The Red Knob

Or to slightly misquote Prendergast’s work - “it’s not just a discourse of pinks and blues”

Whether or not they are aware, practitioners who work around young men’s sexual health issues are encumbered by a theoretical debate which lies at the root of all health work with men: do we attempt to challenge and change men in order for them to reconsider the masculine behaviours which impact upon their heath - or do we work with men ‘as they are’ and make use of male cultures to address men’s health behaviours? Pinks and blues? A feminist and sociology inspired ‘ critical studies on men camp’ and a social marketing, public health based ‘men’s health studies’ camp? Take your pick.

In The Red Knob bunker, surrounded as we are by the arcane research literature of both sides of the argument, and several decades worth of experience between the Knobsters, we happen to think it should be a bit of both - that practitioners need to have a flexible base of practice in order to address needs. What is problematic is that hegemony of practice guidance on work with young men currently lies with the feminist inspired camp that seeks to challenge and change men, to enable men to reconsider aspects of their masculinity. ( At this point it’s worth stating that we have nothing against feminism - indeed we recommend  feminist approaches - where appropriate.) This pioneering guidance was produced around 10 years ago and has provided the basis for work with young men since then ( if you’ve seen it that is… which is another issue…)

This is great where it works - and it does work - but not with all young men. Erudite chaps such as Simon Forrest have written that this may well be because of the lack of skills of some practitioners  - which may well be the case, and addressing that is another blog posting and a whole lot more, but there may well be other factors at work which the theoretical basis of current guidance, sociology and Connell’s ‘masculinities’ does not address - because it is not recognised in sociologist and feminist  literature except in terms of criticism and disagreement. The science is never settled – or at least not in this instance. A ‘factor’ which is criticised by sociologists is that of an evolutionary psychological basis for some of men’s behaviours - an anathema in sociological and feminist terms (McCaughey’s Caveman Mystique provides a good example of this sort of reprobation – for a response take a look at Buss’s The Evolution of Desire).

Whilst this is all grist to the mill in terms of academic argument it is not helpful to practitioners. Let’s say it again - practitioners require a flexible base of practice! To address the ‘how’ we work with young men – we need to know the ‘why’ of why they act as they do. The research points to both sociological and cultural factors, and evolutionary psychological/biological factors as having an influence on men’s health behaviours; this is a concern for sociologists and some schools of feminist thought  - the 2007 Sociology paper  by Jackson and Rees, The Appalling Appeal of Nature: The Popular Influence of Evolutionary Psychology as a Problem for Sociology provides evidence of this stance – a stance against “simplified evolutionary accounts of human nature”. Thus the argument continues with two valid areas of research at variance – and the impact on men’s health is that in a UK context practitioners may( if at all)  only be aware of one side of the debate – that of the sociology side, and hence practice driven by this – and not that of an equally valid field of research – and its potential for practice. (And as for Myers Briggs Type Indicator psychometric tests, extraversion and introversion and relevance to male communication and interaction with others (participation and discussion?)…but let’s not get go off at too many vague tangents. ) Some of this may well be political – a perceived ‘left pole’ occupied by sociology (it’s from the left so it must be right…) and a ‘right pole’ occupied by nasty evolutionary psychologists who just can’t wait to experiment and administer all sorts of medication to sort out society’s ills. Both are simplistic arguments. We need to take the politics out of this – it’s about addressing real health needs not academic pogroms!

If some of men’s behaviours are due to their evolutionary psychology/biology it doesn’t mean that we shouldn’t address those behaviours that are detrimental to health – not a bit of it! Indeed some of this may well buttress  sociological research on ‘masculinities’. What it means is that we need to reconsider how we work with young men, and how we apply research from different fields of research to best address men’s health needs. However, the way in which we address those needs has to be via a social marketing approach that is inclusive of different theories,  makes use of a wider base of the sociological tradition, and recognises the concept of authenticity as well as masculinity.

For those young men who inhabit entrenched masculine cultures, and for whom there is a credibility cost in engaging with approaches based on current practice guidance that seeks to challenge and change their masculinity ( ie whether from our own ethical stance we approve or not, that they’re comfortable with their masculinity and the masculine cultural group they inhabit and are resistant to change) then there may need to be – for some academics and people who write the practice guidance – an uncomfortable reconsideration of practice. That in instances where there are barriers to engagement with ‘entrenched masculinities’ we may need to utilise aspects of masculine culture to work within those cultures to affect change – not use approaches based upon current guidance that in such instances impose barriers to change.

There are examples of work that uses culture to engage with masculine cultural groups – in work with cultures of gay men Terrence Higgins Trust have made use of aspects of gay culture to address health issues, for example The Bottom Line, Below the Belt, and The Manual as visual examples – yet despite a depth of heterosexual male cultures there is little evidence of this sort of approach in sexual health work with heterosexual men – although there is evidence in other fields of practice – for example mental health ( CALM   - although not exclusive to heterosexual men) and in substance use work .

The Red Knob itself provides an example of targeted work with one masculine cultural group – a group that inhabits a subculture with recognisable codes traits and idioms – an authentic subculture; the point is it’s targeted at that group – it’s not aimed at all young men and it won’t work with all young men – but the approach we have developed works with some; others – young men who inhabit other cultural or subcultural groups, and some practitioners, academics and the architects of guidance may well not approve – but it’s not meant for them!

The Red Knob is based upon a social marketing approach. Social marketing is not a theory in itself – merely it provides a framework on which different theories can be hung to create an intervention which in terms of work with young men is most likely to succeed with a targeted masculine cultural group. How did we arrive at a decision to use the approach we use with the Red Knob? We used a simple model developed by a social marketing consultant at  the Central Office of Strategic Information  ( you can view it on the website if you browse through…). We define our approach as a social marketing base of practice.

What is interesting is that whilst much public health and health improvement work has embraced a social marketing methodology open to many theoretical approaches, guidance on practice work with young men has continued to plough a furrow based upon one theory – sociology based masculinities. Things may change. The architects of the previous guidance are currently holding four workshops  - in London, Bristol, Manchester and York, to explore a revision of the guidance on work with young men. May change. It may be that we are presented with examples of ‘what works’ based upon the same old, same old. And if so, we’ll have to try it and see – we cannot be dismissive of an approach that works with a lot of young men – the Knobsters use it themselves. However, there may well be an opportunity lost for another decade – if the architects of guidance fail or refuse to recognise why we need a broader base of the sciences to provide the ‘why’ that drives the ‘how’

The Knobsters have no gripe about turning off the social gender conditioning – of course we must challenge ‘the givens’ where appropriate –but we need balance and flexibility; for all those young men who are happy to talk about issues,  there will also be those who do not – possibly because of the cultures they inhabit and engagement around issues or that engaging with statutory services themselves are problematic – or for others that their psychology, their personality inhibits them from doing so; there is no acknowledgement within current guidance that some young men do not wish to talk about issues – even if we might want them to; we are failing sections of the young male populace if we fail to explore other approaches

This is not a challenge to sociology and feminist inspired academia and practice, neither is it a challenge to a ‘men’s health studies camp’ that recognises the value of evolutionary psychology and biology; this is a challenge for all involved in health work with men – a requirement for a reciprocal and integrated practice that acknowledges a wider base of theory in academia, and one which acknowledges a broader base in the sociological tradition. We can challenge and change – but sometimes guys we need to look beyond our own confines. Young men deserve nothing less.

Filed under: Op Ed