An Epidemic of Male Suffering
June was Pride Month, celebrated in many countries around the world. Less well-known, and far less well-publicized, June was Men’s Mental Health Month. “What?” you say. “There’s a month dedicated to Men’s Mental Health? Why?”
Consider a couple of statistics. Worldwide, men are just ever so slightly more than 50% of the population. If you exclude China and India from those numbers, men are just under 50% of the population. At the same time, men account for three quarters or more of all successful suicides, at the rate of one every minute of every day. In the US, Italy, and Brazil, it’s 80%, with France, the UK, and Australia not far behind. In Australia, among males aged 15-44, the leading cause of death is suicide.
What’s going on? As men, we are taught from a very early age to suppress our emotions, that we must be tough (“boys don’t cry”), that expressing our feelings or needing emotional support is weakness, and so on. And these are expectations of masculinity that are drummed into us repeatedly from the very beginning of our lives, as therapist and author Terry Real describes in his seminal book on male depression, “I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression"[1]
We begin sending boys the message that they have fewer emotional needs than girls in the very first moments of life. One research team studied parents’ responses to newborns in the first twenty-four hours after delivery. The researchers selected newborns that matched in weight, length, alertness, and strength, so that there were no significant differences between boys and girls. Nevertheless, both mothers and fathers perceived newborn sons as: “more alert, stronger, larger featured, more coordinated, and firmer.” They saw baby daughters as “less attentive, weaker, finer featured, less coordinated, softer, smaller, more fragile and prettier.”
In a classic study in the field of gender research,[2] John and Sandra Condry videotaped the reactions of a nine-month-old infant to various stimuli: a teddy bear, a jack-in-the-box, a buzzer, and a doll. They played the ten-minute tape for 204 male and female adults who were asked to interpret what they had seen. Some were told the baby was male, others in the group were told it was female. The adult subjects saw the crying “girl” baby as frightened, but when they thought they were watching a boy, they described “him” as angry.
While we may not think of these differences in how we see and treat boys and girls as significant in any meaningful way, in fact, they can lead to long-lasting psychological and physical challenges in adult men. We are taught that, as men, we should not express sadness, fear, or vulnerability, because expressing those emotions is weakness. “Masculine” emotions like anger or frustration, which seem like more traditionally “powerful” emotions, avoid the perceived risk of admitting vulnerability.
Yelling at your kid leaves a scar you can see on an MRI. An actual, measurable scar, smaller gray matter in the prefrontal cortex and amygdala, the exact same pattern researchers used to only find in cases of severe childhood abuse. Here's why it happens: The amygdala is your threat detector, the evolutionarily ancient part of the brain responsible for the flight or fight response. In a developing brain, it's still being built, and it's built by use. Every harsh yelling episode fires it. Occasionally, that's fine. The brain is designed to handle acute stress. But regular exposure turns occasional use into overuse. And a region that gets overused during a developmental window activates more. It gets physically remodeled, smaller and less capable of returning to baseline.
Psychologists and therapists have only in the last twenty-five or so years begun to understand that these differences, especially repeated and compounded over a period of years, are repetitive traumas – not Trauma with a capital “T,” like sexual abuse, or witnessing a horrific event, but traumas, nevertheless. And those traumas, especially starting in early childhood, create the same lasting damage, the same neuro-physiological effects as more obvious capital “T” trauma. This kind of chronic trauma is called Complex Post-Traumatic Stress Disorder, or C-PTSD.[3]
There is a silent, mostly unrecognized, and untreated epidemic of suffering by men. Silent because even the men, especially the men, are unaware that they are suffering, apart from some nebulous feeling of stress, dissatisfaction, or unhappiness, and no awareness of what lies at the root of it all. An epidemic, because the sheer number of men suffering is far greater than we realize.
Multiple research studies done by the National Institutes of Mental Health (NIMH) and others have shown that there is no significant difference between men and women in the incidence of childhood trauma. Yet women are nearly twice as likely as men to be diagnosed with Complex PTSD,[4] and more likely to recognize, talk about, and seek treatment for depression. Why has it taken so long to figure out? As Terry Real says in “I Don’t Want to Talk about It,”
“Understanding that innumerable small acts of passive trauma are driven by images of masculinity requires of us an act of conscious deliberation. Like fish trying to get a good look at the water they swim in, we find it hard to keep in focus the passive injuries we inflict on boys, because they are both so subtle and so common.”
The “traditional” characterization of what it means to be a man – that definition of masculinity that says that men are providers, aggressive, privileged, physically strong, hypersexual, and unemotional drives men to the pursuit of success and power, and that exacts a high toll on them. Because they’ve been taught to suppress their emotions from a very early age, the pressure and stress lead them to turn to alcohol, drugs, affairs, and other self-destructive behaviors. It is these many millions of men who suffer from undiagnosed and untreated depression. From their number comes those who, when they can’t cope any longer, choose to end their suffering by ending their lives.
What can be done about this silent epidemic? Healing suffering first requires recognizing that it is suffering and unearthing its source. Only then can you begin to take steps toward healing.
In the next installment of this series, we’ll look at what’s involved in healing from childhood trauma.
Healing from Childhood Trauma
In the first article in this series, we talked about the societal and cultural norms that define masculinity, the prescribed roles of men as provider, protector, and leader, and the taboo against feeling or showing emotion, except for so-called “masculine” emotions, like anger. And we touched on the lifelong negative impacts of unrecognized and unhealed childhood trauma in men.
Letting go of the “you” that you created to survive.
Language is how we create and evaluate every experience in our lives, and the language we give to our experiences quite literally wires circuits in our brains. A critical part of healing from childhood trauma is giving different language to those experiences.
Healing and reparenting the little boy inside you is not simply about understanding your pain as a jumping off point to stepping into your power as an emotionally mature man. That little boy was hurt! And he developed strategies to cope and protect himself that kept him safe and that no longer serve you as an adult.
For me, it was becoming a people pleaser in the extreme and finding my sense of self-worth in what other people thought about me, rather than within myself. And it was about an unending quest for excellence in everything I did, because nothing short of excellence was ever acceptable to my father. Excellence across the board was the only acceptable standard.
Your little boy needs to be held and comforted in all the ways that you were not. He needs to be reassured that it’s OK to hurt, it’s OK to cry, it’s OK to be angry and sad about all the things he didn’t get. And he needs to be acknowledged and honored. How much strength must he have had to protect you all the way into adulthood! But the strategies and coping mechanisms he created to protect himself are not serving you as an adult. A surprisingly simple and powerful way of doing that is visualizing a conversation with that little boy you were.
Close your eyes, take a deep breath, and find your little boy inside you. Invite him to come and sit on your lap, and reassure him that it’s safe. Tell him that you understand his sadness and his anger, and that it must have been a gargantuan task for him to protect himself, and you. Look him in the eyes, tell him that you love him, and thank him for all that he has done for you, and let him know that he doesn’t need to do it anymore. Reassure him that it’s your turn to take care of him, and he no longer needs to watch over you and protect you. Release him from that responsibility. Let him go! For something new to live, something old must die. Your little boy is long overdue for rest from his labors. He will always be a part of you, and you will always hold him dear in your heart. But it’s time to let him off the hook, to let him retire, to allow him to relax.
When I did this exercise myself, I laid that part of me to rest. I had a wake. I gave him a eulogy. I spoke to him with admiration for his strength, and immense gratitude for protecting me. And, in my mind’s eye, I lay him in a coffin, closed the lid, and lowered him into the ground. He’s still very much a part of me. I would not be the man I am today without him. Now, I build upon the foundation that my little boy laid for me as only an adult can do, rather than making him continue to carry that burden.
The process of connecting to your little boy, understanding him, acknowledging him, honoring him, and letting him go is full of emotion. There will be sadness – sadness about what he experienced, sadness about understanding how hard he worked to keep you whole, sadness about letting him go. There may be anger – anger at how he was treated, anger with your parents, perhaps even anger with yourself for not noticing sooner and sparing him all those years of hurt. There will be joy – joy that he is finally getting what he has needed from you, joy that you have released him from his enslavement as your protector, far beyond what should ever have been asked of him, joy that you get to care for him, rather than the other way around. And there will be joy and wonder as you begin to see the immense opportunity in front of you to become the man you knew you always could be and wanted to be. You are the hero of your own story. It’s time to step into your power.
In the final installment of this series, we’ll talk about how to help the men in your life who are struggling with things they may not understand themselves.
Helping the Men in Your Life
Many men who are depressed don’t know it – their depression manifests as anger, irritability, isolation, or aggression instead of sadness. They themselves, their families, friends, and even their doctors may not always recognize their anger or aggression as symptoms of depression. About one half of all diagnosed depressions initially present predominantly or exclusively with physical symptoms. Many of these depressions are not only not recognized or misdiagnosed, but also ineffectively treated. By comparison to men, many women with depression present as sad, or express sadness.
Men with depression may feel very tired and lose interest in work, family, or hobbies. They may be more likely to have difficulty sleeping than women who have depression. Sometimes they mistake mental health symptoms for physical symptoms. For example, a racing heart, tightening chest, ongoing headaches, or digestive issues can be signs of a mental health problem, but often, men who experience these symptoms will see their doctor about the physical manifestations rather than psychological symptoms.
Therapist and author Terry Real calls that unrecognized and undiagnosed depression “covert,” hidden in a man’s unconscious mind, whereas overt depression is visible and recognizable for what it is. Real further explains that the only way out of covert depression is overt depression, which explodes into consciousness when a man’s covert depression can no longer be contained within his unconscious mind. Those close to men – their loved ones, doctors, even psychotherapists – may miss a diagnosis of covert depression, and a man often camouflages his condition not just from those around him, but even from himself. That is not a willful, intentional camouflage, but an unconscious one. It’s just not OK as a man to feel vulnerable or express vulnerability. These men are never diagnosed as depressed because their depression is covert, hidden deeply in their unconscious mind. Other men fail to get help because their expression of the disease does not fit the classic model of depression as described in the Diagnostic and Statistical Manual of Mental Disorders.[5]
These men’s depression, hidden from those around them and from their own conscious awareness may lead them to behaviors that seem out of proportion or incongruous with what’s really going on. They bury themselves in work, they may wrap their frustration in anger or numb it with alcohol or recreational drugs, or they are adrenaline junkies, dangerously pushing the limits in their sport or physical endeavors.[6] Having learned as boys that they must not bring vulnerable feelings into the open fosters behaviors that leave them ever more disconnected from the people around them. As fathers, they may long to be involved more deeply with their children – to be the kind of father their father was not. Unfortunately, their unrecognized and untreated mental health struggles often lead them to, paradoxically, reenact the very drama with their children that they themselves experienced as children, and desperately wish to avoid.
Many of the difficult behaviors in men’s relationships are driven by their depression. The concepts of “masked depression,” “underlying characterological depression,” and “depression equivalents” have been written about sporadically for years but have rarely been systematically studied. Martin Opler, an American anthropologist and social psychiatrist, observed in 1974, “Masked depression is one of the most prevalent disorders in modern American society, yet it is perhaps the most neglected category in psychiatric literature.”[7] That neglect continues. If overt depression in men tends to be overlooked, covert depression has been rendered all but invisible.
So, what can you do?
First off, be aware of the signs that a man in your life may be depressed. That can often look different from a woman who is depressed. A depressed man may be uncharacteristically irritable, may seem withdrawn and isolated, may have lost interest in work, or in activities that he typically enjoys. He may seem unable to uphold commitments or responsibilities that he previously was always on top of.
There are several things you can do, and things you shouldn’t.
Things you can do:
· Let him know you’re available to support him. Because men typically don’t ask for help, being willing to sit with him and listen can mean the world to him. Don’t assume that because he’s your husband or father or best friend, he knows you’re available to support him.
· Practice Active Listening. Maintain eye contact, giving him your full attention. Ask him open-ended questions, paraphrasing what he says to show that you understand what he’s telling you. The more you can do this, the more comfortable he will be sharing his thoughts, feelings, and struggles with you.
· Encourage him to seek treatment, and offer to help him find treatment options. Depression is not something he can treat by himself, and you can’t treat him, so gently guiding him toward seeking professional help will be a huge service to him.
· Know what the warning signs of suicide are. Not only can you potentially save his life, but you will also know when it is crucial to say something or seek help on his behalf. Remember that 80% of successful suicides are by men. Some of the common signs to look for include:
o Complete social withdrawal
o Talking about suicide, death, or dying
o Acquiring a firearm or other means to die by suicide
o Giving away money or belongings
o Saying goodbye to people with a sense of finality
o Increased use of alcohol or substances
o Increased risk-taking behaviors
If you are concerned that a man in your life may be suicidal, voice your concern to them and ask if they are thinking about suicide. Asking does not increase suicide risk but does increase the likelihood they will get help.
· Stay Connected. Staying connected with your male loved one can provide the support they need to make it through their symptoms, or even just feel like they are not alone. Loneliness can worsen depressive symptoms, so checking in on your male loved ones goes a long way. Continue to engage in activities together and maintain social connections. Isolation can worsen depression, so encourage him to stay connected with friends and family while respecting his need for space when necessary.
· Be patient. There can be periods of improvement followed by setbacks. Don’t rush him or have unrealistic expectations for a quick recovery. Instead, be consistent about offering support and understanding. Give him positive feedback on the things you see him working on or improving, and if he gets discouraged, remind him that it will take time, and you’re there for him.
· Check in regularly, but be aware of respecting his boundaries. Consistently checking in on how he’s doing will help him feel supported. But, while you can make yourself available to listen, spend time with him, and offer support, it is up to him to share his thoughts and feelings with you, and accept your support. Be a faithful friend while giving him the space he might need to work through things with the help of a therapist.
Things you absolutely should not do:
· Above all, don’t minimize or invalidate his feelings. Don’t pressure him to just “snap out of it” or dismiss his struggle with platitudes like “just think positive thoughts.” This can increase his sense of isolation and hopelessness. He could possibly believe that you don’t understand what he is going through and may not be open to learning. Try not to get frustrated and give up or avoid him, as this can have the same effect.
· Don’t think it’s your responsibility to “fix” him. It’s not, and you can’t. Trying to fix him implies that there is something damaged about him. He is not your project, but someone to encourage and support.
· Never ignore or minimize warning signs of suicide! If you see behavior that concerns you, talk to him about it or seek some professional support to address it. If he is openly talking about suicide or death, take it seriously and communicate your concerns. If you need help, call the suicide hotline in your area.
· Don’t minimize his feelings by saying things like “It’s not that bad,” or “You’re overreacting.” This can deepen his sense of isolation and helplessness, making it less likely that he’ll open up or seek help. Instead, try to acknowledge that what he is experiencing is significant to him, and provide a safe space for him to talk about it without judgment.
· Don’t offer unsolicited advice! Ask if he would like some help or to think things through together. This can help him realize that he can trust you, that you’re not going to try and rescue him, but rather hear him out.
Male depression, as with all depression, is an insidious affliction. For men, in particular, depression can be much more dangerous, precisely because men, having been taught not to feel hide their depression, even from themselves. In the saddest cases, that unrecognized depression ends in a man taking his own life to escape his pain. Understanding the specific characteristics of male depression, and all the dark tunnels and hidden places that comprise it, and supporting the men in your life to discover their wounds and heal them is an invaluable service, not just to them, but to all of the people who love and care about them, and to the world.
[1] https://www.amazon.com/Dont-Want-Talk-About-Overcoming/dp/B017JP3CGC/ref=sr_1_2?crid=133A7PCQ1OPHV&keywords=I+Don%E2%80%99t+Want+to+Talk+about+It&qid=1703449017&sprefix=i+don+t+want+to+talk+about+it%2Caps%2C253&sr=8-2
[2] Sex differences: A study of the eye of the beholder.
[3] https://my.clevelandclinic.org/health/diseases/24881-cptsd-complex-ptsd
[4] Complex Post-Traumatic Stress Disorder or C-PTSD is caused by ongoing trauma that lasts months or years, often in childhood, and usually caused by a parent or caregiver.
[5] https://www.psychiatry.org/psychiatrists/practice/dsm
[6] By no means is this meant to imply that all men who like adrenaline-pumping activities are depressed!