James Donaldson on Mental Health – Suffering in Silence Contributes to a Higher Suicide Rate in Men

Balewa had received counseling but stopped seeing a therapist when he turned 18, and his mother isn’t sure how consistently he took his medication.

When dealing with issues of mental health, men are less likely to get help because they believe their struggle  makes them less of a man. Men want to believe they can handle all of their problems on their own and often aren’t aware their symptoms could mean something more serious might be happening, according to psychologists and the National Institute of Mental Health (NIMH).

Suicide rates in the U.S. have increased 33 percent since 1999, and the rate of suicide in Boone County has risen drastically from 4.56 deaths by suicide per 100,000 people, to 10.49 per 100,000 since 2008.

According to a 2013 report from the Centers for Disease Control and Prevention, suicide also accounted for $50.8 billion in medical and work-loss costs. On college campuses, suicide is the second-leading cause of death among students. Untreated mental illness and substance abuse are the primary causes of suicide. Substance abuse often becomes an unhealthy coping mechanism for mental illness, especially when it goes untreated.

Alarmingly, the group most likely to die by suicide is also the group least likely to get assistance for mental health issues. In 2017, the most recent year that data is available, the suicide rate for men was nearly 3.7 times higher than the suicide rate for women, at 22.4 suicide deaths per 100,000 men to 6.1 suicide deaths per 100,000 women.

Why men?

A close look at the CDC’s National Violent Death Reporting System reveals that the primary contributor to higher rates of suicide in men is lethality of the methods used. Over 56 percent of male suicide deaths in 2015 were gun-related, while 32 percent of female suicide deaths involved a gun.

Secondly, while all symptoms of mental illness can be present in both men and women, men may show symptoms of anger, irritability and aggression while many women may seem sad, according to the NIMH. Men are also more likely to externalize emotions than women, according to a 2011 study by the American Psychological Association. This may make it more difficult for men to get support from friends and family when they need it.

“If you see one of your friends who’s angry and upset all the time, or he’s drinking a lot more, maybe depression isn’t the first thing you think about, but it could be one of the issues that the guy is dealing with that he doesn’t even realize,” said Joshua Beharry, the Project Coordinator for HeadsUpGuys.org, a website where men like Beharry himself have shared their personal struggles with mental health. The site is also a resource for people seeking help.

Resources like HeadsUpGuys are vital because the third factor contributing to higher rates of suicide for men is they’re less likely to seek help for or even recognize they have a mental illness.

A 2015 report by the CDC shows 84 percent of male suicide victims had no known mental illness, compared to 16 percent of female suicide victims. According to the NIMH, men are more likely to go to a doctor with concerns about the physical symptoms of mental illness than they are to knowingly seek help for a mental illness. There’s a stigma attached to seeking help for emotional struggles that men are seen as “unmanly” or weak.

Beharry said that when he was struggling with depression he was also unable to reach out for help on his own until it got to a point where the physical symptoms of his depression became too much for him to conceal.

“I didn’t reach out until I got so sick that I couldn’t hide what was going on anymore,” Beharry said. “Eventually, I got to the point that I just wasn’t sleeping at all, and I wasn’t even eating. I was just too tired to keep pretending things were OK. I thought if I couldn’t figure it out on my own, then it was my problem. I think, being a man, I thought it was about my character.”

Hiding the hurt

“I used to think that having mental illness was an attack on your masculinity,” said Briar Napier, a 20-year-old sophomore at MU and a member of the executive board for Active Minds, a mental health awareness advocacy group for students. “Men are stereotypically the breadwinners of the family, and I feel like when we feel that we are incapable of doing it, it hurts us emotionally because we’re made to feel like that’s what our biological role is on Earth.”

For most of his life, Napier said, he has suffered from anxiety and depression that eventually led to an eating disorder. He believed “being a man” meant he would have to handle his mental health issues on his own.

Depression in men can be inherited genetically as well as come from environmental factors like the loss of a job or relationship. People of all ethnicities and socio-economic backgrounds are susceptible.

Napier’s struggle with mental health began when he was very young and sensitive about his weight. After losing more than 30 pounds early in high school, he started to feel better about himself and more confident. But as some of that progress began to slip away later in high school and into his freshman year of college, his mental health began to slip with it.

“I was feeling that in my mind the best way to try and salvage what I had left was to binge and purge, and it stuck with me for several years now,” Napier said. Despite his worsening mental health posing a risk to his physical health, it would be years before he would seek help.

“No one really noticed it because I didn’t talk about it,” Napier said. “And if there were any signs I would try to hide it.”

“I can remember this one situation, in particular, my mother asked me if I was feeling suicidal,” Napier said. “I was, but I told her no. I lied straight to her face, and it’s always kind of stuck with me. My mother is the person I trust most in my life, and I couldn’t tell her to her face that I had problems.”

Men fear judgment from family and peers if they talk about emotional struggles and issues of mental wellness, but hiding those struggles often results in more misunderstandings from people who aren’t aware of what’s going on or have misconceptions about mental illness.

“My dad my entire childhood growing up, he had depression, but this was never talked about in our family,” said Zach Lahr, president of the Mizzou Student Suicide Prevention Coalition. “It was major depressive disorder, and so seeing him staying on a couch for three days and not getting up or anything, we just thought he was lazy. We just kind of assumed that these issues were more personality traits, not necessarily that he was struggling or that there were certain aspects we weren’t able to see that were affecting him.”

Men who suffer from depression are likely to withdraw from family and friends or become isolated, according to the NIMH’s “Men and Depression” page. Isolation can be dangerous when combined with untreated mental illness because it cuts men off from the support systems they need to encourage them to get help. Men can even blame themselves for their isolation, increasing feelings of depression.

‘Can’t just rub some dirt on it’

Since it’s so common for men suffering from mental illnesses to not seek treatment and feel ashamed of their struggles, psychologists have taken to the web in an attempt to reach out to men. Similar to HeadsUpGuys, ManTherapy.org is another website that has tried to connect with men in a way that is easier and more relatable.

Backed by a team of comedy writers and clinical psychologist Nathaan Demers, Man Therapy features the fictional Dr. Rich Mahogany, an online therapist designed specifically to appeal to men. Features on the site include a “head inspection” that uses input from a survey to give the reader an idea of the state of his mental health and provides resources based on the results.

The site also posts professionally vetted answers to common questions like, “Can I just fix my problems by myself?” and, “When a person dies by suicide is there something wrong with that person’s character?” Each feature on Man Therapy is guided by Dr. Mahogany’s very Ron Swanson-like sense of humor. Tips and adages include:

• “A mustache is no place to hide your emotions.”

• “It turns out there are worse feelings than being kicked in the giblets.”

• “According to science, bad things can happen to men, too.”

The idea is to make it easier for men to loosen up and get comfortable with approaching their mental wellness.

“If we wait till a man is in crisis with a loaded firearm, we’re far too late,” Demers said.

“So we know that we need to get men talking about mental health long before that crisis is occurring, so that when a crisis does occur, that man either has the tools to be able to cope with that on his own or knows where to reach out to.”

Demers compared mental health to minor injuries like falling off a bike. Most of the time a scraped knee will heal itself, but every once in a while a more serious injury, like breaking an ankle, requires professional attention. Just as with a serious medical injury, a serious mental health crisis will benefit from treatment.

Or, as Dr. Mahogany says, “You can’t just rub some dirt on your emotions.”

Getting help

Like with any disease, mental illnesses can get better with proper treatment and support. For that process to begin, however, there has to be a realization that there’s a larger problem — whether by noticing signs of a loved one’s poor mental health or in oneself. Once the illness is recognized, it can still be difficult to make the next step to seek help. The National Institute of Mental Health says, “It is important that friends and family support their loved one and encourage him to visit a doctor or mental health professional for evaluation.”

While getting professional help is the start of the climb, the road to better mental health can still be an uphill journey. Counselors are able to provide a wide range of assistance that is personalized to meet the needs of each patient.

Some people may worry about side effects of going on medications, but not all treatments require medication. According to the NIMH website, “The increasingly popular ‘collaborative care’ approach combines psychical and behavioral health care.”

And needing a little extra help from medication isn’t a greater a sign of weakness or failure. Rather than a shortcut, medication can be a means of gaining traction.

Napier said  his mental health took a turn for the better after he sought treatment at the MU Behavioral Health Center.

“The therapist kind of led me to the external factors that were causing this,” Napier said. “She told me it’s not going to go away, but you can better control it, and you can take steps in your life to make this more manageable.”

Napier said he does as much as he can to stay active and get out of the house by going on hikes or playing golf and basketball. But the biggest change came from talking with other people through Active Minds who struggled as he did.

“I became surrounded by a community of people who had similar experiences to me,” Napier said. “It was good to know that I wasn’t alone, that you don’t need to struggle in silence.”

And for Lahr, the changes he saw in his father after he was hospitalized for his depression and got treatment changed the misconceptions he had and saved his father’s relationship with his mother.

“He goes to therapy; he reads more; there’s been a shift since we’ve all kind of gotten to a better understanding of it,” Lahr said. “Just being able to connect more with him on those issues, we’ve been able to see a pretty positive change in his overall behavior.”

With knowledge of mental illnesses and knowing the right tools to combat a mental health crisis when it arises, men can be better equipped to take care of their mental wellness.

Henderson said the memory of her son Balewa pushes her to spread awareness about mental health, but there’s still a long way to go. Balewa’s name is Swahili for “happiness,” and it’s his times of happiness that his mother chooses to remember. Those memories give her hope that the disease he struggled to overcome can be treated and that, with help, others can beat it.