More than six million men are diagnosed with depression, according to the National Institute of Mental Health (NIMH). Left untreated, this condition can lead to a plethora of difficulties related to family, friends, and career. Psychologists around New England examined the complexity surrounding the issues of males seeking psychological help.
According to Michael E. Addis, Ph.D, professor in the department of psychology at Clark University in Worcester, Massachusetts, research has found that men utilize mental health services less frequently than women because of negative attitudes.
“There are individual differences in the degree to which men buy into the societal norms of masculine ideology,” he said. “It’s important to be self-reliant at all times and stay in control of emotions. Number one is not doing anything perceived as feminine and seeking mental help services is seen as a more feminine act. It produces a greater degree of fear and shame.”
Additionally, men have difficulty in recognizing personal emotional distress. “They appear to have a higher bar for considering mental health a problem. They think if they can get themselves to work, they’re okay. But when they can’t get out of bed, then they’ll think about seeking help,” Addis said.
In his book “Invisible Men,” Addis explores a male paradox. “On one hand men are highly visible,” he said, citing the prevalence of males in business, politics, entertainment, and other areas.
“But they have personal vulnerability, which is related to the cost of ‘staying power.’ They keep their real selves hidden. This gives rise to untreated depression,” he said.
Addis feels that the situation has improved. He finds that male college students are somewhat more amenable to acknowledging and seeking counseling, most likely because of readily available on-campus resources.
Campaigns, such as NIMH’s “Real Men. Real Depression,” and the military’s increased attention to mental health problems have also made some strides.
“The longer I study, the more I’ve come to view this as less and less an individual issue. It’s a social and cultural issue. We need to head toward changing the message on a broad scale. We have to have day-to-day conversations with boys and de-emphasize gender, but focus on healthy living,” Addis said.
Reluctance to Seek Help
While males in general are reluctant to seek help, those in the military and law enforcement are particularly disinclined, according to Mark Holbrook, Ph.D, LCPC, private practitioner in Brunswick, Maine, whose client base predominantly comprises this population.
Prior to opening his practice in 2003, Holbrook served as a police officer so he clearly understands the everyday stressors that can precipitate psychological and emotional difficulties.
He explained that men, in general, are not very comfortable with emotions and struggle to identify their own feelings. But for his clients, acknowledging emotions falls outside the traditional stoic nature of the military and law enforcement.
“[Police officers] respond to crises and have to be effective dealing with whatever the situation is. Situational stoicism is crucial to success. The problem becomes–‘what happens when they leave the crisis situation?’”
“They compartmentalize and to some degree are able to do this for a long time. But if you take an emotional experience and wall it off, over time it builds up. You find that it manifests as irritability, anger at home, excessive use of force on the job or alcohol abuse.”
For officers or military whose careers span two or three decades, a plethora of incidents left unprocessed can create psychological problems.
“If a police officer doesn’t process [an incident] at the time, it builds up and works to express itself in some way while the person struggles to contain it,” Holbrook said.
Critical Incident Stress Management
Holbrook pointed out that critical incident stress management (CISM) has become pervasive in many police departments in recent years. Although well intentioned, this practice falls short of providing any real long-term benefit.
He noted that police, fire or other emergency workers dispatched to distressful incidents are often mandated to attend a CISM session. Unfortunately, many individuals believe a single session will adequately ameliorate any emotional repercussions. “That is a gross over-simplification,” he said.
Rather than address male psychological health after a traumatic incident, Holbrook advocates for an “annual resiliency review.” He said, “If you get the officer to go to therapy once a year to check in, you build a relationship when he doesn’t need help. There is no pressure. Rather it’s a learning experience that removes stigma.”
Holbrook emphasized that law enforcement is a different type of work and the people who do the job require special support throughout their careers.
“It needs to become more normal for administrators and supervisors to talk about psychological well-being of a police officer, to listen to the awful stuff and the emotional impact it has.”
Raising awareness, particularly through star power, is helping to reduce stigma, according to Rick Barnett, Ph.D, private practitioner in Stowe, Vermont and founder/president of Carter, Inc., a non-profit Center for Addiction Recognition Treatment Education Recovery.
He applauded a recent article in the New York Times by rapper Jay Z endorsing therapy, which he believes will prompt more men to come forward.
Other well-known figures, such as former quarterback Terry Bradshaw and Prince Harry, have brought the subject of male depression out of the shadows through public advocacy for the benefits of psychological intervention.
“The more people read and the more public figures talk and reveal their struggles, the more men will reach out for help,” Barnett said, but emphasized that making an appointment is a first step.
“Therapy is not a quick fix. It’s harder with men to process difficulties at the level of emotion versus cognition. They want practical steps.”
Barnett helps his male clients become more aware of their inner feelings. “There is an art to sitting in an office and being able to detect non-verbal signs of emotion,” he said. Changes in body position or voice might warrant stopping the session to bring the client’s attention to the changes.
Barnett emphasized that male reluctance does not occur in all cases. “Some men are willing to talk and some have to work around emotional processing and think outside the box,” he said.