Little boys blue

The death of Robin Williams highlighted the role depression, anxiety and severe illnesses (such as Parkinson’s in his case) can play in the act of suicide, while the launch of the World Health Organisation’s first ever World Suicide Report showed that men are almost twice as likely to commit suicide than women.

There are differences related to cultures and countries, but men are more likely to complete the act of suicide whereas women are more likely to attempt suicide. As a result of the British legacy in many countries in the Commonwealth, the act of suicide remains illegal, so if your gun does not get you, the legal system will. More than 40 years ago, looking at low rates of suicide in black men in New York, it was observed that the rates of suicide were indeed low but those of homicide in this group were high, indicating that men swaggered their way out by arguing, ‘I will kill or get killed.’ Men tend to use more violent methods in completing suicide, and they tend to deal with their depression by drinking or through aggression or acts of violence.

What stops men from seeking help early?

Social expectations about masculinity, particularly the view that men will be able to cope as they are perceived to be stronger, may contribute to a perception that it is unmanly to seek help. The way boys are brought up not to cry means that men may find it extremely difficult to express their feelings to anyone, including their male friends. Such a phenomenon is even more common in certain cultures. Geert Hofstede, a Dutch sociologist, posited that cultures have five dimensions, one of which is related to masculinity/femininity. These attributes are related to learned styles of inter-personal interactions. Masculine cultures suggest that boys don’t cry and should fight back and prevail in performance games. Competitive sports are part of the school curriculum and macho behaviour in the workplace is expected. In cultures with a high masculinity index, the engine power of their cars is important to men and they live in order to work. In such highly masculine societies the fate of the poor is seen as the poor’s problem, thus any failure to achieve is personal rather than systemic. Men become more attractive to women by their achievement and status. Among the masculine cultures are Japan, German-speaking countries, Latin American countries and English-speaking countries such as the US, UK, Australia, New Zealand and Ireland. These cultures encourage men to be macho and in control of everything including their emotions. They may therefore find it difficult to express some emotions in particular those of sadness, tearfulness and depression as ‘men don’t cry’. This means that a lot of these feelings get internalised, making it difficult to seek help.

Men also tend to use more macho and violent methods of suicide such as hanging, guns or jumping from heights. Often feeling low is accompanied by tiredness and variations in mood as the day progresses, sadness, tearfulness, sleep disturbances and altered sleep patterns, low libido, poor appetite and loss of weight. Depression in men can often present with irritability, outbursts of sudden anger, increased loss of control, risk-taking, aggression and increased alcohol intake to mask feelings of depression and irritability. Men may also use drugs more often to self-medicate and hide feelings of depression, as the general stereotype is that men do not get depressed and if they do, it is ‘moral weakness’.

Therefore men tend to cope with and manage underlying depression in different ways. Often men are competitive and depression is interpreted as a sign of failure and therefore they may find it difficult to share these feelings with anyone. They may feel isolated but may not acknowledge that. In addition, their internal world would emphasise their feeling a failure and bleak views of the world and their future. Studies have shown that between 60 and 90 per cent of those who commit suicide have mental disorders. Thus early diagnosis and management is critical.

What causes Depression?

In addition to the usual causes of job loss, failed relationships or the death of loved ones, depression runs in families. Relationship difficulties, separation and divorce, stressful jobs and lack of support at work, not being promoted or being promoted above one’s capabilities can all cause stress, which will contribute to depression. New fathers are also prone to develop depression seeing difficulties in bringing up babies. The loss of a job or lack of promotion may be seen as emasculating, leading to feelings of depression compounded by feelings of rejection and low self-esteem.


What to do?

A thorough and proper assessment is needed to ensure that there are no underlying physical causes. General practitioners are well placed to do this in the first instance so that a suitable referral to specialists can be made. This will include thorough mental-state assessment as well as physical assessment. Many physical illnesses including arthritis, diabetes, hypertension and an underactive thyroid can all cause depression.

Staying and keeping active, especially taking physical exercise, can help in some cases. It is important that partners and wives are involved in engagement of the patient. Spending time with families and friends, especially if one can share one’s feelings, may help. A balanced diet and avoiding alcohol and self-medication will also help. In mild to moderate depression, cognitive behaviour therapy has been shown to be effective. Other talking therapies may help too. However, in severe depression antidepressants may be needed. These drugs have been proven to be effective and are not addictive. The right types of medication such as a more sedating drug when the individuals are agitated and more stimulating medication when they are tired and drawn may help.

Families should remain watchful in both identifying the symptoms and signs of suicidal ideas. Supporting and encouraging their loved ones to seek help sooner and also keep a careful eye on warning of the possibility of suicide will help. Various organisations such as the Samaritans, the Mental Health Foundation and the Royal College of Psychiatrists have information leaflets in various languages and can be downloaded easily from their respective websites. Talking about feelings is not an unmanly thing but will open up various avenues so that no one has to suffer in silence.

  • Thing about depression is as soon as it is mentioned, everyone claims to have it.

    • This is such an unhelpful comment. It’s like you did not even read the article, or having read it you did not understand it. So one wonders why you are even commenting. Just a schmuck with an opinion.

      • Philip Hollett

        You are projecting. Let me guess, you have depression and nobody understands you huh? Such a special little snowflake.

  • tumiwisi

    The DSM (Diagnostic and Statistical Manual of Mental Disorders) keeps redefining mental illnesses to encompass ever increasing proportion of the population. Over 30% of population has ADD, over 20% depression, etc. The ICD-10 codes thus generated ensure that there is a revenue code to be billed. And up goes income of the practitioners of the voodoo science (aka Psychiatry) ….

    • “It’s all a conspiracy by doctors.” Spot the American. In American people pay for their health care through insurance. Here in the UK we see the same prevalence of mental distress but health care is provided for by taxes. So the conspiracy, if it exists, can only exist in the US. But the citizens of the US are famously blind to anything happening outside their own borders.

      The DSM has many faults, but it primarily describes mental distress it does not prescribe it. If you bothered to look at the diagnostic criteria you’d know that having the traits or the kinds of distress that make up a diagnosis is no picnic.

      The fact is that as prejudices like yours are chipped away at, we recognise that people in modern life are suffering from life sapping mental distress. The point of the DSM is to try to help medical practitioners understand mental distress and to help them treat it.

      It’s quite clear that just as modern life is destroying the environment and causing long term changes to the climate, the same range of lifestyles is causing mental distress at unprecedented levels and often in ways not recognised before.

  • We need to understand how depression is created and then also understand how so many men will not seek help.

    1. Depression occurs as our average stress redefined as many layers of “maintained mental work” from past, present, future experiences, problems, weights and values we develop over time, along with may circumstance, along with values society has created for Males, creates sufficiently maintained, high layers of mental that slowly create an inability for a person to achieve have feelings of self-worth (or desire to live). Note our present definition of average stress sees only some present, situational events as the cause for our average stress and cannot see how our minds are very complex and are dealing with many layers of many past, present, future unresolved mental work along with the need to maintain both sufficient needs and “love and honor from society” or feelings of self-worth many men seek from society.

    Try to picture an upright rectangle representing our full mental energy. Then begin drawing in from the bottom, narrowly spaced, horizontal lines, representing our maintained layers of average stress. Our minds are dealing with many “maintained layers of mental work that take away real mental energy. As those layers of mental work reach toward the top of that upright rectangle, they create both psychological suffering and a much shorter reflection time. This in turn creates more intensity of mental work to make up for the lack of mental energy available. This will eventually prevent a person from obtaining many areas of needs that person is seeking. Over time, the drain of adrenalin, and continued failure create over time a continued draining of self-worth or desire to live. In most cases, this just leads to more escapes from over-eating to over-shopping to drug and alcohol abuse. However, in for many, this leads to suicide and even suicide with violence.

    2. Our present, genetics models are not able to see how average stress (from our individual environments) is very different for all of us and so creates these conditions. The persons who work in research and preside over psychological groups tend to reflect their over-stabilized environments upon others and so can only imagine those other persons are somehow mentally disturbed or sick. This is one reason why many men will not seek help, for such branding of mental illness, usually only leads to more condescension and ridicule, even from those individuals who supposed to be helping those men. Society allows more aggressive treatment toward any Male who appears weak in some way.

    This treatment to make Males tough begins infancy with small aggressive treatment that increases from parents, teachers, peers, and society over time. This very early creates more social/emotional distance/distrust of adults/others, which only sets up a strong value system for more anger, anxiety, preparation for defense, and fear of anything appearing weak. Male children, later adults are also given love and honor only on condition some achievement, status, etc. It is long customary for society to give more aggressive treatment to any Male who appears weak. Support is not used for fear of coddling. Today in the information age, the more aggressive treatment creating more significant layers of average stress; much less mental, emotional, social, verbal support and much less care for fear of coddling from a young age; along with providing love and honor (the essentials for self-worth) are now creating many boys, later men failing in the information age and so more increases in dropouts, depression, escapes, and suicide. This is the extent society will go to make Males, even boys tough from a young age, even to the point of suicide.