Abstract: This scoping review was conducted following the broad guidelines that have become popular since the framework was defined by Arksey and O’Malley (2005). This method was chosen due to the rapidly changing situation regarding males and their responses to Covid-19 and the lockdown conditions imposed in most nations. The aim here is to urgently summarise and collate existing epistemology surrounding the male suicide rate, coping strategies, social pressures and available intervention approaches to men in mental health crisis for the purposes of advising counsellors, policies and approaches to men in distress. The findings reveal a persistent bias toward men in mental health services and a need for a progressive understanding of potentially positive male masculinities.

Keywords: masculinities, male mental health, counselling, male psychology, suicide, Covid-19, boys, and men.

Table of Contents

Definitions

Method

Similarities and Shared Issues

Significant Differences

Gaps Identified

Further Research Recommended

Summary

Conclusion

---

The study of psychology has progressed from the Hippocratic approach to human health in ancient Greece, yet we remain in the realm of Plato’s theory of healing body and soul (Kleisiaris et al., 2014). Contemporaries are suggesting a need to revive these principles: “In a scientific culture where the very concept of biologically based gender difference is unfashionable, it inevitably becomes that-much harder to research and address observable differences between male and female behaviour even where these are strikingly obvious and urgent as is the case with suicide” (Seager, 2019, p. 228). The purpose here is to update the literature within the contemporary epistemology of what is considered male mental health in a crisis. In The Palgrave Handbook of Male Psychology and Mental Health (Barry et al.,2019), Seager (2019) proposes; moving away from stereotypes toward archetypes may operationalise “evidence surrounding male help-seeking, risk-taking behaviour and suicide itself” (2019, p. 228). As we will see below, others have called for less repetition of “predominantly descriptive findings” (Oliffe et al., 2021, p. 440), and rather; more action on masculine-specific targeting of boys and men’s mental health, especially during a crisis.

Definitions

This research revealed the variety in which terms are used depending on the location of the study, the origins of the authors and the studied groups. For example, Western, educated, industrialized, rich and democratic (WEIRD) authors have various ideas around first nations groups (being the original occupants of the land). In Canada Oliffe et al. (2021) also use the term “two-spirit indigenous men” (2021, p. 440) which may require detailed explanations to anyone from the wider global population. Therefore, for clarity, certain words herein are given a short definition and context to avoid any postmodernist misinterpretation in the language used below. Extended quotation is used for the same reason.

Traditional masculinity will be used in the African context of ancient indigenous culture that predates colonial influences. Revealingly, the term has many similarities in cultures across the globe; traditional culture expectations “delineate men as brave, noble, emotionally intelligent, and strong, and thus, must not be irrational or emotional in the face of challenges or overwhelming events… emotionally intelligent, self-reliant, and competent, they exhibit denials when a mental issue arises, may avoid engaging in emotional discussions, and instead of disclosing problems, they may engage in premature termination of such discussions” (Ezeugwu & Ojedokun, 2020, p. 3).

Hegemonic masculinity is derived from concepts developed by R. W. Connell in the early 1980s around “experience of men's bodies…[in] labor [sic] politics” using a research project conducted in a high school that adopted an “activist point of view” (Raewyn Connell, n.d.). As a technical, and relevant clarification, note that today “Raewyn is a transsexual woman, making a formal transition late in life. Most of her earlier work was published under the gender-neutral name R. W. Connell” (Raewyn Connell, n.d.). The articles and theoretical propositions made by Connell have had a significant impact on feminist and gender discourse in popular culture and academia over the last 30 years, being cited 86412 times on Google Scholar (Raewyn Connell, n.d.).

Masculinities are considered to be variable over time and place (Barry et al., 2019; Oliffe et al., 2021; Sousa et al., 2021) The popular term hegemonic masculinity would eventually be redefined in Hegemonic Masculinity: Rethinking the Concept (Connell & Messerschmidt, 2005) as being less rigid, acknowledging the plurality of male behaviour.

Recently, this plurality has been supported by various studies, for example; Sousa et al. (2021) noted: “contradictions between hegemonic masculinity and the mobilization of other possible masculinities” (p. 5) in their findings.

Toxic masculinity was coined by a men’s movement leader in the 1980s to denote “militarized, authoritarian masculinity” (Harrington, 2021, p. 3). Usually used with no definition in academic papers, but occasionally is described as “violence, domination, aggression, misogyny, and homophobia” (p. 5). Arguably, this term has a social hierarchical element weaponised by “already privileged men” (p. 6). Notably, this term is not used to describe any other human group and has failed to produce successful operational interventions for anti-social male behaviour and is considered by many to be outdated biased language from popular culture with little empirical basis (Buss, 2021; Frias Armenta & Corral-Verdigp, 2010; Seager & Barry, 2019b; Sousa et al., 2021).

Method

This scoping review which aims to “map rapidly the key concepts underpinning a research area” (Arksey & O’Malley, 2005, p. 21); began with search terms such as male mental health, men in therapy, male suicide, masculinity, and male psychology. Initially, over 60 journal articles were selected if they had significant findings using statistically relevant samples. Other information was gathered from reputable Handbooks published by Palgrave, Wiley, Nova Science and the APA. Opinions by noteworthy figures were gathered from popular websites. As the review progressed the author accessed several books published by prominent figures in psychology and men’s mental health. Most references are after 2012, however, relevant seminal literature was included regardless of the date published to provide a deeper perspective on this historic and existential topic.

Similarities and Shared Issues

A striking similarity in the literature reviewed (Ashfield & Gouws, 2019; Barker, 2005; Berke et al., 2020; Cleary, 2017, 2019a; Courtenay, 2011; Enderstein & Boonzaier, 2015; Ezeugwu & Ojedokun, 2020; Gqola, 2007; Graaff & Heinecken, 2017; Harrington, 2021; Inhorn et al., 2009; Kevane, 2012; Khan et al., 2020a; Mamun, 2021; Milner et al., 2018; Nduna & Tshona, 2021; Rafal et al., 2018; Ridge, 2019; Sousa et al., 2021; Stiawa et al., 2020; van Duin et al., 2019; Yousaf et al., 2015), is the theme of toxic, traditional and hegemonic masculinity being named as the root of men’s mental health problems; as piqued by the much-debated Guidelines for Psychological Practice with Boys and Men (APA, 2018).

Notable media outlets and scholars quickly reacted to the document: one called it a “cumbersome and unwieldy approach” (Whitley, 2019, para. 9). Renowned researcher, clinical psychologist and public figure Jordan B. Peterson called it “predictable, reprehensible, infuriating and disheartening” (Peterson, 2019, para. 1), while twelve other noteworthy scholars compiled a response rejecting the American Psychological Association (APA) language and definitions used in the document (Twelve Scholars Respond to the APA’s Guidance for Treating Men and Boys, 2019).

These articles reveal the contentiousness in the field of men’s mental health. However, there has been a shift with the term masculinity from its early dimorphic incantation in Theorising Gender by Connell (1985) with its self-confessed “political implications” (1985, p. 260), to Hegemonic Masculinity: Rethinking the Concept by Connell and Messerschmidt (2005); where they call for “recognizing internal contradictions and the possibilities of movement toward gender democracy” (Connell & Messerschmidt, 2005, p. 829). These terms are now openly criticised and questioned by both feminists and men’s mental health advocates alike (Harrington, 2021; Seager & Barry, 2019b).

A study in Brazil found a positive “mobilization of other possible masculinities” rather than any evidence of negative hegemonic or toxic masculinity (Sousa et al., 2021). A common theme remains pervasive throughout all the literature: that stoic, repressive, aggressive, rigid male gender roles need to be challenged (Barry et al., 2019; Buss, 2021; Cleary, 2019a; Oliffe et al., 2021; Shafti et al., 2021; Stiawa et al., 2020). A worrying development in male culture is the involuntary celibate (incel) social contagion among very-online males in WEIRD nations reviewed by Van Brunt and Taylor (2021); they report that we must confront these issues urgently, that male self-isolation, bitterness, anger, misogyny, deliberate stagnation and failure to negotiate successfully for their needs, is not an acceptable solution; even if the approach to achieve this is not an agreed-upon method (Bryon, 2021; Costello, 2020; Farrell & Gray, 2018; Hoffman et al., 2020; Van Brunt & Taylor, 2021).

Significant Differences

There is much debate about masculinity, what it is, how to define it and whether it’s good or bad (Barker, 2005; Berke et al., 2020; Brown, 2019; Cleary, 2019c, 2019a; Enderstein & Boonzaier, 2015; Groth, 2019; Hoang et al., 2013; Inhorn et al., 2009; Lomas, 2013; Parent et al., 2018; Ridge, 2019; Seager & Barry, 2019b; Seedat et al., 2014; Yousaf et al., 2015). Perhaps unsurprisingly, suicide rates of men can’t be explained, or addressed using the fluid-gender paradigm, rather; socioeconomic status is more relevant, with masculinity being variable within context (Cleary, 2019a; Hoang et al., 2013; Seager & Barry, 2019b).

In a 15-year study reported by Cleary (2019), they did not reveal any “male-specific ”factors that restrict help-seeking with regards suicide, adopting the social-constructivist lens they blame “environments” (p. 185) and cultures (Cleary, 2019a). This perspective stands in contrast to many others: Geary (2020), Barry et al. (2019), Oliffe et al. (2021), Frias Armenta and Corral-Verdigp (2010), David M. Buss (2021), and more who use bio-psycho-social and evolutionary biology approaches to explain male-specific mental health holistically.

Additionally, in a systematic review conducted by Hunt et al. (2017) in Australia of “peer-reviewed literature across the disciplines of psychology, medicine and allied health” (p. 2) they conclude that there is a “need for scientific research to clarify male presentation of suicidality” (p. 1). Surprisingly, they found a lack of research in male-specific signs of suicide (Hunt et al., 2017).

Further, studies on the psycho-endocrinological effect are showing that male-specific hormone balances will interact with mood and depression in unique ways in males (Geary, 2020; Hooven, 2021; Kutlikova et al., 2021; Russo et al., 2012; Walther et al., 2017; Zitzmann, 2020). Nevertheless, most would agree that: “men demonstrate higher suicide rates than women at all times and across regions and ethnic and socioeconomic groups” (Khan et al., 2020b, p. 652), effectively challenging the socio-constructivist theory regarding male mental health and defying worldwide cultural variables in gender-specific behaviours (Campisi et al., 2020; Demissie & Clayton, 2018; Khuzwayo et al., 2018; Mamun, 2021; Moore et al., 2021; Oliffe et al., 2021; Quarshie et al., 2020; Seager, 2019; Shilubane et al., 2015; Shuja et al., 2020; Stiawa et al., 2020; van der Merwe, 2019).

Gaps Identified

In a Canadian scoping review that screened 1096 articles down to 68, of which 58 were quantitative, covering suicidality in “sexual minority, Indigenous, middle-aged, and military men” (Oliffe et al., 2021, p. 433), they conclude: “While male subgroups who are vulnerable to suicidality and suicide were consistently described, these insights have not translated to tailored upstream suicide prevention services for Canadian boys and men. There may be some important gains through integrating social and mental health care services for marginalized men, implementing school-based masculinity programs for adolescent males, orientation clinicians to the potential for men’s mid-life suicide risks (i.e., separation, bereavement, retirement) and lobbying employers to norm help-seeking among active military, veterans, and first responder males”. (Oliffe et al., 2021, p. 433)

In contrast, Cleary (2019a) declares her sample deliberately avoided intervention reporting that “[therapy] did not happen due to the men’s unwillingness to engage…[and] their antipathy to the therapies available” (2019a, p. 182). However, Cleary (2019) does report that some men successfully engaged in group therapy and that the interventions on offer may not be well suited to all males (Cleary, 2019). This theme is picked up by Seager and Barry (2019b) where they describe the Positive Psychology/Positive Masculinity Framework (PP/PM) developed by Kiselica and Englar-Carlson (2010): this approach takes a positive view of masculinity in therapy and has been successfully deployed with boys and men. They make the contemporary argument that “It is not so much masculinity therefore that needs to change as our collective social attitudes towards it” (Seager & Barry, 2019b, p. 119).

Further, a surprising finding in some studies is that the stigma around men who do seek help also comes from mental health workers themselves, with some clinicians labelling these men as “weak”, “soft” and “wimps” (Stiawa et al., 2020, p. 11). They highlight that men responded to interventions that recognise traditional masculinity as a valuable resource rather than a weakness, that labelling traditional masculinity as a risk factor is “one-dimensional thinking” (Stiawa et al., 2020, p. 11). This finding mirrors Seager and Barry (2019) who call for a positive masculinity approach and Ezeugwu and Ojedokun (2020) who suggest working with traditional beliefs in an inclusive model for African men. There is evidence here to further support the finding of Seager and Barry (2019a) that there is a bias and a cognitive distortion in dealing with males in a mental health crisis that in turn reinforces the stoic behaviour seen by most men in crisis.

Significant in the male-specific articles versus others on general mental health is the sex-specific strategies employed by males in crisis (Ezeugwu & Ojedokun, 2020; Frias Armenta & Corral-Verdigp, 2010; Khan et al., 2020a; Moore et al., 2021; Oliffe et al., 2021; Rafal et al., 2018; Sousa et al., 2021; Stiawa et al., 2020). From the bio-psycho-social perspective, male-specific results are common in interpersonal violence research (Frias Armenta & Corral-Verdigp, 2010). For example, Sousa et al. (2021) note that during Covid- 19 lockdowns males utilised virtual networks, family, friends and institutional support to “overcome solitary pursuits” (p. 5). Holt et al. (2019) also note the Ubuntu-style community

support networks in South Africa that do not exist in the United Kingdom. They report that several peer support networks have been deployed in the United Kingdom with success especially by providing “male role models in relatable black men” (p. 381). It is also relevant that gang culture in South Africa is being challenged by the peer support and wilderness therapy provided by Usiko in Cape Town (Pinnock, 2015). Others state that men must begin to see themselves as more than mere providers (Brown, 2019).

Further Research Recommended

The common element among many articles is a call for more interventions targeting men’s mental health: (Barry et al., 2019; Buss, 2021; Cleary, 2019b; Farrell & Gray, 2018; Frias Armenta & Corral-Verdigp, 2010; Oliffe et al., 2021; Shafti et al., 2021; Stiawa et al., 2020). It is being suggested that men are no longer the disposable sex described by Warren Farrell PhD (2019); predetermined to suffer in silence, to march in wars they didn’t want, die in jobs they had to take, wallow in basements alone and celibate unable to negotiate successfully for their needs, banished to the wilderness for the failure to provide, stigmatised by society and biased by popular media as toxic.

In a study across five psychiatric hospitals in Germany, the authors conclude that mental health workers must be trained in “the role of gender and its implications” and adopt gender-specific services (Stiawa et al., 2020, p. 2). They list several studies that found the consideration of the “patients’ sex” (p. 2) is essential for better outcomes. Significantly, their sudy found that males have distinct expectations from therapy, for example, shorter duration, more input from the therapist and solution-focused methods (p. 9). They found that most mental health practitioners recommended methods tailored for males (Stiawa et al., 2020). From the scoping review by Oliffe et al. (2021), they made suggest targeting the vulnerable categories of males and reaching adolescent males early by de-stigmatizing mental illness, normalising help-seeking and providing help to others through a positive masculinity lens based on the successes discovered in their review.

The systematic review by Hunt et al. (2017) concludes that the ‘R U OK’ program used in Australia had many false positives, whereby men misleadingly replied they are not suicidal because they had already entered the pre-suicidal phase of a “positive mood state” (p. 8). The authors called for more research into the significant signs of male-specific suicide (Hunt et al., 2017). This effect can also be seen in the lack of self-reporting from males after the lockdown periods of 2020 to 2022 due to the Covid-19 pandemic reported by Moore et al. (2021) in the United Kingdom.

More optimistically, an analytical, qualitative snowball study from Brazil revealed that among 400 males:

More optimistically, an analytical, qualitative snowball study from Brazil revealed that among 400 males: “mobilization of masculinities emerged from men towards the recognition of weaknesses and psycho-emotional vulnerabilities, with narratives that reveal the expression of feelings, pain, discomfort and psychological suffering, and showed themselves to be sensitive and engaged in performing practices, including autonomous ones, of mental health care”. (Sousa et al., 2021, p. 1)

They acknowledge the sample group may have been more educated than others. However, this in itself is worth investigating further in low-resource areas: in the absence of better childhood education, which aspects of education allowed this group to transcend the crisis better than others? (Sousa et al., 2021). However, some responders verified findings by others that the healthcare system did not “meet the demands” (p. 5) of these men during the pandemic (Sousa et al., 2021).13

Summary

Hippocratic medicine is the foundation of contemporary human health treatment, ethics and approach (Kleisiaris et al., 2014). The ancient Greek physicians deployed observations of “location, climate, age, gender, habits” and other factors (p. 3). This paper began by contextualising the male in mental health crisis within the milieu, political agendas and public opinions. A consistent similarity is the contentiousness of male psychology terms, outcomes and approaches deployed today, with the term masculinities emerging recently within the positive psychology arena. Within the competing camps, we have the social[1]constructivist, feminist, bio-psycho-social, psycho-endocrinological and evolutionary biologist approaches that give a holistic picture reminiscent of the Hippocratic philosophy of human health. However, what is evident is that the male-specific approach to mental health research and intervention model is producing previously unachievable positive outcomes for boys and men.

There appears to be some evidence supporting a bias in male mental health regarding the application of effective interventions to assist vulnerable categories of males. It appears stigma that help-seeking is reinforced by practitioners in the mental health field, with men who seek help being given derogatory labels. Emerging from non-WEIRD authors is a strong defence of traditional masculinity as an inclusive basis for more positive expressions of masculinities. Significantly, positive masculinities have emerged organically in studies and community work conducted in areas as diverse as Cape Town, the United Kingdom and Brazil, revealing a commonality in potential methods. A universal theme appears: that males require a different approach during a mental health crisis if they want positive outcomes.

Conclusion

This study concludes that males are adopting new masculinities and exploring exciting ways of being “a man”. Young men are exposed to an infinite resource through the internet, and the militarised man is receding into the past of human behavioural memory. The successes of Feminism have come full circle to confront boys and men of all regions, ethnic and socioeconomic groups to ask them: What could you be if you deviated from predetermined biologically driven motivations?

How we help males in mental health crisis must be rooted in a holistic approach: “The bottom line is that an understanding of sexual selection and associated sex differences can provide a framework for understanding how exposure to various types of stressors can affect girls and women differently than the affect boys and men” (Geary, 2020, p. 449).

Abstract: This scoping review was conducted following the broad guidelines that have become popular since the framework was defined by Arksey and O’Malley (2005). This method was chosen due to the rapidly changing situation regarding males and their responses to Covid-19 and the lockdown conditions imposed in most nations. The aim here is to urgently summarise and collate existing epistemology surrounding the male suicide rate, coping strategies, social pressures and available intervention approaches to men in mental health crisis for the purposes of advising counsellors, policies and approaches to men in distress. The findings reveal a persistent bias toward men in mental health services and a need for a progressive understanding of potentially positive male masculinities.

Keywords: masculinities, male mental health, counselling, male psychology, suicide, Covid-19, boys, and men.

Table of Contents

Definitions

Method

Similarities and Shared Issues

Significant Differences

Gaps Identified

Further Research Recommended

Summary

Conclusion

---

The study of psychology has progressed from the Hippocratic approach to human health in ancient Greece, yet we remain in the realm of Plato’s theory of healing body and soul (Kleisiaris et al., 2014). Contemporaries are suggesting a need to revive these principles: “In a scientific culture where the very concept of biologically based gender difference is unfashionable, it inevitably becomes that-much harder to research and address observable differences between male and female behaviour even where these are strikingly obvious and urgent as is the case with suicide” (Seager, 2019, p. 228). The purpose here is to update the literature within the contemporary epistemology of what is considered male mental health in a crisis. In The Palgrave Handbook of Male Psychology and Mental Health (Barry et al.,2019), Seager (2019) proposes; moving away from stereotypes toward archetypes may operationalise “evidence surrounding male help-seeking, risk-taking behaviour and suicide itself” (2019, p. 228). As we will see below, others have called for less repetition of “predominantly descriptive findings” (Oliffe et al., 2021, p. 440), and rather; more action on masculine-specific targeting of boys and men’s mental health, especially during a crisis.

Definitions

This research revealed the variety in which terms are used depending on the location of the study, the origins of the authors and the studied groups. For example, Western, educated, industrialized, rich and democratic (WEIRD) authors have various ideas around first nations groups (being the original occupants of the land). In Canada Oliffe et al. (2021) also use the term “two-spirit indigenous men” (2021, p. 440) which may require detailed explanations to anyone from the wider global population. Therefore, for clarity, certain words herein are given a short definition and context to avoid any postmodernist misinterpretation in the language used below. Extended quotation is used for the same reason.

Traditional masculinity will be used in the African context of ancient indigenous culture that predates colonial influences. Revealingly, the term has many similarities in cultures across the globe; traditional culture expectations “delineate men as brave, noble, emotionally intelligent, and strong, and thus, must not be irrational or emotional in the face of challenges or overwhelming events… emotionally intelligent, self-reliant, and competent, they exhibit denials when a mental issue arises, may avoid engaging in emotional discussions, and instead of disclosing problems, they may engage in premature termination of such discussions” (Ezeugwu & Ojedokun, 2020, p. 3).

Hegemonic masculinity is derived from concepts developed by R. W. Connell in the early 1980s around “experience of men's bodies…[in] labor [sic] politics” using a research project conducted in a high school that adopted an “activist point of view” (Raewyn Connell, n.d.). As a technical, and relevant clarification, note that today “Raewyn is a transsexual woman, making a formal transition late in life. Most of her earlier work was published under the gender-neutral name R. W. Connell” (Raewyn Connell, n.d.). The articles and theoretical propositions made by Connell have had a significant impact on feminist and gender discourse in popular culture and academia over the last 30 years, being cited 86412 times on Google Scholar (Raewyn Connell, n.d.).

Masculinities are considered to be variable over time and place (Barry et al., 2019; Oliffe et al., 2021; Sousa et al., 2021) The popular term hegemonic masculinity would eventually be redefined in Hegemonic Masculinity: Rethinking the Concept (Connell & Messerschmidt, 2005) as being less rigid, acknowledging the plurality of male behaviour.

Recently, this plurality has been supported by various studies, for example; Sousa et al. (2021) noted: “contradictions between hegemonic masculinity and the mobilization of other possible masculinities” (p. 5) in their findings.

Toxic masculinity was coined by a men’s movement leader in the 1980s to denote “militarized, authoritarian masculinity” (Harrington, 2021, p. 3). Usually used with no definition in academic papers, but occasionally is described as “violence, domination, aggression, misogyny, and homophobia” (p. 5). Arguably, this term has a social hierarchical element weaponised by “already privileged men” (p. 6). Notably, this term is not used to describe any other human group and has failed to produce successful operational interventions for anti-social male behaviour and is considered by many to be outdated biased language from popular culture with little empirical basis (Buss, 2021; Frias Armenta & Corral-Verdigp, 2010; Seager & Barry, 2019b; Sousa et al., 2021).

Method

This scoping review which aims to “map rapidly the key concepts underpinning a research area” (Arksey & O’Malley, 2005, p. 21); began with search terms such as male mental health, men in therapy, male suicide, masculinity, and male psychology. Initially, over 60 journal articles were selected if they had significant findings using statistically relevant samples. Other information was gathered from reputable Handbooks published by Palgrave, Wiley, Nova Science and the APA. Opinions by noteworthy figures were gathered from popular websites. As the review progressed the author accessed several books published by prominent figures in psychology and men’s mental health. Most references are after 2012, however, relevant seminal literature was included regardless of the date published to provide a deeper perspective on this historic and existential topic.

Similarities and Shared Issues

A striking similarity in the literature reviewed (Ashfield & Gouws, 2019; Barker, 2005; Berke et al., 2020; Cleary, 2017, 2019a; Courtenay, 2011; Enderstein & Boonzaier, 2015; Ezeugwu & Ojedokun, 2020; Gqola, 2007; Graaff & Heinecken, 2017; Harrington, 2021; Inhorn et al., 2009; Kevane, 2012; Khan et al., 2020a; Mamun, 2021; Milner et al., 2018; Nduna & Tshona, 2021; Rafal et al., 2018; Ridge, 2019; Sousa et al., 2021; Stiawa et al., 2020; van Duin et al., 2019; Yousaf et al., 2015), is the theme of toxic, traditional and hegemonic masculinity being named as the root of men’s mental health problems; as piqued by the much-debated Guidelines for Psychological Practice with Boys and Men (APA, 2018).

Notable media outlets and scholars quickly reacted to the document: one called it a “cumbersome and unwieldy approach” (Whitley, 2019, para. 9). Renowned researcher, clinical psychologist and public figure Jordan B. Peterson called it “predictable, reprehensible, infuriating and disheartening” (Peterson, 2019, para. 1), while twelve other noteworthy scholars compiled a response rejecting the American Psychological Association (APA) language and definitions used in the document (Twelve Scholars Respond to the APA’s Guidance for Treating Men and Boys, 2019).

These articles reveal the contentiousness in the field of men’s mental health. However, there has been a shift with the term masculinity from its early dimorphic incantation in Theorising Gender by Connell (1985) with its self-confessed “political implications” (1985, p. 260), to Hegemonic Masculinity: Rethinking the Concept by Connell and Messerschmidt (2005); where they call for “recognizing internal contradictions and the possibilities of movement toward gender democracy” (Connell & Messerschmidt, 2005, p. 829). These terms are now openly criticised and questioned by both feminists and men’s mental health advocates alike (Harrington, 2021; Seager & Barry, 2019b).

A study in Brazil found a positive “mobilization of other possible masculinities” rather than any evidence of negative hegemonic or toxic masculinity (Sousa et al., 2021). A common theme remains pervasive throughout all the literature: that stoic, repressive, aggressive, rigid male gender roles need to be challenged (Barry et al., 2019; Buss, 2021; Cleary, 2019a; Oliffe et al., 2021; Shafti et al., 2021; Stiawa et al., 2020). A worrying development in male culture is the involuntary celibate (incel) social contagion among very-online males in WEIRD nations reviewed by Van Brunt and Taylor (2021); they report that we must confront these issues urgently, that male self-isolation, bitterness, anger, misogyny, deliberate stagnation and failure to negotiate successfully for their needs, is not an acceptable solution; even if the approach to achieve this is not an agreed-upon method (Bryon, 2021; Costello, 2020; Farrell & Gray, 2018; Hoffman et al., 2020; Van Brunt & Taylor, 2021).

Significant Differences

There is much debate about masculinity, what it is, how to define it and whether it’s good or bad (Barker, 2005; Berke et al., 2020; Brown, 2019; Cleary, 2019c, 2019a; Enderstein & Boonzaier, 2015; Groth, 2019; Hoang et al., 2013; Inhorn et al., 2009; Lomas, 2013; Parent et al., 2018; Ridge, 2019; Seager & Barry, 2019b; Seedat et al., 2014; Yousaf et al., 2015). Perhaps unsurprisingly, suicide rates of men can’t be explained, or addressed using the fluid-gender paradigm, rather; socioeconomic status is more relevant, with masculinity being variable within context (Cleary, 2019a; Hoang et al., 2013; Seager & Barry, 2019b).

In a 15-year study reported by Cleary (2019), they did not reveal any “male-specific ”factors that restrict help-seeking with regards suicide, adopting the social-constructivist lens they blame “environments” (p. 185) and cultures (Cleary, 2019a). This perspective stands in contrast to many others: Geary (2020), Barry et al. (2019), Oliffe et al. (2021), Frias Armenta and Corral-Verdigp (2010), David M. Buss (2021), and more who use bio-psycho-social and evolutionary biology approaches to explain male-specific mental health holistically.

Additionally, in a systematic review conducted by Hunt et al. (2017) in Australia of “peer-reviewed literature across the disciplines of psychology, medicine and allied health” (p. 2) they conclude that there is a “need for scientific research to clarify male presentation of suicidality” (p. 1). Surprisingly, they found a lack of research in male-specific signs of suicide (Hunt et al., 2017).

Further, studies on the psycho-endocrinological effect are showing that male-specific hormone balances will interact with mood and depression in unique ways in males (Geary, 2020; Hooven, 2021; Kutlikova et al., 2021; Russo et al., 2012; Walther et al., 2017; Zitzmann, 2020). Nevertheless, most would agree that: “men demonstrate higher suicide rates than women at all times and across regions and ethnic and socioeconomic groups” (Khan et al., 2020b, p. 652), effectively challenging the socio-constructivist theory regarding male mental health and defying worldwide cultural variables in gender-specific behaviours (Campisi et al., 2020; Demissie & Clayton, 2018; Khuzwayo et al., 2018; Mamun, 2021; Moore et al., 2021; Oliffe et al., 2021; Quarshie et al., 2020; Seager, 2019; Shilubane et al., 2015; Shuja et al., 2020; Stiawa et al., 2020; van der Merwe, 2019).

Gaps Identified

In a Canadian scoping review that screened 1096 articles down to 68, of which 58 were quantitative, covering suicidality in “sexual minority, Indigenous, middle-aged, and military men” (Oliffe et al., 2021, p. 433), they conclude: “While male subgroups who are vulnerable to suicidality and suicide were consistently described, these insights have not translated to tailored upstream suicide prevention services for Canadian boys and men. There may be some important gains through integrating social and mental health care services for marginalized men, implementing school-based masculinity programs for adolescent males, orientation clinicians to the potential for men’s mid-life suicide risks (i.e., separation, bereavement, retirement) and lobbying employers to norm help-seeking among active military, veterans, and first responder males”. (Oliffe et al., 2021, p. 433)

In contrast, Cleary (2019a) declares her sample deliberately avoided intervention reporting that “[therapy] did not happen due to the men’s unwillingness to engage…[and] their antipathy to the therapies available” (2019a, p. 182). However, Cleary (2019) does report that some men successfully engaged in group therapy and that the interventions on offer may not be well suited to all males (Cleary, 2019). This theme is picked up by Seager and Barry (2019b) where they describe the Positive Psychology/Positive Masculinity Framework (PP/PM) developed by Kiselica and Englar-Carlson (2010): this approach takes a positive view of masculinity in therapy and has been successfully deployed with boys and men. They make the contemporary argument that “It is not so much masculinity therefore that needs to change as our collective social attitudes towards it” (Seager & Barry, 2019b, p. 119).

Further, a surprising finding in some studies is that the stigma around men who do seek help also comes from mental health workers themselves, with some clinicians labelling these men as “weak”, “soft” and “wimps” (Stiawa et al., 2020, p. 11). They highlight that men responded to interventions that recognise traditional masculinity as a valuable resource rather than a weakness, that labelling traditional masculinity as a risk factor is “one-dimensional thinking” (Stiawa et al., 2020, p. 11). This finding mirrors Seager and Barry (2019) who call for a positive masculinity approach and Ezeugwu and Ojedokun (2020) who suggest working with traditional beliefs in an inclusive model for African men. There is evidence here to further support the finding of Seager and Barry (2019a) that there is a bias and a cognitive distortion in dealing with males in a mental health crisis that in turn reinforces the stoic behaviour seen by most men in crisis.

Significant in the male-specific articles versus others on general mental health is the sex-specific strategies employed by males in crisis (Ezeugwu & Ojedokun, 2020; Frias Armenta & Corral-Verdigp, 2010; Khan et al., 2020a; Moore et al., 2021; Oliffe et al., 2021; Rafal et al., 2018; Sousa et al., 2021; Stiawa et al., 2020). From the bio-psycho-social perspective, male-specific results are common in interpersonal violence research (Frias Armenta & Corral-Verdigp, 2010). For example, Sousa et al. (2021) note that during Covid- 19 lockdowns males utilised virtual networks, family, friends and institutional support to “overcome solitary pursuits” (p. 5). Holt et al. (2019) also note the Ubuntu-style community

support networks in South Africa that do not exist in the United Kingdom. They report that several peer support networks have been deployed in the United Kingdom with success especially by providing “male role models in relatable black men” (p. 381). It is also relevant that gang culture in South Africa is being challenged by the peer support and wilderness therapy provided by Usiko in Cape Town (Pinnock, 2015). Others state that men must begin to see themselves as more than mere providers (Brown, 2019).

Further Research Recommended

The common element among many articles is a call for more interventions targeting men’s mental health: (Barry et al., 2019; Buss, 2021; Cleary, 2019b; Farrell & Gray, 2018; Frias Armenta & Corral-Verdigp, 2010; Oliffe et al., 2021; Shafti et al., 2021; Stiawa et al., 2020). It is being suggested that men are no longer the disposable sex described by Warren Farrell PhD (2019); predetermined to suffer in silence, to march in wars they didn’t want, die in jobs they had to take, wallow in basements alone and celibate unable to negotiate successfully for their needs, banished to the wilderness for the failure to provide, stigmatised by society and biased by popular media as toxic.

In a study across five psychiatric hospitals in Germany, the authors conclude that mental health workers must be trained in “the role of gender and its implications” and adopt gender-specific services (Stiawa et al., 2020, p. 2). They list several studies that found the consideration of the “patients’ sex” (p. 2) is essential for better outcomes. Significantly, their sudy found that males have distinct expectations from therapy, for example, shorter duration, more input from the therapist and solution-focused methods (p. 9). They found that most mental health practitioners recommended methods tailored for males (Stiawa et al., 2020). From the scoping review by Oliffe et al. (2021), they made suggest targeting the vulnerable categories of males and reaching adolescent males early by de-stigmatizing mental illness, normalising help-seeking and providing help to others through a positive masculinity lens based on the successes discovered in their review.

The systematic review by Hunt et al. (2017) concludes that the ‘R U OK’ program used in Australia had many false positives, whereby men misleadingly replied they are not suicidal because they had already entered the pre-suicidal phase of a “positive mood state” (p. 8). The authors called for more research into the significant signs of male-specific suicide (Hunt et al., 2017). This effect can also be seen in the lack of self-reporting from males after the lockdown periods of 2020 to 2022 due to the Covid-19 pandemic reported by Moore et al. (2021) in the United Kingdom.

More optimistically, an analytical, qualitative snowball study from Brazil revealed that among 400 males:

More optimistically, an analytical, qualitative snowball study from Brazil revealed that among 400 males: “mobilization of masculinities emerged from men towards the recognition of weaknesses and psycho-emotional vulnerabilities, with narratives that reveal the expression of feelings, pain, discomfort and psychological suffering, and showed themselves to be sensitive and engaged in performing practices, including autonomous ones, of mental health care”. (Sousa et al., 2021, p. 1)

They acknowledge the sample group may have been more educated than others. However, this in itself is worth investigating further in low-resource areas: in the absence of better childhood education, which aspects of education allowed this group to transcend the crisis better than others? (Sousa et al., 2021). However, some responders verified findings by others that the healthcare system did not “meet the demands” (p. 5) of these men during the pandemic (Sousa et al., 2021).13

Summary

Hippocratic medicine is the foundation of contemporary human health treatment, ethics and approach (Kleisiaris et al., 2014). The ancient Greek physicians deployed observations of “location, climate, age, gender, habits” and other factors (p. 3). This paper began by contextualising the male in mental health crisis within the milieu, political agendas and public opinions. A consistent similarity is the contentiousness of male psychology terms, outcomes and approaches deployed today, with the term masculinities emerging recently within the positive psychology arena. Within the competing camps, we have the social[1]constructivist, feminist, bio-psycho-social, psycho-endocrinological and evolutionary biologist approaches that give a holistic picture reminiscent of the Hippocratic philosophy of human health. However, what is evident is that the male-specific approach to mental health research and intervention model is producing previously unachievable positive outcomes for boys and men.

There appears to be some evidence supporting a bias in male mental health regarding the application of effective interventions to assist vulnerable categories of males. It appears stigma that help-seeking is reinforced by practitioners in the mental health field, with men who seek help being given derogatory labels. Emerging from non-WEIRD authors is a strong defence of traditional masculinity as an inclusive basis for more positive expressions of masculinities. Significantly, positive masculinities have emerged organically in studies and community work conducted in areas as diverse as Cape Town, the United Kingdom and Brazil, revealing a commonality in potential methods. A universal theme appears: that males require a different approach during a mental health crisis if they want positive outcomes.

Conclusion

This study concludes that males are adopting new masculinities and exploring exciting ways of being “a man”. Young men are exposed to an infinite resource through the internet, and the militarised man is receding into the past of human behavioural memory. The successes of Feminism have come full circle to confront boys and men of all regions, ethnic and socioeconomic groups to ask them: What could you be if you deviated from predetermined biologically driven motivations?

How we help males in mental health crisis must be rooted in a holistic approach: “The bottom line is that an understanding of sexual selection and associated sex differences can provide a framework for understanding how exposure to various types of stressors can affect girls and women differently than the affect boys and men” (Geary, 2020, p. 449).