'… Men don't cry. In clinic when a man cries, you can see it might be the first time he's cried in a long time, and it's almost as if he's wiping the shame off his face rather than the tears. Men need to cry. And feel OK about it.' - Dr Stephen Barratt, junior psychiatrist
'Not seeking help becomes a common trait and isn't even mentioned to friends of the same gender. Like for fear of becoming seen as less of an "Alpha."' - J.R. a student
The unspoken epidemic of male suicide may find some blame in society. Despite depression, self-harm and suicide attempts being more likely in women, rates of completed male suicide grossly outweigh that of their female counterparts. Media-influenced perception of the ideal man rarely allows for emotion. You rarely see James Bond, Bruce Willis or Thor expressing much sensitivity. This article discusses the cause and burden of suicidal depression, why men are especially at risk and what can be done to save lives.
A global perspective
Depression is an increasing global burden, representing the greatest contribution to premature death for people between the ages of 18 and 44. Up to 10% of people may experience a major depressive episode in their lifetime. Onset may occur in two peaks - in young adulthood and later in life, after age 65. Men tend to be under-represented, with as few as one in 10 of those fitting clinical criteria actually seeking help. Delayed diagnosis and treatment and a number of male behavioural traits, lead to a higher suicide risk. The cause of depression is debated, but widely-accepted to be composed of biological, social, genetic and psychological causes.
Suicide attempts in men reflect those behavioural traits favoured both by society and those selected through evolution. Aggression, dominance and impulsivity are met with abrupt, irreversible and violent deaths from hanging and hand-held weapons. Male tribal and hunting behaviours become self-destructive in the modern age. A heavy reliance on drug or alcohol use often prompts attempts, with a coincidental loss in rational thinking and social support increasing risk. Men are less likely to adjust to chronic stress, develop healthy coping strategies or seek help due to societal pressures to 'man up' or 'be strong'. These evolved traits may carry a high proportion of blame for the development and worsening of depression.
The social expectation of the 'manly man' is ingrained into our culture. From an early age, men are discouraged from communicating emotions, forced into competitive fields and rewarded for brazen acts of dominance and superiority. These behavioural traits become imperative to young males, who strive for success at the cost of health. The erroneous association between self-destruction and validation becomes hard-wired. Men who show emotion or 'weakness 'are often chastised in professional fields. Chronic pressure, failure or risk of failure may contribute heavily to depression.
Men are more likely to turn to alcohol and other drugs to seek solace from depression. Alcohol is a known depressant, and addictive behaviours often worsen underlying mental health issues. This cycle often worsens depression, which is left untreated due to male fear of seeking help. Often men will continue for years, distracting themselves through different means, without actually addressing underlying issues. This is a ticking time bomb.
Fortunately, the decrease in male suicide rates over the recent years speaks of success. Men are either speaking up, or doctors are becoming more attuned to problems. In either case, communication is key in getting early diagnosis and reducing risk of suicide. The greatest barrier for most is the perceived 'weaknesses' of seeking help. By encouraging a greater societal tolerance to the very natural and real issue of male depression, we can begin to identify and help those in need. Depression is not sexist, and therapy is not weakness.
A societal change is necessary to dispel the deeply ingrained misconceptions of 'manly' stereotypes and remove the link between self-flagellation and success. Challenging generations of genetic and conditioned behaviour is difficult, but not without promise. Success is not synonymous with early death.
I encourage you to think and talk about depression, and realise that the real 'weakness' is in accepting the false rules of society. Perhaps male depression deserves as much recognition as prostate cancer or other problems. Maybe a billboard is the first step to real change? We are all in this together, for better or for worse. So speak up, we are ready to listen.
For further support and advice, visit Depression Alliance or Samaritans.
Ben is a young NHS doctor in the Southwest. His interests include neurology, health communication, and medical ethics. He is also an avid advocate of compassionate care and quality improvement, running a project in the Southwest around medical humanities. Please follow and support: Dr Janaway on Facebook Dr Janaway on Twitter
The opinions expressed in this article are the author's alone and do not reflect those of the NHS or associated agencies. All facts are based on the best available evidence. Online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice. The author is happy to receive questions. There are no conflicts of interest and due consideration has been given to the consequence of conclusion or interpretation.
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