Dr Chido Rwafa Mental Wellness
As discussed in previous articles, mental health is defined as a state of well-being in which an individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a meaningful contribution to the community.
The mental well-being of men is not often talked about but is critical for our families, communities and for society as a whole to function optimally. Men too can be affected by common mental health problems.
One common challenge faced by many men but not always recognised is depression.
What does depression look like in a man?
Many of the symptoms of depression are similar between men and women and these can include a sad or low mood, fatigue, loss of motivation, poor sleep, changes in appetite, poor concentration, low self esteem, feelings of helplessness, feelings of hopelessness and at its worst thoughts of death and suicide.
There are some symptoms that may be more prominent in men and these may not always be recognised as typical symptoms of depression, this can lead to many men misunderstanding what will truly be going on while their friends, family and colleagues may also misread the situation as well.
Some symptoms that may occur with depression in men include:
- Frustration, irritability, anger and aggression: some men may struggle to express many emotions and may be socialised to act out rather than to express sadness, show grief or to allow themselves to cry or be tearful. When experiencing depression, some men may become easily frustrated, may become irritable more often, may struggle with managing their anger and feel excessively aggressive. This may then result in hostile treatment of others, harsh words and sometimes even violence in homes which unfortunately can result in further social isolation and worsening of the depression.
- Alcohol and substance misuse: While alcohol and substance use can be mental health problems on their own, misuse of substances can be an outward expression of deeper problems like depression or anxiety. Alcohol and substances can sometimes be used to “self- medicate” the emotional pain, sadness, insomnia and hopelessness of depression. Alcohol and substances can be used to try and build up bravado or self esteem or to overcome anxiety or cope with helplessness. Unfortunately, when a man starts to misuse alcohol and substances to try and cope with depression they will often be misunderstood. They maybe further stigmatised as alcohol and substance abuse is often misunderstood as a moral failure. This can make it even harder for men struggling like this to get the help that they need.
- High risk behaviour: Depression in men may manifest as high risk, self-destructive behaviour. This can be seen as speeding while driving or sometimes as road rage.
Some men may engage in risky sexual behaviour. Some may engage in high-risk investments. Some men may engage in escape behaviour in mistaken attempts to deal with their emotional pain. This may be excessive spending or extramarital affairs/cheating. Again, these behaviours may be misunderstood by men themselves and those around them making it difficult to get to the root cause of these issues and to deal with the depression itself.
- Emotional numbness and detachment: Depression can cause some men to struggle to connect with others emotionally. They may feel emotionally numb, unable to feel emotion and to express emotions. They may become emotionally detached from friends and family and this may result in breakdown of relationships and a deepening of the feeling of isolation again making it difficult to reach out for help.
- Avoidance behaviour and overworking: Some men with depression may recognise that they maybe struggling emotionally but will tend to avoid the problem, they may avoid talking about or avoid any deep conversations that may address the challenges.
Some men may bury themselves in work (over-working).
Working excessively is often rewarded in society so this may make it harder to recognise this as an avoidance behaviour which may be rooted in depression.
- Suicide: Up to 800 000 people die from suicide each year globally and sadly, rates of suicide cases are twice as high for men compared to women. More women attempt suicide, but more men actually die by suicide. These are preventable deaths that result from unmanaged or poorly managed depression in many cases. Other risks for suicide include alcohol and substance use and poor social support. Men with depression are less likely to be diagnosed and managed appropriately due to a number of reasons and thus can sadly turn to suicide to end their emotional pain even though help is available.
What stops men from getting help when struggling with depression?
There are several barriers that can prevent men from reaching out for help and from accessing help for depression and other mental health problems.
These can include internalised gender stereotypes, social and cultural expectations.
Traditional gender roles and expectations can mask depression.
Men are often expected to be “strong” and “in control” and this may make it difficult for men to acknowledge when they are feeling emotionally overwhelmed.
Men’s emotional pain can sometimes often be belittled, men are often expected to contain their pain.
Whether it is at a funeral or if it is after a heartbreak, men are often discouraged from crying or they are seen as weak if they do.
This creates a barrier, preventing men from getting the help they need when in emotional distress.
Men generally struggle with poor health consciousness and poor health seeking behaviour.
Again, this may be due to social and cultural expectations that men must be strong and suffer in silence. This may mean than men may only come to health centres when they are very ill. Men are also less likely to get routinely screened for depression and other common mental health problems as compared to women. This again becomes a barrier for men to get timely help.
Positive masculinity and the journey to mental well-being for men.
Masculinity does not mean that one should not seek help. In fact, it is a sign of strength to be courageous enough to reach out and seek for help when in distress.
As a man you may not feel comfortable opening up about your emotional pain to many people, but you are encouraged to have a few trusted, close friends who you can be open and vulnerable to, you can also contact your nearest health care provider for help.
If you or a man you know maybe struggling with depression or emotional distress, please reach out for help.
It is okay to acknowledge when you are not okay even as a man. Masculinity is also modelled.
Men learn to be men from other men, boys learn about masculinity from older men.
For men to learn to become more emotionally aware and emotionally vulnerable, it is important that we start to see role models for positive masculinity and to re-imagine social and cultural support systems that help men address emotional challenges.
We need to reflect . . . are we creating spaces in our families and communities that are safe for boys and men to express themselves when they are in distress? What social and cultural expectations on men can we change to allow men to truly be mentally healthy?
Look out for next week’s article as we continue to demystify mental health and wellness when we will unpack depression in women.
l Association of Health Care Funders of Zimbabwe (AHFoZ) article written by: Dr Chido Rwafa Madzvamutse, Consultant Psychiatrist. Cell +263714987729)
(www.ahfoz.org ; ahfoz@ahfoz.co.zw)