Why men are careless about their health

How do we men talk about our health, and why don’t we do it enough?

When the doctor asked a friend of mine what he was doing at the clinic that day, the answer was a jovial: “I don’t know. Well, I do — so my wife, who told me to come, can stop breaking my balls!”

My friend, an almost 50-year-old father of three, is telling me about his health check a few days ago. His wife smiles a smile which sits somewhere between relief for her insistent win, and resignation at the narrative. I feel a bit uncomfortable: Am I a sour grape if I don’t smile along with him? Should I say something? I haven’t been asked anything, so I stay quiet, not wanting to be a bore.

It did however feel like a great opportunity to bring up this issue. It reminded me of a diploma in masculinities and social change which I took last year, led by Argentine psychoanalyst Débora Tajer. She spoke of how men come to health care late, and when they do it, it’s at a woman’s suggestion, or because we simply can’t ignore it anymore.

Of course, some men do get basic health checks, irrespective of it being on their own initiative or at someone else's (be it a medical certificate needed for work or sports). But it’s not the norm, nor is it the only way we can describe our relationship to our health, or how we look after ourselves.

In an article titled “Why do men hardly go to the doctors, and how does it affect their health?” in Spanish daily newspaper El País, doctor Benno de Keijzer describes a pattern where boys usually see their doctors up until they are 13, before “disappearing and returning as pensioners in their 60s with aches and pains”. The specialist from Mexico, who is also an anthropology professor at the Autonomous University of Mexico, adds wryly: “What we do find is young men and adolescents holding up the A&E units of hospitals on a Friday or Saturday night”.

Then there’s the care we don’t take care of. Take prostate checks, something which could help detect the cancer which most affects men. According to the Latin American Movement against Prostate Cancer (MOLACAP), more than 65% of cases are detected when they are already at an advanced stage. One of main reasons men won’t rush to see a urologist is because it is seen as a taboo; there can be a lot of fear around having a rectal area checked during a medical.

Which guy hasn’t heard the comment — delivered as part lecture, part joke — about whether it’s OK to slip in a finger or two back there? It’s an indicator of whether you like anal sex, which brings the threat that you might be gay ever closer. And being “gay” means you’re weak, that you rank lower on the unattainable scale of hegemonic masculinity. (Luckily the fourth series of British show Sex Education is out on Netflix — and goes to task exploring this taboo amongst heterosexual men.)

Now that I think of it, there are distinct instances or the most basic facets of self-care which reveal themselves in the jokes which try to suggest the paths that men should take (if we don’t want to be seen as lesser men).

• When it comes to food, advice from the World Health Organization and general consensus amongst experts is that a varied diet, rich in fruit and vegetables, without too much sugar and alcohol, can limit the risk of illnesses. I go about trying to incorporate healthier habits, until I’m scolded (and especially in my steak-heavy country of Argentina) with variations such as: “You’re eating a salad? Don’t be a sissy! Eat this rib”; or: “You’re not drinking?! C’mon, that water’s going to hurt going down. Have some wine instead”.

• It’s common sense that physical exercise helps general fitness, both mental and physical. But there are some sports which count as exercise, and some others. “Oh, you do yoga and pilates? It’s going to turn you gay, watch out. Oh, I see, you’re smart! You’re going to look at asses, right?”

  

  Photo by Gabriel on Unsplash

Mental health

Mental health is another of our biggest taboos. It has helped that elite sportsmen — successful, talented, millionaires — have shown their vulnerable sides and told their stories publicly with regards to their own mental health, from Spanish footballer Andrés Iniesta to U.S. swimmer Michael Phelps.

Mental health remains a stigma though, which in a sense is more complex for those men who think they can do it solo. But what extremes will we go to in our situations before we’ll finally seek out therapy, or ask for help?

The reality has a lot to do with machismo. Men die from suicide far more than women worldwide, and this difference between the sexes increases with age.

Andoni Ansean, a psychologist and president of the Spanish Foundation for Suicide Prevention, told Spanish newspaper El Mundo: “The expectations are different for each gender, and it becomes assumed by the individual. It’s murky terrain, but it’s what it means to tell a girl she is a princess in her pink dress and a boy that he is a prince with his sword. It’s telling boys not to cry. All of these roles make it harder for men to ask for help than women”.

That the tendency across the world is the same — that so many men kill themselves — is something we should think about. There is no honor in keeping pain, sadness or pain to one’s self. Looking after ourselves makes all the difference.

I have to confess that I have never felt so much doubt, fear, worry and questions than in these last five years, since becoming a father. Amongst other things, something which surprised me is that it is not a conversation that we often have amongst each other, which was also one of the reasons I started this newsletter. I’m not alone; others do it very well, like

Kevin Maguire

with his great newsletter The New Fatherhood and Sebastián Blanco’s Soy papá (“I’m a Dad”, in Spanish). They bring important topics to light, like postpartum depression in men.

Being a man

It’s hard to say what really makes a man in the twenty-first century. Those signals which show us we’re moving away from hegemonic masculinity are the clearest. All of this has to do with how men relate to their health.

Among the notes I took from the class with Débora Tajer, I highlighted these:

“In general, men tend to live seven years less than women. Excesses and exposure to the risk of hegemonic masculinity. Living for achievements, violent conflict resolution, failing to understand fatigue. Men come to their senses later (when it comes to a heart attack or broken bone, etc). Masculine excess mortality has avoidable causes, like car accidents from speeding, murders, suicides, extreme sports, initiation rites. Groupness: things that men would not do alone, are done together in a group. Men kill and are killed more than women. Alcohol as a self-prescribed drug, to be uninhibited or manage situations of anxiety or depression. My self-esteem will take a hit if I am not working, if I stop, if I am not successful”.

Now that I am 41 and am raising two boys, I find it easier to deal with some of those demons. And of course having spent the last decade in therapy helps, and I can look at some of those problems from the bigger picture, in a time when feminists are making themselves heard amidst so much struggle, and also because of the pandemic, when mental health worries really became more evident.

Yet, I’m always surprised by how deeply ingrained all of this is, and sometimes subtly. 

Just by looking at how society and its different actors and institutions (education, health) relate to my children, I can understand a lot. I see how “being a real man” has begun for my eldest in the nursery he goes to — from the colors he should pick, to the clothes he should wear, to the sports he should be playing, and the superheroes he should love, the girls he should like, and the list goes on…)

I am not exaggerating. These last four years I’ve seen Lorenzo, my son, changing, and even more so because at home, we give him the freedom to choose what he wants. That shopping list of conditioning he receives may seem like tiny drops from a leaky tap, but the bucket overflows at a certain point.

Lorenzo was not even a year old when he was told “don’t cry, don’t be gay”, like many other boys have been told. Since then, we’ve heard the same phrase dressed up in different ways: “don’t cry, it’s nothing”, “little superhero boys don’t cry”, and so on. Lorenzo was not allowed to have a folder with an image from the movie Frozen on it, since it was “for girls” — like the color pink which he liked but does not pick anymore.

We went to a birthday party the other day, and in the middle of a musical game, I noticed that Lorenzo was not dancing — he was shy, so instead he jumped around and did a cartwheel to show that he didn’t care for the music. Some of the fathers were joining in the game, dancing with their kids, but in the end only the girls were holding up the dancefloor. Why didn’t boys join? Why didn’t Lorenzo dance there, if we often find him treating the living room as his own personal disco? I see him dancing in secret, but when I enter the room he smiles and stops, until we ourselves get in on the dancing ourselves.

Photo by Helena Lopes on Unsplash

How to change

There are some places we can start to change this: demystifying masculinity, for example, because self-care does not make us any less of the men we are, rather it makes us more responsible (for ourselves, for our wellbeing, and for those around us).

It’s not easy, but it’s good to come back to a core idea: we are not, and don’t have to be invulnerable. It’s completely fine if we can’t manage everything. We could be depressed, or suffer from depression. We don’t need to hide it, lessen it, or occupy ourselves to move away from it. We all face emotional challenges. Looking for help is not a sign of weakness, but a sign of courage.

I know it’s complex. Being as strong as a superhero is something that we have internalized. I find it difficult to tell Lorenzo who’s stronger: Lionel Messi, or the Incredible Hulk. By the time he was four, Lorenzo had already understood that “being stronger” was something fundamental. I know he’s weighing it all up by the kinds of questions he asks me — whether I cry in this or that situation, for example. And that’s where I feel I can accompany him in the feeling, because being honest could be a way of showing him how to be vulnerable, and it's not synonymous with weakness, nor is it something to be ashamed of.

Like every father, it’s about giving our children what we feel we didn’t have. It's trying to teach them that taking care of their mental and physical health is a sign of strength and wisdom. I repeat it to my kids, because I repeat it to myself too: “There’s nothing wrong in asking for help. Superheroes don’t exist. Look after yourself, kid”. Look after yourselves, my friends. Which is what I should have told my friend instead of thinking I was going to be a bore. 

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I’d love to hear from you if you think men feel more pressure to show themselves as being strong and not showing vulnerability. And especially if you have tips on how it can be different.

This is an important conversation which is very important in changing the stigma around male health, and which affects everyone in the end.

Once again, thank you for reading, commenting, sending mails and sharing this newsletter with others. If you think of someone who’d like to read it, do send it to them!

Stay well.

A hug,

Nacho

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📣 Nabeelah Shabbir, a member of this community and a friend, edited and improved this newsletter with lots of love. Thanks, Nabeelah! 🙏 If there are mistakes, they are my fault, not hers! (and please forgive me for them!)