I have been a clinician specializing in men’s mental health for more than fifty years. Professionally, the work began for me on November 21,1969 when I held my newborn son in my arms and made a vow that I would be a different kind of father than my father was able to be for me and to do everything I could to help men live fully healthy lives.
Personally, my work began much earlier. In 1949, when I was five years old, my forty-three-year-old father took an overdose of sleeping pills. He had become increasingly depressed when he couldn’t support his family doing the work he loved. Fortunately, he didn’t die but was committed to Camarillo State Mental Hospital, forty miles north of our home in Los Angeles.
I didn’t understand what happened to my father, but my uncle agreed to visit him at the hospital and my mother wanted me to go with him.
“Your father needs you,”
she told me. I didn’t understand why he was in a hospital or what I could do to help, but being a dutiful son I went with my uncle every Sunday for a year even though I was becoming increasingly frightened and confused seeing my father locked up with “crazy” people. I wrote about my experiences, my father’s deteriorating mental health, and his eventual escape in my book, My Distant Dad: Healing the Family Father Wound.
I grew up, went to college at U.C. Santa Barbara, then in 1965 was awarded full-tuition fellowship to attend medical school at U.C. San Francisco. I wanted to become a psychiatrist and help men like my father but found medical school to be too restrictive in their approach to treating patients.
I transferred to U.C. Berkeley’s School of Social Welfare and later returned to school and earned my PhD in International Health. My dissertation research was published as a book, Male vs Female Depression: Why Men Act Out and Women Act In. I have had a long and successful career thus far helping men and their families to live fully, love deeply, and make a positive difference in the world.
The field has changed a great deal since I first began my work in 1969. I was excited to learn about a new book by a colleague, Andrew P. Smiler, Clinical Work With Men: Understanding Masculinity in Psychotherapy. I recently had the opportunity to interview Dr. Smiler for my MenAlive podcast.
Clinical Work With Men is the kind of book I wish were available when my father needed help, but glad it is available now. Drawing on extensive research and clinical experience, Smiler introduces seven common masculinity types — from the breadwinner and the protector to the angry man and the player — each with its own strengths, struggles, and therapeutic applications. Through vivid clinical vignettes and actionable strategies, therapists will learn to:
- Recognize the core values and identify themes that drive male clients’ behavior;
- Build rapport by aligning therapeutic approaches with clients’ self-understandings;
- Address emotional development, social connection, and intersectional challenges and
- Apply practical interventions tailored to diverse masculinities.
Dr. Smiler is an award-winning author, therapist, and psychologist. His therapeutic practice focuses on helping teenage boys, adult men, and their families live happier, healthier, and more productive lives. He is a past president of the American Psychological Association Division 51, the Society for the Psychology of Men and Masculinities. He is also the author of several other books including Is Masculinity Toxic? A Primer for the 21st Century.
The Emerging Field of Gender-Specific Medicine
Marianne J. Legato, MD, is an internationally renowned academic, physician, author and lecturer. She pioneered the new field of gender-specific medicine. She is a Professor Emerita of Clinical Medicine at Columbia University College of Physicians & Surgeons and an Adjunct Professor of Medicine at Johns Hopkins Medical School. Dr. Legato is also the founder and director of the Foundation for Gender-Specific Medicine, which she created in 2006.
In her 2002 book, Eve’s Rib: The New Science of Gender-Specific Medicine and How It Can Save Our Life, she says,
“Until now, we’ve acted as though men and women are essentially identical except for the differences in reproductive function. In fact, information we’ve been gathering over the past ten years tells us that this is anything but true, and that everywhere we look, the two sexes are startlingly and unexpectedly different not only in their normal function but in the ways they experience illness.”
Dr. Legato is not the only clinician and researcher to take the risk to tackle sex and gender issues. There are many, including David C. Page, MD. Dr. Page is professor of biology at the Massachusetts Institute of Technology (MIT) and director of the Whitehead Institute, where he has a laboratory devoted to the study of the Y-chromosome.
“It has been said that our genomes are 99.9% identical from one person to the next,” says Dr. Page. “It turns out that this assertion is correct as long as the two individuals being compared are both men. It’s also correct if the two individuals being compared are both women. However, if you compare the genome of a man with the genome of a woman, you’ll find that they are only 98.5% identical. In other words, the genetic difference between a man and a woman are 15 times greater than the genetic difference between two men or between two women.”
In looking ahead to the future of gender-specific healthcare, Dr. Paige is hopeful.
“Here’s what I think. We need to build a better tool kit for researchers that is XX and XY informed rather than our current gender-neutral stance. We need a tool kit that recognizes the fundamental difference on a cellular, organ, system, and person level between XY and XX. I believe that if we do this, we will arrive at a fundamentally new paradigm for understanding and treating human disease.”
One of the most innovative and effective programs in this emerging field is Man Therapy, led by Joe Conrad.
“Man Therapy was launched in 2010,” says Conrad. “We realized early on that if we waited until men were in crisis, we would be too late. From the beginning, our team set three goals for Man Therapy:
1) Break through the stigma surrounding mental health by making it approachable.
2) Encourage help-seeking behavior.
3) Reduce suicidal ideation.
“Through research, men told us to just give them the information they needed to fix themselves, so we built a website that provides a broad range of information, resources, and tools to do just that. It is extremely rewarding to know that we are accomplishing our goal of positively impacting and changing men’s lives.”
Another important program is the American Institute for Boys and Men (AIBM) founded by Richard V. Reeves, author of the book Of Boys and Men: Why the Modern Male is Struggling, Why It Matters, and What to Do About It. One of the chapters in the book, and a focus of the work of AIBM, is titled “Men Can Heal: Getting Men into Jobs of the Future.”
Reeves notes there has been great success getting more women into STEM (Science, Technology, Engineering, and Mathematics) professions. Now we need to get more men into HEAL (Health, Education, Administration, and Literacy) professions. Given the challenges facing men today, there is a great need to get more men trained to work in the field of men’s mental, emotional, and relational health.
Dr. Smiler Offers Help For Men and Their Families Now
Following our interview Dr. Smiler offering some concluding remarks about what he hopes other therapists will learn when they read the book.
“I want to expand how you think about men and masculinity and help you move away from cultural stereotypes so you can meet your male clients where they are and recognize the positive and negative components of their masculinity.”
Dr. Smiler offers therapy and coaching services as well as workshops. He offers practical problem-solving for men and those who support them.
“Whether you’re a guy looking to improve your own life or you’re a concerned parent, teacher, or coach — creation starts here,” says Dr. Smiler.
You can learn more about Dr. Andrew P. Smiler and his work here:
You can watch our full interview here.
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