It is not a common observation for any clinician working in rural or urban areas around Pakistan that patients regularly present with psychosomatic and psychosexual problems. In a heavily patriarchal, male dominated society, male pride, made chauvinism, male ego, male superiority and male dominance are of utmost importance that needs to be kept and protected at any cost, sometimes at very high prices that are beyond common imagination and comprehension. I have reflected upon clinician’s experience in a consultation room with regards common psychiatric presentations in one of my previous blogs especially those that lead to generation of low self esteem. The purpose of this write up is to understand one major factor contributing towards development of low self esteem in males.


Motivation is common observation, day to day experience and recurrent presentation of clients with such complaints during consultations. My mind says that I must learn and understand the culture and mindset of the people that I am dealing and interacting with and my heart says that I must find the best way to help and support them.

Sexual potency, sexual dominance, sexual superiority and sexual chauvinism is clearly synonymous with self esteem in the culture and society. Most consultations start with dissatisfaction with the size or shape of private parts or extreme dissatisfaction with the duration of intimacy or or inadequacy or lack of satisfaction with the overall quality of intimate interactions. This obviously is not culture specific and such presentations are universal. Once major psychiatric conditions have been ruled out including possibility of a body dystrophic disorder and once a confirmation had been achieved that there are no medical conditions that are responsible for these presentations then the journey of exploration starts that what are the causative factors and understandings that are responsible for causing this mindset and psychological understanding that affects the client so strongly that he usually is panic stricken, extremely depressed or immersed in a pool of shame and guilt because of what he is going through and because his manhood it at stake. Nonetheless when you approach these very expansive and extremely valued difficulties and challenges with an open mind keeping an intention to fully understand them to help the client then the sequence of discussion is almost as follows

1) Patient describes dissatisfactions that I have described above. When asked what is the standard or criteria that you are comparing yourself against then no answer is achieved and the usual expression is that it’s so obvious.
2) When asked if you ever had any sex education from family or an institution. The blanket ameer is an absolute no as it is a taboo to talk about sex and sexuality with elders or with teachers.
3) Then where does the information come from? The answer is that it’s from peers or from common observations.
4) When asked where do the peers get their information from the usual answer is that they get it from social media and from the streets.
5) The source of information on social media is the pornographic material that World Wide Web is universally offering, although despite being in a strongly religious culture and having strict sensor criteria, such material is readily available on web and in the form of other media tools like a CD or a DVD.
6) The other source available on streets is the huge surge of claims that are offered my ‘Hakeems’, ‘quacks’, ‘self proclaimed sex therapists’ and even fake medical practitioners. The wall chalking, the radio advertisements, the social media posts all have a strong common theme of a “Manhood”, “Masculinity” and “Sexuality” that is unrealistic, beyond normal and certainly abnormal when considers in anatomical and physiological terms.
7) The unrealistic and impossible standards are set of this flood of fake and bogus information and as the majority is uneducated ( more than 60%) therefore once such standards are accepted or propagated by peers then they get peer validation and are accepted without much scepticism or criticism by the majority.
8) The entire building is based on fake grounds. Those models who show up their bodies in especially created movies might be 0.2% if the world population and the acts performed are under heavy intake of not only aphrodisiacs but a variety of other chemicals too.
9) However as there is no other source of information available in the society therefore what is accepted my majority as the cultural validation too.
10) For males the chase and attempts to achieve such unrealistic standards continue to generate frustration, helplessness, disappointment, inferiority and sense of failure, disappointment that eventually lead to low self esteem. It is a self perpetuating machine, a vicious circle that doesn’t need any fuel from anywhere and is able to keep itself up and running automatically and autonomously.

I had an opportunity to ask my friends from Community Medicine Department that aren’t you people developing something for people’s education. I got the answer that yes we are doing and books are available, but what do you think that how many people read that and even if some of them read them then compare the numbers with those who read the adverts and writings in the walls that dominate the books by million folds.

My heart says that the recipe of development of low self esteem in our male youth is written on the walls of our cities then.

(Chenab Club Library Faisalabad)
2nd Dec 2018