Mental Health Matters: Men’s mental health

Happy spring!

It looks and feels like spring is here, and while it may come and go for a bit, we are headed towards warmer weather!

I grew up on the prairie where there are wide expanses of land, mostly grassland originally, now a checkerboard of commodity crops like corn, soybeans and hay. In some areas, one must travel a good hour or more to get to an airport, or major supermarket.

Out in the Dakotas and farther west, you may see signs along the Interstate that read: “Check your fuel gauge! Next exit is 150 miles.” It’s a place where you learn to time your excursions into town so that you can kill several birds with one stone, so to speak. 

This presented a challenge not only for access to air flights and groceries, but health care services as well. General health care was one thing, but mental health care was a whole different story. The National Institutes for Mental Health (NIMH) reports that over 60% of rural Americans live in mental health provider shortage areas with 65% of nonmetropolitan areas lacking a psychiatrist. Telehealth options are beginning to address some of these desert mental health communities, but that is a recent development. 

I grew up in a household where we were always in the grip of a chronic, episodic mental health mine field. My dad, educated through the eighth grade, suffered mightily from what we very well might call bipolar disorder today. However, during his lifetime, in the rural community where we lived, no one spoke about mental health. In fact, we lived in a mental health illiterate world. All we knew in my own house, was that occasionally but unpredictably, our world would disintegrate into a massive mental health crisis. We had no idea what was happening or what to do about it. 

Mental health is at its base stigmatized and poorly understood.

When it comes to men’s mental health, we might best multiply those two factors several times. While this area of health affects all people, our societal norms create a particularly dicey situation for men. Especially during my dad’s lifetime, men had to be stoic, portray themselves as strong figures, with absolutely no room for vulnerability. While some of that has changed since the mid 1900s, this narrative is still strong enough that many men still find it difficult to talk about feelings and are slow to seek help.

Mental health problems are very common among men. Research provides a glimpse of the lay of the land. Men frequently experience depression, anxiety and post-traumatic stress. Men are more prone to substance abuse/use as well as suicide. The World Health Organization reports that men are three times more likely to die by suicide than their female counterparts.

Frightening as these statistics are, they highlight the need for open conversations regarding men’s mental health.

There are barriers that men face in addressing their mental wellbeing. Culturally, they are discouraged from emotional expression. There are still many communities and families where the phrases “man up,” or “big boys don’t cry,” create an environment where emotional vulnerability is still viewed as a weakness. As a result of the lack of emotional expression, it is difficult to even recognize that they are struggling. Masking coping with substances are so culturally acceptable that no one questions or wonders if anything is amiss. This becomes a strong barrier to seeking help when needed. 

Even more complicated is when we factor in communities of faith, regardless of denomination or belief system. Mental health issues are often seen as a weakness of will, lack of faith or signs of unfaithfulness. “If you would just pray about this more often, it would get better.”  “Your faith must not be strong enough or you wouldn’t have this problem.” Studies on patients recently discharged from inpatient mental health care reveal that one of the most difficult places to return to after an inpatient mental health hospitalization are faith communities. There is still a lack of understanding about the origins of mental health problems as well as knowledge of effective treatment options. We now understand more and have more evidence-based practices available to us than ever before in human history. 

This all leads to the load of guilt and shame that men in particular face when they carry the burden of a mental health condition. While we often lump both guilt and shame together, they are distinct from each other. Guilt can be characterized as being about doing. It is the discomfort we feel when we believe we have done something wrong or crossed a boundary of some kind. It can be helpful when it compels us to make the wrongs right, if in fact we are legitimately at fault. In contrast, shame is about being. It is the internal belief that you are fundamentally flawed, unworthy or “bad” as a person. Your existence is a “mistake.” Ultimately, it is reasonable to be able to right a wrong action. On the other hand, there is little to be done about shame, since by the very fact of being, you are already a mistake. If my existence is a mistake, there really is only one solution: to cease to be. 

To be clear, most of the fodder for either of these two comes from an early part of our lives where we had no choice about accepting them. Someone must pour this into us to become a problem. We don’t conjure these emotions and beliefs on our own.  

So, we need to ask: what are the signs of mental health struggles in men? Both men, and those around them need to recognize what we are seeing in our loved one to be of help.

Following are some signs to watch for and recognize:

Persistent sadness or low mood – we all have our emotional variability, but when we see these signs consistently, it is heads up time to pay attention. 

Changes in appetite or sleep patterns – He may have begun to eat less or eat more. You may find that he hardly sleeps at all, wakes up frequently or sleeps all the time. Depression is a brain based chemical problem that also impacts sleep and appetite. 

Increased anger or irritability, also known as emotional dysregulation – You may notice that his mood has become less regulated, or that he has episodes of anger or irritability. 

Withdrawal from social activities – Things that he used to be involved in are no longer of interest. It may take a huge effort for him to leave the house, or to spend time with loved ones. This is not because he does not care, but it is a clinical symptom of depression. 

Substance use – Often we humans turn to our own form of medication treatment through the forms of increased alcohol, marijuana or other drug use. You may see these behaviors in your loved one. 

What are some ways that you can help? To begin, recognizing the role of open dialogue and communication can be a great comfort. Remember, for most men, opening conversation about these issues can be very uncomfortable due to the pressure they face about being strong, self-reliant and independent.

Creating a safe environment for him to talk is crucial. Foster an atmosphere of support which emphasizes understanding and compassion. Encourage your loved one to seek out professional help. We can set the tone for this by normalizing therapy, as this is a critical factor in mental health recovery and eventual maintenance.

Building a support network is important. Years ago, I was a part of a “Circle of Care.” It consisted of a couple of friends, and a pastor who met on a regular basis with a mutual friend who was struggling with depression and anxiety. We met over coffee, shared our support for the friend, asked how we could be helpful and had a genuine interest in how they were really feeling and coping. These impromptu support groups can be a safe place for someone with mental illness. 

Encourage your loved one to seek professional help. There are many practitioners to choose from, including licensed clinical social workers, licensed professional counselors, psychologists (all of whom provide therapy or counseling) and psychiatrists (who largely provide medication evaluations and management). You can find reviews and descriptions on the websites of their businesses. Asking friends and relatives for anyone they have had a good experience with is another way to find someone.

Psychology Today also has a search engine online where you can locate someone in your area. You can also sort these finds by practitioners who see clients face to face, and/or virtually. You can also find practitioners on these sites who specialize in men’s mental health. 

Another healthy practice is to normalize conversations about mental health. We can start this in our own homes, with friends, in our faith communities or with coworkers. It will become far less uncomfortable as we practice these conversations.

One very valuable resource is: NAMI – The National Association for Mental Illness, including the National Office at NAMI.org, or find your local affiliate by googling “NAMI Near Me.” NAMI provides trainings, awareness campaigns, weekly support groups and educational meetings. Some of NAMI’s signature programs include Family to Family for those whose loved ones are suffering with mental health issues. NAMI Homefront is a program that works specifically with veterans and their families. NAMI Peer to Peer provides support for those who are personally struggling with a mental health condition. Nami Basics on Command is an educational program for parents, caregivers and other family members. NAMI Provider is an educational program for mental health practitioners.

Our brothers, fathers, sons and partners are not immune from the epidemic of mental health conditions. In fact, they are at greater risk due to their socialization to appear strong and resilient. And the fact is, they ARE strong and resilient. But they are also vulnerable and at high risk for suffering over many years, as well as the risk for suicide. Hopefully conversations about mental health can become a routine occurrence in our homes, places of work and worship, and amongst friends. Soon, I will share a column with you with ideas about how to start those conversations.

Happy spring!