Boys, do cry: why men won’t talk about their mental health

When I last saw my father before the stroke that would eventually take his life in 2011, something was amiss. He appeared as if he had become weary, and I sensed a certain negativity in his outlook. He was quieter and when he spoke, he peppered his speech with apologies for what he thought he hadn’t done for the family, and with regrets about what he had supposedly done. He was being hard on himself.

My father was a self-made man who rose from dire poverty to establish himself professionally, eventually carrying out far-reaching philanthropic work for his community. And yet, he appeared disappointed and, worse, unwilling to talk about it.

The irony doesn’t escape me as a mental health professional. If there is one regret I have, however, it is that I didn’t push him enough to seek help at the time. He wasn’t one to talk much about his mental health, even though it was obvious to others that he needed to.

On October 10, we mark the World Health Organisation’s World Mental Health Day. This year it is particularly significant as we are now, finally, coming out of what has been a catastrophic global trauma in the form of the Covid-19 pandemic. We are trying to get to grips with its social, psychological and economic ramifications. Researchers in the field think we are at the precipice of a mental health pandemic, the full effects of which are yet to be felt. The WHO reported in March that the pandemic triggered an increase in the global prevalence of anxiety and depression by 25 per cent.

Even in normal circumstances in the UK, where I previously worked, three quarters of suicides recorded were in men — the most vulnerable being those aged 45-54 years. There is also evidence to suggest that men are less likely to talk about their mental health symptoms than women; a UK study last year revealed 40 per cent of men will simply not discuss the topic.

Masculinity encourages boys and men to avoid what may be considered “feminine” in social contexts. Conversely, they are expected to be tough and sometimes aggressive. This often also means men are expected to distance themselves emotionally.

By recognising these gendered expectations, boys and men unwittingly put themselves at risk of developing myriad health and social difficulties, such as interpersonal violence, substance misuse, depression and anxiety. Men are over-represented in prisons, persons going missing, sleeping rough, and being dependent on alcohol and drugs.

Stereotypes, similarly, can harm both men and women’s opportunities, including health access. For example, a mood disorder can be dismissed in women as being “just emotional” and in a man as “just being irritable and violent”. In many cultures, men grow up being taught to “toughen up” and that “boys don’t cry”. These beliefs are so permeated in societies that a lot is at stake personally and professionally for men to ask for help.

According to a host of recent studies, work pressures, financial issues and concerns about their health were the top three causes for mental health issues in men’s lives today. In many cultures, men are expected to be the breadwinners and, therefore, expected to always be in control. So it is no surprise that it is harder for men to open up.

More research by the WHO in 2019 suggested one in every eight people was living with a mental disorder. Men are certainly not immune.

Criteria for mental health disorders are largely similar for men and women. However, some symptoms of depression, for example, are more common in men than women. Men are likely to experience irritability, sudden anger, risk-taking and aggression. They are also likely to use negative coping mechanisms, such as using alcohol and illicit substances.

I wondered what would have happened if my father had talked through his issues. What if he didn’t grow up being expected to “hold it all together”? What if he were taught that men can talk about their feelings and be more of a man for doing so. In his case, we will never know.

But, to the fathers, brothers, sons, friends and husbands of the world, I would like to say this: we know you care about your loved ones, but it’s time you showed some compassion towards yourselves. Talking to someone you trust can help significantly and, if things get more complicated, there are several evidence-based effective talking therapies. There will be at least one you will find suitable and that will meet your health needs to life-changing and, sometimes, life-saving effect.

Dr Waleed Ahmed is a consultant psychiatrist at the Priory Wellbeing Centre, Abu Dhabi; www.priorygroup.ae