In the world of men's health magazines the stereotypical male is reticent, stoical and haughtily indifferent to exhortations to live a healthy lifestyle and to submit regularly to medical inspection. I wish that a few more like this would turn up at my surgery, in place of the intensely disease-aware and health-obsessed young men currently shuffling through the waiting-room doors.
Indeed I was beginning to think that the hard man who haunts the men's magazines had become extinct, when one turned up recently. Now 75, he had a stroke some years ago, leaving him with a hemiparesis and dysphasia. Although he is confined to a wheelchair, he still insists on coming up to the surgery, assisted by his wife. The effort required for such an outing — for he is always impeccably dressed, with collar and tie and polished shoes — is clearly enormous. When I say that I would be happy to visit him, his wife just says, ‘he likes to come’. Yet so unusual has such an outlook become that he now seems to be a visitor from the distant past, if not from another planet.
For today's promoters of men's health, my patient manifests seriously disturbed behaviour. His reluctance to parade his distress indicates denial of his deeper emotional needs and his smart appearance suggests a perfectionist mentality, if not obsessional compulsive disorder. He is clearly in dire need of counselling.
As recently as 10 years ago, males between the ages of 10 and 65 years were rarely seen in general practice. We mostly saw women and children, and old people, who are, of course, predominantly female. Now, men, particularly young men, are frequent attenders (and earnest articles in the medical press suggest methods of persuading adolescents that they too should join the queue).
The men's health magazines often claim that they are following the trail blazed by the women's movement. In fact, in its early radical phase, the women's movement regarded the world of medicine as patriarchal and oppressive and attempted to organise key aspects of women's health care autonomously. However, once the radical moment passed, this movement was rapidly incorporated by the medical establishment: the former samizdat handbook Our Bodies, Ourselves is now a mainstream publication and can be found on many GPs' shelves.1 What started out as a challenge to medical authority over women contributed to the evolution of a more comprehensive system for the medical regulation of women's lives — notably in the spheres of pregnancy and childbirth and in the promotion of screening tests of dubious efficacy such as cervical smears and mammography.
Lacking any radical impulse, the men's health magazines have taken the degraded end product of the women's health movement as their model. Far from challenging medical authority, they urge men to submit themselves to it on a greater scale than ever before. In choosing campaigning issues, advocates of men's health have proceeded by analogy with the feminists: they had cervical smears — we demand prostate examinations; they can do breast self-examination — we can play pocket billiards.
The parallel between screening tests for cervical and prostatic cancer is richly symbolic. Just as the smear test exposes women not merely to the medical gaze, but also to vaginal penetration, so the palpation of the prostate involves digital penetration of the male rectum. The slippery finger may be less impressive than the metal speculum, but it is no less significant as an instrument of symbolic domination. It is striking that long after medical authorities have accepted the uselessness of both breast and testicular self-examination, the popular health magazines continue to promote them. The extent of popular approval of all these techniques — out of all proportion to any value they might have in reducing the impact of cancer — is a potent indicator of modern society's pathological preoccupation with health. When it's time for my old patient to go, he looks me in the eye and shakes hands. As the new man slouches out, in his shabby black and grey, his eyes cast downward, he avoids a handshake or offers a feeble gesture in response. As the hard men die out, the new men have become like stereotypical old women.
- © British Journal of General Practice, 2006.
