Show Him Some Love: Men Need Friendships, Closeness | Opinion

The highly lauded 12 Oscar-nominated film, The Power of the Dog, underscored the deep emotional connections in male relationships that are often painstaking and unsanctioned, feelings that also resonate with many men off the screen.

The 2021 Saturday Night Live skit, Man Park, has nearly 4 million views as it pokes fun at this lack of social connection among men. Even though the term "bromance" addresses the lifelong connections of male friends and is saluted in popular culture through TV shows such as Scrubs (J.D. and Turk), Game of Thrones (Jon Snow and Samwell Tarly) and Friends (Joey, Ross and Chandler) and in films like The Lord of the Rings trilogy (Frodo and Sam), Ocean's Eleven (Danny and Rusty) and Star Trek (Kirk and Spock), the reality is that these characters embody a level of closeness that is aspirational for most men.

A 2020 report by the United Health Foundation and the AARP Foundation found that approximately one-third of U.S. adults report that the longest they have gone without interacting with others outside their household since the start of the pandemic was between one and three months.

Now more than two years into COVID-19 restrictions, that stretch of time is even longer. While social attachments of many Americans were suffering even before the arrival of COVID, recommendations for social distancing and stay-at-home orders made physical isolation even worse. Men are particularly at risk.

Approximately one in five American men said they do not have a close friend, according to the Survey Center on American Life's May 2021 American Perspectives Survey. Only 30 percent of men reported having a private conversation with a close friend when they divulged personal emotions in the past week.

As a practicing psychiatrist for 17 years who has seen firsthand the untoward effects of pandemic quarantine in my patients, the consequences of this detachment are dire.

Loneliness is not strictly gendered and affects both men and women and all those across the gender spectrum.

Societal venues that create spaces for affiliation among men, including fraternities and varsity athletics, have also not had the desired effect. Some have had outright dangerous effects by promoting male bonding through denigration of others, including women. The problem of loneliness remains: Friendship is more than just affiliation and requires substantial investment of time and emotional energy for both men and women.

Loneliness increases risk of mental illness among men. According to a March 2021 study, persistent loneliness independently predicts risk of Alzheimer's disease. Additionally, psychiatric illnesses such as major depressive disorder often go unrecognized in men due to reluctance to discuss one's symptoms.

Progression of clinical depression over time may result in suicidal ideation, and men often use more lethal means of self-harm than women. But social support has well-known protective effects on mental health. A 2021 United Kingdom study demonstrated that men with higher self-reported loneliness are at increased risk for suicide but the risk was partially attenuated by living with another.

Men with high self-reported loneliness also suffer more physical health problems. U.S. Surgeon General Vivek Murthy has championed the need for greater recognition of the deleterious health effects of loneliness and social isolation in his 2020 book, Together: The Healing Power of Human Connection in a Sometimes Lonely World.

Additionally, a 2022 Danish study in the Journal of Epidemiology & Community Health demonstrated that a cumulative number of years living alone predicted higher inflammatory markers among middle-aged men. When unchecked, ongoing systemic inflammation incurs a greater risk of death.

Research from Finland showed loneliness predicted early mortality among men ages 42 to 61, including deaths from cancer and cardiovascular disease. Loneliness also alters immune responsiveness and can detrimentally decrease vaccine efficacy.

Mid-life can be an intense period of adjustment for most men. For many men, middle adulthood serves as a timepoint to review all one has done and what one still has left to do with limited years remaining. These realizations may be unsettling and are neglected by our current mental health care system.

A man sits on a rock
A man sits on a rock to watch the sunset in Los Angeles, Calif. FREDERIC J. BROWN/AFP via Getty Images

Psychiatric specialists exist for youth in child and adolescent psychiatry, for older adults in geriatric psychiatry and for women in women's mental health specialties. However, no specialty exists for the challenges that accompany mid-life for men, even though the concept of a "mid-life crisis" has become widely colloquial since its introduction by psychoanalyst Elliott Jacques in 1965.

Although Jacques' idea of a stagnant period in middle-aged men has received criticism, the idea still has traction in American consciousness. Stresses imposed by multiple and competing roles of partner, father, son, brother and professional (among others) can serve as a useful anchor point for connection in male friendships.

The "alpha male" trope damages male friendships as American gender stereotypes condition boys and men against empathy. Displays of physical and emotional affection are at best not reinforced and at worst scorned as the antithesis of masculinity. Other non-Western cultures have no such double standard.

Men in India hold hands as a gesture of friendship but not romance, and such behavior is not a blemish on masculine self-concept. Stereotypical stoicism and indifference—the "boys will be boys" motif—are increasingly recognized as maladaptive and harmful to social development.

Instead, male friendships benefit from deep emotional connection. In a 2021 study published in Current Psychology, disclosure of emotional distress between men improved psychological well-being, increased feelings of being understood and resulted in less reported loneliness.

A partner or spouse may not be enough to address loneliness. Male friendships may become more detached after a committed romantic relationship starts and as more time is invested in one's partner.

Some may argue that a dedicated spouse or partner is all that is necessary in mid-life, but this counterargument is overly reductionist.

Recently, an older male patient told me he wanted to die; his wife of 50 years had passed away and his chronic medical problems were exhausting. He lambasted younger generations for a perceived poor work ethic and vehemently criticized the medical establishment as unreliable.

Since the pandemic, he said he felt increasingly isolated. When all social engagements moved to "virtual," he felt virtually nonexistent—no cell phone, Wi-Fi or companionship.

In subsequent sessions, he spoke of his military service and regaled the men he met—honest, humble and dedicated men who would willingly scout a foxhole first to save his life. But after he married and left the service, these friendships did not last.

And despite all the vitriol, he never permitted our conversations to end. Bereft of any other social connections, his loneliness was palpable. In time, he found hope in our conversations, and he wanted to connect with other older adults through resources provided to him, albeit apprehensively.

As COVID has magnified the desire for human contact for every person, it is important to acknowledge that for everyone across gender identities, social networks have been stifled at substantial cost to themselves and society.

It is as important as ever now for everyone to connect with their closest friends to cultivate enduring friendships that aid their physical and emotional well-being.

Charles Hebert, MD, is director of the Psychiatric Consultation Service and associate professor of psychiatry and behavioral sciences at Rush University Medical Center, and a Public Voices Fellow of The OpEd Project.

The views expressed in this article are the writer's own.