Men and Mental Illness -- Subtle Signs to Look For
A new report from the Centers for Disease Control and Prevention (CDC) revealed that nearly four times more men than women take their own lives -- a statistic I found breathtaking, all the more so when doing the math reveals that 75 men and boys kill themselves each day in the US. It has always seemed that women are more likely to suffer depression or mental illness -- and if you don’t agree with that statement, what names come quickly to mind when you think of celebrities with depression? Princess Diana, Marilyn Monroe, Brooke Shields and more. What characters are you likely to see in the role of "a person who needs help coping with life" on all those TV commercials promoting antidepressants? A woman. And in real life, when you hear the phrase "nervous breakdown," to whom does it usually apply? Yup -- a woman.
But that’s all anecdotal, not scientific. With the CDC’s new suicide numbers, it’s very clear that we have a cultural gap in our understanding of mental health in the US. Given the link between suicide and depression, the high rate of suicide among men is evidence that men’s depression is either not being treated or is not being treated effectively.
When I contacted Will Courtenay, PhD, an Oakland psychotherapist who is affiliated with The Centers for Men, Young Men and Boys at Harvard Medical School’s McLean Hospital, he told me that while extensive research of national databases suggests otherwise, the truth is that males are equally vulnerable... and sometimes actually more vulnerable to mental and emotional problems from early in life. He said there is a "cultural blindness" underlying the belief that males are stronger than females not only physically, but also mentally. In fact, Dr. Courtenay said, "Boys are at much greater risk than girls for many types of mental disorders." Examples of mental disorders that affect boys in greater numbers than girls are dyslexia, autism and attention deficit hyperactivity disorder (ADHD). And, said Dr. Courtenay, "Boys are also less likely to receive the care they need. For example, among children and adolescents ages nine to 17 years who are depressed, boys are less likely than girls to receive professional help."
Manning Up to the Facts
Nonetheless, even though it’s widely acknowledged that depression is rampant in our country, Dr. Courtenay noted that there’s more of a stigma attached to it in men because it’s seen as a sign of weakness.
These past few years have added fuel to this fire, because the recession has left many more men without work or facing the threat of joblessness. Men who have served in the military are also suffering post-traumatic stress disorder in record numbers. And it’s not just celebrities like Charlie Sheen or Mel Gibson who rant and throw public tantrums -- Dr. Courtenay said that such behavior is a common manifestation of men’s depression. Sometimes the irritability, anger and impulsiveness turns into violent behavior that includes not just temper tantrums and road rage but also domestic abuse.
Where women often turn to one another when suffering emotionally, men are generally less comfortable doing so -- as a result, said Dr. Courtenay, men often deal with depression by drinking and socializing with their friends less. Lacking support and feeling isolated, they become even sadder and more alone.
Truth In Numbers
If you need further convincing, here are some figures from the recent report by the CDC:
In the year studied, 2007, there were 34,598 suicides in the US -- 27,269 by males and 7,329 by females.
Among ages 15 through 19, 1,221 males committed suicide, compared with 260 females.
Among people between the ages of 20 and 24, 2,260 men committed suicide compared with 399 women.
In no age group did more women than men take their own lives.
What to Look For... What to Do
Dr. Courtenay said it is important for men (and the women who love them) to be on alert for feelings and behavior that can be symptoms of mental problems -- including hopelessness... inability to sleep... irritability... outbursts of anger... incidents of aggression... and even frequent headaches or other physical symptoms with no medical explanation, as these often are associated with factors contributing to chronic depression. Especially worrisome: Any addictive behaviors, including those involving gambling, pornography, sex, overeating and, of course, abusing drugs and/or alcohol.
It’s true that everyone -- male, female, healthy or unhealthy -- feels sleepless, irritable, anxious and/or frustrated from time to time. I asked Dr. Courtenay how partners can recognize a deeper problem and then help. In general, he said, seeing a qualified mental health therapist is the best course for a man who is depressed or who may be heading that way...
Watch for signs of the symptoms mentioned above that go on for some period of time.
Encourage him to go for a consultation. As a general rule, avoid using the word "therapy." Instead, say something along the lines of "It could be a smart move to get a consultation" or "Everyone needs a teammate or a coach sometimes" or "It really makes sense to speak with an expert." Ironically, Dr. Courtenay said, one way to get some men to agree to try therapy is to play to their image of themselves as tough -- by essentially asking them, "Is it more manly to avoid dealing with a problem or to face up to it directly with the best tools available?" The answer is obvious -- "man up" and see a therapist!Let him know that the costs (risks) of untreated depression can be great -- he probably doesn’t realize this. And when educating men, the key is high information with low pressure. So, put some articles on his nightstand. If he just begins to think about getting help, he doubles the chance that he’ll actually do it.
For parents with boys who might have problems, Dr. Courtenay said...
Be aware of these behaviors: Withdrawal, aggression, doing worse in school, or a sudden change of interests.
Keep in mind that boys are highly unlikely to confide in their parents about psychological problems. Few would say directly, "I’ve thought about killing myself."
At the first sign that a boy is struggling, ask what’s going on. Communicate that it’s OK to ask for help. Boys may be more comfortable speaking with someone other than a parent. If that’s the case, don’t take it personally. Encourage your son to speak with a trusted adult friend, a school counselor or a therapist who has experience working with boys of his age. It’s a sign of strength -- your own and his -- to get help when you need it.
Will Courtenay, PhD, LCSW, a psychotherapist in private practice in Oakland, California. He is founding editor of the International Journal of Men’s Health and author of Dying to Be Men: Psychosocial, Environmental, and Biobehavioral Directions in Promoting the Health of Men and Boys (Routledge). Dr. Courtenay’s latest project at The Centers for Men, Young Men and Boys at McLean Hospital, Harvard Medical School, Belmont, Massachusetts, is research into postpartum depression in fathers. http://www.themensdoc.com/.