Dr. Tepper discusses treatment concerns and offers suggestions for health care practioners.

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Treatment Concerns

As described, the subtle and not-so-subtle messages accumulated over the years can leave men with an acquired disability feeling the loss of manhood. Medical impairment leads to disability and disability, to dependency. Often after a disability, a man moves from a position of independence to a situation where he is forced to depend on his mother or spouse or partner. Dependency makes a man feel childlike, like a non-man. Complicating the matter is that the majority of rehab nurses who the man in the rehab unit or hospital depends on for his basic care are women.

When faced with loss of strength and self-reliance, men are unable to express the fear and despair they are feeling with their new disability since they are trained to mistrust and dislike the more vulnerable and expressive side of themselves (Zilbergeld, 1992). Men’s inability to express fear and despair limits their ability to get comforted, to find release in tears, and may manifest itself in denial or anger. Denial and anger may, in turn, impede the rehabilitation process.

"Because anger is one of the few feelings men believe they can have, it's often a mask for other feelings, especially such as feeling hurt or fear, that suggest weakness. It's much easier for men to deal with anger than these other emotions" (Zilbergeld, 1992) (p.239). Accordingly, men have a tendency to display excessive masculinity when they are afraid and, conversely, to act out of a sense of imperfect masculinity (Pittman, 1991).

Because of emphasis on strength and self-reliance men may deny they need help adjusting (Zilbergeld, 1992). They try to go through the rehabilitation process on their own. They often have trouble admitting they need help and do not want to burden their loved ones with complaints. Therefore, men don't acknowledge worries or fears to providers or partners. This hinders intimacy with their partners which adds distance in a relationship when closeness is needed.

"Men drown feelings in drugs, alcohol, or sex to satisfy need for body contact/touch and distraction from feelings" (Zilbergeld, 1992, p. 30). Therefore, unexpressed feelings over losses may lead to substance abuse. Rehab providers and loved ones may overlook the substance because they feel that the abuse is justified because of the dreaded physical condition the man is in.

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