Those of us who have lived a long time can look back at social change and how it affected the family, the community, and, subsequently, our practices. The impact of these changes on our society can be mind-boggling.

The recent recession has led to an increase in the number of stay-at-home fathers, many of whom experience stigma because of their nontraditional roles. How can we help fathers who find themselves in these roles because of a work-related transition?

The question was inspired by a paper by Aaron B. Rochlen, Ph.D., and his colleagues, "Stay-at-Home Fathers’ Reasons for Entering the Role and Stigma Experiences: A Preliminary Report."

Dr. Rochlen and his colleagues recruited 207 men from stay-at-home father blogs, support/play groups, and forums. Most of the men were white and heterosexual, and had middle to high incomes. The participants were evaluated based on their completion of several scales, including the 12-item Multidimensional Scale of Perceived Social Support and the 5-item Satisfaction With Life Scale. They also were asked several questions, including whether they had experienced an incident they consider to be stigma-related because of their role as stay-at-home fathers.

The findings were sobering: Thirty-six percent of the stay-at-home fathers surveyed got reactions from other adults reflecting "a general prejudice toward men in traditionally female roles." Furthermore, men who reported experiences that were stigmatizing also experienced weak social support – which predicts negative physical and psychological adjustment for stigmatized groups such as people who are HIV positive, single mothers living in poverty, and people with mental illness (Psychol. Men Masc. 2010;11:279-85).

This stigmatization has been occurring while more and more fathers are opting to make this choice ("Current population survey, 2006 Annual Social and Economic Supplement," Washington: U.S. Department of Commerce, Bureau of the Census. The recession of 2008-2009 (and the current economic aftershocks) have exacerbated these trends, so that we now have 158,000 stay-at-home fathers.

The Male Ego

The issue of what it means to be a "man" is one that we deal with regularly in psychotherapy. A male measures his manhood and is instantly concerned that he not do anything that undermines his power. Any insult or disrespect must be responded to, and he must be competitive with all men (and sometimes women) in his sphere.

If a man feels put down, he must retaliate to regain his status, that is, his feeling of being "man enough." Men in marriage want to feel in control – and given the large number of domestic violence cases in America, between 3 and 10 million per year – we know that some men lose control if they feel that the woman in the house is becoming too controlling or too powerful.

In short, it takes a certain kind of man to agree to stay home and take care of the children – in other words, to go against traditional cultural and gender norms. Such circumstances often prove so humiliating to the man, who feels he has lost his manhood, that they might cause a psychiatric disorder. I have never seen a couple in therapy in which the issue of control was not an essential part of the reason they had sought treatment.

Another issue that is a manifestation of these inner conflicts is erectile dysfunction. Men suffer a great deal if their penises do not work right. We know that there are many more men with erectile dysfunction than we thought just by noting the large number of prescriptions for Viagra and Cialis sold in this country. In the 50 years that I have been doing therapy, I have had a great many men worrying about the size of their penises. This is another way of expressing feelings of inadequacy.

I have digressed from the issues of stay-at-home fathers explored in the paper, because it does not raise any of these issues and remains very superficial in terms of trying to understand what is going on in these men. The authors do get close to the underlying issues as they examine the problem of stigma that stay-at-home fathers experience. Most of the stigma is expressed by stay-at-home moms, which can be quite humiliating for the man who is trying to be a good dad to his children and to take care of the house, the meals, the laundry, and so on.

Fifty percent of this perceived stigma fell into two major categories. The first is subsumed under ignorance of, or unfamiliarity with, the stay-at-home father role. The stigmatizer appears to have no familiarity or experience with a male serving as the primary caretaker of the children.

The second set of stigmatizing remarks saw the stay-at-home father as violating traditional gender roles/norms or value systems. These responses reflect a general prejudice toward men who were in traditionally female roles.

Reluctant Pioneers

The reported number of stay-at-home fathers is not particularly large in a country the size of ours. Nonetheless, these men are very courageous. Not only have they lost their jobs and have wives who earn more than they. They now find themselves in the position of "usurping" the woman’s traditional role.

Many of the men in the study truly wanted to take on the caretaking role. They sought to have an influence on their children’s values and watch them grow. Others wanted to nurture their children in a way that was different from the way they were nurtured while growing up.

Another factor that pushed some men toward their decision was the high cost of day care. These fathers wanted to spend more time with their children during their formative years and apparently had the ego strength to do it.

These men have good egos. They know who they are, and are able to shrug off wisecracks about homosexuality and other insensitive remarks and innuendos that would undermine most men.

I have a patient who has a very bad case of post-traumatic stress disorder that is the result of burns he received while working for a gas company. The explosion happened more than 10 years ago. Still, my patient is unable to overcome his sense that he wasn’t man enough at the beginning when his partner, the man who caused the explosion, approached him in the hospital and implied that he should lie to the company about what happened. "I should have gotten out of bed and kicked his ass" is a sentence I’ve heard many times from this patient.

This is a man who could never be a stay-at-home father. His persona is too wrapped up in his being a man and doing the manly thing. On the other hand, the men in this study were able to say, "I saw this as an opportunity I couldn’t pass up," or "Past experiments suggested that I would be better than my wife at staying home," or, "My partner is less nurturing that I am when it comes to children." These are men who are able to put the children ahead of themselves while making a life-transforming decision – and feel good about it.

Assumptions of Outsiders

The assumption by outside onlookers that there must be something wrong with this man is one of the most difficult hurdles that the stay-at-home father will have to confront. Other men and women who are traditional in their thinking about male and female roles not only think something is wrong, but express their doubts to the stay-at-home father. This is why I feel that it takes a man with a strong ego to undertake this role.

Another factor that undermines stay-at-home fathers is institutionalized homophobia, which pervades much of America. Again, this issue is not raised in the report, but I suspect that given the extent to which heterosexual stay-at-home fathers challenge gender roles, many of them face hostility comparable to that experienced by their homosexual counterparts.

I know of a homosexual couple who decided to adopt two children from a foreign country. One of them quit his job and was the stay-at-home parent. The amount of love this couple showered on these children should have been the envy of most parents in the community. This was a no-brainer for them. They experienced all of the problems of any parents with 2- or 3-year-olds. I haven’t spoken to them in several years, but I’m curious about how they will handle the issues of adolescence with their children.

Being a nurturer is learned and an attribute that can be difficult to find in our society. In this age of reality shows, video games, and 24-hour news cycles, far too many adults – and children – want to hurt or undermine others. This is all the more reason to cherish these men, who are willing to submerge their own ambition and change their futures to provide their children with the nurturing they need to grow and mature. (Of course, women have been making these kinds of sacrifices for years, but that’s a topic for another time).

One of the sad findings of this study was the feelings of lack of support that the stay-at-home fathers experienced, exacerbated by the stigma. When a stigma-related event took place in a playground, for example, the stay-at-home father found himself isolated and alone. The participants’ responses regarding stigma highlight the importance of helping stay-at-home fathers, addressing stigmatizing responses from others, and coping with isolation or rejection in settings that might have been considered the domain of stay-at-home mothers. Here is a place where the strength of the marriage might be tested. It is essential for the working wife to support the stay-at-home father and help him deal with the ignorant prejudices that lead to these remarks. If you are a psychiatrist consulted to help a couple in the throes of making such a decision, this is a kind of advice that would prove to be powerful and useful.

This column, "Fink! Still at Large," appears regularly in Clinical Psychiatry News, a publication of Elsevier. Dr. Fink is a psychiatrist and consultant in Bala Cynwyd, Pa., and professor of psychiatry at Temple University in Philadelphia.

Many Stay-at-Home Dads Face Stigma of Nontraditional Role