Читать книгу Hard to Love - Joseph Nowinski - Страница 14
ОглавлениеMBPD: Misunderstood, Mistreated, Men
Imagine that you are a therapist and I refer a client to you using the following brief description:
Dear Dr. Jones:
Thank you for agreeing to meet with Chris, who is thirty years old. Chris currently works full-time as a graphic designer while also taking graduate courses evenings and weekends toward an advanced degree, and hopes to eventually secure a teaching position in a community college.
Chris reports a history of severe difficulty in relationships, specifically feeling “let down” and “taken advantage of” on several occasions. Chris also reports some trouble controlling emotions and apparently can “swing” from intense depression to intense anger rather quickly. This also often happens in the context of relationship conflict. As a teen, Chris reports having engaged in some minor “cutting” behavior when stressed, though this stopped a few years ago. Since then, however, Chris admits to drinking heavily when under stress or when feeling depressed. Chris was prescribed an antidepressant one year ago and though the medication is taken as prescribed, Chris does not feel that it has helped much. Accordingly, I am referring Chris for counseling with you.
What is your first impression: Is “Chris,” as described in the above “referral”:
• A thirty-year-old woman, or
• A thirty-year-old man?
Take a moment to read the following:
I have long wondered what was wrong with me. I have intense emotional swings where I can go from being angry to almost giddy in a flash, or else fall into a deep depression. I can’t seem to tell what triggers these mood swings, though they sometimes seem to control my life and cause a lot of trouble for me in relationships.
I am sensitive and creative, and I’ve always worn my feelings on my sleeve, as they say. I cry easily, both in joy and sadness, and also have these weird episodes of anger. I’ve been told I am thin-skinned and often take words or feelings personally that others say aren’t intended that way.
What do you think? Is this a woman or a man describing him- or herself?
The overwhelming majority of people who read these statements tend to believe they were penned by a woman who is describing herself. In fact, they are the statements made by a man.
In the case of the imaginary referral above, this same bias emerged when a group of fifty-two professionals working in a mental health agency in California were asked to make a provisional diagnosis of a patient—identified as either male or female—based on a description of his or her symptoms. These professionals were unable to accurately diagnose the presence of Borderline Personality Disorder in men despite the fact that the symptoms were exactly the same in the two descriptions. In other words, these clinicians, as experienced and well trained as they may have been, were essentially “color blind” when it came to seeing BPD in men versus women.
What is the source of this bias, and why is it important?
Buying into Sexual Stereotypes: Tomboys and Sissies
The bias that leads people to think that the previous examples describe a woman instead of a man have their roots in the sexual stereotypes that were the subject of the last chapter, namely the idea that boys (and men) are inherently rugged and resilient, whereas girls (and women) are inherently delicate and sensitive. One doesn’t have to look far to find visual and written reflections of these stereotypes. They are conjured, for example, in the “reality” television series about men who make a living catching alligators with their bare hands from a rowboat, or by mining in the harshest reaches of the earth, or by shouting abuse at employees of their restaurant kitchens. We see this type in television ads for trucks and in movie characters such as Iron Man or The Incredible Hulk (who has a stereotypically “male” way of expressing anger)—“Hulk smash!” Even the socially prominent CEO in his custom suit lords it over his workers, and relishes snapping out, “You’re fired!” without a trace of sensitivity. These men, society seems to say, are “real men.”
Traditionally, female characters were not allowed to exhibit behaviors like the above and still be considered “real women.” Instead, they were portrayed as the “hooker with the heart of gold” as in Pretty Woman, or the “manic pixie dream girl,” as bubbly, eccentric, and elusive as Holly Golightly in Breakfast at Tiffany’s, or as the nurturing and motherly Mrs. Weasley of Harry Potter fame.
Our culture is beginning, though, to accept more active, competitive, and “tough” female characters. In recent years images of strong and resilient women have increasingly appeared. Consider, for instance, Ellen Ripley in the Alien films, Lisbeth Salander in the book/film The Girl with the Dragon Tattoo, or the youthful heroine Katniss Everdeen in the book/film Hunger Games. Similarly, women’s competitive sports are increasingly evident on television. Although it is safe to say that even today, women athletes are presented as less aggressive than, say, male football players. Women basketball and tennis players are just as competitive as their male counterparts, but are still frequently the subject of attention as much for their appearance and personalities as for their aggressiveness.
Generally, though, women today seem to have a larger variety of models to follow, and more types of ways to be a “real woman.” But men, by and large, still have only the “silent” or “violent” stereotypes on which to model themselves.
Is there a kernel of truth in sexual stereotypes? Perhaps. Statistically, men do commit crimes of violence much more frequently than women do. And men do occupy professions that require sheer physical strength in significantly larger numbers than women do. On the other hand, when a recent candidate for the US presidency voiced the opinion that women ought not to be placed in direct combat duty positions in the military he was roundly criticized. In reality, women do occupy combat positions in the military, and women can act as aggressively as men in that position. So attitudes, at least, are changing. That said, there remains a good deal of deep-seated cultural bias about the way men and women should be.
And both men and women are inclined to buy into stereotypes about how they ought to be. Evidence of this attitude can be found in how our culture reacts to those whose behavior and temperament differ from these stereotypical expectations. As mentioned earlier, the term “tomboy” has long been used to refer to girls who, unlike so-called “princesses,” or “girly girls,” are inclined to wear rough-and-tumble clothing and engage in rough-and-tumble activities. Tomboys, like their biological boy counterparts, are more likely to be interested in climbing trees or playing contact sports than experimenting with make-up or playing with dolls. Tomboys, however, are much more accepted in society than their male equivalents: “sissies.”
The man who wrote the statements describing himself as someone who is sensitive and who cries easily is susceptible to being labeled a sissy. He is also susceptible to thinking of himself that way. And whereas there is relatively little shame in a girl being labeled a tomboy, especially in today’s society, there is not yet equivalent acceptance for the boy who is labeled a sissy.
The reality of our lives is that while society is becoming more open and accepting of all kinds of differences, change happens slowly. And like it or not, gender stereotypes do persist.
Without fear of judgment, what do you think your reaction would be if you were a boy (or a man) whose personality included traits associated with being “sensitive,” “thin-skinned,” and “emotional.” Would you be inclined to be proud of that? Or would you have mixed emotions about it? Might you even be a little embarrassed or ashamed about it? Most men I ask this question of respond that at best they would have mixed feelings about describing themselves that way, and some would actually be ashamed to be described that way. Yet those traits are characteristic of what it means to have MBPD. The man who wrote the statements cited previously was therefore actually very brave to do so.
Why Men Don’t Seek Help
You’ve probably heard of cultures in which the concept of “face” is important, and in particular, the need to “save face.” Saving face refers to the need to preserve and present a certain image to others (and also to one’s self). For most men this means presenting a “face” that includes the following traits:
• Ruggedness: The opposite of being “sensitive” or “thin-skinned.”
• Resilience: The ability to withstand stress without breaking down.
• Aggressiveness: The ability and willingness to use aggression to defend one’s self as well as to be competitive in pursuing a goal.
• Independence: The idea of being self-sufficient, the so-called “captain of my ship.”
Men vary with respect to just how much they feel a need to present themselves to others as well as to think of themselves in these terms. By the same token most men feel at least some need to present this type of “face” to the world and to see that “face” when they look in the mirror. Simply put, trying to live up to expectations and save face as a man is why men in general are much less willing to reach out for help—or admit that they need it—than are women. This accounts for such seemingly self-defeating “male behavior” as refusing to stop and ask for directions when they are driving and as a result ending up getting lost. Asking for directions would mean “losing face” for many men—so, they’d rather push on, finding their way through trial and error. This has infuriated millions of women. For these men (and lots of women) the invention of the Global Positioning System, or GPS, has been a gift from Heaven. The GPS allows men to find their destination without ever having to admit that they might be lost.
If men are reluctant to admit they are lost while driving, imagine how difficult it might be for them to admit that they might feel lost emotionally—out of control, emotionally “sensitive,” or “thin-skinned.” And now imagine how much harder it could be to admit that they have a flaw in their personality that is standing in the way of their ability to lead a fulfilling life.
Actually, it is not necessary to imagine how difficult it is, as research has demonstrated repeatedly that men are in fact more reluctant than women to seek help for emotional problems such as anxiety or depression. They also tend to strongly resist their partners’ suggestions that they go for couple’s counseling when their relationships are in crisis. As noted earlier, bouts of “free-floating anxiety” as well as depression are common among men who, as boys, experienced significant abuse, neglect, or rejection. And again, if men are reluctant to admit to and seek help for anxiety, depression, or relationship problems, imagine how resistant they could be to seeking help for a “personality disorder.”
The unvarnished truth, then, is that men themselves actually contribute to the fact that MBPD is under-diagnosed, by virtue of their reluctance to admit to the exact symptoms that are associated with it, as well as their reluctance to seek help in general, for fear of losing face.
A Typical Case
Zack, now twenty-five, had never liked school much and had dropped out at the start of his senior high school year. Back then he’d had a small circle of friends with whom he mostly just hung out and smoked pot. In the summer months they would meet at a secluded clearing in the town park that was well known to other teens as a spot to get high. When the weather turned cold the small group would gravitate toward a detached garage that was adjacent to one of the boys’ homes. According to Zack they did not interact. Rather, they literally just “hung out” together, the cannabis making them feel mellow. None of them did well in school, and only one member of this group actually graduated.
