Simon Menelaws is a dude, a dad, a husband, a doctor, a writer, a yogi, but above all, a human. He hails from Scotland and moved to Australia in 2012 seeking sunnier climes. He is an advocate for mental health, and is especially passionate about men's mental well-being. He believes in the strength of vulnerability; our need as men to practice openness; and wine, coffee, and Roger Federer.
If someone had told me one year ago that I would have an eleven month-old baby and my wife would be undergoing chemotherapy for breast cancer, I would have imagined myself crumpled in a corner somewhere, rocking to and fro, my wife lying gasping for breath, my five year-old daughter crying, and me occasionally making animal-like groans. This is the image my anxious, catastrophe-thinking self would have immediately presented me with.
But I’m not doing that. Currently, I’m sitting on the deck of a family friend’s cabin just outside Byron Bay overlooking rolling, lush green hills. My eleven month-old is asleep in the room with his sister for an afternoon nap. My wife is reading, sitting cross-legged on a sofa, sitting there in all her bald, glorious beauty. We’ve come away for a few days to recuperate before her next round of chemotherapy begins in five days’ time. And we are actually feeling quite relaxed and enjoying the moment despite the knowledge of the long, tough months ahead: more chemo, a bilateral mastectomy, radiotherapy, removal of her ovaries, an early menopause, then unknown years ahead of hormonal therapy.
So why this big difference between what my fear was (i.e. not coping, falling apart, not fulfilling my role as a husband and father), and what our actual reality is?
And that word ‘fear’, is the key.
For a long time – since I was a child – I have struggled with anxiety. I have been scared of multiple things, but it could probably be summed up as: I am terrified of fucking up my life, or someone else doing it for me. I have been scared of poverty, illness, tragedy, accidents, homelessness, abandonment, rejection, failure, loneliness, death of loved ones, Hell, lack of balance in my life, disappointing people, not achieving what I ‘should’ in my career and relationally, messing up my children, failing my wife, being a bad friend, a bad son, a bad grandson, a bad nephew, a bad cousin (fortunately I have no siblings to fail), a bad doctor, a bad writer.
I could go on – you get the point. At times, anxiety has become so pervasive that my mood dropped and I became depressed. It further exacerbated low self-esteem, poor self-confidence, and, at times, a strong dislike and disregard for myself.
The reasons for this life-long anxiety and poor self-esteem are clear to me now after many years of therapy, soul-searching, and self-learning and acceptance. I don’t want to go into that here, but suffice to say: if you have a family history of mental illness, come from a ‘broken’ household (not amicably separated parents), have witnessed violence and/or substance abuse, have been part of fanatical religious groups, and have been subject to any form of abuse (psychological, sexual, or physical), there is a high likelihood that there will be an appearance of mental illness at some point in your life,
The last three months since my wife was diagnosed with breast cancer touched on a lot of my previous fears: her death; the desolation of our family; the pressure on me as her carer and becoming the primary carer for our children; taking time off work and therefore a change in my status and role as an employee. And it was terrible initially. The first forty-eight hours were some of the most difficult of our lives as we had no idea how advanced the cancer was. The diagnosis was so unexpected that the anxious, catastrophizing parts of me felt like it was completely feasible that she was riddled with metastases and had only a few months to live. (CT of her chest, abdomen, and pelvis showed no evidence of metastatic spread beyond one or two of her axillary lymph nodes.)
Some of the more concrete fears were: I’m not strong enough to care for her and our two children; I’m not brave enough to remain emotionally stable through this; I can’t be a single dad to these two little children; we don’t have enough money for me to be off work; what if there are complications during chemotherapy or surgery?
A lot of it could be summed up as, am I going to come through this or am I going to fail? Am I man enough for this?
I’ve learned a lot over the last three months about myself, about my wife and our relationship, and about the goodness and kindness of others. It’s also led to me to reflect a lot on my own mental well-being, and how a man living in the west in the 21st century can go through a difficult life event and emerge from it feeling more connected to himself and others.
It’s hard to bullet point, but for the sake of brevity, here are some of the lessons.
Know your flash points
Be aware of your personality, your temperament, and your character, and how these interact and direct your behaviours. A childhood and adolescence that has been marked by adverse experiences (the term used in child and adolescent psychiatry for a shitty start in life), or a family history of mental illness, mean that there is a higher likelihood of developing mental illness. Impaired mental health will affect your coping strategies. EVERYONE is scared of something; but if you suffer from generalised (or specific) anxiety, be aware of how a difficult life event will exacerbate your experience of those symptoms. Be aware of your coping mechanisms: withdrawing? Drinking? Avoidance? Working harder?
Know your story
This is related to the above point, but more specifically: know the story that plays out in your head when times are difficult and your mental health is ailing. Be able to recognise the phrases and images that come into your mind as you start experiencing feelings of anxiety, or foreboding, or failure. For example, my negative story was, I am going to fail. Once we recognise these stories, we can see them for what they are – stories. The reality is that many of us do appear as Mr Perfect – outwardly successful and together – but we need to be careful of the discordance between how we see ourselves and the reality, and how we portray ourselves to others and the reality. We are not how much we earn, what we look like, what was done to us as children, what mistakes we have made, or the negative feelings and emotions that go on in our head. We are an almagamation of ever-changing thought processes, character developments, and personality weaknesses and strengths. Mental illness is one of the major variables that affect our quality of life and which can be addressed with the appropriate medical, psychological, and physical interventions.
Shortly after finding out my wife’s diagnosis I decided to start blogging about our experience of her illness. It was driven partly by a lot of reading I have done on the power of vulnerability and the necessity of that to live a wholehearted life (see Brene Brown’s TED talk - https://www.ted.com/talks/brene_brown_on_vulnerability). It was also in keeping with two of my main values – living with authenticity and genuineness. To me, living with authenticity and genuineness is important to how I conduct relationships and how I care for my mental health. I am a doctor who works in psychiatry, and for me it is hypocritical and incongruent to assist other people in recognising and dealing with some incredibly complex and hurtful experiences in their lives, which have contributed to their mental illness, if I cannot expect the same of myself. This vulnerability is still scary and I can feel threatened by it at times. But after years of having worked on my anxiety, my fear of others, and my boundaries, I feel able to do this. Blogging publicly is not everyone’s way to deal with things, and I would not advise it if it is an event or process which is still very raw and has not been addressed in a confidential and professional manner. But authenticity with yourself, people you can trust, and mental health professionals (including a good GP) is essential for your recovery and maintenance of good mental health.
Have a lifeline
Know where to go when the shit hits the fan. If you have a history of suicidal thoughts or attempts, or a family history of suicide, or a history of substance misuse (including cannabis and binge-drinking), know where you can go when you are not coping. This can be a 24-hour phone helpline, your local public mental health service (also available 24 hours), a sponsor, or a trustworthy friend or family member. Suicide is still the biggest killer of men under the age of 40 in Australia. I feel deeply saddened by the death of Dan Vickerman: intelligent, athletic, successful, part of a beautiful family. A 6’9” Mr Perfect. Stress and fear of failure can be hugely powerful drivers for men to attempt suicide because of the perceived shame and feelings of embarrassment associated with help-seeking. In addition, some men literally don’t have the language to express their feelings or emotions in words (which can be due to trauma, education and/or socialisation about feelings, or alexithymia – the inability to experience emotions due to depression). Ultimately, TALK, Talk when it feels like it is the hardest thing to do. Talk when it feels like it won’t help or make any difference. Talk when you’ve lost all hope of any change.
Look after your body, and thereby your mind
Long working hours, disrupted sleep, unhealthy diets, too much alcohol (including the occasional binge session), smoking, lack of physical activity, constant digital and technological bombardment, constant broadcasting of distressing and stressful local and world events; these all take a toll.
There is more and more research being produced which is starting to give some more information about how processes taking place biologically within the brain, including those involved in our psychological experience, affect other body systems and our immune response. There is well-documented evidence for what can only be termed brain damage in infants who are subjected to trauma and stress during some of the most formative years of brain development (another very critical period of neurodevelopment is adolescence).
So: sleep (without your phone on beside the bed); reduce the amount of processed foods; increase fruit and veg intake; increase physical activity; consider doing yoga or practicing meditation (both of these have shown positive outcomes for decreasing stress and anxiety through complex neurobiologically mediated mechanisms. Check out https://www.powerliving.com.au/ - a style of yoga very open to men started by a great guy called Duncan Peak with studios in Sydney, Melbourne, Perth, Adelaide and Auckland). The simplest things are the building blocks on which we can learn the more complex and difficult lessons.
Invest in your mind
Engaging in psychological therapy is an investment in yourself and your most significant relationships. A lot of people feel like they cannot justify the time or expenditure. My own view is that we cannot justify not engaging in psychological therapy if we want to engage in a full and meaningful life. The World Health Organisation states that ‘there is no health without mental health.’ It is very difficult to engage in the good and positive things in our life without robust mental health. Furthermore, untreated mental illness will generally get worse over time, especially when life hits one of its many unexpected roadblocks (career change, having kids, a relationship break-up, deterioration in physical health, moving house, etc). And also very importantly, untreated mental illness can have a negative impact on those around the sufferer, especially a partner and children. Investing in your mental health, by engaging in psychological help with an attitude of curiosity and openness, is a win-win situation. A good therapist knows that it is scary and unnerving for someone to open up about painful and often shame-inducing events and feelings. Thankfully, the very talking and opening up about these things starts the process of change and recovery, before you even learn any psychological tools for dealing with the issues.
Invest in relationships
The recent findings of the Harvard Study of Adult Development, which tracked and examined the lives of more than 700 men since 1938, showed a definite correlation (but not necessarily causation) between people who have supportive relationships in their life, and contentment and happiness. Spousal relationships and friendships are what we need when the going gets tough. Sometimes spousal relationships can be the cause or subject for stress, so it is important that we have open and supportive relationships outside of that to help us reflect on the marriage/partnership. With the changing family structure and declining popularity of marriage, there is a higher likelihood that people will not have one life-long partner, which was more common when this study was started. But regardless, what this study highlights is connection. We are social beings, who thrive off relationship and interaction with others. Even introverts cannot live in total seclusion. I cannot emphasise enough from my role as a doctor in psychiatry how important it is to have others whom you can be supported by. Personally, this has been a big learning experience over the last months. It has been difficult to ask for or just to accept help at times, but if I am truthful (or genuine) with myself, it’s what I have wanted on some level. It is sometimes easier in the short-term to not ask or accept help; often I don’t feel like I have the emotional capacity or resources to return what I feel may be expected by someone whom I ask for help. But it is cancerous to the soul. We need our friends. We need our mates. We need people who would not be afraid to ask difficult questions (are you anxious? Are you depressed? Do you feel like there’s no way out?). We need people to give us a hug when we are feeling isolated and physically tense. We need the people who are good at talking and listening, and we need the people who are good at taking us out and doing things. We need both, but often it is easier to settle only for the ‘do-ers’ as a guy. This requires vulnerability and openness on the part of the giver and the receiver – words which do not sit easily with the western male, and which we need to be a part of changing. Otherwise, we will still feel alone; we will still feel unable to ask for help; we will still see our need as effeminate and ‘weak’; we will still see suicide as the only way out.