On the surface, statistics show that men have better mental health than women. For example, in 2007, 12.5% of men, compared to 19.7% of women had a “common mental health disorder”. This is only the case if we do not take into consideration complications created by financial stressors. Men with the lowest household income had 3 times the rate of common mental health disorders than men with the highest household income (23.5 vs 8.8%). For people in the lowest income group, gender differences in experiencing mental distress disappeared. In such instances both 1 in 4 men and women experienced mental health difficulties. Some scholars argue that male expressions of distress are different to what we have come to expect as indicators of being upset, terming them as atypical.

It might be strange to think that us humans, society, and health care professionals have expectations regarding the expressions or indicators of emotional distress. But it is true. Some examples of this are that we understand that someone is in pain with a water like substance flowing from our eyes, aka tears. Pain in this case includes both physical and emotional dimensions. In the field of mental health and with regards to accessing care, such biases in understanding one’s expressions of distress can play a major role in the quality of care a man (in this case) is likely to receive. Because of this, there is a need to hold in awareness that typical unhealthy “male behaviours” like alcohol use could showcase and/or be used to manage distress.

Holding this in awareness is not excusing or normalising unhealthy behaviours, regardless of their function for coping. It is about being considerate towards the fact that men might use an entirely different spectrum of actions, behaviours, and vocabulary to express themselves. As such, this calls for flexibility in tuning in to expressions of distress. For example, through research on group therapy contexts, it has been shown that men share their inner experiences in terms of information i.e. this and this happened and then this unfolded etc, and use the same approach when offering support to others. Women on the other hand prefer to express their feelings and give emotional and social support to others in times of need. Moreover, it was shown that women were able to clearly express their emotions while men tended to imply emotion and used battle metaphors.

When asked to identify three things that tend to happen when they are worried or feeling low, one in 10 men said they get angry when they are worried. When experiencing a mental health problem, many men reported that they will externalise or ‘act out’ their symptoms through disruptive, violent, and antisocial behaviour. Only 8% of women reported feeling angry when worried. By contrast, women reported that they are more likely to ‘act in’ (against their inner self), with mental health problems manifesting as low self-esteem, feelings of guilt and reduced concentration.

The more ‘feminine’ symptoms and language of distress are used to describe emotional turmoil by the different classification systems of mental health i.e. feeling guilty. This poses a significant complication since classification systems like DSM are what mental health assessments are based on. What one scores on one of these assessments could be the make-or-break point of accessing specialised treatment. For example, if an organisation only accepts people who experience severe difficulties of a specific distress, not meeting the intake criteria (based on their scores), infers that the person will not be able to access support through the specific service provider.  As such, the language of assessing mental difficulties creates biases in overlooking expressions of distress among men (i.e. presentations of hostility, substance use, blaming others). This means that feminine expressions of distress are what one expects to see and subsequently measure and analyse when exploring a person’s inner difficulties. Men’s “symptomatology” of distress (what is actually exhibited or made obvious to the naked eye) are more likely to bring them into contact with the criminal justice system than mental health providers. Mental health classifications thus, reinforce social constructions of gender by over-diagnosing women and ignoring men. While aggressive or violent behaviour is never acceptable, there need to be clearer diagnostic principles in recognising mental health problems that may underpin aggressive or violent behaviour in men, to ensure appropriate support is given.

We need to acknowledge that gender impacts help seeking in many and complex ways. We know that men are more reluctant to seek help than women, regardless of their health or psychological concerns. This hinders the ability for early interventions and implies that a problem prevails and maybe worsens. As such, its negative impact on men’s lives is prolonged and its impact on their wider relationships, health and context will be greater.  Societal expectations of gender infer that some men might negotiate stigma in seeking help by accommodating, normalising, and denying problems. Men and boys experience pressure to underplay health symptoms especially to peers, to avoid the negative consequences they would experience if they were to demonstrate psychological difficulties. While the reasons for this are complex and out of the scope of this article, traditional masculine values such as self-reliance and stoicism can play a role in creating the belief that if men talk about mental health difficulties, they are weak. These social pressures delay help seeking, with men having to reach a higher threshold of distress before seeking help, in comparison to women. This does not necessarily mean that men are “stronger” than women. If we use the expression bursting at the seams, men wait it out longer than women prior to seeking a method of adaptive decompression.

To complicate matters of male mental health even more, research has found that gay, bisexual and trans (GBT) men are more likely to experience poor mental health, substance misuse, social isolation, self-harm, and suicidal thoughts than heterosexual men. More than two in five GBT men (46%) have experienced depression in the last year compared with 13% of heterosexual men. Gay men are twice as likely (10.9%) and bisexual men three times as likely (15%) as the general population to report having a longstanding psychological or emotional difficulty. Some 43% of bisexual men and 32% of gay men have thought life was not worth living in the last year, with 18% of bisexual men and 7% of gay men reporting that they had deliberately harmed themselves.

There are limited statistics relating to trans men specifically. From the data available, however, we know that almost half of trans people (46%) have thought about taking their own life in the last year.  A 2012 study of over 1,000 people who identify as trans found that almost 9 out 10 trans people (88 %) have experienced depression at some point. It also found that 75% of trans people have experienced anxiety at some point, 58% felt that they had been so distressed at some point that they had needed to seek help or support urgently, and 10% of trans people have been an inpatient in a mental health unit at least once. The reasons for poor mental health amongst GBT men are diverse and complex. They are linked to stigma and discrimination related to sexuality and gender identity. Intersectionality with race, disability, age, socio-economic status, and a range of other characteristics increases the risk of poor mental health and makes it harder to access support.

Additionally, GBT men report negative experiences of health services because of their sexuality and gender identity. This includes issues accessing care, having their specific health needs overlooked and encountering inappropriate curiosity, or witnessing discriminatory or negative remarks about LGBTIQ+ people from health care professionals. Together this erodes trust in services and reduces engagement, for the entire LGBT+ population. An entire segment of our population, is left emotionally unattended, marginalised and disadvantaged.

Despite the relative invisibility of men in mental health research to date, studies suggests that men have a rich subjective life which has been neglected and they do experience distress. They experience suffering and we should not assume that it is expressed in the same ways as it is by women. Time and time again we witness that men narrate their distress in ways which are hidden from view or/and are difficult to interpret.  It is important to remember that men have been constructed problematic as a homogeneous group by writers in the past i.e. masculinity being lethal or/and dangerous. Simultaneously though, in the area of mental health, it is men who have been invisible, and women have been repeatedly problematised.

Early life, biographies, relationships, discourses, performativity, affect, gender relations, material bodies, social contexts and constructions of wellbeing are all important in understanding men, and their subjectivities and distress. This implies a danger of men’s distress to be continually played in silence. Outcomes like higher suicide and substance abuse rates among men, urge us to reconsider distress and gender constructions more closely. If we look to poetry, this phenomenon is emotively described below:

Can’t you hear my silent screams?
They are so loud they echo in my dreams.

Behind this face that carries a smile
Lies a dark road that goes on mile after mile.

My silent screams have been going on for years,
But it always falls on so many deaf ears.

How can they hear these silent screams in my mind?
They can’t hear my thoughts if I keep telling them I’m fine.

What can I tell them? These silent screams carry no words.
It’s just feelings of sadness and darkness that come in its herds.

How can I explain so people understand this?
It’s like walking around in a suffocating black mist.

It’s holding on to happiness like holding water in your hands.
It just trickles between your fingers and disappears into the sands.

I can’t explain how this feels; it’s so extreme,
So I hold my mouth shut to cover my silent screams.

Aaron. “Silent Screams.” Family Friend Poems, September 4, 2019. https://www.familyfriendpoems.com/poem/silent-screams-7

Despite the boxed in view point of male psychological distress, many practitioners out there are available, knowledgeable, and capable to help men deal with whatever is causing their inner turmoil. Look for them and approach the subject of accessing support. Waiting it out does not need to be part of the way you do things.

References:

Ridge, D., Emslie, C., & White, A. (2011). Understanding how men experience, express and cope with mental distress: where next?. Sociology of health & illness33(1), 145–159. https://doi.org/10.1111/j.1467-9566.2010.01266.x

Biddle, L., Donovan, J., Sharp, D. and Gunnell, D. (2007) Explaining non-help-seeking amongst

young adults with mental distress: a dynamic interpretive model of illness behaviour, Sociology of Health and Illness, 29, 983–1002.

Branney, P. and White, A. (2008) Big boys don’t cry: depression and men, Advances in Psychiatric Treatment, 14, 256–62.

Get it off your chest: a report on men’s mental health. (n.d.). Mind. https://www.mind.org.uk/about-us/our-policy-work/reports-and-guides/get-it-off-your-chest-a-report-on-men-s-mental-health/