S5E16: Conversations About Toxic Masculinity

Mariam: My brownies are world-famous. You guys don't even know. They key to them is that you have to under bake them because I think the altitude affects your baking. Did you guys know that? So I under bake and they're perfect.

Neil: Why is that a thing?

Mariam: I don't know. I bet there's some scientific reasoning behind it. We'll figure it out after this, Neil.

Harjit: Yeah, I think that's a great activity for Neil and Mariam.

Sajjad: Biochem majors, they can unite.

Harjit: Yeah, they can unite and be excited about altitudes.

Hi, everyone. Welcome to "Bundle of Hers." This is Harjit in the virtual studio. We also have Mariam.

Mariam: Hi.

Harjit: And then we have two really special guests joining us today. They are both medical students. So we have Sajjad. He's a second-year medical student. Hi Sajjad.

Sajjad: Hi.

Harjit: And we also have Neil. He's a third-year medical.

Neil: Hi. Thanks for having me.

Harjit: Hi, Neil. I'm really excited about our conversation today. It's been something that I think as the "Bundle of Hers," we discuss a lot of our stories in medicine. And a majority of the people that speak on this podcast are talking about identities that are underrepresented. So a lot of times we've had women come and speak about their femininity and how it impacts their lives.

But one thing that we also felt like was underrepresented is the actual discussion about masculinity. It's a concept that we all are aware of, but we don't really talk about it. We thought it'd be great to have this conversation with the both of you, so we're thankful that you will be part of the podcast today.

I wanted to start with this question. What does masculinity mean to you, and when did you know your masculine being? So we'll start with Sajjad.

Sajjad: Oh, put me on the spot. Okay.

Harjit: Yeah.

Harjit: Well, I guess, first of all, I guess from growing up, it felt like it was always just placed on people who were born as males. That's this thing that was ingrained into, I guess, me growing up. As I progressed, I realized that really wasn't the case and there's more of a balance.

So for me, masculinity means leadership, assertiveness, dominance, masculine. I don't know if there was an exact moment where I realized it, but it was more of, I guess, imposed just growing up. A present given to you would be a car. Or if I cried as a kid, my mom would be like, "No, you shouldn't cry. You're a boy. You're a man. You're a boy. Don't cry." And I guess, over time, it just kind of got imposed, this masculine ideology, I guess.

Neil: Yeah. So I think Sajjad touched on something really interesting, which is that when you're a really young kid, a lot of what you learn about masculinity is in the context of being told what not to do. Being told that boys don't do this, men don't do this.

Then the other half is kind of the . . . I remember feeling pressure when I was very young just because people like my parents and extended family would make comments like, "Oh, you are going to take care of us when you're older. You are going to do all these things." And this sense of being a caretaker and provider definitely comes to mind.

And I was thinking yesterday night about when did that actually start? Why do I think that? And it was probably around the same time I figured out that I was a boy.

Harjit: And how did that pressure make you feel? Do you feel like it was in line with what you wanted?

Neil: More or less. Everyone wants to take care of the people they love, but it hits a little different when you're a 5-year-old kid and your mom is telling you, "Oh, yeah, you are going to do this."

Mariam: I have a question for both of you, actually. Was there ever a point growing up where you had this realization that this wasn't working for you, these masculine standards, or the pressure more so associated with it? Did you guys ever have that moment, or was that something more so just you accepted it and this is just the way of life? Did you have a critical moment?

Neil: Yeah. So not the pressure necessarily, but I'm not a super loud person. I'm not a super assertive person. So a lot of this assertiveness and trying to be a leader and take control of situations was really not working for me. That's just not what my personality is. If I ever did try, it usually didn't go well because I just wasn't feeling it.

Sajjad: Yeah. For me growing up, I was a lot more, I guess, emotional, growing up here in the States. Just [inaudible 00:04:00] my siblings too and just in general. It could be cultural, it could just be ideologies coming from my parents, but it was always instilled onto me to not be so emotional and almost forced out of me, I guess.

I struggled a lot, I think, going through just school. I was always the shy kid, quiet, and I didn't really talk much. Over time, I felt more pressure to not be that way, to be more assertive or more dominant, be more outward in who I am and make myself present and known, have other people be aware of my presence.

I think a lot of that shaped a lot of my personality because I struggled quite a bit trying to find that space where I could balance . . . trying to balance and trying to figure out where I fit in social circles, I guess.

Harjit: I kind of want to touch on that a little bit, Sajjad and Neil, what you talked about, the emotional part or not being the loud one but being someone who is thinking about things within themselves and then acting.

We think of masculinity and something big in masculinity is weakness. And if you have weakness, that's tied to shame. And vulnerability is seen as weakness, right? The emotional self, the self that expresses what they want or what they feel because they have to be in control. They can't share that, right? It's difficult because a lot of times it's required to be vulnerable to have a connection, may that be with your friends, your family, people you work with.

What I'm hearing from both of you is there were some qualities in masculinity that you felt were in line with your true self, but there were also qualities that weren't in line with your true self.

Kind of along that line, have you guys ever heard of the term "toxic masculinity," and do you ever feel that's something you've struggled with?

And I just want to clarify for the listeners, when I say "toxic masculinity," I'm not saying masculinity is toxic, but the ways that it is changed into behaviors can sometimes cause harm to every single individual regardless of their identity.

Sajjad: When I think of toxic masculinity . . . And I love how you said that you're not saying masculinity is toxic. It's just there are behaviors within that that are toxic, and I 100% agree.

For me, I remember when the rhetoric of toxic masculinity came about and I was really infatuated by it. So I had a lot of time to introspect on it. Cultural norms build this thing about what being a man is or what manhood is, or these things that are kind of imposed on boys growing up. It's projected in a way that's in direct opposition to being feminine or womanhood, in general. It's always presented in that way.

I think, as a result, it gives this sense of masculinity a sense of entitlement to certain things. And it almost feels like, a lot of the times, that entitlement results in a lot of if things don't go the way that they feel the entitlement in, it results in things of aggression, anger, all these things that I would say are deemed toxic.

A lot of the times, it's with individuals that don't even really realize the effects of how they were raised are manifesting in that way. It's almost like they weren't ever given the tools to realize that that is toxic.

Neil: Yeah, I agree with Sajjad 100%. When other people are teaching you what it means to be a man and all the things that you're supposed to be, you are supposed to be special or remarkable in some way. And then, obviously, as an adult, even as a young adult, that doesn't always manifest in the way that you expect it will or that you want it to. And you're also not really encouraged to exercise your emotional intelligence. The ways that it makes people act out, I think, get pretty nasty.

In terms of toxic masculinity, I've struggled more with not living up to the toxic ideal. You are supposed to come into a room and be a presence. Not always even in a positive way, but people are supposed to know you're there and you're supposed to make your mark somehow.

I guess that's one of the lessons that I feel I learned that I decided is kind of stupid, is that you should be memorable or leave a mark in some way, even if it's not completely positive.

Harjit: Oh, that's so interesting.

Neil: I think so. And I think kind of the implicit thing that that rides on is that if you're a man and you're taught all these things about yourself, about what you're supposed to be, and someone is reacting negatively to your presence, that's not really your problem because you're being exactly what you're supposed to be.

Harjit: Wow. That's kind of deep.

Mariam: I know. I'm speechless.

Harjit: That emotional intelligence, because it's not something that we exercise, we're not . . . I mean, as a masculine trait, you're not supposed to be aware of what people are thinking. You're just supposed to be aware of yourself and how you're making yourself known. I think that's something that I just thought of when you said that.

Sajjad: For some reason, the one thing that pops into my head is Batman. Growing up, I loved Batman. But if you really think about his traits, it is in a lot of ways toxic. He has this misogynistic view over how he treats women and how it's depicted in comics and in the movies and the shows. He has this aggressive nature to him. And when he's little, he's bullied for being emotional and that manifests in the way it does. I don't know. I just think of Batman.

Neil: That's a great one.

Mariam: It's funny that you mention Batman, because I happen to love Batman. So now I'm thinking of why I love Batman, and it had me thinking of how as a society, in general, we kind of romanticize a lot of traits of toxic masculinity, right? That kind of emotional unavailability, that misogynistic attitude. And I was just thinking about, especially in the ways that we're raised, we're kind of taught to expect those types of things from the men in our lives.

When I first heard the term "toxic masculinity," it clicked for me, but it clicked in a different way than it obviously clicked for you guys. For me, I didn't feel like I had to necessarily embody toxic masculinity. I felt that, growing up, I had to admire these traits when, in fact, I did not admire them, right?

Hearing that term for the first time and kind of being critical about these traits for the first time created this really interesting dissonance.

There's a new Batman movie that just came out. So now I'm going to watch it and I'm going to kind of be really critical about the reasons why we romanticize these characters in a sense.

Harjit: You know what's so interesting? I think that being men of color, the view of toxic masculinity is much more overt. And I need to say this because I do know that people who are in the dominant society in America, white men also embody some traits of toxic masculinity. But with BIPOC individuals, and I will be very straight up with especially black men, it's a huge thing that's shown, right?

So I guess I want to complicate this conversation further and ask you how your racial and ethnic identities interact with your masculinity.

Neil: In a lot of brown cultures, and Indian culture certainly, there's a much more strict adherence to that kind of script. Men are supposed to be men, women are supposed to be women, and if you behave in a way that kind of breaks from that mold, people will notice. They will say it to your face. They'll be confused. And they'll want to know, "Why are you doing that? That's not manly." They will even phrase it like that.

Harjit: I've seen that. What about you, Sajjad? What do you think?

Sajjad: I think that it does impose. It's very strict gender roles, especially in my culture. I mean, you'd probably say our cultures are very similar.

And I can speak on this from a perspective that I have from my mom because my mom played a very unique role when it comes to the culture in general. So my mom is a very masculine being, but it's not normal in a culture that we come from because typically they're pushed down on and they're suppressed.

It's been very unique just hearing her stories because of how much of society she had to fight just to be who she was. And she always talks about how just because she knew more than some of the men around her . . . She was able to even physically do stuff that other men can't. She's a very capable woman, can almost fix anything in the house. Doesn't need any help from anyone, really. She always does it herself.

I don't know. It still confuses me to this day, because even though she was that way, she still imposed certain gender-specific roles growing up. So that always confused me.

I think I went a roundabout way to answer your question, but . . .

Mariam: It's really interesting that you say that because . . . So Sajjad and I are both Afghan, and my mom kind of embodies a lot of masculine traits too. She was put in a situation where she kind of had to be a little bit more independent.

I was just thinking about how interesting that was too, because my mom will also kind of . . . Even though she kind of embodies these "more masculine traits," she doesn't necessarily punish me, but she'll reprimand me for doing the same thing. And it's so interesting to see her step into that role, but then step out of it.

Especially thinking about it in a cultural context, you both mentioned there are these really strict gender norms. And I sometimes think that those gender norms are built out of trauma and kind of a necessity to make it in a new place.

I think about how a lot of our parents came from different places and they suffered a lot of different things, a lot of different traumas, a lot of different systems. I think sometimes we think specifically about communities of color, and we think about these gender norms and toxic masculinity particularly in these communities, and you have to talk about the specific challenges that people experienced within these communities that kind of forced those gender norms.

Neil: I think that's spot-on because when you do interrogate a little bit, I feel like people have a hard time giving you clear answers. But at least for the folks I've asked, like Indian folks who are older than me, it comes down to it's because that's the best division of labor to ensure survival.

At least for most of us that have parents or grandparents that immigrated to the States, that context is totally irrelevant to us. But there's something about gender roles in particular that just cuts really deep and is hard to let go of.

Harjit: It's a generational thing, right? That's why, I guess, I asked you all in the beginning, "What does masculinity mean to you?" because there's a societal side and then there's your personal side.

And I think that we never get the opportunity to find our individualism within our masculinity and femininity, because I truly believe we all embody both characteristics. But that's where it's like you have to pass it on generation to generation because it was probably a part of survival. I guess that's why we live and we've been critical and we're having this conversation, is to really understand ourselves.

I grew up with a lot of qualities that I thought were masculine because I thought I had to be that way to get what I wanted, so people would notice me, and I made a mark.

And I think this comes back to what Neil said. A lot of it is about making a mark. I thought I had to embody masculine traits, even though I feel like personally I was closer to feminine traits, just so I could prove myself. And it led to a lot of distress in my life, which I'm now coming to terms with.

But I do wonder a lot of stuff that you don't process and get in anger and isolation, how does it change who you are? And can you practice who you are?

How do you think your masculinity has impacted your personal and professional life? Neil, what do you think?

Neil: I feel like people are . . . either new people I meet or just folks from my family, they're waiting to respect me, if that makes sense. They expect that they'll meet me and I'll have all these positive qualities and I'll be someone that they want to get to know and respect and, in exchange, will take care of them.

But there are a lot of positive qualities that you feel attributed to you from the get-go. And if you do even the barest minimum to live up to those, you get to kind of own it. I think, overall, people treat me pretty nice.

Harjit: Because you're a man? Is that what you're saying?

Neil: That's what came to mind first when you asked that question, and I think that's because I'm one of the . . . there aren't a lot of men in my family. Most of my cousins are women. I have a younger sister who's two years younger than me, pretty close to age. And there is a difference in how much attention they pay to all of us and to me, in particular, especially when I came here and started going to school and all that. And I think it was based on that, "Oh, he's the one who's going to take care of us."

Harjit: I see.

Sajjad: Yeah, I can definitely relate to what Neil said. Family, I'd say very similar to what Neil said, mainly because . . . So my dad passed away when I was 11. I have an older brother, but he suffers from certain mental health stuff that he goes through. So I guess a lot of pressure was put on me to provide for the family in some way or show that I'm going to do that. And as a result, that's manifested in ways of respect and I'm viewed a certain way within my family.

People that I haven't even met . . . I'll talk to random people in my family and I've never met them, but they'll treat me a certain way and I can visibly see that it's that way. I think it stems from just the amount of, I guess, trust or whatever that my mom has placed in me and how she expresses that to everybody else. And that kind of manifests in that way.

So a lot of it comes from my mom because, obviously, it wasn't always the case. A lot of it was my brother initially, but once he started to "not live up to the expectations" that I guess the family had on him, it switched.

I can literally remember when that happened too, just from me being more empowered in the family versus when I wasn't. I was kind of under the radar doing my thing and nobody really paying attention to then all of a sudden making that switch. And that was very evident for me.

Harjit: So we're all in medicine, and I guess I see a lot of masculinity in medicine. It's very apparent. How does this topic or this conversation kind of translate to medicine, and what are your thoughts on that?

Neil: I think people in the hospital respond really positively to masculine energy. And that refers to docs who are precepting me, residents, other staff, patients even. They want to see you come in and act like a man basically, come in and have confidence whether you feel that internally or not.

You should walk into the room and kind of leave an impression and really own the encounter in a way that feels maybe a little more showboat-y and aggressive than I would do it in a casual social context. But so far, I feel like that behavior has been rewarded. People have responded really positively to that.

Harjit: I have another take. I do think it's rewarded and responded well to, but I always wonder how that impacts patient care, patients' agencies, and having that talk of connection and vulnerability and what they understand about their illness.

How can they not depend on you? They're getting this medication from you. You're helping them with a certain thing, but how can they then create tools that they can utilize so they can move forward or have forward progression in their life in that way or growth?

And I'm probably saying this from a psychiatric perspective because I think my conversations with patients that are both men and women and the way they view me is probably quite different. But I do know that there are the assertive doctors, which are listened to and patients abide by, but then there are also the ones that sit there and kind of have those emotional connections.

And the reason, Neil, I say that to you is because I know you do both. We've conversations of how you talk to your patients. I think that, yes, confidence is rewarded, but how do you also then have vulnerable conversations with your patients?

Neil: No, this is true.

Harjit: Yeah.

Neil: So, usually, I think I start out kind of how I was talking before with that demeanor. And then in the first meeting or maybe a subsequent meeting, depending on how things go, I tend to soften up and almost be myself more, and then that's when I ask other questions.

I feel like when you're putting on a show like that, it becomes easy to kind of blow off concerns and not listen as closely as you should to things that aren't going to fill in some box in your acronym for history of presenting illness.

Harjit: What do you think, Sajjad? How do you see yourself? I know you're still in second-year, but something you're looking forward to. So what are your thoughts on this?

Sajjad: For me personally, I think I would probably approach it just how I usually would be in normal conversation. I guess it would be more of like a trial and error to see what works and what doesn't. Just seeing from outside perspective and hearing from other people, the assertive and the masculine approach is what's best received by patients.

Obviously, you touched on very important things of those vulnerable conversations and these times where some conversations are more tough to have, and it can be very insensitive coming from a more assertive or dominant approach. Some of those things have to be approached differently.

I don't know. I think working to try to have that balance, because I think the profession in itself does demand you to be a certain way to be successful at least. I'm not saying that there are people who have approached it differently that haven't been successful, but historically speaking, people that are I guess more naturally leaning feminine tend to take on too.

And it makes me question or wonder about how that impacts their personal lives, because they have to be a certain way or they're forced to be a certain way. I hope that you guys can talk about this is. They're forced to be a certain way in that dynamic, but then they have to force these changes or be more natural to themselves and trying to put on an act to be a certain way. How does that affect your personal relationships and your personal lives?

Mariam: Are you asking us?

Sajjad: Yeah. I'm just curious because it's something I've always wondered.

Mariam: I'm going to just give the caveat. So Harjit can speak to this more because she meets with patients more regularly. I'm a second-year still. But in, I guess, the limited amount of time that I have seen patients or even in the work that I did prior to this, I think there is something to be said about having confidence.

I have a hard time associating confidence with just being a masculine trait. Some advice that I get a lot from my female mentors will be, "You deserve to take up space. Take up more space just like a man would." And so, in that sense, I understand it, right?

But I also think there's something to be said about having softness in a patient interaction, having those pauses, listening. Just like everybody alluded to here, you build trust with your patients that way when you're actually listening to them.

And I think, historically, we're led to believe that we have to act a certain way and have this more "masculine energy" so our patients trust us more and we seem more competent. But at the end of the day, like Harjit said, that really impacts patient care, right? Is that really taking care of your patients, or is that all about putting up a show?

I kind of understand the utility of putting up that show. And this might change because I haven't had a lot of patient interaction, but I think something that I've been trying to be more mindful of is just being my authentic self with patients.

And I think Harjit . . . I haven't seen her with patients, but just knowing who Harjit is . . . I really want to hear your take on this, Harjit. I think that's a really powerful thing. I think you end up taking care of your patients a lot better by being your authentic self, because I think people can sense that.

Harjit: Yeah. I think, Mariam, you basically hit the nail on the head of what I was going to say. I think confidence is rooted in self-concept and understanding oneself. And that means you are able to identify what are your feminine features, what are your masculine features, and then using them as your strength, right?

And so for me, I am assertive because I want what's best for my patient. So I go in there and I'm like, "Hey, this is what I'm seeing. What do you think? Do you agree with me? Do you disagree with me?" I let my patients question me.

But I feel like even when they question me, I still have confidence on why I'm allowing them to question me. It's because I'm helping them strengthen their understanding of their diagnosis so that they can feel empowered and have the confidence that they're being treated the way they should be treated.

I totally agree with all of you. It's very much taught in our education that we have to be "assertive" and show strength and show leadership in the way that people see it. But is that the only way to live a life? No. I think there are a lot of paths that one person can take to reach the same outcome.

Even this conversation, I hope that all of us think a little bit more about what we're raised as and what we're told to do and what's rewarded, and what feels like us and what really is centered in who we are as people.

When I think of masculinity in medicine, you'll see it the way you're treated. Even as a resident, I have had to do a lot of things on my own.

I remember this particular conversation, which I had with a co-resident of mine. There was a nurse. They were basically not listening to me in a sense because I needed some patient's dressings changed, and I called them and I said, "Okay, fine." I just got tired and I'm like, "I'll do it myself."

And then my co-resident, he was like, "Hey, do you want me to call the nurse? You shouldn't be doing that yourself." He then called and the response was completely different.

And this is just one story in a lot of stories, but I think that there is that advantage of being a masculine being in medicine because that's what it's set up for. But does that mean that that's the only way things need to work? No.

Mariam: This system was built for men. Think about our demographics, right? I think we still have a long ways to go in terms of changing the system. But I think it's important to think critically about how to change the system, but especially as men, how you guys can also challenge those masculine "standards" within healthcare.

Neil: I think part of it is the way you act. I think a lot of it is things you choose to say out loud and the conversations you have with others. I don't think it's necessarily enough just to, on a personal level, bring that softness or act differently with patients or with staff.

Every day, you notice someone either judging or acting differently or actively trying to punish someone for acting in a way they don't like. When you're in a position where you're able to do so without some catastrophic retaliation against you, I think you have to be a little mean about it and bring it up and make somebody feel bad for doing a shitty thing. I think that's scary to do, though, especially in your workplace, especially in a hospital.

Harjit: So you're saying challenging people, Neil?

Neil: Yeah, in addition to kind of those personal-level changes. But I don't think it's enough just to embody the change you want to see. I think you have to tell people about it.

Harjit: Okay.

Sajjad: Yeah. I mean, I would agree with Neil. I think that's perfect, is holding our peers accountable. It is a very male-dominant field, and as a result, it is up to the males to hold the other males accountable if they are presenting with traits that are toxic, that we've been talking about in terms of in the healthcare space.

If it's being presented in a certain way . . . The example that you brought up, Harjit, about the nurse. A situation like that, the co-resident holding the peer accountable. Obviously, it shouldn't have to go to that point, idealistically not go there, but unfortunately it does. And being aware that these things exist, having that accountability in place, and just like Neil said, calling them out and holding them accountable.

Harjit: Well, thanks so much, Sajjad and Neil, for sharing that. I think it's important to be something, but then also express it so people notice. And I think that's kind of what both of you have mentioned, is externalizing your feelings because you may have that advantage of people respecting and listening to you, right? Challenging those thoughts and embodying those masculine traits in a way that it's healthy for you and people around you.

I'm really grateful you guys had this conversation with us. It's very much the opposite of what we were talking about with masculinity, where I think vulnerability isn't rewarded, but you both were very vulnerable on this episode. So we thank you so much for that.

Is there anything else you all wanted to share? It's okay if you don't. I just need to know.

Neil: No. Just thanks for having us on.

Harjit: We are so grateful that the listeners are going to be listening to these topics. If you have any thoughts, please let us know. You can follow us at @bundleofhers on Instagram, and also find us at www.bundleofhers.com, and listen to us on all platforms.

It's good to be able to have this conversation, and hopefully you all have reflections and this is maybe something you can share with other people as well.

Thanks for being a part of our episode, y'all. Bye. I'm really bad at the "bye," Mariam.

Mariam: Bye.

Harjit: Bye.