Although they are just as treatable as other medical problems, mental illnesses can be hard to talk about. Although 88 percent of Texans believe the stigma surrounding mental illness should be removed, nine out of 10 Texans find it harder to talk about mental issues than physical issues, according to the Meadows Mental Health Policy Institute.

Although the broader societal stigma affects men and women alike, men face additional hurdles to discussing and seeking help for mental health problems. According to the American Psychological Association, societal expectations for men create a fear that seeking or needing help is not masculine behavior. Some prominent men have talked publicly about their struggles with mental health issues to help weaken the stigma. 

According to Mental Health America, former quarterback Terry Bradshaw often had panic attacks after football games and was diagnosed with clinical depression in the late 1990s, and former running back Earl Campbell was diagnosed with panic and anxiety disorder in 1989.

Still, men are less likely than women to seek treatment for mental illness even though studies show mental illness is a problem for men. Statistics from Mental Health America show that 6 million men suffer from depression each year, more than 3 million men have a panic disorder or phobia, and 90 percent of people diagnosed with schizophrenia by age 30 are men. Moreover, suicide accounted for 2.2 percent of all male deaths in 2011.

“When we talk about masculinity, there are three hallmarks,” said Andrew Keller, chief executive officer of the Meadows Mental Health Policy Institute. “The first is strength, the second is responsibility — being a provider for your family — and the third is not being a woman. Men don’t want to be perceived as feminine.”

Discussing feelings and admitting weakness are seen as feminine qualities — a factor that contributes to men’s reluctance to seek treatment for mental health issues — but Keller said the main factor is responsibility. Men don’t want to be seen as weak or incompetent. 

“If I tell my employer that I’m depressed, do you think she will trust me with the level of responsibility she would otherwise?” Keller said, adding that sometimes the workplace will accommodate mental health problems and sometimes a mental illness does actually affect a person’s ability to perform in the workplace, so the issue is complex.

“There’s so much shame attached to weakness,” said Dan Smith, a volunteer who facilitates one of the men’s groups at River City Advocacy in New Braunfels. “How can you be strong if you’re admitting a weakness?”

Untreated mental illness can lead to a kind of vicious circle in which a man’s circumstances make him feel like he will never have the things men are expected to have, Keller said. Ninety-five percent of men with schizophrenia are single, most are unemployed and most do not have stable housing situations — all things that make them think they will never be “real men,” Keller said.

“It really does cut to the core,” he said.

However, these circumstances are what Keller called a “functional metastatis” of schizophrenia. If it is treated, especially if it is caught early, schizophrenia patients can find themselves in much better situations. Keller said that 25 percent of depression cases and more than 75 percent of schizophrenia cases manifest before age 20, at a time when a person’s parents can influence them to seek treatment.

One of the biggest issues in men’s mental health, Keller said, is recognizing what depression looks like in men. 

“When men are depressed, we don’t act the same way that women do,” he said. “We don’t cry. We get irritable and angry, which makes it harder to feel sorry for us. Then we start drinking, because that’s manly.”

These conditions can lead to criminal behavior, Keller said. A vast majority of prisoners in the United States are men, many of whom could be treated for mental illness instead of punished with incarceration.

“Until we start pushing the frontier, where these things are considered something to be treated, nothing’s going to change,” Keller said.

Smith said the support group he facilitates helps men learn different and more effective ways to cope with difficulties.

“We reinforce good behavior with each other,” Smith said. “I think the most common issue men come in with is when their coping strategies are affecting their life — their family, their jobs, their relationships. There are other ways to deal with this other than doing something violent, while maintaining your assertiveness.”

The group also focuses on letting men know that they are not their problems.

“You can put a name to anger, to aggression, but to put a name to that melancholy where you can’t move ... there’s a word for it, but if you name it, it becomes who you are,” Smith said. Not allowing a man’s issues to define him helps him open up about what he is facing.

Smith said the men’s groups at River City Advocacy give men an outlet for their feelings that they might not find elsewhere. For example, he said, “Guys typically aren’t allowed to be spontaneous and creative. We’re not allowed to be who we are.” The support groups encourage men to channel their energy into creative endeavors.

According to the American Psychological Association, a man with access to a supportive group of other men might be more likely to seek help than a man whose only peer groups discourage it. 

“When you see another guy that’s dealing with what you are, you stop feeling like you’re alone,” Smith said. “You feel like you are a man.”

The men’s group Smith leads is a very relaxed environment.

“It’s very open,” he said. “We don’t have a rigid structure at all.”

Smith said sometimes they sit and talk about things like cars or sports, but, “We’ll get into some very serious stuff if someone’s having a bad day.”

Because men are reluctant to admit a problem or a weakness — “What guy wants to go to anger management?” Keller said — Keller takes a different approach in dealing with male patients. Instead of asking them to talk about their feelings, he focuses on helping them get better so they can be “real men,” including being good partners and fathers and providers.

Keller said that only one-third of people who need mental health care seek it out, so the problem isn’t only with men. He believes the bulk of the problem is that people don’t believe they can be treated effectively.

“The main reason people in general don’t seek treatment is they don’t think they can get better,” he said. “I would tell them, you don’t have to be in trouble at work. Your family doesn’t have to suffer. You can get better.”

Keller said the mental health profession should be more active in letting people know that treatment works.

“We should talk about how many people are in remission from depression,” he said. “The primary burden is on us to put the information out that you can get better.”

Smith also had words of encouragement for men who want to seek help.

“There are places where your privacy is respected, where you’re not seen as less of a man,” he said, “and where you can come out a stronger man than you were before.”

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