Why do men see a doctor, on average, 27 percent less often than women do? Why are we reluctant to undertake treatments requiring more than one clinical visit, and why are we reluctant to read — and follow — the instructions on pill bottles? Finally, is there any cure for men’s general refusal to accept medical considerations — and solutions — as an avoidable aspect of aging gracefully and even happily?
The evidence for some of the above conclusions is abundant and depressing. Men, representing roughly half the population of the United States, account for only 40 percent of physicians’ visits, according to the National Institutes of Health. And a nationwide telephone survey revealed that about three-quarters of American women have had a physical in the last year, compared with only about 60 percent of men.
This is explained in various ways. Men don’t like to appear — or to be — vulnerable. They don’t like being told what to do, and they don’t like being without recourse (as in, “You have no alternative to angioplasty …”). And men have no tradition, as women do, of giving each other friendly and available help.
Women are more likely to face the possibility of a debilitating illness before a diagnosis makes that an unavoidable reality. Men, on the other hand, wait until they have prostate cancer or a blocked artery before they begin to take the problem seriously. They feel that they have to be demonstrably ill, without recourse, and therefore forced to acknowledge the fact before they can do so openly and without remorse.
There are some strengths to the typical masculine approach, which often includes taking action. Men exercise more than women, which may have something to do with the roles men assume in and outside the workplace. They are less likely to be overweight and to suffer from chronic diseases like diabetes and osteoporosis.
The rate of depression among men is half that of women, although again this statistic could be related to women’s willingness to seek consultation and men’s reluctance to do so. Men keep problems to themselves and seek to solve them through increased mental and physical activity, which in some cases leads to recovery and in others merely postpones a breakdown.
On average, men die about seven years sooner than women do. This bleak statistic could be altered by earlier medical consultation and treatment, and by a more ready acceptance of the necessity of altering one’s style of life. This would include more personal involvement in understanding, preventing and dealing with sickness, including reading some of the vast store of information now readily available about health.
It would also mean medical consultation on a more regular basis, starting as younger men rather than as older ones. But as an internist in Washington, D.C., told me, “Men are not interested in going to the doctor before the age of 50 for anything other than sex-related problems.”
Psychologists believe that a basic shift in men’s psychological conditioning is needed to change this. Men should talk more about their feelings as well as their physical ailments, and in so doing open themselves up to possibilities beyond merely taking action and seeming self-reliant. This would mean abandoning, or at least questioning, the notion of the male authority figure that remains the cornerstone of American masculinity.
This stereotype of the strong and silent male persists in popular culture, including such avatars as Marlon Brando and Clint Eastwood, while sociologists question the premise that men are really that much different from women emotionally. They are suggesting that much of what is accepted as inherent “maleness” is in fact behavior learned from domineering fathers and movie idols. The implication is that it can be unlearned — at least to the extent that men can become responsible for their own bodies and psychological well-being — even if that means giving up the archetypal self-image.
Such questions about men have spawned a new academic enterprise, “masculinity studies,” that mimics the earlier efforts of feminism. It seeks to explain, and presumably to change, male behavior. At the same time, organizations of men concerned about American masculinity have proliferated, running the gamut from Warrior Soul, a group concerned with such male “problems” as repressed anger over circumcision, to a division of the American Psychological Association that promotes the study of “how gender shapes and constricts men’s lives.”
This is the Society for the Psychological Study of Men and Masculinity and its stated values include “the importance of personal sharing” and “the beneficial aspects of self-exploration.” The traditional male role has led, according to SPSMM, to “negative consequences, harmful activities and unhealthy interactions.” It has also led, as the statistics all show, to unhealthy non-interactions — like those between doctors and male patients.
The growing awareness of a man’s cultural baggage and psychological complexity is unlikely to entirely revamp the American male any time soon. But all the effort would be worthwhile if it simply brought about more prostate exams and the notion that there is a direct relationship, at any age, between behavior and good health.