Findings
Across data sources, the consistent need for discreet and appropriate emotional support stands out as the most discussed area, but its use is severely hindered by cultural expectations of masculinity. Perceived cultural expectations to maintain an image of strength in line with stereotypical gender roles stands out as the dominant theme throughout the texts, and this, in turn, differentially impacts peer support, partner relationships, and the ability to care for children.
The Need to "Be Strong" as a Barrier to Support
Although other issues (e.g., fertility, treatment, information resources) surfaced in the analysis, the frequency and salience with which men reported perceived masculine cultural expectations to "be strong" or maintain a "stiff upper lip" prompted the focus on emotional support through social channels. Men describe the pressure to be strong as an overarching barrier that prevents them from receiving and offering emotional support, particularly in relationships with peers, partners, and children, which is consistent with research on other age groups (Moynihan, 1998; Nicholas, 2000; Oliffe, 2007). For example, one member wrote the following online.
Being a man, you always have to cover up your suffering as much as possible. "Never let them see you hurting" is something that always went through my head…. I felt like I had to be strong for everyone else. Well, that's probably one of the mistakes I made. Maybe letting others see the suffering I was going through might have made them stand up and help carry me along.
Conflicting goals between being strong and being honest about his emotional state acted as a barrier to his ability to seek and receive support. The emotional balance is so delicate that one focus group member even advocated having a loved one "freak out on your behalf because then you can also feel like you're being the strong one." He discussed such a relationship as allowing him to maintain his perception of strength while being in an environment where open emotional concern is accepted.
Another focus group member, who used mental health services several years post-treatment, detailed that internal barriers about being open with his feelings initially stood in the way of therapy.
I always believed in therapy, but I was too proud or too something to really pursue it. I'm not struggling with depression or anything. I feel like I'm a pretty well put together guy. However, I've seen the service [therapy] and it made me realize like, "Wow. Even though I thought I had everything put together, I could be better."
However, according to participants here and in other research, personally acknowledging weakness would hurt perceptions of masculinity (Winnett, Furman, & Enterline, 2012).
Peer support: Men in this study remarked that the social support they receive from other males is inadequate or nonexistent as a result of masculine gender expectations. They reported discord between masculine strength and the perception or experience of illness leading friends to create distance. In the interviews and focus group, men strongly asserted the importance of peer support, despite its rarity.
Even if there are less-than-ideal circumstances that wind up being a result of it [a cancer diagnosis], you can deal with it. Having that support structure will help you get through. If it works out and you're cancer free for the rest of your life, fantastic. If you have to struggle through it, it sucks, but at least you'd have friends.
At the same time, many participants lamented the loss of friends because of their cancer experience. One online forum member discussed peer support during his cancer.
There is always that lack of brotherhood. People that may not know exactly what you are going through but can make fun of you all the same. Punch you in the port. Slap you on the stitches. The ones that are willing to stick by even if the thought of losing you is too unbearable.
Men value and desire friendships during this difficult time, in part because even just the opportunity for peer support is valued (Chapple & Ziebland, 2004).
[Y]ou get what you get, and you don't have to listen to certain people, or you can listen to certain people. You're given an opportunity. And, at least in my opinion, it's better to be given the option than to not even know it's there in the first place.
However, gendered support notions can drive inadequate interactions with other males.
The others, generally speaking, are in some combination of denial and "chin up, buck" attitude. To make things worse, I think other guys use inappropriate humor to deal with their discomfort on the topic. I find I have to do some serious reading between the lines to figure out what the hell they are trying to tell me.
Partner support: Another prominent area of support challenges stemming from perceived expectations of masculinity involves romantic relationships. Effective support for male survivors seems to come from spouses and romantic partners who view the cancer experience as a joint effort.
One focus group member described a situation with his partner, where they sought a diagnosis for his as-yet-unexplained symptoms together. "[M]y partner was a little bit excited like, 'Cool! It's cancer. It's kind of dangerous, but they know how to treat it now.'" He reported benefitting from the joint approach with his partner and the partner's optimistic outlook. Another focus group participant discussed the importance of having each care provider always deliver information to him and his wife as a couple, so that they are "able to digest it at the same time, [and] be there for each other."
One popular topic in the online forum was the need to set aside conversational time explicitly dedicated to not discussing cancer.
The other thing that we've been doing is, while we're spending time together, take an hour or two off from talking about cancer. It's amazing how hard that is at the moment, but it's also helping us remember what we're like together.
Supporting children: Men with children added concerns about providing emotional support for his existing family despite how perceptions of masculinity can initially prevent effective family communication. Information, support, or strategies concerning how to explain and share the cancer experience with children stood out as a little-addressed family issue.
Unfortunately, no one seems to have straight forward advice about what to do in this situation. There were times when it was impossible to shield [son] from things, and we've had to explain a few things that no preschool kid should ever need to know about…. I think, though, that by including him in the situation, rather than having someone care for him or something like that, that he felt more connected to us.
One interviewee put this need to focus on family in all aspects of the cancer experience as, "I think it's becoming almost more tribal. People are flocking toward the pack that they trust." For some men in the online forum, their outcomes were better connections to loved ones, findings similar to earlier research that examined young men facing masculinity-threatening fertility issues (Schover, Brey, Lichtin, Lipshultz, & Jeha, 2002).
It's very humbling to have to admit this, but I really am becoming a better dad and husband through this. And yes, I just wish that it could of happened another way.