At a glance:
- Mental illness happens to both sexes, but the key difference boils down to a sense of masculinity.
- Are the ways to alleviate the situation asking too much of how the male brain is wired?
- It's important to see mental illness as a result of chemical changes which has a physical effect.
It's a fact that is often repeated, but is no less shocking for all that: over three-quarters of all suicides are by men. Indeed, by one count, suicide is the largest cause of death for men under 35. That’s right: a man in that age group is more likely to kill himself than die of cancer or some other terminal illness, or by accident. In part that’s down to bloody determination.
“Men are less likely than women to attempt suicide in the first place,” notes Dr Joshua Gordon, a neuroscientist and director of the National Institute of Mental Health in the US. “In fact, they’re half as likely to do so. But they’re much more likely to succeed when they do. And that’s because men use much more lethal means—here in the US typically a gun—so they’re more likely to die on the first attempt. Other methods fail because there’s some time lapse involved—women tend to try to overdose on drugs, which allows for a window of discovery. Pills might not kill you. One bullet in the right place will.”
It makes for grim reading: gay men, war veterans, those with BAME (black, Asian and minority ethnic) backgrounds— men, in other words, facing the stresses of marginalisation or experience—all report higher rates of suicide. The same is especially true of men on low incomes, with the socioeconomic hardships, relationship breakdown and unemployment that can follow from this. Research has shown that up to one in seven men who become unemployed will develop a depressive illness over the subsequent six months.
But it also highlights the sheer prevalence of mental illness, and, in a sense, just how normal it is. For all society’s squeamishness in addressing mental illness—as opposed to the practical response that a physical illness typically encourages— one in 20 men have a major depressive episode in any given year, a potentially crippling episode of the kind that Winston Churchill referred to in his diaries as “his black dog”; cast the net of mental illness wider and it’s estimated that one in eight men have experienced a common mental health problem.
Of course, mental illness is not just a male issue, though there are some differences between men and women when it comes to this debilitating experience. Autism is much more commonplace in men than in women; schizophrenia is slightly more commonplace; a violent reaction to mental illness—as reports of mass shootings around the world and instances of domestic abuse might both indicate—tends to be almost exclusively a male one.
Similarly, mental illnesses typically ascribed to women— most notably eating disorders—increasingly show in men too; while we know that some mothers become depressed after having a baby, we now know that one in 10 new fathers also have similar problems. Over and over again, however, the key difference between the sexes lies, crucially, in men’s reluctance to seek help. And that boils down to self-image, specifically one’s sense of masculinity.
All the traits stereotyped as characteristically male—self- dependence, dominance, stoicism, control, being the provider, with many studies suggesting that worries about work, financial pressures and health concerns all typically feature highly among key influences on the male state of mind—cut against a readiness to recognise that one might be mentally ill and, even if that is tacitly acknowledged, to do anything about it.
“Depression to me was for weird people, sad people, lonely people, [so] how could I ever be depressed? Anxiety [was] something that weak people suffer from,” recalls Steve (not his real name), as recounted to Time to Change, a social movement working to change perceptions of mental illness.
“Growing up in the era that I did, with mental health still very much a stigma, and education on the subject non-existent, I can hardly be blamed, or be alone, in my thinking. I managed to fool myself into thinking I was fine, so it hardly comes as a surprise that others didn’t notice. I just put my misery down to a recent break- up and ignored my own internal cries for help.”
Certainly Steve is not alone. Broadly, men are not good at talking about how they feel—in fact, conversation is likely to revolve around just about anything but that, even with family. Add the events that can bring on mental illness—bereavement, abuse, addiction, divorce and so on—precisely those we’re most uncomfortable talking about, and the effect can be doubled.
How much easier is it for someone to ask about, and for you to tell, that war story of how you broke your leg?
It’s hardly surprising then that, according to one study, men make up only around a third of referrals to psychological therapists—a problem made worse by the fact that, according to (admittedly 20-year-old) studies in Germany and the US, gender stereotyping may even lead to the under-diagnosis of mental health problems in men; elderly women were likely to be given the diagnosis of depression more often than elderly men presenting with the same symptoms.
According to a 2015 study commissioned by Priory—the British mental healthcare organisation internationally known for treating the mental health problems of the likes of Ronnie Wood, Eric Clapton and Robbie Williams among many others—40 percent of men won’t talk to anyone at all about their mental health, despite the fact that 77 percent of those polled recognised it was having a negative impact on their performance at work, parenting abilities and relationships (adding insult to injury, depression has a higher incidence among men who are divorced).
And why wouldn’t that 40 percent talk to anyone at all? In descending order, these men claimed, somewhat unconvincingly, that they had learnt to deal with their mental state themselves, that they didn’t want to be a burden on anyone, that they were too embarrassed, that there was too much of a stigma around mental health, that they didn’t want to admit they needed support and that they didn’t want to appear weak. They had to ‘man up’, ‘grow some balls’ and keep it all in. Yet opening up is essential.
“It was very scary, one of those times when I just couldn’t find the words to describe how I felt and what had been going on,” admits James, whose anxiety, unaddressed, transmuted into depression characterised by a loss of interest in hobbies he once loved, in inexplicable feelings of guilt and shame and what he calls “an internal hatred for myself ”.
“I didn’t want to push these feelings on anyone else. [But] if I had not expressed how I was feeling I don’t like to think about what could have happened. [The people I spoke to] guided me in the right direction to find myself again.”
Small wonder that, when the UK’s Princes William and Harry gave interviews on their own mental health challenges earlier this year, it made the international news. Likewise other celebrities who have done the same—Brad Pitt, Dwayne Johnson, Bruce Springsteen, Ryan Reynolds, John Hamm and Donald Glover, who attempted suicide—many of them icons of manliness.
In the face of fears about losing status or their careers, senior executives in major companies are speaking out about their own mental health troubles too—a good thing seeing as, if it was once a bad back that was the leading reason for absence from work through sickness, now it’s anxiety and depression.
Clearly, that ‘strong silent’ male stereotype may mask more of a psychological mess below, especially if some booze is involved. Just ask Don Draper. Men are more likely to self-medicate in some way. Alcohol and drug abuse, as a consequence of mental illness, is two to three times more rife among men than among women. Slow-motion suicide, it’s sometimes called.
“Drinking is part of a lot of male cultures and is seen as a way of dealing with stress,” explains Dr Paul McLaren, consultant psychiatrist at the Priory’s well-being centre and hospital. “You string yourself out on drink rather than find a chum to talk to. That’s a vicious circle. It becomes difficult to know if the mental illness is progressing or secondary to the levels of drinking. Of course, it’s not just societal elements that drive male responses to mental health issues. It’s genetic too.”
“We don’t really know whether it’s a question that men are less aware that they have a problem or are less willing to seek help when they are,” adds Dr Joshua Gordon. “And we don’t have a lot of data to confirm as to why men are less willing to admit they’re feeling a certain way—depressed or anxious, for example—such that it’s often friends or family who are first to spot there’s a problem and bring it to that man’s attention. But what’s very likely is this idea prevalent in many cultures that men are meant to be self-reliant, which of course mental illness plays against.”
But, for all we know, that may be asking too much of the way the male brain is wired.
So what can be done to alleviate this dire situation? It would be easy to say that men need to be more self-aware and truthful with themselves, and to take action when they feel that something is amiss, as they would if they developed a persistent ache. But, for all we know, that may be asking too much of the way the male brain is wired. Rather, the onus tends to fall on men (and women) to pay attention to the other men around them.
“We need to take up a position of much greater awareness of the men in our lives,” argues Gordon. “We need to be regularly asking them how they feel, to be looking for changes in behaviour”. Since men tend not to get obviously teary or upset, these changes, he says, may exhibit in their sleep (too much or too little), appetite, attitude, lack of sex drive or if they develop compulsive behaviours or obsessive thoughts.
In men especially, other signs include if they’re misusing drugs or alcohol, engaging in high-risk activities or showing signs of much greater irritability or sudden aggression. Not for nothing is being unusually quick to anger sometimes darkly referred to as ‘depression with enthusiasm’.
“We’re often afraid to raise such issues with male friends and family members we care about because we’re worried about getting it wrong, and that itself will create problems,” he adds, advising that a man-to-man chat can occur even while out for a run or a drive, thus avoiding uneasy eye-to-eye contact. “But the fact is sufferers often suffer in silence and actually welcome being approached. Whether it’s all about some social construct of masculinity or because men are inherently not good at reading their own feelings, we can change that.”
Indeed, it’s revealing that even in the most male of environments—the likes of the US Army, for example—steps are being taken to make this man-to-man oversight possible. Aware that the stresses of military life—from being away from family to the breakdown that can follow post traumatic stress disorder—can disable both the individual and, in turn, the efficiency of their units, the US Army has recently introduced a buddy system by which servicemen are paired up with the intention of monitoring each other’s state of mind.
“It’s a way of encouraging a person who’s not feeling right to to reach out and to have someone to reach out to, even for one soldier to offer to take the other’s weapon if there’s a sense that they may be suicidal,” says Gordon. “But the point is these are soldiers—really macho guys—and they can be encouraged to talk to each other.”
That can also help dispel another problem that often prevents men in particular from getting help: the incorrect belief that nothing can be done to help them; a sense that’s particularly acute with mental illnesses the likes of depression because one of its symptoms is hopelessness. Friends and family—and, because they’re authority figures, medical professionals especially—have to convey that, whatever their mental illness, there is some solution to how they feel.
That, of course, is if the sufferer can be got in front of a doctor. The Priory study previously mentioned also revealed that almost a quarter of respondents wouldn’t feel comfortable talking even to them because they wouldn’t want to waste the doctor’s time. This is why it’s important to see a mental illness as a result of chemical changes in the brain. The fact is that it is a physical problem as much as any illness affecting your organs, blood or bones.
“Comparing mental illness with a physical one is tricky because you can have the latter once, it gets better and goes away, and that’s not the case for a lot of mental illness,” argues Chris O’Sullivan, head of business development at the Mental Health Foundation. “That said, if you break a leg in the street, people will come to help you, and that’s not always the case if you have a panic attack. There’s this ongoing stigma that encourages us to think of mental illness as something ‘other’.
It doesn’t help that there are so many things that affect our mental health. It can be hard to distinguish illness from the ups and downs of everyday life. That can affect the willingness to address a problem and shape the reactions of others to it. Yet the idea that mental illness is something that happens to other people is blown out of the water by the stats. So, yes, we need mental health to be discussed in a much more matter of fact way that pays attention to what different groups in the population need.”
And fast. According to the mental health charity Mind, getting men to talk more is one thing. But then there is the lack of readily accessible services suitable for their needs, notably in the crisis support that men’s often late diagnosis requires. There should be more asking of men what men want in relation to mental illness. Even with growing awareness, even with generational shifts in attitudes, the future for male mental health is touch and go.
After all, these are, in some senses, tough times for men and boys alike.
Of course, power structures are still overwhelmingly in male hands. But in a post-feminist environment, not only are boys being outperformed in the classroom—and, more perplexingly, expect to be outperformed—but the portrayal of men and male identity in contemporary society is often negative.
Positive male role models are thin on the ground. The shoe may be on the other foot, but the demonisation, marginalisation and objectification of men—leading to a crisis in understanding what masculinity is in the 21st century—can hardly be a good recipe for the positive mental health of the young as they grow older.
“But I’m absolutely positive,” counters Simon Gunning, CEO of the Campaign Against Living Miserably, a movement against male suicide that has seen calls to its helpline double over the last year.
“There’s a huge amount of work to be done still, but there’s much greater general awareness [of mental health problems in men]. There are ideas of masculinity we’d encourage to be challenged. Look at how the MeToo movement is helping to redefine masculinity for women and men alike or how my own 13-year-old son is quite happy being both a boxer and a ballet dancer.
“Of course, there’s massive complexity to the issue of masculinity—just look at all the body image nonsense men contend with now—and this search for a definition of who we are as men, and how we stand against these external, cultural definitions, do play out in our mental health,” adds Gunning. “But I’m a middle-aged man and carry the kind of metaphorical luggage that I’m now seeing there’s a real readiness to question. And while that’s more or less easy in different parts of society, we really need to encourage men to take that opportunity.”