Britain’s National Men’s Health Week in June 2006 kicked off in London with the opening of the ‘Dick Monologues’, a show in which ‘men were invited to stand up and discuss their relationship with their penis and anything else that springs to mind – including mental health issues and what has worked for them’.[1] Like most activities of the men’s health movement, this one self-consciously apes earlier feminist initiatives, in this case Eve Ensler’s ‘Vagina Monologues’, which started as an off-Broadway show in 1998 and became an international hit. Though the Vagina Monologues was presented as a subversive assertion of female sexuality, its focus on the vagina implied a celebration of passive/receptive heterosexual intercourse, whereas an earlier generation of feminists had claimed the clitoris as the site of active, polymorphous, female pleasure. By contrast, the Dick Monologues had no subversive ambitions of any kind, giving the male sexual organ a diminutive boy’s name (like Willy) as an inoffensive claim on some of the public attention being received by its female counterpart.

What a contrast between the image of the penis in the world of heavy metal ‘cock rock’ in the 1970s and that presented in the Dick Monologues thirty years later. The extravagantly phallic symbolism of the electric guitar, the spandex costumes with codpieces and all the macho posturing projected a crass but confident male sexuality, celebrated in numerous groupie memoirs. By the 1990s, the priapic penis had been displaced in the public realm by the image of a detumescent organ that could only overcome ‘erectile dysfunction’ through a series of medical interventions, culminating in sildenafil, marketed as Viagra in 1998.

Men attending the Dick Monologues were invited to discuss their penises – together with ‘mental health issues’. Though this link between the male organ and psychiatric illness may seem curious, even anachronistic (redolent of nineteenth century theories linking female hysteria and the womb), it arises from the commitment of the Men’s Health Forum, official sponsor of National Men’s Health Week, to the theme of men’s mental health. As is now de rigeur in the world of health promotion, the forum commissioned a survey to reveal the extent of the problem of male mental health. Reflecting the forum’s desperate need to attract media attention, the findings were shocking. It discovered that 76 per cent of men had experienced depression and anxiety (see Fitzpatrick 18.2.2003) and ‘18 million men have mental health problems’ (Men’s Health Forum 12.6.2006). One response to this finding might be to say that if nearly everybody is mentally ill, then this should be regarded as the normal state of affairs and we should simply accept that we are all a bit mad. Of course, this is not the response of the Men’s Health Forum, which believes that this catastrophic level of mental illness requires major shifts in public policy and widespread professional therapeutic intervention.

The men’s health movement emerged in the 1990s to promote greater awareness of health issues among men, along the lines pioneered by earlier campaigns among women.

In the early 1970s the women’s health movement criticised medical intervention in women’s lives as paternalistic and patronising and particularly questioned doctors’ control over pregnancy and childbirth, contraception and abortion (Fitzpatrick 2001: 135). The Boston Women’s Health Collective handbook Our Bodies, Ourselves (1972) rapidly made an international impact.[2] A Women’s Health Handbook, subtitled ‘a self-help guide’, inspired by the Boston group, was published in Britain in 1976. These guides included detailed advice on ‘self-examination’ (including the use of the vaginal speculum) and information about a wide range of women’s health problems.

By the 1980s, the radical impulse of women’s liberation – together with that of other oppositional movements – had passed, and the women’s health movement was rapidly assimilated into the medical mainstream. What started out as a challenge to medical authority over women contributed to the evolution of a more comprehensive system for the regulation of women’s lives. This was most apparent in the promotion of screening tests such as cervical smears and mammography, despite increasing expert doubts about the efficacy of such investigations and growing concerns about their adverse effects. Whereas in the 1970s feminists had condemned the ‘medicalisation’ of women’s lives, a decade later activists were likely to demand more medical intervention.

In the course of the 1990s, women’s health campaigns gathered momentum, particularly around the promotion of greater awareness of breast cancer. In sympathy with the wider promotion of ‘healthy lifestyles’, these campaigns sought to encourage women to renounce cigarettes and alcohol and to take more exercise and eat more fruit and vegetables. However, activists baulked at promoting the only lifestyle factors even remotely linked to breast cancer – early childbearing and prolonged breast-feeding. Another important theme, again common to wider health promotion campaigns, was to encourage women to seek professional help and guidance – even if only to allay anxieties generated by the breast awareness campaigns (which had a disproportionate impact on younger women at lowest risk of cancer).

By the early 2000s, the women’s health movement had moved far from its feminist roots. Whereas campaigners in the 1970s had repudiated traditional feminine stereotypes, even to the extent of adopting masculinist postures and forms of dress, their daughters self-consciously embraced images of vulnerability and victimhood.

Lacking any radical impulse from the outset, the men’s health activists have taken the degraded end product of the women’s health movement as their model. Far from challenging medical authority, they urge men to submit themselves to it on a greater scale than ever before.

The parallel between screening tests for cervical and prostatic cancer is richly symbolic. Just as the smear test exposes women not merely to the medical gaze, but also to vaginal penetration, so the palpation of the prostate involves digital penetration of the male rectum. The slippery finger may be less impressive than the speculum, but it is no less significant as an instrument of symbolic domination. It is striking that long after medical authorities have accepted the uselessness of both breast and testicular self-examination, the men’s health movement and the popular health magazines continue to promote them.

In early 2006 a new study was widely reported showing that the Prostate Specific Antigen test (PSA) – the most widely used screening test for prostate cancer – does not contribute to an increased life expectancy in men who have it (Concato et al 2006). This study simply confirmed the results of numerous similar studies over the previous decade. Despite all the evidence against using PSA as a screening test and the reservations of all the official screening bodies, men are still asking for PSA tests – and the men’s health movement is still encouraging them to do so. The extent of popular approval of all these techniques – out of all proportion to any value they might have in reducing the impact of cancer – is a potent indicator of modern society’s pathological preoccupation with health.

Why are people so willing to subject themselves to a screening test that offers scant benefits yet carries significant risks of harm?

One factor in the popularity of PSA testing is that it is backed by powerful commercial forces which assiduously promote its benefits, particularly in the USA. The drug companies are skilful in using celebrity sponsorship and providing human interest stories for newspapers and television stations which have an insatiable appetite for disease, particularly cancer. Though there is an expert consensus against comprehensive screening for prostate cancer, some prominent urologists and oncologists with links to pharmaceutical companies and advocacy organisations continue to support PSA testing.

Yet neither commercial nor medical influences can explain the dramatic rise in the demand for PSA testing in recent years. Both these factors are relatively weaker in the UK than in the USA, yet British men are flocking in for PSA tests. To explain why men have responded with such enthusiasm to the promotion of screening tests we have to turn to the changing attitudes towards health and disease in society in general, and among men in particular.

To any individual worried about their health, the great attraction of screening tests is the promise ‘early detection-better outcome’. This has a great commonsensical appeal, reflected in popular convictions such as that ‘if only he had reported those symptoms earlier, he would be still alive today’. Unfortunately, in relation to prostate cancer, there is little evidence to support this conviction, or the associated notion that picking up the disease through a screening test even before symptoms are apparent guarantees an even better prognosis. The real problems of prostate cancer are that its natural course is not well understood and that no current form of treatment has been shown to prolong life. One of the options recommended by oncologists is ‘watchful waiting’ – that is to defer treatment of uncertain value and wait to see how the disease evolves. Though this course of action involves the least risk of adverse side-effects (such as incontinence and impotence), it still carries the curse of increased cancer awareness, brought home by a raised PSA result. You will not live any longer, or any healthier, but under a cloud of fear of the future.

Individual attitudes towards cancer screening are powerfully influenced by the contemporary cultural climate in which cancer awareness campaigns have acquired a prominent position. These campaigns seem to have taken the place of the protest movements of the past: instead of demonstrating against unemployment or war, people now march to raise awareness of disease. These campaigns provide role models of ‘survivors’ – distinguished by their commitment to ‘fighting’ cancer, in relation to their own condition, and in overcoming public ignorance about the condition. The identity of ‘cancer survivor’ echoes that of political militant, though this new identity is conferred by a biological misfortune rather than a process of personal and political development. Activist survivors are among the most enthusiastic promoters of screening tests, offering their personal experience as a vindication of the procedure.

If the campaign against prostate cancer offers men new identities as cancer victims/survivors, the wider men’s health movement provides a range of negative judgements on traditional ‘hegemonic’ masculinity (Lee & Frayn forthcoming). Once associated with positive images of strength, assertiveness and competitiveness, stoicism, altruism and patriotism, masculinity is now depicted as a danger to health and as a cause of premature death. The old spirit of independence, risk-taking, and emotional containment is condemned as a state of denial, as men are criticised for not seeking regular professional assessment of their physical and psychological health. In short, the men’s health movement seeks to pathologise masculinity and to medicalise men’s lives (Rosenfeld & Faircloth 2006).

Will the cultivation of a ‘new man’, moulded on the stereotypical ‘old woman’ – cautious and conservative, passive and self-effacing, mild-mannered and deferential – result in better health and longer life expectancy among men? The one firmly established link between lifestyle and health is that between smoking and lung cancer, yet, whereas rates of smoking among men have steadily declined, those among women have fallen more slowly and, among young women, have even increased. It is doubtful whether exhorting men to behave more like women is likely to achieve significant changes in their lifestyles.

The area of mental health – the main focus of the 2006 Men’s Health Week – seems least likely to yield benefits. The inflation of psychiatric diagnosis reflected in the survey quoted above encourages men to redefine their experiences of loss and disappointment in terms of mental health labels. This is likely to result in more and more men regarding themselves as suffering from mental illness and undergoing various forms of treatment, all of uncertain efficacy. This is more likely to undermine individuals’ capacity to deal with their own problems of life in their own ways, through their own informal networks.

The danger of the men’s health project is that, in disparaging masculinity, it risks endorsing a wider diminution of human subjectivity. There can be little doubt that the cultivation of a caricatured form of masculinity, manifested in boorishness and insensitivity and in destructive behaviours, carries both individual and social costs. Yet the values of individual autonomy and responsibility are vital to both personal and social development, to health and welfare in the widest sense. Even more importantly, the self-determining citizen is the foundation of a democratic society. If men and women are reduced to the status of enfeebled clients of the therapeutic state, then we are no longer capable of deciding our own destiny, in either personal or social terms.

This is an edited version of a longer article entitled, ‘The Men’s Health Movement: A Morbid Symptom’, in The Journal of Men’s Health & Gender

Reference: JMHG286

The full article is available online via the following DOI link:
http://dx.doi.org/10.1016/j.jmhg.2006.07.001

[1] Men’s Health Forum, Dick Monologues. See http://www.menshealthforum.org.uk/userpage1.cfm?item_id=1849#se

[2] See also the latest edition (Boston Women’s Health Book Collective 2005)

BostonWomen’s Health Book Collective (2005). Our Bodies, Ourselves: a new edition for a new era. Boston, Boston Women’s Health Book Collective.

Concato, J. et al (2006). The effectiveness of screening for prostate cancer. Archives of Internal Medicine 166: 38-43.

Ehrenreich, B. (2001). ‘Welcome to Cancerland: A mammogram leads to a cult of pink kitsch’. Harper’s Magazine. November 2001.

Fitzpatrick, M. (18.2.2003). Therapeutic pi. spiked.

Fitzpatrick, M. (2001). The Tyranny of Health: Doctors and the Regulation of Lifestyle. London, Routledge.

Holland, W.W. & S. Stewart (2005). Screening in Disease Prevention: what works? Nuffield Trust/European Observatory on Health Systems and Policies, Radcliffe Press.

Lee, E. & E. Frayn, (forthcoming). ‘The “feminization” of health’. D. Wainwright (ed) A New Sociology of Health. London, Sage.

Men’s Health Forum (12.6.2006). 18 million men have mental health problems. Men’s Health Forum.

Rosenfeld, D. & C. Faircloth (2006). Medicalised Masculinities. Philadelphia, Temple University Press.