Later Life Mens Group by tyndale


									       Human Doings
Man’s Search for Meaning in Later Life
       and How we can Help.
            Presented by
          Dr David Spektor
       Structure of Presentation
•   Meaning of Life?
•   Meaning in Later Life
•   Masculinities
•   Masculinities and Mental Health
•   Gender and Suicide
•   Age and Suicide
•   Psychology and Occupational Therapy Working
•   Later Life Men’s Groups + Men’s Sheds
     Meaning of Life

                Meaning of Life?
•   Sigmund Freud – Pleasure
•   Albert Adler – Power
•   Abraham Maslow – Self-Actualisation
•   Carl Jung – Individuation (knowing one’s self/soul/spirit)
•   Irvin Yalom – Engaging in What we Fear most – death
•   Theologians – Surrendering in life and faith to a higher
  Viktor Frankl – Purpose
“He who has a Why can bear
     almost any How.”
         Purpose in Later Life

• Men define their masculine identity in this
  generation particularly by being:
• Provider/Breadwinner
• Physically Strong
• Powerful
• Protective
• Potent
 All of this gives men a purpose/ a reason for existing.
How do young men define their
   There is a Difference between
  being Male and being Masculine.
• Gender is so pervasive in our society that
 we assume it is bred into our genes. Most
 people find it hard to believe that gender
 is constantly created and re-created out of
 human interaction, out of social life, and is
 dependent on everyone constantly “doing
 gender.” (West and Zimmerman, 1987).
   There is a Difference between
  being Male and being Masculine.
• Individuals are born sexed but not
 gendered, and they have to be taught to
 be masculine or feminine. As Simone De
 Beauvoir said “One is not born, but rather
 becomes, a woman…it is civilization as a
 whole that produces this creature…which
 is described as feminine (1952, p. 267…”
       Is there such a thing as
• It is important to be aware of the
  existence of multiple versions of
  masculinity – thus “masculinities.” This is
  of up most importance within the
  healthcare industry.
• Masculinities are ever-changing and often
  contradictory even within one individual’s
  day, and of course lifetime.
 Masculinity and Mental Health

• Not a Large Research Area but
• What we do know: Men Repress, Women
  Express! (help seeking behaviour).
• Women diagnosed more often with
  depression but men commit suicide more
  often than women.
   Masculinity and Mental Health
• Noble, 1992 – Study asking women and
 men: What are you most afraid of?

• Women answered: Most afraid of being
 raped and/or murdered.

• Men answered: Most afraid of being
     Men and the Concept of Being
• Many researchers in this area believe that men
    are inherently homophobic.
•   This does not refer to the irrational fear of gay
    men. Rather it represents their greatest fear. It
    “comes out of the depths of manhood: a label of
    ultimate contempt for anyone who seems sissy,
    untough or uncool.” (Leverenz, 1986; p. 455).
•   Hence many derogatory words used by men to
    other men which denote being gay.
       Gender and Suicide Rates
• Up until 9 years old suicide rates for boys and
    girls are pretty much identical.
•   From 10-14: Boy’s rate is twice as much.
•   From 15-19: Four times as much.
•   From 20-24: Six times as high.

• It seems that as boys experience the pressures
    of the male role, their suicide rate increases.
    Gender and Suicide Rates

• In the last 40 years Men’s suicide rates
 (ages 20-34) have gone from twice the
 rate of young women to four times the

• Men’s suicide has increased 26% whereas
 women’s has decreased 33%.
 Suicide in Later Life by Gender
                                    Suicide Rates for Ages 65 to 85+





Rates per 100,000
                    20                                                               Females




                         65-69   70-74             75-79               80-84   85+
                                                 Age Group
Global Statistics by Age and Gender
 World Health Organisation (2000)
New Zealand Elderly Population
• High Rates of suicide among elderly men. (20 per
    100,000 where as it is 3 per 100,000 in women).
•   Focus here is on youth suicide.
•   Suffering does not distinguish between young and old.
•   No guidelines for GPs exist to recognise depression in
•   Higher completion rate.
•   Firearms most common tool.
•   Alcohol and Substance abuse not an important factor in
    elderly suicide.
•   Widowers are ten times more likely to commit suicide.
       Common Risk Factors

• The recent death of a loved one.
• Physical Illness, uncontrollable pain or fear
  of prolonged illness.
• Perceived poor health
• Social Isolation and loneliness
• Major changes in social roles (e.g.
How does this relate to what we
    are discussing today?
• When working in old age and mental
  health problems – we must step away
  from a disease ideology.
• For example some Psychologists believes
  that most mental health problems are
  caused by some form of Trauma, Neglect
  and/or Abuse.
• “Psychiatric Disorders” are actually people
  reacting normally to abnormal events.
       What are we as Health
    Professionals doing for Men in
              Later Life
• Short Answer – Nothing!
• Psychologists – Criticised for female focused therapies
    based on feminist ideology and providing therapeutic
    space more amenable to female way of
•   Occupational Therapists – Criticised for offering
    therapeutic activities which play to women’s interests
    and strengths leaving men feeling emasculated and
    having to fit in to a female dominated program.
•   Work force – Mental Health dominated by female
   Psychology & Occupational
   Therapy have the Answer!
• Occupational Therapy and Clinical
 Psychology need to work together.

• Human beings are occupational and
 emotional creatures and using all our
 capabilities is absolutely essential to our
 identity and happiness.
Psychology & Occupational Therapy
        have the Answer!

• Later Life Men’s Groups

• Men’s Sheds
         Later Life Men’s Group
• Based on a model used by Institute of Group Analysis
  (IGA) for Adult men who have multiple years in mental
  health system for abusing others and being abused.
• Group is based on ideas from Social Gerontology, and
  thus differs from traditional groups. The outline of the
  group is adapted to the culture, gender and generation
  we serve and ensures appropriate respect for the elder
  men we see.
• Idea is to give the men autonomy in the group. They
  decide when we invite a new member, also discharge
  and attendance, time and regularity.
      Later Life Men’s Group

• Not a “manualised” group such as CBT for
  Anxiety or CBT for Depression, but rather
  an ongoing group which is always present.
• Run by two male group coordinators.
• Based within a framework which holds the
  idea of “masculinities” and puts forward
  the idea of emotional liberation for men.
           Criteria for Inclusion
• Men aged 65 or Over
• Do not have severe cognitive deterioration
• Do not have a long-standing history of
    entrenched and “intractable” mental health
•   Are not current in-patients.
•   Have identified difficulties associated with
    retirement, loss of role, physical health/strength,
    bereavement, and/or sexual relationships.
                Group Members
• 14 group members (maximum 16 –split between 2
•   Age range: 73-89
•   5 members have had strokes.
•   3 members have Mild Cognitive Impairment.
•   2 members have diagnosis of Bi-Polar Disorder.
•   7 members are previous in-patients.
•   3 members have attempted suicide in recent past (less
    than six months ago).
•   2 members wives are in care.
•   2 members are widowed.
                       Topics Discussed
•   Suicide
•   Depression
•   Anxiety
•   Physical Illness
•   Death
•   Loss of Life Partner
•   Relationship Problems
•   Sex
•   Divorce
•   Being a Man
•   Masculinity
•   Role as Father
•   Role As Provider
•   Being male growing up in 30s, 40s and 50s.
•   Moving into Retirement Home
•   Dementia
And many more.
         Later Life Men’s Group
• Been running for over 12 months.
• Started with one group, now have two.
• None have dropped out which is very unusual
    for group psychotherapeutic work.
•   Rarely experience DNAs, which again is unusual.
•   Very Positive Feelings towards group dynamics,
    cohesion and therapeutic benefit.
•   Most importantly, connections have been
    maintained outside group.
Men’s Space?
Men’s Sheds
              Men’s Sheds

• A shed is a functional space, a place given
 to function where things get made or
 repaired, built or broken.

• Men’s sheds are actively trying to enhance
 men’s health and well-being.
• To address men’s physical and emotional health and
    social well-being.
•   To address issues of social isolation, loneliness and
•   To promote the social interaction of men especially those
    in transitional periods (e.g. retirement, bereavement, ill-
    health, mental health).
•   To share and preserve skills, abilities and interests.
•   To provide a purpose for men.
               Men’s Sheds

• Men’s Sheds provide a male-positive
  context that satisfies a wide range of
  needs not currently available in more
  formal settings.
• The group it targets is traditionally difficult
  to reach: older and sometimes isolated
      Is it difficult to set up?

• In reality NO!
• Work Space
• Tools
• Expertise
• Defined Aims/Goals
• Only Major Issue as always is FUNDING.
               Is it enough?
• Is a Later Life Men’s Group Enough?

Research suggests that as men age they stray
  from a eurocentric/autonomous view of the self
  and seek out connections with others. Older
  men’s work becomes more centred on emotional
  work of relational concerns. A search for
  emotional meaning replaces self-reliant values of
  earlier masculinities. But does it provide a
  purpose – a reason to live through suffering?
               Is it Enough?
• Is a Men’s Shed enough?

• With loss of employment, physical health,
  strength, and potency comes a loss of identity or
  purpose. A men’s shed enables men to feel
  useful, and provides a purpose. But does it
  enable them to share feelings and emotions and
  work through personal issues that impact on
  their mental health?
• The combination of a Later Life Men’s
  Psychotherapeutic Group which runs alongside a
  Men’s Shed will fulfill both tasks – as one is as
  needed as the other.

• It enables men to DO and to BE!

• Thus men can be Human Doings and Human
  Beings as they approach the final act of life.

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