The Stigma of Men’s Mental Health

Barriers to Diagnosis and Treatment

Mental illness was a global public health issue well before the onset of the COVID-19 pandemic, but increased stress, isolation, and social challenges during the past two years have added pressure to an already vulnerable population. Unfortunately, the persistent stigma surrounding mental health continues to present a barrier to care, particularly for men, highlighting the need for increased men’s mental health awareness.

While mental health diagnoses in women are double that of men, far more men die by suicide each year. In 2019 suicide rates among men in the United States were 3.7 times that of women. Studies suggest that depression in men is less likely to be reported and/or accurately diagnosed which may underpin this discrepancy.

The stigmatisation of mental health in western society perpetuates shame and denial which prevents people from seeking help for mental health distress. It’s estimated that in 2020 more than half of those suffering from mental illness did not receive treatment.

In addition to other factors such as accessibility and affordability, stigmatisation creates a barrier to care that affects the entire population but may have a disproportionate impact on men’s mental health. 

Anxiety and Depression in Men

Mental Health America reports that more than 6 million men in the US suffer from depression and 3 million from anxiety every year. As concerning as those numbers are, it’s likely that the available data doesn’t accurately reflect the true breadth of men’s mental health issues. Partially due to men’s resistance to acknowledging or seeking treatment for negative emotions and also to potential misdiagnosis, depression in men goes largely untreated.

Anxiety and depression in men is a serious medical issue rather than a personal failure or sign of weakness as many men themselves believe to be the case. Environmental stress that exacerbates symptoms is often related to financial and career pressure. The ability to be productive and provide for loved ones is a deeply ingrained ideal of what it means to be a man in western society. 

The pandemic appears to have made matters worse. A recent survey by the Cleveland Clinic showed that 77% of male respondents have experienced increased stress levels since the onset of the pandemic and 59% indicated that their mental health has been more negatively impacted in the past two years than during the 2008 recession. 

Depression is a treatable condition but requires that symptoms are identified and treatment is sought. When a person suffering from mental health challenges is unable to recognise their own symptoms, it’s sometimes helpful when a loved one can provide insight if they sense someone is experiencing depression. Traditional symptoms of depression include:

•  Sadness
• Flat affect
• Feelings of emptiness and being unworthy
• Loss of enjoyment or interest in things 
• Too much or too little sleep
• Loss of appetite

These symptoms may be present in both men and women who are experiencing a depressive episode. However, the behavioural manifestations tend to be different for men. When men are unable to accept that they are having negative feelings nor seek help to deal with them, they may exhibit any or all of the following:

• Avoidance of loved ones
• Heightened irritability 
• Damaging interrelational behaviour
• Increased substance use
• Anger outbursts
• Obsessive work habits
• Impulsivity and high-risk behaviour

Men who aren’t taught healthy coping skills may manifest these externalized behaviours as a result. In cases where men are willing to discuss their experiences with a clinician, the disclosure of these aspects of their distress without speaking to underlying traditional symptoms leaves plenty of room for misdiagnosis.

Men of colour and diverse ethnic backgrounds are at even higher risk for mental illness and isolation. Coupled with already existing stigmatisation, minority populations also tend to be less trusting of medical institutions and therefore less likely to seek treatment. Issues of accessibility and affordability are of greater concern in underserved communities, increasing the gravity of an already challenging issue.

What Prevents Men From Recognising Symptoms and/or Seeking Help

Cultural beliefs in western countries regarding mental health, and men’s mental health, in particular, continue to perpetuate the stigma that prevents people from getting the treatment they need. The nature of men’s mental health issues being largely unaddressed has been referred to as a silent epidemic and has become an urgent public health concern.

Socialisation and Cultural Stigma

Social constructs of gender are ubiquitous in the western world. Until recently there has been little question as to the validity of masculine and feminine roles. The way that people are socialised into these constructs often informs the way that they navigate their internal environment and interact with the world around them. 

Boys are taught a model of masculinity that idealises traits like self-reliance, strength, assertiveness, and independence. This leaves very little room for experiencing or expressing emotion without being at odds with expectations. Girls on the other hand are expected to be emotional, sensitive, and collaborative putting them in a better position to seek help when in distress. 

Men in adulthood experiencing mental health challenges are less likely to seek help because they see help-seeking as a vulnerability for which traditional masculinity doesn’t allow. In the absence of coping skills or treatment to deal with negative emotions, depression in men may lead to dysfunctional coping mechanisms that look like: 

• Concealing or ignoring negative emotions
• Increased substance use
• Interrelational aggression
• overworking

While these strategies may provide momentary relief, they do nothing to resolve mental health disturbances. For men to effectively acknowledge and seek treatment for these challenges, they need to reasonably expect to be supported rather than judged. 

Internalised Stigma

Reluctance to seek help for negative emotions may not only be the result of cultural stigmas but also one’s own judgment about what it means to need help from others. Men who have internalised the belief that mental health issues signify weakness may actively deny their own symptoms or lack awareness around them altogether. 

Without having been taught how to recognise their own feelings, accept them as normal, and seek help when appropriate, men often lack the insight and language to initiate a conversation about the suffering they experience. This results in lower utilisation of mental health services which may give the appearance that there is less need for mental health intervention in men. But more likely is representative of the need to adhere to traditional masculinity roles at all costs.

Clinical Criteria

While the causes of depression in men and women appear to be similar (environmental stress, underlying illness, genetic factors, early childhood trauma), the symptoms of depression between men and women often manifest differently. 

Current diagnostic criteria are such that traditional symptoms of depression like sadness, lethargy, feelings of hopelessness, and worthlessness are more likely to result in a diagnosis. With men often displaying more externalised symptoms including anger, impulsivity, and substance use they may be less likely to receive a diagnosis due to a mismatch between symptomology and the current criteria.

Men’s Mental Health Awareness

Increasing men’s mental health awareness to potentiate positive outcomes will likely require a shift in several paradigms. Starting in early childhood, teaching boys to identify and process their own emotions without judgment could serve them later in life. Giving children the freedom to feel and express the full range of human emotions without the confines of gender norms may decrease the self-stigma associated with men’s mental health in future generations. 

Healthy and diverse traits of masculinity must be modelled to replace toxic, stereotypical expectations. Men need to be encouraged and taught how to become aware of their own internal environment coupled with support when they reach out for help to increase accurate diagnosis and successful treatment outcomes.

In recent years social media users have taken aim at the stigma surrounding mental illness as more people publicly disclose their personal struggles. Are these outcries for a reframe around what it means to live with mental illness truly creating awareness? It’s hard to quantify and not enough research has been done to draw concrete conclusions. 

It is however clear, that online communities are emerging via social media connections where people can learn from and support each other through shared experiences of various mental health challenges. Peer support and easier access to mental health professionals via telehealth present additional support to those who may be reluctant to physically access services in their communities.

Microdosing for Depression 

Psychedelics research conducted in recent years is showing increasing promise for the treatment of several mental health conditions. As men’s mental health awareness continues to bleed into the mainstream, psychedelic treatments may become a suitable alternative to antidepressants.

A recent study conducted by UC San Francisco and Imperial College London found that psilocybin promotes increased connections between various parts of the brain in depressed people. Participants showed a decrease in emotional avoidance and improvement in cognitive function. 

MindBio Therapeutics is currently conducting clinical trials researching the efficacy of psychedelic medicines in the treatment of several mental health disorders including depression and anxiety. We look forward to sharing the findings of this cutting-edge research and helping to meet the unaddressed needs in men’s mental health. 

 By MindBio Health Correspondent Emily Verdoorn