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 Together. • Later Life Men’s Groups + Men’s Sheds Meaning of Life WHAT IS THE 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 being/spirit. 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 masculinity? 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 Masculinity? • 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 Burgeoning. • 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 Why? • 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 LAUGHED AT! Why? Men and the Concept of Being Weak • 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. Really? 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 rate. • 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+ 45 40 35 30 25 Rates per 100,000 Males 20 Females 15 10 5 0 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 elderly. • 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. retirement). 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 communicating. • 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 practitioners. 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 problem. • 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 groups) • 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. Aims • To address men’s physical and emotional health and social well-being. • To address issues of social isolation, loneliness and depression. • 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 men. 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? Conclusion • 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.