Being a Man with an Invisible Disability: College Men's Experiences

In many important ways, having a disability challenges traditional masculinity ideology. Understanding how men conceptualize and negotiate their identities both as men and as individuals with disabilities is important as men comprise a large percentage of students with disabilities, specifically invisible disabilities. The prevalence of invisible disabilities, which are disabilities not visibly apparent to others, has been increasing across all levels of education, including higher education (Marder et al., 2003). Previous studies have explored the intersections between masculinity and disability, however they were narrowly focused on men with visible impairments (e.g., Gershick & Miller, 1995) and men with chronic illnesses (e.g., Charmaz, 1995; Gibbs, 2005). Furthermore, none of these studies examined men within the context of higher education, which is important as college plays a significant role in the development of masculinity (Harris, 2010; Kimmel, 2008). The present study used grounded theory, a qualitative research approach, to explore the experiences of 22 college men with invisible disabilities through the use of in-depth interviews. This study examined how these men conceptualized their dual identities as men with invisible disabilities and how they engaged with the academic accommodations process. A grounded theory was developed providing a framework for understanding the experiences of these men that captured four central themes of (a) embodying masculinity, (b) losing masculinity, (c) preserving masculinity, and (d) cultivating masculinity.


viii LIST OF TABLES
. A steady increase in the numbers of these students has been noted across all levels of education including higher education (National Council on Disability, 2003;Snyder & Dillow, 2010). This population, however, is growing unevenly with the prevalence of individuals with invisible disabilities far surpassing that of those with visible ones (Marder, Levine, & Wagner, 2003). Invisible disabilities, those not readily apparent to others, include many different types of categories (Davis, 2005). Although people with invisible disabilities may not face the same types of stigmatization as people with visible disabilities, Davis argued that they are still "subject to forms of rejection, humiliation, and social disapproval that are importantly similar" (p. 154). She offered that the hidden nature of invisible disabilities is partly a consequence of the manner in which the surrounding environment does not sufficiently accommodate their multifaceted needs, thereby rendering them invisible in another sense. Marder and colleagues (2003) found that students, ages 13 to 16, who identified as having disabilities, primarily identified as having learning disabilities (62%). They further reported that 30% of these students had comorbid disability identities including intellectual disabilities, attention deficit hyperactivity disorder (ADHD), traumatic brain injuries, and other health impairments (OHI). Among these students, boys ages 13 to 16 were found to comprise the majority of every disability category including emotional difficulties, OHIs, autism, and ADHD (Marder et al., 2003). A similar pattern of disabilities has been observed in higher education.
A recent national survey of 201,818 first year students enrolled in colleges and universities in the United States found that 14.6% of the student population identified as having a disability. Of these students, 11.9% identified with at least one disability category and 2.7% identified with more than one disability category. Of these disabilities, the most frequently reported were invisible in nature (Higher Education Research Institute, 2011). This report further indicated that among the three most frequently reported disabilities (ADHD, mental health diagnoses, and learning disabilities), more first year men identified with ADHD and learning disabilities than first year women (Marder et al., 2003). These statistics suggest that college men constitute a large percentage of students with invisible disabilities.
When examining individuals with disabilities in college, it is important to consider how the disability laws that govern education differ fundamentally at the postsecondary level. Unlike the disability laws presiding over primary and secondary schools, those governing higher education require greater student involvement in the academic accommodations process (Cawthon & Cole, 2010;Stodden, Jones, & Chang, 2002). In order for college students with disabilities to receive academic accommodations they must first identify themselves to their institution's disability services office. They also need to provide documentation that specifies their disability and provides information regarding the impact of their disability on their academic functioning (U.S. Department of Education, 2011). This requirement of selfdisclosure, coupled with the nature of having a disability not readily apparent to others, may hold particular challenges for invisibly disabled college men since seeking help and engaging in intimate conversations are antithetical to the American ethos of masculinity (Addis & Mahalik, 2003;Courtenay, 2000). Consequently, this process poses unique challenges for college men whose cultural script for how to act masculine may not include these types of interactions, and, whose characteristics of traditional masculinity conflict with cultural stereotypes about disabilities (Shuttleworth, Wedgwood, & Wilson, 2012). Certainly, this is not the case for all college men with invisible disabilities; the way some men negotiate these intersecting identities may differentially influence how they experience the accommodation process in college. While there is a greater percentage of young men who identify as having an invisible disability (Higher Education Research Institute, 2011;Marder et al., 2003), they do not access disability services and receive accommodations to the same extent as do college women with invisible disabilities (Newman, Wagner, Cameto, Knokey, 2009). This discrepancy further underscores the importance of better understanding college men with invisible disabilities so that colleges and universities may learn how to better serve this unique population in the future.

LITERATURE REVIEW
The following discussion serves to situate the current study within the context of existing scholarship on masculinity and disability. This literature review highlights extant research used to inform the current study and includes research related to traditional masculinity, the intersections between masculinity and disability, men's help-seeking behavior, and the college accommodations process. It explores how previous studies expanded the knowledge base on masculinity and disability but also points out the gaps that remain. This literature review also provides information regarding the usefulness of qualitative research in exploring issues relating to identity, and discusses how constructivist grounded theory can be used to expand the current knowledge base on college men with invisible disabilities.

Traditional Masculinity
American men contend with a society that judges their gendered performance against an unattainable masculine standard (Connell, 1990). This standard, referred to as "hegemonic masculinity," represents a socially idealized masculine archetype of masculinity that fully embodies traditional masculine characteristics. Goffman (1963) once described America's ideal man as "Young, married, white, urban, northern, heterosexual, Protestant father of college education, fully employed, of good complexion, weight, and height, and a recent record in sports" (p. 128). About a decade later, Brannon (1976) summarized the hegemonic masculine ideal as the avoidance of anything feminine, the desire to obtain wealth, power, and status, the suppression of emotion, and the valuing of aggression and risk-taking.
Another important facet of hegemonic masculinity is that it is nearly unachievable (Connell, 1990). While virtually all men fall short of this ideal they vary in the extent to which they embody its characteristics (Connell & Messerschmidt, 2005). In an attempt to capture the power differentials between different masculinities, Connell (1995) created a hierarchy. Connell placed hegemonic masculinity at the top of the hierarchy signifying that this type of masculinity holds the most power. The smallest percentage of men fall into this category. Underneath hegemonic masculinity, Connell placed "complicit" masculinity, reflecting men who embody and endorse traditional masculine characteristics to an extent that affords them many of the benefits associated with hegemonic masculinity. Men in this category rarely challenge this hierarchical system of power and dominance. Connell argued that "complicit" masculinity results in the maintenance and perpetuation of traditional masculine ideology. Connell placed what she referred to as "subordinated" masculinity, such as gay masculinity, at the bottom of the hierarchy because traditional masculinity symbolically associates this type of masculinity with women and femininity. Connell recognized that some men were afforded privilege and power because of their masculinity status but could become trivialized by other identities such as their race, ethnicity, sexual orientation, or disability identities. Connell referred to these masculinities as "marginalized," capturing how other social identities could mediate the role of power and dominance associated with hegemonic masculinity. One type of marginalized masculinity is disabled masculinity.

Masculinity and Disability
The dichotomy between cultural ideas about masculinity and disability has been of keen interest to researchers who explore the lives of men. Asch and Fine (1998) describing this dichotomy said, "Having a disability [is] seen as synonymous with being dependent, childlike and helpless-an image fundamentally challenging all that is embodied in the ideal male: virility, autonomy and independence" (p. 3). The desire to untangle what Shuttleworth and colleagues (2012) referred to as the "dilemma of disabled masculinity" (p. 174) has led some researchers to explore the impact of this dichotomy on men with disabilities, predominantly men with visible disabilities.
Masculinity and visible disability. Efforts to understand how men with disabilities negotiate them on top of the pressures of traditional masculinity have largely focused on men with visible disabilities (e.g., Gerschick & Miller, 1995;Ostrander, 2008;Sakellariou, 2006;Taub, Blinde, & Greer, 2010). This predominant focus may relate to the centrality of the physical body within traditional masculine ideology and many of the major masculinized institutions, including athletics (Connell, 1995;McKay, Messner, & Sabo, 2000;Messner & Sabo, 1994;White, Young, & McTeer, 1995), the military (Connell, 1995;Higate & Hopton, 2005), and the domain of sexual ability and performance (Gilmore, 1943;Plummer, 2005). The success of these institutions has, in part, relied heavily on the notion of a strong, healthy, "masculine" body. As the idea of being able-bodied has become significantly associated with hegemonic masculinity, it is of little wonder that the gendered performances of men with physical limitations are judged in this context.
In a chapter on masculinity and body normativity in Western culture, Gerschick (2005)  can get a boner…or if I even want sex." He went on to describe how his own sense of masculinity, at first, had been deeply connected to society's idealized viewed of masculinity and how he had to reconcile this with society's stigmatized view of disability. For Morrison-Gurza, his heavy reliance on traditional masculinity eventually changed into his rejection of it. Just as his masculine identity could not be understood apart from his disability identity, his disability identity could not be understood in isolation either. He understood how able-bodiedness had become deeply woven into American society's conceptualization of both masculinity and disability.
As so much of masculine hegemony centers on the physical body, it comes as little surprise that psychologists, sociologists, and gender theorists have been interested in the way visible disability identities are conceptualized by affected men and those around them.
Using Connell's (1995) masculinity hierarchy as a conceptual framework, Gerschick and Miller (1995) qualitatively analyzed the narratives of several men with mobility impairments to better understand how those men reconciled their masculinity and disability identities. They observed how they engaged with three processes: reformulation, reliance, and rejection. Gerschick and Miller noted that these processes were not mutually exclusive as some of their participants engaged in different processes at different points of their lives. The men who engaged in reformulation, sought to redefine traditional representations of masculinity to align with their current ideas regarding their level of functioning. For example, one of the participants, who was heavily dependent on aides for personal care, described himself as independent because he felt he was in full control of his daily schedule.
The men who engaged in the process of reliance, adopted hyper-masculine attitudes and beliefs in an attempt to meet traditional masculine standards despite the ways in which they might have been physically limited by their disability identities. In her work with school-aged boys with physical impairments, Benjamin (2001) made similar observations. She observed that these boys were highly invested in "tough, physically powerful imagery" and argued, "their macho performances had the quality of fantasy defenses against untenable daily reality; the reality of growing up as physically disabled boys in macro-and micro-cultures that equate physical strength and perfection with (masculine) power and desirability" (p. 46). Gerschick and Miller (1995) similarly described how the process of reliance was maladaptive as it often led to feelings of inadequacy.
A third process, rejection, reflected men's refusal to define their masculinity by rigid traditional definitions, similar to Connell's (1995) process of "counter-sexist politics" (p. 55). Gershick and Miller (1995) argued that the process of rejection appeared to hold the most promise for freeing men from the restrictive notions of traditional masculinity by allowing them to develop a healthy perception of their social identity as disabled men. However, it was the least utilized process among the three reflecting an inherent difficulty in rejecting deeply ingrained gender norms. As many of Gershick and Miller's participants experienced, the entrenched norm of ablebodiedness served to marginalize their non-normative bodies. Davis (2005) also argued that able-bodiedness can create challenges for individuals with invisible disabilities as their able-bodied appearance often signals the inaccurate perception that they do not have a disability. Davis further argued, "When someone looks like a nondisabled person but claims to be disabled, this is jarring" (p. 205). For men, this has made having an invisible disability a unique experience.
Masculinity and invisible disability. At the same time that Gerschick and Miller (1995) were examining identity negotiations among men with visible disabilities, Charmaz (1995) explored similar concepts among men with invisible disabilities. In her study, Charmaz observed how men with chronic illnesses, like men with visible disabilities, were faced with having to reconcile their masculine identity with their disability identity. Charmaz described these identity conflicts as "active versus passive, independent versus dependent, autonomy versus loss of control, public persona versus private self, and domination versus subordination" (p. 267). She argued that chronic illnesses often undermined the sense of status and privilege afforded to them by their masculinity. In describing this idea she said, "Illness can reduce a man's status in masculine hierarchies, shift his power relations with women, and raise his self-doubts about masculinity. Consequently, chronic illness can relegate a man to a position of "marginalized" masculinity in the gender order" (p. 268). Charmaz observed that men with chronic illnesses experienced major life changes in their status in work, athletics, sexual activities, and leisure.
In her study on men with arthritis, Gibbs (2005) observed similar processes as those described by Gerschick and Miller (1995) which provided evidence for the applicability of these processes to men with chronic illnesses. Gibbs' study further supported the idea that although men with invisible disabilities are often able to meet many of the normative body standards that visibly disabled men are not, they may still wrestle with what their disability status means for their masculine identity. Men, like the participants in both Charmaz's (1995) and Gibbs' studies, were forced to contend with society's stereotypes about individuals with disabilities, specifically that they are "perceived to be, and are treated as, weak, pitiful, passive, and dependent" (Gerschick & Miller, 1995, p. 185), all characteristics eschewed by traditional American masculinity. In particular, the behavior of seeking help, which has been denigrated by traditional masculinity, presents unique difficulties for men with disabilities. Addis and Mahalik (2003) summarized much of the literature on men's helpseeking behavior and concluded that, collectively, men are less likely than women to seek help. They argued that the underlying behaviors associated with asking for help, such as "relying on others, admitting a need for help, or recognizing and labeling an emotional problem" are in direct conflict with "the messages men receive about the importance of self-reliance, physical toughness, and emotional control" (p. 7). As these behaviors have been pushed away by traditional masculine ideology, they have become stereotypically associated with feminine behavior (Addis & Mahalik, 2003;Brannon, 1976). As a result, Courtenay (2000) argued, "Men and boys who attempt to engage in social action that demonstrates feminine norms of gender risk being relegated to the subordinated masculinity of 'wimp' or 'sissy'" (p. 1389). Vogel and colleagues (2006) also argued that this is especially problematic for men who internalize societal ideas about gender as self-stigma and may perceive themselves as weak and unmanly if they were to ask for help.

Help-seeking in college.
A study by Wimer and Levant (2011) found that college men who highly endorsed traditional masculine ideology were more likely to avoid seeking help in academic contexts than those who endorsed it less. Reetz, Krylowicz, and Mistler (2014) examined this behavior specifically related to seeking counseling. They surveyed 497 counseling center directors of colleges within the United States and found that college men have not been seeking counseling related services to the same extent that college women have. They wrote: Service utilization by diverse groups is generally proportionate to the general student body as it has been in previous years. The notable deviation continues to be with male students, only making up 33.9% of clients but comprise 43.8% of the student body. (p. 14) These researchers also reported differences among college men. For instance, they found that male athletes were the least likely group of men to utilize counseling services. This trend is substantiated in the general population of the United States where men with mental health disabilities do not seek counseling help at the same rates as women with them do (Komiya, Good, & Sherrod, 2000). These findings are alarming given the fact that though women are more likely to attempt suicide, men are more likely to die from their attempt (National Institute of Mental Health, 2013).
In terms of seeking help from disability service offices, a 10-year longitudinal study of a nationally representative sample of individuals with disabilities, found no statistically significant gender differences across several variables related to the disclosure of their disability and receipt of accommodations (Newman et al., 2009). It should be noted, however, that several qualitative differences were observed. The first was that fewer college men (35.7%) who considered themselves disabled disclosed their disability to their college compared to college women (38.7%). The second was that a larger percentage of college men with disabilities (47.9%) compared to college women with disabilities (40.2%) sought general help with their academics. Certainly, not all college men avoid help which is why it is necessary, as stressed by Addis and Mahalik (2003), to understand within-group and within-person variability when it comes to men's help-seeking behavior.
The majority of these studies examined students with disabilities as a collective group.
However, as the percentage of students with other types of invisible disabilities continues to increase, particularly students with mental health disabilities (Kitzrow, 2003), more recent studies have expanded to include these students.
Of particular relevance to the present study, is previous research examining factors that prevent students with invisible disabilities from accessing accommodations. For instance, Newman and Madaus (2015a) found that students with invisible disabilities were less likely than students with visible disabilities to seek academic accommodations. When examining particular aspects of the accommodations process that might present more challenges to students with invisible disabilities, Elacqua (1996) found that students with invisible disabilities reported more negative experiences when interacting with faculty members than did students with visible disabilities. Similarly, a study by Barnard-Brak, Lectenberger and Lan (2010) found self-disclosure to be a particularly challenging aspect of the accommodations process for students with invisible disabilities. They wrote, "The academic accommodations process for students with disabilities steps out of the realm of typical interpersonal discourse as the process requires disclosing what would normally be personal and privileged information to an essential stranger, a faculty member" (p. 413). Davis (2005) recognized that people with invisible disabilities often face the burdensome process of self-disclosure. She contended that because these identities are not visibly apparent to others, their legitimacy is subject to a greater level of scrutiny.
To illustrate this, she wrote: Those whose disabilities are invisible may also have to convince other people that they really are disabled….Thus, what they must do is meet a burden of proof. They thus face a double bind: either they forgo the assistance or accommodation they need -and thus suffer the consequences of attempting to do things they may not be able to do safely by themselves -or they endure the discomfort of subjecting themselves to strangers ' interrogations. (p. 154) This conflict presents two important challenges for college men who, in order to receive academic accommodations, must share their specific disability identity with their disability services coordinator as well as with their professors. First, since the characteristic of being able-bodied is intimately connected to traditional masculinity (Connell, 1995), college men with invisible disabilities may be able to 'pass' as masculine and may therefore be reluctant to share their disability status so as to avoid undermining their privileged masculine status. Second, in adhering to the "strong-andsilent" masculine script, college men may not willingly share intimate details of their life with others if they endorse this notion and desire to preserve an appearance of strength (Mahalik, Good, & Englar-Carlson, 2010, p. 79). While there is a lack of understanding related to college men's help-seeking behavior specifically related to disability services, a broader context of men's help-seeking behavior helps to place this issue in a larger context of hesitation and resistance.

Toward an Understanding of College Men with Invisible Disabilities
Gaps in the literature. Previous research, which sought to better understand the experiences of men with disabilities, expanded the field in many important ways.
Nonetheless, significant gaps remain in the literature. While previous research on men with physical impairments helped to shed light on the processes they engaged in as they negotiated this identity with their masculinity, it was primarily focused on men with visible disabilities (Gerschick & Miller, 1995;Shuttleworth et al., 2012). In an attempt to broaden this understanding, Charmaz (1995) and Gibbs (2005) concentrated their work on men with invisible disabilities. While these studies were important in exploring how men with invisible disabilities negotiated their identities, they were narrowly focused on men with chronic illnesses and therefore did not explore the experiences of men who identified with other types of invisible disabilities, such as learning problems, mental health issues, ADHD, or autism.
In addition to the relative absence of research on men with invisible disabilities in the extant literature, there are few studies that have examined their experiences within a specific context, such as college. This depth of awareness is necessary to gain a comprehensive understanding of the role contextual factors may play in how men conceptualize their multiple identities. As college plays a significant role in the lives of men, more studies should focus on examining masculinity within its context (Harris, 2010;Kimmel, 2008). While college men's hesitancy toward the academic accommodations process has been linked to concerns regarding stigma and discrimination (Salzer, Wick, & Rogers, 2008), no prior study has examined the role of traditional masculinity in how college men with invisible disabilities experience the academic accommodations process. This is important to explore because in addition to needing to reconcile opposing social identities, these men must negotiate the academic accommodations process which challenges many traditional masculine norms with its unique demand of self-disclosure.
Another important gap in the literature on college men with invisible disabilities concerns intersectionality (Shuttleworth et al., 2012). Intersectionality is a theoretical framework that provides a structure for understanding how multiple identity dimensions such as race, gender, or sexual orientation, intersect with larger social dimensions of power and privilege, such as racism, sexism, and heterosexism (Bowleg, 2012;Tatum, 2000). Additionally, intersectionality may provide a relevant framework for examining how college men conceptualize their invisible disability amid their other social identities. In their review of the development of research on men with disabilities, Shuttleworth and colleagues (2012) argued that it is important to use the framework of intersectionality as it allows researchers to "explore how the power differentials embodied in the intersecting categories of class, ethnicity, and sexuality interact with disabled masculinity" (p. 185). Jones and McEwen's (2000) Multiple Dimensions of Identity Model, was developed within a framework of intersectionality to help capture the complexity of multiple identities. This model was developed to help account for differences in saliency of individuals' various identity dimensions and highlighted the surrounding societal structures that influenced how individuals conceptualized their complex identities. This model, however, has not been applied to studies examining college men with invisible disabilities. By addressing these gaps, the existing body of knowledge about this population can be expanded. One of the most useful means of inquiry to address these gaps is qualitative, specifically, constructivist grounded theory.

Justification of Methods
Grounded theory and understanding identities. Qualitative methods of inquiry, which are designed to examine experiences and phenomena that have not been widely studied (Brown, Stevens, Troiano, & Schneider, 2002), are well-suited to address the aforementioned gaps in the masculinity and disability literature. Among the many qualitative research approaches, grounded theory has been used in previous research focused on identity (e.g., Abes & Jones, 2004;Gerschick & Miller, 1995;Gibbs, 2005;Harris, 2010). Grounded theory, which generates a theoretical framework for understanding human processes, may help to extend existing theories on men with visible disabilities.
Glaser and Strauss developed grounded theory in the 1960s thus providing a framework for creating theory inductively (Glaser, 1992). Glaser and Strauss viewed traditional methods of theory generation as limited in that they lacked sensitivity to the varying experiences of participants. They proposed grounded theory as an alternative to the traditional approach of theory generation which focused primarily on hypothesis testing in order to verify or disprove an existing theory. Grounded theory was developed to illuminate the subtle nuances of variation in human experiences that the traditional methods did not elucidate (Guba & Lincoln, 1994;Hays & Singh, 2012). Holton (2010) aptly described what grounded theory brought to the research table, so to speak, when she wrote "Grounded theory offers a somewhat 'counter-culture' alternative for the experienced practitioner with an intuitive sense that the preconceived, normative, and prescriptive extant theories simply do not capture the reality they experience" (p. ii). In other words, grounded theory would help researchers understand complex human experiences in ways that deductive theory generation methods could not. Holton (2010) also discussed how grounded theory could be used by both expert and novice researchers alike.
Constructivist grounded theory. Since its inception, four types of grounded theory have emerged and include classical grounded theory, Straussian grounded theory, constructivist grounded theory, and feminist grounded theory; each based on fundamentally different theoretical assumptions while remaining alike in their overarching goal of bringing depth to the knowledge of human experiences (Evans, 2013). Constructivist grounded theory, developed by Charmaz, evolved from a social constructionist framework which posits that reality is a "social construction of the mind" and that "there exists as many such constructions as there are individuals" (Guba & Lincoln, 1989, p. 43). For researchers working within a constructivist paradigm, Howell (2013) argued, "Knowledge, truth, reality and theory are considered contingent and based on human perception and experience" (p. 16), underscoring the importance of getting at the level of experiences in gaining knowledge. Constructivist grounded theory, therefore, departed from classical grounded theory in its underlying assumption that meaning is not passively waiting to be discovered, but is instead actively created through interactions (Breckenridge, Jones, Elliot, & Nicol, 2012;Evans, 2013;Guba & Lincoln, 1994). This assumption gave way to another unique feature of constructivist grounded theory, that of intimately positioning the researcher in the meaning-making process through what is referred to as "co-construction" (Charmaz, 2014, p. 235). In this approach to grounded theory, "Researchers, in their 'humanness,' become part of the research endeavor rather than objective observers, and their values must be acknowledged by themselves and by their readers as an inevitable part of the outcome" (Mills, Bonner, & Francis, 2006, p. 2). As the main focus of this project was to understand how college men make meaning of their disability and masculine identities and how they experienced the academic accommodations process, this project was guided by the paradigm of constructivism.
In-depth interviewing. In-depth interviewing, often employed in grounded theory research, has been widely used in studies examining identity development and intersectionality (e.g., Abes & Jones, 2004;Gerschick & Miller, 1995;Gibbs, 2005;Harris, 2010). This method has also been used in studies examining other similarly complex phenomena and processes (e.g., Marshak et al., 2010). As Hays and Singh (2012) had discussed, qualitative research is often useful in understanding "how people actually experience and live in a multicultural society" (p. 22). This type of information is critically important in allowing for the collection of information that reduces generalizations regarding a cultural group. For example, Banks and Hughes' (2013) study on African American men with disabilities, allowed for a complex analysis of the range of college experiences that these students had and took into account broader contextual factors.
Developed primarily from the qualitative approach phenomenology (DiCicco-Bloom & Crabtree, 2006), in-depth interviews have been used in grounded theory studies to examine identity development and the intersections between multiple identities. They facilitate a 'deep' level of understanding of participants' experiences (Johnson, 2002). One type of deep understanding gained from this interviewing method is that which goes "beyond commonsense explanations" for understanding experiences or phenomena (Johnson, 2002, p. 106). For instance, Gerschick and Miller's (1995) use of in-depth interviewing to understand how men coped with their physical disability identities yielded a much more complex understanding of the experience beyond simply acknowledging that it challenged their masculinity. Another type of depth afforded by this interview method relates to the knowledge gained from how our "assumptions, practices, and ways of talking partly constitute our interests and how we understand them" (Johnson, 2002, p. 106). In other words, construction of meaning can occur through the discourse that occurs between participants and researchers.
Since the primary goal of this study was to understand the meaning-making processes with which college men understood their simultaneous identities as men and as persons with invisible disabilities, a quantitative approach would not have been appropriate; mainly because these processes are not quantifiable and therefore do not lend themselves to quantitative methods of inquiry (Guba & Lincoln, 1994). One of the ways in which qualitative research transcends the limitations inherent in quantitative inquiry is by providing researchers with methodological tools allowing them to gather "rich insight" into the human condition; an important component of qualitative research that rests on the assumption that human behavior is intimately linked to the meanings people attach to their behaviors. The qualitative approach of grounded theory was chosen as the most appropriate method of inquiry to use as this study was concerned with the way in which college men make meaning of their multiple identities.

Purpose of Study
This study sought to use constructivist grounded theory to contribute to the existing scholarship on masculinity and disability. By focusing on invisibly disabled college men, the aim of this study was to help move the field beyond its predominant focus on men with visible impairments (Shuttleworth et al., 2012). The study further sought to incorporate notions of intersectionality to better understand how other social identity dimensions influence college men's perceptions of their disability identities.
Lastly, this study sought to understand how invisibly disabled men experienced the academic accommodation process in college. The following three research questions were used to guide the study:  (Glaser & Strauss, 1967). An appropriate sample size for a grounded theory study is based on a number of different factors (Mason, 2010) with the main goal being that the sample is large enough to generate sufficient data. Sufficient data is understood to be that which "illuminate[s] patterns, concepts, categories, properties, and dimensions of the given phenomena" (Thomson, 2011, p. 46). For the present study, the sample size was informed by Creswell's (2007) suggestion of a sample with at least 20-30 participants. This number was similar in range to many similar grounded theory dissertations (Mason, 2010).
Sample demographics. All 22 participants identified as men. As shown in Table 1, the ages of the participants ranged from 18 to 30 years, with the exception of one who was an older graduate student (age of 52). The sample was also predominantly Caucasian with the exception of four participants who identified as bior multi-racial and two who identified as African American. The participants varied in terms of their year in college; all participants, with the exception of one, identified as an undergraduate student and they represented a variety of majors. All participants identified as heterosexual and only two participants identified as military veterans. As shown in Table 2, the participants identified with a variety of invisible disabilities.
Information contained in the tables is presented using the participants' own words in an effort to stay true to their perspectives and experiences. Can also be referred to as social anxiety Note. All names are pseudonyms; TBI = Traumatic brain injury; OCD = Obsessivecompulsive disorder; ADHD/(ADD) = Attention deficit hyperactivity disorder. a Disability descriptions kept in participants' own words.

Measures
Participants completed eight demographic questions and a semi-structured interview.
Demographic questionnaire. The eight demographic questions asked participants to identify their age, race/ethnicity, gender, sexual orientation, year in college, college major, military history, and disability/ies (see Appendix A). This form was used to collect basic demographic information from each participant and to facilitate conversation during the interview, particularly for discussion regarding multiple identities.
Interview protocol. The interview protocol consisted of 14 semi-structured questions (see Appendix B), the format which was chosen to facilitate openness and flexibility (Kvale, 1996). Participants who had received academic accommodations responded to a total of 13 questions. Those who had not received accommodations responded to a total of 12 questions. Several of the interview questions used were adapted from previous studies that examined similar processes. This technique has been used in other qualitative studies (Warren, 2002). Jones and McEwen's (2000) Multiple Dimensions of Identity Model was also used to guide question development.
Examples of items included "What does being a man mean to you," "Can you describe your experience of having a disability that other people cannot see," and "Can you talk about your decision to register (or not to register) with Disability Services?"

Procedures
Sampling strategies. Purposive sampling was selected as the main sampling strategy to enhance the information-richness of the present study (Brown et al., 2002;Patton, 2002). A recruitment email was sent to all college men with invisible disabilities who were registered with the disability services office at the university where the study took place (see Appendix C). In order to include the perspectives of college men with invisible disabilities who were not registered with disability services, additional recruitment announcements were made in several introductory psychology course lectures (see Appendix D). Additionally, informational cards were placed in the waiting room of the university's counseling center (see Appendix E). Snowball sampling was also used and resulted in the recruitment of two participants who became informed about the study from another participant.
Inclusionary criteria. The inclusionary criteria for this study was: (a) identification with being a man; (b) current enrollment as an undergraduate or graduate student at the university; and (c) identification with having an invisible disability, with or without an official diagnosis. To help determine the appropriateness of individuals' participation in the study, an operational definition of invisible disabilities was used as a guide (see Appendix F). Some individuals without formal diagnoses of a disability were included because they felt they had valid experiences of having a disability. The present study also included individuals who had not registered with disability services. They were included as their experiences helped to broaden the understanding of why some college men did not get help from disability services.
Research setting. The research setting is described in order to situate the study in the surrounding context in which it took place. Participants were selected from a single institutional setting: a large public university in the northeastern United States.
Based on enrollment statistics from the Fall 2015 semester, approximately half of the student body, including graduate students, was considered 'in-state.' This setting served as an appropriate place to conduct the study because of the availability of college men who comprised approximately 45% of the student body. In terms of diversity, at least 20% of the student body identified as non-White students. There were also a variety of student organizations representing the scope of student interests and experiences. The two on-campus organizations with the greatest student participation were Greek Life and athletics.

Data Collection
In-depth, semi-structured interviews were used as the primary method of data collection for this study. A single in-person interview was conducted with every participant. The interviews, which took place in a private room in a building located on the campus, lasted approximately 45 to 60 minutes. Each interview was audiorecorded using two digital recorders (one to ensure proper backup). After participants were provided with a brief overview of the study, they were asked to read and complete the Informed Consent Form (see Appendix G). Afterwards, participants were asked to complete the demographic questionnaire. Before beginning the interview, the participants were given the opportunity to choose their own pseudonyms to ensure their anonymity.
After the interviews were conducted, a team of four undergraduate research assistants transcribed them. The researcher assistants were trained by the researcher on how to use the transcription software 'Express Scribe.' Two assistants worked to complete one interview; the first transcribed the interview in its entirety and the second was responsible for checking the transcription for errors. Once the transcription was completed, it was sent to the researcher who conducted a final review for accuracy. All of the transcriptions were de-identified to maintain the participants' confidentiality. Other identifiable information, including names of people and specific organizations, was removed. In these cases, the names of the individuals were replaced with descriptors, such as "disability services coordinator" or "professor."

Data Analysis
In keeping with the constructive grounded theory approach, the data were analyzed using three main coding processes: open, focused, and theoretical coding.
Data analysis began with the interview process. The interview questions -which focused broadly on exploring participants' notions of masculinity, their experiences of having an invisible disability, and their patterns of help-seeking behavior -were used as a guide to facilitate conversation between the participant and the interviewer. An effort was made to use open-ended questioning to facilitate the sharing of participants' experiences and perspectives while limiting the influence of preconceived ideas on their responses (Charmaz, 2011). The method of constant comparative analysis, a technique unique to grounded theory methodology (Glaser & Strauss, 1967), was used throughout the data analysis phase. The researcher used this non-linear method of analyzing data by engaging in simultaneous data collection and analysis (Charmaz, 2011). This simultaneous data collection and analysis also helped inform subsequent interviews.
Immediately following each interview, the researcher listened to the recording and made notes on ideas and initial codes. As codes began to develop into potential categories, focused questions were added to the interview protocol to explore codes further (Charmaz, 2011;Hood, 2007). For example, as the code "help-seeking" was being developed, additional questions such as "What other help services have you accessed on campus?" were added to the interview protocol to further examine its parameters. Charmaz (2011) stated this procedure was useful for "increasing the power and usefulness of an emergent theoretical category and constitutes a pivotal step in theory construction" (p. 167).
Once all the interviews were transcribed and the researcher had done an initial round of open coding, two research assistants (one undergraduate and one graduate student) completed a second round of open coding. The researcher trained the research assistants by providing them with literature outlining the process for how to engage in open coding. The research assistants practiced by coding alongside the researcher until they became familiar with the coding process. All coders attempted to use gerunds, or the noun form of verbs, for as many codes as possible. Charmaz (2011) argued that the use of gerunds helps to "preserve action and promote seeing processes that a language of topics and structures minimizes" (p. 172). Examples from the present study of gerund codes include "overcoming adversity," "seeking/avoiding help services," and "powering through." After each transcript was coded, the research assistants met with the researcher and reviewed every code. The process of dialoguing was used to reach 100% consensus about a code before moving forward. The initial coding process yielded 119 initial codes.
The data that emerged from the initial coding phase were organized during focused coding. The 119 initial codes were refined into 41 focused codes. During focused coding, the most significant and frequent codes that related to the research questions were further examined by the researcher and one research assistant. In order to conduct a comparative analysis of the focused codes, the transcripts were reviewed for every instance of the focused codes. For example, every segment of narrative coded as "symptom severity" was organized into a single word document, providing the researcher with a comprehensive way of exploring this focused code. This allowed for a thorough review of each piece of narrative coded as "symptom severity" and led the researcher to think about this code as a motivating factor for some participants to seek help from disability services. Thus, this comparative process allowed for a deeper understanding of the contexts and parameters of each focused code.
Once focused coding was complete, the 41 codes were further refined into theoretical categories during the theoretical coding process (Charmaz, 2014;Evans, 2013). Four theoretical categories emerged, including "agents of help-seeking," "perceiving one's disability," "identity salience," and "experiencing loss." The relationships between these categories were examined through the processes of memowriting and diagramming. Memo-writing, or the process of writing "informal analytic notes" (Charmaz, 2014, p. 162), was used throughout the entire data analysis phase.
Through memo-writing, Charmaz (2011) argued that researchers became engaged "in sustained and successive analysis of [the] emerging categories" (p. 166). In addition to writing memos, the pre-writing technique of diagramming was used. By diagramming, the researcher was able to visually explore ideas that facilitated the memo-writing process (Charmaz, 2014;Rico, 1983). Diagramming also facilitated the conceptualization of the theoretical categories and their relationships to one another (see Figure 1). The process of thinking about how these categories related to one another formed the foundation of the grounded theory. The grounded theory was composed of the following four themes: (a) embodying masculinity; (b) losing masculinity; (c) preserving masculinity; and (d) cultivating masculinity.

Trustworthiness
The concept of trustworthiness captures the level of confidence that researchers have that their results accurately and truthfully represent human experiences as they are experienced and perceived by the participants. Trustworthiness consists of a collection of processes akin to the quantitative notions of validity and reliability, was used in the present to establish academic "rigor" (Morrow, 2005, p. 250). Several methods of trustworthiness were used including credibility, dependability, triangulation, transferability, immersion, and researcher reflexivity.
Credibility. Credibility, which is similar to the quantitative notion of internal validity, helped ensure that the present study measured what it purported to measure (Shenton, 2004). In order to determine if the analytic categories and interpretation of the data accurately represented the participants' experiences, member checking was used. Participants were asked to review their transcripts, participate in follow-up dialogue, and provide feedback throughout the data analysis and interpretation phase.
At times, participants' shared experiences and perspectives that deviated from the majority of experiences contained within a theme or subtheme (Patton, 1999). These negative case examples are represented throughout the results section because, although different, they are still valuable. Additionally, peer debriefing was used to help ensure that the grounded theory was closely aligned to the data. Several peers reviewed portions of the study and provided feedback on the interpretation of the data.
These peers included fellow graduate students, undergraduate students, school psychology professionals, and professionals in the disability service field. In order to further reduce bias, the researcher did not engage in any literature review beyond that which was mandated by the proposal stage of this project. Once the data analysis was completed, only then did the researcher delve back into the literature to construct the discussion chapter. This was done to minimize the influence of preconceived ideas on the results (Christiansen, 2011).
Dependability. This idea of dependability relates to a study's replicability (Shenton, 2004). To meet the standard of dependability, the data collection, data analysis, and data interpretation phases of this study was described in detail to facilitate future replication.
Triangulation. One method of triangulation that was used in this study was analyst triangulation in which multiple individuals coded and analyzed the data and reviewed the findings (Patton, 1999). A total of four research assistants reviewed the transcripts, assisted with the coding process, and were involved with the data interpretation from the open coding phase through to the theoretical coding phase.
Transferability. Similar to the notion of external validity, transferability is used to establish parameters around the generalizability of the results. As a result of the small sample sizes indicative of grounded theory research, it is particularly important to include this information to understand the extent of a grounded theory's generalizability (Morrow, 2005). In the present study, transferability was established by providing a detailed description of the study's research setting, participant demographics, and data collection and data analysis methods.

Immersion.
In order to ensure that the data were "adequately interpreted" (Morrow, 2005, p. 256), efforts were made to engage in data immersion whereby the researcher was engrossed in the data to the fullest extent possible (Miller & Crabtree, 1992). To facilitate immersion, the researcher was intimately connected with the data from its collection to its analysis. The researcher conducted all of the interviews and follow-up communications, listened to every audio recording multiple times (once immediately after the interview and several times during the transcription process), and read and re-read the transcripts and memos throughout until the grounded theory was developed. Morrow (2005) wrote that these "repeated forays into the data ultimately lead the investigator to a deep understanding of all that comprises the data corpus (body of data) and how its parts interrelate" (256). It was this step that allowed the researcher to gain a great level of familiarity with the data.
Researcher reflexivity. As constructivist grounded theory is concerned with the way in which the researcher co-constructs theory with the participants, the researchers' own subjectivities can, and often do, influence the interpretation of the data. Thus, it is recommended that the researcher engage in the process of reflexivity.
Researcher reflexivity allows for transparency in understanding the lens through which the researcher views the world. As a woman with an invisible disability, the researcher/author was both an insider and outsider in relation to the participants in this project. As an individual with an invisible disability, the researcher related to some of the experiences participants shared regarding their disabilities. Being diagnosed with Crohn's Disease at the age of 16, the researcher shared some similar experiences to that of her participants regarding what it is like to have an invisible identity that, at times, has impacted her negatively. Prior to entering college, she had a surgery that effectively placed her symptoms into remission and as a result she did not register with her disability service office in college. However, during graduate school, when her symptoms began to reappear, she registered with the office and received accommodations every semester in which she had classes. As a woman, the researcher was an outsider in the sense that though impacted by society's rigid notions of gender, she did not experience the world in the same way as did many of her participants.
Traditional gender roles did not consciously influence her decision to register with disability services in graduate school nor did it influence how she conceptualized her disability identity. These are the experiences that she brought with her to this project.

Overview of The Grounded Theory
The grounded theory sought to provide a framework for understanding the following research questions: (a) how do college men with invisible disabilities understand and make meaning of their disability identities; (b) what influences do other social dimensions of identity, such as gender, race, and sexual orientation, have on how college men understand their disability identities; and (c) how do college men with invisible disabilities experience the academic accommodations process in college? In order to more deeply understand the intersecting identities of masculinity and disability within the context of college, data from 22 college men with invisible disabilities were analyzed using a constructive grounded theory approach. The grounded theory that emerged was the product of 119 open codes that were grouped and refined into 41 focused codes. These codes were then elevated to the following four theoretical categories: "agents of help seeking," "perceiving one's disability," "identity salience," and "experiencing loss." A constant comparative analysis of these categories resulted in the development of a grounded theory composed of four central themes. These themes, illustrated in Figure 2, were (a) embodying masculinity, (b) losing masculinity, (c) preserving masculinity, and (d) cultivating masculinity.
The grounded theory provided a framework for exploring how college men negotiated their masculinity and disability identities. It also helped explore how they experienced the academic accommodations process. The idea of 'being masculine' appeared throughout the participants' narratives and seemed to permeate many aspects of their lives. This was particularly evident in how traditional masculine ideas were expressed through both their words and actions. The first theme of the grounded theory, "embodying masculinity," attempted to capture these expressions. The second theme, "challenging masculinity," sought to represent the ways participants perceived their disabilities as identities that challenged -or had the potential to challenge -their masculinity. The third theme, "preserving masculinity," examined how participants attempted to mitigate these threats to their masculinity. Lastly, the "cultivating masculinity" theme sought to capture how participants went beyond preserving their masculinity to enhancing it through their involvement in certain activities and organizations. Their interactions with the academic accommodations processes are woven throughout the four themes of the grounded theory.

Embodying Masculinity
To embody something is to tangibly express that which is conceptual. In this study, it was evident that masculinity was more than an abstract concept. It was a way of being. Regardless of how participants defined themselves in terms of traditional masculinity, they embodied these traits through their words and actions. Discussed below are the ways participants thought about their masculine identities and how traditional masculinity played a role in these conceptualizations. Particular attention is paid to the three most prominent notions of traditional masculinity -independence, toughness, and success -that appeared throughout the participants' narratives.

"It's Just Who I Am"
For many participants, their masculine identities were inextricably linked to a deep sense of self. For instance, Isaac expressed how his essence as a person was closely tied to his manliness when he said, "[Masculinity is] just something I identify with…it's kind of like an innate feeling." Often, this sense of innateness pushed masculinity, as an identity, far from the conscious experience of many participants.
For instance, when Jared was asked how often he was cognizant of his masculinity he replied, "Never. It's just who I am." Like Jared, Devon's masculinity was not an identity that explicitly crossed his mind. When asked how often Devon thought about his masculinity he replied, "Consciously, not a whole lot, but it comes up every day at least in actions that I do and stuff like that." Mario echoed this sense of automaticity about his masculinity when he said, "I think…that throughout my life, I thought about it so much, now it's like second nature. So, everything I do, I guess, is a masculine type of thing." It seemed as though both Devon and Mario were suggesting that despite not consciously thinking about their masculinity, they nonetheless felt that it played a significant role in how they interacted with the world.
There were times, however, when participants were consciously thinking about their masculinity, particularly when they felt it was being challenged. For instance, Joe said, "I just-I don't really think of it that much unless, you know, something happens where I'm tested in some way." Similarly, this 'test' for Mario occurred when he became aware of when his actions fell in the realm of femininity. He shared: ...you don't really notice what's masculine but you notice what's more feminine. So, it's more like everything is masculine until you notice something's feminine and that's when you realize, "I'm not doing anything masculine at the moment," or something like that. So, I think it's in pretty much everything-every thought I have.
For Mario, this heightened awareness of femininity led to a heightened awareness of his masculinity. This desire to avoid being perceived as feminine was shared by Anthony who exclaimed, "I don't think I would ever go out of my way to do anything that wouldn't be masculine…I enjoy being masculine and keeping my masculinity." Both Mario and Anthony understood that their masculinities were tenuous identities prone to external threats.

Salience of Traditional Masculinity in Conceptualization of Identity
Traditional masculine ideology figured prominently in participants' conceptualizations of masculinity. Though participants expressed a range of definitions of masculinity, many encompassed traditional masculine attributes. While not all participants featured traditional masculine traits in their personal definitions of masculinity, many expressed awareness of society's expectations of masculinity.
Gustav referred to these expectations as the "collective conscience," and suggested that many traditional traits such as "physical strength" and "being flirtatious" were "masculine in the common conscience." Gustav, who did not endorse many traditional masculine traits in his personal definition of masculinity, focused on the idea of being emotionally strong. He shared: I would say probably one trait that's commonly associated with men that kind of applies to me is difficulty in expressing myself through emotions. Generally, I tend to not visibly show a huge amount of emotion. I mean, if somebody like really, really gets on my nerves then I might-it might be visible, but, for the most part, I tend to not show huge amounts of emotion. And as a result of just ordinarily not really showing much emotion I tend to struggle with expressing my emotions.
The emotions that Gustav tended to show were frustration or anger, which, according to traditional masculine ideology, are acceptable for men to show. Peter was also aware of society's ideas about masculinity. In describing his perspective of the "collective conscience," he said, "So, the traditional form of masculinity is, I guess, aesthetically tall, muscular; skill-wise is versatile, responsible, proud, strong, confident." For Donald, these traditional ideas were so pervasive that when he was asked to describe what masculinity meant to him he replied, "Wow…Hard to say. All that comes to mind are things that I think…traditional beliefs." He later described how the "collective conscience" view of masculinity stemmed in large part from the views held by his girlfriend. He remarked: I think she has some kind of old school notions about masculinity and looks at me as the strong one, the one that's not supposed to cry, kind of, you know? Always have an answer or solution even when you don't know the answer kind of person.
Like Donald, many participants reflected on where their ideas about masculinity came from. Many felt the media played a significant role in infusing traditional ideas of masculinity into their lives. This was true for Elliot who felt that his ideas about masculinity were products of "what I've gotten out of society and how I think that's been kind of presented, whether it's through media or other sources...." Similarly, Zachary recounted how his ideas about masculinity came from "basically everything, including also media and TV 'cause you see things that you want to be like...." In addition to being emotionally strong, the participants also felt that to be a man meant they should protect themselves and other people.
The notion of protection was notable throughout many of the interviews. "To be a man," Ben said, meant "being able to do the right thing without any thought or any hesitance…and without having any problems in the way." He elaborated on what doing the "right thing" meant when he said, "…if someone's getting picked on…doesn't matter who they are, if they're a man or if they're female. Does not matter.
I feel like it's the right thing to do if you were to stand up for 'em." This notion of protecting oneself and others was also shared by Curtis: My definition of masculinity is just being able to take care of yourself and everyone around you…'cause I feel like if you can't take care of your family, if you don't care about your family at all, or the people you are close to or the people you say you are close with, like can you really call yourself a man? Jared articulated a similar description of protection when he said, "It's, you know, being able to take care of the people that you need to take care of without having to depend on anybody else and just getting the job done at the end of the day." The idea of being able to stand up for oneself was also voiced by Joe who shared, "I believe I'm able to verbally and physically stand up for myself and I'm able to stand out as masculine." Being someone who others can depend on also factored into Dayton's idea of masculinity. He described, "I just kind of picture it like more how my dad is, pretty much someone who takes care of people." For Nelson, the idea of protection took on a more chivalrous tone. He said: I have felt that when I was in a-quite a long-term relationship and during that I did feel that it was -as the man -kind of my job to, you know, take care of…like if we were going out to eat or things like that, no matter the timeframe, like it was, you know, I felt that because I was a man, that it was important for me to take care of that. If we were going places, I would particularly be the one to, you know, drive or kind of get that stuff figured out.
The idea of being someone others can depend on and someone who does not rely on others was poignantly illustrated by Curtis, who shared: The problem, at least, with my family is that they are very dependent on god. Like, I remember we had a very bad storm and I was like, "We have to get a generator, we have to get ready!" And my dad was saying something dumb like, "It will be all be alright, god will protect us" and I was like, "No, Dad! (laughs) This is a huge storm! Like, we might actually loose power and we have to get ready!" I don't know, people are so like…dependent on things and that kind of falls back down with the masculinity thing like being able to take care of yourself and people around you and not have to depend on others, may they be real or not.
For Curtis, even the reliance on spiritual beings was something he felt was unmanly.
The idea that men should be reliable was also articulated by Julian, who reflected: I feel like a man should…I don't want to say it like how society seems to see it, but a man should most likely be the head of the family, someone who isn't afraid to voice opinion or actions, someone who's willing to take action when necessary in order to benefit the people around him… When asked if there were components of this definition that did not fit with his sense of masculinity, Julian responded, "No, I feel like I kind of fit the stereotype but other people's definitions could be different." The traditional masculine notions in his definition included ideas of patriarchy, confidence, assertiveness, and aggressiveness.
Other definitions offered by participants included ideas about strength. Joe articulated this when he said, "I believe I'm strong, mentally and physically." Thomas referred to aggression, hot-bloodedness, and testosterone as "man qualities." He said, "Occasionally, getting aggressive, you know, the tendencies of possible short tempers, hormones, those kinds of traits." Not all participants embraced traditional masculine ideology in conceptualizing their masculinity. Wade, for example, found stereotypical attributes of masculinity incongruent with his idea of masculinity. He shared: You watch commercials and every time there's a household man displayed in a commercial, he's doing something stupid or his wife is talking down to him. He can't ask for directions, you know…those stereotypes, and they're very sort of offensive in a lot of ways and I don't think that that's a good picture of masculinity at all. That's something that I've tried to move away from… Like Wade, Peter expressed a desire to dissociate with the masculine "collective conscience." When asked what being masculine meant to him Peter replied, "I have a hard time answering this question because I try my hardest not to identify with the traditional form of masculinity." Interestingly, participants like Wade and Peter, who articulated a desire to distance themselves from the traditional masculine stereotype, did not fully separate themselves from the influence that traditional masculinity had on their ideas and behavior. Wade, for instance, who found many traditional masculine stereotypes offensive, remarked: But at the same time, you can't go swing the other way and just feel needy and it's...yeah, I think that's a lot of what it is, it's tied up in emotion, not showing emotion or not being allowed to feel emotion is a big deal in the picture of masculinity that's been painted, traditionally.
The idea that men should embrace their emotions but take care not to embrace them too intensely that it might be perceived as being "needy," is deeply rooted in traditional masculine ideology. Though Wade tried to distance himself from some attributes of traditional masculinity, he adopted many others. He felt these attributes came primarily from his involvement in Boy Scouts. He shared: I think I draw a lot from the Scout Law and Code in my idea of what a man should be, in that…just to sort of reiterate where I'm drawing from, the Scout Law is something we say every single meeting. The scout is trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean and reverent. So, I've said-I have that sort of drilled into my head and all of those qualities are things I think I associate with masculinity.
Peter, like Wade, articulated that he did not want to associate his idea of masculinity with the traditional definition. He did, however, embody certain traditional traits. For example, when asked why he did not seek academic accommodations from disability services he said, "A lot of my pride came from not wanting to ask for help." He later admitted, that traditional masculinity might actually play a more significant role in his life than he was previously aware of. To this point, he said, "I don't make a conscious effort to be masculine. And my pride, I don't consciously tie to masculinity but subconsciously it could be." Other participants discussed their struggle to untangle their sense of masculinity from society's rigid definitions. For instance, Zachary reflected: The [traditional masculinity traits] that I'm not a fan of, but I also participate in even though I don't like it, are the fact that, you know, men are looked at as supposing to be strong, leaders, always at the gym, always trying to improve, getting the best jobs. Even though those aren't good stereotypes those are still, you know, the stereotypes…Even though I don't want to it still…because for a lot of them you just want to be the best you can be even if it's not like, trying to directly tie into the gender stereotype, it just kind of happens.
This challenge of trying to avoid exhibiting traditional masculine characteristics while accepting their pervasiveness in society was shared by Eddie, who said: I don't know, I've always been…I feel like I've kind of put myself around that concept because there's certain aspects that I get drawn to. Like, I am a big sports guy, stuff like that and that's often generalized with masculinity and…I don't know…I feel like I try not to tie myself into that too much but it definitely, subconsciously, affects me.
In discussing the specific traditional masculine attributes of toughness and strength, Eddie acknowledged that these ideas are often considered "the stereotype kind of, to [masculinity]." In describing how he embodied these attributes, he shared: I mean, in some ways, I still try and exhibit those features but, at the same time, I feel like more subconsciously, I try to exhibit those features but consciously I'm trying to say like, "Hey, this is not what defines a man." So, it's a difficult question.
Here, Eddie acknowledged that despite trying to break away from traditional masculine characteristics, they still played an important role in his life, particularly in the way they manifested in his behavior. Regardless of the extent to which participants embraced or eschewed traditional masculine attributes, notions of independence, toughness, and success figured prominently throughout their narratives.
Independence. For many participants, independence appeared to be a central element in their conceptualizations of masculinity. Some participants mentioned this trait explicitly, like Joe who asserted that, for him, masculinity meant "being independent to an extent, being able to do things on your own," and Nelson who remarked, "I've always been so independent," and Elliot who said that to be masculine is to be "able to do everything on their own." Often, participants discussed independence in reference to their help-seeking behavior and their desire to do things on their own. For instance, David shared, "Well, again, I think, like how you said being self-sufficient, I think that's really important to me. And I don't really like taking other help I guess." For Ben, solving problems without the help of others was a substantial part of being masculine. He said: I guess, I would add on to the 'being a man' thing…a lot of, like, being able to do things on your own without anyone else's help or-I would say that's also a pretty big part of as, you know, what we were talking about just before this.
He went on to discuss how men he knows avoid going to the doctor for the sake of being viewed as independent. Though Ben had sought help for his stutter during middle and high school, he stopped receiving these services once he felt he could help himself on his own. He said: I've already been through a couple speech therapists and at this point, like, I know what, you know, works for me. I know what, you know, doesn't work for me and so I figured that I can just do these same things just by myself and just, know you, and it's been working fine since.
In addition to self-sufficiency, participants valued having confidence in their own abilities, leading them to feel assured in their decision not to seek help with disability services. Elliot articulated this when he remarked: I don't know if it's because of my masculinity and not wanting help. I think I'm a very independent person and I don't like to, you know, I think when I'm doing something, I'm doing it the right way and so I don't ask for help a lot.
In terms of being independent academically, Julian shared that though he seeks help "here and there," he tends "to try to keep up on [his] own." Similarly, Thomas expressed, "I want to better myself, so I try to do a lot of stuff without asking for help.
Even though help can help move me forward, I kind of want to do it on my own." Like Thomas, Isaac saw independence as a tool for growth and learning. This was evident in his discussion about his decision to not receive academic accommodations. He said: It does kind of force me to be in a position where I have to handle things myself, which I feel like would be an important lesson to learn going on in life, whether I have a job or whether it's for my job or something like that.
Isaac, who had not registered with disability services shared: I didn't know it was that for the longest time. I thought I was just having issues controlling the way that I thought about things and…I thought it was something that I could just deal with myself, you know, and that I didn't need anybody else…because I could take care of myself.
Some participants recognized that taking care of oneself independently did not always result in the best outcome. Mario, for instance, shared: I think if I was able to be more in touch with myself and more in touch with other people, it'd help me out in a lot of situations, because a lot of situations I wouldn't tell anyone anything and I like I still do-don't and it doesn't really help me out as much 'cause I try to do everything myself.
Though he acknowledged that getting help might be beneficial for him, Mario described how he continued to struggle to ask for help. Peter struggled to do this as well. He shared: So, where's the line between that and then getting over myself and asking for help to make my situation better? Because, I definitely could benefit either with not being as absent-minded as I am or being more responsible. There are different resources that I could take advantage of that I don't. So, it's a Catch-22 for me. And I've been struggling with that philosophy for a while. I think, in recent years, since I've been in college, I've been more flexible with asking for help. At least, I've been trying to.
Peter acknowledged how his desire to be independent has, at times, impeded his academic progress in school. Though Peter felt he had gotten better about asking for help, it continued to remain a challenge. Wade shared a similar experience of how his reluctance to ask for help led to academic setbacks. He recounted: I'd like to think if I had actually followed the advice that I'd gotten from here and just taken the rest of the semester, withdrawn, taken a year and come back, that the rest of my career would've been much smoother here. 'Cause it's sort of been an uphill battle since.
However, unlike Peter, Wade ultimately decided to register with disability services in an attempt to avoid further academic setbacks. Devon similarly acknowledged a shift in the emphasis he placed on being independent when discussing his reasoning for seeking academic accommodations. He said: I wanted to try to be as proactive as possible and, I don't know, try to seek help when like-'cause I don't know, I realized last year that I couldn't do it all by myself and so any help I could get would be amazing.
Like Devon, Jeremy seemed to recognize there were benefits in relinquishing some sense of independence to receive help. Jeremy, who seemed the least hesitant among the participants when it came to seeking help from disability services said, "I really wanted that advantage and really wanted to give myself all the tools that I could to succeed." His desire to achieve success was, however, linked to independence in the sense that he viewed his academic success as critical to obtaining gainful employment in the future.
Toughness. Like independence, toughness was highly valued as a component of masculinity. It was salient throughout participants' dialogue about what it means to be masculine and permeated many aspects of their daily lives. For instance, Elliot remarked, "In terms of my own sense of masculinity, I'd say it's about, you know, being tough, not showing emotions, and being perceived as someone who is strong.…" For Nelson, toughness was associated with physical strength. In describing his idea of masculinity Nelson said, "I wanna' say, it's definitely been a little bit like again, you know, the bigger, stronger…." For Joe, toughness was a physical attribute as well as a mental one. The idea of being dominant also factored into Joe's idea of toughness. He shared: I guess a lot of people, if you're a man, a lot of people look up to you as being, I guess, a dominant figure and being able to protect yourself and protect others. So, if you're not able to do that, I don't think you would fall into the category of masculine. For many participants, being tough was synonymous with not being perceived as weak. For instance, Elliot said being masculine means "to show no weakness and stuff like that." In describing what it meant to be unmanly, Donald said, "Perhaps, a general weakness-sense of weakness, helplessness." Similarly, Ben said, "I wanna' say cowardice is probably what I would think of that's not masculine." Mario also shared: The way I think the masculinity that I guess I grew up with or was instilled in me was to never show weakness and that's something that's been good and bad. But to never show weakness and like, if your family's all down, you gotta' be the one that's still strong. Or in hard times you gotta' be the one that's strong or thing's like 'don't cry' or just always being the one that's like the rock of everything. So, yeah, that's what I think strong has meant to me.
Although Mario felt strongly that toughness equated to manliness, he acknowledged that it was both "good and bad." Julian expanded on the "bad" side of being emotionally tough. He argued: You know how people think that men can't be in tune with their emotions? I don't believe that. I feel like it's part of being a person and it's like a man crying shouldn't define him…I think emotions should definitely be shown in a family because, for one, for children, it gives them a different sense of who you are, you know? And it's getting me to think, like, the way I am because of how my parents acted and like, okay, I was never the one to really tell my parents like personal information because I know they would react differently. Then, I'm like, that's not how I want to be.
Like Mario, Julian's ideas about toughness came from experiences within his family.
In particular, they came from his father, a man Julian described as not displaying I think, I guess the way I was raised, I mean I had-like my father's like at a very old age now and I was raised…where he's from a certain time period and my grandfathers and my uncles are from a certain time period so they're more like tough and everything. And the way I was raised with my brother was always like bullying me and everything. So, it's like, there was one point in my life when I was younger where I had to stand up for myself and had to make sure they know that I'm tough and you know try to grow as a person and try to take on responsibility and try to actually stand up for myself and be strong.
Both Julian and Joe shared how their fathers and other prominent adult men in their lives were influential in how they thought about their masculinity. In terms of passing down the traditional notion of toughness, Eddie also described the role of his father.
He said: I mean my dad was always kind of like that tough guy, like he's got that mindset too and when I was growing up my sister once said, "Dad, I want to mow the lawn" and then I ended up mowing the lawn because he was like, "No, that's a thing that guys do." So, at age 11, I was mowing the lawn (laughs) just to stop my sister from doing it.
In addition to the pressure from their fathers and other adult male figures to be tough, participants also felt pressure from their male peer groups. Ben described how his ideas of toughness came primarily from school. He shared: Oh, that's mainly from like my-I would say my interactions in school. Like ever since an early age, I was always told as a kid like, oh just, you know, "shrug it off," you know, "just deal with it. You're-be a man"…It was a -you know, be the biggest man out of all your friends.
Ben likened this pressure to be the "alpha" male among his friends to a "pecking order" among chickens, fighting to see "who is the highest up, who is the lowest…." David also felt this pressure to be the "biggest man" among his male friends. In recalling the feeling that he needed to protect his image of toughness in front of his friends he said, "…when I'm with my friends and like…if someone calls you soft or something you have to show that you're not. Not like you're fighting or anything just like in a group environment." The group environment that had an influence on David was an unstructured group of male peers. Participants also developed their ideas about toughness from more structured male groups like the Boy Scouts and the military.
While the latter is not an all-male organization like the Boy Scouts, it has been a traditionally male-dominated field particularly in the two branches of the military that both Jared and Keith belonged to. For Wade, who discussed the influence of the Boy Scout Law on his definition of masculinity, described the organization's influence on his sense of toughness. He shared: I had some role models in scouting, you know, from doing backpacking trips and going camping and hiking and just, you know, experiencing things where-not danger-but, you know, things where decisiveness needed to happen and you had to be clear-headed and think things through and do things the right way and that definitely made me think of masculinity in a different way.
For Jared, his ideas about toughness were derived primarily from his time in the Marines. In describing the way toughness permeated his daily life during that time, he recalled: I really haven't had any major influences other than the Marine Corps…so, for me, masculinity…it's very stereotypical. It's very, you know, just being like the testosterone-hyped, alpha-type that, you know, you don't get pushed around, you never get backed into a corner, you always find a way to fight out. I mean, for me, that's what masculinity is.
Though Jared did not always think about his masculinity explicitly, it was always a part of his life as a Marine. In recalling how often he thought about his masculinity, he said: I'd say all the time because it's all about perception and weakness can be used against you very easily. So, you don't directly think like I need to act like a badass right now. You-but you think, like I can't act weak right now.
For Jared, being tough was more than exuding an image of hardness. Toughness also meant the potential difference between life and death. He recounted, "You kind of get it instilled in you; it's a kill or be killed world…you kind of had to develop real tough skin real quick, otherwise you weren't gonna' make it." Like Jared, Keith also spent time in the armed forces, completing two tours of duty in Iraq as a member of the Army. He also reflected on the influence that military culture had on his idea of toughness. He said, "I was in the military, so they really kind of beat it out of us the idea that machismo was mutually exclusive with behaving a certain way." Both Jared and Keith reflected on how this extreme sense of toughness followed them into their civilian lives. Jared admitted, "It's hard to get rid of. I've softened a lot, believe it or not. It's-I've had to 'cause you can't just go around, you know, if someone bumps into you, you can't throw 'em across the aisle." Keith recognized that tempering his toughness did not mean it vanished. He noted that after retiring from the Army, he carried with him a "really thick skin" that made it "harder for good stuff too." Many participants prided themselves on being tough, like Devon who commented, "I take pride in kind of being tough which sounds kind of strange, but that's important to me." When asked to expand on what he meant by "being tough" he shared: Handling things a certain way. I like to try to show that I-even though I deal with anxiety and stuff, I do have leadership skills, so I like to try to demonstrate that in any way I can. And that in turn makes me feel, I guess, masculine and just kind of stuff like that. But it's still kind of hard to describe.
For Devon, being tough manifested in his ability to overcome obstacles, particularly difficulties that stemmed from his disability. For Devon, the act of "being tough" was deeply connected to his sense of masculinity. Similarly, Joe spoke about being tough by overcoming obstacles. In describing this type of toughness, Joe used the term "powering through." Like Devon and Joe, Ben embodied toughness by maintaining control of his behavior. He shared: Like, I remember a few times where [my stutter] was pretty bad. Like I would tell the teacher before…I'm not comfortable with, you know, going up there and speaking, like I have a stutter…but that was only like freshman and sophomore year of high school and then after that I just said screw it, I'm just gonna' go for it and just…I'm just gonna' have to power through it because I gotta' be a man about it.
Ben directly associated "powering through" with manliness. Joe, a journalism student, associated it particularly with success. In remembering obstacles he had overcome in publishing one of his articles he recounted, "I pushed through that and that's very, very important to me and I'm very, very passionate and prideful." Some participants expressed how maintaining an image of toughness manifested in not having intimate conversations with other people, including close friends. For instance, Eddie remarked: I do sometimes feel like even with my closest friends I don't really want to talk about it just 'cause, I don't know, I just-it's just hard to open up a lot of the times, even though I have friends that will come over to talk to me and they will be extremely open with me but I still have a lot of trouble opening up to them. I'm not sure why I haven't broken into that code of why I can't truly…I mean sometimes I'll have little breakthroughs where I can tell things and I'm usually open about the surface of the disease but I don't often go into how it truly affects me. I don't know…I kind of keep that to myself.
Similarly, Anthony had difficulty opening up to others, particularly his male peer group. He attributed this difficulty directly to his masculinity. He said: Just like being a guy, most guys are usually stereotyped to not share their feelings and be emotional and stuff, so it's definitely harder for me to share the fact that I think I do have OCD to all my friends and all the guys in the fraternity 'cause it might make me look like weak or like…I don't know. I don't think anybody would really call me like a pansy or something if I shared that with them but just like based on society standards…I was kind of hesitant to share that information with anybody besides my close family.
Anthony acknowledged that being a part of a society that pressures men to be tough, strong, and in control of their emotions has made it difficult to be open with others about his disability. Like independence and toughness, the idea of success permeated participants' narratives and was connected to their ideas about masculinity.

Success.
Ideas of success were infused throughout participants' narratives in two distinct ways. The first was through the expression of traditionally masculine images that participants associated with success and achievement. The second was through the value participants placed on their academic and professional identities. In terms of imagery, Keith described success in the following way: Let's see…I mean, I guess people usually associate it with being like an alpha male type where you kind of always have the right…well not even the right answer but always have an answer. Or always assert confidence or at least that demeanor and kind of like what they might call like a go-getter or, you know, typically that would be falling in line with that.
Other participants expressed this "go-getter" imagery, like Joe who exclaimed, "I always want to aim for the best and reach success in any way I can." For Joe, success was achieved by being tough and powering through obstacles. He shared, "If I have all these setbacks and I'm able to push and push and push to be successful in a lot of areas, I think that's really important to me." Dayton's frame of reference for success came from ideas about his father. He said, "Pretty much, just my general idea of being a man is just what my dad has shown me, what he's done: owning his own company, being successful." In speaking about things Dayton considered unmanly he remarked, "Someone who's unsuccessful, weak, not very out-like not talkative, not willing to go get what they want….But for the first one, it's just really-it's just really not being able to achieve things." In describing success, some participants used imagery that conjured up an image similar to that of the Don Draper character of Madmen. In other words, the image of a well-dressed, firm, and powerful businessman. For instance, Nelson said: Over the summer, we had specific days where I would have to sit down and have meetings with-I was working for a forty or fifty million dollar company; I had to sit with the CEO of a company and it's like, I'm over here sweating bricks but I gotta' go put a suit on, things like that, you know? That outward appearance definitely I think-more of, you know, kind of a masculine-that's more of a masculine view for me, you know? Get that suit-that nice black suit type of deal.
It was clear that Nelson valued being a part of a financially successful company.
Interestingly, the "outward appearance" he described as masculine also figured into the image of success presented by Keith: I mean, if you had to choose an aesthetic it would be the typical three-piece suit with the tie and slicked-back hair and that type of deal. But I'd say generally speaking people would agree on that consensus.
Elliot felt he gained a sense of masculinity from his professional experiences. He shared: I have a masculinity just from where I've worked in and, you know, got an experience in the working world and that's kind of where I've built those ideas from…I worked for a software company which tend to be super dynamic and, you know, kinda' on the cutting edge of where companies are going and for that I felt that my professional appeal or my professional view is something that I've used to kinda' make myself even a little bit more masculine, you know, the shaking hands type of thing, that typical walk into a boardroom, you know?
Acts as simple as shaking hands, as Elliot described, were intimately tied to some participants' sense of masculinity. For instance, Donald described feeling acutely aware of his masculinity when he met new people. He shared, "…considering that I was right-handed and it's my right hand in question and the first thing you usually, typically do when you meet someone is shake hands, that kind of throws things off right there." In addition to the value participants placed on exuding images of confidence and success, participants valued their identities and images as students. For instance, Devon shared, "Also what's been a lot more important to me lately is my academic identity" which he described as "a game; like I try to do as well as I can and stuff like that." Many participants perceived academics as the key to obtaining gainful employment in the future. David, for instance, when asked to describe what masculinity meant to him said, "I mean, I guess that I know that one day I want to have a job." Donald also described how professional success corresponded with feeling masculine. He recalled, "When I first got my first full time job, for example, and moved out of my parents' home it was…that was especially…that felt masculine.
It felt like I was like that same kind of powerful ability." Some participants explicitly associated their academic success and future career success with their sense of masculinity. For instance, Devon shared: I mean, in terms of academics, I don't know, I want to be able to achieve as much as possible, obviously. And, I don't know, I mean maybe they don't tie together directly, but if I feel that I've done as much as I can and I've achieved as much as possible then I feel better about myself as a man and as a person.
Like Devon, Jeremy tied his academic success with his future career success. When asked to describe his important identities Jared said, "I would identify myself with engineering. I'm an engineering student and I'm graduating in May." Jared decided to major in engineering because, "I wanted to go to school and then get a job afterwards, so I wanted to do something that had good employment." Other participants, like Jeremy, identified strongly with their major or career field. For instance, Nelson referred to his "professional identity" as one that he "value[ed] greatly." Like Nelson, Joe highly valued his identity as a journalism student. He shared, "My aspiration is to be a sports journalist." In fact, later in the interview, Joe referred to himself by saying "I am a sports journalist." Despite no longer being able to participate in the Marines to the same extent he did prior to acquiring his disability, Jared said, "I am a Marine. I love being active duty. I love my job. I was really good at my job." Jared not only loved his career, but it also provided him with a sense of self-efficacy; he was good at being a Marine.

Losing Masculinity
In many ways, participants conceptualized their disabilities as identities that threatened their sense of masculinity. Sometimes their disability identities impacted their sense of masculinity in its entirety while other times it impacted particular aspects. Participants' disability identities challenged many of the traditional masculine attributes they embodied including independence, toughness, and success. Some losses were more permanent whereas others were more temporary and occurred only in certain contexts and situations. The following discussion examines how participants experienced losses in each of these domains and how their disabilities impacted their masculinity in more general ways.

Losing Independence
Many participants shared similar experiences of how their disability identities negatively impacted their sense of independence. For some participants, like Dayton, this occurred mainly in relation to seeking help. Dayton shared what it felt like for him when he had to ask his friends for help with a paper. He explained: When I actually need it-like need help with a paper, I do go to my friends that I know are better at spelling and grammar than I am and that's a little de-like, I can't think of the word-like unma-like it kind of takes away from my masculinity a little bit.
Though Dayton ended up asking his friends for help, he did so at the expense of his masculinity. This experience of feeling less masculine as a result of asking for help was a feeling many participants wanted to avoid. During a discussion with Ben about the influence of early gender socialization on later help-seeking behavior, he offered the following insight: Which is exactly what I was told, yeah, power through. That's what I was told all the time. It's like…when you're told pretty much your entire early life, like, "Oh, just power through everything, just be a man about it, grow up, you're fine, just, you know, shake it off," like all that stuff…I think it's just kind of messed up in some ways to me, you know what I mean?...I just feel like a lot of guys just…I feel like it's almost like a-like it would hurt their ego almost if they went to go get help 'cause that's not manly. A man should, you know, be able to do things on his own. Like should be independent….
Though Ben sought help from a speech therapist when he was an adolescent, he had difficulty shaking the pressure he felt to be independent in college. For Ben, being independent meant being fully in control of himself. This was evident during a discussion with Ben about his decision not to register with disability services. He explained, "I feel like my disability can be overcome and controlled…." He added, "I feel like even if the process was different, I don't think I would-I still wouldn't go through with it, because as I said before, I can work through it, I can improve on it." Joe, who unlike Ben received academic accommodations from disability services, expressed a similar desire to maintain an image of independence. He said: I'm very prideful in what I do. I work very, very hard and I'm very passionate and I think my grades are very high to an extent. I put in a lot of work. So, I think, I don't want people to say, "Oh, he has autism, he's not able to do this and this" and it goes back to the point of ability or capability of being able to do something. I think I wouldn't want to tell people because I want people to understand that I'm a human being first and I'm able to do this regardless of my disability just like everybody…I wouldn't want them to say, "He's autistic and he's not capable," because that would, to an extent, damage their perceptions of me.
In addition to wanting to be perceived as capable, Joe subtly touched upon what he understood to be underlying stigma about individuals with autism, specifically that people with autism are perceived as people who cannot do things independently.
Despite Joe's fear that asking for help might confirm people's stereotypes about autism, he recognized that his disability's impact on his academics was too significant to ignore. Not all participants, however, felt comfortable relinquishing their independence for their academics. For instance, Peter was registered with disability services but chose not to receive academic accommodations. In discussing his decision not to receive accommodations Peter shared, "Well, pride comes from having confidence and being able to do something. Or, just the confidence in yourself. So, to ask for help is to publicly acknowledge that you aren't as competent as you could be." Peter associated asking for help with losing credibility.
One participant who did not articulate that he felt a sense of loss in terms of his independence or pride or credibility in asking for help was Jeremy. Jeremy, who sought a private evaluation to diagnose his disability for the purpose of providing him with the necessary documentation needed to receive academic accommodations, remarked: You know, if this is a problem I have, I want to have it diagnosed and take the drugs with the consult of a doctor and a physician and figure out exactly what's going on and what I should be doing, you know? How to make myself better, you know? The best I could be.
Jeremy, who said in regard to his lack of reliance on traditional masculine ideology, "I mean, I never really think: I'm a man, I'm masculine, I do this," did not feel -or care about -a lost sense of independence. He did, however, highly value success, which proved to be a significant motivator for him in pursing assistance with disability services.

Losing Toughness
In addition to the concerns participants had about losing actual or perceived independence, many participants felt their disability identities threatened their sense of toughness. Throughout the interviews, many participants expressed the idea that disability equated to weakness. Joe, for instance, described his disability using the term 'weakness' instead of 'disability' when he said, "If all I do is show my weaknesses or my discrepancies then that might give somebody the wrong idea of autism." Keith, in talking about how he found yoga to be effective in managing the symptoms of his disability, similarly used the term 'weakness' as well. He said: I do a lot of yoga, I like to practice yoga and I think that definitely has helped me think of the way-of my disability as being an injury that I need to-not an injury but as a weakness that I need to strengthen rather than something that's broken and can't be fixed. Everything can be worked on and fixed and-not fixed, but made stronger. You can always, you know, make an injury feel better and emotional injuries and mental injuries aren't any different than physical injuries in that sort of aspect.
While not all participants used the term 'weakness' as a synonym for disability, many worried about being stigmatized by society in that way. This concern led some participants to not disclose their disability identity to others. For instance, Anthony expressed, "I would definitely be more hesitant to tell my friends just because it makes me look kinda' weak." Similarly, Elliot, who identified as having Scoliosis, described how he avoided the issue of disclosure with his friends. He shared: Well, it's tough 'cause I -whenever I'll be with people and maybe I just, you know, I'm going out with friends or something and I realize after a walk in town that my back is starting to hurt and I can't continue, I have to, you know, maybe make an excuse like say, "Hey, I'm sorry, I've got homework to do" and then leave. So, they might think that I'm just abandoning them whereas I'm really knowing, you know, I want to stay here but I can't because I'm in pain.
For Elliot, it was not easy sharing his disability identity with his friends. He explained, "I think, you know, maybe it comes back to the masculinity that, you know, you want to be perceived as tough and, you know, having to leave for doing something so simple as just walking around is tough." For Thomas, the academic accommodations process triggered a similar feeling. He explained, "I felt weak. I felt that I...that I didn't belong." When asked if there were specific parts about the process that made Thomas feel weak he said, "I think the whole process collectively just made me feel that way." Wade, who identified as having an anxiety and mood disorder, felt that his disabilities were connected to an inner, personal weakness. He shared: It was going from high school, where I could get good grades without really trying at all, to college, where I needed to at least put in some time and instead I was, you know, I was experimenting with drinking for the first time and smoking cigarettes and hanging out with large groups of people and just-it's exposed a lot of the really weak points of my character, I think. It was a hard time.
Like Wade, Donald expressed how his disability led him to feel physically and emotionally vulnerable in a way he had not previously experienced. He shared: Another thing that was very unsettling was…I had a third degree burn on my foot that healed very well and while not generally painful by itself, it's very vulnerable and I quickly hated being in crowds of any sort because I was afraid I would get stepped on which would put me into orbit, literally (laughs). I was afraid that I was going to hurt somebody because it just made me so angry, I mean, it was pure rage not just pain. That was like-well, it is, it's like an Achilles heel for me that…and that's very invisible and when I'm in crowds now, I mean, I have to tell people, "You're bumping into me. That actually hurts because I have an injury there you don't see." I'm actually still kind of coming to grips with that.
Similarly, both Mario and Joe shared how they felt vulnerable because of their disability identities and described how this perceived weakness was exacerbated by the vulnerability they felt as men of color. When asked how his racial identity influenced how he thought about his disability identity, Mario described: I really think it does because as a male you're typically…well the way I grew up, as a male you're not supposed to show weakness. And as a male of color, you're even more or less not supposed to show weakness. So, when those two things happen it just makes you feel even more secluded because as a male of color, if you're already an outcast, you're somewhat different. And then as a male, if you're an outcast, you're already different, so with me being the way I am it's hard kind of to connect with people because there's not too many males of color. So, if you can't connect with them and then there's not too many males that can-that are the way you are, so if you can't connect with anyone it's kind of something difficult for yourself to realize. So, I think the disability I have I think really sets me back in that type of way.
For Mario, his difficulty connecting with others, coupled with feeling that as a man of color he needed to project a façade of toughness, left him feeling alone in his experience of having an invisible disability. For Mario, his disability identity not only challenged his sense of toughness, but also contributed to a loss of social connection with others. He further shared: 'Cause like I stated, I don't really say too much to people or too much about myself. So, as I kind of explained myself, I think I thought a lot about things that I've gone through or things I have to go through, so I don't think I ever realized like being a male of color with a disability how that sets me back or how just having a disability sets me back and not being able to tell people and realizing why I guess I don't feel too comfortable telling people things. And I think I realize how partly as I get older it may get harder 'cause there are less people in your life, so I think I realize how much of an effect a disability can have without you, yourself, and other people realizing that you have it.
Joe also shared how his racial identity influenced how he thought about his masculinity and, in turn, his disability. He remarked: Well, being an African American male, I think, to an extent, influences that masculinity. There's a lot of I guess…biases to an extent and there's a lot of stereotypes…and I think being a young Black man, I have to be able to portray myself in a high way and I have to be able to be strong mentally and physically as well as-as anybody would have to, to be a male. I think if I show any areas of weaknesses, I think that would be, to an extent, demeaning to my race and I think that would just show they're weak in some way.
Joe felt pressure not only to display toughness but also to not allow his disability to interfere with his academic potential as a student. He worried about his image as a young, African American man and understood there were unique pressures on him to act a certain way because of his race. He also worried about being stigmatized because of his disability. He shared: If I'm an autistic student in their class and they see me and I'm just, I guess, not doing something I'm supposed to or I'm just struggling in something, they might think, "Well, I guess this is how all autistic people are." For Joe and other participants, the fear of being stigmatized because of one's disability posed a threat to participants' sense of toughness. As many participants equated toughness with physical strength, this was also an area where some participants experienced loss.
Losing physical abilities. The inability to perform physically as a result of a disability identity was experienced by several participants. For instance, when describing situations in which Donald felt a heightened sense of awareness regarding his disability identity, he said, "I think if I'm depressed, certainly when I try to do something and I don't-I'm having difficulty." Donald expressed how he felt his disability identity led to a loss in his overall ability to perform physical tasks. He shared, "Growing up, I always felt this…kind of just general feeling stronger or faster even, better…self that, you know, that was what really was taken away." Donald responded to this loss by trying to keep his invisible disability hidden. He said, "I want to say I've tried to make it invisible with the physical stuff, whether just trying to feel better, or feel normal, or just feeling bad and feeling sorry for myself, or some sort of denial…." He expressed a desire to hide some of the manifestations of his disability to appear more able-bodied than his disability allowed him to be. Jared also shared how his disabilities led him to experience loss related to physical abilities. He expressed: So, I don't think about my disabilities, I think about what the consequences of my disabilities are. Which again, primarily is not being able to do what I wanna' do. You know, I can't be as active as I once was, just can't physically do it. So, the consequences, they're always with me. I mean, it's just something that you kind of have to deal with and work through.
Jared conceptualized losing his ability to be as active as he used to be as just one of the many "consequences" of his multiple disability identities. For Eddie and Elliot, these consequences were experienced as a loss of their abilities to perform athletically.
Eddie, a previous runner, recounted: It was a very frustrating period because I'm a runner and I was running cross country and, all of a sudden, I-we had taken a break over the summer and then I had started up training in the maybe very end of the summer, beginning of the fall. I was just doing really poorly and, at first, I thought I was just really out of shape I was just, I was really frustrated and then the season started going and I just wasn't getting better. I was like…I couldn't perform at all. Like Eddie, Elliot described how after acquiring his disability, he eventually had to relinquish his valued spot on his baseball team. He shared: I'd say the first thing that kind of hit was I wasn't able to continue playing baseball, which is something that I really enjoyed doing up through middle school and my first year of high school. I was trying out for the team and then part of the way through the try-outs was when I was diagnosed and started having back pain and it got to the point where I just couldn't play and so I ended up having to quit the team. And that was pretty rough.
For Elliot, this loss of physical ability was, at times, amplified by his family's reactions toward him, particularly when he was unable to perform a physically demanding activity. He recounted: You know, I have the experience of where I'll be helping with yard work or something like that or, you know, mowing the lawn or something back at home and when I realize that I'm not able to continue doing that, I think it's very disappointing to me. It's, you know, I get the sense that it's kind of disappointing to my family, I think, in a way. I know they're very supportive, but I can feel the sense there….
As these participants voiced frustration with the 'consequences' of their disabilities, they also expressed a sense of nostalgia over the abilities they felt they no longer had, and the athletic activities they were no longer able to participate in. Other participants expressed similar kinds of frustration toward their disability identity when it impacted their sense of success.

Losing Success
For many participants, their disabilities impacted their success by diminishing their sense of self-efficacy, defined by Albert Bandura as "One's belief in one's ability to succeed in specific situations or accomplish a task" (Luszczynska & Schwarzer, 2005). Participants' sense of self-efficacy was challenged in terms of their physical abilities, but also in the domain of academics and professional life. Joe, for instance, expressed pre-emptive concern about not being taken seriously in a future employment position as a journalist. He shared: I mean, it is a very, very challenging life disability and I will have it for the rest of my life, and I understand that, but I think some people who are, I guess, uninformed about autism would think very lowly if they see one example of somebody who has discrepancies or struggles a lot…and I think if you show any areas of weaknesses, or if you're timid, or if you're not doing your job to the best of your ability, that'll lower people's perspective of journalism. They'll say, "Hey, if this journalist is not doing his job and if he's not taking things seriously, why should I take him seriously?" In addition to feeling as if his disability impacted his sense of self-efficacy, specifically his ability to become a successful journalist, Joe worried about being respected by others in the workplace. Respect, which was articulated by some participants in their definitions of masculinity, was something that some participants worried might be made vulnerable by their disabilities. This was a concern for Ben, who worried that his stutter might cause him to appear less capable and less intelligent to others. He said:

Sometimes I would think my stutter would almost like lessen my masculinity 'cause I wouldn't be able to get my point across, which is what my like-was
probably what was my like biggest concern, honestly. Like 'cause I feel as a, you know, manly man, I have to be able to put my point across, I have to be able to do it clearly and concisely. And if I'm stuttering, my-like if I'm stuttering the entire way through it, I mean, who is gonna' take me seriously? You know, it's like, who is this blubbering fool, you know?
Ben worried that others would not respect him because his stutter often made it difficult for him to express his thoughts eloquently and in an articulate manner. Not only did Ben worry about not being respected or taken seriously, he also felt that his inability to express himself clearly -a manifestation of his disability -could detract from his sense of masculinity.
Participants' often viewed their disability identities as limiting them in some way. Sometimes, the stories they shared about feeling inadequate or limited by their disabilities were accompanied by expressions of feelings such as depression, embarrassment, and frustration. Joe, for instance, in discussing the impact his autism had on his academic ability, recalled a particularly difficult semester: So, it was very tough at that point because there are certain aspects of autism where you can't like…there's a lot of time management issues and things that you can't really-there's a lot of memory issues and things like that sometimes. It's when you take on more responsibility it can be challenging…one of the challenges of autism was balancing my time, balancing my work, balancing my attention to my work, and making sure everything was perfect…it took a lot to get through that semester.
Nelson also shared Joe's expression of frustration with how difficult he felt his disability made it for him to keep up academically. In discussing how being in college amplified the frequency with which he thought about his disability as well as his sense of frustration, he shared: I would say most of the time. It's more so now because I'm in school and it's almost like a constant reminder just because I feel like I-I need to perform at the same level but given the same standards and like teaching styles as other people, you know, that's not how I do-that's not the best way for me to go about like…and it's like I have to put in a lot of extra work typically to stay up at that level so that's definitely a daily thing.
Nelson also noticed how his disability altered his ability to learn in a similar way to his peers. He remarked: Like where it has made a difference in comparison to other people is just in class mostly…mostly a lot in class. Like, you know, people will be like, "Oh, you know, you don't understand that?" It's like, "Hold on, you gotta' give me a minute to process it and get through it and I'm gonna' have to read or watch it again"...It takes me that extra couple of minutes to read and understand a question. Where it may take you two minutes to read and get the question, it might take me three or five.
Both Jeremy and Curtis expressed a similar sense of frustration in feeling that they had to work twice as hard as their classmates because of their disabilities. Jeremy articulated a sense of frustration specifically regarding his time management abilities.
He explained: I procrastinate a lot. So, when it's like two in the morning and I still haven't started my essay and I've been trying to start it since seven, I've just been staring at the blank screen for hours, I'm like, "This sucks. Why am I like this? I hate this. I hate school. I want to be done," and then I think, if I didn't have ADHD…imagine if I could start my work when I meant to start my work? If I could be productive during the day and not only get my stuff done late at night? Imagine how much earlier I could have got this done?
Though Jeremy felt that his grades were satisfactory, he felt his disability impacted his quality of life and made things more difficult for him at school. Before receiving an official diagnosis for his disability, Julian shared a similar frustration: It's been kind of hard because for a while I, at least, thought that I'm falling behind and it was a 'me' problem, you know? And I just felt like people didn't really experience this, so I just kind of kept quiet about it. Just on my own, I just worked hard-I tried to work harder just to keep up.
Curtis also felt he was performing well academically and shared that he viewed his learning disability as "just a motivation because, frankly, just having a disability kind of sucks for the most part." When asked to elaborate on what 'sucked' about having a learning disability he replied, "Just not being on even terms as everyone else; having to basically stay up 'till three o'clock to get the right amount…the same grade as someone who studies for two hours, basically." Though his disability did not impact his grades, Curtis expressed frustration over how laborious the process of learning was for him because of his disability. Like Curtis, Thomas expressed how his disability made him feel academically inadequate, especially when he compared himself to his peers. He said, "You know there was the reading stuff where I'd lack in reading.
Everyone would be faster than me. I'd still be reading the same paragraph when they were already three down." Sometimes, this sense of inadequacy came from external sources, such as family members or peers. Dayton, who also identified as having a learning disability, shared: Well, one of my disabilities is that I'm terrible at spelling, like I'm pretty bad and when I'm texting my friends it's just like it sometimes isn't the best-best grammar used and that's one of the things that my friends make fun of me for…I just put my head down in shame a little bit and that's like kind of unmasculine.
Dayton's invisible disability was manifested in his inability to adequately express himself through writing. In this way, his disability became visible to others. Dayton was particularly concerned about it being visible to his male friends because they often mocked him for his poor grammar, making him feel demoralized and emasculated.
Similarly, Curtis shared how he felt inadequate as a result of how other people treated him. He said, "I feel like people, because they don't know I have a disability, just assume I'm dumb almost (laughs), especially in terms of my handwriting-my handwriting's atrocious-like my brother rips on me all the time for it." He described how people often misattributed his behavior to undesirable qualities, such as being dumb or lazy, because they were not aware he had a disability that his behavior could be attributed to. This experience was shared by many participants who described how this occurred often in academic settings. Mario, for instance, expressed how he was often concerned with how his professors might perceive his behavior that he attributed as a function of his disability. He shared: I think that's really had a toll on me 'cause it does seem like I'm not prepared in class or sometimes it just seems like I don't want to-I miss a class because I just didn't want to be there.
In sharing this experience, Mario contemplated whether or not academic accommodations would benefit him in this regard. He said: But, I don't know. Maybe I should've [received accommodations] because in the classroom, it's kind of hard for professors to know that I have this thing and I can't go up to them for office hours 'cause I just don't feel comfortable or if I'm not talking in the class, I don't feel comfortable. They don't know that, so sometimes my academics suffer. Or, if sometimes I just don't feel like I can go to class just because I have that social anxiety, the professor doesn't know. He just thinks I'm not showing up.
Wade also worried about how manifestations of his disability might be misperceived by his professors and negatively impact their perceptions of him. He shared: They knew from in class, if they asked me a question I knew the answer, so they knew that I did well on tests, they knew that I knew the material. So showing up late with an assignment, sort of comes off as being lazy or flippant or not caring when you're really-that wasn't the case, it was just…I might even have the assignment done, I just didn't-couldn't bring myself to bring it to them as soon as I could have liked.
Zachary, who identified as having a vision disability, had the experience of getting in trouble in class as a result of how his disability affected his behavior. He recalled, "And also, teachers always yell at me because they think that I'm sleeping in class,

too."
Losing one's career. As many participants equated success with having a career, participants spoke about experiences of loss related to their professional identities. Some participants shared a similar experience of loss related to their inability to participate in the armed forces. Unlike other career fields, the military -a bastion of traditional masculinity -can preclude individuals with certain disabilities from joining the service, or may remove individuals who have acquired certain disabilities from active duty. This occurred with Zachary and Jared, detracting from their sense of masculinity. As a result of his disability identities, Zachary was unable to fulfill his professional dream to be in the army. He shared: The only [people whom] I tried to hide [my disabilities] from were military recruitment officers…I wanted to join the army and I thought it was just going to be my eyes that held me back but then I learned that even though my asthma doesn't bother me at all anymore, because I was diagnosed with it after age sixteen I couldn't join any branch of… couldn't even join the reserves. So that was kind of hard….
Zachary went on to discuss, rather unenthusiastically, how he ended up pursing a major in accounting. Perhaps of all the participants, Jared's experience of loss related to his professional identity and, subsequently, to his masculinity was the most extreme. He poignantly recalled: So, this is tough…I love being a Marine. I am a Marine. I love being active duty, I love my job, I was really good at my job and I'm obviously not stupid so, being in the infantry I moved up quick. I came home to help out with my mother when my brother went to school. It was supposed to just be a few months…I was in a car accident…and I woke up three weeks later from a coma, handcuffed to the bed, with a ventilator in my throat….Literally, from the bottom of my sternum all the way to the bottom of my belly button was just wide open and they had removed, you know, my gallbladder, ninety percent of my pancreas, my spleen, I had a lacerated liver, I had ruptured my diaphragm, I had shattered my right hand, I had a brain injury and that just kind of all gets thrown at you real quick. You're like, "Huh, shit! That's not good." I never made it back to North Carolina. Never saw my unit again. I got stashed in an admin' station in Providence, which is an infantry Marine's hell. Two years there. That was a-you want to talk about masculinity getting crushed? That was a tough one to swallow. It still is a tough one to swallow. Unlike many of the participants who shared the experience of living with their disabilities for the majority of their lives, Jared acquired his disabilities during his college years as a result of an automobile accident. In describing how he felt both his career and body had been shattered, Jared said: Can't do that though...but, not being able to choose the career that I want to do -more than anything in the worldthat's devastating. And that's something, to this day, I haven't worked through. Jared reiterated the devastating impact his disability had on him when he said, "So, that's-it was tough. I said it's-like my choices kind of, you know? I feel like I made the right choices and then, they kind of got stolen and that's kind of hard to deal with." The toll, however, on his sense of masculinity was clear. When asked how he viewed his masculinity after acquiring his disabilities he said, "Probably higher than I should." When asked what he meant, Jared explained: 'Cause I-I'm still-I'm further along now than I ever have been, but I've taken several steps back, mentally. Physically, I'm progressing, you know I just turned thirty like a week ago, I'm graduating college, I'm gonna' be starting a new career that I don't even want. It's [laughs] it's that it's just-everything about this is tricky. It's just, it feels like you take one step forward, two steps back and there's a trap around the next corner for you and you kind of gotta' learn to maneuver….

Not All a Loss
While every participant shared an experience of loss related to their disability identities, a few participants also shared ways in which they viewed their disabilities or aspects of their disabilities more positively. Some participants expressed how their disability identities strengthened their sense of empathy. For instance, Wade shared: It's made me much more aware of other people struggling with the same things. There's two or three students I've reached out to who were struggling who-they are-they were already working with disability services, but I was-I offered them sort of a perspective on what was going on with them, and tried to help as far as not just academically, but like the way they thought of themselves. And because I empathized a lot with thinking poorly of yourself and it's something I see a lot and I didn't want them to feel that way 'cause they shouldn't-they should feel and be positive about who they are in a way that they can succeed. It's definitely made me more empathetic now.
Eddie, in contemplating what it has been like living with his disability, similarly remarked, "Sometimes I think of it almost as a blessing in some ways. It has given me a lot of perspective and opened my eyes to a lot of different things." Gustav shared that he came to enjoy, to some extent, his sense of being direct with people, as he felt his autism made it difficult for him to be anything less than honest. He shared: One thing that's, I guess, sort of a tick that I have is that I'm more or less incapable of sugar coating what I think. Like, I will just outright say exactly what is on my mind if I-if I like feel I'm not going to be attacked for it. And so actually this has resulted in friends of mine saying that I have told them the sweetest things they've heard in their entire lives when honestly, I was just stating my honest opinion of them, so…there are benefits, there are drawbacks. It's sort of complicated especially since you wouldn't really expect the benefits to be that strong but they're definitely there. More so, recently I've noticed.
Isaac, who like Gustav had a diagnosis of obsessive-compulsive disorder (OCD), at times, felt that his disability improved his relationships with his friends. He shared: There are some positive sides to it, just like, I kind of think about the same thing over and over and over again. So, if somebody, for example, tells me that their favorite candy is a Hershey's bar or something like that, I'll think about that over and over and over and over again and when it's their birthday, I'll get them a Hershey's bar and they're like, "Oh, you remembered! That's very nice!" (laughs) But, I just, I constantly think about it, so…there are some positive social aspects of having a disability such as this.
In addition to recognizing how their disability identities might have benefitted them socially, Gustav and Isaac also had the experience of having their disabilities benefit them academically. For Gustav, his disability identity helped in terms of his executive functioning abilities. He explained: Then with OCD comes of course perfectionism, but I mean that's both a blessing and a curse. Honestly though, it's a blessing more often than you would expect. Like, it definitely helped me with keeping things orderly, doing things in a timely fashion, that sort of thing. It's irritating that if I-if I step out of line even slightly it results in me sort of flipping out about something that probably was out of my control, but it can actually be beneficial at times.
For Isaac, his disability helped him with his challenging computer science major. He shared: I feel like…when I'm trying to solve an issue with computer science-when I'm programming something-I definitely think about it over and over again and try to think about a lot of different ways that I can fix something. So, in that kind of regard, I think of it in a positive sense where my disability sometimes could help me with that aspect of my identity.

Preserving Masculinity
As participants felt they lost aspects of their masculinity, particularly their independence, toughness, and success, as a result of their disabilities, they engaged in ways of thinking and behavior that served to preserve their valued masculine identities. The "preserving masculinity" theme of the grounded theory illuminates the different ways in which participants responded to their experiences of loss. The varied means through which participants engaged in efforts of preservation are highlighted throughout the following discussion.

Preservation Through Distancing
Participants' disability identities, unlike their masculine identities, were very salient in their daily lives. Despite this salience, however, many participants did not present their disabilities as central to their sense of self. Instead, they pushed these identities away from their important identities, particularly their masculinity, and distanced themselves from it. For instance, participants like Joe accepted his disability identity but did not present it as a focal point of his identity. He shared: I am autistic and I understand that, but I think those positive aspects of my life define who I am, not autism. So, I've come so, so far and so, so close to these big time accomplishments, so I think my passion and my work ethic and my determination really defines who I am and I don't really think…I mean, autism makes me who I am but it doesn't really define who I am, I think.
Instead, Joe preferred that others viewed him through a lens of grit and toughness.
Other participants minimized their disability identities by avoiding the use of the term 'disability' to referring to that identity. For instance, Ben remarked, "I try not to see my stutter as a disability." Though Ben presented a tempered view of his disability identity he nonetheless positioned it at a distance from his masculine identity. He said: It's just part of who I am and I can't really change it so I see it as just another, for lack of better words, I would say it's like a piece of flair…I mean, I usually, I don't look on it negatively anymore. I mean, I sometimes do in, you know, presentations and stuff. I'm just like dammit, like I should've, you know, I should've controlled it more and everything. But positively, like when I make it through certain things, say if I make it through a presentation or if I meet a bunch of new people and I don't really stutter, I look at it positively like, "Oh look, I've-I can finally-I can control it" and, you know, and kind of...I don't know, I haven't really thought of having a stutter as like a purely positive thing, but I don't really see it as negative though.
Ben viewed his stutter as an identity status that was not entirely negative but prided himself on his ability to overcome the negative impact it occasionally had on him, particularly in social settings. Similarly, Peter did not want to view his ADHD as a disability and preferred to view the attributes of it as just part of human variation. He said: And again to this day after the diagnosis I don't identify that much with it…yeah, um I don't necessarily think that the diagnosis was not credible. And I'm not saying I don't have ADHD. I just don't-I try not to internalize I guess the word would be, I don't internalize the meaning of having ADHD. Because I think a lot of behaviors associated with ADHD most people exhibit just on a different level. I think they're very common.
Other participants attempted to place their disability identities outside their conscious frame of reference. Both David and Jared spoke about not wanting to "believe" they had disabilities. For instance, David said, "I'm just stubborn and I try to believe that I don't actually have [a disability]." Jared, who experienced a profound sense of loss in terms of his masculinity, which he attributed directly to his disability, shared: It's almost like I had to fool myself into thinking something that I didn't really believe…that, you know, I wasn't this disabled person, like I didn't have these problems, that I could work through it and get back to where I was.
Not all denial and distancing came directly from the participants themselves. Both Curtis and Wade, for instance, described how members of their family also engaged in distancing and denial of the participants' disability identities. For instance, Curtis shared, "In terms of my African identity, like sometimes my parents forget I have a learning disability and I know for a fact my brother doesn't even acknowledge it." Wade also described how his parents chose not to acknowledge his disability identity.
After being hospitalized and diagnosed with his disability in college, Wade described the following response from his family: It was an interesting thing, my family showing up at the hospital. They didn't really know how to react and they-we still don't talk about it. My father was especially interesting. He just sort of tried to ignore where we were and tried to, I don't know, make me feel at home, I think.
Wade recalled another instance in which his parents did not want to acknowledge that he had a disability. After his hospitalization, Wade sought an evaluation from an outside provider. He recalled: That was an interesting interaction with my parents, again, because the reason [the doctor] didn't really confirm that diagnosis was he wanted my parents to fill out some questionnaires about my childhood and me growing up and they didn't want to do that…they sort of dodged it and I think they had a lot of other things-they made it seem that they had a lot of other things going on that were very important and I think I kind of let it go. I didn't really stress how important it was to me to really to figure out what was going on. But I think they didn't wanna' re-live admitting that I had problems, they didn't-they had that sort of blindness that all parents have, where, you know, you don't-their kids are perfect, you know, there's not-they don't wanna' admit that there's an issue that they might've possibly, you know, even had a hand in.
Wade suggested that perhaps his parents felt guilty about any role, even genetic, they might have played in their son having a disability, causing them to deny its presence in Wade's life.

Keeping the Invisible, Invisible
Another way participants engaged in preserving their masculinity was by hiding their disability identity from others. In keeping their invisible disability hidden, participants maintained a sense of control over their image they projected to the world, helping them avoid further losses, and minimized feelings and experiences of stigmatization.
Maintaining control. Unlike visible disabilities, invisible disabilities afforded participants some level of control over keeping these identities hidden. Though Joe acknowledged that his identity as an individual with autism was a significant identity in his life, he did not want to be defined by it. The hidden nature of his invisible disability allowed him more flexibility in making that decision. He shared: I don't really…some of my family members know but I don't really share it with a lot of people because I just don't want them to identify me as autistic. I want them to identify me as who I am because that doesn't affect the person I am.
Thomas discussed how he felt embarrassed at times when his disability identity became visible to others, which was why he chose to keep it as hidden as possible. He shared: I mean, I guess it could relate to the masculinity part that we talked about earlier is that I don't tell people. Occasionally people will be like, "You spelled this wrong" and it's small stuff like that and you're just like…I feel it inside but I ignore it and don't let them know.
Thomas' desire to "ignore it" was also shared by Donald who expressed, "I was definitely hiding it. I wanted it to be invisible. I practiced that as much as possible." Many participants expressed a sense of comfort in feeling they had control over whether or not they made their disability visible to others. Referring to the invisible nature of his disability Devon said, "It's frustrating at times, but at the same time I like that no one's going to notice if I don't show it." Elliot seemed to share Devon's sense of relief regarding the hidden nature of his disability when he recalled: I was diagnosed with Scoliosis. And it was rough at first. It wasn't something that anybody could see or tell and I tried to do my best to present myself without the disability and so nobody really knew about it.
Julian and Jeremy, like Devon and Elliot, seemed comforted by the invisible nature of their disability identities as it allowed them control over disclosure. Julian shared: I mean for the most part, it's kept pretty private. So, no one will really know unless I tell them and that's mostly what I like about it. It's not something that's visible or something that people can see…I mean, some of my friends I tell them because I don't really mind them knowing. But apart from that I don't really bring it up.
In a follow-up conversation with Julian, he elaborated on his reasoning for choosing not to disclose his disability identity to many people. He said, "I would say I don't really bring it up to others other than my friends because it's an invisible disability. If I wasn't to tell them, no one would know, so I keep it to myself." Julian had even shared that he was initially hesitant about participating in this study because in doing so, he would be revealing his identity to another person: the researcher. He said, "I feel as though a little part of me didn't want to come because it's like I didn't want to show that I had a disability or like let it be known." With the exception of disclosing his disability to receive help, Jeremy typically kept his disability identity private as well.
He shared: To me, it was something I kept to myself and I knew I had it and I felt like I didn't need to share it with anyone else. It's not a disability where it would hinder my work performance or hinder my ability to do something safely or affect anyone else. And I didn't feel like it was something I needed to disclose with anyone.
Curtis, who had disclosed his disability identity with his fraternity brothers, shared: Mostly, I didn't really talk about it to people. Honestly, most people who I see every day have no idea that I have one. Pretty much only people who know are the people in my fraternity because I told them during one of my speeches while I was pledging.
Avoiding loss. In addition to the desire to feel 'normal' and maintain a sense of control over their images, some participants hid their disability identities to avoid experiencing a loss, whether actual or perceived. Joe, despite having some positive experiences in the past, worried about the potential ramifications of revealing his disability identity to his peers. He shared: I don't really share it with a lot of my friends. I don't really tell them that. I told a couple here that I have autism or I have a learning disability. I didn't really specify. I said, you know, I have some setbacks that I have to deal with and they said nothing would change. That it wouldn't impact the way they viewed me, so I appreciate that. But, I mean, I don't trust certain people to be able to understand that because I told some people in high school and that damaged the way…their perceptions of me. That damaged our friendships. Some of my friendships. So, I think keeping it to myself would be beneficial to me.
Joe also expressed concern whether or not disclosing to future employers might lead to a loss of some kind related to his career. He recognized that while his disability was mostly invisible, it had the potential to manifest itself in ways that might present future challenges. He shared: So, in my mind, if I have some discrepancies now, how will I be able to get rid of them when I'm in the professional world? Or how will I be able to hide them to an extent? I wouldn't want them to see, you know, that I'm slow or I'm lagging behind or I'm forgetful or certain things like that. I wouldn't want them to see that, so I'd have to try to hide it to an extent.
Avoiding stigmatization. Participants' awareness of the stigma that exists in society regarding disabilities factored into their decisions regarding whether or not to keep their disability identities private. This was true for Curtis who said: I guess the reason why I didn't tell people I had a learning disability was because I felt…I was more scared of how they would react mainly because you always feel like people who have visible disabilities are kind of almost cast out, almost like rejected, so I thought if it came to be public knowledge about my learning disability then I would be cast out too.
Participants, particularly with mental health disabilities, worried about sharing their disability identities with others for fear of being stigmatized. Gustav shared: It could be like fear of judgment about that because as I said, there's a lot of stigma about disabilities. Like disabilities in general, but especially mental disabilities. And like I-it's like I don't really see why I should risk getting stigmatized before the person knows anything else about me.
Gustav felt that many people still held false and inaccurate ideas about mental health disabilities. In describing what he meant by this, he explained: I mean, obviously, disabilities as a whole have a sort of social stigma. But, like, especially like mental disabilities do because people treat them like they aren't real disabilities, like they're something that just…just thinking a certain way can get you past, like depression can be cured with just happy thoughts. So, as a result, there's a pretty big stigma there and I feel like if these disabilities weren't invisible I would probably be more stigmatized.
Gustav, like other participants, embraced the invisible nature of his disability because it reduced the likelihood of being stigmatized by others. Keith, who also identified as having a mental health disability, expressed strong feelings regarding his desire to avoid being stigmatized. Keith, having experienced stigma related to his career in the armed services, felt that disclosing his disability to others would potentially be a worse experience. He shared: Well, because people don't know how to talk about it yet. It's coming along slowly. I mean, every time something has to do with mental health the ignorance is ridiculous…I get enough crap questions when it comes to just veteran stuff so it's like…I consider it like levels. So, it'll be like, here's something that a lot of people talk about and I get a crap load of stupid questions that annoy me and then disability stuff a little bit higher than that, so I don't really touch upon that at all…imagine if something that's less intense such as just participating in the army gets you…people ask you things…you know, they annoy you, you don't even want to hear them, right? So, if something that's less intense gets that response than something that I would consider more intense, such as having a disability or something, I don't even want to hear the questions that people will have for that! If I'm just like, "Oh yeah, I take medication" they'll be like, "For what? You have mental issues or something?" And I'm like, great. Now, I have to have a conversation with somebody who isn't developed enough in their head to come across the fact that not every person that has something they have to medicate or whatever is like off their rocker. It's not really about that. It's really just about people being uncomfortable or having to manage certain situations.
As a result of negative interactions he had with people when he disclosed his military identity, Keith remained careful about whom he shared his disability identity with. He described: Unless I know that they can handle it, which is silly -"handle it" -there's nothing to "handle," but if there's something that has to be discussed, if I think they're capable of at least being mature about it then yeah, situation permitting.
For many of the same reasons, Isaac was careful not to share his disability identity with just anyone. Trust played an important role in deciding whom he shared his disability identity with. Isaac felt that this sense of trust was more easily facilitated with individuals who shared a similar disability identity to him. He explained: Fortunately, I have a very supportive group of friends that struggle with various mental disabilities. They have shared their experiences with me because they trust that I will understand them and support them. I also share the details of my disability to people that I feel will handle the information in the same way. Many people, including some of the people that I felt comfortable sharing my story with, do not understand my supposedly "unique" case of OCD. While people are used to OCD being a disability that causes one to be very clean and to check things very often, many do not know about people who experience OCD like me. I do not check things very often and I am by no means a tidy person, but I obsess over a lot of things, including my speech, the way I walk, the volume of my breathing, and other things that I need to accomplish such as schoolwork or other responsibilities. This leads to a lot of people not being able to understand the information when I communicate to them, which is often embarrassing since communicating is one of the things I obsess about the most. Because of this, I have trouble with opening up about my condition.

"A Testament To Our Strength"
In addition to preserving masculinity through distancing, minimizing, and hiding their disability identities, participants also preserved their masculinity through their help-seeking behaviors, or lack thereof. At the time of this study, half of the participants had not registered with disability services or were registered but chose not to receive academic accommodations. In exploring with participants their reasoning for not choosing to register or receive accommodations, many of them expressed a desire to preserve their sense of independence and toughness -attributes important to their masculinity. Isaac, for instance, described how by not receiving accommodations, he was forced to learn how to cope with his disability on his own. He shared: I don't like the feeling of not being able to accomplish something because of my diagnosis, which is why I am against special accommodations. However, because of this, I have to deal with these situations very often. Dealing with these situations allows me to get better at managing my stress, so I tend to look at the positive side of this dilemma. This is also a reason why I do not seek special accommodations.
David, who registered with disability services but did not request accommodations, echoed Isaac's desire to want to deal with his disability independently. He remarked: I'm just stubborn. I don't tend to use a lot of the accommodations they tell me that I should. Like having someone take notes for you, like I think I can do that myself. And they tell me that I don't process it as well and which-I don't know if I believe that, so I feel like I can do a lot of what they tell me my disability affects on my own maybe.
Similarly, Donald reflecting back to his college years shared: I did not seek any help services in college. In retrospect, I wish I had. Back then, I believe, I was still on my I-don't-need-any-help upswing. I had a fulltime job throughout most of college, so I imagine I foolishly believed I needed no help then.
As participants felt they could manage their disabilities, they were able to remain independent and not feel they needed additional assistance from disability services. To this point Ben stated, "I feel like even if the process was different, I don't think I would-I still wouldn't go through with it because as I said before, I can work through it, I can improve on it." Peter, who was registered with disability services but had not yet received academic accommodations, recalled: That idea of being diagnosed kind of spawned this increased sense of, or decreased desire to ask for help, because of having a diagnosis or a handicap, so to speak, would elicit a desire for greater help and I didn't want to be put in this category of needing more help.
In addition to Peter's association between having a disability and needing help, he also shared that he gained a significant sense of pride from doing things on his own, which he admitted was also connected to his sense of masculinity. He said: I knew that I was struggling with asking for help because I had already acknowledged that it's mostly a pride thing, but I had never applied it to masculinity…I began thinking about: I wonder if this notion of masculinity and the view of having pride and not needing help from others as a dominant male…if there could be a relationship here between that and not wanting to ask for help for my accommodations or for my disability.
Peter did, however, acknowledge that at times he remained unsure as to whether or not he was making the right decision by not receiving accommodations. He shared: So, like before I was talking about not wanting to ask for help. I felt that I've come this far doing as well as I have, which I am okay with, and this has been a back and forth for me for a long time. It's like, where's the line between holding my ground and trying to make myself stronger so that I can do things more independently without having to depend on medication or other people.
Despite contemplating how or if accommodations would benefit him, Peter remained resolute in his commitment to his independence. When asked if he would consider seeking accommodations in the future, he said: No. I mean, from what I know of the process it's very convenient, very helpful, everyone there in disability services is trained to be accommodating. So, it's not the people or the system itself I think. Personally, for me, it's all personal.
Isaac, who had been to the university's counseling center but had not decided to register with disability services, shared: I guess…because…at the, I don't know…now that we're talking about this maybe it is a masculinity thing where it's like, I would have to register for disability-whereas it's just something that I kind of know and that nobody else knows, but like if I have to register for it then I guess that's a problemthat might be a pride thing or that might be attributed to, "Oh, I don't need that, you know, because I can deal with my problems myself," you know? And I guess that is a masculinity-kind of a thing. Or it could be contributed to like the masculine identity.
Later during the interview he shared, "I think that would be the biggest connection to masculinity that my disability has, you know, is kind of not seeking help or anything like that because I-I-you could contribute that to a masculine thing." Participants also expressed a desire to preserve their sense of strength and project an image of toughness. Thomas, for instance, in describing why he chose not to receive accommodations from disability services explained, "Because I want to fight through it and be like everyone else and not have to sit there and belittle myself and beat myself over small things, so I'll push over it and constantly strive to look better." Peter echoed Thomas' desire to persevere through challenges associated with his disability identity when he said: I think most people, including myself, most people would appreciate being able to struggle through something in order to be able to say they struggled through it and accomplished it as opposed to bragging about getting help and accomplishing it, you know? I guess it's more pride that comes from struggling than comes with asking for help.
For Peter, the act of struggling provided him with a sense of pride that he tied to his masculinity. He even provided the following perspective on why some men, like Isaac, might be more likely to seek counseling services rather than disability services. He hypothesized: I think with that, comparing men having to go in and ask for help compared to men coming in to talk about it, I think men would be more comfortable coming just to talk about it because they have the opportunity…instead of asking for help they have the opportunity in a way to express the effort that they have made in keeping something secret. Or, they're able to find some appreciation in expressing that yes, I have been battling with this and yes, I have overcome this thing, but I still do struggle…it's like we have a testament to our strength, so to speak, by not having asked for help thus far.
Being strong and not asking for help, despite potentially struggling, was important to Peter because it allowed him to preserve his appearance and sense of toughness. Ben echoed this sentiment when he said, "I would rather see it as an obstacle I have to overcome or like, you know, be able to overcome if I need to." For some participants, the desire to preserve their sense of toughness outweighed any negative ramifications of not seeking help. Dayton, who received academic accommodations for only one semester, said: [The accommodations] helped me out and it did help, but then like I started to fall off again, not really asking for help, like I think it kind of has like a masculinity thing. I just don't really want to ask for help, even if I need it.

Help-Seeking To Preserve Success
While many participants seemed to want to preserve their independence and toughness by not seeking assistance with disability services, other participants placed a greater value on preserving their academic success. This led many of them to register with disability services and receive academic accommodations.
Accommodations as essential for academic success. Many participants sought help from disability services because their desire to protect their success, via their academics, prevailed over their desire to preserve their independence or toughness. One of these participants was Jeremy who highly valued success and felt strongly that college was a prime setting in which to develop self-advocacy skills necessary for future success. He said: And learning how to-part of school is learning how to do that. How to be successful in school and how to graduate, you know, the skills you learned whether or not it's how to ask someone for help…you're going to be doing that the rest of your life, so learning that now and really mastering it is important.
In recalling why he did not hesitate to seek accommodations from disability services Jeremy expressed, "I really wanted that advantage and really wanted to give myself all the tools that I could to succeed. So, I inquired about disability services and then went through a whole bunch of long processes to get tested." While Jeremy seemed less influenced by other traditionally masculine ideas, he did endorse the traditional idea of being successful at any cost. To this point, he shared: It's just something that I decided one day that I wanted all the help I can get and I'm taking advantage of it. And not everyone has the same opportunities. Not everyone can afford to go get tested or not everyone has the transportation or the support to do it, but…that sucks for them. Sorry, it's not a fair world. I'm going to do everything I can to get ahead.
Similarly, Joe recalled: I think that was a very…that was a decision I had to make no matter what. I mean, I do have a disability, and I do need accommodations, and I do need extra assistance in some areas, so I think that was a no-brainer type of decision.
When asked if he felt that the accommodations were crucial to his academic success, Joe replied, "Yes. I think that was-just I had to make sure I had to do that. To make that decision to register as soon as possible." Donald used similar language in describing his decision to receive accommodations as a graduate student. He shared: When I first started, I actually took a leave of absence and sat in on some undergrad-level courses to try to get up to speed, realized how fast paced those were, and there was no way that I was able to keep up just with note-taking, for example. I knew I wouldn't maintain and it became clear to me very quickly that I needed some help and it was kind of a no-brainer really-(laughs) no pun intended-that I wasn't going to make it alone.
Other participants viewed accommodations as a form of insurance to protect against the potential negative impact their disabilities could have on their academics. For instance, Eddie recalled, "I met with [name of DSS coordinator] and we sat down, we talked about what realistic situations could happen that I would need to be covered for, kind of. It's almost like insurance." Though he had yet to use any of the accommodations provided to him, Eddie, who had Crohn's Disease, further shared: I have not benefited from any of the accommodations I've scheduled for, like I've never actually needed to take advantage of them. I'm on Humira now and I've been relatively healthy throughout my college career. So, I'd asked for extra time on exams in case during a flare I had to go to the bathroom a lot and I was missing time and permission to leave class whenever needed, which most professors are okay with. And I think I got one more but I can't remember. But the accommodations I asked for are kind of like just-just in case it's an emergency kind of thing or just, you know…and so it's more just a backup plan than anything.
Viewing accommodations as a means of being prepared was also articulated by Devon, who said: And so that was really my thought process doing that was just I wanted to make sure that in case of any issues…I just wanted to make sure I have like a backup plan and a system in place because that's how I do best, is like having a-I don't know, I always have a plan and stuff, so I thought this would be the best decision.
Both Nelson and Zachary, who received accommodations in high school, also wanted to have accommodations in place to ensure they would be protected in the event that they needed them. For instance, Zachary shared: I had a 504 Plan for the entire span of high school and I just wanted to make sure that I had something like that in college because I was hoping for some kind of-even if it was very small-a safety net so that if I miss classes I won't just be dropped from the class like any other student because, most likely, I'm not missing it to skip class or because I stayed up too late. It's most likely that I'm missing it because I'm sick.
In addition to wanting to make sure he had accommodations in place at the beginning of each semester, Zachary also used the accommodations to legitimize his disability identity. He worried that without the accommodations his professors might make erroneous assumptions about his behavior, such as skipping class when he needed to be absent because of a flare-up. Wade, who also worried about his professors' misperceptions of his behavior, used accommodations to make his invisible disability visible to his professors. He shared: A lot of it, I didn't use much of that. Mostly, it was just to open the lines of communication with the professor to let him know that I was-I wasn't being lazy. So, that way it's sort of, it was a thing where I could come to the semester-the professor-at the beginning of the semester and sort of be like, "This is what's going on, if I'm acting weird or I'm falling behind on work or if I just up and leave during lecture, this is why. I'm not trying to be disrespectful or lazy or anything like that." And just being able to be open with my professors helped me out a lot 'cause I had-I have a lot of trouble with communicating.
Similarly, Eddie used his accommodations to pre-emptively explain his behavior, such as absences, to his professors. He said, "So teachers can be aware that this is, you know, real and it's recognized." While some participants received help from disability services regardless of how severe they perceived the effect of their disability was on their academics, others needed to reach a point of more significant impact in order to become open to seeking help from disability services.
Experiencing "a tipping point." Not all participants saw value in academic accommodations until their academics became significantly impacted by their disabilities. For Keith, this point came after his first year. He recalled: Well, it was affecting my work. I was constantly in a fog. C-o-n-s-t-a-n-t-l-y in a fog. I was always tired, always irritated, I couldn't focus, and I was constantly stressing out and I didn't like the way I felt. It was a tipping point. I remember it was when I was at a table at the library with people studying for an exam…I forget which exam…pretty sure it was late freshman or early sophomore year…probably early sophomore year because freshman year was a cake-walk, and I was freaking out so heavily and I couldn't think, like it was just a haze. And it was pretty much at that point there where I knew I had to talk to somebody, had to figure something out.
Jeremy, who identified as having ADHD and a sleep disorder, shared a similar experience of how his disabilities impacted his academics, compelling him to seek help from both medical and disability service professionals. He said: Sophomore year I was tired all the time. I was-I couldn't stay awake in any of my classes no matter how many-I was getting at least eight and a half hours of sleep, I was keeping a sleep journal. I was just tired all the time and I kept getting sick because I was tired and I was having a lot of trouble focusing on schoolwork and I just didn't care about anything.
Like both Keith and Jeremy, Wade had not initially registered with disability services until he recognized the significant impact his disability was having on his academic performance. He described "hit[ting] a breaking point" in college. He recalled: So, when I first came to school I was just really overwhelmed socially and it started to really affect my schoolwork and from there I just started this sort of positive feedback loop of stress and anxiety. I stopped sleeping at night and I ended up having just a complete breakdown in the beginning of my sophomore year. I was hospitalized for a couple weeks and that's when I sort of realized a lot of the things that I dealt with through high school, a lot of the things I felt through high school and middle school weren't typical and that I was kind of just muddling through and trying to make things work in a way that was just overly difficult for no good reason.
Wade admitted that he was initially "bull-headed" about not going to get accommodations after returning from his hospitalization. He shared: I think that might also feed into the whole idea of admitting when you're hurt which is an important thing for me and just being able to back off when you need to take a second…and I just wasn't willing to do that and it cost me. And then, I just tried to push forward through into the next semester and take another full course load and I did awful. It just wasn't very good at all.
Wade's acknowledgment of being stubborn and not wanting to admit he needed help was also shared by Jared. In describing his path to disability services, he recalled: I didn't, initially. So, I didn't register until my third year here 'cause I didn't feel like I needed it-and I didn't. My first two years were probably two of the best years I had physically and mentally…and my third year is when I started to suffer the consequences of being as active as you have to be to kind of keep up with all of that. It came back. The pain came back in a bad way. It spiked, my meds had to go up…the pain is exhausting and then the meds just don't help anything aside from the pain. But it makes it hard even just to wake up in the morning. It's tricky. So, I finally kind of just gave in. I said, you know, let's see what they'll do for me.
Asking for help, for many of these participants, was not something they had wanted to do initially. Instead, it was something they felt they had to do. This was evident in the way Jared said he "gave in" describing how he felt about going to disability services; a very different way of perceiving accommodations from participants who viewed them as forms of insurance and protection. For other participants, the impact of their disabilities on their academic performance did not have to be severe in order to motivate them to get assistance. Dayton, for instance, went to disability services for accommodations for courses he felt his disability disproportionately affected. He Likewise, Ben said, "If I had a disability, like a severe one, I would definitely go." This was not the case for Thomas. During a discussion with him about whether or not there were any circumstances under which he would seek accommodations from disability services, he shared: Probably not. Because they all lead to the same like end result…presenting my disability to someone. And stating that I need these things in order to advance my education kind of made me feel like I'm being treated differently. And I wanted to be treated exactly the same as everyone else.
Thomas appeared steadfast in his desire to remain independent and not receive academic accommodations. Similarly, Isaac articulated that there were no circumstances under which he would seek accommodations from disability services.
He said: I'm pretty static in my position about it. I don't know, I can't imagine a lot of things would make me want to get disability services. Not that I think they're bad or anything like that, I just, personally, I wouldn't…or, I don't think I would.
While not all participants embraced the idea of registering with disability services and receiving accommodations, almost all of them utilized non-disability service related help, mainly in terms of academic support.
Seeking non-disability service help. While only half of the participants sought assistance from disability services, almost all of them accessed help services related to their academics, such as the university's writing center and academic skills and tutoring center. Many of them saw these services as directly related to their academics and seemed less hesitant to seek this support. Ben, who expressed no desire to register or receive accommodations with disability services, shared the following about tutoring: I went to tutoring once for my-for Calc II and Chem 112. That was in the same semester, so that kind of sucked...I wanted to do, you know, good on [the third exam] so I made sure I went to tutoring and stuff 'cause that was a really tough semester. So, I actually had a lot of presentations that, you know, semester so I was also really kind of like just stressed out.
Ben viewed going for tutoring help as fundamentally different than going to disability services for help, mainly because he associated the tutoring service with his academics. He shared, "The [academic center], I feel like that was, for me, more reinforcement to make sure that like what I was already studying was, you know-I'm like on track." In comparing tutoring to disability services he said, "I wasn't being graded on my stutter." Anthony, who had not registered with disability services, shared the following insight regarding the on-campus services he accessed. He said, "When I feel like I need to use it I will. The writing center is definitely like a huge tool for people to use…so, I'm really open to that and the [academic center]." Anthony, however, did not feel the same way about the counseling center. He shared: I think maybe I'd be a little more hesitant to go to counseling than I would to go to the [academic center] 'cause counseling you gotta' talk about your feelings and stuff whereas the other stuff is kind of just tutoring.
For Anthony, because he viewed the academic center as strictly related to academics, he found it easier to go there for help than to the counseling center or disability services. Peter, like Anthony, did not receive academic accommodations. Peter, who spoke about his desire to persevere through his difficulties on his own, expressed a different sentiment toward help when he felt it was directly related to his academics.
He said: Well, I don't have confi-I'm not very confident in my math skills and I was taking pre-calc and calculus, so I was like, alright, I can't. There are only two or three math requirements for my major and you have to get a C or better, so I was like there's too much at stake to risk not asking for help. So, yeah, it's just like understanding situations or appreciating the context. David, who also accessed the academic center for tutoring added that he felt more comfortable going to tutoring than disability services because the former service was "offered to everyone." Both Keith and Julian described using the academic center as well as meetings with their professors as types of help they accessed at college. Keith recalled: I've been to the [academic center]…I was just trying to be a good student and I always went to office hours, so I could have a friendship with my professor, so I could have that influence my grades if anything ever went south.
Interestingly, Keith used meetings with his professors as a form of insurance and protection, similar to how some participants used their academic accommodations.
Curtis, who admitted to not using the academic center recently, recalled using it as a first year. He shared, "I did a lot my freshmen year, but now I'm taking upper level classes and there's not much help for that besides going to professors' offices." When asked if he would go back to the academic center if he recognized he needed that type of help, he said he would. Similarly, Julian preferred going to his professors for help but would occasionally go to the academic center when he felt it was necessary. In talking about the academic center he shared, "Usually, if I'm really stuck and the teacher's office hours don't fit my schedule, that's when I usually go there, but usually I just try to go to my teachers and talk to them." Joe, in offering insight into why he accessed his professors' office hours for help, said "I think because I wanted to stay on top of all of my work…I tried to the best of my ability to meet with professors as much as possible every week to stay on top of my work." Jeremy, who was registered and with disability service and received accommodations, also accessed his professors' office hours. For him, getting help when he needed it was directly connected to his ability to be successful as a student. He exclaimed: I mean, if you're having trouble in class and you're not going to office hours then you're just shooting yourself in the foot. If you don't understand something and you can't learn on your own, you need to learn it or you're not going to be able to pass it.
Other participants, like Thomas, remained resolute in their commitment to being independent. Thomas, who said that he had no intentions of registering with disability services or receiving accommodations, shared a similar reason for not accessing other on-campus services. He said, "Because like I said, I want to be able to do it on my own."

Cultivating Masculinity
The fourth theme of the grounded theory was organized to reflect the ways in which participants went beyond preserving their masculinity to enhancing and developing it. This was achieved through three primary means. The first was through participating in activities that were closely linked to the traditional masculine attributes participants embraced. The second was through their involvement in groups and organizations that facilitated a sense of social connectedness and belonging among their male peers. Lastly, the third was through their involvement in activities or organizations that allowed them to further distance themselves from their disability identities.

Doing "Guy Things"
Many participants found ways to develop their masculine identity through their participation in activities that were closely linked to their masculinity. Anthony, for instance, expressed his general enjoyment in participating in "stereotypical guy stuff." He shared: I mean, I definitely like being a man…I enjoy playing the sports I play and being in the fraternity that I'm in and I just…I like being a man and masculine. I can't imagine being a female. I don't think there's a problem with that, but...I don't know, I enjoy being a man and being able to do guy things with my friends and like, stereotypical guy stuff, so I enjoy that.
Not all involvement in traditional masculine activities occurred with as much conscious effort as it did with Anthony. For instance, Mario shared: Yeah, I definitely would say that because I don't really realize it but I guess the things you say I do are more masculine things. I wouldn't really say that but other people would. 'Cause you're a football player they-that's something somebody would say was masculine or if you're in a group of all males, that's pure masculinity. So, I think mostly everything I do ties into it but that's not something I only focus on. But I guess it just happens with the second nature I grew into with the things I kind of lean towards were probably more masculine things.
As Mario described, athletics was an activity that many participants engaged in that factored heavily into their masculinity. Dayton, whose father played a substantial role in the development of his masculinity, recalled how he spent a lot of time with his father involved in traditionally masculine sports. He said, "I was a competitive shotgun shooter before college and I would go with [my father], and it would just be all a bunch of men and like one or two other kids and that's just how it was." In college, Dayton continued his involvement in athletics on the sailing team, which he described as being "pretty important" to him. Ben also described the significant role that sports played in his life. He shared: Well, I would say that athletics are kind of pretty…well they were pretty big for me. Like now I just play for fun, but I played baseball for a long time and I stopped playing recently. But I would say definitely like I would say sports are very, very important to me.
When asked if his involvement on the baseball team was at all related to his sense of masculinity, Ben said that through sports, he garnered a sense of what it meant to be a leader among other men. In describing the power hierarchy on his baseball team he said, "…when you're 13 you don't really have much say or if you are the new kid, but once you turn 15 and you're on a team you're pretty much king like, do what-like you tell people what to do." Baseball, for Ben, provided him with the opportunity to hold a position of power over other men. He recalled: Everyone wanted to be the one on the team that like, you know, was I guess I'll use the term 'alpha' I guess and, you know, everyone wants to be that person and it just...I kind of just thought about it a lot and it just, it kind of relates to a lot of things nowadays. Like I feel like in your friend group you always have that one person who always goes that extra mile-like everyone, you know that one person that everyone really likes and stuff and I almost see that as like the new leader… Leadership -a quality that some participants spoke about when describing what it meant to be masculine -was an attribute that participants cultivated through athletics.
David, for instance, who had always enjoyed playing and watching sports, became enamored with coaching sports as well. He shared, "I coach basketball for little kids and that's always been something that has been really good. That's another like, that's like leading a group of kids that look up to you. That's something else that's important to me." It seemed that his involvement in sports and coaching sports were related to his sense of masculinity. He remarked: I mean setting a good example for them and like giving them-people look up to you. Just knowing that they like you is like something cool. I'm a camp counselor too so I think it's cool that you can have an impact on people.
For David, his involvement in playing and coaching sports related to his masculinity in the sense that he was able to cultivate his leadership skills. In addition to cultivating masculinity through positions of leadership, there was also the sense that through sports, participants could enhance their masculinity by enhancing the appearance of their physical body to meet traditional masculine ideals. This was the case for Nelson, who used to be a swimmer. In talking about how swimming helped Nelson cultivate his masculine identity, he recalled: In the world of athletics as well, like I was a butterflier in high school and so it was, you know, those guys tend to be a little bit bigger and broader in the shoulders type of deal and that definitely helped me feel a little bit more masculine....
For Nelson, swimming provided him with a means through which he could enhance his masculinity in the physical sense. As the butterfly stroke tends to build upper body muscles, Nelson was able to achieve a particular body type -broad shouldered -that he perceived as traditionally masculine. For Wade, his involvement in rock climbing helped him gain a sense of confidence. He shared: Being a climber, it helps me sort of phrase things in my head, like problems, things that need to be solved, or challenges, or-it makes me a lot more confident in facing challenges, having-knowing that I've done things that are hard before. One of those things where it's like, I've, you know, I've had worse….
Thomas also sought particular activities that would enable him to develop physically and help him achieve his future career aspirations of being a stuntman and a skydiving instructor. Thomas described how he was hoping to go through Boot Camp to help him better prepare for these careers. He shared: But now that I'm in my junior year, I've been thinking a lot about where I really want to be and how I'm going to get there...but film is where I want [to be]. So, I found a thing for being a stuntman where I love doing stunts and that kind of originated from playing video games: 'Assassins Creed' which involved a lot of Parkour and then I started doing it with friends and it was like, "This is fun" and saw the opportunities that came of it and so one day I was just on a website and it said, "Free tuition for college if you register" and I was like, "That would be great. That would help me even more." So, I took that opportunity and then slowly as I started talking to the recruiter it made more sense to discipline myself, you know, get into physical shape and be able to know chain of command in society as well as in authority positions. And then when I'm done, I will be able to have a chance to step into my actual career and have a job that I will like to do, which would be a skydiver instructor.
Thomas hoped that by going through Boot Camp, he would be able to develop a sense of toughness through discipline and physical rigor to help him succeed professionally.

Being in the "Boy's Club"
Another means through which participants cultivated their masculinity was through their involvement in male-dominated organizations and groups of male peers.
Many participants valued their friendships with other men. For Devon, his fraternity served as a place where traditional masculine culture was reinforced and where he found acceptance among other men. He shared: I happen to be in a fraternity so that reinforces masculinity a lot because it's a boys' club…well, I'm a recent transfer student…so one thing that was really important for me was getting involved in Greek Life here and because I was in a fraternity at my old school. So, I just-I joined the chapter here, but it was very, very important to me to get settled in that regard and like, I don't know, kind of feel like welcomed and respected and all of that. So that was insanely important to me.
In explaining what it meant to him to be a member of a fraternity, Devon described: Regarding the fraternity, just knowing that there's a group of like eighty, ninety guys that like me and are my friends and they welcomed me in this semester without even knowing me like, I don't know, that just makes me feel better about myself, and, I don't know, just helps me feel, I don't know, for lack of a better word, good.
Just as Devon valued being accepted by other men, so did Curtis. In talking about how he felt after he shared his disability identity with his fraternity brothers, he remarked: Well, when I was pledging my fraternity there was a lot of doubt about me because I generally try not to tell people about my secrets, my business, so they felt like they didn't really know me enough to accept me when I was pledging and the secret I was trying to stay away from was that I had a learning disability. So, during my fall presentation, before they started the vote on me if I should be a brother or not, I told them during my presentation…which went better than expected. I thought I was going to like cry or something but I didn't and they cheered me on. So, that was a good feeling 'cause that was really like the first time that I was accepted I felt…like publically accepted by a large group because I have a learning disability.
Gaining acceptance among male peers was also very important to Anthony. He shared: My fraternity is definitely really important to me, like I grew really close with all my fraternity friends this semester…we've all become like a really tight knit group of guys and they're definitely important to me. So, like every weekend that's who I'm gonna' see and every second of the day, usually…that's definitely important to me, you know, like being a good brother to my brothers is very important to me. I would never screw one of them over…bro code. It's a big deal.
Keith, who helped start his own fraternity on-campus exclaimed, "Honestly, my [fraternity] experience, I would say, was actually more fulfilling than my military experience." He went on to describe his fraternity as "unconventional" and made up of "a bunch of freaks." He said, "But we're happy, so it's interesting because I almost feel like we act as a group study for the counter point to the typical fraternitymasculinity because we're all men and we all exhibit leadership qualities." In recalling a recent competition between fraternities he described: Coincidentally, we don't perform well in the things that involve athleticism but everything else that involves technicality or effort we do win. So, you know, like the people we beat took almost every single athletic-based event. They dominated…people were flying in the air for like tug of war and things like that, but we hold our own for the singing competition. We fundraised SO much money that it dwarfed most things. We sent half of our fraternity to the head shave. Like the second highest sent 14 people, we sent 25. So, when it comes to the things we think are important in terms of, you know, things that actually matter, we excel at and then the typical masculinity type things, since we're talking about it, we don't do so well.
Though Keith described his fraternity as non-conforming in terms of traditional masculine norms, he and his fraternity brothers did embrace notions of leadership, competition, and success. Nelson also enjoyed this aspect of competition on his swim team. He described: Like it was me and five other guys and most of us could like bench press Buicks because that's how much we had to swim to keep up and compete with each other. And that gave me from a social aspect more of a kind of a big, strong, bulk-man kind of view.
Through their involvement in activities and organizations that reinforced and bolstered certain aspects of their masculinity and provided them with feelings of acceptance among other men, these activities also helped provide participants with ways to further distance themselves from their disability identities

Putting The "Mask On"
For some participants, the means through which they cultivated their masculinity also served to further distance themselves from their disability identities.
Nelson, who identified as having dyslexia, shared how his disability often left him feeling inadequate. To counter these feelings of inadequacy, Nelson tried to improve in other areas. He shared: I don't always do as great in classes as most people and like sometimes I definitely…I don't know how to describe it, I don't want to say like bulk myself up but like build myself up a little bit more just because I feel like I'm a little taken down by like grades and things like that.
In elaborating on what he meant by "build [him]self up," he explained: Like, it's actually more of like an internal thing, like I kind of build myself up like mentally like, "Okay you know, this may not have gone right for me but these things are going right for me" type of deal. Like I almost put on kind of a-I wanna' say like a shield; like kind of a mask on almost.
Nelson focused on ways to improve his skills in other areas that he had associated with his masculinity. He shared: I have actually always kind of prided myself on that in almost like a-you can call it a make up for, you know, where I don't do well in school is I try to build on the professional end and I try to like build up my communication skills, build up my interpersonal skills, and more in a professional environment.
Nelson also turned to athletics to strengthen his sense of masculinity. He expressed: The athlete still kicks inside me, definitely. That is also probably the place where I've felt as though, like I was compensating for the disability as well, and, you know, 'cause sometimes I felt a little lesser having that disability in the way that like you get a test back everyone seems to do well and you get like a 62 or something like that and it's like, after that, I gotta' go to swim practice and I kind of poured the rest of it into swim practice and I felt like if I could, you know, kind of show that I was a very strong swimmer and could compete and stuff like that, I could be like…it was personally for me a make up for the-a compensation for the disability.
Nelson exclaimed that he "100%, would use swimming as an escape" and described the pool as his "proving ground." David, who shared how his involvement in sports and athletics related to his masculinity, felt that his athletic identity provided him with an outlet through which he could temporarily separate himself from his disability. For Devon, his involvement in his fraternity served a similar function. He shared: [The fraternity] just kind of takes me away, like I don't have to…I just feel normal, which I usually do but it just kind of makes me feel more confident and like I'm not focusing on all of these stupid things that like, I don't know, my brain goes like a million miles an hour.
Similarly, Elliot described: I think a lot about my religion. I'm def-you know I went to church a lot when I was living in Connecticut and, you know, haven't really gone or done anything in school. So, I'd say I'm very religious. That's an identity I think about a lot. I'm also very passionate about music, so I'm a singer. I do a lot of that stuff, a cappella groups here, so that's another identity I enjoy. I don't think I really have had any experiences with my disability when it comes to my religion and music and I think that's something that makes me enjoy it because I haven't had to, you know, that disability hasn't played into it so I enjoy that kind of escape from it.
This type of escape, however, was not experienced by all participants. This was especially true for Jared who felt that since acquiring his disabilities, he had not yet found any means through which he could rebuild and strengthen his sense of masculinity.

DISCUSSION
The grounded theory that emerged from the data is organized into four central themes highlighting how participants embodied, lost, preserved, and cultivated their masculinity within the context of their disability identities and surrounding college milieu. The following discussion examines how these themes address the initial research questions, explores the relationship of the grounded theory to existing literature, and discusses the implications, strengths, limitations, and future directions of the study.

Relationship of Grounded Theory to Research Questions
This study was guided by three research questions. The first was how do college men with invisible disabilities understand and make meaning of their disability identities? The second was what influences do other social dimensions of identity have on how college men understand their disability identities. Lastly, the third was how college men with invisible disabilities experience the academic accommodations process in college. In terms of the first question, the theme "embodying masculinity" highlights how participants valued their masculinity by expressing traditional masculine traits, both by including them in their definitions of masculinity and by behaving in accordance with these ideas. This theme, coupled with the "losing masculinity" theme, represents participants' experiences of loss related to their disability identities. These themes help provide an understanding of why participants placed their disability identities at a distance from their valued masculine identities.
The third theme, "preserving masculinity," focuses on the value participants placed on their masculine identities to protect them from experiencing further losses. The fourth theme, "cultivating masculinity," sheds light on efforts participants made to further develop and strengthen their masculinity. These efforts served to reinforce traditional masculine ideas and help participants further distance themselves from their disability identities.
In terms of the second question, both the "cultivating masculinity" and "preserving masculinity" themes highlight the unique ways that other social identity dimensions influenced how participants conceptualized their disability identities.
Many of the important identities expressed by participants shared close relationships with their masculine identities, such as being athletes or fraternity brothers. The only role these identities appeared to play in how participants thought about their disability identities was by helping participants distance themselves from them. This was evident in the way some participants described these identities as providing an "escape" from their disability identities.
The "preserving masculinity" theme represents how participants distanced themselves from their disability identities in order to protect their masculinity. This theme also reflects the desire shared by many participants to keep their invisible disability hidden from others. For example, the way Julian spoke about his desire to keep his disability identity hidden from others was fundamentally different from how he spoke about his racial identity, which was very important to him and his sense of masculinity. While he spoke about keeping his disability identity "pretty private," he spoke about "embrac[ing]" his African American identity. Identities that were important to participants, they did not hide from others. These identities also appeared to provide them with a sense of self-efficacy and competency, unlike their disability identities that participants expressed often made them feel inadequate and detracted from their masculinity.
Lastly, the emergent theory provides a framework for understanding how college men with invisible disabilities may experience the academic accommodations process. The "preserving masculinity" theme illustrates the complex relationship between participants and disability services. Half of the participants were not registered with disability services or had registered but did not receive accommodations, with many of them stating they had little interest in seeking services in the future. Several participants registered and received accommodations, but only after their academics had been negatively impacted by their disabilities. Only a few participants proactively registered with disability services and received accommodations. Many of the reasons participants gave for why they avoided or were hesitant to use disability services related to their desire to preserve their independence and toughness. For some participants, however, their desire to preserve their success was greater and served to motivate them to seek disability services, especially if their academics were in jeopardy.

Relationship of Grounded Theory to Existing Literature
In many ways, the grounded theory is authenticated by extant literature on traditional masculinity and its influence on the lives of men. The grounded theory also expands on existing research that has examined the intersections of disability and masculinity.
Traditional masculinity. Perhaps one of the most salient connections the grounded theory has with existing literature is its relationship to research on traditional masculinity in American society. The existing scholarship on masculinity situates the attributes of independence, toughness, and success that were prominent in participants' definitions of masculinity in a broader context. These attributes resonate with Brannon's (1976) decades-old conceptualization of American masculinity, where he proposed the following four ideas as foundational tenets of masculinity: "No Sissy Stuff," reflecting the idea that men should avoid appearing weak or feminine; "The Big Wheel," emblematic of the idea that men should strive to be wealthy and powerful; "The Sturdy Oak," representing the idea that men should be reliable, dependable, and emotionally strong, and lastly "Give 'em Hell," epitomizing the idea that men should be aggressive and risk-taking.
In terms of seeking help from disability services, the traditional notions of independence, toughness, and success were used as guiding principles for how participants made their decisions whether or not to receive help from disability services. In understanding how independence played a role, Beaton (2016), in his TEDx Talk, shared that he felt that in the modern world, men continued to feel pressure "to be a lone wolf" and "to figure it out by [them]selves in order to be a real man." This pressure to maintain a masculine image was related to toughness as well.
Many participants who chose not to access disability services did so to maintain a sense of toughness. Peter, for instance, who felt that not getting help from disability services was a testament to his strength, shared that he preferred to "battle" his challenges instead of surrendering and getting help with them. Peter's valuing of toughness, in this sense, was not so different from what Seidler (1997) wrote about masculinity over a decade ago. He said: Within modernity the masculine is defined in opposition to the feminine, for we have to constantly prove as boys that we are not 'soft' or 'weak.' This inner fear of 'being weak' stays with us long into our adult lives as men. It is part of living out the dominant myths of masculinity and it connects to a pervasive sense that we will only be 'real men' if we have fought in battle. (p. 41) Only a few participants in the study proactively sought accommodations, with many others seeking them only after their academics had suffered, suggesting that perhaps this "inner fear of being weak" as Seidler described, is still quite relevant today.
Seidler also commented on the traditional masculine idea of success. He argued: Because masculinity, especially in a middle class professional world, has so much to do with being 'successful' and 'achieving,' it can serve as a pressure in whatever domain we might have chosen…sometimes we can feel as if we do not exist outside of our work and the success we have made of it. (p. 174) Seidler's description of the pressure men feel to be "successful and achieving" was expressed among participants in the present study. The themes of "embodying masculinity" and "preserving masculinity" highlight this immense pressure for success. Not only did participants include ideas about success in their definitions of masculinity, but they served to motivate them to seek help from disability services when their academics were in jeopardy, at the possible expense of their independence and toughness.
How traditional masculinity ideas develop and are maintained has been a substantial focus of research in the field of Men and Masculinities Studies. Many participants, in describing their ideas about masculinity, discussed how their families, school, and media all played important roles in the development of their ideas about masculinity. In a recent TED Talk, Connor Beaton (2016), founder of ManTalks, spoke about the early socialization process. He said, "You see at a very young age, most boys and young men are taught that their highest value as a man is their ability to dominate, to control, and to succeed at all costs." Though not the main focus of the present study, the "embodying masculinity" theme illuminates how gender socialization played a role in how the participants conceptualized their masculinity and disability identities and interacted with help-related services.
"Precarious" masculinity. Participants' experiences of feeling as if their disability identities compromised their masculinity identities -or aspects of their masculinity identities -is reflective of the masculinity as a precarious identity idea put forth by Vandello, Bosson, Cohen, Burnaford, and Weaver (2008). This notion that masculinity is susceptible to external threats was hinted at by Anthony who said regarding his masculinity, "I enjoy keeping it." The work of Vandello and colleagues authenticates Anthony's thought process through evidence suggesting that masculinity is an identity that is constantly being judged and lessened by others. Many participants experienced a diminished sense of masculinity as a result of their disability/ies in social contexts, particularly in the presence of their male peers. Kimmel (2008), who has researched and written extensively on men and masculinity, wrote about what participants in the study experienced. He said, "Here's what guys know. They know that every move, every utterance, every gesture is being carefully monitored by the self-appointed gender police, ensuring that everyone constantly complies with the Guy Code-even if they don't want to" (p. 97). He went on to say, "In the United States, proving masculinity appears to be a lifelong project, endless and unrelenting. Daily, grown men call each other out, challenging one another's manhood" (p. 100). These ideas help to better understand Donald, who worried about his handshake; Ben, who worried about his stutter; and Elliot, who worried about whether or not he would be able to assist with manual tasks.
This unique experience for men relates to participants' explanations for why they infrequently shared their disability identities with their male peers, mainly because they worried how they would be viewed in their peers' eyes. With the exception of Curtis, participants did not share their disability identity with their male peer groups in college for fear of being ostracized or made fun of. Seidler (1997) argued that this fear of not being accepted by others often led men to protect their vulnerabilities with a figurative 'mask.' He wrote, "At some level we all learn to wear our masks, for we learn to adapt to what is expected of us within the dominant culture.
Often we fear rejection if we show more of ourselves" (p. 80). Extending this point further, Vandello and colleagues (2008) wrote, "The greater precariousness of manhood relative to womanhood may therefore reflect a psyche adapted to an ancestral environment of relatively intense competition and constant jockeying for status among men." Their work lends interpretive value to understanding the themes of "losing masculinity" as well as "cultivating masculinity" and helps to better understand the important role of male peers in how participants preserved and cultivated their masculine identities.
The male peer group. In "cultivating masculinity," participants' involvement in all -or heavily dominated -male organizations were conceptualized in this project as attempts to escape the emasculating nature of their disability identities. Their involvement in these groups also served as means through which participants found acceptance among other men. Kimmel's (2008) exploration of American initiations into manhood parallels many of the experiences shared by the participants. In understanding why it was so important for participants to engage in these groups and seek acceptance from their male peers, Kimmel (2003) wrote, "We are under the constant careful scrutiny of other men. Other men watch us, rank us, grant our acceptance into the realm of manhood. Manhood is demonstrated for other men's approval. It is other men who evaluate the performance" (p. 125). Additionally, Kimmel (2008) argued, "In America's fraternities, military boot camps, and military schools, and on athletic teams, it's always peers who are initiating peers." Just as Kimmel described, many participants in the study cultivated their masculinity through these same institutions. They viewed their male peers as gatekeepers to acceptance in the world of men. Many participants shared that they highly valued their male peer groups. In terms of seeking help, Addis and Mahalik (2003) noted how these valued groups could create a barrier for men. They said: He is also unlikely to seek help if groups of men who are important to him endorse norms of self-reliance or other norms that suggest his problem is nonnormative. Finally, help seeking is less likely to the degree that a man calculates that rejection from an important social group, as well as his view of himself as deviant, are costs too great to risk in relation to the help he might receive. This is especially true if he feels he will sacrifice his autonomy by seeking help. (p. 11) Much like the participants in this study, Addis and Mahalik observed how the fear of being seen by male peers as not self-reliant served as a motivating factor for men to hide certain parts of themselves from other men.
Help-seeking. Statistics on college student attrition rates suggest that men are dropping out of college at a higher rate than women (Hartley, 2010). Given the significant proportion of college men with disabilities, many of them invisible (Marder et al., 2003), Barron (2016) postulated that one reason explaining this phenomenon may be the large percentage of college men with disabilities who are not seeking out available services at the same rate as are college women. The grounded theory helps add further explanation to this statistic as it suggests that college men may not be seeking out help from disability services among other help-services, because it threatens their sense of masculinity, particularly their sense of independence and toughness.
Intersectionality. Jones and McEwen (2000) presented a conceptual model with which to understand multiple dimensions of identity. At the center of their model was a person's "core" identity, which included highly valued personal attributes and characteristics. They considered gender as an identity existing outside the core identity, but noted that for some individuals their gender identity might be "integrally connected to the core" (p. 409). As evidenced by the "embodying masculinity" theme of the present study's grounded theory, many participants placed their masculine identity close to their core sense of self. In terms of where outside identities were placed in relation to the core, Jones and McEwen discussed the role of salience. They said, "For example, if culture is particularly salient to an individual, the placement of the dot on that dimension is closer to the core" (p. 410). This, however, was not the case for participants in the present study. Almost all participants thought about their disability identities frequently and discussed its significant impact on their lives.
According to Jones and McEwen's model, their disability identities would be considered salient. For participants, however, salience did not necessarily equate to closeness, as they distanced their disability identities from their core, masculine self, which is highlighted by the "preserving masculinity" theme. In this way, the grounded theory expands on Jones and McEwen's model, suggesting that perhaps the extent to which outside identities cause experiences of loss or stigmatization might moderate the relationship between salience and the proximity of that identity to a person's core sense of self.
The experience of loss. Loss, which was experienced by participants to varying degrees, was illustrated by the "losing masculinity" theme. This theme shares some similarity to Charmaz's (2011) work on understanding the identity development of individuals with chronic illnesses. She observed how her participants lost 'valued selves' or pieces of their identities they considered central to their lives and sense of purpose. Her grounded theory of "losing and regaining a valued self" was similar in many ways to the experiences of the participants in this study with the 'valued self' being their masculine identities. In describing the idea of loss, Charmaz wrote, "Such losses are devastating, uncontrollable-overwhelming. These losses impose uncertainty, portend permanence, undermine autonomy, and cause grief and suffering." For participants in this study, the level of permanence of their loss of masculinity varied, relating to the nature of the disabilities and other significant factors. For instance, participants who were diagnosed during early childhood had lived with this identity for several years. These participants did not appear to experience the same jarring sense of loss to their valued masculine self that was observed in Charmaz's (2011) participants, with the exception of Jared. Like the individuals in Charmaz's study, Jared, as a result of his disabilities, lost his sense of purpose in life that was directly related to his masculinity. In addition to how long participants had lived with their disability/ies, some of their losses were more temporary in nature. Ben, for instance, who identified with having a stutter from early childhood, spoke candidly about how his stutter made him feel less masculine but only in certain contexts.
Many participants in this study were able to retain or rebuild a sense of masculinity through preservation and cultivation efforts. The "preserving masculinity" and "cultivating masculinity" themes relate, to some extent, to Charmaz's (2011) theme of "regaining a valued self." In explaining this, Charmaz wrote, "Both negative judgments and positive measures give an individual the comparative material to articulate a new narrative of self with fresh purposes." Similarly, participants in the present study found ways to strengthen their masculine identities in the face of their disabilities. In addition to efforts they made to push these identities farther away from their masculine ones, they found social acceptance among male peers through their involvement in all-male organizations or groups.
The grounded theory also provides a unique perspective on the work of Gerschick and Miller (1995), who explored the identity development of men with physical disabilities. They found that the men in their study engaged in three different processes while negotiating their masculinity identity with their physical disability status. They described one of these processes, "reliance," as: The reliance pattern is reflected by an emphasis on control, independence, strength, and concern for appearances. Men who rely on dominant conceptions of masculinity are much more likely to internalize their feelings of inadequacy and seek to compensate or overcompensate for them. Because the problem is perceived to be located within oneself, rather than within the social structure, this model does not challenge, but rather perpetuates, the current gender order.

(p. 203)
In much of the same way, the participants in the present study mirrored the "reliance" process through the ways they embodied traditional masculine characteristics.
Interestingly, Gerschick and Miller observed the predominance of "control, independence, strength, and concern for appearance" (p. 203) among their participants, that was similarly observed with the participants in the present study. The grounded theory themes of "losing," "preserving," and "cultivating masculinity" further illuminate how the "reliance" process that Gerschick and Miller observed among men with visible disabilities is also relevant for college men with invisible disabilities. This observation that the participants in the present study negotiated their masculinity and disability identities in similar ways to the men in Gerschick and Miller's study suggests that perhaps traditional masculine ideology plays a similar role in men's live, regardless of whether their disability identities are visible or not. As it may seem logical to draw the conclusion that men with invisible disabilities have fundamentally different experiences than men with physical disabilities, the results of this study suggest that they may be similar in more ways than previously thought.

Implications of The Grounded Theory
This study, which has expanded the existing scholarship on masculinity and disability, has several important implications, particularly for professionals working with college men with invisible disabilities. One implication is for disability service offices to focus more attention on the language they use when presenting their services to students. Many participants who resisted help from disability services, referred to academic accommodations using words or phrases with negative connotations, such as having "an extra leg over everyone else," "extra assistance," or having "more than someone else." These phrases and ways of conceptualizing accommodations were in stark contrast to the language used by the participants who proactively sought accommodations. These participants often used words with more positive connotations, such as "insurance" and "back-up plan." These phrases are similar to ideas of preparedness, a traditional masculine trait that factored into some participants' definitions of masculinity. As such, it might be advantageous for disability service providers to explore how language is used with college men with invisible disabilities in speaking with them about their services. Reframing traditional notions of independence and toughness might help college men counter their hesitations and reservations about seeking accommodations from disability services. For example, it may be advantageous to help college men with invisible disabilities recognize that seeking help despite pressure from the traditional masculine doctrine does, in fact, require tremendous strength and toughness.
A second implication relates to men's male peer groups. The present study suggests that male peer groups serve as bastions of acceptance for men and as a means by which men can enhance their masculine identities. Thus, it may be important for providers who work with college men with invisible disabilities to explore how a college man's male peer group might be acting as a barrier to their help-seeking. A recent study from South Africa found that peer educators might serve as valuable delivery tools for health-related information, particularly for young men (Meagley, 2016). Perhaps developing disability service peer liaisons for the wider campus community may be beneficial in de-stigmatizing help-seeking around disability issues for all students, and in particular for college men. As the present study found that male peers groups were highly valued in the lives of the participants, it might be advantageous to place male-peer disability liaisons within the major male-dominated institutions on campus, including Greek Life, athletics, and veteran organizations.
A third implication of the study is in the need to recognize how invisible disabilities present unique challenges for college men. In discussing men with visible disabilities, Gerschick (2005) once wrote, "Because of the tremendous pressures to conform and the perceived rewards associated with doing so, people will go to great lengths to make their bodies appear more normatively masculine" (p. 373). Many participants, whose bodies could pass as "normatively masculine," spoke about this luxury afforded to them by the invisible nature of their disabilities. However, it was not without its challenges. The participants walked a delicate line between invisibility and visibility. Many of them worried about how other students and faculty members might perceive their behavior, which was not easily attributable to their hidden disabilities. Gerschick argued, "…typically the condition is not readily apparent and as a consequence does not automatically trigger stigmatization and devaluation.
Conversely, having quadriplegia and utilizing a wheelchair for mobility is highly visual, is perceived to be severe, and frequently elicits invalidation" (p. 372). Though the men in the present study did not contend with the same challenges of being physically disabled, they too experienced stigmatization and devaluation, both internally and externally.

Strengths of The Study
In following the procedures aligned with a constructivist grounded theory approach, the findings of this study reflect how college men understand themselves as men with invisible disabilities and how they experience and interact with the college accommodations process. The trustworthiness of this study was ensured through the use of member checking, in which interpretations and conclusions of the data were 'checked' by participants to ensure that the interpretation of the data was aligned with the experiences of the participants. Peer debriefing was also used that resulted in the development of alternative ideas relating to the data that were explored to reduce researcher bias. An additional strength of this study was the sample of 22 participants that allowed for theoretical saturation of the categories (Creswell, 2007).
Another strength of this study was in the 'deep' level of understanding that was facilitated by the use of in-depth interviewing. This breadth of knowledge is important especially when researchers are 'outsiders' to the sample population, as was the case of the present study of a woman researching the experiences of men, despite her 'insider' status as a person who identifies as having an invisible disability. Thus, using in-depth interviews allowed the researcher to learn about the meanings of experiences of participants who were members of a different group (men), as well as for her as an inside members to gain a broader understanding of her own membership (as invisibly disabled).

Limitations
While the present study provides valuable information on how college men with a variety of invisible disabilities understand themselves as men and navigate the college experience, there are important limitations. One limitation of a grounded theory is that it is specific to the sample of the present study. While the study was diverse in terms of disabilities, it lacked important diversity in other areas, namely sexual orientation, as all of the participants identified as heterosexual. It was also a predominantly Caucasian sample. As such, the grounded theory may not be generalizable to contexts outside the college setting and with college men of different racial, ethnic, and sexual orientation backgrounds. It should also not be concluded solely from this study that these experiences are unique to men. By only focusing on college men, this study was unable to provide insight into whether college women with invisible disabilities conceptualize their disability identities and interact with the disability service process in a manner similar to college men.
It is also important to recognize that the emergent theory of any constructivist grounded theory study is a product of interpretation and not free from bias. To this point, Charmaz (2014) warned, "The theory depends on the researcher's view; it does not and cannot stand outside of it" (p. 239). As such, it is important to recognize that while the grounded theory described in the study is a co-constructed representation of participants' experiences, the researcher's experiences and biases are likely to have rendered these ideas in a manner different than if another researcher had conducted the study. Even with the use of member checking and peer debriefing, the results should be interpreted with the understanding that the researcher's theoretical lens and past experiences likely colored the interpretation of the data, even if minimally. By engaging in researcher reflexivity, the researcher identified herself as an individual with an invisible disability with previous research experience related to men and masculinities. It is therefore possible that these experiences influenced, to some extent, the resulting grounded theory.

Future Directions
To expand further on the findings from this study, future research should explore the intersections between masculinity and invisible disability with populations that were not represented in the sample, for instance gay or transgender college men.
Some of the experiences shared by participants who identified as racial minorities should also be explored in future research. Some of the participants who identified as African American spoke about issues related to marginalization, which are important and should be explored with a larger sample of non-White college men with invisible disabilities.
Future research should also explore these themes with college women with invisible disabilities. While women may not feel that having an invisible disability threatens their sense of womanhood, seeking help from disability services may evoke some feelings around perceptions of femininity. It would be interesting to examine how traditional gender stereotypes, for instance, that women need help and are dependent, influence how women experience the accommodations process. Just as some participants in the present study felt the accommodations process challenged their sense of independence and toughness, would women express similar hesitation because it affirms the traditional stereotype that women need more help than men?
Future research on this topic with college women would allow for a broader view of how strict gender norms impact the help-seeking behaviors of men and women alike.
Although this study included participants with a variety of invisible disability identities, it would be advantageous to further examine these processes with participants who share specific types of invisible disabilities. This would allow for a more thorough examination and understanding of college men who share similar invisible disability identities. Future research should also explore how the time of diagnosis influences how men think about their disability identities. In other words, how does being diagnosed with a disability as a child versus as an adult influence how men with invisible disabilities negotiate this identity with their masculinity? For men who are diagnosed with invisible disabilities from birth or early childhood, what role does development play in how they negotiate their disability identities with their masculinity? A longitudinal or cross-sectional study could help address these questions.

Conclusion
The present grounded theory study focused on college men with invisible disabilities. Through in-depth dialogue with 22 participants, a grounded theory emerged that formed a conceptual framework for understanding how these participants understood themselves as men with invisible disabilities. The grounded theory further elucidated the role that traditional masculinity played in how these participants positioned their disability identities at a far distance from their masculinity. It also examined the processes that these men engaged in to preserve their valued masculine self and how they made efforts to strengthened and cultivated it.
Despite contemporary efforts to bolster the national dialogue about traditional masculinity and its negative impact on boys, men, and women, the results of this study suggest that further work in this area needs to be done. Postsecondary education is increasingly being recognized for its role in the development and maintenance of traditional and hegemonic masculine ideals (Harper & Harris, 2010). Thus, this study underscores the need to continue challenging some of the maladaptive notions about what it means to be a man that continue to create barriers for college men in seeking help.
[For Participants who are registered but have not received accommodations]: 12. Can you describe for me the reasons why you decided not to receive accommodations and what, if anything might change your mind about receiving accommodations?
Ending Questions 13. Is there anything that you might not have thought about before that occurred to you during this interview? 14. Is there anything that you would like to ask me?
Thank you very much for sharing your experiences with me. Your perspective is extremely helpful and I appreciate your willingness to participate.
After your interview is transcribed, I will send you a copy via email. I would like to make sure we understood the main points of your comments and observations. I also want to allow you time to reflect on the interview. May I contact you after we transcribe the interview? Yes ____ No _____ If yes, this will take approximately 30 minutes.
Please let me know if you would like a copy of my study results. Yes _____ No_____. If yes, where can I send them to you? _______________________________________ I would like to make sure we understood the main points of your comments and observations. May I contact you after we transcribe the interview? Yes ____ No _____ Do you know of other college men who have an invisible disability who you think may be interested in participating in this study? No____ Yes (please provide student's name and contact information):____________________________________________

Subject: Participants Needed for Study on College Men with Invisible Disabilities
Dear Student, My name is Maggie Korn and I am doctoral student in the School Psychology program at the University of Rhode Island. As part of my dissertation research, under the direction of my major professor, Dr. Margaret Rogers, I am conducting a qualitative study on the experiences of college men with invisible disabilities. Invisible disabilities are disabilities that other people do not know you have unless you were to tell them. You are receiving this email because you are registered with the Office of Disability Services for Students at URI. Your email address was obtained from their database of students registered with the office.
I am writing to ask for your time and participation in this research project. The purpose of this study is to understand college men's masculinity as it relates to their disability and vice versa. I am also interested in learning more about how college men with invisible disabilities experience the academic accommodations process in college. This information would contribute greatly to the field of masculinity and disability research as well as inform how disability services may better serve students. To be able to take part in this study you must be a college man at least 18 years of age with an invisible disability. If you are registered with Disability Services but have not received academic accommodations you are still eligible to participate.
If you choose to take part in this study, you would complete a brief demographic questionnaire and participate in a one-to-one audiotaped interview with the researcher that would take approximately 45 -60 minutes. Any information that you provide will be strictly confidential and your name will not appear in any reports resulting from the study. Participants may elect to participate in a follow-up via phone, email, or inperson meeting for additional questions or to clarify previous responses. These followup communications will last approximately 30 minutes. Participants will be given $20 as compensation for their participation. If you are eligible to receive course credit for your participation, you may choose the credit in lieu of the $20.
This study has received Institutional Review Board approval. If you are interested in participating, please email me at maggie_korn@uri.edu. You may also contact the Principal Investigator, Dr. Margaret Rogers at mrogers@uri.edu. Thank you for taking the time to read this e-mail. I hope that you will consider participating in this study!

Operational Definition of Invisible Disability
As no clear definition of invisible disability exists in the current literature, the following operational definition was developed using both the Americans With Disabilities Amendments Act (2008) as well as considerations from Davis' (2005) paper regarding the role of self-disclosure in the lives of people with invisible disabilities. In the present study, an invisible disability was defined as a disability that substantially limits one or more major life activity and includes impairments that are episodic or in remission but when active substantially limit at least one major life activity. An invisible disability may be considered different from a visible disability in that it requires a 'burden of proof' beyond that of individuals with a visible disability.
In other words, an invisible disability is one that in the majority of settings, a person's disability status is not perceivable by others unless it is explicitly disclosed. Examples of these types of disabilities may include attention deficit hyperactivity disorder, learning disabilities, mental health disabilities, chronic health impairments/illnesses, traumatic brain injuries, and autism spectrum disorder.
Benefits: If you choose to participate, your answers will help expand our knowledge of the experiences of college men with invisible disabilities. It will also help to inform how disability services work with college men.
Compensation: You will be given $20 for your participation. If you are eligible to receive course credit for your participation, you may choose the credit in lieu of the $20.
Confidentiality: Your participation in this study is confidential. Identifying information will be removed from transcripts and pseudonyms will be used. None of the information will identify you by name. All data will be maintained in a locked facility at the University of Rhode Island.

Decision to quit at any time:
The decision to participate in this research project is up to you. You do not have to participate and can refuse to answer any question. You may withdraw from the study at any time with no consequences.

Rights and complaints:
The researcher will use a digital recording device in order to audio record the full interview between the participant and the researcher. Please indicate your decision to be recorded by placing an "X" on one of the lines below followed by your signature.
I agree______ or I decline______ to be recorded. _______________________________________ Signature of Interviewee