"Men's bodies, men's selves": men's health self-help books and the promotion of health care

International Journal of Men's Health, Jan, 2003 by Andrew Singleton

Men suffer two cancers unique to them: testicular cancer and prostate cancer. Men in their teens through their late thirties are particularly at risk of developing testicular cancer. One way to prevent mortality from testicular cancer is early diagnosis, which is best achieved through screening, either performed by a health professional or the individual. Men, however, are not always successful in achieving early intervention. Indeed, it is axiomatic in the scholarly literature on men's health to observe that "men engage in fewer health-promoting behaviors" (Davies et al., 2000, p. 259), especially when it comes to this type of cancer. These behaviors include men visiting the doctor when they discover something unusual or taking the time to engage in self-screening for cancer. Among the explanations offered for why this is the case is the popular view in scholarly discussions of men's health that "looking after oneself" is a transgression of prevailing masculine codes of behavior (Courtenay, 2000a; Pease, 2002; Sabo, 2000; Sabo & Gordon, 1995).

All six books examined for this paper have sections on testicular cancer. To begin, readers are informed about the prevalence, etiology, risk factors, treatment, and chances of survival. These accounts invariably use direct, non-technical, even "folksy" language: "When cancer is diagnosed, the testicle is usually removed. 'If you lose one, you can still get along pretty well with the other,' says Dr. Nadig" (Caine et al., 1996, p. 325).

The most notable aspect of the discussion about testicular cancer, however, is the primacy placed on the individual taking personal responsibility for early detection, in this case, in the form of self-screening. The Male Body: An Owner's Manual (Caine et al., 1996), for example, instructs the reader that:

   Cure ... depends on early detection. And that's where you come in.
   It's your job to detect testicular cancer. "I don't think I've ever
   discovered a testicular cancer that the patient didn't know about,"
   says Dr. Gleich. (p. 325)

In like manner, How Men Can Live as Long as Women (Goldberg, 1993) notes:

   [The] testicular self-exam is unquestionably the most vital for guys
   under forty. Simply put, you don't see the doctor often enough for
   him to have a decent chance of catching testicular cancer before
   it's too late. It's your responsibility to find it and save your own
   life. (p. 11)

There is little doubt that self-screening is a very useful tool in reducing men's risk of mortality from this type of cancer. The abiding expectation that the individual is accountable for early intervention, however, has the effect of moving responsibility or the onus of responsibility (in terms of costs and labor) away from medical providers and, thus, governments and health organizations. In this sense, exhortations for the individual to be solely responsible "privatizes health" (Watson, 2000).

As is to be expected with self-help literature, the reader is not just told what to do (i.e. self-screen), but also how to do it. All except one book has a picture that depicts how a testicular self-examination is undertaken (the book without the picture does have a similar one captioned "Inside the testicles"). In each case, the picture is accompanied by text explaining the procedure. Again, the language is in the everyday vernacular rather than being excessively medical. For example, The Complete Book of Men's Health (Editors of Men's Health, 1999) says: