524 Chapter 13others for assistance or to ask others for help.
This will only be problematic if help is needed.
For example, a cardiac patient who refuses to
ask for assistance with mowing the lawn or
shoveling snow is placing himself or herself at
risk for a fatal heart attack.
In addition, the mere existence of a
chronic illness may be viewed as a weakness,
and vulnerability and weakness are inconsis-
tent with the male gender role. Studies have
found that adolescent males feel more stig-
matized by chronic illness than adolescent
females (Williams, 2000). A chronic illness will
be especially threatening to men to the extent
that it undermines their breadwinner role,
which is the case when women go to work,
men retire, or men reduce their workloads in
response to their illness (Charmaz, 1995).
The male gender role might also im-
pede adjustment by interfering with compli-
ance to physician instructions. For example,
among cardiac patients, strong orders by
physicians to follow a strict diet, exercise
regularly, and refrain from physical exer-
tion could evoke a state ofpsychological
reactance(Brehm, 1966). Psychological re-
actance occurs when you perceive that some-
one has taken away your freedom or sense
of control by telling you what to do. To re-
store that freedom, you do just the opposite
of what was instructed. A more familiar term
for this idea is “reverse psychology.” Think
of the times you told someone to do just the
opposite of what you wanted so they would
react against your instructions and do what
you really want. Psychological reactance may
be dangerous in the case of failing to ad-
here to physician instructions. In this case,
patients’ noncompliance restores personal
control at the expense of taking care of them-
selves. People who might be most vulnerable
to noncompliance as a result of psychologi-
cal reactance are those who score high onthe gender-related trait unmitigated agency.
Unmitigated agency has been associated with
poor adjustment to heart disease, in part due
to the failure to adhere to physicians’ instruc-
tions (Helgeson, 1993) and poor health be-
haviors, in particular smoking (Helgeson &
Mickelson, 2000).
Another feature of the male gender role
that might impede adjustment to illness is
difficulties with emotional expression. The
traditional male role requires men to keep
feelings and vulnerabilities hidden from oth-
ers. However, the failure to share feelings
and difficulties will keep others from provid-
ing needed support. In a study of men with
prostate cancer, unmitigated agency was as-
sociated with difficulties with emotional ex-
pression (Helgeson & Lepore, 1997). It was
these emotional expression difficulties that
explained the link of unmitigated agency to
poor psychological and physical functioning.
On the positive side, characteristics of
the male gender role may be quite helpful in
coping with chronic illness, when the illness
is construed as a problem meant to be solved.
To the extent there are clear-cut behaviors
that can solve or “control” the problem, men
might be especially likely to engage in those
behaviors. A study of patients with heart dis-
ease showed that men were more likely than
women to attribute the cause of their illness
to controllable factors (e.g., diet, overwork-
ing, alcohol), and less likely than women to
attribute the cause of their illness to uncon-
trollable factors (e.g., heredity; Grace et al.,
2005). One behavior that is helpful for man-
aging many illnesses is exercise. Male cardiac
patients are more likely than their female
counterparts to exercise (Hunt-Shanks et al.,
2009). Exercise, in and of itself, is consistent
with the male gender role. Exercise can also
be construed as a problem-focused coping
behavior. Adolescent males with diabetesM13_HELG0185_04_SE_C13.indd 524 6/21/11 12:55 PM