Accessing the multitude within: A psychoanalytic perspective on the transformation of masculinity at mid‐life1

This paper reflects upon the essential components of male identity that commonly are reworked in middle age. The author argues that healthy masculine gender identity involves an ongoing, plastic process of destabilization and reconstruction at various pivotal developmental stages, particularly during middle adulthood. In essence, a man's mature transformation of his sense of masculinity results when finite concepts of gender identity are superseded by an awareness of the complexity of one's multiple, early and diverse gender identifications. A clinical case provides insight into how psychoanalytic treatment can contribute to a new experience of masculinity. The case illustrates how a maturing man, meeting an altered sense of identity in mid‐life, relies less on gender splitting and more on reuniting previously antithetical intrapsychic elements. Why this more pluralistic, polythreaded masculinity frequently must wait until mid‐life is further clarified. Specific importance is attached to the early development of male gender identity as it is founded on the boy's unique struggles in separating from his mother. The foundation for male gender identity formation is reconsidered as the author questions the ‘dis‐identification’ model while explicating how the boy's striving for narcissistic completion shapes the gendered masculine ego ideal. Classically termed ‘phallicism’ is understood both to facilitate and obstruct a man's adult development, while the concept of ‘genitality’ is augmented by the postclassical notion of ‘interiority’. At mid‐life, ‘phallic’ ego ideals (resting on omnipotence, desires for narcissistic completion and gender splitting) are transformed into more realistic, ‘genital’ ego ideals (synthesizing autonomy and connection). The achievement of a mature, less sharply gendered ‘masculine’ ego ideal (revitalizing the foreclosed dimensions of both the early maternal and paternal imagos) occurs as the balance of forces shifts in the direction of true genitality rather than defensive phallicism.     

Rational Emotive and Cognitive Behavior Therapy with Adult Male Offenders

Criminal behaviour has devastating effects upon society. Cognitive therapy, broadly defined, has been shown to be effective with offenders. REBT philosophy, in particular, appears ideally suited to treating this heterogeneous population. Although this chapter focuses on adult male offenders, the presented principles apply to most offender groups. Fundamentals and research support of empirically supported treatment are presented. Common clinical challenges are discussed, and case examples illustrate general principles.     

Group psychotherapy with the aging gay male: Treatment of choice

This article summarizes many issues facing gay men as they age. Aging for gay men is a complex phenomenon involving identity, self-esteem, internalized homophobia, stereotypes about older gay men, and the paucity of positive gay male images or role models to help direct their development. In this article, I will attempt to illuminate some of the complex variables of aging, as well as illustrate through case examples that group psychotherapy is a particularly helpful forum for skills development for middle age and older gay men. The themes covered include: 1) commitment struggles—especially anxiety management and conflict resolution, 2) self-esteem regulation, 3) projections and internalizations, 4) capacity for intimacy, and 5) unresolved grief and loss due to the impact of AIDS: Alone vs. Lonely.     

Reproductive issues in adults with cystic fibrosis: Implications for genetic counseling

This article reviews reproductive issues faced by the growing number of individuals with cystic fibrosis (CF) who reach adulthood. Approximately 97–98% of males with CF are infertile and they may have an increased risk for genitourinary anomalies. Females with CF may experience delayed puberty, irregular menstrual cycles, and decreased fertility. Women with CF who have good clinical scores, good nutritional status, and normal lung volumes with mild to moderate airway obstruction, have a better chance for successful pregnancies. The role of the genetic counselor in counseling adults with CF is discussed and resources for CF adults are provided.     

A qualitative aspect of learning-sensitive open field ambulation in mice

Maze training was shown to affect qualitative aspects of the learning-sensitive open-field (OF) ambulation in male Swiss albino mice. The changes in thigmotactic (wall-seeking) behaviour were most pronounced when significant signs of learning occurred, usually on the third day of training. Also daily changes in thigmotaxis from before to after training were found. Mice not subjected to maze training exhibited a different thigmotactic pattern of behaviour. The present series of experiments indicated that separate starting-points (centre or wall) influenced the thigmotactic behaviour as opposed to the shape of the OF (circular or square).     

Self-control in male and female rats

Eight male and 8 female Wistar rats were exposed to a discrete-trial procedure in which they chose between the presentation of a small (one pellet) or a large (three pellets) reinforcer. The delay to the small and large reinforcer was 6.0 s in the first condition of Experiment 1. Subjects consistently chose the large reinforcer. When the delay to the small reinforcer was decreased to 0.1 s in the next experimental condition, all subjects continued to choose the large 6.0-s delayed reinforcer. When the contingencies correlated with the two levers were reversed in the next experimental condition, the majority of subjects (5 males and 6 females) still chose the large delayed reinforcer over the small immediately presented reinforcer. The delay to the small reinforcer was maintained at 6.0 s, but the delay to the large reinforcer was varied among 9.0, 15.0, 24.0, and 36.0 s in Experiment 2, in which 4 males and 4 females participated. Most subjects consistently chose the large increasingly delayed reinforcer, although choice for the small 6.0-s delayed reinforcer developed in some females when the large reinforcer was delayed for 24.0 or 36.0 s. These choice patterns were not predicted from a literal application of a model that says choice should favor the alternative correlated with the higher (amount/delay) ratio.     

Biological correlates of social support and pressure at work in managers

The aim was to explore the patterns of correlations between psychosocial stress indices and neuroendocrinological factors in managers. Fifty-eight male managers in three Swedish companies constituted the sample. They answered two questionnaires with 17 selected stress indices and also an organizational test. The indices have been analyzed by means of computations of age adjusted partial correlations with nine different variables analyzed in fasting blood samples. The serum concentrations of lipids were the variables most strongly correlated with psychosocial factors. Neither smoking nor physical activity changed the correlations significantly. Good social support at work and in private life was consistently associated with low adverse serum lipids and corresponding lipoproteins. On the other hand, some indices of social support were associated with indices of high arousal levels. This may indicate a possible psychophysiological “load effect” of some aspects of social support in managers. The analyses of corporate culture measured as “Rules of the Game” indicated that “bureaucracy” was significantly associated with high LDL-cholesterol and low HDL-cholesterol. Managers have special conditions and therefore the patterns of associations between psychosocial conditions and coping strategies on one hand and endocrine-biochemical state on the other hand may be different, from those of other groups. To what extent such differences are due to individual characteristics or environmental factors needs to be further investigated. According to the results, however, good social support is in general health promoting also to managers, at least with regard to serum lipids. Bureaucracy, on the other hand, seems to be dangerous to the health of managers.     

HIV voluntary counselling and testing among recently initiated and traditionally circumcised men in the Eastern Cape Province of South Africa

HIV voluntary counselling and testing (VCT) is a cornerstone of the national strategic plan for HIV/AIDS treatment, care and support in South Africa. However, research shows that the utilisation of VCT services is disappointingly low, particular among males. This article focuses on the factors associated with the intention to test for HIV-infection among recently initiated and traditionally circumcised men in the rural areas of Eastern Cape Province, South Africa. Individual face-to-face interviews were conducted among 1656 sexually active men. Logistic regression analyses were used to explore the association between intention to test for HIV and psychosocial factors. Overall, 35.1% of the participants reported ever having tested for HIV. Intention to test for HIV was positively associated with perceived probability of getting an STI, positive attitudes towards gender-based violence, received general teachings about being a responsible man and highest grade passed. These findings provide specific information that can be used in the development of a focused cultural sensitive STI/HIV prevention programme aimed to increase VCT uptake among sexually active young men, which can be integrated into initiation and health education practices.