Michael Gurian on Masculinity, Neuroscience and Psychotherapy

Michael Gurian: As you know, my work focuses on nature, nurture and culture. So, I and my team work in all these areas. On the nature side, the brain differences are quite robust, and it's important for psychotherapists to consider this when working with male clients. In the psychotherapy profession, it’s, “come in, sit, talk for 50 minutes,” and that may be a beautiful match for the female brain in the aggregate, and in general a beautiful match for a brain that does words on both sides, that connects words to feelings and memories on both sides.

It's not as good a match for male clients, who only do words on the left, mainly the front left; who only connect words to memories, are sensorial, and who need more movement, more cerebellum involvement. So, the male/female brain differences, I think, are one of the most important and underutilized parts of our profession. And when we do use them, when we do train people, like when I speak at psychotherapy conferences or do trainings with psychotherapists, their minds are blown when they see the brain scans.

And they say, “Oh. Okay. We'd better take this into account.” And they alter their practices and succeed more with boys and men. So, I would say that's a primary thing. And it doesn't negate LGBTQ clients. Those groups are set up ideologically by people as if they're in opposition, but they're not and their experiences are well-integrated into neuroscience. 

MG: The sit-and-talk method will work with about one out of five males darn well. It sure works with me because I like to sit and talk when I'm in therapy. But we've got to always remember that we also only have about one out of five males in general staying in therapy, boys or men. So, it can work with some, but no. We must expand and use peripatetic methods.

MG: Yes, they're all within that range. Prior to writing Saving Our Sons, I wrote, How Do I Help Him?, which is a practitioner's guide for psychotherapists. And all those methods you listed are featured in that book because I have had success with all of them. They all come within the range of expressive modalities, and I have found that boys and men really like working with sand and art. I've even expanded it to looking at the use of video games in treatment. Graphics allows movement, so yes, all of those are great.

MG: I work with adolescents, puberty onward – 10, 11, 12. I worked with one such boy whose father fought over in the Middle East in Iraq, came back and was struggling with a lot of issues. The boy, therefore, was having issues as well. And we used video games including Halo, and we looked at what were the messages in Halo and what was Halo trying to do for soldiers. He really got into that. And at a certain point I was able to work with the whole family. The dad and the son, who was 13, had a session in which they were working through what the father had experienced in Iraq and his own PTSD using Halo.

MG: I think you know from reading my other work that I have a different vision of male development. Let me preface it by saying that I always caution males and families about videogames. But videogames, even more than the violence in them, are fantasy and not as causal in my mind—and there have not actually been causal links proven between violent video games and violent behavior.

And one of the ways we know that is we look at how violent the videogames are in Japan where there's very little violence. And so, we can do cross-cultural studies and try to really figure this out. For me, the bigger worry is how these games may desensitize kids to violence even though it hasn't been causally proven. The thing that worries me the most about videogames is the whole way that the dopamine system is getting messed up. That's harming male development even more.

For instance, I'm begging parents, “No videogames on school nights—only a couple hours on the weekends.” And I show them the scans and all the research about how this goes. And I show this to therapists too. I'm not a huge fan of video games. I also don't overreact to them. I try to use them. So, if it's a good link to something like for the kid with the dad who returned from war, there was useful language in Halo that I could use in therapy to help both father and son communicate better. I worked with that family to cut back on the videogames out of concern for his brain development even more than out of concern for violence. 

MG:  I don't do much with that. By focusing on toxic masculinity every ten years or so, our culture is recycling an anti-male movement. And we've done this for all the decades that I’ve been in the field, 30 years, and each one has some merit. None of us like bad men doing bad things. I was a victim of sexual abuse as a boy and I certainly am very clear on males who abuse and who rape. None of us want that.

The issue and the reason I don't use the concept of toxic masculinity much in my work is that it's based on a conceptual structure which we would never apply to females. We don't talk about femininity anymore and we don't talk about toxic femininity. Well, with males, what we do is we say, as the APA just said, “Well, you know, masculinity is the problem, especially traditional masculinity. And then it becomes toxic masculinity.” Well, masculinity is not a problem. And, in fact, masculinity is crucial for male development.

And masculinity does include, even though it's a culture construct, male/female brain difference. It includes the male development arc, which is different than the female development arc. It includes all the necessity for males of rites of passage. All these things that come under “masculine,” we simply should not condemn. And one of the primary ways we know that masculinity is crucial to male maturation is through father and absent father studies. So, we can directly link male disturbance, discomfort, difficulties later in life—and a lot of female issues as well—to lack of a father.

What the father transmits to the child is masculine development. So, I think the problem is with the word and what people think is masculine or isn't masculine. And then, of course, we add on “toxic masculinity” whenever we see a guy do a bad thing. And I think it's the wrong frame, and what it does is disallow what I think is the most necessary, which is to figure out what males and masculinity really are and to work with those.

For instance, there are more than 100 brain differences that all of us as psychotherapists have to integrate. If we're arguing about masculinity and toxic masculinity, we're not going to integrate those. We're going to be saying, “Well, guys should be crying like girls do. They should be talking about their feelings in the same way. Why can't they just sit down in my...” And then, “They shouldn't be stoic because stoic is toxic,” which, of course, has been disproven. Stoicism is not toxic. You know, on and on that goes.

I'm very vigilant about male behavior and male accountability. But I don't use that frame, and I think the APA used the wrong frame.
 

MG:  The good thing about the APA guidelines is that our profession has stepped up and said, “Okay. The world isn't a zero-sum world in which girls and women are victims and are struggling and boys or men have privilege and they're doing fine.” In fact, as all of us have been saying for decades, boys and men are behind girls and women. They're not doing fine. They need a lot of help, and they need help from our profession. We are in the trenches as a profession to help them.

I love that the APA did that—it is great and a long time coming. But once they go with a pure psycho-sociology approach in which they never mention the male brain—they just don't mention it—then we're back in the big problem. So, the rewrite for me would be, “Look at all the great stuff in these APA guidelines, but you're not going to change male lives, you're not going to save males, you're not going to help males heal by constantly talking to them about how bad masculinity, and that they shouldn’t be stoic, and shouldn't be aggressive.”

And males are simply not going to stay in our profession. And once they hear it—their wives drag them in, their moms drag them in for the first two or three sessions, they just keep hearing this stuff—they're going to find ways to leave. They're going to say that the therapist doesn't understand them. So, what we have to do is understand them. I would say rewrite the guidelines to spend more time now on understanding how important masculinity is to their development and their maturation, how to work with them based on the way the male brain is set up. 

MG: I gave one example about verbals. You talked about expressives. I'll give another example, which is aggression and a strategy that's a great with males. We're taught not to interrupt, to use our cognitive behavior strategies and to elicit from the client what's going on inside through a lot of listening—a little bit of guidance but a lot of listening.

Well, a lot of guys need us to interrupt them when they go off on tangents, and/or they need us to interrupt them and/or prompt them because they don't have access verbally to the feelings that we are asking them to access. A male brain can take an hour, two hours, a day, two days longer to access that thing we're trying to get them to access in our office. If we prompt them some, we can help them. We were really trained to work with females but weren't really trained to work with male brain.

And, in fact, most or all of us were not given anything in grad school to prepare us to work with males in particular. We came out of grad school thinking males and females are basically the same. Well, now what we do is we practice this strategy. And as they go tangential or as they are trying to figure out the feeling or the memory we're trying to get them to access, we prompt.

And so I will prompt and say, “Okay. So, it sounds like you're saying you got really angry right then,” or, “it sounds like you're saying that actually made you feel ashamed,” something like that, to help them. And then they say, “Yeah. Yeah, yeah.” Or they'll say, “No, no, no,” but then about 30 seconds later, they'll say, “Yeah, and then I felt really bad.” And so, the biggest thing we can do for males is to not see the 50 minutes as a pure listening environment or a mainly listening environment with the assumption that they'll get there themselves.

A lot of guys won't get there themselves. And if we don't prompt them, interrupt their tangents, get them back on track, they won't respect us as therapists. Guys are task-focused, and they want their mentor, who is their counselor now, to really help them. And they don't respect someone sitting there for 50 minutes, listening to them go off on tangents. They just don't respect that. 

MG: Well, male development, because masculinity is such a charged word, you know? I'm an advocate for everyone understanding male development, and I do think our profession isn't as good at that as I wish.

MG: I don't think so. Everyone should be case-by-case. We were talking about the brain spectrum and the one-in-five males, like myself, who can just come in and sit and talk. And then my therapist says a little something. Then I go off on a deep tangent. You know, there are a lot of guys who do that, and they don't need what I'm talking about here. But for the majority of guys, I would not say it's too aggressive. And what it will do is it will keep them in therapy.

I also use spatial and motor activities to get the right side of their brains working. I'll throw a ball back and forth and, as I talk, I'm squeezing the ball. Obviously, most of the talking should be going on with my client. I throw the ball to the client. That excites the right side of the brain, which is completely dormant when all we do is sit and talk. That can create more connectivity. So, then it's his turn. He's got the ball. More of his brain is already active.

He throws the ball back to me. He didn't quite get at it. I say, “I think what you're saying is you were really scared right there. Is that what you're saying?” I throw the ball back to him. About half the time, he'll say, "No. I wasn't scared," because that's a vulnerable feeling. “No. I wasn't scared.” But he'll process. We'll go back and forth.

By prompting him to try to understand that he was scared or for him to say, no, he wasn't scared, he will ultimately say something that's got emotionality to it and maybe he will link to a memory. And then we can get back to the root feelings like fear. We can get back to shame. It may be too aggressive for some clients. I'm case-by-case, for sure. But since we're talking in the aggregate, I think, for males, it keeps clients sitting in our chairs. 

MG: Unfettered masculinity! Boys don't shoot up schools because of masculinity, right? They're mentally ill, depressed. I was asked to look at all the profiles of all the school shooters around 1998 to 2003. I'm going to speak in the aggregate because there's confidentiality there. Basically, all those guys were depressed.

The key element is, when males get depressed, they tend toward withdrawal and/or toward violence. The AMA has worked with this for 25 years. So, I don't bring masculinity and toxic masculinity into my practice. I'm not talking to my male clients about toxic masculinity. It's not my area.

If they're doing something that is wrong behavior—you know, adultery or some kind of violence—of course, I'm pointing that out and I'm working with that. They don't need a frame that says that it’s toxic masculinity. That's not really going to help them anyway. What they need is help with depression. They need help with understanding why they don't have the impulse control to not hit, what is chemically going on for them. That's what they need.

The masculinity/toxic masculinity thing is more a public frame that folks can use, and I believe to a great extent, to avoid what is going on inside male development. It avoids the depression. It avoids all these developmental issues males face by attaching it to a culture construct. So, no, I don't use it much in my practice. 

MG: Absolutely. We have a bunch of guys, and right now it's mainly white guys, who are at the top. They control a lot at the top. So, there's one set of optics that really helps push the concept that males inherently have privilege, especially white males. And that creates then a war—a gender war and a race war—because, of course, tens of millions of males and white males don't have privilege. They are depressed. They're struggling. They can't find jobs. So, we have that mythos and the optics that white males control everything and have everything.

Then we've got the other set of optics, which is a bunch of bad guys who do bad things. Their numbers are not actually very high. If we look in the aggregate of males, it's not very high, but they're constantly reported. None of us like that behavior. And so, the academic universe said, “Come up with a concept.” And that concept was toxic masculinity.

And then we run with that when, in fact, the real life that's lived in the trenches is males of all colors who are struggling, in the aggregate. Absolutely more black and Latino males when we proportionalize that out. But we still have at least nine million white males right now who are without work and who've stopped looking for work and they're not even counted in the unemployment rolls. So, we've got the reality of that.

And then the reality with our male clients is that very few if any of them are becoming violent because of masculinity. They're becoming violent, again, because of mental illness, lack of impulse control, self-regulation—all of these things that are not cultural constructs but rather have to do with the way the brains work and issues that have arisen for them in their family systems. So, as you know, when I'm looking at violent clients, I'm looking for the three actual causes of male violence, none of which are masculinity.

The three actual causes are: 1) neurotoxins affecting cells in the brain, 2) trauma, and 3) under-attachment, especially in infancy, to a primary caregiver. Those three are proven causes of male violence, and those would be the ones that I would be trying to help them with. And in all these cases, they become depressed, and they tail toward withdrawal and/or violence. So, that's really what I work with.

For actual male clients in the trenches, I don't see a lot of gain by us spending a lot of time with cultural constructs that are not causal. Just like I wrote quite a bit in my books on girls, I don't spend a lot of time arguing that girls become anorexic or bulimic because they see images of thin women. That is not causal, right? That is something we've got to get them away from—we've got to get them to stop looking at those images of thin women. 

MG: Oh, yeah, especially the male brain.

MG: Therapists may think of male aggression, even male anger as covering up fear, right? Therapists are often trained to see that as something to avoid or something that may show defect whereas I look for depression. It's not always there, but I know that aggression is one of the ways that the male brain masks depression.

Guys are covert in their depression, and females are more overt. When covert, it hides under anger and aggression. It can also hide under substance abuse. One of the ways that covert depression manifests for males is through substance abuse—they're medicating depression. They may also be genetically predisposed to addiction , and so arises the need to medicate depression. 

MG: The reason it crosses cultures is that it comes in on the Y chromosome. In utero, the brains differentiate male and female, even including the whole gender spectrum. But they still differentiate male and female in utero. So, as these kids come out, yeah, we've got a much more fragile male brain than we realize.

MG: Both brains can be fragile, meaning that they can be vulnerable to neurotoxic effects and trauma. Social-emotional development is tougher for males, especially tougher if they don't have fathers—another Y chromosome in there helping them, and/or male role models throughout the lifespan, but especially ten to 20.

What the male brain tends to sacrifice is social-emotional. It'll retain things like spatial, but we don't have as many brain centers and connectivity. Females do that on both sides of the brain and are oxytocin-driven which is the so-called bonding chemical. If males don't have key relationships early on in life and are then impacted by neurotoxic effects too early, their brains tend to sacrifice social-emotional growth at the cortical level, and it then manifests behaviorally. 

MG: If their role models are bad males, obviously, we don't want them, but most men can provide good mentoring. Coaches can be mentors. Faith communities are systematically set up for mentoring. If kids are in school, we can become citizen scientists and watch them gravitate at five, at six, at seven, at eight to whoever is the male teacher. We also want to remember that female therapists and women are mentors too. This is not either/or. And gay couples can raise great kids.

I beg therapists to create academic systems that support more males so that they can become therapists. A lot of these guys who are raised by single moms and grandmas would benefit from a male therapist. As a profession, we have got to generate more male therapists to be these mentors and then generate more information to female therapists so they understand guys so that they can be mentors too. Again, it's not an either/or. You don't absolutely have to have a male therapist. At a certain point, you're going to need a one, but you don't absolutely have to have a one right now. A woman therapist could do it right now too if we train her in it. 

MG: I love the women who are treating boys, but yeah, it's a systemic problem that started around 50 years ago, assuming and remembering that before between 30 and 50 years ago, most psychologists and psychiatrists were male.

But as we moved toward more verbal literacy and the notion of “use your words” that is practiced in both these professions, we set the profession up to be a verbal literacy platform without neuroscience to understand male/female brains differences. So, males are pulling out and pulling away in stages.

Fewer males than females move into our academy. They're not going to graduate school. They're not going to become therapists. And more males will become psychologists and psychiatrists, but far fewer become therapists. The males know that the academy is doing this—it's inchoate for them; it's unconscious. I don't think they've studied brain science, but they know, “Wow! Am I going into a profession where I'm going to be sitting there with a client for 50 minutes, trying to get this client to say stuff, knowing that for many clients, especially males, it won't work? And for me as a guy, I need to be a certain kind of guy to be able to sit eight hours a day, 50 minutes per hour, in that chair,” right?

So, I think that to some extent, we're losing them at the academy level. And then as they come out, we start losing the men as clients and as patients because there isn't academic training for most of the therapists, who are female, in understanding the male brain. And, we lose them in our therapeutic work with couples as it is generally the wife or the partner who brings the guy in, and it's clear the therapist doesn't know how to work with him. So, he pulls out of treatment as well. He's seen as a failure. So, from the academy to the therapy office, we are losing males because of systemically pervasive attrition. 

MG: Males need time. One thing that doesn't work for anyone, especially males in my opinion, is brief therapy. Outside of that, cognitive behavioral can work, dialectical can work, client-centered as solution-oriented absolutely can work. EMDR is another one that absolutely can work. Client-centered may be problematic because unless the therapists get retrained in understanding the male brain and then accommodate the associated strategies, they will probably have difficulty with the four out of five males who they will then lose. I like a combination.

A lot of my approach is not based on trying to create a new theory, but to teach everyone the brain differences—nature, nurture, culture—and then teach the strategies. At the Gurian Institute, we have about 100 strategies we teach, which clinicians and educators then integrate into whatever theory they have had success with.

MG: What the data will back up is that both coed and single-sex classes are great, but that there are certain ways in which single-sex is better than coed for certain populations, especially middle-schoolers, especially if we want to enhance girls' assertiveness and self-esteem and especially if we want to give boys male role models and help them with literacy.

Separate-sex can be great, and we support that in a bunch of schools. Now, at the same time, in therapy, there's a double reason why we might try separate-sex groups. I did actually lead a couple of women's groups but pulled out quickly because I ultimately said to them, “No. You need a woman,” because they were talking about creating a safe space that is sex and gender-connected.

And for the trans person, they would pick whichever works for them to go with whatever, you know, I would argue is their brain sex, which may be different than their anatomical. You go into that group, and you're in a group of other male brains, or you're in a group of other female brains. And even though male and female are on a spectrum, everyone who gets in that group knows what they're talking about. They know that this is a different energy. There's a different kind of safety here.

You know, the group is just a great modality for getting at important issues because males need to hear other male stories. And females need to hear other female stories in order to feel supported. Males sometimes can't figure out their story until they hear someone else's story. 

MG: Okay, in what age group? Because people mean different things by transgender. I want to know what you mean.

MG: Okay, adolescents. We now can see trans on the brain. And if folks are curious about this, I write about this in The Minds of Girls and Saving Our Sons. I have the new research from Belgium, the Netherlands, Spain and the U.S.. It’s harder to see at nine or ten, of course, but after the hormones hit by mid-adolescence, you can see it. So, we know that trans is on the brain, and we think we know that in around .3%, .4% of people. You can also have someone who's gay, but they're not sexualized yet. They don't understand that they're gay, and they think they're trans. Their parents think they're trans. So, we must be careful about age groups and knowing when we can decide what is what and help the client and the family decide.

So, it's not a “choice,” just like we now know from our biological research that being gay or lesbian is not a choice which was a myth of 20, 30 years ago. It's on the brain. And in dealing with the client, by, let's say, 15, we now can know that this is not gender dysmorphia, that this is trans. I love talking to those clients about the brain scans because it really helps them to feel comfortable being trans because we can point to scans and say, “Look at this. You think you're female-to-male. Some people have told you you're not female-to-male, but, you are because, look, your brain is operating more male than what we call a cisgender brain.” And the other way, if you're male-to-female, “Look. Your brain is operating more female. Your gonads are male, but your brain is operating more female. You are trans.” So, I think talking to them about brain research even if they can't afford to get a scan, is important.

Also, this is a vulnerable population so we need to form groups to support them, especially since they may not be getting group support in a society which still doesn't understand this research and is still arguing about whether trans exists or not. It does exist. We've just got to be aware it only exists in this small population.

Finally, it's still going to be important to work with these clients around depression and anxiety because that brain is a human brain that's still going through the issues that all adolescents experience. So, while there is first and foremost the trans issue, we still need to help them with depression, anxiety, anorexia, bulimia and ADHD. 

MG: I think the certainties that we're grappling with are mainly a culture-focused approach to our profession and not a brain-focused approach. I just look at how many psychotherapy conferences I am invited to speak at. Very few! At those conferences, there is very little discussion about male/female brain differences. There are these political and ideological certainties that come out of a cultural/academic perspective. I would say we need to set aside those cultural certainties around masculinity and look at the brain research. Just hold off for six months and study something else.

What I know works from 30 years of doing it and all this data is that we must study the male and female brain and study and inculcate how to work with the male brain. And once one starts doing that, a lot of those other cultural certainties will drift away, while some of them might still stick. And then we've really tested out those culture-based certainties with hard science, neuroscience, and applying neuroscience in our profession.

And that, I think is the big challenge for our profession right now. And I hope that people will read this and will say, “Yeah. Let's get Gurian in our conference. He'll be controversial. Some people will think he's saying something weird,” which I'm really not, “but let's get this into psychotherapy more and spend more time on the actual brain and especially the male and female brain, since it's mainly males we lose.” That would be my advice. 

MG: No. I generally do keynotes, and so I'm invited. I don't go through the process. I just am so busy and so in demand, that when I've been invited, it's been to do keynotes.

MG: Yes, especially in the areas of sex and gender where we've turned our back. I mean we're still doing neuroplasticity and other wonderful brain research. But when it comes to sex and gender, our profession is very much ruled by more of a culture perspective. And especially regarding males, it's ruled by the concept that “we tell boys not to cry, we tell them not to open up. That's why they suffer,” which is, you know, just very, very thin. But that's the perspective. And since that's the perspective in sex and gender, I would say we've turned away from the brain. In other areas, I think we are very brain-friendly.

MG: ’Til I die.

MG: Thank you so much. You're wonderful. Thanks for having me.