Men’s Mental Wellness

by Brian P. Ellis

Men’s mental health advocacy is important for many reasons, but one reason that stands out is the fact that men face some unique and serious challenges in life.

Mental Health Statistics

  • Men are 3.9 times more likely to die by suicide than women—that’s 80% of suicides (CDC, 2020).
  • Men account for 92% of all workplace fatalities in the US (US Bureau of Labor Statistics, 2021).
  • Men are more likely to use illegal drugs than women, and they are 4 times more likely to have alcohol use disorder (National Institute on Drug Abuse 2022; Devaud et al., 1999).
  • 80% of homicide victims are male (United Nations, 2019).
  • Boys are more likely to be victimized by physical bullying than girls (Woods & White, 2005).
  • 70% of all homeless persons are male, and they are more likely to be unsheltered than female homeless persons (NAEH, 2022).
  • 93.2% of incarcerated persons are male (Federal Bureau of Prisons, 2022).

Lower Help-seeking Rates

Not only do men face some serious challenges, but there is a pervasive stigma associated with help-seeking in males.

  • Men are less likely to seek help for mental or physical health problems. Women in the United States are 1.6 times more likely to receive mental health treatment compared to men (Wang et al., 2005).

Social and Cultural Issues

  • Approximately 1 in 5 American men admit to not having a single close friend, according to the results of the American Perspectives Survey (Cox, 2021).
  • The number of American men without a close friend has increased from 3% to 15% since 1995, and men report higher rates of loneliness than women (Cox, 2021).

Higher Rates of Maladaptive Coping

  • Men have higher substance use rates. Men are more likely to use illegal drugs than women, and they are 4 times more likely to have alcohol use disorder (National Institute on Drug Abuse 2022; Devaud et al., 1999).

What We Do in Therapy

Look at problem areas in your life (see the wellness wheel exercise):

Addressing men’s mental / physical health in therapy is relatively the same as with any client, regardless of gender, however, there are some key areas we often look at that are unique to men.

“Toxic” or unhealthy masculinity is a cultural phenomenon that reinforces the most problematic aspects of stereotypical maleness. It often involves ridicule for anything seen as feminine or weak (which might lead to suppression of emotions), and it praises aggression and hyper-competitiveness.

(Author’s note: As a men’s mental health advocate, I want to emphasize here that I do not necessarily support the broad view of “toxic masculinity”, nor do I particularly like that term; some organizations have supported a very sweeping view of what toxic masculinity is, to the point where a lot of benign or healthy behavior is labelled as “toxic”. Nevertheless, the popularization of this term has opened up an important conversation in our culture that can lead to some positive developments if we approach the conversation in the right spirit.

I also want to note here that unhealthy masculinity is not just the result of men’s attitudes; a lot of women lend support to problematic conceptions of masculinity. To list a few examples that I have observed: the idea that men should physically fight over insults, that men must always appear tough, that it is unmanly for a man to talk about his emotions, etc.)

To address social or cultural issues that contribute to isolation we can explore getting involved with organizations or groups, or finding hobbies or interests. We also frequently discuss the importance of maintaining relationships and repairing damaged relationships.

In regards to sexual and romantic relationships, we may explore how to find a compatible partner/s, the importance of safe sex and consent in sexual relationships, and how to discuss relationship difficulties with partner/s.

Discuss healthy masculinity:

What is healthy masculinity? We might say it is all of the positive or prosocial qualities of manhood, without the problematic behaviors.

To get a good conception of healthy masculinity it is helpful to look at what it is not (unhealthy masculinity) and contrast the two.

  • It is not about glorifying violence, or using violence to solve problems that can be solved otherwise (honor culture / groupthink). Healthy masculinity means being protective, even up to the point of using force when absolutely necessary, but it also means being wise and seeking rational and peaceful solutions whenever possible.
  • It is not about degrading or abusing women, or anyone. Healthy masculinity is respectful of others. Criticism, when necessary, should be constructive and seek to change minds, not alienate.
  • It is not about being aggressive or hyper-competitive. Healthy masculinity channels competitiveness appropriately.
  • It is not about degrading others or about disrespecting people because of their sexuality or their way of being. Healthy masculinity is accepting of differences. Criticism, when necessary, should be constructive and seek to change minds, not alienate.
  • It is not about expressing anger in unproductive ways or only being comfortable with anger (see the anger iceberg graphic). Healthy masculinity involves understanding and being communicative about our emotions, but not responding automatically to them. (In therapy, we often use approaches such as rational emotive behavioral therapy and mindfulness to develop emotional regulation.)

Notes on anger: There is no evidence to suggest that men experience anger more intensely, or at higher rates, but men are more likely to express their anger impulsively and physically (and with greater consequences) than women. Which might be part (there are many other factors at play in this issue) of the reason why 90% of all homicides were perpetrated by males (United Nations, 2019).

Healthy masculinity does not suppress emotion and is comfortable with being vulnerable when this is needed. Healthy masculinity does not see emotional expression as being weak or feminine (nor does it criticize weakness or femininity). However, healthy masculinity entails not responding automatically to emotion. Healthy masculinity is about managing emotions through tactful expression, reduced automatic reactivity (mindfulness), and challenging irrational beliefs that lead to distressing emotions (REBT). 

Utilize Practical and Existential Approaches:

Career counseling — career is a major part of life, and can provide life meaning / satisfaction (or, conversely, a mismatched career can lead to life dissatisfaction and lack of fulfillment). Career counseling is often part of therapy.

Meaning and authenticity — existential therapy deals with finding our own purpose or meaning for living (meaning gets us through difficult times and helps us to feel content with our lives), and helps us to live according to our sense of meaning and our values.

Philosophy of life — a philosophy of life can provide ethical and practical guidance, and it may allow us to connect with a community.

Some of the Advantages of Counseling

  • Confidentiality
  • Sharing some things with friends or family may not be prudent (counseling is temporary as opposed to a possibly life-long relationship)
  • Objectivity of an outsider (you may be “too close to the problem” to see effective solutions; Solomon’s paradox)
  • Input from an experienced professional
  • Interventions that are evidence-based, not just anecdotal
  • Counseling is not just advice, it is a collaborative approach

Mental Health Resources for Men:

  • HeadsUpGuys: Men’s mental health site focusing on depression in men.
  • Man Therapy: Serious but irreverent approach to men’s mental health with lots of great links and resources.
  • Men’s Group: men’s online discussion forum and support group

References:

Centers for Disease Control and Prevention. (2022, June 28). Suicide data and statistics. Centers for Disease Control and Prevention. Retrieved August 15, 2022, from https://www.cdc.gov/suicide/suicide-data-statistics.html

Cox, D. A. (2021, April 7). The State of American Friendship: Change, challenges, and loss. The Survey Center on American Life. Retrieved August 15, 2022, from https://www.americansurveycenter.org/research/the-state-of-american-friendship-change-challenges-and-loss/

Devaud LL, Matthews DB, Morrow AL. Gender impacts behavioral and neurochemical adaptations in ethanol-dependent rats. Pharmacology Biochemistry and Behavior. 1999;64:841–849.

Federal Bureau of Prisons. BOP Statistics: Inmate Gender. (n.d.). Retrieved August 15, 2022, from https://www.bop.gov/about/statistics/statistics_inmate_gender.jsp

National Alliance to End Homelessness. Demographic data project: Gender and individual homelessness. (2019, September 30). Retrieved August 15, 2022, from https://endhomelessness.org/demographic-data-project-gender-and-individual-homelessness/.

National Institute on Drug Abuse; Center for Behavioral Health Statistics and Quality. Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2017. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf. Accessed November 7, 2017.

U.S. Bureau of Labor Statistics. (2021, December 16). Census of fatal occupational injuries summary, 2020 – 2020 A01 results. U.S. Bureau of Labor Statistics. Retrieved August 15, 2022, from https://www.bls.gov/news.release/cfoi.nr0.htm

United Nations : Global Study on Homicide. Office on Drugs and Crime. (2019). Retrieved August 15, 2022, from https://www.unodc.org/unodc/en/data-and-analysis/global-study-on-homicide.html

Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):629-40. doi: 10.1001/archpsyc.62.6.629. PMID: 15939840.

Woods, S., & White, E. (2005). The association between bullying behaviour, arousal levels and behaviour problems. Journal of Adolescence, 28(1), 381-395.

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