It's being called a silent crisis, a sleeper issue. But there are signs that this sleeper is at last awakening. Around the world studies, surveys, web networks, journals and newspaper articles are shedding light on a shadowy subject: men's mental health.
Among the findings is the revelation that new fathers are also vulnerable to postpartum depression. In Canada, young and middle-aged men are being hospitalized for schizophrenia in increasing numbers. The gender gap among people with mental illness is much narrower than might be suspected. The StatsCan Canadian Community Health Survey on Mental health and well-being found that 10% of men experienced symptoms of the surveyed mental health disorders and substance dependencies, compared to 11% of women. In the United Kingdom, studies of depression show a major shift in the traditional gender imbalance, with depression rising among men and decreasing among women.
The greatest evidence of male vulnerability is in suicide statistics. Among Canadians of all ages, four of every five suicides are male. In the UK, men are around three times more likely to kill themselves than women. In New South Wales, Australia, suicide has overtaken car accidents as the leading cause of death in males since 1991.
According to the Toronto Men's Health Network (TMHN), even the concept of "men's health" is relatively new in Canada. Dr. Don McCreary, co-chair of TMHN, associate editor of the International Journal of Men's Health and one of a small handful of men's health researchers in Canada, says there are a number of reasons for this.
One reason is the low priority given to men's health issues in the research community. More funding and more specialists in this area will encourage ongoing research into male mental health.
Male and societal attitudes have fostered the silence. "The women's health movement was very self-directed," says Dr. McCreary. "Women banded together to work on problems with health delivery. Men don't want to do that. We have inculcated a culture in our society that men have to be tough, men have to be strong. Our society is very good at punishing gender deviation in men. Weakness is not considered to be masculine."
The "code" governing men's behaviour is one of the prime barriers preventing men from seeking help. According to UK-based MaleHealth.com, men may feel it's "weak and unmanly to admit to feelings of despair." Because it's easier for men to acknowledge physical symptoms, rather than emotional ones, their mental health problems can go undiagnosed.
Beliefs about masculinity also encourage men's general lack of interest in health issues; many men simply don't believe they are susceptible to depression, so why bother learning about it? Similarly, risky behaviour, seen especially in younger men - including abuse of alcohol and/or drugs and violence - can mask their emotional problems, both from themselves and their physicians.
Western society's view of the value of men is seen as an important factor affecting men's mental health. An Australian study suggested that "there is a strong element of negativity in our culture about men which cannot contribute to positive mental health...".
Greater recognition of the significance of men's roles as fathers and partners would help men cope with the difficult feelings that accompany a breakup and the loss of full access to their children. The social isolation experienced by many men at such a time is believed to a factor in the high rate of suicide amongst divorced men.
What do a firefighter, police officer, US Air Force First Sergeant, college graduate and publisher have in common? They are all male and they have all suffered from serious depression. They told their stories for the National Institute for Mental Health "Real Men. Real Depression." campaign.
It's estimated that up to 6 million American men have depression each year - about half the figure for women. But this gender disparity is being questioned, in the US and elsewhere. In focus groups conducted by the NIMH, "men described their own symptoms of depression without realizing they were depressed." They made no connection between their mental health and physical symptoms, such as headaches, digestive problems and chronic pain.
Dr. Michael Myers has noted the same thing, saying, "I couldn't do my job as a psychiatrist if I didn't listen to women describe their concerns about men." A psychiatrist and clinical professor in the Department of Psychiatry at the University of British Columbia, Dr. Myers says, "In men, mental illness can be masked. We've known for decades that women are more apt to recognize illness of any sort and go to their doctor. This doesn't mean women are healthier, but that some men just repress it. We believe a lot of somatization [symptoms] in men, for example, migraines, back pain, irritable bowel syndrome, is rooted in depression."
The consequences of masked depression can be devastating. "Too many men out there are suffering," says Dr. Myers. "They're acting out the depression." Acting may take the form of hostility and irritability; verbal violence and abusiveness; drinking to excess; or womanizing. Canadians can obtain more information about depression by contacting your local branch of the Canadian Mental Health Association or visiting the following website to find a crisis line in your area.
"In cases of marital breakup, there is a very important link between the man's mental health and how the divorce goes," continues Dr. Myers, who is the director of the Marital Therapy Clinic at St Paul's Hospital in Vancouver. He says that when children are involved, and an ongoing relationship is maintained, the father better adapts to his changed circumstances. "If there's a complete severing, then men can become suicidal."
Along with genetics and stress, MaleHealth.com points out that social and psychological factors can contribute to men's depression. Men's focus on competition and feeling powerful can be adversely affected by unemployment and the presence of women in the workplace. Physical illness, in particular a life-threatening condition, is another trigger for depression, since it directly impacts a man's sense of strength and status.
Raising awareness about men and their vulnerability to depression is a rising trend and "may help in terms of reducing the stigma attached to mental health," says Dr. McCreary.
Some focused steps are being tested. A study in Australia reports that a men-only prompt list for physicians and patients, designed to overcome male reticence and low mental health literacy, assisted 60% of male patients in raising issues with their doctor.
National men's health organizations in the United States, Australia, the United Kingdom and Europe are growing focal points for men's health research. The acknowledged lack of data on male health is leading to calls for a needs-driven rather than a gender-based approach to health care.
Promotional campaigns, web sites, journals and networking groups targeting men and their mental health awareness are breaking the silence that has long surrounded this topic. But there is a long way to go before the depth and breadth of knowledge about men's mental health issues approaches that relating to women.