Masculinities and mental health: a look at the management of health care offered to men in a municipality in the Northeastern SertãoAbstract
This article analyzes the relationships between masculinities and mental health based on the care provided to men who access the SUS in the Pernambuco hinterland. Anchored in gender studies and contributions from the field of masculinities, it understands psychic suffering as a socially situated experience, crossed by gender norms, power relations, and structural inequalities. The research adopts a constructionist theoretical-methodological approach and was conducted in a CAPS III, using interviews/conversations with mental health professionals. The analysis of discursive practices examined repertoires about gender, masculinities, and health that inform the management of care provided to men. The results indicate that, although professionals recognize the influence of gender norms on the experience of male suffering, these understandings do not always translate into care practices. There is a persistence of a biomedical logic marked by the centrality of symptoms and by referrals for psychiatric hospitalization. The study also identifies professional strategies aimed at building a bond and adherence to treatment, problematizing the risks of reinforcing gender stereotypes. It is concluded that the critical incorporation of discussions about masculinities in mental health practices is essential to improve care and promote more comprehensive and equitable attention to men.
Keywords:
Mental Health; Masculinities; Health Care
Resumo
Este artigo analisa as relações entre masculinidades e saúde mental a partir do cuidado ofertado a homens que acessem o Sistema Único de Saúde (SUS) no Sertão pernambucano. Ancorado nos estudos de gênero e nas contribuições do campo das masculinidades, compreende o sofrimento psíquico como uma experiência socialmente situada, atravessada por normas de gênero, relações de poder e desigualdades estruturais. A pesquisa adota uma abordagem teórico-metodológica construcionista e foi realizada em um Centro de Atenção Psicossocial (CAPS) III, utilizando entrevistas/conversas com profissionais da saúde mental. A análise das práticas discursivas examinou repertórios sobre gênero, masculinidades e saúde que informam a gestão do cuidado ofertado aos homens. Os resultados indicam que, embora os profissionais reconheçam a influência das normas de gênero na experiência do sofrimento masculino, essas compreensões nem sempre se traduzem em práticas de cuidado. Observa-se a persistência de uma lógica biomédica marcada pela centralidade dos sintomas e por encaminhamentos para internação psiquiátrica. O estudo também identifica estratégias profissionais voltadas à construção de vínculo e à adesão ao tratamento, problematizando os riscos de reforço de estereótipos de gênero. Conclui-se que a incorporação crítica das discussões sobre masculinidades nas práticas de saúde mental é fundamental para qualificar o cuidado e promover uma atenção mais integral e equitativa aos homens.
Palavras-chave:
Saúde Mental; Masculinidades; Cuidado em Saúde
Gender and mental health: a brief discussion
This article proposes a dialogue on gender and masculinity within the theme-field of mental health. Discussing the intersection between gender and mental health requires a critical examination of categorizations, as they tend to reduce the complex human experience and constrain the multiple ways of existing.
Mental health can be understood as the product of sociohistorical processes that shape subjectivation processes, knowledge, and practices. From this perspective, recent literature on medicalization, biomedicalization, and pharmaceuticalization shows that nonmedical issues are repeatedly converted into “disorders” and that the gender dimension must be addressed intersectionally, especially in the Latin American context (Caponi, Mazon, and Bianchi, 2023). This approach highlights the field’s transdisciplinary complexity. It reveals how social inequalities, equipment, and moralities permeate psychological distress and its management, including patterns of psychotropic medication overuse among privileged groups and, simultaneously, barriers to access among vulnerable populations.
We should underscore that these forms of distress arise from power asymmetries present in social relations and from the persistent, rigidly defined gender roles and identities throughout history. In this regard, distress is not considered a psychopathological category; rather, it is also viewed as an intersubjective experience that mediates everyday interactions (Andrade, 2010).
Ana Paula Andrade (2010) argues that mental health and gender are important dimensions of the subjectivation process, influencing both public policies and care approaches in mental health services. We note here that subjectivation processes are understood as the ways through which individuals constitute themselves as subjects based on relations of power and knowledge and on the reflexive and intentional relations through which they seek to understand, regulate, and transform themselves.
Along the same lines, Benedito Medrado and Jorge Lyra (2008) underscore the importance of analyzing gender from a relational perspective, interpreting social dynamics through the lens of the inequalities produced by the male/female binary. For the authors, gender operates as a mode of subjectivation that permeates the experience of psychological distress; disregarding its marks weakens mental health analysis (Medrado and Lyra, 2008).
When gender is adopted as an analytical category, the asymmetries in people’s constitution, configurations, and relationships become explicit in subjectivation processes and in interpretations of this distress. Thus, subjective forms of malaise assume the shape of a particular social configuration, requiring an analysis that is situated and sensitive to the hierarchies that produce them (Santos, 2009).
Thus, gender, as a subjectivation regime, is understood to guide ways of thinking about and intervening in mental health, in dialogue with Judith Butler’s proposition of gender as a historical-discursive norm (Butler, 2008). This interpretive lens also appears in the literature on public policies, which reveals dynamics of medicalization that particularly affect women who use public services. Masculinity norms also continue to shape access, engagement, and forms of mental health self-care: men tend to delay seeking services, negotiate meanings of “strength” and “self-sufficiency” when they become ill, and report care pathways marked by institutional and relational barriers (Rocha and Zucchi, 2025).
Analyses of the implementation and management of the Brazilian National Policy for Comprehensive Men’s Health Care (PNAISH) indicate discontinuities and weaknesses in federal coordination, resulting in the limited reach of actions specifically directed toward men and difficulty translating guidelines into care routines (Brandão, 2024; Medrado et al., 2024). In Primary Health Care settings, participatory strategies and organizational arrangements designed with male users and teams show potential to expand receptive care and access, provided that they confront the culture of the “man who does not get sick” and reorganize flows and practices (Rodrigues et al., 2023).
Moreover, care experiences are permeated by work- and class-related markers, producing asymmetries in recognizing distress and providing support (Albuquerque, Assis, and Campos, 2024), as well as by multiple gender markers, with trans men and transmasculine people facing additional barriers to access and receptive care (Pinho et al., 2025). In summary, recent literature converges on the need for policies and practices informed by masculinities – and sensitive to gender norms, class, and intersectionalities – to reduce underuse, strengthen therapeutic bonds, and improve the quality of public care provided to men.
Given this context, the Extended Clinic constitutes a relevant strategy within the Brazilian Unified Health System (SUS) by operationalizing Singular Therapeutic Projects jointly developed with users and teams – centered on therapeutic bonds, continuity, and shared responsibility – and by activating Matrix Support to connect Primary Health Care and Psychosocial Care Centers (CAPS), improve interprofessional work, and redirect access pathways. Reviews and practice-based studies describe the Singular Therapeutic Project (PTS) as one of the principal mental health care strategies and show the post-pandemic updating of Matrix Support to sustain shared plans and integrate care levels (Mattos and Gutiérrez, 2023).
Within this approach, it is essential to consider the gender values and ideals that circulate within the professional field itself. In many situations, insufficiently problematized assessments of affects and behaviors – regarded as “appropriate” or “inappropriate” for men and women – may distort diagnostic interpretations and care planning. The purpose here is not to identify those at fault, but to determine how gender relations become institutionalized and are reproduced in service routines, producing asymmetric effects and calling for practices to be reviewed (Medrado and Lyra, 2008).
In light of this, the following question arises: if socially constructed truths about gender produce psychological distress by regulating subjectivities, how do they guide – or fail to guide – care in mental health services? Therefore, this article’s general objective is to reflect on the care provided by the Brazilian Unified Health System (SUS) to men in Pernambuco’s Sertão region and, specifically, to examine the discursive repertoires – that is, the ways of speaking, arguing, and describing the world in interactions through which meanings are constructed – concerning gender, masculinities, and health produced by mental health professionals in this territory, problematizing whether and how these conceptions inform their practices. To this end, we consider the contrast between the limited visibility of masculinities in policies and the availability of frameworks such as the PNAISH, questioning the gap between the normative text and care routines.
Masculinities as a social construction of gender
Michael Kimmel (1992) and Mara Viveros Vigoya (2018) offer fundamental reflections on masculinities that are central to this study. Kimmel (1992) believes that masculinity is neither genetically inscribed nor fixed in a “current of the collective unconscious, waiting to be actualized by a particular man, or simultaneously by all men” (Kimmel, 1992, p. 135). Masculinity is a social construction that occurs at relational, contextual, and historical levels. Accordingly, one of the principal analytical strands focuses on masculinities as political production, and this is the strand adopted here. We are aligned with studies on the politics of contemporary masculinity, which approach gender through its historical construction and take the feminist perspective as a reference.
Colombian anthropologist and researcher Mara Viveros Vigoya (2018) makes important contributions to this debate through her analyses of masculinities that articulate gender, power, and intersectionality in a Latin American context. She also problematizes masculinity not as a universal or fixed trait, but as a set of historically situated categories and experiences permeated by social power relations, including race, class, and territory. This perspective contrasts with essentialist interpretations that treat “the masculine” as something natural or homogeneous.
In her work “The Colors of Masculinity: Intersectional Experiences and Practices of Power in Our America”, Viveros (2018) argues that masculinities manifest in diverse ways in Latin American societies and are shaped by social, cultural, and historical dynamics specific to the region. She emphasizes that these masculinities are intertwined with power relations that operate intersectionally with categories such as race and class, implying the need to examine the multiple “colors” or facets of ways of being a man in concrete contexts.
Viveros also engages with feminist studies and takes a critical stance toward the tradition that marginalizes analyses of men within gender theory. She says that understanding masculinities requires shifting attention away from hegemonic and universal positions and considering men’s particular experiences in social contexts marked by structural inequalities, such as those characterizing many Latin American countries.
In summary, Viveros’ approach to masculinities highlights: (1) that masculinity is socially and historically constructed and is neither natural nor homogeneous; (2) that it is necessary to analyze how gender intersects with other forms of inequality, such as race and class; and (3) that the study of masculinities in Latin American contexts must consider practices of power specific to each place and historical period.
Understanding this historical and situated dimension requires considering the struggle for dominance, taking as a reference the central definition of masculinity, which is invariably constituted through normative gender standards. This dominant definition provides both material and psychological advantages but, at the same time, allows contestation or modification over time because it is a historical construction (Connell1, 1995).
The feminist interpretation of gender is grounded in the critique of an established truth. From this perspective, recognizing the relational dimension of gender becomes essential. Gender is thus approached as an effect of relations among men, among women – considering inequalities arising from class, gender, sexuality, and age group – and between men and women – gender inequalities – within a given social context. These relations are based on power asymmetries. From a feminist perspective, the concept of gender is, therefore, a political strategy for problematizing inequalities resulting from sexual differences (Medrado, Corrêa, and Lyra, 2016).
It is, therefore, necessary to reject the binary opposition that claims permanence and fixity and to adopt a historical and analytical understanding aimed at deconstructing the terms that naturalize sexual difference (Scott, 1995).
In patriarchal culture, this difference is expressed hierarchically, as the masculine is fixed at the pole of authority. However, although patriarchy is a dichotomous historical organization in which male dominance and female subordination prevail, not all men benefit equally from this configuration (Connell, 1995). This is because masculinities are constituted simultaneously in relations between men and women through gender inequality and among men through inequalities based on sexuality, race, and other factors (Kimmel, 1998).
Within this relational organization among men, according to Djalma Thürler and Benedito Medrado (2020), there is a central model of masculinity whose reference point is a White, middle-class, heterosexual, cisgender man in early middle age. This model becomes the standard for other men and ultimately defines as inadequate those who do not conform to it (Kimmel, 2016). In the specific context of men’s health, we should recognize that hegemonic masculinity points to an ideal model of being a man (Connell and Messerschmidt, 2013), situated in the positive valuation of risk (Spink, 2001) and in distancing oneself from care – whether providing or seeking it – because care is coded as feminine and, therefore, abject.
The inequalities arising from this ideal model generate psychological distress and are harmful to so-called “inadequate” masculinities, as those who do not reproduce or perform these valued characteristics are excluded from subject status. This has been confirmed throughout history: when we revisit the men who were the first patients in asylums, they were men who did not fulfill the social roles of provider and worker, either because they did not wish to or were unable to do so, or whose performance was deemed insufficient. This group included men who were sexually and affectively oriented toward other men or who showed an inclination toward celibacy, which involved not only refusing contact with women but also rejecting the idea of marriage (Engel, 2008).
Moreover, with regard to sexual practices, the emerging social configuration at the time determined that men should perform the role of “macho,” which, according to the masculine moral standards of the period, required them to be procreators; otherwise, they were labeled mentally ill or abnormal (Engel, 2008). Thus, masculinities are understood as historical constructions that vary across cultures and over time within the same culture. They also differ within the same culture because of local specificities and change throughout each man’s life (Kimmel, 1998).
The notion of hegemonic masculinity designates a normative arrangement, historically situated in the West, that establishes socially constructed “truths” about what counts as being a man. It is not an essence, but a pattern that varies over time and across cultures and also differs within the same culture according to regional and territorial markers, among other cleavages such as class, race, and sexuality. Moreover, individual trajectories reconfigure these norms throughout life (Connell, 1995; Kimmel, 1998).
Within this framework, the “macho” is not a creation specific to a particular region, although the Western hegemonic pattern is permeated and reformulated by territorial culture. It is, therefore, understood as a historically constructed position that articulates gender and regional belonging and values attributes culturally associated with the masculine, such as virility, courage, strength, and resilience in the face of the territory’s material conditions (Connell, 1995). Recognizing this local tradition legitimizes its characteristics and then destabilizes it when necessary, thereby increasing the visibility of other ways of being a man that coexist in the region.
Methodological procedures
This research was guided by Social Constructionism, which entails deconstructing culturally rooted notions by questioning regimes of truth inscribed in conceptual constructions. Adopting a constructionist perspective invites a review of conventions, based on the understanding that they are rules constructed in a specific society at a particular historical moment (Spink and Frezza, 1999). Moreover, the study adopted a qualitative approach because, according to Maria Cecília Minayo (2017), this approach addresses the human event by emphasizing its social reality.
Within this logic, the study was conducted at a Type III Psychosocial Care Center (CAPS III) in Pernambuco’s Sertão region. Information was produced through interviews/conversations within the service’s daily routine. They were held in the staff meeting room at times selected by the professionals, considering the small number of professionals present at the service and the possibility of reserving the room exclusively for this purpose, thereby safeguarding the privacy and confidentiality. According to Vera Menegon (2013), interviews should be approached critically with regard to their legitimation, while conversation should be understood as a social practice available for producing information in the field.
Based on this conception of the interview as a conversation situated within the service’s daily routine, the interviews were conducted using a predefined guide addressing central themes to the research objectives. Nevertheless, the guide did not operate as a rigid boundary, as new questions were formulated whenever deemed pertinent, providing greater fluidity to the interactions. With the participants’ consent, all interviews were audio-recorded and subsequently transcribed. In total, five professionals from the CAPS III Mental Health team participated. Four had higher education qualifications, and one had secondary-level training. Three were men, and two were women, and all had worked at the service for at least one year. We emphasize that we chose not to provide a more detailed categorization of the participants because the study was conducted in a medium-sized city, where relationships are closer and the service under study had a small professional team. Thus, more detailed descriptions could jeopardize the participants’ confidentiality and anonymity.
This study is nested in a broader research project approved by the Human Research Ethics Committee (CEP) and, therefore, complied with all applicable ethical requirements. The interviews/conversations were conducted with the authorization of the Municipal Health Secretariat of the municipality concerned and after the interlocutors who agreed to participate had provided written informed consent (TCLE).
The analysis of discursive practices was conducted from a constructionist perspective to identify regularities and contradictions in the participants’ repertoires (Spink and Frezza, 1999). This method understands language as actively used and encompasses both its regularities and different forms of repertorization (Spink and Medrado, 2004). Therefore, aligned with Mary Jane Spink and Benedito Medrado (2004), the study aimed to analyze social events by placing their particular and general dimensions in tension in order to transform the social order through the construction of tools that support such change.
From this perspective, in which language is understood as a social practice and meaning production as situated and relational, the interviews in this study were analyzed using the Ideas Association Map (Spink, 2010). This analytical tool organizes transcribed excerpts from conversations in tabular form to preserve the sequence of interactions and make visible how questions, comments, and responses are articulated within the dialogical flow, allowing the interpretive process to be followed without separating the utterance from the conditions in which it was produced. Within this logic, the map functions as a tool for visualizing the interanimation of utterances, facilitating the identification of meanings that stabilize, shift, or become contested throughout the encounter, as well as the connections among repertoires, themes, and stances that emerge within the researcher-participant relationship.
Results in dialogue
In the field of Mental Health, listening, from the first contact onward, entails being fully receptive to the user’s narrative and, beyond diagnosis-oriented listening, creating conditions to co-analyze distress regarding the individual’s history and life context, avoiding protocol-driven reductions and supporting the development of Singular Therapeutic Projects (Pedigone and Signorini, 2023).
However, listening in services remains excessively focused on symptoms, which may hinder the identification of situations of distress or those that exacerbate illness, especially those arising from gender inequality and the specific difficulties faced by men. Supporting this observation, one of our interlocutors, Carlos, emphasized that, unfortunately, there is still a tendency to medicalize distress rather than truly listen to it. In other words, medication is used to erase distress, rather than to minimize symptoms so that this distress can be cared for in other ways. He stressed that this practice is even more evident in care provided to men, because of both cultural barriers and structural limitations, such as service operating hours that are not conducive to men’s participation.
According to Carlos, psychological distress is frequently silenced or treated exclusively with medication, which compromises qualified listening. In the case of men, this situation is aggravated by cultural factors that make it difficult to express vulnerability. Particularly in the case of men, we can observe a pattern of care that favors the medicalization of distress. This approach reduces the practice of listening and, consequently, the possibilities for subjective elaboration, which may aggravate distress and hinder care.
This care model is centered on biomedical and curative logic and is frequently adopted by health professionals when caring for men, reproducing what Schraiber et al. (2010) criticize as generalist care that is detached from gender issues and focused solely on signs and symptoms. The hegemonic model of masculinity, grounded in the denial of vulnerability, hinders the recognition of psychological distress by rendering gender inequalities and the relational dimensions linking masculinities to distress or illness invisible. Influenced by cultural norms, men themselves often resist acknowledging these states as they attempt to reaffirm their strength and differentiation from the feminine (Machin et al., 2011).
However, as noted by our interlocutor José, once a therapeutic bond is established with a male user, treatment adherence tends to proceed more smoothly. The professional also noted that, unlike women, who generally open up more readily, men initially show resistance but become engaged in the therapeutic process as a relationship of trust is built.
Thus, when the therapeutic bond is established, a significant change in treatment adherence and continuation can be observed. A relationship of trust between the professional and the user becomes essential to care continuity. José also emphasized that the health professional’s gender can facilitate the bond with male users. He says men tend to feel more comfortable when cared for by other men and show resistance when women provide care. In the professional’s view, this preference appears to be related to cultural factors, as men seeking help believe that a professional of the same gender would be better able to understand them because they supposedly share the same experiences and difficulties. At his workplace, three male nurses have facilitated this process, as many male users identify with them and choose them as reference professionals to whom they report their problems.
Therefore, one element that stands out in the practices observed is the influence of the professional’s gender on the formation of this bond. Many men show greater openness to expressing themselves to professionals of the same gender, which may be related to identification and the perception that the other person shares similar cultural references and experiences. The presence of male professionals has, therefore, been used as a strategy to facilitate the therapeutic approach with users, with these professionals acting as facilitators of the care process. This gender-based identification strategy has made it possible to work around the cultural factors that prevent these users to express their feelings and, consequently, to reduce the interference of these factors with treatment.
The professional Roberta also commented on the strategy of using male professionals to facilitate treatment adherence, especially in cases of resistance to medication. She says men generally feel that they are being understood when guidance comes from another man because they believe he would understand their difficulties more realistically. The interlocutor affirms that this perception is frequently used as a strategy to prevent treatment discontinuation, particularly when medications cause significant adverse effects, as in the case of Haldol.
Despite its apparent effectiveness, this strategy raises concerns about the risk of reinforcing sexist values that discredit the knowledge of female professionals. Assigning greater legitimacy to the words of a male professional may indicate an essentialization of gender roles, reiterating stereotypes that associate the masculine with authority and understanding at the expense of women’s technical competence, which ultimately goes unrecognized. This perception points to the need to problematize the cultural foundations that sustain such conceptions, permeate health services, and ultimately underpin care provision and care seeking practices.
In contrast, professionals have developed certain strategies to overcome the cultural obstacles imposed by hegemonic masculinity. The strategy highlighted by Carlos concerns building a bond with male users. He reported that, in his practice, he seeks to respect each individual’s subjective time without pressuring people to disclose their concerns immediately. He affirms that it is essential to allow users to feel comfortable and safe enough to present their needs when they are ready, even if this occurs long after the first contact. This approach seeks to create an environment of trust in which care can be provided with greater depth and effectiveness.
Respecting the user’s time, without any pressure to disclose their concerns quickly and allowing these concerns to be addressed well after the first contact, enables users to discuss them more comfortably and constitutes a practice that favors developing more effective care. Moreover, professionals’ use of personal accounts also appears to create a horizontal bond and a humanized therapeutic relationship.
In this regard, Carlos mentioned that, during this process, he usually shares some of his own experiences to promote identification and facilitate the bond. He also emphasized that respecting the user’s time allows addressing more complex themes gradually, favoring more qualified listening. He observed that distress often has no single cause, but rather involves a set of factors that must be understood patiently. Mental health care provided to men continues to be permeated by normative gender models. The organization of services often reinforces this logic by assigning different referral pathways to men and women.
This fact is illustrated by Carlos, who observed that, in general, women are more frequently referred to social assistance services, such as the Social Assistance Reference Center (CRAS) and the Specialized Social Assistance Reference Center (CREAS), especially in contexts of violence and ruptured social bonds. Men, in turn, are more frequently referred to psychiatric hospitals when experiencing extreme distress, even when this does not necessarily result from a professional’s direct decision, but rather from a suggested course of action within the service.
Thus, while women are more frequently referred to social assistance services such as CRAS and CREAS, men tend to be referred to psychiatric hospitals in situations of intense distress. This difference reveals a tendency toward psychiatrized men’s distress. In contrast, women’s distress is understood more broadly within its social and relational contexts, especially those marked by gender-based violence and the rupture of affective bonds.
From this perspective, Carlos described the case of a particular male user who was referred to the social assistance network several times because of a severe violation of his rights and intense distress. However, he acknowledged that this was an exception. In general, men are ultimately referred for psychiatric hospitalization as a means of preserving life when their distress exceeds the limits of the support offered at the unit. He added that, in his experience, only one woman had received this type of referral, and this occurred because of problematic medication use that further aggravated her distress.
Marcos’s account corroborates this perception. According to him, many of the men who arrive at the mental health service do so through referrals directly from the psychiatric hospital. He reported that a substantial proportion of the male users cared for at the unit had already undergone previous hospitalizations or were hospitalized after beginning outpatient treatment. He also observed that, proportionally, men remain hospitalized for longer periods than women.
These accounts reveal a gender-based distinction in referrals and in how distress is managed by services, revealing an undeclared pattern that reflects deeply rooted practices. The prevalence of psychiatric referrals for men and the referral of women to social assistance services indicate different views of these individuals, possibly influenced by normative conceptions of gender and social expectations surrounding masculinities and femininities.
Although not always explicit, this distinction in referrals points to an institutional pattern that operates differently by user gender. In cases involving men, the predominance of referrals for hospitalization indicates a persistent perspective that associates extreme distress with personal risk and, thus, requires institutional control. In the case of women, distress tends to be more contextualized, allowing approaches that encompass other dimensions of social life.
These practices reinforce the biomedical model in care provided to men, operating on the basis of signs and symptoms while neglecting the relational and subjective aspects of illness. This finding calls for criticism of medicalization sustained by a gender culture that conceals the complexity of masculinities and their implications for the health-illness-care process (Schraiber et al., 2010). Moreover, it reinforces the need to reconsider mental health care strategies that can overcome the invisibilization of men’s distress without simultaneously reproducing gender stereotypes.
Some professionals’ sensitivity in recognizing that men’s distress is permeated by social demands, such as the provider role, unravels cracks in the traditional logic of listening centered solely on clinical complaints. Cultural pressures related to productivity, financial responsibility, and the impossibility of failure create a context of anguish that is often silenced. Listening to these forms of anguish, therefore, becomes a political act of resistance to the dominant care model, which continues to insist on rendering the gendered marks of illness invisible.
In summary, the analysis of practices in mental health services in the Pernambuco Sertão region reveals an urgent need to revisit care models, especially with regard to men care. There is a need to develop strategies that address the singularities of men’s distress without reproducing the logic of hegemonic masculinity, thereby enabling care that is more sensitive, comprehensive, and politically committed to gender equity.
This situation becomes evident when recent research addressing masculinities and mental health is analyzed, as the findings demonstrate that the logic of hegemonic masculinity continues to guide and define care relationships. For example, a study conducted in Paraíba (Sá and Camêlo, 2024) addressing the social representations of mental health constructed by male university students showed that these men focused on strength and courage, with a corresponding devaluation of affective responsibility toward themselves and others. Although the importance of mental health care was recognized, expectations to perform self-sufficiency and avoid showing vulnerability continued to weigh heavily.
However, this logic is not sustained only in the Northeast. A study conducted with male users of mental health services in Santos, São Paulo (SP) (Rocha and Zucchi, 2025) explored how constructions of masculinity intertwine with narratives of distress and how individuals articulate self-care practices. The findings indicate that feelings of personal and professional failure – unemployment, inability to perform one’s usual work, and self-esteem undermined by illness – and disappointing relationships involving affective losses and betrayal – for example, women in family roles were expected to meet care expectations that were not always fulfilled, causing pain – ultimately generate isolation, shame, and guilt. These emotions are central to men’s distress and are frequently articulated with external expectations related to work and affective relationships. These narratives evidence how the model of hegemonic masculinity intertwines with men’s distress.
Moreover, this study reveals the ambivalence of these men’s self-care strategies. Although there are attempts at conformity – following treatment and seeking help – there is also resistance, modified medication use, and attempts to cope with distress in less institutionalized ways, which may either help or pose risks.
All of this reinforces the need to revisit care practices directed toward men, considering the issues involving the model of hegemonic masculinity and the distress arising from the social constructions that sustain it. It is also necessary to consider the local cultural issues that permeate it and ultimately produce specificities, without losing sight of the fact that these are grounded in the hegemonic discourse on masculinity that, by definition, sustains them but also extends beyond them.
Final considerations
We should emphasize that psychological distress arises both from inequality in social gender relations and from rigid established gender roles and identities. Our interlocutors believe that these historical and social factors contribute to men’s greater difficulty in expressing their distress.
Although professionals’ discourses on gender, masculinities, and health recognize the importance of historical and social aspects, these considerations are often not reflected in everyday care practices, revealing a lack of articulation between these discussions and professional practices. As a result, issues arising from gender inequalities and the specific difficulties faced by men tend to be rendered invisible. However, some interlocutors reported efforts to develop strategies for approaching and caring for these men.
From this perspective, the analysis of masculinities in mental health care gains depth when viewed through the lens of intersectionality, because experiences of distress, access, and continued engagement with services are shaped not only by gender but also by markers such as race, social class, territory, educational attainment, generation, and sexuality, which operate jointly in producing vulnerabilities and privileges. Thus, the difficulty in expressing pain and seeking help attributed to expectations of masculinity may assume different meanings according to concrete living conditions, producing differentiated barriers for particular men and increasing care inequalities when practices are directed toward a supposedly universal subject.
The lack of adequate listening to men’s distress reveals a tendency toward the medicalization of these cases, especially when compared with the distress of female patients. Despite this tendency, men frequently do not adhere to pharmacological treatment, resulting in a higher rate of referral to psychiatric hospitals than that observed among women. This dynamic, marked by the medicalization of distress and resistance to treatment, not only distances these men from psychosocial services but also aggravates their distress.
We should, therefore, underscore that, although women are generally recognized as being socially permitted to express difficulties and vulnerabilities more freely – given an assumed incompleteness and fragility – while men, pressured by expectations of completeness and problem-solving capacity, tend to restrict themselves to objective descriptions of symptoms, the approach used with both remains identical. Such homogeneity suggests that gender specificities are not adequately addressed in the care process, which may limit the effectiveness of the practices adopted and reinforce current inequalities in the social field.
We question whether this becomes an obstacle to men’s access to and continued engagement with mental health services, since the approach used by professionals does not consider men’s difficulty in expressing their distress, even though the professionals recognize this difficulty.
Thus, we identify a practice that renders invisible issues that generate distress or deteriorate illness and that arise from the social relations and gender inequalities permeating men’s experiences. This situation occurs although some of our interlocutors report the use of strategies to engage with and care for users.
Thus, although mental health professionals perceive the gender nuances that permeate the provision of care, these nuances are not considered in their practices, which ultimately target a universal, nongendered subject.
We hope that this study can contribute to reflection on the topic investigated, while recognizing its limitations. These limitations include the small number of interlocutors and the delimitation of the field of analysis, as this was an exploratory study. In addition, the participants’ narratives took a cisgender, heterosexual, White man as their reference, which ultimately limited the problematization of other dimensions, such as racial issues. We highlight that the lack of an intersectional perspective did not result from an intentional decision, but rather from the lack of these markers in the discourses of the professionals interviewed.
Data Availability Statement:
The contents will be made available at the time of publication of the article.
References
- ALBUQUERQUE, F. P.; ASSIS, C. D. N.; CAMPOS, D. A. Trabalho, classe e masculinidades em serviços de atenção em saúde mental. Fractal: Revista de Psicologia, v. 36, p. e52482, 2024.
- ANDRADE, A. P. M. de. O gênero no movimento da reforma psiquiátrica brasileira. In: MALUF, S. W.; TORNQUIST, C. S. (orgs.). Gênero, saúde e aflição: abordagens antropológicas. Florianópolis: Letras Contemporâneas, 2010.
- BRANDÃO, C. C. et al. Gestão federal da Política Nacional de Atenção Integral à Saúde do Homem (PNAISH): uma análise histórico-crítica. Interface – Comunicação, Saúde, Educação, v. 29, p. e240378, 2024.
- BUTLER, J. Problemas de gênero: feminismo e subversão da identidade. Trad. Renato Aguiar. 2. ed. Rio de Janeiro: Civilização Brasileira, 2008.
- CAPONI, Sandra; MAZON, Márcia; BIANCHI, Eugênia. Gênero e saúde mental em questão. Revista Estudos Feministas, v. 31, n. 1, p. e93286, 2023.
- CONNELL, R. Políticas da Masculinidade. Educação e Realidade, Porto Alegre, v. 20, n. 2, 1995.
-
CONNELL, R. W.; MESSERSCHMIDT, J. W. Masculinidade hegemônica: repensando o conceito. Revista Estudos Feministas, Florianópolis, v. 21, n. 1, p. 241-282, abr. 2013. Disponível em: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-026X2013000100014&lng=en&nrm=iso>. Acesso em: 16 abr. 2024.
» http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-026X2013000100014&lng=en&nrm=iso - ENGEL, M. G. Sexualidades interditadas: loucura e gênero masculino. História, Ciências, Saúde, Manguinhos, Rio de Janeiro, v. 15, p.173-190, jun. 2008.
- KIMMEL, M. La producción teórica sobre la masculinidad: nuevos aportes. In: RODRIGUES, R. (ed.) Fin de siglo Género y cambio civilizatorio. Santiago: Isis International, 1992. p. 129-38. (Ediciones de las mujeres, n. 17).
- KIMMEL, M. S. Masculinidade como homofobia: medo, vergonha e silêncio na construção da identidade de gênero. Equatorial, v. 3, n. 4, p. 97-124, 2016.
-
KIMMEL, M. S. A produção simultânea de masculinidades hegemônicas e subalternas. Horizontes antropológicos, Porto Alegre, v. 4, n. 9, p. 103-117, out. 1998. Disponível em: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-71831998000200103&lng=pt&nrm=iso>. Acesso em: 17 abr. 2024.
» http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-71831998000200103&lng=pt&nrm=iso -
MACHIN, R. et al. Concepções de gênero, masculinidade e cuidados em saúde: estudo com profissionais de saúde da atenção primária. Ciência & Saúde Coletiva, Rio de Janeiro, v. 16, n. 11, p. 4503-4512, nov. 2011. DOI: https://doi.org/10.1590/S1413-81232011001200023 Disponível em: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232011001200023&lng=en&nrm=iso>.
» https://doi.org/10.1590/S1413-81232011001200023» http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232011001200023&lng=en&nrm=iso -
MATTOS, M. P. De; GUTIÉRREZ, A. C. Novas conformações do apoio matricial em tempos de pandemia de COVID-19. Ciência & Saúde Coletiva [online], v. 28, n. 12, pp. 3495-3506, 2023. DOI: https://doi.org/10.1590/1413-812320232812.04862023 Disponível em: <https://doi.org/10.1590/1413-812320232812.04862023 https://doi.org/10.1590/1413-812320232812.04862023EN>. ISSN 1678-4561. Acesso em: 22 set. 2025.
» https://doi.org/10.1590/1413-812320232812.04862023» https://doi.org/10.1590/1413-812320232812.04862023» https://doi.org/10.1590/1413-812320232812.04862023EN - MEDRADO, B. et al. Análise da implementação da Política Nacional de Atenção Integral à Saúde do Homem. Interface – Comunicação, Saúde, Educação, v. 29, p. e240372, 2024.
-
MEDRADO, B.; LYRA, J. Por uma matriz feminista de gênero para os estudos sobre homens e masculinidades. Revista Estudos Feministas, Florianópolis, v. 16, n. 3, p. 809-840, dez. 2008. Disponível em: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-026X2008000300005&lng=en&nrm=iso>. Acesso em: 17 abr. 2024.
» http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-026X2008000300005&lng=en&nrm=iso - MEDRADO, B.; CORRÊA, T.; LYRA, J. Homens e masculinidades no contexto da violência de gênero: para além dos serviços para agressores. In: VEIGA, A. M.; LISBOA, T. K.; WOLFF, C. S. (orgs.). Gênero e violências: diálogos interdisciplinares. Florianópolis: Edições do Bosque/CFH/UFSC, 2016. pp. 162-180.
- MENEGON, V. M. Por que jogar conversa fora? Pesquisando no cotidiano. In: SPINK, M. J. Práticas discursivas e produção de sentidos no cotidiano: aproximações teóricas e metodológicas. São Paulo: Cortez, 2013.
- MINAYO, M. C. de S. Amostragem E Saturação Em Pesquisa Qualitativa: Consensos E Controvérsias. Revista Pesquisa Qualitativa, v. 5, n. 7, 2017.
-
PEDIGONE, J. M. C.; SIGNORINI, L. H. A obstrução da escuta clínica na saúde mental: Uma crítica psicanalítica. Jornal de Psicanálise, v. 56, n. 104, 2023. DOI: https://doi.org/10.5935/0103-5835.v56n104.08
» https://doi.org/10.5935/0103-5835.v56n104.08 - PINHO, A. A. S. et al. A busca por trajetórias de cuidado e acesso à saúde por homens transgêneros e pessoas transmasculinas no Brasil. Saúde e Sociedade, v. 34, n. 2, p. e240286pt, 2025.
- ROCHA, R.; ZUCCHI, E. M. Masculinidades e narrativas de sofrimento mental e autocuidado. Interface – Comunicação, Saúde, Educação, v. 29, Supl. 1, p. e240357, 2025.
- RODRIGUES, J. P. et al. Implementation strategy for men’s health actions: action-research potentialities and challenges. Texto & Contexto – Enfermagem, v. 32, p. e20230187, 2023.
-
SÁ, A. A. de A.; CAMÊLO, E. L. S. REPRESENTAÇÕES SOCIAIS CONSTRUIDAS POR HOMENS UNIVERSITÁRIOS SOBRE A SAÚDE MENTAL. Revista Fragmentos de Cultura - Revista Interdisciplinar de Ciências Humanas, Goiânia, Brasil, v. 34, n. 5, p. 220–226, 2024. DOI: https://doi.org/10.18224/frag.v34i5.14607 Disponível em: <https://seer.pucgoias.edu.br/index.php/fragmentos/article/view/14607>. Acesso em: 29 set. 2025.
» https://doi.org/10.18224/frag.v34i5.14607» https://seer.pucgoias.edu.br/index.php/fragmentos/article/view/14607 -
SANTOS, A. M. C. C. dos. Articular saúde mental e relações de gênero: dar voz aos sujeitos silenciados. Ciência & saúde coletiva, Rio de Janeiro, v. 14, n. 4, p. 1177-1182, ago. 2009. Disponível em: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232009000400023&lng=en&nrm=iso>. Acesso em: 12 abr. 2024.
» http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232009000400023&lng=en&nrm=iso -
SCHRAIBER, L. B. et al. Necessidades de saúde e masculinidades: atenção primária no cuidado aos homens. Cadernos de Saúde Pública, Rio de Janeiro, v. 26, n. 5, p. 961-970, maio 2010. Disponível em: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2010000500018&lng=en&nrm=iso>. Acesso em: 13 abr. 2024.
» http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2010000500018&lng=en&nrm=iso - SCOTT, J. Gênero: uma categoria útil para análise histórica. Educação & Realidade, Porto Alegre, v. 20, n. 2, p. 71-99, 1995.
-
SPINK, M. J. Trópicos do discurso sobre risco: risco-aventura como metáfora na modernidade tardia. Cadernos de Saúde Pública, v. 17, n. 6, p. 1277–1311, nov. 2001. DOI: https://doi.org/10.1590/S0102-311X2001000600002
» https://doi.org/10.1590/S0102-311X2001000600002 - SPINK, M. J.; FREZZA; R. M. Práticas discursivas e produção de sentidos: a perspectiva da Psicologia Social. In: SPINK, M. J. Práticas discursivas e produção de sentido no cotidiano: aproximações teóricas e metodológicas. São Paulo: Cortez, 1999.
- SPINK, M. J.; MEDRADO, B. Produção de sentidos no cotidiano: uma abordagem teóricometodológica para análise das práticas discursivas. In: SPINK, M. J. P. (Org.). Práticas discursivas e produção de sentidos no cotidiano: aproximações teóricas e metodológicas. 3. ed. São Paulo: Cortez, 2004.
- THÜRLER, D.; MEDRADO, B. Masculinidades contemporâneas em disputa. Periódicus, Salvador, n. 13, v.1, maio-ago. 2020.
- VIVEROS VIGOYA, M. As cores da masculinidade: experiências interseccionais e práticas de poder na Nossa América. Rio de Janeiro: Papéis Selvagens, 2018
