Without warning the rope snapped; weakened by old age and weathering. John, one moment laughing as he swung out over the undergrowth was the next uttering a surprised cry as his body fell heavily to the ground. He slithered down the steep, dry slope, rolling uncontrollably, and crashed into the bushes at the bottom.
The rest of us stood stunned as the dust settled. Moments before, we had been walking through the summer woods talking about how men tended to ignore warnings from their bodies, laugh off their injuries and disregard their health. This rope, hanging from a tree, seemed a happy diversion.
We scrambled down to where John was stirring, pulling sticks from his hair. We picked him up, and dusted him down. 'I'm fine, I'm OK', he kept repeating, laughing off his injuries, 'I'm just winded, that's all.'
Talking it over later, John admitted that he had actually knocked his head quite badly, but felt unable to say anything at the time - his energies went into denying that anything was wrong, to dismissing what had happened as trivial, and getting back to what we had been doing.
Could this culture-borne technique of denying injury explain the abnormally low uptake of healthcare amongst men? Roger, a GP of some 18 years who is interested in men's health issues finds two thirds of his patients are women. 'That's the experience of a majority of GPs, not just me,' he comments, 'but apart from the complications of childbirth and the drop in hormones associated with the menopause, women are no more prone to illnesses than men.'
So why are there not more of them in the waiting room, and why do they often appear to have come unwillingly, brought if not by their physical incapacity then by something or somebody else? By the 'Stop, in the Name of Love' television advert for instance, or their partners. "My wife thought I ought to come", Roger reports some as saying. 'Sometimes the wife comes in: "I dragged him along" she says, and you get this very reluctant man coming in and looking at the floor.'
Perhaps women, who still do most of the childcare, will be at the surgery more frequently, and while they are there, suggests Roger, 'they are more liable to talk to the doctor about their backache, whereas a man, because he hasn't got to go to the surgery with the child, may ignore the backache.'
What is it about men that makes us, as a group, so reluctant to deal with our health until it begins to becomes a major inconvenience to our everyday lives? I talked to some men about their own experiences and feelings surrounding health, healthcare, and their relationships with doctors. What, I asked first, was this 'thing' called 'health'?
Geoff lives with his partner and their two children under six. He spends a couple of days a week in three part-time jobs. 'Health isn't something that you really think about until you are ill,' he said, 'and then you try and forget about it as quickly as possible.'
This is a common observation and is echoed by Tony who is 28 and spends time childminding and giving massage and is involved in setting up a men's housing co-op. 'Health is something I've taken for granted a lot. I never think of feeling healthy but I do think, when I'm ill, that its a big issue. I guess we're brought up as men to think of health in terms of 'Going to the doctor' around some sort of physical ailment. It was not until I got into alternative medicine that I began to make the connection that going to the doctors was: going in, sitting down, having a prescription written and being given some sort of pills. The alternative approach was more linking into the emotional stuff and self help; taking responsibility for your own health rather than feeling like your body was like a car that got rusty or dented and got fixed.'
For many of us, our cars seem to need to be so rusty and dented that they are virtually immovable before we drag them round to the surgery. What happened to regular MOT's? Are they so unmacho? Tony recalls that his father 'wouldn't go to the doctor for anything, not because he had anything against conventional medicine; he just wouldn't go.' Although at a lot of levels Tony reject the machismo thing of 'I'm not ill; I can look after myself, I'll be alright, he admits that it works at all sorts of subtler levels as well. 'I'm really inconsistent about my own health in terms of taking care of it. I remember times in relationships where my partner has been giving me a hard time about going to the doctor and that sort of reticence about getting something done about my own health.'
Jim is 34 and works as an academic researcher. Looking back, he can see periods when he kept the accelerator hard down, ignoring graunching sounds from beneath the bonnet: 'There was a period of several months (I was finishing a thesis) when I would go in to work at 9am and come back at 2am. I would be working continuously all through the day and getting only a small amount of sleep. There was an immense feeling of pride that I could function like that. But when I look back I was physically functioning, but mentally I was not really there. I thought I was perfectly healthy since I was not actually incapacitated physically'.
| ...it was a matter of honour not to be off sick |
Even those who work in healthcare and see the results of such attitudes are not, of course, immune. 'Where I worked before,' remembers Roger, 'it was a matter of honour not to be off sick. So we just worked through the flu and the colds and suppressed the feelings that came out in all sort of sneaky ways; on our families or with each other. We never checked it out, never made it easy to say "right, now do you want to go home?"'. Although his work atmosphere is different now, still some of the attitude remains. 'I think a bit of that is still in me, part of the man in me I suppose...'
Another disincentive for approaching the surgery door could be fear of the unknown. Roger thinks that men may just not know the way the service functions. 'The women have had to use the system through their own pregnancies and bringing their children along and so there is a regular contact with the system.' For men without that contact, he feels, a visit to the doctor is liable to be the first for many years; 'and when the contact comes it is quite fragile and difficult.'
Roger himself recently experience the awkwardness at first hand when he woke up with stomach pains. 'I hadn't seen my own doctor for about fifteen years. The pain didn't go away. It was horrible and I wanted to see my doctor, not as a doctor but as a man of 47. I know the system and I found it really difficult. It was Saturday morning... the doctor wasn't there. I had to go and see somebody else. I wanted to see my doctor. It was an amazing experience for me; I just felt very awkward being a man of that age coming up against that problem.'
Even when you have succeeded in seeing a doctor, the attitude you are received with may not encourage a return. Tales of bad experiences abound. Geoff talked of getting crawling to the telephone to get a back problem treated. When the doctor arrived he 'had obviously decided that it was only worth a couple of minutes of his time as he'd parked his car in the middle of the road with the hazard lights on. I was lying on the floor. He said "What's the matter then?" I said "Well, I don't know, but something's gone in my back". He didn't even bend down to look at me; he poked me with his toe and said "Is that where it hurts?". I said it was. "Right, get someone to take this to the chemists for you." It was definitely the worst bedside manner I had ever come across. I didn't go and see that doctor again.'
Roger feels however that 'a lot of men come wanting me to supply a solution and make them better quickly, often so that they can go back to work'. They want an answer "This is wrong with you, take these and you'll get better". Rarely is it as simple as that.'
Tony admitted that some GP's were good, 'but quite a lot of them I find appalling. They don't really want to listen to you. They've written the prescription before you've introduced yourself.'
Such experiences spurred Tony into using alternative practitioners, an acupuncturist and a homeopath. This increasing use of complementary practitioners Roger thinks is a general trend. 'The reason most cited is dissatisfaction with their GP or the consultant in hospital, often because they didn't listen or didn't have time.'
A number of men put themselves as the person responsible for their own health. Geoff did not regard it as a doctor's responsibility. 'It's my responsibility to make sure that I stay healthy and I don't need to call on people.'
Roger agreed. 'I'm not in any way dumping responsibility on them - they come along to see the doctor for guidance and help. I have a certain knowledge of things so that I can inform somebody, but I think they are responsible for their own health.'
'I want to use professionals as an aid to my education - as a resource.' said Tony.
A realisation of the connections between emotional and physical health seems to have been a significant event in several lives.
Steve, for example, who is 25 and does some voluntary work in an adult literacy centre, had back problems for some years which were treated, but not fully explained by doctors. 'The time that I got the problems was quite an anxious time for me. I often used to be able to feel the tension down the muscles in my back and in my neck. I think from that I started thinking that the physical problem could be a result of my mental state; how I felt about myself and other things that were going on rather than just the physical. I started looking into relaxation and counselling. At the moment I feel my health is my state of mind as well as my physical state; being relaxed and being happy is just as important to me as whether my back is hurting.
'I worked for several weeks with a slight throat infection and feeling terribly tired the whole time,' recalled Jim, 'but nothing that became bad enough for me not to go into work. Eventually I talked to my GP and he suggested taking time off work. I was staggered at how quickly my physical symptoms disappeared once I'd had the stress of work taken away. That was the instant that actually made me realise that there was something connecting my emotional and physical sides.'
Tony was working as a student nurse when he began to develop allergies and asthma. I was going to doctors and saying "I've got asthma" and they were saying "Oh no you haven't, you've just got a chest infection; take these drugs."' Dissatisfied, he went to a homeopath. 'Most of the stuff she did was just counselling. We talked a lot about my whole life. I'd never done that with anybody before. She just allowed me to explore it, and eventually what I came to was that the reason for my asthma was that I was blocking my emotions both in relation to the woman that I was living with and very much in relation to the work that I was doing. Being able to identify that myself was very powerful.'
And having identified a connection, it often gives an added route to looking after oneself. As Geoff comments, 'I know I need something to do other than childrearing. Although it is quite good fun, there are times when it can be boring, mindblowingly boring. I think work, even part time work two days a week, keeps me mentally on the go.'
It was obvious that many of the men I talked to had taken on board the idea of health being an emotional as well as a physical thing, and that both needed to be treated. But there was a mistrust of the GP system, a feeling that it was only capable of dealing with rust and dents on the bodywork. They looked elsewhere for emotional support; to alternative practitioners, to partners. In the Seventies, the growth of 'well woman' clinics, where women could go for regular check-ups when well so that illness could easily be recognised, was an attempt to question this use of GP's. 'Well man' clinics have been much slower off the ground; two years ago only a handful existed in the UK. Roger himself was involved in trying to set one up. 'We had a male nurse, we did a mailing of all the men between certain ages in our practice. There were no takers, after several attempts we let it drop.' Somehow, the formula was wrong.
But now there is a another beast on the stage; the new GP contract imposed by the government on general practice. 'The government see preventive medicine as getting people along, measuring their height, blood pressure and doing blood tests,' explains Roger, and they think in that way they will prevent disease. They've made a financial incentive so that if you do run these clinics with five people in them, you get paid a certain amount of money. They've taken money away from other areas so in order just to earn the same basic amount of money we now have to do clinics.'
Roger's practice has decided to take the beast by the horns. 'We got along two male nurses who are trained in counselling, an occupational health worker and myself. I called it a Men's Health Check and put up a couple of notices in the surgery. We pitched it in the evening between 7 and 8 so that men who were at work could get to it.' Much to his surprise, it was oversubscribed by three times. 'When the men came along it was obvious they'd never had this opportunity before. I found that I could not stop them once they had started talking. They were concerned about their eating, they were concerned about their health, their weight, their lifestyle.'
'What I was trying to do,' says Roger about the Men's Health Check, 'was to make it so that people could actually come along and just talk with someone sensitively listening. That sounds very vague, but I think that is what is going to be important.'
Copyright © Achilles Heel Collective
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