Mental health stigma, misdiagnosis, and masculine stereotypes can prevent men from seeking support for their depression. Al Levin explores.
I was 41 when it seemed like my world came crashing down around me.
My first experience with depression could be what some call situational depression. It started shortly after I received a promotion at work. I had been an assistant principal in a large urban school district for several years and was being promoted to principal in a different building.
I was thrust into a new role with a great deal of responsibility. At the same time, I had a 5-year old, a 3-year old, and two new-borns at home.
It started with a knot in my stomach that wouldn’t go away, making it difficult to eat. My mind seemed to be racing all the time, and I could barely sleep.
There were times when I had no more than 10 hours of sleep for the entire week. I found myself dreading the thought of showing up to work.
Eventually I realised that I needed help. I reached out to my family doctor and also started seeing a therapist. Within a couple of months, I felt as though I was on the road to recovery.
Then the symptoms started again
Three years later, almost to the day, I experienced my second major bout of depression.
Things were going well at work and at home when I noticed, with no previous signs at all, that things were changing in my body.
I remember telling my brother, “My body feels different… this isn’t going to be good.” What I didn’t realise is that I was about to fall into a depression that made my last experience seem like a walk in the park.
Trying to sort the problem on my own
Many of my symptoms were similar, yet much stronger, than my first bout of depression.
I lost almost 50 pounds because I couldn’t eat, and I was again struggling to get any sleep at all. I had a hard time remembering things and staying focused. I avoided social settings as much as possible. I began to isolate myself. I had uncontrollable crying bouts in the evenings.
I took some time off from work, but in hindsight this maybe wasn’t the best choice. Without structure, I found my symptoms getting worse. I couldn’t get off of the couch. At this point, I started to have generalised thoughts of suicide.
Two weeks after I went back to work, those thoughts became more of a detailed plan, and the idea that I might actually go through with it seemed possible. I spoke with my family and my psychiatrist and checked myself into a three-week partial hospitalisation program.
This program was the start to my lengthy recovery. I’m happy to say that I’ve been symptom-free for four years. Since my recovery, I’ve dedicated much of my free time to mental health advocacy, especially for other men struggling with depression.
Admitting there’s a mental heath problem
Although I masked my depression for some time, as many men do, I sought help relatively early because of the sudden debilitating nature of my symptoms.
But many men continue their day-to-day lives, masking their depression for years, attempting to appear as though nothing is wrong. They often isolate and keep their feelings to themselves. And as they mask their depression, the symptoms often continue to worsen.
I often see how many boys are taught that they are supposed to be “tough.” A lot of us are taught that certain emotions (like anger) are fine, but things like fear and sadness — or anything that would make us appear vulnerable — should be kept under wraps. In my experience, those lessons followed some of us into adulthood.
Many men associate mental health issues with shame and guilt
After I completed my treatment program, I joined a support group for men with depression and continue to attend meetings to this day.
Many of the other men I’ve met there speak of the shame and guilt of having a mental illness. They’re concerned about the impression others may have of them due to stigma and the discrimination they may face if they seek professional support.
Looking back on my own situation, there was definitely shame. When I would pick up my medicine at the pharmacy, I’d look around to make sure that nobody I knew was there.
When I got home, I’d tear any documentation into pieces to make sure that nobody would find any proof that I was taking medication for depression. On the way to my therapist’s office (which was only blocks away from the school where I worked), I’d try to shield my face so that nobody would see me entering the building.
Mental health stigma is a huge roadblock to finding help
Together, stigma and stereotypes of masculinity can prevent men from seeking the support they need from a medical professional.
Paul Gilmartin of the Mental Illness Happy Hour podcast told me that he first realised he needed help after a road rage incident. He found himself in his car screaming angrily at pedestrians who continued to cross the road in front of him while the light was red.
Paul says that one of the pedestrians walked up to his window, leaned in “with a look of disgust and pity,” and said, “Son, get a hold of yourself” before walking away. That was Paul’s moment of clarity.
When I asked him why he hadn’t sought help prior to that incident, he told me that he believed his emotions were fleeting, and even so, he didn’t know how to go about getting help.
“I did a pretty good job lying to myself that I had my [expletive] together,” Paul said. “That event turned that idea upside down.”
Depression symptoms may present differently in men and women
In recent years, the scientific community has also learned that depression may manifest itself differently in men than it does in women.
A 2013 study in JAMA Psychiatry found that men experiencing depression were more likely to exhibit signs such as:
- anger attacks/aggression
- risk-taking behaviors
- substance abuse
The study encouraged clinicians to seek out these symptoms and other “alternative negative outcomes” when caring for men whose depression may be undiagnosed.
Delays in care due to stigma or misdiagnosis often mean that many men continue to suffer in silence, which can lead to disastrous outcomes.
Untreated mental health issues are a leading cause of male suicide
While more women attempt suicide, men die by suicide nearly four times more often than women.
SUICIDE PREVENTION: If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Here is a list of suicide prevention crisis centres in Europe
The question remains: How can we support men in seeking support for depression and other mental health issues?
Getting the mental health support we need
It’s encouraging to learn about clinical advancements in mental healthcare, and to see more and more work being done by various organisations toGreen Heading 2 shine a light on depression.
Those are big picture initiatives that can help a lot of people. But in my opinion as someone who’s lived with depression, I believe that we also have to start small and focus on our own communities and do the work to dismantle the stigma around depression.
More men who have overcome the challenges of depression or who are still struggling with it should share their stories. The more we’re able to have conversations around men and depression, the more likely it is that more men will take the first necessary step of reaching out for support.
Depression isn't a character flaw
For those men who are struggling, it’s important to recognise that you do have an illness — and that depression is, in fact, a medical condition and not some character flaw or moral failing. A great first step might be to share what you’re experiencing with a professional.
While nothing can replace the advice of your doctor, there are a few online resources that might be helpful as you take these first steps:
Guys, it’s OK to not be OK, but you don’t have to suffer alone. Seeking help is a sign of strength, not weakness.
Looking back at my own situation, I’m incredibly thankful that I made the decision to leave work in order to enter a program for recovery.
It was one of the hardest things I’ve had to do, but it was so incredibly worth it.
NPS-IE-NP-00039 September 2020