Focus

The strong, silent type

Is masculinity bad for men’s mental health?

By Dr. John Ogrodniczuk and Dr. John Oliffe

Don is a 41-year-old self-employed welder from a small rural town. He has been happily married to Joan for 18 years and has three healthy boys. Don coaches his oldest son’s hockey team and curls in the local men’s league. His friends describe him as gregarious, giving and outgoing.

Thirteen months ago, Don incurred a back injury on the job that kept him off work for two months. He had to stop curling and coaching hockey. In the acute phase of his injury, Don required physical assistance from Joan, which he often commented was humiliating. Eventually, he attempted to resume welding, but recurring back pain meant he could only work intermittently.

Joan noticed that Don was increasingly irritable and angry. He began to drink six cans of beer every evening along with a few shots of whiskey to help him sleep. He slept and ate much more than usual. He was increasingly housebound and spent a lot of time on the Internet researching self-help back cures. He refused to host guests any longer. Intimacy disappeared from his marriage.

Recognizing that Don was “not his normal self,” Joan suggested that he see their family doctor. Don would snap back, “What the hell can he do? My back is wrecked for good.” Don would occasionally visit the doctor for check-ups on his back, but he never disclosed other health concerns.

Don grew more despondent and isolated. One Sunday, Don’s wife and sons returned from church and found a note taped to the bedroom door. In it, Don explained how he felt useless and hopeless since his injury – that he was no longer a good man, that he was no longer a good husband and father, that he was a burden. Joan found Don lying across the bed, dead from a self-inflicted gunshot wound.

This composite case highlights the intersection between men’s mental health, masculinity and help-seeking attitudes and behaviour. It is well documented that men seek help for mental health issues less often than women do. Many factors inhibit men from seeking help for mental illness. The way that men think about themselves as men may be a contributing factor. Men tend to be concerned with being competitive, powerful and successful. Traditional notions of masculinity mean that men are supposed to be tough and self-reliant; that they manage pain and take charge of situations. It’s a sign of weakness to need help or depend on someone else, even for a short time or in a time of crisis.

This traditional view of how men should be – always tough and self-reliant – is also held by some women. Some men worry that if they talk about their feelings of depression, their partner may reject them. This can make it hard for men to acknowledge they have a health problem, especially a mental health problem.

We also know that men are more likely to arrive in the emergency room than in general practice, which reflects men’s denial of illness, preference for self-surveillance and reliance on self-management strategies. It means that mental health issues, such as depression, often go unrecognized, sometimes until it is too late, as in Don’s case.

Evidence also suggests that men have difficulty articulating their problems when talking with health care providers. And health care providers who see men at routine check-ups or during visits for physical complaints may themselves miss the signs of depression or other mental health issues. Depression affects men and women, but what they experience and how they respond is quite often different. Men tend to focus on the physical symptoms, such as feeling tired or losing weight. They are also more likely to say they feel irritable or angry, rather than saying they feel “down.” This is one reason why men often don’t recognize that they are depressed – and neither do their health care providers.

Don’s fate is all too common for depressed men, whose illness often goes undetected and untreated. However, such a tragic outcome can be avoided. Knowing and investigating the signs and symptoms of depression in men is a critical first step. Furthermore, being aware of and able to connect men to various treatment options can positively impact the lives of men and their families.

In our experience, all-male group therapy may provide men with a safe environment to discover and express intense and vulnerable emotions associated with their depression, and allow them to connect through their shared experience. They offer men an opportunity to connect with other men and regain a sense of purpose and well-being.

Realizing the potential for helping men with depression or other mental health issues will, of course, depend on men’s willingness to acknowledge that asking for help is a sign of strength, not weakness. When men do seek help, it is also important for us as mental health professionals to be aware of our own values and biases about men because these attitudes influence treatment. The growing number of men’s health organizations focusing on research in men’s health will play an important role in creating awareness and promoting social acceptability of mental health issues among men.

Dr. John Ogrodniczuk is an associate professor in the Department of Psychiatry at the University of British Columbia. Dr. John Oliffe is an associate professor with the university’s School of Nursing.

Suffering silently: Health services fast facts

One of the biggest differences between men’s and women’s health is their respective use of health services. According to Statistics Canada’s Canadian Community Health Survey on Mental Health:

10% of men experienced symptoms of the surveyed mental health and addiction issues, compared to 11% of women. (Other statistics show that 4 of 5 suicides are male.)
Men are 1.5 times less likely than women to turn to psychiatric services.
Women are twice as likely to consult a psychologist.
Women are 2.5 times more likely to turn to a general practitioner.

When the going gets tough, the tough get help: Resources for reaching men

American Men’s Studies Association
A forum for researchers and practitioners to exchange information and gain support for work on men and masculinities. You can also link to the 2009 conference, held in Montreal, Quebec, to see what Canadian researchers are doing in this area.

HIMM: Health, Illness, Men and Masculinities
This group of Canadian researchers focuses on masculinity as a social determinant of health.

Men and Depression – National Institute of Mental Health
This section includes resources for health care professionals, including screening tools, information about treatment options and a link to its national awareness campaign, Real Men. Real Depression. On the website, search the term “men and depression.”

Men Get Depression
This U.S. education and awareness campaign aimed to increase knowledge, reduce stigma and promote screening and treatment for depression and educate the public about depression and suicide risk in men.

Men’s Health Forum
This UK-based organization recently released a report, Untold Problems: a Review of the Essential Issues in the Mental Health of Men and Boys. In developing of a guide on how to meet the mental health needs of men identified in the report, the forum invites people to submit suggestions. For the report and to submit ideas, choose “Issues” and then “Mental Health.”

Men’s Health Research Program – University of British Columbia
This program studies men’s depression and men and smoking, among other health topics.

Men’s Mental Health – Mind
The British mental health organization Mind provides information for professionals who work with men experiencing mental health issues. Also read about Mind’s Get It Off Your Chest awareness campaign for men’s depression and the resulting report about men’s health-seeking behaviour. On the website, search the term “men’s mental health.”

Society for the Psychological Study of Men and Masculinity
Division 51 of the American Psychological Association publishes the journal Psychology of Men and Masculinity. Also visit the website of the APA’s 2nd National Psychotherapy with Men Conference, held this month, to see what is happening in the field.