Mental health stigma: Open up, men told

Izah Azahari

Recent studies indicate that one in eight men suffer from common mental illnesses and the prevalence of psychotic illness is believed to be roughly equal for men and women.

Since its introduction in August 2018, the Clinical Psychology Services has received 91 walk-ins up to April 2019 – 33 men and 58 women.

There is also constant debate about the true level of common mental health disorders as stigma largely impacts the under-reporting for mental illnesses within men.

This was said by Psychologist Zahid bin Haji Md Daud from the Psychology Clinic Division of the Ministry of Health (MoH) during the ‘Men – Breaking Barriers for A Better Mental Health’ forum, held in conjunction with Men’s Health Awareness Month (Movember) and World Health Day 2020 on November 7.

Zahid said depression and suicide are ranked as a leading cause of death among men, and yet they are still far less likely to seek mental health treatment than women. A majority of men feel work, finance and health are their main concerns in life.

“Experiencing mental illness as a man is particularly unique,” said Zahid. “Many men tough it out and struggle alone.”

Zahid said, men are socially raised to be tough and dependable, where most find it hard to express emotion.

Psychologist at the Psychology Clinic Division of the Ministry of Health (MoH) Zahid bin Haji Md Daud speaks during the forum. PHOTO: IZAH AZAHARI

“There is also prominent stigma in society that tells men who have a mental illness to simply deal with it.

“We should try to understand the barriers on why men are reluctant to seek help for their mental health,” said Zahid.

These barriers include stigma, cultural upbringing, and expressing of mental health issues differently which often lead to self-diagnosis and self-medicating.

“It’s a pity that mental health has a negative stigma surrounding it, which leads most men to detest opening up in fear of being perceived as weak or less of a man,” Zahid said.

“The lack of education about the topic makes addressing such issues difficult.”

In terms of cultural upbringing, he said, the way that males are brought up might explain the difficulties of expressing emotions or feelings. Masculinity and machoism are still observed throughout diverse cultures as men are taught to be strong and quiet, with roles as fathers, husbands and sons who are breadwinners or someone that people can depend on which consequently leads men to not seek help when feeling depressed.

“With men less willing to ask for help, they will continue to experience symptoms contributing to depression, which may lead to substance use and other risky behaviours,” said Zahid.

Habits and mannerisms learnt early in life help explain the difference between men’s and women’s openness to seek help.

Talking more about how we feel will help alleviate the symptoms, Zahid said.

The psychologist said that the notion of ‘being strong’ or ‘getting on with it’ affect how men perceive their symptoms, especially when they run into problems they cannot solve.

“We are all human at the end of the day and hit roadblocks in life, we have emotions to manage and issues to resolve,” he said.

Apart from discussing feelings, Zahid said the symptoms experienced by men may also be distinct from women.

Some men with depression or an anxiety disorder hide their emotions and may appear to be angry or aggressive, while many women will often express sadness.

The ways of coping with emotional issues are different as some may turn to drugs, gambling, drinking, or become angry and show aggressions.

Both men and women may also experience symptoms of depression as something physiological, such as a racing heart, digestive issues, or headaches. Men are also more likely to see their doctors about physical symptoms as opposed to emotional symptoms, he added.

From his experience dealing with male clients, Zahid said they tend to express ‘anxiety symptoms’ as dangerous with the likes of catastrophic thoughts with regards to their health such as a heart attack, despite medical investigations showing otherwise, leading to frequent visits to the doctor if psychological intervention is not conducted.

Seeking information from the Internet can be useful, however when it’s complicated by strong emotions, patients can potentially over-diagnose or under-diagnose their symptoms, which may lead to delay in seeking clinical treatment.

“There are plenty of online tests which can tell how depressed you are, but as all good doctors know, there is nothing to replace clinical judgement when making a diagnosis,” said Zahid.

“Questionnaires can only give some guidance around what the problem may be, but in the end clinical judgement is the gold standard in mental health and many other areas of medicine.”

He added that making a mental health diagnosis isn’t just about the number on a scale, as it is about understanding someone’s life and how their symptoms impact it.

At times the problem is so great and urgent that making the diagnosis and deciding on a treatment is easy, but more often, it is not so clear and needs careful thought and discussion about whether or not a diagnosis would be helpful.

“People who believe that they’re diagnosed with a specific medical or mental health condition may attempt to cure that problem by changing their diet, taking over-the-counter medications or otherwise attacking the issue at its source,” said Zahid.

“Unfortunately, if people are working from a flawed assumption about what they have, they might be taking steps they simply don’t need to take.”

Zahid said men can educate themselves and others, be aware, communicate, view physical and mental illness as equal, show compassion for themselves, and have realistic expectations.

Friends and family may feel helpless or unsure of ways they can help a loved one with mental health issues. There are plenty of ways to offer support and help a loved one get the treatment they need, such as using first-person language and avoid derogatory slang, expressing support, offering to help with tasks, making them feel included, educating other friends and family members, and being empathetic.