This week's blog is brought to our Mr. Perfect community by David Graham.
Depending on how you count it, Dave is embarking on his 3rd or 4th career. After completing postgraduate research in mathematics he spent the next decade working for Defence, which included deployments to Afghanistan and the Middle East. He’s now a Doctor (psychiatry registrar), a research fellow, a fiction writer, and loving life as a second time Dad.
I remember drinking coffee for the first time with Terry back in 2015. The café was filled with a bunch of middle aged men in lycra. I think I must have had about 3 cups of coffee. By that time it was like talking to an old friend. Our conversation ranged across a number of topics.
Then he slid a crisp white business card that simply said MR. PERFECT. It would have been in the first batch of Mr. Perfect cards. Maybe it was the first one.
Ever since then I’ve been a supporter of Mr. Perfect and what it stands for. I love the grassroots concept. I love its ironic view of men’s mental health and the sideways glance it takes to men’s mental health. To me it’s not surprising that it’s taking off. Mr. Perfect fits a niche, something that’s really needed for the conversation we need to have. It’s gets men talking, it gets men thinking about what’s going on with mental health, and it gets men doing something about their own mental health.
The dark reality is out there. One in five men develop anxiety. One in eight men develop depression. These are less than women. Men are more than twice as likely to have a substance use disorder, and are more likely to use them in anxiety or depression. Suicide is the really frightening statistic: six out of eight suicides are male, and the number of men who die by suicide is double the road toll.
Recently I’ve been pondering the question: what is men’s mental health? I don’t think it’s about the numbers that I’ve just cited above. They’re just a symptom, a sign. I think it’s something else.
A cascade of other questions flow. Why should mental health be gendered? Surely it’s all just mental health? And surely that’s all just health?
But it’s not.
When it comes to health, different approaches are needed to address subtle differences in health. The narrative of mental health differs from the narrative of, say, cardiovascular health. All these different narratives are woven together in a rich and barely comprehensible tapestry. They each have a subtly different voice, a different style. It’s a little like the chapters in James Joyce’s Ulysses, which incidentally was organised around body systems.
These different styles are reflected in different treatment approaches, different preventative measures, different ways of regarding the patient. William Osler once said “it is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” This is axiomatic in psychiatry: each patient’s mental illness is utterly unique.
If the narrative of mental health is different from other areas of health, then surely the same line of logic extends towards subnarratives within mental health. This is reflected to an extent in the subspecialties of psychiatry.
Gender is an enormous part of our own stories. Men, women, transgender, intersex, genderqueer, genderfluid… Wherever you bask upon that vibrant spectrum, it colours our sociocultural norms, which in turn shapes out personal narratives and therefore our sense of self – including the psychopathologies of the self.
Gender differences in mental health are real. Gender norms have a strong undercurrent, and their polarising effect can be seen played out in the school yard. I would like to think things are changing, but when I’m buying clothes and toys for my kids the cisgender binary is so overt. Pink t-shirts with rainbow unicorns emblazoned with “keep dreaming.” Black or blue t-shirts with skulls and monsters “be brave.”
This is reductionist; my Robert Downey Jr meme just wants to burst out.
Young boys are taught to bottle things up. To be tough. To go it alone. To figure it out. And boys have a more limited range of emotional expression than girls. Really, how much of that is innate? This narrative is reinforced throughout our lives. It silences us all. It snuffs out difference. We turn on ourselves, then vomit toxic and self-destructive masculinity.
Discourse on men’s mental health has been lacking. Men are less likely to meet the diagnostic criteria for depression and anxiety than women, but why? Do women actually experience higher rates of depression and anxiety? Or are the diagnostic criteria skewed? Are the symptoms gender specific? Do men instead mask their symptoms with alcohol and illicit substances? Do they instead take risks or become violent?
These masks are certainly reflected in the statistics. Indeed, research is emerging that links traditional masculine norms to increased risks of mental illness. What is more destructive is that traditional masculinity resists help seeking, not just in mental health but all aspects of health. And those around them suffer with them. Clearly understanding men’s mental health sheds light on the different ways men access or prefer to access mental health services, as well as the impact that it has on those around them.
But men’s mental health is not just about how it differs from a binary opposite, namely women. I think this cisgenderism is absurd. As I said before, gender is a spectrum that colours the experience of health. Men’s mental health sits at a multidimensional intersection of history, politics, philosophy, economics, linguistics, interpersonality and psychology.
And this is all set against a backdrop of tectonic shifts in each of these dimensions.
Much has been written and discussed about toxic masculinity; I won’t go into its regressive nature here suffice to say that it so neatly exposes this complex interplay. Consider instead the men of Sardinia as a counterpoint. They’re among the oldest people in the world and are ageing well. This is unique on this pale blue dot we call home. Genetics plays a part and the environment plays a part.
What is really surprising to me is that the gap between male and female health is almost non-existent. The men talk. They connect. They’re active. They have a rich emotional range. These are part of their sociocultural norm. There is no gender difference in talking and connecting. It’s just part of being human. Freud said that mental health is about a patient’s capacity to love and work, and Winnicott extended this (rightly in my mind) to include play. I think that the men of Sardinia have that figured out.
And I think that here lies the essence of men’s mental health.
On the one hand it’s recognising there is a distinct tone to this expression of the human condition. But on the other hand it’s the challenge of excavating what it means to be a man. It’s the challenge of laying sociocultural norms and biases bare. It’s the challenge of weeding out the toxic elements and planting the seeds of connection. It’s the challenge of taking a stand for each other, taking a stand against toxic masculinity, and saying me too shoulder to shoulder.
Resilience is built through adversary together, never alone. Together we love. Together we work. Together we play. The benefit of helping our men connect and talk is clear. And it starts with each of us to pass on to each other and to our sons and our daughters. From here we recover masculinity and enrichen our emotional and psychological tone.
There is a real strength in vulnerability, a subterranean strength that takes a stand and says I am vulnerable; I am flawed; I don’t have the answers; I need help.
After all of that, let’s play.
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