Have You Heard the One About the Guy with Prostate Cancer?
Should therapists be turning to football and jokes to reach a wider audience of men in need?
When I was a graduate student in psychology, I worked at a cancer center. One of my responsibilities was to meet with new patients as they received, drip by drip over many hours, chemotherapy infusions. In one corner of the clinic, a woman I’ll call Lisa was battling breast cancer. Lisa’s friends had organized a complex and complete support tree for her, with meal delivery, dog walking, child care, and bill paying. Lisa snuggled into a quilt they had stitched for her. Lisa was never alone.
Nearby sat “Rick,” a sinewy, divorced man in his early 60s, fresh from his latest surgery for an aggressive cancer that had attacked his mouth, esophagus, and beyond. I was Rick’s only visitor. He hadn’t revealed his cancer to anyone, he said with grim pride, not even his grown children. He was going to get through the grueling treatment the same way he got through Vietnam: just “get it done.”
Psychotherapy was offered at no cost to patients at the nonprofit center. Rick made an appointment with me, then canceled it. He was happy to say hello when I stopped by his chair, but “therapy” was out of the question, even for a guy struggling with the potential loss of half his face, and perhaps his life.
The episode haunted me: Was teeth-gritting silence a culturally appropriate and functional coping mechanism, and my concern merely a reflection of female-centered values writ large by my too-enthusiastic inexperience? Thus began my quest to figure out how to get men like Rick to let me help them with the profound emotional implications of their physical ills.
What I discovered was a trail of research showing that men with cancer are offered psychological assistance far less often than women are, and that even when it is offered in the form of support groups or therapy, men are far less likely to participate.
It makes a kind of sense. Today’s cancer support network evolved as the result of breast cancer advocacy that found its voice and honed its political power beginning in the 1980s, after former first lady Betty Ford helped destigmatize the disease by revealing that she had breast cancer. Susan G. Komen for the Cure and a bevy of other cancer support groups also organized, raising both public consciousness and funds for research. Community cancer centers and American Cancer Society chapters soon joined academic institutions affiliated with the National Cancer Institute’s Comprehensive Cancer Center network in offering support groups, therapy, and social work to support all cancer patients.
Breast cancer, both in research and practice, has received a disproportionate share of attention, benefiting far more women than men with cancers of all kinds. I went to the National Library of Medicine’s PubMed online database—the most comprehensive collection of published medical studies on earth—to compare breast cancer and prostate cancer, two diseases that are diagnosed in almost equal numbers each year in the U.S., and take a similar emotional as well as physical toll. As of May, published, peer-reviewed studies on “breast cancer and support” outnumbered those on “prostate cancer and support” by 56,000.
But here’s the rub: when researchers from the University of Cologne pooled the results of 37 well-designed studies of psychosocial support from cancer centers around the world, they found that men, when they did participate, benefited more. Much more. Nearly twice as much more, showing measureable reductions in symptoms of distress and a return to psychological well-being.
Some digging revealed that more than 1 in 3 previously psychologically healthy men—read “regular guys”—experience diagnosable symptoms of depression and anxiety during treatment of various forms of cancer. Those numbers seem to point to the need for therapy in some form, at least short-term, that would be palatable to men.
When cancer patients are asked about their emotional needs, most men reject “support” from medical professionals, seeking only “information.” In one such study, in the United Kingdom in 2006, a male melanoma patient summed it up in classic stiff-upper-lip: “Mind you,” he said, “I never pour my heart out to anyone really, but if I do feel a bit low, then I will have a chat with my wife.” That could work, of course, if the wife is up to it. But research points to serious overload in many spouses who find themselves playing psychologist to a sick husband. Yale School of Nursing researchers, in six major studies representing more than 400 couples, found that partners’ psychological levels of distress significantly exceeded that of the cancer patient himself.
A small survey published last year in the journal Psycho-Oncology further muddies the boulder-strewn waters that would advocate for self-sufficiency: among 35 prostate cancer patients, more than half agreed with the statement, “I should be able to take care of my problems by myself.” And yet, virtually the same percentage said, “I would be less depressed if I talked about my problems.”
A majority agreed with this statement, “I don’t want to become dependent on a therapist,” and, paradoxically, this one: “It is almost as important for my doctors to listen to me talk about my emotional problems as to cure my cancer.”
It all made me wonder how men with prostate cancer support each other—in man code, “exchange information.” Could cancer centers create new, nonthreatening avenues of support to replace gatherings that might look to men like thinly disguised pink-ribbon knockoffs?
A University of British Columbia analysis of 16 prostate cancer support groups zeroed in on the idea that humor might allow for easier discussions about the impact the disease can have on sexual function. One cancer patient told researchers: “I was always a little suspicious of support groups as being a bunch of touchy-feely stuff, you know, and I’m not that kind of an emotional exhibitionist… this one was real good, down-to-earth, have some fun while you’re about it, because there is nothing like having a good laugh.”
Australian researchers eavesdropped on online cancer chat rooms and discovered that men and women offered about equal doses of support and information. But the support offered to men by men—delivered with sharply barbed humor, riddled with battlefield expletives, and marked by graphic descriptions—sounded a lot like the bonding of members of a sports team.
That wouldn’t surprise the psychologists who created the “Positive Masculinity Model.” Mark Kiselica at the College of New Jersey and Matt Englar-Carlson at California State University, Fullerton, have developed a list of “male strengths,” to counter what they perceive to be pessimistic and judgmental characterizations of masculine development and behavior.
In their view, it makes sense to look beyond the image of the brooding stoic and acknowledge that guys are also socialized to prize courage, humor, and male bonding—traits that provide a strong framework for healthy relationships.
Looking at the list, I can see opportunities to frame support that would fit comfortably into the characteristics of the Positive Masculinity Model. Would it be so difficult to convey the message that it’s the bravest guys who have the guts to talk about their cancer to others?
Ready to lighten up a little—or a lot—I think I have an idea for how guys like Rick might be helped to swagger into a cancer battle: huddling with some buddies, cracking a few jokes, and perhaps taking some plays called in from the sidelines, where trained professionals like myself may be looking on.