Great Male Breakdown

The Great Male Meltdown
Men regularly court disaster when it comes to their own health. Traits such as toughness, stoicism, and fearlessness can translate into medical disaster. It's time men learned to make a fuss

Congressman Dean Gallo was a dynamo whose fierce dedication helped launch the Cancer Institute of New Jersey in the early '90s. Yet when it came to his own cancer, the otherwise savvy Gallo was slow to catch on. He ignored the backaches, then the urination problems and, ultimately, even the loss of his sex drive. He'd been on his feet a lot, he told his future wife, Betty, and besides, he was 55 years old. For six months Betty pushed and prodded, and finally Dean went to an orthopedist, who did a bone scan. "It lit up like a Christmas tree," Betty recalls. "There were lesions all over his back." In light of the urinary symptoms, Dean then had his blood tested for prostate-specific antigen (PSA), a protein elevated in prostate cancer. A normal PSA is between 1 and 4. Gallo's reading was a shocking 833. Gallo's advanced prostate cancer had metastasized to his bones, and he was given three to six months to live. But he fought back, enduring surgery, radiation, experimental chemotherapy and immunotherapy, each with its own sickening side effects, from bone fractures to nausea and unrelenting pain. He had one thrilling remission that lasted six months—giving him the chance to marry Betty—before he died. He'd survived two and a half years.

Haunting Questions

Could Dean Gallo have beaten the disease if he'd had the bone scan and PSA test immediately after the backaches started, instead of six months later? "One thing I know is that he would have been dead a lot earlier if he hadn't had the tests when he did," says Betty Gallo. "But six months is a long time to wait; earlier it might have been controlled." In fact, if Dean had been in the habit of getting a PSA test every year, he might still be alive today.

Like many men who get sick, Dean Gallo found himself in a state of deep denial. Yet the sad reality is that others might have taken even longer to uncover the cancer and confront the truth. Men are typically strangers to their own health. Preventive medicine and early detection rank way down on their list of priorities. And they frequently pay for it with their lives. Men are far likelier than women to die early from diseases, many of them treatable.

Of every 100,000 people, for instance, 297 men die of heart disease each year, but just 197 women. Cancer, likewise, takes 238 men per 100,000 compared to 163 women. In the United States, men live an average of six years less than women do. According to a Lou Harris poll, men were three times more likely than women to avoid doctors when they had persistent minor medical symptoms. Many neglected to seek routine screenings, even if sent reminders and offered free testing by their health plans.

Meat on the Table, Head in the Sand

Men's mind-set toward medicine may be an artifact of their evolutionary past, when they faced so much danger and their life expectancy was so short they tended to discount the future and focused, instead, on immediate needs, theorize Margo Wilson and Martin Daly, a husband-wife team of evolutionary psychologists at McMaster University in Hamilton, Ontario.

"In the ancestral environment, women cared for dependent offspring, while putting food on the table and mating were the essential roles for men," says Daly. "So if a woman detected infection or disease in herself, her appropriate response might have been to sequester herself and heal, while conceivably a man's was to bring home another dead animal or quickly get laid." Instead of speeding off to a doctor, says Daly, "we're still unconsciously asking ourselves, 'Have I acquired enough goods? Have I put enough dead animals in the fridge?'"

One male in this prehistoric mold is Eric Stonlower (name has been changed), a trucker from Portland, Oregon, who drove a rig to pay the mortgage while his wife stayed home with the kids. Transporting pallets of groceries across the Pacific Northwest for days on end, Stonlower had few opportunities for exercise and limited choices for meals. When he began feeling troubling signs—heartburn, nausea and shortness of breath—he didn't know what they meant, and wouldn't see a doctor for weeks. When he learned he'd suffered a heart attack (probably on the road) and had sustained heart damage, no one was more shocked than Stonlower himself.

"Before my heart attack, I pushed myself hard for overtime. After, I had to quit trucking, period," he explains. Today working for the same company as a salesman (at lower pay), Stonlower maintains a low-fat diet and exercises regularly—but heart disease will always be a factor in his life.

In our evolutionary past, "a sense of invulnerability had great value in meeting challenges," Wilson notes. "The early mariners were risk takers, and some of it really paid off. Striking out into the world against all odds has always been a very 'guy' thing." To prevail, such men adopted a set of classic "male" traits: confidence, strength, toughness, independence, stoicism, fearlessness. But today, faced with fewer physical dangers, these same qualities can pose a risk to their health.

Overriding Evolution

To alter the pattern, we must break through men's emotional barriers. The strategy endorsed by Matthew Mintz of George Washington University is a national media blitz. Venues like the Superbowl, he suggests, would be perfect for promoting healthy male lifestyles: good nutrition, regular exercise, weight control, smoking cessation and, especially, regular physician checkups. Men should be coming in at least for a couple of blood pressure and cholesterol tests in their 20s, Mintz says, with additional tests like the PSA and colonoscopy being introduced in their 40s and 50s. "I guarantee that if there was a regular health segment on SportsCenter, men would become more interested in their health," he insists.

To overcome their medical inertia, education must be pervasive and start young. From their earliest days, after all, boys are predisposed to tough it out rather than admit they might be sick. Alex Weintraub, a 13-year-old from an exclusive New Jersey suburb, was the apple of his father's eye, in part because of his budding basketball talent. But one day last year Alex quit the game. "He refused to play at all," said his father Alan, a Manhattan attorney, who felt bereft. "I loved going to those tournaments, and I thought Alex did too."

Apparently not. Turning to what his dad jokingly called "punk culture," Alex took up skateboarding. "I'm too tired to play basketball," he complained. No one understood what was going on with Alex until a relative with similar childhood symptoms pressed him for details. Finally, months after the problem began, Alex was able to put what he really felt into words: Whenever he exerted himself, he couldn't breathe. A pulmonary specialist diagnosed Alex with sports-induced asthma and prescribed an inhaler. He's now back playing basketball and explains the episode in typical male fashion: "I didn't want to make a fuss."

"We need to get rid of this ridiculous 'boys don't cry' thing," says writer Armin Brott, an advisor for the Men's Health Network, a nonprofit group with a focus on health education. "Males can't shake it for the rest of their lives. Because of their early training, men don't want to talk to anybody when they're hurting. Fathers have an opportunity to teach their sons to take charge of their health," Brott concludes. "They need to tell them, 'It's OK to feel vulnerable. It's OK to reach out."

article curtosey www.psychologytoday.com