Psychological and Psychiatric Problems in Men

Joan Gomez

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429850936
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

What causes a man to become depressed or even psychotic?

This book, originally published in 1991, provides an account of a grossly neglected subject: the social, sexual, psychological and psychiatric problems facing men. Dealing with issues such as aggression, violence, criminality, sexuality, and alcohol and drug dependence, it will be essential reading for health professionals, social workers and welfare officers, as well as those interested in gender studies.

Chapter one

La difference

Men are different. Yet they are people, too. Women’s physical and emotional characteristics and sufferings have been studied, written about and mulled over – and over. By contrast, the problems particularly affecting men are neglected – even by themselves. Men make far less use than women of the whole range of health care services except those concerned with accidents, alcohol and sexually-transmitted diseases. They consult doctors, psychiatrists and social workers less often, spend fewer days in bed and far fewer off work than females in similar circumstances. In planning a psychiatric facility, for example, twice as many places must be allowed for women as for men. Yet in the final analysis men are the sicker sex. They die sooner and suffer more of the serious chronic diseases as well as the sudden, death-dealing disasters such as coronary thrombosis. Psychological disorders affecting men are frequently more dramatic, often dangerous and likely to have far-reaching results.

Psychopathy, drug dependency, delusional aggression and sexual deviations are all much commoner in males. While women take overdoses and live to tell the tale, men are likely to commit suicide using violent means. Adolescent delinquency, and crime, whatever its causes, are mainly male problems: not through lesser moral rectitude but because of a greater propensity for energetic action. Schizophrenia, the major psychiatric scourge, affects the sexes equally but strikes earlier in the male and is more severe. While most families can cope with a schizophrenic daughter at home, even the most devoted parents – or wife – find a son with the same disorder too difficult to live with. At the end of the road, more than 90 per cent of the homeless and hopeless down-and-outs who wander the urban wilderness are men. Schizophrenia, alcoholism and personality problems beset this group.

In western culture men suffer less than women from the standard neuroses and minor psychiatric disorders (Briscoe 1982) but work-aholism is predominantly male, and so is its sequel, burnout. Mood disorders affect women more than men in the west, but the most disturbing of them – mania – more often affects men, and with a greater risk of appalling consequences. An energetic man with delusions of enormous power and wealth may be in a position to destroy his company or his government. Among the psychosomatic disorders women have a corner in headache, nervous stomach, eating disorders and high blood pressure, while men under stress may develop peptic ulcers, asthma or ischaemic heart disease. This is the situation in the west. In developing countries such as India, Uganda and New Guinea, men suffer more than women from all types of mental problems including depressive illness -in sharp contrast. In South America the situation is again opposite with psychologically-disturbed women easily outnumbering the men. This may be due to the machismo concept, making it unacceptable for a man to show physical weakness or admit to anxieties or depressive thoughts.

The big question is to what extent the differing tendencies between males and females are biologically based, and how much is due to social expectations and early learning experiences. Sex roles are taught by parents and society, but biological sex itself makes boys and girls respond differently. As important as what adults attempt to teach is what the children themselves choose to learn. Anti-establishment and feminist activists make angry and agonized attempts to recast the male and female moulds. Yet the stereotypes remain, dented but not badly damaged, even in decadent western circles. The ineradicable male qualities of height and muscularity and the more efficient use of fuel by the muscles, regardless of any training programmes, are admired and sought after still. Even in today’s sophisticated society, material success is positively statistically associated with above-average height. This has led ambitious parents to attempt to buy growth hormone injections to make their sons grow taller. Male athleticism means fame, honour, hero-worship and for the few, a great deal of money. Women cannot compete in this sphere, particularly obvious in tennis. With this biological headstart, unhampered by cyclical hormone swings, pregnancy and what follows, it is not surprising that men retain the dominant role.

In agricultural communities men and women have separate tasks, appropriate to their physical strength. But in modern urban society, even where affluence and technology have diminished the value of muscle power, men still play most of the leading roles. Even as children boys prefer to play with their own sex, while little girls enjoy playing with either. The same situation is replayed later with men’s clubs or sports activities, but with no equally pleasurable retreat for women together. Men also have an awareness of their scarcity value. Their lives are spangled with dangers from Day One. Despite the risks of childbirth, women have consistently outnumbered men since the late Middle Ages. Only in 1987 in the UK did the balance shift: in one age range, 15–29, there are more males (Dixon 1987).

Sandra Bern (1981), writing from a feminist viewpoint, has studied the psychological attributes which differentiate between the sexes:

Males score high on:

assertiveness

analytical ability

independence

athleticism

self-reliance

combativeness

toughness

leadership

physical courage

moral courage

ability to solve problems

emotional reticence

Females excel in:

emotional expressivity

intuition

adaptability

nurturance

patience

reliability

tact

helpfulness

sympathy

reasonableness

Obviously all these qualities are present to some extent in everyone, but the trend is clear. The most crude male and female stereotypes are constantly presented by the media, particularly in advertising. Women are seen as interested almost exclusively in hairsprays, laundry, floor-cleaning and slimming – and the story-line is romance. Men are targeted for alcoholic drinks, cars, business and travel, with male chauvinism portrayed in those who use the product. Television plays are dominated by action men: fierce, fearless and – for all we can tell – illiterate. Women are slim, and dim.

The Type A go-getting, dynamic personality is something only men aspire to, in spite of its reputation for bringing on sudden death. This is an example of the risk-taking behaviour men cannot resist and little boys practise in advance. The reasons for the better health and survival rates of married compared with single men rest in the sensible caring and restraining influence of the other sex.

Chapter two

Biological aspects

Men in the main are bigger and stronger than women, and usually more competitive, aggressive and actively interested in sex, as remarked by Darwin more than a century ago. These traits are among many that are biologically-based. Male/female differences are present from the moment of conception and develop dramatically during life before birth and again, with renewed vigour, at puberty. The changes are guided by the powerful sex steroids, organizing and differentiating the tissues prenatally, activating them from adolescence onwards. Anatomical development of the genital organs is only one area influenced by the sex hormones before birth. There are also far-reaching effects on attitudes and behaviour in childhood and beyond. For example, if a girl baby has been exposed to male hormones as a foetus, or suffers from congenital adrenal hyperplasia which has the same result, she is likely to grow into an energetic, tomboyish girl, more interested in cars than dolls, in career than marriage (Baker 1980). It follows that sex-hormone factors operating before birth as well as later determine the way in which psychological problems and disorders differ between the sexes. Paranoid delusions in a schizophrenic man, for example, are far likelier to lead to physical violence than in a women patient. There are no female equivalents of Peter Sutcliffe, the schizophrenic murderer of many women.

Early development and later effects

Male programming begins with the Y-chromosome from the sperm, the essential determiner of sex. The basic structure of every foetus is female, until the Y-chromosome, if present, produces special modifications. If there is a Y-chromosome, the embryo is male no matter how many X-chromosomes he may have, as, for instance in Klinefelter’s syndrome (XXY). The masculinizing effect of the Y-chromosome is mediated through HY-antigen, attached to the short arm of the Y-chromosome near the centromere. The amount of HY-antigen depends on the number of Y-chromosomes, and is increased in males of 47 (XYY) karyotype, compared with the usual 46 (XY) arrangement. In human twin pairs of different sexes, the female may be slightly more masculine than most, because of seepage through the placenta of the magical HY antigen. In the equivalent ‘freemartin’ cattle or sheep the female twin is sterile, but this does not apply to humans. The male twin is, of course, unaffected. It has been found that among a significant proportion of male transsexuals, there are abnormally low levels of HY antigen (Engel et al. 1980; Spoljar et al 1981).

HY antigen sets off the whole developmental sequence with the germinal ridge of the embryo forming the testes. These embryonic testes are already producing testosterone, the most important male sex hormone, from the seventh week after conception. Its essential action at this stage, helped by another male hormone, Mullerian inhibiting factor, is to suppress the development of the female type of reproductive apparatus, and to impose the male pattern. Testosterone is secreted by the Leydig cells of the testis. These are plentiful in the foetus and newborn, their production stimulated by hormones from the placenta. The descent of the testes from the abdomen requires supplies of testosterone from the Leydig cells. Soon after birth these cells almost disappear, to increase in number again at puberty. They comprise about 20 per cent of the adult testis. Testosterone output hits its maximum at about age 20, and falls off very gradually, reaching 50 per cent of its top value at 60 plus. There is a wide individual variation, however, completely unrelated to the masculine stereotype of athletic appearance. Mullerian inhibiting factor, made in the Sertoli cells of the testis, guides the formation of the testicular extras: the epididymus, seminal vesicle, and vas deferens or sperm tube, on each side.

The development of the brain and nervous system

Before and shortly after birth there is active growth and development in the brain and nervous system, divergent in the two sexes. Testosterone and its potent conversion product, dihydrotestosterone, act in the male to modify the basic female blueprint. The speech cortex in the left temporal lobe of the brain has developed by the twentieth week in the womb, and is smaller in the male. On the other hand his visuospatial cortex in the right hemisphere, concerned with assessing three-dimensional relationships, develops earlier than in the female and is more highly elaborated. Even in the pre-school stage the differing abilities of boys and girls are noticeable. Little boys of 3 or 4 show more skill and enjoyment in building with Lego and the like than little girls, but with two-dimensional jigsaws the sexes cope equally. Boys usually have better binocular vision throughout life, also relevant to constructional aptitude. The male brain, on average, is larger than the female, by about 150ml in the adult, but the cerebral circulation is faster in females and they have proportionately more grey matter. They also have more connections between the two sides of the brain, served by a larger splenium in the corpus callosum, the main bridge between the hemispheres. Because of their different and asymmetrical brain development, males tend to excel in mathematical reasoning and such skills as map-reading, while females do better in the use of words, rote learning and perceptual speed and dexterity. Differences between the sexes in interests, outlook and activities are also influenced by the sex hormones, but there is a huge learning factor which clouds the biological effects (Flor-Henry 1983). Faced with an intellectual problem or other stress, men pour out more of the activating neurotransmitters, dopamine and noradrenaline, than women. However, the actual performance in meeting the challenge is about equal. This variation in brain-chemical response between the sexes may be a matter of biology, or perhaps men are programmed by their upbringing to react energetically to problems calling for mental effort. Women might be expected, by tradition, to be alerted particularly by the cry of a child or a person in pain. It is well known that, for whatever reason, mothers – and grandmothers – wake at the sound of their baby’s cry, while fathers sleep on.

Puberty and after

No one knows precisely what sets off puberty, but it is probably a pattern of signals from various parts of the brain, impinging on the hypothalamus. At this stage it starts producing luteinizing hormone releasing factor, LHRH, for the first time. This in turn stimulates the pituitary to make luteinizing hormone, LH, and follicle-stimulating hormone, FSH, the two hormones which control the reproductive apparatus in the adult. Their effect is cyclical in the female but sustained in the male. In the testes, LH brings on the increase in testosterone-producing Leydig cells, and FSH controls sperm production. While the pituitary continues making LH and FSH from puberty lifelong, testosterone levels decline gradually from middle adulthood. From their late 50s most men notice, and often worry about, a fall-off in sexual performance. The average age for giving up intercourse is 68. Both the dramatic developments at puberty and the gentle climacteric decline depend largely on the amount of available testosterone. There is no male equivalent to the sharp cut off of fertility at the female menopause.

Between the ages of 13 and 20 testosterone stimulates the penis, scrotum and testes to enlarge eightfold. It induces the larynx to get larger and the skin all over the body to grow thicker, with increased activity of the sebaceous glands causing acne in some. The bones are considerably strengthened by the deposition of calcium salts, and there is a specific effect on the shape of the pelvis. It lengthens to a funnel with a narrowed outlet – well adapted for load-bearing. Most important in male adolescents is an increase in muscle mass to almost double, with more proteinous tissue all over the body. The musculature in the upper part of the body is much more powerful than that of the female, even if the latter is athletically trained. Because of its marked effect in building muscle, testosterone or its analogues, the anabolic steroids, are widely used by athletes to improve their performance. They are also used in a somewhat dubious way in the hope of increasing strength and vigour in elderly men. While testosterone causes a spurt in total body growth during puberty, it also encourages the closing off of the epiphyses of the long bones. The result is that the final height of a man is slightly less than it would have been had he been deprived of testosterone. Castration, an age-old method of preventing the production of male hormone, is used to make domestic animals more docile, and was used also to make me...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• 1. La difference
• 2. Biological aspects
• 3. Social and learning factors
• 4. Genetic factors
• 5. Aggression and violence
• 6. Childhood disorders
• 7. Neuroses
• 8. Eating disorders
• 9. Psychoses
• 10. Personality problems
• 11. Alcohol and drug abuse
• 12. Sexual problems
• 13. Work, family and psychosomatics
• 14. Endpiece
• References
• Index