Men at Work

MS Plus acknowledges the traditional owners of the land this podcast has been recorded on, the Wurundjeri people of the Kulin Nation. We pay our respect to their elders, past, present, and emerging.

Jess: Welcome to the MS Plus podcast series. My name is Jess. I'm the Health Promotion and Wellbeing Coordinator at MS Plus and today we are discussing men's health, specifically men with MS’s Health and how this can interact in the workplace. I'm speaking with Jeff Florence who's been with MS Plus now for over seven years, starting as an Occupational Therapist in the Employment Support Service where he's now a service delivery manager overseeing the program.

Jeff and I discussed the complexities of men's health and how this is influenced by more stereotypical gender norms and gender roles. We refer to partners as typically being female. We acknowledge that this isn't reflective of every man's situation or experience. Here's our chat.

Jeff, thank you for having a chat with me today. We know that MS is predominantly diagnosed in women, but a quarter of all those diagnosed are men, and we also know that men's approach to taking care of their health or healthcare is very different, less likely to seek help and when they do, it's often at a later point, in maybe, a disease or a condition going on. You support men in the workplace. What's your view on men's health and, even the attitudes towards maintaining wellbeing, especially, in work?

Jeff: Yes, thanks for asking. It is really interesting, the role that I'm in. I work with men and women around maintaining them in the workplace. But it does bring out a very interesting side to, I guess, for lack of another way to put it, the male approach and the female approach and, I'll really jump in and get myself out of hot water right from the beginning and say that anything I say can be applied to males and females, but there are certain mindsets that are definitely quite predominant with males that you can't get away from.

There is a very traditional approach that's often taken with the male, that the male is the breadwinner of the family, can't be seen as being weak, can't be seen as having any problems, must be at the forefront of everything, and all of that can lead to, can have a lot of difficulty reaching out and asking for help. As I said, and I will keep saying this all the way through, this can be applied to females as well but, for a generic approach that we're taking here, you can't escape that there is a very dominant male approach to that, particularly, we do know that the numbers are lower with males that have MS, but, it does mean that within that grouping, these are definitely patterns that you see quite regularly.

Jess: I think it's pretty widely acknowledged that there are those stereotypes that are really present. The research tells us that men's self-esteem is really linked to their employment, being that traditional breadwinner. So, these gender norms really are still quite prevalent, even today. Do you think that ties into why men might not come forward and acknowledge their health or, self-care can be seen as, that's not what men do?

Jeff: I think we're not still stuck in the seventies and, there's a lot of approaches that we've moved a long way since then, but we are still moving to where we were. You go back to the seventies and it was very, (I just dated myself, didn't I?) but you go back to those periods and it was very much, you just don't speak about anything. The guy goes out, he earns the family income and brings it home and, you're not allowed to break, you're not allowed to stop, you're not allowed to do anything, you're not allowed to show any faults, any issues, but, you've just got to keep that going.

We've definitely come a long way that it's easier to be able to reach out, but there is still that mindset that, I've got to look after my family, I've got to provide for the family, I've got to be the one that leads the way, won't break down, won't have any issues. And what we're talking about here is, is not an MS thing.

If you speak to cardio doctors, if you speak to, when I used to work in a rehab many years ago, and, you'd see the problem with, males going through issues with their backs and so forth, where often it's not until you get to the point where it's a quite a jeopardizing point that, someone will actually reach out and say, I need help.

If you look in the mental health area, I'm sure that you could grab a whole range of psychologists that would back me up on this, that, the number of males that come and see someone where they're in need of help is a very difficult thing, and even within the MS world, it means that we have all of those factors, but, accepting the issues, the difficulties, the health with MS, not just the reaching out for the help, but accepting that symptoms are building up on someone. It's all very difficult.

Jess: Yes, and in your role with the Employment Support Service, do you find that with male clients that you're supporting, being able to look at the difficulties they're having in the workplace can be different than say, the female clients that you're supporting, like having to acknowledge symptoms or that, even the fear of maybe, speaking up in the workplace,

Jeff: Yes, definitely. Again, I'm going to keep saying it, male and female, but a lot of the more physical roles are roles that males are doing. That's changing slowly, but following from where they've been traditionally, a lot of the more physical roles are male oriented and, a lot of the symptoms that we see with MS are the ones that do affect the physical side.

So, for example, clearly the most common symptom that we see is fatigue. Now, if you are climbing ladders up and down every day, if you are climbing around on roofs, if you are on building sites, if you are in carpentry or, any of those sort of roles, particularly the trade roles, they're really quite physical roles and they're the sort of roles that with symptoms like fatigue, neuromuscular fatigue, heat intolerance, they're all the sort of symptoms that are really going to flare up when you're trying to do these sorts of jobs and so, it gets very difficult.

But then the other side to it, it is also a really difficult thing to then reach out to the employer, and this is actually what I see every day. It is a really difficult thing to then reach out to the employer and say, I'm having difficulty with this, because the overriding concern that everybody has is, if I tell my employer I'm going to get the sack because I can't do the job anymore. This is what we try to help out within our role, is, that if someone does need to disclose it to the employer, we do look at making sure the employer understands so that we can look at what other options there are in the workplace, what alternatives that are not going to be demanding on those sorts of symptoms as before.

But, it's very easy to say it from this side. When you're on the initial side of it, that a lot of the clients are where, it's me, it's the job, it's the symptoms that are building up on me, it's my employer. Do I tell or don't I tell? It's a really scary place. I'm not going to say that, I mean, we often get really good results and employers want to help, but, in most cases it's a really scary place though, to be able to sit there and say, will I lose my job?

Jess: Yes, the uncertainty of it. And I was doing some reading and it was saying that men are more likely to take risks in the workplace, especially when they might have these really gendered views of masculinity and, you just put up, and deal with things. And it can, I guess, add to that anxiety in the workplace and, just putting up with things until something happens. Something's got to give.

Jeff: Pride's a tricky thing, isn't it? And, I say pride, but it's not as black and white as pride. It's, I guess one of the ways to look at it is, that it's the consequences of, if I'm affected, if I stop, if I pull back, if I lose my job, particularly if I have a family, how many other people are affected, and I'm again very generic here. My wife, my kids, all of these people are affected by the things that happen to me. It is the same if you've got a wife or the female is affected, but, I think the way that it plays within the male mind is a little bit different because, it's not being able to admit to having those difficulties.

Jess: It's almost like there's a lot of like internalized shame about, if people, particularly men having to reduce or change roles in the workplace, like really struggling with that and feeling really ashamed that it's a deficit within themselves.

Jeff: Yes. I'll tell you what I think the difference is. If you've got a carpenter, say, and I'm really going to get into trouble here, but a male carpenter, a female teacher, if you've got MS and both are being affected in the workplace by their symptoms, if you've got the female teacher, that's being affected and changes need to be made then she'll bring into question her role as a teacher, her identity, sense of identity as a teacher. If you've got the male who's the carpenter, he will bring into question his role as a carpenter, but in addition to that, he'll also bring into question his role as a male. Am I still the same man, the same bloke that I used to be? If I go through fatigue, if I can't get through the day without needing to collapse and sleep for a day, if I have trouble walking around, if I need a stick or a walking aid or something to be able to get around, it brings into question that whole identity around the male being a male as well as being a carpenter.

Jess: Yes, absolutely. That whole view of themselves and things like that and, having spoken to a lot of clients over the years, it's often, I think changes in the workplace are tied to such big changes in how we see ourselves and, particularly for men when there's all these sorts of societal pressures maybe that are still there. They are changing, as you say, but I don't think we're where we want to be just yet.

Jeff: No, no, definitely not. I think the other thing that the male is more inclined to do, and I'm not saying females don't, is, all of those things, he's more inclined to bottle, and all of the emotions, all the acceptance, all the stress, the anxiety, every one of them, as you've said before, difficulty talking about it. So, it all just gets bottled up and released in other ways and, that can almost create a symptom in itself. You know, for all the symptoms we talk about, with fatigue, with heat intolerance, with neuromuscular weakness in the leg or, any of those symptoms we might speak about, if you take whole range of symptoms, that whole anxiety, stress, all of it, you almost create a symptom of its own, based around the mental health of accepting and coming to terms with the condition that you're going through.

Jess: Absolutely, and it's so important for people to reach out for support, but also, I guess making people feel safe that they can, it's almost trying to change cultures in workplaces that, speaking up and, reaching out for help isn’t a sign of weakness.

Jeff: Yes.

Jess: You know, not even just the workplace, but particularly in this instance.

Jeff: I think the other thing too that I can say all this because I'm a bloke, but I think the other thing too is that, I think males have a lot more difficulty being able to see outside of themselves, so they may bottle all that up. They may contain all of that, all that stress, all that anxiety, but, being able to see outside of themselves, to see how that affects the people around them. They have a lot of difficulty with that, whereas, I think probably, a lot of the female clients that I work with, are probably more open to being able to see how their situation, how their symptoms, how their stress, their anxiety, how it may affect the people around them. It's a little different on their side than the males. It's a lot more closed off.

Jess: Yes, absolutely. And even, having networks for men to share information. With women typically, and again, this is very like a stereotypical view, but women will typically talk more about their health with each other, have check-ins about wellbeing, whereas, from my understanding, you'll probably be far more knowledgeable than this, but with men it's not typical to chat about your health and how things are going mentally or your wellbeing. That's not a topic that is general conversation?

Jeff: No, definitely not. Well, not definitely, but, to males it's a lot harder, to females it can be a little easier, but then it depends on who it is. Where, it is more likely to be a topic of conversation female to female than it is male to male. Most definitely. It's not the sort of thing you sit over the barbecue and cook a barbie and, have a chat about it, not the sort of thing you might sit in a bar and have a beer over and have a chat about what's going on. And fortunately, there's a lot of campaigns happening at the moment to try and move and shift that thought. But It's a goalpost that we are changing, but not quite there yet.

Jess: Yes, absolutely. And I guess in your experience, what would your suggestion be to someone who's struggling, even if they're maybe not working or working, but, how to take that first step in reaching out for support or looking after your health in a better way?

Jeff: The first thing is to really understand that the situation you're in is that you're not the first person to be there. That absolutely the situation you're in is unique to you and, you never take away from that because it is unique in that, all the context around it, your situation, your health condition, the job, the family, the friends, all of that, that's unique to you. So, you can't take away that, but, being on the pathway, the journey that you're on, there are people who've been on similar paths before, and being able to reach out and tap into those sort of support networks, I think is a very good thing.

So, for example, if you reach out to Plus Connect, we've got a lot of resources through Plus Connect, through MS Plus. For example, the peer support groups, we've got services that can help people out, we put you in touch with psychologists and so forth that can help out, but all of these resources that are there to be able to reach out.

I mean, the very first instance for anyone I think is a close friend or a partner, feeling comfortable to just reach out and say, I need help. Not feeling like it's a burden because, what you don't realise is the more you contain it, the more it builds up to become a burden in ways that you just don't see. And being able to open that doorway a little bit and say, look, this is what I'm going through. I'm not saying this to burden you, I'm saying this to open it up so that I can get a little bit of this out and share it. I can get some feedback. I can talk openly and honestly, I can feel like, what is it, a burden shared is a burden halved. And being able to open that up and then reach out to other resources from there, as I said, like Plus Connect or any of the other services, or talking to your doctor about it.

This is part of what the GP service is as well, is being able to talk to your doctor openly about, not just the condition, but how you feel about having the condition, how it's affecting you, because that whole mental health side of it, that whole being able to speak about it, is just as crucial as any of the physical symptoms that you may be going through.

Jess: Absolutely.

Jeff: Particularly if you are someone who's chosen not to disclose the condition in the workplace. People who haven't, and I'm absolutely not prejudicing one way or the other. I've seen both sides of it that some people do disclose, some people don't, and I completely understand both sides of that equation, but the people who haven't disclosed it means that there's a lot more bottling up happening there, and they're the ones that I do worry about a lot. And if you're not going to be able to have that discussion in a workplace, then you need to make sure that you are comfortable to have that discussion in other places.

And I'm not saying the discussion in the workplace is a discussion around how you feel, but at least you're opening up and venting that a little bit more, whereas, those who aren't with friends and family around that know, you need to have another resource to be able to open that up a little bit too.

Jess: Absolutely, even just being able to speak to your partner, and this is a very typical male with a female partner, but I couldn't count how many men I've spoken to and be like, oh, I'm up on the ladder and I know I shouldn't. My wife always gives me hell about it, and, it's like you can hear in their voice they're worried about whatever the symptom is and they know that their partner is, but they're just sort of putting on a brave face and, cleaning out the gutters or whatever it may be.

Jeff: Well, you know what I like to do sometimes when I'm talking to people is put a mirror on them. And you can do this more easily with someone who's got a partner. And, the question is simply, okay, you've got the fatigue, you are climbing up, you might be cleaning out the leaves, or whatever you are doing, if your partner had the MS and definitely not wanting to wish it on anyone, but if your partner had the MS, what would you want them to do?

Now, it's not necessarily to say you can't climb up, it depends on where your symptoms are at, or what you go through, but it might be that someone's standing at the bottom of the ladder. The worst-case scenario there is you are climbing up the ladder, you fall down and no one's around. Now I've had people who've gone through that situation, it's a very difficult situation, because then you end up with broken legs and things like that and, that's on top of all the MS issues, but it may be that you look to do things a little more safely, based around, open discussions about your symptoms. Based around open discussions about how they're affecting you and what limitations they may bring in.

It may not necessarily be stop doing it all together. It may be look to do it in a more safe way, but the starting point there is have that open discussion so that you can say, okay, I'm going through a fatigue moment at the moment, so let's not do it now. Let's do it tomorrow morning when I'm feeling a little bit more safe to do it. And when we do, I'll go up the ladder, but you stay down the bottom, just keep the ladder steady, make sure that everything's safe as we do it. Or it might be that we get someone else to come in and do the ladder.

Whatever the circumstance may be around your particular symptoms, but the starting point, as we said is, that open discussion about it and feeling free to say, I'm feeling okay to do it now, or I'm not feeling okay to do it now.

Jess: Yes, absolutely. It doesn't always have to be, just when I'm not feeling up to it, but as you said, that today I can and, being able to do that.

Jeff: Yes. Is anyone going to die, or is anyone going to get hurt if we don't do it right now?

Jess: Exactly. And probably always be there tomorrow.

Jeff: That's it.

Jess: Yes, I think that's so helpful and, hopefully as society and things change, like tearing down those toxic masculinity views and things like that, and encouraging men to really look after themselves and taking care of your health as a priority will become much more of a commonplace thing because, we don't want to have the statistics that we do, men's life expectancy being so much shorter than women, for so many different reasons. I think, there's some really good tips in there.

Jeff: As we've said, there's enough that you're battling with the MS on its own, the problem is that not being open about what you're going through from the MS can lead to other issues outside of the MS.

As I said, you climbed the ladder because you were too proud not to. You climb the ladder, you have fatigue, you have weakness, you fall down the ladder, you break a leg. Not an MS issue that's going to knock you out and cause also all sorts of difficulty and you're going to have difficulty recovering with the broken leg, because of the MS symptoms.

As we said before, not opening up about how you're feeling, what you're going through can lead to a build-up and a bottling of the stress and the anxiety and all of those issues. And that can lead to any number of different health issues: mental health issues, cardio issues, all sorts of different things that are not MS, but, because of the way you've handled it, it's led to that being another issue that's secondary to the MS, because the MS wasn't dealt with properly the first way, not properly, not in a way that, could have deflected anything like that. So, it's that secondary side that you really want to worry about.

Jess: Yes, some really good points there.

Thank you so much for having a chat about this today. And, hopefully, men out there will maybe have a listen to this, and their partner might suggest to have a listen, and feel a bit more empowered to reach out for support

Jeff: Yes, we're a stubborn bunch, aren't we?

Actually, I think that's a really good point what you just said too. Just quickly before you go, I think partners shouldn't be afraid to try and open it a little bit. I mean, you want to be careful not to badger, but gently opening those doors and creating a safe space so someone feels comfortable to open that up, s something that works on both ends too.

Jess: Yes, definitely. I think that's a really good point. I think that's just a really good way to look at things.

So, thank you so much for chatting about this today. It's a really important area, for men to see their health as a priority, and hopefully, avoid some of these additional problems that arise when it's not treated or looked into soon enough.

Jeff: Thank you for the opportunity to do this. It's such an important thing.

Jess: Absolutely. All right. Thank you so much, Jeff.

Jeff: Not a problem. Thank you.

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