Male Mental Health and Building Emotional Resilience
by Dr Levent Yurdakul, Clinical Psychologist
Movember is upon us again and male health gets a look in, all too briefly.
Men for centuries have been given the message “man up” “grow a pair” and other such alpha male advice. Those who could not live up to such expectations often got sidelined, saw themselves as a failure, got depressed and yes some committed the ultimate act of despair and took their own life. It was not ok to say “I can’t” and “I need help”.
Sadly this view has also been propagated by women in some quarters who have been brutalised in a society where the “what does not kill you makes you stronger” or stoic approach continues to dominate. I have seen this in my clinical work where men and women have come seeking help because they had a tyrant of a female manager. Not only men but plenty of women still embrace this man up culture and yes the year is 2018!
Thankfully there is a silver lining to this ominous cloud. The new generation of young women and men coming through are increasingly more willing to talk about their difficulties and feelings and get help. The work of Princes’ William and Harry has also gone some way to pushing the issue of mental health and especially male mental health into the public arena because they are viewed as plausible male role models who too have faced challenges.
During my clinical psychology training one of the most frequently quoted statistics was around the very low percentage for men entering into therapy, with women making up 60-75% of patients seen for mental health related issues. One solution was to destigmatize mental health and psychological therapy and another was to bring more males into professions such as counselling, psychotherapy and clinical psychology. There is still a great deal of work to be done in both areas. Hence when I was asked to write a blog about male mental health I saw this as an opportunity to offer the perspective of a male within the clinical psychology profession that could encourage men to get the help they may need.
Positive Role Models in the Social Media Age
At a recent pre-football match meal with a group of men in the 40+ to 60+ category, besides football, we talked about a range of topics such as our children, relationships, work related challenges, health and for those who are approaching retirement, useful/meaningful occupation of time. We also reflected on the sobering reality that one of the guys had suffered a cardiac arrest the year before and technically had been dead for 15 minutes when the paramedics eventually managed to start his heart again with the defibrillator on the 4th attempt. He sustained six broken ribs during CPR but survived to tell the tale!
The next day I reflected on the experience and besides the great atmosphere of Wembley what stood out for me was the intelligent conversation and the accrued wisdom (hard earned) of these men. It also reminded me of just how important good health is and how often I like many others take it for granted.
In my career approaching 25 years in mental health I have come to realise in considering not only my own psychological development and the trajectory of the many clients I have worked with that there is a vital skill in order to survive and thrive; developing the emotional resilience to live with good judgement and maintain a positive mindset in the face of adversity.
Yet as I have seen so often there are many reasons why some people are not able to arrive at such a desirable position. I use the word desirable because I do believe that being able to withstand the challenges of life and live with some degree of psychological coherence, purpose and joy are all too easily overlooked in a world now where instant gratification, success and fame are touted as the things to aspire to. If fame and fortune are not gained, one has simply failed in the social media frenzy that we live in. Facebook has sadly evolved from being a point of contact to selling lifestyle. Even more depressing is how it has shaped the posts of many where they put up the highlights of their life (holidays, latest purchases etc) creating a totally distorted picture of everyday life; not everyone is living the Hollywood A lister lifestyle but on Facebook and Instagram it seems that pretty much everyone is! This leaves impressionable young men and women (and older ones too) vulnerable to considering themselves as somehow inadequate and that they are missing out on life. It sows the seeds of discontent based on a fallacy and impacts mood adversely.
Having positive role models whether it is a father, grandfather or a mentor is crucial for boys. It provides a blueprint, a how, to help them get through life’s challenges, and by that I am not referring to the “man up” strategy for every adversity. If such a male figure is not available the process of developing a blueprint becomes more complicated for teenage boys transitioning into adulthood and the likelihood of distress that can lead to mental health problems increases.
Some Sobering Statistics
The Office of National Statistics (ons.gov.uk) most recent data indicate that suicide rates have been declining for men and women since records began in 1981, however from 2007-13 with the economic downturn there was an increase in male suicides. Since the 1990s men have been three times more likely to die through suicide than women and over the last ten years male suicide rates have been at around 14 per 100,000 compared to 4 per 100,000 for women. Research by the Samaritans (Wyllie et al. 2012, Men, Suicide and Society) indicates a complex set of reasons and these include increased family breakdown leaving more men living alone; the decline of many traditionally male-dominated industries; and social expectations about masculinity. Men that are most at risk of suicide are the young (15-29), middle aged and elderly, those in the care of mental health services and those in the criminal justice system. Men are also by nature more likely to complete acts of suicide because they use more lethal methods.
Although men like women may have a network of same sex friends, compared to women the quality of these relationships may be insufficient rendering men feeling lonely and isolated particularly if there is a significant event such as the breakdown of a marriage. Add to this the challenges faced by such men in more deprived areas and the desperation can begin to mount. There is compelling research which shows that socio-economic status and relative inequality in terms of income plays a significant role in developing mental health problems (Wilkinson and Pickett 2009, The Spirit Level). The UK is one of the most unequal rich countries in terms of income (second only to the USA) and as a result has some of the highest rates of mental illness amongst rich countries. For example in Japan where income inequality is low 8% of the population have mental illness compared to the UK which has higher income inequality and mental illness is around 23% of the population. Besides mental health, Wilkinson and Pickett describe with compelling evidence how this large income inequality impacts adversely on a whole range of societal concerns such as community life and social relations, drug use, physical health and life expectancy, obesity, educational performance, teenage births, violence and imprisonment and social mobility.
How Do You Cope with Stress?
I go for a run. It has literally saved me from despair on many occasions when life’s challenges seemed overwhelming, often giving me a fresh perspective and helping me to see a way forward. Troubling thoughts that may have been bugging me would get processed and I probably had some of my most useful insights whilst running. The idea of making sense of one’s experiences and being able to see a possible solution to a challenge is crucial to good mental health.
Staying with the idea of running if we consider life to be a marathon most would agree that for a marathon one has to prepare otherwise the odds of finishing are very low. In order to prepare you need the basics like suitable kit, a good diet and time to fit in your runs. You also need good time management and motivation to achieve the goal. It also helps if you have the support of others who know what you are trying to achieve. On the day of the marathon you are also dependent on a number of things going to plan, for example that you are able to pace yourself, take in the right levels of fluids, not have to deal with extreme weather and hope that your legs don’t cramp up.
It does not take a huge stretch of the imagination to see that this is also an analogy for life. What if you are born into a family where there are very few emotional or material resources? Where the support is just not there to prepare you for the marathon that is life. You go to school or to work feeling overwhelmed unable to cope but have to get on with it somehow. All the time you feel inadequate to the task in hand. How do you “man up” when you feel don’t have the inner resources or the support from others to get the job done? How do you “man up” when no one showed you the way in the first place? Answer: You most likely struggle on until you either succeed or until one day a seemingly small event tips you over the edge (as Bukoswksi wrote “but a shoelace that snaps with no time left”). Despair, depression, anxiety, addiction, self-harm and sometimes suicide can follow.
Learning How to Develop More Effective Emotional Coping
The term emotional regulation frequently crops up in psychology and psychiatry. It usually refers to the ability to manage negative emotions such as anxiety, anger and frustration and maintain the ability to function. Yet we all have times when we can get overwhelmed by strong negative feelings. Learning how to deal with negative feelings and developing emotional resilience is vital for survival and to be able to thrive.
Practically there are many things a person who is struggling with low mood or anxiety can do (provided they have some basic means at their disposal). I have listed some of these below.
- Eat well. A varied and healthy diet has a significant positive impact on our mood and how we feel about ourselves.
- Sleep: Get into a good routine and maintain it best as you can. Read up on sleep hygiene.
- Keep caffeine and alcohol under control, avoid illicit drugs.
- Regular exercise can have a significant positive impact on mental health. You feel isolated? Sign up for a sport that has a social element like a running group.
- Do yoga, tai chi, mindfulness, exercise, whatever works for you. Use apps that help you to breathe better, relax and teach meditations skills.
- Problems: We all have them. If you are ruminating excessively, get up and do something proactive; change the environment you are in, do something tangible. The majority of problems we ruminate on rarely get fixed through worrying which is a passive process that isolates us.
- Stay in problem solving mode. Ask yourself “how can I do this?” instead of “why is this happening?” Find out how others have dealt with such problems.
- Stay in the moment: Work on finding pleasure in the simple things in life such as a long walk or a cup of tea and a good conversation with a friend.
- Social support: Talk to people you trust and get a different perspective. Avoid people who make you feel worse (at least for a while until you feel better or until you have worked out why). Emotional dependency sometimes keeps us hooked into friendships that are unrewarding and toxic. If each time you come away from seeing an old friend you feel rubbish, reflect on what is going on here that makes you feel this way. Sometimes we remain in relationships because they are familiar but unsatisfactory. Life is also about making new and more rewarding friendships. Put yourself out there and be open to new friendships.
- Knowledge is power. Read around mental health and positive psychology. Get insight into why you are having certain difficulties and work on the “how can I…?”
- Ask yourself “How can I develop a more truly positive, expansive mindset?” and be willing to act on the ideas that emerge.
- Listen to Ted talks. This one on emotional agility is pure gold: https://www.ted.com/talks/susan_david_the_gift_and_power_of_emotional_courage?language=en
These are some ways in which one can learn to regulate distressing emotions more effectively and recognise that having troublesome thoughts an feelings need not mean your life is crumbling around you. Developing the capacity to deal with the world as it is and not how we want it to be is vital to negotiating life’s challenges and leading a more meaningful and content life.
Psychological Therapy: To Do or Not to Do?
For many life can be very challenging. Being able to make sense of one’s difficulties, ask for help when needed, air thoughts to get perspective, develop a mindset where being able to see beyond the difficulties may be impeded by all sorts of reasons. I have described some of these reasons earlier.
If you are struggling do not ignore your feelings and give in to false positivity by “manning up”. Don’t be ashamed to seek help. Facing up to those difficult feelings could be the turning point in finding a sustainable way forward. Be willing to get help through the NHS and if you have the means be willing to invest in your mental health financially (if the support you need is not available through the NHS). I am often surprised by how people will spend large amounts of money on all sorts of things but when it comes to mental health they hesitate. It could be one of the best investments that you ever make in your personal development. I have had many years of personal therapy and every penny was well spent. For me it is part of a process of understanding myself, how I deal with certain situations, how to make changes for the better and to have the emotional support and perspective of a trained professional who provides a counterpoint when I am in need of a balancing force.
I don’t think I can do the topic of male mental health justice in a blog and what I have offered here is a selective set of facts and ideas that I hope will encourage and motivate readers to help themselves or someone they know who is in need
Levent is a clinical psychologist in private practice at Brighter Spaces Guildford and central London. He is also a part of a new collective of mental health clinicians in Guildford: the Surrey Healthcare Clinic.