Remember the first time I came here [to therapy]. I said [...] all Americans, all they’re doing is crying and confessing and complaining – a bunch of fucking pussies. Fuck them! And now I’m one of them, a patient! 

Tony Soprano

Suicide is three times higher in men than women. If you find this fact surprising, perhaps even more surprising is the lack of public research or even curiosity about why this is the case. One obvious explanation is that while women are allowed to show their deeper feelings, men are prohibited from doing so. For a man to seek help and admit to problems means risking his very sense of masculinity. This means that men are more likely to bottle up their feelings until they literally snap or explode. For this reason it has been suggested that The Sopranos has at last provided a good role model for men’s mental health, because it is the first major TV drama series to depict an archetypal male, a gangster boss no less, going to a therapist. So this should be a major breakthrough for men, right? Well, yes and no. This article explores the ways in which men’s expectations of therapy might be affected by The Sopranos.

Background

The Sopranos was a popular US television drama, broadcast between 1999 and 2007. A key thread running through the series was the psychotherapy of the protagonist, Tony Soprano (played by the late James Gandolfini), a New Jersey Mafia boss and archetypal macho male. The show was highly acclaimed and even won an award from the American Psychoanalytical Association. It has been claimed by Professor of Psychiatry Dr Glen O. Gabbard that more men started seeking therapy as a result of the show. If this is true, then what kind of expectations might this TV show be raising for men? In this article we try to explore this question using Martin Seager's that there are 3 ancient rules that make up a “script” for masculinity that men have to live up to:

1. A real man must be a fighter and a winner 
2. A real man must be a provider and protector (especially to women and children) 
3. A real man must retain mastery and control at all times. 

These rules are rigid and if broken can lead to a catastrophic sense of failure and masculine shame, which in turn may lead to suicide. A recent research study by the authors supported the idea that such gender rules do exist for both men and women. In particular, men and women who felt that they had to be a fighter and a winner, or a provider and protector, were significantly more prone to suicidal thinking. So what happens if, keeping these rules in mind, we examine key themes that came up in The Sopranos? Furthermore, what might a man considering entering therapy think about how these issues are explored in The Sopranos? 

Fatherhood 

Perhaps because he lost his own father early in life, Soprano is shown to be highly macho in his fathering, controlling or criticising rather than encouraging his son, Anthony Junior (AJ). Much of Soprano’s experience as a father raises issues that can be related to by viewers e.g. ‘do as I say, not as I do’. Being a success at fatherhood is a key part of living up to the masculinity rules (winning, providing and maintaining control) and this means that a man can  really be wounded by failures with his children. Men who have issues with their children or their fathers would be perhaps encouraged by the role model of Soprano to seek therapy to talk about this, but at the same time Soprano is not depicted as succeeding in therapy and therefore it is not clear what the message is for male viewers and what the balance might be between encouragement or discouragement of their hopes. 

Masculinity

Soprano’s crew are hyper-masculinised in a way that may appeal especially to men who feel de-masculinised or who are seeking a strong sense of male identity. Although high levels of homophobia are depicted in The Sopranos, for men thinking about seeking therapy for issues around sexuality, there is some encouragement in the fact that Soprano himself, a man who describes homosexuality as ‘a victimless crime’, is seeking therapy at all.  

Soprano’s initial reluctance to seek therapy is shown in the quotation at the start of this article and this perhaps offers viewers a realistic model of conflict that might encourage men in real life to grapple with the idea of help-seeking. Furthermore, peer support and peer conflict about male help-seeking are realistically modelled in The Sopranos, because once Soprano takes the brave step of telling the three central members of his gang that he has been in therapy, two of them are accepting, and one shares that he has been in therapy too. The youngest and most headstrong of the crew (Christopher) isn’t supportive, a reaction that lends realism to the scenario. 

There are many ways in which men today may feel de-masculinised, and these can be seen in terms of failures to live up to the gender rules. For example, a man might be unemployed (thus fail to provide) and become depressed (thus failing to control his emotions). Men in situations like these may well be inspired by seeing Soprano – an alpha male – showing vulnerability and seeking help. It is easy to imagine that Soprano’s help-seeking behaviour could serve as an important role model in these circumstances. 

Soprano’s evident failure to live up to the masculine ideal coupled with his ‘everyman’ qualities, means that it is easier for the average man to identify with him and that Soprano could offer a realistic model for men considering seeking therapy. However, it is not clear from the story of his therapy as a whole whether his therapy journey is ultimately being advertised as something that any man can seriously undertake, or as something that simply mocks the weakness behind his false machismo.

Domestic violence and partner violence

Violence by men against women is, rightly, regularly cited in the media as a repugnant crime. However violence by women against men is relatively invisible in the media. Perhaps surprisingly, given stereotypes about domestic violence, Tony Soprano is portrayed as a victim of domestic violence, not as a perpetrator. For example, after Soprano fails to show up at his son’s swimming competition, Carmella throws an ornament at him and proceeds to pummel him with her fists. Likewise, his two girlfriends provoke him by throwing objects at him.

Although domestic violence is mentioned by Soprano in his therapy, this issue is never explored, perhaps partly because the violence is dwarfed by the scale of the other violence in his life. Also it is unlikely that Soprano, like many male victims of domestic violence, would accept the idea of being a ‘victim’ of violence at the hands of his wife. Indeed it is likely that Soprano’s self-esteem often hangs by the threads of his sense of being a fighter and winner, and a provider for his family. What would be the result of his therapist deconstructing these props to his self-esteem? Perhaps questioning these fundamentals of the gender script would facilitate therapy by forcing him to confront this failure to live up to the male gender rules.  The fact that neither Soprano nor Dr Melfi ever even comment on his status as victim of domestic and partner violence means that The Sopranos doesn’t offer much encouragement for male viewers who are suffering this kind of violence, and who might benefit from discussing this in a therapeutic situation.  

Ironically, this powerful mob boss is powerless in the face of the women in his life. He wants a woman who will take care of him, but says that they all ‘break his balls’. It would have been very interesting to see how Soprano would cope with being helped to see himself not just as a perpetrator of harm to others but also as a victim, not only of domestic violence at the hands of his wife but of emotional abuse from his mother. Again, this is an example of an opportunity lost to explore a key subject, an unfortunate omission in an otherwise well-scripted drama.

Women

Much of Soprano’s therapy focuses on his relationship with his mother, who is hostile and manipulative, using guilt, ridicule and shaming as a way of controlling others. Dr Melfi suggests that his mother has a personality disorder. Soprano’s wife Carmella supports him – at least superficially - as a homemaker, but vents her frustration at him regularly. Although generally turning a blind eye to it, she occasionally berates him for his philandering and eventually leaves him because of it, or at least this is the reason she gives him - she too has a roving eye and only lack of opportunity prevents her from being unfaithful. Soprano’s girlfriends are demanding and abusive. Although Soprano has a strong emotional bond with his daughter Meadow, her teenage attitude and impending independence are a source of pain for him.

In terms of the male gender rules, it is clearly portrayed in the series that Soprano’s masculinity and sense of being in control is continually undermined by his mother. Male viewers might therefore be able to identify with his struggle to live up to the script and defend or assert his masculinity. Seeing a strong male character seeking help for issues related to women may also be said to challenge the ancient gender script and to inspire other men to do the same. 

Dr Melfi is herself a woman and there is a sexual tension between Dr and patient which may not create helpful expectations in the male viewer of having a “lady shrink” (Carmella’s term). The therapeutic relationship becomes another problem with women that Soprano must deal with, and at the same time is an opportunity to change the pattern. The way that this is portrayed in The Sopranos can be said to provide a model that shows that these issues can be faced, both in therapy and perhaps also by extension in other contexts too. 

The portrayal of therapy in The Sopranos

The type of therapy used in The Sopranos is psychoanalytic psychotherapy. Tony sees Dr Melfi twice weekly for 50 minutes for several years and pays out of his own pocket each time. A man in the UK seeking treatment in the NHS will most likely go on a long waiting list, at the end of which he will receive six sessions of goal-focused CBT without having to pay a fee (apart from through his taxes). These two types of therapy – psychotherapy and CBT - are very different, and a man in the UK expecting something like the therapeutic experience portrayed in The Sopranos would be in for a surprise. 

The Sopranos may offer a pessimistic model of therapy in that Melfi eventually decides Soprano is incurable, not only because his panic attacks recur but because she comes to believe that he is an incurable psychopath. To the viewer, Soprano’s struggles with masculinity are therefore possibly being caricatured and pathologised and there is a question mark over whether Soprano is a genuine psychopath, given how much he cares for at least some family members. There is also the question of whether genuine psychotherapy with a criminal is possible given the limitations on client disclosure and problems of confidentiality relating to illegal activities. 

Conclusion: The Sopranos offers some hope

If men don’t seek therapy because it represents an admission of weakness that undermines their masculine identity, then the fact that the macho Tony Soprano is portrayed as seeking therapy must be a good thing in challenging attitudes and providing a role model for men. On the other hand, the outcome of Tony Soprano’s therapy, being labelled as a psychopath and rejected as a suitable patient, gives a very different and less encouraging message about men in therapy. 

Whilst The Sopranos misses several opportunities to show male emotional life in a more realistic light, it does use drama and comedy powerfully to explore the status of masculinity in the modern world. The fact that Soprano’s therapy does not end successfully is, we hope, not the take-home message of this highly acclaimed TV series. Although it would be naive to suggest that mental health promotion campaigns for men should use Tony Soprano as their poster boy, it is interesting to consider whether an alternative form of therapy – something more male-centred - may have suited Soprano better. There is a case to be made for developing more gender-sensitive therapy models for men, but in the meantime the success of The Sopranos offers some hope that the masculine ideal can evolve and become less of a burden, not just for men but also for the women who share their lives.

• John Barry, chartered psychologist, is a research co-ordinator at UCL. Martin Seager is a clinical psychologist. 
• A poster based on the above piece was presented at the Male Psychology Conference at UCL in June 2014. The abstract appears in Appendix 1 of the New Male Studies journal (Seager M, Sullivan L, and Barry JA (2014). The Male Psychology Conference, University College London, June 2014. New Male Studies, 3, 2, 41-68)
• A research paper on the Gender Scripts theory will be published in New Male Studies Volume 3, Issue 3 in the Autumn of 2014.