Young Men and Mental Health with Matthew Stefanko of MANUAL

Apr 11

“Be tough” is the message men from every generation have heard growing up. But awareness and understanding of men’s mental health is on the rise. Matthew Stefanko, the CEO and Founder of the MANUAL visits college campuses around the country to encourage young men to become the best version of themselves. Matthew and David discuss how to break through the stigma men face in getting help.

“We’ve set up a system where you have to cry and be vulnerable to get mental health … I think we need to do a better job of saying that it’s okay to access improvement in the way that works for you.”

- Matthew Stefanko

Matthew Stefanko is the chief executive officer of MANUAL, a men’s health company with a mission to inspire young men to become the best version of themselves. Prior to MANUAL, Matthew led Shatterproof’s National Stigma Initiative as a vice president. Prior to Shatterproof, Matthew worked in management consulting, and he previously worked in local government at the Baltimore City Health Department. Matthew has a dual degree in Economics & Government from Cornell University. He is based in Washington, D.C.

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David Magee: I'm David Magee, and this is The Mayo Lab Podcast. So happy you're with us on The Mayo Lab Podcast once again. As always, we've got Alexis Lee along for the ride. Alexis, how are you?
Alexis Lee: I'm doing well. How are you?
Magee: I am so great because this is a conversation particularly if you are a parent of young men, or, hey, if you just have to engage with young men in general, there's a lot to learn about young men, and I think there's a lot of ways we have to help them.
This conversation, Alexis, I think, is important, really hits home with me, first of all, because I had two sons that really struggled with substance use disorder beginning in middle school and into high school, and a lot of that was self-medication.
To be honest, even when I was in middle school and high school, I really struggled with self-identity. Who am I? What's my role in the world? There were expectations, I felt like, of who I was supposed to be that I think I battled long into adulthood.
So the very notion that someone in a company is out there digging in at the college level to engage with students around their wellbeing is a big deal. We've got just that guest for this episode.
Lee: We do, Matthew Stefanko. He's the CEO of Manual, a men's health company with a mission to inspire young men to become the best versions of themselves. They have a really unique approach to how they're working with students on college campuses everywhere. He gives some great insights into what they're learning about men everywhere.
Magee: Not to be missed. Matthew Stefanko, welcome to The Mayo Lab Podcast.
Stefanko: Thanks for having me.
Magee: All right. So, look, you have started a company, Manual, that seeks to help young men find their way. Help me understand, what is this company and what's your mission?
Stefanko: Yeah, sure. So at a really high level, Manual's mission is to inspire young men to be the best versions of themselves. So that's the short of it. Really, the motivation behind Manual is ultimately, like many things, what ended up being the design of it in many ways, but a lot of that was personal, but then also what I was seeing in my professional career.
So, personally, I grew up in a relatively small, I guess increasingly suburban town in Minnesota. But a lot of the men that I grew up around were blue-collar truck drivers, military, et cetera, and sharing their perspectives around emotion, vulnerability, all these sorts of things, that wasn't really normal growing up. I think as I've done this more and have had more conversations, that's not really unique to really any part of our country. It's actually pretty universal in a lot of ways.
Magee: Right.
Stefanko: I struggled myself with mental illness, specifically anxiety. It took many years into college, after, of dealing with that, using alcohol as a coping mechanism, like so many young men and young adults generally do.
That was what really inspired me to move into the behavioral health space in general. And so, I had different stints in Baltimore City, at their health department. I was at Shatterproof, a nonprofit for focused on addiction. When I was at Shatterproof, that was really the motivation behind Manual from a professional standpoint, because I was seeing two things. One, the campaigns that we were running around health promotion were extremely successful, except with one demographic. It was men, 18 to 35.
Magee: Interesting.
Stefanko: We couldn't figure out how to get to them. Then second, and critically, when I was looking at the overdose data, who was dying? It was men in their 30s, 40s, 50s, and men in their 20s more generally.
So there's this interesting thing of this is the group we've got to get in front of if we want to save these lives, and then they're not compelled to use it. I just started this exploration of what's going on with young men in our society today, and seeing the graduation and enrollment rates rapidly decline, seeing the suicide rate being significantly higher. Men were just retracting from all of these institutions and not utilizing them.
It became very clear to me that it was because of the way, typically, we talk about health, wellness, all of these things, the way we design it are completely at odds with the way that men are socialized. So if you're raised one way and then you get to an environment where it's saying you need to be in touch with your feelings, you need to be vulnerable, you say, "Well, that's not for me." You resist it and you pull away.
And so, you can do one of two things. You can decide to try to force men to rapidly change the way they're socialized and it's the boys should cry mentality, or you can say let's try to meet these men where they are and try to adapt programs to do that.
And so, that's what we've been building over the last seven, eight months. We take a variety of approaches from an intervention standpoint. That includes this pretty high-quality content that we work around with experts that we build for these guys. We have a peer-based program, or we have full-time staff on our team who are what we call men's guides, who do oversight, and have these anonymous chats and conversations with these guys.
Magee: So that's done digitally? So you're engaging with them on a digital platform?
Stefanko: Correct.
Magee: Is that the-
Stefanko: Yeah. Exactly. So we partner with institutions that serve these young guys. So that might be universities, it might be with national fraternities, it might be with the inner fraternity councils. Then they ultimately give our service and our platform to the guys that they serve for free. That includes a whole suite of things.
It's all digital and it's meant to scale and it's meant to really meet these guys where they are. So they have emails, so we have a weekly newsletter. They're on social media, so we add them to a closed group on Instagram, and they can see our content on Instagram. They text. And so, rather than pulling them to an app, we actually just text them directly and we get their phone number. Then, of course, they watch videos on their phone. And so, we have an online platform where they can watch all of our content.
So we really try to meet them wherever they are. Interestingly, we've found that these guys do pick a lane. They prefer just working with us through the newsletters, or they prefer just working with us through the texts or whatever it might be. But, yeah, that's the service that they ultimately receive, and then they have access to that during the duration of the partnership that we have with these schools.
Magee: Is there anything ... Tell me a few things ... Engaging with college students so far, young men, tell me a few things you've learned about them. Where are they now?
Stefanko: Yeah, they're not in great shape. I mean I think that ... And the numbers bear that out. I mean they're definitely struggling. I think they are increasingly coming around to the idea that they need help, but they're finding that that help is not compelling to them once they reach out. And so, they often are finding other pathways, which is a whole additional problem, which is really scary and challenging.
But we've learned a few things. I mean, one, when you think about the experience of counseling centers or substance use centers, or where men should be potentially getting help, many of them, especially Black men, Hispanic men, et cetera, they're not finding themselves in the therapists and counselors that are often at these schools.
It's not the school's problems, it's a workforce problem. But, inevitably, if 78%, 80% of your counseling workforce are women, and the vast majority of those are white women, if you're a young Black man, you want to speak with a young Black man about your problems, who's a therapist. You're not going to find one. It's going to be really difficult. And so, they're seeing that disconnection.
Second, we're learning about the language a lot that gets talked about. I've now been on the road and been in dozens of counseling centers and on campuses, and we've made a lot of progress opening up about mental health. But, unfortunately, most of the messaging about mental health is, "How are you feeling? If you need help, reach out. We're here for you. Are you dealing with anxiety? Are you dealing with depression?"
All of that language is stuff that is totally at odds with these guys. They don't want to deal with their feelings. They want to optimize. They want to self-improve. But that's not the messaging that they're receiving. And so, they stay away from it.
There's just still that stigma. There's that internalized stigma. So, yes, we've made a lot of progress, but we've not overcome all of the progress.
So these guys still don't want to talk with their buddies about what's going on, at least not in a meaningful way. They don't feel like they have pathways to get help. When we've talked with a lot of young women, many of the things that enable them to get help, they have a sister that tells them about a great OB/GYN or a therapist or an app to use. Guys aren't going to their buddies about their erectile dysfunction issues or their anxiety or their drinking problems.
And so, there's just no entry path for them into getting that further help, and that's what we try to produce and build, I guess.
Magee: So you mentioned drinking in young men. Look, I wrote a whole book about this culture. I lived it myself. I watched my sons go through it. I'll say the alcohol and, in many ways, the marijuana culture, because I think a lot of studies show that while men and women are really impacted by marijuana addiction and misuse, often we're seeing males are more prone to that, certainly in the alcohol culture.
Look, I mean we're based in the deep south. In the deep south, often the stereotype is you get a truck, you kill a buck, you start drinking. So this substance culture, in many ways, from Minnesota to the deep south, is so deeply ingrained in young men in so many ways that it's almost an expectation for some, this rite of passage, this pronouncement. Do you see that? If so, I mean what's our way out of that?
Stefanko: Yeah, it's a big question and it's absolutely part of it. I think one of the biggest challenges that we have in the university setting ... And I know we've talked in other conversations about the need to go even further upstream. So I mean that's part of the conversation is that we are talking about substance use education too late.
So when I was growing up, even though I stayed away from substances until I got to college, every Christmas, when we were out at the hot tub at the random courtyard in the middle of nowhere, all of the adult men were five beers deep or a few beers deep or whatever it was. It never even got to a point of problematic substance use from my perspective, but it was there. It was the culture. And so, you do feel like as you're growing up, you have to adopt that culture.
So earlier education is key. Then I think there's a translation or a conversation that we need to have with our young men, but really young adults in general, about identifying whether or not you have a problem relative to a bunch of other people who are behaving in the same way.
That's the problem that I think a lot of these young guys have, which is that the education that they're receiving feels very binary. Here's what a substance use disorder is. If you drink more than five drinks in a night, you've got a problem. They're looking out onto all their buddies. Everybody around them is drinking five drinks a night.
Magee: Absolutely.
Stefanko: And so, what I always talk about is these three kinds of groups that we need to be able to teach guys how to identify where they fit in that group. There's the kind of guys who are drinking aggressively in college that are going to be just fine when they graduate.
There's not a genetic predisposition. Once they start having a job, they start having a family. They might drink on the weekends. They might, during a bachelor party or whatever it might be, imbibe a bit more than normal. But they're going to be fine and they're not going to exhibit those symptoms of substance disorders.
Then you've got people like me who was binge drinking, blacking out related to my mental health issue. So I had untreated mental illness. And so, I was binge drinking to cover up that social anxiety. And so, until I dealt with that mental illness, I was always going to have those problems with alcohol use and all the sorts of things. Then you've got people who have substance use disorders.
When you're a 19 year old guy, it's very easy to justify and rationalize your behavior because you don't know which of those three groups you fit into, and most of the education that you're receiving doesn't have that level of nuance. It's just if you're drinking a lot, you have a problem and you're like, "Well, then everybody in my house has a problem."
Magee: Everybody, yeah.
Stefanko: And so, that's the kind of nuance that we need to get. Then we need to teach friends and people around these people to be able to identify and have those kinds of conversations, because I think if you asked any of my friends in college, "Matt was just a heavy drinker." But there was never that, "Oh, I think there's something else going on," or whatever. It's just, "Oh, he just drinks more than us, but we're all drinking a lot anyway. So how bad could it be?"
Magee: When my son Hudson woke up in the hospital after an accidental drug overdose when he was in college, he was in a coma for a couple of days. While he was in a coma, some of his friends called me to the side and they said, "Hey, when he wakes up, you should know, he might need some help because he's been on something for a while." It didn't dawn on them to sound the alarm of emergency at that time because they were just seeing it all around them.
I think that education process ... You're right, there's a difference. It looks different in different individuals. You might have one individual having two alcohol drinks a day, but using marijuana morning, noon, and night and mixing in some pills, and then they have a problem. But they can't look across others and see exactly a mirror reflection to help them understand that they have a problem.
Stefanko: Yeah.
Magee: The other thing that you talked about that's so interesting, reminds me of when, as a middle-aged man, I grew up with some anxiety and depression, just like you were talking about you faced as a young man, and I never dealt with it. I didn't understand what it was. I didn't even know how to put my finger on it.
So I go to a psychiatrist as a middle-aged man, for the first time. I walk in there in all my male ego. I walk in there and I don't say, "Hey, I sometimes am depressed. I'm often anxious. I don't know who I am literally and I'm not sure I do figuratively. Help me." What I said is, "Man, I'm a man." I put that armor up. "Hey, here's the thing. If I could just finish this book I've got under contract on deadline, I'll be fine."
Really, that's all it is. It's just like if I could just get to the holidays, if I could just finish that project, if I could just get in the new house, the new job. That's what I said.
So what I did is I walked out with a prescription of Adderall, which I soon was misusing. And I did finish that book. But then when I began to pair that with alcohol, my life spiraled out of control. That's on me, and I own that, because I didn't speak a truth in that first meeting with a psychiatrist.
But going back to what you were saying, I'm not passing the buck, but how I was raised in the culture, I didn't understand how to speak the truth. I was taught generally, culturally, there is no such thing as that truth.
Stefanko: Yup. The number of adult men who are in their 30s, 40s, 50s, 60s that I speak with about Manual that then open up to me, and I'm maybe the second or third person that they've opened up to about what they're going through, it's, "I've told my wife. I just started therapy, and now I'm talking with you," or sometimes it's, "I haven't even told my wife that I'm going through this."
I mean that's the level of how deeply ingrained this hesitance to reach out for help and express a need and all these sorts of things is for so many men. And so, then when you look at our young adult men and when you look at the sons of those guys, it's like how well-equipped could they really be to be able to confront these sorts of things when that conversation was never something that was going on at home?
Because I can tell you from the conversations I've had with these young adults, you can feel it when your parents are struggling. You almost always know, even if you don't know the depth of it.
Magee: You feel it.
Stefanko: You know to some degree what's going on. If they're not openly talking about, "Here's what I'm doing to get help," and this was my story, you just assume, well, that's the way business gets done around here. We just aren't going to-
Magee: We're just going to bury it. Just feel the grief and move along.
Stefanko: We're just going to bury it and go through. When you trace that down, and I think it's probably related to the things you saw on your parents and the things my dad saw on his parents, I certainly know that's true with the people that I'm hanging out.
Magee: I don't think in my household truth was ever spoken, I'm being honest. It was a conservative household of ... They thought they were rooted in truth. We were in church every Sunday when I was little. I'm telling you, everything was a lie. There was no truth. It's like I could have a red shirt and somebody would tell me it was white if they thought it would make somebody feel better. I mean there was no truth.
Stefanko: Yeah. A big part of my exploration on this, personally, is every day trying to remove blame from the individuals that I was around and really trying to understand that we're set up societally as men to fail in this regard. I mean we really are. We're taught to be this way.
Then, also, all of the solutions and the things that are being developed aren't built in a way that is compelling based on the way we're socialized. This is the hill I'll die on of something that we've talked about a lot is I don't think that having boys should cry and men should be emotional or any of those things aren't good, lofty goals or whatever it might be. But why do we, as men, have to get there to be able to get mental healthcare, therapy, or all these sorts of things? We've set up a system to say you have to cry and be vulnerable to get mental healthcare and all these sorts of things.
I've been very lucky to meet with a lot of men who have gone on journeys, whether it'd be mindfulness or meditation or therapy, or they've gotten prescriptions that have benefited them and all these sorts of things. They've gotten there in their own way based on the way that they were socialized and how they fit into the world as men. I think we need to do a better job of saying that it's okay to access care and improvement and optimization, or whatever you want to call it, in the way that works for you and not make it this barrier of you've got to get out.
Magee: You can't do it unless you fully cross over this line-
Stefanko: Yeah, exactly.
Magee: ... and become somebody else.
Stefanko: That's right.
Magee: Alexis, you played sports in college. You played volleyball. I'm guessing, from a woman's perspective, you faced some of these issues there, I mean, of having to ... Did you feel pressure, like you have to be a certain way as an athlete?
Lee: Oh, yeah. There's always that pressure of you're going to show up on time, you're going to do five extra reps. You're going to do what you need to do to get the job done, but actually you're going to do more than you need to do to get the job done, because we expect this level of you.
I think we are doing a lot better job now in the athletic space of having these conversations with the athletes of it's okay to cry. If you're hurt, you need to take care of your body. If you're struggling, let's talk about it. And so, I think they're doing a lot better job in that space.
It comes from the top down, but I also think it starts at home. It starts in the family. It starts in the community you're surrounding yourself with. So, Matthew, I want to ask you, as a female, how can we better support men in our lives? How can we open that conversation, that gate, create a safe space where it's like it's okay to cry without saying it's okay to cry?
Magee: Yeah.
Stefanko: Yeah, it's a great question. I think it's interesting because I have my personal perspective and maybe a bit of a nuanced answer in that some of the Manual users actually are women on these college campuses, because ...
Magee: Okay.
Stefanko: It's a small number-
Magee: Okay, but you have some.
Stefanko: ... but they're using it as a mechanism to help their partners or their brothers or whatever it might be.
Magee: Interesting.
Stefanko: I hesitate or pause because I think it's an important question, because I do think that there is an overreliance of men on women to help them get through this. There's too much burden being born by women as the de facto therapists for all of these men. Honestly, if you want to go really dramatic, and it's how a lot of things like domestic violence and verbal abuse and all these sorts of things start-
Magee: Absolutely.
Stefanko: ... because you start to say this is my only outlet.
Magee: Crave more.
Lee: Yeah.
Stefanko: So I only hesitate to say that I do think a lot of what we're trying to do with Manual, and what more institutions need to do, is to step up for men so that they're not so reliant on that individual woman in their life to be there. I'll be very open, Olivia, my fiancee, helped me through a lot when I was going through things when I was 22, 23, 24. It was an undue burden on her, certainly. And so, there should have been more around.
But I do think that, largely, if I had to answer what can women do more generally, et cetera, I think some of it has to do with redefining expectations of what they value in men that they're dating or those sorts of things, which starts to get to be a very dramatic conversation.
But I do think we hear a lot from young men confusion of, "I'm told to be tough. These girls like me if I'm quiet," and all these sorts of things. Then at the same time, we're hearing ... This is just what I'm hearing from 18, 19, 20-year-old guys across the country. "Then at the same time I'm being told to be vulnerable and to open up and to cry. Then at the same time, then those girls aren't as attracted to me anymore."
This is just what they're telling me. It's a very, very complex conversation from that point, so I don't know if I have a perfect answer. But I do think that if we're asking men to be more complex and more nuanced and more open, and we're saying that's a good thing to aspire to, not just women but as a society in general, we need to be excited about that and then promote that when it happens versus saying, "We actually liked you the old way when you were tough and reserved and guarded and you weren't open."
I think that's not just a conversation for women and partners or whatever, it's a conversation for parents and the institutions that we're a part of, athletic departments and coaches. I think they need to be comfortable with their guys being different than what they were 20 or 30 years ago. If they're not, those men are going to just revert back to what they were raised on.
Magee: So one answer I have for that, because that is a great question, and I love what you have to say, Matthew, on that. For me, personally, there was a big change in my life. So in my marriage even, when I felt as a ... My wife would have a position of fear around things, like you're talking like you don't know if you want to stay in this job because you feel like you're called to do this. She would feel fear around that.
What I always say, I'm a broken record about being seen and heard, I can't say that enough, is a big shift for us when I begin to see her and hear her not around expectations of her, just who she was and really hear what she was feeling, and the same was in reverse.
I always say I actually went and made a whole lot more money once I was seen and heard that I didn't want to be viewed as making money. That's actually a true story. That's actually a true story. I crumbled under the pressure of that fear around the expectation of what I needed to do.
Once we got to a point, in both ways, where I could articulate being seen and heard as me, and I have these fears and I don't want to be trapped into a job I don't like, even if it does put some financial burden, really, once we got to that point and it took that pressure off ... And I do think that's the thing.
I mean there are still many stereotypes that exist and I wish I could say that we still don't often see men in a perspective of you will go be the breadwinner. I mean it is the 21st century, but that still exists in many respects. Men also place that pressure on themselves.
Stefanko: I think it's about ... We talk about this a lot, of redefining all the words that men are raised on and really trying to change that. So I don't personally think there's anything wrong with wanting to be resilient or being a provider to your family. Those are both-
Magee: That's right.
Stefanko: I don't even know if you'd call those masculine traits, those are not just human traits, but, regardless, they're good things to aspire to. I think most men would say they want to be tough and resilient and providers to their family. It's the second degree of what does being tough mean and what does resilient mean? What does being a provider mean? Maybe for your family it means stepping up and raising the kids and being around if your partner's the one who's out being the breadwinner. But you've got to be comfortable with that and not tie your identity up so much with it.
Or for resiliency, I often talk about how I don't see resiliency as holding on and resisting getting help as long as you can until you break down and hurt all the people around you. But growing up, that's what I thought and that's what I was taught.
Now I believe that resiliency is saying I've got this issue. I'm going to go nip it in the bud and I'm going to get rid of it or manage it to the point where I'm not going to hurt the people around me and I'm not going to cause these issues and all those sorts of things.
So it's not about punishing the idea that a lot of these young men have with saying, "I want to be tough. I want to be resilient. I want to be a provider. I want to be seen that way." It's about saying what is the actual manifestation of that to the people around you versus what is the faux expectation that you've built up that actually if you unpack it isn't as good as it seems.
But that requires a whole community effort. Alexis, to your point, everybody's got to get on board with that. If you don't, then that foundation starts to crumble.
Lee:. I want to ask something of the culture we're in now. It's like our parents didn't ask for help, our grandparents sure as heck didn't ask for help kind of thing, of that level of almost guilt. You feel like you're going to let them down by stepping up and asking for help. Have the guys that you've been talking with talked about that at all? What level does the guilt or a shameness of it play a factor?
Stefanko: Yeah. I think it's starting to shift. I mean I graduated in 2016. When I talk with the guys that are on these campuses now, I mean there's a monumental sea change that is happening around that guilt piece, I think.
So I actually think that, to some degree, the guilt and the shame is less about the disappointment of the toughness and resiliency. It's really about the lens of all the people around them and the perception that they have of those people.
I think what that looks like for ... I mean, to be totally frank, the biggest concern I get is not about parents. It's about girls. It's how are they going to view me as a guy who does these sorts of things and opens up and has these kinds of conversations? So I hear that quite a bit.
Then from their peers. So it's how are the guys around me going to value me as a leader, or whatever it might be, if I'm the one guy who has to go get help or whatever it might be?
And so, a big part of the conversation that we're having with these young guys is trying ... There is a level of normalization. The analogy I always give is if you play three-on-three basketball with any ... You five guys to go play three-on-three basketball with on any college campus, one of them is going to be dealing, statistically, it's at a very high level, with a substance use disorder. One of them is going to be dealing with some level of anxiety, depression. One of them is going to have erectile dysfunction before the age of 25.
Now if you go up to any group of six guys on a college campus and say, "Hey, that's your friend group," they're going to say, "No way. No way that's my friend group." Those are six other guys. I was like, well, maybe. But then you just picked a lucky friend group. Because if you run that scenario enough times, that's what you're going to find.
And so, there clearly is something there. I don't know if it's guilt as much from what I've heard, but it's whatever that ... Maybe shame's the right word, but it's that barrier that gets built up between the perception of those groups of people to who I am and my identity, which we know is very perilous and tricky anyway as an 18 or 19-year-old, let alone all those layers of who you're supposed to be as a "man" get layered into it.
Magee: Have you learned anything from the engagement with students so far that is valuable to share to parents? I mean I get to engage with a lot of parents. I get in schools throughout the country. Just last week, I was at a school. I had a couple of hundred parents at a meeting. Parents continually line up to ask me, "Help me communicate with my young man." I mean they don't know how. They feel like they get bottled up and they can't chisel their way through.
Stefanko: Yeah. I think maybe not as comforting of an answer because it's more preventative than in the moment, but having these conversations earlier and building up that confidence, I think, when someone's younger to say you can be proud of wanting to get help, or whatever it is, when you're in middle school or elementary school or high school, or whatever it might be. I think that's a big part of the conversation.
I would say ... And policing any young adult social media or whatever it might be is a tricky subject. But I would say that parents do need to understand the type of men that these men are seeing on social media.
This was something that I had mentioned earlier, but I'm a general believer that when people are struggling, they typically don't do nothing. They have some outlet somewhere, even if it's unproductive. We know these men aren't going to their collegiate counseling centers or to their community or to their parents or their friends. A lot of them have found these safer spaces online through these kinds of well-known chauvinists, like Andrew Tate and people like that, who are on social media, Liver King and Fresh&Fit Podcast, and all these people that you may have not heard of, or parents may have never heard of, that have millions of followers and who are espousing messages that meet these guys where they are.
So that idea of we hear you, we see you, we know that you're struggling and not questioning that or debating it, that's the first line that these guys take on social media. That welcomes these guys in. And so, they're seeing a lot of content that is justifying a lot of their behavior.
And so, if you as a parent are rejecting that immediately, or if you're not accepting that these young guys maybe feel like they are struggling in some way, they're not going to listen to you. They're going to listen to these other people.
And so, that's a lot of the work that we're doing on these college campuses as well to say it's a tricky dialogue in 2023 to say men are struggling and young men need more help, because, in many ways, menstill have a significant amount of power-
Magee: Man, it is a tricky dialogue.
Stefanko: They have a significant amount of power in society. They heard a lot of people. When you think about sexual assault and domestic violence and all these sorts of things, it's hard to square up in our dialogue why we should give young men more support while simultaneously, one, they've had a lot of support for many years and, two, they do all these potentially negative things.
And so, what I can say is if you double down and go to these young guys and say, "Actually you should be just fine. Do the work by yourself," they're going to find another outlet, and that other outlet is even worse than what they've already been consuming.
And so, it's a tough dialogue because of where we are in today's society. There's no perfect answer. But I do think you've got to at least empathize with what they're feeling, even if you don't totally agree with it, because that's how you get them on the path to getting more help versus pushing them towards these people that I can tell you are pushing out messages [inaudible 00:35:54].
Magee: Well, absolutely, because we want fewer of those problems we talked about.
Stefanko: Correct. Correct.
Magee: So one issue I can tell you that, anecdotally for me, I'm seeing rapidly on the rise. I'm no counselor. I don't pretend to be. But because the Magee name is on a university center at the University of Mississippi that helps students, and it's named after my late son, I get a lot of first-level reach out from parents and students all over the country, not just at the University of Mississippi, who will say, "Hey, I'm struggling," or, "My child is struggling. Where would you turn for help?"
So my role is consistently to not even pretend to be a counselor, but get them quickly into counseling. I'm a first step, "Oh, well, yes. Let's get you right in. Here are some places to go."
The thing that I'm seeing rapidly, let's say two years ago, I would see plenty of female eating disorder, where do I go? No male eating disorder. Suddenly, suddenly in this past semester, I heard from three to four young men, or parents of, it's just rapidly showing up on the radar, of male eating disorder.
Stefanko: Yeah. There was an interesting article in The New York Times, I don't know, six months ago or something, about the concept of ganorexia.
Magee: Yes. I saw that.
Stefanko: This is, I actually think ... I think you can pretty easily connect one dot to another, of men are feeling disconnected. They go to social media to find space. They find that space. Those people are ... Inevitably, they're just multi-level marketing hustlers.
Magee: That's right.
Stefanko: I mean that's what they're doing. They're trying to sell a product or whatever it might be. They do that by something very similar to what engendered a lot of women's eating disorders and things like that. They set expectations that are impossible to achieve unless you do something behind the scenes that nobody else is going to achieve.
So there was this notable story that's ... It's comedic, but at the same time very sad and I think telling to this situation of this guy Liver King who has millions of followers. All of his videos are him eating raw organs and raw testicles and all these sorts of things. And all of these men are buying his desiccated pills, these desiccated bull testicle pills, because they're trying to get bigger. They're massively changing their workout routine, the way they eat, the way they see themselves. It turns out that Liver King had been on a just exorbitant amount of steroids for a few years.
Now that doesn't get talked about. These guys don't know about it. And so, they're sitting there saying, "I'm doing all the things that this guy's telling me to do. It's not showing up. I've got to go even more dramatic. I have to- "
Magee: So then I've got to do something else.
Stefanko: I've got to do something so extreme and so intense that's going to push me to a point of being very unhealthy, having an eating disorder, or whatever it might be.
And so, yeah, I think these things are intimately connected. It's why, in a lot of the work with Manual, we don't try to necessarily have the first conversation with these guys be about anxiety or alcohol use or whatever it might be. Sometimes the first conversation is about sleep or sexual performance or just fitness or whatever it might be, because that's something that they do want to improve on right now. They might not want to improve on their mental health, but they want to sleep better and they want to be better at sex. They want people around them to find them more attractive and they want to make more money, or whatever it might be.
And so, we try to start the conversation there and actually say that being more mentally healthy and having healthy exercise habits and healthy eating habits, all those things, are going to contribute and be connected.
But, yeah, it's a huge problem. It's going to continue to get worse. This industry is rapidly propagating very, I would say, quietly on social media, but it's gigantic.
Magee: It is.
Stefanko: It's really rough.
Magee: It seems to be happening fast.
Stefanko: Yes.
Magee: And so, when you think of what young men face, I mean ... There's no getting away from the football culture. Look, I watch football Saturdays, sometimes on Sunday, because I grew up in that culture. But the reality is if you're a young person today, yeah, it's the 21st century and so much has changed, but look at the exposure they get in pornography, in roles, in objectifying women, in how they're positioned there.
Then you look at this football culture. Very largely driven around alcohol, driven around ... It's negative if you're injured. You've got to get back in the game. You've got to be fit. It's this macho, macho culture that, frankly, not only all of America, but a good bit of the world is pretty tuned into. That is a pure male-driven culture.
Stefanko: I think that ... And this is maybe a little bit outside of the football culture, but also the social media, but I think there's connection pieces, is what you really have to do with young guys is have honest conversations with them about what is attainable for them, how they should mix up what they want to do with this broader culture that they're seeing, because I think a lot of where the challenges happen is when young guys start to project what they think they should be based on what they're seeing from these, whether it'd be celebrities or influencers or athletes or whatever.
And so, if you're sitting and stewing all day, saying, "I can't be that, but I want to be that," and you don't understand the underneath of it all, like what kind of sacrifice are they putting in, what kind of advantages did they have or not have, all those sorts of complexities, you start to think that maybe you should become that or you need to replicate some of that kind of behavior.
But it's really difficult. I mean I think we see that there still is no shortage of men with celebrity power, influence, et cetera, who do really bad things to a lot of people. I'm not saying that's football players or culture generally, but in any of these kinds of fields, you see that. If they're not getting punished, if they're still getting celebrated, all those sorts of things, it's hard to measure up, "Well, why shouldn't I try to go do that thing?" because it seems like they're having a level of success.
So I don't know. It's a big question. I don't really know if I have a solution to it other than to say we try to teach young men about attainable pathways to whatever their own personal level of success is and what they hope to achieve versus trying to project whatever they're seeing out in the world onto their own lives. I think that gets you part of the way.
But inevitably when you see that kind of macho culture, and it is so ingrained in the US, we're always going to be fighting against that to some degree, or not even fighting against it but just acknowledging that it's there and it's going to exist and we're going to have to coexist with it in some way.
Magee: So you're the founder and CEO of Manual. You're on college campuses, including doing some work on the University of Mississippi campus where you've had many young men sign up and engage on other campuses. Tell us just where you are now and what you see is the future for Manual.
Stefanko: Yeah. We're really excited about the initial traction. So we launched on campuses, so the University of Mississippi and Morgan State University, just in October. We already have a little over 2,000 men enrolled in the platform across the country-
Magee: Nice.
Stefanko: ... which is really exciting, in just the first few months. We expect that to be somewhere around five to 10,000 men enrolled in just the next few months. We're in a bunch of different colleges across the country, including starting a partnership with the Inner Fraternity Council at the University of Alabama. It's just down the road.
Then I'm really also proud of the work that we're doing with HBCUs and some of the Hispanic-serving institutions. So we have an incredible partnership with MSU Denver. There's a real men's health leader out there, Dr. Steve Rissman, who's been a real champion of us, and then some work with Elmhurst and Morgan State University, Clark Atlanta.
All of these conversations that we've been having about young men are even more complex and interesting and difficult when we talk about the culture of Black men and Hispanic men and GBTQ+ men, how all those sorts of things start to intersect and become more challenging.
So we're really trying to figure out how to serve those men as well, and continuing to just try to expand the types of content that we're doing, expand the diversity of our team so that we can better serve more diverse men across the country, and hopefully be in a position where we're serving tens of thousands, hundreds of thousands of men over the next couple of years and giving them one of their first opportunities and resources to engage in these kinds of conversations, these kinds of dialogues in the collegiate setting, hopefully in the high school setting.
Frankly, more so than we even expected, when we have conversations with these young guys, even when they're 19, 20, they're telling us, "I wish I had this when I was 14, 15."
Magee: Right.
Stefanko: So we know that there's a lot of work that needs to be done there. Then we've had a lot of conversations about what does it look like to adapt what we're doing to men who are 30, 40, 50, 60. It becomes even more difficult because things are so ingrained.
But the reality is men are leaving the workforce at a really rapid rate. Men are dying, I mean, daily, weekly, on job sites, in the construction industry, and all these sorts of things because of issues of substance use and suicide, et cetera.
So there's a deep hurt with a lot of men and it's affecting a lot of parts of society. It's hurting women. It's hurting families. So that's where we're going to be playing and operating. Going back to the football analogy, I mean I think we're on the one yard line going the other way, and excited about what's to come.
Magee: Yeah. So where can people find out more about Manual?
Stefanko: Sure. So our website is manual.care. You can see some of our videos and some of the information and some of the universities that we're partnered with. We're always open to having a conversation. I mean we really see this as a movement that needs to be created around advocating for our young men and how to support them in the context of where we are and getting them more high-quality resources that make them better family members, better husbands, better partners, better fathers, all these sorts of things. So anybody who wants to be around that mission, we can probably find a way to create a partnership.
Magee: I hope everybody wants to be around that [inaudible 00:46:33].
Stefanko: So that's the best way.
Magee: All right. Matthew Stefanko, thanks for joining us on The Mayo Lab Podcast.
Stefanko: Thanks so much.
Lee: Thank you for joining us on this episode of The Mayo Lab Podcast. The Mayo Lab Podcast is produced by Dr. Natasha Jeter, Dr. Meagan Rosenthal, David Magee, Alexis Lee, and Slade Lewis.
This podcast was recorded at Broadcast Studio in Oxford, Mississippi. The show was mixed and mastered by Clay Jones, and our original music was composed by Slade Lewis.
The Mayo Lab Podcast is brought to you by the William Magee Institute for Student Wellbeing. For more information on The Mayo Lab, head over to themayolab.com and follow us on social media @TheMayoLab.
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This podcast represents the opinions of David Magee and guests of the show. This podcast is not intended to be a substitute for the medical advice of a licensed counselor or physician. The listeners should consult with their mental health professional in any matters relating to his or her health or the health of a child.