Men are in trouble. To read the statistics, it can look as if we have lost our collective heads! The statistics suggest that men are three times more likely to kill themselves than women and three times more likely to go missing or become dependent on alcohol; that the suicide rate, particularly amongst middle-aged men, has increased over the last decade; and that men are far more likely to be detained by the Government, either as prisoners or psychiatric inpatients.^{1, 2}

What is the matter with us? And what are we doing about it? The evidence is incomplete and harbours complexities, but it does seem that men may be experiencing something of a cultural limbo where we have been forced to jettison one social role but have not found a replacement and that the consequent uncertainty makes it difficult for some of us to identify a sense of purpose or to seek the help we need when we find ourselves struggling without one.

We could look to King Lear as a benchmark. He is OK whilst he’s king, but when he gives up his job as head of state, the screws come loose. And then, with time on his hands, he encounters his worst fear: ‘Oh let me not be mad, not mad, sweet heaven; keep me in temper; I would not be mad!’³

Men’s mental health is news. It is in the broadsheets, on breakfast news, a topic on You and Yours. Male celebrities are lining up as part of Mind’s ‘Get It Off Your Chest Campaign’ to share their testimonies on how the black dog of depression has plagued them. The implication is clear: if Alistair Campbell, Melvyn Bragg and Stephen Fry, with all their money and success, can admit to the blues, it is all right for you to do so too. The campaign is aimed to acknowledge the economic recession, to access the queue outside the Job Centre and encourage more of the troubled men who stand in that queue to also join the one outside the doctor’s surgery and the counsellor’s consulting room. The Government and its health advisors are well aware of the correlation in the past between economic and emotional downturn – according to past experience of recession and a recent survey, one in seven men will develop depression within six months of losing their jobs⁴ – and their message is: you are going to feel very bad and when you do, it is OK to speak to someone about it.

Men, work and wellbeing
The assumption which underpins this initiative is that being out of work is a terrible blow to a man’s sense of worth and that work is still so central to a man’s sense of identity that to be without it is crushing. It has made me re-visit my own experience of mental illness (it still hurts me to call it that – more of that shame later) and to consider the relationship between work and wellbeing.

The thing is, I was not out of work. I was very much in work. That, at least in part, seemed to be the trouble. I was a teacher and had been, happily, for 15 years. But I found myself asking out loud whilst walking the dog along the beach, ‘What is the point? What am I going to do now?’ The ‘now’ referred in my case, to the fact that I was 15 years in and looking at another 15 at least. Was this all there was? But it also took account of the fact that my wife, who had previously focused her time and effort on the home and bringing up our children, had subsequently trained to become a teacher and was now busy doing what I did. What did that say about my role and what I had spent most of my adult life at? I began to feel, if not usurped, then duplicated. What had changed was not my role at work but the payoff for that work in the domestic setting.

I have canvassed friends and acquaintances – all men of this certain age – and I have not had to throw the stone far to hit another man with a comparable tale. The stock phrase that accompanies the reluctant admittance of misgiving is, ‘I wish I had done more with my life’. On the face of it this looks to be a fairly general expression of existential angst and may well also be used by people who are not middle-aged men, but what I was hearing was a sense that what these men had pursued as a career, what they had done for a living, had not come up to scratch, not fit the bill, been something of a disappointment.

Changing work patterns
What is different for our generation compared to our fathers’ is the imperative. They had to work to provide for the nuclear families that more of them were part of. (There are other cultural and social trends and phenomena that cannot be covered here.) In the generation since, patterns of work have changed; arguably the workplace itself has changed and become more feminised. Without the clear distinctions, without the clear financial imperative and implied clarity of purpose, what has emerged for many men is doubt – about the point of the work we do and more fundamentally about the role we perform.

It seems that whereas in times past, being in work – any work – might sustain a man’s sense of identity, the current generation is more demanding of the work they do. There are clear cultural and economic reasons for this. Since we, as a generation, watched our fathers work and retire, to borrow the language of the global economy that has precipitated the ‘Get It Off Your Chest’ campaign, men’s stock has fallen. Regardless of what they did, our fathers were, in the majority of cases, breadwinners. According to Paul Farmer, Mind’s chief executive, ‘Being a breadwinner is something that is still crucial to the male psyche.’5 But well before the current economic malaise, our role as breadwinner was steadily eroding.  

Within the fiscal system, a building society in the 1970s would only work out a family’s credit rating based on the male income. Thus a man of my father’s era, whatever his work might be, was safely established as provider. Being the primary, often the sole earner legitimised him. Now monies are lent against joint income. Work once defined a man as a draughtsman or a plumber; it also defined him as lord and economic master within the nuclear family. Work, whatever its type, might put food on the table, and the table under the food. Thus, the nature or content of the work might not be of such importance because the pure financial necessity for the man to keep the family afloat was so strong and consequently so rewarding. For a while now, this has not been the case. In fiscal terms, many men are no longer providers, they are contributors.

A changing workforce
This leaves us with an anomaly. The world of work has moved on. In the past three decades society has changed, with more women working than ever before – 45 per cent of the workforce are women.6 Current figures show the workforce to be made up of 51 per cent men and 49 per cent women. In 1981, men filled 3.2 million more jobs than women. Now the numbers are almost equal, with men performing 12.8 million jobs and women 12.7.⁷ The forecast is for even more women to be working in future. Men are not and will not be the dominant providers they once were. The workplace has been feminised and ‘new men’ – and I would count myself and the men I have consulted as belonging in this category – have accepted the changing role of women, but we have not been able to make the necessary adjustments to change ourselves. 

In short, we are living in the past, using outdated definitions of maleness and finding ourselves wanting. We are still firmly attached to a value system which places work as central to our sense of esteem. Work is often a crucial marker of masculine status.¹ We use a similar blueprint of maleness to the one our fathers used, but in circumstances which make this blueprint unsuitable.

We inhabit a cultural cusp. There exists a time lag between intellectual and genuine acceptance. The tribe of the new man can argue that ethically there is nothing wrong with the woman working and the man staying at home, but in reality we are yet to accept this notion emotionally. We do accept the woman in the workplace, but if men enter the female arena of childcare and caring in general, we tend as a tribe and a culture to suspect both their competence and their motivation. So men are in limbo. This certainly was, and is still true of me. I am still working to redefine my role as a man, in counselling terms to relocate the source of my self-esteem. And I am not alone.

Men and mental health
The source of our trouble is only inferred in the Mind campaign through its timing, however. Campbell, Bragg and Fry have their eye more on the second handicap to men’s wellbeing: they alert us to the fact that when men do experience mental trauma, they do not react in healing ways.

Here again, men find themselves in a similar quandary. In a world where women have fought for and acquired rights and access similar to men’s, we sometimes define ourselves not by positive male attributes but by asserting the negatives: we know we are men because we are not women and we are not being feminine. In doing so, we shoot ourselves in the foot a second time. We are doers not talkers, problem solvers and copers, not whingers. Worrying is for wimps (sic: women). Thus in this climate where we suspect there are men in crisis out there, the same definition of maleness that insists on the central importance of work, also insists that real men get on with it and do not ask for help. 

Here again, I imagine my own experience to be representative. I became aware of feeling very low in January 2004, but ‘coped’, maintaining a social front and getting on with it, until the wheel came off completely in April 2005 and I felt bereft and desperate. The suicide rates quoted earlier suggest that other men may follow this spiral to its absolute conclusion. When I did admit the need for help, I was so drained by a year of putting on the brave face that I understood my position to be hopeless and had exhausted the energy and confidence I would need to work on my problems alongside a life that carried on. In other words, I collapsed, retreated from the world, and computed this collapse as an irreversible failure. Having shored up my sense of self by presenting a false front to the outside world, when the front came down I felt suddenly exposed, unable and unworthy to return to my professional position. And as I intimated earlier, the overwhelming feeling that lurked in the shadows throughout my ‘coping’ year, and continues to haunt me even now, was shame; shame for not managing, shame for having collapsed, shame for being weak, shame for needing help.

Barriers to seeking help
There seem to be numerous cultural barriers that stand in the way of men seeking the help they need when they find themselves in crisis. The interventions that are available to us all are interpreted by men as feminine in style and origin. In the same way that we are not adjusted to the shift in work patterns, we are no better adjusted to accept the forms of help that are available. The same outdated definition of maleness that requires us to work to display our worth also denies us access to counselling and talking cures. In response to the same needs that depressed or anxious women might have, instead of ‘acting in’ which women do – consciously acknowledging low mood and diminished pleasure8 – men ‘act out’, displaying anger and self-destructiveness.

Bob, a male friend, reported his own response to a desperate low period; he sought out Steve – a man at a similarly low ebb – and went on a series of benders. Their joint agenda, even though they both knew times were dark and dangerous, was alcoholic oblivion. At no point on the long days they spent together in the pub, did the subject or source of their misery ever come up or get discussed. Instead, they conspired in numbed silence.

Bob and Steve are not inarticulate people. Their jobs require them to converse and explain, and ironically to offer help, yet their understanding of what constitutes male behaviour – the male conspiracy – prevented them, even in their darkest hour, from confronting their demons head on, and crucially from confessing their own need for help.

Part of the reason for this may be in the presentation of the help available. There is evidence, which is acknowledged in the findings of the Mind survey, that doctors’ surgeries and counselling rooms appear to men to be places for women. They are commonly furnished with female reading matter, decorated in a pastel palette and open only during office hours (when we should be at work!). These environments pose the same threats to our manhood as perfume counters or dress shops. We understand them as places where we do not belong. If we find ourselves there, it must signal failure, a disintegration of what makes us men – and so we do not go. 

Men bar themselves on two counts from therapeutic intervention. In the first place, the behaviours that men exhibit in response to depression and anxiety do not fit current criteria used to diagnose these conditions. According to Mind, ‘The criteria for diagnosing mental health problems should be expanded to include male acting out behaviour (taking drugs, drinking, getting aggressive) as well as traditional signs of depression (sleepless nights, crying, feeling low).’⁹ 

It is also possible that some transference occurs in the doctor’s surgery. Men are so resistant to a diagnosis of mental ill health, that doctors absorb this resistance and are reluctant to make a diagnosis that would not perturb them if the patient in front of them were a woman. Secondly, even if men themselves feel they might need help, the services offered are housed in what look dangerously like female environments, so to enter here is to walk further into an abyss which threatens to rob them of their manhood.

A final and telling response came from another friend, Eric. I know Eric to have suffered from depression in the past so asked if I could gather his thoughts on the subject of mental health. ‘When men get miserable they either get over it or wallow,’ said Eric. When pressed on ‘wallow’, this included drinking to forget and other forms of self-destruction but also took in ‘dwelling on things’ – any form of self-reflection, let alone chewing someone else’s ear about it. I was writing for a magazine I said. ‘What’s the magazine?’ Eric asked. When I told him, he wondered aloud: ‘I know there is that men’s magazine – Nuts. I thought you might be writing for The Nutter.’

The reaction felt so male! I cannot imagine any of my female friends formulating such a defensive or mediated response. It confirmed that, as John Gray insists, in some ways, certainly in managing emotional difficulty, the genders really are from different planets. Eric is no longer depressed and the brutal humour in his reaction – he also knows of my history – betrays utter relief in being able to distance himself from the experience. It is clear that the stigma that attaches itself to mental illness for men may take years of concerted effort from government and health professionals
to remove. Celebrity soundbites raise the issue but even a PR guru like Alistair Campbell would be hard pressed to shake the grip this stigma has on the British male psyche.

References 1. Wilkins D. No problem, mate! HCPJ. Lutterworth: BACP. 2007; 7(3). 2. National Institute for Mental Health in England (NIMHE). National suicide prevention strategy for England: annual report 2007. NIMHE; 2008. 3. Shakespeare W. King Lear. 1605. 4. Kivimaki M et al. Organisational downsizing and increased use of psychotropic drugs among employees who remain in employment. Journal of Epidemiology and Community Health. 2007; 61:154-8. 5. Mind. Men and mental health: get it off your chest. Press release. Mind; 2009. 6. Johnson A. Women make up nearly half the work-force. So why are they only directors at 9 per cent of firms? The Independent. Sunday 4 January 2004. 7. www.statistics.gov.uk/cci/nugget.asp?id=11 Published on 31 July 2002. 8. Gillon E. Gender differences in help seeking. HCPJ. Lutterworth: BACP. 2007; 7(3). 9. www.mind.org.uk