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December 6, 2016

The Challenge of Men's Mental Health

Reuel S. Amdur

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Boys don't cry. What doesn't kill you makes you stronger. These are among many of the aphorisms that are indicative of an ethos of masculinity that bodes ill for male mental health.

This subject was the topic of an information session at the Royal Ottawa Hospital on November 17.

Psychologist Don McCreary traced the development of public awareness and action around the problem of male mental health.  He pointed to the Kids’ Health Line in the late 1990’s as one resource that encouraged males to reach out.  Then there is the Movember movement. 

Movember began in Australia in 2003 and now is active in 21 countries, including Canada. 

Men are encouraged to grow a moustache during the month of November, and funds are raised on Giving Tuesdays, for research on men’s mental health, prostate and testicular cancer, and physical inactivity.  It has raised $23 million for research and given special attention to Aboriginal youth and those who are in prison.

There is stigma attached to male mental health problems.  Shame and embarrassment lead men to avoid treatment, but openness lessens the stigma. 

In any case, the topic is not one that has had much attention.  Another speaker, Jean-François Claude, commented on his reluctant move to receive treatment for depression four and a half years ago.  At that time, he googled men’s mental health, getting virtually no hits. 

His treatment has been of great help, and he now is reaching out to help others.  Claude initiated and continues to run the Men’s DEN (Depression Education Network, for men and their loved ones).

Talk about mental health does not always lead men with problems to taking action. 

And once engaged the person needs to keep engaged.  In case of relapse, the need is to re-engage.  This pattern applies regardless of sex, but it is more of a challenge for men because of stigma.  The stigma is social but it is also internalized. 

Citing various authorities, McCreary noted some of the barriers to seeking treatment in our concept of manliness.  Treatment is “sissy stuff.” 

A man needs to be a “big wheel,” successful, looked up to.  He needs to have an air of toughness, self-confidence, and self-reliance.  He needs to have an aura of aggressiveness, violence, and daring, a winner, never a failure.

Masculinity gives priority to status, power, toughness.  It is opposed to femininity.  Power may be exercised over other family members, as dominance.  In relation to sex, he is a playboy who pursues women as a game. 

Boys and men learn these elements of masculinity, being socialized through rewards and punishments.  While “modern” men deviate from this standard, for others the failure to accomplish the defined role may lead to anxiety, depression, and substance abuse.

Manhood is socially achieved or earned.  It is not inherent, and men work actively toward achieving it and maintaining it.  It can be lost or taken away.  It is affirmed by others, not just by self. 

Because of what men incorporate as their role, falling short of the role model may lead to depression.  They may identify the symptoms such as fatigue, irritability, low mood, and restlessness as physical.  In any case, men’s symptoms may be different from those for women and may include anger and substance abuse.  McCreary feels that there is a need to develop new tools to measure depression in men. 

For men, depression indicates shame and weakness.  There is a strong tendency to maintain the illusion of control and usefulness.  Self-isolation may give a man a way of protecting his sense of strength and control. 

The definition of masculinity that people incorporate militates against seeking help.  Often, men seek help only when their internal resources are depleted or when the depression is severe.  Yet, treatment is most likely to be successful when initiated earlier rather than later.  Men fear disclosure of emotion, making engagement in treatment difficult. 

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