In the last post, I discussed some characteristics (positive and negative) of machismo. However, it is not enough to only explain the culture of machismo to students in Spanish for Healthcare Professionals courses. It is also very important to demonstrate how knowing about machismo can enable them to better provide for some of their Latino patients who may hold to that belief. In this post, I would like to suggest a few of the negative impacts that machismo can have, not only on the man but also on his family. I would also like to offer a few suggestions for how to use the positive aspects of machismo to motivate the man to better care for himself and his family. For the sake of brevity, I will limit myself to naming these connections between health and machismo and citing sources which can be consulted for more specific information. However, it should be kept in mind that the suggestions I mention are taken from studies and may not include all aspects or may be disputable. The students themselves, as experts in the medical field, should be given the opportunity to discuss machismo and offer other possible suggestions.
Some of the negative aspects to machismo that were mentioned last week include: “exaggerated manliness”, paternalism, violence, abuse, control, alcoholism, vengeance, hypersexuality and risk-taking behavior. When considering the impact of these aspects on health, we first notice that the men have a tendency to avoid routine care, whether it be a yearly check up or a prostate exam. It may be that they feel invincible, disagree with the authority who says it should be done or because they find it emasculating. Regardless of the reason, men who uphold machismo are much less likely to be seen for routine care or any care until they are already sick. [references].
In terms of sexuality, there is a sense that a “real” man has a strong sexual appetite that cannot always be satisfied by one woman. This gives rise to infidelity. There is also, as Sternberg notes, a devaluing of the woman to where she is considered a vehicle for the purpose of reproduction, of pleasure, or even to transmit sexual illness (there is sometimes a belief that it is the women who spread sexual illnesses). Due to this view, the male is often not motivated to take part in avoiding pregnancy or preventing the transmission of STIs; these are the role of the woman. As is probably obvious, this leads to higher incidences of STIs and unwanted pregnancies. Also, women influenced by marianismo are quick to forgive their husbands for abuse or sexual infidelity (for reasons I will touch on next week) which allows this behavior to continue.
Another impact of machismo on health is alcoholism. “Real men drink” is a belief common to many cultures. In machismo in particular, Seqeuira (2009) points out that heavy drinking is glorified in this culture because a sign of manly strength and dominance is being able to drink a lot without showing its effects. This allowance and tolerance of the man´s drunkenness through acceptance or excusing it as part or being a man can inhibit his ability to overcome or even see the problem.
Probably the most well known effect of machismo is violence, especially domestic violence. As Klofas and Delaney (2009) noted, though this aspect is well known to those familiar with machismo, there are few articles which touch on it. However, Alvarado with the Laredo Morning Times (a Texas news site) cites the District Attorney´s Domestic Violence Unit when he affirmed that “most of the time the cause of 800 domestic violence arrests each year in Laredo is machismo” (Alvarado 2007).
Control is another negative machista characteristic which can have a psychological impact on both the man and the woman. Also, excessive control can be a warning sign for physical abuse, and by assessing the amount of excessive control one can gain a better idea of whether or not there may be physical abuse. For example, while working in Western North Carolina, various social workers stated that when working with Latinas they use questions such as: “Does your husband control what you wear? Do you have friends? Do you decide when you leave the house and where you will go?” Oftentimes, a woman with a controlling or machista husband will answer these questions more readily not realizing that it is often a warning sign for abuse. Because of this, these questions can be used as a gateway to learn more about the family dynamic and start to build trust with the woman. The same social workers also stated that after answering these questions honestly, the female patients were more likely to later on discuss the physical abuse that occurred in the home.
In order to show their manliness, men who hold to machismo often partake in risky behavior. This means they are more likely to have accidents and injuries, more likely to drive under the influence, and less likely to have protected sex. For men with recurrent injuries or recurrent tests for STIs, there should be a discussion directed to the heart of the issue –the need to prove his manliness– rather than just running the tests or warning them that it is not wise to behave as they are.
Finally, men who are raised and educated in this cultural idea of masculinity are at an increased risk to suffer more mental health and physical disorders. Studies show that there are significant positive correlations between machismo and depression and machismo and stress, even when the study controlled for acculturation (Fragoso & Kashubeck 2000). These are not things men will readily admit to since machismo also insists that the man keep his emotions at a distance because emotions are viewed as a feminine thing. However, knowing this cultural aspect should encourage the assessment of mental health issues.
The treatment of all of the issues presented fall within the knowledge set and expertise of the doctor and therefore do not need to be taught in a Spanish for Healthcare Professionals course. Also, some of the articles cited also give good advice on how to confront these situations in a culturally-sensitive manner. However, one of the most effective behavioral training and motivating techniques is to connect the problem at hand with beliefs the patient holds. So, how can we use the positive aspects of machismo in our treatment of a patient who adheres to machismo, especially in reference to the negative health impacts presented above? If you remember from the last post, positive aspects include: family-centeredness (man as the protector and caretaker of the family), honor, dignity, respect, loyalty and duty. Therefore, in some situations we can reference these characteristics to build motivation and effect change. For example, in the case of the avoidance of routine care, discussing the importance of the man´s self-care in order for him to be able to best provide and care for his family. It can also be discussed that routine care does not take away from one’s manliness but strengthens it because it allows the man to be stronger and healthier, thus taking away the fear of appearing more feminine by seeing the doctor regularly. This is an especially important discussion in terms of prostate exams, a very delicate issue when treating a machista man. I once heard (well, interpreted for) a doctor who told a patient who was afraid that the prostate exam would take away from his sexual poder that it would do the opposite, it would protect his sexual abilities. Needless to say, the man agreed to the exam.
There are some situations where appealing to the positive aspects of machismo will not be enough to overcome the negative ones. One example is domestic violence. The control and the violence is seen as a right and as part of the male-female relationship. There is no evidence to show that any amount of appealing to family-centeredness will consistently change this behavior. (Side note: in some anecdotal cases it has, but I do not find it has occurred enough to warrant its consideration as a viable way to confront the issue.)
As is shown in various studies, machismo can have a severe impact on the health and well-being of the patient. However, if we only discuss machismo, we are missing the other half of the story, marianismo, which identifies why the women go along with this behavior and also explains other characteristics seen in clinic that are similar to but not part of machismo. Next week, we will take a closer look at this cultural belief.
Alvarado, Celina (2007): Machismo plays role in domestic violence [en línea] Laredo Morning Times 7 September 2007. <http://madmax.lmtonline.com/textarchives/090507/s5.htm>
Bryner, Jeanna (2009): “Study: Machismo cuts men´s lives short” [en línea], Live Science, <http://www.livescience.com/5619-study-machismo-cuts-men-lives-short.html>
Cianelli, Rosina; Lilian Ferrer, y Beverly J. McElmurry (2008): “HIV Prevention and low-income Chilean women: machismo, marianismo and HIV misconceptions” [en línea], Culture, Health and Sexuality 10(3): 297-306 <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603075/>
Clarke, Juanne y Julie Robinson (1999): Testicular Cancer: Medicine and Machismo in the Media (1980-94) [en línea], Health (London) 3: 263-282, <http://hea.sagepub.com/content/3/3/263.short>
Delgado, Melvin (2006): Social Work with Latinos: A Cultural Assets Paradigm. Oxford University Press: New York.
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Fragoso, Jose M y Kashubeck, Susan (2000): “Machismo, Gender Role Conflict, and Mental Health in Meican American Men” [en línea], Psychology of Men and Masculinity 1(2): 87-97, <http://www.researchgate.net/publication/232520714_Machismo_gender_role_conflict_and_mental_health_in_Mexican_American_men>
Hola Doctor Daniel (2013): “Machismo en la comunidad hispana.” Recuperado el 16 de mayo 2013 de http://holadocdaniel.blogspot.com.es/2013/01/machismo-en-la-comunidad-hispana.html
Mendoza, Eunice (2009): “Machismo Literature Review” [en línea], Center for Public Safety Initiatives, <http://www.rit.edu/cla/cpsi/WorkingPapers/2009/2009-12.pdf>.
Saenz de Miera, Rosario et al (2005): Guía de atención sanitaria. A la mujer víctima de violencia doméstica. Gobierno de Aragón: Aragón. Recuperado el 16 de mayo 2013 de http://www.aragon.es/estaticos/GobiernoAragon/Organismos/Instituto%20Aragon%C3%A9s%20de%20la%20Mujer/Documentos/GUIA.PDF
Sequeira, David (2009): The Machismo and Marianismo Tango. Dorrance Publishing Co.: Pittsburg.
Sobralske, Mary (2006): Machismo sustains health and illness beliefs of Mexican American men. Journal of the American Academy of Nurse Practitioners 18: 348-350. Recovered from http://www.ncfh.org/pdfs/2k12/9380.pdf.
Sternberg, Peter (2000) “Challenging machismo: Promoting sexual and reproductive health with Nicaraguan Men” [en línea], Gender and Development 8(1): 89-99, <http://www.jstor.org/discover/10.2307/4030311?uid=3737952&uid=2&uid=4&sid=21102167640463>
The Advocates for Human Rights (2003): “Health Effects of Domestic Violence”. Recuperado el 16 de mayo 2013 de http://www.stopvaw.org/health_effects_of_domestic_violence