Karan Upadhyay (name changed), 30, broke up with his fiancee of three years a few months back. The Mumbai-based digital marketing executive spiralled into depression, experienced low self-esteem and felt lost. “I believed I wasn’t good enough,” he says.
Upadhyay, who sought therapy and has been continuing it since is not alone. Many men go through a mental health crisis after a breakup, but they are far less likely than women to admit they need emotional support.
Gender has always played a role in mental illness and its effects. While more women than men are likely to be affected by mental illness, women are also more likely to seek help or treatment. Societal norms, pressures and expectations keep men from displaying their vulnerable side, meaning that male mental health is often overlooked. Not surprisingly, more men than women die by suicide every year; according to the World Health Organisation, twice as many men die from suicide as female. Also, the prevalence of substance and alcohol use is much higher in men; this unhealthy coping response plays a significant role in delayed help-seeking. To mark Men’s Health Month, we speak to clinical psychologists about when men should seek help and not bottle up their emotions.
A question of culture
The emotional responses of men to situations have been and continue to be shaped by our socialisation process, which includes observational learning as a child, understanding cultural norms and gender roles, and finally, the construct of what masculinity should entail. Sadly, in all these diverse processes, the singular recurrent theme is that vulnerability in men is a sign of weakness and hence, unacceptable.
Pallav Bonerjee, a consultant clinical psychologist and neuropsychologist at the Vidyasagar Institute of Mental Health and Neuro & Allied Sciences (VIMHANS) in Delhi, points out it is seen as emasculating, even sacrilegious. “The expectation from men is to remain resolute and endure adversity. Seeking help would expose his inadequacy and lower his status among peers and rivals,” he says.
“Paradoxically, it is seen as acceptable for men to take refuge in alcohol and other psychoactive substances. Keeping feelings bottled up could lead to aggression and anger management issues, and the usual victims are family members (read spouse), children and pets or strangers on the road while commuting. Such outbursts are often rationalised as a form of release, and are followed by remorse and shame,” says Bonerjee. Over time, this pattern of dysfunctional coping leads to the build-up of more severe stress, perpetuating the cycle and eventually leading to signs of clinical anxiety or depression, he says.
Culture has played a huge role in creating this rugged image of masculinity. Mumbai-based Dr Amit Malik, the founder and CEO of InnerHour, a mental health service, says that the need to conform to traditional gender roles plays a huge part in men refusing to engage with mental health services. “Traits associated with traditional masculinity include stoicism and self-reliance, which do not fit comfortably with psychological help-seeking,” he says. This, in turn, results in the internalisation of discriminative views held by society, further discouraging men from seeking help.
Interestingly, women seem to respond more healthily to a stressful situation by reaching out to larger support systems. Dr Malik shares that there is a difference in the stress response exhibited by men and women. “It is characterised by ‘fight-or-flight’ in men and ‘tend-and-befriend’ in women,” he says.
Stress hormones released by a specific incident lead to physiological changes, such as a pounding heart, tense muscles, sweating and rapid breathing. “Some men get angry or argumentative, which is a part of the ’fight’. Others flood emotionally with feelings of helplessness, anxiety and frustration, and they to retreat into a foul mood and sleep as a way to escape; that’s the ‘flight’ part of the reaction.”
While the image of women visibly mourning a shattered relationship is a common trope in movies and books, the loss of a partner doesn’t just affect women. Dr Fabian Almeida, consultant psychiatrist, Fortis Hospital, Kalyan in Mumbai, references a new study in the journal Social Science and Medicine: Qualitative Research in Health. It found that most men developed new or worsening symptoms of mental illness after break-ups, such as anxiety, depression, suicidal thoughts, anger and heightened substance use.
“Men’s mental health conditions often manifest in symptoms such as risk-taking behaviours, aggression, violence, obsessive ruminations, restlessness, addiction. The truth is that far more men are suffering than the statistics show,” says Almeida.
Taking charge of mental health
Bonerjee observes that in the past decade of his clinical practice, he has seen a steady increase in the number of men who are now comfortable with the idea of seeking therapy. “There seems to be a need to question the stereotyped masculine-feminine gender role that has been the norm so far,” he says.
Almeida concurs with Bonerjee. He adds that statistics related to mental health in men are gradually beginning to indicate better help-seeking involvement. “This is especially true when it comes to relationships and break-ups. The modern-day man is much more in sync with his emotions,” he says.
Men are more likely to seek help when their professional lives are affected. While the underlying concern could range from relationship stress to health concerns, what actually motivates him is when there is a negative impact on his work.
“Men don’t express or even acknowledge depressive symptoms due to socialisation. Men’s coping is likely to align with the male stereotype, with men preferring self-reliance and autonomy over professional care. This self-reliance can often significantly deplete internal resources as help-seeking is delayed until a crisis point is reached,” Malik says.
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Bonerjee believes that men need to prioritise their mental health the way they would their physical health or professional life. “Tons of men go to the gymnasium on a regular basis because they want to remain fit and take charge of their physical health. Ironically, many of the same individuals will shy away from a mental health professional, even when they know they need some support,” he observes.
“Being a man,” he says, does not exclude one from being a human being first, and there is no greatness in silent suffering. “It is a show of strength to be able to own one’s vulnerabilities and work towards a solution.”
Divya Naik is a Mumbai-based psychotherapist