Ep. 159 | Men’s Mental Health: Why It’s Hard to Ask for Help (And Where to Start)

Hello and welcome to another edition of Everyday Therapy. I am Brett Cushing and I am here with my highly esteemed host, Dr. Karin Ryan. Hello. Karin, I am very excited about today's topic. happen to be an expert on this because we're talking about men. Yeah. And I've been one for over half a century. I think I have some experience I can talk about today. I think you do as well, right? And mental health, which you've probably been in for a quarter of a century at least, right?

are qualified. I think you know some men too. I do. I have some good men in my life. Yes. I know lots of men. So we're talking about men and mental health particularly. Why men struggle getting to receive mental health services. Yeah. And by way of analogy, think this might help. Imagine that you're in a room, in an office room, and the fire alarm is going off and everybody's running and you can hear some panic and

there's a man sitting there at his screen still working and everyone's leaving but he's still looking at his screen the smoke is billowing up and he's still at his screen and refuses to leave. Why? Because he does not want to acknowledge that he cannot control his environment.

And that begs the question, is that stubbornness? it pride? Not necessarily. And I think that's where a lot of people go. And that's where the narrative can be is that men are just stubborn or they're prideful. And actually what we can talk about today is how much of their behavior is socialization. It's learning behavior. And it comes more from what we're taught and learning as we grow up in our culture. The message that they are receiving.

the second they, you know, take a first breath, right? Yes, exactly. Right. Yeah. So, yeah, don't cry. I didn't hear that as a baby, but I heard it a lot growing up. And yes, don't be a baby. That's what I heard. So yes. So maybe we could jump in talk a little bit about why men's mental health often goes unnoticed.

spoken. Yeah, unspoken, unrecognized, uncared for, right? That's the main thing is we hope that this like can start to shift that a little bit as we talk about men and their mental health, right? I think we need to because some of the research shows that men suicide rate is five times higher than that of women. And 83 % of the men who have had died by suicide, 83 % of them have no prior record of receiving any mental health services. Yes. Could have been

Yes, and they deserve the support, right? And so it's shifting this mindset and how we think about it, right? Like you highlighted, so many of those messages are be strong, right? Handle it yourself. Don't show emotion. And really oftentimes a misconception about what therapy looks like, you know, they envision or we envision people like laying and crying and just emoting all the time. And is that part of therapy? Absolutely. But I think there can be a really misperceived expectation about what therapy is and who

who goes to therapy and for what. So there's all of these factors coming into play. And not to mention, just going into a therapy office is not what men are conditioned for. So we'll talk about how that can be even a bit threatening for men. I think also inherent within this is the sense of vulnerability. Men are kind of socialized, oftentimes.

to be tough, to not show emotion and not be vulnerable and...

To be vulnerable for men oftentimes can be perceived as weakness. I can't show that. so there's this double bind that men feel they're in, whether they realize it or not, is I have this emotion, I don't know what to do about it. And some of the research shows that men actually know that they're having symptoms, but highly unlikely to go talk to anybody about it. So how do we help with this vulnerability? Because that's a big obstacle for them.

And I think about vulnerability even being in regards to sometimes it's like, be strong, have it all together. But also I think about the expectation of like, be calm, be grounded, be wise, be logical. And the misperception that then when we're having mental health symptoms or we're experiencing depression or anxiety, that then somehow we're not wise or we're not grounded or we're not smart enough. And that is so far from the truth. But you can see like wanting that perception to be.

I've got it together.

Yes, yeah, and it can feel like an uphill battle for many men in our culture to achieve that perception. Yes. Just because of the way men are portrayed sometimes in the media and on TV and things. So you have the one hand where the man in the action movie is Mr. Independent, goes and saves everybody. And then in other, it's almost another extreme, know, in certain sitcoms that I grew up with is the man was kind of a goof and a buffoon. mean that. So, yeah.

find a middle path here. Yes, and I like that you highlighted the numbers, Brett, because you're highlighting, you know, the increased risk of suicide and struggling alone and then how many, you know, the gender differences and who seeks therapy and just making it very clear, like, mental health struggles are human. They are not more feminine, more masculine, have gender involved, that any gender experiences mental health essentially at the same rate. It's just how much do we seek treatment and care and they're different.

maybe different types of mental health experiences, but this idea that it's more of a female issue is absolutely incorrect. Absolutely, yes. Because men do have emotions. Men have thoughts. Men have behaviors. Men have stressors. Men have trauma. Yes. Everything. It's part of what it is to be human. Exactly. so mental health is a human issue.

not a gender issue. And I think the struggle for many men is that this double bind that they're still in our culture today, this traditional

male socialization that men, to be a man is to be stoic and to be unemotional, to be impenetrable. And then the other end is that men today are also, there's this modern moral value, if you will, that men, a real man is sensitive, is vulnerable and is present and is engaging. And I see men wanting to live up to that and they want to be, they really want to be a good dad. They want to be a good husband and they're running ragged,

to do all of those things and still...

be living up to that traditional value of being stoic and being tough. And it's really hard to know. And so they kind of waffle between both extremes. And that's a lot of pressure for men. It's a lot of pressure. And it's a lot of figuring out what is right for each context, right? As you're describing that, I'm thinking about the men in my life and the men I've worked with and trying to navigate the expectations and the different roles that they're in. Right. And so, and how quickly that can shift.

right from going from a meeting to then coming home and trying to snuggle a two-year-old and being patient and all the things that go into that and how those external and internal factors which we'll talk more about later too play just what a challenge that can be right mm-hmm so what this can look like for men as we are

having difficulty navigating these two extremes and finding, I like the way you put that, the right expression for the right context. What it can look like when we're struggling to navigate that can be irritability, can be anger, and it oftentimes gets directed externally as if they're angry about their spouse, they're angry at their kids, they're angry at their boss. And oftentimes it is they're really angry at themselves.

Especially with depression, again, gender expectations and some kind of social norms are that women can feel more sad. They can be more down. They can do that. So women might experience depression a little bit more feeling down. can as well. But oftentimes that's why it shifts to that irritability or anger because they don't have permission internally, externally to be sad, to be down.

right, like want support and care. And so of course, then the human response is going to be, I'm irritable and angry because I can't get what I need. so well said. I feel validated by that too, man. Because I had heard this little anecdote. You see a woman in public crying and you think, hope she's OK. And then you see a man crying in public and you think, wow, what's his problem? Yeah. Yes. It sort of captures how we have this compassion for one and this kind of intolerance.

of the other. So men are kind of caught these are like you said these are real emotions, real stressors. Yes. Where do we go with it? And I think like as you're listening to this podcast I invite you if you want to take a second and just think about what Brett just said. How would you respond to seeing a woman cry? How would you respond to seeing a man cry?

Whether that's a stranger on the street, someone in your family, and then lovingly, can I ask yourself, and is that how I want to respond? Am I supporting men's mental health on how I would respond and do I want to shift that? And I think that's such a great point because the anger and the irritability is seen at the surface. And a of times we know behind anger, it's usually fear or sadness. Always, almost always. And my dad, died a year ago, love him, and I misunderstood his anger growing up. It came out externally.

But I learned over the years what he really wanted and was angry about is he wanted to provide the perfect vacation for the family. when that didn't go right, he was upset at himself that he wasn't able to deliver. Yeah. And what are your thoughts, Breton, about why he wanted the perfect vacation?

wow, that's because what did that mean that meant what yeah, he's he's well for him meant that he did better than his dad Yeah, and meant that he's able to provide on a cop's income Mm-hmm What he really wants for his family? He was able to deliver the goods deliver the goods and I what I'm curious if you think he also Wanted to have family connection. So like a good vacation means our family loves one another. We're connected We care for each other and even though it comes out this way underneath there's that

main goal like we all want this really positive healthy human connection. Yes and so then it comes out as anger which results in disconnection whereas if men can be freed up to experience the real emotion it doesn't mean they're gonna have to be sobbing crying but just I'm super sad. Yeah. That affords intimacy and connection and that gets lost. I'm just so glad I never struggled with that on vacation. kids could tell some stories. Right.

talk about it right we're all just working on all our stuff. What happens then too is they go into this we go into withdrawal because well it feels shame for having the emotion or for expressing it inappropriately maybe in a destructive way. feeling misunderstood. Right so nobody understands, now I'm just gonna withdraw and now not gonna feel anything. Yep and kind of that shutting down so when you're highlighted you know in your metaphor at the beginning about like you know the smokes coming up right like what are some of the signs for when men might be experiencing kind of

and mental health needs and what'll help them recognize, okay, this is a time when I wanna start talking about it or I wanna acknowledge what I'm experiencing, right? So we talked a little bit about that irritability and anger, some emotional withdrawal. What else do you see, Brad?

You know, coming through. I the self-medicating, because that's also socially acceptable too for men. Yeah. The men can go to a bar and they, that's actually where they do talk sometimes because if you're, you're having the alcohol to self-medicate pain, you're also lowering those inhibitions and they start talking. Yeah. And it's a little bit of a pressure release for men. And you kind of have alcohol as your alibi because it's just the alcohol. Like, yeah, look at Brett. Yeah. He's really had a few too many.

This is funny and you're not necessarily seen in a negative way. You have this kind of alibi with the alcohol Yeah, you essentially have permission. Yes, then to talk about things that you wouldn't normally yes And it's talked about usually not in the most constructive manner in that context either. Yeah, and I what I see too is often, you know a desire for kind of control or holding things together And so that might look like working or like really being driven in one area like putting everything into work or everything into

one thing and kind of trying to negate and distracting yourself from what's happening. So sometimes it's shutting down and sometimes it's gone full force into one.

or a couple of areas. what I also see that men do is kind of capture everything we said is they go, they suppress. So there's suppression, suppression, suppression of how they're feeling, their sense of need to connect and be vulnerable. They suppress all of that, the stress of life, and then it just builds up and then they go to explosion and it just comes out. And then it's, oh, I suck, I'm the worst husband, worst father, and then it goes right back to suppression and withdrawal again. And it's just vacillating back and forth.

Exactly. Yeah. And so, right. So if you're thinking about what does the mindset look like, like I should be able to handle this, like it's not that bad yet, right? Like waiting until that threshold is well beyond, right? Like when it would actually be helpful to get help. I don't have time or I don't know where to start or like I'm scared. Like, I don't know what this is going to look like. Like, I don't want to do that. I feel uncomfortable. Right. Right. And there is courage, right. And coming in and

what I think Brett and I would both highlight to you, and I think he asked men who have been in therapy, is like, yeah, it really can be uncomfortable at first, and then after a session or two, you're like, not actually that bad. Right, yeah, it's something that can be a sense of, and source of relief for men, because...

I feel understood now. Somebody actually gets this and understands me. What's important about that too is that men oftentimes are socialized. There's only one person I'm going to open up to if I do it all and it's going to be my partner. That is a lot. If men are socialized to only open up to their partner, that's a lot to put on her. That's a lot of weight to bear and then there's an expectation.

expectation that she's gonna fix me. Yeah, fix me. Yeah, and that's too much for her. That's not a realistic expectation And therapy can be a really nice help. Yeah, absolutely Yeah, and and it's just when when we're talking to a loved one about our mental health, right? Whether that's a spouse or a really close loved one like they can't be as like Have a healthy emotional boundary there because they're involved in it, right? So they're it's great. Yes We want you to talk with your spouse and your loved ones

and your family members about how you're feeling, what you're doing. And like Brett just highlighted, the importance of having a therapist or having somebody outside of that family system or your spouse can be really helpful because it's another perspective and it's a space then where you can really process and get what you need and you're not worried about the other person. Right, yes, not having to have that worry is really relieving. I think also what might be helpful for people is to know...

what are the signs and symptoms I should be looking for when the man in my life is having certain symptoms that it's concerning and now I need to say something, how do I know that? it's, well there's a lot of withdrawal that happens with men.

We like to withdraw and sometimes that's okay. It's just a question of my hiding or am I just replenishing and getting happy when I'm withdrawing. And if it's for hiding, then we want to be concerned about that. Guys can play video games and go in their man cave for a couple of hours. It's just a question of what's the motive behind And is that truly restorative, right? Yes. Yeah. watching for sleep issues, right? So having trouble sleeping, you know, can be signs of anxiety, waking up early,

having trouble going to bed, kind of being really restless are absolutely important things to watch for too. Or kind of like just not talking as much and shutting down, know, not enjoying things they want to do, you know, stopping going to activities that they used to go to, right? Or feeling like things are just too much, like watching for slips in like hygiene or work performance. So kind of stop and like caring about how they look as much or how they, you know, that can be signs and physical symptoms, right? We know we experience.

Anxiety is oftentimes a very physiological thing and so watching for like headaches, migraines, muscle tension, stomach aches, those sort of things are also signs that our body will be communicating to us sometimes first. Absolutely. So we want to be looking for that.

And trying is so hard, I do get it. Trying to look past the behavior and past the emotion, past the anger and the irritability that's coming out. is that sense, oftentimes, of feeling afraid. anger helps me feel like I'm in control. But really I might be afraid or I'm just sad. And trying to relate to him then, not on what you're seeing on the surface. And that can be hard because that can be kind of scary too. Yeah.

about surface like that, it reminds me of the importance of, know, when we're talking with men, especially if you're, you um, have male friends, um, is really like trying to like, if we're trying to work on this mental health piece, right. And we're trying to work on talking about real stuff, right. Just my encouragement would be like, can you try to have like beyond surface level conversations? Right. So yes, you can do that and shoot the breeze and talk about things and watch the game together and talk about like glory days. Um, which is kind of fun, but then it's talking about like, and how are you really?

Like, yeah, I saw that your mom was not doing well. How are you doing with that? You know, how's work? How is work really? Do you feel satisfied there? What do you have? How is that going? And then sharing how you're feeling. So asking more directly about things you know that they're experiencing in your life. That can feel like a safe way to get there, where if you have seen somebody's graduating from high school and they're going to be an empty nester, or they just had a baby, or their parents are ailing. Asking about that.

how are you doing, right? It acknowledges that as humans we experience stressors and that these can be things that are challenging to navigate. And so even acknowledging that it's a challenge, again, helps that vulnerability, helps that openness and starts talking about it. And I'm hearing you and it's so appreciating. Your questions were all beginning with how.

not why. And for men being asked, why, why do feel this way? And why are you doing this?

They don't know. There are some studies that show they don't have the, and they're not conditioned to have the emotional vocabulary to talk about it. So it can feel, when they're asked the why questions, it can feel as though they're being cross-examined and that's going to result in them shutting down and isolating more because they're going feel incompetent. But the how questions or what questions, what do think you can do better? What might help you with this that's more task oriented for them?

answer that. Yeah or even what do you what do you need? Like what can I help you with? do you need? But you can see by asking how are you doing with this? What you are doing is acknowledging that this is something that the human being is navigating, that this man is going through. And so when you say how are you doing with that? They can say actually it's been going really well or man I don't know like it's up and down and something and then it invites it but it's that truly acknowledging and validating because we talk about validation a lot.

write on this podcast and that is a key piece of like you are validating that this is something they're going through. Yes, yes. And if you find, I'm gonna throw this in no extra cost today, if you find that your man in your life is really struggling and resistant to going to therapy, you could ask what do you think, is there a risk in going to therapy? there any perceived?

risk. Yeah. And it really would get them to start thinking about that. Yeah. Or you get the flip side of that is what do you think is the benefit of not going? In other words, is life right now, is that working for us? Yeah. So and notice the, is it working for us? Kind of inclusive language. Yeah. Yeah. And I think it's, it's also helpful to realize that when you go to therapy, right, like you're, you're trying it out.

So if you sign up for therapy, you know, you call Sage of Behavioral Health and you get scheduled with an intake and you kind of say what you're looking for. And they pair you with somebody and you come in and you sit down in their office. Like you are not now committed to this person and committed to therapy for the next five years or even year. Right? Like what that means is you are going in and seeing how it goes. And so I think really highlighting of like, you know, what are your thoughts about just trying? Like would that feel okay? Like what are your thoughts? Cause you don't have to stay if you don't like it. Want to just try it out.

And that, again, feels more manageable.

It gives them an exit. Yeah. When I work with law enforcement and do therapy with them, and I know this from my dad who was a cop, that they always like to sit in the corner so they have their exits and they can see everything. And that's kind what you're saying is men, they need to feel that some sense of control, because when they come into the office, therapy, why can be threatening is they're looking eye eye with somebody, oftentimes more often than not it's going to be woman, and looking at another woman,

in the eyes talking about emotions. That is not part of a man's world. So it's very threatening and a good therapist working with men can be sensitive to that, provide a lot of validation of their culture, also provide a lot of...

those action oriented kind of questions and not be necessarily looking directly at them. They can kind of almost side by side and even engaging in something while they process things. Yeah, and as a woman, right, like working with men when they come in, you know, during that first session when I'm talking with them, I'm asking like, how do you feel about coming into therapy? You how do you feel about having a female therapist? You know, what has your experience been with therapy? Like kind of, and so we're having that conversation. And so there's this openness and a transparency and we're like,

We're talking about that together, right? And so I think being thoughtful about, you just highlighted this, that it's therapy is oftentimes very collaborative and we can be action oriented and problem solving. And yes, we're going to talk about emotional expression and understanding that, but it's going to be in a way that feels validating and fitting for you, right? We're never going to, as a therapist, I'm never going to force somebody to do therapy, like a certain way. Then I think that's so helpful for people to remember that.

The therapist, yes, we have styles and we have kind of orientations that we use, but we are trying to meet you where you're at and sincerely trying to be a team with you and work on like what you need. again, not again, highlighting that you don't have to know exactly why you're coming in. You can have vague things that are like, you know, the room was filled with smoke. I don't really know. Like I'm just feeling off or here's what, and like.

then we will figure that out together because maybe you have not ever been given the language to know exactly what you're going through. That's our job. I really want to.

parts and practical things for people if they are struggling with talking to a man in their life who's very important and is struggling. How do I talk at what's maybe the best means to do that? So I would say if you're having struggles with that, do something and talk with them. If you notice women can call and hey, how was your day? And they can talk to each other. How are the kids? Men never do that. It's we call each other if we need help with something around the house to fix, or if we want to do something.

And so if you're having difficulty connecting and talking, go on a walk and talk. Go out to eat, go grab coffee and talk. Go for a drive. If you're working out, notice that can be side by side and process and talk while you're doing. It's a lot less threatening and it'll help him to feel much, much more relaxed. Yeah. Yeah. And, and being thoughtful too about what, what you are surrounding yourself with in regards to like how individuals are talking about mental health. So.

There are amazing athletes and people who are doing a really great job, Michael Phelps, talking about mental health. And there's many people that do a really nice job highlighting and normalizing men's experience of mental health. And so if you're thinking, you know, I'm kind of willing, I'm wanting to shift that a little bit. Maybe I'm open to that. I invite you to follow people who talk about mental health in really healthy ways. Follow the men who are talking about mental health in ways that feel honest.

helpful.

Yes, it reminds me of a scene in Iron Man 3, where you have Iron Man the superhero, after he's gone through much trauma in previous two episodes, he starts having panic attacks. And he doesn't have control, and he doesn't look competent, and he is scared. And Robert Downey Jr. played it really well. And it really highlighted that a man can be tough, and a man can be strong and courageous, and a man can have weakness and be afraid.

totally okay. And that's my heart for all men that are listening that it doesn't have to be an either or. You can both be reliable, solid, strong as a rock, and you can be vulnerable as well and have greater emotional connection. 100%. Well, thank you for joining us today. We hope that this has been helpful for you and we are already looking forward to next time together. Take care, everyone.