Men - anxiety depression and suicide

What stops men asking for and getting the help they need?

Carl Webster Psychologist, Psychotherapist Sydney and Illawarra
0424650 630

I recently attended a funeral of a friend's son, a 34 yr old single man who fell or jumped from a
cliff.    His friends and family said that over the past two years he had begun to withdraw from
social contact, had lost the girl he loved and had been dealing with some other physical and
vocational issues.  His symptoms and behaviour suggested he was suffering from depression
and/or anxiety, yet he had been resistant to asking for help.  He was one of more than 2500
Australians who will die this year from suicide and 75% of them are likely to be men . As a
psychologist I know from my practise that numbers of men of all ages are turning to health
professionals for help with social, emotional and psychological issues, but many men still are'nt.  
These I think, are some of the reasons why.

Fear is one of our most primitive reactions and has been vital to our evolution.  When we feel
threatened in some way for whatever reasons, we are likely to have a psycho-emotional  or
neuro-physiological reaction of 'fight or flight'.  Our survival mechanism wants us to run and
hide, or get out there and 'do' something that will deal with the problem.  When we are
experiencing fight or flight, we are likely to be aroused, tense, anxious and stressed.  We are
unable to think clearly and may lose our perspective.  Unfortunately, suicide may present itself
as a way out of our problems when in fact it is no-win for everybody in most cases.  My friend's
son had a likely 50 years of life ahead of him.

Shame is perhaps the hardest feeling to tolerate.  We feel shame when for whatever reason we
feel stuck, helpless and unable to respond to ourself and to others in an assertive way.  We may
believe we are to blame, we may feel intimidated by others or judge that no-one cares for us.   
Our fight/flight response may look more like 'freeze' and we are overcome by anger,
frustration and helplessness.  We may lose perspective and believe there is no way out of the
situation except by directing our frustation and helplessness against ourself.

We tend to think of trauma as an acute episode such as a car accident or being attacked.  
Trauma may occur in one episode and may involve illness, surgery, relationship break up, losing
one's job or even moving to a new location.   Yet trauma can also build up over time due to
repeated incidents and then become chronic trauma.  There may have been family problems in
our early years, we may have felt neglected, manipulated or intimidated.  We may have suffered
abuse, illness or disability, learning difficulties or witnessed excessive conflict or violence.  We
may have felt guilty or ashamed for what was happening to us or those around us.  Trauma in
whatever form it comes in, can become internalised and result in ongoing symptoms such as
anxiety, depression and social withdrawal.

Self blame
We know when we don't feel good and when there is something wrong.  If our car
down we are likely to seek help at the garage, but when we feel WE are breaking down, a not
uncommon response is to keep pretending we are OK and avoid admitting it to ourself or other
people.  (cf Fear, shame and trauma).  As adults we want to feel in control and able to look after
ourselves, to fix our problems and not be overly dependent on others.  Unfortunately the weight
of our own expectations (often reinforced by others at home, at work and by friends) can often
lead us to blaming ourself for having the problem in the first place and also blame ourself for
not being able to fix it.  'We don't like how we feel' becomes 'we shouldn't feel like this' (and
it's our fault).   Losing perspective we may judge ourself as a failure, as hopeless, useless and
not good enough.    How many of us seriously want to admit having those thoughts to anyone
else?   Yet humans fail often, we all make mistakes and we are all dependent on others.  
Consumer society creates expectations of material success,  constant happinness and wish
fulfillment.  Yet many children grow up feeling criticised, judged and overly responsible for the
failings of others.  Educational institutions are not perfect, our skills aren't all the same and
employers aren't always reasonable, fair or sometimes even available.  We do need  to take
responsibility for our actions but that doesn't mean we should always blame ourself when
relationship or circumstances go against us.

We all don't like feeling bad or unhappy and alcohol provides a convenient and socially acceptable
way of numbing our feelings and thoughts.  Unfortunately it tends to keep us avoiding facing up
to our problems and taking responsibility for doing something about them.  We know when we are
over the limit to drive and if we are drinking to excess then we will not think straight, feel our
feelings or maintain perspective.  Alcohol may make us feel slightly better in the short term but
its  continued excessive use is likely to depress our mood and make us feel worse and magnify
our problems.

We are social creatures and generally need and enjoy (at least some of the time) the company
of others.     Losing a long term relationship can be devastating and even more so when children
are involved.  Finding friends with whom we can be real,  frank and emotionally honest can be
difficult.  Men have traditionally been less communicative than women and more likely to hide
their feelings from other men.  Yet men are human beings, they are sensitive, emotional and can
sometimes be vulnerable.   Sometimes the best person (including a health professional) to talk
to for men can be another man.   

To ask for help is weak
This can be a particular problem for men.   Evolutionally, men have relied on brains and brawn.  
They have often needed their physical strength to fight and sometimes flee, to hunt and grow
their food, build and protect their shelters and compete for mates.  Men have fought and died in
many wars and can still die on some jobs.  Society and the media still overvalue the conquering
hero (cf Hollywood, the pay of CEOs and the pay gap for women doing the same jobs).  Society
and some individuals still like to blame weaker others for being a problem (cf   noisy children,
teenagers, women, refugees, drug users).  Society says its good to succeed, its not ok to fail.  
By this reasoning we have to stay strong, be independent and avoid admitting we are not coping
at all costs.  Unfortunately by avoiding our own embarrassment, fear, shame and problems we
can only go on to judge ourself as weak and a failure.  It takes real courage to accept and admit
that we aren't feeling good and would like some help.

A few pointers
Like many others, my friend's son had some fears about consulting a health professional.  He
may not have wanted to be medicalised, labelled, pathologised and drugged.  He may have
witnessed or had negative experiences in dealing with health professionals.  He may have been
scared of being not listened to, patronised, judged and dismissed.  We are all entitled to
respect, to be listened to carefully and given information and options.  Health professionals are
there to serve us.  Finding the right person may mean trying out more than one person.  Having
anxiety, depression and suicidal thoughts doesn't have to mean automatically taking medication.  
We have the right to choose who we talk to and what treatment we receive.  If one professional
or treatment isn't working then we should seek out other people and other treatments.  If its
good enough to do all this for our tractor, car, washing machine or computer, its got to be good
enough for us.  We deserve to look after ourself and each other in the best way we can.