Under normal circumstances—e.g. in a time when the American Psychological Association (APA) has not released guidelines questioning whether norms associated with “traditional masculinity” (e.g. stoicism) are harmful to the mental health of men, and a shaving commercial is not being run that criticizes “toxic masculinity”—I would be reluctant to publicly share a story of personal adversity that, as a sometime aficionado of existentialist philosophy, I know I must ultimately face alone.
But in the spirit of opening up, here goes.
I have brain cancer. Not the kind that killed John McCain, Ted Kennedy, or Beau Biden. At least not yet. I am afflicted with a low-grade glioma (specifically, a grade-2 infiltrative astrocytoma). My neurosurgeon informs me that experts do not distinguish between benign and malignant brain tumors. Instead, they distinguish between low-grade and high-grade tumors, the point being that all brain tumors naturally progress to death. There is no cure. High-grade simply gets you there faster. In the words of one study, “all low grade gliomas eventually progress to high grade glioma and death.” In short, barring some unforeseen circumstance like a plane crash or another mortal illness, I will die of brain cancer. It’s only a matter of time, unless researchers suddenly discover a cure. It could be one year. Two years. Five years. Twenty years. But according to this study, the average life span of someone with a low-grade glioma is seven years.
Of course, few people know when they are going to die. But for many, a diagnosis of brain cancer understandably comes as a devastating shock. A gut punch, a first step on a long walk into deep, dark depression. In this predicament, good news is learning that you have a few more years to live, not that you have been cured. News like this is not easy to live with. It does have the advantage of forcing you to take stock of your life and not waste time. But it comes with the overriding disadvantage that death is ever present in your mind. You know it’s coming. It’s no longer an abstraction lurking somewhere in the far-off future. It’s real, and it’s coming sooner than you’d like.
Yet, when I first received the call from the neurologist, my immediate reaction was to congratulate her. A few months earlier, I went into the emergency room with flu-like symptoms and seizure-like spasms. A CT scan revealed a lesion in my brain. The doctors diagnosed it as an “old stroke” but they could not figure out why a man under 40 with low blood pressure and low cholesterol, who had no loss of speech and full muscular control over both sides of his body, had suffered a stroke. Several tests revealed inconclusive results. I went to see a second neurologist a few weeks later. She also ordered a battery of tests that revealed inconclusive results. Perplexed, she suggested that I get regular MRIs to monitor my brain and be on the lookout for any developments.
When the results from the first MRI came in, she was able to determine, after consulting with the radiologist, that the lesion was a low-grade brain tumor. She called me immediately, only an hour or two after the MRI, leaving an urgent message on my voicemail, telling me to interrupt any meeting she was in. I called back when I got to work and settled into my seat. The receptionist connected me.
“Make sure you’re sitting down for this,” she said, and informed me that I had a brain tumor.
I received the news calmly. I felt no panic.
“Congratulations,” I said. After months of inconclusive tests, she had figured out the cause of the lesion.
I subsequently saw a neurosurgeon at Johns Hopkins Hospital. Two weeks later, I went under the knife and was fortunate to undergo a successful surgery. By successful, however, I mean the surgeon achieved a “nearly full” resection. That is, he got as much of it as he could. As noted, the specific tumor was diagnosed as a grade 2 infiltrative astrocytoma, meaning that the cancerous cells have long synaptic connections that extend into healthy tissue. As the neuro-oncologist informed me during a post-surgical consultation about a month or so later, it’s impossible to remove every cancerous cell.
Now I go in for a routine MRI every three months. The first MRI revealed an area of hyper-intensity that was concerning, but a subsequent MRI two months later revealed that nothing had changed. I’m okay for now. I await the next MRI.
* * *
During this ordeal, not once have I cried. Not once have I felt depressed, anxious, or out of sorts. Not once have I felt a need to seek therapeutic help. On the morning of surgery, I worried more about losing cognitive abilities if the surgery went awry than I did about death. One of my sisters commented that I was so calm she thought the doctors must have given me a Valium. I was, in a word, stoic. I think about Hamlet in Act 5, exhibiting a quietist, contemplative air, inclined to philosophize with a gravedigger and marvel at poor Yorick’s skull as the gravedigger breezily went about his morbid business. Indeed, a friend from high school, now a professional psychiatrist who I had dinner with two nights before my surgery, remarked how impressed he was with my “anxiety management” and “philosophical” attitude.
In sum, I confronted adversity with the kind of attitude that now seems to have come under scrutiny, even criticism, in the APA’s new guidance document, which cites research suggesting that “the study of men need[s] the same gender-aware approach” that has been applied to the study of women, and that “[t]he main thrust of the subsequent research is that traditional masculinity—marked by stoicism, competitiveness, dominance and aggression—is, on the whole, harmful.”
As a former undergraduate philosophy major, I have studied my fair share of Freud, whose theory of psychoanalysis, according to Harvard psychologist Steven Pinker, is partly responsible for the “folk theory” that repressing emotions is bad and expressing them is good, one of the two “dogmas” Pinker identifies as underlying the new APA guidelines. As a professional economist and CFA charter-holder, I have also studied my fair share of behavioral economics, which has fruitfully incorporated insights from psychology into the study of economic decision-making. Nonetheless, I am not a psychologist. Thus, it is not my place to provide a professional assessment of the state of psychological research on “traditional” masculinity.
Yet I find myself disheartened by this new APA report. As one Twitter thread argued, the report implies: “Biology doesn’t matter. Neuroscience doesn’t matter. Thousands of years of evolution doesn’t matter. Everything gets reduced down to gender ideology: Power, privilege, & sexism. These are the defining problems of men, especially traditional men.” Indeed, social justice ideology infuses the report. Aside from using typical social justice buzzwords such as privilege, oppression, cisgender, gender bias, patriarchal, heteronormative, intersectionality, and micro-aggressions, it begins by noting that “[i]n the past 30 years, researchers and theorists have placed greater emphasis on ecological and sociological factors influencing the psychology of boys and men, culminating in what has been termed the New Psychology of Men,” so that, for example, “socialization for conforming to traditional masculinity ideology has been shown to limit males’ psychological development, constrain their behavior, result in gender role strain and gender role conflict.” The very first guideline leads with the headline: “Psychologists strive to recognize that masculinities are constructed based on social, cultural, and contextual norms.”
The guidelines do acknowledge that they “may not be applicable to every professional and clinical situation” and that they “are not definitive and are designed to respect the decision-making judgment of individual professional psychologists.” Nonetheless, I worry that the social justice movement has imbued “traditional” masculinity with an ideological taint that focuses on social-cultural-historical “constructs” as sources of oppression and marginalization (as the Catholic school kids from Covington, Kentucky learned this past weekend).
But when I think about how I have managed to develop a healthy perspective about brain cancer, which has helped me continue to live a happy and productive life and not succumb to anxiety and depression, I have stoicism to thank. I touched on this before in an essay on why I am a man who chooses not to cry. I argued that emotional restraint is not the same as emotional repression, a distinction that seems lost in the emergence of “toxic masculinity” as a prominent theme in the culture wars of the 21st century (as we see in the controversial Gillette commercial and the new APA guidelines, but also in social media memes, in therapy sessions, in lecture halls, in university seminars and workshops, and in a freshmen orientation session at Gettysburg College).
Loosely speaking, “toxic masculinity” refers to a specific assortment of conventional attitudes, behaviors, and taboos associated with masculinity that are deemed toxic to the relations between men and women, and also detrimental to the mental health of men. But as with many ideas that gain traction in the social justice movement, “toxic masculinity” can be hard to define, particularly as the notion gets commandeered by new-wave feminist movements. Its definition can vary depending on the purpose or agenda it serves (even origins can be hard to trace—did it originate as part of a men’s organization modeled on the 12-step programs of Alcoholics Anonymous or as part of the Mythopoetic Men’s Movement?). But without encountering too much disagreement, one can begin by defining it as an outward display of competitiveness and aggressiveness in male social behavior that goes beyond healthy competition and assertiveness, and that such cutthroat aggression stems from emotional repression.
Indeed, the APA’s guidelines explicitly associate “traditional masculinity” with stoicism, competitiveness, dominance and aggression. But is emotional restraint toxic? Not necessarily. The Stoic philosophers of ancient Greece equated virtue with a mastery of emotion in the belief that passions cloud reason and undermine the mind’s pursuit of logos, or universal reason. For the Stoics, a good life is inseparable from a vigorous and successful effort to restrain the play of emotions. Self-control is fundamental to happiness, where happiness is a kind of equanimity in the face of life’s adversities. This is not unlike the ethical view of 17th-century Dutch philosopher Baruch Spinoza, who argued for a conception of human happiness that depends crucially on the restraint of emotion (properly conceived). But there was nothing inherently male-centric in the Greek Stoics and Spinoza’s ethics. Though they lived in male-centered societies, one would be hard-pressed to argue that stoic equanimity is a virtue that is only available to men.
* * *
In my essay on choosing not to cry, I point out that the Gettysburg College orientation session treats freshmen to a documentary titled ‘The Mask You Live In.’ A trailer for the documentary begins with former coach and NFL football player Joe Ehrman saying that the “three most destructive words that every man receives when he is a boy is when he’s told to be a man.” In sketching out what it means to “be a man” in our culture, the trailer shows a clip from an interview in which a boy says that “if you never cry, then you have all these feelings stuffed up inside of you and then you can’t get them out.” The trailer immediately cuts to a segment in which a psychologist and educator named Dr. Niobe Way claims that boys have “bought into a culture” that doesn’t value certain behaviors because they have been “feminized,” and that a culture that doesn’t value relationships, empathy, or caring will generate a society of boys and girls who go “crazy.”
Her comments are interspersed with headlines of stories about acts of homophobia and bullying, as if to imply that the alleged disparagement of “feminized” behaviors like empathy and caring directly leads to destructive social outcomes. The video cuts to segments in which boys talk about being prone to violence or suicide because of unresolved anger issues. In their telling, to “man up” and not cry, or even to not talk about emotions, is regarded as harmful and contributes to a host of social problems like suicide and homicide. In short, to “be a man” in our culture is to be a victim of “toxic masculinity,” and none of it is good for men or society.
But if a boy does cry, is he less likely to get into trouble later in life? Is he less prone to depression or suicide? Of course not. There are multiple factors in the long causal chain that can lead to a dysfunctional life. These factors depend on the specific genetic endowments, personalities, and environmental circumstances of each individual man. Dysfunction is a feature of both sex (the biological reality of being born a male) and gender (cultural attitudes about what it means to be a man). It also reflects the relentless interplay between genetic predispositions and social, cultural, political, and economic influences. For example, as I have written about here, here, and here, the last half-century has seen a material decline in labor force participation by prime-age men, which raises an important question of whether the declining mental health of males in the 21st century is a function of “toxic masculinity” or larger economic forces.
The point remains, however, that crying does not eliminate a congenital reticence or moodiness that may be molded and reinforced by an unstable upbringing (or structural changes in the economy). Moreover, trying to alter a congenital reticence may hinder an introverted boy’s quest to discover and accept who he is, or inadvertently cast a value judgment on the more laconic culture of a place like New England. In each case, a boy who is less inclined to be emotionally expressive may be made to feel guilty when instead he should be proud of his biological or cultural identity. It is possible that some boys conditioned by congenital introversion or a more reserved culture may benefit from intervention by mental health professionals who may encourage more emotional expression. But it does not necessarily follow that these boys have been conditioned to devalue emotional expression because they have been exposed to a masculine social construct. Some boys are reticent by nature, and some cultures may not be as expressive as others. Tolerance for emotional expression should not be accompanied by intolerance for emotional restraint.
As a man who believes wholeheartedly that mental health is a serious and under-appreciated discipline, I fully support the effort of any man, or woman, to come to terms with anxieties, complexes, traumas, and other emotional vulnerabilities, either with family, friends, or mental health professionals. At the same time, I would emphasize again that restraining emotion is not the same as repressing emotion.
Like the Stoics or Spinoza, I view the passions as a distraction from the rational quest for equanimity in the face of life’s adversities. In my experience, I feel worse after crying. The same hardships remain. Crying amounts to little more than a stormy emotional interlude that delays resolution of a conflict. The emotions pour out in a massive heap of confusion without the pilot of a rational mind to steer the ship and point in the direction of clarity and understanding. I think it’s possible that a social stigma against crying can give rise to emotional repression, and that may undermine some men’s psychological health. However, I also think it’s possible that crying can be as traumatic for some as it may be cathartic for others. Telling one man it’s okay to cry may make him feel better, but telling another may make him feel worse.
The APA’s new guidelines claim that “traditional masculinity ideology discourages men from being intimate with others and is the primary reason men tend to have fewer close friends than women.” This is news to me as someone who can count about a dozen “close friends.” All of those friends, and others, offered a great deal of emotional support when they learned I had brain cancer. But I invariably told them not to worry. For me, a healthy and happy life is one of emotional restraint in the face of life’s adversities. Dealing with brain cancer has been no different.
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