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I am an actual licensed therapist and while there are a number of real actual creating barriers specific to men pursuing mental health treatment there are a few factors I’ve consistently seen that are ubiquitous across gender, race, sexuality, class, etc
Money, time, availability
Therapy is inaccessible. I am a therapist who mostly works with insurance companies. They pay me about 100-115/hr. My clients will often have a high deductible health plan which means they need to pay this $100-115 per session until they hit their deductible, which can be 5,000+ dollars. It’s a lot to ask someone to pay $100+ weekly. On top of that they still usually have a responsibility afterwards of (typically) 10-30% so $10-34.5 per meeting which is still a notable weekly cost for many people on the high end especially after shelling out $400+ a month for months on end.
Other clients have PPO insurance which is a fixed cost per meeting but this can vary wildly. More affluent clients have excellent PPOs where they might pay $10-20 per meeting which is not terrible. But that’s rare. We are often covered under the “specialist” copay and many PPO plans have tiered provider coverage now. So a copay for me might be $50 or more per meeting (the worst I saw was $125 which was absurd because it was actually $27 more than I’d get from the insurer in question).
So you have this on top of these plans taking hundreds of dollars out of each pay check. “Well budget for it”. Hard to do because the need for therapy can be inconsistent and many of these people are coming in fo(and specifically symptoms like poor money management). Then on top of that even if you do budget for it you have the inherent issue that the need for outpatient therapy is often not dire/acute so if something more pressing comes up (eg a serious dental/medical issue, car breaks down, short on rent) therapy might be the corner to cut if it’s already established because in the overwhelming majority of cases you won’t die without it; it will just lower your quality of life (sometimes significantly so)
Then comes the time portion. Even if you can get past the cost barrier you have the availability of the therapist and yourself. I’m a night owl and I work late but many of my colleagues don’t. I’m pretty nontraditional though, no kids and my partner is very career oriented themselves whereas many of my peers tend to value the traditional 9-5 much more so they can be home for their children and such.
So when you go to schedule with someone it’s often that you can only get seen during business hours. It’s one thing when it’s a doctors appointment that you have once every few months that you need to duck out of work for but a weekly hour long engagement is much harder to explain. This brings back in the masculinity issues - many men find this basically impossible to disclose to the workplace and basically wouldn’t even try to get an exception for weekly therapy. Even without explicitly saying so asking for 1 hour open a week consistently for a doctors appointment is going to be perceived as therapy by many. But stigma aside many of us simply can’t do that. I’m on the practitioner side and I know I’ve ignored my own physical health at times because it was inconvenient to schedule doctor appointments during my workday.
Our systems of employment (at least in the USA) simply do not provide or protect for medical leave, even when it’s very brief and especially when you are a low level employee (executives and admins tend to have less of an issue ducking out for doctors appointments in my experience at least). There is no legal right to paid or unpaid time off for medical appointments in the USA and that is completely disgusting in 2023.
The final piece is practitioner availability. I have a waitlist through October at the moment and am not accepting new clients. All of my colleagues are in the same boat. The old practices I used to work at constantly call me to see if I’ll take any referrals because their waitlists are so overloaded. The hospitals and clinics I have referral relationships with email me every week for updates. It’s extremely stressful. Every new client, especially adolescent, complains that they are happy to finally have someone after waiting 3-6 months. Even if someone wants a therapist they have to wait ages. It is not uncommon that I get someone and when I call them to start they say they don’t even remember why they called in the first place.
We need more people doing the work. Or ideally we need to make societal reforms so that there are less people experiencing mental health issues. I’ve been doing this almost 15 years now. I, and anyone who doesn’t exclusively work with the rich, can tell you that a significant degree of what we work with is people who lack resources and not proper mental illness. I mean, it is depression and anxiety, but it’s because they have been paycheck to paycheck for years or theyre under a mountain of student loans or credit card debt and the stress is just too much to bear. And their jobs won’t give them raises and there aren’t any other jobs out there that pay more. Not everyone is a software developer or investment banker that can jump ship to another 6 figure job with cushy benefits. Most people work jobs that pay 40-60k with shit benefits and little upward mobility.
To answer your question more directly:
In my opinion it’s a systemic issue based around that super fun phrase everyone loves, “toxic masculinity”. I personally do not subscribe to gender labels but I am amab/male presenting and get a lot of male clients as a result. Many of them tell me they hide the fact that they are in therapy from everyone but their partner. This is indicative of the problem; that being in therapy is weak. That being in therapy makes them a bitch, a wuss, all kinds of pejorative terms. It’s bad, is my point.
So part of the answer imo is not in having doggies and cool dude stuff in the office. Its far more complex and involves redefining masculinity to still including things like being a lumberjack or carpentry or whatever. From there though you need to shed the part where it means you have to be emotionally numb to everything, constantly display strength, embrace the fucked up misrepresentation of stoicism that has you shove all your feelings into your stomach, and glorify anger, rage, and violence as the only appropriate means of emotional expression.
this could also be extended to the stigma surrounding therapy itself and the tendency to associate therapy need with weakness. This is an issue that goes beyond therapy though; there are people who won’t see medical doctors for the same reason even though they’re in physical pain. Our pride is our downfall.
Tldr make therapy cheap and accessible, make protections for workers to seek medical care, increase the amount of practitioners (or decrease the need for them), and systemic reform to the societal concept of masculinity and pride. So probably gonna take awhile
This was quite simply the greatest 'not rant' I've read in a long time. Really well reasoned and I completely agree (although, in New Zealand we don't suffer from nearly as much pressure).
One of the things that really keeps me repelled by conventional therapy in business hours is not just the time out from work, but it's the emotional hangover that lasts hours or days in some cases. Fuck trying to pokerface my way through that one - one drop of verbal praise and it'll be the ugly waterworks all over again...
God, emotional hangover, that puts it so well. I did three sessions and I was a complete wreck the whole week after the 2nd and for a few days after the 3rd. My therapist is now taking an extended leave of absence and I don't know if I have it in me to try again.
This is a fantastic response, and it's good to see someone taking a practical view of time/money/availability concerns.
One aspect I haven't seen raised much is a slightly subtler parsing of the whole masculinity thing. Perhaps it's generational (I'm genx), perhaps it's cultural (I'm not from the US), but I think perceived weakness is a misreading of the motivation, or perhaps even a more-acceptable out, for many guys.
Perhaps this might give someone out there an angle they find useful, who knows?
A chunk of it from my perspective, and as best I can gather for a lot of guys I know, isn't about being seen as a pussy, it's just... my problem to deal with, not something anyone else has control over or responsibility for, any more than they can go pee for me when I need to. The anxiety here isn't jocks kicking sand in your face, it's the sitcom dad asking what the hell you expect him to do about it, idiot.
It's associated with and caused by cultural gender norms and the way we're raised, but I think it's a misleading oversimplification to suggest that it's just about not appearing masculine enough. It's not about being 'man enough' to tough it out, it's that as men, they're taught that the only resource they have is themselves.
And a second major facet is that for a lot of guys, losing control of their emotions in and of itself represents painful catastrophic failure. While guys definitely get punished and shamed for displaying vulnerability, the flipside of that is that they tend to rely on the resulting rigidity for refuge and protection. But especially since they get no opportunity to practice controlled, minor release of negative emotions, that protection is all or nothing; one good crack and the entire structure collapses. And that's not the cathartic but ultimately healing purge people think of it as, but rather a terrifying, traumatic and destructive breakdown of everything that's holding them together. And most guys I know would no more put themselves in that harm's way than they'd shove their arm down a garbage disposal.
Again: caused by shitty gender norms, but the connection isn't the one people usually paint. We're no longer told during our upbringing that boys don't cry; that's a horrible relic of the bad old days. Instead boys are told that only babies cry. Crying isn't feminised, it's infantilised. The shame associated is not due to being inadequately male, but inadequately adult (but only if you're male). This of course does women no favours; when men see crying in women as accepted and encouraged, what they hear is that women must be fundamentally infantile on some level themselves.
If we want to see better emotional resilience in men specifically, and better use of mental health resources by men, I think the most effective change would be a cultural shift creating a safer environment in which they can be vulnerable. There's no use telling men that they should be vulnerable, in a society that will just hurt them for it; the ground needs to be prepared first. That means a hard, critical look at gendered expectations around emotional expression in children, and a significant change to how they're raised. It means treating phrases like 'man-baby', 'man-flu' and 'male tears' as toxic and offensive on par with racial slurs, and a bunch of surrounding attitudes treated like the ingrained racism of boomer grandparents.
It'd be really nice if we could stop telling people how to do their gender altogether, and stop using gender-compliance as a proxy for admirable character traits. Every time well-meaning people promote the notion that Real Men Are (generous / honest / hardworking / etc.), they're pushing the converse, that insufficiently-masculine people are (mean / shifty / lazy / etc.), and that makes the whole problem worse, not better.
This is pretty much what I meant by that fucked up misinterpretation of stoicism
Like you have the actual Aurelius stoicism which has some very good value; everyone should read meditations once or twice. But then it’s been cliff notes’d and perverted by a bunch of people into to lose the message entirely from “be in control of your emotions” to what you’ve described: horrific rigidity to keep it all in at all times until of course it doesn’t work anymore and you break down spectacularly. Like somehow the message has gone from “control” to “emotional numbness”
A similar dynamic has happened with nihilism where some the writings on it are not so bleak and terrible; that it is an expression of freedom. But over the years it’s been perverted into nothing matters, why bother
reminds me of this
Does FMLA not cover this? I had a coworker that was able to use that to call off basically whenever they wanted because their doctor put in for it due to stress.
FMLA is unpaid leave. This is a major oversimplification, but it's so an employee can take an extended leave from work and return to their job afterwards. And even though it's unpaid, there are still a lot of limitations on it.
Maybe the company I work for is going above and beyond then and just calling it that because there's definitely a paid version of FMLA I've seen people use. Even for shorter periods and intermittent health problems.
That's what it sounds like to me. Well, actually, it just sort of sounds like your company is calling normal paid sick leave "FMLA". It's nice to have, regardless of what it's called, and very sad that it's not a given everywhere.
That’s for long term medical leave, like if you need to go to rehab. I mean for being able to go to like a single hour long doctors appointment. There is no protection for that whatsoever. If you need to go to a doctors appointment during work hours your boss has every right to tell you to go fuck yourself; you are not entitled to time off for a doctors visit even if it’s unpaid