The crying man and the content of sadness

In the latest in our series on men and masculinity, psychologist Roger Bretherton reflects on what he learned about being a man from his own mid-life crisis.

Roger Bretherton

Roger is a Clinical and Coaching Psychologist.

A person stand looking out a wide set of windows covered in rain.

Daniil Onischenko on Unsplash.

My midlife crisis began with crying. Alone. In the car. In the study surrounded by books. Curled up on the bathroom floor. Waves of sadness crashed over me, and I couldn’t hold them back. So sudden and inexplicable was this lapse into grief that I felt the need to keep it to myself. It was shameful. It took a month before I finally told anyone and even then, my hand was forced by bursting into tears in front of them. They wondered if it was hormonal. Maybe I was eating badly or sitting still too much. But I knew the sadness had content.

I was slowly being crushed by the feeling that I had failed to be, or missed the opportunity to become, the man I was supposed to be.

It is difficult to make sense of such sadness though. It doesn’t come labelled with its own meaning. It fails to announce itself. It doesn’t ride into our consciousness on a unicycle waving a sign that reads: you are now sad about getting old and feeling like you have failed as a man. It takes a bit of detective work to find out what it all means. But in the end, I had to acknowledge that I was slowly being crushed by the feeling that I had failed to be, or missed the opportunity to become, the man I was supposed to be. In the three areas of life that mattered most to me, family, work, and church, I was a failure. I knew that’s what I thought because my tear ducts started twitching whenever I said it aloud. Of course, I couldn’t get anyone to agree with me. It’s not a fact. It is a massive unrealistic incapacitating overgeneralisation. But apparently the poor twisted neurones of my emotional brain had failed to get that memo.

Every feeling of failure implies a vaguely defined sense of the success that could have been ours but has been lost. If I had failed as a man, what kind of man was I supposed to be? I came to realise that I had unintentionally imbibed a seductive model of masculinity that was ultimately unachievable. For want of a better term I came to call it the man-at-the-centre. The man-at-the-centre game is really easy to play. It is a simple rule of thumb for what any man should be. It works in any context you can think of, and goes like this…

What should a man be at work? He should be at the centre of a team of adoring colleagues.

What should a man be at home? He should be at the centre of an adoring wife and family.

What should a man be at church? He should be at the centre of an adoring congregation.

The man-at-the-centre game requires that every situation a man enters should immediately configure itself into a picture postcard in which he holds pride of place.

Obviously, this view defines masculinity entirely in terms of power. And not even the kind of power that makes any sense. Not the power to be wise, or brave, or generous, or fair, or honest, or loyal. But the power to force other people be exactly as we would like them to be. The insistence that social life is only acceptable if made to conform to our exact specifications. The man-at-the-centre equates masculinity with being in charge, and even the tiniest lapse in control as a failure to be a man, a surrendering of one’s right to exist as a male. Kierkegaard summed up despair in precisely these binary terms, the desire to be Caesar or nothing.

A one-way ticket to Blametown

I can’t be sure if this insight is true of ALL men, some men, or just me. Maybe it has nothing to do with masculinity at all. Perhaps I’m just describing my own narcissism. But either way, it’s embarrassing to admit that I even thought this. I don’t even know where this belief came from. It goes against everything I have stood for in support of women, and in collaboration with men. It is quite frankly a ridiculous thing to believe - and yet there I was, just as surprised as anyone else to find myself believing it. It turns out the old church billboard was right:

You are not what you think you are; but what you think, you are.

And I don’t really want to chalk it up to The Patriarchy. Whenever anyone starts on about The Patriarchy, I have the ominous feeling I’m about to be blamed for something. It reminds me how I used to feel when I worked in mental health services in the NHS.

Two- or three-times a year it seems the national media are obligated to run a story about the inadequacy of care for people with mental illness. Usually based on a report about people being let down. The catastrophic failure of care for young women with eating disorders, or young men with depression, or women on the autistic spectrum. The stories are heartbreaking, and everyone agrees that something must be done. As a lowly frontline worker, nobody blamed me, but I knew that in the weeks that followed I’d be subjected to something that felt very much like blame. No one said it was my fault, but the demands, the hours, the targets, the scrutiny, the bureaucracy would proliferate. None of it would solve the problem, but those who were trying to help would not go unpunished.

So, as a one-way ticket to Blametown, I’m not keen on too much talk about The Patriarchy. But when I consider my hardwired tendency to think of masculinity as the man-at-the-centre, and the despair that accompanies the failure to definitively accomplish this, am I not describing something a little bit like patriarchy? A social system that offers men such a restricted view of what it means to be male, that almost no one can be happy confining themselves to it. An invitation to inhabit a narrow bandwidth of conversations, interests, clothing, emotions and sitting positions so as not to score an own goal for the men’s team by betraying weakness. It’s not like any of this is working for anyone but, beyond exorcism, what can we possibly do about it?

The real Man-at-the-centre

It's not a huge surprise that this midlife crisis struck when it did. Every crisis has a context. Every breakthrough starts with a breakdown. Sometimes I feel like I invited it, because for the last five years I have been practicing contemplative prayer. Twice a day – on a good day – I hole up somewhere alone. Sometimes the study or the bedroom, my office at work, a bench in the park or a seat by the window. I pray in the same places I cry. The twenty-minute timer on my smart phone begins and ends with the sound of a monastery bell. And when it is set, I close my eyes and follow the simple rule of contemplative practice: lifting my heart to God with a humble stirring of love. And for twenty minutes that is all I do. In response to every distraction or entertaining thought, I turn from the noise of my mind back to being lovingly present to the mysterious Presence in the present moment.

Among all the well-intentioned ideas, initiatives, and apps that promise a solution, this is the only answer that has truly addressed the crisis of my own masculinity.

One of the central tenets of contemplative prayer is that when we make space for God like this, we not only meet Him, but we also meet ourselves. I don’t think my insight into needing to be the man-at-the-centre would have been available to me, if I hadn’t been practicing its polar opposite several times a day. In the discipline of contemplative prayer, we decentre the ego, we step over our self-absorption, we fill our consciousness with something that is not us. My experience of it is that when I turn to God with love, I find myself held in a vast field of loving attentiveness, infinitely greater than my own. And over time, this creeps into every corner of life, infecting every moment of contact with family, friends, colleagues, and students with the supreme joy of simply being there for that unique unrepeatable moment of their existence. Whether I am the man-at-the-centre of home, work or church becomes an irrelevance. What matters is not what these situations give to me, but what I can give to them.

This speaks to the supreme paradox at the heart of Christianity. One that is in constant danger of slipping through our fingers. If we grasp it too hard it crumbles in our hands. It stems from the fact that there is a man-at-the-centre of the Christian religion. Arguably the most famous man of all time. Depicted in icons, brushed into frescoes, melted in stained glass, moulded in sculpture, and portrayed on camera. His face appears everywhere, and if we are not careful, we may mistakenly assume that we are celebrating his fame – the greatest influencer ever born. But what makes Jesus the man-at-the-centre is not the ingenuity with which his publicity machine crowned him king of the hill, but the absolute giving of self that characterised his life. The real Man-at-the-centre is the radically de-centred Man.

Personally, I find there to be a seamless continuity between the Jesus I meet in scripture, and the Spirit that animates the life of prayer. Among all the well-intentioned ideas, initiatives, and apps that promise a solution, this is the only answer that has truly addressed the crisis of my own masculinity. Not a humiliation of masculine power, but a profound transforming and redirecting of it. It is the only thing I have yet found that can truly photosynthesise the carbon-dioxide of fear, rage and self-hatred that suffocates so many men, into the liberating oxygen of joyful loving strength that is their birthright.

Article

Care

Change

26 July 2024

6 min read

Are we forgetting how to care?

The profound act at the heart of nursing.

Helen Cowan

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient

Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care. Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions?

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers.

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’.

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care.

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?”

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness.

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.”

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.