Unlearning Toxic Masculinity

David: I’m here with Hedieh Azadmehr. Thank you so much for being with us.

Hedieh Azadmehr: Thanks for having me today.

David: Absolutely. Yes. Let’s start with having you tell us a bit about your story; your background and how you got into this world of recovery.

Hedieh Azadmehr: I was born and raised in Iran. I started my career as being a software engineer. I started working with computers, and, well, I find it being quite dissatisfying for me. The whole graduate program was miserable. Working in the field was not satisfying. I had this idea that I’m missing out a lot, and found sitting in front of the computer and working with numbers and computers all day long was not what I was looking for.

David: You wanted to work with people?

Hedieh Azadmehr: Yes, that was my passion. I was working this way for a couple of years. As for the organization that I was working, we would do also a lot of research because we were collaborating closely to some sort of, also, mental health facilities. I got involved with a research group, and they were working on child abuse.

I was supposed to do the data analysis for them. Later on, because they did not have enough people for working, so I start also doing some sort of also data collecting for them. Then I needed to do some interviews for the children, and I find myself to be very interested in what was going on, and started reading a little bit around it. From then, I know that’s what I want to do.

I started studying for masters in psychology. After I finished my masters, due to some circumstances, we had to leave our country. I left my country to England, and from England I moved to Germany. Germany, I did my PhD there for a couple of years, still for me getting involved to work directly with humans was difficult because in Germany, when I started, I didn’t know much about the German language and it was involved, still I needed to do only research.

I was continuing doing research til five years ago, that we moved to the US. Since then, I start working in the recovery field again. Well, I knew that I wanted to work with women and children. My involvement with addiction happened quite by accident. I would call it the “greatest accident in my entire life”. I can say I’ve never done something that fulfilling in my entire life, and so grateful to be in the field and being able to contribute to recovery for people.

David: Yes. Now you are working with SCRC here in Southern California as clinical director?

Hedieh Azadmehr: Right.

David: Could you tell us a little bit about the work you’re doing there and what that’s all about?

Hedieh Azadmehr: I started with SCRC right when I started my career here. I started as an intern and then gradually promote to be the clinical supervisor, and now clinical director. We have a six-month program for men in recovery and addiction. We provide them with different treatment, focusing a lot on trauma. We have a lot of people with different qualifications, with different skills using many different modalities to working with men, particularly in addiction.

Having collaborating closely with schools, bringing students from schools to have access also to what is newest there, what is going on out there. Normally, when we get a client, the client stays with us for six months. We get them after they finished a month of inpatient. After that, we’ve worked a little bit on continuing the stabilization with them.

During this, each client worked with a therapist and a counselor at the same time. They received group therapy, individual therapy, and as I said, many different modalities that we are working to work on men trauma. As we were working, it was pretty obvious, very clear, that underlying all those issues that they are dealing with today with the name of addiction, is coming from and deeper-rooted issue in their past traumas.

David: Do you consider it extended outpatient kind of setting, or are they staying there?

Hedieh Azadmehr: They live in our sober living, but it is intensive outpatient.

David: Yes. You’re working with this male population, and then you’re giving a presentation here at Innovations in Recovery about unlearning toxic masculinity?

Hedieh Azadmehr: Right.

David: I’m excited to dive into this. Let’s start by defining, what is toxic masculinity, for someone who’s not familiar?

Hedieh Azadmehr: If you’re talking about some particular ways that we expect men and boys to behave, or simply put it in words that, a very particular way of being that we expect men to be strong, to be independent. We know that a lot of emotion for men is not okay to show, so they have to be able to filter those emotions to fit within those boundaries that we are building for them.

As I’m going to talk also about this, this is the problem because they need to achieve that level. It’s not that this is something that they are coming with, but they need to be able to filter those emotions, and then present in a way that the society expects from them. At times, that could be very toxic and very dangerous.

David: It’s those traditional gender roles, and how that limits them or distorts their sense of self?

Hedieh Azadmehr: Right.

David: A part of this is looking at the gender roles, and those are evolving, slowly but surely, within the culture. Even within that, sometimes that becomes toxic. Sometimes it does, and it is kind of a spectrum there. Why do you see that become toxic in certain circumstances?

Hedieh Azadmehr: If you’re looking at all human condition in a spectrum, everything that is going between those two ends could be toxic. For example, if a focus for a man is to be the one who is handling everything, a man who cannot show emotion, a man who take this role of being masculine bodily in very extended way, or become so consumed with what he needs to like as a way of avoiding what is, society-wise for him, is not okay to show; that could be pretty toxic.

They need to abdicate part of their own humanity or a human being is whole, and then you arc by the society, by your surroundings; you are forced to put away some of it.

David: Yes. You have to suppress part of yourself.

Hedieh Azadmehr: Right, and then trying to fit with the box that it’s assigned for you. That could be pretty toxic. Then for men not being able to connect to themselves, not feeling safe enough to show their emotions, constantly needing to filter those emotions because that could be perceived one way or the other. We know that it’s very damaging. We know that at the end of the day, all those emotions that we are dealing with, they are energy produced in our body. Some way or the other, we need an outlet for that energy.

If we are not able to discharge them in a healthier way, they still need to be discharged; and then for a lot of men, going through drug and alcohol or other destructive behavior as a way of discharging this energy, that’s when we are talking about masculinity becoming toxic.

David Okay. Yes. They have to find a way to discharge that. One way is like addiction, substance use. What are some other ways?

Hedieh Azadmehr: For example, all the other, again, human behavior that could when we go to an extent doing this, could be toxic, for example; work, sex, exercise, gambling, and all the other behavior that is being used as an escape from dealing what is going on inside and what is, at some point, a person is unable to deal with it.

David: Like you said, you’re working with a population of all males who are dealing with substance use disorders. How do you generally see this manifest in your population there at SCRC?

Hedieh Azadmehr: I am not sure if I’m clear, the question.

David: I guess, what are some examples of the symptoms or the major common like challenges, barriers that you see in the guys that you’re working with?

Hedieh Azadmehr: For example, for the most part, I’ve worked with multiple people, like too many clients, and I’ve never seen somebody coming to treatment talking about their addiction and thinking, “Everything was going so well.” They may present this at the beginning, “Everything was going so well. I started doing this, and then I fall into the addiction.” There is always something traumatic going on in their life; whether they are being raised in a dysfunctional family, whether they’re being abused as a child, as an adolescent, or some way or the other, being bullied, not being able to connect to other people, and all sort of issues that is feeding their addiction.

Once, for all of us, then we have to deal with too many different stressors in life that adult life put on us and we don’t have that coping skills to deal with, then at some point, a person would give in to something as a way of being able to deal. To be honest, when I’m looking at it through some of those people addiction is a survival mechanism, even for all of them. Survival mechanism. It’s not clear how that person would be dealing with all those trauma if they did not have that outlet.

At the beginning, it served the purpose. It alleviates the pain, allows them to connect to other people, allow them to forget about their pain, but then at some point, it becomes so destructive that it becomes all about a drug and alcohol, and that person is no longer able to function in the society.

David: You’ve mentioned this that a lot of this has to deal with the underlying trauma.

Hedieh Azadmehr: Right.

David: You say that, especially among males, that those misdiagnosed, under-diagnosed. Why is that? Why is it not diagnosed accurately more often?

Hedieh Azadmehr: For some reason, we know that until really recently not lots of treatment centers were looking at addiction and they’re looking at trauma, underlying addiction. Not every treatment center is specialized in those modalities for treating PTSD. Interestingly, in one study, they published a result that 80% of people who are in treatment for addiction, their PTSD symptoms have never been assessed by a standardized questionnaire.

It hasn’t been much attention. We are looking at addiction at the very surface level. We use Motivational Interview. We help them to identify their triggers. We can use years’ worth of these techniques, but if you’re not looking at underlying issue for addiction, we are lost in there when that person, again, being triggered next time by his memory of trauma, how this person is being able to deal with if we have not delved into this before and helped them to get some treatment and recover from what is feeding their addiction.

David: If that goes untreated, that can end up not just affecting them in a toxic way, that can affect the people around them.

Hedieh Azadmehr: Right. Also, we know that if that underlying issue remains untreated, we don’t get much success in treating substance abuse. They eventually would go back to the same place using the same mechanism that they were using to deal with those symptoms.

David: When trauma is addressed in treatment effectively, how can that help male patients specifically engage with the rest of the addiction treatment, the recovery program?

Hedieh Azadmehr: For example, a lot of them when they’re coming to treatment, they don’t even have insight about their trauma. They don’t even know what is going on for them. For them being able to acknowledge, “Okay, I am broken. There is a problem. I need to work on the problem,” being able to talk about their emotion, being able to talk about their history of abuse, feel safe enough to get in touch with themselves, being able to connect to another human being and talk about what has been going on, give them a relief from their symptom.

Also, when they are sitting with each other, working with each other, male population, learning that, for a lot of men, it seems their trauma is covered by all other issues that men present. A lot of them have this idea that they are the only one who is dealing with this issue. Just learning that they are not alone, there are other people dealing with those symptoms.

Then once their PTSD being appropriately treated, then we have better chance and higher chance of helping them to recover from their addiction, whereas when we leave that part alone, their relapse rate shows.

David: Sure. Once they learn that they’re not the only one, that also helps build the community, which I imagine is a big part of what you’re trying to build there among the men at SCRC, right?

Hedieh Azadmehr: Right, yes. Yes. We connect them with each other with outside resources. Resourcing is one of the very important work that we are doing. They are getting connected with other men, other people in recovery, and attending daily, I would say, a 12-step meeting working with their sponsor also, as well as being in treatment working on other issues.

Calling addiction as a disease of isolation as well, that would be pretty appropriate, that how these people not only they are isolated from other human being around them, also not feeling themselves as well, and then allowing them to connect to themselves and to other people as a way of helping them to recover.

David: Back to the toxic masculinity part of this, how do you help men unlearn that and learn to still be a man but be in a different way?

Hedieh Azadmehr: From what I’ve learned is that their pain has never been acknowledged, has never been validated. Normally, the society believes that men cannot feel the emotional pain. For them being able to get connected to their pain, being able to learn that other men are also suffering from this same problem, learning that stuff about there is no stigma around you feeling psychological pain, and finding that we need to provide men with a lot of psychoeducation.

Learning that about what has happened in the past not necessarily was your fault and being able to process it from that perspective as well. Being able to alleviate a lot of guilt that never allowed them to connect to what was happening. Being able to talk about it and receive some sort of sympathy, some sort of help from it.

Learning from other men, that’s the way that we’re trying to help them to learn a little bit more about themselves. Knowing that if they’re feeling some way, feeling some sort of emotion, that that emotion, there is a reason that they are feeling this emotion. There is nothing wrong to feel sadness, to feel grief, to feel happiness. It’s okay to love somebody, or if you’re angry, all those emotions, there to communicate. They are an instant messaging system.

If you are ignoring them, that we’re ignoring a good part of what is going on, and then as a result, we never know how to deal with it.

David: The men that you’re working with, when they start learning this, are they receptive right off the bat? Is it like relief of like, “Good, I can relax this out?” or are they still resistant to it?

Hedieh Azadmehr: No, it’s not coming easy. It requires a lot of work. It’s really a gradual process and, for some, a very slow process, but on the other hand, at the end, very rewarding.

David: Yes. Definitely. A lifelong process, I’m sure.

Hedieh Azadmehr: Right. Yes, definitely.

David: We’ll just take a pause moment here. Is there anything else you wanted to cover or something that you’ll be speaking in your presentation that we haven’t talked about?

Hedieh Azadmehr: No. We’ve pretty much talked a lot about what I’m going to present tomorrow.

David: Perfect. Well, then, I’ll just wrap up with this final question. Everyone who works in this field has their own reasons for being in it, getting up every day, fighting this cause of recovery. For you, could you sum up what this mission means to you, why this matters to you?

Hedieh Azadmehr: The fact that just seeing somebody moving on with their life, seeing somebody to be able to overcome their addiction, their trauma. These people are transferring to a different person after they are recovering from trauma. What I would say, this work is, for me is the most rewarding thing that I’m doing in my life.

I’m a mother, that’s absolutely rewarding, but I would say if I want to compare these two, I am not able to choose one.

David: Powerful. All right. Thank you for being with us.

Hedieh Azadmehr: Thank you so much. Thanks, David. Thank you.