprit. Another factor we found, as you know, the COVID epidemic has been politicized to the hilt. And so the other factor is we found that holding conspiratorial attitudes about the pandemic also moderated that relationship between masculinity and adherence to CDC practices. That is, the more a man believed that COVID was a, you know, was a fraud and it was just designed to make President Trump look bad and all this other stuff. things along those lines, to that extent they were less willing to engage in mitigation practices. And that's coming out in APA's journal, Health Psychology, I believe. We'll be looking for that.

So just to change gears a little bit, and probably this would be the last question. In this past year, we've seen an uptick in the number of athletes who are talking about their health struggles, Naomi Osaka, Simone Biles, probably they're the most. most famous among these, but men are speaking up as well, including football and basketball players. Do you think that this reflects a broader change in men's willingness to talk about mental health and will it make some men more open to reaching out for help? Yeah, this has been going on for several decades, actually. Most recently, I live in Northeast Ohio and one of our basketball players.

Kevin Love had a panic attack during a basketball game and had to leave and go and to the locker room and later was quite open about it. And he also was very critical of masculinity in what he said. Basically, he said, you know, we were raised to never show, you know, any vulnerability. We're always supposed to be, you know, 100% on and ready for competition. And but, you know, we're human beings and we're made of flesh and blood, not steel and bolts. And I mean, I think this can have a very positive effect because among certain groups of men, athletes are almost revered, at least good athletes are, and to see major athletes coming out expressing their vulnerabilities, saying it's healthy to do so, saying they felt better after getting therapy,

I think can help a lot. Do we have any evidence that it has helped? Studies like that haven't been done, that I'm aware of, but they should be. One last word. I know that's, I said that was the last question, but it occurs to me just for our listeners. if there are men out there who really want to deal with their feelings, who want to become, you know, less restricted in the way that they live, where and how can they find help? How can they find a therapist, say, who would understand this? Well, the National Register of Health Service Providers in Psychology has a service called Find a Psychologist. If you just go to the National Register, you know, I think it's national register.com. the find a psychologist is right on the front page, and you can find a licensed psychologist in your

local area, and I think most psychologists, you know, would be able to help such a potential client deal with the things that are bothering them. But beyond going to a therapist, I would say to men who might be listening, who might have some of these issues, you know, we have to brave the shame. We were made to feel ashamed of ourselves for not being fully masculine, and that was nonsense. If you're married, if you have children, you have to learn how to open up your heart to your family, to really let them in, to take the barriers down. You can do it. It's not easy. You will feel bad about it. You might feel ashamed of yourself. But honestly, those lessons you learn as a child are not valid. And a better approach is to have an open heart and an open mind and to freely

express your emotions to the people you care about. Dr. Levant, I want to thank you not just for joining us today, but for this very important work that you've been doing for so many years. I personally appreciate it. And I'm sure many of our listeners do as well. Thank you. Thank you. You can find previous episodes of Speaking of Psychology at www.combeckycology.org.combeckycology. or on Apple, Stitcher, Spotify, or wherever you get your favorite podcasts. And please leave us a review. If you have comments or ideas for future podcasts, you can email us at speaking of psychology at APA.org.

Speaking of Psychology is produced by Lee Weinerman. Our sound editor is Chris Condyenne. Thank you for listening. For the American Psychological Association, I'm Kim Mills.