PORTSMOUTH, N.H. (AP) -- Few people, save his sister, knew of attorney Jeffrey Gutin's emotional problems. For years, Nina, herself a psychologist, begged him to see a therapist. Always, he refused.

Then in April 1995, in the prime of his life, Gutin committed suicide by combining alcohol and prescription drugs.

Devastated by his son's death, Irving Gutin started a fund in his son's name to address why it is so difficult for men to seek help for physical and mental problems.

"Asking for Directions," a New Hampshire project that explores how men approach - and avoid - health care, grew out of the family's grief.

"The family wanted something that would connect health care and mental health care with some of the gender issues Jeffrey experienced - having to succeed and be perfect and strong," said Chuck Rhoades, an independent researcher. "They saw that as being a major factor in his decision to kill himself."

Men will go to extreme lengths to avoid seeking help, particularly when it concerns their health. At the root of the problem, psychologists believe, is insecurity: feelings of being pressured not to reveal weakness and frustration at relinquishing control to doctors.

Dr. Frederick Magaziner of Baltimore, a dentist for 40 years, has seen the results. He has treated men who used sandpaper or their wives' emery boards to adjust the fit of their dentures, some who go as far as revving up their electric sanders.

Cavities prompt a separate set of creative treatments.

"I've had them stick all kinds of things in cavities thinking they can get by, from chewing gum to a roofer who put hot tar on a stick, let it cool down a bit, then put it in his mouth," Magaziner said. "One gentleman used caulk."

Getting such men to seek help before they resort to power tools is the goal of "Asking for Directions." For more than a year, Rhoades has led workplace discussion groups where men can talk about their health problems: any subject from physical aches and pains to mental health and sexual troubles.

Rhoades came up with the name on his way to meet the first group, in Stratham. He got lost, and did not stop to ask for help. Though the name is a play on the stereotypical male driver, it is also "about asking men themselves for directions on how we, as men, can approach our health care differently," Rhoades said.

The project, funded with a grant from the Greater Piscataqua Community Foundation, is designed to identify the barriers that prevent men from taking care of themselves.

The discussion format itself helped some men confront their problems and change their behavior. Some joined health clubs, some made doctor's appointments or scheduled colon screenings - after hearing other men express their own insecurities.

"Since groups can provide a context that is both uncomfortable and stimulating, patterns can emerge more quickly," said Leonardo Leiderman, a psychologist who runs the Latino Treatment Services Center at St. Vincent's Hospital in Harrison, N.Y.

In one of Rhoades' group sessions, one man complained about losing feeling in his arm, but didn't think it was serious enough to discuss with his doctor. When he reasoned that money was tight and his young son should come first, other group members seized on the excuse.

"You have a kid now, you've got to be there for him," one man said.

"So this guy who had been putting up this macho thing didn't say anything for a while, but maybe 10 minutes later, he starts saying, 'I've been thinking about that. I've been thinking you might be right,"' Rhoades said.

"It was about one man giving another man permission to take care of himself."

The project is an extension of a survey Rhoades did in 1999, when he interviewed 73 Seacoast area men from 30 occupations. One of them summed up the prevailing attitude toward health care when he said, "I get an annual physical every 16 years."

That attitude spreads far beyond New Hampshire: In a national study, 24 percent of men said they hadn't seen a doctor in the previous year compared to just 8 percent of women.

The 2000 study by the Commonwealth Fund, a New York-based health research firm, also found that men delay getting care, despite warning signs. When asked what they would do if they were in pain or feeling sick, 24 percent said they would wait as long as possible before seeing a doctor.

The men in Rhoades' groups, whether they're dockyard workers, National Guardsmen or lawyers, report a similar tendency to procrastinate on health matters.

Steve Chaisson, co-owner of a printing company in Portsmouth, went through the program with his five male employees last fall. Despite a family history of heart disease, Chaisson said he had a "typical male approach" to taking care of himself.

"I avoided any problems until they became unmanageable," he said.

Leiderman has found that Latino men are particularly reluctant to seek mental health care.

"Culturally, there is a stigma against mental illness and those who seek mental health services," he said. "Being macho means that you should be strong and self-sufficient."

He tries to overcome such machismo by helping men identify why they are reluctant to seek help and then set clear goals. It's not enough to say you'll call a doctor. You have to say when you'll call, and what you'll do if you don't get through on the first try.

Chaisson said it didn't take long for members of his group to trust each other.

"Men generally don't talk about these subjects in idle conversation, but having a forum to do so without any repercussions or judgments among ourselves made it a comfortable experience," he said.

Rhoades' groups meet once a week for five weeks. He provides medical literature and some topic suggestions, but tries not to dominate the sessions.

"One guy started out talking about how he didn't exercise enough - a pretty safe topic," Rhoades said. "By the third or fourth session, he started talking about his alcohol use, how he wanted to reduce that, how it made it difficult for him to control his anger with his family."

Control is key to putting men at ease, said Dr. Myron Bromberg, a dentist in Reseda, Calif.

"It's really more a matter of men liking to fix things. They don't ask for directions because they like to figure things out or fix them themselves," he said. "When they come to a dentist, they realize they can't fix themselves, so maybe they choose not to be in that situation."

His solution is to make men feel like they are calling the shots. Even for a cleaning, he explains the procedure and asks them if that's what they want him to do.

"Once they gain confidence that they're in the driver's seat and in control," he said, "they delegate that authority to you."

Copyright 2002 The Associated Press. All rights reserved.