The socialisation of developing boys

In our introduction we presented three reasons for considering men and depression -  men are a numerical minority among patients with depression, and they require effective interventions; in community samples there seem to be more men with depression than are receiving treatment for it; and emotional distress in men might indicate depression. Theories of sex differences, gender roles and hegemonic masculinity can be combined in an effort to explain why men are the numerical minority patient group when so many seem to have depression. Although Kraemer (2000) argues that men may be biologically disadvantaged by a fragile X-chromosome, he claims that this disadvantage is immediately mitigated once an infant’s sex is known. Boys are subject to their own biological and psychological development that cannot be separated from the cultural and historical context in which they are socialised. The advantage of taking a combined approach is that it should force us to consider the individual and social together.

In a pioneering study of schoolboys, Frosh et al(2002) found that masculinity seemed to be lived through attempts to avoid being seen as feminine or homosexual. In particular, femininity and homosexuality seemed to be associated with displays of emotions and the schools reported that if boys displayed such emotions they were subject to, and would subject others to, insidious bullying. Although usually associated with younger children, the cliche’ ‘big boys don’t cry’ is an example of how a young boy may be denied a masculine identity because he has displayed emotion. It is important to consider what this means for men and depression in practice, as the suggestion seems to be that developing boys are socialised into emotionally inarticulate young men, unable to express depression. If adolescent girls hold the monopoly on discussions relating to emotions, then by implication boys are restricted from entering these domains. This rather stark bipolarisation of emotional-feminine and unemotional-masculine must influence men’s ability to recognise their own emotional difficulties, how they express them and how they seek help to cope with them. A further suggestion is that ‘health’ more generally is seen as a feminine issue, which means that the problems of genders roles and masculinities are not limited to emotional health (White, 2006).

Future -  gender equality policy
The ‘Real men. Real depression’ campaign of the US National Institute for Mental Health (Rochlen et al, 2005) and the publication of the leaflet Men Behaving Sadly by the UK Royal College of Psychiatrists (2006) demonstrate the growing recognition of depression in men. However, recent changes towards proactive gender equality may mean that health services have to adapt and incorporate an explicit focus on men and depression. The UK Equality Act 2006, which came into force April 2007, places a statutory duty (termed the ‘gender duty’) on public bodies to ensure that where men and women have different needs services are planned and developed in ways that successfully meet them. If, for example, a local coroner’s office were to report a rate of suicide greater in men than in women, we would presume that under the gender duty the local health services would need to do something to reduce male suicide. Nevertheless, health services currently lack the expertise required for providing solutions targeted specifically at men (Men’s Health Forum, 2006), which means that they may fail to meet their obligations under the gender duty. Health service projects have been designed to meet men’s health needs and it is important that we learn from these as services are developed on the basis of the different needs of men and women.

MCQs and EMI

  1. A man attends your surgery and you consider him to be typical of the masculine gender role. The most productive tactic to explore the possibility that he has depression is to -
      1. ask how he feels about his emotional difficulties
      2. focus on his physical symptoms
      3. ask about any issues or problems he is experiencing.

  2. Assuming that ‘male depression’ exists, diagnosis should be based on -
      1. international diagnostic criteria with both men and women
      2. international diagnostic criteria with women and ‘male depression’ instruments with men
      3. diagnostic criteria and ‘male depression’ instruments with both men and women.

  3. Hegemonic masculinity is best described as -
      1. the taken-for-granted view of what it is to be a man in a specific context
      2. the norm that men aspire to
      3. the societal view of what it is to be a man that is forced on everyone.

EMI
Theme -  clinical diagnosis
Options

  1. weight loss
  2. disturbed sleep
  3. ideas or acts of self-harm or suicide
  4. alcohol dependence during difficult times
  5. loss of interest or enjoyment f physical aggression.

For each patient in the scenarios below, select from the above list the symptom that is absent from international classifications of depression -

  1. A 40-year-old man is cheerful and friendly when he attends your surgery. When pressed, he reports that for as long as he can remember he has had periods when he loses interest in his hobbies, eats too much and puts on weight. When asked about his strategies for dealing with these periods he reports that the only thing that helps him is drinking, otherwise things get out of control as he cannot relax.
  2. A 22-year-old man attends your surgery with visible bruising to his face and knuckles. Since graduating from university, he has separated from his long-term partner and had to relocate away from friends and family to start his job. After further discussion, he reports that has been feeling low and has moments when he becomes inexplicably angry, starting fights for no reason.