US Search Mountainside Treatment Center From Addiction to Recovery MENTAL HEALTH STIGMA What We Get Wrong About Men How social norms silence men’s emotions and what to do about it. Posted April 26, 2024 Reviewed by Hara Estroff Marano Share Tweet Share Email KEY POINTS Men who endure adverse childhood experiences (ACEs) are likely to externalize symptoms of PTSD. Traumatic events that are considered “acceptable” —war, fights,accidents—are no less harmful. Most men feel shame and fear when coming forward about their struggles. Therapy can help men define masculinity for themselves, explore emotions, and develop healthy coping skills. By Daniel Sexton, M.S., LMHC When I was in graduate school, I was told to be aware that men in group therapy tend to be closed off, avoidant of expressing emotions, and have difficulty being vulnerable. This is not my experience. I find that men often crave the opportunity to be vulnerable, to be tender, and to have that given in kind. Some arrive at sessions with hard exteriors but underneath is a fear of revealing their inner selves to others. Exploring Adverse Childhood Experiences Adverse childhood experiences, or ACEs, are stressful or traumatic events that happen in a child’s life before the age of 18. They can include physical, emotional, or sexual abuse, witnessing violence in the home or community, neglect, or even household dysfunction like parental separation or mental illness. Such experiences can have a significant and lasting impact on a person’s health and well-being, affecting them throughout adulthood. Of the ten questions that comprise the test for ACEs, men report at a higher rate than women that a member of their household was incarcerated (Giano et al., 2020) and that they were physically abused (Jones et al., 2022). Growing up with a caregiver in jail or experiencing any form of abuse can be a heavy burden that most children and teens are not taught how to emotionally process. Two men enjoying coffee together while looking at a phone.Source: Stockrocket/ iStock The Effects of Traumatic Childhood Experiences Western society encourages men to handle events that can be traumatic with a display of stoicism and toughness. Some traumatic events are even considered acceptable for men to experience—warfare, fights, beatings—although they can be extremely physically destructive. Traumatic events that do not fall into these categories can quickly be normalized or swept away as unimportant despite being dangerous to one’s mental health. When exploring the impact of ACEs on boys, harmful effects show up in the greater likelihood of males to externalize symptoms of PTSD than women (Jones et al., 2022). Externalized symptoms include aggression, delinquency, and other forms of acting out. Ultimately, such unhealthy actions can perpetuate a cycle of behavior that supports the standards that have already been set. Higher ACE scores lead to an increased likelihood of lifelong illnesses, suicide rates, development of addiction, and more. Children with even one ACE score are at a elevated risk for developing depression and anxiety (Bevilacqua et al., 2021). Men who are victims of childhood sexual abuse are more likely than others to experience suicidal ideation and actually attempt suicide (Easton et al., 2013). Why Aren’t Men Asking for Help? Norms that encourage men to act strong and resilient directly oppose the vulnerability that traumatic events imply. Given the expectations put on men by such norms, being the victim of verbal, physical, and/or sexual abuse directly suggests that the individual does not fit within the standards and is therefore valueless. Deep feelings of shame is one consequence. Coming forward would compound the internalized shame—it would mark those men as not fitting the norm in the eyes of others as well as in their own eyes. Ironically, being willing to address the pain of the past in spite of a fear of doing so is more masculine than burying it further for the sake of ego, provided it is physically safe to do so. Men are also trained to not be able to recognize when mental health issues are occurring. They are less likely to be able to identify symptoms of depression when they occur, with rates of diagnosis for males being almost half of those for women. Moreover, when men are diagnosed with depression they have more severe symptoms, with higher rates of substance abuse, violence, and suicide attempts (Seidler et al., 2016). MENTAL HEALTH STIGMA ESSENTIAL READS How Medical Psychiatry May Worsen Mental-Health Stigma Ignore Popular Culture Portrayals of Mental Illness In 2022, suicide rates in America hit an 80-year peak, with the rate for men being 22.8 per 100,000 people (Petras, 2023). Underreporting of mental health issues and instances of abuse is more likely if men are not able to understand them as they occur. The internalized stigma associated with being vulnerable acts both as a defense mechanism to protect one from the judgment of others and as a prison for those suffering from experiences outside the norms perpetrated by it. By acting in accordance with the norms, men are insulated from criticism, and any that does get through can be dismissed, as it does not fit into the worldview. It is a system that perpetuates itself through the behavior of those who suffer from it. But it promises a state that is impossible to achieve—invulnerability. True invulnerability comes from having the strength and safety within oneself to be vulnerable. How Can Men Express Themselves and Find Support Resources? If we acknowledge that we have created a society in which emotional neglect toward men is acceptable, then doing so can be a first step in dismantling the pattern of behaviors that are often seen among troubled men. Throughout my professional experience, I have watched men enter addiction treatment lacking the language to express how they are feeling. By the time they are ready to leave, they can communicate with themselves in a way they didn’t think possible. Therapy offers men the chance to define masculinity for themselves, explore their emotions, and develop healthy coping mechanisms for stress, anger, or sadness. A therapist can be a nonjudgmental sounding board, helping men navigate difficult situations and process trauma and challenges that may be holding them back. Beyond therapy, building a strong support network is crucial. Joining a club or sports team fosters a sense of belonging and connection. Sharing experiences with other men who understand the pressures of masculinity can be incredibly validating. Such connections can provide a platform for open communication and emotional expression, allowing men to be their authentic selves without fear of judgment. Daniel Sexton is a Master Credentialed Alcoholism and Substance Abuse Counselor, a Licensed Mental Health Counselor, and an Internationally Certified Alcohol and Drug Counselor with a Master of Science degree in Mental Health Counseling. At Mountainside, he uses a person-centered approach to to recovery. References Foss, K. (2022, November 14). What is toxic masculinity and how it impacts mental health. Anxiety and Depression Association of America, ADAA. https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/wha… Giano, Z., Wheeler, D. L., & Hubach, R. D. (2020, September 10). The frequencies and disparities of adverse childhood experiences in the U.S. – BMC public health. BioMed Central. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-0… Jones, M., Pierce, H., & Shafer, K. (2022, May 4). Gender differences in early adverse childhood experiences and youth psychological distress. Journal of Criminal Justice. https://www.sciencedirect.com/science/article/abs/pii/S0047235222000459 Bevilacqua, L., Kelly, Y., & Heilman, A. (2021, January 13). Adverse childhood experiences and trajectories of internalizing, externalizing, and prosocial behaviors from childhood to adolescence. Child abuse & neglect. https://pubmed.ncbi.nlm.nih.gov/33454138/ Easton, S., Renner, L., & O’Leary, P. (2013, June 11). Suicide attempts among men with histories of child sexual abuse: Examining abuse severity, mental health, and masculine norms. Child Abuse & Neglect. https://www.sciencedirect.com/science/article/abs/pii/S0145213412002566 Seidler, Z., Dawes, A., Rice, S., Oliffe, J., & Dhillon, H. (2016, November 10). The role of masculinity in men’s help-seeking for depression: A systematic review. Clinical Psychology Review. https://www.sciencedirect.com/science/article/abs/pii/S0272735816300046 Petras, G. (2023, November 29). US suicide rate reaches highest point in more than 80 years: See what latest data shows. USA Today. https://www.usatoday.com/story/graphics/2023/11/29/2022-suicide-rate-hi…