Phone-based crisis intervention and suicide prevention frequently involves guiding a caller toward an (often tenuous) agreement that there’s a reason to get through the next day, or maybe just the next hour.

Toward the end of a recent call, the man I’d been talking to for over 40 minutes summed up the call by saying, “Yeah, I get it…man up.”  He went on to mildly berate me, suggesting that he could have had the same stupid conversation with his dad if his dad hadn’t died.  But I’ll take that as a victory.  He agreed he would stay alive to see his kids on the weekend.

He would not agree to turn his gun over to a friend or family member, which would have helped lessen the likelihood of impulsive, violent suicide.  But, for the time being, he had put it away.  And at least he was calling.

Still, the “man up” comment stuck with me.  I suppose on a greatly reductive level, “man up,” was a component of what I had been saying—especially from the perspective of someone who, based on his interpretation of the world around him, had been getting that message for quite some time–that he needed to just take care of his problems and quit complaining.  But it is not the kind of phrase I would ever use with someone, or the kind of message I would try to convey.

My conversation with him had woven in and out of a number of concerns, with the crux of the conversation coming down to the caller’s children, and his responsibility (like that of all parents) to do whatever possible to ensure their well-being.  It is a conversation I’ve had hundreds of times.

The majority of such calls, involving people who have children but are contemplating suicide, involve the caller expressing that his/her children will be better off without them.  There are a small number of variations on the ‘logic’ behind such a thought—usually involving the children not having to suffer through the heartache of the bad parenting they will certainly continue to experience, the hassles the kids will face by bouncing back and forth between divorced parents, and the notion that the children will “get over it” in time.  If the children are young, callers express that it won’t make that big of an impression.  If the children are older, the parents think the children ‘don’t need me anymore’ or are mature enough to process what happened and move on with their lives.

Never mind the mental twists and turns it takes to imagine that children will have coping skills enough to deal with the suicide of a parent, when that parent doesn’t have the coping skills to deal with loss much less permanent than death—loss of a job, loss of a home, loss of a marriage—or any of numerous variations and combinations of things and people that have gotten away.  Statistical studies show that children of people who commit suicide are at greatly increased risk for attempting/committing suicide themselves.  In an overly-simplistic explanation, the increased risk can relate to genetic factors involved in mental health issues, but it also involves behavior modeling.  Our parents are usually the most significant modelers of behavior in our lives.  And we are all doomed to become our parents.

At any rate, I found myself having the same basic conversation with a woman less than two hours later.  “What messages are you sending your kids if you kill yourself?”  I challenged the cognitive distortions in her justifications for suicide, and explained the threat of her children committing suicide and otherwise potentially being saddled with mental health issues from the suicide of a parent.  Ultimately, we got to a similar end result—the caller agreeing she would put up her pills, and live another day.

But in the conversation with the woman, there was no idea of needing to “woman up”–no need to do what was stereotypically feminine in order to go on living, even though the idea of someone ‘sacrificing’ (in this case, the twist being that sacrificing meant staying alive) for one’s children is something that stereotypically falls more heavily on women.

With the ‘man up’ comment replaying itself in my thoughts repeatedly over the next few days, I realized I was (internally) protesting too much.  The notion that I had a nearly identical conversation with a woman that same night seemed like a defensive position more than a straightforward assessment.

I ran through other ideas, examining the way I deal with men versus the way I deal with women.  For example, any form of counseling involves meeting the client where the client is.  Such meeting includes the client’s perceptions of self in relation to gender.

Still, the client’s perceptions are not the same as my way of interacting with the client.  The client’s perceptions dictate a number of things about how I will approach the client, what thoughts might be challenged and how, for example.  But at base, how I deal with people of different genders is on me.  And I need to be aware of whether those dealings are clinically appropriate or not, whether they are tinged with personal biases about what constitutes being appropriately manly or womanly, or fitting into any other gender identity.

I have no problem acknowledging that I speak to people of different genders differently, and that things such as age, economic status, religious beliefs, education, ethnicity, and a whole host of other concerns can color the interactions I have with them.  An awareness of how clients differ in background falls under a heading of “cultural competence.”  Conducting all sessions or interventions in the exact same fashion would be negligent.

Cultural competence includes the need to avoid approaching clients from any viewpoint of prejudice.  In U.S. culture, with its heavy bias toward the idea of women being nurturing and emotional, and men being stoic and strong, it is easy to fall into a trap of diminishing men who seek support, while being much more accepting of women seeking support.  The underlying concepts of weakness and strength, as relates to seeking support, diminish everyone.  Accepting girls and women who seek support while being less accepting of men and boys who do the same indicates an underlying belief in the weakness of women–the need of women to have support, while believing men don’t–or shouldn’t.

In a context where men are expected to “man up” and take care of their problems, rather than to seek help in processing what is going on with them, it makes sense that many men reaching out for help are, if not hostile, at least pensive and anxious—feeling there is something inherently wrong with seeking help, so taking a position challenging those who might help them.

As a culture, we in the U.S. encourage defensiveness and entrenchment in men—refusal to change—with the exception of encouraging men to become ever harder, ever more willing to engage in aggressive fortifying of their position, with that position often being one of isolation.  The processing men do frequently gets externalized to the point where it is not processing at all.  They, for example, focus on fixing the world, usually by berating the weak, or advocating the destruction of people seen as enemies, rather than addressing the personal in their lives and what such isolation and fortification does to them.

I posit that the gender-stereotyped notion that men need to take action is in large part what leads men to commit suicide most often in a rather violent and impulsive fashion.  When the problem is your whole life, and you’ve been taught that the appropriate response to problems is action, frequently violent action, then ending one’s life can seem like an appropriate reaction when that life has gone off the rails.  Mix in alcohol, drugs and weapons, and suicide can seem a reasonable course of action, and be carried out quickly—a decisive form of action, a manly form of action.

This is not to say that I think men in the U.S. are “victims” of the mental health system or of some pro-suicide/anti-male conspiracy.  Men, whether willingly or unwittingly, participate in, and perpetuate, the stereotypes that trap them…the stereotypes that say seeking help is synonymous with weakness.  And so, long as angry men rail against the “wussification” of the nation, they are advocating for a culture of death before mental health, and ensuring that men will not seek help for mental health issues, or if they do, that it will come with a heaping helping of defensiveness and hostility, potentially putting clinicians in a position of enduring abuse, or having to break down numerous walls, before being able to engage productively with male clients.

So, instead of urging anyone to “man up,” perhaps perhaps there could be a kind of unstated encouragement to “people up”–and not in the reductive way that “man up” is used, but in a way that is expansive.  To “people up” could mean to recognize our responsibilities to one another as human beings, whether that be as parents, clinicians, friends, family members, or citizens.  We need to recognize the harm in gender stereotypes, particularly if seeking help and support is connected to stereotypes of weakness.